FRI0638 LUMBAR SPINE BONE MASS DENSITY AS A PREDICTOR OF FRACTURES IN PATIENTS WITH COELIAC DISEASE: AN OBSERVATIONAL STUDY
Authors: Mariam Gaddah, Marwan Bukhari
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Previous studies have indicated that Lumbar spine Bone Mineral Density (BMD) could be used as an indicator to predict fractures in patients with coeliac disease (1). Patients with coeliac disease are at a higher risk of developing fragility fractures as a result of the underlying metabolic pathology. Despite previously highlighting the lumber spine BMD usefulness in predicting fractures, score systems, like the FRAX score still has not acknowledged it.Additionally recent data suggested that using a ratio of Body mass index (BMI) to BMD could increase the predictive models for fracture. <h3>Objectives</h3> Through a large observational study, we set out to determine the various predictors of fractures in patients with coeliac disease. Age, gender and lumber BMD were some of the factors that were considered in relation to fractures. This data was scrutinised to assess specifically the lumbar BMD's ability to predict fractures with and without using the BMI ratio. <h3>Methods</h3> A sample of 788 patients with coeliac disease referred for bone density estimation to a scanner in the North west of England from 2004-2010 was used to assess various predictors of fractures. Data were initially analysed using simple statistical analyses (chi-squared for categorical variables and T-test for continous variables) to compare patients who had sustained a fracture to those that had not sustained a fracture. The data was then subject to further analysis initially using univariate and then multivariate logistic regression models. Variables analysed included Lumbar spine L1-L4 BMD, BMI/BMD ratio, gender, age at scan, family history of fractures, alcohol, smoking and rheumatoid arthritis. In order to further assess the Lumber spine BMD's vs BMI/BMD in predicting fractures, the data was further adjusted for age and gender and models compared using areas under the reciever operating characteristic (ROC) curve. <h3>Results</h3> Out of the 788 patients referred in the analysis period, 159 (20.2%) sustained a fracture. The mean age at the time of the scan was 55.4 (SD 14.4). A total of 576 (73.1%) were female and of those 127 (22%) had sustained a fracture. Female gender was significnatly associated with fracture (p&lt;0.003). Patients with fractures were older 59.2 years (SD14) compared to 54 years (SD 14) (p&lt;0.001). Using the multivariate model, it was evident that even after being adjusted for age and gender, the lumber spine BMD was a good predictor of fractures (OR 0.08 95%CI 0.02,0.3). This performed better than the ratio of BMD/BMI. AUC 0.64 vs AUC 0.62. <h3>Conclusion</h3> The FRAX tool should consider using lumbar spine BMD as an indicator of fragility fractures in patients with coeliac disease. We have shown using both univariate and multivariate analyses that many factors are associated with fragility fractures, but the lumber spine BMD was the best predictor. This study took the data another step further and adjusted the data for gender and age and added the ratio of BMI to BMD, but still reached a similar conclusion. Lumbar spine BMD shold be taken into consideration with more care in this group of patients. <h3>References</h3> [1] Sinha R, Bukhari M. THU0462 The Predictors of Fracture in Patients with Coeliac Disease: An Observational Study, Annals of the Rheumatic Diseases2016;75:359. <h3>Disclosure of Interests</h3> Mariam Gaddah : None declared, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen and Novartis.