Osteoporos Int (2017) 28 (Suppl 1):S127–S636 DOI 10.1007/s00198-017-3950-2
World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2017): Poster Abstracts
# International Osteoporosis Foundation and National Osteoporosis Foundation 2017
P101 and the analyte concentrations (r=-0.347, p=0.016, and r=- THE EFFECT OF BONE-SEEKING ELEMENTS PRE- 0.549, p <0.001, for lead and aluminum, respectively). SENT IN BONE ON DUAL-ENERGY X-RAY ABSORP- However, the deviation of BMD observed from clinically rel- TIOMETRY AND QUANTITIVE ULTRASOUND- evant concentration of lead and aluminum, which is under 100 MEASUREMENTS: A PHANTOM STUDY μg/g was within 1% of the coefficient of variation of BMD D. Jang1,E.DaSilva1, J. Tavakkoli1, L. Slatkovska2,A.M. intrinsic to DXA. No statistically significant correlation be- Cheung2,A.Pejovic-Milic1 tween QUI and analyte concentrations was observed for all 1Department of Physics, Ryerson University, Toronto, Canada, three elements. 2Centre of Excellence in Skeletal Health Assessment, Joint Conclusions: The results of this study suggest that, strontium Department of Medical Imaging, University of Toronto, induces artificial elevation of BMD measured by DXA as Toronto, Canada previously documented [2], but it does not influence QUI determinations. The use of QUS in conjunction with DXA Objectives: To use trabecular bone-mimicking phantoms to can potentially aid with BMD monitoring of patients who investigate the effect of bone seeking elements such as stron- are taking strontium or has a history of strontium intake. tium, lead and aluminum on bone mineral density (BMD) as Furthermore, clinically relevant levels of bone lead and alu- determined by dual-energy x-ray absorptiometry (DXA), and minum do not induce detectable deviation in measurements of quantitative ultrasound index (QUI) as derived by quantitative BMD or QUI, making both modalities useful in assessing ultrasound (QUS) systems. patients with elevated bone lead or aluminum levels. Materials and Methods: Seven strontium-substituted trabec- References: ular bone-mimicking phantoms with Sr/(Sr+Ca) mole ratios [1] Rizvi B et al. Medical Physics 2016;43:5817 ranging from 0 to 2% mol/mol were constructed using the [2] Liao J et al. Bone 2010;47:882 method previously developed by our research group [1]. Similarly, four lead-doped and four aluminum-doped phan- toms were constructed with the respective analyte concentra- P102 tions ranging from 50 to 200 μg/g. In addition, a 0 μg/g HIP AND EYE INVOLVEMENT IN ANKYLOSING phantom was constructed for the baseline measurements of SPONDYLITIS lead and aluminum. The volumetric mineral density of all C. Criveanu1,C.F.Palici1,A.E.Musetescu1,A.L. phantoms was kept constant at 200 mg/cm3. The phantoms Barbulescu1, F. A. Vreju1, A. Rosu1,P.L.Ciurea1 were quantified for their BMD and QUI by a Hologic 1University of Medicine and Pharmacy, Craiova, Romania Horizon® DXA device and a Hologic Sahara® QUS device, respectively. Background: Ankylosing spondylitis (AS) is a chronic sys- Results: A strong positive correlation was observed between temic inflammatory disease that primarily affects axial skele- BMDdeterminedbyDXAandmoleratioofstrontium ton, but with an important involvement of peripheral joints (r=0.993 and p <0.001). In the cases of lead and aluminum, and extra-skeleton disorders. Hip involvement in AS is a com- negative correlations were observed between measured BMD mon and disabling condition and in contrast to the classical S128 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 changes of AS in the spine, inflammation in the hip does not in the architecture and overall appearance of the bone. The lead to formation of new bone, but results in an erosive dis- disorder may be monostotic or polyostotic and affect any ease. Acute anterior uveitis is a common manifestation of AS, bone in the body, but never the entire skeleton. PDB is that can occur onset or in the course of the disease, and can classically identified in the skull, thoracolumbar spine, pel- lead to serious visual complications. vis as well as long bones of the lower extremity. Objectives: To evaluate radiological hip abnormalities and to Interactions between environmental and genetic factors establish a correlation with acute anterior uveitis. are considered essential to the development of Paget's dis- Methods: This study group included 36 male patients with ease. Mutations in the codingregionofsequestosome-1 define AS, with 45,5 years mean age (range 23-68) and mean (SQSTM1), which encodes the p62 protein are linked to disease duration of 17,4 years. All patients were assessed for Paget's disease. Chronic measles (MV) infection has been hip involvement by performing an X-ray radiography and suggested the environmental factor induce Paget's disease. ophthalmological exam for anterior uveitis. Typical clinical It is a well-characterized metabolic disorder of bone due to findings included regional pain, muscle atrophy, flexion con- rapid bone remodeling and turnover that results in bony tractures and limitation of motion on hip joint. Anterior uveitis overgrowth at single or multiple skeletal sites and presents is easily to diagnose by red and painful eye, photophobia and as radiographical and biochemical markers alterations. blurred vision. Bisphosphonates are now considered as the standard treat- Results: The radiographic findings was concentric space ment for active Paget’s disease that subsequently normal- narrowing (38,8%), osteophytosis (27,7%), protrusion izes alkaline phosphatase and PTH levels, and pain relief. acetabuli (13,8%), 11,1% was normal and 8,3% had hip an- Material and methods: The nonrandomized retrospective kylosing and needed total hip replacement. Radiographic and study was conducted. Thirty-six patients with diagnosed clinical signs of hip involvement showed significant positive PDB were included in this study. Indications for therapy in- correlation. Coxitis tend to begin early in disease course, av- cluded extensive disease, pagetic deformities, neurologic erage age of hip involvement was 36 years. From the 36 pa- complications, and pagetic pain. Patients were treated with tients, 9 (25%) had one or more acute anterior uveitis episodes long-term pamidronate from 2008 to 2015. The study group in the course of disease. From them, 3 (33,3%) needed total consisted of 17 males and 19 females in average age 60,3 hip replacement, 4 (44,4%) had protrusion acetabuli and the years (men - 60,6 years and women 58,2 years). The average remaining 2 (22,2%) had a normal hip joint. follow-up was 4,27 years. Alkaline phosphatase, PHT, Conclusions: Patients with early AS onset had higher fre- Calcium, Phosphorus, and 25OH D3 were tested. The therapy quencies of hip involvement and also had a greater need for was administered when alkaline phosphatase or PTH increase total hip replacement, as compared with patients with adult- or when pain deteriorated. The pamidronate was administered onset AS. We consider that hip involvement in AS patients intravenously at a dose 1 mg/kg of body mass. Vitamin D was should be assessed routinely in both young and adult AS pa- supplemented if required. tients. The study demonstrates an association between coxitis Results: The mean serum alkaline phosphatase level was and anterior unilateral and recurrent uveitis. Uveitis and 259,77 U/L (maximum 2606) before therapy and 152,19 coxitis require simultaneous rheumatology and ophthalmolo- U/L after treatment, a decrease of 58,58% (P<0.01). gy approach, being associated with unfavorable evolution of Calcium and Phosphorus levels were within the norm range AS. (Ca 8,87 mg/dL; Ph 3,31 mg/dL) but 25 OH D3 was usually low 24,4 j.m. (3,8-52). Laboratory findings usually normal- ized after pamidronate administration. Local orthopedic defor- P103 mities due to PDB (hip osteoarthritis 3 cases, tibial deformities LONG-TERM EFFECTS OF INTRAVENOUS PAMIDRO- in 2 cases), spinal stenosis 2 cases required conservative or NATE IN PAGET'S DISEASE OF BONE surgical treatment. Pamidronate was well tolerated. A "flu- W. Glinkowski1, J. Janowicz1,T.Rudnicki2 like" syndrome after the infusion was infrequently reported. 1Medical university of Warsaw, Warszawa, Poland, 2Baby Patients reported significant pain relief after pamidronate Jesus Clinical Hospital, Warszawa, Poland administration. Conclusions: PDB in Poland is relatively rare. This disorder Objective: To evaluate the effect of intravenously adminis- is frequently referred to orthopedic department specialized in tered pamidronate in patients with Paget's disease of bone. metabolic bone diseases due to laboratory findings or ortho- Background: Paget’s disease of bone (PDB), also known pedic deformity. The intravenous administration of as osteitis deformans since 1877. PDB has been regarded pamidronate in a dose of 1 mg/kg of the body mass in patients as the second most frequent metabolic bone disorder in with Paget's disease of bone, was efficient in remissions of many publications. The prevalence of PDB in Poland is symptoms like pagetic pain and decrease of serum alkaline low. This bone remodeling disorder is leading to changes phosphatase level. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S129
P104 patients with vertebral haemangioma presenting with myelop- EPIDEMIOLOGY OF VITAMIN D SUPPLY IN GER- athy treated surgically. MANY: ASSESSMENT ON 1343 UNSELECTED Materials and method: Six patients (Mean age 14.17 years, PATIENTS range: 12- 17 years, 3 females and 3 males) treated by J. D. Ringe1,P.Farahmand1 laminectomy, laminectomy + alcohol embolization, 1West German Osteoporosis Center (WOZ) at Klinikum laminectomy + alcohol embolization + bone cement injection Leverkusen, University of Cologne, Cologne, Germany and laminectomy + alcohol embolization + instrumentation from 2010 to 2014 with minimum 2 years follow up were Vitamin D insufficiency is increasingly recognized as an im- included. Clinical/Neurological outcome was assessed using portant risk factor in the pathogenesis of falls and osteoporotic American Spinal Injury Association (ASIA) scale. fractures. Aim of this trial was to get information about the Demographical, clinical, radiological, operative details and vitamin D supply from a representative cohort of females and postoperative events were retrieved from hospital records. males in the average German population.266 GPs cooperated Only one patient underwent only laminectomy was operated with our center in this study by taking blood samples from outside with procedure abandoned due to bleeding. That pa- their daily ambulant patients regardless of the actual reason for tient was followed up here consultation. In these blood samples Vitamin D (25-OH-D), Result: Myelopathy was present in all patients. The pre- parathyroid hormone, calcium, phosphate, alk. phosphatase, operative ASIA score was A in 5 and C in 1 patient. All had gamma-GT and creatinine were measured in one central lab- pan vertebral body VH with severe cord compression in tho- oratory. Furthermore the patients filled in a questionnaire (age, racic region on imaging study. Immediate embolization was sex, previous falls or fractures, skin type, Vitamin D-supple- achieved in all patients in which alcohol was injected, which mentation, acute or chronic diseases, medications. The trial made laminectomy and soft tissue hemangioma removal rel- was performed between Feb. 26th and May 25th. Laboratory atively easy. Post-surgery, at mean follow up of 41.33 months and personal data became available from 1343 patients (615 (range 25 to 69 months) all patients showed improvement in men and 728 women). The age distribution ranged from 20 to power. ASIA score was E all patients at last follow up. 99 years, the average age of the whole cohort was 57.6 years Conclusion: Present study is largest series of pediatric symp- (men 58.2, women 57.2). The mean 25-OH-D-value for the tomatic VH with more than 2-year follow up. Over all out- whole cohort was 16.2 ng/ml (range: 6.0 to 66.8, median 14,1 come was good with decompressive surgery. ng/ml). 16% of the patients had 25-OH-D-values below 8 ng/ ml (=20 nmol/l), 37% below 12 ng/ml (=30 nmol/l) and 94% showed values below 32 ng/ml (=80 nmol). Parathyroid hor- P106 mone levels were in 29% of cases in the upper tertile of nor- PREDICTIVE FACTORS FOR RESPONSE TO ULTRA- mal, while 16% were above the upper normal limit of 65 pg/ SOUND-GUIDED INTRA-ARTICULAR GLUCOCOR- ml.Since 25-OH-D values above 80 nmol/l are regarded as TICOIDS IN KNEE OSTEOARTHRITIS optimal for bone and muscle and general health this means S. Slimani1,A.Aissoug2, S. Aouidane1,H.Bounecer1,M.M. that we found in this particular population a high prevalence Makhloufi1,A.Ladjouz-Rezig3 of moderate to severe Vitamin D-insufficiency the latter to- 1Department of Medicine, University of Batna, Batna, gether with secondary hyperparathyroidism. Algeria, 2Private practice, Batna, Algeria, 3Rheumatology Department, Benaknoun Hospital, Algiers University Medicine Faculty, Algiers, Algeria P105 MANAGEMENT OF PAEDIATRIC VERTEBRAL Aim: To investigate predictive factors for good outcome of HAEMANGIOMAS PRESENTING WITH ultrasound intra-articular glucocorticoids in knee osteoarthritis MYELOPATHY WITH MINIMUM 2-YEAR FOLLOW (OA). UP Methods: We conducted a prospective monocenter cohort P. K. Singh1,P.S.Chandra1,S.S.Kale1,B.S.Sharma1,A.K. study including 116 patients with knee OA, after failure to Mahapatra2, D. R. Sawarker1 standard treatments, with pain > 4 (numerical rating scale 1Neurosurgery, All India Institute of Medical Sciences, New NRS 0-10). Patients received an ultrasound-guided injection Delhi, India, 2Neurosurgery, All India Institute of Medical of 40 mg triamcinolone acetonide in their most painful knee. Sciences, New Delhi, New Delhi, India We exhaustively collected demographic and clinical data at inclusion, as well as lab, radiographs and ultrasound parame- Introduction: Pediatric vertebral haemangiomas (VH) are ex- ters of the included knees. WOMAC score was calculated at ceedingly rare benign and highly vascular tumours of spine. inclusion and after 4 weeks. Responders were defined as pa- Purpose of study was to evaluate the long term outcome of tients with at least 40% improvement of their WOMAC score. S130 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Univariate analysis was performed in order to select possible osteoarthritis, the availability of outpatient consultations rheu- predictive factors, and stepwise multiple logistic regression matologist or hospital treatment for osteoarthritis in history analyses were conducted to identify predictors of response. was performed. Application prior to admission nonsteroidal Results: Among the 116 patients, 101 were females. Median anti-inflammatory drugs and SYSADOA treatment was esti- age was 64 years (40-85) and mean duration of the disease mated. Comparing of patients according to severity of pain, was 14.1±14.8 years. Mean BMI was 29.9±3.8 kg/m2.Mean functional disability of joints, number of painful joints, signs NRS of pain was 8.4±1.2 and mean WOMAC was 73.3 of synovitis, duration of the pain syndrome before treatment ±11.8 at inclusion. 70.0% of the knees were grade 3 or 4 of was conducted. The severity of the changes in laboratory pa- Kellgren-Lawrence. 98% of knees expressed ultrasound syno- rameters, their dynamics in the course of treatment, duration vial effusion and/or hypertrophy at inclusion. After 4 weeks, of hospitalization in different subgroups of patients was 61.2% of patients were responders. Regression analysis estimated. showed that patients with a BMI <30 kg/m2 (OR=0.38, Conclusion: Osteoarthritis is one of the leading causes of 95%CI 0.16-0.89) and an ESR <20 mm (OR=0.27, 95%CI hospitalization of patients with acute articular syndrome. It 0.08-0.90) were more likely to respond to ultrasound-guided is necessary to develop optimal algorithms for diagnosis and glucocorticoids injection. Having both predictive factors of treatment of osteoarthritis in AAS. good response increases the response rate to 73.5%, whereas having no predictive factor decreases the response rate to 25.0%. P108 Conclusion. Our study is the largest study evaluating predic- ACUTE ARTICULAR SYNDROME: DEVELOPMENT tive factors of response for intra-articular glucocorticoids in- AND IMPLEMENTATION OF A SYSTEM OF jections in knee OA. Also, it is the first study of predictive DIAGNOSIS AND TREATMENT factors for ultrasound-guided injections. Patients with high A. S. Povzun1,K.A.Povzun1 BMIs and high ESR seem less likely to respond to intra- 1Scientific Research Institute of Emergency Care n.a. I.I. articular injections. Dzhanelidze, Saint-Petersburg, Russian Federation
Introduction: Acute articular syndrome (AAS) is a heteroge- P107 neous group of diseases, common to which is the articular OSTEOARTHRITIS AS A CAUSE OF ACUTE ARTICULAR apparatus involvement into the pathological process. Most SYNDROME rheumatology hospitals provide only the planned hospitaliza- A. S. Povzun1,K.A.Povzun1 tion of patients, however, the problem of hospitalization and 1Scientific Research Institute of Emergency Care n.a. medical care for patients with AAS had not previously been I.I.Dzanelidze, Saint-Petersburg, Russian Federation solved. Purpose: Since 2008 in Saint-Petersburg Scientific Research Introduction: Since 2008 in Saint-Petersburg Scientific Institute of Emergency Care named after I.I. Dzhanelidze was Research Institute of Emergency Care n.a. I.I. Dzhanelidze developed and implemented a program of management of introduced a program for the treatment of patients with acute AAS patients. The purpose of this program is to create oppor- articular syndrome (AAS). Osteoarthritis is a common cause tunities of hospitalization for emergency indications patients of significant pain syndrome requiring hospitalization of the with a preliminary AAS diagnosis. patient for urgent reasons. At the same time, a large number of Materials and methods: The performance of this project at patients with AAS are delivered with an unknown nosological the 7/24 on duty multidisciplinary emergency medicine hos- diagnosis, during the diagnostic process is verified as pital allows to use all diagnostic capabilities of the emergency osteoarthritis. department, to ensure the consultation of different medical Purpose: The purpose of the study was the research of oste- specialists. oarthritis as the cause of AAS. During the development phase, carried out the coordination Material and methods: There were patients with AAS, direct- with the city Bureau of emergency medical services and Chief ed to hospital inpatient treatment, the final diagnosis of which rheumatologist about the possibility of sending patients with a was recognized as osteoarthritis. In the 2008-2012 years total diagnosis of AAS, not with the specific nosological diagnosis. 377 patients were surveyed (51, 64, 106, 78 and 78, This approach provides a purposeful direction for these pa- respectively). tients from outpatient centers and ambulances directly to the Results: The proportion of patients with osteoarthritis in rela- Institute of Emergency Care with a goal to their concentration tion to the total number of patients with AAS was determined. in the multispecialty hospital for differential diagnostics pro- Comparing by age, gender of patients, the incoming diagno- cedures with simultaneous beginning of symptomatic and sis, the presence of previously verified diagnosis of pathogenetic therapy. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S131
Results: The main principles of differential diagnostics of Conclusion: This persistent truncal dystonia appears to be AAS and groups of nosological forms were presented. potentially reversible with CHEIs discontinuation as reported Recommendations on optimizing the algorithm of examina- in the literature. The connection between CHEIs treatment and tion of patients were revealed. Initial symptomatic therapy PS may be considered as likely because dystonia stopped with aimed at the speedy relief of pain, which improves the com- CHEIs discontinuation in most cases, which suggests that pliance of patients. Subsequently assigned pathogenetic ther- CHEIs alone can induce reversible PS in Alzheimer’sdisease apy will be more likely to be effective because the patient had patients. The frequency of this rare side effect should increase previously noted the effectiveness of symptomatic therapy. in the future with the growing number of polypharmacy old The main groups of medications and key features of their Alzheimer’s patients. In order to the improve quality of care, destination were considered. The stages of pathogenetic ther- systematic efforts to increase clinicians’ awareness and apy, the most commonly occurring drug interactions and side reporting all adverse events with CHEIs use should become effects were reflected. We summarized the 1658 rheumatic the rule. patients treatment experience in our Institute from a cohort Reference: D. Huvent-Grelle et al, Relation between Pisa of AAS patients. The distribution features of the patients with Syndrome and Cholinesterase inhibitors use for elderly recurrence of articular syndrome in previously verified diag- Alzheimer’s disease patients, JAGS 2014;62:2450 nosis and newly diagnosed disease requiring clarification of nosological forms were presented. Conclusion: Successful experience of creation and con- P110 firmed the effectiveness of the system of providing medical VERTEBRAL FRAGILITY FRACTURES: FREQUENCY care for AAS patients allow us to recommend its widespread OF LOCALIZATION introduction. K. Ampatzidis1,D.Ampatzidi2,F.Palermo3,F.Finocchiaro3, E. Tigano4, R. Sorace1 1Geriatrics Section - University of Catania - A.O. Cannizzaro, P109 Catania, Italy, 2Society of Psychosocial Research and RELATION BETWEEN CHOLINESTERASE Intervention (SPRI – EPSEP in Greek), Ioannina, Greece, INHIBITORS USE AND PISA SYNDROME 3University of Catania, Catania, Italy, 4Interpreter and transla- D. Huvent-Grelle1,S.Demarle2, E. Boulanger1,F.Puisieux1 tor of English, Catania, Italy 1CHRU Lille/ Pôle De Gerontologie, Lille, France, 2La Vie Active, Rue Beffara, Arras, France Vertebral deformities represent the most frequent and feared complication of osteoporosis together with the femur fracture Background: Few cases of Pisa syndrome (PS) or they are associated to an increase of the morbidity, disability pleurothotonus have been reported in the literature. This syn- and of mortality. The evaluation of such deformities is assign drome is an acquired, persistent truncal dystonia which appears from many years to the Genant semiquantitative method to be potentially reversible. It is characterized by an involuntary which establishes three degrees of reduction of vertebral side flexion (on the right hand side or on the left) of the body height. Nowadays such deformities unfortunately are not al- and head and associated with a backward axial rotation, so that ways accurately described in the radiological report and so the the person seems to be leaning like the leaning tower of Pisa. patients delay the therapeutical approach. The aim of our There are two types of dystonia. Some patients develop clinical study is to evaluate the prevalence of vertebral fractures from features of acute dystonia whereas others develop delayed dys- fragility in relation to the age, the sex and the eventual corre- tonia. Patients are not aware of their dystonia. This syndrome lation of the mentioned fractures with the densitometric and was first described as a rare side effect of long–term classic BMI value in a 1062 subjects (average age 67.72 years old neuroleptics medications. Pisa syndrome reported after ±10.62 SD), 987 of them females and 75 males, which have Cholinesterase Inhibitors (CHEIs) use is uncommon. arrived for the first time to our observation and have not been Methods: We describe 27 patients worldwide with probable put under therapy for osteoporosis. From the data obtained by AD who presented PS with CHEIs use including 10 cases in our sample it is clear that are meanly interested vertebra T7, France. Then we analysed the differences and the similarities T8, T11 and T12. In the males the vertebra more frequently between our findings and others, reported in fifteen articles interested of fracture results to be the T5 while in the females (PubMed). Measurements and results: Description of individ- the T7. With the coming of age the most interested vertebra ualcasenarrativesofPSpatientsonCHEIs during a period of are the T11 and T12. The presents of osteoporosis at femur thirteen years. PS is now attributed to a rare side effect of the neck level is correlated with a major probability of vertebral three CHEIs medications available (donepezil, rivastigmine fracture at T10, T11, T12, L1, L2 and L3, while the presents of and galantamine) whatever the dosage or the pharmaceutical osteoporosis at ward level is correlated in a significantly way form used (oral or transdermal form). with a major prevalence of vertebra fractures at T4, T6, T10, S132 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
T11, T12, L1, L2, L3 and L4. Obesity at general has a nega- P113 tive influence over the health of the spine and in particular the PHILOS PLATE IN THE TREATMENT OF OSTEO- obesity of 1st degree in a significantly way in the deformation POROTIC PROXIMAL HUMERUS FRACTURE of the T11 and T12. At the moment we can affirm that the J. Lopezsubias1, M. Lilloadan2, N. Perezjimeno2,A. osteoporosis is underdiagnosed and undertreated and so it re- Aguilarezquerra2 mains the real obstacle to pass in order to reduce the sanitary 1Miguel Servet University Hospital, Zaragoza, Spain, cost and, most important, to protect the health of the skeleton. 2Department of Orthopaedic Surgery. H. U. Miguel Servet, Zaragoza, Spain
P111 Introduction: The “Philos plate” is an alternative for the treat- EFFECTS OF A 24 MONTHS TREATMENT WITH ment of osteoporotic proximal humerus fractures. Proximal DENOSUMAB IN A GROUP OF PEOPLE SUFFERING humerus fracture is the third most common osteoporotic frac- FROM OSTEOPOROSIS: OUR EXPERIENCE ture in our area. 70% of cases affect women with osteoporosis. K. Ampatzidis1,D.Ampatzidi2,F.Palermo3,F.Finocchiaro3, Objective: To evaluate clinical and radiographic short- E. Tigano4, R. Sorace1 medium term results of the Philos plate, in the treatment of 1Geriatrics Section - University of Catania - A.O. Cannizzaro, osteoporotic proximal humerus fracture in 3 and 4 fragments. Catania, Italy, 2Society of Psychosocial Research and Materials and Methods: A retrospective study was per- Intervention (SPRI – EPSEP in Greek), Ioannina, Greece, formed in our hospital, on 44 patients undergoing Philos 3University of Catania, Catania, Italy, 4Interpreter and transla- plate from 2010-2012. The indications for surgical inter- tor of English, Catania, Italy vention were osteoporotic proximal humerus fracture in 3 and 4 fragments. Patient-oriented outcomes were obtain- Osteoporosis is a systemic disease of the skeleton charac- ed using the Constant Score postoperatively at 3, 6, 12, terized by a reduced bone mass and by an alteration of the 24 months. In addition, functional ranges of motion were bone micro architecture, both factors are determinant of measured in forward elevation and internal and external an increase of the fracture risk. The fractures constitute rotation. Preoperative and postoperative Visual Analog the most relevant clinical event and they affect with much Scale (VAS) were recorded. frequency the wrist, vertebra and femur. The aim of our Results: The mean patient age was 78,6 years (range, 51-85 study has been that of evaluating the effects of denosumab years). The mean follow-up was 4,3 years (range, 6 months- 6 on 148 patients affected by osteoporosis. The subjects years). 85% of the patients were women. 59% were right enrolled on this study have been examined with DXA shoulders and 41% left shoulders. The average preoperative L1-L4 and femur districts, calculation of the fracture risk pain score was 7, with a range from 5 to 9. Preoperative through FRAX algorithm and questionnaires to evaluate Constant score averaged 21,9, with a range from 16 to 29. the occurring of fractures at the beginning of the treatment Postoperatively, all scores improved with a mean pain score (t0) and after 24 months of therapy (t1). To compare the noted at 1, range 0 to 6; mean Constant 40,5, with a range 23 results registered before and after 24 months of treatment to 55; Mean Abduction was 70, forward elevation was 80 have been used chi square and the Wilcoxon signed rank degrees, external rotation of 41 degrees. Internal rotation 43 test. After 24 months of therapy with denosumab the pa- degrees. 25 patients were satisfied with the functional results tients have shown a significant recovery of mineral bone of surgery while 13 were somewhat dissatisfied and 6 were density on the spine (p<0.001) and on the femur dissatisfied. The overall incidence of complications was 12 (p<0.001) in terms of t-score, z-score and BMD with a cases, 2 cases of infection, 4 cases of avascular necrosis, 6 considerable reduction of the fractures risk of the hip cases of non-union. (p<0.01) through the calculation of the FRAX algorithm, Conclusions: Philos plate is a therapeutic option for the treat- while such calculation regarding the reduction of the frac- ment of proximal humerus fracture, providing good pain re- ture risk apart from the hip fracture, even though there lief, but their long-term functional results are not entirely sat- was a positive trend it did not reach a significant statisti- isfactory than expected, design improvements are necessary in cal difference (p=0.076). From the date obtained by our order to achieve better results. experience, we can see that the drug used resulted in great relevance effects over patients affected by osteoporosis and in general it was well tolerated and produced a sig- P114 nificant improvement of the adherence levels. In this way THE NCB (NON-CONTACT BRIDGING) PERIPROS- from what we have studied we can affirm that denosumab THETIC FEMUR SYSTEM FOR THE TREATMENT drug represents an important progress on the osteoporosis OF OSTEOPOROTIC PERIPROTESIC treatment. M. Lillo1,J.Lopezsubias1,N.Perezjimeno2 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S133
1Miguel Servet University Hospital, Zaragoza, Spain, Orthopaedic Surgery / Medical University of Vienna, 2Department of Orthopaedic Surgery. H. U. Miguel Servet, Vienna, Austria Zaragoza, Spain Aims: Subchondral bone changes seem to contribute to the progression of knee osteoarthritis (OA). This study Introduction and Objectives: Despite the success of total hip aimed to analyse subchondral bone microstructure in prosthesis is inevitable in many cases the appearance intra- specimens of late-stage knee OA in respect to articular and postoperative complications. These complications in- cartilage damage, meniscus integrity and knee joint clude: vascular lesions, peripheral nerve injuries, osteoporotic alignment. periprosthetic fractures and leg discrepancy. Osteoporotic Methods: 30 proximal tibiae of 30 patients (20 female and periprosthetic fracture after a total hip arthroplasty is a com- 10 male) with late-stage OA that were retrieved during mon complication due to the increase in hip replacements and total knee arthroplasty (TKA) were scanned using a the advanced age of the population. Is more common in wom- high-resolution Micro-Computed Tomography (μCT). en with bone comorbidities (osteolysis, osteoporosis) and met- The scans were semi-automatically segmented into five abolic diseases (rheumatoid arthritis, corticosteroids, Paget...), regions of interest (ROIs). The ROIs were than further after a low-energy trauma or even without it. For the classifi- analysed using a commercially available software. The cation of these fractures is used the Vancouver classification, degree of articular cartilage damage was assessed semi- which divides them into types A, B and C. quantitatively by magnetic resonance imaging (MRI) be- Material and Methods: A retrospective study was per- fore surgery. formed at the HUMS on 20 patients undergoing. The Results: The mean bone fraction volume in the medial NCB plate system plate for the treatment osteoporotic compartment was significantly higher compared to the periprosthetic hip fractures, from 2014 to 2015. We ana- mean bone fraction volume in the lateral compartment lyzed the indications and the complications in the use of (62,07±12,53 vs. 52,57±13,33). The differences were sta- this system. tistically significant (p=0,007). The submeniscal mean Results: The mean patient age was 76,3. 16 patients were bone fraction volume in the medial compartment was sta- women. In all cases occurred after fall from their own tistically significantly higher compared to submeniscal height. 12 cases were classified as B1 Vancouver classifi- mean bone fraction volume in the lateral compartment cation, 6 as B2 and 2 as B3. In cases classified as B1 they (56,76±12,8 vs. 47,36±14,97; p=0,015). There was a sig- were treated by open reduction and osteosynthesis with nificantly lower bone fraction volume in the medial the NCB plate system plate. In cases classified as B2 submeniscal subchondral bone compared to the and B3 the NCB plate system plate was associated to subchondral bone fraction volume from the medial tibial the implantation of cemented long stem. The patients plateau compartment (p=0,041). There was a significant were allowed to start walking with partial weight bearing difference in the lateral submeniscal subchondral bone at six weeks after surgery. There were no complications of fraction volume compared to the subchondral bone frac- the surgical wound. At 12 months after surgery in all tion volume from the lateral tibial plateau compartment cases seen radiographic bone healing. 12 patients refer (p=0,024). The bone fraction volume in all weight bearing no subjective sensation of pain and almost rejoined his locations (medial meniscus, medial tibial plateau, lateral normally activities. 8 patients had to limit considerably meniscus, lateral tibial plateau) was significantly higher its activity. compared to the non weight-bearing reference point be- Conclusions: Osteoporotic periprosthetic hip fractures in- low the ACL (p=0,000). In intact menisci, there was a cidence is increasing in our health area. For the preven- significantly lower subchondral bone fraction volume tion of this pathology, it is important to educate doctors compared to subluxated or luxated meniscus in the medial and patients, monitoring and treating osteoporosis, advis- (p=0,020) and lateral compartment (p=0,005). Varus ing the patient regarding risk activities and caring intra- alignment had a significantly higher subchondral bone operative surgical technique. fraction volume in the medial compartment than valgus, whereas valgus alignment had a significantly higher subchondral bone fraction volume in the lateral compart- P115 ment (p=0,011). MICROSTRUCTURAL ANALYSIS OF SUBCHON- Conclusion: The results of this study show significant differ- DRAL BONE IN KNEE OSTEOARTHRITIS ences of subchondral bone microstructural parameters in re- L. A. Holzer1,M.Kraiger2,A.Leithner1, G. Holzer3 spect to cartilage damage, meniscus’ structural integrity and 1Department of Orthopaedic Surgery / Medical University of knee joint alignment. Therefore, subchondral microstructural Graz, Graz, Austria, 2Institute of Medical Engineering / Graz bone changes seem to be a secondary process in the late-stage University of Technology, Graz, Austria, 3Department of OA of knee caused by mechanical changes. S134 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
P116 I. Pérez-Coto1, M. A. Sandoval-García1, A. Sierra-Pereira1,S. HEPCIDIN INHIBITION ON THE EFFECT OF Roncero-Gonzalez1, D. Hernández-Vaquero1 OSTEOGENESIS IN ZEBRAFISH 1Department of Orthopaedic Surgery, Hospital Universitario Y. Jiang1,2,3,Y.Yan4, X. Wang2,3,G.Zhu1, Y.-J. Xu2,3 San Agustin, Avilés, Spain 1Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, China, 2Department Objectives: To study the severity of long-term periprosthetic of Orthopedics, The Second Affiliated Hospital of Soochow bone destruction in Total Hip Replacements (THR), calculate University, Suzhou, China, 3Osteoporosis Diagnosis and the volume of lytic lesions using CT studies and three- Treatment Technology Institute of Soochow University, dimensional reconstruction techniques and compare this Suzhou, China, 4Institute of Neuroscience, University of method with the MRI-based diagnosis. Oregon, Eugene, United States Material and Methods: We selected 15 THR with long- term periprosthetic osteolysis which had been previously Iron overload, as a risk factor for osteoporosis, can result in the studied with X-ray and MRI. We conducted a CT high- up-regulation of Hepcidin,andHepcidin knockout mice display quality study using an artifact reduction software. Based defects in their bone microarchitecture. However, the molecular on it, bone density loss was analyzed and the volume of and genetic mechanisms underlying Hepcidin deficiency- lytic lesions was calculated, using a specific free-access derived bone loss remain unclear. Here, we show that hepcidin medical imaging program. Also, the results were com- knockdown in zebrafish using morpholinos leads to iron over- pared with MRI findings to check the sensitivity and load. Furthermore, a mineralization delay is observed in osteo- specificity of the method. blast cells in hepcidin morphants, and these defects could be Results: Osteolysis was detected in all cases. CT detected partially restored with microinjection of hepcidin mRNA. 27 lesions (1.8 per case) with an average volume of 7.21 Quantitative real-time PCR analyses revealed the osteoblast- cm3 per lesion and 12.98 cm3 per case. Osteolysis affect- specific genes alp, runx2a, runx2b, and sp7 in morphants are ed a total of 35 pelvic areas (2.33 per case). Assuming downregulated. Furthermore, we confirmed qRT-PCR results MRI as gold standard, CT had a sensitivity and specificity by in situ hybridization and found downregulated genes related of 81% and 84% respectively. to osteoblast function in hepcidin morphants. Most importantly, Conclusions: Three-dimensional techniques based on we revealed that hepcidin was capable of removing whole-body CT studies allow us to analyze, in a accurately and repro- iron which facilitated larval recovery from the reductions in ducibly way, the presence and volume of osteolytic bone formation and osteogenesis induced by iron overload. lesions in THR. Such lesions are very prevalent and can Iron overload, as a risk factor for osteoporosis, can result in haveadisturbingvolume.Theadvancedanalysiswehave the up-regulation of Hepcidin,andHepcidin knockout mice performed give us information about the location and display defects in their bone microarchitecture. However, the magnitude of the lysis and helps us to plan the proper molecular and genetic mechanisms underlying Hepcidin treatment. Thanks to that method, we can know the deficiency-derived bone loss remain unclear. Here, we show amount of bone deficit, the need for biological treatment that hepcidin knockdown in zebrafish using morpholinos leads or the quantity of bone grafting necessary in the operation to iron overload. Furthermore, a mineralization delay is ob- room. served in osteoblast cells in hepcidin morphants, and these de- fects could be partially restored with microinjection of hepcidin mRNA. Quantitative real-time PCR analyses revealed the osteoblast-specific genes alp, runx2a, runx2b, and sp7 in morphants are downregulated. Furthermore, we confirmed qRT-PCR results by insituhybridization and found down- regulated genes related to osteoblast function in hepcidin morphants. Most importantly, we revealed that hepcidin was capable of removing whole-body iron which facilitated larval recovery from the reductions in bone formation and osteogen- esisinducedbyironoverload.
P117 THREE-DIMENSIONAL CT-BASED STUDY OF THE VOLUME OF BONE DESTRUCTION IN LONG- TERM TOTAL HIP ARTHROPLASTIES Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S135
P118 Background: In some previous studies, subjects with PREVALENCE OF UPPER GASTROINTESTINAL metabolic syndrome were more likely to have osteopo- BLEEDING RISK FACTORS IN THE OSTEOAR- rosis. Also, osteoporotic fractures were more frequent in THRITIS PATIENTS patients with metabolic syndrome. Since non-alcoholic S. H. Kim1,J.M.Yun1,D.W.Shin1 fatty liver disease (NAFLD) is considered as the hepatic 1Department of Family Medicine, Seoul National University manifestation of the metabolic syndrome, we performed Hospital, Seoul, Republic of Korea this study to assess the association between the presence of hepatic steatosis and subsequent decline of BMD. Background: As upper gastrointestinal bleeding (UGIB) is a Methods: We conducted a study of 2637 Korean people high-risk condition with high morbidity and mortality, the (mean age, 54.8±8.3; no. of men=427), who had under- increasing trend of NSAIDS-induced UGIB has led to re- gone health checkup in a 3rd degree hospital at least twice search focusing on arthritis patients, who are potential long- from 2006 to 2013. The baseline hepatic steatosis was term consumers of these predisposing drugs. We aimed to evaluated with ultrasonography. The decline of mineral assess the prevalence of possible risk factors of UGIB and density was defined as the difference between baseline their age-group specific trend among osteoarthritis patients and subsequent BMD, divided by the time interval. We and general population. performed multivariate regression by gender adjusting Methods: We utilized data from the National Health baseline characteristics including age, BMD, bone mineral Insurance Service that included claims data and results of density, waist circumflex. the national health check-up program. Comorbid conditions Results: The mean decline per year was 0.004±0.023 with (peptic ulcer, diabetes, liver disease, and chronic renal failure), hepatic steatosis and -0.001±0.022 without steatosis. In mul- concomitant drugs (aspirin, clopidogrel, cilostazol, NSAIDs, tivariate regression, the presence of hepatic steatosis assessed steroid, anticoagulants, and SSRI), personal habits (smoking, by ultrasonography was not associated significantly with alcohol consumption, and sedentary lifestyle) and BMD change in both men and women. In men, the p-values Helicobacter pylori infection were considered as possible were 0.57 for L1, 0.56 for L2, 0.38 for L3, 0.57 for L4 and UGIB risk factors. 0.95 for mean BMD for L-spine, respectively. In women, the Results: A total of 93,855 osteoarthritis patients out of p-values were 0.74 for L1, 0.64 for L2, 0.91 for L3, 0.18 for 801,926 general population aged 20 and above were included. L4 and 0.49 for mean BMD for L-spine, respectively. The prevalence of individual and concurrent multiple risk fac- Conclusion: There was no significant association between the tors became higher as the age increased. The prevalence of presence of hepatic steatosis and BMD change. Although pre- each comorbid condition and concomitant drug were higher in vious study in Korea indicated significant association between osteoarthritis patients than the general population. 60.98% of NAFLD and low bone mass, the result was obtained from osteoarthritis patients and 27.84% of the general population analysis without considering waist circumflex. Further well had at least one or more risk factors of UGIB. The prevalence designed studies are essential for clarifying the association of individual and concurrent multiple risk factors in younger between NAFLD and low BMD. age groups were also substantial. Furthermore, when personal habits and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in P120 younger age groups. AN AUDIT OF TREATMENT FOLLOWING A LOW Conclusion: The prevalence of various UGIB risk factors was TRAUMA WRIST FRACTURE PRESENTING TO higher in osteoarthritis patients. Physicians who care the osteo- THE ACCIDENT AND EMERGENCY DEPARTMENT arthritis patients should consider individualized risk assessment ATA PRIVATE HOSPITAL IN MALAYSIA FROM 2011 regardless of age when prescribing drugs that predisposes to TO 2015 UGIB. Additionally, subjects with high risk should control S. S. Yeap1, M. A. Nur-Syabeela2, V. Thirunavukkarasu2,S. modifiable UGIB risk factors such as H. pylori infection. Thambiah2, S. Intan-Nureslyna2,Z.S.Siti-Yazmin2,P. Balan1,F.L.Hew1,S.P.Chan1 1Subang Jaya Medical Centre, Subang Jaya, Malaysia, P119 2Faculty of Medicine and Health Sciences, University Putra THE ASSOCIATION BETWEEN THE PRESENCE OF Malaysia, Selangor, Malaysia HEPATIC STEATOSIS AND DECLINE OF BONE MINERAL DENSITY Objective: To look at whether there was a treatment gap in J. M. Yun1,S.H.Kim1,D.W.Shin1 patients with low trauma wrist fractures presenting to an 1Department of Family Medicine, Seoul National University Accident and Emergency Department (AandED) at a tertiary Hospital, Seoul, Republic of Korea private hospital in Malaysia. S136 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Material and Methods: The records of patients over the age Objective: We aimed to compare volumetric BMD (vBMD) of 50 attending AandED from 2011-2015 with a diagnosis of and cortical bone geometry in patients with EDS hypermobil- Colles’/wrist fracture were obtained. Information was extract- ity type (EDS-HT) and age- and sex-matched controls. ed for those with a low trauma fracture. Data was analysed Material and Methods: 42 female EDS-HT patients (mean using IBM SPSS Statistics version 22.0 for Windows. age 40.0±10.8 years) and 42 controls were included in a cross- Results: 191 patients presented with a wrist fracture for sectional study. vBMD and bone geometry at the tibia (4% the years 2011-2015. 58 of these were due to accidents, and 66% region) as well as lower leg muscle cross-sectional which left 133 (69.9%) low trauma wrist fractures for area (CSA, 66% region) were measured using pQCT. analysis. The median age of the patients was 58 years Results: Although EDS-HT patients did not differ from con- (IQR 14). 86 (64.7%) were female, 89 (66.9%) were trols with regard to trabecular or cortical vBMD, they present- Chinese. 5 patients had a previous low trauma fracture, ed with about 6.3% smaller trabecular bone area (p=0.014), but only 2 had treatment. Following the low trauma wrist 8.9% smaller cortical bone area (p=0.005), 6.6% smaller cor- fracture, only 16/133 (12.0%) were given treatment. Of tical thickness (p=0.021), and albeit non-significant, 2.9% those given treatment, 6/16 (37.5%) were given calcium/ smaller periosteal circumference (p=0.101). As a result, vitamin D/activated vitamin D only and 10/16 (62.5%) strength-strain index was 9.8% lower in EDS-HT patients as were given active osteoporotic treatment. For those given compared to controls (p=0.039). Furthermore, EDS-HT was treatment, the median duration of prescribed treatment associated with a 10.8% decreased muscle CSA (p=0.004) was 1 month. There was no significant difference in de- without differences in muscle density. Bone/muscle CSA ratio mographic factors, medical history or osteoporosis risk was within the normal range and did not differ between factors between wrist fracture patients who were treated groups. and not treated with osteoporosis medication. Conclusions: EDS-HT patients present with both a trabecular Conclusions: Currently, treatment for osteoporosis following and cortical tibial bone size deficit as compared to controls, low trauma wrist fractures in Malaysia is inadequate with only which might contribute to their increased fracture risk. As 12% receiving some treatment, and in those who are treated, indicated by the decreased muscle CSA and normal the median duration of treatment was only 1 month. bone/muscle CSA ratio, this bone size deficit is probably sec- ondary to decreased mechanical loading in these patients with known muscle dysfunction. P121 SECONDARY BONE SIZE DEFICIT IN PATIENTS WITH EHLERS-DANLOS SYNDROME P122 C. Verroken1,P.Calders2, I. De Wandele2,F.Malfait3,H.-G. WHY A SIX-WEEK COURSE OF PHYSIOTHERAPY Zmierczak1,S.Goemaere1, J.-M. Kaufman1,B.Lapauw1,L. ON PATELLOFEMORAL PAIN SYNDROME HAS A Rombaut4 SIGNIFICANT EFFECT ON PAIN AND FUNCTION 1Unit for Osteoporosis and Metabolic Bone Diseases, BUT NOT ON STRENGTH AND FLEXIBILITY? A Department of Endocrinology, Ghent University Hospital, FOCUS GROUP STUDY Ghent, Belgium, 2Department of Rehabilitation Sciences and K. P. Papadopoulos1 Physiotherapy, Ghent University-Artevelde University 1Allied and Public Health, Anglia Ruskin University, College, Ghent, Belgium, 3Centre for Medical Genetics, Chelmsford, United Kingdom Ghent University Hospital, Ghent, Belgium, 4Department of Rehabilitation Sciences and Physiotherapy, Ghent University- Objectives: The purpose of this focus group study was to estab- Artevelde University College and Centre for Medical lish North-West Wales (NWW) physiotherapy treatment of Genetics, Ghent University Hospital, Ghent, Belgium Patellofemoral Pain Syndrome and report the barriers that stopped physiotherapists from increasing strength and flexibility and the Background: Ehlers-Danlos syndrome (EDS) comprises a contradictions of physiotherapists’beliefs regarding their practice. group of inherited connective tissue disorders, caused by var- Methods: The investigation was based on specific and priori ious defects in the biosynthesis or secretion of fibrillar colla- designed questions. Two focus groups were conducted, where gens. As collagen represents a major constituent of the bone physiotherapists discussed the results of a feasibility study matrix as well as of tendons and muscle, bone strength in EDS conducted in their department which showed that physiother- patients might be impaired both via direct and indirect path- apy treatment had a significant effect on pain and function but ways. Although decreased muscle strength, decreased areal not on strength and flexibility. The Ritchie and Spencer (1994) bone mineral density (BMD) and increased fracture risk have method of qualitative data analysis was selected because This been reported, no studies have investigated volumetric bone framework analysis is particularly appropriate when a study parameters in these patients. has clear aims at the outset. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S137
Results: 11 hypotheses were discussed whist 13 evidence state- Table 1. Clinical form of osteoporosis in male population. ments were reported by the merger of the answers to the hypoth- eses. A level of consensus was described using the moderator’s notes. Patellofemoral Pain Syndrome physiotherapy works; not through strength and flexibility but through pain and function improvement. According to the physiotherapists, the main reason for not achieving strength and flexibility improvement was there was not enough time to physically increase those components. In addition, the available literature is based on athletic patients with PFPS, while patients who are referred in the NHS clinic of NWW All patients received antiosteoporotic treatment denosumab district hospital are largely non-athletic. These patients do not subcutaneous injection once in every 6 months, with calcium comply with the prescribed exercises, thus, physiotherapists only supplement - 1500mg elemental calcium and Vit D 800 IU. prescribe simple and functional exercises. These exercises im- DXA was used for the evaluation efficacy of treatment once prove pain and function however, this practice often only has a yearly in 3 years. BMD basic values are shown in Table 2. short-term effect and most of those patients have to return after a Table 2. BMD value assessed in different clinical manifesta- few months for more physiotherapy. tions of OP (M±). Conclusions: The specific exercises for patients with Patellofemoral Pain are not effective because they are not used by NWW physiotherapists. Group classes and better educa- tion on the importance of specific exercises and self-managing should be researched whilst the long-term effect of these treat- ment components should also be assessed. Acknowledgements: The author would like to thank RCBC Wales for funding this study Reference: Ritchie, J. and Spencer, L. (1994). Qualitative data Results: analysis for applied policy research. Analysing Qualitative 1. The research has shown that male osteoporosis is most Data. London, UK: Routledge. prevalent in population with coronal arteriosclerosis that pos- sibly corresponds with recent hypothesis of simultaneous oc- currence of the pathological mechanisms - atherosclerosis and P123 osteoporosis. MALE OSTEOPOROSIS: CLINICAL HIGHLIGHT, 2. Based on results of our study, denosumab has the best safety REMARKEBLE DETAILS index among other antiosteoporotic agents. therapy with L.-K. Kilasonia1,L.Lagvilava1,T.Rukhadze1,S.Zeikidze1, denosumab showed no side effects or complications. N. Kirvalidze1, M.-K. Kopaliani2 3. The lowest BMD values and highest T-score deviations 1Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia, 2Tbilisi were observed in males with atherosclerosis (p<0,001). State University, Tbilisi, Georgia 4. Therapeutic efficacy of denosumab in males with osteopo- rosis have exceeded 80%. Introduction: Two decades ago osteoporosis had gender dis- 5. Based on 3-year experience of using denosumab, male pop- tinction. It was considered as a women’s disease. Now borders ulation showed better results on denosumab compared to bis- of a gender, set previously, are diminishing, pointing to the phosphonate treatment. As denosumab mechanism is related newly emerged medical direction called male osteoporosis. to particular pharmacological target, its efficacy can be ex- Year of 2014 is announced as the year of male osteoporosis plained with a speculation that males accumulate more by IOF. There are many unanswered questions though: What BMD in comparison to women and lesser bone is lost in are the risk factors of male osteoporosis? How the principles men than in women population . of basic therapy are chosen? 6. The pursuit of pharmacologic agent against male osteopo- Objectives: To evaluate BMD in osteoporotic Georgian male rosis is still in progress. population and analyse antiosteoporotic treatment outcome Materials and Methods: Since 2007, 970 Georgian male with diagnosis of OP are under regular medical supervision. P124 Age groups are as follows: 279 men under 45 years, 460 men PTH CHANGE OVER TIME AND MORTALITY: A 46-60 years, 191 men 79 years and above. The diagnosis of LONGITUDINAL STUDY OF ELDERLY WOMEN osteoporosis was made by T-Scores using DXA method on D. Buchebner1,L.Malmgren2,A.Christensson3,F.E. Hologic 1000 System. McGuigan2,P.Gerdhem4, M. Ridderstråle5,K.Akesson2 S138 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
1Department of Internal Medicine, Division of Endocrinology, AMONG KOREAN ADULTS AGED 50 YEARS OR Hallands Hospital Halmstad, Halmstad, Sweden, 2Clinical and MORE Molecular Osteoporosis Research Unit, Dept. of Clinical E.-Y. Choi1 Sciences Malmo, Lund University, Malmo, Sweden, 3Internal 1Family Medicine, School of Medicine, Dankook University, Medicine Research Unit, Dept. of Clinical Sciences Malmo, Cheonan City, Republic of Korea Lund University, Malmo, Sweden, 4Department of Orthopedics and Biotechnology, Karolinska Institute, Solna, Background: Discordance between knee pain and radiologic Sweden, 5Department of Endocrinology, Clinical Obesity osteoarthritis is well known. This study was to investigate factors Research, Skåne University Hospital, Malmo, Sweden associated with knee pain with different grades of knee osteoar- thritis among Korean adults aged 50 years or more. Objective: Age-related increases in PTH have been reported Methods: Total 5,978 Korean aged 50 years or more who previously but whether these changes are associated with neg- underwent the radiographs of the knees were analyzed from ative health-outcomes has not been satisfactorily investigated Korean National Nutrition and Health Examination Survey con- in elderly women. In this study, we describe the change in ducted in 2010-11. Radiographs of the knees were scored for PTH over time and its association to mortality in 75-year-old osteoarthritis using the Kellgren-Lawrence scale. Multivariate women (OPRA cohort). logistic regression analysis adjusting for sociodemographic fac- Material and Methods: 1044 women aged 75 attended at tors, lifestyle factors, comorbidity and health status was used baseline and were followed for up to 15 years with reassess- for analysis. ment at ages 80 (n=715) and 85 (n=382). Data on PTH, Results: The prevalence of knee pain was higher in female 25OHD, calcium, phosphate and kidney function (eGFR) compared to that of male (P<0.001), and increased as increasing was collected. The presented analyses use 646 women who severity of radiologic knee osteoarthritis. Female was associated attended both investigations at ages 75y and 80y. with increased risk of knee pain in all of Kellgren-Lawrence Comorbidities were only available at age 80. The relationship degrees. In most of Kellgren-Lawrence degrees, depression between PTH and mortality over 15 years was investigated was associated with increased risk of knee pain, and those with using Cox proportional hazards models. high school diploma or higher were associated with decreased Results: Between ages 75 and 85, half of the women had stable risk of knee pain. A few factors (age, body mass index, and no or decreased PTH levels (51%; n=169). Amongst those whose alcohol drinking) were also associated with increased risk of knee PTH increased (n=164), the majority (64%; n=105) remained pain for particular grades of radiographic knee osteoarthritis. within normal range despite increases of up to 50% above base- Conclusions: Knee pain increased as increasing severity of line values. These women had lower 25OHD (74 vs. 83, radiologic knee osteoarthritis. Although there were differences p=0.001) compared to women with normal levels. eGFR, phos- of risk factors associated with knee pain with different grades of phate and calcium were unchanged. Increases of more than 50% knee osteoarthritis, female, depression were associated with in- (36%; n=59) resulted in PTH levels above normal range (mean creased of knee pain, and those with high school diploma or 9.5±6.0 pmol/L) leading to a pronounced decline in eGFR (42 higher were associated with decreased risk of knee pain in most ±12 vs. 54±14 mL/min/1.73m2, p<0.001) compared to women of Kellgren-Lawrence degrees. with up to 50% PTH increases. 25OHD, phosphate, calcium and BMI remained more or less unaltered. At age 75, elevated PTH was associated with greater risk of dying (HR=1.4 [1.1-1.8], P126 p=0.007) over a 15-year-period. The association was attenuated DEMYELINATING DISEASES AFTER ANTITNF however when adjusted for eGFR, 25OHD, smoking and phos- TREATMENT IN RHEUMATIC DISEASES: OUR phate (p=0.082). CLINICAL EXPERIENCE ABOUT THIS RARE SIDE Conclusion: The majority of women maintained normal PTH EFFECT levels over 10 years and even increases up to 50% still resulted M. Novella-Navarro1,M.Muñoz-Gómez1, M. Pavo-Blanco1, in PTH levels within the normal range. Elevated PTH was not A. Rodríguez- Verdú1, J. Salvatierra1 independently associated with mortality but rather reflects im- 1Rheumatology, Complejo Hospitalario Universitario de paired health as indicated by lower 25OHD and eGFR. Granada, Granada, Spain Outcome in a patient presenting with elevated PTH is closely related to vitamin D status, kidney function and comorbidities. Background: The onset of demyelinating diseases due to antiTNFα therapy in rheumatic diseases is an uncommon side effect. Currently, the evidence-based data are available from P125 case reports or case series which try to understand the possible FACTORS ASSOCIATED WITH KNEE PAIN WITH cause-effect association. According to “BIOBADASER” DIFFERENT GRADES OF KNEE OSTEOARTHRITIS (Spanish Register of Adverse Events of Biologic Therapy in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S139
Rheumatic Diseases), the incidence of demyelinating diseases 1Master of Healthcare Delivery/ Eastern Virginia Medical in Spain is 0.05 cases 1000 person-year with antiTNFα (stud- School, Norfolk, United States, 2Center for Health Analytics ies performed with etanercept, adalimumab, infliximab) com- and Discovery/ Eastern Virginia Medical School, Norfolk, pared to 0.02-0.04 in general population. We report our clin- United States ical experience about four clinical cases. Patients and Methods: We expose four patients whom Objective: We examined the agreement between self-reported developed neurologic symptoms compatible with demye- osteoporosis and bone mineral density (BMD) results through linating disease over the course of a year with antiTNFα dual-energy x-ray absorptiometry (DXA) using data from a therapy. national representative sample taken from the U.S. communities. Methods: Six-year data from the continuous National Health and Nutrition Examination Survey (NHANES) 2005-2006, 2007-2008, and 2009-2010 were merged. Participants includ- ed adults 50 years of age or older whose data appeared in both questionnaire and medical examination data files. Self- reported osteoporosis was defined by an affirmative response to a question in the osteoporosis questionnaire then compared with BMD-defined osteoporosis, defined by BMD values tak- en from the examination data. Results: Agreement between self-reported osteoporosis and DXA results were low. Kappa was only 0.24 (95%CI=0.21- 0.27), and sensitivity and positive predictive value were Results: The three patients who developed peripheral nervous 28.0% and 40.8%, respectively. When stratified by gender or system affectation, responded successfully to medication age group, agreement remained poor. withdrawal, regarding to the improvement of neurologic fea- Conclusion: Self-report of osteoporosis would not be suitable tures, even clinical remission. Although a switch of the thera- for accurate prevalence estimates for osteoporosis regardless peutic target was necessary in order to manage the baseline of gender or age group. inflammatory disease. On the other hand, the patient who suffered from central nervous system disease did not improve after antiTNF discontinuation, so to stablish a specific treat- P128 ment was required. In all the four cases studied, we observed HEALTH BENEFITS AND CONSEQUENCES OF THE that neurologic features were developed due to monoclonal EASTERN ORTHODOX FASTING IN MONKS OF antibodies, not to soluble TNF receptor. MOUNT ATHOS: A CROSS-SECTIONAL STUDY Discussion: So far, the association between demyelinating S. Karras1, A. Persynaki2, A. Petróczi3,E.Barkans3,H. diseases onset and antiTNFα therapy remains unclear. It is Mulrooney3, M. Kypraiou1,T.Tzotzas4, K. Tziomalos5,K. still unknown if these drugs are able to cause these patholo- Kotsa1, A. Tsioudas6, C. Pichard2,D.Naughton3 gies, reveal a previous unidentified latent disease or converse- 1Division of Endocrinology and Metabolism, First ly, there is not any causal link. However, in most cases, an Department of Internal Medicine, Medical School, Aristotle improvement in neurologic symptoms and signs is detected University of Thessaloniki, AHEPA Hospital, Thessaloniki, once the drug is removed. This fact, prompt us to consider that Greece, 2Nutrition Unit, Geneva University Hospital, a cause-effect relationship is plausible. In view of the above, Geneva, Switzerland, 3School of Life Sciences Pharmacy some recommendations should be made: it is mandatory to and Chemistry, Kingston University, London, United discontinue the antiTNFα treatment if any neurologic symp- Kingdom, 4St. Luke's Hospital Panorama, Thessaloniki, toms or signs appear and, the use of these drugs must be Greece, 5First Propeudeutic Department of Internal avoided in patients (and first-degree relatives) with medical Medicine, Medical School, Aristotle University of history of demyelinating disease. Thessaloniki, AHEPA Hospital, Thessaloniki, Greece, 6Laboratory of Clinical Nutrition, Department of Nutrition and Dietetics, Alexandrian Technological Educational P127 Institute, Thessaloniki, Greece FACTORS ASSOCIATED WITH THE ACCURACY OF SELF-REPORTED OSTEOPOROSIS IN THE Objectives: Greek Orthodox fasting (OF) is a diet dictated by COMMUNITY the Orthodox religion and involves 180-200 days of fasting T. Cunningham1,S.DeShields2 per year. The aim of this cross-sectional study was to examine, S140 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 for the first time, the characteristics and effects of anthropom- D, glycemic control and the onset of osteoporosis and/or etry, cardio-metabolic markers and calcium homeostasis as it bone fractures predisposition in T1DM and T2DM is practiced by Athonian monks (AM). patients. Materials and Methods: Body composition (bioelectrical Methods: The sample consists of 1151 patients (350 men impedance analysis) and levels of occupational physical ac- and 799 women) divided into three groups: 400 patients tivity (light, moderate, intense) were evaluated in 70 monks with T1DM of which 19 with osteoporosis (age 42,39 (age: 38.8±9.7 years). Energy intake was measured for two ±13.66 yo; BMI 23,88±3,28), 401 patients with T2DM separate days of Athonian fasting: a non-restrictive day of which 64 with osteoporosis (age 62.01±13.21 yo; (NRD) during a weekend of Nativity Fast, and a restrictive BMI 30,25±8,83), 350 non-diabetic patients with osteopo- day (RD) weekday during Great Lent. For a subsample of the rosis (NDP) (age 64.59±10.45 yo; BMI 25,64±4,17). In cohort (50 monks, age=38.7±10.6 years) biochemical blood all subjects nutritional status, anthropometric, metabolic analyses were conducted. and glycemic control parameters, BMD (as T-score) at Results: The daily energy intake of the 70 AM was very low the lumbar spine (LS-BMD), femoral neck (FN-BMD) during both RD and NRD (1265.9±84.5 vs. 1660±81 kcal, and total femur (Ftot-BMD) were measured. Prevalence p<.001). A statistically significant difference between energy of bone fracture between the different groups were intakes in RD and NRD was observed: carbohydrates (159.6 determined. ±21.8 vs. 294.3±23.4 g, p<.0001) and saturated fat (12.7±0.0 Results: Low vitamin D levels were found in both T1DM vs. 16.4±0.0 g, p<.0001) were lower, whereas protein (89.2 (16.38±2.74 ng/mL) and T2DM (15.04±9.35 ng/mL) as ±1.3 vs. 72.35±1.3 g, p<.0001) was higher during RD. Body well as low daily calcium intake (634.84±159.97 mg/day weight (74.3±12.9 kg) and body mass index (23.8±4.1 kg/m2) and 649.43±189.86 mg/day, respectively). About 89% of of the cohort were independent of age and level of physical T1DM and 37,5% of T2DM had T-score≥-2,5; T1DM had activity. An optimal profile for lipid and glucose parameters also a FN-BMD (T-score: -2.373±0.68 vs. -1.91±0.72; (total cholesterol: 183.4±41.7 mg/dl, LDL: 120.6±37.6 mg/dl, p=0.016) and Ftot-BMD (T-score: -2.368±0.79 vs. -1.60 triglycerides: 72.2±31.3 mg/dl, HDL: 48.5±14.2 mg/dl, ±0.96; p=0.003) significantly lower than T2DM and a LS- fasting glucose 84.4±10.1 mg/dl and HOMA-IR 1.02±0.40) BMD significantly lower compared to NDP (T-score: - was found. Profound hypovitaminosis D (8.8±6.2 ng/ml), 2.26±0.79 vs. -2.91±0.86). Instead, T2DM had a LS- high PTH: 115.5±48.0 pg/ml with normal serum calcium BMD, FN-BMD and Ftot-BMD significantly higher than levels (8.9±3.2 mg/dl) was observed. those of NDP (p=0.0001, p=0.004, p=0.007). We did not Conclusions: Unaffected by variation in lifestyle factors, the found a positive correlation between BMD and HBA1c. results of this unique study offers clear evidence for health 1% of TIDM, 3.2% of T2DM and 14.8% of NDP had benefits of the strict Athonian fasting through optimal lipid vertebral fractures; 22.7%, 9.2% and 14% had non- and glucose homeostasis. In the context of a health-promoting vertebral fractures. T2DM had 38% reduction in risk of diet among the general population, further evaluation of ad- non-vertebral fractures (OR 0.62, 95% CI=0.39-0.98) vantages and disadvantages of this highly restrictive variant of compared with controls; instead, T1DM had an increased Mediterranean diet is warranted. risk of non-vertebral fractures (OR 1.81, 95% CI 1.24- Acknowledgements: The authors thank the “Holy 2.66). Supervision Council” and monks at Mount Athos for their Conclusions: We confirm that T1D had an increased risk of participation. fractures. Calcium intake and vitamin D resulted insufficient in all groups. HBA1c did not affect BMD or risk of fractures in all groups. P129 CORRELATION BETWEEN BONE AND GLUCIDE METABOLISM DEPENDING ON THE NUTRITIONAL P130 STATUS IN DIABETIC PATIENTS TREATMENT OF OSTEOPOROSIS BY IBANDRONATE S. Alfieri1,2 IN PATIENTS WITH RHEUMATOID ARTHRITIS 1Endocrinology Department, Campus Biomedico Rome, L.-K. Kilasonia1,L.Lagvilava1, S. Zeikidze1,T.Rukhadze1, Italy, 2Endocrinology Department, Policlinico Gemelli, N. Kirvalidze1,M.-K.Kopaliani2 Rome, Italy 1Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia, 2Tbilisi State University, Tbilisi, Georgia Background: Diabetes mellitus and low-trauma fractures are major causes of morbidity and mortality worldwide. Introduction: Scientists often discuss about similarity be- The objective is to evaluate the relationship between nutri- tween the pathogenesis of rheumatoid arthritis and osteoporo- tional status, dairy calcium intake, serum levels of vitamin sis. It was established that factors that show the degree of Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S141 disease (CRP, ESR test) are associated with the degree of first group (n=23) included patients with elevated nicotinamide osteoporosis; moreover, it is discussed as prognostic indicator phosphoribosyltransferase levels (more than 5.9 ng/mL), the of BMD in the course of RA. Can osteoporosis be an immune second group (n=57) consisted of patients with normal visfatin disorder of the bone connective tissue? It was used level (less than 5.9 ng/ml). Also were determined the levels of ibandronate. high-sensitivity C-reactive protein (CRP, Biomerica, Cat. № Materials and Methods: 45 RA female patient of 21-50 7033) and ESR in each of the two groups. age group (BMD L1-L4 <2.5 SD). Patients were using Results: Patients with elevated levels of nicotinamide ibandronate in intermissive regime -150 mg per month phosphoribosyltransferase had the following laboratory pa- during 1 year, with combined medication CaD3 Nycomed rameters (M+m): ESR - 20,4±1,08 mm/h, CRP - 12,43±1,3 forte. In control group 20 patients were examined with low mg/l. The second group had following data: ESR 14,8±0,66 mineral density indicators, that indicators, that they used mm/h, CRP 6,2±0,62 mg/l. Thus, patients with elevated levels only CaD3 Nycomed forte (used 1 tablet per day 0). In all of nicotinamide phosphoribosyltransferase had significantly cases the diagnosis of rheumatoid arthritis was made by higher concentrations of ESR and CRP (p<0,001). ARA - 1987 year diagnostic criteria. All patients were Conclusions: Thus we revealed relationship between serum using medications, 50 patients - methotrexate; 15 - delagili; nicotinamide phosphoribosyltransferase level and laboratory 56 - glucocorticosteroids (oral); 60 patients - NSAID. markers of inflammation in OA. These data indirectly confirm BMD was measured by DXA (Hologic Q-1000). BMD hypothesis of nicotinamide phosphoribosyltransferase’spro- dynamics of indicators in RA patients after 1 year of treat- inflammatory properties. ment by ibandronate.
P132 THE RELATIONSHIP OF NEUTROPHIL-TO- LYMPHOCYTE RATIO AND MORTALITY IN TROPICAL DIABETIC HAND SYNDROME J. A. Coruña1,M.V.L.Guanzon2, J. M. Coruña1 1Orthopaedics and Traumatology / Corazon Locsin Results: Montelibano Memorial Regional Hospital, Bacolod, 1) The antiresorptive effect of ibandronate is shown on BMD Philippines, 2Endocrinology-Internal Medicine / Corazon indicators, in blacks - 6,8%. Locsin Montelibano Memorial Regional Hospital, Bacolod, 2) Usage of ibandronate drug showed no side effect at all. Philippines 3) With antiresorptive effect of ibandronate, it was followed by decrease of back pain (vertebral ache) and other areas of skeleton. Introduction: The neutrophil-to-lymphocyte ratio (NLR) is an accessible laboratory parameter said to be predictive of mortality. Tropical diabetic hand syndrome (TDHS) com- P131 prises upper extremity infections affecting patients RELATIONSHIP BETWEEN NICOTINAMIDE with insulin resistance in an equatorial climate. PHOSPHORIBOSYLTRANSFERASE SERUM LEVEL Objectives: In this retrospective cohort study, we reviewed AND LABORATORY MARKERS OF INFLAMMA- NLR among TDHS patients and its association TION IN OSTEOARTHRITIS PATIENTS with mortality during admission and after discharge. Y. Akhverdyan1, B. Zavodovsky1, Y. Polyakova1,L. Methods: Twenty-five hands from 25 consecutive patient re- Seewordova2,M.Kuznetsova1, I. Zborovskaya1 ferrals were enrolled from January 1, 2014 to December 31, 1Federal State Budgetary Institution «Research Institute of 2015. Complete blood count upon admission and survival sta- Clinical and Experimental Rheumatology», Volgograd, tus after orthopaedic management were collected Russian Federation, 2Research Institute of Clinical and and tabulated in a spreadsheet. Receiver operating character- Experimental Rheumatology, Volgograd, Russian Federation istic (ROC) curve were used to assess the utility of NLR in predicting mortality. Purpose: To study relationship between serum levels of nic- Results: Majority of the patients were males (76%) with a otinamide phosphoribosyltransferase and laboratory markers mean age of 50. The right side was affected most (56%). of inflammation in patients with osteoarthritis (OA). The mean neutrophil count was 78.36 and 13.96 for lym- Methods: We determined nicotinamide phosphoribosyltrans- phocytes. NLR interquartile range was 8.10 with ferase (visfatin) level in sera of 80 patients with primary OA by Q1 (<3.43), Q2 (3.44-9.33), Q3 (9.34-12.43) and Q4 indirect enzyme-linked immunosorbent assay (RaiBiotech, cat (>2.43). In-hospital mortality was 52%, mortality in 6 months № EIA-VIS-1). We divided the patients into two groups: the at 58%, and in 12 months at 100%. ROC value for admission S142 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 mortalities was 0.939, mortality six months after discharge at P134 0.989, and in twelve months at 0.988, with findings statisti- A STUDY ON THE PREVALENCE OF PATHOLOGIES cally significant (p<0.05). Area under the curve for all three OF THE CERVICAL SPINE IN PATIENTS WITH specified times describe NLR as an excellent diagnostic tool. ESSENTIAL HYPERTENSION Conclusion: Patients with increased NLR have higher inci- M. Nalgieva1,A.Nalgiev2 dence of in-hospital mortality. Within one year, all 1Advisory and Diagnostic Center "Health + Plus", Nazran, TDHS patients expired. TDHS mortality can be attributed to Russian Federation, 2The Centre of Protection of NLR. Motherhood and Childhood of the Republic of Ingushetia, Nazran, Russian Federation
P133 Objective: Installation of the prevalence of osteochondrosis PREPUBERTAL IMPACT OF PROTEIN INTAKE AND in the development of essential hypertension. PHYSICAL ACTIVITY ON WEIGHT BEARING Design and Method: The diagnosis of hypertension was made PEAK BONE MASS AND STRENGTH IN HEALTHY based on the criteria recommended by the European (2003) MALES and Russian (2004) societies of cardiology. The presence and T. Chevalley1,J.-P.Bonjour1, M.-C. Audet1,F.Merminod1,B. severity dorsopathy on the background of osteochondrosis ac- van Rietbergen2,R.Rizzoli1,S.Ferrari1 cording to generally accepted clinical and radiological criteria. 1Division of Bone Diseases, University Hospitals and Faculty From the study were excluded patients with severe and malig- of Medicine, Geneva, Switzerland, 2Department of nant hypertension, severe cardiac insufficiency, myocardial in- Biomedical Engineering, Eindhoven University of farction or stroke in the last 3 months. Results were examined Technology, Eindhoven, Netherlands 121 patients with essential hypertension Results: It was found that in 81 (66.9%) patients with essential Context: Peak bone mass (PBM) and strength are important hypertension, we observed changes in the spine. The authors determinants of fragility fracture risk in later life. During analyzed the most frequent clinical and radiological symptoms growth bone is responsive to changes in nutrition and physical of cervical degenerative disc disease with this combination of activity (PA), particularly when occurring before pubertal pathological processes. In the study of the cervical spine most maturation. commonly detected signs of uncovertebral arthrosis 9.09% (11 Objective: In prepubertal healthy boys, protein intake (Prot- people), and also abnormal mobility in one or more interverte- Int) enhances the impact of PA on weight-bearing bone. We bral segments -6.6% (8 people), straightening of the lordosis, hypothesized that the synergism between Prot-Int and PA on scoliosis, uneven decrease in height of intervertebral discs – 19 proximal femur as recorded at mean age of 7.4 years would (15.7%), spondyloarthrosis - 27,2% (33 people). Disc protru- track until PBM. sion C6-C7-14 people (11.5%). In most patients, it is dominated Methods: 124 boys were followed from 7.4 to 15.2 and 22.6 by the degree of cervical osteoarthritis by Zekera. years. At 7.4 years they were dichotomized according to the Conclusions: In the examined group of patients with essential median of both PA and Prot-Int. hypertension in middle-aged and elderly people the frequency Results: In boys with PA > Median (310 vs. 169 kcal.d-1), of concomitant dorsopathies (osteoarthritis) of the cervical higher vs. low Prot-Int (57.7 vs. 38.0 g.d-1) was associated spine was 66.9%, this figure indicates the possible relationship with +9.8% greater femoral neck (FN) BMC (P=0.027)at of these pathologies, and may help in the treatment of people 7.4 years. At 15.2 and 22.6 years, this difference was main- with hypertension not amenable to medical therapy. tained: FN BMC: +12.7% (P=0.012) and +11.3% (P=0.016), respectively. With PA > Median, in Prot-Int > vs.
P140 Material and Methods: The ELISA assay evaluated here is a NEW ENTITY “NECROTIZING SWEET’S SYNDROME” quantitative immunoassay for in vitro determination of the
PRESENTING AS NECROTIZING FASCIITIS WITH A concentration of 1,25(OH)2 Vitamin D in serum. It was com- GOOD RESPONSE TO IMMUNE SUPPRESSANT pared against an extensively validated 2D ID-UPLC-MS/MS TREATMENT method# able to measure picomolar concentrations of both 1 1 2 Y. -H . Ki m ,H.-S.Kim,H.-R.Kim 1,25(OH)2 Vitamin D3 and D2 in human serum. The compar- 1The Soonchunhyang University Seoul Hospital, Seoul, ison was performed on 80 serum samples originating from the Republic of Korea, 2Konkook University Hospital, Seoul, routine testing of the VUMC laboratory (VU University Republic of Korea Medical Center, Amsterdam, The Netherlands). Results: A linear regression was used to establish the correla- Sweet’s syndrome (SS) is characterized by fever, neutrophilia, tion between both methods. A slope of 0.92, an intercept of 2.6 diffuse dermal neutrophilic infiltrate without infection and pg/mL and a correlation coefficient R of 0.87 were obtained. painful, erythematous papules or plaques on the extremities, The exclusion of an isolated high concentration sample provid- face, and neck. Treatment with systemic corticosteroids results ed slightly different values (Y=0.98X – 0.6 pg/mL, R=0.85). in a swift and dramatic improvement in both dermatosis- Conclusion: The new 1,25(OH)2 Vitamin D ELISA assay related symptoms and skin lesions. Although SS and necro- proved to be correctly calibrated as evidenced by the regres- tizing fascitis (NF) are different diseases, a new variant of sion slope close to 1.0 and the little intercept value. The sam- necrotizing Sweet’s syndrome that mimics NF has been re- ple to sample correlation between both methods was accept- ported in immunocompromised patients. able for a routine use of the assay. Necrotizing SS is a new variant of neutrophilic dermatoses char- Reference: # Dirks NF et al. J Steroid Biochem Mol Biol 2015 acterized by the rapid onset of edematous, erythematous, and Dec 10. pii: S0960-0760(15)30149-7. warm cutaneous necrotic lesions with deep tissue neutrophilic infiltration in the absence of an infection. It can occur as the first manifestation of human immunodeficiency virus (HIV) infec- P142 tion, dermatomyositis, Behçet’s disease, inflammatory bowel EFFECT OF BODY SURFACE, BODY SITE AND disease, hematological malignancies, solid tumors, and medica- SUNSCREEN APPLICATION ON PRODUCTION OF tions such as GCSF. Its etiology remains unclear, but it is pos- VITAMIN D AND 25-HYDROXYVITAMIN D AFTER tulated that it can be mediated by a hypersensitivity reaction in A SINGLE NARROWBAND UVB EXPOSURE which cytokines may be involved, followed by the infiltration of F. Libon1,J.Courtois2,C.LeGoff2,P.Lukas2,N.Fabregat- neutrophils, as in traditional SS. The main treatment for necro- Cabello2,L.Seidel3,E.Cavalier2,J.-Y.Reginster4,A.F.Nikkels1 tizing SS is a systemic corticosteroid, similar to other types of 1Dermatology, University of Liège, Liège, Belgium, 2Clinical SS. Because the clinical features of necrotizing SS and NF are Chemistry, University of Liège, CHU de Liège, Liège, similar, necrotizing SS is likelytobemisdiagnosedasNF.For Belgium, 3Bio-Statistics, University of Liège, CHU, Liège, this reason, incorrect diagnosis can lead to a vicious cycle of Belgium, 4Public Health, Epidemiology and Health mistreatment, leading to debridement, expansion of the disease, Economics, University of Liège, CHU, Liège, Belgium and further debridement. Therefore, early and correct diagnosis is important for managing necrotizing SS. As in our case, a Objective: To study the effect of body surface, body site and precise assessment of recent infliximab treatment, prompt histo- sunscreen application on production of vitamin D pathologic evaluation from a biopsy of the necrotic lesion, and (cholecalciferol) and 25(OH)D (calcidiol) after nb-UVB exclusion of infection are essential for a correct diagnosis. In exposure. addition, a multidisciplinary approach including clinicians, sur- Methods: Four groups of 15 volunteers were exposed to a gical teams, and pathologists could be crucial for sharing opin- single 0,8 MED on 9% (head and hands), 23% (head, hands ions about the existence of unusual neutrophilic dermatoses. and arms), 50% (head, hands, arms and limbs) and 96% (total body) of the body surface. Vitamin D and 25(OH)D were measured before and at days 1, 2 and 5 post-exposure. The P141 same procedure was repeated with a 50+ sunscreen (Figures 1 EVALUATION OF A NEW 1,25(OH)2 VITAMIN D and 2). ELISA ASSAY IN A ROUTINE LC-MS LABORATORY Results: Vitamin D and calcidiol AUC values in groups 1 to 4 N. Heureux1 increased according to the body surface exposed (3,90, 7,00, 1DIAsource Immunoassays, Louvain-la-Neuve, Belgium 14,9 and 30,0 ng/ml, 91,9, 94,8, 107 and 126 ng/ml, respec- tively). Using sunscreen the values were: 0,67, 0,82, 3,62 and
Objective: To evaluate a new 1,25(OH)2 Vitamin D ELISA assay 2,24 ng/ml (vitamin D) and 79,8, 84,8, 98,7 and 113 ng/ by comparison with a validated 2D ID-UPLC-MS/MS method. ml(calcidiol). Specific body part analysis revealed that head S146 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and hands produced significantly more vitamin D compared that newly diagnosed fractures in the ED are seen in fracture to other body parts. clinic within 72 hours. Conclusion: Vitamin D and calcidiol production increases Material and Methods: Data was audited against section 1 of with exposed surface, significantly reduced by sunscreens. the BOAST 7 guidelines, which states that “following acute Anatomical sites differ in their vitamin D production traumatic orthopaedic injury, patients should be seen in a new capacities. fracture clinic within 72 hours of presentation with the injury. This includes referrals from emergency departments, minor inju- ry units and general practice.” Results: Initial audit revealed that 9.78% of patients from AandE met the target audit standard of 100% adherence to the BOAST 7 guidelines. The average time from diagnosis to clinic was 9.78 days. Change was implemented by means of a consultant-led VFC and new referral pathway. This allowed for screening of referrals and expedition of urgent cases. This re- audit allowed for 88% of patients to be virtually reviewed with 72 hours and 27.17% of patients to be discharged to the GP due to inappropriate referral. Conclusion: The use of a consultant-led VFC and a clearly outlined referral pathway has resulted in a significant improve- ment in the adherence to the BOAST 7 guidelines and the quality of referrals to fracture clinics. This has enhanced clinical time Figure 1. Mean and SD of vitamin D (ng/ml) of every study management, prioritisation, quality of care and most importantly group with and without sunscreen. patient safety. It has highlighted that the use of VFC is a safe and efficient way of ensuring orthopaedics patients have appropriate follow up.
P144 BODY MASS INDEX, VITAMIN D DEFICIENCY AND PHYSICAL ACTIVITY IN OSTEOPOROSIS R. Alimanovic-Alagic1,S.Sokolovic2,M.Vrcic3,A. Kapetanovic4,E.Rabari5, S. Hodzic4 1Clinic of Nuclear Medicine and Endocrinology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina, 2Clinic of Heart disease and Rheumatism, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina, 3Faculty of Sport and Physical Education, University of Sarajevo, Sarajevo, Bosnia and Herzegovina, 4Center for Figure 2. Mean and SD of 25(OH)D (ng/ml) of every study Medical Rehabilitation and Spa Treatment. Reumal Fojnica, group with and without sunscreen. Fojnica, Bosnia and Herzegovina, 5Health Institution Spa Terme Ilidza, Sarajevo, Bosnia and Herzegovina
P143 Introduction: Skeletal disease of bone thinning and compro- ORTHOPAEDIC VITRUAL FRACTURE CLINIC: mised bone strength, osteoporosis, continues to be a major SOMETHING TO BOAST ABOUT? public health issue in the aging population. Building and D. P. R. Coffey1,S.P.Hudson-Phillips2 maintaining bone mass requires a combination of nutrients 1Chelsea and Westminster Hospital NHS Trust, London, and physical activity. Body mass index (BMI) as a predictor United Kingdom, 2Guys and St Thomas' Hospital NHS of fracture risk. Risk factors are numerous and there is no Trust, London, United Kingdom single cause of the disorder. Exercise prescription also in- cludes a window of opportunity to improve bone strength. Objective: To assess whether the introduction of an orthopae- Aim: To determine the influence of sport, BMI and vitamin D dic consultant-led Virtual Fracture Clinic (VFC) will improve deficiency on bone mineral density in patients diagnosed the adherence to the BOAST 7 guidelines which recommends with osteoporosis. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S147
Materials and methods: The study included a group of 548 We also calculated the TBS adjusted FRAX and compared it patients, 30 to 65 years of age, diagnosed with osteoporosis to the aBMD adjusted FRAX in order to find how TBS could and osteopenia and treated at the Clinical Center University of affect the fracture risk assessment of our population. Sarajevo, over 12 months period. The study was designed as Patients and Methods: In a cross-sectional study, a number of prospective. For each patient we provided personal history 486 postmenopausal women with osteoporosis screening indica- and diagnostic procedure: bone mineral density (BMD) at tion were recruited from rheumatology clinic of two different lumbar spine and proximal femur, weight and body mass university centers and were referred to densitometry ward in (BMI) presence as risk factors for osteoporosis, physical ac- order to undergo aBMD and TBS evaluation. The simultaneous tivity and D vitamin deficiency. BMD and TBS were performed and TBS adjusted FRAX in Results: Low BMD is an independent predictor of hip and addition to BMD adjusted FRAX was calculated, accordingly. spinal column risk fracture or other fractures. BMD depends Results: In total, 174 osteoporotic, 222 osteopenic and 90 on the mineral value and vitamin D deficient. Weight and body normal postmenopausal Iranian women were evaluated in this mass (BMI) associated with low bone mineral density affects the study. The mean TBS was 1.336 (±0.113), ranging from 0.949 bone structure and results in bone degradation. Risk factors for to 1.601. According to TBS results, 48 postmenopausal wom- the prediction of osteoporosis and fractures have been less thor- en with degraded, 204 postmenopausal women with partially oughly studied in younger patients. In patients who are still degraded and 234 postmenopausal women with normal bone actively involved in sports activities osteoporosis occurs in only micro-architecture were evaluated in this study. A significant 9% of cases. However, in patients who do not participate in correlation was seen between L1–L4 TBS and spine L1–L4 sports activities osteoporosis occurs in 55% of cases and in those aBMD (r=0.508, P<0.001). The correlation of TBS and fem- who are moderately involved in sports activities osteoporosis oral neck aBMD was also statistically significant (r=0.464, occurs in 36% of cases. P<0.001). In addition, a significant negative correlation was Conclusion: We evaluated the association between the weight observed between TBS and the age of study population (r=- and BMI. Active sports, maintenance of body weight, varied 0.412, P<0.001). In order to evaluate the effect of TBS on diet, sufficient intake of vitamin D, and sun exposure can fragility fracture risk and to decide who may mostly benefit increase bone density and prevent fractures. One of the best from pharmaceutical treatment, FRAX algorithm was calcu- ways to strengthen your bones and prevent osteoporosis is by lated for osteopenic women once with and once without TBS getting regular exercise. adjustment. Since osteoporotic patients are indicated for phar- References: maceutical treatment regardless of their fragility fracture risk, 1. Karlsson MK, Rosengren BE. Dtsch Z Sportmed 2012;63:9. FRAX was not calculated for this group. In addition, normal 2. Brock K et al. J Steroid Biochem Mol Biol 2010;121:462. individual are not indicated for pharmaceutical treatment. As a 3. Marques EA et al. Age (Dordr) 2012;34:1493. result, FRAX was not assessed for this group either. Based on aBMD adjusted FRAX, no osteopenic woman of our cohort had major osteoporotic fracture risk of higher than 20% and P145 pharmaceutical treatment was not indicated, accordingly. THE ADDED VALUE OF TRABCULAR BONE SCORE Considering hip fracture risk, 12 (2.4%) osteopenic postmen- (TBS) TO CONVENTIONAL BONE DENSITOMETRY opausal women of our study showed hip fracture risk of more IN MANAGEMENT OF POSTMENOPAUSAL than 3%. Given the NOF guideline, pharmaceutical osteopo- OSTEOPOROSIS rotic treatment is indicated for this group. 24% of osteoporotic M. Zabihiyeganeh1,A.Mirzaei1 patients in this study had normal TBS, which is a valuable 1Bone and Joint Reconstruction Research Center, Shafa guidance for choosing the best treatment strategy. On the other Orthopedic Hospital, Iran University of Medical Sciences, hand near half of osteopenic patients showed abnormal TBS. Tehran, Islamic Republic of Iran Conclusion: A significant correlation was observed between TBS and aBMD values of Iranian postmenopausal women of Background: Osteoporosis is known as a major public health our study. In addition, adding TBS to the FRAX algorithm and problem mostly affecting postmenopausal women and aging BMD results may change the therapeutic threshold in individuals of both sexes. Trabecular bone score as a measure osteopenic patients, and guide the type of therapy in osteopo- of bone microarchitecture has been newly added to the osteo- rotic patients respectively. porotic and fracture risk assessment process. However, the evaluation of TBS and its association with fracture risk assess- ment in Iranian population has not been performed. Here we P146 assessed the bone micro-architecture of postmenopausal THE IMPACT OF BODY MASS INDEX ON QUALITY Iranian women using TBS method and compared it to the OF LIFE AFTER LIGAMENTOPLASTY OF THE TBS data of other regions to find out the potential differences. ANTERIOR CRUCIATE LIGAMENT OF KNEE S148 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
M. Milankov1,M.Obradovic2, M. Vranjes2 Material and Methods: Data was audited against the 1Department of Orthopaedic Surgery and Traumatology, RCOS guidelines (date, patient demographics, operating Clinical Center Vojvodina, Medical Faculty, University surgeon(s), consultant responsible, indication for surgery, of Novi Sad, Novi Sad, Serbia, 2Department of operation performed, operative findings, serial numbers of Orthopaedic Surgery and Traumatology, Clinical Center prosthetics used, closure/sutures used, intra-operative Vojvodina, Medical Faculty of Novi Sad, Novi Sad, complications, post-operative complications, surgeons Serbia signature). The quality of post-operative instructions was compared to eight criteria deemed clinically important by Introduction: Requirements which are set represent into members of the multi-disciplinary team (bloods, antibi- young athletes cause injury of ligament and meniscal sys- otics, weight bearing status, length of weight bearing sta- tem of knee. In the last few years the number of reported tus, VTE prophylaxis, post-operative X-rays, removal of cases of completed reconstruction of the anterior cruciate sutures/clips and follow up). ligament of knee have doubled.Purpose: Purpose of this Results: 50% of the mandatory RCOS guidelines and 0% study is to show if there are some significant difference of the recommended post-operative instructions met the in quality of life between persons with different values of target audit standard of 100% adherence. Change was im- body mass index (BMI) after anterior cruciate ligament plemented through team education and the use of a new reconstruction. proforma incorporating all mandatory and recommended Material and methods: The study involved 510 patients who criteria. All mandatory RCOS criteria were then met with underwent reconstruction of the anterior cruciate ligament at 100% adherence apart from consultant responsible the Department of Orthopaedic Surgery and Traumatology, (95.7%). All criteria for recommended post-operative in- Clinical Center of Vojvodina in Novi Sad in the period from structions were met with 100% adherence with the excep- March 2013 to December 2015. It is calculated BMI for each tion of weight-bearing status (69.6%). patient account to established formula and results were pre- Conclusion: The use of a new and more detailed orthopae- sented on based indices which are set by WHO. The life qual- dic operation note proforma has resulted in significant im- ity of these patients was determined by KOOS questionnaire. provement in adherence to the RCOS guidelines and the Results: Injury of anterior cruciate ligament are basically quality of post-operative instructions. This led to the more often in men population. In our study, 413 patients were maximisation of post-operative care patients receive from male and 97 patients were female. The age average of patients members of the multi-disciplinary team. Most importantly, was 27 years old. The average value of BMI was 24,65 with this small change has had a big impact on optimising pa- the biggest part of normal nourished patients. It is determined tient safety, preventing unnecessary prolonged length of low but significant difference in quality of life of patients with stay in hospital and reducing the risk of medico-legal ac- different values of BMI. If BMI is higher than total score of tion to the trust. the KOOS questionnaire is lower, the words the quality of life is worse. Conclusion: The life of persons with higher value of BMI P148 (BMI>24,9 kg/m2) after anterior cruciate ligament reconstruc- PREVALENCE OF OSTEOPOROSIS IN THE tion is not as good as life of persons with normal BMI (18,5- ALBANIAN POPULATION AND MAIN RISK FACTORS 24,9 kg/m2). E. Shkurti1, D. Shtiza2 1University of Medicine, Tirana, Albania, 2University Hospital Centre Mother Theresa, Tirana, Albania P147 IMPROVING THE QUALITY OF TRAUMA AND Background: Our study aims to assess the Albanian bone ORTHOPAEDIC OPERATION NOTES: IMPLEMENTING status and the prevention of osteoporosis. In 2010, 22 million CHANGE WITH THE USE OF A PROFORMA females and 5.5 million men were evaluated to have osteopo- S. P. Hudson-Phillips1, B. M. Sephton2,D.P.R.Coffey3 rosis in the EU; and 3.5 million new fragility fractures were 1Guys and St Thomas' Hospital, London, United Kingdom, maintained, including 620,000 hip fractures, 520,000 verte- 2London North West Hospital Trust, London, United bral fractures, 560,000 forearm fractures and 1,800,000 other Kingdom, 3Chelsea and Westminster Hospital, London, fractures. Preceding and incident fractures also reported for United Kingdom 1,180,000 quality-adjusted life years lost throughout 2010. The expenditures are supposed to amplify by 25% in 2025. Objective: To assess the adherence of orthopaedic operation Methods: A total of 6954 chronological individuals of both notes to the Royal College of Surgeons (RCOS) guidelines genders were monitored, gathering medical data through the and to evaluate the quality of post-operative instructions. FRAX™ questionnaire, and evaluating heel bone rigidity by Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S149 quantitative ultrasonography (QUS). The 12-year hazard for balance exercises; functional training; joint conservation hip and major osteoporotic fractures was analyzed considering techniques in occupational therapy; biomechanical inter- individual or family history of fragility fracture, smoking, al- ventions such as using a quad cane and lateral insole cohol misuse, rheumatoid arthritis, extended steroids postula- wedges)inthethirdweek. tion. Supplementary risk factors were assessed, counting pre- Results: Pain was quantified using the visual analog scale. mature menopause, reduced sunlight revelation, low nutrition- Pain pre-intervention and after pharmacologic management al calcium ingestion, physical inactivity, amount of pregnan- in the first week was 10/10, decreasing to 6/10 in the second cies, months of lactation, tobacco cigarettes smoked per year, week with rehabilitation using modalities, further going precise sources of minor osteoporosis. In the course of a cor- downto4/10inthethirdweekwithmaximalrehabi- relation survey, the power of every feature on the expansion of litation. Disability was quantified using the Knee Injury and osteoporosis was examined. Osteoarthritis Outcome Score, with improvement in all 5 do- Results: 16% of females undergo from osteoporosis, as ob- mains post-intervention: pain, other symptoms, disability in served by QUS T-score. The estimation of FRAX™ activities of daily living, disability in sports and recreation, established the weight of the previously known risk aspects. and quality of life. Outcome measures also included The correlation survey disclosed the implication of some sup- OARSI-recommended performance-based tests: 30-second plementary factors, for instance hyperthyroidism, chair stand test (pre-intervention:6.5 repetitions, post-inter- nephrolithiasis, Crohn disease, ulcerative colitis prior to age vention:13 repetitions), 40-meter fast-paced walk test (pre-in- 50. tervention:30 seconds, post-intervention:26 seconds), stair- Conclusions: The elevated prevalence of minor osteoporosis climb test (pre-intervention:28.76 seconds, post-interven- in the Albanian population obviously shows the significance tion:25 seconds), timed up and go test (pre-intervention:14.91 of further risk features not yet incorporated in the FRAX™ seconds, post-intervention:10.44 seconds), and 6-minute walk algorithm, for which preventive measures should be taken into test (pre-intervention:430 meters, post-intervention:475 me- account. Screening campaigns may allocate both early diag- ters). Qualitatively, before intervention, pain led her to stop nosis and admission to treatment. working as a seamstress and confined her at home, leading to feelings of isolation and loneliness. Post-intervention, she re- sumed work, started going out again, and reported feeling less P149 lonely. THE ROLE OF REHABILITATION MEDICINE IN Conclusions: In this elderly patient, the challenge was to MANAGEMENT OF PAIN AND DISABILITY IN AN manage pain and disability beyond traditional NSAID use. ELDERLY PATIENT WITH KNEE OSTEOAR- Rehabilitation medicine improved her quality of life. THRITIS AND COMPLICATED CO-MORBIDITIES M. O. Ocon1,G.D.Inciong1 1Department of Rehabilitation Medicine, Philippine General P150 Hospital, Ermita, Manila, Philippines BONE MARROW LESION IN ADVANCED OSTEOAR- THRITIS OF THE KNEES. CORRELATION STUDY Background: Pain and disability are debilitating effects of BETWEEN HISTOPATHOLOGICAL FINDINGS AND knee osteoarthritis. Guidelines in pain management focus on STRUCTURAL DAMAGE. NSAIDs, with their use restricted by cardiovascular, gastroin- Y. A bd E lm ot al eb 1,H.Bassiouni2 testinal, and renal comorbidities. Given such comorbidities, 1AL-Azhar university, Egypt, Cairo, Egypt, 2AL-Azhar uni- how then do we manage pain and disability? versity, Rheumatology Dept., Cairo, Egypt Objectives: To quantify and manage pain and disability by pharmacologic and non-pharmacologic means, focusing on Purpose: To correlate histopathology of a bone marrow lesion rehabilitation and outcome measures. (BML) pattern with severity and structural damage in osteo- Methods: The participant is a 72-year-old Filipino female arthritic knees. with knee osteoarthritis, Kellgren-Lawrence 3, with upper Materials and Methods: Twenty consecutive patients (age gastrointestinal bleeding from chronic NSAID use, chron- range, 59–66 years; mean, 65 years) referred for total knee ic kidney disease from diabetic nephropathy, and diabetes replacements were examined with sagittal short inversion mellitus. Intervention occurred for 3 weeks: weak opioids time inversion-recovery (STIR) and T1- and T2-weighted (tramadol/paracetamol) in the first week, adding physical MRI one week prior to surgery before surgery. Different therapy (superficial heat, transcutaneous electrical nerve structural abnormalities on MRI were compared with those stimulation, and phonophoresis with indomethacin on on histologic maps. both knees) in the second week, and maximizing rehabil- Results: The histopathology of BML in cases of OA re- itation (joint mobilization; stretching, strengthening, and vealed that (6) biopsies of cases showing bone marrow S150 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 fibrosis (30%), (4)of them grade 1(20%) and (2)of them -65) years. The duration of their disease ranged from one to 15 grade 2(10%). years. The control groups were 8 males (32%) and 17 females (18)biopsies showing cyst(90%), (9)biopsies showing abnor- (68%). Their ages ranged from (40-65) years. We excluded: 1. maltrabeculae(45%),(2)ofthemwithgrade1(10%),(4)ofthem Significant conditions of the spine, hips, or feet that affect the grade 2 (20%)and (3) of them grade3(15%). (5)Biopsies show- ability to walk. 2. Significant medical conditions that affect ing lymphocyte (25%), (40%)of them had++CD3, while the ability to walk and function. 3. Inflammatory arthritis, (60%)ofthemhad++CD20.(5)Biopsiesshowingfattymarrow such as rheumatoid or gouty arthritis. 4. Degenerative arthritis (25%), (9)biopsies showing haemosidrotic marrow (45%), secondary to other conditions, such as hemochromatosis, (6)biopsies showing blood vessels (30%), (5)of them with Wilson´s disease, or ochronosis. 5. Current significant soft grade 2 (25%) and (1) with grade 3 (5%). The MRI findings of tissue rheumatism such as fibromyalgia, or trochanteric bursi- OA patients had been revealed that there was (6)patients with tis. 6. Significant trauma and surgery (including arthroscopy) BML of grade 1 (30%), (10)patients of grade 2 (50%) and or intra-articular corticosteroid injection to the index knee (4)patients of grade 3 (20%). within 6 months of enrollment. The patients were allowed to Conclusion: continue on the medications that they have proinflammatory - BML has a strong correlation with radiographic sever- cytokines (IL-1β) and degradative enzymes (MMP-13) are ity measurements of osteoarthritis of the knee and pain. measured - In patients with knee osteoarthritis, BML in bone under- Results: Patients who had 3 flare-ups showed the statistically neath cartilage markedly increase risk for structural pro- significantly highest mean IL-1β and MMP-13 level. There gression in the knee. was no statistically significant difference between patients - Hyperemia and hematopoietic marrow were possible reasons with no flare-up, 1 flare-up and 2 flare-ups; all showed statis- for appearance of BML as high signal- intensity on STIR tically significantly lower mean levels. Control group showed images. the statistically significantly lowest mean IL-1β level. There - BMLs are a cornerstone in progression of osteoarthritis. was a statistically significant positive (direct) correlation be- tween IL-1β, disease duration, KL, VAS, stiffness score, pain score, functional score, WOMAC and KOFUS. An increase in P151 all these variables is associated with an increase in IL-1β and DETECTION OF SERUM LEVEL CHANGES OF MMP-13. MATRIX METALLOPROTIENASE-13 AND INTER Conclusion: There is a potential role for IL-1β and MMP-13 LEUKIN-1 BETA DURING REMISSION AND biomarkers in assessing the development in osteoarthritis. IL- FLARE-UPS OF PRIMARY OSTEOARTHRITIS OF 1β and MMP-13 were founded to be correlated positively in THE KNEES patients with knee OA this correlation sounded right as the Y. A bd E lm ot al eb 1,H.Bassiouni2 expression of MMP-13 depends on the level of IL-1β. 1Rheumatology Dept., AL-Azhar university, Egypt, Cairo, Although all medications groups failed to lower the level of Egypt, 2AL-Azhar university, Rheumatology Dept., Cairo, IL-1β and MMP-13,yet there was a numerical difference in Egypt favor of diacerine and NSAID. Patients on both diacerine and NSAID had the lowest rate of flare ups. It is recommended Introduction: The diagnosis of osteoarthritis is currently that the early measurement of biomarkers may detect cases to based on radiographic criteria (e.g., joint space width) and progress and thus stronger treatment may be given for these clinical symptoms (e.g., pain and loss of function). The eval- groups. uation of new disease-modifying osteoarthritis drugs (DMOADs) is performed on the same basis, since the regula- tory bodies currently require evidence for an impact on radio- P152 graphic joint space narrowing (JSN) and an impact on symp- CHARACTERIZATION OF MOLECULAR PROFILE toms. However, the limitations of radiography have led to OF SARCOPENIA IN OSTEOPOROTIC AND research into alternative parameters for monitoring osteoar- OSTEOARTHRITIC PATIENTS thritis that could serve as biomarkers in drug development. J. Baldi1, M. Scimeca2, E. Bonanno2,E.Piccirilli1,E. Aim: To detect the serum level of MMP-13 and IL-1β in OA Gasbarra1,R.Iundusi1, U. Tarantino1 of the knee during remission and exacerbation and if these 1Department of Orthopedics and Traumatology, Rome, Italy, biomarkers can be validated as gold biomarkers in assessing 2Anatomic Pathology Section, Department of Biomedicine OA progression and drug development in OA. and Prevention, University of Rome, Rome, Italy Methods: This study was performed on 60 patients with knee OA, 18 males (30%) and 42 females (70%), all diagnosed as Background: Sarcopenia has emerged as an important risk osteoarthritis of one or both knees. Their ages ranged from (40 factor for osteoporosis. Indeed, it might decrease bone Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S151 strength by reducing mechanical loading to the skeleton. 1Orthopedics/Gwangju Veterans Hospital, Gwangju, Reduction of mechanical stimulation could result from de- Republic of Korea creased maximal force that weaker muscles produce and/or less time that the skeleton is loaded due to relative immobility, Objectives: To evaluate the prevalence of osteoporosis in the and thus bone formation is reduced. Aim of this study is to Alzheimer's disease patients. identify the possible molecular pathways involved in physio- Methods: 128 patients with Alzheimer's disease were includ- pathogenesis of sarcopenia. In particular, we performed mor- ed in this study. The patients were diagnosed with Alzheimer's phological and immunohistochemical studies to investigate disease using Korean-Mini Mental Status Examination (K- the expression of BMP2, BMP4, BMP7, Myostatin and vita- MMSE) and checked bone mineral density using single- min D receptor (VDR) and their relationship with the activity energy (SE) quantitative computed tomography (QCT) in of muscle CD44 + stem cells. 2010. To define abnormality in terms of QCT of the spine, a Methods: We obtained muscle biopsies from 30 female pa- bone mineral density (BMD) spine below 80 mg/cm3 is indic- tients underwent total hip arthroplasty for osteoarthritis (OA) ative of osteoporosis and BMD between 80 and 120 mg/cm3 (mean age 71.6±10.3) and 30 age matched female patients is indicative osteopenia. with osteoporotic fragility fracture of the femoral neck (OP). Results: The prevalence of osteoporosis in the control group Thanks to immunohistochemistry, transmission electron mi- is 29.73%. The prevalence of osteoporosis in the Alzheimer's croscopy and immunogold labeling we investigated the role of disease patients is 96.87%. The prevalence of osteopenia in BMP-2/4/7, VDR, myostatin and CD44+ satellite muscle the Alzheimer's disease patients is 3.12%. The prevalence of cells. severe osteoporosis fracture in the Alzheimer's disease pa- Results: Morphometric investigations allowed us to dem- tients is 32.03%. onstrate the delay in the onset of Sarcopenia in OA pa- Conclusion: The prevalence of osteoporosis in Alzheimer's tients. As concern immunohistochemistry, we found that disease patients is higher than in the control group. BMPs and nuclear VDR were more expressed in OA pa- tients than OP ones. In OA patients muscle loss rate was replaced by adipose tissue (18.32%), in OP muscle atro- P154 phic fibers were substituted by adipose (8.27%) and con- SOME PATHOPHYSIOLOGICAL ASPECTS OF PAIN nective tissue (6.68%). The morphometric analysis in OA SYNDROME IN OSTEOARTHRITIS patients showed 38.00% of atrophic fibers (17.90% type I Y. Polyakova1, L. Seewordova1, Y. Akhverdyan1,N. and 20.10% type II). In OP group, we observed more than Fofanova2, T. Rogatkina2,B.Zavodovsky1 50.00% of atrophic fibers with prevalence of type II fibers 1Federal State Budgetary Institution «Research Institute of (21.10% type I and 39.20% type II). Moreover we found Clinical and Experimental Rheumatology», Volgograd, that OA muscle biopsies there were a significantly higher Russian Federation, 2VolgSMU, Volgograd, Russian number of BMP-2-positive fibers (62.79±6,205) as com- Federation pared with muscle of OP patients (13.92±3.343). Finally, results showed a significantly different rate of CD44+ The influence of inflammatory cytokines on cartilage and cells in OA as compared with OP. Noteworthy, our data subchondral bone is considered to be important in the patho- showed an age dependent decrease of nuclear expression genesis of OA. Nicotinamide phosphoribosyltransferase of VDR in OP patients but not in OA. As concern (Nampt) is one of the newly identified proinflammatory fac- myostatin, we note a strongly association between their tors [1]. It is known that Nampt is also a potential target for the expression and degenerative phenomena observed in bi- nerve growth factor (NGF), which may influence on pain opsies of OP patients. severity. Conclusion: The identification of the molecular profile of Objective: To study the relationship between dynamics of sarcopenia can provide the rational for new therapies. In par- pain and Nampt's level in patients with OA. ticular, our data allowed us to propose the use of human re- Materials and methods: We studied 80 patients with primary combinant BMPs, VIT. D3 supplementation and the anti- OA in accordance with the ACR criteria. To assess the level of myostatin molecules as drugs capable to prevent or treat pain in patients OA we used functional WOMAC index and sarcopenia of OP patients. visual analogue scale (VAS). Hypocaloric diet and a health- promoting physical activity were recommended for all pa- tients for weight loss. Only 18 patients (23%) were able to P153 reduce body weight by 5 kg or more for 3 months. E SURVEY OF PREVALENCE OF OSTEOPOROSIS Results: To study the effect of weight loss on the clinical IN ALZHEIMER'S DISEASE PATIENTS manifestations of OA, patients were divided into two groups. K.-Y. An1 The first group achieved weight loss by 5 kg or more (18 S152 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 persons). The second group was formed of patients who had carbohydrate and lipid metabolism than patients in control body mass reduction less than 5 kg and patients without group. These data indirectly indicate that obesity may be an weight loss (62 persons). We noted that body weight reduction important risk factor for OA progression. We also hypothesize more than 5 kg led to significant reduction in severity of OA’s that visfatin may be an important factor of OA progression. clinical manifestations (decreasing of pain level (VAS) at rest and during walking, total WOMAC score), and normalization of laboratory markers (high-sensitivity C-reactive protein). P156 Conclusion: In our study we revealed relationship between MANDIBULAR ALVEOLAR BONE CHANGES: decreasing body weight, Nampt level and severity of the pain EFFECTIVE OSTEOPOROTIC FRACTURE RISK syndrome in OA. These data indirectly confirms the hypoth- PREDICTOR esis that Nampt may influence on NGF-dependent pain in OA. M. Majumder1,M.Harun2,T.Ahmed3,M.Latif3 Reference: 1. Polyakova Y et al. Osteoporos Int 2016; 1Department of Medicine, Comilla Medical College, Comilla, 27(Supp.1):82. Comilla, Bangladesh, 2Department of Conservative Dentistry, Chattagram Dental College, Chittagong, Bangladesh, 3Department of Medicine, Comilla Medical College, P155 Comilla, Bangladesh NICOTINAMIDE PHOSPHORIBOSYLTRANSFERASE AS FACTORS PREDISPOSING TO OSTEOARTHRITIS Introduction: Osteoporosis is closely related to fragile AND METABOLIC SYNDROME PROGRESSION fracture and consequently excess mortality rate more L. E. Sivordova1, Y. V. Polyakova1, V. I. Kravtsov1,Y.R. than 20% in the first year of fracture. Early prediction Akhverdyan1, B. V. Zavodovsky1 of osteoporotic fracture risk can prevent this devastating 1Federal State Budgetary Institution «Research Institute of consequence. This prospective study showed that Clinical and Experimental Rheumatology», Volgograd, Postmenopausal osteoporotic women having sparse man- Russian Federation dibular trabecular pattern, low mandibular alveolar bone mass with dental radiography had statistically significant Objective: To study the effect of reducing body weight more lower trabecular bone score (TBS) which is predictive of than 5 kg on the clinical manifestations of OA, markers of future osteoporotic fracture. carbohydrate, lipid metabolism and nicotinamide phospho- Purpose: The purpose of the study was to explore the possi- ribosyltransferase (visfatin) serum levels in patients with OA. bility of using mandibular trabecular pattern and mandibular Materials and methods: We observed 110 people: 80 pa- alveolar bone mass on dental radiograph to identify fracture tients with OA and 30 healthy individuals (control group) with risk in postmenopausal osteoporosis. body mass index (BMI) of 25 to 35 kg/m2, aged 18 to 79 Methods: 90 Postmenopausal women were included in years. Visfatin level in serum was determined by indirect solid this study with the complaint of osteoporosis like symp- phase ELISA test (RaiBiotech, cat № EIA - VIS -1). toms. Patient with suspected conditions affecting bone Results: Hypocaloric diet low in animal fats and a health- mineralisation and edentates were excluded from this promoting physical activity was recommended for all patients. study. All patient were evaluated by dual energy X-ray The first group consisted of patients who were able to reduce absorptiometry (DXA) for bone mineral density (BMD), body weight by 5 kg or more (18 pers.). The second group was TBS using TBS insight free software for GE-Prodogy formed of patients having reduced weight by less than 5 kg advance BMD machine and digital dental radiographs and patients who did not reduce body weight (62 pers.). We for mandibular trabecular pattern and mandibular alveo- revealed statistically significant decreasing of visfatin concen- lar bone mass (MABM). All patients were divided into tration in 1st group (4,33±0,39 before treatment and 2,40 three groups according to mandibular trabecular pattern ±0,23 ng/ml after treatment). The dynamics of visfatin in as group A (Sparse), group B (alternative Sparse and 2nd group was not statistically significant. In the 1st group Dense) and group C (Dense). we noted reduction in the severity of clinical manifestation, Results: The results showed that TBS was lower in visfatin, glucose, lipid profile, C-reactive protein (CRP) group A (1.273±0.108) than group B (1.296±0.103) levels. Weight loss also led to the normalization of metabolic and group C (1.301±0.09). MABM was also lower in disorders. In 2nd group we observed tendency to normaliza- group A (74.94±21.93) than group B (92.32±15.23) and tion of all parameters, but significant difference was only group C (93.09±18.03) those was statistically significant found for CRP, severity of pain at rest and during walking (p<0.05). according to VAS scale and WOMAC total score. Conclusion: Mandibular trabecular pattern and MABM on Conclusion: OA patients with weight loss of more than 5 kg dental radiograph is significantly effective as TBS and BMD had more obvious pain relief, significant improvement of for prediction of osteoporosis and fracture risk. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S153
P157 Conclusion: The PEMFs with a strength of 5 to 150 G (or 0.1 EFFECTS OF PULSED ELECTROMAGNETIC AND to 0.3 G) and frequency of 5 to 64 Hz with sweep current of 7 STATIC MAGNETIC FIELDS ON MUSCULOSKE- to 7KHz may be an effective modality to relief pain and im- LETAL LOW BACK PAIN: A SYSTEMATIC REVIEW prove function in patients with chronic low back pain. There is APPROACH no sufficient evidences to confirm this effectiveness in acute M. Javaherian1,S.BashardoustTajali1,M.Hadizadeh1 low back pain. To achieve appropriate effectiveness, it is sug- 1Physiotherapy Department at Tehran University of Medical gested to perform this treatment modality at least 20 minutes Sciences, Tehran, Islamic Republic of Iran per day for 9 sessions. The SMFs have not been reported to be substantially effective in decreasing pain or improving func- Objective: This systematic review was conducted to evaluate tion following chronic musculoskeletal low back pain. More effects of pulsed electromagnetic (PEMF) and static magnetic RCTs are necessary to achieve much effective characteristics fields (SMG) on pain and functional improvement in patients for these modalities. with musculoskeletal low back pain (LBP). Methods: Seven electronic databases were searched system- atically by two independent researchers to identify the pub- P158 lished randomized controlled trials (RCTs) on the efficacy of AN AUDIT ON THE INVESTIGATION AND MANAGE- pulsed electromagnetic, static magnetic, and therapeutic nu- MENT OF MALE OSTEOPOROSIS IN MALTA clear magnetic fields. The identified databases for systematic M. Rogers1,J.S.Gauci2,J.M.Gauci2,M.Azzopardi2,A. search were Ovid Medline®, Ovid Cochrane RCTs and Borg1 Reviews, PubMed, Web of Science, Cochrane Library (from 1Rheumatology, Mater Dei Hospital, Msida, Malta, 1968 to December 2015), CINAHL, and EMBASE (from 2Medicine, Mater Dei Hospital, Msida, Malta 1968 to February 2016). The appropriate keywords were se- lected through Mesh Scopus. All references of the selected Objectives: Osteoporosis is becoming increasingly recog- studies were searched to identify second hand relevant manu- nized as an important health problem in men, with one in four scripts. All human published RCTs in English would be in- men over the age of 50 years developing at least one cluded to the study if they reported changes on pain and/or osteoporosis-related fracture1. The primary aim of our audit functional disability following application of magnetic fields was to evaluate whether male patients with a low bone mineral on musculoskeletal low back pain. All studies with surgical density (BMD) are being investigated and managed in con- approaches, patients with pelvic pain, and combination of oth- cordance with the Endocrine Society Guidelines2. We also er treatment techniques (such as acupuncture or diathermy) assessed whether BMD scans are being requested according were excluded from the systematic review. The identified to guidelines. studies were critically appraised and the data were extracted Materials and Methods: All consecutive male patients who independently by two raters (M.J and S.B.T). Probable dis- had a BMD measurement between over a period of four agreements were resolved through discussion between raters. months at Mater Dei Hospital were included. Information on Results: In total, 1505 abstracts were found through initial patient demographics, indication for BMD assessment and search of the international databases. The abstracts were investigations were obtained from patients’ medical notes reviewed to identify appropriate relevant manuscripts. and iSoft Clinical Manager®. Seventeen potentially relevant studies were retrieved Results: A total of 115 patients had a BMD scan performed as full-text of which 1448 were excluded based on during the study period. Mean age was 56.6 years (SD±14.6). inclusion/exclusion criteria. Ten selected articles were cat- BMD assessment was indicated in 54.8% (n=63) of patients egorized into three subgroups: PEMF (6 articles), SMF (3 [age >70 years or age >50 years with presence of one risk articles), and therapeutic nuclear magnetic fields (tNMF) factor]. 56 patients had their BMD scan result recorded in their (1 article). Since one study evaluated tNMF, we had to notes. Of these, 33.9% had osteoporosis (n=19) and 42.9% exclude it. In the PEMF group, one study of acute LBP osteopenia (n=24). Twenty-one (48.8%) of these patients were did not show significant positive results and majority of referred for BMD assessment by a rheumatologist. From the relevant studies were in favour of the PEMF effectiveness cohort of patients with low BMD, 25.6% (n=11) had Vitamin on chronic low back pain (CLBP) indicated that magnetic D levels checked [mean 28 ng/ml], 41.9% (n=18) had testos- fields might relief pain level and improve function in pa- terone levels checked [mean 10.3 nmol/L] (14% and 20.9% tients with CLBP. Among all relevant studies, only one requested by rheumatologists respectively). All patients had article did not report significant differences between treat- renal, calcium, phosphate and liver function tests; none had ment and control groups. In the SMF group, two articles 24-hour urinary calcium levels checked. 81.4% (n=35) were reported near significant pain reduction without any func- prescribed calcium and 79.1% (n=34) Vitamin D supple- tional improvement ments. 63.1% of patients with osteoporosis were on treatment S154 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
[bisphosphonates (n=11) or denosumab (n=1)]. Advice on Results: Our search yielded 3,227 articles; 27 articles were weight-bearing exercise was documented in 20.9% (n=9). eligible for review. Differences in hip fracture rates ap- Smoking cessation advice was documented in 10.3% of peared to be continent-specific; lower rates were observed smoking patients. for indigenous persons in all countries except for Canada Conclusions: A significant proportion of BMD assessments and Australia where the opposite was seen. Indigenous per- are not being requested according to guidelines and investiga- sons had higher rates of trauma-related fractures; the tion for secondary causes of low BMD in men is often incom- highest were observed in Australia where jaw fracture plete. Increased awareness of guidelines is required to opti- was 22-times greater for indigenous compared to non- mise patient management to reduce fracture risk thus avoiding indigenous women. After adjustment for confounders, in- potential complications leading to significant morbidity, mor- digenous compared to non-indigenous persons had a three- tality and increased healthcare costs. fold greater risk of osteoporotic fracture and five-fold great- References: er risk of craniofacial fracture; diabetes, substance abuse, 1. National Osteoporosis Foundation. Fast Facts on comorbidity, income, locality, and fracture history indepen- Osteoporosis. www.nof.org/osteoporosis/diseasefacts.htm. dently increased fracture risk. Accessed 4th October 2016. Conclusions: The paucity of data, and apparent continent- 2. Watts NB et al. J Clin Endocrinol Metab 2012;97:1802. specific differences, suggest an imperative to further inves- Acknowledgements: DrMariaAngelaGrima,DrDillon tigate indigenous status and fracture epidemiology and Mintoff, Dr Malcolm Mintoff, Dr Jessica Spiteri. aetiology. Our findings also have implications for commu- nities, governments and healthcare professionals to en- hance the prevention of trauma-related fractures in indige- P159 nous persons, and an increased focus on modifiable life- FRACTURES IN INDIGENOUS COMPARED TO NON- style behaviours to prevent osteoporotic fractures in all INDIGENOUS POPULATIONS: A SYSTEMATIC populations. REVIEW OF RATES AND AETIOLOGY S. L. Brennan-Olsen1, S. Vogrin2,R.Kinsella2, W. D. Leslie3, M. Toombs4, G. Duque2,S.M.Hosking5, K. L. Holloway5,B. P160 J. Doolan5, L. J. Williams5, R. S. Page5,J.A.Pasco5,S.E. UTILITY AND PITFALLS OF THE FRAX® TOOL Quirk6 RESULTS IN BRAZILIAN ELDERLY POPULATION 1Australian Institute for Musculoskeletal Science, The O. B. Malheiro1,M.A.M.Maia1,C.J.Machado2,E.N.De University of Melbourne, Melbourne, Australia, 2Australian Morais1,A.M.Kakehasi1 Institute for Musculoskeletal Science, The University of 1Geriatric Department of Federal University of Minas Gerais, Melbourne and Western Health, St. Albans, VIC, Australia, Belo Horizonte, Brazil, 2Epidemiology Unit of Federal 3Department of Internal Medicine, Faculty of Health Sciences, University of Minas Gerais, Belo Horizonte, Brazil University of Manitoba, Winnipeg, Canada, 4Rural Clinical School, University of Queensland, Toowoomba, Australia, Background: The Fracture Risk Assessment Tool (FRAX®) 5School of Medicine, Deakin University, Geelong, Australia, wasintroducedbytheWorldHealthOrganization(WHO)to 6School of Population and Global Health, The University of estimate the 10-year probability of osteoporotic fractures in Melbourne, Melbourne, Australia untreated patients with osteopenia. This tool is validated for Brazilian population since 2013 but the applicability in this Objectives: Compared to non-indigenous persons, indige- developing country has not been confirmed. nous persons experience disproportionately greater morbidity, Objectives: To compare the indication for pharmacological and a reduced life expectancy; however, conflicting data exist treatment in a Brazilian elderly population considering the regarding whether a higher risk of fracture is experienced by results of FRAX with bone mineral density (FRAX/BMD), indigenous compared to non-indigenous persons. We system- FRAX without BMD (FRAX) and of BMD classification ac- atically evaluated evidence for whether differences in fracture cording to the WHO. rates exist between indigenous and non-indigenous popula- Methods: The study population consisted of patients over tions of any age, and to identify risk factors that might explain 60 years of age from primary care units who had clinical potential differences. indication for BMD assessment. BMD was undertaken at Methods: In August 2016 we conducted an e-search of lumbar spine and femur by dual-energy X-ray absorpti- PubMed, OVID, MEDLINE, CINAHL, and EMBASE. ometry (DXA) Hologic Discovery W system and BMD Using the World Health Organization reference population results were classified according to the WHO criteria. as standard, hip fracture incidence rates were re-standardized Clinical data was obtained from patient records (second- for comparability between countries. ary osteoporosis, smoking, alcohol consumption, use of Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S155 glucocorticoids, rheumatoid arthritis, family history of hip P162 fracture, and previous history of fracture) and the 10-year TRENDS IN POST-OSTEOPOROTIC HIP FRACTURE probability of hip and major fractures was calculated CARE FROM 2010 TO 2014 IN A PRIVATE HOSPITAL using FRAX. Receiving operator curve (ROC) analysis, IN MALAYSIA model calibration and decision curve analysis were used S. S. Yeap1, M. F. R. Nur Fazirah2, C. Nur Aisyah2,Z.S.Siti to compare fracture prediction in FRAX® and Yazmin3, S. Intan Nureslyna3, S. Thambiah3,F.L.Hew1,B.P. FRAX/BMD groups. Lim4,Y.S.Siow4,S.P.Chan1 Results: 1,000 subjects were included, mean age 76.4 1Department of Medicine, Subang Jaya Medical Centre, years, 755 (75.5%) women. Osteoporosis, osteopenia and Subang Jaya, Malaysia, 2Faculty of Medicine and Health normal BMD were found in 439 (43.9%), 426 (42.6%) e Sciences, University Putra Malaysia, Selangor, Malaysia, 135 (13.5%) patients, respectively. One hundred and nine 3Department of Pathology, Faculty of Medicine and Health (10.9%) patients have already suffered a fragility fracture Sciences, University Putra Malaysia, Selangor, Malaysia, and 40 of those individuals presented with normal BMD or 4Department of Orthopaedic Surgery, Subang Jaya Medical osteopenia. In 366 (36.6%) patients it was not possible to Centre, Subang Jaya, Malaysia calculate FRAX score due to inability of recollection. The application of FRAX tool would lead to the indication of Aim: To look at the treatment of patients after a low trauma treatment for 40% of the osteopenic patients and for 62.4% hip fracture and to study the trends between 2010 to 2014. of the osteoporotic patients. Correlations between FRAX Materials and Methods: The hospital admissions database and FRAX/BMD were positive and statistically significant was searched for all patients over the age of 50 years who for both the 10-year probability of hip fracture and major were admitted with a hip fracture. Hip fractures due to fracture (0.704 and 0.594, respectively, p<0.001). ROC accidents or hip replacements for arthritis were excluded. curve analysis showed that the FRAX/BMD was superior Data was analysed using IBM SPSS version 22 for in identifying patients at risk of hip (Figure 1) and major Windows. fractures. Results: 370 patients over the age of 50 years were admitted Conclusion: Despite the easy access and simplicity of FRAX with a hip fracture, of which 257 (69.5%) were low trauma, it is not possible to disregard DXA, especially for patients with presumed osteoporotic, hip fractures. The median age was risk factor for fragility fractures. 79.0 years (IQR=12.0). 75.1% were female and 77.4% of Chinese ethnicity. 93/257 (36.2%) received treatment after their hip fracture, but out of these, 22/93 (23.7%) were on P161 calcium/vitamin D only. The median duration of patients’ THE EFFECT OF GRAFT ORIENTATION IN THE treatment was one month (IQR=2.5). The percentage of pa- ARTHROSCOPIC OSTEOCHONDRAL AUTOTRANS- tients treated following a hip fracture from 2010 to 2014 were PLANTATION 52.5%, 31%, 34%, 29.5% and 30.2% respectively. S. Park1, K. Choi1 Significantly more patients were treated in 2010 compared 1Dongguk University International Hospital, Seoul, Republic to the other years, but there was no difference in the number of Korea of patients treated in the years 2011-2014. Conclusions: The number of patients being treated after an Purpose: To introduce the clinical results of arthroscopic osteoporotic hip fracture in Malaysia remains low with only osteochondral autotransplantation are greatly affected by sur- 36.2% given treatment; of those, only 76.3% received active gical technique and graft orientation. osteoporosis medication. There was a reduction in patients Methods: 76 arthroscopic osteochondral auto transplantations getting treated from 2011-2014 compared to 2010 which is were practiced. The Lysholm knee score and NRS scale was disappointing. Once on medication, the median duration of recorded initially and 3, 6 and 12 months after the surgery. treatment was only 1 month. Follow up knee MR were done on 30 patients. The radiologic parameter, alpha angle and beta angle was analyzed in the group. Result: The mean Lysholm knee score improved from 64.43 P163 to 91.1. The Pearson coefficient of the clinical results of pa- OSTEOPOROSIS IN A PATIENT WITH SPINAL CORD tients with alpha angle and beta angle was -0.548, -0.792, INJURY: CHALLENGES IN THE THERAPEUTIC respectively. P-value was 0.002, 0.0001 respectively. APPROACH Conclusion: The surgical technique and graft orientation in J. Barroso1,M.Carvalho2,S.Pimenta3 the arthroscopic osteochondral autotransplantation is impor- 1Centro Hospitalar de São João/ Faculdade de Medicina da tant parameter affecting clinical results of patients. Beta angle Universidade do Porto, Porto, Portugal, 2Centro Hospitalar de was stronger parameter to predict the clinical results. São João/ Neurology Department, Porto, Portugal, 3Centro S156 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Hospitalar de São João/ Rheumatology Department, Porto, 1Department of Endocrinology, 424 General Military Portugal Hospital, Thessaloniki, Greece, 2Department of Endocrinology and Diabetes, 251 Hellenic Air Force and VA General Hospital, Objective: Osteoporosis is a frequent complication after spi- Athens, Greece, 3Laboratory of Clinical and Molecular nal cord injury, with a cumulative risk of 6.17 times superior Endocrinology, 1st Department of Internal Medicine, AHEPA to the normal population. The loss of bone mass begins early, University Hospital, Aristotle University of Thessaloniki, and is of approximately 1% of bone mineral density (BMD)/ Thessaloniki, Greece, 4Department of Rheumatology, 424 week in the first months after lesion. The complications asso- General Military Hospital, Thessaloniki, Greece, 5Private prac- ciated with osteoporosis in this population are potentially se- tice, Thessaloniki, Greece, 6Laboratories “Analysis”, vere and the therapeutics available present little success. We Thessaloniki, Greece, 7Center for Bone Quality, Leiden report a clinical case of osteoporosis in a spinal cord injury University Medical Center, Leiden, Netherlands patient and therapeutic challenge. Material and Methods: Clinical case report - 38 year-old Purpose: To investigate clinical and biochemical characteris- male patient, with C4 AIS A spinal cord lesion due to tics of patients with vertebral fractures following denosumab neuroborreliosis, with 11 years of evolution. When the lesion discontinuation. occurred supplementation with vitamin D and calcium, asso- Methods: Detail history and serum samples were obtained ciated with a bisphosphonate (pamidronate) was started and from postmenopausal women who: a) sustained vertebral frac- maintained (pamidronate for 5 years). In January 2015 the tures following denosumab discontinuation (Dmab/-Fx+, patient began complaints of lumbar discomfort with mobiliza- n=5); b) sustained vertebral fractures while treatment-naïve tions. A lumbar CT revealed diffuse and accentuated signals (Fx+, n=5); c) sustained no fractures 18-20 months off- of osteoporosis with lumbar fractures between L1 and L4 denosumab (Dmab/Fx-, n=5). Serum measurements included: vertebrae. The metabolic study presented normal values of i) procollagen type 1 N-terminal propeptide (P1NP), C- ionized calcium, beta-crosslaps, osteocalcin, parathormone terminal cross-linking telopeptide of type 1 collagen (CTx), (PTH) and vitamin D. Treatment with teriparatide was initiat- osteoprotegerin (OPG), soluble receptor activator of nuclear ed in January 2015. Eight months after, a CT revaluation factor kappa B (NF-κB) ligand (sRANKL) and sclerostin showed slight worsening of the osteoporotic fractures, with levels; ii) circulating microRNAs (miRs) that regulate osteo- sinking of the vertebral platforms from L1-L5. A discrete rise clastogenesis through modulation of expression of the recep- of bone reabsorption markers, with normal PTH was also tor activator of NF-κB (RANK), RANKL, and cathepsin K seen. (CTSK) and tartrate-resistant acid phosphatase (TRAP) Results: The antiosteoporotic therapies in spinal cord lesion (namely miR‐503, miR-21-2 and miR‐222-2, respectively); show accentuated therapeutic limitation both concerning bone iii) serum gene expression of RANK, CTSK, TRAP, OPG formation and eviction of progression of the disease. In this and RANKL. clinical case we show that despite the use of a bisphosphonate Results: Compared to Fx+, Dmab/Fx+ women had higher and posterior introduction of teriparatide we could not im- lumbar spine BMD values (p=0.019), P1NP (p=0.036) and prove the bone mass, with tomographic worsening of the le- CTx (p=0.123) levels, decreased miR-503 (p=0.044) and sions and rising of the bone reabsorption markers. miR-222-2 (p=0.038) expression, and higher RANK (13-fold Conclusions: The osteoporosis in the medular lesion is asso- increase, p<0.05) and CTSK (2.6-fold increase, p<0.05) ciated with diverse factors: immobilization, osteoanabolic ef- mRNA expression. Compared to Dmab/Fx-, Dmab/Fx+ fect of the loss of sensorial and sympathetic innervation, low- women had similar BMD values and higher CTx levels ering of anabolic factors and paracrine influence of local (p=0.015). Compared to Fx+, Dmab/Fx- women had changes amyotrophy. Bisphosphonates seem to diminish the loss of inmiRsandmRNAlevelsinthesamedirectionwithDmab/Fx+ BMD but do not lead to new bone formation, and teriparatide, women but considerably smaller and nonsignificant. thought less studied, does not seem to relate to BMD increase. Conclusions: Bone fragility in women with clinical vertebral New experimental drugs are currently in research, but the fractures after stopping denosumab therapy is pharmacologic approach stills limited. pathophysiologically different from that of treatment-naïve women with osteoporosis and clinical vertebral fractures and is associated with upregulation of osteoclastogenesis. The small P164 number of women with this rare event studied is a limitation. INCREASED OSTEOCLASTOGENESIS IN PATIENTS EXPERIENCING VERTEBRAL FRACTURES FOLLOWING DENOSUMAB DISCONTINUATION P165 A. D. Anastasilakis1,P.Makras2, M. P. Yavropoulou3,G.T. BONE LOSS AND MUSCLE WASTING INDUCED BY Sakellariou4, F. Papadopoulou5,S.Gerou6, S. E. Papapoulos7 BOTULINUM TOXIN (BTX) IN MICE CAN BE Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S157
IMAGED AND QUANTIFIED BY MICROCOMPUTED A. A. Al Saedi1,G.Duque2 TOMOGRAPHY (MICROCT) 1Melbourne Medical School, The University of Melbourne, D. Chappard1,H.Libouban1,E.Aguado2, C. Guintard2 Melbourne, Australia, 2Australian Institute for Musculoskeletal 1GEROM, University of Angers, Angers, France, 2ONIRIS Science, The University of Melbourne and Western Health, St. ENVN Nantes, Nantes, France Albans, VIC, Australia
Objectives: Muscle and bone masses are highly correlated, Background: Circulating osteoprogenitor (COP) cells are muscular activity is responsible of the loading regimen of considered a surrogate of the stem cell population in muscle each bone. Immobilization induces a severe sarcopenia as- and bone. Low levels of COP cells are associated with frailty sociated with a marked bone loss. Sarcopenia induced by and disability (Gunawardene et al. J Gerontol A Biol Sci Med BTX has been poorly investigated while bone loss is better Sci. 2015). Lamin A, a protein of the inner nuclear membrane, acknowledged. plays vital role in stem cell survival, replication, and differen- Material and methods: Twenty-one female mice were spread tiation. Lamin A deficiency affects osteoblast differentiation into 7 groups. At day-0, 18 mice received a BTX injection in and muscle mass and has been associated with osteosar- the right quadriceps to induce paralysis; the left contralateral copenia (Tong et al, Mech Ageing Dev. 2011). Therefore, side was used as control. Mice were sacrificed at 7, 14, 21, 28, we hypothesized that quantification of lamin A in stem cells 56 and 90 days post-BTX (3 mice per group). The day-56 and could be used as a more robust biomarker for musculoskeletal day-90 periods correspond to the recovery of disuse because diseases, and also as a predictor of frailty and disability in of reversible effect of BTX. The remaining group was not older persons. However, a non-invasive method to quantify injected and sacrificed at day-0. Bones of both hindlimbs were lamin A expression in stem cells was still required. imaged by microCT; morphometric analysis was done on the Considering that COP cells are a non-invasive source of stem femur and tibia (bone volume). The same hindlimb were im- cells, in this study, we aimed to develop and validate a flow- mersed in a contrast agent solution containing Hg. This heavy cytometric protocol to quantify lamin A expression in COP metal strongly binds to myoblasts. Three parameters were cells. calculated for the gastrocnemius and quadriceps femoris: area Methods: A random sample of community-dwelling individ- (mm2)occupiedbyeachmusclein2Dsection,circularityand uals aged 65 and older enrolled in the Nepean Osteoporosis aspect ratio (form factors). Then, the muscles were carefully and Frailty (NOF) Study (mean age 82.8; N=77; 70% female; dissected and weighed on a precision scale. 27 fit, 23 pre-frail and 27 frail). COP cells were identified by Results: Bone volumes were significantly reduced on the par- flow cytometry using selective gating of CD45/OCN+ cells. alyzed side after day-21 (p=0.02) and recovery was observed Lamin A was quantified in COP cells using percentage of after day-90. Area of both muscles was significantly lower in lamin A/C+ COP cells and also Mean Fluorescence the paralyzed limb from day-7 (p=0.03); the decrease was Intensity (MFI) for lamin A in COP cells. Logistic regression maximum at day-21 (-46.9%, p=0.001) for the gastrocnemius models estimated the relationship between the percentage of and day-28 (-47.9%, p=0.001) for the quadriceps. No differ- lamin A-expressing COP cells and prevalent disability and ence in geometric form factors was found between the para- frailty. lyzed and non-paralyzed limb confirming a global atrophy of Results: percentage of lamin A-expressing COP cells is de- the muscles. Similar results were obtained with the anatomical creased with age. Low lamin A expression in COP cells is also method which identified weight loss. Significant correlations associated with disability. Both Barthel (activities of daily were obtained between the area (microCT) and weight for the living) and OARS (instrumental activities of daily living) gastrocnemius and quadriceps muscle (r=0.782, p <0.001). scales decreased with lamin A values (p<0.004, p<0.01 re- Recovery of the muscles was complete at day-90. spectively). Lamin A MFI also decreases with age Conclusion: The use of specific contrast agents as “stains” for (p<0.001), in addition, low MFI values were associated with microCT opens new perspectives to better understand muscu- a significantly higher score in the frailty index (Rockwood) lar and skeletal relationships. The present study illustrates the (p<0.03). Moreover, lower percentage of COP cells express- relationships between evolution of bone and muscle mass dur- ing lamin A was associated with two-fold greater odds of ing the onset and recovery of sarcopenia and bone wasting. being frail than being fit (odds ratio (OR)=2.06, 95%CI=0.98-4.3). Conclusion: In this study we demonstrated the feasibility of a P166 new non-invasive diagnostic method to quantify of lamin A A NON-INVASIVE METHOD TO ANALYZE LAMIN A expression in COP cells. Low levels of expression of lamin A EXPRESSION IN CIRCULATING OSTEOPRO- were associated with the presence of disability and frailty. GENITOR (COP) CELLS AS A BIOMARKER FOR Although longitudinal studies are still required, this diagnostic MUSCULOSKELETAL DISEASE method offers a valid a reliable tool to diagnose S158 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 osteosarcopenia and to predict frailty and disability in 1Faculdade de Medicina da Universidade de Lisboa, Lisbon, osteosarcopenic patients. Portugal, 2Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, 3EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia, Lisbon, Portugal, P167 4Catolica Lisbon School of Business and Economics, Lisbon, NON-TRAUMATIC OSTEONECROSIS OF THE Portugal, 5Faculdade de Ciencias Medicas, Universidade Nova FEMORAL HEAD IS ASSOCIATED WITH LOW de Lisboa, Portugal, Lisboa, Portugal BONE MASS M. S. Soyfoo1, V. Gangji1, A. Heuschling1, V. Afzali1,R. Objectives: To describe the productivity loss associated with Moreno2, C. Gillet1,J.Rasschaert1,J.P.Hauzeur3 the clinically confirmed osteoarthritis (OA). 1Department of Rheumatology, Hôpital Erasme, ULB, Methods: We analysed data from the population-based Brussels, Belgium, 2Department of Nuclear Medicine, EpiReumaPt study (Sep2011-Dec2013). 10,661 inhabitants were Hôpital Erasme, ULB, Brussels, Belgium, 3Department of surveyed to capture all cases of rheumatic and musculoskeletal Rheumatology, CHU Liege, Liege, Belgium diseases within a representative sample of the population. We analysed all participants aged 50-64 years, near the official retire- Objective: This prospective study was undertaken to deter- ment age and all OA cases were clinically validated, according to mine whether osteonecrosis of the femoral head (ONFH) was the ACR classification criteria. For retired participants, years of associated with an increased prevalence of osteoporosis (OP) working life lost (YWLL) were determined as the difference be- and whether the increased prevalence of OP was related to the tween each OA participant’s age and the respective retirement age stage of ONFH at diagnosis. when self-reported retirement was caused by a rheumatic condi- Methods: We included 243 patients with ONFH and 399 age tion, while the potential YWLL (PYWLL) was the difference and sex-matched healthy controls. Data were gathered includ- between official and actual retirement ages. An official wage da- ing demography, risk factors, ARCO staging of ONFH and tabasewasusedtoestimateproductivitybygender,ageandregion bone mineral density (BMD). using the human capital approach. The effects of OA on the like- Results: Overall, BMD (defined by the T-score) was signifi- lihood of early exit from paid employment and the attributable cantly lower in the ONFH group at both the femoral head (-0.96 fractions estimates were obtained at the individual level by mul- ±1.11) and the lumbar spine (-1.22±1.47) compared to the con- tivariable logistic regression. trol group (-0.55±0.97 and -0.73±1.31) (p<0.01). The ONFH Results: In the survey, more than half of the population aged group depicted a significantly higher proportion of osteopenia between 50 and 64 years were out of paid work (51.8%) and (50.39% vs. 40.87%, p=0.027) and of OP (18.78% vs. 7.33%, p had an OA prevalence of about 30% (29.7%; men: 16.2% and <0.001) relative to the control group. Stage 1 and 2 ONFH women: 43.5%. Knee OA: 18.6%; hand: 12.6%; hip: 3.6%). patients (53.86%, adj. p-value=0.0203; odds of 1.54 (95% CI: OA is associated with early exit from paid employment, spe- [1.04; 2.29])) were at a higher risk of osteopenia than the control cifically knee OA (OR: 2.25; CI: 1.42-3.59; p=0.001). Other group (40.88%), but not stages 3 or4 (48.47%, adj. p-val- OA locations do not have a statistically significant effect on ue=0.2569; odds ratio of 1.27 (95% CI: [0.78; 2.06]). Patients work loss. Early exit from paid employment due to OA led to with stage 3 or 4 ONFH (25.31%, adj. p-value<0.001; odds ratio a total of 143,262 YWLL and 338,822 PYWLL (84 and 198, of 3.93 (95% CI: [1.63; 10.96])) were at a higher risk of osteo- respectively, per 1000 inhabitants in the age group 50-64). porosis than patients in the stage 1 and 2 ONFH (7.24%), and The estimated annual indirect cost attributable to OA was compared to the control group (7.33%, adj. p-value<0.001; odds €656 million (€384 per capita; €1294 per OA patient and ratio of 4.89 (95% CI: [2.77; 8.76]). Multivariate logistic regres- €2095 per OA patient out of work). Females contributed with sion showed that the GC use was the only independent factor 61.6% of these costs (€404 million). associated with a higher risk of OP in stage 3 and 4 ONFH. Conclusions: A considerable amount of productivity loss is Conclusions: This study showed that fractural stages ONFH associated with OA. Premature withdrawal from employment were associated with a 5-fold risk of osteoporosis. Therefore, attributable to OA amounts to approximately 0.39% of the we advise that patients suffering of ONFH should be screened national GDP. The high prevalence and the impact of this for low bone mass. disabling chronic disease highlight the need to prioritize pol- icies targeting early exit from work in OA.
P168 THE PRODUCTIVITY LOSS ASSOCIATED WITH P169 OSTEOARTHRITIS THE IMPORTANCE OF THE ORTHOPAEDIC P. A. Laires1,H.Canhão2, A. Rodrigues1, M. Eusébio3,M. SURGEON IN THE PREVENTION OF A SECOND Gouveia4,J.C.Branco5 FRAGILITY HIP FRACTURE Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S159
M. Osca Guadalajara1,L.J.FloríaArnal1,A.C.Urgel P170 Granados1, M. Royo Agustín1,A.CastroSauras1,P. USE OF ANTI-OSTEOPOROSIS DRUGS IN TYPE 2 Gonzalez García2 DIABETIC PATIENTS: A POPULATION-BASED 1Hospital Obispo Polanco Teruel, Teruel, Spain, 2Department COHORT STUDY of Geriatrics, Orthogeriatric Unit, Hospital Obispo Polanco, D. Martinez-Laguna1, C. Carbonell-Abella1,A.Soria- Teruel, Spain Castro1,X.Nogués2,A.Diez-Perez2,D.Prieto-Alhambra3 1Institut Catala de la Salut and Idiap Jordi Gol, Barcelona, Introduction: Hip osteoporosis fracture in elder patients is a Spain, 2Department of Internal Medicine, Hospital del Mar- frequent pathology in Trauma and Orthopaedics Units. It is Imim and Autonomous University of Barcelona, Barcelona, estimated 9 million fragility fractures per year around the Spain, 3Musculoskeletal Biomedical Research Unit, world, which 1.6 million are hip fractures. This disease would University of Oxford, MRC Lifecourse Epidemiology increase due to the people aging. So the surgeon has double Centre, Southampton, Oxford, United Kingdom role, treating the fracture surgically and preventing refracture by administrating drugs in order to reduced morbidity and Objective: An increased fracture risk has been described as a mortality as well as health cost. complication of type 2 diabetes mellitus (T2DM), despite Objectives: The aim of this work is to know hip refracture T2DM patients having a relatively high bone mineral density index in those patients who suffer their first hip fracture in our compared to the general population. We analyzed the associ- area (Teruel, Spain) and if they were correctly treated with ation existing between T2DM status and the prevalence of osteoporosis drugs for secondary prevention. Furthermore, 1.anti-osteoporosis drugs (AOD) use and 2.previous frac- to analyse the factors that could change this refracture index. ture/s. Methods: Prospectiverandomizedstudyof100patientswho Material and methods: Population-based cohort study using suffered their first episode of hip fragility fracture in Trauma data from the SIDIAP Database which contains clinical infor- and Orthopaedic Unit of Hospital Obispo Polanco of Teruel. mation from primary care, hospital admission records, and We excluded the cases of high energy traumatism. The mean pharmacy invoice data for >5 million patients (80% of the age was 82 years old and 73% of the patients were women. population) in Catalonia, Spain. We selected all ≥50 years 60% suffered an intracapsular hip fracture. The mean surgery old T2DM patients registered in SIDIAP in 2006-2013 and delay was 3.6 days. Before the episode of hip fracture, 35.4% 2 diabetes-free controls were matched to each T2DM partici- of the patients had been previously diagnosed of osteoporosis pant on age (±2 years), gender and primary care center. Main disease. However, only 10% of them were treated with osteo- outcomes were prevalent fractures (except face, skull, jaw, porosis drugs. hand or fingers) and the use of AOD grouped into Results: Osteoporosis treatment was prescribed in 8% of the bisphosphonates (BF), calcium and vitamin D supplements patients at hospitality discharge and 22% first one month-con- (CaD) and any anti-osteoporosis drug (AAOD). We used lo- sultation. It means that only 30% of them received secondary gistic regression to estimate the risk of AOD use according to prevention drugs for osteoporosis. In a mean of 20 months T2DM status, adjusted for age, gender, body mass index, period, 18% of the patients had a hip refracture, all of them smoking, alcohol intake, previous ischemic heart (IHD), cere- on the contralateral side. So 1 of 4.5 patients of our area suf- brovascular disease (CVD), and previous fractures. fered a second hip fracture. The rate of hospital mortality was Results: We identified 166,106 T2DM patients and 332,212 7%. We observed a higher mortality rate in the first year after matched non-diabetics. T2DM subjects had higher prevalence the first hip fracture in comparison with the next five years. At of previous fractures (1.3% vs. 0.3%), CVD (5.9% vs. 3.0%) five year of following-up, more than half of the cases had died. and IHD (9.9% vs. 4.1%) than non-diabetic. The use of BF in The refracture index was statistically significant with two var- T2DM was of 6.59%, compared to 9.26% in non-diabetic iables. First, the type of hip fracture (p=0.05), having higher (p<0.001); the use of CaD 9.72% vs. 12.34% (p<0.001); and risk those patients who suffered an extracapsular fracture the use of AAOD 7.64% vs. 10.66% (p<0.001). After [OR=1, 6 (IC 95% 1,04-2,6)]. Second, the presence of a pre- adjusting for confounders, T2DM patients appeared less likely vious osteoporotic fracture (p=0.03) [OR=2,7 (IC 95% 1,16- toreceiveBF(OR=0.67;95%CI0.64to0.68),CAD 6,5)]. (OR=0.71; 95% CI 0.70 to 0.73) or AAOD (OR=0.66; 95% Conclusion: Hip fragility fracture is a prevalent disease in our CI 0.64 to 0.67) therapy than non-diabetics. Trauma and Orthopaedics Services. As it is known and we Conclusion: Although T2DM patients have a higher preva- showed in our study, fragility fracture is a predictor to suffer lence of fracture, they are 30% less likely to receive any anti- another fragility fracture. Therefore, we should raise aware- osteoporosis therapy when compared to matched non-dia- ness in clinicians and surgeons to ensure secondary osteopo- betics. Fracture risk underestimation (due to higher BMI and rosis prevention in order to avoid a second hip fracture as well BMD) and lower awareness in T2DM patients might explain as other fragility fractures. these findings. S160 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
P171 Objective: To evaluate the effect of brace treatment on bal- TREATMENT OF OSTEOARTHRITIS KNEE WITH ance performance in AIS subjects. AUTOLOGOUS CONDITIONED SERUM: Study design: systematic literature review COMPARATIVE, PROSPECTIVE STUDY Method: The search strategy was based on the Population D. Hang1 Intervention Comparison Outcome method. A search was per- 1Shin Kong Orthopedic Sports Medicine Institute, Taipei, formed in PubMed, Scopus, ISI web of knowledge, Ovid, Taiwan, Province of China Cochrane library (CENTRAL) and Google scholar databases by using selected keywords. Eleven articles were selected for Objective: To compare the efficacy of the standardized injec- final evaluation. tion therapies of (1) autologous conditioned serum (ACS) Results: Most of the studies showed AIS subjects were char- against (2) corticosteroid in patients with knee pain secondary acterized by a significant increase in the center of pressure to osteoarthritis. parameters compare with healthy subjects. Wearing brace in Material and Methods: 92 patients with knee pain (more than AIS subjects can improve quiet standing balance via muscle three months) secondary to radiographically confirmed osteoar- co-contraction and proprioceptive stimulation, but after thritis were followed prospectively after intra-articular knee in- weaning brace duration, improvement in balance parameters jection of either ACS (series of four injections over 2 weeks) or in the scoliosis subjects was not observed. corticosteroid (one time injection). All patients were followed Conclusion: In longer follow up, brace can improve balance prospectively and at 6 and 12 months after the injection. Pre- control but studies using high quality methods are needed to and post-treatment values were determined by Visual Analog support effectiveness of bracing on balance performance in Scale (VAS), global patient assessment, and WOMAC score. AIS subjects. Results: In group 1, 68.9% of patients experienced 50-100% pain reduction at 6 month and 70.5% after 12 months. Average pain relief (VAS) at 12 months was 58.4% (6.07 to 2.52) P173 (p<0.05). The WOMAC score showed significant (p<0.05) in- CONDITIONAL ABROGATION OF ATM IN crease in function (70.3 vs. 27.2), mobility (8.6 vs. 3.1), and OSTEOCLASTS EXTENDS OSTEOCLAST significant decrease in pain (20.9 vs. 9.0) at 12 months. LIFESPAN AND RESULTS IN REDUCED BONE In group 2, 15.2% of the 34 knees experienced 50-100% pain MASS reduction at 6 month and 4.7% at 12 months after injection. T. Hirozane1, T. Tohmonda1,M.Yoda1, M. Shimoda2,Y. Average pain relief (VAS) at 12 months was 0.13% (5.57 to Kanai2,M.Matsumoto1, H. Morioka1,K.Horiuchi1,M. 5.56). The WOMAC score showed decreases in function (69.9 Nakamura1 vs. 73.9), minimal decrease in pain (20.17 vs. 20.16), while slight- 1Keio University School of Medicine, Department of ly increase in mobility (8.63 vs. 7.9). When comparing the two Orthopedic Surgery, Tokyo, Japan, 2Keio University School groups at 6 and 12 months post-injection, the changes in pre- and of Medicine, Department of Pathology, Tokyo, Japan post-injection pain (VAS and WOMAC), function and Mobility (WOMAC) was more significant in group 1 (p<0.05). Objectives: Ataxia-telangiectasia mutated (ATM) is a Conclusion: Treatment with conditioned autologous serum 350 kDa Ser/Thr protein kinase that plays an essential role (Orthokin) effectively reduces pain in osteoarthritic knees. in DNA damage repair. While mice lacking ATM exhibit re- The risk profile is minimal for both treatment regimens. duced bone formation and increased bone resorption, the po- tential cell-autonomous functions of ATM in osteoclasts are not yet fully understood. In the present study, we generated P172 mutant mice in which Atm is specifically abrogated under the A SYSTEMATIC REVIEW OF ORTHOTICS ON control of the cathepsin K promoter (AtmCtsk mice) to eluci- BALANCE PERFORMANCE IN IDIOPATHIC date the potential function of ATM in regulating osteoclast SCOLIOSIS SUBJECTS activity. A. Aboutorabi1,M.HashemiYari2 Methods and Results: In a preliminary experiment, we found 1Department of Orthotics and Prosthetics, University of Social that ATM is activated at a higher level in mature osteoclasts Welfare and Rehabilitation Sciences, Tehran, Islamic than in bone marrow-derived macrophages, indicating that Republic of Iran, 2Pharmacy Faculty of Tehran University of ATM is involved in a later stage of osteoclastogenesis or in Medical Sciences, Tehran, Islamic Republic of Iran the maintenance of osteoclast functions. Bone morphometric analysis and μCT analysis showed that AtmCtsk mice have re- Background: Adolescent idiopathic scoliosis (AIS) patients duced bone mass compared to control mice, indicative of in- have postural equilibrium problems and using spinal braces creased bone resorption activity in osteoclasts lacking ATM. are common nonsurgical methods in treatment of these subjects. Abrogation of ATM in osteoclast precursors did not result in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S161 any remarked impact on their differentiation; however, we found that osteoclasts lacking ATM are less prone to apoptosis both in vivo and in vitro, indicating that ATM negatively reg- ulates osteoclast longevity. In accordance, osteoclasts lacking ATM showed an overall increase in the amount of bone resorp- tion compared to control cells in vitro. Of note, we found that NF-kB, a signaling molecule critically involved in the regula- tion of osteoclast survival, is highly activated in osteoclasts in The mean of 25(OH)D was 18.3±5.76 (3-29 ng/ml) in the the absence of ATM. Taken together, these observations indi- whole group, 28 (11.5%) were deficient (<10 ng/ml of cate that ATM suppresses NF-kB activity and thereby indirect- 25(OH)D). Eucalcemia was a feature in the whole group ly regulates osteoclast survival and bone resorption. (mean of 9.60±0.40, range 8.70-11.1 mg/dl) with exception Conclusions: Our data show that AtmCtsk mice exhibit re- to 3 patients with borderline hypercalcaemia in patients with duced bone mass due to increased bone resorption, and that type 2. On average iCa was within normal values (1.16-0.112 abrogation of ATM in osteoclasts renders these cells less mmol/l), yet 112/244 (46%) expressed subnormal levels. All prone to apoptosis and extends their lifespan by enhancing comparisons of 25(OH)D, tCa and iCa between type 2 NF-kB activity. (lightest) and other groups were non-significant apart from the frequency of subnormal iCa in type 2 vs. type 3, p=0.0123.The mean of PTH was 56.9±25.7 pg/ml yet 77/ P174 239 (32%) expressed secondary hyperparathyroidism (<65 IMPACT OF SKIN-COLOUR ON HYPOVITAMINOSIS pg/ml). The P value between type 2 and other types were D IN A MIDDLE EASTERN POPULATION. NS as well. H. M. Al Attia1 Conclusions: By and large, the above data were not dis- 1Department of Internal Medicine and Rheumatology, criminatory between the groups with different skin types Universal Hospital, Abu Dhabi, United Arab Emirates thus hypovitaminosis D could not be shed light upon on the basis on the color of the skin in this cohort. Information Background: Abu Dhabi, is the capital city of the UAE enjoys on dietary habits, dressing styles and duration of sun ex- year round sunshine and hot climate (average 34.46°C). The posure if any are to be considered in conjunction with the population is extremely heterogeneous. Arabs and Asians from above data. the Indian- subcontinent form the majority of the population. Despite the ample sunshine however, most people tend to stay indoors avoiding the exposure to the excessive heat during the daytime. This and some other social and dietary factors could P175 have an impact on the existing high prevalence of PREVALENCE OF BONE FRACTURES IN PATIENTS IN hypovitaminosis D. Several studies in the past have attempted RENAL REPLACEMENT THERAPY: RELATIONSHIP to identify the factors behind the vitamin inadequacy. This WITH POTENTIAL RISK FACTORS 1 2 3 work is focusing on the skin colour type of the residents and S. Lapman ,A.Negri, R. Heguilen 1 2 whether it adds to the understanding of the problem. Cetec Srl, Buenos Aires, Argentina, Idim, Buenos Aires, 3 Patients and methods: The records of 247 adult patients with Argentina, Hospital Fernandez, Buenos Aires, Argentina hypovitaminosis D (<30 ng/ml) have been studied. They were categorized according to their skin colour using Fitzpatrick Background: Bone fractures are an important cause of mor- skin scale. Data of 25(OH)D, total calcium (tCa), ionized cal- bidity and mortality in patients in renal replacement therapy. cium (iCa) and PTH were also sought. Data of patients with The aim of this unicenter observational study was to quantify chronic renal failure, on vitamin D supplementation, on corti- the prevalence of bone fractures by anatomical site in preva- costeroids were excluded. Comparison made between the lent patients in hemo and peritoneal dialysis and to study its lightest and each of the other groups separately. relationship to potential risk factors. Results: 179 (72.5%) were Arabs and 56 (22.5%) were Methods: We performed a retrospective analysis of medical Asians. The lightest skin type was type 2. Table 1 shows the records of all adult prevalent patients in hemo and peritoneal distribution and the characteristics of the patients according dialysis at our center on July 1, 2016. We searched for factors their shin type. The mean of 25(OH)D was 18.3±5.76 (3-2 that could be related to fractures as age, sex, dialysis vintage 9ng/ml) in the whole group, (18.0±5.77, 18.6±5.73, 17.3 BMI, concomitant diseases, laboratory parameters and medi- ±6.32, 19.4±4.66 1in (. 6 were D deficient (9%) in individuals cations used. with type 2. Results: We included 118 patients, 110 in hemodialysis and Table 1. 18 in peritoneal dialysis. Prevalence of bone fractures was S162 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
13.5% (16/118). There were no fractures in peritoneal dialysis body height and VAS scores could not be detected in both patients. Fractured patients had a mean age of 61.4±12.9 groups. years; 52.2% were females with a time in dialysis of 62.6 Conclusion: The comparative analysis of this study shows ±46 months. The most prevalent fracture site was the hip (6 that promising results can be achieved with the augmentation pat. 55.6%); in 2 patients the fracture was bilateral followed of vertebral fractures with the Vertect Jack Device. When by the spine (5 pat. 45.4%). Mean Pi was 5.0±1, calcium 8.4 compared with kyphoplasty, advantages show in terms of ±0.5, CaxP 41.9±9.2, iPTH 462±488, Alk Phosp (U/L) 136 targeted and thus more gentle application possibility and bet- ±175. We could not find risk factors associated with fractures ter pain relief over a period of 6 months after surgery. Further in this population. study results should help to demonstrate the efficacy and tol- Conclusions: Fractures were seen only hemodialysis patients erability of the new method. and were more prevalent at the hip. We could not find risk factors associated with fracture prevalence. P177 LOW BACK PAIN ORIGINATING FROM THE P176 SACROILIAC JOINT: 1 YEAR RESULTS FROM A VERTECT JACK DEVICE: A NEW METHOD FOR RANDOMIZED CONTROLLED TRIAL OF AUGMENTATION OF VERTEBRAL FRACTURES CONSERVATIVE MANAGEMENT VS. MINIMALLY R. Bornemann1, Y. Rommelspacher1,D.C.Wirtz1,R. INVASIVE SURGICAL MANAGEMENT Pflugmacher2 R. Pflugmacher1,R.Bornemann1,J.Dengler2,D.Kools3,A. 1Universitätsklinikum Bonn, Bonn, Germany, 2Department of Gasbarrini4,D.Prestamburgo5, B. Sturesson6 Orthopedics and Trauma Surgery, University Clinic Bonn, 1Universitätsklinikum Bonn, Bonn, Germany, 2Department of Bonn, Germany Neurosurgery,Charité,Berlin,Germany,3Department of Neurosurgery, Hospital Aalst, Aalst, Belgium, 4Instituto Summary: Kyphoplasty is a proven minimally invasive pro- Ortopedico Rizzoli di Bologna, Bologna, Italy, 5Department cedure for the treatment of patients with osteoporotic fractures. of Orthopedics and Traumatology, Legnano, Italy, By augmentation of fractured vertebral body, however, a very 6Department of Orthopedics, Aleris, Ängelholm Hospital, large portion of the intervertebral structures will be destroyed. Ängelholm, Slovakia With the help of a new device (Vertect Jack Device), the erec- tion of the vertebral body will be carried out gentler. Background: In approximately 15-30% of patients with Objective: In the present study, the new method should be chronic low back pain (LBP) a significant part of the pain clinically tested for efficacy and safety for the first time in originates from the sacro-iliac joint (SIJ). Chronic SIJ pain is patients. As a comparison results of previous treatments with associated with disability and poor quality of life. Recently, kyphoplasty are used. minimally invasive surgical treatments have been developed Material and methods: For Vertect Jack Device study pa- for those who fail conservative or interventional therapies tients with painful vertebral fractures were selected in which (e.g. steroid injections, RF ablation). We report here the 12- conservative treatment had not yielded sufficient results. For month results from a European multicenter randomized con- comparison random data from the records of patients who had trolled trial comparing clinical outcomes of minimally inva- been treated with kyphoplasty were selected. The Vertect Jack sive sacroiliac joint fusion (SIJF) vs. conservative manage- Device what placed under the central fractures and then ment (CM) for patients with chronic SIJ pain. erected. After having restored the vertebral height the device Objective: To compare the safety and effectiveness of conser- was removed and cement injected. Clinical and radiological vative management (CM) to minimally invasive sacroiliac examinations were carried out before and after 1,3, and 6 joint fusion (SIJF) in patients’ low back pain (LBP) originat- months. ing from the sacroiliac joint (SIJ) pain. Results: In the Vertect Jack Device Group the data of 40 Design and Methods: 103 adults with chronic LBP originat- patients were evaluated. For group 2 (kyphoplasty) 50 pa- ing from the SIJ were randomly assigned to CM (N=51) or tients were selected. There was a significant difference in SIJF using triangular titanium implants (N=52). CM consisted the duration of the surgery (Group 1: 27.4, Group 2: 45.9 of optimization of medical therapy, individualized physiother- minutes). A significant difference of 20 mm with regard to apy and adequate information and reassurance as part of a the reduction of VAS scores (0- 100 mm pain intensity) multifactorial treatment. The primary outcome was the differ- was detected. Under the application of Vertect Jack ence in change in self-rated LBP at 6 months, using the visual Device an average increase of 3.1 mm of vertebral height analogue scale (VAS). Other effectiveness and safety end- was achieved. In group 2, the erection averaged 0.4 mm. A points, including leg pain, disability using Oswestry correlation between the postoperative change of vertebral Disability Index (ODI), quality of life using EQ-5D-3L, and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S163
SIJ function using active straight leg raise test (ASLR), were <74/100 mm to >45/100 mm and 12 (32%) patients had sig- assessed up to 12 months. nificant improvement VAS <44/100 mm. Results: At 12 months, mean LBP improved by 41.6 VAS Conclusion: Treatment with methotrexate in patients with points in the SIJF group vs. 14.0 points in the CM group osteoarthritis of the knee, refractory by traditional drugs, could (treatment difference of 27.6 points, p<.0001). Mean ODI be an optional therapy. Its use can improve pain and synovitis. improved by 25.0 points in the SIJF group vs. 8.7 points in the CM group (p<.0001). Also, mean improvements in leg pain and EQ-5D-3L were large after SIJF and superior to those P179 after CM. CM subjects were allowed to cross over to SIJF EFFECT OF ETORICOXIB ON CARTILAGE TISSUE after 6 months. Subjects who crossed to surgical treatment METABOLISM IN PATIENTS WITH OSTEOARTHRITIS had no pre-crossover improvement in pain and ODI scores; R. Yatsyshyn1, O. Shtefiuk1,H.Fedoroych1, J. Sandurska1,O. after crossover, improvements were as large as those original- Drogomeretska1, M. Yatsyshyn1 ly assigned to SIJF. One case of postoperative nerve impinge- 1Ivano-Frankivsk National Medical University, Ivano- ment occurred in the surgical group. No important late adverse Frankivsk, Ukraine events occurred between month 6 and 12. Conclusions: For patients with LBP originating from the SIJ, Objective: To study the effect of etoricoxib on cartilage tissue minimally invasive SIJF with triangular titanium implants was metabolism in patients with coxarthrosis. safe and more effective than CM in relieving pain, reducing Materials and Methods: There were examined 38 patients disability, improving patient function and quality of life. Our with newly diagnosed coxarthrosis, namely 31 (81.6%) fe- findings will help to inform decisions regarding its use as a males and 7 (18.4%) males. All the patients were divided into treatment option in this patient population. 2 groups: Group I (20 patients) received diclofenac sodium at a dose of 100 mg/day; Group II (18 patients) received etoricoxib at a dose of 90 mg/day. The state of cartilage tissue (matrix P178 metalloproteinase (MMP)-3, MMP-9, osteoprotegerin (OPG) METOTHREXATE USE IN THE TREATMENT OF and pro-inflammatory cytokines (ІL-1, TNF-α) was monitored OSTEOARTHRITIS OF THE KNEE at hospital admission and 6 months after starting treatment. A. Zoto1, T. Backa1,V.Salko1, E. Rapushi1,E.Ktona1,E. Results: In patients of Group II in contrast to Group I, more Xherahu1, L. Nuhaj1 positive dynamics of changes in cartilage tissue evidenced by 1Rheumatology Service UHC “Mother Theresa” Tirana, more pronounced reduction in the serum levels of MMP-3, Tirana, Albania MMP-9, and OPG 6 months after starting treatment was ob- served. There was a directly proportional correlation between Objective: To evaluate the treatment with methotrexate in the levels of ІL-1, TNF-α and the levels of OPG, MMP-3 and patients with osteoarthritis of the knee refractory by traditional MMP-9. 6 months after therapy, in patients of Group II, treatment. TNF-α and ІL-1 titers were significantly lower compared to Material and Methods: This is a prospective cohort study patients of Group I. High titers of pro-inflammatory cytokines that include 37 patients that fulfill clinical criteria of American (TNF-α, ІL-1) worsened the course of osteoarthritis causing College of Rheumatology for knee osteoarthritis. These pa- cartilage erosion. tients were followed as outpatients. Inclusion criteria for treat- Conclusions: 1) In patients with coxarthrosis, there was a ment with methotrexate were synovitis, pain and inefficacy of clear directly proportional correlation between the processes traditional treatment to reduce pain and synovitis. Synovitis of cartilage tissue degradation and the activity of chronic in- was detected clinically and by ultrasound imaging at the be- flammatory process. 2) The use of etoricoxib (90 mg/day) in ginning and at the end of the study. Pain was assessed using patients with coxarthrosis reduced the severity of the inflam- the visual analogue pain scale (VAS), (0–100 mm), at the matory syndrome, thereby preventing cartilage degradation, beginning and at the end of the study. Knee pain in all patient as evidenced by the values of MMP-3, MMP-9, IL-1, was at least ≥ 75/100 mm on a VAS scale in activity. Patients TNF-α and OPG levels. have received methotrexate 10 mg/week for 24 weeks. Reference: Chen JJ et al. Asian Pac J Trop Med. 2014 Results: The mean (±SD) age of the patients was 59.17 (±8.75) Apr;7(4):297. years. The mean (±SD) duration of disease was 9.21 (±3.54) years. Female patients are 20 (54%) and male patients are 17 (46%). Before treatment with methotrexate all patients were P180 with severe pain, while after treatment with methotrexate at ASSESSMENT OF PRO- AND ANTI-INFLAMMATORY 24 weeks, 6 (16%) patients had no improvement, VAS remains CYTOKINES IMBALANCE WITH DISEASE ≥ 75/100 mm; 19 (51%) patients had partial improvement, VAS SEVERITY OF RHEUMATOID ARTHRITIS S164 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
A. Aggarwal1, A. Sharma2,A.Bhatnagar3 Several factors involved in its pathogenesis. These factors are 1Center of Excellence in HIV Care, Department of Internal heredity, elderly, race, ethnicity, hormones, physical inactivity, Medicine, PGIMER, Chandigarh, India, 2Department of sunlight exposure, vitamin D deficiency and certain drugs. In Internal Medicine, PGIMER Chandigarh, Chandigarh, India, Africa, few data are available and the disease prevalence is 3Department of Biochemistry, Panjab University Chandigarh, may be underestimated. In Senegal, measure of bone mineral Chandigarh, India density is recent. In this study, our objective was to determine DXA patients profile and epidemiological, clinical character- Background: An array of cytokines is involved in the dis- istics of patients for densitometry examination. Thus, 43 cases ease severity of systemic autoimmune diseases such as were collected; lumbar and femoral sites were evaluated. rheumatoid arthritis (RA). Study of cytokine balance in Median lumbar T-score was - 0.91 and the femoral T-score - RA may persuade both the diagnostic process and therapeu- 0.16. Osteopenia was found in 35% of patients and osteopo- tic approaches. rosis in 26%. Bone Mineral Density was abnormal in 60% of Objectives: To assess the levels IL-18, TNF-α in serum sam- cases. This study is another proof of documented reality of ples and IFN-γ, IL-8, and IL-4 positive NK and NKT cells of osteoporosis in Senegal. It determines frequency in a popula- peripheral blood of RA patients and their correlation with tion at risk. For the future, it opens way for further larger disease activity score. studies to get better profile of the patients and prevalence Materials and Methods: This retrospective study included osteoporosis in Senegal. 70 newly diagnosed RA patients (49 females, 21 males) and matched 100 healthy controls. Disease activity score was cal- culated using standard DAS28. Levels of IL-18 and TNF-α in P182 serum samples were quantified using ELISA while intracellu- PAGET'S DISEASE IN SENEGAL: TWO CASES OF A lar expression of IFN-γ, IL-4 and IL-8 in NK and NKT cells RARE DISEASE IN BLACK AFRICAN POPULATIONS were determined by multicolour flow cytometry. Differences A. R. Ndiaye1,I.Diédhiou1 between the means were compared and levels were correlated 1Hôpital Principal de Dakar, Dakar, Senegal with DAS28 using suitable tests. Results: Mean age of patients and healthy controls were 35.2 Mr. MD is a man 72 years old is admitted for spontaneous and 33.8 years, respectively. Average DAS28 score of the pa- pain, permanent, crushing type, pelvis above the right hip tients was 5.21. Level of IL-18 was found to be 3.04-fold higher evolving for two years, without night or morning stiffness while 5.9-fold higher expressions was recorded for TNF-α in but increase with hearing loss, temporal and parietal head- patients as compared to healthy controls. Moreover, IFN-γ+ ache. A physical examination of the musculoskeletal sys- NK, IFN-γ+ NKT, IL-8+ NK, and IL-8+ NKT cells were also tem, standing was unremarkable, walking without limp raised in RA patients (67.3±14.6, 63.3±20.7, 62.2±16.8, and was done without help. The hip was painful to the active 72.6±14.2). However, IL-4+ NK and IL-4+ NKT cells were and passive mobilization movements including schedules markedly (p<0.001) diminished (2.27±2.50 and 2.35±3.68) in and counter clockwise rotations upset as well as the abduc- patients. IL-18, TNF- α,IFN-γ, and IL-8 were positively cor- tion and flexion of the thigh on the pelvis. Pressure iliac related while IL-4 was inversely correlated with DAS28. spines and lower lumbar and sacrococcygeal was painful. Conclusions: The balance of Th1 and Th2 cytokines were The patient showed no inflammatory syndrome. Serum cal- poised towards Th1 in RA. Anticytokine agents may serve cium was normal. We noted an isolated increase in alkaline as potent therapeutic agent in RA treatment. The work is in phosphatase levels to 401 IU/l. The radiograph showed bi- progress to investigate these cytokines as biomarkers of dis- lateral heterogeneous sclerosis of the spongy iliac bone ease severity. thickening lines and iliac ischial pubic straight and almost disappearance of the right hip joint space. There was a marked thickening of the cortex on the femoral proximal P181 third and thickening of the cranial vault. MRI showed cor- DXA CONTRIBUTION IN BONE DENSITOMETRY tical thickening of the right pelvic bone, a greasy type of EVALUATION ON OSTEOPOROSIS IN SENEGAL: signal at the bone marrow of the right pelvic bone with a RESULTS OF A STUDY REALIZED IN AFRICAN hyper signal T1, an intermediate T2 signal cancellation with BLACK POPULATIONS fat. After injection, there was a medullary enhancement of A. R. Ndiaye1,I.Diédhiou1 the right hip bone is remodelled. Bone scan showed: intense 1Hôpital Principal de Dakar, Dakar, Senegal focal hyper fixations skull, the right clavicle, right hemi- pelvis, small and large left trochanter, sacrum, the sacroiliac Osteoporosis, a public health problem is able to occur severe left, the right external condyle of the shaft splints. This fractures and its prevalence increases in developing countries. symptomatology was pathognomonic of Paget's disease. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S165
The second patient is a man 72 year old with no history, regardless of knee osteoarthritis. Visual analogue scale for received for pain electively serving basin on the right side, knee pain was higher in patients with MSUS abnormalities intense (VAS=8/10), pulsating, almost permanently, without (p<0.001). But there was no statistically difference of irradiation, exacerbated by the local pressure with night MGUS abnormalities with presence of thyroid autoantibodies. recrudescence without morning stiffness. Physical examina- Conclusion: Both hypothyroid and hyperthyroid status was tion objectified no musculoskeletal deformity, but woke significantly associated with MSUS abnormalities with knee pain on palpation and mobilization of the right hip. There arthralgia. MSUS is a useful tool to detect clinically early was no oedema or collateral circulation or limitation of joint joint abnormalities. We suggest that patients with diagnosed amplitudes. Biologically, serum alkaline phosphatase (ALP) thyroid dysfunction and who remain uncontrolled, should was raised to 4 times normal. Osteocalcin, procollagen type assess the MSUS examination in patients with arthralgia. 1 N the terminal pro-peptide, the marker CTX resorption Moreover, a thyroid function test for unexplained arthritis were not assayed, helpful exam that if PAL is normal. maybe warranted. Radiography showed cortical thickening of the ischial pubic branch, a heterogeneous sclerosis gypsy moth of the iliac wing, a steady narrowing of the femoral hip-spaced lines P184 and thickening of the iliac ischial pubic. This aspect is CHANGES IN KNOWLEDGE AND ATTITUDE ABOUT pathognomonic of PD, the patient underwent treatment with VITAMIN D AMONG SCHOOL STUDENTS IN ZAGA- zoledronic acid intravenously 5 mg. The outcome was ZIG DISTRICT, SHARKIA GOVERNORATE, EGYPT: favourable to 10 months with reduced pain (VAS=2/10) AN INTERVENTION STUDY and normal PAL. A. A. El Badawy1,M.M.Aboserea1,E.M.Mortada1,E.H. Waly1, N. Raafat Abdelfatah2,S.A.ElBadawy3 1Community Medicine Department, Zagazig Faculty of P183 Medicine, Cairo University, Zagazig, Egypt, 2Biochemistry HYPOTHYROID AND HYPERTHYROID STATUS WAS Department, Zagazig Faculty of Medicine, Cairo University, STRONGLY ASSOCIATED WITH MUSCULO- Zagazig, Egypt, 3Rheumatology and rehabilitation SKELETAL ULTRASONOGRAPHIC ABNORMA- Department, Cairo University, Cairo, Egypt LITIES WITH ARTHRALGIA H.-S. Kim1, B.-Y. Kim1, S.-S. Kim2 Objectives: To determine the impact of health education in- 1The Soonchunhyang University Seoul Hospital, Seoul, tervention program on students’ knowledge, and attitude Republic of Korea, 2Department of Internal Medicine, concerning vitamin D as well as the effect of vitamin D and Gangneung, Asan Hospital, Ulsan University College of calcium supplementation on serum levels of 25(OH)D, total Medicine, Gangneung, Republic of Korea Ca, ionized Ca and parathormone among studied students. Subjects and methods: Arandomizedcontrolledinterven- Objective: To determine whether musculoskeletal ultrasono- tion study in which subjects were randomly assigned to an graphic (MSUS) abnormalities were observed according to intervention and control groups, with the intervention being the state of thyroid disease. a health education program with vitamin D and calcium sup- Methods: Patients with thyroid disease were categorized as plementation during the academic year 2012-2013. The esti- euthyroid, hypothyroid, or hyperthyroid status according to mated sample size was 138 students (69 students in each their disease activity and evaluated the association with group). The study was carried out over 3 phases: pre-test, MSUS abnormalities. In addition, the association of the pres- intervention and 6 months. Knowledge and attitude of the ence of thyroid autoantibodies with MSUS abnormalities was studied students about vitamin D were measured as well as also studied. In MSUS, an experienced rheumatologist exam- their level of serum 25(OH)D, total Ca, ionized Ca and PTH. ined the presence of synovial fluid, synovial hypertrophy, and Some associated risk factors were also studied. grade of power Doppler in the knee joint. Results: It was found that poor dietary habits among the Results: A total of 109 patients participated in the study. studied students were prominent. Logistic regression anal- MSUS abnormalities were statistically significantly higher in ysis revealed that vitamin D can only be predicted by the hyperthyroid or hypothyroid status than in euthyroid status level of ionized calcium, parathormone level, total calcium (p<0.001). However, there was no statistically significant dif- level and duration to sun exposure. Application of pre-test ference between hypothyroid status and hyperthyroid status. and posttest revealed a significant improvement among the The presence of MSUS abnormalities with abnormal thyroid group submitted to the health education. The highest im- function was corrected according to the presence of radiolog- provement was noticed as regards how to prevent vitamin ical Knee osteoarthritis. Both hypothyroid and hyperthyroid D deficiency, followed by health problems and complica- status was still associated with MSUS abnormalities tion related to vitamin D deficiency and finally causes of S166 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 vitamin D. In contrast the attitude did not show similar years (p<0.004) due to most patients were female at premen- improvement. The comparison between the levels of opausal age. There is significant association between smoking 25(OH)D, total Ca, ionized Ca, and parathormone level and osteoporosis in DM patients (p<0.002), Also BMI show before and after the intervention showed significant chang- no significant association with osteoporosis in DM patients as es after health education and vitamin D and calcium most of patients were obese or overweight with increase bone supplementation. mineral density. Conclusion and Recommendations: Health education pro- Conclusion: There is significant association between gram had an appreciable impact in improving knowledge and smoking and osteoporosis in DM patients. positive attitude of students about vitamin D. Vitamin D and calcium supplementation as well improved the laboratory re- sults. Accordingly, we need to consider the implementation of P186 health education programs together with vitamin D and calci- MEAN SERUM 25OHD IN THE GENERAL POPULATION um supplementation for all students in the preadolescent and CORRELATES WITH DAY LENGTH AND UV INDEX adolescent stages to avoid vitamin D deficiency and conse- S. D. C. Thomas1 quently improve their health. 1Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
P185 Introduction: Vitamin D deficiency is a significant public SMOKING IS ASSOCIATED WITH INCREASED RISK OF health concern with inadequate vitamin D status in 31% of OSTEOPOROSIS IN DIABETES MELLITUS PATIENTS the Australian population1. Up to 50% of the population may T. Alsaadawi1 be vitamin D insufficient or deficient in winter months2. 1Hilla Teaching Hospital, Babylon, Iraq Nationwide epidemiological studies show that latitude and season are independent factors affecting vitamin D status2. Background: Diabetes mellitus, in particular type 2 diabetes The following study was performed to determine the relative mellitus (T2DM), is a common metabolic disease with in- influence of day length and UV index on serum vitamin D creasing prevalence throughout the world. Musculoskeletal status. (MSK) complications of diabetes mellitus (DM) are the most Method: Mean monthly serum 25OHD for all samples common endocrine arthropathies. Osteoporosis is considered analysed by pathology providers in SA (Adelaide 34.9285oS, a global public health problem currently affecting over than 138.6007oE) and Victoria (Melbourne 37.8136oS, 144.9631oE) 200 million people. Osteoporosis is the most common system- during 2012 (January to July)3 were linearly regressed against ic skeleton illness that characterized by reduce of bone mass average monthly day length and UV index. and disruption of bone architecture resulting an increased risk Results: The mean serum 25OHD for each month was higher of fragility fractures which represent the main clinical conse- in the SA population. The mean serum 25OHD in the popu- quence of the disease. Smoking is associated with multiple lation was correlated with average monthly day length and complications of diabetes; the risk of complications associated UV index to a similar extent. The correlation coefficient was with tobacco use and diabetes in combination has been stated higher for the SA population compared to Victorians. (0.9 vs. to be approximately 14 times higher than the risk of either 0.7). smoking or diabetes alone. Discussion: Population vitamin D status is highly dependent Objective: To assess the association of smoking with osteo- on the average number of daylight hours and UV index. porosis in diabetes mellitus patients. Despite public education regarding skin cancer, our popula- Patients and Methods: A cross sectional study was conducted tion appears to be reliant on sunlight for vitamin D. Those on 150 patients with diabetes mellitus mainly type 2. All patients with limited or no exposure to sun such as infants and the were seen in the Department of Rheumatology in Hilla Teaching elderly therefore will require supplementation. Hospital. Patients’ data were obtained via face-to-face interview References: performed by rheumatologist. DM related data, such as dura- 1. Nowson CA et al. Med J Aust 2012;196:1. tion, Smoking history, drug use (oral hypoglycemic drugs, in- 2. Daly RM et al. Clin Endocrinol 2012;77:26. sulin), body mass index (BMI), patient send for DXA to confirm 3. Australian Bureau of Statistics, National Biomedical diagnosis of osteoporosis, also after exclusion of other causes of Survey, 2011-2012, released April 2014. osteoporosis by exclusion criteria which done by many hormon- al and other laboratory investigations. Results: Among 150 patients with DM, 60.70% were females P187 and 39.30% were males, as the females predominant in the AGE AND BMI ARE STRONGER DETERMINANTS study. There is association between osteoporosis and age <50 OF SERUM PTH THAN CALCIUM INTAKE OR Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S167
VITAMIN D STATUS IN HEALTHY POSTMENO- H.-J. Shin1,H.-S.Na1 PAUSAL WOMEN 1Department of Anesthesiology and Pain Medicine, Seoul S. D. C. Thomas1,M.Horowitz2,H.A.Morris3 National University Bundang Hospital, Seongnamsi, 1Endocrine and Metabolic Unit, Royal Adelaide Hospital and Republic of Korea Department of Biochemistry, Clinpath Laboratories, Adelaide, Australia, 2Endocrine and Metabolic Unit, Royal Objective: We investigated the role of adjuvant analgesics if Adelaide Hospital, School Medicine, Faculty of Health used intraoperatively during total knee arthroplasty (TKA) Sciences, University of Adelaide, Adelaide, Australia, under spinal anaesthesia. Propofol and dexmedetomidine 3Directorate of Chemical Pathology, SA Pathology and were compared. School of Pharmacy and Medical Sciences, University of Methods: The dexmedetomidine group received 1 μgkg-1 South Australia, Adelaide, Australia dexmedetomidine for 10 min followed by a continuous infu- sion at 0.1–0.5 μgkg-1 h-1. In the propofol group, propofol Introduction: Serum parathyroid hormone level has been was infused continuously via a target-controlled infusion de- reported to rise with age. Hyperparathyroidism is a vice, and the effect-site concentration was maintained with a recognised cause of osteoporosis in postmenopausal women. range of 0.5–2.0 μgml-1. The numerical rating scale (NRS) The rising PTH level with age has been attributed to several for pain at rest, the cumulative amounts of fentanyl adminis- factors and the present study was undertaken to estimate the tered via intravenous patient-controlled analgesia (IV PCA), relative importance of several factors in healthy postmeno- rescue analgesics, and antiemetics were compared between pausal women. the two groups during the postoperative 24 h and 48 h. Method: Fasting blood samples were collected from commu- Results: Dexmedetomidine significantly reduced the consump- nity dwelling healthy postmenopausal women for biochemical tion of fentanyl during the postoperative 24 h [64.4 (64.0) analysis. Abdominal visceral fat content was measured using vs.177.5 (164.9) μg, P <0.001)] and 48 h [151.3 (112.5) vs. DXA and weight and height were recorded. Pearson correla- 393.8 (333.6), P=0.001)]. NRS was determined to be lower at tion analysis was used to determine univariate relationships postoperative 24 h [1.48 (0.9) vs. 2.9 (1.6), P <0.001] and 48 h between variables and linear stepwise regression analysis was 48 h [2.3 (0.9) vs. 3.5 (1.4), P=0.001] in the dexmedetomidine performed to determine multivariate relationships. group than in the propofol group. There were no significant Results: PTH was significantly positively correlated with age, differences in the amount of antiemetics and rescue analgesics BMI and serum crosslaps and negatively correlated with cal- between the two groups at postoperative 24 h (P=0.488 and cium intake. Abdominal fat mass, fasting glucose and total P=0.143)and48h(P=0.155 and P=0.078). cholesterol positively correlated with PTH but did not reach Conclusions: Intraoperative dexmedetomidine sedation was significance. Age and BMI were found to be significant de- more effective in relieving acute postoperative pain after TKA terminants of serum PTH. Calcium absorption, serum ionised with less opioid use compared with intraoperative propofol Ca or vitamin D status were not strong determinants of PTH. sedation. Vitamin D status was significantly negatively correlated with abdominal fat mass. Discussion: The main determinants of serum PTH in P189 healthy postmenopausal women appear to be age and ESTIMATED LONG TERM COST SAVINGS FROM BMI. The rise in PTH with age may be explained by a IMPLEMENTING A FRACTURE LIAISON SERVICE rising BMI, a rising creatinine level or a fall in calcium AT A HOSPITAL IN DENMARK intake. When evaluating postmenopausal women with hy- L. Lombard1, E. Hernlund2,L.Hansen3,F.Marin4 perparathyroidism their weight or BMI should be consid- 1Health Outcomes and Health Technology Assessment, Eli ered as well as biochemical parameters. Women with Lilly and Company, Windlesham, United Kingdom, greater abdominal fat content are at risk of vitamin D 2Mapi Group, Stockholm, Sweden, 3Danish Center for deficiency. Healthcare Improvements, Aalborg University, Aalborg East, Denmark, 4Medical Affairs, Eli Lilly and Company, Windlesham, United Kingdom P188 THE INFLUENCE OF INTRAOPERATIVE SEDATIVE Introduction: Osteoporosis (OP) affects hundreds of millions ON ACUTE POSTOPERATIVE PAIN IN TOTAL of people worldwide. A prior fragility fracture is a strong risk KNEE ARTHROPLASTY UNDER SPINAL factor for future fractures. Programmes such as a fracture ANAESTHESIA: A COMPARISON BETWEEN liaison service (FLS), that include identification, assessment DEXMEDETOMIDINE AND PROPOFOL – A and treatment, are successful interventions for secondary RANDOMIZED TRIAL fracture prevention. S168 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Aim: To estimate the budget impact over time after introduced non-invasive tool which indirectly assesses bone implementing FLS in a mid-sized hospital in Denmark. quality and fracture risk independently of BMD. Methods: The budget impact model, with a Markov structure Aim: To assess the added value of TBS in subjects with the and 6 months cycle length, estimated the cost and fracture MetS. consequences of implementing a FLS. The health states were Subjects and methods: A retrospective cross-sectional study hip, clinical vertebral, forearm and other OP fractures. In ev- 104 Caucasian subjects diagnosed with the MetS using the ery cycle, the model population is at risk of fracture and death. ATPIII criteria. Body composition and bone density were The risk of fracture is reduced by patients receiving anti-OP assessed by dual X-ray absorptiometry (GE Lunar Prodigy) treatment. Two scenarios were modelled: A scenario where and the lumbar spine images were also analyzed using the FLS is not implemented (20% of patients receive treatment TBS iNsight (version 2.1.2, Med-Imaps) in order to generate after a fracture) and a scenario where FLS is implemented TBS-adjusted T-scores. (60% of patients receive treatment after a fracture). The pop- Results: The study group consisted of 57 men (55%) and 47 ulation included men and women, 50 years or older with a women (45%) with a mean age of 58±10 (±SD) and a mean fragility fracture in the last 6 months. The hospital perspective BMI 32.9±4.4. The mean T-score was +0.05±1.3 while the was used including cost of FLS (excluding drug costs) and mean TBS adjusted T-score was -0.8±1.4. Classified by lum- direct healthcare cost of fractures. bar BMD T-score, bone density was normal in 83 subjects Results: Over a 10-year period, assuming 3096 patients (80%) but indicative of osteopenia in 19 (18%) and osteopo- fracture each year, FLS management and diagnosis costs rosis in 2 (2%) participants. After TBS adjustment, however, (DXA, x-rays, GP visits) were higher in the FLS scenar- the number of subjects with abnormal T-score more than dou- io compared to non-FLS scenario (Danish Krone bled to 43%, out of which 29 (28%) were classified as (DKK)-1.79million(M) and DKK-15.08M, respec- osteopenic and 16 (15%) were clearly within the osteoporosis tively)(1DKK=0.13€). However, the cost of subsequent range. Indeed, most osteoporotic subjects (14/16) were missed fractures was lower in the FLS scenario compared to by standard BMD but identified by TBS-adjusted BMD. non-FLS scenario (DKK84.08M). This resulted in a net Notably, after TBS adjustment 31% of subjects originally de- savings of DKK67.22M for the FLS scenario. The net fined as "normal" by BMD alone, had to be reclassified as savings per patient entering a FLS was DKK1,171 and osteopenic, and 6% as osteoporotic. Likewise, 32% of there were 35 avoided fractures per 1000 patients enter- BMD-defined osteopenic subjects were reclassified as osteo- ing a FLS. porotic after TBS adjustment. Subjects reclassified as osteo- Conclusion: This model estimates a substantial net saving of porotic were significantly heavier (105 kg±5.5 vs. 93kg±1.7 DKK67.22M over 10 years with the implementation of a FLS p=0.015). Men were more likely to be reclassified than wom- compared to no FLS. en but this was not statistically significant, the age of the Disclosures: Study funded by Eli Lilly. subjects reclassified was not significantly different either. Conclusions: In this sample of metabolic syndrome pa- tients, bone mineral density identified only one of 7-8 P190 subjects at risk for fragility fractures. In this setting, the TRABECULAR BONE SCORE UNCOVERS assessed bone status is significantly shifted downwards OSTEOPENIA AND OSTEOPOROSIS IN A LARGE following TBS-adjustment. Hence, the trabecular bone FRACTION OF PATIENTS WITH THE METABOLIC score seems to provide added value over standard bone SYNDROME mineral density in assessing bone fragility in metabolic V. Rouach1,Y.Marcus1,J.Sack1,M.Yaron1,G. patients and it needs to be further validated in this pop- Shenkermam1, Y. Sofer1,G.Sheffer1,E.Carmeli2, N. Stern1 ulation. 1Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv, Israel, 2Rambam Health Care Campus), Haifa, Israel P191 Background: The metabolic syndrome (MetS) is a constella- GLUCOCORTICOID-INDUCED CLINICAL tion of medical conditions consisting of central obesity, hyper- VERTEBRAL FRACTURE AND MORTALITY IN glycemia, hypertension, and dyslipidemia, in which each acts JAPANESE FEMALE PATIENTS WITH on bone tissue in different ways. Since MetS often precedes AUTOIMMUNE RHEUMATIC DISEASES diabetes mellitus (DM) and much like type 2 DM is largely I. Tastuno1, Y. Sato1,T.Sugiyama2 driven by obesity, bone fragility might be under-estimated by 1Toho University Sakura Medical Center, Sakura, Japan, bone mineral density (BMD) alone in MetS patients, as is the 2National Hospital Organization Shimoshizu National case in DM. The trabecular bone score (TBS) is a recently Hospital, Yotsukaido, Japan Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S169
Although osteoporotic fracture is a known independent risk evaluated by DXA. Serum 25-hydroxyvitamin D level was for mortality in postmenopausal osteoporosis, whether gluco- measured by the Nichols Advantage competitive binding corticoid (GC)-induced osteoporotic fracture is independently chemiluminescence immunoassay. Vitamin D insufficiency associated with mortality in autoimmune rheumatic diseases is defined as a 25(OH)D concentration of <30 ng/ml. remains unclear. We investigated whether clinical vertebral Results: In men (n=54), weight, BMI and fat mass were neg- fracture is a risk factor of 10-year mortality in pre- and post- atively correlated to TBS (r=-0.38; p <0.01, r=-0.30; p <0.05 menopausal female patients with autoimmune rheumatic dis- and r=-0.31; p <0.05 respectively) while serum vitamin D eases receiving high-dose GC treatment. This was a single- level was positively correlated to TBS (r=0.36; p <0.01). center observational cohort study conducted at Shimoshizu The positive association between TBS and serum vitamin D National Hospital (Chiba-Shimoshizu Rheumatic Cohort). remained significant after adjustment for BMI. Vitamin D- Among female patients aged ≥18 years who were newly treat- sufficient men (n=22) had a significantly higher TBS (1.423 ed with high-dose GC (initial doses ≥20 mg prednisolone ±0.081 vs. 1.347±0.082; p <0.01) compared to vitamin D equivalent per day) for at least 6 months between 1986 to insufficient men (n=32). In women (n=61), weight, BMI and 2006, 42 patients who died within 10 years from treatment fat mass were not significantly correlated to TBS while serum initiation, and 223 alive patients who were followed for 10 vitamin D level was positively correlated to TBS (r=0.47; p years were studied. The diseased group had significantly older <0.001). The positive association between TBS and serum age (61.2±13.2 vs. 39.1±13.5, p<0.001), lower daily dose vitamin D remained significant after adjustment for BMI. (38.3±12.5 vs. 45.6±15.8 g/day, p<0.001), lower BMI (20.0 Vitamin D-sufficient women (n=18) had a significantly higher ±2.9 vs. 21.2±3.1, p<0.05), higher rate of smoking (31.0 vs. TBS (1.417±0.113 vs. 1.364±0.079; p <0.05) compared to 15.7%, p<0.05) and higher prevalence of clinical vertebral vitamin D insufficient women (n=43). fracture (64.3 vs. 17.9%, p<0.001) compared to the alive Conclusion: Our study suggests that serum vitamin D is a group. Cox regression model demonstrated that the indepen- positive determinant of TBS in young Lebanese adults. To dent risks for mortality were age (>50 years) [HR (95%CI): our knowledge, this is the first study to find positive correla- 4.79 (1.98-11.60), P<0.001], smoking [2.30 (1.17-4.53), tions between serum vitamin D and TBS in young adults. p=0.016), and clinical fractures [3.07 (1.52-6.23, p=0.002]. Optimizing serum vitamin D levels may be associated with Clinical vertebral fracture was independently associated with higher TBS values in young adults. Our study provides an mortality among pre- and postmenopausal female patients of additional evidence of vitamin D on bone health. newly receiving high-dose GC treatment for autoimmune rheumatic diseases. P193 DIAGNOSIS AND TREATMENT OF MYOTONIC P192 AND MYOFASCIAL SYNDROMS OF NECK PAIN VITAMIN D AND TRABECULAR BONE SCORE IN A. Filippovich1 YOUNG LEBANESE ADULTS 1National Science and Practice Centre of Medical Assessment A. Alwan1,A.J.Berro1,J.Matta2,F.Frenn2, M. Rizkallah3, and Rehabilitation, Minsk, Belarus G. Maalouf3,H.Zouhal4,R.ElHage1 1Department of Physical Education, Fass, University of Objectives: The dynamic monitoring of 195 patients with Balamand, Kelhat El Kurah, Lebanon, 2Industrial Research myotonic and myofacial syndromes of neck pain was done Institute, Beirut, Lebanon, 3Bellevue University Medical Center, against the control group of 45 people. Faculty of Medicine, Saint Joseph University, Mansourieh, Methods: An extended neurological examination was carried Lebanon, 4STAPS, University of Rennes 2, Rennes, France out which included roentgenometry of cervical and vertebrocranial areas of spinal column, electromyography of Aim: To explore the relation between serum vitamin D and 7 to 9 relevant muscles, finding of the “key” muscle and the TBS in a group of young Lebanese adults. overall computer aided assessment of osteomuscular, cardio- Methods: 54 young Lebanese men (22 normal-weight, 23 respiratory and oxygen transport system disorders. overweight and 9 obese) and 61 young Lebanese women Results: Clinical and electromyographic criteria for diagnosis (45 normal-weight and 16 overweight) whose ages range from of myotonic and myofascial syndromes of neck pain were 18 to 35 years participated in this study. Bone mineral content identified based on the occurrence rates. The role of major (BMC) and BMD were determined for each individual by system disorders in pathogenesis of neurological manifests DXA at whole body (WB), lumbar spine (L1-L4), total hip of neck pain was studied. New therapeutic approaches to stop- (TH), and femoral neck (FN) (GE Healthcare, Madison, WI). ping pain and myotonic syndromes were developed; the ef- Body composition and trabecular bone score (TBS) were also fectiveness of early rehabilitation measures was demonstrated. S170 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
The prevailing myotonic syndromes were identified which P195 were the musculus obliquus capitis inferior syndrome (in 68, ACUPUNCTURE TREATMENT FOR PATIENTS or 39.4% patients); superscapular area syndrome (33% of pa- WITH LOW BACK PAIN tients); musculus scalenus anterior and musculus scalenus A. Filippovich1 medius syndromes (18.9%); musculus pectoralis minor syn- 1National Science and Practice Centre of Medical Assessment drome (9.7%). Hypodynamia caused system disorders were and Rehabilitation, Minsk, Belarus noted in 78.3% patients including excessive body mass and fat content; reduced blood circulation rate and heartbeat volume Objectives: 78 patients with myotonic (MT) syndromes of and the pronounced decrease of PWC170. The most informa- lumbar osteochondrosis surveyed in dynamics for the purpose tive spondylographic findings were reduced thickness of pos- of their early diagnostics, studying of frequency, search of the terior areas of intervertebral disks from CI to CVII (52.3 to most interested muscles with revealing of a "key" muscle for 77.9% of patients), cervical lordosis impression (76.4%) and applying differentiated acupuncture uncovertebral arthroses (58.2%). Methods: The complex of methods including dynamics of the Conclusion: The most seriously affected (“key”)musclesin neurologic status, manual testing of muscles, CT, МRI, elec- neck pain patients were found. Diagnosis and treatment strat- tromyography of 5-6 muscular groups, reovasography of feet egies for neck pain patients were developed. was used. Results: Most clinically pronounced were the following syn- dromes: transverse muscle(23; 29,4%), oblique muscle (32; P194 41,1%)abdominal muscles, stomach, lumbar quadrate mus- SOME ASPECTS OF REHABILITATION FOR cles (28; 35,9%), big (19; 24,3%), large (42; 53,8%) and small PATIENTS WITH LOW BACK PAIN muscle(16; 20,5%), gluteus, piriform (29; 37,2%), and also A. Filippovich1 adductor (17; 21,8%), abductor (19; 24,3%), quadriceps 1National Science and Practice Centre of Medical Assessment femoris (41; 52,6%)muscles, gastrocnemius (43; 55,1%) and and Rehabilitation, Minsk, Belarus peroneal (29; 37,2%). In 54 (69,2%) patients prevailed asso- ciated (two and more) syndromes. Acupuncture points of gen- Objectives: Examinationof78patientswithmyotonic(МТ) eral action (GJ4, MJ6, E36, RP6, TR5, V40) and local mus- syndrome of lumbar osteochondrosis. cularpointswereusedtostoppainmuscularspasm,taking Methods: Patients went through the clinical estimation of into account the revealed MT-syndromes. Katadolon was ad- neurologic status, manual testing of muscles, CT and MRI of ditionally prescribed for stable pain syndrome (100mg/days, back bone lumbar department, interferential and needle elec- 10 days) for powerful analgesic, muscle relaxing effects, de- tromyography of the most damaged muscular groups, dosed leting of «painful memory», preventing of pain chronification. loading veloergometry, revasography of feet, and shins. Complex therapy appeared to be effective in 75 (96,2%) Results: It was established for the first time, that among MT- patients. syndrome patients 54 (69,2%) an associated damage of two or Conclusion: Timely diagnostics of associated MT-syndromes more muscles prevailed. The most damaged ("key") muscles of lumbar osteochondrosis allows to validate adequate therapy appeared to be gastrocnemius muscle (43; 55,1%), gluteus methods. medius (42; 53,82%), quadriceps femoris (36; 46,2%), rectus abdominis and external oblique (32; 41,1%), peroneal muscle (29; 37,2%), piriform muscle (29; 37,2%), lumbar quadrate P196 muscle (28; 35,9%), gluteus maximus (19; 24,3%), gluteus SOME CLINICAL AND ELECTROMYOGRAPHIC minimus (16; 20,5%), adductor (14; 17,9%) and abductor (9; CRITERIA FOR DIAGNOSIS OF MYOTONIC AND 11,5%) thigh muscles. Medical-rehabilitation complex on MYOFASCIAL SYNDROMES OF NECK PAIN damaged extremity was approbated in 27 patients with MT A. Filippovich1 syndrome. The complex included oral reception of katadolon 1National Science and Practice Centre of Medical Assessment (100 mg 3 times a day for 10 days), tractions on Fintrac-471 and Rehabilitation, Minsk, Belarus table (with force from 3 to 55 kg, a course of 8-10 sessions) and also acupuncture with use acupuncture points of general Methods: The dynamic monitoring of 195 patients with myo- action with vascular autonomic nervous system orientation tonic and myofacial syndromes of neck pain was done against (G14, MJ6, E36, RP6, TR5, V40) and locally-segmented the control group of 45 people. An extended neurological points on the most damaged muscular groups (АТ60, VB30 examination was carried out which included roentgenometry with deep introduction to piriform muscle; VB 34, VB41, F3). of cervical and vertebrocranial areas of spinal column, elec- Conclusion: After treatment damaged extremity pain has tromyography of 7 to 9 relevant muscles, finding of the “key” completely disappeared in 19 patients. muscle and the overall computer aided assessment of Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S171 osteomuscular, cardiorespiratory and oxygen transport system indicative and not safe for patients and to appoint the effective disorders. pathogenetic treatment including antiallergic, antihistamine Results: Clinical and electromyographic criteria for diagnosis preparations in a combination with probiotics (linex, etc.). of myotonic and myofascial syndromes of neck pain were Conclusion: At formation of the program of medical rehabili- identified based on the occurrence rates. The role of major tation of patients with MS it is necessary to consider not only system disorders in pathogenesis of neurological manifests activity of demyelination process, but also to exclude food al- of neck pain was studied. New therapeutic approaches to stop- lergy presence. It is necessary to exclude also the use of multi- ping pain and myotonic syndromes were developed; the ef- component dishes by patients with MS with a food allergy. fectiveness of early rehabilitation measures was demonstrated. The prevailing myotonic syndromes were identified which were the musculus obliquus capitis inferior syndrome (in 68, P198 or 39.4% patients); superscapular area syndrome (33% of pa- TECHNICAL MEANS OF REHABILITATION FOR tients); musculus scalenus anterior and musculus scalenus PATIENTS WITH BACK PAIN medius syndromes (18.9%); musculus pectoralis minor syn- A. Filippovich1 drome (9.7%). Hypodynamia caused system disorders were 1National Science and Practice Centre of Medical Assessment noted in 78.3% patients including excessive body mass and fat and Rehabilitation, Minsk, Belarus content; reduced blood circulation rate and heartbeat volume and the pronounced decrease of PWC170. The most informa- Examination of 78 patients with myotonic (МТ)syndromeof tive spondylographic findings were reduced thickness of pos- lumbar osteochondrosis in the age group of 21-60 years old terior areas of intervertebral disks from CI to CVII (52.3 to was conducted. Out of them men – 40 (51,3%), women – 38 77.9% of patients), cervical lordosis impression (76.4%) and (48,7%). Patients went through the clinical estimation of neu- uncovertebral arthroses (58.2%). rologic status, manual testing of muscles, CT and MRI of back Conclusions: The most seriously affected (“key”)musclesin bone lumbar department, interferential and needle electromy- neck pain patients were found. Diagnosis and treatment strat- ography of the most damaged muscular groups, dosed loading egies for neck pain patients were developed. veloergometry, revasography of feet, and shins. It was established for the first time, that among MT-syndrome patients 54 (69,2%) an associated damage of two or more P197 muscles prevailed. The most damaged ("key") muscles ap- FEATURES OF CEREBROSPINAL FLUID DYNAMIC peared to be gastrocnemius muscle (43; 55,1%), gluteus DISORDERS IN PATIENTS WITH INITIALLY medius (42; 53,82%), quadriceps femoris (36; 46,2%), rectus CHRONIC VIRAL ENCEPHALITIS abdominis and external oblique (32; 41,1%), peroneal muscle A. Filippovich1 (29; 37,2%), piriform muscle (29; 37,2%), lumbar quadrate 1National Science and Practice Centre of Medical Assessment muscle (28; 35,9%), gluteus maximus (19; 24,3%), gluteus and Rehabilitation, Minsk, Belarus minimus (16; 20,5%), adductor (14; 17,9%) and abductor (9; 11,5%) thigh muscles. Methods: MRI head, spinal cord, research of cerebrospinal Medical-rehabilitation complex on damaged extremity was fluid and its dynamic, immunological researches. approbated in 27 patients with MT syndrome. The complex Results: At an estimation of the received data of general con- included oral reception of katadolon (100 mg 3 times a day for tent of IgE in blood serum the following parameters of the 10 days), tractions on Fintrac-471 table (with force from 3 to food allergy were considered: 0 - absence or below a threshold 55 kg, a course of 8-10 sessions) and also acupuncture with [0,00-0,34 IU/ml], 1 - threshold level [0,35-0,69 IU/ml], 2 - use acupuncture points of general action with vascular auto- moderately increased [0,70-3,49 IU/ml], 3 - considerably in- nomic nervous system orientation (G14, MJ6, E36, RP6, TR5, creased [3,50-17,49 IU/ml], 4 - high [17,5-49,9 IU/ml], 5 - V40) and locally-segmented points on the most damaged very high [50,0-100 IU/ml], 6 - exclusively high level [> muscular groups (АТ60, VB30 with deep introduction to 100,0 IU/ml]. Thus it is necessary to underline, that threshold piriform muscle; VB 34, VB41, F3). Course of treatment - level was regarded by us as a fact of presence of a food allergy 12-15 sessions. at patients MS, which indicators (the general IgE) could ac- After treatment damaged extremity pain has completely dis- crue, especially at increase of available clinical symptoms MS appeared in 19 patients, pain essentially decreased and in- or occurrence of the new symptoms. Thus changes of creased tolerance of physical activity in 6 patients. It is immunogram indicators simultaneously took place. Among established, that katadolon shows not only analgesic and 23 patients with MS surveyed by us, the food allergy is re- neuroprotective, but also myorelaxing action on muscles of vealed in 4 people (17,4%). It has allowed to exclude the pelvic girdle and feet in patients with acute and chronic application of glucosteroid therapy, which is counter- pain syndrome. S172 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
P199 Mansourieh, Lebanon, 3Industrial Research Institute, Beirut, ACTIVITY CRITERIA OF DEMYELINIZATION Lebanon, 4EA-3300, APERE, Sport Sciences Department, PROCESS University of Picardie Jules Verne, Amiens, France A. Filippovich1 1National Science and Practice Centre of Medical Assessment Aim: To compare compression strength index (CSI), and Rehabilitation, Minsk, Belarus bending strength index (BSI) and impact strength index (ISI) among obese, overweight and normal-weight Methods: 396 multiple sclerosis patients from 15 to 33 years young women. old were examined and assessed by a set of factors: clinical Methods: 117 young women (20 obese, 36 overweight and 61 methods, immunoassays, myelinotoxic activity (MTA), CT normal-weight) whose ages range from 18 to 35 years participat- and MRI of cerebrum and spinal cord, myelinotoxic activity ed in this study. Bone mineral content (BMC) and BMD were (MTA). determined for each individual by DXA at whole body (WB), Results: A latent phase (the first group, 79 patients, 19.9%) is lumbar spine (L1-L4), total hip (TH), and femoral neck (FN) (GE characterized by slight increase in MTA of blood serum (7.6 Healthcare, Madison, WI). Body composition was also evaluated ±1.2 units; control group – 3.9±0.82 units; р<0,001), decrease by DXA. Composite indices of femoral neck strength (CSI, BSI of CD4+ in blood (34.8±1.64%, control group – 40.1±2.4%; and ISI) were calculated as previously described [1]. p<0,001) and by large increase in CIC levels (92.56±3,1 op- Results: WB BMC and WB BMD were significantly higher tical units compared to 69.32±4.28 in control group; in obese women compared to normal-weight women (p p<0,001). <0.05). Lumbar spine BMD was not significantly different A slow progradient phase of MS (second group, 156 patients, among the three groups. TH BMD and FN BMD were signif- 39.4%) is distinguished by moderate evident (apparent) in- icantly higher in obese women compared to normal-weight crease in MTA of blood serum (22.3; p<0,01 in comparison women (p <0.001). CSI, BSI and ISI values were significantly with 1st group), significant decrease of T-lymphocyte in blood lower in obese and overweight women compared to normal- serum by 32.4%, CD22+ by 71.1%, CD4+ by 33.9%, CIC weight women (p <0.001). In the whole population (n=117), levels by 12.4%, along increase in CD8+ by 1.3 times, weak BMI was negatively correlated to CSI (r=-0.66; p <0.001), induction of TNF-α at 84.3%; IL-8 at 4.8% patients. An acute BSI (r=-0.56; p <0.001) and ISI (r=-0.54; p <0.001) but pos- phase (third group, 144 patients, 36.3%) coupled with signif- itively correlated to WB BMC (r=0.27; p <0.01), WB BMD icant increase in MTA of blood serum (40.4±1.22 units) in (r=0.36; p <0.001), TH BMD (r=0.32; p <0.001) and FN comparison with 1st and 2nd groups. Acute condition of MS BMD (r=0.27; p <0.01). Moreover, body weight was nega- distinguished by significant increase in blood CD8+, IL-2P+, tively correlated to CSI (r=-0.58; p <0.001), BSI (r=-0.50; p Ig G,A,M, CIC level along decrease of T-lymphocyte <0.001), ISI (r=-0.38; p <0.001) but positively correlated to (51.7%±1.56%) and CD22+ levels. Increase in IL-2P+ at WB BMC (r=0.45; p <0.001), WB BMD (r=0.47; p <0.001), 64.1% patients coupled with significant increased TNF-α и TH BMD (r=0.38; p <0.001) and FN BMD (r=0.39; p IL-8. In the fourth group (17 patients, 4.4%) fast progress of <0.001). Finally, fat mass percentage was negatively correlat- MS distinguished by high MTA level of blood serum (78.2 ed to CSI (r=-0.62; p <0.001), BSI (r=-0.52; p <0.001), ISI ±4.4 units), persistent immunological changes: increase in (r=-0.46; p <0.001) but positively correlated to WB BMD CD4+, CD8+, IL-2P+, IgG, IgM, IgA, CIC along decrease (r=0.20; p <0.05). of T-lymphocyte, CD22+. In comparison with 3rd group sig- Conclusion: This study suggests that obesity is associated nificant decrease of CD8+ along increase in CIC took place. with lower CSI, BSI and ISI values in young women. Conclusions: Measurement of blood serum MTA and im- Implementing strategies to increase femoral neck strength in- mune reactivity in combination with clinical and MRI find- dices in young obese women may be useful for preventing ings helps to correctly estimate the rate of demyelinization in osteoporotic fractures later in life. multiple sclerosis patients. Reference: Karlamangla AS et al. Osteoporos Int 2004;15:62.
P200 P201 DECREASED COMPOSITE INDICES OF FEMORAL THE NATURAL ANTIOXIDANTS LYCOPENE AND NECK STRENGTH IN YOUNG OBESE WOMEN POLYPHENOLS SHOWN PREVIOUSLY TO LOWER A. J. Berro1,A.Alwan1, M. Rizkallah2,J.Matta3,F.Frenn3, THE RISK OF POSTMENOPAUSAL OSTEOPOROSIS G. Maalouf2,S.Ahmaidi4 ARE NOW SHOWN TO STIMULATE BONE 1Department of Physical Education, Fass, University of FORMATION AND INHIBIT OXIDATIVE STRESS IN Balamand, Kelhat El Kurah, Lebanon, 2Bellevue University OSTEOBLASTS CULTURED IN-VITRO Medical Center, Faculty of Medicine, Saint Joseph University, L. Rao1,A.V.Rao2 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S173
1Dept of Medicine, University of Toronto, and Dept. of P202 Medicine, Div. of Endocrinology and Metabolism, St. EFFECT OF IBANDRONATE THERAPY ON SERUM Michael's Hospital, Toronto, Ontario, Canada, 2Dept of HOMOCYSTEINE AND LEPTIN IN POSTMENO- Nutritional Sciences, University of Toronto, Toronto, PAUSAL OSTEOPOROTIC FEMALES Ontario, Canada S. Tariq1,2,S.Alam3, M. Baig4 1Pharmacology and Therapeutics/ University Medical and Separate clinical trials previously showed that tomato Dental College, The University of Faisalabad, Faisalabad, lycopene and polyphenol-containing nutritional supple- Pakistan, 2Physiology/University Medical and Dental ments lowered the risk of postmenopausal osteoporosis College, The University of Faisalabad, Faisalabad, Pakistan, with increased total antioxidant capacity and decreased 3Pharmacology and Therapeutics/ Shaikh Zayed Postgraduate lipid and protein oxidations and bone resorption marker Medical Institute, Shaikh Zayed Hospital Lahore, Lahore, (1,2). Pakistan, 4Clinical Biochemistry/ King Abdul Aziz Objectives: To delineate the mechanisms involved in the ac- University (KAU) Jeddah, Saudi Arabia, Jeddah, Saudi tion of lycopene and polyphenols in vitro on the bone-forming Arabia osteoblasts cells. Materials and Methods: Lycopene Study;clonedhuman Objective: The incidence of osteoporosis and osteoporotic CD34+ osteoblasts were pre-treated separately with 1 mM fractures is increasing in the world. Therefore, it is essential of various cis:trans lycopene for 48 hours prior to or after to find out the modifiable risk factors contributing to osteopo- induction of oxidative stress with 250 mM of H2O2 for 3 rosis. The current study was planned to determine the effects hours. Polyphenol Study; Extracts of nutritional supplements of ibandronate on serum homocysteine and leptin levels in greens+TM or bone builderTM were added alone or in combi- postmenopausal osteoporotic females and to correlate these nation to osteoblasts SaOS-2 cells. For both studies, with BMD. Mineralized bone nodule formation (MBNF) was quantified Methods: Forty-two newly diagnosed and untreated postmen- using Von Kossa stain and the oxidative stress parameter re- opausal osteoporotic females were selected on the basis of their active oxygen species (ROS) measured using a fluorescent BMD(BMD <-2.5) from Orthopaedic Outpatient Department of dye assay. Shaikh Zayed Hospital, Lahore, Pakistan and thirty-six, age and
Results: Lycopene Study; Addition of H2O2 resulted in sig- BMI matched nonosteoporotic postmenopausal females were nificant increase in ROS. (p<0.001), and a decrease in also selected as a control group. Baseline physical and biochem- MBNF (both: p<0.001). Pre- and post-treatment with 45:55 ical parameters were compared. In osteoporotic patients, chang- or 28:72 but not with 5:95 cis:trans lycopene resulted in es in circulating leptin and homocysteine levels were studied significant lower ROS (p<0.001) and higher MBNF after six months therapy with ibandronate (150 mg). The col-
(p<0.05), compared to treatment with H2O2 alone. lected data was analyzed on SPSS 16. Polyphenol Study: greens+TM alone inhibited ROS in a Results: There was no significant difference observed in the dose-dependent manner. greens+TM, and the bone- mean value of all baseline parameters except BMD in both builderTM extracts when added separately had a significant groups. After six months treatment with ibandronate, a signifi- dose-dependent stimulatory effect on MBNF, while a com- cant change was observed in serum leptin levels (19.48±1.60 bination was six times more effective than either one alone. ng/ml vs. 14.09±0.85 ng/ml, p<0.002), while no considerable (significant, p<0.05). change observed in serum homocysteine levels (16.22±0.95 Conclusions: The beneficial effects of lycopene and μmol/l vs. 16.80±1.03 μmol/l, p<0.63). Serum leptin was found polyphenols from nutritional supplements in lowering significantly correlated with anthropometric parameters. No cor- the risk of postmenopausal osteoporosis may be attrib- relation of serum leptin and homocysteine was found with BMD uted to their antioxidant properties to lower oxidative (r=0.09, p-value=0.54; r=-0.17, p-value=0.27). stress and ability to stimulate bone formation in osteo- Conclusion: Our results show that the ibandronate reduces blasts. The results of our clinical and in vitro studies serum leptin levels while it has no effect on serum homocys- provide good evidence for the potential use of these teine levels. Further studies are needed to explain how the natural antioxidants as alternative or complementary decrease in serum leptin level may help in reducing the pro- agent with other drugs for the prevention and manage- gression of osteoporosis. ment of postmenopausal osteoporosis. References: (1) Rao LG et al. Osteoporos Int 2007;18:109. P203 (2) Kang NN et al. J Nut Health Aging 2012;1:183. CALCANEAL ULTRASOUND ASSESSMENT OF Acknowledgements: Grant supports from CIHR and indus- BONE HEALTH AND ASSOCIATION OF SOCIO- trial partners. DEMOGRAPHIC CHARACTERISTICS WITH BONE S174 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
MINERAL DENSITY IN PRE AND POSTMENO- 1Pharmacology and Therapeutics/ University Medical and PAUSAL FEMALES Dental College, The University of Faisalabad, Faisalabad, S. Tariq1,3, M. Baig2,M.Shahzad4 Pakistan, 2Clinical Biochemistry/ King Abdul Aziz 1Pharmacology and Therapeutics/ University Medical and University (KAU) Jeddah, Saudi Arabia, Jeddah, Saudi Dental College, The University of Faisalabad, Faisalabad, Arabia, 3Physiology/University Medical and Dental Pakistan, 2Clinical Biochemistry/ King Abdul Aziz College, The University of Faisalabad, Faisalabad, Pakistan, University (KAU) Jeddah, Saudi Arabia, Jeddah, Saudi 4Pharmacology, University of Health Sciences Lahore, Arabia, 3Physiology/ University Medical and Dental Lahore, Pakistan College, The University of Faisalabad, Faisalabad, Pakistan, 4Pharmacology, University of Health Sciences Lahore, Objective: Leptin plays a pivotal role in body weight control Lahore, Pakistan and it is considered a regulator of bone mass density. This study was aimed at finding out whether leptin is a predictor Objective: The current study was planned to measure the of bone mass density (BMD) in premenopausal women bone status and to identify associated risk factors, so that fur- (PMW) and postmenopausal osteoporotic women ther strategy can be developed for preventing and managing (PMOPW) or if it has any association with BMD. osteoporosis in females. Methods: 192 women (98 PMOPW and 94 PMW) were re- Methods: The present study was conducted at a tertiary care cruited for this study. The control group was BMI matched hospital. Females of age group 20-80 years were included in with osteoporotic subjects. BMD assessment was done on the the study, 1810 females were assessed for their eligibility for calcaneus by peripheral ultrasound bone densitometry. Serum the present study, and finally 1205 females were selected. From leptin concentrations were measured by ELISA. all participants, information was collected about socio- Results: Serum leptin and BMD values were significantly demographic characteristics (age, marital status, education, oc- different in both groups (leptin, 18.56±8.65 ng/ml vs. 21.64 cupation, place of living), medical history and gynecological ±9.80 ng/ml, p=0.02) and (BMD, -.70±.19 vs. -3.17±.59, history. The bone mineral density (BMD) assessment was done p=0.000), respectively. In PMOPW, the Serum leptin and on the calcaneus (heel) by peripheral ultrasound bone densi- BMD were considerably correlated with weight (lep, r=0.53, tometry. The collected data was analyzed with SPSS 22.0. p≤0.001; BMD, r=-0.21, p=0.02), BMI (lep, r=0.52, p≤0.001; Results: Univariate analysis showed that education (second- BMD, r=-0.27, p=0.005), waist circumference (lep, r=0.61, ary and primary education, illiterate), age (30-39 yrs, and 60- p≤0.001; BMD, r=0.18, p=0.04), hip circumference (lep, 69 yrs) and occupation (housewives) were significantly asso- r=0.58, p≤0.001). Multivariate linear stepwise regression ciated with low bone mass density (LBMD). Multivariate analysis showed that weight and BMI in PMW and analysis showed that primary education (OR=3.83, 95%CI PMOPW, were independent predictors of BMD. In both 2.30 - 6.38), illiterate (OR=3.83 95%CI 2.52 – 5.82) and age groups, the serum leptin level was not the predictor of BMD. 30-39 years (OR=0.25 95%CI 0.13 – 0.49), age 40-49 years Conclusion: The present results indicate that body weight and (OR=0.30 95%CI 0.15 – 0.59), age 50-59 years (OR=0.42 BMI have an impact on BMD, while serum leptin is not as- 95%CI 0.22 – 0.79), were significantly associated with low sociated with BMD in both PMW and PMOPW. bone mineral density (LBMD). The prevalence of osteoporo- sis and osteopenia was 27.2%, 29.8%, respectively, while 43% subjects had normal BMD. In the premenopausal group, P205 9.9% and 32.2% were osteoporotic and osteopenic respective- IMMUNOLOGICAL MONITORING OF OSTEOAR- ly and in the postmenopausal group, 39%, 28.1% were oste- THROSIS SPA TREATMENT oporotic and osteopenic respectively. I. Gontar1, O. Emelyanova1,L.Maslakova1, O. Rusanova1,A. Conclusion: Our results show that within our country Trofimenko1 population, the prevalence of osteopenia and osteoporo- 1Federal State Budgetary Institution «Research Institute of sis is very high, and osteopenia occurs at a very early Clinical and Experimental Rheumatology», Volgograd, age and less educated or illiterate women have more Russian Federation chances to have LBMD. A differentiated treatment of 55 patients with osteoarthrosis (OA) depending on the disease stage activity, presence of synovitis, as well as associated diseases was carried out in P204 Gelendzhik resort in terms of Mediterranean seaside- ASSOCIATION OF SERUM LEPTIN WITH BONE mountain climate with moderate humidity. MINERAL DENSITY IN POSTMENOPAUSAL OSTEOPOROTIC FEMALES Aim: To objectify activity, stage and spa treatment efficiency S. Tariq1,3, M. Baig2,M.Shahzad4 evaluation the immobilized granular antigen drugs with Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S175 magnetic properties based on collagen type I and II were used patients received 1200 mg of calcium and 800 IU of vitamin in the diagnostic test complex. D. plain radio graphs were repeated every fourth week until Materials and methods: A correlation between the level of radio graphic evidence of fracture healing was confirmed. specific antibodies, articular cartilage destruction degree and Functional outcome was assessed with use of Western inflammation in the synovial membrane severity was ob- Ontario and McMaster Universities Osteoarthritis (WOMAC) served in immunoassay (ELISA) method. index and the Short Musculoskeletal Functional Assessment Results: Thus, when rapidly progressive OA, the antibodies (SMFA) level to collagen I was 0.115±0,020, to collagen II-0,118 Results: The mean time to fracture healing was 12 weeks for ±0,023 in comparison with healthy persons (to collagen (group 1), compared with 12.6 weeks for (group 2) and 9 I-0,026±0,003, to collagen II - 0,030±0.002). Regarding ra- weeks for (group 3).At 16 weeks, all fractures in the treatment diological stage OA, the highest antibodies level to collagens I group were healed. Healing was assessed radiologically. and type II was in stage III. The role of synovitis in the devel- Conclusions: Evidence that teriparatide combined with opment and OA progression deserves special attention being denosumab promote fracture healing and improves the func- one of the most frequent complications of degenerative pro- tional outcome in cases of proximal femoral fracture more cesses in joints with OA, secondary synovitis exacerbates the than either drug alone. disease, increases arthralgia severity and is accompanied by dysfunction of the joints. With the development of reactive synovitis in OA patients, the antibody level to collagen of P207 types I and II increases (type I -0,128±0,013, II -0,124 SUBJECTIVE SLEEP QUALITY IN SARCOPENIC VS. ±0.01), unlike patients without signs of synovitis (type I - NON-SARCOPENIC OLDER ADULTS FROM THE 0.089±0,01, II-0,093±0,01). SARCOPHAGE COHORT Conclusion: The surveyed patients, who were treated with M. Locquet1,C.Beaudart1, L. Delandsheere1,J.-Y. iodine-bromine baths and magnetic therapy, manifested the Reginster1,O.Bruyère1 reduction of joint pain, signs of reactive synovitis, improved 1Department of Public Health, Epidemiology and Health joint function, and reduction of anti-inflammatory drug use. Economics, University of Liège, Liège, Belgium Objective: The present analysis seeks to compare subjective sleep quality measures between sarcopenic and non- P206 sarcopenic elderly subjects diagnosed following 6 different COMBINATION OFTERIPARATIDE AND DENO- definitions of sarcopenia. SUMAB ACCELERATE PROXIMAL FEMUR FRAC- TURE HEALING Material and Methods: Cross-sectional data used in this A.-E. Elsalmawy1 analysis were collected from the SarcoPhAge (for 1Department of Orthopedic Surgery and Traumatology, Sarcopenia and Physical Impairment with Advancing Age) Alnoor Specialist Hospital, Makkah, Saudi Arabia cohort, a prospective study aiming to assess the incidence of sarcopenia and its related clinical and physical parameters Background: Teriparatide and denosumab as isolated therapy among subjects aged 65 years and over. A diagnosis of has been shown to increase bone mineral density and to reduce sarcopenia was established according to 6 different defini- the rate of fractures in patients with osteoporosis. Teriparatide tions: Baumgartner et al, 1998; Delmonico et al, 2007; Cruz- alone could improve fracture healing. The purpose of the pres- Jentoft et al, 2010; Fielding et al, 2011; Morley et al, 2011; ent prospective, randomized, study was to evaluate the effect Studenski et al, 2014. For this purpose, 3 main assessments of combined therapy on the course of proximal femoral were carried out: an evaluation of lean mass using Dual- fracture-healing and functional outcome in postmenopausal Energy X-Ray Absorptiometry (Hologic Discovery A, women that was not receiving any osteoporotic medications USA), a measure of muscle strength with a hand- prior to fracture. dynamometer (Saehan Corporation, MSD Europe Bvba, Methods: One hundred eighty patients had routine dual ra- Belgium) and an assessment of physical performance by the diographs, to document proximal femoral fractures all frac- Short Physical Performance Battery test. To evaluate the sub- tures internally fixed with gamma nail one or two days post jective quality parameters of participants’ sleep, we used the admission. Sixty patients (group 1) received a once-daily in- validated French version of the Pittsburgh Sleep Quality Index jection of 20 [mu]g of PTH starting within two days after (PSQI). This self-administered questionnaire evaluates 7 dif- admission to the hospital, and forty-six (group 2) patients ferent components of sleep. Points are awarded to each aspect received denosumab 60 mg subcutaneous injection starting (maximum 3 points) and are added to obtain a total score second day after surgery, repeated every six months and sev- (maximum 21 points). The higher the score, the more it re- enty four patients (group 3) received combined therapy, All flects major sleep difficulties. S176 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Results: A total of 255 individuals, aged 74.71±5.79 years, have Results: During FREEDOM, 438 pbo and 272 DMAb sub- completed the questionnaire. Depending on which of the 6 differ- jects had an OP fracture (mean age at first on-study fracture: ent definitions was employed for the diagnosis, the prevalent 74.1 and 74.5 yrs). Of these, 54 (12.3%) and 24 (8.8%) sub- cases of sarcopenia ranged from 15 subjects (5.88%) to 83 sub- jects had ≥1 subsequent fracture in the pbo and DMAb groups, jects (32.55%). Only one definition gave rise to a significant dif- respectively. Adjusted subject incidence per 100 patient-yrs ference between sarcopenic and non-sarcopenic subjects (Cruz- was lower for DMAb (6.7) vs. pbo (10.1). Combining all Jentoft et al, 2010). It indicated that sarcopenic participants had DMAb subjects from FREEDOM and Ext, 794 (13.7%) had higher scores for 2 of the sleep components: the sleep latency and an OP fracture (mean age at first on-study fracture: 76.5 yrs). the day-time dysfunction, which would both be altered in Of these, ≥1 subsequent fracture occurred in 144 (18.1%) sarcopenic subjects compared to others (p=0.003 and p=0.048, subjects, with an adjusted subject incidence of 5.8 per 100 adjusted for age and number of co-morbidities). However, for the patient-yrs, similar to FREEDOM DMAb (6.7 per 100 pa- 5 other definitions, there was no statistically significant difference tient-yrs). Among subjects with ≥1 subsequent fracture, 90% between sarcopenic and non-sarcopenic subjects regarding the had only 1, and spine fracture was most frequent. The risk of PSQI score or any of its 7 components separately. having subsequent on-study OP fracture was lower in all Conclusion: No major clinically relevant differences in sub- DMAb subjects compared with pbo (HR 0.60 [95% CI: 0.43– jective sleep quality between sarcopenic and non-sarcopenic 0.81]; p=0.0012). subjects were found, regardless of the definition of sarcopenia Conclusions: The risk of a second fracture with continued employed. DMAb treatment remains lower than pbo, suggesting a frac- ture sustained while on DMAb is not necessarily indicative of treatment failure, and treatment continuation should be P208 considered. THE RISK OF SUBSEQUENT OSTEOPOROTIC Acknowledgements: C Desborough (Amgen [Europe] FRACTURES IS DECREASED IN PATIENTS GmbH) provided editorial assistance. EXPERIENCING FRACTURE WHILE ON Disclosures: Funded by Amgen DENOSUMAB: RESULTS FROM THE FREEDOM Author disclosures: DL Kendler – grants/research support AND FREEDOM EXTENSION STUDIES from Amgen, Eli Lilly, Astra Zeneca, Astalis; consultant D. L. Kendler1,A.Chines2,M.L.Brandi3, S. Papapoulos4,E. for Amgen, Eli Lilly; Speakers’ Bureau for Amgen, Eli M. Lewiecki5, J.-Y. Reginster6, C. Roux7,M.MunozTorres8, Lilly. A Chines – employee and holds stock of Amgen. A. Wang2, H. G. Bone9 ML Brandi – grants/research support from Amgen, MSD, 1University of British Columbia, Vancouver, BC, Canada, Eli Lilly, Novartis, Alexion, Shire; consultant for Shire; 2Amgen Inc, Thousand Oaks, CA, United States, 3University Speakers’ Bureau for Shire; honoraria from Amgen, of Florence, Florence, Italy, 4Leiden University Medical MSD, Eli Lilly, Novartis, Alexion, Shire. S Papapoulos Center, Leiden, Netherlands, 5New Mexico Clinical Research –consultant for Amgen, Axsome, Merck, USB; honoraria and Osteoporosis Center, Albuquerque, NM, United States, from Mereo Biopharma, Novartis. EM Lewiecki – grants/ 6University of Liège, Liège, Belgium, 7Paris Descartes research support from Amgen, Eli Lilly, Merck; consul- University, Paris, France, 8Hospital Universitario San Cecilio, tant for Amgen, Eli Lilly, Merck, Radius; Speakers’ Granada, Spain, 9Michigan Bone and Mineral Clinic, Detroit, Bureau for Shire. J-Y Reginster – grants/research support MI, United States from Amgen, Eli Lilly, Bristol Myers Squibb, Merck Sharp and Dohme, Rottapharm, Teva, Roche, Novartis, Objective: Assess the risk of subsequent fracture among pa- GlaxoSmithKline, Servier, Pfizer, Theramex, Danone, tients experiencing fracture on FREEDOM and FREEDOM Organon, Therable, Boehringer, Chiltern, Galapagos; Extension (Ext). consultant for Amgen, Eli Lilly, Servier, Novartis, Materials and Methods: In FREEDOM, postmenopausal Negma, Wyeth, GlaxoSmithKline, Roche, Merckle, women with osteoporosis were randomized to placebo (pbo) Nycomed-Takeda, NPS, IBSA-Genevrier, Theramex, or denosumab (DMAb) for 3 yrs. During the 7-yr Ext, all UCB, Asahi Kasei, Endocyte; lecture fees from Merck subjects received DMAb. We report subsequent osteoporotic Sharp and Dohme, Eli Lilly, Rottapharm, IBSA, (OP) fractures (new vertebral or nonvertebral) in subjects who Genevrier, Novartis, Servier, Roche, GlaxoSmithKline, received ≥2 doses of DMAb during FREEDOM or Ext, had Merckle, Teijin, Teva, Analis, Theramex, Nycomed, an OP fracture on treatment, and continued treatment post- NovoNordisk, Ebwee Pharma, Zodiak, Danone, Will fracture, compared with subsequent fractures in pbo subjects. Pharma, Amgen. C Roux – grants/research support from Subsequent fractures were analyzed as recurrent events using Ultragenyx; consultant for Amgen, UCB, MSD, Alexion. a stratified Cox model with the robust variance estimation M Munoz Torres – consultant for Amgen, Eli Lilly, adjusting for prior fracture. Alexion; honoraria from Amgen, Eli Lilly, Alexion. A Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S177
Wang – employee and holds stock of Amgen. HG Bone – grants/research support from Amgen, Merck, Shire; consultant for Amgen, Merck, Grunenthal; Speakers’ Bureau for Amgen, Shire.
P209 EFFECTS OF UP TO 10 YEARS OF DENOSUMAB TREATMENT ON BONE MATRIX MINERALIZATION: RESULTS FROM THE FREEDOM EXTENSION (EXT) D. W. Dempster1,J.P.Brown2,S.Yue3, S. Rizzo4,D.Farlay4, R. B. Wagman3, A. Wang3,X.Yin3, G. Boivin4 1Columbia University, New York, NY, USA and Helen Hayes Hospital, New York, NY,United States, 2Laval University and CHU de Québec (CHUL) Research Centre, Quebec City, QC, Canada, 3Amgen Inc, Thousand Oaks, CA, United States, 4INSERM, UMR 1033, Univ. Lyon, Université Claude Bernard Lyon 1, Lyon, France
Objective: Report bone matrix mineralization indices at yrs 2 and 7 of the FREEDOM Ext, representing 5 and 10 yrs of DMAb treatment, respectively. Materials and Methods: Transiliac crest bone biopsies were performed at yr 2 and/or 3 of FREEDOM (Reid JBMR 2010) and yrs 2 (Brown JBMR2015) and 7 (Dempster ASBMR 2016) of the Ext. Bone matrix mineral- ization was assessed by digitized quantitative microradiog- raphy in a blinded fashion and analyzed using a Matlab program (Montagner J X-Ray Sci Technol 2015). The mean degree of mineralization of bone (DMB) and heterogeneity index (HI) of DMB were calculated for cancellous and cortical bone, endocortical and periosteal cortical sub-com- partments, and total bone. Acknowledgments: Claire Desborough, Amgen (Europe) Results: Biopsies from 72 women in FREEDOM (30 pla- provided editorial assistance. cebo, 42 DMAb at 2 or 3 yrs) and 28 and 21 women in Disclosures: Funded by Amgen the Ext who had received DMAb for a total of 5 and 10 Author disclosures: DW Dempster – grants/research support yrs, respectively, were evaluated. Subject demographics from Eli Lilly; consultant for Amgen, Merck, Eli Lilly; Speakers’ in this sub-study were comparable to FREEDOM. Bureau for Amgen, Eli Lilly. JP Brown – grants/research support Through 10 yrs, DMAb resulted in significant increases from Amgen, Eli Lilly; consultant for Amgen, Eli Lilly, Merck; in mean DMB and a significantly lower HI in total bone Speakers’ Bureau for Amgen, Eli Lilly. S Yue – employee and compared with placebo (p<0.05; Figure). There were no holds stock of Amgen. S Rizzo – grants/research support from significant differences in mean DMB or HI between 5 Amgen, Biom’up, NIH, Noraker, and Servier. D Farlay – grants/ and 10 yrs of DMAb treatment; DMB and HI plateaued research support from Amgen, Biom’up, NIH, Noraker, Servier. between 5 and 10 yrs. Similar results were seen in all RB Wagman – employee and holds stock of Amgen. A Wang – bone compartments assessed. employeeandholdsstockofAmgen.XYin–employeeandholds Conclusions: These data suggest mean DMB reaches a stock of Amgen. G Boivin – grants/research support from maximum by yr 5. Clinical outcomes (BMD gains and Amgen, Biom’up, Hoffman-La Roche, Eli Lilly MSD, NIH, low fracture incidence) with DMAb through 5 yrs likely Noraker, Procter and Gamble, Servier. reflect closing of the remodeling space and increases in secondary mineralization of bone matrix. Additional mechanisms may contribute to long-term clinical out- P210 comes, including reduction in cortical porosity and pres- PREVALENCE OF JOINT PAIN AND OSTEOARTHRITIS ervation of modeling-based bone formation. IN OBESE BRAZILIAN POPULATION S178 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
G. C. de Campos1, D. M. Pacca1,A.R.Zorzi1,E.A.Chaim2, presented recommendations for compliance with the phys- J. B. Miranda1 ical activity, as well as vitamin D consumption. A patient 1Department of Orthopaedics/University of Campinas was in touch with a doctor-endocrinologist, if he has any (UNICAMP)/Hospital de Clínicas, Campinas, Brazil, additional questions. We examined data from a survey of 2Department of Bariatric Surgery/University of Campinas 500 patients registered in the online system www.rightdiet.ru (UNICAMP)/Hospital de Clínicas, Campinas, Brazil and 50 patients control group who were given the same recom- mendations on the appointment. Surprisingly, the consumption Purpose: To define the prevalence of joint pain and osteoar- of milk and dairy products increased by 2.7 times, compared thritis of the knees and hips in obese patients awaiting bariatric with patients in the control group. The exposure to the sun was surgery. observed 15 to 30 minutes daily, compared with the control Material and Methods: Prevalence study (cross-sectional) group 5-10 minutes. Regular physical activity were the main conducted in patients referred to bariatric surgery. We applied group of 260 minutes per week, in control group 80 minutes the visual analogue pain scale (VAS) and the WOMAC ques- per week. tionnaire. X-rays of the hips and knees were evaluated. The Conclusions: Very important how we can make delivery of primary endpoints were self-reported joint pain and the diag- the material. We live in a world of high technologies and lack nosis of osteoarthritis by clinical and radiological criteria of of time. Often the patient has no opportunity to go to the the American College of Rheumatology. doctor for an appointment, and during reception it is not al- Results: 141 patients were interviewed (85.1% women) with ways possible to discuss all aspects, and even if it was possi- a mean age of 40 years. The mean body mass index was 46. ble, some information is forgotten by patients. So we need to The lumbar spine and knee joint were the most commonly improve the quality of information material, including using reported as painful (77.9% and 73.2% respectively). online technologies to improve the quality and duration of life Prevalence of osteoarthritis of the knees or hips was 77.7%. of our patients Prevalence of knee osteoarthritis was 63.1% and hip osteoar- thritis was 40.8%. Age, mean VAS and WOMAC scores were higher in the osteoarthritic individuals. P212 Conclusion: We found a prevalence of 90.1% of pain symp- RADIOGRAPHIC MEASUREMENTS IN THE HIP toms and 77.7% of osteoarthritis in hips or knees, in morbidly JOINT AND PATIENT-REPORTED OUTCOMES: A obese patients referred to bariatric surgery. The prevalence of POPULATION-BASED STUDY knee osteoarthritis was 63.1% and hip osteoarthritis was J. A. Kopec1, H. Qian2, J. Cibere3, H. Wong1,L.C.Li4,M. 40.8% in this sample. Barber5, H. Prlic5, C. Zhang6, C. Ratzlaff7,B.B.Forster8,J. M. Esdaile3 1School of Population and Public Health / University of P211 British Columbia, Vancouver, BC, Canada, 2Centre for MOBILE AND WIRELESS TECHNOLOGY TO COMBAT Health Evaluation and Outcome Sciences / St. Paul’s OSTEOPOROSIS USING ONLINE PROGRAM OF GOOD Hospital, Vancouver, BC, Canada, 3Department of Medicine NUTRITION AND WRIGHT DIET: PREVENTION AND / University of British Columbia, Vancouver, BC, Canada, PART OF THE TREATMENT OF OSTEOPOROSIS. 4Department of Physical Therapy / University of British V. Krylov1 Columbia, Vancouver, BC, Canada, 5Arthritis Research 1Endocrinology, Moscow, Russian Federation Canada, Richmond, BC, Canada, 6Department of Family Medicine, University of Calgary, Calgary, Canada, 7Arthritis Introduction: It is too much easier and cheaper to prevent a Centre and College of Medicine, University of Arizona, decrease a bone density and fractures, than in the future to Tucson, AZ, United States, 8Department of Radiology / treat osteoporosis and its complications. University of British Columbia, Vancouver, BC, Canada Materials and methods: We used an online system for pa- tient education based on the video lessons, full of humor, Objectives: Radiographic measurements of alpha angle and pictures, and cartoons to convey the necessary information lateral centre edge angle in the hip joint are important for the on good nutrition, necessary to do exercises and the need for diagnosis of femoroacetabular syndrome, a major risk factor exposure to the sun to our patients. for hip osteoarthritis. Our objective was to determine if these Results: Watching the short movies, the patients formed measurements are associated with hip-related patient-reported the habits of good nutrition during the first month already, outcomes (PROs) in young and middle-aged individuals in the which includes a diet with restriction of fat, digestible general population. carbohydrates and daily consumption of low-fat dairy Materials and Methods: A stratified random sample of products, slow carbohydrates, protein and fiber. We also Caucasian men and women aged 20-49 with and without hip Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S179 pain was selected using random digit dialling from the popu- 5Hôpital Edouard Herriot, Lyon, France, 6Hospital lation of Metro Vancouver, Canada. The alpha and lateral Universitario Quirónsalud Madrid, Madrid, Spain, centre edge angles were measured bilaterally on x-ray using 7University of Sheffield, Sheffield, United Kingdom Dunn and AP views, respectively. PROs were measured by the Copenhagen Hip And Groin Outcome Score (HAGOS), Purpose: Compare cumulative 10‑yr incidence of major oste- which has scales for symptoms, pain, daily activities, sports, oporotic (MOP; hip, spine, forearm, humerus) and hip fracture physical activity, and quality of life. We performed descriptive (fx) in subjects completing FREEDOM Extension (Ext) with 1) analyses and a regression analysis with restricted cubic 10-yr fx probability predicted by FRAX, 2) that estimated for a splines, adjusted for age and sex and weighted for sampling hypothetical cohort of 10-yr placebo (pbo) controls. design. Methods: Subjects in this analysis received 10 yrs of Results: Data were obtained for 499 subjects. Alpha angle DMAb (3 yrs FREEDOM; 7 yrs Ext; 60 mg Q6M), distribution was bimodal (modes at 50-55 and 60-65) with a completed the 10-yr visit, and missed ≤1dosein mean at 54o. Lateral centre edge angle distribution was sym- FREEDOM and ≤1 dose in the Ext (n=1,278). Kaplan- metric with a mean of 34o. In the spline analysis, higher alpha Meier estimates of cumulative 10-yr incidence of MOP angle was generally associated with better HAGOS scores for and hip fx were calculated; 10-yr fx probability predict- alpha<50o and worse scores for alpha>60o. The associations ed by FRAX (with femoral neck BMD) at FREEDOM were statistically significant for symptoms (Left and Right, baseline was also calculated. MOP fx rate in a hypo- see Figure), daily living (R), sports (L and R), physical activ- thetical cohort of 10-yr pbo controls (virtual twins) was ities (L and R), and quality of life (R). No association was estimated using simulation and baseline characteristics found between the lateral centre edge angle and HAGOS identical to the 10-yr DMAb completer group. scales. Results: The observed cumulative 10-yr fx incidence (95% CI) was lower than the 10‑yr mean (SD) fx probability pre- dicted by FRAX for both MOP (10.75% [9.05%–12.46%] vs. 16.42% [9.06%]) and hip (1.17% [0.58%–1.76%] vs. 6.14% [6.52%]) fx. The observed cumulative 10-yr MOP fx inci- dence was significantly lower than that estimated for the vir- tual twins (10.75% [9.05%–12.46%] vs. 23.13% [17.76%– 28.87%]; RR=0.49 [0.36–0.64]). Conclusions: Fx incidence with 10 yrs of DMAb treatment was lower than the 10-yr probability predicted by FRAX for both MOP and hip fx. 10-yr MOP fx incidence was also lower Conclusions: In young and middle-aged individuals, alpha than the fx rate estimated in a hypothetical cohort of 10-yr pbo angle, but not lateral centre edge angle, is associated with controls. These data support the long-term efficacy of DMAb patient-reported hip outcomes, such as symptoms, function, in reducing MOP and hip fx. activity, and quality of life. Figure. Ten-year Observed, FRAX-predicted, and Virtual Acknowledgement: The study was funded by the Canadian Twin-estimated MOP Fracture Incidence Institutes of Health Research (Grant No. PAF-107513).
P213 DENOSUMAB TREATMENT FOR 10 YEARS IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS WAS ASSOCIATED WITH SUBSTANTIALLY LOWER FRACTURE INCIDENCE RELATIVE TO THEIR BASELINE FRAX-PREDICTED PROBABILITY E. Siris1,N.Pannacciulli2,P.D.Miller3, E. M. Lewiecki4,R. Chapurlat5, E. Jódar Gimeno6,N.S.Daizadeh2,R.B. Wagman2, J. A. Kanis7 1Columbia University Medical Center, New York, NY, United States, 2Amgen Inc, Thousand Oaks, CA, United States, 3Colorado Center for Bone Research, Lakewood, CO, United States, 4New Mexico Clinical Research and Acknowledgements: C Desborough (Amgen [Europe] Osteoporosis Center, Albuquerque, NM, United States, GmbH) provided editorial assistance. S180 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Disclosures: Funded by Amgen limitations of current diagnostic schemes for both conditions. Author disclosures: ESiris– consultant for Amgen, Merck, For instance, the benefits and limitations of dual energy X-ray Radius. N Pannacciulli – employee and holds stock of Amgen. absorptiometry (DXA) as a diagnostic and research tool will be PD Miller – grants/research support from Amgen, Alexion, analyzed (Dr. Binkley). Then, we will discuss evidence-based Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, diagnostic and therapeutic interventions that pose promising Immunodiagnostics, Merck, Merck Serrano, National Bone opportunities for both conditions, which include the review of Health Alliance, Novartis, Radius, Roche Diagnostics, nutritional, physical activity and pharmacological interventions Regeneron, Ultragenux; consultant for Amgen, AgNovos, Eli (Prof. Duque). Finally, we will translate this information into Lilly, Merck, Radius Pharma, Roche, Ultragenyx. EM practical approaches that can improve older adult care. Lewiecki – grants/research support from Amgen, Eli Lilly, Merck; consultant for Amgen, Eli Lilly, Merck, Radius; Speakers’ Bureau for Shire. R Chapurlat – grants/research sup- P215 port from Amgen, Merck, Pfizer, Roche-Chugai; consultant for PHYSICAL ACTIVITY, NUTRITION AND BONE Amgen, Bioiberica, Pfizer; other financial support from MINERAL DENSITY IN OLDER ADULTS AbbVie, Amgen, Biogen, BMS, Eli Lilly, MSD, Pfizer, J. Carvalho1,N.Duarte2,E.Marques3 Roche-Chugai. E Jódar Gimeno – grants/research support from 1Research Centre in Physical Activity, Health and Leisure Amgen, MSD; consultant for Amgen; Speakers’ Bureau for Eli (CIAFEL), Faculty of Sport, University of Porto, Porto, Lilly. NS Daizadeh – employee and holds stock of Amgen. RB Portugal, 2UNIFAI, ICBAS, University of Porto, Porto, Wagman – employee and holds stock of Amgen. JA Kanis – Portugal, 3Higher Education Institute of Maia (ISMAI), Maia, grants/research support from Amgen, GSK, Pfizer; consultant Portugal for AgNovos, Eli Lilly, Medimaps, Radius Health. The main purpose of this study was to evaluate the association between habitual physical activity, nutritional intake and P214 BMD in elderly. The sample consisted of 128 participants, OSTEOSARCOPENIA: A PRACTICAL APPROACH 91 women (71,1%), aged between 60 and 84 years old. Data FOR THE PREVENTION OF FALLS AND OSTEOPO- collection comprised: (i) questionnaire to collect demographic ROTIC FRACTURES data; (ii) Dual-energy X-ray absorptiometry (DXA -total and G. Duque1, N. Binkley2, A. Frisoli3 hip) for body composition and bone density measurement; 1Australian Institute for Musculoskeletal Science, The University (iii) accelerometers (7 days) to assess habitual physical activ- of Melbourne, Melbourne, Australia, 2Department of Geriatrics, ity; (iv) nutritional intake was assessed by food records (4- University of Wisconsin, Wisconsin, United States, 3College of days recall). For statistical analysis descriptive statistics, stu- ’ Medicine, University of São Paulo, São Paulo, Brazil dent t-test for independent measures, Pearson s correlation coefficient were used and for analysing BMD in function of In older persons, the combination of osteopenia/osteoporosis nutritional intake the Generalized Linear Models was used. and sarcopenia - known as osteosarcopenia - has been pro- The level of significance in all tests was 5%. Results showed: posed as a subset of frailer individuals at higher risk of insti- (i) a statistical significant association between anthropometric tutionalization, falls, and fractures. Osteosarcopenic patients variables, namely, weight, height and muscle mass, and bone have very particular clinical, biochemical, diagnostic, and density; (ii) no statistical differences in mean physical activity functional characteristics that could be identified in clinical according to the T-score value was observed; (iii) considering practice. In addition, new therapies targeting both muscle nutritional intake, a statistically significant association was and bone are being developed. In this symposium, we will found between the average intakes of vitamin A, vitamin K present a clinical definition of osteosarcopenia aiming to de- as a function of the T-score value in men, but in women, only a scribe the clinical, functional, and biochemical features that statistically significant association was found in the consump- are unique to these patients. The use of imaging combined tion of saturated fatty acids and vitamin D. The findings of this with functional assessments for the diagnosis of osteosar- study indicate that the older subjects with a greater weight, copenia will be discussed. In addition, we will analyze pre- taller and with larger amounts of muscle mass, present health- ventive measures and therapeutic interventions that can bene- ier values of bone mineral density. In spite of habitual physical fit both muscle and bone simultaneously. We intend to go over activity did not have a significant effect on BMD it seems that the translational aspects of sarcopenia and osteoporosis re- nutritional intake, particularly in relation to vitamin D, vitamin search, and highlight expected outcomes from different inter- A, vitamin K and saturated fatty acids, seems to be important ventions for both conditions. We will initially review the clin- to bone health of older adults. ical, functional and biochemical characteristics of this syn- Acknowledgments: CIAFEL is Supported by FCT with grant drome (Dr. Frisoli). Next, we will discuss the benefits and UID/DTP/00617/2013 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S181
P216 mortality and functional decline. Further work is required to RELATIONSHIPS BETWEEN MARKERS OF replicate these associations and to delineate the underlying INFLAMMAGING AND MUSCLE MASS, STRENGTH biological mechanisms. AND FUNCTION: RESULTS FROM THE HERTFOR- DSHIRE COHORT STUDY L. D. Westbury1, N. R. Fuggle1, H. E. Syddall1,N.A. P217 Duggal2,E.M.Dennison1,J.Lord2,C.Cooper1 BOTH HIGH AND LOW SERUM SEROTONIN 1MRC Lifecourse Epidemiology Unit, University of LEVELS PREDICT INCIDENT NON-VERTEBRAL Southampton, Southampton, United Kingdom, 2Institute of FRACTURES Inflammation and Ageing, University of Birmingham, H. Kristjansdottir1, C. Lewerin1,U.Lerner2,E.Waern3,O. Birmingham, United Kingdom Ljunggren4, H. Johansson5, D. Sundh6,M.Karlsson7,S. Cummings8,H.Zetterberg9,M.Lorentzon10,C.Ohlsson11, Objectives: To investigate the longitudinal relationships be- D. Mellström10 tween markers of inflammaging and the following outcomes in a population-based UK cohort study: appendicular lean 1Sahlgrenska University Hospital, Section for Hematology mass, walking speed, level and change in grip strength and and Coagulation, Gothenburg, Sweden, 2Centre for Bone EWGSOP sarcopenia. and Arthritis Research at Department of Internal Medicine Materials and Methods: Analyses were based on a sam- and Clinical Nutrition, Institute for Medicine, Sahlgrenska ple of 336 community-dwelling older men and women Academy at University of Gothenburg, Gothenburg, (aged 59 to 70 years) who participated in the Sweden, 3Geriatric Medicine, Institute of Medicine, Hertfordshire Cohort Study (HCS). Inflammaging Sahlgrenska Academy, University of Gothenburg, markers were ascertained at baseline using enzyme- Gothenburg, Sweden, 4Department of Medical Sciences, linked immunosorbent assay (ELISA) techniques and Endocrinology and mineral metabolism, Uppsala University, Bio-Plex Pro Assays. Grip strength was measured at Uppsala, Sweden, 5Institute for Health and Aging, Australian baseline and follow-up (median follow-up time: 10.8 Catholic University, Melbourne, Australia, 6Geriatric years [inter-quartile range 10.2 to 11.6]) and change in Medicine, Department of Internal Medicine and Clinical grip strength was ascertained using a residual change Nutrition, Institute of Medicine, Sahlgrenska Academy, approach. At follow-up, appendicular lean mass was Gothenburg, Sweden, 7Department of Orthopaedics and ascertained using DXA; customary walking speed was Clinical Sciences, Lund University, Skåne University measured; and EWGSOP sarcopenia status was Hospital,Malmö,Sweden,8San Francisco Coordinating ascertained. Gender-adjusted linear and Poisson regres- Center, California Pacific Medical Center, San Francisco, sion was used to examine the associations between United States, 9 Department of Psychiatry and inflammaging markers and outcomes with and without Neurochemistry, University of Gothenburg, Gothenburg, adjustment for anthropometric and lifestyle factors. Sweden, 10Geriatric Medicine, Department of Internal Results: Mean (SD) age at baseline was 63.8 (2.5) and Medicine and Clinical Nutrition, Institute of Medicine, 65.6 (2.7) years among men and women respectively. Sahlgrenska Academy, Mölndal, Sweden, 11Centre for Bone Higher levels of CRP were associated (p<0.04) with low- and Arthritis Research (CBAR), Sahlgrenska Academy, er grip strength and higher appendicular lean mass at University of Gothenburg, Gothenburg, Sweden follow-up, and accelerated decline in grip strength from baseline to follow-up. Higher levels of IL-1Ra were as- Objectives: To investigate if circulating serotonin is associat- sociated (p<0.05) with slower walking speed; and higher ed with incident fractures and falls in elderly men. levels of cortisol and IL-8 were associated with lower Material and methods: The MrOS (osteoporotic fractures in appendicular lean mass (p<0.05). Higher levels of IL-8 men) study is a population based study of elderly men. In the were also associated with increased risk of sarcopenia Swedish Gothenburg part, 950 men (aged 69-81 years) with (fully-adjusted relative risks per SD increase in IL-8: baseline serotonin measurements were included. Fasting se- 1.37 [95%CI: 1.10, 1.71], p=0.005). All associations rum serotonin was measured with enzyme-linked immunosor- were robust in gender adjusted and fully adjusted bent assay (Immuno-Biological Lab Inc, Minneapolis MN, analyses. USA). Risk for fracture was determined by Cox proportional Conclusions: This study provides evidence that markers of hazards models. inflammaging are associated with muscle mass, strength and Results: In total 233 incident fractures were observed in radio- function in community-dwelling older people. These relation- graphic registers up to 10 years from baseline, of which 104 ships may partly explain the link between elevated levels of were non-vertebral fractures with 60 hip fractures. Serotonin inflammaging and age-related outcomes such as morbidity, levels were positively associated with hand grip strength S182 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
(r=0.09, P=0.005), inversely with total hip bone mineral density Conclusion: This study showed significant reduction of pain (BMD) (r=-0.10, P=0.003) and body mass index (BMI) (r=- and improvement in quality of life, after kinesio taping thera- 0.13, P<0.0001), but not with lumbar spine BMD (r=-0.04, py in patients with knee OA and can be safely prescribed. P=0.20). Serum serotonin was associated with all fractures in a non-linear way tested with quadratic term models (P=0.03) in- dicating u-formed risk curve with quintiles of serotonin. No P219 association was seen between serotonin and all fractures in linear LOW BONE MINERAL DENSITY AND FRACTURES models. The hazard ratio (HR) was 1.93 (CI 1.19-3.13) for non- ARE ASSOCIATED WITH INCIDENT CARDIOVAS- vertebral fracture when comparing quintile 1 to quintile 2-4 CULAR DISEASE: A SYSTEMATIC REVIEW AND (referent group) and 2.36 (CI 1.51-3.71) for quintile 5 vs. refer- META-ANALYSIS ent group. The HR for hip fracture was 1.60 (CI 0.81-3.20) for N. Veronese1,B.Stubbs2,G.Crepaldi3,M.Solmi4,C. quintile 1 vs. referent group and 2.95 (CI 1.68-5.21) for quintile Cooper5,J.-Y.Reginster6, R. Rizzoli7,S.Maggi8 5 vs. referent group. A multivariate analysis adjusting for age, 1National Research Council-Aging Branch-Padova, Padova, BMI, BMD hip, smoking, fall, SSRI did not substantially alter Italy, 2King's College London, London, United Kingdom, these results. No association was seen between serotonin and 3Italian Research Council, Padova, Italy, 4University of vertebral fractures. A multivariate analysis showed odds ratio Padova, Department of Neuroscience, Padova, Italy, 5MRC (OR) 1.90 (CI 1.28-2.82) for falls in serotonin quintile 1 vs. Epidemiology Resource Centre, University of Southampton, quintile 2-5 during the last year preceding the measurements. Southampton General Hospital, Southampton, United Conclusions: Both low and high levels of serotonin predict Kingdom, 6University of Liège, Liège, Belgium, 7Division non-vertebral fractures but not vertebral fractures in elderly of Bone Diseases, Geneva University Hospitals and Faculty men, indicating a relation between cortical bone and seroto- of Medicine, Geneva, Switzerland, 8National Research nin. Serotonin is positively associated with hand grip strength Council, Padova, Padova, Italy and inversely with hip BMD which in part might explain the u-formed fracture risk. Objective: An emerging evidence base suggests that low bone mineral density (BMD) and fractures are associat- ed with cardiovascular disease (CVD). We conducted a P218 systematic review and meta-analysis summarizing the EFFECTS OF KINESIO TAPING METOD ON PAIN evidence of low BMD and fractures as risk factors for AND QUALITY OF LIFE IN PATIENTS WITH KNEE future CVD. OSTEOARTHRITIS (OA) Material and Methods: Two independent authors searched G. Bogdanovic1, N. Stanisavljevic1,M.Zdravkovic1,D. major databases from inception to 1st August 2016 for longi- Pajovic1,J.Dragicevic1 tudinal studies reporting data on CVD incidence (overall and 1CHC Bezanijska Kosa, Belgrade, Serbia specific CVD) and BMD status and fractures at baseline. The association between low BMD, fractures and CVD across Introduction: OA is the most common degenerative joint longitudinal studies was explored by calculating pooled ad- disorder and a major public health problem worldwide. justed hazard ratios (HRs)±95% confidence intervals (CIs) OA of the knee is a major cause of mobility impairment, with a random-effects meta-analysis. which has an unpredictable and negative impact on Results: Twenty-eight studies (18 regarding BMD and 10 health and QoL. fractures) followed-up a total of 1,107,885 participants for a Aim: To determine if kinesio taping method can change pain median of 5 years. Taking those with higher BMD as the and quality of life in patients with OA. reference, people with low BMD were at increased risk of Methods: Twenty-five patients with OA (ages 59.74+ developing CVD during follow-up (11 studies; HR=1.33; 10.58), remain of disease 6.8 + 2.9 year, were evaluated 95%CI: 1.27-1.38; I2=53%) after adjusting for a median of 8 usingVAS scale, WOMAC scale and Short Form 36 confounders. This finding was confirmed using a decrease in (SF36). Patients had tri time in 12 days therapy with one standard deviation of baseline BMD (9 studies; HR=1.16; kinesio taping method. VAS scale, WOMAC and SF36 95%CI: 1.09-1.24; I2=69%). The presence of fractures at were analyzed at baseline and after two weeks. Statistical baseline was associated with an increased risk of developing analysis included Wilcoxon's rank sum test. CVD (HR=1.20; 95%CI: 1.06-1.37; I2=91%). Regarding spe- Results: After two weeks of kinesio taping therapy all patients cific CVD, low BMD was associated with an increased risk of were with no side effect. Patient showed a decrease of pain developing coronary artery disease, cerebrovascular condi- measured by VAS scale -21 patients (84.0%), improvement of tions, and CVD associated death. Fractures at baseline was WOMAC scale 22 patient (88.0%)) and improve quality of associated with an increased risk of both cerebrovascular con- life -21 patients(84%). ditions and death due to CVD. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S183
Conclusion: Low BMD and fractures are associated with a N. Veronese1, B. Stubbs2,M.Solmi3,M.Noale1,J. higher CVD risk and possibly death. Demurtas4, A. Vaona5,S.Maggi6 1National Research Council-Aging Branch-Padova, Padova, Italy, 2King's College London, London, United Kingdom, P220 3University of Padova, Department of Neuroscience, ADHERENCE TO A MEDITERRANEAN DIET IS Padova, Italy, 4ULSS Grosseto, Grosseto, Italy, 5ULSS 22 ASSOCIATED WITH LOWER INCIDENCE OF Verona, Verona, Italy, 6National Research Council, Padova, FRAILTY: DATA FROM THE OSTEOARTHRITIS Padova, Italy INITIATIVE N. Veronese1,B.Stubbs2,M.Noale1,M.Solmi3, R. Rizzoli4, Objective: Research considering the relationship between di- G. Crepaldi5,S.Maggi6 etary magnesium (Mg) and osteoporosis and fractures are 1National Research Council-Aging Branch-Padova, Padova, sparse and conflicting. We thus aimed to investigate of Mg Italy, 2King's College London, London, United Kingdom, intake and the onset of fractures in a large cohort of American 3University of Padova, Department of Neuroscience, men and women involved in the Osteoarthritis Initiative (OAI) Padova, Italy, 4Division of Bone Diseases, Geneva over a follow-up period of 8 years. University Hospitals and Faculty of Medicine, Geneva, Material and methods: A longitudinal study design using the Switzerland, 5Italian Research Council, Padova, Italy, OAI dataset was employed. Dietary Mg intake (including 6National Research Council, Padova, Padova, Italy those derived from supplementation) was evaluated through a food frequency questionnaire at baseline and categorized Objective: To investigate if adherence to a Mediterranean diet using gender-specific quintiles; osteoporotic fractures were pattern is associated with a lower incidence of frailty in a large evaluated through self-reported history. cohort of North Americans. Results: Overall, 4,436 participants (1,858 Males; 2,578 Material and Methods: Adherence to the Mediterranean diet Females), mean age of 61.3±9.1 years were included. During was evaluated using a validated Mediterranean diet score follow-up, 789 individuals (284 men and 505 women; 17.8% of (aMED) classified into five categories. Frailty was defined using the baseline population) developed a new fracture. After the Study of Osteoporotic Fracture (SOF) index as the presence adjusting for 12 potential confounders at baseline and taking of ≥2 out of: (i) weight loss >5% between baseline and the those with lower Mg intake as reference (Q1), all the remaining subsequent follow-up visit; (ii) inability to do five chair stands; quintiles according to Mg intake, were at a significant lower risk (iii) low energy level according to the SOF definition. The of fractures, ranging from a reduction of 26% in Q2 (HR=0.74; strength of the association between aMED (divided into catego- 95%CI: 0.58-0.93, p=0.01) to a reduction of 44% in Q5 ries) and incident frailty was investigated using Cox’s regression (HR=0.56; 95%CI: 0.42-0.75, p<0.0001). These results were, models used to obtain a hazard ratio (HR) with 95% confidence however, significant only in women when we stratified our data intervals (CIs), adjusted for potential confounders. by sex. 27% of the sample met the recommended Mg intake and Results: During the 8 year follow-up, of the 4,421 participants were at an 18% decreased risk of future fractures. initially included, 362 became frail. The incidence of frailty Conclusions: Higher dietary Mg intake has a protective effect on was approximately half in those with a higher adherence to the future osteoporotic fractures, particularly in women. Those meet- Mediterranean diet vs. those with a lower adherence. After ing recommended Mg intake appear at lower risk of fractures. adjusting for 10 potential confounders, the participants with the highest aMED scores were found to have a significant reduction in incident frailty (HR=0.71; 95% CIs: 0.50-0.99, P222 p=0.047) with respect to those in a lower category. With re- THE RELATIONSHIP BETWEEN KNEE OSTEO- gard to individual components of the Mediterranean diet, low ARTHRITIS AND INCIDENT HYPERTENSION: A consumption of poultry was found to be associated with REPRESENTATIVE LONGITUDINAL STUDY higher risk of frailty. N. Veronese1,B.Stubbs2,T.Smith3,J.-Y.Reginster4,S. Conclusions: Higher adherence to a Mediterranean diet was Maggi5 associated with a lower incidence of frailty over an 8-year fol- 1National Research Council-Aging Branch-Padova, Padova, low-up period, even after adjusting for potential confounders. Italy, 2King's College London, London, United Kingdom, 3University of East Anglia, Norwich, United Kingdom, 4Department of Public Health, University of Liège, Liège, P221 Belgium, 5National Research Council, Padova, Padova, Italy DIETARY MAGNESIUM INTAKE AND FRACTURE RISK: DATA FROM THE OSTEOARTHRITIS Objective: Whilst people with osteoarthritis are more like- INITIATIVE ly to have cardiovascular disease, there is a paucity of S184 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 information considering incident hypertension vs. controls. exploratory meta-analysis comparing bone health outcomes The aim of this study was to determine whether knee in patients with MGUS vs. controls. osteoarthritis was associated with an increased risk of de- Material and methods: Two independent authors searched veloping hypertension. PubMed and Scopus from inception until November 11, 2015. Material and Methods: Data were identified from the A meta-analysis of cross-sectional and longitudinal studies Osteoarthritis Initiative (OAI) dataset, a multi-center, lon- investigating fractures and BMD was conducted. gitudinal, observational study, collected data on Standardized mean differences (SMD) ±95% and confidence community-dwelling adults. Knee osteoarthritis was de- intervals (CIs) were calculated for BMD, and risk ratios (RRs) fined through radiological and clinical assessment. were calculated for prevalent and incident fractures. Incident hypertension was defined as a systolic Results: Of 174 initial hits, 10 studies of moderate methodo- BP>140 mmHg and/or a diastolic value >90 mmHg. logical quality were eligible, including 8,711 individuals with Multivariate Cox’s regression analyses were constructed MGUS vs. 52,865 controls. Compared to controls, subjects where the presence of knee osteoarthritis as the exposure with MGUS showed significantly lower values for radial cor- and incident hypertension during follow-up interval (96 tical volumetric BMD (1 study; SMD=-5.45, 95%CI: -7.24 to months) as the outcome. -3.66), but not at the lumbar spine, femoral neck or hip. The Results: 3,558 people with normal blood pressure values incidence of fractures was higher in people with MGUS at baseline were analyzed (1,930 with knee osteoarthri- (n=7,466) vs. controls (n=52,304) (RR=1.36, 95% CI: 1.28- tis/1,628 without). The incidence of hypertension within 1.44, I2=0%) over a median of 12.5 year follow up. The inci- the follow-up interval was significantly higher in people dence of vertebral fractures was particularly elevated with knee osteoarthritis compared to those without (60 (RR=2.50, 95%CI: 1.53-4.06) although limited to two studies. vs.551000persons/years;p<0.0001). After adjusting Conclusion: although with limitations, our preliminary meta- for 12 potential confounders, people with knee osteoar- analysis suggests that patients with MGUS are at higher risk thritis had a 13% higher chance of developing hyperten- of fractures despite evidence for differences in BMD being sion (hazard ratio=1.13; 95%CI: 1.01-1.26, p=0.03). equivocal. Future longitudinal research is required to confirm Propensity score analysis substantially confirmed these our findings and determine if fracture prevention interventions findings. are warranted in people with MGUS. Conclusions: This is the first longitudinal data analysis to demonstrate that people with knee osteoarthritis have a higher chance of developing hypertension compared to those without P224 osteoarthritis. Our data suggest that blood pressure should be MODERATE-TO-VIGOROUS PHYSICAL ACTIVITY monitored in this population and preventing interventions pro- IS MORE IMPORTANT THAN SEDENTARY TIME vided to mitigate the potential adverse consequences of hy- FOR IMPROVING MUSCULOSKELETAL HEALTH pertension. OUTCOMES IN MIDDLE-AGED WOMEN F. Wu1, K. Wills1,L.L.Laslett2,B.Oldenburg3,G.Jones1,T. Winzenberg1 P223 1Menzies Institute for Medical Research, University of MONOCLONAL GAMMOPATHY OF UNDETER- Tasmania, Hobart, Australia, 2Menzies Institute for Medical MINED SIGNIFICANCE AND BONE HEALTH Research, Hobart, Australia, 3School of Population and OUTCOMES: A SYSTEMATIC REVIEW AND Global Health, University of Melbourne, Melbourne, EXPLORATORY META-ANALYSIS Australia N. Veronese1,B.Stubbs2, M. Solmi3, C. Luchini4,S.Maggi5 1National Research Council-Aging Branch-Padova, Padova, Objectives: The effects of physical activity (PA) and Italy, 2King's College London, London, United Kingdom, sedentariness on musculoskeletal outcomes remain unclear 3University of Padova, Department of Neuroscience, in middle-aged adults. We aimed to describe associations of Padova, Italy, 4University of Verona, Verona, Italy, 5National objectively measured PA and sedentary time and self-reported Research Council, Padova, Padova, Italy strenuous physical activity (SPA) and time watching television/videos (TTV) with musculoskeletal outcomes in Objective: Monoclonal gammopathy of undetermined signif- middle-aged women. icance (MGUS) is a common condition in the elderly. A num- Material and Methods: This was a 10-yr follow-up of a ber of studies have investigated the relationship between 2-yr osteoporosis education randomized controlled trial MGUS and bone health outcomes including bone mineral among 470 women aged 25-44 years (36-57 years at density (BMD), osteoporosis and fractures, but no meta- follow-up) examining associations of time spent seden- analysis exists. We conducted a systematic review and tary and in light and moderate-to-vigorous PA (MVPA) Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S185
(by Actigraph GT1M accelerometer) with lumbar spine region of interest (ROI). On each ROI a fractal parameter was (LS) and femoral neck (FN) bone mineral density computed along vertical and horizontal axis for two ranges of (BMD) (by dual-energy X-ray absorptiometry), lower scales. The obtained TBT parameters were combined with the limb muscle strength (LMS) and balance (timed up patients age, gender and BMI in logistic regression models eval- and go test (TUG), functional reach test (FRT), lateral uated using the area under the receiver operating characteristic reach test (LRT) and step test (ST)) using linear regres- curves (AUC) and the diagnostic odds ratio (DOR). sion. Associations of baseline SPA and TTV with these Results: Within the 344 knees, only 63 (18%) developed outcomes were also tested. IRKOA after 48 months. Among these knees 44 (13%) worsen Results: MVPA was beneficially associated with FN BMD their JSN grade. Neither age, gender and BMI, even combined (0.005 g/cm2, 0.001 to 0.009), LMS (β=1.48 kg, 95%confi- did predict IRKOA (AUC 0.56) nor JSN (AUC 0.59) worsening. dence interval (CI) 0.45 to 2.52), ST (0.12 steps, 0.02 to 0.23) However, severe cases, (i.e.. knees that developed a KL grade of and TUG (-0.043 seconds, -0.070 to -0.016). Associations be- 3 or more) were more predictable (AUC 0.67). For all the models tween MVPA and LMS, TUG and ST but not FN BMD including only the clinical covariates, the DOR were always <1 persisted after adjusting for sedentary time. Neither sedentary indicating a poor efficiency for IRKOA prediction. The inclusion time nor light PA was associated with any outcome after adjust- of the TBT parameters to the models improved significantly the ment for MVPA. After adjusted for confounders, including global prediction results for IRKOA (AUC 0.64) and for JSN SPA, TTV was detrimentally associated with LMS (-6.8, -12.6 worsening (AUC 0.72). Severe cases were better predicted to -1.1 for 2-3 and -3.8, -12.8 to 5.1 for ≥3vs.≤1 hour/day), (AUC 0.76). The DOR confirmed the added value of TBT for TUG (0.11, -0.04 to 0.26 and 0.17, -0.06 to 0.40), ST (-0.64, - the KL (DOR 4.97) and JSN worsening (DOR 5.16) prediction. 1.22 to -0.05 and -1.02, -1.93 to -0.10) and LRT (-1.10, -2.0 to - Conclusions: These results indicate that TBT parameters 0.18 and -1.23, -2.66 to 0.20) but not FRT. Conversely, SPAwas assessed when JSN and osteophytes are not yet apparent on beneficially associated with LMS and all balance tests except radiographs may be useful in predicting the onset of radiolog- for LRT. Neither SPA nor TTV was associated with BMD. ical tibiofemoral OA. The enhanced prediction in the JSN and Conclusions: MVPA appears more important than light phys- severe cases may suggest that the subchondral bone changes ical activity or sedentary time for many musculoskeletal out- reflected by TBT are more associated with the JSN process comes in middle-aged women. Moreover, both SPA and TTV than the osteophytes. in younger age independently predicted LMS and balance in Reference: [1] Janvier T et al. Osteoarthritis Cartilage 2016 midlife, suggesting potentially detrimental role of specific Oct 11. pii: S1063-4584(16)30314-4. sedentary behaviours beyond total sedentary time. These need to be considered when developing interventions to improve habitual physical activity and sedentary behaviours across P226 young adulthood that aim to improve musculoskeletal health. TUMOR-INDUCED OSTEOMALACIA (TIO): A CASE SERIES G. Fabbriciani1, M. S. Massarotti2,P.Filipponi3 P225 1IRCCS Istituto Ortopedico Galeazzi, Rheumatology Unit, SUBCHONDRAL TIBIAL BONE TEXTURE Milano, Italy, 2Humanitas Research Hospital, Rheumatology PREDICTS INCIDENT RADIOGRAPHIC KNEE Unit, Rozzano, Milano, Italy, 3Associazione Regionale OSTEOARTHRITIS: DATA FROM THE Umbria Osteoporosi, Perugia, Italy OSTEOARTHRITIS INITIATIVE T. Janvier1,E.Lespessailles2,R.Jennane1, H. Toumi1 Objectives: TIO is a rare acquired syndrome characterized by 1I3MTO-EA 4708, Université d'Orléans, Orléans, France, severe hypophosphatemia due to abnormal production of fi- 2Rheumatology, Hospital Orleans, i3mto Laboratory, broblast growth factor 23 (FGF 23) and we hereby report four Orleans University, Orléans, France cases of TIO with diagnostics and therapeutic challenges. Material and Methods: all patients have similar clinical and Objective: Evaluate whether trabecular bone texture (TBT) biochemical features with long history of diffused pain, pro- parameters measured by computer radiographs [1] predict in- gressive fatigue and fragility fractures, low serum phosphorus cident radiographic knee osteoarthritis (IRKOA). with reduced tubular resorption, increased serum alkaline Material and Methods: Knee Radiographs grades 0 were se- phosphatase, normal serum calcium, iPTH and 25-OH-D, lected based on Kellgren-Lawrence (KL) scale from the calcitriol inappropriately low and elevated FGF 23 levels. Osteoarthritis Initiative public use dataset. Each patient had a Results: the 1st patient is 40-year old man with primary TIO, bilateral fixed flexion computed radiographs acquired 48 months had FGF 23 value of 690 RU/mL (n.r. <100) due to apart among 4 different centers. Each baseline radiograph was hemangiopericytoma in the right maxillary sinus. The 2nd semi-automatically segmented into a patchwork of 16-squared patient is 54 years old woman with neurofibromatosis causing S186 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
TIO, the FGF 23 was 237 RU/mL. The 3rd and 4th patients level. This quality improvement (QI) project utilized a quan- were diagnosed with TIO-like syndrome, they are women of titative retrospective study design involving 91 patients. 50 and 61 years old, FGF 23 levels of 560 and 440 RU/mL Outcome data was compared on patients who had previously respectively, neoplasm production FGF 23 was not detected undergone a bone density test using a DXA scan and also had and genetic causes of hypophosphatemia were excluded. The Vitamin D OH 25 laboratory testing over the previous three- 1st patient showed normalization of FGF 23 levels after tu- year period. The main outcome that was measured was the mour removal and after 6 months he recovered completely. number of patients diagnosed with osteoporosis or osteopenia The 2nd and the 3rd patients were treated with phosphate and the laboratory blood level value of vitamin D OH 25. supplements and calcitriol with partial response. For the 4th Other variables included DXA scan results, vitamin D OH patient the standard medical therapy of TIO was failed, then it 25 lab results, gender, age, steroid use history and exercise was decided to treat him with cinacalcet resulting increased history. Using one-way ANOVA testing, the study identified serum phosphorus and significant bone healing. four groups; once this was completed, multiple regression was Conclusions: patients with acquired form of used to analyze the variables involved. hypophosphatemic osteomalacia driven by FGF-23 where Outcomes and Measures: The study consisted of 12 men and the source of ectopic FGF 23 is not detected, are classifiable 79 women. 39% of patients had both osteoporosis or as TIO-like syndrome. It is not known whether this is due to osteopenia and vitamin D deficiency, 36% of patients had inability to find the tumor or they represent separate forms of osteoporosis or osteopenia and did not have vitamin D defi- the same syndrome. Cincalcet-induced hypoparathyroidism ciency, 5% of patients had normal bone and were vitamin D reduces phosphaturic effect of FGF 23, therefore it can be deficient and 20% of patients had normal bone and normal promising option for TIO-like syndromes resistant to the ther- vitamin D results. Results of the one-way ANOVA test apy with phosphate and calcitriol. To our knowledge this is the showed a significance of p=0.026 for vitamin D when com- 2nd report in the international literature reporting the efficacy pared to the control group diagnosis. The results of this anal- of cincalcet in TIO syndrome (1). ysis show that vitamin D deficiency is a statistically signifi- Reference: 1) Geller JL et al. J Bone Miner Res 2007;22:931. cant factor in osteoporosis and osteopenia. The factor of vita- min D deficiency had a higher statistical significance than exercise history, steroid use, gender, and age. P227 DETERMINING THE EFFECTS OF VITAMIN D ON OSTEOPOROSIS AND OSTEOPENIA P229 S. T. Tilgner1 THE ROLE OF A NOVEL GENE, FAM210A (FAMILY 1Innovative Health Care, Lake Havasu City, United States WITH SEQUENCE SIMILARITY 210, MEMBER A) IN BONE AND MUSCLE Problem: Vitamin D deficiency is a concern, not only in the K. Tanaka1,Y.Xue1,J.B.Richards2, D. Goltzman1 United States, but worldwide. Identifying a correlation for 1Calcium Research Laboratory, McGill University Health osteoporosis and osteopenia in vitamin D deficient patients Centre, and Division of Endocrinology, Department of may reduce the risk of osteoporosis-related fractures. The Medicine, McGill University, Montreal, Canada, PICO question for this capstone project was: In osteoporotic 2Departments of Medicine, Human Genetics, Epidemiology or osteopenia patients, what is the relationship between re- and Biostatistics, McGill University, Montreal, Canada duced serum levels of vitamin D OH 25 compared to normal serum levels of vitamin D OH 25, in the incidence of osteo- Background: Linkage between muscle and bone has recently porosis or osteopenia? Osteoporosis contributes to fracture noted. Genome-Wide Association Studies have identified risk in patients, which subsequently has been shown to result SNPs intronic to FAM210A, which are strongly associated from an insufficiency in vitamin D. with the risk of fracture, but less so with bone mineral density Purpose: The purpose of the project was to evaluate the rela- (BMD) reduction [Nat Genet 2012]. However, the skeletal tionship between osteoporosis and osteopenia and Vitamin D function of FAM210A remains unknown. OH 25 levels. Objective: We investigated the effect of Fam210a on bone Goals and Objectives: The goal of this study was to deter- and muscle using 2-month-old mice with targeted deletion mine if a relationship existed between vitamin D deficiency of Fam210a (Fam210a±and tamoxifen-inducible Fam210a-/ and osteoporosis or osteopenia and note its significance. -). We examined tissue expression of Fam210a protein by Identifying a correlation between these factors may help to Lac Z staining, and investigated serum and urine biochemis- raise awareness in the investigator’s practice and community. try, BMD, bone mineral content (BMC), biomechanical tests, Plan: The issue was identified as outlined above, and the parameters of trabecular and cortical bone micro-architecture project was implemented using PICO analysis at the doctorate using micro computed tomography (μCT), grip strength, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S187 average quadriceps muscle cross-sectional area (MCA) and obtained. Serum was collected for IL-6 determination at baseline mRNA levels of myogenic genes. and after 3 months of training (>24 h after the last training in order Results: By Lac Z staining, Fam210a was mainly expressed to avoid bias due to acute exercise-induced changes). in muscle, heart and brain. There was no difference in the Results: All exercise interventions were well tolerated by the levels of serum and urine calcium as well as phosphate be- participants. 3 months IST induced a significant decrease tween wild-type (WT) and Fam210a±mice as well as between (p=0.027) in circulating IL-6 in male only. No significant control (Cont) and Fam210a-/- mice. BMD and BMC of changes were observed in the other exercise groups nor in Fam210a-/- were significantly lower than those of Cont (fe- female participants. male: p=0.01 and p=0.01, respectively, male: p=0.03 and Conclusions: Resistance training at high external load can p=0.01, respectively). Three point bending tests showed that reduce circulating IL-6 levels in older male subjects, contrary the maximal load, stiffness and work to failure of Fam210a to resistance training at lower external resistance which did ±and Fam210a-/- mouse bones were significantly lower than not result in significant changes. The lack of effect of IST in those of WT and Cont, respectively (p<0.05). In addition, by female persons is in line with earlier reports and might be μCT, cortical bone volume and cortical thickness of Fam210a related to sex-differences in body composition, which needs ±were significantly lower than those of WT (p=0.01 and further investigation. p=0.02, respectively), and cortical porosity of Fam210a±was significantly greater than that of WT (p=0.02). Interestingly, grip strength and average quadriceps MCA of Fam210a±and Fam210a-/- were significantly lower than those of WT and Cont, respectively (p<0.01). Moreover, mRNA levels of MyoD, myogenin and Myf6 of Fam210a±were significantly lower than those of WT (female: p=0.03, p=0.01 and p=0.01, respectively; male: p=0.03, p=0.03, and p=0.04, respectively). Conclusions: These findings indicate that Fam210a has a cru- cial role in modulating bone strength via effects on bone and muscle. Fam210a might be an important factor in the interac- P231 tion between muscle and bone. INFLUENCE OF SUNLIGHT EXPOSURE ON BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH ESTROGEN DEFICIENCY IN P230 MENSTRUAL HISTORY 1 2 1 DOSE-RESPONSE RELATIONSHIPS FOLLOWING 3 A. Kapetanovic , D. Avdic , S. Hodzic 1 MONTHS RESISTANCE TRAINING IN OLDER Institute for Medical Rehabilitation and Spa Treatment. 2 ADULTS ON CIRCULATING IL-6: PRELIMINARY Reumal Fojnica, Fojnica, Bosnia and Herzegovina, Faculty RESULTS FROM THE SENIOR’S PROJECT of Health Studies, University of Sarajevo, Sarajevo, Bosnia INTENSIVE TRAINING (SPRINT) and Herzegovina K. Liberman1,L.N.Forti1,R.Njemini1,L.DeDobbeleer1,V. Knoop1, I. Beyer1,I.Bautmans1 Objective: Estrogen deficiency is associated with low bone 1Frailty in Ageing Research Unit, Brussels, Belgium mineral density. The objective of this study was to examine in- fluence of sunlight exposure on bone mineral density in postmen- Background: Exercise is known to counter age-related chronic opausal women with estrogen deficiency in menstrual history. low-grade inflammation. Less is known about the dose-response Material and Methods: The study included 100 postmeno- relationships following resistance training in older adults. pausal women, aged 50 to 65 with estrogen deficiency in men- Methods: 113 older persons aged 71±5 years participating in the strual history. The subjects were divided in two groups, exami- Senior’s Project Intensive Training (SPRINT, an ongoing exercise nation and control group, based on bone mineral density values. intervention study) were randomized into 3 months exercise 3x/ The women in the examination group (n=50) had osteoporosis. week at either: intensive resistance training (IST, 3x 10 repetitions The women in the control group (n=50) had osteopenia or nor- @ 70-80% 1RM, 13 male, 21 female), strength endurance train- mal mineral bone density. Bone mineral density was measured at ing (SET, 2x 30 repetitions @ 40% 1RM, 16 male, 25 female) or the lumbar spine and proximal femur by Dual–Energy X–ray flexibility training (FT, 3x 30 seconds, 12 male, 26 female). Absorptiometry using Hologic QDR-4000 scanner. Resistance training consisted in leg press, chest press, leg abduc- Results: The average daily exposure to sunlight, in the sum- tor, leg adductor, low row and vertical traction. All exercise ses- mer, in women with osteoporosis who had estrogen deficiency sions were supervised by a trained exercise coach. Every 2 weeks, in the menstrual history amounted to 43.40 minutes and in training weights were adapted according to the strength gains women without osteoporosis 56.60 minutes. The difference in S188 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 the length of sunlight exposure between a group of women with (steroids and methotrexate 20mg/week) for the concomitant osteoporosis and group of women without osteoporosis was arthritis. statistically significant, p <0.001. The average daily exposure to sunlight, in the winter, in women with osteoporosis who had P233 estrogen deficiency in the menstrual history amounted to 20.00 VITAMIN D AND HOMOCYSTEINE INVERSELY minutes and in women without osteoporosis 25.80 minutes. RELATED IN POSTMENOPAUSAL WOMEN The difference in the length of sunlight exposure between the S. Tariq1,2,K.P.Lone3 group of women with osteoporosis and group of women with- 1Physiology/ University Medical and Dental College, The out osteoporosis was statistically significant, p <0.01. University of Faisalabad, Faisalabad, Pakistan, Conclusion: Results of this study suggest that sunlight expo- 2Pharmacology and Therapeutics/ University Medical and sure has positive influence on bone mineral density in post- Dental College, The University of Faisalabad, Faisalabad, menopausal women with estrogen deficiency in menstrual Pakistan, 3Physiology and Metabolic disorders, University history. Protective effects have been demonstrated in case of of Health Sciences, Lahore, Pakistan daily exposure to sunlight for a period of 56.60 minutes in the summer and 25.80 minutes in the winter. Objectives: Osteoporosis is a most common age related, mul- tifactorial disease. The study was designed to see the correla- tion between serum homocysteine (Hcy), vitamin D and bone P232 mineral density (BMD) in postmenopausal non-osteoporotic, A RARE SCLEROSING BONE DISORDER: A CASE osteopenic, and osteoporotic females and compare these OF MELORHEOSTOSIS values between the three groups. G. M. Guidelli1,M.Bardelli1, M. Galeazzi1,E.Selvi1 Material and Methods: In this cross sectional study postmen- 1Rheumatology Unit, University of Siena, Siena, Italy opausal females between 50-70 years of age were taken and divided into three groups, non-osteoporotic (n=52). osteopenic Melorheostosis is a rare, non-familial sclerosing bony disorder (n=69), and osteoporotic (n=47) females. ANOVA and of poorly understood etiology. It was first described by Leri in Kruskal-Wallis test were applied to compare groups while 1922. It is characterized by soft tissue contractures with over- spearman's rho correlation was used to establish correlations. lying slowly evolving linear hyperostosis. It usually occurs in Results: Significant negative correlation of homocysteine was the limbs and frequently crosses synovial joints, and there is observed with vitamin D in postmenopausal non-osteoporotic often ossification in local soft tissues. The typical presentation females (rho=-0.428, p=0.002) and vitamin B12 in non- is painless, asymmetric joint contracture prior to age 6 years, osteoporotic (rho=-0.410, p=0.003) and osteopenic (rho=-0.415, however, patients can present at any age with various symp- p <0.001) females, but no significant correlation was observed toms, including pain, limb swelling, and restricted range of with T-Score, Z-Score and ultrasound bone profile index (UBPI). motion of extremity due to soft tissue contracture. Although Conclusion: There is significant inverse relation between vi- melorheostosis can affect any bone, the lower extremities are tamin D and homocysteine in postmenopausal non- more frequently involved. The overlying skin may be thickened osteoporotic females, but no significant results are found in due to lymphedema, tense, erythematous, and shiny. Other osteoporotic women and no significant relation of homocys- changes in soft tissue include anomalous pigmentation, indura- teine and vitamin D was found with BMD. tion and edema of the subcutaneous tissues, periarticular fibro- Disclosures: The research has been funded by grant from sis, weakness and atrophy of muscles, perivascular fibrosis with higher Education commission, Islamabad, Pakistan. obliteration of blood vessels, and linear scleroderma. We report a case of a 52 year old Caucasian man, admitted to our unit for the presence of acute arthritis involving both knees and ankles, P234 associated with joint contractures and a limitation in the range COMPARISON OF PARAMETERS OF BONE of motion of his left knee. Skin of both legs was characterized PROFILE AND HOMOCYSTEINE IN PHYSICALLY by cutaneous hardening and thickening, and erythematous ACTIVE AND NON-ACTIVE POSTMENOPAUSAL changes. The patient was previously diagnosed as having FEMALES Eosinophilic Fasciitis, although his lab tests did not reveal any S. Tariq1,3,K.P.Lone2 raise in eosinophil count and/or hypergammaglobulinemia, but 1Physiology/ University Medical and Dental College, The only a mild increase in acute phase reactants. The diagnosis of University of Faisalabad, Faisalabad, Pakistan, 2Physiology melorheostosis became clear when the patient underwent X-ray and Metabolic disorders, University of Health Sciences, evaluation, which revealed the typical linear hyperostosis on his Lahore, Pakistan, 3Pharmacology and Therapeutics/ left femur, the so called "candle-wax" aspect. The patient was University Medical and Dental College, The University of given symptomatic treatment and immunosuppressants Faisalabad, Faisalabad, Pakistan Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S189
Objectives: Optimal physical activity is important in attaining a peak bone mass. Physically active women have better bone mineral density and reduce fracture risk as compare to females living a sedentary life. The objective of this study was to compare parameters of bone profile and serum homocysteine levels in physically active and non-active postmenopausal females. Material and Methods: In this cross sectional study post- menopausal females between 50-70 years of age were recruit- ed and divided into two groups: Physically inactive (n=133) performing light physical activity and Physically active (n=34) performing moderate physical activity. Physical activ- ity (in metabolic equivalents), bone mineral density and serum homocysteine levels were assessed. Spearman’s rho correla- tion was applied to observe correlations. Two independent
sample t test and Mann Whitney U test were applied to com- pare groups. P‑value ≤ 0.05 was taken statistically significant. Results: Parameters of bone profile were significantly higher and serum homocysteine levels were significantly lower in postmenopausal females performing moderate physical activ- ity as compared to females performing light physical activity. Homocysteine was not significantly related to T-score and Z- score in both groups. Conclusion: It is thus concluded that improving physical ac- tivity could be beneficial for improving the quality of bone, decreasing fracture risk and decreasing serum homocysteine levels. Disclosures: The research has been funded by grant from higher Education commission, Islamabad, Pakistan.
P235 RELATIONSHIP OF ANTHROPOMETRIC MEASURES WITH BONE MINERAL DENSITY IN POSTMENOPAUSAL NON-OSTEOPOROTIC, OSTEOPENIC AND OSTEOPOROTIC WOMEN S. Tariq1,2,K.P.Lone3 1Physiology/ University Medical and Dental College, The University of Faisalabad, Faisalabad, Pakistan, 2Pharmacology and Therapeutics/ University Medical and Dental College, The University of Faisalabad, Faisalabad, S190 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Pakistan, 3Physiology and Metabolic disorders, University of TaqMan genotyping assays. Serum levels of RANKL and Health Sciences, Lahore, Pakistan OPG were determined using ELISA Results: There was no significant difference in genotypic and Objectives: Body mass index (BMI) has been shown to be more allelic frequencies of all the four studied SNPs among osteo- important predictor of bone mineral density (BMD). The objective porotic and normal group. However, CC and CG genotypes of of this study was to investigate the relationship of anthropometric rs2073618 SNP in OPG gene is significantly associated lower measuresincludingbodymassindexwithBMDinpostmenopaus- BMD at femur in control subjects (p>0.0001). al non-osteoporotic, osteopenic and osteoporotic women. Conclusion: None of the four studied SNPs (rs1805034, Material and Methods: In this cross sectional study postmen- rs35211496, rs2277438 and rs2073618) in RANK, RANKL, opausal females between 50-70 years of age were recruited and and OPG gene are associated with osteoporosis risk. divided into three groups: non-osteoporotic (n=52), osteopenic However, C allele of rs2073618 in OPG gene is a risk for (n=69) and osteoporotic females (n=47). Anthropometric mea- lower BMD at femoral site. Further studies with larger sample sures and bone mineral density were assessed. ANOVA was size are required to confirm this association. applied to compare groups while post hoc Tuckey’s test was used for multiple comparisons between the groups. Spearman's rho correlation was used to establish correlations. P237 Results: BMI (p=0.034) and hip circumference (p=0.013) FEATURES OF PREOPERATIVE PLANNING OF were significantly higher in osteopenic as compared to osteo- TOTAL HIP REPLACEMENT IN PATIENTS WITH porotic females and waist to hip ratio was significantly higher HIP-SPINE SYNDROME (p=0.005) in osteoporotic as compared to non-osteoporotic A. V. Alabut1, V. D. Sikilinda1,A.V.Pilieva1,D.S.Chuyko1 females. Significant positive correlation of BMI was found 1Rostov State Medical University, Department of with T-score (p=0.022) and ultrasound bone profile index (p Traumatology and Orthopedics, Rostov on Don, Russian <0.001) in postmenopausal females. Federation Conclusion: High BMI is associated with high BMD and reduced fracture risk in postmenopausal females. Increasing Relevance: Stabilometry is a quantitative evaluation method age and high waist to hip ratio can also lead to reduced BMD of the function of balance in a vertical position with vibrating in postmenopausal females. supports. It is one of the most promising diagnostic methods Disclosures: The research has been funded by grant from for the development of hip spine syndrome in patients during higher Education commission, Islamabad, Pakistan. the preoperative period of total hip replacement. Materials and methods: The average age of the study pa- tients is 67.2±1.2 years. The first group (n=43) includes pa- P236 tients with end-stage coxarthrosis during the preoperative pe- ASSOCIATION STUDY OF SINGLE NUCLEOTIDE riod of total hip replacement who are experiencing Low back POLYMORPHISM OF RANK, RANKL AND OPG pain (LBP). The second is a control group (n=32) including GENES IN POSTMENOPAUSAL OSTEOPOROTIC relatively healthy people of average age 43.6±2.3 years. Using SAUDI SUBJECTS the stabilometric complex ST 150, the following parameters R. BinBaz1 were investigated: 1. The function of balance on the pressure 1Biochemistry Department, College of Science, King Saud center (PC,%) in different foot configurations in the frontal University, Riyadh, Saudi Arabia and sagittal planes; 2. Weight distribution difference on the lower limbs (WD,%); 3. Statokinesigram area. Background and aims: Osteoporosis is determined by an Results: In the first group for PC on the frontal plane, pressures interaction between genetic, metabolic and environmental fac- were symmetrical in all configurations. PC indicator in the sag- tors. Thus, the present research aimed to determine the asso- ittal plane showed asymmetry inclined towards the «inopera- ciation between genetic variants in the RANK, RANKL and ble» limb on average + 12.2 (+5.1; +24.6)% tending to hind OPG gene and osteoporosis in postmenopausal Saudi women. pressure. In the second group for PC the frontal plane was In addition, to evaluate whether these genetic variants has any stable. WD on the lower limbs in the first group amounted to influence on serum biochemical and bone markers. an average of 7 (4,5; 13)% in favor of the healthy limb. In the Study design: 100 Osteoporotic and 100 age-matched healthy second group, there were slight fluctuations±1-2% in both di- controls were enrolled and were genotyped for two SNPs in rections. The statokinesigram of the first group showed an elon- RANK gene (rs1805034 and rs35211496) and one each in gated ellipse tending to deviate along the abscissa by 7-10 °, RANKL (rs2277438), and OPG (rs2073618) genes using along the ordinate by 3-5 ° tending towards the upper pole. In Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S191 the second group, the statokinesigram was located in the center Objective: To show the level of adherence to calcium, vitamin of the intersection of the axes with a wavering central point. D and drugs for osteoporosis in order to osteoporosis duration. Conclusions: Stabilometric analysis of functional deformations Material and Methods: The prospective analysis is per- can be used as a component in the preoperative planning of total formed from 20 November to 20 December 2015 at the hip replacement in patients with comorbid LBP syndrome. Special Hospital for Rheumatic Diseases Novi Sad, Serbia. The study involved 80 postmenopausal women who were diagnosed with reduced bone mineral density (BMD) by dual P238 X-ray absorptiometry and all respondents filled in the same MODIFICATION OF SAVAGE TENDON REPAIR questionnaire. Morisky scale was used to analyze adherence to A. V. Alabut1, V. D. Sikilinda1,F.M.Gamidov1,L.V. calcium, vitamin D and drugs for osteoporosis. We also mon- Gorobets1, A. V. Pilieva1 itored correlation of adherence to calcium, vitamin D and 1Rostov State Medical University, Department of Traumatology drugs of osteoporosis in order to osteoporosis duration. The and Orthopedics, Rostov on Don, Russian Federation central tendency measures, ANOVA test and T-test were used for statistical analysis. Relevance: Many of the popular tendon suture tech- Results: The average age of participants was 65.52±8.29 niques have several flaws: lack of strength and adapta- years. 67.5% had osteoporosis (duration M 4.29±3.36 years) tion, circulatory disorder, a large number of nodes and and 32.5% osteopenia (duration M 3.54±2.42 years). Most all of that is the cause of early postoperative patients showed a low level of adherence to calcium complications. (92.7%), vitamin D (77.8%) and drugs for osteoporosis Materials and methods: 80 pig tendons were used for the (67.9%). Looking at the osteoporosis duration there is no sta- experiment. The tendons were sutured using modified Savage, tistically significant difference in relation to adherence to cal- Bunnell-Cuneo, Kraskow and Kessler techniques. A blocked cium (T-test=-1.32, p=0.196) and drugs for osteoporosis (T- encircling suture was used as adaptive suture. Suture material: test=0.167, p=0.867). On the other hand, there is statistically Polysorb 2-0 and for adaptive sutures Prolene 4-0. Tensile significant difference in relation to adherence to vitamin D in strength was determined using a dynamometer with a load order to osteoporosis duration (T-test=-2.02, p=0.049). of 300 N (30 kg). Women with low level of adherence to vitamin D had longer Results: The modified Savage technique involved the follow- osteoporosis (M=4.4) and women with medium level of ad- ing: reducing the number of core sutures to four, stitching both herence to vitamin D had osteoporosis approximately 2 years the front and the rear walls to avoid passing the strand through (M=2.11). the whole tendon, thus reducing the number of needle injec- Conclusion: Adherence to calcium, vitamin D, and drugs for tions, enabling better edge adaptation, reducing the number of osteoporosis is critically low among postmenopausal women threads on the tendon surface and avoiding disrupting blood which may cause serious complications. Physicians should supply to the tendon. The experimental results obtained indi- actively seek causes of the low adherence and ways of its cate that the strongest suture is the modified Savage technique increase in order to better treatment and prevention of compli- with an average tensile strength of 282 N (28.2±1.6 kg). cations. Suture 221 N (22.1±2.2 kg), Kessler technique 92 N (9.2 ±1.7 kg), Bunnell-Cuneo technique – 81 N (8.1±1.7 кг). Conclusions: The modified Savage tendon suture technique P240 is the most durable and makes it easier to adapt the tendon MODELING- AND REMODELING-BASED BONE edge as compared to other techniques. FORMATION IN THE ANABOLIC VS. ANTIRE- SORPTIVE (AVA) STUDY IN POSTMENO-PAUSAL WOMEN WITH OSTEOPOROSIS P239 D. W. Dempster1,H.Zhou1,R.R.Recker2,J.P.Brown3,C.P. THE EFFECT OF THE OSTEOPOROSIS DURATION Recknor4,E.M.Lewiecki5,P.D.Miller6,S.D.Rao7,D.L. ON THE ADHERENCE TO CALCIUM, VITAMIN D Kendler8,R.Lindsay9,J.H.Krege10,J.Alam10,K.A. AND DRUGS FOR OSTEOPOROSIS Taylor11,V.A.Ruff11 B. Erdeljan1,M.Maksimovic-Simovic1,D.Lazarevic2 1Regional Bone Center, Helen Hayes Hospital, W 1Rheumatology, Special Hospital for Rheumatic Diseases, Haverstraw, NY, United States, 2Department of Medicine, Novi Sad, Serbia, 2Institute for Cardiovascular Diseases, Division of Endocrinology, School of Medicine, Creighton Department for Radiology Imaging Diagnostics, Sremska University, Omaha, NE, United States, 3Rheumatology and Kamenica, Novi Sad, Serbia Bone Diseases Research Group, CHU de Quebec (CHUL) S192 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Research Centre and Department of Medicine, Laval University, Quebec City, QB, Canada, 4United Osteoporosis Centers, Gainesville, FL, United States, 5New Mexico Clinical Research and Osteoporosis Center, Albuquerque, United States, 6Department of Medicine, CO Center for Bone Research, Lakewood, CO, United States, 7Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, MI, United States, 8Department of Medicine (Endocrinology), University of British Columbia, Vancouver, BC, Canada, 9Regional Bone Center, Helen Hayes Hospital, W. Haverstraw, NY, United States, 10Eli Lilly and Company, Indianapolis, IN, United States, 11Musculoskeletal and Men’s Health, Lilly USA, LLC, Indianapolis, IN, United States
Objective: To compare early effects of an established anabol- ic (teriparatide: TPTD) vs. a prototypical antiresorptive (denosumab: DMAb) agent on modeling- and remodeling- based bone formation (MBF and RBF). Materials and Methods: Postmenopausal women with osteo- porosis were randomized to open-label TPTD (20 mcg/day) or DMAb (60 mg once) for 6 months. Double fluorochrome label- ing was performed at baseline (BL) and prior to transiliac biopsy at month 3, when any effects of a transient rise in endogenous P241 PTH with DMAb should be observable. Bone formation was THE PROTECTIVE EFFECT OF HONOKIOL ON expressed as a proportion of bone surface (BS), and was con- HUMAN UMBILICAL CORD DERIVED MESEN- sidered RBF if the underlying cement line was scalloped, MBF CHYMAL STEM CELLS IN TNF-Α AND IL-1Β if it was smooth, and overflow MBF (oMBF) if over a smooth INDUCED INFLAMMATORY ENVIRONMENT OF cement line adjacent to RBF. Mean changes from BL were OSTEOARTHRITIS compared between treatment groups using ANCOVA; within H. Wu1,Y.Qiu1 group differences were tested by paired T-tests. 1First Affiliated Hospital, College of Medicine, Xi'an Jiaotong Results: At BL, mean RBF/BS, MBF/BS, and oMBF/BS University, Xi'an, China were similar between the TPTD and DMAb groups in the cancellous, endocortical, and periosteal envelopes. At 3 Objectives: Mesenchymal stem cells have been expected to months, with TPTD, all types of formation increased signifi- be a promising seed cell for cartilage repair, but the outcome cantly in the cancellous and endocortical envelopes (range: 3- was far from satisfaction. Osteoarthritis (OA) is degenerative 22-fold; all differences p<0.001), as did MBF/BS in the peri- and inflammatory disease of synovial joint. TNF-α and IL-1β osteal envelope (4-fold, difference p<0.001). Response to are main pro-inflammatory cytokines responsible for initiation TPTD was especially robust in the endocortical envelope and progression of OA, trigger different downstream path- (Figure). In contrast, with DMAb all types of formation were ways, lead to chondrocytes apoptosis and cartilage degrada- decreased or unchanged except MBF, which increased 2-fold tion. Honokiol is an extract from a herb and anti-inflammation in cancellous envelope (BL=0.1%, 3 month=0.2%, difference is one of its main features. We hypothesize that an OA dose of p=0.048). All types of bone formation were significantly TNF-α or IL-1β has the suppressive effect on human umbil- greater with TPTD vs. DMAb, excepting oMBF in periosteal ical cord-derived mesenchymal stem cells (hUC-MSCs), envelope. meanwhile, honokiol can partly protect hUC-MSCsby Conclusions: A short course of TPTD generally increased blocking NF-κB pathway. RBF, MBF, and oMBF in the 3 bone envelopes, while Material and Methods: hUC-MSCs were cultured in different these were mostly reduced or unchanged with DMAb, culture medium for osteogenesis, chondrogenesis and adipogen- reflecting the marked difference in mechanism of action esis. Differentiation results were evaluated by specific cytochem- of the 2 drugs. The results also provide the clearest ev- ical staining and quantitative real-time polymerase chain reaction idence to date that TPTD stimulates MBF on the perios- (qRT-PCR). Different group were treated with TNF-α (20ng/ml), teal surface. IL-1β (10ng/ml) and Honokiol (10μM) for 2 weeks, then cells Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S193 were collected and analyzed by qRT-PCR, western blot, ELISA musculoskeletal examination compared to examination of other and fluorescence microscopy. Results were expressed as mean systems. Only 21% opined that they had enough opportunities ±SD. Groups were compared by student t-test, p <0.01. to learn MSK examination. Of the remaining, 51% felt inade- Results: Positive staining results were found in osteogenesis, quate opportunities for learning MSK examination while 28% chondrogenesis and adipogenesis. qRT-PCR analysis showed had neutral replies. It was noticeable that only 50% of partici- high expression of differentiation marker genes (Runx-2, pants had a Rheumatology or Orthopedics rotation. The pre-test ALP, Sox-9, Col2a1, Aggrecan, CEBP, FABP4/aP2). TNF-α survey showed a majority were independent learners. 80% used or IL-1β induced apoptosis of hUCMSCs, promoted expres- free internet based materials, preferably YouTube or Medscape sion of Caspase-3, COX-2, MMP-1, -9, 13, IL-6, and sup- (81%) while 61% discussed with peers. It is worrying that most pressed expression of Sox-9, Aggrecan and Col2a1 in hUC- (55%) are confident in the reliability of e-materials. Almost 40% MSCs. Honokiol partly reversed these effects by blocking p- preferred a self-study methodology and 38% remained neutral. IKKα/β,p-IκBα and p-p65 expressions in NF-κBpathway. 14 out of the 15 learners who participated in the voluntary Conclusions: TNF-α and IL-1β suppressed the survival and posttest survey had completed the GUEST 5 step methodology. chondrogenesis of hUC-MSCs. But honokiol protected hUC- All agreed their confidence in doing an independent MSK ex- MSCs and maintain the chondrogenic potential in inflamma- amination improved after going through the GUEST e-learning tion by blocking NF-κB pathway. Our findings suggest that methodology. All of them chose e-learning, especially a reliable combination of anti-inflammation and stem cell may improve website, over other methods. They feedback that GUEST based the outcome of cell-based cartilage repair. e-learning was simple and easy. Conclusion: Internet-based learning is preferred among “Gen Z” doctors, We propose a guided e-learning methodology for P242 musculoskeletal examination. E-learning could be part of a WHEN IN DOUBT, WHO TO ASK? GUEST-5, AN structured training programme for the relevant group. INTERNET BASED GUIDED E-SELF STUDY FOR LEARNING MUSCULOSKELETAL EXAMINATION S. J. Vadassery1,W.L.Lui2, S. Cheong3, T. Soon Yin2,B.Chia3 P243 1General Medicine, Tan Tock Seng Hospital, Singapore, ASSOCIATION OF SELF-REPORTED MUSCULO- 2Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, SKELETAL SYMPTOMS WITH SERUM LEVELS OF 3Information Technology, Tan Tock Seng Hospital, Singapore VITAMIN D AND MULTIVARIATE CYTOKINE PROFILE IN HEALTHY WOMEN Background: Studies reveal that trainee doctors lack confi- F. Azizieh1, K. Alyahya2,K.Dingle1 dence in Musculoskeletal (MSK) examination. As 1Gulf University for Science and Technology, Mubarak Al- Generation-Z prefers internet-based learning, medical educa- Abdullah Area, Kuwait, 2Public Authority for Applied tors can consider e-based guided teaching. There is limited Education and Training, Kuwait data on e-based teaching of MSK examination. Objective: A pilot study to assess current learning opportuni- Objective: Although a large number of studies investigated ties among doctors and acceptability of e-learning of MSK possible relation between serum levels of vitamin D or cyto- examination. kines with disease progress and prognosis, similar studies with Methods: A cross-sectional study among junior doctors in our respect to self-reported symptoms are still controversial. The teaching hospital. Interested participants were given access to overall objective of this study was to look into the association the 5-step e-based, pre-verified GUided E-Self sTudy material between serum levels of vitamin D, pro- and anti-inflammatory for learning musculoskeletal examination. Step (1): History cytokines with self-reported symptoms related to musculoskel- taking (2): Differential diagnoses using the Diagnosaurus (3) etal pain in an adult healthy women population. Joint anatomy using Youtube videos (4) Physical examination Methods: Venous blood samples were collected from 117 using YouTube videos, (5) Discussion with experts via an adult, healthy women and serum levels of vitamin D, pro- online platform. Participants feedback on current learning op- inflammatory cytokines (IL-1b, IL-6, IL-8, IL-17, IFN-g portunities in MSK examination as well as pre and post inter- TNF-a) and anti-inflammatory cytokines (IL-4, IL-10, IL- vention change of confidence in MSK examination using a 13) were measured. Groups were tested for differences in sin- voluntary questionnaire e-survey. gle parameters, pro-/anti-inflammatory cytokine ratios as well Results: 97 doctors participated in the pre-intervention as for differences in multivariate cytokine patterns. survey. Only 21% of them were confident in conducting MSK Results: There were no significant associations between se- examinations. 79% opined they were less confident in rum levels of vitamin D and the self-reported musculoskeletal S194 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 symptoms studied. However, serum levels of the pro- rates between the two groups was observed (p=0.62). inflammatory cytokine IL-8 were significantly higher in sub- Common adverse reactions were found to be pain after the jects with musculoskeletal pain as compared to subjects who injection and dyspepsia. reported no symptoms (p=0.008). The pro-/anti- inflammatory Conclusions: Injection of triamcinolone seems to be suffi- cytokine ratio showed a pro-inflammatory cytokine domi- cient and safe to treat anserine syndrome. The oral adminis- nance in subjects with self-reported symptoms particularly in tration of meloxicam, and perhaps other NSAIDs, does not groups with deficient levels of vitamin D. However, the mul- improve the efficacy of triamcinolone in the treatment of the tivariate cytokine pattern analysis was not significantly differ- anserine syndrome. ent between the two groups. Conclusion: These data point to a possible role of pro- inflammatory cytokines as a contributing factor in self- P245 reported symptoms related to musculoskeletal pain. COMPARISON BETWEEN DIARY-ACTUATED Acknowledgment: This research was funded fully by Public REHABILITATION PROGRAM AND CONVENTIONAL Authority for applied Education and Training (PAAET) pro- PHYSICAL THERAPY ON MOBILITY AND FUNCTION ject no. (BE-14-09). FOLLOWING TOTAL KNEE ARTHROPLASTY S. Thiengwittayaporn1, N. Kangkano2, N. Krishnamra2,N. Charoenphandhu2 P244 1Department of Orthopaedics, Faculty of Medicine Vajira DOES NSAIDS PROVIDE ANY ADDITIONAL Hospital, Navamindradhiraj University, Bangkok, Thailand, BENEFIT IN THE TREATMENT OF ANSERINE 2Center of Calcium and Bone Research (COCAB), and the SYNDROME? A RANDOMIZED, DOUBLE-BLIND, Department of Physiology, Faculty of Science, Mahidol PLACEBO-CONTROLLED TRIAL University, Bangkok, Thailand S. Thiengwittayaporn1,S.Phatwong1,N.Kangkano2,N. Charoenphandhu2 Introduction: Alleviation of pain and improvement of phys- 1Department of Orthopaedics, Faculty of Medicine Vajira ical function are the main expected outcomes after total knee Hospital, Navamindradhiraj University, Bangkok, Thailand, arthroplasty (TKA). Although TKA is an effective treatment 2Center of Calcium and Bone Research (COCAB), and the for patients with end-stage knee osteoarthritis (OA), patients Department of Physiology, Faculty of Science, Mahidol sometimes exhibit strength, functional, and mobility deficits University, Bangkok, Thailand as compared to preoperative status. All these residual impair- ments affect patients’ ability to perform normal daily activities Introduction: Anserine syndrome displaying the symptoms and ambulation. of spontaneous medial knee pain with tenderness in the Objectives: (i) to investigate the effectiveness of diary- inferomedial aspect of the joint is a common complaint in actuated rehabilitation program compared to routine rehabili- clinical practice. There is no definite consensus for the treat- tation program at 2- and 6-weeks post-TKA, (ii) to investigate ments of this syndrome; however, the common treatments whether the diary-actuated rehabilitation program was able to include steroid injection and oral administration of non- provide significant improvements from baseline of clinical steroidal anti-inflammatory drugs. outcomes at 6 weeks after TKA. Objectives: We hypothesized that there would be no signifi- Material and Methods: Eighty OA patients who underwent cant difference in the success rates (patient’ssymptomsand primary TKA were randomly assigned to the diary-actuated physical signs were completely resolved, and > 70% improve- rehabilitation or routine rehabilitation groups. All patients re- ment in the pain VAS) when anserine syndrome is treated with ceived a 6 weeks of home-based rehabilitation program and triamcinolone injection with or without oral meloxicam. were evaluated preoperatively (baseline), and at 2-, and 6- Materials and Methods: A randomized, double-blind trial weeks postoperatively. The primary outcomes were evaluated was conducted in 64 patients with anserine syndrome given by using range of motion (ROM), the American Knee Society an injection of 20 mg of triamcinolone. The patients were Clinical Rating System (KSS 1989) and the new Knee Society randomly separated into two groups: Group A received oral Scoring System (KSS 2011). The secondary outcomes were meloxicam for 7 days (n=32) and Group B received placebo obtained through six-minute walk test (6MWT) and stair- tablets for 7 days (n=32). At three weeks after the injection, climbing test (SCT). primary outcomes (patient’s symptoms, physical signs and Results: The patients who received diary-actuated rehabil- pain scores) and adverse reactions were assessed by an inde- itation exhibited significantly greater values in active knee pendent, blinded evaluator. extension, total active knee ROM, total passive knee Results: The success rates were 50% and 40.6% for Groups A ROM and all subscales of KSS 1989 (knee score and and B, respectively. No significant difference of the success functional score), and KSS 2011(objectivekneescore, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S195 satisfaction score, and functional activity score) than rou- Results: The low-trauma fractures were present in 44.6% of tine rehabilitation at 2- and 6-weeks after surgery. subjects, from which there were 0.47±1.3 vertebral and 0.36 Moreover, diary-actuated rehabilitation provided an earli- ±0.71 and nonvertebral ones, respectively. There is a statis- er recovery in active knee extension, passive knee flexion, tically significant negative correlation between TUG test and total passive knee ROM, satisfaction score of KSS 2011, T score (p<0.001) being moderately expressed for all T and functional score of KSS 1989 and KSS 2011 whereas scores (T-score for femoral neck r=-0.512, p<0.001; T- routine did not yield such outcomes. score for hip r=-0.489, p<0.001; T-score for spine r=- Conclusions: The newly designed diary-actuated rehabilita- 0.440, p<0.001). Therefore, the lower T-score, the higher tion program enhanced greater improvement and early recov- TUG test result. There is a statistically significant positive ery of knee mobility and knee function with a high rate of correlation between number of fractures and TUG test patient satisfaction even during subacute period following (p<0.001) being moderately expressed (r=0.48). Therefore, TKA. the higher number of fractures, the higher TUG test score. There is also a correlation between number of vertebral frac- tures and TUG test score (r=0.49, p<0.001), positive and P246 moderately expressed. CONNECTION BETWEEN OSTEOPOROTIC FRAC- Conclusion: By timely assessment and treatment of patients TURES AND TIME UP AND GO TEST IN POSTMENO- with low bone mineral density, falls could be prevented and PAUSAL WOMEN WITH LOW BONE MINERAL therefore the fractures too. DENSITY J. Zvekic-Svorcan1, N. Igic2, A. Mikov3, T. Jankovic1,K. Filipovic1, M. Vuksanovic4, S. Subin-Teodosijevic5 P247 1University of Novi Sad, Faculty of Medicine, Special SELF-ASSESSMENT OF HEALTH IN POSTMENO- Hospital for Rheumatic Diseases, Novi Sad, Serbia, PAUSAL WOMEN WITH LOWER BONE MINERAL 2University of Novi Sad, Faculty of Medicine, Novi Sad, DENSITYINCOMPARISONTONUMBERAND Serbia, 3University of Novi Sad, Faculty of Medicine, LOCALIZATION OF LOW-IMPACT FRACTURES Institute for Children and Youth Health Care of Vojvodina, N. Igic1, J. Zvekic-Svorcan2, A. Mikov3,N.Prvulovic Novi Sad, Serbia, 4University of Belgrade, Faculty of Bunovic4, J. Vasic5,K.Boskovic6 Medicine, "Zvezdara" University Medical Center, Belgrade, 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia, 5General Hospital "Djordje Joanovic", Zrenjanin, Serbia, 2University of Novi Sad, Faculty of Medicine, Serbia Special Hospital for Rheumatic Diseases, Novi Sad, Serbia, 3University of Novi Sad, Faculty of Medicine, Institute for Introduction: Fractures connected to falls in patients with Children and Youth Health Care of Vojvodina, Novi Sad, low bone mineral density are in rise as a health problem. Serbia, 4University of Novi Sad, Faculty of Medicine, Objective: To investigate connection between number/ Oncology Institute of Vojvodina, Sremska Kamenica, Serbia, localization of osteoporotic fractures and Timed Up and Go 5Railway Healthcare Center, Belgrade, Serbia, 6University of Test (TUG test) in postmenopausal women with low bone Novi Sad, Faculty of Medicine, Clinical Center of Vojvodina, mineral density. Medical Rehabilitation Clinic, Novi Sad, Serbia Material and methods: The retrospective-prospective cross- sectional study encompassed 74 postmenopausal women av- Introduction: Effect of low-impact fractures on quality of life eraging 71.73±5.37 years of age, who have been referred to is often underestimated. the Special Hospital for Rheumatic Diseases in Novi Sad, Objective: To investigate how postmenopausal women with Serbia. All patients had their bone mineral density measured lower bone mineral density self-asses their health regarding at L spine and at the hip, and the results were interpreted as the number and localization of low-impact fractures. T score according to the valid definition of osteoporosis. Material and methods: The retrospective-prospective cross- Exclusion factors: patients with a T score higher than -1 SD, sectional study encompassed 74 postmenopausal women av- having other metabolic bone diseases, hypotension, vision or eraging 71.73±5.37 years of age, who have been referred to hearing disturbances, Parkinson’s disease, cognitive disorders, the Special Hospital for Rheumatic Diseases in Novi Sad, gait and balance disturbances. All subjects were tested by Serbia. All patients had their bone mineral density measured TUG test and questioned regarding presence, number and lo- using the central DXA method, and the results were calization of low-impact fractures. The correlation was ob- interpreted as the T score according to the valid definition of served between T score, number/localization of fractures and osteoporosis. Exclusion factors: patients with a T score higher TUG test. All subjects had signed the informed consent form. than -1 SD, having other metabolic bone diseases, hypoten- Statistical analyze was done using SPSS v.20. sion, vision or hearing disturbances, Parkinson’s disease, S196 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 cognitive disorders, gait and balance disturbances. All sub- at the early stages is challenging to the non-rheumatol- jects were asked to self-assess their health on a scale from 0 ogist. Referral to special early arthritis clinics can im- (worst) to 100 (best) and were questioned regarding presence, prove considerably the outcome. We have established an number and localization of low-impact fractures. Correlation early arthritis clinic to set up a network with primary was observed between self-assessed health and number/ care physicians for the prompt referral of patients with localization of fractures. All subjects had signed the informed suspected inflammatory arthritis of recent onset. This consent form. Statistical analyze was done using SPSS v.20. clinic offers full diagnostic and prognostic evaluation, Results: The low-trauma fractures were present in 44.6% prompt therapeutic intervention and patient education. of subjects, from which there were 0.47±1.3 vertebral Control of the disease in this cohort will be tight aiming and 0.36±0.71 nonvertebral ones, respectively. The self- at DAS scores less than 2.6 (remission) by defined assessed quality of life is in statistically significant neg- treatment escalation protocols involving DMARDs alone ative correlation with the number of vertebral fractures or in combination with biologics. In this cohort, issues (r=-0.253, p<0.05). The correlation is low, pointing to related to the pathogenesis and prognosis of early arthri- weak connection. Therefore, the more vertebral fractures, tis will also be addressed. the lower life quality. The number of nonvertebral frac- tures and total number of fractures were not connected to the quality of life. There is a statistically significant pos- P249 itive correlation between self-assessment of life quality ASSESSMENT OF KNOWLEDGE ABOUT THE BARC and T score. Correlation is moderately expressed for T- CENTRE AND SATISFACTION WITH THE EDUCA- score for femoral neck r=0.280, p<0.05; T-score for hip TIONAL SERVICES AVAILABLE r=0.322, p<0.001 and T-score for spine r=0.470, P. A. Bacon1,S.A.Thaqi2 p<0.001. Therefore, the higher T-score, the lower self- 1Division of Immunity and Infection Medical School (East assessed quality of life. Wing)-Edgbaston, Birmingham, United Kingdom, 2Center Conclusion: By prevention and treatment of patients with low for Family Medicine, Research Office for Rheumatology bone mineral density, fractures could be prevented and there- Disease, Gjakova, Republic of Kosovo fore the quality of life increased. The aim if this proposal is to determine knowledge in the general population about arthritis; to ascertain if this has P248 improved in the decade since our Needs Assessment; and EARLY DIAGNOSIS, PATHOGENESIS, PROGNOSIS the satisfaction with the educational material now avail- AND TREATMENT OF EARLY INFLAMMATORY able to support communities and arthritis sufferers. ARTHRI-TIS, IN A SOUTHERN EUROPEAN POPULATION Background: BARC (Birmingham Arthritis Resource S. A. Thaqi1,T.Boumpas2, I. Sidiropoulos2 Centre) was set up to provide education and support to peo- 1Center for Family Medicine, Research Office for ple with arthritis and their cares, based on a formal Needs Rheumatology Disease, Gjakova, Republic of Kosovo, Assessment. BARC aims to promote self-coping – to help 2Department of Rheumatology, Clinical Immunology and people to deal with the physical and social disabilities Allergy in Collaboration with the Clinic of Social and caused by their disease. It is sited in the city centre public Family Medicine, Department of Social Medicine. library and works alongside the regular medical NHS service University of Crete, University Hospital, Voutes, Heraklion, provision. Services for Rheumatology have always had low- Greece er priority (and funding) than those for acute services such as Cancer and Heart disease. In addition they have histori- The aim of this proposal is to determine knowledge in the cally been somewhat restricted in the West Midlands (the southern European general population with rheumatoid in- UK region where Birmingham is the central city) compared flammatory arthritis. to the rest of the UK. The picture is also complicated by the Inflammatory arthritides (rheumatoid arthritis, ankylos- high percentage of ethnic minority groups locally (generally ing spondylitis, psoriatic arthritis, reactive arthritis/ referred to as BME groups – Black and Minority Ethnic). Including and Cardiovascular Disease one Resic Birmingham is set to become the first major UK city where Factors which bring to them) affect approximately 1- BME groups will become the majority within the next ten 1.5% of the population of Greece. Recent data have years. There is evidence that “excluded groups” -suchas highlighted their significant social and economic cost. immigrants, the poor and the less-well educated – have If not adequately treated, irreversible joint damage may poorer health but do not access the NHS in the same way occur and is accelerated during the first 1-2 years of the as the white middle-class population for a variety of reasons, disease. However, recognition of inflammatory arthritis including cultural, language and poverty barriers. This is Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S197 clearly relevant to the wider European scene where there is We have also addressed the need for relevant patient- increasing pressure from immigration while currently both education material understandable to those for whom health and social programmes are threatened by the financial English is not their mother tongue. We recently completed recession. a set of educational leaflets, designed as "bottom-up" ma- The BARC project was started a decade ago with a formal terial - that is based on questions people actually ask research process to determine the extent of current ser- rather than information doctors think patients ought to vices and what people wanted. This “Needs Assessment” know. They are in simple English, avoiding technical showed that both medical profession and public perceived terms, so as to be easily understood. The first six have a need for more information provided in an informal set- been translated into Urdu and recorded on CD's in both ting (i.e. a non-medical setting) - and wanted it in a range languages, as well as in print format with a few cartoons of languages (Adab et al Rheumatology 2004).There was to illustrate them. A preliminary piece of market research also a widespread desire for more support services for in the BARC Centre shows that the volunteers think they patients. The BARC centre was set up on the basis of this are what is needed (and a small sample of clients listening in space provided by the City in the Central Library and is to the first one agreed). The Urdu translation has also manned by volunteers. These have been selected and been approved by a range of Indian colleagues as being trained by the Centre manager, Chan Gordhan, who has both true to the English information and understandable a long background in social and voluntary work. The vol- by a range of local language speakers. The translation is unteers come from a range of ethnic backgrounds and not strict Urdu but includes phrases used in Bollywood importantly they have all had some personal rheumatic films (watched by all the local S. Asian groups) as well as problem. Thus they fit what the UK government is now some English words generally used in the version of calling “expert patients” - and promoting the idea that “Urdu” widely used around Birmingham. they are best placed to help others since they have learnt questionnaire-based assessment of the first of these CD’s – on how to cope. Interestingly our experience shows that Understanding Arthritis – showed that clients gave it high volunteering to help others also empowers them to deal scores for clarity of information and obtaining information with their own lives, so they should also be the best that they wanted. In general they found the CD helped them placed group to teach us how to empower our clients. to cope (Sharif’08). We are just completing an assessment of Our data also shows that the BARC service is wanted as the CD on rheumatoid arthritis and the outcome is very excit- well as needed locally. ing. The challenge was far greater here as the usefulness of the The key point in developing any new service is to pro- CD was examined in a specialist RA clinic which already had vide an evidence base for it. BARC set out to do this a highly trained specialist nurse providing explanations and from the outset. Following the initial "Needs support to patients. Despite this the comments made at the Assessment" We carried out a focus group study to de- focus groups demonstrated that the study participants had termine what patients from BME groups were looking found the additional BARC service a major help (Kumar for from the local health services (Bacon’05). A key fac- et al’09). There is now patient pressure to set up such a service torexpressedbytheparticipants was the desire to be on a regular basis in the hospital setting. This would be in line listened too. They were dissatisfied with their doctors with the recent Report from the influential Kings Fund which who were seen to lack time to take in the patients noted a lack of understanding on the quality of RA care and broader complaints. This echoes wider concerns about the struggle many RA patients have to access quality care poor doctor –patient communications – an area which (Kings Fund’09). the Royal College of Physicians is holding an enquiry In the same way, we have struggled to reach our target for new into at present. attendees at the BARC centre, despite the evidence for the BARC has set up sympathetic listening as one of the basic need for and the success of the BARC service. Total numbers parts of the service (Gordhan’03 and ‘08). This is provid- accessing the BARC service, including phone calls and web- ed by trained volunteers. They are themselves patients and site hits, have increased year-on year but surprisingly there has come from a range of ethnic and linguistic backgrounds, been no increase in personal visitors. A number of community so that they are able to provide culturally sensitive guid- centres have asked for the manager to go out to specific groups ance to clients. We have collected data on who has with promotional and educational talks. This alternative ap- attended and how satisfied they are with the service pro- proach has proved very popular but many attendees have said vided (Treharne’04). Approximately 40% of attendees they were not aware of the BARC centre. These outreach come from the BME groups, similar to the general popu- sessions are demanding on Chan Gordhan’s time and there lation. Thus we are getting through to target populations - is an excellent service available at the library. Thus the next but not in large enough numbers. We have also had high essential step is a study of why people are not coming in the gradings for client satisfaction. predicted numbers. S198 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Hypothesis: We propose that the population in general tend to downplay the importance of their musculoskeletal problems. This is reinforced by the poor publicity that arthritic diseases get compared to some others. Analysis of the relative impor- tance given by press or TV showed that heart disease and cancer got far more attention and were treated as serious sci- entific problems. Rheumatic diseases by contrast were seen as “lifestyle problems” for which there was no real medical treat- ment. The existence of a ground-breaking local service does not appear to have changed that mold to any major extent. Each time that the BARC Centre has been discussed on local radio there has been a sharp rise in client enquiries – but only for a short period. We intend to analyse the degree of local awareness of the BARC and at the same time look further into the responses of those who do actually come to seek help. Methods: The first aspect will be carried out by collecting data about knowledge of BARC and satisfaction with current educational support using standardised questionnaires. This will target both a random population (people accessing the Central Library for any purpose) and specific communities such as local Sikh and Somali populations who have already identified a perceived need for an increased service for their groups. A minimum of 200 library people will be sampled at random in each grouping. The second part (analysis of satis- faction with current services) will be completed by analysis of the data collected over the past two years from attendees at the Centre, who are all asked to complete such a form. The data from this project will be compared to that obtained 10 years ago in the original Needs Assessment Broader Aspects of Fellowship: The advantages of taking on this project would be to widen your experience into qualitative research and introduce you to a new but important area of rheuma- tology, patient education. The latter has many messages for some- one practicing in a major city with an immigrant population and you have already reported working with several ethnic minority groups in Kosova. We have been thinking about this project for some time, so there are some things already in place to facilitate your research. We have already trialled a simple questionnaire for these assessments. A sociology student is currently using these to collect some preliminary data from library visitors. That experi- ence will focus the further development of the project. A trained health psychologist is available to help with analysing the ques- tionnaires and the unstructured material coming from the “free comment” section at the end of each form. In the same way, the set of forms collected from clients attending the Centre in its early years have been analysed and will form a useful comparison with the planned analysis of the comments collected from recent clients. This exercise will definitely lead to at least one published paper. The methodologies used will be of value to you in assessing the worth of conventional treatment options across the field of rheumatology. Our specialty deals with incurable chronic dis- ease and there is increasing evidence that patients have a dif- ferent perspective on the outcome to their doctors (Hewlett’03). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S199
Helping people to cope with chronic disability, improving their life by addressing their real concerns rather than measuring “medical outcomes” like degree of swelling or ESR, is becom- ing increasingly important. Finding ways of reaching out to the large percentage of the population who have a disability related to a rheumatic problem is also essential to persuade politicians to take the subject seriously (andinvestinit!).Thustheexpe- rience gained from this would be advantageous to your career in many ways – and I believe you would find working in BARC both interesting and rewarding. Once in place here you can join in all the usual University Rheumatology Departmental activi- ties, from seminars to clinical meetings. We would also work to get you some exposure to Rheumatoid Arthritis clinics as an observer on an informal basis. That will be easier to do with colleagues on the ground than to set up formally in advance with the current NHS bureaucracy. You will have free time to catch up on your reading, particularly on the fairly large literature on self-coping and on what people expect from health services. You would need this to write a good paper and I would expect you to write up a comprehensive introduction and methods section well before data collection has been com- pleted. Of course we will be available to discuss that with you – but it will be your responsibility to produce the first version. I believe that an important part of such a fellow- ship is learning how to plan and write up your own re- search projects for the future.
P250 VITAMIN D DEFICIENCY IN ECUATORIAN POSTMENOPAUSAL WOMEN WITH TYPE 2 DIABETES E. López Gavilanez1, K. Guerrero Franco1, S. Ochoa Guevara2,A.SegaleBajana2, M. Navarro Chavez3,N. Bautista Litardo4 S200 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
1Servicio de Endocrinologia Hospital Docente Policia P251 Nacional Guayaquil #2, Guayaquil, Ecuador, 2Servicio DIFFERENCES IN THE EARLY EFFECT OF ANTI- Medicina Interna, Hospital Docente Policía Nacional RANKL ANTIBODY ON BONE RESORPTION AND Guayaquil N°2, Guayaquil- Ecuador, Guayaquil, Ecuador, BONE FORMATION 3Servicio Medicina Interna Hospital Luis Vernaza, T. Omiya1,J.Hirose1,T.Miyamoto1, S. Tanaka1 Guayaquil, Ecuador, 4Servicio de Endocrinología Hospital 1Department of Orthopaedic Surgery, The University of de SOLCA Guayaquil, Guayaquil, Ecuador Tokyo, Tokyo, Japan Objective: We examined the early effects of anti-RANKL Objectives: To evaluate the prevalence of vitamin D deficien- (receptor activator of nuclear factor κB ligand) monoclonal cy in postmenopausal women with type 2 diabetes mellitus antibody in ovariectomized mice to evaluate the differences (T2DM), and investigate whether there is correlation between of the speed of drug effect on bone resorption and bone for- serum levels of vitamin D with the bone mineral density mation in histological findings. (BMD) and other metabolic variables. Materials and Methods: Ninety six women postmenopausal Material and Methods: Twelve-week-old female C57BL/6 who attended to clinical control of T2DM in Service of mice were ovariectomized. Four weeks after the surgeries, the Endocrinology of HDPN-G2 in the period January 2012 to ovariectomized mice were treated with anti-RANKL antibody November 2015, we measure serum levels of vitamin D (single injection of 5mg/kg). We euthanized mice before in- (VD), glycosylated hemoglobin (HbA1c), HOMA, parathy- jection of anti-RANKL antibody (Day0) and after 1, 2, 3, 4, 5 roid hormone (PTH), ionic calcium, osteocalcin, urinary or 6 days from the day of injection (Day1, 2, 3, 4, 5 or 6). Hind deoxypyridinoline, and the lumbar spine and neck of femur limbs and lumbar spines were subjected to histological and BMD by DXA. Premenopausal women, impaired renal func- histomorphometric analysis. tion, type 1 diabetes, secondary osteoporosis and women who Results: In the cancellous bone of tibia and lumbar spine, received treatments which alter metabolism of bone were ex- histomorphometric analysis demonstrated that there was no cluded. We divided in two groups of patients according to significant difference in bone volume (BV/TV and Tb. N). serum levels VD ≥30 (sufficiency) and <30 (insufficiency). Bone resorption parameters (ES/BS and Oc.S/BS) rapidly de- This last group is subdivided in severe deficiency (<10 ng/ creased to almost undetectable levels at day 3. There were mL), moderate insufficiency (10-19 ng/mL) and mild insuffi- significant differences between Day 0 and Day 2, 3, 4, 5 and ciency (20-29 ng/mL). We performed an analysis of linear 6, and between Day 1 and Day 2, 3, 4, 5 and 6. On the other correlation between VD and all variables and one multiple hand, bone formation parameters (OV/BV and Ob.S/BS) and regression analysis with VD such as the dependent variable. bone formation speed parameters (BFR/BS and MAR) kept The results are expressed by mean±standard deviation. The almost same level from Day 0 to Day 6. In the cortical bone of software Epidat 3.1 was used for data analysis. femur, histomorphometric analysis demonstrated that bone Results: We found a significant reduction in serum levels of resorption parameter (Ps. ES/Ps) rapidly decreased. There VD in patients with T2DM. Mean of age 64±11, BMI 29±5, were significant differences between Day 0 and Day 2, 3, 4, VD 22±8, and PTH 39±27. We found with sufficiency of VD 5and6,andbetweenDay1andDay2,3,4,5and6. in 12.5% of cases, insufficiency of VD reported 87.5%; insuf- However, there was no significant difference in bone forma- ficiency were graded mild 52% (n=44), moderate tion parameters (Ps. MAR and PS. BFR/PS). 42%(n=36) and severe 4.8%(n=4). Conclusion: Anti-RANKL antibody rapidly decreases bone resorption parameters. However, bone formation maintains in the early phase after the treatment. This is one of the reasons why anti-RANKL antibody increases bone mineral density both in cancellous bone and cortical bone.
P252 OSTEOPOROSIS PREVALENCE IN LUNG TRANSPLANT PATIENTS M. Barceló-Bru1, S. Farietta-Varela1, B. Rodríguez-Diez1 1Rheumatology Unit, Hospital Vall d'Hebron, Barcelona, Conclusions: Our results show a high prevalence of vitamin Spain D deficiency in ecuatorian postmenopausal women popula- tion with diabetes mellitus type 2. We found no correlation Background/Purpose: Osteoporosis prevalence in lung trans- between VD and other variables nor with BMD. plantation candidates is between 1621%. In the last years, the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S201 survival rate after lung transplantation has definitely improved, had pre transplant osteoporosis improved to osteopenia due to the improvement of the surgical techniques, of the treat- posttransplant, out of which 12 had been previously treated. ment in the intensive care unit and the development of better Conclusion: In our series the prevalence of osteoporosis and immunosuppressive therapy. In spite of this, it was observed osteopenia was of 38% and 45.8%, respectively. The preva- that there is a rapid loss of bone mass in these patients in the lence of pretransplant symptomatic fractures was of 9.5%. The first year posttransplantation, probably due to prolonged immo- prevalence of posttransplant osteoporosis and osteopenia was bilization postsurgery, to high doses of glucocorticosteroids of 38.5% and 48.6%, respectively. The prevalence of used to prevent acute rejection and to the immunosuppressive posttransplant symptomatic fractures was of 11.2%. In our regimen. Prospective studies have been conducted which dem- cohort, the majority of patients whose bone densitometry onstrated changes in bone mass and a major incidence of frac- worsened from normal/osteopenia to osteoporosis had not re- tures in lung transplant patients. Our objectives were to deter- ceived pre transplant prophylactic treatment. The mine the prevalence of osteopenia, osteoporosis and fractures posttransplant bone mass loss was between 12%, and the most in lung transplantation candidates and lung transplant patients affected regions were the total femur and the femoral neck. in a reference center as well as to evaluate the change of bone mass pre and post transplantation. Methods: We included 179 patients from the cohort of lung P253 transplant patients of Vall d’Hebron University Hospital, EVALUATION OF OSTEOPOROSIS RISK FACTORS whose femoral and lumbar bone mineral density determina- IN LUNG TRANSPLANT PATIENTS tions pre and posttransplant were available. Since it is a retro- S. Farietta-Varela1, M. Barceló-Bru1, B. Rodríguez-Diez1 spective study and the moment of the posttransplant bone 1Rheumatology Unit. Hospital Vall d'Hebron, Barcelona, densitometry could not be standardized, the patients were Spain stratified depending on the moment of the realization of the densitometry: less than 6 months, between 7 and 12 months Background/Purpose: Patients with a terminal lung disease and more than 12 months after the transplant. have a great number of risk factors for the development of Results: Out of the 179 patients, 110 were men and 69 were osteoporosis. Although much has been learned about the fac- women, and their average age was 51±10.4 years. The prev- tors that contribute to bone mass loss, in our study we try to alence of pre and posttransplant osteoporosis, osteopenia and determine the risk factors in groups of similar diseases. The symptomatic fractures is shown in table 1. study´s objective is to determine if the known risk factors for low bone mass are more prevalent in each of the studied lung diseases and if these correlate with the presence of osteoporo- sis in lung transplantation candidates. Methods: 179 patients were included, from the cohort of lung transplant patients of the Vall d’Hebron University Hospital, whose pre transplant bone densitometry at lumbar spine and No significant differences were observed when comparing the femoral neck were available. 3 groups of lung diseases were percentage of men and women with osteoporosis and osteopenia selected, due to the differences related to the grouping of risk ’ before and after the transplant, in relation to the patients sex or factors and the glucocorticosteroid doses required before age. The change of bone mass posttransplant, expressed in gr/ transplantation. The groups were: Chronic Obstructive cm2 was of 1.3% (±15.3) in the lumbar spine, 2.1 (±11.3) in the Pulmonary Diseases (COPD), Interstitial Lung Diseases ’ femoral neck and 2.1(±9) in the total femur. The patients diag- (ILD) and Other Diseases (lymphangioleiomyomatosis, cystic nostic change after lung transplant is shown in table 2. fibrosis, primary and secondary pulmonary hypertension). The glucocorticosteroid dose was stratified as follows: high dose if it was more than 5mg/day for more than 3 months (or prednisone equivalent) or more than 3 times a year, and low dose if it did not meet these conditions. Results: 179 patients were included, with an average age of 51 ±10.4 years, without sex related differences. 69 were women More than 60% of the patients did not have a diagnostic change (66% of them were at menopause at the moment of the trans- after the transplant. Out of the 11 patients with normal pre trans- plantation). 12.3% (22 patients) of the patients had a low body plant bone densitometry and posttransplant osteopenia, 9 had mass index, 57% were smokers with an average of 24.7 pack- previously received osteoporosis treatment. Out of the patients ages/year, 5% consumed more than 40 grams of alcohol per day, with pre transplant osteopenia, 16 had osteoporosis afterwards, 8 44% were sedentary, 8.4% had first degree relatives with an of whom had not received previous treatment. 14 patients that osteoporotic fracture, 15.6% had osteopenia and 86% had S202 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 received glucocorticosteroids, 56.4% of them at high dose. The intervene can be previous to the transplant, such as the indi- risk factors more prevalent in Chronic Obstructive Pulmonary vidual risk, the underlying disease, the treatments received but Disease in comparison with the other groups as well as the also the ones related to the lung transplant, like the prolonged prevalence of each of them are shown in postsurgery immobilization. The rate of bone mass loss in the Table 1. lumbar spine and the femoral neck in the first year is around 25% and fracture prevalence is between 18-37%. The objec- tives of this study were to evaluate the effect of antiresorptive, glucocorticosteroids and other immunosuppressive treatments on bone mineral density in lung transplant patients. Methods: This is a retrospective study on a cohort of 179 patients who were submitted to lung transplant between 2004 and 2014 in the Vall d’Hebron University Hospital. A bone densitometry was practiced to all patients before and after the lung transplant. The comparison between the deter- minations was made by calculating the percentage of change in bone mass expressed in g/cm2 at each of the explored region: the lumbar spine (L2-L4), the femoral neck and the total femur. For the analysis of the effect of immunosuppres- The risk factors associated with osteoporosis in all the patients sant therapy on bone mineral mass, a subgroup of 136 patients were a low body mass index, smoking and previous fracture. was selected, who were receiving a standard treatment regi- In the different groups of lung diseases, the risk factor associ- men: glucocorticosteroids, tacrolimus and mycophenolate. 3 ated with osteoporosis in the Chronic Obstructive Pulmonary groups were established, depending on the moment of the Disease group as well as in the Interstitial Lung Disease group densitometry realization: in the first 6 months, between 6 was the presence of a previous fracture, with an OR of 1.81 and 12 months and more than 12 months after the lung trans- (1.442.28) and 3.31 (1.0710.24), respectively. In the group of plant. The correlation between bone mineral loss in the re- other diseases the risk factor associated to osteoporosis was gions of interest and the accumulated dose of each of the the glucocorticosteroid treatment, with an OR of 1.95 treatments was evaluated using logistic regression and multi- (1.083.52), without differences related to the dose. variate analysis. Conclusion: In our cohort, the risk factors for low bone mass, Results: Out of the 179 patients, 121 received treatment for depending on the disease, were smoking and sedentarism in osteoporosis after the lung transplant (89 were previously re- the Chronic Obstructive Pulmonary Disease group. In the ceiving it). Table 1 shows the number of treated patients as same group there was a major prevalence of menopause and well as the received treatments. The average time (rank) be- glucocorticosteroid treatment, in comparison to the other tween the start of the treatment and the realization of the bone groups. But the prevalence of high glucocorticosteroid dose densitometry posttransplant was of 24 months (5-120). in this group was lower than in the others. The risk factors for osteoporosis in lung transplantation candidates were previous fractures, smoking and a low body mass index. In the Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease groups the factor with greater association to osteoporosis was the presence of previous fractures and in the other diseases group glucocorticosteroid treatment.
Among the 136 patients (58.8% men) who were selected for P254 the study of the effect of immunosuppressants on bone min- THE EFFECT OF IMMUNOSUPPRESSIVE AND eral mass, 49 (36%) had been diagnosed of Chronic ANTIRESORPTIVE THERAPY ON BONE MINERAL Obstructive Pulmonary Disease, 64 (47%) of Interstitial DENSITY IN LUNG TRANSPLANT PATIENTS Lung Disease and 23 (17%) of other pulmonary diseases. S. Farietta-Varela1, M. Barceló-Bru1, B. Rodríguez-Diez1 The average percentage of variation of the bone mineral mass 1Rheumatology Unit. Hospital Vall d'Hebron, Barcelona, in all 136 patients was of +1.3% in lumbar spine, 3.4% in Spain femoral neck and 2.3% in total femur. The percentage of var- iation of bone mineral mass pre and posttransplant in the treat- Background/Purpose: Osteoporosis is a very frequent com- ed patients was of 2.8% for the lumbar spine, 0.5% for the plication in recipients of a lung transplant. The factors that femoral neck and 1.3% for the total femur, in comparison to Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S203 the group of untreated patients where the variation was of 2.5, 5 others use the concept of low muscle mass plus a weakness 5.4% and 3.9, respectively. There was no significant differ- in the muscle function: Cruz-Jentoft et al. (2010); Fielding ence in the average accumulated dose of glucocorticosteroids et al. (2011); Morley et al. (2011); Chen et al. (2014); and immunosuppressants between patients whose Studenski et al. (2014). posttransplant bone mineral mass improved or worsened, in Results: The 306 subjects enrolled in this analysis were none of the studied regions, nor in the global study or in either 74.9±5.93 years old and included 182 women (59.5%). of the subgroups of studied diseases. In the multivariate anal- Depending on the definition employed, the prevalence of ysis, feminine sex was the only variable which was associated sarcopenia varied from 5.88% (Morley et al.)to33.99% to bone mineral loss in all the studied regions, except for the (Delmonico et al.). The sensitivity of the SARC-F ques- femoral neck. tionnaire ranged from 22.12% (Delmonico et al.)to Conclusion: The patients who received antiresorptive treat- 75.00% (Chen et al.) and the specificity from 84.86% ment pre transplant have a major increment of bone mineral (Studenski et al.) to 87.06% (Cruz-Jentoft et al.). We noted mass at the lumbar spine and a lower posttransplant bone that a lower sensitivity was found for the 2 definitions of mineral mass loss than the not treated ones. No association sarcopenia involving only the notion of muscle mass was observed between glucocorticosteroid and other immuno- (Baumgartner et al.; Delmonico et al.). Moreover, all pos- suppressants and posttransplant bone mineral mass. itive predictive values were always less than 50%, with a minimum of 17.31% (Chen et al.) and a maximum of 44.23% (Delmonico et al.). The lowest predictive negative P255 value was 68.11% (Delmonico et al.) and the best one SENSITIVITY AND SPECIFICITY OF THE SARC-F reached around 99% (Chen et al.). QUESTIONNAIRE ACCORDING TO DIFFERENT Conclusion: Globally, for most of the definitions considered DEFINITIONS OF SARCOPENIA: RESULTS FROM in our analysis, our results are in line with the performance THE SARCOPHAGE STUDY established in the initial validation of the SARC-F tool (i.e. a M. Locquet1,C.Beaudart1, L. Delandsheere1,J.-Y. poor sensitivity and an excellent specificity). This screening Reginster1,O.Bruyère1 tool seems thus to detect with precision the absence of 1Department of Public Health, Epidemiology and Health sarcopenia but seems less precise in affirming the presence Economics, University of Liège, Liège, Belgium of this geriatric syndrome.
Objective: Our aim was to assess the performance of the SARC-F questionnaire in a cohort of Belgian elderly subjects, P256 according to the various existing definitions of sarcopenia. DOES FORCE-TIME CHARACTERISTICS DURING Material and Methods: We analyzed cross-sectional data SUSTAINED CONTRACTIONS DIFFERENCE IN available from the SarcoPhAge (for Sarcopenia and YOUNG CONTROLS, OLD COMMUNITY-DWELLING Physical Impairment with Advancing Age)cohort,aresearch AND HOSPITALIZED GERIATRIC PATIENTS? project seeking to gather scientific data characterizing L. De Dobbeleer1, I. Beyer1,R.Njemini1,S.Pleck1,N. sarcopenia in a population of subjects over 65 years old. We Zonnekein1,T.Mets1,I.Bautmans1 carried out 3 main assessments: the skeletal muscle mass in- 1Frailty in Ageing Research Unit, Brussels, Belgium dex using Dual-Energy X-Ray Absorptiometry (DXA) (Hologic Discovery A, USA), the muscle strength with a Introduction: Fatigue is considered as one of the key- hand-dynamometer (Saehan Corporation, MSD Europe elements for physical frailty at higher age, but surprisingly Bvba, Belgium) and the physical performance with the Short data on strength drop characteristics during sustained maximal Physical Performance Battery test (including data regarding contraction in elderly are scarce. gait speed). Moreover, for this specific investigation, we used Methods: A secondary data-analysis was performed on a French-translated version of the SARC-F questionnaire, continuously recorded force-time data during sustained composed of 5 questions and reflecting 5 components: maximal grip effort until exhaustion in 91 geriatric pa- strength, assistance in walking, rise from a chair, climb stairs tients (83±5 years), 100 old community-dwelling (74±5 and falls. A maximum of 2 points are assigned to each ques- years) and 100 young adults (23±3 years). Fatigue resis- tion and subjects with a score greater than or equal to 4 are tance (FR) was expressed as the time during which grip considered sarcopenic. We proceeded to a one-to-one compar- strength (GS) drops to a certain percentage of its maxi- ison analysis regarding the tool performance (i.e., calculation mum. The GS curve was divided into 4 parts for each of sensitivity and specificity), following 7 different definitions participant: 1) from GSmax to 75% GSmax;2)from75% of sarcopenia. Two are based on the concept of a low muscle GSmax to 50% GSmax; 3) from 50% GSmax to 25% GSmax; mass: Baumgartner et al. (1998); Delmonico et al. (2007). The and 4) from 25% GSmax to fatigue. S204 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Results: The initial phase (first 25% strength drop) was sig- warranted, LP did not alter cartilage thicknesses as well as nificantly shorter in geriatric patients compared to the 2 other proteoglycan content but hyaline cartilage biomechanical groups. Subsequently, the second part was almost twice as properties were impaired. In each investigated zone, and in- long in old community-dwelling compared to old patients dependently of the joint mechanical loading pattern, elastic and young healthy. However, although the second part of the modulus and indentation force necessary to reach a depth of GS decay was longer in old community-dwelling, the third 25 μm were decreased in a respective range of -20 to -45% part was significantly shorter in this group compared to young (p<.001) and -10 to -30% (p<.001). EAA supplementation controls and hospitalized patients. The last part of the GS restored IGF-I systemic level from 4 week of treatment and decay was markedly longer in the young controls. fully normalized SB and cartilage quality alterations. Conclusion: Force-time characteristics during sustained max- We suggest that protein malnutrition alters cartilage quality imal handgrip effort are different according to age and clinical and could predispose to osteoarthritis while EAA supplement condition. Especially the differences in the initial phases of the had a curative effect. strength drop can be an opportunity for simplifying the pro- cedure of the available FR test in the future. P258 OSTEOPOROSIS, A COMMON CONDITION AND P257 YET SO COMPLEXE: DO WE HAVE SOLUTIONS ALTERATION OF CARTILAGE AND SUBCHON- FOR ALL CASES? DRAL BONE (OSTEOARTHRITIS LIKE) INDUCED C. Ciofu1,B.-I.Gavrilă1,C.Lupașcu1,V.Stoica1,S. BY PROTEIN MALNUTRITION IS TREATED BY Badelita2,D.Coriu3 NUTRITIONAL ESSENTIAL AMINO ACIDS 1Department of Internal Medicine and Rheumatology SUPPLEMENTS Cantacuzino Hospital, Carol Davila University of Medicine C. Lavet1,P.Ammann2 and Pharmacy, Bucharest, Romania, 2Hematology, Fundeni 1Department of Internal Medicine Specialties Service of Bone Clinical Institute, Carol Davila University of Medicine and Diseases Geneva University Hospitals, Geneva, Switzerland, Pharmacy, Bucharest, Romania, 3Hematology, Fundeni 2Department of Internal Medicine Specialties Service of Bone Clinical Institute, Carol Davila University of Medicine and Diseases Geneva University Hospitals, Geneva, Switzerland Pharmacy, Bucharest, Romania Elderly patients frequently suffer from protein malnutrition leading to major alteration of the somatotropic axis including Aims: We present the case of a male patient, 65 years old who lower systemic and local IGF-I production known as major is hospitalized for swollen and tender joints. He also presents anabolic agent for cartilage and bone homeostasis. Protein petechial lesions all over his body. malnutrition could affect both cartilage and SB and may con- Methods: The patient is known with rheumatoid arthritis from tribute to osteoarthritis development while essential amino 2010 diagnosed and monitored in Dr. I. Cantacuzino Hospital, acids supplements could reverse these potential deleterious Department of Internal Medicine and Rheumatology, and fol- effects. lows treatment for this disease with conventional synthetic DMARDs (csDMARDs) and corticosteroids. The patient Mature Sprague Dawley rats (6-months-old) were pair fed a has a long medical history and associate at this time a complex chow diet (NP, 15% casein, 1 group) or an isocaloric low pathology: rheumatoid arthritis with extra-articular manifesta- protein diet (LP, 2.5% casein, 2 groups) for a period of 12 tions (vasculitis), chronic myeloid leukemia (in treatment with weeks. Following this period, one of the two groups submitted rituximab and imatinibum). Also he had multiple orthopedic to LP was treated with essential amino acids supplementation interventions over time (total right hip prosthesis for aseptic (LP+EAA, 2.5%+5%). Femurs were collected 24 weeks after osteonecrosis of the femoral head without a definite cause- protocol initiation. Phase-contrast microcomputed tomogra- 1998, complete left subtrochanteric fracture with phy using contrast agent allowed determination of trabecular Intramedullary nail fixation 2014). At the initiation of cortico- morphometric parameters as well as hyaline and calcified car- steroid therapy (2010) was performed bone densitometry test tilage thickness, and proteoglycan content estimation of both that showed T score of -3 at the hip. We started treatment with condyle. Indentation allowed determination of cartilage mate- bisphosphonates, calcium with vitamin D3. Paraclinic exams rial level properties in three indentation zones of each condyle reveals severe thrombocytopenia (PLT count 24.500mmc), chosen according to their joint mechanical loading pattern intense biologically inflammatory syndrome (ESR 105 mm/ related to rat ambulation. h, CRP 51.2 mg/dl) and pelvis x-ray showed intramedullary LP diet induce lower systemic IGF-I (-45%, p<.001) and low- nail without signs of fracture strengthening for the left hip. er SB trabecular mass and mineral density (respectively -30% After we consulted the haematologist who recommended and -3%, p<.001). Despite additional histologic study is pulsetherapy with corticosteroid, we decided to repeat the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S205 osteodensitometry test, showing a T score of -3.5. Given the P260 current circumstances, we decided administration of GENOMIC ANALYSIS OFA MULTIGENERATIONAL pulsetherapy with methylprednisolone, with favorable evolu- FAMILY WITH EARLY ONSET AND SEVERE FORM tion of platelets count and inflammation tests. OF OSTEOPOROSIS Results: Despite treatment with bisphosphonates, calcium A. Andreadi1, S. Zampatti2, B. Capuani1, D. Pastore1,M. and vitamin D3 patient shows increased degree of osteoporo- Cerilli3, D. Della Morte4,A.Bellia4, C. Pecconi2,A.Galli3, sis and presents fragility fracture without signs of M. Romano3,E.Giardina2,G.Novelli2,D.Lauro4 consolidation. 1Department of System's Medicine, University of Rome Tor Conclusions: At a patient receiving important immunosup- Vergata, Rome, Italy, 2Department of Biomedicine and pressive treatment (csDMARDs, rituximab, imatinibum) Prevention, Medical Genetic Section, University of Rome who also requires further administration of corticosteroids, Tor Vergata, Rome, Italy, 3UOC of Endocrinology, to prevent worsening of osteoporosis and fractures, do we Diabetology and Metabolic Diseases, University Hospital have optimal therapeutic solutions? Foundation PTV, Rome, Italy, 4Department of System's Medicine, University of Tor Vergata, UOC of Endocrinology, Diabetology and Metabolic Diseases, University Hospital P259 Foundation PTV, Rome, Italy TREATMENT OF OSTEOPOROSIS AND INTERFE- RENCE BETWEEN SPECIALTIES Osteoporosis is a common complex disease caused by the B.-I. Gavrilă1,C.Ciofu1,C.Lupașcu1,V.Stoica1,S. interplay of genetics and environmental factors. In our clinical Badelita2,D.Coriu2 unit we described an early and severe form of osteoporosis 1Department of Internal Medicine and Rheumatology segregating in an Italian family according autosomal domi- Cantacuzino Hospital, Carol Davila University of Medicine nant (AD) inheritance pattern and presence of multiple verte- and Pharmacy, Bucharest, Romania, 2Hematology, Fundeni bral fractures treated with pharmacological therapy. Clinical Institute, Carol Davila University of Medicine and Genes reported in association with osteoporosis are frequently Pharmacy, Bucharest, Romania involved in hormonal pathway (ESR1) osteoclast function (RANKL, OPG) or underlie well known syndromic phenotypes Aims: We present the case of a 68 years female patient, who is as osteogenesis imperfecta (COL1A1, COL1A2). In addition to hospitalized in the Rheumatology Clinic in May 2015 with these, several studies have reported associations in other genes or suspicion of rheumatoid arthritis. She complains also of low loci apparently without a direct link with the pathogenesis mech- back pain and polyarticular swelling and tenderness. anism of osteoporosis (MHC, ZBTB40, FONG). Methods: The patient was recently hospitalized in a We analyzed the pedigree using a panel of microsatellite markers Hematology Clinic where she was diagnosed with multi- located to investigated regions. The presence of linkage was ruled ple myeloma IgG kappa (May 2015), but without starting out for candidates genes (LOD<-2) As a consequence, we did not a specific treatment. She is guided to our clinic due to attain the identification of one gene as responsible of this early and painful joint symptoms. Based on physical examination, severe osteoporosis. These results confirmed the small contribu- laboratory tests (rheumatoid factor, anti-CCP antibodies, tion of numerous genes to the pathogenesis of osteoporosis, lead- inflammation tests positive) and X-rays we confirm the ing to a lack in the identification of single responsible genes, every diagnosis of rheumatoid arthritis. The x-ray for spinal in severe and apparently AD transmitted forms. column shows multiple vertebral compressions and spine To our knowledge, this is the second report of a severe and early bone densitometry (T-score) is -3. We begin treatment form of osteoporosis, after Parisi et al. in 2001.Our results under- with bisphosphonate and corticosteroids in small doses, lie the importance of familial evaluation to define BMD, in order with favorable evolution. to detect family members at high risk of fracture. Moreover, the Results: After 6 months of treatment the joint symptoms linkage analysis confirms the genetic heterogeneity of osteopo- were remitted, the tests for inflammation are negative, but rosis. Further researches are necessary to identify major genes T score now is -3.5. The Haematologist consider myeloma primarily contributing to the phenotype of the disease. controlled and recommends continuation of treatment with bisphosphonates and corticosteroids. Conclusion: At a patient with multiple myeloma con- P261 trolled by bisphosphonate therapy with glucocorticoids, EFFECTS OF 12 MONTHS OF RESISTANCE TRAI- in which osteoporosis is widening, against the risk of NING VS. ENDURANCE TRAINING ON BONE fragility fracture, which is the appropriate treatment? MINERAL DENSITY IN YOUNG OVERWEIGHT MEN Haematologist should interfere therapeutically, allowing R. El Hage1, C. El Khoury1,J.Matta2,F.Frenn2,G.Maalouf3,M. elimination of corticosteroid treatment? Rizkallah3,A.Pinti4, E. Watelain5,H.Toumi4, E. Lespessailles6 S206 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
1Department of Physical Education, Fass, University of Objective: To determine the association of BMLs present on Balamand, Kelhat El Kurah, Lebanon, 2Industrial Research two different MRI sequences and baseline Western Ontario Institute, Beirut, Lebanon, 3Bellevue University Medical and McMaster Universities Osteoarthritis Index (WOMAC) Center, Faculty of Medicine, Saint Joseph University, scales, change in WOMAC scales, cartilage defect progres- Mansourieh, Lebanon, 4I3MTO-EA 4708, Université sion, and cartilage volume loss in older adults over 2.7 years. d'Orléans, Orléans, France, 5UMR 8201, CNRS, Valenciennes, Materials and methods: 394 community-dwelling adults Valenciennes, France, 6Rheumatology, Hospital Orleans, i3mto aged 50-80 years were assessed at baseline and 2.7 years. Laboratory, Orleans University, Orleans, France BML presence at baseline was scored on T1-weighted fat- suppressed 3D gradient-recalled acquisition and T2- Aim: The aim of this study was to analyze the effects of two weighted fat-suppressed 2D fast spin-echo MRI sequences, different training protocols on body composition, bone min- at the medial and lateral tibial and femoral, and superior and eral content (BMC) and bone mineral density (BMD) in a inferior patellar sites. Knee pain, physical function limitation, group of young overweight men. and stiffness were assessed using WOMAC. Cartilage volume Methods: Forty-two young overweight men (body mass and defect scores were assessed using validated methods. index >25 kg/m2) whose ages range from 18 to 32 years Ordinal logistic, linear, log binomial, and mixed effect model were randomly assigned to resistance training group regression were used to describe the association between base- (RTG), endurance training group (ETG), or a control group line BML presence with baseline WOMAC, change in (CG). The experimental groups performed incremental WOMAC, cartilage defect progression, and cartilage volume training for 12 months, three sessions per week. Weight, loss adjusting for confounders. height, body composition, BMC, BMD, maximal strength Results: BMLs were commonly present on both MRI se- and maximal aerobic velocity were measured before and quences (86%). BMLs present on T2- and T1-weighted se- after the training period. quences were associated with increased odds of a higher cat- Results: Both experimental groups (RTG and ETG) showed egory of knee pain and physical function limitation (OR=1.45 significant decreases in weight, body mass index (BMI), fat – 1.70; all P<0.05) but not stiffness. Longitudinally, BMLs mass and fat mass percentage. RTG showed significant in- present on T2- and T1- weighted sequences were associated creases in maximal strength, maximal aerobic velocity, whole with worsening knee pain (β=1.04 and 1.31, respectively; body BMC and lumbar spine (L1-L4) BMD. ETG showed P<0.05) and worsening stiffness (β=0.46 and 0.47, respec- significant increases in maximal aerobic velocity and L1-L4 tively; all P<0.05) but not worsening physical function limi- BMD but a significant decrease in whole body BMC. CG did tation. Site specific BMLs present on T2- and T1-weighted not show any significant changes in bone variables. RTG sequences predicted cartilage defect progression (RR=1.30 – showed the highest improvements in bone variables and mus- 5.26; all P<0.05). Lateral tibiofemoral BMLs present on T2- cular strength. and T1-weighted sequences predicted lateral tibiofemoral car- Conclusion: In conclusion, the present study shows that re- tilage volume loss (β=-41.95 and -37.92, respectively; sistance training is an effective method to decrease fat mass P<0.05). and to increase bone mineral density in young overweight Conclusions: Subchondral BMLs were commonly detected men. on both T1-and T2-weighted MRI sequences. They were as- sociated with clinical outcomes including symptoms, cartilage damage and loss, suggesting that either MRI sequence could P262 be used to measure BMLs. EXAMINING THE CLINICAL CORRELATES OF Disclosures: JPP and JMP are shareholders in ArthroLab. MRI-DETECTED SUBCHONDRAL BONE MARROW LESIONS (BMLS) USING TWO MRI SEQUENCES S. M. Mattap1, K. Wills1,L.L.Laslett2,C.Ding1,J.-P. P263 Pelletier3, J. Martel-Pelletier3, F. M. Cicuttini4, D. Aitken1, TREATMENT OF SPONTANEOUS OSTEONECROSIS G. Jones1 OF THE KNEE (SPONK) AFTER ARTHROSCOPIC 1Menzies Institute for Medical Research, University of MENISCECTOMY Tasmania, Hobart, Australia, 2Menzies Institute for Medical A. Torgashin1,S.Rodionova2 Research, Hobart, Australia, 3Osteoarthritis Research Unit, 1Federal State Institution «Federal Scientific Research University of Montreal Hospital Research Centre Institute for Traumatology and Orthopedics named after N. (CRCHUM), Montreal, Quebec, Canada, 4Department of N. Priorov», Korolev, Russian Federation, 2Federal State Epidemiology and Preventive Medicine, School of Public Institution «Federal Scientific Research Institute for Health and Preventive Medicine, Monash University, Alfred Traumatology and Orthopedics named after N. N. Priorov», Hospital, Melbourne, Australia Moscow, Russian Federation Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S207
Spontaneous osteonecrosis of the knee affects a different pa- Results: Patients were grouped into two arms: with OP - 154 tient population with a different pattern of bony involvement. females (59%) and without OP -107 (41%). OP patients were Materials and methods: We report on a series of 23 patients older as compared to patients without OP (59,5±10,8 vs. 52,9 (the average patients age was 61 years) who had symptomatic ±11,2 years, р=0,0001), with longer RA duration (12(7-20) medial meniscus degenerative tear followed-up with magnetic vs. 9(6-15) years, р=0,001) and more pronounced destructive resonance imaging (MRI). All patients had arthroscopic changes by Sharp score (168,5(96,5-216,5) vs. 93,5(53,5- meniscectomy. 136,5), р<0,0001). OP patients demonstrated significantly When we see SPONK condyles of the femur or tibia, we higher incidence of more severe functional decline (FD) examined bone resorption markers (Urinary free (НAQ > 2 scores) (43,4 vs. 29,5%, RR=1,47, 95% CI 0,98– deoxypyridinoline, serum collagen type 1 crosslinked) and 2,21, р=0,05), and had longer intake of glucocorticoids (GCs) prescribed (in the postoperative period): alfacalcidol 0.75-1.0 (72(26,5–120) vs. 48(11–79,5) month, р<0,01), in higher dai- μg/day), ossein hydroxyapatite 2 tablets 2 times a day, zole- ly doses during the previous year (5(3,8–8,8) vs. 3,75(2,5–5) dronic acid 5 mg 1 times per year. mg/day, р=0,002), with higher total dose (14,4(5,4–24,2) vs. Results: In 43% noted the presence of avascular necrosis of 7,2(1,5–14,4) g, р<0,01) as compared to patients without OP. bone condyles, forming the joint. In 57% of them showed an Analysis of traditional risk factors showed that OP patients increase in bone resorption markers, suggesting an activity of had lower body weight (65,2±11,4 vs. 70,4±14,3 kg, the process and that these persons antiresorptive therapy has р=0,001), the majority of them were in post-menopause been assigned. (90,9 vs. 65,4%, RR=1,39, 95%CI 1,2–1,61, р<0,0001), ex- Conclusion: Often meniscus damage combined with aseptic perienced long immobilization periods earlier (16,2 и 7,4%, necrosis of the femoral condyles. RR=2,3, 95% CI 1,08-4,9, р=0,02) and fractures (49,4 vs. We believe that use of adequate bone therapy can improve of 23,4%, RR=2,17, 95% CI 1,49-3,16, р<0,0001). outcome meniscectomy. Multivariate logistic regression identified the following major OP risk factors in RA patients: menopause (odds ratio (OR)=5,2, 95% CI 1,9–14,5, р=0,001); low energy fractures P264 (except vertebral and femoral neck fracture) in anamnesis MAJOR RISK FACTORS OF OSTEOPOROSIS IN (OR=2,6, 95% CI 1,2–5,5, р=0,02); FD HAQ (OR=1,6, RHEUMATOID ARTHRITIS FEMALE PATIENTS 95% CI 1,04–2,6, р=0,03); RA duration (OR=1,05, 95% CI E. Taskina1,L.I.Alekseeva1, I. Dydykina1,M.M. 1,003–1,1, р=0,03), and average GCs daily dose during the Podvorotova1, A. V. Smirnov1, E. L. Nasonov1 previous year (OR=1,3, 95% CI 1,2–1,5, р<0,001). 1Nasonova Research Institute of Rheumatology, Moscow, Conclusion: RA duration, functional decline by HAQ, and Russian Federation average GCs daily dose during the previous year, alongside with menopause and low energy fractures are the major risk Prevalence of osteoporosis (OP) is much higher in rheumatoid factors of OP development in RA female patients. arthritis (RA) patients as compared to general population in all age groups, and OP development is associated with both com- mon or “traditional” risk factors, and RA – linked factors. P265 Although, specific contribution of each factor into OP devel- SURGICAL STATUS OF PATIENTS WITH ORTHO- opment in RA patients remains unclear. PEDIC DISEASE BASED ON THE ESTIMATED Objective: To identify major risk factors of OP development GLOMERULAR FILTRATION RATE in RA female patients. H. Kikuchi1, H. Kasuga1,N.Okada2,M.Kamiya3,S.Soen4 Materials and methods: The study included 261 RA female 1Orthopaedic Surgery, Kindai University Sakai Hospital, patients (1987 АCR criteria), aged 20-75 years (mean age - Sakai, Japan, 2Orthopaedic Surgery, Sumoto-itsuki Hospital, 56,8±11,4 years). An individual patient’s file contained an- Sumoto, Japan, 3Orthopaedic and Rheumatology, Kindai thropometric parameters, social and demographic data, case University Nara Hospital, Ikoma, Japan, 4Orthopaedic history, clinical examination and lab findings, traditional OP Surgery and Rheumatology, Nara Hospital Kinki University risk factors, patient’s joint status, info on concurrent diseases, Faculty, Ikoma, Japan pain intensity and general health status evaluation by VAS. Hand and distal feet plain X-rays were taken for each patient. Introduction: We determined the percentage of patients, over Van der Heijde modified Sharp method was used to score the 70 years of age and rheumatoid arthritis (RA), with suspected erosions and joint space narrowing in hands and feet. Axial chronic kidney disease (CKD) with estimated glomerular fil- bone mineral density (BMD) was measured using DXA scan. tration rate (GFR) <60 mL/min/1.73 m2 among orthopedic DXA T-score was used in postmenopausal women (n=210), patients, and compared these patients with those suffering and Z-score in menstruating women (n=51). from renal anemia as chosen concurrent controls. Subjects and S208 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Methods: Among 7,810 patients in whom eGFR and muscle and bone health. Subjects who had spinal surgery were Hemoglobin (Hb) values were determined in our Hospital excluded as well as subjects with a body mass index (BMI) between 2012 and 2016, the possibility of CKD and the num- >35kg/m², because TBS values in excess of this value affect ber of surgical cases were investigated in (1) 702 patients with the accuracy of TBS. Sp was diagnosed according to the RA, (2) 1,194 orthopedic patients age 70 years or older, and European Working Group on Sarcopenia in Older People (3) 498 patients receiving erythropoietin therapy for renal (EWGSOP) (i.e., a low muscle mass plus either low muscle anemia. strength or low physical performance). The appendicular mus- Results and Discussion: (1) There were 197/702 (28.1%) RA cle mass index (SMI) and the total hip Bone Mineral Density patients with eGFR <60 mL/min/1.73 m2, and 105 underwent (BMD) were determined using Dual-Energy X-Ray surgery: preoperative autologous blood donation was used in Absorptiometry (DXA) (Hologic Discovery A, USA), muscle 38 patients, intraoperative and postoperative blood recovery in strength was assessed by a hand-dynamometer (Saehan 62, and allogeneic blood transfusion in 11 (10.4%). (2) There Corporation, MSD Europe Bvba, Belgium) and physical per- were 500/1,194 (41.9%) patients age 70 years or older who formance by the Short Physical Performance Battery (SPPB) showed eGFR <60 and 232 underwent surgery: preoperative test (/12 points). We used the cut-off limits proposed by the autologous blood donation was used in 66 patients, intraoper- EWGSOP, classifying women in the “low SMI group” when ative and postoperative blood recovery in 98, and allogeneic its value was <5.50kg/m², the “low muscle strength group” blood transfusion in 33 (14.2%). (3) Sixty-one/498 patients when strength was <20kg and the “low physical performance (12.2%) underwent surgery: preoperative autologous blood group” when SPPB <8 points. The thresholds of <7.26kg/m² donation was not feasible, intraoperative and postoperative (for SMI), <30kg (for muscle strength) and <8 points (for blood recovery was used in 32 patients, and allogeneic blood physical performance) were used for men. Bone quality was transfusion in seven (11.5%). determined using the “Trabecular Bone Score” software (TBS Conclusion: When the possibility of renal anemia was exam- iNsight®, Med-Imaps, Geneva, Switzerland, version 2.1). A ined in orthopedic patients who had RA or who were 70 years low TBS value reflects poorer bone microstructure and, con- of age or older. versely, a higher TBS value is correlated with better bone microstructure. Analyses were performed both on univariate and multivariate model (model 1 adjusted for age and number P266 of comorbidities and model 2 adjusted for age, number of BONE QUALITY ASSESSMENT AMONG SARCOPENIC comorbidities and BMD). AND NON-SARCOPENIC ELDERLY SUBJECTS FROM Results: Our study sample comprised 288 elderly subjects THE SARCOPHAGE STUDY aged 74.7±5.7 years (59.0% women). Sp was diagnosed in M. Locquet1,C.Beaudart1, L. Delandsheere1,J.-Y. 43 individuals (14.9%). Of the 288 participants, 81 (21.8%) Reginster1,J.A.Kanis2, O. Bruyère1 had a low SMI, 98 (34.0%) a low muscle strength and 57 1Department of Public Health, Epidemiology and Health (19.8%) a poor physical performance. In the univariate anal- Economics, University of Liège, Liège, Belgium, 2Centre for ysis, there were no statistically significant differences in TBS Metabolic Bone Diseases, University of Sheffield Medical value between Sp and non-Sp subjects (1.270 vs. 1.299, School, Sheffield, United Kingdom p=0.10), nor between subjects with low SMI compared to those with higher SMI (1.192 vs. 1.196, p=0.74). However, Objective: Sarcopenia (Sp) and osteoporosis both represent a in subjects with weaker muscle strength and those with ade- public health burden because of potential harmful conse- quate muscle strength, TBS values were significantly lower in quences for elderly health. A new medical imaging technique, elders with low muscle strength (1.266 vs. 1.310, p<0.001). the “Trabecular Bone Score” (TBS) indirectly measures bone This difference remained significant when adjusted for age microarchitecture. Some studies have already suggested an and number of comorbidities (model 1) (p=0.02) but was not association between sarcopenia and osteoporosis but none evident in model 2, when BMD was added as a covariate has examined the relationship between bone quality and mus- (p=0.45). A significantly lower TBS value was also observed cle parameters of sarcopenia. For this reason, we sought to among participants with poor physical performance compared compare bone quality (i.e., TBS values) among sarcopenic to those with better physical performance (1.260 vs. 1.304, and non-sarcopenic subjects. p=0.005). As in the case of muscle strength, TBS values were Material and Methods: The current analysis used data avail- significantly lower in subjects with low physical performance able from the SarcoPhAge study (for Sarcopenia and Physical in the multivariate model including age and number of comor- Impairment with Advancing Age), an ongoing project follow- bidities (p=0.03) but was no longer statistically different when ing 534 community-dwelling elderly subjects with a main BMD was also included in the model (p=0.14). objective of assessing outcomes of sarcopenia. For this ancil- Conclusion: TBS score, reflecting bone architecture and, sub- lary investigation, we analyzed cross-sectional data related to sequently, bone strength, is decreased in elderly subjects Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S209 presenting a low muscle strength and a decreased ability to Objective: In the last years, symptomatic slow acting drugs physical performance. However, this difference is no longer for OA (SYSADOA) have been largely studied and have met significant when the values are corrected for bone mineral considerable interest among clinicians. SYSADOA are used density. This reflects a major interaction between bone quan- generally as a ground therapy with the main rationale to re- tity and quality in elderly subjects. Further prospective re- duce consumption of nonsteroidal anti-inflammatory drugs searches are needed to explore the relationship between mus- (NSAIDs) and thus to limit the related adverse events. cle parameters and bone quality to support the hypothesis of Materials and methods: In this study, we have evaluated the common pathways in the concomitant age-related decline in short-term effect on an oral combination of collagen, glucos- muscle and bone tissues. amine and curcumin on early symptomatic knee osteoarthritis. 40 patients were treated for 1 month and could assume anal- gesics or NSAIDs if necessary. P267 Results: At 2 months, the mean reduction of the WOMAC COMPARISON OF THREE TREATMENT PROTOCOLS score was 36% (p<0.001) and the mean reduction of the WITH INTRA-ARTICULAR LOW OR INTERMEDIATE WOMAC pains score was 40% (p<0.001). Only two patients MOLECULAR WEIGHT HYALURONIC ACID IN reported sporadically need to assume analgesics, no side ef- EARLY SYMPTOMATIC KNEE OSTEOARTHRITIS fects during the study period. F. Galluccio1 Conclusion: These data demonstrate that the oral combina- 1Div. of Rheumatology, Department of Clinical and tion of collagen, glucosamine and curcumin is safe, well tol- Experimental Medicine, Firenze, Italy erated and shows a rapid action reducing pain and improving joint function and stiffness in early symptomatic knee Introduction: Viscosupplementation with hyaluronic acid osteoarthritis. (HA) is indicated for non-responders to non-pharma- References: cological therapy, to analgesics or when NSAIDs are contra- • Bijlsma JW et al. Lancet 2011;377:2115. indicated. The aim of this study is to compare the efficacy, • Loeser RF et al. Arthritis Rheum 2012;64:1697. safety and costs of three different HA treatment (Sinovial • Liu-Bryan R, Terkeltaub R. Nat Rev Rheumatol 2015;11:35. HighVisc, Sinovial One and Hyalgan). • Jordan KM et a;. Ann Rheum Dis 2003;62:1145. Patients and methods: 90 patients with grade I/II Kellgren- • Bruyère O et al. Semin Arthritis Rheum 2014;44:253. Lawrence knee OA were included in three groups, the first • Gouttenoire J et al. Biorheology 2004;41:535. was treated with Hyalgan (weekly for 5 weeks), second with • McNamara PS et al. Vet Clin Nth Am: Sm An Pract Sinovial HighVisc (weekly for 3 weeks) and the third group 1997;27:863. with a single injection of Sinovial One. Results: All three treatments were effective with an average reduction of WOMAC score of 18.9 points for Hyalgan, 18.04 P269 points for Sinovial HighVisc and 17.92 points for Sinovial DIFFERENCES BETWEEN YOUNG AND OLDER One. The comparison of the three groups did not show any ADULTS IN THE RATE OF POWER DEVELOPMENT statistical difference in terms of efficacy. NHS and social costs EXCEED DIFFERENCES IN PEAK POWER are respectively 419,12 and 853,43 € for Hyalgan, 338,64 and E. Van Roie1, S. Van Driessche1,I.Bautmans2,C.Delecluse1 599,22 € for Sinovial HighVisc, 221,56 and 308,42 € for 1KU Leuven, Department of Kinesiology, Leuven, Belgium, Sinovial One. 2Gerontology Department (GERO), Faculty of Medicine and Conclusion: All three treatment resulted equally effective Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium with no statistically significant differences thus, the treatment with Sinovial One may be considered clinically effective as Objective: Age-related declines in muscle mass and maximal other two regimens but with a very efficient cost profile in muscle strength have been extensively documented. However, early symptomatic knee OA. maximal strength requires at least 300ms to be achieved, which makes it less functionally relevant in situations that require quick and powerful responses of muscles, such as P268 balance recovery following sudden perturbations. Parameters EFFICACY OF AN ORAL COMBINATION OF COLLA- that characterize the ability to produce force rapidly, such as GEN, GLUCOSAMINE AND CURCUMIN FOR EARLY power and the rate of power development, might be more SYMPTOMATIC KNEE OSTEOARTHRITIS functionally relevant, but have been less studied. The aim of F. Galluccio1 the present study was to investigate the age-related differences 1Div. of Rheumatology, Department of Clinical and in power and in the rate of power development during isotonic Experimental Medicine, Firenze, Italy knee extensions (Biodex System 3 dynamometer). S210 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Material and methods: Thirty-six young (♂ 21, ♀15, Results: Among the 534 subjects (60.5% of women, mean age=22±2 yrs) and fifty-six older adults (♂ 26, ♀ 30, age of 73.5±6.16 years) enrolled in the study, 73 have been age=68±5 yrs) performed four ballistic isotonic contractions diagnosed sarcopenic, which represented a prevalence of against four loads (0, 20, 40 and 60% of the maximal isomet- 13.7%. After two years, only 336 subjects came for the ric strength at 90° knee angle). Power was calculated as the follow-up evaluation (T2 evaluation), which represents product of torque and velocity. Peak Power (pP) was calculat- 62.9% of the total sample. Reasons for the 198 subjects for ed as the highest value of the power-time (P-t) curve. Mean not coming back are as follow: 20 died, 59 presented a phys- rate of power development (RPDmean) was calculated as the ical incapacity (e.g. institutionalisation, mobility impairment, linear slope from the start of the movement till pP was serious comorbidities, etc.), 12 were lost to follow-up, and reached. Maximal RPD (RPDmax) was determined as the unfortunately, 107 refused to pursue the study. Only 33 of steepest part of the P-t curve. the 73 sarcopenic subjects diagnosed at baseline were seen Results: Young men and women showed higher pP (♂ 24- at T2 evaluation. This is partly due to a significantly higher
41%, ♀ 31-37%), RPDmean (♂ 37-45%, ♀ 41-44%) and incidence of deaths among the sarcopenic (9.59%) subjects RPDmax (♂ 35-52%, ♀ 43-46%) compared to older men and compared to non-sarcopenic (2.82%) with a crude OR of women at all loads (all p <0.01). In addition, the ratio 3.65 (IC95% 1.41–9.49) and an adjusted OR (on age, number
RPDmean/pP was significantly higher in young as compared of comorbidities and number of drugs) of 4.00 (IC95% 1.51– to older men and women at all loads (all p <0.05). 10.6). Moreover, 9 sarcopenic subjects (12.3%) announced, Conclusions: Age-related differences in the rate of power during the two years of follow up, being physically unable to development exceed differences in peak power regardless of pursue the study. Between inclusion and T2, a significantly the load, which may have important implications to age- higher incidence of hospitalisation has also been observed for related functional decline. Future research should focus on sarcopenic subjects (52.9%) compared with non-sarcopenic identifying appropriate exercise regimens to improve the rate ones (29.0%) (p=0.004) with a crude OR of 2.75 (IC 95% of power development in old age. 1.34–5.63) and an adjusted OR (same adjustments than those used for the analysis of deaths) of 2.61 (IC95% 1.18–5.76). No differences between groups regarding the incidence of P270 falls (p=0.63), fractures (p=0.34), physical decline (reported THE SARCOPHAGE STUDY: EVOLUTION OF SAR- as decline of gait speed (p=0.34), of the SPPB test (p=0.63) COPENIC SUBJECTS AFTER 2 YEARS OF FOLLOW-UP and of the chair rising test (p=0.63)) have been reported. C. Beaudart1, M. Locquet1, J.-Y.Reginster1, J. Petermans2,O. Conclusion: The results of the SarcoPhAge study at T2 indi- Bruyère1 cate a higher incidence of death and hospitalisation among 1Department of Public Health, University of Liège, Liège, sarcopenic subjects compared to non-sarcopenic ones after Belgium, 2Geriatric Department, CHU of Liège, Liège, two-years of follow-up, which highlights the public health Belgium burden of sarcopenia.
Background: The SarcoPhAge study (for Sarcopenia and Physical impairments with advancing Age) has been designed P271 to measure, among other things, the relationship between MUSCLE MASS AS THE MAIN COMPONENT OF sarcopenia and the incidence of falls, hospitalisations, frac- BODY COMPOSITION ASSOCIATED WITH BONE tures, mobility decline and mortality after two-years of fol- MINERAL DENSITY low-up. N. A. G. França1, B. S. E. Peters1,M.M.S.Lima1,E.A. Methods: This SarcoPhAge study is an ongoing longitudi- Santos1,P.C.Santos1,L.A.Martini1 nal study which enrolled 534 subjects aged 65 years or 1Nutrition Department, School of Public Health, University of older. A complete diagnosis of sarcopenia has been per- São Paulo, São Paulo, Brazil formed for all subjects according to the algorithm devel- oped EWGSOP at inclusion and once a year every follow- Objective: To investigate the relationship between obesity ing year. Muscle mass was measured by Dual Energy x-ray and low muscle mass and low bone mineral density. absorptiometry, muscle strength was measured by grip Material and Methods: This cross-sectional study included strength and physical performance was measured with the 214 subjects aged ≥50 years, both sexes, from the Health Short Physical Performance Battery (SPPB). A research Survey-Sao Paulo (ISA-Capital 2014/2015). Body composi- assistant was in charge of meeting the participants once a tion and bone mineral density (BMD) were assessed by DXA year during a 1-hour clinical visit during which a large (Lunar iDXA Advance). Appendicular skeletal muscle mass number of sociodemographic, anamnestic and clinic data (the sum of muscle mass of arms and legs, kg) was divided by were collected. height2 (m2) and classified according to the European Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S211
Working Group on Sarcopenia in Older People. Body Fat was Results: The average age of patients was 60.64±6.7, educa- evaluated by applying the Fat Mass Index (fat mass (kg)/ tion: primary 22 (23.9%), intermediate 45 (48.91%), and height2) using the reference values from NHANES. BMD higher 25 (27.17%). Average BMI was statistically insignifi- was obtained from spine (L1-L4) and femoral neck and diag- cant in start and after 12 months research (27.02±63.9 kg/m2 nosed according to T-score values. Osteopenia and osteopo- vs. 27.07±3.8 kg/m2, p=0.7). Statistically significant in mean rosis were pooled and regarded as the risk category (low BMD of the lumbar spine and femoral neck, at start and after BMD). A joint variable was created as: without obesity or 12 months research (lumbar spine 0.71±0.2 g/cm2 vs. 0.77 low muscle mass (no change); obesity; low muscle mass; ±0.1g/cm2, p<0.0001 and neck of femur 0.8±0.12 g/cm2 vs. obese and with low muscle mass (obesity + low muscle mass). 0.83±0.1 g/cm2,p=0.001). The relationship between such categories and low BMD in Conclusion: Regular practice of exercises statistically signif- both sites was investigated by logistic regression (crude) and icantly improves BMD in PMO. adjusted for age, sex, and 25-hydroxyvitamin D (25OHD) concentrations. Results: 86 (40.2%) and 105 (49.1%) individuals present- P273 ed low BMD in spine and femoral neck respectively. The FALLS: RISK AND PREVENTION IN PRIVATE RHEUMA- observed frequency of individuals without change was TOLOGY PRACTICE 39.7%, followed by 35.05% with obesity, 22.9% with X. Grapton1, P. Lemesle2, V. Strotz3 low muscle mass, and 2.34% with obesity + low muscle 1Private Rheumatology Practice, Colombes, France, 2Private mass. Only low muscle mass was associated with low Rheumatology Practice, Bois-Colombes, France, 3Private BMD in spine after adjusting for age, sex and 25OHD Rheumatology Practice, Antony, France (OR: 3.41, 95%CI: 1.58 - 7.37). The model for femoral neck showed the same behavior in the crude model, but Objectives: After identifying fall risk factors (RF) and defining after including the adjustment variables beyond low mus- the percent of fractured fallers and the part of osteoporotic wom- cle mass (OR: 2.41, 95%CI: 1.07 - 5.40), obesity was also en in this population, we want to evaluate the relevance of bal- associated with low BMD (OR: 0.49, 95%CI: 0.25 - ance tests and favor prevention measures for those patients. 0.99). The category obesity + low muscle mass was not Materials and Methods: 110 patients >60 years (24 con- significant in any model, but with tendency to risk. trols), having fallen within a year, have seen 28 private prac- Conclusion: Low muscle mass was associated with increased tice rheumatologists and were subject of our multicentre ret- odds of low BMD at the spine and femoral neck, while obesity rospective study. had a protective behavior only at femoral neck. Results: Fallers mean age was 75 years. 37% of the fallers within a year fractured after falling. Among them, 95% were postmenopausal (PM) fractures. Post-fall or PM fracture sites P272 are identical. In order: spine 26%, wrist 18%, ribs 6%. The THE ROLE OF EXERCISE IN WOMEN WITH POST- circumstances of the falls are: 1) lack of attention, 2) slipping, MENOPAUSAL OSTEOPOROSIS 3) stumbling. 61% of the fallers have at least one physical ac- V. Koevska1 tivity (PA), among them 71% a weight-bearing PA. The most 1Institute for Physical Medicine and Rehabilitation, Skopje, common PA was walking 46%. Among the fractured, 32% had Former Yugoslav Republic of Macedonia PA, 42% had not. 72% of the fallers had at least one fall RF, 94% had intrinsic RF, 28% extrinsic, and an average of 2 RF within Introduction: In the treatment of postmenopausal osteoporo- the older than 80 sis (PMO), except drug therapy, suitable program of exercise Intrinsic factors: 1) osteo-articular, 2) eye-vision, 3) postural, to maintain and improve bone mineral density (BMD) is 4) drugs, out of 13 items necessary. Extrinsic: 1) obstacles, 2) footwear, out of 7 items. 45% of the Material and methods: 92 women with postmenopausal os- fallers within a year had at least one osteoporosis RF 1) low teoporosis were treated in Institute for Physical Medicine and BMI, 2) corticosteroids, 3) early menopause, 4) smoking, out Rehabilitation, Skopje, R. Macedonia, from January 2015 to of 9 items. 69% of the patients had recent bone density September 2016. The exercises consisted of respiratory exer- measures, which was lower only at femoral neck of fractured cises, strengthening and stretching exercises for paravertebral, fallers vs. nonfractured fallers. The unipodal balance test was abdominal muscles and muscles of the upper and lower limb, relevant (less than 5 seconds) in 42% of the patients with or and exercises for balance and coordination. The exercises without fractures. Get up and go test was not relevant. We were practiced twice a week, for 45 minutes. BMD was de- recommended at least 2 fall prevention measures 1) correct termined by dual-energy x-ray absorptiometry, at baseline and D vitamin levels, 2) physical activity, 3) reeducation, 4) eye- after 12 months research. vision correction, out of 12 items. S212 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Conclusion: A significant part of menopaused women with significantly different between FHoP and SHP groups anteriority of falls and fractures will refracture after falling (1.199±0.118 and 1.204±0.137 respectively), before and after again. After treating osteoporosis, we should correct fall RF adjustment for age, BMI and spine BMD. In multivariate by doing unipodal tests and encourage them to keep on PA analysis, low TBS value was associated (p<0.001) with age- and prescribe reeducation. ing, high BMI and low spine BMD. Conclusion: Our data show similar TBS values in patients with FHoP and those with SHP, suggesting no protective ef- P274 fect of FHoP on bone microstructure. This phenomenon could FUNCTIONAL HYPOPARATHYROIDISM HAS NO explain the high prevalence of this biological profile in post- PROTECTIVE EFFECT ON BONE MICRO- menopausal women with fragility fracture. STRUCTURE DETERIORATION INDIRECTLY ASSESSED BY TRABECULAR BONE SCORE IN POSTMENOPAUSAL OSTEOPOROTIC WOMEN P275 WITH FRACTURES SERUM 25-HYDROXYVITAMIN D IN OSTEOPOROTIC A. Amouzougan1,H.Locrelle1,D.Dénarié1, M. Normand2,P. PATIENTS TREATED WITH CALCIFEDIOL Collet1,B.Pallot-Prades1,H.Marotte3,T.Thomas3 J. M. Olmos-Martínez1,1,F.Arnaiz1, J. L. Hernández1,I. 1Service de Rhumatologie, CHU de St-Etienne, Saint-Etienne, Sierra1,J.Gonzalez-Macías1 France, 2INSERM U1059, Lab Biologie Intégrée du Tissu 1Department of Internal Medicine, Hospital Universitario Osseux, Université de Lyon, Saint-Etienne, France, Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, 3INSERM U1059, Université de Lyon, Service de Santander, Spain Rhumatologie, CHU de St-Etienne, Saint-Etienne, France Objectives: a) To assess the serum concentrations of 25- Objective: With aging, functional hypoparathyroidism hydroxyvitamin D (25 (OH) D) in patients treated for more (FHoP) is a common biological profile, but the consequences than one year with bi-weekly or monthly doses of calcifediol; of FHoP on bone remain unclear. In fact, some data suggested and b) to determine if there are any change in PTH levels after no protective effect on bone mineral density (BMD) in these the administration of both doses of calcifediol. circumstances, despite the lack of secondary hyperparathy- Material and Methods: We studied 94 patients with osteo- roidism (SHP) in response to vitamin D insufficiency. We porosis (82 females and 12 males) aged 44-93 years (71±10 hypothesized that FHoP could rather alter bone microstruc- years) who had received calcifediol treatment for at least one ture. We conducted a cross-sectional study comparing year. Forty-one of them were treated with 0.266 mg of Trabecular Bone Score (TBS), a parameter indirectly calcifediol every fortnight (biweekly) and the remaining 53 assessing bone microstructure, independent of BMD, in oste- with the same dose of calcifediol per month (monthly dose). oporotic postmenopausal women with either FHoP or SHP. Serum levels of 25 (OH) D and parathormone (PTHi), before Materiel and Methods: We retrospectively selected postmen- (baseline) and one year after initiation of treatment (post), opausal women visiting our Fracture Liaison Service (FLS) were measured. after a non-vertebral fracture (NVF), with a lumbar DXA mea- Results: Baseline levels of 25 (OH) D were lower in patients surement (Lunar iDXA) available for TBS calculation. FHoP receiving biweekly calcifediol than in those receiving the was defined by the combination of normal PTH values and monthly dose (p <0.05). With both treatment regimens a sig- 25(OH)D levels <75nmol/L. A multivariate analysis was used nificant increase in 25 (OH) D concentration was observed. to determine the association between TBS and age, body mass The concentrations reached with the monthly schedule were index (BMI), spine and hip BMD, and presence of FHoP or adequate, while those reached with the biweekly pattern ap- SHP. proximate values that some authors consider excessive and Results: We included 234 women, mean age 64.8±10 years. potentially harmful. Serum PTHi levels decreased significant- Of these, 82.5% had FHoP and 17.5% SHP. These groups did ly after administration of calcifediol, although on this occasion not differ in age at menopause and BMI but those in the latter there were no differences between the two treatment regimens group were significantly older (p<0.002). There was no sig- (Table). nificant difference between FHoP and SHP groups in spine Biweekly Monthly Biweekly Monthly and hip BMD values (0.902±0.179g/cm2 vs. 0.907±0.174g/ Baseline Post Baseline Post cm2 and 0.793±0.163 g/cm2 vs. 0.787±0.216g/cm2,respec- 25(OH)D(ng/ml) 17.9±7.4 59.3±18.2* 21.9±8,1 38.1±16.5* tively) before and after adjustment for age and BMI. PTHi (pg/ml) 62.8±27.7 36.4±17.6* 57.4±19 39.3±13.2* In the whole population, there was a significant correlation Conclusions: Monthly administration of 0.260 mg of between TBS and spine or hip BMD (r=0.30 and r=0.20 re- calcidiol is sufficient to achieve adequate levels of vitamin D spectively; p <0.0001). The TBS values were low and not and prevents the increase of PTH. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S213
Acknowledgment: Supported by grant from the Instituto de decreasing Smurf1 activity, increasing BMP signaling and Salud Carlos III (PI15/00521) that included FEDER funds promoting osteogenic differentiation in vitro. In vivo data from the EU. showed that (DSS)6 facilitated the derivative targeting osteo- blasts and promoting systemic bone formation with no detect- able toxicity (Fig. 1e-1g). P276 Conclusion: Inhibition of osteoblastic Smurf1 could be a pre- FROM PRECISION MEDICINE TO DRUG cision medicine-based bone anabolic strategy in BMP-2n/ DISCOVERY: INHIBITION OF OSTEOBLASTIC Smurf1e subgroup of age-related osteoporotic individuals. SMURF1 PROMOTES BONE FORMATION IN References: DISTINCTIVE INDIVIDUALS WITH AGE-RELATED 1. Starman JS et al. J Trauma Acute Care Surg 2012;72:676. OSTEOPOROSIS 2. Zhang G et al. Nat Med 2012;18:307. C. Liang1, S. Peng2, B.-T. Zhang3,A.Lu1,G.Zhang1 1Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong, 2Department of Spine Surgery, Shenzhen People’sHospital, Ji Nan University Second College of Medicine, Shenzhen, China, 3School of Chinese Medicine, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
Objective: BMP signaling is essential for osteoblastic bone formation. Recombinant human BMPs (rhBMPs) have been used for spinal fusion. However, emerging evidences demon- strate large inter-individual variations in local bone anabolic action of rhBMPs1. Smurf1 ubiquitinates BMP transducers and is a bone formation suppressor. Recently, we classified age-related osteoporotic individuals into subgroups based on distinct intraosseous BMP-2 levels and Smurf1 activity. One major subgroup with a decreased BMP-2 level and normal Smurf1 activity (BMP-2d/Smurf1n) showed satisfactory rhBMP-2 response during spinal fusion, whereas another ma- jor subgroup with a normal BMP-2 level and elevated Smurf1 activity (BMP-2n/Smurf1e) had poor rhBMP-2 response (Fig. 1a-1b). Further, Smurf1 gene silencing improved rhBMP-2 response and osteogenic differentiation in BMP- 2n/Smurf1e subgroup, leading us to hypothesize that inhibition of osteoblastic Smurf1 could be a precision medicine strategy to promote bone formation in BMP-2n/Smurf1e subgroup. Materials and Methods: We designed in silico strategy to screen small molecular Smurf1 inhibitors and examined ef- fects of the optimal inhibitor on local spinal fusion in BMP- 2n/Smurf1e subgroup. We conjugated the inhibitor to an 2 osteoblast-targeting oligopeptide (DSS)6 and examined its effectsonsystemicboneformationinBMP-2n/Smurf1e subgroup. P277 Results: We identified a chalcone derivative as the optimal THE REGULATION OF BONE METABOLISM BY Smurf1 inhibitor. For BMP-2n/Smurf1e subgroup of aged os- RESOLVIN D1 teoporotic mice, the chalcone derivative effectively inhibited H. A. Benabdoune1,Q.Shi2, E. P. Rondon2, J. Fernandes3,M. Smurf1 activity, increased BMP signaling and promoted Benbderdour1 in vitro osteogenic differentiation. Local administration of 1Pharmacology/Université de Montreal/Centre de Recherche the derivative enhanced spinal fusion with no obvious toxicity de l'Hôpital du Sacré Coeur de Montréal, Montreal, Canada, 2 3 (Fig. 1c-1d). After conjugation of the derivative with (DSS)6, Université de Montréal, Montreal, Canada, Orthopedie/ (DSS)6 facilitated the derivative entering osteoblasts, Université de Montreal, Montreal, Canada S214 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Objective: We recently reported that resolvin D1 (RvD1), an Objective: We previously reported efficacy on fracture risk ω3 fatty acids derivative, strongly inhibits inflammation and reduction of monthly IV IBN 1mg in the MOVER study in catabolism in human osteoarthritic cartilage (Benabdoune Japanese osteoporotic patients (pts). This post-hoc analysis et al. inflammation research. 2016). Thus, the objective of this presents additional 3-year data on BMD gains with respect study is to further investigate its effects on bone metabolism. to achieving the BMD T-score target. Materials and methods: First, to assess osteoclasts (OC) re- Material and Methods: MOVER was a randomised, double- cruitment, murine macrophages RAW267.4 were incubated blind study in ambulatory pts aged ≥60 years with fragile with LPS with or without RvD1 (0-1μM) for 48 hours. fracture, BMD of the lumbar spine (LS) or proximal femur TRAP and cathepsin-K, were assessed by western blot, enzy- (hip and femoral neck) <80% of the young adult mean and 1– matic staining and immunocytochemistry. TNF-α,IL-1β,IL- 5 vertebral fractures in the thoracic and/or lumbar spine. 1265
6, IL-10 and PGE2 levels were measured by ELISA. Second, pts received monthly IV IBN (0.5mg, 1mg) or oral risedronate to investigate bone resorption, human monocytes from (RIS) as active comparator. healthy donors were seeded in hydroxyapatite plates and treat- Results: The per-protocol set comprised 1134 pts (IBN 0.5mg ed with LPS with or without RvD1 (0-1μM) for 3 weeks. Plot n=376, IBN 1mg n=382, RIS n=376). Baseline pt character- formation was assessed by Von Kossa staining. Third, to eval- istics were balanced across the groups. Over 3 years, greatest uate osteoblasts metabolism, human trabecular osteoarthritic (and significant) increases in BMD at the LS (9.0%) and prox- osteoblasts (OAOb) were obtained from trabecular bone after imal femur (3.1%) were seen with IV IBN 1mg [CTI, 2013; total knee arthroplasty. OAOb were treated with either RvD1 JBMM, 2015]. In pts with LS BMD T-score ≤–2.5 at baseline, (0.1-1μM) alone, or VitD3 with or without RvD1 (0.1-1μM), the proportion of pts with LS BMD T-score >–2.5 was: for 48 hours. Alkaline phosphatase (ALP) activity and 21.8%, 27.0% and 20.5% after 1 year; 23.4%, 34.6% and osteocalcin (OCN) release were determined by ELISA. 22.0% after 2 years; and 25.7%, 42.2% and 25.3% after 3 Results: Our results clearly show that RvD1 inhibits OC re- years, with 0.5mg IBN, 1mg IBN and RIS, respectively. The cruitment and activation. Furthermore, it decreases bone resorp- proportion of patients with LS BMD T-score >–2.5 increased tion to background level, as indicated by the inhibition of the with treatment duration in all treatment groups. These findings expression of OC phenotype markers (TRAP and cathepsin-K) were consistent for proximal femur BMD gains: the propor- and hydroxyapatite matrix resorption. Besides, RvD1 reduces tion of pts with hip BMD T-score >–2.5 was: 14.8%, 19.4% by2to3-foldinflammatorycytokines(TNF-α,IL-1β,IL-6)as and 16.8% after 1 year; 19.5%, 20.4% and 19.2% after 2 well as PGE2 and concurrently enhances by 2-fold the anti- years; and 16.4%, 21.3% and 15.2% after 3 years, inflammatory cytokine IL-10 in OC. Moreover, RvD1 main- respectively. tains ALP activity at a constant and slightly higher level than Conclusions: Monthly IV IBN 1mg demonstrated the greatest the control, while it has no effects on OCN release, either with BMD gains amongst treatments in the MOVER study. In the or without VitD3 treatment, in human OAOb. current analysis, IV IBN 1mg also showed the greatest pro- Conclusion: Our results clearly show that RvD1 may play an portion of pts with LS BMD T-score >–2.5. The proportion of important role in the inhibition of bone resorption and the reg- pts achieving a BMD T-score >–2.5 increased with treatment ulation of bone metabolism. Additionally to our previous data, duration. These findings suggest that treatment adherence is our findings suggest that RvD1 presents a novel and original important for effective disease management with osteoporotic perspective to musculoskeletal and bone diseases therapy. agents.
P278 P279 THE EFFECT OF MONTHLY INTRAVENOUS (IV) CORRELATION BETWEEN THE DURATION OF IBANDRONATE (IBN) 1MG ON BONE MINERAL MENOPAUSE AND CLINICAL RISK: TEN-YEAR DENSITY (BMD) GAINS IN THE MOVER STUDY: CROSS-SECTION ADDITIONAL TREAT-TO-TARGET ANALYSIS A. Klimo1 H. Hagino1,M.Ito2,T.Nakano3,H.Mizunuma4, M. Tobinai5, 1Specialized Hospital for Rehabilitation ''Banja Kanjiza"', J. Hashimoto5, S. Yoshida5, K. Endo5,T.Nakamura6 Kanjiza, Serbia 1School of Health Science and Rehabilitation Division, Tottori University Faculty of Medicine, Tottori, Japan, 2Center for Objective: To examine the influence of a number of clinical risk Diversity and Inclusion, Nagasaki University, Nagasaki, factors in order to evaluate the origin of osteoporotic fractures on Japan, 3Tamana Central Hospital, Kumamoto, Japan, the bone mass of women with osteoporosis and osteopenia, de- 4Fukushima Medical University, Fukushima, Japan, 5Chugai pending on the existence and length of menopause. Pharmaceutical Co. Ltd, Tokyo, Japan, 6Aoba Hospital, Material and methods: Observational analytical cross- Tokyo, Japan sectional study covered a population specimen of 1159 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S215 persons who underwent central DXA osteodensitometry on value obtained by VAS indicating the intensity of pain felt in the spine and hip in the Specialized hospital for rehabilitation the week preceding the moment of the examination.Results: "Banja-Kanjiža" in Kanjiža in the period between 2006 and A wide range of variation of every index was observed. The 2016. All were tested for the presence of clinical risk factors. mean values of pain indexes observed in patients with limited All the women (N=1096) were questioned on the time of the cutaneous involvement were compared with the mean values occurrence of menopause, and its duration was calculated of patients with diffuse cutaneous involvement: the mean of from the moment of measuring of the bone mineral density. PRI of patients with limited cutaneous involvement was Results: The study has a 93.7% power for a α=0,05 error higher than the mean of patients with diffuse cutaneous in- level to discover a statistically significant difference between volvement with a significant difference; no significant differ- female patients with the duration of menopause up to 9 years ence was instead observed in the comparison of the other and those who had it for 10 and more years in relation to indexes. No significant difference was observed in the com- incidence of osteoporosis. Women with more than 2 clinical parison of mean values of the indexes observed in patients risk factors (CRFs 2+) are on the border of conventional levels with different duration of the disease. Three subgroups of of significance when it comes to incidence of osteoporosis patients with SSc and pain were identified: 1) patients with (p=0.070 and p=0.065). CRFs number is a statistically signif- pain due to digital ulcers; 2) patients with joint pain; 3) pa- icant predictor of osteoporosis when the influence of the du- tients with other kinds of pain. The mean values of pain in- ration of menopause is excluded (n=0.022). If the CRFs num- dexes observed in every subgroup were compared with the ber is observed as a numerical parameter, the difference be- mean values observed in the other subgroups and in the whole tween women with osteoporosis and osteopenia is statistically group of patients with pain. No significant difference was significant only in the group of women with menopause last- observed.Conclusions: The data indicate that pain is a fre- ing less than 9 years (Z=-2.587; p=0.010). Women with early quent and important cause of suffering in SSc patients. The menopause have a statistically lower T-score on the spine (t=- association of different methods was useful to obtain a careful 2.353; p=0.019) than women whose cycle stopped in the usual evaluation of pain and should be used in clinical research on time. There is a statistically significant difference between pain in SSc and in other chronic diseases. women with osteoporosis with and without early menopause with CRFs 2+ (X2=54.904 p<0.001), especially between the groups with menstruation vs. menopause 6=> years (p<0.001) P281 and group menopause ≤5 vs. 6=> years (p<0,001). There is a MUSCULOSKELETALTUMOR PROFILE IN SAIFUL higher T-score correlation on the femur (Rho=0.293 p<0.001) ANWAR GENERAL HOSPITAL MALANG A 5-YEARS than on the spine (Rho=0.830 p<0.030) in women with men- EXPERIENCE opause 6=> years (T-score femur Rho=0.260 p<0.001) with B.-S. Putra1,I.Irsan1,S.Isma1 CRFs FR 2+. 1Orthopaedic and Traumatology, Saiful Anwar Hospital Conclusion: Women with menopause for six and more years Malang, Malang, Indonesia and have more than two CRFs for osteoporotic fracture have the highest risk of osteoporotic fracture of the femur. Introduction: Musculoskeletal tumor are relatively rare and they represent less than 1% of all malignancies in all age groups. Most common malignant tumors were osteosarcoma P280 (1.68/million/year), chondrosarcoma (0.79/million/year) and EVIDENCE FOR DIFFERENT CAUSES OF PAIN IN Ewing sarcoma (0.76/million/year). Most common benign SSC PATIENTS: A CHALLENGE FOR THE bone lesion were osteochondroma (5.81/million/year), simple RHEUMATOLOGIST IN PRACTICE bone cyst (2.13/million/year), and enchondroma (2.05/mil- R. De Luca1 lion/year). 1Rheumatology Aouc Careggi, Florence, Italy Methods: Orthopaedic and Traumatology Department of Saiful Anwar Hospital as one of the health center in East Aim: to evaluate the prevalence of pain in patients with sys- Java has managed musculoskeletal patients for already 10 temic sclerosis (SSc), to analyze the characteristics of pain and years, and the most complete data collected within last 5 years. to compare different methods for pain assessment.Methods: This system were developed to gather type, location, final In a group of 100 patients with SSc, pain was reported by 79 diagnosis, treatment and follow ups of the musculoskeletal patients. Pain was assessed in 56 patients with: 1) the Pain tumor. Rating Index (PRI) of the McGill Pain Questionnaire Results: Bone tumors had higher cases than soft tissue tumor. (MPQ); 2) the Present Pain Intensity (PPI) of the MPQ; 3) a The peak of incidence for musculoskeletal tumor occurs in the value obtained by a visual analogue scale (VAS) indicating the patient older than fifty. Long bone is the most common place intensity of pain felt in the moment of the examination; 4) a for musculoskeletal tumor. Metastatic Bone Disease or S216 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Secondary Tumor achieve the highest cases for musculoskel- procedures. In the surviving patients, 18 of whom (60%) had etal tumor. Lung metastases distributed higher mortality rates been treated for osteoporosis before surgery, the preoperative for metastastic bone tumor patients. bone mineral densities were high, ranging from 41% to 81% Conclusion: Incidence of musculoskeletal tumor arising each (mean, 62.1%±11.2%). On the other hand, in the deceased year with high number of malignancy cases. Patients survival patients, only two of whom (18%) had received preoperative rates increased after early detection and undergo complete treatment, the preoperative bone mineral densities were lower, treatment. Based on that, our database in Orthopaedic and ranging from 36% to 66% (mean, 57.5%±10.7%). Traumatology Department of Saiful Anwar Hospital has a Conclusion: Our observations suggest osteoporosis treatment very important role to manage musculoskeletal tumor patients. before fracture to be associated with the outcomes of very elderly individuals, i.e., those age 90 years or older.
P282 OUTCOMES OF PATIENTS 90 YEARS OF AGE OR P283 OLDER WHO UNDERWENT SURGERY FOR FRAGILITY HIP FRACTURES IN PATIENTS UNDER PROXIMAL FEMORAL FRACTURE 65 YEARS OLD: A PROSPECTIVE STUDY N. Okada1,H.Kikuchi2,M.Kamiya3,S.Soen4 J. C. Minarro1, A. López-Jordán1, M. J. López-Pulido1,A. 1Orthopaedic Surgery, Sumoto-itsuki Hospital, Sumoto, González-Fernández1, P. Carpintero2 Japan, 2Orthopaedic Surgery, Kindai University Sakai 1University Hospital Reina Sofía, Córdoba, Spain, 2University Hospital, Sakai, Japan, 3Orthopaedic and Rheumatology, Hospital Reina Sofía, Cordoba, Spain Kindai University Nara Hospital, Ikoma, Japan, 4Orthopaedic Surgery and Rheumatology, Nara Hospital Kindai University Objectives: There have been few prospective studies exam- Faculty, Ikoma, Japan ining young and middle-aged patients with hip fracture. We therefore investigated postoperative complications and 1-year Objective: We reported the usefulness of osteoporosis treat- mortality in young and middle-aged patients with hip fracture. ment for the very elderly at a congress last year. This study Material and Methods: 106 consecutive patients younger aimed to examine the outcomes of very elderly Japanese pa- than 65 years with hip fracture were prospectively included tients (³90 years of age) who underwent surgery for proximal in a study lasting 6 years. Comorbidities, post-operative com- femoral fracture according to treatment strategies and surgical plications, length of hospital stay and 1-year mortality were procedures. recorded. Results were compared with another group of 250 Methods: We surveyed age, sex, body mass index (BMI), patients with hip fractures over 65 years randomly selected comorbidities, treatment before fracture, preoperative bone and treated at the same hospital. mineral density, surgical procedures, and outcomes in 41 pa- Results: Mortality was lower in patients younger than 65 tients at least 90 years of age who underwent surgery for years (3.77%) than in older patients (23.22%) (p <0.001). proximal femoral fracture and were followed up at hospitals However, the number of visits to specialists due to medical affiliated with Kindai University. complications (p <0.05), and hospital stay was longer (p Results and discussion: Theagesatthetimeofsurgery <0.001) in patients under 65. ranged from 90 to 98 years (mean, 93.6±2.4 years). There Conclusions: Patients younger than 65 years with fragility hip were 2 men and 39 women. BMI ranged from 16.3 to 27.3 fracture have a significantly lower mortality than older pa- (mean, 20.0±2.6). The following comorbidities were ob- tients. Nevertheless, they have a greater number of complica- served: hypertension in 22 patients, heart failure in 17, demen- tions, a longer hospital stay and therefore an increased health tia in 10, diabetes mellitus in 8, chronic kidney disease in 7, spending. and cancer in 5. While 30 patients had been treated for oste- oporosis with bisphosphonate, parathyroid hormone, anti- P284 receptor activator of nuclear factor-kB antibody, etc., before ACETABULAR PERFORATION BY CEPHALIC admission, 11 had received no treatment. The preoperative SCREW AFTER INTRAMEDULLARY NAILING IN bone mineral densities ranged from 38% to 81% (mean, OSTEOPOROTIC HIP FRACTURE 60.7%±11.3%). The surgical procedures performed were fem- R. Cañadillas Rueda1,D.ObreroGaitán1, R. Herrera Mármol1 oral head replacement in 20 patients and intramedullary frac- 1Neurotraumatological Hospital of Jaen, Spain, Jaén, Spain ture fixation in the other 21. Follow-up periods ranged from 7 to 78 months (mean, 29.7±19.0 months) in surviving patients Introduction: Hip fractures are an important cause of mor- and from one to 36 months (mean, 14.5±13.9 months: both bidity and mortality in the elderly. Together with vertebral male patients died within one year after surgery) in those who fractures, proximal humerus and distal radius, they constitute died. No differences were observed in BMI or surgical one of the most prevalent fracture groups in the adult Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S217 population. They have an incidence of 250000/year in the posteromedial cortex (these are more unstable fractures).6. USA. Its age of maximum incidence is of 84 years in the They have higher index refractories. women and 79 years in the man. Its incidence is increasing Conclusion: Osteoporosis is a silent disease with few clinical in recent years due to increased life expectancy and better manifestations. Risk factor screening and monitoring of pa- control of comorbidities and associated pathology. Advances tients who have suffered previous fractures is critical. Medical in medical and surgical treatment have allowed dramatic de- treatment with antiresorptive and osteoformers, diet, physical velopment in results, reducing mortality, and achieving better exercise, rehabilitation, etc. must be meticulously cared for in and better results. these patients, and the surgical technique must be precise and Case: We report the case of a 84-year-old female patient, exact to avoid complications arising from the stress that the autonomous for the activities of her daily life, and with inde- implant causes in the osteoporotic bone. Complications of pendent living in solitude, without comorbidities or serious osteoporotic fractures are more frequent and more severe, diseases of interest. He had a proximal humerus fracture the and their results are often conditioned by prior surgery. previous year, and several osteoporotic, and asymptomatic vertebral collapses, discovered by chance on a previously per- formed chest X-ray. The patient suffers falling through the P285 stairs of her home, and is brought to our hospital, where she USING TERIPARATIDE INJECTION IN TREATING is diagnosed of pertrochanteric hip fracture on the left. COMMINUTED FRACTURES IN NON-OSTEOPO- Emergency surgery is performed, with intramedullary nailing ROTIC ADULTS with a cephalomedullary nail of 180mm at 130º and dynamic A. M. Ali1,H.A.Elazaly1 distal block. Surgery is rapid, and proper reduction and fixa- 1King Faisal Medical Complex, Taif, Saudi Arabia tion of the fracture is achieved. At 3 postoperative days the patient begins to walk with walker support and begins reha- Objectives: To study the effect of using Teriparatide injection bilitation and physiotherapy immediately, without incident for 3 months after open reduction and internal fixation (ORIF) and with promising results.He walks autonomously with a of comminuted fractures in healthy non-osteoporotic adults walker every month, although discomfort in the left inguinal Material and Methods: King Faisal Medical Complex in region persists. At three months, radiologic consolidation of Taif is a referral central hospital accepting road traffic acci- the fracture is already confirmed, and the correct functioning dents (RTAs) occurring in Taif city and 8 other rural commu- of the implant is confirmed, although pain persists in the in- nities around. During the period of 31 months (from April guinal region. At 6 months the patient spontaneously suffers 2014 to December 2016); we conducted a case series study an accidental fall while walking, and is brought to our center, for selected RTAs victims admitted in our hospital. We includ- diagnosed of disassembly of the implanted intramedullary ed young non-osteoporotic adult patients with comminuted system. The head screw has perforated the acetabulum and fracture of the shafts of long bone who need ORIF. We ex- has been lodged inside the major pelvis, and there has been cluded patients with associated head injuries and patients with a disconnection of the femur with the iliac. Due to the com- previously hormonal disturbances. All patients underwent promise of vascular, nervous and visceral structures, urgent ORIF surgery with bridging plate or interlocking surgical intervention is planned, with removal of the intramedullary nail with or without artificial bone substitute. osteosynthesis material and partial left hip cemented As a result of the comminuted nature of our selected patients; arthroplasty. The femoral head severely damaged by osteopo- none of these fixation was compressing the fracture edges. rosis has been partially destroyed as it has been subjected to This situation calls for the use of Teriparatide injection in the gait stress, and the acetabulum has a significant perforation. first 3 months of the healing period, to catalyze the healing Discussion: Osteoporosis is the most prevalent bone metabol- process. Patients were separately consented about using ic disease in the population, and its incidence increases with Teriparatide injection as it is an out of label indication for increasing age and life expectancy. Due to their consequences, the medication. Calcium and vitamin D supplements were fractures called "by fragility" appear more frequently on a given. Monthly follow-up with check x-rays were done to pathological bone severely damaged in its macro and micro- all our patients till complete healing. scopic architecture, which makes difficult the medical treat- Results: 26 patients were included in our study, all patients ment as well as surgical, functional and rehabilitator, and as a completed the 3 months period of Teriparatide injection. 19 consequence: patients reached complete healing by the end of the first 3 1. Decreases the quality of the bone fixation of the implants.2. months (73.1%), 5 patients reached complete healing in the Consolidation problems.3. Surgeries are more technically de- second 3 months (19.2%), while 2 patients (7.7%) experi- manding and poorer surgical results are achieved.4. Surgeries enced non-union which needed revision surgery for them. are more prolonged and have a higher index of post-surgical Conclusion: In our series; it was evident clinically and radio- complications.5. Causes greater comminution of the logically that Teriparatide promotes callus formation and S218 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 callus volume, thus promoting fracture healing. We are con- OHD or different between fractures and controls. Subjects vinced through our experience that Teriparatide should be with >3 hours/day outdoors had higher 25-OHD (24.3±7.7 indicated for promoting fracture healing especially for com- vs. 21.8±8.2 p=0.03); no difference between fractures and minuted fractures regardless the presence of osteoporosis. controls. Participants in outdoor sports >2 hours/week had Many case-series studies in the literature agree with our find- higher 25-OHD (24.1±8.3 vs. 21.2±8.7, p=0.02); fracture ings. However, more studies are needed to gain required evi- group more likely than controls to play outdoor sports dence level to consider Teriparatide injection in treating com- (p=0.04). minuted fractures in non-osteoporotic adults. Between fracture and controls groups, mean serum calcium (9.8±0.6 vs. 10.0±0.4, p=0.04) and PTH (36.2±16.5 vs. 26.7 ±15, p<0.001) were different. Hyperparathyroidism was pres- P286 ent in 5.7% of fracture subjects, 1% of controls; all insuffi- ENVIRONMENTAL EFFECTS ON SERUM VITAMIN cient, deficient or severely deficient for 25-OHD. D AND PARATHYROID LEVEL VARIABILITY IN Conclusion: A majority was 25-OHD insufficient or deficient PEDIATRIC PATIENTS WITH ACUTE FRACTURE with lowest levels in Blacks/African Americans, Asians and VS. HEALTHY CONTROLS Hispanics. 25-OHD was not significantly different between S. Merwin1, J. Avarello2,A.Olson3,R.Crabb4,M.Lesser5,S. fracture and non-fracture groups. Despite high rates of Poon6 hypovitaminosis D, calcium homeostasis was maintained. 1Orthopaedic Surgery/Montefiore Medical Center, Bronx, Dietary supplementation exerted no effect on serum 25- United States, 2Pediatric Emergency Medicine/Cohen OHD but exposure to sunlight was associated with higher Children's Medical Center, New Hyde Park, United States, levels. Further investigation of higher PTH noted in the frac- 3Orthopaedic Surgery/NYU Hospital for Joint Diseases, ture group is warranted to understand its role in the setting of New York, NY, United States, 4Hofstra Northwell School of bone disruption. Medicine, Hempstead, United States, 5Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, United States, 6Pediatric Orthopaedic Surgery, Shriner's Children's P287 Hospital, Los Angeles, United States GENETIC PREDICTION OF LIFETIME RISK OF FRACTURE Objectives: Vitamin D (25-OHD) deficiency and insufficien- T. P. Ho-Le1, J. R. Center2,J.A.Eisman3,H.T.Nguyen1,T.V. cy are reported worldwide in healthy children; its relationship Nguyen4 to parathyroid hormone (PTH) in bone health is not well stud- 1Centre for Health Technologies, University of Technology, ied in children. We investigated if children with fracture have Sydney, Australia, 2Bone Biology Division, Garvan Institute lower serum 25-OHD than those without and evaluated rela- of Medical Research; St Vincent Clinical School, UNSW tionships between 25-OHD and serum PTH and calcium, and Australia, Sydney, Australia, 3Bone Biology Division, effects of diet and sunlight exposure on 25-OHD. Garvan Institute of Medical Research; St Vincent Clinical Material and Methods: Cross-sectional study in an urban School, UNSW Australia; Notre Dame University School of children’s hospital emergency department in Northeastern Medicine, Sydney, Australia, 4Centre for Health U.S.to to collect serum 25-OHD, PTH and calcium in children Technologies, University of Technology; Bone Biology with fractures and “healthy” controls, ages 1-17 from 1/14-6/ Division, Garvan Institute of Medical Research; School of 16. Exclusions: steroids >30 days in past year, IBD, malab- Public Health and Community Medicine, UNSW Australia, sorption, bone dysplasia, malignancy, hypothyroidism. Sydney, Australia Nutrition and activity survey was administered. We defined 25-OHD ≥30ng/ml sufficient, 20.0-29.9ng/ml insufficient, Aim: Residual lifetime risk of fracture (RLRF) is highly var- 12.0-19.9ng/ml deficient, <12ng/ml severely deficient. iable between individuals, and we hypothesize that the varia- Enrollment continues to 350. tion is partly due to genetic factors. This study sought to de- Results: 105 in fracture group, 112 controls. Overall mean 25- velop a genetic profiling of BMD-associated genetic variants OHD: 23.2±8.5 ng/mL, 22.8±7.6 in fractures, 23.6±9.2 in for predicting the lifetime risk of fracture for men and women. controls (ns). Overall: 21.2% 25-OHD sufficient, 42.4% in- Methods: The study was designed as a population-based pro- sufficient, 29.0% deficient, 7.4% severely deficient. 25-OHD spective study that involved 1326 men and 2189 women aged in Caucasians 26.2±8.6, 20.0±6.4 in Black/African 60 years at study entry. During the follow-up period (1989- Americans, 19.4±7.7 in Asians, 21.3±7.4 in Hispanics, 21.6 2009), the incidence of fragility fractures was ascertained from ±7.1 in Indians (p<0.001). Winter mean 20.4±6.6 vs. summer X-ray reports. The incidence of mortality was also 25.8±8.4 (p<0.001).Self-reported sunscreen, multivitamin ascertained. Femoral neck bone mineral density (BMD) was and dairy intake were not associated with higher serum 25- measured by dual-energy X-ray absorptiometry. A polygenic Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S219 risk score (GRS) was generated by summing the weighted score (8.4, IQR 3.8-18.0) than normoglycaemia (5.5, IQR number of risk alleles for each single-nucleotide polymor- 2.4-10.0) and IFG (5.5, IQR 2.6-9.8) (p=0.001). A similar phism (SNP), with the weight being regression coefficients pattern was observed for hip FRAX without BMD; diabetes associated with BMD. The RLRF from the age of 60 was had a higher score (3.3, IQR 0.9-7.4) than normoglycaemia estimated by survival analysis taking into account the compet- (1.3, IQR 0.4-3.7) and IFG (1.5 IQR 0.4-4.0) (p=0.001). ing risk of death. When including BMD, the association with diabetes became Results: After adjusting for competing risk of death, the non-significant. For MOF FRAX, median scores were 4.5 RLRF for women and men from age 60 was 36% (95% CI, (IQR 2.4-8.3), 4.3 (IQR 2.3-8.9) and 5.7 (IQR 2.6-9.5) for 34-39%) and 21% (95% CI, 18-24%), respectively. normoglycaemia, IFG and diabetes, respectively (p=0.392). Individuals with greater GRS had higher mortality-adjusted Hip FRAX scores for women with normoglycaemia, IFG lifetime risk of any fracture. For instance, among women with and diabetes were, 0.8 (IQR 0.2-2.8), 0.8 (IQR 0.2-2.9) and GRS≥4.24, the mortality-adjusted RLRF was 42% (95% CI, 1.2 (IQR 0.3-3.0), respectively (p=0.590). 35-47%), 1.17-fold greater than average. In men with Conclusions: We report that women with diabetes had a GRS≥4.24, the RLRF was 24% (95% CI, 19-28%), 1.14-fold higher FRAX score for both MOF and hip fractures when greater than the average. Moreover, the association between BMD was not included. However, when BMD was included, GRS and RLRF was independent of femoral neck BMD. For the association was attenuated. The results of this study concur hip fracture, the mortality-adjusted residual lifetime risk was with previous observations that fracture risk is higher in indi- 10% (95% CI, 8-12%) for women and ~5% (95% CI, 3-6%) viduals with diabetes, despite a higher BMD. for men; among those with higher GRS, the risk was 15% (95% CI, 9-20%) and 6% (95% CI, 3-9%) for women and men, respectively. P289 Conclusion: These data suggest that a profiling of BMD- OCCURRENCE AND PREDICTORS OF OSTEOPO- associated genetic variants could help identify individuals ROSIS AND SARCOPENIA IN YOUNG EUGONADAL with high lifetime risk of fracture. These results can be useful INDIANS WITH HIV INFECTION in promoting efforts aimed at preventing development of risk D. Dutta1,M.Sharma2,R.Bansal3,U.C.Garga4,A.Anand5, factors for fracture in young individuals. N. Sharma6,U.Garga4 1Department of Endocrinology, Venkateshwar Hospitals, Dwarka, New Delhi, India, 2Department of Rheumatology, P288 Venkateshwar Hospitals Dwarka, New Delhi, India, FRAX (AUS) SCORES IN WOMEN WITH DYSGLY- 3Department of Endocrinology, PGIMER and Dr RML CAEMIA AND DIABETES Hospital, New Delhi, India, 4Department of Radiology, L. L. DeAbreu1,K.L.Holloway1,M.A.Kotowicz1,M.A. PGIMER and Dr RML Hospital, New Delhi, India, 5Anti- Sajjad1,J.A.Pasco1 Retroviral Therapy Clinic, PGIMER and Dr RML Hospital, 1Deakin University, Geelong, Australia New Delhi, India, 6Department of Biochemistry, PGIMER and Dr RML Hospital, New Delhi, India Background: Individuals with diabetes have higher fracture risk despite higher BMD. Fracture prediction in diabetes is Objective: This study aimed to determine occurrence and challenging, with FRAX underestimating risk for these indi- predictors of osteoporosis in premenopausal women and viduals. This study aimed to investigate FRAX score with and eugonadal men with HIV. without BMD for women with dysglycaemia. Methods: 220 men and 214 women with HIV were screened, Methods: This study included 566 women, aged 50+ years, of which 115 men (30–50 years-age) and 103 women (25–45 enrolled in the Geelong Osteoporosis Study. Impaired fasting years-age), clinically stable, having >1-year follow-up, glucose (IFG) was defined as fasting plasma glucose (FPG) underwent hormonal and DXA analysis. 40 male and 75 fe- ≥5.5mmol/L and diabetes as FPG≥7.0mmol/L, use of male matched controls were evaluated. antihyperglycaemic medication and/or self-report. FRAX Results: HIV males and females had significantly lower (Aus) 10-year probabilities of major osteoporotic (MOF) and BMD and Z-scores at all sites. Osteoporosis was diagnosed hip fracture were calculated, with and without BMD, resulting in 64.35% males; commonest site being radius total (RT) in four FRAX scores per participant. Kruskal-Wallis test for (49.56%), followed by radius 33% (45.21%), radius ultra dis- non-parametric data was used to examine differences between tal (RUD) (36.52%), lumbar spine (LS) (19.13%), neck of the three glycaemia groups. femur (NOF) (17.39%), total femur (TF) and greater trochan- Results: There were 252 women with normoglycaemia, 247 ter (GT) (7.82% each). Osteoporosis was diagnosed in with IFG and 67 with diabetes. For MOF FRAX calculated 34.95% HIV females, commonest site being RUD (24.27%), without BMD, women with diabetes had a higher median followed by radius 33% (17.48%), RT (15.53%), GT, NOF S220 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and LS (6.80% each). HIV males and females had significant- active group included 15 patients (9 men and six women, the ly lower fat mass (FM), lean mass (LM), fat% (FP), bone average age 32.1±10.2 years with a range of 17 to 52 years), mineral content (BMC), gynoid (G) fat,% skeletal muscle and the inactive group 11 patients (8 men and three women, the mass (PSMM) (sarcopenia), compared to controls. LM and average age 38.9±9.0 years with a range of 17 to 50 years). FM was -15.65% and -11.54% lower in HIV. Sarcopenia Results: The PON and ARE levels were found to be signifi- was observed in 40% males and 17.5% females with HIV cantly lower in the patient group than the control group (controls none). HIV males with osteoporosis had higher (p<0.01). The PON levels of the active and remission groups HAART use, immune reconstitution inflammatory syndrome were 96.23±57.84, and 112.2±65.14, respectively. The ARE (IRIS), tuberculosis, lower FM, LM and sarcopenia. Logistic levels of the active and remission groups were 30.49±5.81, regression revealed PSMM, age and delta (Δ) CD4 count and 30.85±6.40 (Table 2). No significant correlations were (change in CD4 count at 1 year of HAART, compared to found between clinical findings and the activity levels of pre-HAART) were best predictors of osteoporosis. Greater PON and ARE in the active patient group (p>0.05). PSMM was associated with decreased osteoporosis, without Conclusions: the activities of the antioxidant PON and ARE adjusting for any variable (Model-1), adjusting for disease enzymes are reduced in Behçet’s disease. Therefore, it may be duration, tuberculosis and IRIS (Model-2), and adjusting for useful to add antioxidant therapy to the conventional treatment model-2 plus gonadotropins and sex steroids (Model-3). of the disease. In later periods, for the demonstration of the Greater ΔCD4 count and age were associated with increased relationship between reduced PON and disease activity, it may osteoporosis after adjusting for models 1 and 3, and models 2 be possible to acquire clearer data particularly by conducting and 3 respectively. HIV females with osteoporosis had signif- studies with higher numbers of patients. icantly higher use of HAART, lower LM, FM and FP. On logistic regression, LM followed by A/G ratio and BMI were best predictors of osteoporosis. P291 Conclusions: Osteoporosis and sarcopenia are major prob- PERIOPERATIVE FACTORS AFFECTING THE lems in young eugonadal men and women with HIV. OCCURRENCE OF ACUTE COMPLEX REGIONAL Decreased skeletal mass, age and rapid improvement in im- PAIN SYNDROME FOLLOWING LIMB BONE mune function were predictors of osteoporosis. FRACTURE SURGERY: DATA FROM THE JAPANESE DIAGNOSIS PROCEDURE COMBINATION DATABASE M. Sumitani1, H. Yasunaga2,K.Uchida3, Y. Yamada3 P290 1Deapartment of Pain and Palliative Medicine, The University PARAOXONASE AND ARYLESTERASE LEVELS IN of Tokyo Hospital, Tokyo, Japan, 2Department of Health BEHÇET’S DISEASE AND THEIR RELATIONS Economics and Epidemiology Research, School of Public WITH THE DISEASE ACTIVITY Health, The University of Tokyo, Tokyo, Japan, A. Kul1,H.Uzkeser1, N. Ozturk2 3Department of Anesthesiology and Pain Relief Center, The 1Physical Medicine and Rehabilitation, Faculty of Medicine, University of Tokyo Hospital, Tokyo, Japan Erzurum, Turkey, 2Department of Biochemistry, Medical Faculty, Erzurum, Turkey Objectives: Complex regional pain syndrome (CRPS) de- scribes a broad spectrum of symptoms that predominantly Objectives: To determine the paraoxonase (PON) and localize to the extremities. Although limb fracture is one of arylesterase (ARE) enzyme activity levels in Behçet’sdisease the most frequently reported triggering events, few large-scale and to investigate whether they are associated with the disease studies have shown the occurrence of and factors associated activity. with CRPS following limb-fracture. This study aimed to show Material and methods: Twenty-six patients (group 1) with the occurrence and identify the factors. active Behçet disease and 28 healthy controls (group 2) were Methods: Using the Japanese Diagnosis Procedure included in this study. While the patients who had at least one Combination database, we identified 39 patients diag- of the symptoms related to genital ulcer, skin lesions nosed with CRPS immediately after open reduction and (acneiform lesions, erythema nodosum-like lesion), active uve- internal fixation (ORIF) for limb-fracture from a cohort itis, arthritis, thrombophlebitis, or central nervous system of 185,378 in-patients treated with ORIF between July (CNS) involvement in addition to oral ulcers were considered and December 2007–2010. Patient and clinical character- as the active group, the patients who did not show clinical istics, such as age, gender, fracture site, duration of anes- symptoms in the last one month due to the medical treatment thesia and use of regional anesthesia, were investigated by (using corticosteroid, colchicine or other immunosuppressive logistic regression analyses to examine associations be- drug) were considered as the inactive group (remission group) tween these factors and the in-hospital occurrence of in the clinical evaluation of patients with Behçet’s disease. The CRPS after ORIF. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S221
Results: The occurrence of CRPS was relatively high in frac- postoperative knee stability without any detrimental effects tures of the distal forearm, but low in fractures of the lower on the clinical results. The degree of the initial graft coverage limb and in patients with multiple fractures. Generally, fe- significantly affected the postoperative knee stability. males are considered to be at high risk of CRPS; however, we found a comparable number of male and female patients suffering from CRPS after ORIF for limb-fracture. In terms of P293 perioperative factors, a longer duration of anesthesia, but not ASSOCIATION BETWEEN FEMORAL FRACTURES regional anesthesia, was significantly associated with a higher AND SUPERIOR EXTREMITY FRACTURES IN THE incidence of CRPS. OLDER PEOPLE Conclusion: Although a limited number of CRPS patients L. J. Osca1, M. Osca Guadalajara1, T. Espallargas1,A.C. were analyzed in this study, reduced operative time might help Urgel Granados1, A. Castro Sauras1,M.RoyoAgustín1 to prevent the development of acute CRPS following limb 1Hospital Obispo Polanco Teruel, Teruel, Spain fracture. Introduction: Femoral fracture is still one of the most prevalent pathologies in the older population. Often, P292 they are secondary to low energy trauma, osteoporosis COMPARISONS OF CLINICAL OUTCOME AFTER being the source of the problem. The association be- ANATOMIC DOUBLE-BUNDLE ACL RECONS- tween femoral and superior fractures is not uncommon. TRUCTION BETWEEN REMNANT TISSUE- However, there are a few reviews in the literature about PRESERVING AND RESECTING PROCEDURES this topic. Our goal is to study the frequency of this E. K. Kondo1 association, as well as establish the treatment when 1Department of Advanced Therapeutic Research for Sports you find two fractures in the same patient and if there Medicine, Hokkaido University Graduate School of is any difference between one fracture and two fracture Medicine, Sapporo, Japan patients. Material and Methods: We present a retrospective study. We Introduction: Preservation of the ACL remnant tissue has took patients over 65 diagnosed with femoral fracture. They attracted notice in the field of ACL reconstruction. were admitted in our hospital between January 2010 and However, no studies have shown clinical evidence regard- December 2015. We took into account sex, age, hospitaliza- ing the utility of ACL remnant tissue preservation as of tion days, functionality, comorbidities, destination when they yet. We have hypothesized that, first, the remnant preser- were discharged and whether they had both fractures. Femoral vation in anatomic double-bundle ACL reconstruction and superior extremity fracture. may improve the postoperative knee stability without Results: We reviewed 961 patients diagnosed with hip frac- any detrimental effects on the clinical results. Secondly, ture. 31 of them (3.32%) present another fracture. 23 of these the degree of the initial graft coverage may significantly patients with two fractures (74.19%) suffered from ipsilateral affect the postoperative knee stability. proximal humeral fracture. The rest presented fractures in dis- Methods: One hundred and seventy-nine patients underwent tal radius and olecranon. Charlson index and Barthel index anatomic double-bundle ACL reconstruction. According to were measured at patient admission. The patients who pre- the Crain’s classification of the ACL remnant tissue, 81 knees sented hip fracture and measurements of 7.1 and 73.13 respec- underwent the remnant-preserving procedure (Group P), and tively. The patients who presented both hip fracture and an- the remaining 98 knees underwent the remnant-resecting pro- other fracture had measurements of 6.62 and 79.51, respec- cedure (Group R). Concerning all background factors includ- tively. Most of the patients were referred to a rehabilitation ing the tunnel positions, there were no differences between the hospital. In addition to follow up their fractures, they could 2 groups. The patients were followed up for 2 years or more. benefit from a rehabilitation program according to their func- Results: The side-to-side anterior laxity was significantly less tional capacity. (p=0.0277) in Group P (0.9 mm) than in Group R (1.5 mm). Discussion: We present a series of 961 patients older than The negative pivot-shift test was also significantly lower 65 years old with hip fracture. 3.32% of them present (p=0.046) in Group P (89%) than in Group R (78%). These superior extremity fracture at the moment of diagnosis. clinical results were supported by the results of the arthroscop- 74.2% were proximal humerus fractures. Based on this ic observations. In addition, there were no significant differ- series’ results, we can state that those patients presenting ences concerning the intraoperative and postoperative compli- both fractures (hip fractures plus another one) don' t have cations between the 2 procedures. worse prognosis neither worse functional recovery than Conclusions: The remnant preservation in anatomic double- those presenting isolated hip fracture. There results agree bundle ACL reconstruction significantly improved the with the literature published. S222 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
P294 clinical trials could be seen as a rare side effect and clinicians THE APPROACH OF MILD PERSISTENT HYPERCAL- should be aware of its existence. CEMIA DURING TERIPARATIDE TREATMENT M. Betivoiu1,I.Soare1,S.Martin2,S.Fica2 1Elias Hospital, Endocrinology Department, Bucharest, P295 Romania, 2Elias Hospital, Endocrinology Department, Carol BACK PAIN AND ASYMPTOMATIC VERTEBRAL Davila University of Medicine and Pharmacy, Endocrinology FRACTURES Department, Bucharest, Romania T. Jankovic1, J. Zvekic-Svorcan1, K. Filipovic1, S. Subin- Teodosijevic2 Introduction: Teriparatide is an anabolic treatment for osteo- 1University of Novi Sad, Faculty of Medicine, Special porosis, indicated for patients with high risk of vertebral and Hospital for Rheumatic Diseases, Novi Sad, Serbia, nonvertebral fractures and for those with glucocorticoid in- 2Rheumatology, General Hospital, Zrenjanin, Serbia duced osteoporosis. Common side effects include nausea, vomiting, hypertension, dizziness, allergic reactions. Introduction: Approximately ¾ of vertebral fractures are Although severe hypercalcemia is very rare, mild hypercalce- asymptomatic and remain unrecognized. mia has been reported in 1-3% of patients. Aim: To determine the correlation between chronic pain in the Case report: We report the case of an 83-year-old female who back and appearance of asymptomatic vertebral fractures in presented to our clinic in June 2015 with complaints of women with postmenopausal osteoporosis. polyarthralgias, back pain, headaches. Her past medical histo- Materials and Methods: The study involved 50 women in ry was significant for rheumatoid arthritis treated with meth- menopause for a period of one year, aged between 50 and 66 ylprednisolone 8 mg/day and methotrexate 20 mg/week, se- years and with back pain. All patients fulfilled criteria that they vere postmenopausal and glucocorticoid induced osteoporosis used to have severe pain in the back, documented in their med- treated with bisphosphonates for 8 years (2007-2015), non- ical history, and had never before determined the bone mineral toxic multinodular goiter. She had multiple fragility fractures density (bone mineral density-BMD) with dual X-ray absorpti- (right malleolus -1986, left forearm -1997, L2 vertebra -2014). ometry (DXA). The intensity of back pain was measured DXA lumbar spine T-score could not be interpreted due to through Visual Analogue Scale (VAS). It was made radiograph degenerative changes, left hip T-score was -1.7 SD (X-ray) of the thoracic and lumbar spine as well as the DXA (BMD=0.725 g/cm2). Treatment with teriparatide 20 mg/ findings. Using questionnaires were determined risk factors for day, calcium 1000 mg/day and cholecalciferol 1000 UI/day osteoporotic fractures. Statistic analyzes were done in the pro- was started. Subsequent evaluations showed good tolerance gram Statistical Package for The Sociences 20.0. and compliance of the treatment. One year later laboratory Results: The mean age of patients was 61 years, in which the tests showed: calcium=10.5 mg/dl, PTH=23.69pg/ml, 25- mean value of the intensity of back pain was 59 mm and lasted OH vitamin D=21.2 ng/ml, osteocalcin=19.9 ng/ml(15-46), an average of 5.6 months. In 61% of the patients on the basis of Beta-crosslaps=0.4 ng/ml(<1), normal biochemistry, TSH, X-ray of the thoracic and lumbar spine was confirmed vertebral FT4. Dorso-lumbar X-ray did not reveal any new vertebral fracture. The most common location of fractures were 35%- fractures. DXA left hip T-score=-1.4 SD. One month later Th11, 32%-Th12 and 25%-L1. Based on the results of DXA we repeated serum calcium 24 hours after the teriparatide findings osteoporosis had 11 examinees, 19 had osteopenia injection and its value persisted mildly elevated (10.9 mg/ while normal findings were recorded in 20 patients. Most com- dl). The patient had no symptoms of hypercalcemia and age- mon risk factors were early menopause (41.5%), smoking specific oncologic screening was negative. Therefore we de- (32.3%) and fractures in relatives (20.5%). cided to continue the treatment with teriparatide and reduce Conclusion: Asymptomatic vertebral fractures are associated the daily dose of calcium at 500 mg with close evaluation of with severe and chronic back pain, which increases with the serum calcium. number of fractures. Therefore, the occurrence of chronic back Discussions: Several suggestions from literature for the man- pain especially in patients with risk factors for osteoporosis agement of hypercalcemia during teriparatide treatment in- requires the attention of clinicians and evaluation in the direc- clude repeating serum calcium levels in 1-2 days, ensuring tion of vertebral fractures. that calcium intake is about 1500 mg/day, searching for other potential causes of hypercalcemia, reducing the calcium in- take by 500 mg/day if hypercalcemia persists, stopping P296 teriparatide in severe cases. SEASONAL VARIATION OF SERUM VITAMIN D IN Conclusions: Our case underlines the importance of close ROMANIA monitoring serum calcium levels during teriparatide treat- D. A. Niculescu1, R. Dusceac1,C.Capatina2,A. ment. Persistent hypercalcemia although not reported in Caragheorgheopol3, C. Poiana2 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S223
1Department of Endocrinology, Carol Davila University of Materials and methods: 98 women (mean age 71,2±8,6) Medicine and Pharmacy, Bucharest, Romania, 2Carol Davila were examined. The patients were divided into 2 groups: University of Medicine and Pharmacy, Bucharest, Romania, group 1, n=50 (mean age 71,4±8,4), control group; group 3Research Laboratory, "C. I. Parhon" National Institute of 2, n=48 (mean age 70,9±9,1), patients with osteoporosis. Endocrinology, Bucharest, Romania The levels of cytokines were studied by ELISA. The data of arterial stiffness were determined by applanation to- Objective: Romania is located in the Northern hemisphere nometry by SphygmoCor, Australia. BMD was studied between 44 and 48 degrees latitude and the seasonal variation in 2 areas: lumbar vertebrae and proximal hip by DXA of serum vitamin D is currently unknown. Our objective was densitometry (Challenger, France). We studied the follow- to evaluate the vitamin D seasonal variation (serum 25- ing parameters: pulse wave velocity (PWV), central pulse hydroxyvitamin D [25OHD]) in an adult Romanian pressure (CPP), augmentation pressure (AP), augmenta- population. tion index (AI). For statistical analyses we used Wald- Methods: We retrieved from our endocrinology center elec- Wolfowitz criteria, multiple regression model. The study tronic database all 25OHD measurements between May 2012 was based on GCP principles. and November 2016. We also evaluated age, sex, diagnosis Results: Increased levels of IL- 6 (11,4±11,9 vs. 7,0±9,4, and date of blood sampling. 25OHD was measured by chemi- p=0,002), IL-8 (31,1±38,5 vs. 22,1, p=0,008), TNF-α (4,86 luminescence (Liaison XL) or electrochemiluminescence ±3,46 vs. 3,4±4,1, p=0,0006), IL-10 (15,9±20,7 vs. 14,4 (Cobas E601 C). ±22,6, p=0,008), IL-4 (16,0±71,4 vs. 3,3±4,9, p=0,002) were Results: There were 14052 subjects of which 8024 (mean age determined in patients with osteoporosis. The central pulse 48.23±18.34 years; 1429 men, 6595 women) did not have a pressure was higher in women with osteoporosis (48,5±20,1 diagnosis of low bone mass (osteopenia or osteoporosis). In vs. 45,5±15,5, p=0,0000). The increase of the augmentation the 8024 subjects mean serum 25OHD was 19.9±9.9 ng/mL. index was revealed in women with osteoporosis, no signifi- 0.73%, 14.4%, 55.59% and 86.12% of subjects had a serum cant differences of augmentation pressure between the exam- 25OHD level below 4, 10, 20 and 30 ng/mL respectively. ined groups were found out (15,9±9,5 vs. 14,9±8, p=0,1. Serum 25OHD showed a marked seasonal variation, with PWV in the second group was higher than in the control group highest levels in September (25.20±10.03 ng/mL) and lowest (9,7±2,3 vs. 9,0±2,1, p=0,00000). The decrease of BMD levels in March (15.51±8.47 ng/mL; p<0.001). The mean mean values in L1-L5 was established in women of group 2 values for winter (n=1776), spring (n=2090), summer (0,974±0,230 vs. 1,031±0,200, p=0,00006), Z-score (0,59 (n=1637) and autumn (n=2521) were17.9±9.38, 16.54±9.09, ±1,75 0,95±1,25, p=0,000), T-score (-0,8±1,6 -0,3±1,2, 22.55±10.02 and 22.63±9.69 ng/mL respectively. The season- p=0,0004). BMD of total hip (0,80±1,6 0,86±0,15, p=0,000; al variation (September vs. March) persisted in all age groups: Z-score 2,7±1,4 3,3±1,7, p=0,0002, T-score 0,94±1,66 1,19 0-20 years (29.46±10.9 vs. 20.14±11.9 ng/mL), 21-40 years ±1,45, p=0,0000) proved to be significantly lower in women (26.54±8.41 vs. 14.66±7.17 ng/mL), 41-65 years (25.11 with osteoporosis than in control group. Multiple regression ±10.22 vs. 14.98±7.64 ng/mL) and over 65 years (21.44 analysis was conducted to identify factors affecting PWV. It ±9.57 vs. 14.86±8.51 ng/mL). was ascertained that age factor (β=0,3 95CI0,08-0,11, Conclusions: In our Romanian population serum 25OHD p=0,027), the level of IL-6 (β=0,34 95CI 0,21-0,16, showed an important seasonal variation with highest levels p=0,04), Z-score of hip (β=5,02, 95CI 8,4-10,6, p=0,0059), in September and lowest levels in March. This seasonal vari- T-score of the Ward’sarea(β=5,07 95CI 6,0-8,1, p=0,005) ation persisted in all age groups. Also, the prevalence of vita- were the independent determinants of arterial stiffness. min D deficiency and insufficiency was very high. Conclusion: Increasing performance of arterial stiffness, levels of some cytokines and decreasing BMD were deter- mined in women with osteoporosis/age, BMD and level of P297 IL-6 were independent factors affecting arterial stiffness. THE RELATIONSHIP BETWEEN ARTERIAL STIFF- NESS CYTOKINE PRODUCTION AND BONE MINERAL DENSITY IN WOMEN WITH OSTEOPOROSIS P298 S. Tsarenok1,V.Gorbunov1, S. Verhoturova2,T.Aksenova1, EVIDENCE FOR CIRCULATING CTRP3 AS A POSSIBLE P. Gromov2 MARKER IN PATIENTS WITH OSTEOARTHRITIS 1Chita State Medical Academy, Chita, Russian Federation, Z. Maghbooli1, A. Hossein-Nezhad1, A. Farokhi2,G. 2Russian Railway Hospital, Chita, Russian Federation Khoshechin2,G.Niketeghad2, S. Mohammadnabi2,B. Larijani2 Aim: To reveal the relationship of arterial stiffness with cytokine 1Osteoporosis Research Center, Endocrinology and production and bone mineral density in women with osteoporosis Metabolism Clinical Sciences Institute, Tehran University of S224 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Medical Sciences, Tehran, Islamic Republic of Iran, Material and methods: A total of 80 persons (33 patients 2Endocrinology and Metabolism Clinical Sciences Institute with skeletal discrepancy as case group and 47 normal persons of Tehran University of Medical Sciences, Tehran, Islamic as control group) were recruited in this case-control study. All Republic of Iran case group had mandibular, maxillary or both prognathism and were candidate for orthognathic surgery. Dual X-ray ab- Objective: To examine serum levels of CTRP3 in women sorptiometry (DXA) densitometer (Hologic) were used to as- with knee osteoarthritis (OA). sess BMD at three bone sites (total hip, femoral-neck, and Material and methods: A population based cross-sectional lumbar spine (L1-L4). Each person was categorized based study was performed in women who complained of chronic on The WHO osteoporosis criteria; osteoporosis (T score ≤ - knee pain. All subjects were followed by clinical and weight- 2.5), osteopenia (-2.5
P301 CATABOLIC EFFECTS OF FGF-1 ON CHONDROCYTES P302 WITH REDUCED CCN2 PRODUCTION THAT TERIPARATIDE FOR TREATMENT OF SPINE PROMOTES CARTILAGE REGENERATION: FRACTURES IN A SPONDYLITIS POSSIBLE ROLE IN OSTEOARTHRITIS A. Lorente Muñoz1, S. Cortes Franco1 A. Elseoudi1, T. Abd El Kader1,2,T.Nishida1,E.Aoyama2,T. 1Neurosurgery, University Hospital Miguel Servet, Zaragoza, Eguchi3, M. Takigawa2,S.Kubota1,2 Spain 1Biochemistry and Molecular Dentistry, Dental School, Okayama University, Okayama, Japan, 2Advanced Research Objective: Cervical fractures often require surgical treat- Center for Oral and Craniofacial Sciences, Okayama, Japan, ment to achieve proper stabilisation and thus prevent 3Dental Pharmacology, Okayama University Graduate School neurological damage associated with an unstable cervi- of Medicine, Dentistry and Pharmaceutical Sciences, cal spine. Okayama, Japan Systemic diseases such as ankylosing spondylitis hinder the surgical treatment of fractures, mainly because of the osteopo- Objective: Osteoarthritis (OA) is characterized by dramatic rosis induced by long-term immunosuppressive and glucocor- changes in chondrocyte metabolism including the action of ticoid treatments. They also pose a surgical challenge because CCN family protein 2 (CCN2) in the cartilage microenviron- the approach is limited by stiffness and kyphotic deformity of ment. CCN family proteins (Connective tissue growth factor cervical spine. (CTGF)/CCN2, Cystein rich protein (Cyr61)/CCN1, and Material and Methods: We report a 52-year-old male patient Nephroblastoma overexpressed gene (nov)/CCN3, play im- with a long history of ankylosing spondylitis, who suffered a portant roles in development and regeneration of cartilaginous whiplash injury, resulting in a C7 fracture. We were not able to tissues. By stimulating the proliferation and differentiation of perform the right approach because of patient´s comorbidity, chondrocytes, CCN2 plays a critical role in the development so we started with teriparatide and orthesic treatment. and regeneration of the cartilage. CCN2 interacts with several Results: Two months after teriparatide treatment beginning, growth factors involved in endochondral ossification, which the patient was in significantly less pain. Cervical spine CT S226 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 showed a clear bone consolidation and 12 months later patient target cells. In addition, the present data provide a preclinical remains in the same clinical situation. proof for the bone anabolic and anti-resorptive activities of Conclusions: The combination of ankylosing spondylitis and KAL671, which further supports its preclinical development vertebral fracture makes it very hard to treat these two condi- against osteoporosis. tions. In the event of pseudarthrosis or when it is impossible to perform appropriate surgical treatment, teriparatide may be an useful treatment because of its bone anabolic action that pre- P304 vents the complications associated with prolonged orthotic POLYMORPHISM OF SOME GENES OF BONE treatment. METABOLISM (VDR BSM1 C.IVS7G> A, LCT 13910 T> C, COL1A 12046 G-> T) AMONG THE REPRETATIVES OF RUSSIAN AND BURYAT NATIONALITIES P303 S. Verkhoturova1, S. Tsarenok2, V. Gorbunov2,T.Aksenova2, STIMULATION OF BONE MASS BY A NOVEL N. Iljamakova1,P.Gromov1 METHYLATED FATTY ACYL AMIDE DERIVATIVE 1Russia Railway Hospital, Chita, Russian Federation, 2Chita S. Baraghithy1, R. Smoum1,M.Attar-Namdar1,R. State Medical Academy, Chita, Russian Federation Mechoulam1,I.Bab1,J.Tam1 1The Hebrew University of Jerusalem, Jerusalem, Israel Objective: To study the frequency of genotypes of the poly- morphous marker of bone remodeling (vitamin D receptor Objective: Among the several endogenous fatty acyl amides gene Bsm1 c.IVS7G> A, the lactase gene LCT 13910 T> C (FAAs) found in bone, oleoyl serine (OS) was demonstrated to and collagen gene COL1A 12046 G-> T) in healthy people be a potent anti-osteoporotic agent in both in vitro and in vivo and patients with osteoporosis (OP) among the indigenous models. However, OS is rapidly hydrolyzed by amidases that population of Transbaikalye of Russian and Buryat limit its activity. Here, we tested if hindering of the amide nationalities. bond by adjacent methyl substituents may potentiate OS’s Materials and methods: 97 women with OP were examined: activity by restraining its hydrolysis. 49 Russian and 48 Buryat people aged between 50 and 80. Materials and Methods: Methylated OS derivatives, oleoyl 123 healthy women of the same age group were included in α-methyl serine (KAL671) and 2-methyl-oleoyl serine the control group. The material for the molecular genetic anal- (KAL681) were synthesized. In vitro efficacy of the deriva- ysis of the DNA samples was extracted from peripheral ve- tives was evaluated both in osteoblast and osteoclast cultures. nous blood. The on-line calculator was used for data 8-week old female C57BL/6J mice were ovariectomized processing. (OVX) or SHAM-operated, and 6 weeks later treated daily Results: It was found, that the recessive allele A of the poly- with OS, KAL671, KAL681 or vehicle (OS: 1, 3, 9 mg/kg/ morphism of VDR - Bsm1 c.IVS7G> A was accumulated day; KAL671: 0.1, 0.5, 1 mg/kg/day; KAL681: 0.3, 1, 5 mg/ among the women of Buryat nationality, but the statistical kg/day) for additional 6 weeks. The compound's in vivo effi- significance was not observed (OR=1.04, CI [0 68, 1.6]). cacy was examined by microcomputed tomography, bone In the analysis of polymorphism of LCT -13910 T> C, it was histomorphometry, and serum levels of bone turnover found that the recessive mutant genotype T / T was present biomarkers. only among Russian women (p=0.0005). C allele was associ- Results: KAL671 and KAL681 stimulated the number of ated with the development of OP to a greater extent among the osteoblasts similarly to OS. However, only KAL671 showed representatives of Buryat nationality (OR=1.04, CI [0.65, improved anti-osteoclastogenic effects over OS by inhibiting 1.6]), but the data were not statistically significant. osteoclast number and activity at a peak of 10-13 Mvs.10-11 The analysis of gene polymorphism COL1A 12046 G->T M, respectively. Treatment with OS or KAL671 completely showed that homozygous dominant allele G (about 97% rescued bone loss in OVXed animals, mainly by increasing p=0.0003) was more common in the people of Buryat nation- trabecular thickness. The most effective dose of KAL671 was ality and the mutant allele T prevailed in the women of 0.5 mg/kg/day, an order of magnitude lower compared to OS. Russian nationality (p=0.0003). Genotypes G/T and Т/Т of Increased bone density resulted from both enhanced bone for- the polymorphism COL1A 12046 G->T associated with the mation and decreased bone resorption, findings that were development of OP among women of both nationalities (OR paralleled with the serum levels of the bone remodeling 1.2 CI [0.8; 1.7]). markers osteocalcin and type-1 collagen C-terminal Conclusion: The gene allele VDR Bsm1 c.IVS7G> A crosslinks. leads to a higher risk of OP in women of Buryat nation- Conclusion: Taken together, these data suggest that α- ality. The genotypes G/T and T/T of COL1A 12046 G-> methylation interferes with amidase activity, thus enhancing T are associated with the development of OP in people the skeletal effects of OS by extending its availability to its of both nationalities. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S227
P305 1Menzies Institute for Medical Research, University of STRESS FRACTURE OF THE FEMORAL NECK IN A Tasmania, Hobart, Australia, 2Melbourne Medical School YOUNG FEMALE RUNNER (Western Campus), The University of Melbourne, A. M. Gómez-Blasco1,V.GarcíaCalvo1, M. Sanz Sainz2,I. Melbourne, Australia Carbonel Bueno1, J. Ripalda Marín1, R. Herrero Serrano3,C. Martín Hernández2 Background: Little is known about the extent to which low 1Department of Orthopaedic Surgery. H. U. Miguel Servet, muscle mass and strength independently contribute to health- Zaragoza, Spain, 2Orthopaedic Surgery and Traumatology related quality of life (HRQoL). Furthermore, it is unclear wheth- Unit. Hospital Universitario Miguel Servet, Zaragoza, Spain, er upper-limb and lower-limb muscle strength have a different 3Miguel Servet University Hospital, Zaragoza, Spain impact on HRQoL. This prospective study aims to describe the association of low muscle mass, handgrip (HGS) and lower-limb Objectives: Stress fractures can be develop up to 15% of muscle strength (LMS) with health-related quality of life usual runners, within which the involvement of the femoral (HRQoL) over 10 years in community-dwelling older adults. neck occurs about 5-10%. They can be classified as fatigue Material and Methods: Participants (N=817; 50% women; fractures when they occur due to repeated loads or insufficien- mean age 63±7.3 years) were prospectively followed for 10 cy fractures when there are differences in bone quality, which years. HRQoL was measured using assessment of quality of can be related to cases of early menopause. It is important to life (AQoL) instrument. Appendicular lean mass (ALM) was know the clinic, diagnostic tests and treatment options, so a assessed using dual energy X-ray absorptiometry. HGS and clinical case is presented at our center. LMS were assessed using dynamometer. Low muscle mass Material and Methods: A 33-year-old female runner who and strength was defined as the lowest 20% of the sex- practices athletics 3-4 days a week, with a history of L4-S1 specific distribution for ALM-to-BMI ratio (ALM/BMI), juvenile arthrodesis due to spondolistesis L5-S1, presented LMS, and HGS. Linear mixed effect regression models, with symptoms of lameness and pain in the left hip for 4 months. adjustment for confounders, were used to estimate the associa- Hip X-ray and CT was performed where we observed a tion between low muscle mass and strength at baseline and 10- subcapital femoral neck fracture without displacement. After year HRQoL. that, the osteosynthesis was performed with 2 percutaneous Results: Median AQoL utility score at 10 years was 0.76 screws. (range –0.03, 1.00), and 49% of the participants obtained scores Results: During the postoperative period she presented no demonstrating a high HRQoL (>0.90). Participants with lower complications. The patient remained 3 weeks without weight baseline LMS (β=–0.057, 95% CI: –0.084, –0.031) and HGS bearing on the limb and partial load was introduced progres- (β=–0.046, 95% CI: –0.073, –0.018) had a clinically meaning- sively to 6 weeks. After one year of follow-up the radiological ful difference in 10-year HRQoL compared to those with nor- controls are satisfactory and the patient is without pain or limp mal strength – the minimal clinically important difference in the and has been reinstated to previous sports practice. HRQoL score is 0.06 for the Australian population. There was Conclusions: Hip fractures due to stress are an uncommon a weaker association between ALM/BMI and 10 years HRQoL entity that is sometimes delayed because of the larval presen- (β=–0.029, 95% CI: –0.057, –0.001). tation that it has, so it is necessary to suspect them in the Conclusions: Muscle strength, which is closely related to presence of pain of mechanical characteristics in typical loca- physical performance and can be easily measured in clinical tions, such as the metatarsals or the hip, especially in patients practice, is more important than muscle mass in estimating the submitted to repetitive loads or with bone fragility (like early long-term quality of life in community-dwelling older adults. menopause). The treatment of these fractures will vary de- LMS was slightly superior to HGS in estimating HRQoL. This pending on the time and extent of the injury. They may be could be due to the relationship between LMS and mobility. conservatively treated in the early evolved cases or the latter evolved cases may need surgical treatment the presenting good results. P307 LONGITUDINAL ASSOCIATIONS BETWEEN SERUM 25-HYDROXYVITAMIN-D PHYSICAL P306 ACTIVITY AND KNEE PAIN AND DYSFUNCTION PROSPECTIVE ASSOCIATIONS OF LOW MUSCLE WITH MUSCLE MASS, STRENGTH AND QUALITY MASS AND STRENGTH WITH 10-YEAR HEALTH- IN COMMUNITY-DWELLING OLDER ADULTS RELATED QUALITY OF LIFE IN COMMUNITY- S. A. Balogun1, T. Winzenberg1, K. Wills1, D. Scott2,M. DWELLING OLDER ADULTS Callisaya1,D.Aitken1,G.Jones1 S. A. Balogun1, T. Winzenberg1, K. Wills1, D. Scott2,M. 1Menzies Institute for Medical Research, University of Callisaya1,G.Jones1, D. Aitken1 Tasmania, Hobart, Australia, 2Melbourne Medical School S228 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
(Western Campus), The University of Melbourne, Melbourne, Context: The rate of age-dependent bone loss has been shown Australia to be an important risk factor of fracture. However, longitudi- nal rates of bone mineral density (BMD) loss in Korea have Objective: Traditionally, analysis has focused on examining not yet been reported. how loss of muscle mass, strength and muscle quality differ Objective: To evaluate the longitudinal changes in BMD in between individuals (between-person comparison). Less well Korea. recognized is how variability in risk factors over time within Design: This was a community-based cohort study. The 2nd the same individual (within-person comparison) is associated examination was conducted approximately 4 years after the with loss of muscle mass, strength and muscle quality. This baseline examination. study aims to describe the associations of between-person and Setting: The study was conducted in the rural area of Chungju within-person variability in serum 25-hydroxyvitamin D City, Korea. (25OHD), physical activity (PA) and knee pain and dysfunction Participants: A total of 3,379 of the 6,007 subjects 40 years with age-related loss of skeletal muscle mass, strength and mus- of age or older completed the follow-up visit, corresponding cle quality over 10 years in community-dwelling older adults. to rates of 60.68% and 53.51% in males and females, Material and Methods: Participants (N=1033; 51% women; respectively. mean age 63±7.4 years) were measured at baseline, 2.5, 5, and Results: The age-standardized osteoporosis prevalence was 10 years. Lower-limb lean mass (LLM) was assessed using 12.81% in males and 44.35% in females. In males, the average DXA, lower-limb muscle strength (LMS) using a dynamome- annual BMD loss at the total hip increased from -0.25% per ter, and lower-limb muscle quality (LMQ) calculated as LMS/ year in their 40s to -1.12% per year in their 80s (p for trend LLM. Knee pain and dysfunction were assessed using the <0.001). In females, the average annual BMD loss at the total Western Ontario and McMaster Universities Osteoarthritis hip increased from -0.69% per year in their 40s to -1.51% per (WOMAC) index. PA was measured using pedometers. year in their 80s (p for trend=0.001). However, the average Linear mixed effect regression models, with adjustment for annual percentage change in spine BMD in females increased confounders, were used to estimate the association of within- from -0.91% per year in their 40s to +1.39% per year in their person and between-person variability in PA, 25(OH) D and 80s (p for trend <0.001). WOMAC score with muscle mass, strength and muscle quality. Conclusions: A substantial number of subjects had osteopo- Results: Between-person effects showed that 10-year average rosis. The spine BMD may not be LLM, LMS, and LMQ were higher in participants with a recommended when assessing BMD change in adults because higher average 25OHD and PA (all p<0.05). Within-person it was relatively stable or even effects also showed that LLM, LMS, and LMQ were higher at increased. time-points when participants had higher PA levels than their 10-year average PA level (all p<0.05). Within-person in- creases in 25OHD were associated with a higher LMS P309 (β=0.10 per nmol/l, 95% CI: 0.03, 0.17) and LMQ (β=0.01 EFFECT OF ADJUVANT THERAPY ON BONE per nmol/l, 95% CI: 0.002, 0.01) but not LLM. Within-person MINERAL DENSITY IN CAUCASIAN WOMEN and between-person increases in WOMAC scores were asso- WITH BREAST CANCER ciated with lower muscle strength and quality but not LLM. M. Tsagareli1,E.Giorgadze1, N. Khachidze2, N. Dolidze1,T. Conclusions: Between-person effects suggests that long-term Sulikashvili1, N. Jeiranashvili1 maintenance of higher levels of PA and 25OHD were associ- 1National Institute of Endocrinology, Tbilisi, Georgia, ated with higher muscle mass, strength and muscle quality. 2Javakhishvili State University, Tbilisi, Georgia Within-person effects demonstrate that increasing one’sown PA level further increases muscle mass, strength, and quality. Objective: To assess the effect of Aromatase inhibitors (AIs) Furthermore, fluctuations in 25OHD and WOMAC scores and selective estrogen receptor modulators (SERMs)on bone within an individual are also important for muscle strength, mineral density (BMD) in postmenopausal Caucasian women muscle quality but not muscle mass. with estrogen receptor-positive (ER+) breast cancer. Materials and Methods: 74 Caucasian women (46-74 years) were enrolled in the study. 38 patients were receiving P308 Aromatase inhibitors (AIs): Anastrozole or Letrozole and 36 PREVALENCE OF OSTEOPOROSIS AND RATE OF patients-selective estrogen receptor modulators (SERMs) - BONE LOSS IN KOREAN ADULTS: THE CHUNGJU Tamoxifen. We have measured BMI, calcium ionized(Ca++ METABOLIC DISEASE COHORT STUDY ), Lumbar Spine (LS) and Total Hip BMD values using dual- K.-H. Baek1, Y.-J. Lim1, M.-I. Kang1 energy X-ray absorptiometry at baseline, after 1, 2, and 3years 1The Catholic University of Korea, Seoul, Republic of Korea of therapy. 24 patients from AI group who were diagnosed to Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S229 have osteopenia at baseline started antiresorptive treatment vertebral compression fractures of the lumbar (L2, L3) spine with Bisphosphonates. 14 patients from AI group and all and right hip. Laboratory analysis revealed alkaline phospha- Tamoxifen treated patients, who had normal BMD at baseline tase level – 236.00 U/L, alkaline phosphatase bone fraction were not given any bone protection treatment. level – 87.00 μg/L, serum phosphorus level – 0.53 mmol/L. Results: Among Aromatase inhibitors treated patients, there Serum calcium, 25(OH)D, parathyroid hormone findings was a decrease in median BMD from baseline to 3 years in showed no abnormality. Femoral bone biopsy demonstrated lumbar spine - 5,22% and total hip - 6,10%. Only 3 patients endosteal osteoplasia. In both cases, total hip arthroplasty was with osteopenia at baseline developed osteoporosis on AI done, and the patient was administered with cholecalciferol treatment. Breast cancer patients treated with Tamoxifen supplementation (8000 IU/day), calcitriol (2 μg/day) and so- showed protection against postmenopausal bone loss. In dium phosphate (2000 mg/day). Additional in case 2 daily Tamoxifen group patients there was a positive effect of subcutaneous injection of 20 μg of teriparatide was initiated SERM in both regions: Lumbar Spine +2,62% and Total for 10 months. Genetic analysis and follow-up programme are Hip +2,03%respectively in 3 years of adjuvant treatment. ongoing. Conclusion: Aromatase inhibitors are associated with accel- Conclusion: Dearth of the guidelines in HR management fre- erated bone loss over the 3-years treatment period. In post- quently leads to misdiagnosis and mismanagement. Multiple menopausal women, treatment with tamoxifen is associated issues must be addressed, and choices for dose adjustment with preservation of the bone mineral density. may not be straightforward. Treatment requires balancing the benefits of treatment and monitoring for potential risks.
P310 MULTIPLE FRACTURES AND SEVERE MUSCULO- P311 SKELETAL PAIN SYNDROME IN PATIENTS WITH PREGNANCY- AND LACTATION-ASSOCIATED HYPOPHOSPHATEMIC RICKETS OSTEOPOROSIS IN THE PATIENT WITH OSTEOGE- A. Kornete1,I.Rasa2,M.Mukane2 NESIS IMPERFECTA 1Riga Stradins University, Latvian Osteoporosis and Bone A. Kornete1,I.Rasa2,M.Mukane2 Metabolism Diseases Association, Riga, Latvia, 2Riga East 1Riga Stradins University, Latvian Osteoporosis and Bone Clinical University Hospital, Riga Stradins University, Metabolism Diseases Association, Riga, Latvia, 2Riga East Latvian Osteoporosis and Bone Metabolism Diseases Clinical University Hospital, Riga Stradins University, Association, Riga, Latvia Latvian Osteoporosis and Bone Metabolism Diseases Association, Riga, Latvia Objective: Hypophosphatemic rickets (HR), also vitamin D- resistant rickets is a genetic metabolic disorder with the prev- Objective: Osteogenesis imperfecta (OI) simultaneously with alence of 1 in 20,000. Down-regulation of FGF-23 gene has pregnancy- and lactation-associated osteoporosis (PLO) is been implicated in the pathogenesis, causing deficient calcifi- rare with an incidence 1 in 25,000 to 30,000. OI is a clinically cation of bones and skeletal deformities. and genetically heterogeneous connective tissue disease char- Material and Methods: Two clinical cases of HR demon- acterized by defects in type I collagen. PLO is an acquired strate the management of two patients with multiple fractures skeletal disorder due to significant changes in calcium and and severe musculoskeletal pain syndrome. bone metabolism during pregnancy and lactation. Both con- Results: Case 1. The 26-year-old woman had sustained mus- ditions lead to similar musculoskeletal abnormalities causing cleweaknessproximalinextremities,painintheback,lefthip bone fragility and increasing the risk of fractures, as well pos- and knee for five years. Patient’s mother had had serum 25- ing serious complications in pregnancy. hydroxyvitamin D (25[OH]D) resistance. X-ray, CT and MRI Material and methods: AclinicalcaseofOIinassociation scans revealed fractures of 7th and 8th ribs, the sacrum and left with PLO presents the patient with multiple vertebral fractures hip. Laboratory analysis confirmed serum 25(OH)D level – and chronic pain during a peri-pregnancy period. 14.00 ng/mL (N=30.00–100.00 ng/mL), alkaline phosphatase Results: The 29-year-old woman had musculoskeletal pain level – 172.00 U/L (N≤117.00 U/L), alkaline phosphatase syndrome in the third trimester of pregnancy that worsened bone fraction level – 51.20 μg/L (N=3.00–19.00 μg/L), serum immediately post-partum. MRI showed vertebral compression phosphorus level – 0.51 mmol/L (N=0.80–1.60 mmol/L). fractures of the thoracic (Th11, Th12) and lumbar (L1) spine, Serum calcium, parathyroid hormone revealed normal find- fragility fracture of the L2 vertebra. The lumbar spine BMD ings. Transiliac bone biopsy confirmed osteomalacia. Case was below the expected range of age (–4.5 SD). 25-OH vita- 2. The 29-year-old woman presented with complaints of pro- min D level was 21.6 ng/mL (N=30.0–100.0 ng/mL), gressive unilateral pain in the back and right hip, accompanied osteocalcin level was 56.6 ng/ml (N=11.0–43.0 ng/ml), β by reduced general mobility. X-ray exhibited multiple CTX level was 0.759 ng/ml (N≤0.573 ng/ml). The red blood S230 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 cells, platelets, calcium, alkaline phosphatase, protein electro- Results: Patients did not present complications in the imme- phoresis revealed normal findings. Additional extra-skeletal diate postoperative period. They kept the arm in sling for 2 manifestations included blue-gray colored sclera. Other sys- weeks, allowing them to perform passive assisted movements. temic diseases were excluded, though the woman avoided Subsequent periodic checks and rehabilitative treatment were dairy products. Low BMD in the absence of fragility fractures, performed. At the follow-up year they were painless and with was observed in two patient’s sisters. The patient was recom- a functional joint balance (Constant Score). mended to discontinue breastfeeding. Vitamin D supplemen- Conclusions: There is still controversy about indications for tation (5000 IU/day), calcium (500 mg/day), analgesics and a treatment of proximal humeral fractures: conservative vs. sur- once-yearly infusion of zoledronic acid for two years were gical, and within the latter the various options. RTSA has administered. L2 vertebroplasty was indicated due to muscu- gained popularity in recent years, especially in patients over loskeletal pain syndrome. Genetic analysis and follow-up pro- 70 years of age with osteopenia, as it may provide a more gramme are ongoing. predictable outcome compared to hemiarthroplasty due to a Conclusions: Therapy with zoledronic acid and surgical sta- lower reliance on tuberosity consolidation and rotator cuff bilization of fracture had significantly beneficial effects: BMD involvement. The use of RTSA in fractures of proximal end has increased, the development of chronic pain and new frac- of humerus is an alternative in selected cases that presents tures has been prevented. Appropriate treatments that reduce satisfactory results. the risk of fractures by addressing both altered bone quality and high bone turnover remain elusive in this patient. P313 SARCOPENIA IN ELDERLY PATIENTS WITH END- P312 STAGE RENAL DISEASE OUR EXPERIENCE IN THE USE OF REVERSE S. Monov1,D.Monova2, E. Peneva3 TOTAL SHOULDER ARTHROPLASTY IN THE 1Clinic of Rheumatology, Medical University, Sofia, Bulgaria, TREATMENT OF OSTEOPOROTIC FRACTURES 2Department of Internal Diseases, Medical University-Sofia, OF THE PROXIMAL HUMERUS Medical Institute, Sofia, Bulgaria, 3Department of Internal J. Ripalda Marín1, A. M. Gómez-Blasco1,V.GarcíaCalvo1, Diseases, Medical Institute, Sofia, Bulgaria M. Sanz Sainz2, I. Carbonel Bueno1, R. Herrero Serrano3,J. A. Camacho Chacón1 Objectives: Sarcopenia is a condition characterized by pro- 1Department of Orthopaedic Surgery. H. U. Miguel Servet, gressive and generalized loss of skeletal muscle mass and Zaragoza, Spain, 2Orthopaedic Surgery and Traumatology function. The prevalence of sarcopenia on elderly patients Unit. Hospital Universitario Miguel Servet, Zaragoza, Spain, with end-stage renal disease (ESRD) has been scarcely inves- 3Miguel Servet University Hospital, Zaragoza, Spain tigated. The aim of this study is to investigate the prevalence of decreased muscle mass and strength alone or combined in Objectives: Fractures of proximal humerus represent up to elderly patients with ESRD according to different methods 6% of all fractures, and in the elderly patient is the third most and cutoff limits and evaluated the agreement between dual frequent fracture. There are various treatment options and energy x-ray absorptiometry (DXA) and surrogate methods controversy about the best option. The occurrence of reverse for the assessment of muscle mass. total shoulder arthroplasty (RTSA) represents a new option Material and Methods: In this observational cross-sectional that would be reserved for selected cases in elderly patients, study, data from 74 elderly (age > 60 years) patients with such as complex fractures in 3-4 fragments, inability to ESRD were recorded. Sarcopenia was considered when the osteosynthesis, high risk of compromising vascularization, patient fit one criteria for low muscle mass assessed by DXA, rupture of the cuff Rotator or rescue of a failure of sum of skinfold thicknesses (SKF), calf circumference and osteosynthesis. We present our experience in the treatment mid-arm muscle circumference (MAMC) and one for low of these fractures using RTSA. muscle strength evaluated by handgrip dynamometer. Material and Methods: We present 8 cases treated in our Normal values for sarcopenia were those recommended by center with RTSA due to proximal humerus fracture in the European Working Group on Sarcopenia in Older People several fragments with a high risk of involvement of (EWGSOP). cephalic vascularization in patients older than 70 Results: Decreased muscle strength was found in 63 years. A CT scan was performed to complete the study (85,13%) of the patients. The prevalence of decreased muscle and perform an adequate surgical planning. The interven- mass varied from 4,05 to 72,97% and of sarcopenia (de- tion was performed by a deltopectoral approach, the hu- creased muscle mass and strength combined) from 4,05 to meral stem was cemented in all cases and the tuberosities 62,16%, depending on the method and cutoff limit applied. were re-sutured. A small percentage of patients (2,7 to 14,86%) were classified Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S231 as sarcopenic by more than one diagnostic criteria. The agree- in uСTX-II level negatively correlated with the dynamics of ment between DXA and the surrogate methods to assess mus- FCT in medial site of the right knee (r=-0.524, p <0.05). cle mass showed better kappa coefficients with SKF (P Conclusions: the once daily intake of 300 mg ASU will lead <0,01). to clinically significant improvement according to WOMAC Conclusions: A wide prevalence of sarcopenia is observed and Lecken's indices with the positive changes in cartilage depending on the method and cutoff limit applied. This may metabolism (decrease of uСTX-II level and increase of the limit extrapolate on to clinical practice. SKF were the surro- FCT) in KOA pts. gate methods to assess muscle mass with the best concordance with DXA in elderly patients with ESRD. P315 ASSESSMENT OF KNEE JOINT STABILITY IN P314 ABNORMAL PREGNANCY EFFICACY OF AVOCADO/SOYBEAN UNSAPONI- M. Fouad1 FIABLES IN A 3 MONTHS TREATMENT IN 1Physical Therapy/El Sheikh Zaid Hospital/Ministry of PATIENTS WITH OSTEOARTHRITIS OF THE KNEE Health, Egypt D. L. Fedkov1,O.B.Iaremenko1 1Bogomolets National Medical University, Kyiv, Ukraine Objective: This study was designed to evaluate the impact of gestational diabetes on the stability of knee Objectives: To evaluate the impact of avocado/soybean joint. Material and Methods: Thirty primigravida preg- unsaponifiables (ASU) on the clinical activity, level of urinary nant women with single fetus in their 3rd trimester (after crosslinked C-telopeptide of type II collagen (uCTX-II) and 36 weeks gestation) have participated in this study, their femoral cartilage thickness (FCT) assessed by ultrasound age was ranged between 20 and 40 years old and their body (US) in patients (pts) with knee osteoarthritis (KOA). mass index was <35 kg/m2. They were selected from the Methods: 16 pts with KOA (3 males, mean age 60.5±3.46, 9 outpatient clinic of obstetric and gynecological department pts had radiographic Grade II and 7 – Grade III) received ASU at Kasr El Aini teaching hospital in period from March 2016 (300 mg/day) in addition to Nonsteroidal Anti-Inflammatory to May 2016. These women were assigned equally into two Drugs (NSAIDs) or alone (10 and 6 pts respectively) during 3 groups, group (A) consisted of fifteen pregnant women, months. Primary efficacy criterion was the change of the they suffered from gestational diabetes, group (B) consisted WOMAC-index from study begin to end of treatment. The of fifteen women with a normal pregnancy. Both groups secondary criterion was the change in Lecken's-index. were evaluated by glucometer for detecting blood sugar uCTX-II were conducted by ELISA using test systems by levelduringmeasurements.Thenallwomenassessedby "IDS" (UK) at baseline, after 1 and 3 months of the treatment. KT 1000 knee ligament arthrometer and Lachman test to US imaging was conducted at baseline and after the end of detect knee stability affection. treatment using US (SonoScape S2, PRC) with 12 MHz linear Results: There was a statistically significant difference be- transducer. Medial, sulcus and lateral sites of femoral articular tween the two groups which was in favor of gestational dia- cartilage and synovial thickness (ST) were depicted and mea- betes group during measurement of knee displacement by sured (in mm) by constant speed proximal-distal transducer lachman test and KT 1000 arthrometer, while in comparison sweeping over the supra-patellar region. of both knees in the same group there was no statistically Results: The completion rate after the 3-month observation significant difference. Comparison between categorical data was 100%. The WOMAC-index decreased for approx. 25% to was performed using Chi-square test. According to the test the end of the first months and for 52.4% to the end of treat- of normality, the comparison between values of different var- ment (p<0.05 and p<0.01 respectively). The decrease of iables in the two studied groups was performed using either t Lecken's-index for 32.8% was statistically significant only at test or Mann-Whitney test whenever it was appropriate. the end of treatment. That were accompanied by a decrease Percent change of Kt 1000 was calculated from the equation: of uСTX-II level for 80.8% (from 15.1±12.0 to 2.9±1.9 ng/ml, − p<0.01) after 1 and 50.1% (to 7.4±10.4 ng/ml, p<0.05) after 3 Mean value of Kt in normal mean value of kt in diabetic months of ASU intake. 40% of the pts have been stopped Mean value of Kt in normal NSAIDs during the treatment period. According to US data  100 decrease of ST for both knees (from 2.58±1.50 to 2.33±1.99, p>0.05) was not statistically significant. The increase of the Conclusion: It could be concluded that gestational diabetes FCT was significant only for medial and sulcus sites of the has a great impact on the stability of knee joint during preg- right knee (from 1.42±0.38 to 1.74±0.56, p<0.01 and from nancy, so care should be taken to avoid joint injury, falls and 1.89±0.53 to 2.06±0.52, p<0.05 respectively). The changes provide self-satisfaction as well as minimal complaints. S232 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
Women should be advised for wearing knee support for pre- exercises along with fifteen sessions of laser treatment for a vention of complications of knee joint instability and advised three week period whereas second group received stretching to perform strengthening exercises for the muscles supporting and postural exercises along with three sessions of ESWTwith the knee joint for prevention from hypermobility complica- a 5-8 day intersession interval. Exercises those included range tions of motion exercises, stretching and postural exercises were programmed to be worked out at home three sessions a day with 10 repetitions each. Patients were instructed to perform P316 those exercises for two months. All patients were evaluated IMPORTANCE OF BONE REMODELING IN BONE before therapy, right after therapy and one month after therapy DEFECTS SURGERY with VAS, pressure pain threshold algometer (PPTA), life M. Lizcano Palomares1, L. Gracia Cortes2,C.Martín quality short form 36 (SF-36) and Beck depression inventory Hernández1 (BDI). 1Orthopaedic Surgery and Traumatology Unit. Hospital Conclusion: Our study showed that both therapy techniques Universitario Miguel Servet, Zaragoza, Spain, 2Miguel yielded beneficial results in patients with MPS. Our results Servet University Hospital, Zaragoza, Spain also showed that laser and ESWT had similar benefits and had no superiorities over one another in the treatments of Methods: The technique of reconstruction of bone defects by MPS. In conclusion, both laser and ESWT might be the choice induction of biological membranes described by Masquelet in of treatment in patients with MPS. 1986 based on a case of pseudoarthrosis after open fracture osteosynthesis of tibia and fibula is presented. We performed an intervention in May 2013 following the Masquelet recon- P318 struction technique, using a tricortical iliac crest graft and ATYPICAL PROXIMAL FEMORAL FRACTURES: stimulating consolidation through medical treatment with BISPHOSPHONATE RELATED FRACTURES teriparatide daily for 6 months, with radiological follow-up V. Roda Rojo1, A. M. Gómez-Blasco2, M. E. Masa Lasheras1, at 3 months, At 6 months and a year, aiming consolidation V. Ga rc ía Ca lv o 2,B.GarciaMartinez2,C.MartínHernández1 at the second postoperative month. 1Orthopaedic Surgery and Traumatology Unit, Hospital Results: The clinical and radiological evolution was satisfac- Universitario Miguel Servet, Zaragoza, Spain, 2Department tory, achieving the consolidation at 2 months of follow-up the of Orthopaedic Surgery, H. U. Miguel Servet, Zaragoza, Spain patient discharged from hospital and the follow-up in external consultations of our center without complications so far. Objectives: To describe a case of an atypical femur fracture for Conclusion: Teriparatide is a bone-forming agent, hPTH (1- prolonged use of bisphosphonates treated with osteosynthesis 34)) is the active ingredient (1-34) of the endogenous human and parathormone, in order to improve the knowledge of this parathyroid hormone regulating calcium and phosphorus metab- entity. olism in bone and kidney. It is indicated in the treatment of Material and Methods: We present the case of a 69-year-old osteoporosis but can be very useful as a therapeutic weapon female patient who has been receiving a treatment with more in case of fractures with poor prognosis, thanks to its direct alendronate due to osteoporosis during a period of time greater effect on the osteoblasts producing an increase of the apposition than four years, with no side effects reported. She comes to of new bone in the trabecular bony surfaces and cortical. our hospital after falling to the ground from her own height, suffering from severe pain and functional impotence at the level of the right hip. During examination, our patient shows P317 her right lower limb in an external rotating attitude and COMPARING THE EFFECTIVENESS OF LASER marked shortening, and she is not able to move her hip active TREATMENT WITH EXTRACORPOREAL SHOCK nor passively due to an intense pain. AP and axial radiographs WAVE TREATMENT (ESWT) IN PATIENTS WITH of the right hip and an AP projection of the pelvis are per- MYOFASCIAL PAIN SYNDROME (MPS) formed, showing a subtrochanteric fracture of the right femur, A.-E. Erdal1, E. Ozyigit1 with a transverse-slightly oblique pattern and a medial spicule. 1Physical Medicine and Rehabilitation, Atatürk University We performed an intramedullary nailing using a Gamma Nail Faculty of Medicine, Erzurum, Turkey (Stryker®), dynamically locked. Postoperative radiological controls are satisfactory. Objective: To investigate and compare the effectiveness of Results: After the surgery, our patient is forbidden to apply laser treatment and ESWT in patients with MPS. weight on the injured hip for 6 weeks, with subsequent pro- Materials-Methods: Patients were divided into two groups gressive partial loading, and alendronate is replaced by randomly, and first group received stretching and postural Parathormone. Periodic radiographic controls are performed Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S233 monthly, showing a correct consolidation of the fracture. was banned again from loading weight on the operated Three months later, mobility is complete without pain. member. Conclusion: Atypical fractures of the subtrochanteric region Results: Two months after the implantation of the plate, the of the femur represent a group of lesions that appear in oste- evolution of the consolidation process is promising, which has oporotic patients or those affected by other alterations of the made possible to start walking with the help of crutches or a bone metabolism. This type of fracture has typically been walker. associated with bisphosphonates, usually after prolonged Conclusion: The use of the DCS plate, although infrequent in use. Epidemiological studies have shown that since the intro- these cases, allows to obtain a new support in the femoral head duction of bisphosphonates as a standard treatment for osteo- avoiding the gap of the extruded screw of the Gamma Long porosis, subtrochanteric fractures have increased over the Nail, thus solving the failure of the previous osteosynthesis. same period, as these fractures may be more difficult to treat Also, the use of parathormone improves consolidation of the because of longer consolidation periods, with a greater ten- fracture. dency to pseudoarthrosis. Therefore, it is advisable to suspend the use of bisphosphonates and change the treatment to para- thormone. P320 CLINICAL FACTORS PREDICT A GREATER INCREASE IN SPINE BONE DENSITY AFTER LACTATION P319 (FACTORS AFFECTING BONE FORMATION AFTER TREATMENT OFA CUT-OUT CASE THROUGH OSTEO- BREASTFEEDING PILOT STUDY [FABB-PILOT]) SINTHESIS WITH DCS PLATE AND PARATHORMONE C. S. Kovacs1, S. Cooke-Hubley1, B. J. Kirby1,C.Wells1,G. M. E. Masa Lasheras1,A.M.Gómez-Blasco2, V. Roda Rojo1, Mugford1, J. Valcour1,J.D.Adachi2 V. García Calvo2,I.GarridoSantaMaria2,C.Martín 1Faculty of Medicine, Memorial University of Newfoundland, Hernández1 St. John's, NL, Canada, 2Medicine, McMaster University, 1Orthopaedic Surgery and Traumatology Unit, Hospital Hamilton, ON, Canada Universitario Miguel Servet, Zaragoza, Spain, 2Department of Orthopaedic Surgery, H. U. Miguel Servet, Zaragoza, Spain Background: Much of the calcium content of breast milk is resorbed from the maternal skeleton, independent of oral Objectives: We define cut-out as the proximal extrusion calcium intake. Bone mineral density (BMD) declines 5- of the screw through the femoral head after the implan- 10% during lactation, which increases the risk of fracture. tation of a centromedular nail. Its treatment poses a chal- After weaning the baby, the skeleton is restored, such that lenge for the surgeon and an important risk for the pa- dozens of epidemiological studies have found that tient. The main objective of this work is to expose a case breastfeeding is neutral or protective against fractures and of CUT-OUT and its resolution using a DCS plate and osteoporosis in the long-term. However, few studies have parathormone. examined the speed and extent of BMD recovery after Material and methods: >Here we present the case of an 87- weaning, or which clinical factors influence this process. year-old female patient with a history of hypertension, osteo- Objectives: We hypothesized that physical activity, nutri- porosis and heart failure, who presented a subtrochanteric tion, hormones, and other clinical factors facilitate bone fracture of the right femur after falling to the ground. For the formation after lactation. Our aims were to determine the diagnosis, simple hip Rx were used in AP and axial projec- BMD increase at six months after weaning, and to obtain tions. During the admission she had an episode of atrial fibril- preliminary data regarding clinical factors that may pre- lation, so it was necessary to postpone the surgery. dict gains in BMD. Subsequently, an intramedullary nailing was performed with Methods: All women must have breastfed near-exclusively 125º Gamma Long Nail. The opening of the fracture site was for 4 to 6 months to cause a significant decline in BMD. At avoided due to patient's heart condition, and it was impossible planned weaning and six months later, we assessed BMD, to obtain an anatomical reduction. Subsequently he was lean mass, and hip structural analysis (HSA) by DXA; chem- discharged home without permission to load weight on the istries; hormones; urine Ca/Cr; nutrition; physical activity; damaged member. Six weeks after the intervention, a new fall overall health. occurred that led to the laterally expulsion of the head screw. Results: 31 women (31.6±3.5 years, 1.53±0.63 births) en- For this reason, it was decided to replace the nail with a 9º rolled at 26.6±2.0 weeks post-partum and all completed the DCS plate. Also, we started a two years treatment with para- study. Most continued to lactate such that only 17% had thormone. Achieving partial consolidation of the fracture, the fully weaned by the follow-up (12 months post-partum). reduction was maintained, adding hydroxyapatite graft. Given Thoracic and lumbar spine increased by 5.1% (p<0.01) and the good evolution, the patient was discharged home and he 4.0% (p<0.03), respectively; cortical sites (hip, total body) S234 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and HSA indices were unchanged. Estradiol increased (115 the patients were female. At baseline 42.6% of patients was to 198 pmol/L, p<0.01), PTH increased (60 to 69 ng/mL, in K-L grade I, 27.6% in K-L II and 29.8% in K-L III. No p<0.04), calcitriol decreased (198 to 115 pmol/L, p<0.01), radiographic changes were observed. During the study period, 25OHD declined (80 vs. 64 nmol/L, p<0.01), CTX de- we found a progressive reduction in WOMAC (48.83±8.94 clined (0.47 to 0.37 ng/mL, p<0.04). P1NP, sclerostin, cal- vs. 10.77±4.52) and NRS (6.32±1.09 vs. 1.00±0.88) values cium, ionized calcium; intake of vitamin D and calcium; (<.0001). and physical activity did not change. Clinical factors that Discussion: The data presented show the 24 months’ efficacy suggest an association with greater increases in BMD in- of Hyalubrix® in knee OA in terms of pain, functionality and clude return of menses, use of progestin-only pill, and re- radiographic progression. The GEE linear regression model duced numbers of feeds per day. used in this study showed that the treatment reaches its max- Conclusions: Spine BMD increases significantly during six imum between the sixth and ninth month when the effect is months after lactation, with greatest gains in those who begin stable and remains unchanged until the twenty-fourth month. to wean sooner, have menses return, and who use a progestin- only contraceptive. P322 UTILITY OF TERIPARATIDE IN THE AGED SPINE P321 SURGERY LONG TERM EFFICACY WITH THREE-MONTHLY S. Cortes Franco1, F. A. Lorente Muñoz1 INTRA-ARTICULAR HYALURONIC ACID (HYALUBRIX®) 1Neurosurgery, University Hospital Miguel Servet, Zaragoza, IN SYMPTOMATIC KNEE OSTEOARTHRITIS: Spain PRELIMINARY RESULTS AT 24 MONTHS. E. Bellucci1,F.Galluccio1, L. Tofani2, M. Matucci Cerinic1 Objective: Surgery for lumbar spine arthrodesis in elderly 1Div. of Rheumatology, Department of Clinical and patients has experienced an increased frequency over the Experimental Medicine, Firenze, Italy, 2Università di past few years; morbidity and mortality in this sense has Firenze, Firenze, Italy been proven to be associated to the lack of bone quality and difficulties with fusion. Recombinant human Introduction: Osteoarthritis (OA) is the most common joint teriparatide [rhPTH (1-34)], a drug used in the treatment disease and the knee is one of the most frequently affected of osteoporosis, has been proposed as a possible co- joints associated with activity limitations, need for walking adjuvant treatment to improve these problems, thanks to devices and increased use of analgesic and non-steroidal ant its anabolizing effect on bone metabolism. In this study, inflammatory drugs (NSAIDs). Hyaluronic acid (HA) is indi- we analyze the possible beneficial effect of teriparatide cated for non-responders to non-pharmacological therapy, to as co-adjuvant treatment in elderly patients with poor analgesics or when NSAIDs are contraindicated. bone quality who have been operated due to lumbar de- Objective: To evaluate the long-term efficacy of a quarterly generative disease with a posterolateral arthrodesis. single intra-articular injection with Hyalubrix® (HA >1500 Material and Methods: We present a prospective clinical kDa, Fidia Farmaceutici Spa – Abano Terme (PD) Italy) in series of 60 patients of over 70 years of age in whom symptomatic knee OA. surgical posterolateral arthrodesis was carried out and Materials and Method: Fifty patients with symptomatic knee who received teriparatide during 18 months as co- OA were enrolled in this longitudinal observational study. All adjuvant treatment. patients were treated with a first 3-weekly regimen followed Results: In our series, we found a fusion rate of 95.1%, with- by a quarterly single injection with Hyalubrix®. The patients out observing any vertebral fractures, arthrodesis hardware were assessed with the WOMAC score and NRS 0-10 pain failure (pull-out) or any other complications associated to scale at baseline (T0) and at each treatment (T1-T8). Kellgren- bone failure. Moreover, a reduction in pain and in the disabil- Lawrence grading (K-L) was assessed at baseline and at 24 ity in the VAS and ODI scales was verified after the combined months to evaluate radiographic disease progression. treatment with surgery and teriparatide, which remained stable Descriptive analyses and GEE linear regression model was during follow-up. performed with SAS 9.3. Conclusions: In our series, we found promising results with a Results: Forty-seven of fifty patients have completed 24 high rate of fusion, without recording any complications. months of follow-up. 3 patients withdrew from the study, Teriparatide could be a useful treatment when it comes to favor- one for accidental knee injury, one for spontaneous ing lumbar arthrodesis by increasing mineral bone density. osteonecrosis (SONK), and the last for missing data. The However, randomized studies with a greater number of patients mean age of the patients was 60.89±9.88 years; 63.8% of are needed to demonstrate the possible beneficial effect. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S235
P323 Physical and Mental components of SF-12 questionnaire TREATMENT STRATEGIES ON MANAGING returned to normal for that age group (43.55 and 51.55 COMPLEX ACUTE AND SUB-ACUTE LOWER LIMB respectively). There was no difference between the sub- TRAUMA IN PATIENTS WITH OSTEOPOROSIS groups concerning the physical and mental subjective USING CIRCULAR ILIZAROV FRAME (PCS and MCS SF-12 component) outcomes (p>0.05). E. Iliopoulos1,N.Morrissey1,S.Cho1,A.Khaleel1 There was no significant correlation between age and 1Ashford and St Peter's Hospitals NHS Trust, Chertsey, subjective outcomes, neither between time of follow-up United Kingdom and subjective outcomes. Conclusions: Complex acute and sub-acute lower limb trau- Background: The treatment of complex acute fractures and ma in patients with osteoporosis can be treated safely and non-unions is a challenge for the orthopaedic surgeons. reliably by using circular Ilizarov frame with good quality of The management of such conditions is becoming even life results. more challenging in poor quality bone due to osteoporosis; and often we have to alter the normal practice to overcome these problems. The use of circular Ilizarov frame in such P324 conditions could be a reasonable option, but is still not well OSTEOPOROTIC VERTEBRAL FRACTURES: established in the literature for elderly and osteoporotic DIFFICULT TO MANAGE patients. N. Pérez-Jimeno1,V.Roda1, J. López1,D.Peña1,A.Charlez1, Aim: The purpose of this study was to illuminate the technical C. Martín1 alternations of the management of the osteoporotic bone and 1Hospital Universitario Miguel Servet, Zaragoza, Spain demonstrate the outcomes after severe acute and sub-acute lower limb trauma in elderly patients, who were treated with Introduction and Objectives: Osteoporotic vertebral frac- circular Ilizarov frame. tures are a common clinical problem and its importance is Materials and Methods: Data from all elderly patients increasing with the aging population. The aim of this clinical (aged over 65 years), treated with an Ilizarov circular case is to present the resolution of two consecutive vertebral frameforsevereacuteandsub-acute lower limb trauma, fractures in the same patient. between January 2002 and December 2014, was collected. Material and methods: 74 year old woman who was ad- Clinical, radiological and quality of life questionnaire mitted from the emergencies for L4 vertebral fracture after (SF-12) data, mortality, complication and revision data low energy accidental fall. CT was reported as burst frac- were also collected. ture with 50% invasion of the spinal canal. L3-L5 open The intact joint above or below was used as a reference to arthrodesis was performed. In the immediate postopera- identify the mechanical axis of the limb. The mechanical axis tive, she presented sciatica and paresis 2-3/5 in right L5 was used in order to achieve alignment and a stable ring of territory. TC was sought thinking about the possibility of appropriate size was applied with at least two wires on each a malposition of the right L5 screw, being our surprise ring. A separate wire was added away of the ring, to increase that the cause of the clinic was a bone fragment located the stability of the ring when necessary (drop wire). The wires in the foramen that contacted with the right L5 root. We were tensioned with increased tension to 130kg force. Four proceeded to a second surgical procedure performing a connective rods were used to connect the rings, in order to right L4-L5 hemilaminectomy, removal the bone fragment achieve a more stable frame. The frame crossed the joint for and review the right L5 root. Sciatica disappeared but the intra-articular fractures in order to protect the reduction and paresis persisted. After 2 weeks, the patient suffered a allow immediate full weight bearing post-operatively. Olive or new fall and x-ray showed a new compression vertebral plain wires were added to achieve fracture reduction or com- fracture in L1. It was decided to kyphoplasty. pression across the non-union. Results: After a year and a half of follow-up, the patient has Results: During this period we treated 44 elderly patients not got sciatica, has minimal lumbar discomfort but persists with Ilizarov circular frame at a mean of age 70.67 years. paresis 2-3/5 in right L5 territory. Good radiological Indications were tibia plateau fractures (Schatzker IV-V- evolution. VI) (41.9%), pilon fractures (20.9%), miscellaneous com- Discussion and conclusions: Osteoporotic vertebral fractures plex lower limb acute fractures (20.9%) and lower limb probably gain more health importance as the population ages. non-unions (16.3%). Mean time in the frame was 176.71 Fortunately, the most of them are asymptomatic and require ±80.6 days. Mortality and complication rates were low minimal or no treatment. However, treatment of patients with (2.7-5.4%) at a mean follow-up 4.2 years. There was no painful fractures, whether or not surgical, can be very case of new induced septic arthritis or deep infection. complex. S236 Osteoporos Int (2017) 28 (Suppl 1):S127–S636
P325 P326 GLOBAL DNA METHYLATION AS A POSSIBLE THE IMPACT OF UNILATERAL ADRENALECTOMY MECHANISM FOR THE EFFECT OF VITAMIN D IN ON BONE STATUS ON MENOPAUSAL WOMEN BONE HEALTH DIAGNOSED WITH NON-SECRETOR ADRENAL Z. Maghbooli1,A.Hossein-Nezhad1,M.Sadeghi1,S. TUMORS: A LONGITUDINAL STUDY Aliakbar1, E. Asadollahpour1,F.Zare1, L. Zakeri2,B. M. Carsote1, S. Paun2,O.Radu3,D.L.Paun4 Larijani3 1Endocrinology Institute CI Parhon, Bucharest, 1Osteoporosis Research Center, Endocrinology and Romania, 2Emergengcy Hospital Floreasca Bucharest, Metabolism Clinical Sciences Institute, Tehran University of Bucharest, Romania, 3UMF C. Davila, Bucharest, Medical Sciences, Tehran, Islamic Republic of Iran, 2School Romania, 4UMF C. Davila and C.I. Parhon, Bucharest, of Nursing and Midwifery, Tehran University of Medical Romania Sciences, Tehran, Islamic Republic of Iran, 3Endocrinology and Metabolism Research Center, Endocrinology and Introduction: Non-secretor adrenal tumors may cause bone Metabolism Clinical Sciences Institute, Tehran University of mineral density (BMD) loss because of longtime exposure to Medical Sciences, Tehran, Islamic Republic of Iran mild persistent cortisol secretion which is found in more than one third of cases. Objective: The aim of this study was to determine the rela- Aim: To analyze the bone profile of menopausal women di- tionship between inter-individual global DNA methylation agnosed with an adrenal incidentaloma (AI) to whom adrenal- and vitamin D levels in postmenopausal women with ectomy was performed or not. osteoporosis. Material and Method: The bone features are provided. Material and methods: The 5-methyl cytosine content was The entire panel of endocrine adrenal profile excluded a assessed by reverse phase high pressure liquid chromatogra- typically secretor tumor confirming the diagnosis of an AI. phy (RP-HPLC) of peripheral blood leukocytes obtained from This is a longitudinal retrospective study in a single ter- postmenopausal women to determine individual global DNA tiary centre of endocrinology from East Europe. The data methylation status (Cm%). Dual X-ray absorptiometry (DXA) were collected from 2010 to 2016. The patient agreed to densitometer (Lunar 7164) were used to assess BMD of three anonymously use their medical records at admission. The bone sites (total hip, femoral-neck, and spinal lumbar verte- patients who suffered unilateral adrenalectomy were re- bras (L2-L4). Each person was categorized based on The ferred to a surgical center where laparoscopic procedure WHO osteoporosis criteria; osteoporosis (T score ≤ -2.5), was done. The indication of surgery was based on in- osteopenia (-2.5 P327 assess directly the patient’s intensity of pain in the last four HOW PAINFUL IS OSTEOPOROSIS? weeks. The possible answers range, using multiple choices of A. Bitzidis1, C. Bitzidou2 descriptive characterizations, from the very intense pain until not 1Orthopaedic Department, St Loukas Hospital, Thessaloniki, at all. The Qualeffo-41 in its specific pain domain has 5 ques- Greece, 2Department of Rehabilitation, School of Physical tions which assess the intensity of pain, using multiple descrip- Education and Sports Science, Democritus University, tive choices of varying answers from no pain until unbearable. It Komotini, Greece also assess the duration of the experienced pain in the last week using numeric and descriptive values ranging from never to Introduction and Scope: Osteoporosis is recognized by the every day/night, all day. World Health Organization (WHO) as an established and well- Results: From the initial cohort of 74 patients (2 males) who defined disease that affects more than 75 million people in the respected the inclusion criteria in this study, 61 returned both UnitedStates,EuropeandJapan.[1]AccordingtotheWHO the SF-36 and the Qualeffo-41 instruments of measurement scientific group on the assessment of Osteoporosis, its chronic with all the above named questions referred to pain answered. progressive process of bone resorption and finally the loss of These 61 (2 males) participated patients had a mean age of 63 bone is not painful and does not create per se any kind of symp- y.o. (38-81) and were on treatment with various anti- toms. The morbidity changes dramatically once a complication osteoporotic agents. 29 patients answered that in the last 4 of bone continuity develops. That is why Osteoporosis is called weeks had no pain and 46 patients that had no pain in the last a ‘silent’ condition.[2] What if Osteoporosis is not as silent as we week. 9 patients had pain at least 2-3 days in the last week. 22 believe it is and indeed it sends messages before its complica- patients answered that in the last month they had at least mod- tions develop but we, the doctors, do not hear them and not take erate musculoskeletal pain and 20 patients answered that their them into account when we treat osteoporotic patients? pain interfered at least quite a bit with their normal work Furthermore, we well know from previous studies, that some including both housework and outside the home. 12 patients agents available in Osteoporosis’ treatment which interfere in experienced pain at least 3-6 hours during day time and 18 bone metabolism, like Calcitonin, have a positive effect on patients considered that their musculoskeletal pain disturbed bone pain and we have adjusted our practice accordingly at least twice their sleep in the last week. when an osteoporotic patient complaints of this type of pain. Conclusions and Study limitations: From the above data is [3] Is there a direct connection between musculoskeletal pain easy to understand that Osteoporosis has not the same and Osteoporosis? And finally, how painful is Osteoporosis? impact on patients regarding the musculoskeletal pain We wanted to further evaluate these questions and better un- but this is present in 52% of the participated patients derstand the level of musculoskeletal pain the osteoporotic who experienced in the last 4 weeks at least a very mild patients experience due to this disease. pain because of the disease. In an attempt to be skeptical Material and Method: Searching in the literature we realized about the study results, one could argue the study design, that there is no specific instrument of measurement aiming to as the sample of 61 patients does not present homogenous assess directly the level of pain the patients experience due to characteristics. Patients with different types of Osteoporosis. That is why we used two different quality of life Osteoporosis (postmenopausal, pharmaceutical, of endo- questionnaires, the generic health survey Short Form 36 (SF-36 crine causes, after prolonged immobilization) were includ- Greek version 1.0) and the International Osteoporosis ed in different stages of severity with various T- and Z- Foundation Quality of Life in Osteoporosis (Qualeffo-41 scores and related complications which could act differ- Greek version) emphasizing onto the separate specific domain ently on the levels of musculoskeletal pain. This was done referred to pain. Both these instruments were previously trans- in order to increase the study sample in the 12 month time lated and validated for the Greek population. [4] From frame. Additionally we wanted to evaluate the pain due to June 2015 until June 2016 we distributed in Northern Greece, the condition, as a result on the musculoskeletal system the SF-36 and the Qualeffo-41 questionnaires in 74 Caucasian regardless of the Osteoporosis’ main cause. Furthermore, osteoporotic patients who respected the inclusion criteria and the different levels of musculoskeletal pain could be at- filled anonymously and simultaneously both. We included in tributed to the lack of documentation regarding the need this study patients diagnosed with primary or secondary of X-rays in all the participated patients in order to ex- Osteoporosis according to the WHO criteria, who had no fragil- clude arthritis in their spine or S-I joints. As an answer to ity fractures previously and also were not diagnosed with arthri- that, according to the initial study design, we wanted to tis in their lumbar spine and the sacro-iliac (S-I) joints. [5,6] We include only patients with X-rays. Although that there assessed the level of musculoskeletal pain as these patients with were some patients with X-rays and no arthritis, there Osteoporosis perceived it in their spine and their 4 limbs. The were other patients with no X-rays who were not keen SF-36 instrument’s pain domain, with the 7th and 8th questions, on having one. On the other hand, although muscle mass S238 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 was not assessed in the sample, the different levels of operated on lumbar arthrodesis stratifying it according to the established Sarcopenia in the participated osteoporotic pa- levels that could be joined, the quantity of hematocrit and tients could play an important role in understanding the hemoglobin prior to the surgery, the comorbidities and previ- different answers given regarding the pain levels. ous treatments. 2. To identify the risk factors in transfusion in This initial attempt to answer and further evaluate the these patients. 3. To estimate the potential saving and reduc- question of how painful is the Osteoporosis, demarcates tion in the use of resources that could be obtained by not doing the need for more studies, eventually better all around the routine blood ordering in this surgery. organized, in order to find safer answers. Towards this Material and Methods: Data capture of all patients who are direction, an important role could play the development going to be operated on lumbar arthrodesis in the Spinal of a specific instrument of musculoskeletal pain measure- Surgical Unit at the University Hospital Miguel Servet in ment in osteoporotic patients with well structured ques- Zaragoza, classifying them according to the number of levels tions regarding the different pain levels and the disability that could be joined (one level, two levels and three or more because of it. This could be proven a useful tool in our levels). The needed information about patients will be: age, practice contributing to a spherical understanding of sex, hematocrit-hemoglobin preoperative and post-operative, Osteoporosis in order to better treat our patients. necessity of post- operative transfusion (Yes/No), volume of References: transfused milliliters, usual medicines that alter coagulation, 1. WHO scientific group on the assessment of Osteoporosis at diseases and physical conditions that may imply a high risk of primary health care, Summary Meeting Report Brussels, bleeding and surgical incidents which have produced a higher Belgium, 5-7 May 2004 bleeding. 2. Assessment of fracture risk and its application to screening Results: If the obtained results supported what has been for postmenopausal osteoporosis. Report of a WHO Study analysed in our clinical experience, new criteria in Group. Geneva, World Health Organization, 1994 (WHO blood. Technical Report Series, No. 843) reserves policy for the lumbar spinal fusion surgery of one or 3. Blau LA et al. Ann Pharmacother 2003;37:564 two levels could be established. 4. Bitzidis A, et al. Osteoporos Int 2015;26(Suppl 1) Conclusions: It is expected that our study means a saving for 5. Genant HK et al. Osteoporos Int 1999;10:259 such a frequent process in lumbar spine surgery. 6. Kanis JA et al. J Bone Miner Res 1994;9:1137 P329 P328 COMPLICATION OF OSTEOPOROSIS: CUT-OUT IN BLOOD MANAGEMENT IN DEGENERATIVE LUM- PATIENT WITH PERTROCHANTERIC FRACTURE BAR ARTHRODESIS SURGERY AT ONE AND TWO TREATED WITH STANDARD GAMMA NAIL LEVELS N. Pardina Lanuza1, M. Angulo Tabernero1,J.J.Sierra M. Angulo Tabernero1, D. Peña Jimenez2, E. Suñen Sanchez2, Serrano1,C.TejedorCarreño1, E. Gonzalez Buesa1,I. A. Loste Ramos2, A. Tabuenca Sanchez2, J. Rodriguez Vela2 Puyuelo Jarne1 1Orthopaedic Surgery and Traumatology Unit, Hospital San 1Orthopaedic Surgery and Traumatology Unit. Hospital San Pedro, Logroño, Spain, 2Department of Orthopaedic Surgery, Pedro, Logroño, Spain H. U. Miguel Servet, Zaragoza, Spain The confluence of some factors (osteoporosis, fracture line, Introduction: The main surgical activity in the Spinal inadequate focus reduction, repeated motorizing, etc.) can Surgical Unit at University Hospital Miguel Servet in hasten a cut-out in gamma nails, showing a prevalence of 2 Zaragoza is based on lumbar arthrodesis regarding the to 4% of the diverse series. In this case, we present a patient cases of degenerative disease of the lumbar spine with with osteoporosis who presented a cut-out after being operated more than 150 cases per year. It is a routine procedure to on pertrochanteric fracture with a gamma nail. order blood prior to the operation. However, the necessity of transfusion is uncommon in lumbar arthrodesis surgery which affects one or two levels. Taking into account this P330 situation, it has been thought the possibility of reducing the WHY SOME OF THE RHEUMATOID ARTHTITIS (RA) routine blood ordering and crossmatch for surgeries of one PATIENTS FRACTURED BUT NOT IN OTHERS? or two levels, with the consequent economical saving and T. T. Cheng1,H.M.Lai1,S.F.Yu1,Y.C.Chen1,F.M.Su1,W. use of resources involved. C. Chiu1,C.Y.Hsu1,J.F.Chen1,C.H.Ko1,Y.J.Su1 Objective: 1. To quantify in a prospective way the real neces- 1Sec. of Rheumatology, Chang Gung Memorial Hospital at sities of blood transfusion in patients who are going to be Kaohsiung, Kaohsiung, Taiwan, Province of China Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S239 Objectives: To explore the risk factors of fragility fracture in assessment), intermediate risk (requiring BMD) or high risk RA. (preventative treatment recommended without BMD). Material and Methods: This is an interim analysis of a RA Methods: A prospective multicentred cohort study recruited registry at Kaohsiung Chang Gung Memorial Hospital in from metropolitan General Practices identified persons Taiwan. Consecutive RA patients between 01-Sep- 2014 and deemed to be at clinical risk of osteoporosis or aged over 70. 31-Nov-2016 were enrolled. On enrollment, we checked as- Osteoporosis risk assessment using BMD and health question- sociated disease markers for each participant and recorded naire. FRAX ® scores with and without BMD values were demographics, evidence of prevalent fragility fracture, life calculated for each patient. ROC curves with the area under style, FRAX-associated risk factors of fragility fracture, and curve (AUC) were generated to calculate sensitivity and spec- medication history The descriptive summary is presented in ificity of FRAX ® (without BMD) in identifying patients with the form of median (IQR). A level of statistical significance of osteoporosis. p <0.05 was used for all statistical tests performed. Results: We identified age specific thresholds for identifica- Results: A total of 583 participants were enrolled. There were tion of patients deemed low risk (BMD not required), inter- 110 (18.9%) participants had prevalent fracture. In univariate mediate risk (requiring BMD) or high risk (treatment recom- analysis, it disclosed older age, female, higher level of body mended). These thresholds resulted in the correct clinical mass index (BMI), more years after diagnosis of RA, longer management decision in 77% of cases. Unnecessary BMDs disease duration, more comorbidity, higher disease activity avoided in 341/543 (63%). Osteoporosis was missed in 51/ score (DAS 28, ESR), less biologics users, higher wrist in- 534 (8%). Absolute Positive Predictive value (+41.6%) and flammation scale evaluated by sonography, glucocorticoid accuracy (+22%) of the FRAX 10-year Hip fracture improved users, non-smokers, non-tea drinker, non-coffee drinker, over recommended cut-offs. higher levels iPTH or Vit D, lower bone mineral density Conclusions: Age specific intervention thresholds based on (BMD), higher prevalence of osteoporosis, and previous fall fracture risk score may reduce the number and cost of unnec- are associated with prevalent fragility fracture. While, after essary BMDs. It identifies who may require BMD and who to adjustment, it revealed that only older age (p<0.0001), higher treat. Those with absolute risk below 1.8 (FRAX-Hip) and level of BMI (p=0.0003), more years after diagnosis of RA 3.85 (FRAX-Major) do not require DXA. The threshold to (p=0.0290), glucocorticoid users (p=0.0204), lower BMD at treat is influenced by user willingness to pay and risk – ben- femoral neck (FN) (p<0.0001), and previous fall in previous efit. year (p=0.0097) are independent risk factors of prevalent fracture. Conclusions: Similar to the conventional risk factors in P332 FRAX tool, older age, glucocorticoid users, and lower UTILISING GARVAN FRACTURE RISK CALCU- BMD at FN also are risk factors of fragility fracture in LATOR WITHOUT BMD TO IDENTIFY WHO TO RA patients. In addition, later attention paid for fracture TREAT VS. WHO TO INVESTIGATE WITH BMD IN after diagnosis of RA and previous fall are two other risk PEOPLE OVER 70 YEARS OF AGE factors of fracture in our cohort. It seems that disease C. Inderjeeth1,W.Raymond2 activity of RA is not related to fragility fracture. Via this 1SCGH and OPH Group and University of WA, Nedlands, investigation, it suggests that to control disease activity Australia, 2SCGH and OPH Group and University of WA, for RA patients is not sufficient to prevent fracture but Perth, Australia needs further investigation. Background: Lack of access and cost of bone mineral densi- tometry (BMD) are barriers to osteoporosis screening. Risk- P331 assessment tools may be useful to screen for osteoporosis. UTILISING FRAX WITHOUT BMD TO IDENTIFY Objectives: Use of GARVAN fracture risk scores (without WHOTOTREATVS.WHOTOINVESTIGATEWITH BMD) to stratify people into low risk (not requiring assess- BMDINTHOSEOVER70YEARSAGE ment) moderate risk (requiring BMD) or high risk (requiring C. Inderjeeth1,W.Raymond1 preventative treatment without need for BMD). 1SCGH and OPH Group and University of WA, Perth, Design, setting and participants: A prospective multicentred Australia cohort study recruited from metropolitan General Practices which identified persons either deemed to be at clinical risk Purpose: Access and cost of DXA are barriers to osteoporosis of osteoporosis or aged over 70. screening. Risk-assessment tools may be useful alternatives. Measurements: Osteoporosis risk assessment using DXA The objective was the use of FRAX fracture risk (without BMD scan and health questionnaire. GARVAN® scores with BMD) to stratify people into low risk (not requiring and without BMD values were calculated for each patient. S240 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 ROC curves with the area under curve (AUC) were generated followed by the 4th and first compartment, compared to those to calculate sensitivity and specificity of GARVAN® (without in healthy subjects, where the most frequently involved is the BMD) in identifying patients with osteoporosis. first compartment, followed by the extensor carpi ulnaris. Results: We identified age specific thresholds for identifica- Conclusions: This study reveals the high frequency of hand tion of patients deemed low risk patients (BMD not required), extensor tendon involvement in patients with RA and can intermediate risk (requiring BMD) or high risk (treatment rec- guide the further assessment in the evaluation of those patients ommended without BMD). These thresholds resulted in the in daily practice. correct clinical management decision 89% of the time. References: Unnecessary BMDs avoided in 350/543 (64%). 1. Trăistaru MR et al. Rom J Morphol Embryol 2016;57:215 Osteoporosis was missed in 28/534 (5%).It improved the ab- 2. Vreju FA et al. Clin Exp Rheumatol 2016;34:673 solute Positive Predictive value (+44.5%) and accuracy 3. Gutierrez M et al. Clin Rheumatol 2016;35:2669 (+12%) of the FRAX® 10-year Hip fracture risk calculator 4. Janta I et al. Rheumatol Int 2016;36:387 tool over recommended cut-offs. Conclusions: Estimating age specific intervention thresholds based on fracture risk score has the potential to reduce the P334 number and cost of unnecessary BMDs. It successfully iden- EFFECT OF HIGH DOSE VITAMIN D SUPPLEMEN- tifies who may or may not require BMD and who to treat. At TATION ON BETA CELL FUNCTION IN OBESE ASIAN- the very least people with an absolute risk below 1.8 and 3.85 INDIAN CHILDREN AND ADOLESCENTS, AGED 11-17 for GARVAN® Hip and Major (without BMD) respectively YEARS: A RANDOMIZED, DOUBLE BLIND, ACTIVE can safely be reassured without recourse to BMD. The thresh- CONTROLLED STUDY old to treat will be influenced by user willingness to pay and S. Varshney1, R. Khadgawat2,M.Gahlot3,A.Jaryal4,N. risk – benefit. Gupta2, V. Sreenivas5 1Endocrinology/All India Institute of Medical Sciences, New Delhi, India, 2Endocrinology and Metabolism/ All India P333 Institute of Medical Sciences, New Delhi, India, 3Dietetics/ HAND EXTENSOR TENDON INVOLVEMENT IN All India Institute of Medical Sciences, New Delhi, India, PATIENTS WITH RA 4Physiology/ All India Institution of Medical Sciences, New F. A. Vreju1,C.D.Parvanescu1,B.A.Chisalau1,S.C. Delhi, India, 5Biostatistics, New Delhi, India Firulescu1, M. Cepareanu1, C. Criveanu1, A. E. Musetescu1, S. Dinescu1,P.L.Ciurea1 Objective: To study the effects of high dose vitamin D sup- 1University of Medicine and Pharmacy, Craiova, Romania plementation on beta cell function and cardiovascular risk factors in Asian-Indian obese children and adolescents, aged Background: Management of rheumatoid arthritis (RA) has 11-17 years. evolved lately, in part due to new biologic therapies and part Methods: A prospective, randomized, double blind active- because of the new imaging techniques that can depict earlier controlled study, was carried out to investigate the effects of involvement in joints and tendons. high dose vitamin D supplementation (Cholecalciferol - Objectives: To evaluate, by ultrasonography (US), the prev- 4000 IU per day) in comparison to daily requirement dose alence and type of the hand extensor tendons involvement in (Cholecalciferol - 400 IU/day) for 12 months. Both the doses patients with RA. of vitamin D were calculated on daily basis but given as once a Methods: Twenty-two patients with RA were included in the month, single, oral dose (120,000 IU vs. 12,000 IU once a study and twenty healthy age matched controls without in- month). Life style modification advice were given to both flammatory diseases were examined as well. The US evalua- the groups before randomization (computer based randomiza- tion included the dorsal aspect of the hand, both in transverse tion in 1:1). Beta cell functions were assessed by, disposition and longitudinal scan, for the evaluation of the following ten- index (The primary outcome of the study, product of dons: abductor policis longus, extensor policis brevis, exten- insulinogenic index and whole body insulin sensitivity; mea- sor carpi radialis longus and brevis, extensor policis longus, sured by oral glucose tolerance test) which was measured extensor digitorum group tendons, extensor digiti minimi and before and after 12 months of supplementation. As secondary extensor carpi ulnaris. The presence of US findings indicative outcomes, lipid profile, inflammatory cytokines (serum of tenosynovitis and tendon damage was investigated. hsCRP, IL-6, TNF-alpha) and cardiovascular risk factors (aor- Results: Tenosynovitis in at least one site, was statistically tic pulse wave velocity and radial pulse augmentation index) significant more frequent in patients with RA than in controls were also assessed before and after supplementation of vita- (p<0,001). Between patients with RA, the most frequent tendon min D. Safety parameters, serum calcium, and urinary calcium compartment involved was the 6th (extensor carpi ulnaris), creatinine ratio were assessed every two monthly. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S241 Results: A total of 189 obese children and adolescents were handgrip strength. Correlations and interactions between all recruited (Mean age: Boys - 12.94±1.51; Girls 13.13±1.72) variables were assessed using univariate and stepwise regres- After life style modification advice, were randomized into sion analyses. two groups, Group A (Intervention group) and group B (con- Results: Results showed that, RASM was positively corre- trol group). No significant difference in any of the clinical and lated with BMD at all assessed sites (r=0.62 for WB, biochemical parameters were seen at baseline. The mean se- r=0.54 for FN, r=0.63 for TROCH, r=0.64 for TH, r=0.56 rum vitamin D level of the study population was 9.21±7.54 for LS) p<0.05 whereas RFM was negatively correlated ng/ml (Intervention group- 8.36±5.45) Control Group- (9.01 (r=- 0.15 for WB, r=- 0.12 for FN, r=- 0.08 for TROCH, ±5.59). At baseline, 94.7% subjects (Intervention group- r=-0.15 for TH, r=- 0.10 for LS). In stepwise regression 94.7%; Control Group- 94.6%) were vitamin D deficient (se- analyses, the beta coefficient of RASM was high and con- rum 25OH Vit.D <20 ng/mL). Only four subjects had serum tributed positively to the construction of the models pro- vitamin D level >30 ng/ml. After 12 months of supplementa- ducing a positive influence on the BMD (β=0.07 for WB, tion, there was a significant increase in serum 25OHD level in β=0.04 for FN, β=0.05 for TROCH, β=0.06 for TH) intervention group in comparison to controls (26.89±12.23 vs. p<0.05. Conversely, RFM was negatively associated with 13.14±4.66 ng/ml, p<0.001). No significant difference in dis- BMD at all bone sites (β=-0.02 for WB, β=- 0.03for FN, position index (primary outcome) as well as other parameters β=-0.02 for TROCH, β=- 0.03 for TH, β=- 0.07 for LS) of insulin resistance and sensitivity were seen after 12 months p<0.05. Handgrip strength was positively associated with of supplementation. Similarly, no significant difference in BMD at all sites. Yet, the correlation coefficient values BMI, HbA1c, fasting blood glucose, lipid profile, inflamma- were weak (r=0.35 for WB, r=0.28 for FN, r=0.38 for tory cytokines and pulse wave velocity were observed after 12 TROCH, r=0.36 for TH, r=0.29 for LS). months. None of the study subjects in both groups developed Conclusions: Our data suggest that in young men, BMD hypercalcemia and hypercalciuria, suggesting safety of is positively associated with lean mass while negatively intervention. with fat mass. We confirmed that RASM is the strongest Conclusion: Supplementation with vitamin D in doses of factor associated with BMD in young men. We recom- 4000 IU per day for 12 months in Asian-Indian children and mend, that physical activity that benefit to enhance lean adolescents did not affect beta cell function as well as cardio- body mass and reduce fat mass can contribute to promote vascular risk factors. bone health. Acknowledgement: Study was funded by Indian Council of Medical Research (ICMR) P336 EXERCISE-INDUCED PAIN AND HEALTH STATUS P335 DIFFER BETWEEN DROP-OUTS AND RETAINERS OF RELATIONSHIPS BETWEEN YOUNG MEN BONE AN EXERCISE PROGRAM FOR KNEE OSTEOARTHRITIS MINERAL DENSITY, MUSCLE MASS AND STRENGTH D. Beckwée1,I.Bautmans1, T. Scheerlinck2,P.Vaes3 T. Sutter1,H.Toumi2, A. Pinti2, A. Valery3, R. El Hage4,E. 1Gerontology Department, Vrije Universiteit Brussel, Lespessailles5 Brussels, Belgium, 2Department of Orthopaedic Surgery and 1University Orleans, I3MTO Laboratory, EA 4708, Orléans, Traumatology, Universitair Ziekenhuis Brussel, Brussels, France, 2University Orleans, I3MTO Laboratory, EA 4708, Belgium, 3Rehabilitation Sciences Research Department, Orléans, France, 3CHR Orleans, DIM Department, Orléans, Vrije Universiteit Brussel, Brussels, Belgium France, 4University of Balamand, Department of Physical Education, El-Koura, Lebanon, 5 CHR Orleans, Background: Exercise effectiveness is related to adherence, Rheumatology Department, Orléans, France compliance and drop-out. The aim of this study is to investi- gate if exercise-induced pain and health status are related to Objective: Investigate the relationships between bone mineral these outcomes during two exercise programmes in knee os- density (BMD), muscle mass and strength. teoarthritis patients. Material and methods: We assessed 100 French young Methods: Symptomatic knee osteoarthritis patients were ran- males (mean age: 24.4±2.8 years; height: 176.4±6.2 cm; domly allocated to a walking or strengthening programme weight: 72.9±9.3 kg). Appendicular lean mass (ALM), rela- (N=19/group). At baseline, patients were categorized according tive appendicular lean mass (ALM/H2) (RASM), fat mass to their health status. Exercise adherence and compliance were (FM), relative fat mass (FM/ H2) (RFM), percentage of body calculated and drop-out rate was registered. For exercise-induced fat and BMD (at lumbar spine (LS), total hip (TH), trochanter pain, patients rated their pain on an 11-point numeric rating scale (TROCH), femoral neck (FN) and whole body (WB)) were (NRS) before and after each training session. Before each session measured using DXA. Muscle strength was evaluated by the maximal perceived pain of the last 24 hours (NRSmax24)was S242 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 assessed. Patients rated their global self-perceived effect (GPE) Conclusions: Pain scores and GPE was not different between on a 7-point ordinal scale after the intervention period. knee OA patients with and without baseline BMLs in this sample. Results: 53% of the participants felt they improved after the programme, 6 patients dropped out. The mean adherence and compliance rates were higher than.83 in both groups. Worse P338 health and higher exercise-induced pain were seen in drop- FRACTURE RISK AND LEVEL OF PHYSICAL ACTI- outs. NRSmax24 during the first 3 weeks did not significantly VITY IN FEMALE OSTEOPOROTIC PATIENTS increase compared to baseline, but correlated negatively with S. Tomasevic-Todorovic1, K. Boskovic1, A. Knežević1,S. adherence during the home sessions (-.56, p<.05). Lower ad- Kevic2, A. Vazic3,F.Hanna4 herence during supervised sessions was significantly related 1Medical Faculty, University of Novi Sad, Novi Sad, Serbia, with higher pre-exercise pain scores (ρ=-.35, p<.05). 2Clinic for Medical Rehabilitation and Physical Medicine, Conclusion: Patients who drop-out show a worse health con- Clinical Center of Vojvodina, Serbia, Novi Sad, Serbia, dition and higher exercise-induced pain levels compared to 3College of Education teacher in Kikinda, Vojvodina, patients that retained the programme. Kikinda, Serbia, 4Public Health Program, Department of Health Sciences, College of Arts and Sciences, Qatar University (Doha, Qatar), Doha, Qatar P337 CAN MAGNETIC RESONANCE IMAGING PROVIDE Introduction: The most common reason for reduction of ADDED VALUE TO EXERCISE PROGRAMS FOR bone mineral density is physical inactivity. KNEE OSTEOARTHRITIS? Aim: Assessment of fracture risk and the level of physical D. Beckwée1,P.Vaes2,S.Raeymaeckers3, M. Shahabpour3, activity in female osteoporotic patients. T. Scheerlinck4, I. Bautmans1 Material and methods: Our cross-sectional study included 82 1Gerontology Department, Vrije Universiteit Brussel, female patients (41 physical active-PA, 41-physical inactive IP), Brussels, Belgium, 2Rehabilitation Sciences Research average age 64,12±8,21 yrs. The data were based on anamneses, Department, Vrije Universiteit Brussel, Brussels, Belgium, questionnaire, as well as measurements of the bone mineral 3Department of Radiology, UZ Brussel, Brussels, Belgium, density by DXA method using the Lunar Prodigy Primo device. 4Department of Orthopaedic Surgery and Traumatology, Center of Vojvodina in Novi Sad. The assessment of the fracture Universitair Ziekenhuis Brussel, Brussels, Belgium risk was executed by applying FRAX index. Results: Theresultsshowedthepresenceofstatistically Purpose: Exercise is effective for reducing knee osteoar- significant differences between physically inactive (IP) thritis (OA) pain but effect sizes vary widely. Moreover, and active patients (PA) of certain factors which influ- not all knee OA patients perceive beneficial effects. ence into bone mineral density of bones (using of alco- Tailoring specific exercises to subgroups of knee OA hol (t=2,357, p=0,05*) and practicing exercise at the patients may increase effectivity. Bone marrow lesions young age (t=-3,342, p=0,01**). The majority number (BMLs) have been suggested as a criterion to define such of physical active patients has low risk level for major subgroups. osteoporotic fracture 21 (51,2%), then intermediate 13 This study aimed to investigate whether BMLs’ (31,17%), and finally high 7 (17,1%). The most of presence/absence is related to treatment outcomes in a physically inactive patients has medium level of risk group of knee OA patients who exercised for 18 20 (48,8), low level has 12 patients (29,2%) and finally weeks.Methods: Subjects with symptomatic knee OA high level of risk has 9 (22%) patients for major oste- started a strength or walking exercise program. BMLs’ oporotic fracture. Results showed no statistically differ- presence at baseline was assessed. Pain was assessed ences in term of the level for major osteoporotic frac- before and after the intervention with the ICOAP ques- ture between PA i IP. There are statistically significant tionnaire. Also the global perceived effect (GPE) on the differences of FRAX for fracture of hip between phys- patient’s complaints was rated. ical active (PA) and inactive patients (IP) (medium level Results: Thirty-five patients (strength (N=17) and walk- PA-15(36.6%); IP 22 (53,7%) (p 0.05). ing (N=18)) were analyzed for BMLs. BMLs were pres- Conclusion: Based on obtained results we confirm that phys- ent in 25 (71%) knees. Five (14%) patients dropped out ical activity affects onto increasing of mineral density of and19(54%)improved(GPE≥5). All drop-outs had bones. Physically inactive patients who often consume alco- BMLs but no difference was seen between drop-outs hol have higher risk of reduction of mineral density of bones and retainers (p>.05). Pain scores did not differ between and possibility of fracture, while physically active patients intervention groups (p>.05) or between patients with who practiced exercise at the younger age have better bone BMLs and without BMLs (p>.05). mineral density. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S243 P339 sarcopenia alone (W-OR: 1.74; 95% CI: 0.81-3.73; THE ASSOCIATION OF OSTEOSARCOPENIA, SARCO- p=0.154, and, LM-OR:1.49; 95%CI: 0.53-4.22; p=0.446) PENIA AND OSTEOPOROSIS WITH WEAKNESS AND or osteoporosis alone (W-OR:1.60; 95%CI: 0.76-3.36; MOBILITY IN OLDER ADULTS WITH CARDI- p=0.212, and, LM-OR: 1.26; 95% CI: 0.48-3.29; OVASCULAR DISEASE: DATA FROM SARCOS STUDY p=0.634). A. F. Frisoli1,F.G.M.Martim1, S. I. Ingham2,A.C.C. Conclusion: Osteosarcopenia, sarcopenia and osteoporosis Carvalho1, P. H. C. Chaves3 alone were prevalent and similar in older adults, however; 1Federal University of São Paulo - Brazil, São Paulo, Brazil, only osteosarcopenia presented strong and significant associ- 2Sao Paulo Federal University, Sao Paulo, Brazil, 3Florida ation with loss of mobility and weakness. International University, Miami, United States Sarcopenia has been associated with worst physical func- P340 tions. Recent articles have been demonstrated that muscle NEUROPATHIC PAIN SYMPTOMS IN PATIENTS and bone present a very intrinsic and heterogeneous inter- WITH HIP, KNEE OR ANKLE OSTEOARTHRITIS action. However, to date, it is unclear whether the associ- A. Knežević1, M. Jeremic Knezevic1,S.Tomasevic- ation of osteoporosis with sarcopenia modifies the associ- Todorovic1,J.Ivacic2, D. Simić-Panić1,K.Boskovic1 ation of sarcopenia with physical functions. We hypothe- 1Faculty of Medicine, University of Novi Sad, Novi Sad, sized that the addition of osteoporosis with sarcopenia by Serbia, 2General Hospital, Senta, Serbia Baumgartner, presents higher association with loss of mo- bility and weakness, than sarcopenia and osteoporosis Objective: The objective of this study was to investigate alone. whether neuropathic pain symptoms are present in patients Methods: Cross-sectional analyses of data from SARCOS with osteoarthritis and to investigate the connection between study, an observational study of the epidemiology of these symptoms, pain duration and pain intensity in these Sarcopenia and Osteoporosis in older outpatients from patients. Cardiology Division of Federal University of Sao Paulo- Material and Methods: This research was designed as a pro- Brazil. All subjects were underwent DXA of total body spective study which included 62 patients with hip, knee, or and bone sites. Sarcopenia was defined by Baumgartner ankle osteoarthritis (the average age 56.61±13.53 years). The method (appendicular muscle mass/height2 <5.45kg/m2 patients were recruited in the period from June 2016 to women and 7.27kg/m2 men). Osteoporosis was diagnosed November 2016. We collected the data of the average pain by WHO criteria. We defined Osteosarcopenia by the pres- intensity in the last four weeks on numeric rating scale ence of Osteoporosis plus Sarcopenia. Osteoporosis and (NRS). We measured neuropathic component to the pain with Sarcopenia were analyzed in an isolated way. Loss of the PainDETECT (PD) questionnaire and grouped patients in Mobility (LM) was diagnosed by the inability to stand 5 three groups: group I negative on neuropathic symptoms, times from a chair, by Chair Stand Test Performance. group II – unclear and group III positive on neuropathic symp- Weakness (W) was established by EWGSOP criteria (Grip toms. All patients had pain that lasted more than 3 months. strength <20kgf women and <30kgf men). Logistic regres- Results: Our sample consisted of 42 women (67.7%), 42 pa- sion, models adjusted for age and gender. SPSS 17 per- tients with knee osteoarthritis (67.7%), 15 patients with hip formed statistical analyses. osteoarthritis (24.2%) and 5 patients with ankle osteoarthritis Results: In 340 subjects, 57.7% were women with mean (8.1%). The majority of the patients were in group I age 78.88±7.4 yo and 77.86±6.7 yo for men. (31(50%)), 15 (24.2%) were in the group II and 16 (25.8%) Osteosarcopenia occurred in 15.9%, Osteoporosis alone patients were in group III; in other words they were positive in 20.6% and Sarcopenia alone in 20% of the sample. on neuropathic pain according to PD. The average pain inten- Subjects with osteosarcopenia presented substantially sity during last four weeks was 6.44±1.63, while the average more W and LM (48.3% and 29.1%), than those with duration of the pain was 57±64.83. When we compared pain sarcopenia alone (W-22.9% and LM-10%), osteoporosis duration with three PD categories, we found that there was a alone (W-25% and LM-13.2%) or none (W-14.9% and significant difference between pain duration in these groups LM-8.1%) (W-p<0.001,andLM-p=0.001). The presence (group I 27.87±27.02 months vs. group II 87.47±77.79 of osteoporosis in subjects with sarcopenia modified sig- months vs. group III 84.88±80.45 months; χ2(Kruskal nificantly the relationship of sarcopenia with weakness Wallis Test)=9.026; p=0.011). The average pain intensity on and loss mobility. Specifically, osteosarcopenia showed NRS was significantly different between groups (group I 5.97 higher and statistical significant association with W ±1.72 vs. group II 6.6±1.18 vs.7.19±1.56; F=3.303, p=0.044). (OR:3.86; 95%CI:1.85-8.06; p<0.001)andLM(OR: Conclusion: The findings of our study show that neuro- 3.21, 95%CI: 1.32-7.82; p=0.010) compared to pathic pain symptoms measured with PD were present in S244 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 about one quarter of the patients with chronic hip, knee, for secondary prevention of hip fracture under current medical or ankle osteoarthritis. Patients in group III had higher system in Hong Kong. Based on these data the drug allocation average pain intensity during past 4 weeks and their pain should be adjust in order to provide acceptable coverage for lasted significantly longer than in the case of the patients patients. who were negative on neuropathic pain symptoms accord- ing to PD. These facts should be considered when plan- ning the treatment for these patients. P342 NOVEL INSIGHTS INTO THE CHARACTERISTICS AND IMPACT OF BONE PAIN IN ADULTS WITH P341 FIBROUS DYSPLASIA HIP FRACTURE AND RENAL IMPAIRMENT IN L. Watts1, J. Barrett1,A.Soni1, P. Wordsworth1,K.Javaid1 HONG KONG: HOW MANY CAN BE SAFELY 1Musculoskeletal epidemiology. Botnar Research Centre, TREAT WITH BISPHOSPHONATE? Nuffield Department of Orthopaedics, Rheumatology and A. W. H. Ho1, S. H. Wong2 Musculoskeletal Sciences, University of Oxford, Oxford, 1Caritas Medical Centre, Hong Kong, 2Department of United Kingdom Orthopaedics and Traumatology, University of Hong Kong, Hong Kong Background: Bone pain is more common in adults with fi- brous dysplasia (FD) and variably responsive to bisphospho- Introduction: Osteoporosis is a major public health con- nate therapy. However, the mechanism of the pain remains cern. A number of pharmacological options are available unknown. Current research into the aetiology of pain in other for the management of osteoporosis. Bisphosphonates are rheumatic disorders such as osteoarthritis, indicate in some widely regarded as the drug class of choice for the pre- patients there is a significant neuropathic component. We here vention of fractures in postmenopausal women, and is describe the proportion of patients with characteristics of neu- the first line drug for secondary prevention of osteopo- ropathic pain and the impact on other patient reported health rotic fracture after hip fracture in Hong Kong. However, outcomes. bisphosphonates was contraindicated in patient with cre- Methods: We used data from a UK prospective cohort atinine clearance less than 35. As both osteoporosis and of patients with rare diseases of bones, joints and ves- renal insufficiency become more prevalent with age, we sels (www.rudystudy.org) that includes patients with FD. conduct a study on what is the prevalence of renal im- Participants are recruited via their clinicians, patient pairment in geriatric hip fracture patient to evaluate the groups and social media to facilitate recruitment across percentage of patient that can benefit from bisphospho- the range of disease severity. Participants completed a nate after geriatric hip fracture in Hong Kong. specific questionnaire for neuropathic pain Methods: We included all geriatric primary hip fracture (painDETECT) as well as other patient reported out- patients who received surgery admitted to Kowloon West come measures including quality of life (SF-36, EQ- Cluster Orthopaedic Rehabilitation Centre consecutively 5D-5L), sleep (Pittsburgh Sleep Quality Index) and ac- in one year 2014-2015. Basic demographics and anthro- tivities of daily living (Nottingham Activities of Daily pometric measurement were collected. Creatinine clear- Living). ance (GFR) was calculated with Cockcroft-Gault formula Results: Of the 43 adults with FD, 88% patients reported pain, using Creatinine immediate after operation and body with 20.9% scoring of ≥8/10 in the last month. Using the weight. painDETECT questionnaire, 18.6% had neuropathic pain Results: There were 360 patients with mean age 81.6 (SD and 55.8% had nociceptive pain with 25.6% unclear. Those 7.57). There were 245 female and 115 male. The mean GFR with neuropathic pain rated their general health as significant- was 41.1 (95% CI 38.6-43.5) for female and was 43.8 (95% ly worse on the EQ-5D-5L than those with nociceptive pain CI 40.4-47.2) for male. 45.3% of female and 31.3% of male (p<0.001). Patients with neuropathic pain reported significant- are within the group of GFR <35ml/min, indicated stage 3 ly worse sleep (p=0.007) as well as lower activity of daily chronic kidney disease. living scores (p=0.001). Discussion: Renal function is known to decline with age and Conclusions: Almost a fifth of adults with fibrous dys- declines at a faster rate after 50 to 60 years of age. Although plasia satisfied criteria for neuropathic pain. Having neu- bisphosphonates are widely prescribed, it was contraindicated ropathic pain was associated with lower quality of life, in patients with severe renal impairment (CrCl <30 or <35 more sleep disturbance, reduced activities of daily living. mL/min). Our study showed there is high prevalence of severe Assessment of neuropathic pain should be considered for renal impairment in patient with primary geriatric hip fracture. adults with fibrous dysplasia as it may inform different This group of patients is not eligible for the first line treatment management decisions. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S245 P343 Objectives: Fragility fractures are associated with higher mor- KNEE OSTEOARTHRITIS AND NEUROPATHIC PAIN bidity and mortality. The aim of this study was to compare SYMPTOMS Bone Mineral Density (BMD) and fracture risk (FR) by the J. Ivacic1,A.Knežević2, M. Jeremic Knezevic2,S. Fracture Risk Assessment Tool (FRAX index), between pa- Tomasevic-Todorovic2, D. Simić-Panić2,K.Boskovic2 tients with or without hyperuricemia aged 50 years or older 1General Hospital, Senta, Serbia, 2Faculty of Medicine, and to investigate potential underlying associated factors. University of Novi Sad, Novi Sad, Serbia Materials and methods: We conducted a study evaluating BMD and FR in a 123 (54 male, 69 female) group with hy- Objective: To determine the frequency of neuropathic pain peruricemia (mean age 63,72 years) compared with a 64 pa- symptoms in patients with knee osteoarthritis. tients (27 male, 37 female) control group (mean age 64,56 Material and Methods: This research was designed as a pro- years). All subjects were Caucasian, above 50 years of age. spective study which included 100 subjects with knee osteo- Patients who presented any cause of secondary osteoporosis, arthritis (the average age 62.81±11.96 years). The subjects as those who were receiving drugs which affect BMD were were recruited in the period from March 2016 to December excluded. BMD was assessed by dual-energy X-ray absorpti- 2016. We collected the data of the present, maximum and ometry (DXA). We obtained anthropometric parameters, average pain intensity in the last four weeks on numeric rating habits, personal and family history. FR was evaluated by scale (NRS). We measured neuropathic component to the pain FRAX index, which was calculated according to interrogatory with the Douleur Neuropathique with 4 questions (DN4). We and femoral neck BMD. divided the patients into two groups according to the results of Results: We found that patients with hyperuricemia had this instrument; the first having the values of DN4<4 and the higher BMD in all areas: femoral neck T-Score (−0,42 vs. - second with scores on DN4≥4. All patients had pain that 1,47; p <0,0001) and L1-L4 T-Score (0,13 vs. -0,99; p <0,05). lasted more than 3 months. Despite, they had a significant elevated hip FRAX index (2.74 Results: There was four times more women than men in vs. 1.43; p <0,01). In our population the patients without hy- our study (80 (80%) vs. 20 (20%)). The majority of peruricemia had more healthy habits including lower alcohol, patients (68 (68%)) scored less than 4 on DN4. There caffeine and soft drinks consumption, more physical activity, was no significant difference in age between two groups less tobacco consumption. Patients with hyperuricemia had (62.65±11.91 vs. 63.16±12.24; t=-0.198, p=0.844). increased abdomen circumference (107,6 vs. 92,32 in the con- When we compared the pain intensity in these two trol group), BMI was 31,87 in patients with hyperuricemia groups we did not find a significant difference for the and 27,09 in the control group, having a positive correlation pain intensity at the moment of the examination (5.75 between BMI and hip T-Score. BMD did not correlate with ±2.20 vs. 6.28±2.11; t=-1.140, p=0.257). On the other glucose control, as measured by glycosylated hemoglobin. hand we have found significantly higher NRS in the Conclusions: Hyperuricemia is pointed as an independent fac- second group for strongest (8.6±1.5 vs. 9.38±0.98; t=- tor for fragility fractures. Bone fractures in patients with hyper- 3.083, p=0.003) and average (5.69±1.92 vs. 6.69±1.87; uricemia lead to higher morbidity that worsens quality of life t=-2.441, p=0.016) pain intensity during the last four and increases mortality, secondary to cardiovascular conditions. weeks. The susceptibility to fractures may be due to worse bone quality Conclusion: The findings of our study show that neuropathic and increased risk of fall. We consider it is important to continue pain symptoms measured with DN4 were present in about one working in identifying the causes of this association so as to third of the patients with chronic knee osteoarthritis. Patients work on the prevention of hip fractures in these patients. in the second group had higher NRS for strongest and average pain intensity during past four weeks. We should keep this in mind when planning the treatment for these patients. P345 STRESS FRACTURE IN PATIENT WITH HYPOPHOS- PHATEMIC RICKETS P344 V. García Calvo1,V.Roda2, J. A. Camacho Chacón1, M. Sanz BONE MINERAL DENSITY, FRACTURE RISK AND Sainz3,A.M.Gómez-Blasco1,M.E.MasaLasheras3 ASSOCIATED FACTORS IN PATIENTS WITH HYPE- 1Department of Orthopaedic Surgery. H. U. Miguel Servet, RURICEMIA Zaragoza, Spain, 2Miguel Servet University Hospital, S. Monov1,D.Monova2,M.Ivanova3 Zaragoza, Spain, 3Orthopaedic Surgery and Traumatology 1Clinic of Rheumatology, Medical University, Sofia, Bulgaria, Unit. Hospital Universitario Miguel Servet, Zaragoza, Spain 2Department of Internal Medicine, Medical University - Sofia, Medical Institute, Sofia, Bulgaria, 3Department of Internal Objective: Hypophosphatemic rickets is characterized by re- Medicine, Medical Institute, Sofia, Bulgaria nal phosphate loss and normal serum calcium levels. The most S246 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 common form of this disease is linked to the X reported 98% were not meeting these recommendations. chromosome.Characteristic symptoms include delayed No studies have investigated the consequences of such growth, bone pain and skeletal deformities. declines in the dairy intakes of Irish older adults and the Our purpose is to present a case of stress fracture in a patient subsequent effects on vitamin micronutrient status. with this condition and its treatment. Objectives: To study the daily dairy intakes of older Materials and Methods: We present a 59 years old female Irish adults and to examine how the frequency of dairy with 5 months of right coxalgia. No previous trauma; No food consumption affects vitamin micronutrient status. history of interest except hypophosphatemic rickets. No acute Methods: Participants (n 4,317) were from the Trinity Ulster bone lesions were evidenced on initial X-Ray. TC is per- Department of Agriculture (TUDA) Study, a large study of formed, which reported subcapital femur fracture, unconsoli- older Irish adults (aged >60 yrs) designed to investigate dated with signs of pseudoarthrosis. We performed gene-nutrient interactions in the development of chronic dis- osteosynthesis of the fracture. Given the marked coxa vara, eases of aging. The daily intake portion for milk, cheese and with a cervicodiaphyseal angle close to 90º, we used a 95º yoghurt was calculated from food frequency questionnaire DCS plate, which was better coupled to the patient's anatomy. (FFQ) responses. Blood samples were analysed for vitamin Results: In the immediate postoperative period, no complica- biomarkers as follows: vitamin B12 (total serum cobalamin tions were recorded. The patient was allowed to partial and holotranscobalamin (holoTC)), folate (red cell folate weight-bearing with crutches. There was no pain.In control (RCF) and serum folate), vitamin B2 (erythrocyte glutathione X-Ray, good reduction and adequate adaptation of the plate reductase activation coefficient (EGRac)), vitamin B6 (serum was appreciated.During admission, the patient was evaluated pyridoxal phosphate) and vitamin D (serum 25(OH)D). by Endocrinology unit, which adjusted medical treatment. Results: The mean total reported dairy intake was 1.16 (SD Conclusions: The main complication of surgical treatment in 0.79) portions per day with males consuming significantly these patients is delayed consolidation, which until now can fewer total dairy portions compared to females (1.07 vs. only be resolved by intervening in the metabolism of calcium 1.21 respectively) (P80 yrs). Overall, only 3.5% of the total and phosphorus. These patients with stress or low energy frac- population (n 151) achieved the recommended daily dairy tures should be subject to multidisciplinary management and intake of three or more servings per day. A significantly higher the best implant should be decided for each case. proportion of females (4%) compared to males (2.4%) met these dairy requirements (P=0.011). Blood concentrations of vitamin B12 biomarkers, RCF, vitamin B2 and vitamin B6 P346 were significantly worse in those with the lowest tertile of DAIRY INTAKES IN OLDER IRISH ADULTS AND dairy intake (0-0.71 servings) compared to those in the highest EFFECTS ON VITAMIN MICRONUTRIENT tertile (1.50-4.50 servings) (P<0.05). STATUS: DATA FROM THE TUDA STUDY Conclusion: This study found that more than 96% of the M. Casey1,E.Laird2, M. Ward3, L. Hoey4,C.Hughes4,K. older adults sampled did not meet current daily dairy McCarroll1, C. Cunningham5, J. Strain6, H. McNulty7,A. intake recommendations. The study is the largest to- Molloy2 date examining dairy intakes in older Irish adults, and 1Department of Gerontology, St James Hospital, Dublin, provides evidence that daily dairy intakes (in particular Ireland, 2Institute of Molecular Medicine, Trinity College, yogurt) contribute significantly to the B-vitamin and vi- Dublin, Ireland, 3Northern Ireland Centre for Food and tamin D biomarker status of older adults. These results Health, Ulster University, Coleraine, United Kingdom, suggest that older adults who are already vulnerable to 4Northern Ireland Centre for Food and Health, Ulster micronutrient inadequacies, are forgoing the nutritional University, Coleraine, United Kingdom, 5Department of advantages of vitamin-rich dairy products. Medicine for the Elderly, St James Hospital, Dublin, Ireland, 6Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, United Kingdom, 7Northern P347 Ireland Centre for Food and Health (NICHE), University of COMPLIANCE WITH AND ACCEPTANCE OF Ulster, Colraine, United Kingdom TERIPARATIDE INJECTION IN SEVERELY OSTEOPOROTIC PATIENTS Background: Consumption of dairy products has been H. A. Elazaly1,A.M.Ali1 associated with positive health outcomes including a low- 1King Faisal Medical Complex, Taif, Saudi Arabia er risk of hypertension, improved bone health and a re- duction in the risk of type 2 diabetes. The suggested dairy Objectives: intake for health in older adults is three servings per day • to evaluate patients compliance with the use of the but recent analysis of the NHANES data for older adults Teriparatide injection; Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S247 • to obtain additional safety data that will supplement the of Konya, Konya, Turkey, 3Department of Anatomy / existing safety profile; Faculty of Medicine of Necmettin Erbakan University, • to investigate the possible causes of therapy discontinuation. Konya, Turkey, 4Department of Physical Medicine and Material and Methods: This is a single-center, prospective, Rehabilitation/ Training and Research Hospital of Derince- cohort study over 30 months (from April 2014 to October Kocaeli, Kocaeli, Turkey 2016) in King Faisal Medical Complex in Taif which is a referral hospital that receive referrals from eight surrounding Objective: To compare the strength of wrist flexion and ex- rural communities around Taif city with a collective popula- tension in healthy volunteers to individuals with and without tion of about 800,000 citizen. Palmaris longus muscle (PLM). All patients included in the study had been started on Methods: Seventy healthy subjects between the ages of 18 teriparatide because they had been diagnosed with os- and 22 years, volunteering to take part were included into this teoporosis. These patients were stratified into two trial. The Institutional Review Board approved the study pro- groups cedures. The inclusion criteria were as follows: sedentary life- 1. First group included 382 patients with osteoporosis style, unknown musculoskeletal disorders and right-handed- (BMD -2.5). Of these, 70 were male (15.3%) and 312 ness. The exclusion criteria included the previous history of were female (84.6%). They also suffered from fragility any fracture or deformity in the forearm, any limitation in the fracture either vertebral or non-vertebral. range of motion of the wrist and any known peripheral nerve 2. Second group included112 patients with severe injuries. Musculoskeletal ultrasound imaging (MUS) was osteoporosis(BMD -3.5). Of these, 14 were male used to assess the presence of PLM. The examination was (15.3%) and 98 were female (84.6%). They did not suffer performed by an experienced physiatrist and radiologist. The from any fractures elbow flexion and extension strength was measured by an All patients were covered by medical insurance, and re- independent physician blinded to MUS results. A hand-held ceived education regarding compliance with Teriparatide digital dynamometer was used to assess the peak force of wrist injection treatment. Compliance was defined by adminis- extension and flexion. tration of the drug up to 12 months, and was recorded Results: Seventy individuals participated into the study, six of duringtheirfollowupat3,6and12months.Datawere whom were excluded according to criteria, and complete re- collected using a questionnaire that was provided to the sults were obtained from the 128 wrists of 64 participants (30 patients during their follow up visits. Exclusion criteria: men and 34 women). The presence of PLM according to gen- High serum calcium levels, High serum alkaline phospha- der and lateralization is summarized in Table 1. For the male taseandhighparathyroidhormonelevelsinthebloodor group, the muscle strength of wrist flexion for the right side other secondary causes of osteoporosis. was 36.03±13.92 N, while it was 34.24±12.23 N for the left Results: 89% of patients in the first group (with fractures) side. There was no significant statistical difference between were compliant while only 76% in second group (without both groups with and without PLM (p>0.05). For the female fractures) were non-compliant. Causes of non-compliant group, the muscle strengths of wrist flexion for the right and varied from confusion 11 (2.2%); nausea, 9 (1.8%); back left sides were 16.20±7.29 N and 15.26±6.79 N, respectively. spasms12 (2.4%);, muscle cramps 14 (2.8%) and nonspe- There was no significant statistical difference between two cific cause 24 (4.9%). Site of injection pain and daily in- groups with and without PLM (p>0.05). Also, there was no jection were improved as patient proceed with the use of significant difference in agonist/antagonist ratio of the wrist the medications between two groups with and without PLM as to both genders Conclusion: Teriparatide injection was well tolerated and and sides (Table 2). showed higher compliance in the group with fragility fractures Conclusion: Based on the results of this study, although PLM compared with the group without fractures. is a fusiform-shaped muscle arranged in superficial flexor compartment of the forearm, it has no significant effect on the wrist flexion or extension strengths. P348 THE CONTRIBUTION OF THE PALMARIS LONGUS MUSCLE TO THE STRENGTH OF WRIST FLEXION P349 AND EXTENSION CORRELATION OF DISTAL RADIUS BONE A. Y. Karahan1,S.Bakdik2,K.E.Ozen3,S.Arslan2,P. DENSITY WITH FRACTURE RISK DETERMINED Yildirim4,F.Oncu2,A.Cicekcibasi3 BY WHO FRACTURE RISK ASSESSMENT MODEL 1Department of Physical Medicine and Rehabilitation/ Faculty (FRAX) of Medicine of University of Usak, Usak, Turkey, L. Tripto-Shkolnik1,N.Peltz-Sinvani1, A. Tirosh1, I. Vered1 2Department of Radiology/ Training and Research Hospital 1The Chaim Sheba Medical Center, Tel-Hashomer, Israel S248 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Bone mineral density (BMD) evaluation by dual-energy x-ray We study the pattern of bone loss (osteoporosis and absorptiometry (DXA) is a mainstay of osteoporosis diagno- osteopenia) in our RA cohort of patients. sis. Lumbar spine and hip are compulsory, while distal radius Data was taken from RA registry in QATAR. All patients (DR) DXA is optional. Yet, most fractures occur among pa- fulfilling 2010 ACR/EULAR criteria for RA were included tients with osteopenia. To overcome this gap, FRAX was de- from period of June 2013 to November 2015. veloped. It combines clinical risk factors with BMD and cal- Objective: To describe pattern of bone loss (osteoporosis and culates fracture probability. The implementation of FRAX osteopenia) in patients with RA living in Qatar. was meant to improve decision making but the model is un- Methods: All those rheumatoid arthritis patients from regis- derused. Occasionally, an osteoporosis is observed only at the try, who underwent DXA scan for estimation of bone mineral DR, resulting in a misdiagnosis when only hip and spine scans density, were included in this observational study. Patients are performed. Its incorporation into BMD measurements were categorized according to value of T score at L1-L4 ver- may guide the physician to initiate pharmacotherapy for frac- tebral, femoral neck and total femur. (T-score less than -2.5 at ture prevention. any of the above site were categorized as osteoporosis and Objective: To analyze the predictive value of DR BMD and between -1 and -2.5 as osteopenia). its correlation with FRAX score. Results: Data of 276 patients were analyzed who had DXA Methods: Patients undergoing routine BMD measurements scan; 79.7% female, 55.1% Arabs, 73.6% were rheumatoid were enrolled. Spine, hip and DR were measured. The patients factor positive, 77.5% anti CCP positive and 33.7% have ero- completed a questionnaire regarding risk factors relevant to sive disease. Mean age of the patients was 51.9+11.8; 55.8% the FRAX. The FRAX scores for hip and major osteoporotic of patients were above the age of 50. Decrease bone density fractures (MOF) were calculated. Correlation of DR bone den- was observed in 48.6% of the patients. Osteoporosis was pres- sity with FRAX scores was tested. ent in 11.6%(1.6% younger than 50, 9.8% older than 50) and Results: 208 patients (27% men) were included (mean age osteopenia in 37% (11.6% younger than 50, 25.4% older than 66+11 years). Hip fracture and MOF FRAX scores correlated 50). In patients younger than 50 years of age 32% were having with DR bone density with Pearson coefficients -0.46 and - osteopenia and 4% were having osteoporosis. Around 26.8% 0.51, respectively. FRAX hip scores in the lowest vs. the patients were receiving medication for prevention of fracture highest quartile of DR BMD were 7.7+6.7 and 2.0+3.6, re- (18.8% alendronate, 6.9% zoledronic acid, 0.7% Teriparatide, spectively (p<0.01). In a subgroup of patients with osteopenia 0.4% denosumab). Concomitant steroid was used in 34.1% of of the spine or hip and osteoporosis in DR, mean FRAX score patients. Fourteen patients (5.1%) had fragility fracture. for hip fracture was 6.9%. Steroid use was significantly associated with osteoporosis, Conclusions: DR bone density correlates well with FRAX osteopenia and fracture. osteoporotic fracture risk. In a subgroup of osteopenic Conclusion: Bone density was decreased in almost half of our patients by traditional measurements and osteoporotic RA cohort patients, which is observed in both groups of pa- by DR scan the FRAX score for hip fractures was im- tients (younger and older then 50years of age). pressively high. This subgroup may benefit from DR Steroid use is significantly associated with decrease bone density. measurement thus increasing the likelihood of referring physicians to prescribe and the regulatory body to approve an anti-osteoporosis medication. These results are especial- P351 ly important in view of the decline trend in osteoporosis OSTEOSARCOPENIA IS MORE ASSOCIATED WITH treatment. DISABILITY COMPARED TO SARCOPENIA OR OSTEOPOROSIS ALONE, IN OLDER ADULTS WITH CARDIOVASCULAR DISEASE: DATA FROM P350 SARCOS STUDY DECREASE BONE DENSITY IN RHEUMATOID A. F. Frisoli1,F.G.M.Martim2, S. I. Ingham3,A.C.C. ARTHRITIS PATIENTS; DATA FROM RHEUMA- Carvalho2, P. H. C. Chaves4 TOID ARTHRITIS REGISTRY IN QATAR 1College of Medicine, University of São Paulo, São Paulo, F. Alam1,M.Hammoudeh1, S. Al Emadi1 Brazil, 2Federal University of São Paulo - Brazil, São Paulo, 1Rheumatology Section, Department of Internal Medicine, Brazil, 3Sao Paulo Federal University, Sao Paulo, Brazil, Hamad General Hospital, Doha, Qatar 4Florida International University, Miami, United States Background: Decrease bone density has been observed in Objective: Disability is associated with higher hospitalization Rheumatoid arthritis (RA) patients. Chronic inflammatory and mortality. Loss of muscle mass and muscle function has stat, immobility and steroid use are important factors, which been identified like etiology factors of disability. Osteoporosis contribute to bone loss in RA patients. is an important risk factor for fractures, and consequently Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S249 disability. However, it is unclear, whether the undermines quality of life. New options are currently being association of osteoporosis with sarcopenia modify proposed to treat earlier stages. Among these, platelet-rich plas- the functional status, compared to sarcopenia alone. We hy- ma (PRP), has been introduced into clinical practice as a mini- pothesized that the addition of osteoporosis with sarcopenia, mally invasive solution to improve the status of the joint surface. by Baumgartner, presents higher association with disability, Purpose: The purpose of this study was to compare the effec- than sarcopenia and osteoporosis alone. tiveness of intra - articular injection of platelet rich plasma and Methods: Cross-sectional analyses of data from SARCOS hyaluronic acid in patients with primary knee osteoarthritis. study, an observational study of the epidemiology of Methods: This study was carried out on sixty patients of Sarcopenia and Osteoporosis in older outpatients from primary knee osteoarthritis with Grade 1, 2, or 3 osteoarthritis Cardiology Division of Federal University of Sao Paulo- according to the Kellgren-Lawrence grading scale. In the PRP Brazil. All subjects were underwent DXA of total body group (n=30), three weekly intra-articular injection of PRP and bone sites. Sarcopenia was defined by Baumgartner was applied and in the HA group (n=30), three weekly doses method (appendicular muscle mass/height2 <5,45kg/m2 of intra-articular injection of HA were applied. Patients were women and 7,27kg/m2 men). Osteoporosis was diagnosed evaluated at baseline and then at 3 and 6 months of follow-up by WHO criteria. We defined Osteosarcopenia by the using the Western Ontario and McMaster Universities presence of Osteoporosis plus Sarcopenia. Osteoporosis Osteoarthritis Index (WOMAC), visual pain scale.(VAS) and and Sarcopenia were analyzed in an isolated way. Doppler ultrasonography of the injected knees. Disability was defined when the subjects presented score Results: Eight patients developed pain and mild swelling after of IADL <24 and or ADL<5. Logistic regression, models PRP injection, while no major complications were observed. adjusted for age, previous fracture and gender. SPSS 17 Statistically significant better results were observed in the performed statistical analyses. WOMAC and VAS scores in PRP and HA group at 3 and 6 Results: In 342 subjects, 56.14% were women with mean age months: at the PRP group the WOMAC score improved from 78.88±7.4 yo and 77.86±6.7 yo for men. Osteosarcopenia 35.13±7.75 to 16.67±11.69, VAS score improved from 5.87 occurred in 16.1% (n=55), Sarcopenia alone in ±1.30 to 2.91±2.14 at 6 months, in the HA group the 20.5%(n=70) and Osteoporosis alone in 19.9%(n=68) of the WOMAC score improved from 39.07±9.12 to 23.1±7.07 sample. Among subjects with osteosarcopenia, 67.3% (n=37) and VAS score improved from 6.1±1.09 to 4.1±1.12 at 6 presented disability, compared to 44.3% (n=31) in sarcopenia months. A significant improvement in Doppler activity group and 47.1%(n=32) osteoporosis group. The presence of (p=0.04) was observed in PRP while there is no improvement osteoporosis in subjects with sarcopenia modified significant- were observed in HA group. The comparative analysis of the 2 ly the relationship of sarcopenia with disability. Specifically, treatments showed statistically significant better results in osteosarcopenia showed higher and statistical significant as- PRP group than in HA group according previous scales. sociation with disability (OR: 2.86; 95%CI 1.42-5.75; Conclusion: The results of this study have shown that the p=0.003) compared to sarcopenia alone (OR: 1.69 95% CI: administration of PRP in OA treatment is a cheap and effective 0.90-3.17; 0.105) and osteoporosis alone (OR: 1.31, 95% CI: method which was more effective than HA injection in reduc- 0.70-2.45; 0.383). ing pain and providing better functional results especially in Conclusion: Disability was very prevalent in older adults with younger patients and mild to moderate degrees of knee OA. osteosarcopenia, sarcopenia and osteoporosis alone, however; References: only osteosarcopenia presented a strong and significant asso- Procha´zkova´ M. Physiol Res 2009;58:419Y25. ciation with disability. Gomoll AH et al. Knee Surg Sports Traumatol Arthrosc 2012;20:468 P352 EFFECTIVENESS OF THE INTRA-ARTICULAR P353 INJECTION OF PLATELET RICH PLASMA VS. INCIDENCE, RISK FACTORS AND FRACTURE HYALURONIC ACID IN THE TREATMENT OF HEALING OF ATYPICAL FEMORAL FRACTURES PATIENTS WITH PRIMARY KNEE OSTEO- IN POSTMENAUPOSAL WOMEN: A MUTICENTER ARTHRITIS: A COMPARATIVE STUDY CASE CONTROL STUDY M. Abd Elazeem1,M.Doma1,A.Moshref1 S.-J. Lim1,K.Kim2,I.Yeo3, Y.-S. Park3 1Rheumatology, Alazhar University Hospital-Asyuit, Asyuit, 1Department of Orthopaedic Surgery/Sungkyunkwan Egypt University School of Medicine/Samsung Medical Center, Seoul, Republic of Korea, 2Department of Orthopaedic Background: Osteoarthritis (OA) is a common and debilitating Surgery/Sungkyunkwan University School of Medicine/ condition associated with pain and the loss of mobility that Samsung Medical Center, Seoul, Serbia, 3Department of S250 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Orthopaedic Surgery/Sungkyunkwan University School of Objective: We conducted a prospective, open label, random- Medicine/Samsung Medical Center, Seoul, Republic of ized trial to report the effect of osteoporosis medications with Korea re-fracture and mortality in postmenopausal women who had experienced a hip fracture. Objectives: To determine the incidence and risk factors of Materials and Methods: A total of 1165 women 50 or atypical femoral fracture (AFF) in menopausal women, we older with acute, first-time, and lower-energy trauma hip performed a multicenter retrospective case-control study. We fracture were contacted, 494 consented to screening, and also investigated the effect of bisphosphonate (BP) use on 281 received osteoporosis medication. They were ran- fracture healing of AFF. domly assigned to receive 17β-estradiol gel 1.5g daily Material and Methods: We retrospectively reviewed the (Estrogen group, n=140) or risedronate 35mg weekly medical records and radiographs of 6,644 patients who expe- (Risedronate group, n=141). We also used 134 patients rienced a hip or femoral fracture at 8 tertiary referral hospitals eligible for the study who refused to give informed from January 2010 to December 2014. Of these, 290 females consent for randomization (eligible refusers) as control over 50 years of age who had a low-energy trauma, group. The primary outcome was new clinical fracture, subtrochanteric or femoral shaft fractures without underlying and the secondary outcome was mortality. disease were identified. All the radiographs were reviewed to Results: The overall new clinical fracture rate was 14.2% (40/ distinguish AFF from typical femoral fracture (TFF). An AFF 281). There were no significant differences in the rate of new was defined by the 2013 American Society of Bone and clinical fracture among all the three groups (Estrogen group; Mineral Research Task Force criteria. Univariate and multi- 12.8%, Risedronate group; 15.6%, Control group; 11.2%, variate logistic regression analyses were performed to identify p=0.234). The overall mortality rate was 13.5% (38/281). risk factors for AFF, and subgroup analyses were performed Although mortality rates were similar between the two medi- according to the fracture site and BP use. The effect of BP use cations in the study group, the randomized patient group on fracture healing of AFF was also assessed. showed significantly lower mortality than the eligible refuser Results: Among 6,644 patients, 196 had an AFF (58 group (Estrogen group; 11.4%, Risedronate group; 15.6%, subtrochanteric and 73 femoral shaft AFFs). The incidence of Control group; 34.3%, p=0.017). AFF was 3.05% of 6,644 patients and 3.93% in female patients Conclusions: Although no significant differences were found over 50 years old. Of the 196 AFFs, 131 patients (66.8%) were in new clinical fracture rates among the three groups, this exposed to BP with a mean duration of 5.7 years. For patients prospective study demonstrated the use of estrogen as well who have been exposed BPs, increased cortical thickness at the as bisphosphonate reduced mortality rate following hip frac- thickest lateral cortex of femur was associated with the devel- ture surgery in postmenopausal women. opment of AFFs (p=0.0319). And AFFs with increased coronal femoral curvature tended to occur more at the femoral shaft site (p=0.0134). Subgroup analysis showed that BP users were less P355 likely to achieve bone union without problems (p=0.0059). PREPATELLAR SUBCUTANEOUS CALCIFICA- Conclusions: This study provided important evidence for pre- TIONS IN SCLERODERMA vious claims that BP is highly related to the development of M. Zabihiyeganeh1, A. Bagheri Fard2 AFF. We demonstrated that increased femoral cortical thick- 1Bone and Joint Reconstruction Research Center, Shafa ness and increased coronal femoral curvature is risk factors for Orthopedic Hospital, Iran University of Medical Sciences, AFF. We also found that BP use delayed the fracture healing Tehran, Islamic Republic of Iran, 2Bone and Joint of AFFs regardless of the duration. Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran P354 EFFECT OF OSTEOPOROSIS MEDICATIONS ON 16-year-old girl with limited cutaneous systemic sclerosis REFRACTURE AND MORTALITY FOLLOWING (lcSSC) presented with painful hard cutaneous calcified HIP FRACTURE SURGERY IN POSTMENOPAUSAL plaques over the extensor surface of the right knees more WOMEN: A PROSPECTIVE RANDOMIZED TRIAL prominent in right knee. She had been diagnosed as having S.-J. Lim1,K.Kim2, Y.-S. Park1 lcSSC 3 years previously on the basis of calcinosis, Raynaud 1Department of Orthopaedic Surgery/Sungkyunkwan phenomenon, sclerodactyly, telangiectases, and positive anti- University School of Medicine/Samsung Medical Center, nuclear antibodies with a centromere pattern. Lateral view of Seoul, Republic of Korea, 2Department of Orthopaedic the right-knee x-ray demonstrated subcutaneous calcifications Surgery/Sungkyunkwan University School of Medicine/ anterior to the patella and also calcification of the patellar Samsung Medical Center, Seoul, Serbia tendon. (Figure 1) Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S251 These radiological findings were consistent with prepatellar bursitis as a result of the lcSSC. Figure 2: Skin hyperpigmentation and ulceration over the patella. 1Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland, 2University of Eastern Finland/ Institute of Public Health and Clinical Nutrition, Kuopio, Finland 3 Department of Orthopaedics and Subcutaneous calcinosis, composed of deposits of calcium Traumatology, Kuopio University Hospital, Kuopio Finland hydroxyapatite, occurs in about 25% of patients with 4 Department of Obstetrics and Gynaecology, Kuopio longstanding limited scleroderma, particularly in patients with University Hospital, Kuopio, Finland anticentromere antibodies, and less frequently in diffuse disease. Objective: To evaluate the associations of Baltic Sea diet Sites of repeated microtrauma such as fingers, forearms, (BSD) and Mediterranean diet (MED) with sarcopenia indices olecranon, and prepatellar bursae are the most typical lo- in elderly women. cations. These calcifications may ulcerate, become infect- Methods: In total 554 women, (age 65–72 years) belong- ed, resemble an infectious process, extrude calcified ma- ing to Kuopio osteoporosis risk factor and prevention terial, or remain subcutaneous causing, rarely, recurrent (OSTPRE) study filled a questionnaire on lifestyle fac- local inflammation due to the release of calcium hydroxy- tors and 3-day food record at the baseline. The positive apatite crystals into the surrounding tissue. There is no components of BSD (fruits and berries, vegetables, fiber standard pharmacological treatment for calcifications in from cereal products, fish, low-fat milk, and ratio of scleroderma. Various drugs have been reported with vari- polyunsaturated fatty acids (PUFA) to saturated FA) re- able success including warfarin, colchicine, probenecid, ceived score 0 for lowest quartile and 3 for the highest bisphosphonates, diltiazem, intralesional corticosteroids, quartile; for negative components (sausage and total fat and minocycline. our patient had purulent discharge from intake (E%)) the order was reversed. For each MED skin ulcer over the calcification, so we started antibiotic score positive component (legumes, nuts and vegetables for treatment of skin infection, along with intravenous (potato excluded), fruits, cereals and potatoes, fish, ratio pamidronate 60 mg. This treatment resulted in significant of PUFA+ monounsaturated FA: saturated FA, and mod- improvement after one week, and we planned to repeat erate alcohol intake of 5 to 25 g/d) a value of 1 was pamidronate 3 months later. given if a persons’ intake was ≥ median, and otherwise 0 was given; two negative components were dairy prod- ucts, and total meat (including sausage and eggs). P356 Participants underwent full body composition dual- ASSOCIATION OF THE BALTIC SEA AND MEDITE- energy X-ray absorptiometry, walking speed 10 m, and RRANEAN DIETS WITH INDICES OF SARCOPENIA squat tests at the baseline and 3 years after. Relative IN ELDERLY WOMEN skeletal muscle index (RSMI) was calculated as skeletal M. I. Isanejad1,2, A.-T. E. Erkkilä2,J.S.Sirola1,T.R. muscle in arms and legs divided by the square of height Rikkonen1,J.M.Mursu2,M.T.Tuppurainen1,4,H.K. (m2). Short physical performance battery (SPPB) score Kröger1,3 and sarcopenia were defined per European working S252 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 group on sarcopenia criteria. Leg muscle quality (LMQ) compiled up to, depression - 6,46±0,15, anxiety - 6,8±0,98, was calculated as walking speed 10m/s divided by leg asthenia - 6,72±0,17 and hypochondria - 5,53±0, 18. muscle mass. According to the data obtained from correlation analysis, mus- Results: Women in the higher quartiles of BSD and MED culoskeletal pain and the number of painful points in patients scores lost less RSMI and total body muscle mass (MM) over with FM were directly related to depression, fatigue, and hy- 3-year follow-up (Ptrend ≤0.034). At the baseline, women in pochondria (p<0.05). Fatigue and stiffness were found to have the higher BSD score quartiles had greater MM, faster walk- a direct correlation with asthenia (p<0.05). When the duration ing speed 10m, greater LMQ, higher SPPB score (Ptrend ≤ of musculoskeletal pain is <5 years, anxiety was notably seen 0.034), and lower proportion of squat test failures. Similarly, to be higher (7,06±0,6 points, p <0.01). There was a signifi- women in the higher quartiles of MED score had significantly cant correlation with depression (r=0.34 p=0.021; 7.45±0.38), faster walking speed 10m, greater LMQ (Ptrend≤0.041) and asthenia (r=0,38 p=0.01; 7.71±0.38) and hypochondriasis higher proportion of squat test completion. (r=0,65 p=0,005; 6 52±0,49), when the duration of pain is > Conclusions: Higher BSD and MED scores as indicator of a 10 years (p <0.05). The age of patients with FM, is a strong healthy diet might reduce the risk of sarcopenia in elderly factor that was directly correlated with the levels of depression women. (r=0,3 p=0.03) and anxiety (r=0,57 p=0.019) in the subjects. Acknowledgments: This study was supported by grants from Results discussion: The results of this study enable us to point Päivikki and Sakari Sohlberg Foundation, Finnish Cultural out at the fact that there is the existence of a correlation be- Foundation—North Savo Regional fund, and Otto A. Malm tween the major clinical manifestations of FM and neurotic Foundation. symptoms, which are part of its clinical picture. Pain felt in the body is a significant source of stress that contributes to an accelerated cascade of actions to eliminate that particular P357 source of danger (pain). The emotional equivalent of such a RELATIONSHIP BETWEEN THE INTENSITY OF reaction constitutes to a state of anxiety. A prolonged state of MUSCULOSKELETAL PAIN SYNDROME AND exposure to chronic pain syndrome contributes to the devel- NEUROTIC DISORDERS IN PATIENTS WITH opment of asthenic and depressive disorders, increased pain, FIBROMYALGIA and insomnia, which all eventually results in the formation of M. B. Ramkhelawon1, G. P. Suleymanova1,R.A.Grekhov2 a vicious circle system. The duration of the disease in FM 1Research Institute of Clinical and Experimental patients may also have a particular role in the development Rheumatology, Volgograd, Russian Federation, 2Volgograd of neurotic disorders. State Medical University, Volgograd, Russian Federation Conclusion: The presence of the identified psychological par- ticulars may well be of a hinder to the efficacy of therapeutic Objective: To study the relationship of musculoskeletal pain and rehabilitation measures undertaken. Effective treatment of syndrome and neurotic disorders in patients with fibromyalgia FM patients comprises in, making the patients actively take (FM). part in the process of the therapy, bringing changes in their Materials and methods: We observed 100 women with pri- overall attitudes and their lifestyle, and hence it is possible to mary fibromyalgia. The average age of the subjects was 43,85 make recommendations to courses of certain kinds of psycho- ±0,79 years, and the mean duration of the disease was 7,23 therapeutic care, such as group and behavioral therapy. ±0,47 years. The diagnosis of the disease was set in accor- dance to the criteria proposed by the American College of Rheumatology (1990). The neurotic symptoms were assessed P358 using the “Level of Neuroticism and Psychopathy” scale LOW VITAMIN D LINKED TO HIGH-DENSITY (Dmitrieva LL, 1990), pain intensity was determined using a LIPOPROTEIN AND BONE LOSS IN POSTMENO- visual analog scale (VAS). The diagnosis was established ac- PAUSAL WOMEN cording to the American Rheumatism Association diagnostic A. Hossein-Nezhad1,Z.Maghbooli1,L.Khorrami-Nezhad1, criteria (1987). Moderate, recurring muscle pain was observed M. Ramezani2,F.Zare1,M.Rezanezhad1,F.Razi1,A.Malek- in 57 patients, resulting in an average score of 4,97±0,31; Hosseini1,B.Larijani3 strong, almost constant muscular pain was seen in 43 patients, 1Osteoporosis Research Center, Endocrinology and accounting for 8,84±0,27 points. Metabolism Clinical Sciences Institute, Tehran University of Results: The scores obtained for intensity of pain was 7,20 Medical Sciences, Tehran, Islamic Republic of Iran, ±0,14, that of fatigue - 7,14±0,14, stiffness - 4,8±0,23, head- 2Baqiyatallah University of Medical Sciences, Tehran, aches - 6,82±0,23, and the number of diagnostic painful Islamic Republic of Iran, 3Endocrinology and Metabolism points, came averaging at a score of 14, 27±0,25. The average Clinical Sciences Institute of Tehran University of Medical scores for neurotic disorders in patients with FM were Sciences, Tehran, Islamic Republic of Iran Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S253 Objective: The aim of the present paper was to review the Material and Methods: The Nutrition UP 65 study was a most important mechanisms explaining the negative associa- cross-sectional observational study conducted in a nationwide tion of high-density lipoprotein levels and bone status in post- cluster sample of 1 500 Portuguese subjects, ≥65 years old. menopausal women. Participants were classified as presenting normal vitamin D Material and methods: A total of 488 postmenopausal wom- levels (≥50.0 nmol/L), at risk of inadequacy (30.0-49.9 en participated in this cross-sectional study who did not use nmol/L) or at risk of deficiency (<30 nmol/L) [1]. The associ- osteoporosis medications and did not have any chronic disor- ation between individuals’ characteristics and vitamin D levels der. Dual X-ray absorptiometry (DXA) densitometer (Lunar was analyzed through multinominal logistic regression (model 7164) was used to assess bone mineral density (BMD) of three A) and multivariable linear regression (Model B) analysis. skeletal sites (total hip, femoral-neck, and lumbar spine (L2- Results: Median Vitamin D plasmatic value was 36.1(IQR: L4)). Each person was categorized based on the WHO osteo- 35.5) nmol/l, 39.6% of participants were at risk of vitamin D porosis criteria; osteoporosis (T score ≤ -2.5), osteopenia (-2.5 deficiency and 29.4% were at risk of vitamin D inadequacy. In Objectives: To evaluate vitamin D status in Portuguese older Introduction: Giant cell is a tumor that appears in adults from the Nutrition UP 65 study and its associated factors. young adults, requiring surgical treatment due to its S254 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 metastatic capacity, but the recurrence rates makes no P362 consensus about therapeutic management. MICROARCHITECTURE AND BONE MINERAL Methods: 23 patients were operated between 1996- DENSITY IN FEMURS AND MAXILLAE OF 2012 at Miguel Servet hospital, performing a mean of 8.9 OVARIECTOMIZED RATS SUBJECTED OR NOT years follow-up. TO TREATMENT WITH BISPHOSPHONATE OR A Results: The functional result was satisfactory in all cases, being CATHEPSIN K INHIBITOR able to perform normal physical activity. Six recurrences were P. C. Romualdo1,N.B.F.F.Cunha1, G. B. Leoni2,M.D. detected, which required surgical treatment, showing complete Sousa-Neto2, R. A. B. Silva1,L.A.B.Silva1,P.Nelson-Filho1 recovery at the end of the follow-up. One patient died 1Department of Pediatric Dentistry, School of Dentistry of by pulmonary metastasis. Ribeirão Preto, University of São Paulo, Ribeirão Preto, Conclusion: Surgery is the most appropriate treatment in giant Brazil, 2Department of Restorative Dentistry, School of cell tumors, having shown good results both in the treatment Dentistry of Ribeirão Preto, University of São Paulo, of primary tumor and recurrences. Ribeirão Preto, Brazil Objective: The aim of the present study was to evaluate the P361 microarchitecture and bone mineral density (BMD) in femurs PROFILE OF OSTEOARTHRITIC PATIENTS UNDER- and maxillae of ovariectomized rats subjected or not to treat- GOING TOTAL HIP AND KNEE ARTHROPLASTY. ment with bisphosphonate or a cathepsin K inhibitor to pre- A. H. Neuprez1,2, W. Kurth3, P. Gillet3, O. Bruyère4, J.-Y. vent osteoporosis. Reginster3 Material and Methods: Twenty rats, approximately 12 1Department of Public Health, Epidemiology and Health weeks of age, were randomly divided into 4 groups: Economics, University of Liège & Rehabilitation and Sports SHAM, animals subjected to sham surgery; OVX, ani- Traumatology Department, CHU Liège, Liège, Belgium, mals subjected to ovariectomy; and OVX/BF and OVX/ 2Department of Public Health, University of Liège, Liège, CK, animals subjected to ovariectomy and treatment with Belgium, Liège, Belgium, 3Orthopaedic Surgery CHU, bisphosphonate and cathepsin K inhibitor, respectively, Liège, Belgium starting 1 day after surgery and administered via gavage. After 12 weeks, the animals were euthanized, and the Objective: The objective of this study is to characterize, based femurs and maxillae were removed and analyzed by on clinical, radiographic, health-related quality of life and de- microcomputed tomography (micro-CT) for analysis of mographic variables, the profile of a large, homogeneous co- bone microarchitecture and BMD. The results were sub- hort of osteoarthritic patients undergoing TKA or THA, in a mitted to statistical analysis, with significance level of public (academic) hospital. 5%. Methods: 626 consecutive patients who underwent primary Results: OVX decreased the BMD of the maxilla and al- total knee arthroplasty (TKA) or total hip arthroplasty (THA) tered femoral microarchitecture (p<0.05). The administration between December 2008 and February 2013, in an academic of the drugs increased the BMD of both bones, but only hospital, and who were diagnosed with hip or knee osteoarthritis bisphosphonate was able to reestablish the phenotypes (OA) (ACR criteria). Data collected at baseline included demo- (p<0.05). The action of the drugs was limited to the femoral graphic and clinical data; Kellgren-Lawrence (KL) radiological Tb.Sp parameter, but only bisphosphonate was able to rees- grading; Western Ontario and Mc Master Universities Arthritis tablish the phenotype (p<0.05). In addition, the OVX and Index (WOMAC); EuroQol five dimensions questionnaire (EQ- the drugs showed no effect on the microarchitecture of the 5D) and EuroQol visual analogue scale (EQ-VAS); 36-item maxilla (p>0.05). Short Form Health Survey (SF-36). Conclusions: The OVX-induced reduction of estrogen levels Results: 346 subjects were diagnosed with hip OA and 280 was able to decrease the BMD of the femur and maxilla and with knee OA. Significant differences between subjects in need altered the microarchitecture of the femur. It was thus inferred of a THA or of a TKA were seen in terms of age, duration of that long bone responds more rapidly to the effects of estrogen complaints, BMI, radiological status, comorbidities, traumatic deficiency than the maxilla. The treatment with bisphospho- of surgical history, health-related quality of life (HRQoL) and nate or cathepsin K inhibitor increased the BMD of the eval- function. uated bones, but only bisphosphonate was able to reestablish Conclusion: Significant differences were observed between the phenotype. patients undergoing TKA and THA. Better characterization of Acknowledgments: This work was supported by the São the “need for surgery” in lower limbs osteoarthritis may lead Paulo Research Foundation (FAPESP) grant 2013/18231-9 to a new definition of responders and failures to pharmacolog- and 2014/13238-8 and by the National Counsel of ical treatment of OA. Technological and Scientific Development (CNPq-PIBIC). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S255 P363 Increased incidence of osteoporotic bone fractures is noted HYALURONIC ACID INTRAARTICULAR TREAT- worldwide, even in children and adolescents. Thus, there is MENT: A BIBLIOMETRIC ANALYSIS currently a high level of interest for new treatment approaches. V. Lopez-Fernandez1 Objective: Determination of rate of fibrocartilage callus for- 1Universidad de Santiago de Compostela, Facultad de mation after bone fractures depending on the treatment Medicina, Santiago de Compostela, Spain method. Patients and methods: 58 patients, between the ages of 9-17 Objective: To perform a Bibliometric Analysis for the quan- years old, with recurrent long bones fractures with bone min- titative study of publications on the use of hyaluronic acid eral density (BMD) less than -2.0, were examined. Depending (HA) as an intraarticular treatment for different pathologies. on the treatment method, patients were divided into 2 groups: Material and methods: The study is based on a PubMed group one (30 patients) received preparation №1 (calcium search for articles that investigated the use of HA between citrate 500 mg, vitamin D3 500 IU, drone brood 100 mg per 2000 and 2016. The keywords were "hyaluronic acid", tablet) – 1 tablet 2 times per day during 12 months. Group two "intraarticular" and "treatment". Of the 180 publications found, (28 patients) received preparation №2 (calcium carbonate 500 162 articles met the inclusion criteria. We examined whether the mg, vitamin D3 500 IU per tablet, without drone brood) by the study was: a) a review; B) in humans, animals or both; C) clin- same procedure. All patients had blood and urine tests of total ical, histological, arthroscopic, biochemical or genetic; D) if the calcium, phosphorus, alkaline phosphatase, and 25(ОН)D study examined the synovial fluid; And e) whether hyaluronic levels. DXA and bone radiography were done prior to the acid might be helpful, it was not recommended, had adverse application of plaster and in dynamics. effects or if there were any doubts / more studies were needed. Results and discussion. 21 of the patients suffered 2 fractures Results: More than 72% of the 162 studies were in humans, of long bones (35±6%), 15 patients (26±6%) – 3fractures,14 approximately 25% in experimental animals and only 2.5% in patients (24±6%) – 4 fractures, the rest 8 patients (15±4%) – 5 both. Of the humans, approximately 75% estimated only the fractures. Blood chemistry showed a moderate decrease of clinical efficacy of HA, almost 10% analysed the synovial fluid total calcium and phosphorus levels in 29 patients (50±6%). and the remaining 17 evaluated the cartilage and the synovial 38 of the patients (66±6%) had low serum 25(OH)D (from 29 membrane by imaging test, histology, arthroscopy or genetics. to 10 ng/ml). Efficiency of the treatment was evaluated ac- Regarding animal studies, around 50% were based only on the cording to the rate of fibrocartilage callus formation and the histology, 39% determined the biochemical response and the 5 increase of BMD during 3-7 weeks after the fracture. In group studies left were clinical, arthroscopic or used imaging tech- one, consolidation of the fractures was observed on average niques or synovial fluid analysis. Having found 24 reviews, a from the 4th week. After 10 months, BMD increased from - high percentage (more than 70%) of the total of 162 articles 2.8±0.2 СО to -1.7±0.15 СО (р<0.005) that is important for recommended the use of intraarticular HA, while 12.34% dis- prevention of subsequent fractures. In group two, consolida- couraged or referred to the appearance of inflammatory, granu- tion of fractures was observed from the 5th week. Increase of lomatous, or infectious arthritis. 1.85% focused on minor adverse BMD was with less certainty, from -2.9±0.3 to -2.1±0.6 СО, effects and 11.11% said that further studies were needed. р>0.05. In group one, consolidation of fractures occurred 7 Conclusion: According to recent literature, HA may be useful days earlier than group two. The patients of the group one for some joint diseases, but at the same time may have some could start their rehabilitation in just 3 weeks after the fracture. adverse effects that must be taken into account. Making a final Conclusion: The preparation №1showedstrongerstimulant recommendation for or against intraarticular HA treatment re- effect on fibrocartilage callus formation and recovery of mains a challenge today. BMD. It is explained by the successful combination of ana- bolic and osteoprotective effects of drone brood hormones, vitamin D, and calcium citrate. P364 HEALING OF RECURRANT OSTEOPOROTIC FRACTURES IN CHILDREN AND ADOLESCENTS P365 DEPENDING ON THE METHOD OF TREATMENT VALIDATION OF GARVAN SCALE IN A SPANISH V.S. Strukov1,A.K.Kislov2, D. E. Elistratov3,O.J.Jones4,J. POPULATION Z. Zherbakova2,T.K.Kuptsova2 M. Sosa-Henríquez1, A.-I. Reyes-Domínguez2,N.Sosa- 1Penza Institute of Postgraduate Medical Training, Penza, Cabrera3,D.Hernández-Hernández2, M. Diaz-Curiel4,M.J. Russian Federation, 2Penza Institute of Postgraduate Gómez de Tejada5 Medical Training, Penza, Russian Federation, 3Parafarm, 1University of Las Palmas de Gran Canaria, Las Palmas de Penza, Russian Federation, 4Methodist Mansfield Medical Gran Canaria, Spain, 2Instituto Universitario de Center, Mansfield, United States Investigaciones Biomédicas y Sanitarias, University of Las S256 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain, Objective: Current studies on body composition changes eval- 3Centro de Salud de Tejina, La Laguna, Tenerife, Spain, uated by dual-energy X-ray absorptiometry (DXA) and mortality 4Servicio de Medicina Interna/Enfermedades Metabolicas risk in elderly have some limitations, such as analysis not strat- Osea, Fundacion Jimenez Diaz, Madrid, Spain, 5Department ified by sex and not compartmentalized (subcutaneous and vis- of Medicine, University of Seville, Seville, Spain ceral tissues) assessment of body fat. Thus, we sought to inves- tigate the association between body composition by DXA (in- Background: Several scales have been described to assess cluding visceral fat measurement) and mortality in a longitudinal, the risk of fracture by fragility in the long run. Garvan prospective, population-based cohort of elderly subjects. scale has not been previously validated in the Spanish Methods: 839 community-dwelling subjects (516 women, population. 323 men), ≥65 years, were assessed by questionnaire on clin- Objective: To study the predictive capacity of the scale ical data, laboratory exams and body composition by DXA. Garvan, explore the predictive capacity to a large sample of DXA APEX software computes visceral adipose tissue (VAT) the Canarian population and therefore, Spanish. by subtracting the subcutaneous adipose tissue from the total Material and methods: 400 patients of both sexes. To all is android fat, which was automatically set to 20% of the dis- applied the scale of risk Garvan, accessing to the calculator of tance from the iliac crest to the base of the skull. All analyses risk available on the website: https://www.garvan.org.au/pro- were performed at baseline. Total body fat was expressed by motions/bone-fracture-risk/calculator/>/p| fat mass index (FMI) [(total body fat (kg) / height2 (m)]. Results: The median of follow-up of the patients was of 15.8 Sarcopenia was defined as low appendicular muscle mass ad- years. Those fractured at the start of the study had values of justed for fat. Mortality was recorded during 4 year-follow-up. risk of any fracture fragility of 27, while those who did not Multivariate logistic regression was used to compute odds suffer a fracture had a value of 13 (p<0.001). We obtained ratios for all-cause and cardiovascular mortality. similar for the hip fracture, because those patients that Results: Over a mean 4.06±1.07 years of follow-up, there sustained a fracture during the follow-up showed an initial were 132(15.7%) deaths. In men, after adjustment for age, value of 8 vs. 3 in those not fractured. The area under the BMI, smoking, physical activity, alcohol, diabetes, dyslipid- corresponding ROC curve was 0,718 (- 95% CI=0,613; emia, cardiovascular event, recurrent falls, 25OHD and PTH, 0,824) and the optimal cut-off point was 18.5. This value is the presence of sarcopenia(OR 11.36, 95% CI: 2.21-58.37, a sensitivity of 0.67 (CI - 95%=0.47; 0.83), specificity of 0.67 p=0.004) and visceral fat mass(OR 1.99 95%CI: 1.38-2.87, (- 95% CI=0.56; 0.77), a negative predictive value of 0.86 (- p<0.001, for each 100g-increase) significantly increased all- 95% CI=0.76; 0.93) and positive predictive value of the 0.40 cause mortality risk, while total body fat (FMI) was associated (- 95% CI=0.26; 0.55). with decreased mortality risk (OR 0.48, 95% CI: 0.33-0.71, Conclusion: We have validated the Garvan scale for a p<0.001). Similar results were observed for cardiovascular Spanish population. In accordance with them results of our mortality in men: sarcopenia(OR 14.84, 95%CI: 5.15-47.72, study, it real utility of this scale is it of screening, because a p<0.001), visceral fat mass(OR 1.66, 95% CI: 1.31-2.10, value lower to 18.5, allows establish a risk very low of fracture p<0.001) and total body fat(OR 0.57,95% CI: 0.43-0.76, p by fragility in the next 10 years. <0.001). In women, only sarcopenia was predictor of all- cause(OR 62.88, 95% CI: 22.59-175.0, p<0.001) and cardio- vascular death(OR 74.54, 95% CI: 9.72-571.46, p <0.001). P366 Conclusions: Sarcopenia and fat distribution are associated EFFECT OF SARCOPENIA, SUBCUTANEOUS with all cause and cardiovascular mortality risk in elderly, and ADIPOSE TISSUE AND ABDOMINAL VISCERAL FAT they are different according to sex. Visceral fat and subcutane- ON MORTALITY RISK OF COMMUNITY-DWELLING ous fat have opposite roles on mortality risk in elderly men, and OLDER ADULTS: A POPULATION-BASED PROS- this is distinct from what is observed in young adults. These PECTIVE COHORT STUDY IN BRAZIL− THE SÃO findings point to the risk of encouraging weight loss in the PAULOAGEINGandHEALTHSTUDY elderly aiming young adult goals. Furthermore, DXA seems to D. S. D. Domiciano1,F.M.S.Santana2,M.A.G.Gonçalves2, be a promising tool for evaluation risk of mortality in elderly, L. G. M. Machado3,J.B.L.Lopes2, C. P. F. Figueiredo2,V.C. since it is easily applicable in clinical practice. Caparbo4, L. T. Takayama4,R.M.R.P.Pereira2 1Hospital das Clinicas, University of Sao Paulo, Rheumatology, São Paulo, Brazil, 2Hospital das Clinicas, P367 University of Sao Paulo, Rheumatology, São Paulo, Brazil, STAND STRONG: CYCLIC YOGA FOR MUSCULO- 3Rheumatology Division, Faculdade de Medicina da SKELTAL HEALTH Universidade de São Paulo, São Paulo, Brazil, 4University M. Machawe1,S.Ahmadi1, Z. Maghbooli2,S.M.Eshaghi3, of Sao Paulo, Rheumatology, São Paulo, Brazil S. Shirazi3, A. Hossein-Nezhad2,B.Larijani2 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S257 1Payam-e-Mehr International Yoga Center, Tehran, Islamic 1Carol Davila University of Medicine and Pharmacy, Republic of Iran, 2Osteoporosis Research Center, Bucharest, Romania Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Introduction: Postmenopausal osteoporosis is associated with Republic of Iran, 3Osteoporosis Research Center, an increased risk of fragility fractures and secondary morbidity, Endocrinology and Metabolism Clinical Sciences Institute, which can significantly impair the quality of life (QoL). Tehran University of Medical Sciences, National Elites Objective: To analyse the QoL in a group of postmenopausal Foundation, Tehran, Islamic Republic of Iran women with osteoporosis compared to an age-matched group of women without osteoporosis and the impact of falling and Objective: This study examined the effects of 5 years contin- fragility fractures on QoL. uous Cyclic Yoga training on bone density, bone formation Methods: The study group consisted of 72 women with post- marker, muscle mass, muscular strength, gait speed and menopausal osteoporosis-35 were under stable antiosteoporotic SARC-F scale in postmenopausal women. treatment with oral bisphosphonates at the time of the study, Methods: The style of Yoga used was Cyclic Yoga that is a while 37 were naïve to antiosteoporotic treatment. The control new style in Hatta Yoga. In a case control study 36 postmen- group consisted of 78 age-matched women without osteoporo- opausal women recruited in two groups that included 17 wom- sis. The QoL was evaluated by means of a generic (EQ-5D) and en in Yoga and 19 controls. The Yoga group participated in a disease-specific [the osteoporosis assessment questionnaire Cyclic Yoga training classes for > 5 years, 60 min per week (OPAQ)] QoL instrument. and the age matched control group did not participate in any Results: The patients with osteoporosis had significantly regular exercise programs. Any chronic illness like auto im- worse scores on body image and pain (OPAQ) (p=0.006 and mune disorders, cancers, neurological diseases and any con- 0.029 respectively) compared to control. In the study group ditions that under treatment with corticosteroids were exclud- patients with falling episodes in the previous year had worse ed. A whole body dual energy X-ray absorptiometry scan was scores for the fear of falling, body image and global QoL performed. The appendicular skeletal mass (ASM) was calcu- (OPAQ) (p=0.024, 0.048 and 0.041, respectively). If corrected lated and skeletal muscle index (SMI) was obtained as ASM/ for the falls number, the number of prevalent fractures was not height2. Grip strength using a hand dynamometer and 6-meter significantly correlated to any of the QoL items. gait speed evaluated. Also, the SARC-F scale translated to Conclusions: Women with postmenopausal osteoporosis Persian was applied to evaluate sarcopenia. have impaired QoL compared to age-matched women. A pos- Results: There was not significant group difference in age (56 itive falling history is particularly associated with affected ±3.8 vs. 56.6±4.7), BMI and SMI. BMD of all sites in Yoga QoL subscores. group was higher than controls, although the differences did not reach statistical significance. Handgrip strength in Yoga group was significantly higher than controls. (23.3±2.8 kg vs. 20.4 P369 ±3.3kg,p=0.01).Likewise,gait speed in Yoga was faster than OUTCOMES AND COMPLICATIONS OF TOTAL controls and PINP in Yoga was higher than controls. SARC-F ANKLE ARTHROPLASTY AMONGST OBESE scale in Yoga was significantly lower than controls. In multivar- PATIENTS: A SYSTEMATIC REVIEW AND META- iate analysis of variance after adjustment for age and BMI, ANALYSIS Cyclic Yoga training directly associated with muscular strength A. A. Sayampanathan1, A. N. Cuttilan1,C.J.Pearce1 (p=0.003), speed gait (p=0.001) and SARC-F scale (p=0.006). 1Department of Orthopaedic Surgery, Ng Teng Fong General Conclusions: Cyclic Yoga is a new style in Hatta Yoga that Hospital, Singapore has been providing harmony of streaming cycle of poses to fortify the positive effects of each asana on muscular strength Objectives: Over recent years, there has been an increased and flexibility. The results showed that regular long-term interest in total ankle arthroplasty (TAA) for the management Cyclic Yoga program improved muscular strength, gait speed of end-stage ankle arthritis. However, complication rates for and SARC-F scale as well as bone formation marker. Cyclic TAA remain high. In this study, we aimed to review the out- yoga may recommend for the prevention of age related comes and complications of obese patients, as compared to sarcopenia and osteoporosis in postmenopausal women. non-obese patients, who undergo TAAs. Methods: We searched MEDLINE, Scopus and Web of Science for 355 unique articles. We eventually included 9 P368 articles within our systematic review and meta-analysis based THE QUALITY OF LIFE IN WOMEN WITH POSTME- on our selection criteria. Data was analysed via Review NO-PAUSAL OSTEOPOROSIS Manager 5.3, using Mantel-Haenszel statistics and random C. Capatina1,C.Poiana1 effect models. S258 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Based on our meta-analysis, we revealed that obese using Cox Proportional Hazards models, controlling for age, patients were at a 1.53 times higher odds of undergoing some BMI, smoking, alcohol, educational level, vigorous physical form of revision of their TAA within a given period of time activity, systolic blood pressure, diabetes/cholesterol medica- (95% CI=1.15-2.03, Z=2.90, I2=0, p=0.00375). Obese pa- tion, HRT use (in women). Potential interactions between sup- tients were also at a 2.04 times higher odds of sustaining plementation and cardiovascular risk factors were also infections (95% CI=1.47-2.85, Z=4.21, I2=42.4, p<0.001). examined. Our systematic review showed that obese patients were also Results: 486,522 participants (median age of 58 years, 54.5% more prone to deep vein thrombosis (DVTs) (OR=8.03, 95% women) had complete data on calcium supplementation. CI=2.95-21.9), venous thromboembolic complications 34,082 participants reported taking calcium supplements. In (OR=3.57, 95% CI=2.04-6.24), wound complications both unadjusted and adjusted analyses, there were no associ- (MD=3.07, 95% CI=0.255-5.89), local complications ations between use of calcium supplements and risk of inci- (OR=2.11, 95% CI=1.50-2.98), systemic complications dent IHD amongst men or women. The p-value for interac- (OR=3.44, 95% CI=2.66-4.46), and medical complications tions with age (years), smoking (yes/no/ex), dietary calcium (OR=3.39, 95% CI=2.56-4.48). intake (mg per day), alcohol intake (≥3 times per week), med- Conclusion: Our meta-analysis showed that obese patients ication for cholesterol/diabetes hypertension (yes/no each) are more prone to complications such as revisions of their and blood pressure (mmHg) were all ≥0.1. Only the interac- TAAs and infective complications. Individual studies have tion between calcium supplementation and BMI amongst fe- also identified DVT and thromboembolic complications as males was significant (p=0.01), but with the only significant well as wound, local, systemic and medical complications as association between calcium documentation and IHD ob- being higher amongst obese patients. We postulate that these served in the highest fifth of BMI [HR=0.51 (95% CI: 0.28, findings are a result of the pro-inflammatory state in obese 0.94), p=0.03]. patients. Further studies should focus on providing pathophys- Conclusion: Use of calcium supplements was not associated iological explanations to the increased complication rates with increased risk of ischaemic cardiovascular, and this was found in this review. not modified by a wide range of cardiovascular risk factors. This research has been conducted using the UK Biobank Resource. P370 CALCIUM SUPPLEMENTATION IS NOT ASSOCIA- TED WITH ISCHAEMIC HEART DISEASE P371 REGARDLESS OF CARDIAC RISK FACTORS: THE SUBCLINICAL ARTICULAR INFLAMMATION IN UK BIOBANK COHORT ADULT CELIAC PATIENTS: AN ULTRASOUND N. C. Harvey1, S. D'Angelo1, J. Paccou2, M. Edwards1,S.E. STUDY Petersen3,C.Cooper1 A. Calabro1, R. Terenzi1, A. Alunno2, D. Macchia3,A.S. 1Musculoskeletal Epidemiology, Botnar Research Centre, Calabrò4, M. Matucci Cerinic1 Nuffield Department of Orthopaedics, Rheumatology and 1Department of Experimental and Clinical Medicine, Musculoskeletal Sciences, University of Oxford, Oxford, University of Florence, Department of Geriatric Medicine, United Kingdom, 2Université Lille Nord-de-France, Lille, Division of Rheumatology AOUC, University of Florence, France, 3NIHR Cardiovascular Biomedical Research Unit at Firenze, Italy, 2Rheumatology Unit, Department of Barts, William Harvey Research Institute, Queen Mary Medicine, University of Perugia, Perugia, Italy, 3Allergology University of London, London, United Kingdom and Clinical Immunology, S. Giovanni di Dio Hospital, Florence, Firenze, Italy, 4Department of Experimental and Objective: We investigated whether use of calcium supple- Clinical Biomedical Sciences, Gastroenterology Unit, ments interacted with cardiovascular risk factors as predictors University of Florence, Firenze, Italy of incident ischaemic heart disease events in the UK Biobank population-based cohort. Objective: Celiac disease (CD) is an immune-mediated sys- Methods: 502,664 men and women aged 40-69 years temic disorder elicited by gluten and related prolamines in underwent detailed characterisation at baseline. Use of calci- genetically predisposed individuals. Rheumatic involvement um supplements was self-reported; information on incident is frequent in CD but often underdiagnosed. Considering the hospital admission (ICD-10) for ischaemic heart disease superiority of Musculoskeletal Ultrasound (MSUS) over clin- (IHD) events was available through linkage to UK Hospital ical examination and conventional radiology in the detection Episode Statistics with up to 7 years follow-up. We investi- of joint inflammatory alterations, we performed MSUS in gated the prospective associations between use of calcium newly diagnosed CD patients on a gluten-containing diet supplements and IHD amongst men and women separately, (GCD) and compared the results with those obtained in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S259 healthy controls (HC) and CD patients in serological and clin- Clinical Sciences, Lund University, Skåne University ical remission, on a gluten-free diet (GFD) for at least one Hospital,Malmö,Sweden,7Clinical and Molecular year. Osteoporosis Research Unit, Department of Clinical Material and Methods: CD patients were diagnosed follow- Sciences Malmo, Lund University and Department of ing standardized diagnostic criteria. CD patients and HC Orthopedics, Skane University Hospital, Malmö, Sweden, underwent a MSUS of the radiocarpal, elbow, knee, I – V 8Uppsala University, Uppsala, Sweden, 9University of MTP, II – V MCP joints performed by two rheumatologists Gothenburg, Gothenburg, Sweden, 10Centre for Bone and with experience in rheumatologic ultrasound, in order to de- Arthritis Research (CBAR), Sahlgrenska Academy, tect the presence of joint effusion or synovial hypertrophy, as University of Gothenberg, Gothenberg, Sweden defined by OMERACT guidelines. Results: We enrolled 24 new celiac patients, 18 remission Objective: Fracture is a key consequence of falls. We inves- celiac patients in GFD and 15 healthy controls. We evaluated tigated, across the 3 Osteoporotic Fractures in Men (MrOS) 798 articulations; interobserver agreement resulted excellent Study cohorts, whether prior falls predicted incident fracture (k=0.91). In CD patients still exposed to gluten, joints were independently of FRAX probability, and whether these asso- more frequently altered (14,5% GCD vs. 6,3% GFD vs. 5,7% ciations varied by age and follow-up time. HC p=0,0003). Considering as a cut-off the finding of at least Methods: We studied older men participating in MrOS 2 joints altered (twice the standard deviation of the HC) CD Sweden, Hong Kong and USA. Available baseline informa- patients on GCD were more frequently involved (54% GCD tion included falls history (in previous year), clinical risk fac- vs. 16% GFD vs. 20% HC p=0,017). Furthermore a logistic tors, BMD at femoral neck and calculated FRAX probabili- regression analysis showed that CD patients still on GCD ties. An extension of Poisson regression was used to investi- have a seven-fold risk of presenting 2 or more joints altered gate the relationship between falls, FRAX probability [major compared to HC (OR 7,20; p 0,02; CI 95% 1,353 - 38,326); osteoporotic fracture (MOF) with BMD], and incident frac- conversely inactive CD patients on GFD resulted to be ture. All associations were adjusted for age, time since base- protected compared to CD patients on GCD (OR 0,07; p line and cohort in base models; additionally further models 0,005; CI 95% 0,012 – 0,465). No difference was observed were used to investigate interactions with age and follow-up between CD patients on GFD and HC (OR 0,533; p 0,52; CI time. 95% 0,076 – 3,725). Results: Information on falls and FRAX probability was Conclusions: Taken together, our results confirm that joints available for: 4365 men in USA (mean age 73.5 years); are frequently altered in adult CD patients still exposed to 1852 men in Sweden (mean age 75.4 years); and 1669 men gluten and suggest that GFD may reduce the risk of rheumatic in Hong Kong (mean age 72.4 years). Rates of prior falls were manifestations. similar at 20%, 16%, and 15% respectively. Mean follow-up time ranged from 8.7 to 10.8 years. Across all cohorts, prior falls predicted incident fracture at any site [HR: 1.68 (95%CI: P372 1.49, 1.89)], MOF [HR: 1.56 (95%CI: 1.33, 1.83)] and hip PRIOR FALLS PREDICT INCIDENT FRACTURES fracture [HR: 1.61 (95%CI: 1.27, 2.04)]. Relationships be- INDEPENDENTLY OF FRAX: THE OSTEOPOROTIC tween prior falls and incident fracture remained robust after FRACTURES IN MEN (MROS) STUDY adjustment for FRAX probability: adjusted HR (95%CI) any N. C. Harvey1,A.Oden2,E.Orwoll3, J. Lapidus4, T. Kwok5, fracture: 1.63 (1.45, 1.84); MOF: 1.50 (1.28, 1.76); and hip M. Karlsson6,B.Rosengren7, O. Ljunggren8,C.Cooper1,E. fracture: 1.53 (1.21, 1.94). In the combined cohort HR for any McCloskey2,J.A.Kanis2,C.Ohlsson9,D.Mellström10,H. fracture associated with prior falls tended to reduce with in- Johansson2 creasing follow-up time (p=0.057). 1Musculoskeletal Epidemiology, Botnar Research Centre, Conclusions: Prior falls predicted incident fracture indepen- Nuffield Department of Orthopaedics, Rheumatology and dently of FRAX probability, confirming the potential value of Musculoskeletal Sciences, University of Oxford, Oxford, falls history in fracture risk assessment, although the ability of United Kingdom, 2Centre for Metabolic Bone Diseases, therapeutic interventions to reverse this risk needs further in- University of Sheffield Medical School, Sheffield, United vestigation. The prior falls/follow-up time interaction is in- Kingdom, 3Oregon Health and Science University, triguing, but requires replication. Portland, United States, 4Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, United P373 States, 5Department of Medicine and Therapeutics and MUSCLE PAIN CAUSED BY UNCONSCIOUS PSYCHO- School of Public Health, The Chinese University of Hong LOGICAL PROBLEMS: CASE REPORT PRESENTATION Kong, Hong Kong, 6Department of Orthopaedics and D. Stepankina1,V.Krylov2 S260 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 1Moscow State University of Psychology and Education, Objective: To compare the effect on Bone Mineral Density Moscow, Russian Federation, 2University Clinical Hospital (BMD) of two therapeutic regimens of intravenous and intra- #1, Moscow, Russian Federation muscular clodronate (CLD) in women with postmenopausal osteoporosis. Introduction: Often numerous of diseases are caused by psy- Patients and Methods: Postmenopausal women aged be- chosomatic problems that remain without medical attention. tween 50 and 75 years old presenting with a lumbar spine Therefore, it is important to take into account the psycholog- BMD T-score <-2.5 and without prevalent fractures were ran- ical status of our patients, as it helps in determining the causes domized (2:1) to receive once-monthly intravenous CLD and treatment strategies, including musculoskeletal diseases. 600 mg (CLD600) or once-weekly intramuscular CLD Materials and Methods: We present a clinical case exam- 100 mg (CLD100). All patients received calcium and chole- ination and treatment of pain and rigor in a hand of the calciferol supplements. BMD was measured at the lumbar patient, the cause of which were unconscious psychological spine (LS-BMD), femoral neck (FN-BMD) and total hip problems. (TH-BMD) at 12 and 24 months. Blood cell counts, serum Case report: We discuss the case of a 30-year-old female creatinine, calcium, phosphate, AST and ALT were assessed who initially presented with quite often complaints such every four months. The primary endpoint was the as irritability, anxiety, rigor and pain in the hand (7 out of mean% change of the LS-BMD, FN-BMD and TH-BMD 10 on the Visual Analogue Scale). During the examination from baseline at the times of follow-up. Secondary endpoints by a neurologist and trauma (including neuromyography, included the occurrence of new clinical fractures and clinical/ MRI of the brain and spinal cord etc.) the organic causes laboratory adverse events. of the complaints were not found. In this connection, the Results: Seventy-two women were enrolled and randomized doctors suspected psychosomatic disorders. The patient to intravenous CLD600 (n=45; mean age±SD, 65±6 years) was sent to the appointment to the psychotherapist, where or intramuscular CLD100 (n=27; mean age±SD, 67±7 woman`s everyday problems were discovered, so the ther- years). The two groups were comparable with regard to apy was started. baseline characteristics (including alkaline phosphatase and Results: During the therapy, it was found out that the uncon- weight). LS-BMD showed a significant increase from base- scious irritation was in relation to the employer, the unwilling- line after one and two years in both groups. After two ness to come to her job and this collective and do unloved years, patients in the intravenous CLD600 group business were cause of pain and rigor, which appear in defined (4.0±5.7%) demonstrated a significantly greater moments and situations. mean% change of LS-BMD compared to those in the intra- Just full consciousness of this problem has led to the removal muscular CLD100 group (2.6±3.6%, p <.05). FN-BMD and of anxiety in the patient, reduction of pain in the hand to 3 TH-BMD did not significantly change from baseline after points, and advance in the direction of treatment. So, after one or two years. Mean% change of FN-BMD after two three months of the therapy the patient got rid of the pain (0 years was 1.6±5.2% in the CLD600 group and 0.8±3.5% in out of 10), rigor and irritability disappeared. Complaints are the CLD100 group. The corresponding figures for TH- not coming back anymore. BMD were respectively 1.8±5.0% for the CLD600 group Conclusion: Despite numerous guidelines in diagnosis and and 0.9±4.5% for the CLD100 group. No clinical or labo- treatment of musculoskeletal diseases, there are still diagnosis ratory relevant adverse event was recorded during the study and treatment mistakes due to the psychological component is period. Two patients in the CLD600 group and one in the not taken into account and is not perceived as a cause of CLD100 group presented with a new non-vertebral fracture disease. So, we need to improve the guidelines for diagnosis after two years. and treatment of musculoskeletal diseases, taking into account Conclusions: Our results confirmed previous findings on the patient's psychological status. BMD with intramuscular/intravenous clodronate, suggesting that an increase in the weekly/monthly doses may potentially produce greater improvements of BMD. P374 EFFECT OF TWO DIFFERENT THERAPEUTIC REGIMENS OF CLODRONATE ON BONE MINERAL P375 DENSITY IN WOMEN WITH POSTMENOPAUSAL RELATIONSHIPS BETWEEN MARKERS OF OSTEOPOROSIS: A 2-YEAR RANDOMIZED TRIAL INFLAMMAGING AND BONE MICROARCHI- A. Giusti1,G.Girasole1, V. Garzia1, V. Siccardi1,A. TECTURE: FINDINGS FROM THE HERTFORDSHIRE Locaputo1,P.Diana1,M.Ponte1, G. Bianchi1 COHORT STUDY 1Department of Locomotor System, Division of Rheumatology, N. R. Fuggle1,L.D.Westbury1, H. E. Syddall1,N.A. ASL3 Genovese, Arenzano, Italy Duggal2,E.M.Dennison3,J.Lord2,C.Cooper3 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S261 1MRC Lifecourse Epidemiology Unit, University of P376 Southampton, Southampton, United Kingdom, 2Institute of PREVALENCE OF PRIOR MAJOR OSTEOPOROTIC Inflammation and Ageing, University of Birmingham, FRACTURES (MOF) IN ADULTS PRESENTING Birmingham, United Kingdom, 3Musculoskeletal WITH HIP FRACTURE – LIMITATIONS AND Epidemiology, Botnar Research Centre, Nuffield SCOPE FOR FRACTURE LIAISON SERVICES (FLS) Department of Orthopaedics, Rheumatology and IN PREVENTION OF HIP FRACTURE Musculoskeletal Sciences, University of Oxford, Oxford, B. Abrahamsen1,A.Frederiksen1,P.B.Johansen1,H.A. United Kingdom Sørensen1 Objectives: It has been suggested that low grade inflamma- 1Holbæk Hospital, Department of Medicine, Holbæk, tion may impact musculoskeletal health in older adults. The Denmark aim of this study was to examine the association between indices of inflammaging and bone mineral density (BMD) in Objective: To examine the prevalence of prior MOF in the a population-based cohort of older adults in the United past ten years preceding hip fracture in order to provide infor- Kingdom. mation about the potential for prevention of future hip frac- Materials and Methods: A sample of 365 participants of tures by FLS initiatives. the Hertfordshire Cohort Study (free-living, older adults) Methods: We included Danes aged 50+ with surgically were recruited. Dual energy X-ray absorptiometry (DXA) treated hip fracture in 2010 (N=8,158) using the Danish was performed at the lumbar spine and proximal femur Hospital Discharge Register. The prevalence of prior at baseline and repeated at a median of 4.5 years (inter- fractures was determined by using data for in- and out- quartile range 3.6 to 5.2). DXA outcomes included both patient treatment with a look-back of ten years. A prior level and change in both total lumbar spine and total hip fracture was only included as a prior fracture if femoral neck BMD. Inflammaging markers were occurring more than 6 months before the present ascertained at baseline using enzyme-linked immunosor- fracture. bent assay (ELISA) techniques and Bio-Plex Pro Assays. Results: A total of 30% of hip fracture patients (33% of wom- Gender-adjusted linear regression was used to examine en and 22.8% of men) had at least one MOF in the preceding the associations between inflammaging markers and out- 10 years. Colles- and humerus fractures constituted >70% of comes with and without adjustment for anthropometric prior MOF. and lifestyle factors. Men were less likely than women to have experienced a prior Results: The mean (SD) ages at baseline were 64.4 (2.5) MOF in the last ten years prior to their hip fracture, chiefly due and 66.5 (2.7) years for men and women respectively. to a lower prevalence of prior Colles and humerus fractures. Lumbar spine BMD increased over follow up in men and women; with a mean (SD) annual change of 0.007 (0.009) and 0.003 (0.014) g/cm2 respectively. Women ex- perienced a mean annual decrease in femoral neck BMD of 0.005 (0.01) g/cm2, however, no decrease was observed in men. Higher levels of IL-1β and adiponectin:leptin ratios were each associated with lower baseline lumbar Summary and conclusions: Despite the clear importance of spine and femoral neck BMD in gender-adjusted FLS, clinicians should be aware that the majority of hip frac- (p<0.04) and fully-adjusted (p<0.05) analyses. Higher tures in women, and in particular men, occur without a prior levels of IL-8 and lower levels of TNFα were each asso- MOF that could have resulted in early detection and treatment ciated with accelerated decline in lumbar spine BMD in of osteoporosis, hence other means of case finding remain both gender-adjusted (p<0.02) and fully-adjusted (p<0.05) very important. With current treatment modalities a maximum analyses. of one in six hip fractures in Denmark can be prevented Conclusions: In a cohort of older adults, high levels of through FLS initiatives. the pro-inflammatory mediator IL-1β and raised adiponectin:leptin ratio are both associated with lower BMD at the lumbar spine and femoral neck at baseline, P377 andhighIL-8andlowTNFα were associated with accel- RISK OF FALL IN PATIENTS WITH KNEE OSTEOAR- erated decline in BMD at the lumbar spine. This adds THRITIS weight to the theory that bone health can be influenced M. Vukovic1, S. Nejkov1, V. Bokan-Mirkovic1, Z. Skaric- by both immune activation and alterations in adipokine Karanikic1 homeostasis. These findings offer avenues for future re- 1Center of Physical Medicine and Rehabilitation, Clinical search to further investigate these relationships. Center of Montenegro, Podgorica, Serbia S262 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Objectives: The aims of this study were to assess the prev- Objective: To study the association between setting of thera- alence of falls in patients with knee osteoarthritis (KOA), py initiation, previous treatment history the 1 and 2-year drug to evaluate balance and risk of fall in these individuals and persistence of anti-osteoporosis drugs (AOD) in primary care. the impact of pain and body mass index (BMI) on their Material and Methods: Cohort study using the SIDIAP da- stability. tabase (www.sidiap.org). Inclusions: women aged ≥50 years, Material and Methods: 34 subjects mean ages 62.35±7.25 incident users of any anti-osteoporosis medication (2012) with included in this study (all over the age of 50). Gender data available for at least 12 months prior to therapy initiation. distribution- male 7 and female 27. Risk of fall was assessed Exclusions: bone diseases/treatments (other than osteoporo- using Tinetti Falls Efficacy Scale (TFES) and Five Times Sit sis), drugs with <100 users. Follow up: from 1st pharmacy to Stand Test (FTSST), intensity of pain by Visual Analogue dispensation until end of follow-up (death, moving out or data Scale (VAS). TFES assesses perception of balance and stabil- extraction date, switching or treatment cessation, whichever ity during activities of daily living and fear of falling in the came first). Persistence definition: concatenated pharmacy elderly population. Total scores can range from 10 to 100, dispensations of index drug (90 days permissible gap). Users lower scores indicate more confidence and higher scores indi- of alendronate were compared to other oral bisphosphonates, cate lack of confidence and greater fear of falling. The inter- strontium ranelate, SERMs, teriparatide and denosumab. pretation of FTSST: time ≥ 12 sec need of further assessment Multivariable Cox regression models were used to estimate for fall risk, time > 15 sec is the optimal cutoff time in Hazard Ratios of therapy cessation according to drug used. predicting recurrent fallers. Results: A total of 19,267 women were identified as incident Results: 11 (32.35%) patients had falls in previous 3 years. users of anti-osteoporosis medication in 2012. Previous drug Mean value of TFES 27.50±12.42, mean values of VAS use history did not affect 1 or 2-year persistence: HR of 1.00, 5.29±1.73, median of FTSST is 20.4 (13-52.68). There is 95% CI 0.96-1.06 and 1.02, 95% CI 0.98-1.07 respectively. a significant moderate positive correlation between TFES Compared to primary care, treatment initiation in secondary and FTSST (S=2295.9, Spearman's rank correlation care was associated with a higher risk of 1 and 2-year cessa- coeff=0.649,p <0.001), moderate positive correlation be- tion (HR 1.30, 95%CI 1.22-1.39 and 1.15, 95%CI 1.08-1.23 tween TFES and VAS by Test for Pearson’s correlation respectively). (t=3.8143, df=32, p <0.001, correlation coeff.=0.559) and Conclusions: Persistence with anti-osteoporosis medications moderate positive correlation between FTSST and VAS was not influenced by previous treatment, whilst setting of (S=3362, Spearman's rank correlation coeff=0.486, therapy initiation seemed to be important: those initiating ther- p<0.001). Median of BMI 29.395 (20.88-43.23) which apy in primary care had a 30% and 15% improved 1 and 2- classifies these patients as overweight. There is a signifi- year persistence respectively. cant moderate positive correlation between FTSST and Disclosure: Amgen S.A provided funding for this study. BMI (S=3586.5, Spearman's rank correlation coeff=0.452, Amgen provided comments on the design of the study proto- p=0.007). col and the analysis plan. The final protocol and analysis plan Conclusions: Patients with KOA belong to group of patients were mutually agreed by SIDIAP and Amgen, based on the with risk of recurrent falls by FTSST. Pain and higher BMI are principle of the “best science known in the research predictor of poorer stability in these patients. field”. Amgen also provided comments on the abstract prior to its submission. However, SIDIAP alone decided whether to incorporate Amgen’scomments. P378 1 AND 2-YEAR PERSISTENCE WITH DIFFERERENT ANTI-OSTEOPOROSIS MEDICATIONS PER PREVIOUS P379 USE AND SETTING OF THERAPY INITIATION: A CALLUS EXTRACT FROM RESVERATROL- POPULATION-BASED COHORT STUDY ENRICHED SYNTHETIC RICE INDUCES DEDIFFE- C. Reyes1, C. Tebe2, D. Martinez-Laguna3, M. S. Ali4,A. RENTIATION THROUGH THE ERK-1/2 PATHWAY Soria-Castro3, C. Carbonell3,D.Prieto-Alhambra5 AND INFLAMMATION THROUGH THE MAPK AND 1Idiap Jordi Gol, Barcelona, Spain, 2Bellvitge biomedical re- PI3K/AKT PATHWAYS IN RABBIT ARTICULAR search institute and Rovira i Virgili University, Barcelona, CHONDROCYTES Spain, 3Institut Catala de la Salut and IDIAP Jordi Gol, S. J. Kim-Kongju National University, Gongju1,S.H.Eo1 Barcelona, Spain, 4Oxford NIHR Musculoskeletal 1Department of Biological Sciences, Gongju, Republic of Biomedical Research Unit, Oxford, United Kingdom, Korea 5Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford and IDIAP Jordi Gol, Oxford, United Purpose: Resveratrol has antioxidant property, anti- Kingdom inflammatory effect, and prevents cardiovascular disease in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S263 human body. Resveratrol transgenic rice line Iksan526 was elastography for the diagnosis of cirrhosis, computer model identified as one intergenic insertion locus by two copies with analysis of joint synovial and DXA test for the evidence of inverted repeats conjunction structure and expected mRNA osteoporosis [1, 2, 3]. expression and resveratrol production. However, the effects of Results: Although we found low levels of serum Mg at 14 IS526, an extract of resveratrol-enriched rice, on differentiation patients and erythrocyte Mg at 28 patients, there was a posi- and inflammatory response in normal cells, including tive correlation between serum and erythrocyte levels chondrocytes, and the mechanism underlying these effects are (r=0,51). Potassium had a different tendency since 12 patients not clearly understood. In this study, we investigated the mo- had low levels of serum K and 15 patients of erythrocyte K, lecular mechanisms of IS526 in chondrocytes. with a high positive correlation between serum and erythro- Methods: Rabbit articular chondrocytes were prepared from cyte values (r=0,89). We also found a positive correlation cartilage slices of 2-week-old New Zealand white rabbits. between erythrocyte levels of Mg and K (r=0,66). Ca serum Primary chondrocytes were treated with various concentration levels were low at 10 patients and erythrocyte levels in 15 of IS526 (50–300 μg/mL) for 24 h or with 175 μg/mL IS526 patients with positive correlation between serum and erythro- for the indicated time periods. The type II collagen and COX- cyte levels (r=0,65). 2, p38, pERK expression levels were determined by western Characteristic symptoms of magnesium deficit were only blot analysis and reduction of sulfated proteoglycan synthesis observed at 7 patients. Further 17 patients had clinical detected by Alcian blue staining. signs of latent tetany and also 23 patients had electromyo- Results: IS562-induced a loss of type II collagen and de- graphic changes, both spontaneous and after the Trousseau creased sulfate proteoglycan levels in a dose- and time- test, even though most patients were normocalcemic [4, 5, dependent manner. In addition, IS526 caused an inflammatory 6, 7]. The computer analysis of electromyographic changes response by inducing the expression of cyclooxygenase-2 indicated a positive correlation between the duration and (COX-2). Furthermore, after treatment with IS526, phosphor- the number of multiplets and erythrocyte Mg levels. We ylation of mitogen-activated protein kinase proteins (ERK and also found a positive correlation between the latency time p38) and Akt in rabbit articular chondrocytes. The inhibition of evoked potentials recorded on electroencephalography of ERK, p38 and PI3K/Akt with PD98059, SB203580, and erythrocyte Mg levels at the patients with normal LY294002, suppressed IS526-induced decrease in type II col- blood ammonia levels. In our study we performed DXA lagen and COX-2 expression. tests and we encountered a number of 16 patients with Conclusions: The results suggest that the IS526 stimulates different stages of osteoporosis [8]. differentiation via the ERK-1/2 pathway and inflammation Conclusion: Cirrhosis-related osteoporosis is a condition that via the ERK, p38, and Akt signaling pathways in rabbit artic- needs to be treated and studies so far admit that Calcium and ular chondrocytes. Vitamin D supplementation are insufficient to contrast the bone loss whereas administration of bisphosphonates are safe and sufficient for cirrhosis-related osteoporosis. P380 References: CORRELATIONS BETWEEN CALCIUM, MAGNE- 1. López-Larramona G et al. J Gastrointestin Liver Dis SIUM AND POTASSIUM DEFICIENCY AND 2013;22:221. OSTEOPOROTIC STATUS IN PATIENTS WITH LIVER 2. Rogoveanu OC et al. Rom J Morphol Embryol CIRRHOSIS 2016;57(Suppl 2):697. O. C. Rogoveanu1,F.Ghergina1,D.N.Florescu2,R. 3. Arteh J et al. Dig Dis Sci 2010;55:2624. Traistaru1 4. George J et al. World J Gastroenterol 2009;15:3516. 1Department of Physical Medicine and Rehabilitation, 5. Kizilgul M et al. Indian J Gastroenterol 2016;35:253. University of Medicine and Pharmacy, Craiova, Craiova, 6. Chinnaratha MA et al. Intern Med J 2015;45:1230. Romania, 2Department of Gastroenterology, University of 7. Mogoşanu GD et al. Biol Trace Elem Res 2016;172:277. Medicine and Pharmacy, Craiova, Craiova, Romania Objective: To evaluate the correlation between magnesium P381 (Mg), calcium (Ca), potassium (K) deficiencies and clinical, SERUM AND SYNOVIAL FLUID LEVELS OF THE electromyographic, electroencephalographic or DXA test ALTERNATIVE MACROPHAGE ACTIVATION changes observed at the patients with liver cirrhosis. PATHWAY REGULATORS (CHIT 1/CCL18) AS Material and methods: We studied 30 patients with liver EARLY BIOMARKERS OF PERIPROSTHETIC cirrhosis. Mg, Ca and K deficiency were evaluated by serum OSTEOLYSIS and tissue (erythrocyte) levels. All the patients were assessed A. Karamitros1,S.K.Trehan2,L.Zambrana2,J.Jo3,E. clinically, with biochemical analysis, ultrasonography and Purdue4,J.T.Nguyen5, J. M. Lane6 S264 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 11st Dept. of Orthopaedics, 251 Hellenic Air Force General P382 Hospital, Athens, Greece, 2Department of Orthopaedic HUMERAL FRACTURES ASSOCIATED WITH OSTEO- Surgery, Hospital for Special Surgery, New York, United POROSIS States, 3Department of Orthopaedic Surgery, Hospital for O. C. Rogoveanu1, R. Traistaru1,D.Kamal1,F.Gherghina1 Special Surgery, New York, Greece, 4Osteolysis Research 1Department of Physical Medicine and Rehabilitation, Laboratory, Hospital for Special Surgery, New York, United University of Medicine and Pharmacy of Craiova, Romania, States, 5Healthcare Research Institute, Hospital for Special Craiova, Romania Surgery, New York, United States, 6Department of Orthopaedic Surgery, Hospital for Special Surgery, New Objective: To assess osteoporosis in patients with humeral York, United States fractures by using DXA tests during recovery. Humeral frac- tures have increasing frequency mainly due to domestic acci- Objective: Periprosthetic osteolysis (PPO) is the most frequent dents and road vehicles accidents with side impact. cause for total hip replacement (THR) failure. Currently, PPO Material and Methods: The study included a total of 136 diagnosis occurs in advanced stages, often necessitating com- patients hospitalized in Orthopedics Clinic at Emergency plex revisions due to extensive bone loss. PPO biomarkers could County Hospital Craiova, Romania between 2012-2016 and facilitate earlier diagnosis. Alternative macrophage activation who benefited rehabilitation treatment after orthopedic treat- pathway regulators, CHIT1 and CCL18, have increased expres- ment in the Medical Clinic of Rehabilitation and Physical sion in patients undergoing revision THR for osteolysis. We Medicine of the same hospital or in ambulatory specialization. hypothesized that synovial fluid and serum levels of CHIT1 Most patients were of older age, which correlated with a num- and CCL18 would be increased in patients undergoing revision ber of predisposing factors. THR for PPO vs. controls without osteolysis. Results: The analysis of the humeral fracture type revealed in Material and Methods: All revision metal-on-polyethylene preponderance surgical neck fractures followed by fractures of THR patients were screened pre-operatively. Patients with the humeral head. In 84 cases (61.7%) we found the existence active/prior infection, previous revision(s), metabolic/ of fracture displacement and in 22 cases (16.2%) we discov- rheumatologic conditions and/or medications affecting bone me- ered open fractures with extensive skin lesions [1]. tabolism, were excluded. According to a priori power analysis, 30 Neurological lesions were relatively rare (11 cases - 8.1%) patients were enrolled. Twenty “osteolysis” patients underwent and were due to lesions of the circumflex nerve in the fracture revision for PPO (based on imaging and operative reports). Ten path or vicious callus formation that sometimes required the “controls” had stable implants and revision for instability (9) or differential diagnosis with upper limb bone tumors [2]. mechanical symptoms (1). Pre-operative serum and intra- All patients followed DXA test which was performed during operative synovial fluid samples were collected. CHIT1, initiation of the recovery therapy at 6 and 12 weeks. A total of CCL18, RANKL and OPG were quantified via ELISA. 71 patients had changes which consisted of various stages of Significance was assessed via two-tailed Fisher’s Exact test. osteoporosis prior to the start physical recovery program. All Results: Among osteolysis and control patients, 11/20 and 4/10 patients received massage and electrotherapy with analgesic were male, average age was 68 and 63 years, 9/20 and 3/10 had and muscle relaxant effect to whom we associated Codman cemented femoral components, and average implant longevity exercises [3, 4]. Rehabilitation included kinetotherapy for the was 15 and 5 years, respectively. CHIT1 was significantly in- recovery of movements in neighboring joints fracture, resto- creased in the osteolysis vs. control patients’ synovial fluid ration of muscle tonicity and trophicity, as well as ability sta- (3,727 vs. 731 nM. p<0.01) and serum (98 vs. 39 nM, bility and muscle control. We also administrated calcium, vi- p<0.01). CCL18 levels were significantly increased in tamin D and bisphosphonates [5, 6, 7]. Rehabilitation program osteolysis vs. control patients’ synovial fluid (425 vs. 180 revealed very good recovery without sequelae in 128 patients nM, p<0.01), but not serum. There were no significant differ- (94.1%) and with remission of prior osteoporosis changes in ences in RANKL or OPG serum concentrations between 58 of 71 patients (81.6%) [8, 9]. groups. Conclusion: Pairing a complex program of rehabilitation with Conclusions: In this prospective case-control study, CHIT1 physical therapy which includes therapy containing calcium, was identified as a novel synovial fluid and serum biomarker vitamin D and bisphosphonates allows recovery of mobility of PPO. CHIT1 expression is induced during macrophage and regression osteoporotic changes in most patients with activation in response to wear debris. CHIT1 monitoring fractures of the humerus. may facilitate early diagnosis of THR PPO and consequent References: avoidance of complex revisions due to implant loosening and/ 1 Neer CS. J Bone Joint Surg Am 1970;52:1077. or bone loss. Furthermore, CHIT1 may represent a novel ther- 2. Trăistaru R et al. Rom J Morphol Embryol 2011;52:1377. apeutic target for PPO. 3. Elliot-Gibson V et al. Osteoporos Int 2004;15:767. IRB: Hospital for Special Surgery #2015-159 4. Solomon DH et al. Am J Med 2004;117:919. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S265 5. Kim TY et al. J Bone Joint Surg Br 2012;94:956. group was 42.16 and 51.96 in the control group, t- 6. Mogoşanu GD et al. Biol Trace Elem Res 2016;172:277. test<0.001. 7. Li YT et al. Osteoporos Int 2015;26:431. Conclusion: Based on the obtained results, we concluded that 8. Fleisch H. J Bone Miner Res 2001;16:437. daily physical activity lasting more than sixty minutes has a 9. Castro-Lionard K et al. Drugs Aging 2013;30:1029. very significant impact on the prevention of falls and osteo- porotic fractures. References: P383 1. Boskovic K et al. Med Pregl 2013;66:221. RISK ASSESSMENT FOR THE FALL IN THE PRE- 2. Boskovic K (ed), Tomasevic-Todorovic S, Vasic J, Zvekic- VENTION OF OSTEOPOROTIC FRACTURES IN Svorcan J, Novakovic-Paro J, Protic-Gava B, Obradović B, RELATION TO THE PHYSICAL ACTIVITY OF THE Doder R, Knezevic A. Osteoporosis, physical activity and ELDERLY nutrition. Monograph, Novi Sad, Faculty of Medicine, 2014. K. Boskovic1,D.Simić-Panić1,M.Grajic2,J.Ivacic3,S. 3. Tsonga T et al. Open Orthop J 2016;10:522. Tomasevic-Todorovic1,A.Knežević1,S.Kevic4 1Faculty of Medicine, University of Novi Sad, Medical reha- bilitation clinic, Clinical center of Vojvodina, Serbia, Novi P384 Sad, Serbia, 2Fakulty of Medicine, University of Belgrade, DENOSUMAB DISCONTINUATION AND REBOUND- Serbia, Belgrade, Serbia, 3General hospital Senta, Serbia, ASSOCIATED VERTEBRAL FRACTURES: CLINI- Senta, Serbia, 4Medical rehabilitation clinic, Clinical center CAL CHARACTERISTICS IN 24 PATIENTS of Vojvodina, Serbia, Novi Sad, Serbia A. D. Anastasilakis1,S.A.Polyzos2,P.Makras3,B.Aubrey- Rozier4, S. Kaouri5, O. Lamy6 Objective: In the elderly the common causes of disability, 1Department of Endocrinology, 424 Military Hospital, morbidity and mortality are falls and osteoporotic fractures. Thessaloniki, Greece, 2 Aristotle University of Since osteoporotic fractures often require ongoing medical Thessaloniki, Thessaloniki, Greece, 3Department of care and expensive treatment, and given that their incidence Endocrinology and Diabetes, 251 Hellenic Air Force is increasing by 2% per year, falls are a significant public General Hospital, Athens, Greece, 4Center for Bone health problem. The aim of this study was to evaluate by the Diseases, Lausanne University Hospital, Lausanne, means of co-ordination and balance assessment whether phys- Switzerland, 5Endo center, Limassol, Cyprus, 6Center of ical activity has an impact on the prevention of falls and oste- Bone Diseases, Lausanne University Hospital Switzerland, oporotic fracture occurrence. Lausanne, Switzerland Material and Methods: The study included 50 patients, 12 menand38womenagedfrom65to87years;divided Objective: To study the clinical and imaging characteristics of into two groups. The experimental group consisted of 25 patients sustaining vertebral fractures after denosumab elderly participants who were active on a daily basis for discontinuation. more than 60 minutes, while the control group was made Methods: Computerized advanced literature search iden- of 25 participants who were active less than 60 minutes tified 13 cases. Another 11 new cases are reported from per day. Groups were age and sex matched. To asses bal- our centers. ance and co-ordination and fall risk we used Get up and Results: Twenty-four postmenopausal women with verte- go test, Timed get up and go test, Morse scale of risk for a bral fracture(s) following denosumab discontinuation, fall, Chair Rising test as well as the Berg Balance Scale. experiencing 112 fractures in total, were analyzed. The The study was anonymous. mean number of fractures per patient was 4.7. The most Results: The results showed a statistically significant dif- commonly affected vertebrae were T12 and L1. All frac- ference between the experimental and control group for tures occurred 2 to 10 months after the last denosumab almost all tests. The average value of the Get up and go injection effect was depleted. 83% of the patients were test, was significantly higher in the experimental group treatment naïve, while 33% had prevalent vertebral frac- (3.0 vs. 1.48 t-test <0.001). The average value of Timed tures. Five (23%) patients were on concurrent aromatase up and go test, in the experimental group was 11.64 and inhibitor treatment. When patients were divided accord- 8.64 in the control group, t-test <0.001. The average value ing to treatment duration with an arbitrary cut-off of two of Chair Rising test in the experimental group was 11.2 and years, those with ≤ 2 years of denosumab treatment had in the control 15.28, t-test<0.001. The average value of less fractures compared with those with > 2 years (mean Morse scale of risk for a fall in the experimental group ±SEM fractures 3.2±0.7 vs. 5.2±1.4, p=0.055). was 22.0 and 34.2 in the control group, t-test<0.01. The Vertebroplasty was used in five patients, resulting in ad- average value on Berg Balance Scale in the experimental ditional clinical vertebral fractures in all cases. S266 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Conclusions: Vertebral fracture(s) following denosumab dis- Results: We assessed 140 women, mean aged 74.9±8.8 continuation are in the majority of the patients multiple and years, with a mean BMI of 26.1±3.9 kg/m2.Resultsare they occur a few months after the effect of the last dose was reported in Table 1. depleted. Therefore, patients should not delay or omit denosumab doses. Fractures are typically osteoporotic, locat- ed at the lower thoracic and the upper lumbar spine. Vertebroplasty is an unsuccessful treatment strategy for such patients. Disclosures: A. D. Anastasilakis has received lecture fees from Amgen, Eli-Lilly, ITF Hellas, ELPEN, VIANEX. P. Makras has received lecture fees and research grants from Amgen; lecture fees from Glaxo, Lilly, Pfizer, Leo, Genesis, Conclusions: Our data analysis demonstrated that 1-year ELPEN, VIANEX. S. A. Polyzos has received lecture fee treatment with denosumab was significantly effective in from Amgen. O. Lamy has received research grants and lec- reducing back pain related disability and in improving ture fees from Amgen, Eli-Lilly and Takeda BMD and HRQoL in a cohort of postmenopausal wom- en with at least one vertebral fracture. P385 EFFECTIVENESS OF DENOSUMAB IN REDUCING P386 BACK PAIN AND IN IMPROVING BONE MINERAL RELATIONSHIP AMONG VISCERAL ADIPOSE DENSITY AND HEALTH RELATED QUALITY OF TISSUE, SERUM LEVELS OF 25-HYDROXYVITAMIN LIFE: 1-YEAR FOLLOW-UP PROSPECTIVE STUDY D3, MUSCLE MASS AND FUNCTION: A RETROS- IN POSTMENOPAUSAL WOMEN WITH PECTIVE STUDY 1 1 1 2 VERTEBRAL FRAGILITY FRACTURES D. Calafiore , A. de Sire , L. Stefano , F. Gimigliano ,G. 1 A. de Sire1,A.Moretti1,G.DiPietro1,C.Curci1,A. Iolascon 1 Mazzola1, F. Gimigliano2,G.Iolascon1 Department of Medical and Surgical Specialties and 1Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 2 Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy, Department of Physical and Mental Health Naples, Italy, 2Department of Physical and Mental Health and Preventive Medicine, University of Campania "Luigi and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy Vanvitelli", Naples, Italy Objective: To assess the relationship among visceral adipose Objective: To assess the effectiveness of denosumab in reduc- tissue (VAT), serum levels of 25-hydroxyvitamin D3 ing back pain related disability and in improving bone mineral [25(OH)D3], and muscle function in a cohort of postmeno- density (BMD) and Health Related Quality of Life (HRQoL) pausal women. in osteoporotic postmenopausal women with vertebral Material and Methods: In this retrospective case-control fractures. study, we analyzed data of a cohort of postmenopausal Material and Methods: We enrolled women aged ≥50 years women referring to an outpatient clinic for the manage- with a diagnosis of postmenopausal osteoporosis that had ment of osteoporosis and sarcopenia. In absence of cut- experienced at least one vertebral fragility fracture. We ad- off of VAT mass recognized by international guidelines, ministered subcutaneous denosumab (60 mg/every 6 we divided the population according to the median val- months) and a supplementation of calcium carbonate (500- ue in two groups (VAT mass ≥814 g vs. VAT mass 1000 mg/day) and cholecalciferol (800 IU/day) for 1 year. <814 g). We assessed serum levels of 25(OH)D3, ap- We assessed at the baseline (T0), after 6 months (T1), and pendicular lean mass (ALM), muscle strength, using after 12 months (T2) of treatment the following outcomes: Hand Grip Strength (HGS) and Knee Extension back pain related disability, assessed by Spine Pain Index Strength (KES), and physical performance, with the (SPI), and HRQoL, using the 12-Item Short Form Health Short Physical Performance Battery (SPPB) and 4- Survey (SF-12), with Physical (PCS) and Mental Health meter-gait speed (4MGS). Composite Scores (MCS) and the European Quality of Results: Of the 368 women (mean aged 67.23±7.73 years), Life - 5 Dimensions - 3 Levels (EuroQol-5D-3L) index 180 (mean aged 64.39±7.59 years) had a VAT mass <814 g (EQ-5D-3L index) and the EuroQol-Visual Analogue Scale and 188 (mean aged 69.88±6.77 years) had a VAT mass ≥814 scores (EQ VAS). Moreover, we evaluated lumbar spine g. Differences in outcome measures between groups are (LS) and femoral neck (FN) BMD at T0 and T2. showed in Table 1. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S267 6.56; p<0.001), and performance (SPPB≤8) (OR 5.58; p<0.001) compared to controls. The normoweight women with hypovitaminosis D had only a greater risk of an impair- ment of muscle strength (OR 6.68; p<0.001) and performance (OR 3.90; p<0.001). Overweight with normal levels of 25(OH)D3 had not significant impairments. Conclusions: In our cohort, separately considering the condi- tions, only the hypovitaminosis D is associated with a higher risk of a muscle function deficit, but the association of Conclusion: In our cohort of postmenopausal women, higher hypovitaminosis D and overweight leads to a significant risk values of VAT mass were significantly associated with lower of having an impairment of both muscle mass and function in levels of 25(OH)D3, a reduced muscle strength, and a reduced postmenopausal women. physical performance. In conclusion, VAT seems to be a pa- rameter that should be assessed in order to better define bone and muscular health in postmenopausal women. P388 MUSCULOSKELETAL IMPAIRMENT IN A PATIENT AFFECTED BY A MUTATION OF THE HUMAN P387 LAMININ ALFA5-CHAIN GENE: CASE REPORT COULD THE COEXISTENCE OF VITAMIN D S. Liguori1,A.deSire1, M. Paoletta1, F. Gimigliano2,G. DEFICIENCY AND OVERWEIGHT HAVE AN Iolascon1 ADDITIVE NEGATIVE EFFECT ON MUSCLE MASS 1Department of Medical and Surgical Specialties and AND FUNCTION? A RETROSPECTIVE ANALYSIS IN Dentistry, University of Campania "Luigi Vanvitelli", A COHORT OF POSTMENOPAUSAL WOMEN Naples, Italy, 2Department of Physical and Mental Health A. Camerlingo1, A. de Sire1,E.Covella1,D.Calafiore1,F. and Preventive Medicine, University of Campania "Luigi Gimigliano2, G. Iolascon1 Vanvitelli", Naples, Italy 1Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Objective: To evaluate the musculoskeletal health status of a Naples, Italy, 2Department of Physical and Mental Health woman affected by a mutation of the human laminin alfa5- and Preventive Medicine, University of Campania "Luigi chain(LAMA5) gene, based on an evaluation protocol for Vanvitelli, Naples, Italy primitive muscle diseases. Material and Methods: We evaluated the patient using a Objective: To prove if the association of hypovitaminosis D protocol for neuromuscular diseases, including: passive range and overweight could exert an additive effect on muscle mass of motion (pROM) of all involved joints; Manual Muscle and function in postmenopausal women. Testing (MMT); North Star Ambulatory Assessment Methods: In this retrospective study, we analyzed data from (NSAA); Functional Ambulation Categories (FAC); Tinetti postmenopausal women, defining as hypovitaminosis D se- Performance Oriented Mobility Assessment (POMA); rum levels of 25(OH)D3 <30 ng/ml and as overweight women Functional Independence Measure (FIM); Fatigue Severity with a BMI of 25-29.9 kg/m2. We divided the population into Scale (FSS); laboratory exams specific for bone metabolism; 4 groups: 1) normal weight with hypovitaminosis D; 2) over- assessment of bone mineral density (BMD) by Dual-energy weight with normal levels of 25(OH)D3; 3) overweight with X-ray Absorptiometry (DXA); the Vertebral Fracture hypovitaminosis D; 4) normoweight with normal levels of Assessment (VFA); Trabecular Bone Score (TBS); Hip 25(OH)D3, considered as controls. We assessed: muscle Structural Analysis (HSA). mass, with the appendicular lean mass-to-BMI ratio (ALM/ Results: The woman, aged 59 years, with a body mass index BMI); muscle strength, using Hand Grip Strength (HGS); of 25.7 kg/m2, was affected by a disease of connective tissue physical performance, with the Short Physical Performance with a heterogeneous clinical picture. After the administration Battery (SPPB). of our specific protocol for neuromuscular diseases, the scores Results: We divided 368 women of 67.2±7.7 years in 4 obtained in the individual scales were: NSAA=12; FAC=3; groups: 95 normoweight with hypovitaminosis D; 90 over- FIM=96; POMA=11; FSS=54. The bone metabolism labora- weight with normal levels of 25(OH)D3; 96 overweight with tory exams were: PTH=33.7 pg/ml, serum calcium=9.4 mg/dl, hypovitaminosis D; 87 normoweight with normal levels of urinary calcium=143.5 mg/24h, 25-hydroxyvitamin D3=22.1 25(OH)D3. Overweight women with hypovitaminosis D had ng/ml, and alkaline phosphatase=87 U/l. The DXA examina- a significantly increased risk of a muscle mass deficit (ALM/ tion showed: lumbar spine BMD=0.812 g/cm3, Ts=-3.1 SD, BMI<0.512) (OR 4.16; p<0.001), strength (HGS<16kg) (OR Zs=-2.2 SD; femoral neck BMD=0.692 g/cm3, Ts=-2.4 SD, S268 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Zs=-1.5 SD. The VFA showed: mild wedges in T8 and T9, the modulation of the RANKL circulating levels. moderate wedges in T10 and T11. The TBS was 1,119; from Accordingly, ex vivo, HC was found to stimulate osteoblast the HSA we obtained the following parameters: Hip Axis activity (+300% mineralised area) while repressing osteoclast Length: 108.4 mm, Femoral Strength Index: 0.9, Cross formation (-60%). Sectional Moment of Inertia: 7,469 mm4, Cross-Sectional Conclusion: HC may stand as a relevant nutritional opportu- Area: 104 mm2, Section Modulus: 450, Buckling Ratio: nity in the design of innovative strategies to manage bone 20,40, and the Neck Shaft Angle=57°. This patient showed a health conditions. difficulty in balance and gait, a moderate perception of the Keywords: Metabolites; Bone; Hydrolysed Collagen; sensation of fatigue, hypovitaminosis D, severe osteoporosis Nutrition; Osteoporosis with multiple fragility fractures, and an altered bone microarchitecture. Conclusions: This complex patient had a heterogeneous clin- P390 ical picture and an adequate management of the musculoskel- NEGLECTED FRAGILITY HIP FRACTURE IN etal health status is mandatory in rare primitive muscle dis- CEREBRAL PALSY eases, such as the mutation of the LAMA5. G. Toro1,M.Bianco1, A. Toro2, G. Calabrò2,S.Mozzillo3,F. Gimigliano4,G.Iolascon1 1Department of Medical and Surgical Specialties and Dentistry, P389 University of Campania "Luigi Vanvitelli", Naples, Italy, 2Unit HYDROLYSED COLLAGEN PROMOTES BONE of Orthopaedics and Traumatology, Sarno, Italy, 3Department of HEALTH IN OVARIECTOMIZED MICE THROUGH Medical and Surgical Specialties and Dentistry, University of THE MODULATION OF BOTH THE OSTEOBLAST Campania, Naples, Italy, 4Department of Physical and Mental AND OSTEOCLAST ACTIVITIES Health and Preventive Medicine, University of Campania A. Daneault1,2,3,J.Prawitt4,V.Coxam1,2,J.Guicheux5,G.-Y. "Luigi Vanvitelli", Naples, Italy Rochefort6, Y. Wittrant1,2 [email protected] Objective: To improve the knowledge about hip fragility frac- 1INRA, UMR 1019, UNH, CRNH Auvergne, F-63009 ture in cerebral palsy (CP) presenting a clinical case of a CLERMONT-FERRAND, FRANCE, 2Clermont Université, neglected femoral neck fracture occurred in a 15 years old Université d'Auvergne, Unité de Nutrition Humaine, BP hemiplegic boy. 10448, F-63000 CLERMONT-FERRAND, FRANCE, Materials and methods: A 15 years old hemiplegic boy with 3Rousselot, Courbevoie, France, 4Rousselot BVBA, CP (Gross Motor Function Classification System – GMFCS - Meulestedekaai 81, 9000 GENT, BELGIUM, 5LIOAD, level II), falling from a standing position sustained a femoral neck INSERM U791, “Skeletal Tissue Engineering and fracture initially misdiagnosed as hip bruise. An increasing hip Physiopathology” team, NANTES, FRANCE 6EA 2496 pain over the next three months forced the patient on a wheel- Pathologie, Imagerie et Biothérapies Orofaciales, UFR chair. The patient was referred to our institution due to persis- Odontologie, Université Paris Descartes and PIPA, PRES tence of hip pain and flection contracture. At that time, the hip Sorbonne Paris Cité, MONTROUGE, FRANCE standard radiograph showed a neglected femoral neck fracture classified as Sandhu type 2. We performed an antero-lateral hip Objectives: Since collagen proteins are a crucial compo- approach with muscles preservation and a T shape capsulotomy nent of bone matrix and collagen-derived products are with postero-lateral flap preservation, in order to open and fresh- widely used in food industry, one may raise the question ening the fracture. The fractures was fixed using three cannulated whether collagen-enriched diets may provide benefits for screw with a transverse one in the calcar. After fracture fixation the skeleton. autologous stem cell concentrate was injected in femoral head Material and methods: In this study we designed an innova- and applied in fracture gap as a gelled membrane. tive approach taking into account the metabolites produced by Results: Six months after surgery a complete fracture healing the digestive tract. Mice serum enriched in hydrolysed-colla- without any complications. An improvement in hip function gen metabolites were collected and cell culture models were and pain was clinically evident. set up to perform ex-vivo experiments. Conclusions: CP is the most prevalent childhood condition Results: This original methodology led us to conclude that associated with low bone mineral density. Hip fractures occur hydrolysed collagen (HC - Peptan©) contributes to limit bone more frequently in this population than in non-disabled children. loss induced by ovariectomy when mice were supplemented Their identification could be difficult in disabled patients, there- with 2.5% (HC/diet) (+3.8%). Limitation of bone loss in this fore it is mandatory to perform a comprehensive evaluation of model was not related to protein content but to a hydrolysed CP patients with persistent hip pain, also performing second collagen specific effect and occurred, at least partly, through level imaging (i.e. MRI). Neglected hip fracture are challenging Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S269 for the orthopaedic surgeon and in patients with CP the appro- Diabetology, Ca'Granda Niguarda Hospital, Milano, Italy, priate treatment should be identified considering also GMFCS. 3Department of Pediatric, Gynecological, Microbiological The use of stem cells is an important augmentation technique for and Biomedical Sciences, Messina, Italy hip preservation surgery in neglected femoral neck fracture. Objective: In animal models, Wnt/β-catenin signaling path- way has been shown to contribute to the modulation of insulin P391 secretion, β-cell function and insulin signaling in skeletal BILATERAL ACUTE ANTERIOR UVEITIS AFTER muscle. Sclerostin and Dkk-1 are soluble antagonists of Wnt ORAL RISEDRONATE ADMINISTRATION signaling, and sclerostin has been associated with an adverse A. M. Dumitru1, A. S. Dragomir1,G.C.Taujan2,R.M.Hristea1, metabolic profile. No data exist on the association between M. E. Olaru1,A.M.Ghemigian3,D.L.Paun4, C. Dumitrache3 sclerostin and Dkk-1 with the main clinical features in preg- 1"C.I. Parhon" National Institute of Endocrinology, Bucharest, nant women with gestational diabetes (GDM). Our aim was to Romania, 2Lotus Med, Bucharest, Romania, 3Endocrinology investigate the possible role of sclerostin and Dkk-1 in preg- Institute CI Parhon, Bucharest, Romania, 4Carol Davila nant women with GDM. University of Medicine and Pharmacy, Bucharest, Romania Materials and Methods: We recruited thirty-five consecutive women with GDM, identified between the 24th and 28th week Background: Rare but serious side effects are described with of gestation by the 75 g oral glucose tolerance test (OGTT), widespread use of bisphosphonates for osteoporosis treat- according to International Association of Diabetes and ment. Surveillance data identified a link between this drugs Pregnancy Study Groups criteria; a group of normal glucose and some inflammatory ocular disease. This include mainly tolerance (NGT) (n=36) pregnant women were considered as uveitis and scleritis but there were also described cases of healthy controls. For each women, levels of sclerostin and conjunctivitis, episcleritis or keratitis. Dkk-1 were assessed the same day of OGTT. All the partici- Case Report: A 59 year old woman received her first dose of pants were followed until delivery, and several maternal and Risedronate treatment for the management of postmenopausal newborn’s features were recorded. osteoporosis and forty-eight hours later, bilateral eye irrita- Results: No significant differences were detected for age, tions, periorbital swelling, blurred vision were presented. height, family history of diabetes, history of previous GDM, The diagnosis of bilateral acute uveitis was established in an sclerostin and Dkk-1 levels when women affected by GDM Ophthalmological Hospital. The patient received topical ste- were compared with NGT women. Moreover, no significant roids after witch ocular symptoms improved. differences were observed between GDM and NGT women as Bisphosphonates therapy was not restarted even if there is for pregnancy outcomes, i.e. gestational week at delivery, ce- not a contraindication in this aspect. Treatment with the same sarean section rate, newborns' gender, neonatal weight and or other bisphosphonates may not induce additional ocular APGAR scores at 1 and at 5 minutes. Finally, at a multiple side effects. regression analysis, sclerostin (OR 0.98, CI 95% 0.87-1.10) Comment: The mechanism by which bisphosphonates cause and Dkk-1 (OR 1.73, CI 95% 0.91-3.30) were not associated ocular inflammatory adverse effects is not clear yet but is with GDM onset. related with acute phase reactions such as elevation of C re- Conclusions: Sclerostin and Dkk-1 levels were not associated active protein, interleukin 1 or 6. Cessation of antiosteoporotic with an adverse metabolic control in pregnant women and drugs may be efficient in some cases but steroids, topical, iv or probably do not play a significant role in the pathophysiology oral administration, are necessary for many patients. The oph- of GDM. thalmologist and the prescribing doctors should be aware of this side effects of bisphosphonates which can occur between 2 to 30 days after medicine administration as we find in med- P393 ical literature. ALTERED IMMUNOBIOLOGYAND REDOX STATUS OF NATURAL KILLER CELLS IN RHEUMATOID ARTHRITIS P392 D. Aggarwal1, A. Aggarwal1, A. Bhatnagar1 SCLEROSTIN AND DICKKOPF-1 IN PREGNANT 1Department of Biochemistry, Panjab University Chandigarh, WOMEN WITH GESTATIONAL DIABETES Chandigarh, India A. Catalano1,N.Morabito1,F.Bellone1,B.Pintaudi2,L. Giunta1, S. Loddo1,F.Corrado3,R.D'Anna3,A.Di Introduction: Rheumatoid Arthritis (RA) is an autoimmune Benedetto1, A. Lasco1 disease with uncertain pathophysiology which involves 1Department of Clinical and Experimental Medicine, interlocked signaling cascades. Redox status and University Hospital of Messina,Messina,Italy,2SSD immunobiology of natural killer (NK) cells might influence S270 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 the disease severity of RA patients. There is insufficient evi- Calcaneus Ultrasound (Sahara Hologic), Tetra polar Bio im- dence in support of this hypothesis. pedance to determine: Lean mass (LM), Fat mass (FM) and Objectives: In this study, the role of oxidative stress (pro and Water (WM). Skeletal muscle mass (MME) are: LM x 0.566 anti-oxidants) and the immune status of NK cell subsets in (Bahat et al, 2016). Relative appendicular skeletal muscle peripheral blood in the disease pathogenesis of RA have been mass (MMAE) was determinate as 0.75 x MME (Iannuzi- investigated. Sucisch e al.2012). Sarcopenia are defined according with Patients and Methods: The study included 100 patients with index NHANES III (Janssen et al.2004) as IMMAE RA, attending the out-patient department of Internal medicine, <6.76 kg/m2. Bone density followed OMS classification: PGIMER Chandigarh. Age and sex-matched healthy volun- (DMO between -1 and -2.5, osteopenia and <- 2.5 T score, teers were included. The state of oxidative stress in peripheral osteoporosis). Menopause status was defined after 9 mouth of blood fractions, NK cells and their altered apoptotic signaling continued amenorrhea. Discriminant analysis was used to de- pathways involving mitochondrial membrane potential, FAS- termine the canonical functions to made associations between associated death domain (FADD) mediated pathways and LM, FM and BMD. Factorial analysis was made to study the DNA damage were studied. potential relevance of environmental factors. Results: There is an acute state of oxidative stress in periph- Results: Women` age is 65.8±10.08. Actual BMI is 26,64 eral blood of RA patients. NK cell subsets were found to be ±4,37. From 30´ a loss of height (4,6±6,5cm) and an increase diminished though there are elevated expressions of ROS, of weight (9.6±9,32 kg) has been detected. LM (%) is 59, 90 depolarized mitochondrial membrane potential, FAS, FASL ±6, 33, MME:21.88±2.44, MMAE: 16,41±1,83. IMMAE in- and active caspase-3 in NK cells of RA patients as compared dex is 6, 92±0,67. Sarcopenia risk affected 40,07% of sample. to healthy controls. Moreover, the DNA damage, assessed as a T-score at lumbar spine and at hip are -2,39±1,14 (border percentage of DNA in comet tail, was significantly elevated. osteoporosis) and -1,91±0,94 (osteopenia). After adjustment Conclusions: The protective role of NK cells cannot be de- for age, discriminant analysis shows that bought degenerative nied in RA pathophysiology. Findings of the present work process are related. The best canonical function to evaluate indicate increased cellular apoptosis of peripheral NK cells LM was L2-L4 (0.811), BMI (0.532) and% Fat (0.294). in the diseased condition. PBMC and RBC are the major sites Factorial analysis shows that 60% of total variance is explain of enhanced oxidative stress. The state of oxidative stress and by the three firth factors. The firth, in which all variables altered immunobiology of NK cells were strongly correlated contribute positively, is related to global body composition. with the DAS28 score. Second one shows menopause as indicative of modification in Acknowledgement: The present study was supported by the fat body mass and loss of lean mass. Health habits (smoke and grant from Council of Scientific and Industrial Research practice of exercise) referee the three factor in opposition of (CSIR), India. LM loss. Conclusions: Sarcopenia is associated with osteoporosis in middle-aged and elderly women. But the present study shows P394 that preventive modifications of life habits must modified BODY COMPOSITION: BONE AND MUSCULAR bought degenerative process. VARIATION IN SPANISH MIDLE AGE WOMEN C. Prado Martinez1,M.Diaz-Curiel2, D. Navarro Despaigne3 1Departamento Biología, Facultad de Ciencias, Universidad P395 Autónoma de Madrid, Madrid, Spain, 2Servicio de Medicina CLINICAL CASES OF WORSENING OR NEWLY Interna/Enfermedades Metabolicas Osea, Fundacion Jimenez DEVELOPED PUSTULOSE PSORIASIS IN Diaz, Madrid, Spain, 3Instituto Endocrinología, Universidad PATIENTS TREATED WITH ADALIMUMAB AND de Ciencias Médicas de La Habana, Havana, Cuba LEFLUNOMIDE V. Po po va 1,A.Batalov2, Z. Vazhev3, J. Peshev4,M.Geneva- Introduction: The relationship between reduced muscle mass Popova5, Y. Ronchev6,J.Peeva7,K.Kraev8,M.Ivanova8,A. and bone status is unclear. This study aim to know the rela- Ivanov3 tionship between body composition, muscle mass and bony 1Department of Rheumatology, Medical university Plovdiv, mineral density in middle age women. UMHAT "Kaspela", Plovdiv, Bulgaria, 2Department of Methods: 1034 women are studied, aged between 40-80 Rheumatology, Medical university Plovdiv, UMHAT years. Women are resident in Madrid (Spain). Project manage- "Kaspela', Plovdiv, Bulgaria, 3Department of Cardiosurgery, ment are made by the FJD and the Department of Biology Medical university Plovdiv, UMHAT "Sv. Georgi", Plovdiv, (UAM). Women were invited to participate in order to obtain Bulgaria, 4Depatrment of General and Clinical Pathology, assessment in Anthropometry and Body Composition. Study Medical university Plovdiv, Plovdiv, Bulgaria, 5Department include: dual-energy X-ray (DXA) in Lumbar spine and hip, of Rheumatology, Medical university Plovdiv, Plovdiv, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S271 Bulgaria, 6Department of Rheumatology, Medical university Introduction: Daily teriparatide (TPT) injections of 20 μg Plovdiv, UMHAT “Kaspela", Plovdiv, Bulgaria, 7Department represent a single life-time option for severe osteoporosis as of Public Health, Medical university Plovdiv, Plovdiv, primary or glucocorticoid-related. Specific protocols are for Bulgaria, 8Department of Rheumatology, Medical university each European country. Plovdiv, UMHAT "Kaspela", Plovdiv, Bulgaria Objective: To introduce the panel of cases study regarding TPT early drop-off - within first 12 months. Introduction: The mechanism causing worsening of the pres- Material and Method: This is TPT Romanian experience ent psoriasis vulgaris and development of pustulose psoriasis (prescribers are endocrinologists), according to a national is unclear. We had 3 clinical cases with peripheral psoriatic protocol. This is an observational study - the decision of arthritis, psoriasis vulgaris and one case with newly developed TPT stop was based on protocol criteria. Subjects were pustulose psoriasis in patient with seropositive rheumatoid included in groups: A –TPT was stopped due to lack of arthritis. All of them are treated with Adalimumab and compliance, B –TPT was stopped due to drug effects (and Leflunomide. lack of signs and symptoms if the medication was Materials and methods: Three patients with psoriasis stopped), and C – patients with a prior condition not re- vulgaris, with starting therapy with Methotrexate 20mg/ mitted when TPT was no longer offered. All the patients weekly and Adalimumab 40 mg every other week s.c. and received vitamin D±calcium. Fragility fracture (FF) dur- one patient with RA. We used disease indexes- PASI, ing the first year were registered. All patients agreed to SDAI, DAS 28, CDAI. Histological proof of skin. At anonymously use their medical records. certain time point switch of MTX with Leflunomide Results: Out of 35 patients (32 menopausal women older than 20mg/daily. 55 years and 2 men), all confirmed with fragility fractures and Results: Due to side effects against MTX it is switched with associated therapy with TPT, 4 patients met the inclusion leflunomide respectively at 12 month, 5,6,9 months. In pa- criteria. No patient was registered in group A, three patients tients there is no worsening of the joint syndrome- no change were included in group 3: 63-year old male with a 4-year in the disease activity indexes and the laboratory tests. In all history of idiopathic osteoporosis with 2 prior FF who devel- patients pustulose psoriasis was proven histologically. The oped vertigo, dizziness and nausea after 2 months of TPT; an case of a female patient is interesting as at the 5th month after 83-year old female with a 7-year history of menopausal oste- the start of the therapy and good initial response- reduction of oporosis with vertebral fractures developed supra-ventricular the inflammatory markers, generalized erythrodermia devel- extrasystoles after 3 months of TPT, an 82-year old woman oped, after which pustulose psoriasis developed, the whole with 4-year history of osteoporosis and previous forearm FF condition of the patient worsened – Diabetes with developed vertigo after one month. Group C included one ketoacidosis, while coping with the skin symptoms and tran- female of 55 years with corticoid osteoporosis and scleroder- sient acute renal failure. After this we switched the patient ma who developed complications of the rheumatologic con- diagnose from RA to pustulose psoriasis. dition including thickening of the skin at the level of subcuta- Conclusion: The mechanisms of the clinical worsening of the neous injections (after 11 months). No FF was registered dur- patients are unknown, although the fact that Leflunomide ing the first year of TPT to any of 35 patients. elicits those processes despite the combination with anti Conclusion: A rate of 11% early drop off was registered when TNF alpha. Probably it changes the synthesis of interferon TPT was offered based on national specific criteria for severe alpha from the dermal plasmatic dendrite cells. osteoporosis. Potential linked side effects should be consid- References: ered for group B. 1. Kary S et al. Ann Rheum Dis 2006;65:405 2. Dereure O et al. Br J Dermatol 2004;151:506 P397 CARDIOVASCULAR RISK SCORE IN PATIENTS P396 WITH OSTEOPOROSIS IN ALBANIA EARLY DROP-OFF THERAPY WITH DAILY V. Duraj1,D.Ruci1,A.Kollcaku1,M.Jordhani1,E.Memlika1 TERIPARATIDE FOR SEVERE OSTEOPOROSIS 1University Hospital Center Mother Teresa, Tirana, Albania A. Gruia1,M.Carsote2, A. Valea3,A.Ghemigian4 1Medlife, Bucharest, Romania, 2C.Davila University of Medicine Introduction: Cardiovascular disease (CVD) and osteoporo- and Pharmacy and C.I. Parhon National Institute of sis are common age-related conditions associated with signif- Endocrinology, Bucharest, Romania, Bucharest, Romania, icant morbidity, mortality, and disability. Even though they 3I.Hatieganu University of Medicine and Pharmacy and Clinical have not been associated to each other, there have been dis- County Hospital, Cluj-Napoca, Romania, Cluj-Napoca, Romania, covered some evidences which may be very interesting in 4Endocrinology Institute CI Parhon, Bucharest, Romania general approach to these diseases. S272 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Objectives: To evaluate the Cardiovascular Risk Score in pa- there is a strong relationship between height and osteopenia tients suffering from Osteoporosis in comparison to normal in Albanian males (p<0.005). people and to assess if there is any significant relationship Conclusions: Osteopenia was found to be more frequent in between Osteoporosis and Cardiovascular Risk factors. patients taller than 156cm. Height seems to be strongly related Methods: This is a case-control study involving 305 patients. to Osteopenia in male Albanian patients. Two hundred patients not suffering from osteoporosis and 105 patients with osteoporosis were evaluated according to SCORE risk (Cardiovascular risk score- European Society P399 of Cardiology). The assessment of cardiovascular risk score PERSISTENT KNEE PAIN AFTER TOTAL KNEE was realized according to ESC guidelines for Cardiovascular REPLACEMENT: PATIENT-REPORTED Risk.Age,Smokingstatus,Sex,TotalCholesterolLevel, OUTCOMES FROM A DUAL-CENTRE ENGLISH HDL-Cholesterol level and Systolic Blood Pressure were COHORT STUDY evaluated and cardiovascular status was compared among R. Pinedo-Villanueva1, R. Gooberman-Hill2,N.K.Arden3,A. the two groups. Judge1 Results: After analyzing the results, it was found that patients 1Musculoskeletal Epidemiology, Botnar Research Centre, with osteoporosis had a mean cardiovascular risk score of Nuffield Department of Orthopaedics, Rheumatology and 5.3% (intermediate cardiovascular risk) and those who did Musculoskeletal Sciences, University of Oxford, Oxford, not suffer from osteoporosis had a mean risk score of 2.8%. United Kingdom, 2Musculoskeletal Research Unit, School Patients with osteoporosis resulted with a cardiovascular risk of Clinical Sciences, University of Bristol, Bristol, United 1.89 times more elevated than the normal group. This relation- Kingdom, 3Oxford NIHR Musculoskeletal Biomedical ship was found to be statistically significant (p<0.05). Research Unit, Nuffield Department of Orthopaedics, Conclusions: This study shows that patients with osteoporo- Rheumatology and Musculoskeletal Sciences, University of sis have a more elevated risk to develop cardiovascular dis- Oxford, Oxford, United Kingdom eases in the future. Evaluating cardiovascular risk in patients with osteoporosis may be helpful in their general approach, Objective: We aimed to compare patient-reported outcomes follow-up and treatment. measures (PROMs) between individuals with and without persistent pain (PP) one year after total knee replacement (TKR). P398 Methods: Data from a cohort of patients receiving TKRs at THE RELATIONSHIP BETWEEN OSTEOPENIA AND hospitals in Oxford and Southampton between 2010 and 2014 HEIGHT IN ALBANIAN MALES were analysed. Patients completed pre-operative and one-year D. Ruci1,V.Ruci1, V. Duraj1,M.Jordhani1,E.Petrela1 follow-up questionnaires, and those with PP were identified 1University Hospital Center Mother Teresa, Tirana, Albania by a score ≤14 in the 7-item pain component subscale of the Oxford Knee Score (OKS). PROMs analysed were the com- Introduction: Osteopenia is known to be related to a genetic plete OKS, which measures pain and function and is scored and constitutional component, which is important in their de- from 0-48, and the EQ-5D, which combines five dimensions velopment and course. Body height, being a distinctive con- of health-related quality of life (QoL) that can be summarised stitutional component, can be an interesting feature in in a score anchored at 0 (death) and 1 (perfect health). suspecting and diagnosing mineral bone diseases. Comparisons of mean values were tested using the t-test for Objectives: To evaluate the relationship between height and normally distributed variables, or the Mann-Whitney test osteopenia in Albanian males, presented at Rheumatology otherwise. Clinic in UHC “Mother Teresa”,Tirana,Albania,and Results: Of the sample of 567 patients who returned the Pegasus Med- Laboratories, Tirana, Albania. follow-up OKS questionnaire, 73(13%) had PP. Whereas Methods: This is an observational study including 414 male 56% of the sample were women, 70% of those with PP were Albanian patients presented at our Rheumatology Clinic be- women (OR 1.9, p<0.05). There was no statistically signifi- tween 2010-2016. Height and DXA was measured in every cant difference in age at operation (mean of 70 years) or BMI patient. All the data obtained were evaluated statistically in (means of 30 and 32) between the groups. order to achieve reliable results. Out of a maximum of 48, mean pre-operative OKS score was Results: It was found that of 414 patients, 121 (29.3%) were 20.1 for patients without PP and 14.1 for those with PP diagnosed with osteopenia and the rest was found to be nor- (p<0.001). After the operation, mean scores increased to mal (293 patients-70.7%). The number of patients taller than 38.8 and 16.9 (p<0.001), respectively. Patients with PP report- 156 cm with Osteopenia was 113 and shorter than 155 cm was ed more problems in all EQ-5D dimensions both before and 8. After statistically calculating our data, it was found that after surgery. Their pre-op EQ-5D summary score was 0.27, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S273 lower (p<0.01) than that of patients without PP (0.48). After levels of RANKL- are as follows: In 8 patients, 5 of which are surgery mean scores were 0.39 and 0.79, respectively at high cardiovascular risk - 40,2 + - 3,2 pg / ml / p <0.005 and (p<0.001). for the other 15 patients 7.2 + - 1.2 pg / ml / p <0,005 /, of Conclusion: Patients with knee pain at 12 months after TKR which 8 are in the group over 20% risk. CIMT- over 1.1 mm in reported worse function, pain and QoL not only after surgery all 8 patients with high serum levels of RANKL and under but also before, when compared with patients without PP. 1.0 mm at rest, while the group at high serum levels of Differences between the groups increased after surgery as RANKL in 75% of subjects experienced varying degrees of those with PP reported minor improvements after surgery stenosis of the common carotid artery and at 87% was ob- whilst those without PP improved significantly in pain, func- served plaque calcification. tion and QoL. Conclusion: Cannot say that the serum levels of RANKL is Acknowledgements: This abstract presents independent re- directly related to plaque instability and the manifestation of search funded by the National Institute for Health Research acute coronary syndrome. Its involvement in the pathogenesis (NIHR) under its Programme Grants for Applied Research of calcification of atherosclerotic plaques in itself could not programme (RP-PG-0613-20001). The views expressed are serve as serum marker in these patients. Perhaps the studies in those of the authors and not necessarily those of the NHS, larger cohorts and more extensive studies could shed light on the NIHR or the Department of Health. the these questions. References: 1. Prabhakaran S et al. Stroke 2006;37:2696 P400 2. Warboys CM et al. Med Rep 2011;3:5 EVALUATION OF SERUM LEVELS OF RANKL AND 3. Sitia S et al. Autoimmun Rev 2010;9:830 THE MEASUREMENT OF CIMT IN HIGH CARDIOVASCULAR RISK PATIENTS WITH INFLAMMATORY JOINT DISEASES P401 V. S. Popova1, A. Batalov2, Z. Vazhev3, M. Geneva- Popova4, HEALTHCARE RESOURCE USE BY PATIENTS J. Peshev5,Y.Ronchev6, J. Peeva7,K.Kraev8,M.Ivanova9, WITH AND WITHOUT PERSISTENT PAIN AFTER M. Jelyazkova1,A.Ivanov10 TOTAL KNEE REPLACEMENT: FINDINGS FROM A 1Department of Rheumatology, Medical University, DUAL-CENTRE ENGLISH COHORT STUDY UMHAT"Kaspela", Plovdiv, Bulgaria, 2Department of R. Pinedo-Villanueva1,R.Gooberman-Hill2,A.Judge1,N.K. Rheumatology, Medical University, UMHAT "Kaspela", Arden3 Plovdiv, Bulgaria, 3Department of Cardiosurgery, Medical 1Musculoskeletal Epidemiology, Botnar Research Centre, University, UMHAT "Sv Georgie", Plovdiv, Bulgaria, Nuffield Department of Orthopaedics, Rheumatology and 4Department of Rheumatology, Medical University, Plovdiv, Musculoskeletal Sciences, University of Oxford, Oxford, Bulgaria, 5Depatrment of General and Clinical Pathology, United Kingdom, 2Musculoskeletal Research Unit, School Medical University, Plovdiv, Bulgaria, 6Department of of Clinical Sciences, University of Bristol, Bristol, United Rheumatology, Medical University, UMHAT, Plovdiv, Kingdom, 3Oxford NIHR Musculoskeletal Biomedical Bulgaria, 7Department of Public Health, Medical University, Research Unit, Nuffield Department of Orthopaedics, Plovdiv, Bulgaria, 8Department of Rheumatology, Medical Rheumatology and Musculoskeletal Sciences, University of University, UMHAT, Plovdiv, Bulgaria, 9Department of Oxford, Oxford, United Kingdom Rheumatology, Medical University, UMHAT, Plovdiv, Bulgaria, 10Department of Cardiosurgery, Medical Objective: To compare healthcare resource use by peo- University Plovdiv, UMHAT, Plovdiv, Bulgaria ple with and without persistent pain (PP) in the operat- ed knee at 12 months after total knee replacement Introduction: Atherosclerosis is inflammatory disease of the (TKR). vessels. The pathogenic role of RANKL is crucial for the Methods: We analysed data from people receiving TKR at calcification of the plaque but is it the same for its stability? hospitals in Oxford and Southampton between 2010 and Materials and methods: We evaluated 23 patients with acute 2014. Patients completed a pre-op and one-year follow-up coronary syndrome, with cardiac surgery intervention and in- questionnaire, and those with PP were identified by a score flammatory joint diseases (PsA, RA) we evaluated the cardio- ≤14 in the 7-item pain component subscale of the Oxford vascular risk with EURO SCORE II, serum levels of RANKL Knee Score. Resource use was measured based on follow-up (N <4,25 pg/ml with Human ELISA kits eBioscience, CIMT- questions about visits to healthcare professionals for problems assessment with US machine Aloka Prosound alpha 7. related to their operated knee. Comparisons of mean values Results: 13 of them with high vascular risk- Euro SCORE II- were tested using the t-test for normally distributed variables, above 20%, in 10 patients - Euro SCORE II is 10%. Serum or the Mann-Whitney test otherwise. S274 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: The sample included 567 people (56% women). Of walking, standing up, limping, interference with work, and these, 73(13%) had PP one year after TKR (70% women). confidence. The pain component subscale pools these into a There was no difference in age at operation or BMI between single score ranging from 0 (most pain) to 28 (no pain). groups, but mean length of hospital stay for people with PP We adopted a data-driven approach to derive groups with was 7.2 days compared to 6.1 for those without PP (p<0.01). different levels of pain using hierarchical clustering. A year after surgery, 28% of people without PP and 62% of ‘Similar’ observations were grouped in clusters and these those with PP visited their GP because of problems with their were split based on inter-observation distance until no further knee. This was reflected in a mean number of NHS GP visits splits could be made, or until the maximum number of clusters of 0.6 and 2.6, respectively (p<0.01). People with PP (25%) (k=2, 3, … 9, 10) was reached. Clusters were examined based were more likely to visit Nurse Practitioners than those with- on distribution of their pain component subscale scores to out PP (17%), with an average number of visits of 2.3 and 0.5 identify if the cluster with the lowest scores (highest pain) respectively (p<0.05). Whilst 45% of those without PP visited was stable as the number of clusters increased. The highest a Physiotherapist, 60% of people with PP did. Average num- value of a stable cluster would be the cut-off point. ber of visits to NHS physiotherapists was 4.1 for people with Results: The distribution of clusters over the pain component PP and 2.3 for those without PP. Half (51%) of people with PP subscale showed a changing shape for the highest pain group consulted with hospital doctors, compared with 22% of those when the maximum number of clusters was set to two or three, without PP. but a consistent distribution was observed when this number Conclusion: Based on a sample of 567 TKR patients, those was 4 or higher. The highest pain component score for the with PP after surgery are more likely to visit healthcare pro- high-pain cluster was 24 for two or three clusters, but it con- fessionals at primary and secondary levels of care during the verged to 14 for four clusters and above. first year, in particular GPs, for problems with their operated Conclusion: Our study identified a high-pain group scoring ≤ knee. This is the first study to explore resource use related to 14 in the OKS pain component subscale. This cut-off point PP after TKR, with clear implications for service planning. can be used to identify patients with chronic pain after TKR. Acknowledgements: This abstract presents independent re- Further work to understand uncertainty around and potential search funded by the National Institute for Health Research relevance of this cut-off point to clinical practice is (NIHR) under its Programme Grants for Applied Research recommended. programme (RP-PG-0613-20001). The views expressed are Acknowledgments: This abstract presents independent re- those of the authors and not necessarily those of the NHS, search funded by the National Institute for Health Research the NIHR or the Department of Health. (NIHR) under its Programme Grants for Applied Research programme (RP-PG-0613-20001). The views expressed are those of the authors and not necessarily those of the NHS, P402 the NIHR or the Department of Health. A CUT-OFF POINT IN THE OXFORD KNEE SCORE TO IDENTIFY PATIENTS WITH CHRONIC PAIN AFTER KNEE REPLACEMENT P403 R. Pinedo-Villanueva1,S.Khalid1, V.Wylde2, R. Gooberman- BONE INVOLVEMENT IN DUCHENNE MUSCULAR Hill2,A.Judge1 DYSTROPHY 1Musculoskeletal Epidemiology, Botnar Research Centre, A. Catalano1,N.Morabito1, S. Messina1,G.L.Vita2, G. Vita1, Nuffield Department of Orthopaedics, Rheumatology and A. Lasco1 Musculoskeletal Sciences, University of Oxford, Oxford, 1Department of Clinical and Experimental Medicine, United Kingdom, 2Musculoskeletal Research Unit, School of University Hospital of Messina, Messina, Italy, 2Nemo Sud Clinical Sciences, University of Bristol, Bristol, United Kingdom Clinical Centre for Neuromuscular Disorders, Aurora Onlus Foundation, University Hospital of Messina, Messina, Italy Objective: To identify a cut-off point in the pain component subscale of the Oxford Knee Score (OKS) that could be used Objective: Duchenne muscular dystrophy (DMD) is a rare X- to identify patients with chronic pain 6 months after primary linked recessive neuromuscular disorder caused by mutations total knee replacement (TKR). in the dystrophin gene. Low bone mineral density (BMD) and Material and Methods: We used data from the English NHS increased fracture risk are often observed in subjects suffering Patient Reported Outcome Measures between 2012/13 and from DMD. Our aim was to determine BMD, history of prev- 2014/15. Data from 126,064 knee replacement patients who alent fractures, bone turn over and to look for possible deter- responded to all 7 pain component questions of the 6 month minants of BMD in this particular population. post-operative OKS questionnaire were included. Questions Materials and Methods: Thirty-one DMD subjects were captured self-reported pain severity, night pain, pain while consecutively evaluated [median age 14 (12 to 21.5) yr.]. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S275 BMD was measured by DXA scan at lumbar spine; C- two subgroups based on surgical and non-surgical causes of terminal telopeptide of procollagen type I (CTX) and premature menopause. The measurement of femoral and spi- osteocalcin (BGP), as bone resorption and formation markers nal bone mineral density (BMD) were done using dual energy respectively, and sclerostin were assessed. Left ventricular X-ray absorptiometry (DXA), the gold standard for the diag- ejection fraction (LVEF%) and forced vital capacity (FVC%) nosis of osteoporosis. were evaluated as possible determinants of BMD. Results: In the study group, 60% (n=24) of patients had sur- Results: The median Z-score values were -2 (-3.6 to -0.8) SD. gically induced premature menopause due to bilateral ovari- Ambulant subjects showed significantly higher lumbar spine ectomy with or without total hysterectomy before the age of Z-score values in comparison with not ambulant ones, and 40 years and 40% (n=16) of patients presented a non surgical subjects with prevalent clinical fractures had significantly cause of premature menopause (unknown cause 50%, 25% lower Z-score values in comparison with subjects without secondary to radiotherapy, 13% autoimmune ovarian failure, prevalent fractures. Z-score values were positively correlated 12% secondary to chemotherapy). The median±SD of femoral with FVC (r=0.50; p=0.01) and FVC was associated with BMD T-score in the surgically induced premature menopause BGP (r=0.55; p=0.02). GC exposure were not associated with subgroup was significantly lower (0.609±0.14 g/cm2) com- poorer BMD. In not ambulant subjects, Z-score values were parative to non-surgical premature menopause subgroup associated with BMI (r=0.54; p=0.02) and sclerostin was as- (0.902±0.12 g/cm2, p<0.005). Moreover, the median±SD of sociated with age (r=0.44; p=0.05). At a stepwise multiple spinal BMD T-score was also lower in the surgically induced regression analysis, age, BMI, FVC and sclerostin levels were menopause subgroup (0.758±0.12 g/cm2) comparative to retained in the model as independent predictors of BMD. non-surgical menopause subgroup (0.998±0.17 g/cm2, Conclusions: In DMD, we observed low BMD especially in p<0.005). not ambulant subjects, irrespective of the use of GC, and iden- Conclusions: The etiology of premature menopause influence tified FVC and sclerostin as determinants of BMD, suggesting the rate of BMD decreasing. Surgically induced premature further insights in the pathogenesis of bone involvement in menopause is associated with a sudden drop in estrogen levels this cohort. and consequently with a more important decrease in bone Because of improved life expectancy, preventing osteoporosis mineral mass compared to non-surgical causes of premature and related fractures should be considered in DMD patients. menopause. P404 P405 THE STATUS OF BONE MINERAL DENSITY IN EFFECTS OF DENOSUMAB ON QUATITATIVE WOMEN WITH SURGICALLY INDUCED PREMA- ULTRASOUND AND DXA MEASUREMENTS IN TURE MENOPAUSE AROMATASE INHIBITOR-TREATED BREAST A. Mirica1,R.Petris1,I.Cotofana1,R.Mirica2, D. L. Paun1 CANCER WOMEN 1Endocrinology Institute CI Parhon, Bucharest, Romania, A. Catalano1,N.Morabito1,G.Basile1, R. M. Agostino2,A. 2Saint John Emergency Hospital, Bucharest, Romania Gaudio3,F.Bellone1,M.Papalia1, C. Scarcella1,M.M.La Fauci1,C.Ferro1,E.Morini1, G. Natale4,A.Lasco1 Introduction: Premature menopause is defined by the loss of 1Department of Clinical and Experimental Medicine, University ovarian function at or before the age of 40 years old. Hospital of Messina, Messina, Italy, 2Department of Human Postmenopausal osteoporosis is associated with Pathology, University of Messina, Messina, Italy, 3Department microarchitectural modifications of the bone and consequently of Clinical and Experimental Medicine, University of Catania, a low bone mineral mass. Surgically induced premature men- Catania, Italy, 4Mineral Metabolism and Nephrology Clinic of opause is characterized by a sudden and dramatic drop in es- Vibo Valentia Hospital, Vibo Valentia, Italy trogen levels causing a rapid decline in bone mineral mass. Objectives: This study aims to study the effect of an abruptly Objective: Bone loss has been reported in postmenopaus- fall in estrogen levels in surgically induced premature meno- al women receiving aromatase inhibitors (AIs) for the pause (bilateral ovariectomy with or without total hysterecto- management of breast cancer (BC), and denosumab has my) comparative with premature ovarian failure (non-surgical been shown to prevent fractures in these subjects. We premature menopause) and their correlation with bone mineral recently observed phalangeal quantitative ultrasound density (BMD). (QUS)tobeassociatedwithdualenergyX-rayabsorpti- Material and Methods: We conducted a retrospective study, ometry (DXA) measurements in BC women receiving collecting data from patients hospitalized in our clinic. We AIs. Aim of this research was to evaluate bone status analyzed the statistical correlations between a study group of by QUS and DXA in women taking denosumab to pre- 40 women diagnosed with premature menopause, divided into vent AIs associated bone loss. S276 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Materials and Methods: 35 postmenopausal BC women, (n=40). DNA from first passage MSCs was extracted and with at least one mild vertebral fractures, who started adjuvant converted with bisulfite to study DNA methylation with the treatment with AIs (i.e. anastrozole, letrozole, exemestane) HumanMethylation450k array. The epigenetic age was esti- were enrolled (mean age 61.2±4.5 yr.) and received subcuta- mated from the analysis of a set of cytokines that show age- neous denosumab (60 mg every 6 months) and oral cholecal- related changes in methylation by using Horvath's software ciferol (25000 IU bimonthly). Phalangeal QUS parameters (Horvath S, Genome Biology 2013). The same strategy was [Amplitude Dependent Speed of Sound (AD-SoS), applied to trabecular bone fragments from 51 patients. The Ultrasound Bone Profile Index (UBPI), Bone Transmission relative telomere length was also analyzed in MSCs and bone Time (BTT)] and DXA at lumbar spine and femoral neck were fragments by qPCR (Cawthon RM, Nucleic Acid Res. 2002). performed at baseline and after 24 months. At baseline, 12 and Results: For MSCs we observed an overall correlation be- 24 months, C-telopeptide of type 1 collagen (CTX) and bone tween the chronologic age and the epigenetic age estimated specific alkaline phosphatase (BSAP) were measured. The from the methylation of DNA (r=0.64). However, there were main outcomes were compared with a control group not re- differences between the two groups. Thus, the residuals to the ceiving denosumab (n=39). global regression line tended to be positive in the group of Results: Differently from controls, women receiving patients with osteoporotic fractures and negative in the group denosumab had a significant improvement of lumbar spine with osteoarthritis, with an average difference of 5.9 years and femoral neck BMD and a significant improvement of all (p=0.007). In bone tissue there also was a good correlation the QUS parameters. The% changes (Δ) of QUS measure- between the chronologic and the epigenetic ages (r=0.67), but ments were significantly associated with ΔBMD at femoral in this case there were not significant differences between both neck. A significant reduction of CTX and BSAP values was groups (p=0.114). The measurement of the relative telomere detected and ΔCTX and ΔBSAP were associated with length did not show differences between the fracture and os- ΔBMD at lumbar spine (r=-0.39, P=0.02; r=-0.49, P=0.01, teoarthritis groups, in either the bone tissue sample (-0.5±1.7 respectively). vs. -0.6±2.0 relative units) or in cultured MSCs. Conclusions: This is the first time phalangeal QUS has been Conclusions: MSCs, obtained from osteoporotic patients, ex- used in the follow-up of bone health in a set of AIs treated BC hibit an accelerated epigenetic aging when compared with women receiving denosumab. Beyond DXA, phalangeal control individuals with osteoarthritis. This could restrict their QUS may also provide additional information on the physical capacity to differentiate into osteoblasts and, consequently, properties of bone tissue (e.g. structure and elasticity) that bone formation. However, such an accelerated aging is not contribute to bone strength. observed in DNA extracted from whole bone tissue. Differences in bone turnover and the mean age of osteocytes, the most abundant cells in bone samples, could help to explain P406 these apparently controversial results. THE "EPIGENETIC CLOCK" IN MESENCHYMAL STEM CELLS AND BONE TISSUE OF PATIENTS WITH OSTEOPOROSIS AND OSTEOARTHRITIS P407 J. A. Riancho1, A. Del Real1,F.M.Perez-Campo2,L. SARCOPENIC OBESITY IS ASSOCIATED WITH Riancho-Zarrabeitia3, M. I. Perez-Nuñez4,S.Horvath5 LOWER PROXIMAL TIBIAL CORTICAL BONE 1Department of Internal Medicine, Hospital Universitario QUALITY, INCREASED INTERMUSCULAR ADIPOSE Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, TISSUE AND POOR PHYSICAL FUNCTION IN Santander, Spain, 2Department of Molecular Biology/ COMMUNITY-DWELLING OLDER ADULTS Universidad de Cantabria, Santander, Spain, 3Department of D. Scott1, C. Shore-Lorenti1,L.McMillan1, R. Clark2,K.M. Medicine, University of Cantabria, IDIVAL, Santander, Sanders3,G.Duque4,P.R.Ebeling1 Spain, 4Department of Traumatology/Hospital U M 1Bone and Muscle Health Research Group, Department of Valdecilla, University of Cantabria, Santander, Spain, 5Dep. Medicine, Monash Medical Centre, Melbourne, Australia, Human Genetics and Biostatistics, University of California, 2School of Health and Sport Sciences, University of the Los Angeles, United States Sunshine Coast, Sunshine Coast, Australia, 3Institute for Health and Ageing, Australian Catholic University, Objectives: To study and compare the DNA methylation age Melbourne, Australia, 4 Australian Institute for in Mesenchymal stem cells (MSCs) and bone tissue obtained Musculoskeletal Science, The University of Melbourne and from osteoporotic patients and controls with osteoarthritis. Western Health, St. Albans, Australia Materials and methods: MSCs were grown from the bone marrow of the femoral head of patients undergoing hip re- Objectives: We previously reported increased incident frac- placement due to osteoporotic fractures or osteoarthritis ture risk in sarcopenic obese compared with obese alone older Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S277 adults, but no differences in falls risk. We aimed to determine Background: Hip fracture is a major public health issue due whether bone quality is compromised in sarcopenic obesity, to an increasing elderly population. X rays are the initial ra- and which components of sarcopenic obesity contribute to diological investigation for suspected hip fracture. However, poor bone quality in older adults. when x-rays are inconclusive, further imaging is required to Materials and Methods: 83 community-dwelling older ensure early diagnosis of hip fracture to prevent delays to adults (mean age 72.8±5.4 years; 53% women) underwent theatre. According to the UK NICE guideline CG124, mag- whole-body dual-energy X-ray absorptiometry to assess ap- netic resonance imaging (MRI) should be offered if hip frac- pendicular lean mass (ALM), body fat percentage, bone min- ture is suspected despite negative X rays of the hip of an eral content (BMC) and density (BMD). Peripheral quantita- adequate standard. If MRI is not available within 24 hours tive computed tomography assessed mid-calf muscle and or is contraindicated, consider computerised tomography inter-muscular adipose tissue (IMAT) cross-sectional areas (CT). The aim of this audit is to compare the current standard (CSA), muscle density and proximal tibial (66%) cortical vol- of management of occult hip fractures at Darent Valley hospi- umetric BMD, area and thickness. Physical function assess- tal to the NICE guideline. ments including muscle strength (dynamometry) and postural Methods: A retrospective study was performed over a 6- sway (computerised posturography) were performed. month period from May 2014 to November 2014 at Darent Sarcopenia was defined as either low relative ALM or hand grip Valley Hospital. All patients received hip imaging including strength according to the Foundation for the National Institutes MRI or CT for occult fractures were included. The time of of Health Biomarkers Consortium Sarcopenia Project definition; imaging requests and the time scans carried out and reported obesitywasdefinedashighbodyfatpercentage. were collected through PACS system and electronic patient Results: Seventeen (20.5%) participants were sarcopenic trauma database. After implementation of new recommenda- obese. Obese alone and non-sarcopenic non-obese demon- tions following the discussion in audit meeting, second cycle strated better knee extension strength and postural sway than of audit was performed from April 2016 to September 2016. sarcopenic obese (all P<0.05). Non-sarcopenic non-obese and Results: First cycle of audit identified 49 patients while sec- sarcopenic alone (both P<0.05) had significantly lower mid- ond audit identified 31 patients. The first audit showed that calf IMAT (relative to muscle CSA) compared with 81% of MRI (14/18) and 84% of CT (24/31) requests occurred sarcopenic obese, and obese alone also tended to have lower and were reported within 24 hours. After implementation of relative IMAT (B=-1.8%; 95% CI -3.7, 0.1; P=0.06). Non- new practice, 100% of hip imaging occurred and were report- sarcopenic non-obese had significantly greater proximal tibia ed within 24 hours. In addition, new practice improves the cortical volumetric BMD (26.3mg/cm3; 3.0, 49.5), and obese result of patients receiving appropriate scans from 52% (19/ alone had greater whole-body BMC (222.8g; 32.3, 413.3) and 35) to 71%(21/31). proximal tibial cortical area (32.6mm2; 5.0, 60.2) and thick- Conclusion(s): Implementation of new practice significantly ness (0.5mm; 0.1, 0.9), than sarcopenic obese. Amongst com- improves the achievement of the target scanning time of 24 ponents of sarcopenic obesity, only ALM was independently hours with appropriate imaging investigation of occult hip and positively associated with proximal tibial cortical area fractures. The new practice can help to meet the standards of (8.8mm2; 4.6, 13.0) and thickness (0.07mm; 0.01, 0.14). NICE guideline by preventing delay of the diagnosis and Mid-calf IMATwas the only independent predictor of cortical achieving the 36-hour target for operating on patients with volumetric BMD (-0.5mg/cm3; -1.04, -0.03). occult hip fractures. Conclusions: Sarcopenic obesity is associated with lower proximal tibial cortical volumetric BMD, area and thick- ness, as well as poor muscle strength and balance. P409 Higher amounts of IMAT may contribute to the poorer CARTILAGE PROPERTYAFFECT THE FOOT BONE bone quality and physical performance of sarcopenic STESS AND STRAIN: A FE MODELLING ANALYSIS obese older adults, increasing their risk for falls and L. Yu1 fractures. 1Loudi Vocational and Technical College, Loudi, China Objective: Cartilage was previously reported to work as im- pact cushioning between segments. However, the property of P408 cartilage changed due to arthritis or other pathologies. This HOW TO OPTIMIZE WAITING TIME AND IMAGING study was aimed to investigate the foot bone stress and strain OPTIONS IN MANAGEMENT OF OCCULT HIP characteristics under static and dynamic conditions during the FRACTURES: EXPERIENCE FROM A UK DISTRICT alteration of foot cartilage mechanical property. HOSPITAL C. K. Chuen1,O.OKOH1,L.Charles1, J. Smith1 Material and Methods: A foot model was rebuilt with 1Darent Valley Hospital, Dartford, United Kingdom MIMICS from CT sliced medical images. SOLIDWORKS S278 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 was used to reprocess the 3D geometric foot model before of +13.6. Maximum improvement was evident after 3 months import into the ANSYS software. Foot cartilage and ligament of the injection. Pain score, walking distance and upstairs was built. The mechanical property of cartilage was adjusted mobilization were the most items increasing the knee society to analyse the bone stress and strain relationship. scoring system. However, range of motion improvement was Results: The stress and strain under the static loading situation minimal. No significant radiological differences were elicited showed that the heel maximum stress was 3.135MPa and in our study with slight insignificant decrease in joint space. maximal deformation was 14.662mm. Under a dynamic load- Conclusion: Although Hyaluronic acid inter-articular injec- ing condition, foot bone presented a similar stress and strain tion is not a recommended line in the standard treatment relationship compared with static situation. Within the carti- of grade 4 osteoarthritis, where patients are candidate for lage elasticity limits, the foot overall strain presented a linear THR to gain the best prognosis. However, significant symp- relationship with cartilage elastic modulus. tomatic improvement was evident in our study for patients Conclusion: In this study, the foot bone stress and strain re- refusing or unfit for TKR, when consecutive lation under static and dynamic conditions were simulated. Hyaluronic inter-articular injection was used. Nevertheless, The cartilage mechanical property was proven to influence no evidence that inter-articular injection modify or stop the the changes. Understanding the stress and strain relationship progress of the disease. would be beneficial for foot arthritis pathological mechanism. This would provide implications for the treatment and reha- bilitation of foot disorders. P411 Acknowledgments: This study is supported by the Hunan SYSTEMATIC REVIEW AND META-ANALYSIS OF Sports Science Society Research Project (NO. 2016XH013). PREVALENCE OF SARCOPENIA IN POST ACUTE INPATIENT REHABILITATION I. Churilov1, L. Churilov2, R. MacIsaac3,E.I.Ekinci4 P410 1Department of Rehabilitation, St Vincent's Health Melbourne, USING HAYALURONIC ACID INTER-ARTICULAR Firzroy, Australia, 2The Florey Institute of Neuroscience and INJECTION IN GRADE 4 OSTEOARTHRITIS OF Mental Health, Heidelberg, Australia, 3Department of THE KNEE FOR PATIENTS REFUSING OR UNFIT Endocrinology, St Vincent's Health Melbourne, Fitzroy, FOR TOTAL KNEE REPLACEMENT SURGERY Australia, 4Department of Endocrinology, Austin Health, A. M. Ali1,H.A.Elazaly1 Heidelberg, Australia 1King Faisal Medical Complex, Taif, Saudi Arabia Objective: To conduct a systematic review of reported prev- Objectives: To measure the efficacy and benefits of alence of sarcopenia in post acute inpatient rehabilitation Hyaluronic acid injection in sever osteoarthritis (OA) of the (IPR) setting. knee for patients refusing or unfit for Total Knee Replacement Methods: The systematic review was conducted according to (TKR). PRISMA guidelines (PROSPERO registration number Methods and Materials: In King Faisal Medical Complex, CRD42016054135). Databases searched: MEDLINE, during the period of 26 months (from October 2014 to EMBASE Cochrane Database of Systematic Reviews, December 2016) we conducted a case-series study of 114 knees Cochrane Central Register of Controlled Trials (CENTRAL), (66 patients; 48 patients with bilateral knee OA and 18 patient Cochrane Methodology Register, CINAHL. Search strategy: with unilateral knee OA. All knees were classified as grade 4 published between January 1988 and October 2016; key terms: osteoarthritis with sever narrowing of the joint space, multiple ‘sarcopenia’ AND ‘inpatient rehabilitation’ OR ‘rehabilitation’ osteophytes, bone scoliosis and deformity. All these knees were AND/OR ‘prevalence’; abstracts available in English. Abstracts candidate for TKR. However, TKR was not carried out for these and subsequently selected full studies reporting the prevalence patients due to either patients refusal or due to patients being of sarcopenia in adults admitted to IPR reviewed irrespective of unfit for TKR due to the presence of severe general illness. design, as long as the diagnosis of sarcopenia included assess- Patients were using NSAIDs and physiotherapy in the course ments of both muscle mass and either muscle strength or func- of the disease. Three consecutive local injections of low- tion. Random effect meta-analysis was conducted. molecular weight Hyaluronic acid were given to all the patients Methodological quality was assessed using MORE tool with 2 weeks interval between each injection. Initial knee soci- (Agency for Healthcare Research and Quality, US Department ety score was recorded before the starting of the injection. of Health and Human Services, 2011) and Joanna Briggs Follow-up with measuring knee society score after 3, 6 and 12 Institute Prevalence Critical Appraisal Tool (Munn et al, 2014). months was done. Follow-up x-ray were done after 12 months. Results: Identified 490 studies, 465 excluded after reviewing Results: Improvement of the knee society score was signifi- titles and abstracts, 25 full text articles reviewed. Three orig- cant in 102 knees (58 patients) with mean value improvement inal research studies met inclusion criteria. Patient populations Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S279 included those after hip fracture in one study and with general summary component compared with the women in the com- deconditioning in two. Identified prevalence of sarcopenia in parison group. individual studies ranged from 46% to 58%. Pooled preva- Conclusions: Among breast cancer patients, musculoskeletal lence of sarcopenia obtained with random effect meta-analy- pain adversely affects both mental and physical components sis: 51% (95%CI 34-59%), heterogeneity I2=52%. Main qual- of HR-QOL. Preventing or treating musculoskeletal ity shortcomings: lack of reporting of inter- and intra-rater pain may improve overall HR-QOL among breast cancer pa- reliability, generalizability to other IPR populations. tients. Conclusions: Original research examining the prevalence of sarcopenia in IPR is scarce. The majority of studies did not use accepted definition of sarcopenia where both muscle mass and P413 strength or function are considered in diagnosis. Sarcopenia EFFECTS OF TWO EXERCISE PROGRAMS ON POS- may be present in approximately half of IPR patients and its TURE AND BACK PAIN IN COMMUNITY-DWELLING prevalence may vary according to the admission diagnosis. ELDERLY WITH HIGH FRAGILITY FRACTURE RISKS References : Di Monaco et al, Aging Clin Ext Res D.-C. Chan1, C.-B. Chang2, J.-K. Liao3, D.-S. Han4, J.-S. 2015;27:465; Sanchez-Rodriguez et al, Arch Geront Ger Hwang5,P.-Y.Liu1, C.-H. Hong6,K.-S.Tsai7,K.-C. 2015;61:176; Sanchez-Rodriguez et al, Arch Geront Ger Huang8,R.-S.Yang9 2014;59:39 1Superintendent’s Office, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu County, Taiwan, Province of China, 2Department of Internal Medicine, P412 National Taiwan University Hospital, Chu-Tung branch, MUSCULOSKELETAL PAIN AND HEALTH-RELATED Hsinchu County, Taiwan, Province of China, 3Department of QUALITY OF LIFE AMONG BREAST CANCER Orthopedics, Shing Kong Wu Ho-Su Memorial Hospital, PATIENTS: EVIDENCE FROM SOUTH INDIA Taipei City, Taiwan, Province of China, 4Department of S. Katpattil1 Medical Affair, National Taiwan University Hospital Beihu 1Al Iqbal Hospital, Thrissur, India Branch, Taipei City, Taiwan, Province of China, 5Department of Internal Medicine, Chang Gung Memorial Introduction: The musculoskeletal pain is one of the Hospital, Taoyuan, Taiwan, Province of China, 6Department leading health problems among women. This study aims of Geriatrics and Gerontology, National Taiwan University to examine the associations between musculoskeletal Hospital, Taipei City, Taiwan, Province of China, pain and health-related quality of life (HR-QOL) among 7Superintendent Office, Far Eastern Policlinic, Taipei City, breast cancer patients and women without a history of Taiwan, Province of China, 8Superintendent Office, National breast cancer. Taiwan University Hospital Beihu Branch, Taipei City, Methods: A cross-sectional study was conducted among 68 Taiwan, Province of China, 9Department of Orthopedics, breast cancer patients for an average of 3.5 years and 137 National Taiwan University Hospital, Taipei City, Taiwan, postmenopausal women without a history of cancer. Province of China Musculoskeletal pain was assessed using a 10-cm visual ana- log scale; HR-QOL was examined using the Medical Background/Purpose: Long-term improper posture may in- Outcomes Study Short Form (SF-36) health survey. Linear crease spine loading and lead to kyphosis, compression frac- regression was used to estimate the associations between pain ture and pain. We aim to examine the effects of 2 exercise and HR-QOL in both groups. interventions on spine curvature, low back pain and other Results: Approximately 64% of the breast cancer patients and associated indices bin community-dwelling older adults with women in the comparison group reported musculoskeletal high fragility fracture risks. pain. Among women with breast cancer, those with pain had Methods: Subjects previously enrolled in 2015 Wang Jhan significantly lower HR-QOL scores in the physical (52.2 vs. Yang Charitable Trust Fund (WJYCTF) community based 42.6;p<0.001) and mental (52.7 vs. 45.5; p=0.01) component exercise program were invited for the 2016 program and summary scores compared with those without pain. In the were assigned to two groups. Integrated care (IC, n=56) comparison group, pain was associated with significantly low- group subjects received weekly 1-hour program led by an er scores in the physical (55.4 vs. 46.0; p<0.001), but not the exercise specialist and muscle training (MT, n=54) group mental, component summary score (52.1 vs. 52.4; p=0.82). subjects received twice weekly 30-min machine based The significant associations between pain and HR-QOL training. Each program was re-designed with special em- persisted after confounder adjustment in both groups. phasis on central trunk muscle. Assessments were done at Among women with similar severity of pain, breast cancer baseline and 12-weeks. Other than frailty and sarcopenia patients reported significantly lower HR-QOL in the mental indices collected from 2015, major outcomes in 2016 S280 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 included lower back pain score, back-to-wall test, balance osteoporosis (T- scores less than -2.5 SD) were considered test, and kyphosis/lordosis scores at 30, 45, and 60 degrees. as 59.8% (n=269) and 22.2% (n=100), respectively. In this Comparisons were made between baseline and 12-weeks study, positive correlations were found between QUS param- andbetween2groups. eters and weight, body mass index, waist circumference, hip Results: Mean age was 72.6±7.6 years with 68.2% female. circumference and waist to hip ratio (all Ps<0.01). On the For the entire cohort, after 12 weeks of intervention, there other hand, significant negative correlations were found be- were significant improvements on back-to-wall test passing tween QUS parameters and age in years, menopause dura- rate (85.6% to 95.5%, p<0.05), balance score (1.78±0.95 to tion,HbA1c,durationofdiabetesaswellassystolicblood 1.65±0.83, p<0.05), and lordosis score at 30 (905.49±507.83 pressure (SBP) (all Ps<0.01). to 1277.82±1932.23, p<0.05) and 45 degree (1117.06 Conclusion: This study showed that T2DM patients had high ±1169.63 to 1322.97±1371.78, p<0.05). However, there is prevalence of osteopenia and osteoporosis. In addition, good no difference on low back pain scores. Also, between groups correlations were found between QUS and socio-demographic differences were not significant. data. As a conclusion, low bone mineral density in T2DM Conclusions: Two exercise interventions with emphasis on patients is a noteworthy problem in Malaysia and it appears central trunk muscle training improved several indices on bal- to be underdiagnosed, undertreated and overlooked until now. ance, and back posture among community older adults with high osteoporotic fracture risks. P415 FRACTURE RISK ASSESSMENT ON JAPANESE P414 PATIENTS WITH CARDIOVASCULAR DISEASES: BONE HEALTH STATUS IN TYPE 2 DIABETES MELLITUS COMPARISON WITH PATIENTS WITH ORTHOPEDIC S. A. Abdulameer1,M.N.Sahib1, S. A. Syed Sulaiman2 DISEASES 1Faculty of Pharmacy, Al-Rafidain University College, M. Kondo-Ando1,H.Muramatsu2,Y.Murahata2,M. Baghdad, Iraq, 2Clinical Pharmacy Department, Universiti Nakanishi2,E.Tomatsu3,I.Hiratsuka3, Y. Yoshino3,M. Sains Malaysia, Penang, Malaysia Shibata3,M.Morita4, H. Yamada4,A.Suzuki3 1Division of Endocrinology and Metabolism, Fujita Health Objectives: This study is aimed to assess the prevalence of University, Toyoake, Japan, 2Nursing Department, Fujita low bone mineral density (LBMD, i.e., osteopenia and osteo- Health University Hospital, Toyoake, Japan, 3Division of porosis) in type 2 diabetes mellitus (T2DM) patients using Endocrinology and metabolism, Fujita Health University, quantitative ultrasound scan (QUS). In addition, to assess the Toyoake, Japan, 4Department of Orthopedic Surgery, Fujita association between QUS score (normal BMD, osteopenia Health University, Toyoake, Japan and osteoporosis) and demographic characteristics and diabetes-related data. Objective: Fracture Liaison Service (FLS) is now considered Methods: an observational, cross-sectional study was under- to be effective to prevent next fracture. International taken with 500 T2DM outpatients over a period of seven Osteoporosis Foundation (IOF) provided The Capture the months in 2012 at Hospital Pulau Pinang in Malaysia. In this Fracture Best Practice Framework (BPF) for improving and study, data were collected using a self-reported structured standardizing FLS in each institute, which recommends frac- questionnaire about the socio-demographic data and osteopo- ture risk assessment to reduce future fracture. In orthopedic rosis risk factor and also retrospective collection of clinical department, medical staffs routinely checked fracture risk, but data from patients’ medical records. The skeletal health status it is not always the case in other departments. In the present was evaluated using QUS measurements to determine the study, we performed risk assessment for osteoporotic fracture prevalence of LBMD at the heel bone (calcaneus) using of inpatients with cardiovascular diseases, to explore if frac- SONOST 3000. ture risk assessment should be extended to non-orthopedic Results: Out of 500, only 450 T2DM patients were screened patients in super-aging society. for BMD using QUS measurement. The mean value of T- Methods: We assessed the risk of future fracture using FRAX score for the total sample was (-1.67±0.83) ((median: -1.65) in 713 patients (aged from 50 below 90 years old) who admit- (range: -3.4 to 1.2) (CI 95%: -1.75 to -1.59)). The mean ted to cardiovascular ward (n=424) and orthopedic ward value of T-score for normal BMD, osteopenic and osteopo- (n=289) in Fujita Health University Hospital. Mean age of rotic patients’ were (-0.41±0.44), (-1.65±0.39) and (-2.76 the subjects was 71±8 years old. We defined high risk (HR) ±0.27), respectively. According to QUS, the prevalence of group of future fracture when FRAX major fracture probabil- normal BMD (T-scores greater than -1 SD) in this sample ity was above or equal to 15%. population was 18% (n=81), while the prevalence of Results: In total, 25.7% of patients were defined as HR group. osteopenia (T-scores between -1 and -2.5 SD) and Female patients admitted to orthopedic ward showed higher Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S281 prevalence of HR group in 70s (70.5%) and 80s (100%) than Conclusion: These results suggest that high extracellular Pi those in cardiovascular ward (61.5% in 70s, 71.0% in 80s). In could keep MSC in immature status without affecting survival orthopedic ward, 70 patients out of 289 was admitted to hospital of the cells. because of clinical fracture. Among them, only 10 subjects were treated for osteoporosis on admission. Patients with prevalent osteoporotic fracture was found in 35 cases, only 3 of which P417 were treated for osteoporosis on admission. In cardiovascular CHANGE OF BONE MINERAL DENSITY DURING ward, there were 16 patients with the history of osteoporotic WAITING PERIOD FOR PANCREAS-KIDNEY fracture, and 75% of them were not treated for osteoporosis. TRANSPLANTATION IN TYPE 1 DIABETES Conclusion: Our findings suggest that it seems worth- I. Hiratsuka1, E. Tomatsu1, M. Kondo-Ando1, Y. Yoshino1,N. while to assessing fracture risk of inpatients outside or- Aida2,M.Shibata1, M. Makino1,T.Itoh2,T.Kenmochi2,A. thopedic ward. Suzuki1 1Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Japan, 2Department of Organ P416 Transplant Surgery, Fujita Health University, Toyoake, Japan PHOSPHATE OVERLOAD KEEPS MESENCHYMAL STEM CELLS IMMATURE AND DOES NOT INDUCE Objective: Both type 1 diabetes mellitus (T1DM) and end- THEIR APOPTOSIS IN VITRO stage renal diseases (ESRD) could be cause of secondary oste- M. Shibata1, N. Yamamoto2, E. Tomatsu1, M. Kondo-Ando1, oporosis. The aim of this study was to assess the change of bone I. Hiratsuka1, Y. Yoshino1, S. Sekiguchi-Ueda1,T. mineral density (BMD) in T1DM patients during waiting period Takayanagi1,A.Suzuki1 for simultaneous pancreas-kidney transplantation (SPK). 1Division of Endocrinology and Metabolism, Fujita Health Subjects and Methods: Post-SPK T1DM patients (n=9, University, Toyoake, Japan, 2Institute of Joine Research, M/F=3/6, age 40.2±5.4 years old) were recruited. They had Fujita Health University, Toyoake, Japan T1DM for 24.4±5.5 years in average, and their mean duration of waiting for SPK was 844±517 days. Eight of 9 patients Objective: Inorganic phosphate (Pi) uptake at the cellu- were on hemodialysis (HD) at the time of transplantation lar membrane is essential for the maintenance of cell (mean duration of HD: 61.5±45.9 months). BMD at the lum- viability because Pi is required for ATP synthesis. In bar spine and at the femoral neck were measured by using addition, Pi uptake via Pi transporter is required for dual-energy X-ray absorptiometry (DXA), when they were osteochondrogenic phenotypic changes of immature os- registered to waiting list and were performed SPK (mean du- teoblastic lineage and for both physiological and patho- ration after transplantation 26.1±3.9 days). We also measured logical mineralization. However, accumulating evidence serum bone-specific alkaline phosphatase (BAP), osteocalcin, suggests that Pi overload from the extracellular milieu intact parathyroid hormone (PTH) and tartrate-resistant acid causes cell stress. In the present study, we explored phosphatase 5b (TRAcP5b). whether or not high Pi affect growth and differentiation Results: The mean femoral neck BMD at SPK were signifi- of mesenchymal stem cells in vitro. cantly lower than that at the registration (Z-scores -1.9 vs. - Methods: Adipose-tissue derived mesenchymal stem cells 1.5) (p<0.05). The mean lumbar spine BMD were also lower were obtained from 8 weeks CH3 mice. The cells were incu- (Z-scores -1.0 vs. -0.9) (p<0.05) at SPK. Femoral neck BMD bated with various concentration of phosphate for 7 days. Cell decreased more in lower intact PTH and BAP at SPK growth was examined by using MTT assay. Fluorescence- (p<0.05). On the other hand, the rate of changes in lumbar activated cell sorting (FACS) was performed to detect MSC- spine BMD were not correlated with bone turn over markers. associated surface markers. Expression of phenotype- The duration of waiting for SPK was not related to the changes dependent transcriptional factors such as PPARγ and Runx2 of BMD at any site. was quantified by qRT-PCR. Apoptosis was detected by Conclusion: In T1DM patients with ESRD, BMD further caspase3/7 activity. decreased during their waiting for transplantation. The de- Results: ADMSC maintained MSC-associated surface crease at femoral neck BMD seems to be associated with markers CD90 and CD105 in high Pi buffer and the results low bone turn over at the transplantation. of MTT assay revealed that the growth of ADMSC was not affected by 3 mM Pi buffer. High Pi (3 mM) decreased the expression of PPARg, RUNX2 and ALP in ADSMC, suggest- P418 ing that high Pi slows down both adipogenic and osteoblastic PERIPROSTHETIC BONE MINERAL DENSITY: differentiation of ADMSC. However, high Pi did not induce DECISIVE FACTOR IN THE RECOVERY OF apoptosis of ADSMC. PATIENTS WITH TOTAL HIP REPLACEMENT S282 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 V. M. Ciortea1, R. Ungur1,L.Irsay1, A. Popa1,M.I.Borda1, National Osteoporosis Society clinical standards for FLS, re- L. Condurovici1 lating to the systematic and proactive identification of verte- 1Department of Medical Science, Medical Rehabilitation of bral fractures (NOS 2015).1 Data was collected at 78 sites “Iuliu Hatieganu” University of Medicine and Pharmacy across the UK. Cluj-Napoca, Cluj-Napoca, Romania Results: 63% (49) of sites had no systematic process in place to identify vertebral fractures. Only 10% (8) sites identified all Introduction: Periprosthetic bone mineral density is correlated newly reported vertebral fractures. 27% (21) had procedures with bone mineral density of the entire skeleton, being influenced in place to identify some vertebral fractures, i.e. those within by a number of factors represented by type of the disease that had certain cohorts. There was considerable disparity across the imposed the hip replacement, as well as type of artoplasty (with UK. Sites in Scotland were significantly more likely to have a or without biocement). The objective of the study is to evidence comprehensive process in place (38%, 6/16 than the rest of the the role of periprosthetic bone mineral density (BMD) in the UK (37, 2/62) rehabilitation of patients with total hip arthroplasty. Discussion: Systematic identification of vertebral fractures Material and method: The study, a representative sample poses a particular challenge to services due to a number of analysis, was carried out at the Department of Medical factors. Vertebral fractures are difficult to identify as they tend Rehabilitation of the ”Iuliu Haţieganu” UMPh Cluj-Napoca, not to present or be admitted in acute settings where FLS are in the period June-December 2009. The study inclusion primarily based. In addition, services require support from criteria were met by a number of 58 patients aged between radiology, including a commitment to avoid ambiguous termi- 30-83 years with uni- and bilateral cemented and uncemented nology when reporting vertebral fractures. Furthermore, as a total hip endoprostheses. A standard study protocol was elab- category, vertebral fractures fall between departments orated, which included the measurement of BMD in the spine (Rheumatology, Orthopaedic, fracture clinic, AandE, spinal and both hips, using dual X-ray absorptiometry (DXA), with services)making systematic identification even more chal- the Lunar Prodigy Advance osteodensitometer, the software lenging. In the FLS database facilities audit(May 2016), the for orthopedic prostheses being available. The device allows most frequently cited barrier to the identification of vertebral to determine the bone mineral content BMC (grams) and bone fractures was the lack of a patient pathway. 2 mineral density (BMD) (grams/cm²), in seven different areas Conclusion : Gap analysis shows a paucity of provision in the around the endoprosthesis, known as Gruen zones. The pa- identification of vertebral fractures. This is a key driver for tients were clinically evaluated using two scales: the Oxford work underway in the NOS to develop a patient pathway for Hip Score and the Quality of Life Questionnaire of the vertebral fractures, in conjunction with clinical experts, to European Foundation of Osteoporosis QUALEFFO-41. promote best practice and best patient care. Results: The two scores were significantly correlated References: (p<0.005) with the diagnosis made based on DXA examina- 1 https://www.nos.org.uk/health-professionals/fracture-liai- tion and with the type of hip endoprosthesis (cemented or son-services uncemented); they were higher in the case of low BMD 2 https://www.rcplondon.ac.uk/projects/outputs/fls-db- (osteopenia/osteoporosis) and cemented endoprostheses. faciliies-audit-fls-breakpoint-opportunities-improving-pa- Conclusions: Low periprosthetic BMD values delay the re- tient-care habilitation of patients with total hip endoprostheses șiand significantly reduce the quality of life of these patients. References: Vissers MM et al, Phys Ther 2011;91:615. Singh P420 J et al, J Am Acad Orthop Surg 2010;18:72. CONGENITAL ADRENAL HYPERPLASIA AND OSTEOPOROSIS: A REALITY? CASE REPORT AND REVIEW OF LITERATURE P419 I. S. Soare1, M. A. Betivoiu1,C.S.Martin2,S.Fica2 IDENTIFICATION OF VERTEBRAL FRACTURES IN 1Department of Endocrinology and Nutrition,. Elias FRACTURE LIAISON SERVICES ACROSS THE UK Emergency University Hospital, Bucharest, Romania, J. Sayer1,S.Stephenson1 2Department of Endocrinology and Nutrition, Elias 1National Osteoporosis Society, Bath, United Kingdom Emergency University Hospital /University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania Objective: To evaluate provision for systematic identification of newly reported vertebral Fractures in patients aged over Background: Congenital adrenal hyperplasia (CAH) is a rare 50 at Fracture Liaison Services (FLS) across the UK. autosomal recessive disorder caused by defective steroidogen- Material and Methods: A gap analysis tool was used to esis resulting in glucocorticoid deficiency; the patients assume measure service provision against Standard one of the a lifelong glucocorticoid (GC) therapy. It is thought that Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S283 excessive GC treatment, in CAH patients, increases the risk with mineral metabolism derangement and low bone mineral of osteoporosis and bone fractures. density. We previously demonstrated that exposure of osteo- Case presentation: We report the case of a 37-year old, fe- blasts (OBS) to sera of sedentary subjects affected by abdom- male, smoker, normoponderal, diagnosed at birth with inal obesity alters cell homeostasis in vitro, leading to disrup- P450c21 hydroxylase deficiency simple virializing form, kar- tion of intracellular differentiation pathways and cellular ac- yotype 46 XX, treated with glucocorticoids since early child- tivity. Thus, aim of present study was to investigate whether hood. Menarche at 8 years old, no pregnancies and normal sera of subjects, before and after physical activity (PA) and menstrual cycle in the last year. She associated long periods of hypocaloric diet (HD) could affect OBS activity in vitro. secondary amenorrhea inconstantly treated with oral Methods: Obese women were evaluated at time 0 and after 4, estroprogestatives. Biochemistry in normal ranges. 6, 12 months of individualized prescribed PA and HD. Dual- Hormonal tests revealed: ACTH=66.66 pg/ml (5-46), testos- Energy-X-Ray Absorptiometry measurements and blood col- terone=164.5 ng/dl, DHEA-S=278.9 μg/dl (60.9-337), 17 OH lections were performed at each time point. OBS were ex- progesterone=69.5 ng/ml, estradiol=91,16 pg/ml, FSH=7.4 posed to sera of subjects as follow: 1) obese (OB T0) 2) obese mUI/ml, LH=4.46 mUI/ml, 25 OH vitamin D=18.1 ng/ml, after for 4 months (OB T4); 3) obese after 6 months (OBT6); PTH=43.8 pg/ml (10-65). Spine DXA revealed a Z score of 4) obese after 12 months (OB T12) of PA and HD. -2DS. Given the normal menstrual cycles we continued sub- Results: OBS exposed to sera of patients, who displayed in- stitution only with Prednisone 5 -7.5 mg/day. We associated creased lean and decreased fat mass (from 55.5±6.5 to 57.1 supplementation with Calcium 1000 mg/day and vitamin D3 ±5.6*% and from 44.5±1.1 to 40.9±2.6**%, respectively), 1000 UI/day. showed a time-dependent increase of Wnt/ β-catenin signal- Conclusion: Some studies suggest that overtreatment with ing vs. cells with sera of obese women before PA and HD, glucocorticoid leads to low BMD in CAH patients, resulting suggesting recovery of this specific intracellular signaling. An from the increased steroid effect on bone and, to a lesser de- increase of β-catenin nuclear accumulation, was also associ- gree, to an over suppression of androgens that have an ana- ated to an increase in Adiponectin receptor-1 (AdipoR1) pro- bolic bone effect. Other studies found no association between tein expression, suggesting a positive effect on cell differenti- BMD and duration of steroid treatment at standard doses. ation program. Moreover, a significant decrease in sclerostin Furthermore, BMD in CAH women under estrogen therapy amount and an increase of P1NP were depicted vs. baseline is similar with those not taking exogenous estrogens. Lower suggesting a recovery of bone remodeling modulation in- values of femur BMD in CAH patients were described and duced by improved body composition. considered a consequence of the pathology itself, and for this Conclusion: Our results show for the first time that sera reason BMD measurement is probably justified in patients of obese sedentary women who increased lean mass and with CAH. Even there are no interventional therapeutic stud- decreased fat mass, by a controlled PA and HD protocol, ies in CAH patients, preventive measures such as physical rescue OBS differentiation and activity, likely due to a activities, calcium and vitamin D supplementation should be reactivation of Wnt/β-catenin-pathway, suggesting that a implemented. correct life style can improve skeletal metabolic alter- ation induced by obesity. P421 IN VITRO CHARACTERIZATION OF OSTEOBLASTS P422 HOMEOSTASIS UPON EXPOSURE TO SERA OF FRAILTY, SARCOPENIA, AND OSTEOPOROSIS: OBESE WOMEN AFTER PHYSICAL ACTIVITY AND THE ROAD STUDY HYPOCALORIC DIET PROTOCOL N. Yoshimura1,S.Muraki1,H.Oka2,T.Iidaka1,R.Kodama1, S. Migliaccio1,V.Bimonte2,C.Marocco3, G. Emerenziani4, H. Kawaguchi3,K.Nakamura4,T.Akune4, S. Tanaka5 R. Fornari3,L.Guidetti4,E.Poggiogalle3, D. Agnusdei5,L.Di 1Department of Joint Disease Research, Tokyo University, Luigi4,L.Donini3,C.Baldari4,A.Lenzi3, E. Greco3 Tokyo, Japan, 2Department of Medical Research and 1Dept. Movement, Human and Health Sciences, Foro Italico Management for Musculoskeletal Pain, Tokyo University, University, Rome, Italy, 2Dept Movement, Human and Health Tokyo, Japan, 3JCHO Tokyo Shinjuku Medical Center, Sciences, Rome, Italy, 3Dept Experimental Medicine, Tokyo, Japan, 4National Rehabilitation Center for Persons Sapienza University, Rome, Italy, 4Dept Movement, Human with Disabilities, Saitama, Japan, 5Department of and Health Sciences, Foro Italico University, Rome, Italy, Orthopaedic Surgery, Tokyo University, Tokyo, Japan 5Endocrinology Center, Siena, Italy Purpose: The present study was performed to investigate the Objective: Obesity is a multifactorial disease linked to meta- prevalence of frailty, as well as the proportion of cases of bolic chronic disorders. Recently it has also been associated sarcopenia (SP) and osteoporosis (OP) coexisting with frailty. S284 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Methods: The second survey of the Research on Osteoarthritis/ ascertained from population-based healthcare databases. Osteoporosis Against Disability (ROAD) study, a large-scale The performance of FRAX, derived without and with population-based cohort study, was conducted between 2008 BMD (Canadian FRAX tool version 3.11), was studied and 2010. We enrolled 1,083 participants (aged ≥60 years; 372 in relation to CKD stage. men and 711 women) of the second survey of the ROAD study Results: The cohort comprised N=10,128 subjects (mean age whose unintentional weight loss, self-reported exhaustion, and 64±13 y), including N=2184 with GFR 30-60 mL/min/1.73 low physical activity had been assessed by using a self- m2 (moderate CKD stage 3) and N=617 with GFR <30 mL/ administered questionnaire. Furthermore, they had completed min/1.73 m2 (severe CKD stages 4-5). During 5 y observation assessments for handgrip strength, gait speed, skeletal muscle there were 585 with incident MOFs (226 with hip fractures). mass by bioimpedance analysis, and bone mineral density by In Cox proportional hazards models, FRAX stratified MOF dual X-ray absorptiometry. We defined frailty in accordance and hip fracture risk regardless of CKD stage (TABLE); gra- with Fried’s definition. SP was defined as per the algorithm of dient of risk was slightly greater for MOF in those with mod- the Asian Working Group for Sarcopenia, while OP was defined erate and severe reductions in eGFR (FRAX*eGFR interac- basedontheWorldHealthOrganizationcriteria. tion P<0.004) and was unaffected by eGFR for hip fractures Results: The prevalence of frailty was found to be 5.6% (men, (interaction P>0.1). eGFR was not an independent risk factor 3.8%; women, 6.6%). Among the individuals with frailty, for fracture in the CKD population when adjusted for FRAX 44.3% (men, 57.1%; women, 40.4%) were diagnosed as hav- risk factors. Observed and predicted cumulative MOF and hip ing SP and 50.8% (men, 21.9%; women, 59.6%) were diag- fracture probabilities (adjusted for competing mortality) were nosed as having OP. After adjustment for age, sex, regional concordant for all eGFR categories, implying satisfactory differences, and emaciation, a logistic regression analysis was FRAX calibration. performed using the presence of frailty as the objective vari- Conclusions: FRAX accurately predicts fracture risk in pa- able and the presence of SP and OP as the explanatory vari- tients with moderate and severe CKD. Clinicians can use the ables. The presence of SP was significantly associated with same fracture risk assessment strategies in CKD patients as in the presence of frailty (odds ratio [OR], 4.59; 95% confidence the general population. interval [CI], 2.31–9.13; p <0.001). By contrast, the presence of OP was not significantly associated with frailty (OR, 1.12; 95% CI, 0.58–2.16; p=0.74). Conclusions: This study suggests that the presence of SP, and not OP, could predict the presence of frailty. P423 FRAX PREDICTS FRACTURE RISK IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE P424 W. D. Leslie1, R. Whitlock1,J.Shaw1, C. Rigatto1,L. HIGH CARDIOVASCULAR RISK IN OLDER MEN Thorlacius1, P. Komenda1,D.Collister1,J.A.Kanis2,N. WITH LOW TRABECULAR BONE SCORE: THE Tangri1 PROSPECTIVE STRAMBO STUDY 1Rady Faculty of Health Sciences, University of Manitoba, P. Szulc1, R. D. Chapurlat1 Winnipeg, Canada, 2Centre for Metabolic Bone Diseases, 1INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, University of Sheffield Medical School, Sheffield, United Lyon, France Kingdom Objective: Many studies show associations between cardio- Objective: FRAX® was developed to predict fracture risk in vascular diseases and fragility fracture. By contrast, data on the general population but its applicability to patients with the link between pre-fracture bone deterioration and cardio- chronic kidney disease (CKD) is unknown. vascular risk are limited. Therefore, our aim was to assess the Materials and Methods: Using the Manitoba Bone association between trabecular bone score (TBS) and the car- Mineral Density (BMD) Database we identified adults diovascular risk in older men. not receiving dialysis services with recent serum creati- Material and Methods: In 779 men aged 60-87 having nine measurements (Diagnostic Services of Manitoba BMI<35 kg/m2 TBS was assessed using a HOLOGIC laboratory database), both measured within 1 y in Discovery A device (TBS iNsight 1.3). During an 8-year prospec- 2005-2010. Estimated glomerular filtration rate (eGFR) tive follow-up, 49 men had acute coronary syndrome (e.g. myo- was obtained from the CKD-EPI equation. Incident ma- cardial infarction, unstable angina) and 162 men died (including jor osteoporotic fractures (MOF) and hip fractures were 51 CV deaths). The analyses were adjusted for age, lifestyle, co- Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S285 morbidities, treatments, body composition and serum levels of Results: While jogging with shoe-H, the peak pressure and testosterone, osteoprotegerin and C-reactive protein. force-time integral in the lateral forefoot and other toes regions Results: Low TBS was associated with higher risk of acute were obviously greater than those of control shoes (p=0.016 coronary syndrome (HR=1.65 per SD decrease, 95%CI: 1.23- and 0.018) and shoes-S (p=0.015 and0.005). On the contrary, 2.22, p<0.001) and was higher in the lowest TBS quartile the plantar pressure in the medial forefoot and central forefoot (<1.142) vs. the highest (≥1.290) one (HR=2.95, 95%CI: showed significant reduction (p=0.008, 0.015 and 0.038, 1.18-7.34, p<0.05). The associations remained significant af- 0.027), and a greater increase in the hallux region (p=0.000, ter accounting for competing risk of death, e.g. HR=1.55 per 0.003 and 0.000, 0.000) with shoes-S. SD decrease, 95%CI: 1.16-2.06, p<0.005. Furthermore, low Conclusion: Shoes-H with stronger rocker stimuli increased TBS was associated with higher risk of cardiovascular death loading to lateral forefoot and other toes. Shoes-S presented (HR=1.64 per SD decrease, 95%CI: 1.19-2.28, p<0.005). The obviously stimuli to the toes’ gripping function, with illustra- risk of cardiovascular death increased across decreasing TBS tion of reduced forefoot loading (medial and central forefoot). quartiles (p for trend=0.01) and was higher in the lowest quar- Based on the stimuli effect of shoes-S, future studies shall tile (HR=3.56, 95%CI: 1.17-10.81, p<0.05) vs. the highest conduct longitudinal study and analyse the performance of a quartile. These associations remained significant after ac- certain period training, which would provide reliable and counting for competing risk of non-cardiovascular death, comprehensive implications and instructions for toes function e.g. HR=1.47 per SD decrease, 95%CI: 1.08-1.99, p<0.05. training. Conclusion: Our data confirm the association between oste- oporosis and cardiovascular disease and show that older men with low TBS have significantly higher risk of adverse car- P426 diovascular outcome. MUSCULOSKELETAL DISORDERS AND PERCEIVED WORK DEMANDS AMONG NURSES: EVIDENCE FROM INDIA P425 A. Sha1 INSTANT BIOMECHANICS RESPONSE OF WEA- 1Al Iqbal Hospital, Thrissur, India RING TOES ROCKER SHOES FOR BUNION Q. Mei1,Y.Gu2,J.Fernandez3 Introduction: Musculoskeletal disorders (MSD) are common 1Auckland Bioengineering Institute, University of Auckland; among nurses and can affect patient outcomes. The study ob- Faculty of Sports Science and Research Academy of Grand jective was to measure prevalence of MSD and their association Health, Ningbo University, Auckland, New Zealand, 2Faculty with perceived work demands and sociodemographic variables of Sports Science and Research Academy of Grand Health, among female nurses at a tertiary care hospital in rural India. Ningbo University, Ningbo, China, 3 Auckland Methods: A cross-sectional study was undertaken in 2015 Bioengineering Institute, University of Auckland, Auckland, throughintervieweradministeredquestionnaireswhichcomprised New Zealand three parts: sociodemographic data, modified Nordic question- naire, and perceived physical and psychological work demands. Objective: Human foot is the direct link between the internal Results: 355 nurses with a mean age of 30.4 years participat- locomotion kinetic chains with the external ambulatory sur- ed. Prevalence of any MSD in the last seven days was 60.5% roundings. However, long term wearing ill-fitted shoes have with low back pain being the most common and elbow pain degenerated foot functions, even deformed foot shape, thus the least common. Occurrence of any MSD was associated forming bunion and hallux. This study aimed to analyse the with age, number of children, working hours at home, BMI, instant biomechanics response of wearing toe rocker shoes, and total work experience. High perceived physical demands which was designed to practice toes functions. score was associated with lower back (OR: 3.06) and knee Material and Methods: Twenty-five male subjects joined the pain (OR: 7.73). jogging test, without history of wearing any rocker or unstable Conclusion: Prevalence of MSD was high and occurrence of shoes. Normal flat shoes were chosen as control shoes, and lower back and knee MSD was associated with perceived experimental shoes (H-Hard and S-Soft) were formed with physical demands. This information should be used as a unstable hemisphere to the hallux region based on material benchmark and guiding tool for designing work place inter- properties. Plantar pressure measurement were conducted ventions to improve working conditions and health of nurses. with Novel Pedar insole system, with frequency at 50Hz. The repeated measures ANOVAwith post hoc Bonferroni test from SPSS 17.0 were taken to analyse the significance among P427 control shoes, shoes-H and shoes-S, with significance level REVERSE TOTAL SHOULDER ARTHROPLASTY IN at 0.05. PATIENTS WITH OSTEOARTHRITIS S286 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 J. A. Camacho Chacón1,J.J.LopezSubias1,V.García Introduction: bisphosphonates inhibit osteoclasts effect - Calvo1, I. Carbonel Bueno1, J. Ripalda Marín1 blocking the farnesyl pirosfat FPP synthase - a key enzyme of 1Department of Orthopaedic Surgery. H. U. Miguel Servet, the mevalonate way, intermediate in the biosynthesis of choles- Zaragoza, Spain terol - which acts as a glucocorticoid receptor agonist. This has led to the analogy to the positive effect on the inhibition of bone Introduction: The Reverse Total Shoulder Arthroplasty, ini- resorption may be expected and the effects of statins. tially emerged as an alternative for the treatment of Aim: to determine whether statins in conjunction with Osteoarthritis, and could not benefit from the anatomical bisphosphonates increase bone density in postmenopausal glenohumeral arthroplasty. Over time current indications have osteoporosis been extended to other pathologies. Methodology: we measured the bone density of the lumbar Objective: To evaluate clinical and radiographic short- spine by DXA before and 27 months after the application medium term results. therapy. First group of 30 patients were treated with Materials and Methods: A retrospective study was per- ibandronate - 150mg in a slow i.v. infusion every III month formed at the HUMS on 22 patients undergoing reverse total and simvastatin - 40mg/day and control group, 30 patients - shoulder arthroplasty from 2004-2013. The indications for only by ibandronate. In both groups applied supplementation - surgical intervention were Osteoarthritis, and patients who calcium 1000 mg/day and Vitamin D3 880 IU / day. Inclusion had the diagnosis of a pseudoparalytic shoulder in the setting criteria: postmenopausal women and hypercholesterolemia - of a Osteoarthritis. A pseudoparalytic shoulder was defined as total cholesterol > 5.4 mmol / l and diagnosed with osteopo- 60 degrees or less of forward elevation with associated ante- rosis T-score of <-2.5). rior and superior shoulder instability. Results: From 20.09.2014 - 29.12.2016 in the Institute Niska Patient-oriented outcomes were obtained using the Constant Banja, ibandronate and simvastatin, were treated and followed Score, preoperatively and postoperatively at 3, 6, 12, 24 months. 30 women, the average age 63.4±5.6. Values T- score at the In addition, functional ranges of motion were measured in for- beginning of treatment was - 2.71SD and BMD=0.674 g/cm2. ward elevation and internal and external rotation. Preoperative Women had hypercholesterolemia with average value of 7.96 and postoperative Visual Analog Scale (VAS) were recorded. ±2.35 mmol / l. Control the group of 30 women without hy- Results: The mean patient age was 72,6 years (range, 51-75 percholesterolemia, average age 62.8±6.2 years, treated only years). The mean follow-up was 5,3 years (range, 6 months-11 by ibandronate T- score in this group at the beginning was - years). 87% of the patients were women. 63% were right 2.58 SD and BMD=0.718 g/cm2. After 27 months of treat- shoulders and 37% left shoulders. The main complaint was ment, the bone density of the spine increased in the first group pain and loss of function for daily living activities. The aver- by 8.2% (p <0.0001) and in the second by 5.8% (p <0.0001). age preoperative pain score was 7, with a range from 5 to 9. Statistical significant difference (p <0.05) increase in bone Preoperative Constant score averaged 23,9, with a range from density was in the first group of patients, treated with simva- 16 to 31. Postoperatively, all scores improved with a mean statin and ibandronate. pain score noted at 1, range 0 to 6; mean Constant 69,2, with Conclusion: In association with statins and ibandronate a range 23 to 74; Mean Abduction was 110, forward elevation seems to be the effect of osteoporosis treatment significantly was 120 degrees, external rotation of 62 degrees. Internal ro- improved tation 63 degrees. Conclusions: Reverse arthroplasty is an excellent therapeutic option for the treatment of degenerative disease of the shoul- P429 der, but their long-term results are not entirely satisfactory FRAGILITY FRACTURE REGISTRY IN HONG than expected, design improvements are necessary in order KONG to obtain better results. I. Ngai1,K.B.Lee1 1Department of Orthopedics and Traumatology, Queen Elizabeth Hospital, Hong Kong P428 INFLUENCE BISPHOSPHONATES AND STATINS TO Background: Hip fractures are common among frail elderly INCREASE BONE DENSITY IN POSTMENOPAUSAL populations and often have serious consequences on function, OSTEOPOROSIS mobility and mortality. International studies have shown that K. Markovic1,R.Filipov1,S.Kozomara1, M. Stoickov1,S. interdisciplinary, multidirectional and systemic assessment for Bacevic2 fragility fracture in elderly is beneficial to patients. However, 1Institute for Treatment and Rehabilitation of Rheumatic and in Hong Kong previously, there was no systemic management Cardiovascular Diseases "Niška Banja", Nis, Serbia, 2General until the setup of Key Performance Index (KPI) for hip frac- Hospital, Prokuplje, Serbia tures in elderly in Hospital Authority (HA). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S287 Methods: A working group on Fragility Fracture Registry using TRAP staining and osteo assay kit respectively. (FFR) has been set up since early 2013, followed by a formal Expressions of osteoclast markers were determined by RT- FFR subcommittee. The mission is to promote integrated clin- qPCR. Further, LncRNA expressions were determined ical care in terms of holistic management journey from admis- through LncProfiler qPCR array and their interaction with sion, operation to rehabilitation, until the patients return to OC markers was identified through bioinformatic analysis community. Prevention of secondary fracture is also impor- (RNA hybrid). tant. A pilot study was started in 6 HA (public) hospitals to Results: Compared to the HD exosomes, β-TM exosomes pro- capture the essential data (acute management, rehabilitation moted osteoclast differentiation in RAW264.7 cells stimulated and 1 year follow-up) for managing fragility fracture patients. with RANKL and M-CSF. β-TM exosomes significantly upreg- Data in 2012 of these 6 hospitals were collected and analyzed. ulated osteoclast specific markers (Nfatc1,Traf6,Ctsk, cFos, A unified multi-disciplinary Fragility Hip Fracture Pathway Mmp9 and Trap) on day 3 and day 5 compared to day 0. We (FHFP), starting from admission to rehabilitation and back to also identified significant increase in the formation of multinu- community, was established in 2015. This pathway was put cleated osteoclast-like cells and pit formation by β-TM into pilot in one of the HA hospitals. exosomes on day 5. Importantly, β-TM exosomes deregulated Results: One-year outcome evaluation has been performed LncRNAs expressions in RAW264.7 cells during osteoclast dif- and the results was convincing (In terms of increase in KPI ferentiation. Further, bioinformatic analysis showed specific performance, decrease in acute length of stay and mortality). LncRNA-mRNA interaction between upregulated LncRNAs Conclusions: The FHFP has been shown to have better func- (AK082072, Dlx1as and SNHG5) and osteoclast proteins, tional outcome, and shorter length of stay. Further integration CathepsinKandDC-STAMP. such as, orthogeriatric collaboration, 7-day rehabilitation, Conclusion: The present study for the first time shows impor- fracture liaison service, community programme, bone-health tant evidence that exosomes from β-TM patients promote and sarcopenia management are all crucial to optimize the osteoclast differentiation. Thus, upregulated LncRNAs by β- FHF care in the near future. TM exosomes might specifically interact with osteoclast re- lated proteins to regulate osteoclast differentiation. P430 BETA-THALASSEMIA MAJOR EXOSOMES MIGHT P431 PROMOTE OSTEOCLAST DIFFERENTIATION PERSISTENCE AND ADHERENCE TO DENOSUMAB THROUGH LNCRNA UPREGULATION FOR THE TREATMENT OF POSTMENOPAUSAL Y. M . Wa ng 1,K.T.Sun2,C.Y.Li3 OSTEOPOROSIS 1Department of Radiology, Taichung Tzu Chi Hospital, A. Parrotta1,G.Muccari2,E.DeLuca3,G.Gallo4 Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan 1O.U. of Physiatry and Rehabilitation, Pugliese-Ciaccio ROC, China, 2Department of Pediatric Dentistry, China Hospital, Catanzaro, Italy, 2O.U. of Internal Medicine Medical University Hospital, Taichung, Taiwan ROC, ,Pugliese-Ciaccio Hospital, Catanzaro, Italy, 3O.U. of China, 3Department of Anesthesiology, China Medical Cardiology, University Magna Graecia of Catanzaro, University Hospital, Taichung, Taiwan ROC, China Catanzaro, Italy, 4Department of Medical and Surgical Sciences, O.U. of General Surgery, University Magna Graecia Objective: Thalassemia Major (TM) is highly linked in de- of Catanzaro, Catanzaro, Italy velopment of osteoporosis. However, the molecular mecha- nism of β-TM-induced osteoclast differentiation is not Objectives: Osteoporosis is an asymptomatic systemic skele- known. Exosomes mediate cell-cell communication and tal disease. Antiresorptive agents are useful, but their effec- LncRNAs are known to mediate important regulatory roles tiveness is limited by the worst adherence and inadequate in human diseases. We aimed at identifying whether β-TM long-term persistence. The aim of this study is to demonstrate exosomes and lncRNAs play key role in osteoclast how the better adherence and the persistence of the treatment differentiation. with Denosumab, a fully human monoclonal antibody with Materials and Methods: Plasma exosomes (n=30) were iso- high affinity and specificity for RANKL, could decrease the lated from β-TM patients and healthy donor (HD) ranging in risk of fractures in postmenopausal osteoporosis. In fact, a age ranging from 12 to 41 years. RAW264.7 cells were stim- greater persistence and a good adherence to treatment for os- ulated with receptor activator for nuclear factor-κB ligand teoporosis is associated with a reduced risk of fractures. (RANKL) 100 ng/ml and macrophage-colony stimulating fac- Materials and Methods: One-hundred-sixty-eight patients tor (M-CSF) 50 ng/ml for osteoclast differentiation in the (166 women and 2 men) were recruited (mean age 77.1 years) presence of HD/ β-TM exosomes. The osteoclasts formation in our Department between November 2013 and November and osteoclast-mediated bone resorption were visualized 2016. Of these patients, nine were also in treatment with S288 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 adjuvant aromatase inhibitors for breast cancer. 60 mg D were between 5 and 20 ng/ml, or monthly if serum levels of Denosumab were administered every 6 months. Two pa- of 25-OH-D were between 21 and 31 ng/ml. Follow up was tients died during follow-up and were excluded from the performed at 3, 6 and 12 months. study. Thirty-one patients have taken Denosumab for 3 years, Results: After 3 months from the beginning of the therapy seventy-one for 2 years, thirty-six for 1 year, fifteen within a eight women and four men had achieved normalization of range between 6 and 8 months and the last fifteen for 6 ALP levels and response rate were maintained at 6 and 12 months. Adherence was defined as receiving a subcutaneous months. Two men had achieved only a partial reduction of injections of denosumab every 6 months (±2 week). serum ALP level at 3 months, whereas at 12 months ALP Persistence was defined as continuation of treatment without levels had decreased to the normal range. These patients had a >60-day gap. Through the use of an appropriate educational lower levels of 25-OH-D. Afterwards to supplementation at 6 program and follow-up at 30 days it was improved patient months they had achieved target values at 12 months. One awareness and empowerment. We have discussed with the man maintained high levels of serum ALP and continued to patients about their preferences (oral bisphosphonates or sub- report pain at follow-up. All patients who had achieved nor- cutaneous denosumab), the role in fragility fractures risk re- mal range values of ALP levels had showed higher quality of duction, side effects and the efficacy of the treatment despite life as assessed by SF-36 as well as reduction of pain on NRS the lack of any tangible “symptom” benefit. at 3, 6, and 12 months. Results: Adherence and persistence rate was 100%. None of Conclusions: These data suggest a clear correlation between the patients have had fractures in the period of observation. bone turnover suppression and improvement of quality of life Conclusions: These data suggest how effective communica- and pain after only 3 months since the beginning of the study. tion and empowerment of the patients can improve adherence and persistence rate. P433 HYALURONIC ACID/SORBITOL COMPLEX P432 IMPROVES CARTILAGE MATERIAL PROPERTIES INTRAVENOUS NERIDRONATE FOR THE TREATMENT P. Ammann1 OF PAGET’S DISEASES OF BONE: CORRELATION 1Department of Internal Medicine Specialties Service of Bone BETWEEN ALP LEVELS AND QUALITY OF LIFE AT 3, Diseases Geneva University Hospitals, Geneva, Switzerland 6 AND 12 MONTHS OF FOLLOW-UP A. Parrotta1,G.Muccari2,E.DeLuca3,G.Gallo4 Visco-supplementation is known to influence positively pain 1O.U. of Physiatry and Rehabilitation, Pugliese-Ciaccio and mobility of patient suffering from osteoarthritis. The rapid Hospital, Catanzaro, Italy, 2O.U. of Internal Medicine, and early reduction of pain was related to improvement of Pugliese-Ciaccio Hospital, Catanzaro, Italy, 3O.U. of joint rheology and in relation with sorbitol acting as free rad- Cardiology, University Magna Graecia of Catanzaro, ical scavenger that interferes with the Hyaluronic acid (HA) Catanzaro, Italy, 4Department of Medical and Surgical degradation and inflammation. Thus long acting effect on pain Sciences, O.U. of General Surgery, University Magna and mobility even after disappearance of the molecule from Graecia of Catanzaro, Catanzaro, Italy the joint cavity is poorly understood but a clinical reality. A physicochemical effect of HA/sorbitol complex (SynolisVA®) Objectives: To evaluate the correlation at 3, 6 and 12 months on articular cartilage micromechanical properties could be one from the beginning of pharmacological treatment, among the of the mechanisms implicated. Indeed the main function of reduction of serum ALP (alkaline phosphatase) levels and cartilage (shock absorption and force transmission) is influ- improvement of quality of life, especially with regards to the enced by its biomechanical characteristics. pain in patients with Paget’s disease of the bone. To verify this hypothesis, distal femurs were harvested Materials and Methods: Eight Women (mean age 69.5 from 12 11-month-old rats. Bio-indentations (Piuma, years) and seven men (mean age 59.7 years) with Optics 11, Netherland) were performed at the level of polyostotic Paget’s disease of the bone and back and knee the medial condyle at three different area submitted pain were recruited in the last year. Diagnosis was per- physiologically to different mechanical loading, before formed using bone scan and measurement of serum ALP and after an overnight incubation in SynolisVA®. levels. 25-OH-D levels were also measured. Quality of life Controls were incubated in PBS. To investigate the per- and pain were evaluated using SF-36 questionnaire and sistence of the effect, all samples were than tested after a NRS (numerical rating scale) respectively. 100 mg of second overnight in PBS. Elastic modulus (MPa) and neridronate were administered by intravenous infusion for maximal force (N) were recorded. Indentation depths 2 consecutive days. 50.000 units of cholecalciferol were were located in the upper part of the hyaline cartilage. administered weekly, if baseline serum levels of 25-OH- Thus cartilage thickness was evaluated by contrast Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S289 enhanced computed tomography with ionic contrast After our patient had the surgery he developed “hungry bone agent using (Hexabrix®) at the site of indentation. syndrome” which aggravated the kidney disease so he had A mean modulus increment by 19.9±3.4% (p=0.001) was three dialysis sessions with good evolution afterwards but at observed in samples incubated with SynolisVA® and by 2.6 the present time he is still slightly hypo calcemic and we are ±3.0% (ns) in the control incubated in PBS. The difference treating him with calcium supplements and active-vitamin D. I between the two groups was significant (p<0.001). This mod- still remains a question whether to treat or not the complica- ification of modulus was associated with a significant incre- tions especially osteoporosis in this case ment of maximal force by 7.3%. These positive effects were observed in all the 3 regions investigated. After a second in- cubation of all samples with PBS the positive significant effect P435 was maintained 16.4.0± 2.9%, the value remaining stable in MONITORING STATUS OF VITAMIN D 25(OH)D3, controls. This study represents a proof-of-concept demonstrat- 1,25-(OH)2D3, OF POLYMORPHISMS VDR AND ing a physicochemical effect of HA/sorbitol complex on car- VARIATIONS OF DBP (VITAMIN D BINDING PROTEIN) tilage material level properties. It also demonstrates the per- IN THE PRAXIS AREA OF THE OSTEOLOGY sistence of the effect even after removal of SynolisVA® from ACADEMY ZLÍN, CZECH REPUBLIC the incubation bath; suggesting a penetration and fixation of P. Novosad1,P.Hrdý1,M.Zemánek2, P. Fojtík3 HA and/or sorbitol in the cartilage. This phenomenon could 1Osteology Academy Zlín, Zlín, Czech Republic, 2Imalab also account for the rapid clearance of HA generally observed Lab. Ltd, Zlín, Czech Republic, 3Agel Research and after injection in the joint cavity. Training Institute, Ostrava-Vítkovice Branch and Hospital These results indicate that physicochemical improvement of Centre of Care for the Gastrointestinal Tract, Ostrava- cartilage material properties by SynolisVA® (HA/sorbitol com- Vítkovice, Czech Republic plex) could represents a major mechanism explaining its long term efficacy. Aims: The research reports on monitoring the status of vita- min D (complex measuring of 25(OH)D3, 1.25(OH)2D3, polymorphisms VDR and variations of Protein binding) in P434 the eastern area of the Czech Republic (2.5 mill patients) VITAMIN D DEFICIENCY AS THE CAUSE OF AVERY which is under the care of the Osteology Academy Zlín. LATE HYPERPARATHYROIDISM DIAGNOSIS Methods: Vitamin 25(OH)D3, Vitamin1.25(OH)2D3 by R. Novac1 using a DiaSorin company’s method. Polymorphisms of vita- 1Emergency Hospital, Moinesti, Romania min D (FokI, ApaI, BsmI and TagI) and variations of DBP (rs7041 and rs4588): DNA was isolated by kit MagNa Pure Hyperparathyroidism is our days a pretty rare cause of kidney Compact Nucleic Acid Isolation Kit I using automated isolator failure. The picture of “stones, bones and groans” has become MagNa Pure Compact from 400 μl non-coagulable blood now history due to the new modern technics that allow us to samples. Detection of all polymorphisms was carried out by analyze the phosphor-calcic balance easily along with the im- a method of real time PCR with the use of hydrolysis and agistic devices that can localize parathyroid glands. FRET probes on LC 480 II (Roche). Correctness of the mo- We present the case of a 71 years old man with 12 years of renal lecular examination results was randomly checked by se- failure history, apparently idiopathic. Two years before the patient quencing on a sequenator ABI 3100 AVANT (Applied addressed us he was proposed for dialysis, which he refused. Biosystem). At the present moment he presented with clear hypercalcemia Results: Since the year 2007 we have carried out n=130 485 with hypophosphatemia, a very high PTH and right Para tracheal measurements of vitamin 25(OH)D3. The average reading mass that we thought was responsible for all of it. This intrigued was 70.3 nmol/L. Winter readings (n=33 849, r=65.93 us so we had this patient’s lab history which apparently did not nmol/L) differed from summer readings (nb=29 465, show hypercalcemia or hypophosphatemia over years. r=79.38 nmol/L). The total number of measuring Our patient had at the time all the complications of hyperpara- 1.25(OH)2D3 during the last two years was 14 084. The av- thyroidism, he had severe nephrocalcinosis, high bone demin- erage value is 119.60 pmol/L. Changes in the individual sea- eralization, nausea, myalgia, meaning we were in front of a sons of the years are not significant. The following polymor- long history of hyperparathyroidism. phisms: FokI, ApaI, TagI, BsmI, were determined from poly- The cause proved to be a vitamin D deficit, which is rare in morphisms VDR receptor. In total, these were stated with hyperparathyroidism because usually high PTH stimulates the 2 127 patients. The most frequent mutations were determined 1-alpha hydroxylase to activate vitamin D. This masked the in BsmI (rs1544410, G>A substitution) 45.1%. This was also hypercalcemia over years but could not prevent the conse- significant in oncological diseases of the alimentary tract. quences of high PTH. Variants DBP rs4588 (mutation 12.0%) and DBP rs7041 S290 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 (mutation 21.6%) n=489 patients, were determined in DBP. and the risk goes up 5 times with doses of 7, 5 mg/day or more Total average reading for those patients was 343.3 mg/L. in the first 3 to 6 months of treatment. For this reason we Conclusion: Due to the high percentage occurrence of muta- consider that clinical evaluation and therapy to prevent osteo- tions in VDR or DBP in our population, we can observe a porosis should be initiated early once glucocorticoids are in- proven insufficiency of mono monitoring 25(OH)D in com- cluded as regular medication to prevent added morbidity to plicated cases. In the discussion we show a possibility for baseline disease. computerised interpretation of vitamin D status designed here for the clinical use. P437 ASSOCIATION OF DYSMOBILITY SYNDROME P436 WITH FRACTURE RISK IN THE MROS COHORT GLUCOCORTICOID-INDUCED OSTEOPOROSIS (GIO): B. Buehring1,B.L.Lewis1,K.E.Hansen2,S.R.Cummings3, 45 YEAR OLD MALE TREATED WITH TERIPARATIDE N. E. Lane4,K.E.Ensrud5,N.Binkley1,P.M.Cawthon3 F. Lopez1,F.Geraci1,C.G.Firpo1 1Osteoporosis Clinical Research Program, University of 1Sanatorio Las Lomas, San Isidro, Argentina Wisconsin, Madison, United States, 2Medicine, Division of Rheumatology, University of Wisconsin, Madison, United Introduction: GIO is the most common cause of secondary States, 3San Francisco Coordinating Center, California osteoporosis. It occurs early, with rapid bone loss in the first Pacific Medical Center, San Francisco, United States, few weeks after initiation of the treatment, with a rate that is 4Center for Musculoskeletal Health, Sacramento, United dependent mainly on the daily dose. Glucocorticoids induce States, 5University of Minnesota School of Public Health, fragility fractures, especially in spine, generating functional Minneapolis, MN, United States disability. Objective: to describe the case of a male patient with GIO Introduction: Osteoporosis, obesity and sarcopenia are risk treated with Teriparatide. factors for fractures and their combination has a negative Case Report: a 45 year old male with diagnosis of effect on musculoskeletal health (MSKH). We proposed a Autoimmune Hemolytic Anemia and Ulcerative Colitis was score-based approach to define this combination as referred as he reported a chronic history of prednisone treat- “dysmobility syndrome” (DS). DS increases mortality in ment with doses up to 100 mg a day for over more than 5 the NHANES cohort but no data exist on fracture risk. years. The current prednisone dose was 4 mg/day at the time The most widely used fracture risk calculator, the WHO of the medical consult. Baseline DXA was performed show- FRAX® tool, does not include several measures of MSKH ing: (08/30/13) L1-L4 Z score -3, 0 CFI Z score -0, 8. such as physical function, muscle mass or falls. In this anal- Complete blood work, evaluating causes of secondary osteo- ysis of the Osteoporotic Fractures in Men (MrOS) cohort, porosis and spine X-Ray were normal. At that time prednisone we examine whether individuals with DS have a higher was switched to hydrocortisone 30 mg/day and suspended incidence of fragility fractures and whether this composite once adrenal function was evaluated as normal. Therapy with score confers additional risk for fracture, beyond risk esti- Calcium, Vitamin D and Teriparatide was initiated. Control mates provided by FRAX. laboratory showed: calcium 9, 4 mg/dl PTH 28, 7 pg/ml VD Methods: The MrOS cohort was utilized in this study. The 32 ng/ml. A new DXA to evaluate treatment response re- score-based approach to define DS includes six factors with vealed: (03/20/14) L1-L4 Z score -1, 7 CFI Z score -0, 5 with one point assigned to each: appendicular lean mass/height2 a bone mass win of 13, 8% in spine. Due to the therapy suc- <7.26 kg/m2, body fat >30%, T-score ≤-2.5, grip strength cess, Teriparatide was suspended. The patient received <30 kg, gait speed <1.0 m/s, and falls in last 12 months. A Teriparatide from October 2013 until July 2014, having had score ≥ 3indicatedDS.Weusedoddsratiosandcoxpropor- only 9 months of treatment in total. No bone fractures or tional hazard models to analyze risks of major osteoporotic adverse effects were reported during this period of time. The fracture (MOF). Men were censored at the time of fracture or last control was carried out in May 2016 (iDXA): L1-L4 Z last follow up. We determined the hazards of fracture using score -1, 9 TBS L1-L4 1,326 CFI Z score -0, 2 showing no presence of DS, the FRAX score, and the FRAX score in significant bone mineral loss. quartiles. We used the program R (www.r-project.org) to per- Results: Our patient responded successfully with an anabolic form all analyses. treatment improving his osteoporosis status and preventing Results: 5827 men ages 74±6 years with a mean BMI of 27.4 fractures in a short period of time. ±3.8 kg/m2 had complete data necessary for this analysis. 391 Conclusion: The Risk of fragility fractures is significantly males (6.7%) met criteria for DS. 571 (10%) experienced a increased in glucocorticoid treated patients. Fractures can oc- MOF including 245 (4%) hip fractures. DS increased the haz- cur with minimum doses such as 2, 5 mg of prednisone/day ards of major osteoporotic (HR 3.31, 95% CI, 2.58, 4.23) and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S291 hip (HR 3.48, 95% CI 2.41, 5.03) fractures. In adjusted The initial query revealed 149 veterans with pelvic, femoral, models, DS and elevated FRAX risk each increased the haz- and/or hip fractures without a recent DXA and/or active OP ards of major osteoporotic and hip fracture. Interaction models therapy. Of those, 32 (31 males, 1 female) patients suffered a showed no significant interaction between the presence of DS FF and qualified for the FLS intervention. 59% of patients had and FRAX score for major osteoporotic (p=0.184) or hip a DXA scan, 35% had their calcium/vitamin D intake (p=0.177) fractures. reviewed, and 40% had started OP therapy or were referred Conclusion: DS was associated with increased MOF frac- to an OP specialist. When the primary care team’s clinical ture incidence even after adjusting for quartiles of FRAX pharmacist instead of the primary care provider implemented risk in this cohort of older men. Our study suggests that the FLS recommendations (10/32 veterans), 100% of the rec- using a composite assessment of MSKH in addition to ommendations were addressed Furthermore, 70% of patients already available tools such as FRAX may improve iden- had a bisphosphonate ordered, whereas it was 9% when no tification of individuals at high fracture risk. Additional pharmacist was involved (p=0.0004). analyses are necessary to examine whether this approach Our study suggests that a pharmacist-led FLS can improve can better distinguish between those who will fracture and post-FF care in US veterans. We found a high percentage of who will not and whether the results can be reproduced in OP care goals met when patients interacted with clinical phar- women. macists. This observation might be due to the fact that most pharmacists had dedicated training in OP management and their interaction with the patient focused on their FF. In sum- P438 mary, our data suggests that clinical pharmacists trained in OP SUCCESSFUL IMPLEMENTATION OF A PHARMA- management can very effectively implement a FLS interven- CIST-LED FRACTURE LIAISON SERVICE AT A US tion. VETERAN AFFAIRS (VA) HOSPITAL T. Holobyn1, B. Lezcano2,J.Kotek3, B. Glynn-Servedio4,S. Wright5,K.E.Hansen6, A. Bridges2,B.Buehring2 P439 1Department of Medicine, University of Wisconsin, Madison, THE IMPACT OF EARLY MENOPAUSE ON BONE United States, 2William S. Middleton Memorial Veterans MINERALIZATION Hospital, Madison, WI, United States, 3Milwaukee VA T. T. Tomic1,Z.G.Grujic1,V.T.Tomic2 Medical Center, Milwaukee, WI, United States, 4Durham 1Specialized Rehabilitation Hospital Banja Koviljaca, Banja VA Medical Center, Durham, NC, United States, 5VA Great Koviljaca, Serbia, 2Faculty of Medicine, Novi Sad, Novi Sad, Lakes Health Care System, Westchester, IL, United States, Serbia 6Medicine, Division of Rheumatology, University of Wisconsin, Madison, United States Introduction: Osteoporosis is a skeletal disease characterized by impaired strength of bones causing an increased risk of Worldwide, an osteoporosis (OP) care gap exists for individ- fractures. Beside local factors, the bone homeostasis depends uals with a fragility fracture (FF). US veterans are no excep- on many systemic regulatory mechanisms, many hormones, tion. To address this OP care gap, fracture liaison services including the great role of the female sex hormone - estrogen. (FLS) are being implemented with the goal to prevent FF. Estrogen exerts a direct or indirect effect on osteoblasts, oste- Here we report the patient outcomes after initiating a FLS at oclasts, and bone marrow cells, which results the prevention a US Veterans Affairs (VA) health care system. of bone resorption. We identified veterans with a pelvic, hip and/or femur shaft Objective: To check how the early menopause, as one of the fracture by querying a central database. We reviewed the cir- factors for osteoporosis, affects bone mineralization. cumstances related to each fracture; veterans with traumatic Materials and methods: This study included 120 postmeno- fractures, OP medication and/or recent dual-energy X-ray ab- pausal women who had osteodensitometry measured in sorptiometry (DXA) were excluded. Veterans with a FF were Specialized Hospital for Rehabilitation Banja Koviljaca at contacted via letter and the responsible primary health care the DXA machine type LUNAR. The criteria for inclusion team was sent a template letter with OP management recom- in the study were: that all subjects had menopause before the mendations via the electronic medical record. age of 45 and had none of the other risk factors of importance Recommendations included DXA, laboratory evaluation, for osteoporosis. We made a questionnaire in which we re- and pharmacologic and non-pharmacologic interventions. In corded data of age, BMI (Body Mass Index) and the values of most cases, trained clinical pharmacists serving as FLS coor- DXA findings: T score and BMD at the lumbar spine and dinators performed all tasks with an expert physician available femur. For better analysis, respondents were divided into three for questions. Presented data are based on a review 4 months groups depending on the length of menopause, i.e. of age. The after recommendations were sent. first group includes women with the shortest period of S292 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 menopause i.e. those to 60 years old, and there were 51 wom- regeneration in osteoporotic conditions. Our previous studies en. The second group includes women from 61 to 70 years old show the osteoprotective and immunoprotective effects of and there were 50 women. The third group includes women neutralizing IL17 antibody. Here, we determine the effect of older than 70 years, 19 of them. Student t-test was used for IL17 neutralizing antibody on new bone regeneration and statistical analysis as a method of testing hypothesis. compare its efficacy with known osteoporotic therapies. Results: The average age of respondents was about 63 Methods: For the study, female BALB/c mice were ovariec- (62.73). The youngest was 45 and the oldest was 78 years tomized or sham operated and left for a month followed by a old. The average value of BMI was 28.06. The average value 0.6 mm drill hole injury in femur mid diaphysis. The treatment of BMD at the hip was 0.842 and at lumbosacral spine 0.904. was commenced next day onwards with anti-IL17, anti The average age of entering menopause was 42.62 years. We RANKL, PTH or Alendronate for a period of 3, 10 or 21 days. registered: normal results in 11 respondents, findings on the Animals were then autopsied and femur bones were dissected level of osteopenia in 45 respondents, and osteoporosis in 64 out for microCT scanning, confocal microscopy, and gene and respondents. protein expression studies. In all three groups of respondents, pathological findings were Results: MicroCT analysis showed that anti-IL17 antibody more statistically significant than normal findings. Among promoted bone healing at days 10 and 21 and the healing respondents from the first group, 86% had pathological find- effect observed was significantly better that Ovx, anti- ings, in the second group 94% and in the third 95%. In all RANKL antibody and ALN; and equal to PTH. Anti-IL17 three groups there was the least DXA findings. In the first also enhanced new bone regeneration as assessed by calcein group 7 respondents (13%), in the second group 3 (6%), and labeling studies. Additionally, anti-IL17 therapy enhanced ex- in the third group 1 (5%) had normal finding. Findings on the pression of osteogenic markers and decreased oxidative stress level of osteopenia was registered in 20 respondents (39%) at the injury site. from the first group, in 19 (38%) from the second group, Conclusion: Anti-IL17 antibody promoted new bone regen- and in 6 (31%) from the third group. The most common find- eration in a cortical bone defect model by augmenting FOXO1 ing in all three groups of respondents was at the level of and ATF4 Activity thereby decreasing oxidative stress. osteoporosis: 24 women (47%) from the first group, 28 wom- Overall, our study demonstrates bone healing and regenera- en (56%) from the second group, and 12 women (63%) from tion potential of neutralizing IL-17 antibody in osteoporotic the third group. Worse finding was more statistically signifi- fractures. cant among older respondents. Conclusion: • Early menopause is a major risk for osteoporosis. P441 • With the duration of menopause increases the percentage VITAMIN D LEVELS IN PATIENTS WITH RHEU- distribution of pathological findings. MATOID ARTHRITIS COMPARED WITH HEAL- • Early menopause requires mandatory screening for osteopo- THY CONTROLS rosis and possibly timely initiation of treatment. V. Boyadzhieva1, N. Stoilov1,R.Rashkov1, R. Stoilov1 1Clinic of Rheumatology, Medical University, Sofia, Bulgaria P440 Objective: To evaluate the levels of vitamin D in pa- FUNCTIONAL BLOCK OF IL-17 CYTOKINE PRO- tients with rheumatoid arthritis undergoing concomitant MOTES BONE HEALING BY AUGMENTING FOXO1 therapy with corticosteroids and DMARDs and healthy AND ATF4 ACTIVITY IN CORTICAL BONE DEFECT controls. MODEL Material and Methods: In the present study we have selected M. Dixit1,D.Singh2 35 patients with rheumatoid arthritis (RA) and 10 healthy 1Endrocrinology, Csir-Cdri, Lucknow, India, 2Endocrinology, controls tested for the levels of vitamin D in the period Csir-Cdri, Lucknow, India January 2016. The age of patients with RA is between 20 - 65 years. The control group corresponds by gender and age of Introduction: The immune system plays very important role patients. The group with RA were diagnosed at least 12 in the fracture healing process. However fracture healing is months prior to this study (according to the criteria of the prolonged in disorders associated with systemic inflamma- ACR/EULAR 2010). All of the patients with RA are on stable tion. Fracture healing is also decelerated in osteoporosis, a dose DMARD at least 12 weeks prior participation in the condition linked with systemic inflammation. Bone regenera- study, corticosteroids at a stable dose of less than 7.5 mg / tion therapies like recombinant human BMP2 are associated day prednisone (or equivalent) at least four weeks prior to with serious side effects. Studies have been carried out where the enrollment. The healthy controls are without clinical and agents like Denosumab and Infliximab enhance bone immunological data for RA, no corticosteroids and/or Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S293 NSAIDS therapy. All of the patients have never received bio- Comments: Use of bisphosphonates in treatment of oste- logical treatment, nor supplemental therapy with vitamin D. oporosis is associated with a risk of atypical femoral Patients were tested for serum levels of 25(OH)D (ELISA). fracture, probably due to suppression of bone turnover, Results: The age of patients with RA is between 20 and 65 including the suppression of “targeted remodeling” -a years (mean age 51). Three (9%) of the patients are men and process by which microscopic cracks appeared in bone 32 (91%) are women. The disease duration is between 1 - 20 structure are resolved by osteoclast resorption and new years (mean 6.06 years). The mean serum vitamin D in pa- bone formation. Denosumab therapy also associates this tients with RA is 11.43 ng/ml. Deficiency of vitamin. D risk, as a consequence of its mechanism of action - (valuesbelow10ng/ml)wasfoundin19of35patients blocking the RANKL interaction with its receptor on (54%). The mean value of vitamin D in healthy controls is osteoclast, and, thus, blocking osteoclast-mediated bone 14.24 ng/ml. No statistically significant difference was found resorption, including “targeted remodeling”.Thereare between both groups p<0.222 (p<0.05). In addition, we com- several cases of atypical femoral fracture described in pare the level of 25(OH)D in RA patients with disease dura- literature in patients switched from bisphosphonates to tion to 5 years and over 5 years. In 13 (37%) of the patients denosumab, with no clear conclusion at this time wheth- with disease duration above 5 years we found vitamin D level er this treatment strategy associates a higher atypical of 11.33 ng/ml which is not statistically different from the rest femoral fracture risk than bisphosphonates or denosumab of 22 (63%), diagnosed in less than 5 years (25(OH)D - treatment alone. 11.63ng/ml) p<246. Conclusions: No significant difference was found between the levels of 25(OH)D in healthy controls and patients with P443 RA in our study. REHABILITATION TREATMENT EFFICACY IN A WOMAN PACIENT WITH OSTEOPOROTIC FRACTURES AFTER VERTEBROBLASTY: A CASE P442 REPORT ATYPICAL FEMORAL FRACTURE AFTER 2 YEARS L. Condurovici1,V.M.Ciortea2 OF ANTIRESORPTIVE THERAPY 1Cluj-Napoca Rehabilitation Hospital, Cluj-Napoca, G. C. Taujan1, A. M. Dumitru2,R.M.Hristea2,M.E.Olaru3, Romania, 2Department of Medical Science, Medical A. M. Ghemigian4,D.L.Paun4,A.S.Dragomir2 Rehabilitation of Iuliu Hatieganu University of Medicine 1Lotus Med, Bucharest, Romania, 2National Institute of and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania Endocrinology C I Parohn, Bucharest, Romania, 3National Institute of endocrinology C I Parohn, Introduction: Osteoporosis is a skeleton disease charac- Bucuresti, Romania, 4Endocrinology Institute CI Parhon, terized by low bone mineral density and deterioration of Bucharest, Romania bone tissue, resulting in an increased risk of fragility fracture. Osteoporotic vertebral fractures are recognized Background: Atypical femoral fractures are described as as a significant health problem particularly in older peo- adverse reactions to long term antiresorptive therapy. The ple with an impact on the quality of life, mobility and risk rises with the duration of the therapy and the patients mortality. Objectives: To examine the effectiveness of described in case reports presented in specialty literature exercise interventions in pain relief and improving qual- went through at least five years of antiresorptive therapy. It ity of life in a patient with osteoporotic vertebral is reported that in the first two years of therapy, the risk is fractures. about 1.8 cases per 100,000 patients. Case report: A 65-year-old woman with primary osteo- Case report: We present the case of a female patient treated porosis presented two vertebral fractures (D7 and D8) with bisphosphonates (alendronate) for 18 months for severe after a fall. She was subjected to vertebroplasty on D7- osteoporosis, with left peritrochanteric fracture in her history, D8. She has come to our attention to the multidisciplin- which developed atypical femoral fracture two months after ary outpatient clinic for diagnosis, therapy and rehabili- she was switched to denosumab. The treating endocrinologist tation of patients with vertebral fracture of Cluj- at that time decided to continue antiresorptive therapy with Napoca Rehabilitation Hospital after 6 months from alendronate, but no significant rise in bone mineral density vertebroplasty. She still presented pain in particular in was noted after another 2 years of therapy. For this reason, dorsal spine. She was affected by hypothyroidism and we decided to start osteoanabolic therapy with teriparatide, she has a positive family history for osteoporosis (mother and after 12 months of treatment, we noticed a significant with femoral fracture). At physical examination she increase in bone mineral density at lumbar spine of 8.2%, with showed pain on spinous processes D7 and D8. She has no response in bone mineral density at right femur. an increased thoracic kyphosis and loss of lumbar S294 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 lordosis, a limited spinal flexion, only slight limitation measured by visual analogue scale (VAS), ESR, CRP, on hip internal rotation and ankle flexion. Height and joint assessment, DAS 28. Pearson correlation analysis weight was measured for calculation of Body Mass is used for statistical analysis. Index (BMI) that was 25,8. The patient was treated with Results: The age of patients is between 20 and 65 years alendronate, cholecalciferol and calcium to decreased risk (mean age 51). Three (9%) of the patients are men and 32 of new fractures that is present also in patients treated (91%) are women. The disease duration is between 1 and with percutaneous vertebroplasty. The patient started a 20 years (mean 6.06 years). 35 (100%) of the patients are specific rehabilitation program for fragility vertebral frac- positive for rheumatoid factor and 33 (94.3%) are positive tures (12 daily sessions, each of 30 minutes). The proto- for anti-CCP. The mean serum vitamin D in patients with col was composed of spine extension exercises, progres- RA is 11.43 ng/ml. Deficiency of vitamin. D (values be- sive resistance exercises, isometric exercises for toning low10ng/ml)wasfoundin19of35patientswithRA the abdominal muscles, exercises in sitting position and (54%). Pearson correlation analysis was used to assess exercisesinstandingagainstthewall.Thepainindorsal the relationship between the levels of vitamin D and the spine was quantified with Visual Analog Scale (VAS). disease activity of RA. No statistically significant differ- The health outcome was measured with the Quality of ence was found p<0.388 (p<0.05). Life Questionnaire of the European Foundation for Conclusion: Although more than half of the patients with Osteoporosis (QUALEFFO-41). rheumatoid arthritis have a deficiency of vitamin D has not Results: Both the score used to assess the pain and the quality shown statistically significant correlation with disease activity of life were significantly improved (p<0,05). observed in these patients. Conclusions: In conclusion the specific rehabilitation pro- gram proposed to this patient has showed good results about pain and health outcome. P445 References: INVERSE RELATIONSHIP BETWEEN BONE 1. Barker KL et al. Trials 2014;15:22. MINERAL DENSITY AND ADIPONECTIN IN 2. Bruyere O et al. Open Geriatr Med J 2012;2:44. MAINTENANCE HEMODIALYSIS PATIENTS M.-H. Hsieh1,H.-R.Chang2 1Department of Orthopaedics, Dalin Tzu Chi General Hospital, P444 Chiayi, Taiwan and Institute of Medicine, Chung Shan Medical EVALUATION OF THE DISEASE ACTIVITY University, Taichung, Taiwan, Province of China, 2Division of (ASSESSED BY DAS 28) AND THE LEVELS OF Nephrology, Department of Medicine, Chung Shan Medical VITAMIN D IN PATIENTS WITH RHEUMATOID University Hospital and Institute of Medicine, Chung Shan ARTHRITIS Medical University, Taichung, Taiwan, Province of China N. Stoilov1,V.Boyadzhieva1,R.Rashkov1, R. Stoilov1 1Clinic of Rheumatology, Medical University, Sofia, Bulgaria Objective: Adiponectin (APN), secreted by adipose tissues, played an important role on energy homeostasis and Objective: To evaluate the levels of vitamin D in patients with antiinflammation. Few studies showed the association be- rheumatoid arthritis undergoing concomitant therapy with tween APN and bone mineral density (BMD) in hemodialysis corticosteroids and DMARDs and the correlation with RA (HD) patients. We conducted this study to investigate the re- disease activity. lationship between APN and BMD in HD patients. Material and Methods: Inthepresentstudywehavese- Material and Methods: From Sep 2013 to Apr 2014, sixty- lected 35 patients with rheumatoid arthritis (RA) tested four HD patients were included in this study. APN was mea- for the levels of vitamin D in the period January 2016. sured by Enzyme-Linked ImmunoSorbent Assay. BMD was The age of patients is between 20 and 65 years. They are measured by dual energy X-ray absorptiometry. Patients was diagnosed with rheumatoid arthritis at least 12 months classified as normal group (T-score > -1.0) or low bone mass prior to this study (according to the criteria of the ACR group (T-score <-1.0) by WHO osteoporosis definition. The / EULAR 2010). All of the patients are on stable dose association between covariates and BMD were analyzed by DMARD at least 12 weeks prior participation in the multivariate regression analysis. study, corticosteroids at a stable dose of less than Results: Of these 64 patients, 41 patients (64.1%) had normal 7.5 mg / day prednisone (or equivalent) at least four bone mass, 15 (23.4%) had osteopenia and 8 (12.5%) had weeks prior to the enrollment. Patients have never re- osteoporosis. More diabetic patients distributed in the normal ceived biological treatment, nor supplemental therapy bone mass group, but not significant (p=0.065). There were with vitamin D. Patients were tested for serum levels of also no statistically significant differences in gender, age, di- 25(OH)D (ELISA method). The disease activity was alysis duration and underlying diseases between two groups. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S295 Among these HD patients with low bone mass, they had lower DMAb, a total of +5.4%. For the women treated with ZOL the body mass index (20.9±1.8 vs. 23.9±3.9 kg/m2, p=0.036), baseline was 0.673g/cm2 and increased at 0.689 g/cm2 atotal lower lumbar BMD (0.761±0.087 vs. 1.073±0.132, p of +2.4%. At TH the increase of BMD was +4.0% for DMAb <0.001) and lower lumbar T-score (-1.1±0.6 vs. 0.74±1.0, and 1.8% for ZOL after 2 years. For FN the change in BMD p<0.001). Instead of these findings, patients with low bone was +2, 5% for DNAb and +0.9% for ZOL. No adverse events mass had higher serum adiponectin (16.05±8.73 vs. 9.74 or new fractures under the therapy. No significant change in ±3.63 μg/ml, p <0.001). Univariate logistic regression analy- serum calcium,25-OHD3, PTH sis showed gender, body weight, white blood cell counts, he- Conclusion: DMAb treatment increased more BMD at LS, moglobin, albumin, alkaline phosphatase and APN were sig- TH and FN by comparing with ZOL in patients with postmen- nificantly different between two groups. After stepwise mul- opausal osteoporosis. Both drugs were effective at 2 years of tivariate logistic correlation analysis, BMD was inversely re- treatment. The difference, greater increases in bone density lated to APN (r=-0.268, p=0.030) in HD patients. may be attributable to access to the cortical compartment of Conclusion: APN may affect bone metabolism in HD patients. bone with DMAb not ZOL. Acknowledgments: This study was supported by a grant from Dalin Tzu Chi Hospital in Taiwan. P447 DETERMINATION OF TRPV1+/T LYMPHOCYTES IN P446 INFLAMMATORY ARTHRITIS AND THEIR CORRE- DENOSUMAB VS. ZOLEDRONIC ACID IN TREAT- LATION WITH ULTRASOUND FINDINGS MENT OF OSTEOPOROSIS IN POSTMENO-PAUSAL R. Terenzi1,G.Cafaro2,O.Bistoni2,A.Alunno2,E. WOMEN Bartoloni-Bocci2,F.Luccioli2, V. Valentini2,R.Gerli2 C. Galesanu1, L. Gheorghe2,N.Lisnic3, V. Zaharia4 1Department of Experimental and Clinical Medicine, 1Endocrinology, University of Medicine and Pharmacy University of Florence, Department of Geriatric Medicine, "Grigore T. Popa", Iasi, Romania, 2Radiology, University of Division of Rheumatology AOUC, University of Florence, Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, Firenze, Italy, 2Sezione di Reumatologia, Dipartimento di Romania, 3Endocrinology, University of Medicine and Medicina, Università degli Studi di Perugia, Perugia, Italy Pharmacy "Grigorie T. Popa" Iasi, Iasi, Romania, 4Endocrinology, University of Medicine and Pharmacy, Iasi, Objectives: The vanilloid receptor type 1 (TRPV1) is mainly Romania expressed by the nervous system where is involved in the transmission of painful stimuli and neurogenic inflammation. Objective: Low BMD is in important risk factor for the frac- TRPV1 expression has also been demonstrated in other cell tures in postmenopausal osteoporotic women. Fractures types including the synoviocytes, where, TRPV1 activation, caused by osteoporosis can be life-threatening and a major induces the production of pro-inflammatory cytokines such as cause of pain and long-term disability. Osteoporosis medi- IL-6 and IL-8. Recently the presence of TRPV1 was also cines can increase bone density and while the increases may demonstrated at the level of CD4 + T lymphocytes where it appear small this can have a very positive effect on reducing seems to play a key role in the activation of the T cell receptor fracture rates. We have proposed to compare the effect on the (TCR). The aim of the study was to evaluate the presence of change of BMD during treatment with two powerful, paren- TRPV1 + T cells in peripheral blood (PB) and synovial fluid teral antiresorptive therapies: Denosumab (DMAb) and (SF) of patients with inflammatory joint disease and osteoar- Zoledronic Acid (ZOL). thritis and to correlate the concentration of TRPV1 + T cells Material And Methods: A randomized study, open-label in with ultrasound variables of illness. which 62 postmenopausal women with osteoporosis were ran- Materials and methods: 6 patients with known domized 1:1 to DMAb 60 mg subcutaneously every 6 months or gonarthritis secondary to chronic inflammatory disease ZOL 5mg IV once yearly for 2 years. Thirty-two osteoporotic (4 psoriatic arthritis, 1 rheumatoid arthritis, 1 ankylosing women received DMAb and thirty received ZOL. All patients spondylitis HLA B27+) and 5 with knee osteoarthritis have received supplement of 1000 mg calcium and 1 mcg associated with joint effusion were enrolled in the study. alfacalcidol/day. BMD was measured by DXA at baseline and The subjects underwent to ultrasound evaluation of gray- to one and two years. The diagnosis of osteoporosis was con- scale synovitis (GSUS), to ultrasound evaluation of firmed using BMD-WHO criteria. We analyzed also: changes in PowerDoppler signal (PDUS) (0-3 definition serum calcium, 25-OHD, PTH and bone alkaline phosphatase OMERACT), to joint aspiration and blood sampling. (PAB) at baseline and at one and two years of treatment. Mononuclear cells of PB and SF were isolated second Results: At baseline mean BMD at LS was 0.727 g/cm2 and gradient (Lympholyte, Cedarlane). The phenotypic char- increased at 0.811g/cm2 after 2 years, at women treated with acteristics of such isolated cells were assessed by flow S296 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 cytometry after staining with anti-CD3-PE and anti- sever disease of longer duration and extensive skin TRPV1-AlexaFluor488. It was performed statistical anal- involvement. ysis by the Mann-Whitney test and calculation of the Aim: To compare the levels of vitamin D and femoral carti- Spearman rank correlation coefficient. lage thickness (FCT) in patients with SSc with that of controls Results: The T lymphocyte expression of TRPV1 in circulat- who were matched for age and sex and to analyze the associ- ing cells significantly correlated with the T cell expression of ations between the (FCT), vitamin D levels and disease activ- TRPV1 in the joints (p=0.0005) (A). However, the percentage ity, severity scores, and quality of life. of T lymphocytes / TRPV1 + did not differ in patients with Material and Methods: Twenty five SSc patients diagnosed inflammatory joint disease than patients with osteoarthritis (B according to ACR/EULAR- 2013 classification criteria and - D). Levels of T lymphocytes / TRPV1 +, both circulating twenty five controls; apparently healthy age and sex matched and articular, significantly correlated with ultrasound degree were studied. Serum levels of 25-hydroxyvitamin D (25[OH] of synovitis (GSUS) (p=0.02 and p=0.003 respectively) (E D) were assessed by (ELISA), levels less than ≤ 10 ng/mL are and F). defined as deficiency, while > 10 ng/mL is defined as insuffi- Conclusions: Our study demonstrates for the first time the ciency. The thickness of femoral articular cartilage was mea- presence of T lymphocytes / TRPV1 + in the joints in subjects sured by ultrasonography (MSU) in patients and controls. with osteoarthritis and inflammatory joint disease. The corre- Three midpoint measurements were taken from each knee: lation between the presence of synovial T lymphocytes / lateral femoral condyle (LFC), femoral intercondylar area TRPV1 + and ultrasound score, expression of the degree of and medial femoral condyle (MFC). synovial proliferation, might suggest the hypothesis that T / Result: We concluded that SSc patients seem to have thinner TRPV1 + lymphocytes are involved in the inflammatory ar- femoral cartilage values at all studied sites than that of control. ticular process. Moreover, the presence of T lymphocytes / A significant difference was found in measurement of right TRPV1 + at the peripheral level, directly related to the con- inter condylar area (p=0.029), right medial condyles centration of the same synovial lymphocyte population, would (p=0.022), left inter condylar area (p=0.036), left lateral con- be considered an indirect marker of inflammatory joint dyle and left medial condyle (p=0.001) between patients and involvement. control. Lower levels of vitamin D was significantly found in SSc patients than controls and that was more predominantly among females (p=0.009) with longer disease duration (p=0.03) and sever skin involvement (p=0.0001). Vitamin D was correlated with SSc severity scale as well as thinner fem- oral cartilage sites studied by MSU, while some sites shown correlation with disease activity parameters. P449 COMBINED ADIPOSE TISSUE-DERIVED MESEN- CHYMAL STEM CELLS (AT-MSCS) INTER- VENTION IN SUPRASPINATUS PARTIAL THICK- NESS TEAR AND LUMBER INTERSPINOUS LIGA- MENT TEAR: EXPERIENCE OF 2 CASES P448 M. R. Khasru1, M. Moniruzzaman2,M.S.Hossain3,M.J. FEMORAL CARTILAGE THICKNESS IN PATIENTS Islam2,A.K.M.Salek1,S.M.Ahmed1,M.M.Khan4,M. WITH SYSTEMIC SCLEROSIS: IT IS RELATION TO T. Uddin1 VITAMIN D 1Physical Medicine and Rehabilitation, Faculty of Medicine, G. Omar1,Y.Aseem1,R.Abdelmajeed1,A.Hassan1 Bangabandhu Sheikh Mujib Medical University, Dhaka, 1Rheumatology and Rehabilitation Department, Minia Bangladesh, 2Physical Medicine and Rehabilitation, Dhaka University Hospital, Minia, Egypt Medical College and Hospital, Dhaka, Bangladesh, 3Physical Medicine and Rehabilitation, Shaheed Suhrawardy Background: Systemic sclerosis (SSc) is a chronic autoim- Medical College Hospital, Dhaka, Bangladesh, 4Physical mune and progressive connective tissue characterized by Medicine and Rehabilitation, Bangabandhu Sheikh Mujib widespread vascular, immune and fibrotic changes of the skin Medical University, Dhaka, Bangladesh and internal organs. Articular cartilage thickness has been pre- viously investigated in few. Lower levels of vitamin D have Introduction: Mesenchymal Stem Cells (MSCs) repair been demonstrated in SSc patients and may be related to more muscle, bone, cartilage, or tendons. MSCs are commonly Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S297 found in the bone marrow, fat cells, circulating blood Objectives: To evaluate femoral cortical bone thickness in and in the joint. Adipose stem cells are the richest source patients with hip fracture (HF) and its association with fracture of stem cells in the body. The adipose stem cell has the type, biomarkers of bone-mineral metabolism and clinical ability to differentiate into chondrocytes, fibroblasts, and characteristics. other musculoskeletal tissue. The use of fat stem cells is Materials and Methods: In 367 (267 females) patients (mean a unique and promising approach and it holds key ad- age 82.9±8.5 years) admitted in 2012 - 2014 with HF (191 vantages over stem and regenerative cells from other cervical, 176 trochanteric) we measured on plain X-rays of the sources. Stem cells in adipose tissue are 500 to 2,500 fractured and opposite side the femoral cortical thickness in- times more than that of bone marrow. Here we discussed dex (FCTI): the mean ratio of the diameter of the shaft minus two cases of Supraspinatus partial thickness tear and the diameter of the medullary canal to the diameter of the shaft Lumber interspinous ligament tear confirmed by USG at 9, 10 and 11cm distal to the centre of the lesser trochanter. and MRI. Associations between FCTI and clinical characteristics, serum Case-1: Mr. X, 48 years, normotensive, nondiabetic, non- biomarkers of bone turnover and mineral metabolism (PTH, smoker, amateur golfer clinically diagnosed as case of 25(OH)-vitamin D, calcium, phosphate, magnesium), albu- supraspinatus tendinopathy. In USG scan, there was linear min and haemoglobin were analysed. articular partial thickness tear in supraspianatus tendon in lon- Results: On the fractured side, in both females and males the gitudinal view measuring about 0.5cm (1.21 cm proximal to mean FCTI was significantly lower in trochanteric compared insertion). Partial thickness tear was also found in MRI. Single to cervical HF (0.397±0.081 vs. 0.437±0.082, p=0.000). On dose autologous Adipose Tissue-Derived mesenchymal stem the non fractured side, the mean FCTI was significantly higher cells (AT-MSCs) with PRP were given. After 2 weeks, graded than that on the fractured one in both cervical (0.479±0.078, exercise was initiated. After 3 months active and passive p=0.000) and trochanteric (0.455±0.077, p=0.000) groups. ROM found Full and pain free in all axis. USG scan showed Among patients with cervical HF, FCTI was lower in females nearly filling of gap by regeneration of muscle. than in males on both the fractured (0.426±0.081 vs. 0.467 Case-2: Mr. Y, a 72 years, old, hypertensive, diabetic, non- ±0.078, p=0.001) and opposite side (0.467±0.075 vs. 0.505 smoker, obese, businessman clinically diagnosed as a case of ±0.078, p=0.003). FCTI was significantly and negatively as- Mechanical Back Pain. USG scan showed tear of interspinous sociated with age, female sex, dementia, congestive cardiac ligament measuring L:0.35x0.62cm, T:0.72x0.76cm; failure, use of walking aids, as well as with biomarkers of L:0.61x0.42cm,T:0.59x0.47cm and L:0.43x0.- bone formation (osteocalcin, P1NP) and bone resorption 35cm,T:0.32x0.37cm at L2/3; L4/5 and L5/S1 level respec- (βCTx) and transferrin saturation, and positively with tively. Then, single dose autologous Adipose Tissue-Derived haemoglobin and albumin levels. Multivariate regression re- Mesenchymal Stem Cells (AT-MSCs) with PRP (Platelet rich vealed as significant independent determinants of FCTI age plasma) in each tear was given. After 2 weeks, surprisingly (p=0.000), female sex (p=0.006), βCTx (p=0.010) [all three patient was found pain free and was advised to start isometric negative] and albumin (p=0.022) [positive]. back muscle strengthening exercise and after 4 weeks, Conclusions: Femoral cortical bone thickness is significantly stretching and strengthening of paraspinal muscles was lower on the fractured compared to the opposite side, in pa- started. After 3 months, USG scan shows full of interspinous tients with trochanteric compared to cervical HF, and in fe- space by interspinous ligament. males compared to males. Lower FCTI, which is independent- Conclusion: Tissue regeneration by AT-MSCs is promising in ly determined by advanced age, female sex, higher levels of our very limited experience. bone resorption and hypoalbuminaemia, appears as a promis- ing risk factor for fragility and fractures. P450 FEMORAL CORTICAL BONE THICKNESS IN P451 PATIENTS WITH HIP FRACTURE: RELATIONSHIP REHABILITATION AND QUALITY OF LIFE IN FE- WITH FRACTURE TYPE, BIOMARKERS OF BONE MALES WITH RHEUMATOID ARTHRITIS AND AND MINERAL METABOLISM, SOCIO-DEMO- OSTEOPOROSIS GRAPHIC AND CLINICAL CHARACTERISTICS R. Traistaru1,O.Rogoveanu1,D.Kamal1,D.Matei1 A. P. Lynn1, W. Srikusalanukul2, A. Fisher3 1University of Medicine and Pharmacy, Craiova, Romania 1Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, Australia, 2Department of Geriatric Medicine, The Objectives: Chronic low back pain (LBP) is one of the most Canberra Hospital, Canberra, Australia, 3Department of common symptom in osteoporosis rheumatoid arthritis fe- Geriatric Medicine, The Canberra Hospital, and Australian males, leading to complex disability. Various rehabilitation National University Medical School, Canberra, Australia programs have been proposed for chronic low back pain in S298 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 females with rheumatoid arthritis and osteoporosis. We history, physical and functional examination (functional mus- assessed the effects of a 6 week complex rehabilitation pro- cular Krauss-Weber and Sorensen tests) and imagistic tests gram (pharmacotherapy, educational sessions, multi-modal (X-rays and sonography). All subjects completed the package exercise training and psychological support) on quality of life of questionnaires (VAS scale and LBP Module) at entry into and self-control of the complex disorders, in females with the study (Time 1), after 2 weeks (Time 2) and after 6 week rheumatoid arthritis and symptomatic osteoporosis. home training (Time 3). The initial treatment plan is focused Materials and Methods: 67 females (43,5 years mean age) on education, relative rest, pain relief, maintenance of posi- with rheumatoid arthritis (mean disease duration 8.6 years) tions that provide comfort, exercises supported by thermo- and osteoporosis (mean disease duration 2,5 years), were ran- electrotherapy and massage. Once the painful symptoms are domly assigned to a rehabilitation group – RG (n=35) and a controlled, stretching and strengthening exercises of the lum- pharmacotherapy (bisphosphonates) group – PG (n=32). bar spine and associated muscles were initiated. Eccentric Clinical evaluation, lab tests, exercise tolerance tests (six min- muscle-strengthening exercises, including more dynamic con- ute walking distance - 6MWD), HAQ score and Arthritis Self- ditioning exercises were performed to the home-training Efficacy Scale (ASES). BMD was measured by dual X-ray program. absorptiometry in lumbar spine. Statistical analysis and corre- Results and discussions: 13 patients were diagnosed with lation between data were done with the ANOVA and chi- postural type of facet syndrome and 33 patients with pathologic square tests. type of facet syndrome (the Kleynhans classifying). The global Results: We found no significant correlation between the painful status was monitored with VAS scale; its mean score mean of T–score and DAS28 value, but a significant correla- increased with 47%. The global functional status was assessed tion between the mean of T-score and pain. Both groups by LBP questionnaire; its mean score increased with 62%. showed clinically and statistically significant improvements Conclusions: The complete assessment of the patient with in HAQ and ASES scores at 6 weeks; ASES scores had im- pain and dysfunctional lumbar status is necessary for positive proved by 41% in the RG and by 23% in the PG. The RG diagnosis. Conservative treatment is most effective for reliev- females were more satisfied with the overall outcome com- ing the FS: medications - help to relieve the pain and inflam- pared with PG subjects. mation; physiotherapy helps to relive the pain syndrome and Conclusions: Osteoporosis rheumatoid arthritis females with modifying activity; exercises – permit to strength back and chronic low back pain benefit from strategies to improve their abdominal muscles, and to restore spinal flexibility. quality of life. Multi-modal exercise (based on the coordina- Dynamic lumbar control is necessary to protect the spine from tion aerobic exercise and strengthening lower limb exercises) biomechanical stresses, including tension, compression, tor- represents the adequate mode of physical training and is more sion, and shear. effective in improving psychological status. Type and duration of physical training must be individualized to each patient, in accordance with severity of rheumatoid arthritis. P453 2-YEAR PERSISTENCE WITH DIFFERENT ANTI- OSTEOPOROSIS MEDICATIONS: A POPULATION- P452 BASED COHORT STUDY THEROLEOFREHABILITATIONINSYMPTOMATIC C. Reyes1, C. Tebe2, D. Martinez-Laguna3,A.Soria-Castro4, LUMBOSACRAL FACET SYNDROME C. Carbonell-Abella3, D. Prieto-Alhambra5 R. Traistaru1,D.Kamal1,A.M.Bumbea1, O. Rogoveanu1 1Idiap Jordi Gol, Barcelona, Spain, 2Bellvitge biomedical re- 1University of Medicine and Pharmacy, Craiova, Romania search institute and Rovira i Virgili University, Barcelona, Spain, 3Institut Catala de la Salut and IDIAP Jordi Gol, Objectives: Facet syndrome (FS) is a condition of the small Barcelona, Spain, 5Oxford NIHR Musculoskeletal Biomedical joints in the spine (called facets) characterized by pain and Research Unit, University of Oxford and IDIAP Jordi Gol, inflammation around the joint. FS generates complex disabil- Oxford, United Kingdom ity, which can be controlled with adequate rehabilitation pro- gram. The aim of our single blind, randomized controlled Objective: To estimate the 2-year persistence amongst inci- study was to determine the importance of complete assess- dent users of different anti-osteoporosis medications. ment and to assess the efficacy of comprehensive rehabilita- Material and methods: Cohort study based on the SIDIAP tion program in the patient with clinical and dysfunctional database (www.sidiap.org). Inclusions: women aged ≥50 years, status caused by lumbosacral FS. incident users of any anti-osteoporosis medication (2012) and Patients and Methods: 46 patients with chronic lumbosacral with data available for at least 12 months prior to therapy initia- FS were studied (21 men and 25 females, mean age 42,35 tion. Exclusions: those with bone diseases/treatments (other than years). Establishing a diagnosis of FS is based on a detailed osteoporosis) and drugs with <100 users. Follow up: from 1st Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S299 pharmacy dispensation until end of follow-up (death, moving out Objective: Osteoarthritis (OA) and osteoporosis (OP) are two or data extraction date, switching or treatment cessation, which- common postmenopausal musculoskeletal disorders. The rela- ever came first). Persistence definition: concatenated pharmacy tionship between OA and OP remains debated with contrary re- dispensations of index drug (90 days permissible gap). Users of sults reported. The non-steroidal anti-inflammatory drugs alendronate were compared to other oral bisphosphonates, stron- (NSAIDs) are the most frequently used agents to prevent pain tium ranelate, SERMs, teriparatide and denosumab. Multivariable from the diseases. However, the negative side effects of the Cox regression models were used to estimate hazard ratios of NSAIDs have attracted considerable attention for the use of me- therapy cessation according to drug used. dicinal plants. Ficus deltoidea (FD) or known as mistletoe fig, is Results: 19,267 women were included. Unadjusted 2-year planted as an ornamental shrub in various parts of the world while persistence [95%CI] ranged from 10.3%[9.1%-11.6%] for it has been used traditionally as herbal medicine in tropical coun- strontium ranelate to 45.4%[43.1%-47.8%] for denosumab tries including Malaysia and Indonesia. In this report, we aim to (Figure 1). After multivariable adjustment, only denosumab evaluate bone alterations related to OA and risk of OP users had a reduced cessation risk at the end of the 2nd year in ovariectomized OA rat model administered with FD leaf (HR of 0.60, 95% CI 0.56-0.64). Conversely, ibandronate, extract. risedronate and strontium ranelate users had an increased risk Material and Methods: Thirty twelfth-week-old Sprague of discontinuation. All other drugs had persistence similar to Dawley female rats were randomized into five groups (n=6). that of alendronate users. The rats were undergoing bilateral ovariectomy (OVX) and Conclusions: Unadjusted 2-year persistence ranged from OA was induced by intra-articular injection of monosodium 10% (strontium ranelate) to 45% (denosumab users). Only iodoacetate (MIA) (60 mg/mL) into right knee joints, exclud- denosumab users had an improved 2-year persistence. ing healthy group. Healthy and OVX-OA non-treated groups Unresolved confounding by indication (i.e., imbalanced dis- were given deionized water while treatment groups were oral- ease severity) might partially explain our findings. ly administered with FD leaf extract (200, 400 mg/kg) or Disclosure: Amgen S.A provided funding for this study. diclofenac (NSAID) (5 mg/kg) once a day for 28 days. We Amgen provided comments on the design of the study proto- determined bone mass density using Archimedes’ principle col and the analysis plan. The final protocol and analysis plan method. We utilized bone mechanical testing and micro- were mutually agreed by SIDIAP and Amgen, based on the computerized tomography (micro-CT), in order to analyze principle of the “best science known in the research the general strength of the bone cortical and the microstructure field”. Amgen also provided comments on the abstract prior of the trabecular bones, respectively. Serum levels of to its submission. However, SIDIAP alone decided whether to osteocalcin, osteoprotegerin, and CTX-I were assessed by incorporate Amgen’scomments. enzyme-linked immunosorbent assay (ELISA). Results: We found that non-treated OVX-OA rat predominantly exhibit OA with inverse relationship with OP, which showed by increased in bone mass density and bone mechanical strength (p<0.05), while these changes were significantly de- creased by FD leaf extract treatments (p<0.05). Conversely, when we zoomed in to the microstructure of trabecular bones (common fracture sites), we demonstrated that the OVX-OA modelhasdevelopedrisktoOPwithreductionintotalbone volume and increase in total porosity (p<0.05) at metaphyseal region (not significant at subchondral region). These findings were supported by bone turnover markers; with non-treated OVX-OA group has significant reduction of osteocalcin and osteoprotegerin (bone formation markers); and increase in CTX-I (bone resorption marker) (p<0.05). Groups treated with P454 FD leaf extract showed reduced risk to OP (p<0.05). RELATIONSHIP BETWEEN OSTEOARTHRITIS AND Conclusions: This study demonstrated evidence of both in- OSTEOPOROSIS IN OVARIECTOMIZED OSTEO- verse and direct relationships between OA and OP in OVX- ARTHRITIS RAT MODEL TREATED WITH MISTLE- OA rat, which may provide insight into the debatable topic of TOE FIG LEAF EXTRACT OAvs. OP. Contradictory results among different assessments 1 1 2 N. A. Che Ahmad Tantowi ,S.Mohamed, L. Seng Fong of bone fracture risk on OVX-OA rat may due to active re- 1 Institute of Bioscience, Universiti Putra Malaysia, Serdang, modeling of bone in order to compensate the loss of cartilage, 2 Selangor, Malaysia, Faculty of Veterinary Medicine, before further detrimental bone loss takes place in trabecular Universiti Putra Malaysia, Serdang, Selangor, Malaysia regions. FD leaf extract was presented as a potent agent S300 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 mitigating bone loss in postmenopausal (OVX) OA. There is Figure 1. Scatterplot (and fitted –unadjusted- linear regression need for further longitudinal study of the relationship between line) of Chitotriosidase and BMSi OA and OP in postmenopausal OA model. P456 LOW FREQUENCY VIBRATION IMPROVES BA- P455 LANCE AND BONE MINERAL DENSITY BONE MATERIAL STRENGTH INDEX BY MICROIN- S. Patru1,I.R.Marcu1,D.Matei1,A.M.Bumbea1,A.C.Bighea1 DENTATION CORRELATES WITH CHITOTRIO- 1University of Medicine and Pharmacy, Craiova, Romania SIDASE LEVELS IN PATIENTS WITH TYPE 1 GAU- CHER DISEASE Objectives: Low intensity mechanical vibration has been A. Diez-Perez1, S. Herrera1, J. Perez-Lopez2, M. Molto- shown to improve musculoskeletal parameters and can be a Abad2,R.Güerri-Fernandez1,E.Cabezudo3, S. Novelli4,J. useful tool as part of the prevention and treatment protocol for Esteve5, A. Hernandez6, I. Roig7, X. Solanich8, D. Prieto- osteoporosis. The purpose of this study is to determine wheth- Alhambra9,X.Nogués1 er 6 months of low frequency vibratory exercise at 15 Hz 1Department of Internal Medicine, Hospital del Mar-IMIM and using a reciprocating plate is effective for improving bone Autonomous University of Barcelona, Barcelona, Spain, 2Inborn mineral density (BMD) and balance in postmenopausal Errors of Metabolism in Adults, Unit of Rare Diseases, Hospital women. Vall de Hebron, Barcelona, Spain, 3Hematology Department, Material and Methods: The study included 15 postmeno- Hospital de Sant Joan de Deu, Barcelona, Spain, 4Hematology pausal women who followed a vibratory exercise programme Department, Hospital de Sant Pau, Barcelona, Spain, consisted of 3 sessions per week, 6 sets of 1 minute, (3 mm in 5Hematology Department, Hospital Clinic, Barcelona, Spain, amplitude, with 60° of knee flexion, with 1 minute rest be- 6Internal Medicine Department, Hospital Comarcal de Sant tween sets). The duration of the vibration programme was Jaume, Calella, Spain, 7Hematology Department, Consorci about 25 minutes, which included 10 minutes warm-up. Hip Hospitalari Parc Taulí, Sabadell, Spain, 8Internal Medicine and lumbar BMD were measured using dual-energy X-ray Department, Hospital de Bellvitge, Barcelona, Spain, 9NIHR absorptiometry and balance was assessed by the blind flamin- Oxford Musculoskeletal Research Unit, Nuffield Department go test, at the beginning of the trial and after 6 months of of Orthopedics, Rheumatology, and Musculoskeletal Sciences, training. Univ, Oxford, United Kingdom Results: After 6 months, the hip BMD was increased 3.2% (P=0.011), lumbar BMD was slightly increased (only 1.7%, Objective: Gaucher disease type 1 (GD1) is a lysosomal dis- p=0.05) and balance was improved by 25%. order caused by a deficiency of beta-glucocerebrosidase, treat- Conclusion: The vibratory exercise programme was more ed by enzyme replacement therapy although diffuse osteopo- effective for improving balance and BMD at the femoral neck rosis remains as a concern. We explored the bone tissue prop- than lumbar BMD, with a high frequency of attendance at erties by microindentation analyzing the correlation of the sessions (92% of the participants completed the programme). biomechanical parameter with the most used marker of dis- ease activity, chitotriosidase levels. Methods: Cross-sectional study of 16 patients with type 1 Gaucher disease (GD1) from the Catalan Study Group on GD and 29 age and gender matched controls. Clinical data, laboratory workup and densitometry were performed. Bone Material Strength index (BMSi) was measured by bone im- pact microindentation using an Osteoprobe instrument, after checking for absence of bone infarcts or any other focal lesion in the area of indentation. Results: As already reported (1), GD1 patients after multivar- iate adjustment, showed significantly lower BMSi compared to controls. Importantly, chitotriosidase levels were negatively correlated with BMSi (linear R2=51.6%, p=0.004) (Figure 1). Conclusion: Bone tissue mechanical characteristics are dete- riorated in patients with GD. BMSi correlates with chitotriosidase, the marker of GD activity. References: (1) Herrera S et al. ASBMR 2016. MO0327 Acknowledgments: CIBERER, ISCIII and Shire Pharm Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S301 References: modifiable nature of the movements, Pilates exercises 1. Torvinen S et al. J Bone Miner Res 2003;18:876. are suitable for all ages, and some studies reported the 2. Gusi N et al. BMC Musculoskeletal Disorders 2006;7:92. effectiveness of these exercises on improving physical functioning among older adults. The objectives of this study were to investigate the efficacy of a specific- P457 exercise intervention based on the Pilates Method on EFFECTS OF TAI CHI EXERCISE ON MUSCLE balance, muscle strength, physical performance and qual- STRENGTH AND BALANCE IN POSTMENOPAU- ity of life (QOL) in postmenopausal osteoporosis SAL WOMEN WITH OSTEOPAENIA women. S. Patru1,I.R.Marcu1,A.M.Bumbea1,D.Matei1,A.C.Bighea1 Material and Methods: Fifty postmenopausal osteoporo- 1University of Medicine and Pharmacy, Craiova, Romania sis women were randomly allocated into two groups: control- home exercise program and Pilates- 1-hour ex- Objectives: In the elderly, reducing risk factors for falls ercise sessions, 3 times per week, 12-weeks. Patients may be more important than improving the bone mass were evaluated at baseline and at after completion the density, because falling presents a much more pressing exercise programs using: the flamingo test, muscular test- threat compared with the slow response to bone strength ing for hip stabilization muscles, physical performance therapy. To reduce risk factors for falls, older adults are level and the Short Form-36 (SF-36) for quality of life. recommended to perform exercises that maintain or im- Results: Balance and muscle strength improved (p <0. prove balance and especially lower extremity strength. 05) in the Pilates group compared to the Home group. This study tried to investigate the effects of 12 weeks Also physical performance test showed significant in- of tai chi intervention on risk factors for falls in post- creases in the Pilates group (p<0.05) whereas there were menopausal women with osteopenia, measuring knee ex- no changes in the control group (p> 0.05). There were tensor muscle strength and balance, baseline and at the significant increases in all parameters of QOL in the end of the trial. Pilates group. Material and Methods: 30 females aged 65 years and Conclusion: Pilates exercises may be a safe and an effec- older with osteopenia were recruited and randomly tive treatment alternative for elderly patients with post- assigned to 12 weeks of tai chi (50 minutes/session, three menopausal osteoporosis. sessions/week, n=15) or a control group (did not perform References: any physical activities, n=15). 1. Bergamin M et al. Age (Dordr) 2015;37:118 Results: The knee extensor muscle strength increased by 2. Kloubec JA. J Strength Cond Res 2010;24:661 15.64% (p<0.001) only for the interventional group, and the period of maintaining balance in the unipodal posi- tion showed an increase of 22.73% for the tai chi group P459 and a decrease of 2.18% for the control group. OSTEOPROTEGRIN INTERACTS WITH BIOMAR- Conclusions: Tai chi improves the strength of the inferior KERS AND CYTOKINES THAT HAVE ROLES IN member and general balance, thus helping in the preven- OSTEOPOROSIS, SKIN FIBROSIS, AND tion of falls and has the advantages of a low cost and VASCULOPATHY IN SYSTEMIC SCLEROSIS: THE easy training activity for elderly people. MULTIFACETED RELATIONSHIP BETWEEN OPG/ References: RANKL/TRAIL AND WNT INHIBITORS 1. Wolfson L et al. J Am Geriatr Soc 1996;44:498 A. Taylan1 2. Hong Y et al. Br J Sports Med 2000;34:29 1Izmir Tepecik Teaching and Research Hospital, Rheumatology Section. Yenisehir, Izmir, Izmir, Turkey P458 Objectives: We investigated the interactions of osteopro- EFFECTS OF PILATES EXERCISES ON PHYSICAL tegerin (OPG) with biomarkers of bone turnover and cy- FUNCTIONING IN POSTMENOPAUSAL OSTEOPO- tokines, including soluble receptor activator for nuclear ROSIS WOMEN factor kappa beta ligand (sRANKL), tumor necrosis S. Patru1,I.R.Marcu1,D.Matei1,A.C.Bighea1 factor-related apoptosis-induced ligand (TRAIL), and 1University of Medicine and Pharmacy, Craiova, Romania Wnt inhibitors, and we evaluated its relationship with osteoporosis, fibrosis, and vasculopathy in systemic scle- Objectives: Pilates is a physical method that combines rosis (SSc). muscle strengthening, lengthening and breathing to de- Methods: The study included 52 SSc patients and 30 velop trunk muscles and restore balance. Due to the healthy controls. Skin thickness, pulmonary fibrosis S302 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and/or hypertension, digital ulcers, and calcinosis were and men over 60 years treated in North Kymi Hospital, assessed. We determined bone mineral density (BMD) Kouvola (86 000 inhabitants), Finland in 2015. Patients and the levels of OPG, sRANKL, TRAIL, secreted were selected by the ICD-10 codes from the electronic frizzled-related protein 1 (sFRP-1), Dickkopf-related pro- patient records. All patients received a questionnaire on tein 1 (DKK-1), and sclerostin. clinical risk factors. Laboratory testing and DXA scans Results: OPG, sRANKL, sclerostin, and sFRP-1 levels were performed. FRAX was used for major fractures were similar between patients and controls (P>0.05). (FRAXMajor) and for hip fracture (FRAXHip). Costs: Femoral neck and lumbar spine BMD and vitamin D DXA scans; laboratory tests; salary for fracture nurse levels were lower, and the OC, NTX, DKK1 and and physician. TRAIL levels were significantly higher, in patients than Results: There were 548 patients (78% women) with in controls (P<0.05). In subgroup analysis, patients with 570 fractures. The mean age of women was 73.5 y higher mRodnan skin scores had significantly higher (SD 12) and of men 77.5 y (SD 10.5). 31% had a wrist DDK1, sclerostin, and TRAIL levels (P<0.05); those fracture; 21% hip; 12% proximal humerus; 10% ankle; with diffuse SSc subtype had lower BMD values than 10% vertebral and 16% other fracture. The response rate those with limited SSc (P>0.05). Correlation analysis for the questionnaire was 73% (400/548). S-25(OH)D showed that calcinosis and pulmonary fibrosis correlated was measured in 67% after on average 109 days after negatively with BMD measures. the injury. Mean S-25(OH)D level of women was 94 Conclusions: This cross-sectional study showed that nmol/L and that of men 93 nmol/L. DXA measurements sRANKL levels were correlated with bone turnover were assessed in 256 patients. Osteoporosis (T-score of markers and may be related to osteoporosis in SSc. The ≤−2.5 SD) was found in 34%. FRAXMajor was ≥20% OPG level was unaltered in SSc patients. Higher TRAIL in 30% of women and ≥10% in 26% of men. FRAXHip levels associated with skin thickness may indicate vascu- was ≤7.5in63%ofwomenandin41%ofmen;>7.5% lar dysfunction or injury. Higher DKK-1 and sclerostin in 37% of women and 59% of men; >10% in 27% levels may be related to a reactive increase in intrinsic of women and in 11% of men; and >20 in 11% of defects due to epigenetic modifications and be promi- women. 83% (333/400) used calcium plus vitamin D nently linked to fibrosis and osteoporosis in SSc. supplements; and 37% anti-osteoporotic medication. Of Patients with diffuse SSc had a higher risk for osteopo- hip fracture patients 28% used anti-osteoporotic drugs rosis and hypovitaminosis D. and 40% calcium plus vitamin D supplements. The total cost was 87 560 e, corresponding to the yearly treat- ment cost of three hip fracture patients in 2013 in P460 Finland. SECONDARY FRACTURE PREVENTION IN SOUTH- Conclusions: According to the Finnish hip fracture guide- EASTERN FINLAND: ANALYSIS OF ANTI-OSTEO- lines all hip fracture patients who are not bedridden and POROTIC TREATMENT AFTER FRAGILITY regain their independence in mobility should use calcium FRACTURES AND COSTS FOR ORGANIZATION IN plus vitamin D and anti-osteoporotic treatment. This was CHARGE not achieved. P. Lüthje1, I. Nurmi-Lüthje2,S.Pigg3,N.Tavast4,P. Rasilainen4, J. Siiskonen4,A.Villikka4,M.Kataja5 1Department of Orthopaedic Surgery and Traumatology, P461 North Kymi Hospital, Kouvola, Finland, 2Department of DEMOGRAPHIC AND CLINICAL FACTORS Public Health, University of Helsinki, Helsinki, Finland, ASSOCIATED WITH BONE MINERAL DENSITY IN 3North Kymi Hospital, Kouvola, Finland, 4Kouvola Health PATIENTS WITH SPINAL CORD INJURY Center, Kouvola, Finland, 5National Institute for Health and S. Kesikburun1,B.Aras1,B.Yılmaz1 Welfare, Helsinki, Finland 1Department of Physical Medicine and Rehabilitation/ Gülhane School of Medicine/ University of Health Sciences, Objectives: Our aim was to analyze the one-year number Ankara, Turkey and secondary prevention of low-energy fractures and to evaluate the costs of these actions. Objective: Loss of motor ability after spinal cord injury Material and Methods: We report the data and treatment is an important cause of immobilization that result in of all low-energy fractures in women aged over 45 years osteoporosis. The objective of this study is to investigate Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S303 the factors associated with bone mineral density in pa- Material and methods: The study included 46 postmeno- tients with spinal cord injury. pausal female RA patients with active disease Material and Methods: A total of 58 patients with spinal (DAS28 3,2) on the stabile highest tolerable dose of cord injury who had undergone DXA during inpatient methotrexate (MTX) therapy during three months prior rehabilitation were reviewed. Demographic and clinical inclusion. No one had OP or glucocorticoid (GC) treat- factors including age, time since injury, level of spinal ment at the study entry. Five out of 46 pts have had low injury, ISCOS-.ASIA impairment scale were analyzed trauma fractures in the past. No other risk factors for OP, using multiple linear regression analysis to find out pre- except RA, were recorded. Patients were randomly dictors for bone mineral density and T score of the fem- assigned to one of four treatment groups during 3 oral neck and total hip. months: 1αD3 1μg (11/46), 1αD3 2μg (12/46) and Results: 45 male (mean age, 40.0±14.3) and 13 female 1αD3 3μg (11/46) daily, or prednisone 20 mg daily, for (mean age, 46.8±17.7) patients were included in the the first month and 10 mg afterwards (12/46), in addition study. 25 (55.6%) male and 3 (23.1%) female patients to MTX. Data collected were: disease activity (DAS 28 had osteoporosis; 11 (24.4%) male and 7 (53.8%) female score), fasting serum levels of carboxyterminal patients had osteopenia. Osteoporosis in male patients telopeptide of collagen type I - sCTX and osteocalcin - was found more frequent than that in female patients OCN (ECLIA Roche diagnostics) at the baseline and at (p=0.039). Bone mineral density and T score of the fem- the end of treatment period. oral neck were significantly associated with time since Results: Patients age was 54,8±12,03 years, average dis- injury (p=0.019, β=0.002; p=0.017, β=0.012, respective- ease duration 7,6±6,85 years and methotrexate dose 15 ly) and suffering from cervical spinal injury (p=0.042, ±3,31mg weekly. Average DAS28 was 5,29±0,914 and β=0.159; p=0.047, β=0.194, respectively) in male pa- 25OHD3 level 30,18±12,468ng/ml. Baseline mean tients only. sCTX 780±402,7 pg/ml, OCN 19,1±8,78 ng/ml. After Conclusion: The findings suggest that male patients after spi- the end of treatment period, we found highly significant- nal cord injury had more frequent osteoporosis in comparison ly reduced disease activity in all four treatment arms with premenopausal female patients. The results for postmen- (p 0,01). Regardless of alfacalcidol dose, sCTX signifi- opausal female patients needs further research. Time since cantly decreased (mean change in all three treatment injury and cervical spinal injury are predictors for bone min- groups 32-40%, p 0,05) in contrast to prednisone use, eral density in male patients with spinal cord injury. where sCTX increased, while OCN decreased. Serum levels of 25(OH)D3 in prednisone users significantly de- creased (p 0,01). There was no alfacalcidol dose depen- P462 dent difference in BTMs changes, nor sCTX, nor OCN. THE EFFECTS ON DISEASE ACTIVITY AND BONE Urinary calcium increased significantly during treatment TURN-OVER MARKERS OF THREE MONTHS in 1αD users, but variations were within the reference TREATMENT WITH ALFACALCIDOL OR PRED- ranges (0,16±0,069 vs. 0,26±0,150g/24h). NISONE IN ACTIVE RHEUMATOID ARTHRITIS Conclusions: Three months of prednisone or high dose FEMALE PATIENTS 1αD3 treatment in postmenopausal women with active K. Simic Pasalic1,K.Gosic1,A.Gavrilovic2, N. Damjanov1, RA, significantly reduced disease activity, while vitamin J. Vojinovic3 D analogue also significantly corrected bone metabolism, 1Institute of Rheumatology, Belgrade University School of as by BTMs assessment, with acceptable safety profile. Medicine, Belgrade, Serbia, Belgrade, Serbia, 2Clinical Center References: Zvezdara, Belgrade, Serbia, 3Clinical Center, Nis, Serbia 1. Ringe JD, Schacht E. Rheumatol Int 2004;24:189. 2. Ringe JD et al. Rheumatol Int 2004;24:63. Background: Rheumatoid arthritis (RA) is the risk factor for osteoporosis (OP) and fractures in both men and women. Alfacalcidol (vitamin D analogue - 1αD3) prevents bone loss P463 and improves bone mineral density in glucocorticoid induced INFORMATIVE ASSESSMENT HORMONAL AND DENSI- OP 1,2, also exerts anti-inflammatory activity. TOMETRY FOR THE DIAGNOSIS OF OSTEOPOROSIS IN Objective: To assess changes in disease activity and bone POSTMENOPAUSAL WOMEN turnover markers (BTMs) in active RA female patients, E. Kosyakova1, S. Verkhoturova2,M.Maksimenya1, treated with high doses of alfacalcidol or prednisone. S. Tsarenok1 S304 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 1Chita State Medical Academy, Chita, Russian Federation, Studies performed in conditions of a microgravity 2Russia Railway Hospital, Chita, Russian Federation models the hypothesis that influence of gravitational load on a various parts of the musculoskeletal system can be a Objective: To evaluate the level of hormones regulate consequence of evolution of biomechanical structures. It bone metabolism and some bone turnover markers, as was shown previously that in the conditions of a micro- well as the values of the densitometry indicators in oste- gravity, postural muscles have the greatest loss in weight oporotic women. and the changes in muscular force can be observed with- Materials and methods: Russian women were examined out increase in muscle mass. All tests were conducted on (48-60 ages): Group 1 – 15 conditionally healthy wom- nonlinear laboratory rats (180-200 g). As a model of en, Group 2 – with osteopenia, Group 3 – 15 with oste- gravitational unloading we used antiortostatic support oporosis. Bone mineral density was revealed by X-ray model. All experiments were performed according to bio- densitometry by T-test. The concentration of parathyroid ethical standards and were approved by local ethical hormone (PTG), calcitriol, Estradiol (E2), cortisol, triio- committee of the Kazan Federal University. Chloral dothyronine levels of Beta-Crosslaps and piridonolina hydrat was used for anesthesia (5mg/kg, intraperetoneal, were testified by ELISA. The statistical analysis of the Sigma-Aldrich). data obtained was processed by the software Statistica The femoral bones were dissected from all tested rats 6.1 (StatSoft). with following weight measurement, density evaluation, Results: Densitometry data differed significantly in groups 2 and measurement of geometrical parameters. At the end, and 3 compared to control (p <0.001) and were equal in the T- the stress tests with a three-points bending were per- test of the femoral neck: 0,90, -1,65, -1,80 SD; on the T-spine formed. After testing Jung's module and limits of tension criterion: 0,35, -1,95, -1,15 SD 1, 2 or 3 groups, respectively. was calculated. Furthermore bones was scanned on The greatest hormonal changes were recorded in the group micro-CT in diaphysis, metaphysis and epiphysis re- with osteopenia (all p < 0.05). The content of E2 in patients gions. After scanning porosity was calculated. The struc- with osteopenia was lower than in the control group (15%) ture of porosity was analyzed (in terms of fabric tensor). and in the group with osteoporosis – 8.4%. Calcitriol levels in It was investigated different groups: control and "hypo Group 2 was higher at 107%, in the group 3 – 43% compared gravitational" on different time of unloading handig (7, with the control. Concentration of PTG in the group with 14, 21, 30 and 40 days). osteopenia was 51% higher than in the control. Calculated It was mentioned that bone extends in the trans- the ratio of the hormones involved in bone remodeling. The verse direction and articular surface increases in most significant differences were found in numbers E2/PTG: "hypogravitational" models. Jung's module decreased in the group with osteopenia the ratio was 46% lower than in slightly, but limits of tension decreased significantly. the control one, and in the group with osteoporosis – 41%. Porosity decreased significantly up to 30 days of Multifactorial statistical analysis showed a strong connection unloading handig. Anisotropy direction changed in all E2/PTG with a change in spine bone mineral density in dif- regions (diaphysis, metaphysis and epiphysis) of the ferent groups. bone in "hypogravitational" models on different Conclusions: It is advisable to use as early biochemical period of unloading handig. These results emphasize that markers of osteoporosis in women the level of PTG, E2 and the muscle atrophy precedes the change in a bone tissue the ratio of E2/PTG. Densitometry indicators both in the T-test after unloading handig and testify that the muscle atro- of the femoral neck, and in the T-spine test are equally infor- phy can promote the subsequent deterioration of a bone mative. structure. This emphasize that the rehabilitation strategy directed on preservation of a muscle also helps to sup- port bone structure during gravitational unloading P464 handig. MECHANICAL PROPERTIES AND STRUCTURE OF BONE TISSUE ARE CHANGED AFTER UNLOADING HANDIG P465 T. Baltina1,O.Sachenkov1, N. Ahmetov1,A.Fedyanin1,I. EFFECT OF PHYSICAL THERAPY AFTER SURGERY Lavrov2,E.Koroleva1,O.Gerasimov1, M. Baltin1 INTERSECTION SYNDROME 1Kazan Federal University, Kazan, Russian Federation, N. Mandic1, S. Stanojevic1 2Mayo Clinic, Rochester, United States 1Dom Zdravlja Nis, Nis, Serbia Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S305 Introduction: Intersection syndrome (IS) presents with diabetic foot conditions, such as foot ulcers. Improper preven- pain and swelling localized to the dorsum of the distal tion of diabetic foot conditions can result in decreased func- forearm, approximately 4 to 6cm proximal to the wrist. tion and quality of life and even amputations of the affected In this area, the abductor pollicis longus (APL) and ex- limb. In fact, the prominence of self-care behaviors and prac- tensor pollicis brevis (EPB) intersect the extensor carpi tices being at the core of diabetic foot management was rein- radialis brevis (ECRB) and longus (ECRL).The basic pa- forced in a consensus statement issued by a multi-disciplinary thology is thought to result from friction at this intersec- panel in 2011.In this study, we aimed to identify the causes for tion point between the muscle bellies and tendons, lead- proper and improper diabetic footcare. ing to tendinopathy and/or bursitis. Materials and Methods: A qualitative study consisting of Purpose: Show the effects of physical therapy (FT) after sur- key informant interviews with 17 healthcare professionals, gical treatment of patients with the IS including doctors and various allied health workers, was con- Method: The patient D.M. age 49 years, housewife, ducted. Participants included had at least 5 years of caring for comes physiatrist Health Centre Nis because of pain in diabetic foot patients either in public institutions or private his left wrist and part above the wrist, as well as minor clinics. Data collected was analysed via thematic analysis. swelling in the area of the styloid process of radius and Results: Diabetic patients were generally observed to have a aggravated abduction and extension of thumb, crepitus in mixture of proper and improper information and beliefs which the movements of the wrist. Guided the diagnosis of eventually influenced the extent of proper footcare. Factors styloiditis radii and treated with physical therapy (IMP, which influenced the extent of proper and improper state of electrotherapy), without clinical improvement. After the information and beliefs were classified into predisposing and completed CTG and echo the findings, and suspected IS precipitating factors. Predisposing factors were further is being sent in the overview plastic surgeon. After sur- categorised into modifiable factors (e.g. education level, so- gery, the person is sent back physiatrist. The following cioeconomic status, social support) and non-modifiable fac- treatment was conducted: IMP, DD, individual tors (e.g. age, presence and severity of co-morbidities kinesiotherapy in the period of 10 days. Monitor the restricting ability to self-care, past experiences). Precipitating effects of the FT was assessed by VAS pain scale, mea- factors were categorized into patient factors (e.g. degree of suring the range of motion in the wrist and thumb, reception of information, presence of psychological barriers), MMT. provider factors (presence and degree of multi-disciplinary Results: 4FT performed after surgery, for a period of two approach to care, presence of administrative inconveniences) weeks, has provided a statistically significant reduction and disease factors (presence of diabetic sensory neuropathy, of pain: before therapy VAS=4, and after treatment complexity of disease process). VAS=0 specified. Increased abduction thumb injury from Conclusions: The extent of proper footcare amongst diabetic 30° to 60°, which is a normal finding and strengthened patients is influenced by numerous predisposing and precipitat- GMS left hand, score the fifth. ing factors. Further studies can look at further development of the Discussion and Conclusions: Physical therapy is given, in described structure as well as quantitatively defining the various addition to surgery, a complete functional recovery of patients, components and factors which make up the described system. with this not so frequent syndrome. P467 P466 TEN-YEAR PROBABILITY OF FRAGILITY FRAC- BARRIERS AND ENABLERS TO PROPER DIABETIC TURES IN PERI AND POSTMENOPAUSAL SAUDI FOOTCARE AMONGST COMMUNITY DWELLERS WOMEN ACCORDING TO WHO FRACTURE RISK IN AN ASIAN POPULATION: A QUALITATIVE STUDY ASSESSMENT TOOL (FRAX) A. N. Cuttilan1, A. A. Sayampanathan1 A. E. Al Fayaa1,A.A.AlMujli1,A.S.AlThani1,M.D.Al 1Yong Loo Lin School of Medicine, National University of Shehri1,A.S.AlKhateeb1, M. K. Al Khalifah1,A.M.Al Singapore, Singapore Asfour1,S.AlShker1, U. Shahi1,M.F.AlFarhan1 1Orthopedic Division, Department of Surgery, King Faisal Introduction: Diabetic foot complications are common with- University, Al Ahsa, Saudi Arabia in Asian populations. They arise due to poor diabetic control and footcare. Studies have shown that proper diabetic control Objective: For the last 20 years, osteoporosis has been a and proper foot care are vital for the overall prevention of major global health concern. Saudi Arabia is not far from S306 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 the epidemic of osteoporosis. According to a 2012- 1Department of Locomotor System, Division of Rheumatology, systemic review, the prevalence of osteoporosis among ASL3 Genovese, Arenzano, Italy Saudi population was estimated to be 34%. In Saudi women,theprevalencewasfoundtobetobe23%. Objectives: To determine the frequency of the acute- There are several factors contributing to the high preva- phase response (APR) after a single intravenous infusion lence of osteoporosis among Saudi females, the most of a nitrogen-containing bisphosphonate (N-BP) and to important one is vitamin D deficiency. A study was con- identify the risk factors for its development. ducted with 200 Saudi females, 100 of which were above Patients and Methods: We considered 206 patients (men 50 years of age, showed that nearly 50% of them have and women) consecutively treated with intravenous N- low levels of vitamin D. The same study claims that only BPs (zoledronic acid, ibandronate or neridronate) for os- 10% of those women are having sufficient exposure to teoporosis or other metabolic bone diseases (Paget, com- sunlight, and only 36% are consuming dairy products plex regional pain syndrome type I or fibrous dysplasia) (250ml/day). Besides other effects of osteoporosis, it is since January 2015. Subjects aged <18 years old or pre- the fragility fractures which is one of the most debilitat- viously exposed to an intravenous N-BP were excluded. ing entity. The best way to treat such fractures is to All patients underwent a comprehensive clinical and prevent them from happening. Hence it is essential to pharmacological assessment. Weight and BMI were mea- quantify the fracture risk based on modifiable and non- sured. Serum calcium, PTH, 25-hydroxy-vitamin D, cre- modifiable factors affecting it. The aim of our study was atinine, CTX and bALP were assessed at baseline. Bone to determine the 10-year probability of fragility fractures mineral density was measured at the lumbar spine, fem- in peri-and postmenopausal Saudi Females with the help oral neck and total hip. The occurrence of any adverse of WHO’s Fracture Risk Assessment Tool (FRAX). event falling within these five symptom clusters within 3 Material and Methods: A prospective cross sectional days from N-BP infusion was defined as constituting an study, conducted in one year recruiting 1539 cases from APR: fever; musculoskeletal (pain and joint swelling); different geographical regions of Saudi Arabia including gastrointestinal (abdominal pain, vomiting, diarrhea); Riyadh (Central), Jeddah (Western), Al Ahsa and eye inflammation; and other (including fatigue, Dammam (Eastern). They were asked to fill FRAX ques- nasopharyngitis, edema, headache and skin disorders). tionnaire. The fracture risk assessment was done and The relationship between the occurrence of APR and compared with other laboratory tests for calcium metab- potential risk factors was explored using logistic regres- olism and BMD. sion models. Results: The ten-year probability of fragility fractures ac- Results: Overall 105 out of 206 patients (51%) presented an cording to FRAX is higher in Saudi peri-menopausal APR (APR+) after intravenous N-BP. The most common women as compared to that of western population. events were acute musculoskeletal symptoms (46%) and fever However, among postmenopausal and elderly females (29%). Overall, the other symptom clusters represented less the risk is almost equal or a few fractions less when than the 8% of the events. Mean age±SD was 67±12 years in we compare it with western population. APR+ subjects and 70±10 years in patients who did not pres- Conclusion: Fragility fractures in postmenopausal Saudi ent an APR (APR-). Clinical and laboratory characteristics women are one of the leading causes of disability and significantly associated (bivariate analyses) with APR were: socioeconomic loss. The extent of problem is higher in a lower number of vertebral fractures (mean number±SD: Saudi population as compared to Western Countries. APR+ 1.3±1.5 vs. APR- 1.8±1.7, P=.014), no long-term use With the help of FRAX we can estimate the probability of statins (APR+ 88% vs. APR- 71%, P=.004), having a met- of such fractures and can take preventive measures to abolic bone disorder other than osteoporosis (APR+ 9% vs. avoid them. APR- 2%, P=.035), and presenting with secondary hyperpara- thyroidism (sHPTH) due to vitamin D deficiency (APR+ 26% vs. APR- 14%, P=.033). In the multivariate logistic regression P468 model sHPTH was significantly associated with APR (OR CHARACTERIZATION OF AND RISK FACTORS FOR 2.3, 95%CI 1.1-5.1, P=.033), while long-term use of statins THE ACUTE-PHASE RESPONSE AFTER (OR 0.3, 95%CI 0.1-0.7, P=.005) and previous exposure to INTRAVENOUS NITROGEN-CONTAINING BISPHOS- oral N-BPs (OR 0.5, 95%CI 0.3-0.9, P=.042) were protective. PHONATES Conclusions: The preliminary analysis of our ongoing A. Giusti1,G.Girasole1, V. Garzia1, V. Siccardi1,A. study identified a number of risk factors for the devel- Locaputo1,P.Diana1,M.Ponte1, G. Bianchi1 opment of APR. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S307 P469 B-12 and D deficiencies. These were common in our 128 PATIENTS WITH SUBACUTE SYMPTOMATIC cohort with subacute symptomatic fragility VCF. Accor- FRAGILITY VERTEBRAL COMPRESSION FRAC- dingly we recommend vitamin B-12 levels and SPE in TURES-HIGH INCIDENCE OF MORTALITY, FALLING, the evaluation of all patients with VCF. These findings MONOCLONAL GAMMOPATHY OF UNCERTAIN support the emphasis on interventions to reduce the risk SIGNIFICANCE AND MYELOMA, PERNICIOUS of falling in the elderly and to recognize and treat these ANEMIA AND VITAMIN B-12 DEFICIENCY: IS THIS A age related conditions in an attempt to mitigate the risk PROFILEOFANOSTEOPOROTICORANAGED of VCF. POPULATION? M. Lovy1, N. Ben-Shlomo2,J.Udkoff3 1Desert Oasis Healthcare, Palm Springs, California, United P470 States, 2Ben-Gurion Medical School, Beer Sheva, Israel, OSTEOPOROSIS IN DIABETIC ALBANIAN WOMEN 3University of California, San Diego, San Diego, California, V. Duraj1,D.Ruci1,A.Kollcaku1,V.Ruci1,M.Jordhani1,E. United States Memlika1, A. Vata2 1University Hospital Center Mother Teresa, Tirana, Albania, Objective: To study factors contributing to both osteopo- 2Regional Hospital of Lezhe, Lezhe, Albania rosis and falling in a cohort of patients with symptomatic subacute fragility vertebral compression fractures (VCF). Introduction: Osteoporosis (OP) and Diabetes Mellitus Methods: We saw 128 patients with symptomatic sub- (DM) are two of the most prevalent diseases worldwide. acute fragility VCF in our community based outpatient Diabetes Mellitus has microvascular consequences which fracture clinic over a two year period. We performed a can cause bone loss and eventually, Osteoporosis in complete history and physical, review of past medical Diabetic patients. records and radiographs, complete blood count, sedimen- Objectives: To evaluate the association between type 2 tation rate, chemistry profile, TSH, urinalysis, vitamin Diabetes Mellitus and Osteoporosis in Albanian women B-12,PTH,25-OHvitaminD,andserumproteinelec- presented at Rheumatology Clinic near UHC “Nene trophoresis (SPE). We performed testosterone level, Teresa” Tirana, Albania. methylmalonic acid, antiparietal cell antibody and intrin- Methods: This is a case-control study including 670 sic factor antibody in select cases. We recorded diseases Albanian patients which were divided into 4 groups: pa- including diabetes, COPD, cardiac, neurological for each tients with DM and OP (7 patients-14.3%), patients with patient. OP and without DM (57-9.2%), patients with DM and Results: There were 92 females aged 45-98 years (mean without OP (42- 85.7%) and patients neither with DM 77.7), 36 males aged 39-94 years (mean 77.6). Factors nor OP (564- 90.8%). Results of DXA were obtained for contributing to falling included peripheral neuropathy-61, Osteoporosis evaluation and results of Glycaemia and use of sedatives-43, blindness-12, foot drop-6, dementia- HbA1c were obtained according to American Diabetes 3, Parkinsons-3, and hyponatremia-2. VCF were precipi- Association guidelines. All the results were analyzed tated by falls in 94 patients, of which 87 occurred at and statistically evaluated. home. VCF occurred with lifting in 8 patients, bending Results: After analyzing the obtained data, it was found in 3, and were spontaneous in 23. Steroid use was re- that there is a strong and statistically significant relation- ported in 18 patients. Age correlated with the number of ship between Diabetes Mellitus and Osteoporosis diseases (p<0.0001). Diagnosis based on laboratory stud- (p<0.005). So, women with Diabetes Mellitus are at a ies included vitamin D insufficiency-29 and deficiency- higher risk to suffer from Osteoporosis. 12, vitamin B-12 deficiency-8, pernicious anemia-6, Conclusion: Our study shows that Diabetic Albanian fe- monoclonal gammopathy of uncertain significance males are more at risk to develop Osteoporosis than nor- (MGUS)-10, myeloma -2, hypogonadism-12, and iatro- mal females. Thus, it is of great importance to evaluate genic hyperthyroidism-3. Ankylosing spondylitis and bone metabolic status in diabetic women in order to pre- lymphoma were diagnosed in one patient each. The av- vent Osteoporosis and its consequences. erage age of those that died was 83.9 years compared to 76.8 of the remaining group (p=0.033). Conclusion: Conditions that increase with age and are associated with an increased risk of fracture include fall- ing, MGUS, myeloma, pernicious anemia and vitamin S308 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P471 P472 TENOFOVIR INDUCED OSTEOMALACIA: A PROFILE INSOMNIA IN PATIENTS WITH CHRONIC LOW OF THREE PATIENTS WITH PAINFUL FRACTURES BACK PAIN WITH LOW PHOSPHORUS AND NORMAL LEVELS M. Geneva-Popova1, V. S. Popova1, R. Karalilova2,S.D. OF VITAMIN D AND PARATHYROID HORMONE Popova2 M. Lovy1 1Department of Rheumatology, Medical University, UMHAT, 1Desert Oasis Healthcare, Palm Springs, California, United Plovdiv, Bulgaria, 2Medical University of Plovdiv, Plovdiv, States Bulgaria Objective: To describe the clinical presentation and course of Background: A sleep disorder is a medical disorder of three patients with tenofovir induced hypophosphatemic the sleep patterns of a person. Sleep disorders are serious osteomalacia. enough to interfere with normal physical, mental, social and Methods: The clinical, laboratory, and radiologic features of emotional functioning. When a person suffers from difficulty three patients referred for evaluation of pain and/or osteopo- falling asleep and/or staying asleep with no obvious cause, it is rosis were reviewed. referred to as insomnia. The relationship between insomnia Results: All three patients were male, had diffuse pain, suf- and depressive illness is complex – depression may cause fered multiple clinical fractures, and were on combination sleep problems and sleep problems may cause or contribute long and short acting opioids at the time of presentation. to depressive disorders. For some people, symptoms of de- Two were in wheelchairs and two had neuropathy. pression occur before the onset of sleep problems. Sleep prob- Table. lems are also associated with more severe depressive illness. Objectives: The aim of the study was to assess insomnia in patients with low back pain and to identify factors associated Y=years, Sx=symptoms in months, VAS=visual analogue scale, alkphos=alkaline phosphatase (39-117 with this insomnia. IU/L), PO4=phosphorus (2.5-4.5mg/dL), K+=potassium (3.5-5.2mml/L), FemN=femoral neck T-score, LS=lumbar spine T-score. Methods: The study included 80 patients suffering from low back pain (55 females and 25 males, mean age: 61.15±8.1 Y=years, Sx=symptoms in months, VAS=visual analogue years). Low back pain, sleep characteristics, types and conse- scale, alkphos=alkaline phosphatase (39-117 IU/L), quences of insomnia were collected. Insomnia severity was PO4=phosphorus (2.5-4.5mg/dL), K+=potassium (3.5- assessed using index of severity of insomnia with a global 5.2mml/L), FemN=femoral neck T-score, LS=lumbar spine score going from 0 (the best situation) to 28 (the worst situa- T-score. tion). Relationship between insomnia and low back pain char- acteristics was analyzed. All patients had hypogonadism and proteinuria and case 1 had Results: Insomnia was reported by 43% of patients and glycosuria. All patients had normal 25-OH vitamin D, vitamin was caused by pain in 79% of them. Insomnia was early, B12, PTH, serum protein electrophoresis, magnesium, CBC, middleandlateinrespectively55,32and13%ofall calcium, CPK, sedimentation rate, TSH. Case 1 had fractures insomniac patients. The mean of index of severity of in- of the hip, sacrum, and humerus; case 2 hip and ribs; and case somnia score was 14.06±2.9. Consequences of insomnia 3 ribs, pelvis and knee. The technetium bone scan showed a were followed by daily activities disturbance (65%), tired- similar pattern of increased uptake in multiple ribs, calcaneus, ness (65%) and mood disorders (21%). Significant corre- metatarsal bones, knees, and sacrum in all three patients. A lations were found between index of severity of insomnia MRI of the knee showed bone marrow edema in case 2 and an and pain (VAS mm) (r=0.620; p<0.001), fatigue (r=0.510; atypical longitudinal fracture of the femur in case 3. Tenofovir p<0.001) and body mass index (r=-0.440; p=0.02). was withdrawn, oral phosphates given, and resolution of pain Multiple logistic regression models have shown that only and biochemical changes occurred in 4-8 months. Bone min- pain (OR=1.421; IC 95% (1.232- 1.833); p=0.01) and eral density in case 1 repeated 1 year after presentation in- body mass index >35 (OR=1.055; IC 95% (1.024- 1.116; creased 16% in the femoral neck and 19% in the lumbar spine. p=0.01) were the significant independent factors related to Conclusion: Long term tenofovir therapy in HIV patients insomnia severity. 25% of the patients with insomnia and can induce a devastating disabling osteomalacia caused by low back pain were with clinical features of depression hypophosphatemia with features of Fanconi's syndrome. A and they needed treatment. low BMI, hypogonadism, and neuropathy may predispose Conclusions: Insomnia prevalence seems to be important in or be associated with this complication. A serum phospho- patients with low back pain. The severity of insomnia was rus and urinalysis should be included in the work up of all related to pain and body mass index >35. Assessment of in- tenofovir treated HIV patients with diffuse pain, fracture, somnia should be integrated to low back pain management or osteoporosis. and so the depression can be protected. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S309 References: Conclusion: The results of the present study did not support 1. Marty M et al. Eur Spine J 2008;17:839 the potential role of VDR BsmI, COL1A1 Sp1, ERα PvuII 2. Yang P et al. J Physiother 2012;58:157 and XbaI polymorphisms in the effectiveness of 3. Sibbritt D et al. BMC Musculoskelet Disord 2016;17:393 bisphosphonates in treatment of postmenopausal osteoporotic 4. Théroux J et al. Pain Res Manag 2015;20:153 women. In order to generalize these results multicenter ran- domized prospective studies with larger sample sizes are required. P473 ROLE OF PHARMACOGENOMICS IN EFFECTIVENESS OF BISPHOSPHONATES IN TREATMENT OF P474 OSTEOPOROTIC PATIENTS RISKS FACTORS FOR HAND OSTEOARTHRITIS IN A. Sepici Dincel1, S. Akbulut Aytürk2,O.Ozyemisci PATIENTS WITH DIABETES MELLITUS TYPE 2 Taskiran2,N.Demirsoy2,V.Sepici2 M. Geneva- Popova1, S. Alimanska2, V. S. Popova3,R. 1Department of Medical Biochemistry, Faculty of Medicine, Karalilova4,A.Batalov3,P.T.Selimov4 University of Gazi, Ankara, Turkey, 2Department of Physical 1Department of Rheumatology, Medical University, Plovdiv, Medicine and Rehabilitation, Faculty of Medicine, University Bulgaria, 2Medical University, Plovdiv, Bulgaria, of Gazi, Ankara, Turkey 3Department of Rheumatology, Medical University, UMHAT, Plovdiv, Bulgaria, 4Medical University of Plovdiv, Objective: Genetics of osteoporosis consists of two fields, Plovdiv, Bulgaria namely genetics of the disease and pharmacogenetics of the drug response. Various investigated candidate genes have Background: Type 2 diabetes mellitus (DM) consists of an been reported to be involved in the pathogenesis of array of dysfunctions characterized by hyperglycemia and osteoporosis. resulting from the combination of resistance to insulin action, Material and Method: The present study was included 21 inadequate insulin secretion, and excessive or inappropriate female patients with postmenopausal osteoporosis whom glucagon secretion. Osteoarthritis (OA) is characterized by were treated with bisphosphonates for one year. Pre and post cartilage degeneration or degradation of one or more joints. treatment L1-L4 BMD, femoral neck BMD and osteocalcin Risk factors for hand osteoarthritis are hand trauma, levels were measured. Patients with a reduction of 2% or less malalignment of a joints, repetitive movements, female gender in BMD were accepted as unresponsive to treatment. The and advanced age, family history, obesity. Diabetes mellitus relationship between effectiveness of treatment and VDR, is regularly considered a risk factor for osteoarthritis in BsmI, Col1A1 Sp1, ERα Pvu II and Xba I receptors was weight-bearing joints, such as hips and knees, but not for the investigated. hands. Results: The genotypic distributions of VDR BsmI, Col1A1 Objective: To evaluate the association of hand osteoarthritis Sp1, ER Pvu II and Xba I polymorphisms were in agree- and diabetes mellitus. ment with that of Hardy-Weinberg. In the Col1A1 Sp1 poly- Methods A study was performed in 64 patients (33 adult morphism, the mean age of Ss genotype was significantly diabetes mellitus patients (Group A) and 31 non-diabetic lower compared to the SS group. No significant difference subjects (Group B) with hand osteoarthritis. OA of hand was found between the other genotypes in age, BMI, calci- was ascertained using the American College of um, parathormone, vitamin D, basal L1-L4 BMD, femoral Rheumatology classification criteria. Multivariable logistic neck BMD and osteocalcin levels. In the VDR BsmI poly- regression was used to evaluate the association of DM with morphism, percentage changes of femoral neck and L1-L4 hand OA, and to evaluate factors associated with hand OA BMD were higher in the Bb group compared to the BB and among DM patients. Odds ratios (OR) with 95% confi- bb groups; however the difference between the groups was dence intervals (CI) were calculated to associate BMI, glu- not statistically significant (Femoral neck: BB (-0.7%), Bb cose, HbA1c, C-peptide with hand OA using logistic re- (7.0%) and bb (-3.0%), p=0.614; L1-L4: BB (-0.8%), Bb gression analyses per standard deviation, stratified for sex (4.5%) and bb (1.5%), p=0.169). In the Col1A1 Sp1 poly- andadjustedforage. morphism, percentage changes of femoral neck and L1-L4 Results: BMI>27wasassociatedwithhandOAinboth BMD were higher in the SS group compared to the Ss groups, OR 1.26 (95% CI 1.12-1.53), glucose and C-peptide group; again the difference between the groups was not sta- were associated with hand OA in group A OR 1.24 (95% CI tistically significant (Femoral neck: SS (2.4%), Ss (-1.4%), 1.18-1.41) and OR 2.03 (95% CI 1.94-2.18). HbA1c showed p=0.307; L1-L4: SS (3.0%), Ss (0.0%), p=0.221). No per- an OR of 1.57 (95% CI 1.44-1.91) for hand OA in group A. centage changes were found in the ERα Pvu II and XbaI The associations of glucose, HbA1c and C-peptide with hand polymorphisms. OA remained significant after adjustment for fat mass. S310 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Conclusions: BMI was associated with clinical hand OA in Results: Women were 98% of the sample. Mean age was both groups - adult diabetes mellitus patients and non-diabetic 59.25 for Cases and 59.01 for Controls (p=0.78). In the t-test, subjects. In patients with DM glucose, HbA1 and C-peptide statistically significant differences for GLP1 and GLP2 were were associated with hand OA, suggesting involvement of not found although GLP1 was lower in Cases (μ±SD=118.38 non-enzymatic glycation in the development of hand OA. ±3.24) than in Controls (μ±SD=126.26±3.73), p=0.11. In the Strict glucose control might therefore have a beneficial effect multiple logistic regression analysis, the OR for plasma GLP1 on the incidence of hand OA. in Cases was 0.89 (0.81-0.98, 95% CI), p=0.021, compared to References: Controls, adjusted by C-telopeptide of type I collagen, calorie 1. Puenpatom RA, Victor TW. Postgrad Med 2009;121:9 and protein intake and spine Z-score. 2. Berebaum F. Ann Rheum Dis 2011;70:1354 Conclusions: Plasma levels of GLP1 are associated with a 3. Nieves-Plaza M et al. J Clin Rheumatol 2013;19:1 significant decrease in the risk of osteoporosis. More studies are necessary to confirm our results. Acknowledgments: This research was funded by a grant from P475 “Instituto de Salud Carlos ROLE OF ENDOGENOUS GLUCAGON-LIKE III (ISCIII)”, and “Fondo Europeo de Desarrollo Regional PEPTIDES 1 AND 2 IN OSTEOPOROSIS (FEDER)”. PI14/01591 C. Montes1, M. Martínez2,C.Tenorio3,M.Garrido4,A. Segarra5, I. Prieto5,M.Delgado6,R.Soriano7, M. De Damas8 1Endocrinology and Nutrition Department / University Hospital P476 La Paz, Madrid, Spain, 2Endocrinology and Nutrition COMPARASION OF EFFICACY OF INTRA Department / University Hospital of Jaén. Science of Health ARTICULER STEROID INJECTIONS IN THE Department / University of Jaén, Jaén, Spain, 3Endocrinology PATIENTS WITH KNEE OSTEOARTHRITIS WITH and Nutrition Department / University Hospital of Jaén, Jaén, OR WITHOUT EFFUSION Spain, 4University of Granada, Granada, Spain, 5Physiology M. G. Geneva-Popova1,V.S.Popova2,K.Kraev3,S.D. Department / University of Jaén, Jaén, Spain, 6Public Health Popova1 and Preventive Medicine Department / University of Jaén, Jaén, 1Medical University of Plovdiv, Plovdiv, Bulgaria, Spain, 7Emergency Department / University Hospital La Paz, 2Department of Rheumatology, Medical University, Madrid, Spain, 8Endocrinology and Nutrition Department/ UMHAT, Plovdiv, Bulgaria, 3Department of Rheumatology, Hospital of Jaén, Jaén, Spain Medical university Plovdiv, UMHAT, Plovdiv, Bulgaria Objective: Recent studies have shown that bone turnover Background: While knee osteoarthritis is often a progressive markers undergo a circadian rhythm, being the intake of food and irreversible degenerative process, functional improve- a cause of acute reduction of resorption markers during day- ment and pain control are reasonable treatment goals. In the time, which is followed by an increase of them by fast at night. knee, injections of corticosteroids into the joint may relieve Main effectors of this response in bone turnover markers may inflammation, and reduce pain and disability. be gastrointestinal peptides. Our objective is to determine if Objectives: The present study aims to compare efficiency of both Glucagon-like peptide 1 (GLP1) and 2 (GLP2) plasma intraarticular steroid injection administered on knee osteoar- levels are related with the incidence of osteoporosis. thritis (OA) patients between conditions whether effusion ex- Methods: One hundred and eighteen volunteers were includ- ists or not. ed in a case-control study: 60 cases and 58 controls, matched Methods: The study included totally 46 patients (36 women by age and sex. Inclusion criteria were for Cases: T-score -2.5 and 10 men, ages 56±5,23) who applied to the knee pain and below and for Controls: normal Bone Mineral Density symptom and were diagnosed with knee OA KL-scale ≥2. (BMD). Exclusion criteria were secondary osteoporosis, dia- Based on the existence of effusion determined clinically, pa- betes mellitus, cancer, hospitalization in the last 6 months and tients were subclassified in 2 groups. Whereas the 1st group current treatment with antidiabetic and anti-osteoporotic was including the patients with clinical effusion; the 2nd drugs. As variables we determined food intake; BMD mea- group was including without effusion. Group 1 and 2 patients sured by Dual-energy X-ray absorptiometry (DXA) in the were administered intraarticular steroid injection (Diprophos 7 posteroanterior spine and hip; bone turnover markers and plas- mg/ml suspension for injection betamethasone) on 1and 7 ma levels of GLP1 and GLP2, using Luminex x-MAP tech- days. Before the treatment, patients were evaluated in terms nology. Statistical analysis: Student's t-test for continuous var- WOMAC pain score, physical function score and visual ana- iables, c² test for categorical variables, and logistic regression log scale. In the post-injection period, patients invited for con- analysis for the calculation of the Odds Ratio (OR) and its trol at the 2nd and 8th weeks were evaluated based on the Confidence Interval (CI). same parameters. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S311 Results: In group A and B a statistically significant recovery Results: In the global analysis, there was no significant was observed in terms of pain, physical activity, and morn- relationship between either rs2707466 or rs2908004 ge- ing stiffness values at the end of both the 2nd and the 8th notypes and the OA phenotype (p=0.14 and p=0.19 re- weeks compared to the initial period (p<0.05). The recovery spectivelyinhipOA,andp=0.41andp=0.16respectively in the injection group A was statistically more significant in knee OA). However, a genotype-phenotype association compared to the group B (p<0.001). There was no statisti- was found in the sex-stratified analysis. Thus, there was a cally significant all parameters difference between the group significant difference in the genotypic frequencies of A and group B based on the controls at the 2nd and the 8th rs2707466 between hypertrophic and atrophic hip OA in weeks (p>0.05) males (p=0.003), with overrepresentation of G alleles in Conclusions: It was observed that intraarticular steroid injec- the hypertrophic phenotype (OR 2.08; CI 1.28-3.38). An tion reduced pain and stiffness related scores whether patients association in the same direction was observed between diagnosed with knee OA have effusion, or not; and developed these alleles and the type of knee OA, with G alleles the functionality. However, these effects were observed only being more common in the hypertrophic than in atrophic for limited period. knee phenotypes (p=0.008; OR 1.956,CI 1.19-3.19). References:1. Hochberg M et al. Arthritis Care Res Similar associations were found for the rs2908004 SNP (Hoboken) 2012;64:465 although it only reached statistical significance for knee 2. Jones A, Doherty M. Ann Rheum Dis 1996;55:829 OA (p=0.017; OR 0.92, CI 0.86-0.989). All these associ- 3. Maricar N et al. Sem Arthritis Rheum 2016;45:556 ations were maintained in models adjusted by age and BMI. Conclusions: WNT16 alleles are associated with the hip P477 and knee OA phenotype in a sex-dependent manner. To WNT16 ALELLES ARE ASSOCIATED WITH our knowledge, this is the first study attempting to ex- DIFERENT OSTEOARTHRITIS PHENOTYPES plore the association of genetic variants with the OA J. A. Riancho1,C.Garcia-Ibarbia1,S.Neila1,C.Garces2,M. phenotype. These data bring forward the need to consid- A. Alonso2, J. Arozamena3, M. T. Zarrabeitia3 er the OA phenotype in future genetic association studies 1Department of Medicine. Hospital U M Valdecilla, of OA. University of Cantabria, IDIVAL, Santander, Spain, 2Department of Traumatology/Hospital U M Valdecilla, University of Cantabria, Santander, Spain, 3Legal Medicine/ P478 University Cantabria, Santander, Spain IMPROVING OSTEOPOROSIS MANAGEMENT THROUGH SIMPLE RADIOLOGY REPORTING Objectives: Genetic factors account for about 40-60% of CHANGES thevarianceinhipandkneeosteoarthritis(OA)riskand J. Sukumar1,A.Gupta1 bone mineral density (BMD). The Wnt pathway is in- 1Glangwili Hospital, Carmarthen, United Kingdom volved in bone and cartilage homeostasis. Polymorphisms of the Wnt ligand WNT16 have been associated with Objectives: International Osteoporosis Foundation (IOF) BMD. There is a complex relationship between BMD and recommends the use of clear, unambiguous terminology OA, which may vary with the type of OA. Hence, we using the word 'fracture', and grading the fracture from mild hypothesized that allelic variations of WNT16 could influ- to severe in reporting, and terms such as collapse, wedging ence the OA phenotype. to be avoided. We aimed to assess vertebral fracture Patients and methods: We studied 509 Caucasian pa- reporting of spinal plain films at our teaching hospital in tients, 363 with hip OA and 146 with knee OA, un- United Kingdom. dergoing joint replacement due to severe primary OA. Method: This was a retrospective observational study. Radiographs were used to classify the OA as atrophic 100 plain spine X-rays (50 thoracic and 50 lumbar) or hypertrophic, by two trained observers. DNA was from hospital PACS system for patients aged above 50 extracted from peripheral blood or buccal swabs and years were analysed over a period of 4 months. We two polymorphisms of WNT16 (rs2707466 and studied the concordance of reports done by local rs2908004), previously associated with BMD, were an- Radiologists comparing with the IOF guidelines which alyzed by a mass-array Sequenom platform or by using required use of the word 'fracture' and avoidance of Taqman assays. The association between the genotypes ambiguous words. and the OA phenotype was analyzed by logistic re- Results: Amongst Thoracic spine x-ray reports (N=50),Mean gression and adjusted for age and body mass index age (71),No of fractures noted (14)- Ambiguous terms used (BMI). (4),Appropriate Grading of fracture used (9/14) Amongst S312 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Lumbar spine films- (N=50)-Mean age (72), No of fractures U=1448; p<0.001; and BMD 1.05 (0.95–1.14) vs. 1.12 noted (14),Ambiguous terms used(0),Grading of fracture used (1.05–1.23) g/cm2; U=1524; p<0.001). (9/14). Conclusions: In the lumbar spine it is characterized by Conclusions: Our study confirms that Radiology reporting the decrease of bone mineral density in the first vertebra, is using ambiguous term such as wedging without but in patients with type 1 diabetes, this trend is most mentioning fracture in some reports. Grading of vertebral pronounced. fracture was used only in 64% of fracture reports by Radiologists. Accurate, clear, unambiguous reporting is essential for accurate identification of vertebral frac- P480 tures. The results of our study were disseminated to THE STATE OF THE BONE MINERAL CONTENT Radiologists and regular educational updates to doctors, AND SERUM CALCIUM IN ADULTS WITH TYPE 1 radiologists and radiographers is ongoing. Early and ac- DIABETES curate diagnosis of vertebral fractures is an important step A. Shepelkevich1, Y. Dydyshka1,E.V.Brutskaya- in optimizing the clinical management of patients with Stempkovskaya2, N. Vasilieva3 osteoporosis. 1Belarusian State Medical University, Minsk, Belarus, 2Belarusian State Medical University, Minsk City Polyclinic N31, Minsk, Belarus, 3Republic Medical Rehabilitation and P479 Balneotreatmentcenter, Minsk, Belarus THE IMPACT OF TYPE 1 DIABETES IN THE SPECIFICITY OF LOSS THE BONE MINERAL Background and aims: Bone mineral content (BMC) is a DENSITY OF THE AXIAL SKELETON parameter that determine the state of the bones miner- Y. Dydyshka1, A. Shepelkevich1 alization, which allows evaluating the use of the DXA 1Belarusian State Medical University, Minsk, Belarus with «body composition». Therefore, the aim of study was to assess the possible association between BMC Background and aims: To date, there is convincing evi- and serum calcium in adults with diabetes type 1 dence of the development of diabetic osteopathy, the spec- (T1DM). ificity of changes in in patients with type 1 diabetes Materials and methods: 95 patients with T1DM (mean (T1DM) is debatable and requires further study. age: 30,6 (24,9–37,5)yrs,durationofDM:13(7–20) yrs, Therefore, the aim was detailed study of the state of the age of manifestation: 17 (12–23) yrs, BMI: 22,86 (21,09– bone mineral density (BMD) of the axial skeleton in 25,16) kg/м2; HbA1c: 8,2 (7,6–8,9)%) and 55 controls, T1DM patients. comparable in sex, age and anthropometric data. The re- Materials and methods: 95 patients with T1DM (60 women, search involved general clinic examination, dual energy 35 males) (mean age: 30,6 (24,9–37,5) yrs, duration of DM: X–ray absorptiometry (DXA) using a program “Body 13 (7–20) yrs, age of manifestation: 17 (12–23) yrs, BMI: composition”. 22,86 (21,09–25,16) kg/м2; HbA1c: 8,2 (7,6–8,9)%) and 55 Results: BMC was lower in T1DM patients as total: 2552 (31 women, 24 men) controls, comparable in sex, age and (2267–2955) vs. 2845 (2485–3339)g; U=1783; p=0,003) anthropometric data. The research involved general clinic and in the next region: BMC Arms (331 (290–394) vs. examination, dual energy X–ray absorptiometry (DXA). 371 (303–467)g; U=1942,5; p=0,019), BMC Legs (969 Z–score of –2.0 or less was regarded as a low bone mineral (839–1124,5) vs1025 (943–1290)g; U=1802; p=0,004), density. BMC Trunk (790 (668–931) vs. 877 (733–1037)g; Results: Low BMD was detected in 15.8% of the sur- U=1830.5; p=0,005), BMC Gynoid (262 (218–313) vs. veyed patients with T1DM and 3.6% of control. There 295 (256–350)g; U=1796,5; p=0,003). Marked decrease were revealed increases in 4.97 times likelihood of de- in total (2.35 (2.19−2.56) vs. 2.52 (2.45−2.57) mmol/L; veloping low BMD in some of the surveyed areas of U=764; p=0,001) and ionized calcium (1.15 (1.12−1.25) the axial skeleton (OR=4.97; 1.18−20.91; F=0,034; vs. 1.29 (1.23−1.30) mmol/l; U=584.5; p<0,001) in the р=0,031) and in spine – in 7.81 times (OR=7.81; 1.04 blood serum in patients with T1DM compared to the con- −58.41; F=0,034; р=0,032) in T1DM patients. Detailed trol. There were no differences in the prevalence of hypo- assessment of BMD in lumbar spine showed the largest calcemia as in terms of total (F=0.027; p=0.168), and decline in the first lumbar vertebra as in patients with ionized calcium (F=0.035; p=0.086). Was not established diabetes mellitus (cr2=90.15; p<0.001) and in a control significant correlation in parameters of BMC with the group (cr2=37.18; p<0.001). However, more pronounced content of total and ionized serum calcium blood in pa- reduction of BMD was proved in diabetes mellitus − tients with diabetes type 1 (p>0.05 for all comparison (Z–score: –0.80 (–1.80 – (–0.20)) vs. 0.00 (–0.60–0.60); pairs). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S313 Conclusions: Was not determined significant association by P482 the state of the BMC with a decrease in serum calcium in ZOLEDRONIC ACID IN PATIENTS AT IMMINENT patients with T1DM, which may be due to other mechanisms RISK OF FRACTURES IN A FLS IN RIO DE JANEIRO of bone loss due to diabetes, to fully understanding further B. Stolnicki1, R. Galdino1,R.Melo1,A.Libman1,H.Maleh1 research is needed. 1Prevrefrat, Rio de Janeiro, Brazil Prevrefrat is a FLS, already active 6 years in Rio de Janeiro, P481 Brazil. We provide services in a federal hospital and two TRABECULAR BONE SCORE IN MEN WITH HMO. We assessed the ability of our FLS to directly reduce DYSGLYCAEMIA AND DIABETES re-fracture rate in patients at imminent risk of osteoporotic K. L. Holloway1,L.L.F.DeAbreu1,D.Hans2,M.A. fracture, using an annual infusion of zoledronic acid 5 mg. Kotowicz3, M. A. Sajjad1,J.A.Pasco1 196 men and women older than 60 years with proximal fem- 1IMPACT, Deakin University, Geelong, Australia, 2Center of oral fracture, two or more vertebral fractures and one verte- Bone Diseases, Lausanne University Hospital Switzerland, bral fracture plus another fracture (wrist, shoulder or ankle) Lausanne, Switzerland, 3Barwon Health, Geelong, Australia were evaluated. All patients were supplemented with calcium and vitamin D treated with annual infusion of zoledronic acid Objectives: Diabetes is associated with increased skeletal fra- 5 mg. The option for the mentioned drug was in order to gility, despite increased BMD. Increased fractures in diabetes facilitate adherence to treatment. Note that these scenarios could be a result of poorer bone quality, such as the incident and prevalent cost of an osteoporotic fracture is microarchitecture which can be assessed using trabecular on average $ 20,000, justifying the cost effectiveness of these bone score (TBS). The aim of this study was to describe the drug. 22 new fractures after a minimal trauma in 21 patients relationship between TBS and normoglycaemia, impaired were found (4 proximal femur, 4 distal radius, 3 pelvis, 3 fasting glucose (IFG) and diabetes in men. vertebral, 2 patella, 2 proximal humerus, 2 periprosthetic Methods: This study included 555 men, age 68.7±12.2 years, proximal femur, 1 ankle and 1 clavicle). We describe the enrolled in the Geelong Osteoporosis Study. IFG was consid- profile of these patients for age, sex, initial fractures, new ered as fasting plasma glucose (FPG) ≥5.5mmol/L and diabe- fractures, clinical risk factors, BMD values and vitamin D tes as FPG≥7.0mmol/L, use of antihyperglycaemic medica- levels. tion or self-report. TBS was determined retrospectively using TBS iNsight software (Version 2.1) from lumbar spine DXA scans (Lunar Prodigy). Using multivariable regression tech- P483 niques the relationship between dysglycaemia and TBS was HEALTH BEHAVIOURS ASSOCIATED WITH assessed, adjusting for age, weight, lumbar spine BMD, dia- SARCOPENIC OBESITY betes medications and those affecting bone (glucocorticoids), J. A. Pasco1, K. L. Holloway1,P.G.Rufus1,N.K.Hyde1,L.J. alcohol intake, smoking, physical activity and socioeconomic Williams1,S.X.Sui1, M. Tembo1, M. A. Kotowicz1 status. No interaction terms were identified. 1Deakin University, Geelong, Australia Results: There were 318 men with normoglycaemia, 172 with IFG and 65 with diabetes. Mean unadjusted TBS for Objectives: There has been little focus on obesity in the normoglycaemia, IFG and diabetes were 1.299 (95%CI elderly, particularly when it occurs in the face of sarcopenia. 1.287-1.311), 1.274 (1.257-1.290) and 1.246 (1.219-1.273), We aimed to investigate the relationship between sarco- respectively (p=0.001). penic obesity (SO), and its components, with poor health Compared to men with normoglycemia, diabetics had lower behaviours. age-, weight- and lumbar spine BMD-adjusted TBS Methods: 353 men and 245 women aged 65-98yr had body (p=0.022), however the association was attenuated for IFG composition assessed by DXA (Lunar) as part of the Geelong (p=0.233). Mean adjusted TBS were 1.293 (95%CI 1.281- Osteoporosis Study. Body fat mass was expressed as a per- 1.304); 1.280 (1.263-1.295) and.260 (1.235-1.286) for centage of weight (%BF) and obesity defined as %BF >25% normoglycemia, IFG and diabetes, respectively. Adjustment for men and >35% for women. Low relative appendicular for all other variables did not affect these relationships be- lean mass (rALM, kg/m2) was T-score<-1. Poor muscle tween dysglycaemia and TBS. function was defined as timed up-and-go >10s for 3m Conclusions: There was no difference in TBS scores between (TUG>10). Self-reported poor health behaviours included normoglycaemic and IGF men, however, those with diabetes smoking (current), alcohol (>20g/d) and sedentary-behaviour. had lower TBS. Thus, the increased fracture risk in diabetic Associations between SO (and its components) and health men may be a result of degraded microarchitecture, indepen- behaviours were determined using logistic regression after dent of BMD. age adjustment. S314 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: 466 were obese, 219 had low-rALM, 205 had Results: By the end of the fifth year, 182 RA patients (87.5%, TUG>10s, and 69 had all three thereby meeting criteria for mean age; 58.6 years old, disease duration; 14 years) and 189 SO. Age-specific prevalence for SO was 65-74yr 6.1%, 75- controls (92.2%, mean age; 57.4) had completed observation. 84yr 13.2%, 85+ 29.7%. Each SO component had the follow- Although the incidence rate of falls significantly differed (RA; ing associations with health behaviours: 0.39, control; 0.21 person-year; py, p=0.002), there was no (a) OBESITY and smoking (OR=0.57, 95%CI 0.25-1.30), significant difference in the incidence of non-VFs between alcohol (1.13, 0.71-1.79), sedentary-behaviour (2.24, RA patients (0.042/py) and controls (0.034/py) during 5 years 1.44-3.49) (p=0.35). Cox proportional hazard regression analysis adjust- (b) LOW-rALM and smoking (1.71, 0.77-3.79), alcohol ed for confounding factors revealed that low BMD at the (1.12, 0.75-1.68), sedentary-behaviour (0.83, 0.57-1.19) thoracic vertebrae and the use of glucocorticoid (GC) at base- (c) TUG>10 and smoking (1.84, 0.81-4.18), alcohol (0.71, line were significant risk factors for non-VF (HR, 2.63; 95% 0.45-1.10), sedentary-behaviour (4.95, 3.36-7.31). CI, 1.49 to 4.66; p=0.001, 2.14; 95% CI, 1.24 to 3.68; SO was associated with sedentary-behaviour (2.45, 1.40- p=0.006, respectively). Surprisingly, RA morbidity per se 4.30), but the relationship with smoking (1.36, 0.38-4.88) was not a risk factor for non-VF (p=0.437). On the other hand, and alcohol (0.94, 0.49-1.79) were not significant. more new VFs were found in RA patients than in the controls Conclusions: SO was associated with sedentary behaviour, (14.3 vs. 7.4%; p=0.033) and they were likely to be more apparently driven by obesity and TUG>10s. Poor muscle per- severe in the patients. Logistic regression analysis selected formance rather than low muscle mass appears to be associat- previous VF (OR, 3.71; 95% CI, 2.00 to 31.0), persistent ed with poor health behaviours. We speculate that the appar- low BMD (OR, 5.11; 95% CI, 1.13 to 23.1), GC use (OR, ent, but non-significant, relationship between TUG>10s and 3.71; 95% CI, 1.14 to 12.0) as significant risk factors for new high alcohol may suggest alcohol avoidance because of phys- VFs in the patients. ical limitations. Conclusion: There was not more non-VF incidence than con- trols, but VF occurred more frequently in RA patients. P484 THE ETIOLOGY OF VERTEBRAL FRACTURE MIGHT P485 BE DIFFERENT FROM NON-VERTEBRAL ONES IN PREDICTORS AND MRI-DETECTED STRUCTURAL PATIENTS WITH RHEUMATOID ARTHRITIS: PATHOLOGY WITH TRAJECTORIES OF PAIN TOMORROW STUDY SEVERITY: A 10.7-YEAR FOLLOW-UP STUDY T. Koike1,K.Mamoto2,T.Okano2,Y.Sugioka3, M. Tada4,K. F. Pan1, J. Tian1,D.Aitken1,F.M.Cicuttini2,C.H.Ding1,G. Inui5 Jones1 1Search Institute for Bone and Arthritis (SINBAD) / 1Menzies Institute for Medical Research, University of Shirahama Foundation of Health and Welfare, Shirahama, Tasmania, Hobart, Australia, 2Department of Epidemiology Japan, 2Department of Orthopaedic Surgery / Osaka City and Preventive Medicine, School of Public Health and University Medical School, Osaka, Japan, 3Center for Senile Preventive Medicine, Monash University, Alfred Hospital, Degenerative Disorders (CSDD) / Osaka City University Melbourne, Australia Medical School, Osaka, Japan, 4Department of Orthopaedic Surgery / Osaka City General Hospital, Osaka, Japan, Objectives: To identify distinct trajectories of knee pain over 5Department of Rheumatosurgery / Osaka City University 10.7 years in an older population, to describe risk factors with Medical School, Osaka, Japan identified trajectories, and to explore MRI-detected structural pathology with the trajectories. Objective: To prospectively determine the incidence of frac- Material and Methods: 1,099 participants (mean age 63 tures and associated predictors in patients with rheumatoid years) were recruited at baseline. 875, 768 and 563 partici- arthritis (RA). pants attended years 2.6, 5.1 and 10.7 follow-up, respectively. Materials and Methods: We started a cohort study named Demographic, psychological, lifestyle and comorbidities data TOMORROW (UMIN3876) that included 208 patients with were obtained at baseline. T1-weighted or T2-weighted MRI RA and 205 age- and sex-matched healthy volunteers in 2010. of the right knee was performed to measure knee structural We had observed the incidence of clinical non-vertebral frac- pathology. Knee radiographic osteoarthritis was assessed by tures (non-VFs) and falls every year. Furthermore, VFs were X-ray. Group-based trajectory modelling was applied to iden- evaluated by thoracolumbar spine X-rays in 2011 and 2015. tify pain trajectories. Multi-nominal logistic regression was At baseline, we measured several confounders for fractures used for the analyses. such as anthropometric parameters, whole body bone mineral Results: Three distinct pain trajectories were defined. density (BMD), and medication. Participants in Group 1 (‘Mild pain’, n=568, 51.7%) had Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S315 relatively stable mild pain over time. Participants in Group was related with the BMD of L3 and L4 (r=0.073, 2(‘Moderate pain’, n=366, 33.2%) had moderate pain over P=0.044 and r=0.225, P=0.015 respectively). After adjust- time.ParticipantsinGroup3(‘Severe pain’, n=165, ed for age, sex, body mass index and smoking status, TC, 15.1%) developed or displayed fluctuated severe pain over LDL-C and HDL-C were not related with the BMD of time. Compared with the ‘Mild pain’,higherBMI,emo- lumbar spines. The level of TG was significantly negative tional problems, and musculoskeletal diseases were signif- related with BMD of L1, L2, L3 and L4 (r=-0.111, icantly associated with both ‘Moderate pain’ and ‘Severe P=0.001 and r=-0.122, P <0.001 and r=-0.124, P <0.001 pain’ trajectories. Younger age, lower education level and and r=-0.127, P <0.001 respectively). unemployment status were also associated with ‘Severe Conclusion: In the present study, we found that there was pain’ trajectory. Presence of cartilage defects and bone significant association between TG level and the BMD of marrow lesions were associated with increased risk of lumbar spines. ‘Moderate pain’ and ‘Severe pain’ trajectories before or after adjustment for confounders. Effusion-synovitis was not statistically associated with ‘Moderate pain’ (P=0.082), P487 but associated with ‘Severe pain’ trajectory. Furthermore, a COMPARISON OF TWO AUTOMATED ASSAYS OF significant dose-response relationship was observed between BTM (CTX-I AND P1NP) AND REFERENCE number of structural abnormalities, and ‘Moderate pain’ and INTERVALS IN A DANISH POPULATION ‘Severe pain’ trajectories. N. R. Jørgensen1, L. T. Møllehave2, Y. B. L. Hansen1,N. Conclusions: This first long-term study identified three dis- Quardon1, L. Lylloff3,A.Linneberg2 tinct pain trajectory groups, suggesting that homogeneous 1Dept. of Clinical Biochemistry, Rigshospitalet, Glostrup, subgroups exist and follow a specific trajectory over time Denmark, 2Research Centre for Prevention and Health, despite large individual variation of pain course. Significant Centre for Health, Capital Region of Denmark, Glostrup, associations between structural pathology and pain trajecto- Denmark, 3Dept. of Clinical Biochemistry, Copenhagen ries suggest that peripheral stimuli may play a role in the University Hospital Hvidovre, Hvidovre, Denmark development and maintenance of pain severity. Objectives: Two reference markers for bone turnover have been proposed; CTX-I bone resorption and P1NP for bone P486 formation. The purpose of the current study was to establish THE ASSOCIATION BETWEEN BONE MINERAL reference intervals for the two markers in a Danish cohort and DENSITY AND LIPID PROFILE to determine the agreement on the two platforms. E.-H. Kim1,H.-A.Seo1 Material and Methods: Fasting sera from 2308 individuals 1Departments of Internal Medicine, Daegu Fatima Hospital, (1250 males and 1058 females, age range 24-76 years) partic- Daegu, Republic of Korea ipating in the Health2006 study were analyzed for CTX-I and P1NP using the automated IDS-iSYS analyzer and the auto- Aims: Due to its prevalence worldwide, osteoporosis is con- mated Cobas e411 analyzer. sidered as a serious public health concern. In order to prevent Results: There was significant disagreement between both the osteoporosis, it is important to assess and treat the risk factors two P1NP assays with a mean difference of -2.786 μg/L (LoA associated with bone mineral density. In recent studies, blood -19.209 – 13.637) (p<0.001) and the two CTX-I assays with a lipid profiles have been suggested to be a risk factor for oste- mean difference of 0.013 μg/L (LoA -0.187 – 0.214) oporosis. So, we examined the relationships between the (p<0.001). For CTX-I there was a systematic bias: at low BMD score and lipid profiles. values Cobas measured a higher value than iSYS and at higher Method: A total of 1174 Korean, who had undergone com- concentrations iSYS measured increasingly higher values prehensive routine health examinations at the Daegu than Cobas. Based on the results, we propose three reference Fatima Hospital were included in the present study. The intervals for each sex: 20-29 years, 30-39 years and 40-80 BMDs of lumbar spines (L1 to L4) were measured by years for men, and 20-29 years, >30 years (pre-menopausal) dual-energy X-ray absorptiometry (DXA), and biochemi- and >30 years (postmenopausal) for women. cal markers including lipid profiles were measured for each Conclusions: There is significant disagreement between the patient. IDS-iSYS and Roche Cobas assays for both reference Result: The mean age of total patients was 52.77±13.29. In markers. Consequently the reference intervals for an adult, univariate analysis, the BMD of lumbar spines (L1 to L4) healthy population are different depending on the analysis was not associated with total cholesterol (TC), low density method used. Therefore, repeated measurements of patient lipoprotein cholesterol (LDL-C), and high density lipopro- samples used for monitoring of treatment should be done on tein cholesterol (HLD-C). The level of triglyceride (TG) the same assay. Moreover, assay-specific reference intervals S316 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 should be used. Harmonization of assays for BTM is highly P489 warranted. BISPHOSPHONATE DRUG HOLIDAYS IN POSTMENOPAUSAL OSTEOPOROSIS: EFFECT ON CLINICAL FRACTURE RISK P488 J. Paccou1, M.-A. Mignot1, N. Taisne1, I. Legroux-Gerot1,B. MICROSTRUCTURAL DECAY IN SPINAL CORD Cortet2 INJURY 1Université Lille Nord-de-France, Lille, France, 2Rheumatology A. Ghasem-Zadeh1,R.Zebaze1,A.Nunn2, M. Panisset3,X.- Department, Roger Salengro Hospital, Lille, France F. Wang4, M.-P. Galea5, E. Seeman6 11Department of Medicine and Endocrinology, Austin Health, Objectives: Bisphosphonates (BP) are the most widely used University of Melbourne, Melbourne, Australia, 2Vicroian treatment for postmenopausal osteoporosis. The optimal treat- Spinal Cord Service, Austin Health, University of Melbourne, ment duration, however, remains unclear. The purpose of this Melbourne, Australia, 3Vicroian Spinal Cord Service, Austin study was to evaluate the fracture risk in postmenopausal Health, University of Melbourne, Melbourne, Australia, women with osteoporosis after discontinuing BP treatment 4Department of Medicine and Endocrinology, Austin Health, (BP 'drug holiday'). University of Melbourne, Melbourne, Australia, 5Vicroian Patients and methods: A retrospective analysis was per- Spinal Cord Service, Austin Health, University of Melbourne, formed at Lille University Hospital (LUH) on postmen- Melbourne, Australia, 6Department Endocrinology and opausal women with osteoporosis who had taken a 'drug Medicine, Austin Health, University of Melbourne ;Institute holiday' or continued treatment after first-line BP thera- for Health and Aging, Australian Catholic University, py (3 to 5 years). All of the patients had been received Melbourne, Australia, Melbourne, Australia in the LUH Bone Clinic between January 1st,2008and December 31st, 2014. After careful evaluation of their Background: Spinal cord injury (SCI) causes rapid bone loss medical records, 183 of the patients were included in due to a reduction in bone formation at the basic cellular unit our study and 166 of them were followed up for 6 to (BMU) level and increased rate of bone remodelling at the 36 months. The occurrence of new clinical fractures surface level, changes that result in microstructural deteriora- during follow-up was also explored. Cox Proportional tion and increased fracture risk. There is lack of information Hazards models were used to investigate the relation- concerning the effects of paralysis on bone microstructure. We ships between BP 'drug holiday' and the occurrence of hypothesised that SCI individuals have i) a severe trabecular clinical fractures, while controlling for confounding fac- bone microstructural deterioration ii) higher cortical porosity tors. Survival without new clinical fractures was ana- in comparison to controls. lyzed using Kaplan-Meier curves and log-rank tests. Methods: We studied 31men with chronic complete SCI (age Predictors of new clinical fractures in both 'drug holi- 43.5±14.2 yrs, duration of paralysis of 1.7-22 yrs), and 90 age day' and continuous-treatment patients were also and sex-matched healthy ambulatory controls, recruited at evaluated. Austin Health, University of Melbourne. Images of the non- Results: The patient charts of 1,894 patients were retrieved dominant distal tibia were obtained using high-resolution from the LUH Health Informatics department. Among quantitative computed tomography (HR-pQCT, Scanco, 82 these, 898 patients with postmenopausal osteoporosis were micron isotropic voxel size). Manufacturer’s and StrAx1.0 identified. Considering our inclusion and exclusion (StraxCorp, Melbourne, Australia) software were used to criteria, 183 women (mean age: 61.8 years; SD: 8.7) who quantify trabecular and cortical compartments indices. had previously undergone BP treatment for 3 to 5 years Results: Compared with controls, SCI cases had 2.3, 1.8, 1.7 were enrolled in our study. The patients had received and 2.5 SD higher porosity in the total cortex, compact cortex, alendronate (n=81), risedronate (n=73), zoledronic acid inner and outer transitional zones and 1.7SD lower matrix (n=20) and ibandronate (n=9). In 166 patients ('drug holi- mineralisation density. Total and cortical vBMD were reduced day' group: n=31; continuous-treatment group: n=135), by 2.4 and 1.7 SD, respectively (all p<0.01). Trabecular bone follow-up ranged from 6 to 36 months (mean duration: volume fraction was 2.4SD lower in cases due to1.4 SD lower 31.8 months; SD: 8.2). The incidence of new clinical frac- number of trabeculae and 6 SD higher separation. Trabecular tures during follow-up was respectively 16.1% (5/31) and bone surface and connectivity density were decreased by 0.9 11.9% (16/135). After full adjustment, the hazard ratio of and 1.4 SD, respectively (all p<0.01). new clinical fractures among 'drug holiday' patients was Conclusion: We infer that spinal paralysis produces profound 1.40 [95% CI: 1.12-1.60; p=0.0095]. For the whole cohort, and rapid loss of cortical and trabecular bone suggesting the only risk factor of new clinical fractures after first-line antiresorptive therapy should be commenced at the time of BP therapy was older age (71.2 (±7.1) years vs. 65.7 (±8.4) presentation. years; p=0.002). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S317 Conclusion: After first-line BP therapy in postmenopausal with muscle strength and gait speed might be consider- women with osteoporosis, the risk of new clinical fractures able. Further studies in older adults (>66 years) will be was 40% higher in subjects who took a bisphosphonate drug recommended. holiday. P491 P490 ALENDRONATE SODIUM IN OSTEOARTHRITIS: PERSIAN VERSION OF THE SARC-F: VALIDATION EFFECTS ON ANABOLIC, CARTILAGE DEGREDATIVE AND CULTURAL ADAPTATION TO EVALUATE MARKERS, CIRCULATING LEPTIN AND THE CLINICAL SARCOPENIA IN IRAN ACTIVITY Z. Maghbooli1,A.Hossein-Nezhad1, B. Larijani2 S. Salman1,S.A.Kadhum2,H.M.Jawad2 1Osteoporosis Research Center, Endocrinology and 1College of Medicine University of Baghdad-Iraq, Baghdad, Metabolism Clinical Sciences Institute, Tehran University of Iraq, 2College of Medicine, University of Baghdad, Baghdad, Medical Sciences, Tehran, Islamic Republic of Iran, Iraq 2Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Med, Tehran, Islamic Objective: Osteoarthritis(OA) is a common arthritic dis- Republic of Iran order and responsible for 2% of disability of people in all world. OA is affects all joint structure including Objectives: To validate the Persian version of the SARC-F cartilage, bone and synovium which characterized by questionnaire and to test its sarcopenia screening efficacy in degradation of cartilage, subchondral bone turn over postmenopausal women. and osteophytes formation. Material and methods: In a cross-sectional study, the Aim: To evaluate the effect of alendronate sodium SARC-F scale was translated to Persian and applied (ALN) on disease activity and physical function, evalu- to evaluate sarcopenia. Muscle mass was estimated by ate the biochemical parameters that are related to OA, bioelectrical impedance analysis (BIA). Appendicular as well as study the impact of ALN on bone anabolic muscle mass was used to calculate skeletal muscle in- markers, degradative markers, MPO and leptin, and to dex (SMI). Grip strength measured by using a dyna- determine its effectiveness in slowing progression of mometer and also the gait speed was assessed at six- disease. meter. Patients and methods: 116 OA patients over 45 years old Results: Totally, 409 postmenopausal Iranian women with Kellgren and Lawrence X-ray grade II and more with mean age 56.47±5.17 (SD) years old (44-66 were enrolled. Baseline assessment was done, WOMAC years) were assessed by the SARC-F scale. The scoring, body mass index and the biochemical parame- Persian language version of the SARC-F scale showed ters with enzyme-linked immunosorbent assay (ELISA) reliability (Cronbach, s Alpha=0.70). Women were analysis of serum TGF (transforming growth factor) beta classified as sarcopenic if they had SMI values below 1, C-terminal cross linked -telopeptide of type II colla- the 25th percentile of the sample studied (<6.64 kg / gen (CTXII), Myloperoxidase (MPO) and Leptin). They m2). Sarcopenia was identified in 25.2% of study were instructed to take alendronate sodium (ALN) population. 10 mg daily for 3 months. Reassessment was done after There were significant correlations between SARC-F 3 months. scale with time of 6-meter gait (r=0.41, p=0.0001), Results: A significant symptomatic improvement in and average two hands muscle strength (r=-0.135, WOMAC scoring regarding pain, stiffness and function p=0.04), but not with SMI (p=0.1). Women with were observed, with significant reduction in serum SARC.F scale ≥4 had week muscle strength and low CTXII, Leptin and TGF beta 1. A nonsignificant reduction average of walking speed (m/s). The sensitivity and in serum calcium, associated with no significant changes in specificity of SARC-F scale for grip strength (<20kg) serum Alkaline phosphatase, MPO joint space width were were 47.22%, and 68.42%; respectively, and for gait also reported. speed (≤ 0.8 m/s) were 53.06% and 60.93%; Conclusion: Alendronate in patients with osteoarthritis respectively. has clinical efficacy in reducing symptoms especially Conclusion: Our study shows the SARC-F questionnaire pain probably through inhibition of leptin and TGF beta successfully adopted in Persian with suitable reliability. 1 with no significant structural improvement, despite Although sensitivity and specificity of SARC-F scale in reduction of CTXii. ALN was safe in old patients with the postmenopausal women aged ≤ 66 years were ques- dyslipidemia since there is no associated lipid distur- tionable for screening of sarcopenia, its correlations bances with its use. S318 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P492 P493 SELECTIVE INHIBITION OF SRC FAMILY KINASES IMPACT OF ANXIETY AND/OR DEPRESSION ON PAIN, UNCOUPLES BONE FORMATION FROM RESORPTION STIFFNESS, AND PHYSICAL FUNCTION IN A SAMPLE THROUGH DIRECT EFFECTS ON OSTEOCLASTS AND OF PATIENTS WITH PRIMARY OSTEOARTHRITIS OF OSTEOBLASTS THE KNEE: A CROSS SECTIONAL STUDY C. Thouverey1,S.Ferrari1,J.Caverzasio1 S. Salman1,A.AlJanabi1 1Service of Bone diseases, Geneva University Hospital and 1Rheumatology Unit, College of Medicine, University of Faculty of Medicine, Geneva, Switzerland Baghdad, Baghdad, Iraq Objectives: Mice deficient in the non-receptor tyrosine Introduction: Osteoarthritis (OA) is the most common kinase Src exhibit high bone mass due to impaired articular disease of the developed countries and a cause bone resorption and increased bone formation. of varying degree of unrelenting pain and of chronic Although several Src family kinase inhibitors inhibit disability. It is not clear in many cases, why many bone resorption in vivo, they display variable effects people with osteoarthritis experience more pain than on bone formation. SU6656 is a selective Src family one would expect based on the extent of their bony kinase inhibitor with weaker activity towards the non- pathology or their radiographs. receptor tyrosine kinase Abl and receptor tyrosine ki- Aim: To examine the effect of anxiety and/or depression on nases which are required for appropriate osteoblast pro- pain, stiffness, and physical function in patients with knee liferation, differentiation and function. Therefore, we osteoarthritis. sought to determine whether SU6656 could increase Patients and Method: A cross-sectional study on a total bone mass by inhibiting bone resorption and by strong- of 101 patients with diagnosis of primary knee oste- ly stimulating bone formation, and to explore its mech- oarthritis (KOA), according to the American College anisms of action. of Rheumatology criteria. Each patient completed Methods: Four-month-old female C57Bl/6J mice re- questionnaires including the Western Ontario and ceived intraperitoneal injections of either 25 mg/kg McMaster Universities Osteoarthritis (WOMAC) SU6656 or its vehicle every other day for 12 weeks. Index and the Hopkins Symptoms Checklist-25 for Bone phenotypes were assessed by DXA, microCT, anxiety and depression (HSCL-25). The presence of histomorphometry and gene expression analyses. anxiety and/or depression symptoms was determined, Effects of SU6656 were also tested in primary osteo- and their effects on the WOMAC scores were clast and osteoblast cultures. assessed. Results: In comparison to vehicle-treated mice, SU6656- Results: In KOA patients 83.2% of were found to have treated mice exhibited higher bone mineral density anxiety and/or depression. Patients with anxiety only or (+4.6%, p<0.02), tibial cortical thickness (+9.7%, depression only had higher pain scores (11.5, 11) re- p<0.05), tibial cancellous bone volume (+40.9%, spectively than those free of these two disorders (8) p<0.01) and trabecular thickness (+17.6%, p<0.01). (P<0.05). The mean pain score of patients who had SU6656 inhibited bone resorption in mice as shown both anxiety and depression (13.4) and that of the total by reduced osteoclast number, and diminished expres- number of patients who have anxiety and/or depression sions of Oscar, Trap5b and CtsK. SU6656 did not af- (13) was significantly higher than that of patients with fect Rankl or Opg expressions in vivo or in osteoblast none (P<0.001). The mean Physical function score of cultures. However, it blocked RANKL-induced osteo- patients with depression (40.8) and those with both clastogenesis, Nfatc1 expression and matrix resorption anxiety and depression (41.3) was significantly higher in vitro. In addition, SU6656 stimulated bone formation than that of the patients with none (28.8), (P=0.021). rates at trabecular, endosteal and periosteal bone enve- The mean physical function score of patients with anx- lopes, and increased osteoblast number in trabecular iety only (36.8) was not significantly higher than that bone. SU6656 did not affect expressions of clastokines of patients with none (28.8), (p=0.18). The Stiffness favoring bone formation in mice. However, it stimulated score in patients with both anxiety and depression osteoblast differentiation and matrix mineralization by (3.5), patients with anxiety only (3.8) or depression specifically facilitating BMP-SMAD signaling pathway only (3.6) were insignificantly higher than the score in vitro. of those who had no anxiety or depression (2), (P> Conclusion: SU6656 uncouples bone formation from resorp- 0.05). The mean total WOMAC score was significantly tion by inhibiting RANKL-induced osteoclast development higher in patients with depression (55.3), both anxiety and function, and by enhancing BMP-mediated osteoblast and depression (58.2), and those with anxiety and/or differentiation. depression (57.5) were more significantly higher than Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S319 that of patients with none (38.8), (P=0.001, P<0.001) were documented. The biochemical analysis per- respectively. formed after 3 and 12 months from treatment’s initi- Conclusions: The presence of anxiety and/or depression ation showed a persistent reduction of PLP within in patients with osteoarthritis of the knee directly and normal values. Bone and muscle pain decreased, im- negatively affect pain, stiffness, and total WOMAC provement of gait and 6MWT were documented. scores. While their negative effect on the physical func- Radiological images after 12 months of treatment tion is indirect. It may be important to screen for the showed the complete healing of the femoral neck presence of these in order to arrange for proper cortical fracture. management. Conclusions: This case report highlights the benefits of asfotase alfa treatment in adult form of HPP. The enzyme replacement therapy should be a worth possibility to be con- P494 sidered for adults affected by severe forms of HPP with mul- ENZYME REPLACEMENT THERAPY IN A PATIENT tiple and recurrent fractures. AFFECTED BY ADULT FORM OF HYPOPHOSPHATASIA Disclosures: FG Conti received consulting fees from Alexion (HPP) Pharma. L. Ciullini1, G. Pugliese1,G.Argento2,F.G.Conti1 1Department of Clinical and Molecular Medicine, Sapienza University of Rome, S. Andrea Hospital, Metabolic Bone P495 Diseases and Diabetes Unit, Rome, Italy, 2Department of PREVALENCE OF SARCOPENIA ACCORDING TO Radiology, Sapienza University of Rome, S. Andrea 10 DIFFERENT OPERATIONAL DEFINITIONS OF Hospital, Rome, Italy FRAILTY F. Buckinx1,J.-Y.Reginster1, C. Beaudart1,T.Brunois1,C. Objective: The aim of this report is to describe the use and Lenaerts1,J.-L.Croisier2, J. Petermans3, O. Bruyère1 benefits of enzyme replacement therapy in an adult HPP 1Department of Public Health, University of Liège, Liège, patient. Belgium, 2Department of Motricity Sciences, University of Methods: Here we describe the case of an adult patient Liège, Liège, Belgium, 3Geriatric Department, CHU of with a delayed diagnosis of HPP, treated with asfotase Liège, Liège, Belgium alfa for 12 months. Biochemicals, radiological and clin- ical parameters were tested before and after treatment Objective: The aim of this study was to compare the initiation. prevalence of sarcopenia among frail nursing home res- Results: A 48-years-old Caucasian woman referred to idents, diagnosed according to 10 different operational our clinic for delayed healing of bilateral proximal definitions. femoral pseudofractures, pelvic and ankle pain resis- Methods: This is an analysis of data collected at baseline in tant to analgesic/anti-inflammatory drugs. In clinical the SENIOR (Sample of Elderly Nursing home interview the patient reported a previous treatment Individuals: an Observational Research) cohort. All sub- with clodronate for her first femoral fracture and since jects received a diagnosis of sarcopenia, based on the def- childhood premature teeth loss/abnormalities, muscle inition proposed by the European Working Group on pain with reduced strength, recurrent metatarsal stress Sarcopenia in Older People (EWGSOP). The frailty evalu- fractures, recurrent enthesopathy. The patient presented ation was based on 10 different operational definitions and with an abnormal device-assisted gait, with a poor the prevalence of sarcopenia was assessed for each of performance at 6MWT. Blood analysis showed very them. low levels of plasmatic and bone alkaline phosphatase Results: A total of 662 subjects from 28 nursing homes (ALP). The levels of pyridoxal phosphate (PLP) were aged 83.2±8.99 years (73.1% of women) were included very high and phosphate levels were slightly high. in this study. In this population, prevalence of Clinical diagnosis of HPP was done, later confirmed sarcopenia was 38.1% and prevalence of frailty varied by genetic analysis of the TNSALP gene. from 1.70% (Frailty Index) to 76.3% (Groningen Frailty During follow-up, she presented a new cortical frac- Indicator and Sega Grid), depending on the definition ture of the right femoral neck and for this reason the used. When regarding the prevalence of sarcopenia option of enzyme replacement therapy was consid- among frail subjects, it was ranged between 32.8% ered. Asfotase alfa was initiated with a dose of 1 (i.e. Frail scale Status and Frailty Index) and 47% (i.e. mg/kg/day s.c. for 6 days/week. Beside a mild local Fried definition). reaction at the injection site, that lasted the first Figure 1. prevalence of sarcopenia according to 10 different month only, no other minor or major adverse events operational definitions of frailty S320 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P497 EFFECTS OF A GIANT EXERCISING BOARD GAME INTERVENTION ON AMBULATORY PHYSICAL ACTIVITY AMONG NURSING HOME RESIDENTS: A PRELIMINARY STUDY A. Mouton1,N.Gillet1,F.Mouton1,O.Bruyère2, M. Cloes1, F. Buckinx2 1Department of Sports Sciences, University of Liège, Liège, Belgium, 2Department of Public Health, University of Liège, Liège, Belgium Objective: The aim of this study was to assess the effects of a giant exercising board game intervention on ambulatory phys- ical activity among nursing home residents. Conclusion: This study highlighted that, among frail nursing Methods: This is a 3-month longitudinal study (one month of home residents, prevalence of sarcopenia varied from 32.8% intervention and 2 months post-intervention follow-up), per- to 47%, according to the operational definition of frailty used. formed in 2 similar nursing homes. The first nursing home has been designated as the intervention group while the second one was the control group. Voluntary, mobile, and oriented P496 subjects (MMSE > 18 points), living in the nursing homes RELATIONSHIP BETWEEN OXIDATIVE STRESS enrolled in this study were included. The intervention was AND TRABECULAR BONE MICROSTRUCTURE IN carried out using a giant game board measuring 4 meters long OSTEOPOROTIC PATIENTS by 3 meters wide, composed of 24 cells, divided into 4 com- M. Giner1 ponents (strength, balance, flexibility, endurance). It was su- 1HUV Macarena, Seville, Spain pervised by a specialist in physical activity during one month. Daily ambulatory physical activity (i.e. the number of steps Experimental studies have suggested that oxidative stress is an per day) were measured using Actigraph GT3X + for a period important factor in the regulation of bone remodeling. Thus, low of 3 consecutive days at the beginning of the study, after the antioxidant levels are associated with a reduced bone mineral intervention (1 month) and at the end of the post-intervention density and increased risk of osteoporotic fracture. Whether ox- follow-up (3 months). idative stress is related to fracture risk is poorly understood. Results: The intervention and control groups consisted of 10 Material and Methods: Cross-sectional study in 21 subjects and 11 subjects, respectively. The mean age was 82.5 (79-89) divided into 3 groups: 7 osteoporotic hip fracture (age: 75±5) years in the first group and 89.9 (87-91) years in the second (OP); 8 osteoarthritis, undergoing hip replacement,(71±4) group (p=0.08). The percentage of women in these groups (OA) and 6 OA ≤ 55 years old. We carried out total hip and was 60% and 72.7% (p=0.54). At baseline, the number of femoral neck BMD (DXA-Hologic Discovery), microstruc- steps per day was comparable in the two groups (2920.9 tural and biomechanical characteristics of trabecular bone ±1351.5 vs. 3386.8±730.7, p=0.19). At the end of the inter- from femoral head(Micro-CT-Scan Sky 1172). In macerated vention, the number of steps was increased on average by trabecular bone, we quantified gene expression of catalase, 79.59±1311.63 in the intervention group whereas it was de- GADD45 (oxidative stress genes), Runx2 and osteoprotegerin creased by -855.48±994.13 in the control group. The differ- (OPG) by qPCR. The results are statistically analyzed with the ence between the 2 groups was not significant (p=0.24). The Kruskal-Wallis and Dunn's post-hoc and correlations by same observation was made at the end of the 3-month follow- Pearson coefficient (SPSS 22.0), p≤ 0.05. up period as we observed an average increase of +754.33 Results: Osteoporotic subjects have an increased expression ±1706.83 steps in the intervention group and an average de- of catalase and GADD45, suggesting increased oxidative crease of -38.72±1004.94 in the control group (p=0.21), com- stress in osteoporotic trabecular bone regardless of age and pared to the results obtained at the end of the intervention. The sex. We also observed a significant increase in the expression increase observed in the intervention group was not significant of Runx2 and OPG in OP group. As expected, BMD values (p=0.10). On the other hand, the evolution observed in the are statistically lower in the OP subjects and they have a worse control group was significant (p=0.02). biomechanic and microstructure bone. Conclusions: The implementation of a physical activity board Conclusion: These results suggest that osteoporotic patients game in nursing homes does not seem to increase the number have an increase of the oxidative stress and bone activity with of steps per day taken by the residents. However, the subjects alterations in the osteogenic genes. benefiting from this intervention seemed to maintain their Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S321 level of ambulatory physical activity during the period studied P499 whereas the subjects not benefiting from the intervention have ATYPICAL FRACTURES OF THE FEMUR AND decreased their ambulatory physical activity. BISPHOSPHONATE THERAPY IN PATIENTS WITH BETA-THALASSEMIA-ASSOCIATED OSTEOPOROSIS: REPORT OF THREE CASES P498 A. Giusti1,V.M.Pinto2,L.Bacigalupo3, A. Barone4,G. PREDICTING THE INTERVENTION THRESHOLD FOR Girasole1,G.L.Forni2, G. Bianchi1 TREATING OSTEOPOROSIS AMONG POSTMENOPAUSAL 1Department of Locomotor System, Division of Rheumatology, WOMEN IN CHINA: A COST-EFFECTIVENESS ANALYSIS ASL3 Genovese, Arenzano, Italy, 2Center of Microcitemia and BASED ON FRAX Congenital Anemias, Galliera Hospital, Genova, Italy, L. Cui1,T.He1,Y.Jiang1,M.Li1, O. Wang1,X.Xing1,W. 3Radiology Unit, Department of Diagnostic Imaging, Galliera Xia1 Hospital, Genova, Italy, 4Orthogeriatric Unit, Galliera Hospital, 1Peking Union Medical College Hospital, Beijing, China Genova, Italy Objectives: Fracture risk assessment tool (FRAX) is popular Objectives: To describe the clinical presentation and course of worldwide to determine the 10-year probability of major os- atypical subtrochanteric/femoral shaft (ST/FS) fractures in pa- teoporotic fracture or hip fracture [1]. We predicted the disease tients with beta-thalassemia-associated osteoporosis. burden of osteoporotic fractures in Chinese postmenopausal Patients and Methods: Patients referred and followed by the women and evaluate the cost-effectiveness of treatment with 3 Center of Microcitemia and Congenital Anemias of the Galliera anti-osteoporosis drugs. We also estimated the intervention Hospital (Genova, Italy) were assessed and evaluated. All sub- threshold of FRAX in Mainland China, at which treatment jects underwent a bilateral x-ray of the femoral diaphysis in- with alendronate or zoledronate could be cost-effective. cluding the area comprised from just distal to the lesser trochan- Methods: We developed a micro-simulation Markov model ter to just proximal to the supracondylar flare. Clinical and in NetLogo 5.3.1 (Evanston, IL) to capture osteoporosis states pharmacological characteristics of the patients, as well as labo- and relevant morbidities including hip fracture, vertebral frac- ratory tests results (including serum calcium, PTH, 25- ture, and wrist fracture, and death. Baseline characteristics hydroxy-vitamin D, creatinine, CTX and bALP) and bone min- including age-specific prevalences, incidences of osteoporosis eral density (BMD) measurements were retrieved from the hos- and osteoporotic fractures and the distribution of risk factors pital database. All patients underwent a comprehensive clinical were derived from the Peking Vertebral Fracture (PK-VF) evaluation, and weight and height were measured. An atypical study, the largest prospective cohort study of postmenopausal ST/FS fracture was defined if two independent reviewers women in Mainland China. We projected incidences of hip agreed on at least four of five major features defined by the fracture, vertebra fracture, wrist fracture and deaths by age 2013 American Society for Bone and Mineral Research criteria. groups under four treatment scenarios: 1) no treatment, 2) Results: We identified three women (age range 36-37 years standard calcium plus vitamin D, 3) treatment with old), out of 36 patients evaluated, who sustained bilateral spon- alendronate, or 4) zoledronate. We also projected total taneous atypical ST/FS incomplete fractures. All three subjects quality-adjusted life-years (QALY) and total costs including have been treated with bisphosphonates (BPs) (alendronate both fracture management and osteoporosis drugs for cost- or pamidronate), with two of them having discontinued the effectiveness analysis. The model was validated by the cumu- treatment one and four years before the occurrence of pain of lative incidences of fractures and the distribution of fractures the thighs (probably indicating the development of the atypical by age groups. fracture). One patient presented also with an insufficiency Results: Treatment with calcium plus vitamin D or with metatarsal fracture. The clinical and radiological presentation, alendronate were dominated by zoledronate, which results and the course of fracture healing (delayed) of these atypical in an incremental cost-effectiveness ratio equals to $16,680 fractures were similar to that described in the literature. A num- per QALY gained in comparison to no treatment. ber of features distinguished these fractures from those de- Treatment with zoledronate could reduce 9.8% of the over- scribed in postmenopausal women receiving BPs: the duration all fracture. Treatment with zoledronate for patients with of BPs therapy in two women was relatively shorter (4-6 years) FRAX score > 0.07 is cost-effective in comparison with no compared to what reported in observational studies; in two treatment. cases the fractures became clinically symptomatic or developed Conclusions: Our study indicates widespread use of after the discontinuation of the BP; the BMD T-scores were zoledronate is of both clinical and economic benefit among below the diagnostic threshold for osteoporosis (-2,5) defined Chinese postmenopausal women with their FRAX score over by the WHO, indicating the presence of osteoporosis; the 0.07. markers of bone turnover at the time of fracture were within Reference: 1. Kanis JA et al. Arch Osteoporos. 2016;11:25. the reference range, indicating no suppression of bone turnover. S322 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Conclusions: This is the third and greatest report of atypical P501 ST/FS fractures in patients receiving BPs for beta- HALF HIP FRACTURE PATIENTS ARE REPORTEDLY thalassemia-associated osteoporosis. Our observations em- ‘WORSE’ THAN DEAD AS BASED ON HEALTH- phasize the need for a better definition of the optimal treatment RELATED QUALITY OF LIFE AT THE TIME OF duration of BP therapy in patients with beta-thalassemia- ADMISSION, WITH PARTIAL RECOVERY AT 1 AND associated osteoporosis. 4-MONTHS FOLLOW-UP: THE SPARE-HIP PROSPECTIVE COHORT D. Prieto-Alhambra1, E. Vaquero-Cervino2, O. Torregrosa P500 Suau3, C. Tejedor Carreño4, J. Teixidor Serra5,J.Sirera- DOWN AT HEEL: THE UTILITY OF QUANTITATIVE Vercher6, I. Sierra Setién7,M.SalomóDoménech8, P. Sáez ULTRASOUND IN DIAGNOSING OSTEOPOROSIS López9, L. Rodríguez Mañas10, I. Pérez-Coto11, I. Peregrín J. Mahon1,D.Moloney1,A.Farrelly1,D.Smith1,L.Mulkerrins1, Nevado12,M.OscaGuadalajara13, S. Mills Gañan14,C. O. Hannigan1, M. Rafferty1,C.McManus1, N. Fallon1,G.Steen1, Martín Hernández15,A.I.GutierrezGanzarain16,L. N. Maher1,R.Lannon1,M.C.Casey1,J.B.Walsh1 Ezquerra Herrando17, L. Evangelista Cabrera18,I. 1Osteoporosis and Bone Health Unit, St James's Hospital, Etxebarria-Foronda19,A.DíezRodríguez20,P.Carpintero21, Dublin, Ireland J. R. Caeiro Rey22,M.BarrésCarsi23,J.D.Avilés Hernández24,I.Andrés-Cano25, I. Aguado Maestro26,G. Objectives: Quantitative heel ultrasound (QUS) is an alterna- Adrados Bueno27,A.Herrera28,A.Diez-Perez29 tive to DXA in osteoporosis (OP) screening. However, its 1Musculoskeletal Epidemiology, Botnar Research Centre, correlation with DXA is ill-defined. We examined relation- Nuffield Department of Orthopaedics, Rheumatology and ships of QUS with DXA, biochemical bone markers and frac- Musculoskeletal Sciences, University of Oxford, Oxford, ture history in patients attending our OP clinic. United Kingdom, 2Complejo Hospitalario Universitario de Materials and Method: We identified patients with contem- Pontevedra, Pontevedra, Spain, 3Metabolic Bone Unit, poraneous QUS and DXA. We compared QUS T-scores, Department of Internal Medicine, Hospital General Broadband Ultrasonic Attenuation (BUA) and Speed of Universitario, Elche, Spain, 4Orthopaedic Surgery and Sound (SOS) with DXA results, fracture history and biochem- Traumatology Unit. Hospital San Pedro, Logroño, Spain, ical bone turnover markers. 5Hospital Vall d Hebron Barcelona, Universitat Autónoma Results: 2294 patients; 83% female; mean age 67.1 yrs (SD de Barcelona, Barcelona, Spain, 6Hospital Lluís Alcanyís, 13.9). Mean BMD total hip 0.767g/cm2 (SD 0.152); mean Xàtiva, Xàtiva, Spain, 7Department of Internal Medicine, BMD spine 0.898g/cm2 (SD 0.194). Both SOS and BUA Hospital Universitario M. Valdecilla-IDIVAL, Universidad significantly correlated positively with BMD hip and spine de Cantabria, Santander, Spain, 8Department of Orthopaedic in linear regression analysis; strongest association was at the Surgery and Traumatology, Hospital Universitario Parc Tauli, hip, where BUA accounted for 35.71% BMD variation (R- Savadell, Spain, 9Geriatric Medicine Department, Hospital square adjusted, p<0.0001). For those with QUS T-score ≤-2.5 Nuestra Señora de Sonsoles, Ávila, Spain, 10Hospital (osteoporotic), odds ratio (adj. for age, sex, BMI) for hip frac- Universitario de Getafe, Getafe, Spain, 11Hospital San ture was 2.17 (95% CI 1.66-2.88, p<0.0001); odds ratio for Agustín, Avilés, Spain, 12Hospital Clínico de Valencia, vertebral fracture 1.83 (95% CI 1.44-2.30, p<0.001). QUS Valencia, Spain, 13Hospital Obispo Polanco Teruel, Teruel, sensitivity and specificity for diagnosing OP by T-score varied Spain, 14Department of Orthopaedic Surgery, Hospital by site. When compared with DXA, a QUS heel T-score of ≤- Universitario La Paz, Madrid, Spain, 15Orthopaedic Surgery 2.5 had 71.21% sensitivity and 69.78% specificity for diagno- and Traumatology Unit. Hospital Universitario Miguel Servet, sis of hip OP; for spine OP, QUS sensitivity was 58.9%; spec- Zaragoza, Spain, 16Servicio de Medicina Interna, Hospital ificity was 73.04%. However, we found that a QUS T-score >- Son Llatzer, Palma de Mallorca, Spain, 17Orthopaedic 1.1 had 90% sensitivity for OP at any site; a QUS T-score ≤- Surgery and Traumatology Unit. Hospital Clínico 3.0 had 89% specificity for OP. No significant correlation of Universitario de Zaragoza, Zaragoza, Spain, 18Geriatric SOS and BUA to bone turnover markers. Medicine Department, Hospital Universitario San Carlos, Conclusions: QUS heel is strongly predictive of BMD at hip Madrid, Spain, 19Department of Orthopaedic Surgery. Alto and also hip fracture and has high sensitivity for diagnosis of Deba Hospital, Mondragón, Spain, 20Orthopaedic Surgery OP of hip. But for the spine it is less predictive of OP, BMD and Traumatology Unit. Hospital Virgen del Puerto, and fractures; nor did it predict increased markers of bone Plasencia, Spain, 21University Hospital Reina Sofía, turnover. We found that the same T-score cuts-off points as Cordoba, Spain, 22Department of Orthopaedic Surgery. used to diagnose OP by DXA, are not equally applicable to Complejo Hospitalario Universitario de Santiago de QUS, and propose that new T-score cut-off points for QUS Compostela, Santiago de Compostela, Spain, 23Trauma Unit. should be considered. Unit of Orthopaedic Surgery and Traumatology. Hospital Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S323 Universitario y Politécnico La Fe de Valencia, Valencia, P502 Spain, 24Orthogeriatrics Unit, Hospital Virgen de la GAP IN SECONDARY FRACTURE PREVENTION Arrixaca, Murcia, Spain, 25Department of Orthopaedic (BUT NOT IN PRIMARY PREVENTION OF Surgery, Traumatology and Rheumatology. Hospital INFECTION AND THROMBOSIS) FOLLOWING A Universitario Puerta del Mar, Cádiz, Spain, 26Department of HIP FRACTURE: THE SPARE-HIP PROSPECTIVE Orthopaedic Surgery, Hospital Universitario del Río Hortega, COHORT Valladolid, Spain, 27Servicio de Medicina Interna del Hospital D. Prieto-Alhambra1, E. Vaquero-Cervino2, O. Torregrosa Universitario Infanta Cristina, Badajoz, Spain, 28Department Suau3, J. Teixidor Serra4, J. J. Sierra Serrano5, M. D. Sanz- of Surgery, Medicine School, University of Zaragoza, Amaro6, M. Sanz Sainz7, M. Salomó Doménech8, P. Sáez Zaragoza, Spain, 29Department of Internal Medicine, López9, D. Rodríguez Martínez10, L. Rodríguez Mañas11,J. Hospital del Mar-IMIM and Autonomous University of M. Olmos12,J.MoraFernández13, S. Mills Gañan14,M. Barcelona, Barcelona, Spain Martínez Ros15, A. I. Gutierrez Ganzarain16, P. Gonzalez García17, J. Fernandez-Lombardia18,L.Ezquerra Objective: To estimate the impact of hip fracture on health- Herrando19, I. Etxebarria-Foronda20,A.DíezRodríguez21,J. related quality of life (HRQoL) up to 4 months post-fracture. C. Díaz Miñarro22, J. R. Caeiro Rey23,A.BañuelosDiaz24,A. Material and Methods: The SPARE-HIP (Spanish Registry Balfagon Ferrer25,I.Andrés-Cano26, G. Adrados Bueno27,A. of Hip and Proximal Femur Fractures) cohort includes a con- Herrera28, A. Diez-Perez29 secutive sample of hip/proximal femur fracture patients re- 1Musculoskeletal Epidemiology, Botnar Research Centre, cruited from a representative 45 Spanish hospitals. Patients Nuffield Department of Orthopaedics, Rheumatology and were consented and recruited at the time of admission for a Musculoskeletal Sciences, University of Oxford, Oxford, hip fracture, and followed at 1 and 4 months. Euro-QoL 5 United Kingdom, 2Complejo Hospitalario Universitario de Dimensions (EQ5D) was used to measure baseline and over- Pontevedra, Pontevedra, Spain, 3Metabolic Bone Unit, time HRQoL. National preferences (Spain) were used to cal- Department of Internal Medicine, Hospital General culate EQ5D utility indices, which range from 0 (worst) to 1 Universitario, Elche, Spain, 4Hospital Vall d Hebron (best), with negative values allowed and equivalent to “worse Barcelona, Universitat Autónoma de Barcelona, Barcelona, than dead”. Global health visual analogic scales (VAS) were Spain, 5Orthopaedic Surgery and Traumatology Unit, also measured. HRQoL over time is reported as median (inter- Hospital San Pedro, Logroño, Spain, 6Hospital Lluís quartile range) and plotted using Kernel Density plots. Alcanyís, Xàtiva, Xàtiva, Spain, 7Orthopaedic Surgery and Results: A total of 696/852 participants with EQ5D data (594 Traumatology Unit. Hospital Universitario Miguel Servet, (85.3%) and 513 (73.7%) with 1 and 4-month follow-up re- Zaragoza, Spain, 8Department of Orthopaedic Surgery and spectively) were included. Baseline (pre-fracture) median Traumatology, Hospital Universitario Parc Tauli, Savadell, EQ5D was 0.72 (0.40 to 0.91), dropping to -0.01 (-0.31 to Spain, 9Geriatric Medicine Department, Hospital Nuestra 0.51) at the time of fracture. Partial recovery was seen at Señora de Sonsoles, Ávila, Spain, 10Hospital Clínico de months 1 and 4, with median EQ5D 0.34 (-0.08 to 0.67) and Valencia, Valencia, Spain, 11Hospital Universitario de 0.58 (0.08 to 0.77) respectively. Similar results were seen in Getafe, Getafe, Spain, 12Department of Internal Medicine, global health VAS, with median 69/100 (50 to 80), 40 (30 to Hospital Universitario Marqués de Valdecilla-IDIVAL, 56), 54 (40 to 66), and 60 (50 to 75, respectively at each time Universidad de Cantabria, Santander, Spain, 13Geriatric point. Medicine Department, Hospital Universitario San Carlos, Conclusions: Hip fracture has a deep impact on patients’ Madrid, Spain, 14Department of Orthopaedic Surgery, quality of life, taking their HRQoL from a median of72% Hospital Universitario La Paz, Madrid, Spain, “best possible quality” to 0% at the time of admission, with 15Orthogeriatrics Unit, Hospital Virgen de la Arrixaca, half of them reportedly “worse than dead” at that time. Partial Murcia, Spain, 16Servicio de Medicina Interna, Hospital Son recovery is seen during follow-up to 4 months. More research Llatzer, Palma de Mallorca, Spain, 17Department of is needed on patient-centered outcomes following a hip Geriatrics, Orthogeriatric Unit, Hospital Obispo Polanco, fracture. Teruel, Spain, 18Department of Orthopaedic Surgery, Disclosures: The SPARE-HIP study has been funded by a Hospital Universitario San Agustin, Avilés, Spain, non-restricted research grant from Amgen. DPA’sdepartment 19Orthopaedic Surgery and Traumatology Unit. Hospital has received unrestricted research grants, and speaker and Clínico Universitario de Zaragoza, Zaragoza, Spain, advisory board fees from AMGEN. PC has been speaker in 20Department of Orthopaedic Surgery. Alto Deba Hospital, Lilly and Amgen, and advisor in Lilly. IAM has received Mondragón, Spain, 21Orthopaedic Surgery and Grant/Research support from AMGEN. EVC has received Traumatology Unit. Hospital Virgen del Puerto, Plasencia, gant/research support from AMGEN, and other support from Spain, 22Hospital Universitario Reina Sofía, Córdoba, Spain, Faes-Farma, MSD. 23Department of Orthopaedic Surgery. Complejo Hospitalario S324 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Universitario de Santiago de Compostela, Santiago de P503 Compostela, Spain, 24Hospital Universitario Rio Hortega, DEFERASIROX INHIBIT DIFFERENTIATION OF Valladolid, Spain, 25Trauma Unit. Unit of Orthopaedic MOUSE RAW264.7 MONOCYTES INTO OSTEOCLASTS Surgery and Traumatology. Hospital Universitario y THROUGH NF-ΚBSIGNAL Politécnico La Fe de Valencia, Valencia, Spain, 26Department G. Y. Zhao1 of Orthopaedic Surgery, Traumatology and Rheumatology. 1The Affiliated Hospital of Jiangsu University, Zhenjiang, Hospital Universitario Puerta del Mar, Cádiz, Spain, China 27Servicio de Medicina Interna del Hospital Universitario Infanta Cristina, Badajoz, Spain, 28Department of Surgery, Objective: To investigate the effects of deferasirox (DFS) on Medicine School, University of Zaragoza, Zaragoza, Spain, differentiation of mouse RAW264.7 monocytes into osteo- 29Department of Internal Medicine, Hospital del Mar- clasts and related mechanism. IMIM and Autonomous University of Barcelona, Barcelona, Methods: RAW264.7 cells were treated with DFS in the pres- Spain ence of receptor activator of NF-κB ligand (RANKL). Cell viability were assessed by CCK-8. The number of tartrate- Objectives: We assessed the proportion of patients on anti- resistant acid phosphatase (TRAP)-positive cells were count- osteoporosis treatment/s during a hospital admission for a hip ed under light microscopy. The levels of transcription factor c- fracture, and at 1- and 4-month follow-up. For comparison, we Fos, nuclear factor of activated T cell c1 (NFATc-1) and ca- also report on anti-thrombotic and antibiotic therapies at these thepsin K (CTK) mRNA were analyzed by Real-Time PCR. same times. The levels of reporter gene of Nuclear transcription factor Material and Methods: The SPARE-HIP (Spanish Registry kappa B (NF-κB) was examined by luciferase reporter assay. of Hip and Proximal Femur Fractures) cohort includes a con- NF-κB P65 were detected by Western Blot. secutive sample of hip/proximal femur fracture patients re- Results: DFS could significantly decrease the number of cruited from a representative 45 Spanish hospitals. Patients TRAP-positive MNCs, and down-regulate mRNA expression were recruited at the time of admission for a hip fracture, of c-Fos, NFATc-1, and CTK, and suppress expression of and followed at 1 and 4 months. Local investigators reported NF-κB reporter gene, and hinder translocation of NF-κB on whether patients were on treatment or started anti-osteopo- P65 to cell nucleus in RAW264.7 cells. rosis, anti-thrombotic and antibiotic therapy during admission; Conclusion: DFS can significantly inhibit differentiation of and whether patients were on anti-osteoporosis agents at 1 and RAW264.7 cells into osteoblast, and the mechanism behind 4-month follow-up. Number and% of patients on the above inhibition may involve suppressed NF-κBactivity. treatments were reported with 95% confidence intervals as- suming a binomial distribution. Results: A total of 852 participants were recruited. Although P504 329 (38.6%) had a history of previous osteoporotic fracture, OCCURRENCE OF BONE FRACTURE IN THE 2 only 67 (7.9% [6.1% to 9.7%]) were on anti-osteoporosis YEARS FOLLOWING A PROLONGED ICU STAY: A therapy at admission. This increased only to 19.8% [17.2% RETROSPECTIVE STUDY INCLUDING A CONTROL to 22.5%] at discharge, 213/741 (28.7% [25.5% to 32.0%]) at GROUP 1- and 211/580 (36.4% [32.5% to 40.3%]) at 4-months. In A.-F. Rousseau1,M.Bawin2,E.Cavalier3, J.-Y. Reginster4,P. contrast, anti-thrombotic and anti-biotic therapies were almost Damas1, O. Bruyère4 universally prescribed (95.2% [93.7% to 96.6%] and 96.4% 1General Intensive Care Department and Burn Centre, [95.1% to 97.6%] respectively). University Hospital of Liège, Liège, Belgium, 2University of Conclusions: There is an unresolved treatment gap in the Liège, Liège, Belgium, 3Clinical Chemistry, University of secondary prevention of fractures, both before and after a Liège, CHU de Liège, Liège, Belgium, 4Department of hip/proximal femur fracture. Interestingly, anti-thrombotic Public Health, Epidemiology and Health Economics, and anti-biotic prophylaxis are much more widely implement- University of Liège, Liège, Belgium ed and close to universal implementation. There is a need for improvement in the delivery of secondary fracture prevention Objective: Clinical consequences of critical illness and critical amongst hip fracture patients. care (CC) on bone health remain largely unexplored. The pres- Disclosures: The SPARE-HIP study has been funded by a ent retrospective study aimed to assess the number of new bone non-restricted research grant from Amgen. DPA’s department fractures (BF) following critical illness focused on patients with has received unrestricted research grants, and speaker and ad- a prolonged length of stay (LOS) in intensive care unit (ICU). visory board fees from AMGEN. ABD has received Grant/ Material and methods: In the CC group, adults admitted in Research support from AMGEN. EVC has received Amgen our ICU during 2013 with a LOS > 7 days were included. gant/research suport from Faes-Farma, MSD. Patients who died in ICU or lost to follow up (FU) were Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S325 excluded. In a second phase, a control group was added, in- prospective follow up, 101 men had incident fragility fracture cluding patients who attended an anesthesia consultation for and 87 men had incident MACCE (acute coronary syndrome, scheduled surgery or invasive procedure during 2013. For stroke, sudden death). each CC patient still alive after the 2y of FU, 2 control pa- Results: After adjustment for FRAX-TBS, higher OPG tients, matched for gender and age, were recruited. levels were associated with higher risk of fracture Demographic and medical data were collected in the medical (HR=1.34 per SD, 95%CI: 1.11-1.61, p<0.005). After ad- chart. Basal fracture risk before admission was calculated justment for FRAX-TBS, fracture risk was higher in the using the FRAX tool. General practitioners were phoned to highest OPG quartile vs. three lower quartiles combined check out new frailty BF during the 2 years after admission. (HR=1.98, 95%CI: 1.31-2.99, p<0.005). A similar pattern Results: A total of 1446 patients were admitted in ICU in was found for vertebral fracture, MOpFx and non-vertebral 2013. Of those, 989 had an ICU LOS ≤ 7d, 169 died during fracture analyzed separately, e.g., non-vertebral fracture ICUstayand3were<18y.Amongthe72patientswho risk was higher in the highest OPG quartile vs. the three died during FU, only one BF occurred in a 62y man. lower quartiles combined (HR=2.38, 95%CI: 1.43-3.96, Finally, new BF occurred in 9 of the 178 patients who were p<0.005). In the men with FRAX-TBS for MOpFx of still alive at the end of FU (5%). Fractured patients did not <15%, higher OPG levels were associated both with higher differ from non-fractured ones based on demographic and risk of all fragility fractures (HR=1.29 per SD, 95%CI: clinical characteristics, excepting for FRAX risks that were 1.06-1.58, p<0.05) and of various fracture subgroups (ver- higher in fractured patients. In the control group, 327 pa- tebral fracture: HR=1.49 per SD, 95%CI: 1.10-2.02, tients were analyzed. Their rate of new BF was 3.4% with- p<0.01). After adjustment for age, weight, lifestyle and out reaching statistical significance compared to the CC cardiovascular risk factors, higher OPG levels were asso- group (p=0.35). They had similar FRAX risks when com- ciated with higher risk of MACCE (HR=1.39 per SD, paredtoCCgroup. 95%CI: 1.09-1.77, p<0.01). After adjustment for con- Conclusions: No statistical difference was observed in BF founders, the risk of MACCE was higher in the highest occurrence 2y after admission in ICU or surgical ward. OPG quartile vs. the lowest one (HR=2.73, 95%CI: 1.06- Results have to be interpreted with caution due to limited 7.03, p<0.05). cohorts, making this study potentially underpowered. CC Conclusion: Older men with the high OPG levels are at fractured patients had significantly higher basal FRAX increased risk of both fragility fracture and MACCE. risks than nonfractured patients, suggesting that screen- Measurement of OPG may improve identification of ing of risk factors would be relevant as soon as ICU older men at increased both cardiovascular and fracture hospitalization in order to implement targeted prevention risk. strategies. P506 P505 DIAGNOSIS AND TREATMENT IN HAND INTER- SERUM OSTEOPROTEGERIN IS A MARKER OF PHALANGEAL ARTHRITIS BOTH FRACTURE AND CARDIOVASCULAR RISK M. Banciu1 IN OLDER MEN: THE PROSPECTIVE STRAMBO 1Universitatea de Vest "Vasile Goldis" Arad, Timisoara, STUDY Romania P. Szulc1, L. C. Hofbauer2, R. D. Chapurlat1 1INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, Hand osteoarthritis affects 38% of the female population Lyon, France, 2Division of Endocrinology, Diabetes, and Bone and 24,5% of the male population aged > 60. The clinical Diseases, TU Dresden Medical Center, Dresden, Germany picture of hand osteoarthritis, according to ACR criteria, are: pain, limited movement and joint deformation. Objective: Fractures and major adverse cardiac and cerebro- Radiological exam includes: standard X-ray, the presence vascular events (MACCE) often occur in one person; howev- of osteophytes, narrowing of joint space, bone scanning. er, data on shared biological markers are missing. We assessed Clinical forms of hand osteoarthritis may be either: a. gen- the utility of OPG for prediction of fracture and MACCE in eralized forms, involving 3 joints or a group of joints; b. men. erosive, with sudden onset, pain, swelling, erythema, joint Material and Methods: In 817 men aged 60-87, serum OPG erosion and aggravating tendency. Therapy in hand inter- was measured at baseline (ELISA Biomedica). Bone mineral phalangeal arthritis was determined according to 13 multi- density and trabecular bone score (TBS) were assessed by centre studies and consists of -symptomatic fast acting DXA. TBS-adjusted FRAX (FRAX-TBS) for major osteopo- drugs -symptomatic slow acting drugs chondroprotective rotic fracture (MOpFx) was calculated. Over 8 yrs of agents (GAG-PS). Treatment in hand osteoarthritis is S326 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 similar with that of knee or hip osteoarthritis. A major role P508 is held by the patient’s compliance to treatment, elimination GENE EXPRESSION ANALYSIS DURING IN VITRO of mechanical risk factors, local physical therapy, analge- MYOGENESIS OF HUMAN SKELETAL MUSCLE sics, anti-inflammatories. Chondroprotective medicine may SATELLITE CELLS prevent, stabilize and even repair cartilage damage. C. Romagnoli1, P. Sharma1, R. Zonefrati1, C. Mavilia1,A. Medical treatment requires individual treatment associated Aldinucci2,M.Innocenti1, L. Cianferotti1,M.L.Brandi1 with physical therapy and, in most severe cases orthesis. 1Department of Surgery and Translational Medicine, University of Florence, Florence, Italy, 2Department of Neurofarba, University of Florence, Florence, Italy P507 UNDERSTANDING PATIENT PREFERENCES FOR Objective: Skeletal muscle regeneration represents a para- OSTEOPOROSIS TREATMENTS mount target for diseases in which skeletal muscle is loss or P. Gopisetty1,A.Gupta1 damage, such as sarcopenia or dystrophy. The importance of 1Medicine, Carmarthen, United Kingdom understanding the mechanisms that underlie the myogenesis process are fundamental for the development of new therapeu- Objective: Adherence with osteoporosis treatment is poor. tic strategies. The aim of this work is to analyse the expression Incorporation of patient treatment preferences into decision- of the most important genes of the myogenic differentiation making may improve patient adherence. The objective of this (MyoD-1, MRF-4, Myogenin, Desmin, Myosin Heavy study was to examine patient preferences for treatment options Chain) and of specific hormone receptors (VDR, TRα, in osteoporosis. TRβ, GCR) in human skeletal muscle satellite cells Materials and Methods: We recruited patients with con- (hSMSCs) in order to identify possible therapeutic targets firmed osteoporosis on DXA scan who were intolerant to for skeletal muscle regeneration. oral bisphosphonates and referred by general practitioner Material and Methods: SMSCshavebeenisolatedfrombi- to specialist osteoporosis clinic for consideration of injec- opsies of human skeletal muscles (pectoralis major, recto ab- tion treatments. Consenting participants were given stan- dominal muscles) in healthy young adult volunteers undergo- dard drug information leaflets and offered a choice of ei- ing plastic surgery. Primary cells have been cultured in growth ther twice yearly subcutaneous Denosumab or yearly medium (GM) and the obtained cell lines characterized by Zoledronate infusion. Patients were informed about equal cytofluorometric assay. Then cells have been differentiated efficacy and some common side effects of these drugs and for 7 days with appropriate differentiation medium (DM) to an opportunity to discuss again in next clinic visit with the evaluate the expression of MyoD-1, MRF-4, Myogenin, specialist. Desmin, Myosin Heavy Chain, Irisin, VDR, TRα,TRβ, Results: The study sample included 126 Caucasian women GCR by RealTime-qPCR, during myogenesis. Statistical and 51 men (median age=71 years). Majority (85%) preferred analysis was performed by Student’s t-test to evaluate the SC Denosumab. Patients’ treatment preferences were strongly significant difference between gene expression values in DM influenced by route of administration with subcutaneous route and the respective value in GM. more acceptable. The results were not influenced by age or sex Results: Cytofluorimetric assay has shown the presence of the of patient, previous fracture status. Main reasons amongst par- satellite cell marker PAX-7 (99.12%) and the mesenchymal ticipants preferring annual infusion was convenience of less stem cell markers CD44 (98.76%), CD90 (68.21%), on the frequent blood test, less hospital visit or undue concern from isolated SMSCs. RealTime-qPCR, performed on hSMSCs af- side effects of Denosumab. 7% were unable to decide and ter 7 days of myogenic differentiation, has revealed significant would agree specialist recommendation. 2% had serious con- increases in gene expressions of MyoD-1, Myogenin, Myosin cerns about drug side effects and did not want injection Heavy Chain, TRα (p<0.005), MRF-4, Desmin, Irisin, VDR treatments. (p<0.001) and TRβ, GCR (p<0.05) with respect to baseline Conclusions: Patient preferences for osteoporosis treat- level, suggesting their involvement in skeletal muscle ment options are strongly influenced by route of adminis- regeneration. tration. Our study results emphasize the need to incorpo- Conclusion: Our results have demonstrated the utility of skel- rate individual patient preferences into treatment decisions etal muscle satellite cells, isolated from human biopsies, to for osteoporosis. This process of decision-making not only study the myogenesis process. All the assayed genes may adheres to the principles of informed consent and patient represent feasible targets in skeletal muscle regeneration. autonomy, but also can increase patient satisfaction and Studies are in progress in order to modulate and manipulate improve compliance, both of which are essential to ensure skeletal muscle differentiation pathway to identify possible successful long-term treatment of osteoporosis and ulti- therapeutic strategies for disorders associated with skeletal mately prevent fractures. muscle diseases. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S327 Acknowledgments: This work was supported by MIUR- stature, diabetes, low BMD at femur and neck (P values, PRIN2012_Muskendo Project and by Marie Skłodowska- 0.031, 0.008, 0.009 and <0.001, respectively). Being 12 y/o Curie Innovative Training Networks_CaSR Biomedicine, and older increases the risk short stature, 7.71 times compared Project n.675228. to younger patients (P-value=0.008). Being 35 y/o and older increases the risk of diabetes, 26.25 times compared to youn- ger patients (P-value=0.03). Being 19 y/o and older increases P509 the risk of Z-score ≤ -2 in femoral region, 5.84 times com- HOW DEMOGRAPHIC AND TRANSFUSIONAL pared to younger patients (P-value=0.002). Being 14 y/o and PARAMETERS EFFECTS BMD AND ENDOCRI- older increases the risk of Z-score ≤ -2 in spinal region, 17 NOLOGICAL DISORDERS IN THALASSEMIA times compared to younger patients (P-value=0.007). MAJOR PATIENTS: AN EXPERIENCE WITH 114 Conclusion: The main factor related with endocrinopathies PATIENTS was age. Short stature, diabetes and low BMD patients were Z. Hamidi1,M.R.Mohajeri-Tehrani2,A.S.Alemzadeh2,F. significantly older. So, we recommend early monitoring of Abbaszadeh-Marzbali2,S.naseri-Sina1,F.Hosnan1,A. thalassemia patients (in their late childhood and early teenage) Naghghash3 ,A.A.Hamidieh4 ,M.Behfar4 ,K. for these complications. Alimoghaddam4,F.Mohseni2, H. Rashidian2,A. Ghavamzadeh5, S. Shirazi6, M. Aboee-Rad2, M. Qorbani7, M. Pajouhi2, B. Larijani2 P510 1Endocrinology and Metabolism Research Center, HIGH-FAT DIET-INDUCED ACCELERATION OF Endocrinology and Metabolism Clinical Sciences Institute, OSTEOARTHRITIS IS ASSOCIATED WITH Tehran University of Medical Sciences, Tehran, Islamic SUSTAINED METABOLOMICS SIGNATURE Republic of Iran, 2Endocrinology and Metabolism Research REGULATED BY LEPTIN/AUTOTAXIN PATHWAY Center, Endocrinology and Metabolism Clinical Sciences M. Kapoor1,P.Datta2, Y. Zhang2, A. Parousis2,A.Sharma2, Institute, Tehran University of Medical Sciences, Tehran, E. Rossomacha2,B.Wu2, I. Kacprzak2, N. Mahomed2,R. Islamic Republic of Iran, 3Shahid Beheshti University, Gandhi2, J. Rockel2 Torfeh Hospital, Tehran, Islamic Republic of Iran, 1Surgery, University of Toronto, Toronto, Canada, 2Krembil 4Hematology-Oncology and Stem Cell Transplantation Research Institute, Toronto, Canada Research Center of Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran, 5Hematology-Oncology and Objectives: The contribution of metabolomic changes in- Stem Cell Transplantation Research Center of Tehran duced by high fat diet (HFD) to osteoarthritis (OA) is poorly University of Medical Sciences, Tehran, Islamic Republic of understood. We investigated if HFD results in distinct and Iran, 6Osteoporosis Research Center, Endocrinology and longitudinal changes to metabolites and their contribution to Metabolism Clinical Sciences Institute, Tehran University of OA pathogenesis. Medical Sciences, National Elites Foundation, Tehran, Methods: Mice were fed normal chow diet until 9-weeks of Islamic Republic of Iran, 7Department of Community age and then placed onto HFD or lean diet (LD) for 18 weeks, Medicine, School of Medicine, Alborz University of followed by resumption of normal chow and evaluated longi- Medical Science, Karaj, Islamic Republic of Iran tudinally up to 12-months of age. Some mice were also sub- jected to surgically-induced OA at the end of HFD or LD. Objectives: Beta-thalassemia major patients frequently have Plasma and knee joints were collected at each time point. endocrinopathies. We tried to determine relation between de- Functional mechanistic studies were performed using human mographic and transfusion factor and endocrinopathies. OA chondrocytes. Material and Methods: Major beta-thalassemia patients, 114 Results: Our results first show that HFD-fed mice exhibit cases, 3–38 yr of age, entered this study. Female to male ratio: acceleration of both spontaneous age-related and surgically- 51/63. Children (less than 20 y/o) formed 57% of participants. induced OA compared to LD-fed mice. Using metabolomic Information about BMD and hormonal and biochemistry analyses, we for the first time, identified that HFD-fed mice blood evaluation including FBS, ferritin, T3, T4 and exhibited a distinct and sustained longitudinal plasma metab- thyroid-stimulating hormone (TSH), luteinizing hormone olite signature rich in lysophosphatidylcholines, even after (LH) and follicle-stimulating hormone (FSH), testosterone resumption of normal chow diet, suggesting their contribution (males), and estradiol (females) entered data sheet. to accelerated OA progression in HFD-fed mice. Using ROC Results: Correlation was measured between age, sex, ferritin and prediction modelling, we showed that concentration of level and the spine and Low BMD and other endocrinological these identified metabolites could efficiently predict diet and diseases. Sex and ferritin level showed no significant correla- cartilage degeneration with an accuracy of 93%. Mechanistic tion with above disorders. Age significantly correlated to short studies revealed leptin/autotaxin pathway as a key driver of S328 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 sustained metabolomic changes as well as induction diaphysary fracture, external cortical fracture, femoral, of catabolic enzyme expression in chondrocytes, thus contrib- osteonecrosis of the jaw, maxillary osteonecrosis, uting to articular cartilage degeneration. bisphosphonates. In order to make a rough estimation of the Conclusion: Together this study is the first to identify a dis- prevalence of both ADRs, the number of patients on tinct, sustained, HFD-induced metabolite signature that is me- bisphosphonates that lived in the hospital catchment area diated by Leptin/autotaxin signaling and correlates with OA was asked to the Madrid region health authority. severity. Results: Six patients (all women with a mean age of 71.5 SD 13.03) were diagnosed with at least one of these ADRs be- tween 2011 and 2015. Three of them had no maxillary lesions P511 (two with AFF and a third patient with bilateral femoral fis- THE WAY THE PATIENT WITH ARTHROSIS. WHY sures). A fourth patient diagnosed with AFF had also a jaw DELAY THE DIAGNOSIS? injury not described as OJ. The other two patients had OJ, one N. Nikolov1,M.Panchovska2 with pathologic femoral fracture and another with right 1UMHAT G. Stranski, Pleven, Bulgaria, 2Medical University, subcapital femoral fracture not declared as atypical. All pa- Plovdiv, Bulgaria tients had been treated with bisphosphonates for more than five years except for the two patients with OJ and femoral From the appearance of the first symptoms of the disease until fracture. Out of the total number of patients treated with the proper diagnosis and appointed therapy sometimes passes bisphosphonates (13,666) between 2011 and 2015 that lived a long period of time. Analysis of the route of rheumatic in the hospital catchment area, a prevalence of 0.029% was patient gives us an idea of the reasons for late diagnosis. estimated for AFF and of 0.39% for OJ. Prevalence of both GPs refer patients with osteoarthritis and dorsopaty other pro- concomitant ADRs was 0.014%. fessionals, most orthopedists and neurologists. The organiza- Conclusions: Half of the patients treated with bisphosphonates tion of world primary care seeks to solve this problem because diagnosed with AFF also presented OJ. Despite the prevalence it is associated with many unnecessary tests and orthopedic of AFF and OJ being very low, they are very serious ADRs. operations, which in turn leads to many suffering patients and Whenever patients are diagnosed with one of these conditions, thus to more spending. This publication analyzes the routing it seems wise to discontinue bisphosphonate treatment and to of patients with arthrosis and dorsopaty for a period of six start a close follow-up one of the patient. years in Bulgaria. P513 P512 COMPARISON OF THE MICRO-ARCHITECTURE CONCOMITANT ATYPICAL FEMORAL FRACTURE OF TRABECULAR LUMBAR BONE BY TBS AND OSTEONECROSIS OF THE JAW IN BISPHOS- (TRABECULAR BONE SCORE) AMONG TYPE 2 PHONATE USERS DIABETIC AND NON-DIABETIC WOMEN OF THE A. Correa-Pérez1, C. Sánchez-Castellanos1,A.J.Cruz- PINARES MEDICAL SPECIALTY CENTER, SAN Jentoft2 JOSÉ, COSTA RICA: CASES AND CONTROLS 1Geriatric Department. Hospital Universitario Ramón y Cajal STUDY (IRYCIS), Madrid, Spain, 2Chair, Geriatric Department. L. Calvo1 Hospital Universitario Ramón y Cajal, Madrid, Spain 1Centro Médico Pinares, San José, Costa Rica Introduction: Treatment with bisphosphonates is associated Objective: To know the relationship between the abnormal with two rare but serious adverse drug reactions (ADRs): values of TBS and type 2 diabetes mellitus as well as the atypical femoral fracture (AFF) and osteonecrosis of the jaw association between different risk factors for fracture and dia- (OJ). The simultaneous appearance of both complications in betes with abnormal TBS values. the same patient is unusual. Materials and methods: A descriptive observational study of Purpose: To describe some cases of patients diagnosed with cases and controls, in which 62 female patients (31 type 2 AFF and OJ after a bisphosphonate-based treatment and to diabetic and 31 non-diabetic), selected from the bone densi- estimate the prevalence of these ADRs in the population treat- tometry database of a private medical center in San José, ed with bisphosphonates attending our hospital between 2011 Costa Rica, are compared to each other to evaluate if there and 2015. are differences in the results of the TBS study between both Methods: A retrospective search of patients diagnosed with groups, as well as the influence that other variables such as AFF and/or OJ was conducted through the hospital computer BMD, age, BMI in each group could have on the TBS system combining the terms (in Spanish): atypical fracture, variable. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S329 Results: The mean age of diabetic patients was 63.9±1.499 subjects (8.7%) had normal T-scores, 59 (51.8%) were years, while that of non-diabetic patients was 59.61±1.466 osteopenic and 45 (39.5%) were osteoporotic. Of 104 subjects years. The body mass index in diabetic women was 30.5 with complete data, mean T-scores were in AP spine -1.58 ±1.031 kg/m2 and in non-diabetic patients 25.6±0.578 kg/ (±1.26SD), hip (neck) -1.506 (±1.029SD) and hip (total) - m2. The TBS (trabecular bone score) had a mean for diabetics 1.365(±1.318SD). 91 subjects had lateral vertebral morpho- of 1.2557±0.015 (without units) and for non-diabetic patients metric assessments, of whom 18 had evidence of vertebral of 1.2816±0.015 (without units). The mean values of T Score fracture. for diabetics were: Lumbar Spine -1,132±0,214 DS, hip - Conclusions: There is high concordance of reduced BMD on 0,532±0,164 DS, femoral neck -1,232±0,135 DS, and for DXAwith osteopenia identified on X-ray. An excellent oppor- non-diabetic patients were: Lumbar spine -1,868±0,217 DS, tunity to investigate further for osteoporosis is when hip -1.039±0.150 DS, femoral neck -1.655±0.160 DS. osteopenia is incidentally diagnosed on X-Ray. Treatment Relationship of TBS with body mass index greater than 30 could potentially be initiated in situations where DXA is not kg/m2 (P value=0.002, OR=9.198) and TBS with low Lumbar available, however prospective analysis of osteopenia on X- spine T-score (P=0.043, OR=6.968). Ray may further outline its suitability in this role. Conclusions: There are no significant differences between the References: TBS values of diabetic and non-diabetic patients if there is a 1. Eriksen EF, Rev Endocr Metab Disord 2012;13:209 significant relationship between abnormal TBS values and 2. “Prevention and Management of Osteoporosis” WHO body mass index as well as low values of lumbar spine t-score. Technical Report Series 921, Geneva 2003 3. "Osteoporosis Guidelines for Health Professionals" Irish Osteoporosis Society P514 AN OPEN SECRET: UTILISING PLAIN FILM X-RAY TO DIAGNOSE OSTEOPENIA P515 O. Hannigan1,N.Garry1, M. Smyth1,P.Claffey2, A. Dillon1, ASSESSMENT OF BONE STRENGTH AND CORTICAL B. McCarthy3,M.C.Casey2, K. McCarroll2,R.Lannon2,J. POROSITY IN A GROUP OF PREMENOPAUSAL Mahon3,J.Browne1, L. Clowry1, J. B. Walsh3 WOMEN WITH CELIAC DISEASE AFTER 3 YEARS 1Department of Medicine for the Elderly, St James Hospital, ON GLUTEN-FREE DIET Dublin, Ireland, 2Department of Gerontology, St James M. B. Zanchetta1,V.C.Longobardi1,J.Bai2,F.Silveira1,F. Hospital, Dublin, Ireland, 3Mercers Institute for Research Costa2,J.R.Zanchetta1 and Aging, St James Hospital, Dublin, Ireland 1Idim, Universidad del Salvador, Ciudad Autónoma de Buenos Aires, Argentina, 2Hospital de Gastroenterología Dr. Introduction: Osteopenia is considered an osteoporosis pre- Bonorino Udaondo, Ciudad Autónoma de Buenos Aires, cursor1, and osteoporosis is a severe global health concern. Argentina The majority of fractures happen in people with T-Scores ly- ing within the osteopenic range2.InIreland1in4menand1in Previously we identified a significant deterioration of trabec- 2 women will develop an osteoporosis related fracture in their ular and cortical microarchitecture in peripheral bones of lifetime, with approximately 300,000 people suffering from premenopausal women with recently diagnosed celiac dis- osteoporosis3. A cost of €551 million per annum is associated ease (CD) using high resolution peripheral compute tomog- with treating osteoporosis related fractures in the elderly in raphy (HR-pQCT), where trabecular bone was the most Ireland3. DXA has long been considered the Gold standard impaired. in diagnosing osteoporosis/osteopenia, but it has been Aim: To assess bone strength and cortical porosity measured established that osteopenia can be diagnosed from X-ray. by HR-pQCT in CD women after 3-years on gluten-free diet This study was to investigate the accuracy of X-Ray at diag- (GFD) and to compare the results with a group of healthy nosis of osteopenia. women of similar age and BMI. Methods: All DXAs with an indication of “Osteopenia on X- Methods: This study is part of a prospective design evaluating Ray” in our university teaching hospital were retrospectively CD patients at diagnosis and yearly after GFD. In the 3rd year- analysed. Each DXA was then reviewed, and presence of visit, 24 premenopausal women were evaluated to assess bone osteopenia/osteoporosis was recorded. T-scores from AP microarchitecture, strength and cortical porosity by HRp-QCT spine, left femur (total) and left femur (neck) were recorded, in addition to the standard tests to assess bone health (DXA along with the presence of vertebral fractures. Statistical anal- scans, lab test and clinical evaluation). We assessed cortical ysis was then performed using Microsoft SPSS. porosity, calculated as the percentage of void space in the Results: Of 1462 DXAs reviewed, 114 had an indication of cortex, and bone strength by microstructural finite element "Osteopenia on X-Ray", 95 women and 19 men. Only 10 analysis (F.E.A) to calculate whole-bone stiffness and failure S330 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 load (Scanco softwares). Results were compared with a con- was made at the beginning of the study and after 2 weeks trol group of 18 healthy women of similar age and BMI who based on knee mobility, muscular strength, pain assessment underwent the same procedures. Comparisons between on a Visual Analogue Scale (VAS) and the Western Ontario groups were performed using unpaired T test or Wilcoxon and McMaster Universities (WOMAC) Osteoarthritis Index Rank Sum according to data distribution. questionnaire. Results: CD patients and healthy controls were comparable in Results: The benefits of the kinetic programs were shown by terms of age, height, weight and BMI (p=NS). Results are a significant improvement on knee mobility and muscular shown in the table. The cortical compartment (density, thick- strength for knee extensors (quadriceps muscle) and knee flex- ness and porosity), did not reach statistical significance be- or muscles. Pain, evaluated on a Visual Analogue Scale, had a tween groups. CD patients had lower stiffness and failure load mean decrease of 4.338 points and the results were a high at the radius (-14%; p<0.01). A the tibia they were 8% lower statistic significant (p=0.000057). The WOMAC score was but not statistically significant. significantly reduced (from 4.32±1.85 to 3.65±1.96, Conclusions: In this group of premenopausal women with p=0.011). The results for the control group remained basically celiac disease, despite 3 years on a gluten-free diet, bone unchanged. strength in the radius was significantly lower compared to a Conclusion: The physical exercise program improves both control group of similar age and BMI. Prospective follow-up functional status and quality of life in patients with knee re- would enable us to assess total extent of the recovery with placement by increasing range of motion and muscular treatment. strength and by reducing pain. P517 IDENTIFICATION OF MICRORNA-181A-5P AND MICRORNA-4454 AS NOVEL BIOMARKERS AND MEDIATORS OF FACET CARTILAGE DEGENERATION M. Kapoor1,A.Nakamura2,A.Sharma2, S. Lewis2,B.Wu2, P. Datta2,K.Sundararajan3, H. Endisha2,E.Rossomacha2,J. Rockel2,I.Jurisica4 1Surgery, University of Toronto, Toronto, Canada, 2Krembil Research Institute, Toronto, Canada, 3Toronto Western Hospital, Toronto, Canada, 4Princess Margaret Cancer Centre, Toronto, Canada P516 ROLE OF PHYSICAL EXERCISE IN PATIENTS WITH Purpose: Osteoarthritis (OA) of spine (facet joints, FJ) is one KNEE ARTHROPLASTY FOR OSTEOARTHRITIS of the major causes of severe low back pain and disability I. R. Marcu1,S.Patru1,D.Matei1,A.C.Bighea1 worldwide. However, specific mechanisms associated with 1University of Medicine and Pharmacy, Craiova, Romania facet cartilage degeneration during FJ OA are largely un- known. For the first time, in this study we investigated the Objective: This study assessed the efficacy of a 2 weeks ex- role of microRNAs (miRNAs) in the pathophysiology of facet ercise program on functional status and quality of life in pa- cartilage degeneration during FJ OA. tients with knee replacement for osteoarthritis. Materials and Methods: Based on MRI and histopathology, Material and Methods: The randomized, controlled, obser- we first established and validated a patient cohort (Group 1 vational study included 81 patients with knee replacement for patients [control group]: normal or mild facet cartilage degen- osteoarthritis, 64 women, mean age 63.7±7.3 years, randomly eration and Group 2 patients [FJ OA group]: moderate to severe assigned to a control group (40 patients) and an exercise group facet cartilage degeneration). Using this large cohort (n=55), (41 patients). All patients were diagnosed with knee osteoar- we screened 2,100 miRNAs using miRNA-array and differ- thritis and had total knee replacement. All patients of the entially regulated the expressions of miRNAs in facet cartilage exercise lot had a stable cardiovascular status and were were further tested by qPCR analysis and investigated their transferred from the Orthopedics Clinic to the Physical and correlation with FJ OA severities based on MRI grading score Rehabilitation Clinic of Emergency County Hospital Craiova. (grade0; normal, grade1; mild, grade2; moderate and grade3; They followed exercise programs based on increasing knee severe). Human FJ OA chondrocytes were cultured and flexion, muscular strength and endurance, improving balance, transfected with miRNA enhancers/inhibitors (or control mim- coordination, respiratory exercises. The patients in the control ic/inhibitor) to determine the effect of miRNA enhancement/ group continued their daily living activities. The evaluation inhibition on the expression of catabolic/inflammatory/ Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S331 anabolic/apoptosis markers. Target genes and signaling path- of bone segments – in 16 (38.1%), amputation, disarticulation ways modulated by miRNAs were also identified using limbs – in 7 (16.7%). Radical surgery performed in 37 (88.1%) mirDIP/pathDIP. Furthermore, we injected the miR-181a-5p patients, non-radical – in 5 (11.9%). The functional outcome of mimic into FJs of rats to see the effect of overexpression of the operated limb was calculated by the MSTS system. Quality miRNAs on animal FJ cartilage in vivo. of life was measured by questionnaire EORTIC-QLQ-C30.The Results: Out of 2,100 miRNAs, we specifically identified 2 survival rate of patients evaluated by Kaplan-Meier method. miRNAs (miR-181a-5p and miR-4454) whose expression Results: Postoperative complications were observed in 7 were markedly up-regulated in FJ OA cartilage compared to (16.7%) patients, tumor recurrence - in 8 (19%). After radical control facet cartilage and the levels of expression were signif- surgery recurrences were detected in 3 (8.1%) patients, after non- icantly correlated with the severity of FJ OA based on MRI radical - in 5 (100%). Distant metastases of chondrosarcoma grading. We then treated FJ OA chondrocytes with miR-181a- were observed 10 (23.8%) cases. After radical surgeries tumor 5p or miR-4454 enhancer/inhibitor and showed that treatment metastases were found in 6 (16.2%) patients, after non-radical - with miR-181a-5p or miR-4454 enhancer significantly elevat- in 4 (80%) patients. Postoperative recovery of limb function and ed the expression of inflammatory/catabolic/apoptosis markers supporting ability was observed in 35 (83.3%) patients. and reduced expression of type II collagen; inhibition of these Functional outcome of the limb after arthroplasty amounted from two miRNAs was able to reverse these destructive effects. Our 64% to 92%. The quality of life of the patients improved from 25 study also identified that in facet cartilage both miR-181a-5p points preoperatively to 84 points postoperatively. Three-year and miR-4454 signal by zinc finger protein (ZNF440) via mod- overall survival rate of patients amounted 72,2±4,1%, five-year ulation of the NF-κB pathway. Furthermore, by injecting miR- - 64,5±4,6%. 181a-5p mimic in rat FJs, we observed a FJ OA phenotype in Conclusions: The chondrosarcoma relapses usually depend facet cartilage associated with enhanced catabolic activity and on radical surgery. Metastases in cases of chondrosarcoma chondrocyte apoptosis in vivo. Our pilot data (n=40) also shows are defined by the degree of tumor cells differentiation. that circulating forms of miR-181a-5p and miR-4454 are also detectable and elevated in patient blood (plasma) with more severe facet cartilage degeneration. P519 Conclusion: Using clinical, in vitro functional and in vivo IOF ONE–MINUTE OSTEOPOROSIS RISK TEST AS studies, we for the first time have identified miR-181a-5p VALUABLE SCREENING TOOL FOR DIFFERENT and miR-4454 as novel mediators of facet cartilage degenera- PATIENTS tion as well as potential OA biomarkers. M. Mukane1,S.Upmale2,M.Mukans2, I. Rasa3 1Riga Stradins University, Riga East Clinical University Hospital, Latvian Osteoporosis and Bone Metabolism P518 Diseases Association, Riga, Latvia, 2Riga Stradins RESULTS OF CHONDROSARCOMA SURGICAL University, Riga East Clinical University Hospital, Riga, TREATMENT AT VARIOUS LOCALIZATIONS IN THE Latvia, 3Riga East Clinical University Hospital, Riga BONES Stradins University, Latvian Osteoporosis and Bone V. Protsenko1,V.Chorneyi1 Metabolism Diseases Association, Riga, Latvia 1Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine Objectives: Osteoporosis is a widespread disease, and the number of such patients is increasing as the world population Objective: To show the results of chondrosarcoma surgical is aging. It has to be diagnosed as early as possible in order to treatment at various localizations in the bones. start treatment and decrease the amount of potentially fatal Materials and methods: Chondrosarcoma amounts 7-16% of complications such as hip fractures. It is reasonable to use the total number of malignant bone tumors. The disease is the IOF One–Minute osteoporosis risk test (the IOF test) as detected in approximately 60% of 40-60 years old patients. a screening tool before patients visit the physician or undergo Chondrosarcomas are divided into primary and secondary. By osteodensitometry. the degree of malignancy chondrosarcomas are divided into Material and methods: The IOF test was translated to highly differentiated, moderately differentiated and poorly dif- Latvian and Russian languages and was given to different ferentiated. Surgery is the main method of chondrosarcoma visitors on the Latvian World Osteoporosis day, 2017 and treatment. Prognosis depends on the degree of chondrosarcoma patients in different medical practices. malignancy. The treatment was provided to 42 patients with Results: Totally 53 respondents filled in the IOF test properly chondrosarcoma. Chondrosarcoma of the limb bones was ob- (94% women and 6% men). Only one respondent did not have served in 29 (69%) patients, of the pelvic bones – in 13 (31%). any risk factors (RF), mostly respondents had 2 or more RF Arthroplasty was performed in 19 (45.2%) patients, resection (83% of all). 72% of all respondents had modifiable RF, 87% S332 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 had non–modifiable RF. 64% had both kinds of factors, and events, etc.). A small part of rsp. had used the journal’swebsite these patients should undergo osteodensitometry. Also, the (21%). 69% of the rsp. liked the journal’s design, 20% liked it respondents were divided into age groups: >40 years (68% very much, and only 5% did not like it. Most of the rsp. (97%) of all) and <40 years old. Respondents older than 40 years mentioned that the informational content of the journal was had significantly more often such RF as parents diagnosed useful, important, and essential. All the rsp. would recommend with osteoporosis (p=0,004), broken bone as an adult Bone Health to their relatives or friends. (p=0,01), suffering from gastrointestinal and endocrine dis- Conclusion: Electronic media and classical communication ease (p=0,044), avoiding milk or dairy products without tak- tools such as journal and website Bone Health are useful and ing any calcium supplements (p=0,04). Respondents age >40 informative in the patients’ view and can help manage patients years positively correlates with a significantly bigger amount with OP and other musculoskeletal diseases. of RF (r=0,516, p<0,001). Conclusion: The IOF One–Minute osteoporosis risk test is a useful and valuable screening tool for revealing patients with P521 osteoporosis, especially patients older than 40 years before their LONG-TERM EFFICACY OF ZOLEDRONIC ACID IN visit to the physician or before they undergo osteodensitometry. PATIENTS WITH PAGET'S DISEASE OF BONE WITH RESDPECT TO PREVIOUS BISPHOSPHONATE TREATMENT P520 A. Gorshtein1, I. Slutzky-Shraga1, G. Tsvetov1,D.Hirsch1 IMPORTANCE OF THE JOURNAL AND WEBSITE BONE 1Institute of Endocrinology, Rabin Medical Center, Petach HEALTH FOR PATIENTS WITH OSTEOPOROSIS AND Tikva, Israel OTHER MUSCULOSKELETAL DISEASES M. Mukane1,S.Upmale2,M.Mukans2, I. Rasa3 Introduction: Paget's disease (PD) is a chronic metabolic 1Riga Stradins University, Riga East Clinical University bone disease, characterized by focal areas of increased bone Hospital, Latvian Osteoporosis and Bone Metabolism turnover. Intravenous zoledronic acid (ZA) is highly effective Diseases Association, Riga, Latvia, 2Riga Stradins in inducing disease control. It has been suggested that previ- University, Riga East Clinical University Hospital, Riga, ous bisphosphonate treatment may be associated with a dimin- Latvia, 3Riga East Clinical University Hospital, Riga ished therapeutic response to ZA. Stradins University, Latvian Osteoporosis and Bone Objective: To compare the long-term efficacy of ZA between Metabolism Diseases Association, Riga, Latvia bisphosphonates-naïve PD patients and patients previously treated with oral and/or intravenous bisphosphonates other Objectives: One of the crucial points in diagnosing and appro- than ZA. priately treating patients with osteoporosis (OP) and other mus- Methods: Medical records of consecutive PD patients that culoskeletal diseases such as osteoarthritis is the patient’s have been treated with ZA and followed at a single medical knowledge about the disease. Different sources of information center between the years 1992 - 2016 were reviewed for med- for the patients (e.g., websites and journals) can be helpful for ical, biochemical and imaging data. The patients were divided managing these diseases. Since 2013, a biannual, bilingual into 2 groups: patients with previous administration of oral or (Latvian, Russian) journal and website Bone Health intravenous bisphosphonates other than ZA (Group A), and (www.kauluveseliba.lv) is available for patients in Latvia. patients who were bisphosphonates-naïve (Group B). Data on There is information about OP and other musculoskeletal dis- disease-related variables and serum total alkaline phosphatase ease risk factors, diagnosis, treatment and prophylaxis options. (ALP) levels were analyzed and compared between the two Material and methods: Questionnaires with 14 questions groups. about the journal and website Bone Health were given to Results: The cohort included 63 PD patients (50.8% male, different respondents (rsp.). Demographic data and rsp. opin- mean age at diagnosis: 65.1±10.7 years). Groups A and B ion about the informational content, design, and usefulness of included 36 and 27 patients, respectively. Thirty patients in the journal and website Bone Health were analysed. Group A (83.3%) were treated with intravenous pamidronate Results: Totally 81 questionnaires was filled in (90% women, prior to ZA treatment. All patients in Group A had disease the median age of rsp. was 48 yrs. [IQR 77–19]). Almost a third reactivation and their treatment was switched to ZA. Serum (30%, n=24) of the resp. had OP or other musculoskeletal dis- total ALP significantly decreased in both Groups following ease. In most of the cases (47%) rsp. had found out about the ZA treatment. Ten and 4 patients in Groups A and B, respec- journal Bone Health from general practice and other specialists tively, received additional 1-3 treatments with ZA, most of (e.g., endocrinologists and rheumatologists), 19% had found them due to osteoporosis. All the patients in both groups had out about it from their family members or friends, 23% – from clinically silent disease at the last follow-up visit. Total serum different sources (patient associations, World Osteoporosis day ALP level was within the normal range in all but one patient in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S333 Group A at the end of follow-up of 4.58±1.6 and 4.18±1.6 zolendronic acid (3 doses) except 2 patients (contraindicated years after ZA administration, respectively. and oral bisphosphonate). Conclusion: ZA is highly effective in PD patients with no Statistical methods: The quantitative variables are described apparent impact of previous bisphosphonate administration by their means and standard deviation or by their median and on therapeutic efficacy. ZA induces and maintains long-term qualitative variables by frequency distribution. The compari- clinical remission and normalizes total serum ALP levels in son of quantitative variables will be done by student's t-test for nearly all PD patients. independent samples and that of qualitative variables by chi squared test, with linear trend test where appropriate. As proof of normality we will use the Kolgomorov-Smirnov test. P522 Results: Failing to complete the collection of all variables, RISK OF NEW FRACTURES OVER 4 YEARS IN since there are patients who have not completed a minimum PATIENTS TREATED WITH TERIPARATIDE DUE of 4 years after treatment, we can say that the tendency is to TO OSTEOPOROSIS have a lower incidence of refracture in those with greater bone J. Pons1 mass gain measured Through DXA. 1Servicio de Reumatología, Fundación Hospital de Calahorra, Discussion: In case of reduction of refractories after treatment Calahorra, Spain with teriparatide, cost-efficiency studies should be carried out in order to assess the indication of such treatment in patients at Introduction: Bone fractures, of any type, location or severity, high risk of fracture without a previous low impact fracture. cause resources and worsen the quality of life. They also bring about an increase in morbidity and mortality. Teriparatide is the treatment of choice in case of osteoporosis with fracture, ob- P523 jectifying both in studies and in real life, an optimal bone gain. EVOLUTION OF BONE MINERAL DENSITY IN Objective: To evaluate whether treatment with teriparatide PATIENTS UNDERGOING BARIATRIC SURGERY: (for 18-24 months) in patients with osteoporosis and fractures POST-INTERVENTION FOLLOW-UP (low impact) decreases the risk of new fractures as a function A. Ilundain1 of bone gain during the treatment period. Bone density with 1Servicio de Endocrinología, Hospital Clínico Universitario DXA will be assessed at baseline and at the end of treatment. Lozano Blesa, Zaragoza, Spain The subsequent period will be between 4 and 10 years. Material and methods: Design: Prospective cohort study. Introduction: Bariatric surgery is an effective treatment for Population under study: Patients who have received complete obesity, achieving a significant weight loss and the comorbid- treatment with teriparatide (at least 18 months) for osteoporo- ities that accompany this disease. Depending on the surgical sis (criteria for BMD) and associated fracture, coming from technique, it is more or less frequent the appearance of nutri- the rheumatology clinic of the Hospital of Calahorra, with a tional and metabolic deficiencies. These deficits are more fre- reference population of 90000 people. The total was 129 pa- quent when mixed surgical techniques are used, with a restric- tients (118 females and 11 males, all of them over 65 years of tive and malabsorptive component, such as gastric bypass or age except 3 (females) under the age of 65). biliopancreatic diversion. Nutritional deficiencies include, in Baseline variables: For each patient the following variables: May or less, malabsorption of fats and fat-soluble vitamins -Clinical variables: Age, sex, time of known evolution of the such as vitamin D, in addition to other micronutrients such disease, smoking, weight, height. as calcium. As a consequence, alterations in the bone mineral -Biochemical variables: PTH, Vitamin D, calcium, phospho- metabolism, the increase of the remodeling and the disorders rus, albumin, magnesium, urea, creatinine.. of the bone mineralization can develop. -Other determinations: Radiology of Dorsal and lumbar spine Objective: To evaluate the state of bone mineral density of and DXA (BMD). patients undergoing bariatric surgery and the evolution over Clinical endpoint: The clinical end point is the appearance of time, as well as the benefit of treatment with calcium, vitamin new bone fracture. D and drugs if there is osteoporosis. Cohort follow-up: All patients are prospectively followed up Material and methods: Design: Prospective cohort study. until the onset of a new fracture, until their death or until the Population to study: Patients undergoing bariatric surgery in a study closes. hospital in Zaragoza. These patients are controlled at the en- Follow-up period: Start of follow-up in January 2006 and last docrinology clinic specialized in bariatric surgery. patient included with term or treatment in October 2014. The Basal Variables: For each patient the following variables: minimum observation period is 4 years after the end of treat- -Clinical variables: Age, sex, tall, Smoking, weight, physical ment with teriparatide. To say that all the patients who re- activity, BMD, treatments for osteoporosis, calcium and / or ceived this treatment, were treated with intravenous vitamin D. S334 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 -Biochemical variables: PTH, calcium, phosphorous, urea, (HA) in concentration of 30% and tricalcium phosphate (TCP) creatinine, Alkaline phosphatase, albumin, magnesium, uri- of 70% was implanted in the bone defect of greater trochanter nary calcium and urinary phosphorus. in 7 rabbits (group C), while HA (30%) and TCP (70%) alone Cohort follow-up: A prospective follow-up of all patients un- in 7 rabbits (group D). Bone defect was left for spontaneous dergoing bariatric surgery is performed. BMD is performed healing in 9 rabbits (group E). Bone samples were taken 12 after the intervention and every 2 years to see the evolution. It weeks after surgery. Histomorphological analysis was will be supplemented with calcium and vitamin D, maintain- done to measure bone volume of trabecular field. ing them at normal serum levels (Calcium: 8'4-10'2 mg / dL Immunohistochemistry was performed to evaluate appear- and vitamin D> 30). ance of osteoprotegerin (OPG). Follow-up period: Start of follow-up in September 2016. Results: Bone volume analysis proved experimentally in- Statistical methods: Quantitative variables will be described duced osteoporosis. Mean trabecular field was higher in group by their means and standard deviation or by their median and A (0.41mm2, SD±0.04, p<0.05, rs>0.72) with comparison to the qualitative through frequency distribution. The compari- group B (0.12mm2, SD±0.07), group C (0.24mm2, SD±0.06), son of quantitative variables will be done by student t for group D (0.23mm2, SD±0.04) and group E (0.21mm2, SD independent samples and that of qualitative variables by chi ±0.08). Group C, D and E showed similar results without square, with linear trend test where appropriate. strong statistical correlation (p>0.05, rs<0.34). Detectable Results: In phase of data collection. changes of expression level of OPG were found. Numerous Discussion: Alterations in bone metabolism such as vitamin OPG positive cells appeared in group A. Groups B, D and E D deficiency, calcium malabsorption and secondary hyper- showed only moderate amount of immunostaining positive parathyroidism are frequent after bariatric surgery. In addi- cells with no difference among them, whereas group C notice- tion, there is a marked increase in bone remodeling and a loss ably recurred to the same level as healthy bone (p<0.05, of bone density following surgery which could be linked U>6.5). Numerous OPG positive cells were found around proportionally to weight loss. It would be of interest to know the strontium doped granules. and quantify, with objective data, the evolution of the bone Conclusion: No considerable difference of bone volume in density of these patients, as well as the speed of osteoporotic traumatized bone and such with biomaterials emperoamiento of the same. Another question to be evaluated proves almost equal influence of biomaterial and trauma on would be the cost-effectiveness benefit of an osteoformer / the bone regeneration and indicates the necessity for osteoprotective treatment at initial stages as primary preven- prolonged time of experiment. However, the notable increase tion added to the already established supplementation with of OPG-containing cells proves the increase of osteoclasto- calcium and vitamin D. genesis suppression and gives the evidence for renew of bone functionality. Acknowledgment: National Research Program No. 2014.10- P524 4/VPP-3/21. Project No. 4 and Department of Morphology, BONE ANALYSIS OF STRONTIUM DOPED BIO- Riga Stradins University, Latvia MATERIALS IN OSTEOPOROTIC RABBITS: COM- PARISON BETWEEN HEALTHY, OSTEOPOROTIC AND TRAUMA AFFECTED BONE P525 J. Zarins1, M. Pilmane2,E.Sidhoma2,I.Salma3 A CLINICAL CASE OF OSTEOPOROSIS, HYPER- 1Department of Hand and Plastic Surgery, Microsurgery THYROIDISM AND CONGESTIVE HEART FAILURE Centre of Latvia, Riga Stradins University, Riga, Latvia, IN A MAN 2Institute of Anatomy and Anthropology, Riga Stradins R. Petris1,A.Mirica1,S.Paun2,R.Mirica3,C.Poiana1,D.L. University, Riga, Latvia, 3Department of Oral and Paun4 Maxillofacial Surgery, Riga Stradins University, Riga, Latvia 1National Institute of Endocrinology "C.I. Parhon", Bucharest, Romania, 2Emergengcy Hospital Floreasca, Objectives: To evaluate bone regenerative properties in oste- Bucharest, Romania, 3Saint John Emergency Hospital, oporotic rabbits’ bone defect filled with and without strontium Bucharest, Romania, 4U.M.F "Carol Davila", Bucharest, (Sr) doped biomaterials and compare between healthy, osteo- Romania porotic and trauma affected bone. Material and methods: Intact bone of 4 healthy rabbits were We present the clinical case of a 73 year old man recently set as standard (group A). Experimental group consisted of 27 diagnosed with congestive heart failure who was submitted matured female rabbits. Osteoporosis was induced by ovari- for endocrinological evaluation in the context of a suppressed ectomy and administration of glucocorticosteroids. Four rab- TSH. Patient also has a recent medical history of hip fracture bits were set as osteoporotic group B. Sr doped hydroxyapatite and no familial medical history. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S335 Results: Hormonal evaluation indicated a suppressed TSH osteodensitometry; seven of them had osteoporosis and (TSH<0,01) with normal fT4 and ATPO. Ultrasound of the three patients - osteopenia. 3 patients received treatment thyroid reveled a hypoechoic macronodule in the left with bisphosphonates (alendronic and zoledronic acids) thyroidian lobe, 5/3,44 cm with hypoechoic halo and in- and 1 patient with denosumab. Four patients received vita- creased vascularity on Doppler. Furthermore, the assess- min D and calcium supplementation during a period of 1 to ment of bone mineral density on DXA showed a T score: 8 years. Four patients did not receive any treatment even -0,4 DS at lumbar spine and -2,6 DS at the left hip. after the diagnosis of osteoporosis. 20 (19.8%) patients 25(OH)Vit D was low (10,71 ng/ml) with normal PTH, were current smokers. 29 (28.7%) patients had smoked in osteocalcin, cross laps and low normal serum calcium.(8,6 the past. The cumulative duration of smoking was 20.6 mg/dl, normal range: 8,6-10,2 mg/dl). In addition, blood ±17.7 years. 11 patients (10.8%) consumed alcohol bever- analyzes indicated normocyte normochromic anemia with ages once in a week, two patients consume alcoholic drinks elevated levels of cholesterol. 3-7 times a week. The others consumed alcohol episodical- Discussion: Laboratory analyzes and investigations has sug- ly. 8 patients (7.9%) received glucocorticoids for a long gested the diagnosis of hyperthyroidism, osteoporosis and period of time. None of them was consulted about the risk congestive heart failure. Patient started therapy with antithy- of osteoporosis. 25 patients (24.7%) had spontaneous falls roid drugs, Alendronate, Vitamin D, calcium and continued in the past year. The average number of falls was 3.2±2.2. therapy with diuretics, beta blockers, statins and antiplatelet The majority of the patients had concomitant diseases. 31 drugs with indication of thyroidectomy. Patients with HF (30.6%) had ischemic heart disease, 54 patients (53.4%) - (heart failure) have a poor physical performance and a higher hypertensive disease. 18 (17.8%) patients had congestive frailty score and the association between heart failure and heart failure. 7 patients (6.9%) were diagnosed with chron- lower BMD (bone mineral density) is known. .In addition ic kidney disease. 18 patients (17.8%) had a diagnosis of our patient also has hyperthyroidism which contributed to cerebrovascular insufficiency. low BMD. Conclusion: Patients with low-energy fractures were not ex- Conclusion: We reported the case of a 73 year-old man diag- amined properly and did not receive appropriate therapy be- nosed with toxic thyroidian nodule, osteoporosis and conges- fore the fracture. Moreover, patients demonstrated significant tive heart failure in which hyperthyroidism and congestive comorbidity that complicated their further therapy and heart failure definitively contributed to osteoporosis and hip rehabilitation. fracture. P527 P526 THE FUNCTIONAL CHARACTERISTICS OF THE THE SCOPE OF THE TESTING AND TREATMENT PATIENTS WITH LOW-ENERGY FRACTURES FOR OSTEOPOROSIS AND ITS COMPLICATIONS D. M. Krutko1,S.O.Mazurenko1, E. M. Gainutdinova1,T.S. IN PATIENTS WITH LOW-ENERGY FRACTURES Maltseva1 D. M. Krutko1,S.O.Mazurenko1, E. M. Gainutdinova1,T.S. 1Saint Petersburg State University, Saint Petersburg, Russian Maltseva1 Federation 1Saint Petersburg State University, Saint Petersburg, Russian Federation Objectives: An assessment of the functional characteris- tics of patients admitted to a hospital with low-energy Objectives: An assessment of osteoporosis risk factors and fracture. the level of anti-osteoporotic treatment, and osteoporosis de- Materials and methods: The study group consisted of 101 tection coverage in patients suffering from low-energy frac- patients (77 women) admitted to Injury Treatment and tures. Evaluation of the prevalence of the osteoporosis risk Orthopedics Center of St. George Hospital (Saint factors and patients’ comorbidity. Petersburg, Russia) with low-energy fractures. The aver- Materials and methods: The study group included 101 pa- age age was 63.7 (17.1 SD) years. Patients were given tients (77 women) with new low-energy fractures admitted to self-complete questionnaires. We used the EQ-5D-5L the Injury Treatment and Orthopedics Center of St. George questionnaire to assess the level of physical activity be- Hospital, Saint-Petersburg, Russia. The average age of pa- fore the last fracture, mobility, self-care, usual activities, tients was 63.7±7.1 years. pain/discomfort, and anxiety/depression. The level of Results: According to the interview, 32 patients (31.6%) physical activity was assessed by the original six-point had at least one low-energy fracture in the past. Only five questionnaire. patients (15.6%) with previous low-energy fractures were Results: The results of the EQ-5D-5L questionnaire are properly examined. 11 patients (10.8%) had results of shown in the Table. S336 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 the last dose of KRN23 in the previous studies to enrollment in this study was > 12 months in all subjects. Results: Twenty subjects enrolled. The mean age was 49.8 years (range 23-69) at extension study entry and 70% were female. Mean serum phosphorus increased from 1.89 mg/dL (0.61 mmol/L) at baseline to an average of 3.31 mg/dL (1.07 mmol/L) at visits corresponding to the midpoint of the dosing interval (i.e., Weeks 2, 6, and 10). KRN23 treatment for 24 Patients’ self-rated health evaluated with the EQ visual analog weeks produced statistically significant (p<0.03) improve- scale (VAS) shows normal distribution with the mean 57.8 ment from baseline in the severity of pain and stiffness and (SD 21.7). We assessed patients’ physical activity with the in physical functioning as measured by the Brief Pain original questionnaire. Only 1 patient was bed-ridden. 8.1% Inventory(BPI)andtheWesternOntarioandMcMaster of patients showed mobility within patients’ home. The ma- Universities Osteoarthritis Index (WOMAC). Significant im- jority (39.4%) limited their activity to walking from home to/ provements in the six-minute walk test (6MWT; +25 m; from workplace or local stores. The second largest part of p=0.047) and timed up and go test (TUG; -2.0 s; p=0.042) patients (33.3%) went for a walk for at least two hours daily. were observed in the overall population at Week 24. In sub- 16.2% of patients performed physical exercises additionally, group analyses, subjects with the greatest improvement from and only 2% of patients had labour intensive job or performed baseline to Week 24 in pain (≥2-point reduction in worst pain constant gym trainings. on BPI; n=9) and stiffness (decrease ≥10.0 on WOMAC Conclusion: The results showed decline of the patients’ func- Stiffness; n=12) also had the greatest improvement in the tional status, high level of the pain, but not high levels of 6MWT (+40.2 and +40.9 m, respectively) and TUG (-2.7 anxiety/depression. Self-rated health evaluations with VAS and -3.7 s, respectively). There were no significant safety demonstrated average values with almost half of the answers findings with KRN23 treatment in this study, with a similar reaching 40-60 points. Patients demonstrated low levels of safety profile as in previous studies in adults with XLH. physical activity. More than a third of the patients restricted Conclusions: KRN23 treatment Q4W significantly improved their physical activity to the walking from home to workplace/ phosphate homeostasis, patient reported outcomes, and mo- local stores, and another third restricted their physical activity bility in these adult subjects with XLH. to walking 2 hours per day. Disclosures: TC: grant support, travel fees from Ultragenyx (UGX); MP: none; TJW: travel fees, consultant UGX; AP: travel fees, advisory panel; KI: none; EI: research grants, trav- P528 el fees, consulting; DL, CTO, MM, JSM: UGX employees; EFFICACY AND SAFETY OF KRN23 IN ADULTS MR: advisory panel UGX; H Zoog, PhD, of UGX provided WITH X-LINKED HYPOPHOSPHATEMIA (XLH): medical writing assistance. DATA FROM A PHASE 2 EXTENSION STUDY T. Carpenter1, M. Peacock2,T.Weber3,A.Portale4,K. Insogna1,E.Imel5,D.Luca6,C.Theodore-Oklota6,M. P529 Mealiffe6, J. San Martin6, M. Ruppe7 IMPACT OF NEUROPATHIC PAIN ON HEALTH 1Yale University School of Medicine, New Haven, United RELATED QUALITY OF LIFE AND DISABILITY IN States, 2Indiana University School of Medicine, Indianapolis, PATIENTS WITH CHRONIC LOW BACK PAIN United States, 3Duke University, Durham, United States, B. Kesikburun1, N. Tezel1, N. Gulgonul1,E.Ekşioğlu1,A. 4University of California, San Francisco, San Francisco, CA, Cakcı1 United States, 5Indiana University School of Medicine, 1Dışkapı Yıldırım Beyazıt Training and Research Hospital, Indianapolis, United States, 6Ultragenyx Pharmaceutical Inc, Department of Physical Medicine and Rehabilitation, Novato, United States, 7Houston Methodist Hospital, Ankara, Turkey Houston, United States Objectives: The aim of this study was to evaluate the frequency Objectives: To evaluate the long-term safety, pharmacody- of neuropathic pain and determine its impact on health related namics (PD), and efficacy of KRN23, an investigational anti- quality of life and disability in chronic low back pain patients. body against FGF23, in adults with XLH. Methods: A total of 120 chronic low back patients participat- Materials and Methods: Adult participants with XLH who ed in the study. Clinical and demographic data were collected. were previously enrolled in the Phase 1/2 studies of KRN23, Those who had low back pain were asked about duration, were enrolled in an open-label extension study and received severity of pain and location including axial low back pain KRN23 every 4 weeks (Q4W) for 24 weeks. The time from and with or without associated leg pain. Severity of pain was Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S337 assessed by using the visual analogue scale (VAS) ranging Results: Examination revealed tenderness on thoracic, lum- from 0 mm (no pain) to 10 mm (worst pain). Low back pain bosacral spine and ribs. associated disability was measured by Oswestry Disability An X-ray of the spine showed multiple vertebral fractures of v Index. Leeds assessment of neuropathic symptom and signs Th 5,6,7,8, and v L2,3 described as osteoporotic. Standard pain (LANSS) scale was used to determine neuropathic pain. laboratory analysis were normal. DXA vL1-4 T- score -2,5 The impact of low back pain on health related quality of life and total hip T- score -2,0. We started treatment with measured using Short Form-36 was investigated. bisphosphonates ant painkillers and continued investigations. Results: 49 patients (40.8%) had neuropathic pain. Age and Bone scintigraphy revealed multiple areas of increased activ- radicular low back pain were associated with neuropathic pain ity suspicious for osteolytic lesions in spine end ribs. We (p=0.016 and p<0.001, respectively). Oswestry Disability consulted orthopedic surgeon, endocrinologist, urologist, gas- score in patients with neuropathic pain was worse than that troenterologist, oncologist- normal findings of chest RTG, in those without neuropathic pain (p<0.001). Patients with echosonography of abdomen and urinary tract, gastroscopy, neuropathic pain had lower physical function, body pain, gen- colonoscopy, tumor markers, and finally hematologist who eral health and physical component subscales of short form– performed bone marrow biopsy. Results showed increased 36 in comparison with those without neuropathic pain atypical lymphocyte infiltration immunophenotype BCL 2+ (p=0.043; p<0.001; p=0.012; p<0.001, respectively). ,CD20 20%, CD10-, BCL6-, MUM1+, CD138-, CD23-, Conclusion: Presence of neuropathic pain was found related Cyclin D1-, CD5-, CD3-, CD117+, IgM+, IgG±, IgD-, IgA-, with poor health related quality of life and disability. Older age IgE-, DBA 44-, CD56- and diagnosis were finally established, and presence of radicular pain were associated with neuro- and treated with CHOP protocol. pathic involvement in chronic low back pain. Conclusion: Primary bone lymphomas are rare, about 3- 5% bone tumors. We wanted to show our diagnostic di- lemmas and investigations we performed in male patient P530 with osteoporosis when secondary osteoporosis is strongly OSTEOPOROSIS WITH OSTEOPOROTIC F RACTURES suspected. AS THE ONLY SYMPTOM OF INTRAOSSEUS NON HODGKIN LYMPHOMA: CASE REPORT S. Subin-Teodosijevic1, J. Zvekic-Svorcan2,T.Jankovic2,K. P531 Filipovic2 EFFECTS OF KRN23, AN ANTI-FGF23 ANTIBODY, IN 1Rheumatology, General Hospital, Zrenjanin, Serbia, PATIENTS WITH TUMOR-INDUCED OSTEOMALACIA 2University of Novi sad, Faculty of Medicine, Special OR EPIDERMAL NEVUS SYNDROME-ASSOCIATED Hospital for Rheumatic Diseases, Novi Sad, Serbia OSTEOMALACIA: INTERIM RESULTS FROM A PHASE 2 STUDY Objective: Primary lymphoma of bone is lymphoma arising T. Carpenter1, P. D. Miller2, T. Weber3,M.Peacock4,M. within the medullar cavity without lymph node and organ Ruppe5,K.Insogna1,D.Luca6,A.Skrinar6, J. San Martin6, involvement. Among primary lymphomas of bone diffuse S. Jan de Beur7 large B-cell lymphoma accounts for the greatest percentage 1Yale University School of Medicine, New Haven, United of cases. Symptoms are aching bone pain, sometimes local States, 2Colorado Center for Bone Research, Lakewood, swelling, with male predilection, mostly reported in the age CO, United States, 3Duke University, Durham, United of 60 years and above, and in 25% cases there are bone States, 4Indiana University School of Medicine, pathological fractures, more common at appendicular than Indianapolis, United States, 5Houston Methodist Hospital, axial skeleton. In contrast to the classical manifestations of Houston, United States, 6Ultragenyx Pharmaceutical Inc, patients with non-bone lymphoma, symptoms, including fe- Novato, United States, 7Johns Hopkins University School of ver, loss of body weight and night sweating, are rarely not- Medicine, Baltimore, United States ed. X- Ray appearance are usually pathological fractures, what can be interpreted like osteoporotic features, then per- Objective: To evaluate the effect of investigational KRN23, a meate pattern of bone lyses and destruction. In differential fully-human mAb against FGF23, on phosphate homeostasis diagnosis- osteosarcoma, Ewing's sarcoma, osteomyelitis, and osteomalacia in adults with epidermal nevus syndrome metastatic disease- needs to be eliminated. Definitive diag- (ENS)-associated osteomalacia or persistent tumor-induced nosis includes bone biopsy with immunohistochemical osteomalacia (TIO). analysis. Materials and Methods: In this ongoing Phase 2 study, sub- Material and Methods: We present a case of a 59-year-old jects receive SC KRN23 (0.3-2.0 mg/kg) every 4 weeks (w). male who came to our clinic with complaints of back and rib Interim data were obtained for 8 subjects (7 TIO, 1 ENS) who pain with 6 months duration. have completed ≥24 w of therapy. S338 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Mean age at entry was 52 y, and time since symp- Materials and Methods: We searched PubMed, Embase, tomsbeganrangedfrom~3to37y.Meanbaseline(BL) CAB Abstracts, CINAHL, Global Health, and 8 databases serum phosphorus (Pi) was 0.55 mmol/L (range: 0.32-0.97; for studies reporting national average dietary calcium intake normal: 0.81-1.29). Serum intact FGF23 ranged from 94 to in adults. We prioritized larger population surveys conducted 2569 pg/mL (median: 288.5; normal: 10-62). Osteomalacia since 2000 but included older or smaller studies, convenience was present in all evaluable BL iliac crest bone biopsies samples, or subpopulations, as necessary. We excluded studies (n=5). Mean serum Pi increased by 0.29 mmol/L, from of children, institutionalized adults, those with comorbidities, 0.55 mmol/L at BL to 0.84 mmol/L at W24 (p<0.0001), and pregnant or lactating women. We extracted mean or me- accompanied by increases in TmP/GFR (BL=1.39 mg/dL, dian (and range or SD) dietary calcium intake for the total W24=2.25; p=0.0002) and serum 1,25(OH)2 D sample and subgroups by age, sex, and socioeconomic factors (BL=24.8 pg/mL, W24=47.6; p=0.003). Mean serum (e.g., wealth, urban vs. rural). P1NP increased by 60%, from 79.1 ng/mL at BL to Results: We have screened 17,137 abstracts and retrieved 111.7 ng/mL at W24 (p=0.01). Mean serum CTx increased about 350 articles. To date, we have data for 62 countries, by 42%, from 0.5 ng/mL to 0.8 ng/mL (p=0.01). One sub- mostly from Europe, South and Southeast Asia, Africa, ject had bone biopsy results available at both BL and W48, Latin America, and the Middle East. From national data, mean which showed improvement from severe to mild osteoma- dietary calcium intake ranged from 288 mg (Nigeria) to lacia. Osteoid thickness decreased from to 16.5 μmatBLto 1151 mg (Netherlands). The 5 lowest estimates of mean die- 9.9 μm at W48, OS/BS decreased from 94% to 75%, and tary calcium intake (<350 mg/d) are from India, Thailand OV/BV decreased from 21% to 10%. Through W24, (women), Nigeria, South Korea, and Malawi. Nine countries treatment-emergent adverse events (TEAEs) were observed had mean intake >1000 mg/d (from Europe or Canada). in all 8 subjects and were frequently musculoskeletal; 2 Within countries, men’s intake tended to be higher. No clear subjects had TEAEs of restless leg syndrome. One serious pattern of mean intake by age is evident. In 3 countries, intake TEAE, neoplasm progression in a subject with preexisting was higher in urban than rural dwellers. metastatic sarcoma, was reported. Conclusions: Dietary calcium intake varies widely across the Conclusions: KRN23 treatment for 24 w improved serum Pi, globe, with lowest intakes in Asia, Africa, and lower income TmP/GFR, and 1,25(OH)2D in subjects with TIO or ENS- countries and highest intakes in Europe and higher income associated osteomalacia. Bone turnover markers also were countries. Average intake is usually higher among men than increased. KRN23 treatment resulted in a marked improve- women. Data from this systematic review will support an in- ment in osteomalacia in the subject who had available BL teractive, global map of average dietary calcium intake. and W48 biopsy results. Acknowledgment: E Gaynor (Ultragenyx [UGX]) provided medical writing support. P533 Disclosures: TC: grant support, travel fees from UGX; PDM: TRABECULAR BONE SCORE IN PATIENTS WITH advisory board, research grants from UGX; TJW: travel fees, RHEUMATOID ARTHRITIS ASSOCIATION WITH honoraria from UGX; MR: advisory board for UGX; SJdB: BONE MINERAL DENSITY AND CLINICAL RISK UGX consultant; DL, AS, JSM: UGX employees FACTORS M. Punda1,S.Grazio2,F.Grubisic2, H. Skala Kavanagh2,I. Doko2,L.Bolic3, M. Bosak Butkovic1,Z.Kusic1 P532 1Department of Oncology and Nuclear Medicine, UHC EVIDENCE TO SUPPORT A GLOBAL MAP OF DIETARY Sisters of Mercy, Zagreb, Croatia, 2Department of CALCIUM INTAKE BY COUNTRY AND SUBGROUPS Rheumatology, Physical and Rehabilitation Medicine, UHC E. M. Balk1, G. P. Adam1, V. N. Langberg1, A. Earley2 Sisters of Mercy, Zagreb, Croatia, 3General Hospital “Dr Ivo 1Center for Evidence Synthesis in Health, Brown University Pedisic”,Sisak,Croatia School of Public Health, Providence, Rhode Island, United States, 2Bacco Reviews, Boston, Massachusetts, United Objectives: Rheumatoid arthritis (RA) is associated with an States increased risk of osteoporosis and fractures. The aim of the study was to determine bone microarchitecture in RA patients Objectives: Globally, there is concern that low calcium intake using trabecular bone score (TBS) in relationship with bone across the population is adversely affecting bone health. To mineral density (BMD) as well as to identify clinical factors better understand the current status of dietary calcium intake associated with low TBS. around the world, the International Osteoporosis Foundation Materials and methods: The study included 60 female pa- commissioned a systematic review of the evidence for average tients with RA who fulfilled the ACR/EULAR criteria. RA- dietary calcium intake by country. related and osteoporosis risk factor data were obtained for Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S339 each patient. Spine and hip BMD were assessed by dual- controls and more costly treatments then after. We suggest energy X-ray absorptiometry. TBS was calculated from baseline and minimal BMD assessment as follows especially anteroposterior image of lumbar spine BMD. for postmenopausal women: At years 40- 50- 60- 65- 70- 75 Results: The patients aged 68.32±9.58 (mean, SD) yrs, while (average 6 time per person). This protocol makes treatment the mean duration of RA was 11.75±10.49 yrs. Osteoporosis strategies much more efficient when applied earlier. (T-score ≤ -2.5) was detected in 22 patients (36.7%) and 16 (26.7%) reported non-traumatic fracture. Thirty-eight patients (64.4%) were currently treated with low-dose systemic gluco- P535 corticoids (GCs) and 12 (20%) were receiving specific osteo- FRAX IN PATIENTS WITH STROKE porosis drugs. The patients were divided into tertiles accord- S. Tomasevic-Todorovic1, K. Boskovic1, A. Knežević1,D. ing to TBS results (1.29±0.09). Those with TBS in the lowest Simić-Panić1,D.Petrovic2,J.Ivacic3 tertile (TBS ≤ 1.25, n=20) were compared with patients with a 1Medical Faculty, University of Novi Sad, Novi Sad, Serbia, TBS in the 2 upper tertiles (TBS > 1.25, n=40). In univariate 2Clinic for Medical Rehabilitation, Clinical Center of analysis patients with low TBS (≤ 1.25) had higher body mass Vojvodina, Novi Sad, Serbia, 3Physical Medicine and index (BMI) (p=0.036) and lower bone density parameters: Rehabilitation, General Hospital, Senta, Serbia total hip BMD (p=0.020), total hip T-score (p=0.021), and total L1-L4 BMD (p=0.049). Although low TBS values Objective: To determine the risk factors for osteoporosis and showed trends of association toward higher CRP/ESR as well fractures in patients after stroke. as with TBS FRAX HF/FRAX MOF and high TBS with Materials and Methods: A cross-sectional study, included currently used specific osteoporosis therapy, Ca and vitamin 56 female patients with stroke (an average age of 68,279 D supplements the results did not reach significance. No as- ±9.3 yrs), who were treated at Medical Rehabilitation sociation was observed between low TBS and age, duration of Clinic, Clinical Center of Vojvodina during 2015 yr. Data the disease, previous non-traumatic fractures, menopause du- were gathered by the means of anamnesis and available ration, or use of GCs. medical documentation. Lunar densitometer was used to Conclusion: In this study of female patients with RA a low determine BMD (bone mineral density in g / cm 2). By TBS strongly correlated with lower BMD and with higher applying the FRAX (Fracture Risk Assessment) calculator BMI. Our results did not show significant association between we are define a ten-year risk of hip fracture and major TBS values and some other verified risk factors for osteopo- osteoporotic fractures. rotic fractures. Further studies including more patients are Results: The most prevalent impairment was right-sided needed to confirm the place of TBS in assessing the fracture hemiparesis (N-30;53.6%). The most common risk factor risk in patients with RA. for stroke was arterial hypertension 45 (37.2%). Based on collected data, the study of risk factors for osteoporosis fractures after stroke, patients were divided into three P534 groups. The first group was composed of people with THE OPTIMUM TIME FOR INITIATION OF osteoporosis and with a history of fracture 10 (17.8%), OSTEOPOROSIS SCREENING the second group of people with osteoporosis without os- M. Owlia1 teoporotic fractures 14 (25%) and the third group was 1Medicine, Shahid Sadoughi University of Medical Sciences, composed of people without osteoporosis 32 (57.1%). Yazd, Islamic Republic of Iran Resultsshowedthatonly15(58%)patientswithosteopo- rosis after stroke was active 30-60 minutes a day. The Main objective in osteoporosis (OP) screening is finding the average age at which menopause in women started was ideal point to detect and treat it. The present guidelines suggest 44±4.189 years. We have found no statistically significant initiation of OP screening in a risk factor-naive people in 65 differences between the total bone mineral density of the years of age for postmenopausal women and 55 for who have femur and lumbar spine between stroke patients with and some risk factors. Repeat OP scanning with 2 years interval is without osteoporotic fractures (p 0.05). In our research, suggested then after in most instances. OP is a silent pathology we found statistically significant difference in the degree and imaging techniques are the most feasible tool for early of fracture risk for a major osteoporotic fracture between diagnosis. Considering the critical years just after peak bone the group of patients after stroke with osteoporotic frac- mass i.e. after around 40 years of age, we think that the start tures (moderate), and the group of patients after stroke point should be shifted to that years for all men and women without osteoporotic fractures (low) and in the control without the evident risk factor. From the economic/ cost point group (p 0.05). The degree of fracture risk for hip frac- of view, we showed that this "early initial screening" bone ture among the groups of patients with stroke was low. densitometry could offset the unnecessary highly frequent We have no found that there are significant differences in S340 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 the degree of fracture risk (FR) for hip fracture among P537 patients after stroke with osteoporotic fractures and with- CHANGE IN WELLBEING AND HEALTH-RELATED out them (p 0.05). QUALITY OF LIFE FOLLOWING A FRAGILITY Conclusion: The results show that the most common risk FRACTURE: AUSICUROS factors for osteoporosis and fractures were: reduced daily K. M. Sanders1,G.C.Nicholson2,E.Seeman3,G.Duque4,R. physical activity and early menopause. The patients after L. Prince5, L. March6, T. Winzenberg7, P. R. Ebeling8,F. stroke with previous fractures had a significantly higher Borgström9, J. J. Watts10 fracture risk for hip fracture and a major osteoporotic frac- 1Institute for Health and Ageing, Australian Catholic ture compared to patients with normal bone mineral University, Melbourne, Australia, 2Rural Clinical School, density. The University of Queensland, Toowoomba, Australia, 3Austin Health, University of Melbourne, Melbourne, Australia, 4Australian Institute for Musculoskeletal Science P536 (AIMSS), Melbourne Medical School, The University of PREVALENCE OF DELIRIUM AND DEMENTIA: Melbourne and Western Health, St Albans, Australia, DETECT (DELIRIUM AND DEMENTIA IN ELDERLY 5School of Medicine and Pharmacology, Nedlands, PATIENTS ADMITTED TO TRAUMA) STUDY Australia, 6University of Sydney Institute of Bone and Joint S. Gupta1,A.Gupta2 Research, Royal North Shore Hospital, Sydney, Australia, 1Psychiatry, Birmingham, United Kingdom, 2Glangwili 7University of Tasmania, Hobart, Australia, 8Department of Hospital, Carmarthen, United Kingdom Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia, 9Quantify Objective: Delirium is common in orthogeriatric hip fracture Research, Stockholm, Sweden, 10Centre for Population osteoporotic population and has impact on outcomes follow- Health Research, School of Health and Social Development, ing surgery hence early detection and management is impor- Faculty of Health, Deakin University, Melbourne, Australia tant. Hip fractures occurs in elderly and dementia is common condition. We took a prospective observational study- Objective: To compare the change in wellbeing using a capa- DETEcT to evaluate the prevalence of dementia and delirium bility instrument and health-related quality of life (HRQOL) and its association with risk factors. in 809 Australian adults with a fragility fracture (Fx) during 18 Materials and methods: Patients aged above 50 years admit- months. ted with hip fractures to trauma ward were included. Material and Methods: Wellbeing and HRQOL data were Following admission data was collected on demographics, obtained prospectively using ICECAP-O and EQ5D-3L re- cognitive status (AMT4) functional status, number of medica- spectively from adults aged 50+ years within 2 weeks of a tions, comorbid conditions, postoperative complications, de- fracture, at 4, 12 and 18 months from patients in 8 locations lay to surgery, use of fascia-iliaca block. Nursing staff were across Australia. Wellbeing was determined by ICECAP mea- educated and instructed to use tools. Delirium was identified suring a person’s capacity (1 of 4 levels) to achieve 5 attri- by 4ATscore done on day 3 or 4 postoperatively. 4AT Scores butes: attachment, role, enjoyment, security and control. We >4 suggested delirium, 1-3 suggested possible cognitive im- examined changes and predictors of the ICECAP and EQ5D pairment, score 0 was normal. for all fractures and by fracture type (hip, wrist and vertebral). Results: Out of total 140 patients mean age 81 years 75% Results: There was a rapid fall in wellbeing and HRQOL at 4 were females. Postoperative delirium based on 4AT score >4 months. Both improve by 12 months, but do not return to pre- was identified in 30% patients. The incidence increased with fracture levels by 18 months except for HRQOL for wrist Fx. age, comorbidities, polypharmacy of more than 5 drugs, not However in contrast to HRQOL, a further decline in wellbeing receiving fascia-iliaca block, history of cognitive impairment. was observed between 12 and 18 months in patients with hip Cognitive impairment (based on AMT4 score) was prevalent and vertebral Fx. Both ICECAP and EQ5D were positively in 25% study population. correlated for all fracture types but the relationship was weak- Conclusions: 4AT and AMT4 are a quick and feasible test to er for hip Fx (Spearman’s correlation; rho=0.484, p<0.001). identify and screen for delirium and dementia even by the The greatest predictor for both wellbeing and HRQOL loss nursing staff. Delirium is common in admitted hip fracture was the baseline measure and fracture type. patients following surgery. Adequate control of perioperative Conclusions: Fx has an immediate and pronounced impact on assessment and management including risk factor control and both a broad measure of wellbeing and HRQOL which ex- early identification of delirium has the potential to improve tends over 18 months. The further decline of wellbeing 12 outcomes. Closer collaboration with mental health teams can months after hip or vertebral Fx is inconsistent with improve management of dementia in this frail elderly HRQOL and reflects the longer term impact of Fx on non- population. physical attributes of attachment, role, enjoyment, security Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S341 and control of one’s life. An increased focus on these aspects Discussions: Patients with SCA display lower T-score values of patient’s wellbeing may reverse this trend. for osteopenia and osteoporosis in lumbar spine(66 patients Disclosures: Funded by the Australian NHMRC and Merck 97.05%) compared to those of the distal radius (35 patients Ltd. PRE, ES and KMS are members of IOF committees. No 51.5%) and collum femori (47 patients 69.1%). T-score values authors report a conflict of interest. for both osteopenia and osteoporosis are lower on lumbar spine, then in collum femori and distal radius. T-score low values in lumbar spine are related to the highest rate of vaso-occlusive P538 crisis that experience these patients in this body region. BONE MASS DENSITY IN PATIENT WITH SICKLE Conclusions: SCA is a risk factor for osteoporosis develop- CELL ANEMIA ment in patients who suffer this haemoglobinopathy. It is nec- E. Rapushi1,3,T.Backa2,A.Zoto1, E. Zicishti1, L. Nuhaj1,V. essary for this patients to be the subjects of periodic bone Salko1,E.Xherahu1,E.Ktona1 BMD measurements. 1Service of Rheumatology, University Hospital Center, Tirana, Albania, 2Rheumatology Service UHC Mother Theresa Tirana, Tirana, Albania, 3Pediatry Service, Hygeia P539 Hospital, Tirana, Albania FAT DISTRIBUTION IN ELDERLY MEN: METABOLIC AND INFLAMMATORY PROFILES Background: Sickle cell anemia is an inherited genetic dis- E. Bani Hassan1,2,O.Demontiero3,M.F.G.Chan4,A.Ng4, order of haemoglobin synthesis. The bone involvement in this G. Duque1,2 pathology ranges from acute manifestations, such as painful 1Australian Institute for Musculoskeletal Science, The vaso-occlusive crisis or osteomyelitis, to more chronic and University of Melbourne and Western Health, St. Albans, debilitating complications, such as: osteonecrosis, osteoporo- Australia, 2Department of Medicine-Western Precinct, The sis and osteopenia, impaired growth and chronic infections. University of Melbourne, St. Albans, Australia, 3Sydney The skeletal manifestations of sickle cell disease result from Medical School Nepean, The University of Sydney, Sydney, changes in bone and bone marrow caused by chronic tissue Australia, 4Department of Endocrinology, Singapore General hypoxia, which is exacerbated by episodic occlusion of the Hospital and Mount Elizabeth Novena, Singapore microcirculation by the abnormal sickle cells. The main pro- cesses that lead to bone and joint destruction are as follows: Introduction and aims: Bone marrow (MAT) and subcuta- infarction of bone and bone marrow, compensatory bone mar- neous (SAT) adipose tissues display different inflammatory row hyperplasia, secondary osteomyelitis and secondary and metabolic behaviour in young and old mice (Gasparrini growth defects. et al, Exp Gerontol, 2009). In old mice, MATadipocytes show Objective: Evaluation of bone mass density (BMD) in patients anti-osteoblastogenic and pro-apoptotic phenotype and ex- with sickle cell anemia (SCA). press higher inflammatory cytokines. However, these differ- Methods: The subject of the study were 68 patients (29 fe- ences have not been assessed in humans. Using a non-invasive male 42.6%, 39 male 57.3%) diagnosed through haemoglobin imaging methodology we aimed to investigate the association electrophoresis with SCA, of age 18 – 39 years with the av- between MAT, SAT, visceral fat (VAT) with insulin resistance erage group of 28.5±3.3 years. There were excluded from the and circulating inflammatory mediators in a population of study the patients who were in premature menopause, those older Asian men. under hormonal treatment, the patients with metabolic dis- Materials and methods: Cross-sectional study of 120 eases and those with vertebral fractures and with the recon- healthy men (age: 67.7±6). Assessments included: anthropo- struction of the coxo-femoral art. All patients were evaluated metric parameters, full serum biochemistry panel, dual-energy the BMD through DXA (dual X-ray absorptiometry) at their X-ray absorptiometry (DXA) and abdominopelvic computed lumbar spine, collum femori and radial distal part. According tomography (CT). to the data results from the DXA, the patients were classified Using CT images MAT was quantified in L2 and L3 vertebra in osteopenic (T-score -1.0 – ≤ 2.5 SD) and osteoporotic (T- and left and right hip marrows; and VATand SATwere calcu- score ≥-2.5SD). lated at the level of L2 and L4. Insulin resistance index Results: The results from the DXAwere as follows according (HOMA-IR) was calculated. to T- score value in each and examined region. Results: MAT volume in all regions of interest (ROIs) was Region: Distal radius Lumbar spine Collum femori T- independent of BMI, VATand SAT. In all femoral ROIs there score result: Osteopenic 28 (80%) 22 (33.3%) 20 (42.5%) was a strong negative association between bone and fat vol- T-score -1.4±0.2 T-score -1.9±0.4 T-score -1.5 Osteoporotic 7 umes within and between ROIs (R=-0.80 to -0.95, p<0.001). (20%) 44 (66.6%) 27 (57.5%) T–score -2.8±.03 T-score -4.2 The correlations were moderate for the L2 and L3 vertebral ±0.5 T-score -3.1±0.5 ROIs (R=-0.27 to -0.43, p<0.001). S342 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Unlike VAT and SAT (R=0.25 to 0.59, P<0.008), MAT was Conclusions: Ankle function exhibited impairments in indi- not associated with insulin resistance indicators in any ROIs; viduals with knee osteoarthritis, especially in the plantar flex- except weakly in vertebrae (R=0.26 to 0.34, p<0.05). Of all ion strength in which the mild osteoarthritis group was weaker adipose tissues, only vertebral MAT volume was negatively than the control. Interestingly, individuals with moderate knee associated with inflammatory mediators IL1α, IL6 and TNFα osteoarthritis demonstrated results similar to the control group (R=-0.23 to -0.31, p<0.05). in plantar flexion strength. The results raise the possibility of a Discussion and conclusion: MAT displays different behav- compensatory mechanism of the plantar flexors developed by iour than other types of fat in older humans. Whereas the patients in more advanced degrees to balance other muscle negative correlation between MAT and bone mass was con- failures. firmed, high levels of MATwere associated with metabolic or Acknowledgments: For the support obtained from CAPES inflammatory markers in a location-dependent manner. scholarship. Further studies are warranted to explore the molecular nature of these findings. P541 ABNORMALITIES IN KNEE STRUCTURE AUSTRALIAN P540 RULES FOOTBALL PLAYERS: THE AFL TAS KNEE BIOMECHANICAL IMPAIRMENTS OF ANKLE STUDY ASSOCIATED WITH KNEE OSTEOARTHRITIS T. Winzenberg1,D.Aitken2,Y.C.Foong2,D.Humphries3,N. G. H. Gonçalves1, L. F. A. Selistre1, F. A. Sendín2,P.R.M.S. Pitchford4,H.Khan2,F.Abram5, J.-P. Pelletier6,J.Martel- Serrão1, C. Cristiano Carvalho1, M. Petrella1, S. M. Mattiello1 Pelletier6,X.Jin2,G.Jones2 1Federal University of São Carlos, São Carlos, Brazil, 1Menzies Institute for Medical Research and Faculty of 2University of Salamanca, Salamanca, Spain Health, University of Tasmania, Hobart, Australia, 2Menzies Institute for Medical Research, University of Tasmania, Objective: Knee Osteoarthritis seems to negatively impact Hobart, Australia, 3The Sports Medicine Practice, Hobart, ankle biomechanics. However, the effect of knee osteoarthritis Australia, 4Victoria University, Footscray, Australia, on ankle muscle torque has not been clearly established. The 5Medical Imaging Research and Development, ArthroLab objective of this study was to evaluate the muscular function Inc, Montreal, Canada, 6Osteoarthritis Research Unit, strength and muscle strength balance of the plantar flexors and University of Montreal Hospital Research Centre dorsiflexors of individuals with knee osteoarthritis in different (CRCHUM), Montreal, Quebec, Canada degrees of severity. Material and Methods: Thirty-seven individuals with knee Objectives: To determine the prevalence of knee structural osteoarthritis and 15 controls, subjected to clinical and radio- abnormalities in Australian Rules Football players, their rela- graphic analysis, were divided into three groups: control, tionship with knee pain and past knee injury, and the relation- mild, and moderate knee osteoarthritis. Participants answered ship between knee structure change and incident knee injuries. the Western Ontario and McMaster Universities Osteoarthritis Materials and Methods: 58 of 75 male players (aged 16-30 Index, and accomplished a muscle strength assessment of the years) from the Tasmanian State Football League underwent ankle using the Biodex dynamometer on isometric, concentric magnetic resonance imaging of both knees early in the season, (concentric/concentric) and eccentric (reactive eccentric) assessing cartilage defects, bone marrow lesions (BMLs), modes. The peak torque, total work and power were obtained meniscal tears/extrusion, and effusion. History of knee injury and processed using MatLab® (version 7.0.1, MathWorks and surgery and knee pain and function (VASand KOOS) and Inc, Natick, MA, USA). The relationship between plantar incident knee injuries were assessed. Measures were repeated flexion and dorsiflexion torques were calculated from the at the end of the season (3-5 months later). processed data. Results: Abnormalities were common at baseline (67% Results: The mild osteoarthritis group (peak torque=26.85 BMLs, 16% meniscal tear/extrusion, 43% cartilage defects, ±3.58) was significantly weaker than the control (peak 67% effusion). At baseline, presence of BMLs was associated torque=41.75±4.42) in concentric plantar flexion (P<0.05). with higher knee pain and dysfunction (VAS 3 vs. 17, P<0.01; The control and the mild osteoarthritis groups were not signif- KOOS 6 vs. 18, P=0.03) in the right but not left knee, and icantly different from the moderate osteoarthritis group (peak higher prevalence of previous knee injury and surgery (21% torque=36.12±4.61) in concentric plantar flexion. There were vs. 53%, P=0.01; 0% vs. 18%, P=0.03, respectively). no significant differences for dorsiflexion among the groups. Findings were similar for meniscal tears/extrusion. Previous The mild osteoarthritis group was significantly lower than the injury and previous surgery were more common in those with control and moderate osteoarthritis groups in the concentric an effusion and with cartilage defects respectively. Incident plantar flexion by concentric dorsiflexion torque ratio. knee injuries were associated with worsening knee pain and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S343 function (VAS -6 vs. 27, P<0.01; KOOS -5 vs. 21, P<0.01), kg, 95%confidence interval (CI):-0.01 to -0.006 and - presence of new or enlarging BMLs (22% vs. 67%, P<0.01) 0.006sec/kg:-0.009 to -0.003 for baseline and change respec- and incident cartilage defects (3% vs. 17%, P=0.03). tively), FRT (β=0.057cm/kg, 95%CI: 0.030 to 0.084 and Interestingly, knee abnormalities were also common in 0.071cm/kg: 0.042 to 0.101) and LRT (β=0.030cm/kg, asymptomatic players with no prior history of injury or sur- 95%CI: 0.012 to 0.049 and 0.022cm/kg:0.002 to 0.043) at gery (5-59%). 12 years. Baseline LMS but not change in LMS was associ- Conclusions: Structural abnormalities commonly seen in os- ated with ST (β=0.044steps/kg, 95%CI: 0.022 to 0.067 for teoarthritis are also common in sub-elite AFL players. Their baseline LMS). associations with pain, function, injury and surgery suggest Conclusions: Greater LMS in young women and slower de- they are clinically significant however, the implication for cline in LMS over time are both associated with better balance long-term knee health is unknown especially in asymptomatic in midlife. This is analogous to how both peak bone mass and players. bone loss contribute to fracture risk in older adults. It suggests Disclosures: JPP and JMP are shareholders in ArthroLab. FA that improving muscle strength in younger women and is an employee of ArthroLab. preventing age-related loss of muscle strength could both be potentially useful strategies to improve balance and reduce falls in later life. P542 BASELINE LOWER LIMB MUSCLE STRENGTH IN YOUNGER WOMEN AND ITS CHANGE IN OVER 12 P543 YEARS INDEPENDENTLY PREDICT BALANCE IN SARCO-OSTEOPENIA VS. SARCO-OSTEOPOROSIS: MIDDLE-AGE: DATA FROM A PROSPECTIVE TOWARDS A UNIFIED DEFINITION OF OSTEOSAR- POPULATION-BASED STUDY COPENIA T. Winzenberg1,F.Wu2,M.Callisaya3, K. Wills3,L.L. G. Duque1, P. Suriyaarachchi2,E.Bani-Hassan1,F.Gomez3, Laslett2,G.Jones3 C. L. Curcio3 1Menzies Institute for Medical Research and Faculty of 1Australian Institute for Musculoskeletal Science, The Health, University of Tasmania, Hobart, Australia, 2Menzies University of Melbourne and Western Health, St. Albans, Institute for Medical Research, Hobart, Australia, 3Menzies Australia, 2Sydney Medical School Nepean, The University Institute for Medical Research, University of Tasmania, of Sydney, Sydney, Australia, 3Universidad de Caldas, Hobart, Australia Manizales, Colombia Objectives: Little is known about which modifiable factors Introduction: In older persons, the combination of low bone affect balance in younger women, despite the importance of mass (osteopenia/osteoporosis) and sarcopenia has been pro- poor balance as a risk factor for falls and fracture in older posed as a subset of frailer individuals at higher risk of falls adults. The aim of this study was to examine the potential and fractures. However, unified criteria to define this syn- for lower limb muscle strength (LMS) to influence balance drome is still lacking. In this study, we aimed to compare the in younger people and specifically assess whether LMS in clinical, biochemical and imaging phenotype and prevalence young women and changes in LMS are both independent of poor outcomes (falls and fractures) in a population of older predictors of balance in middle-age. fallers classified as sarco-osteoporotic (SOP), sarco- Materials and Methods: This was an observational study osteopenic (Sop), and non-sarcopenic/non-osteopenic. following up women aged 25-44 years at baseline who were Methods: We assessed 344 individuals (79% females), previous participants in a 2-yr population-based randomised aged 52-99 years, who were referred to the Falls and controlled trial of osteoporosis education interventions. Ten Fractures Clinic at Nepean Hospital, Penrith (Australia). years after the completion of the trial, 347 women were BMD was determined using DXA, with osteopenia defined assessed measuring LMS (by dynamometer, also measured as a BMD between -1.0SD and -2.49SD and osteoporosis at baseline) and balance by the timed up and go test (TUG), as a BMD less than -2.5SD. Sarcopenia was determined by step test (ST), functional reach test (FRT) and lateral reach test fulfilment of at least two of the following criteria: appen- (LRT). Linear regression was used to examine associations dicular lean mass by height2 (ALM/ht2 method) <-2 SD between baseline LMS and its change over 12 years with compared to young individuals, gait velocity <0.8m/sec- balance measures at 12 years. ond and grip strength <20kg for females and <30kg for Results: There was a mean decline in LMS of 17.3 kg over 12 males. Chemistry profile included 25(OH)vitamin D, para- years. In multivariable models which were adjusted for poten- thyroid hormone, albumin, creatinine, calcium, phosphate, tial confounders, both baseline and change in LMS were in- vitamin B-12, folate and TSH for all patients, and serum dependently beneficially associated with TUG (β=-0.008sec/ testosterone in men. S344 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Osteopenia was present in 57% of those with recommendations. Taking into account indexes of BMI pa- sarcopenia (125/216). Osteoporosis was present in 42% of tients were divided into 3 groups: normal weight, overweight those with sarcopenia (91/216). Mean age of the Sop and and obesity. SOP were 79.7 and 81.3 years respectively. Univariate analy- Results: Among the patients of these groups the frequency of ses showed that both Sop and SOP were more likely than non- reduced BMD was 88,5% - 340 people (46% of osteoporosis - sarcopenic/non-osteopenic individuals to be female (OR 3.73, 177 people, osteopenia 42,5% - 163 people). Significant dif- CI95% 2.19 – 6.3, p<0.001), older (p<0.001), and significant- ferences in BMD rank in all three groups (p=0,004) and be- ly associated with arthropathy and poor mobility. Compared tween groups: normal weight – obesity were obtained. with Sop, multivariate analysis found age, female gender, de- Evaluation of BMD values at the lumbar spine is also charac- pression, higher nutritional risk, BMI <25, and history of pre- terized by the presence of significant differences between the vious fractures to be significantly associated with SOP. three groups (p≤0,001) and in groups: normal weight - obesity Compared to normal, SOP are at higher risk of fractures and overweight - obesity (p <0,05). Significant differences in (OR 4.268, CI95% 2.382 – 7.645, p<0.001). Both groups values of BMD of the proximal femur according to the BMI is showed a similar risk of falls. Biochemical and hormonal pro- not revealed. file showed no differences between SOP and Sop groups. Conclusions: The findings evidence a direct correlation of Conclusion: Sop and SOP are components of the same syn- indicators BMD of the lumbar spine in patients with OA of drome, which could be named as Osteosarcopenia. Both knee joints, and BMI. groups are at higher risk of falls. As expected, when suffering from both osteoporosis and sarcopenia, older patients are at higher risk of fractures. In conclusion, screening for P545 sarcopenia in those with osteopenia or osteoporosis – PREVALENCE OF SECONDARY HYPERPARA- indistinctively – would improve the diagnosis rates for those THYROIDISM IN PATIENTS WITH DIABETES with osteosarcopenia, allowing for improvements in the man- MELLITUS (DM) WITH CHRONIC KIDNEY agement of these individuals at very high risk for falls and DISEASE fractures. G. G. Akramova1, F. A. Takhirova1,N.S.Nazarova2,N.M. Alikhanova1, M. M. Shakirova1 1Republican Specialized Scientific-Practical Medical Centre P544 of Endocrinology, Tashkent, Uzbekistan, 2Tashkent Pediatric CHANGES OF BONE MINERAL DENSITY AT Medical Institute, Tashkent, Uzbekistan ELDERLY PATIENTS WITH THE OSTEOARTHRITIS OF KNEE JOINTS DEPENDING ON BODY MASS Objectives: Life expectancy of patients (Pts) with chronic INDEX kidney disease (CKD) has increased, recently. Renal M. N. Lobanov1,L.G.Grigoricheva1,A.V.Popovceva1 osteodystrophy occurs in CKD Pts when GFR is below 60- 1Federal State Budgetary Institution "Federal Center of 65 ml/min and is one of the complications of CKD. The ob- Traumatology, Orthopedics and Endoprosthesis jective of study was to estimate Ca-P M and osteoporosis (OP) Replacement" of the Ministry of Health of the Russian due to secondary hyperparathyroidism (SHT), developed in Federation, Barnaul, Russian Federation Pts with DM 1, 2 and CKD of 3-4 stages. Body mass index (BMI) is an important determinant that af- Materials and methods: Altogether, 730 Pts with DM 1,2 at fects the level of bone mineral density (BMD) of different 3-4 stage of CKD were examined. Total Ca, P, alkaline phos- skeletal sites. However, data on the relationship of BMI and phatase (AP), PTH levels - measured. Spinal and femoral change indices densitometry BMD in patients with osteoar- bones - examined by DXA densitometry. Obtained results - thritis (OA) are contradictory. analyzed statistically: quantitative indicators determined by Wilcoxon, qualitative - with Fisher-Irvine's test. Objectives: To estimate changes of BMD in elderly patients Results: GFR lower than 65 ml/min was in 264 Pts out of 839 with OA of knee joints, who received treatment in a special- Pts with DM 1,2 that comprised 31.5%. SHTwas diagnosed in ized hospital of a traumatology profile, depending on BMI. 75 Pts out of 264 Pts (30.2%). Frequency of SHT among Pts Materials and Methods: The analysis of BMD and calcula- with type 1 and 2 DM comprised 24% (n=18) and 76.0% tion of BMI in 384 patients with OA of knee joints of varying (n=57), correspondingly. Compared to the group of "SHT-", severity, aged from 65 to 83 years, mean age - 71,2±4,65 (335 changes of all values of P-Ca M, such as reduction of Ca, of them women – 87,2%, men 49 - 12,8%) were done. Patients increased P, AP, and PTH were in "SHT+" group. Average performed BMI calculation of the standard formula and dual- concentration of PTH in the "SHT+" group was 82.7 pg/ml, energy X-ray absorptiometry of the lumbar spine and proxi- total Ca - 1,9 mmol/L and P - 1.8 mmol; AP ranged 135-846 mal femur with a score of T-criterion, according to WHO U/L and 328 U/L on average. Prevalence of SHT showed that Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S345 it was more common in women (53.3%) than in men (46.6%), Results: Between-person effects showed that 10-year average although there was no significant difference. Pts with SHT falls risk was lower in participants who had a higher 10-year had either of bone mineral density disorders (BMDD): OPn average 25OHD (β=–0.005 per nmol/l, 95% CI: –0.008, – in 66,6% (n=50) and OP in 33,3% (n=25). Although there was 0.002, P<0.001), log-MVPA (β=–0.16 per minute, 95% CI: no difference in the frequency of OPn, with regard to gender –0.22, –0.10, P<0.001) and lower mean WOMAC score (55,5%±5,7 and 44,5%±5,2 in men and women respectively), (β=0.005 per-unit score, 95% CI: 0.003, 0.01, P<0.001). the frequency of OP was more common in women than men Within-person effects showed that a higher falls risk at any (70%±5,3 and 30%±3,4, respectively). time-point was associated with higher than average WOMAC Conclusions: score (β=0.002 per-unit score, 95% CI: 0.0003, 0.004, 1. SHTwas seen nearly in 1/3 of the Pts with DM, whose GFR P=0.025) and lower than average log-MVPA (β=–0.15 per was less than 65 ml/min. minute, 95% CI: –0.24, –0.06, P=0.003), but not 25OHD, at 2. BMDD, in the form of OPn and OP, were detected in 100% the same time-point. of Pts with SHT. Conclusions: Within-person analysis showed that at time- 3. Mean concentration of indicators, reflecting disturbances of points when participants had higher pain and dysfunction Ca-P M, such as AP, Ca, P, and PTH were beyond normal and lower MVPA, they also had a higher falls risk. This sup- ranges. ports clinical recommendations of promoting PA for reducing falls risk in older people, but it also suggests that having higher knee pain and dysfunction above an individual’saver- P546 age may warrant more attention as falls risk is likely to be ASSOCIATION OF BETWEEN-PERSON AND higher at this time. WITHIN-PERSON VARIABILITY IN SERUM 25- HYDROXYVITAMIN D, PHYSICAL ACTIVITY, KNEE PAIN AND DYSFUNCTION AND FALLS RISK P547 IN COMMUNITY-DWELLING OLDER ADULTS CORRELATION BETWEEN PLASMA FIBROBLAST D. Aitken1, T. Winzenberg1, K. Wills1,D.Scott2,G.Jones1, GROWTH FACTOR 21 LEVELS AND REGIONAL M. Callisaya1,S.A.Balogun1 BONE MINERAL DENSITY REVEALS AN INVERSE 1Menzies Institute for Medical Research, University of RELATIONSHIP Tasmania, Hobart, Australia, 2Department of Medicine, R.-H. Hao1, S.-S. Dong1,D.-L.Zhu1,H.N.Thynn1,H.Yan1, School of Clinical Sciences at Monash Health, Faculty of Y. Guo1 Medicine, Nursing and Health Sciences, Monash University, 1Key Laboratory of Biomedical Information Engineering of Melbourne, Australia Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China Objective: Traditionally, analysis has focused on examining how risk factors for falls differ between individuals (between- Background: Osteoporosis is the most prevalent bone disease person comparison). Less well recognized is how variability leading to a high risk of fracture. A bunch of secreted mole- in risk factors over time within the same individual (within- cules were identified as regulators in skeletal homeostasis. person comparison) is associated with falls risk. To describe FGF21 modulates glucose and lipid metabolism, and recently, the associations between falls risk, and between-person and was found to be responsible for bone loss in animals. within-person variability in 25-hydroxyvitamin D (25OHD), However, there was a published study that held the contradic- physical activity (PA), knee pain and dysfunction in tory view and reported a positive association between plasma community-dwelling older people. FGF21 levels and BMD in women. The controversial state- Material and Methods: Data for 1053 participants (51% ments suggest further investigation. Here, we examined asso- women; mean age 63±7.4 years) studied at baseline, 2.5, 5, ciations of FGF21 levels with regional BMDs in 168 unrelated and 10 years were analysed. Falls risk (Z-score) was measured Chinese subjects to draw a more reliable conclusion. using the validated Physiological Profile Assessment. Knee Material and Methods: 168 healthy Chinese subjects were pain and dysfunction were assessed using the Western recruited including 49 males and 119 females. Fasting plasma Ontario and McMaster Universities Osteoarthritis index FGF21 levels were determined using the ELISA method. (WOMAC). Moderate and vigorous PA (MVPA) was mea- Regional BMDs and body composition were measured by sured using accelerometer. Linear mixed effect regression dual energy X-ray absorptiometry (DXA). models, with adjustment for confounders, were used to esti- Results: Correlation analyses observed that FGF21 was in- mate the association between falls risk and between-person versely associated with the BMD of femoral neck (neck- and within-person variability in PA, 25OHD and WOMAC BMD, P=0.034) and Ward’s triangle (Ward’s-BMD, score. P=0.002) at the hip region, and the results remained S346 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 significant even after adjusting for sex, age and body compo- (Confidence Interval (CI) 1.17-2.8; p<0.01] and osteoporosis sition (P=0.048 for neck-BMD; P=0.002 for Ward’s-BMD). [OR 2.07 (CI 1.34-3.2); p<0.01]. Furthermore, subjects with a Meanwhile, the association between FGF21 levels and spine family history of hypertension and/or diabetes mellitus (DM) BMD reached a near significant level (P=0.057) after adjust- were less likely to develop osteoporosis by 37% and 39%, ment. There was no significant signal presented when consid- respectively [OR 0.63 (CI 0.45-0.88); p<0.01 and OR 0.61 ering sex determine. (CI 0.44-0.86); p<0.01, respectively]. Lastly, subjects with Conclusions: Contrary to the previous study, we support the DM was 31% less likely to develop osteoporosis [OR 0.69 previous laboratory findings by obtaining the negative relation (CI 0.49-0.98); p<0.05] and 67% less likely with Crohn's dis- between FGF21 and regional BMDs in Han Chinese popula- ease [OR 0.33 (CI 0.14-0.78); p<0.05]. tion. With a larger sample set and rational body composition Conclusion: The present study showed new risk factors adjustment, our study provides a more convincing result com- not previously identified in osteopenia and osteoporosis paring with the early published. in the Saudi population. While still controversial and Acknowledgement: This work was supported by the understudied even in the current literature, some chronic National Natural Science Foundation of China (81573241) metabolic conditions are protective of osteoporosis among and Natural Science Basic Research Program Shaanxi Saudi middle-aged females. The present findings warrant Province (2016JQ3026). further investigation. P548 P549 NOVEL SOCIO-DEMOGRAPHIC RISK FACTORS DOES VITAMIN D DEFICIENCY INFLUENCE THE FOR OSTEOPENIA AND OSTEOPOROSIS IN THE INCIDENCE AND PROGRESSION OF KNEE MIDDLE-AGED SAUDI FEMALE POPULATION OSTEOARTHRITIS? A SYSTEMATIC REVIEW S. Sabico1,N.M.Al-Daghri1, N. J. Aljohani2,Y.Al-Saleh3, V. V. Vi ja y 1, R. V. Vaishya1,A.K.A.Agarwal1,P.L.Lama1 M. Fouda Neel4,E.Sheshah5,O.S.Al-Attas1, M. S. Alokail1 1Department of Orthopaedics, Indraprastha Apollo Hospital, 1Biochemistry Department, College of Science, King Saud New Delhi, India University, Riyadh, Saudi Arabia, 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, 3King Objectives: Vitamin D has been believed to have a bearing in Abdulaziz Medical City, College of Medicine, King Saud Bin the pathogenesis of knee osteoarthritis (OA). This study was Abdulaziz University for Health Sciences, Riyadh, Saudi done systematically to review the correlation between vitamin Arabia, 4King Khalid University Hospital, Riyadh, Saudi D levels in knee OA in the adult population and the outcome Arabia, 5King Salman Bin Abdulaziz Hospital, Riyadh, of vitamin D supplementation in knee OA. Saudi Arabia Methods: An exhaustive search of Pub Med and Cochrane library database was done with keywords vitamin D, knee and Objective: Risk factors for bone-related diseases such as age, osteoarthritis for a period from Jan 2005 to December 2015. gender and family history, to name a few, are well established. All Randomized Control Trials (RCT), Cohort, Case-control, In the present study we tried to explore other socio- cross-sectional studies were included in the present systematic demographic variables not previously identified as risk factors review. for osteopenia and osteoporosis, particularly in the Saudi fe- Results: The search resulted in a total of 86 studies; out of male adult population. which 11 studies were included in the current review. There Methods: We studied 1270 Saudi adult female subjects taken were two Randomized Control Trial (RCT), one case-con- from the Saudi Osteoporosis Registry Database. They were trol, four cross-sectional and four cohort studies (Figure 1). grouped based on the presence or absence of osteoporosis and These studies comprised of a total of 5137 participants osteopenia; 310 with osteoporosis (Age 58.6±8.8; Body Mass (ranging from 46 to 1248) Our results suggested there Index (BMI) 30.5±6.0), 568 with osteopenia (Age 56.2±7.8; was a moderate evidence of positive association in vitamin BMI 33.5±6.0) and 392 normal (without osteoporosis and D deficiency (VDD) and progression of radiographic OA osteopenia) (Age 53.3±7.7; BMI 34.1±5.8). A general ques- (ROA), as assessed by Kellgren and Lawrence (KL) grad- tionnaire was filled which included medical and family history ing (Figure 2). However, VDD was not associated with the as well as other sociodemographic variables. Anthropometrics incidence of ROA and MRI-detected change in focal carti- was taken. Diagnoses of osteoporosis and osteopenia were lage defect. However, this study has a limited evidence for based on DXA scans. a positive correlation in VDD and the cartilage volume Results: Age- and BMI adjusted multinomial logistic regres- loss. There was also limited evidence showing no role of sion results showed that having a lower education status was vitamin D therapy in reducing cartilage volume loss and significantly associated with osteopenia [Odds ratio (OR) 1.63 kneepaininKneeOA. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S347 Conclusion: The VDD is common and has been associated with P550 knee OA, in an adult population. However, there is still incon- KNOWLEDGE AND PERCEPTION ABOUT MEDICAL sistent evidence regarding the prevention of incidence and pro- JOURNALISM AMONG MEDICAL REPORTERS: gression of ROA after vitamin D therapy. There is a need for BARRIERS AND OPPORTUNITIES multicentric and well-conducted randomized studies with larger M. R. Khasru1,F.Haseen2, S. Yunus2,S.A.R.Sabuj3,A.K. samples to conclude the positive effect of Vitamin D therapy. M. Salek1 Figure 1. PRISMA chart 1Physical Medicine and Rehabilitation, Faculty of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 2Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 3Ekushey Television, Dhaka, Bangladesh Media is an important source of health-related information for the public, policymakers and health professionals. It can in- fluence individuals’ health behaviors, prompt policymakers to make decisions to promote health and disseminate health re- search results to the medical and science community. It is well recognized that the media plays an enormously influential role in public responses to health issues. It has substantial power in setting agendas. Medical professionals have always been sen- sitive to the persuasive power of the mass media Over the past three decades, a number of works have investi- gated how news is sought and shaped by journalists within media organizations. Many health and medical scholars and professionals would agree with those doctors and news com- mentators who recently stated that the media fails health ser- vices, and that the structural limitations on news production made “evidence based journalism” a “forlorn hope”. Media can also be a tool to promote evidence-informed policymaking and bridge the existing “know-do” gap through disseminating research results to policymakers and the public. In Bangladesh we did not find any research work or any data about perception of medical Journalism among health re- porters and health professionals. This Qualitative and Quantitative quasi experimental study will be carried out in Bangabandhu Sheikh Mujib Medical University among Medical Journalists, Health Professionals and Policy Makers to The present study will be conducted to Figure 2. Evidence level for VD association with knee OA. 1) explore the nature of media coverage of health stories and evidences, 2) assess the quality of health reporting, 3) under- stand the perception of reporters and physicians about medical journalism, 4) identify the factors influencing health reporting, 5) identify strategies to enhance the use of evidences in health journalism and 6) design and test an intervention program to improve the quality of medical journalism. Data will be collect- ed by (1) Checklist of medical health news review (2) Questionnaire and (3) Qualitative guideline on Key Informant Interview, Focus Group Discussion. After collection, data will be checked for inadequacy, irrelevancy, and inconsistency. Irrelevant and inconsistent data will be discarded. Both qualitative and quantitative data will be analyzed. Results will be published in peer reviewed journal and a well circulated newspaper. S348 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P551 1Department of Internal Medicine and Medical Disciplines, EFFICACY OF VARIOUS VITAMIN D CORRECTION Sapienza University of Rome, Rome, Italy, 2Department of STRATEGIES IN SAUDI ADULTS AND CHILDREN Internal Medicine and Medical Disciplines, “Sapienza”, N. M. Al-Daghri1, S. Abd-Alrahman2, M. N. K. Khattak2,Y. Rome University, Rome, Italy, 3University of Foggia, Foggia, Al-Saleh3,N.J.Aljohani4, O. S. Al-Attas2,M.S.Alokail1 Italy, 4University of Rome 'Tor Vergata', Rome, Italy, 1Biochemistry Department, College of Science, King Saud 5Policlinico Gemelli Hospital, Rome, Italy, 6Rehabilitation University, Riyadh, Saudi Arabia, 2King Saud University, Hospital, I.R.C.C.S Santa Lucia Foundation, Rome, Italy, Riyadh, Saudi Arabia, 3King Abdulaziz Medical City, 7Department of pediatrics, "Sapienza" University, Rome, College of Medicine, King Saud Bin Abdulaziz University Italy, 8Department of Public Health and Infectious Diseases, for Health Sciences, Riyadh, Saudi Arabia, 4King Fahad Section Health Statistic, “Sapienza” University, Rome, Italy Medical City, Riyadh, Saudi Arabia Objective: to investigate the effect of 18 months parathyroid Background: Vitamin D deficiency is highly prevalent in the hormone 1-84 (PTH 1-84) treatment on serum levels of bone Saudi population and there are different strategies. This study morphogenetic protein 4 (BMP 4) and vascular endothelial aims to evaluate the efficacy of different strategies for vitamin growth factor (VEGF), in postmenopausal women with D deficiency correction in Saudi adults and children. established osteoporosis. Methods: A total of 860 Saudi school students (children’s) Methods: Thirty-seven postmenopausal women with osteopo- aged 12-17 years and adults (teachers) aged 25-50 years were rosis (mean age 72.9±8.1 years old) and 23 healthy controls recruited over a 6 month period were included in this inter- (mean age 68.9±9.9 years old) were enrolled. Patients were treat- ventional study, whose baseline serum 25 (OH) D falls below ed with daily subcutaneous injections of PTH (1-84) 100 mcg for (<50nmol/l) were selected from different secondary schools in 18 months, plus calcium 1 gr and vitamin D 800 IU per os daily. Riyadh, Saudi Arabia. Serum (OH) D deficient subjects were Blood samples were taken every 6 months during the study. grouped according to different vitamin D correction schemes: Results: At baseline, there were no differences considering sun-exposure, vitamin D-fortified milk consumption, oral vi- anthropometric parameters, co-morbidities, current medica- tamin D supplementation (1000IU/day) and control (advise). tions used between patients and controls. Mean serum VEGF Follow up measurements were done after 6 months. levels were significantly higher in osteoporotic patients com- Results: Follow-up results revealed that the prevalence of pared to controls (436.7±259.7 vs. 260.3±184.3 pg/ml, server serum vitamin D deficiency significantly decreased p=0.006), while there were no differences in mean serum (23.9% at baseline vs. 10.7% after 6 months; p<0.001) in values of BMP 4 (5.3±1.7 vs. 5.7±1.6 pg/ml, p=0.40). Serum the oral vitamin D supplementation group and this was not VEGF levels increased by approximately 20% after 12 months observed in other correction strategies. 6-month oral vitamin of PTH (1-84) treatment compared to baseline (p=0.03) and by D supplementation also showed significant positive associa- 22% after 18 months (p=0.01). A significant increase of 10% in tions between delta (Δ) changes in improving total and HDL- mean serum BMP 4 levels was observed after 18 months of cholesterol in both adults and children. The least effective PTH (1-84) treatment compared to baseline (p=0.02). In the strategy were observed in milk group in adults and control control group we found no differences after 18 months com- (advised) group in children. pared to baseline in BMP 4 (5.7±1.6 vs. 6.0±1.5 pg/ml, p=0.53) Conclusion: A 6-month oral vitamin D supplementation was and VEGF (260.3±184.3 vs. 257.4±107.1 pg/ml, p=0.94) the most effective way to improve lipid profile and vitamin D Conclusions: PTH (1-84) treatment increased serum levels of VEGF status in both Saudi children and adults than sunlight exposure and BMP 4 in postmenopausal women with severe osteoporosis. and vitamin D fortified dairy products consumption. The latter strategy is the least effective in adults and giving advice is the least effective in children, probably due to poor compliance. P553 PARATHYROID HORMONE IN RELATION TO VARIOUS VITAMIN D METABOLITES IN ADULT P552 FEMALES THE EFFECT OF PARATHYROID HORMONE (1-84) N. Al-Daghri1, S. Yakout1,I.Bukhari2, M. Khattak2,Y.Al- TREATMENT ON SERUM BONE MORPHOGENETIC Saleh3, N. Aljohani4,O.Al-Attas2,M.Alokail2 PROTEIN 4 AND VASCULAR ENDOTHELIAL 1Biochemistry Department, College of Science, King Saud GROWTH FACTOR IN POSTMENOPAUSAL WOMEN University, Riyadh, Saudi Arabia, 2King Saud University, WITH ESTABLISHED OSTEOPOROSIS Riyadh, Saudi Arabia, 3King Abdulaziz Medical City, J. Pepe1,C.Cipriani2,F.P.Cantatore3,A.Fabbri4,E.Pola5,V. College of Medicine, King Saud Bin Abdulaziz University Vinicola6,O.Raimo2,F.Biamonte2, R. Pascone7,C.Ferrara8, for Health Sciences, Riyadh, Saudi Arabia, 4King Fahad S. Minisola2 Medical City, Riyadh, Saudi Arabia Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S349 Background: Vitamin D binding protein (DBP) and albumin showed minimal osteopenia, parathyroid glands scintigraphy are the important determinants of circulatory 25(OH)D in without pathological changes. The patient received vitamin D adults. Physiological function of vitamin D is particularly reg- supplement. After cast removal 6 weeks later she still felt mod- ulated by DBP. Physiological function of vitamin D is partic- erate pain in her foot while walking. CT-scan proofed full frac- ularly regulated by DBPs. Serum parathyroid hormone (PTH) ture consolidation, otherwise was unremarkable. A week after is considered as the biological activity reader of circulating CT the patient felt increasing pain in her right foot. X-ray was 25(OH)D. We therefore examined the relationships between performed and 3d metatarsal bone fracture was diagnosed. A serum total, free and bioavailable 25(OH)D vs. PTH in appar- month later cast was removed. Gradually pain reduced. Her ently healthy Saudi female adults. PTH, phosphorus, vitamin D reached normal limits. Methods: A total of 350 apparently healthy Saudi female adults [(Mean±standard deviation) Age (years) 52.9±9.2; Body Mass Index (kg/m2) 32.9±5.4)] were included in this observational study. Anthropometrics was measured as well as fasting glucose, lipid profile, calcium and phosphorous using routine methods. Serum 25(OH)D was measured using an electrochemiluminescence im- munoassay. Serum DBP was determined by ELISA. Free and bio- available 25(OH)D were calculated by comparing concentrations of total 25(OH)D, DBP, and albumin. Results: Data revealed that circulating total 25(OH)D had weak but significant inverse association with DBP (R=-0.24; p<0.01), and strong inverse associations with free 25(OH)D (R=-0.87; p<0.001), albumin bound 25(OH)D (R=-0.88; p<0.001) and bioavailable 25(OH)D (R=-0.89; p<0.001). None of the vitamin D metabolites, including 25(OH)D, cor- related with serum PTH. Conclusion: Various metabolites of 25(OH)D are not corre- lated with serum PTH in Saudi adult females. Bioavailable, albumin-bound and free 25(OH)D cannot be surrogate mea- sures for vitamin D status, at least in this population. P554 MULTIPLE STRESS FRACTURES IN A WOMAN WITH ANTIPHOSPHOLIPID SYNDROME AND VITAMIN D DEFICIENCY A. K. Tarasova1 1Chaika Clinics, Moscow, Russian Federation A 44-year old, non-smoking woman with definite antiphospholipid syndrome (there spontaneous abortions before 10 weeks of gestation, venous thrombosis, twice positive anticardiolipin antibodies), otherwise healthy, presented with sudden pain and swelling of her right foot, that developed during several hours while walking. X-ray performed on the same day was unremarkable. US revealed mild synovitis of the second metatarsophalangeal joint. CBC, CRP, RF, uric acid were nor- mal, ANA 1:320 (ENA were absent). The patient was advised ice applications, topical and oral NSAIDs. Two weeks later pain in her foot persisted and intraarticular steroid injection was per- formed, also without significant effect. X-ray showed 2nd meta- tarsal bone fracture and cast was applied. Her calcium, creatinine and TSH were normal, phosphorus slightly decreased. She had moderate vitamin D deficiency and mild PTH elevation. DXA S350 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P555 P556 DOES THE SITE OF VARUS DEFORMITY IDENTIFY VITAMIN D RECEPTOR GENE POLYMORPHISMS THOSE AT HIGHER RISK OF PROGRESSION IN MODIFY CARDIOMETABOLIC RESPONSE TO EARLY SYMPTOMATIC OSTEOARTHRITIS OF VITAMIN D SUPPLEMENTATION IN T2DM THE KNEE: DATA FROM THE OSTEOARTHRITIS PATIENTS INITIATIVE (OAI) N. Al-Daghri1,A.Mohammed2,O.Al-Attas1,M.Ansari2,K. J. S. Palmer1, L. D. Jones1,A.P.Monk1,D.J.Beard1,K. Wani2, S. Sabico1, G. Tripathi3, M. Alokail2 Javaid1, A. Price1 1Biochemistry Department, College of Science, King Saud 1Musculoskeletal Epidemiology, Botnar Research Centre, University, Riyadh, Saudi Arabia, 2King Saud University, Nuffield Department of Orthopaedics, Rheumatology and Riyadh, Saudi Arabia, 3Westminster University, London, Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom United Kingdom Background: There is conflicting evidence on the favorable Objectives: To determine which of the geometric alignment effects of vitamin D supplementation on metabolic profile in variables contribute to symptomatic and radiographic progres- Type 2 diabetes mellitus (T2DM) patients and this might be sion of knee osteoarthritis (OA). due to genetic variations in vitamin D receptor (VDR). Thus, Material and Methods: The OAI is a multicentre, observa- we studied the metabolic effects of a 12-month vitamin D tional, prospective cohort study. Its publically available datasets supplementation in T2DM patients according to VDR and imaging archive, enable researchers to investigate the nat- polymorphism. ural history of knee osteoarthritis (OA). To be included in this Methods: 204 T2DM subjects received 2000IU vitamin D3 study subjects had to demonstrate early to moderate radio- daily for 12- months. Serum 25(OH)D and metabolic profiles graphic osteoarthritis (Kellgren Lawrence grade 1, 2 and 3), were measured pre- and post-supplementation. VDR poly- symptoms in the knee for more than half the days of a month morphisms (Taq-I, Bsm-I, Apa-I and Fok-I)wereidentified in the past year, complete follow up at 24 months and long leg using TaqMan genotyping assays. radiographs (LLRs) available for analysis. 1,327 knees from Results: Vitamin D supplementation significantly increased 961 subjects were included. All LLRs were assessed using HOMA β-cell function (p=0.003) as well as significantly de- Medicad® (Hectec GmbH, Germany) planning software. This creased triglycerides, total and LDL-cholesterol (p <0.001). gives reproducible measurements of the key angles which con- The lowest increment in 25(OH)D levels was detected in pa- tribute to overall lower limb alignment including; medial prox- tients with Fok-I CC genotypes (p<0.0001). With vitamin D imal tibial angle (MPTA), medial proximal femoral angle correction, carriers Taq-I GG genotypes showed significantly (MPFA), lateral distal tibial angle (LDTA) and lateral distal better improvements in triglycerides, LDL- and total choles- femoral angle (LDFA). Outcomes were assessed at 2 years. terol, insulin, HbA1c and HOMA-IR (p<0.005, 0.01, <0.001, Symptom worsening was defined by a deterioration in <0.005, 0.03 and 0.01, respectively). Similarly, subjects car- WOMAC score of >9points. Structural progression was de- rying Bsm-I TT genotypes showed significantly better im- fined by joint space narrowing >0.7mm. Demographic charac- provements in triglycerides (p=0.01), insulin and HOMA-IR teristics including age, BMI, employment status, smoking sta- (p<0.05). tus and other co-morbidities were recorded. Generalised esti- Conclusion: VDR polymorphisms influence metabolic re- mating equations were used to identify which variables predict- sponse to vitamin D supplementation as improvement in gly- ed symptom or structural progression. cemic and lipid profile was more evident in carriers of Taq-I Results: In 1,327 knees (Female=60%, mean age years) with GG and Bsm-I TT genotypes. symptomatic knee osteoarthritis, 19% demonstrated structural progression and 16% demonstrated symptom progression at 2yrs. Baseline WOMAC score (p<0.001) and BMI (p=0.02) P557 were predictive of symptom progression. Of the four measures COMPUTER DIAGNOSTICS OF OSTEOPOROSIS BY of alignment, only medial proximal tibia angle (MPTA) pre- EVALUATION OF MICROARCHITECTONICS OF dicted structural progression (p<0.001). BONE Conclusions: This is the first study to identify that specifically K. Aminov1 varus alignment of the proximal tibia predicts structural pro- 1Tashkent Institute For Postgraduate Medical Education, gression in early symptomatic knee OA. This finding may Tashkent, Uzbekistan inform clinical decision making in patients presenting with early knee OA. Background: Osteoporosis is among the most spread meta- Acknowledgments: NIHR Biomedical Research Unit, bolic disease of the skeleton which leads to a high percentage Oxford of disability among the working population. CT Changes in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S351 bone in osteoporosis appears in reducing bone density and Hospital of Jaén, Jaén, Spain, 4Endocrinology and Nutrition microarchitectural bone tissue, which leads to multiple Department/ Hospital of Jaén, Jaén, Spain, 5Physiology microscratches. Digital processing of medical images, partic- Department / University of Jaén, Jaén, Spain, 6Odontology ularly CT scans of vertebras, opens up new opportunities for Faculty, University of Granada, Granada, Spain, 7Public quantitative diagnostic criteria changed bone structure, as well Health and Preventive Medicine Department / University of as to assess mineral bone density. Jaén, Jaén, Spain Aim: To study the possibilities of digital analysis of computer tomograms of the skeleton to reveal osteoporosis. Objective: A relationship between Glucagon-like peptide Material and Methods: To implement the objectives of the 1 (GLP1) and 2 (GLP2) and osteoporosis has been dem- study developed special software designed for the analysis of onstrated. The enzyme responsible for its metabolization, tomographic images on a personal computer. CT image of the dipeptilaminopeptidase 4 (DPP4), has also been associat- lumbar vertebral body in the axial projection of the archive ed with osteoporosis, although the existing evidence is was transferred to the scanner of PC. Obtained in the study of scarce. Our objective is to evaluate whether there is a anatomical specimens vertebrae ICP values were compared relationship between DPP4 and osteoporosis and bone with the calcium, phosphorus and magnesium in the samples. remodeling. Results: Analysis of data obtained from digital processing of Methods: One hundred and eighteen volunteers were in- CT scans showed significant differences in some indicators in cluded in a Case-Control study: 60 cases and 58 controls, patients groups I and II. So, ICP values patients in groups I matched by age and sex. Inclusion criteria were for Cases: andIIamountedto16,2±1,3and11,5±1,7%respectivelyand T-score -2.5 and below and for Controls: normal Bone had significant differences. LTE values were also significantly Mineral Density (BMD). Exclusion criteria were second- higher in patients in group I compared with same indicators in ary osteoporosis, diabetes mellitus, cancer, hospitalization group II (P <0.05). When measuring the APC reliable differ- in the last 6 months and current treatment with antidiabetic ence in the groups studied were found. Changing the number and anti-osteoporotic drugs. As variables we determined and trabecular thickness that occurs when osteoporotic bone food intake; BMD measured by Dual-energy X-ray absorp- reflected on the cut vertebra ratio, a decrease in bone density tiometry (DXA) in the posteroanterior spine and hip and number of elements per unit area. A significant decrease in the Bone Turnover Markers (BTM). DPP4 activity was deter- values of Lt | p revealed patients of group II, consistent with mined using “DPP4 Activity Assay Kit”,bySigma- changed ICP and also indicates the growing osteoporotic Aldrich. Statistical analysis: Student's t-test for continuous changes with increasing duration of treatment with variables, c² test for categorical variables and regression hemodialysis. lineal analysis. Conclusion: Thus, the digital analysis of CT lumbar vertebrae Results: Women were 98% of the sample. Mean age allows to evaluate the architecture of bone and mineral densi- was 59.25 for Cases and 59.01 for Controls (p=0.78). ty. Given the definition of the ICP values, LTE, APCs for Results for DPP4 activity and BTM are presented in unmodified bone becomes possible to develop diagnostic Table 1. criteria for early diagnosis of osteoporosis. We have devel- Conclusion: There is an association between DPP4 and BTM oped a method of estimating the state of the bone allows in patients with osteoporosis. Studies are necessary to evaluate complex to study IPC and architecture of bone and can be the consequences on BMD and BTM of therapy with DDP4 costly alternative methods of assessment of the IPC (CCV inhibitors in diabetic patients. and DXA) and bone microarchitectonics analysis by high- Acknowledgments: This research was funded by a grant from resolution MRI and CT. “Instituto de Salud Carlos III (ISCIII)”,and“Fondo Europeo de Desarrollo Regional (FEDER)”.PI14/01591 P558 DIPEPTIL-AMINOPEPTIDASE 4 (DPP4) AND ITS RELATIONSHIP WITH OSTEOPOROSIS AND BONE REMODELING C. Montes1, M.-J. Martínez2, C. Tenorio3, M. Serrano4,A. Segarra5, M. Garrido6, P. Santiago4, M. Delgado-Rodríguez7 1Endocrinology and Nutrition Department / University Hospital La Paz, Madrid, Spain, 2Endocrinology and Nutrition Department / University of Jaén. The Department of science of health / University Hospital of Jaén, Jaén, Spain, 3Endocrinology and Nutrition Department / University S352 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P559 of bone micro-architecture quality, called the trabecular bone MRI DIAGNOSTICS OF COMPRESSION FRACTURES score (TBS), has been proven to predict future fragility frac- OF THORACIC SPINE tures independently of both BMD and the FRAX. K. Aminov1 Patients and methods: In this prospective, longitudinal cohort 1tashkent Institute For Postgraduate Medical Education, study, we compared three risk assessment instruments — the Tashkent, Uzbekistan FRAX, the TBS, and a TBS-adjusted FRAX score — in their ability to predict future fragility fractures over a minimum of Background: A compression fracture of the spine refers to one five years of follow-up among postmenopausal osteopenic of the most serious injuries. The cause of spinal fractures can be a women with no prior fragility fractures. We also sought to sudden load on the spine (usually fall), and regular daily load due determine if more- vs. less-stringent criteria were better when to lower bone density in a patient (osteoporosis). Medical Statistics stratifying patients into higher-risk patients warranting states: at least 1 time in the life of a compression fracture occurs in osteoporosis-targeted intervention vs. lower-risk patients in 40% of men and women over 80 years. More often, compression whom intervention would usually be deemed unnecessary. fractures occur in young people are very mobile, active lifestyle. Results: Over a mean 5.2 years follow-up, 18 clinical fragility Objective: To specify informative value of magnetic-resonance fractures were documented among 127 women in the age 50 imaging (MRI) with compression fractures of the thoracic spine. years and older (mean age=66.1). On multivariate analysis utiliz- Materials and methods: The material for the study were 80 ing regression models and Kaplan-Meier curve analysis, less- patients with suspected traumatic spinal injury, aged from 43 stringent criteria for the FRAX and TBS-adjusted FRAX were to 78 years. All patients were underwent: MRI of the thoracic capable of predicting future fractures, while more-stringent spine. Diagnostic work-up was performed on MRI apparatus criteria were incapable of doing so. Neither TBS threshold alone Siemens 1,5T. was a significant predictor of future fracture in our study. Results of the study. Patients performed X-ray examination in However, Hazard ratio analysis revealed slight superiority of the which all of traumatic changes in thoracic vertebrae were TBS-adjusted FRAX over the FRAX alone (HR=3.09 vs. 2.79). found. As a screening method in all patients was conducted Conclusions: Adjusting the FRAX tool by incorporating the MRI. In the 45 cases confirmed the presence of traumatic TBS may be useful to optimize the detection of postmeno- lesions of the vertebrae, in 9 patients traumatic changes were pausal osteopenic women with no prior fractures who warrant detected in 6 cases there was a contusion of the vertebrae. osteoporosis-targeted therapy. Conclusions: According to the study it found that MRI of the spine revealed such changes, which are not visualized by X-ray examination that helps in choosing the right tactics of treatment P561 and monitoring its effectiveness. MRI should be the first meth- DEVELOPMENT OF THE FIRST IN VITRO MODEL od of choice in the diagnosis of spinal compression fractures. OF CANCER STEM CELLS FROM A RARE HUMAN SMALL OSTEOSARCOMA FOR STUDYING NEW THERAPEUTIC MOLECULAR TARGETS P560 G. Palmini1, R. Zonefrati1, C. Romagnoli1, F. Marini1,A. DIFFERENT THRESHOLDS FOR THE FRAX AND Aldinucci2,C.Mavilia1,G.Leoncini1,D.A.Campanacci3, TBS-ADJUSTED FRAX USED FOR PREDICTION OF A. Simoni4, R. Capanna5,A.Franchi4,M.L.Brandi1 CLINICAL FRACTURES IN OSTEOPENIC POST- 1Department of Surgery and Translational Medicine, Unit of MENOPAUSAL WOMEN WITHOUT PREVIOUS Bone and Mineral Diseases, University of Florence, University FRACTURES Hospital of Florence, Florence, Italy, 2Department of M. Kuzma1,D.Hans2,T.Koller1, E. Nemethova1,P. Neurofarba, University of Florence, Florence, Italy, 3Unit of Jackuliak1,Z.Killinger1, H. Resch3,J.Payer1 Ortopedia Oncologica e Ricostruttiva, AOU Careggi, 1Comenius University, Faculty of Medicine, 5th Department University Hospital of Florence, Florence, Italy, 4Department of Internal Medicine, University Hospital, Bratislava, of Surgery and Translational Medicine, Unit of Anatomical Slovakia, 2Center of Bone Diseases, Lausanne University Pathology, University of Florence, Florence, Italy, 5Clinica Hospital Switzerland, Lausanne, Switzerland, 3Medical Universitaria Ortopedia e Traumatologia, Pisa, Italy Department II - St. Vincent Hospital Vienna, Vienna, Austria Objective: To establish a bone cancer stem cells (CSCs) line Introduction: Little is known about the clinical relevance of from the small cell osteosarcoma (SCO), a rare human prima- treating postmenopausal women with no prior history of fra- ry bone cancer. gility fracture and bone mineral densities (BMD) within the Material and Methods: The human SCO sample has been osteopenic range. In recent years, in addition to BMD and collected at the “Unit Ortopedia Oncologica e Ricostruttiva”, FRAX fracture probability assessments, a surrogate measure AOUC Careggi, Florence, with informed consent approved Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S353 by the local Ethical Committee. First, primary human cancer Material and methods: A total of 146 male patients with cell culture of SCO have been established. After that, the definite diagnosis of RA at the age of 59 years. Depending subpopulations of CSCs have been isolated from these, with on the reception of glucocorticosteroids (GCS) is allocated the sphere-formation assay. Hence, the cancer stem cell phe- two subgroups: I subgroup - 40 patients not receiving cortico- notype has been evaluated by several cellular assays/stainings, steroids and II subgroup - 66 patients receiving corticoste- by flow cytometry analysis and by analysing the expression roids. The control group consisted of 24 healthy men, matched profile of the main genes related to CSCs phenotype. by age and body mass index. IPC Study in the lumbar spine Results: For first, we have established a primary cell culture (L1-L4) and femoral carried out by dual-energy X-ray absorp- of an high grade SCO from the sample collected, named tiometry using osteodensitometry. Evaluation of body compo- OSA3. Consequently, from this we have started to isolate sition was carried out with the help of "Pod" program. CSCs and we have established a SCO-CSCs line, marked as Results: In 63% of patients with RA revealed male BMD OSA3-CSCs. The stemness of OSA3-CSCs line has been reduction corresponding to osteopenia / OP (OP was diag- confirmed by observing their capacity to differentiate into nosed in 36 (24.7%) patients with RA, and osteopenia - in 56 osteoblasts and into adipocytes, by showing the positive pres- (38.4%)). The incidence of OP in the II subgroup was signif- ence of the mesenchymal stem cells (MSCs) and of the em- icantly higher (p <0,05), than in the I subgroup (48.5% and bryonic stem cells (ESCs) markers into the cell line, and by 5% respectively). The most significant decrease in BMD ob- evaluating a good rate as clonogenic capacity. The presence of served in femoral neck in the study group as a whole, and in the ESCs markers was confirmed also by their gene expres- individual subgroups. There was a negative correlation be- sion together with the positive expression of the marker genes tween the degree of RA activity and performance of the IPC of the CSCs phenotype. We have also assessed the neoplastic as a lumbar spine (r=-0,4, p <0.05), and the proximal femur phenotype by demonstrating the presence of the expression of (r=-0,38, p <0.05). Evaluation of body composition showed genes involved in invasion/migration processes and in the that the treatment group had a significant decrease in total pluripotency of CSC, by the agar soft and by the Aldehyde lean mass (TM) body, as well as the trunk and extremities dehydrogenase 1A1 (ALDH1A1) assays. TM compared with those of control group (p <0,05). Conclusions: In conclusion, we have established a primary Sarcopenia detected in 80 (55.8%) of RA patients, whereas cell culture from a collected SCO sample. We have isolated in the control group it was absent. In 50 (67.6%) of patients and completely characterized a SCO-CSCs line at cellular and with RA male sarcopenia observed to decrease the level of molecular level. For the first time we have established a good the IPC osteopenia (35.2%) and OD (32.4%). After receiving cellular model for the study of the biology of the SCO and of a negative correlation parameters TM and the absolute 10- the particular cluster of CSCs, with the final goal to discover year risk of osteoporotic fractures (r=-0,302, p <0,05) on the new possible molecular targets to develop more effective ther- FRAX. apies against this rare type of osteosarcoma. Conclusion: 63% of men suffering from RA, observed Acknowledgements: Supported by the Istituto Toscano BMD decrease corresponding OP / osteopenia with a pri- Tumori (ITT)_Regione Toscana_Grant Proposal 2010. mary decrease in BMD at the femoral neck. Reduced BMD in patients with RA was significantly associated with a high degree of disease activity (r=-0,4, p <0.05). Receiving P562 corticosteroids had no significant effect on BMD at the THE DIAGNOSTICS OF OSTEOPOROSIS IN MALE femoral neck. Analysis of body composition in 55% of REUMATOID PATIENTS RA patients revealed a decrease in TM limbs to the level D. Aminova1 of sarcopenia. Received correlation decrease BMD and 1Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan TM limbs (p <0,05; r=0,28). Thus, in patients with RA Rheumatoid arthritis (RA) - chronic immune inflammatory males along with OP / osteopenia revealed a significant joint disease leading to early disability of patients at high risk decrease in TM, that in view of the biomechanics of the for cardiovascular events and osteoporotic fractures. Of par- movements may be an additional risk factor for falls and ticular relevance, this problem becomes in men with RA, due fractures. to more frequent severe disease and increased mortality in the year after the fracture. Reduced bone mineral density (BMD) and muscle mass are significant predictors of fracture, which P563 leads to the high importance of studying the state of the IPC DIFFERENT EFFECT OF BIOLOGICS VS. METHO- and body composition. TREXATE ON BONE TURNOVER IN ACTIVE RHEUMATOID ARTHRITIS: 1-YEAR FOLLOW-UP Objective: improving the diagnosis of osteoporosis in pa- Z. Killinger1, L. Sterancakova1,M.Kuzma1,P.Jackuliak1,S. tients with RA male subjects. Tomkova2, P. Vanuga3,J.Payer1 S354 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 1Comenius University, Faculty of Medicine, 5th Department 1INSERM UMR 1033 - University of Lyon, Rheumatology of Internal Medicine, University Hospital, Bratislava, Department, Hôpital Edouard Herriot, Hospices Civils de Slovakia, 2Department of Internal medicine, 1st Private hos- Lyon, Lyon, France, 2INSERM UMR 1033, Université de pital, Šaca, Košice, Slovakia, 3National Institute of Lyon, Lyon, France, 3Service de Néphrologie, Rhumatologie Endocrinology and Diabetology, Lubochna, Slovakia et Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Bron, Introduction: It was shown, that anti-TNFα agents may France, 4Reproductive Medicine Department, Hospices Civils reduce circulating RANKL, resulting from favorable de Lyon, Lyon, France, 5INSERM UMR 1033, Université de change in OPG/RANKL ratio and thus increases bone Lyon, Hôpital E Herriot, Lyon, France, 6Reproductive formation and decreases bone resorption markers. In Medecine, Hospices Civils de Lyon, Lyon, France addition, the role of glucocorticoids (GC) use (and their reduction during anti-TNF therapy) and menopause Klinefelter syndrome (KS) is a frequent disease due to the status on bone turnover markers (BTM) remains un- karyotype disorder XXY (1/660 male births). In literature, explained. patients with KS have an increased prevalence of osteoporosis Objective: Comparison of the biological disease-modifying and a 40-fold increased risk of surmortality by femoral neck antirheumatic drugs (bDMARDs) and conventional synthetic fracture. Nevertheless, their bone microarchitecture is largely DMARDs effect on BTM after one year of active rheumatoid unknown. Thus we aimed to analyze in vivo bone arthritis (RA) treatment and with regard to GC use and men- microarchitecture of KS patients by high resolution peripheral opause status. quantitative tomography (HRpQCT). Patients and methods: A 12-month prospective follow-up Non-mosaic KS patients included in the French Research in 105 patients with active RA (Disease Activity Score - Fertility Program were included before introduction of andro- DAS 28 > 5.1) was performed. This cohort was divided gen therapy. They underwent assessment of areal BMD at in two groups: group 1 (n=84, mean age 54 yrs) treated lumbar spine and hip by DXA as well as whole body compo- with bDMARDs (anti TNF blockers) and group 2 (n=21, sition (DiscoveryA, Hologic®) and bone microarchitecture at mean age 53 yrs) treated with non-biological DMARDs distal tibia and distal radius by HR-pQCT (XtremeCT, Scanco (Methotrexate) with equivalent GC dose (6.2 mg vs. 6.6 Medical AG®). Each patient was age-matched with two to mg), respectively. From group 1, also a subset of patients three healthy adult men from the STRAMBO cohort (adults) without GC treatment (n=29) was analysed. BTM, and the VITADOS cohort (teenagers). Statistical analyses osteocalcin (OC) and CTx were measured at baseline were adjusted for height and body weight. and after 1 year of treatment using conventional We enrolled 103 men: 24 patients with KS and 79 healthy electrochemiluminescence immunoassay. controls aged respectively mean (±SEM) 24±2 years and 27 Results: During follow up, a significant increase in serum ±1 years (p=0.07). KS patients were leaner than controls (BMI levels of osteocalcin in patients within group 1 (19,8 ug/l at 22.5±1.1 vs. 24.8±0.4 kg/m²; p=0.027). Except one, none of baseline vs. 27,1 ug/l at month 12; p<0.001) and increase of the KS patients had personal fracture history. Nearly half of OC in the subset of pts without GC treatment (20,3 ug/l at the patients had a regular sport activity (11; 46%). baseline vs. 27,4 ug/l at month 12; p<0.001) was observed. In Surprisingly, only 36% of KS patients had low serum total group 2 the levels of OC remained unchanged. In both groups, testosterone (<10nmol/L). Relative appendicular lean mass no treatment effect on CTx or menopause status influence was was lower in KS than controls (7.5±1.3 vs. 8.9±1.0 kg/m²; observed. p<0.001). Lumbar spine and total hip areal BMD were signif- Conclusion: Significant increase of OC levels, but not CTx icantly lower in KS patients than controls with 0.949±0.02 vs. levels was observed only in group treated with bDMARDs. In 1.076±0.02 g/cm² and 0.987±0.03 vs. 1.110±0.02 g/cm² re- addition, sustained OC increase was observed in patients with- spectively (p<0.001). out GC treatment, which supports theory that bDMARDs may Furthermore, bone microarchitecture was severely and signif- have beneficial effect on BTM. icantly impaired at the tibia with a significant decrease of BV/ TV (p=0.02), cortical thickness (p<0.001) and all vBMD (to- tal, cortical and trabecular; p≤0.002). In addition, cortical area P564 was significantly decreased at both sites (tibia and radius) BONE MICROARCHITECTURE ANALYSIS BY HR- (p=0.008). PQCT OF YOUNG ADULTS WITH KLINEFELTER In young KS patients, naïve of androgen therapy, we observed SYNDROME REVEALED SEVERE BONE FRAGILITY lower areal and volumetric BMD and severely impaired tra- C. B. Confavreux1,A.Piot1,P.S.Szulc2,J.Bacchetta3,S. becular and cortical bone microarchitecture at the weight- Ailloud2,H.Lejeune4,R.D.Chapurlat5,S.Boutroy2,I. bearing distal tibia. Follow-up of bone microarchitecture of Plotton6 these patients under androgen therapy will be performed. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S355 P565 Objectives: To evaluate changes in serum bone turnover PREVALENCE AND RISK FACTORS OF LOW BONE markers and Wnt inhibitors at 7- and 30-days after initiation MINERAL DENSITY IN ANTIRETROVIRAL of low dose glucocorticoid (GC) treatment of early THERAPY-NAIVE HIV-INFECTED YOUNG MEN Rheumatoid Arthritis (RA). J. Paccou1,N.Viget1,E.Drumez1,B.Cortet2,O.Robineau1 Methods: 27 adult patients suffering from early RA were 1Université Lille Nord-de-France, Lille, France, 2Department prospectively enrolled. Blood tests including C-Reactive of Rheumatology, Lille University Hospital, Lille, France Protein (CRP), amino-terminal propeptide of type 1 procollagen (P1NP, marker of bone formation), Objectives: Patients with human immunodeficiency virus carboxyterminal telopeptide of type 1 collagen (CTX, marker (HIV) infection have a higher risk of low bone mineral density of bone resorption), Sclerostin, and Dickkopf-related protein 1 (BMD) and fragility fracture, but little is known of these risks (DKK1) were detected at baseline and 7 and 30 days after in antiretroviral therapy (ART)-naïve, HIV-infected young starting low dose of GC (methylprednisolone 4 mg/day). men. Our aim was to investigate prevalence of low BMD Results: At baseline we observed a significant positive corre- and factors associated with BMD levels in this population. lation between CRP and DKK1 serum levels (r=0,63; p<0,05) Methods: In this cross-sectional study, dual-energy x-ray ab- and between DKK1 and CTX serum levels (r=0,38; p<0,05). sorptiometry (DXA) was used to measure BMD and for lab- A significant decrease in serum levels of CRP, P1NP, and oratory assessments. BMD at the lumbar spine, total hip and Sclerostin was observed after 7 and 30 days of GC treatment femoral neck was expressed as a Z-score (number of standard (p<0,05). About DKK1, it has been detected a not significant deviations away from the mean in an age-, race-, and sex- tendency to decrease after starting GC. CTX serum levels matched reference population). Low BMD was defined as showed no significant changes. Z-score ≤−2 at any of the three sites. Prevalence of low Conclusions: This study has shown that a low dose GC treat- BMD was evaluated, as were risk factors associated with ment might have complex and conflicting short-term effects BMD z-scores at the lumbar spine, total hip and femoral neck. on bone metabolism in early RA (a reduction of bone forma- Results: The study cohort comprised 49 men, of which 87.8% tion, without increase of bone resorption), different from those were white. Mean age was 31.6 (±7.7) years and mean BMI was observed with higher dose, in other diseases or in healthy 22.7 (±4.0) kg/m². Half of the patients (51.0%) were current subjects. The observed decrease in P1NP and Sclerostin serum smokers. The prevalence of low BMD was 24.5% [95% CI, levels might mean that also low dose of GC could acutely 13.3-38.9]. Low oestrogen levels and low BMI were associated with suppress bone formation and induce loss of function and/or low BMD z-scores at each skeletal site, whereas current smoking number of osteocytes. and high IGF1 levels were associated with low BMD z-scores at lumbar spine. Among the HIV-related factors, low CD4+ cell count was associated with low BMD z-scores at the lumbar spine. P567 Conclusion: We found a high prevalence of low BMD in an 17-ΒETA-ESTRADIOL PREVENTS OXIDATIVE ART-naïve cohort of young men. Risk factors associated with STRESS-INDUCED APOPTOSIS IN OSTEOCYTES low BMD z-scores were those traditionally found in HIV in- BY GSTP1-1 OVEREXPRESSION dividuals (low BMI, current smoking, and CD4+ cell count), V. Domazetovic1, F. Fontani1,G.Marcucci2,T.Iantomasi1, or linked to endocrine hormone levels (estradiol, IGF-1). M. L. Brandi2,M.T.Vincenzini1 1Department of Biomedical Experimental and Clinical Sciences "Mario Serio", Biochemistry Section, University of P566 Florence, Florence, Italy, 2Department of Surgery and SHORT-TERM EFFECTS OF LOW DOSE GLUCO- Translational Medicine, Unit of Bone and Mineral Diseases, CORTICOIDS ON SERUM LEVELS OF BONE University of Florence, University Hospital, Florence, Italy TURNOVER MARKERS AND WNT INHIBITORS IN EARLY RHEUMATOID ARTHRITIS Objective: Estrogen plays an important role in bone growth M. Vitiello1, O. Viapiana1, N. Malavolta2, G. Saviola3,R. and in regulating bone turnover in adult bone. Estrogen Bortolotti4,L.Idolazzi1,F.Bertoldo1,D.Gatti1, M. Rossini1 deficiency causes bone loss, increased oxidative stress 1Rheumatology Section, Department of Medicine, University and osteocyte apoptosis. This leads to increased bone turn- of Verona, Verona, Italy, 2Rheumatology Unit, AOU of over and resorption observed in osteoporosis in postmeno- Bologna, Policlinico S. Orsola Malpighi, Department pausal women (1). Previously, it has been demonstrated in Cardio-Toraco-Vascolare Alma Mater Studiorum, Bologna, osteocytes that starvation induced-apoptosis is related to Italy, 3Rheumatology and Rehabilitation Unit, Salvatore reactive oxygen species (ROS) production, c-Jun N-termi- Maugeri Foundation IRCCS, Castel Goffredo, Mantua, Italy, nal kinase (JNK) activity and alteration of factors involved 4Rheumatology Unit, S. Chiara Hospital, Trento, Italy in bone remodeling (2). The aim of this study was to S356 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 identify molecular mechanism by which 17β-Estradiol Methods: Cross-sectional study was conducted in Railway (17β-E2) prevents osteocyte apoptosis induced by oxida- Healthcare Institute, Belgrade, in period Jan 1st- April 31, tive stress. 2016. 250 postmenopausal women, aged 45-86 years, were Materials and Methods: Amurineosteocyte-likecellline, included. Study included only those who were first time on MLO-Y4, was used to study starvation-induced apoptosis; BMD testing and never had treatment therapy for osteoporosis ROS were measured by fluorimetric analysis; apoptosis by before. BMD was measured on Hologic Discovery C device, DNA fragments; expression of glutathione S-transferase P1- on lumbar spine and hip region. The vertebral fracture assess- 1 (GSTP1-1), caspase and JNK activation by western blot; ment was performed, and Th4-L4 region was analysed in aim GSTP1-1/JNK association by immunoprecipitation and im- to detect vertebral fractures on the same device. The lumbar munoblots; GSTP1-1 involvement in 17β-E2 effect by spine scans were reanalysed in TBS iNsight® software siRNA transfection. (V1.9.2, Med-Imaps, France) and TBS was calculated. All Results: 17β-E2 quickly prevents starvation-induced apo- the participants were previously tested using an epidemiolog- ptosis, caspase and JNK activation related to oxidative ical questionnaire. stress in osteocytes, but it is not able to reduce ROS levels. Results: In relation to the existence of a small trauma fracture, Therefore, estrogen effect occurs through GSTP1-1 over- the subjects are divided into two groups: with no previous expression and the maintenance of GSTP1-1/JNK associa- fracture- 121 (48,4%) and group with fracture-129 (51,6%). tion thus inhibiting JNK activity. N-acetylcysteine also Postmenopausal women with fractures have a higher percent- preserves JNK bounding to GSTP1-1, but this is due to age of osteoporosis measured on the lumbar spine (46.3% vs. its antioxidant action. 34.1%; χ²=4.883, df=2, p=0.09)) according to DXA findings Conclusion: The data demonstrate that 17β-E2 is able to and totally degraded microarchitecture than women without prevent osteocyte apoptosis by a non-redox-regulated mecha- fractures (85.1% vs. 45.7%; χ²=43.10, df=2, p=0.00). TBS is nism involving GSTP1-1 overexpression and JNK activity lower in women with a greater number of fractures (F=12.4, inhibition. They suggest a possible role of GSTP1-1 in bone p=0.00), and the lowest values are in the group of participants repair mechanisms. with spine fractures (F=14.28, p=0.00). 93.2% of women with Acknowledgements: Fondazione Cassa di Risparmio di vertebral fracture have lowest values. There is a statistically Pistoia e Pescia and MIUR. significant positive correlation between BMD and T-score References: with TBS. All correlations are of medium intensity and statis- 1. Manolagas SC et al. Nat Rev Endocrinol 2013;9:699. tically significant at p <0.0001. 2. Fontani F et al. Calcif Tissue Int 2015;96:335. Conclusion: TBS is a useful adjunct in the evaluation of frac- ture risk. Combining the normal and osteopenic BMD values with the lowest range of TBS can help in defining P568 a significant subset of non-osteoporotic women at higher risk CORRELATION BETWEEN TRABECULAR BONE of fracture which is useful in clinical practice and patient SCORE AND LOCALISATION AND NUMBER OF management. FRACTURES IN POSTMENOPAUSAL SERBIAN WOMEN J. Vasic1, J. Zvekic Svorcan2,F.Gojkovic1, J. Elez3 P569 1Department of Physical Medicine and Rehabilitation, TREATMENT WITH NERIDRONATE IN ADULTS AND Railway Healthcare Institute, Belgrade, Serbia, 2University CHILDREN WITH OSTEOGENESIS IMPERFECTA: of Novi Sad, Faculty of Medicine, Special Hospital for DATA FROM OPEN-LABEL, NOT CONTROLLED, Rheumatic Diseases, Novi Sad, Serbia, 3Department of THREE-YEAR ITALIAN STUDY Internal Medicine, Railway Healthcare Institute, Belgrade, A. Fassio1,C.Benini1, E. Vantaggiato1,V.Campagnol1,A. Serbia Giollo1,G.Tripi1,G.Adami1,O.Viapiana1, M. Rossini1,D. Gatti1 Introduction: Osteoporosis is a disease characterized by low 1Rheumatology Section, Department of Medicine, University bone mineral density and impaired microarchitecture of bone of Verona, Verona, Italy tissue, leading to increased bone fragility and a consequent increase in fracture risk. Conceptual description of the disease Neridronate is an amino-bisphosphonate licensed in Italy for puts into focus two important characteristics of bone: bone the treatment of osteogenesis imperfecta (OI). The aim of our mineral density and quality, especially bone microarchitecture. study was to assess the long-term efficacy and safety of this Aim: To investigate the correlation between Trabecular Bone treatment in patients with OI. The patients enrolled were di- Score (TBS) and Bone Mineral Density (BMD), localisation vided by age into two groups: 55 patients younger than 20 and number of fractures. years old (included) and 114 patients older than 20 years old. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S357 Both groups were observed for 3 years. Neridronate was ad- Results: Most of young adults showed a low-quality antiox- ministered by i.v. infusion at the dosage of 2 mg/kg, up to a idant intake (only 17.6% of women and 20.3% of men had a maximum of 100 mg at three-monthly intervals for three score of 4 or 5 in DAQs). A positive correlation between years. Dual X-ray absorptiometry of the lumbar spine and DAQs and BUA was observed in women (r=0.117; hip were evaluated every 6 months. Blood calcium, phos- p=0.024). Linear regression analysis revealed that DAQs phate, albumin, fasting urinary calcium/creatinine ratio, uri- was significantly associated with BUA parameter in women nary free-deoxypyridinoline and serum bone alkaline phos- after adjusting by body weight, height, calcium intake and phatase were obtained at baseline and every 3 months. physical activity (p=0.035). No significant associations be- The mean lumbar spine and total hip BMD significantly and tween single antioxidant and calcaneus QUS measurement progressively increased from baseline up to month 36 in both were found. patients groups. The mean lumbar spine and total hip BMC Conclusion: Our findings suggest that high-quality antioxi- significantly increased to any time point from baseline up to dant intakes could influence bone health in young women. month 36 in both patients groups. The mean number of frac- Future studies should further investigate the role of antioxi- tures observed in the 3 years of treatment was significantly dant nutrients against osteoporosis. lower than that observed in the 3 years before the start of treatment in both groups. Adverse drug reactions (ADRs) were reported in 31 patients (56.4%) younger than 20 years P571 and in 29 patients (25.4%) older than 20 years. Most of AEs ESTROGEN RECEPTOR 1 GENE POLYMORPHISMS were symptoms of an acute phase reaction, which was report- AND HEEL BONE ULTRASOUND IN EARLY ed in 47.3% of patients younger than 20 years and in 22.8% of ADULTHOOD those older than 20 years. Serious adverse events (SAEs) were M. Correa-Rodriguez1,J.SchmidtRio-Valle1, B. Rueda- reported in 19 patients (34.5%) younger than 20 years and in Medina1 26 patients (22.8%) aged older than 20 years. None of the 1Department of Nursing, University of Granada, Granada, reported SAEs in both groups was considered as treatment- Spain related. Long-term treatment with i.v. neridronate has positive effects Introduction: Genetic factors are considered as determinant on BMD, BMC, bone turnover markers and fracture risk with in several phenotypes relevant to the pathogenesis of osteopo- a good safety profile in both groups. rosis including heel quantitative ultrasound (QUS) measure- ment. Different genetic variants in estrogen receptor 1 (ESR1) have been shown to influence bone phenotypes in later life. In P570 order to identify genetic markers contributing to bone mass DIETARY ANTIOXIDANT QUALITY SCORE (DAQS) acquisition during adulthood, we aimed to investigate the role AND HEEL BONE ULTRASOUND ATTENUATION IN of ESR1 polymorphisms in bone status assessed by heel QUS YOUNG ADULTS in a population of young adults. M. Correa-Rodriguez1,J.SchmidtRio-Valle2, B. Rueda- Methods: The study sample consisted of 466 healthy subjects Medina2 of Caucasian ancestry (315 females and 152 males) with a 1Department of Nursing. University of Granada, Granada, median age 20.39±2.70. Six ESR1 polymorphisms Spain, 2Department of Nursing, University of Granada, (rs302033, rs2982552, rs2982575, rs2504063, rs2234693- Granada, Spain PvuII and rs9340799-XbaI) were selected as genetic markers and genotyped using Open Array technology. Bone status was Introduction: The intake of antioxidants could positively in- estimated in the right heel with QUS. fluence bone mass by preventing bone metabolism against Results: In the unadjusted analysis, rs2982575 polymor- oxidative stress. The aim of this study was to investigate the phism was significantly associated with QUS parameter in possible influence of Dietary Antioxidant Quality score the whole sample (p=0.014, β (95% CI)=-0.114 (-1.023, - (DAQs) on heel bone ultrasound attenuation in a population 0.115). However, after adjusting for multiple confounding of young adults. factors (age, sex, weight, height, physical activity and Methods: The study population comprised 605 young calcium intake) this association did not remain significant. Spanish adults (median age 20.38±2.67). Bone mass was mea- For the rest of the selected SNPs in ESR1, no significant sured by heel quantitative ultrasound (QUS) to determine association was observed with QUS parameter in the com- Broadband Ultrasound Attenuation (BUA, dB/MHz). DAQs bined population as well as stratifying individuals accord- was applied to calculate antioxidant nutrients intake. Linear ing to gender. regression analyses were performed to investigate the possible Conclusion: Our findings revealed a lack of significant asso- influence of DAQs on calcaneal QUS. ciation between ESR1 polymorphisms and heel quantitative S358 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 ultrasound in a cohort of young adults suggesting that ESR1 P573 gene do not play a major role in the acquisition of bone mass REFERENCE VALUES FOR CALCANEAL BROAD- during early adulthood. BAND ULTRASOUND ATTENUATION IN COLOMBIAN YOUTH: THE FUPRECOL STUDY M. Correa-Rodriguez1, C.-F. Navarro-Pérez2, E. González- P572 Jiménez1,R.Ramírez-Vélez3, J.-E. Correa-Bautista3,B. PAIRWISE SNP-SNP INTERACTION INFLUENCING Rueda-Medina1, J. Schmidt Rio-Valle1 QUANTITATIVE HEEL ULTRASOUND IN EARLY 1Department of Nursing, University of Granada, Granada, ADULTHOOD Spain, 2University of Vic Central-University of Catalonia, M. Correa-Rodriguez1,S.Viatte2,J.Massey2, J. Schmidt Rio- (Manresa, Spain), Manresa, Spain, 3University of Rosario Valle1,B.Rueda-Medina1, G. Orozco2 (Bogota, Colombia), Bogotá, Colombia 1Department of Nursing, University of Granada, Granada, Spain, 2Arthritis Research UK Centre for Genetics and Objective: Bone mineral density (BMD) reference values for Genomics, Centre for Musculoskeletal Research, Faculty of children and adolescents have not been published for a Latin- Biology, Medicine and Health, Manchester Academic Health American population. In this regard, the aim of this study was Science Centre, The University of Manchester, Manchester, to establish a normal reference range of calcaneal broadband United Kingdom ultrasound attenuation (BUA) in Colombian children and ad- olescents with ages ranging from 9 to 17.9 years. Introduction: Osteoporosis is a complex disease deter- Material and Methods: A sample of 1001 healthy Colombian mined by multiple genetic variants that interact with each youth (boys n = 445 and girls n = 556), children, and adoles- other and with the environment modulating individual sus- cents (9-17.9 years old) participated in the study. A calcaneus ceptibility. The aim of this study was to perform SNP-SNP QUS parameter (BUA) was obtained for boys and girls, strat- interaction analyses in selected candidate genes influenc- ified by age group. Furthermore, height, weight, fat mass per- ing heel quantitative ultrasound (QUS) parameter in a pop- centage, and body mass index were measured. Centile ulation of young Caucasian adults to identify non additive smoothed curves for the third, tenth, 25th, 50th, 75th, 90th, effects and, potentially, novel insights into the mechanism and 97th percentiles were calculated using the LMS method of disease. (L [curve Box-Cox], M [curve median], and S [curve coeffi- Methods: The study population comprised a total of 575 cient of variation]). individuals (mean age 20.41; SD 2.36) whose bone status Results: Mean (±SD) values for the participants' anthropo- was assessed through QUS to determine broadband ultra- metric data were 12.9 ± 2.3 years of age, 45.2 ± 11.5 kg sound attenuation (BUA, dB/MHz). Thirty-two SNPs were weight, 1.51 ± 0.1 m height, 19.5 ± 3.1 kg/m(2) BMI, and included as genetic markers on the basis of their previous 69.5± 17.1 dB/MHz BUA. Overall, all variables were signif- association with QUS and/or bone mineral density (BMD) icantly higher in boys except in BMI and body fat percentage. parameters. The association of all possible SNP pairs with Girls generally had higher mean calcaneal BUA (dB/MHz) QUS was assessed by linear regression and a SNP-SNP values than the boys, except in the age ranges 16 and 17.9, interaction was defined as a significant departure from ad- p > 0.05. In addition, the BUA (dB/MHz) increased with age ditive effects. throughout childhood and adolescence and reached a plateau Results: The pairwise SNP-SNP analysis revealed several by age 15-17.9 for girls. significant interactions. The interaction involving SNPs Conclusions: For the first time, our results provide sex- rs9340799 and rs3736228 located in the ESR1 and LRP5 and age-specific BUA reference values for Colombian genes, respectively, showed the strongest association after children and adolescents aged 9-17.9 years. A more spe- adjusting for BMI, physical activity and calcium intake cific set of reference values is useful for clinicians and (p-value=0.001, β(95% CI)=14.289 (5.548, 23.029). In researchers and informs clinical practice to monitor bone addition, our model reported others such as TMEM135- mineral status. WNT16 (p=0.007, β(95%CI)=9.101 (2.498, 15.704), Acknowledgments: The FUPRECOL Study received ESR1-MBL2/DKK1 (p=0.012, β(95%CI)=13.641 (2.959, funding from the Instituto Colombiano para el Desarrollo 24.322) or OPG-LRP5 (p=0.012, β(95%CI)=8.724 de la Ciencia y la Tecnología “Francisco José de Caldas” (1.936, 15.512). COLCIENCIAS [Contract N° 671-2014 Code Conclusion: Our findings provide new insights into the ge- 122265743978]. The authors are grateful to the Bogota netic architecture of QUS traits supporting for the first time District Education Secretary for the data used in this research. that several SNP-SNP interactions, especially that between The authors would also like thank the Bogota District stu- ESR1 and LRP5 genes, influence heel QUS in Caucasian dents, teachers, schools, and staff, who participated in this young adults. study. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S359 P574 with glucocorticoids (GCs) and prophylactic bisphos- DIAGNOSTIC ACCURACY OF SERUM BONE phonates. TURNOVER MARKERS TO DETECT BONE GAIN IN POSTMENOPAUSAL WOMEN TREATED WITH PROPHYLACTIC BISPHOSPHONATES P575 M. Correa-Rodriguez1,M.Ortego-Jurado2, J.-L. Callejas- EFFICACY OF DENOSUMAB IN PATIENTS WITH Rubio3, R. Ríos-Fernández3,B.Rueda-Medina1,N.Ortego- STEROID INDUCED OSTEOPOROSIS WITH/ Centeno3 WITHOUT PRIOR TREATMENT WITH BIPHOS- 1Department of Nursing, University of Granada, Granada, PHONATES Spain, 2Unidad de Medicina Familiar y Comunitaria, Palma M. Correa-Rodriguez1, B. Rueda-Medina1, M.-T. Cruces- de Mallorca, Spain, 3Unidad de Enfermedades Autoinmunes y Moreno2,R.Ríos-Fernández3, J.-L. Callejas-Rubio3,M. Sistémicas, Hospital Universitario San Cecilio, Granada, Rodriguez2, N. Ortego-Centeno3 Spain 1Department of Nursing, University of Granada, Granada, Spain, 2Unit of Systemic Diseases, University Hospital Introduction: Osteocalcin (BGP), osteoprotegerin (OPG), Complex of Granada (Spain), Granada, Spain, 3Unidad de bone-specific alkaline phosphatase (BALP), C-telopeptide Enfermedades Autoinmunes y Sistémicas, Hospital crosslaps (CTX), tartrate-resistant acid phosphatase Universitario San Cecilio, Granada, Spain (TRAP), intact-parathyroid hormone (iPTH) and 25- hydroxyvitamin D (25[OH]D) play an important role in Objectives: To assess the benefits of Denosumab as an bone metabolism. Thus, the aim of this study was to inves- antiresorptive treatment in patients with steroid-induced oste- tigate the diagnostic accuracy of these serum bone turnover oporosis who received or not prior therapy with bisphos- markers to detect bone gain in a population of postmeno- phonates. pausal women treated with glucocorticoids (GCs) and pro- Material and Methods: retrospective, descriptive, observa- phylactic bisphosphonates. tional and follow-up study of patients with chronic glucocor- Methods: A total of 71 postmenopausal women suffering ticoids therapy and with secondary prophylaxis of steroid- different systemic autoimmune diseases treated with glu- induced osteoporosis with Denosumab that where attended cocorticoids (GCs) and prophylactic bisphosphonate in the in the Autoimmune Systemic Disease Unit of San Cecilio Systemic Diseases Unit of the San Cecilio Hospital Hospital (Granada). We observed the variations in bone min- (Granada, Spain) were enrolled (mean age 56,1±16,1). eral density (BMD), femoral neck (FN) and lumbar spine (LS) Bone mineral density (BMD) measurements in lumbar during a period of one year. Also, in those patients treated spine (LS) and femoral neck (FN) were carried out at the previously with bisphosphonates, we compared the increase beginning of the study and after 1 year. Serum levels of obtained with these facing Denosumab. The statistical analy- BGP, OPG, BALP, CTX, TRAP, iPTH and 25[OH]D were sis was performed using SPSS. The normality of the sample measured as bone turnover markers. Diagnostic accuracy was verified using the Shapiro-Wilk test and comparison of was evaluated by Receiver operating characteristic (ROC) continuous variables was performed using T-Student for curve analysis. paired samples. Results: A total of 30 postmenopausal women (42%) Results: We included a total of 21 patients, 17 of them showed an increment in LS BMD. Statistically significant womenwithanaverageageof61yearsandallmenopaus- lower levels of serum BALP (p=0.02), CTX (p=0.02), al. After a year of therapy with Denosumab, there was an TRAP (p=0.04) were identified in this group in compari- increase of BMD at lumbar spine and femoral neck in 76 son with women who not presented increased LS-BMD. and 85% respectively as reflected in table 1. On the other BALP (Area under curve (AUC)=0.655, p=0.049), CTX hand, 13 of the patients included had received prior therapy (AUC=0.661, p=0.040) and TRAP (AUC=0.716, with bisphosphonates, 6 of them with annual densitometry p=0.006) demonstrated moderate diagnostic accuracy. after starting them. When compared the average percentage Regarding FN, 25 patients (35%) showed bone gain. gained in annual densitometry for each therapy, Compared with postmenopausal women who did not have Denosumab had a greater increase in BMD both LS an increase in FN-BMD, only serum level of CTX were (4,28 vs. - 1.10%) as FN (3.63 vs. - 1.6%) being statistically observed to be statistically significant increased (p=0.03). significant at FN (p 0.024). CTX as molecular marker had low diagnostic accuracy Conclusion: We consider that Denosumab could be an (AUC=0.678, p=0.028) effective alternative therapy in patients with steroid- Conclusion: Our findings suggest that baseline serum induced osteoporosis who have poor response to classic levels of BAP, CTX, and TRAP are not suitable to treatments or who have any contraindications for the use detect bone gain in postmenopausal women treated of these. S360 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P576 Materials and Methods: This is nonrandomized prospective THE LEVEL OF MARKERS OF BONE DESTRUCTION IN study. 197 postmenopausal female patients completed the 24 THE SERUM IN NATIVE PEOPLE OF TRANSBAIKALYE months treatment with teriparatide. Over all changes in bone OF RUSSIAN AND BURYAT NATIONALITIES mineral density (BMD) were measured. BMD were measured S. Verkhoturova1, S. Tsarenok2, V. Gorbunov2,T.Aksenova2, every 6 months both in lumbar spine (L2-L4) and in femoral P. Tereshkov2,P.Gromov1 neck. Patients who had compression fracture of lumbar spine 1Russia Railway Hospital, Chita, Russian Federation, 2Chita (L2-L4) or sever deformity were excluded from spinal BMD State Medical Academy, Chita, Russian Federation study. Patients were divided in two groups. Prior bisphospho- nate group had more than 1year exposure to bisphosphonate Objective: To assess the level of C-terminal telopeptide and (n=88). Bisphosphonate naïve group had no previous bisphos- serum pyridinoline among native people of the region of phonate exposure (n=81). Patients with less than a year of Transbaikalye of Russian and Buryat nationalities. bisphosphonate exposure were excluded from this study Materials and methods: 58 women with OP were examined (n=28). The response to teriparatide was compared using - 29 women of Russian nationality and 29 women of Buryat change rates of BMD from baseline. PINP was measured at 3 nationality aged between 50 and 80. 20 healthy women of the months and correlation between BMD increase was evaluated. same age group were included in the control group. The level Result: The patient demographic showed no significant of pyridinoline and C-terminal telopeptide in the serum was change between two groups. The overall change rate of determined by a standard laboratory kits "Biohommak". BMD from baseline were 11.7% for lumbar spine and 4.6% Results: It was found out that the levels of pyridinoline were for femoral neck. The change in spinal BMD was 9.3% and not significantly different in groups of women of Russian and 14.6% (p<0.0001) at 24 months, in the prior bisphosphonate Buryat nationalities suffering from OP: 1.9 [1.6, 2.6] nmol / l group and bisphosphonate naïve group, respectively. The re- and 1.9 [1.6, 2] nmol / L, respectively (p <0.05). Similar data spective change in femoral neck BMD was 1.5% and 8.3% were obtained on the level of C - terminal telopeptide: in the (p<0.0001) at 24 months. PINP at 3 months had strong rela- group of Russian people with OP the concentration was 0.49 tion with femoral neck BMD increase. [0.3; 0.6] ng / ml and in the group of Buryat people it was 0.5 Discussion: Middleton et al.1) reported that prior bisphospho- [0.4; 0.8] ng / mL. The correlation analysis between the pa- nate exposure might suppress the treatment response to rameters studied and the indicators of a ten-year absolute risk teriparatide. Our data clearly show that prior bisphosphonate of fractures was carried out to identify the relationship be- exposures inhibit the increase of BMD both in spine and fem- tween the levels of markers of bone destruction. The direct oral neck compare to bisphosphonate naïve group. correlation between the level of C-terminal telopeptide and Conclusion: Prior treatment with bisphosphonate prevented HF(R=0,42, p=0.025) was established in the patients of increases in both spinal and femoral neck BMD in Japanese Russian nationality. The direct relationship between the level population. We should consider using teriparatide prior to bis- of C-terminal telopeptide and MO (R=0,37, p=0.04) was phosphonate if the osteoporosis is sever and patient is at risk established in the patients of Buryat nationality. for a fracture. Conclusion: The level of bone resorption markers in serum Reference: 1) Middleton et al. Calcif Tissue Int 2007;81:335 did not differ in patients with OP and healthy people of both nationalities. The concentration of C-terminal telopeptide has a direct correlation with a high risk of hip fractures among the P578 representatives of Russian nationality and the risk of any os- ATYPICAL BILATERAL FEMORAL SHAFT FRACTURE teoporotic fractures (MO) in the women of Buryat nationality. IN PATIENT TREATED WHIT BIPHOSPHONATESES R. M. Agudo Alonso1,R.ParrónCambero2,M.García Sánchez3,A.M.CulebrasLópez4, A. Rebollar Merino4,L. P577 M. Gete García3 THE EFFECT OF BISPHOSPHONATE ON THE 1Servicio Medicina Interna/Hospital Universitario Príncipe de TREATMENT RESPONSE TO TERIPARATIDE IN Asturias, Alcalá de Henares, Spain, 2Servicio Traumatología/ JAPANESE POPULATION Hospital Clínico Fundación Jimenez Díaz/, Madrid, Spain, T. Kodama1 3Medicina Interna. Hospital Universitario Príncipe de Asturias, 1JCHO Saitama Medical Center, Saitama, Japan Alcalá de Henares, Spain, 4Medicina Interna/Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain Objective: The previous antiresorptive treatment may influence the response to teriparatide. The objective of this study is to deter- We report a patient with previous history of long-term bisphos- mine the effect of prior bisphosphonate exposure on the treatment phonate intake who suffered the fracture of both femurs consec- response to teriparatide (1-34 PTH) in Japanese population. utively. The radiological characteristics of both fractures Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S361 allowed to catalog a posteriori of atypical fractures associated (2) BLA did not affect osteoblast differentiation(Alkaline phos- with the prolonged treatment with bisphosphonates. After sur- phatase staining), mineralization(Alizarin red staining) and gery, treatment with bisphosphonates was definitely suspended, osteoblastic-specific genes expression (RUNX 2, COL, ALPl, initiating treatment with subcutaneous PTH 1-34. At 2 months Bglap, SPP1, Sparc) in vitro.(3) Titanium-particle-induced of prosthetic replacement, assisted load support was restarted osteolysis and ovariectomy-induced osteoporosis were prevented assisted by orthoses support in ischium, showing complete ra- by BLA in vivo. diological consolidation at 4 months after surgery. Atypical frac- Conclusions: These results demonstrated BLA effectively tures represent an entity of recent definition that in the last years inhibited osteoclastogenesis without affecting osteoblast differen- have attracted considerable attention due to the publication of an tiation and mineralization, prevented titanium-particle-induced increasing number of its clinical suspicion before they appear osteolysis and ovariectomy-induced osteoporosis in vivo. and the characteristics of this type of fractures to provide the most appropriate clinical and surgical treatment. This fractures are most commonly located in the proximal third of the femoral P580 shaft and usually occur as a result of low energy trauma. It is GEOGRAPHIC HETEROGENEITY IN HIP FRACTURE essential to know the incidence in general population of these INCIDENCE IN DENMARK, A REGISTER-BASED fractures in patients without osteoporosis who are not treated NATIONAL STUDY ON SURGICALLY TREATED HIP and untreated, so that studies to demonstrate this association are FRACTURES carried out. It is important to advise patient who uses these drugs B. Abrahamsen1,K.H.Rubin2,P.B.Johansen1,H.A. about the possibility of this type of fracture, so that any pain in Sørensen1 thigh or groin which may appear is reviewed. It is also important 1Holbæk Hospital, Department of Medicine, Holbæk, to highlight the potential association of contralateral fracture that Denmark, 2Odense Patient Data Explorative Network, will require study by the surgeon. University of Southern Denmark and Odense University Hospital, Odense, Denmark P579 Objective: To obtain information about any geographic vari- BULLEYACONITINE A, AN ANALGESIC AND ANTI- ation in hip fracture rates between residents of urban and rural INFLAMMATORY DRUGS, INHIBITS OSTEOCLAST areas or privileged vs. more deprived areas of the country. FORMATION IN VITRO, TITANIUM-PARTICLE- Methods: We used National Hospital Discharge data to deter- INDUCED OSTEOLYSIS AND OVARIECTOMY-INDUCED mine the age and gender specific rates of surgically treated hip OSTEOPOROSIS IN VIVO VIA SUPPRESSING RANKL- fractures (N=8,045, age 50+) for 2010 within each of ten areas INDUCED ACTIVATION OF NF-ΚB SIGNALING of the country defined by the Eurostat (‘NUTS’ level 3 clas- PATHWAYS sification). Location was by residence not location of event. L. W. Zhang1,Y.Y.Fan1, M. X. Feng1,X.H.Lei1,C.T. Yuan 1,A.Qin2,D.Hong1 1Orthopaedic Department, Taizhou Hospital, Linhai, China, 2Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Objectives: To explore the mechanism of bulleyaconitine A (BLA) inhibiting osteoclast differentiation and maturation. Methods: In this study, the effects of BLA on osteoclast for- mation, bone resorption, osteoblast differentiation and miner- alization were initially assessed in vitro, followed by further investigation on titanium-particle-induced osteolysis model and osteoporosis of ovariectomized rat model in vivo. To fur- ther explore the signaling pathways mediated by BLA during osteoclastogenesis, the effect of BLA on RANKL-activated NF-κB signaling pathway was examined. Results: (1) BLA inhibited RANKL-induced osteoclast differen- tiation, osteoclast-specific genes expression(CTSK, CTR, ACP5, V-ATPase-d2, V-ATPase-a3, NFATc1) and bone resorption in a concentration dependent manner without toxicity to BMMs, which was caused by suppressing the NF-κB signaling pathway. S362 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Standardized hip fracture rates (per 1,000 person 45.9% (n=109). Lowest rates in fluoxetine, 6.7% (n=30). years) for age 50+ for women (fig 1) ranged from 4.1 (E OR for hip osteoporosis, comparing citalopram to fluoxe- Zealand) and 4.3 (N Zealand) to 5.3 (N Jutland) and 5.7 tine, was 11.86 (95% CI 2.69-52.29, Pearson’s chi-squared (Inner Copenhagen), a difference of 40% between lowest test p<0.001). and highest rate. For men, rates were 1.8 (E Zealand) to 2.7 Conclusions: We confirmed in an elderly Irish population that (Inner Copenhagen), a difference of 50%. Low risk areas had ADTs are associated with lower BMD hip, and higher risk of the highest average personal income (N and E Zealand) while hip fracture. While no single drug was clearly linked with high risk areas, except Inner Copenhagen, had low average reduced BMD or increased fracture, some evidence indicates incomes (N Jutland and W Zealand). that fluoxetine may be associated with a less-negative impact Summary and conclusions: Considerable differences in hip on bone health compared with other ADTs. fracture rates, which parallel socioeconomic differences, are present in Denmark despite a comprehensive universal nation- al health service. While Inner Copenhagen had the highest hip P582 fracture rates, rates were also high in predominantly rural THE ANTAGONISTIC EFFECT OF ESTROGEN AND areas with low family incomes such as W Zealand and N IRON ON BIOLOGICAL ACTIVITY OF OSTEOBLASTS Jutland. AND OSTEOCLASTS W. Xiao1, X. Youjia2 1Department of Orthopaedics, The Second Affiliated Hospital P581 of Soochow University, Suzhou, China, 2Department of THERAPEUTIC AFFECT: THE EFFECT OF ANTI- Orthopedics, The Second Affiliated Hospital of Soochow DEPRESSANT MEDICATIONS ON BONE HEALTH University, Suzhou, China J. Mahon1,R.M.Duffy1, C. Power1,N.Fallon1,G.Steen1,M. C. Casey1, J. B. Walsh1, K. McCarroll1 Objective: To understood the antagonistic effect of estrogen 1Osteoporosis and Bone Health Unit, St James's Hospital, and iron on biological activity indicators of osteoblast and Dublin, Ireland osteoclast, and to explore the role of reactive species and NF-κB signaling pathway in this progress. Objectives: Depression and antidepressant medications Methods: 1, The primary osteoblasts were cultured in vitro. (ADTs) negatively affect bone health, but little is known of The experiment were divided into four groups treated as fol- the relative impact of different ADTs. We aimed to establish lows:(1) cells received with 10uM ferric ammonium citrate the bone health implications of ADTs for elderly patients at- (FAC); (2) a group intervention using 10nM estradiol (E2); tending our osteoporosis clinic. (3) E2 pretreatment and using the same concentration of FAC Materials and Method: We identified patients prescribed intervention; (4) a group of normal control. ALP staining and ADTs: Venlafaxine, citalopram, escitalopram, fluoxetine, ser- ALP activity were detected. The expression of gene were ex- traline, paroxetine, mirtazapine, duloxetine, amitriptyline, clo- amined through q-PCR. 2, Cell line RAW264.7 was used for mipramine, lofepramine, dothiepin and trimipramine. We osteoclasts assay. Cells were divided into 4 groups as osteo- compared them with a random control group not prescribed blasts research. 10nM estradiol and 50μM FAC were used for ADTs. We examined DXA bone mineral density (BMD) and intervention. Trap staining and resorption pit assay were ex- T-scores, and fracture history. amined. The expression of bone resorption gene were exam- Results: 1578 individuals: 522 on ADTs; 1056 control. ined through q-PCR. Level of ROS in each group were tested Mean age 66.9 (SD 14.6); 79.2% female; mean BMD total using a multi-detection reader. Cytoplasmic and nuclear pro- hip 0.795g/cm2 (SD 0.156); mean BMD spine 0.908gcm2 teins of osteoclasts were extracted. Expression of nuclear pro- (SD 0.189). Patients on ADTs had significantly lower hip teins p50, p65, pp65, cytoplasmic proteins p50, p65, IκBα, BMD than controls: BMD hip 0.025g/cm2 lower in ADT pIκBα were measured with western blot analysis. group (SE 0.010, 95%CI 0.011–0.048, p<0.002), adjusted Results: 1, The level of ALP was significantly suppressed by for age, gender, BMI. BMD spine did not differ significantly FAC with or without estradiol (P<0.05), which was in between groups (p=0.850). Those on ADTs had higher correspondence with the consequences of ALP prevalence of hip fracture: OR 2.18 (95% CI 1.68-2.83, staining. Meanwhile, FAC could inhibit the gene expression p<0.001). BMD hip was significantly lower in patients on of SP7, Runx2 in presence or absence of E2. 2, FAC could ADTs who had never had hip fracture: BMD mean differ- only stimulate osteoclasts differentiation in the absence of ence 0.121g/cm2 (SE 0.017, 95%CI 0.087–0.154, p<0.001). estradiol. Iron heightened trap positive cells number in the There was significant variation in prevalence of hip osteo- absence of E2, while there was no significant difference be- porosis between different ADTs, p<0.001, chi-squared test. tween FAC group and FAC+E2 group, which was Highest rates were in: mirtazapine, 50% (n=20); citalopram, in correspondence with the consequences of resorption pit Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S363 assay. FAC could stimulate the gene expression of Ctsk, Acp5, Conclusions: Imaging techniques are not as sensitive in MMP9 and Calcr only in the absence of E2. Gene expression detecting specific changes for osteoporosis in patients ratio of the optical density was positively correlated with ac- with aseptic necrosis of the femoral head, T score tive oxygen content. Western blot result: Pretreatment with E2 (DXA) is more useful, indicating the extent of the bone significantly suppressed the activation of p65 and p50, where- destruction fairly. We believe that treatment with as phosphorylated IκBα, p65, and p50 were increased in the alendronate in patients diagnosed with aseptic necrosis presence of FAC. of the femoral head, regardless of age, can play an Conclusion: Estrogen inhibits iron-induced osteopenia by important role in slowing bone destruction from the af- eliminating ROS and suppressing the NF-κB signaling path- fected area. way in osteoclasts. This inhibition seemed to be non-related with osteoblasts and bone formation. P584 INFLUENCE OF TOBACCO ON BONE QUALITY P583 AMONG WOMEN LIVING IN LAUSANNE EVALUATION OF ALENDRONATE TREATMENT IN B. Aubry-Rozier1,M.Metzger1, O. Lamy1,D.H.Hans1,J. PATIENTS WITH ASEPTIC NECROSIS OF THE Pête1 FEMORAL HEAD 1Center of Bone Diseases, Lausanne University Hospital D. Kamal1,R.M.Trăistaru1,K.C.Kamal1,D.O.Alexandru1, Switzerland, Lausanne, Switzerland O. Rogoveanu1 1University of Medicine and Pharmacy, Craiova, Romania Objective: Tobacco influences negatively the bone health. Although many studies have shown that smokers have a Objectives: Aseptic necrosis of the femoral head is a con- lower bone mineral density (BMD) and a higher risk of dition caused by partial or total interruption of blood supply, fractures, studies investigating the effect of smoking on which ultimately leads to bone tissue necrosis. Responsible bone quality are rare. The aim of this study was to evaluate management therapy is either conservative (hygienic-dietary the impact of tobacco on bone quality as assessed indirect- measures, lifestyle changes, wearing walking aids, ly by trabecular bone score (TBS) in the women from the physiotherapy, physical therapy, medication) or surgically OsteoLaus cohort. – saving methods (drilling biopsy, bone grafts, osteotomies) Material and Methods: OsteoLaus is a population-based or reconstructive (partial or total arthroplasties). The objec- cohort of 1500 randomly selected Caucasian women (50 tive of our study was to assess the effectiveness of to 80 y old) living in Lausanne, Switzerland and followed alendronate therapy in a group of patients diagnosed with every 2.5 years. Amongst other classical clinical factors for this condition. osteoporosis, women were asked about their smoking Material and Methods: The study, type single-blind, ran- habits, and had both spine and hip BMD (by DXA) and domized, was carried out over the year 2016 (January- spine bone texture measurements by TBS. For this study, December 2016). It included 34 patients, aged between we used baseline data. Participants were divided into smok- 23 and 62 years, diagnosed in evolutionary stages II and er and nonsmoker (FRAX questionnaire). Differences be- III (Ficat and Arlet), which were divided into two groups. tween groups were assessed with adjustments for age, cal- Lot I- 16 patients (4 women and 12 men) who received cium and vitamin D intake and menopausal hormone ther- conservative treatment and medication – alendronate; apy (MHT) exposition. group II - 18 patients (5 women and 13 men) who received Results: Results: 1320 women were included (mean age only conservative treatment. The two groups were evalu- 64.63±7.64 y, mean BMI 25.75±4.52). 1082 women were ated clinically and paraclinical - laboratory tests, imaging nonsmoker and 238 were smoker. No significant differ- techniques (Rx, CT, MRI), DXA test, initial and at com- ences between the two groups were noted in spine BMD pletion of the study. (0.912 vs. 0.925, p=0.17). However, significant differences Results: After imaging evaluation, there were highlighted were found between groups for femoral neck (0.721 vs. changes in the bone from the affected hip, in some cases also 0.729, p=0.02), total hip BMD (0.839 vs. 0.857, p<0.01) at the contralateral one, such as bone loss, increase of bone and TBS (1.354 vs. 1.365, p<0.01). Smoker had lower transparency and loss of trabecular structure. Comparing dis- values than nonsmoker. tributions of the two groups according to DXA test, we found Conclusions: In this study, women who are smokers have a for group I a statistically significant improvement (chi lower spine bone quality than women who are nonsmoker. For square=0.026 p <0.05), whereas in the case of group II, we density, the femur is a better site than the spine to show the observed that the differences were not significant (chi effect of tobacco. Otherwise, lumbar spine BMD increases square=0.870 p> 0.05). with age due to increase of degenerative disorder. In S364 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 conclusion tobacco has an impact not only on bone quantity, P586 but also on bone quality. COMPARISON OF RISK FRACTURE ASSESSED BY THE FRAX TOOL IN HIV-INFECTED PATIENTS FOLLOWED IN A SPANISH TERTIARY HOSPITAL REGARDING NON P585 HIV-INFECTED SPANISH POPULATION THE IMPORTANCE OF DIAGNOSING HEART F. López-Gutiérrez1, W. Sifuentes-Giraldo1,M.Vázquez- DISEASES IN ELDERLY PATIENTS WITH OSTEO- Díaz1,J.Casado-Osorio2 ARTHRITIS 1Rheumatology/Ramón y Cajal University Hospital, Madrid, D. Kamal1,R.M.Trăistaru1,K.C.Kamal1,O.C. Spain, 2Infectious Diseases/Ramón y Cajal University Rogoveanu1,M.D.Macovei-Moraru1,L.D.Marinescu1 Hospital, Madrid, Spain 1University of Medicine and Pharmacy, Craiova, Romania Objective: To assess the bone mineral density (BMD) and 10- Objectives: Due to poor or atypical symptoms of heart dis- year fracture risk according to the World Health Organization ease in the elderly, at least a quarter of cases remain undiag- (WHO) Fracture Risk Assessment Tool (FRAX) in patients nosed. Clinical syndromes of the elderly with mixed coronary with human immunodeficiency virus (HIV) infection follow- pathology and osteoarticular become manifest weeks or ed in a tertiary hospital of Madrid and compare them with the months later, if complications arise that lead to new onset heart ESOSVAL cohort, which included 11035 patients and is rep- failure or when there are high oscillations in blood pressure. resentative of the non-HIV population seen in Spanish tertiary The objective of our study was the identification of all elderly hospitals. patients diagnosed with osteoarthritis of various localisation Material and Methods: We performed a cross-sectional and ischemic heart disease, hospitalized during a year in our study in which FRAX values were determined in a prospec- clinic. tive cohort that included patients with HIV infection seen in Material and Methods: The study was a prospective one the Infectious Diseases Department of our center during the and was conducted over a period of one year (January period from 2010 to 2015. Collected data included demogra- to December 2016). They were included in the study a phy, comorbidities, treatment, risk factors required for the total of 485 patients, aged between 60 and 75 years, FRAX calculation and densitometric variables. diagnosed with osteoarthritis in different locations. Results: 97 patients from a total of a total of 311 had bone Evaluation of patients was performed by clinical and densitometry data and FRAX assessment available and were laboratory (lab tests, imaging techniques-Rx, CT, MRI, included in this study. The mean age of the patients was 55.4 ECG, Holter ECG for 24 or 48 hours, echocardiogra- years (range: 50-80), 75 were men (77%), most of them were phy), cardiology check-up. Caucasians (89%), with a mean body mass index of 24.2 Results: Following the clinical history, symptoms of ische- (range: 15-32.7). The median time of HIV infection was 194 mic cardiovascular diseases have been revealed in 117 el- months (interquartile range [IQR]: 155.2- 259), the median derly patients diagnosed with osteoarthritis, 34 men and 83 nadir of CD4+ lymphocytes was 168 (IQR: 81-308) and con- women. After performing an electrocardiogram and Holter comitant hepatitis C virus infection was present in 40%. ECG, we found that a number of 29 of the 34 men and 71 Among the risk factors included in FRAX calculation, 44% of 83 women who accused symptoms of ischemic heart reported smoking, 10% inadequate alcohol consumption and disease were highlighted electrocardiographic changes. 9 3% hyperthyroidism; there was no history of steroid therapy men(26.4%)and32women(38.5%),patientswhowere or previous fractures in any case and only one had a family explicit about the existence of specific symptoms, were history of hip fracture. The mean value of BMD in lumbar tested by performing an electrocardiogram and echocardi- spine (LS) was 0.9 g/cm2 (range: 0.83-0.99) and in femoral ography, changes that suggest the existence of a previous neck (FN) 0.74 g/cm2 (range: 0.65-0.82). For the comparison MI (myocardial infarction), which most of them did not with the ESOSVAL cohort the worst value of T-score in either notice at the time of occurrence. LS or FN was chosen and the patients were classified accord- Conclusions: Elderly patients with osteoarthritis general- ing to WHO definitions (osteoporosis ≤ -2.5, osteopenia -1 to - ly have a sedentary lifestyle, with activity limitation due 2.5); the results are presented in the table. Only the data for the to manifestations of osteoarthritis and cannot perceive 50-64 years group were compared because the number of the onset of cardiovascular pathology. An extended clin- older HIV patients in our center was small. No significant ical history, insisting on elements that could indicate the differences were found between the categories of osteopenia presence of disease, as well as conducting a thorough and osteoporosis in both genders, but there was a significant clinical and laboratory assessment are essential in the difference with respect to the risk of both major and hip frac- diagnosis, proper evaluation and management of these tures in males, being higher in patients with HIV infection patients. compared to the population of the ESOSVAL cohort. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S365 comorbidities were also relevant risk factors. Attention to all such risk factors, most importantly advanced age, will assist in identifying PM women at short-term subsequent Fx risk. Conclusions: HIV-infected patients followed in our center do not show significant differences regarding the prevalence of osteopenia and osteoporosis compared to non-HIV Spanish population represented by the ESOSVAL cohort. However, the fracture risk estimated by FRAX is significantly higher in men with HIV infection probably due to a higher frequency of associated risk factors. References: 1. Compston J. J Intern Med 2016;280:350. 2. Sanfélix-Genovés J, et al. Osteoporos Int 2013;24:1045. P587 SHORT-TERM FRACTURE (FX) INCIDENCE AND RISK FACTORS FOLLOWING FRACTURE IN A SWEDISH DATABASE STUDY J. Banefelt1,K.Akesson2, O. Ljunggren3, A. Spångeus4,L. Karlsson1,O.Ström5,G.Ortsäter1,C.Libanati6,E.Toth6 1Quantify Research, Stockholm, Sweden, 2Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden, 3Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden, 4Department of Endocrinology/Department of Medical and Health Sciences, Acknowledgements: Funded by UCB Pharma. Linköping University, Linköping, Sweden, 5Quantify Disclosures: JB, LK, OS and GO are employed by Quantify Research and Department of Learning, Informatics, Research, and were funded by UCB to conduct this study. KA Management, and Ethics, Karolinska Institutet, Stockholm, has received lecture fees from Merck, UCB, Eli Lilly, Amgen. Sweden, 6UCB Pharma, Brussels, Belgium OL has received lecture fees from Eli Lilly and Amgen. AS has consulted for Amgen, and worked on speaker bureau for Objectives: To report the incidence of subsequent Fx within Amgen and Eli Lilly. CL and ET are employed by, and own 12 months (m) after a Fx in postmenopausal (PM) women, stocks in, UCB Pharma. and identify associated risk factors. Materials and Methods: Women ≥50 yrs with any type of Fx were identified from a Swedish national registry between 2006–2012; cumulative subsequent Fx incidence over 12m P588 was determined. Potential baseline (1 yr before index Fx) risk BONE MINERAL DENSITY AND CAROTID ATHE- factors were included in a risk-survival model (Fx as outcome; ROSCLEROSIS IN PATIENTS WITH DIABETES death as competing event). TYPE 2 Results: 242,108 women (mean age 74 yrs) were included. Fx V. Va si lk ov a 1,T.Mokhort2, M. Zmailik3,E.Naumenko4 type at baseline was: 21.4% hip; 6.2% spine; 72.3% non-hip/ 1Department of Endocrinology. Gomel State Medical non-vertebral (NHNV). 16,145 subsequent Fx events were University, Gomel, Belarus, 2Department of Endocrinology. seen within 12m (cumulative incidence: 7.1% at 12m [95% Belarusian State Medical University, Minsk, Belarus, CI: 6.9%–7.2%]). Risk factors for Fx within 12m are shown 3Department of Endocrinology. The Republican Research (Table). Center for Radiation Medicine and Human Ecology, Gomel, Conclusions: Fx occurrence is a strong risk factor for subse- Belarus, 4Department of Functional Diagnostics. The quent Fx. Fx risk was high over the first 12m post Fx. Republican Research Center for Radiation Medicine and Furthermore, vertebral Fx was associated with a twofold in- Human Ecology, Gomel, Belarus crease in Fx risk vs. NHNV Fx. Known risk factors for Fx, e.g. advanced age or steroid use, contribute to an increased Fx risk Objective: Osteoporosis and atherosclerosis are the two most within 12m. Drugs influencing falls and multiple common diseases in elderly individuals and are associated S366 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 with significant morbidity, mortality, and disability. Many ep- for over 20 years. While ALN reduces risk of vertebral, non- idemiological studies have shown that low bone mineral den- vertebral and hip fractures by 55%, 64% and 47% respective- sity (BMD) and atherosclerosis appear to be related. This as- ly1, adherence to treatment is problematic and >50% discon- sociation has been proposed to be explained by a number of tinue within 12 months2,3. Upper gastrointestinal (GI) side biological mechanisms including similar processes of bone effects are one of the most common reasons for treatment and vascular mineralization, osteoblastic differentiation by discontinuation4. ALN 70mg effervescent (ALN EX) was de- lipid oxidation, and shared risk factors including lifestyle fac- veloped to improve the GI tolerability; it is ingested as a buff- tors, estrogen deficiency, and vitamin D receptor polymor- ered solution of fully dissolved ALN to increase the pH in the phisms. Moreover, the connection between BMD and athero- stomach and to eliminate the contact of solid ALN with esoph- sclerosis is also controversial. The aim of this study was to ageal mucosa5. examine the relationship between bone mass and carotid mea- Objective: To assess the impact of ALN EX on occurrence of surements in patients with diabetes type 2 (DT2). upper GI adverse reactions (AR). Material and Methods: 250 patients both sexes with type 2 Materials and Methods: The post-marketing experience diabetes aged 55.87±19.03 years were studied. Control group with ALN EX, launched in 2012, comprises of approxi- included 84 healthy subjects the same age. The definition of mately 1,485,183 prescriptions, which translate into normal BMD, osteopenia, and osteoporosis was made accord- 123,765 patient years and 5,940,732 ingestions. Number ing to the criteria of the WHO. Carotid intima media thickness ofupperGIAR,descriptiveofGItolerabilityandassoci- (cIMT) and carotid plaque occurrence were determined by B- ated with use ALN EX were extracted from the mode ultrasound and BMD by dual-energy X-ray absorptiom- pharmacovigilance database. etry. The plaques were measured in both common and internal Results: Three serious, erosive oesophagitis (1) and abdomi- carotid arteries. nal pain upper (2); and 28 non serious GI AR were reported. Results: BMD of lumber spine and cIMT were inversely Among the non-serious AR were abdominal pain upper (4), associated in patients with DT2. The correlation was stron- GI pain (1), dyspepsia (2), dysphagia (1), nausea (4) and GI ger in females than in males, and in females, the correlation disorder (3). was stronger after menopause. Patients with DT2, with Conclusion: The reported frequency of esophagitis with ALN carotid plaque had higher cIMT at low BMD than at nor- Tablets is 0.1 – 1%6. Assuming the same frequency for ALN malBMD,p=0.020.Multiplelinear regression analysis EX in the 123,765 patient years, at least 123 cases of reveals that age (p<0.001), smoking (p=0.001), and osteo- oesophagitis would be expected. Even when considering that porosis (p=0.007) were significantly associated with in- only 6-10% of all ARs are reported7 post-marketing, the num- creased cIMT. In women, cIMT was significantly related ber of ALN EX cases is appreciably below the level expected to age (p=0.02) and osteoporosis (p=0.03). In men, though for ALN Tablets. there was no significant relationship, a trend toward old The available safety data suggest that ALN EX is associated age and having osteoporosis was observed in increased with a lower frequency of upper GI AR than reported for ALN cIMT (p=0.054, p=0.058). Tablets and that it is a well tolerated oral bisphosphonate op- Conclusion: We found inverse association between BMD tion in the management of osteoporosis. and carotid measurements in diabetic patients. Diabetes References: type 2 patients, especially postmenopausal women, with 1. Black DM et al. J Clin Endocrinol Metab 2000;85:4118. decreased BMD may have a higher risk of developing 2. Briesacher BA et al. Pharmacotherapy 2008;28(4):437. coronary atherosclerosis. 3. Weycker D et al. Osteoporos Int 2006;17(11):1645. 4. Invernizzi M et al. Aging Clin Exp Res 2015;27:107. 5. Hodges LA et al. Int J Pharm 2012;432:57. P589 6. Fosavance 70mg SPC. www.ema.europa.eu; accessed 12. UPPER GASTROINTESTINAL SAFETY WITH THE Jan 2017 BUFFERED SOLUTION OF ALENDRONATE 70 MG: 7. Mazzitello C at al. J Pharmacol Pharmacother 2013; POST-MARKETING EXPERIENCE 4:S20. J. Hruska1,F.K.Jorgensen2, C. Pierleoni-Nielsen2,E.F. Disclosures: Dr Hruska receives consultancy fees from Eriksen3 EffRx Pharmaceuticals SA. Dr Jorgensen is consultant 1MeDACom GmbH, Zurich, Switzerland, 2Klifo A/S, working for EffRx Pharmaceutical SA since 2013. Dr Glostrup, Denmark, 3Department of Clinical Endocrinology, Pierleoni-Nielsen is consultant working for EffRx Oslo University Hospital, Oslo, Norway Pharmaceutical SA since 2016. Dr Eriksen has received compensation for speaker engagements, advisory boards Alendronate (ALN) and other bisphosphonates have been the or consultancies from Lilly, Novartis, Merck, Amgen, mainstay in osteoporosis management and fracture prevention IDS and EffRx. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S367 P590 term functional recovery in men with a fragility fracture of SKELETAL MUSCLE INDEX AND BONE VARIABLES the hip. IN A GROUP OF YOUNG OVERWEIGHT MEN Material and Methods: We investigated 80 of 95 men with a A. Khawaja1,A.J.Berro1,G.Maalouf2,C.ElKhoury1,F. hip fracture admitted consecutively to our rehabilitation hos- Frenn3,J.Matta3,H.Zouhal4,R.ElHage1 pital. All the hip fractures were either spontaneous or due to 1Department of Physical Education, Fass, University of minimal trauma (trauma equal to or less than a fall from a Balamand, Kelhat El Kurah, Lebanon, 2Bellevue University standing position). Body composition was assessed by dual- Medical Center, Faculty of Medicine, Saint Joseph University, energy x-ray absorptiometry at a mean of 19.1 (SD 4.1) days Mansourieh, Lebanon, 3Industrial Research Institute, Beirut, after fracture occurrence and aLM was calculated as the sum Lebanon, 4STAPS, University of Rennes 2, Rennes, France of lean mass in arms and legs. Functional recovery at the end of post-acute inpatient rehabilitation was evaluated using Aim: The purpose of this study was to explore the relation- Barthel Index scores. ships between skeletal muscle index (SMI) and bone variables Results: The patients with aLM above the FNIH cut-point of (bone mineral content, bone mineral density, geometric indi- 19.75kg had significantly higher Barthel Index scores ces of hip bone strength and trabecular bone score) in a group (p=0.002) and significantly higher age-adjusted odds of gaining of young overweight men. a Barthel Index score ≥85 (odds ratio=7.17; 95% CI 1.43-35.94; Methods: Forty young overweight (BMI > 25 kg/m2)men p=0.017) than those with aLM below the cut-point. Conversely, whose ages range from 18 to 32 years participated in this patients’ categorization according to either Baumgartner’scut- study. Weight and height were measured, and body mass in- point (7.26kg/m2) for aLM/height2 or FNIH cut-point (0.789) dex (BMI) was calculated. Body composition, bone mineral for aLM divided by body mass index (BMI) was not signifi- content (BMC) and bone mineral density (BMD) were mea- cantly associated with the Barthel Index scores. sured by DXA. Appendicular skeletal mass (ASM, in kg) was Conclusions: Categorization according to the FNIH threshold calculated by summing the muscle masses of the four limbs, for aLM, but not according to the FNIH threshold for aLM/ assuming that all non-fat and non-bone mass is skeletal mus- BMI or Baumgartner’s threshold for aLM/height2,significant- cle. SMI was defined as ASM/height2. Lumbar spine trabec- ly predicted the short-term recovery in activities of daily living ular bone score (TBS), femoral neck cross-sectional area (FN following a hip-fracture in men. The FNIH cut-point for aLM CSA) and femoral neck cross-sectional moment of inertia (FN emerges as a valid threshold to discriminate the patients ac- CSMI) were also measured by DXA. cording to their functional recovery. Results: SMI was positively correlated to whole body (WB) BMC (r=0.46; p <0.001), WB BMD (r=0.43; p <0.001), TBS (r=0.23; p <0.05), total hip (TH) BMD (r=0.34; p <0.001), FN P592 BMD (r=0.37; p <0.001), FN CSA (r=0.46; p <0.001) and FN RELATIONSHIP BETWEEN BONE MINERAL CSMI (r=0.39; p <0.001). DENSITY AND ALCOHOL CONSUMPTION Conclusion: This study suggests that SMI is a positive deter- S. Monov1,D.Monova2, M. Stambolova3, R. Shumnalieva1, minant of bone strength parameters in young overweight men. M. Todorova3 Optimizing SMI in young overweight men may help to pre- 1Clinic of Rheumatology, Medical University, Sofia, Bulgaria, vent osteoporosis later in life. 2Department of Internal Medicine, Medical University - Sofia, Medical Institute, Sofia, Bulgaria, 3Department of Internal Medicine, Medical Institute, Sofia, Bulgaria P591 LOW LEAN MASS AND THE SHORT-TERM FUNC- Objective: Alcohol is widely consumed across the world in TIONAL RECOVERY IN MEN FOLLOWING A FRA- different cultural and social settings. Most population-based GILITY FRACTURE OF THE HIP: A PROSPECTIVE studies have shown a positive association between alcohol and STUDY bone mass and no change or a decrease in fracture risk. It has M. Di Monaco1, C. Castiglioni1,E.Milano2 been difficult to demonstrate alcohol-induced bone loss and 1Osteoporosis Research Center, Division of Physical increased fracture rate. The malnutrition, lack of exercise, hor- Medicine and Rehabilitation, Presidio Sanitario San Camillo, monal changes are additional causative factors, which also Fondazione Opera San Camillo, Torino, Italy, 2Division of contribute to the effects of alcohol consumption on bone and Physical Medicine and Rehabilitation, Presidio Sanitario San mineral metabolism. Camillo, Fondazione Opera San Camillo, Torino, Italy The aim of this study is to evaluate the effect of alcohol intake on bone mineral density (BMD) and fracture risk. Objective: To assess the capability of different definitions Material and Methods: A cross-sectional study was per- of low appendicular lean mass (aLM) to predict the short- formed including 137 men, aged 35-72 years. Alcohol intake S368 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 wasdeterminedbyself-administered questionnaires, and mice were of normal size. Femur lengths of Prx1- BMD was measured by dual energy x-ray absorptiometry. Cre;Men1f/f and Osx-Cre;Men1f/f mice were shorter whereas ANOVA was used to determine the relationship between al- those of OC-Cre;Men1f/f mice were of normal length. Prx1- cohol intake and BMD, and ANCOVA was performed after Cre;Men1f/f and Osx-Cre;Men1f/f mice had reduced bone adjusting for age, body mass index, education, household in- mineral density by dual energy X-ray absorptiometry whereas come, smoking status, calcium intake and physical activity. that of OC-Cre;Men1f/f mice was normal. By 3-dimensional Types of alcohol consumption differ between (a) light, only micro-computed tomography imaging of femur, all three occasional consumption, (b) heavy chronic alcohol consump- strains of Men1 knockout mice had decreased trabecular bone tion, and (c) binge drinking. volume with altered trabecular structure and decreased cortical Results: 34 men reported light, only occasional alcohol in- bone thickness. In all strains of knockout mice trabecular take; 75 reported heavy chronic alcohol consumption, and 28 number and spacing were decreased and increased, respective- reported moderate to heavy intake in the year before baseline. ly. Primary calvarial osteoblasts of all strains of knockout mice A positive association between light alcohol consumption and relative to those of wild-type mice were deficient in mineral- BMD was shown, in contrast to the negative effect of binge ization and differentiation as assessed by Alizarin red, von drinking on BMD. Moderate alcohol consumption is not Kossa and alkaline phosphatase staining, and had altered gene harmful to bone health and may even be beneficial. expression profiles. Osteoblasts from heterozygous Beneficial effects do not appear to be mediated through an (Cre;Men1+/f) mice were intermediate in this respect. action on bone metabolism. Greater alcohol intake was not Conclusions: Menin plays a crucial role in the development associated with greater risk for hip fractures. Men with heavy as well as maintenance of bone mass. Haploinsufficiency of alcohol intake, but not patients with binge drinking, had a osteoblast menin may contribute to the more severe bone phe- lower risk of two or more incident falls (heavy intake: relative notype of the hyperparathyroidism of MEN1 relative to that of risk (RR)=0,61, 95% confidence interval (CI)=0,58-0,89; sporadic primary hyperparathyroidism. Menin is a potential binge drinking intake: RR=0,81, 95% CI=0,66-1,20) than pa- gain-of-function therapeutic target for treatment of low bone tients with light alcohol intake. mass disorders. Conclusions: Alcohol consumption is a risk factor for osteo- porosis based on the frequent finding of a low bone mass and increased fracture incidence in alcoholics. P594 FUNCTIONAL HYPOPARATHYROIDISM IN 257 HIP-FRACTURE WOMEN WITH SEVERE VITAMIN P593 D DEFICIENCY: A CROSS-SECTIONAL STUDY OFA OSTEOBLAST MENIN AND BONE MASS: STUDIES POORLY UNDERSTOOD CONDITION IN CONDITIONAL KNOCKOUT MICE M. Di Monaco1, C. Castiglioni1,E.Milano2 G. N. Hendy1, J. Abi-Rafeh1, L. Canaff1, I. Troka1 1Osteoporosis Research Center, Division of Physical 1Research Institute of the McGill University Health Center, Medicine and Rehabilitation, Presidio Sanitario San Camillo, Montreal, Canada Fondazione Opera San Camillo, Torino, Italy, 2Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Background: Menin, the product of the MEN1 tumor sup- Camillo, Fondazione Opera San Camillo, Torino, Italy pressor gene, facilitates cell proliferation control and differen- tiation. Our in vivo studies showed the importance of menin in Objective: To investigate the factors associated with function- the mature osteoblast and for maintenance of bone mass in al hypoparathyroidism, i.e., inappropriately normal levels of adult mice. Objective: In the present study, we examined the parathyroid hormone (PTH) despite severe vitamin D defi- in vivo role of menin at earlier stages of the osteoblast lineage ciency, in hip-fracture women. through conditional knockout of the Men1 gene. Material and Methods: We studied 405 women who had Materials and Methods: This was implemented through Cre- serum 25-hydroxyvitamin D below 12ng/ml, 20.0±5.9 LoxP recombination at the level of the limb bud (mean±SD) days after a fragility fracture of the hip. PTH osteochondroprogenitor, osteoblast progenitor as well as the was assessed by a chemiluminescent immunometric assay, mature osteoblast. Prx1-Cre;Men1f/f, Osx-Cre;Men1f/f and and bone mineral density (BMD) by dual-energy x-ray ab- OC-Cre;Men1f/f mice represent knockout of the Men1 gene sorptiometry at the unfractured femoral neck. in the mesenchymal stem cell, the preosteoblast and the ma- Results: Two-hundred fifty-seven of the 405 women (63.5%; ture osteoblast, respectively. Mice were analyzed at six 95%CI 58.8%-68-2%) had inappropriately normal levels of months of age. PTH despite severe vitamin D deficiency, whereas the remain- Results: Prx1-Cre;Men1f/f and Osx-Cre;Men1f/f mice were ing 148 had secondary hyperparathyroidism. The women with smaller than wild-type littermates whereas OC-Cre;Men1f/f functional hypoparathyroidism were younger (78.7±8.1yr vs. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S369 82.4±6.7yr; mean difference 3.7yr; 95%CI 2.2-5.3yr; the effect of vitamin D on osteoporosis and osteopenia, know- p<0.001), had higher estimated glomerular filtration rate ing that the identification of a correlation for osteoporosis and (79.0±23.8ml/min vs. 69.1±21.1ml/min; mean difference osteopenia in vitamin D deficiency patients may reduce the 9.8ml/min; 95%CI 5.2-14.5ml/min; p<0.001), higher phos- risk of osteoporosis related fractures and, may be, improve phate levels (3.7±0.6 mg/dl vs. 3.4±0.6 mg/dl; mean differ- incidence of osteopenia. The level of [25(OH)D] fluctuates ence 0.3mg/dl; 95%CI 0.2-0.4mg/dl; p<0.001), and higher according to seasons, the reference ranges observed in femoral bone mineral density (T-score -2.6±0.8 vs. T-score - “healthy" populations may be different in summer and winter. 2.9±0.9; mean difference 0.23; 95% CI 0.1-0.4; p=0.010) than All experts agree that a threshold definition of vitamin D de- those with secondary hyperparathyroidism. Conversely, we ficiency should be determined in relation to clinical outcomes, found no significant differences between the two groups of corresponding to a value below which a detriment for health women in body mass index, albumin, albumin-adjusted calci- could be expected. It is different whether we consider the um, 25-hydroxyvitamin D, and magnesium. At binary logistic general population or diseased patients. The synthesis of sev- regression, age, glomerular filtration rate and femoral BMD eral recent studies does not conclude with high evidence to the maintained a significant association with the PTH status. usefulness of systematical vitamin D supplementation what- Conclusions: Functional hypoparathyroidism is a highly ever the age. When taking in account the different parameters prevalent condition in hip-fracture women. It is associated and the suspension of meta-analysis based on unstandardized with higher femoral BMD than secondary hyperparathyroid- [25(OH)D] results, additional studies are needed to define ism, despite similar vitamin D depletion and after adjustment optimal treatment modalities, including dose, mode of admin- for multiple potential confounders, including younger age and istration and duration in each situation. higher glomerular filtration rate. P596 P595 DENOSUMAB FOR JUVENILE PAGET’S DISEASE: IS SYSTEMATICAL VITAMIN D SUPPLEMENTATION FIVE-YEAR RESULTS FROM TWO ADULT COULD BE POTENTIALLY USEFUL IN CASE OF PATIENTS WITH “BALKAN” MUTATION IN THE DEFICIENCY TNFRSF11B GENE R. Amir1 S. A. Polyzos1, G. Mintziori1,A.D.Anastasilakis2,K. 1Centre de Santé des Fagnes, Chimay, Belgium Anastasilakis3,F.Adamidou1,Z.A.Efstathiadou1,M.Kita1 1Department of Endocrinology, Ippokration General Hospital, The discovery of both vitamin D receptor expression and the Thessaloniki, Greece, 2Department of Endocrinology, 424 ability to convert 25-hydroxyvitamin D [25(OH)D] to 1,25 General Military Hospital, Thessaloniki, Greece, dihydroxyvitamin D in immune cells identified a potential role 3Department of Ophthalmology, 424 General Military for vitamin D in immunoregulation, in addition to its role in Hospital, Thessaloniki, Greece the muscular, endocrine and central nervous systems. Case control and cohort studies have suggested that high vita- Objective: The 5-year effect of denosumab (Dmb) adminis- min D level were associated with a reduced risk of autoimmune tration on bone turnover markers, pain, retina lesions and diseases, type 2 diabetes, cardio-vascular diseases, irritable hearing loss in two adult patients with juvenile Paget’sdisease bowel syndrome, depression, cancers and infectious diseases. (JPD) due to homozygous “Balkan” mutationinthe Nevertheless, during many years, multiple hypothesis TNFRSF11B gene, resulting in defective osteoprotegerin. concerning the effective contribution of vitamin D supplemen- Material and Methods: Patient #1 and #2, a 35-year woman tation witch is potentially different in supposed effects or effec- and a 32-year man at baseline, were administered Dmb for 5 tive impact of vitamin D deficiency, was probably modulated years. After a preparatory period, Dmb (30mg) was adminis- by an unavailable vitamin D measurement standardisation. tered every 3 and 2 months in patient #1 and #2, respectively. Resolving this situation requires excellence in measurement Calcium and cholecalciferol administration were also admin- of serum total [25(OH)D] and the recognized standard for istered as indicated. Total alkaline phosphatase (TSAP), bone- defining an individual’s vitamin D status, even it could be specific alkaline phosphatase (BSAP) and procollagen type I useful to introduce a concept of different thresholds. To ad- N-terminal peptide (PINP) were measured with ELISA. A 10- dress this situation the vitamin D standardization program point visual analogue scale (VAS) was used to estimate bone (VDSP) developed a reference measurement system based and articular pain. Standard retinal and otological examination on gold standard procedures, in NIST and Ghent University, were performed annually. to standardize current and future research on this topic. VDSP Results: Despite initial fluctuation in patient #1, TSAP was also developed methodology for standardizing prior research. normalized in both patients, being around the middle (50-70 This standardisation may help to improve the determination of U/l) of the reference range (25-120 U/l) for the last 2 and 3 S370 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 years in patient #1 and #2, respectively. BSAP and PINP gen- improvement is well above 50%; there is a correlation be- erally followed the same pattern as TSAP. VAS substantially tween indicators estimated as moderately high (0.8). improved in both patients (patient #1: 8-9 at baseline, 0-1 at Conclusion: The improvement of the clinical and functional year 1 and thereafter; patient #2: 7 at baseline, 2-3 at year 1 parameters has a significant impact on increasing the quality and thereafter). In parallel, the self-reported well-being and of life in patients with mechanical lumbar pain. quality of life improved in both patients. The loss of hearing and the retinal lesions (angioid streaks) remained unchanged in both patients during the treatment. No adverse event, in- P598 cluding hypocalcemia or secondary hyperparathyroidism, was POLYMORPHISM OF ESTROGEN RECEPTORS observed during the 5-year treatment. ALPHA GENE AND BONE MINERAL DENSITY IN Conclusion: Low-dose Dmb every 2-3 months consistently WOMEN WITH CHRONIC KIDNEY DISEASE ON normalized bone turnover and improved VAS and well-being HEMODIALYSIS THERAPY in both patients with JPD. No deterioration was observed in S. O. Mazurenko1,M.V.Aseev2,A.A.Enkin3,O. hearing and retina lesions. Since recombinant osteoprotegerin Mazurenko4 is not commercially available, Dmb, acting on the same path- 1Saint Petersburg State University, Saint Petersburg, Russian way as osteoprotegerin, seems to be an alternative therapeutic Federation, 2Perinatal Laboratory at State Institute of approach for JPD. Obstetrics and Gynecology n.a. D.O. Otta, Saint Petersburg, Disclosures: S.A. Polyzos has received a lecture fee from Russian Federation, 3Dialysis Center of Leningrad Regional Amgen. A.D. Anastasilakis has received lecture fees from Hospital, Saint Petersburg, Russian Federation, 4Saint Amgen, Eli-Lilly, ITF Hellas, ELPEN, VIANEX. AMGEN Petersburg Hospital named after L.G. Sokolov, Saint did not contribute to the concept and design of the study or Petersburg, Russian Federation the writing of the abstract. Objective: The aim of the study was to analyze the influence of estrogen receptors alpha polymorphism on bone mineral P597 density and risk of fractures in female patients receiving he- THE IMPACT OF REHABILITATION PROGRAM ON modialysis patients. INCREASING QUALITY OF LIFE IN PATIENTS Materials and methods: To study gene polymorphism we WITH LOW BACK PAIN used samples of DNA from lymphocytes nuclei of female pa- I. R. Marcu1,S.Patru1,A.C.Bighea1,D.Matei1 tients with CKD on hemodialysis. The middle age of the pa- 1University of Medicine and Pharmacy, Craiova, Romania tients was 43.7±12.5 years. The patients did not differ signifi- cantly by duration of hemodialysis. For polymorphism analysis Aim: The studies concerning the quality of life in patients we used 1 Ed Taq polymerases and 0.4 μМ oligonucleotide with mechanical low back pain proved the impact of this con- primers. Zones of restriction for each endonucleases were dition on their daily living activities and on their social and signed as small letters (p, x), whereas the absence of restriction professional life. The main purpose of this study was to eval- zones for each endonucleases was signed as capital letters P, X. uate the efficacy of complex rehabilitation treatment and its The genotypes pp, Pp, PP were defined for endonuclease influence on the functional status and on the quality of life in PauII, and xx, Xx, XX for endonuclease XbaI. The patients patients with mechanical low back pain. were classified as homozygous (pp, xx, PP, XX) and heterozy- Material and Methods: The study included 138 patients with gous (Pp, Xx). Bone mineral density was analyzed with dual mechanical lumbar pain, mean age 41.52±11.63 years, energy absorptiometry in lumbar spine, hip, and arm. randomised in function of the treatment in three lots: two Results: The prevalence of allele “X” in studied population control lots with medication (56 patients), respectively with was 30.2%, allele “x”–69.8%. The prevalence of allele “P” kinesitherapy (41 patients) and a test lot with physical therapy was 39.5%, and “p”–60.5%. Patients with genotype XX had and exercises (41 patients). All patients were evaluated clini- higher BMD than patients with Xx and xx genotypes. Lowest cal and functional at the initiation of the study, after 3 months, BMD was revealed in patients with Xx genotype. In groups 6monthsandoneyear. divided by alleles “p” and P”, the lowest BMD was revealed Results: The efficacy of physical-kinetic treatment is reflected in patients with genotype “PP”. We did not reveal the differ- by statistically significant improvements (p<0.05) of mean ence in the incidence of fractures in genotype groups. scores for the questionnaires for functional status- RMDQ Conclusion: Genotype “XX” and presence of allele “p” in (Roland-Morris Questionnaire) and for the quality of life- female CKD patients was associated with the highest BMD. HAQ (Health Assessment Questionnaire), for lumbar pain We did not find association of polymorphism of estrogen re- evaluated on a visual analogue scale (VAS) and for spinal ceptors alpha with fracture risk in studied population of he- mobility (Schöber’s test). RMDQ influence on HAQ modialysis patients Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S371 P599 hospital, Ibiza, Spain, 3Department of Endocrinology and BONE MINERAL DENSITYAT PATIENTS OF EARLY Nutrition. University Hospital and Health Sciences Research ONSET RHEUMATOID ARTHRITIS institute Germans Trias i Pujol. Institute Research and B. Rexhepi1,S.Rexhepi1,M.Rexhepi1, V. Sahatçiu-Meka2, Hospital Germans Trias i Pujol. CIBER of Diabetes and M. Qorolli2 Associated Metabolic Diseases (CIBERDEM). Instituto de 1Rheumatology Clinic, University Clinical Centre of Kosovo, Salud Carlos III (ISCIII), Badalona, Spain, 4Institut Catala Prishtina, Albania, 2University of Prishtina, Prishtina, Albania de la Salut and IDIAP Jordi Gol, Barcelona, Spain, 5Internal Medicine Department, Parc de Salut Mar, Universitat Objective: Rheumatoid arthritis (RA) is a chronic inflamma- Autònoma de Barcelona, IMIM (Hospital del Mar Research tory and destructive joint disease that affects 0.5–1% of the Institute), Red Temática de Investigación Cooperativa en world’s population and commonly leads to significant disabil- Envejecimiento y Fragilidad (RETICEF), Instituto de Salud ity and consequent impairment of quality of life. Osteoporosis Carlos III FEDER, Barcelona, Spain is an early and common feature in RA and occurs during the course of the disease as extra articular manifestation of rheu- Background: Patients with type 2 diabetes mellitus (T2DM) matoid arthritis which may result in increased risk of fractures, have an increased risk of fragility fractures due to several morbidity and mortality. In this study we evaluated bone min- factors, such as a greater risk of falling due to hypoglycaemia eral density changes in patients with early onset rheumatoid and/or impaired bone quality. Anti-diabetic oral agents and arthritis. insulin may also impact on fracture risk. There is however Material and methods: We investigated 30 patients with ear- scarce data available on the effect of such therapies combined ly onset rheumatoid arthritis in Private Clinic “Rheuma”. as usually prescribed in real-life practice conditions. Bone mineral density of these patients measured at lumbar Objectives: The objective of this study was to compare the spine and hip by using dual energy x-ray absorptiometry scan risk of fracture among T2DM patients who are users of differ- (DXA-Stratos800). Demographic and clinical data were col- ent antidiabetic treatments. lected like age, gender, BMI, menstrual status, disease dura- Methods: A nested case-control study was conducted using tion, erythrocyte sedimentation rate, vitamin D level, total incident T2DM patients registered in computerised primary care calcium level, phosphorous, clinical disease activity index records in the Sistema d’Informació per al Desenvolupament de and seropositivity for rheumatoid arthritis was measured. la Investigació en Atenció Primària (SIDIAP) between 2006- Results: A total of 30 patients fulfilling inclusion criteria were 2012, with follow-up available until end/2013. registered. Among the total number 21 patients or 70% were Each case (incident fractures of the hip, spine, wrist, or female, with mean age of patients 50.95±7.87 years. Nine proximal humerus in 2006-2013) was risk-set matched with patients or 30% were male, with mean age 42.01±11.01 years. five controls of the same gender, calendar year of T2DM di- Twelve or 40% had low bone mineral density. Low bone min- agnosis and age at index date (±10 years). Study exposure eral density was found higher in female patients with 21 included metformin mono-therapy (reference category), insu- (70%) as compared to male patients 9 (30%), whereas higher lin monotherapy, and other antidiabetic medications (alone or low bone mineral density was found in 15 (71.4%) female in combination as prescribed in actual practice) in the 180 patients that were in post-menopause stage. days before the index date. Conditional logistic regression Conclusion: Low BMD was found in patients at earlier stage analysis was used to estimate odds ratios and 95% confidence of the rheumatoid arthritis with seropositivity, age and meno- interval adjusting for the following confounders: age, gender, pausal status as significant risk factors. HbA1c level, body mass index, history of fracture, co-mor- bidities, and concomitant medication use. Results: Data on 12,277 T2DM patients (2,049 cases and P600 10,2280 controls) was analysed. Insulin use was associated ANTIDIABETIC MEDICATION USE AND THE RISK with increased fracture risk (adjusted OR 1.63 [95%CI 1.30- OF FRACTURE IN TYPE 2 DIABETIC PATIENTS: A 2.04]), as was the combination of metformin + sulphonylureas NESTED CASE-CONTROL STUDY (adjusted OR 1.29 [1.07-1.56]). No significant association was D. Prieto-Alhambra1,E.Losada-Grande2,B.Soldevila3,M. found with other antidiabetic medications and/or combinations. Sanni Ali1, D. Martinez-Laguna4, X. Nogués5,A.Diez- Discussion: Insulin and sulphonylureas use appear to be as- Perez5,M.Puig-Domingo3,D.Mauricio3 sociated with an increased fracture risk when compared to 1Oxford NIHR Musculoskeletal Biomedical Research Unit, metformin amongst recently diagnosed T2DM patients. Nuffield Department of Orthopaedics, Rheumatology and Residual confounding cannot be ruled out, and more studies Musculoskeletal Sciences, University of Oxford, Oxford, are needed to confirm these findings. Given their impact, risk United Kingdom, 2Medicine Department. Universitat of fracture should be taken into account in the management of Autonoma de Barcelona. Endocrinology section. Can Misses T2DM patients. S372 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P601 P602 SLEEP DISORDERS ARE ASSOCIATED WITH BONE HEALTH INDEX IN BOYS AND ADOLESCENTS TRABECULAR BONE SCORE AND OSTEOPOROTIC WITH KLINEFELTER SYNDROME FRACTURE, NOT WITH BONE MINERAL DENSITY J. De Schepper1, C. Ernst2, I. Gies3 N. A. Lambert1,D.H.Hans2,R.Heinzer3,J.Haba-Rubio3,P. 1Pediatrics UZ Brussel, Brussels, Belgium, 2Radiology UZ Marques-Vidal4,O.Lamy2 Brussel, Brussels, Belgium, 3Pediatrics, Brussels, Belgium 1department of Internal Medicine, Chuv, Switzerland, Lausanne, Switzerland, 2Center of Bone Diseases, Lausanne Background and objectives: Although adult men with University Hospital Switzerland, Lausanne, Switzerland, Klinefelter syndrome are known to be at higher risk for oste- 3Center for Investigation and Research in Sleep, Chuv, oporosis, studies regarding bone status during childhood and Lausanne, Lausanne, Switzerland, 4Department of Medicine, adolescence are very rare. Therefore, the bone mineral status Division of Internal Medicine, Lausanne University Hospital was evaluated retrospectively in pediatric KS patients.at the Switzerland, Lausanne, Switzerland level of the metacarpal bones of the left hand using an auto- mated radiogrammatic method (BoneXpert). Context: Sleep disorders and osteoporosis increase with age Methods: In 19 (6 prepubertal) KS boys and adolescents bone and are associated with high morbidity, mortality and economic age using the Greulich and Pyle method as well as the Bone burden. The prevalence of sleep-disordered breathing in Swiss Health Index (BHI), which describes bone mass as a function women is 23% above 40 years and the remaining lifetime risk of the cortical thickness of three metacarpals and the metacar- of osteoporotic (OP) fracture at 50 years is >50%. Poor sleep pal width and length, were calculated by the program from the quality is associated with increased risk of fall and inconsistent- most recent X ray of the left hand and wrist. The bone age was ly with low bone mineral density (BMD), but the effect sizes expressed as a z-score for gender and chronological age and were small and the mechanisms are unknown. Our study aimed BHI as z-score for gender bone age. Height and BMI z score to assess if sleep characteristics are associated with markers of were transformed into SDS values based on a reference data bone health: BMD, microarchitecture assessed indirectly by set for Flemish children. trabecular bone score (TBS), and OP and non OP fractures. Results: Median (range) age, body height SDS and BMI SDS Methods: OsteoLaus is a population-based cohort of 1500 ran- were respectively 13.5 (4.8-16.8) years, 1.10(-1.32-2.28) and domly selected Caucasian women (50 to 80 y old) living in 0.70(-2.27-2.78). In total 8/13 KS adolescents had a high (> Lausanne, Switzerland. All women had lumbar spine BMD and 15 mIU/L) FSH concentration and only 2 had a decreased TBS, hip BMD, vertebral fracture assessment, and questionnaire testosterone concentration. Median (range) bone age SDS about OP and non OP fractures. A random selection of 660 wom- and BHI SDS were 0.04 (-1.92-2.67) and -0.64(-2.93-1.10). en was included in the HypnoLaus Sleep cohort study and had a Overall, 6/19 KS patients had a low (z-score ≤−1.0) bone polysomnography. Total sleep time (TST), sleep onset latency mineral status. No significant correlations between BHI SDS (SOL), slow-wave sleep and rapid eye movement sleep (REM) and age, bone age, bone age sds, height sds and BMI sds and quantity, apnoea-hypopnoea index (AHI), oxygen desaturation FSH were present in the studied population. index (ODI) and sleep efficiency were evaluated. Conclusion: KS boys and adolescents have a slightly de- Results: After adjustment, sleep parameters were not associ- creased bone mass, irrespective of pubertal and gonadal status, ated with BMD, AHI and ODI were inversely associated with adiposity and tallness. Preventive measures as sufficient cal- TBS. All the results for fractures were adjusted for age, BMI cium and vitamin D intake should be encouraged in KS pa- and psychoactive drugs. Sleep onset latency was associated tients with a low bone mass. with OP fractures (p<0.001). REM was associated with OP and non OP fractures (p<0.05). We create a score of “sleep quality” including 6 parameters: total sleep time, sleep onset P603 latency, slow-wave sleep, REM sleep, AHI, and sleep efficien- OSTEOPOROTIC HIP FRACTURES AND BENZO- cy. This score was significantly lower only for women with DIAZEPINES prevalent OP fracture: women with OP fracture vs. women M.-L. Suarez-Huerta1, V. Lo pe z- Fe rn an de z 2,A.Serrano3 without fracture (-0.25±0.09 vs. 0.05±0.04, P<0.03). 1Orthopaedic Surgery and Traumatology - University Hospital Conclusion: Our study demonstrates for the first time that Leon, Leon, Spain, 2Orthopaedic Surgery and Traumatology - TBS is altered in women with high AHI or high ODI. We University Hospital Torrejon, Torrejon de Ardoz, Spain, found however no relevant association between BMD and 3Psychiatry - University Hospital Leon, Leon, Spain sleep characteristics. The sleep quality score was lower for women with OP fracture. Further studies are needed to: 1) Objectives: To evaluate the excess risk posed by the use of explain how some sleep characteristics affect TBS; and 2) benzodiazepines (BDZ) for osteoporotic hip fractures. To validate the score of “sleep quality” in other studies. compare the clinical outcome during hospitalization of Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S373 patients with hip fractures treated with BDZ respect to those a minor surgical osteosynthesis with a 3 tension band wiring without this treatment. through a minimal lateral approach instead of a prosthesis Material and Methods: All patients who were admitted in replacement. The administration of Teriparatide and a non the last year with hip fracture in the Hospital de León were weight-bearing protocol for a minimun of 3 months was the included. We collected the following data: Age, sex, length of treatment initiated on early postperative period. She did not stay, death, surgical procedure, psychopharmacological treat- have any postoperative complications. ment and total number of drugs. We defined as a patient with Results: On consecutive radiological imaging check-ups we poor outcome who had one or more of the following criteria: verified a complete healing of her fracture which resulted in Death, length of the stay over 20 days or failure to perform pain resolution, a range of motion between 0-90º and the abil- surgical procedure. ity to self-sufficient deambulation supported by crutches. Results: The prevalence of BDZ among patients treated at a Teriparatide treatment was maintained for another 24 months health center is 27.3% [1]. In our group of hip fractures was of and currently she is taking Denosumab every 6 months with- 33.63%. We found a total of 559 patients, of whom 73.5% out suffering any other fracture. were women (N=411) and 26.5% men (N=148) and the mean Conclusion: Teriparatide is a recombinant formulation of en- age was 87.46±5.41 years. The proportion of women taking dogenous PTH. Although the main indication of Teriparatide BDZ was significantly higher than men (p=0.047). The pro- is to act as an anti-osteoporotic drug, a systematic review of portion of death was not different (p=0.77) nor the length of the literature reveals several reports of its applicability in frac- the stay (p=0.74) in patients who were taking BDZ. We found tures, non-union and pseudoarthrosis because it may enhance a significant older age in the treatment group (p=0.037). osteogenesis. Even though these hypotheses seem very hope- Among patients with poor outcome we did not found a signif- ful, further studies are needed in order to support its beneficial icantly higher proportion who received BDZ (p=0.86) al- effects as an adjuvant therapy to promote fracture healing though we identified as associated with poor outcome male since its use is not licensed for that purpose yet. Due to the sex (p=0.0002) and the total number of drugs patterned medical history of our patient and because the surgical proce- (p=0.0004). Age was not associated with poor outcome of dure (prosthetic replacement and osteosynthesis) was not free the patients (p=0.098). of potential and severe complications, we did choose to use Conclusions: Consumption of BDZ is a risk factor for hip Teriparatide for this goal. fractures. The use of BDZ is associated with female and older patients with hip fracture. The use of BDZ not raise the risk of death or poor outcome during hospitalization. Factors of poor P605 outcome in hip fractures are male sex and the total number of BILATERAL HIP PAIN AFTER INNOCENT FALL patterned drugs. M. Perez Santamaria1, M. J. Dominguez Arevalo1, M. Peraza Sanchez1,E.CasusoSaenz1,A.Mohammed-Salem1 1Hospital de Laredo, Laredo, Spain P604 EFFECT OF TERIPARATIDE “OFF LICENSE” ON Objective: Themaingoalofthiscasereportistoshowan FRACTURE HEALING: A CASE REPORT unusual combination of two common fractures. M. Perez Santamaria1, M. J. Dominguez Arevalo1, M. Peraza Material and Methods: 87 year-old woman. Hypertension, Sanchez1 hypothyroidism and atrial fibrillation treated with apixaban 1Hospital de Laredo, Laredo, Spain were the comorbidities presented in her medical history. She was sent to the emergency services due to severe disabling Objective: We present a case report showing a potential use of bilateral coxalgia following a fortuitous fall in the street. The Teriparatide as a coadjuvant on fracture healing. X-ray study confirmed that there was a bilateral pertrochanteric Material and Methods: We present the case of a 81 year-old fracture. woman referred to our clinic following a right knee Results: Due to the severity of her injuries, we performed a periprosthetic fracture. She underwent a total knee surgical fixation with trochanteric intramedullary nails right arthroplasty (TKA) 10 years prior and a further replacement after anticoagulation therapy was antagonized for 48 hours. with a constrained condylar knee prosthesis 4 years later. She During postoperative period she suffered an upper gastroin- presented a supracondylar femur fracture at the level of fem- testinal bleeding episode which required treatment by the oral stem and loosening signs on tibial and femoral compo- Internal Medicine Service that consisted in drug therapy and nents (Rorabeck and Taylor Classification, type III). a packed red blood cells transfusion. By the time she was Significant comorbidities were morbid obesity (BMI >45), discharged, we prescribed her a treatment based on hypertension and ischemic cardiopathy (3 stents placed in). Denosumab every 6 months, supplemented with calcium plus Due to her high anesthetic risk, we decided to proceed with D vitamin. At her 3-month check-up both clinical and S374 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 radiological evolution of her injuries was good, and the frac- exchange. Diagnostic microbiology yielded positive results tures were consolidated. Nowadays she is able to walk pain- within the 10 samples following sonication and intraoperative lessly aided by a cane (Barthel=70, Holden=3). She has not biopsy (Sensitivity=100%). A conservative approach was suffered any additional fractures to date. chosen in the 8 remaining patients (6 TKA and 2 THA). Conclusion: Bilateral extracapsular hip fractures following a Their clinical manifestations improved in all of them at low energy trauma are extremely unusual in elderly. After follow-up 3 months later, except in one case of TKA. This reviewing the literature to date, we found that there are only later patient was underwent to surgical examination, resulting a few cases like ours reported. It´s related with younger people in positive microbiological infection after surgical samples following high energy trauma, due to malignancy complica- were analyzed (Specificity=87.5%). tions or secondary to seizures. These type on injuries are usu- Conclusions: Diagnosis of periprosthetic infection may be ally the result of a concomitant rotation force applied over a challenging, especially in chronic cases with minimal mani- baseline «insufficient» bone, meaning “insufficient” as a bone festations and findings on laboratory data, because neither a with abnormal baseline quality because of reduced elastic gold standard has not been reached yet. Recently, some au- compliance. Typically, surgical fixation is the procedure used thors suggested several laboratory assays, such as measure- to manage these injuries. Also, it is strongly recommended a ment of RCP and other biomarkers at synovial fluid, or serum multidisciplinary approach in order to minimize anesthetics levels of procalcitonin and interleukin-6. The alpha-defensin and surgical risks and to reach the best postoperative out- protein is a peptide released from neutrophils when exposed to comes. Since these fractures are frequently associated with a pathogen organism. The mere fact that their synovial levels bone fragility, drug therapy is highly recommended. In our are unaffected with antibiotherapy neither other inflammatory case, we chose denosumab due to its tolerance threshold, its factors makes alpha-defensin a promising target as a biomark- therapeutic compliance profile and its lower risk of vertebral er of joint infection. Based upon our limited data, we may and non-vertebral fractures (including hip fractures) in post- conclude that alpha-defensin test may be a useful tool to aid menopausal women. an earlier diagnosis of this type of infection. P606 P607 A NEW PERSPECTIVE FOR THE DIAGNOSIS OF PERIPROSTHETIC HIP INFECTION CAUSED BY PERIPROSTHETIC INFECTION LISTERIA MONOCYTOGENES: A CASE REPORT M. Perez Santamaria1, M. J. Dominguez Arevalo1, M. Peraza M. J. Dominguez Arevalo1, M. Perez Santamaria1, M. Peraza Sanchez1, P. Paz Ramirez1,E.CasusoSaenz1 Sanchez1,C.OrtegaAlvarez1, E. Casuso Saenz1 1Hospital de Laredo, Laredo, Spain 1Hospital de Laredo, Laredo, Spain Objective: To assess usefulness of newer biomarkers for ear- Objective: The main purpose of this case is to show a lier diagnosis of periprosthetic infection. periprostetic infection caused by an unusual pathogen. Material and Methods: Between May 2015 and October Material and Methods: A 79-year-old man was admitted 2016, we have used alpha-defensin screening test during in 18 referring a clinical picture of pain associated with inflamma- cases of painful prosthesis without any apparent reason. The test tory signs on his right thigh. The patient’s medical history was implemented in cases where infection findings were objec- included hypertension, and chronic liver disease due to an tively absent following laboratory study (reactive C protein hepatitis C virus infection caused by a blood transfusion after [RCP] and erythrocyte sedimentation rate [ESR]), microbiolog- a hip fracture surgery 30 years treated with a total hip ical culture and/or disorders on x-ray or bone scan examination. arthroplasty. Several complications appeared on the next years Our study included 10 female and 8 male patients, age from and required to perform an exchange of acetabular component 48 to 81 years (mean=67.4 ys). Time from surgery ranged 7 years ago and a new implant 2 years later with a constrained from 22 months to 19 years (mean=10.3 ys), including 11 total acetabular component due to prosthetic instability. A study knee arthroplasty (TKA) and 7 total hip arthroplasty (THA). was ordered with x-ray and bone scan, which documented Screening involved to obtain synovial fluid samples through the diagnosis of septic loosening of his hip arthroplasty, with standard knee arthrocentesis and X-ray guided hip a massive bone stock loss involving the greater trochanter and arthrocentesis, assessing the findings based upon a marketed proximal femur (Paprosky IIIa). ELISA-like test where alpha-defensin, acting as an antigen, Results: In light of the diagnosis of chronic total hip binds to an specific antibody, resulting in a colorimetric reac- arthroplasty infection, we decided an approach with a two- tion and allowing its diagnostic performance. stage exchange arthroplasty, with antibiotic loaded cement Results: 10 positive results were obtained (5 TKA and 5 (ALC) in the form of spacer at the first stage. Sonication of THA). These cases were treated surgically with a two-stage removed prosthesis suggested a diagnosis result compatible Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S375 with Listeria Monocytogenes infection. Based on results of osteoblast expression. Dose optimization and/or discovery of culture and sensitivity tests, a 6 weeks of intravenous bone-specific statins or their bone-targeted delivery offers Ampicillin course was instaured until acute phase reactants great potential in the treatment of osteoporosis. were completely normalized. After antibiotic therapy was com- Objective: The aim of this paper is to present the problems of pleted, the patient underwent to a definitive surgical treatment osteoporosis as a result of hormone imbalance in climacteric with a cemented double mobility acetabular implant and distal women and to determine the frequency of increased values of locked modular stem. Postoperative period was unremarkable cholesterol and osteoporosis. and nowadays our patient is painless, with a good functional Methods: dealt with 88 patients, of whom 61 suffered from capability and just need a walking cane as assistance. osteoporosis-study group. The control group makes 27 Conclusions: Listeria monocytogenes is a gram-positive an- patients. Determination of bone density in all patients was aerobic bacterium. Manifestations of listeriosis are rich and done in the way of the. osteodensitometry Testing of the varied, specially gastrointestinal and neurological, and excep- lipidograms was done by painted enzyme reaction. tionally bone and joint involvement. Periprosthetic infection Results: Listened was 88 postmenopausal women on com- by Listeria monocytogenes was not described until 1990, and bined therapy and the result were compared with subjects from that time there has been only 34 cases reported on liter- who were only HRT. BMD was significantly higher in the ature in a French study and 50 cases reported overall. This group with combined therapy. This study has shown that type of infection is related to advanced age (>60 years), im- statins can improve the effects of estrogen on bone density. plants and immunocompromised states (diabetes, malignan- We analyzed in our study the effect of statin on biochemical cies, steroids therapy, rheumatic diseases, etc.). Usually is a markers of bone metabolism, depending on age of the post- food-borne illness. Clinical manifestations associated joint in- menopausal women and our study suggest a positive effect of volvement are insidious, with minimal impact on laboratory statin on bone turnover in older patients. results, which is compatible with chronic infections that can Conclusion: We found a strong association between the re- be spread through blood. Even though available information is duction of fractures and BMD patients who were on treatment limited, a consensus have been reached recommending re- by statin and a very small effect of statin on markers of bone moving all the implants (otherwise recurrence >40%) and in- remodeling. travenous antibiotic therapy with ampicillin or penicillin ex- tended, at least 6 weeks, trying to reach the healing. In our case we could highlighted the absence of any infectious risk P609 factors to develop his joint involvement due to listeriosis and ANTI-RESORPTIVE THERAPY COMPROMISES that clinical manifestations were more aggressive than usual. BONE’S MATERIAL COMPOSITION PREDISPOSING TO ATYPICAL FEMORAL FRACTURES R. Zebaze1,C.Y.Chiang1,H.Nguyen2,Y.Peng3,A.Ghasem- P608 Zadeh1, X.-F. Wang1, S. Iuliano1, M. B. Zanchetta4,J.R. CHOLESTEROL LEVEL IN SERUM AND OSTEO- Zanchetta4,P.R.Ebeling2,E.Seeman5 POROSIS 1Departments of Endocrinology and Medicine, Austin Health, Z. Mirkovic1,J.Mirkovic2,T.Novakovic1,S.Milinic1,M. University of Melbourne, Melbourne, Australia, 2Department Lazic3, T. Fajertag4,G.Jankovic5 of Medicine, Monash University, Melbourne, Australia, 1University of Pristina, Faculty of Medicine, Internal Clinic, 3Straxcorp, Melbourne, Australia, 4Idim, Universidad del Priština /Kosovska Mitrovica, Serbia, Kosovska Mitrovica, Salvador, Ciudad Autónoma de Buenos Aires, Argentina, Serbia, 2University of Pristina, Faculty of Medicine, Clinical 5Departments of Endocrinology and Medicine, Austin of Ophthalmology, Priština /Kosovska Mitrovica, Serbia, Health, University of Melbourne, Institute for Health and Kosovska Mitrovica, Serbia, 3Pharmaceutical institution Ageing, Australian Catholic University, Melbourne, Australia Belgrade, Serbia, Belgrade, Serbia, 4Generaly Hospital/ Kosovska Mitrovica, Serbia, Kosovska Mitrovica, Serbia, Background: Antiresorptive therapies slow bone remodeling 5Generaly Hospital/ Smederevo, Serbia, Smederevo, Serbia and thereby slow microstructural deterioration. However, the less often renewed bone matrix may accumulate microcracks Background: Most of the current therapies available for its and undergo more complete mineralization facilitating treatment are limited to the prevention or slowing down of microcrack propagation. We hypothesized that treated women bone loss rather than enhancing bone formation. Discovery with atypical femoral fractures (AFFs) are distinguished from of statins as bone anabolic agents has spurred a great interest similarly treated women without AFFs by having less deterio- among both basic and clinical bone researchers. In-vitro and rated microstructure and higher matrix mineral density (MMD). some animal studies suggest that statins increase the bone Methods: Distal radial cortical porosity and MMD were mea- mass by enhancing bone morphogenetic protein-2 mediated sured using high resolution peripheral computed tomography S376 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 in 342 healthy pre- and 55 healthy postmenopausal women overestimated on larger bones. Trabecular bone score (TBS), and 109 women treated with antiresorptives; 49 with AFFs, 29 a gray-level texture measure derived from lumbar spine (LS) with incident typical fragility fractures and 31 remaining frac- DXA image, appears to be independent of bone size. We ture free. Deterioration in porosity and MMD was quantified aimed to assess TBS in a group of women > 50 years with using Strax1.0 and expressed as a Material Fragility Score short stature, compared to a control group. (MFS). Results were expressed as standardized deviations Material and Methods: We retrospectively analyzed LS scores relative to the young normal mean (SD)±sem and odds DXA scans of all women aged 50 to 90 years old with short ratios (OR with 95% confidence intervals (CI). stature (<144 cm in height), from a single center as part of Results: There was an inverse association between cortical their clinical routine care, between 2006 and 2016. The con- porosity and matrix mineral density in healthy women and trol group comprised of women > 161cm in height, selected in women treated with antiresorptives without AFF. Women from the same database and matched to the case group for age with AFFs had 0.88±0.26 SD (p <0.0001) lower cortical po- and LS BMD. Patients with a body mass index (BMI) outside rosity but 0.68±0.17 SD higher matrix mineral density than of 15 - 37 kg/m² range, and those with artifacts at the LS that treated women without AFF (p<0.0001); features captured in precluded image analyses were excluded. Site-matched LS the MFS which distinguished treated women with AFF from TBS was extracted from the DXA image (GE-Lunar treated women without AFF [OR=5.7, 95%CI 2.5-12.9, P Prodigy Advance #41985 software Encore 9.3v) using the <0.0001, sensitivity 77.4%, specificity 65.4%] and from un- TBS iNsight software v2.1. Rede Mater Dei Ethics committee treated women [OR=7.5, 95%CI 3.1-18.2, P <0.0001, sensi- approval CAAE 56045216.0.0000.5128. No conflicts of in- tivity 80%, specificity 65.3%]. terest to declare. Conclusion: High porosity and high matrix mineral density Results: The study population included 346 women (173 per captured using a material fragility score identifies women at group). Cases and controls were matched for age (69.8±8.7 vs. risk for AFF. High porosity and low matrix mineral density 69.8±8.5 yrs; p=0.9), LS BMD (0.992±0.155 vs. 0.990±0.160 may identify women at risk for typical fragility fractures; a g/cm2; p=0.8), and LS BMD T-score (-1.6±1.3 vs. -1.6±1.3; distinction that may assist in targeting therapy. p=0.9). Cases had a lower height (141±2 vs. 165±3 cm; Disclosures: R Zebaze has received research support from p<0.0001) and body weight (55±8 and 71±12kg; p<0.0001) than Amgen, speaker fees from AMD and is one of the inventors controls, but greater BMI (27.4±4.2 vs. 26.3±4.2 kg/m2; of the StrAx1.0 algorithm. A Ghasem-Zadeh is one of the p=0.013). Despite the comparable LS BMD between both inventors of the StrAx1.0 algorithm. Y. Peng is the groups, TBS was greater on cases group than in controls' StraxCorp employee. E Seeman has received research support (1.347±0.102 vs. 1.248±0.111; p<0.0001). A total of 97 women and lectured at national and international meetings funded by (47 cases) had a LS BMD T-score in the osteoporotic range. In from Allergan, Amgen, Asahi pharmaceuticals, Eli Lilly, and this subgroup of subjects; age, LS BMD, and BMI were compa- MSD; is a director of the board, renumerated as Chief Medical rable between cases and controls, but TBS was greater in women Officer, shareholder in StraxCorp, and is one of the inventors with short stature (1.298±0.102) than in taller women (1.184 of the StrAx1.0 algorithm. ±0.111; p<0.0001). Remarkably, 34% of patients with short stat- ure had a normal TBS (>1.350), despite being considered osteo- porotic by BMD T-score. In contrast, none of the women with P610 osteoporosis in the control group had a TBS > 1.350. TBS AND BMD ASSESSMENT IN WOMEN WITH Conclusion: TBS is greater in women with short stature than SHORT STATURE in their taller counterparts. These findings suggest that TBS J. C. M. Eleuterio1, B. C. C. Silva2,P.P.M.Alvarenga2,M.P. may offer advantages over aBMD alone to assist treatment Diniz2,M.B.Leite2,C.A.M.Silva2, M. M. S. Soares3,B.M. decisions on individuals with smaller bones. Camargos4 1School of Medicine, Centro Universitario de Belo Horizonte - UNI-BH, Brazil / Rede Mater Dei, Belo Horizonte, Brazil, P611 2School of Medicine, Centro Universitario de Belo Horizonte PRELIMINARY RESULTS OF AN ONGOING STUDY - UNI-BH, Brazil, Belo Horizonte, Brazil, 3Department of OF CONCOMITANT TREATMENT WITH TERI- Medicine, Federal University of Minas Gerais – UFMG - PARATIDE AND ZOLENDRONIC ACID IN SEVERE Brazil, Belo Horizonte, Brazil, 4Densimater - Rede Mater OSTEOPOROSIS Dei de Saúde, Belo Horizonte, Brazil S. Marwah1 1Marwah Clinic, Gurugram, India Objective: Areal bone mineral density (aBMD) by dual X-ray absorptiometry (DXA) is influenced by bone size such that Objective: To describe preliminary results of a long term on- true BMD is underestimated on smaller bones and going study of concomitant treatment of teriparatide and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S377 zolendronic acid in the treatment of severe osteoporosis in risk is uncertain. We examined this question in the FIT Long Indian patients term extension Trial (FLEX) study. Material and method: In this prospective, observational Material and Methods: In FLEX, after 5 years of study planned for four years, we enrolled patients between alendronate during FIT, women were re-randomized to 5 more 60 to 80 years with severe osteoporosis defined as T score years of ALN or to placebo and followed for 5 years. We more than -3 and bone mineral density (BMD) less than 0.5 studied only the placebo group. The association of 1 and 3 g/cm2. Injection teriparatide and zolendronic acid were given year change in hip BMD or BTM (serum Bone ALP and urine concomitantly to all enrolled patients. Teriparatide was given NTX) were examined as predictors of any incident VF (mor- in the dose of 20 mcg subcutaneously daily. Dose of phometric or clinical) over 5 years. Multivariate logistic re- zolendronic acid was 5 mg every year. Vitamin D, calcium gression was used to adjust for confounders (age and prevalent and protein supplements were added as required. Efficacy of fracture at ALN discontinuation). concomitant treatment was evaluated by calculating percent- Results: Following 5 years of ALN there were a total of 51 age of patients reporting improvement in activity of daily liv- incident VF among 437 placebo women (13%). BMD, prev- ing (ADL) whereas safety was evaluated by recording adverse alent VF and age at the time of stopping significantly predict- events. ed incident VF risk after stopping (p<0.05). One or three-year Results: A total of 336 patients [female 226 (67.3%); male change in either BMD or BTM after ALN discontinuation did 110 (32.7%)] were enrolled in this study. The indications for not significantly predict 5-year risk of VF. For example, one- giving study treatment included glucocorticoid associated os- year% change in total BMD was not significantly associated teoporosis, impending hip fracture, loosening of hip implant with risk of incident VF (OR=1.1 per 1% decrease, p=0.11). and poor result of anti-resorptive treatment given alone. Of the Conclusions: Follow-up measurements of BMD or BTM af- enrolled patients 220 (65.5%) have completed the study of ter 1 or 3 years of BP discontinuation are not associated with four years while 100 (29.8%) patients are still under study vertebral fracture risk after adjusting for baseline measure- treatment. A total of 16 (4.8%) patients dropped out from ments, prevalent vertebral fractures and age. This is similar the study. Out of all completed patients, 90% reported im- to previous results for clinical fractures. These results suggest provement in activity of daily living (ADL) whereas 10% that these follow-up measurements are of little clinical utility were not sure about the improvement. However, no patients during a drug holiday after 5 years of ALN. reported deterioration in ADL. A total of six (1.8%) patients had hip fracture which needs to be operated. No serious ad- verse event or complication was reported in this study. P613 Conclusion: Preliminary results of our ongoing study show THE IMPACT OF SARCOPENIA ON THE RESULTS that concomitant administration of teriparatide and OF LUMBAR SPINAL SURGERY zolendronic acid along with routine treatment of calcium and H. Inose1,A.Okawa1 vitamin D is effective and well tolerated in patients with se- 1Department of Orthopaedic Surgery, Tokyo Medical and vere osteoporosis. Dental University, Tokyo, Japan Objective: The purpose of this study was to investigate the P612 prevalence of sarcopenia and to evaluate the impact of CHANGE IN BONE MINERAL DENSITY (BMD) OR sarcopenia on the results of lumbar spinal surgery. BONE TURNOVER MARKERS (BTM) DID NOT Materials and Methods: This study included two groups: PREDICT RISK OF VERTEBRAL FRACTURE one group consisted of patients with lumbar spinal disease AFTER DISCONTINUATION OF ALENDRONATE IN (LSD group) and a second group consisted of patients without THE FLEX STUDY (control group). 1:1 propensity score-based matching was per- S. Chang1,D.Bauer2,D.Black2 formed. Sarcopenia was diagnosed when the appendicular 1Clinical and Translational Science Institute, University of skeletal muscle mass index by Dual energy X-ray absorptiom- California, San Francisco, San Francisco, United States, etry was ≤ 7.0 kg/m2 for male patients and ≤ 5.4 kg/m2 for 2Dept of Epidemiology and Biostatistics, University of female patients. In order to evaluate the impact of sarcopenia California, San Francisco, San Francisco, United States on the clinical outcome of lumbar spinal surgery, the Japanese Orthopaedic Association (JOA) score, the recovery rate based Objectives: There are few data to guide clinical decision mak- on the JOA score, and Visual Analogue Scale (VAS) score ing after stopping bisphosphonates (BPs) for a drug holiday. were compared within the LSD group. We have previously shown that 1 or 3 year change in BMD or Results: 54 matched pairs without residual significant differ- BTM after stopping alendronate (ALN) did not predict clinical ences were created. The prevalence of sarcopenia showed no fracture risk, but whether they predict vertebral fracture (VF) statistical difference between groups (LSD group 38.9%, S378 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 control group 53.7%). In the LSD group, while VAS score peptide level was remained higher in adenoma group (0,64 showed no statistical difference between the sarcopenia sub- ±0,03 E/mL) compared to control group (0,58±0,03 group and non-sarcopenia subgroup, the sarcopenia subgroup E/mL)(p=0.24).The correlation did not obtained between the demonstrated inferior results for the JOA score and recovery cardiometabolic risk factors and bone formation markers. rate at final follow-up when compared with the non- Conclusions: Cardio metabolic risk factors and bone forma- sarcopenia subgroup (p<0.05). tion markers including osteocalcin and procollagen levels were Discussion: This study demonstrated high prevalence of found to be higher in non-functional adrenal adenoma com- sarcopenia among Japanese populations and its negative effect pared to control group, however the statistical difference did on clinical outcomes after lumbar spinal surgery. not obtained. The small study group may be the reason of statistical similarity. Tumorigenesis process in development of adrenal adenoma may play a role in the increased bone turn- P614 over. Therefore patients with non-functional adrenal adenoma OSTEOCALCIN AND PROCOLLAGEN-3 N-TERMINAL should be followed for the increased cardiometabolic risk and PEPTIDE LEVELS IN NON-FUNCTIONAL ADRENAL behind this they should be followed for the healthy bone status. ADENOMA E. C. Cakir1, A. A. Atasoy2,S.A.Ahbab2,D.K.Kayas3,Y. D. Doventas4,M.K.Koldas4,E.A.Ataoglu2 P615 1Endocrinology and Metabolic Diseases Department, Haseki A RISK ASSESSMENT STUDY ON WORK-RELATED Training and Research Hospital, Istanbul, Turkey, 2Internal MUSCULOSKELETAL DISORDERS AMONG Medicine, Haseki Training and Research Hospital, Istanbul, DENTISTS IN MANGALORE CITY Turkey, 3Internal Medicine, Istanbul, Turkey, 4Biochemistry, S. Katpattil1 Haseki Training and Research Hospital, Istanbul, Turkey 1Al Iqbal Hospital, Thrissur, India Aim: The etiology and underlying pathology of non- Background: Work-related musculoskeletal disorders functional adrenal adenoma has not been clearly defined, (WMSDs) are responsible for morbidity in many working yet. The percentage of adrenal adenoma that became function- populations, which are of multifactorial in origin and of global al is still unclear, furthermore what triggers the acquisition of concern due to industrialization. Dentists as one of the health- functionality is not yet fully defined. Bone formation marker care professionals are prone to develop these WMSDs. The including osteocalcin and procollagen-3 N-terminal peptide study aims to determine the prevalence of WMSDs among (P3NP) is not evaluated in adrenal adenoma. In various liver dentists in Mangalore region and explores the various risk disease P3NP has been obtained to be higher. Additionally, in factors for the development of MSDs and WMSDs. the liver disease with fibrosis, P3NP is the predominantly Materials and Methods: This proposed study is a cross- molecule of collagen deposition. Therefore; we evaluated sectional study conducted among dentists of two randomly these markers together with cardiometabolic risk factors in selected dental colleges of Mangalore, India. A structured adrenal adenoma group. questionnaire was used to collect the demographic informa- Materials and Methods: We studied twenty-two newly diag- tion, occupational history, risk factors, and ergonomic aware- nosed adrenal adenoma patients and 20 healthy participants in ness with job task details. Prevalidated standardized tools such a tertiary health-care center. Fasting glucose, insulin, lipid as quick exposure check list, rapid entire body assessment profile, and osteocalcin and procollogen-3 N-terminal peptide score sheet, and Nordic Musculoskeletal Questionnaire were levels were evaluated. also used. Data were entered in MS-Excel and analyzed Results: Mean age was 54,91±9,11 year in adenoma group through SPSS version 22. and 49,70±10,63 year in control group. Mean fasting glucose, Results: More than 88% of the participants reported pain and insulin, HOMA-IR, CRP, osteocalcin and procollagen levels discomfort in at least one part of their body. The major affect- were higher in adrenal adenoma group compared with the ed body part is neck, followed by the lower back and wrist. control group, however; the differences did not reach statisti- More than half of the orthodontists and oral surgeons reported cal significance (p>0.05). Mean osteocalcin was 21,10±7,15 that their MSDs are work-related origin. Pearson's correlation ng/ml in adenoma group, it was 19,54±7,55 ng/ml in control test indicated that there is a positive correlation between the group. After adjusted for age mean osteocalcin level was current exposure and risk (r=0.789). Multivariate regression remained higher in adenoma group (21,01±1,57 ng/ml) com- analysis found that younger participants, male (OR=3.7), in- pared to control group (19,63±1,69 ng/ml)(p=0.55). Mean volved physical activity (OR=1.04), dentists not taught about procollagen-3 N-terminal peptide level was 0,65±0,18 E/mL ergonomics in their dental school (OR=1.69) or never in adenoma group, while it was 0,58±0,12 E/mL in control attended any workshops (OR=1.38), who reported task in- group. After adjusted for age mean procollagen-3 N-terminal volving sustained muscle contraction (OR=1.72) or task with Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S379 repetitive movements (OR=1.89) are the major risk factors for P617 the development of MSDs among the dentists. DOES OBESITY CAUSE CHRONIC INFLAMMATION? Conclusion: This risk assessment study found that there is a THE ASSOCIATION BETWEEN COMPLETE BLOOD high prevalence of MSDs and WMSDs among dentists. PARAMETERS WITH BODY MASS INDEX AND Ergonomic awareness and health promotion need to be inte- FASTING GLUCOSE grated with the professional practice for dentists. T. T. Koca1 1Physical Medicine and Rehabilitation Clinic, Research and Training Hospital, Malatya, Turkey P616 Aim: To determine the relationship of complete blood count SCLEROSTIN DOWN-REGULATION STIMULATES (CBC) parameters and derivates with fasting blood sugar and BROWNING OF HUMAN BM-MSCS the body mass index. I. Gurt1,M.El-Haj2,H.Artsi1,E.Cohen-Kfir3,O.Safran2,R. Dresner-Pollak1 Methods: This was a prospective, observational clinical 1Endocrinology and Metabolism Service, Department of study. Hospitalized patients who received a physiotherapy Medicine, Hadassah-Hebrew University Medical Center, program in the Physical Medicine and Rehabilitation Clinic Jerusalem, Israel, 2Department of Orthopedics, Hadassah- between March and June 2016 were included in the study. The Hebrew University Medical Center, Jerusalem, Israel, age, height, weight, body mass index (BMI), fasting blood 3Institute of Medical Research Israel-Canada, Hebrew glucose, erythrocyte sedimentation (ESR), C-reactive protein, University-Hadassah Medical School, Jerusalem, Israel and CBC parameters (leukocytes, platelets, neutrophils, lym- phocytes, and monocytes) and red cell distribution width, Background: Adipose tissue is composed of visceral, subcu- platelet distribution width, neutrophil–lymphocyte ratio taneous and marrow depots. The role of marrow adipose tissue (NLR), and platelet–lymphocyte ratio of the patients were (MAT) remains obscure. MATwas discovered to actively par- recorded. The relationship between the BMI, fasting glucose, ticipating in whole organism metabolism. Marrow adipocytes and CBC parameters and derivates were investigated. Patients were found to express both white and brown adipocyte char- were assorted into the following groups based on BMI: acteristic markers. This brown-like phenotype diminished BMI≤25 kg/m2, normal; BMI=26–30 kg/m2, overweight; with aging and diabetes in mice. Sclerostin, an inhibitor of and BMI>30 kg/m2, obese. A P value>0.005 was considered the canonical Wnt pathway, was recently reported to positive- statistically significant. ly regulate adipogenesis in vitro. We asked if blocking Results: A significant difference in the lymphocyte count, sclerostin affects MAT gene expression profile. ESR, and NLR values was observed across the three groups Material and Methods: Fresh femoral bone marrow was har- (P=0.011; P=0.021; P=0.04). A significant difference in NLR vested during femoral canal preparation in female patients was found between groups 1 and 3 (P=0.04). Between groups undergoing partial hip replacement following a hip fracture 1 and 3, a significant difference in platelet count was noted (n=2) or hip replacement (n=1). Mesenchymal stem cells were (P=0.013). On separating the groups into two groups: normal plated and treated with the anti-sclerostin antibody (Scl-AbII), and overweight/obese, a significant difference in lymphocyte kindly provided by Amgen. mRNA expression of adipogenic count, glucose, and ESR values was observed (P=0.038; gene markers: PPARγ2, AP2/FABP4,UCP1, Dio2, PGC1α, P=0.05; P=0.013). The lymphocyte count, ESR, and glucose PRDM16, FOXC2 and β3AR was determined by quantitative values were found to be higher in the overweight group. real time PCR. The study was approved by the Hadassah- According to Spearman's correlation analysis, the BMI and Hebrew University Medical Center ethics committee (HMO- NLR values were found to be negatively correlated 361-06), and informed consent was obtained from each pa- (P=0.029; r=.145); however, the lymphocyte count and ESR tient prior to surgery. values were positively correlated (P=0.009; r=.173); Results: Blocking sclerostin with the anti-sclerostin antibody (P=0.013; r=.182). did not affect PPARγ2 and AP2 expression. However, a dra- Conclusions: This study found a negative correlation be- matic increase in brown-like adipocyte gene markers was ob- tween the NLR and BMI values and a lower NLR value served including a 2-fold increase in the expression of the in the obese group compared with the normal group. thermogenic gene UCP1, the hallmark of brown adipocytes, The overweight group showed a higher lymphocyte Dio2 (12-fold), β3AR (6-fold), PGC1α (2-fold),PRDM16(2- count, thereby confirming the positive correlation of fold),FOXC2(14-fold). lymphocyte count with BMI. A comprehensive clarifica- Conclusion: Blocking sclerostin promotes a brown-like adi- tion of the mechanisms underlying the relationship be- pocyte gene program in human femoral MAT. Blocking tween obesity and inflammation may allow developing sclerostin is an emerging novel therapy for osteoporosis. It treatment strategies to reduce the negative effects of may also favorably affect fat metabolism. obesity. S380 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P618 P619 FRAGILITY FRACTURES OF THE CUBOID: CLINICAL DEPRESSION, ANXIETY, PERSONALITY TRAITS, EXPERIENCE AND LITERATURE SURVEY AND GENDER DIFFERENCES IN PATIENTS WITH E. Ntouvali1 PRIMARY RESTLESS LEG SYNDROME 1Orthopaedic Surgery and Traumatology, Diagnostic and T. T. Koca1,N.B.Siverekli1 Therapeutic Center of Athens "Hygeia" S.A, Athens, 1Physical Medicine and Rehabilitation Clinic, Research and Greece Training Hospital, Malatya, Turkey Cuboid fractures are rare foot fractures, usually resulting Aim: To investigate some personal traits accompanying pri- from trauma or repetitive stress on the lateral foot column. mary restless leg syndrome (RLS). Recently, we have been focusing on a subset of cuboid Method: The study included 75 patients with RLS who vis- fractures which could be characterized as “fragility frac- ited Physical Therapy and Rehabilitation outpatient clinic be- tures”. Their timely diagnosis and effective treatment can tween February and June in 2016. The diagnostic criteria for be challenging, with long – term sequelae on the patients’ RLS were determined according to the 2003 minor criteria of quality of life. Therefore, a high degree of suspicion for the International RLS Working Group. The depression and this type of injuries is required, which can be achieved by anxiety levels of the patients were evaluated using Beck de- sharing information and increasing awareness regarding pression and Beck anxiety scales. Hacettepe Personality such fractures. With this objective, we are hereby present- Inventory(HPI) (Team A) was used to detect personality traits. ing our clinical experience and a review of the pertinent Results: The gender-based results indicated statistically signif- literature. icant differences in some subtypes such as neurotic symptoms, Since December 2012, unilateral cuboid fractures in 3 psychotic symptoms, personal adaptation, and general adapta- postmenopausal female patients have been diagnosed tion. Higher neurotic and psychotic symptoms (with less and treated by the author. With respect to the mecha- scores), lower personal adaptation score, and higher general nism of injury, the aforementioned patients reported on adaptation score were observed in females relative to males. a preceding accident with minimal - force trauma; in However, males were younger than females. The patient group addition, one of them was under anti – osteoporotic was very similar to the general population in terms of self- treatment with denosumab. There were associated soft fulfillment, family relation, social relation, social norm, antiso- – tissue injuries in all 3 cases and a concomitant frac- cial personality features, social adaptation, and general adapta- ture of the base of the ipsilateral fifth metatarsal in 1 tion sub-parameters, but emotional stability, neurotic and psy- case. Despite clinical and radiological examination, the chotic symptoms, and personal adaptation sub-parameters were cuboid fracture diagnosis was initially missed in all 3 different and stayed under the 25% percentile. In multiple re- patients, who resorted to the author’s advice due to gression analysis, evaluation of personality sub-features with persistent symptoms after an average 2 – week interval. Beck anxiety scale results detected significant correlations be- At that point, clinical signs attributable to a cuboid tween emotional stability, social norms, and personal self-reli- fracture were recorded. A targeted CT and MRI exami- ance. Evaluation of personality sub-features of the patients ac- nation revealed sagittal, undisplaced, cuboid fractures cording to Beck depression scale results also revealed a statis- with intraarticular expansion in 2 out of 3 cases and a tically significant correlation between psychotic symptoms. similar, extraarticular cuboid fracture in 1 case. All 3 Conclusion: Patients with RLS showed gender-based differ- patients were treated conservatively with immobilization ences in neurotic, psychotic, emotional stability, and personal of the injured foot in a short – leg cast and avoidance adaptation parameters compared with the general population. of weight – bearing for 6 – 8 weeks, followed by phys- ical therapy to ensure their prompt functional rehabili- tation. P620 Cuboid fractures can be missed owing to their relative SPECIAL FEATURES OF BONE MINERAL META- rarity and the simultaneous occurrence of more readily BOLISM AND BODY COMPOSITION IN CHILDREN identifiable foot lesions. There is a lack of published WITH NEPHROTIC SYNDROME articles about cuboid fractures in osteopenic or osteo- N. Volkova1, A. Soltsava2,I.Kozyro2, N. Vasileva3 porotic postmenopausal women, who may be more sus- 12th City Children's Clinical Hospital, Minsk, Belarus, 2Belarusian ceptible to such fractures after minimal – force trauma. State Medical University, Minsk, Belarus, 3Republican Center for Hence, further studies aiming to the identification of Medical Rehabilitation and Balneotherapy, Minsk, Belarus cuboid fractures as “fragility fractures” that could po- tentially influence current treatment guidelines are Objective: to learn characteristics of biochemical markers of required. bone metabolism, parameters of bone mineral density (BMD) Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S381 and fat component of body composition for early diagnosis of protein antibody (ACPA) positive subjects without evidence bone disorders in children with nephrotic syndrome (NS). of arthritis and in patients with RA using HRCT. Material and Methods: We compared data of laboratory in- Material and Methods: We enrolled 22 consecutive pa- vestigations (phosphorus (P), total calcium (Ca), parathyroid tients,6 men and 16 women (mean age 48.93±12.1 SD) all hormone (PTH), and alkaline phosphatase (ALP)), protocols ACPA-positive. 6 subjects without clinical evidence of arthri- of dual-energy X-ray absorptiometry of the axial skeleton and tis; 10 patients with early RA (E-RA) naive to therapy (dura- total body of 24 children with NS (group 1 – G1, age 10,41 tion <24 weeks); 6 patients with clinically manifest RA (CM- ±4,59 yrs) and 13 children of control group (G2, age 11,30 RA) in therapy (duration <36 months). All patients underwent ±10,77 yrs, p=0,55). Group 1 was divided in subgroups G1a to a HRCT of the chest (Somatom definition Siemens) with (relapse of NS, n=11) and G1b (remission of NS, n=13). helical supine inspiratory acquisition contiguous (5mm); im- Results were processed using SPSS17 and Excel 10. ages were reconstructed at 1 mm every 20 mm with high- Results: Children with NS have had from 1 till 12 relapses by resolution algorithms. HRCT images were reviewed by 2 ra- the time of study. 19 children (82,3%) received steroid therapy diologists who were blinded to each subject with regard to in the average dose for prednisolone 0,96±0,77 mg/kg. G1 disease status. Lung abnormalities were classified as the pres- showed significantly lower age-matched z-score of BMD of ence or absence of airways disease (1 or more of the follow- lumbar spine (L1-4) (-0,97±0,86) compared with G2 (0,06 ing: bronchial wall thickening, bronchiectasis, centrilobular ±1,00, p=0,024). One child of G1 had low bone density (z- opacities and abnormal air trapping) or parenchymal disease score of BMD L1-4=-2,9). Total BMD was similar in the (1 or more of the following: ground-glass opacities/ alveolar groups (0,90±0,11 g/cm2 in G1 vs. 0,95±0,18 g/cm2 in G2, infiltrates, nodules, and interstitial lung disease/ fibrosis). p=0,38). Fat component of body composition was increased in Results: Pulmonary nodules were detected in 12/22 (55%) G1 (40,63±10,90%) compared with G2 (24,81±7,75%, patients: 2/6 (33%) of positive ACPA subjects without arthri- p=0,002). Android/gynoid fat ratio was higher in G1 (0,95 tis, 7/10 (70%) of the E-RA patients, 5/6 (83%) of patients ±0,15) than in G2 (0,70±0,20, p=0,003). Children of G1a CM-RA. Others pulmonary abnormalities were observed: fi- showed lower level of Ca than control (2,19±0,19 mmol/l brosis (45%), enfisema (18%); consolidation, bronchiectasis, vs. 2,41±0,18 mmol/l, p=0,002). Concentration of Ca in bronchial wall thickening and abnormal air trapping in 13%; G1b was similar to G2 (2,41±0,13 vs. 2,41±0,18 mmol/l, ground glass opacities (9%). These lung abnormalities had a p=0,96) We did not reveal significant difference in of PTH, significantly higher prevalence in patients CM-RA respect to t P and ALP levels in the groups (p>0,05). those without arthritis (p=0.021). Conclusions: Most children with NS showed normal BMD Conclusion: This preliminary study demonstrated that pul- of lumbar spine, though it was decreased compared with monary nodules are developed early and frequently in the healthy controls. Patients with NS had higher fat compo- course of the RA. Because the early lung involvement in nent in body composition with increased android type of its RA is often subclinical and hardly detectable by commonly distribution. used tests (PFR), the results of this study suggest the use of HRCT in positive ACPA subjects without arthritis and E- RA patients. P621 EARLY PULMONARY ALTERATIONS IN PATIENTS WITH ANTI-CITRULLINATED PROTEIN ANTIBODY- P622 POSITIVE RHEUMATOID ARTHRITIS USING HRCT EVALUATION OF SLEEP DISORDER AND ITS EFFECT D. Diacinti1,F.Vullo1,G.Cannavale1,B.Lucchino2,M.Di ON SEXUAL DYSFUNCTION IN PATIENTS WITH Franco3,C.Cipriani3,S.Minisola3, G. Gori1, C. Catalano1 FIBROMYALGIA SYNDROME 1Department of Radiological Sciences, Oncology and T. T. Koca1,G.K.Acet1,E.Tanrıkut2,B.Talu3 Pathology, Rome, Italy, 2Department of Internal Medicine 1Physical Medicine and Rehabilitation Clinic, Research and and Medical Disciplines, “Sapienza”, Rome University, Training Hospital, Malatya, Turkey, 2Obstetrics and Rome, Switzerland, 3Department of Internal Medicine and Gynecology Clinic, Research and Training Hospital, Medical Disciplines, “Sapienza”, Rome University, Rome, Malatya, Turkey, 3Department of Physiotherapy, Faculty of Italy Health Sciences, Inonu University, Malatya, Turkey Objective: It is known that anti-citrullinated protein antibod- Objective: Sexual problems are commonly seen in women ies (ACPA) are present years before the onset of clinical rheu- with fibromyalgia syndrome (FMS). The objective of this matoid arthritis (RA) and the lung could be a venue for ACPA study was to reveal the relationship between the severity of formation. Aim of this study was to evaluate the presence of symptoms, sleep disorder, and sexual dysfunction in women subclinical pulmonary abnormalities in anti–citrullinated with FMS. S382 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Materials and Methods: A total of 140 sexually active wom- relationship between charge density and ultrasound wave en with FMS aged 17-67 years who presented to our physical speed (and attenuation) is shown. medicine and rehabilitation outpatient clinic between January Results: We can simply conclude that the excessive charge 2016 and June 2016 were enrolled in the study. The patients’ ions in bone fluid flow are attached on the trabecular struts and age, height, body weight, body mass index (BMI), and general increase the fast wave velocity and attenuation in ultrasound. pain score [visual analogue scale, (VAS)] for the last 1 week Since the charge ions are gathered on the trabecular struts, were recorded. The patients were given three different sets of which recruit the osteoblasts to be attached. questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Conclusion: The fast wave in ultrasound may play an impor- Fibromyalgia Impact Questionnaire (FIQ), and Female tant role in bone remodeling process of trabecular bone and it Sexual Function Index (FSFI). may explain why osteoporosis is treated by a low intensity Results: The mean age of the patients was 40.3±8.5 years; ultrasound. the mean BMI was 27.1±4.4 kg/m2, VAS (last 1 week) Acknowledgement: This research was supported by Basic was 6.9±2 cm, the mean PSQI was 24.8±10.8 (one patient Science Research Program through the National Research with PSQI ≤5), FIQ was 65.9±19.2, and FSFI was 19.0 Foundation of Korea (NRF) funded by the Ministry of ±6.9. No significant relationship was observed between Education (grant number 2015R1D1A1A09057878) the mean PSQI and BMI values (p=0.401), whereas a sig- nificant relationship was found between the mean values of VAS, FIQ, and FSFI (p=0.03; p=0.034; p<0.001, re- P624 spectively). In Pearson’s correlation analysis, a positive CAN ALP BE THE SURROGATE MARKER OF BONE correlation was noted between PSQI and VAS (r=0.324; TURNOVER? p<0.001) and FIQ values (r=0.271; p=0.001). A signifi- H. Tanigawa1, Y. Tamagawa1,S.Nishiwaki1,S.Imai2 cant relationship was found between the FIQ and VAS 1Kusatsu General Hospital, Kusatsu City, Japan, 2Shiga values (p<0.001). P less than 0.005 was considered statis- University of Medical Science, Otsu City, Japan tically significant. Conclusion: Sleep disorder is regarded as the underlying It is important to measure bone turnover markers (BTMs) as cause for many signs and symptoms in FMS. Sexual dysfunc- well as bone mineral density in the diagnosis and treatment of tion may develop in women with FMS, based on the severity osteoporosis. However the measurement of BTMs remains to of the disease and poor sleep quality. We found that sleep be less prevalent due to the high cost. Serum ALP level is dysfunction was significantly related with the severity of dis- commonly determined in the basic blood test. We questioned ease, pain, and sexual dysfunction. We also found a positive if it can be used as the marker for the rough estimation of the correlation between VAS and PSQI. bone turnover. The present study thus investigated the corre- lation between ALP and BTMs in serum levels. BTMs (P1NP and serum NTX) and ALP ware measured in P623 blood samples obtained from 85 patients (12 male and 73 fe- OSTEOPOROSIS MAY BE TREATED BY ULTRASOUND: male) in our hospital from January 2015 to July 2016. The THEORETICAL EXPLANATION WITH STREAMING average age was 68.5 years old. Thirty six patients were given POTENTIAL no drug treatments for osteoporosis before examination, while Y. J . Yo on 1 others had been administered either bone resorption inhibitors 1College of Engineering, Hanyang University, Seoul, (34 examples) or Teriparatide (15 example). Republic of Korea Data points showed a non-standard distribution, and therefore analysis was performed by Spearman rank correlation. A Objective: Osteoporosis may be treated by a low intensity strong correlation (coefficient of correlation, 0.801) between ultrasound and, theoretically the relationship of ultrasound P1NP and ALP was found. A correlation was also found in the with streaming potential, a primary stimulus of bone remod- analysis between serum NTx and ALP (coefficient of correla- eling process, is explained theoretically. tion, 0.602). Introduction: Bone remodeling process is mainly induced by Consistent with a previous study showing a correlation be- bone fluid flow, streaming potential, piezoelectricity, and so tween ALP and Bone ALP (BAP), our results revealed that on. Clinically a low intensity ultrasound treatment to osteopo- in serum levels ALP shows a correlation with P1NP and NTx, rosis has been studied. Thus we try to examine the relationship suggesting that variations in serum ALP levels reflect the dif- between ultrasound and streaming potential, one factor of ference in bone turnover. In clinical practice, bone resorption bone remodeling process. inhibitors are often administered even in the case of a low Methods: Poroelasticity theory combined with charge density bone turnover, increasing the risk of Severely Suppression (or streaming potential) is employed and numerically the Bone Turnover (SSBT) and Atypical Femoral Fracture Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S383 (AFF). Thus the index of serum ALP levels may provide Conclusion: Low BMD is associated with high rates of IA safety consideration for osteoporosis medications. and IMT in postmenopausal women. Shortest telomeres were The present study suggests that serum ALP levels can be used observed 2.45 times as often in patients with low bone mass, as a potential maker of bone turnover. Because serum ALP though the relationship was not confirmed by the regression level is obtained in normal blood test, it is thus worth consid- analysis. This fact suggests that osteoporosis is not a result of ering this low cost index to avoid inappropriate use of bone the bone tissue’s early aging, but rather is an outcome of the resorption inhibitors. changes in bone cell function and bone remodeling. P625 P626 BONE MASS AND VASCULAR WALL CONDITION MODERATE MECHANICAL STIMULATION MODU- DEPENDING ON CELLULAR AGING BIOMARKERS LATES CHONDROCYTES AFFECTED BY THE IN POSTMENOPAUSAL WOMEN TRIGGER DIACEREIN UNDER INFLAMMATORY I. Skripnikova1, N. Alikhanova1,O.Тkacheva2,I. AND NON-INFLAMMATORY CONDITIONS Strazshesko1, V. Vygodin1, V. Novikov1, L. Murashko1,E. B. Steinecker-Frohnwieser1, H. Kaltenegger2, L. Weigl3,A. Abirova1,N.Sharashkina1,O.Isaykina1 Mann3,W.Kullich4,A.Leithner2,B.Lohberger2 1National Research Center for Preventive Medicine of the 1Ludwig Boltzmann Department for Rehabilitation of Internal Ministry of Healthcare of the Russian Federation, Moscow, Diseases, Cluster for Arthritis and Rehabilitation, Groebming, Russian Federation, 2Russian Clinical Research Center for Austria, 2Department of Orthopedic Surgery, Medical Gerontology, Moscow, Russian Federation University Graz, Graz, Austria, 3Department of Special Anaesthesia and Pain Therapy, Medical University Vienna, Objective: to study the association of bone mineral density Vienna, Austria, 4Ludwig Boltzmann Department for (BMD) with the intima-media thickness (IMT), the athero- Rehabilitation of Internal Diseases, Cluster for Arthritis and sclerotic plaques (ASP), the pulse wave velocity (PWV) and Rehabilitation, Saalfelden, Austria the augmentation index (AI) depending on telomere length (TL) in postmenopausal women. Objective: Osteoarthritis (OA) as the main chronic joint dis- Materials and Methods: 107 women at the age range of 45- ease, characterized by destruction of articular cartilage in the 82 years old were observed ambulatory and included into a joints, concerns almost forty% of adults over the age of sixty, cross-sectional study. The lumbar spine and hip BMD was thereby causing significant restrictions in life quality. The determined using DXA (Hologic, USA). IMT and ASP treatment of pain and disability as the main clinical symptoms were examined using duplex scanning. PWV and AI were includes a number of medical approaches comprising a limit- measured using applanation tonometry (SphygmoCor). ed combination of pharmacological and non-pharmacological The telomere DNA in the genome was estimated by the therapies. To study treatment options in more detail, the real-time PCR. The median telomere length was 9.75 kbs. study was designed to explore the influence of a mild me- The highest tercile of telomere length distribution (≥ 10,00 chanical stimulation combined with the disease modifying kbs) was ranked as ‘the longest’, the lowest tercile (<9,50 osteoarthritis drug (DMOAD) diacerein on inflammatory kbs) was regarded as ‘the shortest’. Statistical analysis was and growth factor regulation in chondrocytes. The alterna- performed using the software application Statistical tive treatment paradigm of a combination therapy was tested Analysis System (USA). at the cellular level as a model for an integrated biophysical Results: With the increase in duration of menopause a gradual approach for osteoarthritis (OA) that might improve treat- increase in the stiffness rate (PWV, AI, IMT, the presence ment options. АSР), decrease of BMD and a telomere length were observed. Methods: Chondrocytes were studied under non- inflam- The maximal vascular stiffness, minimal BMD values and the matory and inflammatory conditions using unstimulated shortest telomeres were found in patients with 10+ years of T/C-28a2 and IL-1β stimulated C-28/I2 cells, both under- menopause. The risk of bone mass loss increased by 3 times in going mild mechanically treatment plus/minus diacerein. patients with values of PWV ≥10 m/sec, by more than 4 times Changes in cyclooxygenase-2 (COX-2), interleukin-6 (IL- in patients with AI ≥ 20% and the IMT >0.9mm and by 2.45 6), and prostaglandin E2 (PGE2) and the growth factors, times in patients with presence of ASP in the carotid arteries as platelet-derived growth factor (PDGF), vascular endotheli- well as in the presence of the shortest telomeres. al growth factor A (VEGF-A) and the basic fibroblast The negative correlation between IA, IMT and BMD growth factor (bFGF) were characterized by quantitative remained valid as a result of a multivariate regression analysis real-time PCR and enzyme linked immune assays. Cell performed, whereas with respect to PWV, ASP presence, telo- proliferation and cell migration under the influence of a meres and BMD such correlation was not confirmed. conditioned medium was determined. S384 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Both treatments reduced IL-6 expression, whereas Conclusions: mechanical stimulation lowered PGE2 synthesis only under 1. Improvement the bone mineral density is agreed inflammatory conditions. IL6 and PGE2 were reduced by 2. According to our experience. More than half patients diacerein plus mechanical stimulation. COX2 expression using the bisphosphonates will experience lateral femur was increased by mechanical stimulation, diacerein alone cortical bone hypertrophy, and more than 40% patients had no effect. Although enhanced PDGF and VEGF-A ex- suffered the AFF. pression was detected, FGF was down regulated by the com- 3. We should notify patient be alertness about the symptoms bined treatment modalities. Physiological changes triggered of thigh pain, groin pain, though the possibility of atypical by the two treatments influenced cell growth and cell migra- fracture after bisphosphonates applied on those OI patient tion of chondrocytes. is not proved Conclusion: Moderate mechanical stimulation (representa- 4. We suggest those patient under the Regular follow bilat- tive for exercises) appears beneficial for the fate of the cell, eral thigh x ray annually and improves the pharmacological effect of diacerein. 5. Consider Ceasing the Bisphosphonates therapy after adult Improvements are based on cross-talks between different ini- or 5 year course therapy tiated pathways. Combining two different treatment options 6. May shift Bisphosphonates to Teriparatide if Bone scan or broadens the perspective to treat OA. PET show stress fracture or atypical fracture over lateral thigh. 7. Risks factors when consideration about the fracture in P627 Osteogenesis imperfect: a type-I collagen abnormality, FRACTURE OR ATYPICAL FRACTURE? THAT IS A osteoporosis, and bisphosphonate. QUESTION: DISCUSSION ABOUT THE BIPHOS- PHONATES TREATMENT IN OSTEOGENESIS P628 IMPERFECTA IMPACT OF CHOLECALCIFEROL SUPPLEMEN- H. C. Chang1 TATION ON THYROID PEROXIDASE ANTIBODY 1MacKay Memorial Hospital- Orthopedics Surgeon, Taipei, TITERS IN PATIENTS WITH HYPOTHYROIDISM Taiwan, Province of China I. V. Pankiv1 1Endocrinology/Bukovinian State Medical University, Objective: Osteogenesis imperfecta (OI)is typically associat- Chernivtsi, Ukraine ed with frequent fractures in childhood and adolescence, thus, bisphosphonates play an important role. However, when they Objective: To evaluate the impact of cholecalciferol supple- get mature, they also face another problems with age- mentation on thyroid peroxidase antibody (TPO-Ab) titers in associated decline in bone density, patients may enter a second patients with hypothyroidism of autoimmune genesis in a ran- period of heightened fracture risk. Several literatures conclud- domized trial. ed that bisphosphonates using may improving the bone den- Material and methods: Fifty two patients with newly di- sity, reducing the fracture rate, decreasing amount of bone agnosed hypothyroidism were randomized into 2 groups. pain. However, prolonged using the Bisphosphonates may The patients of the first group additionally received chole- result in atypical femur fracture (AFF). calciferol in a dose 4000 IU/daily (28000 IE/weekly) and Material and Methods: We reviewed the documents of those calcium in a dose 1000 mg/daily during 12 weeks. The patients ever visited or admitted to Macky Memorial Hospital patients of the second group received levothyroxine and Since 1989. Finally, we total collect 19 patients data. There are calcium in a dose 1000 mg/daily during 12 weeks. The 10 patients under 18-year-old and mean age is 12.2-year-old,9 positive result of treatment was defined as 25% fall in adults whose mean age are 34.5-year-old.Total 19 patients’ TPO-Ab titers. mean age is 22.7-year-old. Results: Vitamin D deficiency was observed in 94.2% Results: There are 15 OI patients continuous received patients with hypothyroidism. In patients with hypothy- bisphosphonates therapy more than 5 years.5 patient were roidism a negative correlation was observed between detected the Gene COLA2 (Four of them are family),9 patient 25(OH)D and TPO-Ab titer after adjusting for age (r=- were detected the Gene COLA1, and 1 patient did not re- 0.172; р=0.046). The additional supplementation of cho- ceived the Gene examination.8 of them had lateral femur cor- lecalciferol resulted in a significant fall in serum TPO-Ab tical bone hypertrophy and 6 in 8 experienced more than one titers in patients of the first group (-48.1%) compared to time of femur fracture (total:9 femur fractures, below the less- second group. Greater than 25% reduction in TPO-Ab er trochanter and above the supracondylar).Bone density of titer was achieved in 73.1% patients in the first group. them were increasing accompanied with bisphosphonates Cholecalciferol supplementation led to a significant in- using. crease in serum 25(OH)D titers with a corresponding fall Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S385 in plasma intact parathyroid hormone levels in the first Conclusion: Iranian reference values of SMI for both genders group. were similar to Asia Working Group for Sarcopenia (AWGS) Conclusions: Cholecalciferol supplementation in patients recommendation and lower than the European values. Further with hypothyroidism have a positive effect on autoimmunity studies from different nations and Middle East countries are as evidence by significant reductions in TPO-Ab titers. needed to obtain reference values for populations enabling the researchers for comparison and more valid reports on sarcopenia prevalence. P629 PEAK MUSCLE MASS AND REFERENCE VALUES TO IDENTIFY SARCOPENIA IN IRANIAN HEALTHY P630 POPULATION BMP-2 AND BMP-4 PLAYS A POSITIVE ROLE IN G. Shafiee1,R.Heshmat2,A.Keshtkar3,B.Larijani4,A. ARTICULAR CARTILAGE MAINTAINING IN MICE Ostovar5 J. Li1,A.Zhu1,H.Zheng1, D. Chen2 1Chronic Diseases Research Center, Endocrinology and 1Liaoning Traditional Chinese Medicine University, Metabolism Population Sciences Institute, Tehran University Shenyang, China, 2Rush University Medical Center, of Medical Sciences, Tehran, Islamic Republic of Iran, Chicago, United States 2Chronic Diseases Research Center, Endocrinology and BMPs, specifically BMP-2 and -4, have been shown to play a Metabolism Population Sciences Institute, Tehran University major role in mesenchymal cell differentiation and chondro- of Medical Sciences, Tehran, Islamic Republic of Iran, cyte hypertrophy. The graded genetic expressions of BMP-2 3Department of Health Sciences Education Development, and -4 within the four major growth plate zones represent an School of Public Health, Tehran University of Medical important molecular component of long bone formation after Sciences, Tehran, Islamic Republic of Iran, 4Endocrinology birth. However, the role of BMP-2 and -4 in mature articular and Metabolism Research Center, Endocrinology and cartilage remains limited. In this study, we investigate the Metabolism Clinical Sciences Institute, Tehran University of significance of the BMP2While BMP signaling plays an im- Medical Sciences, Tehran, Islamic Republic of Iran, 5The portant role in chondrocyte metabolism, and BMP2 and BM Persian Gulf Tropical Medicine Research Center, Bushehr and BMP 4 gene in articular cartilage maintaining at postnatal University of Medical Sciences, Bushehr, Islamic Republic stage in mice vivo. of Iran Objective: To observe the phenotype of deleting BMP-2 and Objective: Sarcopenia is a common problem in elderly BMP-4 gene in chondrocytes in the development and main- with the adverse outcomes. The objective of this study taining of articular cartilage in mice. Try to demonstrate the was to estimate the peak appendicular skeletal muscle mass molecular mechanism of articular cartilage development and (ASM) and age of its attainment by sex among Iranian degradation through BMP 2 and BMP 4 gene related population. signaling. Materials and Methods: A total of 691 men and women Material and Method: Bmp-2, Bmp-4 conditional knockout aged 18-94years participated in this cross-sectional, mice, (Bmp-2 Bmp-4)Col 2 ERmice were generated by breed- population-based study in Bushehr, Iran. ASM was measured ing (Bmp-2,Bmp-4)fx/fx mice with Col2-CreER transgenic by dual x-ray absorptiometry(DXA). Cut-off points for men mice. Knee joints were harvested from 3 months and 6 months and women were established considering two standard devia- old mice for histology to compare the difference in morphol- tions below mean values of skeletal muscle index (SMI) for ogy of AC. Immunohistochemical were performed to analyze young reference groups. The relationship between ASM and the OA-related proteins expression, which involves mmp13, age was described by the second degree regression models. adamts 4, and adamts 5. Two standard deviations below the mean SMIs of reference Result: 1. The silence of BMP2 and BMP4 induced articular groups were as cut-off values of low muscle mass in Iranian cartilage degradation phenotype, such as narrowed AC area, population. shortened AC depth, and massive subchondral bone, and the Results: The peak ASM values were 21.35±0.12 kg and osteometric data of calculated AC area is consistent to the 13.68±0.10 kg, and the age at peak ASM were 26 (24-28) dramatically morphology changes in both 3- and 6- month years and 34 (33-35) years for men and women, respectively. old mice. (P<0.05) 2. The protein expression of MMP 13, Mean and standard deviation (SD) of SMI in those ages were Adamts4 and Adamts5 in superfacial zone of articular carti- 7.01±0.02 kg/m2 and 5.44±0.02 kg/m2 among men and wom- lage tissue is significantly increased in (BMP2, BMP4)Col 2 ER en, respectively. Calculated cut-off values of low muscle mass Group in 3-month old mice. (P<0.05) While in the 6-month among Iranian population were 7.0kg/m2 and 5.4 kg/m2 old mice there showed the same tendency but the data is not among men and women, respectively. statistical. S386 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Conclusion: Bmp2 and Bmp4 are not only involved in the P632 formation of articular cartilage but also the mature carti- GIANT DIFFUSE IDIOPATHIC SKELETAL HYPEROS- lage metabolism and play a positive role in cartilage TOSIS (DISH) AND ELEVATED BONE TURNOVER IN maintaining. A PATIENT SUFFERING FROM PSEUDOHYPOPARA- THYROIDISM TYPE I J.-P. Devogelaer1,M.Doyen2,J.Malghem3 P631 1Rheumatology Department/Cliniques Universitaires Saint- INFLUENCE OF VITAMIN D STATUS ON BONE Luc, Bruxelles, Belgium, 2Rheumatology Department, DENSITY AND BONE TURNOVER DURING WEIGHT Cliniques Universitaires Saint-Luc, Bruxelles, Belgium, RESTORATION IN PATIENTS WITH ANOREXIA 3Radiology Department, Cliniques Universitaires Saint-Luc, NERVOSA Bruxelles, Belgium A. Giollo1, C. Caimmi1,A.Fassio1,C.Benini1,E. Vantaggiato1, R. Dalle Grave2,M.ElGhoch2,L.Idolazzi1, A female patient aged 56 developed the last 6 months walking D. Gatti1, M. Rossini1 difficulties necessitating the use of a walker. Pseudohypopara- 1Rheumatology Section, Department of Medicine, University thyroidism type I (PSP1) was diagnosed at the age of 25, based of Verona, Verona, Italy, 2Department of Eating and Weight on hypocalcemia, slight hyperphosphatemia, high iPTH and Disorder, Villa Garda Hospital, Garda, Italy lack of response of u-cyclic AMP to PTH injections; 24-H urinary calcium was low. Moreover, an heterozygote mutation Background: Patients with Anorexia Nervosa (AN) have of ARG 231 HIS was found. A brain CT-scan showed FAHR’ low vitamin D status and progressive bone loss, the latter calcifications. She also had brachymeta-carpia and – tarsia. She preventable by normalization of weight gain. However, if developed menopause at the age of 36, and she was put on the efficacy of a nutritional intervention in improving hormone replacement therapy (HRT) until the age of 52. C- bone health depends on vitamin D status is currently cell hyperplasia necessitated thyroidectomy and substitution. unknown. Hyperplasia of 4 parathyroid glands was observed during the Objective: To investigate the potential role of vitamin D sta- operation. Later on, diabetes mellitus developed, but without tus in determining the efficacy on bone mineral density signs of neuropathy. MRI of the cervical and lumbar spine (BMD) of weight restoration in AN. showed spinal stenosis, as well as majestic DISH. Biological Methods: 91 female AN subjects underwent an inpatient work-up beyond hypocalcemia demonstrated a dramatic in- weight restoration treatment. Vitamin D (25-OH-D) levels, crease in sCTX when HRT was weaned. Renal function dete- bone mineral markers and BMD assessed by DXA were eval- riorated (complication of hypertension). Spinal stenosis is a uated both at baseline and post-treatment. rare, but recognized complication in PSP, but giant DISH is Results: There was a significant increase in weight, BMI, unusual in a patient aged 56 y. Extremely elevated bone turn- P1NP (all p <0,001) and PTH (p <0,04). Conversely, a over is not seen in hypoparathyroid states. The BMD values of significant decrease was found in 25-OH-D (p <0,04) and the patient were still in the normal range. The cause of the high CTX (p <0,05). The mean BMD values were significantly turnover cannot be attributable to PTH (resistance) nor in increased only at the spine (1.0±3.6%, p=0.009). A signif- 1,25(OH)2D3. Postmenopause can be accompanied by an ac- icant positive trend was demonstrated between post- celeration of bone remodeling, but not to such an extent. Renal treatment 25-OH-D and BMD percentage changes at the insufficiency could have contributed, however. Such a majestic spine (p=0.032). The increase in spine BMD resulted sig- DISH rapidly developing could also be a responsible factor. nificantly higher only for patients with a post-treatment 25- OH-D ≥ 30 ng/ml (p <0,03), and was inversely correlated with CTX values after treatment (R2=0,095; p <0,03). A significant positive correlation was found between both absolute and percentage changes in weight and percentage changes in P1NP (R2=0,27) but not with percentage chang- es in CTX. Conclusion: In AN, the efficacy of weight restoration could depend primarily on bone formation. A hypovitaminosis D status counteracts the efficacy of the nutritional treatment because of an increase in bone resorption mediated by a secondary hyperparathyroidism. Our study strongly sup- port the use of vitamin D supplements for bone health in AN patients. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S387 Results: The average 10-year probability of major fractures is 7,8% (8,9% in women and 5,5% in men (p=0,0001)), hip fractures – 0,7% (0,9% in women and 0,4% in men, p=0,0001)). By the age of 70 the risk of major fractures in women and men increased by 2 and 1,2 times respectively, while the risk of hip fractures increased by 5,5 and 4,5 times in women and men respectively. In women10-year probability was authentically higher in all age groups across all cities in comparison with that in men both for major and hip fractures. The proportion of individuals who had a previous fragility fractures, was 15,2% (in total 1211 respondents, 438 men and 773 women). According to the schedule defining inter- vention threshold for Russia, 30,6% of the respondents (371 people) were determined to be in a high-risk of fractures zone (red) and 69,4% of the respondents (840 people) - in the low- risk of fractures zone (green). Conclusion: The average 10-year probability of major and hip fractures increased with age regardless of participants’ P633 gender, and was significantly higher among female popula- APPLICATION OF A RUSSIAN MODEL OF THE WHO tion. The majority of the respondents with the previous fragil- FRACTURE RISK ASSESSMENT TOOL (FRAX®) ity fractures (individuals with the known high risk of fractures I. Skripnikova1,M.Myagkova1,S.Shalnova1,A.Deev1,E. requiring medical intervention), according to the schedule de- Indukaeva2,G.Tolparov3,J.Grinshtein4,A.Efanov5,V. fining intervention threshold for Russia, have been included Ilyin6, N. Kulakova7, S. Nedogoda8,S.Romanchuk9,S. into the green zone which implies the low sensitivity of the Boytsov1 intervention threshold currently established for Russian 1National Research Center for Preventive Medicine of the Federation. Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation, 2Institute for Complex Issues of Cardiovascular Diseases, Siberian Branch, Russian Academy P634 of Medical Sciences, Kemerovo, Russian Federation, DEVELOPMENT AND VALIDATION OF ANTHROPO- 3North-Ossetian State University, Vladikavkaz, Russian METRIC PREDICTION MODEL FOR ESTIMATION Federation, 4Krasnoyarsk State Medical University, OF MUSCLE MASS IN THE ELDERLY Krasnoyarsk, Russian Federation, 5Tyumen State Medical R. Heshmat1,G.Shafiee1,A.Keshtkar2,B.Larijani3 University, Tyumen, Russian Federation, 6Institute for 1Chronic Diseases Research Center, Endocrinology and Socioeconomic Development of Territories, Russian Metabolism Population Sciences Institute, Tehran University Academy of Sciences, Vologda, Russian Federation, 7Pacific of Medical Sciences, Tehran, Islamic Republic of Iran, State Medical University, Vladivostok, Russian Federation, 2Department of Health Sciences Education Development, 8Volgograd State Medical University, Volgograd, Russian School of Public Health, Tehran University of Medical Federation, 9Cardiology Dispensary, Ivanovo, Russian Sciences, Tehran, Islamic Republic of Iran, 3Endocrinology Federation and Metabolism Researcher Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Objective: To estimate the 10-year probability of major oste- Medical Sciences, Tehran, Islamic Republic of Iran oporotic fractures and hip fractures among the urban popula- tion of the Russian Federation based on the Russian model Objective: Age- related muscle loss, named sarcopenia, has FRAX. been linked to functional declines and an increased risk of Material and methods: Representative samples of the pop- complications. The aim of this study was to identify predictors ulation from 8 Russian cities were used as a material for of low skeletal muscle mass in older adults toward develop- analysis. In total 9143 Russian residents participated in the ment of a practical clinical assessment tool for use by clini- study, among them 6324 were women and 2819 were men cians to identify subjects requiring dual-energy X-ray absorp- aged 40-69 years (mean age 53,29±0,02 years). 10-year tiometry (DXA) screening for muscle mass in Iranian older probability of fractures was calculated on the basis of the people. Russian model FRAX without BMD using the batch pro- Materials and methods: Data were available for 2000 people cessing of data. aged ≥60 years who participated in the second stage of S388 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Bushehr Elderly Health (BEH) program, a population-based Z=x-μ/σ. WHO 2007 growth charts for boys and girls were prospective cohort study, in a southern province of Iran. The used to assess physical growth. Accordingly, a Z-score of <-2 participants were randomly assigned to two groups; a model- for height was considered as stunted growth and BMI of <-2 development group and a validation group. was considered as underweight or thin for age. Appendicular skeletal mass (ASM) was measured by DXA, as Results: A total of 380 patients were included. Mean age at the dependent variable. To estimate predictive model, multiple first evaluation was 10.6±3.3 with M:F ratio of 1.1:1. Majority linear regression analysis, anthropometric measures contains; of patients were taking calcium (87%) and vitamin D (77%) weight, height, limb circumferences (upper arm, forearm, supplements and 46% required calcium infusions for muscle thigh and calf), waist, hip and neck circumferences, age, sex, spasm on regular basis. Despite 82% of patients having bone body mass index (BMI), hand grip strength were used as in- pains, 81% had ECOG score of “Zero” (Fully active). Fifty dependent variables. ASMDXA was used as criterion measure- five% were taking analgesics whereas, modest degree of pain ment. Agreement was verified by intra-class correlation coef- “Hurts even more” was present in 37.1% children. Forty-eight ficient (ICC) and by the Bland-Altman technique. (12.6%) had history of fractures. Most (n=338; 88.9%) had Results: Prediction models were established using the data normal facial bone structure whereas frontal bossing, promi- from model -development group. A five- variable model nent maxillary bones, prominent zygomatic bones and bowing was developed as follows: ASM=9.29 - 0.18×age - 4.68×sex of legs were present in 5.5%, 3.2%, 4% and 1% children + 0.09×(hand- grip strength) + 0.22×calf circumference + respectively. Mean±S.D of different variables were: 0.196×BMI (where adjusted R2=0.79, P<0.0001. The high Haemoglobin: 7.6±1.3 g/dl, ferritin 5401±2650.2 ng/ml, agreement (ICC=0.85) observed between ASM estimated by height Z-score: -2.65±1.64, weight Z-score: -1.82±1.12 and equation and DXA. This model performed well in the valida- BMI Z-score: -1.77±1.40. With increasing age, decrease in tion group. pre-transfusion Hb and an increase in ferritin levels along with Conclusions: The simple anthropometric prediction model worsening BMI and height Z-scores were observed. developed in this study showed useful and good practical tool Significant association of higher ferritin levels (5632.75 in clinical evaluation to estimate muscle mass and thus ±2543.97ng/ml) was found in patients with stunted growth sarcopenia in elderly people (n=250, 66%; p=0.019). Conclusions: Despite very poor bone health in this study, majority of Pakistani children with transfusion dependent β- P635 thalassemia were able to maintain a good functional status. QUALITY OF LIFE AND FUNCTIONAL STATUS IN Appropriate transfusions and chelation along with good nutri- RELATION TO BONE HEALTH IN PAKISTANI tion must be ensured for maintaining optimum bone health. CHILDREN WITH TRANSFUSION DEPENDENT Β- Reference: 1. Wong DL EM, Wilson D, Winkelstein ML, THALASSEMIA Scharwtz P: Wong's Essential of Pediatric Nursing. M. S. Shaikh1,B.Moiz1,A.H.Khan1, S. Alidina1,A. 2001:1301. Rahim1,R.Iqbal1 Disclosure: This study was supported by institutional re- 1Aga Khan University, Karachi, Pakistan search council of Aga Khan University. Objective: To determine quality of life and functional status in relation to bone health in Pakistani children with transfusion P636 dependent β-thalassemia. A COMPARISON IN DETERMINING OF VITAMIN D Material and methods: This was an observational descrip- STATUS BETWEEN COMMERCIALLY AVAILABLE tive study conducted at Fatimid Foundation Karachi from ASSAYS January 2013 to December 2014. All the patients with diag- P. Vanuga 1,P.Huba2, I. Sagova3,J.Payer4, A. Vanuga2 nosis of transfusion dependent β-thalassaemia major were 1Dpt. of Endocrinology, National Institute of Endocrinology recruited. Following demographic and anthropometric vari- and Diabetology, Lubochna, Slovakia, 2Alphamedical, ables were recorded: site and severity of bone pains, fractures, Lubochna, Slovakia, 3DptofInt.Med.I,University abnormalities of facial bones, weight, height and intake of Hospital, Martin, Slovakia, 4Comenius University, Faculty analgesics, calcium and vitamin D supplements. Two labora- of Medicine, 5th Department of Internal Medicine, tory parameters, pre-transfusion haemoglobin (Hb) and serum University Hospital, Bratislava, Slovakia ferritin levels were also included. Bone health assessment for pain was performed using Wong-Baker Faces Pain rating Objective: To compare the effectivity of various assays used scale1. Performance status was assessed using Eastern in the determination of vitamin D concentrations. Cooperative Oncology Group scoring (ECOG). Z-scores for Material and methods: Serum 25-hydroxyvitamin D levels height and weight were calculated utilizing following formula: were measured from blood samples of 109 patients with Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S389 different immunochemical methods. We compared the perfor- & 60 patients (24,7%) with T-score suggestive of OP, 47 mance of three automated vitamin D immunoassays (Abbott, (78,3%) reported VF at DXA; Roche, Siemens) mutually and to high – pressure liquid chro- & 86 patients (35,4%) with T-score suggestive of osteopenia, matography (HPLC), which was chosen as the golden standard 78 (90,7%) reported VF at DXA; in measuring vitamin D concentrations. Linear regression mod- & 97 patients (39,9%) with normal T-score, 93 (95,9%) re- el (Pasinng – Bablok) and Bland Altman analysis were used to ported VF at DXA; compare the performance of methods of measurement tested. The chi-square test shows an important relationship between Results: Taking into account the permissible error of measure- bone mineral density (BMD) and incidence of VF in the sam- ment 21.5% (CV=10% Bias=5%), our Bland-Altman analysis ple (P=0,002). demonstrated that results obtained by all of the assays differ Conclusions: A correct diagnostic approach to OP is to use significantly. The mean concentration of 25-hydroxyvitamin diagnostic procedures to identify both BMD and patient's D obtained by HPLC-UV (76.82 nmol/l) was nearest to the risk of fracture by completing a MOC with a qualitative mean concentration given by the Roche assay (78.28 nmol/ l). and quantitative evaluation of the vertebral column through The biggest difference in the 25-hydroxyvitamin D mean were MRX. This technique permitted to identify VF even in pa- observed between HPLC method and the Siemens method tients with T-scores not suggestive of OP who are not ap- (49.59 nmol/l). Levels of vitamin D measured using the parently at risk for VF. The diagnosis of this fracture Roche assay were overestimated compared to results given suggests an increased risk of other ruptures, not related to by HPLC, while Siemens and Abbot assays underestimated BMD, as proposed by the National Osteoporosis Foundation its level. The deviation from the HPLC means increased as the (NOF)1 (Kanis et al.), and the International Osteoporosis levels measured grew. The rate of conformity of vitamin D Foundation (IOF)2. They state that these diagnostic tech- level measurement between HPLC and Abbot was 65.21%, niques should be used in the screening of patients at risk HPLC and ROCHE 59.63%, HPLC and SIEMENS 47.79%. of OP and in the therapeutic follow up of osteoporotic Conclusion: Our results implicate statistically significant and patients. clinically relevant variation in the vitamin D levels measured References: with different immunochemical methods. 1. National Osteoporosis Foundation Review of the evi- dence for prevention, diagnosis and treatment and cost effectiveness analysis. Osteoporos Int 1998;8 (Suppl 4): P637 S1-S85 CONFRONTING MORPHOMETRIC X-RAY RADIO- 2. Kanis JA et al. Osteoporos Int 2002;13:527. GRAPHY AND DUAL-ENERGY X-RAY ABSORPTIO- METRY IN THE DIAGNOSIS OF OSTEOPOROSIS A. Stefani1, G. Desideri2,A.Camerota1, A. C. Carucci1,S. P638 Caporuscio3,M.Canzoni4, A. Raffaele5, M. L. Sorgi3 STUDY OF RADIOLOGIC SIGNIFICANCE OF 1Geriatric Unit, Department of Life, Health and Environmental ARTICULAR JOINT WIDTH COMPARING STANDING Sciences, University of L'Aquila, Avezzano's Hospital, RADIOGRAPHS, MRI AND ARTHROSCOPIC Avezzano, Italy, 2Geriatric Unit, Department of Life, Health FINDINGS IN KNEE OSTEOARTHRITIS and Environmental Sciences, University of L'Aquila, N. Muñoz-García1, V. Lopez-Fernandez2,J.Cordero- Avezzano, Italy, 3University of Sapienza, Rome, Italy, 4ASL- Ampuero1,R.Madero-Jarabo3 Viterbo, Viterbo, Italy, 5Geriatric Unit, Avezzano's Hospital, 1Universidad Autónoma de Madrid. Facultad de Medicina, Avezzano, Italy Madrid, Spain, 2Universidad de Santiago de Compostela, Facultad de Medicina, Santiago de Compostela, Spain, 3La Objective: To compare two techniques for the diagnosis of Paz University Hospital, Madrid, Spain Osteoporosis (OP). Dual-energy-x-ray absorptiometry (DXA) allowed patients to be classified in to three catego- Introduction: Articular joint width in osteoarthritic knees ries: osteoporotic, osteopenic and normal. Morphometric is a parameter widely used in standing radiographs, but few x-ray radiography (MRX) was used to diagnose vertebral papers study the correlation between this measurement and fractures (VF). osteoarthritic degree comparing radiographs, MRI and Materials and Methods: From 2006 to 2010, 290 patients arthroscopy. who went to an outpatient clinic were involved in this obser- Objective: To study the usefulness of articular joint width and vational study. 243 of them (72 men and 171 women with an its correlation with osteoarthritic degree in standing radio- average age of 64,5 years) completed the study. graphs, MRI and arthroscopy. Results: Even without a compatible T-score diagnosis for OP, Material and methods: Three years prospective study of 59 some patients reported VF at DXA as below: patients (63% males) of 49.6 years (21-82) with chronic pain S390 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 in their knee. Standing radiographs were classified according Materials and Methods: We conducted this population- to Kellgren-Lawrence (intraobserver correlation 0.95). MRI based study using data from the National Health Insurance images were classified according to Vallotton criteria. Research Database of Taiwan during the period from 2000 Interobserver correlation for MRI was calculated by Kappa to 2011. Each patient was randomly frequency-matched with index (0.37), McNemar symmetry and Wilcoxon Signed 4 controls without thalassemia, based on age and index year of Ranks tests (interobserver correlation 0.576). Arthroscopic diagnosis. We identified 2,008 patients with thalassemia and findings were graded with Outerbridge criteria. The articular 8,032 controls. Cox's proportional hazard regression analysis joint width was related to osteoarthritic degree with Spearman was performed to estimate the effect of thalassemia on the risk and Mann-Whitney tests. of osteoporosis. Kaplan-Meier curves of the probability of Results: Diagnostic accuracy of radiographs was calculated in osteoporosis for each cohort were compared using the log- 0.423 (Kappa index 0.251) and MRI in 0.491 (Kappa 0.333), rank test. establishing arthroscopy as gold standard. Articular joint Results: The risk of developing osteoporosis was significant- width was inversely and strongly correlated with osteoarthritis ly higher in the thalassemia cohort (adjusted hazard ratios degree in the three diagnostic procedures (p<0.001). If these (aHR)=1.75, 95% confidence intervals (CI)=1.30-2.36), thal- results were stratified in two groups of articular joint width, <5 assemia major cohort (aHR=3.48, 95% CI=0.48-25.3) and millimeters wide group (<5mm) and >5 millimeters wide thalassemia minor cohort (aHR=1.78, 95% CI=1.31-2.41) group (≥5 mm), the three parameters showed a high degree compared to the group without thalassemia. The cumulative in <5mm group. In this group, the average decrease in articu- incidence of osteoporosis was higher in the patients with thal- lar joint width was more evident (1.94 mm) than in ≥5mm assemia than in the controls (P<0.001). group (1.82 mm). Conclusion: Our large population-based cohort study pro- Conclusions: Articular joint width in standing radiographs vides evidence that thalassemia may increase the risk of oste- shows a strong correlation with osteoarthritic degree in radi- oporosis in Taiwan. ography, MRI and arthroscopy. It could be considered a com- plementary diagnostic tool to monitoring osteoarthritic dis- ease in knee. P640 References: NEGATIVE EFFECT OF CURATIVE ANTI-THROMBOTIC 1. Spahn G et al. Arthroscopy 2006;22:1233. TREATMENT IN AN INFECTED HIP PROSTHESIS 2. Amin S et al. Arthritis Rheum 2005;52:31. R. Ene1,Z.A.Panti1,M.Nica1,M.P.Popa1, M. Pleniceanu1, M. Cirstoiu2,P.E.Ene3, C. Cirstoiu1 1Orthopedics and Trauma, Emergency University Hospital P639 Bucharest, Bucharest, Romania, 2Obstetrics and THALASSEMIA AND SUBSEQUENT RISK OF OSTEO- Gynecology, Emergency University Hospital Bucharest, POROSIS: A NATIONWIDE POPULATION-BASED Bucharest, Romania, 3ENT, Emergency University Hospital COHORT STUDY Bucharest, Bucharest, Romania Y. M . Wa ng 1,K.T.Sun2,C.T.Peng3,C.Y.Li4 1Department of Radiology, Taichung Tzu Chi Hospital, Currently total hip replacement (THR) surgery is the most Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan common joint replacement procedure in the orthopedic field. ROC, China, 2Department of Pediatric Dentistry, China The rising number of THR cases brought an increased inci- Medical University Hospital, Taichung, Taiwan ROC, dence of complications. One of the major, surgically and med- China, 3Department of Pediatrics, China Medical University ically challenging complications is the infection. Late infec- Hospital, Taichung, Taiwan ROC, China, 4Department of tions of THR often lead to loosening of the prosthesis which Anesthesiology, China Medical University Hospital, requires the removal of the implant and thorough debridement Taichung, Taiwan ROC, China of the infection site. The gold standard in the case of an in- fected prosthetic material is removal of the implant followed Objective: Thalassemia-associated osteoporosis constitutes a by rigorous debridement and revision arthroplasty which can major complication in patients with thalassemia. The associa- be done as a one or two stage procedure. tion between risk of osteoporosis and thalassemia is yet to be We present a patient with multiple comorbidities that fully examined. Most of the studies identified are of poor underwent total hip arthroplasty with a Birmingham Hip quality, are not randomized controlled, and include small Resurfacing (BHR) type of implant, 11 years ago. This patient number of participants. We performed nationwide presented in the emergency room of Bucharest University population-based cohort study to investigate whether thalas- Emergency Hospital (SUUB) with sepsis. The clinical and semia major or minor is associated with an increased risk of paraclinical examination during the hospitalization revealed developing osteoporosis. acute endocarditis and multiple splenic abscesses which Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S391 required valvuloplasty accompanied by intense anticoagulant was begun for 3 weeks. The patient discharged after 4 weeks therapy and splenectomy. Periprosthetic collection detected with normal inflammatory markers values and good function- by the CT scan required the removal of the implant and mul- al result. MRSA infections in orthopedics represent an in- tiple subsequent surgical interventions with sanitation creasing health problem. Early diagnosis and swift treatment purpose. are crucial for a good clinical result. Because of the curative anticoagulation required by the valvuloplasty, bleeding caused by the hip surgeries could not be controlled, creating a vicious circle that sustained repeated P642 hematoma formation and infection despite correctly per- A COMPARISON OF VITAMIN D LEVELS IN PATIENTS formed treatment. All these led to septic shock and the death WITH ACNE VULGARIS AND HEALTHY INDIVIDUALS of the patient. G. Saraç1,T.T.Koca2,S.Şener1 The association of these two pathological entities has grim 1Department of Dermatology, Inonu University, Malatya, prognosis, with a very difficult management and very little Turkey, 2Physical Medicine and Rehabilitation Clinic, experience recorded in the specialty literature. Research and Training Hospital, Malatya, Turkey Introduction: It is a common opinion that vitamin D plays a P641 role in many immune system disorders. This study aimed to MULTIPLE MUSCULO-SKELETAL ABSCESSES IN A determine vitamin D levels in patients with acne vulgaris. YOUNG MALE PATIENT Methods: The study sample included 90 patients who came to R. Ene1,Z.A.Panti1,M.Nica1, M. Popa1,M.Pleniceanu1,M. the outpatient dermatology clinic of Malatya Public Hospital Cirstoiu2,P.E.Ene3, C. Cirstoiu1 between March 2015 and June 2015, and were diagnosed with 1Orthopedics and Trauma, Emergency University Hospital cystic nodular acne clinically. The control group included 67 Bucharest, Bucharest, Romania, 2Obstetrics and voluntary healthy individuals. The 25-hydroxyvitamin D3 Gynecology, Emergency University Hospital Bucharest, [25-(OH) vit D3] levels were recorded for both groups. Bucharest, Romania, 3ENT, Emergency University Hospital Results: In the group of patients with acne, the 25-(OH) vit Bucharest, Bucharest, Romania D3 level was 18.28±9.92 (reference interval 10–40 ng/ mL), and it was 15.40±10.92 in the control group. When Septic arthritis is an infectious pathology that can occur in any the two values were compared statistically, the result was age group, the most common pathway being hematogenous p: 0.924 (p>0.05) and there was no statistically significant dissemination. In the orthopedic field the most frequent bac- difference. teria is the S. Aureus which in the near past has developed Discussion and Conclusion: It is believed that vitamin D significant resistance to antibiotics especially for methicillin. plays a role in the etiopathogenesis of acne vulgaris due to The treatment is a major challenge, which consists of surgical its anti-inflammatory and antimicrobial properties. The stud- and medical treatment based on the antibiogram, which is ies conducted with larger patient sets canprovide a clearer crucial for targeted therapy and good clinical results. We pres- view of the correlation between vitamin D and acne. ent a case of a 31 year old male patient with swelling and pain of the left tight and left knee, symptoms which appeared 3 weeks prior to his admission in our department. In this period P643 he also experienced headache, nausea, fever and vomiting. APPLICATION OF MULTIPLE GENES TESTING The clinical examination reveals the presence of intra- DATA FOR RISK ASSESMENT AND PREVENTION articular liquid in the left knee and a swollen thigh. We per- OF OSTEOPOROSIS formed a fine nail aspiration of the intraarticular collection, the P. Marozik 1,I.Mosse1,E.Rudenka2, A. Rudenka3,K. sample was sent to microbiological exam and antibiogram. Nestsiarenka1,O.Samakhavets4 Routine laboratory test showed elevated white blood cell 1Institute of Genetics and Cytology NAS Belarus, Minsk, levels with marked inflammatory response (ESR, C reactive Belarus, 2Belarusian State Medical University, Minsk, protein, fibrinogen). Radiological findings were not modified Belarus, 3Belarusian Medical Academy of Postgraduate however MRI described a well determined perifemoral liquid Training, Minsk, Belarus, 4Minsk City Clinical Hospital, collection from the proximal third of the femur communicat- Minsk, Belarus ing with the articular space of the knee. Surgical debridement was necessary in order to eliminate the perifemoral collection. Objective: In recent years, an increasing evidence of genetic The microbiological exam determined the presence of predetermination of bone mineral density appeared. Over the Staphylococcus Aureus resistant to Methicillin (MRSA). past decade, hundreds of potential markers of genetic predis- Intravenous treatment with Ciprofloxacin and Vancomycin position to osteoporosis (OP) were identified, and several S392 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 attempts were made on use of these specific polymorphisms of Japanese individuals meets the criteria for VitD D/I. for OP risk evaluation. However, there are still difficulties Therefore, the aim was to elucidate the factors that are useful with complex interpretation of genetic testing data, consider- for identifying individuals with VitD D/I who are at high risk ing multiple markers interaction. The purpose of this work of fractures. was to identify allelic combinations and haplotypes of gene Methods: The subjects were 201 healthy postmenopausal variants, involved in bone metabolism, and to evaluate their women who had undergone osteoporosis screening. Serum collective association with predisposition to OP in Belarusian levels of 25-hydroxyvitamin D [25(OH)D], intact parathyroid postmenopausal women. hormone (PTH) and sclerostin were measured. Dual-energy Methods: Sixty-six Belarusian postmenopausal women with X-ray absorptiometry was used to measure bone mineral den- OP, as well as 92 age-matched control subjects, were geno- sity (BMD) at the lumbar (L) and the femoral neck (FN). typed for VDR ApaI (rs7975232), BsmI (rs1544410), TaqI Results: Osteoporotic fractures were observed in 71 subjects. (rs731236), Cdx2 (rs11568820), COL1A1 Sp1 (rs1800012), Subjects had a mean age of 64±8 years, and the following COL1A2 A18162G (rs42517), COL5A1 C/T (rs12722) and values: 25(OH)D 16±4ng/mL; sclerostin 1.3±0.4ng/mL; L- LCT T-13910C (rs4988235) gene polymorphisms. BMD T-score -1.6±1.3, Z-score 0.3±1.1; FN BMD T-score - Significance was assessed using χ2 test and multivariate lo- 1.5±0.8, Z-score 0.1±1.0. Serum levels of 25(OH)D had sig- gistic regression (R-package). The differences were consid- nificant negative correlations with age and PTH, and signifi- ered significant at P<0.05. cant positive correlations with L and FN BMD, but no corre- Results: We found that rs7975232, rs1544410 and rs731236 lation with sclerostin. The fracture group had significantly markers are in a strong direct linkage disequilibrium lower levels of 25(OH)D as well as L and FN BMD and (P<0.001), suggesting that risk alleles of these markers are significantly higher levels of sclerostin (p<0.01). When sub- preferably inherited jointly. For the bearers of unfavorable jects were classified into four groups based on 25(OH)D and haplotype A-B-t (consisting of rs7975232 rs1544410 and L-BMD levels, the low 25(OH)D/low L-BMD group had a rs731236 risk alleles), the risk of OP is significantly higher significantly higher proportion of fractures than the other (OR=4.3, 95% CI 1.4-5.3, P<0.01). This haplotype was over- groups. Furthermore, the low 25(OH)D/high sclerostin group represented in OP patients group compared to all other haplo- had a significantly higher proportion of fractures than the high types. For the careers of unfavorable A-B-t-T-G allelic combi- 25(OH)D/high sclerostin and high 25(OH)D/low sclerostin nation, constructed from rs7975232, rs1544410, rs731236, groups. Logistic regression analysis revealed that the group rs1800012 and rs42517, the risk of OP was significantly in- with low 25(OH)D/low L-BMD as well as low 25(OH)D/high creased (OR=19.5, 95% CI 4.6-140.1, P=0.02) compared to sclerostin were a significant risk factor for fracture even after the bearers of wild-type a-b-T-G-A combination. This data, adjustments for age and BMI. obtained for all allelic combination, can be used for genetic Conclusion: Candidate indicators for identifying cases at high risk score calculation. risk of fractures among individuals with VitD D/I include Conclusion: Our findings highlight the importance of iden- measurements of L-BMD as well as sclerostin in addition to tified allelic combinations of VDR, COL1A1 and COL1A2 25(OH)D. gene polymorphisms and reveal mechanisms of their col- lective interaction with each other for OP risk evaluation purposes. Complex screening of these can be used to im- P645 plement personalized prevention, treatment and rehabilita- ANTIOSTEOPOROTIC ACTIVITY OF GENISTEIN tion programs. AGLYCONE IN POSTMENOPAUSAL WOMEN: EVIDENCE FROM A POST HOC ANALYSIS OF A MULTICENTER RANDOMIZED CONTROLLED P644 TRIAL RELATIONSHIPS BETWEEN BONE FRAGILITY M. Atteritano1,V.Arcoraci1,A.Bitto1, D. Altavilla2,R. CAUSED BY VITAMIN D DEFICIENCY/INSUFFICIENCY D'Anna3,F.Squadrito1 AND BONE MINERAL DENSITY AS WELL AS 1Department of Clinical and Experimental Medicine, SCLEROSTIN IN POSTMENOPAUSAL WOMEN University Hospital of Messina, Messina, Italy, 2Department M. Yamauchi1, K. Nawata2, M. Yamamoto1, T. Sugimoto1 of Paediatric, Gynaecological, Microbiological and 1Internal Medicine 1, Shimane University Faculty of Biomedical Sciences, University of Messina, Messina, Italy, Medicine, Izumo, Japan, 2Health and Nutrition, The 3Department of Pediatric, Gynecological, Microbiological University of Shimane, Matue, Japan and Biomedical Sciences, Messina, Italy Objective: Vitamin D deficiency/insufficiency (VitD D/I) is a Background: Genistein has a preventive role against bone risk factor for fractures. It has been reported that the majority mass loss during menopause. However experimental data in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S393 animal models of osteoporosis, suggest an anti-osteoporotic Materials and methods: The research group consisted of 100 potential for this isoflavone. men aged> 50 years and certainly the diagnosis of psoriatic Methods: We performed a post-hoc analysis of a previously arthritis (GRAPA, 2006) in combination with osteoporosis published trial that investigated the effects of genistein in post- and osteopenia according to criteria developed by WHO and menopausal osteopenic women. A cohort of the enrolled post- confirmed by DXA. menopausal women was, in fact, identified at the baseline as Results: The study highlighted the clinical features of var- osteoporotic (n=121) on the basis of their T-score and ana- iants developed from psoriatic arthritis, which were char- lyzed thereafter for the 24 months treatment with either acterized by a wide diversity of manifestations of articular 1000 mg of Calcium and 800IU Vitamin D3 (placebo; syndrome, expressing itself through five clinical variants: n=59), or Calcium, Vitamin D3 and Genistein aglycone (54 polyarticular (31%), axial (25%), oligoarticular (18%), dis- mg/day; genistein; n=62). The parent study was a randomized, tal interphalangeal (15%) and mutilant (11%). Based on a double-blind, placebo-controlled trial involving postmeno- complex clinical and laboratory examinations we have pausal women with a femoral neck (FN) density <0.795 established the association of axial injuries in all clinical g/cm2. variants, allowing early diagnosis of psoriatic arthritis, Results: According to FN T-scores at baseline 31.3% of the assessing disease severity and prognosis. Simultaneously genistein and 30.9% of the placebo recipients were osteo- it appreciated the severity of osteoporotic damage. It has porotic. In placebo group and genistein group, th10-year been found that 55% of men have shown osteopenia, and hip fracture probability risk was 4.1±1.9 (SD) and 4.2±2.1 45% - osteoporosis. Pain in the spine, were reported in 47% (SD) respectively, assessed by FRAX. Mean BMD at the of cases; bone pain in the upper limbs and lower 30%. Men femoral neck increased from 0.62 g/cm2 at baseline to 0.68 who use glucocorticoids have a much lower bone density g/cm2 at 1 yr and 0.70 g/cm2 at 2 yrs in genistein recipi- (T score -3.1) compared with men not given glucocorti- ents and decreased from 0.61 g/cm2 at baseline to 0.60 coids (T score -1.7). The most advanced osteoporosis was g/cm2 at 1 yr and 0.57 g/cm2 at 2 yrs, in placebo recipi- found in polyarticular forms (M T-score -3.0) and mutilat- ents. At the end of the study only 18 postmenopausal wom- ing (M T-score -3.3), followed by axial (M T-score -2.6) en had osteoporosis in genistein group with a prevalence of with osteopenia in oligoarticular forms (M T-score -1.7) 12%, whereas in placebo group after 24-months the num- and distal interphalangeal (M T-score -1.6). In men with a ber of postmenopausal women with osteoporosis was rational Ca> 950 mg / day T-score was 1.75; but at 850- unchanged. 950 mg / day T-score was 2.05. The third group with the Conclusion: This post hoc analysis is a proof-of concept lowest rational Ca, 750-850 mg / day, are most susceptible study suggesting that genistein may have a great potential to pathological fracture, because the T-score is -3.1 them. for the treatment not only of osteopenia but also of osteopo- Male smokers have T-score lower than non-smokers, so rosis in postmenopausal women. However this proof-of con- patientswhosmokeT-scorewas-2.64and-2.36inthe cept study needs to be confirmed by a large, well designed and smoking (p <0.05). The frequency of femoral neck frac- appropriately focused randomized clinical trial in a population tures in men is almost the same age between 50-70 years at high risk of fractures. (50-60 years constitute 4% and at the age of 60-70 years is 7%, so there is a considerable increase in risk), but notes that begins to increase after the age of 70 years being 9% (p P646 <0.05). With increasing age and increasing values are ob- THE IMPORTANCE OF SECONDARY OSTEOPOROSIS served over 10 years and fracture probability is 0.7% at the AT PATIENTS WITH PSORIATIC ARTHRITIS IN age of 50-60 years; 0.8% at age 60-70 years and 5.9% older DEPENDING OF CLINICAL EVOLUTIONS than 70 years (p <0.01). L. Chislari1, E. Russu1,S.Agachi1,L.Rotaru1 Conclusions: Osteoporosis was imposed as nosologic unit 1USMF "Nicolae Testemitanu", Chisinau, Republic of being detected very commonly in patients with psoriatic Moldova arthritis, even the able men. In the evolution of the disease they were presented with high frequency following risk Objective: Psoriatic arthritis causes chronic joint damage and factors: age, smoking, corticosteroid, intake low calcium functional disorders of bone and joints with significant social and, in particular, depending on the version clinical dis- and health costs associated with a high rate of morbidity and ease: the most serious - mutilant and polyarticular and light mortality. It evolves with changes in both the erosive and show in oligoarticular and distal interphalangeal. It was destructive joint and bone as it is found in approximately determined importance of FRAX score for the prevention 40-60% of patients. Our aim was to study the peculiarities of of fractures, especially in patients with a history the clinical course of psoriatic arthritis in men with relation to compounded, glucocorticoid use, smoking and low calci- degree of expression of osteoporosis. um intakes. S394 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P647 Results: A total of 68 patients were enrolled at Chang Gung DISCOVERY OF POLYMORPHISMS IN THE 101 KB Memorial Hospital, in northern Taiwan. The mean serum VITAMIN D RECEPTOR GENE THAT CAN AFFECT 25(OH) D level was 26.9±8.4 ng/mL, and lower vitamin D OSTEOPOROTIC FRACTURES AMONG POST- level 25.8±7.9 ng/mL in 32 (47%) patients with hip and ver- MENOPAUSAL WOMEN SEEN AT THE PHILIPPINE tebral fractures, compared with 27.8±8.9 ng/mL in 36 (53%) ORTHOPEDIC CENTER patients without fractures, resulting in a prevalence of vitamin M. P. Zumaraga1,P.J.Medina2, C. P. Saloma3 D inadequacy of 65% of patients. 1Food and Nutrition Research Institute, Taguig City, Conclusions: High prevalence of vitamin D inadequacy was Philippines, 2Philippine Orthopedic Center, Quezon City, found among women with osteoporosis and fragility hip or Philippines, 3National Institute of Molecular Biology and vertebral fracture patients in Taiwan. Biotechnology, Quezon City, Philippines Aim: The study discovered genetic variants in the entire 101 P649 kB vitamin D receptor (VDR) gene for osteoporotic fractures VITAMIN D RELEVANCE AND VDR ASSESSMENT using targeted next generation sequencing (TNGS) approach. FOR PREVENTION OF OSTEOPOROSIS IN DENTAL Patient and Methods: A total of fifty women with and with- PRACTICE out fragility fracture seen at the Philippine Orthopedic Center F. S. Martelli1,F.Piccotti1,M.Martelli1 were included. DNA libraries were constructed using the Ion 1EDN Clinic, Florence, Italy Ampliseq Library Kit v 2.0 and a custom VDR AmpliSeq™ panel before they were sequenced using the Ion Torrent Objective: The aim of this paper is to investigate the variabil- Personal Genome Machine. The variant calling was based ity of vitamin D receptor (VDR) genetic polymorphisms in a on the GATK best practice workflow and annotated using periodontal disease population and its associated correlation Annovar tool. with the severity of periodontitis. Results: A total of 1,496 unique variants were identified. Materials and Methods: The study group for the investiga- Novel sequence variations were found among diseased and tion was comprised of 4454 patients who attended our clinics healthy groups at a rate of 23.1% and 16.6% of total discov- for periodontal treatment between the period January 1st 2013 ered variants, respectively. Noteworthy is the discovery of two and January 1st 2016. According to the literature, the VDR disease-associated novel heterozygous frameshift deletions polymorphisms studied were TT, Tt and tt. DNA was extract- (Pearson chi square p-value <0.05). ed from the patients using buccal swabs. Conclusion: Taken together, these findings show the power of Results: The prevalence of VDR genetic polymorphisms, as- using TNGS in identifying sequence variations in a very large sociated with a low vitamin D affinity (TT and Tt) were found gene and the surprising results obtained in this study greatly to be present for the majority of the sample (3769 patients: expand the catalogue of known VDR sequence variants that 84.42%). The TT polymorphism was found in 1534 patients may represent an important clue in the emergence of osteopo- (34.44%) and the Tt polymorphism in 2226 (49.48%). This rotic fractures. means that in a periodontal disease affected population, early detection of people at high risk of future osteoporosis is possible. P648 Conclusions: Thereisscientificevidenceshowingthecor- VITAMIN D LEVEL IN TAIWANESE OSTEOPOROSIS relation between VDR polymorphism TT and the increased WOMEN risk of developing periodontitis. Insufficient levels of vita- J. S. Hwang1,Y.R.Li1,F.H.Liu1,S.T.Chen1 min D is very often associated with the TT variant of VDR, 1Division of Endocrinology and Metabolism, Department of which provokes, in the same way, systemic problems of Internal Medicine, Chang Gung Memorial Hospital, Chang bone mineralization also increasing the risk of developing Gung University, Taoyuan, Taiwan, Province of China osteopenia and osteoporosis. Bone is the main component of the periodontal support tissue and every dental treatment Objectives: The aim of this study was to evaluate the vitamin has a deep impact on the bone supporting teeth or implants. D level in postmenopausal osteoporosis women with and The success and long term stability of the treatment is di- without vertebrae or hip fractures in northern Taiwan. rectly related to bone density and metabolism. The individ- Study design and methods: This single center, cross-section- ual profiling of bone metabolism and the genetic assess- al, observational study analyzed the vitamin D level in ment of the VDR variants, allow dental practitioners to Taiwanese postmenopausal osteoporotic patients with and alert their patients early about the risk for osteoporosis without non- trauma fragility vertebral or hip fracture that and future fragility fractures. The use of new, simple and received post-fracture medical care at osteoporosis clinic. non expensive diagnostic techniques of genetic screening Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S395 allows dental specialists to identify periodontal patients Conclusion: In terms of the increased SA/PM ratio, SPP-ILE with possible decreased bone mineral density; at this stage can be a suitable exercise for scapular winging subjects. SPP- patients can be referred to an endocrinologist to start a long ILE exercise is also better than KPP-ILE in terms of the di- term and low cost program of prevention. A complete un- minished compensatory rotation through increased scapular derstanding by dentists of the strong correlation between stabilization muscles and co-contraction of abdominal trunk skeletal bone density, periodontal health and osseo- stabilization muscles. In conclusion, SPP-ILE exercise can be integrated implant success could open new therapeutic ap- a useful exercise for subjects with scapular winging. proaches for periodontitis and bone regeneration tech- niques. This will help the NHS to reduce the economical and biological costs related to fragility fractures. P651 DEVELOPMENT OF A NEW IMMUNOASSAY FOR CATHEPSIN K GENERATED PERIOSTIN FRAGMENT P650 AS A BONE SPECIFIC BIOMARKER COMPARISON OF MUSCLE ACTIVITYAND TRUNK P. Garnero1, M. Lachize2,E.Biver3, N. Bonnet4,S.Ferrari4 COMPENSATION DURING MODIFIED PUSH-UP 1Division of Bone Diseases, Geneva University Hospitals and PLUS EXERCISES IN PEOPLE WITH SCAPULAR Faculty of Medicine, Geneva, Switzerland, 2University of WINGING Geneva, Geneva, Switzerland, 3Division of Bone Diseases, Y. -J . B ae k 1,C.-H.Yi2 University Hospitals and Faculty of Medicine, Geneva, 1Dept. of Physical Therapy, Graduate school of Yonsei Switzerland, 4Geneva University Hospital, Geneva, Switzerland University, Wonju, Republic of Korea, 2Dept. of Physical Therapy, College of Health Science, Yonsei University, Periostin (Postn) is a matricellular protein mainly expressed in Wonju, Republic of Korea bone, but is also present in several other tissues. Available immunoassays for circulating Postn detect the intact protein Objective: To compare the muscle activity, muscle activity and are not specific for bone tissue. ratio, and rotation degree of the thoracic and lumbar spine Objective: To develop a bone-specific Postn immunoassay during a modified push-up plus exercise. based on the detection of fragments generated by cathepsin Material and Methods: Twenty subjects with scapular K. winging participated. The subjects performed a standard Methods: Human recombinant Postn was incubated with ca- push-up plus with ipsilateral leg extension (SPP-ILE) and thepsin K at 37°C for various times and for different Postn/ knee push-up plus with ipsilateral leg extension (KPP-ILE). Cathepsin K ratio. The released Postn fragments were charac- During the SPP-ILE and KPP-ILE exercises, the serratus an- terized by LC-MS/MS. Rabbit antibodies directed against the terior (SA), pectoralis major (PM), ipsilateral external oblique synthetic sequence of the most efficiently generated cathepsin (ipsiEO), and contralateral external oblique (contEO) muscle K Postn fragment was produced and used for the development activities were assessed with surface electromyography, and of a competitive ELISA. Serum from160 healthy elderly rotation degree of thoracic and lumbar spine were assessed women (mean age: 65 yr) participating in the Geneva with a 3D motion tracking system. For normalization, muscle Retiree Cohort were measured with this ELISA and data were activities during maximal voluntary isometric contraction correlated with hip aBMD by DXA, HR-pQCT parameters of were collected for each muscle. The SA/PM ratio and the tibia and the bone markers S-CTX and PINP. ipsiEO/contEO ratio were calculated from the normalized Results: The sequence of 20 fragments that were efficiently muscle activities. generated from cathepsin K digestion of intact Postn was Results: The muscle activities of the SA, PM, ipsiEO, determined by targeted LC-MS/MS. The abundance was contEO, and SA/PM ratios were significantly higher during highest for the 688GSLQPIIK695 sequence (K-Postn, SPP-ILE than KPP-ILE. The ipsiEO/contEO ratio decreased patent filed P1971PC00) located in the C-terminal domain significantly during SPP-ILE compared to KPP-ILE. The tho- of Postn. The antibody directed against the GSLQPIIK racic and lumbar rotation values were significantly lower in peptide did not detect intact POSTN and the K-Postn pep- SPP-ILE. Increased muscle activities were expected when tide elongated or shortened by 1 amino acid at the C- more weight on the upper limbs induced more activation of terminal end. Immunohistochemistry of the tibia of mice muscles to maintain posture during SPP-ILE. As a trunk sta- showed that the K-Postn peptide localized at the perioste- bilizer, increased bilateral EO activities stabilized the trunk um surface of cortical bone region, specifically in osteo- and decreased lumbar rotation due to balanced activation of cytes and lacuno canalicular system. The ELISA for serum bilateral EO during SPP-ILE. Trunk stabilization also induced K-Postn has intra and inter assay variability below 14%, effective SA activation. Thus, SA/PM ratio was increased, and respectively. The lower limit of detection was 7 ng/ml and thoracic rotation was decreased during SPP-ILE. the dilution recovery of human serum ranged from 99 to S396 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 120% (median 109%). In elderly women, serum K-Postn P653 levels negatively correlated (p=0.03-0.02) with cortical pa- NON-CODING RNA: A NEW STRATEGY TO IMPROVE rameters of the tibia, but not with trabecular measures, hip BONE REGENERATION aBMD, S-CTX and PINP. M. I. Almeida1,A.M.Silva1,D.M.Marques1,C.R. Conclusion: We have developed a sensitive and precise Almeida1, H. Caires1,M.T.Pinto2,L.Fabris3,C.Ivans4,G. ELISA for the detection of a cortical bone specific Postn frag- A. Calin4,S.G.Santos1, M. A. Barbosa1 ment generated by cathepsin K in vivo. This new bone marker 1i3S; INEB; University of Porto, Porto, Portugal, 2i3S; should be useful for the clinical investigation of patients with Ipatimup, Porto, Portugal, 3MD Anderson Cancer Center, osteoporosis and other metabolic bone diseases. Houston, United States, 4MD Anderson Cancer Center, Houston, United States P652 Objectives: Bone fractures are highly prevalent in patients EFFECT OF 6-MONTH ISOTRETINOIN TREATMENT suffering from osteoporosis and a cause of patient disability. ON 25-HYDROXYVITAMIN D LEVELS IN PATIENTS The differentiation of Mesenchymal Stem/Stromal Cells WITH ACNE VULGARIS (MSC) into osteoblasts is crucial for bone regeneration. G. Saraç1,T.T.Koca2,S.Şener1 Non-coding RNAs (ncRNAs) are involved in key regenera- 1Deparment of Dermatology, Inonu University, Malatya, tive processes such as cell proliferation and differentiation. Turkey, 2Physical Medicine and Rehabilitation Clinic, Although some ncRNA are currently being used in clinical Research and Training Hospital, Malatya, Turkey trials to treat human diseases, the vast majority remains unex- plored. In this study, we aim to use ncRNA to regulate mech- Aim: Acne is a chronic inflammatory disease that affects the anisms that promote bone formation and repair. pilosebaceous units of the skin. Isotretinoin is a derivative of Material and Methods: To achieve this goal, expression the synthetic 13-cis-retinoic acid and is an efficient drug for levels of microRNAs (miRs) and long non-coding RNAs acne treatment. In clinical studies, the negative effects of long- (lncRNAs) during osteogenic differentiation of bone-marrow term and short-term isotretinoin use on vitamin D levels and derived-MSC and MC3T3 cell line were determined by micro- bone metabolism restrict its use. In this study, the effect of arrays and/or RT-PCR. Then, ncRNA levels in MSC were isotretinoin treatment on vitamin D levels was examined in modulated in vitro by electroporation or transfection to address patients with acne vulgaris. their effects on osteogenic differentiation and proliferation and Method: Ninety patients with clinically diagnosed acne to analyze their paracrine effect on angiogenesis. Finally, the vulgaris who came to the Malatya Public Hospital underlying molecular mechanisms were determined. Dermatology Clinic participated in this study. Patients who Results: Our results show that miRs, namely miR-195, miR- had been using any systemic drug for the previous month or 497 and miR-29, and transcribed ultraconserved regions (T- who had any systemic disease were not included in the study. UCR), namely uc.64+, are involved in osteogenic differentia- Patients with abnormalities in calcium (Ca), alkaline phospha- tion. Anti-miR-195 improves expression of osteogenic tase (ALP), and parathyroid hormone (PTH) levels, which markers, including ALP mRNA and protein levels, and in- affect vitamin D metabolism, also were not included in the creases MSC proliferation as shown by the increased percent- study. Patients were treated first with 0.5 to 1.0 mg/kg (per age of Ki-67+/DAPI+ cells. The paracrine effect of MSC con- kilogram of body weight) doses of isotretinoin, with the aim of dition media on angiogenesis is also modulated by miR-195 total dosage of 120 mg/kg. The patients’ 25-hydroxy vitamin and this effect are mediated by VEGF [1]. Moreover, we show D3 [25'(OH) vit D3] levels were measured before treatment that lncRNAs may interact with miRs. and at the sixth month of treatment. Conclusion: ncRNAs control crucial processes of bone regen- Result: Among the 90 patients who participated in the study, eration including MSC differentiation, MSC proliferation and 51 (56.7%) were female, and 39 (43.3%) were male, with an angiogenesis. Therapeutic strategies using ncRNAs will open age range of 16 to 50 years (mean±standard deviation) age, new venue for the treatment of bone fractures and may be 23.55±5.58 years. Eight patients dropped out of the study. The useful to promote bone formation in osteoporotic lesions. patients’ (mean±standard deviation) 25'(OH) vit D3 level was References: [1] Almeida et al, 2016 18.28±9.92 before treatment and 13.28±7.78 at the sixth Acknowledgments: This work was funded by Norte Portugal month of treatment (p=0.000). Regional Operational Programme (NORTE-01-0145- Conclusion: The negative effect of isotretinoin on vitamin FEDER-000012), under the PORTUGAL2020 Partnership D levels and bone metabolism has been shown in previous Agreement, through ERDF; COMPETE; FCT (SFRH/BPD/ studies. In this study, 25'(OH) vit D3 levels decreased sig- 91011/2012 (MIA); SFRH/BD/85968/2012 (AMS)). MIA nificantly in patients treated with isotretinoin in the long would like to thank the award L’Oréal Portugal Medals of term (p>0.000). Honor for Women in Science. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S397 P654 system compare the results with the system database ac- SECONDARY OSTEOPOROSIS RISK IN RHEUMATOID cording by the height, age, weight and gender from the ARTHRITIS FEMALE PATIENTS health population. The inclusion criteria: Angle of Cobb > D. Matei1,S.Patru1,A.M.Bumbea1,I.R.Marcu1,R.M. 40º. The exclusion criteria: Severe pain(9-10/10);neuro- Trăistaru1,A.C.Bighea1 logical disease; hip and knee replacement; vertebral ar- 1University of Medicine and Pharmacy, Craiova, Romania throdesis/anchyloses. We evaluated 50 women between The effects of rheumatoid arthritis (RA) on bone include struc- 51-87 years mostly of them with the osteoporosis and tural joint damage (erosions) and osteoporosis. The latter may some of them with the vertebral fracture. Measuring lead to increased risk for fractures, which are associated with Cobbs angle: 2nd thoracic vertebral superior plate and increased morbidity and mortality.(1) 12th thoracic inferior plate. The pain and disability evaluation: pain score, Roland- Morris and Oswestry Objective: To evidence the risk factors for development of questionnaire. secondary osteoporosis in patients with rheumatoid Conclusions: There is no difference in Overall rating of arthritis. control and stability between the group with and without Patients and methods: We observed 59 patients with SPINOMED. The Spinm group shows the clinically signif- established rheumatoid arthritis, aged between 34 and 71 icant results in decrease of anterior displacement years (an average of 46,65); for each patient BMD was mea- inRomberg testing and anterior displacement in voluntary sured by means of dual energy X-ray absorptiometry (DXA) control and ability evaluation - that means that the center of of hip and lumbar spine); we watched the presence of the gravity moved back towards. There is no risk of equilibri- common risk factors of osteoporosis, anterior corticosteroid um disturbance in the patient which wearing Spinomed treatments, the activity level of the illness and the stage of brace. disease. Results: 38 patients presented at the moment of study gen- eralized osteoporosis; we found a significant correlations P656 between osteoporosis and the following parameters: the THE EFFECTS OF WEIGHT LOSS APPROACHES stage of disease (prediction R²:0.613), the functional ON BONE MINERAL DENSITY IN ADULTS: A Steinbroker class (prediction R²:0.507), activity of disease SYSTEMATIC REVIEW AND META-ANALYSIS OF (DAS28) (prediction R²:0.414) but no important correla- RANDOMIZED CONTROLLED TRIALS tions were found between osteoporosis and smoking or S. Shab-Bidar1, S. Soltani2 corticosteroids therapy. 1Department of Community Nutrition, School of Nutritional Conclusion: For the examined patients, the secondary osteo- Sciences and Dietetics, Tehran University of Medical porosis was underrated; the osteoporosis management should Sciences, Tehran, Islamic Republic of Iran, 2Department of be considered early in the disease evolution. Nutrition, School of Public Health, Iran University of Reference: (1) Haugeberg G et al. Curr Opin Rheumatol Medical Sciences, Tehran, Islamic Republic of Iran 2003;15:469 Background/Objectives: Findings are not consistent on the effect of weight loss on bone mineral density (BMD). We P655 conducted a systematic review on the randomized con- THE IMMEDIATE EFFICACY OF SPINOMED trolled trials to assess the effect of weight loss strategies BRACE IN THE POSTURE AND EQULIBRIUM IN including calorie restriction and exercise programs on THE PATIENT'S WITH HYPERKYPHOSIS BMD in adults. T. K. Kranjcec1 Methods: A structured and comprehensive search of 1Rehabilitation Activa Mutua, Barcelona, Spain MEDLINE and EMBASE databases was undertaken up to March 2016. Study-specific mean differences (MD) were Objective: We wanted to determine do the SPINOMED pooled using a random-effects model. Subgroup analysis Brace (MEDI) produce the changes in relation with the pos- and meta-regression were used to find possible sources of ture, equilibrium and ability in the moment when you put the between-study heterogeneity. brace on. Results: Thirty two randomized controlled trials met Study design: We evaluated Overall Rating of control and predetermined inclusion criteria. The meta-analysis re- stability in the patients affected by hyperkyphosis using vealed no significant difference on total BMD (MD: the measuring system for equilibrium made by IBV per- 0.007, 95% CI: -0.020–0.034, p=0.608). In contrast, the formed2measures.1withtheSPINOMEDen2ndwith- pooled data of studies showed a significant effect of weight out respecting 30 min of rest between the testing. The loss on hip BMD (MD: -0.008, 95% CI: -0.09to -0.006 gr/ S398 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 cm2, p<0.001) and also lumbar spine BMD (MD: -0.018 P658 gr/cm2,95%CI:−0.019 to -0.017, p<0.001). BMD in the EFFECTIVENESS OFAN UNLOADING KNEE BRACE hip site decreased after more than 4 months, especially in IN THE TREATMENT OF PATIENTS WITH KNEE those who were obese. Moreover, calori-restriction inter- OSTEOARTHRITIS: A PHASE III RANDOMIZED ventions longer than 13 months showed a significant de- CONTROLLED TRIAL creased in lumbar spine BMD. P. Thoumie1,M.Marty2, B. Avouac3, E. Coudeyre4 Conclusion: Weight loss led to significant decreases at the 1Rehabilitation Department and Physical Medecine, hip and lumbar spine BMD but not at the total. Weight loss Rothschild Hospital, Paris, France, 2Department of response following calorie-restriction resulted in a de- Rheumatology, Henri Mondor Hospital, Creteil, France, crease in hip and lumbar spine bone density especially 3Rheumatologist, Paris, France, 4Rehabilitation Department more than one year; whereas an exercise-induced weight and Physical Medecine, Clermont-Ferrand, France loss did not. Objectives: The effectiveness of knee braces in the treatment of patients with knee osteoarthritis (KOA) remains controver- P657 sial despite their wide clinical use. The aim of this RCT was to THE RISK OF OSTEOPOROTIC FRACTURES AND assess the additive effect of the unloading knee brace in con- BODE INDEX IN PATIENTS WITH CHRONIC servative treatment of knee osteoarthritis. OBSTRUCTIVE PULMONARY DISEASE Material and Methods: Patients with symptomatic medial E. Kochetova1 KOA (Kellgren-Lawrence grade II-IV) were randomized into 1Petrozavodsk State University, Petrozavodsk, Russian either Brace group (brace + usual care) or Control group (usu- Federation al care alone). The unloading knee brace (Rebel Reliever®) is a gradually-adjustable lightweight aluminum unloading knee Objective: to study the risk of osteoporotic fractures and the brace that applies corrective forces by a 3-point pressure sys- BODE index in patients with chronic obstructive pulmonary tem. Usual care consisted of analgesics and self exercises pro- disease (COPD). gram. Primary endpoint was the global last-24h knee pain Material and Methods: 212 patients with chronic obstruc- (assessed via a 100-mm visual analogic scale [VAS]) after 6 tive pulmonary disease (COPD) were observed. The inves- weeks of treatment. Secondary endpoints included pain during tigated group was made by the patients having the long motion (100-mm VAS), function (Lequesne index), clinical experience of smoking. Research of function of external global improvement according to both patients and investiga- breath was studied with multimodular installation of type tors, responder rate, as well as safety and observance. «Master-Lab/Jaeger». Research of bone mineral density Results: Study population (ITT population) consisted of 67 (BMD) was studied with the densitometer « Lunar DPX- patients aged 65.7±9.6 years, mainly women (65.7%). Of them, NT». The assessment of risk of osteoporotic fractures was 32 were assigned to the Brace group and 35 to the Control calculated by means of the computer program FRAX. group. At baseline, last 24h-pain was 63.8±10.6 mm in the Patients were identified with the BODE index (body mass Brace group and 64.7±13.5 mm in the Control group. Pain index, airflow obstruction, dyspnea, and exercise during motion was 73.4±12.7 mm and 71.9±13.8 mm in the capacity). Brace and Control groups, respectively. Function (Lequesne Results: The BODE index increased with stage of COPD, index) was 13.4±3.7 in the Brace group and 12.6±3.2 in the minimum level of BODE index was in patients with COPD Control group. At 6 weeks, last 24h-pain had decrease signif- 2 stage 2.23±0.88. At 3 stage COPD the BODE index was icantly more in the Brace group than in the Control group (- 5.05±1.19, at 4 stage of COPD the BODE index was 7.0 41.4±3.4 mm vs. -15.4±3.2 mm; p<0.0001). Similarly, higher ±1.0. Bone mineral density (BMD) of the hip in patients decrease for pain in motion (-51.9±3.5 mm vs. -19.9±3.3 mm; with COPD 2 stage was 0.97±0.13, in patients with COPD p<0.0001) and algofunctional Lequesne index score (-5.8 vs. - 3 stage BMD was 0.87±0.14, in patients with COPD 4 2.3; p<0.001) were observed in the Brace group compared to stage BMD was 0.7±0.17. The maximum risk of hip frac- the Control group. Clinical global improvement was more pro- tures was detected in patients with COPD 4 stage – 3.2 nounced in the Brace group, with more patients feeling ‘better’ (1.1-5.4). Minimum risk of hip fractures was diagnosed to ‘considerably improved’ in the Brace group than in the in COPD 2 stage- 1.0 (0.5-2.1). The correlation coefficient Control group (86.2% vs. 3.1%), and with investigators between BODE index and BMD was -0.71, p <0.005. The reporting more patients ‘much’ to ‘very much’ improved in correlation coefficient between BODE index and fracture the Brace group than in the Control group (82.1% vs. 3.1%). risk was 0.54, p <0.05. Responder rate (OARSI-OMERACT criteria) was significantly Conclusions: The correlation between the BODE index and higher in the Brace group (72.4% vs. 34.4%; p=0.003). Safety the risk of fractures was noted. and observance to the brace were excellent. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S399 Conclusions: Superiority of this unloading knee brace + usual Conclusions: These data indicate that the effect of blueberry care compared to usual care alone was demonstrated. on apoptosis and expression of osteoclastogenic factors in Combining the used unloading knee brace with usual care is osteocytes is mainly due to its antioxidant component, al- a powerful therapeutic strategy to handle medial knee osteo- though the involvement of other components in modulating arthritis. NCT02021136. these effects cannot be excluded. They show that blueberry may be useful for inhibiting bone resorption and reducing inflammatory events associated with bone diseases related to P659 oxidative stress. ROLE OF BLUEBERRY EXTRACTS IN OXIDATIVE Acknowledgements: Ente Cassa di Risparmio di Pistoia e STRESS-INDUCED APOPTOSIS AND EXPRESSION Pescia and MIUR. OF OSTEOCLASTOGENIC FACTORS IN OSTEO- Reference: 1. Fontani F et al. Calcif Tissue Int 2015;96:335. CYTES V. Domazetovic1, G. Marcucci2,T.Iantomasi1,C. Ghelardini3,M.L.Brandi2,M.T.Vincenzini1 P660 1Department of Biomedical Experimental and Clinical CORRELATION OF CLINICAL MEASURES WITH Sciences, Florence, Italy, 2Department of Surgery and POTENTIAL CONTRIBUTING FACTORS IN FEMALES Translational Medicine, Unit of Bone and Mineral Diseases, WITH PATELLOFEMORAL PAIN University of Florence, University Hospital, Florence, Italy, A. Omidi1, F. Esfandiarpour1,A.Rezazade2, S. Zahednejad1 3Department of Neuroscience, Psychology, Drug Research 1Musculoskeletal Rehabilitation Research Center, Physical and Child Health, Neurofarba, Pharmaceutical and therapy Department, Rehabilitation School, Ahvaz Nutraceutical section, University of Florence, Florence, Italy Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran, 2Department of Radiology, Faculty of Objective: Osteocyte apoptosis due to microdamage is related Medicine, Ahvaz Jundishapur University of Medical to oxidative stress, increased bone turnover and resorption en- Sciences, Ahvaz, Islamic Republic of Iran countered in various bone diseases. In previous studies, we dem- onstratedinanosteocyte-likemurine cell line, MLO-Y4, that the Background: Patellofemoral pain (PFP) is a common mus- starvation-induced apoptosis is due to increased oxidative stress. culoskeletal disorder which is characterized by retropatellar or Moreover, an increased expression of osteoclastogenic factors peripatellar pain during activities which impose compressive such as receptor activator of nuclear kB ligand (RANKL) and forces on articular surfaces. The etiology of PFP is thought to sclerostin has been observed in starved osteocytes. Antioxidants be multifactorial. Reduced strength and flexibility of lower reverted these events showing their protective effect regarding limb muscles, malalignments of the lower extremity, and pa- osteocyte apoptosis in vitro (1). tellar malalignment have been proposed as major contributing Given that there are various studies indicating the potential of factors to PFP. However, relationship of the potential risk fac- blueberries in improving the balance between bone formation tors with pain and function in people with PFP is not well and bone resorption, the aim of this study was to investigate understood, yet. The purpose of this study was to investigate the role of blueberry extract in reactive oxygen species (ROS) the correlation of the contributing factors with pain and func- production, apoptosis and expression of osteoclastogenic fac- tion in females with PFP. tors in osteocytes. A comparison with N-acetylcysteine Materials and Methods: Fifty females with PFP (age=27.5 (NAC) effect was also performed. ±4.8 years) and 50 matched healthy females (age=25.3±4.8 Materials and Methods: MLO-Y4 cells were used to study years) participated in this cross-sectional study. Muscle apoptosis induced by starvation that mimics “in vitro” the strength, muscle flexibility, and pain were assessed using a apoptosis due to microdamage "in vivo". ROS were measured fixed dynamometer, an inclinometer, and visual analog scale, by fluorometric analysis; apoptosis by DNA fragments; respectively. Kujalla questionnaire and step-down test were RANKL and sclerostin expression by western blot. used to determine function. The navicular drop height and Results: Preliminary results show that the extracts of blueber- intercondylar/intermalleolar distance were measured to assess ry are able to reduce ROS production in concentration- and foot pronation and knee valgus and varus alignment. Sulcus, time-dependent manner and to prevent apoptosis in starved Congruence and Lateral patellar angles, and Insall-salvati ratio MLO-Y4 cells. They also inhibit the increased expression of were determined on axial and lateral patellar radiographs tak- RANKL and sclerostin due to increased oxidative stress, and en in 45° and 30° knee flexion angles. The data were analyzed these effects are similar to those observed in NAC treated using an independent t -test, bivariate correlation test and osteocytes. However, antioxidant effect of blueberry does stepwise regression. not seem closely related to its anti-apoptotic and anti- Results: There were significantly lower strength of the knee osteoclastogenic effect. extensors (P <0.001), the knee flexors (P <0.001), the hip S400 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 abductors (P <0.001) and the hip lateral rotators (P <0.001) in position that do not have a negative effect on any of their the PFP group as compared to the healthy group. The hip diseases (for example they must not increase the blood pres- medial rotators (P=0.027), illiotibial band (P=0.004) and sure), but achieve the ideal aim, so increase the strength of quadriceps (P <0.001) flexibility in the PFP group were sig- the extensor muscles of the spine and decrease the kyphosis nificantly lower as compared to the healthy group. There were shape of the trunk. It is important to see the face of every no significant difference in the knee varus-valgus alignment participant, because the change of facial expression is an (P=0.176), and navicular drop (P=0.132) between the groups. important nonverbal sign. The participants also have to see Also, no significant difference was found in the radiologic the leader of exercises, so that what everyone sees and hears indexes between the groups. Based on regression analysis, at the same time complete each other. One of the conditions quadriceps flexibility and hip abductor muscle strength may of doing the exercises the right way is that we understand predict Kujalla (R2=0.13) and step-down scores (R2=0.11) in what we have to do. The level of the intensity of the exercises females with PFP. No significant correlation was found be- (the number of repetitions) have to be felt by the participants tween pain intensity with other variables of interest in PFP on the basis of the Borg scale, and the leader helps them with group. it. Conclusions: Our findings indicate that there is a significant correlation between objective measure of function and the hip abductor and external rotator muscle strength and Iliotibial P662 band flexibility in PFP group. There was also a significant CONSIDER IDIOPATHIC TRANSIENT OSTEOPOROSIS correlation between Kujalla scores and the knee flexor strength IN THE UNEXPLAINED PAIN OF THE FOOT and quadriceps flexibility. Quadriceps muscle flexibility and S. L. Calvisi1,M.Meloni2 the hip abductor muscles strength may predict subjective and 1Unità Operativa Medicina Interna, Nuoro, Italy, 2Unità objective functional scores in females with PFP, respectively. In Operativa Neurochirurgia, Gravedona, Italy general, lower limb muscles strength in females with PFP is significantly less than a healthy matched group. A 51-year-old woman was investigated for longstanding (7 weeks) severe right foot pain associated with mild swelling and functional limitation, developed without history of trauma P661 or infection. Neoplastic, inflammatory and infective diseases TAILORED EXERCISES IN A LOCAL CLUB FOR were excluded, laboratory tests were negative, conventional OSTEOPOROSIS PATIENTS WITH COMORBIDITY X-ray pointed out osteopenia of the bone involved. V. Meszaros1,M.Hacsunc2, K. Zalatnai1 Consecutive magnetic resonance (MRI) revealed a picture of 1Hungarian Osteoporosis Patient Association, Budapest, spongy bone marrow edema. The final diagnosis was "tran- Hungary, 2Menopause Osteoporosis Ambulance, St. John's sient osteoporosis (TO) of the foot”. The patient was treated Hospital, Budapest, Hungary with analgesics, immobilization of the foot and intravenous bisphosphonate for 12 months. After this therapy she was The Club was founded in September 2014, it is the local part asymptomatic and the MRI images showed significant im- of the HOPA (Hungarian Osteoporosis Patient Association) it provement. TO is a self-limited syndrome without a definable is helped by the borough (Budapest, 12th district). The venue cause characterized by extremity pain of unknown etiology, of our programs is one of the cultural centres of the borough, the diagnosis is confirmed with MRI once other causes are the Cultural Saloon. In the first months there were 51 partic- excluded. Even if uncommon this condition should be known ipants (49 women and 2 men aged from 56 to 91), 19 of them by the clinicians. regularly took part in our sessions. Our programs were: one hour a month of exercises with a physiotherapist, one hour a month lectures. From September 2015 we had osteoporosis P663 exercises once a week. The number of participants increased. HYPERPARATHYROIDISM SECONDARY TO Until June 2016 the number of the participants was 79 (74 VITAMIN D DEFICIENCY women, 5 men, aged from 59-92). Regularly 30 people took S. L. Calvisi1,M.Meloni2 part in the exercise sessions. 1Unità Operativa Medicina Interna, Nuoro, Italy, 2Unità Since the average age was about 70, we did not differentiate Operativa Neurochirurgia, Gravedona, Italy osteopenia from osteoporosis. We did exercises that are im- portant and useful for patients with osteoporosis. We found it Secondary hyperparathyroidism is a common complication of also important to take into consideration that multimorbidity many clinical conditions. is typical of elderly people. For the leader of the exercise We reported the case of a 35 years old woman with a family program it is important to teach the elderly exercises and history of thyreopathy. An ultrasound (US) examination and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S401 thyroid function tests were prescribed as a routine monitoring. ±10.28 years had smoked and 61.3% did not. If we generalize The US assessment showed parathyroid hyperplasia of two patients' BASDAI mean scores, it can be said that the disease glands. Therefore a specific bone-mineral metabolism analy- is in the active period. Expected FVC, FEV1, MIP, MEP, and sis was conducted. The results pointed out a severe Vitamin D 6 MWT distance percentage, according to their age and gen- (VD) depletion (below 20 ng/ml) with phosphaturia, second- der groups, decreased. Also spinal mobility, the functional ary hyperparathyroidism and osteopenia. We started a VD oral status and quality of life appear to have decreased (Table 1). supplementation with high doses (50.000 IU once a week) for Table 1. AxSpa Patients’ disease activity level, functional sta- 8 weeks, followed by maintenance therapy of 1500 IU one a tus and quality of life level. day. The blood level of VD increased and the PTH normal- Mean±SD ized. In this case an inadequate exposure to sunlight and anti- BASDAI (0-10): 4,07±1,99 convulsants medications were assumed to be the cause of VD FVC% (>%80): 77,21±14,16 deficiency. Chronic risk factors for VD depletion should be FEV1% (>%80): 79,21±14,88 kept in mind in order to avoid abnormalities in calcium, phos- Pred MIP% : 73,17±22,72 phorus, PTH levels and bone metabolism. Pred MEP% : 54,89±17,15 Pred 6 MWT%: 77,09±16,066 BASMI (0-10):4,27±2,02 P664 BASFI (0-10) :3,28±2,47 DISEASE ACTIVITY, FUNCTIONAL STATUS AND ASQoL(0-18) :8,84±5,62 QUALITY OF LIFE OF AXIAL SPONDYLOARTHRITIS Conclusion: Our research is the first screening study in PATIENTS LIVING IN CYPRUS: A PILOT STUDY AxSpA patients living in Cyprus and it is aimed to increase S. Oksuz1,E.Unal2,G.Er1 the number of samples. In the light of information, we suggest 1Eastern Mediterranean University, Health Sciences Faculty, that AxSpA patients with high disease activity may have re- Physiotherapy and Rehabilitation Department, Famagusta, duced pulmonary function, functional exercise capacity, spi- Cyprus, 2Hacettepe University, Health Sciences Faculty, nal mobility and quality of life. The exercises recommended, Physiotherapy and Rehabilitation Department, Ankara, as a part of physiotherapy program, at this time should aim to Turkey develop all of them. References: Objective: To investigate the disease activity level, pulmo- 1. Black LF, Hyatt RE. Am Rev Respir Dis 1969;99:696. nary function, exercise capacity, functional level, spinal mo- 2. Troosters, T et al. Phys Ther 2002;82:826. bility and quality of life of Axial Spondyloarthritis (AxSpa) patients living in Cyprus. Material and Method: Thirty one patients (%35.5 women, P665 %64.5men) who received Axial Spondyloarthritis diagnosis CORRELATION BETWEEN QUALITY OF LIFE OF THE according to the ASAS criteria and signed an informed con- PATIENTS WITH KNEE OSTEOARTHRITIS AFTER sent form were included in the study. Pulmonary functions ARTHROPLASTY AND CLINICAL PARAMETERS (Forced Vital Capacity (FVC%) and Forced Expiratory vol- PREOPERATIVELY ume (FEV1%)) were measured with portable FUTUREMED S. Jandric1,Z.Jovicic2 Discovery Spirometry, pulmonary muscle strength (maximal 1Department of PRM, Faculty of Medicine of University of Inspiratory Pressure (MIP%) and Maximal Expiratory Banjaluka, Banjaluka, Republic of Srpska, Bosnia and Pressure (MEP%)) was measured with CAREFUSİON Herzegovina, 2Institute for Rehabilitation: Dr Miroslav MicroRPM. Functional exercise capacity was measured with Zotovic”, Department of Orthopedic Surgery, Banjaluka, 6 minute walk test (6 MWT%), functionality was measured Republic of Srpska, Bosnia and Herzegovina with Bath Ankylosing Spondylitis Functional Index (BASFI), disease activity was measured with Bath Ankylosing Objective: Total knee arthroplasty has been shown to be an Spondylitis Activity Index (BASDAI) and quality of life effective procedure in improving of quality of life of the pa- was assessed with Ankylosing Spondylitis Quality of Life tients with knee osteoarthritis and disability. Clinical assess- (ASQOL). Predicted percentages of MIP MEP and 6 minute ment of patients before knee arthroplasty could predict quality walk test distance were calculated by using formula. (1,2) of life of these patients after arthroplasty and rehabilitation. Permission of the ethics committee was taken from Hacettepe The aim of this study was to establish correlation between University on 05.04.2016 with Decision No.GO 16 / 147-07. quality of life of the patients with severe knee osteoarthritis Result: 31 voluntary axial spondyloarthritis with a mean age 6 weeks after knee arthroplasty and early rehabilitation with of 44,35±11,48 years was included in our study. It was noted clinical parameters (age, BMI, waist circumferences, physical that 38.7% of the patients with symptom durations of 19.68 function, pain and stiffness) before arthroplasty. S402 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Material and Methods: Prospective research includes 96 pa- medium positive correlation between VAS and RMDQ tients (average age 67.5±9.2 years, range of 45-78 years) that (t=2.301, df=27, p-value=0.03, correlation coefficient=0.405) underwent total knee arthroplasty. Early program of used Pearson’s correlation test. There is no significant corre- kinesitherapy and occupational therapy was performed. lation between BMI and AF (S=4561.1, p-value=0.5236, cor- Instrument used for assessment of the quality of life, physical relation coefficient -0.123) and between BMI and RMDQ function, pain and stiffness is modified version of Western (S=3028.1, p-value=0.1834, correlation coefficient 0.254) Ontario and McMaster Universities Osteoarthritis Index used Spearman's rank correlation test. (WOMAC). All patients completed the questionnaires preop- Conclusion: This study has found significant correlation with eratively and 6 weeks postoperatively. Pearson test of correla- lumbar kinematic and functional disability. On the other hand, tion was used to analyze numerical data. influence of overweight on mobility of the lumbar spine is not Results: Quality of life of the patients with knee osteoarthritis found. 6 weeks after arthroplasty shows significant correlation with physical function (r=0.547, p<0.00), pain (r=0.281, p<0.01) and waist circumferences (r=0.208, p<0.05) preoperatively. P667 Conclusion: Results of our research show that physical func- MUSCLE STRENGTH AND PHYSICAL PERFORMANCE tion, pain and waist circumferences of the patients with knee FROM MIDLIFE AND BONE HEALTH IN EARLY OLD- osteoarthritis before arthroplasty influences on the level of the AGE: THE MRC NATIONAL SURVEY OF HEALTH AND quality of life after total knee arthroplasty. These findings can DEVELOPMENT be important for creating the program of preoperative rehabil- K. A. Ward1,D.Kuh2,S.Muthuri2,A.Moore2,C.Cooper3, itation and for assessment of indications for arthroplasty. R. Cooper2 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom, 2MRC P666 Lifelong Health and Ageing Unit at UCL, London, United MOBILITY OF THE LUMBAR SPINE AND FUNCTIO- Kingdom, 3Musculoskeletal Epidemiology, Botnar Research NAL DISABILITY IN PATIENTS WITH CHRONIC Centre, Nuffield Department of Orthopaedics, Rheumatology LOW BACK PAIN and Musculoskeletal Sciences, University of Oxford, Oxford, S. Nejkov1, M. Vukovic1, Z. Skaric-Karanikic1, V. Bokan- United Kingdom Mirkovic1 1Center of Physical Medicine and Rehabilitation, Clinical Objective: There are few prospective data investigating how Center of Montenegro, Podgorica, Serbia muscle strength and physical performance in adulthood may relate to later bone health. The aim of this study was to test Objectives: The aim of this study was to examine the associ- associations between grip strength, standing balance and chair ation between lumbar mobility and functional disability and rise speed, measured from midlife, with bone outcomes in the influence of body mass index (BMI) on the mobility of early old age in men and women from a British birth cohort lumbar spine in patient with chronic low back pain (CLBP). study, the MRC National Survey of Health and Development. Material and Methods: The study was conducted on 29 Materials and methods: At age 60-64y, 1583 (824 women) patients-13 men (mean age 47.61±11.92) and 16 women had assessments of bone including pQCT (radius) and DXA (mean age 51.25±13.69) with CLBP which lasted more than (hip). Analyses were stratified by sex, and associations be- three months (mean duration 12.62±6.87 months). To assess tween bone outcomes (radius: volumetric BMD, cross- range of motion (ROM) of lumbar spine we measured ante sectional area (CSA), medullary area; hip: aBMD, femoral flexion (AF)- distance from fingers to floor in centimeters. neck cross-sectional moment of inertia (CSMI), total hip Weight and height were measured to calculate BMI. We used CSA) and grip strength, chair rise speed and standing balance Roland-Morris Disability Questionnaire (RMDQ) to assess (assessed at ages 53 and 60-64) were tested using linear re- disability. The RMDQ is scored as a unidimensional scale gression before and after adjustment for height and weight. summarizing answers to all 24 questions (Yes/No) regarding Results are presented as percentage mean [95%CI] difference daily life functioning. Visual Analogue Scale (VAS) is used in DXA- and pQCT outcome per unit difference in strength or for evaluated back pain. We used EZR statistical software in performance measure. the statistical analysis. Results: In men, stronger grip at ages 53 and 60-64 was as- Results: Mean value of AF was 26.60±9.20, mean value of sociated with greater radius (0.3 [0.2,0.4]) and hip RMDQ 15.62±3.90, mean value of VAS 6.03±1.49 and me- (0.2[0.2,0.3]) CSA, femoral neck CSMI (0.5[0.3,0.6]) and dian of BMI was 25.86 (19.09 -41.35). There was medium hip aBMD (0.2[0.1,0.3]); all p<0.001). Associations with positive correlation between AF and RMDQ (t=2.9887, CSA and CSMI measures were robust to adjustment for body df=27, p-value=0.006, correlation coefficient=0.499) and size. In women, similar sized associations were found and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S403 remained after adjustment for body size for radius CSA according to standard protocols. Central obesity was defined 0.4[0.2,0.5], hip CSA 0.2[0.1,0.3] and hip aBMD as WC>88 cm. Following a 12-h overnight fast, venous blood 0.2[0.0,0.3]. Neither chair rise speed nor standing balance samples were obtained from all participants, centrifuged, and were consistently associated with bone outcomes with the stored immediately at -80oC for later measurement. Serum exception of chair rise speed and radius CSA (p<0.001) and resistin concentration was measured by ELISA assay vBMD (p<0.05) in men. (BioVendor, Modrice, Czech Republic). Data are expressed Conclusions: In a large, nationally representative study, grip as the mean±SD. Continuous variables were evaluated using strength had the most consistent, positive associations with ANOVA test, categoric variables by Chi square tests. A p clinically relevant bone outcomes at the radius and hip. <0.05 was considered statistically significant. All statistical Fewer associations were found with chair rise and standing analyses were performed using SPSS program. balance performance, possibly because grip strength is a more Results: Ninety one patients, aged between 41 and 60 years, direct measure of muscle function and therefore better indica- were 75.8±1.0kg in weight and 163.3±0.6cm in height. Based tor of the muscle bone relationship than these measures which on radiographic changes, the patients were classified into three are dependent on more body systems. Evidence for the impor- groups in relation to OA grades: mild, moderate and severe. tance of muscle bone relationships in midlife and early old age Albeit nonsignificant, a trend of increased plasma resistin val- suggest midlife may provide an opportune time for interven- ue with the increment in OA grade was observed. tion for prevention of disability associated with sarcopenia Conclusion: Serum resistin may provide a non-mechanical and osteoporosis in later life. link between obesity and joint integrity in OA. Acknowledgements: This work was supported by the UK Medical Research Council MC_UU_12019/1 and MC_UU_12019/4, U105960371. P669 PLANTAR PRESSURE MEASUREMENT OF PLANTAR FASCIITIS AND RELATIONSHIP WITH P668 PAIN AND FASCIAL THICKNESS PLASMA RESISTIN ARE ASSOCIATED WITH A. Ulusoy1,L.Cerrahoglu2 CLINICAL SEVERITY IN KNEE OSTEOARTHRITIS 1Urla State Hospital, Izmir, Turkey, 2Department of Physical E. Alissa1,L.Alzughaibi1,Z.Almarzouki1,M.S.Alardawi1 Medicine and Rehabilitation, Celal Bayar University, Manisa, 1Faculty of Medicine, King Abdulaziz University, Jeddah, Turkey Saudi Arabia Objective: Plantar fasciitis is the most common cause of heel Objective: It has been shown that risk of primary knee and hip pain in adults. These patients modify their gait pattern due to joint replacement for osteoarthritis (OA) relates to both adi- the heel pain. We aimed to investigate whether there was a pose mass and central adiposity. This is suggestive of a poten- significant difference in the plantar pressure distribution after tial link between dysfunctional metabolism and joint damage. pain relief by successful treatment response in plantar fasciitis Systemic adipokines have been suggested to function as me- and relationships with fascial thickness. diators between adipose tissue and joint metabolism in osteo- Methods: 49 patients with a diagnosis of chronic unilateral arthritis. Therefore, the aim of the current study is to explore plantar fasciitis received 3 weeks of physical therapy interven- the association between plasma resistin with clinical severity tion and home exercises. Visual Analog Scale (VAS), plantar in female patients with knee OA and central obesity. pressure measurement by pedobarographic assessment and Material and Methods: The study was conducted in 91 fe- magnetic resonance imaging were performed before and 1 male participants with primary knee OA, who were consecu- month follow up after intervention. At 1 month follow up tively recruited from the orthopaedic clinics at King participants were divided into 2 groups according to the good Abdulaziz University Hospital (KAUH), Jeddah, Saudi or poor response to the treatment. The success criteria of the Arabia. Patients with secondary OA (such as those with a treatment was defined as percentage decrease of heel pain history of trauma, inflammatory rheumatic disease) were ex- more than 60% from baseline at 1 month after treatment for cluded. The study was approved by the medical ethics com- pain (VAS) measurements. mittee of KAUH. OAwas diagnosed by clinical and radiolog- Results: 44 participants completed the study. The number of ic evaluation based on the American College of the subjects were 24 in Group 1 who had successful response Rheumatology criteria. Western Ontario and McMaster to the treatment, while 20 subject in Group 2 with poor re- Universities Arthritis Index scores were used to grade pain, sponse. The dynamic plantar pressure values of the medial joint stiffness and limitations in function among OA patients. forefoot was significantly increased, p=0.015 after treatment Anthropometric measurements including weight (kg), height in the patients with successful treatment response (Group 1). (cm), waist and hip circumferences (cm) were measured There was no significant plantar pressure change in patients S404 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 with poor treatment response. Plantar fascia thickness posi- results suggest that improving yogurt intakes could be a valu- tively correlated with dynamic thumb pressures (coronal able and cost-effective health strategy for maintaining bone p=0.03 r=0.434, sagittal r=0.451 p=0.02). health in older adults. Conclusion: These findings showed that fascial thickness and dynamic plantar pressures were associated with each other. Plantar pressure increased on the forefoot medial as a P671 result of the restoration of the gait with significant decrease LONG TERM FOLLOW-UP OF SUBJECTS FROM in pain. THE FRACTURK STUDY FOR NEW FRACTURES, MORTALITY AND MORBIDITY U. Akarirmak1,S.Tuzun1, N. Eskiyurt2,M.Sarıdogan1,D. P670 Palamar1,S.Oncel3,F.Atalay4, H. Christiansen5,J.A. GREATER YOGURT CONSUMPTION IS ASSOCIATED Kanis5, Turkish Osteoporosis Society6, International WITH INCREASED BONE MINERAL DENSITY AND Osteoporosis Foundation7 PHYSICAL FUNCTION IN OLDER ADULTS 1Istanbul University, Cerrahpasa Medical Faculty, Physical M. Casey1,E.Laird2, M. Ward3, K. McCarroll1,L.Hoey4,C. Medicine and Rehabilitation Department, Istanbul, Turkey, Hughes4, C. Cunningham5,J.Strain3,H.McNulty6,A. 2Istanbul University, Istanbul Medical Faculty, Physical Molloy2 Medicine and Rehabilitation Department, Istanbul, Turkey, 1Department of Gerontology, St James Hospital, Dublin, 3Dokuz Eylul University, Physical Medicine and Ireland, 2Institute of Molecular Medicine, Trinity College, Rehabilitation Department, Izmir, Turkey, 4Gazi University Dublin, Ireland, 3Northern Ireland Centre for Food and Faculty of Medicine, Physical Medicine and Rehabilitation Health (NICHE), University of Ulster, Coleraine, United Department, Ankara, Turkey, 5WHO Collaborating Centre Kingdom, 4Northern Ireland Centre for Food and Health, for Metabolic Bone Diseases, University of Sheffield Ulster University, Coleraine, United Kingdom, 5Department Medical School, Sheffield, United Kingdom, 6Turkish of Medicine for the Elderly, St James Hospital, Dublin, Osteoporosis Society, Istanbul, Turkey, 7International Ireland, 6Northern Ireland Centre for Food and Health Osteoporosis Foundation, Nyon, Switzerland (NICHE), University of Ulster, Colraine, United Kingdom Objective: In 2009, the Fracturk Study determined the in- Background: The associations of yogurt intakes with bone cidence of hip fracture and prevalence of osteoporosis in a health and frailty in older adults are not well documented. The random sample of the general population in Turkey. The aim was to investigate the association of yogurt intakes with aim of the present study was to assess the subsequent frac- bone mineral density (BMD), bone biomarkers and physical ture risk in men and women over 50 years of age who were function in 4,310 Irish adults from the Trinity, Ulster, determined to have an osteoporotic fracture, compared to Department of Agriculture aging cohort study (TUDA). “healthy” subjects whose bone mineral densities were mea- Methods: Bone measures included total hip, femoral neck suredin2009. and vertebral BMD with bone biochemical markers. Materials and Methods: Data collection was performed Physical function measures included Timed Up and Go via Telephone Aided Telephone Interviews (CATI). Two (TUG), Instrumental Activities of Daily Living Scale and different questionnaires were applied; one for those sub- Physical Self-Maintenance Scale. jects who were determined to have an osteoporotic fracture Results: Total hip and femoral neck BMD in females were 3.1 in 2009, and the other for healthy subjects whose BMDs - 3.9% higher among those with the highest yogurt intakes were measured in 2009. A total of 656 (out of 1974) ques- (n=970) compared to the lowest (n=1,109; P <0.05) as were tionnaires were successfully completed for healthy sub- the TUG scores (-6.7%; P=.013). In males, tartrate-resistant jects with BMD measurements. Successful questionnaires acid phosphatase (TRAP 5b) concentrations were significant- were completed in 16 (out of 35) subjects with osteopo- ly lower in those with the highest yogurt intakes (-9.5%; P rotic fracture. <0.0001). In females, yogurt intake was a significant positive Results: Seven% of healthy subjects had an osteoporotic frac- predictor of BMD at all regions. Each unit increase in yogurt ture in the 7-year time frame (2009 – 2016). 13.4% of those intake in females was associated with a 29% lower risk of subjects whose femoral neck T-score was below -2.5 had an osteopenia (OR 0.71; 95% CI 0.51 – 1.01; P=0.037) and a osteoporotic fracture; significantly higher than that of subjects 37% lower risk of osteoporosis (OR 0.63; 95% CI 0.44 - 0.91; with higher femur neck T-scores. Osteoporotic fracture rate P=0.014) and in males, a 51% lower risk of osteoporosis (OR was 6.8% among those whose femur neck T-score was be- 0.49; 95% CI 0.25 - 0.94; P=0.032). tween -2.5 and -1.0 and the rate was 4.0% among those whose Conclusion: In this cohort, higher yogurt intake was associ- femur neck T-score was above -1.0. FRAX scores (calculated ated with increased BMD and physical function scores. These without BMD) of those subjects who had an osteoporotic Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S405 fracture was higher than that of those without incident fracture values of bone alkaline phosphatase (58 mg/l; n.v. <17) (7.41 vs. 5.63), significant at 90% confidence level (p=0.074). and low-normal values of 1,25(OH)2D (26.2 ng/ml; n. v 43% of those whose femoral neck BMD score was below -2.5 20-67) were also observed. A total body CT scan showed were having regular follow up for their osteoporosis‘ two suspicious areas located in the head of the right femur management. and in the right tibia, even though the Octreosan™ showed Sixoutof16subjectswhoweredeterminedtohavean an increased uptake of the tracer only in the femur. We osteoporotic fracture in 2009 died during these 7 years. decided to remove first the head femur lesion and perform None of deaths was attributed to the incident to the inci- intra-operative FGF23 assay to confirm tumor resection; if dent fracture. Four out of 14 (relatives of the 2 deceased this had been unsuccessfully, we would have extended the could not respond) subjects had new fractures. Five out of operation to excise the second bone lesion. Basal, 10, 60 14 did suffer impairment of their activities of daily after the and 225 m’ values after excision of the right femoral head first fracture. were 423, 127, 56 and 30, respectively. Starting from the Conclusion: Under current situation, 7% of the study pop- 60 m’ all values were in the normal range. The brisk fall of ulation over 50 years of age will have an osteoporotic FGF23 values suggested that the head femur lesion was fracture within a 7-year time frame. More than half of responsible for the syndrome. On histological examina- patients do not have a regular follow up for osteoporosis tion, a mesenchymal tumor with highly vascular prolifera- treatment. In order to reduce the rate of osteoporotic frac- tion pattern (hemangiopericytoma-like tumor), was ture, efforts should be increased for secondary prevention diagnosed. of fractures. Conclusion: This is the first report showing the possibility of intra-operative FGF23 assay to monitor tumor resection in patients with tumor induced osteomalacia. This approach P672 could be particularly useful to prevent incomplete resection INTRA-OPERATIVE FGF23 ASSAY DURING SURGERY or in case of multifocality, that has been recently described as a FOR TUMOR INDUCED OSTEOMALACIA: TOWARDS cause of surgical failure. A PRECISION MEDICINE L. Colangelo1,W.Gianni1,M.Cilli1,C.Sonato1,J.Pepe1,C. Cipriani1, V. Danese1, V. Fassino1, A. Corsi2,O.Moreschini3, P673 S. Minisola1 TERIPARATIDE TREATMENT IN A HEART TRANS- 1Internal Medicine and Medical Disciplines/Sapienza PLANT PATIENT WITH CHRONIC KIDNEY DISEASE University of Rome/Policlinico Umberto I, Rome, Italy, AND LOW-TURNOVER BONE DISEASE: A CASE 2Department of Molecular Medicine/Sapienza University of REPORT Rome/Policlinico Umberto I, Rome, Italy, 3Department of H.-P. Dimai1,P.Krisper2, D. Wagner3,A.Fahrleitner- Anatomical Sciences, Histological, Forensic Medicine and Pammer1 Locomotive System/Sapienza University of Rome/Policlinico 1Department of Internal Medicine, Division of Endocrinology Umberto I, Rome, Italy and Metabolism, Medical University of Graz, Graz, Austria, 2Department of Internal Medicine, Division for Nephrology, Objective: To investigate the usefulness of fibroblast Graz, Austria, 3Department of Surgery, Division for growth factor 23 (FGF23) intra-operative assay to monitor Transplantation, Graz, Austria resection of tumor in patients with tumor induced osteomalacia. Low-turnover bone-disease is a complication of chronic Case description: A 33-year-old man with five years’ history kidney disease and long-term steroid therapy. Currently, of lumbar and pelvis pain together with multiple vertebral the only bone anabolic treatment available is teriparatide fractures was admitted to our hospital. He was diagnosed an- (TPTD). So far no data exist in heart transplant patients kylosing spondylitis one year before and treated with anti- and only one single case with histomorphometric analysis TNFa therapy without benefit. On physical examination, he of a dialysis patient with low-turnover bone disease has had severe kyphosis, proximal weakness with difficulties in been published so far. performing daily activities. He was unable to walk without The current report shows the effect of a 1-year TPTD crutches. therapy in a cardiac transplant patient with 10 vertebral Results Laboratory investigation showed low tubular reab- and 3 peripheral fractures who had developed chronic sorption of phosphate (1.28 mg/dl) despite chronic kidney failure while receiving triple immunosuppressive hypophosphatemia (1.2 mg/dl). Increased plasma values therapy. of FGF23 (673 pg/ml, ELISA LIAISON, Diasorin, A transiliac bone biopsy following tetracycline labeling Saluggia, Italy; n.v. <95 pg/ml) together with elevated was performed prior and after one year of treatment, S406 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 showing an increase in bone formation and improvement Yates Chi-square (df=1) 8,02 p=0,00462. Prevalently we of structural indices (20-fold increase of Osteoid Volume/ found mild and moderate vertebral deformities in thoracic Bone Volume, 4-fold increase of Osteoid Surface/Bone spine. Surface and increases of wall thickness (+15%), trabecular thickness (+9%) and trabecular number (+38%)). Bone mineral density was stable, no new vertebral fractures P675 had occurred, the therapy was well tolerated and the patient THE INFLUENCE OF BODY WEIGHT ON BONE improved clinically. MINERAL CONTENT IN NORWEGIAN ADOLE- SCENTS: THE TROMSØ STUDY, FIT FUTURES O.-A. Nilsen1,G.Thrane2, T. Christoffersen1,N.A.Emaus1 P674 1Department of Health and Care Sciences, UiT- The Arctic VERTEBRAL DEFORMITIES IN POSTMENOPAUSAL University of Norway, Tromsø, Norway, 2Department of TYPE 2 DIABETIC WOMEN Health and Care Sciences, UiT The Arctic University of O . V. Vo dy an ov a 1, A. P. Shepelkevich2,N.S.Korytko2,N.A. Norway, Tromsø, Norway Vasilieva3 1Belarusian Medical Academy of Postgraduate Education, Objectives: Osteoporosis and fragility fractures constitute Minsk, Belarus, 2Belarusian State Medical University, a global health problem. Maximization of the genetic Minsk, Belarus, 3Republican Medical Rehabilitation and potential for bone mineral acquisition during growth Balneotherapy Centre, Minsk, Belarus may reduce fracture risk later in life. The association between body weight (BW) and bone accumulation in Objective: To assess the vertebral deformations in postmen- adolescence remains controversial. The aim of this opausal type 2 diabetic women. population-based study was to explore the influence of Materials and methods: We examined 100 type 2 diabetic BW on bone mineral content (BMC) development in late women (mean age: 59,4+ 6,2 yrs, mean BMI: 32,4 +6,11 adolescence. kg/m2,durationofDM– median 7[5;12] yrs, duration of Material and Methods: In 2010-2011 we invited all first menopause median 8,5[4;15] yrs.). The control group upper secondary school students in Tromsø to the Fit consisted of 77 healthy age- and BMI-matched persons. Futures study and 1038 adolescents (93%) attended. We Bone mineral density (BMD) was measured with DXA measured total body (TB) BMC (g) by DXA. Two years with lateral vertebral assessment (LVA). We used the later, in 2012-2013, we invited all participants to a follow- Genant classification to assess a grade of vertebral up survey and 820 adolescents attended, providing 688 deformity. repeated measures. BW and height were measured to the Results: Osteoporosis (T-score <-2,5) has been revealed in nearest 0.1 kg and 0.1 cm and sexual maturation assessed 16% (n=16) of diabetic patients, osteopenia in 43% (n=43), by questionnaires. Linear mixed models were used to as- normal BMD in 41% (n=41). In the control group the dis- sess the time dependent associations between BMC and tribution BMD was comparable to diabetic patients (osteo- BW. We included 351 girls and 296 boys aged 15 to 17 porosis 14%(n=11), normal BMD 39%(n=30), osteopenia years at baseline in the analysis. 47%(n=36)). Type 2 diabetic patients had 29 vertebral de- Results: Mean follow-up time were 1.9±0.02 years. Mean formities that was statistically higher than in the control annual changes for TB BMC were 39.6±6.3 g and 118.8 group (16,4% vs. 4,5% respectively, Yates Chi-square ±8.9 g for girls and boys, respectively (p<0.000). For girls, (df=1) 8,02 p=0,00462). In diabetic group there have been average annual BW change were 1.4±0.3 kg. BW change detected mild vertebral deformities (1st degree) (n=32), for boys were 2.7±0.4. After controlling for baseline age, moderate deformities (2nd degree) have been found in 5 height, sexual maturation and time between measurements, patients, severe deformities (3rd degree) have been in 2 we found that BW was positively associated with TB patients detected in Th12. 8 patients had 2-3 deformities BMC; 19.2±2.1g for girls and 18.6±2 g for boys of different types at the same time. In the control group (p<0.05). Intercepts and random slopes for weight varied all the deformities were mild and moderate (n=8). Wedge significantly across participants in both models; For girls deformities and biconcave deformities have been presented SD for: (u0j)=481.3 and (u1j)=8.0 (p<0.05). in equal frequency while crush deformities only in 2 pa- Correspondingly for boys, 446.7 and 6.3. Intercepts and tients. Thoracic vertebras were more frequently deformed slopes covaried positively; cov (u0j,u1j) for girls and boys compared with lumber ones. were 63.2 and 39.6. Conclusions: Our study showed that vertebral deformities Conclusion: Our results indicate a positive combined might have place in postmenopausal diabetic women between- and within subjects association between TB BMC (16,4%), in comparison with the control group (4,5%) and BW. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S407 P676 P677 EFFECTS OF ABALOPARATIDE-SC ON BONE NIGHT SWEATS ALONE DOES NOT PREDICT MINERAL DENSITY AND RISK OF FRACTURE IN GREATER BMD LOSS: A PROSPECTIVE POSTMENOPAUSAL WOMEN AGED 80 YEARS OR POPULATION-BASED STUDY IN WOMEN AGED OLDER WITH OSTEOPOROSIS 43-63 FROM THE CANADIAN MULTICENTRE M. McClung1,N.C.Harvey2,L.A.Fitzpatrick3,P.Miller4,G. OSTEOPOROSIS STUDY Hattersley5, Y. Wang6, F. Cosman7 E. M. Wong1, G. Tomlinson2,M.Pinto-Dias3,J.C.Prior4,A. 1Oregon Osteoporosis Center, Portland, OR, United States, M. Cheung5 2MRC Lifecourse Epidemiology Unit, University of 1Department of Medicine, University of Toronto, Toronto, Southampton, Southampton, United Kingdom, 3Radius Ontario, Canada, 2Department Of Medicine/Toronto General Health, Inc, Wayne, PA, United States, 4Colorado Center for Hospital, Toronto, Canada, 3Institute of Medical Sciences, Bone Research, Lakewood, CO, United States, 5Radius University of Toronto, Toronto, Canada, 4Department of Health, Inc, Waltham, United States, 6Radius Health, Inc, Medicine/Vancouver Coastal Health Research Institute/ Parsippany, NJ, United States, 7Helen Hayes Hospital, West University of British Columbia, Vancouver, Canada, Haverstraw, NY, United States 5University Health Network, Toronto, Canada Objective: Abaloparatide-SC (ABL-SC) is a novel, selective Objective: Our primary objective was to compare 2-year activator of the PTH 1 receptor signaling pathway. ABL-SC changes in lumbar spine (LS) BMD between women with reduced vertebral and nonvertebral fractures and bone mineral clinically important night sweats (at least moderate severity density (BMD) compared to placebo (PLB), and reduced ma- ≥3 times in the last 2 weeks; VMSn) and without. jor osteoporotic fractures compared to teriparatide (TER). Methods: We examined data at baseline and 2-year follow-up Here, we report safety and efficacy of ABL-SC in women for 1570 women, aged 43-63, in the Canadian Multicentre ≥80 years in the ACTIVE trial. Osteoporosis Study(CaMos), a prospective Canada-wide Material and Methods: ACTIVE was a phase 3 trial of 2463 study of skeletal health. We used linear regression to assess postmenopausal women with osteoporosis, randomized 1:1:1 the relationship between VMSn and BMD change. Covariates to double-blind ABL-SC 80 μgorPLB,oropen-labelTER included age, reproductive status, weight, physical activity, 20 μg SC for 18 months. Women ≥80 years of age enrolled in estrogen use, and family history of fracture. ACTIVE were studied for changes in BMD from baseline and Results: The prevalence of clinically important VMSn was safety. Fracture rates are presented, but these exploratory anal- 12.2%. Women with VMSn were younger (54.5 vs. 55.3 yses were not powered to detect differences between treatment years, p=0.02) and less likely to use estrogen (39.8% vs. groups. 51.4%, p<0.05). LS, total hip (TH), and femoral neck (FN) Results: 140 women ≥ 80 years [mean 82 years; range 80-86 BMD were similar between groups at baseline and 2-year years; mean femoral neck (FN) T-score -2.5] were randomized follow-up. In unadjusted and adjusted models, a non- to receive ABL-SC (n=51), PLB (n=43), or TER (n=46). At significant greater loss in LS BMD at 2-year follow-up baseline 51 (36%) patients had a prevalent vertebral fracture, was seen in women with VMSn (mean difference -0.42%, 58 (41%) reported ≥1 prior non-vertebral fracture, and 52 95%CI(-1.08, 0.24), p=0.21). Age and reproductive status (37%) had no prior fractures. Incidence rates for new vertebral (in separate models), weight, and estrogen use accounted fractures were 0%, 6%, and 3%, and Kaplan-Meier estimated for variations in LS BMD. Similar results were seen when rates for nonvertebral fracture were 2.2%, 5%, and 5.3%, for evaluating 2-year change in TH and FN BMD (mean dif- ABL-SC, PLB, and TER, respectively. At 18 months, signif- ference -0.41%, 95%CI(-0.90, 0.08), p=0.10 and -0.42%, icant increases in BMD from baseline were observed for 95%CI(-1.08, 0.24), p=0.24, respectively). No difference ABL-SC vs. PLB at the total hip (mean change 3.86% vs. in low-trauma fracture incidence was seen between groups 0.60%; treatment difference [TD] 3.13% [95% CI 1.44%, at 2 years. 4.81%]; P=0.0004), FN (3.61% vs. 1.24; TD 2.87% [95% Conclusion: We did not find a significant association between CI 0.82%, 4.92%]; P=0.0068), and lumbar spine (12.11% clinically important VMSn and 2-year BMD change that was vs. -0.01%; TD 12.30% [95% CI 9.34, 15.26]; P<0.0001). not already accounted for by other modifying factors, but a Adverse events appeared similar across groups and similar trend towards greater BMD loss with VMSn was appreciable. to the overall population. Our results, though, are restricted to VMSn and may not truly Conclusions: Among a small subpopulation of postmeno- capture the relationship between VMS and BMD. Additional pausal women with osteoporosis ≥80 years of age enrolled research involving VMS and bone loss and fracture incidence in ACTIVE, ABL-SC resulted in significant improvement in is needed. BMD, and numerical reduction in risk of vertebral and Acknowledgements: AM Cheung is supported by a Tier 1 nonvertebral fractures, compared to placebo. CRC in Musculoskeletal/Postmenopausal Health. S408 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P678 Methods: US examination of the 1st MTPJs of both feet was GO – ON AND CARTINORM IN TREATMENT OF performed in 25 male patients with first attack of gout and 25 GONARTHROSIS male patients with asymptomatic hyperuricemia. The pres- Z. Golubovic1, P. Stojiljkovic1, I. Golubovic1,5,Z. ence of bone erosions adjacent to tophaceous material; tophi, Radovanovic2,B.Ristić3,A.Mitić4,I.Micic1,A.Krstic5,N. hyperechoic material surrounded by anechoic rim; and Djordjevic6,S.Milijić6,S.Stamenić6 hyperechoic band over the articular cartilage (double contour 1Clinic for Orthopaedic and Traumatology Clinical Center, sign) were compared between groups. Nis, Serbia, 2Clinical Center Nis Serbia, Nis, Serbia, 3Clinic Results: 25 male patients (average age 55.24) with first attack for Orthopaedic Surgery and Traumatology Clinical Center in of gout and 25 age-matched male patients with hyperuricemia Kragujevac, Kragujevac, Serbia, 4Faculty of Medicine, (average age 54.12) were compared. Double contour sign we University in Nis, Nis, Serbia, 5Faculty of Medicine, found in 64% of gouty joints and in 36% with asymptomatic University of Nis, Nis, Serbia, 6Clinic for Orthopaedic hyperuricemia (P <0.001); tophaceous material, was seen in Surgery and Traumatology, Clinical Center in Nis, Nis, Serbia 24%gouthy joints and in 8% with asymptomatic hyperurice- mia (P <0.001); erosions were seen in 28% and in 8% with Gonarthrosis is a degenerative disease of the knee joint (knee asymptomatic hyperuricemia (P <0.001). OA), which is accompanied by pain and a limited range of Conclusions: These data show that US examination of the 1st movements. In addition to the standard treatment of the knee MTPJ may help in the early diagnosis of the gout, identifying OA, which includes anti-rheumatic drugs and physical thera- sonographic features of the disease even in clinically silent py, the GO-ON, a sterile non-pyrogenic solution of sodium joints. hyaluronate could be used in combination with Cartinorm tablets. We analyzed 28 patients with gonarthrosis, who have been P680 treated at the Clinic for Orthopaedic Surgery and RETROGRADE INFECTION AFTER A TREATMENT Traumatology in Niš, from 01.09.2016. to 31.12.2016. by OF A TROCHANTERIC FRACTURE IN A FEMALE intra-articular administration of the GO-ON ampules in the PATIENT WITH OSTEOPOROSIS knee joint. In the analyzed group there were 16 (57,14%) Z. Golubovic1, P. Stojiljkovic1, I. Golubovic1,5,Z. women and 12 (42,86%) men. The GO-ON ampules were Radovanovic2,B.Ristić3,A.Mitić4,I.Micic1,A.Krstic5,N. administered once a week at a dose of 25mg (2.5ml of solu- Djordjevic6,S.Milijić6,S.Stamenić6 tion) for the period of five weeks. After that, the patients were 1Clinic for Orthopaedic and Traumatology Clinical Center, prescribed tablets Cartinorm (Glucosamin, Chondroitin, Nis, Serbia, 2Clinical Center Nis Serbia, Nis, Serbia, 3Clinic Vitamin D3, Calcium, Manganese, Chromium, Vitamin C) for Orthopaedic Surgery and Traumatology Clinical Center in once a day. The Pain and the range of movements of the knee Kragujevac, Kragujevac, Serbia, 4Faculty of Medicine, were studied before and after the intra-articular GO-ON ad- University in Nis, Nis, Serbia, 5Faculty of Medicine, ministration and Cartinorm tablets. University of Nis, Nis, Serbia, 6Clinic for Orthopaedic Analyzing the results, we have found that the GO-ON in com- Surgery and Traumatology, Clinical Center in Nis, Nis, Serbia bination with Cartinorm proved to have very good effects in 20 (71,43%) patients, good in 6 (21,42%) and 2 (7,14%) pa- Osteoporosis represents a generalized bone disease, which is tients had partial improvement. characterized by the reduction of the bone mass, and conse- quently by the reduction of the strength of the bones. Osteoporosis occurs in both sexes, but it is more frequent in P679 women after the menopause. A 78-year-old female patient ULTRASONOGRAPHY OF THE FIRST METATARSAL (P.V.) got a transtrochanteric fracture of the femur. After the PHALANGEAL JOINT IN EARLY GOUT PATIENTS complete preoperative preparation, a surgery has been done, V. Skakic1,A.Skakic2,J.Jovanovic3, L. Stefanovic4 osteosynthesis with an internal fixator by Mitković. During 1Institute for Therapy and Rehabilitation, Niska Banja, Serbia, the postoperative course the screws of the internal fixator 2Urology Clinic, Clinical Center Nis, Nis, Serbia, 3Institute for disintegrated and fell out, and a bed sore and a perforation Treatment and Rehabilitation Niska Banja, Niska Banja, of the skin formed. During the local anesthesia the screws of Serbia, 4Dom Zdravlja, Kraljevo, Serbia the internal Mitković fixator were removed but the propaga- tion of the infection continued. Despite the regular bandaging Objective: To investigate by ultrasonography (US), frequen- and the antibiotic therapy the infection did not simmer down. cy and characteristics of the first metatarsophalangeal joints The surgery was performed again and the osteosynthetic ma- (1st MTPJs) changes of patients with first attack of gout and in terial was completely removed and a flow drainage was set up. patients with asymptomatic hyperuricemia. Along with the antibiotic therapy and the regular bandaging Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S409 the infection simmered down. As a result of the disintegration Conclusion: The burden of hospital care for patients with hip and the infection, 4cm curtailment of the left leg remained. fractures is large. Though both non-diabetics and diabetics The female patient begin to move with a help of the underarm with other comorbidities present at the time of admission crutches. had more delays to operation and longer hospital stays, the burden appears to be even more in diabetics compared to non- diabetics with the former more likely to have post-operative P681 complications and ultimately needing longer inpatient care. IN PATIENT CARE FOR DIABETIC AND NON- DIABETIC PATIENTS WITH OSTEOPOROTIC HIP FRACTURES IN A FRACTURE LIAISON SERVICE P682 AT AN ASIAN HOSPITAL: BRINGING THE EFFECTS OF LOW-VOLUME HIGH-INTENSITY BURDEN INTO THE SPOTLIGHT RESISTANCE TRAINING ON BONE MINERAL M. Chandran1,X.F.Huang1,K.Choo1,D.Tay1,Y.Hao2 DENSITY AND FALLING RISK FACTORS IN 1Osteoporosis and Bone Metabolism Unit, Singapore General OSTEOPENIC/OSTEOPOROTIC WOMEN Hospital, Singapore, 2Health Services Research and J. Conviser1, C. Slagowski2,R.Moynes2,S.DIxson2,D. Biostatistics Unit, Singapore General Hospital, Singapore Smith2 1Performance Health Systems, Northbrook, United States, Introduction: Osteoporosis as well as Diabetes are increasing 2University of Wyoming, Laramie, United States exponentially in Asia. Whether and how the burden of hospi- Resistance training (RT) improves muscular strength, falling tal care and problems after admission for osteoporotic hip risk factors, and is associated with maintenance of bone min- fractures differ between diabetics and non-diabetics has not eral density (BMD), which is important to minimize fractures been explored in SE Asian populations. and costs, estimated at $20 and $30 billion in the U.S. and Method: Retrospective review of patients admitted with new Europe, respectively. bioDensity is a low-volume high-inten- osteoporotic hip fractures and recruited into a FLS at sity RT approach. Four limited-range exercises (chest press, Singapore’s largest hospital. CP; leg press, LP; core pull, Core; and vertical lift, VL) are Results: The study population included 150 non-diabetics and performed at a voluntary-maximal effort for 5-seconds each 88 diabetics. Chinese constituted 87.4%, Malays 6.7% and once per week to elicit multiple body weight loading of the Indians 3.8%. 81.5% were women. Mean age was 74 years musculoskeletal system. (10.3). On Univariate analysis, mean ((SD) time to operation (TTO) in days was significantly more in diabetics compared to Objective: To determine whether 24-weeks of bioDensity non-diabetics; 4 (3) vs. 3.1 (3.3); p=0.002. Length of Hospital training improves BMD and risk factors for falling in Stay (LOHS) in days significantly differed between diabetics osteopenic/osteoporotic women. and non-diabetics; (mean (SD) 14.3 (7.7) vs. 12.6 (10.8) re- Methods: 24 women (58±9.3 yrs; 24.1±4.0 kg/m2; T-scores spectively; p=0.006). Major post-operative complications <-1.0) completed once per week bioDensity training for 6- were more in diabetics (19.3% vs. 8.7%; p=0.023). Non- months. Pre- and post-training measures: BMD (total, lumbar, diabetics were more likely to be discharged to their homes femoral neck) and body composition (DXA), Y-balance test, (55.3% vs. 42%) compared to diabetics who were more likely Senior Fitness Test, and muscular strength. Paired t-Test data to get discharged to nursing homes or step-down facilities analyses. (p=0.037). There were no in-hospital deaths in either group. Results: At 24-weeks, there was no change in BMD (any site) After adjusting for age and gender, patients with one or more or body composition (body fat or lean mass). CP (42%), LP co-morbidities at admission had a delay in time to operation (41%), and VL (29%) strength increased (P<0.05). Balance by 1.66 days (CI 0.8-2.51; p<0.001) compared to those who (right: 82.6% to 86.3%; left: 83.0% to 86.8%) improved sig- had none. Logistic regression showed that the odds of devel- nificantly (P<0.05) along with agility (9%), chair-to-stand oping post-operative complications was 2.15 times (0.98- transfers (19%), and floor-to-stand transfer time (22%). 4.74) higher in diabetics compared to non-diabetics Pharmacotherapy regimen and lifestyle were stable across (p=0.055). Both diabetic and non-diabetic patients with one study duration. or more other co-morbidities at admission had on average 3 Conclusion: The absence of change in BMD is not entirely days longer LOHS and those who developed a post-operative surprising despite the low BMD of participants. While complication had 9 days longer LOHS than those who did not evidence suggests that high mechanical loading favorably im- (p=0.014 and p<0.001 respectively). Linear regression analy- pacts BMD, the 24-week training exposure may be insuffi- sis adjusted for age, gender, co-morbidities and post-operative cient duration for measurable adaptation. Without a matched complications showed that LOHS was longer in diabetics by control group, it is unknown whether bioDensity may have 1.16 days compared to non-diabetics (1.01-1.34; p=0.036). prevented/diminished the typical decline in BMD over time. S410 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 The favorable changes in muscular strength, balance, and fall- willingness to undergo the measurement again while 2% of ing risk factors are clinically meaningful and may confer a participants were unsure whether they would be willing to lower fall/fracture risk. In the absence of lean muscle mass undergo the procedure again. change, strength improvement may be due to improved neu- Conclusions: In this study, the OsteoProbe® was well accept- romuscular facilitation, e.g., Type 2 motor unit recruitment. ed by participants. These preliminary data suggest that The low-volume high-intensity bioDensity approach im- microindentation testing with the OsteoProbe® is feasible in proves several fall risk factors in osteopenic/-porotic women. clinical settings. Further longitudinal controlled trials should assess whether bioDensity attenuates age-related decline in BMD in at-risk populations. P684 INTEGRATING REGULATORY ELEMENTS AND GWASS IDENTIFIES NOVEL SUSCEPTIBILITY P683 GENES AFFECTING BONE MINERAL DENSITY IMPACT MICROINDENTATION TESTING OF S. Yao1, S.-S. Dong1, R.-H. Hao1, Y.-X. Chen1, Y.-J. Zhang1, CORTICAL BONE USING THE OSTEOPROBE®:A X.-F. Chen1,J.-B.Chen1, T.-L. Yang1 FEASIBILITY STUDY IN POPULATION-BASED MEN 1Key Laboratory of Biomedical Information Engineering of P. Rufus1, K. L. Holloway1,A.Diez-Perez2, M. A. Kotowicz1, Ministry of Education, School of Life Science and S. L. Brennan-Olsen3,J.A.Pasco1 Technology, Xi'an Jiaotong University, Xi'an, China 1Deakin University, Geelong, Australia, 2Department of Internal Medicine, Hospital del Mar-IMIM and Autonomous Objective: We aimed to identify new susceptibility genes University of Barcelona, Barcelona, Spain, 3Australian for osteoporosis through integrating regulatory features Institute for Musculoskeletal Science, The University of and previous genome-wide association studies (GWASs) Melbourne, Melbourne, Australia data. Material and Methods: Osteoporosis-associated SNPs Objective: Bone mineral density (BMD) does not fully eluci- were obtained from NHGRI GWAS Catalog, PheGenI da- date fracture risk; the largest absolute number of fragility frac- tabase and two recently published GWASs. The regulatory tures occurs in people with osteopenia. Other determinants of features derived from Encyclopedia of DNA Elements and bone strength such as bone material properties and RoadmapEpigenomicsMappingwereusedtoacquirethe microarchitecture may contribute to fracture risk. characteristics of osteoporosis-associated SNPs with ma- OsteoProbe® is a novel device that assesses bone material chine learning methods. Subsequently, we predicted the strength index (BMSi) in vivo. Research using this device is genome-wide SNPs using optimized algorithm to discover expanding, underscoring the need to assess acceptability in the new susceptibility variants. We further utilized Genetic clinical setting. In this preliminary study we assessed partici- Factors for Osteoporosis Consortium (GEFOS) dataset pant tolerability and feasibility of the OsteoProbe®. and three in-house GWAS samples to check the associa- Materials and Methods: In 107 men enrolled during 2016 in tions between predicted positive SNPs and bone mineral the Geelong Osteoporosis Study (age 33-92yrs), BMSi was density (BMD). measured using the OsteoProbe® at the mid-tibia in reclined Results: We predicted 37,584 novel candidate osteoporosis- position after the administration of local anaesthetic. associated loci with optimized algorithm. 369 of them were Immediately following measurement, each participant com- significantly associated with femoral neck or/and spine BMD pleted a questionnaire that asked them to rate on a line scale in the meta-analysis results after multiple testing corrections. (out of 10) the level of pain that was anticipated and experi- We also found three novel genes that were significantly asso- enced, their initial reluctance towards the measurement and ciated with spine BMD, including AMT (P=8.98 × 10-7), GAL their willingness to undergo the measurement again. Of 107 (P=7.89 × 10-8)andESPL1 (P=1.95 × 10-7). AMT encodes potential participants, exclusions were: needle phobia (n=2), one of four critical components of the glycine cleavage system skin infections (n=5), excessive soft tissues around mid-tibia which provides a bypass reaction in glycine metabolism and region (n=7), due to discomfort (pressure, no pain) after the GAL encodes the precursor of galanin. Both glycine and first indentation (n=2). galaninhavebeenreportedtobeassociatedwithosteoporosis. Results: The mean (±SD) BMSi was 83.2±6.4 (range 62.7- As for ESPL1, it has been reported to be correlated with SP7,a 94.5). The expectation for pain during OsteoProbe® measure- transcription factor that responsible for regulating osteoblast ment was low (1.61±1.64), as was actual pain experienced differentiation. Our findings highlighted the credibility of our (0.34±0.74). Participants were not reluctant to undergo mea- prediction. surement (0.43±1.15). Acceptability of the OsteoProbe® mea- Conclusions: Combining GWASs and regulatory elements surement was high; 98% of participants indicated a through machine learning could provide additional Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S411 information for understanding the molecular mechanism of levels of emotional problems and low levels of structural dam- osteoporosis. Our results would provide insights on age (56%). People within Class 1 were more likely to be searching osteoporosis-associated genetic variants. The female, had greater BMI, lower education level, more comor- three susceptibility genes, AMT, ESPL1 and GAL could bidities, more severe knee pain and more painful sites as com- be novel targets for etiology research and treatment of pared to Class 2 and Class 3. Furthermore, WOMAC pain osteoporosis. scores and number of painful sites were consistently greater Acknowledgments: This work was supported by the National at baseline, 2.6, 5.1 and 10.7 years in Class 1 than Class 2 and Natural Science Foundation of China (81573241) and Natural Class 3 (all P<0.05). Science Basic Research Program Shaanxi Province Conclusions: Psychological and structural factors interact (2016JQ3026). with each other to influence pain perception. P685 P686 DIFFERENTIATING AND VALIDATING ‘PAIN PHENO- A FOCUSED LITERATURE REVIEW OF THE TYPES’ IN KNEE OSTEOARTHRITIS DIRECT MEDICAL COSTS ASSOCIATED WITH F. Pan1, J. Tian1,D.Aitken1,F.M.Cicuttini2,C.H.Ding1,G. CLINICAL FRACTURES IN THE UNITED STATES Jones1 Y. Jiang1, R. Barron1,A.Grauer1 1Menzies Institute for Medical Research, Hobart, Australia, 1Amgen Inc, Thousand Oaks, CA, United States 2Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash Objectives: Osteoporotic fractures can either be grouped University, Alfred Hospital, Melbourne, Australia by fracture location, such as vertebral and non-vertebral, or by whether they are associated with clinical symp- Objectives: Pain in osteoarthritis (OA) is very common and toms, which especially helps to further characterize ver- often involves multiple joints. It is multifactorial and tebral fractures. Of all vertebral fractures, approximately individualised with multiple factors involved in the genesis 30% are clinical vertebral fractures that generate most of and pain experience, such as structural pathology, psycho- the morbidity and mortality. We evaluated the direct logical factors and pain coping strategies. Thus it may be medical costs associated with clinical fractures (both possible to group people together based on specific factors clinical vertebral and non-vertebral), clinical vertebral which are linked to experiencing pain. Therefore, this fractures, and non-vertebral fractures, and determined study aimed to identify and validate ‘pain phenotypes’ in the impact of the grouping of fractures by location or knee OA. by symptoms on the average costs and the total US med- Material and Methods: 1099 participants (mean age 63 ical costs associated with these composite fracture years; range 51-81 years) from the population-based classifications. Tasmanian Older Adult Cohort study participated at baseline. Methods: We conducted a focused literature review using 875, 768 and 563 participants were traced years 2.6, 5.1 and PubMed from 2001 to present using the key words of frac- 10.7 follow-up, respectively. Demographic, psychological, ture(s) and cost(s) or expenditure(s). More, we included only lifestyle and comorbidities data were obtained at baseline. original research on osteoporotic fractures that reported or T1-weighted or T2-weighted fat saturated MRI of the right allowed the calculation of clinical, clinical vertebral, and knee was performed to measure knee structural pathology– non-vertebral fracture costs. Costs were normalized to 2016 cartilage defects, bone marrow lesions (BMLs) and effusion- US dollars using the medical Consumer Price Index. Average synovitis at baseline. Knee pain was assessed using Western fracture costs for commercially insured patients and Medicare Ontario and McMaster Universities Osteoarthritis Index patients and the total costs of the fracture groupings in the US (WOMAC) at each time-point. Presence of pain (yes/no) at were analyzed. the neck, back, hands, shoulders, hips, knees and feet was Results: Findings are shown in Table 1. Clinical fractures can assessed by questionnaire at each time-point. Latent class cost between $14,404 - 17,806 on average depending on in- analysis, was used to differentiate ‘pain phenotypes’ consid- surance type, and can cost $21 billion a year in the US. ering sex, body mass index (BMI), emotional problems, co- Conclusions: Clinical fractures are a costly composite frac- morbidities, number of painful sites and knee structural dam- ture grouping. Osteoporosis treatment and future studies age on MRI. should focus more on reducing the disease burden of clinical Results: Three pain phenotypes were identified: Class 1: high fractures. levels of emotional problems and low levels of structural dam- Disclosures: The study was funded by Amgen Inc. All au- age (24%); Class 2: high levels of structural damage and low thors are employees of Amgen, and hold stocks or stock op- levels of emotional problems (20%); Class 3: relatively low tions of Amgen. S412 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 rash with denosumab is also uncommon. The following case reports the extremely rare occurrence of both adverse events in the same patient. Materials and Methods: A 60-year-old Asian lady with a past medical history of osteoporosis, presented with new onset left thigh pain and difficulty weight-bearing without any pre- ceding trauma. Medications included 9 years of oral alendronate, calcium carbonate and cholecalciferol. Results: X-Ray of the left femur revealed an incomplete trans- verse lucency in the lateral cortex of the femoral diaphysis with cortical thickening. Nuclear medicine scan confirmed a small focus of activity in the left femoral shaft with an identical focus of activity in the right femur, also corresponding to lateral transverse lucency on X-ray. Data was consistent with bilateral, atypical femoral shaft fractures. Laboratory studies were nor- mal except for a low 25-hydroxyvitamin D level of 19 ng/mL. She failed to improve with conservative therapy and had suc- cessful bilateral intramedullary nailing. Bisphosphonate thera- P687 py was discontinued. She was supplemented with adequate PREVENTION OF OVARIECTOMY-INDUCED BONE calcium and cholecalciferol. Two years later, serial DXA LOSS IN MICE BY BORTEZOMIB showed significant bone mineral density loss. She started Y. Lee1 denosumab 60 mg subcutaneously every 6 months. One week 1Dept. of Biochemistry, School of Dentistry, Kyungpook following each injection, she developed an unbearable gener- National University, Daegu, Republic of Korea alized urticarial rash. Denosumab was stopped after the third injection. Subsequently, the rash did not recur. After 18 months, Bone homeostasis is achieved through coordinated activities of she developed a lumbar spine compression fracture. She will be bone-forming osteoblasts and bone-resorbing osteoclasts. started on teriparatide with close follow-up. When the balance is skewed in favor of osteoclasts due to Conclusions: Clinical suspicion for AFF should be high in hormonal or inflammatory issues, pathologic bone loss occurs patients on long-term bisphosphonates. Imaging of both fe- leading to the conditions such as osteoporosis, rheumatoid ar- mursisnecessarytoavoidmissing bilateral fractures. thritis, and periodontitis. Bortezomib is the first in-class of pro- Alternative management strategies for osteoporosis should teasome inhibitors used as an anti-myeloma agent. In the pres- be explored following the occurrence of skin rash ent study, we show that bortezomib directly inhibited the recep- with denosumab. tor activator of nuclear factor kB ligand (RANKL)- dependent osteoclast differentiation of mouse bone marrow macrophages. Bortezomib significantly reduced the induction of osteoclast P689 marker genes and proteins including nuclear factor of activated CORRELATION BETWEEN BONE MINERAL DEN- T-cells, cytoplasmic 1 (NFATc1). The intraperitoneal injection SITY AND SERUM TRACE ELEMENT CONTENTS OF of bortezomib reduced ovariectomy-induced osteoclastogenesis ELDERLY MALES IN BEIJING URBAN AREA and protected the mice from bone loss. These data propose L. Wang1,H.T.Yu1,G.H.Yang1,Y.Zhang1,3,X.Y.Song1,T. novel use of bortezomib as a potential anti-resorptive agent. J. Su1,W.F.Ma1, F. Yang1,L.Y.Chen1,L.He2,Y.Z.Ma1 1Center of Orthopedics, the 309th Hospital of PLA, Beijing, China, 2Division of Science and Technology, National P688 Institute for Nutrition and Food Safety, Chinese Center for BILATERAL ATYPICAL FEMORAL FRACTURES Disease Control and Prevention, Beijing, China, 3Center for AFTER ALENDRONATE AND SEVERE RASH WITH Systems Biomedical Sciences, University of Shanghai for DENOSUMAB Science and Technology, Shanghai, China J. Maharaj1 1Division of Endocrinology/Wheeling Hospital, Wheeling, Objective: Trace element levels are associated with the United States incidence of osteoporotic fractures, but related mecha- nisms remain unknown. Trace elements may interfere with Objective: Bilateral atypical femoral fractures (AFF) are in- growth, development and maintenance of bones. Therefore, frequent complications of long-term bisphosphonates. Skin we investigated whether plasma trace element levels are Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S413 associated with bone mineral density in elderly males in Results: Both the CSD and CON groups had an attenuation of Beijing. weight gain after 3-month intervention. The plasma glucose Material and Methods: After epidemiologically investigat- level of CSD group was higher than that of the CON group ing 91 elderly males with age ranging from 50 years to 80 during the IPGTT (P<0.01). The CSD rats showed a marked years, we obtained a total of 30 healthy (group 1), 31 increase in HOMA-IR and ITTcompared with the CON group osteopenic (group 2) and 30 osteoporotic (group 3) subjects. (P<0.01). There were no significant differences of AST, ALT, Blood was collected, and serum concentrations of trace ele- creatinine, and most lipid parameters between the CSD and ments were detected. Elderly males in the three groups were CON groups (P>0.05). carefully matched in terms of body mass index. Iron, manga- Conclusion: The CSD has a marked effect on glucose homeo- nese, zinc, copper, selenium, cadmium and lead were analysed stasis, comprising glucose intolerance and insulin resistance. by inductively coupled plasma-mass spectrometry. Bone min- eral density (BMD) was measured by QDR-2000 dual-energy X-ray absorptiometry. Correlation between BMD and serum P691 element contents was analysed using SPSS16.0. EFFECTS OF BONE MINERAL DENSITY ON Results: The plasma levels of manganese, zinc, copper, sele- GERIATRIC HIP FRACTURES nium and lead were similar in all of the groups (P>0.05). S. K. Choo1,H.K.Oh1, M. J. Shin1, Y. K. Kang1 Cadmium was significantly and negatively correlated with 1Orthopedic Surgery, Inje University, Ilsan Paik Hospital, BMD of the lumbar vertebrae (P<0.05). Moreover, cadmium Goyang City, Republic of Korea and iron contents significantly differed in osteoporotic and healthy groups. Objective: The bone mineral density(BMD) of the proximal Conclusion: These elements may directly and correlatively femur was measured on geriatric hip fracture patients to eval- affect BMD in elderly males. Many trace elements may di- uate if BMD of the patient affects type and severity of hip rectly and correlatively influence BMD. Future studies should fractures. be conducted to evaluate serum and bone levels of these trace Material and Methods: From 2003 to 2016, 808 hip fracture elements to determine the relationship of these trace elements patients aged over 65 yrs old who had bone densitometry with osteoporosis. study by dual-energy x-ray absorptiometry (DXA) of the hip within 1 month of the fracture was evaluated. There were 333 femur neck fractures and 475 intertrochanteric fractures. The P690 fracture type was divided into neck and intertrochanteric frac- EFFECTS OF CHRONIC SLEEP DEPRIVATION ON tures and neck fractures was subdivided into stable(Garden GLUCOSE HOMEOSTASIS IN RATS stage I, II) and unstable (GS III, IV) fractures and Pauwel’s L. Wang1,X.W.Xu1,Y.Zhang1,X.Y.Song1,W.F.Ma1,W. type 1, 2, 3. Trochanteric fractures were subdivided into AO/ J. Zhai1, T. T. Wang1, C. Wang1,D.Li1,L.He2,Y.Z.Ma1 OTA classifications. The correlation between fracture type 1Center of Orthopedics, the 309th Hospital of PLA, Beijing, and subdivisions were compared with the patients age, China, 2Director of Division of Science and Technology, BMD, t-score, and Z-score. National Institute for Nutrition and Food Safety, Chinese Results: Out of 808 patients only 143 patients had positive Z- Center for Disease Control and Prevention, Beijing, China score. The intertrochanteric fracture groups were 2 yrs older(79.5/77.3) and had poorer T-score(-2.5/-2.2) than neck Objective: Epidemiological studies have shown that chronic fracture but better Z-score(-0.65/-0.85)(p<0.0001). In the neck sleep disturbances resulted in metabolic disorders. The pur- fracture groups, statistically not significant but stable(Garden pose of this study was to assess the relationship between stage I and II) fractures had poorer T-score(-2.36/-2.16) and Z- chronic sleep deprivation (CSD) and the glucose homeostasis score(-0.75/-0.62)(p=0.08). Pauwel’stype2wasthemost in rats. common type but no correlation was found with the bone Material and Methods: Twenty-four rats were randomly di- density and fracture type(p=0.12). In the intertrochanteric vided into CSD group and control (CON) group. The CSD fracture group, A1 fractures had poorest T-score(A1/A2/A3:- rats were intervened by a modified multiple platform method 2.7/-2.46/-2.2) and Z-score (-0.997/-0.784/-0.585) compared (MMPM) to establish an animal model of chronic sleep dis- to A2 and A3 type(p=0.01). turbances. After 3-month intervention, all rats were subjected Conclusions: More than 77% of hip fracture patients had to an intraperitoneal glucose tolerance test (IPGTT) and an negative Z-score implies that not only the absolute value of insulin tolerance test (ITT), and the body weight, aspartate the bone density but their poor age matched value may be a aminotransferase (AST), alanine aminotransferase (ALT), cre- implications for hip fractures. Intertrochanteric fracture atinine, lipid profile group, and homeostasis model groups were older and had poorer BMD since it is more relat- assessment-IR (HOMA-IR) were measured. ed to osteoporosis. Stable femur neck fractures and S414 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 intertrochanteric fractures had poorer bone density because P693 very light trauma may cause these fractures in more osteopo- THE EFFECT OF COOLED-DOWN PELOID AND rotic patients. WATER IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS Z. Grujic1, T. Tomic1,N.Jevtić1,A.Jokic1 P692 1Specialized Rehabilitation Hospital Banja Koviljaca, Banja COMPARISON OF FUNCTIONAL EXERCISES ON Koviljaca, Serbia LOWER-EXTREMITY MUSCLE ACTIVATION IN PEOPLE WITH CHRONIC ANKLE INSTABILITY Objective: To determine the effect of cooled-down peloid and Y.-J. Jung1, C.-H. Yi1 water in patients with rheumatoid arthritis in its active stage. 1Yonsei University, Wonju, Republic of Korea Materials and methods: The research was conducted at Specialized Rehabilitation Hospital in Banja Koviljača, Objective: To compare muscle activation of lower extremity Serbia, as a prospective study with 35 patients with active and trunk using surface electromyography (EMG) during five rheumatoid arthritis (RA) who had as a treatment method functional exercises and to determine optimized functional sulphuric peloid and water in cooled-down state. The control exercises in subjects with chronic ankle instability. group with the same number of examinees had a combination Material and Methods: Twenty-four subjects with chronic of electrotherapy and hydrotherapy using tap water (four-cell ankle instability (CAI) participated. Subjects performed five baths). Both groups had kinesiotherapy and therapy using functional exercises in random order: (1) forward lunge (FL), low-frequency electromagnetic field. The following factors (2) rotational lunge (RL), (3) anterior direction one leg standing were monitored: DAS - 28 (Disease Activity Score), the du- exercise (A-OLS), (4) posteriomedial direction one leg stand- ration of morning stiffness, the strength of hand grip and func- ing exercise (PM-OLS), (5) posteriolateral direction one leg tional assessments of loco motor apparatus. standing exercise (PL-OLS). During the functional exercises, Results: Average value of DAS – 28 score in the examined group we collected surface EMG data of peroneus longus (PL), lateral was reduced from 6.1739 to 4.6539 and in the control group from head of gastrocnemius (GCM-L), gluteus medius (Gmed), 6.0032 to 5.4104 (p<0.001**, F=58.149; Eta2=0.461). peroneus longus (PL), ipsilateral erector spinae (ES-ipsi), and In the examined group, the average duration of morning stiff- contralateral erector spinae (ES-con) muscle activities. A 5-s ness was reduced from 103.43 to 94.14 min. (p=0.004**) and maximal voluntary isometric contraction (MVIC) value was the difference between groups is of statistical significance calculated to determine a basis for EMG normalization. (p=0.022*). The increase in strength of hand grip of both Results: There were significant differences in PL and GCM-L hands is significant in both examined group (p <0.01**) and muscle activities during the five functional exercises (p<0.05). the control group (p <0.05*) as well as the difference between During A-OLS, PL and GCM-L muscle activities significant- groups at the end of the treatment period (p <0.05*). ly higher than the other exercises (FL: p=0.005, RL: p=0.006, Patients in the examined group achieved improved results in PM-OLS: p=0.007, PL-OLS: p=0.008/ FL, RL, PM-OLS, PL- performing the “Standupandwalk” test by 2.38 sec (p <0.05*), OLS: p<0.001, respectively). The muscle activity of Gmed and in the control group by 0.88 sec (p > 0.05*) and the difference significantly lower in RL than the other exercises (FL: between the groups is statistically significant (p<0.05*). p=0.001, OLS: p<0.001). Among the OLS exercises, muscle Conclusion: The application of cooled-down peloid and wa- activity of Gmed was lowest in A-OLS. The muscle activity of ter of Banja Koviljača have a favorable effect in patients with ES-ipsi and ES-con significantly lower in FL and A-OLS than active RA on the decrease of paint intensity levels, decreasing the other exercises (PM-OLS and PL-OLS: p<0.001). the inflammatory process and improving the functional status Conclusion: We thought that the exercise for people with CAI of the affected joints. should have to increase of ankle muscle activation preferen- tially and at the same time, to lessen the activity of the muscles in the hips and trunk that compensate for unstable ankles. In P694 A-OLS, PL and GCM-L muscle activities were much higher CHANGE IN CAUSE OF MORTALITY IN FRAGILITY than other exercises, as well as Gmed, ES-ipsi, and ES-con FRACTURE PATIENTS OVER A FEW YEARS IN A muscle activities were lesser than the other OLS exercise. This MAJOR TRAUMA CENTRE study findings suggest that A-OLS may have an advantage E. L. Harrison1, S. Naraen2 over the other exercises in activating PL and GCM-L muscle 1University Hospital Aintree, Liverpool, United Kingdom, contributing ankle stability and in reducing other muscles ac- 2Orthogeriatrics, Liverpool, United Kingdom tivation of proximal part. Therefore, A-OLS would be an ef- fective method to activate ankle muscles in rehabilitation of Objectives: It is well recognised that fractured neck of femurs people with CAI. (NOFs) are often terminal events. This study compares 30 day Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S415 mortality for inpatients following hip fracture at a trauma centre circumstances. Smoking has been proved to be a risk factor to both national and pre-regular orthogeriatrician input. It looks for osteoporosis, while the molecular mechanisms underlying at causes of death and the impact regular orthogeriatrician re- is unknown. In this study, we aimed to identify susceptibility view had on this including length of stay (LOS). genes for osteoporosis through interaction analysis between Material and Methods: Data was collected from local hip smoking behavior and genetic factors. fracture and bereavement office databases for both LOS and Methods Using microarray gene expression data of circulat- mortality. Hip fracture ward LOS was collected for 2013 and ing B lymphocytes from 40 females (GSE13850), including 2015. Mortality data was collected for two periods; October 20 smokers and 20 non-smokers with low or high bone min- 2010-September 2011 and November 2014-December 2015, eral density (20 low vs. 20 high), we conducted a two-way which was then compared to national hip fracture database analysis of variance to screen candidate genes associated with figures. both BMD and smoking behavior. Functional pathway enrich- Results: In October 2010-September 2011, there were 24 ment analysis was applied to determine potential functional deaths from a total 343 fractured NOFs (7.00%; national aver- genes for osteoporosis, then followed by a validation at pop- age 8.0%1) with an average time until death of 10.66 days. In ulation levels employing gene-environmental interaction anal- November 2014-Oct 2015, there were 34 deaths from a total ysis, with genome-wide genotype and phenotype (hip or spine 480 fractured NOFs (7.01%; national average 7.5%2)withan BMD, smoking behavior) data from 1617 Caucasian adults average time of death of 8.24 days. There was also a statisti- (phs000390.v1.p1). cally significant difference in pre-morbid status; in the first Results We identified 441 genes significantly associated with study period the ASA grade was 2.81 compared to 2.95 (stu- interaction between BMD and smoking (FDR adjusted P- dents T-test 0.002). This was reflected in the AMTS; in October value <0.05). One functional pathway: Gap junction (includ- 2010-September 2011 it was 6.93 compared to 8.05 in ing 12 susceptibility genes), was exclusively significantly November 2014-October 2015. This was also statistically sig- enriched (BH adjusted P-value <0.05). Moreover, 3 genes nificant (<0.0001). Most deaths had medical origins with pneu- (ADCY9,EGFR,PRKG1) in Gap junction were validated to monia remaining the most common. When looking at LOS the be associated with interaction between hip (spine) BMD and mean in 2013 was 25 days compared to 20 days in 2015. smoking. These 3 genes all have close relationship with bone Conclusion: Mortality rates were below the national average in metabolism. both periods examined along with improved LOS. There was a Conclusions Here we discovered a new regulatory framework more widespread cause of death in 2015 reflecting patients connecting smoking and osteoporosis and demonstrated the having more complex co-morbidities, and also the regular ded- importance of gene-environmental interactions in disease eti- icated orthogeriatrician service, which provides daily reviews. ologies, which would offer new targets for osteoporosis relat- These in-depth reviews allow earlier recognition of any medical ed to smoking. problems, thereby minimising potentially avoidable causes of Acknowledgement: This work was supported by the death and helping to reduce LOS. The regular orthogeritrician National Natural Science Foundation of China (31471188, also provides a much valued link to rehabilitation services. 81573241) and Natural Science Basic Research Program References: Shaanxi Province (2016JQ3026). 1. Royal College of Physicians. National Hip Fracture Database annual report 2012 - Supplement. London: RCP 2. Royal College of Physicians. National Hip Fracture P696 Database annual report 2015. London: RCP, 20152011 SARCOPENIA AND OSTEOPOROSIS ARE NOT INDEPENDENT PREDICTIVE FACTORS OF HOSPITAL LENGTH OF STAY AND 6 MONTHS P695 MORTALITY RATE IN CRITICALLY ILL PATIENTS IDENTIFICATION OF SUSCEPTIBILITY GENES O. Malle1,K.Amrein1,H.P.Dimai2 FOR OSTEOPOROSIS THROUGH INTERACTION 1Department of Internal Medicine, Division of Endocrinology ANALYSIS BETWEEN SMOKING BEHAVIOR AND and Diabetology, Medical University of Graz, Graz, Austria, GENETIC FACTORS 2Department of Internal Medicine, Division of Endocrinology X.-F. Chen1,Y.-Y.Duan1,Y.Guo1 and Diabetology, Medical University of Graz, Graz, Austria 1Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Objective: Sarcopenia is a reliable marker of patient frailty Technology, Xi'an Jiaotong University, Xi'an, China that estimates the physiologic reserve of an individual pa- tient. We evaluated the impact of sarcopenia and volumet- Background Osteoporosis is influenced by the interaction ric BMD on both hospital length of stay and 6-months- between various genetic factors and environmental mortality rate in critically ill patients assessing clinical S416 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and morphometric data using abdominal CT scans includ- Material and Methods: Twenty-four rats were randomly di- ing total psoas area (TPA), psoas muscle density (PMD), vided into CSD and control (CON) groups. Rats were subject- skeletal muscle index (SMI) and bone mineral density ed to CSD by using the modified multiple platform method (BMD). (MMPM) to establish an animal model of CSD. Biochemical Materials and Methods: Based on the data from the parameters such as levels of serum N-terminal propeptide of VITdAL-ICU randomized clinical trial1) we retrospectively type I procollagen (PINP), N-terminal cross-linking reviewed abdominal unenhanced and contrast-enhanced CT telopeptide of type I collagen (NTX), growth hormone examinations performed for any indication of a total of 37 (GH), estradiol (E2), serum 25(OH)D, and calcium (Ca) were critically ill patients (18 women, 19 men) with a mean age evaluated at 0, 1, 2, and 3 months. After 3 months, each fourth of 59 years. CT scans were taken between 6 months before lumbar vertebra and the distal femoral metaphysis of the left and 3 days after intensive care unit (ICU) admission. Defining extremity of rats were harvested for micro-computed tomog- sarcopenia we used cut-off values for TPA (642,1 mm2/m2 in raphy scans and histological analysis, respectively, after the women and 784 mm2/m2 in men) and PMD (31.1 Hounsfield rats were sacrificed under an overdose of pentobarbital units (HU) in women and 33.3 HU in men), both measured at sodium. the level of L1, as well as for SMI (5.45 kg/m² in women and Results: Compared with rats from the CON group, rats from 7.26 kg/m² in men). Likely osteoporosis was defined by Th11 the CSD group showed significant decreases in bone mineral or L1 trabecular attenuation of ≤ 110 HU. TPA and PMD density (BMD), bone volume over total volume, trabecular could not be obtained in 11 patients, BMD in 1 patient. The bone thickness, and trabecular bone number and significant impact of these parameters on both hospital length of stay and increases in bone surface area over bone volume and trabecu- 6-months-mortality rate were analyzed. lar bone separations (P <0.05). Bone histomorphology studies Results: Mean adjusted TPA was lower in women vs. men showed that rats in the CSD group had decreased osteogene- (478 vs. 749 cm3/m) as well as PMD (34.6 vs. 41.3 HU), SMI sis, impaired mineralization of newly formed bones, and de- (6.2 vs. 7.7 kg/m²) and BMD (141.1 vs. 157.2 HU). Using teriorative trabecular bone in the secondary spongiosa zone. In defined cut-off values, 73% had sarcopenia assessed by TPA, addition, they showed significantly decreased levels of serum 24% when assessed by PMD, and 38% when assessed by PINP (1 month later) and NTX (3 months later) (P <0.05). The SMI. 28% had a trabecular attenuation value of ≤ 110 HU. serum 25(OH)D level of rats from the CSD group was lower No significant influence on hospital length of stay and on 6- than that of rats from the CON group after 1 month (P <0.05). months-mortality rate was detected, irrespective of the mor- Conclusions: CSD markedly affects bone health by decreas- phometric parameter used (TPA, PMD, SMI; BMD p>0.05). ing BMD and 25(OH)D, deteriorating the bone However, survivors showed better values than patients who microarchitecture, and decreasing bone formation and bone died within 6 months: TPA: 652 vs. 530 cm3/m; PMD: 38.4 resorption markers. vs. 37.4 HU; SMI: 7.03 vs. 6.96 kg/m²; BMD: 156 vs. 145.8 HU. Conclusion: These data suggest that the presence of P698 sarcopenia and likely osteoporosis assessed through CT scans FRACTURES SUSTAINED PRE- BUT NOT DURING is not an independent predictive factor of hospital length of OR POST-PUBERTY ARE ASSOCIATED WITH stay and 6-months-mortality rate in patients who are critically BONE PARAMETERS IN EARLY ADULTHOOD ill. A limitation of the current study was the relatively small Y. Yang 1,F.Wu1,K.Squibb1,B.Antony1,F.Pan1,T. number of patients included. Winzenberg1,G.Jones1 Reference: 1) Amrein K et al. JAMA 2014;312:1520 1Menzies Institute for Medical Research, Hobart, Australia Objectives: The long-term impact of fractures occurring in P697 childhood on bone development is unknown. This study EFFECTS OF CHRONIC SLEEP DEPRIVATION ON aimed to investigate the association between fractures oc- BONE MASS AND BONE METABOLISM IN RATS curred in different stages of puberty with bone parameters in L. Wang1,X.W.Xu1,Y.Zhang1,X.Y.Song1,L.Y.Chen1,T. early adulthood. J. Su1,T.T.Wang1,W.F.Ma1,F.Yang1,W.J.Zhai1,D.Li1, Material and Methods: We followed 201 young adults Q. Chen1,Y.Z.Ma1 (mean age (SD)=25.5 (0.7) years) from birth for 25 years. At 1Center of Orthopedics, the 309th Hospital of PLA, Beijing, age 8, 16 and 25, fractures were self-reported with X-ray con- China firmation and areal bone mineral density (aBMD) was mea- sured at the lumbar spine (LS), hip and total body (TB) by Objective: To assess the effects of chronic sleep deprivation Dual Energy X-ray Absorptiometry. Total, trabecular and cor- (CSD) on bone mass and bone metabolism in rats. tical volumetric bone density (Tt.vBMD, Tb.vBMD, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S417 Ct.vBMD) and microarchitecture indices (cortical thickness, parathyroid hormone(PTH) and 25(OH)VD were tested. The porosity and trabecular number, separation and thickness) BMD and serum biochemical levels were compared. were obtained by high-resolution peripheral quantitative Results: The incidence of osteoporosis and osteopenia in computerised tomography in radius and tibia at 25 years. study group was 25.7% and 48.6%respectively.The incidence Multivariable linear regression was used to analyse the asso- of osteoporosis and osteopenia in control group was 20% and ciations of the occurrence of pre-pubertal fractures (occurring 38.3%respectively.At all lumber sites, postmenopausal female before age 8 years) and pubertal and post-pubertal fractures kidney transplantation recipients had low BMD compared (between ages 8-25 years) with all bone parameters. with the premenopausal female kidney transplantation recipi- Results: During the 25 years, 101 people experienced at least ents (P<0.05). While in control groups, only the bone mineral one fracture. Twenty-four sustained their first fracture before density of L1 differed significantly between postmenopausal puberty and 77 in the pubertal/post-pubertal period. Pre- and premenopausal women who did not receive the kidney pubertal fracture was not associated with aBMD at age 8, transplant (P<0.05).Blood creatinine, urea nitrogen, uric acid but was inversely associated with LS aBMD (standardized and phosphorus significantly increased in the study group β=-0.56, 95%CI: -0.97, -0.14; -0.69, 95%CI: -1.11, -0.28 compared with control group (P <0.05).The rate of glomerular for 16 and 25 years respectively), hip (-0.48, -0.88, -0.07; - filtration decreased in the study group compared with control 0.61, -0.99, -0.22) and TB (-0.46, -0.86, -0.06; -0.58, -0.94, - group (P<0.05). There is significant difference in bone alka- 0.22) at age 16 and 25 after adjusting for confounders. At 25 line phosphatase(BAP), parathyroid hormone years, pre-pubertal fracture was significantly associated with (PTH),Osteocalcin(OC), 25(OH)VD and β-CTX between all vBMD measures, cortical porosity, trabecular number and study and control group(P <0.05). separation in the tibia (standardized β=-0.72 to 0.80), but only Conclusion: Compared with women who did not receive the associated with Tb.vBMD, trabecular number and separation kidney transplant, the bone mineral density of female kidney in the radius (standardized β=-0.56 to 0.71). Fractures occur- transplantation recipients is lower. Bone turnover markers ring later than pre-puberty were not associated with any bone should be monitored periodically to guide the osteoporosis parameters. treatment. Conclusions: Incident fractures in pre-puberty but not subse- quent to this are associated with poorer bone outcomes in later childhood and early adult life. Children who sustain such frac- P700 tures may be at risk of long-term poorer bone health and ben- FRACTURE RISK IN PATIENTS WITH TYPE 2 efit from interventions to improve this. DIABETES MELLITUS T. Karonova1, A. Andreeva1, V. Tikhomirova2,S. Gelmutdinov1,M.Budanova1,I.Beletskaya2, E. Vasilieva1, P699 E. Grineva1 CLINICAL ANALYSIS OF BONE MINERAL DENSITY 1Federal Almazov North-West Medical Research Centre, St. OF FEMALE KIDNEY TRANSPLANTATION Petersburg, Russian Federation, 2First St. Petersburg State RECIPIENTS Medical University, St. Petersburg, Russian Federation L. Wang1,X.M.Fu1, Y. Zhang1, X. Y. Song1,L.Y.Chen1,T. J. Su1,T.T.Wang1,W.F.Ma1, F. Yang1, W. J. Zhai1,C. Objective: Recent studies have suggested association be- Wang1,D.Li1, Q. Chen1,Y.Z.Ma1,Z.L.Li2 tween high fracture risk and type 2 diabetes mellitus even 1Center of Orthopedics, the 309th Hospital of PLA, Beijing, when BMD is normal. We examined type 2 diabetic patients China, 2Center of Organ Transplantation, The 309th Hospital and calculated 10-year probability of fracture using FRAX® of PLA, Beijing, China tool to assess subjects with high risk factor. Material and Methods: A total of 126 type 2 diabetic pa- Objective: To observe immunosuppressive therapy especially tients aged 40 to 79 years (mean 61,3±0,8), 35 males and glucocorticoid treatment effects on the skeleton in female kid- 91 females were examined. DXA (Lunar Prodigy, USA) was ney transplantation recipients,we selected and analyzed the performed in 56 subjects (50 females). Serum 25(OH)D and bone mineral density of them. iPTH levels was performed using lab kits for Abbott Architect Material and Methods: We chosen 70 cases of female kidney 8000, intra-assay CVs for 25(OH)D ranged from 1.60 to transplantation recipients–38 postmenopausal and 32 premen- 5.92% whereas the inter-assay CV ranged from 2.15 to opausal as study group, and 60 cases of women who did not 2.63%. HbA1c was determined by standard method. receive the kidney transplant 30 postmenopausal and 30 pre- Results: The study results showed that only 29 subjects had menopausal as control group. The bone mineral density BMD normal body mass index (BMI), while 97 subjects were over- was measured by dual energy X-ray absorptiometry.The height, weight or obese. All subjects had eGFR more than 45 ml/min/ weight, the serum biochemical, bone turnover marker, 1.73 m2. Mean HbA1c was 8,3±0,3% (from 5,9 to 11,2%). S418 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Duration of diabetes was 1-36 years with the mean value of inactive pituitary adenoma matched by age, sex and BMI were 12,9±1,2. Approximately 50% of diabetic subjects invited to participate. Bone samples were taken during received the insulin monotherapy or in combination with transsphenoidal adenomectomy from the base of the sella- antihyperglycemic drugs. Serum 25(OH)D level was between turcica, immediately placed in lysis buffer (QIAzol) and sub- 10,1 and 37,7 ng/ml (mean 18,5±3,8). We found negative jected to homogenization. 24h urine free cortisol (24hUFC) correlation between 25(OH)D and iPTH (r=-0,35, p=0,04). was measured by an immunochemiluminescence assay on a Only 10 subjects (8,3%) had normal vitamin D status (serum VitrosECi (60-413 nmol/24 h). Total RNA isolation from 25(OH)D level more than 30 ng/ml), 116 subjects (91,7%) bone tissue with on-column digestion of the genomic DNA were insufficient or deficient. These data were similar to the was carried out with miRNeasy Mini Kit on the automatic previous results we had seen in the general population of the station "QIAcube". Reverse transcription was carried out North-West region of Russia. We did not find association be- using a High-Capacity RNA-to-cDNA Kit. Gene expression tween 25(OH)D and HbA1c level. Thirteen patients had frac- analysis was performedby Real-Time PCR on StepOnePlus ture in their medical history. DXA results showed low BMD instrument with Custom TaqMan Array 48 Plus plates. in 15 (26,8%) diabetic patients. We found positive correlation Results: We enrolled 24 subjects (15 patients with CD and 9 between BMD in neck and BMI (r=0,55, p=0,0004) and neg- with hormonally inactive pituitary adenomas); 18 females and ative correlation between BMD and age (r=-0,47, p=0,001) in 6 males, the mean age was 41 years (confident interval (CI) diabetic patients. BMD in patients with or without fractures in 95% 36-46) mean BMI - 29 (CI95% 26–32) kg/m2. There their anamnesis was the same (p>0,05). We calculated 10-year were no significant difference between the groups. Mean probability of fractures using FRAX® tool and found that 24hUFC in subjects with CS – 1168 (CI95% 702–1634) major osteoporotic risk was from 2,1 to 16,0% (mean 6,5 nmol/24h. ±0,3) and hip fracture risk was from 0,1 to 4,0% (mean 0,6 Expression of osteoblast activity and bone formation genes ±0,1). Risk of fractures was associated with age (r=0,26, was decreased in patients with CD: ALPL 0,34 (CI95% p=0,002), diabetes duration (r=0,31, p=0,002) and BMI (r=- 0.24-0.43, p <0.001), BGLAP 0,41 (CI95% 0.28-0.54, p 0,24, p=0,008), and was not associated with HbA1c, <0.001), COL1A1 0,26 (CI95% 0.14-0.37, p <0.001), 25(OH)D or iPTH levels. COL1A2 0,51 (CI95% 0.33-0.69, p <0.001), MMP2 0,52 Conclusion: Our results showed that patients with sub- (CI95% 0.41-0.62, p <0.001). The expression of SOST 5,3 compensated diabetes mellitus type 2 and eGFR more than (CI95% 1,8-8,8, p <0.001), WNT10B 10,24 (CI95% 5,26- 45 ml/min/1.73 m2 have low serum 25(OH)D level and nor- 15,22, p <0.001), WNT3A 1,44 (CI95% 0,3-2,57, p=0.016), mal BMD in most cases. FRAX® tool using in these popula- CD40 3,5 (CI95% 3,13-3,91, p <0.001), BMP7 2,03 (CI95% tion could identify subjects with high fracture risk even with- 1,22-2,83, p <0.001) was increased in subjects with out DXA. Diabetes duration as well as age positively corre- hypercortisolism as compared to inactive pituitary adenoma. lated with risk of fractures. Conclusion: Hypercortisolism suppress genes expression re- lated to bone formation and these effects most likely realized through increased expression of SOST and Wnt signaling P701 pathway. EFFECTS OF ENDOGENOUS HYPERCORTISOLISM Disclosures: This study was supported by the Russian Science ON BONE TISSUE MRNA LEVELS RELEVANT TO Foundation (grant № 15-1530032). BONE METABOLISM T. A. Grebennikova1,Z.E.Belaya1,G.A.Melnichenko1,O.I. Brovkina2, A. G. Nikitin2,L.I.Astaf’eva3,A.Y.Grigor’ev1, P702 I. I. Dedov1 FATIH DISTRICT-GERIATRICS STUDY: MOOD AND 1Endocrinology Research Centre, Moscow, Russian COGNITION OF OLD PEOPLE WHO LIVE IN COM- Federation, 2Federal Research and Clinical Center FMBA, MUNITY Moscow, Russian Federation, 3N.N. Burdenko Neurosurgery P. K. Kucukdagli1, G. B. Bahat Ozturk2,M.A.Karan2,C.K. Institute, Moscow, Russian Federation Kilic2 Molecular basis of the glucocorticoid-induced osteoporosis is 1Istanbul University Istanbul Medical School Department of largely unknown. Internal Medicine Division of Geriatrics, Istanbul, Turkey Objective: To investigate gene expression profiles that regu- Aim: In this abstract, we aimed to investigate the mood and late bone metabolism in bone tissue samples from patients cognitive problems of old population living in Fatih/Istanbul with Cushing’s disease (CD). province. Materials and Methods: patients with clinically evident and Material and Method: Elder people who live in addresses biochemically proven active CD and patients with hormonally specified with cluster sampling method were included in the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S419 study. Third and fourth year students of İstanbul Medicine vertebral fractures; 136 (23%) had Colles fractures; and 75 Faculty worked as pollsters. Pollsters took standard training (13%) had a hip fracture. 106 patients (18%) are currently for related evaluations. Elder people whose ages between 65 on treatment. 491 (82%) are no longer on treatment with and 101 were included in the study. Cognitive condition scan- 367 (75%) having completed 18 months or more of treatment. ning was done with mini-cog test and depression scanning 122 patients (25%) stopped treatment before 18 months. Of was done with GDS-SF. Life quality measurement with EQ- these, the mean length of time on treatment was 195 days. 5D life quality survey, functional capacity evaluation with 6- Reasons for prematurely stopping included self-discontinued items KATZ Daily Life Activities Scale and 8-items 19 (16%), side effects 62 (51%), death from any cause 8 (7%), LAWTON-BRODY Instrumental Daily Life Activities Scale incidental cancer diagnosis 4 (3%), lost to follow up 8 (7%) were evaluated accordingly. Number of illness and drug, pres- and other 21 (17%). Most side effects experienced were mild ent dementia, hypertension, diabetes and hyperlipidemia diag- and included rash 4 (6%), palpitations 4 (6%), headaches 6 nosis were noted. (10%), fatigue 7 (11%), nausea 11 (18%), dizziness 12 (19%) Results and Discussion: This study includes 204 old cases and generalised/joint pain 29 (47%). However a small number (94 male,110 female). Average age: 75.4±7.3 year. Table 1 reported night sweats 1 (2%), UTI/kidney stones 3 (5%) and summarizes demographic, cognitive and mood, functuality weight loss 1 (2%). and life quality evaluation data and distribution between gen- Conclusions: In our study adherence and persistence with ders. While depression scanning positiveness is meaningfully TPTD was higher than that reported with oral antiresorptive high in women (22.6% vs. 4.3%; p <0.001), mini-cog scan- treatments. The major factor that reduced adherence and per- ning test and present dementia diagnosis are similar in both sistence was tolerability. These findings are important, as high genders. Life quality measurement was meaningfully low; adherence and persistence with therapy is necessary to ensure chronic disease and the number of drugs were higher. There an optimal therapeutic outcome. is no meaningful difference between two genders about age about basic GYA point, present HT, DM, HL diagnoses and subjective health status score. P704 Conclusion: Old people in society have significant levels of SHORT-TERM SMOKING CESSATION DECREASES cognitive dysfunction and depressive mood. Depressive SERUM SCL LEVELS AND THEREBY PROMOTES mood, low-life quality, multidisease and drug usage are more BONE FORMATION, CAUSING HUNGRY BONE and education level and functionality is less than men for SYNDROME women. R. Watanabe1,N.Tai1,J.Hirano1,Y.Ban1,R.Okazaki1,D. Inoue1 1Third Department of Medicine, Teikyo University Chiba P703 Medical Center, Ichihara, Japan ADHERENCE AND PERSISTENCE TO TERIPARATIDE TREATMENT Objective: Smoking increases fracture risk. We have re- G. Steen1,N.Maher1,N.Fallon1,A.Dillon1,J.Mahon1,J. ported that short-term smoking cessation results in re- Browne1, R. Lannon1, J. B. Walsh1, K. McCarroll1, M. Casey1 stored bone formation. However, the mechanism remains 1Bone Health and Osteoporosis Unit, Mercer's Institute for unclear. Successful Ageing, St James's Hospital, Dublin, Ireland Material and Methods: In this prospective study, we recruit- ed 29 Japanese male smokers (37.7±8.2 years old, 16.9±11.3 Objectives: Osteoporosis increases the risk of fracture and pack years). Bone and calcium (Ca)/phosphate (P) metabolic associated morbidity and mortality. Efficacy of anti- markers, inflammatory cytokines, and serum sclerostin (SCL) osteoporotic treatment is based on drug potency and adher- levels were measured 0, 1, 2 and 4 weeks after smoking ence and persistence. Teriparatide (TPTD) is the first anabolic cessation. agent developed for the treatment of osteoporosis and can Results: Two weeks after smoking cessation, Osteocalcin significantly reduce the incidence of vertebral fractures. We (OC) and P1NP were significantly increased (OC:15.0±5.0 aimed to evaluate adherence and persistence to TPTD treat- → 20.6±5.1 ng/ml (+44.7%, p<0.01), P1NP 44.0±15.5 → ment in patients with severe osteoporosis in a specialised 54.0±19.0 ng/ml (+26.4%, p<0.01)), whereas Tracp-5b was Bone Health Service. decreased from 322.8±110.9 to 282±82.7 mU/dL (-8.5%, Materials and Method: A cross-sectional and retrospective p<0.001). Serum Ca and P levels were also significantly longitudinal study was performed of all patients in our clinic decreased. Intact PTH (40.1±19.3 pg/mL) and 25(OH)D with severe osteoporosis treatedwithTPTDfrom2004to2016. (16.3±5.9 ng/mL) showed no correlation, and both signifi- Results: 597 patients commenced TPTD from 2004 to 2016: cantly increased after smoking cessation. 1,25(OH)2Dlevels 90% female, mean age 70 years (range 30-99); 225 (38%) had remained unchanged. Increase in P1NP and OC was already S420 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 recognized at one week without any appreciable changes in reappearing. In some less developed countries it hardly PTH. Decrease in P correlated with plasma cotinine concen- went away, though this study is small but it gives and tration at baseline (r=-0.493, p<0.01), FGF-23 also decreased prove that early supplementation from neonatal period on- as a result of P decline. Serum SCL was negatively correlated wards is going to benefit young children in preventing with OC (r=-0.493, p<0.01) at baseline, and significantly de- orthopedic, cardiac, renal and CNS ailments during growth creased at week 2 (23.7±13.3 → 20.1±10.6 pmol/L, -7.1%). period, as the importance of vid D, in various system phys- Changes in SCL and OC were more remarkable in those with iology is being postulated, further more elaborative studies higher IL-6 at baseline, and were not correlated with PTH may require to increase importance of vit D in various changes. early clinical presentation. Conclusion: Increased bone formation and decreased bone resorption after smoking cessation was followed by both PTH elevation and Ca decline, suggesting a hungry bone- P706 like phenomenon. And such bone metabolic changes, at least CROSS-CULTURAL ADAPTATION AND VALIDATION in the early phase, were not dependent on systemic hormones OF THE FILIPINO TRANSLATION OF THE KNEE but were more likely associated with diminished inflammation INJURY AND OSTEOARTHRITIS OUTCOME SCORE and resultant decrease in SCL. (KOOS) IN FILIPINOS WITH KNEE OSTEOARTHRI- TIS AT THE UNIVERSITY OF THE PHILIPPINES- PHILIPPINE GENERAL HOSPITAL (UP-PGH) P705 A. Villanueva-Misa1,E.Penserga1 GENU-VALGUM AND VIT D 1Philippine General Hospital, Manila, Philippines N. Gemawat1 1Hindustan Chamber Chikitsalaya, Mumbai, India Objectives: 1.) To cross-culturally adapt and validate the Filipino translation of KOOS in patients with knee osteoar- Genu Valgum commonly called "knock-knee", is a condi- thritis (kOA) at the UP PGH. tion in which the knees angle in and touch one another 2.) To validate the Filipino translation of KOOS with the when the legs are straightened. Individuals with Filipino Short Form 36 Health Survey (SF-36). severe valgus deformities are typically unable to touch Methods: Filipino version of the KOOS was cross-culturally their feet together while simultaneously straightening the adapted and validated from the English version following legs. This condition from the age of 6 months, children standard guidelines (Beaton, 2000). Patients were asked to with vitamin D deficiency often present with bony complete identical questionnaires containing the Filipino ver- deformity knock knees (genu valgum). The clinical presen- sion KOOS and Filipino SF 36, with re-test on the same pa- tation is common during 3-6 years group and gives a strong tients after a median of 14 days. Reliability was assessed using evidence of vit D deficiency. Vitamin D deficiency has Cronbach’s alpha and intraclass correlation coefficients (ICC), emerged as a significant public health problem throughout dimensionality using convergent and divergent construct the world. Even in the Indian context, it has been reported validity. tobepresentinmajorityofchildreninspiteofwideavail- Results: The Filipino translation of KOOS was adminis- ability of sunlight. During school health program it was teredto30patientswithkneeOA(kOA).Cronbach'sα foundtobeacommonfinding,andweherewithpresent across the Filipino KOOS domains ranged from 0.71 to our finding and its relation with vit D. 0.89 suggesting internal consistency. The reproducibility Total 25 (20%)children 4-6 year of age group of a primary of measurements of all KOOS subscales by ICC ranged school among 150 children were detected to have genu valum from 0.97 to 1.0. Convergent construct validity is shown deformity as clinical presentation of rickets, 10 cm of more of moderate correlations between KOOS ADL (0.38, p=0.03) distance between feet keeping both knee in contact, being and knee related QoL (0.42, p=0.02) by SF-36 Physical common, it was reconfirm with parental interview regarding Functioning (PF). Strong correlation (0.51, p=0.003) was absent of any vit D, supplementation. observed between KOOS sports and recreation domain All the children were put on therapeutic doses of oral vit D for with SF 36 PF. Divergent construct validity was shown in six months, and were reassessed about improvement accord- the weak correlation between KOOS pain (0.015, p=0.93) ing to distance between both feet, keeping their knee in same and symptoms (0.15, p=0.42) with SF 36 Social level of contact. Functioning. It was noted and observed that all children has shown, Conclusion: The Filipino version of KOOS is a valid and remarkable improvement in gait stability, running, scholas- reliable instrument to measure the different aspects of tic performance and parental perception of wellbeing of disability affecting quality of life of Filipino patients their children. Rickets, once thought vanquished, is with kOA. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S421 P707 Andrographis paniculata, exhibits several pharmacological THE INCIDENCE OF OSTEOPOROSIS IN ADULT effects including anti-inflammatory, anti-cancer, anti-asthmat- POPULATION OF KAZAKHSTAN ic, and neuro-protective properties. AP has been recently re- S. Issayeva1,D.Dilmanova1,B.Issayeva1, O. M. Lesnyak2 ported to be a promising natural compound for the treatment 1Asfendiyarov Kazakh National Medical University, Almaty, of osteoclast-related bone diseases. However, its osteogenic Kazakhstan, 2North-Western State Medical University named differentiation effect on MSCs is unknown. We aimed to ex- after I.I. Mechnikov, Saint-Petersburg, Russian Federation amine the proliferative and osteogenic effects of AP on human mesenchymal stem cells. Objective: Osteoporosis (OP) and associated fractures, due to Material and Methods: Human bone marrow-derived MSCs the high prevalence and the severity of the socio-economic was used to examine the proliferative and osteogenic effects of consequences represent a major public health problem. Our AP. MSCs were cultured in growth medium or in osteogenic aim was to study the incidence of diseases of the musculoskel- condition medium with/without AP in a concentration depen- etal system (DMSS), including the OP in the adult population dent manner at dose rang 0.1-10 μM. The proliferation of of the Republic of Kazakhstan from 2011 to 2015. MSCs was examined by growth kinetic assay. Osteoblast dif- Material and methods: Analysis of DMSS, including the OP, ferentiation and mineralization were determined by alkaline according to official statistics of the Ministry of healthcare of phosphatase (ALP) staining and Alizarin red staining assay, Kazakhstan, during the studied period. respectively. Real time PCR was employed to examine the Results: In 2015 with DMSS have 638248 people, they were effect of AP on the expression of osteoblast-specific genes dominated by women (63.3%). Persons 60 years and older including RUNX2, ALP and osteocalcin. made up 179120, of them women made up 68.8%. The in- Results: AP at 0.1-5 μM increased MSCs proliferation. At 7– crease rate in persons with DMSS compared with 2011 and 21 days, AP also accelerated osteogenic differentiation of amounted to about 75 thousand and 35 thousand, respectively. MSCs, as indicated by the increases in ALP activity and Patients with OP in 2015 was 1264, of which women is osteoblast-specific mRNA expression including RUNX2, 74.6%, and those 60 years and older - 410, including women ALP and osteocalcin. Subsequently, it promote osteoblast of 75.6%. The increase rate of OP during this period totaled function, as indicated by the increases in cacium deposition 111.37%, women – 134.58%. The diagnosis of OP was first in osteoblast cells. installed in 2015 in 418 people, of whom 69% were women, Conclusion: Andrographolide effectively promotes MSCs the increase rate in comparison with 2011 – 132.2% and proliferation and osteoblast function in vitro. It may have clin- 133%, respectively. One third of patients with OP were per- ical relevance for prevention or treatment bone disease as well sons 60 years and over, of which women prevailed (73.6%), as osteoporosis. the increase rate is 40.5% and 37.3%, respectively. Acknowledgment: This research project was funded by grant Thus, the prevalence of OP in Kazakhstan amounted to 72.05, from faculty of Medicine, Thammasat University. among women 104.04 (per 100 thousand) (2015). Conclusion: The incidence and the increase rate of OP in Kazakhstan demonstrates the importance of the problem. P709 PRIMARY HYPOPARATHYRODISM WITH CROHN’S DISEASE P708 M. Kimura1,M.Mituhasi1,K.Kobayashi1, S. Kawasima1,J. THE EFFECT OF ANDROGRAPHOLIDE ON OSTEO- Matui1, S. Ogawa1 GENIC DIFFERENTIATION OF HUMAN MESENCHY- 1Endocrinology and Metabolism, Department of Internal MAL STEM CELLS Medicine, Aomori, Japan D. Tantikanlayaporn1,N.Phunikom1,P.Kheolamai1 1Faculty of Medicine, Thammasat University, Khlong Luang, A case report of primary hypoparathyroidism with Crohn’s Pathum Thani, Thailand disease is reported being in difficulty on diagnosis. A 72- year-old women was admitted because of tetanic seizure with Objective: A decreased in osteogenic differentiation from hypocalcemia. She presented with 2 months of general mal- mesenchymal stem cells (MSCs) could at least partly account aise, and a month of severe myalgia. Her medical history is for the degenerative in musculoskeletal disorders like osteo- depression, and Crohn’s disease undergoing tube feeding be- porosis. Plant-derived compounds have been developed for cause of malabsorption syndrome after resection of the small the treatment of menopause-related disorders such as osteopo- bowel. Physical exams showed significant for positive rosis. Since estrogens enhance the risk for hormone-sensitive Trousseau and chvostek’s sign. Laboratory data revealed the cancers, searching for new alternatives is needed. existence of hypocalcemia, hypokalemia, and slightly elevat- Andrographolide (AP), a natural product isolated from ed intact PTH, showed Ca 6.2 mg/dl, Pi 3.7 mg/dl, intact-PTH S422 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 49 pg/ml, 25OHD 12 ng/ml,1-25OHD 23.8 pg/ml. There is no and exercise pool and land and therapies based on the use of evidence of hypomagnesia,1.9mg/dl. These data seemed un- electrical pulses. Evaluating the medical treatment, we found likely the existence of primary hypoparathyroidism and sug- that the average number of drugs was 7/patient (Fig 1). gested vitamin D deficiency. Ellsworth-Howard test showed Conclusion: Complex and multidisciplinary approach is increased excretion of cAMP in urine after PTH injection needed to treat osteoarthritis, and also a good therapeutic alli- compared with normal range of response, indicating primary ance with high level of patient adherence is essential for the hypoparathyroidism. (U4-U3=3.1 μmol/h, U4/U3=55.2, successful therapy to handle the highly individualized phar- cAMP level of U4:160000 pmol/ml). Because of chronic macological and nonpharmacological treatment in parallel. Vitamin D deficiency due to malabsorption syndrome, induc- Besides providing the availability of different therapies geo- ing Crohn’s disease and after resection of the small bowel), graphically and financially; great emphasis should be put on Primary hypoparathyroidism may be overlooked. The intact- the disease and culture specific factors affecting patient adher- PTH revel decreases after a half year, when the vitaminD3 ence in order to ensure the best therapeutic outcome. This (alfacalcidol) replacement therapy has been started. That sug- study is going to be the basis for our further study, to develop gested primary hypoparathyroidism. In the hypocalcemia due adherence questionnaire based on the Quality by Design to chronic Vitamin D deficiency, PTH level showed apparent- methodology. ly high in the primary hypoparathyroidism. This case gave attention to be diagnosed for hypoparathyroidism. P710 EVALUATION OF PATIENT ADHERENCE INFLUEN- CING FACTORS IN CASE OF HUNGARIAN OSTEO- ARTHRITIC PATIENTS OF THE SOUTH PLAIN REGION H. Fekete1,R.Fekete2,I.Csoka1 1University of Szeged, Faculty of Pharmacy, Szeged, Hungary, 2Muscoloskeletal Rehabilitation Centre of University Teaching Hospital, Kiskunfelegyhaza, Hungary Fig. 1. Factors influencing adherence of osteoarthritic patients Objective: Measurement of adherence’s determining factors in case of osteoarthritic patients in a Central European P711 Country, Hungary. In spite of the fact, that Hungary joined ECONOMIC IMPLICATIONS OF HIP FRACTURE IN the “Bone and Joint Decade” program among the first coun- THE MIGUEL SERVET UNIVERSITY HOSPITAL tries, and 17% of the population was counted suffering from DURING 2014 arthritic disease (European Health Interview Survey, 2014); a A. Martín Martínez1, J. López2, M. Campoamor Gonzalez2, large population based survey is not available up to date. This V. Ga rc ía Ca lv o 2, C. Martínez Aznar2, C. Martín Hernández1, indicates the necessity of the survey. J. A. Camacho Chacón2 Methods: A retrospective data gathering was made according 1Orthopaedic Surgery and Traumatology Unit. Hospital to the ethical standards, based on final reports in case of 400 Universitario Miguel Servet, Zaragoza, Spain, 2Department patients; diagnosed and treated with hip and/or knee arthrosis of Orthopaedic Surgery. H. U. Miguel Servet, Zaragoza, Spain within the period of 2007-2013. The WHO dimensions of adherence to long-term therapies were used for structuring Objectives: To determine the incidence of hip fracture in a and to evaluate points, where interventions should be made. southern European city and set it is burden (associated direct Results: Most of the patients were women (69%), the average economic costs) during 2014. age was ~72 year, within the range of 50-90 years. Urban and Methods: Data were collected from medical records of all country-side citizens were represented as well. Overweight patients admitted in our Hospital due to new low-energy trau- and obesity was found in 78,48% of the cases, determined ma hip fracture, during the period from January 1 to December by BMI index. Most frequent co-morbidities: other musculo- 31, 2014. Exclusion criteria were high-energy trauma, primary skeletal (94,75%), cardio-vascular (76,5%), gastro- bone diseases and bone metastatic disease. Re-admissions for oesophageal and diabetes mellitus (36,25%) and neurological the same fracture were excluded when calculating the inci- disorders (26%). The non-pharmacological therapies were dence, The estimated costs included ambulance transportation used in conformity with national therapeutic guidelines, most and continuous hospitalisation immediately after the hip frac- frequently used ones were: targeted massage, aerobic activity ture, which are covered by the Aragon healthcare system. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S423 Results: 610 patients supporting osteoporotic hip fracture Conclusions: The comorbidity of COPD patients, which in- (452 female 158, male), incidence was 119 new cases per cludes osteoporotic fractures and cardiovascular risk is actu- 100.000 population - year. 78% occurred in subjects older ally very important. than 75 years, and the peak number of fractures occurred in individuals above 80-years of age. 70% patients suffering hip fractures were women. The global economic burden was P713 2.868.882 €, as a result of the sum of hospitalisations FALSELY INCREASED LUMBAR BONE MINERAL (2.424.864 €), implants Cost (411.642 €) and ambulance DENSITY DUE TO ECHINOCOCCAL CYST transportations (26.376 €). M. Cokolic1,U.Ksela1, A. Zavratnik1 Conclusions: Hip fracture incidence in our health area is sim- 1Dept. of Endocrinology and Diabetology, University Medical ilar than the national rate, this data will help to assess the Centre, Maribor, Slovenia, Maribor, Slovenia importance of interventions in order to reduce the number of fractures and associated costs. Objective: An 81-year old female with known osteoporosis was reassessed for bone mineral density (BMD) measure- ment. Her baseline BMD and lumbar spine T-score (L1- P712 L4) in 2004 were 0.699 g/cm2, -3.5 SD, total left hip T- THE 10-YEAR RISK OF OSTEOPOROTIC FRAC- score was 0.618 g/cm2, -2.7 SD. For a decade, she was TURES BY MEANS OF FRAX PROGRAM AND treated with alendronate 70 mg, cholecalciferol 7000 IE CARDIOVASCULAR RISK BY MEANS OF SCORE per week, and calcium supplements. Over the last two SCALE IN PATIENTS WITH CHRONIC OBSTRUC- years, she was prescribed denosumab 60 mg as well as TIVE PULMONARY DISEASE CaandvitaminD. E. Kochetova1 Material and Methods: Recent DXA check-ups with the 1Petrozavodsk State University, Petrozavodsk, Russian Hologic Explorer device showed abnormal BMD elevation Federation in L1-L2. A strong increase (17.4%) in BMD was noted when comparing the 2016 and 2017 DXA measurements in Objective: The purpose of this study was to investigate the L1-L2; however, L3-L4 appears to be stable (5.5%). risk of osteoporotic fractures by means of FRAX program Compared to baseline DXA measurements in 2004 the and the cardiovascular risk by means of the SCORE scale BMD increased by 39.8% in L1-L2 and by 7.6% in L3- in patients with chronic obstructive pulmonary disease L4. Over the last 13 years, the BMD increased in total by (COPD). 55.8% (uncorrected). Lumbar spine T-score (L1-L4) in Materials and Methods: The investigated group was made 2017 was 1.046 g/cm2, 0.0 SD and increased by 19.3% by the patients having the long experience of smoking. (due to correction and L1 compression); lumbar spine T- 212 patients with chronic obstructive pulmonary disease score (L1-L4) measured in 2017 was 0.800 g/cm2, -2.2 SD (COPD) were observed. Research of bone mineral density and increased by 4.0% in the hip; total left hip T -score was (BMD) was studied with the densitometer « Lunar DPX- 0.665 g/cm2, -2.3 SD – considering the 10-year high frac- NT». The risk of osteoporotic fractures was calculated by ture risk (major osteoporotic fracture 19%, hip fracture means of the computer program FRAX. The assessment 9,2%). CT scans revealed a descending Echinococcal cyst of cardiovascular risk was calculated by means the due to kyphoscoliosis overlapping vertebras L1+2. During SCORE scale. The comorbidity index Charlson was this time, the patient's height was decreased by 8 cm; how- noted. ever, a decreased in height by 14 cm was noted since her Results: The absolute risk of major osteoporotic fractures youth. was minimal in patients with COPD 2 stage 4.9 (3-5.8). Conclusions: Several medical conditions, such as osteo- The maximum risk of major fractures was in the COPD 4 phyte formation, osteoarthritis, ankylosing spondylitis, stage 7.4 (5.4 -9.6). The risk of hip fracture was signifi- vertebral fractions, and aortic calcifications can increase cantly increased with the deterioration of the stage of BMD. The study showed that calcium carbonate pills po- COPD. The very high cardiovascular risk was prevailed sitioned lateral to the spine can change the BMD. To our in the overall group of COPD patients (68.9%). The high knowledge, this was the first case of falsely increased lum- cardiovascular risk was noted in 18.3% patients, the mid- bar spine BMD due to a calcified Echinococcal cyst. The dle cardiovascular risk was in 12.8%. The correlation co- interpretation of DXA measurements requires full attention efficient between cardiovascular risk and index of comor- of the examiner, who should clarify suspected cases in bidity Charlson was 0.71, p <0.005. The correlation coef- order to avoid false results. Measurements should be car- ficient between risk of hip fracture and index of comorbid- ried out in a technically correct manner with the exclusion ity Charlson was 0.3, p <0.05. of suspicious elements in the ROI. S424 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P714 P715 FORECASTING INCIDENT RADIOGRAPHIC KNEE IMUNE –ENDOCRINE MODULATION OF BONE’S OSTEOARTHRITIS FOR WOMEN: THE METABOLISM RELEVANCE OF HIP MORPHOLOGY AND BONE S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, MINERAL DENSITY D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 C. Garriga1, M. T. Sanchez-Santos1,2,A.Judge1,3,K.Javaid1, 1Faculty of Dentistry, University of Medicine and Pharmacy, M. K. Javaid3, K. M. Leyland1,2, D. Prieto-Alhambra1,D. Craiova, Romania, 2Department of Endocrinology, University Hart4, T. Spector4,C.Cooper1,3, N. K. Arden1,2 of Medicine and Pharmacy, Craiova, Romania, 3Department 1Musculoskeletal Epidemiology, Botnar Research Centre, of Obstetrics and Gynecology, Queen Mary Hospital, Nuffield Department of Orthopaedics, Rheumatology and Craiova, Romania, 4Department of Orthopaedic and Musculoskeletal Sciences, University of Oxford, Oxford, Traumatology CF2, Bucuresti, Romania, 5Department of United Kingdom, 2Arthritis Research UK Centre for Sport, Radiology, University of Medicine and Pharmacy, Craiova, Exercise and Osteoarthritis. Nuffield Department of Romania, 6Endocrinology Department, Philanthropy Orthopaedics, Rheumatology and Musculoskeletal Sciences, Hospital, Craiova, Romania University of Oxford, Oxford, United Kingdom, 3MRC Lifecourse Epidemiology Unit, University of Southampton, Introduction: The similarity between Ig and hormone can Southampton General Hospital, Southampton, United extend on the functional structures: hormones include attach- Kingdom, 4Department of Twin Research and Genetic ment part as Ig, but also function’s print regions, such as Epidemiology, King's College London, London, United fragments of Ig and Fc. It is assessed that the physiological Kingdom role of sexual hormones on immune system activity is to con- tribute to achieve an appropriate stability regarding immune Objective: To develop and internally validate a clinical risk complexes. This balance is dynamic and results from antago- model to predict incident radiographic knee osteoarthritis nistic actions stability between male and female sexual (RKOA) in a population-based cohort of middle aged women. hormones. Methods: We followed-up 649 women (1,662 knees) with x- Objectives: To identify cases with hypogonadal osteoporosis, ray at baseline (year 1) and year 5 using community based evaluation of BMD, assessment hormones on gonadotropin cohort of women in London, UK, 1988-1994. The outcome axis and immunological markers of bone turnover. was incident RKOA defined as Kellgren and Lawrence (K/L) Method: The study were effectuated on 24 cases with grade 0-1 at baseline and ≥2 at year 5. Bootstrap backward hypogonadotropic and hypergonadotropic hypogonadism logistic regression analysis identified predictors of incident with ages 13 to 40,from which Turner syndrome with femi- RKOA. Two models were generated: 1.a clinical model in- nine phenotype (8), Klinefelter syndrome (5),syndrome of cluded patient measures, medication, wet biomarkers and pauper ovaries(8) hypothalamic amenorrhea (3 cases).At all knee symptoms; and 2.a model adding radiological variables. cases BMD was appreciated by dual absorptiometry with X Models performance was assessed by calibration and rays and gonadotropic hormones study were assessed in the discrimination. same time with immunological markers and bone turnover Results: Univariable analysis found 33 of 105 factors associ- evaluation. ated with incident RKOA (p<0.20). The clinical model iden- Results: At 11 cases osteoporosis was confirmed and tified age, quadriceps circumference and cartilage degradation osteopenia at 9 cases, the remnants patients (4) had BMD, markers (serum cross linked C-telopeptide of type II collagen) biochemical, and immunological markers in normal values. as predictors. After including radiological variables (radiolog- Conclusions: Estrogen stimulates the production of immuno- ical model), the predictors of outcome were older age, higher globulin and the conversion IgM → IgG by increasing the quadriceps circumference, knee pain, knee baseline K/L grade number of “autoreactive" B cells and the control part of the 1 (vs. grade 0), higher hip α-angle, higher z-score bone min- expression phenotypic of IgM (through the X chromosome). eral density (BMD) at the spine L1-L4, and contralateral Progesterone has the tendency to "suppress" immune reactiv- RKOA at baseline. Calibration statistics showed high level ity, having anti-estrogenic effects. May decrease T-cell prolif- of agreement. The area under the curve (AUC) for the clinical eration in vitro, but increase the number of CD 8 cells without model was 0.692, reaching 0.797 in the radiological model. disturbing nonresponder functions. Androgens have immuno- Conclusions: We have developed and internally validated two suppressive effects, as decreases the production of immuno- models predicting incident osteoarthritis in short term (4 years). globulin by reducing the stimulation of B cells and immune The most powerful prediction is related to radiological vari- complexes. Cytokines affect the metabolism of bone cells ables including hip morphology and BMD as important predic- Interleukin-1, was the first "immune" cytokine identified as tors. This points to a RKOA origin beyond the knee area and the following actions on bone metabolism: enables bone cells are potentially useful for clinical and epidemiological studies. replication, stimulates the bone resorption and attach the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S425 resorption to bone formation, stimulates the collagen synthesis low-risk subjects. In particular, the time needed to complete and increases the IL-6 synthesis involved in resorption. How the five times sit to stand test increased while the capacity of IL-1 stimulates IL-6 production by osteoblastic and marrow adaptation to a random perturbation decreased in subjects with stoma cells, it is possible that the interaction of these cytokines high risk of fall compared to medium or low-risk subjects. to be implicated not only in pathological bone resorption, but Conclusions: The findings of our ongoing study suggest that also in normal bone remodeling. hunova robotic measures are specific and sensitive to identify balance impairments and estimate fall risk in older subjects. P716 FALL RISK ASSESSMENT IN ELDERLY PEOPLE P717 USING HUNOVA, A ROBOTIC REHABILITATION DIFFERENTIATED THERATEUTIC APPROACH IN DEVICE HYPOGONADAL OSTEOPOROSIS V. Sq ueri 1,A.Cella2, J. Saglia1,A.Giusti2,C.Prete2,F. S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, Vallone2, B. Senesi2, E. Zigoura2, E. Tavella2, L. Ciaccia1, D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 M. Avella2, V. Garofalo2, P. Aguzzoli2, C. Sanfilippo1,A. 1Faculty of Dentistry, University of Medicine and Pharmacy, Pilotto2 Craiova, Romania, 2Department of Endocrinology, University 1Rehab Technologies, Fondazione Istituto Italiano di of Medicine and Pharmacy, Craiova, Romania, 3Department Tecnologia, Genova, Italy, 2Geriatric Care, Orthogeriatric of Obstetrics and Gynecology, Queen Mary Hospital, and Rehabilitation Department, E.O. Galliera Hospital, Craiova, Romania, 4Department of Orthopaedic and Genova, Italy Traumatology CF2, Bucuresti, Romania, 5Department of Radiology, University of Medicine and Pharmacy, Craiova, Objective: To introduce an automatic, robotic assisted sensi- Romania, 6Endocrinology Department, Philanthropy tive quantification of balance impairments and fall risk using a Hospital, Craiova, Romania new robotic system (hunova). Patients and Methods: This is an observational trial that There are many therapeutic options in osteoporosis induced foresees the enrolment of 99 subjects, aged >65 years. by gonadal failure (ovarian or testicular), and the suitable ther- According to the number of falls and/or fractures in the last apy approach should be based on the following principles: 12 months, each participant is allocated to one of the follow- efficiency, comorbidity, extraskeletal effects, cost-benefit ing groups: low (no falls), medium (1-2 falls) and high (> 2 correlation. falls or 1 fall + 1 fragility fracture) risk of fall. All participants Objectives: For cases with late puberty-hypergonadotropic undergo a Comprehensive Geriatric Assessment (CGA) to hypogonadism(gonadal dysgenesis) and hypogonadotropic calculate the Multidimensional Prognostic Index (MPI). hypogonadism - the major objectives of hypogonadal osteo- Moreover, Tinetti Test, Time Up and Go, Walking Speed, porosis prevention were: to insure the sexualisation develop- Short Physical Performance Battery, Hand Grip, the FRAIL ment process, to maintain the stability of bone mass during scale, femoral neck and total hip bone mineral density (DXA), ontogeny, to control the factors that induce osteoporosis and body composition (DXA), and blood tests have been per- its consequences (osteoporotic fractures). For cases with syn- formed. The instrumental assessment session includes auto- drome of pauper ovaries have focused on: assessment of pa- matic measurements using hunova, a new robotic device de- tients with increased risk of osteoporosis, exclude secondary signed to assist the sensorimotor rehabilitation process and the causes of osteoporosis, the selection of appropriate treatment. functional evaluation of lower limbs and trunk. hunova allows Materials and Methods: Casework included in our study is the evaluation of traditional stabilometric parameters as well represented by 57 patients, from which late puberty (26 cases) as the implementation of different dynamic environments that and syndrome of pauper ovaries (31 cases). Investigations stimulate postural responses. The examinations are performed target were to evaluate the bone mineral density with X-ray on the robotic platform both in bipodalic standing and seated absorptiometry (BMD) and the assessment of biochemical position. markers of bone turnover (osteocalcin, CrossLaps). The treat- Results: At present, a total of 36 older subjects (mean age: ment options are available for patients with late puberty and 77.6±6.6 years, 17 males) were enrolled in the study. Twenty for cases with syndrome of pauper ovaries: non- two patients reported no falls in the last 12 months (76.1±5.8 pharmacological approach and therapeutic intervention with years), 7 participants had a medium risk of fall (77.5±7.0 pharmacological agents in correlation with the pathogenetic years) and the remaining 7 participants were included in the mechanism of hypogonadal osteoporosis. Estrogen- high risk group (82.7±6.9 years). Preliminary results of the progestogen substitution is the first therapeutic approach in robotic tests demonstrated a poorer performance in the dy- syndrome of pauper ovaries to prevent osteoporosis, metabol- namic tests in the high risk group compared to medium- and ic and visceral complications. For cases with late puberty the S426 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 therapeutic solution associate the estrogen-progestogen/ an- normal: 0.4-1 mg/dl), creatinine clearance of 42.6 ml/min drogen substitution with antiresorptive medication (Cockcroft). Given the presence of chronic kidney disease, (bisphosphonates) or proformatoare. bisphosphonate treatment was withheld and the patient was Results: In our study, we observed a decrease of the Tscore up referred to a nephrologist for further evaluation. Strontium to 14-16% after 6 months of treatment with bisphosphonates ranelate and raloxifene were contraindicated due to high risk at patients with syndrome of pauper ovaries. At other cases of thrombosis. Hyperparathyroidism and vitamin D deficien- with Turner syndrome (4) and syndrome of pauper ovaries (7) cy excluded teriparatide treatment. Denosumab could be a treated by us for 3 months with bisphosphonates in doses of therapeutic option, but only after adequate vitamin D and 35 mg / week, we noticed a reduction of CrossLaps serum up calcium status is achieved. The patient was prescribed vita- to 38.5% and osteocalcin up to 41.3% compared to basal level. min D supplements to achieve 25-OH D level of 30 ng/ml, Conclusions: Regular assessment of biochemical markers of with careful monitoring of calcium, phosphorus and PTH bone turnover (osteocalcin, CrossLaps) and bone mineral den- levels. sity (BMD) gives useful information about the effectiveness Conclusions: Osteoporosis-related fractures are a major cause of therapy. of morbidity and mortality in the elderly population. Due to high prevalence of co-morbid conditions that often pose a barrier to specific treatment, it is essential to balance the risks P718 and benefits and adjust treatment according to individual fac- CHALLENGES OF OSTEOPOROSIS MANAGEMENT tors so as to improve bone health and quality of life. IN THE ELDERLY: CASE REPORT A. Morar1, F. Tomesc2,M.Carsote3, A. Valea4 1Clinical Hospital of Infectious Diseases, Cluj-Napoca, P719 Romania, 2Clinical Center of Diabetes, Nutrition and BONE’S MINERAL DENSITY IN TURNER SYNDROME Metabolic Diseases, Cluj-Napoca, Romania, 3University of S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, Medicine and Pharmacy “Carol Davila”, National Institute D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 of Endocrinology “C.I. Parhon”, Bucharest, Romania, 1Faculty of Dentistry, University of Medicine and Pharmacy, 4University of Medicine and Pharmacy "Iuliu Hatieganu", Craiova, Romania, 2Department of Endocrinology, University Clinical County Hospital, Cluj-Napoca, Romania of Medicine and Pharmacy, Craiova, Romania, 3Department of Obstetrics and Gynecology, Queen Mary Hospital, Objective: Osteoporosis is highly prevalent in the elderly Craiova, Romania, 4Department of Orthopaedic and population and disease management presents certain particu- Traumatology CF2, Bucuresti, Romania, 5Department of larities that require a multidisciplinary approach. We describe Radiology, University of Medicine and Pharmacy, Craiova, the challenges of osteoporosis treatment in an elderly patient Romania, 6Endocrinology Department, Philanthropy with multiple chronic medical conditions. Hospital, Craiova, Romania Material and Methods: We report the case of an 80 year-old female diagnosed with osteoporosis, vitamin D deficiency and Objectives: Identification and confirmation cases with Turner secondary hyperparathyroidism. Bone profile evaluation in- syndrome, evaluation of BMD and hormone markers. cluded: dual energy X-ray absorptiometry (DXA), spinal ra- Method: The study was performed on 10 patients with diography, parathyroid hormone (PTH) and serum 25- Turner syndrome with female phenotype. Cytogenetic inves- hydroxyvitamin D (25-OH D). tigation (sexual chromatin, karyotype, chromosomal Results: An 80 year-old female presenting with multinodular banding) confirmed the diagnosis of Turner syndrome. The goiter, type 2 diabetes and obesity was evaluated for asthenia, hormonic explorations were focused on the study of: FSH, fatigue and diffuse joint pain. The patient also suffered from LH, estradiol, progesterone. Bone mineral density was eval- moderate to severe hypertension and ischemic and hyperten- uated by dual X-ray absorptiometry (BMD).The scan was sive cardiomyopathy. Thyroid function tests were normal. made at the radius, hip and lumbar spine in anterior- Evaluation of calcium metabolism showed high PTH (165.3 posterior incidence. It is estimated that the bone mass mea- pg/ml, normal: 15-88 pg/ml), normal serum calcium (9.86 surements at spine and hip are suitable for fracture predict- mg/dl, normal: 8.9-10.3 mg/dl) and ionized calcium (4.37 ability than those at the peripheral skeleton. The result is mg/dl, normal: 4-5.4 mg/dl). Low 25-OH D levels (of 13.7 expressed as bone mineral density (BMD) in g / cm ²,T and ng/ml) suggested secondary hyperparathyroidism. DXA scan Z scores. Osteoporosis and osteopenia diagnosis is revealed low BMD of 0,862 g/cm3 and T score of -2.8 SD established according to recommended rules by OMS, based (total spine), T score -1.9 SD (femoral neck). FRAX predicted on the value of T score. Due to the heterogeneity of patients a 5% risk of major osteoporotic fracture and 1.6% risk of hip age with Turner syndrome, we evaluated Z score to appreci- fracture. Laboratory tests showed high creatinine (1.83 mg/dl, ate BMD and removed the age factor. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S427 Results: The hormonic investigations revealed insignificant took antiosteoporotic medications and 37% - took calcium values of feminine hormone (estradiol, progesterone) and the supplements and vitamin D only. Patients with vertebrae frac- hypothalamic-pituitary debaclu (very high LH and FSH).Is ture took osteoporosis medication significantly more often unanimously accepted that Turner syndrome, severe shortage than persons with any other type of OP fracture. Only 20% estroprogesteronic by anovarie early puberty is becoming ev- of women were persistent to antiosteoporotic treatment during ident at puberty age by the absence of puberty sexualization, observational period. We found a strong negative correlation when the body does not receive the processing defining sexoid between the severity of symptoms of depression, assessed by sexualization. Through bone densitometry, osteoporosis was HADS questionnaire, and adherence to antiosteoporotic treat- confirmed at 7 cases and 3 cases with osteopenia. Z score ment: r=-0.78, -0.92 and -0.78 (р<0,05) in 12, 24 and 36 values ranged from -1.73 DS - DS 4.44. months, respectively. Conclusions: Conclusion: OP fractures for a long time worsened the QOL 1. Appreciate that concurrent evaluation of BMD and hor- and caused psycho-emotional disturbances, which negatively mone markers at patients with Turner syndrome, provide use- influenced the adherence of patients to antiosteoporotic ful information on bone remodeling process. therapy. 2. To prevent fragility fractures, hormone replacement therapy is necessary associated with the proformation medication. P721 THE EFFICIENCY OF THERAPEUTIC MEANS IN P720 OSTEOPOROSIS INDUCED BY GONADAL HORMONES QUALITY OF LIFE AND PSYCHO-EMOTIONAL S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, STATUS IN POSTMENOPAUSAL WOMEN WITH D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 OSTEOPOROTIC FRACTURES 1Faculty of Dentistry, University of Medicine and Pharmacy, N. V. Toroptsova1,O.V.Dobrovolskaya1 Craiova, Romania, 2Department of Endocrinology, University 1Nasonova Research Institute of Rheumatology, Moscow, of Medicine and Pharmacy, Craiova, Romania, 3Department Russian Federation of Obstetrics and Gynecology, Queen Mary Hospital, Craiova, Romania, 4Department of Orthopaedic and Objective: To assess the quality of life (QOL), psycho- Traumatology CF2, Bucuresti, Romania, 5Department of emotional status and treatment persistence in postmenopausal Radiology, University of Medicine and Pharmacy, Craiova, women with osteoporotic (OP) fractures during a 3-year pro- Romania, 6Endocrinology Department, Philanthropy spective study. Hospital, Craiova, Romania Subjects and methods: Main group - 196 women (mean age 66±9 years) after OP fractures of five sites (proximal femur, In modern therapy of hypogonadal osteoporosis are discussed distal forearm, neck of humerus, vertebrae and ankle) and two distinct aspects: prevention of osteoporosis and the treat- control group – 60 women (mean age 65±9 years) who had ment of osteoporosis. no history of fractures. Assessment of QOL was conducted Objectives: The major aims of osteoporosis prevention in- using a questionnaire EuroQOL-5D (EQ-5D) and psycho- duced by gonadal failure (ovarian or testicular) are: to insure emotional status - questionnaire HADS. Treatment adherence the sexualisation development process, to maintain the stabil- was estimated by patient diary in 12, 24 and 36 months after ity of bone mass during ontogenesis; to decrease the incidence the fracture occurred. of osteoporotic fractures. Results: Retrospective value of QOL using EQ-5D before Material And Methods: In the study were included 43 fracture in women of main group was the same as among hypogonadal cases from which: late puberty 19 cases aged control group: 0.73±0.23 and 0.71±0.18, respectively between 12 -25 years, gonadal dysgenesis 11cases(8 female (p>0,05). Significant deterioration of QOL was observed in phenotype with Turner syndrome, syndrome Klinefelter- 3), 100% of women after osteoporotic fracture, and psycho- hypogonadotropic hypogonadism 8 cases (pituitary dwarfism emotional disturbances on a scale HADS was diagnosed in with sexual infantilism -2, 6 cases of genital syndrome 79% of patients. Recovery of integral value of EQ-5D up to 12 adiposo - female 2 male 4) and syndrome of pauper ovaries month was identified in patients with fracture of distal forearm 24 cases aged between 20-33 years. Paraclinical investiga- or ankle, up to 18 - with fracture of neck of humerus or ver- tions palette were pointed on: LH, FSH, estradiol, testoster- tebrae, up to 24 - with fracture of proximal femur. However, one, progesterone, TSH, FT4, IGF-1, cortisol, prolactin, the domains "personal care" in patients with hip fractures and BMD was evaluated by dual absorptiometry with X rays "anxiety / depression" in patients with vertebral fractures has and the markers study of bone turnover. The administration not recovered even to 36th month. Antiosteoporotic treatment of curative treatment aims to: increase or at least stabilize the during the first year was started in 62% cases: 25% of patients bone mass, ensure bone quantity and quality ; prevent S428 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 fractures, therapy of complication fractures, maintain an opti- Results: Serum calcium presented low values in 14 patients (9 mum physical condition. patients with natural and 5 with surgical menopause), normal Results: Requires curative therapy: values at 80 patients (63 with natural and 17 with surgical - Patients with sexoid osteopenia and T score below -1.5 DS; menopause) and elevated values to 3 patients, all with natural - Patients with sexoid osteopenia associated with fragility menopause. Serum magnesium presented low values on 13 fractures; patients (8 patients with natural and 5 with surgical meno- - Hypogonadal patients with T score below -2.5 SD. pause), the normal values at 81 patients (64 with natural and Currently are available many therapeutic agents that can stop 17 with surgical menopause) and elevated to 3 patients, all or slow down the loss of bone mass, reduce bone remodeling with natural menopause. rate and decrease the risk of fracture. Conclusions: The majority of patients presented normal Modern osteoporosis therapy, split pharmacologic agents into values of serum calcium and magnesium. In all patients with two main classes: hypocalcemia has been determined the levels of serum PTH - Antiresorptive agents (inhibitors of bone resorption) and vitamin D. To all were noted a correlation between them - Proforma agents (stimulators of bone formation). and was diagnosed with hypoparathyroidism after thyroidec- The ideal therapy should work on all forms of osteoporosis, tomy. At 3 patients with hypercalcemia, serum PTH and vita- not only on the cortical bone but also on the trabecular with a min D was elevated due hyperparathyroidism. Evaluation of high compliance and tolerability and benefit / cost favorable renal function in 2 of these patients showed some deficiency, correlation. may explain the mood of hypercalcemia. The percentage of Conclusions: In today's modern medicine, osteoporosis pre- 82.47% of our study with normal levels of serum calcium vention aims to remove the risk of the first fracture, so the confirm the most studies assert that, in general, in postmeno- same drugs can be used for both: prevention and treatment pausal osteoporosis, calcium level in serum is normal. In our of osteoporosis. The therapy in hypogonadal osteoporosis is study, hypocalcemia is due by accidental damage of parathy- followed by: periodic evaluation (6-12 months)of BMD and roid during thyroidectomy. Recent studies have identified biochemical markers of bone turnover. magnesium as an important factor in bone metabolism, correcting its deficit representing a very easy means of pre- vention of osteoporosis. Moreover, in recent years, it has for- P722 mulated the idea that assessment of serum magnesium can STUDY OF BONE MINERAL METABOLISM IN help to identify patients with high risk of developing POSTMENOPAUSAL OSTEOPOROSIS osteoporosis. S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 1Faculty of Dentistry, University of Medicine and Pharmacy, P723 Craiova, Romania, 2Department of Endocrinology, University STATUS OF 25 (OH) VITAMIN D IN UZBEK POST- of Medicine and Pharmacy, Craiova, Romania, 3Department MENOPAUSAL WOMEN of Obstetrics and Gynecology, Queen Mary Hospital, L. S. Abboskhujaeva1,S.I.Ismailov1,N.M.Alikhanova2,G. Craiova, Romania, 4Department of Orthopaedic and I. Allayarova1, M. M. Shakirova1 Traumatology, CF2, Bucuresti, Romania, 5Department of 1Republican Specialized Scientific-Practical Medical Centre Radiology, University of Medicine and Pharmacy, Craiova, of Endocrinology, Tashkent, Uzbekistan, 2National Research Romania, 6Endocrinology Department, Philanthropy Center for Preventive Medicine of the Ministry of Healthcare Hospital, Craiova, Romania of the Russian Federation, Tashkent, Uzbekistan Bone play an important role in the storage of calcium and Background: VitaminD(25(OH)D)– a fat-soluble other mineral salts. Normal adult bone is termed lamellar prohormone, which is essential for bone metabolism through bone. The organic matrix constitutes 30-40%, and mineral its regulatory actions on Ca and phosphate. Vitamin D defi- salts 60-70%, of the dry weight of bone. ciency is particularly frequent in women of menopausal age. Objectives: The aim of this study was to evaluate levels of Due to the high prevalence of 25 (OH)D deficiency and its calcium and magnesium in serum at patients with postmeno- adverse effects on human health, identifying its deficiency is pausal osteoporosis. one of the priority areas for improvement of public health. Method: The study were effectuated on 97 patients with post- Aim: To determine the level of 25(OH)D in women of 50 menopausal osteoporosis diagnosed by DXA,75 women with years of age and older who reside in Tashkent, Uzbekistan. natural menopause and 22 patients with surgical menopause. Materials and methods: The cross-sectional study included To all the patients taken into study were determined calcium 272 women permanently residing in Tashkent. An absorpti- and magnesium in serum. ometry method was used to determine serum total calcium Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S429 (Ca) and nonorganic phosphorous (P), and a kinetic method proximal humerus (39855 / 937,8€), vertebrae (51167 / was used to determine alkaline phosphatase (AP) activity by 1203,9€) and ankle (43345 / 1019,9€). The highest COT in the amount of liberated 4-nitrophenol. Commercially avail- OPF of the proximal femur was related to the rather high able kits (CIS Bio International, France) were used to measure frequency of surgical treatment (31% arthroplasty and 48% levels of parathyroid hormone (PTH). internal osteosynthesis). In women with OPF of distal fore- Results: The mean age of patients comprised 56.0±3,7 years arm, proximal humerus, vertebrae or ankle surgical treatment (Me 56.0; IQR 53.0-59.0). The mean level of 25(OH)D in the was performed only in 5,6%, 26,2%, 2,3%, and 30,3% of studied group was 17.7±9.52 ng/ml (Me 16.9; IQR 10.2- cases, respectively. The cost of antiosteoporotic drugs 22.3).The indicators of calcium-phosphorus metabolism were accounted for only 7% of the total COT, due to their rare as following: Ca (2.22±0.21 mmol/L – Me-2.20; IQR 2.10- prescription, regardless of the site of the OPF. Only 25% of 2.34), P (1.35±0.26 mmol/L – Me-1.33; IQR 1.18-1.51), AP patients took antiosteoporotic drugs and 37% took calcium (246.8±74.3 U/L–Me-240/0; IQR 189.5-290.5) and PTH supplements and vitamin D. (35.9±35.6 pg/ml – Me-27.8; IQR 9.9-50.6). The deficit of Conclusion: In women with OPF the total average COT dur- 25(OH)D<10.0 ng/ml was seen in 23.5% of cases, the levels ing the first year was 61150 (1438,8€). The treatment of pa- >10 and <20 ng/ml – in 42.3% of patients, >20 and <30 ng/ml tients with the fracture of proximal femur and of forearm was – in 22.4% of cases and >30 ng/ml – in 11.8%. the most and the least expensive, respectively. The rate of Conclusion: Such deficiency of 25 (OH) D as <20.0 ng/ml is surgical treatment makes substantial contribution to the differ- not uncommon among Uzbek women and is seen in 65.8% of ence between COT of different OPF. them, near-optimal levels – in 22.4%, the optimal content of 25(OH) D – only in a minority of patients. P725 MODIFICATION OF LIPID METABOLISM IN P724 POSTMENOPAUSAL OSTEOPOROSIS THE COST OF TREATMENT OF PATIENTS WITHIN S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, ONE YEAR AFTER THE OSTEOPOROTIC FRAC- D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 TURE IN RUSSIA 1Faculty of Dentistry, University of Medicine and Pharmacy, O. V. Dobrovolskaya1, N. V. Toroptsova1,O.M.Lesnyak2 Craiova, Romania, 2Department of Endocrinology, University 1Nasonova Research Institute of Rheumatology, Moscow, of Medicine and Pharmacy, Craiova, Romania, 3Department Russian Federation, 2Ural State Medical University, of Obstetrics and Gynecology, Queen Mary Hospital, Ekaterinburg, Russian Federation Craiova, Romania, 4Department of Orthopaedic and Traumatology CF2, Bucuresti, Romania, 5Department of Aim: The survey of costs of treatment (COT) of patients with Radiology, University of Medicine and Pharmacy, Craiova, osteoporotic fracture (ОРF) within one year in municipal Romania, 6Endocrinology Department, Philanthropy healthcare institutions of the city of Moscow. Hospital, Craiova, Romania Methods: 196 women were included (mean age 66±9 years) who had ОРF in one of five sites: proximal femur, distal fore- Osteoporotic bone loss is characterized by a marked decrease arm, proximal humerus, vertebrae or ankle. COT assessment in osteoblast number and bone was performed on the basis of a standardized questionnaire forming activity, in the face of an unaltered or slightly in- that included data on inpatient and outpatient treatment, per- creased osteoclastic bone resorption. sonal expenses and social benefits. The individual direct COT Recent evidence suggests that hyperlipidemia may contribute was estimated on the basis of healthcare service rates provided to osteoporosis, and that lipid by the Fund of Obligatory Medical Insurance of Moscow for oxidation may be the mechanism underlying this process. 2014 year, indirect COT (payments for temporary disability, Objectives: The aim of this study was to evaluate the lipid permanent disability and early retirement) - on the basis of metabolism at patients with postmenopausal osteoporosis. minimum wage amount in 2014 year. COT was reported in Material And Method: The study were effectuated on 97 Russian Rubles ( ), the approximate COT in Euros (€)was patients with postmenopausal osteoporosis diagnosed by also calculated. DXA, 75 women with natural menopause and 22 patients with Results: The total average COT during the first year after OPF surgical menopause. At all patients was determined serum was 61150 (1438,8€). Average direct and indirect COT were levels of cholesterol, triglycerides and lipemia. 53962 (1269,7€) and 7188 (169,1€), respectively. The mean Results: Serum cholesterol levels were elevated at 62 patients individual COT of patients with proximal femur OPF aver- (45 with natural and 17 with surgical menopause), the normal aged 101243 (2382,2€) was significantly higher (p<0.01) values at 19 patients (16 with natural and 3 with surgical than COT for distal forearm OPF (22080 / 519,5€), menopause) and low values in 16 patients (14 with natural S430 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and 2 with surgical menopause). Serum triglycerides have Material And Method: Were taken in study 100 patients diag- elevated values at 58 patients (41 with natural and 17 with nosed with postmenopausal osteoporosis. At all patients were surgical menopause), normal values at 23 patients (20 with calculated BMI (body mass index) and via the FRAX algorithm, natural and 3 with surgical menopause) and low values in 16 the risk of major osteoporotic fracture over the next 10 years. patients (14 with natural and 2 with surgical menopause). Results: 2 patients were underweight (BMI ≤ 19, 9 kg/m2), 33 Serum lipemia presented elevated values in 59 patients (42 patients with normal weight (BMI=20-24.9 kg/m2),36 over- with natural and 17 with surgical menopause), normal values weight patients (BMI=25-29, 9 kg/m2), 20 patients with obe- of 22 patients (19 with natural and 3 with surgical menopause) sity gr I (BMI=30 -34, 9 kg/m2), and 9 patients with obesity gr and low values in 16 patients (14 with natural and 2 with II (BMI=35-29, 9 kg/m2). surgical menopause). The risk of major fracture was 6.06. Based on these data we Conclusions: The menopause is associated with progressive established an inverse correlation between BMI and risk of increase of total cholesterol and especially LDL-cholesterol, major osteoporotic fracture (r=-0,299; p=0.003 respectively triglycerides and α-lipoprotein and with decreased HDL-cho- r=-0,356; p=0), that is a BMI more rose is associated with a lesterol, this being due to the estrogenic deficiency of post- lower risk of fracture. This correlation was stronger in the case menopausal women. The estrogenic deficiency alters the bal- of patients with early menopause. ance between free radicals and antioxidants, causing oxidative Conclusions: That correlation may be due to the positive role stress and thus, dyslipidemia and cardiovascular of the estrogen hormones produced at the level of body fat on disease. Recent research suggests that there is a strong positive skeleton, but also protective effect of fat in case of falls. In correlation between osteoporosis and hyperlipidemia. The literature, the link between obesity (BMI) and risk of fracture mechanism by which lipids may cause osteoporosis is current- is still controversial, some studies proving that BMI has grown ly being investigated. It is believed that hyperlipidemia, in- protective of the risk of fracture, while others deny this fact. creased consumption of fats and cholesterol and/or alterations in the endogenous cholesterol biosynthetic pathway, may lead to the accumulation and abnormal deposition of lipids within P727 the vasculature, specifically (in this case) bone vasculature. RELIABILITY OF MEASUREMENTS OF SERUM TOTAL AND IONIZED CALCIUM, PHOSPHATE, ALKALINE PHOSPHATASE AND PTH IN DIAG- P726 NOSING HYPOVITAMINOSIS D CORRELATION BETWEEN BMI AND RISK OF H. M. Al Attia1 MAJOR FRACTURE IN POSTMENOPAUSAL OSTEO- 1Department of Internal Medicine and Rheumatology, POROSIS Universal Hospital, Abu Dhabi, United Arab Emirates S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 Objectives: To review the ability of routine biochemical 1Faculty of Dentistry, University of Medicine and Pharmacy, markers in supporting the diagnosis of hypovitaminosis D. Craiova, Romania, 2Department of Endocrinology, University Methods: The data of 70 adult patients with a biochemical of Medicine and Pharmacy, Craiova, Romania, 3Department diagnosis of hypovitaminosis D underwent assays for total of Obstetrics and Gynecology, Queen Mary Hospital, and ionized serum calcium (tCa and iCa),phosphate Craiova, Romania, 4Department of Orthopaedic and (P),alkaline phosphatase (AP) and parathyroid hormone Traumatology CF2, Bucuresti, Romania, 5Department of (PTH).Data of patients with chronic renal and hepatic disease Radiology, University of Medicine and Pharmacy, Craiova, and corticosteroid intake were excluded. Romania, 6Endocrinology Department, Philanthropy Results: Their mean age was 42.7±13.6 yrs with F:M of 1.5:1. Hospital, Craiova, Romania 46 individuals (65.5%) were from Arab states. The mean of 25(OH)D was 19.8±5.01 ng/ml(N, > 30ng/ml) but only 3 had Osteoporosis is characterized by bone loss and decrease of deficiency levels of <10ng/ml)p=0.0001.None had hypocalce- bone resistance which leads to the appearance of fragility frac- mia with a mean of t Ca of 9.57±0.409(N,8.4-10.5 mg/dL) tures. Currently it is considered that osteoporosis present sev- instead, 2 had borderline hypercalcemia of(10.6mg/dl).The eral of pathogenetic mechanisms which converge at bone loss mean of iCa was 1.13±0.153 (N,1.16-1.32mmol/L).However and damage of structural skeletal microarchitecture. These 40 (57%) expressed low iCa vs.30 with normal values, p=0.12, factors, together with an increased risk of falls, contributes yet the level’s mean was significantly low in the former (1.07 to the increasing incidence of fragility fractures in patients ±0.171 vs.1.21±0.32mmol/ in others with normal iCa), with osteoporosis. p=0.0001.The mean of serum phosphate of 67/70 assays was Objectives: To evaluate the correlation between BMI and risk also within normal of 3.6±0.32 mg/dL,(N 2.6-4.5 mg/ of major osteoporotic fracture, vertebral or nonvertebral. dL).Normal values of AP were observed in the 56 tested Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S431 individuals (35-118U/L,mean75.346±23.036 U/L). 22/62 (43.7%) were regular consumers of dairy products, and their assayed for PTH had secondary hyperparathyroidism (35.5%) number was significantly lower in the group of OP (27.5%) and 40 with normal levels, p=0.002.However, the mean of PTH than in the group of normal BMD (61.9%; OR 0.23; 95% was significantly higher in the former group,(84.8±19.7 vs.42.8 CI0.13-0.41; p <0.0001) and osteopenia (32.3%; OR 0.29; ±11.7ng/ml),p=0.0001. A possible risk factor that 58(83%) in- 95% CI0.18-0.48; p <0.0001). Likewise, less than half women dividuals have led predominantly indoors daily activity vs.2 of (46.3%) responded positively on the question about daily predominantly outdoors activity and 12 (17%) of both activi- physical activity for at least 30 minutes a day. Such women ties. Clothing was partially or completely occlusive of sunlight were less common in the group of OP (33.0%) than in the (veiling) in 24/42 (57%) of the females. group of normal BMD (56.9%; OP 0.37; 95% CI 0.22-0.64; Conclusions: Routine measurements of total calcium, phos- p=0.0004) and osteopenia (42.5%; OP 0.56; 95% CI 0.35- phate and alkaline phosphatase are rather unreliable markers 0.90; p=0.02). Early menopause was significantly more com- or predictors of hypovitaminosis D even when the insufficien- mon among women with osteoporosis (39.6%) than in women cy has been sufficient to produce secondary hyperparathyroid- with nBMD (20.6%). ism. Nonetheless, the relevant data of the ionized calcium Conclusions: Irregular consumption of dairy products, low make it a potential predictor of the condition. This warrants physical activity and the duration of menopause were the risk studying larger number of individuals in future studies. factors in the studied group of women. Moreover, clinical suspicion based upon history and aware- ness of risk factors should remain the gold standard for requesting 25 (OH) D estimation. The poor dietary intake P729 and inadequate sunlight exposure remain highly prevalent fea- CHARACTERISING ANTI-OSTEOPOROSIS DRUG tures of hypovitaminosis D. USERS IN REAL WORLD PRIMARY CARE SETTINGS IN SPAIN: A DATA-DRIVEN CLUSTER ANALYSIS S. Khalid1,M.S.ALI1, A. Silman1, D. Prieto-Alhambra1 P728 1Musculoskeletal Epidemiology, Botnar Research Centre, PREVALENCE OF OSTEOPOROSIS AMONGWOMEN Nuffield Department of Orthopaedics, Rheumatology and LIVING INBUKHARA REGION OF UZBEKISTAN Musculoskeletal Sciences, University of Oxford, Oxford, L. S. Abboskhujaeva1,S.I.Ismailov1,N.M.Alikhanova1,G. United Kingdom I. Allayarova1, M. M. Shakirova1 1Republican Specialized Scientific-Practical Medical Centre Objectives: We attempted to characterize the population of of Endocrinology, Tashkent, Uzbekistan anti-osteoporosis drug users by determining groups of patients with similar features. Objective: to study the prevalence of postmenopausal osteopo- Material and Methods: We used data from the SIDIAP rosis and various risk factors among women of Bukhara region. Database (anonymized primary care medical records for Materials and Methods: Questioning of 378 women from 50 >80% of the population of Catalonia, Spain). Data from to 80 years of age who are in menopause and live in Bukhara 37,996 incident users of anti-osteoporosis drugs (2007-2014) region. with complete data on risk factors was analysed. Patient fea- Results: The prevalence of osteoporosis (OP) among sur- tures included age, gender, body mass index, smoking, alcohol veyed postmenopausal women living in Bukhara region com- drinking, Charlson index, steroid and sedative/s use, and frac- prised 24.1%, osteopenia - 33.6%. The number of women at ture history. We adopted a data-driven approach to derive clus- age of 50-59 was lower in group with OP (53.6%), than in ters of patients with similar characteristics. Using the hierarchi- groups with normal BMD (OR0.06; 95%CI 0.03-0.14; cal clustering technique, similar patients (i.e. with the smallest р<0.0001) and osteopenia(OR 0.39; 95%CI 0.22-0.71; pair-wise distances) were placed into the same cluster [1]. Each р=0.003), while the age groups 60-69 years (27.5%; OR cluster was further divided until no further divisions could be 9.72; 95%CI 3.81-24.8; р<0.0001) and ≥70 years (15.4%; made, or if the max number of clusters was reached. Bone OR 28.9; 95%CI 3.73- 223.9; р<0.0001) were presented by mineral density (BMD) of individual clusters (available for a greater number of women than in the group with normal total of 2079 patients) was examined as an external validation. BMD. The proportion of residents with normal BMD de- Results: Five groups were identified, which can be summarised creased with aging (from 50.5% at age 50-59 years to 10.9% as: 1. elderly multi-morbid men with high prevalence of – at60-69 years of age, and up to 5.0% – at age ≥70 years). The smoking and drinking; 2. elderly women with high co- proportions of women with body weight <57 kg and BMI morbidity; 3. systemic steroid users; 4. secondary prevention <18.5 kg/m2 were not significantly different in groups of nor- (previous fracture history); and 5. younger (early post- mal BMD (respectively 23.1% and 2.5%) and the group of OP menopause) women with low-medium co-morbidity. Group 4 (respectively 13.2% and 2.2%). Less than half of women had the lowest hip BMD (Table 1). S432 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Conclusion: Our study identified expected (clusters 1 to 4) as Conclusions: Total testosterone are correlated with bone den- well as surprising (cluster 5, probably not in need for therapy sity in the forearm and total body, but not with fracture history. according to guidelines) sub-groups of anti-osteoporosis drug We conclude that in elderly women, endogenous testosterone users in actual practice settings. Further work should explore is a significant determinant of both trabecular and cortical the cost-effectiveness of anti-osteoporosis drugs within these bone density and is associated with fracture history. sub-groups. Reference: [1] Murtagh F. A survey of recent advances in hierarchical clustering algorithms. The Computer Journal P731 1983;26:354. PERSISTENCE WITH ONCE-DAILY TERIPARATIDE Disclosure: DPA’s department has received unrestricted research 20UG IN COMMON POPULATION grants, and speaker and advisory board fees from AMGEN. O. Ruzickova1,E.Stehlikova1, J. Tomasova2, M. Sokalska1 Table 1. baseline characteristics of patients within the derived 1Institute of Rheumatology, Prague, Czech Republic, 2Institute clusters. Units:%, unless specified. of Research in Rheumatology, Prague, Czech Republic Background: Teriparatide is drug of the choice in the treat- ment of the postmenopausal osteoporosis, glucocorticoid in- duced osteoporosis and male osteoporosis for the patients in the highest risk of fracture. Usually we have data from multicentric, randomized, double blind, placebo or active comparator controlled trials. The efficacy of the teriparatide was performed on the study population, which fulfilled inclu- sion and exclusion criteria. Persistence with osteoporosis treatment is essential in reduction of fracture risk, optimal outcome and healthcare resource use. Objectives: To describe persistence with once-daily teriparatide 20 ug during 24 months in common population. Methods: Patients with postmenopausal osteoporosis, gluco- corticoid induced osteoporosis and male osteoporosis who fulfil ACR criteria for these subgroups of osteoporosis, who started treatment with teriparatide between January 2011 and P730 June 2016 were analysed. CORRELATION BETWEEN BONE DENSITY AND They underwent DXA examination and laboratory examina- SERUM TESTOSTERONE IN ELDERLY WOMEN tion (serum level of Ca, 25-OH-vitamin D, P1NP, beta CTX, S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, osteocalcin, u-Ca) DXA examination was performed in the D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 most important regions of interest: lumbar spine, total femur 1Faculty of Dentistry, University of Medicine and Pharmacy, (hip), femur neck (neck). Our osteocentre is equipped with Craiova, Romania, 2Department of Endocrinology, University iDXA Lunar machine. Persistence and reasons for early ter- of Medicine and Pharmacy, Craiova, Romania, 3Department of mination with treatment were analysed. Obstetrics and Gynecology, Queen Mary Hospital, Craiova, Results: Romania, 4Department of Orthopaedic and Traumatology CF2, Bucuresti, Romania, 5Department of Radiology, University of Medicine and Pharmacy, Craiova, Romania, 6Endocrinology Department, Philanthropy Hospital, Craiova, Romania Objectives: To evaluate the relation between bone density and serum testosterone in elderly women. Material and Method: We studied serum testosterone, bone density and risk of osteoporotic fracture at 50 women over 70 years old. Results: We established a significantly correlation between serum testosterone at the spine(r=0,135;p 0,05),the Conclusion: These results of common population of patients hip(r=0,130;p 0,05),the proximal forearm(r=0,18;p 0,01) and suffering from the postmenopausal osteoporosis, glucocorti- in the total body(r=0,138;p 0,5). coid induced osteoporosis and male osteoporosis confirm high Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S433 persistence with teriparatide treatment. Analogous results were The aim was to estimate the prevalence and risk factors for vertebral described in other observational studies in common population. fracture in patients with T2DM as compared to a control group. Material and methods: 233 patients with T2DM from an out- patient clinic in Moscow and 233 healthy control subjects living P732 in the same area underwent lateral X-Ray imaging from Th4 to THE MEASUREMENTS OF Β-CROSSLAPS ON L5 to evaluate vertebral fractures and were interviewed in rela- AGING,MENOPAUSE AND OSTEOPOROSIS WITH tion to other low-traumatic fractures. All available vertebrae were FRACTURE graded by an experienced radiologist through visual inspection S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, of lateral spinal images, without direct vertebral measurement, as D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 either normal or deformed if visual inspection perceived at least a 1Faculty of Dentistry, University of Medicine and Pharmacy, 20% reduction in vertebral height. In addition to this, risk factors Craiova, Romania, 2Department of Endocrinology, University for fractures incorporated into FRAX were evaluated. Diabetes of Medicine and Pharmacy, Craiova, Romania, 3Department of complications, HbA1c, creatinine and glomerular filtration rate Obstetrics and Gynecology, Queen Mary Hospital, Craiova, (GFR) were taken from the most recent medical documentation. Romania, 4Department of Orthopaedic and Traumatology CF2, Results: the mean age of enrolled participants (66 males; 390 Bucuresti, Romania, 5Department of Radiology, University of female) was 64 (95% CI 63-65) years old with no statistically Medicine and Pharmacy, Craiova, Romania, 6Endocrinology significant difference between T2DM and control subjects. Department, Philanthropy Hospital, Craiova, Romania Vertebral fractures were confirmed in 36 (15%) cases with T2DM and in 37 (16%) cases of control subjects p=0.5. Objectives: To evaluate the effect of aging, menopause, and Non-vertebral fractures were more common in T2DM – 62 osteoporosis on the measurements of serum β-CrossLaps. cases (27%) as compared to 44 in a control group (19%) Material And Method: In 6 children, 28 premenopausal healthy p=0.027. Multiple fractures were also more common among women, 48 postmenopausal healthy women and 22 patients with subjects with T2DM – 21 (9%) cases as compared to control osteoporotic fractures, β-CrossLaps was measured by RIA. group - 8 (3%) p=0.012. Patients with T2DM and vertebral Results: The age-related changes of β-CrossLaps shows that fractures fall more frequently as compared to patients with the values were extremely high before the age of I6 years and T2DM without vertebral fractures p=0.043. They also had decreased between age 16 and 29,and after the age of 40 years, multiple fractures more frequently (p<0.001). However, we the values tended to increase and to vary widely with age. In did not find statistically significant difference in age, sex, di- menopause, β-CrossLaps in 12 postmenopausal subjects aged abetes complications, HbA1c, creatinine and CFR values or 44-59 were significantly higher than those in 18 premenopausal any other risk factors for fractures. subjects aged 44-59. There was no significant correlation be- Conclusions: Patients with T2DM have similar rate of verte- tween β-CrossLaps and years since menopause in 36 postmen- bral fractures as elderly people without T2DM. Frequent opausal subjects. β-CrossLaps in the group with osteoporotic falls and other multiple fractures in subjects with DM2T might fracture were higher than those in the postmenopausal group. be the potential risk factors for vertebral fractures. Conclusions: β-CrossLaps is a useful bone resorption marker which well reflects an increase of bone resorption associated with the bone modeling at childhood and high bone resorption P734 after menopause and higher bone resorption in osteoporotic THE ROLE OF Β-CROSSLAPS ASSAYS IN MONI- patients with fractures. TORING BISPHOSPHONATE TREATMENT AND HRT S. A. Preda1,O.R.Pavel2, I. Vasile2,L.P.Pavel3,E.Stefan4, P733 D. M. Albulescu5,A.Camen1, C. Constantin5,A.Covei6 VERTEBRAL FRACTURES IN PATIENTS WITH 1Faculty of Dentistry, University of Medicine and Pharmacy, TYPE 2 DIABETES MELLITUS Craiova, Romania, 2Department of Endocrinology. University of T. O. Yalochkina1, Z. E. Belaya2,N.V.Tarbaeva2,L.Y. Medicine and Pharmacy, Craiova, Romania, 3Department of Rozhinskaya2,T.T.Tsoriev2,G.A.Melnichenko2,I.I. Obstetrics and Gynecology. Queen Mary Hospital, Craiova, Dedov2 Romania, 4Department of Orthopaedic and Traumatology. CF2, 1Moscow out-patient clinic № 219, Moscow, Russian Federation, Bucuresti, Romania, 5Department of Radiology, University of 2Endocrinology Research Centre, Moscow, Russian Federation Medicine and Pharmacy, Craiova, Romania, 6Endocrinology Department, Philanthropy Hospital, Craiova, Romania Diabetes mellitus type 2 (T2DM) has been associated with an increased risk of fractures. However, the study addressing The β- CrossLaps marker is a specific and sensitive index of vertebral fractures remains controversial bone resorption. S434 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Objectives: To evaluate the clinical utility of the assays by Two models (ASM 1, ASM2) developed by Lee et al (Am J measurement of serum β- CrossLaps from women undergo- Clin Nutr, 2000) from the West and two models (ASM3, ing antiresorptive treatment with bisphosphonate or by hor- ASM4) developed by Wen et al (Asia Pac J Clin Nutr, mone replacement. 2011) from Asia were considered. ASM1 and ASM3 are Material And Method: The study were effectuated on52 pa- based on skin fold thickness and circumferences and ASM2 tients with bisphosphonate treatment and 18 patients with and ASM4 are based on body weight and height. Gender, age HRT. At all patients we are measured serum levels of β- and race are independent variables used in all models. Pearson CrossLaps baseline, at 3,6,9 and 12 months of treatment. correlation coefficient (r), coefficient of determination (R2) Results: In serum from women on treatment with the bisphos- and standard error of estimate (SEE) were calculated and phonate the β-CrossLaps levels decreased by approximately paired sample t test was performed. 75% compared to baseline after 3 months of treatment. and Results: Mean (SD) age of the study group was 49.0 (8.2) stayed at this level for another 3 months of treatment. years. Mean (SD) ASMMDXA and ASMM estimated in kg by Significant declines in the CrossLaps levels were as well ob- four models were, ASMMDXA=15.39 (2.75), ASM1=18.36 served after 3 and 9 months of treatment with SERM. (3.27), ASM2=16.46 (3.01), ASM3=15.44 (2.40) and Compared to baseline these changes in CrossLaps levels were ASM4=14.44 (2.45), respectively. Correlation of approximately 50 and 60%, respectively. The decrease in ASMMDXA with ASMM estimated were, ASM1=r:0.68, CrossLaps levels observed in serum from women treated in R2:0.47, SEE:2.02kg; ASM2=r:0.91, R2:0.81, SEE:1.18kg; 28 day cycles with sequential and combined doses of 2 mg ASM3=r:0.90, R2:0.81, SEE:1.17kg; and ASM4=r:0.91, estradiol and 50 pg gestodene for 6 and 12 months were ap- R2:0.82, SEE:1.14kg, respectively. Estimated ASMM by proximately 70% and 75%, respectively. ASM3 was not significantly different (p>0.05) from Conclusions: β-crosslaps are useful in monitoring the effect ASMMDXA but the ASMM estimated by the other three for- of antiresorptive therapy with bisphosphonate or hormone mulae were significantly different from the ASMMDXA substitution. (P<0.05). Conclusion: Correlations between ASMMDXA and ASMM estimated by all models were high. Although skin fold thick- P735 ness and circumferences model developed by Wen et al CONCORDANCE BETWEEN MEASURED AND showed highest concordance with ASMMDXA, weight- ESTIMATED APPENDICULAR SKELETAL height models developed by both Lee et al and Wen et al also 2 MUSCLE MASS WITH MODELS DEVELOPED IN showed the higher concordance with ASMMDXA with high R THEWESTANDASIA:WHATISBESTFORSRI and low SEE. More studies are required to validate the accu- LANKAN ADULT WOMEN? racy of the models in other age groups. N. Rathnayake1,G.Alwis2,J.Lenora3,S.Lekamwasam4 1Allied Health Science Degree Programme, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, P736 2Department of Anatomy, Faculty of Medicine, University ASSOCIATION BETWEEN HEPATITIS B INFECTION of Ruhuna, Galle, Sri Lanka, 3Department of Physiology, AND THE INCIDENCE OF HIP FRACTURE: COHORT Faculty of Medicine, University of Ruhuna, Galle, Sri ANALYSIS OF NATIONAL HEALTH INSURANCE Lanka, 4Department of Medicine, Faculty of Medicine, DATA University of Ruhuna, Galle, Sri Lanka Y.-F. Chang1,L.-C.Ou2, F.-W. Liang3, C.-S. Chang1,W.-T. Ou4, T.-H. Lu3,C.-H.Wu5 Objective: This study was undertaken to determine the valid- 1Family medicine, National Cheng Kung University Hospital, ity of two existing anthropometric models in estimating the Tainan, Taiwan, Province of China, 2Family medicine, Antai appendicular skeletal muscle mass (ASMM) in Sri Lankan Medical Cooperation Tien Sheng Memorial Hospital, women. Pingtung, Taiwan, Province of China, 3Department of Public Materials and Methods: A cross-sectional study was carried Health, College of Medicine, National Cheng Kung out with 165 women aged between 30-60 years. ASMM (kg) University, Tainan, Taiwan, Province of China, 4Internal was quantified with DXA (ASMMDXA) (Hologic Inc. Medicine, Antai Medical Cooperation Tien Sheng Memorial Bedford, USA) and anthropometric measurements (body Hospital, Pingtung, Taiwan, Province of China, 5Institute of weight, height, circumferences and skin fold thickness at spe- Gerontology, National Cheng Kung University, Tainan, cific sites) were obtained. The limb circumferences/girths were Taiwan, Province of China corrected for subcutaneous adipose tissue thickness. Corrected girths respectively were: corrected arm girth (CAG), corrected Aim: To analyze the association between hepatitis B infection, the thigh girth (CTG) and corrected calf girth (CCG). incidence of hip fracture, and hip fracture related complications. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S435 Method: We selected 13,022 adults aged 40 years and older for both treatment cohorts. A higher proportion of denosumab diagnosed with hepatitis B using Taiwan National Health users compared with OBP users had received another osteo- Insurance Research Database from 2000 to 2013 and porosis treatment prior to initiating denosumab/OBPs (60% 230,219 adults without hepatitis B as the comparison cohort. vs. 3%). 83% (CI95:81–85) of denosumab users were persis- Hip fractures from 2000 to 2013 were identified from medical tent at 12 months, 69% (CI95,66–71) at 18 months, and 62% claims to evaluate the risk of hip fracture using Cox propor- (CI95:59–65) at 24 months. For OBP users the persistence tional hazard model. rates were lower: 49% (CI95:48–49) at 12 months, 40% Results: The crude incidences of hip fracture for subjects with (CI95:39–41) at 18 months, and 34% at 24 months (CI95: and without hepatitis B were 2.4% and 5.4%, respectively. 33–34). Cox regression analysis showed that diabetes, cancer history, Conclusion: In this analysis of patients over 70 years old, chronic kidney disease, prior fracture history, alcohol hepati- those treated with denosumab were more persistent than those tis, using anti-osteoporotic drug, aged 65years and older, and treated with OBPs. Higher persistence may lead to better out- liver cirrhosis were positively associated with the incidence of comes, including fracture prevention. hip fracture after adjusting for gender, rheumatoid arthritis, Funding: Amgen (Europe) GmbH steroid use, thyroid disease, and parathyroid disease. Disclosures: MI: Employee and stock options – Amgen; LK, Compared with subjects without Hepatitis B, the adjusted JB, OS: employees of Quantify Research. HR of hip fracture was 0.68 (95% CI, 0.57-0.82) for those with hepatitis B. Moreover, diabetes, rheumatoid arthritis, cancer history, chronic kidney disease, using anti- P738 osteoporotic drug, and aged 65 years and older were positively BONE MINERAL DENSITY AND VITAMIN D associated with the complications of hip fracture after control- LEVELS IN PATIENTS WITH RHEUMATOID ling for potential confounders. ARTHRITIS Conclusions: Previous hepatitis B infection was inversely D. Anghel1, L. M. Ciobica1, M. M. Negru2, C. Jurcut3,L. associated with the incidence of hip fracture, but not signifi- Otlocan4,A.Coca1 cantly associated with the complications after hip fracture. 1Central Military Hospital Bucharest, Bucharest, Romania, 2Clinical Hospital "Sfanta Maria" Bucharest, Bucharest, Romania, 3Dr. Carol Davila Central Military Emergency P737 University Hospital, Bucharest, Romania, 4Clinical Hospital TREATMENT PERSISTENCE WITH DENOSUMAB "Sfanta Maria", Bucharest, Romania AND ORAL BISPHOSPHONATES (OBPS) IN SWEDISH OSTEOPOROTIC WOMEN OLDER Background: Rheumatoid arthritis (RA) is a chronic disease THAN 70 YEARS frequently associated with osteoporosis. Vitamin D plays a M. Intorcia1,L.Karlsson2,J.Banefelt2, O. Ström2 crucial role in the development and maintenance of a healthy 1Amgen (Europe) GmbH, Zug, Switzerland, 2Quantify skeleton and vitamin D deficiency is associated with disorders Research, Stockholm, Sweden of calcium metabolism and autoimmune diseases. Objectives: To investigate the relationship between low bone Objective: Osteoporosis is a common skeletal bone disorder mineral density and 25- hydroxyvitamin D level in patients associated with increased risk of fractures. Treatment persis- with RA. tence is often suboptimal in osteoporosis leaving many pa- Methods: We recruited 81 postmenopausal women with RA tients at risk of fractures. Moreover, it is known that incidence and 65 healthy postmenopausal women matched for age, body of fractures increases with age. The objective of this analysis mass index, menopausal age as a control group. All patients was to estimate persistence with denosumab and oral with RA met the criteria (ACR/EULAR 2010). Vitamin D bisphosphonates (OBPs) in Swedish osteoporotic women deficiency is diagnosed when 25- hydroxyvitamin D level is older than 70 years. <20 ng/ ml. None subject in both groups were on calcium / Methods: The study utilised data from the Swedish pre- vitamin D medication. Bone mineral density was measured in scribed drug register and included women older than 70 years all women in both groups with dual energy X- ray absorpti- initiating denosumab or OBPs (alendronate or risedronate) ometry at spine and femur. Serum levels of 25- between May 2010 and July 2012. Patients were defined as hydroxyvitamin D and bone turnover markers were examined. persistent from treatment initiation until discontinuation All patients had a spine X-ray for vertebral fracture presence. allowing for a grace period of 56 days. Patients were followed Disease Activity Score (DAS28) including 28 joint counts until the end of the study period (31 March 2013) or death. was assessed for all patients with RA. Results: The study identified 1,485 and 20,456 incident users Results: Bone mineral density at lumbar spine and femoral of denosumab and OBPs, respectively. Mean age was 79 years neck were significantly lower in patients with RA compared S436 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 with controls. Bone turnover markers were significantly results for age did not change them materially although the higher in patients with RA compared controls and the serum association between ASMM and GS (r=+0.05, p=0.35) became of 25- hydroxyvitamin D was lower. 25- hydroxyvitamin D non-significant. In subgroup analyses, ASMM showed signif- deficiency was detected in 87,2% RA patients and 49,8% in icant correlations with HGS, in both pre (r=+0.42, p<0.05) and control group (p<0,001). In RA group the serum level of 25- postmenopausal women (r=+0.43, p<0.001), but not with GS hydroxyvitamin D was significantly correlated with bone min- [premenopausal women: r=+0.03, p>0.05 and postmenopausal eral density and bone turnover markers. The vertebral frac- women: r=+0.05, P>0.05]. HGS showed positive correlation tures were found in 21 patients with RA and 18 of them have with GS (r=+0.23, r<0.05) only in premenopausal women not low levels of 25- hydroxyvitamin D whereas in control group, with postmenopausal women (r=+0.13, r>0.05). 6 patients had a vertebral fractures. DAS28 and 25- Conclusion: This study shows a significant association be- hydroxyvitamin D were significantly correlated (p<0,001). tween ASMM and HGS, not affected by age or menopausal Conclusion: Our data revealed that rheumatoid arthritis patients status. However, age and menopause have significant impact on with osteoporosis had a lower level of 25- hydroxyvitamin D. the association between ASMM and GS and HGS and GS. This The activity disease and vertebral fractures was significant cor- could be due to the fact that GS is determined by factors other related with the low level of 25- hydroxyvitamin D. than ASMM such as prevalent diseases and drugs in old age. P739 P740 ASSOICIATIONS OF MEASURES OF SARCOPENIA DEVELOPMENT AND CROSS VALIDATION OF AMONG MIDDLE AGED WOMEN WITH FOCUS TWO PREDICTIVE MODELS TO ESTIMATE THE ON THEIR AGE AND MENOPAUSAL STATUS APPENDICULAR SKELETAL MUSCLE MASS IN N. Rathnayake1,G.Alwis2,J.Lenora3,S.Lekamwasam4 ADULT WOMEN IN SRI LANKA 1Allied Health Science Degree Programme, Faculty of N. Rathnayake1,G.Alwis2,J.Lenora3,S.Lekamwasam4 Medicine, University of Ruhuna, Galle, Sri Lanka, 1Allied Health Science Degree Programme, Faculty of 2Department of Anatomy, Faculty of Medicine, University Medicine, University of Ruhuna, Galle, Sri Lanka, of Ruhuna, Galle, Sri Lanka, 3Department of Physiology, 2Department of Anatomy, Faculty of Medicine, University Faculty of Medicine, University of Ruhuna, Galle, Sri of Ruhuna, Galle, Sri Lanka, 3Department of Physiology, Lanka, 4Department of Medicine, Faculty of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri University of Ruhuna, Galle, Sri Lanka Lanka, 4Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka Objective: This cross sectional study examined the association of measures of sarcopenia; appendicular skeletal muscle mass Objective: This study was undertaken to develop and cross (ASMM),handgripstrength(HGS)andgaitspeed(GS)among validate two simple predictive models to estimate the appen- middle-aged women in Sri Lanka and to determine whether the dicular skeletal muscle mass (ASMM) in a group of healthy association is influenced by age and menopausal status. adult women in Sri Lanka. Materials and methods: A sample of healthy 184 premeno- Materials and methods: The study consisted of two groups of pausal (mean age 42.5(6.0) years) and 166 postmenopausal middle age women between 30-60 years. ASMM (kg) was women (mean age 55.1(3.8) years) were studied. ASMM (kg) quantified with DXA (ASMMDXA) (Hologic Inc. Bedford, was measured by DXA (Hologic Inc. Bedford, USA). HGS USA) and anthropometric measurements; body weight (kg), (kg) was measured with hand held dynamometer in the right height (m), circumferences (cm) and skin fold thickness (mm) hand. GS (m/s) was measured with 4 meter customary pace at specific sites were obtained. The limb circumferences/girths walking. Association of all three measures was determined were corrected for subcutaneous adipose tissue thickness. with the Pearson correlation coefficient (r) and age adjusted Corrected girths respectively were corrected arm girth (CAG), partial correlation. corrected thigh girth (CTG) and corrected calf girth (CCG). In Results: Mean (SD) ASMM, HGS and GS of pre and post- the 1st step, (n=165), two simple anthropometric models were menopausal women were as follows: developed based on the data obtained from multiple regression ASMM – 16.06(2.51) and 14.87(2.96) kg (p<0.001) analyses (ASMMDXA=dependent variable; anthropometric mea- HGS – 19.06(6.06) and 15.27(4.27) kg (p<0.001) surements and menopausal status=independent variables). In the GS – 1.19(0.17) and 1.07(0.16) m/s (p<0.001) 2ndstep (n=167), the developed models were cross validated. When pre and postmenopausal women were taken together, Results: The developed two models were: ASMM showed significant (p<0.001) correlations with both 1. ASMM1=0.205(weight)+8.728(height)-0.722(menopausal HGS (r=+0.46) and GS (r=+0.12). HGS and GS were also status)-9.166 significantly correlated (r=+0.28, p<0.05). Adjusting above [Menopausal status: 1=premenopausal, 0=postmenopausal] Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S437 2. ASMM2=0.241(CAG)+0.179(CTG)+0.197(CCG)+ intracellular signaling proteins. The pharmacological input 15.858(height)-0.033(age)-25.770. of diacerein was evaluated by Western blotting, Human TM The correlations between ASMMDXA and ASMM1, ASMM2 Phospho-MAPK Proteome Profiler Array, and the were 0.92 (R2=0.84, SEE=1.16) and 0.84 (R2=0.72, TransAM® STAT3 transcription factor assay. SEE=1.29), respectively. Intra class correlations were high Results: In healthy chondrocytes, diacerein treatment signifi- (0.91, 0.79 respectively) with wide range of 95% confidence cantly downregulated the phosphorylation of focal adhesion intervals. There were no significant differences between kinases (FAK) FAKY397 and FAKY925. However, FAKY576/577 ASMMDXA and ASMMs estimated by two models. The mean remained unchanged. In the OA model, only phosphorylation difference reported from two models were 0.09, 0.16 (p>0.05) of FAKY397 was significantly downregulated. Protein expres- showing strong concordance with the ASMMDXA. Bland and sion of MAPK phosphorylation targets was analysed. The Altman plots revealed satisfactory agreements of newly devel- Raf-MEK-ERK pathway represents one of the best character- oped models with ASMMDXA with only few observations ized MAPK signaling pathway. After diacerein treatment beyond the 1.96 SD tolerance limits. ERK1/2 phosphorylation showed significant downregulation Conclusion: Two models developed and cross validated in only in healthy chondrocytes. The strongest decrease was ob- this study show a high measurement concordance in estimat- served for STAT3Y705 phosphorylation both in healthy and ing the ASMM in this group of women. It, however, has to be OA chondrocytes. These results were confirmed using the validated in other age groups and in both genders and also for STAT3 activity assay. The Akt downstream pathway was ac- the perimenopausal women where the menopausal status is tivated after diacerein treatment, especially in OA not defined well. chondrocytes, although in healthy chondrocytes the Akt path- way remained unaffected. Conclusions: MAPK inhibition has the potential to slow dis- P741 ease progression in OA and may reduce pain. Further under- THE EFFECT OF THE DMOAD DIACEREIN ON MAPK standing of the function of MAPK as well as upstream and PHOSPHORYLATION AND THEIR DOWNSTREAM downstream effectors may lead to the development of more PATHWAYS IN HUMAN CHONDROCYTES specific inhibitors with less toxicity that could be used as B. Lohberger1,H.Kaltenegger1, A. Leithner1,W.Kullich2,B. structure-modifying drugs for OA. Steinecker-Frohnwieser2 1Department of Orthopedic Surgery, Medical University Graz, Graz, Austria, 2Ludwig Boltzmann Institute for Rehabilitation P742 of Internal Diseases, Saalfelden, Austria DO ANTHROPOMETRIC INDICES PREDICT THE BONE MINERAL DENSITY OF PRE AND POSTMENO- Objectives: Osteoarthritis (OA) is a multifactorial, complex PAUSAL WOMEN? disease affecting approximately 15% of the world's popula- N. Rathnayake1,G.Alwis2,J.Lenora3,S.Lekamasam4 tion. Worldwide the prevalence of OA is steadily increasing, 1Allied Health Science Degree Programme, Faculty of leading to an ever rising economic burden. Current therapies Medicine, University of Ruhuna, Galle, Sri Lanka, for OA including disease modifying OA drugs (DMOADs) 2Department of Anatomy, Faculty of Medicine, University aim to preserve normal joint function as well as reduce dis- of Ruhuna, Galle, Sri Lanka, 3Department of Physiology, ease intensity and symptoms. The DMOAD diacerein, an Faculty of Medicine, University of Ruhuna, Galle, Sri anthraquinone, functions as a slow-acting OA drug by Lanka, 4Department of Medicine, Faculty of Medicine, exerting anti-inflammatory, anti-catabolic, and pro-anabolic University of Ruhuna, Galle, Sri Lanka properties on cartilage and synovial membranes. The ESCEO regards diacerein as beneficial for the treatment of Objective: This cross-sectional study examined the ability of OA. Mitogen-activated protein kinases (MAPKs) are intracel- predicting bone mineral density (BMD) using anthropometric lular signaling proteins, which play a central role in control- measurements in a group of pre and postmenopausal women ling pathways that regulate production and activity of multi- in Sri Lanka. ple mediators of joint tissue destruction. In this study, the Materials and methods: Two groups of healthy premeno- therapeutic potential of diacerein regarding MAPK inhibition pausal (PreMW) (n=136) and postmenopausal (PMW) was investigated. (n=120) women were studied. Total body BMD (g/cm2)ex- Material and Methods: IL-1β stimulated C-28/I2 (OA mod- cluding the head was measured with DXA (Hologic Inc. el) and unstimulated T/C-28a2 (healthy) chondrocytes were Bedford, USA). Height (m), weight (kg), skin fold thickness treated with 50 μM diacerein for 48 hours. The effect of the of suprailiac (SISFT), triceps(TrSFT),biceps(BiSFT), anthraquinone on phosphorylation status was evaluated using subscapular (SSSFT), thigh (ThSFT) and calf (CSFT) and antibodies targeted to specific phosphorylation sites on circumferences of waist (WC), hip (HC) were measured. S438 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Pearson correlation coefficient (r), coefficient of determina- according to international recommendations: severe deficien- tion (R2) and standard error of estimate (SEE) were calculated. cy <30nmol/L, deficiency 30-50nmol/L, adequate >50nmol/L Results: Mean (SD) age of PreMW and PMW were 42.0(6.2) and ideal >75nmol/L. SPSS was used for data analysis. years and 56.0(3.7) years respectively. Mean (SD) total body Results: The mean of available vitamin D levels (n=144) is BMD of PreMW and PMW were 0.877(0.097) and 65.8±31.5nmol/L. Levels are less than 75nmol/L in 61% of 0.806(0.083) respectively (p<0.001). patients, 34% are deficient and 13% are severely deficient. The correlations between BMD and anthropometric indices Vitamin D levels are significantly (p<0.05) lower in men among PreMW are; height: r=+0.26, p<0.001, weight: r=+ (49.7 vs. 68.9nmol/L), patients not on supplements (57.8 vs. 0.59, p<0.001, WC: r=+0.19, p<0.001, HC: r=+0.27, 76.4nmol/L), excess alcohol intake (47 vs. 68.1nmol/L), cur- p<0.001, SISFT: r=+0.05, p=0.18, TrSFT: r=+0.10, p=0.11, rent smokers (50.9 vs. 69.1nmol/L) and low vitamin D dietary BiSFT: r=+0.10, p=0.11, SSSFT: r=+0.16, p<0.05, ThSFT: intake (58.1 vs. 74.9nmol/L). Factors predicting vitamin D r=+0.06, p=0.23, CSFT: r=+0.05, p=0.28. deficiency include smoking (59.3% vs. 29.6% deficient, The correlations between BMD and anthropometric indices p<0.01, OR 3.5) or having a BMI less than 20 kg/m2 (50% among PMW are; height: r=+0.36, p<0.001, weight: r=+ vs. 28.4%, p<0.05, OR 2.5). Factors protective against vita- 0.60, p<0.001, WC: r=+0.47, p<0.001, HC: r=+0.53, min D deficiency are taking vitamin D supplements (45.1% p<0.001, SISFT: r=+0.30, p<0.001, TrSFT: r=+0.38, vs. 21%, p<0.05, OR 0.32) or having a sufficient dietary in- p<0.001, BiSFT: r=+0.37, p<0.001, SSSFT: r=+0.47, take of vitamin D (46.2% vs. 21.2%, p<0.05, OR 0.31). There p<0.001, ThSFT: r=+0.29, p<0.001, CSFT: r=+0.17, p<0.05. is no association between vitamin D levels and bone mineral Weight was the strongest predictor of BMD among both density or fracture site. PreMW (r:0.59, R2:0.35, SEE:0.07) and PMW (r:0.60, Conclusion: In this cohort, 61% have a less than ideal vitamin R2:0.36, SEE:0.06). D level and 34% are deficient. Smoking predicts vitamin D The predictive models derived to estimate the BMD in both deficiency. Supplementation and sufficient dietary intake are PreMW and PMW respectively are: partially protective. Targeted optimisation of vitamin D levels PreMW BMD=1.057+0.011(weight)-0.008(HC) [r:0.69, in fragility fracture patients with these characteristics can max- R2:0.47, SEE:0.07] imise bone health. PMW BMD=0.534+0.005(weight)-0.004(CSFT)+ 0.003(SSSFT) [r:0.65, R2:0.40, SEE:0.06] Conclusion: Data shows the ability of selected anthropomet- P744 ric measures to predict total body BMD among PreMW and METABOLIC DISORDERS AND RELATED FACTORS PMW. Correlations between measured anthropometric indices SEEN IN THE FIRST TWENTY FOUR HOURS, IN and BMD were different between the two groups. Skin fold PATIENTS WITH PRIMARY TOTAL KNEE AR- thickness showed significant correlations only in PMW and THROPLASTY this could be due to the contribution of fat mass to maintain M. S. Şenol1,A.M.Öztürk1,F.I.Can2,T.K.Eren1,A.E. circulating estrogen level in old age. Güven3 1Gazi University Faculty of Medicine Orthopaedics and Traumatology Department, Ankara, Turkey, 2Ankara P743 Penitentiary Institution Campus Hospital, Ankara, Turkey, SMOKING PREDICTS VITAMIN D DEFICIENCY IN 3Gazi University Faculty of Medicine Public Health A FRAGILITY FRACTURE POPULATION Department, Ankara, Turkey G. Fitzgerald1, D. Askin1,N.McDonald1,R.Mullan1 1Department of Rheumatology, Tallaght Hospital, Dublin, Objectives: The incidences of acute kidney injury (AKI), se- Ireland rum electrolyte disorders and acute liver injury (ALI) in 24 hours after total knee arthroplasty (TKA) are analyzed. The Objective: Vitamin D plays an important role in bone health. relationship with these metabolic complications and the fac- There is a paucity of literature regarding the epidemiology of tors like age, gender, applying simultaneous bilateral TKA, vitamin D levels in a fragility fracture cohort. The aim of this using antibiotic-loaded bone cement and the type of anesthe- study is to determine the prevalence and predictors of low sia are assessed; and determining the patients at risk is aimed. vitamin D levels in a fragility fracture population. Material and Methods: The 1263 patients, who were under- Material and methods: All fragility fractures (n=720) cap- gone TKA at our clinic in the years between 2011 and 2016, tured over 2 years by a fracture liaison service of an academic and diagnosed with gonarthrosis were studied; and the inci- teaching hospital were included in this cross-sectional study. dences of AKI, serum electrolyte disorders and ALI in 24 Demographics, clinical data, blood tests and bone mineral hours after surgery and the factors that may affect these con- density were collected. Vitamin D levels were stratified ditions are sought retrospectively. Student t test has been used Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S439 to compare continuous variables between cases and controls, Results: We have found a high prevalence of HLA-B7, B17 and chi-square statistics have been used to compare frequency and B27 which were increased in comparison with controls distributions. Results were considered statistically significant (p=0.012, pc=0.024, RRf=3.1), but the strongest predictive when p value was <0.05. factors among patients with polyarthritis and axial disease Results: 1263 TKA cases were analysed and the mean age was of ankylosing spondylitis for an aggressive disease. An 67 (42-91). AKI was seen in 0,5% of the patients right after the association was found between CD determinants of lym- surgery and 5,8% of the patients 24 hours after the surgery. phocytes (CD2, CD3, CD4, CD8, CD19, CD20, CD22) Elderly patients, male gender, having high creatine levels preop- and ankylosing spondylitis, but most important were: for eratively (≥1.00 mg/dl) and applying simultaneous bilateral peripheral form CD2, CD4, CD8 in comparison with con- TKA were statistically significant factors for having AKI. trols (p=0.003, pc=0.009, RRf=2.6); for axial form CD4, Hypernatremia was a seldom complication whereas CD8 and CD22 in comparison with controls (p=0.001, hyponatremia was seen in 31.7% of the patients 24 hours after pc=0.021, RRf=3.5). The most advanced osteoporosis the surgery. Spinal anesthesia and male gender were found to be was found in axial forms (M T-score -2,9) and in peripheral statistically significant risk factors for developing hyponatremia. form (M T-score -2,5), with osteopenia in peripheral form Hypopotassemia was seen in 11,8% of the patients 24 hours after (M T-score -1.7) in 27%. the surgery and female gender and general anesthesia were found In patients with a rational Ca> 950 mg / day T-score was 1.95; to be a risk factor. Hypocalcemia was recorded in 12.5% of the but at 850-950 mg / day T-score was 2.25. patients 24 hours after the surgery. ALI was a rare condition after Conclusions: TKA and seen in 0.8% of the patients right after the surgery and • There were several strong association between HLA- 1.2% of the patients 24 hours after the surgery. antigens (B7, B17, B27), lymphocytes CD2, CD4, CD8, Conclusion: AKI is a common complication and the inci- CD22 and ankylosing spondylitis. dence increases with elder patients, male gender and applying • The strongest predictive factors among patients with periph- simultaneous bilateral knee arthroplasty. ALI is noted as a rare eral and axial disease of ankylosing spondylitis for an aggres- complication. Hyponatremia, hypopotassemia and hypocalce- sive disease were HLA-B7, B27 with a significant linkage mia are found to be frequent electrolyte disorders and it is (p=0.0001, RRf=2.9). recommended to be diagnosed and treated when they are • Osteoporosis was imposed as nosologic unit being detect- symptomatic. ed very commonly in patients with ankylosing spondylitis. In the evolution of the disease they were presented with high frequency following risk factors: genetic, intake low P745 calcium and, in particular, depending on the version clini- CORRELATION BETWEEN OSTEOPOROSIS AND cal disease: the most serious – axial form and light show in IMMUNO-GENETIC DETERMINANTS AT PATIENTS peripheral. WITH ANKYLOSING SPONDYLITIS IN REPUBLIC OF MOLDOVA L. Chislari1,E.Russu1, L. Groppa1, E. Deseatnicova1,V. P746 Cazac1 THE MUSCULOSKELETAL BENEFITS OF GAIT SPEED 1USMF "Nicolae Testemitanu", Chisinau, Republic of Moldova MAINTENANCE IN OLDER MEN AND WOMEN M. H. Edwards1,K.A.Ward1,K.A.Jameson1,E.M. Objective: Ankylosing spondylitis is an inflammatory joint Dennison1,C.Cooper1 disease, with unknown aetiology, associated with genetic fac- 1MRC Lifecourse Epidemiology Unit, University of tors and presents a heterogeneous clinical pattern, expressed Southampton, Southampton, United Kingdom by different manifestations such as axial or peripheral arthritis with mild to very severe osteoporosis. The aim of this study Objective: Loss of mobility with age can be associated was to analyze: with significant morbidity in later life. In particular, there • the clinical manifestations of arthritis and associations with are few data on the relationships between measures of mo- osteoporosis and immunological disorders by appreciation of bility, such as gait speed, and longitudinal changes in mus- lymphocytes cell determinants (CD) with identifying markers culoskeletal parameters. We therefore investigated these for aggressive joint disease associations using a well phenotyped cohort of older men • the clinical manifestations of ankylosing spondylitis and and women. associations with human leukocyte antigens (HLA-antigens) Materials and Methods: Westudied172menand156 and identifying markers for aggressive joint disease women from the Hertfordshire Cohort Study, each of which Method: There were 29 primary patients with ankylosing underwent peripheral quantitative computed tomography spondylitis. (pQCT) of the tibia (38%) in 2004-5 and then again in S440 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 2011-12. Gait speed was assessed for all of these at baseline treatment pathway compared to current clinical practice (3-metre walk) and for 164 men and 147 women at follow- in Sweden. up (8-foot walk). percentage change per year was calculated Material and Methods: The analysis was carried out for gait speed, muscle cross-sectional area (mCSA), fat using a model that simulates the eligibility of individual cross-sectional area (fCSA) and diaphyseal bone parameters patients to be considered for pharmacological treatment (total area (Tt.Ar), cortical area (Ct.Ar), cortical density during one year and their projected osteoporosis treat- (Ct.BMD), and polar stress strain index (SSIp)). The bone, ment pathway, quality adjusted life years (QALYs) and fat and muscle parameters were then transformed using the costs over their remaining lifetime. All patients regard- Fisher-Yates rank-based inverse normal transformation to less of treatment or no treatment were simulated. create sex-specific z-scores. Relationships between gait Information on current management of osteoporosis in speed and pQCT parameters were assessed using linear terms of patient characteristics and treatment patterns regression. were derived from a Swedish osteoporosis research da- Results: The mean age of men and women at baseline was tabase based on national registers and patient records. 68.9 and 69.3 years respectively. Mean (SD) follow up time Current (standard) clinical management was compared was 7.17 (0.39) years. Mean (SD) baseline gait speed was with alternative scenarios mirroring Swedish treatment higher in men than women at 0.94 (0.16) and 0.89 (0.16) guidelines: (1) persistence in osteoporosis treatment ini- m/s respectively (p=0.01). Rate of decline did not differ sig- tiators increased by 50%; (2) non-persistent patients nificantly by sex. A greater baseline gait speed was associated switch to next line treatment; (3) patients with ≥15% with a slower decline in diaphyseal Ct.Ar and SSIp in men and 10-year fracture risk (FRAX) undergo BMD measure- Tt.Ar in women. In men, rate of loss of gait speed was posi- ment and start treatment if T-score ≤-2; (4) patients with tively associated with rate of loss of Ct.Ar. In both men and hip/vertebral fracture start treatment; (5) scenario 1–4 women, a slower decline in gait speed was associated with a combined. slower increase in fCSA and slower decline in mCSA al- Results: The proportion of patients treated for osteopo- though the latter association only reached statistical signifi- rosis increased in scenarios 1–5 compared with current cance in women. All relationships were maintained after ad- management. The maximum benefit, i.e. health gains justment for the corresponding baseline bone, fat or muscle obtained with scenario 5, was estimated at 3,864 parameter (p<0.05). QALYs. Costs of fractures in this scenario decreased Conclusion: Maintenance of gait speed is associated with a by €133M and the cost/QALY was €21,646. The margin slower increase in subcutaneous fat in the lower limb. In men, of investment, i.e. the maximum amount that could be the rate of loss of Ct.Ar is associated with both baseline and invested in the healthcare system to achieve these im- rate of loss of gait speed. This suggests that interventions to provements up to the limit of the willingness to pay for optimise and maintain mobility may help to ameliorate the a QALY in Sweden, was estimated at €187M on a pop- age-related deterioration in bone health. ulation level (€3,419/patient). Table 1 presents the re- sults for all scenarios. Conclusion: The analysis showed that better compliance P747 to treatment guidelines is associated with better out- COST-EFFECTIVENESS OF COMPLYING WITH comes and cost-savings. From a cost-effectiveness per- TREATMENT GUIDELINES IN SWEDEN spective, there is also a considerable room for invest- E. Jonsson1, A. Hansson-Hedblom1, O. Ljunggren2,K. ment to achieve these improvements in the management Akesson3, A. Spångeus4,F.Borgström5,J.A.Kanis6 of osteoporosis. 1Quantify Research, Stockholm, Sweden, 2Department of Disclosures: Funded by an unrestricted grant from Medical Sciences, Endocrinology and mineral metabolism, Medtronic. Uppsala University, Uppsala, Sweden, 3Lund University, Dept. of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Malmö, Sweden, 4Dept. Medical and Health Science, Linköping University, Linköping, Sweden, 5Quantify Research and Karolinska Institutet, Stockholm, Sweden, 6Catholic University of Australia, Melbourne, Australia and University of Sheffield, Sheffield, United Kingdom Objective: To estimate the cost-effectiveness of improve- ments in the management of osteoporosis over the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S441 P748 with widespread tender points in specific areas, easy fatigabil- THE IMPACT OF IMAGE ANALYSIS ERRORS (IAE) ity and sleep disorder. Recent studies revealed several markers ON LUMBAR SPINE (LS) AND PROXIMAL FEMORAL of inflammation in FMS, but the role of inflammation on the (PF) DUAL ENERGY X-RAYABSORPTIOMETRY (DXA) development or progression of FMS is still uncertain and con- C. G. Monaco1,C.Messina1,A.Poloni1,A.Biacca1,F.M. troversial. Mean platelet volume (MPV), red blood cell distri- Ulivieri2,L.M.Sconfienza1 bution width (RDW), neutrophil-to-lymphocyte ratio (NLR), 1Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte Italy, 2Fondazione IRCCS Ca' Granda - Ospedale Maggiore ratio (MLR) and RDW-to-platelet ratio (RPR) may reflect the Policlinico, Milan, Italy systemic inflammatory response associated with many dis- eases, but their roles in FMS are unclear. The aim of the Purpose: IAE in LS and PF DXA are common. We evaluated present study was to evaluate the routine hematological pa- the effect of IAE on bone mineral density (BMD) and T-score. rameters on FMS and to explore their clinical significance. Methods and Materials: DXAimagesofpatientswhoper- The study included 213 patients with FMS and 113 healthy formed a LS/PF DXA in January-March 2015 were retrospec- individuals. Medical records, Erythrocyte sedimentation rate tively reviewed. When a IAE was present, an expert radiolo- (ESR), C-reactive protein (CRP), white blood cell count gist made necessary corrections. For LS-DXA we considered (WBC), platelet count (PLT), RDW, NLR, PLR, MLR, RPR the average L1-L4 BMD and T-score. For PF-DXA we con- and MPV levels were retrospectively recorded from patient sidered the total hip (TH) and neck values of BMD. files. There were no significant differences in WBC, PLT, Results: We evaluated n=131 LS-DXA and n=142 PF-DXA RPR, MLR levels between two groups (all p>0.05). MPV, in 150 patients. We found IAE in n=79 LS-DXA (60.3%) and RDW, NLR, PLR and CRP values were significantly higher n=93 PF-DXA (65.5%). Most frequent IEA for LS-DXAwere in the FMS group than in the control group (all p<0.05). CRP inaccuracies in vertebral inclusion/exclusion (40/79; 50.6%) was positively correlated with NLR and MLR in FMS pa- and intervertebral lines placement (ILP) (37/79; 46.8%). Most tients. Our study showed that hematological markers especial- frequent IEA for PF-DXA were incorrect neck-box areas ly NLR might be used as markers that show inflammation in (NBA) and total-box area (TBA), 36/93 (38.7%) and 33/93 patients with FMS. (35.4%) respectively. After re-analysis, mean L1-L4 BMD: baseline=0.885±0.165, corrected=0.863±0.162 (varia- tion=2.6%); mean NBA BMD: baseline=0.658±0.104, P750 corrected=0.659±0.108 (variation=-0.2%); mean TBA PREVALENCE OF VERTEBRAL DEFORMITIES IN BMD: baseline=0.766±0.113, corrected=0.764±0.112 (varia- TYPE 1 DIABETIC PATIENTS tion=0.3%). Differences between LS-DXA BMD and T-score O . V. Vo dy an ov a 1, A. P. Shepelkevich2,N.S.Korytko2,N.A. pre- and post-correction were statistically significant (p<0.01) Vasilieva3 when considering all errors as well as inaccuracies in vertebral 1Belarusian Medical Academy of Postgraduate Education, inclusion/exclusion alone. For errors in ILP, differences were Minsk, Belarus, 2Belarusian State Medical University, significant only for BMD values (p<0.05). No significant dif- Minsk, Belarus, 3Republican Medical Rehabilitation and ference was found between baseline and corrected PF-DXA in Balneotherapy Centre, Minsk, Belarus terms of BMD and T-score, considering all errors, incorrect NBA and incorrect TBA. Aim: To assess the prevalence of vertebral deformities, bone Conclusion: IAE significantly impacts only on LS-DXA and mineral density in type 1 diabetic patients. not on PF-DXA. IAE should be avoided for a proper diagnosis Materials and methods: we examined 103 type 1 diabetic and therapy. patients (37 males, 66 females, age: 31 [24,9;38] yrs, duration of DM: 12 [7;19] yrs, HbA1c: 8,7±2,1%, BMI: 23,1 [21,8;25,8] kg/m2). The control group consisted of 62 health P749 age- and BMI-matched persons (14 males, 48 females). Bone HEMATOLOGICAL INDICES IN PATIENTS WITH FI- mineral density (BMD) was measured with DXA with lateral BROMYALGIA vertebral assessment (LVA). We used the Genant classification S. Hira1,M.Gem2 to assess a grade of vertebral deformity. Spinal deformity in- 1Department of Clinical Biochemistry, Tatvan State Hospital, dex (SDI) proposed as surrogate marker of bone quality, was Bitlis, Turkey, 2Department of Orthopaedic Surgery and calculated by summing the severity and the number of the Traumatology, Dicle Medical School, Diyarbakir, Turkey vertebral fractures. Results: BMD was lower in type 1 diabetics either at spine (Z- Fibromyalgia syndrome (FMS) is a common rheumatologic score -0,55+1,21 vs. 0,25+1,1, p<0,001) and at femoral neck disorder characterized by generalized musculoskeletal pain (Z-score -0,65+1,09 vs. 0,2+0,95, p<0,001) in comparison S442 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 with control group. 16,4% of type 1 diabetic patients had were enrolled. At the Dual-energy X-ray absorptiometry as- vertebral deformities (n=27) (4 patients had 2-3 deformities sessment, the mean lumbar spine T-score was -2.76±1.14 stan- of different types at the same time) that was statistically higher dard deviations (SD) and the mean femoral neck T-score was - than in control group (3,6% (n=6), p=0,0177). 21% of dia- 2.49±0.80 SD. During the study, the persistence was 91.4% betics showed vertebral fractures in spite of Z-score BMD and the total dropouts were 75 (8.6%). After 12 months of higher than -2. SDI had the tendency to be higher in type 1 treatment, persistence to therapy was over 99% that was main- diabetics comparing with controls (0 [0; 1] vs. 0[0; 0], tained during all the study. The 4% of study population, who p=0,007). had started earlier therapy, reached 56 months of treatment Conclusions: Type 1 diabetics showed an increased preva- with a persistence of 100%. lence vertebral deformities (p=0,0177), regardless of BMD. Conclusion: This multicenter observational real practice A possible reduction of bone quality may play a role in the study showed that persistence to denosumab treatment in our increased prevalence of vertebral deformities. A larger study cohort of postmenopausal women was very high. High persis- had to be performed to confirm these data. tence to therapy could be particularly linked to the pharmaco- logical schedule, but also to other factors such as frequency of visits, and opportunity to call the doctor could play a role in P751 the persistence to treatment in these patients. EVALUATION OF DENOSUMAB PERSISTENCE IN POSTMENOPAUSAL WOMEN AFFECTED BY SEVERE OSTEOPOROSIS: A MULTICENTER P752 OBSERVATIONAL REAL PRACTICE STUDY PAIN AND HEALTH RELATED QUALITY OF LIFE S. Migliaccio1,D.Francomano2, E. Romagnoli2,C. IN PATIENTS WITH PRIMARY OSTEOPOROSIS Marocco2,R.Fornari2,G.Resmini3,A.Buffa4,G.Di B. Dunoiu1,D.Matei2, S. Patru2,I.R.Marcu2,A.C.Bighea2 Pietro5, S. Corvaglia4, F. Gimigliano6, A. Moretti5,A.de 1Rehabilitation Department, Emergency Hospital, Craiova, Sire5,N.Malavolta4,A.Lenzi2,E.A.Greco2,G.Iolascon5 Romania, 2University of Medicine and Pharmacy, Craiova, 1Dept Movement, Human and Health Sciences, Foro Italico Romania University, Rome, Italy, 2Dept of Experimental Medicine, Section of Medical Pathophysiology, Endocrinology and Osteoporosis, often overlooked and undertreated, is one of the Nutrition, University “Sapienza” of Rome, Rome, Italy, most common metabolic bone disease and can result in dev- 3Center of Osteoporosis and Skeletal Metabolic Diseases, astating physical, psychosocial, and economic consequences. Section of Orthopaedic and Traumatology, Treviglio- Objective: The study has proposed to highlight the influence Caravaggio Hospital, Bergamo, Italy, 4St Orsola-Malpighi of pain status in quality of life for patients with primary oste- Hospital, University of Bologna, Department of Medical and oporosis (type 1 and also type 2) and the importance of com- Surgical Sciences, Division of Internal Medicine, Bologna, plex health care. Italy, 5Department of Medical and Surgical Specialties and Patients and methods: 81 patients with osteoporosis (bone T Dentistry, University of Campania, Naples, Italy, scores<-2.5SD; BMD was measured by means of dual energy 6Department of Physical and Mental Health and Preventive X-ray absorptiometry of hip) completed questionnaires detail- Medicine, University of Campania, Naples, Italy ing lifestyle factors and co-morbidities before (T0) and three month after a complex rehabilitation program (T1) associated Objective: To evaluate persistence to denosumab treatment in with osteoporosis medication. Each patient was evaluated osteoporotic postmenopausal women. using 100mm VAS pain (by spinal compression fractures), Material and Methods: In this multicenter observational real SF-36 and EQ- 5D questionnaires. practice study we recruited postmenopausal women affected Results: The mean age was 63.7±6.6 years; the mean duration by osteoporosis. We included women aged >50 years, able to of pain was 3.51±0.23 years. The SF36 was significantly cor- receive a prescription according to the Italian reimbursement related with the level of pain (p <0.01). For all patients, the criteria in force during the study period for anti-osteoporotic presence of pain had repercussions on SF-36-physical health pharmacological treatment. They initiated a treatment with (correlation: 0.629). After rehabilitation program was per- subcutaneous denosumab 60 mg/every 6 months between formed, the SF-36 and EQ-5D improved, with statistically November 2011 and May 2016. Women who had received significant differences between initial and final average. aromatase inhibitors were excluded. Patients were evaluated Conclusion: The principal goals of health care for these pa- at baseline and every 6 months for all treatment length. tients are to maintain independence and preserve good quality Persistence data were evaluated for a total of 36 months. of life; the results of study support the idea that the general Results: Eight hundred seventy women (with a mean age of health and functional status are strongly influenced by the 70 years and a mean body mass index of 24.8±4.1 kg/m2) level of pain. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S443 P753 women. However correlations appear stronger in postmeno- COMPARISON OF ASSOCIATION BETWEEN pausal women compared to premenopausal women. The rea- APPENDICULAR SKELETAL MUSCLE MASS AND son behind such correlations needs to be explored in future BONE MINERAL DENSITY AT DIFFERENT SITES studies. OF PRE- AND POSTMENOPAUSAL WOMEN N. Rathnayake1,J.Lenora2, G. Alwis3,S.Lekamwasam4 1Allied Health Science Degree Programme, Faculty of P754 Medicine, University of Ruhuna, Galle, Sri Lanka, EFFECT OF MINODRONATE ON VERTEBRAL 2Department of Physiology, Faculty of Medicine, University BONE MICROARCHITECTURE AND STRENGTH of Ruhuna, Galle, Sri Lanka, 3Department of Anatomy, IN VIVO ASSESSED BY CLINICAL COMPUTED Faculty of Medicine, University of Ruhuna, Galle, Sri TOMOGRAPHY Lanka, 4Department of Medicine, Faculty of Medicine, T. Mawatari1,S.Arisumi1,S.Ikemura2,G.Matsui1,T. University of Ruhuna, Galle, Sri Lanka Iguchi1, H. Mitsuyasu1, K. Kawano1, M. Takahashi1,Y. Nakashima2 Objective: This cross sectional study examined the asso- 1Department of Orthopaedic Surgery, Hamanomachi ciation between appendicular skeletal muscle mass Hospital, Fukuoka, Japan, 2Department of Orthopaedic (ASMM) and bone mineral densities (BMD) at different Surgery, Kyushu University, Fukuoka, Japan skeletal sites of healthy pre- and postmenopausal women. Objective: Minodronate (MIN) is one of the most potent Materials and methods: The study included a randomly bisphosphonates, and has been reported to increase bone min- selected sample of healthy premenopausal (n=184) and eral density (BMD) and reduce fracture risk. The purpose of postmenopausal women (n=166). ASMM (kg) and BMDs this study was to clarify the effect of MIN in vivo on the (g/cm2) were measured with DXA scanning (Hologic Inc. vertebral microarchitecture and strength estimated by finite Bedford, USA). Associations between ASMM and total element analysis (FEA). body BMD (TBBMD), total spine BMD (TSBMD), total Material and Methods: Treatment-naïve MIN-treated female hip BMD (THBMD), femoral neck BMD (FNBMD), tro- osteoporosis patients (n=10) and non-treated age-matched his- chanter BMD (TroBMD) were determined with Pearson torical control (n=10) were retrospectively evaluated. Areal correlation coefficient (r). Coefficient of determination BMD (aBMD) scanned by DXA, and 3D data of 3rd lumbar (R2) and standard error of estimate (SEE) were also spine scanned by quantitative computed tomography (qCT) at observed. a spatial resolution of 351 x 351 x 500μmwererepeatedly Results: Mean (SD) age of pre and postmenopausal women evaluated. Bone volume fraction (BV/TV), trabecular thick- were 42.5(6.0) years and 55.1(3.8) years, and mean (SD) ness (Tb.Th), trabecular number (Tn.N), and connectivity ASMM of pre and postmenopausal women were density (CD) were calculated by custom-made software. In 16.06(2.51) kg and 14.87(2.96) kg (p<0.001), respectively. addition, vertebral fracture load defined as the vertebral BMDs of all sites were significantly higher among premeno- strength index was estimated by FEA (Mechanical Finder, pausal women compared to the postmenopausal women Tokyo, Japan). (p<0.001). ASMM showed significant correlations with total Results: After 1year, non-treated control lost -2.9% of aBMD, and all regional BMDs in both pre and postmenopausal wom- and the MIN group gained 6.3%, while BV/TV changed - en (p<0.001) in both age unadjusted and age adjusted 14.6% and +15.3%, respectively. Tb.Th and Tb.N in non- correlations. treated control were severely decreased over 1-year period (- The correlations between ASMM and BMDs among premen- 4.7%, -10.0%, respectively), whereas MIN could reverse opausal women are; TBBMD: r=+0.23, R2=0.05, TSBMD: changes in those parameters (+5.5%, +9.2%, respectively). r=+0.25, R2=0.06, THBMD: r=+0.41, R2=0.16, FNBMD: CD, however, could not be improved by the treatment (- r=+0.33, R2=0.10, TroBMD: r=+0.31, R2=0.09. 27.9% vs. -3.2%). FEA revealed severe strength loss in the The correlations between ASMM and BMDs among non-treated control and gain in the MIN group (-15.3%, vs. postmenopausal women are; TBBMD: r=+0.41, R2=0.16, 10.0%). TSBMD: r=+0.42, R2=0.17, THBMD: r=+0.56, Conclusion: Our results indicate that evaluation of aBMD by R2=0.31, FNBMD: r=+0.58, R2=0.33, TroBMD: r=+0.46, DXA would underestimate both changes in bone R2=0.21. microarchitecture and strength. Despite the apparent increase Conclusion: Premenopausal women, compared to postmeno- in bone volume by MIN, it might be difficult to reestablish pausal women had higher ASMM and BMDs in all sites stud- trabecular connectivity. In order to prevent connectivity loss, ied. ASMM has positive and significant associations with total earlier therapeutic intervention would be necessary before the as well as regional BMDs in both pre and postmenopausal connectivity has been lost. S444 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Disclosures: This work was partially supported by a Grant-in- P756 Aid from the Japan Society for the Promotion of Science CLUSTER ANALYSIS OF BONE MICROARCHITEC- KAKENHI: Grant No. 15K10480. TURE FROM HIGH RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY (HR- PQCT) AND FRACTURE IN THE GLOW STUDY P755 A. E. Litwic1, L. Westbury1,D.E.Robinson2,K.A.Ward1,C. THEUSEOFVITAMINDINPREVENTIONANDTREAT- Cooper3,E.M.Dennison1 MENT OF OSTEOPOROSIS: OUR EXPERIENCE 1MRC Lifecourse Epidemiology Unit, University of S. Mulic1,D.Antic2,A.Hajdarovic3 Southampton, Southampton, United Kingdom, 2Arthritis 1Rheumatology Department, University Clinical Center, Research UK Centre for Epidemiology, University of Tuzla, Bosnia and Herzegovina, 2 UCC Tuzla, Manchester, Manchester, United Kingdom, 3MRC Lifecourse Rheumatology Department, Tuzla, Bosnia and Herzegovina, Epidemiology Unit, University of Southampton, MRC Human 3University Clinical Center Tuzla, Tuzla, Bosnia and Nutrition Research, Elsie Widdowson Laboratory Oxford Herzegovina NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Southampton, United Kingdom Vitamin D is known as liposoluble vitamin found in food, but is also produced endogenously. This initial form of vitamin D Objective: A recent study in the Hertfordshire Cohort Study is actually an inert form that must undergo two hydroxylation (HCS) reported two separate micro-architectural bone pheno- processes to become active. Serum concentrations of 25 (OH) types associated with high fracture rates, as assessed by HR- D, active form of vitamin D, are the best indicator of vitamin pQCT. We aimed to replicate these findings in the D status in the body and reflect the endogenous production of Southampton arm of the Global Longitudinal Study of vitamin D as well as the food and supplement intake. 25 Osteoporosis in Women (GLOW) study. (OH) D is a biomarker for the presence of vitamin D in Material and methods: Women recruited from local prac- human body, but has not yet fully clear to what extent 25 tices completed annual questionnaires, including fracture (OH)D also serve as biomarker of efficiency. Based on data events, for 5 years. Data were available for 220 women, mean from the U.S. Institute of Medicine in 2010. it has been age 70.2 (5.6) years at time of scanning. Participants concluded that serum 25 (OH) D levels less than 30nmol / underwent HR-pQCT (XtremeCT) imaging (voxel size 82 L (<12ng/ml) are vitamin D deficiency, and values 30- μm) of the distal radius. Standard image analyses were per- 50 nmol / l (12-20ng/ml) represent the values of insufficiency formed for assessment of macrostructure, regional densitom- of vitamin D. Today is practically a world pandemic of vita- etry and trabecular microarchitecture. Linear regression was min D insufficiency/ deficiency in the general population. used to examine the relationships between individual High prevalence of vitamin D deficiency was confirmed in HRpQCT parameters and fracture history. K- means all parts of the world.In Bosnia and Herzegovina, there are partitioning cluster analysis was used to identify 4 clusters. little data on vitamin D intake and 25 (OH) D serum levels Mean total hip aBMD and differences between fracture vs. used both in prevention or treatment. We have conducted few non fracture groups were determined for each cluster. small researches in order to evaluate the serum levels of Results: Fifty two women reported a fracture after the age of 25(OH)D as well as to establish whether the substitution of 45. In unadjusted analyses, history of fracture was associated D vitamin and Ca is sufficient. with lower intra-cortical porosity (p=0.033), trabecular densi- In a small research at our department and Orthopedic clinic on ty (p=0.002) and trabecular number (p<0.001), and higher 30 patient with hip fracture, 89.7% had low values of 25 trabecular separation (p<0.001). Whilst 2 clusters (Cluster 3 (OH)D vitamin, and only 10% of patients were taken substi- and 4) had a significantly lower hip aBMD (p<0.001) com- tution therapy with vitamin D. pared to Cluster 1; only individuals in Cluster 4 had a signif- In 50 patient with lupus erythematosus on steroid therapy we icantly higher risk of fracture (Relative risk [95% CI] com- have found that 14 (41.1%) did not take any prophylaxis, and pared to Cluster 1: 2.68 [1.31, 5.48], p=0.007). In Cluster 4, 16 (47.05%) were subdosed with Ca and D vitamin. there were differences in HRpQCT-measured trabecular pa- In our patients treated for postmenopausal osteoporosis with rameters: lower trabecular density and number and higher Pamidronate we have found 12 out of 30 with fragile fractures trabecular separation compared to the analysis sample, (4 with multiple fractures), and 97.5% of patient were whereas Cluster 3 had higher trabecular area and lower cor- subdosed, and 78.45% had vitamin D deficiency (<30mol/l). tical area, thickness and density compared to the analysis In conclusion it can be said that in the majority of patients sample. insufficiency / deficiency of vitamin D was found, and that Conclusion: A cluster analysis of HRpQCT parameters in patients who are on substitution therapy were often GLOW derived one cluster (4) with a significantly higher frac- subdosed. ture risk. However 2 phenotypes (3- cortical parameters and 4 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S445 – trabecular parameters) were very similar to previously report- laser therapy, local steroid injection and kinesio-taping in the ed results from the HCS, where both were associated with treatment of lateral epicondylitis with regard to clinical variables higher fracture risk. The different findings between the two and functional status. studies may reflect the younger mean age at scan in GLOW. Materials and Methods: 90 patients with lateral-epicondylitis were included. Mean age of the patients (68 women and 22 men) was 47.53 years. Patient-rated tennis-elbow evaluation P757 (PRTEE) scores and positivity of Maudley test, Cozen's test BONE METABOLISM IN PSORIATIC ARTHRITIS and Millis test were recorded before the treatments and one H. P. Bhattoa1,Z.Szekanecz2,Z.Petho2 month after the treatments. The patient's elbow range of mo- 1Department of Laboratory Medicine, University of Debrecen, tion (ROM) degrees and elbow pain intensity at rest, move- Debrecen, Hungary, 2Department of Rheumatology, University ment and night which was evaluated with visual analog scale of Debrecen, Debrecen, Hungary (VAS) were recorded. Patients were randomized by sealed envelope method into 3 groups; kinesio taping (n=30), local Introduction: Skeletal manifestations as a result of abrupt steroid injection (n=30) and low-level laser treatment (n=30). bone metabolism may be predominant in psoriatic arthritis The first group received 5 sessions of kinesio taping with 3 or (PsA). 4 days intervals, second group was treated with one dosage of Patients and materials: A total of 118 PsA patients were re- local steroid and local anesthetic injection, and third group was cruited from the out-patient unit of the Department of treated with low-level laser five sessions per week for two Rheumatology between September 2015 and June 2016. weeks duration. Psoriasis severity was assessed by the PASI score, severity of Results: At the evaluation of first month after treatment, rest arthritis and axial symptoms was determined by the DAS28 pain, night pain, PRTEE-pain scores and PRTEE-functional and BASDAI indexes. Blood samples were drawn to measure scores were significantly better than pre-treatment scores in all 25 hydroxyvitamin D (25OHD), parathyroid (PTH), osteocalcin groups (p<0.05). Additionally Maudley test, Cozen's test and (OC) and C-terminal telopeptides of type-I collagen (CTx) levels. Mills test's positiveness were significantly decreased (p<0.05) Lumbar spine (LS) and femoral neck bone mineral density was in all groups. There were no significant differences between measured using DXA and peripheral qCT was used to measure groups in terms of VAS pain scores, Cozen's test, Maudley test distal radius BMD. FRAX questionnaire was also administered and Mills test positivity. In local steroid injection group, im- to determine the risk of fractures in the consequent 10 years. provement in PRTEE-daily-activities-sub-group scores, Results: The mean (range) age of the PsA patients was 53 (25- which indicate functional status, were significantly higher 85) years. The mean (range) 25OHD level was 53 (6-120) than in kinesio taping and low-level laser treatment groups nmol/L. Disease activity correlated significantly with age (p<0.05). (p=0.043), psoriasis activity (p=0.031), ten year probability Conclusion: As a conclusion, all three treatment methods of a major osteoporotic fracture as per the FRAX question- (local steroid injection, kinesio-taping and low-level laser naire (p=0.005) and 25OHD levels (p=0.020). LS BMD therapy) have similar efficacy on reducing symptoms in showed a non-significant negative correlation with disease lateral epicondylitis; but after first month, better functional activity. Both FRAX calculated major and hip fracture risk improvement was determined with local steroid injection correlated significantly with qCT measured BMD values. treatment. Conclusion: The disease activity in PsA is directly correlated with FRAX related fracture probabilities. P759 A CASE OF ASSOCIATION OF OSTEOGENESIS P758 IMPERFECTA AND GRAVE’SDISEASE THE EFFICACY OF KINESI TAPING, LOCAL STEROID M. S. Sheremeta1,I.M.Belovalova2, E. A. Pigarova2 INJECTION AND LOW LEVEL LASER THERAPY IN 1Department of Radionuclear Therapy of Endocrinology PATIENTS WITH LATERAL EPICONDYLITIS Research Centre, Moscow, Russian Federation, P. Borman 1, A. Esmer2,B.Nacir3,M.Guler3,A.Karagoz3 2Endocrinology Research Centre, Moscow, Russian 1University of Hacettepe Faculty of Medicine Dept. of PMR, Federation Ankara, Turkey, 2Cankiri Devlet Hastanesi, Cankiri, Turkey, 3Ankara Education and Research Hospital Clinic of PMR, Introduction: Osteogenesis imperfecta is very rare genetic Ankara, Turkey disorder that has various comorbidities. One of them is auto- immune thyroid disease. Objectives: The aim of this randomized-prospective-controlled Aim: To describe a clinical case of Grave's disease (GD) in a and single blind study was to compare the effects of low-level patient with osteogenesis imperfecta. S446 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: A 19-year old woman was referred to our tertiary performed. Authors examined further only 3 age groups care endocrine medical center for radioiodine treatment of 55-65, 66-80 a 80 and more due to low number of DMT1 GD. Her appearance was otherwise unremarkable except patients. DMT1 group of 109 patients (75 women and 34 for pronounced blue sclerae and hypermobile joints. Her men) had average vitamin D level 55.6 nmol/l (median anamnesis was remarkable for repeated fractures since 3 48.6 nmol/l), DMT2 group of 1889 patients (1203 wom- years old till present which mostly appeared at low trauma en and 686 men) had average vitamin D level 53.8 nmol/ conditions: left tibia, right tibia, left elbow, left radius, l, (median 51.5 nmol/l). All patients from the control right knee, cranial bones. She was not officially diagnosed group had repeatedly checked level of vitamin D and with osteogenesis imperfecta but was empirically treated basic parameters (weight, height, BMI and supplementa- in the right way by antiresorptives for a bit more than 2 tion with calcium and vitamin D). Results were compared later years (2 months with 150 mg ibandronate per os with a set of newly measured patients without diagnosis followed by 4 sc injections of denosumab 60 mg every of E10 and E11. DM patients had significantly lower 6 months). The treatment was started because of bone loss vitamin D level than the control group. The group was (DXA Z-criteria -3.4 SD at the spine and -2.8 SD at the divided into 2 groups. One received supplementation proximal femur sites) and high bone resorption assessed with calcium and vitamin D and the second group was by CTX (beta-crosslaps). During antiresorption treatment without supplementation, and according to the season of she received 500 mg of calcium a day and her labs were blood samples examination - summer and winter. Level as follows: Ca total – 2.36 mmol/l (2.15-2.55), Ca ion – of vitamin D was related not only to the age group, but 1.32 mmol/l (1.03-1.32), PTH – 38 pg/ml (15-65), ALP – also to the time of blood sample tests, supplementation 58 U/l (0-270), osteocalcin – 17.53 ng/ml (11-35), CTX – and BMI. 0.061 ng/ml (<0.580). GD is an autoimmune endocrine Due to low number of patients there was no correlation found disorder in which autoantibodies are able to activate thy- in DMT 1. roid stimulating hormone receptor in the thyroid gland There was no significant difference between the level of vita- inducing gland's hyperplasia and thyroid hormone excess min D in DMT 2 in summer and winter and no significant with the later responsible for high bone turnover osteopo- difference among type of supplementation. Only BMI had a rosis. Autoimmunity is postulated to be driven by low significant effect on vitamin D level in different types of sup- quality collagen predisposing to increased autoantigen plementation and age. T score surprisingly did not correlate presentation. The autoimmune thyroid pathology, with type of supplementation but with BMI. There was no Hashimoto thyroiditis, is thought to be associated with correlation in osteocalcin but a significant difference was osteogenesis imperfecta but to this date GD was not found in CTx in DMT2 patients experienced a significantly described. higher number of nonvertebral fractures than the control Conclusions: GD may be one of the presentations of group. thyroid autoimmunity in the setting of osteogenesis imperfecta. P761 RELATIONS BETWEEN MAXIMAL HALF SQUAT P760 STRENGTH AND BONE VARIABLES IN A GROUP VITAMIN D LEVELS, BMD AND FRACTURES IN OF YOUNG OVERWEIGHT MEN PATIENTS WITH DIABETES MELLITUS TYPE 2 A. Khawaja1,N.Fayad2,G.ElKhoury1,G.Maalouf3,J. V. Vy sk oc il 1,A.Planickova1 Matta4, F. Frenn4, H. Zouhal5, R. El Hage1 1Charles University Hospital PLZEN, Plzen, Czech Republic 1Department of Physical Education, Fass, University of Balamand, Kelhat El Kurah, Lebanon, 2Université The authors examined a group of 1998 diabetes patients Libanaise, Faculté de Pédagogie, Beirut, Lebanon, 3Bellevue which included 1278 females and 720 males. Only 109 University Medical Center, Faculty of Medicine, Saint Joseph patients suffered from diabetes mellitus type I (DMT1) University, Mansourieh, Lebanon, 4Industrial Research and 1889 patients from diabetes mellitus type II Institute, Beirut, Lebanon, 5STAPS, University of Rennes 2, (DMT2). Rennes, France Patients were divided into six age categories: 18-25, 26- 39, 40-54, 55-65, 66-80, 81 and more. Vitamin D level, Aim: The purpose of this study was to explore the re- osteocalcin, CTx and hip T score was measured in all lationships between maximal half squat strength and patients. Age categories were selected according to the bone variables (BMC, BMD, hip geometric indices and age groups in the control group of 2900 patients without TBS) in a group of young overweight men (BMI > 25 diabetes where DXA measurement was previously kg/m2). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S447 Materials and methods: 76 Lebanese young overweight defined as symptom severity score (SSS) and functional (BMI > 25 kg/m2) men whose ages range from 18 to 32 status score (FSS). Electrophysiologic studies comprised years participated in this study. Body composition and motor and sensory latencies (CMAPL, SNAPL) and am- bone variables were measured by DXA. Maximal half plitudes (CMAPA, SNAPA) of median nerve. The patients squat strength was measured by a classical fitness machine were randomized into three groups receiving either KT (Smith machine) respecting the instructions of the national performed three-times by intervals-of 4-day (Group 1); a association of conditioning and muscular strength single S/LA injection to carpal-tunnel (Group 2); or (NCSA). splinting alone for three-weeks (Group 3). The clinical Results: Maximal half squat strength was positively cor- and electrophysiologic studies were performed at baseline related to whole body BMC (r=0.37; p=0.001), whole and at third week. body BMD (r=0.29; p=0.01), L1-L4 BMD (r=0.42; p Results: 58 female and 2 male patients (mean age, 48.2 <0.001), total hip BMD (r=0.26; p=0.02), femoral neck ±8.9 years; disease-duration, 2.8+3.5 months) were includ- BMD (r=0.32; p=0.004), femoral neck cross-sectional ar- ed. There were no differences between the groups regard- ea (r=0.44; p <0.001), femoral neck cross-sectional mo- ing demographic variables on entry. Compared to baseline; ment of inertia (r=0.27; p=0.01) and femoral neck sec- post treatment VAS-pain and FSS scores improved signif- tion modulus (r=0.37; p <0.001). Using multiple linear icantly in the KT and splint groups at third week. regressions, positive correlations between maximal half According to nerve conduction studies, electrophysiologi- squat strength and several bone variables measured cal variables were improved in both KT and injection (whole body BMC, whole body BMD, L1-L4 BMD, groups but the difference was not statistically significant femoral neck BMD, femoral neck cross-sectional area (p>0.05; Table 1). and femoral neck section modulus) persisted after adjust- Conclusion: We imply that three-times of KT by 4-day ment for lean mass. intervals and splinting have favorable effects on pain Discussion: These results highlight the positive influence and functional status in the early period (up to one month) of maximal strength of the lower limbs on bone variables in patients with CTS. As the improvement in pain- in young overweight men. Our results have practical im- intensity was more significant with KT than in splinting; plications in the field of the prevention of osteoporosis in we suggest that KT may be an alternative non-invasive men. method, instead-of splinting, for CTS patients in the early Conclusion: This study suggests that maximal half squat period. strength is an independent determinant of bone mass, bone Table 1. The clinical/electrophysiologic properties of patients mineral density, and geometric indices of femoral neck in according to groups young overweight men. P762 THE KINESIO TAPING; LOCAL ANESTHETIC/STEROID INJECTION AND SPLINTING IN THE TREATMENT OF PATIENTS WITH CARPAL TUNNEL SYNDROME: A CLINICAL AND ELECTROPHYSIOLOGICAL STUDY S. Kocaoglu1,A.Esmer1,M.Okumus1,E.Ozturk2,F.Kaygisiz1, G. Demir1 1Ankara Education and Research Hospital Clinic of PMR, Ankara, Turkey, 2University of Hacettepe Faculty of Medicine Dept. of Biostatistics, Ankara, Turkey Objectives: The aim of this study was to investigate the effi- cacy of local anesthetic/steroid injection (S/LA), kinesio- taping (KT) and splinting in patients with carpal tunnel syn- drome (CTS) with regard to pain, disability and nerve conduc- tion studies. Materials and Methods: 60 patients with CTS were en- rolled. Visual analog scale (VAS) was used to assess the intensity of pain. Symptom severity and functional status were evaluated by Boston-Questionnaire and scores were S448 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P763 References:- Bruyère O et al. Semin Arthritis Rheum SELF-MANAGEMENT EXERCISE PROGRAM 2014;44:253. ASSOCIATED TO SPA THERAPY INCREASED THE - Gay C and al. Ann Phys Rehabil Med 2016;59:174. PHYSICAL ACTIVITY LEVEL OF PEOPLE WITH SYMPTOMATIC KNEE OSTEOARTHRITIS: A QUASI-RANDOMIZED CONTROLLED TRIAL P764 C. Gay1, C. Guiguet-Auclair2, N. Boisseau3,L.Gerbaud4,E. THE INFLUENCE OF LIFE STYLE RISK FACTORS Coudeyre5 ON BONE MINERAL DENSITY 1Physical and Rehabilitation Medicine Department, Clermont- G. Stefanovski1,T.Popovic2, M. Glogovac Kosanović3 Ferrand University Hospital, Clermont Ferrand, France, 1Rheumatology, Institute "Dr M. Zotovic", Banja Luka, 2Public Health Department, Clermont-Ferrand University Bosnia and Herzegovina, 2Faculty of Physiotherapy, Hospital, Clermont Auvergne University, PEPRADE, EA Prijedor, Bosnia and Herzegovina, 3Neurology, Institute "Dr 4681, Clermont Ferrand, France, 36Laboratory of the M. Zotovic", Banja Luka, Bosnia and Herzegovina Metabolic Adaptations to Exercise under Physiological and Pathological condition (AME2P), Clermont Auvergne Objective: The life-style risk factors for osteoporosis in the University, EA 3533, Clermont Ferrand, France, 4Public female population differ from country to country. Our objec- Health Department, Clermont-Ferrand University Hospital, tive was to find out the relationship between life style factors Clermont Auvergne University, PEPRADE, EA 4681, and bone mineral density (BMD) in women of Banjaluka Clermont Ferrand, France, 5Rehabilitation Department and region. Physical Medecine, Clermont-Ferrand, France Material and Method: The study included 1164 Caucasian women (age 36 –75; mean age 58.3) free of medications af- Objective: To assess effectiveness of self-management exer- fecting bones. BMD was measured at lumbar spine and left cise program associated to spa therapy at 3 month on the hip by DXA (Lunar Prodigy). According to the WHO defini- improvement of physical activity (PA) level, disability, pain, tion of osteoporosis, the participants were divided into three anxiety, fears and believes in symptomatic knee osteoarthritis (3) groups: normal BMD (N): 144 (12.37%); osteopenia (OA) people. (OPN): 356 (30.58%) and osteoporosis (OP): 664 (57.04%). Material and Methods: Prospective, multicentric, quasi- Data about lifestyle factors was collected by standardized nu- randomized controlled trial with alternate month design meth- merical questionnaires. The accepted level of significance was od (one month periods). People with symptomatic knee OA sat at p<0.05. people (stage I-IV, Kellgren-Lawrence scale) with low and Results: In total sample correlation analyses indicated signif- moderate PA level were included in 3 spa therapy resorts. icant association between low BMD and: increased caffeine 2 2 Intervention group (IG) received 5 self-management exercise intake (c gr=9.210; p<0.01), low calcium intake (c gr=5.991; 2 sessions (1h30; education, aerobic, strength training, range of p<0.05) and inadequate physical activity (c gr=9.210; motion) + information booklet + 18 sessions (1h) of conven- p<0.01). In comparison between N and OP groups, the signif- tional spa therapy (STC). Control group (CG) received infor- icant association was found but at greater significance. mation booklet + 18 sessions of STC. The primary outcome Conclusion: The results show the specifics of our population was changes at 3 months in PA level (IPAQ short form score) regarding the life style factors causing the changes in BMD. and secondary outcomes were WOMAC function, pain, HAD This could be useful in screening the patients for DXA. anxiety/depression, KOFBeQ fears and believes changes. Results: 131 subjects were included. Both groups significant- ly increased PA level measured with continuous IPAQ total P765 score (MET-minutes/weeks), with superiority for IG (+77.8%, IS THERE A RELATIONSHIP BETWEEN AUTONOMC p=0.0062) than CG (+50.7%, p=0.0099). Disability (-12,8%; NERVOUS SYSTEM ACTIVITY AND BONE MINERAL p=0.0032) and pain (-15.2%; p=0.0370) also decreased sig- DENSITY IN NON MEDICATED PERIMENOPAUSAL nificantly for both groups. Anxiety (-11.6%; p=0.0195) and WOMEN? fears and believes (-18.2%; p=0.0146) decreased significantly J. Elez1,F.Gojkovic2, J. Vasic2, V. Culafic-Vojinovic3 only in intervention group. Other data will be presented later. 1Department of Internal Medicine, Railway Healthcare Conclusions: This study confirms the impact of STC on dis- Institute, Belgrade, Serbia, 2Department of Physical ability and pain and gives news data’s on physical activity Medicine and Rehabilitation, Railway Healthcare Institute, level. Self-management exercise program improve anxiety, Belgrade, Serbia, 3Euromedic, Belgrade, Serbia fears and believes. Complex educational strategies comprising information booklet with or without self-management exer- Introduction: Osteoporosis is a skeletal disorder charac- cise program can be proposed and adapted to OA phenotypes. terized by a low bone mass and structural deterioration Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S449 of bone tissue. Its consequences are compromised bone Discussion: One of the noteworthy findings of our study was strength and an increased risk of fracture. There are that higher overall ANS activity was associated with higher findings reported that leptin, a hormone produced by BMD. Difference was also found between pre- and postmen- fat, inhibited bone formationinmice,thiseffectwas opausal subjects, with overall SNS activity and BMD both mediated by the sympathetic nervous system (SNS). being significantly decreased in the postmenopausal as com- Since these discoveries, the autonomic nervous system pared to the premenopausal subjects. (ANS) has attracted attention as a newly recognized regulator of bone remodeling, and a number of clinical and experimental studies have shown that SNS activa- P766 tion is associated with reduced bone mineral density EFFECT OF RITUXIMAB ON QUALITY OF LIFE (BMD). WITH RHEUMATOID ARTHRITIS MEN TO Materials and Methods: The present study involved 120 BASELINE BONE MINERAL DENSITY premenopausal women (47.9±4.0 years) and 156 post- T. Raskina1,M.Koroleva1,O.Malyshenko1 menopausal women (53.4±6.0 years). After height and 1Kemerovo State Medical University, Kemerovo, Russian weight measurements had been obtained, BMD was mea- Federation sured at the lumbar spine by dual-energy X-ray absorpti- ometry and the data were expressed as a T -score. ANS Objective: On the results of a prospective four-year observa- function was evaluated by analyzing the electrocardio- tion to evaluate the effect of rituximab on the quality of life gram (ECG) R–R interval variability. ECG data were dig- with rheumatoid arthritis (RA) men with different bone min- itized with a sampling rate of 1 kHz and the R–Rintervals eral density (BMD) to baseline. were stored sequentially. The spectral powers were calcu- Material and Methods: We observed 36 men with docu- lated for the following respective frequency bands—the mented diagnosis of RA (criteria ACR, 1987) with the low frequency (0.03–0.15 Hz) power (LP), an indicator combined therapy of methotrexate (mean dose of 13.56 of both SNS and PNS activity; the high frequency ±0.34mg/week)andrituximabtostandardscheme (0.15–0.5 Hz) power (HP), which reflects solely PNS ac- (1000 mg intravenously in the 1st and 15th days, the course tivity; and total (0.03–0.5Hz)power(TP)representing - 2 infusion, the average number of courses – 3.65±0.09). the overall ANS activity. In order to assess the balance All patients were randomized into two groups according to between SNS and PNS activities, we used LP/HP and HP/ the level of BMD and T-score: patients with osteopenia TP as indicators of SNS and PNS activities (SNA and (group 1, n=15) and with osteoporosis (group 2, n=21). PNA). Statistical differences between groups were To assess bone mineral density was performed dual- assessed using Student’s unpaired t test for parametric energy X-ray absorptiometry. To assess Life Quality (LQ) measures and the Mann–Whitney U test for non- questionnaires EQ-5D and HAQ were used. All patients parametric measures, and p values \0.05 were considered completed questionnaires on the baseline and then every statistically significant. Data are expressed as mean±SD 12 months to 4 years follow-up. or medians (range). Statistical differences between groups Results: When calculating a quantitative index for health were assessed using Student’s unpaired t test for paramet- questionnaire EQ-5D established that baseline in patients ric measures and the Mann–Whitney U test for non- with osteoporosis health index indicator was lower than in parametric measures, and p values p≤0.05 were consid- patients with osteopenia – 0.22±0.06 and 0.37±0.04 ered statistically significant. Data are expressed as mean (p=0.038). After 4 years of therapy there was a statistically ±SD or medians. significant increase in the index in both groups of patients Results: There were no significant differences between relatively baseline data – 0.47±0.02 and 0.62±0.04 (p pre- and postmenopausal subjects in height, weight, body <0.001 and p <0.001, respectively). Similar relationships mass index (BMI). BMD was significantly higher in pre- observed in the analysis of the dynamics of the index menopausal than in postmenopausal subjects (105.4 HAQ. Baseline in patients osteopenia HAQ index was ±16.5% vs. 91.3±15.3%, p\0.01). In premenopausal sub- 1.86±0.11, in patients with osteoporosis – 1.91±0.16 jects, no significant difference was observed in BMD be- (p=0.82), which corresponds to moderate functional im- tween the SNS- and PNS-dominant groups (103.5±18.4% pairment in patients of both groups. During therapy HAQ vs. 107.2±14.6%). However, in postmenopausal subjects, index was significantly decreased in both groups (HAQ BMD was significantly higher in the SNS-dominant group group 1 – 1.31±0.12, HAQ group 2 – 1.44±0.14, than in the PNS-dominant group (94.1±16.3% vs. 88.4 p=0.0006 and p=0.004) ±18.8%, p\0.05) ; BMD was also significantly different Conclusion: According to the results of a four-year observa- even after adjustment for age and BMI (93.5±15.5 vs. tion noted a positive effect of rituximab on the quality of life of 89.1±12.0, p\0.05). men with osteopenia and with osteoporosis. S450 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P767 P768 FRACTURE RISK AND RISK FACTORS OF HYPOVITAMINOSISDINOSTEOPOROTICPA- FRACTURES IN ANKYLOSING SPONDYLITIS TIENTS PRESENTING WITH VERTEBRAL FRAC- N. Nigil Haroon1,C.Pray2, N. Feroz3 TURE IN A TERTIARY LEVEL HOSPITAL IN BANG- 1Northern Ontario School of Medicine, Sudbury, Canada, LADESH 2University College Cork, Dublin, Ireland, 3Royal College S. Anwaruzzaman1, M. I. Majumder2 of Surgeons in Ireland, Dublin, Ireland 1Department of Orthopaedic surgery, Comilla Medical College, Comilla, Bangladesh, 2Department of Medicine, Aims: We conducted a meta-analysis to examine the risk of Comilla, Medical College, Comilla, Bangladesh fractures in patients with ankylosing spondylitis (AS). Additionally, we evaluated the risk factors of vertebral frac- Introduction: Hypovitaminosis D is widespread and is tures (VFs) in AS. re-emerging as a major health problem globally leading Methods: Two authors independently searched Embase and to bone pain, muscle weakness, increased risk of osteo- Medline for studies that had assessed the risk of fractures in porosis, falls and fractures. Hypovitaminosis D remain in AS. two forms as deficiency (Serum 25 OHD level <10 ng/ Results: 21 studies were eligible. Patients with AS had high ml) and insufficiency(serum Vitamin D3 10-30 ng/ml). frequency of VFs (OR (95% CI): 1.96 (1.52-2.51)). Major risk Causes of osteoporosis(OP) are multifactorial, vitamin factors for VFs include low BMD at the femoral neck and total D insufficiency can be an important etiological factor hip, male gender, disease duration, BASDAI, BASRI and in- in elderly. flammatory bowel disease. The risk of non-vertebral fractures Materials and Methods: A total number of 468 osteopo- (OR (95% CI): 1.0 (1.04-1.15)) was 10% higher in AS pa- rotic patients with vertebral compression fracture were in- tients than controls. The risk of hip fractures in AS patients cluded in this study. Patient with osteomalacia was exclud- was not statistically significant (OR (95% CI): 1.17 (0.71- ed considering clinical and radiological criteria. OP was 1.92) (Figure) assessed by bone mineral density(BMD) estimation using Conclusion: We found that patients with AS are at high risk of GE Healthcare Lunar Prodigy densitometer. After confir- VFs. Male sex, duration of AS, mSASSS, BASRI and low mation of OP and vertebral compression fracture by X- ray, BMD at the hip were associated with the risk of VFs. Current serum Vitamin D3 level was measured using enzyme evidence on the risk of hip fractures in AS is inconsistent. Data linked fluorescent assay. on the effect of NSAIDs and TNF inhibitors on fracture risk in Results: Majority patients in age group 40-60 years AS is limited. which was 260(55.6%) followed by 60-80 years of age which was 185(39.5%) and16(3.4%) cases were above 80 years. Female vs. male was 449(95.9%) vs. 19(4.1%) respectively. Hypovitaminosis D was in 85.14% patients and sufficient in 14.96% patients. BMD was 4.744 ±.9626gm/cm2 in deficient group and -3.274±.7502gm/ cm2 in sufficient group (p=0.0001).Vitamin D deficien- cy was found in 55 patients- male 1(1.8%) and female 54(98.2%), Vitamin D insufficiency was in 343 patients- male 13(3.8%) and female 330(96.2%), sufficient level in 84 patients. Vitamin D3 level was high in patients living in rural areas than patients living in urban area which was 23.842±8.2157 ng/dL and 19.479±8.7441 ng/ dL respectively (p=0.0001).The mean vitamin 25OHD level was high among the patients with adequate sun- light exposure than inadequately exposed patients- 37.253±5.4884 ng/dL and 19.318±6.6483 ng/dL respec- tively (p=0.0001). Hypovitaminosis D showed statisti- cally significant correlation on vertebral fracture and lower BMD level. Conclusion: Hypovitaminosis D was associated to more os- teoporotic vertebral fracture. Exposure to sunlight and vitamin D supplementation is recommended to preserve bone health and reduce fracture. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S451 P769 P770 PREDICTIVE ABILITY OF BIOMARKERS LINKED KNEE OSTEOARTHRITIS PATIENTS ARE LESS WITH SYNOVITIS FOR FUTURE INCIDENCE OF ACTIVE THAN THE GENERAL POPULATION KNEE OSTEOARTHRITIS IN THE COMMUNITY C. Gay1, C. Guiguet-Auclair2,C.Mourgues3, C. Levyckyj4, BASED COHORT OF MIDDLE-AGE WOMEN L. Gerbaud5, E. Coudeyre6 S. Kluzek1, C. S. Thudium2, A. C. Bay-Jensen2,M.Karsdal2, 1Physical and Rehabilitation Medicine Department, D. Hart3, T. Spector3, J. L. Newton1,N.K.Arden4 Clermont-Ferrand University Hospital, Clermont Ferrand, 1Nuffield Department of Orthopaedics, Rheumatology and France, 2Public Health Department, Clermont-Ferrand Musculoskeletal Sciences (NDORMS), University of University Hospital, Clermont Auvergne University, Oxford, Oxford, UK, Oxford, United Kingdom, 2Nordic PEPRADE, EA 4681, Clermont Ferrand, France, 3Public Bioscience, Herlev, Denmark, 3Department of Twin Health Department, Clermont-Ferrand University Hospital, Research and Genetic Epidemiology, King's College PEPRADE, EA 4681, Clermont Auvergne University, London, London, United Kingdom, 4Nuffield Department of Clermont Ferrand, France, 4Service Research and Orthopaedics, Rheumatology and Musculoskeletal Sciences, Development, Royat, France, 5Public Health Department, University of Oxford, Oxford, UK, Oxford, United Kingdom Clermont-Ferrand University Hospital, Clermont Auvergne University, PEPRADE, EA 4681, Clermont Ferrand, France, Objective: Recent studies have suggested that knee syno- 6Rehabilitation Department and Physical Medecine, vitis precedes development of radiographic knee osteoar- Clermont-Ferrand, France thritis (RKOA) and is associated with knee pain. Less than half of middle-aged individuals with RKOA will report any Objective: Describing the level and factors affecting the concurrent knee pain. Matrix metalloproteinase (MMP)- physical activity practices of knee osteoarthritis (OA) generated collagen type III (C3M) fragments and resistin patients. arebothassociatedwithkneesynovitis in knee osteoarthri- Materials and Methods: In total, 548 knee osteoarthritis pa- tis (KOA). Our aim was to evaluate the association be- tients were interviewed via self-administered anonymous tween the serum levels of these two biomarkers and future questionnaires between September and November 2014, in incidence of either painful RKOA or RKOA without pain, nine spa therapy resorts (France). The main outcome was in a community-based cohort of middle-aged women with physical activity level, evaluated by the International no RKOA at baseline. Physical Activity Questionnaire (short version) (IPAQ). Methods: We studied 582 participants (mean age 53.2, mean Secondary outcomes included sociodemographic and clinical BMI 25) from the Chingford Women Study who had a data, comorbidities, as well as barriers to and facilitators of Kellgren Lawrence (KL) score of 0 in both knees at baseline practicing regular physical activity, evaluated over 24 specific and we measured serum levels of C3M and resistin 1-2 years elements. later. Ten years after the baseline x-ray, we determined the Results: The study population’s mean age was 67.6 years incidence of RKOA defined as KL ⩾2 and painful RKOA (SD 7.9), including 73.9% women and 30.9% obese indi- defined as knee pain present on any number of days in the viduals with a mean body mass index (BMI) of 28.2 kg/m2 preceding month in the knee with RKOA. Each log- (SD 5.7). Multi-joint osteoarthritis (OA) affected 92%, transformed normalised biomarker results were utilised in a 71.6% of whom had comorbidities. The mean Visual separate logistic regression model adjusted for age and BMI Analogue Scale (VAS) pain intensity score was 4.5/10 with depended variable defined as either the painful RKOA or (SD 2.5), 51.4% better than the Patient Acceptable RKOA without pain. Symptom State (PASS). Mean WOMAC function was Results: 25% of women developed RKOA 10 years after the 36.6/100 (SD 20.7), 57.5% better than PASS; 67% of pa- recruitment, but only 37% of these affected reported any con- tients used analgesics, half of them at least once a week. current knee pain. Statistically significant associations were According to the IPAQ, 42.6% of patients reported high found between higher level of C3M and the risk of developing activity levels, 38.6% moderate, 18.8% low, and the medi- painful RKOA (odds ratio (OR) equal 3.4, 95% confidence an IPAQ total activity score was 2628 metabolic equivalent interval(CI) of 1.4 to 8.1) and between higher levels of resistin of task (MET)-min/week. Only a third of patients received and RKOA without pain (OR=0.59 95% CI: 0.38, 0.91). non-pharmacological treatment corresponding to the latest Conclusion: In a population of middle-aged women without recommendations. Variables significantly related to KOA, selected serum biomarkers, can identify high-risk indi- inactive/minimally active physical activity levels were viduals for developing painful RKOA and those at lower risk obesity (p=0.0181), gender (p=0.0041), and biomedical of developing RKOAwithout pain. These findings will poten- barriers, related to self-efficacy. tially facilitate the targeted recruitment of participants to pri- Conclusions: The OA study population was less active, mary and secondary preventive intervention trials. more sedentary, and had more comorbidities and more S452 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 barriers to physical activity practice than the overall pop- P772 ulation. This study could help better adapt health care mea- MRI CARTILAGE COLOR MAPPING AND THE sures, while taking into account patients’ overall status, EFFECTIVENESS OF OSTEOARTHRITIS TREAT- including symptoms of OA pathology and comorbidities, MENT providing tailored educational strategies with respect to E. Trofimov1, A. Trofimova1,V.Mazurov1 physical activity. 1Rheumatology Department, North-Western State Medical References: University named after I.I. Mechnikov, Saint-Petersburg, - McAlindon TE et al. Osteoarthritis Cartilage 2014;22:363. Russian Federation - Shih M et al. Am J Prev Med 2006;30:385. Objective: to evaluate the efficacy of different groups of drugs on the clinical course of osteoarthritis (OA) of the early P771 knee joint and biochemical status of cartilage tissue using GENDER FEATURES OF MORTALITY IN OSTEO- magnetic resonance imaging (MRI) with T2-color mapping. POROTIC HIP FRACTURES Patients and methods: 153 patients with knee OAwere stud- T. Raskina1,Y.Averkieva1, M. Koroleva1 ied: in 74,6% women and 25.3% men; mean age 46,2±4,3 1Kemerovo State Medical University, Kemerovo, Russian years; mean disease duration was 2,3±1,4 years. All patients Federation were randomized into three groups, matched for sex, age and disease duration: group 1 (n=60) received oral etoricoxib Objective: To investigate gender-specific mortality in the os- 30 mg QD, group 2 (n=60) – oral glucosamine sulfate teoporotic hip fractures in older adults. 1500 mg QD, group 3 (n=33) – intraarticular injections of Materials and Methods: tracked mortality in osteoporotic 2mlof1.5%hyaluronicacidthreetimesevery7days.All fractures of the proximal femur in 432 patients (328 wom- subjects had 0-I radiographic stage of OA according to en and 104 men) aged 50 years and over in different pe- Kellgren-Lawrence. At baseline, after 6 and 12 months we riods of observation: 0-6 months, 7-12 months, 13-24 assessed the severity of OA using WOMAC index, VAS glob- months. Information about fractures and their outcomes al and pain. In addition, to determine the biochemical status of obtained according to the archives of trauma care, logs cartilage at baseline and after 12 months performed MRI with municipal registry office, a telephone survey of patients an indication of T2 relaxation time. and their relatives. The study included patients with radio- Results: After 24 weeks of therapy in all groups there was a graphic evidence of hip fractures that occurred with mini- significant decrease (p<0,05) WOMAC index. The positive mal trauma. dynamics persisted by the end of the study, but in group 2, Results: It was found that after 6 months after injury died this trend was significantly better (p<0,05) compared with 1 95 out of 432 patients are under observation. Overall mor- and 3 by treatment group. The intensity of pain according to tality was 22,0%. In the group of patients who died was VAS in group 1 by the end of the study was 31±7.6 mm, in dominated by females: 73 women (16,5%) and 22 men group 2 - 17±4,7 mm and group 3 - 25±5,4. The dynamics of (5,1%) (p<0,0001). However, in the structure of mortality VAS (global) was significantly better (p<0,05) in the group 2. statistically significant differences by gender are not ob- The tolerability of therapy until the end of the observation tained by: of 328 women died 73 (22,26%), of 104 men - remained satisfactory and was not significantly different in 22 (21,15%) (p=0,9). Within 12 months after the fracture all groups. Qualitative analysis of the dynamics of destruction mortality rose to 137 cases (total mortality rate – 31,8%), of cartilage was performed by measuring the time T2 relaxa- for women - 104 (24,1%) cases, men - 33 (7,7%) tion area of the medial condyle of the femur and tibia. The (p<0.0001). In the structure of mortality by gender statis- initial data before treatment in group 1 was 33,3±10,4 ms, in tically significant differences were found: of the 328 died group 2 - 32,8±12,2 ms, in group 3 - 32,9±11,8 ms (p> 0.05) 104 women (31,78%), of 104 men - 33 (31,73%) (p=1,0). (fig.1). After 56 weeks of treatment the absence of cartilage After 24 months after hip fracture 184 cases of death were tissue degeneration according to T2 relaxation time (35,7 recorded (total mortality rate – 42,6%). In the group of ±10,2 ms, p<0,05) in patients receiving glucosamine sulfate patients who died were women and 140 cases among wom- (group 2). The most significant values to change the structure en (32,4%) and 44 - for men (10,2%) (p<0,0001). of cartilage observed in the group 1 - 47,1±10,4 ms, (p<0,05). Mortalityindicatorsbygenderin24monthsalsodidnot In patients treated with intraarticular injections of hyaluronic differ significantly: from 328 died 140 women (42,68%), (group 3) T2 relaxation time was 41,2±10,6 ms, (p> 0.05) of 104 men - 44 (42.31%) (p=1,0). (fig. 2). Conclusions: It was found that in all periods of observation in Conclusions: The use of the technique T2 mapping color of the structure of mortality by gender statistically significant cartilage allows the recognition of OA in the earliest stages, differences were obtained. and helps to control the influence of drugs at the disease from Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S453 a position before the onset of knee x-ray changes. In patients Results: Of the 27 patients, 19 were women and eight men, glucosamine sulfate marked positive effect in reducing levels with a mean age of 67 years (SD 7.8) and mean body mass of pain, WOMAC index compared with baseline and in com- index (BMI) of 29.2 (SD 8.2). The motivators were identified parison with patients treated with etoricoxib and hyaluronic as physical (well-being, decreased pain, surrounding view of acid. The use of glucosamine sulfate gives you the ability to them), personal (lifestyle, psychological well-being), societal provide long lasting symptomatic effect and a structural- (relationships, view of them), and environmental (living). modifying effect. They differed by gender, with the concept of performance predominant for the men, other people’s views for the women. The barriers were psychological (fear of pain, lack of motiva- tion), physical (knee pain, asthenia), and were also potentially related to life events (depression, hospitalization). Conclusions: The study population had an overall positive idea of the value of physical activity for knee osteoarthritis. The patients expressed beliefs and knowledge broadly in line with current recommendations. Compliance with these recom- mendations remains moderate. An educational support for Figure 1. Biochemical status of normal cartilage tissue using progressive adapted physical activity and identification of bar- MRI with T2-color mapping riers and motivators could help improve adherence. In the absence of validated tools, developing and validating a ques- tionnaire on specific knee osteoarthritis motivators and bar- riers would be judicious. References: - Mazières B et al. Joint Bone Spine 2008;75:589. - Petursdottir U et al. Phys Ther 2010;90:1014. Figure 2. Biochemical status of cartilage tissue using MRI with T2-color mapping in clinical groups P774 EARLY DIAGNOSTICS OF THE HETEROTOPIC OSSIFICATION IN PATIENTS WITH SPINAL CORD P773 INJURY MOTIVATORS AND BARRIERS TO PHYSICAL ACTI- M. Bystrytska1,N.Balatska1,V.Povoroznyuk1 VITY IN KNEE OSTEOARTHRITIS PATIENTS: A 1Department of Clinical Physiology and Pathology of QUALITATIVE STUDY Locomotor Apparatus, D.F. Chebotarev Institute of C. Gay1,E.Benedicte2,C.Levyckyj3, E. Coudeyre4 Gerontology NAMS Ukraine, Kyiv, Ukraine 1Physical and Rehabilitation Medicine Department, Clermont-Ferrand University Hospital, Clermont Ferrand, Aim: To define the peculiarities of bone turnover markers and France, 2Department of General Practice, Clermont Ferrand, identify specific parameters of the heterotopic ossification Faculty of medicine of Clermont Ferrand, Clermont Ferrand, (HO) development in patients with spinal cord injury (SCI). France, 3Service Research and Development, Royat, France, Methods: In the study were included 23 patients with SCI – 4Rehabilitation Department and Physical Medecine, first group (average age 26.4±0.9 yrs, duration of SCI 3 to 12 Clermont-Ferrand, France months) and 23 healthy subjects appropriate age and gender (average age 29.4±1.4 yrs.). In the first group included 11 Objectives: To explore the barriers and motivators to regular patients with SCI and HO (average age 25.5±1.3 yrs, duration physical activity in knee osteoarthritis patients of SCI ‑ 6.4±1.3 mos) and 12 patients with SCI without HO Materials and Methods: A cross-sectional, qualitative study (average age 27.2±1.4 yrs, duration of SCI ‑ 6.0±0.8 mos). based on 20 semi-structured individual interviews and two Serum markers of bone formation (osteocalcin, procollagen focus groups. The interviews continued until data saturation. type 1 N-terminal propeptide (P1NP)) and bone resorption Data collection was carried out by interviews recorded, then (collagen type 1 cross-linked C-telopeptide (β-CTx)) were transcribed and coded. The analysis was performed according determined by the electrochemiluminescence method “ECL to the researcher triangulation method. Patients suffering from technology” by Elecsys® assay. knee osteoarthritis according to criteria of the American Results: SCI patients had significantly higher bone turnover College of Rheumatology (ACR) were recruited from spa markers than control group: P1NP (264.9±47.0 ng/ml vs. 48.3 therapy resorts (France, Royat). ±3.8 ng/ml, p<0.001), serum β-CTx (1.51±0.11 ng/ml vs. S454 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 0.48±0.04 ng/ml, p<0.001), osteocalcin (54.8±8.6 ng/ml vs. Results: at baseline, mean CA-IMT was similar in the 3 24.2±1.52 ng/ml, p<0.001). There were obtained that levels of groups; though mean CA-IMT increased after 12 months, bone remodeling markers in patients with HO were signifi- the increase was statistically significant only in teriparatide- cantly higher in comparison with SCI patients without HO: treated patients (1.0, 0.8-1.2 vs. 1.1, 0.9-15 mm, P=0.04), P1NP (408.5±76.9 ng/ml vs. 133.2±15.7 ng/ml, p<0.001), where CA-IMT increase positively correlated with alkaline serum β-CTx (1.75±0.14 ng/ml vs. 1.28±0.14 ng/ml, phosphatase levels (r=0.767, P=0.008) and negatively with p<0.001), osteocalcin (82.4±13.6 ng/ml vs. 29.4±3.1 ng/ml, HDL cholesterol levels (r=-0.65, P=0.03), suggesting an in- p<0.001). Receive operating characteristic curves were used volvement of both active bone remodeling and lipid profile. to identifying specific bone turnover markers of HO forma- At baseline, mean serum OPG and OPN levels did not differ tion. Youden’s index for P1NP was equal to 187.3 ng/ml (sen- among the groups; at 12 months, OPG levels were lower in the sitivity=94%, specificity=90%, AUROC=0.97, p<0.000) and teriparatide and zoledronate groups than in controls (6.3, 5.4- for osteocalcin level ‑ 49.6 ng/ml (sensitivity=97.1%, speci- 6.9 and 6.4, 5.5-8.4 vs. 9.5, 7.6-12.7 pmol/L; P=0.008), while ficity=90.1%, AUROC=0.99, p<0.000). OPN levels were not affected. Both OPG and OPN did not Conclusion: The study showed P1NP level above 187.3 ng/ correlate with changes in CA-IMT. ml and osteocalcin level above 49.6 ng/ml should be consid- Conclusions: Treatment with teriparatide may be associated ered as an early predictor of heterotopic ossification formation with increase of CA-IMT and low circulating OPG, a protec- in patients with spinal cord injury. tive factor against vascular calcification; these changes have likely poor clinical relevance in patients without overt vascu- lar disease. P775 EFFECT OF 12 MONTHS TREATMENT WITH TERI- PARATIDE ON INTIMA-MEDIA THICKNESS OF P776 CAROTID ARTERY IN PATIENTS WITH SEVERE IMPACT OF PHYSICAL ACTIVITY ON THE MUSCU- POSTMENOPAUSAL OSTEOPOROSIS LOSKELETAL HEALTH EVALUATED WITH BONE G. Guabello1, S. Corbetta2 DENSITY, BONE TEXTURE AND BODY COMPO- 1IRCCS Istituto Ortopedico Galeazzi, Rheumatology Unit, SITION: THE OSTÉOLAUS STUDY Milano, Italy, 2IRCCS Istituto Ortopedico Galeazzi, B. Aubry-Rozier1,D.H.Hans1,O.Lamy1,M.Metzger1,M. Endocrinology, Milano, Italy Favre1 1Center of Bone Diseases, Lausanne University Hospital Objective: Daily administration of teriparatide/PTH1-34 is an Switzerland, Lausanne, Switzerland established therapy for severe osteoporosis because it de- creases the risk of fractures and increases vertebral and femo- Introduction: Osteoporosis is a systemic and progressive dis- ral bone mineral density. Evidence suggests that PTH is in- ease leading to an increased risk of fragility fractures. volved in arteriosclerosis and cardiovascular risk. The intima- According to the mechanostat theory, bones and muscles are media thickness of the carotid artery (CA-IMT) is an early considered as a common functional unit. The bone marrow quantitative marker of generalized atherosclerosis. The pur- mesenchymal stem cells differentiate into osteoblasts if they pose of this study was to investigate whether 12 months treat- receive appropriate mechanical stress. A diminution of muscle ment with teriparatide may affect CA-IMT as well as osteo- mass, called sarcopenia, is associated with a reduction of bone protegerin (OPG) and osteopontin (OPN), biochemical factors strength and poor physical performances. involved both in bone metabolism and vascular calcifications. Objective: To evaluate the impact of the sedentarity on bone Patients and Methods: this observational, prospective study mineral density (BMD), microarchitecture assessed indirectly investigated 9 patients (aged 70, 62.5-73.5 years, median, range by trabecular bone score (TBS), and body composition. interquartile) with osteoporotic fractures treated with 20 Method: OsteoLaus is a population-based cohort of 1500 microg/die sc teriparatide; 11 patients (aged 73, 65.7-74.2 randomly selected Caucasian women (50 to 80 y old) living years) with osteoporotic fractures treated with 5 mg/years ev in Lausanne, Switzerland. For this study all participants zoledronate and 10 age-(70.5, 65.7-74.2 years), BMI-, glyce- had: FRAX® questionnaire, PAFQ (Physical Activity mic and lipid profiles-matched, non-fractured, free from anti- Frequency Questionnaire), BMD, TBS and body composi- osteoporotic drugs, patients. Patients and controls were all fe- tion. Exclusion criteria: corticosteroids/immunosuppressors, males, non-active smokers, with no overt carotid disease or risk Cushing, hyperparathyroidism, malabsorption, respiratory/ factor, and supplemented with 100000 U/month of oral chole- cardiac insufficiency, anticancer drugs and antidepressants. calciferol. They were evaluated at baseline and after 12 months. 1,026 women were included. Sedentarity was defined by: ≤ CA-IMT was measured at right common carotid artery. 10% physical activity in 4+BMR (Basal Metabolic Rate). All Circulating OPG and OPN were also measured by ELISA. the results were adjusted for age and BMI except for body Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S455 composition parameters where results were adjusted only for The laboratory data were obtained from blood samples after age. an overnight fast. Metabolic syndrome is defined according to Results: 63.7% of the subjects were sedentary. Between the 2 modified ATP-III criteria. Vitamin D sufficiency is defined as groups the following results were all statistically significant serum 25-hydroxyvitamin D concentrations ≧20 ng/mL. (p<0.05): active women were younger (63.30 vs. 65.03), had The homeostatic model assessment (HOMA) index is used lower BMI (24.71 vs. 25.99). They had a higher BMD at the to quantify insulin resistance. Basic demographic and labora- femoral neck and total hip (0.732 vs. 0.723 and 0.858 vs. tory data are compared between groups with and without 0.848 respect.), a higher spine TBS (1.366 vs. 1.357), a lower MetS. Binary multivariate logistic regression model for inde- FRAX TBS (10.31% vs. 11.15%). They had less fat mass pendent factors of MetS is analyzed. (61.44 kg vs. 64.07 kg). However BMD at the spine, visceral Results: Of the 523 vitamin D-sufficient subjects (M/F=269/ fat mass and ALMI showed no difference. 254, mean age=76.0±6.2 y/o, range=65-102 y/o), prevalence Conclusion: The active postmenopausal women have a better of MetS is 46.5%. The average vitamin D level is 44.0±11.1 bone health and less total fat mass. We did not see differences ng/ml. Serum vitamin D is negatively associated to in term of lean mass and ALMI. Prevention, including phys- osteocalcin, HOMA index, and body mass index. Subjects ical activity, could have a positive influence on chronic dis- with more components of MetS criteria tend to have relatively eases: by reducing the body mass index and visceral fat mass lower serum Vitamin D. Logistic regression model showed which are deleterious for cardiovascular health, and by that serum vitamin D level (OR=0.97, CI=0.958-0.998), phys- delaying the emergence of osteoporosis. ical activity (OR=0.45, CI=0.25-0.85) and osteocalcin level(OR=0.29, CI=0.1-0.82) were negatively independent factors, as well as female (OR=2.3, CI=1.2-4.2) and HOMA P777 index (OR=33.8, CI=14.9-76.8) were positively independent ASSOCIATION BETWEEN METABOLIC SYNDROME factors of MetS. AND VITAMIN D LEVEL IN VITAMIN D-SUFFICIENT Conclusions: Relatively lower vitamin D level is still an in- OLDPEOPLELIVINGINSOUTHERNTAIWAN dependent risk factor for metabolic syndrome, even in old C.-H. Wu1, C.-M. Wang2, C.-S. Chang3, Y.-F. Chang3, C.-J. people without vitamin D deficiency. The vitamin D may be Chiu1, M.-T. Hou4,C.-Y.Chen3, P.-Y. Liu5 a surrogate of insulin resistance linking to metabolic syn- 1Institute of Gerontology, National Cheng Kung University, drome and warrant for further study. Tainan, Taiwan, Province of China, 2Medicine, National Cheng Kung University, Tainan, Taiwan, Province of China, 3Family medicine, National Cheng Kung University Hospital, P778 Tainan, Taiwan, Province of China, 4Physical Therapy and FAT MASS IS A STRONGER DETERMINANT OF Assistive Technology, National Yang-Ming University, BONE MASS THAN SKELETAL MASS INDEX IN A Taipei, Taiwan, Province of China, 5Division of Cardiology/ GROUP OF YOUNG WOMEN National Cheng Kung University Hospital, Tainan, Taiwan, A. J. Berro1,A.Khawaja1,N.Fayad2,G.Maalouf3,J.Matta4, Province of China F. Frenn4,S.Ahmaidi5, H. Zouhal6,A.Alwan1,R.ElHage1 1Department of Physical Education, Fass, University of Background/Purpose: The vitamin D deficiency may not Balamand, Kelhat El Kurah, Lebanon, 2Université only impair the bone metabolism, but also play as the mediator Libanaise, Faculté de pédagogie, Beirut, Lebanon, 3Bellevue in several chronic diseases including type 2 diabetes mellitus, University Medical Center, Faculty of Medicine, Saint Joseph cardiovascular disease, and metabolic syndrome(MetS). University, Mansourieh, Lebanon, 4Industrial Research Whether it is true in vitamin D-sufficient old people is rarely Institute, Beirut, Lebanon, 5EA-3300, APERE, Sport investigated. Sciences Department, University of Picardie Jules Verne, Method: In 2012, the cross-sectional survey was conducted Amiens, France, 6STAPS, University of Rennes 2, Rennes, with whole district random sampling of 1,966 community- France dwelling old people in Tian-Liao District, Kaohsiung city, Taiwan-a tropical, agriculture-based, hyper-aged community. Aim: The purpose of this study was to explore the relative A total of 549 subjects were enrolled with the response rate of importance of fat mass and skeletal mass index on bone var- 50% (549/1098). Structured questionnaires including basic iables in a group of young women. characteristics, life style, and medical history along with Methods: 50 young women (12 obese, 30 overweight and non-invasive assessment tool including International 8 normal-weight) whose ages range between 18 and 32 Physical Activity Questionnaires, mini-nutrition assessment years participated in this study. Weight and height were and 10-item Short Portable Mental Status Questionnaire were measured, and body mass index (BMI) was calculated. interviewed face-to-face by well-trained staffs individually. Body composition, bone mineral content (BMC) and bone S456 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 mineral density (BMD) were measured by DXA. was 65%, and denosumab 59%. The persistence rate was 41- Appendicular skeletal mass (ASM, in kg) was calculated 43% for weekly vs. 12-16% for daily OP treatments. Median by summing the muscle masses of the four limbs, assuming time until treatment change ranged from 133 days for daily that all non-fat and non-bone mass is skeletal muscle. SMI alendronate to 664 days for quarterly IV ibandronate. was defined as ASM/height2. Lumbar spine trabecular Zoledronic acid and denosumab had a median time until treat- bone score (TBS), femoral neck cross-sectional area (FN ment change of >730 days. Similar results were found for CSA) and femoral neck cross-sectional moment of inertia older patients. (FN CSMI) were also measured by DXA. Conclusion: This study showed that less frequent dosing of Results: fat mass was positively correlated to WB BMC OP treatments results in better persistence. This is also appli- (r=0.30; p=0.02), WB BMD (r=0.39; p=0.002), FN BMD cable for elderly patients using OP treatments. Disclosure: (r=0.26; p=0.04), FN CSA (r=0.45; p=0.0001) and FN Funded by Amgen EUROPE (GmBh) CSMI (r=0.46; p=0.0004). SMI was only correlated to WB Authors Disclosures: MI and GWare Amgen Employees and BMD (r=0.35; p=0.009), TH BMD (r=0.29; p=0.02) and FN have received Stock. Jetty A. Overbeek, Josephina G. Kuiper, CSA (r=0.36; p=0.007). Fernie J.A. Penning-van Beest are Employees of the Conclusion: This study suggests that fat mass is a stronger PHARMO Institute for Drugs Outcomes Research. determinant of bone mass and geometric indices of femoral neck strength than skeletal mass index in young women. P779 PERSISTENCE WITH TREATMENTS FOR OSTEO- POROSIS: A REAL-WORLD STUDY IN THE PHARMO DATABASE NETWORK J. A. Overbeek1, M. Intorcia2,J.G.Kuiper3,F.J.A.Penning- van Beest3, G. Worth2 1PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands, 2Amgen (Europe) GmbH, Zug, Switzerland, 3PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands Objectives: To describe persistence with treatments for oste- oporosis in a real-world setting in The Netherlands. Material and Methods:FromPHARMO’s General Practitioner Database, patients newly treated with an osteoporosis (OP) drug between 2007-2013 were selected and included in one or more of the following drugs cohorts: daily or weekly oral alendronate, 6-monthly subcutaneous injec- P780 tion denosumab, intravenous [IV] or oral quarterly or CORRELATION OF SOME OXIDANTAND ANTIOXI- weekly ibandronate, daily, weekly or monthly risedronate, DANT ENZYMES IN FIBROMYALGIA raloxifene, teriparatide, or yearly IV zoledronic acid. D. Cepoi-Bulgac1,V.Cepoi1,L.Groppa1 Persistence was defined as the number of days of uninter- 1Department of Rheumatology, State University of Medicine rupted use (gap between prescriptions <60 days) of the OP and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of treatment defining the cohort. Persistence rates were de- Moldova termined after one and two years (for patients with com- plete follow-up). Objective: Despite significant effort done in the research of Results: The study included 37,018 patients. The majority of fibromyalgia, it remains an obscure entity. To study the patients were female (74-99% across cohorts) and mean age correlation of some indices of oxidant and antioxidant ranged between 63-72 years. Approximately half of the pa- systems with Tender Point Index (TPI) in fibromyalgia. tients had at least two years of follow-up. After one year, daily Methods and Materials: 30 patients with established fi- and weekly drugs had a persistence rate of 21-35% and 55- bromyalgia and duration over 12 months, based on 2010 56% respectively. Persistence with denosumab was 79% and ACR Diagnostic criteria were assessed according to a zoledronic acid 100%, per yearly dosing frequency (table 1). comprehensive plan, including some indices of the oxi- At two years, the persistence rate for zoledronic acid cohort dant and antioxidant systems’ activity, particularly: early, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S457 intermediate and late lipid peroxides (u/l), serum certifies the efficacy of the rehabilitation program in- malondialdehyde (mkmol/l), serum total antioxidant activ- cluding physical exercise for the patients suffering from ity (mmol/l), serum total prooxidant activity (mkmol/l), scapulohumeral periarthritis and motivates the continua- superoxide dismutase (u/l), serum catalase (mkmol/l) and tion of the study on a longer period of time and on a serum nitric oxide (mkmol/l). In an attempt to objectivize larger number of patients. the musculoskeletal findings in fibromyalgia patients, the Tender Point Index was used. To assess the relevance of these assays in fibromyalgia patients, correlation analysis P782 was performed. COLD STRESS IN MICE INCREASES NERVE Results: Although most patients displayed some sort of anom- GROWTH FACTOR ACTIVITY IN BROWN FAT alies of the oxidant and antioxidant systems, not much of a AND OSTEOCALCIN EXPRESSION IN BONE correlation with TPI could be observed for most indices, ex- C. Camerino1,E.Conte1,A.Fonzino1,K.Musaraj1,R. cept for nitric oxide, for which we established a moderate Caloiero1, D. Tricarico1 negative correlation (-0.47, p<0.05). 1University of Bari, Bari, Italy Conclusion: Although the results displayed a negative corre- lation (the higher the value of TPI, the lower the value nitric), Brown adipose tissue (BAT) is controlled by the the established correlation is quite unspecific and further anal- Sympathetic nervous system (SNS) and has the ability to ysis should be performed. dissipate energy through uncoupling protein-1 (UCP-1), influencing energy expenditure. SNS influences bone and recent studies have demonstrated a positive correla- P781 tion between BAT activity and bone. Nerve Growth Factor PHYSICAL EXERCISE PROGRAM IN PATIENTS (NGF) genes are expressed in brain, BAT and bone where WITH SCAPULOHUMERAL PERIARTHRITIS they coordinate brain and body reactions to challenges. I. R. Marcu1,S.Patru1,D.Matei1,A.C.Bighea1 Similarly Osteocalcin (Ost) acts on bone, glucose metab- 1University of Medicine and Pharmacy, Craiova, Romania olism and brain. We previously showed that NGF and its receptor p75NTR genes are highly expressed in BAT vs. Objective: to examine the effects of a 3 weeks kinetic pro- brain in mice, suggesting that NGF acts as a regulator of gram on pain and the functional status of patients with energy. To investigate the role of NGF and Ost in bone scapulohumeral periarthritis. and energy regulation we analyzed NGF, p75NTR and Ost Material and Method: We conducted an observational, mRNA from 3 months old mice after cold exposure with prospective, randomized study on a sample of 80 patients UCP-1 as positive control. Mice were divided into three with scapulohumeral periarthritis. The patients were ran- groups (n=5/group): room temperature (RT=23 °C), cold domly assigned to a control group (40 patients) who re- stress for 6h and 5 days. Mice as control group were all ceived electrotherapy, physical therapy and massage placed at RT for 5 days, while the cold groups were (group 1) and a study group (40 patients) whose therapeu- placed at 4 °C for the above mentioned times. The mice tic program also included daily physical exercise (group 2). were sacrificed and the interscapular BAT, bone and brain Evaluation of patients was done on day 1 and after 3 weeks were analyzed for mRNA content. The exposure to 6h of of rehabilitation treatment. The clinical and functional pa- cold stress enhanced mRNA levels of UCP-1 and NGF rameters assessed were: pain on a visual analogue scale genes in BAT by 3 and 2.5-fold vs. controls, respectively, (100 mmVAS), physical impairments (muscular strength reducing mRNA of p75NTR by 19-fold. The UCP-1 gene and mobility of shoulder joint) and disabilities (ADL 24 was still up-regulated after 5 days of cold stress, the NGF and movement capacity). gene was not affected and mRNA of the p75NTR gene Results: The scores for functional parameters improved: was reduced by 7-fold vs. controls. The mRNA levels of pain- 43.5% (group 2) and 32.9% (group 1) (p=0.000054); Ost in bone were upregulated following 6h and 5 days physical impairments: muscular strength- 9.7% (group 2), cold exposure vs. controls and downregulated in brain. without improving by group 1, mobility: 34.8% (group2) In sum, NGF mRNA expression significantly increases and 23.2% (group 1); disabilities: ADL- 53.6% (group 2) after short term cold stress in BAT with no change in brain and 40.2% (group 1), movement capacity- 45.7% (group2) or bone. Ost gene was instead upregulated in bone follow- and 32.7% (group 1). The results were statistic significant ing cold stress. These results suggest that during cold (p<0.05). stress BAT-dependent thermogenesis is associated with Discussion and Conclusions: Improvement of pain, phys- NGF activity and Ost may exert local long-term protective ical impairments and disabilities for the study group effects on bone. S458 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P783 P784 BALNEO-PHYSIOTHERAPY EFFECTS ON FUNCTIONAL ONE-YEAR CHANGES IN BONE MINERAL DENSITY VARIABLES IN PRIMARY AND SECONDARY HIP WITH HIGH-DOSE PREDNISONE IN PATIENTS OSTEOARTHRITIS WITH RHEUMATOID ARTHRITIS M. L. Cevei1,A.I.Gasparik2,R.N.Suciu1,D.L. L. A. Rasch1,L.H.D.vanTuyl1,M.Kremer1,I.E.M. Stoicanescu3 Bultink1,M.Boers2,W.F.Lems1 1University of Oradea, Faculty of Medicine and Pharmacy, 1Amsterdam Rheumatology and immunology Center | VU Oradea, Romania, 2University of Medicine and Pharmacy, University Medical Center, Amsterdam, Netherlands, Târgu Mures, Romania, 3University of Medicine and 2Department of Epidemiology and Biostatistics, VU Pharmacy, Timisoara, Romania University Medical Center, Amsterdam, Netherlands Hip osteoarthritis impact on functional capacity and hence Background: Recently, we showed that treatment with onwalkingmaybeassessedbygaitanalysisperformed COBRA-light therapy including prednisone with initially 30 with BTS-G walk device that measures 17 parameters mg/day, was as effective as the original COBRA scheme, with grouped in 3 dimensions. Due to numerous information initially 60 mg/day [1], in the treatment of rheumatoid arthritis that provides, it allows a comprehensive analysis for eval- (RA). Since high-dose glucocorticoids are associated with uating the influence of rehabilitation therapy on gait bone loss, we investigated the differences in bone mineral parameters. density (BMD) after one year of treatment in both arms. Objective: proving balneo-physiotherapy efficiency by Objectives: To determine whether there is a significant differ- comparing initial walking test values with those obtain- ence in BMD between COBRA and COBRA-light, and to ed after medical rehabilitation. determine the difference in change in BMD between baseline Material and Method: The study included 165 patients and 52 weeks between these groups, at the lumbar spine (L1- hospitalized in Medical Rehabilitation Clinical Hospital L4), total hip, and femoral neck. Baile Felix, Romania, during January 2016 - June 2016. Methods: An open-label, randomised controlled, non- Patients were diagnosed with primary or secondary hip inferiority trial of patients with active, newly diagnosed RA osteoarthritis. On Kellgren Lawrence radiographic grad- following a treat-to-target protocol. ing they all were grade II. Mean age was 59.63±10.63 Results: BMD data were determined in 144 out of 164 included years. Patients were divided into two groups: lot I includ- RA patients, all randomized to either COBRA (n=71) or ed 87 cases with primary hip osteoarthritis and lot II in- COBRA-light (n=73) therapy. Both at baseline and after 52 cluded 78 cases with secondary hip osteoarthritis. Patients weeks, no significant difference in BMD was found between followed a complex medical rehabilitation therapy with COBRA and COBRA-light, at all sites. Changes between base- painkiller, functional re-education, stability improvement, line and week 52 are shown in Table 1. No significant difference joint mobility improvement purposes. Hydrotherapy with in change in BMD between COBRA and COBRA-light was thermal water at 36ºC, electrotherapy, kinetotherapy, mas- found, at all sites. However, COBRA-light showed a significant sage, occupational therapy were applied over a period of decrease in BMD in the lumbar spine and total hip after 52 14 days. weeks, whereas the femoral neck and the COBRA group did not. Results: In lot I there was a minimal increase in speed, left Conclusions: No difference in change in BMD between step length, gait cycle duration, left stance phase duration, COBRA and COBRA-light was found. The overall bone loss left single support duration and double support duration was small, which suggests that the negative effects of (high- and right step duration. Right single support duration, right dose) prednisone on bone might be counteracted by the large and left swing phase duration have moderately improved. reduction in disease activity as a result of combination therapy In lot II there was a minimal improvement of left stance and tight control treatment. phase duration, the other investigated parameters remained References: [1] Ter Wee MM, et al. Ann Rheum Dis 2015 unchanged. Disclosures: This research was performed within the frame- Conclusions: Balneo-physiotherapy improved walking, as work of project T1-106 of the Dutch Top Institute Pharma, and evidenced by the parameters investigated in the gait test. was additionally funded by an unrestricted grant from Pfizer. Comparison of the mean parameters values at initial gait evaluation with those obtained after rehabilitation showed a slight improvement. The study draws attention to the impact of grade II hip osteoarthritis on the functional ca- pacity and consequently gait, forcing the early diagnosis and rehabilitation therapy. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S459 P785 quarter of the year. Further evaluation of the kind of arthritis SURVEY ON THE USE OF COMPLEMENTARY THE- (OA vs. RA vs. SpA) there was no significant difference RAPIES AMONG FILIPINOS WITH ARTHRITIS among the study population using nutriceuticals (p=0.604), E. Vista1, L. Hamijoyo2,S.Navarra2 vitamin and minerals (p=0.488), mind body therapies 1St. Luke's Medical Center Rheumatology Section, Taguig (p=0.163), energy therapies (p=0.428), diet (p=0.588) and City, Philippines, 2University of Santo Tomas Hospital, movement therapies (p=257); however it showed that more Manila, Philippines rheumatoid arthritis patients use herbal medicines (p=0.053), topical medications (0.019) and items worn (0.014). Introduction: Use of complementary and alternative medi- Conclusion: Filipino arthritis patients used CAM to supple- cine (CAM) for chronic conditions has been part of the ment conventional treatments. Health care providers should Philippine healthcare setting. There is little information, how- be aware of the high use of CAM and incorporate questions ever, on CAM use among adults with clinic-confirmed diag- about its use into routine assessments and treatment strategies. noses, particularly rheumatic diseases that are treated by rheumatologists. Objective: To assess the frequency and types of CAM therapy P786 used by Filipinos with chronic arthritic conditions including ADVANTAGES AND DISADVANTAGES OF PERCU- osteoarthritis (OA), rheumatoid arthritis (RA) and TANEOUS FOREFOOT SURGERY spondyloarthropathies (SpA). V. Lopez-Fernandez1, N. Muñoz-García2 Methods: A total of 83 participants were randomly selected 1Orthopaedic Surgery and Traumatology - University from the clinic population of rheumatologists at 2 tertiary care Hospital Torrejon, Torrejon de Ardoz (Madrid), Spain, centers – University of Santo Tomas Hospital and St. Luke’s 2Universidad Autónoma de Madrid, Facultad de Medicina, Medical Center. The patients were classified within strata de- Madrid, Spain fined by age, sex, and diagnostic group, educational back- ground, occupation and average annual salary income. Objective: To review the recent literature on the evaluation of Personal interviews were conducted by appointment in partic- advantages and disadvantages of percutaneous forefoot sur- ipants’ homes or in a clinic and during lay forums. gery against open surgery for common pathologies such as Respondents completed an interviewer- administered survey hallux valgus or metatarsalgia. including quality of life and visual analog pain scale written in Material and Methods: This article is based on a PubMed English and Filipino. The selected CAM items were based on search with the keywords “percutaneous”, “forefoot” and a review of the literature and feedback from members of "surgery". The advantages and disadvantages proposed by Special Interest Groups of the Philippine Rheumatology the authors of the 37 articles identified from 2010 to 2016 Association. CAM items were included in the survey if they were evaluated. were locally used for arthritis. Participants were further asked Results: For less severe cases, hallux valgus percutaneous to describe other therapies they were using for their arthritis surgery presents results similar to the traditional one surgery Results: Among the 83 patients included in the study 32 were (similar correction of the intermetatarsal and metatarso- diagnosed with RA (38.6%), 40 with OA (48.2%) and 11 with phalangeal angles) and could be used in patients with previous SpA (13.3%). Sixty seven (80.7%) were women and nearly surgery since it damages to a lesser extent the soft tissues, half of them were housewives or unemployed (43.4%). causing more aesthetic scars. Regarding to the osteotomies Majority of the group finished until high school (39.8%) with of the lesser metatarsal bones, the efficacy is comparable, 43.4% belonging to the group with an annual income between patient satisfaction is higher with AOFAS score >85/100 and 30,000-70,000 pesos. Among the CAMs, a total of 66 (79.5%) the procedure is less expensive. Current practice recommends used vitamins and minerals, 54 (65.1%) used topical medica- a mixed strategy combining traditional open surgery with per- tions, 50 (60.2%) employed massage therapists/ “hilot”,40 cutaneous technique for hallux valgus: open surgery with min- (48.2%) used nutriceuticals, 28 (33.7%) used movement ther- imally invasive incision for Chevron osteotomy with 2-screw apies and 16 (19.3%) used diet. Only 12 (14.5%) used herbal implant and percutaneous surgery for P1 osteotomy. However, medicines, 10 (12%) used items worn, 10 (12%) used mind there are some disadvantages: the possibility of skin burns, the body therapies and 5 (6%) used energy therapies. Most of the need for special equipment, the exposure to ionizing radiation patients had their disease diagnosed for more than five years and a long learning curve. One limitation of the review is that before they tried using CAMs (61.4%) and 66 (79.5%) there are few studies of high level of evidence comparing open claimed to have improved pain scores and quality of life dur- vs. percutaneous surgery. ing the period that they are using CAM’s. Seventy three (88%) Conclusion: Following a review of the current literature on used conventional treatments together with CAMs and nearly the subject, it is concluded that, despite some disadvantages, half (47%) of the total population visit their doctors each percutaneous forefoot surgery seems to be a useful technique S460 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 for selected patients because it has similar results to open bisphosphonates during 2005-2012. Personal medical history surgery but with lower postoperative morbidity. But, since was significant for non-insulin dependent diabetes and hyperten- there are few level 1 evidence studies, we could not conclu- sion. Physical examination revealed flat foot, dorsolumbar sively recommend this technique for all patients, and a case- dextroconcave kyphoscoliosis, lumbar spine and bilateral hip by-case evaluation is necessary. joint mobility limitation, crackles with knee mobilization, arthrit- ic changes of both hands, varicose hydrostatic legs. Forefoot bilateral radiographs revealed bilateral valgus flat foot, tibial- P787 tarsal osteoarthritis and intertarsal and metatarsophalangeal oste- RELATIONSHIP BETWEEN OBESITY, METABOLIC oarthritic changes. Lumbar X-ray revealed advanced SYNDROME, AND OSTEOPOROSIS AMONG THE spondylosis. DXA investigation showed T score values within ELDERLY AGRICULTURAL AND FISHING normal limits. Lean Body Mass (LBM) whole body was 6.642 POPULATION IN TAIWAN g/cm2. BTS G-walk device was used to assess physical perfor- Y.-C. Tung1,T.-H.Tung2 mance, which was reduced when performing Timed up and Go 1Department of Medical Imaging and Radiological Sciences, test. Evaluation of handgrip strength with Jamar dynamometer I-Shou University, Kaohsiung, Taiwan, Province of China, revealed low values: 19.66 for the right hand and 16.66 left hand. 2Department of Medical Research and Education, Cheng- Laboratory tests showed abnormal values of total cholesterol, Hsin General Hospital, Taipei, Taiwan, Province of China HDL cholesterol, LDL cholesterol and triglycerides revealing the existence of a metabolic syndrome. 10 Meter Purpose: To explore the relation between obesity, metabolic Walk Test was performed in 10.87 s, very high value. syndrome, and osteoporosis amongst the elderly agricultural Treatment objectives: maintaining blood pressure and blood glu- and fishing population in Taipei, Taiwan. cose level within normal ranges. Medical rehabilitation targets Methods: The study participants were conducted with a total painkilling, combating contracture, increasing stability of the of 4,360 (2,758 men and 1,602 women) healthy elderly sub- lower limb joints, maintaining joint mobility within normal jects voluntarily admitted to a teaching hospital for a physical limits, correcting spine posture foot statics. Therapeutic means: check-up in 2010. Osteoporosis was defined as bone mineral salt restriction, low carbohydrate and hypolipidic diet, calcium- density is 2.5 SD or more below the young adult mean (−2.5 rich foods. Pharmacologic therapy used antihypertensive, oral SD or lower). antidiabetic, cholesterol lowering medication, calcium supple- Results: The prevalence of osteoporosis for this elderly study ments, C, D3 and K vitamins. Rehabilitation therapy included population was found to be 34.4%. The prevalence of osteo- hydrotermotherapy with thermal water at 36ºC, painkiller elec- porosis for metabolic syndrome proved to be substantially trotherapy (TENS), kinetotherapy, occupational therapy to re- greater (p-value for χ2 test<0.0001) than it was for one or duce the risk of falls. Low rib T-score values highlighted by two metabolic factors. Using multinominal logistic regression DXA whole body T-score -2.6 indicates an increased risk of rib analysis, age, sex, metabolic syndrome, higher BMI, and fractures. We investigated the patient to detect sarcopenia, values higher uric acid appeared to be statistically significantly relat- from DXA whole body were normal, but dynamometry and ed to osteoporosis. Timed Up and Go test revealed decrease of physical perfor- Conclusion: The prevalence of osteoporosis was related to mance, thus she has also sarcopenia. obesity, uric acid, and the degeneration of metabolic syn- drome. Promoting this population with controlled obesity, uric acid, and health improvement for metabolic function are P789 essential. THE EFFECTS OF RH-PTH (1-34) ON BONE META- BOLISM IN HYPOPARATHYROID PATIENTS G. Marcucci1,L.Masi1,F.Giusti1,C.Fossi1,F. P788 Franceschelli1,S.Parri1,M.L.Brandi1 SARCOPENIA IN AN OSTEOPOROTIC CASE 1Bone Metabolic Diseases Unit, Department of Surgery and D. L. Stoicanescu1,R.N.Suciu2,A.I.Gasparik3,F.Cioara2, Translational Medicine, University of Florence, Florence, M. L. Cevei2 Italy 1University of Medicine and Pharmacy, Timisoara, Romania, 2University of Oradea, Faculty of Medicine and Pharmacy, Objectives: The aims of the study, conducted on Oradea, Romania, 3University of Medicine and Pharmacy, hypoparathyroid subjects not adequately controlled with conven- Târgu Mures, Romania tional therapy, were to evaluate the effects of rhPTH (1-34), as replacement therapy, on reduction of calcium and calcitriol sup- We present the case of a 72 years-old woman, diagnosed with plements, calcium-phosphate (Ca-P) homeostasis, bone turnover osteoporosis in 2005 who followed treatment with markers (BTMs), and parameters of quality of life (QoL). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S461 Material and Methods: The Phase III, open-label, non-com- Bisphosphonates approved for GIO, might induce jaw parative, single-center, pharmacological-experimental study osteonecrosis; thus additional therapeutics are required. included 10 patients (aged 18-65 years) of both sexes with Adenosine receptor agonists are positive regulators of bone refractory hypoparathyroidism. The recruited patients were remodeling, thus the efficacy of adenosine receptor stimula- treated with subcutaneous injections of rhPTH (1-34) (starting tion for treating GIO was tested. dose 20 μg once daily for 2 weeks, followed by 20 μgtwice In a preventive study GIO was induced in Sprague-Dawley daily for 10 weeks). rats by methylprednisolone (MP) for 60 days. Animals were Results: Seven out of ten patients reduced of at least 50% randomly assigned to receive polydeoxyribonucleotide calcium supplement, of these six patients were able to stop (PDRN; 8mg/kg), or PDRN and DMPX (3,7-dimethyl-1- this supplement completely; eight out of ten patients reduced propargylxanthine, an A2 antagonist), or vehicle (0.9% NaCl). of at least 50% supplementation of calcitriol, and of these Another set of animals was used for a treatment study, follow- seven patients were able to stop this supplement completely. ing the 60 days of MP-induction rats were randomized to Biochemical exams, showed that mean values of serum receive (for additional 60 days) PDRN, or PDRN and albumin-corrected Ca increased rapidly and remained stable DMPX, or zoledronate (7.5 ug/kg), or vehicle. Control ani- over time, within the normal range, except few cases of hypo- mals were administered with vehicle for either 60 or 120 days. hypercalcemia, while mean values of serum P decreased, re- MP treatment determined severe bone loss, the concomitant use maining within the normal range (no statistically significant of PDRN prevented the developing of osteoporosis. In rats treat- difference, between baseline and the end of treatment period). ed for 120 days, PDRN restored bone architecture and bone Average values of Ca-P products remained within the normal strength; increased B-ALP, osteocalcin, osteoprotegerin and range (no statistically significant difference, between baseline stimulated the Wnt canonical and non-canonical pathway. and the end of treatment period). The mean 24-h urinary Ca Zoledronate reduced bone resorption and ameliorated the histo- excretion showed a slightly increasing trend (no statistically logical features, without significant effects on bone formation. significant difference, between baseline and the end of treat- Our results suggest that adenosine receptor stimulation might ment). The slight average increment in 24-h urinary Ca excre- be useful for preventing and treating GIO. tion, within the normal range, and some episodes of hypercal- ciuria, were justified by the initial rise in BTMs. The analysis of BTMs showed, indeed, a significant increase in markers of P791 bone formation and resorption. No fractures were described, ULTRASTRUCTURE OF BIOMINERAL OF BONE RE- and the baseline mean values of bone mineral density at base- GENERATE IN RATS AFTER 60-DAY APPLICATION line were normal-high. The analysis of SF-36 (36-Item Short OF SODIUM BENZOATE Form Survey) showed that rhPTH (1-34) improved the QoL in O. N. Fastova1, V. I. Luzin1, I. S. Prykhodchenko1,N.A. terms of "social activities" and "vitality". Mosyagina1 Conclusions: The study showed that rhPTH (1-34) was effec- 1SE Lugansk State Medical University, Lugansk, Ukraine tive in maintaining the mean serum albumin-corrected Ca levels within the normal range, allowing a significant reduc- Objective: To examine ultrastructural features of biomineral tion of calcium and calcitriol supplements, with an improve- of bone regenerate in rats after 60-day sodium benzoate (SB) ment of some parameters of QoL. The levels of BTMs showed intake of various concentrations. a significant increase during the treatment period, probably, to Material and Methods: The experiment involved 210 male reverse the typical state of over-mineralized bone of hypopara- thoroughbred rats with initial body weight of 200-210 grams. thyroidism. No fractures were reported. The 1st group (K) comprised animals that received daily per os 1mlof0.9%solutionofNaCl,the2nd and the 3rd groups (SB1 and SB2) received per os 1 ml of SB in dosage of 500 or P790 1000 mg per kg of body weight daily, the 4th group (D) com- ADENOSINE RECEPTOR STIMULATION IMPROVES prised animals with defect in both tibiae made when in groups GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN 2 and 3 SB was discontinued. The 5th and the 6th groups ARATMODEL (DSB1 and DSB2) comprised the rats who received SB and G. Pizzino1, N. Irrera1,G.Pallio1, M. Atteritano1,D. had defects in tibiae also made after SB discontinue. Altavilla1, F. Squadrito1, A. Bitto1 Observation terms constituted 3, 10, 15, 24, and 45 days after 1Clinical and Experimental Medicine/University of Messina, discontinue of experimental influences. For the purposes of Messina, Italy testing of bone regenerate biomineral taken with correspond- ing bone fragment we used X-ray scatter analysis. Glucocorticoid-induced osteoporosis (GIO) is a secondary Results: In DSB1 group, size of elementary cells of regener- cause of bone loss. ated bone tissue along c-axis as well as crystallites size was S462 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 larger than those of D group in the period from the 15th to the alignment according to Lelièvre and the protruding screws 24th days by 0.23% and 0.17% and by 14.34% and 6.08% were removed. respectively. Microtexture coefficient was lower than that of Results: 5 Weeks later, the patient was seen again and her the controls in the period from the 15th to the 45th day by wounds had healed perfectly. She had improved clinically, 4.68%, 5.75%, and 4.70% respectively. not feeling pain while walking with normal shoes, and In DSB2 group, size of elementary cells along c-axis and callosities had almost disappeared. X-rays were satisfacto- crystallites size were larger than those of D group in the pe- ry with a correct metatarsophalangeal joint space of the riod from the 10th to the 45th day by 0.18%, 0.23%, 0.21% lateral toes. and 0.12%, and by 4.01%, 15.24%, 7.06%, and 4.11% re- Conclusion: The metatarsal alignment following Lelièvre spectively. Size of elementary cells along a-axis was also Technique could be a useful salvage procedure for metatarsalgia larger than that of D group in the period from the 15th to the appearing after an arthrodesis of the first metatarsophalangeal 45th day by 0.28%, 0.15%, and 0.13%. Microtexture coeffi- joint. It could be an alternative to Weil osteotomy with high risk cient was also lower than that of the controls in the period of pseudarthroses in osteoporotic patients. from the 3rd to the 45th day by 6.61%, 6.57%, 8.16%, and 5.67% respectively. Conclusion: SB intake thus slows down formation of crystal P793 lattice in bone regeneration zone. Intensity and duration of CLINICAL INVESTIGATION OF PREVALENCE AND alterations depend directly on dosage of SB and last from ASSOCIATED METABOLIC FACTORS OF OSTEO- the 15th to the 45th day of observation with daily dosage of POROSIS AMONG THE FEMALE ELDERLY 500 mg per kg of body weight and from the 3rd to the 45th day AGRICULTURAL AND FISHING POPULATION IN of observation with daily dosage of 1000 mg. TAIWAN T.-H. Tung1 1Department of Medical Research and Education, Cheng- P792 Hsin General Hospital, Taipei, Taiwan, Province of China METATARSAL ALIGNMENT FOLLOWING LELIÈVRE TECHNIQUE FOR METATARSALGIA IN A POST- Purpose: To explore the prevalence and associated metabolic MENOPAUSAL WOMAN factors of osteoporosis among the female elderly agricultural V. Lopez-Fernandez1, M.-L. Suarez-Huerta1 and fishing population in Taiwan. 1Orthopaedic Surgery and Traumatology - University Methods: Subjects (n=1,602) aged 65 years and over volun- Hospital Torrejon, Torrejon de Ardoz (Madrid), Spain tarily admitted to a teaching hospital for a physical checkup were collected in 2010. Osteoporosis was defined as bone Objective: Case report of successful management of forefoot mineral density is 2.5 SD or more below the young adult mean pathology in an osteoporotic postmenopausal woman follow- (−2.5 SD or lower). ing Lelièvre Technique. Results: Among these subjects, the estimated prevalence of Material and methods: osteopenia and osteoporosis were 35.7% and 48.1%, respec- A 86 year-old woman, diagnosed with osteoporosis among tively. From the multiple logistic regression, age (OR=1.08, other comorbidities and who had previously undergone 95%CI: 1.02-1.15), waist circumference (OR=1.04, 95%CI: hallux valgus surgery more than 10 years ago (arthrodesis 1.01-1.09), total cholesterol (OR=1.04, 95%CI: 1.02-1.07), of the first metatarsophalangeal joint), complained of less- and uric acid (OR=0.92, 95%CI: 0.85-0.96) were statistically er toe metatarsalgia. Although she used especial bandages significantly related to osteoporosis after adjustment for con- to be able to wear shoes, she could not walk more than 10 founding factors. minutes without stopping due to forefoot pain. Physical Conclusion: Several clinical factors were indicated pertaining examination revealed painful callosities under the metatar- to the prevalence of osteoporosis in the female elderly among sal heads and deformities of the lesser toes (crossover sec- fishing and agricultural population. ond toe and 2nd and 3rd hammer toes) could be found in addition to a pair of protruding screw heads from the pre- vious surgery. After trial for months with the application of P794 a plantar orthosis and a protective padding as a first line of WHAT FACTORS DEFINE THE EFFECT OF THERAPY treatment, she was not relieved so she enquired about al- WITH DENOSUMAB IN WOMEN WITH RHEUMA- ternative treatment. The option of a surgical approach was TOID ARTHRITIS AND OSTEOPOROSIS? explained and the patient accepted, so second weight- P. Kovalenko1,I.Dydykina1,A.Smirnov1, E. Nasonov1 bearing foot radiographs (X-rays) were taken in order to 1Nasonova Research Institute of Rheumatology, Moscow, decide the best technique. We performed metatarsal Russian Federation Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S463 Objective: To define a contribution of various factors (an- AN patients at the first visit are diagnosed as osteopenia. amnesis, clinical/laboratory markers, glucocorticoids (GC) The best way to treat osteoporosis in AN patients is to take intake, etc.) on the response to therapy with denosumab in enough in nourishment and increase their weight, but ac- women with rheumatoid arthritis (RA) and osteoporosis tually it is very difficult. We have successfully treated os- (OP). teoporosis of AN patients with fragility fractures in by Material and Methods: 66 postmenopausal women (mean Teriparatide. age 59,6±7,4) with RA (mean duration of RA 17,7±10,4 Objectives: The objective of this study is to evaluate the effect years) and OP received s/c denosumab 60 mg every 6 of Teriparatide for osteoporosis in AN patients. months pro 1 year. RF- positive were 72%, ACCP – 74% Material and Methods: We have treated 2 female patients, of patients. 34 (49%) continued GC. At baseline and after with their age 42 and 59 respectively. They were diag- 12 months of therapy it was carried out the dual energy x- nosed as restricting type AN and received therapy with ray absorptiometry at 3 sites: lumbar spine (L1-L4), hip psychosomatic medicine. Their period of amenorrhea is neck (HN) and distal forearm (DF) and x-ray of hands 9 and 18 years, respectively. Their BMD of lumber spine and feet (Sharp/van der Heijde (SVH) score). After 12 are 0.58 and 0.61g/cm2, respectively. The initial treat- months it was noted the increase of BMD in L1-L4 and ments of both patients were Vitamin D, raloxifene and HN, a tendency to increase (р=0,0529) in DF. Positive bisphosphonate. Fragility fractures occurred in both pa- dynamics (increase or stabilization of BMD) was noted in tients during the treatment, so we had switched the treat- 89% patients at L1-L4, 67% - at HN and 60% - at DF. The ment to Teriparatide. The blood exam, X-ray (the thoracic Statistica 6.0 was used. and lumber vertebra) and BMD (the lumber spine and Results: Negative response on therapy in L1–L4 is associ- proximal femur) were checked during treatment on a rou- ated with GC intake (> 3 months in anamnesis) (р=0,034) tine basis. and the beginning of GC intake after menopause onset Results: Their BMD of lumber spine increased 16.7% and (р=0,023). In HN positive response on therapy is associat- 15.6% respectively from base line within 2 years. There was ed with higher concentration of the RF (initially and in no additional fracture in one patient and no complication has dynamics) (р <0,05) and the beginning of menopause later occurred. than RA onset (р=0,024), the negative response – with GC Conclusion: Teriparatide is one of the most effective med- intake (> 3 months in anamnesis) (р=0,024). In DF positive ical agents for treating osteoporosis in AN patients, and we response on therapy is associated with RF-positivity strongly recommend it if the patients have any fragility (р=0,02), the negative response back correlates with in- fractures. crease in erosion score and total SVH score: r=–0,360 (р <0,05). Conclusions: Positive response on therapy with denosumab P796 in NH and DF is associated with RF-positivity. The particular THE USE OF TRABECULAR BONE SCORE(TBS) IN contribution to the negative response in L1-L4 and HN is THE FRAX FRACTURE RISK PREDICTION IN associated with GC intake (previous intake more than 3 ASIAN TYPE 2 DIABETIC SUBJECTS months in the anamnesis), purpose of the GC after menopause C. Hew1,L.Lee1, K. Feiza1,H.Lim1,J.Lim1, S. Yeap2,F. onset. Hew2 1Puchong Medical Specialist Centre, Puchong, Malaysia, 2Department of Medicine, Subang Jaya Medical Centre, P795 Subang Jaya, Malaysia TREATMENT OF OSTEOPOROSIS WITH TERIPA- RATIDE IN ANOREXIA NERVOSA PATIENTS Objective: Type 2 diabetes mellitus (DM) is associated T. Sasaki1,T.Kodama2,C.Nakamoto3 with an increased fracture risk but at greater bone mineral 1Department of Orthopedic Surgery, Tokyo Metropolitan density (BMD). The TBS is a novel gray scale analysis of Health and Medical Treatment Corporation Ohkubo BMDasobtainedbyBMDwhichgivesinformationon Hospital, Tokyo, Japan, 2JCHO Saitama Medical Center, microarchitecture and bone quality. This study compared Saitama, Japan, 3Department of Psychosomatic Medicine, the performance of TBS, BMD, and original and TBS- JCHO Saitama Medical Center, Saitama, Japan adjusted FRAX scores in T2DM patients compared with their non diabetic (nonDM) control. Introduction: Osteoporosis is one of the common compli- Methodology: This retrospective study enrolled consecu- cations in anorexia nervosa (AN) patients. Bone mineral tive patients who had a BMD measured in the facility density (BMD) in AN patients are low due to the shortage between 2014 and 2016. The subjects were divided into of nutrition and the low level estrogen. As a result, 50% of DM and nonDM; and the 2 groups were compared with S464 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 one another. All those with conditions that could affect short-term precision and scanned twice, with repositioning bone and calcium metabolism e.g. primary hyperpara- for duplicate hip scans. Least significant changes (LSC) thyroidism, active thyrotoxicosis; or on medications that were computed for aBMD and 3D-DXA measurements. could affect bone e.g. steroid, bisphosphonate are ex- 67 postmenopausal women (66±5.7 years [55 - 76]) were cluded. Lumbar spine and femur neck BMDs were ob- included to measure monitoring time intervals for bone tained using dual-energy X-ray absorptiometry (DXA). status assessment. DXA scans were collected at baseline TBS was obtained using the TBS iNsight software pro- and 12 months. Monitoring time intervals were computed gram (Med-Imaps, Pessac, France) with BMD DXA for aBMD and 3D-DXA measurements by dividing LSC images. by the median change per annum. All DXA scans were Results: There were 30 DM and 35 nonDM subjects with a performed using a Lunar iDXA scanner (GE Healthcare, mean (+SE) age (67.9+1.41 vs. 57.7+1.34; p<0.01) and Madison, WI). BMI (26.8+0.8 vs. 24.3+0.8; p<0.05). There is a difference Results: LSC for total hip aBMD was 0.009 g/cm2.LSC in the FRAX major fracture risk between the DM and associated with the 3D-DXA measurements were nonDM subjects without TBS (11.4+2.0 vs. 6.2+1.4, 0.057 mm for the mean cortical thickness, 16.8 mg/cm3 p<0.05) and with TBS incorporated (12.2+1.9 vs. 6.6+ for the integral vBMD, 15.5 mg/cm3 for the trabecular 1.4, p<0.05). There is no difference in the hip fracture risk vBMD, and 16.6 mg/cm3 for the cortical vBMD (total in both groups with or without TBS. The incremental risk hip). Median annual changes for the postmenopausal wom- of major fracture risk ascribed by TBS is not different en included in this study were -0.006 g/cm2 (aBMD), - between the DM and nonDM subjects (0.81+0.28 vs. 0.017 mm (mean cortical thickness), -5.7 mg/cm3 (integral 0.38+0.15, p=0.16). vBMD), -3.9 mg/cm3 (trabecular vBMD), -6.1 mg/cm3 Conclusion: This study showed that the FRAX major frac- (cortical vBMD). This resulted in monitoring time inter- ture risk was higher in DM compared to the nonDM but vals of 4.1 years (aBMD), 3.3 years (mean cortical thick- this could be due to the DM being significantly older. The ness), 2.9 years (integral vBMD), 4.0 years (trabecular failure to find a significant difference in the FRAX fracture vBMD), and 2.7 years (cortical vBMD). risk with or without TBS incorporated in the fracture risk Conclusion: Monitoring time intervals were similar or assessment may be due to the small number of subjects in shorter for 3D-DXA measurements than for standard the study. A larger number of subjects and using matched aBMD measurements, indicating that the 3D-DXA mea- controls would assess the use of TBS in fracture risk as- surements might be precise enough for monitoring bone sessment better. status in postmenopausal women in clinical routine practice. P797 SHORT-TERM PRECISION ASSESSMENT AND P798 MONITORING TIME INTERVAL TO ASSESS BONE EFFECTIVENESS OF HIP LAVAGE FOLLOWED BY STATUS IN POSTMENOPAUSAL WOMEN BY 3D- INJECTION OF TRIAMCINOLONE WITH OR DXA WITHOUT HYLAN G-F20 IN MODERATE HIP L. Humbert1,S.DiGregorio2, L. Del Río2 OSTEOARTHRITIS 1Galgo Medical, Barcelona, Spain, 2CETIR Centro Médico, M. U. Rezende1,H.M.Gurgel1,G.C.Campos2,M.I. Barcelona, Spain Hissadomi1, R. Frucchi1, T. Pasqualin1,A.F.Pailo1 1Department of Orthopedics and Traumatology, Faculdade de Objective: To evaluate the short-term precision and monitor- Medicina, Universidade de São Paulo, São Paulo, Brazil, ing time interval to assess bone status in postmenopausal 2Department of Orthopaedics/University of Campinas women by 3D-DXA. (UNICAMP)/Hospital de Clínicas, Campinas, Brazil Material and Methods: The 3D-DXA software algorithm (Galgo Medical, Barcelona, Spain) provides 3D subject- Objective: To evaluate the effects of adding different doses of specific models of the proximal femur from DXA projec- hylan G-F20 to hip joint lavage and triamcinolone in moderate tions. The algorithm registers a 3D appearance model of hip osteoarthritis (HOA) the femoral shape and density onto the DXA image of the Methods: Eighty-two patients with grades II and III KandL hip of the patient, and quantifies the cortical thickness and HOA were randomized to one of four groups: Lavage and the volumetric BMD (vBMD) of the integral, trabecular, triamcinolone (group 0); Lavage, triamcinolone and 2mL of and cortical bone. Study participants were collected at hylan G-F20 (group 1); Lavage, triamcinolone and 4mL of CETIR Centre Mèdic (Barcelona, Spain). 33 participants hylan G-F20 (group 2); Lavage, triamcinolone and 6mL of (67±11 years [52 – 93]) were included to evaluate the hylan G-F20 (group 3). WOMAC questionnaires and range Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S465 of motion (ROM) measures were taken at baseline, one, three, group women (n-21, 40-50 years) before and II group six and 12 months postoperatively. two years later after treatment; III group women (n-24, Results: Groups were similar at baseline for age, BMI, 50-65 years) and IV group respectively. BMD was mea- KandL, WOMAC (pain, stiffness, function and total) and sured at three sites (distal radius, midshaft tibia and ROM (p>0.05). Sixty-seven patients completed the study. proximal phalanx) using the ultrasound bone sonometer All groups improved between baseline and the first month (Sunlight, Omnisense). maintaining results through the study period (p<0.001). At Results: The mean data for T score in the I group was: distal one month Pain improved 35.1% (Group 2) to 47.6% radius -1.4±0,02; tibia -1.3±0,05; proximal phalanx -1.5±0,11; (group 1). At one year, pain results remained improved in the II group T score: -1.0±0,05; -1,1±0,15; -1.2±0,03; in the between 17.5% (group 2) and 42.3% (group 0) with no III group T score: -2.3±0,13; -2.2±0,11; -2,6±0,04; and in the differences between groups (p>0.5). WOMAC function IV group T score -1.5±0,14; -1.3±0,08; -1.7±0,11 at the same improved 32.6% to 46.3% in the first postoperative month. measurement sites respectively. One-year function remained improved between 19.9% Conclusions: In both groups before treatment BMD was (group 2) to 36.8% (group 0). WOMAC stiffness results decreased. However in the group of the aged women showed more consistent improvements through the study BMD was lower as estrogen levels decline naturally at period in groups 2 and 3 (p<0.05 for group 3). Flexion the time of menopause and they are at particular risk of improved mostly in group 3 in respect to group 0 at one osteoporosis. BC treatment with AI can lead to weakening year (p<0.001). Internal rotation improved also in hylan of the bones. After therapy with Bonviva BMD increased group 1(p<0.001). in both groups and was at the same level during two years. Conclusion: Lavage and triamcinolone improve function and Women who have had an early menopause and are taking pain of patients with moderate HOA. Results can be improved AI therapy are most likely to benefit from bisphosphonates. by adding Hylan G-F20. In conclusion, AIs related bone loss appears to be manage- able and, therefore, any risk to bone health should be weighed against its overall efficacy and tolerability profile P799 for the treatment of hormone-sensitive postmenopausal BONE LOSS IN WOMEN WITH BREAST CANCER BC. TREATED WITH AROMATASE INHIBITORS M. Zodelava1, G. Tsikhiseli2,S.Nijaradze2, N. Tskhovrebashvili1, N. Tatishvili3, M. Tskhovrebashvili4,T.Mamaladze1 P800 1Department of Osteoporosis and Rheumatology, Ltd SEX-DIFFERENCES IN SOCIO-DEMOGRAPHIC "Unimedi Kakheti-Caraps Medline", Tbilisi, Georgia, CHARACTERISTICS AND RISK FACTORS AMONG 2Department of Clinical Oncology, Ltd "Scientific Research PRIMARY HEALTH CARE USERS DIAGNOSED Centre of Clinical Oncology", Tbilisi, Georgia, 3Department WITH OSTEOARTHRITIS IN TRANSITIONAL of Rheumatology, "Tbilisi Central Hospital", Tbilisi, Georgia, ALBANIA 4Centre of Endocrinology, Metabology and Dietology F. Hoxha1, A. Tafaj2,E.Roshi3 "Enmedic", Tbilisi, Georgia 1Central Polyclinic, no.3, Tirane, Albania, 2QSUT “ Mother Teresa” Hospital, Tirane, Albania, 3Chief of Department of Objective: Hormone therapy with aromatase inhibitors Public Health, Tirane, Albania (AIs) is a vital part of treatment for hormone receptor- positive breast cancer (BC) and is taken for a total of Objective: To assess sex-differences in the distribution of five years and more. Treatment for BC that decrease socio-demographic characteristics and risk factors among pri- estrogen levels even further can add to the risk of oste- mary health care users diagnosed with osteoarthritis in oporosis and breaks. The aim of the present study was to Albania, a post-communist country in the Western Balkans determine bone mineral density (BMD) in women with which is currently undergoing a rapid political and socioeco- BC treated with AI to prevent and reduce side effect, of nomic transition. this well-documented and beneficial therapy, as it is bone Material and Methods: This study included all individuals loss. who were diagnosed with osteoarthritis during January Material and Methods: We have studied 45 postmeno- 2013 – December 2014 in several primary health care cen- pausal women with new case histories of BC aged 40 - ters in Tirana, the capital city of Albania. Overall, during 65 years. All patients were treated with anastrazole 1mg this two-year period, 1179 individuals were diagnosed with per day; ibandronate 3mg intravenous injection every 3 osteoarthritis. Of these, 521 were men (mean age: 60.1 months and calcium 1200 mg per day with Vitamin D. ±10.6 years) and 658 were women (mean age: 58.1±9.6 Patients were divided in four age-matched groups. I years). Diagnosis of osteoarthritis was based on the history S466 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 of the disease, physical examination, laboratory findings There have been a few attempts to use RF current for the and radiological findings – in line with the criteria of the treatment of painful conditions of joints of the extremities. It American College of Rheumatology. Binary logistic re- was also used for the treatment of painful conditions of the hip gression was used to assess the sex-differences related to joint. the socio-demographic characteristics (age, place of birth, Objective: The aim of this study to evaluate the efficacy employment, marital status, educational attainment, in- of radiofrequency (RF) application to sensory nerves for come level, social status) and risk factors (smoking, alco- the management of chronic pain in patients with knee hol intake, body mass index, genetic factors, accidents, OA. weight lifting, heavy physical exercise and preexisting in- Patients and methods: A prospective interventional study flammatory diseases) among individuals diagnosed with conducted at Assiut university hospital in Egypt between osteoarthritis. July 2014 and December 2015 thirty patients with chron- Results: In multivariable-adjusted logistic regression ic knee OA were included in the study. RF neurotomy of models controlling simultaneously for all socio- the genicular nerves was done. The outcome measures demographic characteristics and risk factors, female gen- included a pain scale (visual analog scale, VAS) and der was inversely associated with older age (OR=0.47, Western Ontario and McMaster Universities (WOMAC) 95%CI=0.28-0.79), rural origin (OR=0.31, 95%CI=0.17- Index. 0.62), smoking (OR=0.35, 95%CI=0.23-0.52), alcohol Results: There was a highly significant correlation (p<0.01) intake (OR=0.04, 95%CI=0.02-0.06) and weight lifting between pre and 2weeks, and 6 months in all parameters ex- (OR=0.22, 95%CI=0.12-0.42). Conversely, female gen- cept for the stiffness. In the case of comparison between der was positively related to a lower education attain- 3months and 6 months, we found a significant correlation ment (OR=5.43, 95%CI=2.85-10.33), genetic factors (p<0.05) in Likert scale and VAS and highly significant cor- (OR=2.04, 95%CI=1.41-2.95) and preexisting inflamma- relations (p<0.01) in pain, difficulties and WOMAC and no tory diseases (OR=1.71, 95%CI=1.01-2.89). No sex- correlation in stiffness. differences were noted for marital status, employment, Conclusion: RF applied to chronic knee OA appears to be a income level, social status, overweight and obesity, ac- safe and effective intervention for pain relieve. cidents involving major trauma, or heavy physical exercise. Conclusion: This study provides valuable evidence about the P802 distribution of socioeconomic characteristics and risk factors TIMING OF EATING POTENTIATES THE EFFECT for osteoarthritis in adult individuals diagnosed with osteoar- OF MECHANICAL LOADING ON BONE thritis in transitional Albania. Our findings should support T. M. Skerry1,H.Samvelyan1,J.Mathers2 rheumatologists, but especially policymakers and decision- 1Oncology and Metabolism, University of Sheffield, makers in Albania in order to design and implement rationale Sheffield, United Kingdom, 2Human Nutrition Research programs and interventions for an effective management and Centre, Newcastle University, Newcastle on Tyne, United control of the burden of osteoarthritis in the overall Kingdom population. The effect of exercise is to strengthen bone or reduce bone loss where it would otherwise occur. However, in older P801 people or those with bone-wasting diseases, it is hard to GENICULAR NERVES RADIOFREQUENCY NEU- exercise with sufficient intensity to influence bone strength ROTOMY IN RELIEVING CHRONIC KNEE OSTEO- directly. As it is known that there are changes in a wide ARTHRITIS PAIN range of gut-derived hormones before and after eating, and E. El-Hakeim1, S. Goma1,R.Gamal1,A.Alawamy2 that many of those hormones have effects on bone, we 1Rheumatology Department/Assuit University Hospitals, hypothesised that the timing of eating affects bones re- Assuit, Egypt, 2Pain and Anesthesia Department/Assuit sponse to loading. University Hospitals, Assuit, Egypt Using a well-established tibial loading model in mice, we subjected groups of mice to osteogenic loading of one Background: Osteoarthritis (OA) is one the most common tibia following different dietary interventions. Loading chronic forms of arthritis affecting patients usually aged above consisted of 40 cycles of axial compression over 6 mi- 45 years. OA decreased health-related quality of life and in- nutes on every other day for 2 weeks. Overnight fasting creased economic costs. Radiofrequency (RF), was used for did not alter the response of bone to loading compared the treatment of chronic pain unresponsive to conservative with mice fed ad lib, but if an overnight fast was follow- therapies. RF has been used for several painful conditions. ed by 2 hours of feeding (by which time the animals Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S467 were replete), the response of the tibia to loading as Results: Elastic braces may be proposed in addition to assessed by microCT and histomorphometry was that the first-line non-pharmacological treatment (informa- there was a significant 10% greater increase in cortical tion/education, exercise and physical activity, weight re- thickness than in animals fed ad lib (n=7, P<0.05). duction). Secondary a biomechanical analysis may be Fasting followed by feeding for 1 or 3 hours before needed to provide a more rigid brace taking into ac- loading resulted in a small increase in cortical thickness count: the topography of pain, the lower limb static that was not significant. In order to determine the effect (varus/valgus), stability, any deformation reducibility. of the potentiating feeding regimen on submaximal load- For unicompartmental OA, one can propose an ing and sub-threshold loading, we compared the effect of unicompartmental discharge brace; a hinged stabilizing three different peak forces of dynamic loading. In each brace for bicompartmental OA with or without instabil- case, fasting followed by loading increased the cortical ity. For patellofemoral OA we can offer an orthotic with thickness significantly when compared to the effect of specific patellar device. loading in ad lib fed animals. Conclusion: Using an original methodology has produced an These results demonstrate the possibility of a lifestyle change applicable algorithm in routine. A prospective validation in that could impact upon the effectiveness of exercise interven- primary and secondary care to thirty patients is needed follow- tions. Naturally as humans are not nocturnal it may not be ed by an evaluation of the implementation of a wide range of simple to translate these findings into a programme for those health professionals in order to definitely validate the with osteoporosis, but our data show clearly that this interven- algorithm. tion can change an ineffective loading stimulus into an effec- Disclosures: This study has been funded by Thuasne. tive one and increase the benefit of already effective loading regimens. P804 VITAMIN D CORRECTION IMPROVES APOLIPO- P803 PROTEIN LEVELS IN A SEX-SPECIFIC MANNER AN ALGORITHM TO IMPROVE KNEE ORTHOSIS N. Al-Daghri1, M. Alokail1, A. Manousopoulpou2,A. PRESCRIPTION FOR OSTEOARTHRITIS PATIENTS Heinson2,O.Al-Attas1,Y.Al-Saleh3,S.Sabico1,N. F. Rannou1, J. Beaudreuil2, J.-M. Coudreuse3, C. Nguyen1,P. Aljohani4,C.Woelk2, G. Chrousos5,S.Garbis2 Deat4, A. Chabaud4,B.Pereira4,A.Lorenzo5,E.Coudeyre6 1Biochemistry Department, College of Science, King Saud 1Department of Rehabilitation, Institute of Rheumatology, University, Riyadh, Saudi Arabia, 2Faculty of Medicine, Cochin Hospital, University Paris Descartes, Paris, France, University of Southampton, Southampton, United Kingdom, 2Lariboisiere Hospital, University Paris Diderot, Paris, 3King Abdulaziz Medical City, College of Medicine, King France, 3Hopitaux Sud de Marseille, Marseille, France, Saud Bin Abdulaziz University for Health Sciences, Riyadh, 4CHU Clermont Ferrand, Clermont Ferrand, France, Saudi Arabia, 4King Saud bin Abdulaziz University for 5Primary Care, University Paris Descartes, Paris, France, Health Sciences, Riyadh, Saudi Arabia, 5Pediatrics, Athens 6Rehabilitation Department and Physical Medecine, University, Athens, Greece Clermont-Ferrand, France Numerous studies have identified several extra-skeletal Objective: To develop an algorithm to help orthosis prescrip- health outcomes to be associated with vitamin D deficien- tion for knee osteoarthritis patients. cy, yet a definitive causal link is yet to be discovered. Our Material and Methods: Systematic review of the literature recent 3D LC-nESI-FTMS proteomic analysis among nor- using a qualitative analysis on PubMed databases, Cochrane mal and overweight but apparently healthy adult Saudis Library and Pedro from 1966 to 2015, using the keywords identified apolipoproteins, a known independent cardio- "knee osteoarthritis", "orthosis" with recommendations vascular risk factor, as one of the 110 serological molecular and highest quality trials. Development of a preliminary signatures that modulate vitamin D levels. The present in- version of the algorithm using data from the literature terventional study aims to compare and validate the iden- and taking into account experience of different health pro- tified apolipoproteins among vitamin D deficient subjects fessionals involved in the management of osteoarthritis that have achieved full vitamin D status correction. 199 patients. The algorithm has then been validated by an in- Saudi adults [89 males, mean age 42.0±10.4; Body Mass ternational multidisciplinary expert college (PMR and Index (BMI) 28.6±4.4kg/m2; 110 females, mean age 39.1 sport medicine physician, rheumatologist, general practi- ±12.0; BMI 30.7±5.3] (with vitamin D deficiency tioner, orthopaedic surgeon, physiotherapist, methodolo- [25(OH)D <50nmol/l] were recruited and given 50000IU gist). This version has then been adapted to obtain an ac- cholecalciferol (VitaD50000®) weekly for 2 months, then ceptable final version. twice a month for 2 months, followed by daily 1000IU S468 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 (VitaD1000®) until month 6. Blood samples were taken at liquid chromatography. Serum PON1 activity were sig- baseline and after 6 months. Serum 25(OH)D was mea- nificantly lower in the patient groups than the control sured using electrochemiluminescence and apolipoproteins group (p=0,020). Vitamin A and vitamin E were signif- (AI, AII, B, CI, CII, CIII and E) using commercially avail- icantly decreased in tendinopathy patients than the con- able kits. In all subjects, serum 25(OH)D increased signif- trols (all p<0,01). There was a significant positive corre- icantly from baseline and after 6 months (32.6±11.1 vs. lation between vitamin A and vitamin E in patients with 63.4±16.4nmol/l; p<0.001). In parallel, a significant in- tendinopathy. These findings showed that serum antioxi- crease in apolipoproteins B, CI, CII, CIII and E (p-values dant levels decreased in patients with tendinopathy. A <0.05) after 6 months compared to baseline was observed. decrease in PON1 activity and vitamins A and E levels After stratification according to sex, only apolipoproteins in patients may indicate the importance of oxidative CII and CIII were significantly increased in males (p- stress in tendinopathy disease. Oxidative stress could be values <0.001), and only apolipoprotein CI was signifi- considered as factors in the pathogenesis of tendinopathy cantly increased in females (p<0.001), showing sexual di- disease and may provide a target for preventing tendi- morphism in the effects of vitamin D with regards to apo- nopathy. lipoprotein levels. The rest of the apolipoproteins were not significantly different pre- and post-vitamin D correction. The present study partially explains the effects of vitamin P806 D correction in the reduction of cardiovascular risk BEHCET DISEASE: A CASE STUDY through significant modification of apolipoproteins, partic- B. Bengana1, A. Boukabous1, N. Bahaz1, S. Mostefai1,Y. ularly the apolipoprotein C class. These effects differ ac- Heddi1,H.Hamzaoui1,S.Lefkir1 cordingtosex. 1Department of Rheumatology Beni-Messous Hospital, Algiers University Medicine Faculty, Algiers, Algeria P805 Introduction: Behcet disease (BD) is a vasculitis of unde- ANTIOXIDANT STATUS IN PATIENTS WITH TENDI- termined causes, progresses in flare-ups with ocular in- NOPATHY volvement, joint and central nervous system damages. S. Hira1, R. Arslan2, C. Tamam3,M.Gem4 The diagnosis is made in front of bipolar aphtosis, cutane- 1Department of Clinical Biochemistry, Tatvan State Hospital, ous events and posterior uveitis. The treatment remains Bitlis, Turkey, 2Department of Clinical Biochemistry, Faculty symptomatic with colchicine, corticosteroids and immuno- of Medicine, Dicle University, Diyarbakir, Turkey, suppressive drugs. 3Department of Orthopedics and Traumatology, Tatvan State Patients and methods: We report a cross-sectional and Hospital, Bitlis, Turkey, 4Department of Orthopedics and multicentric study in a series of 70 cases followed in rheuma- Traumatology, Faculty of Medicine, Dicle University, tology since 1986 to date. The diagnosis of BD was made on Diyarbakir, Turkey international criteria (ICBD). Results: 70 cases reported: 51 male for 19 female, index Tendinopathy is a painful chronic condition that occurs ratio=3, the average age of diagnosis is 37 years (18-72), in and around tendons in response to overuse. Various the juvenile onset seen in 5 cases. Mucocutaneous disor- intrinsic and extrinsic risk factors have been identified, ders are reported as buccal aphtosis in 38% (bipolar but the molecular pathogenesis and etiology of the dis- aphtosis 62%), pseudofolliculitis in 55%, erythema ease remains unclear. However, the presence of oxidative nodosum in 16%, vasculitis in 9%, positive pathergy test stress in the development or progression of tendinopathy in 10%, joint disorders reported in 95%, thrombophlebi- is unknown. Paraoxonase-1 (PON1) is an important an- tis in 11% and ocular involvement in 39%, neurologic tioxidant enzyme that prevents lipids and cell membranes damage in 18%, inflammatory syndrome seen in 49%, from peroxidation. Vitamin A and vitamin E have anti- HLAB5in23%.Onthetreatmentside:88%aretaking oxidant properties against oxidative stress-induced cellu- colchicine, 28% on anticoagulant drugs, 56% on cortico- lar damage. The aim of this study was to investigate steroids, 11% cyclophosphamide, 5 on azathiprine, 2 relationship between serum antioxidant status markers chloraminophene. Good results have been reported for and tendinopathy disease. 34 tendinopathy patients and 52 cases and 2 deaths. 31 healthy volunteers were included for this prospective Conclusion: Behcet disease needs attention for its multi- observational study. Serum PON1 enzyme activities were organ involvement. The takeover depends in severity of dis- measured using enzyme-linked immunosorbent assay. ease, often needing to have recourse to use: corticoids, immu- Serum vitamins A (retinol) and E (α-tocopherol) levels nosuppressive drugs, less than interferon alpha, thalidomide were measured simultaneously by high performance or anti TNF alphaz. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S469 P807 P808 THE HISTOLOGICAL STRUCTURE OF THE FACTORS ASSOCIATED WITH GOOD TOLERANCE MANDIBULAR CONDYLAR CARTILAGE IN RATS AND INTOLERANCE OF METHOTREXATE IN OF VARIOUS AGES AFTER APPLYING PATIENTS WITH INFLAMMATORY JOINT DISEASE PERFORATED TIBIAL DEFECTS B. Bengana1, A. Boukabous1,M.MoussaMebarek1,Y. A. M. Pilavov1,V.I.Luzin1,E.Y.Shutov1,I.Y. Heddi1, H. Hamzaoui1, N. Bahaz1, S. Mostefai1, S. Lefkir Kozhemyaka1 Tafiani2 1SE Lugansk State Medical University, Lugansk, Ukraine 1Department of Rheumatology Beni-Messous Hospital, Algiers University Medicine Faculty, Algiers, Algeria, Objective: To analyze histological structure of the mandib- 2Rheumatology, University Hospital Centre, Beni-Messous, ular condylar cartilage (MCC) in rats of various ages after Algiers, Algeria applying perforated tibial defects and finding possibility of medication with quercetin. Background: The methotrexate (MTX)is by far the most pre- Material and Methods: The experiment involved 252 male scribed drug in the treatment of various inflammatory condi- rats (young, adult, and senile): the 1st control group; the tions, the data on assessment of factors associated with 2nd group - animals with 2.2 mm defect in the both tibiae; its intolerance or better tolerance in patients with inflammato- the 3rd group animals with defect in the tibia that received ry joint disease (IJD) is lacking. The aim of this study was to per os quercetin in dosage of 0.32 g per kg daily. The appreciate the frequency of MTX intolerance and to define the animals were withdrawn from the experiment by the 7th, factors linked to it in people followed for IJD. the 15th,the30th, and the 90th day after applying tibial Methods: We have identified all patients treated by defects by means of anaesthetized decapitation. Upon ex- MTX only (oral or subcutaneous administration) for all piration of observation terms the frontal sections of the IJD taking this DMARD at least since three months, we MCC were hematoxylin-eosin stained and put to light mi- have evaluated the adverse events by laboratory moni- croscopy for measurements of mandibular condylar carti- toring and Methotrexate Intolerance Severity Score lage zones. (MISS),we selected all people with MTX intolerance Results: A plain defect in the tibia had inhibiting effects on but also everyone with good tolerance and we compared activities of MCC. In young rats peak of alterations was the both groups, we have deduced the factors associated registered by the 15th day when zones of proliferation (ZP) with a better tolerance of this treatment. and osteogenesis (ZO) were narrower than controls by Results: One hundred twenty five patients was included, 95 6.72% and 7.51%. In adult and senile rats peak of alter- women and 30 men, mean age was 45±+ 13,3 years; 65 ations was registered by the 30th day when ZP and ZO Rheumatoid Arthritis (RA), 21 Ankylosing Spondylitis were narrower than of controls by 5.40% and 8.36%, and (AS), 15 Psoriatic Arthritis (PA) et 24 Sjogren Syndrome by 6.05% b 9.60%. Restoration of registered alterations (SS) among them, 51% have showed an intolerance with also depended on age of animals: in young rats by the MTX (with 19% cessation of therapy) against 49% of better 90th day after applying tibial defects significant differences tolerance. Factors linked to a bad tolerance was: patients with from the control values some differences were still ob- advanced age (p <0.001) and MTX dose given once weekly served, in adult rats in the same period most differences (p=0.02) were still observed, and in senile rats histological structure Conclusion: The frequency of intolerance of MTX is relative- of the MCC did not restore. ly high ( half of our population), this is particularly true for Application of quercetin significantly reduced negative advanced age patients and the absence of splitting the oral effects of experimental conditions (increase of width dose of MTX. MCC zones and primary spongiosa content). In young and adult rats restoration signs manifested in the period from the 7th to the 90th day, and in senile animals – P809 from the 30th daytothe90th day. THE EFFECTS OF 60-DAY SODIUM BENZOATE Conclusion: A plain defect in the tibia had inhibiting INTAKE AND IONIZING RADIATION ON GROWTH effects on structure of MCC. Deviations degree and re- RATE OF THE MANDIBLE IN RATS covery rate depend on age of animals. Faster recovery I. G. Stepanenko1,V.I.Luzin1,L.I.Chystolinova1,M.G. rate was observed in young animals while senile animals Gryshchuk1 exhibited few signs of recovery. Application of quercetin 1SE Lugansk State Medical University, Lugansk, Ukraine in dosage of 0.32 g per kg of body weight reduced neg- ative effects of experimental conditions on structure of Objective: The study is aimed at investigation of growth rates MCC. of the mandible in rats in readaptation period after 60-day S470 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 application of sodium benzoate (SB) and exposure to ionizing differences in the trajectories among cohorts with different radiation (IR), and finding possibility of medication with sea types of fractures, regional [1] and patient factors. buckthorn oil (SBO). Materials and Methods: Insurance claims for three prospec- Material and Methods: The experiment involved 240 rats tive cohorts of patients with hip fracture, wrist fracture and with initial body weight of 180-200 g. The animals were dis- proximal humerus fracture among US Medicare beneficiaries tributed into 8 groups as follows: intact animals for the con- age 66 and older with an index fracture occurring during trols, animals that received per os SB in dosage of 1500 mg 2007-2011. Several types of standardized costs are included per kg daily for 60 days, animals exposed to IR (total 4 Grey in for each participant. Standardized costs per beneficiary are 4 sessions), received SBO in dosage of 300 mg per kg, com- accumulated in each 30-day period from time of enrollment bined SB and IR, SB and SBO, IR and SBO, and all three until death or end of follow up. agents simultaneously. The animals were withdrawn from the We used a joint modeling approach [2,3,4] for survival and experiment by the 1st,the7th,the15th,the30th, and the 60th cost data to study individual level trajectories of Medicare cost day after cessation of experimental influences by means of data and survival in the fracture cohorts. Our approach in- anaesthetized decapitation. The mandibles were excised and cludes patients whose death times are censored. We use two put to gross measurements (V.I. Luzin, 2004). regression sub models: a piecewise exponential model for Results: Upon SB discontinue, ramus height, alveolar buttress survival time, and a retrospective spline regression model for width, and width of lower incisor decreased as compared to costs. This allows for examination of factors affecting surviv- the controls by 7.13%, 5.93%, and 7.70%; after IR discontin- al, the terminal trend, and time trends in the cost among sur- ue same values decreased by 12.41%, 7.98%, and 9.96%. viving individuals. After combined action of SB and IR those values were lower Results: Through simulations, we demonstrate that our ap- by 13.49%, 10.02%, and 12.80%. Restoration of growth rate proach produces accurate estimates and confidence intervals. also depended on influence: by the 30th day after SB discon- Conclusion: Our method is effective for estimating survival tinue some differences were still observed, and after cessation and end of life cost trends in elderly fracture cohorts. of combined action growth rate did not recover. References: Application of SBO reduced negative effects of experimental 1. Wennberg JE, The Dartmouth atlas of health care. 1996, conditions on growth rate of mandible. The best recovery Chicago: American Hospital Publishing. outcome was observed in animals that received only SB and 2. Kurland BF et al, Stat Sci. 2009;24(2):211. the lowest recovery outcome was yielded in rats exposed to 3. Li ZG et al. Stat Med 2013;32:1394. combined action of IR radiation and SB. 4. Davis MA et al. Health Aff (Millwood) 2016;35:1316. Conclusion: 60-day application of SB in dosage of 1500 mg per kg of body weight, exposure to IR and combined action result in marked decrease of growth rate that expands even to P811 readaptation period. This fact urges searching for medication THE ROLE OF MYOFASCIAL SYNDROME OF THE and prophylactic measures for such a state. According to our CERVICAL PART IN DEVELOPMENT OF CHRONIC findings SBO well satisfies this demand. BRAIN ISCHEMIA A. E. Barulin1,O.V.Kurushina1,A.A.Drushlyakova1 1Volgograd State Medical University, Volgograd, Russian P810 Federation FACTORS INFLUENCING END OF LIFE COST AND SURVIVAL IN ELDERLY OSTEOPOROTIC Objective: One of the most common diagnoses in neurology FRACTURE COHORTS practice is chronic brain ischemia. The prevalence of T. D. Tosteson1,Q.Yang2,A.N.Tosteson3,J.Munson4,Z.Li5 cephalgic syndrome in this disease varies from 37 to 74%. 1BiIomedical Data Science/Dartmouth, Lebanon, NH, United The aim of the study was to determine biomechanical disor- States, 2The Dartmouth Institute for Health Policy and Clinical ders of the spine and their influence on the development of Practice, Geisel School of Medicine at Dartmouth, Lebanon, chronic brain ischemia. NH, United States, 3The Dartmouth Institute for Health Policy Material and methods: The study involved 68 patients and Clinical Practice, Geisel School of Medicine at Dartmouth, with the diagnosis of the chronic brain ischemia aged Lebanon, United States, 4Medicine//Dartmouth-Hitchcock, from 38 to 68 years. Clinical examination included neu- Lebanon, NH, United States, 5Biomedical Data Science/ rological and kinesiological examinations. Specific origi- Dartmouth, Lebanon, United States nal test: map of headache localization. To assess the con- dition of statodynamic muscles and symmetry of the spine Objective: To study the trends and factors influencing end of and extremities we used the method developed by us, life cost in elderly fracture cohorts by comparing the based on visual and optical analysis. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S471 Results: Headaches were localized as follows: frontal pain - (48.8%) were diagnosed with osteoarthritis. 15 patients 20.6%, frontotemporal pain - 36.8%, parietal pain - 10.3%, (34.9%) presented hand osteoarthritis and 9 patients (20.9%) occipital pain - 32.3%. The results of visual and optical exam- presented knee osteoarthritis. Hand osteoarthritis did not in- ination yielded a common combination of scoliotic spinal de- fluence the values of DAS28, SDAI, patient’s and physician’s formity: it was a violation of posture and symmetry changes in visual analogue scale (VAS) or ultrasound scores (p>0.05). the shoulder girdle and shoulder blades. During the palpation For patients with knee osteoarthritis, significantly higher of the spine trigger points were found in the lower oblique values for DAS28 were observed at baseline (p=0.018) and muscle of the head - 14.7%, trapezoidal muscle - 60%, muscle were maintained significantly higher after 12 months of ob- lifting the shoulder blade - 45.1%, scalene muscle – 32.4%. servation (p=0.031). All the other parameters were not influ- Almost every examination demonstrated "the phenomenon of enced by the presence of knee osteoarthritis (p>0.05). recognition": when the trigger point was pressed, the pain the Conclusions: Significantly higher values of DAS28 were ob- patient had originally presented to the doctor with was served in patients with ERA who associated knee osteoarthri- reproduced. tis, while the values of SDAI were not influenced, suggesting Conclusions: When the diagnosis of patients with chronic that SDAI may be superior to DAS28 in evaluating patients brain ischemia is made, the vascular aspect is generally taken with ERA and knee osteoarthritis. Not the same tendency was into account but other aspects are not differentiated. The ex- observed in patients with ERA and hand osteoarthritis. The amination showed that patients with chronic brain ischemia values of patient’s VASwere not influenced by the presence of suffer a violation of the musculoskeletal system, which leads hand or knee osteoarthritis suggesting that these types of os- to abnormalities in the cervix. These facts clearly prove the teoarthritis do not influence the patients’ perception of the significance of development of musculofascial reactions with disease activity. Moreover, the values of ultrasound scores biomechanical abnormalities in locomotor field and points to were not influenced by the presence of osteoarthritis. the importance of the further study of etiopathology of chronic References: 1. Aletaha D et al. Arthritis Rheum. 2010;62:2569 brain ischemia. P813 P812 OFFICE-BASED PRESCREENING OF CORTICAL THE INFLUENCE OF OSTEOARTHRITIS ON BONE THICKNESS IN FEMALE HIP CLINICAL, BIOLOGICAL AND ULTRASOUND ARTHROPLASTY PATIENTS PARAMETERS OF PATIENTS WITH EARLY H. Aro1,S.Nazari-Farsani1,K.Peura2, M. Vuopio1 RHEUMATOID ARTHRITIS 1Department of Orthopaedic Surgery, Turku University T. Serban1,I.Satulu2,M.Istoc3, O. Vutcanu3,A.Circiumaru3, Hospital, Turku, Finland, 2Department of Orthopaedic M. Milicescu1, M. Bojinca1 Surgery, University of Turku, Turku, Finland 1Department of Internal Medicine and Rheumatology, "Dr. I Cantacuzino" Clinical Hospital, "Carol Davila" University of Objectives: Female hip arthroplasty patients over 65 years of Medicine and Pharmacy, Bucharest, Romania, 2Department of age are at highest risk for periprosthetic fractures of Rheumatology, Kalmar County Hospital, Kalmar, Sweden, uncemented stems probably because of poor bone quality. 3Department of Internal Medicine and Rheumatology, "Dr. I Dual-energy X-ray absorptiometry (DXA) screening for low Cantacuzino" Clinical Hospital, Bucharest, Romania bone mineral density (BMD) of the proximal femur may help in risk assessment of this complication. We asked if office- Objective: To evaluate the possible impact of osteoarthritis on based measurement of cortical bone thickness could be useful the clinical, biological and ultrasound parameters currently for prescreening of female arthroplasty patients. evaluated in patients with early rheumatoid arthritis (ERA). Material and Methods: Sixty-one postmenopausal women Material and Methods: We have evaluated the data obtained with primary hip osteoarthritis and without diseases or drugs from patients with ERA referred to the Early Arthritis affecting bone metabolism underwent preoperative measure- Research Center (EARC) of “Dr. I. Cantacuzino” Hospital. ment of apparent multi-site (tibia and radius) cortical bone 43 patients were diagnosed with ERA in the EARC between thickness using a mobile pulse-echo ultrasound device. The 2010 and 2016 and were enrolled in this study. Only data from cortical bone thickness index obtained from the measurements patients who fulfilled EULAR/ACR 2010 criteria for RA (1) takes into account the patient’s age and body characteristics and had a symptom duration of less than 12 months were (weight and height). An index below 0.876 g/cm2 was applied analyzed. Patients were evaluated at baseline and after 12 according to the previously defined 90% sensitivity threshold months. as indication for DXA screening (1). The normalized cortical Results: There was a clear predominance of women (62.8%). bone index was validated against local BMDs measured by The mean age was 55.47±13.71 years. At baseline, 21 patients standard DXA. S472 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: The normalized cortical bone index was below the crystallites and increase of microtexturing coefficient). After threshold value in 23 women (38%), who were considered to GE administration on the 60th days of observation in immature require DXA screening. The index correlated significantly rats crystallites dimensions decreased as compared to the 2nd (r=0.558, p<0.001) with the BMD of the femoral neck. The group by 5.34% and microtexture coefficient increased by approach showed 68% sensitivity, 80% specificity, 65% posi- 3.95%, in mature rats by 5.51% and 4.50%, and in elderly rats tive predictive value and 82% negative predictive value in the – by 2.04% (p>0.05) and 4.31% respectively. identification of patients with osteoporotic or osteopenic BMD Conclusion: Long-term excessive intake of PO results in de- of the index hip. Applying T-score <-2.0 of the femoral neck as rangement of the crystal lattice of DB. Terms and intensity of the discriminator, the index showed 100% sensitivity and 84% alterations depend on age of experimental animals. specificity. Administration of GE reduced negative effects of palm oil Conclusion: The normalized cortical bone index reduced the on the crystal lattice of DB. Faster recovery rate was observed need of preoperative DXA for identifying female hip in young animals, slower - in senile animals. arthroplasty patients with low BMD of the proximal femur. Reference: 1. Karjalainen et al. Osteoporos Int 2016;27:971. P815 THE IMPACT OF VERTEBRAL FRACTURES ON P814 HEALTH RELATED QUALITY OF LIFE IN ULTRASTRUCTURE OF DENTIN BIOMINERAL OF OSTEOPOROTIC PATIENTS ATTENDING A BONE THE LOWER INCISOR IN RATS OF VARIOUS AGES HEATH SERVICE AFTER EXCESSIVE PALM OIL INTAKE N. Maher1, N. Fallon2,G.Steen3,P.Brown2,J.Mahon4,A. K. R. Ismailova1,V.I.Luzin1,A.V.Liashchuk1,I.V. Dillon5, K. McCarroll6, J. B. Walsh2,M.Casey6 Haivoronska1 1Bone Health and Osteoporosis Unit, Mercer's Institute for 1SE Lugansk State Medical University, Lugansk, Ukraine Successful Ageing, St James's Hospital, Dublin, Ireland, 2Bone Health and Osteoporosis Unit, Mercer's Institute for Objective: To analyze ultrastructure of dentin biomineral of Successful Ageing, St James's Hospital, Dublin, Ireland, the lower incisor (DB) in rats of different ages after excessive 3Bone Health and Osteoporosis Unit, Mercer's Institute for palm oil (PO) intake and administration of Garciniae Successful Ageing, St James's Hospital, Dublin, Ireland, cambogia extract (GE) as medication. 4Bone Health and Osteoporosis Unit, Mercers Institute for Material and Methods: The experiment involved 216 rats of Successful Ageing, St James's Hospital, Dublin, Ireland, three ages: immature, mature and elderly animals. The ani- 5Bone Health and Osteoporosis Unit, Mercers Institute for mals were split into the groups as follows: the 1st group com- Successful Ageing, St James Hospital, Dublin, Ireland, prised intact animals (the controls), the 2nd group comprised 6Bone Health and Osteoporosis Unit, Mercers Institute for the animals that received intragastric PO in dosage of 30 mg Successful Ageing, St James's Hospital, Dublin, Ireland per kg of body weight, and the 3rd group PO and intragastric GE in dosage of 0.25 mg per kg of body weight. The animals Objective: Vertebral fractures are a common complication of were withdrawn from the experiment by the 1st,the10th,the osteoporosis and are associated with back pain and functional 30th and the 60th day after 6-week of PO intake. Burned and impairment, which can influence mood and lead to depres- powdered DB were taken to X-ray scatter analysis. sion. This can have a negative impact on patient health related Results: Excessive intake of PO resulted in derangement of quality of life (HRQOL).We investigated the effect of verte- the crystal lattice of DB; deviations degree depends on age of bral fractures on HRQOL in osteoporotic patients. animals. The alterations started manifesting from the 1st day of Materials and Methods: A cross sectional study was carried observation and continued growing throughout the whole ex- out amongst patients attending a bone health service for oste- periment. In immature animals crystallites dimensions in- oporosis assessment. 50 patients with vertebral fractures and creased as compared to the control values from the 1st to the 50 patients with no vertebral fractures were included. All pa- 60th days of observation by 4.39%, 5.36%, 5.58% and 5.45% tients completed the Quality of Life Questionnaire of the and microtexture coefficient decreased by 3.38%, 4.19%, European Foundation for Osteoporosis (QUALEFFO) on first 4.16% and 4.49% respectively. In mature animals the same attendance. Each patient received a Dual Emission x-ray ab- values changed in the same way by 0.16% (p>0.05), 0.89% sorptiometry (DXA). Vertebral fractures were diagnosed by a (p>0.05), 6.05% and 6.67% and by 2.65%, 3.55%, 4.04% and lateral vertebral assessment (LVA). The QUALEFFO is a dis- 4.44% and in old animals – by 4.41%, 4.82%, 4.77% and ease specific HRQOL questionnaire targeting fracture assess- 4.92% and by 3.32%, 4.00%, 5.13% and 5.73%. ment specific to patients with vertebral fractures. It comprises Administration of GE reduced negative effects of PO as com- 41 questions in 5 domains: Pain; Physical Function; Social pared to the 2nd group (diminishing of elementary cells and Function; General Health Perception and Mental Function. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S473 Results: 50 community dwelling patients in each group. 5:1 were enrolled. 112 taken in charge by the orthogeriatric co- female to male ratio. Mean age 71years (Range 31-92). 62% management team and 108 by the orthopaedic team with a patients had previous fractures with 69% taking bone health consultant service as support. Both groups were compared medication on presentation. 14% were treatment naive and with 210 hip fracture patients consecutively enrolled in the 21% were on calcium and vitamin D supplements only. same period of the previous year and managed in accordance Vertebral fracture patients were older, had a higher prevalence with a traditional orthopaedic care model. Measurements were of non vertebral fractures. They experienced more pain (m=42 several clinical indicators, including time to surgery, length of v 32), reduced physical (m=36 v 23) and social function stay, in-hospital and 1-year mortality. (m=50 v 45) and poor mental health (m=41 v 34) when com- Results: Patients in the OGC (OR 2.62; CI 95% 1.40-4.91) pared to those with no vertebral fractures but not significantly but not those in the CGS (OR 0.74; CI 95% 0.38-1.47) (p=.4) Overall HRQOL was reduced in patients with vertebral showed a higher probability of undergoing surgery within 48 fractures, however not significantly. hours compared to those in the TOC. Moreover, the OGC (β:- Conclusion: Our results support previous findings that 1.08; SE: 0.54, p=.045) but not the CGS (β: -0.79; SE: 0.53, HRQOL is decreased in patients with vertebral fractures. p=.148) was inversely associated with length of stay (LOS). The nonsignificant nature of our results might be explained Ultimately, patients in the OGC (OR 0.31; CI 95% 0.10-0.96) by the relatively low numbers involved in this study and the but not those in the CGS (OR 0.37; CI 95% 0.10-1.38) expe- inclusion of a significant cohort of younger people with oste- rienced a significantly lower 1-year mortality rate compared to oporosis who tend to be healthier and fitter than older patients. those in the SOC. All analyses were independent of several It highlights the importance of preventing and treating verte- confounders. bral fractures to reduce their impact on HRQOL. Conclusion: Older persons managed by the OGC showed better clinical indicators, including time to sur- gery, LOS and mortality rates, than those managed in P816 accordance with the consultant geriatric service or tradi- THE ORTHOGERIATRIC COMANAGEMENT tional orthopaedic care. IMPROVES CLINICAL INDICATORS IN HIP FRACTURE PATIENTS COMPARED WITH CONSULTANT GERIATRIC SERVICE AND TRADITIONAL P817 ORTHOPAEDIC CARE METABOLIC SYNDROME IN PATIENTS WITH GOUT R. Serra1, C. Ruggiero2,M.Baroni2,S.Ercolani2,E. L. Rotaru1, L. Groppa1, E. Russu1, S. Agachi1, D. Cepoi- Zengarini2, R. Radicchi2, G. Rinonapoli3, A. Caraffa3,R. Bulgac2,L.Chislari2 Valecchi 4,A.Giusti5, G. Pioli6,P.Mecocci2 1Department of Rheumatology, State Medical and 1Department of Geriatrics and Rehabilitation, Santa Croce Pharmaceutical University «Nicolae Testemitanu», Chisinau, Hospital, Azienda Ospedaliera Ospedali Riuniti Marche Republic of Moldova, 2Department of Rheumatology, State Nord, Fano, Italy, 2Section of Geriatrics, Department of University of Medicine and Pharmacy, Chisinau, Republic of Medicine, University of Perugia, Perugia, Italy, 3Orthopedic Moldova and Traumatologic Unit, Department of Surgery, University of Perugia, Perugia, Italy, 4Medical Direction, Hospital S. Objectives: To determine the prevalence of metabolic syn- Maria della Misericordia, Perugia, Italy, 5Geriatric Care, drome in patients with gout, and study its manifestations de- Orthogeriatric and Rehabilitation Department, E.O. Galliera pending on the nature of renal disease. Hospital, Genova, Italy, 6Neuromotor Diseases Department, Methods: One hundred and forty five patients with gout have ASMN-IRCCS, Reggio Emilia, Italy been examined (according to ACR criteria, 2014). 117 of them were diagnosed with chronic gout, and 28 with acute gout. Objective: To compare clinical indicators of hip fracture pa- Age of the patients ranged from 17 to 79 years old. The pa- tients treated in accordance with orthogeriatric comanagement tients were monitored in the period 2007-2016. Disease dura- (OGC), consultant geriatric service (CGS) and traditional or- tion in these patients was between 1 and 40 years. All patients thopaedic care (TOC). were examined by instrumental and laboratory methods. Material and Methods: this is a single-centre, prospective Results: The mean age of patients with gout was 48 years. At intervention study in which hip fracture patients admitted to onset, the following distribution of joint involvement was no- the acute traumatological ward of a teaching hospital were ticed: the lower limbs were affected more frequently, particu- assigned to the orthogeriatric comanagement or geriatric con- larly the first MTP joint – 134 (92%), followed by ankle joints sultant service and both branches were compared with a ret- in 86 (59%), and knee joints in 59 (41%) respectively. To a rospective control group managed in accordance with a tradi- lesser extent the joints of the upper limbs were involved - in 19 tional orthopaedic model of care. 430 hip fracture patients (13%) patients. In the study group, patients with chronic gout S474 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 prevailed - 117 (81%) while relapsing evolution was regis- P819 tered in 28 (19%) patients. With regard to kidney involvement ULTRASTRUCTURE OF DENTIN BIOMINERAL OF THE – 74 (51%) patients had tubular-interstitial nephritis with uric LOWER INCISOR IN RATS AFTER IMPLANTATION OF acid diathesis, and 62 (42%) patients had nephrolithiasis. MANGANESE ENHANCED HYDROXYAPATITE Metabolic syndrome (MS) was diagnosed in 89 (61.4%) pa- IMPLANTS INTO TIBIA tients with gout. According to the frequency of MS compo- D. A. Astrakhantsev1,V.I.Luzin1, E. P. Berezhnoy1,E.N. nents, Systolic BP> 135mmHg was recorded in 132 (91%) Skryabina1,Y.P.Osipova1 patients, a Waist Circumference of > 94 cm was seen in 89 1SE Lugansk State Medical University, Lugansk, Ukraine (61.4%) patients, triglycerides> 1.7mmol/l in 78 (54%), and glucose> 6.1 mmol/l in 61 (42%) patients. Decreased glomer- Objectives: The study is aimed at analysis of ultrastructure ular filtration rate below 60 ml/min was detected in 64 (44%) of dentin biomineral of the lower incisor in rats after of gout patients with MS and in 28 (19%) patients without implantation of manganese enhanced hydroxyapatite into MS. the tibia. Conclusion: All of the above results correspond to data from Material and Methods: The study involved 252 male rats. international studies pointing to the fact that the presence of The 1st group comprised intact animals, the 2nd group - the metabolic syndrome in patients with gout leads to organ animals with 2.2 mm defect in the tibia, and the groups 3 damage, regardless of geographic location, but depends on through 6 - the animals with the defects filled with hy- disease duration. droxyapatite enhanced with 0.0%, 0.1%, 0.25%, and 0.5% share of manganese. Burned and powdered dentin was tak- en to X-ray scatter analysis and calculated crystallographic P818 parameters of the dentine biomineral. FEMORAL NECK T-SCORE IN POSTMENOPAUSAL Results: Fracture modeling (2.2 mm defect in tibia shaft) WHITE WOMEN AND ITS RELATION WITH THE leads to instability of ultrastructure of dentin biomineral MONTH OF THE YEAR OF THE DXA EXAMINATION of the lower incisor (enlargement of elementary cells and A. Mereu1, E. Scapin1, L. Saba1 crystallites, and micro texture coefficient decrease) the 1P.O. Duilio Casula - A.O.U. di Cagliari - Università degli 15th to the 180th days of observation. Implantation of Studi di Cagliari - U.O.C. di Radiologia, Monserrato (CA), pure hydroxyapatite into defect also affects stability of Italy crystal lattice of dentin biomineral of the lower incisor; alterations are observed from the 15th to the 60th days of Objectives: The aim of this study was to analyze whether the observation and after that crystal lattice began to restore. femoral neck T-score and osteoporosis or lack thereof in post- Manganese enhanced implants significantly reduce nega- menopausal white women might depend by the month of the tive effects of fracture on stability of ultrastructure of year when the DXA is executed. dentin biomineral; the most effective were the implants Material and Methods: 9,619 different postmenopausal with 0.25% of manganese. With manganese concentra- white women who had a single hip DXA scan, were retro- tion increase up to 0.25% micro texture coefficient on spectively analyzed. Age range was between 19 and 98 years, the 30th and the 90th day was higher than those of the age of menopause was between 15 and 65 years. Femoral 3rd groupby2.61%and1.74%,andsizesofcrystallites neck T-score was calculated using the NHANES database from the 30th to the 60th day were lower than those of (2005-2008). The subjects were also classified according to the 3rd group by 4.60% and 5.7% respectively (from their bone mineral density category (normal, osteopenic, os- here and on, all numeric values are significant with teoporotic status), deducted by their femoral neck T-score. p<0.05). Implants with 0.5% of manganese cause man- DXA scans were executed in all months of the year. ganese intoxication observed as decrease of micro tex- Statistical analysis was performed using the Bartlett test, ture coefficient on the 7th,the60th,the90th and 180th one-way ANOVA and Pearson's chi-squared test. days of observation with intensity peak at the 90th day Results: A statistically significant difference between any of observation as compared to the control values of the month of the year was observed neither on the base of the T- 3rd group by 2.89%, 2.91%, 3.88%, and 3.09% score (one-way ANOVA, p=0.5601) nor on the base of the respectively. bone mineral density category (Pearson's chi-squared test, Conclusions: Application of manganese enhanced implants p=0.6436). T-score histogram approximated a Gaussian curve significantly reduces negative effects of bone fracture on in all months. ultrastructure of the dentin biomineral. Implants with Conclusions: Our study results showed that a DXA scan could 0.25% share of manganese proved to be the most effective be performed on postmenopausal white women in any month while implants with 0.5% share of manganese produced of the year without obtaining significantly different results. signs of manganese intoxication. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S475 P820 Objectives: The aim of the study is to analyze ultrastructure ALTERATIONS IN DNA METHYLATION MIGHT of biomineral of the mandibular ramus in rats of different ages EXPLAIN THE IMPAIRED BONE REMODELING IN after 60-day inhalation of epichlorohydrin vapors (EV) and DIABETIC PATIENTS administration of thiotriazoline (T) and Echinaceae tinctura Z. Maghbooli1,A.Hossein-Nezhad1,M.Sadeghi1, H. Adibi1, (ET) as medication. B. Larijani2 Material and Methods: For the purposes of study we select- 1Osteoporosis Research Center, Endocrinology and Metabolism ed 420 male rats of three ages. The 1st group comprised intact Clinical Sciences Institute, Tehran University of Medical animals, the 2nd group comprised the animals that received Sciences, Tehran, Islamic Republic of Iran, 2Endocrinology inhalations of EV in dosage of 10 MPC as a single 5-hour and Metabolism Clinical Sciences Institute, Tehran University exposure per day, the 3rd group received EV and intraperito- of Medical Sciences, Tehran, Islamic Republic of Iran neal T in dosage of 117.4 mg per kg of body weight, and the 4th group comprised the animals that received EV and Objective: The aim of this study was to assess whether bone intragastric ET in dosage of 0.1 mg of active substance per turnover markers were associated with global DNA methyla- 100 grams of body weight. The animals were withdrawn from tion levels in diabetic patients. the experiment by the 1st,the7th,the15th,the30th, and the Material and methods: The 5-methyl cytosine content was 60th day after EV discontinue. Burned and powdered mandib- assessed by reverse phase high pressure liquid chromatogra- ular rami were taken to X-ray scatter analysis. phy (RP-HPLC) of peripheral blood leukocytes obtained from Results: By the 1st day upon EV discontinue, crystallites di- 174 type 2 diabetes patients to determine individual global mensions (CD) in young animals increased as compared to the DNA methylation status. The biochemical and metabolic pa- control values by 9.93% and microtexture coefficient (MC) rameters and bone turnover markers were assessed in all dia- decreased by 9.89%. In adult animals the same values betic patients. changed in the same way by 7.16% and 11.28% and in old Results: Our findings showed serum levels of at least one of animals – by 6.90% and 7.04%. In readaptation period by the the studied bone turnover markers that include osteocalcin 60th day of observation in young and adult animals MC de- (OC), carboxyterminal collagen crosslinks (CTX), creased by 3.44% and 5.22%, and in old animals CD in- procollagen I aminoterminal propeptide (PINP) and PTH were creased as compared to the control values by 6.61% and MC affected by age, sex, BMI, duration of diabetes, Michigan decreased by 6.21%. Administration of T or ET reduced neg- diabetic neuropathy scale, estimated-glomerular filtration rate ative effects of EV as compared to the 2nd group during inha- (e-GFR), liver function tests, 25(OH)D and global DNA lation and after it (diminishing of elementary cells and CD and methylation levels. There were no significant correlations be- increase of MC). After T administration, deranged features of tween serum levels of studied bone turnover markers and the crystal lattice restored in young rats by the 30th day, adult FBS, HbA1c, insulin, lipid profile, hs-CRP and HOMA index. animals exhibited restoration signs throughout the whole ob- In a general linear model, after adjusting for age, sex, BMI, servation period and in old animals signs of restoration were and duration of diabetes, there was significant association be- observed by the 15th and to the 60th days. After ET adminis- tween levels of global DNA methylation and PINP (p=0.001) tration, in young animals restoration of the crystal lattice was independent of Michigan diabetic neuropathy scale, eGFR, observed by the 1th to the 60th days, in adult by the 7th to the and serum levels of liver function tests and 25(OH) D. 60th days, and in old animals – by 60th day of observation. Conclusion: Our findings demonstrate for the first time that Conclusions: 60-day inhalation of EV results in derange- alteration of global DNA methylation levels in type 2 diabetes ment of the crystal lattice of bone mineral. Deviations patients plays an independent role in bone turnover. This re- degree and recovery rate depend on age of animals. lationship might explain a possible mechanism of impaired Faster recovery rate was observed in young animals while bone remodeling that induced by chronic hyperglycemia con- old animals exhibited few signs of recovery. Application dition in diabetic patients. of T or ET reduces negative effects of EV. We proved T to be more effective than ET. P821 ULTRASTRUCTURE OF BIOMINERAL OF THE P822 MANDIBULAR RAMUS IN RATS OF VARIOUS AGES PREVALENCE OF MORPHOMETRIC DEFORMITIES AFTER 60-DAY EXPOSURE TO EPICHLOROHYDRIN IN PATIENTS WITH LUMBAR OR DORSAL ACUTE VA PORS PAIN V. A. Gavrilov1,V.I.Luzin1,N.P.Mishchenko1,L.V. C. A. Guillen Astete1,C.PijoanMoratalla1,J.R.Quiñones Stklyanina1 Torres1 1SE Lugansk State Medical University, Lugansk, Ukraine 1Ramon y Cajal University Hospital, Madrid, Spain S476 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Objective: To determine the prevalence of morphometric de- concerns regarding possible bone weakness and injury risk. formities in vertebral bodies of postmenopausal women radio- The purpose of this study was to examine if OL was 1) safe logically assessed due to lumbar or dorsal acute pain in a and 2) effective for individuals having low body mass urgency and emergency environment. index(BMI). and to consider potential benefits for individuals Methods: A simple randomization of registries of women of with a diagnosis of AN. 65+ years old who consulted in our AandE department in Methods: Adults with BMI of 14.0 - 18.5 were drawn from an 2015 and 2016 were performed. The registries collected were electronic database of all adults (N=21,096) using OL weekly for 120% of the amount of the sample size calculated for a not a minimum of 24 weeks (n=260). Numbers of participants meet- finite population of urgent consultation, with a 3% precision ing or surpassing minimal compressive force associated with and a theoretical estimated prevalence of 7% based on local bone formation (a multiple of body weight >4.2) were assessed. studies about vertebral fractures. Metrical studies on the ra- Results: Ninety five% of participants (n=247) created OL diographic charts were performed in every registry on D9 to forces associated with bone reformation without report of in- L5 vertebral bodies from the lateral approach using the Genant jury. Mean force generated for the subject population were scale recommendations. The study were performed by 5.96 MOB with sd 2.94. A greater percentage of subjects with an expert rheumatologist blinded to the clinical AandE report. low BMI were able to achieve the minimal MOB than those in Results: Two hundreds and seventy five registries were in- the average and high BMI categories. cluded with dorsal and lumbar acute pain. Grade I, II and III Discussion: Individuals with low BMI had sufficient strength Genant deformities were identified among 62 (22.5%), 30 to create compressive forces associated with bone formation. (10.9%) and 18 (6.5%) of radiological studies from patients OL may have restorative potential and low risk of injury in a assessed due to dorsal acute pain, respectively. Grade I, II and population with low BMI - a group historically plagued by III Genant deformities were identified among 31 (11.2%), higher injury risk than those with normal BMI. Results may be 49 (17.8%) and 33 (12.0%) of radiological studies from pa- relevant in addressing bone health concerns among individ- tients assessed due to lumbar acute pain, respectively. uals with history of AN. Additional research is needed to Prevalence of at least one dorsal vertebral body deformity validate OL with AN in bone reformation. was 40.0% (95% CI 34.39-45.89%). Prevalence of at least one lumbar vertebral body deformity was 41.09% (95% CI 35.44-46.99%). Lumbar deformities grade I and II counted as P824 much as 70.7%. Dorsal deformities grade I and II counted as IN-OFFICE PROTEOMIC PLATFORM FOR BONE much as 83.6%. From all the 93 grade I deformities, 6.4% MARKER MEASUREMENT were reported as fractures in the clinical report. Grade II de- P. Khashayar1,G.Amoabediny2, J. Vanfleteren3, B. Larijani4 formities were recognized in 20.2% of all the cases and Grade 1Orc/EMRI/TUMS-CMST/UGENT, Ghent, Belgium, III deformities were recognized in 92.1% (P<0.001). 2University of Tehran, Tehran, Islamic Republic of Iran, Conclusions: Although this is an study focused in symptom- 3University Ghent, Ghent, Belgium, 4Endocrinology and atic patients, it presents the prevalence of grades I and II Metabolism Research Center, Dr Shariati Hospital, Tehran Genant deformities that are usually clinically ignored. Since University of Medical Sciences, Tehran, Islamic Republic of Iran the consideration of morphometrical vertebral deformities is relevant in order to choose how to treat a patient with osteo- Objectives: Current trends towards theranostics and provision porosis, it is highly important to take into account that many of of personalized diagnostic therapy tailored to an individual these fractures are ignored on AandE environment even in has emphasized the need for inexpensive point-of-care and symptomatic patients. in-office devices, capable of performing rapid analysis, with small volumes of sample, minimum number of assay steps, and no need for highly skilled personnel for routine checkup P823 and patient screening. In this work, we report a microfluidic OSTEOGENIC LOADING FOR IMPROVED BONE proteomic platform that can easily be translated into an in- MINERAL DENSITY IN ADULTS WITH LOW BODY office biomarker diagnostic tool to be used by clinicians. MASS INDEX This platform integrates microfluidic technology with electro- J. M. Conviser1 chemical sensing to measure serum levels of different bio- 1Ascend - Consultation in Health Care, Chicago, United markers with comparable accuracy with the current state-of- States the-art, electrochemiluminescence (ECLIA) and ELISA, but in shorter time and probably cheaper. Objective: The benefits of osteogenic loading (OL) for im- Material and Methods: Microfabricated Au electrodes proved bone health are documented but not previously studied encased in a microfluidic chamber were functionalized to im- in individuals with anorexia nervosa (AN), in part due to mobilize the antibodies, which can selectively capture the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S477 corresponding antigen. The magnitude of the response current P825 varied linearly with the concentration of the relative biomark- FACTORS ASSOCIATED WITH FIVE-YEAR er, and thus was used to quantify the concentration of the MORTALITY RATE IN OLDER POST HIP FRACTURE relative biomarker in serum samples. ADULTS Results: We demonstrated the implementation, feasibility and N. Maher1,G.Steen2,N.Fallon3,A.Dillon2,J.Mahon4,J. specificity of this platform (Osteokit), the first in its kind, in Browne2,K.McCarroll1, J. B. Walsh2,M.Casey1 assaying serum levels of bone turnover markers using 1Bone Health and Osteoporosis Unit, Mercers Institute for osteocalcin (Oc) and C-terminal telopeptide of type 1 collagen Successful Ageing, St James's Hospital, Dublin, Ireland, (CTX). The detection limit of osteocalcin was 1.94 ng/mL, 2Bone Health and Osteoporosis Unit, Mercers Institute for whereas that of CTX was 2.77 pg/mL. Our results also Successful Ageing, St James Hospital, Dublin, Ireland, showed the sensitivity of Osteokit to be comparable with 3Bone Health and Osteoporosis Unit, Mercers Institute for ECLIA when human serum samples were used. According Research and Aging, St James Hospital, Dublin, Ireland, to the results, the coefficients of variation for the ECLIA and 4Bone Health and Osteoporosis Unit, Mercers Institute for Osteokit were calculated to be 4.6% and 3.7% for Oc, and Successful Ageing, St James's Hospital, Dublin, Ireland 6.4% and 7.7% for CTX. The high correlation between our sensor results and that of ECLIA was also reported (Figure 1). Objective: Hip fractures are associated with high risk of death Conclusion: Our results show that Osteokit could some day be during the immediate post fracture years. We investigated if a used as an alternative for ELISA/ECLIA, especially in the de- Nurse-led care package, incorporating early bone health clinic veloping countries and rural areas. The device may also be used access at 3 months, with a multidisciplinary approach to falls to monitor the osteoporosis treatment more efficiently and prob- risk and bone health, reduced post fracture mortality. ably help identify high turnover patients in an earlier phase. Methodology: Consecutive hip fracture patients admitted to the study site were invited to participate in a RCT. 226 patients were included and randomised into intervention (114) and control (112) groups. Inclusion criteria were ≥60years and MMSE ≥18. These patients were followed up for 5 years. Mortality information was obtained from; hospital’selectronic patient’s records system(EPR); Registrar’s Office of Births Deaths and Marriages and online death notice site(rip.ie). Randomisation carried out by computerised minimisation pro- gramme. Data analysed using SPSS. Results: 396 patients attended study site. Mean age; 77 years, (40 -96years). 69% female. Overall mortality rates were 14%, 22%, 29%, 37% and 44% at 1,2,3,4 and 5 years respectively. Study population (Intervention and Control groups) mean age 81 years(+/>sub|-8 years), female and 76 years(+/>sub|-8 years) male. Mortality rates were 8%, 14%, 25%, 33% and 40% at 1,2,3,4 and 5 years respectively. Significant difference noted at 1 and 2 years. Intervention group mortality rates were 5%, 9%, 23%, 30%, 37% and in Control group 10%, 20%, 27%, 36% and 43% at 1,2,3,4,and 5 years respectively. Significant difference noted at 2 years(p=.02). Risk factors for increased mortality were male gender(p=.02), older age(p=.04), reduced cognition (p=.001), admission from nursing homes(p=.001), delay of >24hrs to surgery (p=.008), increased length of stay(p=0.001), discharge to LTC(p=0.001), reduced pre-fracture mobility(p=.001), re- duced ability to self-care(p=001), reduced Amended Barthel Score at 15 months(p=001), HADS depression at 15 months (p=001), at risk of malnutrition at 15 months(p=003). Conclusion: Intervention improved mortality rates in year 1 and 2 post fracture. Mortality was dependent on; pre Figure 1. Correlation plot comparing ECLIA vs. Osteokit in and post fracture physical and psychological health status; CTX and Oc measurement. and time to surgery. S478 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P826 P827 USE OF TERIPARATIDE THERAPY IN OSTEOPOROTIC WHAT AN ORTHOPEDIC SURGEON SHOULD PATIENTS: AN ESI EXPERIENCE KNOW ABOUT SCREW CUT OUT AND BONE K. Malik1,S.Gupta2,A.Gupta3 QUALITY 1Orthopaedics /ESI Hospital, New Delhi, India, B. Limousin Aranzabal1, E. Fernandez Tormos1, C. Arraiz 2Orthopaedics / ESI hospital, New Delhi, India, Diaz1, D. Guzman Domenech1,F.BrañasBaztán2,O.Marín 3Orthopaedics/ ESI Hospital, New Delhi, India Peña1, R. Larrainzar Garijo1 1Hospital Universitario Infanta Leonor, Madrid, Spain, Objective: To conclude the results of Teriparatide therapy 2Geriatric and Internal Medicine Department. Infanta Leonor on Osteoporotic patients reviewed after DXA scan (3 sites). University Hospital, Madrid, Spain Body: In recent years there has been an explosion in the development of new drugs for the treatment of osteoporosis. Introduction: The hip fracture is one of the XXI century Recombinant human parathyroid hormone(20 μg/day) is a epidemics. The most common treatment for pertrochanteric recent addition to this armamentarium with a novel mecha- hip fractures is the intramedullary nailing, although other nism of action, which was approved by the US FDA for the types of devices are used also like the nail-plate. The objec- treatment of postmenopausal osteoporosis and male osteo- tives of this work are: to identify the type indecency of screw porosis secondary to hypogonadism in November 2002. "cut-out" in our series; analyze the potential mechanical or This anabolic drug influence processes associated with bone biological origin; and study the functional significance in formation to a greater extent and earlier than bone reabsorp- those patients. tion. Also, it positively affect a number of skeletal proper- Method: We analyzed retrospectively a case series of patients ties besides bone density, as intermittent administration of with pertrochanteric hip fracture. In our series are 589 cases parathyroid hormone (PTH) results in an increase in the treated between 2009 and 2013 in our hospital. We selected number and activity of osteoblasts leading to an increase cases of complications with subsequent reoperation grouped in bone mass and improvement in skeletal architecture at by DRGs. We found 9 cases of "cut out" reoperation. We an- both the trabecular and cortical bone. Human recombinant alyzed demographics data, functional parameters (BARTHEL parathyroid hormone (hrPTH 1-84) and human recombinant Index), laboratory parameters (Vit. D), radiological parameters PTH peptide 1-34 (teriparatide) belong to this group. It is (Tip-Apex Distance (TAD) and Parker Ratio (PR)). the first osteoporosis treatment that leads to the formation of Results: With a comparable groups of cases and controls with new bone with architecture similar to normal bone. The respect to demographic data; We found a higher rate of objective of this paper is to review PTH actions, indications, BARTHEL in the series of cases (10%). The analytical param- benefits and adverse effects at our hospital reviewed after eters indicated a clear hypovitaminosis D in patients with DXA scan. pertrochanteric hip fracture, being more marked in our case Materials and methods: Inclusion criterion postmenopausal series. In our cases the radiological parameters analyzed indi- women and males above 50 years with polyarthralgia and cated a TAD> 25 in 50% and 50% TAD <25. In 100% the atraumatic collapse fractures screw was in a middle position as PR. The incidence of screw Results: Postmenopausal women and males having cut-out was 1.35%. We detected a possible mechanical origin polyarthralgia with no clear indications of spinal pain and in 50% of cases and biological in the remaining 50%. We radiological testing (x-rays) showing thinned vertebral end detected a reduction in the functional parameters of 18.75% plates and cortices, after DXA proved to be osteoporotic pa- in the BARTHEL Index. tients and with DXA scan reading of more than -3.5 (accord- Conclusion: Even though we have a low incidence of screw ing to WHO standards >-2.5) treated with teriparatide therapy, cut-out in our series in comparison to the literature, this has not out of which > 80% patients were pain relieved. Total patients less importance. This phenomenon has a significant impact on studied were 100, out of which 80 were female and 20 were the functional parameters of patients. Two important routes of males. improvement for reducing the incidence are: improve the sur- Conclusion: Teriparatide therapy proves beneficial in the os- gical technique (SBP <25mm and PR> 66%) and improve the teoporotic patients and has increase in the number and activity biological environment, placing great importance to vitamin D. of osteoblasts leading to an increase in bone mass and im- provement in skeletal architecture at both the trabecular and cortical bone. Out of 100 patients, 20 lost in follow up due to P828 various reasons, 3 had side effects and discontinued therapy. RELATIONSHIPS BETWEEN DNA METHYLATION Disclosure: Patients in our hospital undergone the therapy are AND MUSCULOSKELETAL HEALTH FROM AN all insured patients under ESI scheme and in any way has no EPIGENOME WIDE ASSOCIATION STUDY: THE financial burden on their pockets. HERTFORDSHIRE COHORT Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S479 E. Curtis1,P.Titcombe1, M. Edwards2,S.Barton1, P. Tsai3,E. differentially methylated genes associated with negative reg- Dennison1,J.Bell4, T. Spector4,A.Valdes5,C.Bell6,N. ulation of osteoclast development (p=2.617 x 10-5). Harvey7,C.Cooper8 Conclusions: We identified a set of differentially methylated 1MRC Lifecourse Epidemiology Unit, University of genes involved in muscular, connective tissue, adiposity and vas- Southampton, Southampton, United Kingdom, 2MRC cular function in late adulthood that were related to musculoskel- Lifecourse Epidemiology Unit, University of Southampton, etal outcomes. Our findings potentially indicate tissue- Portsmouth Hospitals NHS Trust, Portsmouth, Southampton, independent epigenetic mechanisms in the pathogenesis of United Kingdom, 3Department of Twin Research and Genetic poorer bone health in later life, or the identification of passive Epidemiology, King's College London, London, United biomarkers of this process. Kingdom, 4Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom, 5Division of Rheumatology, Orthopaedics and P829 Dermatology, University of Nottingham, Nottingham, DIET QUALITY AND HRPQCT IN OLDER United Kingdom, 6MRC Lifecourse Epidemiology Unit, COMMUNITY-DWELLING ADULTS FROM THE University of Southampton, Institute for Developmental HERTFORDSHIRE COHORT STUDY. Sciences, University of Southampton, Southampton, United S. C. Shaw1,C.Parsons1,M.H.Edwards1,K.A.Ward1,S.M. Kingdom, 7MRC Lifecourse Epidemiology Unit, University Robinson1,E.M.Dennison1, C. Cooper1 of Southampton; NIHR Southampton Biomedical Research 1MRC Lifecourse Epidemiology Unit, University of Centre, University of Southampton, Southampton, United Southampton, Southampton, United Kingdom Kingdom, 8MRC Lifecourse Epidemiology Unit, University of Southampton, NIHR Biomedical Research Unit, University Background: Few studies have examined the association of Southampton, NIHR Oxford Musculoskeletal Biomedical between dietary patterns and bone microarchitecture, size Research Unit, University of Oxford, Southampton, United and volumetric density. No studies have previously inves- Kingdom tigated this relationship using high resolution peripheral quantitative computed tomography (HRpQCT). We inves- Objectives: We investigated epigenome-wide DNA methyla- tigated the relationship between diet quality and HRpQCT tion in the peripheral blood of older adults in relation to bone measures in older adults from the Hertfordshire Cohort indices. Study. Methods: Femoral neck (FN) bone mineral content (BMC) Methods: Data were available for 184 men and 166 women. and bone mineral density (BMD), lumbar spine (LS) BMC Dietary data was collected at baseline (1998-2003) using an and BMD and grip strength were assessed using DXA administered food frequency questionnaire. A prudent diet (Hologic QDR 4500) in in 49 men and 50 women from the score (PDS), a dietary pattern indicating high consumption Hertfordshire Cohort Study (mean age 64.4 years). DNA of fruit, vegetables, oily fish and whole grain cereals, with methylation in these subjects was analysed using the higher scores reflecting a greater quality of diet, was identified Infinium HumanMethylation450 BeadChip (450k). Standard using principal component analysis. HRpQCT images were quality control and removal of ambiguous and co-locating acquired, at follow up in 2012, from the non-dominant distal SNP probes resulted in the assessment of 383,230 CpGs. radius and tibia using a Scanco XtremeCT scanner. The results were adjusted for age, sex, plate position, chip, Relationships were investigated using linear regression anal- and white blood cell composition. ysis and were adjusted for age, smoking status, alcohol intake, Results: We found differentially methylated positions social status, physical activity and height. Additional adjust- (DMPs) at epigenome-wide statistical significance (p-value ments of years since menopause and HRT use were made for ≤1.305 × 10-7), including 9 DMPs associated with FN women. BMC, 10 DMPs with FN BMD, 3 DMPs with LS BMC, 47 Results: The mean (SD) PDS was -0.24 (1.23) for men and DMPs with LS BMD and 36 DMPs with grip strength. Of 0.62 (1.14) for women. In women, a SD change in PDS was note was the identification of DNA methylation changes as- positively associated, after adjustments, with radial total area sociated with both femoral neck BMD and grip strength in and trabecular area β=7.14, P<0.05 and β=7.77, P<0.05, re- DTWD2, a gene previously associated with BMI and subcu- spectively. Similar positive associations were observed with taneous adiposity, and SKI, a proto-oncogene associated with PDS and total area and trabecular area at the tibia β=15.96, skeletal, muscular and arterial morphology. A DMP in the P<0.05 and β=16.22, P<0.05, respectively. Negative, non- Marfan-syndrome related FBN1 gene was strongly associated significant associations were observed for cortical and trabec- with both LS BMC and LS BMD. Gene Ontology (GO) path- ular density at both the radius and tibia. No significant way analysis (FDR ≤ 0.25, and corrected for array bias with associations were observed between PDS and HRpQCT missMethyl) for determinants of LS BMC was enriched for measures in men. S480 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Conclusions: Our data suggest that diets high in fruit, vege- P831 tables, oily fish and whole grain cereals in early old age are VIRTUAL ORTHOPEDIC-REHABILITATION- associated with greater bone size but not volumetric bone METABOLIC COLLABORATIVE MANAGEMENT density or microarchitecture in later life in women. FOR OSTEOPOROTIC HIP FRACTURE O. Tell Lebanon1, D. Netzer2, E. Yaacobi3, Y. Berner4,D. Spiegel5,R.Bacharach6,D.Nabriski1,M.Nyska3,Y.Brin3, P830 P. Rotman Pikielny1 KINESIOTAPING IN RECOVERING OF THE 1Metabolic Bone Diseases Service, Endocrine Institute, Meir MOVEMENT PATTERNS IN PATIENTS WITH Medical Center, Kfar Saba, Israel, 2Department of Medical MYOFASCIAL PAIN SYNDROME IN THE LOWER Management, Meir Medical Center, Kfar Saba, Israel, BACK 3Department of Orthopedics, Meir Medical Center, Kfar O. V. Kurushina1,A.E.Barulin1, B. M. Kalinchenko1 Saba, Israel, 4Department of Geriatrics, Meir Medical 1Volgograd State Medical University, Volgograd, Russian Center, Kfar Saba, Israel, 5"Dorot" Medical Center for Federation Rehabilitation and Geriatrics, Netanya, Israel, 6Clalit Health Services, Netanya, Israel Objective: To determine the effect of kinesiotaping (KT) in the decreasing of myofascial pain syndrome (MFPS) in the Purpose: Osteoporosis treatment for hip fracture patients can lower back. reduce the risk of additional fractures; yet, most post-fracture Material and methods: The study involved 67 patients with patients do not receive it. We reported that multi-disciplinary MFBS in the lower back. Patients were randomly allocated team management increased osteoporosis treatment rates; into two groups: experimental (kinesiotaping and pharmaco- however, only 50% of hip fracture patients came to the meta- logical treatment) - 34 patients and control (only pharmaco- bolic clinic for evaluation. To improve adherence, we con- logical treatment) - 33 patients. Clinical examination included: ducted a prospective "closed-loop" virtual collaborative study classic neurological examination with kinesiological tests. where patients were evaluated without formal clinic visits. Stato-dynamic violation of the spine were evaluated by the Methods: An Orthopedic-Rehabilitation-Metabolic hip frac- method based on visual and optico-visual biomechanical anal- ture team was established. Interventions included vitamin D ysis. The pain assessed using a visual analogue scale (VAS). loading in the orthopedic and rehabilitation departments and In order to correct muscle imbalance and biomechanical dis- individualized osteoporosis treatment. Osteoporosis drug rec- orders the original complex of relaxing and fascial techniques ommendations were approved by the HMO administration and were used (I-shaped and Y-shaped tapes). Patients received relayed to the family physician. Primary endpoint was drugs treatment included 3-4 applications lasting 4-5 days. issued to patients. Secondary endpoints were vitamin D mea- Results: Initial data of biomechanical examination: 1) the surement in the orthopedic and rehabilitation departments, vi- center of gravity offset sagittal axis was 10,5±0,2°; 2) the tamin D levels >65 nmol/l in rehabilitation, and osteoporosis frontal axis - 10,1±0,2°; 3) violation of the parallel region diagnosis and metabolic clinic referral in discharge letters. boundaries (PRB) at biacromion line was 11,9±0,87°; 4)at Results: Two hundred-six hip fracture patients (81±12.2 years- bikristoiliacal line - 10,5±0,6°; 5) at the upper bikondill line of-age, 69.5% women) were operated April-September 2016; - 8,6±0 3°. Biomechanical data at the end of the treatment 154 (74%) were excluded because they were not HMO members, course: the center of gravity on the frontal and sagittal axis had pathologic or high-energy fractures, died peri-operatively or significantly decreased in the second group to 4.3±0.4° and had post-loading vitamin D level <65 nmol/l. Treatment was 5.1°±0.5, compared with the first group to 5,9±0.4 and 6.1 recommended for 52 (25.2%) patients: 7 were declined for ad- ±0.3° respectively (p≤0,5). Deviation of PRB: biacromion line ministrative reasons, 3 died before treatment was administered to 4,9±0,3° in the main group and 6,1±0,5° in the control and 13 of 42 prescriptions (30%) were filled. Zoledronic acid, group, bicristoiliacal line to 5,0±0,2°, in the second group teriparatide and denosumab injections were recommended to (with pharmacotherapy) - 6,2±0,4°. 67%, 19% and 13% of patients, respectively. Vitamin D was There was noted the repositioning of the upper bicondillar line measured in 78% in the orthopedics and 82% in rehabilitation in the second and the first group (3,3±0,6° and 4,1±0,7°, re- departments. Orthopedic discharge letter included osteoporosis spectively, p≤0,5). diagnosis in 73% and metabolic clinic referral in 91%. Conclusions: 1) KT application for the treatment of Conclusions: Virtual Orthopedic-Rehabilitation-Metabolic myofascial pain syndrome should be an alternative treatment collaboration led to disappointing results, as 30% of recom- choice. 2) Complex treatment including kinesiotaping and mended prescriptions were issued. Further research is required pharmacotherapy more effective than the use of a combination to remove barriers to osteoporosis care for hip fracture of pharmacotherapy and classic physiotherapy. This data patients, such as providing drug therapy directly to patients points to the importance of this issue. during rehabilitation. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S481 P832 These results are in line with the current view that T2DM ASSESSMENT OF BONE QUALITY WITH induces microarchitectural deteriorations of bone tissue. TRABECULAR BONE SCORE (TBS) IN TYPE 2 Moreover, our data suggest that TBS may be a useful tool in DIABETES MELLITUS (T2DM) the assessment of bone quality in T2DM. F. Baleanu1, P. Bergmann2,A.S.Hambye2, C. Dekelver3,S. Cappelle3, M. Moreau4, M. Paesmans4, R. Karmali1,J.J. Body1 P833 1Department of Endocrinology, CHU-Brugmann, Université IMPACTS OF USING CHRONIC DRUGS WITH ANTI- Libre de Bruxelles, Brussels, Belgium, 2Department of INFLAMMATORY EFFECTS ON SKELETAL Nuclear Medicine, CHU–Brugmann, Université Libre de MUSCLE AND INFLAMMATION (DRUGS INDEX Bruxelles, Brussels, Belgium, 3Department of Internal FOR MUSCULAR FATIGABILITY) IN THE SPRINT Medicine, CHU-Brugmann, Université Libre de Bruxelles, PROJECT PARTICIPANTS Brussels, Belgium, 4Data Centre, Inst. J. Bordet, Université M. A. H. Alturki1, I. Beyer1,I.Bautmans1 Libre de Bruxelles, Brussels, Belgium 1Gerontology (GERO) and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussels, Patients with T2DM present an increased risk of fracture, de- Belgium spite the observation that bone mineral density (BMD) from DXA is often higher in T2DM compared with nondiabetic Objective: Frailty in older population has dragged the atten- population. The paradoxical increase in fracture risk suggests tion due to its associated risks including falls, incident disabil- that there are diabetes-associated alterations in material and ity, hospitalisation, and mortality. Many regular or chronic structural properties. Because BMD is central to fracture pre- drugs are taken by elderly which may show a favourable or diction, a consequence of this paradox is a lack of suitable unfavourable effects on their skeletal muscles. Here we aim to methods, including FRAX, to reliably predict fracture risk in investigate the predictive effects of using chronic medication patients with T2DM. TBS provides an indirect measure of on skeletal muscle and inflammation in 160 participants aged bone quality by evaluating pixel gray-level variations in 64–87 years. DXA images of the lumbar spine. Methods: One hundred sixty participants (female=103, Objective: To compare DXA and TBS values between pa- male=57) were recruited. Each participant was assessed in- tients with T2DM and control subjects with similar FRAX cluding the health status, maximal handgrip strength (GS), scores. muscle fatigue resistance (FR, time for GS to drop to 50% Design and settings: We performed a cross-sectional analysis of its maximum during sustained contraction) and grip work using BMD results from subjects participating in FRISBEE (GW, integrating GS and FR), the 6 min walk test (6MWT), study, an ongoing prospective epidemiological study in a the 30-Second Chair Stand Test and muscle mass. A serum population-based cohort (Brussels, Belgium) of 3560 post- sample was drawn to test C-reactive protein (CRP). Each par- menopausal women aged 60-85 years. We investigated 260 ticipant was given Drug Index (DI) scores based on the use of subjects with baseline DXA examinations (Hologic) from the drugs that can affect positively or negatively on skeletal mus- FRISBEE cohort among whom 65 had known T2DM at in- cle and/or its effects on inflammation (higher scores reflects clusion. Subjects were separated into 2 groups based on the beneficial effects on muscle), participants were categorized presence of T2DM. We studied 3 controls for each diabetes into a stratified six-level classification system according to case. Subjects were matched on age and baseline FRAX score their health status, going from A (completely healthy) to C for major osteoporotic fractures (with BMD). TBS (TBS (cardiovascular pathology or abnormal ECG). iNsight software, MedImaps, France) was derived for each Results: Participants with a worse health status showed sig- spine DXA examination. nificantly higher DI scores than the other healthy participants Results: Age and FRAX scores were similar between the 2 (p=0.005). In addition, participants with better health status groups: 69.9±5.8 years and 9.5±6.7 in T2DM vs. 69.8±5.6 years showed significantly higher GW and better outcomes in the and 9.9±6.7 in controls. We found no significant difference be- 6MWT than the least healthy group (p=0.043 and, p=0.023). tween mean T score values in T2DM vs. controls: -0.39±1.29 vs. There was no significant difference between these two groups -0.61±1.50 at the lumbar spine (p=0.15), -0.75±1.04 vs. -0.86 for the CRP values (p=0.156). Men with lower DI score (score ±1.03 at the femoral neck (p=0.2) and -0.25±1.02 vs. -0.45 <0) showed significant greater values for the 30-Second Chair ±0.98 at the total hip (p=0.06). However, mean TBS was signif- Stand test (p=0.037) while CRP values did not differ icantly lower in T2DM (1.185±0.172; 1.14 to 1.22) compared significantly. with nonT2DM group (1.267±0.132; 1.24 to 1.28; p=0.005). Conclusions: Chronic diseases and chronic use of drugs can Conclusion: Despite similar DXA values, we found a lower influence muscular outcomes in elderly. However, in our co- TBS score in diabetic compared with nondiabetic subjects. hort, the chronic use of drugs did not reflect beneficially on S482 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 their physical nor the C-reactive protein results. In contrast to osteoporosis may be used to detect sarcopenia and its pheno- our hypothesis, we have noted that these drugs did not aid for types in order to inform prognosis and adjust the management better muscular outcomes. Nevertheless, future studies are plan. necessary for exploring and determining their possible bene- ficial actions. P835 LOW BONE MINERAL DENSITY IS THE MAIN P834 CONTRIBUTOR TO FALLS-RELATED HEALTH PECULIARITIES OF BONE MINERAL DENSITY BURDEN IN THE ELDERLY AND BODY COMPOSITION IN WOMEN WITH L. Sanchez-Riera1, N. M. Wilson2, D. Prieto-Alhambra3,C. RHEUMATOID ARTHRITIS COMPARED TO Cooper4, P. Halbout5, A. Woolf6,L.March2 WOMEN WITHOUT RHEUMATOID ARTHRITIS 1Department of Rheumatology University Hospital Bristol S. Myasoedova1,O.Rubtsova2,E.Myasoedova1 NHS Foundation, Bristol, United Kingdom, 2Institute of 1Ivanovo State Medical Academy, Ivanovo, Russian Bone and Joint Research, University of Sydney, Sydney, Federation, 2City Clinical Hospital #4, Ivanovo, Russian Australia, 3Oxford NIHR Musculoskeletal Biomedical Federation Research Unit, University of Oxford and IDIAP Jordi Gol, Oxford, United Kingdom, 4Oxford NIHR Musculoskeletal Objective: To establish specific features of bone mineral den- Biomedical Research Unit, University of Oxford, Oxford, sity (BMD), body composition and skeletal muscle changes in United Kingdom, 5International Osteoporosis Foundation, middle-aged and elderly women with rheumatoid arthritis Nyon, Switzerland, 6Institute of Health Care Research, (RA) compared to women without RA. Universities of Exeter and Plymouth, Exter and Plymouth, Material and Methods: The study included 86 women with United Kingdom RA aged 59.06±7.52 years and 81 women without RA aged 57.4±5.3 years. BMD in spine and femur and body composi- Objectives: Falls are the leading injury type in population 70 tion was assessed using Lunar Prodigy device (General years and above and a major health burden and cause of death Electric). BMD was estimated according to T-score. globally. Most of such burden is due to bone fractures. In the Osteopenia was defined as T-score -1 to -2.5 σ;osteoporosis Global Burden of Diseases (GBD) Initiative, the worldwide was defined as T score ≤-2.5 σ. Obesity was detected if fat attributable burden of falls due to low bone mineral density mass estimate was ≥32%. Sarcopenia was defined as lean (BMD) was analysed through its relationship with fractures. mass index (LMI)<5.64 kg/m². Descriptive characteristics Methods: The estimates followed the Counterfactual Risk (means, percentages, etc.) were used to summarize character- Assessment Methodology used in the GBD study (1). istics of the cohorts. Comparisons of characteristics between Systematic review was performed seeking population-based cohorts were made with Chi-square and Fisher tests. studies with femoral neck (FNBMD) measured by Dual-X- Results: We have detected significantly lower femoral BMD Ray-Absorptiometry in people 50 years and over. Age- and (p<0.001), fat (p=0.005) and muscle (p=0.003) in women sex- specific levels of mean±SD FNBMD (g/cm2)wereex- with RA compared to their non-RA counterparts. Both, wom- tracted from eligible studies, and this was used as the exposure en with RA and those without RA had high prevalence of low variable. The age and sex-specific 99th percentile from non- BMD meeting criteria for osteopenia or osteoporosis. There Hispanic whites in the National Health and Nutrition was no statistically significant difference in the prevalence of Examination Survey (NHANES) 2009-2010 was used as the- osteopenia in women with and without RA (52% and 61%, oretical minimum risk factor exposure distribution, to estimate respectively; p=0.614). Osteoporosis was somewhat more the potential impact fraction (PIF) of FNBMD for fractures. common in RA compared to the non-RA group (39.5% and Relative risks of FNBMD for fractures were obtained from a 25.9%, respectively; p=0.062). Over 90% of women in both previous meta-analysis (2). Coded hospital data was used to groups were obese. However osteopenic obesity was less calculate the fraction of falls-related deaths due to fractures. common in women with RA (50%) than in those without Disability levels were established by applying disability RA (67.5%, p=0.019). Based on LMI findings, sarcopenia in weights to each type of fracture. Then, PIFs were applied to the form of osteopenic sarcopenia and sarcopenic obesity was obtain attributable deaths and disability due to low BMD. more prevalent in women with RA (13.95%) than in those Results: The absolute global health burden for falls in the without RA (4.94%, p=0.047). population 70 years and above almost doubled between Conclusions: Women with RA have higher prevalence of 1990 and 2015. More than 50% of such burden was attribut- osteoporosis and sarcopenia compared to women without able to low BMD. Low BMD could explain more than three RA. Assessment of the body composition by radiographic quarters of all deaths due to falls and two fifths of all falls- densitometry in female RA patients with osteopenia or related disability in this age group. Mortality and disability Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S483 due to low BMD doubled during the 25-year period. Low method, levels of Ca, P, Mg were determined by biochemical BMD ranked 9th for contributions to worldwide disability method. The levels of osteocalcin (Oc), calcitonin (Ct) were among 79 preventable risks factors. determined by ELISA. The level of C-reactive protein (CRP) Conclusions: In those aged 70 and over the importance of low was determined by using of a latex test. The X-ray examination BMD as a preventable risk factor for falls health burden is a of knees was performed for all patients with OA. growing concern, given the global population trajectories, and Results: A statistically significant relations were found be- requires urgent attention. tween the degree of diagnosis complexity and radiological References: 1. Forouzanfar M et al, Lancet 2016; 2. Johnell O changes by Kellgren (M-L c2=14.69 p=0.0032<0.05). We et al, JBMR 2015 found significant negative correlation between the level of Figure 1. DALYs, Deaths and YLDs caused by falls attribut- Oc and glucose (r=-0.56, p=0.010464), HbA1C (r=-0.51, able to low BMD among 70 years and older (Available from p=0.022.004). The group 2 demonstrated moderate positive http://vizhub.healthdata.org/gbd-compare/). correlation between the level of P and the following indices: HOMA (r=0.64, p=0.002409), glucose (r=0.54; p=0.013150), IRI (r=0.46; p=0.040257). In group 3, the level of Oc nega- tively correlated with glucose (r=-0.57; p=0.001492) and HOMA (r=-0.57; p=0.001557), another negative correlation was determined between level of Mg and HbA1C (r=- 0.376405, p=0.048356). Also, the negative correlation be- tween CRP and Oc was determined in the 1st group (t=– 0.41, p=0.010151<0.05) and in the 3rd group as well (t=– 0.33; p=0.014710<0.05). Conclusion: The study demonstrates that changes of bone me- tabolism and their relationships to carbohydrate metabolism in patients with OA and comorbid T2DM may indicate the impact of carbohydrate metabolism disorders on bone tissue remodel- ing, which can lead to progression of osteoarticular changes in patients with OA. P837 P836 OSTEOPOROSIS AND FRACTURES IN THE REAL INDICATORS OF BONE TISSUE METABOLISM IN WORLD SETTING PATIENTS WITH OSTEOARTHRITIS AND ITS E. Pantazi1,A.Travlos1,E.Vogiatzi1, I. Kostoglou- COMBINATION WITH TYPE 2 DIABETES Athanassiou2 MELLITUS 1Department of Endocrinology, Alexandra Hospital, Athens, M. Oliinyk1, L. Zhuravlyova1 Greece, 2Department of Endocrinology, Red Cross Hospital, 1Department of Internal Medicine #3 / Kharkiv National Athens, Greece Medical University, Kharkiv, Ukraine Introduction: Osteoporosis is a bone disease which predis- Objective: To investigate the level of osteocalcin, calcitonin, poses to bone fragility. Nowadays, the population is screened alkaline phosphatase, as well as the level of Ca, P, Mg and for osteoporosis and measures are taken for fracture preven- their correlation with carbohydrate metabolism in patients tion. Additionally, in the western world of food abundancy with osteoarthritis (OA) alone and in those with combination people are urged to have a diet rich in calcium, are given of OA with type 2 diabetes mellitus (T2DM). calcium supplements and are being treated for vitamin D de- Methods: A total of 70 patients were examined (22 males, ficiency. Moreover, osteoporosis treatment is administered. mean age 54.68±0.84 years) in Regional Hospital of Kharkov, Therefore, the relationship between osteoporosis and fractures control group included 20 healthy volunteers. All patients in the real world setting is very interesting. were divided into 3 groups: group 1 (n=21) - with OA, group Aim: To study the prevalence of fragility fractures in a cohort 2 (n=20) - with T2DM, group 3 (n=29) - with combined of patients being followed up and treated for osteoporosis in a course of OA and T2DM. The survey plan included indices center of excellence for the management of osteoporosis in of carbohydrate exchange (insulin, glucose, HbA1C, HOMA- Athens. IR). The level of HbA1C was <7.5% in all patients. The level Methods: A cohort of 91 patients, 82 female and 9 male, who of alkaline phosphatase (ALP) was determined by colorimetric were followed up and treated as needed for osteoporosis in a S484 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 center of excellence for osteoporosis management in Athens Results: The 3 groups differed in age: 66.6±6.2, 62.5±6.7 and was studied. The age of the patients was 69.71±1.09 years. 61±7.8 years for PU, CU and NU respectively (CU vs. NU: Bone mineral density was measured in the spine and in the p=.008, PU vs. NU: p<.001). BMI was 26.1±4.2, 25.9±4.5 hip. The number of fractures having occurred in the cohort and 25.2±4.1 kg/m2 for PU, NU and CU respectively (CU studied was recorded. vs. NU: p=.09, PU vs. NU: p=.45). Average time since Results: Bone mineral density in the spine as assessed by T MHT withdrawal in PU was 8.4 years. All the results were score was -1.9±0.11 (mean±SEM) and in the left hip -2.6 age-adjusted. Total fat mass was lower for CU (CU Results: Mean age at baseline was 36.5±7.5 years. A statisti- Conclusions: For the first time we have shown that muscle cally significant decrease of the integral vBMD (-11.9 mg/ power, from jumping mechanography, is predictive of falls in cm3, -3.0%, p=0.001) and cortical vBMD (-4.0 mg/cm3, - an elderly cohort. Jumping mechanography is precise and 0.4%, p=0.004) was observed at the neck. The cortex at the easy to perform, measuring lower limb muscle strength; chair neck was also significantly thinner after 1-year of treatment (- rise speed had a similar OR in this cohort but did not distin- 0.05 mm, -3.2%, p=0.006). No significantly significant differ- guish between faller and non-fallers. Jumping ence was observed for the trabecular vBMD at the neck. mechanography provides an alternative tool to assess frailty, Conclusion: The 3D-DXA analysis of the 34 HIV patients sarcopenia and fall risk. included in this study showed that treatment with tenofovir induces significantly significant changes at the cortex (thick- ness and density). P843 Reference: [1] Humbert L et al. IEEE Trans Med Imaging VITAMIN D LEVELS IN A RHEUMATOLOGY 2017;36:27. OUTPATIENT CLINIC O. D. Messina1,G.Maldonado2, C. Ríos3 1Hospital Cosme Argerich, Buenos Aires, Argentina, P842 2Universidad Espíritu Santo, Guayaquil, Ecuador, 3Centro DO JUMPING MECHANOGRAPHY ASSESSED de Reumatología y Rehabilitación, Guayaquil, Ecuador MUSCLE FORCE AND POWER PREDICT FALLS? RESULTS FROM THE HERTFORDSHIRE COHORT Introduction: Vitamin D is a hormone known to play a fun- STUDY damental role in phosphocalcic metabolism, however in re- C. Parsons1,M.H.Edwards1,C.Cooper1, E. M. Dennison1, cent years has shown an association between vitamin D defi- K. A. Ward1 ciency and different rheumatic diseases. 1MRC Lifecourse Epidemiology Unit, University of Purpose: To evaluate vitamin D levels in patients at a rheu- Southampton, Southampton, United Kingdom matology center during a period of 2009-2015. Methods: A retrospective study of patients who attended a Background: Jumping mechanography is a method to quan- rheumatology center, who had an initial study of 25(OH)D tify parameters of muscle strength (force and power) from serum. Vitamin D levels were classified as: Ideal: 30-40 ng/ normal daily movements. Previous studies have shown asso- dL, deficiency: 30-20 ng/dL, insufficiency: 20-10 ng/dL and ciations between bone outcomes and age with jump force and severe insufficiency: <10 ng/dL. power, however less is known about whether these measure- Results: 279 patients with a mean age of 58 years [8-93], 86% ments predict falls. Falls are common in later life, and often women [58.4 years] and 14% men [59.8 years] were included. lead to loss of confidence and independence. We aimed to The mean value of vitamin D in general was 29.09 ng/mL, determine whether a novel measurement to quantify lower 41.2% (115) of patients with values >30ng/ml and 58.8% limb muscle force and power is related to falls in the elderly. (164) below this range. The most frequent primary diagnoses Methods: Data were available for 166 participants who origi- were: osteoarthrosis, rheumatoid arthritis, fibromyalgia and nally participated in the Hertfordshire Cohort Study. osteoporosis, of which the lower levels of vitamin D ≤30 ng/ Participants performed a two-leg countermovement jump on a dL were identified in 53.8%, 69.7%, 76.5% and 42.9%, ground reaction force platform. From this jump force and pow- respectively. er are quantified. In addition the efficiency of movement (how Conclusion: There is a high incidence of hypovitaminosis D much force is expended to generate power) and the Esslinger in Ecuadorian patients who came to a rheumatology outpatient Fitness Index (EFI), an age and gender matched Z-score, is clinic. derived. Jump force and power were normalised for body weight before analysis. Falls history (falls in the last year) was recorded at follow-up 2 years later, and logistic regression P844 analysis was used to determine which jumping mechanography TERIPARATIDE AND DENOSUMAB COMBINATION measurements predicted falling status. TREATMENT IN A BONE HEALTH CLINIC Results: The mean (SD) age was 75 (2.5) years, 55% A. B. Broderick1,R.O’Toole1, N. Fallon1, J. Mahon1,K. (n=92) were males and 23% (n=39) reported having fall- McCarroll1 en. As power increased and EFI decreased, the risk of 1Medicine for the Elderly Department, St James' Hospital, falling decreased (odds ratio (OR)=0.37, P=0.01 and Dublin 8, Ireland OR=0.97, P≤0.01 respectively). No statistically significant association was found between force or efficiency of Objective: Recent studies have demonstrated combination movement with falls risk. teriparatide and denosumab treatment to be effective and well Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S487 tolerated in improving Bone Mineral Density (BMD) in both electrotherapy and thermotherapy, kinetic program, massage. the lumbar spine and hip compared with monotherapy(1). We Also the most used medications was anti-inflammatory therapy. set out to evaluate the utilisation of this combination treatment Parameters chosen as representative of the evaluation were: for severe lumbar spine and hip osteoporosis in a specialist index of severity for OA of the knee by Lequesne, The bone health clinic. Health Assessment Questionnaire (HAQ) for physical perfor- Material and Methods: We identified individuals via our mance measures of function, pain severity (VAS) and Short hospital’s Bone Health Clinic database who had been com- Form-36 (SF-36) questionnaire (assessing the quality of life). menced on this combination treatment over 1 years 2015 Data Results: The mean age was 64.4±8.3 years; the mean duration was collected on their pre-treatment Bone Mineral Density of knee pain was 4.08±1.27 years and the mean duration of (BMD), pre-treatment and where available, 6-month follow- knee OA was 6.47±0.51 years. Almost half of the patients up bone markers and treatment compliance. were overweight and majority, 17 patients, had at least one Results: Seven patients were identified with an average age of co-morbidity, the commonest being hip osteoarthritis. The 80 (range 70 to 88). All patients have completed at least 6 physical health status showed lower score as compared to months combination treatment at the time of data analysis. mental health component. The domain concerning physical Average baseline T-score for the lumbar spine was -4.9 (range health components showed positive correlation with age. We -3.5 to -5.9) and for right hip was -3.8 (range -3.5 to -4.4). found a significant negative correlation between age and phys- Bone Marker levels for Carboxyterminal collagen Crosslinks ical functioning (p=0.001). The better scores in SF36 (espe- (CTX) and procollagen type 1 amino-terminal propeptide cially in the physical functioning domain) were observed in (P1NP) at pre-treatment for the 4 patients was.039 and male responders (p=0.01). There was significant association 106.5. Three patients had follow-up bone marker levels fol- between SF36 and education level (correlation 0.69). Patients lowing 6 months of treatment with an average CTX and P1NP with higher body mass index (BMI) and existence co- of 0.081 and 16.9. All patients tolerated the combination treat- morbidities scored lower in both of the SF36 domains. ment without any reported side effects. Conclusions: The patients with knee OA need a complex, Conclusion: Our data outlines the characteristics of the indi- medical and rehabilitation treatment to improving the level viduals selected for the treatment with both teriparatide and of pain and finally the quality of life. denosumab in our clinic. We expect the use of this combina- tion treatment for a small number of select patients with both severe lumbar spine and hip osteoporosis to continue. P846 Reference: 1. Leder BZ et al. J Clin Densitom 2016;19:346 HEALTH RELATED QUALITY OF LIFE IN YOUNG PATIENTS WITH KNEE OSTEOARTHRITIS D. Matei1,S.Patru1,I.R.Marcu1,A.M.Bumbea1,R.M. P845 Trăistaru1, D. Neagoe1,A.C.Bighea1 MEASURING PATIENT SATISFACTION WITH 1University of Medicine and Pharmacy, Craiova, Romania COMPREHENSIVE HEALTH PROGRAM FOR Traumatic knee injury strongly contributes to knee osteoar- KNEE OSTEOARTHRITIS thritis (OA) development in the young adult. When chronic B. Dunoiu1,D.Matei2,V.Ionica3,A.C.Bighea2 excessive loads are applied to the knee joint, especially in a 1Rehabilitation Department, Emergency Hospital, Craiova, joint with altered kinematics, the mechanical demand eventu- Romania, 2University of Medicine and Pharmacy, Craiova, ally exceeds the ability of the joint to repair itself, setting the Romania, 3Rehabilitation Department, Emergency Hospital, stage for OA development.(1) Craiova, Romania Objective: The aim of the study was to evaluate the impact of Aim: To assess the level of knee pain in patient with knee the clinical and functional status on the quality of life in young osteoarthritis and the measuring patient satisfaction with com- patients with knee OA; to investigate the disabilities and how plex pain management. We also aimed to ascertain the asso- they affect the patient’s perception of their condition; to estab- ciation between socio-demographic and medical status of pa- lish the type of index that is most valuable in these matters. tients with knee OA and their quality of life. Material and methods: we observed 63 patients with Methods: 21 patients who fulfilled the ACR criteria for knee established secondary knee OA (ACR criteria), aged between osteoarthritis were included in the study; the patients were ob- 37 and 58 years (an average of 43,64). We used visual analog served over 3 month. Each patient was fully evaluated in two scale for rating the pain by the patient (VASp) and disease moments: T1 – initial, at inclusion in the study; T2 - after an status by the physician (VASph), Modified Health average period of 3 months; during this period the patients Assessment Questionnaire (MHAQ), WOMAC questionnaire. followed a comprehensive healthcare program. The rehabilita- Results: VASp scale was significantly higher in the male pop- tion program included: igieno-dietary and patient education, ulation (p<0,05) and was strongly correlated with WOMAC S488 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 value (r=0,711) and a reverse correlation between VASp, cohort BC prevalence was 7.5% and median age at diagnosis VASph and MHAQ was noted (r=0,600). Correlations were 46 (32-54)years. In the PALGA database BC prevalence in FD found for all indices according to BMI but the most significant was 6.5% at 51 (27-75)years. BC risk was 3.4-fold increased being for the physical function subscale of WOMAC (95%CI:1.6-5.9) compared to the Dutch general population (r=0,627). Patients residing in urban areas have higher values and 13.2-fold (95%CI: 6.2-22.8) in thoracic FD. In the NIH for all subjective indices taken into account and differ from the cohort BC prevalence was 4.5% and median age at diagnosis physician’sevaluation. 36 (27-46)years. BC risk was 3.9-fold increased (95%CI:1.2- Conclusion: With no known therapies that can prevent the 8.2) and 5.7-fold (95%CI:1.4-13.0) in thoracic FD. A GNAS- course of disease, knee OA is one of the leading causes of mutation was found in four of nine BC specimens(44%). chronic disability in younger adults. Our findings constitute a Conclusion: We demonstrate an increased risk of developing strong rationale for increasing efforts aimed at better treatment breast cancer at a younger age in polyostotic FD and MAS of knee injury. particularly with thoracic FD lesions suggesting that that screen- Reference: 1. Stiebel M et al. J Sports Med 2014;5:73 ing for BC should be advocated at a younger age in these pa- tients, especially in case of thoracic localisations of FD lesions P847 INCREASED RISK FOR BREAST CANCER IN P848 POLYOSTOTIC FIBROUS DYSPLASIA AND DOES PHYSICAL PERFORMANCE TESTING MCCUNE-ALBRIGHT SYNDROME PREDICT FALLS? RESULTS FROM THE N. M. Appelman-Dijkstra1,B.C.J.Majoor2,A.Boyce3,O. HERTFORDSHIRE COHORT STUDY M. Dekkers4,M.T.Collins3,P.D.S.Dijkstra2,N.A.T. C. Parsons1,M.H.Edwards1,C.Cooper1, E. M. Dennison1, Hamdy1 K. A. Ward1 1Department of Medicine, Division Endocrinology and Center 1MRC Lifecourse Epidemiology Unit, University of for Bone Quality, Leiden University Medical Center, Leiden, Southampton, Southampton, United Kingdom Netherlands, 2Department of Orthopedic Surgery and Center for Bone Quality, Leiden University Medical Center, Leiden, Background: Falls are common in later life, and many result in Netherlands, 3Skeletal Clinical Studies Unit, Craniofacial and fractures. In addition to loss of confidence and independence, Skeletal Diseases Branch (CSDB), National Institute of Dental they are also associated with significant health economic burden. and Craniofacial Research (NIDCR), National Institutes of Falls clinics are widespread in clinical practice, but referrals are Health (NIH), Bethesda, United States, 4Department of typically only made after a significant fall history. We considered Medicine, Division Endocrinology and Epidemiology, Leiden whether simple physical performance (PP) testing might predict University Medical Center, Leiden, Netherlands falling in a community dwelling older population. Methods: Data were available for 267 study subjects who Introduction: Fibrous dysplasia (FD) is a rare bone disorder, participated in the UK component of the European Project caused by mutations of the GNAS-gene, also identified in on Osteoarthritis (EPOSA) and, who originally participated associated tumours such as myxomas (Mazabraud syndrome) in the Hertfordshire Cohort Study (HCS), UK. PP testing in- and other malignancies. cluded 6m timed up and go (sec), grip strength (kg), gait speed Objective: To explore a possible relationship between breast (m/s)and chair rise time (secs). An overall assessment of low cancer (BC) and FD in two well-characterized FD cohorts PP was determined from assessments of walking speed, chair from the Netherlands (LUMC) and the USA (NIH). stands and balance (tandem stand). Falls history (falls in the Method: Data on age at diagnosis, localisation of FD and last year) was recorded at follow-up 3 years later, and logistic breast cancer were retrieved from hospital records of 134 regression analysis was used to determine which PP measures (LUMC) and 121 (NIH) female FD patients and the preva- predicted falling status. lence of BC was calculated for the combined cohorts. The Results: The mean (SD) age was 75.6 (2.6) years, 50.6% prevalence of BC was validated in the Dutch cohort using (n=135) of subjects were women and 27% (n=72) reported histology reports data on 645 female FD patients from the having at least one fall in the previous year. As grip strength National Dutch Pathology database (PALGA). Standardized- increased, the risk of falling decreased (odds ratio (OR)=0.97, morbidity-ratios (SMR) were calculated by comparing BC P=0.03); the longer it took a participant to complete the 6m data in FD with those of general population registries. timed up and go the greater the risk of falling (OR=3.31, GNAS-mutation analysis was performed on 9 available breast P=0.02). An overall assessment of low PP was associated with cancer biopsy specimens. an increased risk of falling (OR=1.92, P=0.03). No statistical- Results: A combined total of 15 patients (6 polyostotic FD, 9 ly significant association was found between gait speed or MAS) had BC. 87% had thoracic FD lesions. In the LUMC chair rise time with falls risk. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S489 Conclusions: Our data suggests that simple PP testing could osteoporosis among patients 50 years and older admitted to predict the risk of falling in the elderly. Further studies could our orthopaedic service: Preliminary Results of The HOOF be completed to further assess whether these PP measures Project. could be incorporated into screening tools to identify patients Materials and Methods: We introduced a specialist nurse- who may be at risk of falling. led, physician-supported fracture liaison programme in our hospitals in 2009 for patients admitted with a fragility fracture of the hip and spine: The HOOF (Hospital Outcomes follow- P849 ing Osteoporotic Fracture) Project. We compared the effec- BENEFITS OF REHABILITATION TREATMENT tiveness of this programme between a historical cohort of AFTER HIP SURGERY TO OLDER PATIENTS hip fractures from 2005 to 2008, and an educational interven- D. Matei1,S.Patru1,R.M.Trăistaru1,I.R.Marcu1,A.M. tion cohort from 2008 to 2009 and a fracture liaison cohort: Bumbea1,A.C.Bighea1 2010 and 2015. Data were obtained retrospectively by chart 1University of Medicine and Pharmacy, Craiova, Romania review of all patients over 50 years admitted with a fragility fracture. Objective: The increase of hip surgery in older patients is seen Results: Data have been validated for more than 1,076 pa- in departments of rehabilitation. Regular exercises to restore the tients, median age: 83 years (R: 50-105), 74% female. Very normal hip motion and strength and also a gradual return to few patients received additional treatment for osteoporosis everyday activities are important for full functional recovery. prior to, or at the time of discharge and <10% were diagnosed Patients and methods: The benefits of rehabilitation treat- with osteoporosis. The educational intervention had little ef- ment after hip surgery(osteoarthritis of the hip and hip frac- fect on diagnosis or treatment rates. A CNS-led fracture liai- tures) in 43 patients aged 66-84 were evaluated. All the pa- son programme resulted in a substantial increase in the num- tients were evaluated using VAS (visual analogue scale) for ber of patients diagnosed and treated for osteoporosis on dis- pain level, ROM (range of motion), muscular strength for hip charge, see table. and knee and SF-36 scale. Conclusion: A nurse-led, physician-supported fracture liaison Results: At the time when patients were admitted for rehabilita- service is an effective way to improve the diagnosis and treat- tion there were marked reductions of strength in the injured limb of ment of older patients admitted with a fragility fracture of the muscles acting at the hip and knee. The main benefit was relief of hip. Educational initiatives had little impact in our hospitals. symptoms, almost 28% of patients being pain free after the reha- bilitation program. Range of hip movement was improved mod- erately in most patients. Marked improvement of strength occurred P851 during rehabilitation (but still significant differences between the DOES TERIPARATIDE IMPROVE FUNCTIONAL limbs at the time of discharge from the rehabilitation unit). OUTCOME BY REDUCING PAIN IN POST Conclusion: After rehabilitation program performed, most TRAUMATIC AVASCULAR NECROSIS OF HUMERAL patients were better able to perform certain activities of daily HEAD? life, even if they were not completely independent requiring D. Sajkovic1, T. Nikolic1,A.Secic1, G. Tajsic1, A. Ladic2 aids or help from others. 1Department of Rheumatology, Physical medicine and Rehabilitation, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia, 2Department of Internal P850 Medicine, University Hospital Centre Zagreb, Zagreb, Croatia A NURSE-LED FRACTURE LIAISON SERVICE HAS POTENTIAL TO MAXIMISE THE DIAGNOSIS AND Objective: Post traumatic avascular necrosis is one of the TREATMENT OF OSTEOPOROSIS: RESULTS OF most common complications of the humeral head fracture. THE HOOF PROJECT Although literature shows some beneficial effect of C. Armstrong1,F.Heaney1,S.R.Kearns1,W.Curtin1,J.P. teriparatide treatment on other osteonecrosis locations there McCabe1,C.G.Murphy1,M.F.Delaney2,J.J.Carey3 is no evidence yet in those cases. 1Orthopaedic Surgery, Galway University Hospitals, Galway, Materials and methods: a 56-year-old female patient, cook Ireland, 2Medicine, National University of Ireland, Galway, by profession, with a medical history positive for low back Galway, Ireland, 3Medicine, National University of Ireland, pain, presented with a right multifragmentary proximal hu- Galway and Rheumatology, Galway University Hospitals, meral fracture with shoulder dislocation and left proximal Galway, Ireland and shaft humeral fracture, after a fall from standing height. Two surgeries were performed: proximal humeral plate on the Objective: To evaluate the effectiveness of a CNS-led fracture right and intramedular fixation with long nail on the left shoul- liaison service for improving the diagnosis and treatment of der. Physical therapy with emphasis on kinesiotherapy was S490 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 performed. Six months after the start of the outpatient rehabil- Lawton, FAC), nutrition(MNA, BMI), number of falls, itation, she complained of severe pain and worsening of the medications. right shoulder function. Right humerus X-ray verified avascu- Results: N=87. Mean age:88.0±4.7. Women:82.8%. lar necrosis of humeral head. This prompted surgical metal Sarcopenia prevalence varied from 8.8% (FJ) to 33.7% extraction and continuation of rehabilitation. We performed (FM). 74.5% had independent ambulation before the fracture, dual-energy X-ray absorptiometry (DXA) which showed os- 69% reported two or more previous falls. 30% had dementia, teoporosis with T-scores as follows; Total Spine -2.1, L1 -3.1, 18.8% moderate to severe dementia. 75.3% had mild to mod- L2 -1.3, L3 -0.9, L4 -2.9, Total Hip -0.5, Neck -1.3. X-ray of erate dependence before admission, only 12.9% were inde- thoracic and lumbar spine was performed and verified a grade pendent for BADL. MNA:10.4±2.7. BMI=25.6±14-7. 1 fracture on the third lumbar vertebrae. Due to the verified 83.7% were on 4 or more drugs before admission. osteoporosis, teriparatide injections were introduced into ther- In multivariate analysis, only the type of fracture was associ- apy, as well as 1200 mg of calcium and 1000 IU vitamin D ated to the presence of sarcopenia (subcapital fractures more daily. frequent, p=0.018). Results: After 24 months of teriparatide treatment and ap- Conclusions: The prevalence of sarcopenia in our patients proximately 3 years after initial trauma she reported mild pain with hip fracture varies according the muscle mass reference in right shoulder and low back just during heavy activity. A cutoff-points used, been more frequent with national refer- new DXA showed improvement in T scores: Total Spine -1.4, ences. Most hip fracture patients do not have pre-fracture L1 -2.2, L2 0.5, L3 -1.2, L4 -2.1, Total hip -0.6, Neck -1.5. sarcopenia. Subcapital hip fractures were more frequent in She achieved right shoulder active abduction of 100 °, forward sarcopenic patients. flexion 110°, extension 60 °, both rotations 60 °. Patient is Acknowledgement: Funded with a grant from Fundación satisfied with functional outcome and has been working for Mutua Madrileña 18 months, feeling well with no limitation in her regular daily activities and her work. Conclusion: Authors believe that although repeated x rays P853 scans showed radiologically worsening of humeral head FOREARM GRIP STRENGTH IS MAINTAINED BY osteonecrosis, functional outcome and reducing pain could 1000 IU OF SUPPLEMENTAL VITAMIN D OVER 6 be improved due to teriparatide treatment. MONTHS AND MODERATELY CORRELATED TO MUSCLE AREA IN MEN >80 Y OF AGE IN LONG- TERM CARE P852 H. Weiler1,I.Germain1,T.Hazell1, C. Vanstone1 PREVALENCE OF SARCOPENIA IN VERY OLD HIP 1Dietetics and Human Nutrition, McGill University, Ste Anne FRACTURE PATIENTS de Bellevue, Canada M. N. Vaquero-Pinto1, C. Miret-Corchado1,C.Sanchez- Castellano1, A. Merello-De-Miguel1, A. C. Ramirez- Objective: To test for the effect of maintaining healthy vita- Archundia2, A. J. Cruz-Jentoft1 min D status on skeletal muscle function in advanced aging. 1Geriatric Department. Hospital Universitario Ramón y Cajal Material and Methods: Men (n=60, > 80 y) in a long-term (IRYCIS), Madrid, Spain, 2Instituto Tecnológico de Estudios care facility received a supplement of 2000 IU/d of vitamin D Superiores, Monterrey, Mexico for 8 weeks followed by a trial using 0 IU/d (placebo), 500 IU/ d or 1000 IU/d of vitamin D administered in foods (e.g., pud- Introduction: This is a substudy of an ongoing study that ding) for 6 months (NCT01437696). Exclusion criteria: mini- aims to identify biological markers (inflammatory and neuro- mental state examination (MMSE) score <18, end-stage renal muscular markers) for the early diagnosis of sarcopenia in disease, and hyperparathyroidism. At baseline and 6 mo, se- patients older than 80 years hospitalized for the surgical treat- rum 25-hydroxyvitamin D (25(OH)D) was measured using a ment of a hip fracture. The aim was to assess the prevalence of chemiluminescent assay (Liaison, Diasorin Inc. USA). Age, sarcopenia (defined as low muscle mass and strength). body mass index (BMI), medications and MMSE values were Methods: Patients admitted to an orthogeriatric unit who gave obtained from chart review. Rheumatoid arthritis was assessed the informed consent for the biomarker’s study. Muscle mass using a disease activity score based on 28 joints and erythro- was assessed preoperatively using bioimpedance analysis, cyte sedimentation rate (DAS28); hydroxychloroquine was Janssen’s (J) and Masanés (M) Spanish reference cutoff- prescribed to n=1 and acetaminophen to n=34. Grip strength points were used to define low muscle mass. Strength was of the non-dominant forearm was assessed using a dynamom- assessed with handgrip strength (Jamar’s dynamometer). eter (Jamar, Patterson Medical, USA). Forearm soft tissue Assessment included socio-demographic data, cognitive composition was assessed at the 66% site using peripheral status(Pfeiffer, GDS-Reisberg), functional status(Barthel, quantitative computed tomography (XCT2000, Stratec, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S491 Germany). Differences among groups over time were tested median age 83 years (R: 50-105), 71% female. 20-39% had a using mixed model ANOVAwith least square means post-hoc prior fracture, 22% were smokers, 10% were taking cortico- testing. Relationships were tested using Pearson correlation steroids and less than 20% were on osteoporosis treatment analyses. historically. Inpatient length of stay and mortality decreased Results: At baseline, average (±SE) age 89.9±0.4 y, BMI 26.3 until health cuts were imposed in Ireland in 2010. ±0.6 kg/m2, DAS28 3.3±0.1, serum 25(OH)D 68.2±1.6 Conclusions: Demographics of people who experience an nmol/L, and grip strength (18.3±0.7 kg) were not different osteoporotic hip fracture in the West of Ireland are similar to among groups. Serum 25(OH)D declined in the placebo group other European cohorts. There is an association between and increased in the 500 and 1000 IU groups (difference±SE healthcare funding, length of stay and mortality which re- placebo: -13.9±2.6; 500 IU: 9.7±4.5; 1000 IU: 9.7±2.7 quires further study. nmol/L, p<0.05). Grip strength was maintained only in the 1000 IU group (placebo: -1.3±0.5; 500 IU: -1.8±0.5; 1000 IU: 0.3±0.6 kg, p<0.05). Forearm muscle area (3138.6±70.4 mm2), density (68.3±0.7 mg/cm3), fat area (1108.9±66.3 mm2) and the ratio of fat:muscle area (36.0±2.3) did not differ among groups. Only muscle area declined over time (-111.3 ±29.1 mm2 p=0.0002), and was associated with grip strength (endpoint r=0.31, p=0.026). Conclusion: A dosage of 1000 IU/d of vitamin D in advanced aging appears beneficial to muscle function based on grip strength. Whether this aids in prevention of falls needs further study. P855 P854 AN INTERPRETATION TEMPLATE REDUCES DXA SECULAR TRENDS OF INPATIENT MORTALITY REPORTING ERRORS AMONG OLDER PERSONS HOSPITALISED WITH N. Binkley1,D.Krueger2, E. Siglinsky2,J.Libber2,E. A HIP FRACTURE IN THE WEST OF IRELAND Shives2, B. Buehring2,K.E.Hansen3 C. Armstrong1,F.Heaney1, P. Arthur2,B.Carthy2,J.J.Carey3 1Osteoporosis Clinical Research Program, University of 1Orthopaedic Surgery, Galway University Hospitals, Galway, Wisconsin, Madison, Wisconsin, United States, 2Osteoporosis Ireland, 2Medicine, National University of Ireland, Galway, Clinical Research Program, University of Wisconsin, Madison, Galway, Ireland, 3Medicine, National University of Ireland, United States, 3Medicine, Division of Rheumatology, Galway and Rheumatology, Galway University Hospitals, University of Wisconsin, Madison, United States Galway, Ireland Objective: DXA is widely used in osteoporosis care. High- Objective: To examine the trend in demographics, hospital quality DXA requires excellent acquisition, analysis and in- length of stay, treatment rates and mortality among hip frac- terpretation. However, errors in clinical practice are common. ture patients admitted to our hospitals over the past decade. We evaluated the effect of a DXA reporting template based on Materials and Methods: We performed a retrospective co- an ISCD model on DXA error rates at two medical centers. hort study of hip fracture patients admitted to Galway Methods: We crafted a DXA reporting template that University Hospitals over the past decade. We identified pa- contained standard text for indication, comparison, findings tients from the hospital fracture liaison programme, and the (BMD and T- or Z-score), impression, FRAX calculation Hospital Inpatient Enquiry System (H.I.P.E.). Patients demo- and least significant change. The template was implemented graphics were reviewed for details of age, gender, prior frac- at 2 clinical sites. Anonymized DXA images and reports from ture status, treatment on admission and discharge, inpatient, prior to and following template implementation were indepen- 30 day and 1 year mortality. We have only included patients dently reviewed by 3 ISCD-certified physicians who assessed 50 years and older in our current study. compliance with reporting guidance and recorded errors. Results: 3583 patients were admitted with a confirmed or Subsequently, all physicians met to reach error consensus. suspected hip fracture between 2005 and 2014. 2483 had a Major errors were defined as provision of inaccurate informa- confirmed fragility fracture, were ≥50 years, and had validated tion that could potentially lead to incorrect patient care deci- data available for analysis. (some files for subjects between sions. Post-template implementation, equal numbers of scans 2007-2009). The mean number of validated fracture admis- from the 5 interpreters at site A and 2 interpreters at site B sions annually for 7 complete years was 304 (R: 199-404), were evaluated. S492 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Here we report major errors from 398 clinical pa- Results: The intensity of endothelin-1, TGFβ2 and VEGF tients; 298 before and 100 after template implementation. expression in the blood vessels was higher in COPD patients Overall, major errors were present in 37% before and 19% with osteoporosis than in healthy. Serum endothelin-1 and E- after template implementation (Table). The template reduced selectin levels were higher in COPD group than in control the odds of major error by 60% (odds ratio 0.40 for major whereas VEGF levels were lower. Serum E-selectin and error, 95% CI 0.22, 0.71, p=0.0008). endothelin-1 inversely correlated with LS and FN (p<0.001), BMC (p<0.05); there was negative relation between endothelin-1 and LM (p=0.003). Serum VEGF directly asso- ciated with LM (p<0.05). The multivariate regression analysis revealed that BMC and serum E-selectin levels were indepen- dently associated with bone loss at the FN (adjusted R2=0.679) whereas LM and serum E-selectin (adjusted Before the template, the most common major errors were in- R2=0.524) were independent predictors of osteoporosis at correct information on BMD change over time and an incor- the LS. Increased serum endothelin-1 and lowered serum rect diagnosis. Following template implementation, these er- VEGF levels independently related to reduced skeletal LM rors remained most common at site B, while incorrect diagno- (adjusted R2=0.396). sis became the most common major error at site A. Conclusion: Change tissue and serum markers of the vascular Conclusion: DXA interpretation errors are extremely com- remodeling, correlations with body composition in end-stage mon and likely adversely affect patient care. Implementation COPD confirms their contribution to bone damage. of an interpretation template reduced major DXA interpreta- Acknowledgment: This study was supported by grants from tion errors, but did not entirely eliminate them. Additional Russian Science Foundation (No. 14-33-00009). interventions, potentially including requiring evidence of ini- tial plus ongoing DXA training and/or certification are neces- sary to provide high-quality DXA reports. P857 OBSERVATION OF RESPONSE TO DENOSUMAB IN PATIENTS ATTENDING A SPECIALIST BONE P856 CLINIC VASCULAR REMODELING MARKERS AND BONE C. Drislane1,M.Smyth1, A. O'Donohoe1,G.Steen2,J. STATUS IN PATIENTS WITH END-STAGE COPD Mahon3,J.-B.Walsh4,K.McCarroll5,R.Lannon2 E. Kochetkova1,L.Ugay1, V. Nevzorova1, Y. Maistrovskaia1 1Department of Medicine for the Elderly, St James Hospital, 1Central Scientific Research Laboratory, Pacific State Medical Dublin, Ireland, 2Bone Health and Osteoporosis Unit, Mercers University, Vladivostok, Russian Federation Institute for Successful Ageing, St James Hospital, Dublin, Ireland, 3Bone Health Unit, Mercers Institute for Successful Background: Systemic inflammation and vascular dysfunc- Ageing, St James's Hospital, Dublin, Ireland, 4Mercers tion could play a role in the development of bone loss in Institute for Research and Aging, St James Hospital, Dublin, COPD. Little is known about a contribution of the vascular Ireland, 5Osteoporosis and Bone Health Unit, St James's remodeling in bone damage. Hospital, Dublin, Ireland Role of serum and tissue vascular remodeling markers in bone loss related to end-stage COPD Background: Denosumab has been available for the treatment Objective: To determine associations between the vascular of severe osteoporosis since October 2010. It is an anti-resorptive remodeling markers and bone composition in end-stage agent which reduces fracture risk and increases bone mineral COPD patients with osteopenic syndrome. density (BMD). It is indicated in postmenopausal women with Methods: The expression of vascular endothelial growth fac- osteoporosis at high risk of fracture. It has been shown to reduce tor (VEGF), endothelin-1, and transforming growth factor be- the incidence of vertebral, non-vertebral and hip fractures. ta2 (TGFβ2) in the blood vessels of striated muscle specimens Method: Using an electronic database we reviewed records of of 20 subjects were assessed by immunohistochemistry meth- those prescribed denosumab at our bone health clinic. 227 od with using immunoperoxidase reaction with monoclonal patients were commenced on denosumab between October and polyclonal specific antibodies. Bone mineral density 2010 and January 2013. Of these, 171 patients had a repeat (BMD) at the lumbar spine (LS) and left femur neck (FN), DXA between the date they commenced and Jan 2017. 68 bone mineral content (BMC), skeletal muscle mass, expressed further patients had a second repeat DXA. We recorded the as lean mass (LM), serum endothelin-1, VEGF, and E-selectin change in T-score in the AP spine and the total hip. levels were assessed in 48 male patients with end-stage COPD Results: Lookingatthe171followupDXAsavailable;mean and in 36 male healthy volunteers. age was 72±10.3 years and mean time to follow-up DXA was Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S493 24.5 months. 165 subjects had spinal results and 168 had hip lower scores for bodily pain (49.6), physical functioning (45.6), results. Mean T-scores at baseline in spine and total hip were - general health perceptions (45.8), energy/vitality (41.3), and 2.86 and -2.3 respectively. First repeat DXA showed an aver- role limitations due to physical health (45.6). Compared to this age improvement of 0.42 SD at the spine and 0.27SD at the group, a sample of OA patients previously reported higher hip. Overall T-scores improved by 15% and 12% respectively. scores in all dimensions except role limitations due to emotion- Subanalysing those with further DXAs over an average 44.5 al problems (57.7) and bodily pain (42.3), and essentially the mths T-scores at the spine improved from mean of -2.82 to - same in emotional well-being (73.9). General UK population 2.46 at second DXA and -2.14 at third DXA i.e. an apparent norms were higher in all dimensions, especially in physical improvement of 25%. T-scores at the spine improved from - functioning (81.0), role limitations due to physical health 2.14 at first DXA to -1.93 at second DXA with plateauing on (80.0) and bodily pain (77.0), and hardly any difference in third DXA to a mean of -1.92. emotional well-being (75.0). Conclusion: In a group of 68 patients on denosumab attend- Conclusion: Quality of life in adults is affected most nega- ing a specialist bone clinic, the serial DXAs show there is tively by the physical dimensions of health, more than for sustained improvement in spinal T scores over 44.5 months. symptomatic OA patients. However, their emotional They show initial improvement at the hip which plateaus. wellbeing is preserved and not much different from that of Reasons for different response will require further analysis the general population, indicating a robustness to physical of factors such as previous treatment as well as bone turnover complaints. markers, vitamin D and fracture history. References: 1. Pollard B et al. BMC Musculoskeletal Disorders 2013;14:346. P858 2. Bowling A et al. J Public Health 1999;21:255. QUALITY OF LIFE IN ADULTS WITH X-LINKED HYPOPHOSPHATAEMIA (XLH): PRESERVATION OF EMOTIONAL WELL-BEING DESPITE P859 SIGNIFICANT LIMITATIONS IN PHYSICAL DETERMINANTS OF IMPAIRED QUALITY OF LIFE DOMAINS IN PATIENTS WITH FIBROUS DYSPLASIA R. Pinedo-Villanueva1, A. Turner1,J.Barrett1, C. Cooper2,K. B. C. J. Majoor1,C.D.Andela2, M. A. J. van de Sande1,A.A. Javaid1 Kapitein3,P.D.S.Dijkstra1,N.A.T.Hamdy4,N.M. 1Musculoskeletal Epidemiology, Botnar Research Centre, Appelman-Dijkstra4 Nuffield Department of Orthopaedics, Rheumatology and 1Department of Orthopedic Surgery and Center for Bone Musculoskeletal Sciences, University of Oxford, Oxford, Quality, Leiden University Medical Center, Leiden, United Kingdom, 2MRC Lifecourse Epidemiology Unit, Netherlands, 2Department of Medicine: Division University of Southampton, Southampton, United Kingdom Endocrinology, Leiden University Medical Center, Leiden, Netherlands, 3Department of Medical Psychology, Leiden Objective: To describe the quality of life of adult patients with University Medical Center, Leiden, Netherlands, 4Department X-linked hypophosphataemia (XLH) using the SF-36 mea- of Medicine, Division Endocrinology and Center for Bone sure and to compare it to patients with osteoarthritis (OA) Quality, Leiden University Medical Center, Leiden, Netherlands and United Kingdom population norms. Methods: We analysed data from 32 individuals aged 16 or Introduction: Fibrous dysplasia (FD) is a rare bone disorder, above, registered in the Rare UK Diseases Study (RUDY) commonly associated with pain, deformity and fractures, platform, diagnosed with XLH completing the SF-36 ques- which may significantly impact on quality of life (QoL). In tionnaire (vs. 1). Responses to all 36 questions were used to this study we evaluate QoL in FD using the Short Form-36 produce scores for the eight physical and emotional dimen- and the Brief Pain Inventory (BPI) questionnaires. Data were sions. Dimensions are scored between 0 and 100 with higher compared with those of the general Dutch population. values representing better health. Scores were compared to Patients and Methods: 138 patients from the 255-strong those reported by a sample of patients with symptomatic, ra- Leiden cohort of FD patients, who were aged ≥ 16 years, diographic OA from England[1] and to the UK population and were seen at the Out-patient Clinic at least once in the norm[2]. previous 3 years, were invited to take part in the study. Data on Results: One subject was excluded because 17 responses were age, gender, type of FD, skeletal burden score (SBS) and missing.The31subjectsincludedwereaged16to79(median biochemical parameters of bone turnover, were retrieved from of 48 years) and 65% were women. Higher mean scores were patients’ records. reported for emotional well-being (73.7), role limitations due to Results: Response rate was 70.3%, with 97 patients, predom- emotional problems (71.0) and social functioning (65.3), and inantly female (65%) completing the questionnaires. S494 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Monostotic FD was predominant (n=62, 64%). FD patients fold lower concentrations than CQ. Thus, BTCQ can efficiently had significantly lower QoL outcome scores than the general bind to bone matrix and release sufficient CQ to inhibit OC Dutch population for all tested domains of the SF-36 except formation and bone resorption both in vitro and in vivo at much for the “Mental health” and the “Role emotional” domains. lower concentrations than CQ. We conclude that BTCQ is a More severe forms of FD, had the more severe SF-36 QoL novel and potentially safe bone-selective anti-resorptive agent outcomes, but there was no significant difference in BPI do- for the prevention of bone loss in diseases characterized by in- mains between different subtypes of FD. QoL impairment was creased OC formation. This strategy could be used to target other greater with higher disease burdens, as reflected by high SBS drugs, such as antibiotics and chemotherapeutic agents, to bone (p=0.003) and high levels of P1NP (p=0.002). and away from other tissues to increase their efficacy and reduce Conclusion: We demonstrate an impairment in all domains of side-effects. quality of life, except for ‘Mental health’ and ‘Role emotional’ domains, in patients with a wide spectrum of FD including its milder forms. We find that high skeletal burden scores, P861 reflecting disease severity, represent the most consistent pre- THE CHANGING FACE OF PRIMARY dictor of impaired quality of life. Our findings hold significant HYPERPARATHYROIDISM clinical implications as they draw attention to the clinically E. Pantazi1, A. Travlos1,E.Vogiatzi1, I. Kostoglou-Athanassiou2 unmet need to address quality of life issues in the management 1Department of Endocrinology, Alexandra Hospital, Athens, of all subtypes of FD, including its milder forms. Greece, 2Department of Endocrinology, Red Cross Hospital, Athens, Greece P860 Introduction. Primary hyperparathyroidism is a disease which A NOVEL STRATEGY TO TARGET CHLOROQUINE nowadays is being diagnosed with increasing frequency. The TO BONE TO INCREASE ITS ANTI-RESORPTIVE diagnosis of primary hyperparathyroidism is based on routine ACTIVITY AND REDUCE SIDE-EFFECTS calcium measurement, which if detected abnormally elevated B. F. Boyce1,Z.Yao1,L.Xing1, A. Ayoub1,R.K.Boeckman leads to the screening of the patient for primary hyperparathy- Jr2,F.H.Ebetino2 roidism. Therefore, primary hyperparathyroidism is frequently 1University of Rochester Medical Center, Rochester, United detected early in the course of the disease. Consequently, severe States, 2University of Rochester, Rochester, United States musculoskeletal manifestations may be lacking in the modern world setting in patients with primary hyperparathyroidism. Nitrogen-containing bisphosphonates and Denosumab are pow- Aim: The aim was to describe musculoskeletal manifestations erful anti-resorptive drugs, which reduce postmenopausal- and in patients with primary hyperparathyroidism being followed age-related bone loss and fractures. However, fears about atypical up in a center of excellence in Athens. fractures and bone necrosis associated with these drugs are lim- Methods: A cohort of 38 patients, 33 female and 5 male, with iting patient and physician enthusiasm for their use. Thus, other primary hyperparathyroidism aged 62.31±1.87 years, being treatments to reduce bone loss and rebuild bone without adverse followed up within a center of excellence in Athens was stud- skeletal effects are highly desirable. We discovered that ied. Musculoskeletal manifestations were recorded in the co- Chloroquine (CQ), a widely used anti-malarial drug, which is hort of the patients studied. still used to as an anti-inflammatory drug to treat rheumatoid Results: Within the cohort of 38 patients with primary hyper- arthritis in some parts of the world, inhibits osteoclast formation parathyroidism being followed up within a center of excel- and prevents ovariectomy-induced osteoporosis in mice. lence in Athens, 12 patients (31.58%) had osteoporosis, 2 However, side-effects, including retinal toxicity and blindness, (5.26%) had osteopenia, 7 (18.42%) had diffuse bone pain, are a concern with long-term treatment of patients with CQ. To 2 (5.26%) had diffuse myalgia and 1 (2.63%) had suffered a address this concern, we have developed a strategy to administer wrist fracture. Within the cohort studied 18 (47.37%) patients CQ in a form that targets it to bone to determine if this allows it to did not have any musculoskeletal manifestations. be given at reduced doses with a lower risk of side-effects, while Conclusions: It appears that primary hyperparathyroidism does delivering effective concentrations preferentially to bone. We not have severe musculoskeletal manifestations, such as osteitis synthesized a novel bone-targeted CQ (BTCQ) by linking CQ fibrosa cystica, in the real world setting in patients followed up to a bisphosphonate with high affinity for bone, but no anti-OC for the disease within a center of excellence in Athens. However, activity. We found that BTCQ inhibits OC and resorption pit patients with primary hyperparathyroidism appear to have dif- formation at 3-4-fold lower concentrations than CQ. A form of fuse bone pain as well as osteoporosis, which may be compli- BTCQ designed such that the linker was non-cleavable had no cated by a fracture in some of the cases. Early detection and significant effect on resorption pit formation. Importantly, BTCQ diagnosis of the disease seems to have altered the face of primary inhibited PTH-induced increased OC formation in mice at 25- hyperparathyroidism in the real modern world setting. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S495 P862 Objectives: To study the characteristics of the pediatric RELATION BETWEEN THE GRADE OF LUMBAR population with at least one risk factor for developing SPONDYLOLISTHESIS AND OSTEOPOROSIS low bone mass / osteoporosis and to measure their cal- E. Scapin1,A.Mereu1, L. Saba1 cium intake. 1P.O. Duilio Casula - A.O.U. di Cagliari - Università degli Studi Material and Methods: Demographic and clinical data were di Cagliari - U.O.C. di Radiologia, Monserrato (CA), Italy prospectively collected from patients aged 2 to 20 years that met at least 1 risk factors for bone fragility, including: inflam- Objectives: To analyze whether the grade of lumbar matory diseases, treatment with Immunosuppressants and/or spondylolisthesis might be related to the osteoporotic status. corticosteroids, gut diseases, chronic systemic disorders, etc. Methods and Materials: 123 lumbosacral spine XRs (29 The average daily calcium intake was collected through the males (23.6%), 94 females (76.4%), age range 28-100 years) Spanish INDICAD 2001 survey study, together with a compre- were retrospectively analyzed. hensive anamnesis. Inclusion criteria were an XR diagnosis of lumbar Results: Data were collected from 50 patients, with a mean age spondylolisthesis (SPL) in absence of trauma or any kind of can- of 9.2 years (2-20), 28 (56%) female, 86% Caucasian, 6% Arab, cer. Incidentally, in all cases the SPL was grade 1 or 2. 2% Asian and 6% Latin. The most frequent diagnoses were: Osteoporosis was mainly diagnosed evaluating the XRs. Food intolerances / malabsorption: 32%, nephropathies: 22%, Included patients were separated according to their gender and JIA: 16%, vasculitis: 10%, other inflammatory diseases: 8%. were subsequently categorized into four groups each: osteoporotic 42% had received systemic corticosteroids at some point, and and non-osteoporotic patients and subjects with grade 1 or 2 SPL. 16% were receiving corticosteroids at present. Average daily We compared grade 1 or 2 SPL between osteoporotic and non- calcium intake was 718 mg/d. They were divided by age groups, osteoporotic subjects using a two-tailed Fisher's exact test. attending to daily calcium needs per group. In Table 1 we can This evaluation was made separately for males and females. observe the Recommended Daily Amount (RDA) of calcium by Results: In males, 12 patients had osteoporosis (41.4%), 17 did the Spanish Association of Pediatrics and the consumption col- not (58.6%). Of those patients who had osteoporosis, 9 cases lected, by age group. Only 3 children with low calcium intake had grade 1 SPL (75%) and 3 cases had grade 2 SPL (25%). were taking supplements. A decrease in calcium CDR adherence Among male patients who had not osteoporosis, 14 cases had was observed with increasing age, statistically significant grade 1 SPL (82.4%) and 3 cases had grade 2 SPL (17.6%). In (p=0.009). There was also a lower calcium intake in the non- females, 62 patients had osteoporosis (66%), 32 did not (34%). Caucasians compared to Caucasians statistically significant Of those patients who had osteoporosis, 55 cases had grade 1 (p=0.044), which was not associated with age. SPL (88.7%) and 7 cases had grade 2 SPL (11.3%). Among Conclusions: Calcium intake in the population under 21 years female patients who had not osteoporosis, 27 cases had grade 1 old with at least 1 risk factor for developing low bone mass / SPL (84.4%) and 5 cases had grade 2 SPL (15.6%). A statisti- osteoporosis is lower than recommended. Larger studies are cally non-significant dependence between the grade of SPL and needed to ratify these results. the osteoporosis or lack thereof was produced, either in males (p=0.6693) or females (p=0.5347) patients. A statistically non- significant dependence was produced between the grade of SPL and gender in osteoporotic patients (p=0.3505). Conclusions: In our results, grade 1 or 2 SPL are not observed significantly more frequently in osteoporotic patients. Grade 1 or 2 SPL was not observed more frequently either in osteopo- rotic males or osteoporotic females. P863 P864 INSUFFICIENT CALCIUM INTAKE IN PEDIATRIC DO THE PROTEINS IN A FINGERNAIL OFFER POPULATION WITH RISK FACTORS FOR INSIGHT INTO THE BONE HEALTH OF THEIR OSTEOPOROSIS DONOR? B. Magallares1,J.Betancourt2,G.Fraga2,A.Marin3,S. M. R. Towler1,J.R.Beattie2 Herrera3, J. Malouf4 1Ryerson University, Toronto, Canada, 2Exploristics Ltd, 1Rheumatology. Hospital de la Santa Creu i Sant Pau, Barcelona, Belfast, United Kingdom Spain, 2Pediatrics. Santa Creu i Sant Pau Hospital, Barcelona, Spain, 3Internal Medicine. Santa Creu i Sant Pau Hospital, Barcelona, Objective: Do the proteins that constitute human fingernail Spain, 4Hospital de la Santa Creu i Sant Pau, Barcelona, Spain offer a window into their donor’sbonehealth? S496 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Materials and Methods: A cross-sectional, multi-centre osteoporosis and lumbar pain, who have underwent 10 outpa- study, ‘Fracture Risk Assessment by Nail correlation study’ tient physical treatments at the Clinic of Physical Medicine (FRAN) was designed to test the link between nail keratin and and Rehabilitation, in the period from January to July 2016. bone health of the nail donors. Raman spectroscopy was ap- The first group of patients (n=30) was treated with PEMF, and plied to nail clippings from 633 postmenopausal British and the second group (n=30) was treated with TENS at the region Irish women, from six clinical sites, of whom 42% had expe- of lumbosacral spine. Pain and its impact on activities of daily rienced a fragility fracture. The Raman spectra were recorded living were evaluated with visual analogue scale (VAS) for by a Sierra Reader (Snowy Range, WY, USA) using 785 nm pain, and with Oswestry questionnaire (OSWI), at the begin- excitation. ning and at the end of the treatment cycle. Results: The differences identified in the Raman spectra of Results: Analysis of the total sample showed the difference in nails sourced from non-fracture and fracture groups can be OSWI score of 9,97±2,03 (range 6-15). In the group of pa- attributed to changes in the order of the keratotic proteins. tients treated by PEMF the difference was significantly better Nails sourced from donors who have not experienced a frac- 11,1±1,83 (range 7-15), than in the group treated by TENS ture contain highly organised alpha helical structures with 8,83±1,56 (range 6-13) (t=5,176; p=0,0001).8.9. Significant ample intra-chain disulphide bonding whereas those sourced reduction of pain according to VAS was found in the total from donors who have experienced a fracture exhibit less sample 3,05±0,87 (range 1-5), with significantly higher aver- ordered, ‘random’ secondary structures with a breakdown in age reduction of pain in the group treated with PEMF 3,53 intra-chain disulphide bonding. ±0,82 (range 2-5) compared to group treated with TENS 2,6 Conclusions: Raman spectra of human fingernails may pres- ±0,63 (range 1-4) (t=5,135; p=0,0001). No positive correla- ent a surrogate marker of bone protein structure status. tion was found in relation to age (VAS - r=-0,055; p=0,677; Acknowledgements: Southampton University Hospitals NHS OSWI – r=-0,106; p=0,418) and DXA densitometry finding Trust, Western General Hospital Edinburgh, Sheffield Teaching (VAS - r=0,026; p=0,843; OSWI – r=-0,091; p=0,490). Hospitals NHS Foundation Trust, Cardiff University Academic Conclusion: Both pulsed electromagnetic field and transcuta- Centre Llandough Hospital, Greater Glasgow and Clyde NHS neous electrical nerve stimulation showed significant analge- Trust (all UK) and the Mid-Western Regional Hospital sic effect and functionality improvement in patients with pri- Limerick (Ireland) for compiling fracture history of the subjects mary postmenopausal osteoporosis and lumbar pain. In both alongside sourcing nail samples. effects pulsed electromagnetic field proved to be a superior Disclosures: Both RB and MT are shareholders in Crescent method among these patients. Ops Ltd, who own intellectual property rights on the relation- ship between nail structure and fracture risk. P866 DIFFERENCES OF TOTAL AREA, PERIOSTEAL P865 AND ENDOSTEAL CIRCUMFERENCE OF THE ELECTROMAGNETIC FIELD AND TRANSCUTANEOUS TIBIA BETWEEN WOMEN OF DIFFERENT AGE ELECTRICAL NERVE STIMULATION IN THE GROUPS AS MEASURED BY PERIPHERAL TREATMENT OF LUMBAR PAIN IN PATIENTS WITH QUANTITATIVE COMPUTED TOMOGRAPHY OSTEOPOROSIS (PQCT): WHICH RADIOLOGICAL SITE TO USE? K. Miladinovic1, N. Vavra-Hadziahmetovic2 K. D. Stathopoulos1,A.F.Mavrogenis2, P. J. Papagelopoulos2, 1Clinic for Physiatry and Rehabilitation, University Clinical G. Skarantavos3 Centre Sarajevo, Sarajevo, Bosnia and Herzegovina, 2Clinic 1Bone metabolic unit, 1st Department of Orthopedics, National for Physical Medicine and Rehabilitation, Clinical Center and Kapodistrian University of Athens, School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina "Attikon" University General Hospital, Athens, Greece, 2Bone Metabolic Unit, 1st Department of Orthopaedics, National and Introduction: Pulsed electromagnetic field (PEMF) and Kapodistrian University of Athens, School of Medicine, transcutaneous electrical nerve stimulation (TENS) are used "Attikon" University General Hospital, Athens, Greece, as physical procedures in the treatment of lumbar pain in pa- 3Bone Metabolic Unit, 1st Department of Orthopaedics, tients with osteoporosis. National and Kapodistrian University of Athens, School of Objective: To analyze the effects of PEMF and TENS in the Medicine, "Attikon”, Athens, Greece treatment of lumbar pain in patients with primary postmeno- pausal osteoporosis as single physical modalities, as well as to Introduction: pQCT is a safe and useful tool for the study of analyze the overall effect of both therapies. long bones in vivo; however, there is currently no consensus Materials and methods: a prospective, comparative study as to which radiological sites are preferable for the study of included 60 female patients with primary postmenopausal geometrical properties such as total area (TOT_A, mm²), Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S497 periosteal circumference (PERI_C, mm) and endosteal cir- concentration of D vitamin and calcium in serum as well as cumference (ENDO_C, mm). body mass index were measured. Material and Methods: We assessed 319 Caucasian ambu- Results: Targeted group consisted of 63 white women, aver- latory women 20-79y using pQCT of the tibia. Exclusion age age of 58.07 years, the variables ranging from 32 to 78 criteria: 1) Bone metabolic disorders 2) previous use of med- years. Average body mass index value amounted to 25.4 kg/ ication for osteoporosis 3) systematic diseases or use of med- m2 with the variables ranging from 17.4 to 39.5 kg/m2. ication known to affect bone 4) fragility fractures of the axial Referential values of mineral bone density were registered in and appendicular skeleton including the tibia. Women were 14.3% (9) patients, average L spine T score value amounted to studied in 6 different age groups per decade of age: 20-29y -0.2 SD; whereas average proximal femur T score amounted N=23, 30-39y N=20, 40-49y N=52, 50-59y N=69, 60-69y, to +0.1 SD. Osteopenia was registered in 49.2% (31)patients, N=82, 70-79y, N=73. For each subject 3 radiological sites average value of L spine T score was -1.7 SD; whereas aver- were obtained (XCT-2000 scanner, Stratec Medizintechnic) age proximal femur T score amounted to -1.3 SD. at the 4%, 14% and 38% of tibia length measured from the Osteoporosis was registered in 36.5% (23) patients, average tibiotalar joint to the median tibial condyle, as suggested by T score L spine values amounted to -3.3 SD; whereas average the manufacturer. We assessed differences of TOT_A (all proximal femur T score value amounted to-1.9 SD. Bone tis- sites), cortical area (CRT_A), cortical thickness sue mineral density changed in 85.7% (54) patients. Average (CRT_THK), PERI_C and ENDO_C (14%, 38%) between D vitamin value in the targeted group amounted to 15.6 μg/ml women of the different age groups and performed statistical with its variables ranging from 3.2 μg/ml to 45.5 μg/ml. D analysis of the results. vitamin within the referential values was found in 6.3% (4) Results: Differences of TOT_A among study groups were patients, the average value of 34.5 μg/ml. Insufficient values found to be statistically significant only at the 14% site of D-vitamin were found in 93.7% (59)patients with average (p=0.003) and not at the 38% site (p=0.678). PERI_C and values of 14.4 μg/ml. No patients were registered with D ENDO_C presented greater values at the 14% site vs. the vitamin values beyond referential values. Average calcium 38% site in all study groups, and differences of PERI_C were values in serum of the targeted group amounted to 2.38 statistically significant among groups only at the 14% site mmol/L with the variables ranging from 2.07 to 2.72 (p=0.002), while differences of ENDO_C were significant mmol/L. Referential calcium values in serum were found in both at the 14% and 38% sites (p=0.000 at both sites). 98.4% (62) patients with average value of 2.38 mmol/L. Conclusions: Based on our results, the 14% site may be pref- Insufficient values of calcium in serum were found in 1.6% erable when comparing geometric parameters of bone be- (1) patients, with the value of 2.07 mmol/L. Hypercalcemia tween subjects of different age-groups. was not registered in the targeted group. Conclusion: In the above research it was shown that breast cancer diagnosed patients exhibit considerably impaired bone P867 tissue structure resulting in either osteopenia or osteoporosis OSTEROPOROSIS AND VITAMIN D VALUES IN with highly insufficient D vitamin values requiring interven- BREAST CANCER PATIENTS ing therapy adjusted to the specific individual needs of pa- S. Saric1,M.Zonic-Imamovic2 tients with a strict follow up of each and every one of them. 1Public Medical Care Institution of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina, 2Tuzla University Clinical Centre, Tuzla, Bosnia and Herzegovina P868 ASSOCIATION OF SERUM ANGIOPOIETIN-2 WITH Introduction: Tissue structure of cancer diagnosed patients CLINICAL AND RADIOGRAPHIC SEVERITY IN has been impaired not only due to the principal diagnosis but OSTEOARTHRITIS PATIENTS also due to the applied therapy protocols affecting metabolism S. Ismail1,H.H.Omar2 of individual tissues. The structure of bone tissue of breast 1Rheumatology Department, Faculty of Medicine, Suez Canal cancer diagnosed patients may also be considerably changed University, Ismailia, Egypt, 2Clinical Pathology Department, and impaired due to the quoted reasons. Faculty of Medicine, Suez Canal University, Ismailia, Egypt Objective: Show osteoporosis frequency, D vitamin and cal- cium values in serum in breast cancer diagnosed patients. Objective: To assess serum Angiopoietin-2 (Ang- 2) levels in Materials and methods: The research covered 63 breast can- knee osteoarthritis (OA) patients and to evaluate its relation- cer diagnosed patients referred to CBR- Saraj Polje in the ship with OA clinical and radiographic severity and inflam- period from 1st of November 2015 to 1st of November 2016 matory markers. for oncological rehabilitation. All the patients' bone mineral Material and Methods: We recruited 72 knee OA patients density (lumbar spine and proximal femur DXA), total and 30 healthy controls. Western Ontario and McMaster S498 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Universities Osteoarthritis (WOMAC) questionnaire was used hospital to the national data and mortality before and after to assess clinical severity. Radiographic severity was evaluat- regular Orthogeriatric input. It also looks at causes of death ed according to Kellgren-Lawrence scale (KL). Serum Ang- 2 and the impact in the care of these patients with regular was measured using enzyme-linked immunosorbent assay review. (ELISA). Serum CRP and ESR were measured to assess Material and Methods: Data was collected from the local hip inflammation. and bereavement office databases between; October 2010- Results: Patients mean age was 57.2±12.4 years and mean September 2011; and November 2014-December 2015. This disease duration was 5.4±4.1 years. Females constituted data was then compared to the national hip fracture database 79% (n=57) of patients. Mean total (WOMAC) score was figures. 66.3±14.08, mean pain score was 13.9±2.3, mean stiffness Results: In October 2010-September 2011, there were 24 score was 4.9±1.06 and mean physical function score was deaths from a total of 343 fractured NOFs (7.00%; national 47.5±11.7. The predominant KL grades were 3 and 4 average 8.0%1) with an average time until death of 10.66 days. (33.3% each, n=24) and only 12.5% (n=9) of our patients In Nov 2014-Oct 2015, there were 34 deaths from a total of were classified in KL grade 1. Low grade inflammation was 480 fractured NOFs (7.01%; national average 7.5%2)withan observed in OA patients; mean serum CRP was 3.02±1.1 mg/ average time of death of 8.24 days. There was also a statisti- L and mean ESR was 25.4±11.07 mm/hr. Serum Ang- 2 level cally significant difference in pre-morbid status; in the first was significantly higher in OA patients (13.18±5.97 ng/ml) study period the ASA grade was 2.81 compared to 2.95 (stu- compared to controls (8.65±5.13 ng/ml), (P<0.001). There dents T-test 0.002). This was also reflected in the AMTS, as in was a positive correlation between serum Ang- 2 and total October 2010-September 2011 it was 6.93 compared to 8.05 WOMAC score (r=0.642, P <0.001), and WOMAC subscale in November 2014-October 2015; which was also statistically categories: pain (r=0.462, P<0.023), stiffness (r=0.449, significant (<0.0001). Assessments revealed that most of the P<0.028) and physical function (r=0.633, P<0.001). There deaths had medical origins with pneumonia remaining the was a positive correlation between Serum Ang- 2 and radio- most common but the incidence of death due to pneumonia graphic severity of OA (r=0.622, P<0.001). Moreover, there was much less during the period of 2014 to 2015. was a strong positive correlation between Serum Ang- 2 and Conclusion: Mortality rates were below the national average ESR (r=0.776, P<0.001) and moderate positive correlation in both time periods examined. with CRP (r=0.435, P<0.034). No correlation was found be- There was a shift in the trend of the cause of death from tween serum Ang- 2 levels and age, disease duration or body avoidable towards the unavoidable causes. We found that mass index. there was a more widespread cause of death in 2015. There Conclusion: Serum Ang- 2 level was significantly elevated in was a reduction in avoidable deaths in patients with increas- knee OA patients and positively correlated with OA clinical ingly complex co-morbidities due to regular multidisciplinary and radiographic severity and inflammatory markers. input. This highlighted potential problems early, through in Therefore, angiogenesis could contribute to the structural depth assessment that minimised avoidable complications damage and pain in OA. Inhibition of angiogenesis may rep- and death resent a potential therapeutic target to control pain, radio- graphic progression and inflammation in OA patients. P870 DOES VITAMIN D AFFECT THE SEVERITY OF THE P869 DISEASE IN PATIENTS WITH ANKYLOSING CHANGING TRENDS IN CAUSE OF MORTALITY IN SPONDYLOARTHRITIS? FRACTURE NECK OF FEMUR OVER FEW YEARS M.-D. Djennane1 AT A TEACHING HOSPITAL IN UK 1Department Medicine Mouloud Mammeri, Tizi Ouzou, S. Naraen1,E.L.Harrison2 Algeria 1Orthogeriatrics, Liverpool, United Kingdom, 2University Hospital Aintree, Liverpool, United Kingdom Introduction: Vitamin D has been found to have a role in the function of the immune system. There have been many studies Objectives: It is well recognised that fractured neck of femurs on the relationship between vitamin D and disease activity in (NOFs) can be terminal events. The British Orthopaedic ankylosing spondyloarthritis (AS). However, the studies car- Association and British Geriatrics Society recommend that a ried out concerned only the groups according to vitamin D multidisciplinary service be offered to the Neck of Femur levels and determined the differences between these patients fracture patients. This should include daily clinical input from in terms of disease activity, functional status, quality of life, Orthopaedic Surgeons and Geriatricians. This study aims and others Clinical parameters. The aim of this study was to to compare 30 day mortality for NOF inpatients at a teaching compare 25-hydroxy-vitamin D (25 (OH) D) in patients with Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S499 SA as well as healthy subjects and to determine the relation- The overall intake of calcium was well below the RDA in both ship between 25 (OH) D levels and Disease, functional status the diabetic and control group with median calcium intake at and quality of life.Patients and Methods: 125 patients with 550 mg/day for all subjects and 80.6% of subject falling below ankylosing spondylitis and 76 healthy volunteers were includ- the RDA of 1000 mg Ca/day. No significant correlations were ed in this study. A first comparison was made between the found between dietary calcium intake and DXA scan results. group of patients and the control group, a second comparison A positive correlation was found between diet vitamin D and was made in the group of patients according to their vitamin D whole body BMC (P=0.01) and hip BMC (P=0.038). status subdivided into 3 subgroups: normal, inadequate and Conclusion: Intake of calcium is not different between deficient in 25 (OH) D.Results: Differences in level (OH) D healthy Type 1 Diabetics and control subjects, with both between patients and controls were statistically significant. The groups not meeting RDA for calcium. Dietary vitamin D is number of patients with SA whose levels (OH) D were classi- significantly associated with BMC for whole body and hip. fied as normal, insufficient and deficient were respectively 32, Disclosures: Funding from National Institutes of Health- 51, and 42. Sedimentation rate (SV), C-reactive protein (CRP) NIAMS #5K23AR055542 and the Gifford Foundation and Bath AS Disease Activity Index (BASDAI) scores were higher in the subgroup in insufficiency and 25OHD deficiency (P <0.05). Functional Bath scores (BASFI) and quality of life P872 (ASQoL) were significantly different between the subgroup SEASONAL INCIDENCE OF HIP FRACTURE IN with normal 25OHD and the deficient subgroups (P <0.05). LITHUANIA Finally, the level of pain, BASDAI, ESR and CRP were in- M. Tamulaitiene1,V.Alekna1, M. Jaramaviciene1,A. versely correlated with 25OHD (P <0.05).Conclusion: Plasma Mastaviciute1,J.Jaramavicius1 levels of 25 (OH) D may be decreased in patients with anky- 1Faculty of Medicine, Vilnius University, Vilnius, Lithuania losing spondyloarthritis and this may negatively affect disease activity, functional status and quality of life. Objective: To analyze the influence of year seasons to hip fractures in Lithuania, during the years 2001 – 2010. Methods: Inclusion criteria were: residents of Lithuania aged P871 40 and over, with primary hip fracture (ICD-10 codes S72.0, CALCIUM AND VITAMIN D INTAKE IN TYPE 1 S72.1 and S72.2) occurred during 2001 – 2010 years. Data DIABETICS AND IMPACT ON BONE HEALTH were collected from patient charts at all 43 orthopaedic- L. Armas1, L. Triplett1 traumatology inpatient departments in Lithuania. Fractures 1Nebraska Medical Center, Omaha, United States were analysed according to the year season in which they have occurred – winter (December, January, February), spring Objective: To compare dietary intake of calcium and vitamin (March, April, May), summer (June, July, August) and au- D among healthy Type 1 Diabetics and control subjects and tumn (September, October, November). identify association with bone mineral density. Results: During the period of 2001 – 2010, a total of 23 160 Material and Methods: A cross sectional study of 108 male hip fractures occurred in Lithuania. Majority of patients where and female subjects (median 37 yrs), 41 with Type 1 Diabetes female – 68.5% (95% CI: 67.9 – 69.1%, n=15 856). Most of and 67 healthy controls. Dietary data was collected via Bloch the fractures occurred in winter – 28.5% (95% CI: 27.9 – self-administered food-frequency questionnaires (FFQ) specific 29.1%, n=6 596), the least in summer – 23.2% (95% CI: to calcium and vitamin D intake. Bone mineral density (BMD) 22.7 – 24.5%, n=5 383). Low energy traumas accounted for and bone mineral content (BMC) measures were obtained using 89.6% (95% CI: 89.2 – 90%, n=20 756). In winter, low energy dual-energy x-ray absorptiometry (DXA, Hologic). Mann- traumas accounted for 92.9% of hip fractures (95% CI: 92.2 – Whitney U tests were used to compare the distribution of dietary 93.47%, n=6 126), and in summer – 86.7% (95% CI: 85.8 – intake of calcium and vitamin D and food groups between dia- 87.6%, n=4 669). High energy hip fractures more frequently betics and healthy controls. Correlations between dietary intake occurred in summer than in other seasons, and accounted for and DXA results were analyzed using Spearman’s rho. 11.2% of hip fractures (95% CI: 10.4 – 12.1%, n=603). In Results: Relative frequency of intake for dairy products was January, 10.7% of all fractures were suffered (95% CI: 10.3 greater in the control subjects as compared to the diabetic – 11.1%, n=2 482), which is the highest percentage among all subjects, though not statistically significant (P=0.056). months, while April holds the lowest number – 7.6% (95% CI: Significant differences in intake of specific foods was found 7.25 – 7.9%, n=1 756). The least fracture incidence per day only for ice cream (P=0.025). Total calcium from both food was indicated in July – 5.8 hip fractures a day. and supplement sources was not different between the two Conclusions: In Lithuania, in the years 2001 – 2010, more hip groups (P=0.116), but supplemental calcium intake was fractures occurred in winter, less – in summer. Low energy slightly higher in the control group (P=0.055). fractures occurred mostly in winter. S500 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P873 P874 BONE TURNOVER MARKER LEVELS IN RISK FACTORS OF LOW BONE MINERAL DENSITY OSTEOPOROSIS PATIENTS TREATED WITH IN FEMALE PATIENTS WITH SYSTEMIC HORMONE REPLACEMENT, DENOSUMAB OR SCLEROSIS AND ITS CORRELATION WITH BISPHOSPHONATE THERAPY DISEASE ACTIVITY AND SEVERITY: A PILOT S. D. Vasikaran1, S. A. P. Chubb1,I.Samsudin1,P. STUDY Glendenning1 M. Radić1,D.Martinović Kaliterna2 1PathWest-Fiona Stanley Hospital, Murdoch, Australia 1Division of Rheumatology and Clinical Immunology Center of excellence for Systemic Sclerosis in Croatia University Objectives: Interpretation of plasma N-terminal Hospital Spli, Split, Croatia, 2Division of Rheumatology and propeptide of type I collagen (PINP) and urine N- Clinical Immunology Center of excellence for Systemic terminal telopeptide of type I collagen (NTX) in osteopo- Sclerosis in Croatia University Hospital Split, Split, Croatia rosis patients treated with anti-resorptive therapy is un- certain as fracture outcome based targets for bone Introduction: Although articular manifestations are frequent markers are not available. We proposed a target for and well described in SSc, the suggestion that SSc may be PINP of 32 ug/L in bisphosphonate treated patients, associated with bone loss and osteoporosis (OP) is still debat- based on an NTX target of 21 nmol BCE/mmol [1]. We ed. In this pilot study we aimed to evaluate the bone mineral examined PINP and NTX levels in a cohort of osteopo- density (BMD) and body composition in women with SSc and rosis patients in routine care treated with hormone re- the relationship between reduced BMD with activity and se- placement (HRT), bisphosphonate or denosumab therapy verity of the disease. to evaluate these target values. Methods: Consecutive SSc female patients who fulfilled Materials and methods: Postmenopausal patients had blood criteria of the ACR and/ or criteria of LeRoy and Medsger for and urine samples collected for the measurement of PINP and SSc and age-matched healthy women were recruited for mea- NTX following treatment for osteoporosis as part of routine surement of BMD and body composition by DXA scan. Risk care, between February 2015 and December 2016. PINP was factors for low BMD in SSc patients were evaluated. We eval- measured on an E170 immunoassay analyser (Roche uated the disease severity using clinical and laboratory param- Diagnostics). NTX was measured on a VitrosECi analyser eters according to the Medsger Severity Scale. The level of SSc (Ortho Clinical Diagnostics) and was corrected for creatinine activity was evaluated according to Valentini activity score. concentration. Statistical analysis was by Analyse-it version Results: 41 postmenopausal SSc patients were studied (age 3.70.1 44.29±15.90 years; disease duration 94.75±88.56 months). Results: Two hundred and fifty six women aged ≥50 y The two groups of SSc patients and control group in our study had measurements of PINP and NTX; 42 were treated were well matched in terms of both demographic and clinical with HRT, 29 with bisphosphonate and 34 with characteristics. Compared with 40 controls, SSc patients had a denosumab. The median [inter-quartile interval (IQI)] significantly lower BMD at the lumbar spine (0.96±0.16 vs. PINP was 30.0 [26.0, 40.0] ug/L, 24.0 [16.3, 33.3] ug/L 1.03±0.11 g/cm2; p=0.02) and the hip (0.87±0.14 vs. 0.94 and 15.0 [11.0, 24.3] ug/L for HRT, bisphosphonate and ±0.12 g/cm2; p=0.04). At the spine, 13 (31.7%) SSc patients denosumab treated patients, respectively. The median and had T score ≤ - 2.5 SD and 3 (7.3%) had osteoporotic frac- IQI NTX was 24.7 [19.7, 35.4] nmol BCE/mmol, 21.1 tures. At the hip, 3 (7.3%) patients had T score ≤ - 2.5 SD but [14.4, 36.8] nmol BCE/mmol and 15.7 [10.4, 28.5] nmol none had hip fractures. The BMD T scores at the femoral neck BCE/mmol for HRT, bisphosphonate and denosumab treat- and/or spine were significantly lower in SSc patients than ed patients. 55% of patients on HRT had PINP ≤32 ug/L controls (p<0.05). The total lean body mass was also lower and 31% had NTX ≤ 21 nmol BCE/mmol. 72% of pa- in patients than control subjects (46.40±7.35 vs. 50.50±5.93 tients on bisphosphonate therapy had PINP and 52% had kg; p=0.01). Multiple regression revealed increasing age, ha- NTX values below these targets; 88% of patients on bitual drinking, lower BMI were unfavorably associated with denosumab had PINP and 68% had NTX below these lower BMD at the spine in SSc patients. The T scores were targets. Medication compliance was not assessed. significantly lower in SSc patients with active disease (activity Conclusions: Patients in routine care require different score ≥ 3, 4.45±1.25) compared with patients with inactive therapeutic targets for bone turnover markers according to disease (activity score <3, 1.52±0.67; p<0.05) Furthermore, the medication they are prescribed. Therapeutic targets based the lower T score had a significant correlations with the skin on fracture outcomes from randomised clinical trials with involvement (p=0.04, r=-0.24). Finally, severity score accord- compliance data are needed. ing to Medsger was higher in the SSc patients with osteopo- Reference: Chubb SA et al. Clin Biochem 2016; doi: rosis than in the SSc patients with osteopenia or normal BMD 10.1016/j.clinbiochem.2016.09.010 [Epub ahead of print] status (p <0.01). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S501 Conclusion: Reduced BMD and lean body mass are prevalent assessed with Fardelonne of questionnaire adapted to local in women with SSc. The SSc patients with more active and/or food sever disease had lower BMD, which suggest possible asso- Results: The average age is 10.23±0.27 years, the median is ciation between disease activity and severity and a reduced 10 years (5-15).The sex ratio is 203 boys / girls 232. The BMD. Appropriate measures against osteoporosis should be average vitamin D is 25.8 and 21.6 respectively in summer undertaken, especially in older patients with low BMI. Bone and winter with a 30% failure rate in summer and 41.4%in health in SSc deserves awareness and is far from fully ex- winter. the average calcium intake is 668±18 mg / day with a plored. This lack of knowledge should trigger prospective median of 613 mg / day (387-1271). In summer, the average studies on the mechanism involved as well as prophylaxis rate of parathyroid hormone is 36±1.25 pg / ml, the median and treatment. was 33 (6-75). (P <0.001). In winter, the average rate is 48 ±1.65 pg / ml, the median is 49. (9.7 to 84.5) (P <0.001). There is an inverse correlation between vitamin D levels and the P875 levels of parathyroid hormone (r=- 0.43, p <0.001), namely PTH REFERENCE VALUES IN A POPULATION OF that PTH decreases vitamin D increases we observed that for ALGERIAN CHILDREN an optimal threshold 25OHD greater than 30 ng / ml, the M.-D. Djennane1,H.Djoudi2, C. Roux3 upper limit of PTH corresponding to the 97th percentile is 1Department Medicine Mouloud Mammeri, Tizi Ouzou, 49 pg / ml, it is 25 -35% lower than the standard provided Algeria, 2Rheumatology Service, EHS Douéra, Algiers, by the laboratory that is 65 pg / ml. We had the opportunity to Algeria, 3Paris Descartes University, Paris, France demonstrate that, for a certain category of 25VTD rate (chil- dren regardless of their rates, those with levels> 20 ng / ml and Background: The measurement of parathyroid hormone those with levels> 30 ng / ml), low calcium intake was signif- (PTH) has become common in everyday practice ever since icantly associated with an average level of PTH higher than in the availability of different high-performance controllers. those with a daily intake of calcium more consistent. In children during growth, disturbances of macro and bone Conclusions: The PTH reference values are highly dependent microarchitecture may occur through a secondary hyperpara- characteristics in particular the reference population of the thyroidism in hypovitaminosis D. The definition of the upper vitamin D status and renal function. The ULN of PTH our limit of normal (ULN) PTH is critical to the management of study to refine the diagnostic sensitivity of asymptomatic asymptomatic hyperparathyroidism reference values of the HPT in the order of 25 to 35%. Other studies on the establish- Parathyroid Hormone (PTH) valid are useful for a better in- ment of PTH reference values are helpful in taking other fac- terpretation thereof. tors such as age into account, BMI and ethnic group. Objectives: Primary objective: Determine the values of reference of PTH in a population of Algerian children. P876 Secondary objective: To establish the influence of calcium GAIT DEFICIT ASSESSMENT IN PATIENTS WITH dietary intake of the PTH. KELLGREN-LAWRENCE GRADE II HIP Methods: This is a prospective cross-sectional population- OSTEOARTHRITIS based study that involved 435 school children aged between D. L. Stoicanescu1, C. Nistor Cseppento2,I.-R.Cevei1,M.L. 5 and 15 years in Daira of Tizi-Ouzou (Algeria). Cevei2 Inclusion criteria: Children whose age is between 5 and 15 1University of Medicine and Pharmacy, Timisoara, Romania, years old. Schooled in the Daira of Tizi-Ouzou and resident 2University of Oradea, Faculty of Medicine and Pharmacy, informed consent (parent or legal guardian). Oradea, Romania Exclusion criteria: School children in Daira Tizi-Ouzou but not resident there. Situations that can increase or decrease The present study aimed to assess the impact of hip osteoar- serum PTH (thyroid, kidney, liver, intestines, cardiovascular, thritis on gait and quality of life using a gait analysis device, pulmonary, epilepsy, tumor). BTS G-walk, and the standardized, validated test MOS SF-36. Consuming treatments hindering PTH metabolism: vitamin We conducted an observational study on 165 patients hospi- D, calcium, anticonvulsants, lithium. talized in Medical Rehabilitation Clinical Hospital Baile Felix, Any situation inducing vitamin D deficiency Parathyroid Romania, during January 2016 - June 2016. Patients were Hormone Assay: intact PTH: sampling conditions: 50 cc of diagnosed with primary or secondary hip osteoarthritis. On venous blood (usually at the elbow crease). It is necessary to Kellgren-Lawrence radiographic grading all were grade II be fasting. Reference Standards Laboratory: 15-65 pg / ml. and their mean age was 59.63±10.63 years. Lot I included Laboratory tests including a calcium and phosphate, renal as- 87 cases with primary hip osteoarthritis and lot II was formed sessment, liver and thyroid dietary calcium intakes were by 78 cases with secondary hip osteoarthritis. Mean value of S502 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 SF-36 score was 45±20.46 in lot I and 44±13.25 in patients control group 1.13 (t=-8.13; p=0.00). On the question “Open from lot II, difference not statistically significant. In cases with a tight or new jar” TOS patients rated 2.38 and control group primary hip osteoarthritis assessment of spatial-temporal gait 1.15 (t=-6.47; p=0.00). On the question “Write” TOS patients parameters with the gait analysis device revealed severe rated 1.49 and control group 0.75 (t=-5.83; p=0.00). On the changes of cadence, duration of the gait cycle, both right question “Turn the key” TOS patients rated 1.43 and control and left step lengths, left and right stance phase duration, left group0.70(t=-5.42p=0.00).Onthequestion“Prepare a and right swing phase duration, double support duration-right meal” TOS patients rated 1.87 and control group 0.97 (t=- AVG value. Speed, double support duration-left AVG value, 7.15; p=0.00). On the question “Cary a shopping bag or brief- single support duration for the right foot were moderately case” TOS patients rated 2.48 and control group 1.20 (t=-9.18; affected. In secondary hip osteoarthritis cases stride length p=0.00). for both left and right steps, left swing phase duration, right Conclusion: Our research definitively pointed on exis- single support duration and double support duration were se- tence influence of the patient´s problems with TOS on verely affected. Left stance phase duration was moderately the daily activities performed as over as under head and affected. The average score MOS - SF36 Health Survey re- shoulders level and required patient´s education and train- vealed a moderate impairment of quality of life, present in all ing how on the appropriate way perform daily activities as patients. In cases with primary hip osteoarthritis severe chang- well as modification and planning further rehabilitation es of gait phases were found in most variables investigated process. with BTS G-walk device. In cases with secondary hip osteo- arthritis, gait phases were within normal parameters for more than half of the studied variables. P878 HEALTH RELATED QUALITY OF LIFE IN FRAIL ELDERLY WOMEN P877 J. Kilaite1, A. Mastaviciute1, M. Tamulaitiene1,V.Alekna1 EVALUATION OF THE DAILY ACTIVITIES IN 1Faculty of Medicine, Vilnius University, Vilnius, Lithuania PATIENTS WITH THORACIC OUTLET SYNDROME N. M. Milenovic1,M.U.Uscumlic1,S.R.Ristic2,B.P. Objective: To analyze the health related quality of life in Popovic3 elderly women with different stages of frailty. 1Special Hospital for Rheumatic Diseases Novi Sad, Novi Sad, Methods: Women aged ≥60 years were included. Frailty Serbia, 2Wattlemore Holdings PTY Ltd All Hours status was defined using Fried’s criteria: weakness, low Physiotherapy, Avoca Beach, Australia, 3Scope International, walking speed, low physical activity, weight loss, exhaustion. Zrenjanin, Serbia Participants were classified as robust, prefrail and frail if they scored 0, 1–2 or 3 points, respectively. Health Objective: Because of the patho-anatomical structure of tho- related quality of life was assessed by the EQ-5D question- racic outlet syndrome (TOS), caused by compressing cervical naire using five dimensions: mobility, self-care, usual activi- circulation and neural structure, patients develop broad specter ties, pain or discomfort, anxiety or depression, and a subjec- of the health problems which influence the daily activities. tive visual analogue scale (VAS) of health state between Aim of the study was to evaluate the influence of patient´s 0 and 100. For statistical analysis, one-way ANOVA with problems with TOS on the daily activities. post hoc test was used to determine the differences between Material and Method: In the study was included 181 partic- groups. ipants: 82 patients with diagnose TOS and 99 healthy volun- Results: The data of 161 women were analyzed: 103 teers. All participants were filled out the questionnaire about (64%) of them were robust, 30 (18.6%) prefrail, and 28 performing daily activities. (17.4%) were frail. Robust women were statistically sig- Results: Patients reported many statistically significant differ- nificantly youngest (mean age – 69.43±6.22 years). In ent health problems caused by TOS which influenced on their prefrail women, the mean age was 70.79±7.92 years. daily activities. On the question “Place an object on a shelf The oldest women were in frail group (75.8±5.98 years). above your head” TOS patients rated 2.80 and control group After statistical analysis of health related quality of life, 1.08 (t=-12.40; p=0.00). On the question “Change a light bulb statistically significant differences were found in EQ-5D overhead” TOS patients rated 3.02 and control group 1.26 (t=- dimensions (p=0.055), except anxiety and depression. 12.36; p=0.00). On the question “Wash or blow dry your hair” Robust women were more mobile (p=0.016), had less dif- TOS patients rated 2.63 and control group 1.21 (t=-11.15; ficulties with self-care (p=0.002), doing usual activities p=0.00). On the question “Wash your back” TOS patients (p<0.001), and were in less pain or discomfort (p=0.001) rated 2.80 and control group 1.30 (t=-10.20; p=0.00). On the than frail women. No statistically significant differences question “Put on a jumper” TOS patients rated 1.99 and were found between robust and prefrail or prefrail and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S503 frail women. It was found that robust women were more P880 satisfied with their health than prefrail (p=0.011) or robust MEDICAL COMPLICATIONS AND OUTCOMES OF (p<0.001) women. No differences were found in health POSTOPERATIVE NECK OF FEMUR FRACTURE status VAS score comparing prefrail and frail women. PATIENTS AT A MAJOR TRAUMA CENTRE IN THE Conclusion: Health related quality of life is statistically sig- UK: A RETROSPECTIVE STUDY nificantly better in robust rather than in frail women. There A. Naraen1,R.Mason2,H.Davis3,G.Austin2,F.Hartley2,P. were no difference in EQ-5D anxiety/depression dimension D'Orton-Gobson2, F. Hopkinson2,O.Cetinoglu2,A. between robust and frail women. Crossman2,S.Naraen2 1St. George’s University of London, London, United Kingdom, 2Orthogeriatrics, Liverpool, United Kingdom, P879 3Orthogereriatrics Liverpool, Liverpool, United Kingdom SURGICAL NUANCES IN THE MANAGEMENT OF ANKYLOSING SPONDYLITIS SPINE TRAUMA Background: Postoperative complications affect 20% of M. Garg1,K.Garg1,P.K.Singh1,D.Agrawal1, B. S. Sharma1 neck of femur fracture (NOFF) patients. The variety in 1Dept. of Neurosurgery, AIIMS, New Delhi, India aetiology of complications affect length of stay, the financial burden on the service and perioperative mortality. Objective: Ankylosing spondylitis (AS) with traumatic Aim: To analyse the frequency and prevalence of medical fractures are ere extraordinary challenges for spine sur- complications occurring in patients with NOFFs. geons. Just a trivial trauma to the rigid and brittle spine Method: A retrospective study reviewing the hospital records may give rise to grave neurological complications that of 332 hip fracture patients between January and December requires early intervention in the form of surgical fixa- 2015. Primary outcome: To assess how the comorbidities and tion. The authors wish to apprise regarding the problems postoperative complications impact the outcomes of patients and surgical nuances in management of such highly un- with NOFFs. Inclusion criteria: 1. Inpatients. 2. Over the age stable deformity. of 60. 3. Admitted with a NOFF. Material and Methods: Four patients of AS with traumatic Results: The study found 62 different postoperative complica- spine fractures underwent CAT scan and MRI to evaluate the tions in our cohort of 332 patients. The most common was anae- extent of injury and plan the line of management. All the mia,whichoccurredin91patients(27%)andmyocardialinfarc- patients presented with ASAIA A neurological grade and tion being the lowest common complication with 7 (2%). The underwent instrumentation for deformity reduction and stabi- highest incidence of postoperative complications occurred in lization. The perioperative adversities confronted by the spine March with 40 patients (12%) and the least in November with surgeons were analyzed. 20 (5%). Although the majority of the admissions were aged Results: Three column fractures with deformity and dis- between 81-90 (145 (44%)), the 91+ age group had the highest placement was seen in all patients. Intubation during in- mortality of 49 (10%) irrespective of comorbidities. The highest duction is challenging due to rigid spine and fibreoptic death percentage was in June: 18%, with no mortalities in intubation is preferable. Pre op positioning to achieve re- October, May or November. Cardiac comorbidities were most duction and sagittal alignment is the mainstay especially in prevalent, with 221 patients (67%) and gastrointestinal was the cervico- thoracic junction fractures wherein 360 degree least: 56 (17%). Pre-morbid ASA classification showed 209 pa- fusion is to be performed. The surgery is associated with tients (63%) were classed as ASA III, indicating severe systemic higher blood loss (mean 1500 ml). Due to brittleness of disease. Postoperatively 191 (57%) became ‘dependent for care’, spine with associated osteoporosis and poor bony purchase whilst 122 (37%) achieved ‘equivalent status or better’. No rela- of screws, long segment fixation is desirable with at least tion between number of comorbidities, mortality or morbidity 3 levels above and below the fracture segment. The ana- was seen. A positive correlation was found between the number tomical bony landmarks are obscured which makes screw of complications and mortality rates: 1% of patients with no placement very tedious. Image guidance system especially complications died, whereas 100% died with 10. 177 patients O-arm is of immense help in such cases. (55%) were prescribed delirium-inducing drugs, 140 (42%) were Conclusions: AS patients are highly vulnerable and even a prescribed hypotensives and 124 (37%) were taking nephrotoxic meager trauma can cause immense neurological deficits and drugs. spinal deformity. The gravity of injury in such patients must Conclusion: In this study more than 60 complications were not be underestimated and demand utmost care while handling recorded, most commonly anaemia. The number of complica- them in emergency or operating rooms. Surgical management tions had a positive correlation with mortality, however no is technically very challenging but with identification of likely relationship between number of comorbidities, mortality or perils that may be encountered, best possible care can be ren- morbidity was seen. Increasing age was found to increase dered to this arduous community. mortality post-operatively. S504 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P881 1Rheumatology department Institute for Treatment and ANKYLOSING SPONDYLITIS COEXISTING WITH Rehabilitation Niska Banja, Niska Banja, Nis, Serbia, BEHCET’S DISEASE: SUCCESSFUL TREATMENT 2Clinical Center Nis Serbia, Nis, Serbia WITH CT-P13 INFLIXIMAB P. Athanassiou1, M. Kostopoulos1,A.Spyridis1,C. Background/Aim: The literature data suggest a negative cor- Katsavouni1, A. Tzanavari1, D. Pantelidis1 relation between osteoarthritis (OA) and osteoporosis (OP), 1Department of Rheumatology, St. Paul's Hospital, Thessaloniki, implying rare simultaneous existence in the same patient and Greece the fact that OA and OP represent two extremes, i.e. two different patient populations. The data about the association Rheumatic diseases are a spectrum of disorders with overlapping of increased bone mineral density (BMD) and osteoarthritis, manifestations and altering characteristics in the course of the and increased bone loss in long-lasting OA during aging are disease. Ankylosing spondylitis (AS) is a systemic inflammatory still controversial. The aim of this paper was to investigate if disease, its pathogenesis still being investigated. Behcet’s disease there was any association of OA of different sites and in- is an inflammatory disease affecting primarily young males. creased BMD, as well as to investigate the correlation between Aim: To describe two cases of patients who developed AS BMD on one hand, and body mass index (BMI), radiologic and Behcet’s disease. The patients were successfully treated grade of OA and duration of postmenopausal status, on the with infliximab and CT-P13, an infliximab biosimilar. other. Methods: A male patient, aged 48 years, presented with low Methods: We studied 235 postmenopausal women aged 50-79 back pain and arthralgias of the wrists and lower extremities since years, with 48 of them with hand OA, 28 with hip OA, 39 with his young adulthood. The diagnosis of AS with HLA-B27 pos- knee OA, 55 with GOA, and 65 controls. The studied groups itive was made. In the course of the disease the patient developed were comparable by the factors of age and duration of postmen- mouth and genital ulcers, anterior uveitis, arthritis of upper ex- opausal period. BMD was measured in the lumbar spine (L1-L4) tremities and gastrointestinal manifestations. Behcet’sdisease on DXA densitometer Lunar DPX and presented in absolute was diagnosed and the disease exhibited a fluctuating course, values in g/cm². until after 22 years it went into remission. The patient had a flare Results: In the groups with hand, hip and knee OA, signifi- of AS with decreased spine mobility and increased inflammation cantly higher values of BMD were found compared to con- indices. The second patient, a male aged also 48 years, presented trols in the age subgroups of 50-59 and 60-69 years, while this with relapsing episodes of anterior uveitis and mouth ulcers. The difference was not significant in the age subgroup 70-79 years. diagnosis of Behcet’sdiseasewasmade.Inthecourseofthe In the GOA group, significantly higher values of BMD were disease he developed inflammatory low back pain with increased found in all age subgroups. Between BMD and BMI, a posi- inflammation indices. The diagnosis of AS was made. tive correlation was found only in the control group (p<0.01) Results: In the course of the disease both patients received and GOA group (p<0.05). There was no correlation of radio- local treatment for the manifestations of Behcet’sdisease.The logic OA grade and BMD in the studied groups. A negative first patient was treated with infliximab for a period of two correlation was found between the duration of postmenopause years with a very good response, the treatment being stopped and BMD in all investigated groups (p<0,01). afterwards. Due to a disease relapse CT-P13, an infliximab Conclusion: OA of different anatomic sites is associated biosimilar was initiated. The second patient was treated with with increased bone mineral density, and the association CT-P13 and cyclosporine with very good response. Both pa- is more conspicuous in younger age groups. The main tients are on treatment with CT-P13, the disease being in predictor of the bone mineral density is the duration of remission. postmenopause, with longer postmenopause associated Conclusions: The coexistence of AS with Behcet’s disease is with lower bone density. being described. Nowadays an autoinflammatory etiology of Behcet’s disease is discussed, while in the pathophysiology of AS both autoimmune and autoinflammatory factors may be P883 involved. In one of the cases infliximab administration and in THE IMPORTANCE OF EXERCISE IN PATIENTS both cases the administration of CT-P13, an infliximab WITH OSTEOARTHROSIS OF THE HIP biosimilar induced remission. A. Jurisic Skevin1,V.Grbovic2, A. Tomic Lucic3,A.Divjak3, M. Veselinovic3, J. Nurkovic4 1Faculty of Medical Science University of Kragujevac, P882 Kragujevac, Serbia, 2Clinical Center Kragujevac, BONE MINERAL DENSITY IN OSTEOARTHRITIS Kragujevac, Serbia, 3Faculty of Medical Science University V. Zivkovic1,B.Mitic2, B. Stamenkovic1,S.Milenkovic1,J. of Kragujevac, Kragujevac, Serbia, 4State University of Novi Jovanovic1,I.Aleksic1 Pazar, Novi Pazar, Serbia Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S505 Objectives: To investigate the importance of exercise on the Republic of Iran, 4Boston University School of Dental Medicine, pain and quality of life in patients with osteoarthrosis (OA) of Boston, United States, 5Worcester State University, Health the hip. Science Department, Worcester, United States Material and Methods: This was a prospective clinical study consisted of 30 patients with primary hip OA treated station- Objectives: This study is an investigation into the epidemio- ary at the Center for Physical Medicine and Rehabilitation logic and economic cost of hip fractures in Iran. from 2011 to 2012 year. On receipt of all the respondents Material and methods: We determined the incidence rates of was filled out the social survey, quantification of pain was hip fractures for all patients treated in teaching hospitals from assessed by visual analogue scale (VAS) and quality of life October 2014 to October 2016 and calculated mortality rates, was measured by the three-level version of the EuroQol five- hospitalization days and direct costs of hospitalization. The dimensional questionnaire (EQ-5D-3L). After that partici- hip fractures report data were obtained from an electronic pants received exercise program for 21 days. Exercise includ- health records that called SEPAS. This nationwide health in- ed balance and proprioception activities, isometric, isokinetic formation system established by Information Technology and exercise with or without resistance, flexibility exercises, core the Statistics Department of the Ministry of Health and cov- stabilization exercises and aerobic/endurance exercise for 30 ered all teaching Hospitals in Iran. International Classification minutes daily. After one month, patients were tested again. of Diseases ICD-9 and 10 will be used as diagnostic codes. Results: The sample consisted of 75% women and 25% men, Inclusion criteria were patients aged ≥50 with a diagnosis of a mean age was 62.64±6.06 years. The most represented were single fracture located at the neck, head, or intertrochanteric retirees 80%, followed by workers and housewives 13.33% and region of the femur treated with total/hemiarthroplasty, screw 6.66%. Quality of life measured by the EQ-5D-3L questionnaire or nail methods. We examined the demographics, location of at the baseline and end of the study showed no statistically sig- fracture, treatment type, length of hospital stay (LOS), direct nificant changes (p> 0.05) in the domains of self-care, the anxiety cost, mortality and early complications during hospitalization. / depression and into common activities of daily living. There Results: A total of 35,451 hip fractures taken from patient was a statistically significant improvement in quality of life (p records in all teaching hospitals connected to SEPAS during <0.05) in the field of mobility, pain / discomfort, EQ VAS. There the study period. Hospital care of patients with hip fractures was a statistically significant reductioninpainmeasuredbyVAS required an overall 246,379 bed-days with an average of 7 pain scale (7.67±1.06; at the end of 3.73±1.78, p <0.001). days. The total cost of hospital treatment of hip fractures in Conclusion: Recent clinical practice guidelines for the man- Iran was IRR 2,066,440,433,765 (US$ 51,661,011), with av- agement of hip OA had strongly recommended that people with erage costs per patient of IRR 58,290,046 (US$ 1,457) in OA exercise regularly, based on evidence that aerobic and teaching Hospital. strengthening programs improve pain, function, and quality of Conclusion: The data obtained from SEPAS, the largest scale life; facilitate weight management; and may slow the progres- nationwide health information system in Iran. Thus, current sion of the disease. Our study showed that exercise led to a study presents the first and largest nationwide data analysis of statistically significant reduction in pain as measured VAS pain osteoporotic hip fracture and detailed information about their scale and improve the quality of life (in the fields of mobility, treatment costs in Iran. Our primary results indicated that the pain / discomfort, EQ VAS) measured by the EQ-5D-3L. incidence rate and direct cost of hip fracture in Iran are signif- icant among Middle Eastern countries. P884 DIRECT COST OF HOSPITAL ADMISSIONS DUE TO P885 HIP FRACTURES: PRIMARY ANALYSIS OF A CLINICAL CHARACTERISTICS OF PATIENTS NATIONAL DATABASE IN IRAN WITH FRACTURES DUE TO FRAGILITY IN A A. Hossein-Nezhad1, Z. Maghbooli1, S. Noursaadat2,M. HOSPITAL POPULATION AT HOSPITAL SAN JOSE Jafarpour2,H.Adibi3, M. Ramezani3,R.Hashemian4,S. IN BOGOTA D.C., COLOMBIA Moattari5,B.Larijani1 A. Medina1,A.Rivera2,A.Alvarado2, K. Bautista2 1Osteoporosis Research Center, Endocrinology and Metabolism 1Endocrinology. Hospital San Jose, Bogota, Colombia, Clinical Sciences Institute, Tehran University of Medical 2Endocrinology-Hospital San Jose, Bogota, Colombia Sciences, Tehran, Islamic Republic of Iran, 2Statistics and Information Technology Office, Ministry of Health and Introduction: The prevalence of osteoporosis increases as the Medical Education, Tehran, Islamic Republic of Iran, population ages (1). It can be considered a benign pathology, 3Osteoporosis Research Center, Endocrinology and but it generates considerable morbidity and mortality second- Metabolism Clinical Sciences Institute, Tehran University of ary to fragility fractures, which increases costs to the different Medical Sciences, National Elites Foundation, Tehran, Islamic health systems of the world (2). Different strategies have been S506 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 created for the detection and management of these fractures the well-recognised fragility fractures in the elderly population with good results (3). As such, its implementation is necessary attending fracture clinics at a teaching hospital in UK. in our setting for the creation of policies and local strategies Method: We looked at the notes of patients (aged 50 years that allow a better approach to this pathology in our and above) who attended the fracture clinic of university hos- population. pital in the UK. Patients with limb fractures following low Objective: To describe the clinical characteristics of patients energy trauma were included. Patients with fractures of the with fragility fractures and their management at San hip, distal radius or vertebra were excluded as well as fractures José Hospital in Bogotá during 2015 and up to July 2016. as a result of high energy trauma. We looked at the records 972 Methods: Descriptive cross-sectional study. Clinical histories patients. of patients from the endocrinology and orthopedics services of Results: Of the 972 records reviewed, 225 patients with low the San José Hospital in Bogotá with diagnosis of severe energy fractures were included in this study. The results were osteoporosis were evaluated from 2015 to July 2016. The grouped as follows; 30 patients had pelvic ring and femoral demographic and clinical characteristics, as well as the treat- fractures (other than neck of femur fractures (13.3%), 12 had ment received, were analyzed. fractures of the tibia (5.3%), 72 had foot and ankle fractures Results: A total of 621 patients with a main diagnosis of os- (32%), and 54 patients had humerus fractures (24%). 21 pa- teoporosis and fractures associated with osteoporosis were tients suffered with radius and ulna fractures (excluding distal found, of which 184 met inclusion criteria (30% fragility radius fractures) (9.3%)and36patientshadotherfrac- fractures). The mean age was 71.5 years (SD: 11.6), the ages tures(16%). There were 6 (2.6%) patients who had suffered ranged from 35 to 99 years. The most frequent fractures were with two or more fractures as a result of the same fall. Age vertebral fractures followed by distal radius, proximal femur range 50 to 82 years. 62% were female and 38% were males. and others at 71 (38.6%), 65 (35.3%), 36 (19.6%) and 34 Conclusion: Despite the small study population, it reflects the (18.5%), respectively. Thirty% of the patients had a previous present trend of fractures occurring in the older population in diagnosis of osteoporosis. Only 30% received complete treat- the UK that is noted in the literature. The greater incidence of ment before fracture and 57.6% received post-fracture fractures in this age group observed particularly in the femur, treatment. humerus, foot and ankle after low energy injury should be Conclusion: Fragility fractures are very frequent pathologies given their due recognition as possible predictors of future in our population. However, these are underdiagnosed and fractures at other anatomical sites. Starting bone protection undertreated, which makes it necessary to implement educa- treatment should be considered as a means of reducing the tion, detection, diagnosis and early management programs to risk of morbidity and mortality due to incidence of hip and avoid complications in the short and long term. We need pro- vertebral fractures in these patients. grams that improve the quality of life of the patients and de- crease the associated morbidity and mortality. P887 MODERN METHODS OF ESTIMATION AND P886 CORRECTION OF STRUCTURAL AND THE INCREASING INCIDENCE OF LOW ENERGY FUNCTIONAL CHANGES OF SKELETAL AND TRAUMA FRACTURES IN SITES OTHER THAN MUSCULAR SYSTEM THOSE RECOGNISED AS FRAGILITY FRACTURES O. M. Ignatyev1, N. I. Turchin1, T. O. Yermolenko1 A. Naraen1,3,R.Mohan2,C.Jakaraddi1 1Odessa National Medical University, Odessa, Ukraine 1Orthopedics, Liverpool, United Kingdom, 2Orthopaedics, Liverpool, United Kingdom, 3University of St Georges, Aim: To increase the effectiveness of therapy and prevention London, United Kingdom of structural and functional changes of the musculoskeletal system in workers of sea-economic complex by using seeking Objectives: Hip, vertebral and distal radius fractures are drugs in combination with kinesotherapy. established as predictors of future osteoporotic fractures. Methods: During the work we have examined 76 employees With increasing longevity there is an increasing number of of sea-economic complex of the South of Ukraine with differ- low energy trauma fractures. The incidence of foot and ankle ent severity of osteoporosis and osteopenia. All patients were fracture is as high as 3 per 1000 woman years and are the most divided into two groups: the main clinical group – has been common fractures in the over 50s. Proximal humeral fractures used for the treatment of bone-seeking therapy and are the 4th most common fracture in the elderly and are now kinesitherapy; clinical control group – only applied bone seek- becoming accepted as a predictor of possible osteoporotic ing therapy. The algorithm of the examination included: his- fractures at other sites. Retrospective study to look at the in- tory taking, the dynamics of the clinical condition of the pa- cidence and aetiology of low energy limb fractures, other than tients, instrumental (ultrasound densitometry) and functional Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S507 (system for registration and processing of biosignals «Insight Due to severe kyphoscoliosis and the resulting concavity of TM») research methods. The dynamics of the parameters abdominal wall, the stomal bag did not adhere well to the were evaluated before treatment, after 3 and 6 months. abdominal wall. The result was a peristomal dermatitis caused Results: The study found that the more rapid improvement in by a leaking bowel content. mineral bone density and NSF Index is defined in the main Conclusion: This case presents a medical challenge, especial- clinical group compared to the control group. ly when the primary diagnosis wasn't completely obvious. Conclusions: The most effective method of treatment of os- Although we noticed an irregular patient's posture, we were teoporosis and osteopenia is a bone-seeking therapy in com- initially mislead and believed that bowel loops herniated dia- bination with kinesitherapy. The used complex of medical phragmatic muscle. After the surgical verification of colonic physical exercises gives the chance to select physical activity carcinoma, it was obvious that dilated bowel loops only depending on initial indicators strictly individually for each shifted diaphragmatic muscle. Unfortunately, heavy vertebral patient. A screening examination of employees allows to iden- pathology disqualified our patient from a possible second sur- tify osteoporosis or osteopenia in the early stages and provide gery, which would include ileostomy closure. the necessary complex treatment, which consequently pre- vents the risk of complications, decrease of work capacity, disability and mortality. P889 SHOULDER PAIN IN HEMIPLEGIC STROKE PATIENTS AND CORRELATION TO P888 REHABILITATION OUTCOME PATIENT WITH SEVERE KYPHOSCOLIOSIS AND K. Boskovic1, D. Simić-Panić1,A.Knežević1, S. Tomasevic- SYGMOID CARCINOMA – AMEDICAL Todorovic1,J.Ivacic2,S.Mikulić-Gutman3 CHALLENGE IN AN EMERGENCY SETTING: A 1Medical Faculty, University of Novi Sad, Novi Sad, Serbia, CASE REPORT 2Physical Medicine and Rehabilitation, General Hospital, A. Ladic1,DSajkovic2,A.Secic2,IPetrovic3 Senta, Serbia, 3Clinic for Medical Rehabilitation and Physical 1Department of Internal Medicine, University Hospital Centre Medicine, Clinical Center of Vojvodina, Serbia, Novi Sad, Serbia Zagreb, Zagreb, Croatia, 2Department of Rheumatology, Physical medicine and Rehabilitation, University Hospital Objective: To analyze the incidence of shoulder pain in hemi- Centre Sestre Milosrdnice, Zagreb, Croatia, 3Clinic for plegic stroke patients and the correlation between motor func- Surgery, University Hospital Centre Zagreb, Zagreb, Croatia tion of affected upper limb and scores of daily living activities with pain levels. Objective: Untreated congenital kyphoscoliosis can in adult- Material and methods: Patients in the initial 6-month period hood lead to low back pain, osteoarthritis, spinal stenosis, after stroke who went through inhospital rehabilitation treat- different neurological and cardiopulmonary problems. It also ment were included in the study. Demographic and clinical exerts secondary effects on gastrointestinal system. features and medical data of the patients were recorded. Materials and methods: A 74-year-old male patient presented Upper extremity Fugl-Meyer Motor Assessment (FMA), with symptoms of low-grade fever, constipation, tachycardia, Frenchay Arm Test (FAT), and Barthel Index (BI) were ap- dyspnea and oliguria. Plain films and multi-sliced computed plied to the patients on admission, at discharge, and after 3 tomography (CT) of the chest revealed aero-liquid levels within months of follow-up. For statistical analysis we used statistical dilated small and large intestine loops, occupying the right program IBM SPSS Statistics 22.0 (Statistical Package for the thoracic cavity, distended cecum up to 8.6cm, stenotic process Social Sciences). Results were presented using standard sta- of the sigmoid colon and a heavy lumbar scoliosis. Due to the tistical measures of central tendency and range of results. To physical state deterioration, i.e. acute abdomen, the patient was determine the difference between variables Chi-square analy- immediately operated on. The subtotal colectomy with unipolar ses and t-test for independent samples were used. ileostoma was performed, due to a visible sigmoid tumorous Results: At the initial evaluation 65 (47.1%) patients had shoul- process - later pathohistologically confirmed as adenocarcino- der pain, at discharge 32 (24.2%) had decreased shoulder pain ma. The primary suspicion of a huge diaphragmatic hernia, was and at 3 months of follow-up 27.4 (17.3%) had shoulder pain of later eliminated during surgery and by finding out the patient's decreased or persistent intensity. Average values of all three history of long-running, surgically untreated severe scales showed significant improvement after 3 months follow kyphoscoliosis, which affected a position of the thoracic vis- up. The FMA, FAT, and BI scores both at admission, discharge cera, further worsened by stenotic colonic process that lead to and follow up showed strong correlation with pain levels. dilated and shifted bowel loops. Conclusions: Shoulder pain in hemiplegic stroke patients has Results: Patient was discharged on the 14th postoperative significant impact on functional outcome and motor recovery day, returning on the regular follow-up two months later. of the affected upper limb. S508 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 References: Objectives: The aim of this study was to compare bone min- -Simić-Panić D et al. Ann Indian Acad Neurol 2015;18:484. eral densities (BMDs) of the affected and unaffected limbs in -Tomasević-Todorović S et al. Ann Indian Acad Neurol stroke patients at two sites, as well as to assess changes in 2016;19:286. BMD during a 6-month rehabilitation program. Additional objective of this was to discover whether there is a correlation between BMD and impairment in stroke patients. P890 Material and Methods: 65 consecutive hemiplegic inpatients, USING SMARTPHONE HARDWARE TO 32 men, age 53.2±11.3 years, and 33 women age 56.1±13.7 were DETERMINE IF ACTIVITY BASED TREATMENT enrolled in this study. BMDs of femoral neck and third lumbar OF LOW BMD ACHIEVES PROPER DOSE vertebra measured by dual-energy x-ray absorptiometry (DXA), RESPONSE FOR OSTEOGENIC ADAPTATION were compared between affected and unaffected sides at admis- L. Freeman1,J.Jaquish2 sion and discharge. Patients underwent evaluation of motor re- 1Aegis Therapies and Post-Acute Therapeutics and Health, covery of the affected extremities by the Brunnstrom stages of Sammamish, United States, 2American Bone Health, Oakland, stroke recovery, and determination of the functional status on the United States basis of scores of functionality in activities of daily living (ADL): Barthel Index (BI) and Rivermead Mobility Index (RMI) Objectives: To apply existing smartphone hardware via applica- Results: Rivermead Mobility Index (RMI), Barthel Index tion to monitor and educate patient populations on the minimum (BI) and motor recovery of the affected extremities evaluated dose response for multiple-of-bodyweight (MOB) compressive by the Brunnstrom stages of stroke recovery improved signif- force osteogenic loading. The resulting application can be a cost icantly at discharge. Affected/unaffected limb BMD ratios effective method for educating patient populations on their ability were 82.6% to 94.1% at admission and 73.6% to 96.1% at to generate bone mass increases with physical activity. discharge, lowest for the femoral neck. Discharge/admission Materials and Methods: Forces that compress bone via impact ratios were 87.3% to 95.8% for the affected and 92.1% to activity can stimulate adaptive response of BMD growth beyond 100% for the unaffected side. BMDs correlated significantly 4.2 MOB.1 Further, more rapid growth in BMD has been seen in with age, body weight, RMI, BI and Brunnstrom stages of magnitudes of loading beyond the minimum dose response of stroke recovery for affected extremities. 4.2 MOB.2 A novel software application that allows impacts Conclusions: BMD of the affected side were lower in the through the lower extremities to be recorded and examined has femoral neck. Over time, not only the affected but the unaf- been developed for educational purposes. Instances of engaging fected BMDs decreased. Age, sex, duration of stroke, anthro- in impact protocols, which include holding the smartphone pometric measurements, motor impairment, and disability lev- against the hip joint while jumping and absorbing impact. el contributed significantly to bone loss according to the site Results: Tests showed 40 consistent results (20 heel and 20 hip) of and time of DXA evaluation. 4.57MOB at the heel, and 2.91MOB at the hip (ANOVA p<0.0001). References: Conclusion: As the accelerometer in a smart phone can be -Simić-Panić D et al. Ann Indian Acad Neurol 2015;18:484. placed near the hip joint, a more accurate representation of -Tomasević-Todorović S et al. Ann Indian Acad Neurol loading into this joint can be seen with a simple Application 2016;19:286. and the standard Smart phone that many people have. These data also reflect the known level of deceleration seen with the musculoskeletal system when reviewing the difference be- P892 tween heel and hip loading events. IS OSTEOPOROSIS A CURABLE DISEASE? References: I. Kostoglou-Athanassiou1, E. Pantazi2,P.Athanassiou3 1. Deere K et al. JBMR 2012;27:1887. 1Department of Endocrinology, Red Cross Hospital, Athens, 2. Hunte B et al. J Osteoporos Physical Activity 2015;3:2. Greece, 2Department of Endocrinology, Alexandra Hospital, Athens, Greece, 3Department of Rheumatology, St. Paul's Hospital, Thessaloniki, Greece P891 OSTEOPOROSIS IN HEMIPLEGIC STROKE Osteoporosis may be a disease of unknown etiology, or a PATIENTS: A LONGITUDINAL STUDY degenerative disorder in the context of aging. Nowadays, the J. Ivacic1, D. Simić-Panić2,K.Boskovic2,A.Knežević2,S. availability of multiple forms of effective drug treatment for Tomasevic-Todorovic2,M.Jovicevic2 osteoporosis have raised the hypothesis that osteoporosis may 1Physical Medicine and Rehabilitation, General Hospital, be not only a treatable but moreover a curable disease. Senta, Serbia, 2Medical Faculty, University of Novi Sad, Aim: The aim was to describe the case of a patient with oste- Novi Sad, Serbia oporosis who after treatment with alendronate for 6 years had Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S509 osteopenia and remains in the state of osteopenia for a long Methods: We extracted data from the Hospital InPatient period after drug cessation. Enquiry system (H.I.P.E.) for all potential osteoporotic frac- Methods: A patient, female, aged 65 years, postmenopausal, tures for men and women aged 50 years and older. We then presented with osteoporosis, T score in the spine being -3.2. extracted data for all admissions where osteoporosis was listed Alendronate 70 mg once weekly was administered along with as either a principle diagnosis, or any diagnosis. We compared calcium and vitamin D. The patient also had hypothyroidism the proportion of fragility fracture admissions with osteoporo- on treatment with L-thyroxine, TSH levels being within the sis admissions to identify the “diagnosis gap” for our normal range. hospitalised fracture population. Results: Bone mineral density measurement was performed Results: The number of fracture admissions has risen over the yearly while the patient was on treatment with alendronate, last decade: 2005 Vs 2014: +30%, and the number of hip calcium and vitamin D. Six years later bone mineral density fractures may be stabilizing (Figure 1), while the number of measurement in both the spine and the hip revealed patients with a diagnosis of osteoporosis has more than dou- osteopenia, T score being -1.3 and -1.1 in the spine and the bled (+106%) during that time period. However the majority hip, respectively. Alendronate was discontinued, while calci- of patients admitted with a fragility fracture are not diagnosed um and vitamin D were administered to the patient. The pa- with osteoporosis, figure 1, although the gap is closing (2005: tient is being followed for her osteopenia yearly, T score in the 10% total, 26% hip Vs 2014: 16% total, 47% hip). Our study hip being -1.1 five years after treatment cessation. has important strengths including use of HIPE which captures Conclusions: In the case presented alendronate appears to information on the majority of Irish Hospitals, but also has have had a long lasting beneficial effect on the bone in a limitations including lack of detailed clinical data, outpatient patient with osteoporosis. The state of osteopenia appears to records, DXA and treatment data. be stable in the presented patient. This case of persistent im- Conclusions: The majority of patients admitted to Irish hos- provement of osteoporosis after long lasting treatment with pitals with an osteoporotic fracture are not diagnosed with alendronate raises the question of whether osteoporosis may osteoporosis by the clinicians taking care of them. This “diag- be a curable disease, not being merely a manifestation of ag- nosis gap” is one reason such patients may receive sub- ing. This case raises the hopeful hypothesis that osteoporosis optimal osteoporosis care. with the emergence of novel effective forms of therapy may be Figure 1. Secular trend in fracture admissions and osteoporo- cured. sis admissions for Ireland. P893 A DECADE OF MISSED OPPORTUNITIES: THE DIAGNOSIS GAP AMONGST OSTEOPOROTIC FRACTURE ADMISSIONS IN IRELAND C. Armstrong1,B.McGowan2,C.V.Bharat3, B. McGuire4,S. O'Higgins5,E.Doherty6,C.Silke2,B.Whelan2,F.Heaney1,J. J. Carey7 1Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland, 2The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland, 3Medicine, National University of Ireland, Galway, Galway, Ireland, P894 4National Centre for Pain Research, National University of Ireland, Galway, Galway, Ireland, 5National Centre for Pain LEG ELEVATION DOES NOT SUBSTANTIALLY Research, National University of Ireland, Galway, Galway, AFFECT TBS RESULTS Ireland, 6Health Economics, National University of Ireland, D. Krueger1, E. Siglinsky1, D. Tran2, L. Del Río3,N.Binkley1 Galway, Galway, Ireland, 7Medicine, National University of 1Osteoporosis Clinical Research Program, University of Ireland, Galway and Rheumatology, Galway University Wisconsin, Madison, United States, 2R and D Department, Hospitals, Galway, Ireland Med-Imaps, Bordeaux, France, 3CETIR Centro Médico, Barcelona, Spain Objective: Recent studies show a large diagnosis gap persists amongst elderly people admitted with osteoporotic fractures Objective: Lumbar spine dual energy X-ray absorptiometry in North America. We investigated whether such a problem (DXA) scans are typically acquired with the patient’s legs exists among older men and women admitted to Irish elevated on a positioning block thereby flattening the normal Hospitals over the past decade. lumbar lordosis. With GE densitometers it is also possible to S510 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 acquire lumbar spine scans with the legs down. BMD values Mexico, 2Clinical Epidemiology Unit, Hospital Infantil obtained with legs down vs. legs elevated does minimally Federico Gómez-Facultad de Medicina UNAM, Mexico differ, however it is unknown if leg elevation affects trabecular City, Mexico, 3Unidad de Investigación Médica en bone score (TBS) results. The purpose of this study is to assess Epidemiología Clínica, Centro Medico Nacional Siglo XXI, the effect of leg position on TBS. Instituto Mexicano del Seguro Social, Mexico City, Mexico, Methods: Lumbar spine (L1-L4) DXA scans acquired in legs up 4Galgo Medical, Barcelona, Spain, 5Musculoskeletal Unit, and legs down positioning using GE Healthcare Prodigy and Galgo Medical S.L, Barcelona, Spain iDXA densitometers. The “OneScan” feature mode was not used. These scans were analyzed with enCORE software v 12.3 or Background: Both type 1 (DM1) and type 2 (DM2) diabetes 14.1. All scans were re-processed using MediMaps TBS increase long term fracture risk (“diabetoporosis”) due to Calculator v2.3 or TBS iNsight v3.0.2 to obtain TBS results. chronic hyperglycemia despite chronic low (DM1) or initially Linear regression and Bland-Altman analyses were performed high (DM2) insulin levels, among other not fully understood to compare TBS results in the legs up vs. legs down position. factors. Furthermore, latent autoimmune diabetes in adults Results: Sixty-four women, mean age and BMI 65.1 years (LADA), a recently recognized model of interest, includes (range 28.2-86.6) and 26.4 kg/m2 (range 18.1-34.8) were stud- features of both types of diabetes, and has been little explored ied on three Prodigy densitometers. Fifty women, mean age for fracture risk. Conventional DXA measurements do not and BMI 68.6 years (range 15.2-92.5) and 26.2 kg/m2 (range reflect bone macro or micro architectural characteristics in 19.9-35.1) were studied on an iDXA densitometer. With diabetes, and is well known, that the microarchitecture fea- Prodigy and standard legs up positioning, the L1-L4 BMD tures are different between DM1 and DM2. 3d-DXA technol- ranged from 0.738-1.549 g/cm2 and was highly correlated ogy reanalyzes conventional DXA images to obtain measure- with legs down positioning, R2=0.99. TBS results ranged ments from cortical and trabecular bone that could help the from 1.072-1.632 and were also highly correlated, R2=0.93 predictive value of this tool in diabetic patients with a mean bias of -0.005 TBS units between leg positions Objective: To analyze BMD and 3D-DXA characteristics in a (Figure). With iDXA and standard legs up positioning, the L1- group of patients with LADA, DM2 and healthy controls L4 BMD ranged from 0.753-1.622 g/cm2 and was highly seeking for possible structural differences between groups. correlated with legs down positioning, R2=0.97. TBS results Methods: Patients diagnosed with T2D according to ADA ranged from 1.040-1.455 and were also highly correlated, criteria and LADA patients (age 30 – 70), positive for at least R2=0.90 with a mean bias of 0.00 TBS units between leg 1 autoantibody: GAD and/or IA-2A). Diagnosis of added im- positions (data not shown). mune disease or a fragility fracture history were exclusion criteria. Anthropometric measurements, serum vitD, and bio- chemical parameters were taken. Conventional DXA scans for body composition, lumbar and femoral BMD with and iDXA GE Lunar were obtained and 3D-DXA analysis of left femur were made. A group of healthy controls were included for com- parison. 3D-DXA software (Galgo Medical, Barcelona, Spain) was used to analyze the cortical and trabecular bone of patients and control group. 3D-DXA registers a 3D appearance model of the femoral shape and density onto the DXA projection to obtain Conclusion: Leg positioning minimally affects TBS results a 3D subject-specific model of the femur of the patient and with GE Healthcare Prodigy and iDXA densitometers but quantify the volumetric BMD (vBMD), volume (for trabecular the difference from legs up to legs down is likely of no clinical and cortical regions) and cortical thickness distribution. significance. Results: 211 subjects (66% women), mean age 52.7 years (+- 11.7) were recruited. Of them 87 (41%) were controls, 58 (27.5%) LADA and 66 (31%) DM2 Z-scores for total body P895 less head, lumbar region and left femur had no significant dif- EFFECTIVENESS OF 3D-DXA AS A TOOL TO ferences among groups. However, 3D-DXA analyses showed DIFFERENTIATE BONE COMPONENTS IN TWO the trabecular content in neck and greater trochanter were di- MODELS OF DIABETES COMPARED TO minished in T2D patients compared to controls and LADA CONTROLS patients (p=0.005). Total cortical thickness showed no differ- P. Clark 1,M.A.Guagnelli2,R.A.Gomez-Diaz3,L.H. ence between groups, but was lower in the neck region in Humbert4,Y.Martelli5,G.Gonzalez-Castelan2 LADA patients compared to controls and DM2 (p=0.044). 1Clinical Epidemiology Unit, Hospital Infantil Federico Conclusions: Our results showed significant differences be- Gómez and Faculty of Medicine UNAM, Mexico City, tween the trabecular structure in DM2 vs. controls as well as Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S511 the cortical thickness in the neck region in LADA patients vs. structure and distribution identified by aBMD and s, and a controls and DM2 using 3D-DXA images. This is as far as we reduced buckling measurement. These differences may under- explore in the literature is the first report using this technology lie the reduced incidence of hip fracture in Chinese. These in LADA and DM2 patients. Our findings need to be observations need to be examined in other data sets and relat- reproduced by other groups. ed to fracture propensity in both Chinese and Caucasian populations. P896 DIFFERENCES IN FEMORAL NECK STRUCTURE P897 BETWEEN ELDERLY CAUCASIAN AND CHINESE PRIMARY HYPERPARATHYROIDISM POPULATIONS: A PERTH-BEIJING COHORT COEXISTING WITH GRAVES’ DISEASE IN A STUDY PATIENT WITH VITAMIN D DEFICIENCY L. Wang1,B.Khoo2,X.Cheng3,K.Brown4,R.Prince5 I. Kostoglou-Athanassiou1, E. Pantazi2,P.Athanassiou3 1Department of Radiology, Beijing Jishuitan Hospital, 1Department of Endocrinology, Red Cross Hospital, Athens, Beijing, China, 2Medical Technology and Physics, Sir Greece, 2Department of Endocrinology, Alexandra Hospital, Charles Gairdner Hospital, Perth, Australia, 3Department of Athens, Greece, 3Department of Rheumatology, St. Paul's Radiology, Beijing Jishuitan Hospital, Beijing, China, Hospital, Thessaloniki, Greece 4Mindways Software, Austin, United States, 5Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Primary hyperparathyroidism is known to coexist with thyroid Perth, Australia cancer and breast cancer. However, primary hyperparathy- roidism coexisting with Graves’ disease is extremely rare. Introduction: Ethnic differences in skeletal structure Aim: The aim was to describe the case of a patient with may be related to the different lower population risk Graves’ disease causing severe hyperthyroidism who in the of hip fracture in Chinese compared to Caucasian pop- course of the disease developed vitamin D deficiency and ulations. Two dimensional mass and size measurements primary hyperparathyroidism. and structural biomechanics were used to assess these Methods: A patient, female, aged 49 years, presented with structural differences. severe hyperthyroidism causing tachycardia, palpitations and Materials and Methods: Participants consisted of 196 weight loss. TSH receptor antibodies were positive in the con- healthy Beijing Chinese women age 76.5±4.8 (mean±SD) text of Graves’ disease. She was treated with methimazole and years, and 237 healthy Perth Caucasian women age 77.1 propranolol and the disease went into remission. A year later ±5.0 years. Validated two dimensional femoral neck images treatment with methimazole was discontinued and 4 months were constructed using QCT and hip structure analysis (HSA) later the patient had a relapse of hyperthyroidism. Laboratory software. Structural measures included cross-sectional area tests revealed hyperthyroidism along with vitamin D deficien- (CSA), scanned area (A), bone mineral content (BMC), and cy and elevated PTH levels. periosteal width. Derived biomechanical measures included Results: Vitamin D was administered along with areal bone mineral density aBMD, section modulus (Z) and methimazole and propranolol. During follow up, despite the buckling ratio (BR) and new assumption free measures normal vitamin D levels, PTH levels remained extremely sigma (s), a measure of the internal distribution of bone pre- elevated and blood calcium levels in the upper normal viously identified as a predictor of hip fracture, and delta (d), range. Ultrasound of the thyroid and parathyroid glands an indicator of center of mass displacement from geometric revealed a parathyroid adenoma adjacent to the left thyroid center were calculated. lobe. The adenoma was visible in a scan with 99mTc- Results: Compared to the Beijing participants the Perth par- sestamibi. The patient is being followed up and prepared ticipants were heavier (Beijing 58.7±11.8; Perth: 66.1±11.0 for surgical treatment of both hyperthyroidism and primary kg), taller (154.9±16.7 vs. 158.9±6.0 cm) and had higher FN hyperparathyroidism. bone mass, area, density, and periosteal width. After adjust- Conclusions: Theextremelyrarecaseofapatientwith ment for frame size the mass was not significantly different concurrent Graves’ disease causing severe hyperthyroid- but no size parameters were substantially affected. Regarding ism and primary hyperparathyroidism along with vita- calculated biomechanical variables s and BR were larger in min D deficiency is presented. This case further illus- the Perth participants, theoretically suggesting greater suscep- trates that primary hyperparathyroidism may be diag- tibility to failure. nosed in the context of severe vitamin D deficiency, Conclusion: These data identified more bone within a smaller being further aggravated by vitamin D administration femoral neck in Beijing participants resulting in greater theo- and that primary hyperparathyroidism may coexist with retical resistance to fracture through improved internal bone thyroid disorders. S512 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P898 Introduction: Asynchronous calibration quantitative comput- MATERNAL VITAMIN D DURING PREGNANCY ed tomography (QCT) is a promising new technology for AND OFFSPRING BODY COMPOSITION: opportunistic screening for osteoporosis; however, few studies FINDINGS FROM THE VITAMIN D IN have compared conventional QCT and asynchronous QCT. PREGNANCY BIRTH COHORT STUDY Moreover, asynchronous QCT has not yet been fully validated N. K. Hyde1,S.L.Brennan-Olsen2,J.D.Wark3,S.M. for the clinical measurement of BMD. Hosking1,J.A.Pasco1 Materials and Methods: We used the European spine phantom 1Deakin University, Geelong, Australia, 2Australian Institute for (ESP) with repositioning during scanning and assessed the accu- Musculoskeletal Science, The University of Melbourne, racy and short-term reproducibility of asynchronous QCT. Intra- Melbourne, Australia, 3The University of Melbourne, Royal scanner and intra-observer precision were each calculated as the Melbourne Hospital Bone and Mineral Service, Melbourne, root mean square of the standard deviation (RMSSD) and the Australia coefficient of variation (CV-RMSSD). We also compared asyn- chronous and conventional QCT results in 50 clinical subjects. Objective: To determine the association between maternal Results: The accuracy of asynchronous QCT for three ESP vitamin D and offspring body composition. vertebrae ranged from 1.4–6.7%, whereas intra-scanner precision Materials and Methods: Participants were mother-child pairs for these vertebrae ranged from 0.53–0.91 mg/cc. Asynchronous recruited from an Australian based birth cohort study, the Vitamin QCT was most precise for a trabecular BMD of 100 mg/cc (CV- D in Pregnancy (VIP) study. Mothers were recruited before 16 RMSSD=0.2%). For intra-observer variability, overall precision weeks gestation and provided a blood sample at both recruitment error was smaller than 3%. In clinical subjects there was excellent and at 28-32 weeks gestation. Of the 402 infants at birth, 209 agreement between the two calibration methods with correlation (52.3%) returned at the 11 year follow-up and 183 had complete coefficients ranging from 0.979–0.988. A Bland–Altman analy- measures for the current analyses. Vitamin D (25(OH)D) was sis demonstrated that methodological differences depended on measured by radioimmunoassay (Tyne and Wear, UK) At 11 the magnitude of the BMD variable. years of age lean and fat mass was quantified using dual energy Conclusion: Our findings indicate that the asynchronous x-ray absorptiometry (GE Lunar Prodigy, Madison, WI, USA). QCT has good accuracy and precision for assessing trabecular Results: There was an interaction between maternal smoking BMD in the spine. and maternal vitamin D status at recruitment, thus data was stratified by smoking status. In smokers, serum 25(OH)D sta- tus at recruitment was negatively associated with fat mass percentage and positively associated with lean mass both (p<0.05). This remained independent of child height, sex and maternal parity. There was no association in non- smokers (p>0.05). There was no interaction between Maternal 25(OH)D status at 28-32 weeks gestation and ma- ternal smoking status. 25(OH)D at 28-32 weeks gestation was not associated with offspring body composition measures. Conclusions: Maternal vitamin D in early pregnancy, but not at a later stage of gestation, is associated with body composition in offspring, in those who smoke during pregnancy. Mothers, who smoke during pregnancy, should be encouraged to quit smoking, and optimise their vitamin D levels from early pregnancy. P899 VALIDATION OF ASYNCHRONOUS QUANTITATIVE P900 BONE DENSITOMETRY OF THE SPINE: VISCOSUPPLEMENTATION FOR OSTEOARTHRITIS: ACCURACY, SHORT-TERM REPRODUCIBILITY, IN SEARCH OF THE RIGHT INDICATIONS AND A COMPARISON WITH CONVENTIONAL K. K. V. Acharya1 QUANTITATIVE COMPUTED TOMOGRAPHY 1Arthroscopy and Sports Injuries, Manipal University, L. Wang1,Y.Su1,C.Yi2, X. G. Cheng1 Manipal, India 1Department of Radiology, Beijing Jishuitan Hospital, Beijing, China, 2Department of Traumatology and Orthopedic Surgery, Introduction: With increase in life expectancy and improved Beijing Jishuitan Hospital, Beijing, China quality of life, the elderly population is on the rise. Majority of Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S513 them invariably have various grades of degenerative changes in Materials and Methods: Participants were children recruited their knee joints. Besides, development of osteoarthritis at young as part of the Vitamin D in Pregnancy study. Data for the age due to numerous reasons (obesity, trauma) is also on the current analyses pertain to the 11-year follow-up (median increasing trends. Approximately 25% of people with pain from age: 10.9 (IQR 10.7-11.4) yrs). 209 of 402 (52.3%) children knee OA experience difficulty performing major activities of measured at birth returned for 11-year follow-up, and 193 had daily living, including walking a quarter mile, climbing stairs, complete data for the current analyses. Children had an assess- and kneeling. Pain killers (topical and systemic) have a short ment of BMC, BMD and lean mass by DXA (Lunar). The term limited role owing to safety concerns, whereas orthotic spine (L2-L4) and total body (less head) (TBLH) sites were supports and physical therapy are some of the alternative options used for analyses. Handgrip strength was measured using a explored with moderate success. There is a definite void in the dynamometer (JAMAR) and muscle strength in the lower current management of such cases and has led to a greater de- limbs with a manual muscle tester (Lafayette). mand for the alternate elixir. Recent clinical studies on intra- Results: There were univariate associations between lean articular use of viscosupplementation have demonstrated favor- mass (ρ 0.49-0.86, all p<0.001) and BMC and BMD at the able outcomes and is rapidly gaining worldwide acceptance. spine and TBLH. Similarly, significant correlations were ob- Material and Methods: In our study conducted between served between muscle strength at all sites and BMD and Jan 2010 to December 2015, we analysed the use of BMC at the spine and TBLH (ρ 0.18-0.54, p≤0.001-0.02). Viscosupplemtation in a tertiary care hospital, with respect After adjustment for height, sex, pubertal status and fat mass, to indications, safety and efficacy in 124 patients. associations remained significant (p=0.001-0.02). In adjusted Result: Following viscosupplementation, patient satisfaction, models including both strength and mass, both remained sig- WOMAC and VAS scores were significantly improved in compar- nificant predictors of BMD. In models using handgrip, a 1kg ison with no injection group (Improvement of Pain:46%, increase in lean mass was associated with a 0.008 g/cm2 Stiffness:32% and Function:43%). Use of concomitant medication (95%CI 0.002,0.013) and a 0.008 g/cm2 (95%CI was significantly reduced (48% at 24 weeks and 50% at 52 weeks). 0.002,0.011) increase in BMD at the spine and TBLH, respec- Conclusion: Analysis of cases of osteoarthrosis treated with tively. A 1kg increase in handgrip strength was associated viscosupplementation revealed variable effects. However, when with a 0.006 g/cm2 (95%CI 0.002,0.009) and 0.004 g/cm2 administered to patients with features of early osteoarthritic (95% CI 0.002,0.006) increase in BMD at the spine and changes and during the early course of the disease, it appears TBLH, respectively. Similar patterns were observed with low- to be valuable especially in alleviating the pain and improving er limbs. The same pattern was observed with BMC. the overall function. Owing to the prevailing controversies and Conclusions: In this cohort, both muscle strength and mass lack of well-defined guidelines in the current literature, there is appear to make independent contributions to bone mineral need for further randomized controlled studies to be conducted measures. Physical activity interventions in school-aged chil- in homogeneous population with further focus on efficacy, for- dren could be targeted at not only increasing muscle mass, but mulation, dosage, standardized scheduling, extended indications also muscle function. and drug delivering techniques. Till then, viscosupplementation has arrived and can be considered as an addendum in the ortho- paedic surgeons armamentarium in tackling osteoarthritis. P902 THE DISCRIMINATIVE ABILITY OF BMD, TRABECULAR BONE SCORE AND FRAX® FOR P901 NON-VERTEBRAL FRACTURES IN PATIENTS IS THERE AN INDEPENDENT ASSOCIATION OF WITH RHEUMATOID ARTHRITIS. MUSCLE MASS AND STRENGTH ON BONE E. V.Kozhemyakina1, O. M. Lesnyak2,T.V.Gracheva1,E.N. MEASURES IN SCHOOL-AGED CHILDREN? THE Gladkova3,O.Y.Sannikova4 VITAMIN D IN PREGNANCY STUDY 1Regional Hospital #1, Yekaterinburg, Russian Federation, N. K. Hyde1,J.D.Wark2,S.L.Brennan-Olsen3,S.M. Yekaterinburg, Russian Federation, 2North-Western State Hosking1,J.A.Pasco1 Medical University named after I.I. Mechnikov, Saint- 1Deakin University, Geelong, Australia, 2The University of Petersburg, Russian Federation, 3Ural State Medical University, Melbourne, Royal Melbourne Hospital Bone and Mineral Ekaterinburg, Russian Federation, 4Institute of Immunology and Service, Melbourne, Australia, 3Australian Institute for Physiology of the Ural Branch of the Russian Academy of Musculoskeletal Science [AIMSS], Melbourne, Australia Sciences, Yekaterinburg, Russian Federation Objective: To determine the relative independent contribution The aim of our study was to evaluate impact of bone mineral of muscle strength and mass on measures of bone mass in a density and trabecular bone score on non-vertebral fracture paediatric population. risk assessment in patients with RA. One hundred forty one S514 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 patients age 53.64±11.41 with duration of RA 9, 59±8,89 year Methods: This is a retrospective study that included an were included in our study. High prevalence of non-vertebral Ecuadorian population between 40-90 years old, who fracture during RA was found (annually incidence rate 2.69 underwent bone densitometry between 2013-2015, and whose per 100 patients/year). We divided patients into two groups – risk of fracture was assessed with FRAX Ecuador, Colombia, 1group with non-vertebral fracture (n=15) and 2group without Brazil and the United States (Hispanics). The DXA values history of any fracture (n=126). All demographic and disease considered were: Osteopenia: T Score -1.0 -2.5 and related data were similar in two groups. High prevalence of Osteoporosis: T Score ≥2.5. osteoporosis (6 (40.00%) in 1 group vs. 34 (26.68%) in 2 Results: We analyzed 837 patients with a mean age of 61.54 group, p=0.221) and osteopenia (4 (26.66%) in 1 group vs. [SD 10.90] (40-90). The predominant gender was female with 40 (31.74%) in 2 group, p=0.470) was found in both groups 87.6% (733) vs. 12.4% (104) male. The mean age of meno- without significant differences. pause was 45.69 [SD 5.4]. The diagnoses according to bone Our data shows that T-criteria hip, FRAX® major osteoporotic densitometry were: 20.3% (170) normal, 30.5% (255) facture risk, FRAX hip fractureriskhaveowndiscriminative osteopenia and 49.2% (412) osteoporosis. The risk of major value, whereas T-criteria in lumbar spine, BMD lumbar spine, osteoporotic fracture in the population using FRAX Ecuador TBS in our measurements have not get significant level for non- was 1.4% (3-13%) and hip 0.4% (0-9.3%). For FRAX vertebral fractures. We did not find disease-related risk factors for Colombia: 4.8% (7-29%) for major osteoporotic fracture and non-vertebral fracture prevalence. Cohort studies have demon- 1.1% (0-17%) for hip fracture. With FRAX Brazil, 3.20% strated that TBS increases the predictive validity for clinical (1.2-25) was obtained for major osteoporotic fracture and spine, hip and any osteoporotic fractures [Hans D, 2011, 2.08% (0-16%) for hip. Finally, FRAX USA (Hispanic) had Rabier B, 2010]. a risk of 2.01% (0-17%) for major osteoporotic fracture and Our study has several limitations. First, our population does not 1.81% (2-12%) for hip fracture (Figure 1). reflect all RA population due status and location of our Regional Conclusions: The risk of fracture for the Ecuadorian popula- Hospital – patients with recent fractures or severity immobility tion according to the FRAX Ecuador calculator was 1.4% for could be missed. Second, a minimal measurements of BMD and major osteoporotic fracture and 0.4% for hip fracture. T-criteria in hip and femoral neck were chosen, that could inter- Surprisingly, this population presents a low risk of fracture fere on analysis. And, finally we think that for non-vertebral using the calculator of this country, in comparison to the fracture very important to take into account falls frequencies in scores obtained using the FRAX of Colombia, Brazil and patients with RA. In several studies, falls were reported to be the the United States (Hispanic). This may indicate that the risk most important clinical risk factors for fractures We suggest is of fracture may be underestimated with FRAX Ecuador, al- required further evaluation of fracture risk in patients with RA. though more specific studies are needed. Figure 1. Risk of fracture by FRAX® score in Ecuadorian population. P903 COMPARATIVE STUDY OF FRAX® SCORE IN ECUADORIAN POPULATION O. D. Messina1,G.Maldonado2, C. Paredes2, R. Guerrero2, M. Mieles2, C. Ríos3 1Hospital Cosme Argerich, Buenos Aires, Argentina, 2Universidad Espíritu Santo, Guayaquil, Ecuador, 3Centro de Reumatología y Rehabilitación, Guayaquil, Ecuador Introduction: Osteoporosis is a systemic skeletal disease characterized by a decrease in bone mineral density with al- terations in bone microarchitecture and an increased risk of fracture. The World Health Organization asserts that it is a major public health problem and increases morbidity and mor- tality in elderly patients. The FRAX® score is a tool that esti- P904 mates the risk of fracture at 10 years. It was adapted to the IDENTIFYING WOMEN AND MEN AT HIGH Ecuadorian population in 2009. FRACTURE RISK BY LEVERAGING THE Purpose: To identify the risk of fracture in the Ecuadorian ELECTRONIC MEDICAL RECORD TO ESTIMATE population using the FRAX® Ecuador calculator and com- FRAX TREATMENT THRESHOLDS pare the results with FRAX Colombia, Brazil and the United S. Amin1,E.J.Atkinson1,S.Khosla1 States (Hispanics). 1Mayo Clinic, Rochester, United States Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S515 Objective: In the busy clinic, identifying individuals at high patients in most of the countries worldwide, understanding fracture (fx) risk who warrant intervention can be a challenge. of the pathological bases for the impairment of bone cell func- As there are several medical conditions that increase the risk tion is a serious matter. However, it is still incompletely un- for bone loss and falls, we explored whether we could exploit derstood how the function of bone cells is regulated at cellular data available in the electronic medical records (EMR) to es- and molecular levels. As bone remodeling is a repetitive se- timate FRAX treatment thresholds to help passively identify quence of bone resorption and bone formation, bone cells patients who would benefit from further bone mineral density need to move to the site of bone resorption cavity to refill (BMD) screening and management. the resorbed bone area. This movement of bone cells is based Materials and Methods: We studied 912 women and men, on the migration capability of bone cells and filling of the previously recruited for our bone health studies, in whom bone cell cavity is also dependent on how fast the proliferation FRAX scores (with and without BMD) had been determined of bone cells would proceed. Therefore, cell migration and and comprehensive medical diagnoses were available through cell proliferation could be linked closely while not much has the medical linkage system of the Rochester Epidemiology been known in this aspect of bone cell function. The data on Project. All diagnoses were categorized by the Clinical bone cell migration and proliferation on single cell bases will Classification Software (CCS) system whereby over 14,000 be presented. ICD-9-CM diagnoses are reduced to 568 clinically meaning- ful categories. If a subject had at least two diagnoses in a CCS category that were at least 30 days apart and within 5 years of P906 their FRAX assessment, the subject was treated as having that OUTCOMES FOLLOWING ELECTIVE TOTAL HIP CCS code. We used Gradient Boosting Machine (GBM) to AND KNEE ARTHROPLASTY IN PATIENTS WITH create models that would predict the treatment thresholds for COAGULATION DEFECTS the FRAX 10-year risk for major osteoporotic (OP) fx (>20%) M. J. Best1,K.T.Aziz1,R.S.Sterling1,H.S.Khanuja1 and hip fx (>3%), based on available diagnoses. Models were 1Department of Orthopaedic Surgery, Johns Hopkins fit using age, sex and CCS category from 80% of the data, Hospital, Baltimore, United States retaining 20% for validation. Results: Of the 564 (62%) women and 348 (38%) men, the Background: Outcomes following elective total hip and knee mean±SD age was 61±16 yrs. There were no significant dif- arthroplasty in patients with coagulation defects are not well ferences in subject characteristics used for FRAX calculation defined. The current literature regarding this patient popula- or FRAX scores between the training and validation sets. The tion is limited by few studies with small sample sizes. This c-statistic for GBM models predicting treatment thresholds for study aims to investigate outcomes following elective total hip FRAX, calculated with BMD, for major OP fx and hip fx were and knee arthroplasty in patients with coagulation defects 0.95 and 0.96, respectively, for the training set, and 0.88 and using a national patient population over a twenty year period. 0.94 for the validation set. Similar results were observed for Methods: The National Hospital Discharge Survey was used FRAX scores without BMD. to identify a cohort of 10,887,942 patients who underwent Conclusion: FRAX treatment thresholds may be reasonably elective total hip or knee arthroplasty from 1990 to 2010. estimated from data available in the EMR to help passively Patients with coagulation defects (N=23,373) were identified identify to the clinician those at highest risk for fracture who and compared to those patients without coagulation defects would warrant further evaluation. Further work to implement (N=10,864,569). Demographic data were collected and the and validate these findings in the EMR system would be groups were analyzed for differences in complication rates necessary. and mortality. Multivariable logistic regression was used to isolate the effect of coagulopathy on complications and mortality. P905 Results: Patients with coagulation defects were younger (64.8 REGULATION OF BONE CELL FUNCTION years compared to 66.6 years, P<0.001) and had lower rates of S. Katsumura1,M.Noda2 comorbidities (51.3% compared to 59.1%, P<0.001) than pa- 1Tokyo Medical and Dental University, Tokyo, Japan, 2Tokyo tients without coagulation defects. Patients with coagulation Medial and Dental University, Tokyo, Japan defects had higher rates of complications including postoper- ative bleeding (4.1% compared to 1.1%, P<0.001), postoper- Bone cell function is important for the maintenance of appro- ative anemia (31% compared to 18.6%, P<0.001), and pulmo- priate bone mass levels. Loss of the balance between bone nary embolism (0.9% compared to 0.4%) compared to those formation and bone resorption leads to osteopenic situation without coagulation defects and required higher rates of blood that precedes osteoporosis. As osteoporosis is a serious age- transfusion (20.3% compared to 15.9%, P<0.001). associated disorder that affect an increasing number of Perioperative mortality was higher in patients with S516 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 coagulation defects than those without coagulation defects (OR 15.8; 95% CI 15.0 to 16.6, P<0.001) and pulmonary (0.4% compared to 0.2%, P<0.001). Multivariable logistic embolism (OR 12.5; 95% CI 11.8 to 13.3, P<0.001) had the regression showed that coagulopathy was independently asso- strongest association with perioperative mortality followed by ciated with a higher rate of complications (OR 2.05; 95% CI pulmonary complications including pneumonia (OR 4.6; 95% 1.99 to 2.10, P<0.001) and mortality (OR 1.64; 95% CI 1.32 CI 4.3 to 4.9, P<0.001) and pulmonary insufficiency (OR 4.6; to 2.02, P<0.001). 95% CI 4.2 to 5.0, P<0.001). Conclusions: Patients with coagulation defects undergoing Conclusions: This is the largest study to date analyzing the elective total hip and knee arthroplasty are at increased risk incidence and perioperative mortality following elective total for perioperative complications and mortality. These findings hip and knee arthroplasty in the United States. There has been emphasize the importance of preoperative risk assessment and a substantial increase in incidence of these procedures over the medical optimization in this patient population. past two decades which is larger than previous reports. Mortality has decreased significantly over the study period. The most pronounced improvement in mortality rate was ob- P907 served from 1990-1999, likely due to improvements in peri- INCIDENCE AND PERIOPERATIVE MORTALITY operative management in these patients. This improvement FOLLOWING ELECTIVE TOTAL HIP AND KNEE was not observed over the second decade of the study, possi- ARTHROPLASTY IN THE UNITED STATES: A 20- bly due to an aging population and an increasing comorbidity YEAR ANALYSIS burden that may have offset further advances in perioperative M. J. Best1,K.T.Aziz1,R.S.Sterling1,H.S.Khanuja1 medical management. 1Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, United States P908 Background: There has been a substantial increase in elective WHAT PHYSICAL ACTIVITY PROGRAM total hip and knee arthroplasty in the United States over the FEATURES ARE IMPORTANT TO PATIENTS WITH past several decades. This study aims to investigate changes in KNEE OSTEOARTHRITIS? A DISCRETE CHOICE incidence and mortality on a national level over a 20 year EXPERIMENT period for patients undergoing this procedure. This is the larg- D. Pinto1,R.W.Chang2, U. Bockenholt3,D.J.Finn4,J.L. est study to date evaluating trends in incidence and mortality Holl4,A.W.Heinemann5,P.Hansen6 following elective total hip and knee arthroplasty. 1Department of Physical Therapy and Human Movement Methods: The National Hospital Discharge Survey was used Sciences/Center for Healthcare Studies/Feinberg School of to identify a cohort of 11,236,835 patients who underwent Medicine/Northwestern University, Chicago, United States, total hip or knee arthroplasty from 1990 and 2010. In order 2Preventive Medicine/Institute for Public Health and Medicine/ to obtain a purely elective study population, we excluded all Feinberg School of Medicine/Northwestern University, patients undergoing surgery for hip or lower extremity frac- Chicago, United States, 3Department of Marketing/Kellogg ture, and those with a diagnosis of infection or malignancy. School of Management/Northwestern University, Evanston, After exclusion criteria were applied a cohort of 10,887,942 United States, 4Center for Healthcare Studies/Feinberg School was identified. Demographic data including incidence, com- of Medicine/Northwestern University, Chicago, United States, plication rates and mortality were obtained. Trends in inci- 5Center for Rehabilitation Outcomes Research/Rehabilitation dence and mortality over the 20 year period were analyzed Institute of Chicago, Chicago, United States, 6Department of and logistic regression was used to isolate independent vari- Economics/University of Otago, Dunedin, New Zealand ables associated with mortality. Results: A total of 10,887,942 patients underwent elective Objective: To assess patient preferences for physical activity total hip and knee arthroplasty in the United States between programs in the management of knee osteoarthritis (OA). 1990 and 2010. Population-adjusted incidence increased from Material and Methods: Patients met eligibility to participate 90 per 100,000 in 1990 to 308 per 100,000 in 2010 (P<0.001). in our study if they were 45 years or older with complaints of National perioperative mortality for the total cohort was 0.2% knee pain, aching or stiffness for at least one month over the over the 20 year period decreasing from 0.9% in 1990 to 0.1% past 12 months; were able to speak and read in English; and by the final study year in 2010 (P<0.001). A larger decrease in expressed interest in becoming more physically active. mortality was seen over the first decade, (0.9% in 1990 com- Patients were excluded if they had a total joint arthroplasty pared to 0.3% in 1999, P<0.001) than that observed over the in their index knee. Patient preferences were assessed using a second decade (0.1% in 2000 compared to 0.1% in 2010, discrete choice experiment that compared hypothetical physi- P=0.760). When controlling for confounders, multivariable cal activity program profiles. Physical activity attributes and logistic regression showed that acute myocardial infarction attribute levels were developed through use of community- Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S517 based focus groups and semi-structured interviews with older Objective: To describe the correlation between different adult community members with chronic knee pain. Six attri- muscle mass criteria and bone mineral density corrected by butes were included in the DCE: physical activity time, phys- age and body fat as co-variables. ical activity effort, monthly cost, convenience, enjoyment, and Material and Methods: We evaluated 1174 women aged benefits for my health. Kmeans cluster analysis was used to 50 to 90 years from the western of Mexico. A whole body identify whether participants clustered on preferences for DXA scan (Hologic QDR 4500) was performed to evaluate physical activity program attributes. All participants were in- the areal bone mineral density of lumbar spine (BMD-L1- vited to complete demographic surveys, radiographic knee L4), Femoral Neck (BMD-FN) and Total Hip (BMD-TH) as assessment, and health outcome instruments. well as body composition (fat and muscle mass). The indi- Results: Final sample included 150 participants; mean age 65, cators used to evaluate muscle mass were 1) the quotient of 72% female, 47% white, non-Hispanic. Patients ranked bene- Appendicular lean soft tissue corrected by body mass index fit for my health (0.26) and enjoyment (0.24) as the two most (ALST/BMI), 2) absolute kilograms of appendicular lean important attributes to a physical activity program. Physical soft tissue (ALSTKG) according to The Foundation for activity time (0.10), physical activity effort (0.11), and month- National Institutes of Health Sarcopenia Project (FNHISP), ly cost (0.13) were equally important. Cluster analysis re- and 3) appendicular lean soft tissue corrected by squared vealed 3 preference clusters: Cluster 1 (n=34) reported a rank- height (ALST/HT2) as propose The European Working ing for enjoyment (0.35) that nearly doubled the ranking for Group on Sarcopenia in Older People (EWGSPOP). We health benefit (0.18); Cluster 2 (n=62) reported a higher rank- performed multiple linear regression analysis for each indi- ing for health benefit (0.38) than enjoyment (0.22); Cluster 3 cator including age and fat mass (kg) as covariables. reported similar preferences across all attributes. Cluster 1 had Results: Bone mineral density (all sections) were signifi- fewer individuals with radiographic knee OA (50% vs. 70% cantly correlated with all muscle mass indicators. For each for Clusters 2 and 3). muscle mass indicators BMD-L1-L4 showed the weakest Conclusion: In the full cohort, patients ranked benefit for correlation and BMD-TH the strongest. Analyzing individu- health as important as enjoyment. When clustered on prefer- ally, the weakest and strongest correlations were observed ence, clusters 1 and 2 differentially ranked preferences for with ALST/H2 + BMDL1-L4 and ALSTKG + BMD-TH, enjoyment and health benefit, suggesting subgroups of indi- respectively (Table 1). viduals with like preferences to which interventions could be Conclusion: Bone mineral density is correlated with the tailored. Further research is required to use DCE-elicited pref- commonly used approaches to evaluate muscle mass. erences to guide intervention development. However, this correlation is strongest when it is evaluated with BMD-TH and ALSTKG. P909 CORRELATION OF BONE MINERAL DENSITY WITH SEVERAL COMMON MUSCLE MASS CRITERIA F. Torres-Naranjo1, R. G. González-Mendoza2, A. Gaytán- González2,N.González-Gallegos3, J. R. López y Taylor2,P. A. García-Hernández4,C.A.Flores-Moreno4,P.DelaPeña- Rodríguez5 1Centro de Investigación Osea y de la Composicion Corporal, Guadalajara, Mexico, 2Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Universidad de Guadalajara, Guadalajara, Mexico, 3Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán, Mexico, 4Servicio de P910 Endocrinología, Hospital Universitario, UANL, Monterrey, ALTERATIONS OF GUT MICROBIOME IN Mexico, 5Servicios Médicos De la Peña, Guadalajara, Mexico RHEUMATOID ARTHRITIS X. H. Wu1,J.Liu2,A.P.Lu2,G.Zhang2 Background: Bone mineral density is known to have a pos- 1Hong Kong Baptist University, Hong Kong, 2Hong Kong itive correlation with lean body mass but results are incon- Baptist University, Hong Kong sistent. There are several indicators of muscle mass used in common operational definitions of low muscle mass, poor Objectives: Rheumatoid arthritis (RA) is a chronic in- concordance between those definitions has been reported. flammatory joint disease, which can cause cartilage S518 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and bone damage as well as disability. Recent studies have indicated that the pathogenesis of RA requires the interaction between genetic and environmental factors, such as gut microbiome. However, current evidence for the alterations of gut microbiome in RA is still limited. Thus, our study aimed to analyze the fecal samples from a cohort patient with RA and to identify the asso- ciated alterations in gut microbiome when compared to healthy controls. Material and Methods: Fecal samples were obtained from treatment-naïve RA patients (n=50) and healthy controls (n=50). High-quality 16S rDNA V3-V4 se- quences were extracted from fecal samples and further sequenced on a 454 Genome Sequencer platform for bioinformatics analysis, resulting in operational taxo- nomic units (OTUs) related to gut microbiota and phy- logenetic tree. Clinical parameters of RA were corre- lated with specific microbial taxa by Correlation analysis. Results: A total of 121227 OTUs was clustered at 97% sequence similarity and assigned taxonomic lineages by comparison with the Ribosomal Database Project database. The OTUs were classified into 35 phylums, 73 classes, 143 orders, 280 families, and 1165 genus. Intriguingly, our data revealed a lower alpha diversity, including richness, even- ness and Shannon Index, as well as a lower Firmicutes / Bacteroidetes ratio in the gut microbiome of RA patients when compared with the healthy controls. Moreover, at P911 genus level, our taxonomic analysis identified 288 differen- ELEVATED MIR-214-3P IN SUBCHONDRAL tially abundant taxa (P<0.05), among which 6 taxa, includ- OSTEOCLASTS PROMOTES SUBCHONDRAL ing Bacteroides, Parabacteroides, Paraprevotella, BONE REMODELING AND ENHANCE CARTILAGE Porphyromonadaceae, Phascolarctobacterium and DEGRADATION IN EARLY OSTEOARTHRITIS Carnobacterium, were significantly enriched in the gut J. Liu1,X.H.Wu2,A.P.Lu2,G.Zhang1 microbiome of RA patients. Conversely, a series of 1Hong Kong Baptist University, Hong Kong, 2Hong Kong butyrate-producing taxa such as Faecalibacterium, Baptist University, Hong Kong Roseburia, Subdoligranulum, Ruminococcus and Pseudobutyrivibrio were depleted in RA patients but Background: Emerging evidence demonstrates that the ac- enriched in healthy controls. Furthermore, we found a neg- tive osteoclast-mediated subchondral bone (SCB) remodel- ative correlation (P<0.05) between the abundance of ing precedes the articular cartilage degradation to play a butyrate-producing Roseburia and the clinical parameters critical role in the initiation and progression of osteoarthri- of disease status and activity such as erythrocyte sedimen- tis (OA). Several recent studies have shown that the tation rate and the blood level of rheumatoid factors (IgM) microRNAs were differentiated expressed in SCB between (Figure 1). OA individuals and non-OA controls, suggesting a poten- Conclusions: In the present study, we demonstrated that tial role of microRNAs in OA pathogenesis. In our previ- the composition of the gut microbiome in RA patients ous studies, we have documented the pro-osteoclastogenic differed from that in healthy individuals. Our results re- role of miR-214-3p. Moreover, we have demonstrated that vealed a decreased microbial diversity accompanied by osteoclast could release exosomal miR-214-3p into circu- altered microbial abundance in the gut microbiome of lation. In this study, we investigated the role of miR-214- RA patients, which could be characterized as ‘dysbiosis’ 3p in osteoclast-mediated SCB remodeling and cartilage and associated with the disease status and activity. The degradation in early OA development. identified alterations in the gut microbiome might provide Aim: To investigate the role of miR-214-3p in osteoclast- an updated overview for postulating molecular understand- mediated SCB remodeling and cartilage degradation in early ings and therapeutic strategy in RA. OA development. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S519 Methods: First, the SCB miR-214-3p expression in femoral Sheffield, United Kingdom, 3 MRC Lifecourse head samples from OA patients and individuals with femoral Epidemiology Unit, University of Southampton, neck fracture (non-OA control) were examined by QPCR. Southampton, United Kingdom, 4Radius Health, Inc., Next, a mouse model with surgery-induced OA, i.e. anterior Wayne, PA, United States, 5Radius Health, Inc, Wayne, PA, cruciate ligament transection (ACLT) model, was established United States, 6Institute for Health and Aging, Catholic for investigating the miR-214-3p expression in serum and University of Australia, Melbourne, Australia SCB osteoclasts by QPCR, the cartilage degradation by safra- nin O-staining histology and the circulating bone remodeling Daily subcutaneous injection of abaloparatide-SC (80mcg) marker (CTX-I) and cartilage degradation marker (CTX-II) by has been shown to significantly decrease the risk of vertebral ELISA. Thereafter, a series of functional experiments, includ- and non-vertebral fractures compared with placebo. The aim ing luciferase reporter assay and gain-and-loss of function of this study was to determine the efficacy of abaloparatide- assay, were performed to identified the potential targets of SC as a function of BMD T-score at the femoral neck using miR-214-3p in regulating OA osteoclast formation and their BMD as a continuous variable. resorptive activity in cartilage explant in vitro. Last, the effect Absolute BMD values from the scanners (Lunar Prodigy or of genetically overexpressing miR-214-3p in osteoclasts on Hologic) were used to calculate standardized values to remove SCB bone remodeling and cartilage degradation in early OA the systematic differences between machine manufacturers. A development were evaluated in vivo. T-score was then calculated using the NHANES reference Results: We found that the SCB miR-214-3p expression levels values for young Caucasian women. The interaction between were significantly higher in OA patients as compared to non- T-score and treatment efficacy [for any clinical fracture and for OA control. In addition, we observed the elevated miR-214-3p major osteoporotic fracture (clinical vertebral, hip, wrist, hu- levels in SCB osteoclasts at the knee joint together with the merus)] was examined by an extension of Poisson regression. increasing serum miR-214-3p levels from day 0 to day 14 after 821 women randomized to the placebo group and 824 women ACLT, which preceded the increase in serum CTX-I and CTX- randomized to abaloparatide-SC were followed for up to 2 years. II. Furthermore, we found that the OA osteoclasts differentiated At baseline, femoral neck BMD T-score ranged from -4.3 to 1.3. from bone marrow monocytes/macrophages (BMMs) of ACLT Treatment with abaloparatide-SC was associated with a 69% mice showed enhanced resorption activity in cartilage explant decrease in the risk of a major osteoporotic fracture compared in vitro as compared to the control osteoclasts differentiated to placebo treatment (95%CI: 38, 85%). The risk of any clinical from BMMs of sham-operated mice. Consistently, the OA os- fracture decreased by 43%; (95%CI: 9, 64%). Hazard ratios for teoclasts also expressed remarkably higher level of miR-214- the effect of abaloparatide-SC on the fracture outcomes did not 3p than the control osteoclasts. In addition, we found that miR- change significantly with increasing fracture probability (p>0.30 214-3p could directly target TIMP2 to promote OA osteoclast for any clinical fracture and major osteoporotic fracture (Figure)). differentiation and enhance their resorption activity on cartilage Abaloparatide-SC significantly decreases the risk of major explant in vitro. Moreover, we also observed highly activated osteoporotic fracture and any clinical fracture in women, irre- osteoclast-mediated SCB remodeling and accelerated articular spective of baseline BMD T-score. cartilage degradation as well as lowly expressed TIMP2 in our Figure. Effect of abaloparatide on major osteoporotic fracture established osteoclast-specific miR-214-3p conditional compared to placebo, expressed as hazard ratio and 95% knockin (CKI) mice in the early period after ACLT. confidence intervals across the range of BMD T-score at Conclusions: Our study suggests that the elevated osteoclas- baseline tic miR-214-3p could target TIMP2 to promote the SCB re- modeling, thus contribute to the early OA development. The therapeutic potential of targeting osteoclastic miR-214-3p as an alternative anti-resorptive strategy for OA remains to be investigated in future study. P912 THE EFFICACY OF ABALOPARATIDE-SC IS INDEPENDENT OF BASELINE BMD H. Johansson1,E.McCloskey2, A. Oden2,N.C.Harvey3,H. Jiang4,S.Modin4, L. A. Fitzpatrick5, J. A. Kanis6 1Institute for Health and Aging, Australian Catholic University, Melbourne, Australia, 2Centre for Metabolic Bone Diseases, University of Sheffield Medical School, S520 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P913 1Centro de Investigación Osea y de la Composicion Corporal, OSTEOCLASTIC MIR-214-3P CONTRIBUTES TO Guadalajara, Mexico, 2Instituto de Ciencias Aplicadas a la OSTEOLYTIC BONE METASTASIS OF BREAST Actividad Física y al Deporte, Universidad de Guadalajara, CANCER Guadalajara, Mexico, 3Departamento de Bienestar y J. Liu1,D.F.Li1,A.P.Lu1, G. Zhang1 Desarrollo Sustentable, Centro Universitario del Norte, 1Hong Kong Baptist University, Hong Kong Universidad de Guadalajara, Colotlán, Mexico The metastatic breast cancer cell could cause exaggerated os- Background: Aging related bone and muscle loss are condi- teoclast formation and excessive bone resorption, leading to tions that increase fracture risk and threat the independence in osteolytic bone metastasis (OBM). It is becoming evident that later life. Numerous studies support the concept of a bone- the interaction between cancer cells and the bone microenvi- muscle unit. Many common pathways leading osteoporosis ronment are important for the development of OBM. (OP) and low muscle mass (LMM) or sarcopenia have been However, our knowledge on the underlying molecular mech- reported, however, the association of these two conditions is anism responsible for the aberrantly elevated osteoclastic bone not well characterized. resorption during the development of OBM is still limited. Objective: To evaluate the coexisting probability and associ- Accumulating studies demonstrate that miRNAs also participate ation between OP and LMM in a Mexican women sample. in regulating osteoclast differentiation and activity. Nevertheless, Material and Methods: We evaluated 1173 Mexican women the role of osteoclastic miRNAs in regulating the osteoclastic aged 50 to 90 years. For diagnosing OP and LMM a site and bone resorption under cancer conditions and its contribution to whole body DXA scan (Hologic QDR 4500) was performed. the development of OBM are largely underexplored. OP was defined according to WHO operational definition as a In this study, we examined the expression profiles of bone mineral density of -2.5 SD in any of the three sites osteoclastogenic miRNAs in human bone specimens and identi- (lumbar spine, hip, or forearm). For LMM we used three dif- fied that miR-214-3p was significantly upregulated in breast can- ferent criteria and cut-off points 1) appendicular lean soft tis- cer patients with OBM. Consistently, we found increased miR- sue corrected by squared height (ALST/HT2) ≤5.45, as pro- 214-3p within osteoclasts, which was associated with the elevat- pose The European Working Group on Sarcopenia in Older ed bone resorption, during the development of OBM in human People (EWGSPOP); 2) appendicular lean soft tissue breast cancer xenografted nude mice (BCX). Furthermore, ge- corrected by body mass index (ALST/BMI) <0.512; and 3) netic ablation of osteoclastic miR-214-3p in nude mice prevent absolute kilograms of appendicular lean soft tissue the development of OBM. Conditioned medium from MDA- (ALSTKG) ≤15.02, both according to The Foundation for MB-231 cells dramatically stimulated miR-214-3p expression National Institutes of Health Sarcopenia Project (FNHISP). to promote osteoclast differentiation. Mechanistically, a series The sample was divided in decenniums and odds ratios of in vitro study showed that miR-214-3p directly targeted (OR) were calculated for each one. For every LMM criteria, Traf3 to promote osteoclast activity and bone-resorbing activity. multivariable logistic regression analysis was performed for In addition, osteoclast-specific miR-214-3p knock-in mice confounding variables (age and body fat). showed remarkably increased bone resorption when compared Results: LMM and OP are associated independently from the to the littermate controls, which was attenuated after osteoclast- criterion used. However, only ALST/BMI showed statistical targeted treatment with Traf3 3’UTR-containing plasmid. In significance in all decenniums analysis. ALST/H2 was not BCX nude mice, osteoclast-targeted antagomir-214-3p delivery significant for >80 years group, and ALSTKG was not signif- could recover the TRAF3 protein expression and attenuate the icant for any decenniums (Table 1). After multivariable logis- development of OBM, respectively. tic regression analysis, we found LMM was significantly re- Collectively, our findings indicate that inhibition of osteoclas- lated to OP for all indicators (ALST/BMI β -3.75; ALST/H2 β tic miR-214-3p may be a potential therapeutic strategy for -0.46; ALSTKG β -0.27; all p<0.001). breast cancer patients with OBM. Meanwhile, the Conclusion: LMM and OP showed significant coexisting intraosseous TRAF3 could be a promising biomarker for eval- probability and significant association for all LMM uation of the treatment response of antagomir-214-3p. criteria. P914 OSTEOPOROSIS AND LOW MUSCLE MASS COEXIST AND ARE ASSOCIATED IN MEXICAN WOMEN F. Torres-Naranjo1, R. G. González-Mendoza2, A. Gaytán- González2, J. R. López y Taylor2, N. González-Gallegos3 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S521 P915 Results: The mean age of the 183 study subjects was 61.41 AWARENESS OF NEUROPATHIC PAIN IN KNEE ±14.21 years and% 87 were women. Women showed worse OSTEOARTHRITIS knee OA symptoms in all WOMAC and SF-36 subcategories M. Yildirim1,K.Ones1, A. Cinar1,G.Goksenoglu1 (all P ≤0.001). 1Istanbul Physical Treatment Rehabilitation Education and Conclusions: Based on the results of this analysis, it can be Research Hospital, İstanbul, Turkey concluded that women with knee OA are at a greater risk for worse symptoms. Objective: Neuropathic pain can be defined as a pain associ- ated with functional abnormality of the nervous system. Neuropathic pain syndromes are heterogeneous conditions. P917 These syndromes do not depend on a single etiopathogenetic ARTERIAL HYPERTENSION IN PATIENTS WITH mechanism or a clinical entity. Neuropathic pain and osteoar- HYPERCALCEMIA thritic pain are both defined as chronic pain. In this study, we E. V. Brutskaya-Stempkovskaya1 investigated pain and neuropathic pain in knee osteoarthritis. 1Belorussian State Medical University, Department Of Methods: One hundred twenty two outpatients who had been Rheumatology, Minsk, Belarus, Minsk, Belarus diagnosed gonarthrosis according to American College of Rheumatology (ACR) classification criteria were included in- Introduction: According to modern studies, patients with hy- to the study. Pain scores using Visual Analogue Scales (VAS), percalcemia have an increased cardiovascular risk. Western Ontario and McMaster Universities Osteoarthritis Objective: to study the prevalence of arterial hypertension in Index (WOMAC) and neuropathic pain scores using DN4 patients with hypercalcemia and in patients without scale. Patients divided into two groups according to DN4 hypercalcemia. score (from 0 to 3) non-neuropathic pain (Group-1) and by Materials and methods: we studied 1,207 people, average the dn4 score (≥4) neuropathic pain (Group-2). age 53,9±17,25 (892 women,315 men) from 18 to 96 years. Results: Our study identified%61.49 had no neuropathic pain. Examination: total calcium, total protein, creatinine, choles- Neuropathic pain rate in these patients was found to be 38.51%. terol and triglycerides, HbA1C, ambulatory blood pressure The average WOMAC pain score in group -1 was 2.79 ± 0.7 monitoring, ECG, an analysis of morbidity (osteoporosis, kid- while the score for VAS was 6.18 ± 1.7. Patients with neu- ney stones, cholelithiasis, ulcer disease, type 2 diabetes, hy- ropathic pain (groyup-2) had WOMAC pain score of 4.63 ± pertension, coronary heart disease, cardiovascular events, can- 1.1 and VAS of 8.36 ± 0.9. It was observed that in two cer, fractures in history). groups, neuropathic pain had a statistically significant enhancing Results: hypercalcemia has been found in 31 people, mean effect on the WOMAC pain score and the VAS (p < 0.001). age was 58,39±11,6 years. Arterial hypertension was detected Conclusion: The neuropathic pain scale may facilitate the in 677 (56,1%) cases, in patients with hypercalcemia - in 23 identification of a neuropathic component to pain in adults (74,2%) patients and in 654 (55,6%) in patients without with knee OA. It is important to consider the existence of hypercalcaemia. neuropathic pain in the treatment of knee OA pain. Significant differences was detected in the prevalence of arte- rial hypertension in patients with hypercalcemia compared all studied patients (χ 2=4,03, p=0,0447); in the prevalence of P916 arterial hypertension in patients with hypercalcemia compared GENDER DIFFERENCES IN KNEE OSTEOARTHRITIS patients without hypercalcemia (χ 2=4,23, p=0,0396). M. Yildirim1,K.Ones1, A. Cinar1,G.Goksenoglu1 Conclusion: The results of the study show an increasing risk 1Istanbul Physical Treatment Rehabilitation Education and of arterial hypertension in patients with hypercalcaemia. The Research Hospital, İstanbul, Turkey prevalence of arterial hypertension in patients with hypercal- cemia was 74,2%. The results suggest the influence of hyper- Objective: To examine the associations of sex with knee os- calcemia on the development of arterial hypertension. teoarthritis (OA) symptomatic severity Methods: Patients (N=183) with symptomatic knee OA were evaluated. Patients were divided into two groups of men and P918 women. Demographic information was obtained by question- ASSOCIATIONS BETWEEN HEALTH LITERACY naire, and radiographic evaluations consisted of weight- AND UPTAKE OF OSTEOPOROSIS PREVENTION bearing semi-flexed knee radiographs. QoL and function were LIFESTYLE RECOMMENDATIONS IN assessed using Western Ontario and McMaster Universities AUSTRALIAN WOMEN Osteoarthritis (WOMAC) Index and Short Form Health S. M. Hosking1,R.Buchbinder2, J. A. Pasco3, L. J. Williams3, Survey 36-item (SF-36). S. L. Brennan-Olsen4 S522 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 1School of Medicine, Deakin University, Geelong, Australia, Objectives: Osteoarthritis (OA) biomarkers reflect joint dam- 2Department of Epidemiology and Preventive Medicine, age and changes in cartilage metabolism and may be used in School of Public Health and Preventive Medicine, Monash diagnosis and evaluation of treatment response (1-4). The aim University, Melbourne, Australia, 3School of Medicine, of this study is to determine the effect of platelet rich plasma Deakin University, Melbourne, Australia, 4Australian (PRP) injections on serum and urine OA biomarkers in pa- Institute for Musculoskeletal Science, The University of tients with knee osteoarthritis. Melbourne, Melbourne, Australia Material and Methods: The study included 26 patients who were diagnosed as knee OA. All patients had Kellgren-Lawrence Objective: To investigate associations between health literacy grade III radiological changes. One cc of PRP was obtained from (the skills an individual requires to manage their health) and 20 cc of venous blood after double centrifugations at 400g for 10 uptake of physical activity (PA), smoking, alcohol intake, and minutes. The patients received 3 injections of PRP at 3-weeks calcium intake guidelines. intervals. Blood and urine samples were collected from the pa- Methods: Data were collected for women (age range 28.3- tients before treatment and at 3 and 6 months. Serum Procollagen 89.9 years) participating in the most recent follow-up of the II N-terminal propeptide (PIINP), osteocalcin, cartilage oligo- Geelong Osteoporosis Study, a population-based cohort locat- meric matrix protein (COMP) and urine collagen-II telopeptide ed in south-eastern Australia. Health literacy scores were gen- (U-CTX-II) were studied in all patients. Clinical outcome was erated using the Health Literacy Questionnaire (HLQ), a evaluated using Western Ontario and McMaster Universities multi-dimensional tool that generates scores across nine do- Arthritis Index (WOMAC) questionnaire and quality of life using mains of health literacy. Dietary calcium and alcohol intake SF-36 and for pain by a visual analog scale (VAS) in all patients wereascertainedbyFoodFrequencyQuestionnaireand before injection and at 3 and 6 months follow-up visits. smoking and PA level were self-reported. Results: There was no statistically significant difference in Participants were allocated to one of 4 health literacy groups cartilage Type II collagen (CII) degradation markers (CTX-II, using hierarchical cluster analysis (Cluster 1=highest health COMP) and CII biosynthesis marker of PIINP (p>0.05). literacy, cluster 4=lowest health literacy). Regression analyses Significant increase was determined in serum osteocalcin levels were used to assess the relationship between HLQ cluster and (p<0.05) which reflects CII biosynthesis. Statistically signifi- uptake of recommendations for osteoporosis prevention. cant improvement in all WOMAC parameters (pain, stiffness, Results: Of the 676 women included in analyses, 25.3% self- physical function (p<0.05) and physical function, physical role, reported vigorous PA, 89.6% were non-smokers, 75.9% did pain, social function, emotional role, mental health, general not exceed the limit of 2 alcoholic beverages per day and health and vitality subscores of SF-36 (p<0.05) was noted. 15.0% met Recommended Dietary Intakes for calcium. In Conclusions: We found statistically significant clinical im- age adjusted models, holding cluster 4 as referent, clusters 1 provements in knee OA patients treated with PRP injections. and 3 were significantly more likely to meet PA recommenda- Our results suggest that PRP injection does not affect cartilage tions (OR 2.62, 95%CI 1.41, 4.88; OR 2.41, 95%CI 1.05, 5.54) breakdown but effects Type II collagen biosynthesis which is but not cluster 2 (OR 1.71, 95%CI 0.91, 3.20). Biphasic asso- reflected by increased osteocalcin levels. ciations with socio-economic status were observed. No differ- References: ences were seen between health literacy clusters and meeting 1- Malfait AM. Osteoarthritis Cartilage 2016;24:21. recommendations related to smoking, alcohol and calcium. 2- Conrozier T et al. J Orthop Res 2012;30:679. Conclusion: Health literacy is likely to play a role in the ability 3- Gonzalez-Fuentes AM et al. Clin Rheumatol 2010;29:619. of individuals to meet PA recommendations for osteoporosis 4- Henrotin Y et al. J Orthop Res 2013;31:901. prevention. However, further investigation is required to deter- mine which health literacy domains are important in osteopo- rosis prevention and if similar associations exist in men. P920 PREVALENCE OF HYPERCALCEMIA IN ADULT IN MINSK-CITY P919 E. V. Brutskaya - Stempkovskaya1, A. P. Shepelkevich2,G. EFFECT OF PLATELET RICH PLASMA ON SERUM M. Kostin3 AND URINE BIOMARKERS IN PATIENTS WITH 1Belarusian State Medical University, Minsk City Polyclinic KNEE OSTEOARTHRITIS N31, Minsk, Belarus, 2Belarusian State Medical University, O. Akan1,F.B.Şirin2,N.ÖlmezSarıkaya1,H.Koçyiğit1 Minsk, Belarus, 3Belorussian State Medical University, 1Department of Physical Medicine and Rehabilitation, Katip Department Of Rheumatology, Minsk, Belarus, Minsk, Belarus Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey, 2Department of Biochemistry, Katip Çelebi University Introduction: The incidence of hypercalcemia varies in dif- Atatürk Training and Research Hospital, İzmir, Turkey ferent populations from 0.042% to 3,9%. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S523 Objective: To investigate the prevalence of hypercalcemia in ordered additional laboratory testing. Only 18% respondents the adult population of Minsk-city. used the World Health Organisation (WHO) fracture risk as- Materials and Methods: were studied 1,207 people, average sessment tool FRAX®, which predicts a patient’s 10-year age 53,91±17,25 (892 women, 315 men) from 18 to 96 years. probability of osteoporosis-related fracture on the basis of Examination: total calcium, total protein, creatinine, choles- age, gender and various risk factors. 78% physicians initiated terol and triglycerides; the analysis of morbidity were made an osteoporotic treatment for one year or more, but only 46% (osteoporosis, kidney stones, cholelithiasis, ulcer disease, di- doctors carried out the control of treatment in a year after start abetes mellitus, hypertension, coronary heart disease, cardio- of therapy, among them 93% persons used DXA, 34% applied vascular events, cancer, fractures in history). bone markers and 29% used laboratory chemistry parameters Results: hypercalcemia has been found in 31 people (2,6 per for monitoring osteoporosis therapy. 60% doctors prescribed 100 adults), women-23, men-8. In the age group up to 30 bisphosphonates (5%- original alendronate, 21% - different years - 145 people, hypercalcemia was founded in 1 case generics of alendronate, 12%- oral ibandronate, 6%- i.v. (0,7%); in the age group of 30-44 years - 244 people, hyper- ibandronate, 12%- original zoledronic acid, 4% - generics of calcemia was detected in 4 (1,6%) cases; in the age group 45- zoledronic acid), 11% - strontium ranelate, 8% - alfacalcidol, 59 years - 270 people, hypercalcemia was detected in 9 cases 3% - denosumab, 16% - supplements of calcium and vitamin (3,3%); in the age group 60-74 years - 404 people hypercal- Donly. cemia – 16 cases (4,0%); in the age group 75 years over - 144 Conclusion: A survey of physicians of 6 specialties showed, people hypercalcemia was detected in 1 case (0,7%). The that patients with osteoporosis are most frequently identified highest incidence of hypercalcemia has been detected in the and treated by rheumatologists and endocrinologists, which age group 45–59 and 60 – 74 years (p<0,05). account for about 1.5% of all doctors in Russia. To improve Conclusion: The prevalence of hypercalcemia in the adult the detection of patients with osteoporosis it is required to population of Minsk-city was 2,6 per 100 adults (26: 1000). widespread adoption of national recommendations on osteo- The highest incidence of hypercalcemia has been detected in porosis and FRAX® tool as the most affordable and cheap the age group 45–59 and 60 – 74 years. method to identify individuals at high risk of osteoporotic fractures. P921 OSTEOPOROSIS MANAGEMENT IN PRIMARY P922 CARE IN RUSSIA CORRELATION OF TNFALPHA LEVEL IN PLASMA O. Nikitinskaya1, N. V. Toroptsova1 TO BONE MINERAL DENSITY IN TYPE 2 DIABETES 1Nasonova Research Institute of Rheumatology, Moscow, OBESE PATIENTS Russian Federation S. D. Ilyas1,E.Medina2,H.Hermansyah1 1Rheumatology Subdivision, Internal Medicine Department, Aim: To evaluate the participation of doctors of different spe- Moh Hoesin Hospital, Palembang, Indonesia, 2Internal cialty in the detection and treatment of patients with Medicine Department, Moh Hoesin Hospital, Palembang, osteoporosis Indonesia Material: A survey of 1,200 physicians (200 in each special- ty: general practitioner, gynecologist, neurologist, rheumatol- Background: Osteoporosis, a global age-related health problem ogist, traumatologist and endocrinologist) from 40 public in both male and female elderly, insidiously deteriorates the mi- health clinics of different regions in Russia was made by using crostructure of bone culminating in fragility fractures, pain and standardised interviews. Questions addressed responsibility disability. Although osteoporosis is normally associated with for bone healthcare, and whether diagnostic procedures, initi- senescence and estrogen deficiency, obese type 2 diabetes ation of bone-specific treatment and follow-up were per- mellitus also contributes to and/or aggravates bone loss in oste- formed in accordance with national recommendations on oporotic patients. In obese type 2 diabetes was found more ad- osteoporosis. ipose tissue who produce more pro-inflammatory cytokine such Result: Among all respondents only 26% physicians consid- as IL-1 and TNF alfa that increase osteoclast differentiation and ered osteoporosis detection as a part of their routine practice. bone resorption. Rheumatologists (71%) and endocrinologists (46%) observed Objective: To find out correlation of TNF alpha level in plas- patients with osteoporosis significantly more often compared ma to bone mineral density in type 2 diabetes obese patients. to traumatologists (12%), general practitioners (11%), neurol- Method: Study was held in Mohammad Hoesin Hospital ogists (9%) and gynecologists (4.5%)(p<0.001andp<0.05, re- Palembang in 2015. This was cross sectional and observation- spectively). 93% physicians recommended to perform bone al analytic study. We collected 42 obese type 2 diabetes sub- densitometry (DXA) as a main diagnostic procedure, 51% jects by non probability consecutive sampling. Bone mineral S524 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 density was checked by densitometry device Stratos brand at etanercept). Joint pain (VAS), disease activity - DAS28, func- spine and femur. We divided the result bone mineral density of tional ability - index HAQ. were assessed before the opera- subjects into normal, low bone density and osteoporosis ac- tion, after 1, 6 and 12 months. cording to WHO criteria. TNF alpha was checked by Elisa Results: The VAS decrease was observed in the first month after method used quantitative enzyme immunoassay. The data the surgery (47,3±18,6 mm), initially it was 70,6±14,3 mm, at 6 was analyzed to significance test used Chi Square or Fisher months decreased by 1.5 times up to 48,0±10 9 mm (p <0.05,) test and spearmen test. after 12 months - up to 30,1±10,0 mm (p <0.05). 6 months after Result: There were 42 subjects collected in this study, consist the surgery disease activity DAS28 significantly (p <0.05) re- of 16 female and 26 male and age between 33 until 66 year duced from 5,51±1,63 to 3,83±0,55; in 12 months DAS28 - old. We found 3 (7,1%) subjects have osteoporosis, 19 3,26±0,62,2. The positive dynamics of the HAQ index: before (45,3%) subjects have low bone density and 20 (47,6%) sub- surgery - 1,72±0,22, a month after - 1,58±0,26, after 6 months - jects were normal. The mean level of TNF alpha were found 1,22±0,28 (p <0.05), at 1 year - 1,03±0,18 points (p <0.05). 2,76 u/l in normal bone mineral density, 2,53 u/l in low bone Conclusion: Arthroplasty in patients with highly active RA density and 1,99 u/l in osteoporosis subjects. We tested corre- may be considered quite reasonable and effective in improv- lation of level TNF alpha to bone mineral density by spearmen ing functional ability and pain relief. Removal of abnormal test was found r=-0,263 on p value 0,093. joint tissues also reduces RA activity, increases the overall Conclusion: There was no correlation of the TNF alpha level response to basic therapy after surgery. to bone mineral density in obese type 2 diabetes. P924 P923 THE EFFECT OF VERTEBRAL OSTEOARTHROSIS CLINICAL AND FUNCTIONAL EFFICIENCY OF (VO) AND VERTEBRAL FRACTURES (VF) ON LARGE JOINT ARTHROPLASTY IN PATIENTS TRABECULAR BONE SCORE (TBS): PRELIMINARY WITH HIGHLY ACTIVE RHEUMATOID ARTHRITIS RESULTS S. Lapshina1,I.Akhtyamov1, L. Miasoutova1 A. Poloni1,C.Monaco1,S.Rapisarda2,G.DiLeo3,C. 1Kazan State Medical University, Kazan, Russian Federation Messina4,L.M.Sconfienza2 1Radiology, University of Milan, Milano, Italy, 2Radiology The synovium in rheumatoid arthritis (RA) produces a variety Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy, of cytokines, causing the destruction of articular cartilage, 3Radiology Unit, IRCCS Policlinico San Donato, San secondary osteoarthritis, determining in some cases the need Donato Milanese, Italy, 4Radiology, University of Milan, for joint replacement. At the same time inflammation within Milan, Italy the joint substrate is the source of the high activity of the underlying disease. It is believed that reconstructive surgery Objectives: TBS is a textural score that provides an indirect on joints are possible only in the period of minimal activity of index of trabecular microarchitecture from lumbar spine (LS) rheumatoid diseases, since the high activity of rheumatoid dual energy x-ray absorptiometry (DXA). We evaluated the diseases leads to difficult rehabilitation period, higher risk of effect of VO and VF on bone mineral density (BMD) and infection. Currently, the possibility of joint replacement in TBS. patients with high activity is debatable and requires serious Methods and Materials: We retrospectively identified all study. patients that performed a LS DXA in January-March 2015 Aim: To evaluate the results of knee and hip joints replace- together with a LS x-ray/MRI (maximum interval with ment in patients with highly active RA, depending of the DXA=6 months). Among them, we included patients with initial therapy and its impact on patient quality of life during VO or VF diagnosed on LS x-ray/MRI with a maximum of the first year after surgery. two vertebrae involved. We calculated the BMD/TBS differ- Materials and methods: Arthroplasty was performed in 24 ence between vertebrae affected by VO/VF and the adjacent patients (mean age - 56,5±9,6 years) with high RA activity vertebrae with the greater values of BMD/TBS; and between (average DAS28 5,51±0,63 points). Duration of the disease - vertebrae affected by VO/VF and the average L1-L4 BMD/ 11,91±4,80 years, seropositive rheumatoid factor in 18 (75%) TBS (average value included the vertebrae with VO/VF). patients. At the time of surgery 16 (66.7%) patients received Results: Out of 258, we included 20 patients (19 females, methotrexate, 3 (12.5%) - leflunomide, corticosteroids (pred- age=72±10y) with VO (n=13) or VF (n=7). Mean BMD nisone at a mean dose of 4,2±4.3 mg per day) - 10 (41.6%) (g/cm2): vertebrae with VO/VF=1.004±0.167; adjacent-verte- patients, of which in combination with DMARDs - 5 (20.8%). brae=0.935±0.154; L1-L4=0.946±0.127. Mean TBS: verte- Basic therapy did not change after surgery. 7 (29.2%) patients brae with VO/VF=1.300±0.122; adjacent-vertebrae=1.252 received. biologics (infliximab, adalimumab, rituximab, ±0.122; L1-L4=1.261±0.091. Considering VO+VF together, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S525 all differences were significant (p<0.05), except for BMD dif- 1 was 22,9 [IQR 30–17] ng/ml vs. group 2 – 22,1 [IQR 29– ference between vertebrae with VO/VF and adjacent- 16] ng/ml. Group 1 and group 2 were compared according to vertebrae (p=0.082). Considering only VO vertebrae, all dif- their 25(OH)D levels (deficiency <19 ng/ml (37% vs. 41%, ferences between vertebrae were significant (p<0.05). p<0,001), insufficiency 20–30 ng/ml (39% vs. 37%, Considering only VF vertebrae, no differences were found p=0,023), normal >30 ng/ml (25% vs. 22%, p<0,001) and with adjacent-vertebrae/L1-L4 for BMD and TBS (p>0.119). additionally >45 ng/ml as optimal level (4% vs. 3%, p<0,001). Correlations between BMD and TBS for vertebrae with VO/ Conclusion: After raising awareness of vitamin D importance VF were all significant (p<0.05): R=0.5247 (VO+VF), for bone health, much more laboratory testing of 25(OH)D R=0.6194 (only VO), R=0.9224 (only VF). level was done, but there is no improvement in vitamin D level Conclusion: Compared to adjacent-vertebrae and L1-L4, VO (possibly tests were done, but the treatment was not started or significantly impacts both on BMD and TBS, while no differ- was not adequate). ences were found for VF. BMD and TBS are positively cor- related, especially for VF. P926 SKIN AND SUBCUTANOUS FAT ATROPHY AFTER P925 CORTICOSTEROID INJECTION FOR LATERAL IMPROVEMENT IN VITAMIN D LEVEL TESTING EPICONDYLITIS: A CASE REPORT AFTER USING THE ELECTRONIC MEDIA AND M. Yildirim1,K.Ones1,G.Goksenoglu1 CLASSICAL COMMUNICATION TOOLS: STUDY 1Istanbul Physical Treatment Rehabilitation Education and FROM LATVIA Research Hospital, İstanbul, Turkey M. Mukane1,M.Mukans2,I.Rasa3 1Riga Stradins University, Riga East Clinical University Lateral epicondylitis are the most common elbow problems in Hospital, Latvian Osteoporosis and Bone Metabolism adults. Corticosteroid injection for the treatment of lateral Diseases Association, Riga, Latvia, 2Riga Stradins epicondylitis is a frequently used method of conservative University, Riga East Clinical University Hospital, Riga, management. A 43 year-old woman was referred to our clinic Latvia, 3Riga East Clinical University Hospital, Riga with a 6 month history of pain along the lateral side of her Stradins University, Latvian Osteoporosis and Bone right and left elbow. She had been treated for lateral Metabolism Diseases Association, Riga, Latvia epicondylitis with 20 mg Triamsinolon heksasetonit to the right and left elbow for lateral epicondylitis due to the resis- Objectives: Vitamin D is crucial for bone mineral density and tance of pain. Pain decreased in 3 weeks. Examination re- osteoporosis. It is necessary to test every person regarding vealed atrophy of the skin and subcutaneous fat over the lat- their age and gender for vitamin D (25[OH]D) level. To reveal eral epicondyle and she had no pain in her two elbow. Patient vitamin D-deficient patients (pts.), it is important to improve had unlimited range of elbow motion. Cortical injection of medical specialists’ and pts. knowledge about the importance lateral epicondylitis is useful for pain but injection into the of vitamin D by the use of electronic media (e.g. websites, lateral site of the elbow may cause skin and fat atrophy in long radio, and television) and classical communication tools (lec- term if appropriate injection technique is disregarded. tures, seminars, and publications). The aim of the study was to analyze the improvement in 25(OH)D testing after having raised awareness about the importance of vitamin D. P927 Material and methods: Electronic data base of one of the SPACEFLIGHT MIMICKS RAPID BONE AGING biggest laboratories (Ltd. Central Laboratory) in Latvia was M. Gerbaix1, V. Gnyubkin2,C.Cécile3,N.Laroche2,F. analyzed. 25(OH)D test results were divided into two groups Peyrin3,G.Gauquelin-Koch4,L.Vico2 (before/after raising awareness). Pts. from group 1 were tested 1French National Center for Space Studies and INSERM from 16.11.11 till 18.10.12, group 2 – from 01.06.2015 till UMR 1059/University of Lyon, Saint Etienne, France, 31.05.2016. Overall 47 752 tests were done. 2INSERM UMR 1059/University of Lyon, Saint Etienne, Results: In group 1 overall 7368 tests were done (women France, 3University of Lyon/INSERM U1206/CNRS 5220, n=6236; 85%), in group 2 – 40 384 tests were done (women INSA Lyon, UCBL/CREATIS and European Synchrotron 31 636; 78%). The number of tests done had increased 5 times Radiation Facility, Grenoble, France, 4French National among females, 7 times – among males (p<0,001). Median Center for Space Studies, Paris, France (Me) age in both groups was similar (57 [68–41] vs. 53 [65– 33]). Proportionally the most significant increase was in the Objective: By providing a weightlessness environment, young adult group (19–34 yrs; group 1 – n=668, 10% vs. spaceflight induces site-specific bone loss in both human group 2 n=6203, 18%; p<0,001). Me 25(OH)D level in group and mice but cellular mechanisms remains unclear. On the S526 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 other hand, during aging, osteocyte apoptosis associated with vertebral fracture. However this risk of fracture may depend lacunae mineral occlusions occurs and bone marrow fat in- of patient profile and other osteoporotic substances given. The creases. Here, we wanted to analyze the effects of spaceflight aim of our study was to evaluate the evolution of this turnover on osteocytes lacunae, osteocytes survival and marrow adi- rebound if a BP was prescribed before and/or at the end of the posity. Then, we aimed to investigate the events occurring biological effect of Dmab. after a short term of earth recovery. Method: We randomly selected a subset of women from Material and Methods: Mature C57/Bl6 male mice flew on our daily practice who had received subcutaneous Dmab the 30-day space Russian BION-M1 high-orbit satellite mission. treatment (60 mg subcutaneously every 6 months) for os- The Flight group was killed after landing, and the recovery group teoporosis for at least one year (2 injections) between 8 days later. The ground control group was kept under spacecraft 2010 and 2016. We separated them in four groups. A: housing conditions. Osteocytes Lacunae of femur cortical sec- No BP neither before nor after Dmab, B: No BP before tions were imaged using Synchrotron Radiation μCT (resolution but BP 6 months after the last Dmab, C: BP before but no 0.7 μm) and 3D shape descriptors were calculated and analysed. BP after Dmab, D: BP before and 6 months after the last Medial, anterior, posterior and lateral zones were analyzed, each Dmab injection. We retrospectively analyzed the evolu- containing more than 1200 lacunae. Osteocytes death and bone tion of bone turnover markers with C-telopeptide (CTX, marrow fat were investigated in femur by histology. ng/l) up to 12 months after the last Dmab injection (6 Results: The lacunar volume fraction was significantly de- months after the last BP prescription). Appropriate statis- creased in the Flight vs. Habitat Control group in medial zone tics were applied. (-33% and -38%, respectively; p<0.025). In the posterior Results: The first 38 women were included (mean age 65±10 zone, the length/width ratio was significantly decreased in yo before the first injection of Dmab). 8 in group A, 13 in the Flight vs. Habitat Control group, indicating a more spher- group B, 10 in group C and 7 in group D. At the end of Dmab ical lacuna shape in the Flight group. Moreover, particularly in treatment, CTX values were significantly lower than baseline the posterior zone, the lacuna mean volume was significantly for all groups (p<0.05) and were respectively A: 84 (±54), B: decreased and the fraction of smaller lacunae (less than 200 336 (±266), C: 80 (±60) and D: 95(±63). 12 months after the μm3) was greater in Flight and Flight+Rec groups vs. Habitat last Dmab injection (~ 6 months after the last BP prescription), Control. Furthermore, the ratio of empty overall lacunae was the CTX were respectively A: 1075 (±321), B: 241 (±236), C: dramatically increased in Flight vs. Habitat Control group 677 (±359) and D: 370 (±286), with significantly lower CTX (11.44% vs. 3.64%, p<0.005) and remained elevated in the in group B compared to group A (p=0.03) and in group C Flight+Rec group (9.71%, NS vs. Flight). Finally, femur bone compared to group A (p=0.05). marrow analyses revealed a marrow adipocytes invasion in Conclusion: In this preliminary study, the exposition to Flight and Flight+Rec groups. BP before or after Dmab treatment attenuates significantly Conclusion: We provide first evidences that one-month the turnover rebound. However, the prescription of BP 6 spaceflight induces osteocyte death along with decreased os- months after Dmab tends to be better than pre-treatment teocyte lacunar volume and increases bone marrow fat, both with BP but without reaching significance. We failed to being hallmarks of aging. No recovery was seen 8-day after demonstrate the superiority of pre- and post-treatment use landing. Given the critical role of osteocytes to orchestrate of BP (group D) which could be related to the sample size bone remodeling, their compromised survival might jeopar- of our preliminary study. Larger study is ongoing to fur- dize bone reversibility, mainly in the most aged. ther warrant our results. P929 P930 EVOLUTION OF TURNOVER BONE MARKERS LONGITUDINAL CHANGES OF TRABECULAR AFTER DENOSUMAB DISCONTINUATION: A BONE SCORE IN PATIENTS WITH CUSHING'S PRELIMINARY STUDY SYNDROME: EFFECT OF TREATMENT O. L. Lamy1,D.H.Hans1, E. G.-R. Gonzalez Rodriguez1,B. T. T. Tsoriev1, Z. E. Belaya1,N.I.Sazonova2,D.Hans3,A.G. A.-R. Aubry-Rozier1,D.S.Stoll1 Solodovnikov4, L. Y. Rozhinskaya1,G.A.Melnichenko5 1Center of Bone Diseases, Lausanne University Hospital 1Neuroendocrinology and bone diseases, the National Switzerland, Lausanne, Switzerland Research Centre for Endocrinology, Moscow, Russian Federation, 2Diagnostic imaging (radiology and CT), the Introduction: The subcutaneous administration of National Research Centre for Endocrinology, Moscow, denosumab (Dmab) twice yearly reduces bone turnover and Russian Federation, 3Center of Bone Diseases, Lausanne increases bone mineral density. Dmab discontinuation is asso- University Hospital, Lausanne, Switzerland, 4Ural State ciated with bone turnover rebound and increased risk of Medical University, Ekaterinburg, Russian Federation, 5the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S527 National Research Centre for Endocrinology, Moscow, C. Lelong1,P.LeNost1, J. Choisne2, J.-M. Valiadis2,R. Russian Federation Winzenrieth1,S.Kolta3, W. Skalli2 1Medimaps, Merignac, France, 2Institut de Biomecanique Endogenous hypercortisolism causes secondary osteopo- Humaine Georges Charpak, Arts et Metiers ParisTech, Paris, rosis and low-traumatic fractures. However, the impact France, 3CEMO, Cochin Hospital, AP-HP, Paris, France of Cushing's syndrome (CS) remission on BMD and TBS and the reversibility of bone complication remains Aim: To evaluate the ex-vivo relationship between TBS, uncertain. computed from DXA acquisitions, and the pull-out Objective: To evaluate the changes in TBS and BMD in pa- strength of pedicle screws in human fresh vertebra. tients with CS in 12 and 24 months after treatment Method: 26 human fresh vertebrae (T12, L4 and L5) Methods: 68 patients with confirmed active CS were en- were selected from 10 donors (mean age 81.8 yrs) by rolled. We assessed lumbar spine (L1-L4) BMD before residents in the Institut de Biomécanique Humaine radical treatment and in 12 and 24 months after it with (Paris, France). Image acquisitions were performed the retrospective TBS evaluation. All measurements were per- dayofthesurgeryusingastandardizedprotocolona formed using a DXA Prodigy device (GEHC Lunar, DXA device (QDR 4500A, Hologic, Bedford, U.S.A.). Madison, Wisconsin, USA). The TBS was derived retro- During the DXA scan acquisition, the vertebrae were spectively from existing BMD scans, blinded to clinical inserted into water in order to simulate the soft tissues outcome, using TBS iNsight software v2.1 (Medimaps, around the bone. Cylindrical pedicle screws with a trap- Merignac, France). ezoidal thread shape were implanted by a single sur- Results: we enrolled 55 females and 13 males (F/M 80.9%/ geon. Biomechanical testing was performed on the ver- 19.1%), mean age was 36.1 years (95% CI 33.5–38.8), tebra in order to measure the pull-out strength of the mean BMI 30.2 kg/m2 (95% CI 28.7–31.7). All subjects pedicle screw. Bone texture was evaluated using TBS had active CS at the initial evaluation; 12 months after the (TBS iNsight, Medimaps, Merignac, France). TBS was treatment 46 subjects were evaluated, 16 remained in an computed into the same ROI used to assess BMD from active stage of disease, whereas 30 were in remission. DXA acquisition. To take into account vertebral mor- After24months40patientsremainedinthestudy,18pa- phology variability a pseudo 3D BMD (3D BMDa) tients were in an active stage of disease (two relapsed), was computed based on a cylindrical approach. however all of them had mild, controlled stage of Relationships between TBS and the pull-out strength hypercortisolism. were evaluated using a Pearson correlation test. A boot- The difference in TBS and BMD values was as following: TBS strap approach on the vertebrae (20 random sampling) (0) – 1.2062 (0.147), TBS (12 months) – 1.298 (0.145), TBS was done in order to evaluate the variability of the (24 months) – 1.291 (0.139) p<0.01. L1-L4 BMD (0) – 1.044 possible associations. A multivariate analysis, that in- (0.02) g/cm2; Z-score -1.43 (0.14), BMD (12 months) – 1.026 cludes DXA TBS and 3D BMDa, has also been (0.141) g/cm2 Z-score -1.38 (0.17), BMD (24 months) – 1.076 performed. (0.140) g/cm2 Z-score -0.95 (0.17) p<0.01. Results: Mean TBS, 3D BMDa and pull-out strength were There was a significant differences in TBS values after 12 1.213±0.126, 0.181±0.04 g/cm³ and 473±419 N respec- months depending on the disease activity (ANCOVA adjusted tively. A moderate but significant correlation has been for initial value) (p=0.044), but not in 24 months (p=0.374). observed between TBS and the pull-out strength (r=0.63; At the same time, we could not find any difference in BMD p=0.0005) while a strong correlation (see Figure 1) was values after 12 months or 24 months in dependence on the observed for 3D BMDa (r=0.71; p<0.0001). Bootstrap disease activity (p=0.084). approach demonstrated the stability of the TBS associa- Conclusion: Both BMD and TBS values improves after treat- tion r²=0.39 [0.33-0.46]. In multivariate analysis, both ment of Cushing’s syndrome. However, TBS seems to be TBS and 3D BMDa remained significantly associated more sensitive than BMD measurements to reflect the with the pull-out-strength (p=0.034, r=0.43 and p=0.003, achievement of a complete remission after 12 months of r=0.57, respectively). The combined model explained treatment. 56.2% (r²-adjusted) of the pull-out-strength. Funding МД-3204.2017.7 Conclusion: The present study demonstrated an associa- tion between TBS and the pull-out strength of the pedicle screws. After adjustment for 3D BMDa, TBS explained P931 18.5% of the pull-out-strength while 3D BMDa explained BOTH TBS AND VOLUMETRIC BMD ARE 32.5%. These results are consistent with those in the lit- ASSOCIATED WITH PEDICLE SCREW PULL-OUT erature. Further ex-vivo studies are needed to confirm STRENGTH: AN EX-VIVO FEASIBILITY STUDY these findings in a larger sample size. S528 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Introduction: Intra-articular injection of hyaluronate is a sig- nificant method in treating mild to medium forms of the knee osteoarthritis(OA). Aim: To test the effects of administration of 1% Na- hyaluronate on reduction of pain and functional status of the patients with OA in the knees. Material and Methods: This study involved 20 patients (14 women and 6 men),average age of 74 with OA of both knees. The diagnosis was set based on ACR criteria. The degree of P932 radiological changes was determined based on Kellgren- PLGA NANOPARTICLES POTENTIATE THE Lawrence classification by rheumatologists and orthopedic PROTECTIVE EFFECT OF CURCUMIN AGAINST surgeons. 70% of the patients had changes of the third de- BONE LOSS IN OVARIECTOMIZED RATS gree,30% of the second degree)The treatment consisted of H. Lee1,M.Y.Um1,T.Y.Ha1,J.Ahn1 administering the hyaluronate to the more painful knee, each 1Korea Food Research Institute, Seongnam, Republic of 7 days during the course of 5 weeks. In 13 patients the treat- Korea ment was applied in the right knee. Level of pain was tested according to the analogous pain scale by VAS, the range of Osteoporosis increases fragility fractures and is a major health knee motion was measured by an angle ruler(shown in de- issue in the elderly. Curcumin, an active constituent of grees), while the functional status was evaluated in accordance Curcuma longa, was reported to exert a beneficial effect on with Oxford Knee and T. Lysholm Knee Scoring scale. The osteoporotic bone loss. However, poor aqueous solubility has evaluation of the patients was performed before the treatment, limited its pharmacological efficacy. Although application of 5 weeks later and 12 weeks after the last treatment. During the poly(lactic-co-glycolic acid) (PLGA) nanoparticles as carriers treatment, amount of consumed analgesics per patient per day for curcumin was demonstrated to improve the bioavailability was monitored. of curcumin, the effect of curcumin-loaded PLGA (C-P) nano- Results: Average pain before the treatment was 8/10 VAS, particles on bone health has not been investigated. To examine after the treatment 4/10, while 12 weeks after the treatment it the therapeutic potential of C-P, we prepared C-P nanoparti- was 5/10. Motion range of the knee increased in 75% of the cles and confirmed curcumin was successfully encapsulated patients. Medium value of the functional status according to within the PLGA polymer. Ovariectomy (OVX)-induced the Oxford Knee Score was 22 before the treatment, 38 after bone loss was found to be ameliorated in rats fed with the treatment and 39, 12 weeks after the treatment. Medium curcumin or C-P. The in vitro release study showed a typical value of the functional status according to the T/ Lysholm biphasic pattern with an initial burst and following sustained Scale was 43 before the treatment, 76 after the treatment, release. Measurement of bone mineral density and observa- and 75 at the end of the observation. In 18 patients the dose tion of trabecular microarchitecture showed that C-P was of analgesics was reduced. more effective than free curcumin against osteoporosis. A Conclusion: intraarticular application 1% Na hyaluronate sig- qRT-PCR analysis demonstrated that C-P significantly im- nificantly reduces pain even 12 weeks after the treatment, proved bone remodeling. These results suggest that encapsu- increases mobility of the knee, improves functional status of lation with PLGA enhances the protective effect of curcumin the knee joints ant patient satisfaction, while the need for against OVX-induced bone loss. This approach could be a analgesics is reduced, and the therapy did not have unwanted promising strategy to improve the therapeutic index of phyto- side effects. chemicals against osteoporosis. P934 P933 CHARACTERIZATION OF A NOVEL CDC73 GENE ANALYSIS OF THE EFFECTS OF INTRA MUTATION IN A PATIENT WITH ARTICULAR IMPLEMENTATION OF 1% NA- HYPERPARATHYROIDISM-JAW TUMOR HYALURONATE IN PATIENTS WITH THE KNEE SYNDROME AFFECTED BY PARATHYROID OSTEOARTHRITIS CARCINOMA S. Kevic1,K.Boskovic2, S. Todorovic-Tomasevic1 S. Ciuffi1,L.Cianferotti1,G.Nesi1,E.Luzi1,F.Marini1,R. 1Clinic for Medical Rehabilitation and Physical Medicine, Zonefrati1,G.Perigli1,M.L.Brandi1 Clinical Center of Vojvodina, Serbia, Novi Sad, Serbia, 1Department of Surgery and Translational Medicine, Unit of 2Clinic for Medical Rehabilitation and Physical Medicine, Bone and Mineral Diseases, University of Florence, Clinical Center of Vojvodina, Novi Sad, Serbia University Hospital of Florence, Florence, Italy Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S529 Introduction: Hyperparathyroidism-jaw tumor syndrome bone mechanical properties, with a relatively small sample (HPT-JT) is an autosomal dominant disorder (1,2). The cell size. The aim of this study was to evaluate the relationship division cycle protein 73 homolog (CDC73) gene, was shown between TBS, BMD and mechanical properties of on a larger to be responsible for the development of HPT-JT syndrome sample of human vertebra ex vivo. (3). This gene encodes an ubiquitously expressed 531 amino Method: 52 vertebrae (L1 to L4) were harvested from 13 acid protein named parafibromin (4). It has been shown to act post-mortem human subjects (mean age 74.9±8.2 yrs). The as tumor suppressor. In fact, loss of heterozygosity (LOH) of isolated vertebrae (including posterior arches) were scanned the CDC73 locus in many HPT-JT associated parathyroid tu- with a DXA device (Prodigy, GE-Lunar) using water to sim- mors from patients with germline mutations is in accordance ulate the soft tissues around the bone. Bone texture was eval- with Knudson’s “two-hit” model for hereditary cancer (2). uated using TBS (TBS iNsight software, Medimaps). BMD Patients and methods: A 41-year-old man with mandible and TBS were evaluated over the same ROI, the largest rect- ossifying fibroma, surgically removed, subsequently showed angle included within the vertebral body. Biomechanical test- severe hypercalcemia due at parathyroid carcinoma (PC). ing was performed on each whole vertebra to measure the Genetic analysis to evaluate germinal and somatic CDC73 gene failure load and the stiffness. The quasi-static compression mutation were performed. RT-qPCR, immunohistochemistry tests were realized with a traction-compression device and western blotting assay were performed to quantify (INSTRON 55000, INSTRON). Relationships between TBS CDC73 mRNA and parafibromina expression, respectively. and mechanical properties were evaluated using a Pearson Results: A novel heterozygous nonsense mutation correlation test. A multivariate analysis, that includes both (c.192delT) in CDC73 gene has been discover. No LOH has TBS and BMD, has also been performed. been revealed in PC tissue. No significantly difference be- Results: Over the 13 subjects, 2 were excluded due to their tween CP and parathyroid adenoma tissues control has been abnormal L1-L4 BMD when looking at the global distribution detected in CDC73 gene expression. On the contrary, both (0.409 and 1.401 g/cm²). No outliers were detected for L1-L4 HIC and WB assay have showed the ~90% reduction of TBS. Among the 44 remaining vertebrae, 9 were excluded due parafibromin expression in CP. to presence of severe arthrosis (presence of osteophytes) or Conclusions: This study describes a novel both germinal and established vertebral fracture. Mean BMD, TBS, failure load somatic heterozygosis nonsense mutation (c.192delT) in and stiffness were 0.854±0.161 g/cm², 1.561±0.098, 2351 CDC73 gene. Moreover, despite the normal CDC73 gene ex- ±1064 N, 4170±1260 N.mm-1 respectively. Moderate but sig- pression, we found a great decrease of the parafibromin ex- nificant correlations (figure 1) were observed with failure load pression. This is coherent with the CP presence, but is incon- for BMD (r=0.65; p<0.0001) and for TBS (r=0.63; p<0.0001). sistent with the genetic result. How is it possible? We suggest Stronger significant correlations (figure 1) were observed with that a mechanism of gene silencing induced by microRNA stiffness for BMD (r=0.65; p<0.0001) and for TBS (r=0.73; could have a role determining the post-transcriptional inacti- p<0.0001). In the multivariate analysis, both BMD and TBS vation of the wild type CDC73 allele. remained significantly associated with the failure load (r=0.50, References: p=0.002 and r=0.47, p=0.005 respectively). The combined mod- 1. Jackson CE, Surgery 1990;108:1006 el explained 52.3% (r²-adjusted) of the failure load. The associ- 2. Bradley KJ, Clin Endocrinol 2006;64:299 ationwiththestiffnessalsoremainedsignificantforBMDand 3. Shattuck TM, N Engl J Med 2003;349:1722 TBS (r=0.49, p=0.004 and r=0.62, p=0.0001 respectively). The 4. Carpten JD, Nat Genet 2002;32:676 combined model explained 64.6% (r²-adjusted) of the stiffness. Conclusion: The present study confirms on a larger sam- ple the correlations between TBS and biomechanical P935 properties of the lumbar spine and those results are in- TBS ASSOCIATION WITH BIOMECHANICAL dependent of spine BMD. Both BMD and TBS charac- PROPERTIES OF HUMAN VERTEBRAE EX-VIVO terize a significant part of the vertebral bone strength D. Tran1,F.Michelet1,C.Lelong1, R. Winzenrieth1,A. which may explain the ability of TBS in conjunction Heraud2,W.Skalli3,D.Hans1 with BMD to improve the risk of fracture in clinical 1Medimaps, Merignac, France, 2Centre Hospitalier Robert practice. Boulin, Libourne, France, 3Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers ParisTech, Paris, France P936 Objective: The clinical utility of Trabecular Bone Score INCREASED RISK FOR INCIDENT HIP FRACTURE (TBS) to evaluate the risk for osteoporotic fracture has been IN MEN WITH TYPE 2 DIABETES widely recognized by the scientific community. To date only D. Mellström1, C. Ohlsson2,O.Ljunggren3,M.Lorentzon1, one study presented data on the relation between real TBS and A. G. Nilsson1, C. Lewerin4,U.Smith5,M.Karlsson6 S530 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 1Geriatric Medicine, Department of Internal Medicine and function showed an increased risk for hip fracture in Clinical Nutrition, Institute of Medicine, Sahlgrenska diabetic men HR 1.63(CI 1.01-2.62). Academy, Mölndal, Sweden, 2Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 3Department of Medical P937 Sciences, Endocrinology and Mineral Metabolism, Uppsala THE EFFECT OF WHOLE BODY VIBRATION University, Uppsala, Sweden, 4Sahlgrenska University EXERCISE ON FRACTURE RISK IN ADULTS OVER Hospital, Section for Hematology and Coagulation, 50 YEARS OF AGE: A SYSTEMATIC REVIEW AND Gothenburg, Sweden, 5Institute of Medicine, Göteborg, META-ANALYSIS Sweden, 6Department of Orthopaedics and Clinical D. B. Jepsen1, K. Thomsen2,S.Hansen3, N. R. Jørgensen4,T. Sciences, Lund University, Skåne University Hospital, Masud5,J.Ryg6 Malmö, Sweden 1Department of Geriatric Medicine, Odense University Hospital, Institute of Clinical Research, University of Objectives: To investigate if men with type 2 diabetes have Southern Denmark, Odense, Denmark, 2Department of increased 10 year risk for hip fracture and other osteoporotic Geriatric Medicine, Odense University Hospital, Institute of fractures. Clinical Research, University of Southern Denmark, Population and methods: The Swedish Mr OS study is a Svendborg, Denmark, 3Department of Endocrinology, multicenter population study of Odense University Hospital, Institute of Clinical Research, osteoporotic fractures in 3014 men (69-81 years). Incident University of Southern Denmark, Odense, Denmark, fractures were searched for in 4Department of Clinical Biochemistry, Rigshospitalet,: computerized X-ray archives. Bone density was measured OPEN- Odense Patient data Explorative Network, The with Lunar Prodigy and Hologic QDR 4500. The probability University of Southern Denmark, Copenhagen, Denmark, of incident fracture was determined by Cox proportional haz- 5Nottingham University Hospitals NHS Trust, Nottingham, ards models. United Kingdom, 6Department of Geriatric Medicine, Results: 297 men had diabetes type 2 at baseline. 197 incident Odense University Hospital, Institute of Clinical Research, hip fractures were recorded University of Southern Denmark, Odense, Denmark and the number of all fractures was 673.The age adjusted hazard ratio, HR, for hip fracture in Introduction: Previous studies have shown promising but diabetic men was 1.52 (95% CI 0.99-2.33) p=0.056. Men inconsistent results on the effect of whole-body vibration ex- with diabetes had an elevated ten year risk for hip frac- ercise (WBV) on bone mineral density, muscle strength, and ture, HR 2.0 (CI 1.30-3.10) after adjusting for age, center, balance. The aim of this study was to investigate the effect of femur neck BMD and BMI. With the same model HR for WBV on fracture risk in adults ≥ 50 years of age. all fractures was 1.32 (CI 1.02-1.701) and for vertebral Methods: A systematic search was performed of published fractures 1.1 (ns) in diabetic men. Diabetic men had papers in the databases PubMed, EMBASE, and the Cochrane higher BMI and fat mass but slower walking speed, lower Central Register the 4th April 2016. Included studies were ran- hand grip strength and more falls. However, the appendic- domized controlled trials examining the associations between ular lean mass was similar in men with diabetes and con- WBV and fracture risk in adults ≥ 50 years of age. The primary trols. BMD was 4-5% higher in diabetic men at hip, lum- outcomes were fragility fractures, fall rates, and the proportion bar spine and total body and was still significant after of patients who fell. Secondary outcomes were bone mineral adjustment for BMI. density (BMD), bone microarchitecture, calcaneal broadband Diabetic men had higher serum leptin and lower vitamin D. In attenuation (BUA), and bone turnover (markers). Relative risk a fully multivariable model the HR for hip fracture among ratios, fall rate ratio/person years, and absolute weighted mean diabetic men was 1.63 (CI 1.01-2.62) adjusting for age, difference were pooled using random effects models and het- BMD, BMI, falls, walking speed, hand grip strength, kidney erogeneity (I2) was estimated. Cochrane Collaboration’sriskof function, leptin and vitamin D. A trend (p=0.06) to interaction bias tool and the GRADE approach were used to evaluate qual- between diabetes and BMD for hip fractures was found, indi- ity of evidence and summarize conclusions. cating that men with diabetes sustain hip fracture at higher Results: 15 papers (14 trials) met the inclusion criteria. BMD. Men with type 2 diabetes had a higher risk for medial Moderate quality evidence from four studies (n=746) showed compared to trochanteric hip fractures OR 2.8 (1.04-7.57). that WBV reduced the rate of falls with a rate ratio/ person years Conclusion: We demonstrate a trend to increased 10 of 0.67 (95% CI=0.50-0.89, p=0.0006; I2=19%). Furthermore, year age adjusted risk for hip fracture in men with di- data from three studies (n=805) found a trend towards falls re- abetes. A multivariable model adjusting for several co- duction (RR=0.76, CI=0.48-1.20, p=0.24; I2=24%). Only one variates as BMD, BMI, falls, hand grip strength, kidney study had data on fragility fractures reporting a non-significant Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S531 trend in fracture reduction (RR=0.47, CI=0.14-1.57, p=0.22). Acknowledgments: We thank Dr. Reikkinen and Dr. Finally, low to very low quality evidence showed no effect on Karjalainen for providing a Bindex® ultrasonometer and their BMD (spine or total hip) and only sparse data were available in support in the interpretation of data. microarchitecture parameters and bone turnover markers. Conclusion: WBV seems efficient in reducing falls and might reduce the risk of fractures, but seems to have no P939 overall effect on BMD or microarchitecture. Further larger RISK OF OSTEOPOROSIS DEVELOPMENT IN trials focusing on fragility fractures are warranted before PATIENTS WHITH RHEUMATIC DISEASES implementing WBV into current guidelines of falls- and L. Miasoutova1,S.Lapshina1 fracture risk interventions. 1Kazan State Medical University, Kazan, Russian Federation Objective: Evaluation of changes in bone mineral density P938 (BMD) in patients with rheumatic diseases. PRESCREENING FOR LOW HIP BMD BY USING Material and Methods: A retrospective analysis of proto- PULSE-ECHO ULTRASOUND colsofX-raydensitometrywasperformedinpatientswho P. van den Berg1, D. H. Schweitzer1 were at the dispensary observation in the Rheumatologic 1Reinier de Graaf Gasthuis, Delft, Netherlands Centre of Kazan City in the period from January 2016 to December 2016. The changes of BMD in two points were Objectives: Fracture Liaison Services (FLSs) encourage DXA taken into account: the lumbar spine and proximal femur. scanning in fracture patients older than 50 yrs, in line with the T-score was evaluated in postmenopausal women and men IOF "Capture the Fracture® Program”. Regrettably, only half olderthan50years.Z-testwasevaluatedinwomenbefore of invitees show up. In this study, pulse-echo ultrasound mea- menopause and men younger than 50 years. 253 patients surement was applied and evaluated for detection of hip osteo- were included in analysis. 100 of them had rheumatoid porosis, which may be beneficial to avoid DXA examinations. arthritis (RA), 52 – ankylosing spondylitis (AS) and 101 Material and Methods: A handheld pulse-echo ultrasonometer had osteoarthritis (OA). (Bindex®, Bone Index Finland, Kuopio, Finland) that measures Results: 85 (33.6%) of 253 patients (74 women and 11 men) cortical thickness at 1/3 length of tibia was used, resulting in a had osteoporosis and 102 (40.3%) patients (84 women and 18 Density Index (DI), which represents an estimate for DXA hip men) had osteopenia according to the criteria of WHO. bone mineral density. Previously, 90% sensitivity and specificity Distribution by rheumatic diseases was as follows. 35 (35%) thresholds for hip osteoporosis with axial DXA have been deter- of 100 patients with RA had osteoporosis and 44 (44%) – mined for DI, classifying patients to healthy (above upper thresh- osteopenia. 13 (25%) of 52 patients with the AS had osteopo- old), intermediate (between the thresholds - DXA investigation rosis and 9 (17,3%) – osteopenia. Osteoporosis and osteopenia needed) or osteoporotic (below lower threshold) DI value. The were revealed in 17 (16.8%) and 24 (23.8%) of 101 patients ultrasound method was evaluated in predicting BMD at the (total with OA, respectively. or neck) hip (Hologic Discovery QDR). Conclusion(s): Osteoporosis is often met in rheumatic dis- Results: We studied 157 consecutive female fracture patients, eases, especially in RA and AS. However, the prevalence of age: mean 65,1; range: 50-89 yrs, attending the FLS. Seven osteopenia is even higher and this situation requires the ac- patients were excluded because of pretibial edema. Based on tions for prevention of osteoporosis and fractures. In addition, DI, 47 patients (31,3%) belonged to the healthy category (defined osteoporosis and osteopenia in OA were observed much more by the manufacturer being >0,844 g/cm2), 48 in intermediate often than it was thought previously. (32%) and 55 in osteoporotic category (36,7%). DXA T-scores at the femoral neck were > -1.0 SD(n=14 (9%)); from -1.0 SD to -2.4 SD (n=96 (64%)) and ≤-2.5 SD (n=40 (27%)). The DI P940 predicted the DXAT-score ≤-2.5 SD at the hip of 98% sensitivity, ASSOCIATION BETWEEN METABOLIC 70% specificity, 99% NPVand 54% PPV. One out of 47 patients SYNDROME AND BONE MINERAL DENSITY IN classified as healthy by DI, had a T-score of ≤-2.5 SD. Finally, COMMUNITY-DWELLING OLDER WOMEN: THE there were 3 patients with morphometric vertebral fractures. All SÃO PAULO AGEING AND HEALTH STUDY (SPAH) these patients had a 'osteoporotic DI' and a hip T-score ≤-2.5SD. L. G. Machado1,D.S.Domiciano1,C.P.Figueiredo1,J.B. Conclusions: The DI excluded osteoporosis at the hip in near Lopes1,V.F.Caparbo1, L. Takayama1,R.Oliveira2,R.M. 100%. A DI value above upper threshold excluded almost Pereira1 completely the presence of osteoporosis at the hip, while in case 1Rheumatology Division, Faculdade de Medicina da of a DI value <0,844 g/cm2 it was a 50:50 chance. DXA scans Universidade de São Paulo, São Paulo, Brazil, 2RDO could be questioned and further threshold studies are needed. Diagnósticos Médicos, São Paulo, Brazil S532 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Objective: To evaluate the prevalence of MS in community- the phantom were performed for the first 45 days, subsequent- dwelling older women with high frequency of overweight/ ly, only one phantom acquisition was measured. We arbitrary obesity and its association with bone parameters. selected the 10 first days to create TBS reference values for Material and Methods: 343 women aged over 65 years were this QC exercise. Phantom precision was computed for both evaluated by specific questionnaire (including history of clin- devices. To develop a TBS QC, we have followed the meth- ical fractures and cardiovascular risk factors). Lumbar spine, odology proposed by Lu et al. (JBMR,1996); i.e. using femoral neck and total hip BMD were evaluated by DXA. Shewart 2 and Tabular CuSum methods. TBS standard devi- Laboratory tests, including calcium, phosphorus, creatinine, ation for the QC was not derived from the phantom precision lipid profile and glucose were also performed. but from a performance target similar to the one on BMD Thoracolumbar spine X-rays were assessed to identify verte- method: TBSsd=in-vivo L1-L4 TBSsd / 2.5. TBSsd=0.008 bral fractures. National Cholesterol Education Program-Adult Results: Phantom precision is lower than the target TBSsd for both Treatment Panel III (NCEP-ATPIII) criteria were used to de- devices (0.005 and 0.002 vs. 0.008 for Prodigy and iDXA respec- fine MS. Logistic regression models were used to analyze the tively). Shewart and CUSUM graphs for iDXA are presented in relationship between MS and bone parameters. Fig. 1. No confirmed alarms were risen for either DXA device. Results: The prevalence of MS was high (62.1%). Women Conclusion: This study demonstrates the potential to develop a with MS had higher BMI (30.7±4.9 vs. 27.2±4.9kg/m2, QC plan for TBS. These two devices exhibited stable comport- P<0.001), body fat percentage (37.7±5.0 vs. 34.9±6.5%, ment during the follow-up. Phantom scanning is sufficient to eval- P<0.001), lumbar spine BMD (0.881±0.171 vs. 0.837 uate software performance using a daily QC program. The number ±0.178g/cm2, P=0.025), femoral neck BMD (0.684±0.120 vs. of days needed to create a stable reference value has to be deter- 0.629±0.121g/cm2, P<0.001) and total hip BMD (0.814±0.131 mined. Further studies are needed to assess the sensitivity of the vs. 0.743±0.140g/cm2, P<0.001) compared to women without method to detect a change in device performance regarding TBS. MS. After adjustments for BMI, logistic regression analyses demonstrated that hip BMD remained as an independent factor associated with MS (OR:10.73 95% CI:1.33-86.55, P=0.026). No significant difference concerning the prevalence of vertebral or nonvertebral fractures was observed between the groups. Conclusion: A positive association between total hip BMD and MS was found, even after adjustment for BMI. Nevertheless, the frequency of vertebral and nonvertebral fractures was similar in women with and without MS. Taken together, these results suggest that higher BMI per se does not explain the positive association between higher BMD and MS and it does not protect against osteoporotic fractures. Further studies are necessary to elucidate the effect of MS on bone mass and fracture risk, possibly related to bone quality. P941 FEASIBILITY STUDY OF A QUALITY CONTROL METHODOLOGY FOR TBS P942 F. Michelet1,D.Krueger2, R. Winzenrieth1,N.Binkley2 ASSOCIATION BETWEEN ULTRAVIOLET INDEX 1Medimaps, Merignac, France, 2Osteoporosis Clinical AND 25-HYDROXYVITAMIN D LEVELS IN OLDER Research Program, University of Wisconsin, Madison, ADULTS IN PORTUGAL United States S. Cardoso1, A. Santos2, P. Padrão3,P.Moreira3,C.Afonso3, T. F. Amaral3, R. S. Guerra3, A. S. Sousa3, N. Borges4 Objective: To develop a Quality Control (QC) methodology 1Faculdade de Ciências da Nutrição e Alimentação, Universidade for TBS using the TBS phantom. do Porto, Porto, Portugal, 2Faculdade de Ciências da Nutrição e Material and Method: A TBS phantom has been acquired Alimentação da Universidade do Porto, I3S—Instituto de almost daily over 339 days (146 measurement days) on a Investigação e Inovação em Saúde, Porto, Portugal, 3Faculdade Prodigy device (GE-Lunar) and an iDXA (GE-Lunar). The de Ciências da Nutrição e Alimentação da Universidade do phantom is composed of a soft tissue region (14 cm tissue Porto, Porto, Portugal, 4Faculdade de Ciências da Nutrição e equivalent, 100% fat content) and a TBS component which Alimentação da Universidade do Porto, CINTESIS - Center for generates 4 different TBS values. Each day, 5 acquisitions of Health Technology and Services Research, Porto, Portugal Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S533 Objective: To explore the association between Ultraviolet Objectives: Aging is associated with increase in body fat and Index (UVI) and serum 25-hydroxyvitamin D3 [25(OH)D] decline in muscle-mass and strength. Sarcopenia may lead to levels considering the effect of other potential influential fac- decreased physical activity and further increase obesity. We tors in Portuguese older adults. aimed to investigate the prevalence of obesity and Sarcopenic Methods: A cross-sectional study was conducted in 1497 obesity(SO) in community dwelling older adults. Portuguese older adults, (≥65 years) within Nutrition UP65 Methods: We enrolled subjects between the ages of 60–99 project1. For each individual blood 25(OH)D was determined years old. We measured muscle-mass using bioimpedence (December 2015-June 2016), and the mean UVI (mUVI) in analysis. Definition of low-muscle-mass was by Baumgartner the respective residence district was calculated for the previ- (skeletal-mass kg/height squared). Sarcopenia was defined ac- ous 30 days. A stepwise linear regression analysis was con- cording to EWGSOP recommendations as sarcopenic muscle ducted in order to formulate the equation to predict 25(OH)D mass and function (usual gait speed or muscle strength). with the independent variables of interest (Table 1). Obesity was defined by two different methods, a fat percentile Results: above 60th percentile (Zoico method) or a BMI of ≥30 kg/m2 Table 1. Factors associated with serum 25(OH)D by multivar- (WHO definition). iable linear regression analysis (r2=0.28, p<0.001). Results: We enrolled 992 subjects (308 men and 684 women). The rates of obesity according to WHO-definition were 29.2% and 53.7% for men and women. The prevalence of sarcopenia was 3.1% in men and 0.4% in women. The rate of SO was 0.3% and 0.1% in men and women when obesity was assessed with Zoico-method and 0 in both sexes when obesity was assessed using WHO definition. Conclusion: Prevalence of obesity in both sexes was higher in our population compared with other populations according to both Zoico and WHO definitions. The rate of sarcopenic muscle-mass was similar for men and lower for women com- pared with other populations. The findings of this study indi- cate that the prevalence of SO in the community-dwelling older adults in our country is low and comparable to other populations. CI: confidence interval. c For the dichotomous variables, baseline categories were P944 coded as 0. LONG-TERM EFFECTIVENESS OF TREATMENT d Baseline: “1-4 years”. WITH ZOLEDRONIC ACID IN PAGET DISEASE OF e Baseline: “Does not know or does not declare”. BONE f Baseline: “None”. L. Villalobos1,A.Alía1,F.J.Bachiller1 g Baseline: “Moderate”. 1 Ramon y Cajal University Hospital, Madrid, Spain Some computed variables and categories were excluded from the final model. Introduction: In the last decade, zoledronic acid (ZA) has Conclusion: The studied factors explained 28% of become the treatment of choice in Paget's disease of bone 25(OH)D’s variance and mUVI showed the highest effect af- (PDB) due to its efficacy, adherence, duration of response ter controlling for socio-demographical, health, diet and nutri- and cost. ZA has been shown to achieve prolonged control tional variables. of metabolic activity of PDB in clinical trials, but there are no Reference: 1. Amaral TF et al. JMIR Res Protoc 2016;5:e184. long-term follow-up studies in clinical practice. Objectives: To study the duration of the biochemical response in patients with PDB treated with a single infusion of ZA and P943 followed in a hospital consultation. To analyze variables asso- OBESITY AND SARCOPENIC OBESITY IN ciated with this response. COMMUNITY-DWELLING OLDER ADULTS Material and methods: All patients with PDB and elevated O. Y. Yilmaz1,Y.T.Topcu1, C. K. Kilic1,G.B.O.Bahat serum alkaline phosphatase (AF> 128 IU/L), who were treat- Ozturk1,M.A.K.Karan1 ed with ZA in the last 12 years (from 2003 to 2015) were 1Istanbul University Istanbul Medical School Department of included. All patients were treated with a single intravenous Internal Medicine Division of Geriatrics, Istanbul, Turkey infusion of 5 mg of ZA. Patients treated with other S534 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 bisphosphonates in the previous year and those with less than patients, p=0.002. Regarding the value measured for total one year of follow-up after ZA were excluded. Serum AF was hip, the difference was also significant (0.2 vs. -1.25, collected in all patients at 0, 6, 12, 18 months, and thereafter, p=0.004). Positive anti-CCP antibodies predicted a low annually. Patients were considered to maintain the response BMD, with a RR of 3.1, p=0.013. For RF, our results also during the time the AF was within the normal range in our revealed different values depending on seropositivity (T-score laboratory (40-128 IU/L). Sociodemographic, clinical and lumbar spine -1.15 +1.33 vs. -0.21+1.14; p=0.01; T score total other analytical variables were collected. A Kaplan-Meier sur- hip -1.32+ 1.32 vs. -0.43+0.92, p=0.09. vival study and a Cox regression-univariate analysis was Conclusions: Immunological profile has an important impact performed. on bone resorption in patients with RA, even from early Results: Seventy patients treated were included, 62.9% were stages, with a significant input on future structural damage, males, and the mean age was 73,4±8,6 years. The baseline AF implying a careful monitoring and proper prevention and ther- was 328,9±140,1 IU / L and the median follow-up time was apeutic management of osteoporosis. 57 months (range 25-156). Six months after infusion 68/70 patients had normal AF (rate of therapeutic response 97%) and at 12 months the response was 100%. During follow-up 11 P946 patients had AF relapse, 5 patients died and 11 were lost to PERSONALITY DISORDERS AND BONE: DATA follow-up. In Kaplan-Meier analysis, 77,6% of patients main- FROM THE GEELONG OSTEOPOROSIS STUDY tained normal AF at 6 years, 73.5% at 8 years, and 63% at 9 (GOS) years, after infusion of ZA. There was no significantly asso- L. J. Williams1,A.L.Stuart1,S.E.Quirk1, M. Berk1,S.L. ciation between loss of response and any of the epidemiolog- Brennan-Olsen2, J. M. Hodge1, V. Chandrasekaran1,J. ical and clinical variables. Cleminson1, J. A. Pasco1 Conclusions: In our study of usual clinical practice, ZA has 1School of Medicine, Deakin University, Geelong, Australia, an effectiveness close to 100% to achieve normalization of AF 2Australian Institute for Musculoskeletal Science, The at 6 months, similar to the results of other series and clinical University of Melbourne and Western Health, St. Albans, trials. In the long term, our results show a longer duration of Australia the response described so far, reaching a survival rate of 63% at 9 years. These data confirm that ZA achieves the goal of Objectives: Data are slowly emerging to suggest an associa- prolonged remission in the majority of patients in clinical tion between personality disorder (PD), a group of psychiatric practice to avoid long-term complications. disorders characterised by maladaptive patterns of behaviour, and increased risk of chronic diseases such as cardiovascular disease, diabetes, gastrointestinal disease and arthritis. P945 Associations with bone are yet to be explored, thus we aimed IMMUNOLOGICAL PROFILE AND BONE LOSS IN to investigate in a population-based sample of women (n=705; PATIENTS WITH EARLY RHEUMATOID 28-94 years). ARTHRITIS Material and Methods: Lifetime mood and PD (Cluster A, B A. L. Barbulescu1,P.L.Ciurea1,B.A.Chisalau1,S.C. and C) was assessed using semi-structured clinical interviews Firulescu1,C.D.Parvanescu1,C.Criveanu1,F.A.Vreju1 (SCID-I/NP and SCID-II). BMD (g/cm2) was measured at the 1University of Medicine and Pharmacy, Craiova, Romania PA-spine and hip using DXA (Lunar). BMD T-scores <1 were defined as low bone mass. Anthropometric measurements Objective: To assess the possible relationship between immu- were performed and medication use and lifestyle factors were nological profile and bone loss in patients with early rheuma- self-reported. Linear and logistic regression models were used toid arthritis (RA). to test the associations, after adjusting for age and weight. Material and Methods: We enrolled 35 patients diagnosed Results: One hundred and thirty-two (18.7%) met criteria for with early RA, according to ACR-EULAR 2010 classification PD [Cluster A, 19 (2.7%); Cluster B, 5 (0.7%); Cluster C, 108 criteria. BMD measurement of the femoral neck, spine and (15.3%)]. BMD among those meeting criteria for Cluster A non-dominant wrist was performed using DXA. PD was 6.2% lower at the hip [mean 0.855 (95%CI 0.784- Results: Most of the patients were women (31; 88.57%), with 0.926) vs. 0.911 (95%CI 0.861-0.691) g/cm2,p=0.031]com- a mean age of 41.72±9.38 years, with a duration of the symp- pared to those without. No associations were observed at the toms under 12 months. A low BMD was found mostly for spine or between Cluster B or C PDs and BMD at either site seropositive cases, statistically significant different, compared (all p>0.05). Four hundred and nineteen (63.2%) had low to seronegative ones, p=0.02; for anti-CCP positive patients, bone mass at the spine and/or hip. Similarly, Cluster A PDs we determined a mean lumbar T-score of -1.5+1.05, signifi- but not Cluster B or C PDs, were associated with an increased cant different of the value calculated for anti-CCP negative likelihood of low bone mass (adjusted OR 3.3, 95%CI 1.0- Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S535 10.7, p=0.05); the relationship was attenuated following ad- was statistically significant both to NaCl and PCP groups. justment for mood disorders (OR 2.8, 95%CI 0.9-9.4, Lower doses of clozapine did not cause changes of these pa- p=0.09). All patterns persisted after further adjustment for rameters in animals in NaCl-C1and PCP-C1 groups. Higher physical activity, smoking, mood disorders (linear regression dose of haloperidol have caused more pronounced decrease of only) and medications know to affect bone. BMD and BMC in NaCl-H2 and PCP-H2 groups. However Conclusion: Cluster A PDs, characterised by odd, eccentric higher doses of clozapine did not have influence of these and non-help seeking behaviours, were associated with reduc- parameters in NaCl-C2 group while in PCP-C2 group cloza- tions in bone mass. Given the dearth of literature, replication pine has even corrected the changes caused by PCP treatment. and research into underlying mechanisms is warranted. Conclusions: Decrease of bone mineral density, seen in SCH patients, could be the consequence of the disease process, but treatment with typical antipsychotic haloperidol leads to fur- P947 ther deterioration of the bones. Atypical antipsychotics ex- DOSE DEPENDENT EFFECTS OF ANTIPSYCHOTICS press dose dependent protective effects on bones. ON BONE MASS IN PHENCYCLIDINE ANIMAL MODEL OF SCHIZOPHRENIA N. Petronijevic1,T.Nikolic1, M. Velimirovic1,G.Jevtic1,T. P948 Stojkovic1,M.Petronijevic2 BROWN TUMORS AS FIRST SIGN OF 1Institute of Medical and Clinical Biochemistry, School of HYPERPARATHYROIDISM IN A YOUNG ADULT Medicine, University of Belgrade, Belgrade, Serbia, D. Gallo1,E.Piantanida1,L.Sassi1,R.Casalone2,E. 2Medical Academy, Clinic of Rheumatology, University of Masiello1,P.Premoli1,E.Bianconi1, M. Annoni3,S.La Defence, Belgrade, Serbia Rosa4, C. Rossi5,C.Marcocci6,G.Dionigi3,L.Bartalena1 1Department of Medicine and Surgery, University of Insubria, Objectives: Schizophrenia (SCH) is a severe neuropsychiatric Varese, Italy, 2Department of Medical Genetics, ASST Sette illness affecting nearly 1% of the world’s population. Long- Laghi, Varese, Italy, 3Department of Surgical and term treatment with typical or atypical antipsychotics is often Morphological Science, University of Insubria, Varese, Italy, required for disease control. Decreased bone mineral density 4Department of Pathology, ASST Sette Laghi, Varese, Italy, (BMD) and increased fracture risk are noticed in SCH pa- 5Department of Medical Genetics, Alma Mater Studiorum, tients. It is not clear whether the disease per se or a life style Bologna, Italy, 6Endocrinology 2 Unit of University of Pisa, together with antipsychotics is the cause of observed changes. Pisa, Italy Phencyclidine (PCP) is non-competitive antagonist of N- methyl-D-aspartate (NMDA) receptors. Perinatal PCP admin- Objectives: Primary hyperparathyroidism (hPTH) in adult- istration to rodents represents animal model of SCH. Reduced hood is often asymptomatic. Conversely, in young people, bone mass in PCP rat model has been reported recently. The hPTH is rare and generally complicated by symptomatic hy- aim of the study was to examine the dose dependent effects of percalcemia, kidney stones and/or skeletal fragility. Brown typical antipsychotic haloperidol and atypical antipsychotic tumors, which are osteoclastic focal lesions, are a rare mani- clozapine treatment on bone mass in male rats perinatally festation in Europe. treated with phencyclidine. Materials and Methods: A twenty-four-year-old female pa- Material and methods: Ten groups of animals were subcu- tient was referred to our Endocrine Unit with hypercalcemia. taneously treated on 2nd,6th,9th and 12th postnatal day (PN), Physical examination revealed short stature and scoliosis. She with either PCP (10mg /kg) or vehicle (0.9% saline). From was limping for a recent left hip atraumatic fracture. As an PN35, two NaCl and two PCP groups have started to receive infant, she suffered from vescico-ureteral reflux. Recently, she haloperidol (NaCl-H1, NaCl-H2, PCP-H1, PCP-H2) in appro- had been diagnosed with complete congenital atrio-ventricular priate doses (1 mg/kg/day or 3 mg/kg/day) and two PCP and block and interatrial shunt. Blood tests revealed elevated two NaCl groups have started to receive clozapine (NaCl-C1, levels of PTH 324 pg/ml (n.v. 6-30), calcium 12.5 mg/dl, NaCl-C2, PCP-C1, PCP-C2) in appropriate doses (20mg/kg/ alkaline phosphatase 826 U/l (30-120), and 25-OH vitamin day or 30mg/kg/day), dissolved in drinking water. The re- D <5 ng/ml. Ultrasound displayed a 24 mm lesion, inferior maining NaCl (control) and PCP group have received drink- to the right thyroid lobe, consistent with parathyroid adenoma, ing water. BMD and BMC were measured in vivo by dual X- confirmed by parathyroid scintigraphy. Radiological exams ray absorptiometry (DXA) on PN98. disclosed metabolic bone disease. In fact, X-rays showed sub- Results: Reduction of BMD and BMC was noticed in PCP cutaneous radial calcifications, while MRI multiple cyst-like perinatally treated rats. Lower doses of haloperidol have spaces and a larger T2-hyperintense lesion, histologically con- caused decrease of both parameters in NaCl perinatally treated sistent with giant cell proliferation. Scintigraphic skull hyper- group (NaCl-H1) and further decrease in PCP-H1 groups that ostosis and severe osteoporosis (BMD 0.6 g/cm2, T-score -4.6, S536 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Z-score -3.8) confirmed the severity of the disease. wrist, humerus, pelvis, ankle, ribs, hip, tibia were seen in Nephrolitiasis emerged. Oral supplementation with calcitriol 54%, 14%, 8%,2%, 5%, 2%, 4% and 4% of patients, respec- and cholecalciferol and rehydration were started. After the tively. Among these 83 patients, 80 (96%) had a bone mineral improvement of vitamin D storage, surgical excision was density assessment. Amongst them, treatment was initiated in scheduled; histological report: intrathymic parathyroid adeno- 70 (87.5%) and refused by 5 (6%) patients. Two patients are ma. Post-surgery hypocalcemia was corrected with calcium under completion. Three patients were lost to follow-up which and calcitriol supplementation. After one year of follow-up, was mainly performed by GPs or the bone specialist (51% and there was a marked improvement of bone mineral density. 46%, respectively). Re-fracture was seen in 2 treated patients Molecular genetic tests (CGH-Array test, karyotype, (one vertebrae and one wrist at 18 and 8 months, respectively). molecular testing for Noonan syndrome) and hormonal exams Conclusion: a coordinated multi-disciplinary secondary frac- (panel for multiple endocrine neoplasia and pituitary diseases) ture prevention program can easily be implemented in primary could not justify the complexity of the case. care if there is close collaboration between GPs, emergency Conclusion: younger patients present with increased disease physicians and a bone specialist at the time of the low trauma severity; delay in evaluation can lead to significant end-organ fracture. Since this outpatient FLS was also associated with a damage. We encourage phosphocalcemic screening in young marked improvement in osteoporosis assessment and treat- people with fragility fractures. Given the complexity of our ment rates, its widespread implementation in the primary care case, a strict metabolic and instrumental follow-up was set. setting is required. References: Disclosure: Lilly Laboratories: consultant activities 1. Nicholson NK et al. Surg 2016;160:1008 2. Luo I et al. Am J Surg 2017;21:146 P950 EQUAL BONE MASS ACQUISITION IN P949 ADOLESCENCE WITH AND WITHOUT A HISTORY FEASIBILITY AND EFFECTIVENESS OF THE FIRST OF CHILDHOOD FRACTURES: A POPULATION FRACTURE LIAISON SERVICES SET UP IN A SWISS BASED STUDY, THE TROMSØ STUDY, FIT OUTPATIENT CLINIC INVOLVING FUTURES COLLABORATION WITH PRIMARY CARE T. Christoffersen1, O.-A. Nilsen1,N.A.Emaus1 PHYSICIANS 1Department of Health and Care Sciences, UiT- The Arctic B. de Moustier1,P.Schaller1,B.Uebelhart2, T. Chevalley2 University of Norway, Tromsø, Norway 1Clinic and Permanence of Onex, Geneva, Switzerland, 2Service of Bone Diseases, University Hospitals and Faculty Introduction: Studies suggest that childhood fractures may of Medicine, Geneva, Switzerland be an early marker of skeletal fragility and low peak bone mass accrual. Population-based studies are few and evidence Context: Fracture liaison services (FLS) set up in hospitals scarce, and the aim of this study was to examine the associa- have been shown to efficiently reduce the fracture care gap. tion between fracture occurrence in childhood and bone mass Objective: To test the feasibility of implementing an outpatient parameters during adolescence. FLS through collaboration between general practitioners Methods: In 2010-2011 all first-year upper-secondary school (GPs) and the local emergency unit (EI) with the aim to show students (n=1117) in two North-Norwegian municipalities an enhancement of bone assessment and treatment rates. were invited to a somatic health survey, the Fit Future study. Methods: Patients who attended the EI with low trauma frac- The attendance rate was almost 93%. This study included 961 ture were recommended to have their bone health assessed girls and boys aged 15-18 years. We measured bone mineral (DXA and biology) by either their GP or a specialist in oste- content (BMC) and bone area (BA) using dual energy X-ray oporosis upon decision of their GPs who were notified imme- absorptiometry (DXA) at femoral neck (FN), total hip (TH) diately. A specific osteoporosis treatment was then given with- and total body (TB) and calculated bone mineral apparent in around 4 months and patients were followed up for a max- density (BMAD, g/cm3) at total hip as BMC-TH/projected imum of 21 months either by their GPs or the bone specialist. bone area3/2. All fractures from birth to DXA screening were The treatment for all patients who had a non-major osteopo- retrospectively recorded from the local hospital. We analysed rotic fracture (20%) was defined based on their FRAX differences in bone mass parameters among girls and boys outcome. Bone assessment rates, treatment initiation/refusal with and without fractures using independent samples t-test. rates as well as recurrent fractures were assessed. Multiple linear regression was used to assess the association Results: the cohort of 83 patients (mean age of 70.8±12.4 between childhood fractures and BMC/BMAD. years) consisted of 88% females. All (31) but one physician Results: The registration recorded 316 fractures in 253 indi- agreed to participate in this study. Fractures of vertebrae, viduals. Fractures were more common in boys (35%) than Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S537 girls (31%). Girls and boys with and without a history of patients came from other services (Internal Medicine, fracture had similar BMC and BMAD at all sites. In girls, Primary Care and Physical Therapy). Pathologies in order of regression analyses controlling for age, height and lean mass frequency derived from Endocrinology were OP in the context showed no statistical significantly associations (beta coeffi- of primary hyperparathyroidism (29%), hypogonadism cients, 95% CI) with -0.03 g (-0.15, 0.09), -0.25 g (-1.03, (26%), bariatric surgery (15%) and glucocorticoid induced 0.53) and -5.50 g (-68.4, 57.4) in BMC-FN, BMC-TH and OP (6%). In 6 patients the inquiry was not related to bone BMC-TB respectively. Corresponding figures for boys were metabolism and the diagnoses were: gout, psoriatic arthritis, -0.01 g (-0.16, 0.13), -0.04 g (-0.97, 0.88) and -12.6 g (-71.5, osteoarthritis, fibromyalgia, among others. The pathologies 46.3) for BMC-FN, BMC-TH and BMC-TB. Similar models most frequently derived from Rheumatology were primary showed no association between childhood fractures and hyperparathyroidism (41%), hypogonadism (18%) and adre- BMAD. nal insufficiency in patients with chronic corticosteroid thera- Conclusion: This study shows that a history of previous frac- py (12%). In 62% of patients referred from Endocrinology and ture does not influence bone mass at adolescence. Therefore, in 65% of patients from Rheumatology underwent some childhood fractures should not be regarded as a marker of change, either diagnosis or treatment. adolescence bone fragility. Conclusion: A multidisciplinary consultation Rheumatology- Endocrinology improves communication between the two specialties and facilitates the standardization of diagnostic P951 and therapeutic criteria. It also represents a convenience for MULTIDISCIPLINARY OUT-PATIENT CLINIC the patient and savings for the hospital, as the number of visits (REUMATOLOGY-ENDOCRINOLOGY) FOR and complementary tests are reduced. PATIENTS WITH COMPLEX METABOLIC BONE DISEASE: 2 YEARS EXPERIENCE E. Casado1, O. Giménez2,M.Arévalo1,M.Rigla2,M. P952 Larrosa1 PREVALENCE OF HYPOCALCEMIA IN ADULTS IN 1Rheumatology, University Hospital Parc Taulí Sabadell, MINSK-CITY, BELARUS Sabadell, Spain, 2Endocrinology. University Hospital Parc A. P. Shepelkevich1, E. V. Brutskaya - Stempkovskaya2,G. Taulí Sabadell, Sabadell, Spain M. Kostin3 1Belarusian State Medical University, Minsk, Belarus, Introduction: Osteoporosis (OP) is a highly prevalent meta- 2Belarusian State Medical University, Minsk City Polyclinic bolic bone disease and may be secondary to endocrine dis- N31, Minsk, Belarus, 3Belorussian State Medical University, eases. In these cases the assessment of a rheumatologist and an Department Of Rheumatology, Minsk, Belarus, Minsk, endocrinologist may be complementary and beneficial for Belarus both the patient and the hospital. Objectives: To describe the experience of two years of a mul- The prevalence of hypocalcemia among patients non-operated tidisciplinary out-patient consultation Rheumatology- the thyroid and parathyroid glands has increased significantly Endocrinology in the care of patients with metabolic bone with the introduction the screening of calcemia. The main reasons diseases. for hypocalcemia are hypoproteinemia and hypoparathyroidism. Methods: A multidisciplinary outpatient clinic Rheumatology- Objective: To study the prevalence of hypocalcemia in the Endocrinology was set in December 2013 to assess patients adult in Minsk. coming from one or another specialty with some metabolic bone Materials and Methods: We studied 1 207 people, average disease that could benefit from both a rheumatologist and an age 53,9±17,25 (892 women,315 men) from 18 to 96 years. endocrinologist. The consultation takes place between 12-14h, Examination: total calcium, total protein; the analysis of mor- on a monthly basis. Demographic characteristics, department of bidity were made. Hypocalcaemia was detected in total calci- origin, diagnosis, complementary tests, and implemented chang- um level under 2,2 mmol / L. es in both the diagnosis and treatment were recorded. Data col- Results: hypocalcaemia was recorded in 40 people (3.3 per lected during the years 2014 and 2015 are presented. 100 adults), the mean age was 42,9±17,63 years (32 women, Results: In these 2 years there have been 20 consultation men-8). In the age group up to 30 years of hypocalcemia was sessions (10 per year), with a total of 103 visits. 54 patients revealed in 12 cases (8,3%); in the age group of 30-44 years - (43 women and 11 men) were treated as first visit. Age 57±15 5 cases (1,3%), 45-59 years - 3 cases (1,1%); 60-74 years - 10 years (range 29-88). There have been 27 successive visits cases (2,5%); >75 years - 1 case (0,7%). (ratio first/successive 2/1) and in 22 cases the patients did The prevalence of hypocalcemia in the age group up to 45 not attend the appointment. 63% of patients (34) came from years was 6,6 per 100 adults. The prevalence of hypocalcemia Endocrinology and 31% (17) from Rheumatology. Three in the age group 45 years over was 1,7 per 100 adults. The S538 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 results of the study indicate a significant occurrence of hypo- haplotype was wild-type A-A-C (total frequency 42.4%, MF calcemia in the age group up to 45 years (χ2=20,34, median - 4.1 points). For the careers of G-C-C haplotype p=0,00001). (8.3%), MF median was 5.1 points higher compared to refer- Conclusion: The prevalence of hypocalcemia in the adult ence haplotype (95% CI: 0.7–9.5, P=0.02). Meanwhile, for population of Minsk-city was 3,3 per 100 adults (33: 1000). the careers of G-C-T-allelic combination, constructed from The prevalence of hypocalcemia in the age group up to 45 risk alleles (9.1%), there was a tendency for MF median in- years was 6,6 per 100 adults. The prevalence of hypocalcemia crease by 4.2 points compared to reference haplotype (95% in the age group 45 years over was 1,7 per 100 adults. The CI: -0.1–8.5, P=0.058). We also revealed that HF median was results of the study indicate a significant occurrence of hypo- 3.4 points higher for the careers of G-C-C haplotype com- calcemia in the age group up to 45 years. pared to reference haplotype (95% CI: 0.8 – 6.1, P=0.02). Conclusion: Our findings suggest that analyzed genetic markers may be associated with FRAX-calculated probability P953 of fractures. ASSOCIATION BETWEEN GENETIC FACTORS OF OSTEOPOROSIS AND FRAX® CALCULATED TEN- YEAR FRACTURE PROBABILITY P954 E. Rudenka1,K.Liaonchyk1,A.Rudenka2,O.Samakhavets3, ECHOSOUND TECHNIQUE FOR SHORT-TERM P. Marozik4 FOLLOW-UPOFTHEDENOSUMABAND 1Belarusian State Medical University, Minsk, Belarus, AROMATASE INHIBITORS EFFECTS ON BONE 2Belarusian Medical Academy of Postgraduate Training, MINERAL DENSITY IN BREAST CANCER Minsk, Belarus, 3Minsk City Clinical Hospital, Minsk, PATIENTS Belarus, 4Institute of Genetics and Cytology NAS Belarus, P. Pisani1, M. Muratore2, F. Conversano1, E. Casciaro1,R. Minsk, Belarus Forcignanò3, M. Ciccarese3,G.Surico3,L.Quarta2,E. Quarta2,A.Greco4,T.DeMarco4,S.Casciaro1 Osteoporosis (OP) is a common disorder with reduced BMD 1National Research Council, Institute of Clinical Physiology, and increased susceptibility to fracture. As much as 80% of Lecce, Italy, 2O.U. of Rheumatology, Galateo Hospital, San BMD variation is determined by genetics. Screening of genet- Cesario di Lecce, ASL-LE, Lecce, Italy, 3O.U. of Oncology, ics factors of predisposition to OP may enable early identifi- Vito Fazzi Hospital, ASL-LE, Lecce, Italy, 4Echolight Spa, cation of risk groups to perform preventive measures. Another Lecce, Italy approach for OP fractures risk calculation is to use fracture risk assessment tool. Objective: To monitor the short-term Denosumab therapeutic Aim: To reveal possible association between allelic variants of effects on bone status in breast cancer patients in treatment OP susceptibility genes and OP probability, calculated from with Aromatase Inhibitors (AIs), through an innovative FRAX®. echographic technique known as EchoSound approach [1]. Materials: A group of 42 Belarusian women with OP, aver- Materials and Methods: 106 breast cancer patients, selected age age 60.5 (56.3; 64.8) years, BMI 26.6 (24.4; 28.0) were for AIs therapy administration and programmed for annual genotyped for COL1A1 Sp1 (rs1800012), COL1A2 A/G spinal/femoral dual X-ray absorptiometry (DXA) were re- (rs42517), VDR ApaI (rs7975232) and VDR TaqI (rs731236) cruited. All the patients underwent DXA examination before polymorphisms using RT-PCR analysis. Association between AIs therapy administration starting (time T0). Then, patients genotyping data and FRAX ten-year probability of major frac- were split into 2 groups: 73 patients received only AIs treat- ture (MF) or FRAX ten-year probability of hip fracture (HF) ment (Group A) and the remaining 33 patients received an was assessed using χ2 test for single polymorphism analysis additional Denosumab treatment, in order to contrast the bone and linear regression analysis for haplotype testing. The dif- loss due to AIs effect (Group B). Follow-up measurements ferences were considered significant at P<0.05. were conducted at 12 (T1) and 18 (T2) months from AIs Results: The data shows that for the bearers of homozygous administration starting. At T1 both DXA exams and C/C-genotype VDR ApaI the median of MF and HF is 2.5 echographic scans (by EchoSound Technology) were realized, times and 3.5 times higher, respectively, compared to bearers whereas only the echographic scans were carried out at T2, of A/A-genotype (P=0.01 in both cases). We found also statis- since DXA is not suitable for short-term follow-up. tically significant association of global haplotype distribution Results: At T1, Group B reported an increase in lumbar spine with HF (c2=16.5, df=7, Global P=0.01), corresponding that bone mineral density (BMD) of 3.89%±1.41% (p<0.05) and this FRAX parameter strongly correlates with analyzed gene 4.15%±0.56% (p<0.05) as measured by DXA and EchoS variants. Analysis of possible allelic combinations of rs42517, scans, respectively; on the other hand, Group A reported a rs7975232 and rs731236 revealed that the most frequent BMD decrement of 1.92%±1.55% (p<0.001, DXA) and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S539 2.24%±0.82% (p<0.001, EchoS). A supplementary BMD in- control group. However, no significant differences were de- crement in Group B was revealed at T2, resulting in a total tected between CLS and SPA groups. Regarding the thoracic BMDincreaseof4.86%±0.95%(p<0.05) during the whole measurements, there was also no significant difference in 18-months period; whereas Group A showed a total BMD myotonometric values. When we evaluate the results of the decrement of 3.80%±1.01% (p<0.001) in the same period. A lumbar measurements according to gender, muscle tone and similar trend was shown for femoral neck BMD. In Group B: stiffness (right) were significantly higher in males, and the at T1 BMD increment of 2.90%±1.21% (p<0.05, DXA) and elasticity (left) was significantly lower in females in the con- 3.19%±0.27% (p<0.05, EchoS); at T2, total BMD increment trol group. No significant difference in stiffness was detected of 3.49%±0.30% (p<0.05). In Group A: total BMD decrease in the CLS group, whereas elasticity and tone were higher in of 2.22%±0.92% (p<0.001). males. In the SPA group, tonus, stiffness, and elasticity (right) Conclusion: The EchoSound approach allowed a reliable were higher in males than females. short-time follow-up of Denosumab effects on BMD varia- Conclusions: Lumbar erector spinae stiffness was high and tions in patients being treated with AIs. elasticity was found to be low in both patient groups. Reference: [1] Casciaro et al, Clin Cases Min Bone Metab Regardless of the nature of pain (inflammatory or mechanic 2015;12:142. origin), similar treatment strategies-along with the primary Acknowledgements: Work partially funded by FESR PO treatment- can be tailored to treat increased stiffness. Apulia Region 2007-13; Action 1.2.4 (grant n. 3Q5AX31: Myotonometric measurements can be used to evaluate the ECHOLIGHT Project). efficacy of these treatment approaches objectively. Disclosures: F. Conversano, S. and E. Casciaro are share- holders of Echolight Spa, a National Research Council spin- off that may or may not benefit from results of this study. A. P956 Greco and T. De Marco are Echolight employees. PROFILE OF A PATIENT WITH OSTEOPOROSIS AND SARCOPENIA M. L. Cevei1,S.E.Mihalcea2,A.I.Gasparik3,R.N.Suciu1,I. P955 R. Cevei4,D.L.Stoicanescu4 EVALUATION OF LUMBAR ERECTOR SPINAE 1University of Oradea, Faculty of Medicine and Pharmacy, MUSCLE TONE, STIFFNESS AND ELASTICITY IN Oradea, Romania, 2Clinical Rehabilitation Hospital Baile PATIENTS WITH CHRONIC LOW BACK PAIN Felix, Baile Felix, Romania, 3University of Medicine and T. Dayanir1,S.Basaran1, I. Coskun-Benlidayi1,G. Pharmacy, Tirgu Mures, Romania, 4University of Medicine Seydaoglu2 and Pharmacy, Timisoara, Romania 1Cukurova University, Faculty of Medicine, Dept. of Physical Medicine and Rehabilitation, Adana, Turkey, 2Cukurova We report a 55 year old woman, who was admitted to the University, Faculty of Medicine, Dept. of Biostatistics, Medical Rehabilitation Clinical Hospital Baile Felix, Adana, Turkey Romania due to back pain, decreased muscle strength and physical performance. Personal medical history revealed left Objectives: To determine the tone, stiffness and elasticity of radius fracture, osteoporosis diagnosed in 2012 for which the erector spinae muscles in patients with chronic low back followed treatment with bisphosphonates. Other comorbidi- pain and to evaluate its associations with clinical variables. ties: recurrent depressive disorder with antidepressant treat- Material and Methods: Between January and June 2016, a ment, chronic hepatitis B inactive form, duodenal ulcer, bilat- total of 138 patients with chronic low back pain were evalu- eral cataract surgery, bilateral knee osteoarthrosis, bilateral hip ated. Seventy patients with chronic lumbar strain (CLS osteoarthrosis, bilateral Dupuytren's contracture. Upon admis- group), 68 patients diagnosed with spondyloarthropathy sion, her physical examination revealed: height 1,62 m, (SPA group) and 42 controls without low back pain were weight 52 kg, static and dynamic vertebral syndrome with evaluated. Muscle tone, stiffness and elasticity measurements limited mobility of lumbar spine and of bilateral hip joints, were performed with a myotonometer device (MyotonPro) crackles with knees mobilization, arthritic changes of both from the lumbar and thoracic erector spinae muscles. Spinal hands, varicose hydrostatic legs, Dupuytren retraction, gener- metric evaluations and questionnaires evaluating pain, disabil- alized sarcopenia. Laboratory investigations revealed low ity and general health status were performed in the patient blood glucose levels, low hematocrit values, low hemoglobin groups. concentration. Lumbar spine radiographs showed vertebral Results: Demographic characteristics of the groups were sim- compression in middle portion of the vertebral body with ilar. There was a significant difference among groups in terms kyphoscoliosis. Pelvic X-ray revealed signs of bilateral hip of lumbar stiffness and elasticity. Elasticity was lower and osteoarthritis. Knee X-ray also revealed bilateral osteoarthri- stiffness was higher in the patient groups compared to the tis, stage I/II. DXA conducted in December 2015 showed S540 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 lumbar spine T score -4.2 and left hip T score -2.9 and Z=-2.4. (quantitative) colorimetric enzyme-linked immunosorbent as- In January 2017 DXA lumbar spine T score was -4.7, left hip say (ELISA), respectively. T-score was -3.1 and right hip T-score was -2.5 confirming the Results: There was no correlation or a weak correlation be- diagnosis. As there was a suspicion of sarcopenia, total body tween the age of the patients and BAP (r=0.429, p=0.097), Lean Body Mass was performed: 7.776 g/cm2. By using the IGF-1 (r=0.369, p=0.158), and osteocalcin (r=0.520, BTS G-walk test we established that physical performance p=0.038). The regression line equation between BAP and was low, 28.6 when performing Timed up and Go test. IGF-1 and osteocalcin were BAP=97.365476377746+ Evaluation of handgrip strength with Jamar dynamometer re- 1.6218866341566IGF-1 (r=0.579, p=0.017), and vealed low values: 11 for the right hand and 14 for the left BAP=121.34976066144+0.93059181897302osteocalcin hand. Medical rehabilitation was performed together with per- (r=0.547, p=0.018), respectively. sonalized diet and pharmacologic therapy, targeting painkill- Conclusions: In women with advanced BC and BMs, all the ing, combating contracture, increasing stability of the lower three considered TMs were partially independent of one an- limb joints, maintaining joint mobility within normal limits, other. However, BAP was significantly (p<0.05) related to correcting spine posture. Rehabilitation therapy included both IGF-1 and osteocalcin, suggesting that this TM is not hydrotermotherapy with thermal water at 36ºC, painkiller useful in the early diagnosis of BMs. However, our results electrotherapy (TENS), kinetotherapy, occupational therapy. should be confirmed by further studies with more patients. P957 BONE ALKALINE PHOSPHATASE, OSTEOCALCIN AND INSULIN-LIKE GROWTH FACTOR-1 AND THEIR RELATIONSHIP IN ELDERLY WOMEN WITH ADVANCED BREAST CANCER AND BONE METASTASES F. Lumachi1,V.Camozzi2,P.Ubiali3,A.DelConte4,S.M. Basso3 1University of Padua, School of Medicine, Department of Surgery, Oncology and Gastroenterology (DiSCOG), Padova, Italy, 2University of Padua, School of Medicine, P958 ® Department of Medicine, Padova, Italy, 3Department of SAFETY PROFILE OF ALLOB , AN ALLOGENEIC Surgery, General Surgery, S. Maria degli Angeli Hospital, OSTEOBLASTIC CELL THERAPY PRODUCT Pordenone, Italy, 4Medical Oncology, S. Maria degli Angeli S. Ena1,S.Pietri1, A. Colliou1, W. Sonnet1,T.Lienard1 1 Hospital, Pordenone, Italy Bone Therapeutics S.A, Gosselies, Belgium Objectives: Although breast cancer (BC) metastasizes pri- Bone Therapeutics is an advanced biotechnology company marily to the regional lymph nodes, distant metastases, includ- which develops innovative osteoblastic cell therapy products ing lung, liver, brain, and bone metastases (BMs) may also for the treatment of orthopaedic conditions. The company is develop. Metastatic bone disease seriously affects the overall currently evaluating its human allogeneic osteoblastic cell ® survival. The diagnostic value of serum bone tumor markers therapy product, ALLOB , in three Phase II proof-of- (TMs) in patients with BMs is still unclear. Unfortunately, it concept trials. Safety profile of ALLOB® was evaluated based seems that there are not reliable TMs to be recommended in on preclinical and clinical safety studies. during follow-up of patients with BC. The aim of this study Methods: A 6-month single dose GLP toxicity study was per- was to evaluate the relationship between bone alkaline phos- formed by intravenous injection of 2.5x106 ALLOB® cells phatase (BAP), osteocalcin, and insulin-like growth factor (n=15/sex) or vehicle (n=5/sex) in NMRI-Nude mice. Toxicity (IGF)-1 in a small group of patients with BC and BMs. evaluation included mortality, clinical signs, body weight and Material and Methods: The medical records of 15 elderly food consumption monitoring, urine, blood and bone marrow (older than 65 years) women (median age 69 years, range 66- analysis and histopathology of organs. In parallel, a ® 74 years) with advanced BC and BMs (confirmed with 18F- biodistribution study after a single administration of ALLOB FDG-PET) were retrospectively reviewed. All patients have at femoral fracture site was evaluated in NMRI-Nude mice using undergone regular measurement of several serum TMs, in- either SPECT-CT imaging between D1 to D7 (111In-oxinate cluding BAP,osteocalcin, and IGF-1. The assay methods were radiolabeling) or highly sensitive real time PCR targeting human automated spectrophotometric immunoassay, sandwich repetitive α-satellite DNA sequences performed on excised chemiluminescence immunoassay (CLIA), and sandwich organs/tissues at D1, D4, D7 and D14 (n=6/group). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S541 Clinical safety profile was evaluated in a Phase I/IIA open- definitions while assessing sarcopenia. The cut-off thresholds label clinical trial in the treatment of delayed-union fractures for muscle mass were defined as the mean-2SD of the values of long bones or interbody fusion. Safety evaluation was of the young reference study population. Low muscle mass was based on occurrence of AE/SAE, physical examination and defined as followings according to Baumgartner, Janssen and vital signs, laboratory measurements and patient open ques- FNIHa-b, respectively: appendicular muscle mass/height2 (kg/ tionnaires. Immunogenicity was also examined. m2), skeletal muscle mass/total body weight*100 (%), muscle Results: Single dose toxicity study demonstrated that over the mass/body mass index (kg/m2). Hypertension (HT), diabetes 6-month observation no safety concern related to ALLOB®. mellitus (DM) and increased waist circumference (IWC) Biodistribution study demonstrated that from D1 to D4, (Male–Female ≥102 cm vs. 88 cm, respectively) were used as ALLOB® cells localized mainly at the fracture site; at D7, the components of metabolic syndrome. ex vivo counting showed that 51±23% of radioactivity signal Results: Total of 970 community-dwelling outpatients between was present at fracture site in ALLOB® treated animals while 60 and 99 years of age. 303 (31.2%) were male and 667 (68.8%) less than 20% (17.3±2.3%) was observed in vehicle control were female. Mean age was 75±7.2 years. N=19 (%2), n=449 mice. Remaining radioactivity signal was localized in kidneys (%46,2), n=601 (%61,9), n=178 (%18,3) of total had lower- and liver. Detection of human DNA by real time PCR show muscle-mass according to Baumgartner, Janssen and FNIHa-b, that at D1 to D14, human cells stay localized at fractured site. respectively. N=309 (%31.8) had lower gait speed, 363 (%37.4) Only rare cells were detected in lungs and in heart at D1. had lower muscle strength, 479 (%49.3) had decreased muscle There was no drug related adverse event reported in patients functionality. Sarcopenia prevalences were 11 (%1,2), 220 followed up so far in the clinical program. No hypersensitivity (%22,6), 315 (%32,4), 106 (%10,9) according to Baumgartner, reactions were reported to the allogenic cells. Janssen and FNIHa-b, respectively. Prevalences of HT, DM, Conclusions: Preclinical and clinical studies document an increased WC were 25.3%, 75%, 65.6% respectively. In chi- excellent safety profile of ALLOB® and provide further sup- square analyses, lower-muscle-mass was associated with in- port for continued development in humans as osteoblastic creased HT and WC according to Janssen and FNIHa method- cell-based therapy. ology (p <0.05), while associated with only increased WC ac- cording to FNIHb methodology (p <0.001). According to Baumgartner methodology there was reverse-association be- P959 tween lower-muscle-mass and increased HT (p=0.055) and RELATIONSHIP BETWEEN SARCOPENIA AND WC (p <0.001). In functional parameters only decreased gait METABOLIC SYNDROME speed was associated with increased WC in MS components P. K. Kucukdagli1, G. B. O. Bahat Ozturk1,C.K.Kilic1,B.I. (p=0.03). According to Janssen methodology increased HT and Ilhan1,M.A.K.Karan1 WC were associated with sarcopenia (p=0.04 and p <0.001, 1Istanbul University Istanbul Medical School Department of respectively) while FNIHa-b methodology was associated with Internal Medicine Division of Geriatrics, Istanbul, Turkey only increased WC (p <0.001). Baumgartner methodology showed that sarcopenia is reverse associated with increased Objectives: Sarcopenia is a prevalent problem in the older WC (p=0.001). There was no association between DM and low- population that is commonly considered for its well known er-muscle-mass, gait speed, muscle strength and sarcopenia. adverse functional associations. Cardiovascular diseases and Conclusion: We observed that relationship between metabolic syndrome are also significant problems whose prev- sarcopenia and MS depends on the kind of definition in alence dramatically increase with age and remain the main sarcopenia. It seems that Janssen methodology has the highest cause of mortality in older adults. These two entities have re- prediction value in terms of MS in older population. cently been suggested to be inter-related and significant evi- dence has accumulated. Previous studies showed conflicting results which may depend on the differences in methodology P960 assessing sarcopenia. In this study, we aimed to investigate the TBS, VFA AND HANDGRIP IN A GROUP OF association between sarcopenia and metabolic syndrome com- POSTMENOPAUSAL WOMEN WITH VERTEBRAL ponents in terms of different sarcopenia methodologies. FRACTURE Methods: Community dwelling older outpatients were prospec- E. Czerwinski1, J. Amarowicz2,A.Kumorek3, M. Warzecha2 tively recruited from the geriatrics outpatient clinics of a univer- 1Department of Bone and Joint Diseases, Faculty of Health sity hospital for assessing hand grip strength and gait speed. Sciences, Jagiellonian University Medical College / Krakow Body composition was assessed by bioimpedance analysis. Medical Center, Krakow, Poland, 2Department of Bone and Musclestrengthwasassessedmeasuringhandgripstrengthwith Joint Diseases, Faculty of Health Sciences, Jagiellonian a Jamar hand dynamometer. We used Turkish population cut-off University Medical College, Krakow, Poland, 3Healthy points according to Baumgartner, Janssen and FNIHa-b Statistic, Krakow, Poland S542 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Objective: To evaluate the results of VFA, TBS and handgrip extension angles at the hip and knee in individuals with OP or test measurement in postmenopausal women. OPe while performing five daily activity tasks from the Safe Material and Methods: The study was conducted in a group Functional Motion test (SFM). of 36 women aged 49-95 years. All patients had been tested Methods: participants were recruited from an osteoporosis with the use of VFA, TBS (Hologic Horizon) and for handgrip specialty clinic and videotaped performing the pour, footwear, strength (Baseline SN 04201183). Vertebral fractures assessed newspaper, sweep, and sit-to-floor tasks of the SFM. Five by VFA were classified according to the Genant scale. raters used DartfishTM software to measure maximum flexion Statistical analysis of the results was performed by Statistica and extension angles at the hip and knee using the video of 12. each task. The inter-rater reliability of all the measurements Results: VFA results showed presence of fractures in 17 was assessed by intraclass correlation coefficient (ICC) and women (40% of the group). Most fractures were located in standard error of the mean (SEM). vertebra T7, Th12, T6 and Th8 (15; 13; 12; 10). Analysis of Results: Twelve participants (eleven females) with mean (SD) TBS in the research group showed significant abnormalities of age 64.7 (12.8) and femoral neck bone mineral density 0.61 bone microarchitecture. The average TBS result was 1,197, (0.07) were included. In all five tasks, knee measurements with only 2 patients having the proper TBS score (>1350). ICC and SEM values ranged from 0.23 to 0.95, and 1.75 to The results showed no statistically significant correlation be- 11.54 degrees, respectively and hip measurements ICC and tween the TBS, BMD, VFA and the number of fractures in SEM values ranged from 0.25 to 0.94, and 2.1 to 11.22 de- patients. Analysis of the muscle strength test showed that av- grees, respectively. erage score of the handgrip was 23.9 kg. Results showed a Conclusion: DartfishTM measurements of maximum knee correlation between handgrip and the value of TBS, however flexion angles in uni-planar tasks demonstrate a moderate to it was not statistically significant (R=0.44). The study demon- excellent degree of inter-rater reliability in patients with OP strated a statistical significant dependence between the num- and OPe, while measurements at the hip joint should be used ber of vertebral fractures (identified by VFA) and the result with caution. The inter-rater reliability was higher when mea- handgrip test (p<0.05). Another statistically significant corre- suring maximum knee angles for pour, newspaper, and sweep lation (R=0.79, p<0.001) between the number of fractures, tasks. In people with OP and OPe, DartfishTM in general is and decrease of growth recorded in patients. clinically feasible software for movement analysis and provid- Conclusions: There is a correlation between the number of ing immediate visual feedback for patient about their move- fractures (noticed by VFA) the handgrip results and the de- ment strategies. crease in growth. TBS results in the group of patients with vertebral fractures are generally low. P962 HI-SALT DIET INDUCES BONE LOSS P961 H. Y. Dar1,Z.A.Choudhary1,R.K.Srivastava1 INTER-RATER RELIABILITY OF DARTFISH Cell and Molecular Immunology Laboratory, Department of MOVEMENT ANALYSIS SOFTWARE FOR Zoology, School of Biological Sciences, Dr. H. S. Gour MEASURING MAXIMUM FLEXION AND Central University, Sagar, India EXTENSION AT THE HIP AND KNEE IN OLDER ADULTS WITH OSTEOPOROSIS AND OSTEOPENIA Objective: Recent studies suggest that high salt intake have the A. Negm1, T. Allen2, Z. Hollingham2, J. MacWhirter2,M. potential to modulate immune system by inducing generation Welsh2,J.D.Adachi3,N.J.MacIntyre2 of Th17 cells, leading to various immune disorders including 1Medicine, McMaster University, GERAS Centre, Hamilton, osteoporosis. Based on these findings we hypothesized to study Canada, 2Rehabilitation Science, McMaster University, the effect of high dietary salt intake on bone health. Hamilton, Canada, 3Department of Medicine, St. Joseph's Material and Methods: 8-10 weeks old thirty male mice Hospital, McMaster University, Hamilton, Ontario, Canada (under standard SPF conditions) in three groups were fed diets with Normal (0.8% NaCl), Lo salt (0.4% NaCl) and Hi salt Objective: Various methods are used to measure hip and knee (4% NaCl). After 45 days mice were sacrificed and analyzed joint motion angles, however their use is often limited by high for various parameters to access the role of high dietary salt cost, or inability to measure dynamic movements. The assess- intake on bone health by using various cutting edge technol- ment of movement patterns is clinically useful in individuals ogies such as SEM, AFM, μCT, FACS, ELISA etc. with osteoporosis (OP) and osteopenia (OPe) through its po- Results: Interestingly we found that high salt intake induces tential to optimize fracture risk assessment. This study aims to enhanced bone loss when analysed by SEM, AFM and μCT. evaluate the inter-rater reliability of using DartfishTM 2-D Both the cortical and trabecular bone histomorphometric pa- Motion Analysis Software to measure maximum flexion and rameters of high salt fed group were significantly reduced in Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S543 comparison to normal and low salt groups. Since Th17 cells Objective: To compare weekly vs. daily teriparatide therapy are the main culprits for enhanced osteoclastogenesis we in postmenopausal osteoporosis. Methods: Study: Open label looked at these cell populations in both primary and secondary non-inferiority In this prospective study 21 patients with PMO lymphoid organs. We observed that high salt intake signifi- were recruited and given the option for daily or weekly cantly induces the differentiation of RoRγt+ Th17 cells and teriparatide injections. Patients in group A were given 20 μg inhibit the differentiation of Foxp3+ Treg cells in both primary of teriparatide daily and in group B were given 60 μgweekly (thymus and bone marrow) and secondary (spleen and lymph for 1 year. BMD was measured at baseline and 12 months. node) lymphoid compartments. Also high salt intake leads to The bone formation marker, type 1 collagen C-terminal enhanced production of osteoclastogenic cytokines (IL-6, IL- propeptide (P1NP) and the bone resorption marker, C- 17 and TNF-α) and inhibits the induction of anti- terminal telopeptide of type 1 collagen (CTx) were measured osteoclastogenic cytokines (IL-10 and IFN-γ) in blood serum. at baseline, 6 weeks, 6 months, and 12 months. More importantly we found that the same was reversed in case Results: In the daily treatment group, BMD at lumbar spine of low salt intake group. and hip increased by 4.1% and 0.2% respectively. Serum Conclusion: Our results for the first time report the effect of P1NP levels increased significantly at 6th week, peaked at 6 high dietary salt intake on bone loss via modulating the bal- months and remained above the baseline at the end of 1 year. ance of Treg and Th17 cells. These results once again high- In the weekly treatment group, there was an increase in lumbar light the importance of environment in the form of high salt spine BMD of 3.1% after 1 year, PINP increased at 6 weeks intake on immune system ultimately leading to increased risk (39.96%), peaked at 6 months (69.24%) and remained elevat- of various inflammatory diseases such as osteoporosis. ed at 1 year (34.64%). CTx levels started decreasing in weekly Acknowledgement: UGC Start-Up grant to RKS for financial therapy, by 6.9% at 6 weeks, 62.08% at 6 months and support and DHGSU for infrastructural facilities. remained suppressed at 1 year (46.9%). There was no statisti- cal difference between two groups. Conclusion: Though, data was too small to be of any signif- icance intergroup comparison, but weekly Teriparatide thera- py was found to have achieved sustained anabolic bone win- dow and thus may be effective in treatment of PMO and bring down the cost of treatment making it a feasible option in poor countries. P964 UNDERSTANDING BETWEEN PHYSICIAN AND PATIENT WITH OSTEOARTHRITIS AS A KEY FACTOR IN INCREASING THE EFFECTIVENESS OF THERAPY L. Miasoutova1,S.Lapshina1,R.Mukhina2 P963 1Kazan State Medical University, Kazan, Russian Federation, COMPARISON OF EFFICACY OF WEEKLY VS. 2Clinical Hospital # 7, Kazan, Russian Federation DAILY TERIPARATIDE IN THE MANAGEMENT OF POSTMENOPAUSAL OSTEOPOROSIS Relevance: Effective long-term treatment of osteoarthritis N. Aggarwal1,V.Gupta2,S.Bhadada3, S. Aggarwal4 (OA) is possible with the active participation of the patient 1Department of Obstetrics, Gynecology, PGIMER, Chandigarh, in this process. At the same time, the patient and the doctor's India, 2Department of Endocrinology, Pgimer, Chandigarh, opinion on this issue are different, which determines the dif- India, 3Department of Endocrinology, Pgimer, Chandigarh, ficulty of effective communication and collaboration with re- India, 4Department of Orthopaedics, Pgimer, Chandigarh, India gard to treatment. Purpose: To identify the most significant problems for the Background: Teriparatide (daily subcutaneous 20 μg) has patient with osteoarthritis (OA) in order to create a system of been approved for the treatment of postmenopausal osteopo- effective interaction between physician and patient in future rosis (PMO). But the cost is prohibitively high and in coun- Materials and Methods: 50 patients with confirmed OA di- tries like India with limited personal resources may not be a agnosis (the average duration of the disease 12,45±5,53 years, feasible option. We tried to compare weekly vs. daily the average age of patients 49,5±15,82 years) responded to 10 teriparatide therapy in an effort to bring down the cost of questions concerning their relationship to the disease and the treatment if found efficacious. impact on the daily life with the need to evaluate the S544 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 importance of each question on a scale from 1 to 10. significantly higher than in men without CHD, 5.7±2.2 U/L Rheumatologists (n=10) and other physicians (n=40) an- and 2.9±4.6 pmol/L respectively (p<0.005). OС concentra- swered the same questions from their point of view, what is tions were higher in patients with CHD compared with the important for patients. Responses were ranked and compared. control group, without statistical significance Results: Physicians and patients opinions coincided in an- (p=0.118). With increasing severity of calcification averages swering the most important question - the forecast for the BAP and OC values were increased, however, significant dif- future in relation to the possibility of movement and overall ferences in the studied parameters found only in patients with health. The second most important for patients was the cost of severe calcification, and in its absence. Thus, in patients with treatment, the third - understanding the causes of the disease severe coronary artery calcification BAP concentration was and its consequences. Thereafter, patients worried about con- significantly higher than in patients without calcification, stant pain and the need to take drugs constantly and possible 24.2±13.0 U/L and 15.2±9.4 U/L respectively side effects. In contrast, doctors believed that patients are wor- (p=0.05). Similar results were obtained when assessing the ried about limitations in everyday life and disability, persistent concentration of OС: in men with severe calcification - 23.0 pain. To a lesser extent they are concerned about the causes of ±14.6 ng/ml, in the absence thereof - 14.7±7.6 ng/ml disease and the cost of therapy. (p=0.05). In assessing the concentration of cathepsin K signif- Conclusions: Understanding the patients opinion to their dis- icant differences were obtained in all the study groups ease will allow to restructure the communication with the (p>0.05). patient, educational programs for them. Physician must pay Conclusions: Increased rates of bone turnover markers is more attention to the explanation of the causes of disease, the characterized by high rates of bone loss in men with CHD, effectiveness and safety of therapy that will improve the qual- that is probably confirms the common pathophysiological ity of life of patients. mechanisms of bone resorption, atherosclerosis and vascular calcification. P965 STATUS OF BONE METABOLISM IN MEN WITH P966 CORONARY HEART DISEASE EARLY ANTI-OSTEOPOROSIS TREATMENT AND T. Raskina1, A. Voronkina2,M.Letaeva1,E.Maluta2,A. RISK OF MORTALITY AFTER HIP FRACTURE: A Kokov3,O.Hryachkova3, O. Barbarash3 POPULATION BASED STUDY 1Federal State Educational Institution of Higher Education C. W. Sing1,C.L.Cheung1 "Kemerovo State Medical University", Kemerovo, Russian 1Department of Pharmacology and Pharmacy, The University Federation, 2State Autonomous Healthcare Institution of Hong Kong, Hong Kong Kemerovo region "Regional Clinical Hospital of Emergency Medical Care", Kemerovo, Russian Federation, 3Federal State Objective: To evaluate the effect of early anti-osteoporosis Budgetary Scientific Institution "Scientific-Research Institute medications on the risk of mortality after hip fracture. of Complex Issues of Cardiovascular Disease", Kemerovo, Material and Methods: Data were obtained from the elec- Russian Federation tronic database in the Hong Kong Hospital Authority. Patients aged≥50 admitted with incident hip fracture (ICD-9 820.XX) Purpose: Rate indices of bone metabolism in men with coro- in 2005-2013 were followed for 30-, 180-, and 365-day all- nary heart disease (CHD). cause mortality. Patients who had cancer at baseline or during Materials and methods: The study involved 102 men aged follow-up period, and had exposure of anti-osteoporosis med- 51-75 years (60.8±6.9 years) with CHD, verified by coronary ications two years prior to hip fracture were excluded. The risk angiography. Assessed the concentration of osteocalcin (OC), of mortality in patients treated with anti-osteoporosis medica- bone alkaline phosphatase (BAP) and cathepsin K in serum by tions in the first 30-days of discharge was compared with enzyme immunoassay. Calcium index was determined by patients without the treatment during the follow-up period Agatston method, based on the value of calcium score using Poisson regression model, adjusted for age, sex, and assessed degree of coronary arteries calcification: 0 units. - comorbidity index. no calcification, 1-10 units. - minimal, 11-100 units. - moder- Results: 37,459 patients (mean age 81 years; 68.5% women) ate, 101-400 units. - increased calcification, more than 400 were included in the analysis. 2,117 (5.7%) patients were units. - pronounced calcification. The control group consisted treated with anti-osteoporosis medications in the first 30- of 20 healthy men (mean age 55.9±1.1 years) without clinical days of discharge. During the 1-year follow-up period, 5,266 and angiographic evidence of CHD. (14.9%) and 137 (6.5%) patients died in the non-treatment and Results: In patients with CHD the absolute value of BAP was treatment groups, respectively. Compared to the non- 23.0±12.7 U/L, cathepsin K - 18.3±23.2 pmol/L, which was treatment group, the risks of 30-, 180-, and 365-day all-cause Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S545 mortality in the treatment group were reduced with an adjust- an indirect indicator of low muscle mass-was observed in the ed relative risk (RR) of 0.29 (95% confidence interval, CI 15.8% of the cases. 0.17-0.50), 0.44 (95% CI 0.35-0.55), 0.50 (95% CI 0.42- Conclusion: Our results of study show that the sarcopenia 0.59), respectively. Among the anti-osteoporosis medications, prevalence of elderly people in our society is low which is bisphosphonate showed significant decreased risks of mortal- similar in other population; however, dynapenia and the low ity (adjusted RR 0.29, 95% CI 0.16-0.5; 0.39, 95% CI 0.30- level of walking speed are very common problems. 0.50; 0.43, 95% CI 0.36-0.53 for 30-, 180-, 365-day all-cause mortality respectively), whereas no significant decreased risk was observed in patients using non-bisphosphonate. The risks of mortality related to cardiovascular diseases (CVD) were further investigated and results were similar. Conclusion: An increasing risk of death after hip fractures has been well documented. Our study showed that early anti- osteoporosis medications associated with reduced risk of mor- tality, including CVD mortality, after hip fracture. A larger sample size is required to study the role of each individual anti-osteoporosis medications in mortality after hip fracture. P967 FATIH GERIATRICS TRIAL: HOW OFTEN IS SARCOPENIA, LOW MUSCLE MASS AND O. Y. Yilmaz1,E.K.Karapinar2, A. C. Celikyurt2,G.B.O. Bahat Ozturk1,C.K.Kilic1,S.A.Avci3,M.A.K.Karan1 1Istanbul University Istanbul Medical School Department of P968 Internal Medicine Division of Geriatrics, Istanbul, Turkey, PATIENT AND CLINICAL FACTORS ASSOCIATED 2Istanbul University Istanbul Medical School, Istanbul, WITH HOSPITAL LENGTH OF STAY AND Turkey, 3Istanbul University Cerrahpasa Medical School, DISCHARGE DESTINATION AMONG OLDER Istanbul, Turkey ADULTS WITH UPPER LIMB FRACTURES: A DATA LINKAGE STUDY EXAMINING HOSPITAL Objective: In this abstract, it is aimed to determine the prev- PATHWAYS alence of sarcopenia and its components in the elderly people S. Mathew1,K.Heesch1, S. McPhail2 who are evaluated by Fatih/Istanbul Province geriatric survey 1Queensland University of Technology, Brisbane, Australia, research. 2Queensland University of Technology and Metro South Methods: In the study, the sample changes from 63 to 101 Health, Brisbane, Australia years old people. Muscle mass is measured by bio impedance analyze (TANITABC532) and is evaluated by Baumgartner Objectives: This study examined several aspects of inpatient Index (skeletal muscle kg/ length2). According to our national care models for older adults hospitalized with upper limb frac- data, low muscle mass (the average of adult-2SD) and muscle tures, including patient and clinical factors associated with power threshold are determined for men and women: <9.2 kg/ hospital length of stay (LOS) and discharge destination. m2, 7.4 kg/m2 and <32 kg, <22 kg respectively. Also, Class 1 Materials and Methods: ICD-10 diagnosis codes from low muscle mass level is determined as 10,1 and 8,2 kg/m2. linked hospital records for adults aged >65 years admitted to The definition of sarcopenia is defined as low muscle mass public or private hospitals in Queensland (Australia) were (SMMI) and reduction of muscle function (OYH or strength used to identify patients hospitalized for treatment of proximal of muscle) by definition of EWGSOP. Additionally, calf girth is humerus, forearm and wrist fractures. Clinical pathways and noted. According to our national references, the low calf girth is demographic characteristics were described, and multi-level determined as being the diameter of calf girth lower than 33 cm. models (two-level random intercept, patients clustered Results: 204 cases (94 men, 110 women) were included in the within hospitals) was used to examine patient and clinical research. Median age was 74,5±7,3 years. The characteristics factors associated with LOS and discharge destination. and their distributions by gender are summarized in the Results: 5,141 unique patients (74% female, mean (SD) age Table 1. The prevalence of sarcopenia and its components 77 (8) years) with proximal humerus (n=2,096), forearm are by order: sarcopenia 5.3%, low muscle mass 9.8%, (n=2,401) or wrist (n=644) fractures from 150 hospitals were dynapenia 51.5%, low walking speed 25.6%. Low calf girth- identified. The most common mechanism of injury was falls S546 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 (n=3998, 77%) and the most frequent admission pathway was and 85% respectively. Pathogenetic therapy has been assigned via the emergency department (n=3,897, 75%). The median to all patients, initially 97.9% pts of the study group and (IQR) acute hospital LOS was 2 (1-6) days, n=2519 (49%) 92.5% in the control group began to take, after 6 months of received care on a specialty orthopedic ward. Most were continuous administration of drugs continued - 89.5% of the discharged directly home (n=3929, 76%), rather than trans- main group patients and 67.5% in control, after 12 months ferred to a hospital rehabilitation unit (n=527, 10%) or another commitment to therapy was 87.5% and 42.5% in the study acute hospital (n=525, 10%). Factors associated with longer and control groups. Densitometry results over time in 12 LOS (expressed as coefficient; 95%CIs) included older age months showed that the BMD gain was significantly (p (per decade 0.10; 0.08,0.13), cerebrovascular disease (0.21; <0.05) higher in the group that took a school for the patients 0.10,0.32), dementia (0.14; 0.09,0.19), COPD (0.22; 0.15, and was 5,6±6,2% at the spine, 4,2±4,5% at the femoral neck 0.29), rheumatoid arthritis (0.63; 0.47, 0.78), all p<0.001. in the basic group, 3,1±4,8% and 1,9±3,2% respectively and Younger patients (per decade -0.58; -0.68,-0.49), males in control group. (0.33, 0.15,0.51), shorter LOS (-0.05; -0.06, -0.03), forearm Conclusion: The educational program improves functional (0.62; 0.45, 0.78) or wrist (0.77; 0.49, 1.05) vs. humerus frac- status and quality of life, maintains a high compliance to re- ture and those without congestive heart failure (-0.52; -1.09, - ceiving drugs, increases adherence to treatment. 0.04) or dementia (-0.34; -0.61,-0.06) were more likely to be discharged directly home. Conclusion: Most older adults hospitalized with upper limb P970 fractures had a relatively short LOS and were discharged di- THE SYSTEM STATUS OSTEOCLASTOGENESIS IN rectly home. Several factors that may be used for identification MEN WITH ANKYLOSING SPONDYLITIS IN of patients at elevated risk of long stays, undesirable discharge DEPENDING ON RADIOLOGICAL STAGE outcomes and who may benefit from targeted clinical care O. Pirogova1, T. Raskina2,O.Malyshenko2 interventions have been identified. 1Regional Clinical Hospital of Veterans of Wars, Kemerovo, Russian Federation, 2Kemerovo State Medical Academy, Kemerovo, Russian Federation P969 EDUCATIONAL PROGRAMS FOR PATIENTS WITH Objective: To assess the state of the system osteoclastogenesis OSTEOPOROSIS IN CLINICAL PRACTICE in men with as, depending on the radiographic stage. R. Mukhina1,L.Miasoutova2,S.Lapshina2 Materials and methods: The study included 60 males: 40 1Clinical Hospital # 7, Kazan, Russian Federation, 2Kazan patients with diagnosis of as (according to modified new State Medical University, Kazan, Russian Federation York criteria 1984) and 20 men without AC. The average age of patients was 42.3+1.9 years, disease duration of An effective and long-term treatment for osteoporosis is not 11.2+5.3 years. To explore relationships between the indica- possible without active patient's right to participate in this tors of regulators osteoclastogenesis and radiological stage of process, which is required to carry out educational programs. the patients were divided into 3 groups: the first group includ- Objective: To evaluate effectiveness of educational interven- ed 3 patients with radiological stage II, the second 16 patients tions for patients with osteoporosis (OP). with radiographic stage III, in the third - 21 patients with Materials and methods: 48 patients with OP (main group) radiographic stage IV. Determination of OPG and RANKL have been trained in the school (5 lessons for a year), 40 were carried out by enzyme immunoassay using Elisa kit patients in the control group, who only came to the rheuma- Biomedica Gruppe (Austria). tologist consultation 4-5 times per year. The groups were Results: The concentration of OPG in patients with as with matched by sex, age, structure (primary and secondary) and different variants of the x-ray stage was significantly higher the severity of OP, the presence of fractures, the resulting than the control group. The lowest percentages are found in therapy. At baseline and after 6 months the intensity of back patients with II-nd stage of the radiological as – 3,65±0,14 U/l, pain (VAS), adherence to treatment were determined. At base- and the highest values determined in men with IV radiograph- line and after 12 months densitometry was performed. ic stage of as, where the concentration of OPG amounted to Results: After 6 months from the start of training intensity of 4.64±0,28 U/l (p=0,059). Levels of RANKL in patients with back pain significantly (p <0.01) decreased by 2.5 times in the as with different x-ray stage was not significantly different study group and 1.5 times in control, constantly wore a corset between themselves and with the control group. So, men with 52% of people from the main group, and 37.5% - in the con- II radiographic stage of as the level of RANKL amounted to trol. Calcium and vitamin D after 6 months continuously re- 0,26±0,06 pmol/l and patients with IV radiographic stage of as ceived 95.8% of the patients who have passed the school and – 0,21±0,03 (p=0,798), respectively. The ratio of OPG/ 90% of patients in the control group, after 12 months 93.7% RANKL was significantly higher in patients with AC IV Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S547 radiographic stage than in patients with II-nd and III-th x-ray Conclusion: Knee joint arthroplasty is an effective method stage. to improve functional capacity, pain relief in gonarthrosis Conclusion: The content of OPG and the ratio of OPG/ and reduces inflammatory activity. Joint function after RANKL in patients with as was significantly higher than in surgery and in the remote period is better for patients men without AC. High level of OPG and the relationship of receiving DMARDs compared to patients receiving corti- OPG/RANKL correspond to a late radiographic stage of as. costeroids. The increase in OPG level and the relationship of OPG/ RANKL in the patients examined may be due to the fact that the vast majority of patients (74%) had late (3 and 4) the stage P972 of the spondylitis. THE ASSOCIATIONS BETWEEN BONE MINERAL DENSITY AND MORTALITY IN ELDERLY MEN AND WOMEN FROM THE KOREAN LONGITUDINAL P971 STUDY ON HEALTH AND AGING (KLOSHA) KNEE ARTHROPLASTY RESULTS IN K. M. Kim1,S.Lim2,T.J.Oh2,J.H.Moon2, S. H. Choi2,H. RHEUMATOID ARTHRITIS PATIENTS WITH C. Jang2 SECONDARY GONARTHROSIS 1Department of Internal Medicine, Seoul National University S. Lapshina1,I.Akhtyamov1, L. Miasoutova1 College of Medicine and Seoul National University Bundang 1Kazan State Medical University, Kazan, Russian Federation Hospital, Seongnam-si, Kyunggi-do, Republic of Korea, 2Department of Internal Medicine, Seoul National Endoprosthesis is an effective method of pain relief and can University College of Medicine and Seoul National improve knee function in patients with rheumatoid arthritis University Bundang Hospital, Seongnam, Republic of Korea (RA). There remains the question of RA drug therapy in the perioperative period Good musculoskeletal condition is crucial component for el- Purpose: To review the results of knee arthroplasty depending derly health status. Osteoporotic fractures, especially hip frac- on the initial activity of the disease. tures, are closely related to increased risks of mortality. We Materials and methods: Knee replacement was done 54 RA aimed to examine the relationship between bone mineral den- patients (48 women, 6 men), mean age 49, 8±16,14 years. At sity and mortality in elderly men and women. We conducted a the time of the operation duration of the disease was 12,79 longitudinal, population based elderly cohort study. ±6,18 years, high activity (DAS28) - in 26%, moderate - in Biochemical parameters and clinical histories were compre- 55.5%, low - 18.5% of patients. 44 (81.5%) pts continued to hensively accessed as baseline evaluation from 2005-2006. take basic anti-rheumatic drugs (DMARDs), 22 (40.8%) pts Bone mineral density was measured at lumbar spine, femur received steroids, including in combination with DMARDs - neck and total hip using dual energy X-ray absorptiometry, 10 (18.6%). Before the operation, and after the 6 months es- and the study subjects were further stratified according to their timated joint pain (VAS), disease activity - DAS28, functional region-specific T-score, normal BMD, osteopenia and osteo- capacity index HAQ were evaluated. In 28 patients the same porosis. Mortality was recorded during 9-year follow up. A parameters were assessed after 12 months. total of 319 men and 330 women aged 65 year or older were Results: Decrease in pain intensity on the VAS was ob- included. Mean age and BMI were 73.8±7.8 and 23.9±3.2 in served in the first month after knee arthroplasty, after 6 men, and 73.2±7.3 years and 24.4±3.4 kg/m2 in women. months the pain (VAS) decreased almost to 31.9 mm (p Seventy-four men (23.2%) and 50 women (15.2%) died dur- <0.05). ing 9-year follow-up. Compared to survived group, subjects Disease activity decreased with HAQ index 1,68±0,94 to 1,15 who deceased were older, had lower BMI and lower serum ±0,73 (p <0, 05). After 12 months, VAS was 25,4±±11,8 mm, albumin level in both men and women. These individuals had HAQ - 1,06±0,63. 6 months after surgery evaluation showed lower BMD at the LS, FN and total hip. In a multivariate cox that VAS in patients treated with corticosteroids (n=22) was - proportional hazard model, osteopenia and osteoporosis at 44,2±16,2 mm, receiving DMARDs without corticosteroids femur neck were significantly related increased risk of mor- (n=32) -35,4±12,1 mm (p <0.05), after 12 months VAS was tality compared to subjects with normal BMD in men 30,8±10,6 mm and 21,3±9,6 mm (p <0.05), respectively, in (Osteopenia: HR 2.090; 95% CI 1.01-4.32; p=0.046 and groups. Significantly (p <0.05) was observed than the positive Osteoporosis: HR 4.15; 95% CI 1.23-13.9; p=0.022). In wom- dynamics in relation to the functional capacity of patients in en, subjects with osteopenia or osteoporosis also showed the group receiving DMARDs with corticosteroids (HAQ 6 higher risk of mortality, but without statistical significance. months -0,98±0,64, 12 months- 0,89±0,56) compared with In conclusion, lower BMD was associated with increased risk patients receiving basic therapy without corticosteroids of mortality in elderly, but this association appeared to be (HAQ 6 months -1,23±0,69, 12 months- 1,14±0,61) stronger in men. S548 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P973 continued to take basic anti-rheumatic drugs (DMARDs) (metho- THREE-DIMENSIONAL CT RECONSTRUCTION IN trexate at a dose of 10-20 mg per week - 32, leflunomide (20 mg THE IMAGING OF ACETABULAR AND PELVIC daily) -5). Corticosteroids (prednisone at a dose of 5-15 mg, an FRACTURES average of 7.1 mg per day) - 25 (46.2%) patients, of which in A. Venter1,F.Cioara1, O. Straciuc1, A. Pirte1 combination with DMARDs - 10 (18.6%). Before the operation, 1University of Oradea, Faculty of Medicine and Pharmacy, and after the 6 months joint pain (VAS), disease activity - DAS28, Oradea, Romania functional ability HAQ index were evaluated. In 32 patients, these same indexes were estimated after 12 months. Purpose: To assay the relevance of 3D CT reconstruction in Results. The reduction of pain intensity VAS was observed in radiological assessment of problem pelvic and acetabular fractures. the first month after a joint arthroplasty, after 6 months VAS fell Material and method: For the period 2012-2016 3D recon- almost to 31.8 mm (p <0.05). Activity of the disease decreased struction was performed in 92 patients with fractures of ace- (high - 11.2%, moderate - 44.4%, low - 44.4%), HAQ - from tabulum and pelvic ring. Plain radiographs and standard CT 1,61±0,41 to 1,09±0,26 (p <0, 05). After 12 months HAQ - 1,01 scan were obtained as well. There were 64 isolated acetabular ±0,28. The analysis showed that in patients not receiving corti- fractures, 15 pelvic ring disruptions and 13 simultaneous ace- costeroids (n=29) arthroplasty was conducted in 13,6±3,2 years tabular-pelvic. The pelvis was examined with Optima GE 16 after RA onset, and receiving long-term steroids (n=25) signifi- CT machine with 5 mm collimation and 0,5 pitch. cantly earlier (p <0,05) - through 9,9±3,5 years. The functional Results: In 20 acetabular(26%),4 pelvic(15,3%) and 7 com- capacity of patients in the group receiving DMARDs without bined(55%) injuries additional lesions were detected after 3D corticosteroids (n=29) (the HAQ 6 months - 0,9±0,24, 12 months reconstruction. In respect to acetabulum most of such features - 0 81±0,16) was significantly (p <0.05) higher compared with (N=14,23%) were discovered in complex fracture patterns, in patients receiving corticosteroids (n=25) without the basic treat- particular in anterior column/posterior hemitransversal and ment (HAQ 6 months -1.13±0.21, over 12 months- 1,24±0,19). both column types. In 8 cases the preoperative planning was Conclusion: Large joints arthroplasty is an effective method changed due to 3D findings. In pelvic ring fractures additional to improve the functional capacity of patients with RA. For lesions revealed by 3D investigation did not affect the prelim- patients receiving corticosteroids need of arthroplasty arises a inary conclusions on fracture type and stability. In 5 of 7 few years earlier. The function of the joints after surgery and in combined injuries information obtained by 3D reconstruction the remote period is better when patients continuously receive concerned acetabular component. In all but one operatively DMARDs compared to steroid therapy, the dose should be treated fractures 3D information was proved during surgery. reduced to a reasonable minimum for the time of surgical Conclusions: 3D reconstruction is found to be of essential value treatment. in imaging of complex acetabular fractures and should be used routinely in evaluation of these injuries. Though in pelvic ring and simple acetabular fractures 3D imaging shows no consider- P975 able diagnostic advantages comparing to plain films and stan- ASPECTS OF PREVENTION LIMITING PHYSICAL dard CT, it is helpful to clarify the stereometry of the injury and PERFORMANCE IN ELDERLY PATIENTS WITH some fracture details and may be performed in selected cases. OSTEOPOROSIS L. Vicas1, F. Cioara1, C. Nistor Cseppento1, M. L. Cevei1 1University of Oradea, Faculty of Medicine and Pharmacy, P974 Oradea, Romania QUESTIONS OF RHEUMATOID ARTHRITIS DRUG THERAPY IN THE PERIOPERATIVE PERIOD OF Getting older often is accompanied by a progressive decline LARGE JOINTS ARTHROPLASTY, ITS IMPACT ON resulted from complex interactions among different age and THE LONG-TERM RESULTS OF SURGERY pathological aspects on multiple systems, resulting in a con- S. Lapshina1,I.Akhtyamov1, L. Miasoutova1 stellation of signs and symptoms that are classified as geriatric 1Kazan State Medical University, Kazan, Russian Federation syndromes. At the elderly persons, there are decreased strength, muscle mass and volume, decrease attributed to the Aim: To analyze the results of large joints arthroplasty depend- disappearance of muscle fibers and qualitative changes of ing on the received rheumatoid arthritis (RA) drug therapy. contractile properties. These are troubling costly health and Materials and methods: Knee and hip joints arthroplasty was social assistance. performed for 54 RA patients (48 women, 6 men), mean age 51,4 Objective: To highlight aspects of dependency prevention ±12,8 years. At the time of the operation disease duration was 11,8 and recovery of elderly patients, how it participates in an ±3,8 years, high activity (DAS28) - in 26%, moderate - in 55.5%, exercise program that will help improve their quality of the low - at 18.5% patients. At the time of surgery 39 (72.2%) pts life. The study evaluated the effectiveness of physical Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S549 therapy program tailored to the clinical aspects mentioned P976 and it tried to define the difficulties in implementing pro- OSTEOPOROSIS AND FRACTURES AMONG grams for physical therapy. RESIDENTS WITH DEMENTIA IN NURSING Material: The study was conducted over a period of one year HOMES: WHICH RESIDENTS HAVE THE on a sample of 40 patients with a mean age of 76.2 years, GREATEST RISK FOR FRACTURES? patients who followed courses of recovery resort and at home. R. L. van Bezooijen1, N. M. Appelman-Dijkstra2,N.A.T. Geriatric syndromes were frequent, like: lower limb osteoar- Hamdy2,V.G.M.Chel3, W. P. Achterberg3 thritis, osteoporosis, sarcopenia, balance disorders, neurolog- 1Florence Health and Care, The Hague, Netherlands, 2Center ic, psychiatric disorders and incontinence. Psychiatric disor- for Bone Quality, Leiden University Medical Center, Leiden, ders include a wide range from mild to psychotic mental Netherlands, 3Department of Public Health and Primary Care, changes involution. Leiden University Medical Center, Leiden, Netherlands Methods: Patients were treated based on specific hydrokinetotherapeutic means at Felix spa resort alongside Objective: 50-80% of nursing home (NH) residents have os- drug therapy for associated diseases. During the program, in teoporosis (OP) and±40% have had a fracture, while only±6% different periods, the treatments were discontinued or modi- receives OP medication. The objective was to survey the sit- fied at various functional levels because of events such as uation on OP among NH residents with dementia only and fractures or intercurrent infections. Therapeutic options aimed whether patient characteristics upon admission can predict at reducing the risk of falls and fractures, through action on fracture risk. health-related and environmental factors that can be influ- Material and methods: A retrospective medical record study enced. Another aim was to create harmonious relations with collecting patient characteristics, OP medication and fractures family or entourage. We conducted tests to identify patients at upon admission and during stay in 9 NH in The Netherlands. risk for falling. This functional test emphasizes reduced lower Student T-test or Pearson Chi-Square test were used to access limb functionality, a factor favoring falls (Standing Tandem, differences between groups for numerical and categorical da- Up and Go, Chair Rising Test). We evaluated the stability, ta, respectively. P<0.05 was considered significant. balance and coordination (test Berg) and rating scales auton- Results: 226 residents were included; mean age 84 years. omy (IADL ADL). We evaluated the quality of life and ap- Mean duration of stay in NH was 2.5 years, 77% was female, plied a Satisfaction questionnaire to family. For quantitative and 70% was able to walk. 15% had the diagnosis OP in their comparison of the mean values of the variables we used medical record, while 39% had had an OP fracture. 91% of Student t-test and calculating correlations between the rows them received vitamin D supplements, 14% calcium supple- of values of quantitative variables we used Pearson correlation ments and 5% bisphosphonates. coefficient. The year incidence for an OP fracture was 6.6% (none-verte- Results: Physical condition has improved in patients involved bral fractures 5.9% and hip fractures 4.1%). Vertebral fractures in self-care actions and actions to decrease functional depen- were hardly reported (0.7%). Women had more often a none- dence. Balance disorders, falls, fractures, very protective fam- vertebral or hip fracture (p=0.045 and p=0.027, respectively) ily circle have had a negative impact in some parts of the study and residents with secondary OP more often had a hip fracture which highlights the improvements are minimal fitness. Even (p=0.040). Residents who had had an OP fracture during their if we noticed improvements in overall muscle functionality, stay tended to have a higher FRAX score upon admission for non decreasing number of falls depend largely on the greater none-vertebral (p=0.086) and hip fractures (p=0.107), respec- mobility of these patients, especially the ambient challenges of tively. Garvan score upon admission, however, predicted the their social status. The risk of falling is great for the patient who actual observed OP fractures better than FRAX score (ob- lives alone. Patients with peripheral vestibular syndromes or served OP fractures in 2.5yr=16.4%; FRAX 10yr=13.4%=> sensory ataxias had fewer failures although they have a higher 2.5yr=3.4%; Garvan 5yr=27.7%=> 2.5yr=13.9%) functional dependency. A noteworthy factor in this group was Conclusion: OP fractures are common and clinical vertebral backing permanent family for these patients. Severe impact fractures are hardly recognized at psychogeriatric wards in that changes family status creates psychotraumatizing situa- Dutch NH. For residents with secondary risk factors and a high tions (leaving children, restricting housing conditions, leaving fracture risk it is, therefore, important to consider additional home, the death of one partner etc.). fracture prevention besides standard vitamin D supplements. Conclusion: Balance problems have a negative impact on pa- tient recovery and elderly. Statistically significant improve- ments global highlighting short temporal functionality break P977 during the study. The variety of social factors influence the GERIATRIC STUDY IN THE DISTRICT OF FATIH: functional status and quality of life. The risk of falling is greater SARCOPENIC OBESITY IN THE ELDERLY in alone patients, neglected and functionally dependent. POPULATION − HOW FREQUENT? S550 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P. K. Kucukdagli 1,C.C.Cimen2,Y.Y.Yavuz2,G.B.O.Bahat Background: Now is important to study new potential Ozturk3,C.K.Kilic3, S. A. Avci4,M.A.K.Karan3 markers of response to treatment in rheumatoid arthritis 1Istanbul University Istanbul Medical School Department of (RA). DNase activity of the blood serum may be useful in this Internal Medicine Division of Geriatrics, Istanbul, Turkey, context. Changes of serum DNase activity in the RA treatment 2Istanbul University Istanbul Medical School, Istanbul, by biological agents previously have been not investigated. Turkey, 4Istanbul University Cerrahpasa Medical School, Objectives: To study the dynamics of DNase serum activity Istanbul, Turkey and other clinical and laboratory parameters during the RA treatment by rituximab (RTX). Aim: To determine the prevalence of sarcopenic obesity in the Methods: 12 RA patients were involved in the study. All elderly population of the Fatih District that take part in this patients fulfilled the EULAR / ACR 2010 RA criteria. 11/12 geriatric screening survey. patients received 4 infusions of RTX at a dose of 1000 mg Materials and methods: Bioelectrical-impedance- analysis according to standard protocol: at 0th and 2th week, and after (BIA) (TANITA-BC532) was used to measure the muscle 24 weeks at 0th and 2th weeks. 1/12 patient received 2 infu- weight. The muscle mass was evaluated with Baumgartner sions of RTX 500 mg at 0th and 2th week. All patients received index (skeleton muscle weight/height 2). Low muscle weight synthetic DMARDs therapy by methotrexate (10-15 mg (average of young adults-2SD) and the threshold for muscle weekly), some of them received glucocorticoids (methylpred- strength are evaluated as the following according to our na- nisolone 4-8 mg daily) and non-steroidal anti-inflammatory tional data -men and women respectively, low muscle weight: drugs. Prior to treatment by RTX patients did not receive <9.2 kg/m2 vs. 7.4 kg/m2; <32 kg vs. <22 kg. In addition, any biological agents. To determine the DNase activity of value of class-1 low muscle weight was determined as 10.1 serum the method of rivanol clot was used. DNase activity and 8.2 kg/m2. The definition of sarcopenia was determined was measured in serum samples before 1st RTX administra- through EWGSOP algorithm and reduction of low muscle tion, at 8-12 weeks after the 1st RTX administration, at 24 and weight (SMMI) and muscle functions (OYH or muscle 36 weeks of treatment. strength). The definition of obesity was evaluated through Results: At week 24, ACR70 improvement reached 41.67% two alternative procedures, which are recommended by the (5/12) of the patients, ACR50 16, 66% (2/12) of the patients, literature as Zoico methodology: the percentile of fat belong- ACR20 - 41,67% (5/12) of patients. At 24 weeks of treatment ing to elderly population is ≥60 or WHO definition: BMI ≥30 by RTX75% (9/12) of patients achieved remission (SDAI 3,3), kg/m2. 25% (3/12) - a low disease activity (3,3 P979 patients with PsA and OP had positive impact on the dynam- EFFECT OF BISPHOSPHONATES ON THE ics of the BMD. DYNAMICS OF BONE MINERAL DENSITY IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH METHOTREXATE P980 O. Samakhavets1, E. Rudenka2,A.Buglova3, A. Rudenka4,L. VALIDATION OF AN MALE MODIFIED Aliachnovich3 OSTEOPOROSIS SIMPLE TOOL FOR TAIWAN 1Minsk City Clinical Hospital, Minsk, Belarus, 2Belarusian (MOSTAI) TO IDENTIFY PRIMARY State Medical University, Minsk, Belarus, 3Belarusian OSTEOPOROSIS IN TAIWAN MEN Medical Academy of Postgraduate Education, Minsk, D.-H. Liu1, P.-C. Wu2 Belarus, 4Belarusian Medical Academy of Postgraduate 1Department of Physical Medicine and Rehabilitation, Shin Training,Minsk,Belarus Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Province of China, 2Division of Chinese Internal Medicine, Objective: To evaluate the influence of antiresorptive therapy Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical on the dynamics of bone mineral density (BMD) in patients Foundation, New Taipei City, Taiwan, Province of China with psoriatic arthritis (PsA) treated with methotrexate (MTX). Objective: Validate the effectiveness of the Male Modified Materials and methods: 62 patients (31 men and 31 women, Osteoporosis Simple Tool for Taiwan (MOSTAi) in identify- mean age 47.2 (8.4) years) with diagnosed PsA according to ing primary osteoporosis in Taiwan men. CASPAR criteria, treated with MTX at doses 15-22, 5 mg / Material and Methods: A bus, equipped with Dual-energy week, were enrolled in the study. Determination of BMD in X-ray absorptiometry(DXA), serving for country-wide BMD lumbar spine (LS, L1-L4) and proximal femurs (PF) was per- test was available between 2008 and 2011. Participants must formed by dual-energy X-ray absorptiometry (“LUNAR complete a questionnaire regarding risk factors of osteoporotic Prodigy”, GE, USA) at study entry and after 12 months. fracture in FRAX® tool before BMD test. The participants are Evaluation of serum calcium, levels of markers of bone re- men (≧50y/o). The participants with a disorder strongly asso- sorption β-Cross laps (conducted by the method of ciated with secondary osteoporosis must be excluded. These electrochemiluminescence (Cobas e411, Roche Diagnostic)) include type I DM, osteogenesis imperfecta, hyperthyroidism, was performed before treatment and after 6 and 12 months. rheumatoid arthritis, liver cirrhosis and steroid use over 5mg Results: Low BMD was found in 58% (n=18) of men with daily more than 3 months. Osteoporosis was defined as lowest PsA, among them osteoporosis (OP) was diagnosed in 32% T-score≦-2.5 at any sites, including lumbar spine(L1 ~ L4), (n=10) and low bone mass (osteopenia) in 24% (n=8). In 52% total hip, femoral neck. We performed MOSTAi (MOSTAi (n=16) of women with PsA decreased BMD was observed: index=0.3 x Weight (kg) - 0.1 x Age (year), cutoff value: OP in 26% (n=8), osteopenia in 26% (n=8). The level of β- 11) to determine the sensitivity, specificity, and area under Cross laps at baseline was 0.370 [0.209; 0.534] ng/ml, total the receiver operating characteristic curve (AUC) for correctly calcium 2.51 (0.18) mmol/L, which corresponded to the ref- selecting men with primary osteoporosis. erence values. There were no any statistical significant differ- Results: A total of 1997 men (mean age: 69.85±9.53 years) ences between levels of β-Cross laps and serum Ca at baseline were enrolled in this study. Of the study subjects, 324 met the and after 6 and 12 months of antiresorptive therapy. For the definition of osteoporosis (16.2%). According to the previous correction of osteopenia PsA patients were prescribed Ca sup- Taiwan study, we select 11 as the cut-off value in MOSTAi. plements at a dose of 500 mg/day and cholecalciferol 1000 IU The AUC of the MOSTAi to identify osteoporosis in the fem- per day. In patients with OP bisphosphonates were adminis- oral neck, total hip, and lumbar spine were 0.742(95% confi- tered (alendronic acid 70 mg / week or 150 mg of ibandronic dence interval (CI95): 0.705-0.779), 0.824 (CI95:0.775- acid / month) for 12 months. The positive dynamics of BMD 0.873), and 0.676 (CI95:0.634-0.719) respectively. The was determined in all patients at all measured skeletal sites: AUC, sensitivity and specificity of the MOSTAi index (cutoff L1−L4 before treatment 1,002 (0,118) g/cm², after treatment value=11) to identify primary osteoporosis in healthy men 1,036 (0,104) g/cm² (р<0,05); total femur before treatment were 0.708 (CI95:0.676-0.740), 63.6% and 71.0%, 0,899 (0,104) g/cm², after treatment 0,913 (0,125) respectively. g/cm²(р<0,05). Conclusion: The MOSTAi may be a simple and effective pre- Conclusion: In patients with PsA treated with MTX and hav- screening tool for identifying the risk of primary osteoporosis ing osteopenia use of calcium and cholecalciferol at doses of in Taiwan healthy men. 500 mg and 1,000 IU, respectively, lead to improvement in Acknowledgements: The authors would like to thank Taiwan BMD after one year follow-up examination. Intake of Osteoporosis Association for offering the data and authorizing bisphosphonates, calcium supplements, cholecalciferol in the data management. S552 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 vitality subscores of SF-36 (p<0.05) was noted in the group treated with PRP. One patient included in PRP group had arthroplasty after first injection and lost follow up. None of the patients in the control group had arthroplasty. Clinical improvement in WOMAC (Pain, stiffness and function) and SF-36 subscores were statisti- cally significantly better in PRP group. Conclusions: Studies with larger sample size and longer follow-up period are needed to evaluate whether PRP injec- tion delays arthroplasty, but our findings suggest that PRP treated patients have better clinical status and quality of life in severe knee OA patients. References: 1-Gobbi A et al. Knee Surg Sports Traumatol Arthrosc 2015;23:2170 2-Jang SJ et al. Eur J Orthop Surg Traumatol 2013;23:573 3-Bottegoni C et al. Ther Adv Musculoskelet Dis 2016;8:35 4- Sánchez M et al. Expert Opin Biol Ther 2016;16:627 5-Sánchez M et al. Arthrosc Tech 2014;3:e713 P981 P982 EFFICACY OF PLATELET RICH PLASMA (PRP) IN FATIH PROVINCE − GERIATRIC STUDY: SEVERE KNEE OSTEOARTHRITIS: CAN PRP FRAGILITY AND CONTRIBUTING FACTORS IN INJECTIONS DELAY ARTHROPLASTY? OLD POPULATION LIVING THE COMMUNITY O. Akan1, N. Ölmez Sarıkaya1, H. Koçyiğit1 P. K. Kucukdagli1,S.G.Gonultas2,A.E.Ersoy2,G.B.O. 1Department of Physical Medicine and Rehabilitation, Katip Bahat Ozturk3,C.K.Kilic3,S.A.Avci4,M.A.K.Karan3 Çelebi University Atatürk Training and Research Hospital, 1Istanbul University Istanbul Medical School Department of Izmir, Turkey Internal Medicine Division of Geriatrics, Istanbul, Turkey, 2Istanbul University Istanbul Medical School, Istanbul, Objectives: PRP is known to be effective in patients with Turkey, 4Istanbul University Cerrahpasa Medical School, early knee osteoarthritis (OA) (1-2). The efficacy of PRP in- Istanbul, Turkey jections in severe knee OA patients is under question (3-5). The aim of this study is to determine efficacy of PRP in pa- Aim: To investigate fragility prevalence and contributing fac- tients diagnosed with severe OA and whether injection of PRP tors among the old population living in Fatih/Istanbul delays arthroplasty. province. Material and Methods: The study included 60 patients who Material and methods: Age range of 60–101 were taken were diagnosed as severe knee osteoarthritis. All patients had into the study. The fragility screened with FRAIL-ques- Kellgren-Lawrence grade IV radiological changes. The pa- tionnaire, functional capacity measurement with KATZ- tients were randomised into PRP and control groups. One cc Activities-of-Daily-Living-Scale(ADL) and LAWTON- of PRP was obtained from 20 cc of venous blood after double BRODY-Instrumental Activities–of-Daily Living Scale centrifugations at 400g for 10 minutes. The patients in PRP (IADL), quality of life measurement with EQ5D-question- group received 3 injections of PRP at 3-week intervals. Both naire, cognitive status with Mini–Cog-test, depression PRP and control groups were given home exercise program. with GDS-SF, malnutrition with MNA-SF, balance and Clinical improvement was evaluated using Western Ontario gait with Romberg-test and postural-instability test, were and McMaster Universities Arthritis Index (WOMAC) ques- evaluated accordingly. We measured muscle mass with tionnaire, SF-36 and visual analog scale (VAS) in all patients bioimpedance analysis (TANITA-BC532). We evaluated at 0, 3 and 6 months follow-up visits. In one year follow up all muscle mass using Baumgartner index (skeletal muscle patients were called and asked for history of arthroplasty. kg/length2). According to our, low muscle mass(young Results: Statistically significant improvement in all adult average-2SD) and muscle threshold values national WOMAC parameters (pain, stiffness, physical function) data, low muscle mass values are=60 percentile among (p<0.05) and physical function, physical role, pain, social old case population values (Zoico methodology) or BMI function, emotional role, mental health, general health and ≥30 kg/m2 (WHO definition). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S553 Results: We included 204 old cases(94 male–110 female). underwent curative total or subtotal gastric resection between Average age:75,4±7,3 years.30.4% of the cases were nor- 2004 and 2013, and had survived at least 2 years without mal,42.6% were prefrail and 27% were frail. There significant disease recurrence. Bone mineral density and presence of frac- differences in these groups in terms of age/number of diseases/ tures were assessed by X-ray. 25 (OH) Vitamin D and serum drugs/hand grip strength/daily life activities/EGYA/cognitive markers of bone metabolism were assessed also. All patients state/SÇT (p=0.001) /MNA/ GDS/Eq-5D score and health were asked about osteoporosis risk factors and previous non- state subjective scoring (p <0.001); BMI (p=0.032), OYH fragility fractures, height decrease, and back pain. Dietary (p=0.03), BIA-fat (p=0.021) and muscle mass (p=0.019). On calcium intake was estimated using a weekly food-intake fre- the other hand, there were no significant differences in calf quency questionnaire. Patients with 25-(OH)-vitamin D ≤ 30 diameter (p=0.25, visceral fat level (p=0.71). While there were ng/mL at baseline received 16 000 IU of vitamin D3 every 10 significant differences between the fragility groups, in terms days during the one-year follow-up. of presence of malnutrition/fear of falling/UI/chronic Results: Forty patients were included in the study. Mean time pain/Romberg’s sign/postural instability/ambulation level/ from surgery was 48.9 (24-109) months. Vitamin D insuffi- presence of depression (p <0.001)/ dementia (p=0.001)/falling ciency and secondary hyperparathyroidism were observed in in past year (p=0.011) and sex (p=0.004), there were no sig- 38 (95%) and 20 (51%) patients, respectively. Densitometry nificant differences in presence of diabetes (p=0.90), hyper- showed osteoporosis in 14 women and 7 men and prevalent tension (p=0.065, fecal incontinence (p=0.10). In regression fractures in 12 women and 6 men at baseline. After 3 months analysis, independent factors to fragility were (dependent var- of vitamin D supplementation, 35 (87.5%) patients reached iable fragility (robust vs. prefrail + frail), independent vari- values of 25-(OH)-vitamin D over 30 ng/mL. After 12 ables: age, sex, disease and drug number, muscle strength, months, 38 (95%) patients were in the normal range of egya and EQ-5D scores; cognitive dysfunction-depression, 25-(OH)-vitamin D. iPTH levels decreased after vitamin D MN, falls, presence of chronic pain) drug number intervention. Mean levels were 58.6±33.0, and only 11 (OR=1.24, p=0.036), cognitive dysfunction (OR=0.3, (27.5%) patients maintained concentrations >70 pg/mL at 3 p=0.016), EQ-5D (OR=1.53, p=0.017). months Conclusion: Our study is a strong study in multiple factors are Conclusion: Oral administration of high doses of vitamin D is taken into account regarding fragility. Our results indicate that easily implemented and restored 25-(OH)-vitamin D and multiple drug usage, cognitive-dysfunction and low-life- iPTH values, which are frequently disturbed after gastric can- quality perception are related major factors regarding fragility. cer resection. P983 P984 VITAMIN D SUPPLEMENTATION USING AN EASY THE IMPORTANCE OF A SUPPORT GROUP IN ADMINISTRATION SCHEME IN LONG-TERM IMPROVING QUALITY OF LIFE AND WELL SURVIVORS AFTER GASTRIC CANCER BEING IN PATIENTS WITH OSTEOPOROSIS RESECTION D. M. Farcas1,A.I.Gasparik2,F.Marc3,C.Suteu3,L. X. Nogués1,M.Climent2,I.Aymar2,J.M.Ramón2,L. Sachelarie4 Grande2,A.Diez-Perez1, M. Pera2 1Physical Rehabilitation Department, University of Oradea, 1Internal Medicine Department, Parc de Salut Mar, Faculty of Medicine and Pharmacy, Oradea, Romania, Universitat Autònoma de Barcelona, IMIM (Hospital del 2ASPOR, University of Medicine and Pharmacy, Tirgu Mar Research Institute), Red Temática de Investigación Mures, Romania, 3University of Oradea, Faculty of Cooperativa en Envejecimiento y Fragilidad (RETICEF), Medicine and Pharmacy, Oradea, Romania, 4University Instituto de Salud Carlos III FEDER, Barcelona, Spain, Apollonia, Iasi, Romania 2Gastrointestinal Surgery and 2Service of Internal Medicine, Hospital del Mar, Hospital del Mar Medical Research Institute Aim: To assess quality of life and some psychological factors (IMIM), Universitat Autònoma de Barcelona, Barcelona, in patients with osteoporosis. Spain Material and methods: Our study consisted in patients wom- en with osteoporosis from Oradea, Romania. The patients Objective: Bone disease in long-term survivors after gastric were divided in three groups. The first group was the support cancer resection has received little research attention. This group ASPOR. It belongs to Association for Prevention of study aimed to investigate bone health after curative resection Osteoporosis in Romania, consisted in 25 women with osteo- of gastric cancer. porosis. The second group, was the placebo group, consisted Patients and methods: We selected from our prospectively in 25 patients with osteoporosis, not included in a support maintained database all patients with gastric cancer who group. The third group, the control group, consisted in 25 S554 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 patients with osteoporosis, sedentary, also not included in a (BMD) and corresponding OS-derived BMD values. At a later support group. The inclusion criteria were: fulfilling the WHO stage, all those cases presenting a typical DXA error as iden- criteria for osteoporosis, complying with the principles of tified by recent literature (e.g., incorrect patient positioning, medical ethics. The exclusion criteria were: severe diseases, presence of artifacts, improper image segmentation, etc.) [2] noncompliance. The mean age in the ASPOR group was of were excluded from the analysis and the actual diagnostic 63.24±4.96, in the placebo group of 64.96±4.74, and in the accuracy of the EchoSound approach was re-assessed by con- control group of 64.04±4.97. In all three groups educational sidering only those patients having a reliable DXA report. level were almost similar. All the subjects from the three Results: Considering all the DXA reports, an overall accuracy groups were measured for osteoporosis by DXA method. of 80.6% in patient classification was obtained, and a good We assessed all the patients for quality of life with Qualeffo correlation between DXA-measured BMD and corresponding 41 Questionnaire, with Hamilton Anxiety Rating Scale for OS-derived BMD values was measured (r=0.75, p<0.001). anxiety, and with Levenstein Stress Perceived Questionnaire After the detailed examination of DXA reports, 63 patients for stress and for self-esteem with Rosenberg Self-Esteem (33%) were excluded from the analysis for the presence of Scale at baseline and 12 weeks later. various errors. An actual diagnostic accuracy of 92.2% Results: showed that the values of all the parameters investi- (r=0.87, p<0.001) was obtained by considering only the re- gated were almost similar at baseline. The values measured at maining 128 patients having a reliable DXA report. the end of the study showed that patients from the support Furthermore, the intra- and inter- operator repeatability of group ASPOR had the best results, than the placebo group OS-derived BMD measurements were evaluated through the and the worst were in the control group. root mean square coefficient of variation (RMS-CV) which Conclusion: this controlled study has the intention to be a resulted to be respectively 0.28% and 0.35%. catalyst for future long term approach on patients with osteo- Conclusion: The common inaccuracies of the routine DXA porosis in a holistic manner, with an accent on adherence to a reports lead to an underestimation of OS accuracy in osteopo- support group. It is also important not to neglect the psycho- rosis diagnosis. The actual performance of different ultrasonic logical implication on quality of life in patients with methods that assumed routine DXA reports as the gold stan- osteoporosis. dard reference could be re-assessed employing the same approach. References: P985 [1] Conversano et al, UMB 2015;41:281. DXA ERROR REDUCTION THROUGH QUALITY [2] Messina et al, Eur Radiol 2015;25:1504. CONTROL AND IMPACT ON ECHOSOUND Acknowledgements: Work partially funded by FESR PO FEMORAL NECK DENSITOMETRY Apulia Region 2007-13 – Action 1.2.4 (grant n. 3Q5AX31: F. Conversano1,M.Muratore2, M. Peccarisi3,P.Pisani1,A. ECHOLIGHT Project). Greco3, M. Aventaggiato3, M. Di Paola1, D. Costanza2,F. Disclosures: Conversano and Casciaro are shareholders of Calcagnile2, A. Grimaldi2, S. Casciaro1 Echolight Spa, a National Research Council spin-off that 1National Research Council, Institute of Clinical Physiology, may or may not benefit from results of this study. Peccarisi, Lecce, Italy, 2O.U. of Rheumatology, Galateo Hospital, San Greco, and Aventaggiato are Echolight employees. Cesario di Lecce, ASL-LE, Lecce, Italy, 3Echolight Spa, Lecce, Italy P986 Objective: To assess the influence of dual x-ray absorptiom- TRABECULAR BONE SCORE MEASUREMENTS IN etry (DXA) report inaccuracies on the performance of the 123 ROMANIAN PATIENTS WITH PRIMARY Osteoporosis Score (OS), a recently introduced ultrasound HYPERPARATHYROIDISM (US) parameter for osteoporosis diagnosis on the femoral D. Grigorie1,M.Ivan2,A.Teodorescu2,L.Ilinca2,L. neck. Brezeanu3, A. Sucaliuc1 Materials and Methods: 191 patients aged in 50-75 years 1National Institute of Endocrinology, Carol Davila University were enrolled in this study. They underwent a conventional of Medicine, Bucharest, Romania, 2National Institute of femoral DXA and an echographic scan of the same anatomical Endocrinology, Bucharest, Romania, 3Carol Davila site by the new EchoSound technology [1]. At first, all the University of Medicine and Pharmacy, Bucharest, Romania DXA reports of the enrolled patients were considered as the reference to evaluate the performance of the OS parameter, Objective: There is evidence for increased overall fracture calculating the diagnostic accuracy in patient classification risk in primary hyperparathyroidism (PHPT). As areal BMD (osteoporotic, osteopenic, or healthy) and the correlation co- by DXA is not effective in capturing all the determinants of efficient between DXA-measured bone mineral density bone fragility, “Trabecular Bone Score” (TBS) has been Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S555 recently proposed as an indirect measure of trabecular sarcopenia was diagnosed using the definition of the microarchitecture. The aim of this study was to assess TBS EWGSOP and applying the T-Score based method. Obesity from spine DXA images in patients with PHPT. was determined using body-fat-based approaches with a cut- Methods: This was a cross-sectional study conducted in an off point of 28% as applied for the present calculation. osteoporosis referral center. One hundred and twenty three Different EWGSOP based suggestions for the diagnosis of patients with PHPT were selected from our database (2010 low muscle mass were calculated and compared. In parallel, to 2016) if they had a valid LS DXA scan. The patients were different methods to evaluate functional Sarcopenia parame- both females (20% premenopausal) and males (10%), mean ters were applied to estimate the variation within the age 59.4yr (range 16 to 83), with both asymptomatic and EWGSOP definition from applying different approaches. symptomatic PHPT (35% kidney stones and 25% fractures); Using the most popular EWGSOP valuation, amongst the mean PTH 194 pg/ml, mean serum calcium 11.2 mg/dl. TBS present cohort 5.1% were classified as sarcopenic. However, indices were derived from LS-DXA images and cutoff points using different methods to calculate the EWGSOP approach, used in term of fracture risk were those previously reported. prevalence for sarcopenia varied between 0.9% and 6.0%. The Results: Mean TBS values of the group was 1.25±0.11: 33% most important characteristics of our cohort were comparable of patients with PHPT had degraded microarchitecture (TBS to German mean values. ≤1.20), an additional 53% had partially degraded The prevalence of sarcopenia in this German cohort of microarchitecture (TBS>1.20 and <1.35) and only 14% had community-dwelling Caucasian men 70 years and older was normal TBS. The prevalence of patients with osteoporosis, slightly higher compared with European neighborhood coun- osteopenia or normal BMD by DXA were 49%, 40% and tries that also applied the EWGSOP definition. Potentially this 11%, respectively. Patients with vertebral fractures had mean could be due to our rather cautious approach within the testing values of TBS numerically lower (1.19) than those without strategy. Indeed, the variation when applying different fractures (1.25). TBS was significantly correlated with methods, cut-off points and testing strategy either prescribed aBMD (p<0.003), but not with age, BMI, years since meno- or even not addressed by the EWGSOP was higher compared pause. Only 4% of patients showing degraded or partially with the application of different Sarcopenia definitions than degraded microarchitecture by TBS had normal LS T-score. determined by comparable methods and testing strategies. Our Conclusion: Our data suggest that TBS measurement adds finding clearly underscores the need for a standardized diag- little information beyond aBMD in the assessment of PHPT nose protocol that not only addresses Sarcopenia components, bone involvement in a group of combined asymptomatic and cut-off points and algorithms but also prescribes a consistent symptomatic patients, including a large proportion (30%) of testing strategy. Since sarcopenia is now included in the ICD- premenopausal and male subjects. 10 (M62.84), which will further increase the relevance of this “geriatric syndrome”, this process should be tackled in the near future. P987 SARCOPENIA PREVALENCE IN GERMANY: EFFECTS OF VARYING TEST PROTOCOLS P988 K. Engelke1,W.Kemmler2, S. von Stengel2 THE IMPORTANCE OF DIAGNOSING BAKER CYST 1Institute of Medical Physics University of Erlangen, IN RHEUMATOID ARTHRITIS Erlangen, Germany, 2Institute of Medical Physics, S. Szasz1, R.-R. Cucuruzac1,H.V.Popoviciu2, L. Bordean3 University of Erlangen-Nürnberg, Erlangen, Germany 1Rheumatology Department, University of Medicine and Pharmacy of Tirgu Mures, Tîrgu Mures, Romania, Due to current demographic trends Sarcopenia is becoming 2Rheumatology Department, University of Medicine and increasingly important for our fast aging societies. However, Pharmacy of Tirgu Mures, Tirgu Mures, Romania, with respect to varying definitions, components and cut-off 3University of Medicine and Pharmacy of Targu Mures, points it is difficult to determine the prevalence of this “geri- Department of Rheumatology, Targu Mures, Romania atric syndromes” in a given population. The aim of the study was thus to determine the prevalence of sarcopenia in Baker cyst arises through a one way valve mechanism, which community-dwelling Caucasian German men 70+ and to de- causes the joint fluid transition from the knee to the cyst in the termine the inherent variation of the European Working Group bursae between the medial gastrocnemius and semimembranosus. on Sarcopenia in Older People (EWGSOP) definition using In rheumatoid arthritis patients, Baker cyst is usually varying approaches, cut-off points and test protocols. underdiagnosed and can be present in the absence of clinical Nine-hundred-sixty-five (965) community-dwelling symptoms. Large cysts can rupture in the distal area causing sy- Caucasian men 70+ living in the area of Northern Bavaria, novial fluid migration between the gastrocnemius muscle, fascia Germany were included into the project. Prevalence of profunda and soleus muscle during an acute increase of internal S556 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 pressure. We present the case of a 47 year old female patient J. Jovanovic1,V.Jovanovic2,S.Bozilov3,M.Karadzic4,S. diagnosed with rheumatoid arthritis 6 years ago, who presented Milenkovic5,V.Zivkovic6 with pain and swelling in the left ankle. Ultrasound examination 1Institute for Treatment and Rehabilitation Niska Banja, Nis, has revealed a fluid collection with linear appearance, dissecans in Serbia, 2Clinic for Orthopedics, Clinical Centre, Nis, Serbia, the calf muscular mass. Musculoskeletal ultrasound examination 3Institut for Treatment and Rehabilitation Niska Banja, Nis, is very important both for positive and differential diagnosis in Serbia, 4Institute for Therapy and Rehabilitation, Niska Banja, patients with rheumatoid arthritis. Nis, Serbia, 6Rheumatology department Institute for Treatment and Rehabilitation Niska Banja, Niska Banja, Serbia P989 THE STUDY OF FRAX TOOLS IN EVALUATING THE Introduction: It is well known that chronical rheumatoid RISK OF OSTEOPOROTIC FRACTURE IN HOHHOT diseases have negative impact on life quality. Pain and N. Dongmei1 joint swelling, limited motion, stiffness and deformity 1Orthopedics Medicine, Second Affiliated Hospital, Inner from one side, as well as fatigue, poor sleep quality and Mongolia Medical University, Hohhot, China depression, on the other hand, significantly reduce life quality. Objective: To evaluate the applicability of FRAX in the pop- Aim: Comparison of life quality, pain intensity and fatigue ulation in Hohhot, Inner Mongolia. intensity of patients with rheumatoid arthritis (RA) and knee Methods: A total of 435 subjects (56 Mongolian and 379 osteoarthritis (knee OA). Han) with osteoporotic fractures, who were examined in our Material and method of work: 105 patients have been exam- hospital from Jan 2016 to June 2016 were selected. The clin- ined: 53 patients with RA and 52 patients with knee OA. ical data of all the patients were retrospectively analyzed. All Groups were homogenous regarding gender and age. Life the risk factors contained in FRAX prediction tool were col- quality has been estimated by means of questionnaire-Short lected. The data including BMD of the femoral neck were Form Medical Outcomes Instruments (SF 36) SF 36F- input into the FRAX prediction tool. Then, the fracture prob- physical sphere and SF 36M-mental sphere. Pain and fatigue ability of main parts (hip, spine, humerus, and wrist) and the intensity was estimated by scale VAS. hip in the next 10 years was calculated. With the consideration Results: Average value of SF 36F with patients suffering from of different nationalities were compared. RA was38.65±23.65 in regard to patients suffering from knee Results: In the total of 354 female subjects, considering dif- OA 60.68±19.67,p<0001. Average value of SF 36M with pa- ferent nationalities, with the Mongolian nationality, the frac- tients suffering from RA was 46.75±25.19 compared to pa- ture probability of main parts and the hip in the next 10 years tients with knee OA having 70.12±20.55,p<0001. Pain inten- was1.1%~20.5% and 0%~13%, as for Han, the probability of sity with patients with RA was 48.79±25.66 compared to pa- main parts and the hip was 1.1%~28.8%,and 0%~ 27%, re- tients with knee OA ranging 47.08±19.82, p=0.612. Fatigue spectively, and in the total of 81 male subjects, considering intensity with patients suffering from RA was 49.28±26.44 different nationalities, with the Mongolian nationality, the compared to patients with knee OA having 30.53±16.58, fracture probability of main parts and the hip in the next 10 p<0001. years was1.2%~7.3% and 0%~4%, as for Han, the probability Discussion and Conclusion: Patients with RA have signifi- of main parts and the hip was 1.1%~17.7%,and 0%~6.8%, cantly less quality of life and greater fatigue intensity com- respectively, the difference of the fracture probability of main pared to patients with knee OA. Pain intensity was not statis- parts and the hip between Mongolian and Han was not signif- tically significantly different. Although patients with RA have icant (P>0. 05), However, femoral neck and lumbar spine poorer values of quality of life, taking into account a big num- bone mineral density of Mongolian subjects were significantly ber of patients with knee OA, a significant implication of this higher than the Han ethnic group(P<0.05). disease is recognized. Pain is significant predictor of poor Conclusion: There are no significant differences between the quality of life. fracture probability of main parts and the hip in part of subject from Hohhot Mongolian and Han population. P991 CLINICAL EXPERIENCE OF GENERIC P990 INTRAVENOUS ZOLEDRONIC ACID IN THE COMPARISON OF PAIN INTENSITY, FATIGUE AND TREATMENT OF OSTEOPOROSIS: BELARUSIAN LIFE QUALITY WITH PATIENTS SUFERRING DATA FROM RHEUMATOID ARTHRITIS AND KNEE E. Rudenka1,G.Ramanau2,N.Charnova3, A. Rudenka4,H. OSTEOARTHRITIS Babak5 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S557 1Belarusian State Medical University, Minsk, Belarus, estimated that elderly people produce 75% less cutaneous 2Gomel State Medical University, Gomel, Belarus, D3 than young adults and this becomes even more significant 3Repablican Scientific Center for Radiation Medicine and in the institutionalised elderly. 1 This study seeks to assess the Human Ecology, Gomel, Belarus, 4Belarusian Medical status of vitamin D supplementation in a long-term care facil- Academy of Postgraduate Training, Minsk, Belarus, 51 ity in Malta, as well as the history of fractures in such Clinical Hospital, Minsk, Belarus institutionalised individuals. Material and Methods: The treatment charts of all 1073 Aim: This retrospective, single-center, non-interventional residents at St Vincent de Paul Long Term Care Facility study was to evaluate the effectiveness and safety of once- (SVP) were assessed to note vitamin D and calcium supple- yearly intravenous infusion of 5 mg/100 mL of generic zole- mentation. Data on vitamin D levels and history of fractures dronic acid (ZA) (Belarus, Belmedpreparaty) in patients with over an 8-year period (2008 – 2016) was gathered using gov- osteoporosis. ernmental digital software containing patient medical history. Materials and methods: We have analyzed data of patient Results: Out of a population of 1073 subjects, 69.9% were records, which were treated with IV ZA on the basis of 1 female (n=750) whilst 30.1% were male (n=323) with the Clinical Hospital of Minsk for the period from January 2013 mean age of the population being 81.3 years. The average to December 2015. Inclusion criteria: age 18 – 85 years; length of stay at the facility was 615 days. The percentage established diagnosis of osteoporosis with or without the his- population receiving vitamin D supplementation was 26.8% tory of low energy fractures; availability of the results of a dual (n=288), the majority of which (61.8%, n=178) were receiv- energy X-ray absorptiometry (DXA) of lumbar spine (LS) and ing a suboptimal dose of 400IU daily. 14.5% of the total pop- proximal femurs (PF), performed not earlier than 3 months ulation (n=156) was receiving calcium supplementation. prior to administration of the drug (BMD1) and after 11 - 14 12.7% (n=136) of residents had their vitamin D levels checked months after administration (BMD2). All subjects also re- over the previous 8 years with 62.5% (n=85) of these being ceived calcium (from 1000 to 1200 mg/day) and vitamin D3 deficient (i.e. levels <20 ng/mL). A history of a fracture was (from 400 to 1000 IU per day) supplementation. Patients with noted in 16.9% (n=171) of the total population, with 40% severe morbid obesity, renal impairment with creatinine clear- (n=69) being hip fractures. 81.3% (n=139) of those who ance less than 35 mL/min, patients taking drugs affecting bone sustained a fracture were not on vitamin D supplementation. metabolism, except calcium and vitamin D, were excluded. Conclusion: The study highlights the need for clear guide- The primary efficacy endpoint was the change of BMD from lines on Vitamin D supplementation, particularly in the con- baseline and after 12 months of ZA treatment. text of the institutionalised elderly. A need emerges for an Results: The study cohort comprised 64 patients (61 women assessment tool which helps identify individuals who are at and 3 men) with mean age of 64.1 years, mean body weight of risk of deficiency and in whom measurement of Vitamin D 60.9 kg, and mean body mass index of 24.3 kg/m2, mean levels should be prompted and any deficiency treated. period of repeated DXA scans – 13,4 months. Repeated Reference: 1. Lips P. Endoc Rev. 2001;22:477. BMD measurements performed after treatment revealed sta- tistically significant positive trend of BMD at LS (BMD1 2 2 0,818 g/cm ,BMD2 0,842 g/cm , t=5,03 p<0,001), right PF P993 2 2 (BMD1 0,764 g/cm , BMD2 0,775 g/cm , t=3,91 p<0,001) THE EFFECTIVENESS OF EDUCATIONAL 2 2 and left PF (BMD1 0,768 g/cm ,BMD2 0,782 g/cm ,t=2,16 PROGRAMS IN IMPROVING THE QUALITY OF p=0,038).The percentage increase in BMD at LS was 5.74%, LIFE AND REDUCING THE INTENSITY OF PAIN 2,3% at left PF and 6.5% at right PF. IN OUTPATIENTS WITH KNEE AND HIP JOINTS Conclusion: Generic ZA is an effective drug which signifi- OSTEOARTHRITIS cantly increase BMD in the LS and PF in patients with OP. L. Miasoutova1,S.Lapshina1 1Kazan State Medical University, Kazan, Russian Federation P992 Relevance: The effectiveness of educational programs for pa- VITAMIN D SUPPLEMENTATION IN LONG TERM tients with regard to facilitating the clinical manifestations of CARE: WHERE DO WE STAND? osteoarthritis (OA) in ambulatory patients is not studied V. D. R. G. The Vitamin D Research Group Malta1 enough. 1S. Buttigieg, M. Bonnici. P. Ferry, Imsida, Malta Objective: To evaluate the effect of participation in educa- tional programs on the level of pain and quality of life in Objectives: Vitamin D status plays an important role in skel- patients with OA of the knee and / or hip joints. etal health and low levels are associated with bone loss, mus- Methods: 52 patients with OA of the knee and / or hip joints cle weakness and falls, particularly in the elderly. It is (x-Ray stage 2-4) took part in the educational program for S558 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 ambulatory patients with OA (study group). 2 hours classes accuracy of the model) was 74.7%; Somers'D coefficient was were held by doctors once a month. Initially and after 3 0.726 (p=0.001); Hosmer-Lemeshov criterion testified about the months the following parameters were evaluated: joint pain general consistency of forecast models with real data (χ2=0,61, VAS, the WOMAC index (Likert scale), overall patients re- p=0.644). The figures shown demonstrate the high validity of the ceiving treatment satisfaction (by VAS, 0-100 mm), the need model. The sensitivity of the model was 76.3%, specificity – of pain therapy. The control group (comparable in age, sex, 87.5%.Theareaunderthe(AUC) ROC-curve was equal to baseline levels of pain according to VAS, the WOMAC index) 0.863. Classification thresholds for predictors included in the mod- included 50 patients with OA of the knee and / or hip joints. el were as follows: for menopausal scale indicators – 8.5 points for Result: After 3 months in the study group: reduction of pain the level of consumption of calcium – 1075 mg/day, figures for intensity on the VAS (49.3±7.3 - at baseline, 24.2±5.6- after 3 25(OH) vitamin D – 21,3 ng/mL for MDA – 7.0 mmol/l. months, the control group - 50.1±6.9 - at baseline, 38.2±6.4 - 3 Computer program "Prediction of postmenopausal osteoporo- months, p<0, 05), the overall assessment of WOMAC index sis" was created. (39.7±14.5 - baseline, 24.6±3.9 - 3 months, the control group - Conclusion: 36.6±10.1 - baseline, 32.9±8.0 - 3 months, p<0.05). Overall The created model along with the FRAX tool, SCORE, ORAI satisfaction with receiving treatment (by VAS) was higher in and OST will allow for a comprehensive assessment of the the training group (79,3±10,2 and 55,8±14,0, respectively, risk of osteoporotic postmenopausal changes. p<0.05). During this period, the proportion of patients who regularly performed physical exercises in the study group was 48.1% of patients, in the control - 20%. In the study group did P995 not need a regular intake of NSAIDs 48.1% of patients, taking GERIATRIC STUDY IN MUNICIPALITY OF FATIH: these drugs 1-2 times a week - 26.9%, almost every day - 25% SARCOPENIA AND SARCOPENIC OBESITY IN of patients. In the control group, these figures were 22%, 48% ELDERLY PATIENTS ACCORDING TO DIFFERENT and 30%, respectively. INDEXE Conclusion: Participation of patients with OA in educational O. Y. Yilmaz1,C.K.Kilic1,G.B.O.BahatOzturk1,S.A. programs increases the commitment to the overall treatment Avci2,T.A.Akcan3,Y.M.Medik3,M.A.K.Karan1 and as a result, may lead to a decrease in the severity of pain in 1Istanbul University Istanbul Medical School Department of the analgesic therapy needs, improves quality of life. Internal Medicine Division of Geriatrics, Istanbul, Turkey, 2Istanbul University Cerrahpasa Medical School, Istanbul, Turkey, 3Istanbul University Istanbul Medical School, P994 Istanbul, Turkey PREDICTION OF POSTMENOPAUSAL OSTEOPOROSIS Introduction: In our study we evaluate patients with different I. Zakharov1, G. Kolpinskiy1,G.Ushakova1 definitions of sarcopenia and sarcopenic obesity and compare 1Kemerovo State Medical University, Kemerovo, Russian prevalence of cases. Federation Methods: We enrolled patients ages between 60 and 101. Skeletal muscle mass were measured with bioimpedance an- Osteoporosis is considered a "hidden epidemic" of modern alyse (TANITABC532). Muscle mass assessed with civilization, due to its high prevalence and certain difficulties Baumgartner-index. In addition; muscle mass values calculat- in the timely diagnosis. The onset of menopause is a signifi- ed according to Janssen, FNIHa and FNIHb definitions and cant factor in the formation of osteoporotic changes. low muscle mass evaluated according to national data base. Aim: To develop a system that predicts postmenopausal Low body mass was defined as a=60TH percentile or BMI 30 osteoporosis. kg/m2 suggested in literature. This was a study of 204 elderly Material and methods: In a study of 96 women in the early patients.(mean-age:75,4±7.3). postmenopausal period it was included. method of binary lo- Results: Sarcopenia and its components’ prevalence are as gistic regression was used. It was estimated the probability of follows: Sarcopenia (S) according to Baumgartner index: the average annual decrease in bone mineral density. 5.3%, low muscle mass:%9.8, dynapenia:%51.5, slower Results: The predictive model included the following factors: the walking tempo:%25.6. On the other hand; S-prevalence ac- level of calcium intake, serum levels of 25 (OH) of vitamin D, cording to Janssen, FNIHa and FNIHb were: 29.3%,37.9% indicators of the total intensity of menopausal disorders and the and 18%, respectively. Lower calf circumference as an indi- importance of MDA concentration in plasma. The developed rect indicator of lower body-mass was%15,8. SO-prevalence model is used to predict the primary (postmenopausal) osteoporo- measured with Baumgartner-BMI is 0%, with FNIHa-BMI is sis. The following results were obtained when assessing the valid- 24.9%, with FNIHb-BMI is 13.2%. Besides; SO-prevalence ity of the model: The percentage of correct reclassification (the measured with Baumgartner-Zoico ile 2.1%, with Janssen- Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S559 Zoico is 18.2%, with FNIHa-Zoico is%23.4, with FNIHb- 1.454-1.665), smokers (OR 1.032; CI 1.097-1.282) and lack Zoico is 14.7%. S-prevalence is higher among women with in or excess of physical activity (OR 1.299, CI 1.153-1525; Janssen and FNIHa (p <0.001). Similarly, SO-prevalence is OR 1.299; CI 1.214-1.389, respectively). For women, severe higher among women with Janssen-BMI, FNIHa-BMI, obesity was significant (1.317, CI 1.095-1.1.584). Among sub- FNIHb-BMI, Janssen Zoico and FNIHa-Zoico (p <0.001, p jects with osteoporosis, 39.9% had to walk up stairs in their <0.001, p=0.02, p <0.001, p=0.003). According to home. Of those, 42.7% reported difficulties to go up and down Baumgartner-Zoico definition women do not have SO thereby the stairs. Almost 30% of patients with osteoporosis had at least it is more common in men, meaningfully (p=0.012). one motor or sensory deficiency that could be corrected: 24% Conclusions: SO-prevalence have been the lowest according of subjects referred a visual impairment but they did not use to Baumgartner index. The highest S-prevalence has been glasses; 80% of who had an hearing impairment did not use detected with FNIHa description and the lowest has been de- hearing aids and 32.7% of those had an impairment in walking tected with FNIHb. SandSO correlation with gender vary did not use any walking aid. among different methods. Our results have shown that Conclusions: our study confirms the high prevalence of po- SandSO is most likely higher in women. tentially modifiable risk factors for osteoporosis and falls in community dwelling older adults, which should be targeted as a non- pharmacological interventions. P996 PREVALENCE OF UNHEALTHY LIFESTYLES AND RISK FACTORS FOR FALLS IN A P997 REPRESENTATIVE SAMPLE OF ITALIAN OLDER USING THE "BEST PRACTICE FRAMEWORK" SUBJECTS WITH OSTEOPOROSIS. QUESTIONNAIRE FOR SELF-AUDIT OF B. Gasperini1,R.Serra1,P.Lamanna1,R.Montanari1,E. SECONDARY FRACTURE PREVENTION SERVICE Prospero2,E.Esipnosa1 ORGANIZATION 1Department of Geriatrics and Rehabilitation, Santa Croce K. Belova1, O. Ershova2 Hospital, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 1Yaroslavl Emergensy Care Hospital, Yaroslavl, Russian Fano, Italy, 2Department of Biomedical Sciences and Public Federation, 2Yaroslavl State Medical Academy, Yaroslavl, Health, Section of Hygiene, Preventive Medicine and Public Russian Federation Health, Università Politecnica Delle Marche, Ancona, Italy Background: The secondary fracture prevention service is Objective: Life style changes as well as the interventions to created today in many countries. The basic principles of its reduce the risk of falling should be promoted in older adults organization are proposed by IOF. Such services may vary due who suffering from osteoporosis. Our study aims to identify to dissimilarity of health care systems in different countries, so the prevalence of unhealthy lifestyles and risk factors for fall- there is need to have a tool for evaluation of the effectiveness ing in osteoporotic community-dwelling older adults. of their work. Materials and Methods: Data come from the Multipurpose Aim: To evaluate the possibility of using the IOF question- Survey “Health conditions and use of health services”. A strat- naire "Best Practice Framework" for self-audit to optimize the ified multi-stage probability design using municipal lists of organization of secondary fracture prevention service in households was used to select a representative sample of Regional Emergency Hospital, Yaroslavl (RF). Italian population. For our purpose, 27003 subjects aged 65 Materials and methods: In the first phase of its establishing a years or older were considered. Smoking status, body mass traumatologist sent a patient with a fracture to the secondary index, physical activity and diet were considered. We also fracture prevention service. Then we changed the organization seeked personal and environmental risk factors for falls. of the service, and added a nurse-coordinator into its staff. We Results: 8633 subjects reported to suffer from osteoporosis. used the questionnaire "Best Practice Framework" to identify 73% were women. The mean age was 77 years compared to shortcomings of organization at both stages. 74 years of the subjects without osteoporosis (p<0.001). 30% Results: In the first phase of the work, we noted poor perfor- followed a diet, in 25% of cases without a medical prescription. mance in several sections of the questionnaire: the identifica- 5.9% were current smokers; 3.5% of subjects were under- tion of patients, the timing of assessment after a fracture, the weight and 3.7% were extremely obese. About 50% of subjects falls prevention, and the frequency of drug therapy initiation. did not perform regular physical activity, while 5.2% did ex- To improve these indicators we added a nurse-coordinator, we cessive exercises weekly. The regression analysis was carried limited cohort of patients by only in-hospital cases, we pro- out on the entire sample and stratified by gender. Factors asso- vided the minimum laboratory exams in the emergency room, ciated with an increased risk for osteoporosis were of older age we created the information booklet for training patient about (OR 1.054, CI 1.049-1.058); followed a diet (OR 1.556, CI the fall prevention. After the second phase of working we have S560 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 identified the next changes: the completeness of identification 1Internal Clinic - Outpatient Department of Rheumatology of patients increased from 26% to 94%, the timing of evalua- and Osteology, Military University Hospital, Prague, tions was reduced from very poor to level 3, the frequency of Czech Republic, 2Department of Radiology, Military initiation of drug therapy increased from 63% to 78%, the Univesity Hospital, Prague, Czech Republic patients with the increased risk of falls were trained. Conclusion: The questionnaire "Best Practice Framework" Introduction: SAPHO (Synovitis-Acne-Pustulosa- proved to be an effective tool in performing the current audit, Hyperostosis-Osteitis) syndrome, an inflammatory musculoskel- allowing to identify problems in the organization of secondary etal disorder dominated by osteitis and hyperostosis, synovitis of fracture prevention service. the joints and more frequently associated with neutrophilic der- matosis such as palmoplantar pustulosis and acne conglobate, was described in 1987. Osteitis most often affects the anterior P998 chest wall (sternum, medial ends of the clavicula and ribs) and STATUS OF VITAMIN D IN MEN WITH HIP vertebrae, less often the long bones, mandible or ilium. Synovitis FRACTURE usually affects the joint adjacent to the affected bone for which O. Ershova1,K.Belova2,O.Sinitsina1,O.Ganert2,M. reason the most common are synovitis of the sternoclavicular, Romanova2, E. Svetalkina2 sternocostal and manubriosternal joints, which may be erosive. 1Yaroslavl State Medical Academy, Yaroslavl, Russian The X-ray image is initially normal. The more sensitive methods Federation, 2Yaroslavl Emergensy Care Hospital, Yaroslavl, are computed tomography (CT) and magnetic resonance imag- Russian Federation ing (MRI); the “bull’s head” image during bone scintigraphy is specific for the SAPHO syndrome. In the X-ray image, the Background: Hip fractures are the most severe complication osteolytic areas are initially dominant, and gradually of osteoporosis. Lower level of vitamin D relates to risk fac- osteosclerosis and hyperostosis become more dominant, with tors for fractures and falls. the consequence of bone hypertrophy. Aim: To assess the level of 25(OH)D in men with hip fracture. Case: A 53 year old patient was recommended for internal Materials and methods: We included in the research men 40 examination for fatigue, elevation of inflammation markers years of age and older, residents of the city of Yaroslavl, (C-reactive protein 32mg/L) and microcytic anaemia. When Russian Federation, who suffered from hip fracture during viewing the patient’s chest, there was a conspicuous massive the period from 01 SEP 2010 to 31 AUG 2011. To measure bulge of the manubrium of the sternum and clavicula with the level of 25(OH)D electrochemiluminescent immunoassay warm-up and mild palpation pain. The patient has observed (ECLIA) was performed on the analyzer “Elecsys 2010”, intermittent mild pain for 11 years already. About 8 years Roche. According to Russian national recommendations, the before start of his problems, he had transitory skin lesions, normal level of 25(OH)D is >30 ng/ml, insufficiency – 20-30 which could have been palmoplantar pustulosis. X-ray, CT ng/ml, deficiency <20 ng/ml, severe deficiency <10 ng/ml. and MRI described the typical changes in the manubrium, The assessment was carried out in the age groups of 40-69 medial part of the ribs and clavicula and relevant joints for years old (n=120) and ≥70 years old (n=92). the SAPHO syndrome. The hypertrophic sternum thickness Results: The average level of 25(OH)D in 40-69 years old was 48mm, which is about 4-fold the dimensions in the case men was 17.34±9.74 ng/ml, ≥70 years old – 16,31±11,81 of a healthy person. Positron emission tomography described ng/ml, p>0.05. Among men aged 40-69 years 17 (14,17%) the inflammatory changes only in the area of the manubrium patients had the normal value of 25(OH)D, 21 (17,50%) had sternum; no other inflammatory focus or neoplasm was the insufficiency, 61 (50,83%) had the deficiency, and 21 detected. (17,50%) had severe deficiency. Among the ≥70 years old Conclusion: The reason for delay or failure in the identifica- patients the normal value was observed in 12 (13,04%) men, tion of SAPHO syndrome, apart from the rare occurrence, insufficiency – in 13 (14,13%), the deficiency – 41 (44,57%), may also the minimal subjective difficulties of the patient a severe deficiency – in 26 (28,26%). and missing skin lesions. Conclusion: Thus, the normal value of 25(OH)D was observed only in 13.68% men who suffered from hip fracture. Deficiency of this vitamin was detected in 70.28% of the patients. P1000 ADHERENCE TO IRANIAN TRADITIONAL DIETARY PATTERN MAY INCREASE THE RISK OF P999 KNEE OSTEOARTHRITIS GRADE IN GIANT MANUBRIUM STERNI BY PATIENT WITH POSTMENOPAUSAL WOMEN SAPHO SYNDROME: CASE REPORT A. Abdollahi1,M.Hajizadehoghaz2, Z. Maghbooli3,K. L. Franekova1,P.Pasek2 Mirzaei1 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S561 1Department of Community Nutrition, School of Nutritional 1University of Medicine and Pharmacy, Craiova, Romania, Sciences and Dietetics, Tehran University of Medical 2University of Medicine and Pharmacy, Department of Sciences (TUMS), Tehran, Islamic Republic of Iran, Neurology, Craiova, Romania, 3County Emergency 2Department of Nutrition Sciences, Faculty of Nutrition Hospital, Orthopedic Department, Craiova, Romania, Sciences and Food Technology, Shahid Beheshti University 4County Emergency Hospital, Rehabilitation, Craiova, of Medical Sciences, Tehran, Islamic Republic of Iran, Romania 3Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Objectives: Patients with paraparesis lose through inactiv- Medical Sciences, Tehran, Islamic Republic of Iran ity 2% of muscle mass per day with progressive bone demineralisation. We intend to highlight the risk of oste- Objective: Several environmental factors have been associat- oporosis in patients with paraparesis for more than one ed with Osteoarthritis (OA), including obesity, nutrition and year. sex. We aimed to explore the association between dietary pat- Material and method: There were evaluated 42 patients with terns and different degrees of knee OA based on Kellgren and paraparesis of different causes: 31 with posttraumatic Lawrence (KandL) score in a group of Tehranian women. paraparesis, 4 of neuropathic issue, 7 due to vascular brain Methods: 250 women with knee pain (age: 52.42±7.64 yo) injury. Patients between the age of 28 and 56 years old, 32 participated in our cross-sectional study. All participants of them being males and 10 females. They were divided in underwent weight-bearing bilateral anteroposterior radiogra- two groups: Group A of 18 patients with paraparesis no longer phy of knees. Weight, height, waist, hip circumference and than 18 months and Group B, 24 patients with paraparesis for bioelectrical impedance analysis were also measured in the more than 18 months. Were included in the study only patients patients. All participants were asked to fill the physical activ- who scored muscle strength values between 3 and 5 during the ity questionnaire. Finally, food intakes were assessed using a muscular testing. All the patients were radiologically assessed 147 item semi-quantitative food frequency questionnaire throughout the lumbar and dorsal spine and evaluated by (SFFQ), from which twenty two food groups and three major osteodensitometry at lumbar level. dietary patterns were derived. Results: Group A presented osteopenia values on Results: Among three major dietary patterns, women in the osteodensitometry evaluation with a T score range from -0.5 higher tertile of traditional dietary pattern (which loaded to -1.4, in Group B there were 8 patients with osteopenia while heavily on red meat, Organ meats, legumes, onion and potato, the rest presented higher than -2.5 values of osteoporosis. The olive, fruit, eggs and nuts) were more likely to suffer from radiologic examination marked out osteoporosis with demin- severe knee OA (OR: 2.178, 95% CI 1.084-4.374). They also eralization and vertebral compression fracture in 8 patients of had higher total energy intake which remained significant af- Group B, diagnosed with paraparesis for more than 3 years. ter adjustments. In addition, age and physical activity (Mets) Fragility induced fracture of the distal radial extremity oc- were lower and hip circumference was greater in women in curred at two of the patients from Group B. In our survey, the highest tertile of western dietary pattern compared to those patients with paraparesis that exceeds 18 months since debut, who were in the lower tertile. Also, participants in the highest the prediction for developing osteoporosis is 38.09%. tertile of the Healthy dietary pattern showed significant results Conclusions: The study presented shows that the neurologi- for BMR, fat free mass, and total body water cal deficit such as paraparesis is a cause of secondary osteo- variables(P<0.05). porosis through prolonged immobilization, respectively by Conclusion: Higher adherence to Iranian traditional dietary low physical activity. The risk of secondary osteoporosis is pattern may increase the risk of knee OA for more than two- higher at patients with long lasting neurological deficit and fold in postmenopausal women. Since the highest prevalence lack of proper physical activity for longer period of time. of knee OA among Asian people has been seen in Iranian rural dwellers, it is recommended that future studies focus on in- vestigating the effects of different Iranian traditional food P1003 groups on the development and/or progress of knee DYNAMICS OF BMD IN WOMEN WITH osteoarthritis. OSTEOPOROSIS AFTER LONG-TERM USE OF BISPHOSPHONATES: ROLE OF ADHERENCE TO TREATMENT P1001 E. Rudenka1,A.Maslo1,O.Samakhavets2, A. Rudenka3,A. THE RISK OF OSTEOPOROSIS IN PATIENTS WITH Evdokimova2 PARAPARESIS 1Belarusian State Medical University, Minsk, Belarus, 21 A. M. Bumbea1,A.C.Bighea1,S.Patru1,D.Matei1,C. Minsk City Clinical Hospital, Minsk, Belarus, 3Belarusian Albu2, B. S. Bumbea3, C. Bostina4 Medical Academy of Postgraduate Training, Minsk, Belarus S562 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Aim: to evaluate the dynamics of bone mineral density 1Department of Surgery and Translational Medicine, Unit of (BMD) in the spine and proximal femurs in subject with os- Bone and Mineral Diseases, University of Florence, teoporosis (OP) receiving bisphosphonates (BP) for 5-8 years University Hospital of Florence, Florence, Italy, 2Nutrition according to their adherence to treatment. Research Foundation, University of Barcelona Science Park, Materials and methods: hospital records of 60 women aged Barcelona, Spain 60 to 80 years diagnosed with OP, with duration of BP intake 5-8 years. The degree of adherence was calculated using Objectives: To evaluate the change of dietary habits for some Medication Possession Ratio (MPR). Patients were divided selected food groups, important for bone health1,intheEuro- into groups according to treatment duration: 10 women with Mediterranean population of the Credits for Health (C4H) duration of 5 years; 17 women with duration of 6 years; 12 project. C4H has been funded by the EC (#602386) and is women with duration of 7 years; 21 women with duration of 8 intended to fight the increasing prevalence of lifestyle- years. The primary efficacy endpoint was the change in BMD related diseases through an innovative multi-stakeholder ap- of lumbar spine (LS) and proximal femurs (PF) from baseline proach based on people empowerment. and after treatment Material and Methods: A randomized controlled trial has Results. As a result of five-year BP treatment in group with been developed recruiting 2064 subjects of three high adherence BMD of LS increased from 0.782 [0.714; Mediterranean countries (Italy, Spain, Greece), in order to test 0.808] g / cm2 to 0.900 [0.840; 0.980] g / cm2 (p 0.041); an Information and Communication Technology (ICT) plat- BMD of PF from 0,858 [0,802;0,975] g / cm2 to 0,902 form, that was characterized by interactive nutritional and [0,880;0,994] g / cm2 (р 0,041). In group with low adherence physical activity sections and a rewarding system (Dynamic gain of BMD of LS was +0,029 g / cm2 (р 0,133), in right PF - platform) or by static information only (Static platform). +0,019 g / cm2, (р 0,617), in left PF - +0,023 g / cm2,(р Recruited subjects were automatically randomized to the in- 0,617). In group of patients who took BP for six years and tervention (Dynamic platform) or control (Static platform) had MPR> 80% dynamics of BMD was as follows: from groups. Food Frequency Questionnaires were administered 0,775 [0,736;0,795] g/cm2 to 0,891 [0,859;0,974] g/сm2 at to both study groups through the ICT platform. The consump- LS (р 0,023); 0,781 [0,666;0,856] g/сm2 before and 0,808 tion frequency of dairy products, fruits, vegetables and meat [0,712;0,882] g/сm2 after treatment in right PF; 0,735 was evaluated. [0,607;0,798] g/сm2 before treatment and 0,800 Results: The interaction with Dynamic platform produced an [0,787;0,841] g/сm2 after treatment in left PF, р 0,041. improvement in food consumption habits. Considering the Those patients from this group with MPR<80% also had sta- achievement of the recommended portions for each food tistically significant gain of BMD: +0,058 g/сm2 (р 0,004) at group, the percentages of Dynamic platform users who met L1-L4, +0,011г/см2(р 0,034) at right PF. In patients with high dietary aims at the end of the study period are as follow: adherence within 7 years of treatment BMD gain L1-L4 was • Fruit: 57.8% (32.1% at baseline); +0,127g/сm2, р 0,023, right PF +0,063g/сm2, р 0,023; for left • Vegetables: 22.2% (15.3% at baseline); PF no significant changes were observed(р 0,130). In group • Red Meat: 68.3% (46.1% at baseline); with low adherence significant differences were not obtained • White Meat 60.7% (55.5% at baseline); (р 0,371). As a result of 8 years of treatment, there was growth • Dairy products 42.2% (29.7% at baseline), with a 72.6% of BMD at all measured sites in group of patients with high (68.3% at baseline) of subjects who declared to prefer low 2 adherence (L1-L4 -+0,094g/сm , р 0,0001; right PF +0,076 fat ones. g/сm2, р 0,005; left PF +0,031 g/сm2, р 0,009. In group Conclusions: Dynamic users demonstrated to be involved with low adherence BMD increase was not statistically with the dietary recommendations of the C4H platform. This significant. is proved by the improvement of the adherence to the Conclusion: Patients with long period of BP treatment and Mediterranean lifestyle. Similarly, this approach could be uti- high adherence had significant increase of BMD in lumbar lized to support people in eating well for bone health. spine and proximal femurs. Reference: 1. IOF “Serveupbonestrengththroughoutlife” (2015). P1004 FOODS FOR BONE HEALTH: DIETARY HABITS IN P1005 THE EURO-MEDITERRANEAN POPULATION OF CASE FINDING IN OSTEOPOROSIS: IS THERE THE CREDITS FOR HEALTH PROJECT STILL A ROLE FOR OSTEORISK? S. Quattrini1, L. Guasti1,B.Pampaloni1,L.Cianferotti1,V. J. Morales-Torres1, J. Morales-Vargas1, C. Tinajero-Patiño2 Fratoni1,C.Fossi1,S.Ciuffi1,J.Ngo2,B.Roman-Viñas2,M. 1Morales Vargas Centro de Investigacion, Leon, Mexico, L. Brandi1 2Hospital Aranda de la Parra, Leon, Mexico Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S563 Increasing both life expectancy and osteoporotic fractures in Methodology: The current study will include 100 Egyptian Mexico, as most of the world, face a limited access to DXA patients with SLE diagnosed according to ACR revised clas- scans in many regions, generating the need for alternatives to sification criteria of SLE. (Hochberg, 1997) identify candidates to receive antiresorptive therapy. The role As well as, 50 normal individuals of matched age and sex as a of FRAX is well defined, but its uptake is limited. Could control group. OsteoRisk (the Latin American version of OST including only Inclusion criteria for this study will involve: age and weight) identify who should be studied with FRAX, 1. Disease duration ≥ 5years. DXA or be treated? 2. Premenopausal patients. Objective: To assess if OsteoRisk can identify postmenopaus- 3. Using long term oral corticosteroids (prednisolone) ≥7.5/d al women who are candidates for antiresorptive therapy. for more than 2 years. Methods: We performed a cross sectional study on women Exclusion criteria: who attended Hospital Aranda de la Parra to get a DXA scan Other diseases that can affect the bone, such as thyroid dis- from 2007 to 2013. The subjects included in this analysis met eases, kidney diseases, and metabolic bone disease. the following selection criteria: age ≥ 50 years; completed the All patients will be subjected to: risk factor questionnaire; had both weight and height mea- • Full history taking sured, and had both femoral neck and spine bone mineral • Complete clinical examination density reported. Subjects were classified according the • Detailed articular examination OsteoRisk in two categories: high risk and moderate to low • Routine laboratory examination risk and per FRAX score for 10-year absolute risk of hip • Plain radiography of dorsolumbar spine (lateral view) fracture in: <3% and ≥3%. We classified subjects who were • SLICC/ACR international collaborating clinics group- candidates for antiresorptive therapy based on: a) a hip or damage index for SLE) (UrowitzandGladman,1998) spine T-score <-2.5 or b) hip or spine osteopenia plus a Results: Results were statically analyzed, tabulated and FRAX score for hip fracture ≥3% and/or major osteoporotic graphically represented. fracture ≥10%. We performed descriptive statistics on data One hundred systemic lupus (SLE) patients were included in obtained. this study. The SLE patients were 94 females and 6 males. Results: We included 2000 females aged 50 to 92 (mean 62 Their age ranged between 19 -48 years with a mean of 29.26 ±8.8) years, with mean height 155 (±0.07) cm and mean ±8.844 years. SLE duration ranged between 6o - 228 months weight 66.1 (±11.6) kg. OsteoRisk at high risk category with a mean of 75.06±32.781months. Their weight ranged showed a statistically significant association with the need between 42-116 (kg) with a mean of 72.71±17.745kg. All for treatment classification (X2=262.47, p <0.000), with a the female patients were premenopausal. The mean number sensitivity of 76.7%, and specificity of 73.5% (compared to of parity of female patients was 2.17±1.253. Only 4 of the FRAX sensitivity 88.6% and specificity 78.6%). Through lo- patients were smoker while the rest 96 patients were non- gistic regression analysis, the odds ratio for need for treatment smoker. The total GCs dose equivalent to prednisone 3.6- was 9.140, p<0.000, 95% CI 6.747-12.382. 64.8±11.6296. Conclusions: OsteoRisk performs well in identifying Demographic and disease related variables. The general char- women who are candidates for treatment. Its graphic acteristics of the study population are shown in Table1. The version could be adapted easily for daily practice and participants' ages ranged from 19 to 48 years. Age of onset of improve the selection of candidates for further study or disease ranged from 8 to 43 years. Their weight ranged be- even treatment. tween 42-116 (kg). All the female patients were premenopaus- al. The mean number of parity of female patients was 2.17. Only 4 of the patients were smoker while the rest 96 patients P1006 were nonsmoker. The total GCs dose ranged from 3.6-64.8 g. PREVALENCE OF VERTEBRAL FRACTURES Conclusion: In our study, vertebral deformities scored ac- SECONDARY TO CORTICOSTEROIDS IN cording to Kleerekoper method (Kleerekoper et al, 1984), EGYPTIAN SYSTEMIC LUPUS ERYTHEMATOSUS were found in 24 (24%) patients these results nearly match PATIENTS those of Almehed et al (2010) who studied 150 SLE patients. H. H. Elhadary1,K.H.Elhadidi1 there was a higher prevalence of vertebral deformities Twenty- 1Rheumatology and Rehabilitation Department / Manial nine% of the patients in Almehed et al, 2010 study had at least Specialized Hospital / Cairo University, Cairo, Egypt one prevalent, radiological, vertebral compression. Eighty- eight% of these fractures were asymptomatic. Bultink et al Objective: To estimate the prevalence of vertebral fractures (2005) study can be compared with our study with a slightly secondary to chronic corticosteroids use in Egyptian patients younger Dutch SLE population, mean age 41 years, where afflicted with SLE. 20% of the patients had at least one prevalent vertebral S564 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 fracture whereas the prevalence was 21% in a premenopausal circulation and activation of macrophage phagocytosis of cohort of SLE women in Brazil. calcified detritus. This therapeutic model can be useful in shoulder rehabilitation after proven calcified tendonitis. P1007 THE ROLE OF MECHANICAL SHOCKWAVES IN P1008 TREATMENT OF SUPRASPINATUS CALCIFYING TENOFOVIR-RELATED FANCONI SYNDROME AND TENDONITIS CHRONIC RENAL FAILURE IN DIABETIC PATIENT: A. M. Bumbea1, A. C. Bighea1,S.Patru1,D.Matei1,A.E. CASE REPORT Musetescu1,R.M.Trăistaru1,C.Bostina2,B.S.Bumbea3 H. Hacisahinogullari1, S. Tekin1, S. Tanrıkulu1,A.Akyıldız1, 1University of Medicine and Pharmacy, Craiova, Romania, A. Kubat Uzum1,F.Aral1, R. Tanakol1 2County Emergency Hospital, Rehabilitation, Craiova, 1Istanbul University Istanbul Medical School, Istanbul, Romania, 3County Emergency Hospital, Orthopedic Turkey Department, Craiova, Romania Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse Objectives: The mechanical shockwaves applied at tendon transcriptase inhibitor used to treat hepatitis B infection. level produce a stimulation of mechanical receptors, pro- Herein, we report a case of tenofovir induced Fanconi syn- prioceptors and at nervous terminations. Through the me- drome who was misdiagnosed as Paget ‘s disease. Case: A chanically process it is accomplished a local circulation 56-year old male who was under TDF treatment for HBV stimulation. Additional shockwaves acting on calcified infection had a fragility femur fracture in 2014 and had been structures by splitting them into fragile points. And also treated with IV zolendronate 5 mg. A few months after that, through the stimulated vascular process and the action of he admitted to another clinic with diffuse bone pain, weak- macrophages occurs a reduction in the size of calcified ness especially at lower extremities, difficulty in ambulation. formations. We intend to highlight the effect of analgesia Because of hypophosphatemia, elevated alkaline phosphatase and remodelling of calcified structure by mechanical (ALP) and increased osteoblastic activity on bone scintigram, shock waves in the supraspinatus tendon proven by mus- Paget’ s disease was the diagnosis and He was referred to our culoskeletal ultrasound. Endocrinology clinic for evaluation of hypophosphatemia Material and method: The study included 52 patients with and osteoporosis. He had a history of diabetes until 2006. different size calcifications at the supraspinatus tendon Serum phosphorus:1.1 mg/dL (N:2.7-4.5 mg/dL), bone insertion level proven by musculoskeletal ultrasound. ALP: 71 μ/L (4-22 μ/L), calcium:9 mg/dL (N: 8,5-10.5 mg/ Patients were divided into two groups, Group A that dL), creatinine 1,6 mg/dL(N: 0.7-1.4 mg/dL), uric acid 1.5 followed a treatment with mechanical shock waves and mg/dl (N:2,5-7,5 mg/dl), TMP/GFR was calculated as 0,008 nonsteroidal drugs, painkillers and topical analgesics. mmol/L. Metabolic acidosis with normal anion gap, amino- Group B followed received the same medical therapy aciduria, hypophosphatemia with increased fractional excre- without mechanical shock waves applied at the tendon. tion of phosphate, glycosuria, hypouricemia and all of which Group A received treatment with mechanical shock waves were compatible with Fanconi syndrome. L1-L4 T score on for10daysrepeatedevery2monthsfor6months.There DXA was -3.4 and bone scan showed increased uptake in the was a clinical evaluation-joint testing, visual analgesic multiple fracture lines. Renal biopsy which was performed to scale (VAS) and musculoskeletal ultrasound initially and identify the etiology of chronic renal failure showed granular after 6 months. degeneration of tubulus and was not associated with diabetes Results: Evaluation at 6 months we noticed that the pa- mellitus. Diagnosis of tenofovir induced osteomalacia due to tients from Group B maintained the same ultrasound find- Fanconi syndrome and phosphate wasting was made. TDF ings and the pain diminished only with 23,4% on VAS in was switched to entecavir 5 mg/d. Oral phosphate supple- comparison with the patients from Group A in which the mentation (sodium phosphate 1500 mg/d) and calcitriol recorded values showed a decrease in VAS by 63,2%.The (0.25 mg thrice a day) were initiated. Phosphate level in- ultrasound evaluation of Group A revealed a reduction in creased to 2.7 mg/dl in 3 weeks and his symptoms improved, the size of the calcified formations by an average of 1,2 he can walk with walker, but creatinine level did not change. mm, two of the cases no longer revealing any calcified Conclusion: Despite being a rare adverse event, Fanconi formation. syndrome secondary to TDF can occur and glomerular Conclusions: Mechanical Shock waves are useful at pa- and tubular function should be monitored closely. This tients with calcified tendonitis through significant pain case also highlights the importance of monitoring for reduction, improving joint mobility and participates at bone disease and clinical aspects of hypophosphatemia calcifications reduction through local stimulation of in these patients. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S565 P1010 P1011 RISK OF FALL FACTORS AND FRAX SCORE IN IS VITAMIN D ASSOCIATED WITH MUSCLE AND ELDERLY PATIENTS FROM THE REPUBLIC OF BONE MINERAL DENSITY IN ELDERLY WOMEN MOLDOVA AND MEN WITH LOW-ENERGY HIP FRACTURES? E. Deseatnicova1,G.Soric2,F.Lupascu-Volentir2,O. Y. Wu 1, L. Wang1,Y.Su1,X.G.Cheng1 Catarau3,S.Agachi4, S. Soric3,A.Negara2,L.Groppa4 1Department of Radiology, Beijing Jishuitan Hospital, 1Department of Rheumatology, State Medical and Beijing, China Pharmaceutical University Nicolae Testemitanu, Chisinau, Republic of Moldova, 2Gerontology Scientific Laboratory, Introduction: The aim of this cross-sectional study was to State Medical and Pharmaceutical University Nicolae examine the relationship between 25(OH)VD3 and quantita- Testemitanu, Chisinau, Republic of Moldova, 3Emergency tive computed tomography (QCT)-derived areal and volume Medicine Department, Emergency Medicine Institute, bone density in the hip and thigh muscle area. Chisinau, Republic of Moldova, 4Department of Methods: Two-hundred and twenty-four elderly patients with Rheumatology, State Medical and Pharmaceutical University low-energy hip fractures were recruited in the study, 157 «Nicolae Testemitanu», Chisinau, Republic of Moldova women (mean±SD age, 78.1±7.6 years) and 67 men (78.5 ±7.3 years). Areal and volume bone mineral density (BMD) Aim: To evaluate the risk of fall factors and FRAX score in in the femoral neck(FN) and total hip (TH) were assessed elderly patients from the Republic of Moldova. using CTXA of QCT. The cross-sectional area of the skeletal Materials and methods: The study included 40 patients aged muscle and fat inside the fascia was calculated at the proximal over 65 years old, mean age 73,77±1,13 y.o. with fragility thigh by Using CT images. Association between 25(OH)VD3 fractures after a fall from the proper height (the first fall ever and QCT variables were explored using linear regression. in life) admitted to the department of emergency medicine Results: Serum 25(OH)VD3 deficiency (<50 nmol/L) was (group I) and 125 patients aged over 65 years old with mean present in all hip fracture patients. No associations were found age 71,5±1,1y.o. without falls in background admitted to the between 25(OH)VD3 and the proximal thigh muscle or fat department of gerontology (group II) during October - measurements in both genders. Correlations between December 2016. Patients with risk factors for secondary oste- 25(OH)VD3 and FN and TH aBMD were weak but significant- oporosis were excluded from the study. Both groups were ly positive in men. However, for women, there was no correla- identical by age and sex. We evaluated FRAX score and fac- tions between 25(OH)VD3 and all bone density variables. tors for the risk of fall in both groups. Conclusion: Thigh muscle variables were not associated with Results: In both groups female sex was predominant 82,50% serum 25(OH)VD3 in elderly women and men with hip frac- vs. males 17,50%. Mean age of females constituted 78,72 tures. Serum 25(OH)VD3 were weakly correlated with FN ±1,32 y.o. and of males 75,85±3,78 y.o. Traumatic conse- and TH aBMD but not vBMD in men. All bone density indi- quences of the falls were fracture of proximal humerus in ces were not associated with 25(OH)VD3. 12,5%, fracture of proximal femur in 65%, fracture of distal radius 7,5% and distal tibia in 15%, as well as vertebral frac- ture in 2,5% and polytopic fractures 5% of the patients from P1012 group I. Analyzing the risk of falls in both groups (status FOOD CONSUMPTION OF A EURO- before the fracture) we could notice significantly higher num- MEDITERRANEAN POPULATION IN THE ber of patients positive for “the risk of fall” factors 80% (group CREDITS FOR HEALTH PROJECT: ROLE OF I) vs. 35,2% (group II), p<0,01. For calculation of FRAX FRUIT AND VEGETABLE FOR BONE HEALTH score we made an abstraction and calculated it using the data L. Guasti1, S. Quattrini1,B.Pampaloni1,L.Cianferotti1,V. as for the day before the fall and the day after the fall in the Fratoni1, C. Fossi1, S. Ciuffi1, L. Serra-Majem2, L. Ribas- first group. For group II FRAX score was calculated just once. Barba2, M. L. Brandi1 As for the day before the FRAX score in both groups was 1Department of Surgery and Translational Medicine, Unit of comparable and constituted 12,46±0,83 vs. 11,86±0,54 Bone and Mineral Diseases, University of Florence, (p>0,05). After the fracture FRAX score in group I increased University Hospital of Florence, Florence, Italy, 2Nutrition dramatically 18,37±0,65 vs. 11,86±0,54 (p<0,05). Research Foundation, University of Barcelona Science Park, Conclusion: In elderly patients due to the presence of Barcelona, Spain conditions that can lead to the increased risk of falls FRAX score can be combined with the appreciation of Objectives: To evaluate the change of dietary habits for veg- the “risk of the fall” factors in order to timely introduce etables and fruits, also important for bone health and typical of preventive measures and decreasefracturerisksand the Mediterranean Diet in the population of the Credits for consequences. Health (C4H) project. C4H has been funded by the EC S566 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 (#602386) and was intended to fight the increasing prevalence of autonomic neuropathy type IV (HSAN-IV) o type V with- lifestyle-related diseases through an innovative multi-stakeholder out anhidrosis, are very rare autosomal recessive genetic approach based on people empowerment, higher adherence to disorders with difficult diagnosis and treatment. A few Mediterranean Diet and an higher level of physical activity. hundred cases have been reported. It associates insensitiv- Material and Methods: A randomized controlled trial has ity to pain, developmental delays, anhidrosis and thermo- been developed recruiting 2064 subjects in Italy, Spain and regulation disorders. The complications of CIPA are es- Greece, in order to test an Information and communication sentially orthopaedic, but the vital prognosis can often be Technology (ICT) platform, that was characterized by interac- challenged and the life expectancy rarely reaches adult- tive nutritional and physical activity sections and a rewarding hood. We report 2 cases from Basurto University system (Dynamic platform) or by static information only Hospital. The first one is a girl who was diagnosed with (Static platform). Recruited subjects were automatically ran- CIPA at the age of 8 months. It was the first description of domized to the intervention (Dynamic platform) or control a CIPA-associated NTRK1 mutation (Sarasola et al. BMC (Static platform) groups. Food Frequency Questionnaires Medical Genetics 2011). She is currently 13 years old and were administered to both study groups through the ICT plat- she suffers corneal injuries, distal phalangeal amputation, form. The consumption frequency of all food groups, included several bone fractures, calcaneo/astragalus osteomyelitis fruits and vegetables, was evaluated. surgically treated that is becoming more aggravated (se- Results: There were some differences in food consumption vere infection/complications). She had vertebral fractures habits between the overall sample of individuals assigned to also, axial curvature is seriously damaged, she could have the static and dynamic platform at the end of the study, but the spinal cord injury and the ankle infection has become interaction with dynamic platform produced a significant in- chronic. The second case is a 5 years-old girl with crease in the consumption of fruits and vegetables. At the calcaneo fracture with osteomyelitis. We realized she can- baseline, the mean values of consumption (in terms of not feel pain, she exhibited corneal and tongue injuries, serv/day) for Dynamic and Static subjects were: several fractures, and aseptic osteomyelitis. The genetic • Fruit: Dynamic 2.40 (S.D. 1.69), Static 2.33 (S.D. 1.55); study showed homozygosis for SCN9A gen (c.2908G>T • Vegetables: Dynamic users 2.29 (S.D. 1.59), Static users (p.Glu970)). There are some other cases with this gene 2.27 (S.D. 1.55). affected, but no one shows this mutation. Instead, the results at the end of the follow-up period were: Results: The genetic studies are different but both are in- • Fruit: Dynamic 3.03 (S.D. 1.55), Static 3.01 (S.D. 1.60); volved in pain regulation. However, the manifestations and • Vegetables: Dynamic 2.78 (S.D. 1.49), Static 2.57 (S.D. 1.57). complications of them are similar and do not differ from other Conclusions: Both platforms produced an increase in the con- cases described in the literature. sumption in fruits and vegetables, with a significant increase for Conclusion: CIPA is a dangerous genetic disorder. Fractures users interacting with the Dynamic platform (p<0.001). An have complications, usually aseptic osteomyelitis, even some- higher adherence to Mediterranean Diet corresponds to an times they are infectious. Our 2 cases present those problems. higher consumption of vegetable foods essential for bone health. Should we decide for surgical treatment with the dangerous Reference: Cosman F et al. Osteoporos Int 2014;25:2359. complications we are sure that they will present or should we stay and only treat the complications of the disease? More studies are needed to answer this question. P1013 CONGENITAL INSENSITIVITY TO PAIN SYNDROME (CIPA): TRY TO PREVENT SEVERE P1014 COMPLICATIONS OR JUST TREAT THEM? RUNNING A NATIONAL AUDIT FOR FRACTURE O. Fernandez-Berrizbeitia1,J.Humayor1,M.Garcia1,E. LIAISON SERVICES DATABASE (FLS-DB): Galindez1, E. Ruiz1, I. Torre1,A.Intxaurbe1, L. Estopiñan1, EXPERIENCES IN EFFICIENT DATA ENTRY J. Blanco1, N. Rivera1, C. Perez1,C.Gomez1, E. Guerrero1,I. C. Gallagher1, N. Vasilakis1,M.K.Javaid2 Zorrilla1, O. Ibarguengoitia1 1Falls and Fragility Fracture Audit Programme/Royal College 1Rheumatology Department, Basurto University Hospital, of Physicians, London, United Kingdom, 2Nuffield Bilbao, Spain Department of Orthopaedics / Rheumatology and Musculoskeletal Sciences / University of Oxford, Oxford, Objective: To show the problems related to making therapeu- United Kingdom tic decisions in patients with CIPA. Material And Methods: Congenital insensitivity to pain Objective: Limited resources mean it can be challenging for with anhidrosis (CIPA) or hereditary sensory and services to enter the data required for the FLS-DB, however Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S567 adopting effective data entry processes could improve efficiency Objectives: The research was aimed to investigate and ensure FLSs can enter data and simultaneously deliver care. falling prevalence and associated factors among el- Material and methods: Data for the FLS-DB data is collect- ders who was evaluated in Fatih district geriatric ed within the FLS service and entered using a secure web- study. based data portal. Data entry can be completed by directly Material and methods: Age range of 60–101 were taken entering records for each patient, or alternatively services into the study. Falling has been evaluated as an exis- can arrange mass upload data from local databases on to the tence of falling within a year. The fragility screened web tool. The dataset specifications, web user guide and a with FRAIL-questionnaire, functional capacity mea- FAQ document were made available as well as a support email surement with KATZ-Activities-of-Daily-Living-Scale and telephone line. (ADL) and LAWTON-BRODY-Instrumental Results: Some FLSs (15) submitted data via mass upload, Activities-of-Daily Living Scale (IADL), quality of though the vast majority (32) entered data directly into the life measurement with EQ5D-questionnaire, cognitive web tool. Although there are far more sites entering data directly, status with Mini–Cog-test, depression with GDS-SF, the total number of records uploaded by the 15 FLSs doing mass malnutrition with MNA-SF, balance and gait with load (16,403), is greater than the total number for sites entering Romberg-test and postural instability-test, were evalu- data directly (15,649). Comparing mean number of records for ated accordingly. FLSs uploading in mass vs. direct entry: Mass upload sites have Results: 204 cases (94 male–110 female) were recruited a mean of 1093.53 while direct entry sites have a mean of only in this research. Average age is 75.4±7.3. Case of fall- 489.09 in comparison. Therefore FLSs manually uploading ing rate is%28.1 in all cases(M:%25.5, F:%30.3). have a mean record upload rate which is less than 50% of mass There was a significant difference among falling and upload sites. This is an indication that the mass upload facility number of disease (p <0.001)-number-of-drug may improve efficiency in data entry. Though the introduction (p=0.003)- fragility-score (p=0.001), IADL (p=0.019), of a local system for maintaining FLSDB records involves a EQ-5D score (p=0.010), depression score (p=0.023) time commitment, it is prudent for FLSs to allocate this time but there wasn′t any significant finding among falling as in the long term it will effectively eradicate the duplication and age (p=0.97), BMI (0.56), afraid of falling involved in entering data into the FLSDB directly. (p=0.16), VAS score (p=0.98), power of muscle Conclusion: The difference in numbers of records uploaded (p=0.053), diameter of foreleg (p=0.60), TUG test across FLSs indicates that there is significant variation across (p=0.96), UGS (p=0.91), ADL score (p=0.065, BIA sites in terms of their ability to enter data. A number of factors parameters (body fat, visceral tallowing, bone), CDT may contribute, however one factor is likely to be the use of good score (p=0.08), MNA score (p=0.065, point of subjec- data processing systems. Mass upload of data appears to be an tive health condition (p=0.16)). Among the group of effective tool for improving efficiency in data entry and further falling, dementia (p=0.003), chronic pain (p=0.028), work is needed to make these tools more widely available. dynapenia (p=0.028), level of ambulation (p=0.036), Disclosures: KJ has received honoraria, travel and/or subsis- fragility (p=0.013) had a significant difference, howev- tence expenses from: Amgen, Eli Lilly, Medtronic, Novartis, er; gender (p=0.47), obesity-DSO(p=0.69), level of ed- Proctor and Gamble, Servier, Shire, Internis, Consilient ucation (p=0.50), HL (p=0.63), existence of MN Health, Stirling Anglia Pharmaceuticals, Mereo Biopharma, (p=0.09), existence of DM (p=0.07), existence of HT Optasia, Zebra Medical Vision (p=0.54), UI (p=0.48), finding of Romberg (p=0.51), postural instability (p=0.38), low UGS (p=0.84), cog- nitive defect (p=0.47, existence of depression P1015 (p=0.35)) did not have a significant difference. FALLING OF ELDERY LIVING IN THE Falling non-related factors in regression analysis in COMMUNITY last 1 year scores were; (depending variability: O. Y. Yilmaz1,P.K.Kucukdagli2, M. E. Erarkadas3,E.O. falling/non-depending variability: disease/number of Ozkaya4, G. B. O. Bahat Ozturk1,C.K.Kilic1,S.A.Avci5, drug/fragility/IADL/GDS-SF/Eq-5d score/dementia/ M. A. K. Karan1 chronic pain/ existence of dynapenia): Existence of 1Istanbul University Istanbul Medical School Department of dementia (OR=0.29, p=0.012) and fragility score Internal Medicine Division of Geriatrics, Istanbul, Turkey, (OR=1.43, p=0.031). 3Istanbul University Istanbul Medical Faculty, Istanbul, Conclusion: Many falling related factors were taken into Turkey, 4Istanbul University, Istanbul Faculty of Medicine, account. As a result, we think that cognitive defect and Istanbul, Turkey, 5Istanbul University Cerrahpasa Medical fragility are major factors which are the related factor of School, Istanbul, Turkey falling. S568 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P1016 P1017 SHORT AND MEDIUM TERM MORTALITY IN PLATELET RICH PLASMA EFECTIVENESS ON ELDERLY PATIENTS WITH HIP FRACTURE: A LEVELS OF PAIN AS A TREATMENT OPTION FOR PROSPECTIVE STUDY KNEE OSTEOARTHRITIS G. Bini1,G.Malatesta1,S.Bernardini1,T.Riccioni1,G. A. Bitzidis1 Pasqualetti1,A.A.Qasem1, E. Bonicoli2,M.Lisanti2,F. 1Orthopaedic Department, St Loukas Hospital, Thessaloniki, Monzani1 Greece 1Dipartimento Medicina Clinica e Sperimentale - Università di Pisa, Pisa, Italy, 2Dipartimento di Ricerca Traslazionale e Objective: Pain and the pain related disability are the major delle Nuove Tecnologie in Medicina e Chirurgia - Università complaints of patients with knee osteoarthritis (OA). In the last di Pisa, Pisa, Italy years and in an effort to control these, new methods have been developed like the intra-articular injections of autologous Objective: Elderly patients with hip fracture develop a high Platelet Rich Plasma (PRP) as a part of the orthobiologic treat- number of adverse events that affect the clinical outcome and ment of OA. The PRP has an anti-inflammatory action and also overall survival. The aim of this prospective study was to releases several growth factors inthejointwhichhaveafavor- identify markers of short and medium term mortality in pa- able effect on the articular cartilage. We wanted to evaluate the tients with hip fracture followed in the Orthogeriatric Unit of effectiveness of an autologous PRP specific preparation on the Pisa University Hospital (AOUP). levels of pain experienced by patients with knee OA. Material and Methods: Patients were consecutively en- Method: Initially and from January 2014 until December rolled from April 2013 to August 2014. All the patients 2016, we included in this study 53 Caucasians (9 males) from underwent a thorough medical history and geriatric multi- North-Western Greece with a known history of knee osteoar- dimensional assessment, including ADL (Activities of thritis who complaint of persistent knee pain. We excluded from Daily Living), CAM (Confusion Assessment Method), the study a total of 14 patients based on the criteria of a recent SPMSQ (Short Portable Mental Status Questionnaire), knee trauma, a known history of coagulopathy, an abnormal CIRS (Cumulative Illness Rating Scale). Routine biochem- Platelet count or being under anticoagulant treatment. The re- ical parameters were also collected. After discharge the maining 39 patients had undergone a standard bilateral standing prevalence of functional recovery and the received rehabil- antero-posterior and profile knee X-ray. These X-rays were itation treatment were assessed by telephone interview. assessed by the same team of doctors for knee OA according Results: We enrolled 270 patients (mean age [±SD] 84.2±6.9 to the Kellgren-Lawrence (K-L) radiologic criteria: OA stage 0- years, 75.8% women) with frail hip fracture (93.3% due to acci- 4. These 39 patients who were diagnosed with at least stage 1 dental fall). The mean hospital stay was 5.6 days (C.I 95% 5.3- unilateral knee Osteoarthritis (stage 1-4 K-L classification) had 5.9), the incidence of delirium was 7.9% (95% C.I 6.8-8.5) and 4 done further intravenous tests of a full blood count and a coag- died (1 man). At follow-up (median 21 months [95% C.I. 20-23]; ulation check. These patients had a mean age of 64.07 y.o. and 45 patients dropped out), 68 patients died (19 men, 27.9%). consented for the PRP treatment. They were asked to fill the Analysis of survival showed a significant worse outcome in males Numeric Pain Rating Score (NPRS) regarding the level of knee (p <0.05) and in patients undergoing prosthesis/endoprosthesis pain they experienced at the time of the assessment. The NPRS compared to those receiving osteosynthesis (p<0.01). is a visual numeric descriptive score assessing the intensity of MDRD>40, measured either at hospital admission or discharge, thepainwith11possibleanswerswhichrangefrom0-10.The correlated with better outcome (p<0.01 and p<0.05, respectively). value 0 represents no pain, the value 5 the moderate pain and Pre-hospital preserved autonomy (ADL≥4) and cognitive func- the value 10 represents the worst pain experienced. After the tion (SPMSQ≤3) were also associated to better outcome (p<0.01, first assessment, we applied the same PRP protocol for all the for both). No correlation was observed with both comorbidity 39 participated patients. According to this every patient had an degree (CIRS) and perioperative delirium. At multivariate logistic intra-articular knee injection of 5 ml PRP once weekly for the regression method, female gender, a shorter hospital length of next 3 weeks. These 5 ml of the autologous PRP preparation stay and the absence of cognitive impairment (SPMSQ>3) were obtained after a peripheric venous blood collection of emerged as the most predictive factors for better overall survival. 20 ml and a single centrifugation on swing rotor for 8 minutes The survivors received any kind of rehabilitation in the 94.7%. at 2400 rotations per minute. The patients were assessed at 1, 3 Conclusion: Several factors significantly affected short and and 6 months after the last intra-articular injection. For the medium term survival. Despite most of them were statistical analysis we used the non-parametric Mann-Whitney unmodifiable, a worse outcome could be at least partially U- test and the parametric t-test and the statistical importance prevented by optimizing the duration of hospital stay, was set at p<0.5. avoiding renal function decline and favouring early mobiliza- Results: All patients attended the 1 month assessment but 2 tion and functional rehabilitation. patients did not attend the 3 month and 4 the 6 month Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S569 assessment. Their answers were not taken into account. The the definition of osteoporosis (16.2%). According to the data obtained from the patients’ given answers was statistical- previous study, we select -1 as the cut-off value in OST. ly important with a p<0.5. The mean value of the pain score The AUC of the OST to identify osteoporosis in the fem- before the PRP application was at 6.38. At 1 month after the oral neck, total hip, and lumbar spine were 0.748(95% application the mean value of the pain score was at 1.66 in confidence interval (CI95): 0.714-0.782), 0.811 comparison with the mean value at 3 months after the last (CI95:0.765-0.857), and 0.656 (CI95:0.614-0.698) respec- injection which was at 1.25. The last evaluation at 6 months tively. The AUC, sensitivity and specificity of the OST showed a mean value regarding the pain intensity of 1.23. index (cutoff=-1) to identify primary osteoporosis in Conclusion: The intra-articular application of the PRP had a healthy men were 0.705 (CI95:0.675-0.736), 76.2% and continuous progressive notable positive effect on the levels of 51.9%, respectively. pain experienced by the participated patients diagnosed with Conclusion: The OST may be a simple and effective pre- at least K-L stage 1 knee OA. In order to strengthen the ac- screening tool for identifying the risk of primary osteoporosis countability of this study’s results, more and better all-around in Taiwan healthy men. organized studies are needed with bigger samples and even- Acknowledgements: The authors would like to thank Taiwan tually with homogenous patient’s characteristics regarding the Osteoporosis Association for offering the data and authorizing knee osteoarthritis severity status. the data management. References: 1. Meheux CJ et al, J Arthroscopy 2016;32:495. 2. Gobbi A et al. J Sports Health 2012;4:162 3. Sampson S et al. Am J Phys Med Rehabil. 2010;89:961 P1018 VALIDATION OF OSTEOPOROSIS SIMPLE TOOL TO IDENTIFY PRIMARY OSTEOPOROSIS IN TAIWAN MEN P.-C. Wu 1, D.-H. Liu2 1Division of Chinese Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Province of China, 2Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Province of China Objective: Validate the effectiveness of the Osteoporosis Simple Tool (OST) in identifying primary osteoporosis in Taiwan men. Material and Methods: A bus, equipped with Dual-energy X-ray absorptiometry(DXA), serving for country-wide BMD test was available between 2008 and 2011. Participants must complete a questionnaire regarding risk factors of osteoporotic fracture in FRAX® tool before BMD test. The participants are men (≧50y/o). The participants with a disorder strongly asso- P1019 ciated with secondary osteoporosis must be excluded. These BONE MINERAL DENSITY AND TRABECULAR include type I DM, osteogenesis imperfecta, hyperthyroidism, BONE SCORE IN UKRAINIAN MEN WITH OBESITY rheumatoid arthritis, liver cirrhosis and steroid use over 5mg V. Povoroznyuk1,A.Musiienko1 1 daily more than 3 months. Osteoporosis was defined as lowest D.F. Chebotarev Institute of Gerontology NAMS Ukraine, T-score≦-2.5 at any sites, including lumbar spine(L1 ~ L4), Kyiv, Ukraine total hip, femoral neck. We performed OST (OST index=0.2 [Weight(kg) – Age(Year)], cutoff value: -1) to determine the Aim: To determine the connection between the bone mineral sensitivity, specificity, and area under the receiver operating density (BMD) and trabecular bone score (TBS) parameters in characteristic curve (AUC) for correctly selecting men with Ukrainian men suffering from obesity. primary osteoporosis. Materials and methods: We examined 396 men aged 40-89 Results: A total of 1997 men (mean age: 69.85±9.53 years) years, depending on the body mass index (BMI) all the subjects were enrolled in this study. Of the study subjects, 324 met were divided into 2 groups: Group A – 129 men with obesity S570 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 whose BMI was ≥30 kg/m2 (mean age – 59.9±10.4 years; Objectives: To estimate age- and sex-specific hip fracture height – 174.4±6.8 cm; weight – 100.0±9.8 kg, BMI – 32.9 rates in Ukrainian population. ±2.6 kg/m2) and Group B – 267 men without obesity and BMI Study Design and Methods: The STOP study (Study of The of <30 kg/m2 (mean age – 60.9±12.5 years; height – 174.3±6.7 prevalence of Osteoporotic fractures in Ukrainian Population) cm; weight – 77.1±9.8 kg, BMI – 25.3±2.6 kg/m2). The BMD was conducted in 2011-2012. It was organized by Ukrainian of total body, lumbar spine at the site L1-L4, femoral neck and Association of osteoporosis with the support of the Ukrainian ultra-distal forearm were measured by DXA (Prodigy, GEHC Association of orthopaedist and traumatologists and was gather- Lunar, Madison, WI, USA). The TBS of L1-L4 was assessed ing the information about incidence of hip fractures in different by means of TBS iNsight® software installed on our DXA parts of Ukraine. machine (product of Med-Imaps, Pessac, France). Results: It was established that incidences per 100 000 per- Results: In total group we found that obese men have signif- sons in both sexes progressively increased with age. At youn- icantly higher BMD in comparison with men without obesity ger ages, up to 67 years, incidence rates were higher in men of lumbar spine (A – 1.289±0.212 g/cm2,B– 1.172±0.237 than in women; but thereafter they were much higher in wom- g/cm2; F=22.59; p<0.001), femoral neck (A – 0.964±0.148 en, almost double at the age of 80–85 years. Overall incidence g/cm2,B– 0.914±0.150 g/cm2; F=25.18; p<0.001), total body of hip fracture was comparable with data from neighboring (A – 1.277±0.098 g/cm2,B– 1.185±0.118 g/cm2;F=57.38; countries (Poland and Romania). p<0.001) and ultra-distal forearm (A – 0.555±0.086 g/cm2,B– Conclusions: As hip fractures are a serious health problem in 2 0.494±0.095 g/cm ; F=37.57; p<0.001). TBS (L1-L4)wassig- Ukraine and around the world, the regional epidemiological nificantly lower in obese men compared to non-obese men (A – data about hip fractures incidence is an important basis for the 1.053±0.161, B – 1.197±0.167; F=66.48; p<0.001). Fat mass development of a national system of prevention and treatment and BMD status showed a significant positive correlation at of osteoporosis and its complications. various sites. The correlation between the fat mass and TBS of L1-L4 was also significant, although negative. Conclusion: In Ukrainian men obesity negatively affected on P1021 TBS L1-L4, despite significantly higher BMD at all measured INSULIN-LIKE GROWTH FACTOR-1 AND FREE sites compared with men without obesity. The study results TESTOSTERONE AS EARLY SERUM MARKERS OF reveal a significant positive correlation between fat mass and OSTEOPOROSIS IN ELDERLY MEN 1 2 3 4 BMD. Correlation between fat mass and TBS L1-L4 was sig- F. Lumachi ,V.Camozzi, R. Tozzoli , R. Spaziante ,S.M. nificant and negative. M. Basso5 1University of Padua, School of Medicine, Department of Surgery, Oncology and Gastroenterology (DiSCOG), P1020 Padova, Italy, 2University of Padua, School of Medicine, EPIDEMIOLOGY OF HIP FRACTURES IN Department of Medicine, Padova, Italy, 3Clinical Pathology UKRAINE: RESULTS OF STOP-STUDY Laboratory, Department of Laboratory Medicine, S. Maria V. V. Po vo ro zn yu k 1, N. V. Grygorieva1,M.O.Korzh2,S.S. degli Angeli Hospital, Pordenone, Italy, 4Department of Strafun3,V.M.Vaida4, F. V. Klymovytsky5,R.O.Vlasenko1,V. Diagnostic Imaging, S. Maria degli Angeli Hospital, S. Forosenko1,J.A.Kanis6,H.Johansson6,E.McCloskey6 Pordenone, Italy, 5Department of Surgery, General Surgery, 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, S. Maria degli Angeli Hospital, Pordenone, Italy Kyiv, Ukraine, 2SI "Institute of Spine and Joint Pathology named after prof. M. I. Sytenko of NAMS Ukraine", Objectives: Osteoporosis is rare in males, affecting almost ex- Kharkiv, Ukraine, 3SI "Institute of Traumatology and clusively the elderly, while up to 30% of postmenopausal wom- Orthopedics of NAMS Ukraine, Kyiv, Ukraine, 4Uzhgorod en may have low bone mineral density (BMD). In both sexes, National University, Uzhgorod, Ukraine, 5Research Institute dual-energy X-ray absorptiometry (DXA) is usually considered of Traumatology and Orthopedics, Krasny Liman, Ukraine, a reliable tool to evaluate bone loss by measuring BMD. 6Centre for Metabolic Bone Diseases, University of However, several potential serum markers of bone remodeling, Sheffield Medical School, Sheffield, United Kingdom including insulin-like growth factor I (IGF-1) and free testoster- one (FT) have been investigated, not only in order to identify Background: Hip fracture is one of the most serious complica- bone changes early, but also to predict subsequent losses in tions of osteoporosis, which has important medical, social and BMD and prevent the risk of some adverse skeletal related economic complications. It is well known that incidence of hip events. The aim of this study was to evaluate the relationship fractures gradually increases with age and depends on the sex, between BMD, serum IGF-1, and FT in a group of osteoporotic but similar epidemiological studies in Ukraine are limited. men older than 65 years with DXA-confirmed osteoporosis. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S571 Materials and Methods: We retrospectively reviewed the bilateral tibial lengthening in childhood. She now presents medical records of 17 elderly men (median age 69 years, range severe triaxial deformity of both legs and a progressive pain 66-76) who underwent DXA (Hologic QDR 4500 C, Waltham, that requires her to use a wheelchair to move around. She was MA, USA) and lumbar spine (L2-L4) BMD measurement. operated performing bilateral tibial osteotomies and Serum IGF-I was measured by an immunochemiluminescent endomedular nailing. Preoperative planning and a strict met- (ICMA) method (Maglumi 2000, SNIBE, China), while serum abolic control were crucial to achieve good results. FT was assayed by a radioimmunoassay (RIA) method Results: A good alignment was achieved and the patient is (Immunotech, Prague, Czech Republic). currently able to walk without pain. Results: The results were the following: LS-BMD=0.760 Conclusions: Hypophosphatemic rickets is a type of ±0.064 g/cm2; IGF-1=140.7±26.3 μg/L; FT=277.6±33.5 hereditary rickets characterized by persistent hypophosphatemia pmol/L. No correlation was found between BMD and the and hyperphosphaturia. The most predominant type is inherited age of the patients (R=-0.28, p=0.27), BMI (R=0.01, in an X-linked fashion and caused by mutation in the gene p=0.96), PTH (R=0.02, p=0.93), and 25-hydroxyvitamin D encoding the phosphate-regulating endopeptidase homolog, X- (R=0.13, p=0.61). The regression line equations between linked. It causes deficient calcification of mineralized structures BMD, IGF-1, and FT were BMD=3.404–120.389IGF-1 such as bones, resulting in severe bone deformities. (R=0.82, p<0.001), and BMD=504.601–2.959FT (R: –0.56, p=0.017). No significant relationship between IGF-1 and FT (R=0.33, p=0.19) was found. P1023 Conclusion: High IGF-1 and low FT serum levels are inde- NON-VERTEBRAL FRACTURES IN UKRAINIAN pendently related to low BMD, suggesting that the two markers WOMEN WITH OBESITY AND METABOLIC together could be used in the early diagnosis of bone loss in SYNDROME IN POSTMENOPAUSAL PERIOD elderly men. Further studies will eventually confirm our results. V. V. Po vo ro zn yu k 1,L.P.Martynyuk2,N.I.Dzerovych1 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, Kyiv, Ukraine, 2I. Hobachevsky Ternopil State Medical University, Ternopil, Ukraine Introduction: The number of obesity in the world has been significantly increasing in population. Abdominal obesity leads to the metabolic syndrome (MS) development. It was researched that components of MS have influence on bone mineral density (BMD), but data are contradictory Aim: To determine peculiarities of non-vertebral fractures in women with obesity and MS. Methods: 590 women aged 50-79 years (mean age – 64,0±8,0 yrs; mean weight –75,8±13.6 kg, body mass index (BMI) – 29.4±5.3 kg/m2, mean duration of menopause – 14,6±8,4 yrs) were examined. The women were compared into the three P1022 groups: A included 298women without obesity (BMI) ≤ 29,9 BILATERAL TIBIAL INCURVATION IN A PATIENT kg/m2), B involved 177 patients with obesity (BMI ≥ 30,0 kg/ WITH HYPOPHOSPHATEMIC RICKETS: A CASE m2). MS was diagnosed in women of the C group(115people). REPORT WomenwereconsideredtohavetheMS according to IDF 1 2 C. Bejarano Lasunción , J. J. Panisello Sebastiá criteria (2005 yr). BMD was measured by the DXA method 1 Orthopaedic Surgery and Traumatology Unit, Hospital (Prodigy, GEHC Lunar, Madison, WI, USA). Results are pres- 2 Universitario Miguel Servet, Zaragoza, Spain, Orthopaedic ent as means (±SD) and categorical variables were expressed as Surgery and Traumatology Unit. Hospital Universitario frequencies. Significance was set at p<0.05. We performed an Miguel Servet, Zaragoza, Spain one-way ANOVA test, multiple regression and correlation anal- ysis. Data were analyzed using “Statistika 6.0” © StatSoft, Inc. Objective: We present a complex case of bilateral tibial de- Results: Non-vertebral fractures were found in 37,92% of the formity in a patient with a strange musculoskeletal disease: A group patients, 29,94% of B group women and 35,56% of hypophosphatemic rickets. the C one. We estimated that patients without obesity have Material and Methods: The case is about a 23-year-old significantly lower BMD of lumbar spine (A – 0,931 woman with hypophosphatemic rickets who was treated with ±0,168g/cm2, B –1,091±0,191g/cm2, C –1,082±0,190g/ S572 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 cm2), femoral neck (A – 0,772±0,113 g/cm2, B – 0,858 between the number of switches and the persistence. Patients ±0,132 g/cm2, C –0,861±0,135g/cm2) and ultradistal forearm with exclusive branded treatment or with exclusive generics (A – 0,347±0,073g/cm2, B – 0,428±0,083g/cm2, C –0,418 treatment had similar correlations. However, in the mixed ±0,088g/cm2) in comparison with women of the groups B therapy group, the number of switches between generics and and C. We did not found significant differences among between generics and branded during the first year of therapy BMD of the B and C group patients (p>0,05). was negatively correlated with the total duration of therapy. The results of the study showed significant better BMD of the C Conclusions: The presence and type of switch between group patients without fractures compared to those with frac- drugs in therapies with bisphosphonates are elements tures. Differences of BMD in patients with and without non- that can affect the persistence in therapy. Nonetheless, vertebral fractures in other groups of the women were not found. they must be evaluated with particular attention in the Conclusion: BMD is better in women with obesity and MS. patient's overall management. Non-vertebral fractures are more common in patients without obesity. P1025 FRACTURE LIAISON SERVICE DATABASE: P1024 DEVELOPING A NATIONAL CLINICAL AUDIT TO USE OF GENERIC DRUGS IN ANTI-RESORPTIVE MEASURE SECONDARY PREVENTION PROVISION THERAPIES: THE RESULTS FROM THE ANALYSIS N. Vasilakis1,S.Rai1,C.Gallagher1, C. Tsang2,M.K.Javaid3 OF A REGIONAL DATABASE 1Falls and Fragility Fracture Audit Programme / Royal F. Giusti1,S.Parri1,G.Gronchi1, L. Cianferotti1,M. College of Physicians, London, United Kingdom, 2Clinical Raglianti1, M. L. Brandi1 Effectiveness Unit / Royal College of Surgeons, London, 1Department of Surgery and Translational Medicine, United Kingdom, 3Nuffield Department of Orthopaedics / University of Florence, Florence, Italy Rheumatology and Musculoskeletal Sciences / University of Oxford, Oxford, United Kingdom Objective: To assess the effects of the switches between drugs and their bio-equivalents on persistence. Objective: Secondary fracture prevention delivered by a frac- Material and Methods: The study is based on the analysis of ture liaison service (FLS) requires effective identification, in- the administrative database of Tuscany Region, within the vestigation, treatment initiation and monitoring of patients. T.A.R.Ge.T. project (Appropriate Treatment of Geriatric re- TheFractureLiaisonServiceDatabase(FLS-DB)was fracture in Tuscany). The study (retrospective, observational) commissioned to measure the delivery of secondary fracture was conducted over a period of 10 years from 2006 until 2015. prevention and adherence to guidelines with a view to For each patient, gender and age were extracted. For each informing quality improvement. considered drug (alendronic, risedronic and ibandronic acid), Material and methods: The audit criteria were based on data about number of dispensed boxes, and date of adminis- NICE technology assessments and guidance on osteoporosis, tration were extracted. and the National Osteoporosis Society clinical standards for Results: The descriptive analyses showed a widespread use of FLSs. Selection of the audit criteria was also informed by the generic drugs. In 2015, for alendronic acid, the generic drugs consensus of a multi-disciplinary group of experts. Data is represent 61.8% of total boxes dispensed and 69.3% of total collected in FLSs and entered using a secure web-based data patients treated. With regard to ibandronic acid, the percentage portal. Individual sites can view their submitted data using live of generic drugs was 33.8% for boxes and 38.8% for patients. run charts with national averaged data. With regard to risedronic acid, the percentage was 60.7% and Results: Data collection began in January 2016. To date 54.1% for the number of packages and for the treated patients, 35,221 records have been entered by 57 FLSs. The first report respectively. is due to be published in April 2017. This will include data There were several significant correlations between the num- from 18,356 patients seen by 38 FLS between January and ber and type of switches (in the first year of therapy) and the June 2016. The report will address the following questions, total duration of therapy. Such correlations depended on dif- what proportion of patients: ferent configurations between generic and branded who were • presenting with a fragility fracture are identified by the FLS? taken during therapy. Three types of therapy have been iden- • are assessed with a DXA? tified: exclusive generics treatment, exclusive branded treat- • are assessed for falls risk factors? ment or mixed therapy. There was a positive relationship • are followed up within 4 months of index fracture? Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S573 • are on a bone protection treatment within 4 months of index osteoporosis. L1-L4 T-score -3.4 SD, left femur neck fracture? T- score -2,9 SD and right femur neck T-score -3.1 • are initiated on a falls intervention within 4 months of index SD. Laboratory findings: normal PTH (59 pg/ml), nor- fracture? mal values of bone turn over markers, normal ionized Conclusion: The FLS-DB aims to provide a feedback calcium (1,13mmol/l) and vitamin D on the low normal mechanism for fragility fractures. This audit is the first limit (25 nmol/l). The patient was treated with step in understanding current secondary fracture preven- alendronic acid 70 mg + cholecalciferol 5,600 IU week- tion care, improving its efficacy and ultimately ly, and Calcium 1000mg daily. Control DXA was per- preventing those who suffer a fragility fracture from formed 2 years after the start of the treatment, with L1- experiencing further fractures. Further work is needed L4 spine T-score - 2.9 SD, left femur neck -2,5 SD and to review the dataset and data completeness for some right femur neck -2,6 SD. The patient continued to take fields could be improved; however the first year of data the same therapy for treatment of osteoporosis and reg- collection has shown it is possible to answer questions ularly took inhaled therapy. Even the number of exac- on the assessment, treatment and management of pa- erbations of asthma remained the same, the treatment tients who sustain a fragility fracture. with bisphosphonates, vitamin D and calcium was Disclosures: KJ has received honoraria, travel and/or subsis- effective. tence expenses from: Amgen, Eli Lilly, Medtronic, Novartis, Conclusion: The patient who had secondary osteoporosis Proctor and Gamble, Servier, Shire, Internis, Consilient caused by the treatment of severe asthma with high Health, Stirling Anglia Pharmaceuticals, Mereo Biopharma, doses of systemic corticosteroids due the unusual ami- Optasia, Zebra Medical Vision nophylline allergy, with routine screening for osteoporo- sis will prevent osteoporotic fracture, the timely treat- ment will improve the T-score, and will reduce the bone P1026 symptomatology. SECONDARY OSTEOPOROSIS CAUSED BY CORTICOSTEROID TREATMENT IN PATIENT WITH IN SEVERE ASTHMA P1028 S. Josifovska Tofiloska1, T. Bajraktarova Prosheva1,S. AGE-RELATED CHANGES IN SPINE BMD BASED Jordanova1 ON DXA EXAMINATION 1Department of Internal Medicine, Clinical Hospital Shtip, P. Borowy 1,E.Czerwinski2 Shtip, Former Yugoslav Republic of Macedonia 1Krakow Medical Centre, Krakow, Poland, 2Metabolic Bone Diseases, Jagiellonian University College of Medicine, Introduction: Osteoporosis represents a systemic disor- Krakow, Poland der with low bone mass and impaired microarchitecture of bone tissue due to many factors. One of the risk Introduction: Despite the fact that the bone mineral density factors is the long-term treatment with systemic cortico- of adults decreases with age leading to osteoporosis, the mea- steroids in patients with severe uncontrolled asthma. surement of this feature by densitometry is subject to error. Purpose: To show developing of osteoporosis in female Especially in the field of spine the actual BMD value may be patient with uncontrolled asthma treated with increased different from the measured one. dose of systemic corticosterone due allergy to Aim: To evaluate the age-related changes in BMD as mea- aminophylline. sured by spine DXA. Case report: A 76 years old woman with severe asthma, Material and methods: 1,284 women aged over 50 were non-smoker, with DM type 2 (cortico-induced), low randomly selected into the study. Between 1997 and BMI (BMI 18 kg/m2), 35 years suffering from asthma, 2003 these subjects were screened for osteoporosis in with VC=75% FEV1=35%. Due to aminophylline aller- the process of which they underwent the densitometry gy, the patient at each exacerbation was treated with and fracture risk assessment. The subjects underwent the higher doses of systemic corticosteroids, combined with spine and/or hip densitometry, in accordance to the inhaled corticosteroids, long-acting beta-2 agonist and methodology of the International Society for Clinical tiotropium bromide. Because of back pain, dual-energy Densitometry. X-ray absorptiometry (DXA) was performed 4 years Results: Despite the increasing age a growth in spine ago, with finding of significant spine and hip BMD was observed in the study group. This tendency S574 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 showsanincreaseinT-scoresastheagevaluesgrow. they are associated to adverse events leading to with- (Figure 1). drawal. Topical cetylated fatty acids (tCFA) has proven to be helpful in knee OA self-administered treatment and they are not burdened with adverse events. Identifying the subgroup of knee OA patients which could benefit from tCFA could be extremely useful in clinical practice. The aim of this study was to verify if there are clinical, radiological or anamnestic predictors of response to tCFA treatment. Materials and methods: One-hundred thirteen patients with knee OA according to ACR classification criteria were enrolled. For each of them were registered anam- nestic data (sex, age), knee OA radiological stage (ac- cording to Kellgren-Lawrence scale) and WOMAC (Western Ontario and McMaster Universities) overall and sub-scales’ scores before treatment. A favourable outcome was defined as an improvement >10% of the maximum score of WOMAC overall score after one week (twice per day) of tCFA treatment. Nonparametric tests were applied; p-value <0.05 was Conclusion: Spine BMD may be impaired by the technolog- considered statistically significant. ical imperfection. X-rays measure the density of all the places Results: A favourable outcome was observed in 52% of - in front and behind a vertebra. Therefore, if the area of patients (59/113). From univariate analysis only measurement includes degenerative changes, their density WOMAC overall and sub-scales’ scores were associat- will be added to the density of the body, and thus the value ed to response (p<0.0001). Multivariate logistic regres- of BMD will increase. For this reason, some patients may sion analyses established that the WOMAC overall display a normal or osteopenic result, when in fact the verte- score was the only predictor of a favourable outcome bral body BMD is low. This leads to an incorrect diagnosis (p<0.0001; Odds Ratio 1.08). Taking into account the and a delay in therapy implementation. Therefore, it is advised WOMAC sub-scales instead of the overall score, both that the patients above the age of 70 have both spine and hip stiffness and physical functional predict the response to BMD measured. tCFA treatment (respectively: p=0.0328 and p=0.0095; OR 1.09 and 0.96). Conclusions: This study support the hypothesis that tCFA P1029 treatment in patients with knee OA may represent a ther- CLINICAL PREDICTORS OF RESPONSE TO apeutic option. We observed that only WOMAC score CETYLATED FATTY ACIDS TOPICAL was a mild predictor of response. These findings suggest TREATMENT IN KNEE OSTEOARTHRITIS that, in order to realise a knee OA tailored therapy, tCFA A. Ariani1,S.Parisi2,G.M.Guidelli3,M.Bardelli3,A. should be prescribed more on the basis of symptoms (es- Bertini4 pecially stiffness and disability) than on radiological im- 1UO Medicina Interna e Reumatologia - Azienda pairment, sex or age. Ospedaliero Universitaria di Parma, Parma, Italy, 2 Struttura Complessa Reumatologia - Azienda Ospedaliero Universitaria Città della Salute e della P1030 Scienza di Torino, Torino, Italy, 3Rheumatology Unit, ARE THERE PROGNOSTIC FACTORS OF NEW University of Siena, Siena, Italy, Siena, Italy, 4South-East FRACTURE OCCURRENCE DURING District, Polo di Langhirano, Azienda Unità Sanitaria BISPHOSPHONATES DRUG HOLIDAY? Locale di Parma, Parma, Italy A. G. Diaz1,S.P.Lucas1, M. Gonzalez Pernas1,M.G. Torres1,C.Martinez1, J. Paluch1,M.Font1, B. Oliveri2,R. Objective: Knee osteoarthritis (OA) is one of the prev- M. Gomez1 alent degenerative affection of the lower extremities. 1Division Endocrinologia, Hospital de Clinicas-UBA, Buenos Analgesics, oral a topical Non Steroid Anti- Aires, Argentina, 2Laboratorio Osteoporosis y Enfermedades inflammatory Drugs are the most common self-treat- Metabolicas Oseas (INIGEM, UBA-CONICET), Buenos ments. Nevertheless, even if they are quite effective, Aires, Argentina Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S575 Objective: to describe changes in BMD and fracture (FX) studies examining the association between skeletal muscle occurrence during bisphosphonates (BPs) drug holiday after andgrowthhormone,aswellasandrogens(Di Monaco M, ≥ 5 years of treatment, in postmenopausal women with oste- 2011; Cruz-Jentoft A. J, 2010; Buehring B, Binkley N, 2013). oporosis (OP) Aim: To study the correlation between skeletal muscles and Methods: A retrospective analysis of 234 postmenopausal growth hormone, total and free testosterone level in older women with OP that discontinued BPs after 5 years of treat- women. ment, were admitted between March 2014 and April 2016. Materials and methods: The study involved 42 healthy Patients with other metabolic bone diseases, secondary OP, women aged 60 to 86 years (mean age – 70.62±6.97 yrs). those under another anti-OP treatment, less than 70% of annual According to age, the examined women were divided into drug compliance or follow-up <12 months after BPs cessation groups: 60-74 years (n=25) and 75-89 years (n=17). Lean were excluded. Clinical data including BPs treatment history, mass of the total body, upper and lower extremities was eval- BMD by DXA at lumbar spine (LS), femoral neck (FN) and uated using Dual X-ray absorptiometry (Prodigy, GEHC total hip (TH) and clinical and/or radiological FX, were ana- Lunar, Madison, WI, USA). Strength of skeletal muscle was lyzed before and after cessation of BFs during 72 months. evaluated using springy carpal dynamometer. To determine the Results: A total of 133 patients aged 71.07 + 7.33 years old functional capacity of skeletal muscle, we used a «4-meter» test. (yo) were included, 51.1% of them were ≥70 yo. Patients To measure the level of growth hormone, total and free testos- received BPs for 99.7±38.7 months. Forty four patients had terone, Immulite 2000 analyzer-based electrochemiluminescent FX: 22 before, 13 during and 9, both, pre and during treat- method was used (Siemens DPC, USA). ment. Follow-up at drug holiday was 44,2 + 21,1 months (12- Results: For the purpose of quartile analysis, women were 72), each patient had 2.47±1.34 (1-6) clinical and BMD con- divided into 4 groups depending on their growth hormone trols. BMD at TH declined 2.04% (p=0,011), without changes values: Q1 – growth hormone <1.12 ng/ml (n=11), Q2 – in LS or FN. Patients with OP features increased during drug growth hormone being 1.13-1.98 ng/ml (n=10), Q3 – growth holiday (54,2% vs. 63,6%; p<0,0001). In patients ≥70 yo, hormone being 1.99-2.60 ng/ml (n=11), Q4 – growth hor- BMD at LS increased 5.3% (p=0,047), probably due to mone >2.61-3.19 ng/ml (n=10). Women with the lowest spondyloarthrosis, while BMD at TH declined 4.1% growth hormone values are also marked with the lowest lean (p=0,007) after 36 months of follow-up. Twenty seven FX mass of upper (р=0.01) and lower (р<0.05) extremities, as were reported in 25/133 (18.8%) patients, 48.5% of them oc- well as appendicular lean mass (р=0.03). We found a signifi- curred in the first three years of drug holiday. Vertebral FX cant correlation between appendicular lean mass and level of was the most common FX (37%) and they were almost twice growth hormone (women aged 60-74 yrs: r=0.36; women than intra-treatment (10 vs. 6, p=0,037). History of intra- aged 60-89 yrs: r=0.31), between strength of skeletal muscle treatment FX and the persistence of OP features at BPs cessa- and level of total testosterone (women aged 75-89 yrs: r=0.55; tion were associated with new FX occurrence (p=0,007), with- women aged 60-89 yrs: r=0.32), free testosterone (women out differences by age and type or duration of BPs therapy. aged 75-89 yrs: r=0.31), growth hormone (women aged 75- BMD at TH was lower in those patients who presented new 89 yrs: r=0.35; women aged 60-89 yrs: r=0.32); between func- FX (p=0,022). The FX rate was higher than the observed tion of skeletal muscle and level of total testosterone (women during treatment (0.27 vs. 0.56 FX/month, p=0,016) aged 75-89 yrs: r=0.46), free testosterone (women aged 75-89 Conclusion: Besides the retention of BPs in bone, there would yrs: r=0.48). be a significant decline in BMD at TH as well a higher FX Conclusion: Significant correlation between parameters of rate, during drug holiday. The main determinants of FX oc- lean mass, skeletal muscle strength, functionality and level currence seem to be the decline of BMD at TH and the history of growth hormone and androgens was determined in older of FX during BPs treatment. We suggest an active follow-up women. in this group of patients P1032 P1031 PREVALENCE OF OSTEOPOROSIS AND SKELETAL MUSCLE AND HORMONAL STATUS IN FRACTURE RISK IN PATIENTS WITH CHRONIC OLDER WOMEN OBSTRUCTIVE PULONARY DISEASE V. V. Po vo ro zn yu k 1,N.I.Dzerovych1, T. J. Solonenko1,R.V. T. Bajraktarova Prosheva1, S. Josifovska Tofiloska1,S. Povoroznyuk1 Jordanova1, S. Markovik Temelkova2 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, 1Department of Internal Medicine, Clinical Hospital Shtip, Kyiv, Ukraine Shtip, Former Yugoslav Republic of Macedonia, 2University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Introduction: In recent years there has been a number of Skopje, Former Yugoslav Republic of Macedonia S576 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Introduction: A number of epidemiological studies have lifestyle, body mass index and bone mineral density shown that osteoporosis is closely associated with chronic to predict the risk of hip fractures and other major obstructive pulmonary disease (COPD). The patients with fractures due to osteoporosis. Diagnosis of vertebral COPD have various clinical risk factors for osteoporosis in- fracture (VF) is important for identifying patients cluding smoking, older age, low body weight, physical inac- who need pharmacologic therapy for osteoporosis. tivity. Decreased pulmonary function, inflammation, gluco- This study shows the importance of radiographic ver- corticoid use and vitamin D deficiency are also risk factors tebral assessment for identifying patients who need related to the development of osteoporosis in COPD. treatment for osteoporosis in diabetic women. Objective: To evaluate the prevalence of osteoporosis and Objective: We investigated the FRAX-estimated fracture risk fracture risk among the patient with COPD, out patients ex- in patients with type 2 diabetes mellitus (DM) compared with amined in pulmonary unit in Clinical Hospital Stip. nondiabetic control group. Methods: The analysis included 2865 patients with COPD. In Materials and methods: We examined 100 type 2 diabetic all patients spirometry was performed by determining the women (mean age: 59,4+ 6,2 yrs, mean BMI: 32,4 +6,11 kg/ FVC and FEV1. Bone mineral density of the hips and lumbar m2,durationofDM– 7[IQR 5;12] yrs, duration of menopause spine was measured with dual-energy X-ray absorptiometry 8,5[IQR 4;15] yrs.). The control group consisted of 77 nondi- (DXA). FRAX tool was used to estimate the 10 years fracture abetic without major diseases age- and BMI-matched persons. risk. Bone mineral density (BMD) was measured with DXA (GE Results: The patients with COPD were divided into Lunar) with lateral vertebral assessment (LVA). The individu- groups according to gender and age. From 2865 patients al 10 year fracture risk was assessed by FRAX tool (http:// with COPD, 1712 (59.5%) were men and 1153 (40.5%) www.shef.ac.uk/FRAX) for Europe-Belarus. women. With normal DXA (T-score -1 and higher) were Results: In comparison of diabetic women with the control 1121 (39%) patients, with osteopenia (T-score -1-2,5 group regardless of vertebral deformities 10-year probabilities SD) were 1264 (44%) and with osteoporosis (T-score of fractures were similar between the groups for major osteo- below -2,5 SD) were 480 (17%) patients. Osteoporosis porotic fractures (MOF) (diabetic 2,6 [IQR 2,0;3,6] vs. non- and osteopenia was found in 61% of patient and the diabetic 2,4 [IQR 2,1;3,1], p=0,2874) and hip fractures (dia- prevalence was higher in woman and in older patients. betic 0,4 [IQR 0,1;0,7] vs. nondiabetic 0,4 [IQR 0,1;0,7], The risk of fractures in the next 10 years was estimated p=0,7269). The prevalence of vertebral deformities in diabetic by FRAX, and was higher in the patients with higher women in our study was higher than in the control group daily doses of corticosteroid therapy, in older patients, (16,4% vs. 4,5% respectively, p=0,00462). Considering the in women and in those with low body mass index. revealed vertebral deformities it is found that the 10-year Conclusion: Severity of COPD, using corticosteroid probability of MOF in diabetic women was higher than in therapy and decrease of BMI are risk factors for high the control group 3,1[IQR2,2;3,95] vs. 2,4[IQR2,1;3,3] prevalence of osteoporosis in COPD patients. The high p=0,018, whereas there was not statistical confidence for the prevalence of osteoporosis and osteopenia is a reason hip fractures. for screening all patients with COPD for osteoporosis, Conclusions: Considering the increased risk of vertebral defor- to recognize the patients with high risk of fracture and mities in postmenopausal Belarusian women with type 2 diabetes to initiate the treatment in the early stage of the disease mellitus radiographic vertebral assessment would be useful for to prevent osteoporotic fracture and to improve the the clinical identification of osteoporosis and fractures. quality of life. P1034 P1033 ABNORMAL BMD RESULT OF THE FEMORAL ASSESSMENT OF THE FRACTURE RISK BY THE NECK DXA RESULTING FROM LOW BODY FRAX IN POSTMENOPAUSAL WOMEN WITH WEIGHT: CASE STUDY TYPE 2 DIABETES MELLITUS P. Borowy 1,E.Czerwinski2, M. Sochocka-Bykowska3 O. V. Vodyanova1, N. S. Korytko2 1Krakow Medical Centre, Krakow, Poland, 2Metabolic Bone 1Belarusian Medical Academy of Post-graduate Education, Diseases, Jagiellonian University College of Medicine, Minsk, Belarus, 2Belarusian State Medical University, Krakow, Poland, 3Wojewódzki Zespół Reumatologiczny, Minsk, Belarus Sopot, Poland Introduction: The fracture risk assessment tool Objective: To show the erroneous measurement of hip BMD (FRAX), devised by the World Health Organization in patients with low body weight as well as to show a solution (WHO), uses several variables, including age, sex, of this issue. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S577 Material and methods: A case of a 47-year-old patient was Results: We included 65 diabetic patients; of these 21 patients analysed. In a period of 5 years he underwent 4 densitometric (32.31%) had type I diabetes while 44 patients (67.69%) had examination of femoral neck. type II diabetes. Age in type I was 24.5±10.5 years while in Results: Based on the first study osteopenia was diagnosed type II was 50.1±8.44 years (P=0.001). DM type ΙΙ showed with T-score of -1.5 in the neck. Prophylactic therapy and a higher BMI(P=0.001), fatigue(P=0.005), shoulder periarthritis follow-up examination after 12 months were recommended as (frozen shoulder)(P=0.034), knee osteoarthritis(P=0.002), a result of the differential diagnosis. The follow-up DXA cheiroarthropathy(P=0.016), anserine bursitis(P=0.001) and showed bone loss in the area of the greater trochanter plantar fasciitis(P=0.003) than type I. Osteoporosis was found (Figure 1.). The succeeding DXA examinations were per- in both types but type II showed more prevalence 13/44 pa- formed after and 5 years (showing more bone loss in the tients (29.5%) while type I showed only 3/21(14.2%). No sta- greater trochanter with a decline in BMD. tistically significant difference between both groups as regard t- Figure 1. score in the three sites. MSUS showed increased prevalence of quadriceps tendon enthesophytes in type I(P=0.033), while Infrapatellar(P=0.023) and retrocalcaneal bursitis(P=0.001) were more prevalent in type II DM. Conclusion: Early evaluation of any diabetic patient regard- ing BMD by DXA scan and soft tissue by MSUS seems to be beneficial for early detection of any abnormality and therefore early management and prevention of complications. References: Conclusion: The observed bone loss in greater trochanter was -American Diabetes Association. Diagnosis and classification caused by the decrease in body weight leading to improper of diabetes mellitus. Diabetes Care 2013;36 (Suppl 1):S67. imagining of the femur. Lunar DXA recognized trochanter -Blake GM, Fogelman I. Hosp Med 2003;64:521. area as a background to the healthy femur due to its too low -Balint PV et al. Ann Rheum Dis 2002;61:905. density/mass. The actual structure of the femur has not been changed and the reduced bone mineral density (neck T-score - 2.0) was not correctly assessed. The proposed solution is to P1036 increase the density of the study area by placing underneath CONTINUOUS POSITIVE AIRWAY PRESSURE the femur a bag of rice or a content of a similar density. TREATMENT IMPROVES BONE MINERAL DENSITY IN MEN AFFECTED BY SEVERE OBSTRUCTIVE SLEEP APNEA P1035 C. Liguori1,F.Placidi1,F.Izzi1,N.B.Mercuri1, U. Tarantino2 PATTERNS OF MUSCULOSKELETAL SYSTEM 1Department of Systems Medicine, University Hospital of INVOLVEMENT IN PATIENTS WITH TYPE I AND Rome, Rome, Italy, 2Department of Orthopedics and TYPE II DIABETES MELLITUS Traumatology, “Tor Vergata” University of Rome, Rome, A. A. Negm1,M.I.Hanafy1,H.Hamoud1,T.I.Adrosy1 Italy 1Rheumatology Department/ Faculty of Medicine, AL-Azhar university/ Al-Hussien University Hospital, Cairo, Egypt Objective: We have recently demonstrated that severe OSA (Apnea-Hypopnea Index>30/h) significantly reduced bone Objectives: To study the different patterns of musculoskeletal mineral density (BMD) in male patients at all ages. The (MSK) system affection in both types of diabetes mellitus aim of this study was to evaluate the improvement of (DM). BMD in lumbar spine and femur in male severe OSA pa- Methods: We performed a retrospective single-center study tients treated by continuous positive airway pressure on sixty five patients during the period from May 2014 to (CPAP). February 2015, to evaluate MSK manifestations in diabetic Methods: Sixty male severe OSA patients underwent dual- patients at Sayyed Galal University Hospital, Cairo, Egypt. energy x-ray absorptiometry for BMD assessment before and Patients were identified as diabetics based on Diagnosis after 1 year of CPAP therapy. We distributed OSA patients in and Classification of Diabetes Mellitus diagnostic criteria two subgroups on the basis of the compliance at the CPAP (1997). Clinical data, laboratory investigations, X-ray, therapy. Compliance was measured by analyzing the software musculoskeletal ultrasonography (MSUS) and Bone min- ventilator report; patients should use their device for at least 4 eral density was measured using Dual energy X-ray ab- hours per night and for 5 days a week. Sixty-two patients sorptiometry (DXA) scan were all collected from all compliant to the CPAP therapy constituted the OSA+CPAP patients. group, while twenty-four patients not showing the adequate S578 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 compliance at the CPAP therapy were included in the OSA- rehabilitation on the reception postoperative scars were CPAP group. healed, skin temperature easily elevated, periarticular edema Results: OSA+CPAP showed the significant increase of knee minimal. Pain was a 7 by VAS. Range of motion in the BMD in the lumbar spine after the 1 year treatment of hips: flexion bending the lower thigh / Flexion with stretched CPAP, whereas the BMD of femur did not change. lower thigh / Abduction (Fb/Fs/ A was 75/60/30 degrees left, Considering the comparison of the parameters obtained at and 80/60/30 right. Range of motion in the knees: Flexion / the 1 year follow-up we observed the significant increase of Extension (F/E) was 100/0 degrees left, and 90/0 right. BMD in L1 in OSA+CPAP than OSA-CPAP. Muscle strength estimate as 3 per manual muscle test Conclusion: This study shows that CPAP restores BMD in (MMT-).The patient walked with pair underarm crutches. On male patients affected by severe OSA. The improvement of the discharged scar sanitized. Local temperature normal, knee BMD was particularly evident in the lumbar spine and mainly without edema, in mild valgus. Pain was 4 by VAS. In left hip in L1. We are aware that L1 is considered a transitional vertebra Fb/Fs/ A was 85/70/35, and 90/70/35 degrees right. F/E knee: at higher fracture risk. Therefore, since OSA could be a detri- 110/0 left. 90/0 right. Muscle strength estimate as 4- per mental factor on BMD leading to osteoporosis and thus giving MMT. She was allowed to walk with one underarm crutch. susceptibility to bone fractures, we showed that CPAP therapy X-ray findings of both knee and hips in correct position. improves BMD in OSA patients. In particular, we supposed Conclusion: Timely rehabilitation after total hip and knee that the correction of both hypoxia and sleep quality may be the arthroplasty are satisfactory solution in RA patients with ad- main candidate in the improvement of BMD in OSA+CPAP vanced joint destruction. patients. Therefore, we encourage clinicians in assessing BMD in male OSA patients inviting them to treat their sleep disorder by CPAP, also for reducing the fracture risk. P1038 QUALITY OF LIFE AND WELL BEING IN PATIENTS WITH HIP OSTEOARTHRITIS P1037 C. Suteu1, D. M. Farcas2 REHABILITATION AFTER BILATERAL TOTAL HIP 1University of Oradea, Faculty of Medicine and Pharmacy, AND SIMULTANEOUS BILATERAL KNEE Oradea, Romania, 2Medical rehabilitation, Faculty of ARTHROPLASY IN A PATIENT WITH Medicine, University of Oradea, Oradea, Romania RHEUMATOID ARTHRITIS –A CASE REPORT V. K. Knezevic1, J. K. Kojovic1, S.-J. Snezana, J. Kedzic Aim: To assess quality of life and wellbeing in a group of 1Institute for Rehabilitation Belgrade, Mladenovac, Serbia patients with hip osteoarthritis. Material and method: Our study consisted in a group of 84 Introduction: Rheumatoid arthritis (RA) is a chronic, inflam- patients with hip osteoarthritis. We split up the patients in two matory autoimmune disorder resulting joint destruction. In the groups. First group consisted in 42 patients who underwent a treatment of end-stage damage of the joints many patients physical rehabilitation program three times per week for 12 with RA require hip and knee arthroplasty. RA is the common months and the second group of 42 sedentary patients. All the indication for these surgery due to the fact that around 90% patients were assessed with Lequesne Index, Short Form 36 these patients have one, often both of the hip / knee affected. for quality of life, Hamilton Anxiety Rating Scale for anxiety, Appropriate rehabilitation in addition to the quality of and Levenstein Index for stress at baseline, at six months and endoprosthesis is crucial to restore the function and quality at twelve months. Patients were recruited from ambulatory of life. system Bihor county, Romania. The mean age in the first Aim: To show the importance of the implementation of reha- group was 61.36±4.31, and in the control group of 62.71 bilitation after surgical procedures to achieve functional re- ±3.45. We found body mass index and educational level al- covery and quality of life. most similar in both groups. Method: We describe a case patient Z. Lj. aged 48 g. who had Results: The values of the Lequesne questionnaire proved a surgery endoprosthesis implantation right hip 2013, left 2014. small improvement at 6 months and at 12 months in the treat- Simultaneous operation of implantation endoprosthesis both ment group, but in the control group we did not find any knees in 2016. Before first and after these operations she had improvement. Also in the group who underwent rehabilitation physical therapy (FT) in our hospital several time. During program the values of both Physical Component rehabilitations we applied the following FT: electro (IFS, la- Summary (PCS) and Mental Component Summary (MCS) ser, magnet, vasculator), hydro, kinesi and work therapy. showed an improvement after 6 and 12 months, than in the Results: Before and after rehabilitation we observed: local control group which showed no improvement in quality of status (scar, local temperature, edema), pain, range of motion, life. Anxiety values diminished in the therapy group after 6 muscle strength and gait, X-ray findings. During the last and 12 months, at the same time, in the control group there Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S579 was a mild increase in values at 6 and 12 months. We noticed similar ALM/ht2, functional and strength tests, fractures also that stress values diminished in the therapy group at 6, 12 and number of falls than those with 25OHD sufficiency. months, and at the same time the mean values of stress in the Physical activity was associated with a tendency toward control group were a little higher at the end of the study. better physical performance tests: walking speed According to our results, we found also correlations between (p=0.071) and chair sit-to-stand tests (p=0.057). In con- quality of life, anxiety and stress. trast, women with BMI>30kg/m2 had lower 25OHD Conclusion: Like other studies, our study pointed out the (p=0,023) and abnormal physical performance tests: worst beneficial effect of rehabilitation therapy and active lifestyle Timed Get-Up-and-Go TUG (p=0.039), and a tendency in improving quality of life and also psychological well-being toward abnormal walking speed (p=0.051) and chair sit- in patients with hip osteoarthritis. We noticed also correlations to-stand tests (p=0,067), but without no difference in falls, between quality of life and some psychological factors in pa- FX incidence or ALM/ht2. tients with hip osteoarthritis. Conclusions: Worst physical performance tests were associ- ated with obesity, sedentary lifestyle and particularly with falls, but not with osteoporotic fracture antecedents. P1039 ALTERED PHYSICAL PERFORMANCE TESTS ARE A RISK FACTOR FOR FALLS BUT NOT FOR P1040 FRACTURES IN OLDER AMBULATORY WOMEN THE ELEVATED LEVELS OF BONE TURNOVER FROM BUENOS AIRES MARKERS IN YOUNG MEN ARE ASSOCIATED S. P. Lucas1,A.G.Diaz1, M. G. Torres1,C.Martinez1,F.Silva WITH BONE LOSS: A LONGITUDINAL STUDY IN Pavon1, R. M. Gomez1, B. Oliveri2 HEALTHY YOUNG ADULTS 1Division Endocrinologia, Hospital de Clinicas-UBA, Buenos C. Verroken1, S. Goemaere2, H. Zmierczak2, K. Toye2,B. Aires, Argentina, 2Laboratorio Osteoporosis y Enfermedades Lapauw1, J.-M. Kaufman1 Metabolicas Oseas (INIGEM, UBA-CONICET), Buenos 1Unit for Osteoporosis and Metabolic Bone Diseases, Aires, Argentina Department of Endocrinology, Ghent University Hospital, Ghent, Belgium, 2Unit for Osteoporosis and Metabolic Bone Objective: To investigate associations between appendic- Diseases, Ghent University Hospital, Ghent, Belgium ular lean mass, obesity and serum 25-hydroxy vitamin D (25OHD) levels with incidence of falls and osteopo- Introduction: In adult men after completion of growth, bio- rotic fractures in ambulatory postmenopausal women ≥ chemical markers of bone turnover are remarkably high as 60 years compared to middle-aged men or young adult women. Little Methods: A cohort of 144 ambulatory postmenopausal is known about the biological significance hereof. Moreover, women ≥60 years admitted at University Hospital from longitudinal data investigating changes in bone mineral den- Buenos Aires for bone evaluation was included. sity (BMD) are lacking in this age group. Anthropometric measurements, 25OHD, appendicular Objective: We investigated DXA-derived bone changes in a lean mass adjusted to height2 (ALM/ht2) by DXA, mus- cohort of healthy men after completion of growth and explored cle strength (Hand-grip test) and physical performance the associations between baseline bone turnover markers and tests: 4-meter Walking speed, 3-meter Timed Get-Up- changes in BMD and bone mineral content (BMC). and-Go Test and Chair sit-to-stand test, were performed. Methods: 428 healthy men aged 25-45 (mean 34.9±5.3) years Abnormal ALM/ht2 was considered <5.67 kg/m2 and participated in a longitudinal population-based sibling-pair study, obesity as body mass index (BMI) > 30kg/m2. with a mean follow-up of 12.4±0.4 (range 11.2 – 13.6) years. Participants responded a questionnaire about history of Areal BMD (aBMD) and BMC were measured at the total body osteoporotic fractures, spontaneous loss ≥ 4.5kgweight (minus head), proximal femur (total hip and femoral neck re- and incidence of falls in the last year, and currently gion), and lumbar spine using DXA. Procollagen type 1 physical activity. amino-terminal propeptide (P1NP), osteocalcin (OC), and C- Results: A total of 144 women aged 69.44±6.9 years with terminal telopeptide of type 1 collagen (CTX) were measured BMI of 28.4±5.6 kg/m2 and ALM/ht2 6.33±0.87 kg/m2 from fasting serum samples using an electrochemiluminescence were included. Women with falls had lower Hand grip technique. Associations between baseline bone turnover markers (p=0.003) and Walking speed tests (p=0.015), a spontane- and annual changes in aBMD and BMC were investigated using ous weight loss (p=0.04) and a tendency toward lower linear mixed-effects modeling, with adjustment for baseline age, ALM/ht2 (p=0.09), but no difference in fracture incidence. weight and weight changes. History of fracture had no association with any functional Results: During the 12-year follow-up period, aBMD at the or strength tests. Women with 25OHD deficiency had total body, lumbar spine, total hip and femoral neck decreased S580 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 by 2.3±3.0%, 1.7±5.3%, 3.1±4.6% and 6.0±5.8%, respective- 0.831] vs. 0.385 [0.289; 0.514] ng/ml, P=0.01). It was found ly (all p<0.001). BMC at the total body, lumbar spine and significant negative correlation between 25(OH)D and β-CTx femoral neck decreased by 1.4±3.9%, 0.9±6.6% and 5.8 (r=-0.25, p=0.006) in patients with systemic postmenopausal ±6.6% (p≤0.002), whereas no change in BMC was observed osteoporosis. Healthy women did not show any significant at the total hip. Higher P1NP, OC and CTX levels at baseline changes in bone turnover markers depend on vitamin D status. were associated with a larger decline in aBMD at the total Conclusion: The results of the study showed that severe vita- body (ß=-0.19 to -0.34, p<0.001), lumbar spine (ß=-0.17 to - min D deficiency is increasing the bone turnover markers in 0.26, p≤0.002), total hip (ß=-0.13 to -0.25, p≤0.008) and fem- postmenopausal women with systemic osteoporosis. Doctors oral neck (ß=-0.13 to -0.18, p≤0.012). Similar associations must pay attention on vitamin D status in complex therapy of were observed with changes in BMC. systemic osteoporosis. Conclusion: The relatively high levels of bone turnover markers in young adult men after completion of growth appear not to be reflective of ongoing bone mass accrual. In contrast, P1042 higher concentrations of these markers are associated with a DIFFERENCES IN FEMORAL BONE more rapid decline in BMD and BMC, possibly reflecting a less MICROSTRUCTURE OF MICE AFTER AN ACUTE favorable skeletal metabolism in these otherwise healthy men. EXPOSURE TO ACRYLAMIDE M. Martiniakova1,A.Sarocka1, R. Babosova1,E.Kapusta2, Z. Goc2,G.Formicki2, R. Omelka3 P1041 1Department of Zoology and Anthropology, Faculty of INFLUENCE OF VITAMIN D STATUS ON BONE Natural Sciences, Constantine the Philosopher University in TURNOVER MARKERS IN POSTMENOPAUSAL Nitra, Nitra, Slovakia, 2Department of Animal Physiology and WOMEN Toxicology, Institute of Biology, Faculty of Geography and N. I. Balatska1, V. V. Povoroznyuk1,O.Mukhaidli1,O. Biology, Pedagogical University in Cracow, Cracow, Poland, Kuziv2, T. J. Solonenko1 3Department of Botany and Genetics, Faculty of Natural 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, Sciences, Constantine the Philosopher University in Nitra, Kyiv, Ukraine, 2Ternopil National Polytechnic University, Nitra, Slovakia Ternopil, Ukraine Objective: This study aimed to examine, for the first time, Aim: To determine the peculiarities of bone turnover femoral bone microstructure of mice after an acute exposure markers depend on the vitamin D status in postmeno- to acrylamide (AA), one of the most common toxins in foods. pausal women. Material and Methods: Twelve clinically healthy 12-weeks- Methods: 160 subjects aged 50-88 yrs. old were included to old Swiss mice (males) were used. The mice were randomly the sturdy: 121 patients (mean age ‑ 63.77±8.61 yr. old) were divided into three experimental groups: E1 group - males were suffered with systemic postmenopausal osteoporosis and 39 treated per orally with 2 doses of AA (1 mg/kg b.w.) in a 24 healthy subjects (mean age ‑ 64.40±8.33 yr. old, p>0.05). hour period; E2 group - mice received 3 doses of AA (1 mg/kg Serum markers of bone formation (procollagen type 1 N- b.w.) during a 48 hour period, and a control group. terminal propeptide (P1NP)), bone resorption (collagen type Histological, histomorphometrical methods and micro- 1 cross-linked C-telopeptide (β-CTx)) and 25(OH)Dtotal were computer tomography were used to determine femoral bone determined by the electrochemiluminescence method “ECL microstructure. The study was approved by the First Local technology” by Elecsys® assay. The optimal vitamin D status Ethic Committee on Experiments on Animals in Cracow was defined when serum 25(OH)D level was 30-50 ng/ml, (No. 175/2012). vitamin D insufficiency and deficiency were noted for Results: In the compact bone, more resorption lacunae (from 25(OH)D levels between 20 and 30 ng/ml and for 25(OH)D 100% to 122%) occurred in mice exposed to AA. The sizes of levels lower than 20 ng/ml, respectively. Severe vitamin D the primary osteon's vascular canals were significantly decreased deficiency was diagnosed when 25(OH)D level was below in groups E1 and E2 (P<0.05). Secondary osteons were signifi- 10 ng/ml. cantly smaller in mice from the E2 group (P<0.05). Cortical bone Results: Due to the results 62.5% examined had vitamin D thickness was not affected by AA exposure. In the trabecular deficiency and 21.9% ‑ vitamin D insufficiency. It was found bone, bone volume and trabecular number were significantly that patients with systemic postmenopausal osteoporosis and increased in mice administered AA (P<0.05). On the contrary, severe vitamin D deficiency had significantly higher bone trabecular separation was significantly decreased in these indi- turnover markers compared with subjects who had optimal viduals (P<0.05). Significantly higher value of bone surface was vitamin D status (P1NP ‑ 52.84 [39.49; 80.39] vs. 34.58 observed in mice from the E1 group whereas trabecular thickness [25.54, 58.67] ng/ml, P=0.053; β-CTx – 0.609 [0.381; was increased in animals from the E2 group (P<0.05). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S581 Conclusion: The effect of AA on microstructure of compact the structural and functional state of bone tissue, especially and trabecular bone tissues is different. The compact bone is in the age group 45-60 years. more resorbed, trabecular bone is more robust and mineral- ized. Therefore, further studies are needed to study mecha- nisms by which AA acts on bone in detail. P1044 Acknowledgements: This work was supported by the Slovak INVESTIGATION ON THE PREVALENCE OF Research and Development Agency under the contract No. SARCOPENIA AND RELATED FACTORS IN SK-PL-2015-0032. The study was also supported by the pro- ELDERLY LIVING IN ACHAIA, GREECE jects VEGA 1/0653/16 and KEGA 031UKF-4/2016. M. Tsekoura1,E.Billis1, C. Matzaroglou1,E.Tsepis1,J. Gliatis2,E.Panagiotopoulos3 1Physiotherapy Department, Technological Educational P1043 Institute of Western Greece, Aigio, Greece, 2Department of EFFECT OF VITAMIN D DEFICIENCY ON THE Orthopaedic Surgery, University Hospital of Patras, Rio, ULTRASOUND DENSITOMETRY DATA Greece, 3Department of Spinal Cord Injuries, University V. V. Po vo ro zn yu k 1,N.I.Balatska1,O.Synenky1 Hospital of Patras, Rio, Greece 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, Kyiv, Ukraine Background: Sarcopenia is a syndrome characterized by progressive loss of skeletal muscle mass, muscle strength Aim: To determine the influence of vitamin D deficiency on and/or physical performance. It is one of the most com- the ultrasound densitometry data. mon problems amongst the elderly worldwide. According Materials and methods: The study involved 227 healthy to the European Working Group on Sarcopenia in Older subjects aged 20-85 years. The average age of men was People, there is no data yet, evaluating sarcopenia in (52.79±14.44) years, and women (51.12±13.72) years of age Greek people. (p>0.05). Serum 25(OH)Dtotal level was determined by Objectives: To evaluate the prevalence of Sarcopenia in older electrochemiluminescence (ECL) method in Elecsys analyzer people living in Achaia-Greece. with cobas test systems. The structural and functional state of Methods: The study's cohort consisted of individuals aged the bone tissue was measured on the heel by Quantitative over 60 years, living in the region of Achaia, in central-west ultrasound densitometer "Sahara" (Hologic). The optimal vi- Greece. Patients’ assessment included the Mini-Mental State tamin D status was defined when serum 25(OH)D level was Examination, as well as the measurement of body mass index, 30-50 ng/ml, vitamin D insufficiency and deficiency were muscle mass, calf circumference, gait speed and handgrip noted for 25(OH)D levels between 20 and 30 ng/ml and for strength. Muscle mass was assessed via bioelectrical imped- 25(OH)D levels lower than 20 ng/ml, respectively. ance analysis grip strength was measured with a specific dy- Results: Studies have found vitamin D deficiency in 50.7% namometer, and the Timed up and Go (TUG) test was used to subjects, insufficiency ‑ in 33.0%, and normal serum 25(OH)D measure physical performance. level in 16.3% of residents. It was evaluated that speed of sound Results: The present study evaluated 154 community- parameter was significantly higher in subjects with optimal dwelling elderly subjects (38 men and 116 women; mean 25(OH)D level (1552.87±37.66 m/s) compared to subjects with age, 70.05, SD=8.04) who volunteered to participate in the vitamin D deficiency (1538.27±28.71 m/s, (p <0,01)) and in- study. Fifty participants (29,2%) were found sarcopenic. sufficiency (1547,99±9,51 m/s, (p <0,05)). Also, it was deter- Logistic regression analysis identified Body Mass Index mined that in subjects 45-60 years with vitamin D deficiency (OR 2.37; 95% CI 1.26-4.47) and calf circumference had ultrasound densitometry data significantly lower compared (OR=0.045; 95% CI 0.01-0.11) to be significantly associated to those who had vitamin D insufficiency (particularly, stiffness with sarcopenia. index: 88.57±14.78 vs. 97.82±17.69,% (p=0.02), speed of Conclusions: Almost one-third of the sample, were diagnosed sound: 1538.68±25.13 vs. 1552.87±27.98 m/s (p=0.03), broad- with sarcopenia according to the criteria developed by the band ultrasound attenuation: 69.29±13.32 vs. 78.41±16.05, European Working Group on Sarcopenia in Older People. dB/MHz (p=0,006)) and optimal serum 25(OH)D level (stiff- Calf circumference and body mass index were associated with ness index: 88.57±14.78 vs. 100.55±22.17,% (p=0.02), speed increased risk of sarcopenia among Greeks. There is a need for of sound: 1538.68±25.13 vs. 1561.05±40.04, m/s (p=0.009)). large multicentered studies evaluating sarcopenia in Greece. It was found that serum 25(OH)D level had a significant pos- itive influence on the parameters of structural and functional state of bone tissue (r=0.15-0.18, p<0.05). P1045 Conclusions: The observations revealed that vitamin D THE ROLE OF EXTRACORPOREAL SHOCKWAVE deficiency and insufficiency have a negative effect on THERAPY IN PLANTAR FASCIITIS S582 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S. D. Birsan1 respectively). In C-group regression relationship between the 1Faculty of Medicine Oradea, Oradea, Romania bone indicators and TFM was insignificant (p=0.4). With in- Demonstration the effect of extracorporeal shock waves in the creasing TFM, BMD at the spine (p=0.008) and femoral neck treatment of plantar fasciitis. (p=0.00004) was significantly increasing. In D-group similar results were observed. The regression relationship between Plantar fasciitis is commonly found in medical practice as TBS and TFM was improbable (p=0.3), and with the growth suffering from painful plantar aponeurosis affecting the of TFM accompanied the increase of BMD at the spine heel due to mechanical pressure at this level. The etiology (p=0.000004) and femoral neck (p=0.0001). is unknown is supposed existence of calcaneal spurs in Conclusion: BMD and TBS probably deteriorate with ad- approximately 60% of patients presenting with pain and vancing of PP. TFM and TLM ratio is not likely to change limitation of movement of dorsal flexion of the foot. 15 with age. In middle and late PP, the BMD of spine and femoral patients had been treated with extracorporeal shock wave neck increases along with TFM. therapy and 10 patients had been treated conservatively with NSAIDs, cold local applications, strengthening exer- cises of the calf muscles and plant. A pain was assessed P1047 by VAS (visual analogue scale), the patients with extracor- EPIDEMIOLOGY AND RISK FACTORS OF LOWER poreal shock wave therapy experienced VAS decreased in LIMB FRACTURES IN PATIENT OF DIFFERENT 70% while patients with conservative treatment just 40%. AGE Extracorporeal shock wave therapy is an alternative thera- N. Grygorieva1, O. Zubach2,R.Vlasenko3 py in fasciitis planting. 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, Kyiv, Ukraine, 2Komunal City Hospital of Ambulance, Lviv, Ukraine, 3Vinnitsa Region Hospital, Vinnitsa, Ukraine P1046 Introduction: Lower limb fractures (LLF) account for BONE MINERAL DENSITY AND QUALITY, BODY approximately one third of all fractures and may result COMPOSITION OF WOMEN IN POSTMENOPAUSAL in substantial mortality and morbidity. Age, osteoporo- PERIOD sis, road collision, obesity and different diseases (osteo- V. V. Po vo ro zn yu k 1,O.Ivanyk1 arthritis, Parkinsonism, cataract, dementia etc.) are the 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, risk factors of LLF. Fractures are a considerable public Kyiv, Ukraine health burden but information about its risk factors in Ukraine is limited. Aim: To examine the bone mineral density and quality, body Objective: To study the risk factors of the LLF of patients composition of women depending on the duration of the post- depending on the age, sex, type of fracture, parameters of bone menopausal period (PP); correlation of total fat mass (TFM) with mineral density, the geometric parameters of the femur and the bone mineral density (BMD) and trabecular bone score (TBS). level of vitamin D in serum. Materials and methods: 179 women (mean age – 58.5±0.4 Material and Methods: We identified 1265 subjects in age 10 yrs; duration of the PP – 11.6±0.6 yrs) were examined. The ex- years old and more, who had at first incident (diagnosis) of LLF. amined were divided into the following groups: A – women in Methods: questionnaires (determination of sex, age, time and the premenopausal period (n=18); B – womeninPPwithadu- reason of fracture), dual-energy X-ray absorptiometry (DXA, ration of less than 5 yrs (n=32); C – women in PP with a duration Lunar, Prodigy), assessment of geometry parameters of the hip of 5-9 yrs (n=39); D – women in PP with a duration of 10-14 yrs (traditional X-ray), biochemical analyses of serum (the evalua- (n=56); E – women in PP with a duration of 15-20 yrs (n=34). tion of level of 25(OH)Dtotal by electrochemiluminescence meth- BMD of lumbar spine, femur and body composition (total fat od, Elecsys, Roche). and lean (TLM) masses) were measured by DXA method Results: Our study confirmed the significant association be- (Prodigy, GEHC Lunar, Madison, WI, USA) and TBS (L1- tween LLF and age and sex. Lower limb fractures were more L4) were assessed by TBS iNsight® software package common among males than among females in the younger age installed on our DXA machine (Med-Imaps, Pessac, France). groups (up to 50 years old). 44.4% from the total fractures Results: BMD at the femoral neck was likely decreasing with were established in patient aged 50 years and older. In this age (p<0.001). The changes in TFM (p=0.01) and TLM group the incidence of LLF was higher in women than in (p=0.05) in patients with various postmenopausal duration men, and the difference has grown up with increasing age. were improbable. Relationship among TBS, BMD and TFM The most common anatomic site of LLF was the tibia and/or of women in premenopausal period (A-group) was found un- fibula (48.9% of all incident LLF), followed by the hip justified (p=0.2 and p=0.2 respectively). In B-group this rela- (29.5%), and the tarsal/metatarsal bones (21.6%). Incidence tionship was equally improbable (p=0.9 and p=0.5 of fracture in patients 50 years and older was 519.8 per 100 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S583 000 patients for all LLF, 226.9 per 100 000 patients for hip had high adherence to PTH therapy (medical possession ratio, fracture and 212.3 per 100 000 patients for tibia and/or fibula MPR≥0.8), 12.3% and 14% of subjects had medium and low fractures. Frequency of tibia and/or fibula fractures rose with adherence to therapy (MPR=0.5-0.8 and<0.5, respectively). aging from 20-29 to 60-69 years and feet fractures increase Interruption of PTH therapy, transient for a couple of months from 20-29 to 50-59 years. The incidence of hip fractures was or permanent, happened in 26.8% of cases, the main reason of highest in the age group over 85 years. Most patients with hip which was the presence of side effects (63.2% of subjects). fractures had vitamin D deficiency or insufficiency, only 5% 36.8% of subjects interrupted PTH therapy for unknown rea- of patients has normal value of vitamin D in serum. Also this sons. All the patients who completed or interrupted PTH ther- study has shown that some geometric parameters of hip have apy received the prescription of sequential therapy with significant influence on hip fracture risk on older patients, antiresorptive drugs but only 72.4% of them followed it for especially hip axis length, neck-shaft angle and cortical bone 4.8±3.0 years. During follow-up after PTH therapy, 4 patients thickness. BMD indices were lower in patients with hip frac- (6.9%) presented fragility fractures, and these subjects were tures in men and women but not differ in patients with feet or among those with low adherence both to PTH and sequential tibia and/or fibula fractures compare with healthy population. therapy with antiresorptive drugs after PTH. Conclusion: Age, sex, parameters of bone mineral den- Conclusion: Although one half of patients completed PTH sity, the geometric parameters of the femur and the level therapy, almost 39% of patients interrupted PTH therapy due of vitamin D in serum are significant risk factors for to side effects which could lead to fragility fractures after lower limb fractures. The presence of these risk factors interruption. Therefore, tight follow-up both during and after should be considered when planning therapeutic inter- PTH therapy is needed in order to reduce fracture risk in this ventions in patients with fractures. kind of patients. P1048 P1049 PARATHORMONE FOR OSTEOPOROSIS TREATMENT EVALUATION OF THE PAIN, NEUROPATHIC PAIN IN REAL CLINICAL LIFE AND SYMPATHETIC SKIN RESPONSE TO V. V. Zhukouskaya 1, M. C. Savanelli2,A.Renzullo1,E. TRANSCUTANEOUS ELECTRICAL NERVE Scarano1,A.Colao1,C.DiSomma1 STIMULATION TREATMENT IN CHRONIC 1Dipartimento di Medicina Clinica e Chirurgia, Divisione MECHANICAL LOW BACK PAIN PATIENTS Endocrinologia, University of Naples Federico II, Naples, A. Ketenci1,E.Yahşi1 Italy, 2IOS and Coleman Srl, Naples, Italy 1Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Istanbul University, Faculty of Background: Since persistence and adherence to osteo- Medicine, Turkey, Istanbul, Turkey porosis treatment influence on fracture outcome, and patients requiring osteoporosis treatment with parathor- Objectives: To investigate the effectiveness of transcutaneous mone (PTH) are at high fracture risk, it is important to electrical nerve stimulation (TENS) in mechanical chronic follow this kind of patients during and after PTH ther- low back pain, and compare the effects of different clinical apy. Therefore, the object of study was to evaluate ad- application methods of TENS on pain, neuropathic pain, func- herence, presence of side effects during PTH therapy tional status, and sympathetic skin response (SSR). and follow-up after PTH therapy. Materials and Methods: 73 patients, aged between 18 and Patients and methods: We analysed all the patients who re- 65, with mechanical suffering from low back pain more than ceived PTH treatment for osteoporosis from 2004 to 2016, three months were included the study. After the baseline mea- and we registered the following parameters: reason of PTH surements, patients were randomized to three physical treat- therapy; side effects; interruption of therapy and its reasons; ment groups. Burst mode TENS was applied at the first group, follow-up after PTH therapy. conventional TENS was applied at the second group while the Results: 87subjects (82 females, 5 males), 67.2±11.3 years- third group received sham TENS application during 15 ses- old, received PTH for osteoporosis treatment due to multiply sions. Patients were evaluated by visual analog scale (VAS), fractures (58.3%), low response to bisphosphonate therapy LANNS (The Leeds Assessment of Neuropathic Symptoms (35.7%), fractures during glucocorticoid therapy (6%). and Signs), DN4 (Douler Neuropathique 4 Questions), 48.3% of subjects completed PTH therapy (18 or 24 months); Modified Oswestry Scoring (MOS), Beck Depression 20.7%dropped-out from follow-up after 6-12 months after İnventory (BDI) and SSR. prescription due to unknown reasons; 18.4% of subjects Results: After TENS application, average VAS scores interrupted PTH therapy after 9.3±5.0 months; and 12.6% of showed statistically significant decrease in whole groups subjects have not finished PTH therapy yet. 73.7% of subjects (p<0,001), after treatment showed statistically significant S584 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 difference between the comparisons of groups. This difference Conclusions: Therapeutic US applications are effective in was due to BTENS (p<0,05). After the treatment, LANNS, reducing the severity of pain furthermore it affects the DN4, MOS, BDI and SSR showed no statistically significant functional status positively by increasing cervical range differences between groups (p>0,05). of motion Conclusions: Burst TENS treatment to lumbar region can be used for short term pain control in chronic mechanical low back pain is an efficient and reliable method. P1051 METABOLIC PARAMETERS AND BONE DENSITOMETRY IN ADULT PATIENTS WITH AND P1050 WITHOUT TYPE 2 DIABETES THE EFFECTIVENESS OF THERAPEUTIC N. Dumitru1,M.Carsote2,A.Buruiana3,E.Petrova3,C. ULTRASOUND IN NON SPECIFIC MECHANICAL Dumitrache4, A. Ghemigian2 CERVICAL PAIN AND COMPARISON OF DIFFERENT 1C.I Parhon National Institute of Endocrinology B, Bucharest, APPLICATION METHODS FOR CLINICAL PRACTICE Romania, 2C. Davila University of Medicine and Pharmacy A. Ketenci1,O.Çelik2, S. Esmaeilzadeh3, D. Sindel4 and C.I. Parhon National Institute of Endocrinology, 1Department of Physical Medicine and Rehabilitation, Bucharest, Romania, Bucharest, Romania, 3C.I Parhon Istanbul Faculty of Medicine, Istanbul University, İstanbul, National Institute of Endocrinology, Bucharest, Romania, Turkey, 2Haseki Hospital, Dept. of Physical Medicine and Bucharest, Romania, 4C. Davila University of Medicine and Rehabilitation, Istanbul, Turkey, 3Department of Physical Pharmacy and C.I. Parhon National Institute of Medicine and Rehabilitation, Division of Pain Medicine, Endocrinology, Bucharest, Romania, Bucharest, Romania Istanbul University, Faculty of Medicine, Turkey, Istanbul, Turkey, 4 Department of Physical Medicine and Diabetes is a major health problem both by the increasing Rehabilitation, Istanbul Faculty of Medicine, Istanbul incidence, and by the associated complications, including sec- University, Istanbul, Turkey ondary osteoporosis through damage of bone micro-architec- ture, according to contemporary data. Objectives: The aim of this study was to investigate the ef- Objective: To evaluate metabolic parameters and bone densi- fectiveness of therapeutic ultrasound (US) in non-specific me- tometry in adult female patients with type 2 diabetes mellitus chanical neck pain, and to compare the effects of intermittent (2DM), compared with non-diabetic women. and continuous US applications on pain severity and function- Method: This is a cross-sectional study obtained in a al disability. Romanian Tertiary Endocrine Center. We analyzed: glyce- Materials and Methods: 71 patients, aged between 18 and mic profile (fasting blood glucose, HbA1c), lipid profile 65, with non-specific mechanical neck pain suffering from (cholesterol, LDL-cholesterol, HDL-cholesterol, triglycer- less than three months were included the study. After the ides), uric acid, phospho-calcium metabolism, the levels of baseline measurements, patients were randomized to three 25 hydroxyvitamin D (25(OH)D), bone markers (Beta- physical treatment groups. US was applied intermittently in CrossLaps - bone resorption marker, osteocalcin - bone the first group and continuously in the second group while the formation marker), assessment of bone mineral density in third group received sham US application during 10 sessions. the lumbar spine and femoral neck (GE Lunar), together Three groups were also treated with TENS. Patients were with anthropometric data, such as body mass index (BMI). evaluated by visual analog scale, algometer, neck disability We used for statistical analysis Student’st-testand and goniometer. Control measurements were three months Spearman correlation. Statistical significance was consid- later after therapy. ered when p <0.05. Results: Pain severity was improved statistically significant in Results: Were enrolled 36 female patients with 2DM and 47 three groups three months later after therapy (p<0,001). Pain control female patients without 2DM. In the 2 DM group: the pressure threshold (PPT) was increased statistically significant 25(OH)D, osteocalcin and magnesium levels was lower in the first and second group after the treatment (p<0,05), (p=0.017, p=0.034, p <0.001) and the BMI, levels of fasting while PPT was decreased in control group. Three months later glucose and triglycerides was higher (p<0.01, p<0.0001, after therapy PPT was increased statistically significant in all p<0.0008). There have been linear correlation between BMI of three groups (p<0,05). Continuous US was observed more and 25 (HO) D level (r=-0.22, p=0.05) and between BMI and effective than intermittent application in cervical rotation bone mineral density in the lumbar spine (r=0.46, p=0.001) in range when the groups were compared after the physical ther- both groups. apy sessions. Continuous application was observed more ef- Conclusion: Based on our observations, 25(OH)D, fective when the group were compared in terms of functional osteocalcin and magnesium levels are lower in the 2DM recovery. group, (borderline significance); BMI correlates positive with Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S585 bone mineral density in the lumbar spine, and negatively with V. V. Po vo ro zn yu k 1,N.I.Dzerovych1,T.J.Solonenko1 25(OH)D, independent of 2DM (borderline significance). 1D.F. Chebotarev Institute of Gerontology NAMS Ukraiine, Kyiv, Ukraine P1052 Introduction: In recent years there has been a number of studies REHABILITATION FOR MOBILITY examining the correlation between vitamin D status and skeletal IMPROVEMENT IN PARAPLEGIA FLACCID IN muscles. However, there are many different approaches to the COMPLEX PLURIMALFORMATIV SYNDROME role of vitamin D metabolism and function of skeletal muscles. WITH STRUCTURAL CHROMOSOME Aim: The research was conducted at the SI «D.F. Chebotarev ABNORMALITIES INV(9)(P12Q13): CASE REPORT Institute of Gerontology NAMS of Ukraine» to study the cor- F. Cioara1, C. Avram1,R.Suciu1, L. Vicas1,M.Cevei1,A. relation between skeletal muscles and vitamin D level in Venter 1, E. Szarka1 women of different ages. 1University of Oradea, Faculty of Medicine and Pharmacy, Materials and methods: The study involved 122 healthy Oradea, Romania women aged 20 to 83 years. According to the gerontological classification, the examined women were divided into groups: Introduction: Chromosomal abnormalities can affect the younger – up to 44 years (n=35), middle – 45-59 years old number or structure of chromosomes. Most genetic abnormal- (n=26), older – 60-74 years (n=44), senile age – 75-89 years ities appear spontaneously. They represent an important part (n=17). Lean mass of the total body, upper and lower extrem- of human genetic pathology not only by frequency but also by ities was evaluated using Dual X-ray absorptiometry (Prodigy, causing phenotypical and structural consequences with con- GEHC Lunar, Madison, WI, USA). Strength of skeletal mus- genital malformation and functional deficiency that affect mo- cle was evaluated using springy carpal dynamometer. To de- tor function and daily living of individual. termine the functional capacity of skeletal muscle we used a Methods: We present the case of a female toddler 10 years «four-meter» test. To determine the level of 25(OH)D old, that we followed up from three to ten years old. The electrochemiluminescent method was used with Elecsys surveillance was during her admission in hospital for rehabil- 2010 analyzer (Roche Diagnostics, Germany). itation treatment. We estimate her neuropsychic and motor Results: We determined a significant correlation between pa- development. We evaluate the patient using various scales rameters of lean mass (r=0.45; t=2.08; p=0.05) and the level of GMFM, ROM, ADL. vitamin D in women of middle (45-59 years) age; skeletal Results: The presence of complex cardiac, genital, digestive, muscle functionality (r=-0.51; t=-2.29; p=0.04) and the level renourinary, bone malformation was life threatening as new of vitamin D in women of older (60-74 years) age. We did not born, and almost not compatible with life. Early vital func- find the significant correlation between parameters of muscle tions support and surgical correction - left colostoma, adapted strength and level of vitamin D. orthopaedic step by step treatment program was applied in Conclusion: Significant correlation between parameters of order to achieve motor development for social abilities. The lean mass, skeletal muscle functionality and the level of vita- case improvement was slowly, but satisfactory. The patient min D was determined in women of middle and older age. was physical prepared before and after each surgical orthopae- dic correction, focusing on functional outstanding, in relation with orthopaedic team. For each stage of case evolution we P1055 adapt prescribing orthoses and other medical devices. At age BONE MINERAL DENSITY AND TRABECULAR of ten the patient was able to walk on short distances with BONE SCORE IN UKRAINIAN POSTMENOPAUSAL supportive devices. WOMEN WITH METABOLIC SYNDROME Conclusion: The presence of congenital abnormalities V. V. Po vo ro zn yu k 1,L.Martynyuk2 creates limits in rehabilitation by severity and multiple 1D.F. Chebotarev Institute of gerontology NAMS Ukraiine, functional deficits. This case is evidence that despite the Kyiv, Ukraine, 2State Higher Educational Institution “I. severity of case, if there is an early intervention and a Horbachevsky Ternopil State Medical University of Ministry dedicated team during the patient’s life long there can be of Health of Ukraine”, Ternopil, Ukraine made important improvements. There is also need for the consequent family support. Aim: To estimate the bone mineral density (BMD) and tra- becular bone score (TBS) in Ukrainian postmenopausal wom- en with metabolic syndrome (MS). P1054 Methods: The study involved 1013 50-79 yrs old women in SKELETAL MUSCLE AND VITAMIN D LEVEL IN postmenopausal period (mean age – 64.44±8.11 yrs; mean du- WOMEN OF VARIOUS AGES ration of menopause – 14.51±8.21 yrs). Patients were S586 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 compared into two groups: A – included 691 women without G. Gronchi1, S. Parri1, L. Cianferotti2,M.L.Brandi2 obesity (BMI≤29.9 kg/m2), B – contained 322 female with MS 1Department of Surgery and Translational Medicine, (IDF, 2005). Additionally groups were divided on subgroups University of Florence, Florence, Italy, 2Department of according to age of patients (50-59 yrs; 60-69 yrs; 70-79 yrs). Surgery and Translational Medicine, Unit of Bone and The BMD of lumbar spine (L1-L4) was measured by the DXA Mineral Diseases, University of Florence, University method (Prodigy, 2005). The quality of bone tissue (TBS L1- Hospital of Florence, Florence, Italy L4) was assessed by the TBS iNsight® software package installed on DXA machine (Med-Imaps, Pessac, France). Objective: Validating a novel network analysis-based method Results: We estimated that women without obesity in total group that is able to provide several statistical indices for describing have significantly lower BMD of lumbar spine (A – 0.950±0.178 drug switching patterns. g/cm2,B– 1.113±0.199 g/cm2; p<0.001) compared to patients Material and Methods: To validate the network analysis- with MS. Analyze of BMD depending on age showed the same based method, data about drug switching patterns were ex- results (50-59 yrs – 1.009±0.169 vs. 1.139±0.200 g/cm2 tracted from the administrative database of Tuscany Region, (p<0.001), 60-69 yrs – 0.932±0.180 vs. 1.089±0.201 g/cm2 within the T.A.R.Ge.T. project (Appropriate Treatment of (p<0.001), 70-79 yrs – 0.912±0.169 vs. 1.117±0.195 g/cm2, Geriatric re-fracture in Tuscany). Moreover, data were also p<0.001). In total group of women we found that TBS L1-L4 generated via simulation in order to have several switching was significantly higher in non-obese patients in compare to configurations with similar matrices but different features. another ones (A – 1.195±0.146, B – 1.153±0.175 g/cm2; Results: Analyses of drug switching patterns are often limited to p<0.001), especially, due to 50-59 yrs old group (A – 1.263 a description of a matrix reporting the different drugs on rows and ±0.125; B – 1.193±0.172, p<0.001). There was not significant columns and the frequency of switches in each cell. Network differences of this index between A and B group women in other analysis (together with graph theory) [1] can provide several tools age groups. It was found significant positive correlation between and indices to go beyond a simple description of the switching BMI and BMD of lumbar spine in all groups and subgroups of matrix. Within this approach, each drug is considered as a node in patients (p<0.05). Correlation between BMI and TBS L1-L4 was a graph and the (possible) switch as an edge. The use of indices significantly negative in total group of women (p<0.05). such as degree centrality (i.e., the number of links incident upon a Conclusion: Ukrainian postmenopausal women with MS node), closeness centrality (i.e., the average length of the shortest have significantly better BMD indexes of lumbar spine, but path between a node and all other nodes), betweenness centrality quality of bone tissue is significantly worse in compare to (i.e., the number of times a node acts as a bridge along the shortest females without obesity. path between two other nodes) as well as clustering algorithms such as InfoMAP [2] can be used to compare more precisely different switching matrices from a quantitative point of view. P1056 By using T.A.R.Ge.T. data and data obtained via simulation, it THE INCIDENCE OF OSTEOPOROSIS AMONG is possible to show the usefulness of this novel method. PATIENTS WITH FIBROMYALGIA Conclusions: Network analysis and graph theory represent a S. D. Birsan1 novel and useful method for analyzing drug switching matri- 1Faculty of Medicine Oradea, Oradea, Romania ces going beyond the limitations of a simple description of drug switching matrices. This study proposed measuring the amount of bone mineral References: density in patients with fibromyalgia. Fibromyalgia is mani- [1] Lewis T G (2009). Network Science. Wiley. fested by pain associated with tenderness of the joints, mus- [2] Rosvall M, Bergstrom CT. Proc Natl Acad Sci USA cles and tendons along with other subjective symptoms. The 2008;105:1118. exact causes of fibromyalgia are unknown, but hormonal im- balance of cortisol and growth hormone could be the cause. In period may 2016 - September 2016 were finding 30 female P1058 persons who have been diagnosed with fibromyalgia. DXA DISABLING FOOT PAIN IN PATIENTS WITH test performed showed a T score between - 3,2 and -4,2 at RHEUMATOID ARTHRITIS patients with risk factors. Making DXA in patients with fibro- M.-D. Clantau1,R.Nartea1,B.Mitoiu1, G. Gheorghievici1,F. myalgia is welcome to tracing and other disease associated. Filipoiu1,A.Nica1 1University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania P1057 Objectives: Many of the patients suffering from rheumatoid A NOVEL NETWORK ANALYSIS-BASED METHOD arthritis are accusing also foot pain. This condition is very FOR ANALYZING DRUG SWITCHING MATRICES frequent and it is also very disabling, affecting people all ages. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S587 The aim of this study is to follow up this group of patients and risk for cardiovascular calcification, morbidity and mortality, measure their function and the quality of life in everyday although these associations are not firmly established. Much living. of what is known about CKD-MBD is based on knowledge Material and Methods: We analyzed all cases of rheumatoid obtained in the dialysis population. Much less is known arthritis from the 3rd Clinic of National Institute of Physical about CKD-MBD in patients with CKD not yet on dialysis. Medicine and Rehabilitation during 2015-2016. In this period CKD changes both the quality and quantity of the bone we selected the patients suffering also from foot pain, and we through its multifactorial influence on bone metabolism, included them in this clinical study. We performed physical leading to loosing of bone mass and increased risk of and paraclinic examination and questionnaires concerning fracture. function and the quality of life (HAQ and AAOS-FAM). THE AIM of this study was to study the prevalence of disor- Results: 49 patients suffering from chronic pain (32 females ders of bone and mineral metabolism, parathyroid glands and 17 males), aged between 39 – 69 years old were included function, vitamin D concentration in patients with various in the study. They all were submitted at first at the same steps stages of CKD, to evaluate the frequency of disturbances of regarding the evaluation, and then after the treatment the fol- BMD and to work up the risk factors of osteoporosis in CKD low up was first at 2 weeks, at 3 months, then after 12 months. patients During this survey only 21 patients answered at the final stage Methods: We analyzed data on 220 adults with CKD aged 20- of the follow-up. The treatment consisted in personalized re- 61 years. 78 (35.5%) patients with CKD II-IV stages and 142 habilitation program and pharmaceutical treatment. The ma- (64.5%) patients on hemodialysis (CKD VD) aged 20-61 jority of them reported that pain still affects the quality of life, years (mean 48,6±3,8 years). The laboratory investigations but with significant improvement during this period. The im- included evaluation of PTH, serum total and ionized calcium, provement of function was reported as good. Statistically, 8 serum phosphate, serum level of alkaline phosphatase and out of 21 patients still suffer from pain walking more than 500 25(OH)D3 concentrations. Regression models were used to m, 12/21 patients suffer from pain during the ADL, 6/21 the determine relationship between lumbar BMD and renal func- pain affects the quality of life and 19 out of the 21 have prob- tion, age, weight, height. lems falling asleep. Results: Results CKD subjects had significantly higher con- Conclusion: The data resulted from this study, showed a centrations of P, Ca × P product and PTH compared to the substantial reduction in physical and professional function- control group. The concentrations of Ca × P product and PTH ing in these group of patients. Physical therapy is a common were significantly higher in hemodialysis patients compared therapeutic solution used also in rheumatoid arthritis, and to CKD stages II-IVones (Ca × P product 4,78±0,11 vs. 3,68 that has demonstrated it is efficacy. Associated with medical ±0,18, p<0,01, iPTH 601,28±68,45 vs. 289,10±60,48 p<0,01) treatment the global results of the study were reduced pain There was no difference in level of 25(OH)D3 between CKD levels with 79% and with 51% improvements in range of II-IV and CKD VD patients (18,71±1,72 vs. 19,55±2,18 ng/ motion ml, р>0,05). Analyzing the compliance with KDIGO 2009 recommended target levels it was found that all four parame- ters met target levels of only 11 (14,1%) patients with CKD II- P1059 IV stages and 4 (3%) CKD VD stage. Vitamin D insufficiency BONE AND MINERAL DISORDERS IN PATIENTS was found in 44.9% of CKD II-IV patients and 51,4% those WITH CHRONIC KIDNEY DISEASE with CKD VD. BMD was decreased in 55.4% CKD II-IV L. P. Martynyuk1,3,S.M.Butvyn2 stages patients and in 19.1% it was lower than -2,5 T SD. In 1Nephrology Department, Ternopil University Hospital, Chair of CKD VD BMD was decreased in 51,1% and in 34,0% it was Internal Medicine, State Higher Educational Institution "Ternopil lower than -2.5 T score units. It was established negative as- State Medical University", Ternopil, Ukraine, 2Chair of Internal sociation between decreased renal function and decreased Medicine, State Higher Educational Institution "Ternopil State BMD (GFR correlated s with spine-BMD (r=-0,452, p<0,05, Medical University", Ternopil, Ukraine, 3I. Hobachevsky the level of serum creatinine correlated s with spine-BMD (r=- Ternopil State Medical University, Ternopil, Ukraine 0,33, p<0,05). Duration of CKD correlated significantly with spine-BMD, (r=-0.45, p<0.05). The degree of bone deminer- Introduction: Chronic kidney disease (CKD) causes distur- alization was more pronounced in individuals with low body bances in calcium and phosphorous homeostasis, abnormali- weight (in patients with CKD stages II-V: r=0,31, p=0,009; in ties in acid-base and vitamin D-parathyroid hormone bal- CKD VD r=0 36, p=0,027). Values of BMD were not related ances, that leads to the impairment of the structure and func- to the duration and cause of CKD. tion of many systems such as the skeletal system, known as Conclusions: It has been established that dominant disorders CKD- MBD. Disorders of mineral and bone metabolism are of mineral metabolism are hypocalcemia, hyperphosphatemia, commonly observed in CKD are associated with increased secondary hyperparathyroidism and 25 (OH) D3 insufficiency. S588 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Such disturbances occur in the early stages of CKD and prog- erosive HOA. 5 women with isolated subtype turned into gen- ress with the decline of renal function, especially in hemodi- eralized HOA. The final number of women with isolated alysis and result in bone loss. Persons with CKD are at higher HОА was only 6 patients; generalized - 10, erosive - 29. risk of low BMD relative to the age-matched general popula- The average number of joints with synovitis amounted tion. The risk factors of bone loss in patients with CKD are 12.5(4.0) for erosive subtype vs. 6.8(3.5) for isolated subtype duration of CKD, female gender, older age, lower body (р<0.05) and 11.6(4.2) for generalized subtype. weight. Negative association between decreased renal func- Conclusions: The detection of synovitis is a prognostic ad- tion and decreased BMD was established. verse factor of transformation of the isolated and generalized References: subtypes into the erosive HOA. 1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. Kidney Int Suppl 2009;(113):S1. 2. Chertow GM et al. N Engl J Med 2012;367:2482. P1061 3. http://www.kdigo.org/clinical_practice_guidelines/pdf/ THE ROLE OF PRIMARY PREVENTION OF Russian–TranslationKDIGOCKD-MBDGuidelineSummary.pdf OSTEOPOROSIS 4. Chronic Kidney Disease: Modeling and Managing Calcium S. D. Birsan1 and Phosphorus Disturbances: CME/CE http:// 1Faculty of Medicine Oradea, Oradea, Romania www.medscape.org/viewarticle/770042?src=0_mp_cmenl_0 Measures that lead to primary prevention was risk factors - poor women, heredity, diabetes mellitus type I, rheumatoid P1060 arthritis, inflammatory bowel disease and hormonal disorders PROGRESSING OF HAND OSTEOARTHRITIS which would be responsible for decreased bone mass. Also, DEPENDS ON SYNOVITIS the risk factors that can be controlled like: smoking, physical O. Balueva1, A. Sarapulova2, O. Teplyakova2 inactivity, alcohol and corticoids. Patients who have risk fac- 1Ultrasound Diagnosis Medical Association “New hospital”, tors that recommendations: calcium-rich foods, physical ac- Yekaterinburg, Russian Federation, 2Ural State Medical tivity and moderate exposure to the sun. University, Ekaterinburg, Russian Federation Objectives: Significant role of inflammation at hand osteoar- P1062 thritis (HOA) requires the assessment of these changes and NO EFFECT OF LONG-TERM COLA INTAKE ON searching of the factors influencing on the progressing of QUANTITATIVE CHARACTERISTICS OF disease. FEMORAL BONE IN MICE Methods: The study included 45 women 45-75 years old with R. Omelka1, V. Meliskova2,J.Conka2, V. Kovacova3,P. the diagnosis of HOA on the criteria of ACR. 22 joints were Sranko1,P.Celec2, M. Martiniakova3 examined at each patient: 2-5 distal and proximal interphalan- 1Department of Botany and Genetics, Faculty of Natural geal joints, joints of the first finger and 1st carpo-metacarpal Sciences, Constantine the Philosopher University in Nitra, joint. The study included multilane gray-scale ultrasound in- Nitra, Slovakia, 2Institute of Molecular Biomedicine, Faculty vestigation. The presence and severity of synovial hypertro- of Medicine, Comenius University, Bratislava, Slovakia, phy and effusion followed by evaluation of the degree of 3Department of Zoology and Anthropology, Faculty of synovitis was determined in the B-mode; the quantity and Natural Sciences, Constantine the Philosopher University in the sizes of osteophytes and bone erosions were evaluated in Nitra, Nitra, Slovakia a similar way. The vascularization of synovial hypertrophy was estimated in the power Doppler ultrasound. The study Introduction: Both, association studies in humans as well as was repeated after 3 years. short interventional animal experiments have shown that cola Results: All patients were divided into three clinical subtypes intake has negative effects on bone mineral density measured of HOA: erosive (16 women), isolated (14 women) and gen- using X-ray absorptiometry. The effects of long-term cola in- eralized (15 women). The average number of joints with sy- take on the microstructure of bones has not been experimen- novitis prevailed in a group with generalized subtype was tally evaluated yet. 12.6(3.7), vs. isolated subtype – 6.8(2.6), р 0.05. The average Objective: To investigate the effects of long-term cola number of joints with osteophytes per one patient was maxi- intake on quantitative characteristics of the femoral bone mal in erosive subtype – 14.1(5.4), in comparison with the in mice. isolated subtype – 8.6 (5.2), p<0.05 and generalized subtype Material and Methods: Adult CD-1 mice of both sexes – 11.1(4.9). After three years 10 patients with generalized (n=42) were randomized into control groups with ad libitum subtype and 3 patients with isolated subtype turned into access to tap water and experimental groups with ad libitum Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S589 access to cola (decarbonated Coca cola) for 6 months. CKD, to evaluate the frequency of disturbances of BMD and Quantitative characteristics of the compact and trabecular bone to work up the risk factors of osteoporosis in CKD patients tissues were assessed at the diaphyseal midshaft and the distal Methods: We analyzed data on 220 adults with CKD aged 20- epiphysis of right femurs using micro-computed tomography. 61 years. 78 (35.5%) patients with CKD II-IV stages and 142 Results: Being heavier, male mice had significantly higher (64.5%) patients on hemodialysis (CKD VD) aged 20-61 compact bone volume, trabecular number and bone surface years (mean 48,6±3,8 years). The laboratory investigations (p<0.01). On the contrary, bone mineral density, cortical bone included evaluation of PTH, serum total and ionized calcium, thickness, trabecular thickness and their separation were signif- serum phosphate, serum level of alkaline phosphatase and icantly higher in females in comparison to male mice (p<0.01). 25(OH)D3 concentrations. Regression models were used to No significant differences were found between the control and determine relationship between lumbar BMD and renal func- cola groups of either sex in any of the measured quantitative tion, age, weight, height. parameters of the compact and trabecular bone tissues. Results: Results CKD subjects had significantly higher con- Conclusion: Morphometrical characteristics of the femoral centrations of P, Ca × P product and PTH compared to the bone were not affected by cola intake for 6 months. Our results control group. The concentrations of Ca × P product and PTH do not support the hypothesis that long-term consumption of were significantly higher in hemodialysis patients compared soft drinks induces osteopenia or osteoporosis. Besides inter- to CKD stages II-IVones (Ca × P product 4,78±0,11 vs. 3,68 species differences a source of interpretational bias could be ±0,18, p<0,01, iPTH 601,28±68,45 vs. 289,10±60,48 p<0,01) the use of decarbonated caffeine-containing cola despite low There was no difference in level of 25(OH)D3 between CKD pH (3.3). Whether similar negative effects would be observed II-IV and CKD VD patients (18,71±1,72 vs. 19,55±2,18 ng/ for the intake of other acid-containing soft drinks remains to ml, р>0,05). Analyzing the compliance with KDIGO 2009 be elucidated. recommended target levels it was found that all four parame- Acknowledgements: The study was supported by projects ters met target levels of only 11 (14,1%) patients with CKD II- VEGA 1/0653/16 and KEGA 031UKF-4/2016. IV stages and 4 (3%) CKD VD stage. Vitamin D insufficiency was found in 44.9% of CKD II-IV patients and 51,4% those with CKD VD. BMD was decreased in 55.4% CKD II-IV P1063 stages patients and in 19.1% it was lower than -2,5 T SD. In BONE AND MINERAL DISORDERS IN PATIENTS CKD VD BMD was decreased in 51,1% and in 34,0% it was WITH CHRONIC KIDNEY DISEASE lower than -2.5 T score units. It was established negative as- L. P. Martynyuk1,S.M.Butvyn2,L.Martynyuk3 sociation between decreased renal function and decreased 1Nephrology Department, Ternopil University Hospital, Chair of BMD (GFR correlated s with spine-BMD (r=-0,452, p<0,05, Internal Medicine, State Higher Educational Institution, Ternopil, the level of serum creatinine correlated s with spine-BMD (r=- Ukraine, 2Chair of Internal Medicine, State Higher Educational 0,33, p<0,05). Duration of CKD correlated significantly with Institution, Ternopil, Ukraine, 3State Higher Educational spine-BMD, (r=-0.45, p<0.05). The degree of bone deminer- Institution “Ternopil State Medical University ”, Ternopil, Ukraine alization was more pronounced in individuals with low body weight (in patients with CKD stages II-V: r=0,31, p=0,009; in Introduction: Chronic kidney disease (CKD) causes distur- CKD VD r=0 36, p=0,027). Values of BMD were not related bances in calcium and phosphorous homeostasis, abnormali- to the duration and cause of CKD. ties in acid-base and vitamin D-parathyroid hormone bal- Conclusions: It has been established that dominant dis- ances, that leads to the impairment of the structure and func- orders of mineral metabolism are hypocalcemia, tion of many systems such as the skeletal system, known as hyperphosphatemia, secondary hyperparathyroidism CKD- MBD. Disorders of mineral and bone metabolism are and25(OH)D3 insufficiency. Such disturbances occur commonly observed in CKD are associated with increased in the early stages of CKD and progress with the de- risk for cardiovascular calcification, morbidity and mortality, cline of renal function, especially in hemodialysis and although these associations are not firmly established. Much result in bone loss. Persons with CKD are at higher of what is known about CKD-MBD is based on knowledge risk of low BMD relative to the age-matched general obtained in the dialysis population. Much less is known about population. The risk factors of bone loss in patients CKD-MBD in patients with CKD not yet on dialysis. CKD with CKD are duration of CKD, female gender, older changes both the quality and quantity of the bone through its age, lower body weight. Negative association between multifactorial influence on bone metabolism, leading to loos- decreased renal function and decreased BMD was ing of bone mass and increased risk of fracture. established. THE AIM of this study was to study the prevalence of disorders References: of bone and mineral metabolism, parathyroid glands function, 1. Kidney Disease: Improving Global Outcomes (KDIGO) vitamin D concentration in patients with various stages of CKD-MBD Work Group. Kidney Int Suppl 2009;(113):S1. S590 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 2. Chertow GM et al. N Engl J Med 2012;367:2482. strong inflammation combined with the anatomical superfici- 3. http://www.kdigo.org/clinical_practice_guidelines/pdf/ ality of the involved structures typical of de Quervain’swere Russian–TranslationKDIGOCKD-MBDGuidelineSummary.pdf expected by the authors to prove an effective and safe 4. Chronic Kidney Disease: Modeling and Managing Calcium treatment. and Phosphorus Disturbances: CME/CE http:// Material and Methods: 10 patients visited at our service www.medscape.org/viewarticle/770042?src=0_mp_cmenl_0 suffering from de Quervain’s disease were recruited. Diagnosis was clinical and ultrasound aided. Treatment: top- ical application of betamethasone plaster: 1/day for 8 days, P1064 then 1/alternate days for other 8 days. EFFECTIVE MEDICAL REHABILITATION ON T0: clinical examination; PRWHE (Italian validated version), PATIENTS WITH OSTEOPOROSIS KYPHOSIS NRS (for spontaneous pain) scores. At T1, one month after, S. D. Birsan1 PGIC evaluation was added. P value assessment was also 1Faculty of Medicine Oradea, Oradea, Romania performed. Exclusion criteria: children and adolescents under 18 years old, allergies to betamethasone valerate or bulking Kyphosis is referred to as a deviation of the spine in the sag- agents, no informed consent, bacterial, fungal, viral skin in- ittal plane by emphasizing the physiological curvature in the fections, skin ulcers, widespread plaque psoriasis. thoracic region. We conducted randomized study on the ther- Results: An improvement in PRWHE and NRS score was apeutic effectiveness of the treatment recovery on a group of observed in 9 of 10 patients: average PRWHE was 74 (± 15 patients with dorsal kyphosis in the osteoporosis that we 4.0) at T0, 14,6 (± 21.4)at T1, p=0.005; average NRS passed have monitored 1 year. That have used methods for assessing from 7,8 (± 1.0) to 2,3 (± 2.5), p=0.005. Swelling of the wrist complex based on measurements with goniometer - the test decreased in all cases at clinical examination. Only one patient consisted as follows: an arm is applied to the spinous process did not show significant improvements in PRWHE (from 77,5 T2 -T3 in dorsal kyphosis and the other arm on the spinous to 75,5) and NRS (from 9 to 9) scores. Average PGIC was 2.3 process T12 - L1, the patient was put to flex maximum trunk (great improvement). and then expand it. The evaluation was performed at 6 Conclusions: Moving from this, betamethasone valerate plas- months. The final conclusion is that medical rehabilitation is ters seem to be an useful alternative to more consolidated and the rule for creating the correct position through continuous invasive treatments for de Quervain’s tenosnovitis. self-toning paravertebral muscle group and toning abdominal and chest muscles by bringing the shoulders blades. P1066 ULTRASONOGRAPHIC EVALUATION OFANTERIOR P1065 KNEE PAIN CAN TOPICAL TREATMENT PROVE USEFUL FOR A. A. Negm1,M.Khairy1,A.Hasseb1,K.M.Abbas1 TENOSYNOVITIC DISEASES? BETAMETHASONE 1Rheumatology Department/ Faculty of Medicine, AL-Azhar VALERATE PLASTERS AND DE QUERVAIN'S University/ Al-Hussien University Hospital, Cairo, Egypt TENOSYNOVITIS: A PILOT STUDY FOR A PROMISING TREATMENT Objectives: The Primary outcome of the present work is to M. Evangelista1,V.Cilli2,R.DeVitis3,F.Marinangeli4 detect type and frequency of Ultrasonographic changes in pa- 1Department Anesthesiology and Pain Medicine/The Catholic tients with anterior knee pain. Secondary outcome is to deter- University in Rome, Rome, Italy, 2Orthopaedics and Hand mine the role of MSUS in early detection of causes of anterior Surgeon, Rome, Italy, 3Orthopaedics and Hand Surgery Unit, knee pain (AKP). Fondazione Policlinico Gemelli, Rome, Italy, 4Department of Patients and Methods: Sixty patients with AKP and 20 sex Anesthesiology, University of L'Aquila, L' Aquila, Italy and age matched healthy control were included in this study obtained from the outpatient of Physical Medicine and Objective: De Quervain’s disease refers to tenosynovitis of Rheumatology Department of El Hussein and Bab El - the first wrist’s extensors (EPB and APL). Its prevalence in Sharia university hospitals. Inclusion criteria: age between the general population is estimated to be 1% circa, with the 20-40. Exclusion criteria: Trauma, Crystal induced arthritis, peak among women aged 40 years old or more. Common connective tissue diseases (RA, SLE, SpA), chronic liver or treatments are NSAIDs, acetaminophen, local corticosteroid kidney disease and previous surgery. Full medical history infiltration, surgery, immobilization in splints. However, in and clinical examination as well as WOMAC, knee the last years, transdermal drug delivery systems have been Conventional Radiography and Musculoskeletal developed, offering a number of advantages over the oral Ultrasonography (MSUS) were done to all patients. route. Betamethasone valerate 2250 mg plasters, due to the Bilateral MSUS examination of the following common sites: Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S591 Insertion of quadriceps tendon, Ligamentum patellae and and parietal lobes. The patient developed a flare with fatigue, Anterior aspect of the knee from medial to lateral. mouth ulcers, convulsions, decreased ability to concentrate, in- According to EULAR guide lines for musculoskeletal ultra- tense delusions and dysarthria. Pulse methylprednisolone i.v. sonography. (Backhaus et al, 2001). followed by pulse cyclophosphamide i.v. were administered Results: The mean duration of knee pain in patients group in order to achieve remission. Disease stabilization was induced was 11.42±9.134 months. ESR, CRP and WOMAC were by pulse cyclophosphamide at bimonthly intervals. higher in patients group (p<0.01). MSUS showed significant- Results: The patient developed musculoskeletal manifes- ly more frequent Supra-patellar and Infra-patellar bursitis in tations at many stages of the disease. At diagnosis the patients than control group (p=0.000). patients had higher fre- patient had arthralgias of both wrists and knees. At dis- quency of cartilage clarity loss (p=0.039) as well as lower ease flare when neuropsychiatric symptoms evolved she cartilage thickness than control, 2.28±0.258 vs. 2.73 had diffuse arthralgias. When remission of the disease ±0.261 mm respectively (P=0.000, 95% CI: 0.31 to 0.58). was induced by pulse methylprednisolone and cyclo- Conclusion: The degree of Knee pain, measured by phosphamide the patient developed muscle weakness. WOMAC, is positively correlated with inflammatory bio- At disease stabilization with pulse cyclophosphamide at markers (ESR and CRP) in patients with Anterior knee pain. bimonthly intervals the patient developed arthritis of the MSUS revealed a positive correlation between Femoral hand joints. Articular Cartilage thickness and the periarticular tendon- Conclusion: Neuropsychiatric lupus is a grave and complex thickness, namely Patellar origin, patellar insertion and manifestation of SLE. The disease may be accompanied by Quadriceps insertion. Interestingly, our data present an evidence musculoskeletal manifestations. of the negative impact of the duration of knee pain over Femoral Articular Cartilage thickness as well as Patellar origin thickness. (FAC thickness get worse with longer duration of pain). P1068 Reference: Backhaus, M et al. Ann Rheum Dis 2001;60:641. THE STUDY ON BONE MINERAL DENSITY MONITORING IN PATIENTS WITH CORTISONE THERAPY P1067 S. D. Birsan1 NEUROPSYCHIATRIC LUPUS AND MUSCULO- 1Faculty of Medicine Oradea, Oradea, Romania SKELETAL MANIFESTATIONS The many uses of cortisone led doctors to introduce P. Athanassiou1,A.Tzanavari1, C. Katsavouni1,C. additional amounts of cortisone therapy to combat cer- Gerodimos1 tain disease. This paper aims to highlight the amount of 1Department of Rheumatology, St. Paul's Hospital, one in patients under cortisone treatment. The study Thessaloniki, Greece group included 15 patients being treated with cortisone for at least 6 months between may - November 2016. Introduction: Nervous system involvement in systemic Monitored parameters were pain by VAS, DAS28, bone lupus erythematosus (SLE) is a grave manifestation of mineral density (T score), quality of life - HAQ scales. the disease affecting health, quality of life and disease The results confirm the date of literature as cortisone outcome. It is one of the most complex manifestations treatment which leads to lower bone mineral density. of SLE and may affect the central, peripheral and au- tonomous nervous system. Complex interrelated patho- genetic mechanisms are involved in disease P1069 pathogenesis. BONE METABOLISM UNIT AS A MULTI- Aim: To describe musculoskeletal manifestations in a patient DISCIPLINARY CLINIC: OUR EXPERIENCE IN with neuropsychiatric lupus. QUIRON SALUD MALAGA HOSPITAL Methods: A patient, female aged 50 years presented A. Muñoz-Garach1, M. C. Ordoñez-Cañizares2, A. Nieto- with SLE with a duration of 20 years. The diagnosis González2, P. Manzano-Fernandez Amigo2, J. M. Garcia- of the disease was made with intense fatigue, hair loss, Almeida1 a light sensitive rash, arthralgias and positive antinucle- 1Bone Metabolism Unit, Endocrinology Department, Quiron ar and anti-dsDNA antibodies. In the course of the dis- Salud Hospital, Malaga, Spain, 2Bone Metabolism Unit, ease the patient developed CNS involvement with epi- Rheumatology Department, Quiron Salud Hospital, Málaga, leptic convulsions, permanent dysarthria and delusions. Spain A brain MRI scan was without specific alterations, however an Introduction: A multidisciplinary clinic has been developed EEG performed was abnormal and a brain single-photon emis- to optimize the diagnosis and treatment of bone metabolism sion CT (SPECT) revealed decreased perfusion of both frontal diseases. Initiated in March 2013, it is carried out S592 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 simultaneously and once a week by an Endocrinologist and a examination, she had restricted range of movement with pain Rheumatologist. and mild joint tenderness. On plain x-ray she found to have Objective: To describe the experience of this bone metabo- AVN of right femoral head suggested by classical crescent lism unit in the last 12 months. sign with preserved articular margins on plain film and Material and Methods: Cross-sectional observational study. A underwent extensive evaluation for a cause. Apart from mal- total of 235 patients were attended from December 2015 to aise, fatigability and moderately elevated erythrocyte sedi- December 2016. In the first visit, we carried out a medical record mentation rate (ESR) of 36 mm in 1st h no other symptom using a checklist form and impedancemetry. We requested a or laboratory feature could be found. Her hemoglobin level blood test with bone remodeling markers (CTX-I and P1NP), was 83 g/L and white cell count, platelet count, C-reactive vitamin D, PTH, sex hormones and 24-hour urine with calciuria protein was normal. After 6 months she presented with a sim- and phosphaturia, densitometry and dorsum-lumbar spine x-rays. ilar pain in left hip and subsequent work up revealed AVN of In the following visit the results were evaluated and the team left femoral head as well on plain x-ray and findings were formed by both specialists agreed the protocol of action. similar to the previous right sided hip joint. Her past medical Subsequently we studied treatment tolerance and analytical, history is pretty significant, she has low back pain for 3 years radiographic and densitometric changes. before her hip pain started, she has anemia, swollen legs, Results: 97% were women with a mean age of 60±9.7 years. arrhythmia and multiple join pain. She did not consume alco- Weight 66.3±12.7 kg, size 158.2±5.8 cm, BMI 26.6±4.9 kg / hol and was a non-smoker. She was not on any form of corti- m2. Impedancemetry data showed that the mean lean mass costeroid or other medications prior to the event except nutri- was 43.0±5.9 kg and the mean fat mass was 23.3±10.1 kg. tional supplements and pain killers. There is family history, 36.2% and 20% of the patients had a personal and family her sister died from Lupus. At the time of the second event of history of fracture, respectively. 15.2% patients had taken pre- hip pain she underwent a comprehensive work up with in- vious corticoid treatment; 9.5% had more than 2 falls in the volvement of a multidisciplinary specialists. In view of persis- last year. 5.7% were active smokers. 87.4% had menopause; tently high ESR and multiple AVN of bones, she underwent a early menopause in 13.4% and surgical menopause in 10.7%. work up for chronic infections such as tuberculosis, and for 60% practiced more than 3 days of physical activity per week, autoimmune connective tissue diseases with serological stud- 78.8% sunbathed more than 10 minutes a day and 36.2% take ies including antinuclear antibody (ANA), Anti Smith anti- adequate dairy milky consumption. Among the digestive an- body (Sm), serum complements C3 and C4, Anti Ro and tecedents, 39% had gastroesophageal reflux and 16.2% hiatus Anti La antibodies. Hematological evaluation for sickle cell hernia. We found that 17.5% have had a vertebral fracture. In disease, thrombophilic conditions including anti-cardiolipin the densitometric data according to T-score they had osteopo- antibodies IgG and lupus anticoagulant test, beta-2 glycopro- rosis 55.06%; Osteopenia 42.76% and normality 2.24%. The tein 1 both IgM and IgG. She has been continuously followed FRAX index was 4.3% for major fracture and 0.9% for hip up with a future plan of hip joint replacement. During the fracture. Among the treatments received prior to the first con- subsequent period patient revealed that she felt mild fatigabil- sultation, 29.5% took bisphosphonates, 9.5% denosumab, ity and hair loss continuously, which she considered not sig- 2.9% PTH. 37.5% calcium with vitamin D. nificant and did not report to the doctor hence further workup Conclusions: A high percentage of patients received treat- was not done for next 4 years. She did not take any medica- ment before coming to the clinic. The most used therapeutic tions except simple paracetamol for hip pains. After about group was bisphosphonates. The aggregate management by 4 years of above events she reported significant hair loss, two specialists in the multidisciplinary clinic is beneficial and which was unusually high according to her. On further assess- improves the quality of care in our patients. ment she found to have isolated thrombocytopenia of less than 100,000/mm3 on repeated blood counts and also continuously high ESR, at times exceeding 100 mm/1st h. Patient was re- P1070 evaluated considering above developments. She had positive A CASE OF SYSTEMIC LUPUS ERYTHEMATOSUS ANA with titer above 1:160 and a positive anti double strand- PRESENTING AS BILATERAL AVASCULAR ed DNA (dsDNA) antibody with titre of 233 IU/mL. Both NECROSIS OF FEMUR these tests were negative 3 years back. She did not report M.R. Runcheva1,D.P.Popovska1, E.DZ. Dzidrova2 abnormality in urinalysis or neuropsychiatric manifestations 1Clinical Hospital Shtip, Shtip, Former Yugoslav Republic of of SLE. In light of above clinical manifestations and serolog- Macedonia, 2Clinical Hospital, Shtip, Former Yugoslav ical studies, definite diagnosis of SLE was made according to Republic of Macedonia SLICC 2012 classification criteria. Her coagulation screening Case report: A 65 year old female has been referred to our was repeated and was negative although beta-2 glycoprotein 1 clinic with right sided hip pain of sub acute onset. Her pain was not repeated. Her initial presentation of bilateral AVN of worsened with movement and weight bearing. On clinical femoral head 4 years back was ascertained as related to Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S593 evolving autoimmune disease, since no other etiology was P1072 evidenced. Patient was prescribed hydroxy-chloroquine and STUDY OF POLYPHENOLS CONTENTS AND simple analgesics in her subsequent management and total ANTIOXIDANT CAPACITY OF THE MEDICINAL hip joints replacement surgery was planned. PLANTS SPECIES UTILIZED IN OSTEOPOROSIS Discussion: AVN or osteonecrosis is caused by loss of A. Pallag1, F. Cioara1,R.Suciu1,T.Jurca1,A.Honiges2,F. blood supply to a part of bone leading to bone necrosis Marc1 and collapse. Diverse etiologies have been described for 1University of Oradea, Faculty of Medicine and Pharmacy, AVN. Chronic inflammatory conditions such as SLE Oradea, Romania, 2Vasile Goldis Western University of considered as a well known cause. In a patient of Arad, Arad, Romania SLE, several factors can lead to bone ischemia and AVN include Raynaud’s phenomenon, vasculitis, fat em- Objective: From the traditional Romanian medicinal boli, corticosteroids, and the antiphospholipid syndrome. plants there are many species which has proven anti- Although the above patient had evidence of a chronic osteoporotic action. In a previous paper we have shown inflammatory disorder such as malaise and high ESR at that the most known and used anti-osteoporotic and os- the outset, she did not have sufficient criteria fulfilling teoporosis preventive medicinal plants are: Achillea the diagnosis of SLE or any other autoimmune disorder millefolium (milfoil), Equisetum arvense (horsentail), and she was not on any form of corticosteroid treat- Urtica dioica (stinging nettle) and Hippophäe ment. Many reviews observed that AVN often develops rhamnoides (sea-buckthorn) [1]. Many epidemiologic shortly after the onset of high-dose corticosteroid thera- studies in women found positive associations between py. Numerous case reports and case series were reported total dietary flavonoid intake and bone mineral density. AVN in already diagnosed SLE patients and after initi- Flavonoids may protect against bone loss by upregulat- ation of corticosteroid therapy, some of them reported ing signaling pathways that promote osteoblast function, AVN in multiple sites. by reducing the effects of oxidative stress or chronic Disclosure: Written informed consent for publication of this low-grade inflammation [2, 3, 4]. case report and any accompanying images was obtained from Material and methods: We studied four species from the patient. spontaneous flora of Romania, Achillea millefolium References: (milfoil), Equisetum arvense (horsentail), Urtica dioica 1. Assouline-Dayan Y et al. Semin Arthritis Rheum (stinging nettle) and Hippophäe rhamnoides (sea- 2002;32:94. buckthorn) in terms of polyphenols content, the total 2. Jacobs B. Clin Orthop Relat Res 1978;130:51. flavonoid content. Total phenolic content was deter- 3. Gontero RP et al. Rheumatol Clin 2015;11:151. mined by the Folin Ciocalteu method. The total flavo- 4. Ozbek S et al. Acta Med Okayama 2003;57:187. noid content was determined using a colorimetric meth- 5. Tektonidou MG et al. Arthritis Rheum 2003;48:732. od. Antioxidant capacity of the extracts was evaluated 6. Fajardo-Hermosillo LD et al. BMJ Case Rep by the following methods: Cuprac assay, DPPH method, 2013;2013.pii:bcr2013008980. FRAP method [5]. 7. Mont MA et al. J Rheumatol 1997;24:654. Results: The amounts of total polyphenols and flavo- noids found in the ethanolic extract of plants are shown in Table 1, the antioxidant capacity of samples in P1071 Table 2. EFFECTIVE KINETIC PHYSICAL THERAPY IN Table 1. Total polyphenols and flavonoids content CHRONIC VENOUS INSUFFICIENCY S. D. Birsan1 1Faculty of Medicine Oradea, Oradea, Romania Venous disorders are progressive evolution and cannot Sample Total polyphenolic Total flavonoid be completely prevented. The therapeutic approach is content content basedoneducatingpatientswithbedrestwithlegsup (mg GAE/100DW) (mg QE/100 DW) higher than the rest of the body, applying stockings, Achillea millefolium (milfoil) 97.88±0.35 88.17±4.56 lymphatic drainage and kinetic exercises Burger. Equisetum arvense L. 85.43±0.07 75.53±3.73 Educating patients and following hygiene measures as- (horsentail) Urtica dioica (stinging nettle) 78.36±0.09 68.95±4.18 sociated with the treatment of vascular limb kinetic Hippophäe rhamnoides 93.07±0.01 82.66±6.13 physical therapy are the key to success with positive (sea-buckthorn) results in the long term. S594 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Table 2. The antioxidant capacity duration of menopause – 14.6±8.4 yrs) were examined. The women were compared into the three groups: A – 298 women without obesity (BMI) ≤ 29.9 kg/m2), B – 177 patients with obesity (BMI ≥ 30.0 kg/m2), C – 115 female with MS (diag- μ μ Sample FRAP ( mol DPPH% Cuprac ( mol nosed according to IDF criteria, 2005 yr). BMD was measured Trolox Trolox equivalent/ equivalent/g by the DXA method (Prodigy, 2005). Data were analyzed gDW) (TE) DW) (TE) using Statistical Package 6.0. Achillea 85.217±0.009 89.20±0.023 52.7±0.097 Results: We estimated that patients without obesity have sig- millefolium nificantly lower BMD of lumbar spine (A – 0.931±0.168g/ (milfoil) cm2,B– 1.091±0.191g/cm2,C– 1.082±0,190g/cm2 Equisetum 79.110±0.035 83.40±0.017 49.2±0.104 – 2 arvense F=55.302, p<0.001), femoral neck (A 0.772±0.113 g/cm , (horsentail) B – 0.858±0.132 g/cm2,C–0.861±0.135g/cm2; F=36.797, Urtica dioica 67.504±0.007 63.10±0.036 36.1±0.008 p<0.001) and radius 33% (A – 0.688±0.123g/cm2, (stinging nettle) B – 0.785±0.019g/cm2,C–0.768±0.099g/cm2, F=44.122, Hippophäe 86.560±0.115 85.00±0.100 77.3±0.105 rhamnoides p<0.001) in comparison with women of the groups B and C. (sea-buckthorn) Significant differences among BMD of the B and C group patients were absent. Non-vertebral fractures were found in 37.92% of the A group patients, 29.94% of B group women Conclusions: Studied medicinal plants represent a rich and 35.65% of the C one. The frequency of non-vertebral sources of flavonoids and have strong antioxidant capacity. fractures did not differ significantly in the groups of patients They contribute on antiosteoporotic activity or osteoporosis A and B, A and C, B and C (X2=3.107, p>0.05, X2=0.182, prevention activity of these plants. Phytotherapy in osteopo- p>0.05 and X2=1.041, p>0.05, respectively). rosis treatment is very important due to the absence of second- Conclusion: Despite the fact that BMD indexes were signif- ary effects and it can be used simultaneously with drug icantly higher in women with metabolic syndrome and obesi- therapy. ty, the frequency of non-vertebral fractures did not differ sig- References: nificantly in the groups of patients. 1. Pallag A et al. Osteoporos Int 2016;27(Suppl. 1). 2. Welch AA, Hardcastle AC. Curr Osteoporos Rep 2014;12:205. P1074 3. Wattel A et al. Biochem Pharmacol 2003;65:35. PRIMARY HYPERPARATHYROIDISM (PHPT) 4. Chiba H et al. J Nutr 2003;133:1892. IMPAIRED 3D CORTICAL DENSITY AT FEMUR AS 5. Pallag A et al. Rev Chim (Bucharest) 2016:67:1623. ASSESSED FROM 2D DXA G. Guglielmi1, R. Winzenrieth2, F. Pugliese3,A.Salcuni4,C. Battista5, A. Scillitani5 P1073 1Department of Radiology, Scientific Institute Hospital “Casa LOW-TRAUMA NON-VERTEBRAL FRACTURES IN Sollievo della Sofferenza”, Foggia, Italy, 2Galgo Medical, UKRAINIAN POSTMENOPAUSAL WOMEN WITH Barcelona, Spain, 3Department of Endocrinology, Scientific OBESITY AND METABOLIC SYNDROME Institute Hospital "Casa Sollievo della Sofferenza", San V. V. Po vo ro zn yu k 1,L.Martynyuk2 Giovanni Rotondo, Italy, 4Department of Endocrinology, 1D.F. Chebotarev Institute of Gerontology NAMS Ukraiine, Scientific Institute Hospital "Casa Sollievo della Sofferenza, Kyiv, Ukraine, 2State Higher Educational Institution San Giovanni Rotondo, Italy, 5Department of Endocrinology, “Ternopil State Medical University ”, Ternopil, Ukraine Scientific Institute Hospital “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy Introduction: Osteoporosis and obesity are two of the world- wide problems, which increase morbidity, disability and mor- Purpose: PHPT is characterized by a chronic hypersecretion tality among people. Abdominal obesity leads to the metabolic of parathyroid hormone (PTH). This hypersecretion impacts syndrome (MS) development. It was researched that compo- bone remodeling process by increasing bone turnover. nents of MS have influence on bone mineral density (BMD), Cortical compartment is predominantly impacted with a thin- but data are contradictory. ning of cortical bone and an increased cortical porosity while Aim: To determine frequency of non-vertebral fractures in contradictory effects have been observed on trabecular com- women with obesity and MS. partment. The purpose of the present study was to evaluate the Methods: 590 women aged 50-79 yrs (mean age – 64.0±8.0 impact of PHPT on bone cortical densities and thicknesses or yrs; mean body mass index (BMI) – 29.4±5.3 kg/m2,mean volumetric trabecular density at the femur. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S595 Methods: Caucasian Italian men and women suffering from hypophosphatemia (1,3 mg/dL), hyperphosphaturia (TMP- PHPT were included between 2011 and 2015. Biochemical GFR: 0,62 mmol/L) and elevated serum alkaline phosphatase analysis that include serum Calcium (sCa), Vitamin D3 (209 U/L) and parathyroid hormone (74 pg/ml) levels. Her (VitD3), PTH 1-84 (PTH) and Phosphorus (P) were per- serum calcium, 25 OHD levels were normal. Because of formed. Presence of fracture was also recorded. Areal BMDs adult-onset hypophosphatemic osteomalacia we suspected were measured by dual X-ray absorptiometry using an iDXA TIO. Physical examination, computerized tomography and (GE-Lunar, USA) at lumbar spine (LS) and at femur (total and magnetic resonance imaging failed to localize the tumor. neck). Cortical volumetric density or thickness as well as vol- Gallium-68 (Ga-68) DOTA-TATE positron emission umetric trabecular density were evaluated from DXA acquisi- tomography/computed tomography (CT) revealed high density tion using 3D-DXA software (Galgo Medical, Spain). of somatostatin receptors in a 10 mm soft tissue lesion Relationships adjusted for age between biochemical dosages, between the lateral rectus and the lateral orbital wall. Also anthropo-morphometric parameters, and bone parameters orbital magnetic resonance imaging showed an 10x6 mm mass were assessed (correlations, partial correlations). with regular margins, indenting lateral rectus to medial site, Results: 77 men and women (9/68) with a mean age of 59 T1A hypointense and homogenous in postcontrast images. ±13.6 years (27-82 yrs) were assessed. Mean PTH level were The tumor was resected by ophthalmologists and histologic 157±87 pg/mL. A significant negative relationship was ob- features of completely excised lesion was consistent with a tained between PTH and total volumetric cortical density phosphaturic mesenchymal tumor with a Ki67 index <5%. (tVCD) at femur (r=-0.25, p=0.029) while no correlations Resection of tumor resulted in rapid normalization of the labo- were found with mean cortical thickness (mCT), volumetric ratory findings and remarkable symptomatic improvement. trabecular density or BMDs (all p>0.010). This negative rela- Conclusion: Non-specific symptoms delay the recognition of tionship remained after adjustment for weight and VitD3 (r=- TIO and patients may become wheelchair- or bed-bound until 0.28, p=0.017). the correct diagnosis is made. Usually, the combination of Conclusion: In this study, we observed a negative effect of the functional and anatomical imaging is needed to localize the PTH level on the volumetric cortical density while no effects tumor. Successfully localization and resection of the causative have been observed on the trabecular compartment. These tumor may cure the disease with complete resolution of symp- results, using a new approach (3D-DXA), are in agreement toms. In long follow-up period, measurement of serum phos- with the literature. phorus level is essential to recognize the recurrent disease. P1075 P1076 AN UNUSUAL LOCALIZATION OF TUMOR SARCOPENIA QUALITY OF LIFE QUESTIONNAIRE INDUCED OSTEOMALACIA (SARQOL) IN SARCOPENIC PATIENTS AND S. Tekin1, S. Tanrıkulu2, H. Hacisahinogullari2,S.Koc2,S. OSTEOARTHRITIS OF THE HIP Tuncer3, B. Bilgiç4, A. Kubat Uzum2,A.Ferihan2, T. Refik2 F. Marc1,D.M.Farcas1,A.Pallag1 1Istanbul University Istanbul Medical School, Istanbul, 1University of Oradea, Faculty of Medicine and Pharmacy, Turkey, 2Department of Internal Medicine, Division of Oradea, Romania Endocrinology and Metabolism, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey, 3Department of Introduction: SarQol questionnaire was recently validated as Ophthalmology, İstanbul University, İstanbul Faculty of a useful tool for the clinicians to assess the well-being, phys- Medicine, Istanbul, Turkey, 4Department of Pathology, ical function, psychological, social implications of sarcopenic İstanbul University, İstanbul Faculty of Medicine, Istanbul, patients. Turkey Objective: To evaluate the quality of life of old patients (over 70 years old) with different severity grades of hip osteoarthri- Introduction: Tumor induced osteomalacia (TIO) is an un- tis (OA) and sarcopenia. usual clinicopathologic entity characterized by abnormal Material and Method: Study included 42 patients admit- phosphate metabolism caused by tumors that secrete FGF- ted during 2016 in the Internal Medicine Department for 23, a phosphatonin. Hypophosphatemia, renal phosphate a flare up of their hip OA and were also diagnosed with wasting and defective bone mineralization that disappear after sarcopenia (muscle weakness, low muscle mass, patho- the resection of an associated tumor. The causative tumor is logic values in timed up and go test - more than 20 often difficult to locate. sec.) We divided them in 2 groups: patients with mild Case: We report a case of 43 year old woman with diffuse bone -moderate forms and patients with ankyloses of the hip. and muscle pain, muscle spasms, progressive weakness over Sarqol questionnaire was used to evaluate their quality twoyearsandrestrictiontobed.Shehadmarked of life. S596 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Patients were aged between 70 and 85 years, with a SM04755 induced expression of tenocyte markers in differen- mean age of 76,7±0,7 years. Among them, 63% were women tiated hMSCs and rTDSCs (EC50=200nM). Single topical ap- and 37% men. The severity of hip OA was evaluated by clin- plication of SM04755 resulted in tendon concentrations ical examination and pelvic X ray. In mild-moderate group >EC50 for up to 24hrs, with minimal systemic exposure or were 28 patients, while the group with ankyloses had 14 pa- toxicity. In the intra-tendon collagenase injection-induced tients (some of them immobilized in bed). The SarQol ques- model, SM04755 treatment significantly increased tendon tionnaire had a score between 55 -65 (mean value 60,4) in health score (p<0.01) (figure 1A, 1B), decreased plasma sarcopenic patients with mild-moderate OA, while the score CXCL1 (p<0.05), reduced gene expression of pro- in patients with severe OA was 47-56 (mean value 51,2). The inflammatory markers (IL-6, TNF-a, IL-1b, INF-g, IL-8) score was lower in older people and also lower in women. (p<0.05), increased expression of tenocyte markers (p<0.01) Patients with ankyloses had higher values - more than 30 (figure 1C) and improved Type I/Type III collagen ratio seconds at up-and-go test than the other group. (p<0.01) in tendon compared to vehicle. Conclusions: SarQol questionnaire represents a valuable Conclusions: Topical SM04755 reduced inflammation and method which helps clinicians from multiple specialties to showed evidence of tendon regeneration compared to vehicle. have a more complex evaluation of the quality of life of SM04755 has potential as a therapeutic intervention for sarcopenic patients, usually with comorbidities. Lower scores tendinopathy. Clinical studies are planned. require more intense therapeutic interventions, to prevent the Disclosures: Deshmukh, Seo, Ibanez, Stewart, and Yazici are risk of institutionalisation, falls, fractures, etc. The effective- employees of Samumed, LLC. ness of therapy is reflected in increased values of SarQol test. P1077 DISCOVERY OF A SMALL MOLECULE WNT PATHWAY INHIBITOR (SM04755) AS A POTENTIAL TOPICAL TREATMENT FOR TENDINOPATHY V. Deshmukh1,T.Seo1,M.Ibanez1,J.Stewart1, Y. Yazici1 1Samumed, LLC, San Diego, United States Objectives: Tendinopathy is an inflammatory, degenerative SM04755 inhibited inflammation and promoted tendon condition caused by injuries or overuse. The Wnt pathway, healing in a rat collagenase-induced tendinopathy upregulated in tendinopathy, plays an important role in model tenocyte differentiation. SM04755, a novel, small-molecule (A) Images of rat tendons stained with HandE from Wnt pathway inhibitor, was evaluated in preclinical studies sham or collagenase-injected and vehicle- or SM04755 to determine its potential to inhibit inflammation and induce (0.3 mg/cm2) treated rats on day 21. (B) Histological tenocyte differentiation, thereby promoting tendon healing. score of inflammation, linearity and density of tendon Methods: Wnt pathway inhibition was measured via cell- fibers, shape of tenocytes and hemorrhage for the rat based reporter assay. Anti-inflammatory activity was evaluat- tendons. Mean±SEM, n=4 sham, n=6 vehicle and ed by cytokine secretion using ELISA in lipopolysaccharides SM04755, **p<0.01. (C) Expression of tenocyte (LPS)- and anti-CD3/anti-CD28-stimulated peripheral blood markers and Type I/III collagen ratio in the tendon fol- mononuclear cells (PBMCs). Differentiation of human mes- lowing sham or collagenase injection and treatment with enchymal stem cells (hMSCs) and rat tendon derived stem either vehicle or SM04755 (0.3 mg/cm2) for 21 days as cells (rTDSCs) to tenocytes was measured by immunocyto- measured by qRT-PCR. n=12, Mean±SEM, ** p<0.01. chemistry for tenocyte markers scleraxis A, tenomodulin and tenascin C. Pharmacokinetics were evaluated following topi- cal application in rats. In vivo efficacy of topical SM04755 P1078 was evaluated in an intra-tendon collagenase-induced rodent VITAMIN D AND VITAMIN D RECEPTORS IN MEN tendinopathy model by tendon histology, chemokine ligand 1 WITH ERECTILE DYSFUNCTION NON-RESPONDING (CXCL1) plasma levels, tendon inflammatory markers, and TO SILDENAFIL tendon regeneration, by expression of tenocyte markers and I. Osman1,T.Mostafa1,D.Sabry2,F.Kareem1 Type I/Type III collagen ratio using qPCR. 1Department of Andrology and Sexology, Faculty of 2 Results: SM04755 was a potent (EC50=152nM) inhibitor of Medicine, Cairo University, Cairo, Egypt, Department of Wnt signaling in hMSCs, and cytokine secretion in LPS and Medical Biochemistry, Faculty of Medicine, Cairo anti-CD3/anti-CD28 stimulated PBMCs (EC50=500nM). University, Cairo, Egypt Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S597 The aim of our study was to assess serum vitamin D as well as sulphate in the blood, excretion rate of uronic acid. vitamin D receptors (VDR) in men with erectile dysfunction Statistical processing was made by program Statistica+. (ED) non-responding to oral phosphodiesterase inhibitor Results: The much higher level of common chondroitin (PDE-5I) sildenafil citrate. The study included 160 men that sulphate in children with JIA was found (p<0.01), that is as were allocated into; healthy potent men, men with ED re- an indicator of metabolic activity caused by inflammatory sponders to sildenafil and men with ED non-responders to process in the connective tissue. In comparison with control sildenafil. Inclusion criteria for sildenafil non-responders were group in investigated patients increased content of the second an inadequate erectile response after at least 4 attempts using (chondroitin-4-sulfates and chondroitin-6-sulfates) and third the highest tolerated drug dose in accordance with manufac- (keratan sulphate and dermatan sulphate) factions of GAGs turer’s guide-lines with respect to timing relative to meals, use was determined (p<0.05). Depending on the gender of of concomi-tant medications and adequate sexual stimulation/ patients with JRA, it was established, that described above arousal. Exclusion criteria were; diabetes mellitus, smoking, features were more common for female patients. The hypertension, cardiovascular disorders, hepatic or renal failures. average level of total GAGs in girls with JIA was lower, They were subjected to history taking, clinical examination, then in boys (p<0.01), while the levels of second (p<0.05) International Index of Erectile Function (IIEF) questionnaire, and third (p<0.01) fractions of GAGs were significantly estimation of serum vitamin D by ELISA method and VDR higher. Changes in proteoglycans content in the blood were gene expression. The results demonstrated that men with ED accompanied by higher levels of excretion of uronic acid in non-responding for sildenafil demonstrated significant decrease daily urine in female patients compared to male patients in IIEF questionnaire scores, mean serum vitamin D as well as (p<0.01). This redistribution of proteoglycans content is serum VDR gene expression compared with healthy potent more specific for degenerative processes, such as initiation men as well as men with ED responding to oral sildenafil. of osteoarthrosis. It gives reason to believe that female Age demonstrated nonsignificant correlation with IEEF, gender is one of risk factors of early development of VDR gene expression and serum vitamin D. Serum vitamin osteoarthrosis against JIA. It is based on determined D demonstrated significant positive correlation with IIEF correlation of female gender with average level of and VDR gene expression. Serum VDR demonstrated sig- chondroitin sulphate (r=0.57; p <0.05), level of total GAGs nificant corre-lation with IIEF and serum vitamin D. It is (r=-0.56; p<0.05), the first fracture of GAGs (r=0.55; p<0.05), concluded that men with ED non-responding to oral PDE- second fracture of GAGs (r=0.72; p<0.01) and third fracture 5Is have significant decrease in serum vitamin D as well as of GAGs (r=0.58; p<0.05), level of excretion of uronic acids VDR gene expression. (r=0.62; p<0.05). Radiological progression of JIA was accompanied with redistribution of proteoglycans. Conclusion: Results give us the reason to believe that female P1079 gender is one of risk factors of early development of FEATURES OF CONNECTIVE TISSUE METABOLISM osteoarthrosis against JIA. It was established that radiological IN CHILDREN WITH JUVENILE IDIOPATHIC progression is also accompanied by a redistribution of proteo- ARTHRITIS glycans. N. O. Panko1,N.S.Shevchenko2,I.S.Lebec2,Y.N.Zajceva3 1Department of Pediatrics, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine, 2 Department of P1080 Cardiorheumatology, SI ''Institute of Children and SEXUAL DIMORPHISM OF VERTEBRAL FRACTURE Adolescent Health Care of NAMS", Kharkiv, Ukraine, RISK AND ASSOCIATIONS WITH BODY MASS 3Department of Cardiorheumatology, Kharkiv State Pediatric INDEX: THE NEWCASTLE THOUSAND FAMILIES Hospital 24, Kharkiv, Ukraine STUDY H. A. Rudman1, K. Hind2, L. Treadgold1,M.Pearce3,F. Objectives: Due to various inflammatory mechanisms in Birrell4 patients with Juvenile idiopathic arthritis (JIA) early expressed 1Division of Medical Physics, University of Leeds, Leeds, metabolic disturbances of structural proteoglycans, collagen United Kingdom, 2Carnegie School of Sport, Leeds Beckett and changes of bones reabsorption occur. Its clinical manifes- University, Leeds, United Kingdom, 3Institute of Health and tation includes chronic progressive erosive-destructive pro- Society, Newcastle University, Newcastle, United Kingdom, cess and osteoporosis development. 4Institute of Cellular Medicine, Newcastle University, Material and Methods: 58 patients with JIA aged from 2 to Newcastle, United Kingdom 18 years old and 28 the same aged healthy children were included to research. Investigation consisted of measurement Objectives: A growing number of studies in women are chal- of level glucosaminoglycans (GAGs) and chondroitin lenging the traditional perception that high body mass index S598 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 (BMI) protects against fracture, with risk more likely to be efficacy was evaluated in a rat coccygeal intervertebral disc determined by the higher loads to the skeleton on falling. needle puncture model using radiographic measurement of However, further evidence is required to elucidate the relation- disc height index (DHI=disc height/vertebral height), and his- ship between BMI and vertebral fracture (VF), especially in tological scoring of Safranin O- stained sections for AF integ- men. This study investigated VF prevalence and BMI in 342 rity, AF and NP border, cellularity, and NP matrix. men and women with a mean age of 62.5 (±0.6) years. Results: SM04690 was a potent (EC50=11nM) inhibitor of Wnt Material and Methods: Men (n=152) and women (n=190) signaling. In vitro, SM4690 increased (p<0.05) NP cell prolifer- from the Newcastle Thousand Families Study birth cohort re- ation (CDI) ~2-fold vs. vehicle and increased Alcian blue absor- ceived anthropometry and a dual energy X-ray absorptiometry bance, indicating differentiation to chondrocyte-like cells (DXA) lateral vertebral assessment (LVA) scan. Deformities, (p<0.01). Single intradiscal injection of SM04690 resulted in detected using vertebral fracture assessment (VFA) software, disc concentrations >EC50 for >180 days, with minimal systemic were defined using the semi-quantitative Genant scale. exposure or toxicity, measured as behavioral health, morphology Femoral neck bone mineral density (BMD), L1-L4 BMD and and microscopic changes. In a rat DDD model, SM04690 treat- FRAX scores were also evaluated. Correlative analysis, inde- ment increased Safranin O-stained cartilage matrix (figure 1A), pendent samples t-tests and logistic regression models were resulting in increased (p<0.05) DHI (figure 1C), and decreased used to explore any sex-specific predictors of VF prevalence. (p<0.05) histology scores (figure 1B) vs. vehicle control. Results: Men were twice as likely than women to have at least Conclusion: In a rat DDD model, SM04690 regenerated NP one vertebral deformity (OR 2.81, p<0.01). Additionally, cells, and cartilage matrix. It also improved disc height, health, higher-grade deformities (moderate and severe) were more and shape compared to vehicle. SM04690 has potential as a prevalent in men (OR 3.44, p<0.01). Obesity was associated treatment for DDD. with a higher prevalence of VF in women (OR 3.32, p=0.01), Disclosures: Deshmukh, Barroga, Hu, KC, and Yazici are and a higher prevalence of moderate and severe VF in men employees of Samumed, LLC (OR 5.03, p<0.01). There were no associations with BMD or FRAX score. Conclusions: We found clear evidence of sexual dimorphism in VF prevalence, although, obesity was associated with a higher likelihood of prevalent VF in both men and women. Further research is required to elucidate this relationship and future studies of VF should consider sex-specific risk factors. P1081 DISCOVERY OF A SMALL MOLECULE WNT PATHWAY INHIBITOR (SM04690) AS A POTENTIAL TREATMENT FOR DEGENERATIVE DISC DISEASE V. Deshmukh1,C.Barroga1,H.Hu1,S.KC1, Y. Yazici1 1Samumed, LLC, San Diego, United States Objectives: Degenerative Disc Disease (DDD), involves degen- eration of intervertebral disc structure, including the nucleus pulposus (NP), annulus fibrosus (AF), and cartilage matrix. Wnt signaling plays an important role in DDD, regulating the prolifer- SM04690 stimulated differentiation of NP cells and improved ation and differentiation of resident NP cells. SM04690, a novel, disc height and health in a rat DDD model small-molecule, Wnt pathway inhibitor was evaluated in preclin- (A) Representative images from intravertebral discs treated ical studies to determine its potential to induce proliferation and with vehicle or SM04690 8 weeks post-injury and stained differentiation of NP cells, thereby promoting disc healing. with Safranin O/Fast green show less interrupted and Methods: Wnt pathway inhibition was measured using a cell- fragmented AF, larger NP and extracellular matrix area, based reporter assay. In vitro proliferation of rat NP cells was and more NP cells compared with vehicle treatment. (B) measured by cell doubling index (CDI=cell number/initial cell Histology scores at week 6 for the vehicle and SM04690- number/days). Differentiation of NP cells into chondrocyte- treated discs as determined by the published histological like NP cells was measured by Alcian blue staining and ab- evaluation scale (C) DHI based on radiographic images at sorbance based quantification. Pharmacokinetics were evalu- week 6 showing significantly higher %DHI with ated by intradiscal injection in rats, followed by analysis of SM04690 treatment as compared to the vehicle treatment. compound concentrations in the disc and plasma. In vivo (n=9, Mean±SD, *p<0.05). Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S599 P1082 joint, situated at the level of the muscles’ insertion or in the ARE NSAID TARGETING TREATMENT IN auricular region. It can manifest as morning redor or have an CHRONIC KNEE OSTEOARTHRITIS? acute character. The studies mention stress and cold as factors E. F. Turovskaia1, L. I. Alekseeva1, E. G. Filatova2 which increase the intensity of the pain. Together with the 1Department of Osteoarthritis and Osteoporosis in V.A. evolution of the disorder the limitation of the movement am- Nasonova Research Institute, Moscow, Russian Federation, plitude of the TM joint occurs as well. This clinical sign is 2Neurological Department I.M. Sechenov First Moscow accompanied by joint cracments. The movement at the TMJ State Medical University, Moscow, Russian Federation level is made in three stages: 1. the rotation movement of the condyle on the meniscus round a transversal axis which Introduction: Recent studies have demonstrated that chronic crosses the centre of the condyles and corresponds to the knee OA mechanisms besides nociceptive pain also include inferior insertion of the temporomandibular ligament; (2-4 central sensitization(CS). CS is characterized with mm); 2. condylo-meniscal rotation and another one of neuropathic(NP) phenomena spontaneous and evoked, re- temporo-meniscal translation, 4 cm; 3. supplementary and ferred hyperalgesia, mood disorder and neurophysiological voluntary the translation movement forward of the meniscus changes (low pressure pain threshold). Currently, pain control and the rotation movement back of the condyle, another 2 cm, in patients with OA cannot provide adequate pain relief. In totally 6 cm. 27% - 61% case NSAID are not effective. Material and method: We conducted an observing study, of Aim: to evaluate the efficacy of NSAID in patients with OA. 10 days, on a group of 7 patients who visited the ambulatory Materials and methods: 40 women (age 55±75), II-III grade surgery for medical recovery of the Emergency Clinical by Kellgren-Lawrence with chronic knee OA were included. Hospital A Iancu Oradea between 2015-2016. We observed Patients were divided in groups in accordance with the results the evolution of the pain, using the VAS scale for pain and the of neuropathic test DN4: 1)patients with positive DN4(n=11) TMJ mobility, after ultrasound treatment in the TM region and patients with negative DN4(n=29); in accordance with together with specific kinetotherapy. presence of spontaneous NP phenomena(for ex. burning, tin- Results: The average age of the patients was 39.57. The VAS gling, current rush): 2)patients with spontaneous NP score decreased from the average 3.71 to 1.42. The TMJ mo- phenomena(n=29) and patients without spontaneous NP phe- bility, quantified by the mouth aperture, increases from nomena. All patients received ketoprophen 100mg twice a day 4.78 cm to 5.28 cm. for 4 weeks. Dynamic of OA severity was assessed by Conclusions: The studied group was 100% made up of wom- WOMAC(mm) and pain intensity by VAS(mm). en, who, after the complex recovery treatment, associated with Results: Statistical analysis showed significant reduction in special prosthetic treatments, including mouth guards, at the pain score after treatment in patients with negative DN4 com- second evaluation, after a 10 days’ treatment presented a very pared with patients who have signs of clinical CS(mean pain low score for pain and an almost quasinormal mobility. relief 26mm vs. 17 mm, p<0,05). The study revealed signifi- cant decrease of WOMAC from baseline to final evaluation in patients without spontaneous NP phenomena(mean WOMAC P1084 redaction 315 mm vs. 199 mm, p<0,05). SHOULDER ULTRASOUND TO DISCRIMINATE Conclusion: Patients with clinical signs of CS have subopti- STRUCTURAL LESIONS IN PATIENTS WITH mal pain control. Therefore, one of the main ways of control- FIBROMYALGIA ling pain should also target CNS mechanisms A. E. Musetescu1,C.Criveanu1,F.A.Vreju1,A.M.Bumbea1, S. Dinescu1, C. Gofita1,C.F.Palici1,A.Rosu1, P. L. Ciurea1 1University of Medicine and Pharmacy, Craiova, Romania P1083 Objective: To discriminate between the structural causes of THE EFFECTS OF ULTRASOUND THERAPY IN THE MIO- shoulder pain in patients with fibromyalgia by using muscu- ARTHROPATHY OF THE TEMPOROMANDIBULAR loskeletal ultrasound, as clinical examination lack specificity. JOINT Shoulder pain is a common condition in clinical practice with C. Bochis1, C. Nistor Cseppento2,L.Lazar2,F.Cioara2 differential diagnosis being quite challenging, as well as a 1Clinica Oro-Maxilo-Facială, Timisoara, Romania, frequent source of pain in patients with fibromyalgia. 2University of Oradea, Faculty of Medicine and Pharmacy, Material and methods: 38 patients with shoulder pain, previ- Oradea, Romania ously diagnosed with fibromyalgia according to 2010 ACR Criteria were included in the study. Patients with recent trauma, Introduction: The mio-arthropathy of the temporomandibu- shoulder fracture or local treatment with corticosteroids in the lar joint is a pathology which often occurs in medical prac- last 3 months were excluded. Complete physical examination tice. Clinically, the most important sign is the pain at the TM and blood analysis were performed for positive diagnosis. S600 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Ultrasound was performed by a trained rheumatologist un- Results: the FRAX-based hip fracture probabilities ranged aware of the fibromyalgia diagnosis,usinganEsaote from 1.2-31.2%. Bone mineral density increased from base- MyLabSix equipment with a multifrequency linear probe of 6 line at 12 month in all patients (lumbar spine 12.4%, total hip – 18MHh. The following structures were assessed bilaterally: 3.2%). Hazard ratios for the teriparatide response did not long head of the biceps tendon, subscapularis, supraspinatus, changed significantly with increased risk probability from infraspinatus and teres minor tendons, gleno-humeral joint re- FRAX model or with vitamin D baseline level. cess, acromioclavicular joint, subacromial subdeltoid bursa. All Conclusions: teriparatide response was not influenced by FRAX pathological findings were recorded regarding tendon thick- risk of fracture alone or in correlation with vitamin D level. ness, homogeneity, calcifications, entesophytes/osteophytes, cortical irregularities, Doppler signal, and bursitis. Results: 53 painful shoulders were found among the 76 ex- P1086 amined. Subscapularis tendinosis was found in 45.28% of the HIP AVASCULAR NECROSIS OR TRANSIENT painful shoulders, in 71.69% tendinosis of supraspinatus and OSTEOPOROSIS OF PREGNANCY 26.41% tendinosis of infraspinatus and teres minor were iden- M. Farago1, F. Cioara1,S.Pop1 tified. In 39.62% osteophytes of acromioclavicular joint and in 1University of Oradea, Faculty of Medicine and Pharmacy, 28.3% of glenohumeral joint were found, while bursitis of the Oradea, Romania subacromial subdeltoid bursa accounted for shoulder pain in 32.07%, in patients with fibromyalgia. Tenosynovitis of the Hip pain during pregnancy is a common symptom women long head of the biceps tendon was diagnosed in 41.5% pa- experience. Most often is caused by postural changes and tients reported to painful shoulders examined, 15.09% had nerve compression. partial ruptures, 3.77% complete ruptures of the rotator cuff, Aim: To identify the cause of severe and progressive hip pain 13.2% calcific tendinitis and 11.32% a positive test for in women during pregnancy. subacromial impingement. Methods: We present the cases of two pregnant women in the Conclusions: In more than 50% of the painful shoulders from third trimester of pregnancy, 31 and 33 years old, highly edu- patients with fibromyalgia a morphological background for cated, with a recent onset of hip pain which in short time shoulder pain other than a myofascial trigger painful point became very intense and disabling and which was resistant was identified through musculoskeletal ultrasound. to postural changes and any allowed pain medication. A de- Musculoskeletal ultrasound is a valuable tool in detecting tailed physical exam was performed and laboratory tests and the presence of shoulder pathological structural lesions such image exam (MRI) were taken into account. as enthesopathy, calcification, bursitis, tenosynovitis even in Results: No history of trauma. High level of pain 8 and 9 on patients with shoulder girdle pain due to fibromyalgia. Visual Analogue Scale (0-10).The physical exam revealed pos- tural malalignment – hyperlordosis and anterior pelvic tilt, hip pain on palpation, abduction and rotation of the affected hip were P1085 limited by severe pain. No motor or sensorial deficit. After clin- IS THERE ANY RELATION BETWEEN FRAX AND ical exam we suspected avascular necrosis of the hip – according VITAMIN D IN TERMS OF RESPONSE TO DAILY to medical literature and our former experience. Laboratory tests TERIPARATIDE TREATMENT? were normal. MRI revealed bone marrow edema of the femoral A. S. Dragomir1,G.C.Taujan1,A.M.Dumitru1,R.M. head which led to the diagnosis of “Transient osteoporosis of the Hristea1,D.L.Paun1 hip”. In order to prevent a fracture, weight bearing restrictions 1C. I. Parhon National Institute of Endocrinology, Bucharest, were applied. Patients remained under medical observation. Romania Conclusions: Transient osteoporosis should be considered for differential diagnosis of severe hip pain during pregnancy. Background: Teriparatide, as an anabolic agent, is prescribed Early diagnosis and treatment are essential in order to prevent to treat patients at high risk of fracture. In our study we evalu- its complication. ated the magnitude of the response to teriparatide treatment in conjunction with FRAX risk of fracture and vitamin D level. Methods: 15 osteoporotic postmenopausal women naïve of P1087 osteoporosis treatment or bisphosphonate pretreated were OSTEOPOROSIS IN PATIENTS WITH DIABETES passed by FRAX risk of fracture and vitamin D level at base- MELLITUS line. All the patients received teriparatide 20mcg daily for at M. Stanciu1, A. Draghici2 least 1 year. Changes in bone mineral density and incidence of 1Department of Endocrinology, Lucian Blaga University new fractures were analyzed and interactions with efficacy of Sibiu, Sibiu, Romania, 2University Emergency Hospital teriparatide treatment were made. Sibiu, Sibiu, Romania Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S601 Introduction: Osteoporosis is a skeletal disorder characterized 1Bone and Metabolism, Bucharest, Romania, 2"C.I. Parhon" by decreased bone strength, deterioration of bone National Institute of Endocrinology, Bucharest, Romania, microarchitecture and increased risk of fractures. Diabetes is a 3Research Department National Institute of Endocrinology, chronic metabolic disease characterized by deficient insulin se- Bucharest, Romania, 4Radiology Department National cretion which may be associated with tissue insulin resistance, Institute C. I. Parhon of Endocrinology, Bucharest, Romania, resulting hyperglycemia. Hyperglycemia directly suppress 5Bone and Adrenals National Institute of Endocrinology, osteoblast-mediated bone formation, favoring osteoclast- Bucharest, Romania, 6Nuclear Medicine Parhon National mediated bone resorption, and indirectly due to the accumulation Institute of Endocrinology, Bucharest, Romania of advanced glycosylation products, leading to deterioration of the quality and bone strength and increased risk of fractures. We present you the case of a 39 years old female that was Methods: To analyze the interaction between osteoporosis referred to us for a large thyroid nodule of the right lobe and and diabetes, through a retrospective study on patients in the mild hypercalcemia in November 2016. At admission, we Department of Endocrinology in Sibiu Hospital between evaluated a hypo anabolic patient, with an enlarged right lobe 2008-2015. We enrolled 140 patients. We considered two of thyroid, normal heart rate and blood pressure. We found groups depending on the diagnosis of diabetes: a study group high calcemic values (12.2 mg/dl), low normal phosphorus of patients with osteoporosis and diabetes that includes 70 values (2.7 mg/dl), high PTH values (432.2 pg/ml), normal patients and a control group of patients with osteoporosis, 25 OH vitamin D values; normal TSH, free thyroxin, triiodo- including 70 non-diabetic subjects. We evaluated this patients thyronine, TPO and thyroglobulin antibodies, normal calcito- by age, gender, type of diabetes mellitus and his complica- nin values. Ultrasound of the thyroid pointed to an enlarged tions, T-DXA score and associated pathology. gland, with a mixt nodule of 4.5/2.6.2.13 cm in the right lobe; Results: Osteoporosis and diabetes is more common in the age thyroid iodine uptake and thyroid scintigraphy revealed a groups 60-69 years and 70-79 years. The number of patients “cold” right nodule. We scheduled a fine needle biopsy of the with type 2 diabetes and T DXA score -3 is significantly “right thyroid nodule” that pointed to a parathyroid nodule with increased (47 patients), compared to patients with type 1 diabe- high PTH values in the wash out. Because parathyroid scintig- tes and T-DXA SCORE -3 (3patients), also the patients with raphy was scheduled mid-January 2017 we decided to perform type 2 diabetes and T-DXA score <-3 is significantly increased a CT scan of the neck and mediastinum for precise parathyroid (19 patients), compared to patients with type 1 diabetes and T tumor localization. This exam confirmed an enlarged right in- DXA SCORE <-3 (1 patient). 94% from patients with diabetes ferior parathyroid gland (4.03/3.42/2.9 cm). Ultrasound of the mellitus were diagnosed with type 2 diabetes and 6% with type abdomen revealed a right kidney stone. Our patient is sched- 1 diabetes. 7% of patients diagnosed with type 2 diabetes and uled for a checkup in January, for DXA, parathyroid scintigra- osteoporosis, needed insulin. Diabetic retinopathy (42%) and phy before surgery (February 2017). The histopathological ex- diabetic polyneuropathy (27%) were the most common com- am will confirm a parathyroid adenoma or carcinoma. plications seen in patients with diabetes and osteoporosis. Thyroid pathology is frequently associated with osteoporosis and diabetes, hypothyroidism has an increased frequency in P1089 the study group (27 patients) compared with controls (11 pa- THE ROLE OF TERIPARATIDE TO AN ORTHOPEDIC tients). Patients with osteoporosis and diabetes are often asso- SURGEON AND ITS EFFECTIVENESS ON THE ciated high blood pressure (46 patients), heart failure (10 pa- FRACTURE HEALING PROCESS tients) and angina (30 patients). C. Coppola1 Conclusion: This study showed that diabetes mellitus type 2 1Dept. of Orthopedics and Traumatology, St Maria Loreto is more commonly associated with osteoporosis (T-DXA Nuovo General Hospital, ASL Napoli 1, Napoli, Italy score > -2,5) and severe osteoporosis (T-DXA score > -3) than diabetes mellitus type 1. Also these data support the impor- Introduction: Despite the use of drugs for osteoporosis can tance of evaluating on a large scale the osteoporosis in patients prevent the risk of further fracture in 30-70% of cases, today with diabetes mellitus. only about 20% of patients with fragility fractures receive ade- quate drug therapy at discharge. This is due to several reasons: the working environment of ortho-trauma surgeons, as many P1088 orthopedic surgeons do not consider the post-fracture second- HYPERPARATHYROIDISM DUE TO A RIGHT ary prevention being a responsibility of their daily work; fears “THYROID” NODULE that treatment for osteoporosis may interfere with the healing of S. E. Oros1,L.A.Diaconescu2,D.Ioachim2,A. the fracture and cause adverse reactions or drug interactions, Cargheorgheopol3,A.Dumitrascu4,R.I.Rosca5,A. especially in geriatric patients undergoing medical Goldstein6,D.Grigorie2 polypharmacy; lack of knowledge about the prescription and S602 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 reimbursement criteria, availability to compile dedicated sheets, pregnancy / lactation and hyperparathyroidism. In a first stage, as well as lack of consideration of the cost-benefit related to the a form with the recent paraclinics that the patient counts will use of anti-osteoporosis drug therapy. In addition, many of be started or new ones will be requested as required to calcu- these patients often present fragility fractures of the long bones, late SLEDAI-2K and verify levels of 25-hydroxy-vitamin D; related to vertebral fractures, with delayed consolidation due to In a second stage will complete the completion of the form the poor bone stock quality (5-30%), that may require further with the report of requested paraclinics. Patients with Lupus surgical treatments. Teriparatide results in a rapid and greater Nephritis will be analyzed independently. The primary out- increase in vertebral bone mineral density (BMD) and a de- come variable is the prevalence of hypovitaminosis D in pa- creased risk of vertebral and non-vertebral fractures in postmen- tients with SLE and the secondary outcome variable is the opausal women and men with osteoporosis, providing also en- relationship between vitamin D levels or levels and the total couraging preclinical results in fracture healing. score or SLEDAI-2K disaggregated components. Objectives: Pointing out the correct use of PTH, according to Expected results: we expect to find a high prevalence of the eligibility prescription criteria, and its effectiveness on hypovitaminosis d in patients with systemic lupus erythema- fracture healing process in fragility fractured patients with tosus in the Latin American population as it has already been complex long bones fracture or refractures, with a high risk identified in Europe and North America of delayed or nonunion. Methods: We present several patients with severe osteoporo- sis who reported multiple vertebral fractures and refractures, P1091 and complex long bone fractures (Humerus AO12-C1, Femur THE POTENTIAL BENEFITS OF THE ORTHO- AO31-B3, AO32-A3, AO33-A3, and Tibia AO42-B1, AO43- GERIATRIC PREVENTION SERVICE C3) with delayed union, who received Teriparatide. V. Pr en ni 1,M.Baroni1, R. Petruccelli2, L. Parretti1,J.Penzo1, Results: All patients healed (avg follow up 4yrs), without any V. Bubba1, G. Rinonapoli2, M. Massucci3, A. Caraffa4,P. systemic or local complications on the fracture site. Mecocci5, C. Ruggiero5 Conclusion: According to the latest literature data, 1Geriatrics, S.M. della Misericordia Hospital, University of Teriparatide confirmed, in our clinical series, to improve and Perugia, Perugia, Italy, 2Orthopaedics and Traumatology accelerate fracture healing and enhance bone formation, even Ward, S.M. della Misericordia Hospital, University of in fragility fractures with a high risk of delayed or nonunion. Perugia, Perugia, Italy, 3Orthopedic Rehabilitation, Media Valle Del Tevere Hospital, Usl 1 Umbria, Perugia, Italy, 4Orthopedic and Traumatologic Unit, Department of P1090 Surgery, University of Perugia, Perugia, Italy, 5Section of PREVALENCE OF HYPOVITAMINOSIS D IN ADULTS Geriatrics, Department of Medicine, University of Perugia, WITH SYSTEMIC LUPUS ERYTHEMATOUS AND Perugia, Italy RELATIONSHIP WITH SLEDAI-2K COMPONENTS IN PATIENTS ATTENDED IN TWO RHEUMATOLOGY Introduction: A gap exists between the evidence-based rec- SERVICES, BOGOTA 2016 ommendations and the real-world management of persons at M. C. Mejia1,R.A.Guzman1, A. A. Teherán1,L.G.Piñeros1, high risk for fractures (1,2). The effectiveness of outpatient V. Cadavid1, M. C. Barrera1 orthogeriatric service for the prevention of re-fractures is 1Fundación Universitaria Juan N. Corpas, Bogotá, Colombia unknown. Materials and methods: older persons discharged from an Objective: To establish the prevalence of hypovitaminosis D orthopedic ward were assessed within 40 days from the index in patients with Systemic lupus erythematosus in Bogotá and fracture. Patients underwent clinical assessment and standard- the factors that contribute to this condition. ized questionnaires by a multidisciplinary team. They receive Methodology: A cross-sectional study will be conducted with indications for falls and fracture prevention, and 6-, 12- and patients treated at the Rheumatology Services of the Juan N. 24-month follow-up for adverse events. Corpas Clinic (CJNC) and the Institute of Autoimmune Results: 197 persons (78% women and 22% men), mean age Diseases (IDEARG S.A.S.). A sample size of 70 patients, 84+3.8 years, were evaluated and these reflect 32% of those 95% CI and 5% margin of error were calculated with the discharged from orthopedic ward. Before index fracture, 52% EPIDAT statistical package. Patients older than 18 years of were functionally independent in the Activity of Daily Living age who meet at least 4 of the 11 American College of (ADL > 5), while 36% in the Instrumental Activity of Daily Rheumatology criteria, 1997, for the diagnosis of SLE (1), Living (IADL > 5). At time of orthogeriatric assessment, 40% who wish to participate in the study, will be included. were cognitively intact (MMSE>24), and 38% had diagnosis Patients hospitalized in the Intensive Care / Intermediate of dementia, mainly mild dementia, 79% were on vitamin D Care Unit will be excluded from renal replacement therapy, and calcium supplements and 5% were on anti-fracture drugs. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S603 After orthogeriatric assessment, 100% had indication for vita- population into a high- and a low-risk group, adding TBS to min D ad calcium supplements, 67% for the most suitable FRAX resulted in a net reclassification index of -0.033 anti-fracture drug treatment, 40% receive recommendations (-0.107–0.177). for appropriate drug treatment of comorbidities, and 80% in- Conclusions: TBS might be of less value in high-risk popu- dications for fall prevention. lations and that the predictive value of TBS may be improved Conclusions: The ortho-geriatric outpatient service is a model by applying the criteria for valid vertebral BMD-assessments of care for the management of hip fracture and frail older issued by ISCD, even for TBS analyses. persons. The effectiveness of this model for the prevention of falls and fractures is under investigation. References: P1093 1. Marsh D et al. Osteoporos Int 2011;22:2051. ADATALINKAGESTUDYEXAMININGEMERGENCY 2. Mitchell P et al. Best Pract Res Clin Rheumatol DEPARTMENT RE-PRESENTATIONS AMONG OLDER 2016;30:536. ADULTS HOSPITALISED WITH OSTEOPOROTIC FRACTURES S. Mathew1,K.Heesch2, S. McPhail1 P1092 1School of Public Health and Social Work and Institute of TRABECULAR BONE SCORE NOT USEFUL IN Health and Biomedical Innovation, Queensland University ELDERLY SWEDISH WOMEN? of Technology and Centre for Functioning and Health H. Lundin1,M.Saaf2, L.-E. Strender1,S.Nyren2,H. Research, Metro South Health, Queensland Department of Salminen1 Health, Brisbane, Australia, 2School of Public Health and 1Department of Neurobiology, Care Sciences and Society, Social Work and Institute of Health and Biomedical Karolinska Institutet, Stockholm, Sweden, 2Department of Innovation, Queensland University of Technology, Brisbane, Molecular Medicine and Surgery/Karolinska Institutet, Australia Stockholm, Sweden Objective: This study examined rates of re-presentation to Objective: Trabecular bone score (TBS) has in several differ- hospital emergency departments (with or without admission) ent populations been shown to add further predictive informa- and mortality among older adults presenting to hospital with tion over that obtained from BMD and FRAX alone. Sweden osteoporotic fractures, including patient and clinical factors and the other Nordic countries have the highest incidence of associated with risk of emergency re-presentation (within 2 fragility fractures worldwide. There are however no studies years) and post-discharge mortality. published on the value of TBS in those populations. The ob- Materials and Methods: Linked emergency department and jective of this study was to assess the effect on predictive hospital admission records (2009-14) for adults aged >65 ability of adding TBS to FRAX. years, who presented to public or private emergency depart- Material and Methods: Population based cohort study of 342 ments in Queensland (Australia) with osteoporotic fractures Swedish women aged 69-79 at inclusion followed for 10 were identified using ICD-10 diagnosis codes. Demographic years. The study had a 94% power to detect a difference in and clinical characteristics, hospital re-presentation (within 2 mean TBS of 0.06, the difference found in the Manitoba co- years post-discharge) and mortality rates were described. Cox hort presented in a study by Hans and colleagues in 2011. proportional hazards model was used to evaluate patient Results: During a mean time of follow up of 9.2 years 20% and clinical factors associated with risk of hospital had at least one a major osteoporotic fracture and about half of re-presentations and mortality. those were hip fractures (incidence 11%). The median FRAX Results: 12,224 unique patients (70% female, mean (SD) age risk for major osteoporotic fractures was 22% and 10% for hip 81(8)) with emergency department presentations for osteopo- fractures. Unexpectedly, after adjusting for all risk factors in- rotic fractures were identified from 153 hospitals. 7,155 pa- cluded in FRAX, TBS had no significant relation to neither tients (59%) were readmitted at least once and n=5,895 (48%) the risk of major osteoporotic fractures (p=0.101) nor of hip had died (censored at 2015). Hip fractures (n=2,705, 14%) fractures (p=0.215). After excluding 37 participants who´s were the most common reason for subsequent emergency vertebral BMD could not be assessed because of suspected department representations followed by cardiovascular vertebral fractures or other artefacts according to recommen- diseases (n=1,289, 7%) and head trauma (n=798, 4%). At dations of the International Society of Bone Densitometry the emergency re-presentations, approximately half were (ISCD), the p-values were lower but still non-significant. discharged without admission to hospital (n=6,477, 52%). For major osteoporotic fractures the p-value was 0.151 and The Cox proportional hazards model indicated (HR; for hip fractures p=0.057. When the median FRAX risk of 95%Cis, p-value): age at index admission (0.93; 0.89, 0.96, major osteoporotic fractures, 22%, was used to divide the p<0.001), longer length of stay (1.01; 1.00, 1.01, p<0.001), S604 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 and a range of comorbidities including myocardial infarction, P1095 peripheral vascular disease, congestive heart failure, and 3D OPTICAL SCANS FOR ASSESSMENT SARCOPENIA, dementia (all p<0.05) were associated with risk of ED re- OBESITY, AND OSTEOPENIA presentation within 2 years. Age (1.38; 1.33, 1.42, p<0.001), J. S. Shepherd1,B.N.Ng1,M.S.Sommer1,J.M.Mastick2,C. longer length of stay (1.01; 1.00, 1.01, p<0.001) male gender M. Miaskowski2,Y.L.Liu1,L.K.Kazemi1 (0.82; 0.76, 0.88, p<0.001), as well as dementia, COPD, 1Department of Radiology, University of California San diabetes, presence of metastatic cancer (all p<0.05) at their Francisco, San Francisco, United States, 2University of index hospitalisation were associated with post-discharge California, San Francisco, San Francisco, CA, United States mortality. Of all markers of functional decline, the most intuitive is de- Conclusion: This study was novel in reporting findings not cline in body lean mass and body shape. Tools to accurately only for hospital re-admissions, but also emergency re- access and monitor change in lean appendicular muscle mass, presentations to ED (without admission) and mortality rates, fat mass, and bone density are typically expensive and diffi- which were high. cult to access for regular clinical visits (i.e. DXA). Objectives: Our long term goal of the Shape Up! Skeletal P1094 Health Study is to provide phenotype descriptors of skeletal DISCRIMINATIVE POWER OR ROMANIAN VERSION health using body shape, and provide the tools to visualize and OF SARQOL QUESTIONNAIRE: PRELIMINARY quantify body shape in research, clinical practice, and person- RESULTS al health assessment. In this study we investigate the rapid G. Mihai1,C.Sucaliuc2, I. M. Pascanu3,A.I.Gasparik4 technological developments in inexpensive, fast 3- 1Endocrinology Department, University of Medicine and dimensional (3D) optical whole body scanning to characterize Pharmacy, Tirgu Mures, Tirgu Mures, Romania, 2University high-fall risk body shape phenotypes related to lean, fat, and of Medicine and Pharmacy, Tirgu Mures, Romania, bone status. 3Endocrinology Department, University of Medicine and Methods: To date, we have recruited a pilot population of 60 Pharmacy, Tirgu Mures, Romania, 4Department of Public women of slightly younger women (age=59±8 years, Health and Health Management, University of Medicine and BMI=26±6 kg/m2). Each participant received a total body, Pharmacy, Tirgu Mures, Romania spine, and femur DXA and whole body 3D optical image. The optical images are represented as a high resolution mesh Introduction: SarQol (Sarcopenia Quality of Life) is the first of over 7,000 nodes. The images were spatially registered disease-specific questionnaire for sarcopenia and has been de- using 75 fiducial marks manually placed by a trained reader. veloped and validated, initially in French language followed a After registration, variance in the node positions was de- year later in English. Recently we provided a translated and scribed using principal component analysis (PCA) to generate culturally adapted version of the original SarQol questionnaire modes of variation. The PCA modes were associated to body in Romanian language. composition measures from DXA using simple linear regres- Objective: This study addressed the need to evaluate the dis- sion to generate optically-derived body composition esti- criminative power of the Romanian SarQol questionnaire. mates related to appendicular lean mass index (sarcopenia), Material and Methods: The sample size included 46 volun- femur neck BMD (osteosarcopenia), fat mass index teers of both sexes, 65 years old or above who completed the (sarcopenic obesity). Romanian SarQol questionnaire. To assess muscle strength Results: We found that 11 PCA modes captured 95% of the we used a hand dynamometer; the Cut off values suggested body shape variation. Seven PCA modes described 87% of the by EWGSOP were used: a muscle strength <20 kg for women variance (R2=0.87) in ALMI, and nine modes described 98% and <30 kg for men assessed. of the variance (R2=0.98) in FMI. One PCA mode was highly Results: Mean age was 71.71 years±9.02.Gender distribution: significant to BMD at the femur total, neck and spine 36 female volunteers (78%) and 10 male volunteers (P<0.005), and two modes explained 35% of the variance of (22%).Among subjects with positive Handgrip Test (n=23), femur neck BMD. Using the PCA modes and the prediction mean SarQol scores were significantly lower compared with equations, avatars were created for specific measures of individuals (n=23) with Handgrip test below the mentioned ALMI, FMI, and BMD. Figure 1 shows representations of cut-off values (60.2±20.2 vs. 81.2±14.2, p- 0.0002). ALMI at the (mean – 3 standard deviations), mean, and (mean Conclusion: In our study, subjects with a positive Handgrip + 3 standard deviations). Test reported a reduced global quality of life compared to Conclusions: We conclude that body composition and bone those with a negative Handgrip Test. We found also a good, density estimates from 3D whole body optical scanning are positive, statistically significant correlation between SarQol accurate to DXA-derived measures. 3D optical cameras may Mean scores and hand grip strength. be an inexpensive non-invasive method for classifying Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S605 populations into at-risk categories of sarcopenia, obesity, and significant lower ingestion of dietetic vitamin D (p=0.002). osteopenia. There were no significant differences in oral supplemented patient group vs. non-supplementation of vitamin D. There was no correlation between dietetic and serum levels of vita- min D or calcium. Conclusions: In this study, vitamin D levels <30μg/L were found in nearly 2/3 of patients and ¾ revealed calcium intake <1200mg/d. There was a tendency for higher vitamin D levels in elderly patients, which may be related to previous supple- mentation. There was a significant negative correlation be- tween 25(OH)D levels and BMI, consistent with literature. We could not find any relationship between 25 (OH)D levels, dietary intake of calcium or vitamin D. A potential bias is the fact rheumatologists request vitamin D dosing in patients with risk factors/clinical features of hypovitaminosis D. Another potential bias is the previous use of supplements. P1096 DIETARY INTAKE OF CALCIUM AND VITAMIN D: CORRELATION WITH BIOCHEMICAL AND P1097 NUTRITIONAL STATUS THE CONNECTION BETWEEN DIASTASIS RECTI M. E. Simoes1,A.Cardoso1, R. Fernandes1, J. Borges1,M.J. ABDOMINIS EVOLUTION AND LOW-BACK PAIN Mediavilla1, J. Vaz Patto1, A. Faustino1,H.Madeira1 FROM CHILDBIRTH TO 6 MONTHS POSTPARTUM 1Portuguese Institute of Rheumatology, Lisbon, Portugal R. Nartea1,S.A.Nica2,D.Nanu2 1National Institute of Rehabilitation Physical Medicine and Objectives: To assess calcium and vitamin D status in a rheu- Balneoclimatology, Bucharest, Romania, 2University of matic outpatient setting. To characterize the calcium and vita- Medicine and Pharmacy, Carol Davila”, Bucharest, Romania min D food ingestion and its relation with BMI and serum levels of 25(OH)D and calcium. Diastasis recti abdominis is a common condition that affects Material and Methods: Observational, transversal, retro- many women during childbearing and in postpartum period spective study including rheumatic outpatients with at least and represent the midline separation of the rectus abdominis one 25-hidroxyvitamin D serum determination. Data muscles along the linea alba. There is poor knowledge on ascertained included gender, age, body mass index (BMI), prevalence, risk factors for development of this condition. oral supplementation on calcium and vitamin D and their se- Later, suck weakness influence the biomechanical posture rum levels. Dietary ingestion was assessed by food frequency causing back pain. questionnaire (fish, egg, meat, milk, yogurt and cheese) ap- The aim of this study is to see if women with DRAwho started plying a software with an algorithm for calcium (mg) and exercise program after delivery had a comparable reduction of vitamin D (μg) daily ingestion quantification.1 Statistics: back pain at 6 month postpartum. Mann-Whitney, Kruskal-Wallis, ANOVA, Chi-Squared tests We realized a retrospective study of 43 women (27 with C sec- and Spearman’scorrelation;p<0.05. Software: SPSS 17. tion delivery and 16 with vaginal delivery) with low back pain Results: 91 patients were included, 91.2% female, mean age and DRA in the late pregnancy period which started a rehabili- 62.6±13.7 years; 45.1% were <65years old. Mean BMI was tation program after delivery (postural training, stretching, iso- 25.5+3.9 kg/m2, 48.4% overweight (BMI>25). Mean calcium metric contraction of the transverse abdominis, resistance train- was 9.36mg/dL; daily calcium ingestion was 996±393mg; ing, education). All patients were similar in ethnicity, full term 76.9% patients with Ca<1200mg and 57.1% Ca<1000mg/d. deliveries and with no comorbidities. DRA was measured in the Mean vitamin D was 30.2±21.9μg/L; 61.5% patients had vi- postpartum period using clinical examination at the anterior tamin D levels under 30μg/L and 35.2% under 20μg/L. Daily sheath of the rectus abdominis, in the region above the umbilical mean dietetic vitamin D was 4,1±1.7μg, with no relation to scar. Low back pain was quantified using VAS scale. serum levels of calcium or 25(OH)D. We compared vitamin D At each level of measurement, the results were statistically in normal BMI vs. obese patients and found significant differ- analyzed using Student-t which showed that both group (C- ences of 25(OH)D levels, higher in normal weight patients, in section delivery and vaginal delivery) exhibited significant the 65-87 years subgroup (p=0.037). Vitamin D levels were improvement (p<0,05) in the reduction of diastasis abdominis. positively correlated to age (p<0.05). Obese patients revealed There wasn’t found any significant differences in pre- S606 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 pregnancy body mass index (BMI), weight gain, child birth the first week especially in relation to collagen rupture; Unlike weight or type of delivery. Women with DRA at 6 month GAGs that break and expose the cartilage. Therefore, clinical postpartum are more likely to report low back pain than wom- proposals should be predicted to protect the breakdown of en without DRA at this moment. GAGs in the acute phase of knee trauma. The limitation of the study is the relatively small number of the patients and a lack of the longer follow-up period. Also it must be mentioned that it is not a multicenter study. P1099 References: CALCIFICATIONS IN DERMATOMYOSITIS: A 1. Benjamin DR et al. Physiotherapy 2014;100:1. CLINICAL CASE WITH AN ALTERATION OF 2. Pascoal AG et al. Physiotherapy 2014;100:344. PHOSPHATE HOMEOSTASIS, CARRIER OF A NEW FGF23 GENE MUTATION L. Masi1,G.Marcucci2,F.Giusti2,C.Fossi2,F. P1098 Franceschelli2,G.Leoncini2,F.Cioppi1,L.Cianferotti2,M. COLLAGEN OF MEDIAL MENISCUS RESISTS ACL L. Brandi2 TRANSECTION TRAUMA IN OA MODEL 1Metabolic Bone Diseases Unit, University Hospital of DIFFERENTLY FROM ARTICULAR CARTILAGE Florence, Italy, Florence, Italy, 2Metabolic Bone Diseases S. M. Mattiello1,A.A.Aro2,F.A.Vasilceac1,P.R.M.S. Unit, Department of Surgery and Translational Medicine, Serrão1, G. H. Gonçalves1,E.R.Pimentel2 University of Florence, Italy, Florence, Italy 1Federal University of São Carlos, São Carlos, Brazil, 2University of Campinas, Campinas, Brazil Objectives: The periarticular calcinosis of the soft tissues is a unique but not rare radiographic finding. The Tumoral Objective: This study aimed to evaluate the biochemical al- Calcinosis (TC) is a rare genetic disorder characterized by terations of the articular cartilage matrix and meniscus in the periarticular cystic and solid tumorals calcifications. The gene onset of knee osteoarthritis (OA) in rabbits, using the OA coding FGF23, its cofactor Klotho or GALNT3, are involved transection model of anterior cruciate ligament (ACL). in the regulation of phosphate homeostasis and mutations of Methods: Three groups of animals were used: ACL transec- these genes are responsible of the pathogenesis of TC. tion (ACLT), Sham (S), and control (C). The animals of the However, the dystrophic calcification, may mimics TC, occur- ACLT and S groups were submitted to surgical intervention. ring in either a localized or generalized pattern, and results All animals from ACLT and S groups were anesthetized. The from an underlying inflammatory process and is found in pa- ACL from ACLT group was broken while the ACL from S tients with normal serum chemistry levels. Dermatomyositis group was sustained intact. After surgery, the animals received (DM) is one of the diseases where calcification may be pres- intramuscular injection of 10% ketofen for 72 hours. The an- ent. Both juvenile and adult forms of DM have been de- imals were euthanized by anesthetic deepening after 7 days of scribed. The disease may present at any age with a bimodal follow-up. Then, the left knee was removed to articular carti- distribution of patients under the age of 18 and between the lage and medial menisci analysis. The medial menisci and ages of 45 and 65 is most common. Females are more com- cartilage of the femur, tibia, and patella were scraped from monly affected than males. Dystrophic calcinosis is seen in up the bone and stored in an -80°C freezer. Total Proteins and to 30% of patients with DM and is characterized by normal glycosaminoglycan sulfate (GAGs) were extracted from the calcium and phosphate levels in serum and appears as a result cartilage and were quantified using colorimetric methods, the of local tissue damage. In the present study we described a dimethyldimethylene blue. Absorbance was measured at 595 Caucasian 67 yrs old women affected by DM with Raynoud nm. The components of GAGs were dosed by agarose gel syndrome. She presented to our attention with left and right electrophoresis. Total collagens from cartilage and medial me- arms, buttocks and peri-sternal calcifications. The laboratory niscus were quantified by hydroxyproline, and the absorbance tests showed serum Pi of 4.6 mg/dL (n.v.:2.5-4.5) Urine measured at 550nm per spectrophotometer. Phosphate 228 mg/24 h (530-850), high bone resorption Results: The cartilage from C group presented more GAGs marker deossipiridynoline and normal bone formation marker per mg of dry tissue than S group (p <0.05). For hydroxypro- bone alkaline phosphatase. Patient showed and inappropriate line, the ACLT group presented higher total collagen concen- levels of 1-25(OH)2 D3 (48,1pg/mL; v.n.:16-65) and low tration per mg of dry tissue in the articular cartilage than C levels of 25 OH D (19.9 ng/ml; sufficient: 30-100). Due to groups (p <0.01). There were no differences between the the presence of these finding we decided to perform a genetic groups in the total collagen concentration and in the GAGs analysis of FGF23. concentrations per mg of dry tissue of the medial meniscus. Material and Methods: DNA was extracted from peripheral Conclusion: The results pointed that the meniscus resists trau- blood by automatic method. The 3 FGF23 exons, including ma facing the rupture of the anterior cruciate ligament during the intron-exon boundary regions, were PCR-amplified and Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S607 analyzed on ABI Prism 3130 Genetic Analyzer (Applied layers), 1 and 3cm of thickness. The coefficient of vari- Biosystems, Foster City, CA. Primer sequences were as fol- ation (CoV) was calculated as the ratio between standard lows: exon 2for ATCAATCCAGGGAGGTTTCA; exon 2rev deviation and mean;% least significant change (LSC%) GGAAACAGGTCACCAGGGTA; exon 1for GGGGTCTT as 2.77×CoV; REP as the complement to 100%of TGCACTTTCTTTC; exon 1rev GGTTGGATTAGCCC LSC%. BMD unit: g/cm2, TBS is unitless. Data are pro- TCCAGT; exon 3for AGGAGGAGCTGGGGAGTG and ex- vided as mean±standard deviation. on 3rev GACCTGGTCCTTGGGAAGA. PCR was per- Results: REP at 0cm: 99.0%-99.4% (BMD), 98.2%-98.8% formed with 1.5 mM magnesium chloride, 0.2 mM (TBS). REP at 3-cm: 98.7%-98.9% (BMD), 97.4-98.2% deoxynucleotide triphosphates, 0.2 μMofeachprimer,1U (TBS). The difference in terms of REP decrease between of Taq polymerase and 100 ng of genomic DNA as template BMD and TBS was comparable at 0 and 3 cm of soft-tissue (with T annealing 58 and 60°C). thickness (-0,8 at 0 cm, -0,7 at 3 cm). Both BMD and TBS Results: DNA analysis shows a C insertion in the intronic significantly decreased with increasing soft tissue, but the re- region between -36 and -37 nucleotide close to the exon 2 duction was more pronounced for TBS. The greatest difference (rs3832879: IVS-36insC) and a new variant at codon 108 for BMD and TBS was found at FA: BMD=0.987±0.010 (0cm) exon 3 (TTC>TTT Phe>Phe) not so far described in the – 0.980±0,013 (3cm), difference of -0,007 (-0.67%, p<0.001); literature. TBS=1.420±0.026 (0cm) – 1.337±0.024 (3cm), difference of - Conclusions: Finally, we described a case of calcinosis in a 0.083 (-6,17%, p<0.001). BMD mean differences between 0- patient with DM and alteration of phosphate homeostasis with 3 cm were always lower than BMD LSC, while TBS mean a new mutation of FGF23 gene. Understanding the functional differences were always higher than TBS LSC. significance and molecular physiology of this novel mutation Conclusions: TBS REP was overall lower compared to BMD can reveal critical information regarding the role of FGF-23 in REP. There was a comparable decrease between BMD REP states of normal and of disorder of phosphate homeostasis and and TBS REP whit increasing soft-tissue layers. Both BMD in patients with DM. and TBS are negatively influenced by increased soft tissue thickness, but only TBS variations exceed the LSC. Thus, for an identical bone quality, TBS may be lower in patients P1100 with high BMI. REPRODUCIBILITY OF BONE MINERAL DENSITY AND TRABECULAR BONE SCORE WITH DIFFERENT SCAN MODES ON PHANTOM: THE EFFECT OF A FICTITIOUS SOFT-TISSUE INCREASE C. Messina1,A.Poloni1, C. Monaco1,G.DiLeo2,F.M. Ulivieri3,L.M.Sconfienza4 1Radiology, University of Milan, Milan, Italy, 2Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy, 3Bone Metabolic Unit, Medicina Nucleare, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy, 4Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy Objective: Trabecular Bone Score (TBS) is a textural score that provides an indirect index of trabecular microarchitecture from lumbar spine (LS) dual energy x-ray absorptiometry (DXA). TBS mean values have been reported to be negatively P1101 influenced by body mass index (BMI), due to the increased VITAMIN D SUPPLEMENTATION WITH thickness of superimposed soft tissue. In this phantom study CALCIDIOL AND CHOLECALCIFEROL AMONG we evaluated the effect of a fictitious increase of soft tissue OLDEST-OLD PERSONS thickness on TBS and bone mineral density (BMD) reproduc- C. Ruggiero1, M. Baroni2, M. Ferracci3, M. Lapenna3,L. ibility (REP). Parretti3,V.Prenni3,V.Bubba3, A. Falorni4, A. Brozzetti4, Material and Methods: An Hologic spine phantom was S. Ercolani1,V.Boccardi1,P.Mecocci1 scanned with a QDR-Discovery W Hologic densitometer. 1Section of Geriatrics, Department of Medicine, University of Fresh pork rind layers of 5mm were used to simulate the Perugia, Perugia, Italy, 3Geriatrics, S.M. della Misericordia in-vivo soft tissues. For each scan mode [fast array (FA), Hospital, University of Perugia, Perugia, Italy, 4Endocrine array, high definition (HD)] 25 scans were consecutively Section, Department of Medicine, University of Perugia, performed, without phantom repositioning, at 0 (no Perugia, Italy S608 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Introduction: Increasing evidence shows that calcidiol in- P1103 creases more rapidly vitamin D plasma levels, as well as de- A NEW MUTATION ON VDR FOR HEREDITERY crease more rapidly PTHi, with positive effects on inflamma- VITAMIN D RESISTANT RICKETS tion and muscle performance (1). L. Ozsari1,A.Cim2 Materials and methods: prospective observational study 1Departments of Endocrinology and Metabolism / University among community-dwelling men and women, aged 75 of Health Science / Sultan Abdulhamid Han Training years and older, consecutively admitted to the acute Hospital, Istanbul, Turkey, 2Division of genetics, Diyarbakır care ward of a geriatric department. Participants had training Hospital, Diyarbakır, Turkey hypovitaminosis D, underwent vitamin D supplementa- tion with calcidiol or cholecalciferol, and blood sam- Objective: Hereditary vitamin D resistant rickets (HVDRR) is pling to measure plasma levels of 25(OH)D, 1-25 an autosomal recessive disease caused by mutations in vita- (OH)D and PTHi during the short-term in-hospital stay min D receptor (VDR). We described two siblings with likely and up to 6-months in the ambulatory follow-up. pathogenetic mutation in Intron 7 c.905+1 G>A in the VDR Results: 33 persons were on cholecalciferol and 34 were that results in HVDRR. on calcidiol, mean age 82.63±5.42, with median Material and Methods: Informed consent was obtained from 25(OH)D at baseline equal to 7.39(9.04) and patients and their parents. Leukocytes were cultured from 7.40(9.92) ng/ml, respectively. During hospital stay whole blood cells. Intron 7 of the VDR gene was amplified (mean length of stay 12.5+3.2 days) we found similar by PCR and sequenced at the protein and nucleic acid facility. increase of 25(OH)D, 1-25(OH) and PTHi plasma levels Results: Patient’s clinical history; 22 year-old-man attended among both groups. At 3 and 6-month evaluations, per- to our clinic for routine control of HVDRR. Alopecia, curves sons taking calcidiol had slightly higher increase in on his waist and leg were presented at the first year of his life. 25(OH)D, with slightly decrease in PTHi plasma levels He was gotten suspicious about HVDRR with reduced serum than those on cholecalciferol. There were no statistical calcium, elevated alkaline phosphatase level, ruling out nutri- changes in calcium plasma levels among both groups. tional vitamin D deficiency and 1α-hydroxylase deficiency. Conclusions: vitamin D supplementation based on calcidiol Treatment with vitamin d, calcium and phosphorous were has effectiveness and safety profile similar to that of cholecal- stared. At the age of eight the treatment was changed as ciferol among oldest-old persons in a real world observational calcitriol and calcium lactate. His sister was also diagnosed study. with HVDRR when she was one month old. She was present- Reference: 1. Meyer O et al. Osteoporos Int 2015;26:373. ed with alopecia. Bone scans revealed rickets. Due to her brother was HVDRR she was started calcitriol and calcium lactate treatment. Their parents were intermarriage. Alopecia P1102 was determined on his scalp and whole body. Yellowish milia ASSOCIATION OF ERECTILE DYSFUNCTION AND on the xerotic base of face, upper and lower extremities were OSTEOPOROSIS IN EGYPTIAN PATIENTS established. Postinflammatory millimetic hyperpigmented I. ElGazzar1,I.Osman2 areas were determined. Serum calcium, phosphorous and vi- 1Department of Rheumatology and Rehabilitation, Faculty of tamin D3 levels were in normal range under the therapy. Medicine, Cairo University, Cairo, Egypt, 2Department of Genetic study of the patient revealed with homozygous muta- Andrology and Sexology, Faculty of Medicine, Cairo tion on Intron 7 c.905+1 G>A. We also determined homozy- University, Cairo, Egypt gous mutation on Intron 7 c.905+1 G>A on his sister. Conclusion: We described a likely pathogenetic homozygous The aim of this study was to investigate the occurrence of mutation in the VDR. The findings of this study support het- Osteoporosis in males with Erectile Dysfunction (ED). Forty erozygous parents. We could not find this mutation on the ED patients and 40 controls with normal sexual function were literature. This can be described as a new mutation in VDR included in the present study. The erectile function of all males for HVDRR patients. was evaluated by the Arabic validated form of the International Index of Erectile Function-5 questionnaire (IIEF-5). Bone mineral density (BMD) measurement for P1104 Osteoporosis was done to all men using Dual Energy X-ray BENEFITS OF USING DYNAMIC TAPE IN ANKLE Absorptiometry (DXA). Statistical analysis was done. Results SPRAIN REHABILITATION PROGRAM showed a significantly higher occurrence of Osteoporosis in R. Nartea1,L.S.Meiu1, T. Vasilescu 1, M. Constantinovici1, ED patients as compared to controls with normal erectile func- A. S. Nica 1 tion. In conclusion, males with ED should be evaluated for the 1National Institute of Rehabilitation Physical Medicine and presence of Osteoporosis. Balneoclimatology, Bucharest, Romania Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S609 Objectives: Ankle sprains represent highly prevalent pathol- Background: Continued development and progress in ogy, with risk of recurrence. Consequently, there are a signif- terms of technology, especially medicine, so the emer- icant number of research reports examining strategies for gency, modern surgical techniques and rehabilitation treating and preventing acute and recurrent sprains (otherwise medicine have made new meanings in the life expectan- known as chronic ankle instability). Worldwide, approximate- cy and quality of life in patients after spinal cord injury. ly one ankle sprain occurs per 10,000 person-days, an estimat- In the past, hope for life after a spinal lesion was bur- ed two million acute ankle sprains occur each year in the dened by multiple complications that led to a drastic United States. shortening in life expectancy of these patients. Dynamic tape is a biomechanical tape that stretches 4-ways Currently, the survival of many decades after spinal cord with strong elastic resistance and recoil of variable degrees that injury is no longer an exception but a rule. This con- absorbs and injects force to reduce the workload on the body. fronts us with more and more cases of patients living The aim of this study is to assess the effects of using dynamic in wheelchair for many years and which require our spe- tape in the rehabilitation program of patients with ankle cial attention. The idea that the patient's organism that sprain. lives in a wheelchair after a spinal lesion, remains an Material and method: We assessed a group of patients (32) open premature aging and faster deterioration of different with ankle sprains (grade 1 and 2) who were treated in our organs and systems based on the finding in these clinic over a period of 2 months; they were usually evaluated patients. in our clinic for the first time 2 weeks after the acute injury. Objective: Analysis of complex consequences of medullary Patients treated with cast immobilization were excluded. After lesions on the physiological process of aging, the effects on clinical and functional evaluation, we obtained informed con- life expectancy and quality of life of patients living a long time sent for treatment and divided the patients in 2 subgroups for in wheelchairs. the rehabilitation program. The first group (15) received Material and method: They were taken 40 patients into ret- kinetotherapy and electrotherapy and the second group of pa- rospective, observational study, patients after spinal injury, all tients (17) received electro- kinetotherapy and additional ap- hospitalized and treated in Rehabilitation Hospital Felix in the plication of dynamic tape. last 3 years. The patients were: 17.5% female, 82.5% male, The rehabilitation program consisted in the application of high 67.5% paraplegics, quadriplegics 32.5%, the main criterion frequency streams and specific kinetotherapy program for 10 for admission being the time since the injury, more than or days. In the second group, Dynamic tape was applied on the equal to 5 years. We analyzed the lot in terms of the impact first and sixth day of treatment. We evaluated pain using the that life in a wheelchair had on different organs and systems, VAS scale (days 1,5,10). For functional evaluation we used quantifying complications and disorders in musculoskeletal, the FAAM questionnaire (days 1 and 10).We performed respiratory, gastrointestinal, urinary, dermatological, cardio- another evaluation 4 weeks after the completion of the vascular, endocrine, neurological dysfunction, early aging, so- treatment. cial reinsertion social issues, life expectancy and quality of life Results: In the first group average VAS=7,26 at day 1, (QoL). VAS=4,6 at day 10 and VAS=2,66 at 4 weeks. In the second Results and conclusions: They were noted as the most com- group average VAS=7,47 at day 1,VAS=4,17 at day 10 and mon causes of damage to the overall health of these patients, VAS=2,05 at 4 weeks. Average FAAM evaluation was 47% at lesions sores type IV, urinary infections followed by fragility day 1, 73% at 10 days, 87% at 4 weeks in the first group. fractures and neuropathic pain. Average FAAM evaluation was 44% at day 1, 76% at 10 days, 91% at 4 weeks in the second group. Conclusions: In the group treated with dynamic tape we ob- P1106 served better improvement in the activities that require stability ASSESSMENT OF WALKING DEFICIT INTO of the ankle. These conclusions can sustain the use of dynamic ARTHROSIS HIP tape in the treatment of ankle sprain, especially for the improve- R. Suciu1, M. L. Cevei1,A.Pallag1, E. Szarka1, F. Cioara1 ment of joint stability (ankle sprain frequently recurs). 1University of Oradea, Faculty of Medicine and Pharmacy, Oradea, Romania P1105 Objectives: The present study aimed to assess the impact on AGING ISSUES IMPACT ON SPINAL CORD INJURY the course of hip osteoarthritis and the quality of life and com- F. Cioara1,R.Suciu1,A.Pallag1,C.NistorCseppento1,M. paring the values obtained from the test drive with the initial Rus1,L.Lazar1 assessment and after finishing medical rehabilitation therapy. 1University of Oradea, Faculty of Medicine and Pharmacy, Material and Methods: We conducted a prospective obser- Oradea, Romania vational study on 55 patients with osteoarthritis secondary S610 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 primitive stage II radiological hospitalized in Medical department of emergency medicine (group I) and 125 patients Rehabilitation Felix in the period January 2016 - June 2016. aged over 65 years old with mean age 71,5±1,1 without falls Patients were divided into two groups Group I 29 patients with in background admitted to the department of gerontology osteoarthritis primitive and group II 26 patients with osteoar- (group II) during October - December 2016. Patients with risk thritis secondary. Each patient had a record of study that in- factors for secondary osteoporosis were excluded from the cluded, besides demographics, quality of life using the ques- study. Both groups were identical by age and sex. We ana- tionnaire MOS-SF 36 (Health Survey) and the impact on func- lyzed concomitant pathologies and tested vitamin D level with tional capacity and hence on walking - highlighted by walk both groups. test conducted BTS device G walk. Results: We determined the presence of most common concom- The average age of the batches was 59.63±10.63 years, males itant pathologies in both groups and attested the following: arte- being in proportion of 60%. rial hypertension 87,5%, vs. 85,9%, coronary artery disease Results: Average score MOS - SF36 Health Survey is a moder- (CAD) 52,69% vs. 32% (p<0,05), diabetes mellitus type 2 in ate impairment of quality of life, in primitive and secondary 22,5% vs. 21,6%, patients after stroke 20% vs. 22,4%, osteoarthritis cases with radiological stage II. Assessment of gait radiculopathies 22,5% vs. 19,2%, obstructive chronic phases using BTS G walk in patients with osteoarthritis of the hip bronchopneumopathy 12% vs. 8%. 94% of patients in our study disclose material changes thereof. Cases with osteoarthritis of the had suboptimal vitamin D level, mean 23,4±0,5ng/ml. Testing of hip variables studied media test drive investigated were changed vitamin D level in group I found mean level 18,6±0,9 ng/ml and more or less, except static phase which shows normal right foot. in group II 28,4±0,7ng/ml, p<0,05. Lower vitamin D level pos- Conclusions: In this study using clinical evaluation by SF-36 itively correlated with the presence of CAD, r=0,58 (p<0,05). questionnaire and walk test performed with the computerized Conclusions: Almost all the patients in the study had subop- BTS G WALK device, draws attention on the impact of radio- timal vitamin D level. Elderly patients with fragility fracture logic stage II hip osteoarthritis on the functional capacity on have lover vitamin D level what can have a negative influence quality of life in patients suffering from hip osteoarthritis, on the risk of falls. Lower vitamin D level in the group of compelling early diagnosis and rehabilitation therapy in pa- study correlated positively with the presence of CAD. tients predisposed to hip osteoarthritis. P1108 P1107 THE ROLE OF ROBOTIC WALKING ASSIST CONCOMITANT PATHOLOGIES AND VITAMIN D THERAPY IN PATIENTS WITH INCOMPLETE LEVEL IN ELDERLY PATIENTS WITH FRAGILITY SPINAL CORD INJURY FRACTURES FROM THE REPUBLIC OF MOLDOVA F. Cioara1, R. Suciu1, N. Pascalau1, M. L. Cevei1, S. Bungau1, E. Deseatnicova1,G.Soric2, F. Lupascu-Volentir2,L. L. Daina1 Volentir3, S. Soric3, L. Rotaru4, E. Russu4, A. Negara2,O. 1University of Oradea, Faculty of Medicine and Pharmacy, Catarau3,L.Groppa4 Oradea, Romania 1Department of Rheumatology, State Medical and Pharmaceutical University Nicolae Testemitanu, Chisinau, Purpose: The purpose of the study was to investigate the Republic of Moldova, 2Gerontology Scientific Laboratory, State therapeutic efficacy of the Lokomat robotic gait training de- Medical and Pharmaceutical University Nicolae Testemitanu, vice in patients with spinal cord injury and physical-kinetic Chisinau, Republic of Moldova, 3Emergency Medicine therapy in the Medical Rehabilitation Hospital Felix. Department, Emergency Medicine Institute, Chisinau, Republic Material and Methods: We included 18 patients in the study of Moldova, 4Department of Rheumatology, State Medical and Medical Rehabilitation Hospital of Felix during January to Pharmaceutical University «Nicolae Testemitanu», Chisinau, March 2016. Patients were selected based on the diagnosis Republic of Moldova of incomplete spinal cord injury. Each patient had a record of study that included, besides demographics, and clinical data Background: Aging is accompanied by a reduction in muscle obtained with the aid of specific assessment scales (FIM ASIA mass and muscle strength. Vitamin D deficiency is associated Scale, Barthel Scale) and evaluation Lokomat. with muscle weakness, slow movements and is common in Results: In the study group of predominantly male rate of 89%, elderly people. the average age was 39 years, all patients underwent incomplete Aim: To evaluate concomitant pathologies and vitamin D lev- lesions of the spinal cord, in terms of the level of trauma predom- el in elderly patients with fragility fractures. inates the thorax with 55%, followed by lumbar 28% and 17% of Materials and methods: The study included 40 patients aged cervical. Nine (50%) patients from all the patients taken in the over 65 years old, mean age 73,77±1,13 y.o. with fragility study, benefited of robotic therapy, 78% had positive develop- fractures after a fall from the proper height admitted to the ments; 22% of them are still at the initial stage. At the end of the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S611 period all cases were able to travel at the same time a longer concerning the evolution of their symptomatology including distance. 89% of them walking longer distances than in the first pain and range of motion. The research has limitations in session and gradually increasing in speed. All patients were able relation with the relatively low number of subjects and the to increase the body weight support force by the guidance was difficulty for a longer follow-up. 95% to 100%, one patient having guiding force 90%. Functional independence, investigated the FIM is severely impaired in 40% of cases studied, they require help from a person both self-service P1110 transfers and to walk, moderate to others 40% - requiring partial OSTEOPATHIA STRIATA WITH CRANIAL help, and almost independent 20%. Performance of activities of SCLEROSIS IN ONE TWIN daily life are affected in patients with incomplete spinal injuries S. Pavlov-Dolijanovic1, N. Vujasinovic Stupar1,R. TVM from 2/3 study group needing assistance from a person. Milenkovic2,S.Seric2 Conclusions: Patients who received a 14 days of Lokomat 1School of Medicine University of Belgrade, Institute of therapy have succeeded to undergo the same time a longer Rheumatology, Belgrade, Serbia1, Belgrade, Serbia, distance after therapy. The decrease in spasticity in patients with 2Institute of Rheumatology, Belgrade, Serbia spinal cord injury is one of the reasons why walking assisted by Lokomatisachievedwithgreaterspeedandforcetosupportits Background: Osteopathia striata with cranial sclerosis (OS-CS) own weight increases. We can say that Lokomat therapy was a is a rare skeletal dysplasia characterized by longitudinal striations success, helping patients with spinal cord injury to be more of the long bone diametaphyses and sclerosis of the cranial vault optimistic in order to recover medical and be one step closer and base. OS-CS is an X-linked dominant condition. This con- to a life as independent. ditions, in combination with a sex ratio in favor of females and an increased morbidity and mortality in males. Patients can be asymptomatic or present with typical facial dysmorphism, sen- P1109 sory defects, internal organs anomalies, growth and mental retar- EVOLUTION OF CLINICAL SYMPTOMS IN dation, depending on the severity of the disease. CALCIFIC TENDINITIS OF THE ROTATOR CUFF: Results: Here, we present the case of two twins 42 year old EXTRACORPOREAL SHOCK WAVE VS. woman and man. Woman initially evaluated for heel pain and PHYSIOTHERAPY pain in the both hips. Her physical examination was normal. R. Nartea1,B.I.Mitoiu1,A.S.Nica1,F.Ojoga1,G. All laboratory parameters were in the normal range. Mologhianu1,L.S.Meiu2, M. I. Constantinovici1,G. Radiographs of the humerus, radius, femur, tibia and fibula Gheorghievici1 revealed longitudinal striations. X-rays of the skull showed 1UMF Carol Davila, Bucharest, Romania 2National Institute osteosclerosis, especially of the vault. Cervical and dorsal of Rehabilitation Physical Medicine and Balneoclimatology, spine, as well as ribs also showed sclerosis. Lumbar spine Bucharest, Romania and pelvis showed sclerosis and longitudinal striations. X- rays of the feet showed spina tendinis Achilis billateralis. Objective: To find the difference between the clinical im- Bone mineral density (BMD) showed osteopetrosis (spine T- provement using extracorporeal shock wave (ECSW) and score/Z-score was +6.1/+6.0 and hip +5.1/ +5.2). Her twin physiotherapy in the calcific tendinitis of the rotator cuff. brother had a normal skeleton. His spine BMD was -0.3 and Material and Methods: Our study involved two groups of hip BMD was -0.7. patients, one treated with extracorporeal shock wave and the other Conclusion: We present a case of OS-CS discovered inciden- with physiotherapy. The protocol recommendations were 3 to 5 tally in a young woman studied for clinical manifestations sessions for ECSW or 10 sessions of physiotherapy. Pain and unrelated to this disease. OS-CS is not a serious disease, al- range of motion were measured before and after the treatment. though it is often associated with other kinds of disorders and Results: We used SPSS for Windows to analyze data regard- extraskeletal malformations that can affect the prognosis. The ing pain and range of motion in the shoulder. Data analysis diagnosis was confirmed by X-rays examination showing typ- included frequencies and was given in mean±standard devia- ical longitudinal striation. tion, minimum and maximum. The paired t test was used for the comparison of parametric results. P values of less than 0.05 were considered statistically significant. The results P1111 showed similar values using both methods without a statistical NEUROLOGICAL MANIFESTATIONS OF THE significance of the difference with a p>0.05. PATIENTS WITH SJÖGREN’S SYNDROME Conclusion: In our study the patients in the two groups had a N. Pascalau1, F. Cioara1,L.Lazar1 globally positive evolution regardless of the treatment under- 1University of Oradea, Faculty of Medicine and Pharmacy, gone. The data showed no difference between the two groups Oradea, Romania S612 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Introduction: Sjögren’s syndrome is a rare immunological Mures, Tirgu Mures, Romania, 5Emergency County Hospital disorder, primary or secondary, characterized by chronicle lym- Deva, Deva, Romania phocyte infiltration of the exocrine glands, tissues or organs. This disorder can be associated with some other disorders: Background: Management of osteoarthritis (OA) has rheumatoid arthritis, systemic erythematous lupus, polymyosi- evolved lately, in part due probably to new pharmacological tis, dermatomyositis or scleroderma. Human body is frequently and physical therapies that act on cartilage and bone and part the target of the external aggressions like viruses, bacteria, al- because of the new imaging techniques that can depict earlier lergens, toxic substances, that can negatively influence it. Even changes in the joints and tendons. worst is when the body’s protection cells fight against the body Objectives: To evaluate, by ultrasonography (US), the femoral itself or against its tissues due to not recognizing them as being hyaline cartilage of the patients with OA, in the three compart- part of the body. There are major differences between different ments: medial and lateral condyle and intercondylar area and to patients. The implication of the central and peripheral nervous find if there is a correlation with clinical findings for each. system into this disorder is proven by different other studies. Methods: Eighteen patients with mild knee OA (disease Peripheral neurological symptoms are weakening of the body duration <2 years and low changes in knee conventional muscles and it seems to be related with the lymphocyte infil- radiography) were included in the study and they underwent trations of the small blood vessels that supply the peripheral clinical and biological evaluation, including HAQ, WOMAC. nerves. Frequent of psychological symptoms that were reported The US evaluation included anterior scan, with the knee fully are cognitive and memory disorders, depression and anxiety. flexed, in transverse scan, but with longitudinal confirmation. Material and methods: We retrospectively reviewed patients The cartilage was identified as the hypoechoic line superficial with Sj gren’s syndrome, known in database of rheumatology to hyperechoic bone cortical line. department of Pelican hospital Oradea, in the last 5 years. Of the Results: The loss of cartilage was clearly higher in the medial 38 patients with this immunological disease, only 2 patients had compartment, especially compared to central, intercondylar peripheral neurologic impairment. Because symptoms can area. Thus, the cartilage thickness was statistically significant overlap and coexist even with manifestations of other diseases, higher in the central area (1.944±0.68) compared to medial Sjögren's syndrome diagnosis can be made sometimes difficult. condyle (1.50±0.46, p=0.0037). We found no significant dif- Peripheral neurologic impairment is unusual and controversial ference between the intercondylar area, compared to lateral and is characterized by the occurrence of peripheral neuropathy one, with only a tendency for the cartilage to be thicker in secondary inflammation of blood vessels witch supplying the (1.944±0.68 vs. 1.708±0.53, p=0.127). There is no difference nerves in proportion variable between 0-60% of cases. between the dominant and non-dominant knee as both in gen- Systemic damage generally occurs between 5 and 15 years after eral cartilage thickness, but in the specific compartment too. the first manifestations of the disease, and neuropathy and mus- There is a high correlation between overall cartilage thickness cle wasting secondary is present in about 20% of cases. (r=0.98) and functional impairment of the patients, except in Conclusions: The evolution of Sjogren’s syndrome is unexpect- the medial compartment (r=0.12). It seems that the disability ed, different from patient to patient, and the peripheral neurologic index is more correlated with cartilage thickness in the dom- impairment may be difficult to differentiate from other neurolog- inant knee (r=0.82). ical entities. The patients who were evaluated and have shown Conclusions: This study reveals that the US might be an neurological and muscles disorders, like polyneuropathy of the important tool in the evaluation of OA patients in daily prac- hands and feet, myalgia, myopathy, were few compared to the tice and that the medial compartment is the compartment cu number of cases in the given timeframe, likely due to polymor- the most important loss of cartilage. In the same time, we can phic symptoms and diagnostic difficulties. speculate that the patients might report disability depending on dominant knee changes. References: P1112 1. Mogoşanu GD et al. Biol Trace Elem Res 2016;172:277. ULTRASOUND CHANGES IN FEMORAL HYALINE 2. Peltea A et al. Med Ultrason 2016;18:457. CARTILAGE OF THE OSTEOARTHRITIS PATIENTS 3. Bruyn GA et al. Ann Rheum Dis 2016;75:842. F. A. Vreju1,D.dumitrescu2,B.A.Chisalau2, P. L. Ciurea2,A. Rosu2,C.Criveanu2, M. Cepareanu2, A. E. Musetescu2,S. Dinescu2,R.Ionescu3, H. V. Popoviciu4,R.Miclaus5,S.C. P1113 Firulescu2,C.D.Parvanescu2 SIMULTANEOUS BILATERAL ACUTE FEMORAL 1University of Medicine and Pharmacy, Craiova, Romania, OSTEOMYELITIS: A CASE REPORT 3Colentina Hospital, University of Medicine and Pharmacy L. Pena Larrea1, F. Dominguez Dominguez1, M. Molinero Carol Davila, Bucharest, Romania, 4Rheumatology Montes1 Department, University of Medicine and Pharmacy of Tirgu 1Hospital Universitario Central de Asturias, Oviedo, Spain Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S613 Introduction and Objective: The simultaneous presentation Mohammed Almutairi, Rafik El Werfalli, Hamid Syed, of osteomyelitis in more than one bone is very unusual and is Tayyab Khan, Adam Waldbillig Reema Shah, J.E.M. Young commonly accompanied by a severe chronic disease. Even in and Aliya A. Khan such cases, other conditions that usually arise in the long McMaster University bones of patients must be ruled out such as immunodefi- The Canadian National Hypoparathyroidism Registry was ciencies. Acute hematogenous osteomyelitis is the most com- formed in 2014 and enrolment began following approval by mon type of bone infection. It arises characteristically in the McMaster University Ethics Review Board. metaphysis of long bones, such as the femur, tibia, and hu- merus (1). Surgery followed by antibiotic therapy is a suitable Objectives: approach for patients who do not respond to parenteral anti- • identify the etiology and presenting symptoms of patients biotics (1). The simultaneous involvement of two or more with hypoPTH. bones has rarely been reported in the literature. When it does • evaluate current treatment practice in Canada. occur, it is usually accompanied by an underlying chronic assess differences in presentation based on etiology of the disease, such as sickle cell anemia (2). In this report, we pres- disease. ent a case of osteomyelitis with bilateral femoral involvement • compare parameters of calcium homeostasis amongst those that developed in a man with an acute lymphoblastic developing complications of nephrolithiasis or nephrocalcinosis leukemia. vs. those without complications. Material And Methods: Case report of a 48-year-old man • assess fracture risk in Canadian patients with hypoPTH. presented to our institution with a complaint of pain, swelling, Material and Methods: 91 patients aged >18 years registered and redness in both legs. He suffered multiple complications in the Canadian National Hypoparathyroidism Registry were of the chemotherapy such as sepsis due to Pseudomona be- reviewed as per the following inclusion criteria: cause of the central catheter. We could see a purulent 1. Chronic HypoPTH (low PTH in the presence of low serum arthrocentesis in both knees and the MR revealed a bilateral calcium for at least 6 months prior to enrolment) osteomyelitis on both distal femurs. The patient received 2. HypoPTH requiring calcium/calcitriol replacement to main- intravenous antibiotics. The recommended duration of anti- tain normal calcium level for at least 6 months prior to biotic therapy is 4 to 8 weeks (3). The infection healed after enrolment several surgical curettages and antibiotic impregnated allo- 3. Post-surgical HypoPTH currently treated with graft incorporation in the joint (imipenem, amikacin and calcium/calcitriol supplements in order to maintain a colistin). low normal calcium level for at least 6 months prior Results and Conclusions: The simultaneous presentation of to enrolment. osteomyelitis in more than one bone is rare and is common- Patients with Pseudohypoparathyroidism were included. We ly accompanied by a chronic disease. Early diagnosis, reviewed etiology, clinical presentation, biochemical profile, appropriate antibiotic therapy, and timely surgical interven- management strategies, markers of skeletal health including tion all increase the chance of a successful outcome for these fractures, bone mineral density (BMD), fracture risk and com- patients. plications including nephrolithiasis/nephrocalcinosis, and bas- References: al ganglia calcification. 1. Herring JA. Infections of the musculoskeletal system. Results: Most patients (62/91) had postsurgical hypoparathy- Pediatric Orthopaedics. Philadelphia: Elsevier; 2008. pp. roidism, followed by 2089–2155. idiopathic/autoimmune disease (26/91) and pseudohy 2. Peltola H. Pediatrics 1997;99:846. poparathyroidism (3/91). The mean age of onset was 41.1 years. 3. Bachmeyer C. Rheumatology 2007;46:1247. Almost all patients were receiving calcium supplements (91.2%) with calcitriol being used by 89% and 3 patients were receiving parathyroid hormone. Complications were reviewed P1114 (nephrolithiasis or nephrocalcinosis) and were present in 26.6% AN OVERVIEW OF THE ETIOLOGY, CLINICAL of treated patients despite a mean calcium phosphate product MANIFESTATIONS, MANAGEMENT STRATEGIES AND <4.4 mmol2/L2. COMPLICATIONS OF HYPOPARATHYROIDISM FROM Basal Ganglia calcification was present in 30% of the patients THE CANADIAN NATIONAL HYPOPARATHYROIDISM reviewed. REGISTRY Hospitalization had been required in 40.7% of the patients. M. Almutairi1,R.E.l Werfalli1, H. Syed1,T.Khan1,A.W. Conclusion: Reema Shah1, J. E. M. Young1,A.A.Khan1 1. HypoPTH is associated with a significant disease bur- 1Department of Medicine, McMaster, Hamilton, Canada, den and leads to hospitalization in a large number of 2Medicine, McMaster University, Hamilton, Canada patients. S614 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 2. Renal complications were present in 26.6% of treated pa- 45 years, the number of cases has increased significantly (+ tients despite maintenance of a calcium phosphate product 25% average increase per decade). in the desired range(<4.4 mmol2/L2). The ideal calcium phos- phate product needs to be reconsidered. 3. Fracture risk was low in the absence of traditional osteopo- P1116 rosis risk factors. DETERMINANTS OF MSDS RELATRD PAIN IN TUNISIAN NURSES M. I. Merchaoui1, M. Hayouni1, L.Bouzgarrou2, P1115 J.Malchaire2, M. Akrout1, M.Touzi3,N.Chaari1. MUSCULOSKELETAL SYSTEM MORBIDITIES IN 1Occupational Medicine department, Monastir, Tunisia, 2 ROMANIA Catholic university of Louvain- Belgium, 3Rheumatology de- C. Daina1,F.Cioara1,M.BOKTOR2,L.Daina1 partment, Monastir, Tunisia 1University of Oradea, Faculty of Medicine and Pharmacy, Oradea, Romania, 2County Hospital of Oradea, Oradea, Objectives: Work related musculoskeletal disorders Romania (MSD) are a common health problem and an increasing cause of disability, especially among hospital staff. The Objectives: In Romania morbidity patterns have under- aim of the present study was to assess the determinants gone significant changes in the past decades through the of musculoskeletal disorders related pain in Tunisian higher prevalence of chronic diseases in the elderly healthcare workers. population. Methods: This is a cross-sectional study conducted in a sam- Thus in the 1970s, the predominant class of diseases were ple of 293 healthcare workers representative of 1181, based on the digestive, respiratory and infectious diseases, which a comprehensive questionnaire about socio-professional char- decreased over time, since they are kept under control acteristics, the NORDIC questionnaire commonly used to nowadays, through specific measures. An increasing trend screen for MSDs by occupational physicians, an 8-item work in the last decades is observed in endocrine, nutritional capacity evaluation (WAI) and on the SF8 health survey for and metabolic diseases (+ 44% average increase per de- the quality of life. cade), circulatory diseases (+ 31%), tumors (+ 30%), men- Results: Fifty one% (51.2%) of our participants complained tal disorders (+ 25%) and musculoskeletal system (+25). about an MSD related pain. The occurrence of the MSD in The study aimed to analyze the incidence of musculoskel- healthcare workers was in relationship with the increase of the etal system disorders in Romania. duration of household work (p<10-3), with the mental (p<10- Materials and Methods: In studying the general morbidities 3) and physical (p<10-3) decline of quality of life scores and indicators of incidence and newly registered cases were used, the work ability index decline (p<10-3). The final model of the data are based on INSP- CNSISP, Annual Health statistics binary logistic regression was made of the duration of house- 2014. The analysed period was 1970-2014. hold work (p<10-3, OR=1.04, CI=[1.02 - 1.05]), the physical Results: In 1970 there were 269291 newly registered cases of quality of life (p=0.001, OR=0.9, CI=[0.91 - 0.97]) and the musculoskeletal system disorders, while in 2014, there were work ability index (p<10-3, OR=0.89, CI=[0.85 - 0.94]). 1302469 of cases, representing 1.8% of the total number of Conclusion: According to our results, occupational preven- newly registered cases, and 2014 this percentage increased to tive majors should be implemented to reduce long exposure to 8.87%. In the study period, the highest reported number of risky physical postures leading to MSD. The management of cases were in 2012 (1377755). In Romania the specific inci- the duration of household work is also a compulsory determi- dence of diseases (per 100 000 inhabitants) shows the follow- nant in preventing the occurrence of MSDs in healthcare ing values: 1329%ooo (1970), 6868,1%ooo (2012) and workers. Based on these measures, we can prevent premature 6542,3%ooo (2014). These diseases are in the 4th place now- aging by MSD-related pain and the decline of physical quality adays after pulmonary diseases, gastrointestinal diseases, neu- of life. rological diseases and sensory diseases. In 1970, the number of discharged patients from these diseases were 136000 (3.3%), in 2009 - 284008 (5.9%) and in P1117 2014 - 248466 (6.7%). The discharged patients from the hospital FRACTURE AND DEMENTIA: FROM EPIDE- per 1000 inhabitants (frequency of discharged patients) MIOLOGICAL TO BIOLOGICAL CONNECTIONS represented 6.5‰ (1970), 13.9‰ (2009) si 12.5‰ (2014). M. Baroni1, V. Prenni1,M.Ferracci1,M.Lapenna1,S. Conclusion: Musculoskeletal system diseases morbidities be- Ercolani1,V.Boccardi1,P.Mecocci2, C. Ruggiero2 tween 1970-2014 has registered a constant increase without 1Section of Geriatrics, Department of Medicine, University of significant differences from year to year. However, in the last Perugia, Perugia, Italy Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S615 Cognitive decline, dementia, and fragility fractures are devas- Materials and methods: The study included 156 elderly pa- tating conditions afflicting the elderly, that result in disability, tients aged over 65 y.o. admitted consecutively to the reduced independence, and considerable burden to patients, Department of Gerontology during September – December caregivers, and the healthcare system. 2016. Frailty syndrome was evaluated by Rockwood stages. The incidence of Alzheimer disease (AD) and fragility frac- Fracture risk was calculated using FRAX score. tures increases exponentially after age 70. Some estimates Results: In the group of study predominated females indicate that one-third of adults in their ninth decade will be 76,92% vs. males 23,07%. Mean age constituted 76,44 diagnosed with either dementia or AD, and that by the ninth ±1,12 y.o. We determined that elderly non-frail patients con- decade, one-third of women and one-sixth of men will fracture stituted 26,92%, slightly frail elderly patients made 32,05%, ahip. moderately frail were 23,71% and severe frailty was found The number of affected individuals continues to rise, especial- in 17,30% of patients. We determined that medium value of ly in developing countries. This trend has become an urgent FRAX score in non-frailty patients constituted 12±0,1, and public health challenge with growing medical, social, emo- this was lower in comparison with the patients with frailty tional, and economic consequences. It is apparent that the syndrome. Thus elderly patients slightly frail had value of incidence of hip fracture and dementia will pose a healthcare FRAX score 14±0,2, moderately frailty patients showed challenge in the decades to come. FRAX score 22,0±0,1 and patients with severe frailty syn- Additionally, several studies indicate an increased fall risk drome had FRAX score of 23,2±0,2. among AD patients. This has been attributed to progressive We have determined that the presence of frailty syndrome cor- loss of memory and cognitive function, the generalized weak- related with age of patients, the number of concomitant pathol- ness associated with sarcopenia, and alterations in posture, ogies. Severity of frailty syndrome correlated positively with gait, and stability seen in the advanced stages of AD. the risk of osteoporotic fracture by FRAX, r=0,64, (p<0,05). Tangled connections exist between brain and bone. Several Conclusions: Frailty syndrome is a common in elderly. hormones and cytokines have been identified as a mediators It correlates positively with increased age, the presence of the complex pathophysiological pathways, as well as inte- of concomitant pathologies and risk of osteoporotic grated central and peripheral neurological networks. fractures. Ultimately, evidence shows that vitamin D supplementation may be useful for brain disease prevention. We aim to review the relationship between cognitive impair- P1119 ment, dementia and both osteopenia and fragility fractures by EFFECTIVENESS AND SAFETY OF highlighting some biological connections between bone and VISCOSUPPLEMENTATION ADMINISTERED AS brain metabolism. In addition, we will focus on the interplay SINGLE INJECTION IN THE TREATMENT OF of antifracture and antidementia treatment options on brain SYMPTOMATIC KNEE OA functions and bone mass and quality. K. K. Foerster1,J.Heisel2 1Retired, Engelskirchen, Germany, 2Retired, Grafenberg, Germany P1118 FRAILTY SYNDROME AND FRACTURE RISK IN Objectives: To investigate the clinical effectiveness and safety ELDERLY PATIENTS FROM THE REPUBLIC OF of a new crosslinked viscosupplement administered as single MOLDOVA injection to patients with symptomatic knee OA. G. Soric1, F. Lupascu-Volentir1, E. Deseatnicova2,L. Materials and Methods: 30 patients (16 women, 14 men) Chislari3, A. Negara1,L.Groppa4 from two clinical sites in Germany were recruited and 1Gerontology Scientific Laboratory, State Medical and clinically followed over a period of 6 months post Pharmaceutical University Nicolae Testemitanu, Chisinau, injection. As study design a non interventional study Republic of Moldova, 2Department of Rheumatology, State (NIS) was chosen. The administered single shot Medical and Pharmaceutical University Nicolae Testemitanu, viscosupplement was a medical class III device consisting Chisinau, Republic of Moldova, 3Department of of 3,3% crosslinked hyaluronic acid of non animal origin. Rheumatology, State University of Medicine and Pharmacy, Clinical evaluations to follow the symptomatic status of Chisinau, Republic of Moldova, 4Department of patients and the safety of the product were done within 1 Rheumatology, State Medical and Pharmaceutical University day, 1 month, 3 months and 6 months post treatment. «Nicolae Testemitanu», Chisinau, Republic of Moldova Lequesne Index (LI), Visual Analogue Scale (VAS) and the Western Ontario McMaster Universities (WOMAC) Aim: To evaluate the presence of frailty syndrome and frac- Osteoarthritis Index were the main parameters to evaluate ture risk in elderly patients from the Republic of Moldova. the status of OA symptoms. S616 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: Viscosupplementation with a single injection result- P1121 ed in a significant improvement of symptomatic knee OA BONE MINERAL DENSITY CHANGE IN CHILDREN based on LI. This result was supported by evaluation of WITH OBESITY VAS and WOMAC, which showed decreased severity of H. Mikhno1,A.Solntsava2,O.Zagrebaeva2, N. Vasilieva3 OA symptoms as well. Local adverse events common to ap- 12nd City Children`s Hospital, Minsk, Belarus, 2Belarusian plication of hyaluronic acid were at the same level compared State Medical University, Minsk, Belarus, 3Republic to viscosupplementation applied as 3-5 injection treatment. Medical Rehabilitation and Balneo Treatment Center, No systemic adverse reactions were observed. Minsk, Belarus Conclusion: These NIS results are encouraging to apply this "single shot" viscosupplement in patients with knee OA and to Aim: To evaluate bone mineral density (BMD) and its rela- continue with larger numbers of patients and a prospective tionship with calcium (Ca) and phosphorus (P) metabolism in controlled study design. children with obesity. Methods: We examined 92 children in the University Hospital (Minsk) from 2011 to 2015 yrs. Body compo- P1120 sition with evaluating of mineral component were made ASSESSMENT OF THE LEVEL OF KNOWLEDGE by dual energy X-ray absorptiometry with the calcula- REGARDING OSTEOPOROSIS AND ITS tion of feet, hands, ribs, hips BMD (g/cm2), Z-test. All PREVENTION METHODS children were divided into 2 groups: group1 – children L. Daina1,R.Suciu1, C. Daina1 with obesity (n=72, boys(B)/girls(G)=47/25, age 15,24 1University of Oradea, Faculty of Medicine and Pharmacy, ±2,02 yrs, weight 96,8±22,5 kg, height 1,71±0,1, BMI Oradea, Romania 32,7±5,3 kg/m²; group2 – normal – weight control (n=20, B/G=9/11, 15,08±2,47 yrs (p=0,3), 52,3 Objectives: One of the priorities of health policy in the field ±11,6 kg (p=0,0001), 1,63±0,1 cm (p=0,04), 19,4±2,4 of osteoporosis is the use of telecommunication technologies kg/m² (p=0,0001)). that facilitate the spread of information among the population Results: Legs BMD were increased in boys with obesity about ways to prevent osteoporosis. The study aimed to (0,94±0,11 g/cm² vs. 1,13±0,17 g/cm² (p=0,03)) com- analyze the level of knowledge about osteoporosis and its pared to control group without significant differences prevention methods. in G (1,29±0,12 g/cm² vs. 1,23±0,02 g/cm ²(p=0,5)). Material and Methods: A questionnaire with 15 items was Ribs BMD were higher in group1 children compared used to evaluate whether people know this disease and its to group2 (B 0,72±0,08 g/cm² vs. 0,59±0,06 g/cm² prevention possibilities. 423 women were included in the (p=0,02); G 0,71±0,05 g/cm² vs. 0,65±0,06 g/cm² study, aged between 45-75 years, from urban area, highly (p=0,05)). There were no significant differences in hand and middle educated, between March 2015 - September 2016. BMD (G 0,87±0,10 g/cm² vs. 0,85±0,13 g/cm² Results: After processing the questionnaires, 15% of women (p=0,836); B 0,93±0,14 g/cm² vs. 0,85±0,15 g/cm² do not know this disease and have never heard of osteoporo- (p=0,360)); pelvis (G 1,22±0,13 g/cm² vs. 0,98±0,14 sis, 58% can not specify the nature of osteoporosis, 76% do g/cm² (p=0,12); B 1,19±0,15g/cm² vs. 1,04±0,21 g/cm² not know the risk factors for the disease, 12% are diagnosed (p=0,09)); total (G 1,18±0,09 g/cm² vs. 1,11±0,13 g/cm² with this condition and 8% are following treatment for osteo- (p=0,29); B 1,17±0,13 g/cm² vs. 1,06±0,14 g/cm² porosis. Regarding the prevention methods: 40% do not know (p=0,21)) in obese children compared to control. A sig- any prevention method, 18% know the names of medications nificant increase in Ca levels were in obese B compared and drugs, 52% nutrition, 26% physical exercises, 29% have to control (2,48±0,07 vs. 2,41±0,001 mmol/l (p=0,001)) discussed about it with their physician and 15% have been with no difference in G 1,23±0,22 vs. 0,95±0,64 mmol/l screened for osteoporosis. The main source of information (p=0,78); B 1,32±0,27 vs. 1,30±0,18 mmol/l (p=0,85)), was the mass media 36% and 23% General Practitioners. and AlP (G 108,06±26,66 vs. 85,13±65,64 IU/l Conclusion: The level of knowledge of the investigated group (p=0,46); B 217,93±57,24 vs. 157,27±26,41 IU/l on osteoporosis, is quite low, in terms of knowledge of risk (p=0,68) in two groups. We found that AlP were corre- factors and prevention methods. It is needed to increase the lated with BMI levels (rs=0,9, p=0,04) and legs BMD activities regarding health care education. Regarding the con- (rp=0,9, p=0,04) in G with obesity. A direct correlation tent of the health care education activities, they should start of feet BMD and Ca (rs=1,0, p=0,05); Ca and spine with information and continue with the second stage which is BMD (rs=1,0, p=0,05) were found in group 1B. the breakthrough of information by inducing a correct, Conclusions: A significant increase in ribs and legs BMD, Ca hygienic-sanitary aware of those people who are receiving levels were found in children with obesity compared to normal health education. weight control. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S617 P1122 To assess dietary calcium intake in a sample of osteoporotic PULSED ELECTROMAGNETIC FIELDS patients at high risk for fracture. MODULATE SCLEROSTIN LEVELS IN WOMEN Material and Methods: 153 consecutive patients having WITH POSTMENOPAUSAL OSTEOPOROSIS suffered a major osteoporotic fracture (67% with verte- A. Catalano1, G. Basile1,F.Bellone1,E.Morini1,C.Pecora2, bral, 22% with hip fracture, 11% with vertebral and hip S. Loddo1,A.Lasco1,N.Morabito1 fractures), aged more than 50 years, of both sexes (133 1Department of Clinical and Experimental Medicine, females and 20 males) were recruited in a Metabolic University Hospital of Messina, Messina, Italy, 2Villa Salus Bone Diseases Unit in the University Hospital of Clinic, Messina, Italy Florence. The Calcium Calculator (CC), a short ques- tionnairedevelopedbyIOFwhichcanbeself-adminis- Objective: Pulsed electromagnetic field (PEMF) could pro- tered, appropriately translated into Italian, was validated mote in vivo and in vitro osteogenesis and enhance bone by comparing the results with a validate frequency food healing with unknown mechanism. Aim of our study was questionnaire (QC) commonly used in clinical practice to evaluate the circulating canonical Wnt signaling antag- as a gold standard to assess calcium intake. Calcium onists sclerostin and DKK-1 in a setting of Caucasian intake from water (tap or bottled water) sources (CW) women with postmenopausal osteoporosis receiving was also considered by itself, since not included by CC PEMFs. andincludedjustinpartbyQC.Datawereexpressed Materials and Methods: 30 participants with sufficient vita- as mean±SD. Statistical analysis by calculation of min D and no other diseases were recruited and randomized Pearson correlation coefficients. into two groups. PEMFs group received PEMFs treatment by Results: Average daily calcium intake (DCI) estimated a dedicated waistcoat applied to the trunk (50 min treatment by CC was 773±374 mg/day, while DCI estimated by session/day, 5 treatment sessions/week, for a total of 25 times QC was 811±329 mg/day. The two estimate are corre- as one course of treatment), while those assigned to control lated, as demonstrated by Pearson’s r value (r=0.246, group received sham PEMF treatment with the same device. p<0.01). The correlation was more significant when Blood sample for evaluation of surrogate markers of bone CC corrected for CW and QC corrected for CW were turn-over were obtained at the beginning and at the end of compared (904±385 mg/day vs. 816±336 mg/day, the PEMFs treatment period. r=0.348 mg/day, p<0.01). While serum 25OH vitamin Results: At baseline, the two groups were not significantly D levels were in the normal range (31.4±17.7 ng/ml) different for age, age since menopause, BMI, BMD, ALP, because of widespread supplementation, just 20-24% of CTX and baseline sclerostin and DKK-1 values. After treat- patients at high risk for re-fracture have a sufficient ment, sclerostin but not DKK-1 levels were significantly re- DCI. duced only in the PEMFs group (-20%, p<0.05) and this was Conclusions: This study validates the use of IOF's CC to associated with an increase of ALP (+8%. p=0.10). estimate DCI in an Italian population of osteoporotic Conclusion: In women with postmenopausal osteoporosis, patients at high risk for re-fracture. This questionnaire our preliminary data provide the first evidence of a modula- can be easily implemented by the addition of estimated tion of sclerostin levels by PEMFs suggesting a possible ex- CW. CW may constitute an important source of calcium planation for PEMFs effects on bone. in the Italian population. The majority of osteoporotic subjects have insufficient DCI, while the majority is vitamin D sufficient. P1123 VALIDATION OF THE IOF’S CALCIUM CALCULATOR TOOL FOR THE ASSESSMENT OF CALCIUM INTAKE P1124 IN AN ITALIAN POPULATION OF OSTEOPOROTIC NECK PAIN IN HEALTHCARE WORKERS: IS NOT PATIENTS AT HIGH RISK FOR FRACTURE AN OCCUPATIONAL DISEASE? L. Cianferotti1,V.Ciampi1, B. Pampaloni1,G.Gronchi1,M. M. I. Merchaoui1, M. Hayouni1, L.Bouzgarrou2, L. Brandi1 J.Malchaire2, M. Akrout1, M.Touzi3,N.Chaari1. 1Department of Surgery and Translational Medicine, 1Occupational Medicine department, Monastir, Tunisia, 2 University of Florence, Florence, Italy Catholic university of Louvain- Belgium, 3Rheumatology de- partment, Monastir, Tunisia Objectives: To validate the Calcium Calculator tool for the assessment of calcium intake in an Italian popu- Objectives: Uncertainty exists with regards to the extent of lation of osteoporotic patients at high risk for prevalence of work related neck pain in healthcare workers. fracture. The aim of this study was to estimate the prevalence of neck S618 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 ache in Tunisian nurses, to specify its determinants and to diseases were examined as well. The US was performed with assess its severity. patients placed in reclined position, with lower limbs extend- Methods: This is a cross-sectional study conducted in a sam- ed, in a slight external rotation and heels close to each other. ple of 293 healthcare workers representative of 1181, from The presence of US findings indicative of synovitis in two teaching hospitals, based on a comprehensive question- coxofemoral joint was investigated. Thus, the distance be- naire about socio-professional characteristics, the perceived tween the hyperechoic bone cortical and the capsule should physical and mental strain, and psycho-social factors at work be less than 7 mm in normal joints and in the same time, the based on "KARASEK scale". symmetry between the two sides is important, as right-left Results: Forty three% (43.3%) of healthcare workers difference shouldn’tbemorethan1mm. complained about a neck ache within the previous year. The Results: Synovitis in at least one site, was statistically signif- latter group had a greater Body Mass Index (p=0.002). Neck icant more frequent in patients with SpA than in controls pain was related to gender (p=0.009) and more frequent in (p<0,001). Between patients with SpA, it was more frequent elder groups of age whatever the gender was (p<10-3). The in AS patients, followed by PsA patients, compared to those final model of binary logistic regression was made of Body with ReA. We found bone cortical irregularities of the femoral Mass Index (p=0.001, OR=1.11, CI: [1.04, 1.18]) and gender head in 4 patients with PsA (36.36%) and 3 with AS(25.0%). (p=0.006, OR=0.5, CI: [0.3, 0.8]).Regarding the severity of Conclusions: This study reveals the high frequency of hip neck ache, the group with the most intense pain had Greater involvement in patients with spondylarthrities and can guide body Mass Index(p=0.024); and the pain intensity was in re- the further assessment in the evaluation of those patients in lationship with the index of seniority in shift work(p=0.033). daily practice. Conclusion: Our results show that neck pain in healthcare References: workers had no occupational determinants. Preventive mea- 1. Iagnocco A et al. Clin Exp Rheumatol 2006;24:229. sures should be focused on the lifestyle and dietary habits to 2. Qvistgaard E et al. Ann Rheum Dis 2006;65:1613. maintain a correct body Mass Index. 3. McNally EG. Practical Musculoskeletal Ultrasound. Philadelphia Elsevier 2005: 23-28, 136-141. 4. Trăistaru MR et al. Rom J Morphol Embryol 2015;56:1447. P1125 5. Schmidt WA et al. Ann Rheum Dis 2004;63:988. HIP JOINT INVOLVEMENT IN PATIENTS WITH SPONDYLARTHRITIES: AN ULTRASOUND STUDY F. A. Vreju1,B.A.Chisalau2,M.Cepareanu1,S.C.Firulescu1, P1126 C. Criveanu1, A. L. Barbulescu1, A. E. Musetescu1,P.L. MUSCULOSKELETAL ULTRASOUND Ciurea1,A.Rosu1,H.V.Popoviciu3, R. Ionescu4,R.Miclaus5, DISCRIMINATIVE FOR ANKLE PAIN IN OBESE C. D. Parvanescu1 POSTMENOPAUSAL WOMEN 1University of Medicine and Pharmacy, Craiova, Romania, A. E. Musetescu1, C. Criveanu2,F.A.Vreju2,A.M.Bumbea2, 3Rheumatology Department, University of Medicine and S. C. Firulescu2,S.Dinescu2,C.Gofita2,A.Rosu2,P.L.Ciurea2 Pharmacy of Tirgu Mures, Tirgu Mures, Romania, 4Colentina 1University of Medicine and Pharmacy, Craiova, Romania Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania, 5Emergency County Hospital Deva, Objective: Essential for patients stability and mobility ankle Deva, Romania joints are a frequent source of pain. The main purpose of the study was to evaluate the ankle joint pathology through power Background: Spondylarthrities (SA) are a group of inflamma- Doppler ultrasound in postmenopausal women with a BMI of tory joint diseases, with both axial and peripheral involvement. 30 or greater. Hips are between most frequent joints involved, early identifica- Methods: 50 consecutive obese female patients with ankle tion of coxitis with new imaging techniques as ultrasonography pain were reviewed. Patients underwent clinical examination (US) or magnetic resonance imaging permits an optimal man- and ultrasound of the ankle joints using an Esaote MyLabSix agement and avoids evolution to femoral head osteonecrosis. equipment with a multifrequency linear probe of 6 – 18MHh. Objectives: To evaluate, by ultrasonography (US), the prev- Fluid, synovitis, tenosynovitis and power Doppler were alence of the coxitis in patients with spondylarthrities. scored on a 0–3 semi-quantitative scale. A total number of Methods: Thirty-one consecutive patients with SpA were in- 100 ankle joints were examined using MSUS. Talonavicular, cluded in the study (12 with ankylosing spondylitis - AS, 11 intertarsal- and tarso- metatarsal joints as well as flexor and with psoriatic arthritis - PsA and 8 with reactive arthritis - extensor tendons, Achilles tendon, were also investigated. ReA) naïve to disease modifying antirheumatic drugs Results: Pathology detected was osteoarthritis of the tibiotalar (DMARDs) and with low disease duration (less than 2 years). and/or talonavicular joint in 72% of the patients (36 out of 50), Twenty healthy age-matched controls without inflammatory followed by tendinosis of the Achilles tendon in 56% of the Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S619 patients (28 out of 50). Gray scale findings were observed in 5245 women had a calculable FRAX probability (1609 in VF 90.3% of the symptomatic patients for Achilles tendinosis (28/ arm and 3636 in CF arm). 2588 women randomized to the pla- 31) as well as in 53% of the asymptomatic patients for Achilles cebo group and 2657 women to alendronate were followed for and calcaneal pain (10/19) (p<0.01). PDUS activity was higher up to 3 years for VF arm and 4 years for CF arm. At baseline, the in symptomatic patients - 35% (11/31) compared to 21% in 10-year probability of MOF (with BMD) ranged from 3.4- asymptomatic patients (4/19) (p<0.01). Tenosynovitis of the flex- 77.5%. Treatment with alendronate was associated with a 60% or tendons was found in 16 patients and of the peroneal tendons decrease in clinical vertebral fracture compared to placebo treat- in 8 patients. Edema of the subcutaneous tissue was identified in ment (95%CI: 37, 74%). The risk of radiographic vertebral frac- 18 patients while crystal deposition was found in 21 patients. ture decreased by 57%; (95%CI: 44, 67%). The effect of Conclusions: Ultrasonographic Doppler imaging can easily de- alendronate on fracture outcome did not change significantly tect degenerative and inflammatory conditions associated with with increasing FRAX probability (p>0.30 for both clinical and ankle pain in obese female patients. Most frequent pathologies radiographic vertebral fracture). As in Donaldson et al detected by MSUS were osteoarthritis of the tibiotalar and Alendronate significantly decreases the risk of clinical and radio- talonavicular joint, followed by tendinosis of the Achilles tendon. graphic vertebral fracture in women included in the FIT study, Pathologic findings are also very common in asymptomatic struc- irrespective of baseline fracture probability. Reference: tures of the ankle and can be best identified using ultrasound. Donaldson MG et al, J Bone Miner Res 2012;27:1804 P1127 P1128 THE EFFECT OF ALENDRONATE ON VERTEBRAL A LONG-TERM ACENOCOUMAROL TREATMENT IS FRACTURE RISK IS INDEPENDENT OF BASELINE ASSOCIATED WITH OSTEOCALCIN SUPPRESSION FRAX FRACTURE PROBABILITY: A POST HOC AND VITAMIN D DEFICITS BUT WITHOUT ANALYSIS OF THE FIT STUDY REDUCTION IN BONE MINERAL DENSITY H. Johansson1,E.McCloskey2, A. Oden2,N.C.Harvey3,D. J. Konstantynowicz1, J. Sawicka-Powierza2, E. Jablonska2, M. Black4,J.Cauley4,J.A.Kanis5 W. Ratajczak-Wrona2, D. Rogowska-Szadkowska2,M. 1Institute for Health and Aging, Australian Catholic University, Garley2, B. Zelazowska-Rutkowska2,W.Jelski2,S. Melbourne, Australia, 2Centre for Metabolic Bone Diseases, Chlabicz2, P. Abramowicz2,A.M.Oltarzewska2 University of Sheffield Medical School, Sheffield, United 1Pediatrics, Rheumatology, Immunology and Metabolic Bone Kingdom, 3MRC Lifecourse Epidemiology Unit, University Diseases, Medical University of Bialystok, Bialystok, Poland, of Southampton, Southampton, United Kingdom, 4University 2Medical University of Bialystok, Bialystok, Poland of California San Francisco, San Francisco, CA, United States, 5Institute for Health and Aging, Catholic University of Objective: Published data on skeletal effects of anticoagulant Australia, Melbourne, Australia therapies, including vitamin K antagonists, are inconsistent. The aim of this study was to assess bone mineral density and Alendronate significantly decreases the risk of vertebral and biochemical markers of bone and mineral metabolism in non-vertebral fracture compared with placebo in women with patients on long-term acenocoumarol (AC) treatment. or without prior vertebral fracture but with low bone mineral Participants and Methods: The cross-sectional study was density (Donaldson 2012). The aim of this study was to carried out in 36 patients (19 males, 17 females; mean age 63.5 determine the efficacy of alendronate on vertebral fracture as ±8.6 years), treated with acenocoumarol, and 25 age- and sex- a function of baseline fracture risk, assessed using the FRAX matched controls. Serum osteocalcin (OC), osteoprotegerin tool, in the Fracture Intervention Trials (FIT). Baseline clinical (OPG), receptor activator of nuclear factor-κB ligand (RANKL) risk factors (age, BMI, prior fracture, glucocorticoid use, rheu- concentrations, 25-hydroxyvitamin D [25(OH)D] levels and total matoid arthritis, smoking and parental history of hip fracture) alkaline phosphatase (ALP) activity were measured. Bone were used to calculate the 10-year probability of major mineral density (BMD) in the lumbar spine and femur regions osteoporotic fractures (MOF) with inclusion of femoral neck was measured using dual-energy X-ray absorptiometry. BMD (FRAX), in both arms of the FIT study [vertebral frac- Results: No significant differences in terms of menopausal sta- ture (VF) arm and clinical fracture (CF) arm]. The interaction tus, BMI, smoking habits and fracture prevalence were found between FRAX probability of a MOF and treatment efficacy between AC users and controls. No differences in femoral or for the outcome of clinical vertebral fracture was examined by lumbar BMD were found either, whereas T-scores and Z- an extension of Poisson regression model. The interaction scores for BMD remained within normal range. Concentrations between FRAX probability and treatment efficacy for new of osteocalcin were significantly lower in patients treated with radiographic vertebral fracture was examined by logistic AC compared with controls (4.5±1.8 vs. 10.2±4.7 ng/ml), and regression. All associations were adjusted for age and study. 25(OH)D was also lower (21.6±6.8 vs. 28.3±6.6) (both S620 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 P<0.001), whereas higher ALP activity was found, compared value=0.004) and taking proton pump inhibitors, (p-val- with controls. When sex-specific associations were studied, the ue=0.043). This model had an overall classification accuracy female AC users, but not male, had significantly higher total of 70.8% with its ability to classify osteoporosis at 72.5%. ALP and increased OPG levels. Multiple regression models, Conclusion(s): The contributing factors identified in this performed among 36 AC users, showed that osteocalcin level study differ from the commonly identified risk factors ob- was independently the most predictive variable for changes in served among the general population such as smoking, alco- OPG, log RANKL and log RANKL/OPG ratio. hol, and corticosteroid use. To note the CHAID technique is a Conclusions: A long-term regular use of acenocoumarol is user-friendly method that could be easily applied in clinical not associated with apparent bone loss or reduction in BMD. practice. However, the prolonged therapy may negatively affect bone metabolism and vitamin D status by leading to a decreased bone formation via osteocalcin inhibition. An increased OPG P1130 concentration, found in women treated with AC, reflects a VITAMIN D RECEPTOR POLYMORPHISM AND possible compensatory mechanism preventing excessive bone BONE MINERAL DENSITY IN TURNER resorption. Metabolic deteriorations may considerably pre- SYNDROME PATIENTS cede changes in BMD and, thus, seem clinically important N. Altamirano-Bustamante1, R. Barrientos- Ríos1, L. Torres- in monitoring acenocoumarol treatment. Maldonado1, M. Altamirano-Bustamante2,P.Rios1,C. Alvarado-Araiza1,M.Mora-Tiscareño1, J. Paredes1,C. Villaroel1, V. Del Castillo1,R.Calzada1,S.Frías1 P1129 1Instituto Nacional de Pediatría, Mexico City, Mexico, USING CHI-SQUARED AUTOMATIC INTERACTION 2Instituto Mexicano del Seguro Social, Mexico City, Mexico DETECTION (CHAID) MODELLING TO IDENTIFY Turner syndrome patients generally have alteration in bone THE RISK FACTORS OF OSTEOPOROSIS AMONG mineral density and osteoporosis. OLDER ADULTS WITH INTELLECTUAL DISABILITY. E. A. Burke1,R.Carroll1, J. B. Walsh2,P.McCallion3,M. Aim: To analyze the distribution of polymorphism rs7975232 McCarron1 of VDR gene and BMD in girls with TS. 1Faculty of Health Sciences, Trinity College Dublin, Dublin, Methods: TS patients were studied. Total Body corporal, Ireland, 2Mercers Institute for Research and Aging, St James Lumbar and femoral BMD were determined by dual-energy Hospital, Dublin, Ireland, 3UAlbany's Center for Excellence X-ray absorptiometry (DXA). The genetic study was per- in Aging and Community Wellness, New York, United States formed with TS patients and 79 controls girls with 46XX. We determined the SNP rs7975232 of VDR gen by the Objective: To identify the contributing risk factors for osteo- KASP method. porosis among older adults with intellectual disabilities using Results: Fifty-four TS patients (36 with 45X) and 18 patients chi-squared automatic interaction detection modelling. with other genetics profile were included. The patients with Material and Methods: The data was drawn from the longi- 45X have low mineral bone content (p=0.072). The genomic tudinal study investigating ageing among people with intellec- distribution of SNP rs7975232 was different from the con- tual disability in Ireland (IDS-TILDA). A quantitative heel ul- trols. The wild-type gen CC predominated in the girls with trasound (QUS) was utilised to determine the bone status of the ST(46.2% vs. 30.2%) and have low mineral bone content participants (N=578). The CHAID method was applied to iden- (p=0.01). The patients with AA (9% vs. 18.4%) have lower tify the contributing predictors for osteopenia and osteoporosis. BMD in the three regions and the total body BMD was the This type of analysis is a decision tree technique which classifies lower (p=0.02). the sample into subgroups to determine the relationship between Conclusions: Our results point out that the distribution of the dependent (bone status) and predictor variables (risk factors) polymorphism rs7975232 of VDR gen can explain the vari- using multivariate technique. The technique identifies the size abilityofbonehealthinTS. and rank of statistically significant differences to determine the best split based on logic ‘if then’. The decision tree algorithm partitions the data into statistically significant subgroups that are P1131 mutually exclusive and exhaustive. OSTEOPOROSIS, FALLS AND FRACTURES IN Results: Over 70% of participants were identified within ei- CHILEAN OLDER PEOPLE ther the osteopenic or osteoporotic categories based on the C. Albala1, L. Lera1,B.Angel1,H.Sanchez1,C.Marquez1,P. QUS. Three major predictor variables reached significance Arroyo2 for the CHAID osteoporosis model. These included, difficulty 1INTA, University of Chile, Santiago, Chile, 2Clinic Hospital, walking (p-value<0.0001), taking antiepileptic medicines (p- University of Chile, Santiago, Chile Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S621 Objective: to describe the prevalence of osteoporosis and its obscure. Some studies have demonstrated an association be- association with the incidence of falls and fractures in tween higher bone mineral density (BMD) and OA. No system- community-living Chilean elders. atic studies have been carried out to exclude the possibility that Methods: Follow up of ALEXANDROS cohorts designed to osteoarthritic patients at the end stage of severe hip osteoarthritis study disability associated with obesity in community dwell- waiting for total hip arthroplasty (THA) suffer from primary or ing people 60y and older living in Santiago/Chile. At baseline secondary OP. Calcaneal quantitative ultrasound (QUS) is recog- 1119 from 2372 participants had DXA scan measurements. At nized as the attractive prescreening tool for osteoporosis, an al- baseline home interviews including history of chronic dis- ternative to dual-energy X-ray absorptiometry. Calcaneal QUS in eases, self-reported disability/functional limitations, falls and a prescreening or stratification algorithm must be based on fractures. Physical performance, anthropometry, dynamome- device-specific cutoffs that are validated in the populations for try and blood pressure were measured. WHO standards for which they are intended to be used. Frost et al. in 2000 conclud- Bone Mineral Density (BMD) classified them in normal, ed, the WHO threshold of T=-2.5 for diagnosing osteoporosis osteopenia and osteoporosis. Nutritional state was determined requires modification when using QUS to assess skeletal status. by WHO standards of BMI. The participants were followed There are a few suggested cutoff parameters used for from 5 to 10 years to determine the incidence of falls and distinguishing osteoporotic cases. The T-score threshold of - fractures according BMD. Logistic regression analysis was 1.80 for three QUS devices was determined by Frost et al. performed to adjust the association between falls, fractures McLeod at al. found a Calcaneal Quantitative Ultrasound stiff- and osteoporosis. ness index cutoff value <65 indicating a high likelihood of oste- Results: The sample was composed by 1119 subjects (68.6% oporosis. Wang at al identified the value 76 of the SI threshold for women) mean age 72.0±6.8, min 60y max 92y. The prevalence best identifying osteoporosis, with sensitivity being 0.800 and of osteoporosis at baseline was 23.2%, higher in women (29.3%) specificity 0.741. Vallipakorn et al. suggested to determine than in men (9.7%). Osteoporosis increased from 16.3% in the the optimal cut-off point of quantitative ultrasound (QUS) group 60-69y, to 26.5% in the group 70-79y and 33.6% in people of the calcaneus to screen osteoporosis at stiffness index 80y and older. At follow up 37.8% of people reported falls (men determined by T-score of ≤ -2.6. Anthropometric measure- 28.4%; women 42.6%,p=0.016). In the subjects with osteoporo- ments may influence the bone density. Obesity is often con- sis the frequency of falls was 35.1% vs. 21.6% in the normal sidered to have a protective effect against osteoporosis. Berg ones (p=0.035). From the people reporting falls, 11% had a frac- et al. have found that BMI is positively associated with bone ture as direct consequence. The frequency of incident fractures stiffness in the general population. The aim of the study was was 22.2% (men 15.8%; women 24.8%, p=0.010), increasing to evaluate the calcaneus quantitative ultrasound (QUS) mea- with age reaching 40% in people 80y and older. Fractures were sures to diagnose the quantity of bone in patients at the end 16.4% in people with normal BMD, 22.7% in subjects with stage of severe hip osteoarthritis. osteopenia and 30.9% in the osteoporotic. After adjustment by Methods: The speed of sound (SOS), broadband ultrasound age, sex, diabetes and BMI categories, the risk of falls was double attenuation (BUA), and stiffness index of the calcaneus by in subjects with osteoporosis (RR=2.1; 95%CI:1.01-4.24, quantitative ultrasonography (QUS) (Achilles Express, GE p<0.05). For fractures the crude association with osteoporosis Healthcare) were measured in 89 patients (17 males and 72 was RR=2.3; 95%CI:1.4-3.9. After adjustment by age, sex, dia- females; average age 64,75 from 35 to 86). All patients were betes and nutritional state the RR was 1.8; 95%CI 1.0-3.2. scheduled to undergo total hip arthroplasty for end-stage OA Conclusion: Osteoporosis, falls and fractures are highly prev- (Kellgren-Lawrence score 3 or 4). Patients were classified alent in Chilean older people. Programmes for the prevention with Normal weight if BMI ranged from 18.5 to 25, of falls are compulsory to prevent fractures in older people. Overweight if BMI ranged from 25 to 30 and Obese for higher values. A group of patients (average age, years) with advanced primary hip OA waiting for THA were recruited for QUS P1132 exam. Calcaneal Stiffness Index, BUA, and SOS were mea- THE OBESITY INFLUENCES QUANTITATIVE sured. BMI was measured. To my knowledge, the relationship ULTRASOUND PARAMETERS IN HIP between QUS of the calcaneus and BMI was never studied OSTEOARTHRITIS PATIENTS SCHEDULED FOR before. McLeod's, Vallipakorn’s, Wang’s and Frost’scut-off TOTAL JOINT REPLACEMENT values were used to differentiate osteoporosis cases from nor- W. Glinkowski1 mal cases. At the calcaneus, significant differences were ob- 1Medical University of Warsaw, Warszawa, Poland served between the BMI groups. Stiffness Index in the hip OA-affected calcaneus presented significant differences (F(2, Introduction: Osteoarthritis (OA) is a common and disabling 86)=6,48; p<0,005) - The mean Stiffness Index in Normal joint disorder affecting millions of people worldwide. The co- weighted patients was 78,2 (Std.Err-3,9); in Overweighted existence of osteoporosis (OP) and osteoarthritis (OA) remains 79,8 (3,1) and in obese cases 97,7 (4,5). S622 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Results: BUA in the hip OA-affected calcaneus presented sig- 1Hebrew SeniorLife, Harvard Med School, Boston, United nificant differences (F(2, 86)=5,8; p<0,005) - The mean BUA in States, 2Mercy Hospital, Philadelphia, United States, 3Hebrew Normal weighted patients was 105,1 (Std.Err-3,1); in SeniorLife, Boston, United States, 4Center for Advanced Overweighted 107,1 (2,4) and in obese cases 119,7 (3,5). SOS Orthopedic Studies, Harvard Medical School, Boston, United in the hip OA-affected calcaneus presented significant differ- States, 5Boston Univ School of Public Health, Boston, United ences (F(2, 86)=6,48; p<0,005) - The mean SOS in Normal States, 6University of Washington, Seattle, United States, weighted patients was 1529,2 (Std.Err-8,2); in Overweighted 7Boston University Medical Center, Boston, United States 1530,5 (6,4) and in obese cases 1564,5 (9,4). There were no significant differences in BMI between groups differentiated Spinal degeneration is common, with high public health using McLeod and Vallipakorn stiffness index cut-off values. burden. Despite the clinical importance, little is known SOS, BUA, and stiffness index obtained by QUS were signifi- about longitudinal changes in facet joint osteoarthritis cantly higher in the obese OA group than in normal or over- (FJOA) and disc height narrowing (DHN), evaluated weight patients. There were forty-four normal bone cases by CT, in community-based populations. (49,5%). Osteopenia was found in 31 (34,8%) cases and osteo- Objective: To determine incidence of FJOA and DHN over porosis in only 14 (15,7%). The basic anthropometrics of 26 6yr in a community-based cohort and evaluate the association patients (29,3%) shown their normal weight. Forty-four cases with baseline back pain. (48,3%) were overweighted, and 20 cases were (22,4%) obese. Methods: Participants included 885 cohort members of the Wang's cut-off distinguished a significant BMI differences F(1, Framingham Study: 491 women, 394 men, 40-85 yr 87)=5,1182, p<0,05. In 35 patients the mean BMI was 26,18 (mean=63, SD=±8 yr). At baseline, participants reported fre- (Std.Err. 0,64) in osteoporosis group distinguished with quency of back pain in the past 12 months as none, some days, Wang's cut-off values. In 54 patients the normal bone group most days, or all days. A musculoskeletal radiologist (MJ) was characterized by mean BMI 28,05 (Std.Err. 0,52). BMI evaluated DHN and FJOA from T4/T5 to L4/L5 on baseline presented no significant differences in BMI between groups and 6yr follow-up CT images, using a 4-point semi-quantita- differentiated using McLeod and Vallipakorn stiffness index tive (SQ) scale as: grade 0=normal, 1=mild, 2=moderate, and cut-off values. 3=severe. Incidence of moderate (SQ2+) FJOA and DHN was Conclusion: Increased bone mineral density (BMD) in a defined as an increase at any spinal level from grade 0 or 1 at hip with osteoarthritis (OA) has been anticipated. baseline to grades 2 or 3 at follow-up. Against a general belief, osteoporosis/osteopenia may Results: 23% of participants reported having back pain on infrequently occur in patients suffering severe hip OA. some days in the past 12 months, 7% on most days, and The obesity has an influence on calcaneal ultrasonic 13% on all days. 6-year incidence was 33% for moderate measures in hip osteoarthritis cases. The observed prev- FJOA and 40% for DHN. More frequent back pain at baseline alence of reduced bone quantity parameters corresponds was associated with greater Incidence of FJOA but not with to the lower weight of the patient suffering the hip DHN (Table). osteoarthritis. The normal weighted patients scheduled Conclusions: Incidence of moderate FJOA occurred in more for THA may require bone density testing. Obesity sig- than one third of the participants over 6 years in our nificantly increases calcaneal ultrasonic bone parameters community-based study and was 60% higher in those in patients suffering severe hip osteoarthritis. reporting back pain on all days in the past year. Incidence of References: moderate DHN was 40% and was not associated with frequen- 1. Frost ML et al. Osteoporos Int 2000;11:321. cy of back pain. 2. McLeod KM et al. J Clin Densitom 2015;18:157. Acknowledgement: This study was supported by the 3. Wang Y et al. Beijing Da Xue Bao 2013;45:766.[Article in National Institutes of Health, National Institute on Aging Chinese] (grant number R01 AG041658), and the National Heart, 4. Berg RM et al. Calcif Tissue Int 2015;97:40. Lung and Blood Institute's Framingham Heart Study (Contract No. HHSN268201500001I). P1133 MORE FREQUENT BACK PAIN IS ASSOCIATED P1134 WITH INCIDENCE OF MODERATE FACET JOINT RELATION OF SERUM VITAMIN D WITH LEPTIN, OSTEOARTHRITIS, BUT NOT DISC HEIGHT BODY COMPOSITION AND CALORIC INTAKE IN NARROWING HEALTHY INDIVIDUALS E. J. Samelson1,M.Jarraya2,A.L.Lorbergs3,D.P.Kiel1,M. L. Jafri1,A.H.Khan1,G.Naureen1, G. Saeed2,R.Iqbal3 L. Bouxsein4,M.S.Yau3,L.A.Cupples5,P.Suri6,A. 1Department of Pathology and Laboratory Medicine, Aga Guermazi7 Khan University, Karachi, Pakistan, 2Aga Khan University, Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S623 Karachi, Pakistan, 3Department of Community Health Only initial test results were included in analysis for subjects Sciences, Aga Khan University Hospital, Karachi, Pakistan with repeated testing for 25OHD. The cutoffs used for defi- cient, insufficient, optimal, hypervitaminosis and toxic levels Background: Leptin is secreted by adipose tissue and is part were, ≤20, 20-30, ≥30, ≥100 and ≥150 ng/ml respectively. of a signaling system that indicates the size of adipose tissue Results: The increase in 25OHD testing since 2010 to 2014 was and affects energy expenditure. This study aimed to investi- 68%. Total 333,862 tests were performed over 5 years period, gate the associations between serum leptin concentrations and average age being 35 years. Cumulative prevalence of deficiency, Vitamin D levels, body composition and caloric and nutrient insufficiency, sufficiency and toxicity over three years were intake in healthy young adult Pakistani medical students. 65.1%, 16.5%, 17.8% and 1.5%. There was a significant increase Methods: Socio-demographic information was collected from in samples with 25OHD toxicity over the 5 years from 0.37% in medical students at AKU from June-August 2014 through inter- 2010 (n=167) to 0.4% in 2014 (n=278); of them 45% were of viewer administered questionnaires; dietary intake of fat, protein pediatric age group (age <18yrs). While hypervitaminosis in 0.8% and calcium and total energy intake, was elicited using a validated in 2010 (n=351) to 1% in 2014 (n=700); with 35% of <18yrs age. regional food frequency questionnaire. Weight, height and body Three% subjects (n=10601 in 5 years) were of ages ≤1years, composition (via bioelectrical impedance analysis) were measured. among them 38% (n=4069), 24% (n=2590), 30% (n=3209), 4% A 4-day phlebotomy camp was held at the Multidisciplinary (n=424), 3% (n=308) had deficient, insufficient, optimal, hypervi- Laboratory and 10 mL of blood was drawn, serum was separated taminosis and toxic vitamin D levels respectively. and stored at -30 °C. Leptin was measured using a kit from Conclusions: Although prevalence of deficiency, insufficien- DIAsource on manual ELISA. 25-hydroxy Vitamin D (25OHD) cy and sufficiency remains high but increasing hypervitamin- was analyzed on an automated analyzer using a kit from Siemens. osis and toxicity of vitamin D, especially in infantile age Results: Mean age of the students (n=101) was 20±0.9 years, group is alarming. These findings suggest that vitamin D re- median leptin 1.59 (0.06 – 25.4) ng/mL, mean 25OHD 15.0 placement therapies by concentrated Vitamin D injections, ±8.61 ng/mL, mean body fat% 20.0±8.15%, median energy in- tablets or oral drops should be used with caution. take 2105 (649 – 6139) kcal and median daily fat intake 61.8 (24.5 – 192) g. Serum leptin was positively correlated with total body fat%, BMI and metabolic age (P<0.05). Inverse correlation P1136 was found between leptin and 25OHD levels, daily energy intake SYSTEMIC LUPUS ERYTHEMATOSUS. and daily fat intake (P<0.05). MUSCULOSKELETAL AND IMMUNOLOGICAL Conclusion: This study reaffirms the role of leptin as a useful MANIFESTATIONS: SUCCESSFUL TREATMENT WITH biomarker of obesity and associated Vitamin D deficiency, partic- BELIMUMAB ularly in the young Pakistani population. This study provides initial P. Athanassiou1, C. Katsavouni1,L.Athanassiou1,A.Tzanavari1, evidence that the distribution of fat may be associated with vitamin M. Kostopoulos1,D.Pantelidis1, I. Kostoglou-Athanassiou2 D status, but this relation may be dependent on metabolic factors. 1Department of Rheumatology, St. Paul's Hospital, Thessaloniki, Greece, 2Department of Endocrinology, Red Cross Hospital, Athens, Greece P1135 THE SHIFTING PARADIGMS: VITAMIN D Introduction: Systemic lupus erythematosus (SLE) is a mul- DEFICIENCY TO HYPERVITAMINOSIS AND tisystem autoimmune disease affecting primarily women in TOXICITY the reproductive age. The disease may also have musculoskel- H. Majid1,L.Jafri1,A.Khan1 etal manifestations. Until recently, there was a paucity of spe- 1Department of Pathology and Laboratory Medicine, Aga cific drug treatment for the disease. Khan University, Karachi, Pakistan Aim: To describe a cohort of SLE patients on treatment with belimumab and its effect on disease manifestations, namely, Aim: There has been increasing awareness of Vitamin D de- musculoskeletal and immunological manifestations. ficiency, but due to lack of clear guidelines for the optimum Methods: A cohort of 10 patients with SLE, 9 female and 1 doses of Vitamin D in deficient states, there is inadvertent use male, is described. The patients were diagnosed with SLE and of higher doses of Vitamin D in patients resulting in toxicity of had arthralgias, cutaneous manifestations, fatigue and in one Vitamin D. This study was done to estimate the prevalence of case pulmonary fibrosis. The patients had decreased C3 and vitamin D toxicity in samples submitted for 25OHD analysis. C4 levels. Belimumab was administered to all of the patients. Material and Methods: An observational study was conducted Results: After belimumab administration arthralgias im- at the section of Chemical Pathology, Department of Pathology proved, cutaneous manifestations improving in all patients. and Microbiology AKUH. Laboratory data analysis of serum Fatigue decreased significantly in all patients, except in the 25OHD performed from Jan2010 to Oct2014 was performed. patient with pulmonary fibrosis, the aforementioned patient S624 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 experiencing only marginal improvement. C3 and C4 levels P1138 increased significantly (p<0.001) after treatment with beli- PSORIATIC ARTHRITIS COEXISTING WITH CHRONIC mumab, ESR levels decreasing after belimumab. SPONTANEOUS URTICARIA. MUSCULOSKELETAL Corticosteroid dosage was decreased significantly in all AND OTHER MANIFESTATIONS patients. P. Athanassiou1, A. Tzanavari1,L.Athanassiou1,C.Kalinou2 Conclusions: Belimumab is a novel therapeutic agent in 1Department of Rheumatology, St. Paul's Hospital, SLE management. It improves clinical manifestations of Thessaloniki, Greece, 2Dermatology Unit, St. Paul's Hospital, the disease, namely musculoskeletal, cutaneous and sys- Thessaloniki, Greece temic manifestations, such as fatigue. Characteristic lab- oratory features of the disease such as complement levels The term chronic spontaneous urticaria has been employed to and inflammation indices also improve. The novel thera- indicate chronic urticaria that is endogenous and independent peutic agent belimumab appears to be a useful addition of any external physical stimulus. There is a clear association in the armamentarium for the management of systemic of a subpopulation of such patients with autoimmunity. lupus erythematosus. Aim: To describe two cases of patients with chronic sponta- neous urticaria coexisting with psoriatic arthritis. Methods: The first patient developed psoriatic arthritis, with P1137 low back pain and sacroiliitis and was treated with THE ROLE OF FERRITIN AND ADIPONECTIN AS A adalimumab. Adalimumab was stopped due to a pregnancy. PREDICTORS OF CARTILAGE DAMAGE ASSESSED After delivery the patient developed a psoriatic rash involving BY ARTHROSCOPY IN PATIENTS WITH the upper extremities and the trunk. In the meantime the pa- SYMPTOMATIC KNEE OSTEOARTHRITIS tient developed chronic persistent urticaria affecting the back. M. Shargorodsky1,Z.Feldbrin1 The second patient had chronic spontaneous urticaria with a 1Wolfson Medical Center, Holon, Israel migratory rash involving many areas of the body appearing and disappearing after 48 h. The patient developed psoriatic Aim: To evaluate whether circulating ferritin as well as arthritis with arthralgias, myalgia and a psoriatic rash. adiponectin in serum and synovial fluid correlate with carti- Results: Both patients received cyclosporine for the treatment lage damage severity assessed by arthroscopy in patients with of psoriatic arthritis and omalizumab for the treatment of knee osteoarthritis. chronic spontaneous urticaria with excellent results. Methods: The 40 subjects with symptomatic knee osteoarthri- Conclusions: Chronic spontaneous urticaria is associated tis were divided into four groups according to arthroscopy with autoimmunity in many cases. In the present study the assessed cartilage damage, using Outerbridge (OB) grading. association of chronic spontaneous urticaria with psoriatic ar- Metabolic parameters and insulin resistance markers were thritis is described. Cyclosporine, which in the cases described determined. herein was used for the treatment of psoriatic arthritis, is also Results: Parameters of bone homeostasis such as PTH, indicated for chronic spontaneous urticaria. Alc Phosphatase, levels of 25OH vit D, serum calcium, and phosphorus were similar in the four groups. Significant difference in terms of serum ferritin was P1139 found: ferritin levels increased from Group 1 to Group CORTICAL SCAFFOLDING CHARACTERISTICS OF 4 in a continuous fashion (p<0.035). Significant by- VERTEBRAE: PRELIMINARY QCT STUDY OF group differences in circulating ferritin persisted even CORTICAL BONE DENSITY IN INTACT LUMBAR after adjustment for age. Although all groups were sim- VERTEBRA OF ELDERLY PATIENTS WITH AND ilar in terms of serum adiponectin levels, significant be- WITHOUT PREVIOUS VERTEBRAL FRACTURE tween groups difference in synovial fluid ADP was J. Narloch1,W.Glinkowski1 found (p<0.037).). However, after controlling for the 1Medical university of Warsaw, Warszawa, Poland age, there was no between-group difference in terms of sy- novial ADP levels. Introduction: The participation in carrying axial loads within Conclusions: Serum ferritin is associated with cartilage the vertebral column by cortical bone increases as a trabecular damage severity assessed by arthroscopy, a more reliable bone of vertebrae diminishes. An attempt to analyze cortical evaluation than radiography. This association was inde- bone using QCT was made in patients with or without a his- pendent of age, sex, BMI, and CRP levels and suggests tory of previous vertebral fracture. that ferritin is actively involved in the progression of Material and methods: In a group of 33 female patients (mean, cartilage damage in patients with symptomatic knee 70.98±9.1 years) with back pain, 94 intact vertebrae were ana- osteoarthritis. lyzed. Patients average height was 161,4 cm; and weight 61,82 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S625 kg. One mm-thick ROI’s were selected for finding differences the femurs, resistance to mechanical stress and plasma levels between upper endplate, lower endplate and frontal cortex of the of calcium, phosphorus, alkaline phosphatase and osteocalcin. vertebral body. Patients underwent CT scan due to the history of Results: Ovariectomized rats treated with S. scardica extracts low back pain after minor trauma. The BMD protocol and phan- had higher BMD on trunk, pelvis, spine as well total BMD tom for each CT examination of the lumbar spine. The data were compared to non-treated rats (p<0.05). Rats treated with used for analysis of vertebral bone mineral density using S.scardica extracts had significant different architecture of femur QCTPro Software (Mindways Software Inc, Austin, TX). neck with more pronounced proximal width 7.73±0.21 mm (dis- Results: Within our group, 38 vertebrae belonged to patients tance between great trochanter and medial surface of femoral with a history of previous vertebral fracture. Mean BMD of the head) than ovariectomized non-treated animals 7.38±0.23, as upper, lower endplates, and frontal cortex were 154.22, 163.08, well distal width (mediolateral distance across distal femoral 223.31 mg/cm3 respectively in a group with no history of frac- condyles) 7.27±0.34 mm vs. 6.87±0.35 mm respectively ture, while these were 138.78, 143.61, 177.45 mg/cm3 in the (p<0.01). All rats had similar plasma levels of calcium and phos- group who sustained a fracture in the past. Wilcoxon Two- phate. Alkaline phosphatase was significantly higher in Sample Test proved differences were statistically significant for treated group (165±32 U/L) than in ovariectomized all mentioned variables. Although significant, the differences (119±10 U/L) or Sham group (116±22) (p<0.05). between groups were more easily seen if trabecular BMD was Ovariectomized animals had lower resistance to mechan- concerned. Cortical parameters of all vertebra were less correlat- ical stress (ultimate load 96.3 MPa vs. 171.4 MPa for ed with t-score than trabecular ones, yet were statistically signif- control animals) while treatment with S. scardica in- icant in Spearman Correlation Coefficient calculation. creased mechanical resistance (142.8 MPa). Conclusions: Vertebral fracture prediction is usually derived Conclusions: Treatment with S.scardica prevents bone loss from trabecular bone mineral density analysis. The role of associated with ovariectomy. cortical bone in preventing vertebrae from failure is still to be investigated. P1141 PEDIATRIC REFERENCE VALUES FOR BONE P1140 MINERAL DENSITY IN MEXICAN CHILDREN SIDERITIS SCARDICA EXTRACT PREVENTS BONE D. L. Lopez-Gonzalez1, P. C. Clark2, M. B. Bello3,M.C. LOSS IN OVARIECTOMIZED RATS Cortina-Borja4 I. Jeremic1, D. Petrovic1, Z. Stanojevic2, S. Petricevic3,V. 1Clinical Epidemiology Unit, Hospital Infantil de Mexico Tadic4, J. Tosic3, S. Vidicevic3,M.Petronijevic5,A.Isakovic3 Federico Gomez, Mexico, Mexico, 2Clinical Epidemiology 1Institute of Rheumatology, Belgrade University School of Unit, Hospital Infantil Federico Gómez-Facultad de Medicina Medicine, Belgrade, Serbia, Belgrade, Serbia, 2Institute of UNAM, Mexico City, Mexico, 3Clinical Epidemiology Unit, Biochemistry, School of Medicine, University of Belgrade, Hospital Infantil Federico Gómez, Mexico, Mexico, 4Institute Belgrade, Serbia, 3Institute of Biochemistry, School of Medicine, of Child Health, University College London, United Kingdom, University of Belgrade, Belgrade, Serbia, 4Institute for Medicinal London, United Kingdom Plant Research, Belgrade, Serbia, 5Medical Academy, Clinic of Rheumatology, University of Defence, Belgrade, Serbia Introduction: Paediatric assessment of "growth and development” has been made by anthropometric measure- Background: While it is believed that estrogen replacement ments (i.e. weight, height) adjusted for age. Technological therapy is safe in most healthy postmenopausal women, there developments have made possible further assessments, like are still existing concerns regarding increased risk for breast and densitometry for bone mineral density. However, there have endometrial cancer as well risk for cardiovascular and thrombo- not been described reference values for Mexican children. embolic disease. Therefore, many natural compounds with estro- Such values are needed to identify abnormal individuals. gen like properties have been considered as alternative to classic Objective: Establish reference values for total body (TB) and hormone replacement therapy and useful to preserve bone loss. lumbar spine (LS) bone mineral density (BMD) for Mexican Objectives: To assess the influence of Sideritis scardica (moun- paediatric population (5-20 years old). tain tea) extract on bone loss induced by ovariectomy in rats. Methods: Population based cross-sectional study. Polyetapic Methods: The study included 24 rats divided in three groups: randomised, stratified sampling recruiting healthy Mexican chil- ovariectomized treated (n-8), ovariectomized non-treated (n-8) dren aged 5-20yo. Subjects that fulfilled inclusion criteria were and sham operated (n-8) rats. Ovariectomized rats were treated scheduled for assessment including: paediatric clinical history, with 200 mg/kg S. scardica extract for 24 weeks and compared 24-hour diet record, physical examination, anthropometry mea- to non-treated ovariectomized rats as well to sham operated surements (weight, height, waist circumference, standardised controls. Bone mineral density, morphometric properties of plicometry), TB and LS dual X-ray absorptiometry with iDXA S626 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 by General Electric. Statistical analysis: We used descriptive sta- tistics for demographic data. We created age- and gender- specif- ic smoothed percentile curves for TB and LS BMD by general- ized additive models for location, scale and shape regression method (gamlss) in RStudio Version 1.0.44. Results: We measured 834 subjects from 4.6 to 20 years old and constructed the smoothed percentile reference curves for TB and LS BMD adjusted by age and sex. Conclusions: The existence of population-specific reference values allows for comparisons between different populations. Various ethnic groups behave differently in health and disease. Current medicine should take into consideration such differences and adapt accordingly. This work has created TB and LS BMD reference values for Mexican children aged 5-20 years old. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S627 P1142 Keywords: Inflammation Bowel Disease, Crohn's EVALUATION OF BONE MINERAL DENSITY IN disease, Ulcerative colitis, Bone Mineral Density, Femur, IRANIAN PATIENTS WITH INFLAMMATORY Spine. BOWEL DISEASE S. Iravani1,M.Nourian2, Z. Abbas Beygi1, P. Riyazi1 1Department of Clinical Researches, Nikan Health Researchers P1143 Institute, Tehran, Islamic Republic of Iran, 2Basic and A QUICK AND FREELY AVAILABLE INSTRUMENT Molecular Epidemiology of Gastrointestinal Disorders FOR ALL PRACTITIONERS AND RESEARCHERS Research Center, Research Institute for Gastroenterology and TO ASSESS HAND DYSFUNCTION IN HAND Liver Diseases, Shahid Beheshti University of Medical OSTEOARTHRITIS (OA): THE FUNCTIONAL Sciences, Tehran, Islamic Republic of Iran INDEX FOR HAND OA WEBSITE FIHOA.NET E. Maheu1, R.-L. Dreiser2 Background: Individuals with inflammatory bowel disease 1Rheumatologist, Rheumatology Department, St-Antoine (IBD) are at higher risk of developing osteopenia and osteo- Hospital, Paris, France, 2Rheumatologist, porosis. Steroids are one of the main treatments in IBD pa- Rheumatology Department, Bichat Hospital, Paris, France tients which may lead to reduced BMD. Aim: The present study was to evaluate unchangeable factors Background: Although Hand OsteoArthritis (HOA) is a fre- like gender, age, disease duration, IBD type and the effects of quent polyarticular disease, which may lead to considerable steroids on patient’s BMD. pain and physical limitations, limited research has been per- Material and Methods: A total of 74 patients referred to formed, compared to lower limbs OA. It may radiologically Imam Reza Hospital were examined in this study. affect more than 67% of women and 55% of men aged over 55 Gender distribution was 51.36% male and 48.64% years old, of whom 20% will have symptoms (Dahaghin S female with an average age of 35.6 years. Minimum age et al. Ann Rheum Dis 2005). Applied to the almost 500 mil- was 15 and maximum age was 52 years. A total of 37 lion inhabitants of the European Union, with people over 60 (50%) ulcerative colitis (UC) and 37 (50%) Crohn’s which will grow up to 33% by 2020, this might represent 150 disease (CD) patients were enrolled to the study. Bone million radiographic hand OA affected individuals of which density was measured by dual-energy x-ray absorptiometry 30 million will suffer from hand pain, stiffness, deformities technique. Stepwise regression analysis was used to and impaired function. HOA burden is very high: pain, func- find predictive variables for bone mineral density tional impairment, deformities and aesthetic damage may im- (BMD). pact patient’ quality of life as much as Rheumatoid arthritis Results: All IBD patients in the study (74 patients) had di- (RA) (Slatkowsky-Christensen B et al. Arthritis Rheum minished bone mineral density at either spine or femur. 2007). Femoral BMD analysis showed that 26 (35.13%) patients The functional Index for hand OsteoArthritis (FIHOA) has were encountered with osteoporosis, 40 (54.05%) with been validated to assess functional impairment in HOA, both osteopenia and 8 (10.81%) had normal BMDs. Spinal BMD in daily clinical practice and in studies or clinical trials analysis also showed that 49 (66.21%) of patients had osteo- (Dreiser RL and Maheu E. Rev Rhum (Engl Ed) 1995; porosis, 19 (25.6%) osteopenia and 6 (8.10%) normal BMDs. Dreiser RL and Maheu E. OA & Cart 2000) and is currently There was a significant difference in spinal BMDs between the recommended instrument to be used for clinical studies/ Crohn's disease and ulcerative colitis groups, but no signifi- therapeutic trials (Kloppenburg M, Maheu E, et al. OA & Cart cant difference in femoral BMDs was seen. Also there was a 2015). significant association between duration of steroid administra- Aim and method: Computerization makes easier clinical data tion and BMD lowering in femur and spin of ulcerative colitis collection in ambulatory practice and in clinical studies or and Crohn's disease suffering patients. trials, and in particular allows for using easily validated Conclusions: Direct correlation between sex, age and reduced evaluation tools to assess patient’ status. We aimed at provid- BMD was observed in both quantitative and qualitative sur- ing all practitioners and the rheumatologic/orthopedic veys. The duration of both Crohn's disease and ulcerative research community with the FIHOA, under a free- of-charge, colitis have a significant relationship with BMD reduction; free-of-copyright and rapidly accessible numeric format, by however, the association was high in Crohn's disease patients. conceiving a free FIHOA website under the responsibility of In the present study, we saw a direct relationship between the instrument’s coauthors and developers. duration of steroid administration and decrease in BMD of Results: FIHOA website provides the FIHOA scoring for the patients. Finally, reduced BMD in the spine and femur of daily clinical practice use, allows for a rapid assessment of IBD patients were compared in this study and it was found the functional impairment of symptomatic hand OA patients, that reduced BMD in the spine is more than the femur. makes easier the efficacy judgement of treatments used in S628 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 practice, or in the context of a therapeutic trial or a survey/ and IL-6 and COX-2), Adipokines (adiponectin, leptin, cohort of HOA patients. It contains 17 different linguistic visfatin), Soluble receptor for leptin (sOB-Rb), Cellular inter- versions. Other linguistic versions are under development. It actions in bone (periostin), Wnt inhibitors (DKKs and SOST) results in a direct calculation of the score, available for the and Uric acid. patient’s file either in a numeric or paper format. The website Results: CTX-II can be determined on IDS Elisa, but is also also provides users with a short history of the instrument and be available on an automated method, on IDS iSYS. This is all references available in the international literature. Last, it very important since using automated methods definitely allows for contacting directly the authors by email. decreases the lab-to-lab variations and thus increases the Conclusion: We hope that the FIHOA.net website will be consistency of the results. Among the type II collagene helpful to practitioners for hand OA patients management in propeptides, PIIANP can be commercially available as an ambulatory practice, and will also help the entire scientific Elisa, proposed by Merck-Millipore and CPII is also avail- community involved in the field of researches in hand OA, able as an Elisa commercialized by IBEX. Pyridinium and OA in general. crosslinks can be measured on serum and urine with a MicroVue Elisa from Quidell. C2C is available at IBEX and CTX can be measured with various Elisa and two auto- P1444 mated methods, Roche Cobas and IDS iSYS. NTX in serum BIOMARKERS OF OSTEOARTHRITIS: PRACTICAL and urine (Osteomark) can be determinaed with an Elisa CONSIDERATIONS from Alere. PINP is available as a RIA assay from Orion E. Cavalier1, J.-Y. Reginster2 Diagnostics but can also be available with two automated 1Department of Clinical Chemistry, University of Liège, methods, Roche Cobas and IDS iSYS. Of note, the Orion Liège, Belgium, 2CARES sprl, Liège, Belgium and IDS assays do recognize the « intact » PINP whereas the Roche one recognizes the « total » one and cross- reacts Introduction: In 2013, the European Society for Clinical and with monomers that accumulate in patients suffering from Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) renal diseases. Finally, C1-2C is commercialized by IBEX. exhaustively reviewed the value of different biomarkers for the We have validated all these assays and have already a good diagnosis, prognosis and follow- up of osteoarthritis. In this work, experience with their use in routine. The CVs are all <15%, we aimed to share our experience on the potential availability of and are even better for automated methods, <8%. Regarding commercially available kits for the biomarkers highlighted by the the biomarkers related to aggrecan metabolism, CS846 is review and/or our experience with some of these assays in order available as a Elisa from IBEX and we have also validated to help different teams that would be willing to run them. this assay. LifeSpan Biosciences proposes a elisa for keratan Materials and Methods: The different biomarkers discussed sulfate in serum and urine, but we haven’t had the opportu- in the paper were : Biomarkers related to collagene metab- nity to validate this assay. There are basically two different olism :C- terminal telopeptide of collagen type II (CTX-II), Elisa for COMP determination, one using a rabbit polyclonal Type II collagen α chains collagenase neoepitope (α-CTX- antibody (Wieselab), the oher a mouse monoclonal one II), Type II collagen propeptides (PIINP, PIIANP, PIIBNP, (Biovendor). We have validated the first one and, to the best CPII), Pyridinoline and Glc-Gal-PYD, Type II collagen cleav- of my knowledge, no paper has compared the clinical per- age product (C2C), Collagen type II-specific neoepitope formances of these two assays. LifeSpan Biosciences pro- (C2M), C-terminal telopeptide of collagen type I (CTX-I, α- pose different elisa kits for serum and urine fibulin 3, CTX-I), N-terminal telopeptide of collagen type I (NTX-I), possessing different measuring range, but we do not have Aminoterminal propeptide of collagen type I (PINP), Types experience with these kits. Many Elisa kits are available I and II collagen cleavage neoepitope (C1,C2); Biomarkers for hyalurinic acid determincation (Corgenix, Teco, related to aggrecan metabolism :Core protein fragments CisBio, R&D) but these kits haven’t been compared to (aggrecan neoepitopes, ARGS and FFGV fragments), each other. We have validated the YKL-40 Elisa assay Chondroitin sulfate epitope 846 and monoclonal antibody from Quidel MicroVue but not sRAGE from 3B3; Keratan sulfate Biomarkers related to other non- NeoScientific. collagenous proteins :Cartilage oligomeric matrix proteins Conclusions: Some automated, but many Elisa methods exist (COMP and its deamidated form D-COMP), Fibulin (peptides for the determination of osteoarthritis biomarkers. The auto- of fibulin 3, Fib3-1, Fib3-2), Follistatin- like protein 1 (FSTL- mated methods seem correctly analytically validated, but the 1), Hyaluronan (hyaluronic acid), Matrix metalloproteinases Elisa have generally been poorly validated. However, refer- (MMP-1, MMP-3, MMP-9, MMP-13 and TIMPs), YKL-40 ence intervals for many of these biomarkers have been recent- (cartilage glycoprotein 39), Soluble receptor for advanced ly published in a very good paper by Krause et al in Ann glycation endproducts (sRAGE) and Biomarkers related to Rheum Dis. This is mandatory for a thorough use of thes other processes:Inflammatory biomarkers (hs-CRP, IL-1β markers in the future. Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S629 P1445 Skeletal muscle mass index (SMMI) was calculated using the RHEUMATOID LUMBAR SPINE CASE PRESENTATION equation MM/height2(values <6.76 kg/m 2 for women and M. Fawzy Khattab1,S.El-Ghamry2,Y.El-Hawary2 <10.76 kg/m2for men were considered inadequate). The poly- 1Orthopaedic department Ain Shams Univerisity, Cairo, unsaturated fatty acids [omega 3 (n-3), omega 6 (n-6)] and the Egypt, 2Orthopaedic Department, Cairo University, Cairo, Egypt n-6/n-3 ratio, expressed as a percentage of the total fatty acids identified were determined by gas chromatography with flame Background: Rheumatoid arthritis is common in cervical ionization detection. Statistical analyses were performed using spine and there are few studies in the literature have SPSS®22.0. Results: The sample was mainly female (84.9%), descriebed the rheumatoid lumbar spine. Managing these pa- and the mean age was 70.4±6.4 yr (60-89 yr), and they were. tient needs complete identification of patient needs and special The SMMI mean was 7.70±1.47 kg/m2and median 7.45kg/m attention to their comorbidities. 2 (interquartile range 6.70-8.32), with 37.5% (n=124) being Purpose: To describe the Radiological features of rheumatoid considered inadequate. The percentage means for n-3 and n-6 lumbar spine and to give surgical tips in management of such were 3.47±1.03 and 39.33±4.12, respectively. The n-6/n-3 osteoporotic vulnerable spine. ratio was 12.23:1±3.46:1. No significant difference was found Study design: Case Presentation of known rheumatoid between individuals with adequate and inadequate SMMI in patient presented with secondary inability to walk with terms of the percentage mean for n-3 (3.44±1.00 vs 3.52 significant back and leg pain. Radiologically She has ±1.09; P=0.683; median 3.28 vs 3.17), n-6 (39.17±3.95 vs lumbar spine instability, perivetebral joint erosions and 39.60±4.38; P=0.493; median 39.40 vs 39.87) and the n-6/n-3 disc erosion, with porotic spine. On MRI She has spinal ratio (12.19:1±3.25:1 vs 12.28:1±3.79:1; canal stenosis and multiple disc prolapse. Patient P=0.816, median 12.16:1 vs 12.62:1). In the binary lo- Undewent decompression and fusion with improvement gistic regression analysis (Backward Stepwise method), of her neurological state. only gender was associated with the SMMI (men were Conclusion: Wound complications occur in up to 25% of 4.64% more likely to have inadequate SMMI than wom- patients. Generalized osteopenia can cause difficulties with en). Conclusion: No associations were found in the instrumentation so augmented screws with bone cement is present study between the SMMI and polyunsaturated recomended. fatty acids. We suggest to conduct further longitudinal Risk include non-union and recurrent instability (adjacent seg- studies, given the role inflammation plays in modulating ment disease). The current perioperative mortality is reported sarcopenia and the anti-inflammatory potential of poly- at 5–10%. Strict image studying and understanding the patient unsaturated fatty acids. needs is mandatory. Medical treatement for rheumatoid and Acknowledgments: We thank the Coordenação de osteoporosis must be considered. Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for Karen M. M. Margutti´s scholarship. Reference: P1146 JANNSEN, I. et al. Estimation of skeletal muscle mass by ASSOCIATION BETWEEN MUSCLE MASS AND bioelectrical impedance analysis. J Appl Physiol 2000; POLYUNSATURATED FATTY ACIDS IN FREE 89(2):465-71. LIVING ELDERLY K. Mello de Mattos Margutti1,2,A.R.Costodio1,N.J. Schuch1,K.Nascimento1,C.H.Augustin P1147 Schwanke2 COMPARISON OF BONE DENSITY MEASURENTS 1Centro Universitário Franciscano (UNIFRA), Santa Maria/ IN TWO DIFERENT POINTS OF THE SKELETON RS, Brazil, 2Biomedical Gerontology Graduate Program, IN MALE GENDER SAMPLE Institute of Geriatrics and Gerontology (IGG), Pontifical K. Chantziara1, C. Maniotis1,P.Makras1, P. Kokkoris1 Catholic University of Rio Grande do Sul (PUCRS), Porto 1Department of Endocrinology, 251 Airforce General Alegre/RS, Brazil Hospital, Athens, Greece Objective: To analyze the association between skeletal mus- Objectives: Osteoporosis is a condition that has been extensive- cle mass index and polyunsaturated fatty acids in free living ly studied in postmenopausal women. Guidelines for osteoporo- elderly. Material and Methods: A cross-sectional study was sis in men have only recently been published (2012). The aim of conducted involving 331 elderly (≥60 yr) who attended com- this study is to evaluate the bone density in the male population munity groups in a South Brazilian city. Muscle mass (MM) when measured at two different points of the skeleton. The pri- was estimated by the Janssen et al. (2000) equation, which mary outcome is to find the point that is more representative of uses electrical bioimpedance data (reactance and resistance). the bone mineral density (BMD) of the whole skeleton. S630 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 Material and Methods: 1390 adult males were measured by osteoporosis is a painless, progressive condition that leads to a the DXA method (Lunar device). Their mean age was 41 weakening of the bones throughout the body meanwhile people ±13,9 years and their mean ΒΜΙ was 26,4±3,0 kg/m2. None with transient osteoporosis experience a sudden onset of pain of the subjects had previously been diagnosed with osteopo- that intensifies with walking or other weight-bearing activities rosis. None of them were taking medication that affects BMD sympthoms that overlaps with the typical pregnancy conditions (thyroxine, cortisone). T-score, Z-score and bone density were due to a fisiological weight gain and uterous position complicat- measured in all subjects in order to identify the best point for ing the diagnosis. It is known that Transient Osteoporosis can the DXA method in males. put patients at greater long-term risk for fractures in different Results: 23,8 % of the males examined were found to have areas of the body. osteopenia (-1 Abbreviations: X-rays, plain radioghaphy, CT, computed to- >45 mL/min, but were similar with those presenting GFR mography; MRI, magnetic resonance imaging >45 mL/min. With T method, the median observed in HD Results: Both patients were examined with x-rays, patients was higher than in non-HD patients, whatever the densidometry and MRI. GFR. On the contrary, median SCL was lower in HD than in (Patient 1: T-score - 2.5, Z - score - 1,9; Patient 2: T- non-HD patients with the M method. After a dialysis session, a score 3,2, Z – score 2,3) significant decrease was observed in HDF, but not in HD mode CONCLUSION: Transient osteoporosis of the hip (TOH), and was always more important if SCL was measured with T, B also known as bone-marrow edema syndrome, is a rare skel- and R methods, compared to the M one. etal disorder of unknown etiology. It can occur in women and Discussion: SCL determination in CKD patients is challeng- middle-aged men, but most often occurs in previously healthy ing and any conclusion is method-depending. Previously de- women during the third trimester of pregnancy. It is essentially scribed relations between GFR and SCL levels may be an a diagnosis of exclusion. An early diagnosis may prevent bone analytical artifact with inactive SCL fragments that would fractures and reduce its risk. accumulate when GFR decreases and would be recognized Bibliography: 1. Ergin T, Selam E et al. Transient by T, B and R, but not M method. Osteoporosis of Pregnancy case report. J. Turk Ger Gynecol Conclusion: SCL determination clearly impacts finding pre- Assoc 2010. 163 – 164 viously observed in CKD and HD patients. 2. Vester H. et al Fractures due to transit osteoporosis of preg- nancy. Orthopedics, 2013, Jul. 36 912 – 6. P1150 LOW BONE MINERAL DENSITY IS A MAJOR P1149 CONTRIBUTOR IN THE GLOBAL HEALTH IMPACT OF THE RENAL FUNCTION ON SCLEROSTIN BURDEN DUE TO ROAD TRAFFIC ACCIDENTS IN DETERMINATION: ILLUSTRATION WITH FOUR PEOPLE AGED 50 YEARS AND ABOVE DIFFERENT ELISA METHODS IN PATIENTS N. M. Wilson1, L. Sanchez-Riera2, D. Prieto-Alhambra3,C. UNDERGOING GFR DETERMINATION WITH IOHEXOL Cooper4, P. Halbout5, A. Woolf6,L.March1 E. Cavalier1,2, J.-Y. Reginster1,2,P.Delanaye1,2 1Institute of Bone and Joint Research, University of Sydney, 1University of Liège, Liège, Belgium, 2CARES sprl, Liège, Sydney, Australia, 2Department of Rheumatology University Belgium Hospital Bristol NHS Foundation, Bristol, United Kingdom, 3Oxford NIHR Musculoskeletal Biomedical Research Unit, Introduction: Sclerostin (SCL) is a promising biomarker for University of Oxford, MRC Lifecourse Epidemiology bone research. It has also been associated, in some studies, Centre, University of Southampton, IDIAP Jordi Gol, with mortality in hemodialyzed (HD) patients. However, lit- Oxford, United Kingdom, 4Oxford NIHR Musculoskeletal erature is conflicting on that point and some authors have Biomedical Research Unit, University of Oxford and IDIAP pointed out that assays used for SCL might explain these Jordi Gol, Oxford, United Kingdom, 5International discrepancies. It remains unclear whether these discrepancies Osteoporosis Foundation, Nyon, Switzerland, 6Institute of come from a lack of clearance or a lack of specificity of the Health Care Research, Universities of Exeter and Plymouth, antibodies used in the assays. Exter and Plymouth, United Kingdom Patients and methods: We have measured SCL concen- trations in 150 healthy and CKD patients who had un- Objectives: To measure the proportion of the worldwide health dergone GFR determination with the iohexol method. burden of road traffic accidents (RTA) in people aged 50 years We have also measured SCL before and after a single and above attributable to low bone mineral density (BMD), as dialysis session in 44 patients. Each sample has been part of the Global Burden of Diseases (GBD) study. measured with 4 different ELISA: Biomedica (B), Methods: The estimates followed the Counterfactual Risk MSD (M), R&D (R) and Teco (T). Assessment Methodology used in the GBD study (1). Results: Median [IQR] SCL concentration in the non-HD pa- Systematic review was performed seeking population-based tients were very different accordingtothemethod:B:1017 studies with femoral neck BMD (FNBMD) measured by [546], M : 36 [21], R : 160 [101] and T: 629 [325] pg/mL. We Dual-X-Ray-Absorptiometry in people 50 years and over. did not observe any systematic differences between the Age- and sex- specific levels of mean FNBMD+/-SD (g/ methods. In univariate analysis, we observed a significant and cm2) were extracted from eligible studies, and this was used inverserelationbetweenGFRandSCLwhenmeasuredbyB,R as the exposure variable. The age and sex-specific 99th per- and T but not with M. The different assays also showed a wide centile from non-Hispanic whites in National Health and variation in HD patients. With B and R methods, HD patients Nutrition Examination Survey (NHANES) 2009-2010 was presented median values higher than those whose GFR was used as theoretical minimum risk factor exposure distribution, S632 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 to estimate the potential impact fraction (PIF) of FNBMD for Objectives: To determine the percent distribution of LTC res- fractures. Relative risks of FNBMD for fractures were obtain- idents among the 8 individual risk levels of our hip fracture ed from a previous meta-analysis (2). Attributable deaths due prediction outcome scale and to examine if the distribution to RTA-related fractures were obtained through coded hospital would be beneficial for the potential transformation of our data. Disability levels were established by applying disability instrument to a Clinical Assessment Protocol (CAP). weights to each type of fracture. Then, PIFs were applied to Material and Methods: Our outcome scale was developed obtain attributable deaths and disability due to low BMD. using the Resident Assessment Instrument – Minimum Data Results: Globally, in 2015, 12.0% (95% CI: 10.5-13.3%) and Set 2.0 (RAI-MDS) for all residents with a LTC admission 29.2% (29.0-30.3%) of deaths caused by RTA were attribut- assessment from Ontario, Canada from April, 1, 2006 to able to low BMD in the population aged 50-69 and 70 years March, 31, 2010 (N=29,848). The scale was created using and above, respectively. This represents a 64% and 97% in- decision tree analysis and includes traditional risk factors for crease in absolute deaths from 1990 data, respectively. The fracture such as prior fractures and fall, age, gender, height and percentage of global health burden caused by RTAs attribut- weight, and LTC specific risk factors for the frail elderly such able to low BMD in the population aged 50-69 was 13.6% as cognitive function, falls, wandering and, transfer status. (11.6-15.4%) and for 70 and over 26.2% (24.9-27.5%). This The outcome scale is capable of both discriminating and represents a 64% and 80% increase, respectively, from 1990 predicting residents at risk for hip fracture over a one year data. For disability, in the population aged 50-69 was 22.3% time period. The scale will be implemented within the RAI- (19.2-25.2%) and for 70 and over 28.2% (26.3-29.8%). This MDS and potentially converted into a CAP. CAP’s are used to represents 64% and 84% increase, respectively, from 1990. assist health care providers to interpret systematically infor- Conclusions: This data shows the non-previously reported mation that is recorded within the RAI-MDS and to provide important role of low BMD as a preventable risk factor for recommendations for care planning of frail older adults. For RTAs’ health burden in population 50 years and over, and its the current analysis, the distribution of LTC residents among growing trends, which requires urgent attention. the 8 individual risk levels of our scale will be examined. Results: Approximately 45% of LTC residents were 85 years and older, 2/3 were women, 1/3 had a prior fall within the past 180 days, and 3% had a prior hip fracture within the past 180 days. A total of 1553 (5.2%) new fractures (including hip, spine humerus, forearm, and pelvis) and 959 hip fractures (3.2%) were reported over the one year time period. The out- come scale has 8 risk levels of absolute hip fracture risk, which range from 0.6 to 12.6%. The distribution of residents within each risk level decreased as the risk level for hip frac- ture increased (Table). The distribution property of the scale allocates 56% of the assessed residents into the lowest three Fig. 1 Deaths, DALYs and YLDs caused by road injuries attributable to risk levels, 36% for risk levels 4 to 6, and 8% for the two low BMD among age groups 50-69 and 70 years and older (Available at highest risk levels. http://vizhub.healthdata.org/gbd-compare/) Conclusion: The large population of lower risk residents is important because the management of too many high References: 1. Forouzanfar M et al, Lancet 2016; 2. Johnell O risk individuals may quickly overwhelm LTC resources et al, JBMR 2005. that are needed for clinical care. The scale’s properties are beneficial for the potential transformation of our tool to a CAP, which will assist clinicians in resident care P1152 planning for hip fracture. A LARGE NUMBER OF FRAIL OLDER ADULTS LIVING IN LONG TERM CARE HOMES ARE AT Table 1 Distribution of Residents Within Each Risk Level of our HIGH RISK FOR HIP FRACTURE Outcome Scale 1 2 3 2 A. Papaioannou ,M.Jantzi,L.Giangregorio, J. Hirdes ,J. Hip fracture risk level categories % (n) in each level D. Adachi4, G. Ioannidis1 Hip fracture risk level 1 13.5 (4,014) 1 Hip fracture risk level 2 18.3 (5,446) Medicine, McMaster Univeristy, GERAS Centre, Hamilton, Hip fracture risk level 3 24.1 (7,198) Canada, 2Health Studies and Gerontology, University of Hip fracture risk level 4 17.0 (5,065) 3 Hip fracture risk level 5 16.6 (4,948) Waterloo, Waterloo, Canada, Kinesiology, University of Hip fracture risk level 6 2.1 (636) 4 Waterloo, Waterloo, Canada, Medicine, McMaster Hip fracture risk level 7 8.0 (2,382) University, Hamilton, Canada Hip fracture risk level 8 0.5 (159) Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S633 P1153 Conclusion: We estimated a differential effect of GWG on TITLE: MATERNAL WEIGHT GAIN DURING offspring bone properties according to maternal weight before PREGNANCY AND OFFSPRING BONE pregnancy. Our results suggest that weight management among PROPERTIES: A DIFFERENTIAL ASSOCIATION IN overweight and obese pregnant women is unlikely to have a OVERWEIGHT WOMEN negative repercussion on offspring bone physical properties. T. Monjardino1,A.C.Santos1,A.Henriques1,C.Cooper2,R. Lucas1 1ISPUP-EPIUnit, Universidade do Porto Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal, 2Musculoskeletal epidemiology. Botnar Research Centre. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. University of Oxford, Oxford, United Kingdom Objective: Weight management strategies during pregnancy have been shown to reduce maternal and child cardiometabol- ic risk. However, since maternal body size has an overall positive correlation with offspring bone mass, pregnancy weight management may also affect offspring skeletal health. Our objective was to assess whether bone physical properties of the offspring at 7 years of age (7y) were associated with maternal gestational weight gain (GWG), particularly in wom- en who were overweight before pregnancy. Material and Methods: We analyzed prospective data from a subsample of 1953 participants from the Generation XXI birth cohort who underwent whole-body DXA scan at 7y. Using prepregnancy weight (self-report- ed) and height (measured or abstracted from ID card) maternal prepregnancy BMI was calculated. Gestational weight gain was computed as the difference between self-reported pre-delivery weight and prepregnancy weight. In the whole sample and for each BMI category (under/normal weight and overweight/obese), associations between GWG and offspring subtotal BMC and aBMD were estimated through linear regression coefficients (95%CI), crude and adjusted for maternal age, height Fig. 1 Associations between gestational weight gam and offspring bone and education. properties by prepregnancy body mass index Results: Mean (SD) GWG was 14.4 (4.1) kg in under/nor- mal weight and 13.1 (4.4) kg in overweight/obese mothers. Overall, GWG was positively associated with offspring P1154 BMC and aBMD at 7y of age [standardized β (95%CI): ASSOCIATION OF CIRCULATING MIRNAS WITH 0.04 (0.00, 0.08) and 0.05 (0.01, 0.09)]. After BMI strati- OSTEOARTHRITIS fication (figure 1), the association between GWG and J.-C. Rousseau1, E. Sornay-Rendu2, O. Borel2,R.Chapurlat3 child´s BMC and aBMD remained significant among un- 1INSERM 1033 Pavillon F Hôpital E. Herriot 69437, Lyon, der/normal weight mothers, in both crude [0.08 (0.03, France, 2INSERM 1033, Hospices Civils de Lyon, Lyon, 0.13) and 0.10 (0.04, 0.15)] and adjusted models [0.06 France, 3INSERM 1033, Hospices Civils de Lyon, (0.00, 0.11) and 0.07 (0.02, 0.12)]. However, among over- Université de Lyon, Lyon, France weight and obese mothers, we observed no beneficial ef- fect of higher GWG on offspring bone properties, in either Background: Sensitive and specific blood biomarkers to de- crude or adjusted models [crude: 0.03 (-0.05, 0.10) and tect the initial stages of osteoarthritis (OA) and to predict the 0.04 (-0.04, 0.12) and adjusted: -0.01 (-0.08, 0.07) and future development of the disease are not available in clinical 0.00 (-0.07, 0.08), for BMC and aBMD, respectively]. routine. Consequently, there is a considerable interest in the S634 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 identification of new markers. In this study, we analyzed the Objective: Glucocorticoids (GCs) prescribed for inflam- differential expression of circulating microRNAs (miRs, small matory diseases are a major risk factor for osteoporosis non-coding RNAs) in subjects with and without OA in the and atraumatic osteonecrosis (ON). Presently, there is no OFELY cohort. effective medical treatment for GC-induced ON. We have Methods: The study group included French women belong- previously shown that treatment with both LLP2A-Ale ing to the population-based cohort OFELY (Os des FEmmes and hPTH (1-34) directed mesenchymal stem cells to the de LYon). Expression levels of serum miR were measured in bone surface and prevented GC-induced bone loss and 10 healthy women without OA at any site (knee, lumbar spine, reduction in vascularity in mice. The aim of this study hip and hand) and in 10 women with a Kellgren & Lawrence was to determine if LLP2A-Ale and hPTH (1-34) could score of 2 and 3 (early and intermediate knee OA) and OA at prevent GC-induced ON and maintain the vasculature others sites (spine disc, hand, hip). These evaluations have within the distal femur. been performed at the same visit, 8 years after recruitment of Methods: Seven-week-old male BALB/c mice were random- the cohort. Both groups were matched for age (healthy: 61.9 ± ized into Placebo, GC (4 mg/L dexamethasone in drinking wa- 3.03 and OA: 63.9 ± 3.4 p=0.17) and menopausal status. The ter), GC + 250 μg/kg LLP2A-Ale (every 2 weeks), GC + 500 expression of the serum micro-RNAs was measured by the μg/kg LLP2A-Ale (every 2 weeks), and GC + 40 μg/kg hPTH Next Generation Sequencing (NGS) method according to (1-34, 5x/week). Mice were sacrificed on day 30 or day 45. the manufacturer’s protocol (EXIQON, Denmark). Study endpoints included bone mass, histologic evidence of Measurements were expressed as Tags per million (TPM), ON, prevalent blood vessels (CD31 and Endomucin expression) the number of reads for a particular miR is divided by the total in the distal femur. Non-parametric Kruskal-Wallis tests were number of mapped reads and multiplied by 1 million. used to determine the differences between the groups. Results: We identified 421 miRs with an expression level ≥ 1 Results: GCs significantly reduced trabecular bone volume and TPM and 241 with an expression level ≥ 10 TPM. When we trabecular thickness compared to placebo on day 30 and 45 compared the two groups, 22 miRs showed differential ex- (p < 0.05). Trabecular number was significantly reduced on pression (p < 0.05) between controls and OA patients. After day45(p<0.05).BothLLP2AAleandhPTH(1-34)treated Benjamini-Hochberg False Discovery Rate (FDR) correction animals had higher bone volume and lower trabecular separa- has-miR-139-5p, has-miR-1299 and has-miR-200a-3p tion compared GC group on day 30 and 45 (p < 0.05). The remained significantly different between OA patients and con- incidence of GC induced ON was 57% on day 30 and 73% trols (p < 0.05, FDR at 5%) (Table). on day 45 and both LLP2A-Ale and hPTH (1-34) prevented incident GC-induced ON lesions (Figure 1). Compared to LLP2A-Ale, hPTH (1-34) and placebo, GCs decreased the staining intensity of both CD31 and Endomucin expression on day 30 and 45. Conclusion: GCs induced trabecular bone loss and ON lesions in BALB/c mice. Both LLP2A-Ale and hPTH (1-34) reduced the incidence and severity of GC-induced ON and maintained vascular integrity. Therefore, both LLP2A-Ale and hPTH (1- Conclusion: With a NGS screening approach, we identi- 34) could be potent agents in the treatment and prevention of fied 3 miRs that are differentially expressed in women GC-induced ON. suffering from OA compared to healthy women. The next step will be the measurement of these specific miRs in the entire cohort to determine the clinical utility of these markers. P1155 BOTH A NOVEL HYBRID COMPOUND LLP2A-ALE AND HPTH (1-34) PREVENTED GLUCOCORTICOID- INDUCED OSTEONECROSIS AND REDUCTION IN VASCULARITY IN A MOUSE MODEL J. A. van Santen1, M.-J. Lim1, Y. E. Lay1, A. Kot1,T.S. Rogers1,W.Yao1,N.E.Lane1 1Center for Musculoskeletal Health, University of California Davis, Sacramento, United States Osteoporos Int (2017) 28 (Suppl 1):S127–S636 S635 P1156 classes. Heavyweight athletes had significantly higher BONE MINERAL DENSITY AND BODY body mass index, lean mass and fat mass compared to COMPOSITION AMONG ATHLETES: their lightweight counterparts (p < 0.05). LIGHTWEIGHT VERSUS HEAVYWEIGHT SPORTS Conclusions: The present findings suggest that weight classi- J. A. van Santen1,T.A.Amorim2,M.T.Sanchez-Santos1,J. fication in sports may be an important determinant of bone L. Newton1, F. Salbany3, c. Pereira3, N. Allen4, M. A. M. health. Further research will bring together collaborative Davies1, K. Jackson1, Y. Koutedakis5, N. K. Arden1 groups to create a comprehensive view on the effects of sport 1Arthritis Research UK Centre for Sport, Exercise and weight-restriction on BMD and body composition. Osteoarthritis, University of Oxford, Oxford, United Kingdom, 2University of Porto, Porto, Portugal, 3Nuffield Department of Orthopaedics, Rheumatology and Table 1 Bone mineral density information according to gender and Musculoskeletal Sciences (NDORMS), University of weight group (n=177) Oxford, Oxford, United Kingdom, 4The Jerwood Centre, Male Female Birmingham Royal Ballet, Birmingham, United Kingdom, Heavy- Light- Heavy- Light- 5School of Sports and Exercise Sciences, University of weight weight weight weight Thessaly, Trikala, Greece (n=45) (n=37) (n=44) (n=51) Spine (Ll-L4) 1.326 1.248 1.263 1.198 Objectives: Energy restriction and weight loss techniques BMD(SD) (0.158) (0.147)* (0.149) (0.156)* are associated with adverse effects on bone mineral den- 1 sity (BMD) whilst participation in sports is known to be Femoral-Neck 1.228 1.209 1.129 1.092 beneficial for skeletal health. However, it is not entirely BMD (SD) (0.171) (0.151) (0.109) (0.131) clear the skeletal health status in lightweight sports Total Hip1 1.224 1.196 1.149 1.095 where participants often use weight management tech- BMD (SD) (0.149) (0.130) (0.120) (0.159) niques to attain relatively low mass. Therefore, the Whole Body2 1.267 1.164 1.097 1.052 aim of this study is to evaluate the differences in BMD(SD) (0.111) (0.093)** (0.085) (0.083)* BMD and body composition among athletes engaged in weight restricted and non-weight restricted sports. Methods: A total of 177 athletes (18 runners, 28 rugby players, 84 rowers and 47 ballet dancers) were recruit- V00198-017-3950-2Fhbdc.tif"alues are mean (SD) ed.BMDandbodycompositionwasassessedbyDual- BMD measured in g/cm2 energy X-ray absorptiometry (DXA), utilising either the SD Standard Deviation GE Lunar iDXA or the GE Lunar Prodigy. Participants 1 Left side only were categorised into two groups according to their 2 Whole body minus head sport characteristics: lightweight (sports where a cate- Significant values are highlighted in bold: gorical weight restriction is applied or where low mass *p<0.05,**p<0.001 is deemed advantageous, e.g., lightweight rowers, ballet, Note: 5 lightweight male and female did not have data available for BMD at long distance running) and heavyweight (sports with no total hip, 7 and 5 lightweight male and female, respectively, did not have data weight restrictions, e.g., rugby, heavyweight rowing and available for BMD at whole body sprinters). Means with standard deviations (±SD) were calculated for each measurement in males and females, P1157 separately. Student t-test was used to determine mean PRELIMINARY RESULTS OF THE ESCAPE TRIAL: differences between weight groups. EARLY SURGERY VERSUS CONSERVATIVE Results: Eighty-two males (45.1% lightweight) and nine- TREATMENT WITH OPTIONAL DELAYED ty-five females (53.7% lightweight), median (IQR) age: MENISCECTOMY FOR PATIENTS OVER 45 YEARS 22.9 (20.7-26.8) years, were analysed. In heavyweight WITH NON-OBSTRUCTIVE MENISCAL TEARS males, BMD was significantly higher in lumbar spine C. H. Bloembergen1, V. A. Van de Graaf1 (1.326 ± 0.158) and body without head (1.267 ± 1Department of Orthopaedic Surgery, Joint Research OLVG, 0.111) compared with lightweights (1.248 ± 0.147) and Amsterdam, Netherlands 1.164 ± 0.093, respectively) at p < 0.05. Significant dif- ferences were also found between female heavyweight Objectives: Purpose of the present study is to compare the and lightweight participants at the same measured sites functional outcome of Arthroscopic Partial Meniscectomy (p < 0.05). There was no significant difference for BMD (APM) and Physical Therapy (PT) in patients between 45 at the femoral neck and total hip between weight and 70 years with a degenerative meniscal tear. Although S636 Osteoporos Int (2017) 28 (Suppl 1):S127–S636 APM is currently under scrutiny, it is still the most performed P1158 surgical procedure in orthopaedic surgery with approximately PERSISTENCE WITH TREATMENTS FOR 700,000 performances annually in the United States of OSTEOPOROSIS: A REAL-WORLD STUDY IN THE America. In this trial we aim to prove non-inferiority of con- PHARMO DATABASE NETWORK servative treatment compared with surgery. J. A. Overbeek1,J.G.Kuiper1, G. Worth2,M.Intorica2,F.J. Material and Methods: We conducted a multicentre A. Penning-van Beest1 randomised controlled trial (RCT) in seven hospitals in The 1PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands and included 321 participants with an MRI-con- Netherlands, 2Amgen (Europe) GmbH, Zug, Switzerland firmed symptomatic, non-obstructive meniscal tear. Patients were randomly assigned to either APM or PT. As primary outcome we Objectives: To describe persistence with treatments for oste- used the International Knee Documentation Committee oporosis in a real-world setting. ‘Subjective Knee Form’ IKDC SKF. Secondary outcomes in- Material and Methods: From PHARMO’s General cluded change in general health, quality of life, pain, level of Practitioner Database, patients with an osteoporosis (OP) drug activities and patient-specific complaints. Follow-up assessment prescription between 2007-2013 were selected and included were performed at 3, 6 and 12 months after randomization. in one or more of the following cohorts: (daily or weekly) Results: In the intention-to-treat analysis, the mean improve- alendronate, half-year subcutaneous injection denosumab, (in- ment in the IKDC score after 1 year was 25,6 points (95% travenous (IV)) or oral) ibandronate, (daily, weekly or month- confidence interval [CI], 22,3 – 28,8) in the APM group and ly) risedronate, raloxifene, teriparatide, or yearly IV zoledro- 19,0 (95% CI, 16,0 – 22,0) in the PT group, which resulted in nic acid. Persistence was defined as the number of days of a significant mean difference of 6,55 points (95% CI 2,1 – uninterrupted use (gap between prescriptions < 60 days) of 11,0; P = ,004) in favour of surgery. The repeated measures the OP treatment defining the cohort. Persistence rates were analysis of variance showed a large main effect of time (P = determined after one and two years (for patients with complete ,000; ES, ,600) but no significant main effect of groups (P = follow-up). ,984; ES ,000) (Figure I). Also, there was an interaction effect Results: The study included 37,018 patients of which the between time and treatment group (P = ,031). majority used weekly alendronate (60%) followed by weekly risendronate (28%). The majority of patients was female (between 74-99% across cohorts) and mean age ranged between 63-72 years across cohorts. Approximately half of the patients had at least two years of follow-up. After one year, by definition the zoledronic acid cohort had a persistence rate of 100%. The persis- tence rate at one year was 79% for the denosumab co- hort. After two years of follow-up, the persistence rate for zoledronic acid cohort was 65% followed by the denosumab cohort (59%). The persistence rate was higher for weekly versus daily antiresorptive treatment. Median time until treatment change ranged from 133 days for daily alendronate to 664 days for IV ibandronate. Zoledronic acid and denosumab had a me- dian time until treatment change of >730 days. Similar results were found for patients ≥70 years of age. Conclusion: It is likely that the prescription regimen of zole- dronic acid and denosumab has a positive contribution to the high persistence rates; zoledronic acid is infused once a year and denosumab injected twice a year. This study showed that Conclusion: After one year, both APM and PT showed less frequent dosing of OP treatments results in better persis- significant improvement in physical function in middle tence. This is also applicable for elderly patients using OP aged patients with an obstructive meniscal tear. There is treatments. no significant benefit of APM over PT for physical Disclosures: JK, JO and FP are employees of the PHARMO function. Therefore, an initial conservative approach Institute which performs financially supported studies for gov- with physical therapy should be considered in patients ernment and related healthcare authorities and several phar- between 45 and 70 years with a non-obstructive maceutical companies. GW and MI are employees of Amgen meniscal tear. and own stock in Amgen.