OP0216 IDENTIFICATION AND MANAGEMENT OF PATIENTSAT INCREASED RISK OF OSTEOPOROTIC FRACTURE: IMPLEMENTATION OF IMMINENT RISK FACTOR IN STANDARD DAILY PRACTICE FOR BONE MINERAL DENSITY ASSESSMENT AND PATIENT MANAGEMENT
Authors: Yasser El Miedany, Maha El Gaafary, Mathias Toth, Waleed Hassan, Annie Mehanna
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Osteoporotic fractures are common and associated with significant morbidity, mortality, and healthcare resource use. The role of the recency of fracture has been shown for both vertebral and non-vertebral fracture risk. However, several patient characteristics contributing to imminent risk for fracture have not been well defined. Furthermore, the inclusion of imminent fracture risk in standard practice remains a challenge. Objectives: to evaluate electronic recording of osteoporosis patients' data using online proforma to request DXA scan, analyse the correlations and the applicability of imminent fracture risk (ImFR) identification and the WHO fracture risk assessment tool (FRAX) for the prediction of osteoporotic fractures in standard practice and its implication on the patients' management. <h3>Methods</h3> 368 patients referred for DXA scanning were included in this work. The online referral form for DXA scanning includes 4 main components: Risk factors for osteoporosis (6 factors) to be completed by the referring doctor; 2. the 8 fracture risk factors identified in FRAX; 3. Risk factors for falls (5 factors) [1] and its score graded as low, moderate and high; 4. Risk factors for ImFR and a question Yes/No regarding the presence of ImFR. For the patients who had fracture in the last 24-months, potential risk factors during the period before fracture were assessed. The BMD as well as 10-years probability of fracture risk were analysed in patients with ImFR and those without. Risk stratification and correlation analyses were applied to analyse the associations between ImFR and FRAX-based probabilities versus BMD at different sites. Data from patients with and without recent fracture were used to identify factors associated with imminent risk for fracture. <h3>Results</h3> Of the 368 subjects, 181 (46.9%) were diagnosed as osteoporotic, and 158 (40.9%) were diagnosed as osteopenic. There was no significant difference on comparing the FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated with and without considering the BMD. Keeping the other factors constant, patient with ImFR had significantly (p &lt; 0.01) lower BMD at both spine and hip in contrast with those without history of ImFR or history of fracture more than 10-years ago. Using data from 24- months before fracture, factors significantly associated with ImFR were high falls risk, older age, poorer functional disability and hand grip, specific comorbidities (central nervous system disease, inflammatory arthritis, Alzheimer's disease, parkinsonism, psychosis) steroid therapy and intake of drugs targeting CNS,. There was no significant difference (p&gt; 0.05) on comparing FRAX estimated 10-year fracture probabilities in those with ImFR compared to those who had previous fracture more than 2-years ago. <h3>Conclusion</h3> It is important to include the ImFR in the referral for BMD assessment. In patients with osteoporosis or osteopenia and no recent fracture, high falls risk, older age, poorer health status, comorbidities were predictive of imminent risk for fracture. Identification of patients with imminent fracture risk may help identify and risk stratify those patients most in need of immediate and appropriate treatment to decrease fracture risk. <h3>References</h3> [1] El Miedany, et al. Falls risk assessment score (FRAS): Time to rethink. J clin Gerontology Geriatrics 2011;2: 21-26 <h3>Disclosure of Interests</h3> None declared