AB0840 SCREENING FOR OSTEOPOROSIS IN AN AMBULATORY AND HOSPITALIZED POPULATION: A 6-YEAR EXPERIENCE IN A UNIVERSITY HOSPITAL
Authors: Olivier Malaise, Marie Detroz, Mathieu Leroy, Lorenzo Leonori, Laurence Seidel, Michel Malaise
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Osteoporosis (OP) is a serious and prevalent disease identified by Dual Energy X-ray Absorptiometry (DEXA) that can be performed in an ambulatory or an hospitalized population. <h3>Objectives</h3> Aims are: (1) to characterize patients who had DEXA in a university department of rheumatology to study its diagnostic efficacy; (2) to look after risk factors specific to our population; (3) to evaluate the efficiency of a non-systematic and opportunistic intra-hospital OP screening by comparing results for ambulatory and hospitalized patients in the different departments of the hospital. <h3>Methods</h3> From 2007 to 2012, 6406 initial DEXA from consecutive patients were prospectively encoded (1494 in 2007, 1158 in 2008, 1079 in 2009, 945 in 2010, 868 in 2011 and 862 in 2012) (identical DEXA). <h3>Results</h3> Cohort characteristics are the following: women 74.4%, mean age (± 1 standard deviation) 60.5 years (± 14.3), mean BMI 25.1 (± 5.1), history of corticotherapy in 30.5%, previous fracture in 29% and current hospitalization in 28.8% of cases. OP (at one of the 3 sites) was diagnosed in 22.3%, a stable value over the years, with, as a repartition, lumbar spine, femoral neck and total hip OP in 13.7%, 13.6% and 9.2% respectively. In 3.9%, OP was diagnosed at all the 3 sites. In univariate analysis, OP risk factors were age, history of fracture and low BMI (for all 3 sites), corticotherapy (lumbar spine and femoral neck) and male gender (lumbar spine). In multivariate analysis, regardless of site, age, fracture history, low BMI, and male gender increased the OP risk. Intra-hospital screening identified OP (at any of the 3 sites) in 31.8% (<i>vs</i> 18.5%, p&lt;0.001 for ambulatory screening) and OP at 3 sites simultaneously in 7.9% (vs 2.3%, p &lt;0.0001). This better efficiency was stable and present for each year analyzed. The intra-hospital population tested was older [64.2 years (13.2) vs 59 (13.2), p&lt;0.0001], with more men (35.2% vs 21.7, p&lt;0.0001), more history of fracture (39% vs 24, p&lt;0.0001) and with a slightly higher BMI [25.4 (5.8) vs 25.1 (4.8), p=0.028], with no difference in corticosteroid use. In addition to T-scores analyzes, Z-scores were also compared and showed similar differences with lower Z-scores in the hospitalized population. <h3>Conclusion</h3> (1) One in five DEXA identified OP at one of the three sites in the ambulatory population but only one in three in the hospitalized patients. Hospital screening is therefore essential and more efficient than the ambulatory one. Hospital time seems to be an opportunity to fill the gaps in ambulatory screening. (2) Intra–hospital screening targeted an older and more masculine population with more fracture history, which may explain its better performance, which does not decline over the years. Z–score differences revealed that the efficiency difference was not only due to an older age of the hospitalized population but could be secondary to more internistical co–morbidities or treatment deleterious for bones. (3) In addition to conventional ones, the male gender is a risk factor for OP, recalling the importance of screening for all and not only in the female population (which represents ¾ of the cohort). <h3>Disclosure of Interests</h3> Olivier Malaise Speakers bureau: Amgen, Marie Detroz: None declared, Mathieu Leroy: None declared, Lorenzo Leonori: None declared, Laurence Seidel: None declared, Michel Malaise: None declared