AB0897 BIMODAL DISTRIBUTION OF VERTEBRAL FRAGILITY FRACTURES (VFF) IN A FRACTURE LIAISON SERVICE (FLS). RESULTS OF A COMPARATIVE ANALYSIS OF PATIENTS WITH VFF VERSUS THOSE WITH OTHER FRAGILITY FRACTURES (OFF).
Authors: B. Hernández-Cruz, F. J. Olmo Montes, M. J. Miranda García, M. D. Jimenez Moreno, M. A. Vázquez Gómez, M. Giner García, M. A. Colmenero Camacho, J. J. Pérez Venegas, M. J. Montoya García
Journal: Annals of the Rheumatic Diseases (2020)

Background: Fragility fractures (FF) represent a health problem and among them, the VFF. They have worse vital prognosis, are at greater risk of new FF, had higher comorbidity, with clinical manifestations in only 30%-40% of cases. One in 6 women and one in 12 adult males will have a VFF. Objectives: To analyze the clinical characteristics of FF patients attended in the FLS at Virgen Macarena University Hospital. Compare the sociodemographic and clinical characteristics of VFF patients with those with OFF. Methods: Design: Prospective cohort. Patients attended in the FLS from May 2018 to November 2019 in a protocolized manner (Openclinica®). Inclusion criteria: a clinical FF in the previous two years. Descriptive statistics: percentages and means with 25 th and 75 th percentile. Inferential statistic by parametric and nonparametric tests. The project was approved by the Ethics Committee and patients signed consent to participate. Results: Data from 414 patients with a first FF are analyzed, 101 (25%) with VFF and 313 (76%) with OFF [188 (45%) hip, 66 (16%) distal radius, 32 (8%) humerus and 27 (6%) miscellaneous (pelvis, ribs, tibia)]. All VFFs analyzed had clinical symptoms and the number of fractured vertebrae was 2 (1-3). In 28 (37%) were FF of dorsal vertebrae, at 25 (33%) lumbar and 23 (30%) dorsal and lumbar. Comparative analysis showed differences in age VFF 71 (62-77) vs OFF 76 (66 – 83) years, p=0.0003. It highlighted a bimodal distribution according to age, with a peak incidence of 55 to 68 years and another between 75-80 years (Graph). Referral unit to FLS: VFF Rheumatology (42%) and/or Traumatology Emergency Room (44%) vs OFF Internal Medicine (45%) and General Traumatology Unit (38%), p=0.0001. There were also differences in the treatment with teriparatide (VFF 20% vs OFF 4%); zoledronate (VFF 6% vs OFF 3%) and alendronate (VFF 44% vs OFF 63%, p=0001); days of immobilization (VFF 30 (0 - 60) vs OFF 10 (0 - 30), p-0.01); they have greater independence to carry out activities of daily life (Barthel Scale) VFF 95(81 – 100) vs OFF 80 (60 – 95), p=0.00001; increased clamping force of hands 18 (12 - 20) vs 12 (8 - 18) mmHg, p=0.001, and lower risk of falls (J D Downton Scale) (VFF 43% vs OFF 60%, p=0,01). While the number of relevant comorbidities was higher in VFF 3 (1 - 5) vs OFF 2 (1 - 4) it was no statistical, p=0.3. The use of GCC was risky for VFF (n=13, 13%) vs OFF (n=17, 5%), p=0.01 and RR (95%CI) 2.3 (1.01 – 5.3) and not for other drugs (GnRH inhibitors, aromatase inhibitors or chemotherapy). No differences in sex were found (VFF 80%- vs OFF 80% women, p=0.9), previous FF history (9% vs 12%, p=0.2), secondary OP (16% vs 21%, p=0.1); percentage of patients with OP by femoral neck DEXA (VFF 35% vs 42%, p=0.2) or by lumbar spine DEXA (VFF 36% vs OFF 34%, p=0.8). Conclusion: VFF have a bimodal age-based distribution, usually occurring in younger patients, with a higher degree of independence and muscle strength and lower risk of falls, although they are associated with longer duration of immobilization, compared to OFF. In our cohort, VFFs affect 2 or more vertebrae and they are commonly treated with parenteral osteoporotic drugs. The use of glucocorticoids doubled the risk of developing a VFF, these findings are similar to those of others published cohorts. This project received a grant of the Ministry Health of the Junta de Andalucía Ref.PIN-0092-2016. Bibliography: [1]Gerdhem P. Best Practice &amp; Research Clinical Rheumatology 27 (2013) 743–755 [2]McCarty J,et al. Diagnosis and management for vertebral compression fractures. American Family of Physicians Jul1, 2016 Vol 94 No 1. Disclosure of Interests: Blanca Hernández-Cruz Speakers bureau: Abbvie, Lilly, Sanofi, BMS, STADA, Francisco Jesús Olmo Montes: None declared, Maria José Miranda García: None declared, María Dolores Jimenez Moreno: None declared, María Angeles Vázquez Gómez: None declared, Mercedes Giner García: None declared, Miguel Angel Colmenero Camacho: None declared, José Javier Pérez Venegas: None declared, María José Montoya García: None declared