Ukrainian Consensus on Diagnosis and Management of Vitamin D Deficiency in Adults

Vitamin D deficiency (VDD) is a global problem, however, there were no Ukrainian guidelines devoted to its screening, prevention, and treatment, which became the reason for the Consensus creation. This article aimed to present the Consensus of Ukrainian experts devoted to VDD management. Following the creation of the multidisciplinary Consensus group, consent on the formation process, drafting and fine-tuning of key recommendations, and two rounds of voting, 14 final recommendations were successfully voted upon. Despite a recent decrease in VDD prevalence in Ukraine, we recommend raising awareness regarding VDD's importance and improving the strategies for its decline. We recommend screening the serum 25-hydroxyvitamin D (25(OH)D) level in risk groups while maintaining a target concentration of 75-125 nmol/L (30-50 ng/mL). We recommend prophylactic cholecalciferol supplementation (800-2000 IU/d for youthful healthy subjects, and 3000-5000 IU/d for subjects from the risk groups). For a VDD treatment, we recommend a short-term administration of increased doses of cholecalciferol (4000-10,000 IU/d) with 25(OH)D levels monitored after 4-12 weeks of treatment, followed by the use of maintenance doses. Additionally, we recommend assessing serum 25(OH)D levels before antiosteoporotic treatment and providing vitamin D and calcium supplementation throughout the full course of the antiosteoporotic therapy.

BONE MINERAL DENSITY AND PROBABILITY OF OSTEOPOROTIC FRACTURES IN WOMEN WITH TYPE II DIABETES MELLITUS

OBJECTIVE

The aim: To assess bone mineral density and 10-year probability of major osteoporotic and hip fractures using the Ukrainian FRAX® version for postmenopausal women with Type II diabetes mellitus and to determine the need for OP treatment according to the algorithm FRAX and BMD.

PATIENTS AND METHODS

Materials and methods: 690 females aged 50-89 years (mean age 67.0±7.7 years) were divided into two groups: Group I (n=345) was made of mostly healthy women, Group II (n=345) - patients with Type II diabetes mellitus. Bone mineral density was measured using dual-energy X-ray absorptiometry, 10-year probability of major osteoporotic and hip fractures was calculated using the Ukrainian FRAX® model.

RESULTS

Results: Bone mineral density and 10-year risk of major osteoporotic and hip fractures did not differ depending on the Type II diabetes mellitus presence, however the frequencies of low-energy, vertebral and all previous fractures were higher in Group II. 19% of women with diabetes mellitus and 38% of healthy ones required antiosteoporotic treatment according to dual-energy X-ray absorptiometry and only 8% and 2%, respectively, according to the FRAX. These indices became higher after recalculation of FRAX taking into account bone mineral density, however they were lower in patients with diabetes mellitus compared to the corresponding rate in the Group I (FRAX (high risk) + bone mineral density: 26% and 41%; χ2 = 18.2; p<0.001).

CONCLUSION

Conclusions: The use of FRAX in combination with bone mineral density resulted in an increased necessity for antiosteoporotic treatment, indicating the urgency of using both indices for osteoporotic fractures prediction in patients with Type II diabetes mellitus.

AB0986 RISK OF SARCOPENIA IN THE WOMEN WITH OSTEOARTHRITIS

Background

Recently, physicians all over the world have been focusing on the relationship between sarcopenia and osteoarthritis (OA) [1, 2]. This connection is considered from different positions: as coexisting conditions, sarcopenia as a risk factor for the progression of OA, or OA as a risk factor for sarcopenia.

Objectives

The aim of this study was to determine the risk of sarcopenia (according to the SARC-F Questionnaire) and the level of probable sarcopenia in Ukrainian women with (hip and knee) OA.

Methods

The study included 271 women aged 50-84 years old (mean age 65.6 ±8.0 years, mean height 162.2±5.6, mean body weight 76.7±14.2, mean BMI 29.1±5.1). All subjects were divided into 2 groups: the group of healthy women (group I, n=176), a group of patients with hip or knee osteoarthritis (OA) (group II, n=95). The risk of sarcopenia was determined by the SARC-F Questionnaire. The probable sarcopenia was determined due to muscles strength (handgrip strength using spring hand dynamometer ≤ 16(kg)) and physical performance (5-time chair stand test > 15 s), the fall risk – by Desmond Fall Risk Questionnaires and function – according to the assessment of IADL scale.

Results

In 20.3% of females without musculoskeletal pathology and in 34.7% of women with OA was detected high risk of sarcopenia. The probable sarcopenia was practically 2 times higher in patients with OA and was equal to 42.1% compared to 21.5% in healthy women. According to the Desmond Fall Risk Questionnaire, 27.5% of healthy subjects and 49.3% with OA had increased fall risk. Low function (according to the assessment of the IADL scale) was detected in 36.4% of females without pathology of the musculoskeletal system and in 57.2% of women with OA.

Conclusion

Our results demonstrated that the incidence of probable sarcopenia was 2 times higher in women with hip and knee OA, as well as the risk of sarcopenia – 34.7%, compared to healthy subjects – 20.3%. Also, the risk of falls and the need for outside help were higher in patients with hip and knee OA but their function (by IADL scale) was significantly lower.

References

[1]Amirthalingam H., Cicuttini F. M., Wang Y. et al. (2019). Association between sarcopenia and osteoarthritis-related knee structural changes: a systematic review. Osteoarthritis and Cartilage, 27, S472. doi:10.1016/j.joca.2019.02.515.

[2]Jin W. S., Choi E. J., Lee S. Y. et al. (2017). Relationships among Obesity, Sarcopenia, and Osteoarthritis in the Elderly. Journal of Obesity & Metabolic Syndrome, 26(1), 36–44. doi:10.7570/jomes.2017.26.1.36.

Disclosure of Interests

None declared

AB1127 ANTIOSTEOPOROTIC TREATMENT AND COVID-19 RISK: IS THERE AN ASSOCIATION?

Background

Nowadays, the COVID-19 and its complications are considered an important medical issue with aggravated medico-social outcomes, both at the worldwide scale, and in terms of various individual countries. Despite the recent ASBMR, AACE, Endocrine Society, ECTS and NOF recommendations according to osteoporosis management in the era of COVID-19 the influence of antiosteoporotic drugs on disease incidence and severity continue to be studied [1, 2].

Objectives

The purpose of this study was to assess the COVID-19 risk for the patients receiving the parenteral bisphosphonate or Denosumab treatment, and the severity of its course in the systemic osteoporosis patients.

Methods

We performed the phone survey and studied the results of 195 patients (92 % women; mean age – 62.7±10.8 years, height – 161.0±8.0 cm, body weight – 68.9±12.3 kg) with systemic osteoporosis depending on the current use of parenteral antiresorptive drugs (Zoledronic acid, Ibandronic acid, or Denosumab, n=125) and compared the results with patients with osteoporosis who did not use any antiosteoporotic drugs previously (n=70). The mean duration of antiosteoporotic treatment did not vary across the groups, accounting for 15 [9-27] months. Prior to the beginning of the antiosteoporotic therapy, all the patients had a confirmed diagnosis of osteoporosis at the Ukrainian scientific-medical Center of osteoporosis.

Results

We did not reveal any significant differences in the COVID-19 frequency and severity depending on the presence and type of parenteral antiosteoporotic therapy. Additionally, there were no differences depending on patients’ age of sex, obesity presence, and other osteoporosis risk factors. The risk of COVID-19 in the patients with systemic osteoporosis did not differ depending on antiresorptive drug use, amounting (Odd Ratio (OR) 95 % CI) to 1.1 (0.6-2.0), or on the use of the definite antiosteoporotic drug (for the Zoledronic acid - 0.9 (0.4-2.0), the Ibandronic acid - 1.1 (0.5-2.3), and for the Denosumab - 1.6 (0.5-5.2).

Conclusion

Our study did not reveal any significant differences in the COVID-19 frequency and severity depending on the presence and type of parenteral antiosteoporotic therapy. We conclude that parenteral antiosteoporotic drugs (Zoledronic acid, Ibandronic acid, or Denosumab) do not have an influence on COVID-19 frequency and severity and can be recommended for the continuation of treatment of patients with osteoporosis.

References

[1]Joint Guidance on Osteoporosis Management in the Era of COVID-19 from the ASBMR, AACE, Endocrine Society, ECTS & NOF. https://www.asbmr.org/about/statement-detail/joint-guidance-on-osteoporosis-management-covid-19.

[2]Blanch-Rubió J, Soldevila-Domenech N, Tío L, et al (2020) Influence of anti-osteoporosis treatments on the incidence of COVID-19 in patients with non-inflammatory rheumatic conditions. Aging (Albany NY). 12(20):19923-19937. doi:10.18632/aging.104117.

Disclosure of Interests

None declared

POS1150 BONE MINERAL DENSITY AND TRABECULAR BONE SCORE IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background

Patients with systemic lupus erythematosus (SLE) have an increased risk of osteoporosis and low trauma fractures due to several important factors: the inflammatory disease itself, low vitamin D level, use of some disease-modifying anti-rheumatic drugs, glucocorticoids, etc. [1]. Bone mineral density (BMD) and trabecular bone score (TBS) measured by DXA are the important parameters of bone strength that evaluate the different aspects of bone architecture [1, 2].

Objectives

The aim of the research was to determine BMD and TBS in women with SLE.

Methods

We have examined 150 females from 20 to 75 years old (average age – 51.1±11.6 years) which were divided into 2 groups: patients with SLE (n=50) and healthy women (n=100). The females did not differ in terms of age (51.4±10.8 and 50.4±13.2 years, respectively; p=0.60), height (163.8±15.4 and 163.6±6.6 cm, p=0.86), body mass (73.6±15.9 and 68.8±14.8 kg, p=0.09), and the duration of the postmenopausal period (8.9±6.9 and 9.6±8.1 years, p=0.81), but the age of menopause was significantly lower in patients with SLE (47.9±4.7 and 42.1±15.3 years, respectively, p<0.05). The BMD was measured at the lumbar spine, femoral neck, proximal femur, and total body, by means of the “Prodigy” unit (CE Medical systems, model 8743, 2005). The TBS was evaluated using the installed TBS iNsight software for an X-ray densitometer (Med-Imaps, Pessac, France).

Results

The parameters of BMD were significantly lower in patients with SLE compared to the healthy women in all measured areas: in the total body (0.95±0.05 and 1.06±0.12 g/cm2, respectively; р=0.03), in the lumbar spine (0.87±0.13 and 0.96±0.17 g/cm2, р=0.02), femoral neck (0.68±0.11 and 0.75±0.14 g/cm2, р=0.03), proximal femur (0.83±0.10 and 0.92±0.16 g/cm2, р=0.02). In the patients with SLE TBS was significantly lower compared to the index in healthy women (1.28±0.11 and 1.33±0.12 un., р=0.02).

Conclusion

The parameters of BMD and TBS in women with SLE are significantly lower than in the healthy population. Our results emphasize the importance of combined BMD and TBS measurement in the evaluation of the different aspects of bone architecture for dynamic monitoring of bone health and risk of fracture in patients with SLE and timely start of osteoporosis treatment.

References

[1]Bultink I.E.M. (2011). Osteoporosis and fractures in systemic lupus erythematosus. Arthritis Care & Research, 64(1), 2–8. doi:10.1002/acr.20568.

[2]Ruaro B., Casabella A., Paolino S. et al.(2020). Trabecular Bone Score and Bone Quality in Systemic Lupus Erythematosus Patients. Frontiers in Medicine, 7. doi:10.3389/fmed.2020.574842.

Disclosure of Interests

None declared

POS1112 COMPARISON OF TWO APPROACHES IN FRACTURES RISK ASSESSMENT IN WOMEN WITH RHEUMATOID ARTHRITIS AND GLUCOCORTICOID USE

Background:

Nowadays, FRAX is the most useful tool for osteoporotic fracture risk assessment that is included in many guidelines. Rheumatoid arthritis (RA) and glucocorticoid (CG) use are two crucial factors for osteoporotic fractures included in FRAX algorithm. According to the last ACR guidelines for the treatment of GC-induced osteoporosis [1], it was recommended to divide the patients into three groups of fracture risk (high, medium and low) that have a great impact on treatment decision. Recently, we received own Ukrainian thresholds [2] for the national version of FRAX that are age-dependent and now widely used in clinical practice.

Objectives:

Our study was aimed to compare two approaches (ACR-2017 and Ukrainian (2019) recommendations) in fracture risk assessment in women with RA and GC use.

Methods:

We examined 195 females with RA aged 40-89 years old who took GC (at dose ≥5 mg/d for ≥3 months) due to RA. The 10-year probabilities of major osteoporotic (MOFs) and hip fractures (HFs) were calculated with and without bone mineral density (BMD) using the Ukrainian FRAX model [3]. The DXA was used to measure the lumbar spine, femoral neck and total body BMDs; T and Z scores were calculated (DISCOVERY Wi, Hologic, Inc., USA).

Results:

FRAX indexes for MOFs and HFs without BMD in patients with RA and GC were (Me [25-75Q]) 12.0 [8.1-18.0] and 4.2 [1.7-7.2] %. The correspondent FRAX indexes with BMD were 13.5 [8.5-20.0] and 5.1 [1.8-8.7] %.

50 % of examined women had previous fractures and 20 % had previous vertebral fractures. BMD of the femoral neck consisted of 0.62±0.13 and L1-L4 BMD was 0.85±0.15 g/cm2. 89 % of females had low BMD at the lumbar spine and / or femoral neck (49 % osteoporosis and 40 % osteopenia).

61 % of women required antiosteoporotic treatment according to ACR-2017 guideline (17.4 % of them a hadhigh risk of MOF and 43.1 % moderate one) without BMD measurement and 64 % of subjects after DXA scan.

According to Ukrainian national guideline, 57 % of patients required antiosteoporotic treatment without BMD measurement and 42 % – after additional DXA examination. After BMD measurement in subjects who required the DXA scan, 78.2 % of females with RA and GC use required antiosteoporotic treatment (additionally to calcium and vitamin D, lifestyle modifications).

Conclusion:

Approximately 60 % of subjects with RA and GC use required antiosteoporotic treatment without additional DXA measurement according to correspondent FRAX indexes from both guidelines. The proportion of women requiring treatment after DXA scan is slightly higher according to Ukrainian recommendations. It proves that both of them can be used effectively in daily clinical practice for fracture risk assessment in females with RA.

References:

[1]Buckley L, Guyatt G, Fink HA, Cannon M et al. 2017 American College of Rheumatology Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis & Rheumatology, 2017;69(8), 1521–1537. DOI:10.1002/art.40137

[2]Povoroznyuk V, Grygorieva N, Kanis JA et al. Ukrainian FRAX: criteria for diagnostics and treatment of osteoporosis. Pain. Joint. Spine. 2019;9(4):7-16. DOI: 10.22141/2224-1507.9.4.2019.191921

[3]Povoroznyuk VV, Grygorieva NV, Kanis JA et al. Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch Osteoporos. 2017;12(1):53. DOI: 10.1007/s11657-017-0343-2.

Disclosure of Interests:

Nataliia Grygorieva Consultant of: Servier, Redis, Vladyslav Povoroznyuk: None declared.

[10-YEAR MORTALITY IN PATIENTS AFTER HIP FRACTURES]

The aim is to study the indexes of short- and long-term mortality in patients after hip fractures (HF). In a retrospective study, the data of 146 women and 82 men with HF aged 50 years and older (mean age (Me [25Q-75Q]): 74.5 [64.7-80.8] years old) hospitalized in 2005-2007 were analyzed. Life outcome data were collected three times (in 2015, 2016 and 2017) by the researcher by telephone contact with patients or their relatives. The analysis was carried out depending on age, gender, type of fracture, the presence of concomitant diseases. The average follow-up period was 121.3 [30.6-143.9] months (143.4 [133.4-150.0] months for surviving patients and 49.4 [10.2-120.3] months for deceased). Women accounted for 64 % of all subjects with HF and were significantly older than men. The average age at the time of death for the deceased (81.2 [72.2-85.1] years) was significantly higher in women (82.0 [72.9-86.8]) compared with men (76, 8 [66.3-84.8] years; Z=2.0; p=0.04), although it did not differ from the indexes of survivors at the end of the study (79.2 [72.8-89.4] years). Hospital mortality rates were 1.3%, 6-month, 1-, 5- and 10-year mortality, respectively - 11.8%, 18.4%, 36.8 \% and 48.2%. Mortality rate was higher in men only in the age group of 80-89 years, while there were no significant differences in mortality depending on the type of fracture. Survival rates did not differ depending on gender, type of fracture, and were significantly higher (p=0.004) in the patients older than 70 years compared with younger patients.

SAT0470 FRAX AND DXA-BASED APPROACHES IN DIAGNOSTICS OF OSTEOPOROSIS RISK IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS

Background:

Nowadays, the bone mineral density (BMD) measured by DXA and FRAX®are the most important methods for fracture risk assessment. Rheumatoid arthritis is a crucial disease for bone loss and osteoporosis development [1] which is included into FRAX algorithm. Ukrainian version of FRAX [2] is а new one and its value should also be assessed in patients with RA.

Objectives:

Our study was aimed to assess the parameters of BMD and FRAX in postmenopausal women with RA.

Methods:

We have examined 635 postmenopausal females aged 50-89 years old which were divided into 2 groups: 1st(control, n=313) – without any factors which have influence on bone metabolism, 2d(n=322) – patients with RA. The 10-year probabilities of hip fracture and major osteoporotic fractures were calculated without BMD parameter using the Ukrainian FRAX model [2]. The DXA was used to measure the lumbar spine, femoral neck and total body BMDs; the T-score was calculated (DISCOVERY Wi, Hologic, Inc., USA).

Results:

FRAX indexes for major osteoporotic and hip fractures were significantly higher in patients with RA (Me [25-75Q]): 9.7 [6.8-15.0] and 3.1 [1.5-6.2] % compared to 6.0 [3.8-8.5] and 1.2 [0.6-2.4] % in females from the control group (p<0.001). 45.3 % of women with RA required antiosteoporotic treatment according to Ukrainian FRAX threshold ratio without measure of BMD compared to 12.1% of subjects from control group. Only 3.4% of patients with RA had FRAX indexes which were less than low threshold (requirement of additional DEXA measurement) compared to 31.3 % of females from control group.

BMD of femoral neck and distal radius were reliably lower in subjects with RA and consisted 0.65±0.13 and 0.69±0.12 g/cm in 1stand 2dgroups, accordingly (p<0.001) and 0.56±0.10 and 0.58±0.09 g/cm (p=0.02) without any significant differences at lumbar spine and total body BMDs. 16.6 % of subjects from the control group and 31.6 % of females with RA had osteoporosis according to DXA parameters (T-score ≤-2.5 SD).

Conclusion:

FRAX should be used more widely in clinical practice for detection of risk of osteoporotic fractures in subjects with RA.

References:

[1]Povoroznyuk V.V., Grygorieva N.V., Karasevska T.A., Dzerovich N.I. Bone Mineral Density and Trabecular Bone Score Indices in Women with Rheumatoid Arthritis According to the Age and Use of Glucocorticoids. SM Rheumatol. 2017; 1(1): 1002.

[2]Povoroznyuk V, Grygorieva N, Kanis JA, Johansson H, McCloskey EV. Ukrainian FRAX: criteria for diagnostics and treatment of osteoporosis // Pain. Joint. Spine.-2019.-9(4).-7-16.

Disclosure of Interests:

None declared

Calcium intake in an adult Ukrainian population

This is a first large epidemiological study of calcium intake in Ukrainian population. The data from 1518 outpatient subjects aged 20-89 years old showed that the mean level of calcium intake composed 615.6 mg/day (735.4 mg/day in males and 565.6 mg/day in females, p < 0.0001) without any significant differences according to age.

INTRODUCTION

Insufficiency in calcium (Ca) intake is a worldwide problem; however, corresponding data regarding Ukrainian population is limited. This research was aimed to investigate the level of Ca consumption in daily rations of Ukrainian adults depending on age and sex.

METHODS

The data from 1518 outpatient subjects from urban and rural areas of Ukraine were analyzed; the Ca intake was evaluated by the method of 24-h dietary recalls during three non-consecutive days by a trained dietitian with further computer calculation.

RESULTS

The mean level of Ca intake in Ukrainian population composed 615.6 mg/day (735.4 mg/day in males and 565.6 mg/day in females) with significantly higher level of consumption in men than in women in whole group and in the subjects aged 50 years and more. In total, 67% of men and 78% of women consumed less than 800 mg/day Ca and only 28% of males and 10% of females consumed more than 1000 mg/day Ca.

CONCLUSIONS

This is a first large epidemiological study of Ca intake in Ukrainian population which confirmed its low level. This insufficiency in Ca intake can have a negative influence on exaggerated bone loss, osteoporosis development, and fracture risk that require forehanded correction.