THU0699 Predictors of fracture and low bone mineral density in patients with history of parental fracture
Authors: M. Dey, M. Bukhari
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Predictors of fragility fracture (FF) risk and low bone mineral density (BMD) in the general population are well-documented. Previous studies have shown strong familial association between parental and offspring BMD and hip fracture, varying according to factors including body mass index and corticosteroids. Little data exists on predictors of FF and BMD in patients with a family history of fracture, despite this increasing fracture risk. <h3>Objectives</h3> We aimed to evaluate predictors of FF and low BMD in patients attending for dual energy X-ray absorptiometry scanning. <h3>Methods</h3> Patients referred for BMD estimation, between 2004 and 2016, with a history of parental fracture, were included. Parameters recorded: femoral and vertebral BMD, height, weight, fat mass, age, smoking, alcohol, corticosteroids, aromatase inhibitors, Depo-Provera, hormone replacement therapy (HRT), rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), breast or prostate cancer, and coeliac disease. Logistic regression was used to model fracture risk, and linear regression was used to model the impact of each factor on vertebral and femoral BMD. <h3>Results</h3> 6053 patients (5513 female) were included. 2094 patients (34.6%) had sustained at least one fracture. Smoking, alcoholism, corticosteroid, increased age, height, and fat mass significantly increased fracture risk. Coeliac disease, HRT, and aromatase inhibitors were protective. Cancer, aromatase inhibitor use, and female gender significantly decreased vertebral BMD. Corticosteroids, RA, and PMR significantly decreased L1–2 BMD. Increased age and height, and decreased weight, fat mass, and tissue thickness decreased vertebral and right femoral BMD; this significantly increased FF risk. Corticosteroids, RA, PMR, Depo-Provera, female gender, and aromatase inhibitors decreased BMD; in the left femur, alcohol, corticosteroid use, increased age, height, and decreased weight decreased BMD. <h3>Conclusions</h3> Similar to studies in the general population, smoking, alcohol, and corticosteroid therapy increase fracture risk, while HRT decreases it. Chronic aromatase inhibitor use increases fracture risk, suggesting a dose-dependent effect. Coeliac disease was found to be protective; previous studies have shown coeliac disease to decrease BMD, with a variable impact on fracture. Concurrent with previous studies, a differential effect of BMD in the dominant and non-dominant hip was found, with decreased right femoral BMD significant for fracture risk. Limitations of this study include lack of dose and duration of medications and lack of comparative data before and after fracture in a single patient. Our study confirms the effect of the above factors on spinal BMD, but suggests a differential effect of smoking and alcohol on L1–2, with corticosteroids, RA and PMR affecting the lower lumbar spine. Our results also suggests a differential effect of the studied factors on the right femur compared to the left, suggesting the dominant femur is more susceptible to factors decreasing BMD. Limitations of this study include the large proportion of female subjects and lack of data on dose and duration of medications studied. <h3>Disclosure of Interest</h3> None declared