AB0623 OSTEOPOROSIS: SCREENING, DIAGNOSIS AND TREATMENT IN TUNISIA: INVENTORY
Authors: S. Jriri, N. El Amri, K. Baccouche, S. Lataoui, H. Zeglaoui, E. Bouajina
Journal: Annals of the Rheumatic Diseases (2021)

Background: Osteoporosis has become a public health issue due to the increasing number of complications in osteoporotic women in terms of morbidity and mortality.His screening has improved since the refund of the bone densitometry, but prevention, diagnosis and treatment of this pathology remain suboptimal. Objectives: a qualitative study to understand barriers towards care initiation and levers to improve awareness and management of osteoporosis among general and specialist practitioners. Methods: The survey was conducted among a random sample of general practitioners and specialists.An anonymous questionnaire was used for this study carried out by mail.It contained 22 questions concerning the socio-demographic characteristics of each practitioner and his patient group, general questions on osteoporosis and questions on the practice in terms of management.The survey lasted about six weeks. Results: 102 doctors have answered.55,3% were experienced doctors and 44.7% were young doctors in training.They were 43 general practitioners,21 rheumatologists,15 orthopedists,13 gynecologists and 10 endocrinologists.The sector of activity in urban and periurban areas was noted in 90% of casesand 5% in rural.43% exercised a liberal activity and57% had a hospital-university activity.60% of participants believed that osteoporosis is a condition associated with morbi-mortality and 85% confirmed that it is an underestimated disease.In 72% of physicians,women over 50 accounted for 25 to 75% of their female patient base.86% of doctors looked for recent information on osteoporosis from medical journals andrecommendations and 11% from representatives of pharmaceutical companies.In a recently menopausal patient,68% of physicians often looked for risk factors for osteoporosis which were: Age in 90% of cases, early menopause in 84%,presence of a family or personal history of fracture in 65 %,a history of prolonged systemic corticosteroid therapy in 46% ofcases;endocrine pathologies in 29%;Chronic inflammatory rheumatism was investigated in 19% of cases,Smoking and alcoholism were investigated in 11% of cases.The diagnosis of osteoporosis was mentioned in case of bone transparency on standard X-rays in 76% of cases,a low-energy trauma fracture in 43.5% and the presence of a risk factor in 35% of cases.98% of responding physicians rely on bone densitometry to make the diagnosis of osteoporosis.41.2% of doctors said they were looking for a secondary cause of osteoporosis or a differential diagnosis by requesting a biology.This assessment included:blood phosphocalcic assessment in 88%,vitamin D in 90%,thyroid assessment in 35%,protein electrophoresis in 38%, inflammatory biologic markers in 20% and immunological factors were requested in 6% of cases.The choice of anti-osteoporosis treatment depended on the bone densitometry result in 88% of casesand the presence of a personal history of fractures in 36.5% of cases.Bisphosphonates were at the top of the therapeutic arsenal of general practitioners and specialists (99.8%).100% of the participants knew the reimbursement criteria for anti-osteoporosis treatment by the national health insurance fund and take them into account when prescribing in 91% of cases.The duration of a therapeutic sequence varied from one practitioner to another: 13% of the doctors did not specify it, 45% treated their patients for five years and 42% kept the treatment for 3 years.When a fracture occurred during treatment, 64% of general practitioners had recourse to a rheumatologist, the rest carried out a densitometric reassessment. Conclusion: The deficits found in the knowledge of both the general practitioners and among others specialists, should be addressed by providing updated information and better awareness of health professionals in order to improve osteoporosis prevention and treatment. References: [1]Taylor, J. C., Sterkel, B., Utley, M., Shipley, M., Newman, S., Horton, M., &amp; Fitz-Clarence, H.2001. Opinions and Experiences in General Practice on Osteoporosis Prevention, Diagnosis and Management. Osteoporosis International, 12(10), 844–848 Disclosure of Interests: None declared.