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AB1023 (2022)
CHARACTERISTICS OF PATIENTS REFERRED FOR FIRST BONE DENSITOMETRY TO A RHEUMATOLOGY FLS, WITH NORMAL RESULTS IN THE LUMBAR SPINE
J. Rosas1, J. C. Cortés-Quiroz2, C. Raya-Santos3, C. Cano4, A. Pons4, M. Lorente Betoret4, J. M. Senabre-Gallego2, G. Santos Soler4, J. A. Bernal4, X. Barber5, J. A. García-Gómez6, on behalf of AIRE-MB
1Hospital Marina Baixa, Rheumatology, 03570, Spain
2Hospital Marina Baixa, Rheumatology, Villajoyosa, Spain
3Hospital Marina Baixa, Rheumatology, Villajoyosa (Alicante), Spain
2Hospital Marina Baixa, Rheumatology, Villajoyosa, Spain
5Miguel Hernández University, CIO, Elche, Spain
5Miguel Hernández University, CIO, Elche, Spain

Objectives: To analyze the characteristics of postmenopausal women referred for the first bone densitometry (BMD), with normal results in the lumbar spine.


Methods: Retrospective study of postmenopausal women, for a first BMD, at a rheumatology FLS, during February/2010-December/2021.

General patient data (age, gender), osteoporosis (OP) risk factors were collected: age at menopause, parental hip fracture, body mass index (BMI), smoking and alcohol habit, drugs and potentially osteopenizing diseases, low-impact fractures in adulthood (fractures of osteoporotic origin included: vertebral, hip, humeral head and distal radius and pelvis), current treatment for OP and FRAX index.


Results: 2.930 postmenopausal women with normal lumbar BMD are included: 505 (17%) had suffered an OP fracture: mean age (SD): 63.2 years (8.5) and of menopause 48 years (10). Among the OP risk factors: early menopause: 818 (28%) women, active smoking: 521 (18%), alcohol > 3 units: 84 (2%), parents hip fracture: 310 (11%). Among osteopenizing diseases: rheumatoid arthritis/chronic arthritis: 112 (4%) patients, inflammatory bowel disease: 44 (2%), arteritis/polymyalgia rheumatica: 35 (1%) and the rest <1%. Among the osteopenizing drugs: omeprazole: 967 (33%) patients, thyroxine: 354 (12%), oral or inhaled corticosteroids: 261 (9%) and aromatase inhibitors: 168 (6%).

427 (15%) patients had had a previous OP fracture: distal radius: 188 (6%), vertebral: 146 (5%), humeral head: 46 (2%) and hip: 47 (2%). 808 (28%) patients were receiving treatment for OP: oral bisphosphonates: 518 (18%), SERM: 136 (5%), strontium ranelate: 75 (3%), denosumab: 51 (2%), teriparatide: 16 (0.7%) and zoledronate: 12 (0.5%) ( Table 1 ).

Characteristics of patients with normal lumbar spine BMD.

TOTAL BMD LS Normal N: 2.930 Normal BMD LS WITH fracture N: 505 (17%) Normal BMD LS WITHOUT fracture N: 2.425 (83%) p
Age in BMD, years, mean (SD) 63,2 70.5 (7.78) 60.6 (26) 0.0001
Menopausal age, years, mean (SD) 48 (8.4) 45 (5.46) 48 (8.48) 0.0001
Early menopause, n (%) 814 (28) 171 (34) 643 (27) 0.07
BMI, kg/m 2 , media (SD) 29,1 (10.3) 29.5 (17.03) 28,9 (10.3) 0.44
Active tobacco, n (%) 521 (18) 40 (8) 481 (20) 0.06
Alcohol ≥ 3 units, n (%) 84 (2) 10 (2) 74 (3) 0.85
Parent hip fracture, n (%) 310 (11) 60 (12) 250 (10) 0.65
Ostepenizing drug, n (%): 1.750 289 (57) 1.461 (60) 0.34
  Omeprazole 967 (33) 178 (35) 789 (33) 0.60
  Thyroxine 354 (12) 53 (10) 301 (12) 0.67
  Corticosteroids 261 (9) 42 (8) 219 (9) 0.83
  Aromatasa Inhibitor 168 (6) 16 (3) 152 (6) 0.62
Treatment, n (%): 808 (34) 226 (48) 582 (24) 0.0001
  Oral bisphosphonate 518 (18) 127 (25) 391 (16)
  SERM 136 (5) 24 (5) 112 (5) 0.02
  Strontium ranelate 75 (3) 20 (4) 55 (2) 1
  Denosumab 51 (2) 31 (6) 20 (0.8) 0.35
  Zoledronate 12 (0.5) 10 (2) 2 (<0.1) 0.84
  Teriparatide 16 (0.7) 14 (3) 2 (<0.1) 0.84
BMD, mean Tscore (SD):   Lumbar spine 0.89 0.04 (1.49) 0.05 (1.49) 0.89
  Femoral neck 0.70 -1.3 (1.06) -0.54 (1.06) 0.0001
   Osteoporosis, n (%) 108 (4) 51 (10) 57 (2) 0.07
    Osteopenia, n (%) 981 (33) 247 (49) 734 (30) 0.0001
  Total hip -0.31 -0.8 (1.12) -0.17 (1.12) 0,0001
FRAX with BMD, mean (SD):
  Mean fracture 5.23 10.6 (5.79) 3.99 (5.78) 0.0001
  Hip fracture 1.54 3.7 (3.58) 1.09 (3.58) 0.0001

The group with OP fractures, are significantly ( Table 1 ): older (p<0.0001), with lower mean age of menopause (p<0.0001), receive more treatment (p<0.0001), especially oral bisphosphonates (p=0.02), have worse results in hip BMD (p<0.0001), with a higher percentage of osteopenia (50% vs 30%, p<0.0001) and worse result in FRAX of major fracture (p<0.0001) and of hip (p<0.001).


Conclusion: Among the patients referred to BMD, although the result of lumbar spine is normal, 17% have suffered an OP fracture, presenting this group: 1) Older age, 2) Osteopenia in hip BMD 50%, with high risk of fracture due to FRAX and they followed treatment for OP, especially oral bisphosphonates. 3) It is advisable to simultaneously perform BMD at the lumbar and hip levels, especially in older subjects


Acknowledgements: The study was supported by a research grant from the Marina Baixa Association for Research in Rheumatology (AIRE-MB).


Disclosure of Interests: None declared

Citation: , volume 81, supplement 1, year 2022, page 1635
Session: Osteoporosis (Publication Only)