AB0847 INCIDENCE RATES OF OSTEOPOROSIS(OP) RISK FACTORS IN A LARGE URBAN LONDON BOROUGH
Authors: Rizwan Rajak, Amanda Perren, Suma Mahendrakar, Momina Zaman, LI Elaine, Michael Kotrba, Amanda Humphreys, Joseph Rehman, Wallace Tan, Fathi Al-Jehani, Suzy Peerman
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Identification of osteoporosis risk factors(OPRFs) is a necessary part of assessing fracture risk and treating patients with OP. Incidence rates of OPRFs are variably reported in the literature. Patients seen in OP clinics tend to have a higher risk of fractures compared to those managed in primary-care hence the need for closer scrutiny of their OPRFs. In some instances, managing modifiable OPRFs may form the principle part of the patient's management plan. <h3>Objectives</h3> We examined the rates of OPRFs in patients attending the Bone Health Clinic at Croydon Health Services NHS Trust. <h3>Methods</h3> Retrospective review of OP patients seen between February-June 2018 at Purley Memorial Hospital and assessed for presence of OPRFs including: demographics,BMI,early menopause,late menarche,nulliparity,secondary medical conditions,medicines,family history of OP/parental hip fracture,recurrent falls,previous fragility fractures(FFs) and lifestyle OPRFs(smoking,alcohol,low calcium intake,sedentary). <h3>Results</h3> 201 patients were included. Mean age was 70-years-old(range:37-96), with approximately 9:1 female:male ratio. Mean BMI was 23(normal) with approximately 20% being &lt;18.5(underweight). 25.5%(46/180-females) experienced an early menopause(&lt;45-years) but only 8.3%(15/180) had late menarche(&gt;16years). Of the 25.5% with early menopause, only 13%(6/46) had been offered HRT. 17% of women were nulliparous. Of the medical conditions, thyroid disease was the most commonly reported(18%) with a third of these being newly diagnosed in clinic. Coeliac was identified in 7.5% with 5% newly diagnosed. 2% had newly diagnosed haematological disorders (MGUS,Myeloma,Lymphoma). Only 8 patients had 2-or-more diagnoses at the same time. Almost 40% had a family history of OP, 19% history of parental hip fracture and 15% had both. The majority 66.7%(134/201) had experienced a previous FF with 36% having suffered 2 or more. 16%(32/201) had experienced recurrent falls. 19% were living sedentarily, 11% currently smoking, 10% drinking 3 or more units of alcohol-per-day and 31% having poor dietary calcium, with 22% having 2 or more of these lifestyle OPRFs. Of the medicines, steroids and PPIs were the most commonly seen. Overall, 73%(147/201) of subjects had at least one modifiable OPRF with over half having 2 or more OPRFs. <h3>Conclusion</h3> This study identified numerous OPRFs and their incidences. Low BMI(&lt;18.5) was common in 1/5 patients requiring input from the dietetics team as part of their treatment plan. Early menopause was seen in a quarter of female patients with just over 10% of these being offered HRT; undoubtedly more could have benefited from intervention at menapause. Many medical conditions associated with OP were identified with several patients being newly diagnosed (coeliac/hypothyroidism/haematological disorders especially). Therefore, global health assessments are needed to identify undetected disease and review and optimise control of established disease. Just under 50% had at least one lifestyle OPRF. Therefore, focus on implementing lifestyle alterations is clearly essential in the management of these patients. Given the high number of patients with at least one modifiable OPRF, it is crucial that OP services are organized accordingly to identify OPRFs to intervene and modify these factors as part of the overarching management plan. <h3>Disclosure of Interests</h3> None declared