AB0625 ARE TUNISIAN WOMEN PRONE TO VERTEBRAL FRACTURES AT A YOUNGER AGE?
Authors: C. Daldoul, N. El Amri, S. Laataoui, K. Baccouche, H. Zegaloui, E. Bouajina
Journal: Annals of the Rheumatic Diseases (2021)

Background: There is an evident increased risk of vertebral fractures (VF) related to ageing. This is due to alterations in trabecular microarchitecture and a decrease in cortical thickness. The International Society of Clinical Densitometry (ISCD) recommend an age threshold of 70 years for VF screening in women. However, a large proportion of VF occurs below this threshold. In Tunisia, there was no previous study evaluating the association between age and VF. Objectives: The aim of this study was to evaluate the relationship between age and prevalent VF in Tunisian women. 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 measurement. Each participant had an extensive medical history investigation, a BMD assessment and a VFA scan to detect prevalent VF using dual energy X absorptiometry DeXa. VF were identified according the Genant semi-quantitative method and grade 1 VF were ruled out. We used the WHO criteria for the diagnosis of osteoporosis and osteopenia. For age, the results were expressed as means with standard deviations (SD) and extreme values and then analyzed with two-tailed Student t test. The receiver operating characteristics curve (ROC) determined cut-offs for age. Statistical significance was set at 5%. Results: Two hundred and ten women were included in this study. The mean age of our patients was 61.51±8.49 with extremes ranging from 40 to 81 years. The distribution of our patients in 10 years age groups showed that: 9% were aged between 40 and 50 years, 34.3% were aged between 50 and 60 years, 38.6% were aged between 60 and 70 years, 17.1% were aged between 70 and 80 years and 1% were aged above 80 years. The mean BMI was 31.04±5.52 kg/m2. Thirty-seven percent of our participants had at least one fragility fracture and a severe fragility fracture was recorded in 10.5%. An early menopause was found in 19.5% of our women. Twenty percent of our population were receiving corticosteroids. 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 mean age in the VF group was significantly higher compared to the non-VF group (64.37 years vs. 60.50 years, p=0.003). The ROC curve identified an age cut-off of 60 years for VF. Age above 60 years was significantly associated with VF (65.5% vs. 43.9%, p=0.006) with an unadjusted risk of 5.42 (95%CI [1.278-4.597]). Among women with VF, 74.5% (41 women) were aged under 70 years which is the threshold proposed by the ISCD for VF screening. Among women aged under 70 years and having at least one VF (41 women), 6 women (14.63%) had an indication for VF screening as they reported a historical height loss of 4 cm and 8 women (19.51%) had an indication for VF screening as they were receiving corticosteroids. Hence, 27women (65.85%) had at least one VF and no indication for VF screening according to the ISCD. Conclusion: Tunisian women over 60 years were at higher risk of VF. Applying the ISCD criteria for VF screening would miss 65.85% of women with VF. Those findings highlight the particularity of this population experiencing osteoporotic VF at an early age. Disclosure of Interests: None declared.