OP0324 CLUSTERING OF FRAGILITY FRACTURES BY SITE IN PATIENTS REFERRED FOR BONE MINERAL DENSITY ESTIMATION: AN OBSERVATIONAL STUDY
Authors: M. Dey, M. Bukhari
Journal: Annals of the Rheumatic Diseases (2020)

Background: Fragility fractures (FF) are those resulting from mechanical forces equivalent to a fall from standing height or less [1]. They most commonly occur in the spine (vertebrae), forearm, and femur, but also occur at other sites. Prevalence markedly increases with age, due to age-related and menopause-related bone loss. FF cause substantial pain and disability, and are associated with decreased life expectancy. While many studies have investigated risk factors associated with FF, there are few data on the association between FF sites in at-risk patients. Objectives: 1. Establish the most common sites of FF in patients presenting for bone mineral density (BMD) estimation. 2. Identify patterns of co-existing FF in the above cohort by applying cluster analysis. Methods: We retrospectively reviewed the clinical records of 28868 patients presenting for BMD estimation at a district general hospital in North West England, 2004-2016, identifying those who had sustained one or more FF. Site(s) of FF were recorded for each patient, categorised as: ankle, elbow, femur, forearm, humerus, pelvis, ribs, spine, tibia or fibula (recorded as “tibfib”). Cluster analysis was performed on fracture sites, using Jaccard similarity coefficient. Results were plotted on a dendrogram and divided into clusters, as per results derived from elbow and silhouette cluster methods. Results: Out of 28868 patients presenting for BMD estimation, 11003 were identified as having sustained one or more FF. 84.6% patients were female, with overall mean age 67.5years and median T-score -1.12 SD. The most common site of FF was the forearm (n=5045), most commonly co-existing with fractures of the tibia or fibula. Frequencies of the most common and co-existing FF sites are shown in Figure 1 (top). Cluster analysis identified 3 clusters: ankle and elbow; forearm, tibia/fibula, ribs, and spine; pelvis, femur, and humerus. The second half of Figure 1 displays the dendrogram of cluster analysis results, with Jaccard similarity measure. Conclusion: We applied cluster analysis to a large cohort of patients presenting for BMD estimation. Our results are in keeping with previous studies demonstrating the FF to most commonly occur in the forearm, and in those with osteopenia (T-score -2.5 &lt; -1 SD) [2]. To our knowledge, this is the first study to apply cluster analysis to sites of FF. Results may be due to differences in cortical and trabecular bone structure, and have potential to aid prevention, monitoring, and management in at-risk patients. References: [1]National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture - Clinical Guideline (CG146). 2012;(August):1–14. [2]Siris ES et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004 May 24;164(10):1108–12. Disclosure of Interests: Mrinalini Dey: None declared, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen and Novartis.