AB0624 COMPARISON OF DIFFERENT FRAX SCORES WITHOUT BONE MINERAL DENSITY FOR THE EVALUATION OF RISK FRACTURE IN MEXICAN PATIENTS WITH RHEUMATIC DISEASES
Authors: G. Figueroa-Parra, A. Y. Lujano Negrete, R. Moyeda Martinez, C. M. Gamboa-Alonso, D. Á. Galarza-Delgado, C. M. Skinner Taylor
Journal: Annals of the Rheumatic Diseases (2021)

Background: Osteoporosis (OP) is characterized by compromised bone strength and deterioration of quality, often leading to fragility fractures(1). Dual-energy x-ray absorptiometry (DXA) is the recommended test for OP screening(1). However, there are limitations to perform DXA on all patients, and the clinicians use screening tools to identify those patients with higher risk, like the FRAX score(2). Nevertheless, these scores have showed low to moderate correlation with DXA in RD patients(3). Objectives: To evaluate the fracture risk in RD patients, using different versions of FRAX scores without a bone mineral density (BMD) measure. Methods: An observational prospective study was performed at the Rheumatology Clinic in the University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico, between August and October 2020. Consecutive patients with a RD were evaluated as part of a “Bone Health Program”(3). Demographics and the risk factors included in FRAX tool was collected from ≥40 years-old patients; FRAX score was calculated online at https://www.sheffield.ac.uk/FRAX/ (algorithm for Mexicans). Four versions were calculated: 1) FRAX score without (w/o) BMD; 2) FRAX score with a T-score of -1.0 (w/Op); 3) FRAX score with a T-score of -2.5 (w/OP) and a FRAX score with positive previous fracture (Fx+). Then were classified as low (&lt;10% for OP or &lt;1% for hip), intermediate (10%-19% for OP or 1%-&lt;3% for hip) and high risk (≥20% for OP or ≥3% for hip). Results are shown in means (SD) or frequency (%). A chi-square test was used to compare groups. Spearman’s correlation test (rho) was done between OP risk and Hip risk in each version of FRAX. P&lt;0.05 was considered statistically significant. Results: One hundred and three patients were included, 93.2% were woman. The most frequent diagnosis was RA in 51.5% of patients, followed by osteoarthritis in 7.8%. 62.1% of patients had a previous BMD measured by DXA. 21.4% had history of previous fracture. 61.2% of patients were taking glucocorticoids. (Table 1). According to FRAX risk w/o BMD, 82 (79.6%) had low risk, 13 (12.6%) had intermediate risk, and 8 (7.8%) had high risk for OP. According to FRAX risk w/o BMD, 59 (57.3%) had low risk, 24 (23.3%) had intermediate risk, and 20 (19.4%) had high risk for hip fracture (Table 2). The correlations between OP risk and Hip risk in each version were as follow: FRAX w/o BMD (rho= .734, P= &lt;.001) FRAX w/Op (rho= .308, P= .002); FRAX w/OP (rho= .476, P= &lt;.001); FRAX with Fx+ (rho= .634, P= &lt;.001). Conclusion: There is a wide variability among the different FRAX risk scores evaluated, and moderate to high correlation between the OP and Hip risk in patients with RD. References: [1]Ann Intern Med. 2017;166(11):818-839. doi:10.7326/M15-1361 [2]Arthritis Rheumatol. 2019;71(suppl 10):3924-3925 [3]Ann Rheum Dis. 2020;79:1190-1191 Table 1. FRAX score risk factors N= 103 95% C.I. Age, years, mean (SD) 57.0 (9.56) 55.1 – 58.9 Female, n (%) 96 (93.2) 86.4 – 96.9 Weight, kg, mean (SD) 68.2 (14.88) 65.3 – 71.2 Height, cm, mean (SD) 154.6 (6.73) 153.3 – 155.9 Previous Fracture, n (%) 22 (21.4) 14.5 – 30.3 Parent Fractured Hip, n (%) 12 (11.7) 6.7 – 19.4 Current Smoking, n (%) 12 (11.7) 6.7 – 19.4 Glucocorticoids, n (%), 63 (61.2) 51.5 – 70.0 Rheumatoid arthritis, n (%) 53 (51.5) 41.9 – 60.9 Secondary osteoporosis, n (%) 1 (1.0) 0.0 – 5.8 Alcohol use, n (%) 1 (1.0) 0.0 – 5.8 Previous DXA, n (%) 64 (62.1) 52.5 – 70.9 Disclosure of Interests: None declared.