POS1116 ENHANCING OSTEOPOROSIS MANAGEMENT: THE CONTRIBUTION OF FRAX® AND VFA IN TUNISIAN WOMEN
Authors: C. Daldoul, N. El Amri, S. Laataoui, K. Baccouche, H. Zegaloui, E. Bouajina
Journal: Annals of the Rheumatic Diseases (2021)

Background: The FRAX® is a tool proposed by the World Health Organization (WHO) to calculate 10-year fracture risk of hip fracture and major osteoporotic fractures. The utility of this tool is to help treatment decision when it is litigious. Previous low trauma fracture represent a factor in FRAX® calculation. However, asymptomatic osteoporotic vertebral fractures (VF) identified on X-rays or Vertebral Fracture Assessment (VFA) scans are rarely included. To the best of our knowledge, there was no previous evaluation of fracture risk in Tunisian women. Objectives: To compare hip fracture risk and major osteoporotic fractures risk using the FRAX® tool, without and with the consideration of asymptomatic VF on VFA. To evaluate the impact of FRAX® calculation and asymptomatic VF identified on VFA on osteoporosis management. Methods: We conducted a cross-sectional study over a period of 5 months at the rheumatology department. The study included post-menopausal women without a previous diagnosis of VF referred for BMD (Bone mineral density) measurement. Each participant had a BMD assessment and a VFA scan to detect VF. The FRAX® was calculated using femoral neck BMD initially without then with consideration of VF. The change of therapeutic decision was assessed after taking into consideration FRAX® and the VFA results. Results: The study included 210 post-menopausal women with a mean age of 61.5±8.5 years. The mean BMI was 31.04±5.52 kg/m 2 . One women was a current smoker and alcohol intake was not found in our sample. Thirty-seven percent of our participants had at least one fragility fracture. A severe fragility fracture was recorded in 10.5% and a previous hip fracture was reported in 5.24%. An early menopause was found in 19.5% of our women. Twenty percent of our population were receiving corticosteroids and 8.2% of our population had rheumatoid arthritis. The mean vertebral and total hip BMD was 0.955±0.165 g/cm2 and 0.850±0.135 g/cm2 respectively. Osteoporosis and low BMD were found in respectively 50% and 34.28%. The median probability of major osteoporotic fracture for our population was 1.5% with an interquartile range from 0.9 to 2.5% without using VFA data and 1.65% with an interquartile range from 1 to 2.6% while taking into consideration VFA results and the difference was statistically significant (p&lt;0.0001). The median probability of hip fracture for our population was 0.4% with an interquartile range from 0.1 to 0.9% without using VFA data and 0.4% with an interquartile range from 0.1 to 1% while taking into consideration VFA results and the difference was statistically significant (p&lt;0.0001). In all patients, the FRAX® was under the threshold intervention even after including the asymptomatic VF and it did not change the therapeutic decision. The presence of asymptomatic VF on VFA changed the therapeutic decision in 15% and indicated an anti-osteoporosis drug therapy. Conclusion: VFA scanning helped in the therapeutic decision in 15% of our population. In this evaluation, we showed that a comprehensive fracture risk pathway incorporating VFA has enhanced diagnosis of vertebral fractures and improved targeting of treatment better than FRAX® tool. Disclosure of Interests: None declared.