VOLUME 25 SUPPLEMENT 2 APRIL 2014

Osteoporosis
International
with other metabolic bone diseases
EDITORS≠ IN≠ CHIEF JOHN A. KANIS AND ROBERT LINDSAY

WCO-IOF-ESCEO
World Congress on Osteoporosis, Osteoarthritis
and Musculoskeletal Diseases
2– 5 April 2014
Seville, Spain
 TABLE OF CONTENTS

OSTEOPOROSIS INTERNATIONAL
Vol. 25 (2014) | Supplement 1

About IOF and ESCEO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Message from the Congress Presidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 9

Congress Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 10

Sponsors and Exhibitors List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 11

Congress Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Venue Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases: Final Programme . . . . . . . . . . . . . . . . . . . . . . . 18

Plenary Lecture Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Oral Communication Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

ESCEO Symposia Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

IOF Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

MTE Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Poster Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Satellite Symposia Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367

Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

Pagination in this file differs from the version of record (Osteoporosis International vol. 25 supplement 2)
found on link.springer.com

This supplement was not sponsored by outside commercial interests ;

it was funded entirely by the society’s own resources

ABSTRACT BOOK 5
 About ESCEO
The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) is a non-profit organization,
dedicated to a close interaction between clinical scientists dealing with rheumatic disorders, pharmaceutical industry developing
new compounds in this field, regulators responsible for the registration of such drugs and health policy makers, to integrate the
management of Osteoporosis and Osteoarthritis within the comprehensive perspective of health resources utilization.

The objective of ESCEO is to provide practitioners with the latest clinical and economic information, allowing them to organize their
daily practice, in an evidence-based medicine perspective, with a cost-conscious perception. www.esceo.org

About IOF
The International Osteoporosis Foundation (IOF) is a non-profit, nongovernmental organization dedicated to the worldwide fight
against osteoporosis, the disease known as “the silent epidemic”. IOF’s members – committees of scientific researchers, patient,
medical and research societies and industry representatives from around the world – share a common vision of a world without
osteoporotic fractures. IOF now represents 195 societies in 93 locations around the world.
www.iofbonehealth.org

Mission
- increase awareness and understanding of osteoporosis.
- motivate people to take action to prevent, diagnose and treat osteoporosis.
- support national osteoporosis societies in order to maximize their effectiveness.

ABSTRACT BOOK 7
 Message from the Congress Presidents
Dear Colleagues,

On behalf of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the International Osteoporosis
Foundation (IOF), it is a pleasure to welcome you to Seville, and to the World congress on osteoporosis, osteoarthritis and
musculoskeletal disease (WCO-IOF-ESCEO). The Congress’ scientific programme has been developed by a team consisting of
members of the Committee of Scientific Advisors of the IOF and the Scientific Advisory Board of ESCEO. We would like to thank
the Scientific Chairs, Professors Cyrus Cooper and René Rizzoli, for taking the lead in setting up an exciting and comprehensive
programme that brings together the world’s best in the bone field, and takes advantage of the synergies and combined expertise
of our two organisations.

We are meeting in Seville with common aims – to gather new knowledge, skills and tools in the prevention and treatment
of osteoporosis, osteoarthritis and musculoskeletal disease. The enlarging focus of this year’s meeting covers major disabling
conditions in elderly people. It is our hope that this Congress will move the field one step forward on all fronts; from new
understanding of bone, joint and muscle metabolism and pathology, to new strategies and options in prevention, diagnosis and
treatment.

The core scientific programme consists of 8 invited lectures by renowned speakers and 57 oral presentations selected from the
very best of hundreds of submitted abstracts. In addition, participants can choose among 14 different Meet-the-Expert sessions
and 11 special sessions and symposia on issues of clinical importance. We also encourage you to attend many of the scheduled
poster sessions, 6 industry sponsored satellite symposia and to visit the large commercial exhibition presented by the leading
companies in the bone field.

The city of Seville offers a most convenient and pleasant setting for international congresses. We hope that you will also take the
opportunity to explore the many attractions in Seville, or simply savour the ‘buena vida’ in this wonderful city!
Thank you for your participation. We will do our best to ensure that this meeting is a memorable, enriching experience for all.

Jean-Yves Reginster John A. Kanis

ESCEO President IOF President

ABSTRACT BOOK 9
 CONGRESS ORGANIZATION
Congress chairmen Scientific advisory board
John A. KANIS Donato AGNUSDEI
IOF President Kristina AKESSON
Jean-Yves REGINSTER Maurice AUDRAN
ESCEO President Jean-Jacques BODY
Mary BOUXSEIN
Scientific committee Maria-Luisa BRANDI
Olivier BRUYERE
Cyrus COOPER
Nansa BURLET
Co-Chair, IOF Committee Scientific Advisors (CSA)
Jorge Benito CANNATA ANDIA
René RIZZOLI Antonio CANO
Co- Chair, ESCEO Scientific Advisory Board (SAB) Etienne CAVALIER
Claus CHRISTIANSEN
John A. KANIS Juliet COMPSTON
IOF President Cyrus COOPER
Jean-Pierre DEVOGELAER
Jean-Yves REGINSTER
Adolfo DIEZ-PEREZ
ESCEO President
Manuel DIAZ CURIEL
Andrea GASPARIK
Nicholas HARVEY
Gabriel HERRERO-BEAUMONT
Mickaël HILIGSMANN
John A. KANIS
Jean-Marc KAUFMAN
Paul LIPS
Roman LORENC
George LYRITIS
Johanne MARTEL-PELLETIER
Eugene McCLOSKEY
Santiago PALACIOS
Socrates PAPAPOULOS
Karel PAVELKA
Jean-Pierre PELLETIER
Jean-Yves REGINSTER
Johann RINGE
René RIZZOLI
Antonio HERRERA RODRIGUEZ
Christian ROUX
Manuel SOSA HENRIQUEZ
Pavel SZULC
Thierry THOMAS

LocaL organizing committee

Adolfo DIEZ-PEREZ and Ramón PÉREZ CANO
Chairs, LOC

Jorge Benito CANNATA ANDIA

Antonio CANO
Manuel DIAZ CURIEL
Antonio HERRERA RODRIGUEZ
Gabriel HERRERO-BEAUMONT
Santiago PALACIOS
Manuel SOSA HENRIQUEZ

ABSTRACT BOOK 10
 CONGRESS ORGANIZATION
Secretariat Sponsors and Exhibitors list
Yolande Piette Communication
Email: [email protected] DIAMOND SPONSORS
Bd G. Kleyer, 108
B-4000 Liège, Belgium
Tel: +32 (0)4 254 12 25
Fax: +32 (0)4 254 12 90
Website: www.piettecommunication.com

Registration and Hotel booking

Pacific World
Diputación 238-244
08007 Barcelona, Spain GOLD SPONSORS
Registration: [email protected]
Hotel booking: [email protected]
Tel: +34 902 090 561

Abstract submission
Yolande Piette Communication
Email: [email protected]
Bd G. Kleyer, 108 SILVER SPONSOR
B-4000 Liège, Belgium
Tel: +32 (0)4 254 12 25
Fax: +32 (0)4 254 12 90

Sponsorship opportunities / Exhibition

GENERAL SPONSORS
Yolande Piette Communication
Email: [email protected]
Alexion
Bd G. Kleyer, 108
Bone Index
B-4000 Liège, Belgium
Danone
Tel: +32 (0)4 254 12 25
Echolight
Fax: +32 (0)4 254 12 90
GE Healthcare Medical Systems
Hologic
Congress venue (3-5 April) Hyprevention
FIBES, Palacio de Exposiciones y Congresos IBSA
Avda. Alcalde Luis Uruñuela, 1 Medi
41020 Sevilla, Spain Medimaps Group
Tel: +34 954 47 87 00 Mindways Software
Fax: +34 954 47 87 20 OsteoSys
Wisepress
Congress venue (2 April)
Casino de la exposición
Glorieta San Diego
41013 Sevilla, Spain
+34 955 47 29 92

Congress website
www.wco-iof-esceo.org

ABSTRACT BOOK 11
 CONGRESS INFORMATION How to reach the congress center?
1) A FREE SHUTTLE SERVICE (by TUSSAM, Sevilla public transport company).
Congress venue (3-5 April) Route: Morning: San Bernardo --> Nervión --> Santa Justa --> Fibes Congress
FIBES, Palacio de Exposiciones y Congresos Center
Evening: Fibes Congress Center --> Santa Justa --> Nervión --> San Bernardo
Avda. Alcalde Luis Uruñuela, 1 Timetables: April 3rd and 4th: one service starting at 08.00 until 8:45 and
41020 Sevilla returning at 18.30
Tel: +34 954 47 87 00 April 5th: one service starting at 08.00 until 8:45 and returning at 15.00
Fax: +34 954 47 87 20
2) FROM THE SAN PABLO INTERNATIONAL AIRPORT

Congress venue (2 April) TUSSAM AIRPORT BUS

There is a bus service between the airport and the city center from 4:30 am
Casino de la exposición until 1:10 am
Glorieta San Diego Please check the timetables : http://www.aena-aeropuertos.es/csee/Satellite/
41013 Sevilla Aeropuerto-Sevilla/en/Seville.htlm
+34 955 47 29 92 AIRPORT - CITY TAXI
Fixed fare for taxis from and to the airport, regardless the area you go within
Operating dates and hours the city of Seville
FARE 1 : 21.89 € (working days, Monday-Friday / 7am-9pm)
Congress Opening hours: FARE 2 : 24.41 € (Monday-Friday / 9pm-7am / Saturday-Sunday-bank holidays/
all day)
Location: Casino de la Exposición FARE 3 : 30.50 € (applied at Easter and April Fair)
Wednesday, April 2 from 16:50 to 21:10 For more information:
www.aena-aeropuertos.es/csee/Satellite/Aeropuerto-Sevilla/en
Congress Exhibition hours:
3) FROM THE RAILWAY STATION
Location : Fibes Congress Center
Thursday, April 3 from 9:00 to 18:30 TRAIN C4
Friday, April 4 from 9:00 to 18:30 This is the best and fastest means to get to Fibes from the railway station
Saturday, April 5 from 9:00 to 15:00 Seville has 3 main train stations: Santa Justa, San Bernardo and Virgen del Rocío.
In addition, there are also two further train halts: Padre Pio and Fibes Conference
Centre.
Registration Desks Opening Hours - C4 Train from Santa Justa Main Train Station reaches FIBES in 6 minutes
Location : Fibes Congress Center - C4 Train from San Bernardo station reaches FIBES in 11 minutes
Thursday, April 3 from 8:00 to 18:30 Fares Single Ticket: 1.70 € - Return Ticket: 1.90 €
More info: www.renfe.com/EN/viajeros/
Friday, April 4 from 8:30 to 18:30
Saturday, April 5 from 8:30 to 15:00 TAXI
Many taxis can be found at the main entrance of the Santa Justa Railway Station
(please note that taxis at Santa Justa Station apply a surcharge of 1.39 &euro)
Poster viewing
BUS
Poster Session 1 (P101-P400)
From Santa Justa: take bus line 27 (gets to Fibes in 10/15 min)
Thursday April 3, 2014 14:00-15:00 It’s approx. 8 min walking from Santa Justa Station.
Take bus line C1 and then take line 27.
Poster Session 2 (P401-P750) From San Bernardo: take bus line B4 (reaches Fibes in approx. 15/20 min)
Friday April 4, 2014 14:00-15:00
4) FROM THE CITY CENTER
Means to get to Fibes from the city/historical centre:
Oral presentation of selected posters
Thursday April 3, 2014 14:00-14:28 TRAM
It runs to/from San Bernardo station (connection with C4 train)
Friday, April 4, 2014 14:00-14:28
METRO
It stops at the city centre and San Bernardo station
(direct connection with C-4 train halt)

BUS
Take the lines 27 and B4 reach FIBES from the city centre or San Bernardo
station.

5) BY CAR

The main highways are the N-IV, coming from Madrid, the A-92, coming from
Malaga and the A-49, coming from the coast. When arriving in Seville, there are
plenty of signs directing to Fibes.

ABSTRACT BOOK 12
 CONGRESS INFORMATION
Accreditation Lunches, coffee and refreshments
European accreditation In order to comply with international compliance rules, no
The WCO-IOF-ESCEO 2014 Congress was granted 18 European official lunches or coffee breaks will be provided.
CME credits (ECMEC) by the European Accreditation Council Coffee, beverages and snacks can be purchased from the
for Continuing Medical Education (EACCME - www.eaccme.eu) Bar point located in the exhibition area and opened during
Congress hours.
Belgian accreditation
Information soon. Media
The WCO-IOF-ESCEO 2014 Congress will not provide any
Badges Media Centre, however Media representatives are free to use
Courtesy of MSD the Internet Corner available durng Congress hours.
Lost badges : 65 euros fee/badge
For registered participants, personalized badges will be Notebook and Pen
requested for entry to all scientific programmes and to access Courtesy of Servier
the exhibition and posters areas. Blank badges are prohibited. A notebook and a pen are included in the congress bag.
Certificate of attendance Pocket programme
A certificate of attendance may be printed at the self-printing
Courtesy of MSD
stations available in the Registration Area from Friday April
A Pocket programme is included with your badge.
4th afternoon to Saturday April 5th. This system will issue your
certificate with date from the barcode printed on your badge.
Please ensure that you have your badge with you. Tourist information
www.visitasevilla.es
Cloakroom
A cloackroom service for clothing and reasonably sized items General emergency number
is available during the opening hours of the Congress. It is European Telephone Number : 112
located next to the registration desk.
Items of value should not be left in the cloakroom. Please make Welcome cocktail
sure to collect all belongings at the end of each day.
Courtesy of Rottapharm | Madaus
All WCO-IOF-ESCEO 2014 participants are invited to the
Congress bags Welcome Cocktail on Wednesday April 2nd, 2014, 20:10 at the
Courtesy of Servier Casino de la Exposicion
Venue : Glorieta de San Diego | CP 41003 Sevilla
Hotel information desk Tel: +34 955 47 29 92
The Hotel Desk is located in the Registration Area during
Registration opening hours. Future meetings
2015 – WORLD CONGRESS ON OSTEOPOROSIS,
Internet access OSTEOARTHRITIS AND MUSCULOSKELETAL DISEASES
Courtesy of ESCEO WCO-IOF-ESCEO 2015
A free Wireless internet connexion is available in the Congress MiCo – Milano Congressi
Center. Milan – Italy
An Internet Corner with computers will be also available to all March 26-29, 2015
delegates at level -1 during the Congress Exhibition Hours.

Language
English will be the official language of the Congress. No
translation is provided.

ABSTRACT BOOK 13
ABSTRACT BOOK
FLOOR 0
Registration Area AUDITORIUM A
Exhibition Area
Auditorium A
Podium (Oral Presentation)
Speakers
preview
room FLOOR -1

Access ramp FLOOR -1

1 2
FLOOR -1

T
EA ON
MAIN

AR RATI
GIS
5 6 FLOOR -1

RE
ENTRANCE
CONGRESS VENUE - FLOOR PLAN LEVEL 0

FLOOR 0

7 FLOOR +1

10
9
11
15 16 17 18
12 PODIUM - ORAL
13 PRESENTATION
FLOOR -1

1. ROTTAPHARM MADAUS 12. BONE INDEX 14 LOUNGE

FLOOR +1
AREA
2. AMGEN 13. MEDIMAPS GROUP
5. DANONE 14. MSD
6. HOLOGIC 15. GE HEALTHCARE MEDICAL SYSTEMS
7. MEDI 16. HYPREVENTION
9. MSD 17. MINDWAYS SOFTWARE
10. SERVIER 18. WISEPRESS
11. ELY LILLY

14
 TERRACE

ABSTRACT BOOK
FLOOR -1
Exhibition Area 22 24
25
Poster Area
26
Internet Corner 20 INTERNET
CORNER 27
Bar - Snack
21 28

FLOOR -1

BAR-SNACK
POSTERS
AREA

Access ramp FLOOR 0

Auditorium A Auditorium A
Exit Floor -1 Exit Floor -1

FLOOR 0

FLOOR 0
CONGRESS VENUE - FLOOR PLAN LEVEL -1

FLOOR 0
20. ALEXION 25. IOF
21. OSTEOSYS 26. FRAX
22. ECHOLIGHT 27. WCO
24. YPC 28. ESCEO

15
 FLOOR +1
Auditorium B

ABSTRACT BOOK
PRESS
Meetings Rooms (Esceo & MTP) E
ROOM
Paris

PARIS
Madrid
Bruselas D A
Press Room *
(* restricted access)

BRUSELAS
A

E D

MADRID
A B
AUDITORIUM B
FLOOR +1

FLOOR 0
CONGRESS VENUE - FLOOR PLAN LEVEL +1

FLOOR 0

FLOOR 0

16
16:50 - 17:50 18:50 - 21:10
ESCEO SY MPOSIUM WCO-IOF-ESCEO - OPENING CEREMONY
Chairpersons: Jean‑Yves Reginster, John A. Kanis
- Efficacy and safety of anti- Casino de la Exposición
osteoporosis medications in the el derl y 18:50 - 18:55
Chairpersons: Jaime Branco, Maria Luisa Brandi OPENING OF TH E MEETING Casino de la Exposición
- Introduction - Maria Luisa Brandi René Rizzoli
- Presentation of the ESCEO Consensus - René Rizzoli
- Optimizing therapeutic adherence in the elderly - John Weinman 18:55 - 19:55
- Wrap-up and conclusion - René Rizzoli INDUSTRY -SPONSORED H ONORARY Casino de la Exposición
- Discussion - Leader: Johann D. Ringe LECTURE
Panel: Jaime Branco, Maria Luisa Brandi, Olivier Bruyère, - The mammalian circadian timing system: how clocks talk to each
Patrice Cacoub, Cyrus Cooper, Adolfo Diez‑Perez, Jonny Duder, other - Ueli Schibler
Roger Fielding, Nicholas Harvey, Mickaël Hiligsmann, John A. Kanis, 19:55 - 20:10
Jean Petermans, Jean‑Yves Reginster, Johann D. Ringe, René Rizzoli, Presentation of the ESCEO-IOF Servier Pierre D. Casino de la Exposición
John Weinman Delmas Prize
17:50 - 18:50 Bess Dawson‑Hughes
Chairperson: Cyrus Cooper Casino de la Exposición Presentation of the IOF SERVIER Young Casino de la Exposición
Best clinical papers published in 2013 Investigator Research Grant
Socrates Papapoulos John A. Kanis
20:10 - 21:10
WELCOME COCKTAIL Casino de la Exposición

18
09:00 - 11:50 11:00 - 11:10
SCIENTIFIC SESSION I OC 6 Auditorium A
Chairpersons: John A. Kanis, Jean‑Yves Reginster FIRST-LINE ANALYSIS OF TH E EFFECTS OF TREATMENT ON
PROG RESSION OF STRUCTURAL CH ANG ES IN KNEE
09:00 - 09:30 OSTEOARTH RITIS OVER 24 MONTH S: DATA FROM TH E
Plenary Lecture 1 Auditorium A OSTEOARTH RITIS INITIATIVE PROG RESSION COH ORT
- The lifecourse epidemiology of musculoskeletal ageing - Presenting author: J. Martel‑Pelletier
Cyrus Cooper Authors: C. Roubille, F. Abram, M. C. Hochberg, M. Dorais, P. Delorme,
09:30 - 09:40 J.‑P. Raynauld, J.‑P. Pelletier
Presentation of the ESCEO-IOF Herbert Fleisch Medal Auditorium A 11:10 - 11:20
Jean‑Yves Reginster OC 7 Auditorium A
09:40 - 10:20 ECONOMIC EVALUATION OF AN OSTEOPOROSIS SCREENING
Oral communications selected from abstracts CAMPAIG N: USING FRAX AS A PRESCREENING TOOL
Presenting author: M. Hiligsmann
09:40 - 09:50 Authors: W. Ben Sedrine, O. Bruyère, P. Jeholet, V. Misson, G. Pire,
OC 1 Auditorium A J.‑Y. Reginster
RELATIONSH IP OF WEIG H T, H EIG H T, AND BODY MASS INDEX
WITH FRACTURE RISK AT DIFFERENT SITES IN 11:20 - 11:30
POSTMENOPAUSAL WOMEN: TH E G LOBAL LONG ITUDINAL OC 8 Auditorium A
STUDY OF OSTEOPOROSIS IN WOMEN (G LOW) DO OSTEOPOROTIC H IP FRACTURES IN RH EUMATOID ARTH RITIS
Presenting author: J. E. Compston VARY IN TYPE, TIMING AND SURG ICAL INTERVENTION AND DO
Authors: A. Z. Lacroix, F. H. Hooven, S. L. Greenspan, S. H. Gehlbach, TH EY IMPACT ON SURVIVAL? RESULTS FROM TWO LARG E UK
A. Diez‑Perez, C. Cooper, R. Chapurlat, S. Boonen, F. A. Anderson, INCEPTION COH ORTS LINKED WITH NATIONAL DATA
S. Adami, L. March, J. C. Netelenbos, J. Flahive, D. W. Hosmer, Presenting author: E. Nikiphorou
N. B. Watts, E. S. Siris, S. Silverman, K. G. Saag, C. Roux, M. Rossini, Authors: L. Carpenter, J. Dixey, P. Williams, P. Kiely, D. A. Walsh,
J. Pfeilschifter, J. W. Nieves, J. D. Adachi R. Williams, A. Young

09:50 - 10:00 11:30 - 11:40

OC 2 Auditorium A OC 9 Auditorium A
QUANTITATIVE ULTRASOUND (QUS) IS ASSOCIATED WITH ASSOCIATION BETWEEN JOINT SPACE WIDTH , KELLG REN-
FRACTURE RISK: A META - ANALYSIS LAWRENCE SCORE, PAIN AND PROG RESSION IN OSTEOARTH RITIS
Presenting author: E. V. McCloskey SUBJECTS FROM TWO PH ASE III STUDIES: A CLINICAL STUDY
Authors: J. A. Kanis, A. Odén, D. C. Bauer, C. C. Glüer, D. Hans, REFERENCE DATABASE
S. K. Kaptoge, K. T. Khaw, M. A. Krieg, A. Kwok, E. Lau, F. Marin, Presenting author: C. Christiansen
T. W. O'neill, E. S. Orwoll, J. Reeve, H. Johansson Authors: A. B. Bihlet, I. B. Byrjalsen, B. J. R. Riis, P. A. Aleksandersen,
M. A. Karsdal
10:00 - 10:10
OC 3 Auditorium A 11:40 - 11:50
RISK FACTORS FOR FALLS AMONG ELDERLY NURSING H OME OC 10 Auditorium A
RESIDENTS: A 2-YEAR PROSPECTIVE STUDY QUALITY OF LIFE BENEFITS OF KNEE ARTH ROPLASTY FOR
Presenting author: F. Buckinx OSTEOARTH RITIS
Authors: C. Beaudart, J. Slomian, D. Maquet, M. Demonceau, S. Gillain, Presenting author: A. Neuprez
J. Petermans, J.‑Y. Reginster, O. Bruyère Authors: G. François, W. Kurth, T. Thirion, C. Daniel, J. P. Huskin,
J.‑Y. Reginster
10:10 - 10:20
OC 4 Auditorium A 12:15 - 13:45
SUBCH ONDRAL BONE TURNOVER, JOINT SPACE NARROWING INDUSTRY -SPONSORED LUNCH SY MPOSIUM Auditorium A
AND OSTEOPH YTE FORMATION MAY BE PREDICTED BY ALPH A- Efficacy and util ity of gl ucosamine sul fate and hyal uronic
CTX, A H IG H BONE TURNOVER DEG RADATION MARKER acid in the management of osteoarthritis
Presenting author: M. A. Karsdal Chairperson: Roy D. Altman
Authors: J. L. H. Huebner, V. K. Kraus, A. C. Bay‑Jensen - Critical review and interpretation of the newest meta-analyses of intra-
articular hyaluronate for knee osteoarthritis - Emmanuel Maheu
10:20 - 10:50 - Crystalline glucosamine sulfate is the only SYSADOA that decreases
Plenary Lecture 2 Auditorium A consumption of NSAIDs in knee osteoarthritis: results from the PEGASUS
- Osteoporosis therapy, beyond fracture prevention - cohort - Lucio C. Rovati
Jonathan D. Adachi - Disease modification in knee osteoarthritis with oral glucosamine
sulfate or intra-articular hyaluronic acid: a review of the current
10:50 - 11:50
evidence - Roy D. Altman
Oral communications selected from abstracts
12:15 - 13:45
10:50 - 11:00
INDUSTRY -SPONSORED LUNCH SY MPOSIUM Auditorium B
OC 5 Auditorium A
H ypophosphatasia: evol ving our understanding of this serious
H OSPITALIZED AND NONH OSPITALIZED VERTEBRAL
and compl ex disease
FRACTURES: COMPARISON OF PATIENT DEMOG RAPH ICS AND
Chairperson: Maria Luisa Brandi
H EALTH RELATED QUALITY OF LIFE IMPLICATIONS
- What we should all know about HPP - Etienne Mornet
Presenting author: A. Svedbom
- HPP: clinical perspectives - Gabriel Angel Martos Moreno
Authors: V. Wintzell, V. Alekna, M. Tamulaitiene, M. L. Bianchi,
- HPP and Osteoporosis - what are the links? - Richard Eastell
P. Clark, M. Diaz Curiel, H. P. Dimai, O. Lesnyak, E. V. McCloskey,
- HPP: an evolving disease landscape - Maria Luisa Brandi
K. M. Sanders, T. Thomas, F. Borgström, J. A. Kanis

19
14:00 - 15:00 - Chal l enges with the devel opment of bone forming Bruselas E
Poster Viewing Poster Area agents in Europe
Session I (P101-P400) Chairperson: John A. Kanis
- Introduction - John A. Kanis
14:00 - 14:28 - Challenges faced by pharmaceutical industry in Europe for the
Oral presentation of selected posters development of bone forming agents - Andreas Grauer
Chairperson: Johanne Martel‑Pelletier - ESCEO experts consensus for the development of bone forming agents
14:00 - 14:07 in Europe - John A. Kanis
P 420 Podium - Discussion - Leader: John A. Kanis
PLASMA SPH ING OSINE 1-PH OSPH ATE LEVELS AND TH E RISK OF Panel: John Caminis, Cyrus Cooper, Andreas Grauer, John A. Kanis,
OSTEOPOROTIC FRACTURES: TH E CEOR STUDY Etoh Masaya, Yasuo Nakamura, Florence Petit‑Dop, Jean‑Yves Reginster,
Presenting author: M.‑S. M. Ardawi René Rizzoli, Koshi Sakamoto, Yannis Tsouderos
Authors: A. A. Rouzi, S. A. Al‑Sibiani, N. S. Senani, M. H. Qari 14:00 - 15:00
14:07 - 14:14 MEET-TH E-EX PERT SESSIONS
P 443 Podium 14:00 - 15:00
DECLINING H IP FRACTURE RISK IN SWEDEN -Fracture heal ing: facts and fantasy Madrid A
Presenting author: A. Odén Thomas Einhorn
Authors: E. V. McCloskey, H. Johansson, J. A. Kanis
14:00 - 15:00
14:14 - 14:21 -New mol ecul es against osteoarthritis Madrid B
P 313 Podium Francis Berenbaum
TH E RELATIONSH IP BETWEEN DXA MEASURES OF MATERNAL,
PATERNAL AND OFFSPRING BONE MASS: FINDING S FROM TH E 14:00 - 15:00
SOUTH AMPTON WOMEN’ S SURVEY -H ormone repl acement therapy in the mal e Madrid D
Presenting author: C. Holroyd Jean‑Marc Kaufman
Authors: P. Taylor, S. C. Crozier, H. Inskip, K. M. Godfrey, C. Cooper,
N. C. Harvey 14:00 - 15:00
-Prevention of bone metastases Madrid E
14:21 - 14:28 Eugene McCloskey
P 413 Podium
IMPACT OF COMPONENTS OF TH E METABOLIC SYNDROME ON 15:00 - 16:40
PROG RESSION OF KNEE OSTEOARTH RITIS IN TH E SEKOIA STUDY SCIENTIFIC SESSION II
Presenting author: C. Parsons Chairpersons: Cyrus Cooper, Jonathan D. Adachi
Authors: M. H. Edwards, F. Eymard, J.‑Y. Reginster, O. Bruyère, 15:00 - 15:30
F. Petit‑Dop, P. Richette, X. Chavalier, E. M. Dennison, C. Cooper Plenary Lecture 3 Auditorium A
14:00 - 15:00 - Definition, pathophysiology and management of sarcopenia -
EDUCATIONAL LECTURE 1 Auditorium B Roger Fielding
- How to formulate a research hypothesis? - Ego Seeman 15:30 - 15:40
14:00 - 15:00 Presentation of the IOF Pierre Delmas Award Auditorium A
ESCEO SY MPOSIA John A. Kanis

- Al gorithm for the management of osteoarthritis in Bruselas A 15:40 - 16:40

Europe Oral communications selected from abstracts
Chairpersons: Marc Hochberg, Olivier Bruyère 15:40 - 15:50
- Introduction - Olivier Bruyère OC 11 Auditorium A
- Why do we need an algorithm for the treatment of osteoarthritis? - TRACKING OF ENVIRONMENTAL DETERMINANTS OF BONE
Jean‑Pierre Pelletier STRUCTURE AND STRENG TH DEVELOPMENT IN H EALTH Y BOYS:
- Presentation of the ESCEO algorithm - Jean‑Yves Reginster AN EIG H T-YEAR FOLLOW UP STUDY ON TH E POSITIVE
- Discussion - Leader: Cyrus Cooper INTERACTION BETWEEN PH YSICAL ACTIVITY AND PROTEIN
Panel: Jaime Branco, Maria Luisa Brandi, Olivier Bruyère, Cyrus Cooper, INTAKE FROM PREPUBERTY TO MID-LATE ADOLESCENCE
Andrea Ildiko Gasparik, Francis Guillemin, Marc Hochberg, Presenting author: T. Chevalley
John A. Kanis, Johanne Martel‑Pelletier, Jean‑Pierre Pelletier, Authors: J.‑P. Bonjour, B. van Rietbergen, S. Ferrari, R. Rizzoli
Jean‑Yves Reginster, René Rizzoli, Stuart Silverman
15:50 - 16:00
- Nutrition for muscul oskel etal heal th in Paris A OC 12 Auditorium A
postmenopausal women EARLY G ROWTH OF LEAN, RATH ER TH AN FAT MASS, PREDICTS
Chairpersons: Maria Luisa Brandi, Adolfo Diez‑Perez, René Rizzoli BONE SIZE AND MINERAL DENSITY IN CH ILDH OOD: FINDING S
- Introduction - René Rizzoli FROM TH E SOUTH AMPTON WOMEN'S SURVEY
- Prevention of musculoskeletal ageing: interplay of nutrition and Presenting author: R. J. Moon
exercise - René Rizzoli Authors: Z. A. Cole, S. C. Crozier, A. Aihie Sayer, J. H. Davies,
- Dairy protein & exercise to promote skeletal muscle anabolism - S. M. Robinson, H. Inskip, K. M. Godfrey, C. Cooper, N. C. Harvey
Luc J. C. van Loon
- Discussion & Take home messages for musculoskeletal health - Leader: 16:00 - 16:10
Jurgen Bauer OC 13 Auditorium A
Panel: Jurgen Bauer, Maria Luisa Brandi, Olivier Bruyère, Cyrus Cooper, FEATURES ASSESSED ON MAG NETIC RESONANCE IMAG ING
Adolfo Diez‑Perez, John A. Kanis, Jean‑Yves Reginster, René Rizzoli, (MRI) IMPROVE PREDICTION OF TOTAL KNEE ARTH ROPLASTY
John Stevenson, Luc J. C. van Loon, Stéphane Walrand (TKA) IN SUBJECTS WITH SYMPTOMATIC RADIOG RAPH IC KNEE
OSTEOARTH RITIS (OA): DATA FROM TH E OSTEOARTH RITIS
INITIATIVE (OAI)
Presenting author: M. C. Hochberg
Authors: A. Yip, K. Favors, J. Sorkin, J. Martel‑Pelletier, J.‑P. Pelletier

20
16:10 - 16:20
OC 14 Auditorium A
LOW SERUM TH YROTROPIN LEVEL AND DURATION OF SUPPRESSION AS A
PREDICTOR OF MAJOR OSTEOPOROTIC FRACTURES: TH E OPENTH YRO
REG ISTER COH ORT
Presenting author: B. Abrahamsen
Authors: H. L. Jørgensen, A. S. Laulund, M. Nybo, T. H. Brix, L. Hegedüs
16:20 - 16:30
OC 15 Auditorium A
INFLUENCE OF LONG -TERM H IV INFECTION ON BONE MICROSTRUCTURE IN
MEN OLDER TH AN 60 YEARS
Presenting author: E. Biver
Authors: A. Calmy, C. Delhumeau, C. Durosier, S. Zawadynski, R. Rizzoli
16:30 - 16:40
OC 16 Auditorium A
LONG ITUDINAL STUDY OF BMD AMONG H IV-INFECTED MEN
Presenting author: K. Walker‑Bone
Authors: A. Samarawickrama, S. Jose, C. Sabin, Y. Gilleece, M. Fisher
17:00 - 18:30
INDUSTRY -SPONSORED SATELLITE SY MPOSIUM Auditorium A
Management of severe osteoporosis: a cal l for action
Chairpersons: René Rizzoli, Maria Luisa Brandi
- Introduction - Maria Luisa Brandi
- Severe osteoporosis, state of the art - John A. Kanis
- Why severe osteoporosis is still an unmet medical need? - Cyrus Cooper
- Strontium ranelate as a treatment of severe osteoporosis: an evidence-based efficacy
- Jean‑Yves Reginster
- Conclusion - René Rizzoli

21
09:00 - 11:50 11:00 - 11:10
SCIENTIFIC SESSION III OC 22 Auditorium A
Chairpersons: Maria Luisa Brandi, Socrates Papapoulos FRACTURE PATTERNS WITH SELECTIVE SEROTONIN RECEPTOR
INH IBITOR, PROTON PUMP INH IBITOR AND G LUCOCORTICOIDS
09:00 - 09:30 USE IN G LOW
Plenary Lecture 4 Auditorium A Presenting author: J. D. Adachi
- Diabetes, obesity, metabolic syndrome and bone - Serge Ferrari Authors: A. Z. Lacroix, R. Lindsay, L. March, J. C. Netelenbos,
09:30 - 09:40 J. Pfeilschifter, M. Rossini, C. Roux, K. G. Saag, E. S. Siris, S. Silverman,
Presentation of the ESCEO-MSD Fellowships Auditorium A F. H. Hooven, S. L. Greenspan, A. Wyman, G. Fitzgerald, S. Adami,
Maria Luisa Brandi F. A. Anderson, S. Boonen, R. Chapurlat, J. E. Compston, C. Cooper,
A. Diez‑Perez, S. H. Gehlbach, N. B. Watts
09:40 - 10:00
Oral communications selected from abstracts 11:10 - 11:20
OC 23 Auditorium A
09:40 - 09:50 H IG H ER SERUM OSTEOCALCIN IS ASSOCIATED WITH METABOLIC
OC 17 Auditorium A SYNDROME SEVERITY IN MEN FROM TH E MINOS COH ORT
ENH ANCED BIOAVAILABILITY OF A NASAL FORMULATION OF Presenting author: C. B. Confavreux
TERIPARATIDE WITH CRITICALSORB™ COMPARED TO A Authors: P. Szulc, R. Casey, A. Varennes, J. Goudable, R. Chapurlat
SUBCUTANEOUS INJECTION: A NONINVASIVE APPROACH FOR
TH E TREATMENT OF OSTEOPOROSIS 11:20 - 11:30
Presenting author: F. Jordan OC 24 Auditorium A
Authors: A. Williams, A. Perkins, T. Masud, R. Pearson, G. King SEROLOG ICAL BIOMARKERS OF JOINT TURNOVER FOR EARLY
IDENTIFICATION OF RESPONDERS TO TOCILIZUMAB
09:50 - 10:00 Presenting author: A. C. Bay‑Jensen
OC 18 Auditorium A Authors: A. S. Siebuhr, C. Christiansen, M. A. Karsdal
ROMOSOZUMAB ADMINISTRATION IS ASSOCIATED WITH
SIG NIFICANT IMPROVEMENTS IN LUMBAR SPINE AND H IP 11:30 - 11:40
VOLUMETRIC BONE MINERAL DENSITY (VBMD) AND CONTENT OC 25 Auditorium A
(BMC) COMPARED WITH TERIPARATIDE A META-ANALYSIS OF TH E EFFECT OF STRONTIUM RANELATE ON
Presenting author: H. K. Genant TH E RISK OF VERTEBRAL AND NON-VERTEBRAL FRACTURE IN
Authors: M. A. Bolognese, C. Mautalen, J. P. Brown , C. Recknor, POSTMENOPAUSAL OSTEOPOROSIS: TH E IMPACT OF SEVERE
S. Goemaere, K. Engelke, Y. C. Yang, M. Austin, A. Grauer, C. Libanati OSTEOPOROSIS AND CONTRAINDICATIONS
Presenting author: J. A. Kanis
10:00 - 10:30 Authors: H. Johansson, A. Odén, E. V. McCloskey, C. Cooper, R. Rizzoli,
Plenary Lecture 5 Auditorium A J.‑Y. Reginster
- Extraskeletal effects of Vitamin D - Bess Dawson‑Hughes
11:40 - 11:50
10:30 - 11:50 OC 26 Auditorium A
Oral communications selected from abstracts PRESERVATION OF BONE MASS IN TRANS WOMEN DURING
CROSS-SEX H ORMONAL TH ERAPY: A PROSPECTIVE
10:30 - 10:40
OBSERVATIONAL STUDY
OC 19 Auditorium A
Presenting author: E. Van Caenegem
VITAMIN D INSUFFICIENCY SUSTAINED OVER 5 YEARS
Authors: K. Wierckx, Y. Taes, S. Vandewalle, K. Toye, J.‑M. Kaufman,
CONTRIBUTES TO INCREASED 10-YEAR FRACTURE RISK IN
G. T'sjoen
ELDERLY WOMEN
Presenting author: D. Buchebner 12:15 - 13:45
Authors: F. E. Mcguigan, P. Gerdhem, M. Ridderstråle, K. Akesson INDUSTRY -SPONSORED LUNCH SY MPOSIUM Auditorium B
Innovative Therapeutic Strategies for Patients with
10:40 - 10:50
Osteoporosis and Fragil ity Fractures
OC 20 Auditorium A
Chairperson: Adolfo Diez‑Perez
TH E EFFECTS OF VITAMIN D ON SKELETAL MUSCLE STRENG TH ,
- Welcome & Introduction - Adolfo Diez‑Perez
MUSCLE MASS AND MUSCLE POWER: A META-ANALYSIS OF
- Role of bone quality parameters in the reduction of fragility fractures
RANDOMIZED CONTROLLED TRIALS
incidence - Adolfo Diez‑Perez
Presenting author: C. Beaudart
- Effects on bone tissue of bone forming versus antiresorptive
Authors: F. Buckinx, V. Rabenda, S. Gillain, E. Cavalier, J. Slomian,
treatments for patients with osteoporotic fractures - Erik Fink Eriksen
J. Petermans, J.‑Y. Reginster, O. Bruyère
- Combination or sequential treatment of patients with severe
10:50 - 11:00 osteoporosis: pros and cons - Jacques P. Brown
OC 21 Auditorium A - Closing Remarks - Adolfo Diez‑Perez
EIG H T YEARS OF DENOSUMAB TREATMENT IN
POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS: RESULTS
FROM TH E FIRST FIVE YEARS OF TH E FREEDOM EXTENSION
Presenting author: S. Papapoulos
Authors: K. Lippuner, C. Roux, C. J. F. Lin, D. L. Kendler,
E. M. Lewiecki, M. L. Brandi, E. Czerwinski, E. Franek, P. L. Lakatos,
C. Mautalen, S. Minisola, J.‑Y. Reginster, S. Jensen, N. Daizadeh,
A. Wang, M. Gavin, R. B. Wagman, H. G. Bone

22
12:15 - 13:45 14:00 - 15:00
ESCEO SY MPOSIUM MEET-TH E-EX PERT SESSIONS
Inside the benefit-risk ratio of osteoporosis Auditorium A 14:00 - 15:00
treatments: a gl obal overview -Risks/benefits of cal cium and/or Vitamin D Madrid A
Chairperson: Jean‑Yves Reginster Peter R. Ebeling
- Introduction - Jean‑Yves Reginster
- Selective estrogen receptor modulators: Raloxifene and Bazedoxifene 14:00 - 15:00
- Jean‑Marc Kaufman -Bariatric surgery and bone Madrid B
- Anti-resorptive treatments: Bisphosphonates and Denosumab - Nicholas Harvey
Serge Ferrari 14:00 - 15:00
- Strontium Ranelate - Cyrus Cooper -Inadequate response in osteoporosis therapy Madrid D
- Peptides of the parathyroid hormone family: PTH and Teriparatide - Adolfo Diez‑Perez
Roland Chapurlat
- Discussion and Wrap-up - Leader: Jean‑Yves Reginster 14:00 - 15:00
Panel: Maria Luisa Brandi, Roland Chapurlat, Cyrus Cooper, Serge Ferrari, -Prevention of G IOP Madrid E
John A. Kanis, Jean‑Marc Kaufman, Jean‑Yves Reginster, René Rizzoli Jonathan D. Adachi

14:00 - 15:00 14:00 - 15:00

Poster Viewing Poster Area -Postmenopausal hormone therapy : risks and benefits Paris A
Session II (P401-P750) Serge Rozenberg
14:00 - 14:28 14:00 - 15:00
Oral presentation of selected posters ESCEO SY MPOSIUM
Chairperson: Johanne Martel‑Pelletier
Qual itative and quantitative Adverse Reactions Bruselas A
14:00 - 14:07 induced by treatment of rheumatic disorders with
P 447 Podium G l ucocorticoid
H OW WELL DOES SELF-PERCEPTION OF FRACTURE RISK RELATE Chairperson: Jean‑Pierre Devogelaer
TO FRACTURE PROBABILITY USING FRAX? FINDING S FROM TH E - Introduction : Role for glucocorticoids in the management of
G LOW STUDY rheumatic diseases - Willem Lems
Presenting author: E. M. Dennison - Skeletal effects of glucocorticoid therapy in rheumatoid arthritis -
Authors: J. E. Compston, A. Wyman, E. S. Siris, S. H. Gehlbach, Kenneth Saag
J. D. Adachi, R. Chapurlat, A. Diez‑Perez, F. H. Hooven, A. Z. Lacroix, - Non-skeletal effects of glucocorticoid therapy in rheumatoid arthritis
J. C. Netelenbos, J. Pfeilschifter, M. Rossini, C. Roux, K. G. Saag, - Pierre Miossec
S. Silverman, N. B. Watts, S. L. Greenspan, J. W. Nieves, L. March, - Discussion - Leader: Jean‑Pierre Devogelaer
C. L. Gregson, C. Cooper Panel: Maria Luisa Brandi, John Caminis, Roberto Civitelli, Cyrus Cooper,
Patrice Cacoub, Jean‑Pierre Devogelaer, Adolfo Diez‑Perez,
14:07 - 14:14 Thomas Einhorn, Olivier Ethgen, Jean‑Marc Kaufman, John A. Kanis,
P 600 Podium Andrea Laslop, Willem Lems, Eugene McCloskey, Pierre Miossec,
DETECTION OF INCOMPLETE NONDISPLACED ATYPICAL FEMUR Jean‑Yves Reginster, Susanne Reiter, Johann D. Ringe, René Rizzoli,
FRACTURES BY DENSITOMETER Kenneth Saag, Yannis Tsouderos
Presenting author: A. M. Cheung
Authors: R. Bleakney, G. Tomlinson, L. E. Tile, H. Mcdonald‑Blumer, 14:00 - 15:00
R. Ridout, H. K. Genant ESCEO-EUG MS SY MPOSIUM
14:14 - 14:21 Can we identify which patients shoul d be treated in Bruselas E
P 553 Podium osteoarthritis?
ANTH ROPOMETRIC CH ARACTERISTICS OF POSTMENOPAUSAL Chairpersons: Olivier Bruyère, Gabriel Herrero‑Beaumont
WOMEN DEPENDING ON APPENDICULAR SKELETAL MASS - Welcome - Olivier Bruyère
Presenting author: V. V. Povoroznyuk - Introduction - Nigel K. Arden
Authors: N. I. Dzerovych, R. V. Povoroznyuk - Physiopathology and Risk factors for Progression - Francis Berenbaum
- Approach to substratification of the treatment of osteoarthritis -
14:21 - 14:28 Tim McAlindon
P 554 Podium - Discussion - Leader: Stephania Maggi
H IP-SPINE DIAG NOSTIC DISCORDANCE IN TH E UNITED ARAB Panel: Nigel K. Arden, Francis Berenbaum, Jaime Branco,
EMIRATES Maria Luisa Brandi, Olivier Bruyère, Cyrus Cooper, Elaine M. Dennison,
Presenting author: N. Wilson Jean‑Pierre Devogelaer, Gabriel Herrero‑Beaumont, Marc Hochberg,
Authors: L. Sanchez Riera, I. Hussein, S. Nuhaily, N. Qahtani, John A. Kanis, Andrea Laslop, Stephania Maggi, Tim McAlindon,
N. Ibrahim, R. Aneja, T. Khan, H. Maashari, S. Waheeduddin, Florence Petit‑Dop, Jean-Yves Reginster, Susanne Reiter,
S. Gonuguntla, M. Al Maini René Rizzoli, Yannis Tsouderos
14:00 - 15:00 15:00 - 16:40
OSTEONECROSIS OF TH E JAW TASKFORCE : IOF Paris E COMMITTEE OF NATIONAL SOCIETIES SPECIAL PLENARY
INTERNATIONAL CONSENSUS SESSION
Chairpersons: Cyrus Cooper, René Rizzoli Lifestyl e and dietary habits for fracture prevention and care
- Introduction and background - Cyrus Cooper Chairpersons: Judy Stenmark, Jean‑Yves Reginster
- Pathophysiology - Juliet Compston
- Incidence , diagnosis and staging - Aliya Khan 15:00 - 15:03
- Advances in management - Archie Morrison Introduction Bruselas A
Judy Stenmark, Jean‑Yves Reginster

23
15:03 - 15:09 16:03 - 16:09
OCs 43 Bruselas A OCs 53 Bruselas A
DOES LIFESTYLE MODIFICATION AND PH YSICAL TH ERAPY CH ARACTERISTICS OF SUBJECTS REPORTING LOW-ENERG Y
IMPROVE QUALITY OF LIFE IN POSTMENOPAUSAL FRACTURES IN A LARG E POPULATION-BASED STUDY
OSTEOPOROSIS? Presenting author: A. Shinkov
Presenting author: U. Swadpanich Sangkomkamhang Authors: A. M. Borissova, J. Vlahov, L. Dakovska, L. Kassabova,
D. Svinarov
15:09 - 15:15
OCs 44 Bruselas A 16:09 - 16:15
LIFESTYLE AND DIETARY H ABITS FOR FRACTURE PREVENTION OCs 54 Bruselas A
AND CARE LIFESTYLE, VITAMIN D AND OSTEOPOROSIS IN A VEIL
Presenting author: M. Tsagareli COVERED WOMAN
Authors: E. Giorgadze, N. Dolidze, T. Sulikashvili, N. Jeiranashvili Presenting author: S. Sokolovic
15:15 - 15:21 16:15 - 16:21
OCs 45 Bruselas A OCs 55 Bruselas A
IMPACT OF DIETARY H ABITS AND PH YSICAL ACTIVITY ON BONE TH E IMPACT OF NON-NUTRITIONAL FACTORS ON VITAMIN D
H EALTH AMONG 40-60 YEAR OLD FEMALES AT RISK OF STATUS IN ELDERLY UKRAINIAN POPULATION
OSTEOPOROSIS IN INDIA Presenting author: V. V. Povoroznyuk
Presenting author: R. Munshi Author: V. Muts
15:21 - 15:27 16:21 - 16:27
OCs 46 Bruselas A OCs 56 Bruselas A
LIFESTYLE RISKS AND MEDICATION ISSUES DISCUSSED WITH A COMMON PROJECT OF TH E OSTEOLOG ICAL CENTRE AT TH E
OSTEOPOROSIS PATIENTS OSTEOLOG Y ACADEMY OF ZLÍN TOG ETH ER WITH TH E
Presenting author: A. I. Gasparik NEUROSURG ICAL DEPARTMENT OF TOMAS BATA H OSPITAL IN
ZLIN MODEL PROJECT: CAPTURE TH E FRACTURE ZLÍN -
15:27 - 15:33 EVALUATION AFTER TWO YEARS
OCs 47 Bruselas A Presenting author: P. Novosad
LIFESTYLE AND DIETARY FACTORS PROMOTING DEVELOPMENT OF Authors: P. Hrdý, M. Filip, P. Linzer, J. Blahos
H IP FRACTURES IN MEN
Presenting author: O. Sinitsyna 16:27 - 16:33
Authors: K. Belova, O. Ganert, M. Romanova, O. Ershova OCs 57 Bruselas A
INTERNET AS A TOOL FOR H EALTH : SURVEY ON TH E INTEREST
15:33 - 15:39 AND TH E USE OF TH E INTERNET AMONG SUBJECTS FROM AN
OCs 48 Bruselas A OSTEOPOROSIS CENTRE – A PRELIMINARY REPORT
TOO FIT TO FRACTURE: INTERNATIONAL CONSENSUS TO Presenting author: J. Slomian
ESTABLISH RECOMMENDATIONS ON EXERCISE AND SAFE Authors: S. Streel, G. Appleboom, C. Beaudart, F. Buckinx,
MOVEMENT FOR INDIVIDUALS WITH OSTEOPOROSIS AND SPINE J.‑Y. Reginster, O. Bruyère
FRACTURES
Presenting author: L. M. Giangregorio 16:33 - 16:40
Authors: A. M. Cheung, A. Heinonen, S. Mcgill, J. Laprade, M. C. Ashe, Presentation of the IOF Committee of National Societies Bruselas A
K. Shipp, J. D. Wark, N. J. Macintyre, H. Keller, R. Jain, A. Papaioannou Medal
Jean‑Yves Reginster
15:39 - 15:45
OCs 49 Bruselas A 15:00 - 16:40
LEISURE TIME COMPUTER USE AND ADOLESCENT BONE H EALTH : SCIENTIFIC SESSION IV
FINDING S FROM TH E TROMSØ STUDY - FIT FUTURES Chairpersons: Bess Dawson‑Hughes, Adolfo Diez‑Perez
Presenting author: A. Winther
Authors: E. M. Dennison, O. A. Nilsen, R. Jorde, G. Grimnes, 15:00 - 15:30
A. S. Furberg, L. A. Ahmed, N. Emaus Plenary Lecture 6 Auditorium A
- Guidelines and intervention thresholds in osteoporosis -
15:45 - 15:51 John A. Kanis
OCs 50 Bruselas A
FALLSCREEN: A COLLABORATIVE EFFORT FOR FEASIBLE AND 15:30 - 15:40
EFFECTIVE PREVENTION OF FALLING IN COMMUNITY Presentation of the IOF Medal of Achievement Auditorium A
Presenting author: H. Sievänen Cyrus Cooper
Author: S. Karinkanta 15:40 - 16:40
15:51 - 15:57 Oral communications selected from abstracts
OCs 51 Bruselas A 15:40 - 15:50
PH YSICAL TH ERAPY BENEFITS UPON FUNCTIONAL STATUS AND OC 27 Auditorium A
FALL RISK IN OSTEOPOROTIC WOMEN FRAX BASED G UIDELINES: IS A UNIVERSAL MODEL
Presenting author: D. Popa APPROPRIATE?
Authors: M. Mihailov, R. Suciu Presenting author: M. Chakhtoura
15:57 - 16:03 Authors: A. M. Cheung, J. A. Kanis, W. D. Leslie, E. V. McCloskey,
OCs 52 Bruselas A M. R. McClung, G. El‑Hajj Fuleihan
RISK FACTORS OF OSTEOPOROSIS IN TURKISH WOMEN BEYOND 15:50 - 16:00
FRAX OC 28 Auditorium A
Presenting author: U. Akarirmak WH ICH FRAX MODEL IS APPROPRIATE FOR SWEDISH
Authors: S. Tuzun, N. Eskiyurt, D. Palamar, M. Saridogan IMMIG RANTS?
Presenting author: H. Johansson
Authors: A. Odén, E. V. McCloskey, J. A. Kanis, M. Karlsson,
M. Lorentzon, D. Mellström

24
16:00 - 16:10
OC 29 Auditorium A
CORTICAL POROSITY OF TH E PROXIMAL FEMUR IDENTIFIES WOMEN WITH
NONVERTEBRAL FRAG ILITY FRACTURES
Presenting author: Å. Bjørnerem
Authors: L. A. Ahmed, R. Shigdel, R. Joakimsen, P. Eldevik, E. F. Eriksen ,
A. Ghasem‑Zadeh, E. Seeman, R. Zebaze
16:10 - 16:20
OC 30 Auditorium A
CH ANG ES IN LUMBAR SPINE QCT, DXA AND TBS FOLLOWING TREATMENT
WITH DENOSUMAB (DMAB), ALENDRONATE (ALN), OR PLACEBO (PBO) IN
POSTMENOPAUSAL WOMEN WITH LOW BONE MASS
Presenting author: T. Thomas
Authors: A. M. Cheung, E. Shane, J. R. Zanchetta, A. Kearns, D. Hans, C. J. F. Lin,
M. Austin, C. Libanati
16:20 - 16:30
OC 31 Auditorium A
EIG H T YEARS OF CONTINUED ODANACATIB TH ERAPY FOR POSTMENOPAUSAL
WOMEN WITH LOW BONE MINERAL DENSITY: RESULTS FROM AN OPEN-LABEL
EXTENSION TO A PH ASE IIB STUDY
Presenting author: R. Rizzoli
Authors: J. A. Rodriguez Portales, C.‑L. Benhamou, J. Halse, P. D. Miller, L. Reid,
C. Dasilva, R. Kroon, A. Leung, D. Gurner
16:30 - 16:40
OC 32 Auditorium A
ASSESSMENT OF PERILACUNAR AND PERICANALICULAR TISSUE MASS
DENSITY ALTERATIONS IN H UMAN JAW BONE AFTER BISPH OSPH ONATE
TREATMENT BY 3D SYNCH ROTRON PH ASE NANOCT
Presenting author: K. Raum
Authors: B. Hesse, P. Varga, M. Langer, F. Peyrin
17:00 - 18:30
INDUSTRY -SPONSORED SATELLITE SY MPOSIUM Auditorium A
Treatment needs in postmenopausal osteoporosis
Chairperson: Adolfo Diez‑Perez
- Welcome & Introduction - Adolfo Diez‑Perez
- Current challenges in the management of postmenopausal osteoporosis -
Eugene McCloskey
- Which patients benefit the most from current treatments? - Santiago Palacios
- Long-term therapy: How long? - Serge Ferrari
- Panel Discussion

25
09:00 - 11:50 11:10 - 11:20
SCIENTIFIC SESSION V OC 39 Auditorium A
Chairpersons: René Rizzoli, Jorge Benito Cannata Andia FURTH ER REDUCTION IN NONVERTEBRAL FRACTURE RATE IS
OBSERVED FOLLOWING 3 YEARS OF DENOSUMAB TREATMENT:
09:00 - 09:30 RESULTS WITH UP TO 7 YEARS IN TH E FREEDOM EXTENSION
Plenary Lecture 7 Auditorium A Presenting author: S. Ferrari
- PTH and bone: lessons from hypoparathyroidism therapy - Authors: J. D. Adachi, K. Lippuner, C. Zapalowski, P. D. Miller,
Roberto Civitelli J.‑Y. Reginster, O. Törring, D. L. Kendler, N. Daizadeh, A. Wang,
09:30 - 09:40 C. O'Malley, C. Libanati, R. B. Wagman, E. M. Lewiecki
Presentation of the IOF Olof Johnell Science Award Auditorium A 11:20 - 11:30
René Rizzoli OC 40 Auditorium A
09:40 - 10:00 EARLY FINDING S FROM PROLIA® POST-MARKETING SAFETY
Oral communications selected from abstracts Auditorium A SURVEILLANCE FOR ATYPICAL FEMORAL FRACTURE,
OSTEONECROSIS OF TH E JAW, SEVERE SYMPTOMATIC
09:40 - 09:50 H YPOCALCEMIA, AND ANAPH YLAXIS
OC 33 Auditorium A Presenting author: M. Geller
RELATIONSH IPS BETWEEN BODY COMPOSITION AND BONE Authors: R. B. Wagman, P. R. Ho, S. Siddhanti, C. Stehman‑Breen,
MICROARCH ITECTURE IN OLDER MEN AND WOMEN OF TH E N. B. Watts, S. Papapoulos
H ERTFORDSH IRE COH ORT STUDY
Presenting author: M. H. Edwards 11:30 - 11:40
Authors: K. A. Ward, G. Ntani, C. Parsons, J. Thompson, E. M. Dennison, OC 41 Auditorium A
C. Cooper EFFECT OF TERIPARATIDE ON H EALING OF INCOMPLETE
ATYPICAL FEMUR FRACTURES
09:50 - 10:00 Presenting author: A. M. Cheung
OC 34 Auditorium A Authors: J. D. Adachi, A. Khan, L. E. Tile, E. R. Bogoch,
TH E EFFECTS OF CALCIUM SUPPLEMENTATION ON CORONARY H. Mcdonald‑Blumer, R. Ridout, S. Cardew, K. Syed, J. Chang, J. Scher,
H EART DISEASE H OSPITALISATION AND DEATH IN H. Hu, S. Morin, A. Papaioannou, S. Jamal, R. Josse, R. Bleakney
POSTMENOPAUSAL WOMEN: A COLLABORATIVE META-ANALYSIS
OF RANDOMISED CONTROLLED TRIALS 11:40 - 11:50
Presenting author: J. R. Lewis OC 42 Auditorium A
Authors: K. L. Ivey, S. Radavelli‑Bagatini, L. Rejnmark, J. S. Chen, SURG ICAL PREVENTION OF FEMORAL NECK FRACTURES IN
J. M. Simpson, J. M. Lappe, L. Mosekilde, R. L. Prentice, R. L. Prince OSTEOPOROTIC PATIENTS: LONG -TERM RESULTS
Presenting author: E. Chiarello
10:00 - 10:30 Authors: G. Tedesco, P. Capra, D. Luciani, S. Giannini
Plenary Lecture 8 Auditorium A
- How long can bone turnover be suppressed? - Socrates Papapoulos 12:15 - 13:45
INDUSTRY -SPONSORED LUNCH SY MPOSIUM Auditorium A
10:30 - 11:50 Interactive Discussion on the Management of Osteoporosis:
Oral communications selected from abstracts Signal ing a Change in the Conversation
Chairperson: Esteban Jodar
10:30 - 10:40
- Welcome & Opening Remarks - Esteban Jodar
OC 35 Auditorium A
- Long Term Treatment of Osteoporosis: The Risk Benefit Equation -
RACIAL VARIATION IN MEASURES OF H IP MORPH OLOG Y
Solomon Epstein
Presenting author: C. P. A. Arden
- The Role of Cathepsin K in Bone Homeostasis - Serge Ferrari
Authors: K. M. Leyland, K. Edwards, M. T. Sanchez‑Santos, T. D. Spector,
- New Approaches to the Treatment of Osteoporosis - Felicia Cosman
A. E. Nelson, J. M. Jordan, M. Nevitt, D. J. Hunter, N. K. Arden
- Question & Answer Session
10:40 - 10:50
14:00 - 15:00
OC 36 Auditorium A
MEET-TH E-EX PERT SESSIONS
TRABECULAR BONE SCORE IS ASSOCIATED WITH VERTEBRAL
AND NON VERTEBRAL FRACTURE IN MEN - TH E STRAMBO STUDY 14:00 - 15:00
Presenting author: S. Boutroy -Management of osteoporosis in Latin America Madrid A
Authors: D. Hans, R. Winzenrieth, R. Chapurlat, P. Szulc Jose R. Zanchetta, Cristiano Zerbini
10:50 - 11:00 14:00 - 15:00
OC 37 Auditorium A -Management of osteoporosis in Middl e East Madrid B
ANKLE FRACTURES ARE ASSOCIATED WITH LOW AREAL BMD Basel Masri, Gemma Adib
AND BONE MICROSTRUCTURAL ALTERATIONS IN
POSTMENOPAUSAL WOMEN 14:00 - 15:00
Presenting author: E. Biver -Responders in osteoarthritis treatment Madrid D
Authors: C. Durosier, T. Chevalley, F. Herrmann, S. Ferrari, R. Rizzoli Olivier Bruyère

11:00 - 11:10 14:00 - 15:00

OC 38 Auditorium A -Advanced bone imaging in osteoporosis assessment Madrid E
H YPOPH OSPH ATASIA IN ADULT: SCREENING OF AN ITALIAN Harry K. Genant
POPULATION G ROUP 14:00 - 15:00
Presenting author: L. Masi -Management of Osteoporosis in Patients with Paris A
Authors: F. Franceschelli, G. Leoncini, M. L. Brandi Rheumatoid Arthritis
Willem Lems

26
14:00 - 15:00
ESCEO SY MPOSIA
- G oal oriented treatment in Osteoporosis Paris E
Chairpersons: John A. Kanis, Jaime Branco
- Introduction - Serge Ferrari
- Lessons from other diseases areas - Eugene McCloskey
- Lessons from osteoporosis - Jean‑Marc Kaufman
- Discussion - Leader: John A. Kanis
Panel: Jaime Branco, Maria Luisa Brandi, John Caminis, Cyrus Cooper,
Elaine M. Dennison, Jean‑Pierre Devogelaer, Andreas Grauer, John A. Kanis,
Jean‑Marc Kaufman, Eugene McCloskey, Socrates Papapoulos, Jean‑Yves Reginster,
René Rizzoli, Serge Ferrari
- Consideration and proposal for defining a reference case for Bruselas E
economic eval uation in osteoarthritis
Chairpersons: Mickaël Hiligsmann, Cyrus Cooper
- Welcome - Mickaël Hiligsmann
- Which comparators and outcome measures should we use? - Marc Hochberg
- Which costs and methods should we use? - Francis Guillemin
- Discussion - Leader: Peter Tugwell
Panel: Nigel K. Arden, Francis Berenbaum, Annelies Boonen, Jaime Branco,
Maria Luisa Brandi, Olivier Bruyère, Cyrus Cooper, Andrea Ildiko Gasparik,
Francis Guillemin, Mickaël Hiligsmann, Marc Hochberg, John A. Kanis, Andrea Laslop,
Jean‑Pierre Pelletier, Florence Petit‑Dop, Daniel Pinto, Jean‑Yves Reginster,
Susanne Reiter, René Rizzoli, Lucio C. Rovati, Stuart Silverman, Yannis Tsouderos,
Peter Tugwell, Rafael Pinedo‑Villanueva
14:00 - 15:00
ESCEO-FIRMO SY MPOSIUM
- G aucher Disease: A rare disease that often affects bone Bruselas A
Chairperson: Maria Luisa Brandi
- Introduction - Maria Luisa Brandi
- Gaucher disease - What a non-Gaucher expert should be aware of - Ari Zimran
- Gaucher disease - What we know and can do about bone in Gaucher disease; the
unmet scientific questions. - Bruno Bembi
- Discussion - Leader: Maria Luisa Brandi
Panel: Bruno Bembi, Maria Luisa Brandi, John A. Kanis, Jean‑Yves Reginster,
René Rizzoli, Ari Zimran

27
W ednesday, Apr il 2 F r iday, Apr il 4
18:55 - 19:55 12:15 - 13:45
SERVIER H ONORARY LECTURE Casino de la Exposición ELI LILLY LUNCH SY MPOSIUM Auditorium B
- The mammalian circadian timing system: how clocks talk to each other Innovative Therapeutic Strategies for Patients with
- Ueli Schibler Osteoporosis and Fragil ity Fractures
Chairperson: Adolfo Diez‑Perez
20:10 - 21:10 - Welcome & Introduction - Adolfo Diez‑Perez
WELCOME COCKTAIL COURTESY OF Casino de la Exposición - Role of bone quality parameters in the reduction of fragility
ROTTAPH ARM | MADAUS fractures incidence - Adolfo Diez‑Perez
- Effects on bone tissue of bone forming versus antiresorptive
Thur sday, Apr il 3 treatments for patients with osteoporotic fractures - Erik Fink Eriksen
- Combination or sequential treatment of patients with severe
12:15 - 13:45 osteoporosis: pros and cons - Jacques P. Brown
ALEX ION LUNCH SY MPOSIUM Auditorium B - Closing Remarks - Adolfo Diez‑Perez
H ypophosphatasia: evol ving our understanding of this serious 17:00 - 18:30
and compl ex disease AMG EN SATELLITE SY MPOSIUM Auditorium A
Chairperson: Maria Luisa Brandi Treatment needs in postmenopausal osteoporosis
- What we should all know about HPP - Etienne Mornet Chairperson: Adolfo Diez‑Perez
- HPP: clinical perspectives - Gabriel Angel Martos Moreno - Welcome & Introduction - Adolfo Diez‑Perez
- HPP and Osteoporosis - what are the links? - Richard Eastell - Current challenges in the management of postmenopausal
- HPP: an evolving disease landscape - Maria Luisa Brandi osteoporosis - Eugene McCloskey
12:15 - 13:45 - Which patients benefit the most from current treatments? -
ROTTAPH ARM | MADAUS LUNCH SY MPOSIUM Auditorium A Santiago Palacios
Efficacy and util ity of gl ucosamine sul fate and hyal uronic - Long-term therapy: How long? - Serge Ferrari
acid in the management of osteoarthritis - Panel Discussion
Chairperson: Roy D. Altman
- Critical review and interpretation of the newest meta-analyses of intra-
articular hyaluronate for knee osteoarthritis - Emmanuel Maheu
Satur day, Apr il 5
- Crystalline glucosamine sulfate is the only SYSADOA that decreases 12:15 - 13:45
consumption of NSAIDs in knee osteoarthritis: results from the PEGASUS MSD LUNCH SY MPOSIUM Auditorium A
cohort - Lucio C. Rovati Interactive Discussion on the Management of Osteoporosis:
- Disease modification in knee osteoarthritis with oral glucosamine Signal ing a Change in the Conversation
sulfate or intra-articular hyaluronic acid: a review of the current evidence Chairperson: Esteban Jodar
- Roy D. Altman - Welcome & Opening Remarks - Esteban Jodar
17:00 - 18:30 - Long Term Treatment of Osteoporosis: The Risk Benefit Equation -
SERVIER SATELLITE SY MPOSIUM Auditorium A Solomon Epstein
Management of severe osteoporosis: a cal l for action - The Role of Cathepsin K in Bone Homeostasis - Serge Ferrari
Chairpersons: René Rizzoli, Maria Luisa Brandi - New Approaches to the Treatment of Osteoporosis - Felicia Cosman
- Introduction - Maria Luisa Brandi - Question & Answer Session
- Severe osteoporosis, state of the art - John A. Kanis
- Why severe osteoporosis is still an unmet medical need? - Cyrus Cooper
- Strontium ranelate as a treatment of severe osteoporosis: an evidence-
based efficacy - Jean‑Yves Reginster
- Conclusion - René Rizzoli

28
Osteoporos Int
DOI 10.1007/s00198-014-2637-1

World Congress on Osteoporosis, Osteoarthritis

and Musculoskeletal Diseases (WCO-IOF-ESCEO 2014):
Plenary Lecture Abstracts

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

SERVIER HONORARY LECTURE of transcription factor binding sites in random synthetic

THE MAMMALIAN CIRCADIAN TIMING SYSTEM: DNA. Using STAR-PROM, we have identified signaling
HOW CLOCKS TALK TO EACH OTHER pathways depending on rhythmic blood-borne signals in
U. Schibler1 humans and laboratory rodents. They involve the diurnal
1
Department of Molecular Biology, University of Geneva, activation of SRF- and forkhead transcription factor-
Sciences III, Geneva, Switzerland dependent genes. The STAR-PROM technology can be
used for the unbiased identification of signaling pathways
This circadian timing system consists of a pacemaker in the in a wide variety of biological systems.
brain’s suprachiasmatic nucleus (SCN) and subsidiary oscil- We acknowledge support from the Swiss National Science
lators in nearly all body cells. The SCN entrains the phase of Foundation (SNF 31-113565, SNF 31-128656/1, NCCR
peripheral clocks through a variety of systemic signals. While Frontiers in Genetics), the European Research Council
feeding rhythms - driven by rest-activity cycles - are the most (ERC-AdG-TimeSignal), the Canton of Geneva, and the Lou-
dominant Zeitgebers for most peripheral oscillators, the SCN is Jeantet Foundation of Medicine.
also employs blood-borne and body temperature- dependent
signals to set the phase in peripheral tissues. PL1
In the first part of the talk I will address the issue of how the THE LIFECOURSE EPIDEMIOLOGY
SCN and feeding rhythms synchronize circadian oscillators in OF MUSCULOSKELETAL AGEING
the liver. To this end we engineered the RT-Biolumicorder, a C. Cooper1,2
1
device enabling us to record circadian gene expression in the MRC Lifecourse Epidemiology Unit, University of South-
liver of unconstrained, freely moving mice during months. ampton, Southampton, United Kingdom, 2Institute of Muscu-
Using this approach, we can readily determine the velocity of loskeletal Science, University of Oxford, Oxford, United
feeding-induced phase shifting, a parameter that is obviously Kingdom
much more sensitive to the disruption of an individual signal-
ing pathway than the steady-state phase. The results indicate Musculoskeletal disease constitutes a major health burden
that the SCN uses both indirect pathways (depending on rest- worldwide. The principal chronic musculoskeletal disorders
activity cycles and feeding rhythms) and more direct (feeding- are osteoporosis, sarcopenia and osteoarthritis; these condi-
independent pathways) to synchronize liver clocks. Moreover, tions increase in frequency with advancing age, and under-
our studies suggest that hepatocyte clocks are strongly standing their epidemiology throughout the life course is
coupled between cells. critical to the development of effective preventive strategies.
In the second part of my talk I will present a novel Osteoporosis contributes to disability and death through its
strategy, dubbed Synthetic Tandem Repeat Promoter association with age related fractures. These fractures typical-
Screening (STAR-PROM), capable of identifying in an ly occur at the hip, spine and distal forearm. It has been
unbiased manner the signaling pathways participating in estimated from incidence rates derived in North America that
the systemic regulation of circadian gene expression. The the lifetime risk of a hip fracture in Caucasian women is
principle underlying this approach is the high frequency 17.5 % with a comparable risk in men of 6 %. Age and sex
 Osteoporos Int

adjusted hip fracture rates are generally higher in Caucasian PL2

than in Asian populations. Furthermore the pronounced fe- OSTEOPOROSIS THERAPY, BEYOND FRACTURE
male preponderance in fracture incidence observed in White PREVENTION
populations is not seen amongst Blacks or Asians in whom J. D. Adachi1
1
age adjusted female to male incidence ratios approximate Medicine, McMaster University, St. Joseph’s Healthcare,
unity. Life expectancy is increasing around the globe, and Hamilton, Canada
the number of elderly individuals is rising in every geographic
region. Assuming constant age-specific incidence rates for Objective: To review the benefits of osteoporosis therapy
fracture, the number of hip fractures occurring worldwide beyond fracture prevention.
among people age 65 years and over, will rise from 1.66 Clinical trials have demonstrated that fractures including
million in 1990 to 6.26 million in 2050. Studies performed spine, hip and nonspine, nonhip fractures may be prevented.
in the United States, Scandinavia and the United Kingdom, Importantly, many therapies have shown early efficacy
between 1930 and the late 1980’s, consistently reported in- with reductions in spine fractures occurring as early as
creases in the age adjusted incidence of hip fractures among 6 months upon initiation of therapy. While fractures are
men and women. This increase appears to have levelled off in the primary outcomes of interest, it is equally important to
the northern regions of the United States, as well as in Europe. consider the effects of therapy on quality of life, the
Rates in Asian populations continue to show substantial rises development of frailty, increased healthcare utilization
between the 1960’s and the present time. In the most recent and ultimately mortality.
data available from the United States, the incidence of first Several studies have shown reductions in quality of life
ever hip fracture declined by 1.4 % per year among women (QoL) associated with a wide variety of fractures. Physi-
and 0.06 % per year among men. The reduction in hip fracture cal and emotional functioning and activities of daily liv-
occurrence was even greater than that expected from the ing are all reduced with fractures. There is an increase in
declining incidence of hip fractures more generally. Age- pain, increased pain related disability and increased days
period-cohort models have suggested influences of all three in bed associated with vertebral fractures. The type of
contributors to these secular trends. Among current risk fac- fracture, the number of fractures and increasing age all
tors for low bone density and trauma, the trends are best affect QoL. Reductions in QoL due to fractures may be
explained by physical inactivity and vitamin D insufficiency. comparable to that seen with heart and lung disease and
Developmental contributions to peak bone and muscle mass, diabetes. Therapy has been shown to prevent the reduc-
for example maternal nutrition and lifestyle, also appear ca- tion in quality of life seen with fractures. While frailty
pable of contributing to cohort effects. may be a risk factor for fractures, it is also true that
Sarcopenia refers to an age related loss of skeletal muscle fractures themselves increase the development of frailty.
mass and function. Between the ages of 20 and 80 years, a This increase in frailty may in part explain the increase in
decline in muscle fibre size and number causes a loss of mortality seen with fractures and the prevention of frac-
muscle mass (30 %), with a greater accompanying loss of tures might logically prevent the development frailty and
muscle strength (60 %). The origins of sarcopenia are multi- subsequent mortality. Both hip and spine fractures are
factorial and include biological senescence, muscle disuse, associated with an increase in mortality with men having
endocrine dysfunction, comorbidity, inflammation and nutri- greater mortality than women. Lyles was the first to dem-
tional deficiency. While the clinical relevance of sarcopenia is onstrate a reduction in mortality when he reported close to
widely recognised, there remains no universally accepted a 30 % reduction in mortality with zoledronate in those
definition of the term. Recent approaches to definition incor- who had suffered a hip fracture. Since then several meta-
porate combinations of decline in fat free mass by DXA; analyses and systematic reviews of bisphosphonate thera-
strength assessments using isometric dynamometry; and poor py have confirmed this overall reduction in mortality.
physical performance using observational tests (gait speed, sit Denosumab has also shown a clinically relevant but sta-
to stand time and standing balance). The establishment of tistically insignificant 20 % reduction in mortality.
these recent methods for the assessment of sarcopenia has In summary, there are many therapies that are effective
led to a characterisation of the prevalence of this disor- in reducing fractures. In addition, they have been shown
der with advancing age in men and women. Modifica- to improve quality of life, prevent the development or
tions of the definition will inform outcome studies and progression of frailty, and reduce overall mortality, im-
future randomised controlled trials. Finally, shared portant outcomes to those suffering from osteoporosis.
aetiological mechanisms underpinning the senescence
of bone, muscle and joint, will open an arena in which References: 1. Adachi JD et al. Mayo Clin Proceedings
novel therapeutic strategies for musculoskeletal disease 2010;85:806
will become available. 2. Adachi JD et al. Osteoporos Int 2011;22:2539
Osteoporos Int

3. Ioannidis G et al. Osteoporos Int 2013;24:59 agreement No. 58-1950-0-014. Any opinions, findings, con-
4. Ioannidis G et al. CMA J 2009;181:265 clusion, or recommendations expressed in this publication are
Disclosures: Amgen, Eli Lilly, Merck, Novartis, Warner Chilcott those of the author(s) and do not necessarily reflect the view of
the U.S. Department of Agriculture.
PL3
DEFINITION, PATHOPHYSIOLOGY, PL4
AND MANAGEMENT OF SARCOPENIA DIABETES, OBESITY, METABOLIC SYNDROME
R. Fielding1,2 AND BONE
1
Nutrition, Exercise Physiology, and Sarcopenia Lab., Jean S. Ferrari1
1
Mayer USDA Human Nutrition, Research Center on Aging, Division of Bone Diseases, Geneva University Hospitals and
Tufts University, Boston, MA, United States, 2 Boston Claude Faculty of Medicine, Geneva, Switzerland
D. Pepper Older Americans Independence Center, Boston,
MA, United States In several Western countries, obesity and osteoporosis each
affect as much 30 % of the aging population, whereas
The age-related loss of skeletal muscle mass and function, diabetes’s prevalence is already over 10 %. In rapidly devel-
sarcopenia, is associated with well characterized functional oping regions of the world, the incidence of these chronic
limitations and physical disability. Underlying these age- disorders increases exponentially. Although the images of an
related changes are physiological changes in the force/power overweight individual with the metabolic syndrome and of a
generating capacity of skeletal muscle that appear to be driven frail elderly with osteoporosis at first seem hard to reconcile,
by changes in skeletal contractile protein function, metabolic there is growing evidence that diabetes and bone fragility
derangements and alterations in neuromuscular activation. I coexist. Hence subjects with type 2 diabetes have a two-
will present data illustrating the age-related changes in skeletal fold increased risk of fracture, despite the fact their aBMD
muscle gene expression, contractile function, neuromuscular is on average higher than in the nondiabetic population.
activation, and the effects of acute and chronic contractile Their increased BMI and aBMD challenge our fracture
activity on changes in phosphorylation and expression of prediction models, including FRAX. Increased risk of
members of the Akt/mTOR signaling pathway in skeletal falls and decreased bone quality have both been advocat-
muscle from young and old animals and humans. Interven- ed, including alterations in collagen crosslinks by ad-
tions that target sarcopenia are currently being explored with vanced glycation end products (AGEs) such as
the goal of improving physical functioning and preventing pentosidine; higher sclerostin levels associated with low
disability in older adults. Although exercise training and other bone formation; and microstructural alterations, particu-
potent anabolic stimuli may attenuate age-related muscle loss larly an increased cortical porosity. The molecular mech-
in healthy older adults and animals, skeletal muscle growth anisms relating glucose, fat and bone metabolism appear
capacity in response to anabolic stimulation appears to be increasingly complex. They involve the transcription fac-
limited with more advanced age and frailty. The cellular tor Pparγ, which promotes fat accumulation at the ex-
processes that initiate muscle hypertrophy and the extent to penses of bone forming cells; Wnt-β-catenin signaling;
which they are altered with age continue to be investigated. inflammatory factors, -i.e., interleukins-, and adipokines, -
We have examined the ribosomal protein S6 kinase (p70S6K), such as leptin and adiponectin-, that influence both insulin
a member of the protein kinase B/mammalian target of resistance and bone loss; and bone-derived molecules,
rapamycin (Akt/mTOR) pathway that has been implicated as including (undecarboxylated) osteocalcin and RANK Li-
an important factor in regulating muscle size during overload gand, both recently found to regulate glucose metabolism.
and disuse atrophy, in both older animals and humans. These Moreover, genomewide association studies have started to
pathways are potential regulators of age-associated muscle unveil common genes that exert pleiotropic effects on the
wasting and may also contribute to the attenuation of muscle susceptibility to both diabetes and osteoporosis. In turn,
hypertrophy that has been reported in older humans and pharmacological agents against diabetes have been found
animals in response to exercise interventions. The underlying to influence bone loss and/or fracture risk, whereas oste-
changes in skeletal muscle biology with age provide exciting oporosis drugs that affect bone turnover and/or RANK
potential therapeutic targets for further investigation. Ligand levels might modulate glucose metabolism.
Disclosures: Consultancies (Cytokinetics, Eli Lilly, Nestle’,
Regeneron), Advisory Board Memberships and stock PL5
(Pronutria, Ammonett, Insidetracker), Grant/Research Support EXTRASKELETAL EFFECTS OF VITAMIN D
(Nestle, Regeneron, National Institutes of Health, USDA). B. Dawson-Hughes1
1
Acknowledgements: Dr. Fielding’s contribution is partially USDA Human Nutrition Research Center on Aging at Tufts
supported by the US Department of Agriculture under University, Boston, MA, United States
 Osteoporos Int

In addition to its classical effects on bone and muscle, has begun to supplant the use of BMD as the primary
vitamin D has been associated with a number of chronic gateway for the assessment of fracture risk.
diseases, including diabetes, cardiovascular disease, and The most widely used assessment tool is FRAX (<a href =
several types of cancer and with increased mortality. “http://www.shef.ac.uk/FRAX”>http://www.shef.ac.uk/
Mechanisms may involve effects of vitamin D and its FRAX</a>). FRAX is a computer based algorithm (<a href =
metabolites on inflammation, proliferation, and apoptosis. “http://www.shef.ac.uk/FRAX”>http://www.shef.ac.uk/
Alternatively, low 25-hydroxyvitamin D (25OHD) levels, FRAX</a>) that calculates the 10-year probability of a major
may be a marker of ill-health. Diabetes currently affects fracture (hip, clinical spine, humerus or wrist fracture) and the
285 million people worldwide at a cost of 11.6 % of the 10-year probability of hip fracture. Fracture risk is calculated
total world health expenditure. Observational studies from age, BMI and well validated dichotomized risk factors.
show a fairly consistent association between low Femoral neck BMD can be optionally input to enhance frac-
25OHD levels and both prevalent and incident type two ture risk prediction. Fracture probability is calculated from the
diabetes mellitus (t2DM). Post hoc analyses of vitamin D risk of fracture and the risk of death. Probabilities differ
trials and small randomized controlled trials with glucose markedly in different regions of the world so that FRAX is
tolerance endpoints suggest that vitamin D may have a role calibrated to those countries where the epidemiology of frac-
in the prevention of type 2 diabetes (t2DM), particularly in ture and death is known (currently more than 50 countries). In
individuals at high risk for developing t2DM, specifically addition to the web site, FRAX has been incorporated into the
those with pre-diabetes. Larger trials are underway to evaluate software of densitometers and is available as an application for
this possibility. With regard to hypertension and cardiovascu- the i-phone/i-pod.
lar disease, brachial artery flow-mediated dilation has been The major clinical application of FRAX is to enhance the
positively correlated with serum 25OHD levels in older assessment of fracture risk to better target interventions, par-
adults. Low serum 25OHD levels have repeatedly been linked ticularly in primary care. However, the utility of FRAX de-
to higher blood pressure and increased risk of cardiovascular pends importantly on the development of guidance on the
disease. There are scattered reports of inverse and U-shaped fracture probability at which treatment should be recom-
associations of 25OHD levels with the incidence of several mended (i.e., the intervention threshold). In the US,
types of cancers. Finality, there have be repeated associations FRAX is reserved for patients with osteopenia and
of low 25OHD levels with increased mortality, and supple- treatment recommended, based on cost-effectiveness,
mentation with 800 IU per day modestly lowered mortality in when the 10-year probability of a major fracture is 20 %
older women. The true effect of vitamin D on chronic disease or above or where the probability of a hip fracture exceeds
incidence and progression will remain uncertain until large 3 %. Similar thresholds are used in Canada. These thresh-
randomized, controlled trials are performed. It is important to olds are unsuitable for use elsewhere because of differences
define any nonskeletal benefits of vitamin D because small in the importance of osteoporosis, the heath care
gains in prevention of common chronic diseases would have budget allocated, current practice guidelines, reimburse-
significant clinical and economic consequences. Clinical trials ment and health economic considerations. In addition
will determine whether low 25OHD levels increase risk of BMD, the gateway for risk assessment in the US, is not
several chronic diseases, or, instead, are markers of ill health. available or has limited availability in most countries of the
world. Although intervention thresholds vary from country
PL6 to country, European guidelines for postmenopausal and
GUIDELINES AND INTERVENTION THRESHOLDS glucocorticoid-induced osteoporosis have been published
FOR OSTEOPOROSIS that incorporate FRAX and which can be applied to all
J. A. Kanis1 countries, irrespective of the availability of BMD. These
1
WHO Collaborating Centre for Metabolic Bone Diseases, may stimulate the cohesive development of risk assessment
University of Sheffield Medical School, Sheffield, United algorithms and the appropriate targeting of treatment.
Kingdom
PL7
An important aspect of guideline development is to PTH AND BONE: LESSONS FROM HYPOPARA-
target treatments to those at high risk of fracture and, THYROIDISM THERAPY
conversely, to avoid treatment in those at low risk. The R. Civitelli1
1
prerequisite is the assessment of fracture risk and the Division of Bone and Mineral Diseases, Washington Univer-
setting off intervention thresholds. In the absence of a sity, St. Louis, MO, United States
prior major fracture, this has historically been undertak-
en by the measurement of BMD. The development of Primary failure of the parathyroid glands (genetic, postsurgi-
risk engines that add information over and above BMD cal, autoimmune, or infiltrative) presents with chronic
Osteoporos Int

hypocalcemia, low bone turnover and increased bone mass. PL8

Hypoparathyroidism, one of the few endocrine insufficiency HOW LONG CAN BONE TURNOVER
states for which a replacement therapy is not yet available, is BE SUPPRESSED?
conventionally managed by high calcium supplementation S. Papapoulos1
1
and active vitamin D metabolites. While with such approach Center of Bone Quality, Leiden University Medical Center,
serum calcium levels can be maintained within an acceptable Leiden, Netherlands
range, this is usually associated with hypercalciuria and risk of
nephrocalcinosis. Attempts have been made at using PTH High rates of bone turnover associated with bone remodelling
analogs as replacement therapy. Daily or twice‐daily PTH(1– imbalance are deleterious for bone strength while reduction of
34) maintained normal serum calcium without increasing urine the rates of bone turnover protects skeletal integrity. The term
calcium in adults and children with hypoparathyroidism. Sim- “suppressed bone turnover” is frequently used to describe
ilar positive results were also obtained with PTH(1–84) given effects of pathological processes or pharmaceutical interven-
daily or every other day, with reduced need of vitamin D and tions on bone metabolism but the level that characterizes
calcium intake and normal urine calcium excretion. Plasma suppression is ill-defined. The purpose of bone remodelling
phosphorus also normalized and bone turnover increased, is thought to be the maintenance of calcium homeostasis and
without consistent changes in BMD by DXA. Although the the repair of fatigue damage. Consequently, persistently low
doses of PTH used in these studies were far higher than those rates of bone remodelling may impair the ability of bone to
used in osteoporosis, intermittent PTH administration is also respond to hypocalcemic stimuli or to repair fatigue damage
used to achieve bone anabolic effects. Indeed, bone biopsy and thereby compromise its strength. Although conceptually
studies have shown increased trabecular number, thickness and valid, this hypothesis is difficult to prove because of method-
bone formation rates, resulting in increased trabecular bone ological limitations in the assessment of pathologically low
volume in hypoparathyroid subjects treated with a PTH(1–84) rates of bone turnover with available tools (e.g., bone histol-
replacement therapy regimen. However, cortical porosity and ogy and biochemical markers of bone turnover). Moreover,
trabecular “tunneling” were also observed, consistent with Heaney suggested that from an evolutionary point of view,
decreased proximal femur bone density reported in some stud- contemporary levels of remodelling activity that are used to
ies. These data would suggest that such PTH regimens result in define reference ranges, are substantially higher than optimal
a mixed anabolic and “catabolic” effect, with activation of both for maintenance of bone strength and Parfitt estimated that
bone resorption (primarily in the cortex) and bone formation turnover in peripheral cancellous bone of only 2 %/year is
(mainly in the spongiosa). To more closely mimic endogenous sufficient to maintain mechanical competence. With these
secretion, continuous PTH(1–34) infusion using a pump was limitations, excessive suppression of bone turnover can be
tested against twice daily injections, resulting in better control operationally defined as the rate which is associated with
of serum calcium and magnesium without hypercalciuria, re- metabolically inactive bone that is unable to respond
duced PTH need to achieve eucalcemia, and normalization of to stimuli and is associated with increased fragility.
bone turnover. While providing the basis for a future PTH Any questions regarding timing of persistence of low
replacement therapy, these studies are also disclosing valuable levels of bone turnover should be examined within this
information for understanding how PTH affects bone homeo- framework and available animal and human data should
stasis. be interpreted accordingly.
Osteoporos Int
DOI 10.1007/s00198-014-2640-6

World Congress on Osteoporosis, Osteoarthritis

and Musculoskeletal Diseases (WCO-IOF-ESCEO 2014):
Oral Communication Abstracts

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

OC1 Birmingham, United States, 17Paris Descartes University,

RELATIONSHIP OF WEIGHT, HEIGHT, AND Cochin Hospital, Paris, France, 18Department of Internal
BODY MASS INDEX WITH FRACTURE RISK Medicine III, Alfried Krupp Krankenhaus, Essen, Germany,
19
AT DIFFERENT SITES IN POSTMENOPAUSAL Helen Hayes Hospital and Columbia University, New York,
WOMEN: THE GLOBAL LONGITUDINAL STUDY United States, 20St Joseph’s Healthcare, McMaster University,
OF OSTEOPOROSIS IN WOMEN (GLOW) Hamilton, Canada
J. E. Compston1, A. Z. Lacroix2, F. H. Hooven3, S. L.
Greenspan4, S. H. Gehlbach3, A. Diez-Perez5, C. Cooper6, R. Objective: Low BMI is a well recognized risk factor for
D. Chapurlat7, S. Boonen8, F. A. Anderson3, S. Adami9, L. fracture in postmenopausal women. Height and obesity have
March10, J. C. Netelenbos11, J. Flahive3, D. W. Hosmer12, N. also been associated with increased fracture risk at some sites.
B. Watts13, E. S. Siris14, S. Silverman15, K. G. Saag16, C. We examined the relationships of weight, BMI, and height
Roux17, M. Rossini9, J. Pfeilschifter18, J. W. Nieves19, J. D. with incident clinical fracture in postmenopausal women par-
Adachi20 ticipating in the GLOW study.
1
University of Cambridge School of Clinical Medicine and Material and Methods: Data were collected at baseline and
Addenbrooke’s NHS Trust, Cambridge, United Kingdom, 1, 2, and 3 years. For hip, spine, wrist, pelvis, rib, upper arm/
2
Fred Hutchinson Cancer Research Center, Seattle, United shoulder, clavicle, ankle, lower leg, and upper leg fractures,
States, 3Center for Outcomes Research, UMASS Medical the time to incident self-reported fracture was modeled over a
School, Worcester, United States, 4University of Pittsburgh, 3-year period using the Cox proportional hazards model and
Pittsburgh, Pennsylvania, United States, 5Hospital del Mar- the best linear or nonlinear models containing height, weight,
IMIM-Autonomous University of Barcelona, Barcelona, and BMI were fitted.
Spain, 6MRC Lifecourse Epidemiology Unit, University of Results: Of 52,939 women, 3,628 (6.9 %) reported an inci-
Southampton, Southampton, United Kingdom, 7Division of dent clinical fracture during the 3-year follow-up period.
Rheumatology, INSERM UMR 1033, Université de Lyon, Linear BMI showed a significant inverse association with
Lyon, France, 8Universiteit Leuven, Leuven, Belgium, 9De- hip, clinical spine, and wrist fractures with adjusted hazard
partment of Rheumatology, University of Verona, Verona, ratios (HRs) (95%CIs) per increase of 5 kg/m2 of 0.80
Italy, 10University of Sydney Institute of Bone and Joint (0.71–0.90), 0.83 (0.76–0.92), and 0.88 (0.83–0.94), re-
Research and Department of Rheumatology, Royal North spectively (all p<0.001). For ankle fractures, linear weight
Shore Hospital, Sydney, Australia, 11Department of Endocri- showed a significant positive association: adjusted HR per
nology, VU University Medical Center, Amsterdam, Nether- 5-kg increase 1.05 (1.02–1.07) (p<0.001). Only linear
lands, 12Biostatistics, University of Massachusetts, Amherst, height was associated with upper arm/shoulder and clavi-
United States, 13Mercy Health Osteoporosis and Bone Health cle fractures: adjusted HRs per 10-cm increase were 0.85
Services, Cincinnati, United States, 14Department of Medi- (0.75–0.97) (p=0.02) and 0.73 (0.57–0.92) (p=0.009), re-
cine, Columbia University Medical Center, New York, United spectively. The best models for pelvic and rib fractures
States, 15Department of Rheumatology, Cedars-Sinai Medical were for non-linear BMI or weight (p=0.05 and 0.03,
Center, Los Angeles, United States, 16Division of Clinical respectively), with inverse associations at low values and
Immunology and Rheumatology, University of Alabama positive associations at high values.
 Osteoporos Int

Conclusion: These data demonstrate that the relationships variance. Interactions between QUS and continuous
between fracture and weight, BMI, and height are site- age and time were explored.
specific. The different associations may be mediated, at least Results: Baseline measurements were available in 46,124
in part, by effects on BMD, bone structure and geometry, and men and women, mean age 70 years (range 20–100). 3,018
patterns of falling. osteoporotic fractures (787 hip fractures) occurred during
Disclosures: Financial support for GLOW is provided by follow up of 214,000 person-years. The summary GR was
Warner Chilcott Company, LLC and sanofi-aventis to the 1.4 (95%CI: 1.4–1.5) for osteoporotic fracture for both BUA
Center for Outcomes Research. and SOS. For hip fracture the GR was 1.7 (95%CI: 1.6–1.8)
for BUA and 1.6 (95%CI: 1.5–1.7) for SOS. However the GR
was significantly higher for both fracture outcomes the lower
OC2 the baseline BUA and SOS (p<0.001). The predictive value
QUANTITATIVE ULTRASOUND (QUS) IS of QUS was the same for all ages (p>0.20) but the predictive
ASSOCIATED WITH FRACTURE RISK: value of both BUA and SOS for osteoporotic fracture de-
A META-ANALYSIS creased with time since baseline (p=0.018 and p=0.010,
E. V. McCloskey1, J. A. Kanis2, A. Odén1, D. C. Bauer3, C. C. respectively). The GR for BUA after 1 year after baseline
Glüer4, D. Hans5, S. K. Kaptoge6, K. T. Khaw6, M. A. Krieg7, was 1.5 (95%CI: 1.4–1.6) and after 6 years it was 1.3
A. Kwok8, E. Lau9, F. Marin10, T. W. O’neill11, E. S. (95%CI: 1.2–1.5).
Orwoll12, J. Reeve13, H. Johansson1 Conclusion: Our results suggest that QUS is an independent
1
WHO Collaborating Centre for Metabolic Bone Diseases, predictor of fracture for men and women particularly at low
Sheffield, United Kingdom, 2WHO Collaborating Centre for QUS values, but the predictive value for osteoporotic fracture
Metabolic Bone Diseases, University of Sheffield, Sheffield, risk decreases with time from baseline.
United Kingdom, 3University of California, San Francisco,
CA, United States, 4Biomedical Imaging, Diagnostic Radiol-
ogy, University of Kiel, Kiel, Germany, 5Lausanne University OC3
Hospital, Center of Bone Diseases, Lausanne, Switzerland, RISK FACTORS FOR FALLS AMONG ELDERLY
6
Department of Public Health and Primary Care, University of NURSING HOME RESIDENTS: A 2-YEAR
Cambridge, Cambridge, United Kingdom, 7Department of PROSPECTIVE STUDY
Musculoskeletal Medicine, CHUV, Lausanne, Switzerland, F. Buckinx1, C. Beaudart1, J. Slomian1, D. Maquet2, M.
8
The Chinese University of Hong Kong Jockey Club, Centre Demonceau2, S. Gillain3, J. Petermans3, J.-Y. Reginster1, O.
for Osteoporosis Care and Control, Hong Kong, China, Bruyère1
9
CCBR (Hong Kong), Hong Kong, Hong Kong, 10Lilly Re- 1
Department of Public Health, Epidemiology and Health Eco-
search Centre, Windlesham, United Kingdom, 11ARC Epide- nomics, University of Liège, Liège, Belgium, 2Department of
miology Research Unit, University of Manchester, Manches- Motricity Sciences, University of Liège, Liège, Belgium,
ter, United Kingdom, 12Oregon Health & Science University, 3
Geriatric Department, CHU Liège, Liège, Belgium
Portland, United States, 13NIHR Musculoskeletal Biomedical
Research Unit, Inst. Musculoskeletal Science, Nofford Ortho- Objective: This study considers demographic and clinical
paedic Centre, Oxford, United Kingdom characteristics of “fallers” subjects to identify which ones
could be considered predictive of the risk of falls among
Objective: Quantitative ultrasound (QUS) is an established elderly nursing home residents.
assessment of bone strength. The aim of this study was to Material and Methods: 100 subjects were followed for
investigate the association between QUS parameters and risk 24 months for the occurrence of falls. Demographic charac-
of fracture. teristics (sex, age, BMI, number of medications, medical
Material and Methods: We studied men and women in history, history of falls) and clinical characteristics (Katz index
nine prospective cohorts from Asia, Europe and North of Independence, Tinetti score, quantitative gait assessed
America. Broadband ultrasonic attenuation (BUA dB/ using a triaxial accelerometer) were collected at baseline.
Mhz) and speed of sound (SOS M/s) were measured Results: A total of 440 falls were recorded during the 2 years
at baseline. Fractures during follow up were collected of the study and 75 subjects fell at least once (mean: 4.44±
by self-report and in some cohorts confirmed by radi- 6.79 falls per patient). The survival curve of Kaplan-Meier
ography. An extension of Poisson regression was used shows that 25 % of the subjects fell in the first 2 months of the
to examine the gradient of risk (GR, hazard ratio per 1 study, while 75 % of subjects fell during the first year of
SD decrease) between QUS and fracture risk adjusted monitoring. Baseline characteristics of “fallers” subjects
for age and time since baseline in each cohort. The compared to “no-fallers” subjects are comparable, except for
results were merged and weighted according to the the Tinetti score (18.4±4.45 points in “fallers” vs. 20.6±4.73
Osteoporos Int

points among “no-fallers”, p=0.04) and step frequency mea- the pathogenesis of OA. CTX-II was correlated to JSN, and
sured in dual task conditions (0.77±0.22 in the “fallers” vs. burden of disease as previously reported. The significant
0.66±0.14 among the “no-fallers”, p=0.02). According to the association of α-CTX to knee bone turnover by bone scintig-
logistic regression model, the step frequency measured in dual raphy suggests that this marker may be a noninvasive surro-
task conditions is the only predictor for falls among institu- gates for active bone turnover in knee OA.
tionalized elderly (p=0.003).
Conclusion: Fallers have a smaller Tinetti score and a greater
step frequency measured in dual task conditions, compared to OC5
“no-fallers” subjects. This is particularly predictive of the risk HOSPITALIZED AND NONHOSPITALIZED
of falls among the elderly nursing home residents. VERTEBRAL FRACTURES: COMPARISON OF
PATIENT DEMOGRAPHICS AND HEALTH RELATED
QUALITY OF LIFE IMPLICATIONS
OC4 A. Svedbom1, V. Wintzell1, V. Alekna2, M. Tamulaitiene2, M.
SUBCHONDRAL BONE TURNOVER, JOINT SPACE L. Bianchi3, P. Clark4, M. Diaz-Curiel5, H. P. Dimai6, O.
NARROWING AND OSTEOPHYTE FORMATION Lesnyak7, E. V. McCloskey8, K. M. Sanders9, T. Thomas10,
MAY BE PREDICTED BYALPHA-CTX, A HIGH F. Borgström11, J. A. Kanis12
1
BONE TURNOVER DEGRADATION MARKER Department of Medicine, Karolinska University, Stockholm,
M. A. Karsdal1, J. L. H. Huebner2, V. K. Kraus2, A. C. Bay-Jensen3 Sweden, 2Faculty of Medicine, Vilnius University, Vilnius,
1
Rheumatology, Herlev, Denmark, 2Duke Medical Center, Lithuania, 3Bone Metabolism Unit, Istituto Auxologico
Durham, United States, 3Rheumatology, Nordic Bioscience, Italiano IRCCS, Milan, Italy, 4Clinical Epidemiology Unit,
Herlev, Denmark Hospital Infantil Federico Gómez and Faculty of Medicine
UNAM, Mexico City, Mexico, 5Servicio de Medicina Interna,
Objective: Osteoarthritis (OA) is the most common form of Enfermedades Metabolicas Oseas, Fundacion Jimenez Diaz,
arthritic disease. Subchondral bone remodeling is cur- Madrid, Spain, 6Department of Internal Medicine, Division of
rently speculated to both an initiator and driver of Endocrinology and Metabolism, Medical University of Graz,
disease. The aim of the current study was to evaluate Graz, Austria, 7Ural State Medical Academy, Yekaterinburg,
a serological biomarker of high localized bone turnover Russian Federation, 8Academic Unit of Bone Metabolism,
previously associated with woven bone and cancer Metabolic Bone Centre, University of Sheffield, Sheffield,
osteolytis, α-CTX, with measures of radiographic knee United Kingdom, 9Department of Medicine, NorthWest Aca-
OA severity and progression and localized knee bone demic Centre, The University of Melbourne, Melbourne,
turnover as assessed by bone scintigraphy. Australia, 10 INSERM U1059, CHU-St-Etienne, Saint
Material and Methods: 149 participants (111 women, 38 Etienne, France, 11LIME MMC, Karolinska University,
men) were included who met ACR criteria for symptomatic Stockholm, Sweden, 12WHO Collaborating Centre for
OA and had the presence of Kellgren-Lawrence (K/L) grade Metabolic Bone Diseases, University of Sheffield, Sheffield,
1–4 radiographic OA in at least one knee. Late-phase bone United Kingdom
scan images of both knees as well as 15 additional joint sites
were obtained 2 h after administration of 99mTc-MDP and the Objective: To compare patient characteristics and health re-
intensity of uptake was scored semiquantitatively (range of 0– lated quality of life (HRQoL) consequences in hospitalized
3) and summed for each joint site. Radiographic knee OA and nonhospitalized patients with vertebral fracture.
progression status was determined after 3-years. α-CTX and Material and Methods: The International Costs and Utilities
uCTXII was correlated to bone scintigraphy and radiographic Related to Osteoporotic fractures Study (ICUROS) is a pro-
features of OA. spective multinational study with the aim of estimating costs
Results: α-CTX was related to OST progression independent and HRQoL related to osteoporotic fractures. Patients rated
of the effects of age, gender, BMI, and HRT (p=0.009). α- their HRQoL before (recollected), directly after the fracture
CTX did not correlate with severity of knee OA based on the (within two weeks after fracture), and at 4, 12 and 18 months
static radiographic features (OST and JSN), but did correlate after the fracture using the EQ-5D instrument. For this interim
with the dynamic measure of bone turnover based on intensity analysis, patients were enrolled from study centres in Austra-
of bone scintigraphic uptake in the medial knee compartment. lia, Austria, Spain, France, Italy, Lithuania, Mexico, Russia
CTX-II was strongly associated with knee OA severity based and the United Kingdom. Data were extracted in November
on osteophyte and intensity of total knee bone scintigraphic 2013.
uptake, and the degree of joint space narrowing. Results: The number of patients initially treated in outpatient
Conclusion: α-CTX was associated with subchondral bone care (inpatient care) with follow-up data directly after fracture,
turnover, and osteophyte formation, both central features of and at 4, 12, and 18 months were 409 (338), 390 (246), 356
 Osteoporos Int

(216), and 345 (191), respectively. Patient characteristics elic- consecutive months the OA conventional pharmacological
ited directly after fracture and HRQoL trajectory after fracture treatment and/or Glu/CS. The main outcomes were knee
are presented in Table 1. structural changes, including the loss of joint space width
(JSW) and of cartilage volume measured by quantitative MRI.
Results: Participants reported taking (+) (n=300) or not tak-
ing (−) (n=300) OA treatment (analgesic/NSAIDs). The +
analgesic/NSAIDs participants had higher WOMAC scores
(p<0.001) and smaller JSW (p=0.01), reflecting more severe
disease at baseline. In the -analgesic/NSAIDs group, partici-
pants taking Glu/CS had significantly reduced loss of cartilage
volume at 24 months in the medial central plateau (p=0.007).
Further subdivision revealed that this effect of Glu/CS oc-
curred in participants with a higher severity of the disease
(JSW ≤ median). In the +analgesic/NSAIDs group, those
taking Glu/CS had significantly reduced loss of cartilage
Conclusion: Patients who were hospitalized in connection to volume in the global plateau at 12 months (p=0.05), and in
a vertebral fracture had lower HRQoL prior to fracture and at the central plateau at 24 months (p=0.05). These effects
all follow-up visits. Whilst the accumulated HRQoL loss was occurred in participants with less disease severity (JSW >
similar in the two patient groups, the relative decrement was median). By contrast, no significant reduction in JSW was
higher in hospitalized patients than in nonhospitalized found between all groups.
patients. Conclusion: In +analgesic/NSAIDs groups and -analgesic/
Disclosures: ICUROS is cosponsored by: IOF, Amgen, Eli NSAIDs groups, participants who took Glu/CS had reduced
Lilly, Medtronic, Novartis, Sanofi-Aventis, Servier, Pfizer, loss of cartilage volume over 24 months in subregions when
and the Australian National Health and Medical Research assessed with qMRI, arguing for a disease-modifying effect of
Council. Glu/CS which could not be identified by X-rays.
Disclosures: Funded in part by Bioiberica. JMP, MCH, JPP:
consultants for Bioiberica. MCH: principal investigator Balti-
more Clinical Center of the OAI. JMP, JPP: shareholders in
OC6 ArthroLab. JPR, MD: consultants for ArthroLab. FA: employ-
FIRST-LINE ANALYSIS OF THE EFFECTS OF ee of ArthroLab. CR: bursary from the Fondation du CHUM.
TREATMENT ON PROGRESSION OF STRUCTURAL
CHANGES IN KNEE OSTEOARTHRITIS OVER
24 MONTHS: DATA FROM THE OSTEOARTHRITIS OC7
INITIATIVE PROGRESSION COHORT ECONOMIC EVALUATION OF AN OSTEOPOROSIS
J. Martel-Pelletier 1 , C. Roubille 1 , F. Abram 2 , M. C. SCREENING CAMPAIGN: USING FRAX AS A
Hochberg3, M. Dorais4, P. Delorme1, J. P. Raynauld1, J.-P. PRESCREENING TOOL
Pelletier1 M. Hiligsmann1, W. Ben Sedrine2, O. Bruyère2, P. Jeholet3, V.
1
Osteoarthritis Research Unit, University of Montreal Hospi- Misson3, G. Pire3, J.-Y. Reginster2
tal Research Centre (CRCHUM), Montreal, Canada, 2Medical 1
Maastricht University, Maastricht, Netherlands, 2University
Imaging Research & Development, ArthroLab Inc., Montreal, of Liège, Liège, Belgium, 3Province of Liège, Health and
Canada, 3Departments of Medicine and Epidemiology and Quality of Life, Liège, Belgium
Public Health, University of Maryland Medical Center, Balti-
more, United States, 4StatSciences Inc., Notre-Dame-de-l’Ile- Objective: To evaluate the cost-effectiveness of an osteopo-
Perrot, Canada rosis screening campaign in the Province of Liège (Belgium).
Material and Methods: A previously validated Markov
Objective: To determine, using data from participants microsimulation model was used to estimate the incremental
enrolled in the progression cohort of the OAI, the cost-effectiveness ratio (ICER), expressed in costs (in €) per
effects of conventional osteoarthritis (OA) pharmacolog- quality-adjusted life-year gained (QALY) gained, of the
ical treatment and those of the combination of glucos- screening/treatment strategy with no intervention. The
amine and chondroitin sulphate (Glu/CS) on knee struc- screening/treatment strategy consisted of prescreening using
tural changes. FRAX followed by a bone densitometry for patients with a
Material and Methods: Six hundred patients with knee OA positive FRAX result and combined with a 5-year branded
were stratified based on whether or not they received for 24 alendronate therapy for women diagnosed with osteoporosis
Osteoporos Int

(BMD T-score≤−2.5). Sensitivity analyses were based on fractures were examined in two consecutive RA inception
model parameters, characteristics of screening campaign and cohorts in the UK (n=2,701) with a single continuous
medication adherence. mode of data collection: the Early RA Study (9 centres,
Results: The ICER for the screening/treatment strategy versus 1986–1998) and the Early RA Network (23 centres,
no intervention in the whole population (mean age=60 years) 2002–2012). Standard clinical, radiological and labora-
was estimated at €66,665 (95%CI: 51,384–81,947) and €39,504 tory measures were recorded yearly, along with comor-
(95%CI: 35,035–43,973) per QALY gained assuming real-world bidities & in-patient hospital episodes including fracture
and full adherence respectively. ICERs decreased to €55,517 and sites and joint surgery. Clinical databases were supple-
€28,520 in the population aged over 60 years (mean age= mented & validated with national databases: the Nation-
65 years). The ICER of the screening strategy decreases when al Joint Registry, Hospital Episode Statistics, and the
improving the follow-up of a positive screening and when in- National Death Register.
creasing fracture risk. Using the price of generic alendronate, the Results: Out of 182 fractures (#) in 6.6 % of patients, 69
cost-effectiveness improved to €50,880 and €32,293 assuming (38 %) involved the hip. For these, two main types of surgery
real-world and full adherence, respectively. were used: 13 total hip replacements (THR#) and 56 dynamic
Conclusion: Our analyses suggest that the osteoporosis screen- hip screw (DHS#) surgeries. Median time from baseline to
ing strategy is cost- effective if the follow up of the screening and hip# was 8 years (IQR 5–15). THR# were undertaken earlier
medication adherence are optimized. Therefore, BMD should be than DHS#, with a median time to surgery from RA onset of 81
performed in all individuals with positive FRAX score; individ- and 102 months, respectively (mean 97 and 121, IQR 60–122
uals having a positive BMD diagnosis should be treated and and 51–190). Female gender and older age at disease onset
adherence to therapy should be optimized. Furthermore, to im- were associated with higher risk for both types of #-
prove the efficiency of the screening strategy, we suggest related hip surgery, compared to non-# hip surgery
targeting screening on women with one or more clinical risk (p<0.001). Mean LoS varied by year of, and types of
factors, or on women aged 65 years and older. RA interventions. Hip# surgery incurred the longest LoS
(median 15 days in the 1990s, 8 in 2000s) but there
was little variation for THR# and DHS#, 9 and 9.5 days,
OC8 respectively (p=0.472). The mean number of all and
DO OSTEOPOROTIC HIP FRACTURES IN only major comorbid conditions was increased (3.7
RHEUMATOID ARTHRITIS VARY IN TYPE, TIMING and 1.4) in hip# patients, compared to non-# (1.8 and
AND SURGICAL INTERVENTION AND DO THEY 0.9, p<0.001), and survival reduced (48 % vs. 20 %,
IMPACT ON SURVIVAL? RESULTS FROM TWO p<0.001). Hip# were recorded as contributory causes of
LARGE UK INCEPTION COHORTS LINKED WITH death in 12 cases.
NATIONAL DATA Conclusion: There were two main types of hip# in RA and
E. Nikiphorou1, L. Carpenter2, J. Dixey3, P. Williams4, P. these incurred the longest LoS and were associated with
Kiely5, D. A. Walsh6, R. Williams7, A. Young8 higher comorbidity and reduced survival compared to all other
1
Department of Applied Health Research, University College orthopaedic surgery.
London, London, United Kingdom, 2Centre for Lifespan &
Chronic Illness Research, University of Hertfordshire,
Hatfield, United Kingdom, 3Department of Rheumatology, OC9
New Cross Hospital, Wolverhampton, United Kingdom, 4De- ASSOCIATION BETWEEN JOINT SPACE WIDTH,
partment of Rheumatology, Medway Maritime Hospital, Gil- KELLGREN-LAWRENCE SCORE, PAIN AND
lingham, United Kingdom, 5Department of Rheumatology, St PROGRESSION IN OSTEOARTHRITIS SUBJECTS
Georges Healthcare Trust, London, United Kingdom, 6Arthri- FROM TWO PHASE III STUDIES: A CLINICAL
tis UK Pain Centre, University of Nottingham, Nottingham, STUDY REFERENCE DATABASE
United Kingdom, 7Department of Rheumatology, Hereford C. Christiansen1, A. B. Bihlet1, I. B. Byrjalsen1, B. J. R. Riis1,
County Hospital, Hereford, United Kingdom, 8ERAS, De- P. A. Aleksandersen1, M. A. Karsdal1
1
partment of Rheumatology, St Albans City Hospital, St Rheumatology, Nordic Bioscience, Herlev, Denmark
Albans, United Kingdom
Objective: Osteoarthritis (OA) is commonly evaluated X-ray
Objective: To examine the nature of osteoporotic hip fracture (KL-score and JSW), as well as patient-reported pain and
in rheumatoid arthritis (RA), its surgical management and function (WOMAC). There is a significant difference between
impact on survival. patient populations recruited in clinical trial and epidemiolog-
Material and Methods: The clinical features, time to, man- ical studies. There is a need for publication of data from large
agement and length of stay (LoS) of different types of hip clinical studies. The aim of the analysis was to investigate the
 Osteoporos Int

associations between JSW, KL-score, pain and JSN (joint WOMAC. Paired Student t-tests were used to compare mean
space narrowing), as well as BMI, by combining data from values of EQ5D, EQVAS, the eight physical and mental health
two phase III studies. areas of SF36 and WOMAC preoperatively, 3 months
Material and Methods: This is a post hoc analysis of two postsurgery and 6 months postsurgery.
randomized, double- blind, multicenter, placebo-controlled Results: 279 patients were enrolled the day before total knee
trials (CSMC021C2301 and CSMC021C2302), evaluating arthroplasty (TKA). Our cohort included 127 men and 152
the efficacy and safety of oral salmon calcitonin in subject women aged from 39 to 86 years (mean 66.8±8.9) and with a
with painful knee OA, enrolling 1,176 and 1,030, respectively. BMI of 29.3±4.7. 123 of them received left knee prosthesis
The analysis included baseline data on KL-score, pain and and 126 of them right knee prosthesis. They were all diag-
function metrics from the WOMAC questionnaire, as well as nosed with primary OA following the ACR criteria. We
demographics and 2-year data on JSN was included for the calculated the various dimensions of WOMAC (pain, stiff-
placebo arm. ness, physical function) and SF-36. The results are summa-
Results: Including all knees in the placebo group, the mean rized in the table (mean ± SD):
JSN was 0.318±0.018 mm, over 2 years. In the non-target
knee, mean JSN progression was 0.279±0.025 mm, whereas
it was 0.356±0.026 the target knee (p<0.05), over 2 years.
These data was analysed in relation to KL-score, BMI and
pain.
Conclusion: This dataset from the largest clinical trial
dataset in OA to date clearly describe correlations be-
tween KL-score, JSW pain and BMI in patients with
symptomatic knee OA is ideally suited for identification
of different phenotypes of OA, and biomarkers associ-
ated with those. Progression in relation to pain and KL
score was different in the target compared to the non-
target knee. Whereas in the target knee KL score was
more important than pain, in the nontarget knee pain
was more important than KL score. Clearly different
levels of progression was observed in relation to KL
score and pain, in which the Q3 but strikingly not the
Q4 quartiles of highest pain, Q3 progressed significantly
faster.

OC10
QUALITY OF LIFE BENEFITS OF KNEE Note: lower score on the SF 36 reflect poorer health/higher
ARTHROPLASTY FOR OSTEOARTHRITIS score of WOMAC reflect bad results.
A. Neuprez1, G. François1, W. Kurth2, T. Thirion2, C. Daniel2,
J. P. Huskin2, J.-Y. Reginster1 Conclusion: At 3 and 6 month follow-up, the EQ5D, the
1
Department of Public Health, Epidemiology and Health Eco- EQVAS and all components of the WOMAC scores show a
nomics, Liège, Belgium, 2Orthopaedic Surgery CHU, Liège, statistically significant improvement compared to presurgical
Belgium status. Patients experience an additional significant im-
provement of health and QOL between 3 and 6 months
Objective: To assess the impact of total knee replacement on after surgery except EQVAS, EQ5D, physical function
quality of life, after 3 and 6 months, in patients with (WOMAC) and mental health (SF36) (no difference
osteoarthritis. between 3 and 6 month follow-up). Three months after
Material and Methods: The primary analysis computed surgery, three dimensions of the SF36 generic QOL toll
changes observed between baseline and 3 or 6 months were significantly improved: physical function, mental
postsurgery in health related quality of life (HRQOL), the health and bodily pain. At 6 month follow-up, all the
EQ5D and EQ5D VAS. Specific HRQOL was assessed with dimensions are improved except “social function and
the Short Form 36 (SF-36) and with the WOMAC Index general health perception”.
Osteoporos Int

OC11 Disclosures: Bert van Rietbergen is consultant for Scanco

TRACKING OF ENVIRONMENTAL Medical AG.
DETERMINANTS OF BONE STRUCTURE AND
STRENGTH DEVELOPMENT IN HEALTHY BOYS:
AN EIGHT-YEAR FOLLOW UP STUDY ON THE OC12
POSITIVE INTERACTION BETWEEN PHYSICAL EARLY GROWTH OF LEAN, RATHER THAN FAT
ACTIVITYAND PROTEIN INTAKE FROM MASS, PREDICTS BONE SIZE AND MINERAL
PREPUBERTY TO MID-LATE ADOLESCENCE DENSITY IN CHILDHOOD: FINDINGS FROM THE
T. Chevalley1, J. P. Bonjour1, B. Van Rietbergen2, S. Ferrari1, SOUTHAMPTON WOMEN’S SURVEY
R. Rizzoli1 R. J. Moon1, Z. A. Cole1, S. C. Crozier1, A. Aihie Sayer1, J. H.
1
Division of Bone Diseases, Geneva University Hospitals and Davies2, S. M. Robinson1, H. M. Inskip1, K. M. Godfrey1, C.
Faculty of Medicine, Geneva, Switzerland, 2Department of Cooper1, N. C. Harvey1
1
Biomedical Engineering, Eindhoven University of Technolo- MRC Lifecourse Epidemiology Unit, University of South-
gy, Eindhoven, Netherlands ampton, Southampton, United Kingdom, 2Paediatric Endocri-
nology, University Hospital Southampton NHS Foundation
Objective: High protein intake (HProt) was shown to enhance Trust, Southampton, United Kingdom
the positive impact of high physical activity (HPA) on proximal
femur BMC/aBMD/Area in healthy prepubertal boys. This Objective: Studies in childhood suggest that body composi-
cohort was followed up until mid-adolescence, testing the tion is associated with BMD. However there is scant evidence
hypothesis that Hprot and HPA would track and thus maintain relating longitudinal changes in fat (FM) and lean mass (LM)
their positive influence on bone structure and strength. to early childhood bone development. We therefore investi-
Material and Methods: BMC/aBMD/Area was measured at gated these relationships in a population-based mother-
femoral neck (FN) and total hip (TotHip) by DXA in 176 boys offspring cohort, the Southampton Women’s Survey.
at 7.4±0.4 and 15.2±0.5 years (±SD). Distal tibia (DistTib) Material and Methods: Total FM and LM were assessed at
microstructure and strength were also assessed at 15.2 years birth, 4 years (4y) and 6–7 years (7y) by DXA (Hologic Discov-
by HR- pQCT and μFEA. ery). At 7 years, total cross-sectional area (CSA) and trabecular
Results: The positive impact on FN and TotHip BMC/aBMD/ volumetric BMD at the 4 % site (metaphysis) of the tibia was
Area of relatively high (>median) HProt vs. moderate assessed using pQCT (Stratec XCT-2000). Total CSA, cortical
(<median) protein intake (MProt) on HPA (>median) recorded CSA and cortical vBMD were measured at the 38 % site
at 7.4 years remained unabated at 15.2 years. At this age, at (diaphysis). FM and LM were adjusted for age and sex and
DistTib, HProt-HPA vs. MProt-HPA was associated standardised to create within-cohort z-scores. Change in LM
(P<0.001) with larger cross-sectional area (CSA, mm2), tra- (ΔLM) or FM (ΔFM) was represented by change in z-score
becular number (Tb.N, mm−1) and lower trabecular separation from birth to 4 years and from 4 to 7 years. Linear regression was
(Tb.Sp, μm). The interaction between physical activity and used to explore the associations between ΔLM or ΔFM and
protein intake was significant for CSA (P=0.012) and Tb.N standardised pQCT outcomes. The β-coefficient represents SD
(P=0.043). Under MProt (38.0±6.9 g.d−1), a difference in PA change in outcome per unit SD change in predictor.
from 168±40 to 303±54 kcal.d−1 was associated with greater Results: pQCT scans and change in body composition z-
stiffness (kN/mm) and failure load (N) of +0.16 and + scores were available for 122 children from birth to 4 years
0.14 Z-score, respectively. In contrast, under HProt and 181 children from 4 to 7 years. ΔLM from 0 to 4 years
(56.2±9.5 g.d−1), a difference in PA of similar magni- was positively associated with total CSA at both 4 % (β=
tude, from 167±33 to 324±80 kcal.d−1, was associated 0.26, p=0.009) and 38 % sites (β=0.29, p=0.001) and 38 %
with a larger difference in stiffness and failure load of + cortical CSA (β=0.24, p=0.008). ΔLM from 4 to 7 years was
0.50 and +0.57 Z-score, respectively. also positively associated with 4 % total CSA (β=0.27, p=
Conclusion: The positive influence of relatively HProt on the 0.08) and with 4 % trabecular vBMD (β=0.32, p=0.04).
impact of HPA on proximal femur macrostructure tracks from Although ΔFM from 0 to 4 years was also associated with
prepuberty to mid-late puberty. At this stage, the impact of 4 % total CSA (β=0.16, p=0.04), there were no associations
HProt on HPA is also associated with microstructural changes between ΔFM from 4 to 7 years and bone geometry or BMD.
that should confer greater mechanical resistance to weight- Conclusion: In this study, gain in childhood LM was posi-
bearing bones. These results underscore the importance of tively associated with bone size and trabecular vBMD at
protein intake and exercise synergistic interaction in the early 7 years. In contrast, relationships between change in FM and
prevention of adult osteoporosis. bone were weaker, suggesting that muscle growth, rather than
 Osteoporos Int

accrual of fat mass, may be a more important determinant of Finally, change in area under the receiver operating character-
childhood bone development. istic curve (AUC) was calculated from logistic regression
models further adjusted for follow-up time.
Results: Of 1,390 subjects enrolled in the “Progression”
OC13 subcohort, 1,024 and 982 subjects with OA involving their right
FEATURES ASSESSED ON MAGNETIC and left knees, respectively, had complete data and were includ-
RESONANCE IMAGING (MRI) IMPROVE ed in these analyses. There were a total of 81 (8.0 %) and 83
PREDICTION OF TOTAL KNEE ARTHROPLASTY (8.4 %) TKAs in the right and left knees, respectively, among
(TKA) IN SUBJECTS WITH SYMPTOMATIC these subjects during 72 months of follow-up. In knee-specific
RADIOGRAPHIC KNEE OSTEOARTHRITIS (OA): Cox proportional hazards models, medical compartment CV
DATA FROM THE OSTEOARTHRITIS INITIATIVE (P<0.05), size of BMLs in the medial femoral condyle
(OAI) (P<0.0001) and logSF volume (P<0.0001) were significantly
M. C. Hochberg1, A. Yip2, K. Favors3, J. Sorkin3, J. Martel- associated with TKA in both knees. After addition of these MRI
Pelletier4, J.-P. Pelletier4 features individually to the “best” base knee-specific models,
1
Departments of Medicine and Epidemiology and Public only size of BMLs (P=0.02 in both knees) and logSF volume
Health, University of Maryland Medical Center, Baltimore, (P=0.02 in both knees) were significantly associated with time
United States, 2University of Maryland School of Medicine, to TKA. Furthermore, size of BMLs and logSF volume
Baltimore, United States, 3VA Maryland Health Care System, remained significantly associated with time to TKA when all
Baltimore, United States, 4Osteoarthritis Research Unit, three MRI features were added to the best “base” model. The
CRCHUM, Montreal, Canada improved prediction based on change in AUC, however, was
minimal with an increase from 0.86 to 0.87 in each knee.
Objective: Features assessed on MRI of the knees, including Conclusion: These data suggest that some MRI findings,
cartilage volume (CV), bone marrow lesions (BMLs) and syno- particularly BMLs and SF volume, minimally improve the
vial effusion, are associated with pain and structural progression prediction of receiving a TKA in subjects with symptomatic
in subjects with knee OA. Few studies, however, have examined radiographic knee OA when added to demographic, clinical
the association of MRI findings with TKA or estimated the ability and radiographic variables.
of MRI findings to improve prediction of TKA over and above Disclosures: Dr. Hochberg is Principal Investigator of the
routine demographic, clinical and radiographic parameters. Baltimore Clinical Center of the OAI. Drs. Martel-Pelletier
Material and Methods: Data from the OAI “Progression” and Pelletier are officers in ArthroLab Inc.
cohort were analyzed. Subjects included were aged 45–79 years
and had symptomatic radiographic knee OA, defined as pain on
most days of at least 1 month during the past year and a definite OC14
tibiofemoral osteophyte in the same knee, in one or both knees LOW SERUM THYROTROPIN LEVEL AND
at baseline; had at least one follow-up visit; had all available DURATION OF SUPPRESSION AS A PREDICTOR OF
knee radiographs through 48-month follow-up visit centrally MAJOR OSTEOPOROTIC FRACTURES: THE
read for Kellgren-Lawrence (KL) grade; and had baseline knee OPENTHYRO REGISTER COHORT
MRIs analyzed for CV at the femoral condyle and tibial plateau B. Abrahamsen1, H. L. Jørgensen2, A. S. Laulund3, M. Nybo4,
(mm3), presence of BMLs in the femoral condyle, and synovial T. H. Brix5, L. Hegedüs5
fluid (SF) volume (mm3), using fully automated quantitative 1
Research Centre for Ageing and Osteoporosis, Department
methodology developed by ArthoLab Inc. (Montreal, Quebec, of Medicine M, Glostrup Hospital, Glostrup, Denmark,
2
CA). Fixed-flexion PA knee radiographs and knee MRIs were Clinical Biochemistry Bispebjerg Hospital, Copenha-
obtained using standard protocols. TKA was self-reported at gen, Denmark, 3Department of Endocrinology, Odense
annual follow-up visits through 72 months and validated with University Hospital, Odense, Denmark, 4Clinical Bio-
medical records. Base knee-specific multiple variable Cox pro- chemistry, Odense University Hospital, Odense, Den-
portional hazards models were constructed with time to TKA as mark, 5Department of Endocrinology M, Odense Uni-
the dependent variable and the following variables from the versity Hospital, Odense, Denmark
OAI baseline visit as independent variables: age, gender, race,
marital status, BMI, depressive symptoms, KOOS quality of Objective: To assess the relationship between thyrotoxicosis
life scores, pain on motion and effusion on physical examina- and osteoporotic fractures in men and women.
tion and KL grade. Improvement in prediction of TKA was Material and Methods: Register-based cohort study in pa-
assessed by examining the improvement in likelihood ratio tients with a serum thyrotropin (TSH) measurement in the
when CV, presence and size of BMLs and logSF volume were region of Funen 1996–2010. All TSH determinations were
added individually and together to the best “base” models. done in the same lab, which served all hospitals and GP
Osteoporos Int

practices. Persons with raised TSH or a history of thyroid/ this study was to investigate the influence of long-term HIV
pituitary disease were not included. infection on bone microstructure in men.
Results: The study population consisted of 222,138 Material and Methods: We determined distal radius and tibia
(96 %) persons with normal and 9,217 (4 %) with cortical and trabecular bone microstructure by HR-pQCT
low TSH. During a median follow-up of 7.5 years, (XtremCT, Scanco Co, Bruttisellen, CH), and aBMD by
13.5 % of the low TSH group and 6.9 % of the normal DXA, in HIV-positive (+ve) men older than 60, compared to
TSH group sustained major osteoporotic fractures HIV negative (−ve) controls. Dietary protein and calcium
(MOF), p < 0.01. A single, low TSH at baseline was intakes, and physical activity were evaluated by
associated with increased risk of hip fractures (Table 1) questionnaires.
but less strongly with MOF (HR 1.06, 95%CI 0.99– Results: Thirty HIV+ve men on successful antiretroviral ther-
1.12, p = 0.058). There was a significant association apy (undetectable HIV- RNA), aged 64.9±3.6 years, with
also with duration of thyrotoxicosis. In euthyroid pa- BMI of 25.7±3.3, infection duration of 17±7 years, CD4 of
tients, the risk of hip fractures (HR 1.45, 95%CI 1.22– 612±304, were compared to 195 HIV-ve men, aged 65.2±
1.71, p < 0.001) and MOFs (HR 1.32, 95%CI 1.19– 1.4 years (p=0.38), with BMI of 26.3±3.4 (p=0.37). Com-
1.46, p < 0.001) increased with each SD unit of TSH pared to HIV-ve men, HIV+ve men had higher CTX, P1NP
decrease. and vitamin D levels (p≤0.002), but similar testosterone (p=
0.68). HIV+ve men had lower areal BMD at the proximal
femur (total hip T-Score −0.7 vs. −0.4, p=0.027), but similar
lumbar spine BMD. At distal radius and tibia, HIV+ve men
had lower total volumetric BMD (−9.5 %, p<0.01; −6.6 %,
p<0.05), lower BV/TV (−13.3 % at both, p<0.01), respec-
Conclusion: In a population-based cohort, a single, first tively. At distal radius, HIV+ve men had lower trabecular
measurement of decreased TSH in a patient without number (−9.3 %, p<0.05) and higher trabecular separation
known thyroid disease was associated with an increased (+18.6 %, p<0.01). Cortical density and cortical thickness
long term risk of hip fracture, which remained signifi- were also lower (−3.1 %, p<0.05; −10.5 %, p<0.01, respec-
cant in women but not in men after adjusting for con- tively). At distal tibia, trabecular thickness was 12.5 % lower
founders. Moreover, the risk of both hip fracture and (p<0.05).
MOF increased exponentially by the length of time Conclusion: At the age when fracture risk markedly increases
during which TSH had remained low. in the general population, long-term HIV infected men have
Disclosures: BA: Grants or trials for Novartis, Nycomed/ alterations of both trabecular and cortical bone microstructure,
Takeda and Amgen. Advisory board Takeda, Merck and which are not captured by areal BMD, and that despite ade-
Amgen. Speakers fees Takeda, Amgen, Merck, Eli Lilly. LH quate vitamin D supplementation. These alterations, which are
supported by unrestricted grant from the Novo Nordisk not explained by hypogonadism, are associated with higher
Foundation. bone turnover markers levels. These data provide a rationale
for fracture prevention measures in the emerging population
of long-term HIV infected men aged of 60 or older.

OC15
INFLUENCE OF LONG-TERM HIV INFECTION ON OC16
BONE MICROSTRUCTURE IN MEN OLDER THAN LONGITUDINAL STUDY OF BMD AMONG
60 YEARS HIV-INFECTED MEN
E. Biver1, A. Calmy2, C. Delhumeau2, C. Durosier1, S. K. Walker-Bone1, A. Samarawickrama2, S. Jose3, C. Sabin3,
Zawadynski3, R. Rizzoli1 Y. Gilleece2, M. Fisher2
1 1
Division of Bone Diseases, Geneva University Hospitals and MRC Lifecourse Epidemiology Unit, Southampton General
Faculty of Medicine, Geneva, Switzerland, 2Division of In- Hospital, Southampton, United Kingdom, 2Department of
fectious Diseases, HIV Unit, Geneva University Hospitals and HIV and GU Medicine, Brighton, United Kingdom,
Faculty of Medicine, Geneva, Switzerland, 3Division of Nu- 3
Institute of Epidemiology & Biostatistics, UCL, Lon-
clear Medicine, Geneva University Hospitals and Faculty of don, United Kingdom
Medicine, Geneva, Switzerland
Objective: To evaluate the change in BMD over 1-year of
Objective: HIV infection is associated with increased fracture follow-up among a cohort of HIV-infected men treated with
risk. Progress in antiretroviral therapy has led to increasing combination antiretroviral therapy (cART) and to explore
number of long-term HIV infected patients. The objective of factors associated with bone loss.
 Osteoporos Int

Material and Methods: A random sample of HIV-infected increases bone formation resulting in greater BMD. The bio-
men were recruited among 1,900 outpatients at an HIV clinic. logical activity of PTH resides in the N-terminal sequence
At baseline and 12-months, all completed a questionnaire with the 34 amino acid peptide (PTH1-34) [teriparatide].
about medication and comorbidities, lifestyle and risk factors Currently administration requires a subcutaneous injection
for osteoporosis. Casenotes were scrutinised for: duration of and an intranasally delivered formulation would potentially
HIV infection, mode of transmission and exposure to cART. improve patient convenience and may improve efficacy. In
DXA of the total hip, femoral neck and lumbar spine was certain patient groups, it has been shown that nasal delivery is
measured at both time points using one Hologic QDR ma- preferred over injections.
chine. Change in absolute BMD at each site was assessed and Material and Methods: CriticalSorb is an advanced nano-
risk factors for loss were investigated using logistic regression enabled nasal delivery system that facilitates the absorption of
for the smallest detectable difference (SDD). macromolecules across biological membranes. We have used
Results: 400 HIV-infected men, mean age 47 years were this technology to develop CP046, a nasal spray formulation
recruited: 94 % Caucasian, 93 % infected sexually and diag- of teriparatide. Solutions of CriticalSorb and teriparatide were
nosed with HIV a median of 9.1 years. 92 % were current prepared and administered intranasally to SD rats and NZW
users of cART, most of whom had undetectable viral loads. At rabbits. The animals also received a s.c. injection in order to
baseline, the prevalence of osteopenia at the lumbar spine, compare bioavailability. Blood samples were collected for up
total hip and femoral neck was 31 %, 36 % and 47 % and of to 6 h and teriparatide concentrations in the plasma were
osteoporosis was 10 %, 3 % and 3 %, respectively. At analysed by LCMS.
12 months, there was no significant change in total hip Results: CriticalSorb proved to be highly effective at enhanc-
BMD, there was a small significant increase in spine BMD ing the transport of teriparatide across the nasal mucosa in both
(p=0.006) and a small, significant decrease in femoral neck rats and rabbits with a relative bioavailability of 79 and 64 %,
BMD (p=0.008). In total, 14 % of men lost >SDD in BMD at respectively. When teriparatide was administered intranasally
the spine and 10 % lost >SDD at the other sites. No associa- to rats without CriticalSorb the bioavailability was below 6 %.
tion was seen with HIV stage, nadir CD4 count, cART use or Conclusion: In conclusion, CriticalSorb is an effective ab-
type and >SDD loss at any site. sorption promoter for the systemic delivery of teriparatide via
Conclusion: Cross-sectionally, we found similar rates of the nasal cavity and offers a non-invasive route for delivery.
osteopenia and osteoporosis to those of other studies. 10 % of The pulsatile pharmacokinetics obtained following nasal de-
subjects showed a significant loss of F.neck BMD over livery of teriparatide may further improve efficacy. Proof of
12 months. We found no significant associations between concept has been demonstrated in animal models and a clin-
BMD loss and recognised risk factors, including type of cART. ical trial is being carried out in postmenopausal women to
Loss of BMD has been shown in cART studies over the first 12– assess nasal deposition and clearance using gamma scintigra-
24 months but our data suggest bone loss stabilises thereafter. phy and to provide pharmacokinetic data comparing nasal and
subcutaneous delivery in humans.

OC17
ENHANCED BIOAVAILABILITY OF A NASAL OC18
FORMULATION OF TERIPARATIDE WITH ROMOSOZUMAB ADMINISTRATION IS
CRITICALSORB™ COMPARED TO A ASSOCIATED WITH SIGNIFICANT
SUBCUTANEOUS INJECTION: A NONINVASIVE IMPROVEMENTS IN LUMBAR SPINE AND HIP
APPROACH FOR THE TREATMENT OF VOLUMETRIC BONE MINERAL DENSITY (VBMD)
OSTEOPOROSIS AND CONTENT (BMC) COMPARED WITH
F. Jordan1,5, A. Williams2, A. Perkins3, T. Masud4, R. TERIPARATIDE
Pearson2, G. King5 H. K. Genant1, M. A. Bolognese2, C. Mautalen3, J. P. Brown4,
1
Critical Pharmaceuticals Ltd, Nottingham, United Kingdom, C. Recknor5, S. Goemaere6, K. Engelke7, Y. C. Yang8, M.
2
Division of Orthopaedic & Accident Surgery, University of Austin8, A. Grauer8, C. Libanati8
Nottingham, Nottingham, United Kingdom, 3Medical 1
UCSF & Synarc Inc., San Francisco, CA, United States, 2The
Physics, University of Nottingham, Queen’s Medical Bethesda Health Research Center, Bethesda, MD, United
Centre, Nottingham, United Kingdom, 4Nottingham, States, 3Centro de Osteopatias Medicas, Buenos Aires, Ar-
United Kingdom, 5 Critical Pharmaceuticals Limited, gentina, 4CHU de Québec Research Centre and Laval Uni-
Nottingham, United Kingdom versity, Québec, QC, Canada, 5United Osteoporosis Centers,
Gainesville, GA, United States, 6Ghent University Hospital,
Objective: PTH is an effective treatment for osteoporosis and Ghent, Belgium, 7Synarc Germany, Hamburg, Germany,
8
unlike other therapies that reduce bone resorption, PTH Amgen Inc., Thousand Oaks, CA, United States
Osteoporos Int

Objective: Sclerostin is an osteocyte-derived inhibitor of OC19

osteoblast activity. In a phase 2 study, romosozumab, a VITAMIN D INSUFFICIENCY SUSTAINED OVER
monoclonal antibody to sclerostin, increased BMD at 5 YEARS CONTRIBUTES TO INCREASED 10-YEAR
the lumbar spine (LS) and total hip (TH) as measured FRACTURE RISK IN ELDERLY WOMEN
by DXA compared with placebo (Pbo), alendronate, and D. Buchebner 1,4 , F. E. Mcguigan 1 , P. Gerdhem 2 , M.
teriparatide (TPTD) in postmenopausal women with low bone Ridderstråle3, K. Akesson1
1
mass. Here, we describe the effect of romosozumab on LS and Clinical and Molecular Osteoporosis Research Unit, Dept. of
TH vBMD and BMC at 12 months as measured by QCT in Clinical Science, Lund University, Malmö, Sweden, 2Dept. of
this trial. Clinical Science, Intervention and Technology, Karolinska
Material and Methods: In this international, randomized, Institute, Stockholm, Sweden, 3Clinical Obesity Research,
Pbo-controlled study, QCT measurements were per- Dept. of Endocrinology, Skåne University Hospital, Malmö,
formed at the “total” LS (mean of L1 and L2 entire vertebral Sweden, 4Dept. of Internal Medicine, Halmstad County Hos-
bodies) and TH in subjects receiving Pbo, subcutaneous pital, Halmstad, Sweden
TPTD (20 μg QD), and subcutaneous romosozumab
(210 mg QM). Objective: Vitamin D insufficiency among the elderly has
Results: Treatment with romosozumab significantly in- been shown to contribute to increased risk of osteopo-
creased integral vBMD and BMC at the “total” LS and TH rotic fractures. Previous studies have used single vita-
from baseline, and compared with Pbo and TPTD (Figure). min D measurements to investigate effects on bone.
TPTD and Pbo were similar at the TH, but not the LS. In the However, in elderly women, relatively little is known
LS trabecular compartment, vBMD increased similarly from about the effects of long-term hypovitaminosis D on bone
baseline with both romosozumab and TPTD (18.3 % vs. health. In this study we investigated sequential assessment of
20.1 %, respectively). At the TH trabecular compartment, serum vitamin D to determine if sustained hypovitaminosis D
romosozumab treatment resulted in significantly larger gains leads to increased 10-year fracture incidence in elderly
than TPTD (10.8 % vs. 4.2 %, P=0.01). Cortical vBMD and women.
BMC gains were larger with romosozumab compared with Material and Methods: Study participants were Swedish
TPTD at the LS (13.7 % vs. 5.7 % [vBMD] and 23.3 % vs. women from the population based OPRA cohort. 1,044 wom-
10.9 % [BMC], P <0.0001) and TH (1.1 % vs. −0.9 % en, all aged 75 attended at baseline (BL), 715 attended at
[vBMD], P=0.12 and 3.4 % vs. 0.0 % [BMC], P=0.03). 5 year follow-up. Serum 25-hydroxyvitamin D (25OHD)
levels (nmol/l) were classified as low (<50), Intermediate
(50–75) and high (>75) and were available for 987 (BL),
and 640 (5 years) women. Women with values in the same
25OHD category at both samplings were considered to have
consistently low, intermediate or high levels. Fracture data
was followed for 10 years through X-rays at the radiology
department.
Results: The incidence of hip fractures within 10 years was
significantly lower in those women who were 25OHD suffi-
cient (≥50 nmol/l) at baseline and maintained this level at
5 years (6.9 % (H) and 9.9 % (Int) vs. 20.6 % (L); (p=0.005
and 0.031). The proportion of women sustaining FRAX frac-
tures was 26.2 % and 30 % in the consistently high and
intermediate 25OHD groups compared to 45.6 % in
the consistently low group. (p=0.004 and 0.022). The
incidence of shoulder, radius and vertebral fractures was
not associated with 25OHD status in our study. The
majority of fractures occurred between 5 and 10 years
after baseline (hip 77 %; FRAX 64 %) however the
Conclusion: Romosozumab significantly increased vBMD time to first fracture (hip and FRAX) did not signifi-
and BMC at the “total” LS and TH compared with Pbo and cantly differ between the three categories of 25OHD
TPTD in postmenopausal women with low bone mass. The using either a single or serial measurement.
gains support the continued clinical investigation of Conclusion: In this population sample of elderly women,
romosozumab to reduce fractures in patients at increased risk. 25OHD insufficiency sustained over 5-years was associated
Disclosures: Amgen/UCB with increased 10-year risk of osteoporotic fracture.
 Osteoporos Int

OC20 additional studies are needed to define optimal treatment

THE EFFECTS OF VITAMIN D ON SKELETAL modalities.
MUSCLE STRENGTH, MUSCLE MASS AND
MUSCLE POWER: A META-ANALYSIS OF
RANDOMIZED CONTROLLED TRIALS OC21
C. Beaudart1, F. Buckinx2, V. Rabenda2, S. Gillain3, E. EIGHT YEARS OF DENOSUMAB TREATMENT
Cavalier4, J. Slomian5, J. Petermans3, J.-Y. Reginster6, IN POSTMENOPAUSAL WOMEN WITH
O. Bruyère2 OSTEOPOROSIS: RESULTS FROM THE FIRST
1
Department of Public Health, Epidemiology and Health Eco- FIVE YEARS OF THE FREEDOM EXTENSION
nomics, Liège, Belgium, 2Department of Public Health, Epi- S. Papapoulos1, K. Lippuner2, C. Roux3, C. J. F. Lin4, D. L.
demiology and Health Economics, University of Liège, Liège, Kendler5, E. M. Lewiecki6, M. L. Brandi7, E. Czerwinski8, E.
Belgium, 3Geriatric Department, CHU Liège, Liège, Belgium, Franek9, P. L. Lakatos10, C. Mautalen11, S. Minisola12, J.-Y.
4
Department of Clinical Chemistry, University of Liege, CHU Reginster13, S. Jensen14, N. Daizadeh4, A. Wang4, M. Gavin4,
Sart-Tilman, Liège, Belgium, 5Support Unit in Epidemiology R. B. Wagman4, H. G. Bone15
and Biostatistics, University of Liège, Liège, Belgium, 6Bone 1
Leiden University Medical Center, Leiden, Netherlands,
2
and Cartilage Metabolism Department, CHU Liège, Liège, Bern University Hospital, Bern, Switzerland, 3Paris
Belgium Descartes Université, Paris, France, 4Amgen Inc., Thou-
sand Oaks, United States, 5University of British Colum-
Objective: There is growing evidence that vitamin D plays a bia, Vancouver, Canada, 6New Mexico Clinical Re-
role on several tissues including skeletal muscle. Previous search & Osteoporosis Center, Albuquerque, United
studies have suggested that vitamin D deficiency is associated States, 7University of Florence, Florence, Italy, 8Krakow
with low muscular function and especially, with low muscle Medical Center, Krakow, Poland, 9Central Clinical Hos-
strength and muscle mass. The objective of this meta-analysis pital MSWiA, Warsaw, Poland, 10Semmelweis Universi-
is to summarize the effects of vitamin D supplementation on ty, Budapest, Hungary, 11Centro de Osteopatias Medicas,
muscle function. Buenos Aires, Argentina, 12Sapienza University, Rome,
Material and Methods: A systematic research of randomized Italy, 13University of Liège, Liège, Belgium, 14CCBR,
controlled trials (RCTs) assessing the effect of vitamin D Ballerup, Denmark, 15Michigan Bone and Mineral Clin-
supplementation on muscle function and performed between ic, Detroit, United States
1966 and June 2013 has been conducted (Medline, Cochrane
Database of Systematics Reviews, Cochrane Central Register Objective: Denosumab (DMAb) is an approved therapy for
of Controlled Trials, manual review of the literature and the treatment of postmenopausal women with osteoporosis at
congressional abstracts). All forms and doses of vitamin D increased risk for fracture. The effects of DMAb treatment for
supplementation, with or without calcium supplementation, up to 10 years are being evaluated in the 3-year FREEDOM
compared with placebo or control were included. The quality study and its 7-year extension. Here, we report the 5-year
of the RCTs was evaluated using the Jadad criteria. results from the extension, representing up to 8 years of
Results: Out of the 215 potentially relevant articles, 21 RCTs continued DMAb treatment.
involving 4,916 individuals (mean age: 65.8 years) met the Material and Methods: During the extension, all women
inclusion criteria. Studies showed a median quality score of received 60 mg of DMAb every 6 months and daily calcium
5/5 points. Results revealed a significant positive effect of and vitamin D. In this analysis, women in the long-term group
vitamin D supplementation on global muscle strength with a received 8 years of DMAb (3 years in FREEDOM and 5 years
standardized mean difference (SMD) of 0.107 (95%CI= in the extension); women in the cross-over group received
0.012–0.201; p=0.028). A moderate effect of vitamin D sup- 5 years of DMAb (3 years of placebo in FREEDOM and
plementation on muscle mass was found with a SMD of 0.265 5 years of DMAb in the extension).
(95%CI=0.032–0.498; p-value=0.026). No effect was found Results: Of the women who entered the extension, 66 %
on muscle power (SMD 0.015; p=0.914). Moreover, effects completed the 5th year. BMD data showed continued mean
are significantly more important with people presenting a increases from the FREEDOM baseline for cumulative 8-year
baseline 25(OH)D concentration lower than 35 nmol/L com- gains of 18.4 % at the lumbar spine (LS) and 8.3 % at the total
pared to others (p=0.03) and with people aged 65 years or hip (TH) in the long-term group and cumulative 5-year gains
younger compared to older (p=0.04). of 13.7 % at the LS and 4.9 % at the TH in the cross-over
Conclusion: Vitamin D supplementation has a small to mod- group (all p<0.0001 compared with FREEDOM and exten-
erate positive impact on muscle function, including muscle sion baselines). Serum C-telopeptide was rapidly and similar-
strength and muscle mass. Evidence supports the use of vita- ly reduced after each DMAb dose with the characteristic
min D supplementation to improve muscle function but attenuation of effect at the end of the dosing period. Incidence
Osteoporos Int

of new vertebral and nonvertebral fracture continued to re- associated with fractures. The objective of this study is to
main low throughout the extension; during year 8, hip fracture assess fracture patterns over 5 years among participants in
incidence was 0.2 % and 0.1 % for the long-term and cross- the GLOW study.
over groups, respectively. Overall incidences of adverse Material and Methods: GLOW comprises women 55 years
events (AEs) and serious AEs were consistent with data of age and older, in 615 primary care practices (17 sites, 10
reported previously in the extension study. countries). Self-administered surveys, mailed at baseline, 12,
Conclusion: DMAb treatment for up to 8 years was associat- 24, 36 and 60 months, sought data on patient characteristics,
ed with continued increases in BMD, persistent reduction of risk factors, estrogen, SSRI, PPI, GC use and antiosteoporosis
bone turnover, and low fracture incidence. The benefit/risk medication (AOM). Multivariable regression calculated odds
profile for DMAb remains favorable. ratios (ORs) and 95%CIs.
Disclosures: Amgen/GSK Results: There were 9,347 subjects who were never treated
with SSRIs, GCs, PPIs, estrogen or AOM, 2,715 on PPIs,
5,304 on GCs and 1,149 on SSRIs at baseline. Risk factors
OC22 that were adjusted for include age, BMI, parental history of
FRACTURE PATTERNS WITH SELECTIVE hip fracture, rheumatoid arthritis, prior fracture, osteoarthritis,
SEROTONIN RECEPTOR INHIBITOR, PROTON celiac disease, Crohn’s disease, Parkinson’s disease, falls in
PUMP INHIBITOR AND GLUCOCORTICOIDS USE the past year, smoking, alcohol intake, anxiety/depression,
IN GLOW general health, physical function and vitality.
J. D. Adachi1, A. Z. Lacroix2, R. Lindsay3, L. March4, J. C.
Netelenbos5, J. Pfeilschifter6, M. Rossini7, C. Roux8, K. G.
Saag9, E. S. Siris10, S. Silverman11, F. H. Hooven12, S. L.
Greenspan13, A. Wyman12, G. Fitzgerald12, S. Adami7, F. A.
Anderson 12 , S. Boonen 14 , R. D. Chapurlat 15 , J. E.
Compston16, C. Cooper17, A. Diez-Perez18, S. H. Gehlbach12,
N. B. Watts19
1
Medicine, McMaster University, St. Joseph’s Healthcare,
Hamilton, Canada, 2Fred Hutchinson Cancer Research Cen-
ter, Seattle, United States, 3Regional Bone Center, Helen
Hayes Hospital, West Haverstraw, NY, United States, 4Uni-
versity of Sydney Institute of Bone and Joint Research and
Department of Rheumatology, Royal North Shore Hospital,
Sidney, Australia, 5VU University Medical Center, Amster-
dam, Netherlands, 6Alfried Krupp Krankenhaus, Essen, Ger-
many, 7University of Verona, Verona, Italy, 8Paris Descartes
University, Cochin Hospital, Paris, France, 9University of
Alabama at Birmingham, Birmingham, United Kingdom, Conclusion: SSRIs are associated with the greatest risk for
10
Columbia University Medical Center, New York, United fracture followed by GCs and vertebral fractures. PPI=s were
States, 11Cedars-Sinai Medical Center, Los Angeles, United the least likely to be associated with fractures.
States, 12Center for Outcomes Research, UMASS Medical
School, Worcester, United States, 13University of Pittsburgh,
Pittsburgh, Pennsylvania, United States, 14Universiteit Leu- OC23
ven, Leuven, Belgium, 15INSERM UMR 1033, Université de HIGHER SERUM OSTEOCALCIN IS ASSOCIATED
Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, WITH METABOLIC SYNDROME SEVERITY IN MEN
France, 16Cambridge University Hospitals NHS Foundation FROM THE MINOS COHORT
Trust, Cambridge, United Kingdom, 17MRC Lifecourse Epi- C. B. Confavreux1, P. Szulc1, R. Casey2, A. Varennes3, J.
demiology Unit, University of Southampton, Southampton, Goudable4, R. D. Chapurlat1
United Kingdom, 18Hospital del Mar-IMIM-Autonomous 1
INSERM UMR1033 - Université de Lyon, Lyon, France,
University of Barcelona, Barcelona, Spain, 19Mercy Health 2
OFSEP - Université de Lyon, Bron, France, 3Central Bio-
Osteoporosis and Bone Health Services, Cincinnati, United chemical Laboratory - Université de Lyon, Lyon, France,
4
States INSERM UMR1060 - Université de Lyon, Lyon, France

Objective: Selective serotonin receptor inhibitors (SSRIs), Objective: Bone has emerged as an endocrine organ regu-
proton pump inhibitors (PPIs) and glucocorticoids (GCs) are lating energy metabolism through secretion of osteocalcin.
 Osteoporos Int

In epidemiological studies, presence of metabolic syndrome CRP. The predictive power of the biomarkers for identifica-
(MetS) was associated with lower osteocalcin level. We eval- tion of responders and nonresponders, was investigated by
uated whether osteocalcin level was associated with MetS logistic regression and CART analysis.
severity in men and whether it was more strongly associated Results: Tocilizumab significantly suppressed (p<0.0001)
with MetS compared with P1NP, BAP, and CTX. the markers MMP3, C1M, C2M, C3M, CRPM and signif-
Material and Methods: We included 798 men aged 51–85 icantly increased (p<0.05) the level of the bone markers
with total osteocalcin measurement. Number of MetS criteria CTx/ostoecalcin. A combination of the biomarkers (C1M,
was used to define severity. We used polytomous logistic C3M, C2M, osteocalcin and CRPM) was able to double
regression to assess the relationship between MetS severity the DAS28 response rate of tocilizumab 27 to 54 %.
and osteocalcin level. When including the change from baseline to 4 cartilage
Results: 30 % of men had MetS. In patients with MetS, the degradation or bone formation the rate was increased to
higher the number of MetS traits were present, the lower was 64 %. Methothraxate had no effect on the markers.
the average osteocalcin level (0–2 criteria: 551 men: Conclusion: Protein fingerprint markers may assist in identi-
19.5±6.7 ng/ml, 3 criteria, 155 men: 19.3±7.4 ng/ml, fication of the patients, who respond most optimally to given
4 criteria, 72 men: 17.3±5.7 ng/ml, 5 criteria, 20 men: interventions, and thus provide a stronger risk/benefit/cost
15.0±5.1 ng/ml; p for trend=0.002). After adjusting for value proposition to patients and payers.
age, 25OHD, testosterone, physical activity, smoking References: 1Bay-Jensen AC et al. Semin Arthritis Rheum
and alcohol consumption, comparison for Akaike infor- 2013;doi: 10.1016/j.semarthrit.2013.07.008.
2
mation criterion of the models using the bone markers, Smolen JS et al. Ann Rheum Dis 2012;71:687.
showed that osteocalcin was the most specifically asso-
ciated with MetS. In the polytomous logistic regression
model, an increase in osteocalcin level of 10 ng/ml was OC25
associated with lower prevalence of severe MetS: three A META-ANALYSIS OF THE EFFECT OF
criteria (OR=0.93 [0.70–1.24]), four criteria (OR=0.54 STRONTIUM RANELATE ON THE RISK OF
[0.34–0.84]) and five criteria (OR=0.28 [0.10–0.82]) in VERTEBRAL AND NON-VERTEBRAL FRACTURE
comparison to no MetS (p for trend=0.008). IN POSTMENOPAUSAL OSTEOPOROSIS: THE
Conclusion: In older Caucasian men, total osteocalcin level IMPACT OF SEVERE OSTEOPOROSIS AND
was associated with MetS severity. Osteocalcin was more CONTRAINDICATIONS
strongly associated with MetS severity than other bone turn- J. A. Kanis1, H. Johansson1, A. Odén1, E. V. McCloskey1, C.
over markers. Cooper2, R. Rizzoli3, J.-Y. Reginster4
1
WHO Collaborating Centre for Metabolic Bone Diseases,
University of Sheffield, Beech Hill Road, Sheffield, United
OC24 Kingdom, 2MRC Lifecourse Epidemiology Unit, University
SEROLOGICAL BIOMARKERS OF JOINT of Southampton, Southampton, United Kingdom, 3University
TURNOVER FOR EARLY IDENTIFICATION OF Hospitals and Faculty of Medicine of Geneva, Geneva, Swit-
RESPONDERS TO TOCILIZUMAB zerland, 4University of Liège, Department of Public Health,
A. C. Bay-Jensen1, A. S. Siebuhr1, C. Christiansen1, M. A. Epidemiology and Health Economics and University of
Karsdal1 Liège, HEC School of Management, Liège, Belgium
1
Rheumatology, Nordic Bioscience, Herlev, Denmark
Objective: There have been recent concerns raised by the
Objective: Personalized medicine is needed in rheumatoid Pharmacovigilance Risk Assessment Committee (PRAC)
arthritis (RA) as response rates are low compared to the side over the cardiac safety of strontium ranelate so that the SmPC
effects and cost of treatments. Anti- IL6R treatments is effec- for strontium ranelate has been modified to contraindicate its
tive in suppression disease activity1–only a small proportion use in patients at high risk of cardiovascular events and to limit
patients are protected from further joint destruction2. Protein treatment to patients at high fracture risk. The aim of the
fingerprint may describe disease-specific mode of actions1. present analysis was to examine the impact of contraindica-
We investigated whether biomarker could identify patients tions for strontium ranelate on the efficacy of intervention. An
that would respond to either anti-IL6. additional aim was to determine the impact of severe osteo-
Material and Methods: Biomarkers were measured in 800 porosis on efficacy.
RA patients treated with methotrexate or tocilizumab (LITHE Material and Methods: We examined the efficacy of stron-
study); C1M and C3M (MMP-degraded type I and III tium ranelate from the primary data of two phase 3 studies in
collagen), CRPM (MMP-degraded CRP), C2M (Cartilage which potential contraindications had been identified at base-
degradation), CTx/osteocalcin (bone balance), MMP3 and line. High fracture risk was defined in several ways including
Osteoporos Int

the WHO criteria (a T-score of −2.5 or less and a prior fragility treatment, despite substantial muscle loss, illustrating the ma-
fracture). A Poisson model was used to study the relationship jor role of estrogen in the male skeleton.
between age, the time since baseline, treatment, calculated
10 year probability on the one hand and on the other hand,
the risk of fracture. OC27
Results: Treatment with strontium ranelate was associated with FRAX BASED GUIDELINES: IS A UNIVERSAL
a 20 % (95%CI=9–29 %) decrease in osteoporotic clinical MODEL APPROPRIATE?
fractures and a 40 % decrease in vertebral fractures assessed M. Chakhtoura1, A. M. Cheung2, J. A. Kanis3, W. D. Leslie4,
by semiquantitative morphometry (95%CI=31–48 %). Neither E. V. McCloskey5, M. Mcclung6, G. El-Hajj Fuleihan7
1
the efficacy of strontium ranelate nor its relation to FRAX was American University of Beirut Medical Center, Beirut, Leb-
altered by adjustment for the severity of osteoporosis or the anon, 2Professor of Medicine, Medical Imaging, Health Pol-
presence of contraindications to treatment. icy Management and Evaluation, Public Health Sciences and
Conclusion: The efficacy of strontium ranelate is maintained Institute of Medical Sciences Director of Centre of Excellence
in severe osteoporosis and in patients in whom the interven- in Skeletal Health Assessment University of Toronto, Toronto,
tion is not contraindicated. Canada, 3WHO Collaborating Center for Metabolic Bone
disorders University of Sheffield, Sheffield, United Kingdom,
4
Medicine and Radiology University of Manitoba, Winnipeg,
OC26 Canada, 5Adult Bone Disease University of Sheffield, Shef-
PRESERVATION OF BONE MASS IN TRANS WOMEN field, United Kingdom, 6Medicine, Oregon Osteoporosis Cen-
DURING CROSS-SEX HORMONALTHERAPY: A ter, Portland, Oregon, United States, 7Medicine, Calcium Me-
PROSPECTIVE OBSERVATIONAL STUDY tabolism and Osteoporosis Program WHO Collaborating Cen-
E. Van Caenegem1, K. Wierckx1, Y. Taes1, S. Vandewalle1, K. ter for Metabolic Bone Disorders American University of
Toye1, J.-M. Kaufman1, G. T’sjoen1 Beirut Medical Center, Beirut, Lebanon
1
Department of Endocrinology, Ghent University Hospital,
Ghent, Belgium Objective: This paper discusses FRAX-based guidelines, de-
rived intervention thresholds, and explores the applicability of
Objective: To examine the evolution of bone in trans women a universal model.
undergoing sex steroid changes, during the first 2 years of Material and Methods: Osteoporosis guidelines were re-
hormonal therapy. trieved from IOF website, Pubmed and Google Scholar, for
Material and Methods: In a prospective intervention study, years 2009–2013.
we examined 49 trans women (male-to-female) before and after Results: The US, UK and Canadian osteoporosis treatment
1 and 2 year of cross-sex hormonal therapy (CSH) in compar- guidelines agree on treating individuals with fragility frac-
ison with 50 age-matched control men measuring grip tures, but adopt different approaches to define treatment
strength (hand dynamometer), areal BMD (aBMD) and thresholds in non-fracture subjects. Applying the National
total body fat and lean mass using DXA, bone geometry Osteoporosis Guideline Group (UK) age-specific interven-
and volumetric BMD, regional fat and muscle area at tion threshold model to the Philippines, China, Indonesia,
the forearm and calf using pQCT. Standardized treatment Lebanon, Jordan, Palestine, Morocco and Tunisia would
regimens were used with oral estradiol valerate, 4 mg daily (or result in recommending treatment in individuals until age
transdermal estradiol 100 μg/24 h for patients >45 years old), 70 years with low 10 year probabilities for major osteo-
both combined with oral cyproterone acetate 50 mg daily. porotic fractures, of <10 %. This approach also results in
Results: Prior to CSH, trans women had lower aBMD at all recommending treatment to a high proportion of such
measured sites (all p<0.001), smaller cortical bone size (all subjects with low risk, for example 25–30 % in Lebanon.
p<0.05) and lower muscle mass and strength and lean body Conversely, applying the National Osteoporosis Foundation
mass (all p<0.05) compared with control men. During CSH, (US) and Osteoporosis Canada composite models, with a
muscle mass and strength decreased and all measures of fat fixed intervention threshold and/or BMD T-score≤−2.5
mass increased (all p<0.001). The aBMD increased at the cutoff, to Asian and Middle Eastern countries would not
femoral neck, radius, lumbar spine and total body; cortical be appropriate. In Lebanon, this model would lead to
and trabecular bone remained stable and bone turnover treating 41 % and 9 % of women age 70–75 years,
markers decreased (all p<0.05). considering 10 % and 20 % intervention thresholds, re-
Conclusion: Although trans women have a lower aBMD and spectively. Similarly, a T-score intervention threshold of
cortical bone size compared with control men before any kind −2.5 is not justified in several countries for women until
of hormonal treatment, probably related to a more sedentary age 70 years, as it would incur treating subjects with an
lifestyle, their skeletal status is well preserved during CSH overall 10-year fracture risk <10 %, and <20 % in the US
 Osteoporos Int

until age 80. Therefore, a hybrid model may be a preferable 50 years the hip fracture incidence (per 100,000) was 39
consideration in countries with low baseline fracture rates, as (95%CI: 38–39) for a Swb woman and at the age of 90 years
adopted in Lebanon. This model uses a fixed 10 % intervention the incidence was 5,629 (95%CI: 5,523–5,738). The corre-
threshold in women <70 years and an age-specific intervention sponding incidences for Fb were 15 (95%CI: 13–17) and
threshold in women ≥70 years. With such approach 19 % of 3,089 (95%CI: 2,812–3,394) after 5 years from immigration.
Lebanese women age 70 years would be treated, a proportion The hip fracture incidence rose slowly with time from immi-
almost identical to that of women with moderate or severe gration for Fb (0.4 % per annum, 95%CI: 0.2–0.6 %) whereas
vertebral compression fractures at this age. Such a model also rates slowly declined with time in Swb.
avoids over treating young subjects at low risk for fracture, and Conclusion: Our results indicate that hip fracture inci-
ensures treating elderly subjects with a fracture risk equivalent dence in Sweden is substantially lower in immigrants
to that of an age-matched woman with a fragility fracture. than in the population born in Sweden. Although there
Conclusion: A universal FRAX based threshold model may is a small rise in incidence after immigration, the inci-
not be appropriate. Further research is needed to explore the dence remains markedly different to that observed in
applicability of different models in various countries. Swedish-born individuals. Thus, the use of a FRAX
model from the country of origin is likely to be more
appropriate than using the Swedish model when estimat-
OC28 ing fracture risk.
WHICH FRAX MODEL IS APPROPRIATE FOR
SWEDISH IMMIGRANTS?
H. Johansson1, A. Odén1, E. V. McCloskey1, J. A. Kanis2, M. OC29
Karlsson3, M. Lorentzon4, D. Mellström5 CORTICAL POROSITY OF THE PROXIMAL FEMUR
1
WHO Collaborating Centre for Metabolic Bone Diseases, IDENTIFIES WOMEN WITH NONVERTEBRAL
Sheffield, United Kingdom, 2WHO Collaborating Centre for FRAGILITY FRACTURES
Metabolic Bone Diseases, University of Sheffield, Sheffield, Å. Bjørnerem1, L. A. Ahmed1, R. Shigdel1, R. Joakimsen1, P.
United Kingdom, 3Clinical and Molecular Osteoporosis Re- Eldevik1, E. F. Eriksen2, A. Ghasem-Zadeh3, E. Seeman3, R.
search Unit, Department of Orthopedics and Clinical Sci- Zebaze3
1
ences, Lund University, Skane University Hospital, Malmö, UiT - Arctic University of Norway, Tromsø, Norway, 2Oslo
Sweden, 4Centre for Bone and Arthritis Research (CBAR), University Hospital, Oslo, Norway, 3University of Mel-
Sahlgrenska Academy, University of Gothenburg, Gothen- bourne, Melbourne, Australia
burg, Sweden, 5Centre for Bone and Arthritis Research at
Sahlgrenska Academy, University of Gothenburg, Göteborg, Objective: Fractures increase as a real BMD (aBMD)
Sweden decreases. However, most fractures arise from the large
population without osteoporosis. The Fracture Risk As-
Objective: FRAX tools are country-specific since the sessment Tool (FRAX) is used to identify these women
incidence of fracture varies between countries. In the but does not include cortical porosity, a major determi-
case of immigrants, the question arises whether the nant of bone fragility.
model for the original or the new country is most Material and Methods: To test whether combining
appropriate. The aim of this study was to investigate measures of porosity with aBMD or FRAX better iden-
the hip fracture incidence of foreign-born individuals tifies women with fractures, we quantified femoral neck
living in Sweden. (FN) aBMD, the FRAX score and femoral
Material and Methods: We studied the incidence of hip subtrochanteric cortical porosity in 211 postmenopausal
fracture in all men and women aged 50 years or more in women aged 54–94 years with fractures and 232 con-
Sweden between 1987 and 2002. The population consisted trols in Tromsø, Norway. Odds ratio (OR) for fracture
of 5 million Swedish-born (Swb) and 423,000 foreign-born and area under the receiver operating characteristic
(Fb) individuals. The effects of age, sex and time from immi- curve (AUC) was calculated using logistic regression
gration on hip fracture were examined by an extension of analysis.
Poisson regression. Results: Women with fractures had lower FN aBMD,
Results: 249,850 Swb and 3,258 Fb individuals sustained a higher FRAX score and higher cortical porosity. Each
hip fracture. The hip fracture incidence rose with age for both standard deviation higher porosity was associated with
groups. The risk of hip fracture was higher for women than for fracture independent of aBMD (OR 2.11; 95%CI 1.67–
men (HR 1.6 (95%CI: 1.6–1.6)) for Swb and for Fb (HR 1.4 2.68) and FRAX (OR 2.10; 95%CI 1.65–2.67). AUC
(95%CI: 1.3–1.5)). The hip fracture incidence for Swb was increased from 0.69 to 0.75 by adding porosity to
approximately twice the incidence for Fb. At the age of aBMD, and from 0.67 to 0.74 by adding porosity to
Osteoporos Int

FRAX (P<0.001). Fewer women needed to be screened to Results: In 215 women (73 DMAb, 68 ALN, 74 Pbo) with
identify one with fracture, combining porosity with aBMD TBS values at BL and 12 mo, mean age was 60 years and BL
(1.9; 95%CI 1.7–2.1) or FRAX (1.9; 95%CI 1.7–2.1) com- mean LS vBMD, LS aBMD T-score and TBS were 90.4 mg/
pared with using only aBMD (4.1; 95%CI 2.8–7.8), FRAX cm3, −2.4 and 1.234, respectively. Overall, vBMD, aBMD
(3.3; 95%CI 2.4–5.5) or porosity (2.3; 95%CI 1.8–3.2). and TBS decreased with Pbo; increased or were maintained
Conclusion: Combining cortical porosity with aBMD or with ALN; and improved, vs. both Pbo and ALN, with
FRAX better identifies women with increased fracture risk DMAb. At BL, TBS was better correlated with vBMD (r=
than aBMD or FRAX alone. 0.42, P<0.001) than aBMD T-score (r=0.13, P=0.051).
Disclosures: R. Zebaze, A. Ghasem-Zadeh and E. Seeman are TBS% changes did not positively correlate with those of
inventors of the StrAx1.0 software. vBMD or aBMD in any treatment group.
Acknowledgements: This study was funded by the North Conclusion: Pbo (calcium/vitamin D) was associated with
Norwegian Health Authorities (ID 5645 1002-11, ID reductions in BMD and TBS. ALN significantly increased
9167/SFP1090-13, ID 9168/SFP1135-13). BMD but not TBS. DMAb significantly improved BMD and
TBS, vs. both Pbo and ALN. TBS appears to capture infor-
mation at both BL and in response to therapy that is not
OC30 reflected by BMD (from QCT or DXA). Further studies are
CHANGES IN LUMBAR SPINE QCT, DXA AND TBS needed to identify the explanation and clinical relevance for
FOLLOWING TREATMENT WITH DENOSUMAB TBS improvements observed with DMAb.
(DMAB), ALENDRONATE (ALN), OR PLACEBO References: 1Nakamura, ASBMR 2012. 2Seeman, JBMR
(PBO) IN POSTMENOPAUSALWOMEN WITH LOW 2010.
BONE MASS Disclosures: Amgen/GSK
T. Thomas1,8, A. M. Cheung2, E. Shane3, J. R. Zanchetta4, A.
Kearns5, D. Hans6, C. J. F. Lin7, M. Austin7, C. Libanati7
1
INSERM U1059, University Hospital of St Etienne, St OC31
Etienne, France, 2University of Toronto, Toronto, Canada, EIGHT YEARS OF CONTINUED ODANACATIB
3
Columbia University, New York, NY, United States, THERAPY FOR POSTMENOPAUSALWOMEN WITH
4
Instituto de Investigaciones Metabólicas, Buenos Aires, Ar- LOW BONE MINERAL DENSITY: RESULTS FROM
gentina, 5Mayo Clinic, Rochester, United States, 6Lausanne AN OPEN-LABEL EXTENSION TO A PHASE IIB
University Hospital, Center of Bone Diseases, Lausanne, STUDY
Switzerland, 7Amgen Inc., Thousand Oaks, CA, United R. Rizzoli1, J. A. Rodriguez Portales2, C. L. Benhamou3, J.
States, 8INSERM U1059, University Hospital of St Etienne, Halse4, P. D. Miller5, I. Reid6, C. Dasilva7, R. Kroon8, A.
St Etienne, France Leung7, D. Gurner7
1
University Hospitals, Geneva, Switzerland, 2Pontificia
Objective: Patients with osteoporosis require treatment to Universidad Católica de Chile, Santiago, Chile, 3Hopital
reduce fracture risk. Fracture risk at the spine is significantly d’Orleans la Source, Orleans, France, 4Osteoporoseklinikken,
influenced by bone microarchitecture. QCT and DXA mea- Oslo, Norway, Colorado Center for Bone Research, 5Univer-
sure BMD, a robust indicator of fracture risk. Trabecular bone sity of Colorado Health Sciences Center, Lakewood, CO,
score (TBS), a novel gray-level measurement derived from United States, 6University of Auckland, Auckland, New
spine DXA image texture, is related to microarchitecture and Zealand, 7Merck & Co., Inc., Whitehouse Station, NJ, United
fracture risk independent of BMD. DMAb is associated with States, 8MSD, Oss, Netherlands
greater BMD gains than oral bisphosphonates and Nakamura
et al. showed this larger improvement was associated with a Objective: Treatment with odanacatib (ODN), a selective
larger reduction in vertebral fracture with DMAb vs. ALN.1 cathepsin K inhibitor, produces progressive increases in spine
To further characterize bone response with DMAb and ALN, and hip BMD in postmenopausal women, as shown in a 2-
we compared QCT vBMD, DXA aBMD and TBS in post- year dose-ranging study and prespecified 3-year extension.1 A
menopausal women with low BMD. further 5-year extension (Years 6–10: NCT00112437) was
Material and Methods: In a randomized, double-blind, designed to evaluate long-term efficacy and safety of weekly
double-dummy study, postmenopausal women aged 50– oral ODN 50 mg. We will present Year 8 interim analysis
70 years with low spine or total hip BMD received DMAb results.
60 mg SC Q6M, branded ALN 70 mg orally QW or Pbo for Material and Methods: In this 5-year extension T-Scores
12 months (mo).2 Lumbar spine (LS) vBMD, aBMD and TBS were initially between −2.0 and −3.5 at the lumbar spine or
were measured from QCT and DXA spine scans obtained at hip and all eligible patients receive open-label weekly ODN
baseline (BL) and 12 mo. 50 mg plus vitamin D3 (5,600 IU weekly) and calcium if
 Osteoporos Int

required. The primary objective is to estimate the change from analyzed, providing the mean mass density as functions of
baseline (randomization start of PN004) in lumbar spine BMD the shortest distances to canaliculi and lacunae.
at Years 8 and 10 and to evaluate long-term safety. Secondary Results: We found significantly higher mean mineralized tissue
endpoints include changes in BMD at the total hip, femoral mass densities for the BP treated samples. In average, 50 % of
neck, hip trochanter and one-third distal radius. Changes in bone tissue was found to be located within less than 1.4 μm and
markers of bone resorption and formation are also evaluated. 14 μm away from the closest canalicular and lacunar bound-
Results: 117 women were eligible to participate in this 5-year aries, respectively. Mass density was highest close to the LCN
extension and received ODN. 37 were <65 years, 80 were and showed a decreasing trend with increasing distance from
≥65 years when they entered the study. Ethnicity of the both canaliculi and lacunae. Mass density gradients adjacent to
patients was: white n=84, Asian n=1 and other races n=32. canaliculi were significantly lower for the BP group.
We will present efficacy and safety data at Year 8. Conclusion: Phase nanoCT based analysis revealed that in
Conclusion: During the 5-year placebo-controlled period of human jaw bone mass density is higher close to both canalic-
this Phase IIb study of postmenopausal women with low uli and lacunae, resulting in gradients and supporting recent
BMD, ODN increased spine and hip BMD and was generally discussion on the ability of osteocytes to interact with their
well tolerated. Data from this extension study will allow us to surrounding matrix [1]. Our results indicate that this interac-
estimate how the effect of ODN on BMD continues beyond tion is not limited to the lacunar boundary, but involves the
5 years and to monitor long-term safety of ODN. canaliculi. Moreover, the smaller pericanalicular mass density
References: 1Langdahl B et al. J Bone Miner Res 2012 gradients in the BP group suggest a mineral saturated state of
27:2251. bone tissue due to the drug treatment.
Disclosures: Funding: Merck & Co., Inc., Whitehouse Sta- References: 1. Qing et al. J Bone Miner Res 2012;27:1018
tion, NJ, USA. Research support: Merck (JARP, PDM, IR), 2. Kerschnitzki et al. J Bone Miner Res 2013;288:1837
Amgen (PDM, IR), Radius & Takeda (PDM), Lilly (PDM), 3. Langer et al. PLoS One 2012;7:e35691
Novartis (IR). Consultant: Merck (RR, JARP, CLB, IR),
Amgen (RR, CLB), Servier (RR, CLB), Danone & Takeda
(RR), Novartis & Lilly (CLB, IR), Rottapharm (CLB). Em- OC33
ployee: Merck (CD, RK, AL, DG). RELATIONSHIPS BETWEEN BODY COMPOSITION
AND BONE MICROARCHITECTURE IN OLDER
MEN AND WOMEN OF THE HERTFORDSHIRE
OC32 COHORT STUDY
ASSESSMENT OF PERILACUNAR AND M. H. Edwards1, K. A. Ward2, G. Ntani1, C. Parsons1, J.
PERICANALICULAR TISSUE MASS DENSITY Thompson2, E. M. Dennison1, C. Cooper1
1
ALTERATIONS IN HUMAN JAW BONE AFTER MRC Lifecourse Epidemiology Unit, University of South-
BISPHOSPHONATE TREATMENT BY 3D ampton, Southampton, United Kingdom, 2MRC Human Nu-
SYNCHROTRON PHASE NANOCT trition Research, University of Cambridge, Cambridge, Unit-
K. Raum1, B. Hesse1, P. Varga1, M. Langer2, F. Peyrin2 ed Kingdom
1
Julius Wolff Institute & Berlin-Brandenburg School for Re-
generative Therapies, Charité - Universitätsmedizin Berlin, Objective: Rates of sarcopenia and obesity are rising. There-
Berlin, Germany, 2Creatis, INSA-Lyon, Université CB Lyon fore, understanding the effects of both muscle and fat on bone
1 European Synchrotron Radiation Facility, Grenoble, France is increasingly important in the optimisation of bone health.
HR-pQCT) permits the in vivo assessment of bone
Objective: The interaction of osteocytes with their surround- microarchitecture. We explored relationships between bone
ing bone tissue is the subject of recent research [1]. The high microarchitecture and body composition in older men and
connectivity of the lacunar-canalicular-network (LCN) and women of the Hertfordshire Cohort Study.
distribution of the mineral around the LCN has recently been Material and Methods: 175 men and 167 women aged 72.1–
demonstrated [2]. The present study investigates alterations of 80.9 years were studied. HR-pQCT images (voxel size 82 μm)
mass density of the pericanalicular and perilacunar matrix in were acquired from the non-dominant distal radius and tibia with
human jaw bone after bisphosphonate (BP) treatment. a Scanco XtremeCT scanner. Standard morphological analysis
Material and Methods: Human jaw bone samples from BP- was performed for assessment of macrostructure, densitometry,
treated donors (N=4) and healthy controls (N=4) were imaged cortical porosity and trabecular microarchitecture. Body compo-
with 3D synchrotron phase nanoCT providing sufficient spa- sition assessment was completed using DXA (Lunar Prodigy
tial resolution (50 nm voxel size) to resolve the LCN and high Advanced). Lean mass index (LMI) was calculated as lean mass
sensitivity to mass density fluctuations [3]. In total, 23 osteo- divided by height squared and fat mass index (FMI) as fat mass
cyte lacunae and their surrounding tissue regions were divided by height squared. All variables were then standardised.
Osteoporos Int

Results: The mean age in men and women was 76.0 and databases were searched from January 1, 1966 to May 24,
76.4 years, respectively. LMI was greater in men, whereas 2013 for potentially eligible studies, reference lists were
FMI and percentage fat mass were greater in women. Cortical checked, and trial investigators were contacted where addi-
area, cortical thickness and trabecular number were positively tional data was required. Eligibility criteria included
associated with LMI and FMI in both men and women. After randomised controlled trials of calcium supplementation with
mutual adjustment, relationships with trabecular number or without vitamin D with events with a mean cohort age
persisted. However, relationships between cortical area and >50 years. Trial data were combined using a random-effects
thickness were only maintained with LMI [tibial cortical area, meta-analysis to calculate relative risk of heart disease events
β(95%CI): men 0.41(0.28,0.54), women 0.40(0.26,0.54)] and in participants supplemented with calcium.
not FMI. Results: The search yielded 661 potentially eligible reports of
Conclusion: Both LMI and FMI were positively related to which 18 met the inclusion criteria and contributed informa-
trabecular microarchitecture. In contrast, only LMI is inde- tion on 63,564 participants with 3,390 coronary heart disease
pendently associated with cortical area and thickness. This events and 4,157 deaths from any cause. Five trials contribut-
suggests differential effects of components of body composi- ed coronary heart disease events with pooled relative risk
tion on bone microstructure. (RR) for calcium of 1.02 (95%CI, 0.96–1.09; P=0.51). Sev-
Disclosures: C Cooper has received honoraria and consulting enteen trials contributed all-cause mortality data with pooled
fees from Amgen, Eli Lilly, Medtronic, Merck, Novartis and RR for calcium of 0.96 (95%CI, 0.91–1.02; P=0.18). Hetero-
Servier. geneity among the trials was low for both primary outcomes
Acknowledgements: This research has been made possible (I2 =0 %). For secondary outcomes the RR for myocardial
thanks to a Research Grant from the International Osteoporo- infarction was 1.08; 95%CI, 0.92–1.26; P=0.33, angina
sis Foundation and Servier. pectoris and acute coronary syndrome 1.09; 95%CI, 0.95–
1.24; P = 0.22 and chronic coronary heart disease 0.92;
95%CI, 0.73–1.15; P=0.46.
OC34 Conclusion: This meta-analysis, using stringent pre-specified
THE EFFECTS OF CALCIUM SUPPLEMENTATION inclusion criteria and outcome reporting, does not support the
ON CORONARY HEART DISEASE hypothesis that calcium supplementation with or without vi-
HOSPITALISATION AND DEATH IN tamin D increase coronary heart disease or all-cause mortality
POSTMENOPAUSAL WOMEN: risk in elderly women.
A COLLABORATIVE META-ANALYSIS
OF RANDOMISED CONTROLLED TRIALS
J. R. Lewis1,2, K. L. Ivey2, S. Radavelli-Bagatini2, L. OC35
Rejnmark3, J. S. Chen4, J. M. Simpson5, J. M. Lappe6, L. RACIALVARIATION IN MEASURES OF HIP
Mosekilde7, R. L. Prentice8, R. L. Prince2 MORPHOLOGY
1
Endocrinology and Diabetes, Sir Charles Gairdner Hospital, C. P. A. Arden1, K. M. Leyland1, K. Edwards1, M. T.
Perth, Australia, 2School of Medicine and Pharmacology, Sanchez-Santos1, T. D. Spector2, A. E. Nelson3, J. M. Jordan3,
University of Western Australia, Perth, Australia, 3Endocri- M. Nevitt4, D. J. Hunter5, N. K. Arden1
1
nology and Internal Medicine, Aarhus University Hospital, Nuffield Department of Orthopaedics, Rheumatology and
Aarhus, Denmark, 4Institute of Bone and Joint Research, Musculoskeletal Sciences, NIHR Musculoskeletal Biomedi-
University of Sydney, Sydney, Australia, 5Sydney School of cal Research Unit, University of Oxford, Nuffield Orthopae-
Public Health, University of Sydney, Sydney, Australia, dic Centre, Oxford, United Kingdom, 2Department of Twin
6
Creighton University, Omaha, NE, United States, 7Endocri- research and Genetic Epidemiology, King’s College, London,
nology and Internal Medicine, Aarhus University Hospital,, United Kingdom, 3Thurston Arthritis Research Center, Uni-
Denmark, 8Division of Public Health Sciences, Fred Hutch- versity of North Carolina, Chapel Hill, United States, 4De-
inson Cancer Research Center, Seattle, United States partment of Epidemiology and Biostatistics, University of
California at San Francisco, San Francisco, United States,
5
Objective: To determine if calcium supplements increase the Chromatic Innovation Limited and NDORMS, University
risk of coronary heart disease in elderly women. of Oxford, Oxford, United Kingdom
Material and Methods: We undertook a meta-analysis of
randomised controlled trials of calcium supplements with or Objective: There is known variation in prevalence of hip
without vitamin D for two primary outcomes: coronary heart osteoarthritis (OA) between racial groups. While cultural
disease and all-cause mortality verified by clinical review, and environmental factors likely contribute to these differ-
hospital record or death certificate. The Cochrane Central ences, morphological variation in hip shape directly affects
Register of Controlled Trials, MEDLINE, and EMBASE biomechanics and alignment, both of which are risk factors for
 Osteoporos Int

OA. This research compares measurements of hip shape be- BMD. Our goal was to assess the ability of TBS to improve
tween English Caucasian, American Caucasian, African discrimination of prevalent vertebral and peripheral Fx in
American and Chinese population groups. men, over aBMD.
Material and Methods: A study sample of 60–70 women Material and Methods: TBS was assessed in 886 men aged
randomly selected from each racial group (Chingford Cohort, 50 years and over from the STRAMBO cohort, who had a
Johnston County Cohort, Beijing Osteoarthritis Study) with lumbar spine (LS) DXA scan (Hologic Discovery A) at base-
an age range of 45–75 and no radiographic OA. HipMorf, a line. 164 men had prevalent fragility Fx (vertebral=70, pe-
validated software program developed by University of Ox- ripheral=74, both=20).
ford was used to measure both hips on each x-ray. Three Results: Men with prevalent Fx were older (73±8 vs. 70±
readers read x-rays blinded to race in addition to clinical 9 years, p < 0.001), had lower TBS (−5.5 %, −0.6SD,
factors. The measurements of interest were lateral centre edge p<0.001), LS_aBMD (−7.9 %, −0.5SD, p<0.001) and total
angle (LCE), alpha angle and femoral shaft angle (FSA). hip (TH) aBMD (−8.1 %, −0.6SD, p<0.001) than men with-
Means with standard deviations (SD) were calculated for each out Fx. After adjustment for age, height, weight and treatment,
measurement and linear regression was used to compare the magnitude of association with peripheral, vertebral and all
groups. types of Fx jointly was similar for TBS, LS_aBMD and
Results: All three readers had good reproducibility for the TH_aBMD with OR per 1SD decrease [95%CI] of
selected measures. Significant differences were found 1.7[1.4;2.0], 1.5[1.3;1.7] and 2.0[1.6;2.5], respectively. In
between group trends for LCE and alpha angle multivariate analysis including the above covariables as well
(Table). FSA was significantly increased (p<0.001) in as LS_aBMD and/or TH_aBMD, TBS remained significantly
African Americans compared to English Caucasians, and associated with an increased prevalence of peripheral and
the Chinese group showed a significantly decreased vertebral Fx alone and in combination (OR=1.7[1.3;2.1],
LCE (an indication of hip dysplasia). English Cauca- 1.6[1.2;2.1] and 1.6[1.3;1.9], respectively). When using
sians had an increased proportion of high alpha angles the WHO classification, 13 % of Fx occurred in osteo-
compared to all other groups. porotic (Fx rate=42 %), 57 % in osteopenic (Fx rate=
23 %) and 29 % in men with T-score>−1 (Fx rate=11 %).
44 % of Fx occurred in the lowest quartile of TBS, regardless
of BMD. By combining osteoporotic men with osteopenic
men in the lowest quartile of TBS, we were able to depict
three times as many Fx as in the osteoporotic men alone (41 %
vs. 13 %) with a rather small decrease of the Fx rate: 38 % vs.
42 %.
Conclusion: TBS is a useful tool to discriminate men with
Conclusion: Variation in morphological measurements of hip and without prevalent Fx, even in addition to aBMD measured
shape was found between several racial groups. These results either at the lumbar spine or total hip. Its use in prospective
indicate the need for further investigation on using hip mor- studies in men should confirm its ability to predict Fx inde-
phology as risk factors for OA. pendently of aBMD.

OC36 OC37
TRABECULAR BONE SCORE IS ASSOCIATED ANKLE FRACTURES ARE ASSOCIATED
WITH VERTEBRAL AND NON VERTEBRAL WITH LOW AREAL BMD AND BONE
FRACTURE IN MEN: THE STRAMBO STUDY MICROSTRUCTURAL ALTERATIONS
S. Boutroy1, D. Hans2, R. Winzenrieth3, R. D. Chapurlat1, P. IN POSTMENOPAUSAL WOMEN
Szulc1 E. Biver1, C. Durosier1, T. Chevalley1, F. Herrmann1, S.
1
INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, Ferrari1, R. Rizzoli1
Lyon, France, 2Lausanne University Hospital, Center of Bone 1
Division of Bone Diseases, Geneva University Hospitals and
Diseases, Lausanne, Switzerland, 3Med-Imaps, Merignac, Faculty of Medicine, Geneva, Switzerland
France
Objective: Ankle fractures are among the most common non-
Objective: Areal BMD (aBMD) is a less powerful predictor vertebral fractures. Previous studies have suggested that pe-
of fracture (Fx) in men than in women. TBS is related to ripheral, but not axial areal (a) BMD predicted, though poorly,
microarchitecture and Fx risk in women independently of ankle fracture risk, in contrast to the well recognized
Osteoporos Int

association between forearm fracture and aBMD. Bone mi- Objective: The process of bio mineralization that occurs in
crostructure analysis may reveal alterations not captured by bone tissue takes place throughout an individual’s life. Com-
aBMD. The objective of this study was to investigate the plex biological systems carefully orchestrating the
association between bone microstructure and ankle fracture. crosstalk between skeletal tissue and modulator of min-
Material and Methods: We determined distal radius cortical eralization include factors acting as promoters or inhib-
and trabecular bone microstructure by HR-pQCT (XtremCT, itors. The physiological role of alkaline phosphatase
Scanco Co, Bruttisellen, CH), together with aBMD by DXA, (ALP) is not fully understood, and a useful model is
in 749 women aged 65.0±1.4 (x±SD) years, with or without provided by the rare genetic disease hypophosphatasia
prevalent ankle or forearm fracture. Dietary protein and calci- (HPP), an inherited disorder characterized by a defect in
um intakes, and physical activity were evaluated by skeletal mineralization caused by tissue nonspecific ALP
questionnaires. (TNSALP) deficiency due to TNSALP gene mutations.
Results: Prevalent ankle and forearm fractures (both having It is highly variable in its clinical presentation, ranging
occurred after the age of 20) were found in 63 (8.0 %) and 59 from stillbirth and absence of mineralization in severe
(7.8 %) women, respectively. As compared with women with- disease to mild dental problems or osteopenia in adult-
out prevalent fracture, and after adjustment for height, weight, hood. Patients with the adult form present with osteo-
dietary intakes and physical activity, postmenopausal women malacia, chondrocalcinosis, nonhealing fractures, and
with prevalent ankle fractures, had lower aBMD (spine: premature tooth loss. BMD is often osteopenic, and
−7.7 %, p<0.0001; femoral neck: −6.4 %, p<0.001; distal the disease is misclassified as primary osteoporosis. It is also
third radius: −4.1 %, p<0.01), and lower distal radius total being mistreated, for example with bisphosphonates, that
volumetric BMD (−7.9 %, p<0.01), cortical thickness (−7 %, also cause misinterpretation of the low ALP levels.
p<0.05) and BV/TV (−10.9 %, p<0.01). The corresponding Scope of the present study was to recognize adult
values in women with prevalent forearm fracture were: HPP in a population of patients referring to the Bone
−8.8 %, p<0.0001; −6.8 %, p<0.001; −3.4 %, p<0.025, for and Mineral Diseases Unit at the University of Florence
aBMD; and −15.1 %, p<0.0001; −11.2 %, p<0.001; −21 %, Hospital.
p<0.0001, distal radius microstructure. For 1 SD decrease as Material and Methods: The clinical records of a popu-
compared with patient without prevalent fracture, ORs lation of 2,850 subjects have been revisited in order to
for ankle and forearm fracture were 1.9 and 2 (both select subjects with low serum ALP before any osteo-
p<0.001), 2 and 2.1 (both p<0.001), and 1.6 and 1.5 porotic treatment, with history of non-healing fractures,
(both p<0.01) for spine, femoral neck and distal third with metatarsal fractures, premature tooth loss, peri-
radius aBMD, respectively. Similarly, ORs were 1.6 and odontal diseases and low BMD. Additional clinical
2.2 (both p<0.01), 1.6 and 2.7 (both p<0.001) and 1.6 symptoms: fatigue, chronic pain, nephrocalcinosis, hy-
and 2.2 (both p < 0.01) for distal radius volumetric percalciuria, and seizures. As the osteoporosis patients
BMD, BV/TV and trabecular number, respectively. There referred to our Unit undergo blood withdrawal to be
was no statistically significant difference in aBMD or bone stored for genetic analysis when informed consent is
microstructure values between women with prevalent ankle obtained. ALP gene was evaluated in suspicion of HPP.
and forearm fracture. Results: So far we identified 16 subjects with clinical
Conclusion: These results highlight lower aBMD and altered characteristic of HPP. The biochemical investigations of
bone microstructure in postmenopausal women with prevalent these patients showed very low values of bone ALP in
ankle or forearm fracture. These alterations suggest that prev- serum (mean 6±2 μg/L; n.v.: 7–22), serum calcium and
alent ankle fractures should be considered as a significant risk phosphate in the normal range. Low levels of vitamin D
factor for subsequent fracture and taken into account in frac- (25OHD3) were observed in all subjects (mean: 15.6 ±
ture risk assessment. 6.1 ng/ml, n.v.: 30–70). BMD measured at the lumbar
spine and femoral neck by DXA showed a picture of
osteopenia or osteoporosis. The results of the genetic
OC38 analysis showed the presence of a variant in exon 5
HYPOPHOSPHATASIA IN ADULT: SCREENING OF codon 152 (CGC>CAC, Arg>His) in heterozygosity in two
AN ITALIAN POPULATION GROUP patients, a variant of exon 9, codon 292; (CCA>GCC;
L. Masi1, F. Franceschelli2, G. Leoncini2, M. L. Brandi2 Pro>Pro) in two patients, a change in intronic IVS5 +14 ex
1
Bone and Mineral Diseases Unit, University Hospital AOU 5 in 6 patients. Six patients did not show mutations in the gene
Careggi, Florence, Italy, 2Department of Surgery and Trans- TNSALP.
lational Medicine, University Hospital of Florence, Florence, Conclusion: These preliminary data, open up to the possibil-
Italy ity that polymorphic variants of the ALP gene may be
 Osteoporos Int

associated with a low BMD with a tendency to spontaneous years 1–3 of DMAb (extension) and decreased to
fractures and insufficient response to drugs used to date in the 1.03 at year 4 (RR=0.48; P=0.004).
treatment of osteoporosis.

OC39
FURTHER REDUCTION IN NONVERTEBRAL
FRACTURE RATE IS OBSERVED FOLLOWING 3
YEARS OF DENOSUMAB TREATMENT: RESULTS
WITH UP TO 7 YEARS IN THE FREEDOM
EXTENSION
S. Ferrari1, J. D. Adachi2, K. Lippuner3, C. Zapalowski4, P. D.
Miller5, J.-Y. Reginster6, O. Törring7, D. L. Kendler8, N.
Daizadeh4, A. Wang4, C. Omalley4, C. Libanati4, R. B.
Wagman4, E. M. Lewiecki9
1
Geneva University Hospital, Geneva, Switzerland,
2
McMaster University, Hamilton, ON, Canada, 3Bern Univer-
sity Hospital, Bern, Switzerland, 4Amgen Inc., Thousand
Oaks, CA, United States, 5Colorado Center for Bone Re-
search, Lakewood, CO, United States, 6University of Liège, Conclusion: Three years of DMAb treatment significantly
Liège, Belgium, 7Karolinska Institutet, Södersjukhuset, reduced the NVFX rate compared with placebo. Continued
Stockholm, Sweden, 8University of British Columbia, DMAb treatment was associated with further reductions in
Vancouver, BC, Canada, 9New Mexico Clinical Re- NVFX rates, which remained low throughout an additional
search and Osteoporosis Center, Albuquerque, NM, 4 years of continuous therapy.
United States Disclosures: Amgen/GSK

Objective: Evidence for further reduction of nonvertebral

fracture (NVFX) beyond 3 years of antiresorptive therapy is OC40
limited. The effects of long-term denosumab (DMAb) treat- EARLY FINDINGS FROM PROLIA®
ment are being evaluated in the ongoing FREEDOM exten- POST-MARKETING SAFETY SURVEILLANCE
sion study. We hypothesized that the NVFX rate with DMAb FOR ATYPICAL FEMORAL FRACTURE,
decreases with 4–7 years of therapy compared with the first OSTEONECROSIS OF THE JAW, SEVERE
3 years. SYMPTOMATIC HYPOCALCEMIA, AND
Material and Methods: During the extension, all subjects ANAPHYLAXIS
received 60 mg DMAb Q6M. Long-term subjects re- M. Geller1, R. B. Wagman1, P. R. Ho1, S. Siddhanti1, C.
ceived 7 years of DMAb (3 years in FREEDOM; 4 years Stehman-Breen1, N. B. Watts2, S. Papapoulos3
1
in extension); cross-over subjects received 3 years of Amgen Inc., Thousand Oaks, CA, United States, 2Mercy
placebo in FREEDOM and 4 years of DMAb in the Health Osteoporosis and Bone Health Services, Cincinnati,
extension. NVFX rates for the first 3 years of DMAb OH, United States, 3Leiden University Medical Center,
were compared with rates in the 4th year of DMAb in Leiden, Netherlands
each group separately and combined and with the
NVFX rate during years 4–7 (long-term group only). Objective: We characterize post-marketing (PM) experience
Adjusted rate ratios (RR) (95%CIs) between observa- for four adverse drug reactions (ADRs) with denosumab
tional periods were computed via generalized estimating (Prolia): atypical femoral fracture (AFF), osteonecrosis of
equation (GEE) Poisson regression. the jaw (ONJ), severe symptomatic hypocalcemia (SSH),
Results: 4,550 of 5,928 (77 %) eligible women enrolled in the and anaphylaxis.
extension (N=2,343 long-term; N=2,207 cross-over). In the Material and Methods: The Amgen PM database undergoes
long-term group, the NVFX rate was 1.98 per 100 subject- continual assessment of adverse events reported from health
years during years 1–3 of DMAb (FREEDOM). This rate care providers, patients, and other sources. AFF and ONJ
decreased during year 4 (extension) to 1.43 (RR=0.73; cases were assessed and adjudicated by independent commit-
P =0.096; Table), and the rate remained low at 1.45 tees. SSH and anaphylaxis prompted further assessment by
during years 4–7 (RR = 0.74; P= 0.016). Similarly for Amgen Global Safety because causality due to Prolia could
the cross-over group, the NVFX rate was 2.20 during not be excluded.
Osteoporos Int

Results: As of September 2013, estimated exposure with extended around the circumference every 6 months for up to
Prolia was 1,252,566 patient-years. Four PM reports have 2 years. Pain, mobility, and progression or regression of
been adjudicated as consistent with the ASBMR definition fracture line as well as surgical intervention were noted.
for AFF (Shane et al., JBMR 2010). All patients had prior Results: All were postmenopausal women (mean age
bisphosphonate (BP) use. Two subjects had healing and two 67 years; 76 % Caucasian, 24 % Southeast/South Asian).
did not have follow-up information. For ONJ, 32 PM reports Eighteen pts. had one iAFF and seven had bilateral iAFFs
were adjudicated as consistent with the AAOMS definition for a total of 32 iAFFs. Mean duration of TPD therapy was
(Position Paper, AAOMS 2009). Risk factors included ≥1: 16.8 months (range 1.2–24.6 months). Three pts. [5 iAFFs]
glucocorticoids, chemotherapy, prior BP use, older age, and underwent surgical repair (2 pts [3 iAFFs] for debilitating
invasive dental procedures. One-third of reports indicated pain/progression of iAFF, and 1 pt. [2 iAFFs] for
resolution, 1/3 were ongoing, and the remainder were un- patient/physician preference). Three other pts. (4 iAFFs)
known. Eight reports of SSH included symptoms of seizures did not have follow-up imaging. Of the remaining 18
and/or tetany; nearly all (7 of 8) had chronic kidney disease, a pts. with 23 iAFFs, 3 iAFFs were completely healed, 6
risk factor for hypocalcemia; most SSH events occurred with- showed healing but still had residual lucent lines, 13
in 30 days of Prolia administration and responded to IV/PO were stable and 1 showed worsening of fracture line.
calcium/vitamin D. For anaphylaxis, five reports included Overall, 32 % were healing or healed, 46 % were
hypotension, dyspnea, throat tightness, facial and upper air- stable, and 21 % had progression of fracture line or
way edema, pruritus, and/or urticaria. Most events occurred required prophylactic surgery. In addition, 4 pts devel-
within 1 day of the first Prolia dose; emergency room treat- oped new lucent lines in the same femur while on TPD
ments included antihistamines and IV/PO steroids with no therapy.
fatal outcomes. Conclusion: TPD may promote healing of iAFFs, but results
Conclusion: These PM events with Prolia have not of our randomized controlled trial will be better suited to
shown any unexpected findings; the benefit/risk profile definitively answer this question.
for Prolia remains favorable. Ongoing safety surveil-
lance will continue in the clinical trial program and
pharmacovigilance activities. OC42
Disclosures: Amgen/GSK SURGICAL PREVENTION OF FEMORAL NECK
FRACTURES IN OSTEOPOROTIC PATIENTS:
LONG-TERM RESULTS
OC41 E. Chiarello2, G. Tedesco1, P. Capra1, D. Luciani1, S.
EFFECT OF TERIPARATIDE ON HEALING OF Giannini1
1
INCOMPLETE ATYPICAL FEMUR FRACTURES 1st Orthopaedic and Trauma Clinic, Rizzoli Ortopaedic
A. M. Cheung1, J. D. Adachi2, A. Khan2, L. Tile1, E. Institute, University of Bologna, Bologna, Italy, 2Ortho-
Bogoch3, H. Mcdonald-Blumer1, R. Ridout1, S. Cardew1, K. paedic and Traumatologic Unit, Ospedale dell’angelo
Syed 1 , J. Chang 1 , J. Scher 1 , H. Hu 1 , S. Morin 4 , A. Mestre, Venezia, Italy
Papaioannou5, S. Jamal6, R. Josse3, R. Bleakney1
1
University Health Network, Toronto, Canada, 2McMaster Objective: The aim of our RCT was to evaluate safety and
University, Hamilton, Canada, 3St. Michael’s Health Centre, efficacy of a new device called Prevention Nail System (PNS)
Toronto, Canada, 4Department of Medicine, McGill Univer- developed for the prevention of femoral neck fractures (FNFs)
sity, Montreal, Canada, 5Medicine, McMaster University, in patients with severe osteoporosis.
Hamilton, Canada, 6Women’s College Hospital, Toronto, Material and Methods: The PNS is a titanium screw with an
Canada hydroxyapatite coating implanted in the femoral neck in order
to reinforce it. We enrolled patients with: intracapsular FNF;
Objective: With increased awareness of atypical femur frac- age ≥65 years; DXA of the noninjured hip with a T-score≤
tures (AFFs), incomplete non-displaced fractures (iAFFs) as- −2.5 SD. All patients received standard treatment for the
sociated with antiresorptive therapy are diagnosed more fre- fractured hip (arthroplasty, emiarthroplasty, cannulated
quently. Optimal therapy for these fractures is unclear. We screws); the contralateral hip was randomized either to receive
describe a case series of 25 patients (pts.) with iAFFs treated PNS (group A) or not: control group (B). During each follow-
with teriparatide (TPD) therapy. up (FU) at 3, 12 and 24 months, DXA, CT and X-rays of the
Material and Methods: All 25 pts. satisfied the criteria set reinforced hip were performed.
forth by the ASBMR Task Force. We assessed radiographic Results: From September 2008 to May 2012 we enrolled 80
fracture healing using CT scans and plain radiographs, mea- patients (46 A, 34 B). The mean age was 83 years (A) and 82.9
suring depth of the lucent line through the cortex and degree it (B). The preoperative DXA was −3.3 SD in both groups. At
 Osteoporos Int

1 month FU no patients reported pain in the reinforced hip. OC44

The walking ability of patients with PNS were comparable to LIFESTYLE AND DIETARY HABITS FOR
controls. The CT scan showed good osteointegration of the FRACTURE PREVENTION AND CARE
PNS. At the longest available FU 23 patients reported one or M. Tsagareli1, E. Giorgadze2, N. Dolidze2, T. Sulikashvili1, N.
more falls. 16 nonfemoral fractures Were recorded: 10 (A) and Jeiranashvili1
1
6 (B) and 7 contralateral hip fractures (CHFs): 3 in the PNS Skeletal Endocrinology Unit, National Institute of Endocri-
group and 4 in the control group. In A all CHFs occurred nology, Tbilisi, Georgia, 2National Institute of Endocrinology,
within 1 month after surgery and there was a difficult Tbilisi, Georgia
screw placement during surgery, in the control group the
CHFs were consequence of a fall (6 months to 2 years Objective: To raise the awareness towards osteoporosis and
after the first FNF). osteoporotic fracture prevention through modification of Life-
Conclusion: No statistical differences were reported be- style and Dietary habits in Georgian population.
tween A and B; however, there is a trend that shows Material and Methods: 567 women were examined at our
prevention of fractures in the PNS group. The device Clinic In 2013–2014 year. All patients diagnosed with
was well tolerated. CHFs in the PNS group should be osteopenia or osteoporosis were involved in a specific pro-
considered a technical error due to the surgical instruments. gramme for nutritional support and lifestyle modification—
Safety of the device can be increased by improving the instru- “Life Without a Fracture”. The programme was specifically
ments to reduce the risk of iatrogenic fractures. Moreover created to increase patient awareness towards bone health and
larger cohort of patients is necessary to evaluate the effective- prevent diagnosed low bone mass progression into Osteopo-
ness in preventing FNF. rosis and Osteoporotic Fracture. Involved patients were hand-
ed brochure “You Have Osteoporosis-First Steps Towards
Fighting It” dedicated to the specifically prepared for series
OC43 of presentation sessions. Brochure featured following chap-
DOES LIFESTYLE MODIFICATION AND PHYSICAL ters: Calcium and Dairy Nutrition; Body Weight and Its
THERAPY IMPROVE QUALITY OF LIFE IN Influence on Bone mass; Smoking and Alcohol Cessa-
POSTMENOPAUSAL OSTEOPOROSIS? tion; Lifestyle Modification; Fall Prevention; Consulta-
U. Swadpanich Sangkomkamhang1 tions and Supervision by a Health Professional. We
1
Obstetrics and Gynecology, Khonkaen Hospital, Khonkaen, have prepared Lecture course on Osteoporosis risks
Thailand and Nutritional Support for Osteoporosis Prevention
and Treatment. Georgian Association of Skeletal Metabolism
Objective: To find an adequate physical therapy program for Diseases members were presenting lectures at the local poly-
women with postmenopausal osteoporosis and to evaluate clinics in order to help primary care physicians to recognize
outcomes regarding quality of life. and diagnose OP in primary healthcare setting. At the end of
Material and Methods: For 1 year we followed 96 women each session they were handed the Book “Issues of Nutrition
(age 47–72) with postmenopausal osteoporosis, under treat- and Bone Health”.
ment with bisphosphonates. Initially, at 6 and 12 months, we Results: Patients involved in the program have showed high
evaluated the patients, using DXA osteodensitometry and SF- motivation to change lifestyle and develop good dietary habits
36 questionnaire. We recommended a short program (30 min) for the prevention or treatment of established bone mass
of fall prevention and ROM exercises, at least three times decrease.
weekly. Conclusion: The program has raised the awareness of prima-
Results: The adherence to physical activity program was ry care physicians towards recognition, correct diagnostics
poor, only 22 % respected the schedule. After 6 months the and timely treatment accompanied with appropriate Nutrition-
SF-36 score was better in patients who performed the pre- al recommendations.
scribed physical training program. 18 patients left the study at
this moment. The average score of SF-36 was significantly
improved after 1 year. We did not find significant BMD OC45
changes after 1 year. IMPACT OF DIETARY HABITS AND PHYSICAL
Conclusion: The implementation of an adequate physical ACTIVITY ON BONE HEALTH AMONG 40–60 YEAR
activity lifestyle may be difficult and requires a suitable OLD FEMALES AT RISK OF OSTEOPOROSIS IN
methods for educating osteoporosis patients. For physical INDIA
therapy activity has no effect on BMD but seems to improve R. Munshi1
1
the quality of life in women with postmenopausal Food and Nutrition Dept. College of Home Science, Punjab
osteoporosis. Agricultural University, Ludhiana, India
Osteoporos Int

Objective: To check the evidence of diet and nutrition and of discussions regarding lifestyle-risks and medication-
physical activity relating to risk of osteoporosis among 40– related issues, when prescribing osteoporosis medication
60 year old women in India. to a patient.
Material and Methods: IOF One-Minute Osteoporosis Risk Material and Methods: The observational-descriptive anal-
Test questionnaire, a separate questionnaire to assess the ac- ysis, carried out in a non-participatory manner, included 227
tivities and their relation to generation of pain and assessment interactions between doctors and osteoporosis patients in sev-
of BMD through broadband ultrasound of wrist. Assessing en ambulatory clinics (rheumatology, physiotherapy, endocri-
dietary habits and food intakes through food frequency ques- nology) in four cities. In all cases the patient was initiated or
tionnaire, following were considered: milk, poultry, fleshy already taking an osteoporosis drug. We observed the pres-
foods, fruits and vegetables along with portion size. ence, and if the case: the length of discussions about lifestyle.
Results: The IOF One-Minute Osteoporosis Risk Test It was also assessed, whether medication issues were
questionnaire provided information regarding genetic discussed (possible side effects, patient fears) and the propor-
risk and secondary risk of osteoporosis. A total of 102 tion of time spent with this, compared to the overall duration
females (40–60 years of age) were assessed, and 43 % of the visit.
were found at risk of osteoporosis. The genetic risk was Results: Lifestyle discussions were present in 14 % of
found among 8 % of subjects, 7 % were suffering from the interactions between the physician and osteoporotic
osteoarthritis and; only 3 % were having thyroid prob- patient. In these cases, it took in average 7 s to discuss
lems. About 78 % had onset of menopause between 47 about lifestyle (including investigation and providing
and 55 years of age. About half of the assessed popu- information or recommendation). Total dialogue about
lation was university lecturers constituting 36 % of osteoporosis medication inclusive: exploring patient
those at risk of osteoporosis. Dietary assessment re- fears or giving advice was observed to represent 10 %
vealed strong relation between less intake of milk, poul- of the time spent with the patient.
try and fleshy foods and increased risk to osteoporosis Conclusion: We observed meetings focused on tasks at the
and related symptoms. The women not at risk were expense of discussions (exploring risk factors, providing in-
found to be physically active having healthy eating formation and advice) that were less than brief and represented
habits. Majority of them were taking milk and poultry a reduced percentage of the encounter. Time spent in lifestyle
on daily basis besides fresh fruits and vegetables. Al- and medication related discussions was insufficient to provide
most 75 % of all women assessed were not exposing patients with adequate information and motivation to reduce
themselves to sunlight daily. their osteoporosis risks and adhere to the prescribed
Conclusion: A positive relation was found between di- medication.
verse food habits and bone health, suggesting foods rich
in vitamins, minerals and other phytochemicals reduce
the risk of bone density loss. A strong relation was OC47
found between physical activity to risk of skeletal prob- LIFESTYLE AND DIETARY FACTORS PROMOTING
lems and related symptoms of pain, supporting the fact DEVELOPMENT OF HIP FRACTURES IN MEN
that exercise stimulates skeletal growth. Early onset of O. Sinitsyna1, K. Belova2, O. Ganert1, M. Romanova3, O.
menopause was also found prevalent among some wom- Ershova2
1
en, at increased risk of osteoporosis. Yaroslavl Medical Academy, Yaroslavl, Russian Federation,
2
Solovev’s Hospital, Yaroslavl, Russian Federation, 3Regional
Hospital, Yaroslavl, Russian Federation
OC46
LIFESTYLE RISKS AND MEDICATION ISSUES Objective: The incidence of hip fractures in Yaroslavl (Rus-
DISCUSSED WITH OSTEOPOROSIS PATIENTS sian Federation) in men aged till 70 years they meet more
A. I. Gasparik1 often than at women that distinguishes the obtained epidemi-
1
University of Medicine and Pharmacy, Tirgu Mures, ological data from other countries. The aim of the study was to
Romania estimate the lifestyle risk factors (smoking, alcohol consump-
tion, the hard physical work, insufficient consumption of
Objective: Compliance with recommendations (lifestyle calcium with food) in men with hip fractures in 40–69 years.
or medication) implies actually a shared responsibility Material and Methods: The main group included 128 men–
between physician and patient and, however adherence inhabitants of Yaroslavl (Russia) aged 40–69 years with hip
is accepted as being linked to >200 different variables, fracture. The control group was included 50 healthy men 41–
it is affected mainly by the communication between the 67 years old. In comparison group there were 108 patients at the
parts. We aimed to explore the frequency and duration age older than 70 years with hip fracture. Consumption of
 Osteoporos Int

alcohol was estimated on CAGE questionnaire. The statistical panel examined literature on exercise effects on: 1)
analysis was carried out by means of a package of the applied falls, fractures, BMD, and adverse events for individuals
programs Statistica 10.0. with osteoporosis or spine fractures; and 2) pain, quality
Results: In the analysis of major osteoporosis risk factors in the of life, and physical function after spine fracture. Evi-
main group comparing with control groups were revealed dence was rated as high, moderate, low, or very low.
significantly more often current smoking (р<0.00001), abuse An online Delphi process (2 rounds) was used to estab-
and systematic alcohol (р<0.00001), heavy physical activity at lish consensus on assessment, exercise, and safe move-
the age of 25–50 years (р<0.01), insufficient consumption of ment related to three cases with varying risk (moderate
dietary calcium (≤1,500 mg/d, p<0.05; ≤500 mg/d, р<0.05). risk for fracture; 1 spine fracture; multiple spine frac-
The comparing of the frequency of the risk factors at the main tures, kyphosis & pain). Duplicate content analyses of
and comparison groups we revealed significantly distinctions. free text responses to each question were performed.
There were following risk factors in the main group: current Results: GRADE Recommendations: All individuals
smoking (р<0.0002), systematically intake alcohol (р<0.05); with osteoporosis should engage in a multicomponent
abuse alcohol (р<0.05), heavy physical activity at 25–50 years exercise program that includes resistance and balance
(р<0.001). Insufficient consumption of calcium with food was training; they should not engage in aerobic training to
revealed in both groups, p>0.05, but more patient of the main the exclusion of resistance or balance training. Response
group consumed ≤500 mg/d, р<0.05. rates on the 2 Delphi rounds were 52 % (39/75), 69 %
Conclusion: The positive correlation of the development of (48/70). Key points: a) current physical activity guide-
hip fractures in men 40–69 years old to the lifestyle factors as lines are appropriate for individuals with osteoporosis in
smoking, systematic consumption and abuse of alcohol, heavy the absence of spine fracture, but not for those with
physical activity, low consumption of calcium with food was spine fracture; b) after spine fracture, aerobic activity of
established. moderate intensity is preferred to vigorous; physical
therapy consultation is recommended; c) daily balance
training and endurance training for spinal extensor mus-
OC48 cles are recommended for all; d) health care providers
TOO FIT TO FRACTURE: INTERNATIONAL should provide guidance on safe movement, considering
CONSENSUS TO ESTABLISH RECOMMENDATIONS activity history and preference rather than providing
ON EXERCISE AND SAFE MOVEMENT FOR generic restrictions (e.g., lifting).
INDIVIDUALS WITH OSTEOPOROSIS AND SPINE Conclusion: Our recommendations guide health care pro-
FRACTURES viders on assessment, exercise prescription and safe move-
L. M. Giangregorio1, A. M. Cheung2, A. Heinonen3, S. Mc- ment for individuals with osteoporosis.
gill4, J. Laprade5, M. C. Ashe6, K. Shipp7, J. D. Wark8, N. J.
Macintyre9, H. Keller4, R. Jain10, A. Papaioannou11
1
University of Waterloo, Waterloo, Canada, 2Department of
Medicine, University of Toronto, Baycrest, Toronto, Canada, OC49
3
Department of Physiotherapy, Health Sciences, University of LEISURE TIME COMPUTER USE AND
Jyvaskyla, Jyvaskyla, Finland, 4Department of Kinesiology, ADOLESCENT BONE HEALTH: FINDINGS FROM
University of Waterloo, Waterloo, Canada, 5Osteoporosis THE TROMSØ STUDY–FIT FUTURES
Canada and University of Toronto, Toronto, Canada, 6Dept. A. Winther1, E. Dennison2,3, O. A. Nilsen1, R. Jorde4,5, G.
of Family Practice, University of British Columbia, Vancouver, Grimnes4,5, A. S. Furberg6, L. A. Ahmed1, N. Emaus1
Canada, 7Department of Community and Family Medicine, 1
Department of Health and Care Sciences, UiT, Arctic Uni-
Duke University, North Carolina, United States, 8Royal versity of Norway, Tromsø, Norway, 2Victoria University,
Melbourne Hospital Department of Medicine, University of Wellington, New Zealand, 3MRC Lifecourse Epidemiology
Melbourne, Melbourne, Australia, 9School of Rehabilitation Unit, Southampton, United Kingdom, 4Endocrine Research
Science, McMaster University, Hamilton, Canada, 10Osteopo- Group, Department of Clinical Medicine, UiT, Arctic Univer-
rosis Canada, Toronto, Canada, 11Department of Medicine, sity of Norway, Tromsø, Norway, 5Division of Internal Med-
McMaster University, Hamilton, Canada icine, University Hospital of North Norway, Tromsø, Norway,
6
Department of Community Medicine, UiT, Arctic University
Objective: To develop consensus on physical activity recom- of Norway, Tromsø, Norway
mendations for individuals with osteoporosis.
Material and Methods: Using the Grading of Recom- Objective: There is growing concern regarding the possible
mendations Assessment, Development and Evaluation adverse effects of decreasing physical activity and obesity on
(GRADE) method, an international multidisciplinary bone health in adolescence. Here we explore the hypothesis
Osteoporos Int

that greater computer use at weekends is associated with lower strengthened largely by similar measures and activities. The
BMD. objective of the FallScreen project (KaatumisSeula in Finnish)
Material and Methods: In 2010–2011 more than 90 % of is to put all relevant evidence on effective fall prevention into
all first year comprehensive school students in the practice.
Tromsø region (a total of 1,038) attended the Fit Fu- Material and Methods: The implementation of FallScreen is
tures study, an expansion of the Tromsø study. BMD at based on a wide, coordinated cooperation between local
total hip, femoral neck and total body was measured as NGOs (including pertinent patient and senior citizen societies)
g/cm2 by DXA (GE Lunar prodigy). Lifestyle variables and health and social caregivers of the community. In short, all
were collected by self-administered questionnaires and older adults aged >65 years living in the community are to be
interviews, including questions on time per day during reached and subsequently evaluated for individual fall risk
weekends spent in front of the television or computer within the normal activities of local NGOs which are trained
and time spent on leisure time physical activities, ac- for basic risk assessment. All reached citizens receive perti-
cording to the Gothenburg instrument. The analyses nent information on physical activity, healthy nutrition (calci-
included 463 girls and 484 boys aged 15–18 years. um, vitamin D, proteins) and lifestyle (alcohol, smoking)
Results: Many adolescent balanced 2–4 h screen time with in general, in addition to information on local activities
moderate or high levels of physical activity. Boys spent more arranged for older people. Those identified at increased
time in front of the computer than girls (p<0.001), and among fall risk are asked to visit a fall prevention clinic, where
boys screen time was positively related to higher BMI levels a more comprehensive evaluation (e.g., medical and
(p=0.010). When we explored associations between BMD medication review, physical functioning and vision,
and screen time in a multiple regression model, that included home hazards) of various factors accounting for the fall
adjustment for age, sexual maturation, BMI, leisure time risk is done, and if necessary, specific measures and
physical activity, smoking, alcohol, cod liver oil and carbon- corrections are taken. This type of clinic is shown to
ated drink consumption, we found contrasting relationships. reduce the rate of falls and related injuries by about
In boys, higher screen time was adversely associated to BMD 30 % among older adults1.
at all sites (p<0.05), and these associations remained robust to Results: The FallScreen project will start in 2014 in the city of
adjustments for all life style factors described above. In con- Seinäjoki, Finland and it is expected to reach 8,000–10,000
trast, girls who spent 4–6 h in front of the computer, had older adults.
higher BMD than counterparts who spend <1.5 h screen time Conclusion: If even few prevented hip fractures can be attrib-
each day; this could not be explained by adjustments for the uted to FallScreen, this collaborative effort between NGOs
measured confounders. and local health and social caregivers will provide a cost-
Conclusion: We see different associations between time spent saving and feasible community-based approach to prevent
in sedentary activities and BMD levels among Norwegian fractures among aging population.
boys and girls, and these findings warrant further studies in References: 1. Palvanen M et al. Injury 2014;45:265
other populations. Acknowledgements: The project funding from Finland’s Slot
Machine Association (RAY) is greatly appreciated.

OC50
FALLSCREEN: A COLLABORATIVE EFFORT OC51
FOR FEASIBLE AND EFFECTIVE PREVENTION PHYSICALTHERAPY BENEFITS UPON
OF FALLING IN COMMUNITY FUNCTIONAL STATUS AND FALL RISK IN
H. Sievänen1, S. Karinkanta2 OSTEOPOROTIC WOMEN
1
UKK Institute and Finnish Osteoporosis Association, Tam- D. Popa1, M. Mihailov1, R. Suciu1
pere and Helsinki, Finland, 2UKK Institute, Tampere, Finland 1
Medical Rehabilitation Hospital, Oradea, Romania

Objective: Fragility fractures are a growing, global health Objective: To test the efficacy of 12 weeks Balance Training
problem leading to increased mortality, morbidity, and de- Program on functional status and fall risk in women with
clined quality of life, besides exerting enormous costs on osteoporosis in Medical Rehabilitation Hospital Felix Spa
health and social care systems. Number of these fractures is Romania. Design: randomized, controlled observational study.
projected to rise exponentially as populations age and have Material and Methods: A total of 54 consecutive outpatients
poorer physical functioning in general. Thus, all practical and were randomized in control group (n=25) and study group (n=
effective efforts need to be targeted to high-risk citizens: i.e., 25), as four patients from study group desisted. Interventions:
to those likely to fall and/or have fragile, osteoporotic skele- The control group received medical treatment for osteoporosis
ton. It is noteworthy that falls can be prevented and bones and educational materials to prevent falls. The study group
 Osteoporos Int

completed a balance training program for a period of 30 min 19.52 % always, 37.30 % sometimes, 31.91 % rarely, 11.26 %
three times weekly for 12 weeks and continued the same exer- never; milk consumption after 50 years 18.80 % always,
cises at home, daily. Outcome measures: Functional mobility 31.80 % sometimes, 32.57 % rarely, and 16.83 % never.
was evaluated by the Timed “Up and Go” Test (TUGT), func- Regular physical exercise or sports activities were reported in
tional balance with Berg Balance Scale (BBS). Assessments: the 27.90 %. The mean age at menarche was 13.69. 28.37 % had
data were expressed as the mean and standard deviation for each premature menopause. The mean number of birth was 4.15
variable at baseline, and after 12 weeks. “Effect size” was applied with a maximum of 15 births. The mean duration of
for Timed “Up and Go” Test and Berg Balance Scale to describe breastfeeding in whole life was 58.62 months. Breast-feeding
the magnitude of the clinical changes. ratio per a child; 33.86 % lactated for 6–12 months, 40.45 %
Results: The difference in BBS score was greater in the study for 12–24 months.
group, no significant changes were registered in control Conclusion: In terms of preventive strategies education of
group. A significant difference in the functional mobility, as patients as well as the healthy population is of great impor-
measured by the TUGT was observed in the study group tance. A primary aim is to establish healthy nutrition habits
compared to control. including increased intake of dairy products in diets, and
Conclusion: Our study showed that balance training per- calcium vitamin D supplementations in women over 50 years.
formed three times weekly supervised by a physiotherapist It is crucial to detect these risk factors in women with
and complemented by home based exercises has important population-based studies in order to establish powerful pre-
benefits in the improvement of balance, mobility and in re- ventive strategies.
duction of falls in women with osteoporosis. Acknowledgements: This study was funded and promoted by
References: 1. Carter ND et al. Br J Sports Med 2001;35:348. the Turkish Osteoporosis Society. T Arasil, F Atalay, G Dinçer,
2. Means KM et al. Am J Phys Med Rehabil 2005;84:238. B Durmaz, Ö El, Y Kirazli, YG Kutsal, S Öncel, Ö Peker.

OC52 OC53
RISK FACTORS OF OSTEOPOROSIS IN TURKISH CHARACTERISTICS OF SUBJECTS REPORTING
WOMEN BEYOND FRAX LOW-ENERGY FRACTURES IN A LARGE
U. Akarirmak1, S. Tuzun1, N. Eskiyurt2, D. Palamar1, M. POPULATION-BASED STUDY
Saridogan1, Osteoporosis Society3 A. Shinkov1, A. M. Borissova1, J. Vlahov1, L. Dakovska1, L.
1
Department of Physical Medicine and Rehabilitation, Istan- Kassabova2, D. Svinarov2
1
bul University, Cerrahpasa Medical Faculty, Istanbul, Turkey, University Hospital of Endocrinology, Medical University of
2
Department of Physical Medicine and Rehabilitation, Istan- Sofia, Sofia, Bulgaria, 2Central Laboratory of Therapeutic Drug
bul University, Istanbul Medical Faculty, Istanbul, Turkey, Management and Clinical Pharmacology, Alexander Universi-
3
PMR, İstanbul, Turkey ty Hospital, Medical University - Sofia, Sofia, Bulgaria

Objective: Although FRAX evaluation doesn’t include some Objective: To explore the prevalence of some factors for low
risk factors regarding lifestyle such as nutritional habits, physical bone strength like age, gender, body constitution, smoking
activity and gynecologic profile. It is still important to explore and vitamin D deficiency in subjects who reported past frac-
these factors in terms of bone health. The aim of this study is to tures in a large population-based study.
explore clinical risk factors regarding bone health with a simple Material and Methods: 2,033 subjects (1,076 female,
questionnaire among women over 50 years of age, and to 957 male), 20–80 years of age participated and filled
increase awareness of community-based risk factors. a questionnaire concerning current or previous morbidity
Material and Methods: This study was performed in 13,530 and medication, past fractures (all and vertebral, hip or
residents via face to face interview by trained staff using a Colles’), smoking habits. Body weight and height were
structured questionnaire, in 12 different geographical regions measured. Blood sample was drawn for 25(OH)D. The
of Turkey. fracture prevalence was estimated and the relationship to
Results: The mean age of females was 62.25, mean BMI the studied factors was explored.
was 29.16. Excessive alcohol intake was 0.4 %, current Results: 90 subjects (4.5 %) reported past fractures (71 fe-
smoking was 12.25 %. Residential location was urban in male, 19 male, p<0.001). Thirteen hip fractures (8 female, 5
72.90 %, rural in 27.10 %. In terms of milk consumption male), 5 vertebral (3 female, 2 male) and 31 Colles’ (22
before 25 years 30.95 % always, 35.65 % sometimes, female, 9 male) were reported. One subject reported more
24.22 % rarely and 9.17 % never; between 25 and 50 years than one fracture. In both genders the subjects with fractures
Osteoporos Int

were older (p<0.001). The females with fractures, but not the Conclusion: The sun exposure is necessary for the bone
males, had higher BMI than those without (29.0±5.0 vs. 27.1 health and total avoidance of sun is connected with extremely
±5.8, p<0.001) and had higher waist circumference (85.1± low vitamin D level in a sera that may lead to premature
12.8 vs. 90.4±11.5). In both genders 25(OH)D was lower in osteoporosis. Different lifestyle has impact on bone strength.
the subjects with fractures, though marginally significant in
the males. In both genders the fracture prevalence was signif-
icantly higher in those with 25(OH)D below 25 nmol/l, as was OC55
the hip, but not the Colles’ fracture prevalence. 25(OH)D THE IMPACT OF NON-NUTRITIONAL FACTORS ON
levelas were lower in the female subjects with obesity VITAMIN D STATUS IN ELDERLY UKRAINIAN
(34.2±16.1 vs. 37.7±17.9, p=0.07). We found no correlation POPULATION
of the fracture prevalence with smoking. V. V. Povoroznyuk1, V. Muts1
1
Conclusion: The subjects reporting fractures were older, Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine
predominantly female and had lower vitamin D. The latter
may be linked to insufficient sun exposure and in the females Objective: Verification of vitamin D status in elderly Ukrai-
to overweight and obesity. Overweight and abdominal obesity nian subjects; assessment of the influence of various factors
especially in the females were associated to fracture on vitamin D and bone tissue status.
prevalence, presumably due to lower physical activity and Material and Methods: 1,209 subjects (90.9 % women, age
unbalanced diet. 50–90 years) from various regions of Ukraine. Blood sampling
done in 2011–2013; separate subset of subjects assessed be-
tween November and April. Vit. D status assessed by measuring
OC54 serum 25(OH)D levels by electrochemiluminescence method
LIFESTYLE, VITAMIN D AND OSTEOPOROSIS IN A (Elecsys 2010, Roche). Vit. D deficiency diagnosed at
VEIL COVERED WOMAN <50 nmol/l (severe deficiency <25 nmol/l); insufficiency - 50–
S. Sokolovic1 75 nmol/l; optimal vitamin D status declared at >75 nmol/l.
1
University Clinical Center, Clinic for Heart and Rheumatic Serum intact parathyroid hormone levels were also assessed.
Diseases, Sarajevo, Bosnia and Herzegovina Subjects completed a set of questionnaires (VAS, Lequesne,
Rolland-Morris, ECOS-16) and underwent DXA. BMI was
Objective: A 47 years old female patient suffering from calculated.
polymorphic musculoskeletal symptoms including fatigue Results: 80.3 % of population found to be vit. D defi-
and fibromyalgia was screened for the premature osteoporo- cient (46.9 % had severe deficiency). Women (mean
sis. Since she has been a wearing a dress code with a veil 29.9±22.1 nmol/l) are affected more significantly than
covering the whole body including head, face and chest and men (38.6±22.5 nmol/l). The deficiency was more pro-
determined lifestyle indicating her extremely low exposure to nounced with age, notably for men (p<0.01). Severely
daily sun, vitamin D sera was measured before and after the obese (>35 kg/m 2 ) subjects had significantly lower
initiation of treatment. Past history showed that she went into 25(OH)D levels (26.1 ± 16.2) than those with normal
premature osteoporosis when she was 38 years old. BMI (34.3±25.3) or moderate obesity. 25(OH)D levels
Material and Methods: A case report study. fluctuated throughout the year with a 2-month lag
Results: Vitamin D level was <3.00 ng/ml and DEXA aver- (mean ultraviolet index values for a given month being
age T score for the lumbar spine was −2,8 and for the hip T a reference). VAS index was closely linked to vit. D
score was −0,8. Two years before T score for the lumbar spine status (mean 38.0±26.3 in severely deficient patients,
was −1,7 and for the hip −0,3 respectively. So, T score has and 14.0±25.2 in patients with optimal vit. D status).
worsened from −1,7 to −2,8 for the lumbar spine and from Other questionnaires revealed a number of correlations
−0,3 to −0,8 for the hip respectively just in a two years. The as well. Biological age was found to be inversely de-
bisphosphonate with vit D in itself was initated as therapy pendent on 25(OH)D levels. Patients in lower quartile
including the supplementation therapy. Dietary regime with by 25(OH)D had significantly lower BMD than those in
the minimum half an hour of sun exposure during the noon the upper quartile (p<0.01).
time was advised. The control DEXA and Vitamin D was Conclusion: Vit. D deficiency is widespread in Ukrainian
measured after one year and improvement was observed, but elderly population; age, male sex and BMI all adversely
not significantly due to entire covered body, head and face affecting 25(OH)D levels. Vit. D deficiency results in mark-
with veil. The muscloscleletal symptoms and general health edly decreased BMD and biological age increase. VAS index
was improved. correlates well with vit. D status.
 Osteoporos Int

OC56 OC57
A COMMON PROJECT OF THE OSTEOLOGICAL INTERNET AS A TOOL FOR HEALTH: SURVEY ON
CENTRE AT THE OSTEOLOGYACADEMY OF ZLÍN THE INTEREST AND THE USE OF THE INTERNET
TOGETHER WITH THE NEUROSURGICAL AMONG SUBJECTS FROM AN OSTEOPOROSIS
DEPARTMENT OF TOMAS BATA HOSPITAL IN ZLIN CENTRE–A PRELIMINARY REPORT
MODEL PROJECT: CAPTURE THE FRACTURE J. Slomian1, S. Streel1, G. Appleboom2, C. Beaudart3, F.
ZLÍN–EVALUATION AFTER TWO YEARS Buckinx3, J.-Y. Reginster3, O. Bruyère1
P. Novosadová1, P. Hrdý1, M. Filip2, P. Linzer2, J. Blahos3 1
Support Unit in Epidemiology and Biostatistics, University
1
Osteological Centre at the Osteology Academy, Zlín, Czech of Liège, Liège, Belgium, 2Neurodigital Laboratory, Colum-
Republic, 2Neurosurgical Department KNTB a.s. Zlín, Zlín, bia University, New York, United States, 3Department of
Czech Republic, 3Osteocentrum and Endocrinology Military Public Health, Epidemiology and Health Economics, Univer-
Hosp, Prague, Czech Republic sity of Liège, Liège, Belgium

Objective: After a logistic analysis of similar programmes we Objective: To evaluate the interest and the level of Internet
have come to a conclusion that the project is plausible only use for health issues among people who use care institutions in
with special cooperation of the workplaces which are, within the field of bone health.
their specialized area, capable of complex patient’s care. Material and Methods: Self-administered questionnaires
Material and Methods: Densitometric detection and diag- were distributed to subject screened for osteoporosis at the
nostics is carried out while using DXA GE Lunar Prodigy, I Bone Metabolism Unit at the polyclinic Lucien Brull (Liège,
DXA GE Lunar Encore including LVA and child software, Belgium).
RTG workplace is equipped with modern digital system Sie- Results: Currently, 30 patients have responded to the
mens, complex spectrum of osteomarkers from blood, survey but the inclusion of subjects is ongoing. The
osteocalcin, bone ALP, CTX, P1NP. Cohorts: women n=45, average age of respondents is 74.3 years, there are
average age: 64.6 years, (3 women more than 80 years of age); 73.3 % of women, 86.7 % of them are retired and
men n=28, average age: 65.0 years. 84.6 % have at least one health problem. Among all
Results: Fracture location: L1-39.2 %, Th12-21 % L2- subjects, 37.5 % are osteoporotic. There are 43.3 % of
12.5 % L3-8.9 % two vertebrae −10.6 % three vertebrae one Internet users, and those who do not use Internet say
time, one time fracture in Th8, L5, L4, Th11, C2. either they do not see the interest of it or do not like it
Type of surgery: vertebroplasty-57 %, traditional treatment or find it too expensive, not easy to use or that it
14.3 %, other surgeries 23.7 % (kyphoplasty, spongioplasty, provides too much information. Among the Internet
transped. Fixation, etc.). users, 63 % of them said searching to be informed
Increased bone turnover evaluated according to OC, CTX and about their health and 27.6 % said using the Internet
P1NP - 28.6 %. as a tool of research. Whatever the means of informa-
Diagnosis: 27 % patients, BMD - L spine, average 0.658 g/ tion, once informed, 73.1 % of them expressed the need
cm2, BMD-Prox. femur and average 0.613 g/cm2, other phys- to talk about it with their relatives, friends or physi-
iological findings and osteopenia BMD L - spine, average cians. All respondents attributed an average score of
0.846 g/cm2, prox. femur: 0.930 g/cm2. 6.6/10 regarding the consistency of information found
Anamnesis: 21 % of patients have previously suffered one on the Internet. The use of Internet differs significantly
fracture at a different location; one patient has undergone two (p=0.007) depending of age: those who use the Internet
fractures at one location in spinal area. All patients were have an average age (69.5 years) lower than those who
educated in motion, dietary and rehabilitation regime. No do not use it (78.2 years). The same observation can be
fracture recurrence so far with any of the observed patients. made about the fact of searching information on their
Conclusion: The key moment in the transition is the organi- health on the Internet (68.3 vs. 76.3 years; p=0.009).
sation based on cooperation and effective database communi- No significant difference was found for socio-economic
cation of individual workplaces and its qualitative control. status or number of health problem.
The aim is to have current updated information about each Conclusion: Even if age appears to be an important factor in
patient at the managing centre and specialists must be able to the use of the Internet for searching for health information in
change a routine procedure to an individual approach at any patients screened for osteoporosis, almost 30 % of the study
moment as the situations may require. From the logistics point population uses Internet for this purpose. Action to promote
of view general practitioners need to be trained in proper health through an Internet platform must therefore take this
cooperation with osteological centres. parameter into account.
Osteoporos Int
DOI 10.1007/s00198-014-2643-3

World Congress on Osteoporosis, Osteoarthritis

and Musculoskeletal Diseases (WCO-IOF-ESCEO 2014):
ESCEO Symposium Abstracts

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

SE1 SE2
EFFICACY AND SAFETY OF ANTIOSTEOPOROSIS EFFICACY AND SAFETY OF OSTEOPOROSIS
MEDICATIONS IN THE ELDERLY MEDICATIONS IN THE ELDERLY: AN ESCEO
M. L. Brandi1 CONSENSUS
1
University of Florence, Department of Surgery and Transla- R. Rizzoli1
1
tional Medicine, Florence, Italy Division of Bone Diseases, Geneva University Hospitals and
Faculty of Medicine, Geneva, Switzerland
Even though the efficacy of osteoporosis pharmacological
treatment in the elderly is well recognized, the The risk of osteoporotic fractures in the geriatric (≥75 years)
underprescription of antifracture drugs is frequent in this vul- and especially the oldest old (≥85 years) is a major healthcare
nerable segment of the population. This is even more true in the concern. At the age of 50, the lifetime risk of experiencing a
oldest old (80 years and older). Such scenario is the opposite fracture is more than 50 % for women and 20 % for men. The
that we would expect from the epidemiological data indicating impact of a fracture on patients’ quality of life is immense,
the growing incidence of fragility fractures in a world’s popu- often heralding the transition to frailty and dependence. The
lation that is growing, with the recognition that fracture risk costs borne by society are also significant, both in terms of
increase progressively with age, irrespective of BMD T-score. immediate care and rehabilitation and over the longer term if
Explanations for the underprescription of osteoporosis drugs dependence begins to take hold. The fact that many older
is the perception that these treatments are perceived as effec- people—at high risk of fracture—receive no treatment or
tive only after long-term treatment. Conversely, anti-fracture highly inadequate treatment—is unacceptable. There is now
efficacy is present already by 12 months. Thus in the elderly sufficient evidence of the already short-term benefits of treat-
and even in the oldest old patient population starting treatment ment and of the long-term safety profile of osteoporosis treat-
with an anti- fracture drug would have time to exert a benefi- ments. There is clear evidence that many older people are
cial effect on BMD. under nourished and vitamin D insufficient—a situation that
The impact of direct and indirect burden of osteoporotic frac- needs to be rectified quickly and before starting any pharma-
tures in the elderly and especially in the oldest old is a major cological therapy. A few major studies did specifically include
healthcare concern, both in term of patients’ lives and society’s older post-menopausal women and had prespecified analyses
costs. This makes unacceptable the underprescription of regis- of fracture endpoints: the HIP study on risedronate, a
tered drugs effective in preventing fragility fractures even in the clodronate study, the TROPOS and SOTI studies on strontium
elderly and in the oldest old. In the elderly population, phar- ranelate, the HORIZON study on zoledronic acid and the
maceutical osteoporosis treatment should change from being FREEDOM study on denosumab. All of these studies showed
cost-effective to being cost-saving. convincing results on fracture endpoints after 3 years of treat-
Recent revised guidance papers in this area, along with cam- ment. A number of RCTs have demonstrated clinically signif-
paigns launched around the world with the aim of reducing the icant benefits in terms of fracture reduction within the first
incidence of secondary fractures are contributing to create year of treatment. Thus even in an oldest old patient popula-
effective standard of care procedures. These efforts will be tion, it appears that starting an osteoporosis treatment would,
reviewed during the Symposium. by and large, have time to exert a beneficial effect. Because of
 Osteoporos Int

the widespread levels of poor adherence to treatment, compli- reasons. OA is a chronic condition involving long term man-
ance and persistence need to be addressed in order to ensure agement in a patient population in whom the mean age is
that the benefits of treatment can be fully realized. In the increasing steadily. The choice of treatment should take into
treatment of the oldest old however safety and dosing consid- consideration a balance between the benefits and risks for
erations might possibly outweigh minor efficacy differences. patients. In addition to the evaluation of every available treat-
The IOF Capture the Fracture Campaign aims at reducing the ment in that regard, it is well known common daily practice
incidence of secondary fractures by the creation of effective for physicians to rely on an orderly and rational approach to
standard of care procedures. The idea is built around the pharmacological treatment of medical conditions such as OA.
adoption of Fracture Liaison Services that provide compre- A therapeutic algorithm aimed specifically at this group of
hensive follow-up of patients after an initial fragility fracture patients would provide physicians with a stepwise approach to
and proposes to establish a Best Practice Framework. Al- treatment, which should benefit the vast majority of OA
though none of these programs specifically targets the oldest patients, integrating in a practical and orderly manner, a pos-
old, it may be hoped that they reach a wide audience that will itive benefit-to-risk ratio of such treatment, thereby reducing
make intuitive associations, and contribute to reduce fracture the risk of management missteps. Such management should
risk and the associated burden in the elderly. aim at improving the quality of life of OA patients while
minimizing the potential risks that can be associated with it.
Therapeutic guidelines are essential for the management of
SE3 OA.
OPTIMIZING THERAPEUTIC ADHERENCE
IN OSTEOPOROSIS
J. Weinman1 SE5
1
Institute of Pharmaceutical Sciences, King’s College AN ALGORITHM GUIDELINE FOR THE
London, London, United Kingdom MANAGEMENT OF KNEE OSTEOARTHRITIS IN
EUROPE: A REPORT FROM A TASKFORCE OF
This paper will provide an overview of the nature, causes and THE EUROPEAN SOCIETY FOR CLINICAL AND
effects of non- adherence to treatment in patients with osteo- ECONOMIC ASPECTS OF OSTEOPOROSIS
porosis. It will begin by providing a background introduction AND OSTEOARTHRITIS (ESCEO)
to the prevalence of the adherence problem and the different J.-Y. Reginster1
1
behavioural aspects of nonadherence, focusing on the distinc- Department of Public Health, Epidemiology and Health Eco-
tion between intentional and unintentional factors. There will nomics, University of Liège, Liège, Belgium
be an emphasis on the role of patients’ beliefs about their
illness and treatment, and the ways in which they have been Osteoarthritis (OA) is the most common form of arthritis and a
shown to affect intentional nonadherence to treatment in os- major cause of disability. Knee OA treatment guidelines have
teoporosis. The final part of the talk will build on these recent been issued by the most influential scientific authorities.
findings by examining their implications for current However, there is a need to find a common denominator to
healthcare practice. This will focus on the ways in which the published and draft guideline documents from different
adherence problems can be identified and managed in routine sources and to generate a treatment algorithm applicable
consultations as well as on the development and application of throughout Europe and elsewhere. Most of the existing prac-
specialist interventions. tice guidelines analyze the evidence behind each proposed
treatment but do not prioritize the interventions. The ESCEO
algorithm summarizes the evidence on all proposed treatments
SE4 and puts them in the sequence suggested by the evidence.
WHY DO WE NEED AN ALGORITHM FOR THE
TREATMENT OF OSTEOARTHRITIS?
J.-P. Pelletier1 SE6
1
Osteoarthritis Research Unit, University of Montreal Hospi- CHALLENGES FOR THE DEVELOPMENT OF BONE
tal Research Centre (CRCHUM), Montreal, Quebec, Canada FORMING AGENTS IN EUROPE: INTRODUCTION
J. A. Kanis1, R. Rizzoli2, C. Cooper3, J.-Y. Reginster4
1
Osteoarthritis (OA) is the most common musculoskeletal dis- WHO Collaborating Centre for Metabolic Bone Diseases,
order. Its prevalence is steadily growing with the aging of the University of Sheffield Medical School, Sheffield,
world population, imposing an increasing medical need and United Kingdom, 2Division of Bone Diseases, Geneva
financial burden on society. The treatment of OA symptoms University Hospital and Faculty of Medicine, Geneva,
can often be challenging to the medical community for many Switzerland, 3 MRC Lifecourse Epidemiology Unit,
Osteoporos Int

University of Southampton, Southampton, and NIHR forming agents may vary and for specific agents may be less
Musculoskeletal Biomedical Research Unit, University than 2 years. To address this situation, the regulation should
of Oxford, Oxford, United Kingdom, 4Department of allow for flexibility to investigate a treatment program that
Public Health, Epidemiology and Health Economics, may involve sequential, cyclical or combination therapy to
University of Liège, Liège, Belgium achieve and maintain optimal benefit and clarify the overall
time of observation necessary for regulatory approval. In this
In recent years significant advances have been made in the regard, 2 years seems a reasonable to evaluate the benefit risk
management of osteoporosis, particularly with respect to the profile of a bone forming intervention.
development of pharmacological interventions to reduce frac- A regulatory framework that allows for practical flexibility to
ture risk. Most of these agents are primarily inhibitors of bone demonstrate the unique effects of an individual agent in light
turnover, sometimes referred to as anticatabolic agents where- of the anticipated use in clinical practice and clearly outlines
as teriparatide, PTH and strontium ranelate act in part or the requirements for approval is necessary to effectively de-
predominately by the stimulation of bone formation (anabolic sign and execute clinical programs to develop novel bone
agents). There is also a number of bone forming agents in forming agents.
clinical development including agents targeting the endoge-
nous inhibitors of bone formation sclerostin and dickkopf-1,
cathepsin K inhibitors, new formulations of PTH and PTHrP SE8
analogues, and calcilytics. The clinical use of these agents in SELECTIVE ESTROGEN RECEPTOR
the management of osteoporosis is dependent on marketing MODULATORS: RALOXIFENE AND BAZEDOXIFENE
authorization from the Committee for Medicinal Products for J.-M. Kaufman1
1
Human Use (CHMP) of the European Medicines Agency last Department of Endocrinology and Unit for Osteoporosis &
updated in 2007. These requirements, well rehearsed for in- Metabolic Bone diseases, Ghent University Hospital, Ghent,
hibitors of bone turnover, pose some problems in the devel- Belgium
opment of bone forming agents. These include the duration of
study, the duration of exposure, offset of effect and the use of Osteoporosis is closely related to menopause in women.
sequential interventions. A consensus view is presented that Therefore, replacing the declining hormones may solve the
might be considered in future guideline provision. estrogen deprivation-associated consequences of menopause.
However, estrogen therapy, alone or combined with proges-
terone, has been associated to a series of potential risks that
SE7 have restricted its use for the treatment of osteoporosis.
CHALLENGES FOR THE DEVELOPMENT OF BONE The diversity of tissue-specific estrogen receptor-cofactors
FORMING AGENTS IN EUROPE: AN INDUSTRY complexes, however, offered opportunities for designing sub-
PERSPECTIVE stances activating these receptors in some tissues (bone) while
A. Grauer1, J. Caminis2 being neutral or antagonistic in others (endometrium, breast).
1
Amgen Inc., Thousand Oaks, CA, United States, 2UCB These so called SERMs or Selective Estrogen Receptor Mod-
Biosciences, Raleigh, NC, United States ulators were primarily designed as antagonists for adjuvant
treatment in breast cancer. However, two molecules, raloxi-
Agents that stimulate bone formation are necessary for the fene and bazedoxifene are currently available for treatment of
management of patients with osteoporosis as they have the osteoporosis because of their demonstrated efficacy profile.
potential to increase bone mass as well as improve bone SERMs are mild depressors of bone remodeling and, there-
microarchitecture. The clinical development of bone forming fore, act as antiresorptives. This degree of suppression is
agents poses a number of interesting scientific and logistical reassuring as to some of the long- term side effects associated
challenges and may require large, complex and costly clinical with some more potent anticatabolic drugs. Their main anti-
trials to generate the necessary evidence to support regulatory fracture effect is in decreasing the risk of vertebral fractures
approval. while an effect on preventing nonvertebral fractures has been
Although many aspects of a development program will fit into suggested by post hoc analyses in high risk subgroups. Their
the established framework for the approval of an most important side effect is an increased risk of venous
antiresorptive drug in this indication, some elements are thrombosis and the associated risk of pulmonary embolism
unique to bone forming agents. This creates clinical, scientific in a degree comparable to estrogen therapy. On the positive
and regulatory challenges. To highlight one example: Which side, they are safe for the endometrium and a protective effect
observation period is appropriate to support the approval of a against hormone dependent breast cancer has been firmly
bone forming agent? The evolving understanding of bone demonstrated. Therefore, there is a group of women at high
biology suggests that the optimal treatment duration for bone risk for vertebral fracture, still too young for having a
 Osteoporos Int

substantial risk of hip fracture, that are good candidates to this the number of patients needed to harm (NNH), i.e., to cause an
class of drugs. In those in the fifties, sixties or even early AFF. Hence the benefits of antiresorptives are far greater than
seventies, at high risk for vertebral fracture and with no their risks, particularly if appropriately targeted to patients with
contraindication the drug can clearly be an option of choice, the highest fracture probability.
with the potential additional advantage of resolution of the Disclosures: Conflicts of interest: Consulting and speakers
effect when the treatment is stopped. This leaves open the fees from AMGEN, GSK, Merck, Eli Lilly; Research grants
options for follow-up treatments with other types of drugs if from AMGEN, Merck and Warner-Chilcott
needed, offering patient and treating physician the possibility
to treat the disease, a chronic condition, for as long as needed.
SE10
STRONTIUM RANELATE
SE9 C. Cooper1,2
1
BENEFITS-RISK RATIO OF OSTEOPOROSIS MRC Lifecourse Epidemiology Unit, University of South-
TREATMENT: ANTIRESORPTIVES-BISPHOSPHONATES ampton, Southampton, United Kingdom, 2Institute of Muscu-
AND DENOSUMAB loskeletal Science, University of Oxford, Oxford, United
S. Ferrari1 Kingdom
1
Division of Bone Diseases, Geneva University Hospitals and
Faculty of Medicine, Geneva, Switzerland Osteoporosis, with its associated morbidity and mortality, con-
stitutes a major public health problem. Women aged 50 years
Most amino-bisphosphonates (BPs) and denosumab (Dmab) have a remaining lifetime risk of suffering an osteoporotic
reduce the incidence of new vertebral and nonvertebral fractures fracture close to 50 %; this compares with around 11 % for
by 50–70 % and 20–30 %, respectively. Whereas the rapid and breast cancer. The last two decades have witnessed the emer-
consistent reduction of vertebral fractures with these drugs may gence of a number of pharmacological strategies to reduce the
mostly be explained by the suppression of stress risers on risk of osteoporotic fracture. An ideal antiosteoporotic drug
trabecular surfaces, the more tedious reduction nonvertebral should demonstrate effectiveness over short and long durations
fractures suggests different mechanisms of action on long bones. of treatment; in different types of patient; at different stages of
QCT (high-resolution) analyses have started to delineate the the life course; and against fractures at vertebral, non-spine and
differential effects of anti-resorptives on cortical bone, which hip sites. Strontium ranelate has been shown to be such an
may explain the wide range of RRR of hip fractures (−20–60 %) agent. Trials have demonstrated anti- fracture efficacy across a
observed in the elderly, depending on the study and the drug broad range of patients ranging from the younger postmeno-
used. Recently, the FDA has questioned the efficacy of long- pausal woman (aged 50–65 years) to those aged over 80 years.
term administration of BPs. Particularly, the strong association Among frail elderly women with co-morbidities, a notoriously
between long-term BPs therapy and the occurrence of atypical difficult group to treat, strontium ranelate is among the only
femoral fractures (AFF) has raised questions about the treatments to have shown both vertebral and non-vertebral
risk/benefits ratio of continuous treatment with these drugs. antifracture efficacy over a 5-year period. Fracture data from
Truth is that only few studies have examined the long-term the 4 and 5 year time points in double-blind, placebo-controlled
effects of antiresorptives, which were primarily focused on trials of strontium ranelate in osteoporotic women reveal: 33 %
BMD changes at spine and/or hip and were neither designed reduction of vertebral fracture over 4 years (RR 0.67; 95%CI
nor powered to look at antifracture efficacy. Hence, the FLEX 0.55–0.81 p).
and HORIZON extension studies, which rerandomized women
previously on alendronate, respectively zoledronate, to continu-
ous treatment or placebo, showed a further gain of LS BMD but SE11
not FN BMD, and further reductions in vertebral, but not non- INSIDE THE BENEFIT RISK/RATIO OF
vertebral fractures. Interestingly, post hoc analyses of these two ANTI-OSTEOPOROSIS TREATMENTS; A GLOBAL
long-term studies indicate that patients whose FN BMD OVERVIEW OF PEPTIDES OF THE PARATHYROID
remained below −2.5 T-score after 3 to 5 years of therapy were HORMONE FAMILY: PTH AND TERIPARATIDE
at greater risk of nonvertebral fractures if therapy was stopped R. D. Chapurlat1
1
vs. continued. In contrast, long-term exposure to Dmab has INSERM UMR 1033, Université de Lyon, Hôpital E Herriot,
shown a continuous increase of hip BMD for up to 8 years so Lyon, France
far, as well as a further reduction of nonvertebral fractures in the
4th year of therapy and beyond. In any case, the number of PTH stimulates bone formation and resorption and can in-
patients needed to treat (NNT), i.e., to prevent a fragility fracture, crease or decrease bone mass, depending on the mode of
with BPs or Dmab, is at least two orders of magnitude less than administration. Continuous infusions, which result in a
Osteoporos Int

persistent elevation of the serum PTH concentration, lead However, GC have also strong immunosuppressive effects,
to greater bone resorption whereas daily injections, which and adequate suppression of systemic inflammation in RA
cause only transient increases in the serum PTH concen- might have bone sparing effects. This was investigated in
tration produces a positive bone balance. Two peptides of the BeSt study, a novel study design comparing four
the PTH family have been developed as bone forming different treatment strategies in which treatment adjust-
agents in phase 3 trials, the 1–34 peptide (teriparatide), ments were made continuously when low disease activity
which produces the main biologic effects [1], and the was not reached in patients with recent onset RA (2). The
intact 1–84 PTH [2]. treatment strategies consists of 4 groups, among which
In a trial enrolling 1,637 postmenopausal osteoporotic group 3 with initial combination therapy with MTX,
women with vertebral fracture (mean age 69), two doses sulphasalazine and quickly tapered high dose of predni-
of teriparatide were compared to placebo (20 and 40 mg/ sone, and group 4 with MTX and tumor necrosis factor
day). After a median duration of follow-up of 21 months, alpha inhibitor infliximab. After 2 years of treat to target
the risk of new vertebral fracture was significantly reduced therapy, no difference was found in decrease in BMD at
by 75 % in the 20 mg group and by 79 % in the 40 mg the spine and hips between all 4 groups. (3). In addition,
group, compared with the placebo group. New non verte- radiological joint damage was low in all 4 groups. This
bral fractures were significantly reduced by 53 % in the clearly suggests that the negative effect of glucocorticoids
20 mg group and by 54 % in the 40 mg group, compared (GC) on bone should be outweighed against the strong
with the placebo group. anti-inflammatory effects of GC on bone (1).
In a randomized placebo-controlled trial over 18 months, Recently it has been demonstrated in a treat to target study
2,532 postmenopausal women with low BMD at the hip aiming at clinical remission that with the use of low dose GC
or lumbar spine were enrolled. Women received 100 mg (10 mg/day combined with MTX) it is possible to arrest both
of recombinant human PTH or placebo daily by subcu- the local and generalized bone loss in RA (4).
taneous injection. PTH reduced the risk for new or These data suggest that it seems possible that with adequate
worsened vertebral fractures, but in sensitivity analyses, suppression of systemic inflammation the negative effects of
the magnitude of the reduction was changed with as- GC on bone can be prevented.
sumptions about fracture incidence in patients who did References: 1. Vis M. Osteoporosis Int 2013; 2) Goekoop-
not complete the study. Nonvertebral fracture risk was Ruiterman YPM Arthritis Rheum 2005; 3) Güler-Yüksel M.
not significantly reduced. Ann Rheum Dis 2008; 4) Goes van der MC. Ost Int 2013.
While the safety profile of teriparatide was favorable with
only minor adverse events, patients on PTH1-84 were quite
often affected with hypercalciuria (24 %) and hypercalcemia SE13
(14 %). SKELETAL EFFECTS OF GLUCOCORTICOID
In this context, teriparatide at 20 mg has been widely used THERAPY IN RHEUMATOID ARTHRITIS
worldwide in the treatment of severe osteoporosis, while K. G. Saag1,2
1
PTH1-84 at 100 mg is marketed only in a few European Center for Education and Research on Therapeutics (CERTs)
countries. Of Musculoskeletal Disorder and Center for Outcomes Effec-
References: 1. Neer R et al. N Engl J Med 2001;344:1434. 2. tiveness Research and Education (COERE), Birmingham,
Greenspan SL et al. Ann Int Med 2007;146:326. AL, United States, 2Division of Clinical Immunology and
Rheumatology University of Alabama at Birmingham,
Birmingham, AL, United States
SE12
INTRODUCTION: ROLE FOR GLUCOCORTICOIDS Glucocorticoids have experienced a resurgence in their use
IN THE MANAGEMENT OF RHEUMATIC DISEASES due to efficacy in RA disease activity and severity. Despite
W. F. Lems1 clear benefits from newer clinical trials, glucocorticoid use is
1
VU Medical Center, Amsterdam, Netherlands marked by a plethora of serious adverse events. At high doses
glucocorticoids produce predictable loss of bone via direct
p>It is well known that both active rheumatoid arthritis deleterious effects on osteoblasts, osteocytes, and osteoclasts.
(RA) and the use of high dose glucocorticoids (GC) are At lower doses, the evidence is less robust, but it continues to
associated with generalized bone loss and with fractures. support toxicity to bone, in a dose dependent fashion. In
This negative effect on bone particularly occurs in pa- contrast to their toxic effect to bone, glucocorticoids also
tients with high dosages of GC and in patients with suppress the pro- inflammatory cytokines that contribute to
suboptimally treated RA, with persisting systemic in- bone loss and these effects potentially partially counter their
flammation (1). negative effects on bone. Beyond bone, new data is emerging
 Osteoporos Int

on the association of glucocorticoids with other adverse out- SE15

comes including infections, atherosclerotic related events, and CAN WE IDENTIFY WHICH PATIENTS SHOULD BE
even pancreatitis. The majority of data on the glucocorti- TREATED IN OSTEOARTHRITIS: INTRODUCTION
coid safety come from observational studies; many of N. K. Arden1,2
1
these studies examining non-rheumatic disease. The asso- NIHR Musculoskeletal Biomedical Research Unit, Universi-
ciation of glucocorticoids with adverse outcomes using obser- ty of Oxford, Oxford, United Kingdom, 2MRC Lifecourse
vational data is prone to bias, such as confounding by indication Epidemiology Unit, University of Southampton, Southamp-
and diagnostic detection bias. Several randomized controlled ton, United Kingdom
trials of glucocorticoids also have examined this issue. However,
RCTs are frequently underpowered to examine these question. A Osteoarthritis is a common disease with significant associated
variety of therapeutic agents are approved for prevention and morbidity, mortality and costs. Although there are a number of
treatment of glucocorticoid induced osteoporosis. The timing of treatments available for osteoarthritis, most aim to improve
initiation, sequencing, and long-term safety of these drugs is a symptoms and as yet there are no proven disease modifying
subject of debate. Despite international guidelines from EULAR drugs. Although most of these treatments reduce pain and
and other groups, many rheumatic disease patients on glucocor- improve function, their effect is limited and heterogeneous
ticoids do not receive prevention for glucocorticoid adverse across patients. Furthermore not all patients diagnosed with
outcomes. osteoarthritis will progress either clinically or structurally.
In the era of personalised medicine, it is imperative that we are
able to predict which patients are going to progress using
SE14 clinical predictors of progression. This will enable targeting
NON-SKELETAL EFFECTS OF GLUCOCORTICOID of interventions to the appropriate patient. Furthermore, in an
THERAPY IN RHEUMATOID ARTHRITIS era of increasing available of treatments, it is important to be
P. Miossec1 able to target the therapy to the appropriate patient. We there-
1
Department of Immunology and Rheumatology, University fore need to identify predictors of response to treatment which
of Lyon, Lyon, France are likely to be different from predictors of progression. Re-
search is progressing in this exciting and important area and
Rheumatoid arthritis (RA) is the most common and severe predictive models should be available within the next couple
inflammatory arthritis. Following the identification of corti- of years.
sone, proofs of concept experiments in RA patients have
quickly shown that steroids had a quick and profound anti-
inflammatory effect on disease activity. At the same time, it SE16
was shown that addition of slow acting drugs could improve OSTEOARTHRITIS: PHYSIOPATHOLOGY AND
the overall efficacy. Based on these early results, steroids RISK FACTORS FOR PROGRESSION
alone or combined have been used for the daily common F. Berenbaum1
1
treatment of RA. Quickly however, it was observed that long University Pierre & Marie Curie, INSERM UMRS-938, AP-
term use specifically at high dose was associated with severe HP Saint-Antoine Hospital, Paris, France
side effects including infections, skin atrophy and bone loss.
More recent results based on in vitro and in vivo studies have Advances in the knowledge of osteoarthritis (OA) pathophys-
indicated however, that use of low dose of steroids could have iology have dramatically progressed in the last 10 years. Ini-
a better efficacy/safety balance. Reasons are much better tially considered as a “cartilage- centric” disease due to tear
understood. Since chronic inflammation induces a cell medi- and wear, our views have now profoundly changed thanks to
ated immune defect responsible of infections with intra- and strong experimental studies, shifting to a more integrative
cellar cellular bacteria, control of inflammation by itself has a view. Cartilage, bone, synovium, adipose tissues, meniscus,
beneficial effect on these side effects. Indeed control of in- tendons, muscles, vessels, all play some roles in the initiation
flammation in RA induces a correction of the production of and/or in the progression of the disease. More interestingly,
Interferon gamma, the signature cytokine of the Th1 pathway. interactions between these tissues are at the forefront of these
Furthermore, it was recently shown that part of this effect was processes. For example, communications between
observed through inhibitory effects of low dose steroids on subchondral bone cells and deep zone chondrocytes may
cell-cell interactions leading to reduced production of two key explain very early events leading to cartilage degradation.
proinflammatory cytokines, IL-6 and IL-17. Additional ef- Synovial cells activated by cartilage fragments that fell down
fects can be observed when low steroid are combined with in the joint cavity during the OA process release a soap of
biotechnology products, which target TNF, IL-6 and other inflammatory and catabolic mediators acting on the surface of
inflammatory pathways. cartilage by activating superficial zone cartilage-derived
Osteoporos Int

chondrocytes. More recently, various pathophysiological opportunity for screening and patient-specific preventive
pathways have been demonstrated according to the known interventions.
risk factors. This lecture will address the different and the There may also be phenotypic subdifferentiation at a
common pathways related to post-traumatic, aging and meta- pathological level. While most OA is considered non-
bolic syndrome-induced OA, the main risk factors for primary inflammatory, biopsy and MRI studies of knees with
OA. OA have revealed a high prevalence of focal synovitis.
The presence of such synovitis correlates with pain and
appears to predispose to structural progression. These
SE17 observations provided a rationale for clinical trials test-
APPROACH TO SUBSTRATIFICATION OF THE ing intra-articular corticosteroids as structure-modifying
TREATMENT OF OSTEOARTHRITIS intervention, as well as biological therapies. Bone mar-
T. McAlindon1 row lesions (BMLs) are also prominent in the
1
Division of Rheumatology, Tufts Medical Center, Boston, subchondral bone of OA joints, correlate with symptoms
MA, United States and associate with progressive cartilage loss. One recent
clinical trial tested zoledronic acid for knees with OA
Deeper understanding of the characteristics of OA and the that exhibited BMLs. Finally, there have been several
pathological processes involved in its development and pro- initiatives to develop targeted therapies directed at artic-
gression has led to a new paradigm as a common final path- ular cartilage repair or regrowth.
way of joint failure. Furthermore, we now appreciate that the In summary, the therapeutic field of OA is benefiting from an
initiating factors can be diverse and often joint specific. Re- acceleration of progress stimulated by recognition of the nu-
search has also characterized a range of processes in osteoar- merous clinical and pathological subphenotypes that offer
thritic joints ranging from cartilage damage to subchondral new insights into potential preventive approaches and thera-
trabecular changes and synovitis, each of which could repre- peutic targets.
sent a target for therapeutic intervention. This polymorphic
nature of OA predicates patient oriented therapeutic ap-
proaches directed at the dominant phenotypic pathways in SE18
the context of individual characteristics and preferences. GOAL-ORIENTED TREATMENT IN OSTEOPOROSIS:
Different manifestations of hand OA were first recog- AN INTRODUCTION
nized as potential subphenotypes, characterized by peri- S. Ferrari1
1
menopausal onset in women, clinical evidence of in- Division of Bone Diseases, Geneva University Hospitals and
flammation, and development of central and peri- Faculty of Medicine, Geneva, Switzerland
entheseal erosions. The association of hand OA with
obesity has, in the absence of a biomechanical explana- The ultimate goal of osteoporosis therapy is to prevent
tion, prompted conjecture about a metabolic basis for fragility fractures. Several drugs have proven efficacious
OA. These insights have been a basis for exploration of and safe to reduce the incidence of new vertebral frac-
hormonal effects on OA (in epidemiologic studies) and tures, and to some extent non-vertebral fractures, however
clinical trials of immune modulators and biological ther- their long-term effects are less well established. Until
apies (with mixed results). recently, no drug, or combination of drugs, appeared ca-
Studies of knee OA have greatly enhanced our understanding pable to improve bone mass and structure continuously,
of the biomechanical factors involved in its progression, es- i.e., until bone strength was fully restored. Hence we have
pecially the structural basis for the development of treated osteoporosis for nearly three decades without really
malalignment and its contribution to progression. There is knowing or considering, how long to treat. However,
evidence that severe malalignment may render pharmaceutical emerging data with some recently developed pharmacolog-
interventions futile. However, different subphenotypes of ical agents suggest that optimal bone strength might be
knee OA malalignment exist (i.e., valgus, varus) and require restored after many years of continuous, sequential or
tailored interventions. combined therapy. This new evidence has therefore paved
Abnormalities, or variation, in articular anatomy also ac- the way to question whether a measurable target could be
count for a number of OA subphenotypes, the most rec- defined for osteoporosis treatment—as has been proposed
ognized of which are the femoral acetabular dysplasias, for diabetes or hypertension- and what the target should
which predispose to impingement and damage to the be: an absolute aBMD value at hip? a given increase in
labrum and articular cartilage. Others identified so far aBMD? a certain value or change in BTMs? A fracture
include patella alta and variation in thumb-base geometry. probability below a certain threshold (using FRAX for
Detection of these abnormalities in individuals offers the instance)? A given strength estimate by finite element
 Osteoporos Int

analysis? Anything else? In the search of an answer to SE20

these challenging questions, this symposium will review GOAL ORIENTED TREATMENT IN OSTEOPOROSIS:
the lessons from other disease areas and the evidence for LESSONS FROM OSTEOPOROSIS
goal-oriented therapy in osteoporosis. J.-M. Kaufman1
1
Department of Endocrinology and Unit for Osteoporosis &
Metabolic Bone diseases, Ghent University Hospital, Ghent,
SE19 Belgium
GOAL ORIENTED TREATMENT IN OSTEOPOROSIS:
LESSONS FROM OTHER DISEASES AREAS The goal of any osteoporosis therapy is to reduce fracture
E. V. McCloskey1 risk and thus to improve or preserve quality of life, function
1
University of Sheffield, Sheffield, United Kingdom and survival. Progress has been made in our ability to select
the patients at substantial risk of fracture, most likely to
There is much that appears, at least at first, both self- benefit from pharmacological intervention with one of the
obvious and logical in the setting of targets or goals in the several available agents shown to fairly consistently reduce
treatment of chronic diseases such as osteoporosis. If fracture risk by 40–60 %. Baseline fracture risk can be
patients are identified to be at risk because of well- estimated by combined use of BMD and validated clinical
characterised components of risk or biomarkers, then the risk factors, e.g., with use of the FRAX® algorithm. In
argument is that a target can be set for that biomarker, the contrast with the situation for some other chronic diseases,
achievement of which would signify a reduced level of such as hypertension or diabetes, there are no obvious
risk. Such approaches can simplify and facilitate disease (surrogate) treatment targets in osteoporosis to help clini-
management decisions, and much is made of their success cians to confidently monitor treatment efficacy or guide
in other fields of medicine, particularly with treatment decisions on issues such as duration of treatment or switch
targets in hypertension, hypercholesterolemia, diabetes to alternative treatment because of treatment failure. Suspi-
mellitus and rheumatoid arthritis. cion of failure is usually because of fracture incidence under
A critical reading of the literature underpinning treat- treatment, decrease or lack of increase of BMD, lack of or
ment targets in these areas does not readily support the escape from expected changes in biochemical markers of
setting of such targets. For example, the often quoted bone turnover (BMT). Unfortunately, on the basis of avail-
meta-analysis of blood pressure reduction and cardiovas- able evidence, none of the routinely accessible possible
cular outcomes found that none of the studies had assessment tools of treatment effect has on closer scrutiny
actually addressed individual tailoring or titration of the potential to set valid and useful treatment goals. Changes
antihypertensive drugs compared with fixed therapy se- in BMD capture only part of treatment effect on fracture risk
lection. Indeed the authors concluded that their analysis and represent a relatively poor surrogate of change of frac-
did not indicate to what extent blood pressure should be ture risk. Changes in BMT can be informative, e.g., to
lowered. More recently, treatment targets for LDL-C and document patient compliance, but their potential as candi-
HDL-C have been questioned and in the recently pub- date for treatment target is limited by several factors, e.g.,
lished 2013 ACC/AHA Blood Cholesterol Guideline, intra- and between-subject variability, variable patterns of
the panel found that despite the previous “consensus” changes according to type of treatment, overall only limited
on targets all the RCTs either compared fixed doses of predictive power at the level of individual patients. Changes
statins with placebo or untreated controls, or compared in fracture risk estimates, e.g., with FRAX®, are not sensi-
fixed doses of higher-intensity statins with moderate- tive to treatment effects, with changes in part driven by
intensity statins. Indeed, the trials were not designed increasing age, and may or may not capture risk factors
to evaluate the effect of titrated (dose- adjusted) statin susceptible to alter fracture risk independently from treatment
treatment to achieve prespecified LDL-C or non-HDL-C effects (e.g., risk of falls). Finally, incident new fracture itself is
goals. For this reason, the panel abandoned the concept rather poorly informative of treatment efficacy in view of the
of treatment targets and instead emphasised the ap- fact that even optimal treatment efficacy ensures only partial
proach of targeting proven therapies to those at highest reduction of fracture risk and a majority of fractures in the
risk. This is a timely lesson from these other disease population occur anyhow in subjects not identified as osteo-
areas but one that is already appreciated within the porotic. Clearly, the time is not ripe to focus on goal-oriented
osteoporosis field with development of risk calculators treatment of osteoporosis, whereas there is presently greater
such as FRAX. potential to improving osteoporosis care by tackling the two
References: Staessen et al. Lancet 2001;358:1305 major issues of underdiagnosis and undertreatment, on the one
Stone et al. J Am Coll Cardiol 2013;pii:S0735-1097(13)06028-2 hand, and of poor treatment compliance, on the other hand.
Osteoporos Int

SE21 evaluation. The CHEERS statement gives orientations regard-

WHICH COMPARATORS AND OUTCOMES MEASURES ing costs and methodological considerations (items 8, 9, 13,
SHOULD WE USE? 14, 19, 20, 21), and has been extended by the ESCEO con-
M. C. Hochberg1 sensus expert group to hand, knee and hip osteoarthritis (OA)
1
Medicine and Epidemiology and Public Health, University of clinical situations.
Maryland School of Medicine and Gerontology Research, Subgroups from the ESCEO expert group listed the most
Education and Clinical Center, VA Maryland, Health Care important topics based on a review of the literature, and made
System, Baltimore, MD, United States a set of preliminary recommendations, further shared in a
face-to-face meeting with the whole group.
General recommendations for a reference case for economic The main focus was on:
studies in rheumatic diseases were published in 2002. Since • Costing considered in two stages: 1) Identifying re-
then, economic evaluations in osteoarthritis (OA) continue to sources incurred for delivering the strategies compared.
show considerable heterogeneity in methodological approach. It should be structured by payer perspective, by type of
The objective of this ESCEO initiative was to develop a drug, examination, disposal, and identified as significant
reference case specific for economic studies in OA including resources, relevant to the health care system and to the
the standard optimal care with which to judge new pharma- payer perspective; 2) Valuing the resources by applying
cologic or nonpharmacologic interventions. the methods that fit the payer perspective.
Four subgroups of the ESCEO expert working group on • Payer perspective, e.g., society, insurer, patient; it should be
economic assessments were charged with producing lists of described and relate to the costs being evaluated. The identi-
recommendations which would potentially improve the com- fication of the correct payer perspective should be governed
parability of economic analyses in OA: outcome measures, strictly by the research economic question. In OA, if no
comparators, costs and methodology. These proposals were specific guideline needs be followed, then the societal per-
presented and refined during a face- to-face meeting in 2013. spective is preferred, then indirect costs should be attributed.
This abstract summarizes the recommendations of the out- The productivity costs are important, may rely on the friction
come measures and comparators working groups. cost method or the human capital approach, and should be
We propose three reference cases: one each for hand, knee and produced separately.
hip OA. The first two have clinical heterogeneity that gives rise • Discount rate: it needs to be applied with the usual agreed on
to different treatment options; specifically, interphalangeal- vs. rule in the country at stake if available.
thumb-base disease for hand OA, and the presence or absence of • Time horizon over which costs and consequences are being
joint malalignment for knee OA. We propose a set of outcome evaluated should be stated and appropriateness justified.
measures for hand, knee and hip OA that are reliable, valid and • Cost-effectiveness threshold: there is no strict recommenda-
responsive to treatment interventions. Finally, we suggest man- tion, since some authors indicate a nominal value, while others
agement strategies that are recommended by various internation- prefer a threshold expressed as a function of the gross domes-
al organizations in published recommendations for the manage- tic product per habitant.
ment of OA that should be further evaluated to help establish a These considerations will be further submitted to larger consen-
consensus on the optimal care for each proposed reference case. sus. They have generic application to OA clinical situations
The ESCEO working groups for outcome measures and com- considered in the reference case (hand, knee and hip OA) and
parators propose a set of specific recommendations for the whatever the treatments recommended as standard optimal care.
conduct and reporting of economic evaluations in hand, knee Disclosures: FG institution received research grants from
and hip OA that could help the standardization and compara- Expanscience, Sanofi and Abbvie.
bility of studies that evaluate therapeutic strategies of OA in
terms of costs and effectiveness.
SE23
GAUCHER DISEASE: A RARE DISEASE THAT
SE22 OFTEN AFFECTS BONE
WHICH COSTS AND METHODS SHOULD WE USE? M. L. Brandi1
F. Guillemin1 1
Department of Surgery and Translational Medicine, Univer-
1
Univerisity of Lorraine, University Paris Descartes, EA 4360 sity of Florence, Florence, Italy
APEMAC, Nancy, France
Gaucher Disease (GD), the most prevalent lysosomal stor-
A reference case must give, among others, clear indications on age disorder, affects multiple organ systems. The bone
costs identification and methods for reporting economic symptoms and signs include osteolytic and osteosclerotic
 Osteoporos Int

lesions, vascular impairment with infarcts and especially spleen, liver, and bone marrow. GD and also
osteonecrosis, osteomyelitis and fragility fractures, and carriership of one mutation are risk factors for
acute and chronic pain resistant to common analgesis Parkinson disease. There is clinical heterogeneity in
therapies. the prevalent type 1 (associated with one N370S muta-
GD represents a congenital disorder not bone in origin, tion and predilection in Ashkenazi Jews); longevity is
but with important bone complications, that deserve a rarely affected. Most visceral/hematological features,
great attention by the physicians who follow these pa- e.g., hepatosplenomegaly and pancytopenia, are treatable
tients. Importantly, bone symptoms can represent the by enzyme replacement therapy (ERT). Intravenous re-
first manifestation of the disease and the patient could combinant imiglucerase (Cerezyme; Genzyme-Sanofi,
see a bone specialist, who most often will not be in the Cambridge MA, USA) has been safe and effective in
condition to make the right diagnosis. >6,000 patients world-wide for >20 years. Since 2010
As recent data show a broad range of bone manifestations in and 2012, respectively, two other intravenous ERTs,
otherwise asymptomatic individuals and benefits of earlier velaglucerase alfa (VPRIV; Shire, Lexington MA) and
versus later GD-specific treatment initiation with respect to taliglucerase alfa (Elelyso; Protalix, Carmiel Israel), are
BMD loss and osteonecrosis, it becomes necessary for the available for naïve and switch-over patients; both are
bone specialist to recognize the disease and to direct the safe and effective in improving visceral and hematolog-
patients to GD dedicated centers. ical features of GD. An alternative modality, oral sub-
Future programs should see bone specialists and GD strate reduction therapy, is available: miglustat (Zavesca,
experts working together to develop studies to recognize Actelion, Allschwil Switzerland) or soon to be FDA
the natural history of bone complications in GD gene approved eliglustat (Genzyme-Sanofi). Importantly, there
carriers and to better define their pathogenesis through- are less common signs of GD e.g., neurological involve-
out in vitro and in vivo studies. Moreover, prospective ment (types 2 & 3), lung infiltration (to varying degrees
analyses should be made on the impact of GD- specific in all types), heart valve calcifications (type 3c), and
therapies and registered osteoporotic pharmacological bone disease (types 1 & 3) which reflect unmet needs
treatments, used alone or in combination. and hence difficult management decisions because ERTs
The Symposium is a first effort towards a multidisciplinary do not cross the blood–brain barrier or reverse these
approach in GD-bone disease. life-threatening/debilitating signs. Although there are ge-
notypes predictive of neurological involvement (e.g.,
L444P/L444P) and heart valve calcification (D409H/
SE24 D409H), to date, there are no predictive markers for
WHAT A NON-GAUCHER EXPERT SHOULD BE patients at risk for lung and/or bone involvement. A
AWARE OF high index of suspicion for GD should accompany
A. Zimran1 skeletal disease in the presence of one or more “classic”
1
Gaucher Clinic, Shaare Zedek Medical Center affiliated with GD signs (but not only in Ashkenazi Jews), including
Hebrew University-Hadassah School of Medicine, Jerusalem, unexplained osteopenia/osteoporosis in young adults, in-
Israel cluding males; bone “crises” not osteomyelitis-related;
Perthes-like presentation; unexplained osteonecrosis of
Gaucher disease (GD), an autosomal recessive disorder large joints; pathological fractures including of ribs;
with decreased β- glucocerebrosidase activity (diagnos- vertebral collapse in young adults; and the benign
tic of GD), results in “Gaucher cells” in affected organs, Ehrenmayer flask of the distal femur.
Osteoporos Int
DOI 10.1007/s00198-014-2638-0

World Congress on Osteoporosis, Osteoarthritis

and Musculoskeletal Diseases (WCO-IOF-ESCEO 2014):
IOF Symposium Abstracts

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

IOF1 report presents current evidence-based recommendations for

OSTEONECROSIS OF THE JAW: INTRODUCTION diagnosis, prevention and management from a multidis-
AND BACKGROUND ciplinary international perspective.
C. Cooper1,2
1
MRC Lifecourse Epidemiology Unit, University of Southamp-
ton, Southampton, United Kingdom, 2Institute of Musculoske- IOF2
letal Science, University of Oxford, Oxford, United Kingdom PATHOPHYSIOLOGY OF ONJ
J. E. Compston1
1
An international taskforce on osteonecrosis of the jaw (ONJ) was Cambridge Biomedical Campus, Cambridge, United Kingdom
formed in January 2012 with representation from national and
international societies concerned with bone health, including the The pathophysiological mechanisms underlying osteonecrosis
International Osteoporosis Foundation. The taskforce formalised of the jaw (ONJ) are unclear. Both infection and necrosis are
a series of key questions relevant to the diagnosis and manage- present in ONJ lesions but the sequence in which these devel-
ment of ONJ in oncology and osteoporosis patient populations. op remains unknown. Dental disease is a well- established risk
These included the definition and stage of ONJ; the aetiology and factor for ONJ and aggregates of bacteria and polymorphonu-
pathophysiology of the disorder; the availability of biomarkers to clear leukocytes are commonly seen; the presence of bacterial
assess the disorder; its prevalence and incidence in different microfilms close to active osteoclastic resorption may contrib-
patient populations; the role of imaging in diagnosis and man- ute to bone necrosis. Adverse effects of bisphosphonates on
agement; and available strategies for prevention and treatment. oral keratinocyes may damage the integrity of the oral mucosa
These questions and a summary of the current evidence were and increase the risk of infection. In addition, activation by
presented by the ONJ taskforce at a meeting in October 2012, bisphosphonates of gamma delta T cells may stimulate the
following which consensus was achieved on each of the subsec- production of pro-inflammatory cytokines and impair the
tions of the critically appraised literature review and graded immune response to infection.
quality of evidence. In the osteoporosis patient population, the The association of ONJ with potent anti-resorptive drugs and
incidence of ONJ was estimated at 0.001 % to 0.01 %, only the increased risk with higher doses of bisphosphonates and
slightly higher than that in the general population. New insights denosumab indicate that suppression of bone turnover may
into the pathophysiology included the effects of bisphosphonate contribute to its pathogenesis. There is some evidence from
and denosumab on gamma delta T-cells, monocyte and macro- animal studies to support this contention, although ONJ is not
phage function, in addition to local infection, inflammation and a characteristic finding in other conditions associated with low
necrosis. Advances in imaging include cone beam CT assessing bone turnover. Inhibition of angiogenesis has also been sug-
cortical and cancellous architecture with lower radiation expo- gested to play a role. However, although bisphosphonates
sure, as well as MRI, isotope scintigraphy or PET. Preventive have anti-angiogenic properties and ONJ has been described
strategies include maintenance of good oral hygiene, interruption in a few patients treated for cancer with anti-angiogenic agents
of antiresorptive therapy for those at high risk, and withholding normal vasculature has been reported in most histological
of treatment until healing of the surgical site in patients receiving studies of ONJ lesions. Finally, increased genetic susceptibili-
high dose antiresorptive therapy. Management continues to be ty to the development of ONJ may occur, for example as a
challenging and is based on the stage of the disease, the size of result of polymorphisms of the farnesyl pyrophosphate syn-
the lesions, contributory drug therapy and comorbidities. The thase or cytochrome P450 CYP2C8 genes.
 Osteoporos Int

IOF3 being revised and will reflect identification of ONJ at a

OSTEONECROSIS OF THE JAW: REPORT FROM preclinical stage.
THE INTERNATIONAL ONJ TASK FORCE 2. Where are the ONJ lesions? ONJ lesions occur more
A. Khan1 commonly in the mandible than the maxilla (2:1 ratio)
1
Clinical Medicine, McMaster University, Oakville, Ontario, and are more prevalent in areas with thin mucosa over-
Canada lying bony prominences such as tori, exostoses, and the
mylohyoid ridge. Radiographic features of ONJ remain
The International ONJ Task Force was formed in January relatively non-specific. Plain film radiography is usually
2012 with representation from the following societies: Cana- unremarkable in the early stages of the disease. The
dian Association of Oral and Maxillofacial Surgeons; Osteo- presence of localized or diffuse osteosclerosis or a thick-
porosis Canada; Canadian Dental Association; Canadian ening of the lamina dura on plain film imaging are
Academy of Oral and Maxillofacial Pathology and Oral Med- preclinical features of ONJ.
icine; American Society of Bone and Mineral Research; Eu- 3. Why does ONJ develop? The pathophysiology of
ropean Calcified Tissue Society; International Bone and Min- osteonecrosis of ONJ is not well understood, but the need
eral Society; International Society of Clinical Densitometry; to explore mechanisms common to both denosumab and
International Osteoporosis Foundation; International Associ- bisphosphonates is required. The sequence of events
ation of Oral and Maxillofacial Surgeons; and The Endocrine leading to the development of ONJ is unclear; in partic-
Society. The Task Force has formalized 10 key questions to be ular, it is unknown whether necrosis precedes or follows
addressed in the diagnosis and management of ONJ in both infection. Dental disease is a well-established risk factor
oncology and osteoporosis patient populations. for ONJ, implicating infection and inflammation in the
A comprehensive literature review has been completed by the pathogenetic process. Bacteria are known to stimulate
Task Force. The published literature has been critically ap- bone resorption and hence the micro-organisms present
praised and graded based on the quality of evidence. The may directly contribute to bone necrosis. Suppression of
identified questions and a summary of the current evidence bone turnover may play a role in the development of
was presented and discussed in detail by the ONJ Task Force. ONJ, however, low bone turnover is not charac-
Funding for the ONJ Task Force has been received solely from teristically seen in affected tissue from ONJ patients.
the sponsoring societies. Bisphosphonates may also activate gamma delta T cells
Key areas of controversy were addressed by the Task Force with altered production of cytokines and impaired im-
and following consensus the full report will be presented. mune response. Anti-angiogenic agents may contribute to
Aspects of the document are presented in brief. the development of ONJ. Polymorphisms in the farnesyl
pyrophosphate synthase or cytochrome P450 CYP2C8
1. How is ONJ defined and staged? It is recommended genes may predispose individuals to develop ONJ.
that the definition of drug-related osteonecrosis of the 4. Are biomarkers useful in identifying ONJ? Suppressed
jaw be expanded to include history of exposure to biomarkers of bone turnover may simply be a reflection
bisphosphonates or denosumab in addition to the ab- of recent anti-resorptive treatment and the present data
sence of prior radiation therapy of the jaw or local do not support low CTX as being useful in identifying
evidence of malignancy. It is recognized that ONJ may individuals at risk of ONJ.
occur in the general population without prior drug thera- 5. How common is ONJ? The majority of the cases of ONJ
py exposure and this has been documented to be a self- have occurred with the use of high-dose IV
limited condition initially described as lingual mandibu- bisphosphonates in the oncology patient population. In
lar sequestration and ulceration and more recently as oral individuals receiving high dose bisphosphonates or
ulceration with bone sequestration (OUBS). The inci- denosumab for oncology treatment, the incidence of
dence of OUBS in the general population is still not well ONJ appears to be 1–15 % and appears to be related to
defined. The components of ONJ diagnosis include: 1) dose and duration of anti-resorptive exposure. The inci-
an exposure history to bisphosphonates or denosumab, dence of ONJ in the osteoporosis patient population
2) exposed bone within the oral cavity for 8 weeks or ranges from 1 to 1500/100,000 person-years of expo-
longer, and 3) no history of prior jaw radiation therapy. sure. It is recognized that ONJ does occur in the general
Areas of exposed and necrotic bone may remain asymp- population without prior anti-resorptive exposure.
tomatic for prolonged periods from weeks to years. 6. What is the role of imaging in diagnosis and manage-
Signs or symptoms may occur before the development ment? Imaging can be of value in identifying the pres-
of clinically detectable osteonecrosis and include pain, ence of pre-clinical disease and those at risk of develop-
tooth mobility, mucosal swelling, erythema, ulceration, ing ONJ. Advances in imaging include cone beam CT
and paresthesias. The clinical staging system is currently enabling assessment of cortical and cancellous
Osteoporos Int

architecture, periosteal bone reaction and sequestrum medications need to be further explored. The effects of
formation with relatively minimal radiation exposure. antiresorptive therapy on bone marrow cells including
MRI, PET alone or in combination with CT and bone macrophages is not well defined. There is a clear need
scanning are also useful imaging modalities in stag- for improved diagnostic and prognostic factors for ONJ.
ing and guiding intervention. Current therapeutic options are inadequate for the pre-
7. Can ONJ be prevented and what is the role of drug vention and treatment of ONJ.
interruption? Discontinuation of antiresorptive therapy
is not necessary prior to dental procedures in low risk
individuals. In those requiring extensive surgery and IOF4
have clinical risk factors including diabetes, glucocorti- UPDATE ON MANAGEMENT OF ONJ
coid therapy, immune deficiencies, etc., interruption of A. Morrison1
1
antiresorptive therapy may be indicated based on the Associate Professor Oral and Maxillofacial Surgery,
clinical judgement of their physician and oral surgeon. Dalhousie University, Halifax, Nova Scotia, Canada
Anecdotal evidence indicates that teriparatide may has-
ten healing and may be a useful treatment option in those The aim of this update is to provide guidance when deciding
with established ONJ. Detailed recommendations will how best to manage the patient with ONJ based on the most
be formalized for the oncology patient with appropriate current evidence.
imaging to guide management. A current survey of the most relevant literature has been
8. Who develops ONJ? What are the risk factors and co- performed to modify existing recommendations as directed
morbidity? A number of risk factors including diseases by better knowledge on the subject when it exists.
and drugs have been identified which appear to increase The mainstay of management for the majority of ONJ patients
the risk of ONJ. is following conservative measures. This means promoting
and maintaining excellent oral hygiene and dental care. Spe-
Co-morbidities Risk factors Jaw bone interventions cifically this includes managing dental caries and periodontal
History of Glucocorticoid use Tooth extraction disease at one’s dentist as well as regular professional
malignancies cleanings every 3–6 months based on the individual patient’s
Smoking/COPD Jaw bone Treatment of needs. The most important management however is the pa-
interventions parodontitis tient’s responsibility for their own homecare.
Rheumatoid arthritis Poor oral hygiene Tooth implantation For caries and periodontitis prone patients, chlorhexidine glu-
Diabetes Chronic Any osteotomy at the conate can be used as a mouth rinse either on a regular basis or
inflammations jaw
as needed periodically. System antibiotics may be required for
Thyroid disease III-fitting dentures Root canal treatment
any acute infective situations such as but not limited to dental
Antiangiogenic
agents
abscess, periodontal abscess, pericoronitis and other soft tissue
Bisphosphonates infections. Treatment of problems of this nature should be dealt
Dinosumab with swiftly and thoroughly once they are diagnosed. The
Blood cell diseases ultimate goal should be to preserve and maintain the dentition,
thus avoiding the need for minor surgery including extractions.
Surgical intervention was originally not promoted and as a matter
9. How should ONJ be managed? There are no universally of fact was suggested by some to be not very successful. How-
accepted treatment protocols. The majority of patients ever there are reports and many authors who have successfully
with ONJ can be managed conservatively with mainte- managed patients with ONJ with surgery. More frequently in the
nance of good oral hygiene, elimination of dental and literature as time passes are there series of patients treated surgi-
periodontal disease, topical antibiotic mouth rinses and cally with successful outcomes. Specifically, ONJ lesions need to
systemic antibiotics. For non-responsive ONJ lesions, be resected beyond the visibly affected area which usually means
surgery is now an option. Experimental treatment in- resecting down to healthy appearing, bleeding bone and achiev-
cludes topically applied ozone, bone marrow stem cell ing tension free soft tissue closure over the wound.
intralesional transplantation and addition of There is no known definitive ‘cure’ for ONJ that is predictable
pentoxifylline and tocopheral to the antibiotic regimen. and repeatable from one individual to another. Conservative
10. Research and future directions: Over the past decade therapy remains the mainstay of management however there is
knowledge pertaining to pathophysiology of ONJ has evidence to support surgical intervention when indicated with
increased however there is a need for more suitable good success. Other adjunctive therapies are being trialed but
animal models. The cellular mechanisms involved in there are no breakthrough treatments to date to replace con-
oral wound healing and the influence of anti-resorptive servative management.
Osteoporos Int
DOI 10.1007/s00198-014-2648-y

World Congress on Osteoporosis, Osteoarthritis

and Musculoskeletal Diseases (WCO-IOF-ESCEO 2014):
Meet-The-Expert Session

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

MTE1 signaling molecules are involved in fracture healing, some

FRACTURE HEALING: FACTS AND FANTASIES are absolutely essential.
T. Einhorn1 Conclusion: Work from our laboratory has demonstrated that
1
Boston University Medical Center, Boston, MA, United fracture healing is completely dependent upon BMP-2. Sim-
States ilarly, angiogenic programs involving VEGF are essential for
bone regeneration.
Objective: To provide an overview of the cell and molecular References: Tsuji K.et al. Nat Genet 2006;12:1424. Wan C
biology of bone repair and regeneration and to interact with et al. Proc Natl Acad Sci USA 2008;105:686.
the audience in a Meet-the-Professor format to answer ques- Disclosures: Consultant/Speakers Bureau/Advisory Activi-
tions and develop discussion. ties: Medtronic, Anika, Harvest, Novartis, Merck. Stock Own-
Material and Methods: Peer reviewed literature and recent ership or Royalties: Medtronic, Biomineral Holdings,
experimental results will serve as the basis for the Healthpoint Capital, Implant Protection, Neostem.
discussions.
Results: Bone repair and regeneration are among the most
reliable and reproducible processes in the human body. They MTE2
are also unique in that the healing occurs with bone as op- NEW MOLECULES AGAINST OSTEOARTHRITIS
posed to the formation of scar. The specific responses in- F. Berenbaum1
1
volved take place in the periosteum, external soft tissues, University Pierre & Marie Curie Paris 06, INSERM
cortical bone and bone marrow and each of these can be up UMRS-938, AP-HP Saint-Antoine Hospital, Paris, France
or down regulated depending on the mechanical strain envi-
ronment. Thus, surgical treatment will influence tissue differ- In 2014, the pharmacological treatment of osteoarthritis (OA)
entiation. While primary cortical bone healing and bone mar- only relies on symptomatic drugs which are known to have
row healing contribute to fracture repair, most fractures either a low effect-size or a nonacceptable safety profile. This
sustained worldwide heal by a process of endochondral ossi- lack of efficacy leads to major unmet needs, especially in OA
fication. This means that the cellular and molecular events that patients with comorbidities and/or with contraindication to
drive chondrogenesis, calcification, remodeling of calcified surgery. In this session, we will first describe the evidence-
cartilage and its replacement with woven and lamellar bone based basis for future targeted therapies. Then, we will try to
are key to the fracture repair process. The molecular events answer to these questions:
that govern these processes begin with cell-fate decisions Should we expect using anti-osteoporotic drugs for OA in the
driven by the expression of specific molecular markers. future?
BMP-2 and GFD-8 are both expressed within 24 h after Should we expect using anti-cytokine therapies like anti-IL-1
fracture; BMP-2 promoting osteogenesis and GDF-8 or anti-TNF in the future?
inhibiting myogenic growth. Specific wnt signaling molecules Should we expect using targeted drugs for pain like anti-NGF
such as wnt 10b will prevent mesenchymal stem cells from in the future?
following an adipogenic pathway and direct them into a Are there any novel opportunities in the early-phase
chondro/osteogenic progression. Although numerous development?
 Osteoporos Int

MTE3 MTE4
HORMONE REPLACEMENT THERAPY IN THE PREVENTION OF BONE METASTASES
MALE E. V. McCloskey1
J.-M. Kaufman1 1
WHO Collaborating Centre for Metabolic Bone Diseases,
1
Department of Endocrinology and Unit for Osteoporosis & University of Sheffield Medical School, Sheffield, United
Metabolic Bone diseases, Ghent University Hospital, Ghent, Kingdom
Belgium
Objective: Many in vitro studies have described the effect of a
Hypogonadism in adolescents interferes with full acqui- variety of bisphosphonates to impede tumour cell adhesion,
sition of peak bone mass and bone maturation. Profound invasion, proliferation, matrix- metalloproteinase activity and
hypogonadism acquire in adulthood results in high bone to increase tumour cell apoptosis. The vast majority of evi-
turnover and rapid bone loss, which can be prevented dence in animal models of metastases has suggested a major
by antiresorptive therapy. Many men present with more potential benefit following administration of various
moderate forms of hypogonadism, e.g., in the context of bisphosphonates. This presentation will address the evidence
obesity, metabolic syndrome and type 2 diabetes, of from human studies, predominantly in breast cancer, for the
glucocorticoid treatment, and of aging (i.e., late onset prevention or delay of clinically detectable bone metastases.
h yp og o na di s m o r L O H ) . A l s o t he s e f or m s o f Material and Methods: A review of the literature of RCTs until
hypogonadism are associated with less favorable evolu- early 2013.
tion of bone mass and osteoporosis with increased frac- Results: While results from early, relatively small controlled
ture risk. Replacement therapy with testosterone (T) studies with older bisphosphonates in breast cancer were
increases bone mass in hypogonadal men, with substan- conflicting, there is now compelling evidence for benefit in
tial gains in young hypogonadal men with still open postmenopausal women with a variety of agents—the benefits
growth plates, and more modest effects in adults and extend to distant, no-bone metastases and survival in some
elderly. However, there are no studies powered to study studies. The reasons for the dependency of effect on meno-
fractures and antifracture efficacy of T treatment has not pausal status remain to be elucidated. Whether it will be seen
been documented. with other agents is not yet clear.
According to guidelines T therapy should be considered only Conclusion: Antiresorptive therapy can play a major role in
in men with established hypogonadism on the basis of con- altering the natural history of bone and distant metastases in
sistent signs and symptoms of hypogonadism and unequivo- women with primary early breast cancer.
cally low serum T, and in absence of contra-indications. In
situations with altered SHBG levels (obesity, aging, etc.)
serum free T is a better marker of gonadal status than total T.
In the tissues T can be 5-alpha-reduced to the more potent MTE5
androgen dihydroT and, importantly, aromatized to estradiol. RISKS/BENEFITS OF CALCIUM AND/OR
It has become increasingly evident that T-derived estrogens VITAMIN D
have many important physiological effects in men. In partic- P. R. Ebeling1
1
ular, effects of T on bone are for a substantial part mediated by NorthWest Academic Centre, University of Melbourne,
estradiol. Therefore T, which can be aromatized, is the drug of Western Health, St. Albans, Victoria, Australia
choice for hormone replacement therapy in men. Many dif-
ferent treatment regimens have been applied and available Optimal bone health depends on an adequate diet calcium
information suggests that there might be differences as to their intake of 1,000–1,300 mg per day and serum 25-
efficacy at the level of the bone, with somewhat lower effects hydroxyvitamin D (25OHD) levels of at least 50 nmol/L at
reported for transdermal administration, possibly related to the end of winter. Serum 25OHD levels Recently, controversy
dosage. Indication for T- treatment is primarily to alleviate has arisen regarding the long-term safety of calcium supple-
symptoms of hypogonadism (e.g., sexual symptoms) and this ments in both prospective observational and interventional
only in absence of reversible causes of hypogonadism. Be- studies. Some, but not all, studies found an association be-
cause of lack of documented effect on fracture risk, osteopo- tween calcium supplements and an increased risk of cardio-
rosis as such is not an indication for T treatment. It has even vascular disease, particularly myocardial infarction. Meta-
been suggested that men with both symptoms of analyses of safety end-points from calcium supplement RCTs
hypogonadism and severe osteoporosis should be treated with have shown small increases in relative risks for myocardial
both T and specific osteoporosis medication. infarction (RR=1.24) and stroke (RR=1.20). However, no
Osteoporos Int

increase in risk was seen with calcium supplement doses of restrict the volume of food ingested (for example vertical
≤805 mg/d. Other studies have shown high total calcium banded gastroplasty and laparoscopic adjustable banding) or
intakes (diet and supplements) are associated with reduced cause malabsorption (for example jejuno-ileal bypass and
cardiovascular events, including reduced carotid atherosclero- bilio-pancreatic diversion), or a combination of approaches.
sis and non-fatal cardiovascular events and stroke. All-cause Both types of procedure appear to increase bone resorption
mortality was also reduced in participants with high total and some may lead to an apparent reduction in BMD. The
calcium intakes. By contrast, only one study has shown high magnitude of the decrease in BMD is difficult to quantify,
intakes of calcium (>1,400 mg/d) in women are associated however, as reduction in adipose tissue may influence DXA-
with higher all-cause and cardiovascular mortality, but not derived assessment of bone mineral. Mechanisms underlying
death from stroke. a deleterious effect of bariatric procedures on bone may in-
Vitamin D supplements are generally safe, with the most volve the reduction of positive factors such as estrogen and
common toxicities being hypercalcaemia and hypercalciuria. leptin from fat tissue; malabsorptive procedures may also lead
However, recent prospective observational studies and RCTs to a reduction in calcium and vitamin D absorption, with
have raised questions about the safety of higher serum consequent secondary hyperparathyroidism.
25OHD levels. Three studies have shown higher serum In this workshop, we will discuss the influence of bariatric
25OHD is associated with an increased risk of prostate and surgery on BMD, bone turnover, and, most importantly, frac-
pancreatic cancers. In two RCTs of intermittent high- dose ture risk. We will also consider potential mechanisms, and
vitamin D supplements there was an increased risk of fractures difficulties with the interpretation of BMD results in the
and falls in elderly postmenopausal women. In the first study context of weight loss. By the end of the workshop, partici-
of 9,440 elderly community-dwelling participants received an pants should have a working knowledge of these subjects,
annual injection of 300,000 IU vitamin D2 or placebo annu- which should inform their clinical practice and allow them to
ally for 3 years, women in the vitamin D group showed an optimally assess such patients.
increased risk of hip/femur fractures (HR 1.80). The second
study of 2,256 elderly community- dwelling Australian wom-
en who received an annual oral dose of 500,000 IU vitamin
D3 demonstrated a 15 % and 26 % increased rate of falls and MTE7
fractures, respectively. INADEQUATE RESPONSE IN OSTEOPOROSIS
The greatest increase in falls occurred in the first 3 months THERAPY
after dosing. Therefore large annual doses of vitamin D are not A. Diez-Perez1,2
1
recommended to treat vitamin D deficiency. Department of Internal Medicine, Hospital del Mar-IMIM
and Autonomous University of Barcelona, Barcelona, Spain,
2
RETICEF, Instituto Carlos III., Barcelona, Spain

MTE6 Lack of compliance to medication is the most common cause

BARIATRIC SURGERYAND BONE of inadequate treatment response to antiosteoporosis drugs.
N. C. Harvey1 However, even under ideal conditions of clinical trials, in
1
MRC Lifecourse Epidemiology Unit, University of highly monitored and selected patients, some individuals fail
Southampton, Southampton General Hospital, Southampton, in responding adequately to therapy.
United Kingdom Treatment failure has been recently defined by a working
group of the IOF in terms of incident fractures while on
Obesity is an increasing public health problem globally, with treatment, lack of response in biochemical markers of bone
the its prevalence (BMI above 30 kg/m2) estimated at 15– remodeling and lack of BMD significant increments1.
20 % amongst middle-aged individuals in Europe. Although Different factors have been associated to this lack of response
the prevalence of individuals with BMI greater than 40 kg/m2 and, among them, an already advanced structural deterioration
(termed “morbid obesity”) is uncertain in Europe, in the or vitamin D deficiency2, poor physical function, higher risk
United States it has been estimated to be 5 %. Many ap- of fracture as assessed by FRAX, falls, several comorbid
proaches to weight loss have been evaluated, but it is increas- conditions, current use of glucocorticoids, older age, PPI use
ingly recognised that the most effective strategies for long- and inflammatory arthritides have been identified as predic-
term weight reduction are those based on surgical treatment. tors of treatment failure2–4. The reasons for these findings
Surgery aimed at weight reduction (termed “bariatric sur- need to be explored although interference with
gery”) comprises a group of related procedures, which may antiosteoporosis drugs, therapeutic ceiling of these agents, or
 Osteoporos Int

lack of specificity of the available drugs for some specific D and exercise are recommended in all patients. Pharmaco-
types of osteoporosis have been invoked. In any case, even logic therapy in adults is recommended for those at higher risk
though the percentage of affected patients is low, more spe- for fractures. Pharmacologic therapies that have been shown
cific, targeted strategies would be desirable to address these to be efficacious in the prevention of fractures or improvement
clinical situations. in BMD include etidronate, alendronate, risedronate and
References: 1. Osteoporos Int 2012;23:2769 teriparatide.
2. J Bone Miner Res 2012;27:817 3. J Bone Miner Res Conclusion: In conclusion, glucocorticoid induced osteoporo-
2014;29:268 4. J Bone Miner Res 2014;29:260 sis remains a significant risk for fracture. Under recognition
and under treatment remains a problem. Randomized clinical
trials demonstrating fracture efficacy for a variety of therapies
have been done and guidelines have been developed regarding
MTE8 prevention and treatment strategies. All that remains is more
PREVENTION OF GLUCOCORTICOID-INDUCED aggressive implementation and adherence to these guidelines.
OSTEOPOROSIS Disclosures: Amgen, Eli Lilly, Merck, Warner Chilcott.
J. D. Adachi1
1
Department of Medicine, McMaster University, St Joseph’s
Healthcare, Hamilton, Ontario, Canada
MTE9
Objective: Glucocorticoids are a common cause of secondary POSTMENOPAUSAL HORMONE THERAPY: RISKS
osteoporosis. Unfortunately while this is a well recognized AND BENEFITS
cause of fractures, a significant diagnostic and therapeutic care S. Rozenberg1
1
gap remains. Department of Obstetrics & Gynaecology, CHU Saint-
Material and Methods: Relevant literature has been Pierre, Free University of Brussels, Brussels, Belgium
reviewed.
Results: Fracture Risk Postmenopausal hormone therapy (PMHT), also called previ-
In considering fracture risk, it is important to recognize that it ously hormone replacement therapy (HRT) is used for the
is not just the use of glucocorticoids that increases the risk of relief of menopausal symptom. The dosage has varied greatly
fracture, but it is the underlying condition that often contrib- throughout the last decades, as it has been reduced four to
utes to that risk. Traditional risk factors such as prior fracture, eight times. By the end of the 1990s, PMHT was mainly used
age and sex are equally important. to prevent chronic diseases such as osteoporosis, coronary
Sex and demographic differences heart disease and dementia, and large prevention trials were
Glucocorticoid induced osteoporosis is often overlooked in undertaken in this context. Following the initial negative
men, however it is evident that men with underlying respira- reports of these trials, notably of coronary heart disease, stroke
tory conditions requiring glucocorticoids are at increased frac- and breast cancer, use of PMHT dramatically decreased.
ture risk and benefit from preventative treatment. Controversy Nowadays, considering the currently available data, it seems
around preventative pharmacologic therapy continues in pre- that an important distinction should be made between the
menopausal women of childbearing age commencing gluco- treatment of climacteric symptoms in young, generally
corticoid treatment. Randomized clinical trials suggest that healthy, postmenopausal women and the prevention of chron-
fractures are infrequent in this population and seldom occur ic diseases in elderly women. PMHT seems to be beneficial
in the first year of therapy. Reduction of glucocorticoid dose and safe for postmenopausal symptomatic younger women,
as quickly as medically possible may be the best strategy. i.e., aged <60 years. Treatments with a high safety profile
More evidence has been published regarding the prevalence should be the preferred option, including low- dose PMHT,
and incidence of children on glucocorticoid treatment. Strate- oestrogen-only therapy in women who have had a hysterec-
gies for the prevention of fractures are being developed as our tomy, and vaginal oestrogen therapy for women with atrophic
knowledge increases in this population. vaginitis. Nonandrogenic progestin might have a reduced
Therapy thrombotic and breast cancer risk, and transdermal oestrogen
Glucocorticoids are recognized as causing fractures at higher could have a reduced thrombotic risk. Nevertheless, PMHT
bone densities than is seen in postmenopausal osteoporosis. should not be used for the prevention of chronic diseases in
As a result many have suggested treatment at a BMD of −1.5 the elderly (i.e., >70 years old) owing to the increased risk of
or less. Traditionally adequate dietary calcium intake, vitamin stroke and breast cancer in these patients.
Osteoporos Int

MTE10 MTE11
MANAGEMENT OF OSTEOPOROSIS IN LATIN MANAGEMENT OF OSTEOPOROSIS IN THE
AMERICA MIDDLE EAST
C. A. F. Zerbini1, J. R. Zanchetta2 G. Adib1, B. Masri2
1 1
Centro Paulista de Investigação Clinica, São Paulo, Brazil, Syrian National Osteoporosis Society, Damascus, Syrian
2
Instituto de Investigaciones Metabolicas and University of Arab Republic, 2Jordan Hospital, Internal Medicine -
Salvador, Buenos Aires, Argentina Rheumatology, Amman, Jordan

The best overall epidemiologic information focusing osteo- Osteoporosis is defined as a skeletal disorder characterized
porosis in Latin America was collected by an IOF task by compromised bone strength predisposing to an increased
force in 2012 (IOF Latin America Audit). Data from 14 risk of fracture (1). It will soon represent a major health
countries were analysed. In these countries the current problem in the Middle East, due to the increase of life
percentage of the population ≥50 y lies between 13 and expectancy (2). Despite countries in the Middle East being
29 %. By 2050, these estimations will increase from be- sunny, we observed a high prevalence of Vit D deficiency
tween 28 and 49 %. The percentage increase in the 70 and (2, 3). The projected increase in the number of hip fractures
over population between 2011 and 2050 averages 280 %. in 2050 is scary, as the number of the population over the
The Latin American Vertebral Osteoporosis Study age of 50 years will double (2,4,5). There is a discrepancy
(LAVOS) included five countries in the region: Argentina, between the Middle Eastern countries in socioeconomic
Brazil, Colombia, Mexico and Puerto Rico. An overall and health care level. A policy for the management of
vertebral fracture prevalence rate of 14.77 % was found osteoporosis in ME in partnership with the decision
for all ages and countries combined. Of note, the vertebral makers, healthcare providers, scientists and CNS should
fracture prevalence rate reached as high as 38 % in women be established.
80 years and over. Data from Argentina revealed an annual The management should include (6,7):
rate for hip fractures as high as 488 per 100,000 for the
over 50 population. New epidemiologic studies are in de- & Assessment of the risk factors by applying FRAX
velopment. Access to DXA machines is limited to urban and 1-min screening test
areas and private clinics in the majority of the region and & Improving access to DXA Scan
machine availability estimates range from 1 to 10 per 1 & Assessment of Vit D status and development of Vit D
million inhabitants. Brazil has the highest number of DXA supplementation strategy
machines (almost 1700). Currently only six of the countries & Improving access to treatment with different therapies
in the region have an online FRAX calculator: Argentina, available in the ME and improving reimbursement policy
Brazil, Chile, Colombia, Ecuador and Mexico. Osteoporosis & Assess and prevent frailty, sarcopenia and falls
is considered a health priority in only three of the 14 & Improving post fracture rehabilitation
countries—Brazil, Cuba and Mexico. Currently, In Argen- & Empowering patients through public awareness cam-
tina, Bolivia, Chile, Colombia, Costa Rica, Guatemala, paigns and fracture risk assessment knowledge, to prevent
Nicaragua, Panama, Venezuela, and Uruguay osteoporosis the first fracture
is not recognized as a major health problem and there are & Fighting heavy smoking and sedentary life style
currently no governmental public awareness programs cov- & Increase awareness of health professionals and public
ering its prevention, diagnosis or management. Bisphospho- & Promoting epidemiological studies and hip fracture
nate therapies are widely available throughout the region registries
with considerable variability in reimbursement policy. Other & Involving the health authorities in all steps aimed at the
osteoporosis therapies such as SERMs, PTH, denosumab, management of the disease and promoting the recognition
strontium are also available but access is limited. Osteopo- of osteoporosis as a priority in the health system
rosis guidelines are available in nine of the 14 countries. & Updating the existing guidelines for the prevention and
Vitamin D studies performed mainly in Brazil and Argen- management of osteoporosis
tina reveal an abundance of hypovitaminosis D throughout
Latin America. The costs of hip fracture calculated in some References: 1. National Institutes of Health Consensus
countries are about (US$): Uruguay 3100, Chile 2000– Development Conference Statement March 27–29, 2000
7000, Argentina 3100, Brazil 3900–12 000, Guatemala 2. The Middle East regional Audit- International Osteo-
4000, Costa Rica 8000, Colombia 6500. porosis Foundation
 Osteoporos Int

3. The First Jordanian National Osteoporosis Record have been primarily based on assessment of standard BMD
(FiJONOR) (BMD) and mass (BMC) by areal or volumetric X-ray-based
4. The incidence of fragility (osteoporotic) hip fractures in imaging techniques. While such BMD/BMC evaluations by
Jordan (FiJoHip) DXA and QCT have clinical utility in detecting bone loss and
5. US Census Bureau July 17, 2003 diagnosing osteoporosis, they do not fully assess the impact of
6. Middle East and North Africa consensus on osteoporosis, J metabolic disorders or therapeutic interventions on the skele-
Musculoskelet Neuronal Interact 2007;7:131 ton or adequately predict the risk of appendicular and axial
7. Making the first fracture the last: ASBMR task force on fractures. Additionally, these standard bone density tech-
secondary prevention, JBMR 2012;27:2039 niques have not achieved regulatory recognition as valid
surrogates for fracture outcome.
As a consequence, there has been considerable interest in the
examination of other factors beyond BMD associated with
MTE12
bone integrity and mechanical competence, including the
RESPONDERS IN OSTEOARTHRITIS TREATMENT
macro- and microstructure and strength of both cortical and
O. Bruyère1
1 trabecular bone, and the basic composition of skeletal tissue.
Department of Public Health, Epidemiology and Health Eco-
The analysis of bone morphology including micro-
nomics and Department of Motricity Sciences, University of
architecture and ultrastructure of the trabecular and cortical
Liège, Liège, Belgium
compartments has been accomplished using the remarkable,
high- resolution imaging capabilities of advanced computed
Osteoarthritis is a clinical syndrome of failure of the joint
tomography (CT), μCT and magnetic resonance (MR) sys-
accompanied by varying degrees of joint pain, functional limi-
tems, combined with advanced image processing and compu-
tation, and reduced quality of life due to deterioration of articular
tational approaches, including finite element analysis (FEA)
cartilage and involvement of other joint structures. Regulatory
for estimating bone strength.
agencies require relevant clinical benefit on symptoms and
These newer advanced imaging technologies now have been
structure modification for registration of a new therapy as a
widely applied in preclinical and clinical research and have
disease-modifying osteoarthritis drug (DMOAD). Different
contributed enormously to our understanding of the complex
groups of experts convened to explore the current burden of
relationships among bone density, mass, geometry, micro-
osteoarthritis, review current regulatory guidelines for the con-
structure, strength and fracture propensity, across a range of
duct of clinical trials, and examine the concept of responder
axial and appendicular skeletal sites, and their variable corti-
analyses for improving drug evaluation in osteoarthritis. They
cal, trabecular and endosteal components. The skeletal conse-
consider that the major challenges in DMOAD development are
quences of aging, disease progression, and response to novel
the absence of a precise definition of the disease, particularly in
therapy have been extensively examined and considerably
the early stages, and the lack of consensus on how to detect
illuminated through application of these advanced bone im-
structural changes and link them to clinically meaningful end-
aging and analysis methods.
points. Responder criteria should help identify progression of
disease and be clinically meaningful. The ideal criterion should
be sensitive to change over time and should predict disease
MTE14
progression and outcomes such as joint replacement.
MANAGEMENT OF OSTEOPOROSIS IN PATIENTS
WITH RHEUMATOID ARTHRITIS
W. F. Lems1
1
MTE13 VU Medical Center, Amsterdam, Netherlands
ADVANCED BONE IMAGING IN OSTEOPOROSIS
ASSESSMENT It is well-known that active rheumatoid arthritis (RA) is
H. K. Genant1 associated with generalized bone loss and with fractures. This
1
University of California, San Francisco, CA, United States negative effect on bone particularly occurs in patients with
suboptimally treated RA, with persisting systemic inflamma-
The skeleton is comprised of cortical and trabecular bone, tion (1); apart from that glucocorticoids (GC) might also have
each contributing to skeletal strength and to fracture resis- a negative effect on bone.
tance. The determination of skeletal status in health and dis- The etiology of osteoporotic fractures in patients with RA is
ease, and its response to therapy and propensity to fracture multifactorial, including both bone-related (low BMI, familial
Osteoporos Int

osteoporosis) and fall-related factors, and is also related to the d) Is there an indication to start with antiosteoporotic drug
severity of the underlying disease. treatment?
A patient will be discussed: a (Dutch) postmenopausal e) Suppose you start with treatment to prevent future frac-
women, 71 years of age, with a wrist fracture 15 years tures: how much vitamin D do you prescribe? 800 IU per
ago. Length 165 cm, weight 65. Because of active RA, day or higher?
she starts with prednisone 10 mg/d and MTX. She is a f) Suppose you start with antiosteoporotic drugs: which
smoker, no alcohol, no familial osteoporosis. T-score hip drugs are first and, eventually, second choice in RA
−1.5, T-score spine −1.4. patients?
During the meeting we will discuss: g) How long do you continue antiosteoporotic treatment?

a) What is her relative risk for vertebral and nonvertebral References: 1. Vis M et al. Osteoporos Int 2013;24:2541.
fractures? Disclosures: Speakers fee/Consultancy: Eli Lilly, Merck,
b) Why is her fracture risk elevated? Servier, Amgen, Novartis, Will Pharma, Takeda, Pfizer,
c) What is her absolute fracture risk? Abbvie.
Osteoporos Int
DOI 10.1007/s00198-014-2642-4

World Congress on Osteoporosis, Osteoarthritis

and Musculoskeletal Diseases (WCO-IOF-ESCEO 2014):
Poster Abstracts

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

P101 Results: Ten studies with a total of 6,250 patients were

COMPARISON OF THE INTERNATIONAL included in the meta-analysis. In the newborn population we
REFERENCE VALUES OF BONE SPEED OF SOUND found two studies Portugal and Israel that include subjects
IN PEDIATRIC POPULATION: META-ANALYSIS with a gestational age between 27 and 42 weeks, with a mean
R. Rivas-Ruiz1, G. Huitrón2,4, J. Salmeron-Castro3,7, J. O. difference (Portugal - Israel [CI 95 %] m/s) of 23.62 [CI 95 %
Talavera1, J. Tamayo5, P. Clark6, D. O. Castelán-Martínez6, 6.29, 40.95] m/s. In pediatric population there were eight
L. Méndez-Sánchez6 studies from Canada, México, Israel, Greece, Portugal and
1
Centro de Adiestramiento en Investigación Clínica, IMSS, Turkey. There were no significant differences between SoS
México City, Mexico, 2Centro de Investigación en Ciencias Israel reference values neither in tibia or radius in comparison
Médicas, UAEM, Toluca, Mexico, 3Unidad de Investigación of vs. Turkey, vs. Greece or vs. Canada (p>0.05). We found
Epidemiológica y en Servicios de Salud, Instituto Mexicano significant differences of the mean SoS (m/s) measurements in
del Seguro Social. Cuernavaca, Morelos, Mé, Cuernavaca, tibia in the comparison of Mexican references values with
Mexico, 4Centro de Investigación en Ciencias Médicas, other countries (Mexico- Other [CI 95 %] m/s) as follows:
Universidad Autónoma del Estado de México, Toluca, Israel −105.29 [CI 95 % −140.05, −70.54], Portugal −115.14
Mexico, 5Comité Mexicano para la Prevención de la [CI 95 % −164.86, −65.42], Greece −239.14 [CI 95 %
Osteoporosis, Mexico City, Mexico, 6Clinical Epidemiology −267.67, −210.62], Turkey −115.14 [CI 95 % −164.86,
Unit, Hospital Infantil de México, Federico Gómez, Mexico −65.42], and Canada −113.51 [CI 95 % −140.25, −86.77]
City, Mexico, 7Unidad de Investigación Epidemiológica, (p<0.001).
IMSS, Cuernavaca, Mexico Conclusion: This study confirms that there are differences
between references values of QUS between countries.
Objective: To compare the international reference values These differences are between Mexican versus European
of the speed of sound (SoS) assessed by multisite quan- countries, but there are no differences between European
titative ultrasound (QUS) in tibia and radius in pediatric countries.
population comparing these values by age and by
countries.
Material and Methods: We conducted a systematic review P102
with meta-analysis of the studies published from 1965 LOWER SCLEROSTIN IN ACQUIRED IMMUNE
to November 2013 on the reference values of QUS DEFICIENCY SYNDROME (LSAIDS)
(Sunlight Omnisense) in newborn, infants and children. A. Y. Almansouri1, M. S. M. Ardawi1,2 H. H. Mosli3, M. E.
A sensitive search of the evidence was performed in Abdulfatah1, O. H. Baaqil1, A. A. Bakheet1, S. A. Turki1, A.
PubMed, Embase, LILACS, ARTEMISA, Cochrane con- M. Althubaiti1, M. M. Almaghrabi1, B. M. Madani1, M. M.
trolled trials register and Bandolier. We calculated de Kotb4, T. A. Madani3, G. A. Jamjoom5
1
mean differences of SoS in tibia and radio between Center of Excellence for Osteoporosis Research, King
countries by gender and age. The results are presented Abdulaziz University, Jeddah, Saudi Arabia, 2Department of
in tables and forest plots to compare raw reference data Clinical Biochemistry, Faculty of Medicine, King Abdulaziz
between countries. University, Jeddah, Saudi Arabia, 3Department of Medicine,
 Osteoporos Int

Faculty of Medicine, King Abdulaziz University, Jeddah, Objective: Almost 20 % of the proximal humeral fractures are
Saudi Arabia, 4Department of Radiology, Faculty of unstable with absolute indications for surgical treatment.
Medicine, King Abdulaziz University, Jeddah, Saudi Good postoperative result requires surgical technique, which
Arabia, 5Special Infectious Agents Unit, King Fahad Medical maintains local blood supply, with good reduction and stable
Research Center, King Abdulaziz University, Jeddah, Saudi fixation and ability for early rehabilitation. The persisting
Arabia osteoporosis is challenging for treatment choice and expected
results. Low profile locking proximal humerus plates (PHLP
Objective: Determine the association of sclerostin levels to and S3) give a good opportunity for realizing of this condi-
BMD changes in patients with HIV infection. tions. The aim of the report is to represent our opinion and
Material and Methods: Serum sclerostin levels, serum results of using proximal humerus locking plates in cases with
dickkopf 1, standardized BMD (sBMD) of lumbar spine moderate to severe osteoporosis.
and femoral neck, and bone turnover markers were mea- Material and Methods: For period of 5 y (2005–2010) we
sured for 30 HIV-infected treatment naïve subjects and have operated on 23 patients - 18 female and 5 male in average
compared to 65 healthy seronegative controls matched for age 71 (62–83) y. Fractures distribution according to AO: 8 -
age and sex. A2.2; 5 - А3.1; 4 - В2.1; 3 - С2.1; 3 - С3.1. Surgical
Results: The mean of measured sclerostin was significantly technique: Open reduction and internal fixation via delto-
lower in the HIV group than the control group (37.52 vs. pectoral approach. Soft tissue preservation. Stable fixation
76.71 pmol/L; p < 0.001). The HIV group also had a with locking plates - 10 type S3 (DePuy) and 13 type LPHP
significantly lower BMD in the lumbar spine and femoral (Synthes).
neck. The mean levels of serum osteocalcin, a bone for- Results: Follow-up was minimum 3 y. We made rating ac-
mation marker, was significantly lower in the HIV than cording to Constant Shoulder Assessment (CSA): 14 (60.9 %)
the control group (15.53 vs. 24.42 ng/ml; p<0.001). The excellent and good; 9 (39.1 %) satisfactory; 2 (8.7 %) poor
HIV group had a mean CD4 count of 170.21 cells/mm3 results. АVN in 2 (8.7 %) patient. We have no observed
(AIDS range). infection and neurovascular complications.
Conclusion: In patients with advanced HIV infection and low Conclusion: Specially designed proximal humerus locking
BMD, we hypothesised that depleted sclerostin levels could plates decrease complications connected with convention-
be part of the severely immunocompromised status caused by al plates in osteoporotic patients, indicated for surgical
HIV infection. treatment. Angular stability allows early rehabilitation
References: Cain CJ, et al. J Bone Miner Res. 2012;27:1451. even in osteoporosis. Avascular necrosis of the humeral
Acknowledgements: We would like to thank Dr. Yasir M. head depends on fracture type and local soft tissue
Mansouri (Department of Cardiology, King Abdulaziz Med- damage.
ical City for National Guard, Jeddah, Saudi Arabia) for his
genuine and continuous support for the principle author. We
are grateful for the Center of Excellence for Osteoporosis P104
Research (CEOR), King Abdulaziz University for funding THE EFFECT OF GRAFT ORIENTATION IN
our research. We would like to thank Mr. Abdullah A. OSTEOCHONDRAL AUTOTRANSPLANTATION OF
Almazrooa and Mr. Mishari Al-Romaihy (Medical Students, EARLY STAGE OSTEOARTHRITIS
Faculty of Medicine, King Abdulaziz University, Saudi Ara- S. E. Park1, C. H. Kim1, J. D. Kim1, O. J. Kwon1
1
bia) for their help in sample collections. Special thanks to Mrs Orthopaedic Surgery, Dongguk University, International
Rose (Laboratory Technician at CEOR) and Ms. Taghreed S. Hospital, Seoul, Republic of Korea
Almansouri (Lecturer in Clinical Biochemistry, Department of
Medical Laboratory Technology, King Abdulaziz University, Objective: To introduce the clinical results of arthroscopic
Jeddah, Saudi Arabia) for her help in running the laboratory osteochondral autotransplantation are greatly affected by sur-
samples. gical technique and graft orientation.
Material and Methods: From Nov 2005 to March 2011, 74
patients, 76 arthroscopic osteochondral autotransplantations
P103 were practiced. The Lysholm knee score and NRS scale was
TREATMENT OF UNSTABLE OSTEOPOROTIC recorded initially and 3 months, 6 months, 12 months after the
FRACTURES OF PROXIMAL HUMERUS WITH surgery. Follow up knee MR were done on 30 patients. The
LOCKING PLATES radiologic parameter, α angle and β angle was analyzed in the
V. L. Rusimov1 group.
1
Arthroscopic Clinic, Military Medical Academy, Sofia, Results: The mean Lysholm knee score improved from 64.43
Bulgaria to 91.1. The Pearson coefficient of the clinical results of
Osteoporos Int

patients with α angle and β angle was −0.548, −0.792, re- P106
spectively. P-value was 0.002 and 0.0001, respectively. CHOLESTEROL LEVELS AND RISK OF HAND
Conclusion: The surgical technique and graft orientation OSTEOARTHRITIS: THE CHINGFORD STUDY
in the arthroscopic osteochondral autotransplantation is D. Prieto-Alhambra1, M. Garcia-Gil2, R. Ramos3, M. T.
important parameter affecting clinical results of patients. Sanchez1, N. K. Arden1
β angle was stronger parameter to predict the clinical 1
Musculoskeletal Epidemiology Unit, Botnar Research
results. Center, Oxford, United Kingdom, 2 Unitat Suport
Recerca Girona, IDIAP Jordi Gol, Girona, Spain, 3Unitat
de Suport Recerca Girona, Catalan Health Institute, Girona,
P105 Spain
KNEE DEFORMITIES AMONG CHILDREN
ATTENDING PRESCHOOLS IN KANDY Objective: To examine whether serum cholesterol profile is
EDUCATIONAL ZONE associated with the incidence of hand osteoarthritis.
R. A. D. Jayawardana1, A. A. J. Rajaratne2 Material and Methods: Prospective population-based cohort
1
Department of Physiotherapy, University of Peradeniya, involving the 277 women included in the Chingford cohort
Peradeniya, Sri Lanka, 2Department of Physiology, University who: 1) completed year 11 of follow-up, 2) had no hand
of Peradeniya, Peradeniya, Sri Lanka osteoarthritis at baseline, and 3) had measures available of
total cholesterol (TC), HDL-cholesterol, LDL-cholesterol and
Objective: Knee deformities are frequently present in chil- tryglicerides (TG) as well as covariates (age, physical activity,
dren of school going ages. Most commonly these deformities BMI, classical risk factors, concomitants drugs, laboratory
represent normal variations for the growth and development tests, menopause) at baseline. Main outcome: incident
of the child. It needs no treatment except for observation and radiographic hand OA at any hand joint according to
reassurance of the parents. If the condition worsens or persists Kellgren and Lawrence criteria (grade ≥2) in year 11th
into late childhood and adulthood then further action is needed of follow-up. Cholesterol variables were categorised into
in addition to cosmetic concerns as they are typically prone to quartiles, and the association with outcome was modeled
injuries. Although there are many types of knee deformities, using multivariate logistic regression adjusted for the
this study was based on bow legs, back knees and knock confounders listed above.
knees. This study was done to assess the common types of Results: 143/277 participants developed radiographic hand
knee deformities and to find out the association between the OA after 11 years of follow-up (cumulative incidence
development of the knee deformities with body weight, body 51.6 %). HDL levels were inversely associated with the risk
height, obesity and gender in children attending preschools in of developing hand OA, with adjusted ORs 0.33 [0.16–0.69],
Kandy Educational Zone. 0.47 [0.22–0.98], and 0.42 [0.19–0.95] for the 2nd, 3rd, and
Material and Methods: A preschool based observational 4th quartiles compared to the first (reference group). Con-
analytical study was conducted in 32 preschools in Kandy versely, TG levels were directly associated (borderline signif-
Educational Zone in 2011. Students were screened for icant) with such risk: adjusted OR 2.09 [0.99–4.44]. No
deformities using physical examinations which involved relationship was found between baseline TC or LDL levels
measuring body weight, body height, intercondylar dis- and hand OA risk.
tance, intermalleolar distance and knee hyperextension by Conclusion: In this population-based cohort of UK wom-
means of weighing balance, measuring tape and en, higher levels of HDLc appear to be protective against
goniometer. radiographic hand OA after 10 years of prospective
Results: A total of 53 (12.184 %) had at least one type of follow-up. Conversely, higher levels of TGs seem to con-
deformity among 435 students screened. 26 (5.977 %) fer a higher risk of hand OA, although the association
had back knees, among which 18 (4.138 %) had unilat- observed was of borderline significance. More research is
eral back knee and 8 (1.839 %) had bilateral back needed to confirm these findings and to examine the
knees, 15 (3.448 %) had bow legs and 14 (3.218 %) excess risk.
had knock knees. The commonest presentation was back
knees.
Conclusion: There was no association between gender
and the development of these three types of knee de- P107
formities. Body weight, body height and obesity were IMPACT EVALUATION OF A HIP FRACTURE
associated with the development of knock knees where- PREVENTION DEVICE
as no association was found with back knees and bow M. Szpalski1, J. C. Le Huec2, F. Sibilla2, S. Costes3, R.
legs. Winzenreith4, C. Vienney4
 Osteoporos Int

1
Iris South Hospitals, Molière Longchamp, Brussels, Belgium, Objective: To correlate functional evaluation, pain severity
2
Groupe Hospitalier Pellegrin, Bordeaux, France, 3Centre and fatigue with IL-6 in patients with hand osteoarthritis.
Hospitalier de Libourne, Libourne, France, 4Hyprevention, Material and Methods: 25 patients were selected according
Pessac, France to EULAR recommendations for diagnosis of hand osteoar-
thritis (HOA). Patients were subjected to anthropometric mea-
Objective: The second fracture of the upper part of the femur surements, clinical examination, functional assessment by
is associated to a dramatic increase of the mortality rate (from chronic illness therapy fatigue scale (FACIT), pain severity
20 to 50 % depending of the studies). Therefore, it is clearly assessment by VAS, determination of Australian Canadian
important to prevent this second fracture. The purpose of this Hand index (AUSCAN), determination of ESR, CRP, rheu-
study is to evaluate the impact of a new prevention dedicated matoid factor and uric acid (to exclude secondary causes of
osteosynthesis implant (PDOI) on patient in terms of safety HOA), and measurement of IL-6. 15 healthy volunteers con-
and effectiveness. stituted the control group.
Material and Methods: The study was performed in an on- Results: IL-6 was significantly higher in patients than in
going, prospective series of 15 PDOIs. To date, three patients controls group. There was positive correlation between IL-6
were implanted. The PDOI was implanted into the contralateral and VAS. There was positive correlation between IL-6 and
hip during the same surgery time of fractured hip gamma nail AUSCAN index. There was positive correlation between IL-6
implantation. Mean follow-up was 3 months. Clinical evalua- and FACIT.
tion included the Oxford hip score, the WOMAC scores. Plan- Conclusion: Hand osteoarthritis has important functional
tar pressure measurements were evaluated at 3 weeks and consequences in terms of pain, reduced grip force, activity
3 months after the surgery using a Win-Pod (Medicapteurs). limitations and participation restrictions. IL-6 correlated sig-
Results: Mean Age and BMI of patients were 83±3 years and nificantly with VAS, AUSCAN and FACIT. IL-6 inhibitors
25±9 kg/m2, respectively. Mean duration of surgery was may be recommended in treatment of HOA.
43 min (range 35–58). Cement quantities were similar over
the three patients (6–7 cc). At 3 weeks, comparison between
the two legs’ plantar pressures revealed no differences (50– P109
50 %). Experiences of pain were comparable between the two IMPACT OF STRONTIUM RANELATE ON THE
legs (0.7 and 1 for the Gamma Nail and the PDOI, respective- QUALITY OF LIFE IN PATIENTS WITH PROXIMAL
ly). At 3 months, WOMAC scores for pain and functionality FEMORAL FRACTURES
were 6 and 36, respectively, and an OHS score of 25. Expe- O. Lupescu1, M. Nagea2, C. Patru2, G. H. Popescu1, A. L.
riences of pain were similar between the two legs (3 and 4 for Dimitriu2, D. Lupescu3
1
the Gamma Nail and the PDOI, respectively). Concerning the University of Medicine and Pharmacy, Clinical Emergency
planar pressures, results obtained were in favor of the Hospital, Orthopedics and Trauma, Bucharest, Romania,
2
PDOI compared to the Gamma nail (53 % vs. 47 %). Clinical Emergency Hospital, Orthopedics and Trauma, Bu-
No osteolysis or implant loosening was observed at the charest, Romania, 3University of Medicine and Pharmacy,
different follow-ups. Bucharest, Romania
Conclusion: At 3 months, patients have maintained good
physical health without any inconveniences, in the contralat- Objective: Among fragility fractures, those of proximal
eral hip, caused by the implantation of the PDOI. Furthermore, femur have a huge impact on morbidity and mortality,
patients tend to more bear their weight on the leg with the significantly influencing the quality of life. The authors
PDOI. These first results are very encouraging and suggest that evaluate the impact of strontium ranelate on life quality
PDOI did not cause additional troubles or pains to the patient. so to see if this antiosteoporotic agent is beneficial or
not.
Material and Methods: Two groups, total of 60 patients
P108 operated for proximal femoral fractures between
CORRELATION BETWEEN FUNCTIONAL 01.01.2011–01.01.2012 were prospectively analysed for
EVALUATION, PAIN SEVERITY, FATIGUE AND IL-6 quality of life using SF 36 questionnaire and the HAQ-
IN HAND OSTEOARTHRITIS DI (Health Assessment Questionnaire Disability Index)
D. Mohasseb1, M. El-Bardawil1, M. Hassan1, D. Hashad2, A. 6 months and 1 year after surgery; group 1 (36 patients)
Zenalabdeen1 received strontium ranelate, group 2 (24 patients) had no
1
Physical Medicine, Rheumatology and Rehabilitation, associated treatment. The fractures were trochanteric and
Alexandria Faculty of Medicine, Alexandria, Egypt, femoral neck and surgery consisted in osteosynthesis with
2
Clinical and Chemical Pathology, Alexandria Faculty DHS (23 patients), Gamma-nail (21 patients), arthroplasty
of Medicine, Alexandria, Egypt (26 patients).
Osteoporos Int

Results: Significant differences appeared between the two (р<0.01). In group 1 - 15(40 %) patients had vertebral
groups, with better results in group 1, regarding the physical deformations, in group 2 - in 9(13 %) (р<0.05), steroids
component score, physical functioning, pain and general (>3 months) were received in 30(81 %) and 50(43 %)
health components of the SF36 and HAQ-DI after 1 year, with patients, respectively, the cumulative dose of steroids was
no significant differences after 6 months. PCS was negatively higher in group 1 (p<0.05). The BMD in group 1 was
correlated to HAQ-DI, no correlation regarding age and sex lower at L1-4 and hand: 0.857±0.147 g/сm2 vs. 0.935±
could be identified. Furthermore, there were no significant 0.117 g/сm2, 0.433±0.104 g/сm2 vs. 0.479±0.057 g/сm2,
differences within the two groups regarding the type of frac- respectively (р<0.05). At least in one of analyzed sites
ture or the type of surgery. osteoporosis was revealed in 14(38 %) patients in group
Conclusion: The study reveals that strontium ranelate has 1 and in 18(26 %) patients in group 2 (р < 0.05). The
direct effect on the outcome of proximal femoral fractures; quantity of erosions in group 1 amounted 61.2±64.1, in
whereas there is no direct correlation between DXA in the group 2–25.3±37.9 points, a total Sharp score 156.3±99.1
studied groups and quality of life, expressed by the two and 109.9±72.1 points, respectively (р<0.05); the index of
described tools. Significant improvement can be produced vertebral deformations of thoracic spine was 0.74±0.13
by adding strontium ranelate after surgical stabilisation, ac- and 0.79±0.03 points, respectively (р<0.05).
cording to prescription. Due to the small number of cases, Conclusion: Every third patient with RA had fractures of
further randomised control trials are necessary in order to peripheral bones, every fourth had vertebral deforma-
definitely describe the effect of antiosteoporotic treatment tions. Patients with peripheral changes had longer dura-
upon the quality of life of these patients. tion of disease, a higher cumulative dose of steroids,
Disclosures: Dr. O. Lupescu: financial support from Servier quantity of erosions and a total Sharp score, thus that
Pharma for speaker and advisory activities. osteoporosis (by BMD) was defined only in 38 % of
patients.

P110
THE CLINICAL AND RADIOLOGICAL P111
CHARACTERISTIC OF PATIENTS WITH ANY ROLE FOR SERUM MAGNESIUM IN THE
RHEUMATOID ARTHRITIS WITH FRACTURES OF BLUNTED RESPONSE OF PARATHORMONE
PERIPHERAL BONES AND VERTEBRAE HORMONE IN EUCALCEMIC PATIENTS WITH
E. Petrova1, I. Dydykina1, A. Smirnov1, M. Podvorotova1, HYPOVITAMINOSIS D?
E. Taskina1, E. Nasonov1, P. Dydykina2, O. Alekseeva2, H. M. Al Attia1,2, S. Nasir1
E. Vetkova2 1
Internal Medicine, La Laguna, Tenerife, Spain, 2Internal
1
Research Institute for Rheumatology RAMS, Moscow, Rus- Medicine and Rheumatology, Abu Dhabi, United Arab
sian Federation, 2Federal State Budgetary Institution, Re- Emirates
search Institute of Rheumatology V.A.Nasonova, Russian
Academy of Medical Sciences, Moscow, Russian Federation Objective: Hypovitaminosis D is not always accompanied by
secondary hyperparathyroidism. Some patients may
Objective: To present the clinical and radiological character- expressed blunted response of PTH. In the search of possible
istic of patients with rheumatoid arthritis with fractures of reason for the blunted response of the PTH, we reviewed the
peripheral bones and vertebrae. serum magnesium (S/Mg) level in patients with and without
Material and Methods: In this research it is included 106 such response.
women with RA, age 23–69 years. The X-ray morphometric Material and Methods: The records of cohort of adults with
analysis of vertebral deformations by the Genant method was hypovitaminosis D who also had their S/Mg concurrently
performed. Radiological signs of RA progressing were estimated. Magnesium assay was carried out by enzymatic
determined by the Sharp/van der Heijde method at 67 method (Architect, Abbott, N = 1.6–2.6 mg/dl). Other
patients. The BMD was assessed by DXA Hologic parameters of interest were age of the patients, serum
Discovery A at lumbar spine (L1-4), at hip neck and calcium, 25 (OH)D and PTH level. The patients were
at nondominant hand. primarily, divided on the basis of the PTH response,
Results: By existence or absence of peripheral fractures in i.e., with secondary hyperparathyroidism and others with
anamnesis patients are distributed in two groups: with frac- blunted response.
tures (group 1) - 37(35 %) patients, without fractures (group 2) Results: 198 patients aged between 14 and 74 years were
- 69(65 %). The mean age was comparable: 54.1±9.6 years in diagnosed with hypovitaminosis D (25(OH) D, <30 ng/ml).
group 1, 51.1±10.6 years in group 2. The duration of RA in Data for S/Mg were available for 65 patients (35 males & 30
group 1 was 16.5±11.5 years vs. 11.6±9.1 years in group 2 females), 34(52.5 %) with secondary hyperparathyroidism
 Osteoporos Int

(>69 pg/ml) and 31 (47.5 %) with blunted PTH response than in others with blunted response (29–68.4, mean of
(mean 106±25.6 vs. 51.7±11.6 pg/ml, p=0.0001). Their age 55.4 pg/ml±10.6, p≤0.0001). The mean of blunted PTH
was comparable in the two groups (44.3±13.9 vs. 43.1± response, however, was not different between those with
13.3 year), respectively, p=0.72. Likewise was the mean of deficient (16) (56.8 pg/ml ± 8.7) and insufficient (66)
S/Mg in the 2 groups (1.84±0.275 vs. 1.81±0.202 mg/dl), p= patients (55.1 pg/ml±11), p=0.57. Both, the age factor
0.64. Mild hypomagnesemia was documented in 3/34 patients and serum phosphorus were nondiscriminatory in pa-
with secondary hyperparathyroidism (9 %) vs. 4 in tients with blunted and normal response of secondary
others with blunted PTH response (13 %), p = 0.75. hyperparathyroidism, respectively.
The mean value was 1.46 and 1.47 mg/dl, respectively. Conclusion: Significant blunted PTH response coexisted
The mean of serum calcium was also comparable (9.37± in these patients with hypovitaminosis D and eucalcemia
0.432 vs. 9.47 ± 0.50 mg/dl), p = 0.41. Borderline regardless to the vitamin status. Such finding poses a
hypocalcaemia, however, was noted in 2 patients neither of challenge to the discriminatory role played by PTH and
whom had an associated hypomagnesemia. Finally, the mean calcium values in classifying hypovitaminosis D patients.
of 25(OH)D was 15.3±6.23 in those with secondary hyper- Moreover, repeating the PTH assay would not be feasible
parathyroidism vs. 16.8±5.86 ng/ml in others with blunted in the follow up of treated patients with the blunted
response, p=0.31. response. Only the assay for vitamin D would be
Conclusion: In this cohort of eucalcemic patients with sufficient.
hypovitaminosis D, the serum magnesium was not discrimi-
natory hence, did not provide any clue towards the blunted
response of the PTH. P113
SENSITIVITY/SPECIFICITYANALYSIS AMONG
RECOMMENDATIONS FOR BONE MINERAL
P112 DENSITY MEASUREMENT IN TAIWANESE
SIGNIFICANT FUNCTIONAL 50 YEARS OLD AND OLDER MEN
HYPOPARATHYROIDISM IN EUCALCEMIC D. H. Liu1, W. C. Chiu2, J. F. Chen2,7, K. M. Lin3, B. C.
PATIENTS WITH HYPOVITAMINOSIS D Cheng4, S. F. Yu2, H. Y. Huang5, Y. K. Soong5, J. S. Hwang6,
H. M. Al Attia1, S. Nasir2 D. C. Chan8, R. S. Yang9, T. T. Cheng2, C. Y. Hsu2
1 1
Internal Medicine and Rheumatology, Abu Dhabi, United Department of Physical Medicine and Rehabilitation, Taipei
Arab Emirates, 2Internal Medicine, La Laguna, Tenerife, Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation,
Spain New Taipei City, Taiwan, Province of China,2Section of
Rheumatology, Allergy and Immunology, Chang Gung Me-
Objective: To assess the observation that some patients diag- morial Hospital - Kaohsiung Medical Center, Kaohsiung,
nosed with hypovitaminosis D were noticed to have normal Taiwan, Province of China, 3Section of Rheumatology, Aller-
levels of PTH in the UAE. gy and Immunology, Chang Gung Memorial Hospital - Chia-
Material and Methods: We reviewed the records of cohort of yi, Chia-yi, Taiwan, Province of China, 4Section of Nephrol-
198 adults (14–74) including 100 males diagnosed with ogy, Chang Gung Memorial Hospital - Kaohsiung Medical
hypovitaminosis D assayed by chemiluminscent microparticle Center, Kaohsiung, Taiwan, Province of China, 5Department
immunoassay for total 25 hydroxyvitamin D3 (25(OH)D). Obstetrics and Gynecology, Chang Gung Memorial Hospital -
PTH was also assayed by chemiluminscent microparticle Linkou Medical Center, Taoyuan County, Taiwan, Province of
immunoassay. China, 6Division of Endocrinology and Metabolism, Chang
Results: 51(25.5 %) patients were deficient. Apart from four Gung Memorial Hospital - Linkou Medical Center, Taoyuan,
patients, the rest were eucalcemic (mean of 9.41 ± Taiwan, Province of China, 7Division of Endocrinology and
0.419 mg/dl). The mean 25(OH)D in deficient patients Metabolism, Chang Gung Memorial Hospital - Kaohsiung
was 9.77±1.93 vs. 18.9±4.51 in the insufficient ones, Medical Center, Kaohsiung, Taiwan, Province of China, 8De-
p < 0.0001. 81(41 %) of the group exhibited blunted partment of Geriatrics and Gerontology, National Taiwan
response of the PTH to the hypovitaminosis D; <69 pg/ml, University Hospital, Taipei, Taiwan, Province of China, 9De-
(15/51(29 %) with deficiency vs. 66/147(45 %) with insuffi- partment of Orthopaedics, National Taiwan University Hos-
ciency), p=0.068. The mean of 25(OH)D was not different in pital, Taipei, Taiwan, Province of China
patients with blunted response and other with secondary hy-
perparathyroidism (16.8±5.02 (7.2–28.9 ng/ml) vs. 16.7± Objective: To evaluate the recommendations for BMD test in
5.90 (2.06–29.7 ng/ml), respectively, p=0.88. For the PTH, Taiwanese men.
the mean was significantly higher in patients with secondary Material and Methods: A bus, equipped with DXA, serving
hyperparathyroidism (69.4–329, mean of 108 pg/ml±39.9) for countrywide BMD test was available between 2008 and
Osteoporos Int

2011. Participants must complete a questionnaire regarding Acknowledgements: The authors would like to thank Taiwan
risk factors of osteoporotic fracture in FRAX® tool before Osteoporosis Association for offering the data and authorizing
BMD test. Osteoporosis was defined as lowest T- the data management.
score≤-2.5 at any sites, including lumbar spine(L1~L4),
total hip, femoral neck. We made use of the database of
the project to compare the positive predictive value of
osteoporosis among the recommendations by National P114
Osteoporosis Foundation (NOF), Osteoporosis Simple INCIDENCE OF COLLES’ FRACTURES IN
Tool for Taiwan (OSTAi), and National Osteoporosis PATIENTS WITH OSTEOPOROSIS: ANALYSIS OF
Guideline Group (NOGG) for Taiwanese men. We also DATA FROM THE “BONLINK” DATABASE
analyze the sensitivity/specificity of each recommenda- J. Vasic1, J. Zvekic-Svorcan2, F. Gojkovic1, J. Elez3, V.
tion by the receiver operating characteristic (ROC) Culafic Vojinovic3, L. J. Nikcevic4
1
curve and calculating area under the curve (AUC) to Physical Medicine and Rehabilitation, Railway Healthcare
determine the more adequate recommendation for BMD Center, Belgrade, Serbia, 2Rheumatology, Special Hospital
test for Taiwanese men. for Rheumatic Diseases, Novi Sad, Serbia, 3Internal
Results: A total of 2,562 Taiwanese men (mean age: 69.7 Medicine, Railway Healthcare Center, Belgrade, Serbia,
4
±9.5 years) were enrolled in this study. Among these Physical medicine and rehabilitation, Special Hospital
subjects, 422 met the definition of osteoporosis and for Cerebrovascular Diseases Sveti Sava, Belgrade,
253 reported history of fragility fractures. According to Serbia
the previous Taiwan study, we select −2 as the cutoff
value in OSTAi. Based on the index score, the Objective: The aim of this study is to determine incidence of
sensitivity/specificity of OSTAi recommendation was fractures of distal part of radius (Colles’ fractures) in correla-
0.656/0.644, compared to 0.924/0.247 (NOF), and tion with BMD and age.
0.746/0.415 (NOGG), respectively. The ROC curve Material and Methods: Prospective study was performed
analysis, as illustrated in Fig, revealed AUC was 0.705 from November 2011 to April 2013 and included
(95%CI (CI95):0.677–0.733), 0.586 (CI95:0.558–0.613), 2,625 participants. Data were collected from two
and 0.581 (CI95:0.552–0.610) for OSTAi, NOF, and “Bonlink” databases from referent DXA centers in Ser-
NOGG, respectively (P < 0.001, between each recom- bia. Participants were referred for lumbar spine and hip
mendation, except for NOF versus NOGG with DXA scan. Results were interpreted according to the
P>0.001). current definition of osteoporosis. They were tested on
presence of risk factors. Previous distal radius fracture
was documented by radiograms or medical history. We
considered the fractures sustained in a fall at the same
level or a little trauma. Statistical analysis (descriptive
statistics and central tendency) was performed using the
program “Bonlink”.
Results: The sample consisted of 97 % postmenopausal
women and 3 % men, average age 63.89±8.18 years.
Average BMD on lumbar spine was 0.818±0.14, femo-
ral neck 0.614±0.23 and total hip 0.789±0.16. Of all
participants 56.5 % suffered low energetic fracture.
There were detected 586 vertebral and 964 nonvertebral
fractures: hip in 7.8 % participants, forearm 52.2 %,
humerus 13.1 %, and other fractures 27 %. Two or
more fractures suffered in 11.6 % participants. Among
nonvertebral fractures, half were Colles’ fractures
(52.2 %). Highest incidence of Colles’ fractures,
52.7 % was among patients with BMD in osteopenic
level, 38 % had BMD in osteoporotic level and 9.3 %
had normal values. Incidence of Colles’ fractures per
Conclusion: Compared to recommendation by NOF or age groups was as follows: in group 40–49 years was
NOGG, OSTAi seems a better recommendation to screen for 48 fractures, 50–59 192, 60–69 -161, 70–79 50 and in
osteoporosis and BMD test in Taiwanese men. 80–89 52 fractures.
 Osteoporos Int

Conclusion: The most common nonvertebral osteoporotic P116

fracture is Colles’ fracture and highest incidence is in patients INCIDENCE OF FRACTURES IN RELATION TO
with low BMD and in age 50–69 years. Forearm fracture often RISK FACTORS PRESENCE: ANALYSIS OF DATA
precedes other osteoporotic fracture. Adequate therapy started FROM THE DATABASE “BONLINK”
on time is very important and can reduce occurrence of F. Gojkovic1, J. Elez2, J. Vasic1, V. Culafic Vojinovic2, J.
osteoporotic fractures. Zvekic-Svorcan3
1
Physical Medicine and Rehabilitation, Railway Healthcare
Center, Belgrade, Serbia, 2Internal Medicine, Railway
P115 Healthcare Center, Belgrade, Serbia, 3Rheumatology, Special
INCIDENCE OF NONVERTEBRAL AND Hospital for Rheumatic Diseases, Novi Sad, Serbia
VERTEBRAL FRACTURES IN RELATION TO BONE
MINERAL DENSITY: ANALYSIS OF DATA FROM Objective: The aim of this study was to determine incidence
THE DATABASE “BONLINK” of fractures in relation to risk factors presence.
J. Elez1, F. Gojkovic2, J. Vasic2, V. Culafic Vojinovic 1, Material and Methods: Prospective study was performed
J. Zvekic-Svorcan 3 during 2012 and included 763 subjects, average age 65.02±
1
Internal Medicine, Railway Healthcare Center, Belgrade, 9.31 years. They were referred for BMD testing on lumbar
Serbia, 2Physical Medicine and Rehabilitation, Railway spine and hip in Railway Healthcare Center, Belgrade.
Healthcare Center, Belgrade, Serbia, 3Rheumatology, Special Measuring was done on Hologic Discovery C device.
Hospital for Rheumatic Diseases, Novi Sad, Serbia All of them were previously examined on presence of risk
factors: previous low energetic fracture, family history of
Objective: To determine incidence of nonvertebral and hip fracture, smoking, alcohol intake, glucocorticoid ther-
vertebral fractures in relation of BMD. apy, low BMI, early menopause, rheumatoid arthritis,
Material and Methods: Study included 763 patients who other diseases that can affect bone and >3 falls per year.
were sent on DXA scan in Railway Healthcare Center, Results were interpreted according to the current defini-
Belgrade during 2012. BMD was measured on lumbar tion of osteoporosis. Data were collected and analysed in
spine and hip. Vertebral fracture assessment (VFA) was Bonlink program. Descriptive statistics and central ten-
done in all participants. Results were interpreted accord- dency were used in statistical analysis.
ing to current definition of osteoporosis. All participants Results: Sample was made from 98 % women and 2 % men.
were examined about presence of low energetic fracture Average BMD on lumbar spine/hip was 0.728±0.09/0.724±
(anamnesis, medical history, radiograms, VFA). Data 0.0988 and average T-score on lumbar spine/hip was −2.17±
were collected and analysed in Bonlink program. Descriptive 0.830/−2.4±0.628. Among all participants, 49.9 %(381/763)
statistics and central tendency were used in statistical had fracture on small trauma or accidental fracture. Incidence
analysis. of fractures in relation to risk factors was presence of previous
Results: Most of participants were women, 98 %, and just fracture 299, positive family history of fractures 134, smoking
2 % were men, average age 65.02±9.31 years. Out of all, 193, alcohol intake 3, glucocorticoid therapy 15, low BMI 28,
63 % had T-score on lumbar spine or hip at the osteopenic early menopause 117, rheumatoid arthritis 9, other diseases
level, 32 % had T-score at level of osteoporosis, and only that can affect bone 12, >3 falls per year 11.
5 % had normal value of T-score. Of the summary number Conclusion: Most frequent risk factors in individuals with
of the participants, 49.9 % (381/763) had fractures, and presence of fracture were previous fracture presence,
from that number 46.2 % (176/381) had vertebral fractures, smoking, positive family history of fractures, early menopause
and 53.8 % (205/381) had nonvertebral fractures. Some and BMI<18. Risk factors are very important in fracture risk
participants had more than one fracture. The most com- assessment and we should actively look for them. Individuals
mon nonvertebral fractures were at the osteoporotic level with presence of risk factors should be send to DXA scan in
55.2 %, than at the osteopenic level 39.4 %, and 5.48 % order to start therapy on time in those who are in high risk to
had fracture with normal BMD. Unless, vertebral fractures have fracture.
are most common in the group of participants with BMD
at the osteopenic level 50.5 %, then 45.1 % at the osteoporotic
level of BMD, and only 4.4 % with normal value of P117
BMD. EFFECT OF GLUCOCORTICOIDS IN
Conclusion: Measurement of BMD on lumbar spine and hip DEVELOPMENT OF DECREASED BONE MINERAL
is the “gold standard” for detecting osteoporosis, but we DENSITY
should seek more for other risk factors in order to prevent J. Zvekic-Svorcan1, K. Filipovic1,1, T. Jankovic1,1, S. Subin-
further osteoporotic fractures. Teodosijevic2, K. Boskovic3, M. Lazarevic1,1, J. Vasic4
Osteoporos Int

1
Rheumatology, Special Hospital for Rheumatic Diseases, Objective: To study and compare the effect botulinum neu-
Novi Sad, Serbia, 2Rheumatology, General Hospital Djordje rotoxin type A (BoNT-A) injections on structural changes in
Joanovi, Zrenjanin, Serbia, 3Rheumatology, Clinic for Medi- juvenile and adult muscle.
cal Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Material and Methods: The present study was conducted in
Serbia,4Physical Medicine and Rehabilitation, Railway the Department of Anatomy, Faculty of Medicine, King
Healthcare Center, Belgrade, Serbia Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. This
investigation examined 32 adults and 32 juvenile rats. Elec-
Objective: Glucocorticoid-induced osteoporosis, and thus in- tron microscopy and immunohistochemical which included
creased risk of osteoporotic fractures, is one of the major side neurofilament immunohistochemistry techniques were used
effects of glucocorticoids use. The aim of the study was to to perform the morphological study.
establish the effect of glucocorticoids in development of de- Results: The results showed that the use of BoNT-A injec-
creased BMD. tions induced morphological changes in the form of muscle
Material and Methods: Prospective study has been done fiber atrophy, disorganization of the muscle fiber structure,
between November 2011 and April 2013, encompassing extension of nerve terminal sprouts, and formation of new
2,625 patients of both genders and various ages. The neuromuscular junctions. The same set of structural changes
sample was obtained by merging databases from two took place in both groups. However, the time scale of these
reference osteodensitometric centers in Serbia, Special changes occurred earlier in juvenile rats than adult muscle.
Hospital for Rheumatic Diseases at Novi Sad and Railway Conclusion: The injection of BoNT-A leads to morphological
Healthcare Center at Belgrade. All subjects had their changes in juvenile and adult rat muscle. These changes were
BMD measured at the lumbar spine and hip. Results were found to be the same in both groups.
interpreted according to the valid osteoporosis definition. Acknowledgements: We would like to thank and ac-
Patients were included after being on glucocorticoid ther- knowledge the Deanship of Scientific Research (DSR),
apy (doses ≥5 mg) more than 3 months. In statistical King Abdulaziz University for their technical and financial
analysis, descriptive statistics, central tendency measures support.
and chi-square test were used.
Results: From total sample, 97 % were females and 3 %
males, with average age 63.89±8.18 years. Average BMD P119
value at the hip was 0.789±0.16 with T-score −1.81± HANDS EXAMINATION IN ABSENCE OF
0.83, and at the lumbar spine BMD was 0.818±0.14, HAND-RELATED COMPLAINTS: AN OUTPATIENT
with T-score −2.39± 0.97. Glucocorticoid therapy was SURVEY
present in 9 % patients, with average treatment duration H. M. Al Attia1, M. A. Ibrahim1
1
2.19±0.89 years. Regarding relation between glucocor- Internal Medicine and Rheumatology, Abu Dhabi, United
ticoid therapy and BMD, a connection was found for Arab Emirates
both the hip and the lumbar spine (X2 =15.71; p=0.000
and X2 =11.96; p =0.000, respectively) with statistical Objective: Performing careful physical examination of the
significance of p<0.01. hands is an important exercise. A few clinicians, however,
Conclusion: Glucocorticoids bring to rapid decrease of may be routinely employing it in their day-to- day practice. In
BMD. Therefore, when prescribing glucocorticoid ther- an early survey, a reference to hand examination was made in
apy it is necessary to prescribe simultaneous supple- only in 13 (8.5 %) of 148 randomly selected records of
mentation of vitamin D, and depending on glucocorti- patients seen in the medical outpatient. This paper aims to
coids dose, also an antiresorption therapy in order to assess the value of hand examinations of patients in clinical
inhibit osteoclastic activity as prevention of osteoporotic practice.
fractures. Material and Methods: 195 adult patients seen in internal
medicine outpatient were examined for physical findings in-
volving the hands. Their selection was based on the lack of
hand-related complaints. Their age ranged between 16 and
P118 86 years (average 47.8±14.2). 99 (51 %) were males.
STRUCTURAL ALTERATIONS INDUCED BY Results: 90 (46 %) exhibited physical findings vs. 105 (54 %)
BOTULINUM TOXIN INJECTION IN JUVENILE who did not, p=0.15. In those with findings, 26/90 (29 %) had
VERSUS ADULT RAT MUSCLE findings relevant to the underlying diagnosis or consistent
S. M. Hassan1, M. H. Badawoud1, A. A. Al-Hayani1 with the complaint (group 1) vs. 64 (71 %) who manifested
1
Anatomy Department, Faculty of Medicine, King Abdulaziz findings nonrelevant to the underlying diagnosis but formed a
University, Jeddah, Saudi Arabia potential towards another diagnosis/es (group 2), p=0.0001.
 Osteoporos Int

A total of 95 findings were identified in those patients (ratio of This study also indirectly points towards the uselessness of
1.06: each patient) representing a wide spectrum of conditions calcium supplementation in osteoarthritis as it has an inverse
(27 & 68) findings distributed in the two groups respectively, relationship with osteoporosis. Large scale studies are re-
p=0.0001. Heberden’s nodes and palmar erythema followed quired to assess this comparison further, which is possible
by clubbing and psoriatic rash were the most common by using these simple screening techniques.
findings. Hemorrhagic telangiectasia, tylosis palmaris, References: Singh M et al., J Bone Joint Surg Am
sclerodactyly, hands hyperpigmentation and palmar erythema 1970;52:457. Bellamy N et al., J Rheumatol 1988;15:1833.
provided clues and directed efforts to rule out potentially Roos EM et al., Osteoarthritis Cartilage 1999;7:216.
serious conditions. There was no gender difference in the
distribution of the findings (46 in males vs. 44 in females,
p=0.88). The clinical examination of the hands, therefore, P121
may reveal physical findings with or without relevance to BONE MINERAL DENSITYAND FREQUENCY OF
the underlying diagnosis in up to 46 % of the patients some OSTEOPOROSIS IN NONMENOPAUSALWOMEN
of which may reflect significant disorders. WITH RHEUMATOID ARTHRITIS
Conclusion: The hand examination remains a pivotal and M. F. Aiche 1 , C. Haouichat 1 , F. Z. Lakehal 1 , N.
integral instrument for a better assessment of patients in the Hammoumraoui1, H. Djoudi1
1
clinical practice. EHS de Douéra, Algiers, Algeria

Objective: To quantify the BMD and to evaluate frequency of

P120 osteoporosis in nonmenopausal women. To examine variables
CORRELATION BETWEEN OSTEOPOROSIS AND associated with low BMD in patients with RA.
OSTEOARTHRITIS Material and Methods: Transversal study based on a group
V. Khanna1, V. Shrimal2, C. Shrivastava2 of 130 nonmenopausal women with RA. All the patients
1
Orthopaedics, Ranjana Hospital, Allahabad, India, 2Ortho- fulfilled the 1987 criteria of the American College of Rheu-
paedics, Eras Lucknow Medical College, Lucknow, India matology for RA diagnosis. The DXA method (Hologic QDR
2000) was used to measure BMD in the anteroposterior lum-
Objective: To find the correlation between osteoporosis and bar spine (L1-L4) and left hip, and clinical data were
osteoarthritis by using Kellgren Lawrence (KL) grading for collected.
osteoarthritis and Singh and Maini Index for osteoporosis. Results: The mean age of the patients was 38.4±8.2 years and
Material and Methods: 300 patients ageing above 45 years the BMI was 25.2±5.8 kg/m2. The median disease duration
were assessed using KL grading for Osteoarthritis in the knee was 8.2±6.3 years. The mean disease activity score (DAS28)
joint and Singh and Maini Index for Osteoporosis in the hip was 4.42±1.3, and mean Health Assessment Questionnaire
joint. The KL grading increases with increasing severity of score (HAQ) was 0.989±0.79. 91.2 % of our patients take an
osteoarthritis. The Singh and Maini Index decreases with average of 6.2±4 mg/d of corticosteroids; whereas 82 % of
increasing severity of osteoporosis. All the patients with any our patients take DMARDs. The mean values of the spine and
history predisposing them to secondary arthritis were exclud- hip BMD are, respectively, of 0.927±0.13 g/cm2 and 0.845±
ed along with patients on long term use of corticosteroids. All 0.13 g/cm2, they’re inferior to those of the control group
cases were assessed by a single doctor so as to avoid interob- which mean values are, respectively, of 0.983±0.11 g/cm2
server variation. Both the KL grading and the Singh and Maini and 0.916±0.11 g/cm2 (p<0.0002, p<9.10-6). The prevalence
index were analyzed and compared with each other with the of osteoporosis at lumbar spine and hip are, respectively,
help of Pearson’s coefficient of correlation. 6.9 % and 12 %. Osteopenia occurred in 33.8 % at lumbar
Results: On comparing a total of 300 cases it is seen that spine and 27 % at total hip. Bivariate analysis demonstrated
osteoporosis is most commonly seen in postmenopausal fe- that several factors such as BMI, disease duration, HAQ score,
males and also in the urban population; whereas osteoarthritis joint damage (modified Sharp score), and cumulative cortico-
is seen most commonly in the rural population. There is a steroid dose were correlated with low BMD at both measure-
slight positive correlation between the KL grading and the ment sites. However, multivariate analysis reveal that the low
Singh and Maini Index which indicates that osteoarthritis and BMI were associated with low BMD at both hip and spine. In
osteoporosis are slightly inversely proportional to each other. addition, disease activity and level of disability were an im-
Conclusion: There is a slight inverse correlation between the portant determinant of hip BMD.
severity of osteoarthritis and osteoporosis. This is comparable Conclusion: This study suggests the magnitude of the osteo-
to studies which have correlated the BMD using DXA for porosis problem in female RA population and confirms the
osteoporosis and KL grading for osteoarthritis. KL grading BMD reduction in RA, independently of the menopause and
and the Singh and Maini Index have never been compared. current use of corticosteroids.
Osteoporos Int

P122 average weekly dose of 12.5 mg. Patients were monitored and
BONE MINERAL DENSITY CHANGES IN PATIENTS divided into two groups. The first group consisted of 44
WITH RHEUMATOID ARTHRITIS patients, 38 women and 6 men in whom beside MTX,
K. Senel1, T. Baykal2, B. Seferoglu1, E. U. Altas1 etanercept was included in the weekly dose of 50 mg.
1
Physical Medicine and Rehabilitation, Ataturk University The other group included 56 patients, 48 women and 8
Medical Faculty, Erzurum, Turkey, 2Physical Medicine and men who continued taking MTX. The use of glucocor-
Rehabilitation, Batman Medical Park Hospital, Batman, ticoids was the excluding criterion for further monitor-
Turkey ing. All patients at baseline and after 1 year had
osteodensitometric examination (DXA) done using LU-
Objective: Our aim was to determine BMD values, NAR review. BMD was measured at the lumbar spine
osteoporosis frequency and to analyse the risk factors (LS) and hips, expressed in absolute values (g/cm2).
that affect bone loss in rheumatoid arthritis (RA) Statistical analyses were done in statistical package for
patients. The Science 20.0 program.
Material and Methods: BMD was measured by DXA at Results: In the first group of patients the received initial value
lumbar spine and femoral neck in 45 female RA pa- of BMD and DXA control finding, located on the LS
tients and 40 healthy age and gender matched control (1.08 g/cm2, 1.04 g/cm2) and hip (0.868 g/cm2, 0.846 g/cm2),
group. The correlations between BMD and age, disease showed statistical difference (t=4.43, p=0.000) and (t=4.14,
duration, BMI, physical activity, disease activity p=0.000). In the second group the received BMD values at
(DAS28 score), functional status (HAQ score), rheuma- LS (0.997 g/cm2, 0.960 g/cm2) and hip (0.834 g/cm2,
toid factor (RF), erythrocyte sedimentation rate (ESR), 0.815 g/cm2) were statistically significant (t=5.29, p=
C-reactive protein (CRP). We assessed clinical features 0.000) and (t=5.33, p=0.000). Comparing changes in
and laboratory parameters. BMD in both groups of patients, patients who were
Results: The mean BMD values were significantly decreased only on MTX had a statistically significant decrease in
in RA patients compared to control group (p< 0.01). BMD values.
Approximately 72 % of patients had osteoporosis and Conclusion: Changed BMD values in patients treated only
osteopenia. The rate of osteoporosis in RA patients was with MTX, after a year, was higher and showed a statistically
36 % at lumbar spine and 35 % at femoral neck. The risk significant difference, as well as when compared with the
factors for osteoporosis was age, disease duration, physical change in BMD in patients treated in combination with
activity and HAQ scores. The was no correlation between etanercept.
ESR, CRP, RF titers, DAS28 and BMD values.
Conclusion: Our findings demonstrated that age, disease
duration, physical activity and HAQ scores in RA patients P124
may be accepted as risk factors for bone loss. OSTEOPOROSIS AND TYPE 2 DIABETES
L. Chislari1, L. Groppa1
1
UEMP Nicolae Testemitanu, Internal Medicine No. 5,
P123 Department of Rheumatology and Nephrology, Chisinau,
CHANGES OF MINERAL BONE DENSITY IN Republic of Moldova
PATIENTS WITH RHEUMATOID ARTHRITIS
TREATED WITH METHOTREXATE AFTER Objective: Determination of the correlation of type 2 diabetes
ONE-YEAR APPLICATION OF ETANERCEPT with indices of BMD and biochemical indices of bone
T. Jankovic1, J. Zvekic-Svorcan1, B. Erdeljan1 metabolism.
1
Rheumatology Special Hospital for Rheumatic Diseases, Material and Methods: The research group included 80
Novi Sad, Serbia patients with a mean age of 52.1±0.2 years (ratio M/F=20/
60) with type 2 diabetes hospitalized consecutive in the De-
Objective: The reduction of BMD in rheumatoid arthritis partment of Endocrinology Republican Clinical Hospital,
(RA) starts early, proinflammatory cytokines are playing an Chisinau. In the control group there were 50 patients without
important role in its emerging. To determine the effect of diabetes but with other basic parameters. All patients were
etanercept on BMD in patients with RA treated with metho- investigated clinically complex, anthropometric, causes the
trexate (MTX) after 1-year application. bone alkaline phosphatase was performed BMD and DXA
Material and Methods: The study was conducted in the lumbar region.
period of 1 year in 100 patients with RA, 86 women and 14 Results: The frequency of risk factors for osteoporotic frac-
men, median age 57, with mean disease duration of 8.9 years, tures was significantly higher in the group of patients with
who had been treated with MTX for at least 3 years in the type 2 diabetes. Alkaline phosphatase levels in patients with
 Osteoporos Int

type 2 diabetes was similar indexes the control group cerebrovascular and malignant diseases in males. How-
(176.2±11.34 vs. 185.5±13.7 nmol/l◦s, p>0.05). While ever, the mortality risk remained unaltered over the
the acid phosphatase as an indicator of bone resorption decade when this was compared to controls for both
was significantly higher in the group with type 2 dia- males (<2009 vs. ≥2009: adj. HR 1.0, 95%CI: 0.8–1.2)
betes (114.64±6.58 vs. 82.4±6.0 nmol/l◦s, p<0.05). The and females (adj. HR 1.1, 95%CI: 1.0–1.2).
average T-index in the lumbar region in patients with Conclusion: The risk of death in the first year after hip
type 2 diabetes was −3.3±0.3 SD, and the control group fracture has declined over the last decade in the UK,
−1.7±0.2 SD (p<0.05). In type 2 diabetic group the with underlying comorbid contributors that differed be-
number of patients with low BMD corresponding to tween males and females. However, the difference in
osteopenia and osteoporosis as T-index results made up mortality risk between hip fracture patients and the
55 % and 21 %, respectively. The research group with- general population remained unaltered. These observa-
out diabetes these indices were 21 % and 9 % (p<0.005 tions highlight the need for the continued implementa-
for osteoporosis). tion of evidence- based standards for good hip fracture
Conclusion: Data show increase indices of bone metabolism care to target potentially preventable complications and
and a high frequency of detection of osteoporosis in women secondary fractures.
and men with type 2 diabetes.

P125 P126
MORTALITY IN BRITISH HIP FRACTURE SEVER DISEASE: AN IMPORTANT CAUSE OF HEEL
PATIENTS, 2000–2010: A POPULATION-BASED PAIN IN CHILDREN: CASE REPORT
RETROSPECTIVE COHORT STUDY L. Tekin1, A. Y. Karahan1, A. N. Tekin2, A. Kucuk3
F. De Vries1, H. G. M. Leufkens1, J. Bijlsma2, P. Elders3, N. C. 1
Department of Physical Rehabilitation and Rehabilitation of
Harvey4, C. Cooper5, P. Welsing2, C. Klop1 State Hospital of Beyhekim, Konya, Turkey, 2Department of
1
Utrecht University, Utrecht, Netherlands, 2University Medi- Physical Rehabilitation and Rehabilitation of Fizikon, Konya,
cal Centre Utrecht, Utrecht, Netherlands, 3VU Medical Cen- Turkey, 3 Department of Rheumatology University of
tre, Amsterdam, Netherlands, 4University of Southampton, Necmettin Erbakan, Konya, Turkey
Southampton, United Kingdom, 5MRC Lifecourse Epidemi-
ology Unit, Southampton General Hospital, Southampton, Objective: Calcaneal apophysitis is the most common
United Kingdom cause of heel pain in athletic children, typically occurring
during a growth spurt and at the beginning of a new sport
Objective: The aims of this study were to examine, over the season. It was first described by Sever in 1912 and later
last decade, secular trends in mortality within hip fracture was named Sever Disease (SD). Sever described a painful
patients and to compare this to mortality trends in the general condition of the heel that occurs only in children and
population of the United Kingdom. never after puberty.
Material and Methods: A cohort study was conducted with- Material and Methods: Case report: A 12-year-old male
in the British Clinical Practice Research Datalink (CPRD). presented in physical therapy and rehabilitation outpatient
CPRD is the world’s largest primary care (n>5 million). Data clinic with 3 month history of bilateral heel pain which was
was linked to national death certificates data for 58 % of all aggravated by activity and shoe wear in the area where the
patients. Patients with a first record of hip fracture (Jan2000– Achilles tendon attaches to the heel. The pain was aggravated
Dec2010; n=31,495) were matched to 4 controls (n=116,649) by activity and relieved by rest. He walked with a limping gait.
by age, sex, and practice. All patients were followed for death, Examination of the foot revealed marked tenderness at the
and hazard ratios (HRs) were calculated. Analyses were ad- posterior calcaneus of both side. Also bilateral subtalar joint
justed for age, sex, disease and drug history, BMI, smoking ranges of motion were decreased in dorsiflexion, plantar flex-
status and alcohol use. ion, inversion, and eversion. Radiograph revealed sclerosis
Results: The overall mortality rate was 22 % 1-year post hip and fragmentation within the calcaneal apophysis. MRI sub-
fracture as compared to 7.8 % in controls. The 1-year mortal- sequently revealed changes in the metaphysis of the calcaneus
ity risk after hip fracture dropped from ≥2009 and was 14 % and the apophyseal area consistent with bony bruising and
lower in the years <2009 (adj. HR 0.9, 95%CI: 0.8–0.9). The microfractures.
decline was attributable to secular changes in elderly patients Results: The desired outcome of physical therapy for a patient
and was greater for males. Respiratory infections were the with SD is the patient’s return to participation in all physical
significant component of the decrease in all-cause mortality activities after the symptoms have resolved. For this to occur,
after hip fracture in females, as were declines in the patient must be able to bear weight through the heel
Osteoporos Int

without pain. Once the patient is no longer experiencing pain, P128

a gradual return to activities can be undertaken. PHOSPHO1: RECOGNITION OF ROLES BEYOND
Conclusion: In a child with heel pain, the differential diagno- SKELETAL MINERALIZATION
sis may include Achilles tendonitis, retrocalcaneal bursitis, K. J. Oldknow1, J. L. Millán2, V. E. Macrae1, G. Karsenty3,
calcaneal stress fractures, calcaneal cysts, osteomyelitis, and M. Ferron4, D. Ball5, L. Bunger6, C. Huesa1, S. Rajoanah7,8,
plantar fasciitis. Usually, these causes can be ruled out with a M. C. Yadav2, N. M. Morton7, C. Farquharson1
1
well performed clinical evaluation. SD is a common condition The Roslin Institute, The University of Edinburgh,
in the growing child. We present the clinical features of one Edinburgh, United Kingdom, 2Sanford Children’s Health
such case found in our region. Research Center, La Jolla, United States, 3Columbia
University, New York, United States, 4 Institut de
Recherches Cliniques de Montréal, Montreal, Canada,
5
Heriot Watt University, Edinburgh, United Kingdom,
6
P127 SRUC, Edinburgh, United Kingdom, 7University of
LSD1-MEDIATED DEMETHYLATION OF HISTONE Edinburgh, Edinburgh, United Kingdom, 8University of
H3 LYSINE 9 CONTRIBUTES TO INTERLEUKIN Edinburgh, Edinburgh, United States
1-INDUCED MICROSOMAL PROSTAGLANDIN E
SYNTHASE-1 EXPRESSION IN HUMAN Objective: To determine if the ablation of the bone specific
OSTEOARTHRITIC CHONDROCYTES phosphatase (Phospho1, P1) confers protection against obesi-
F. E. El Mansouri1, S. S. Nebbaki1, M. Kapoor1, H. Afif1, J. ty and diabetes in mice.
Martel-Pelletier1, J.-P. Pelletier1, H. Fahmi1 Material and Methods: All experiments were carried out on
1
Osteoarthritis Research Unit, CRCHUM, Montreal, Canada wildtype (WT) and P1−/− mice. Calvarial osteoblasts were
extracted in the standard manner for protein and mRNA
Objective: Microsomal prostaglandin E synthase-1 (mPGES- analysis. Metabolic studies were conducted on 120 day male
1) catalyzes the terminal step in the biosynthesis of PGE2, a mice fed either a control (6.2 % fat) or high fat diet (HFD,
critical mediator in the pathophysiology of osteoarthritis 58 % fat) for 3 months.
(OA). Histone methylation plays an important role in Results: Esp (encoding the phosphatase OST-PTP) which
epigenetic gene regulation. In this study, we investigated controls hormonally active osteocalcin (GLU13-OCN) secre-
the roles of histone H3 (H3K9) methylation in interleukin- tion, was 20-fold more highly expressed in P1−/− osteoblasts
1β (IL-1)-induced mPGES-1 expression in human (p<0.05). Unexpectedly, serum levels of GLU13-OCN were
chondrocytes. normal suggesting an OCN-independent mechanism of P1
Material and Methods: Chondrocytes were stimulated regulated energy metabolism. P1−/− mice were hypoglycaemic
with IL-1 and the expression of mPGES-1 mRNA was (WT 9.48±0.31 mmol/L, P1−/− 8.30±0.26 mmol/L; p<0.01)
evaluated using real-time reverse transcriptase PCR. and showed improved glucose and insulin tolerance compared
H3K9 methylation and the recruitment of the histone to WT mice (p<0.05). These observations were consistent with
demethylase LSD1 to the mPGES-1 promoter were the finding of smaller (mg/g BW) subcutaneous (WT 4.51±
evaluated using chromatin immunoprecipitation (ChIP) 0.37, P1−/− 2.79±0.42; p<0.01), mesenteric (WT 13.2±1.34,
assays. The role of LSD1 was further evaluated using P1−/− 5.56±1.61; p<0.01) and epididymal (WT 13.7±1.81,
the pharmacological inhibitors, tranylcypromine and P1−/− 6.96±0.58; p<0.001) fat deposits noted in P1−/−
pargyline. mice at necropsy and confirmed by MRI and CT. Re-
Results: The induction of mPGES-1 expression by IL-1 cor- markably, P1−/− mice resisted the pronounced weight
related with decreased levels of mono- and dimethylated gain (WT 38.0±1.54 g, P1−/− 32.4±1.26 g; p<0.05)
H3K9 at the mPGES-1 promoter. These changes were con- and diabetes (WT 10.3 ± 0.53 mmol/L, P1−/− 9.27 ±
comitant with the recruitment of the histone demethylase 0.77 mmol/L; p < 0.05) exhibited by WT mice when
LSD1. Treatment with tranylcypromine and pargyline, potent fed a chronic HFD, not explained by altered activity.
inhibitors of LSD1, prevented IL-1-induced H3K9 demethyl- Histology revealed smaller epididymal adipocytes, de-
ation at the mPGES-1 promoter and mPGES-1 expression, creased fat content, decreased pancreatic islet number
suggesting that LSD1 mediates IL-1-induced mPGES-1 ex- and increased mitochondria number in brown fat
pression via H3K9 demethylation. (p < 0.05). However, no differences were observed in
Conclusion: These results indicate that H3K9 demethylation brown fat specific genes including Ucp1 suggesting
by LSD1 contributes to IL-1-induced mPGES-1 expression canonical thermogenesis does not underlie metabolic
and suggest that this pathway could be a potential target for protection.
pharmacological intervention in the treatment of OA and Conclusion: Our findings indicate P1 deficiency improves the
possibly other arthritic conditions. metabolic profile of mice in vivo and confers resistance to
 Osteoporos Int

obesity and diabetes most likely through a primary effect on References: 1. Franceschi, J Bone Miner Res 1990;5. 2.
bone metabolism/turnover. Hie, J Nutr Biochem 2011;22. 3. Park, Int J Exp Pathol
2012;93.

P129 P130
ASSOCIATIONS BETWEEN VITAMIN C AND QUALITY OF LIFE IN PATIENTS WITH
QUANTITATIVE HEEL ULTRASOUND AND SPINE OSTEOARTHRITIS IN ASSOCIATION WITH AND
FRACTURE RISK WITHOUT TYPE 2 DIABETES ASSESSED BY
H. Finck1, A. R. Hart1, M. A. Lentjes2, A. Jennings1, R. N. QUESTIONNAIRE SF-36
Luben2, K. T. Khaw2, A. A. Welch1 L. Groppa1, L. Chislari1, V. Cazac1
1 1
Norwich Medical School, University of East Anglia, Nor- UEMP Nicolae Testemitanu, Internal Medicine No. 5, De-
wich, United Kingdom, 2Department of Public Health and partment of Rheumatology and Nephrology, Chisinau, Re-
Primary Care, University of Cambridge, Cambridge, United public of Moldova
Kingdom
Objective: Impact on the quality of life at patients with
Objective: Vitamin C sufficiency may play a role in osteoarthritis in association and without type 2 diabetes by
preventing osteoporosis and fractures via osteoblastic colla- questionnaire SF-36.
gen synthesis1, osteoblastogenesis2 and osteoclastogenesis3. Material and Methods: To achieve the aim and objectives of
This study aimed to determine cross-sectional and prospective the study a group of 80 patients with type 2 diabetes was
associations between intakes and plasma levels of vitamin C selected (mean age of 58.1±0.2 years), in association with
with heel ultrasound and spinal fracture risk in older British osteoarthritis. A second group of 80 persons, with osteoarthri-
men and women. tis, was selected as a control group, which corresponded by
Material and Methods: A random subcohort of 4,000 age and sex with the study group. Patients in the studied
participants and 1,502 participants with fractures, includ- groups were subjected to a detailed assessment using SF-36
ing 202 spine fractures, were selected from the EPIC- questionnaire.
Norfolk prospective cohort study (39–77 years). Vitamin Results: Following analysis of SF-36 questionnaire re-
C intake from foods was estimated using a 7-day diet sults, according to patients responses, it was determined
diary and plasma levels with a fluorometric assay. Heel that the average physical activity performed by patients
broadband ultrasound attenuation (BUA) and velocity of with type 2 diabetes, such as the possibility of self-
sound (VOS) were determined with a CUBA Clinical service, walking distance 500 m, was 25.90±0.45, com-
Ultrasonometer (McCue Ultrasonics, UK) at 18-months pared to group II, which was 27.22 ± 0.26 (p < 0.05).
follow-up. After excluding those with incomplete data, Reduced working capacity and the difficulties arising
adjusted BUA and VOS were assessed by quintiles (Qs) in relation to it, led to an average of 6.87±0.13 on
of intake (n =2323) and plasma levels (n =2077) using the RP scale in patients with type 2 diabetes, compared
ANCOVA. Spinal fracture risk was calculated for intake to group II patients (8.93 ± 0.02) (p < 0.001). Somatic
(n=4142) and status (n=3643) using adjusted Cox pro- pain in group I patients showed a mean of 3.68±0.22,
portional hazard ratios (HRs). and 3.01±0.03 in group II (p<0.001). Worsening gen-
Results: The median follow-up was 12.6 years. VOS was eral health resulted in averages of 15.27±0.26 in group
significantly higher in Q4 (β 9.65 m/s, P=0.019) and Q5 (β I, and 23.67±1.27 in group II (p<0.001). Social activity
8.79 m/s, P=0.035) compared to Q1 of vitamin C intake in in group I patients showed averages of 6.03±0.13, and
men, and BUA in women (Q4 β 2.56 dB/MHz, P=0.041; Q5 7.68±0.05 in group II patients (p<0.001). Reduced activ-
β 4.06 dB/MHz, P=0.001). The association across all quin- ity and inattention in group I patients showed averages of
tiles of intake but not status was also significant (men VOS β 5.37±0.09, compared to group II (5.85±0.04). The state
2.47 m/s, P=0.008; women BUA β 0.81 dB/MHz, P=0.004). of anxiety and depression in patients with type 2 diabetes
Spinal fracture risk was not related to intake but those men in resulted in averages of 18.3±0.23, compared to group II
plasma Q4 had a significantly lower risk than Q1 (HR 0.26, patients (24.5±0.21) (p<0.001).
95%CI 0.10–0.69). Conclusion: Thus, we conclude that type 2 diabetes and
Conclusion: Higher vitamin C intake from foods is asso- its osteoarticular complications significantly affect the
ciated with higher heel ultrasound in men and women. patient’s physical and psychoemotional status, providing
Further work is needed to assess the preventive effects of a major contribution to the solitary physical and motor
vitamin C intake and status with spinal fracture risk. disorders.
Osteoporos Int

P131 Conclusion: The traditional comparison of pediatric BMD

INCLUSION OFANTHROPOMETRIC PARAMETERS and BMC data against age-, sex- and race-matched controls
IN THE CREATION OF REFERENCE CURVES FOR can be refined if anthropometric parameters are taken into
PEDIATRIC BONE MINERAL DENSITYAND BONE account.
MINERAL CONTENT: IMPACT ON References: 1Zemel BS et al., J Clin Endocrinol Metab
CLASSIFICATION OF BELOW-NORMAL 2011;96:3160. 2Zemel BS et al., J Clin Endocrinol Metab
INDIVIDUALS 2011;95:1265.
T. N. Hangartner1, D. F. Short1, V. Gilsanz2, H. J. Kalkwarf3,
J. M. Lappe4, S. Oberfield5, J. A. Shepherd6, B. S. Zemel7,
K. Winer8
1
Wright State University, Dayton, OH, United States, 2Chil- P132
dren’s Hospital Los Angeles, Los Angeles, CA, United States, OSTEOPOROSIS SCREENING AND MANAGEMENT
3
Cincinnati Children’s Hospital Medical Center, Cincinnati, IN OLDER FALLERS PRESENTING TO HOSPITAL:
OH, United States, 4Creighton University, Omaha, NE, Unit- PILOT EXPERIENCE WITH A DEDICATED
ed States, 5Columbia University, New York, NY, United GERONTOLOGY NURSE
States, 6University of California at San Francisco, San P. K. Shibu1, R. Visvanathan1, D. Hudson2
Francisco, CA, United States, 7Children’s Hospital of Phila- 1
Aged and Extended Care, Queen Elizabeth Hospital,
delphia, Philadelphia, PA, United States, 8Eunice Kennedy Adelaide University, Woodville, Adelaide, Australia,
2
Shriver National Institute of Child Health and Human Devel- Aged and Extended Care, Queen Elizabeth Hospital,
opment, Bethesda, MD, United States Woodville, Adelaide, Australia

Objective: To assess the implication of including anthropo- Objective: To evaluate effectiveness of a gerontology nurse in
metric variables in the creation of reference curves for areal osteoporosis screening and management in older hospital
BMD (aBMD) and bone mineral content (BMC) in pediatrics. fallers.
Material and Methods: Analysis of the DXA data collected Material and Methods: We conducted a prospective audit-
as part of the BMD in Childhood Study (2012 boys and girls, intervention-audit cycle based on standards of UK National
5–22 y old, 10,525 visits), resulting in aBMD and BMC Institute of Clinical Excellence guideline: “Osteoporosis:
observations at lumbar spine, hip, forearm and whole body. assessing the risk of fragility fracture”. A gerontology nurse
Multivariate statistics were used to rank order the independent audited current practice over 2 months on all eligible ortho-
variables age, sex, race, height, weight, percent body fat pedic, cardiology inpatients and falls clinic patients aged
(%fat) and sexual maturity. Two different models were created 65 years or older in our hospital in South Australia. She then
for each aBMD and BMC parameter, the practical model with did osteoporosis and fracture risk screening, facilitated inves-
age, sex, race, height and weight, and the full model, adding tigations, treatment and implemented an osteoporosis educa-
%fat. We compared the number of subjects that fell below 2 tion program during a 2 month intervention period on recruit-
standard deviations in our models with those below 2SD of ed patients. Evaluation for compliance was done telephoni-
the standard LMS model1, which is based on age, sex and cally at 2 months.
race, and of the height- adjusted Z-scores2. Results: 43 patients were audited pre-intervention and 30
Results: 50–82 % of subjects identified as below normal patients recruited post intervention. Both groups had compa-
(≤2 SD) based on the LMS model were not classified as rable baseline demographics and mean Charlsons comorbidity
below normal in our practical model. Using the full index. FRAX risk scoring was done in 30/30 patients post
model, misclassification increased for all aBMD and intervention compared to 3/43(p<0.001). Vit D and BMD
BMC parameters, ranging from 49 % to 92 %. Height- testing was done in 27/30(90 %) and 18/30(60 %) post inter-
adjusted Z-scores reduced misclassifications to 33–60 % vention compared to 22/43(51.1 %) and 5/43(11.6 %)
in comparison to the practical model and to 41–73 % in (p<0.001). Appropriate osteoporosis diagnosis was made in
comparison to the full model. For both models, misclas- 26/30(100 %) and antiresorptives started in 20/26(76.9 %)
sifications in comparison to the LMS model were worse post intervention compared to 22/43(62.8 %) and 16/
for BMC than aBMD. As BMC is more influenced by 35(45.7 %) (p<0.001). Osteoporosis diagnosis was conveyed
bone size than aBMD, inclusion of height and weight in to GP in 26/26(100 %) post intervention compared to 22/
the model reclassifies small subjects away from the low- 35(62.8 %) (p<0.001). Screening, clinical investigations, di-
er tail of the distribution, which is not done by the LMS agnosis, treatment and clinical handover was lower in the
model, which takes care of body size through the surrogate ward areas compared to the falls clinic but improved post
of age. intervention across all areas.2 month follow up demonstrated
 Osteoporos Int

good compliance with osteoporosis education and 90 % ad- P134

herence to antiresorptives. PROGRESSIVE INCREASES IN HIP BONE
Conclusion: This study confirms a major osteoporosis care MINERAL DENSITY (BMD) WITH DENOSUMAB
gap that can be improved with a gerontology nurse focusing TREATMENT COULD BE EXPLAINED BY
on osteoporosis management in older hospital fallers. CONTINUOUS MODELING-BASED BONE
Disclosures: The investigator initiated study was supported FORMATION
by an educational grant from Novartis Inc. C. Libanati1, M. S. Ominsky1, R. W. Boyce1, P. Kostenuik1,
R. Baron2, R. B. Wagman1, D. Dempster3
1
Amgen Inc., Thousand Oaks, CA, United States, 2Harvard
School of Medicine and of Dental Medicine, Cambridge,
P133 United States, 3Columbia University, New York, United
EFFECTIVENESS OF TREATMENT OF States
POSTMENOPAUSAL OSTEOPOROSIS PATIENTS
AND RHEUMATOID ARTHRITIS PATIENTS WITH Objective: DMAb is associated with progressive BMD
IBANDRONIC ACID increases with long-term administration up to 8 years
M. Ivanova1 despite persistently low bone turnover and evidence of
1
Ministry of Interior Medical Institute MVR, Sofia, Bulgaria limited iliac crest tetracycline labeling.1 To test whether
these BMD increases result from a non-remodeling de-
Objective: The osteoporosis is concomitant disease for rheu- pendent mechanism to accrue bone matrix, we examined
matoid arthritis patients and occurs in postmenstrual period. A fluorochrome labeling in proximal femur from ovariec-
comparative 12 month research about effectiveness of tomized (OVX) cynomolgus monkeys (cynos) treated
ibandronic acid tablets, 150 mg per month was performed in with DMAb for 16 months (mo).
which participated 62 patients with postmenopausal osteopo- Material and Methods: Following OVX, mature 9+-year-old
rosis or rheumatoid arthritis. cynos were treated for 16 mo with vehicle (n = 20) or
Material and Methods: The patients were divided in two 25 mg/kg/month DmAb (n=14). Fluorochrome labels were
groups: group A consists of 34 postmenopausal women with administered at 6, 12 and 16 month.
osteoporosis and group B of 28 women with rheumatoid Results: Despite very low bone resorption and forma-
arthritis and secondary osteoporosis. The bone density of the tion indices histologically and by markers,2 DXA fe-
lumbar spine is measured before the treatment with ibandronic mur neck BMD with DmAb further increased from
acid and 1 year after that. The patients have taken ibandronic 5.9 % at 6 month to 11.3 % over baseline at 16 month.
acid tablets, 150 mg per month for 1 year. They all have taken Proximal femur sections confirmed the low surface
calcium supplement 1200 and vitamin D3, 1 μg daily. Inclu- extent of label in the trabecular compartment. However,
sion criteria: postmenopausal osteoporosis patients and rheu- there was consistent and prominent labeling in the
matoid arthritis patients for whom the arthritis occurred at cortex, primarily on the superior endocortex (12/14
least 2 years before. Exclusion criteria: patients with endo- cynos) and inferior periosteal surface (11/14 cynos).
crine disease and secondary osteoporosis, women with early These regions typically contained all 3 superimposed
surgical menopause. labels over smooth cement lines, spanning 6 to
Results: Baseline characteristics were similar between the 16 month, suggesting that modeling-based bone forma-
groups in terms of age 63.6±4.2 years. In the beginning the tion progressed continuously during DmAb administra-
BMD of lumbar spine was L1-L4 T-score (−2.56±1.32) for tion. Persistent modeling on a background of maximal
group A patients and L1-L4 T-score (−2.61±1.24) for group B suppression of remodeling could explain continued
patients. After 1 year of treatment the results are the BMD of BMD and mass increases with DmAb in the cortical
lumbar spine for group A is L1-L4 T-score (−1.86±0.24), and compartment at the hip, already suggested by increased
for group B is L1-L4 T-score (−2.15±0.42). Comparing the mass and thickness in QCT images in clinical studies.
obtained values a very significant statistical difference Importantly this augmentation of bone mass occurred at
(p>0.001) was noticed. biomechanically relevant sites on the superior and in-
Conclusion: The effectiveness of treatment with ibandronic ferior aspects of the femur neck, and corresponded to
acid of rheumatoid arthritis patients is lower than the effec- bone strength increases.3
tiveness of treatment of postmenopausal osteoporosis patients Conclusion: In cynos, continual modeling-based bone forma-
under all other equal conditions and without concordant dis- tion occurs during DmAb therapy. This is the first histological
eases lowering the BMD being present. Lower increase of the evidence of a potential mechanism for the clinical observa-
BMD was measured for rheumatoid arthritis patients com- tions of progressive BMD increases with long-term DmAb at
pared to postmenstrual osteoporosis patients. the hip.
Osteoporos Int

References: 1 Papapoulos 2013, 2 Kostenuik 2011, 3 Ominsky Conclusion: With DMAb treatment, hip vBMD, cortical
2011 thickness and mass, and resulting strength increased
Disclosures: Amgen/GSK regardless of age (</≥75). Measured cortical parameters
decreased in Pbo-treated women ≥75. Significant im-
provements in cortical bone parameters in women ≥75
P135 with DMAb vs. Pbo and, perhaps more importantly, vs.
CLINICAL RELEVANCE OF CHANGES IN HIP BL may be particularly relevant as they occur when
CORTICAL BONE PARAMETERS IN RESPONSE TO cortical bone is deteriorating and fracture risk is expo-
DENOSUMAB (DMAB) VS. PLACEBO (PBO) IN nentially increasing. DMAb’s positive effect on cortical
POSTMENOPAUSALWOMEN WITH bone may be a vital factor to reduce hip fractures in
OSTEOPOROSIS <75 AND ≥75 YEARS OLD women at greatest fracture risk.
H. K. Genant1, T. M. Keaveny2, C. Zapalowski3, K. Engelke4, Disclosures: Amgen/GSK
T. Fuerst5, D. L. Kendler6, C. Recknor7, S. Boonen8, A.
Wang9, P. Dakin9, C. Libanati9, M. R. Mcclung10
1
USCF & Synarc Inc, San Francisco, United States, 2UC P136
Berkeley and O.N. Diagnostics, Berkeley, United States, SECONDARY OSTEOARTHRITIS OF HIPS BY
3
Amgen In, Thousand Oaks, United States, 4Synarc, ACHONDROPLASIA: CASE REPORT
Erlangen, Germany, 5 Synarc, San Francisco, United G. Chiriti1, D. M. Dimulescu1, G. Mologhianu1
States, 6 University of British Columbia, Vancouver, 1
Medical Rehabilitation, University of Medicine and Pharmacy
Canada, 7United Osteoporosis Centers, Gainesville, United Carol Davila, Bucharest, Romania
States, 8Leuven University, Leuven, Belgium, 9Amgen Inc.,
Thousand Oaks, CA, United States, 10Oregon Osteoporosis Objective: Skeletal dysplasia represents a heterogeneous
Center, Portland, United States group of diseases, characterised by abnormalities of growth
and remodeling of the cartilage and bone, affecting the
Objective: Cortical bone deterioration is an important con- skull, spine and extremities, in varying degrees; achon-
tributor to the exponential increase in fracture risk in older droplasia is the most common dwarfing condition hav-
women. Treatment efficacy data in such women are lacking. ing a prevalence of 1/25000 live births. The purpose of
In FREEDOM, DMAb treatment improved both cortical and this case report was to assess the role of a complex
trabecular bone compartments, with significant gains in hip program which include physical and kinetics rehabilita-
volumetric BMD (vBMD), cortical thickness and mass, and tion treatment for a patient with secondary osteoarthritis
total hip strength. DMAb also robustly reduced hip fracture of hips by achondroplasia.
risk in older postmenopausal women with osteoporosis. To Material and Methods: We present the case of a female
further explore these associations, we evaluated DMAb’s (42 years), hospitalised for gait disorders, mechanical pain
effects on hip cortical bone parameters in women of the thoracolumbar spine, hips and knees. Clinical find-
<75/≥75 years old. ings: thoracic lumbar kyphosis, lumbar hyperlordosis, hip
Material and Methods: In FREEDOM, women received flexum bilateral, genu revurvatum bilateral, deficit at the
DMAb 60 mg or Pbo Q6M for 36 months (mo) and daily level of the elbow extension (20°); height of this patient:
calcium/vitamin D. Hip QCT scans were obtained at baseline 120 cm. Radiologic findings: degenerative changes of the
(BL) and 12, 24 and 36 month in a subset of women. Scans thoracic-lumbar spine, osteoarthritis of hips developed
were analysed in a blinded-to-treatment manner to measure lesions. The lumbar MRI examination: lumbar canal ste-
hip vBMD using MIAF, hip cortical thickness and mass using nosis. The complex program of rehabilitation utilised
Bone Mapping, and hip strength using FEA. Analyses includ- pharmacological treatment; electrotherapy with antalgic
ed subjects with observed data at BL and 36 month (n=36 and myorelaxant effect; sedative massage for the
DMAb; n=26 Pbo). dorsolumbar spine; kinetotherapy for improvement of
Results: In women <75 (n=40) and ≥75 (n=22), DMAb the gait.
resulted in similar and significant increases in hip Results: Physical and kinetics rehabilitation treatment im-
vBMD and cortical thickness and mass vs. both BL proved pain - VAS score was reduced from 10 points to 7
and Pbo at 36 mo (p<0.02), associated with significant points; the score of Tinetti Gait Scale has improved from 6
increases in hip integral and cortical strength vs. BL in points to 9 points; ADL score improved from 40 points to 35
both age groups (p<0.02). Losses in measured parame- points.
ters of hip cortical bone were observed in Pbo-treated Conclusion: Clinical and functional indices (pain, disability,
women ≥75, in whom hip fracture risk is known to gait parameters) has improved by physical and kinetics
exponentially increase. treatment.
 Osteoporos Int

References: Bombelli R, Structure and function in normal P138

and abnormal hips, Springer, Berlin, 1993. ANALYSIS AND EVALUATION OF RISK OF FALLING
Winn J et al, Am J Med Genet A 2007;143:2502. IN POSTMENOPAUSAL WOMEN WITH
OSTEOPOROSIS
K. Lin1, H. Li2, X. Zhu2, H. Lin2
1
Washington University School of Medicine, St. Louis, Unit-
P137 ed States, 2Center of Bone Metabolic Diseases, Nanjing Drum
SECONDARY OSTEOARTHRITIS OF HIP Tower Hospital, Nanjing, China
ASSOCIATED WITH CERVICAL AND LUMBAR
DEGENERATIVE DISC: CASE REPORT Objective: To study the relationship between osteoporosis
D. M. Dimulescu1, G. Chiriti1 and the risk of falling in postmenopausal women.
1
Medical Rehabilitation, University of Medicine and Pharmacy Material and Methods: 104 cases of postmenopausal wom-
Carol Davila, Bucharest, Romania en over 60, who take out-patient examination or treatment in
our hospital, were divided into two groups by BMD results:
Objective: The purpose of this case report was to 53 postmenopausal women with osteoporosis and 51 post-
assess the role of a complex program which include menopausal women without osteoporosis. The age, height and
physical and kinetics rehabilitation treatment for a body weight were not significantly different, while a balanced
patient with secondary osteoarthritis of hips produced examination was informed to get the risk of falling index.
by dysplasia, associated with cervical and lumbar Results: There is difference between two groups. The risk of
degenerative disc. falling index of osteoporosis group (49.8±3.938) was higher
Material and Methods: We present the case of a 67 years old than nonosteoporosis group (38.16 ± 2.916) (t = 2.376,
patient, hospitalised in our clinic for gait disturbances; P ≤ 0.05).
mechanical pain at the cervicolumbar spine and for Conclusion: Postmenopausal women with osteoporosis are
more likely to fall than non-osteoporosis women, which leads
permanent pain in the lower limbs joints. In clinical-
to the risk of osteoporotic fracture increased. Postmenopausal
functional assessing of the patient we found vertebral
women with osteoporosis should pay more attention to bal-
static syndrome and vertebral dynamic syndrome in-
ance training and prevent osteoporotic fractures caused by the
tensely modified; at the hips: articular evaluation-
occurrence of falls.
flexion=70°, extension=0°, abduction=adduction=15°, in-
ternal rotation=external rotation=0°; muscular testing-
gluteus maximus and medius 3, ilio-psoas 3-, quadriceps
P139
3-, hamstrings muscles 3. Difficult walk with bilateral
AUDIT ON KNEE PAIN IN ACUTE REHABILITATION
Trendelenburg, with support in walking frame. The
W. F. Lim1, A. Stone1
complex program of rehabilitation utilised: pharmaco- 1
Derriford Hospital, Plymouth, United Kingdom
logical treatment; electrotherapy; massage; kinetotherapy
for improvement the paravertebral muscles flexibility Objective:
and hamstrings muscles, strengthening the abdominal
muscles, gluteus muscles, quadriceps; improvement of & Ascertain knee pain prevalence in an elderly population in
the walk using a Canadian crutch. Plymouth, United Kingdom
Results: VAS score was reduced from 12 points to 9 points; & Aggressive pain relief escalation with intra-articular
the score of Tinetti Gait Scale has improved from 5 points to 8 steroid and local anaesthetic when simple analgesia
points; moving capacity has increased, making possible walk (paracetamol, topical NSAIDS1) not effective
out of the house, with limits; ADL score got after the rehabil- & Knee aspiration and lab analysis of synovial fluid
itation program a slight improvement from 42 points to 36 & Allow patients with knee pain to rehabilitate less
points. painfully
Conclusion: The rehabilitation program improved clini-
cal and functional indices (pain, disability, gait parame- Material and Methods:
ters), without a significant influence on myoarticular
testing. & Consecutive patients admitted to ward over 4 months were
References: Bombelli R, Structure and function in normal asked if they had knee pain
and abnormal hips, Springer, Berlin, 1993. & VAS for pain (VASP) were obtained (0–10) and timed up
Sbenghe T, Kinesiology-Movement Science, Medical and go test (TUAG) was performed by physiotherapist
Publishing House, Bucharest, 2005. & Simple analgesia offered
Osteoporos Int

& Subsequently, second cohort of consecutive patients admit- plays a role in bone metabolism. However, although the
ted to ward over 5 months were asked if they had knee pain association of IL-17 has been extensively studied in
& VASP and TUAG done osteoclast-mediated bone resorption, the role during
& Simple analgesia given osteoblast-mediated bone formation has rarely been explored.
& Patients with pain despite simple analgesia were offered Material and Methods: For in vitro evaluation of osteogen-
knee aspiration and injection with steroids (80 mg esis, rat calvarial osteoblast precursor cells were cultured for
traimcinolone) and local anaesthetic (5 ml 1 % lidocaine)2,3 14 days in osteogenic media in the presence or absence
& Knee aspiration attempt done; any synovial fluid tapped of 100 ng/ml IL-17. The osteogenic activities were ob-
was sent to the laboratory for microscopy served by alkaline phosphatase staining and alizarin red
& After 48 h, VASP and TUAG was repeated staining. The mRNA expression of alkaline phosphatase,
osteocalcin, and osterix was also measured using real-
Results: time PCR. To further test whether IL-17 affects bone
formation in vivo, bone filling was examined by μCT
& Cohort 1 had 227 consecutive patients. 6 %(14) had knee and histological observation at 8 weeks after critical
pain. Mean TUAG=82 second(s), VASP=7.0 sized defects were made on rat calvaria.
& Cohort 2 had 382 consecutive patients. 8 %(34) had knee Results: IL-17 significantly reduced the expression of
pain not improved by simple analgesia. Mean TUAG= alkaline phosphatase, osteocalcin, and osterix as well as
91.7 s, VASP=7.0 alkaline phosphatase and alizarin red staining in vitro.
& 48 hours after injection, mean TUAG=53.5 s (p<0.001), IL-17 also significantly inhibited the filling of calvarial
VASP=2.2 (p<0.001) 27 %(9) defects in vivo.
& aspirates show crystal arthropathy [18 %(6) pseudo gout, Conclusion: The negative effect of IL-17 on bone formation
9 %(3) gout], 15 %(5) pus cells, 15 %(5) no pus cells, no in a rat model may suggest a species-specific role of IL-17 on
growth, 39 %(11) dry tap and 3 %(1) not sent osteogenesis.
Acknowledgements: This work was supported by Biomedi-
Conclusion: cal Research Institute grant, Kyungpook National University
Hospital 2013.
& Knee pain prevalence in Plymouth acute care of the elder-
ly ward is 6–8 %
& Pain significantly decreased by intra-articular steroid and
local anaesthetic injection; enabling faster TUAG P141
& There is underdiagnosis of crystal arthropathy in the DIAGNOSIS OF BONE LOSS IN WOMEN OF
Plymouth elderly cohort DIFFERENT AGES BY QUANTITATIVE COMPUTED
TOMOGRAPHY
References: I. S. Zakharov1, G. I. Kolpinskiy1, G. A. Ushakova1, A. S.
1. NICE guidance OA knee (CG59) Shkaraburov2
1
2. Age Ageing 2013;42:151 Kemerovo State Medical Academy, Kemerovo, Russian Fed-
3. Cochrane Database of Systematic Reviews, 2006: 2 eration, 2Clinical Consultative and Diagnostic Centre, Keme-
“Intra-articular corticosteroid for treatment of osteoar- rovo, Russian Federation
thritis of the knee”
Objective: Osteoporosis is an important health problem due
to the high prevalence and the risk of complications arising.
P140 This disease is characterized by decreased bone mass, de-
IL-17 INHIBITS RAT OSTEOGENESIS BOTH IN creased bone strength and high risk for fracture. Diagnostic
VITRO AND IN VIVO sign of osteoporosis is a decrease in BMD [1,2], which begins
Y. G. Kim1, Y. Lee2 with the reduction of trabecular bone. In this regard, the
1
Department of Periodontology, School of Dentistry, definition of BMD in women of different ages by QCT is
Kyungpook National University, Daegu, Republic of Korea, relevant and will assist in the prediction and early diagnosis of
2
Department of Biochemistry, School of Dentistry, bone loss.
Kyungpook National University, Daegu, Republic of Korea Material and Methods: Kemerovo State Medical Academy
and Clinical Consultation and Diagnostic Center conducted a
Objective: Interleukin-17 (IL-17) is a set of proinflammatory study of BMD by QCT in women of different age groups.
cytokines produced by a subset of helper T cells. IL-17 is not Area of diagnostic interest were II-IV lumbar vertebrae (L2-
only involved in the immune response of the tissue but also L4). Investigated the trabecular and cortical parts of the
 Osteoporos Int

vertebrae. BMD was expressed in mgCa-HA/ml. The study 1.07–4.74; p=0.033) while obese-group BMI was the protec-
involved 145 women aged over 20 years. tive factor (OR 0.22; 95%CI 0.09–0.55; p=0.001). Subgroup
Results: Based on this study following data were obtained. In analysis of abnormal BMD at spine showed that advanced age
the I- th group (at the age of 20–29 years) total trabecular bone was also the significant risk factor (OR 2.32; 95%CI 1.1–4.87;
BMD L2, L3 and L4, respectively, was: 165.5, 168.5 and p=0.027).
182.6 mgCa-HA/ml. Conclusion: The prevalence of osteoporosis and
In the II- th group (at the age of 30–39 years): 153.4; 154.8 osteopenia are high in elderly female. Obese group has
and 160.8 mgCa-HA/ml. In the III- th group (at the age of 40– the benefit over the bone mass density and the major
49 years): 137.4, 134.9 and 139.0 mgCa-HA/ml. In the IV- th risk factor for low bone density is advanced age. Early
group (over 50 years): 109.9, 105.9 and 111.8 mgCa-HA/ml. screening and detection of low bone density will pro-
Conclusion: According to the results of densitometry carried mote development and testing of medical interventions
out by QCT revealed that the women surveyed moderate focusing on at-risk adults and will bolster effective
decrease in BMD occurs at the age of 30–39 years, a signif- osteoporosis preventive behaviors.
icant loss observed after 40 years of age (p<0.05).
References: 1. Official Positions of the International Society
for Clinical Densitometry, October 2007, supersedes all prior P143
«Official Positions» publications. ASSOCIATIONS OF GAMMA-GLUTAMYLTRAN
2. WHO Study Group “Assessment of fracture risk and its SFERASE ACTIVITY WITH BONE METABOLISM IN
application to screening for postmenopausal osteoporosis”, PATIENTS WITH HIP FRACTURE:
Geneva, Switzerland: World Health Organization, 1994. PATHOPHYSIOLOGICAL AND CLINICAL ASPECTS
A. Fisher1
1
Departments of Geriatric Medicine and Orthopaedic Surgery,
P142 Australian National University Medical School & Canberra
RISK FACTORS OF OSTEOPENIA IN THE ELDERLY Hospital, Canberra, Australia
FEMALE PATIENTS OF GERIATRIC CLINIC,
BANGKOK HOSPITAL IN 2013 Objective: To examine the relationship between serum γ-
T. Chokkatiwat1, P. Wattanapanom1 glutamyltransferase (GGT) activity and parameters of
1
Bangkok Hospital, Bangkok, Thailand mineral and bone metabolism and its prognostic value
for short-term outcomes in patients with osteoporotic
Objective: To study the prevalence and risk factors of hip fracture (HF).
osteopenia in the elderly female patients attending Geriatric Material and Methods: In 761 HF patients (mean age 82.3±
Clinic, Bangkok Hospital during January to June 2013. 8.8 years, 75 % women) serum levels of GGT and other liver
Material and Methods: We searched for the medical records markers, 25(OH)vitamin D, PTH, calcium, phosphate, mag-
of all elderly female patients who visited the clinic and nesium, parameters of bone formation (osteocalcin, OC, and
underwent BMD measurement during January to June 2013. bone specific alkaline phosphatase, BAP) and bone resorption
The baseline characteristics including personal history, (urinary N- terminal telopeptide of type 1 collagen corrected
medications and laboratory parameters were collected. for creatinine, NTx/Cr), adiponectin, leptin, resistin, vitamin
The BMD was measured by DXA at the hip and B12, folic acid, markers of iron metabolism and thyroid
lumbar spine. The data were analyzed using SPSS function were measured and clinical characteristics recorded.
version 19.0. Results: GGT was elevated (>128 U/L) in 7.5 % of patients.
Results: Of 116 patients, the prevalence of osteopenia and GGT was significantly and negatively associated with age (r=
osteoporosis were 50.9 % and 12.9 %, respectively. The −0.198, p=0.001), OC (r=−0.206; p<0.001), NTx/Cr (r=
prevalence of osteopenia at hip was 44.3 %, compared with −0.179; p=0.004), thyroxine (T4, r=−0.185; p=0.002), and
38.8 % at lumbar spine. Obese patients (69 % vs. 36.1 % in positively with alanine aminotransferase (ALT, r=0.371;
normal BMD and abnormal BMD groups respectively; p= p<0.001), BAP (r=0.302; p<0.001), TSH (r=0.116; p=
0003), alcohol consumption (9.5 % vs. 1.4 %; p=0.037) were 0.050), and vitamin B12 (r=0.224; p<0.001). In multivariate
associated with a lower risk of abnormal BMD in a univariate. logistic regression after adjustment for age, sex, markers of
In logistic regression analysis, the protective factors of abnor- liver function, mineral and bone metabolism, adipokines,
mal BMD were obese-group BMI (BMI>30), (odds ratio alcohol consumption, diabetes and cardiovascular disease,
[OR] 0.16; 95%CI 0.05–0.47; p=0.001) and alcohol con- OC (p=0.006), NTx/Cr (p=0.007), adiponectin (p=0.034),
sumption (OR 0.07; 95%CI 0.01–0.78; p=0.03). Subgroup ALT (p=0.002) and age (p<0.001) were independent and
analysis of abnormal BMD at hip showed that the significant significant determinants of serum GGT activity. Higher GGT
risk factor was advanced age (>65 years) (OR 2.25; 95%CI levels (>30 U/L) were prevalent in men (OR=1.9, p=0.016),
Osteoporos Int

patients with diabetes (OR = 2.2, p = 0.013), and alcohol P145

overusers (≥3 times a week, OR = 6.4, p = 0.002). GGT COMPLIANCE BETWEEN THE NEED FOR
>30 U/L on admission was an independent predictor of TREATMENT OF OSTEOPOROSIS AND
prolonged hospital stay (>20 days, OR=2.0, p=0.019). RECOMMENDATIONS FOR TREATMENT IN REAL
Conclusion: In patients with HF serum GGT levels (within CLINICAL PRACTICE IN PATIENTS WITH
the physiological range) and parameters of bone remodelling RHEUMATOID ARTHRITIS (RA) IN RUSSIAN
are significantly associated. Higher GGT levels were predic- FEDERATION
tive for prolonged hospital stay. I. Dydykina1, E. Vetkova1, M. Podvorotova1, E. Taskina1, A.
Smirnov1, A. Sinenko2, T. Ruskina3, D. Peshekhonov4, S.
Myasoedova5, B. Zavodovski6, P. Dydykina1, E. Petrova1,
V. Zhigulin1, L. Alekseeva1, E. Nasonov1
1
P144 Research Institute for Rheumatology RAMS, Moscow, Rus-
HYDROLYZED COLLAGEN PROMOTES sian Federation, 2Regional Clinical Hospital of Vladivostok,
OSTEOBLASTOGENESIS AND PRESERVES BONE Vladivostok, Russian Federation, 3Medical University, Keme-
MASS IN OVARIECTMIZED MICE rovo State Medical Institute, Russian Ministry of Health,
A. Daneault1, V. Coxam1, V. Fabien Soulé2, Y. Wittrant1 Kemerovo, Russian Federation, 4 Medical University
1
INRA, Theix, France, 2Rousselot, Courbevoie, France Voronezh State Medical Academy Burdenko, Voronezh,
Russian Federation, 5Medical University, Ivanovo State
Objective: Collagen I is the main component of organic bone Medical Academy, Ministry of Health, Ivanovo, Russian
matrix. Its correct synthesis, folding and degradation are cru- Federation, 6Research Experimental Institute of Rheuma-
cial for bone homeostasis. According to this pivotal role in tology, Russian Academy of Medical Sciences, Volgograd,
bone structure, we investigated the potential health benefits of Russian Federation
hydrolyzed collagen (HC) on bone using translational
approaches. Objective: Fractures, which arise in consequence of general-
Material and Methods: Translational approaches: from cell ized bone loss in RA, often lead to disability and death in
culture to preclinical trial. patients. Timely made recommendation for the treatment of
Results: Regarding the influence of HC on bone forming osteoporosis (OP) is an important aspect of clinical practice.
cells in vitro, we first insured the absence of cytotoxicity of We studied the compliance between the need for treatment of
HC addition in culture media. As compared to BSA control OP and recommendations for treatment in clinical practice in
conditions, HC even promoted pre-osteoblast proliferation. patients with RA.
Then cells were tested for differentiation parameters in the Material and Methods: Inside of the cross-sectional retro-
presence of HC. HC from bovine origin resulted in a spective study of a large cohort of patients with RA from 12
significantly higher alkaline phosphatase activity after clinical centers in Russian Federation, 296 patients aged 41–
7 days of incubation when compared to its BSA control 89 years were selected. The threshold of therapeutic interven-
condition. This observation was supported by mineraliza- tion was defined by FRAX and by our predictive model,
tion assays demonstrating that bovine HC enhanced Ca/P which has been designed upon the basis of the statistical
nodule formation in MC3T3-E1 cultures. To confirm these analysis of a wide range of clinical parameters to identify
encouraging results, C3H/HeN mice were ovariectomized patients with RA with high risk of low-traumatic
(OVX) to induce bone loss and were given, in parallel, HC fractures.
enriched diets to determine whether HC intake may con- Results: 262 (89 %) women and 34 (11 %) men were included
tribute to bone health by preventing decrease in BMD upon the study. Women’s average age was 64.2 yo, men’s was
OVX. Diets were designed to contain 15 % casein, 17.5 % 65.1 yo. OP was diagnosed in 22 % patients, 15 % patients
casein or 15 % casein plus 2.5 % HC from bovine origin. had a history of low-traumatic fractures. 111 (38 %) patients
As expected, OVX induced a dramatic loss of BMD. had indications for the treatment defined by FRAX, and 94
However, HC fed OVX mice exhibited a significant higher (31 %) patients had by model for patients with RA. In the
BMD than OVX control mice, thus validating a protective clinical practice the treatment for osteoporosis was recom-
effect of HC on bone health. mended 27 % and 24 % patients, respectively. 185 (62 %)
Conclusion: Finally, from an integrated point of view, patients didn’t have the indications for the treatment defined
our results further support the relevance of HC-based by FRAX, and 202 (68 %) did not have indications for the
nutritional strategies in the management of osteoporosis treatment defined by model, however, in the clinical practice
prevention. the treatment was recommended 22 % and 24 % patients,
Disclosures: This work was partly funded by Rousselot SAS, respectively. 71 (24 %) patients received recommendation
Courbevoie, France. for the treatment of OP. Adherence of the therapy was 69 %.
 Osteoporos Int

Conclusion: Detected incompliance between the need for from 5 to 25 % in noncomparative, small cohort stud-
the treatment of OP in patients with RA and recommen- ies. We aim to compare the prevalence of TSS and its
dation for the treatment in clinical practice, while ad- risk factors of development in a large multiracial Asian
herence of the therapy was high. Introduction of FRAX population.
or predictive model for allocation of group of patients Material and Methods: Retrospective review of midsagittal
with RA with a high risk of fracture in the clinical MRI spine images at a University hospital in 1 year. Spinal
practice will contribute to a personalized approach to stenosis was defined as canal diameter of ≤10 mm, measured
the treatment prescription. from the posterior cervical vertebra/disc wall to anterior
surface of the corresponding lamina. Patients were divid-
ed into four groups, no stenosis, lumbar stenosis only,
P146 cervical stenosis only and TSS. Patients’ demographics,
QUANTITATIVE ULTRASOUND MEASUREMENTS race, comorbidities and lumbar radiological report data
OF STIFFNESS INDEX IN YOUNG ADULT FEMALES were examined.
L. F. Hammad1 Results: 926(479♂,447♀) patients with average age 50(20–
1
Department of Radiological Science, College of Applied 96)yrs were studied. Cervical canal diameters in TSS patients
Medical Sciences King Saud University, Riyadh, Saudi were the narrowest among the 4groups with C2/3 disc: 11.6,
Arabia C3/4:9.7, C4/5:9.4, C5/6:8.9, C6/7:10.0 and C7T1:11.4 mm.
The incidence of TSS was 26.2 %. The prevalence of TSS in
Objective: The aim of the study was to investigate the use of Chinese was 30.7 %, Indian 12.5 %, Malay 22.5 %. The TSS
quantitative ultrasound (QUS) in the young (20–25 years) prevalence in patients with 1 level lumbar canal stenosis was
Saudi females to obtain stiffness index values related to bone 12.5 %, 2 levels 6.4 % and 3 levels 4.1 %. Multivariate
quality. analysis showed patients aged 40–59 year (p = 0.000,
Material and Methods: In 101 young females recruited, Exp(B):5.8, 95%CI 2.8–12.0), aged >60 year (p=0.000,
QUS measurements were performed in the calcaneus region. Exp(B): 10.5, 95%CI 4.8–22.9), Chinese race (p=0.008,
Measurements were made using Lunar Achilles Insight TM - Exp(B): 2.5, 95%CI 1.3–4.9), patients with 1 level lumbar
GE Healthcare which is a heel water bath ultrasound system. stenosis (p=0.000, Exp(B): 63.3, 95%CI 29.2–137.3), 2
Stiffness index (automatically calculated from broadband ul- levels lumbar stenosis (p = 0.000, Exp(B): 67.7, 95%CI
trasound attenuation and the speed of sound), T-score and Z- 29.4–155.7) and 3 levels lumbar stenosis (p=0.000, Exp(B):
score were recorded using a standard protocol supplied by the 106.6, 95%CI 43.6–260.5) are significant risk factors for TSS
manufacturer. development.
Results: 33 % and 3 % had osteopenia and osteoporosis in the Conclusion: TSS is a highly prevalent condition with patients
calcaneus, respectively, stiffness index values=81.52 and having the narrowest cervical canal measurements. The prev-
54.33, respectively. Of the 101 subjects, 65 young females alence of TSS in Chinese is the highest. Patients of advanced
did not suffer from osteopenia in that region with a mean age or increased levels of lumbar canal stenosis are at risk of
stiffness index=100.95. A strong association between Stiff- developing TSS.
ness index with weight was found but not with height.
Conclusion: We found that more than a third of the young
Saudi females sampled suffered from osteopenia in the calca- P148
neus region; body weight had a positive relationship with AGE-RELATED CHANGES IN BONE QUALITY
stiffness index. USING DXA AND HR-PQCT: A FIVE-YEAR
LONGITUDINAL STUDY OF THE CALGARY
POPULATION-BASED COHORT
P147 D. A. Hanley1, L. A. Burt2, A. L. Ménard3, H. M. Macdonald4,
TANDEM SPINAL STENOSIS: A 926 MULTIRACIAL S. K. Boyd2
1
ASIAN PATIENTS’ PREVALENCE AND RISK CaMos Centre Director, Departments of Medicine, Commu-
FACTORS ANALYSIS nity Health Sciences, and Oncology, University of Calgary,
W. L. B. Tan1, G. Liu1, H. K. Wong1 Calgary, Canada, 2Department of Radiology, Faculty of Med-
1
National University Hospital, Singapore, Singapore icine, McCaig Institute for Bone and Joint Health, University
of Calgary, Calgary, Canada, 3Department of Mechanical
Objective: Spinal stenosis is regarded as a consequence of Engineering, Ecole Polytechnique of Montréal, CHU Ste-
degenerative osteoarthritis of the spine. Tandem spinal steno- Justine Research Center, Montréal, Canada, 4Department of
sis (TSS) is defined as concomitant spinal canal stenosis in Orthopaedics, Child & Family Research Institute, University
both cervical & lumbar spines. The incidence of TSS ranges of British Columbia, Gurgaon, India
Osteoporos Int

Objective: Age-related bone loss measured by DXA occurs at in Asian female atypical femoral fracture (AFF) patients
a rate of 1 % per year, but the age at which bone loss occurs and compare them with sex and age-matched controls.
varies with skeletal site and imaging modality. Age-related Material and Methods: Thirty-one Asian female AFF pa-
bone loss measured with HR-pQCT may differ from DXA. tients were sex and age- matched to 31 femoral neck (NOF)
We compared subject-specific longitudinal age-related bone and 31 intertrochanteric (IT) fracture patients. The parameters
changes at different skeletal sites using two imaging were generated from Thomas Beck's Hip Structural Analysis
modalities. (HSA) program, which interprets DXA data into engineering
Material and Methods: Women (N=135, 60+ yrs) from the metrics. The parameters analyzed were BMD, cross-sectional
Calgary cohort of the Canadian Multicentre Osteoporosis area (CSA), cross-sectional moment of inertia (CSMI), section
Study (CaMos) participated in a 5-year follow-up study. Areal modulus (SM), average cortical thickness (ACT), and buck-
BMD (aBMD) at the femoral neck (FN) and total hip (TH) ling ratio (BR). The regions analyzed by HSA comprised of
were obtained from DXA (Hologic) scans (left hip). The three cross-sections measured at the narrowest diameter of the
nondominant radius and left tibia were scanned using femoral neck (NN), the intertrochanteric area (IT), and the
HR-pQCT (Scanco Medical). Total volumetric BMD proximal femoral shaft (FS). A 2-sample t-test was used to
(Tt.BMD), cortical BMD (Ct.BMD), trabecular BMD compare HSA parameters in the AFF group (n=31) with the
(Tb.BMD) and cortical porosity (Ct.Po) were assessed control group (n=62), with statistical significance defined as
using standard and automated segmentation methods. p<0.05.
Finite element analysis (FEA) estimated apparent bone Results: AFF patients had significantly greater BMD, CSA,
strength. Repeated measures ANOVA and T-tests assessed and ACT and lower BR at all three measured regions com-
change over time. pared to sex and age-matched NOF and IT fractures. Femoral
Results: Results are expressed as percentage change per year shaft section modulus was not significantly greater in AFF
from 5-year data. DXA-derived aBMD decreased between patients than controls.
0.8 % (FN) and 1.0 % (TH) whereas HR-pQCT- derived Conclusion: AFF patients have better metrics of bone
Tt.BMD declined between 0.5 % (tibia) and 1.5 % (radius) mineral mass and hip structural geometry at the NN and
(p<0.05). At the radius, Tb.BMD decreased 1.2 % and IT regions compared to sex and age-matched controls.
Ct.BMD 0.7 % (p<0.01). At the tibia Tb.BMD did not change These metrics support why AFF patients do not fracture
(p>0.05) and Ct.BMD decreased by 0.9 % (p<0.01). The at the NN or IT regions and are consistent with changes
greatest change was in Ct.Po, which increased by observed with prolonged bisphosphonate exposure. AFF
10.3 % at the radius and 6.5 % at the tibia (p<0.01). patients have better bone mineral mass, but not hip struc-
FEA results revealed a 0.6 % annual loss in radial bone tural geometry, at the femoral shaft, which is contrary to
strength (p<0.05). improvements at the FS region frequently observed with
Conclusion: Our 5-year longitudinal study of women 60+ yrs prolonged bisphosphonate exposure. Further research is
revealed that age- related changes differ according to imaging needed to clarify the difference in femoral shaft section
modality and skeletal site: more bone loss occurred at the modulus between AFF patients and patients with
radius than tibia. Whether this holds true for men will be the prolonged bisphosphonate exposure.
subject of our continued study, and we will further explore the
use of HR-pQCT and FEA to relate these changes to fracture
risk.
P150
12-MONTH PERSISTENCE WITH DENOSUMAB
(DMAB) IN WOMEN WITH POSTMENOPAUSAL
P149 OSTEOPOROSIS (PMO): INTERIM RESULTS OF A
HIP STRUCTURAL ANALYSIS OF ATYPICAL 24-MONTH PROSPECTIVE OBSERVATIONAL
FEMORAL FRACTURES IN BISPHOSPHONATE STUDY IN GERMANY, AUSTRIA, GREECE AND
TREATED WOMEN BELGIUM
A. C. C. Chou1, J. S. B. Koh2, A. C. M. Ng2, D. T. C. Chua3, P. Hadji1, N. A. Papaioannou2, E. Gielen3, M. F. Tepie4, E.
M. A. Png2, D. C. E. Ng2, T. S. Howe2 Zhang4, L. Kalouche-Khalil5, A. Fahrleitner-Pammer6
1 1
Duke-NUS Graduate Medical School, Singapore, Singapore, Philipps-University of Marburg, Marburg, Germany,
2
Singapore General Hospital, Singapore, Singapore, 3Changi 2
University of Athens, Medical School, KAT Hospital,
General Hospital, Singapore, Singapore Athens, Greece, 3University Hospitals Leuven, Leuven,
Belgium, 4 Amgen Ltd, Uxbridge, United Kingdom,
5
Objective: The aim of this study was to examine hip Amgen (Europe) GmbH, Zug, Switzerland, 6Medical
structural geometry parameters derived from DXA scans University Graz, Graz, Austria
 Osteoporos Int

Objective: It is widely recognised that poor persistence to/ P151

adherence with PMO therapy leads to increased fracture risk1 BONE STRUCTURE IN PATIENTS WITH
and less frequent dosing may contribute to better persistence/ MYELOFIBROSIS
adherence2. We report medication-taking behavior of PMO S. Farmer1, A. P. Hermann2, V. Shanbhogue2, S. Hansen2,
women following receipt of their first DMAb injection in H. Vestergaard3, H. Frederiksen3
1
clinical practice. Department of Haematology, Institute of Health, Odense
Material and Methods: The study design has been described University Hospital, Odense, Denmark, 2Department of En-
elsewhere3. The current pre-specified interim analysis includ- docrinology, Odense University Hospital, Odense, Denmark,
3
ed data as of August 2013, for patients in Germany, Austria Department of Haematology, Odense University Hospital,
and Greece. Belgium centers started enrolment later and did Odense, Denmark
not have data available. Interim endpoints included 12-month
persistence and adherence (2 consecutive DMAb injections: Objective: In patients with myelofibrosis, osteosclerotic
no more than 6 months+8 weeks apart, and within 6 months± changes appear in the bone tissue as the result of growing
4 weeks, respectively), Medication Coverage Ratio (MCR;% and thickening of the bone trabeculae. (1) Despite this bone
of time a patient was covered by DMAb)3, adverse drug formation a recent nationwide population-based cohort study
reactions (ADRs) and serious ADRs (sADRs). showed that patients with chronic myeloproliferative neo-
Results: Of 1,200 women enrolled, 1,199 were included plasms (CMPN) in general have a higher rate and risk of hip
in the analysis. Baseline characteristics were consistent fractures. (2) We conducted a cross-sectional study to evaluate
with those of a PMO population4. Overall, 12-month bone structure MF patients using conventional DXA and
DMAb persistence and adherence were 91.5 % HR-pQCT.
(95%CI: [89.8, 93.0 %]) and 86.9 % [84.9, 88.8 %], Material and Methods: 20 MF patients (10 men and 10
respectively, and mean MCR 93.1 % [92.25, 93.91 %] women) from department of haematology, Odense University
(Figure). ADRs and sADRs were reported for 3.8 % Hospital, Denmark were included All patients meet the
and 0.3 % of patients, respectively. There were 2 inde- diagnostic criteria of primary myelofibrosis or myelofi-
pendently adjudicated cases of osteonecrosis of the jaw brosis secondary to another CMPN according to WHO
(one resolved, the other ongoing). No fatal ADRs were 2010-criteria with International Classification of
reported. Diseases, 10th revision. Areal BMD was assessed in
the lumbar spine (L1-L4) and nondominant hip by
DXA, and a 3D assessment of bone geometry, volumet-
ric BMD, and microarchitecture of the nondominant
distal radius and tibia were measured using a HR-
pQCT scanner. Data are compared with healthy volun-
teers matched on age, sex, and height, in a 1:1 ratio.
Blood samples were analyzed for procollagen type I N-
terminal pro-peptide (PINP1), a marker for bone forma-
tion. Levels of PINP1 in 20 healthy blood-donors were
used as reference. Data are presented as mean- values
including 95%CI. Results from patients and controls are
compared using t- test and the statistical significance
level set at p<0.05.
Results: Mean age of the patients was 69.8 (95%CI: 66.3–
73.4). The patients had higher BMD in spine 1.10 (0.93–1.08)
vs. 0.93 (0.87–1.00), but not of the hip 0.93 (0.85–1.02) vs.
0.90 (0.82–0.98). HR-pQCT showed consistently increased
Conclusion: In PMO clinical practice in Germany, Aus- bone mass, particular trabecular volumetric BMD, tra-
tria and Greece, overall 12-month persistence to DMAb becular BV/TV, and trabecular number, although statis-
exceeded 90 %. ADRs/sADRs are consistent with those tical significance was not reached. PINP was increased
observed in other DMAb studies and will continue to be in patients.
evaluated. Conclusion: This study demonstrated elevated level of
References: 1Siris et al, Am J Med 2009; 2Warriner and PINP in MF patients indicating increased bone forma-
Curtis, Curr Opin Rheumatol 2009; 3Tepie et al, ECTS tion rate. The DXA and HR-pQCT results indicate that
2013; 4Papaionnnou et al, ASBMR 2013 these patients have increased trabecular bone mass, but
Acknowledgements: Amgen/GSK did not reach statistical significance. Myelofibrosis is a
Osteoporos Int

rare disease and the number of patients included was References: Gómez Alonso C et al. Nefrologia 2003;
small. 23(Suppl 2):73.
References: 1. Mellibovsky L et al. Bone 2004;34:330
2. Farmer S et al. Br J Haematol 2013;163:603
Acknowledgements: This study was founded by the Region
of Southern Denmark. P153
PRESARCOPENIA, SARCOPENIA AND SEVERE
SARCOPENIA AMONG IRANIAN ELDERLIES: THE
P152 FIRST EPIDEMIOLOGICAL REPORT
PROGRESSION OF IDIOPATHIC COXARTHROSIS: R. Heshmat1, R. Hashemi 2 , A. R. Dorosty Motlagh 2 ,
VITAMIN D ASPECT M. Payab 2 , A. Esmailzadeh 3 , P. Pasalar 4 , F. Siassi 2
A. V. Kalashnikov1, G. V. Gayko 1, O. V. Kalashnikov 1, 1
Chronic Diseases Research Center, Tehran University of
L. I. Apukhovskaya2 Medical Sciences, Tehran, Islamic Republic of Iran, 2School
1
State Institution, Institute for Traumatology and Orthopae- of Nutritional Sciences and Dietetics, Tehran University of
dics of NAMS of Ukraine, Kyiv, Ukraine, 2State Institution, Medical Sciences, Tehran, Islamic Republic of Iran, 3School
Institute for Biochemistry O.V. Palladin of the NAS of of Nutrition and Food Science, Isfahan University of Medical
Ukraine, Kyiv, Ukraine Sciences, Isfahan, Islamic Republic of Iran, 4Endocrinology
and Metabolism Research Institute, Tehran University of
Objective: To define interrelation between changes in mineral Medical Sciences, Tehran, Islamic Republic of Iran
and vitamin D exchange and idiopathic coxarthrosis
progression. Objective: The purpose of this study was to determine the
Material and Methods: 30 patients with stage IVof idiopath- prevalence of sarcopenia, the age related loss of skeletal
ic coxarthrosis according to Kellgren and Lawrence have been muscle mass in Iranian older adults based on the definition
studied and compared with 30 healthy persons (control by European working group on sarcopenia (EWGSOP).
group), statistically standardized in age and gender. We have Material and Methods: Using cluster random sampling, 300
subdivided forms of idiopathic coxarthrosis into rapidly pro- participants (150 of each sex) were selected in Tehran, the
gressive (≤5 years from the beginning to the final stage of the capital of Iran. In each cluster, 2 individuals (1 male, 1 female)
disease), moderately progressive (from 5 to 10 years) and were invited through home interviews from the following age
slowly progressive (>10 years). Insufficiency of vitamin D groups: 55–59, 60–64, 65–69, 70–74, and over 75. Skeletal
exchange has been verified according to Gomez classification muscle mass was measured by DXA. Appendicular skeletal
(2003); the content of 25(OH)D, phosphorus and calcium, muscle (ASM) was calculated as well. Muscle strength and
activity of total alkaline phosphatase and its isoenzymes in performance were evaluated according to hand grip strength
blood serum have been defined. and 4-m gait speed. According to EWGSOP definition, indi-
Results: For idiopathic coxarthrosis, notable is the 100 % viduals with abnormal ASM were considered as
prevalence of vitamin D disorders and 20.25 % of the severest presarcopenic. Presarcopenic individuals with abnormal mus-
vitamin D deficits. Rapidly progressive idiopathic cle strength or performance were considered sarcopenic. Par-
coxarthrosis has shown 44.5 % cases of vitamin D deficiency, ticipant with all three abnormal criteria were considered se-
55.5 % of vitamin D deficit; moderately progressive form of verely sarcopenic.
the disease demonstrated 82 % of vitamin D deficiency and Results: The prevalence of presarcopenia, sarcopenia and
18 % of vitamin D deficit; slow progressing idiopathic sever sarcopenia in total population were 30 %, 18 % and
coxarthrosis has shown 50 % of vitamin D deficiency, 5.7 %, respectively. The prevalence of presarcopenia,
12.5 % of vitamin D deficit and 37.5 % of vitamin D sarcopenia and sever sarcopenia in female were 25.3 %,
hypovitaminosis. Vitamin D supply in case of idiopathic 15.3 % and 5.3 % compared to 52.7 %, 20.7 % and 14.7 %
coxarthrosis is closely connected with mineral metabolism for male. An increase in the prevalence of sarcopenia was
and its disorders. Rapidly progressive form has shown signif- observed with age. This increase was more significant among
icantly reduced (p≤0.01) coxarthrosis indicators of serum the age group over 75 years old in both genders. The lowest
calcium, phosphorus, alkaline phosphatase and its isoenzymes prevalence of sarcopenia was observed in age group 65–69 for
(bone marrow and the gastrointestinal) and 25(OH)D, com- female and 60–64 for male.
pared to slowly progressive form. Conclusion: This is the first study performed on sarcopenia in
Conclusion: Signs of idiopathic coxarthrosis are: insufficien- community-dwelling elderly Iranians. The prevalence of
cy of mineral and vitamin D exchange, usual for 100 % of sarcopenia was considerable in Iranian elderly. Unlike studies
patients. Progression of idiopathic coxarthrosis depends on in western populations, Iranian men suffered more from
the level of vitamin D production by human body. sarcopenia compared to women.
 Osteoporos Int

P154 scanning table with hips flexed and knees flexed over a 90º
FRAX TO EVALUATE THE FRACTURE RISK OF support pad (modified supine position) and supine (supine
PEOPLE IN NANJING position). Predictive indices were calculated for spinal BMD
L. Bao1, X. Xu1, X. Cheng1 DXA measurements acquired with patients in the supine
1
Nuclear Medicine, First Affiliated Hospital, Nanjing Medical position; these included sensitivity, specificity, and the likeli-
University, Nanjing, China hood ratio (LR) for a negative test (-). A diagnosis of osteo-
porosis was excluded for a LR(-) less than 0.2. Osteoporosis
Objective: To evaluate the applicability and to predict fracture was defined as a BMD T-score of ≤−2.5.
risk of different gender groups in Nanjing using the WHO Results: For the modified supine and supine position during
released FRAX fracture risk assessment tool. DXA scanning in women, BMD measurements were
Material and Methods: 1,383 cases of people were grouped 0.911 g/cm2 and 0.915 g/cm2, respectively; in men they
and the personal data including the risk factors were collected were 1.117 g/cm2 and 1.124 g/cm2, respectively. The difference
and entered the FRAX tool in Nanjing Research. Then 10- in BMD between positions was 0.40 % (95%CI: 0.29, 0.51;
year fracture probability of hip and osteoporotic fractures were P<0.001). The coefficient of variance (CV%) for BMD mea-
calculated, various aspects containing fracture history and surements was 0.66 %. Accordingly, the clinical equivalency of
BMD were compared. the spinal BMD results between the two positions was pre-
Results: Fracture risk of female population is much higher served. The sensitivity, specificity, and LR(-) of osteoporosis
than male, the probability of fracture risk of hip and body are diagnosis following DXA scanning in the supine position was
simultaneously increased with age, and history of fractures is 94 %, 99 %, and 0.066, respectively, compared with results
an important risk factor, With or without BMD values will acquired using the standard position.
affect the calculation of FRAX 10-year probability of hip Conclusion: DXA measurements acquired with patients in
fracture recurrence, 10-year fracture risk of recurrence of the supine position slightly overestimated BMD vs. the mod-
previous fracture population is much higher than people with- ified supine position. However, this BMD overestimation is
out fracture history. After excluding history of fractures, body small and not significant. The clinical equivalency between
and hip fracture prediction showed no significant difference positioning methods for DXA is preserved to the extent that
with or without BMD. osteoporosis can be reliably diagnosed in the supine position.
Conclusion: Our research successfully established that
FRAX tool can be effectively applied to fracture risk assess-
ment in Nanjing, FRAX tool still has clinical significance P156
even if without previous fracture history and BMD value, COMMUNITY OSTEOPOROSIS AND FALL
FRAX tool combined BMD have clinical value in patients PREVENTION PROGRAM IN NORTHERN TAIWAN
with or without previous fractures. D. C. Chan1, J. S. Hwang2, L. C. Lim1, K.-S. Tsai3, R. S.
Yang4
1
Department of Gerontology and Geriatrics, National Taiwan
P155 University Hospital, Taipei, Taiwan, Province of China, 2Di-
THE EFFECTS OF LEG POSITIONING ON SPINAL vision of Endocrinology and Metabolism, Department of In-
BONE MINERAL DENSITY MEASUREMENTS AND ternal Medicine, Chang Gung Memorial Hospital, Taoyuan,
THE DIAGNOSIS OF OSTEOPOROSIS Taiwan, Province of China, 3Superintendent Office, National
S. Ikegami1, M. Kamimura2, S. Uchiyama1, K. Mukaiyama1, Taiwan University Hospital BeiHu Branch, Taipei, Taiwan,
Y. Nakamura1, H. Kato1 Province of China, 4Department of Orthopaedics, National
1
Department of Orthopaedic Surgery, Shinshu University Taiwan University Hospital, Taipei, Taiwan, Province of China
School of Medicine, Matsumoto, Japan, 2Center for Osteopo-
rosis and Spinal Disorders, Kamimura Orthopaedic Clinic, Objective: To determine the feasibility and effectiveness of an
Matsumoto, Japan osteoporosis and fall screening plus referral program in
Northern Taiwan.
Objective: The aim of this study was to investigate which Material and Methods: In 2013, seven community education
differences in leg positioning affect spinal BMD measure- campaigns on osteoporosis and fall prevention were conduct-
ments and the diagnosis of osteoporosis. ed in Taipei City, New Taipei City, and Taoyuan County,
Material and Methods: Subjects included 1,039 Japanese Taiwan. Ten questions were tested before and after the educa-
patients, 878 women and 161 men (mean ages: 67 and tion courses to determine the effectiveness of the program.
71 years, respectively). Spinal BMD (L1-4) was measured Participants were screened with FRAX® and fall risk ques-
using DXA with patients lying in two different positions; the tionnaires (FRQ). High risk subjects (10-year probability of
standard lumbar scanning position, with patients supine on the predicted risk ≥3 % for hip fracture, ≥20 % for major
Osteoporos Int

osteoporotic fracture, ≥2 fall in previous year, or scored ≥4 on aorta using Kauppila’s semiquantitative score. During the
FRQ) were referred to hospitals for further osteoporosis and follow-up, 182 men died.
fall assessments and managements. Results: After adjustment for confounders, the odds of severe
Results: Among 1,159 participants, 1,051 with complete data AAC score (>6) increased with total disc narrowing score
were analyzed. Mean age was 69.5±10.3 years with 82.8 % (OR[95%CI]=1.26 per SD increase [1.01–1.58]). After simi-
(n=870) women. Mean test score improved from 6.1±1.8 to lar adjustment, the odds of AAC>6 were higher in the highest
8.3±1.7 points (paired t-tests p<0.001) and 95 % were satis- tertile of total disc narrowing score vs. the lowest tertile (OR=
fied with the educational courses. Roughly 3/5 (61.8 %, n= 1.89 [1.04–3.42]). Osteophytosis and subchondral sclerosis
649) were considered high risk. However, only 127 (12.1 %) were not associated with AAC severity. Prospective data on
were successfully referred for further managements. Among AAC progression were available in 613 men. In 148 men
them, 53 (41.7 %) had clinical diagnosis of osteoporosis AAC was stable. After adjustment for confounders, the prob-
defined as having a fragility fracture or BMD T score ≤−2.5. ability of AAC stability decreased with increasing total osteo-
Although 27 (21.3 %) received anti-osteoporosis medications, phyte score (OR=0.76 per SD increase [0.60–0.99]). The
only 10 (7.9 %) were eligible for National Health Insurance probability of AAC stability was lower in the highest tertile
reimbursements. Referred subjects had multiple fall risk fac- of total osteophyte score vs. two lower tertiles combined
tors including fall related chronic conditions (n=96, 75.6 %), (OR=0.51 [0.30–0.86]). After adjustment for confounders
taking high risk medications (n=109, 85.8 %), abnormal gait (including AAC), total OA grade (HR=1.25 per SD increase
(n=44, 34.6 %), weak muscle power (n=48, 37.8 %), and [1.03–1.50]) predicted mortality. Both higher total OA grade
balance problem (n=38, 29.9 %). and severe AAC contributed to the risk of death. After adjust-
Conclusion: Community educational campaigns were wel- ment for confounders, men who had higher total OA grade
comed and effective in improving osteoporosis and fall related and severe AAC had higher risk of death (HR=2.63 [1.48–
knowledge. Even significant numbers of high risk individuals 4.65]) compared with men who had lower total OA grade and
were screened out, relatively few actually accepted the referral less severe (or absent) AAC.
for further managements. Efforts should be made to improve Conclusion: In older men, severe spine OA is associated with
the referral efficiency. greater AAC severity and greater risk of AAC progression.
Acknowledgements: The authors thank the Wang Jhan-Yang Severe OA and severe AAC contribute jointly and indepen-
Public Trust Fund for sponsoring the study. The sponsor dently to higher all-cause mortality in older men.
reviewed and approved the study protocol but did not interfere
with study conduction, data analysis or interpretation. The
authors also thank the Taiwanese Osteoporosis Association P158
for coordinating this study. ASSESSMENT OF BONE MICROARCHITECTURE
IMPROVES INCIDENT FRACTURE PREDICTION IN
MEN: THE STRAMBO STUDY
P157 P. Szulc1, S. Boutroy1, R. D. Chapurlat1
1
IN MEN, SEVERE SPINE OSTEOARTHRITIS IS INSERM UMR 1033, Université de Lyon, Hospices Civils
ASSOCIATED WITH ABDOMINAL AORTIC de Lyon, Hôpital E Herriot, Lyon, France
CALCIFICATION AND ALL CAUSE MORTALITY:
THE MINOS STUDY Objective: Areal BMD (aBMD) measured by DXA poorly
C. Estublier1, R. D. Chapurlat1, F. Marchand2, P. Szulc1 identifies men at high fracture risk. We studied the value of
1
INSERM UMR 1033, Université de Lyon, Hospices Civils HR-pQCT for fracture prediction in men.
de Lyon, Hôpital E Herriot, Lyon, France, 2 CARMI, Material and Methods: Among 821 men aged 60–87 follow-
Montceau les Mines, France ed up for 6 year, 70 men sustained fragility fractures. We
calculated aBMD T-score using hip and distal radius aBMD
Objective: We studied the association of spine osteoarthritis in young men (STRAMBO) and hip aBMD in young women
(OA) with abdominal aortic calcification (AAC) severity and (NHANES).
its progression rate as well as with all-cause mortality in older Results: Most microarchitectural parameters were associated
men. with fracture risk when adjusted for age, weight, prior falls
Material and Methods: A cohort of 766 men aged 50– and fractures (HR=1.25–1.94 per SD, p<0.05). After further
85 year was followed up prospectively for 7.5 years (for adjustment for distal radius aBMD, low trabecular number
AAC) and for 10 years (for mortality). Spine OA was assessed (Tb.N) and more heterogeneous trabecular distribution (high
at six intervertebral spaces using Lane’s score. Total score of Tb.Sp.SD) were associated with higher fracture risk (HR
each parameter was calculated as sum of its values for six [95%CI]=1.94 [1.46–2.56] and 1.61 [1.25–2.08] per SD). In
intervertebral levels. AAC was assessed in the abdominal a similar model including hip aBMD, higher Tb.Sp.SD at
 Osteoporos Int

distal tibia was associated with higher fracture risk (HR=1.41 adjustment for confounders, serum sclerostin increased across
[1.06–1.86] per SD). In men with osteopenia at the hip and the quartiles of total disc space narrowing score (trend<0.001).
elevated Tb.Sp.SD (highest quartile), fracture risk was higher Average serum sclerostin increased with the increasing grade
vs. men with normal hip aBMD (HR=2.77 [1.36–5.65]) and of disc space narrowing (p for trend<0.005). However, all the
vs. osteopenic men with normal Tb.Sp.SD (HR=2.20 [1.10– associations between disc space narrowing and sclerostin
4.41]). Their fracture incidence was close to that in men with levels lost significance (p>0.23) after additional adjustment
the hip T-score<−2.5 (3.5 vs. 3.3 /100 p-yrs). The results were for total hip BMD, osteophyte severity and subchondral scle-
similar when hip aBMD in women was used to calculate T- rosis score. Men with subchondral sclerosis at ≥2 interverte-
score thresholds. In men with osteopenia and low Tb.N (low- bral levels had slightly higher sclerostin levels vs. other men
est quartile) at distal radius, fracture risk was higher vs. men (p=0.053). This trend became nonsignificant after adjustment
with normal aBMD (HR = 2.34 [1.07–5.13]) and vs. for total hip BMD, osteophyte severity and disc space
osteopenic men with normal Tb.N (HR=3.05 [1.28–7.28]). narrowing score (p=0.88).
Their fracture incidence was close to that in men with T- Conclusion: In older men severe osteophytes, but not disc
score<−2.5 at distal radius (3.2 vs. 3.3 /100 p-yrs). The results space narrowing or subchondral sclerosis, were independently
were similar for osteopenia and Tb.Sp.SD at distal radius. In associated with higher sclerostin concentration.
osteopenic men with normal bone microarchitecture, fracture
incidence was similar to that in men with normal aBMD.
Conclusion: Assessment of bone microarchitecture by HR- P160
pQCT may improve fracture prediction in older osteopenic RISK FACTOR PROFILE OF YOUNG HIP
men. FRACTURE PATIENTS IN INDIA
P. Dharmshaktu1, D. Dhanwal1, V. Dixit1
1
Department of Medicine, Maulana Azad Medical College,
P159 New Delhi, India
SERUM SCLEROSTIN IS HIGHER IN MEN WITH
SEVERE OSTEOPHYTES AT THE SPINE: THE Objective: There has been a paucity of studies in young
MINOS STUDY population with hip fracture and no such study was done in
P. Szulc1, C. Estublier1, C. Bertholon1, F. Marchand2, R. D. India. Therefore, this prospective study was performed to
Chapurlat1 evaluate profile of risk factors of hip fracture in young
1
INSERM UMR 1033, Université de Lyon, Hospices Civils patients.
de Lyon, Hôpital E Herriot, Lyon, France, 2 CARMI, Material and Methods: Over a span of 3 years, 51 patients of
Montceau les Mines, France fragility hip fracture under 50 years of age were enrolled in
this study. Background data and risk factors were evaluated to
Objective: To analyze cross-sectionally the association be- the preset proforma. Fasting venous samples were analyzed
tween spine osteoarthritis (OA) severity and serum sclerostin for 25-hydroxyvitamin D (25-OHD), intact PTH, alkaline
level in older men. phosphatase (ALP), calcium, and phosphorus.
Material and Methods: In 694 men aged 50–85 year, spine Results: The mean age of hip fracture subjects below 50 years
OA was assessed at six intervertebral spaces using Lane’s age was 46.27±12.78 which was comparable in both men and
score. Total score of each parameter was calculated as sum women. Only four of 51 study subjects were under 40 years of
of its values for six intervertebral levels. Sclerostin level was age. Of 51 subjects, 26 were men and 25 were women.
measured in fasting serum (TECOsclerostin EIA, Majority of men with hip fracture were smokers. All the
TECOmedical). BMD of total hip was measured by DXA women were nonsmokers. Sun exposure was found to be
(Hologic QDR1500). inadequate in majority of study subjects. Vitamin D deficiency
Results: After adjustment for age, weight, 17ß-estradiol level was found in 39 out of 51 subjects accounting 76.47 % of total
and glomerular filtration rate, serum sclerostin level increased young population. Among vitamin D deficiency subjects, 21
across quartiles of total osteophyte score (trend<0.001). were men and 18 were women. Mean 25-OHD was 12.22±
Sclerostin level was 15 % (0.42SD, p<0.001) higher in the 7.6 ng/ml in men and 10.97±7.3 ng/ml in women. Hyperpara-
highest vs. the lowest quartile. After similar adjustments, thyroidism was found in 28 (54.9 %) out of total 51 study
sclerostin level increased with the increasing osteophyte grade subjects.
(trend<0.001). It was 13 % (p<0.005) higher in men with Conclusion: Majority of young patients with fragility hip
severe osteophytes vs. men who had no or mild osteophytes. fracture both men and women in India have vitamin D defi-
The link between osteophyte severity and sclerostin level was ciency and secondary hyperparathyroidism. Therefore, vita-
significant (p<0.05) after further adjustment for hip BMD, min D deficiency is a major risk factor along with smoking
disc space narrowing and subchondral sclerosis. After among men in young hip fracture patients from India. Further,
Osteoporos Int

vitamin D intervention studies are needed for its role in P162

prevention of hip fracture in young population. THE STATUS OF SERUM VITAMIN D IN PATIENTS
Acknowledgements: Abhishek Misra for his immense sup- ATTENDING A PHYSICAL MEDICINE AND
port and contribution to the statistics in the study. REHABILITATION DEPARTMENT IN TURKEY
M. Okumus1, G. Demir1, T. Ozgun2, P. Borman1, A. Karagoz1
1
Department of Physical Medicine and Rehabilitation of
P161 Ankara Training and Research Hospital, Ankara, Turkey,
2
FRACTURES AND CLINICAL OUTCOME IN Department of Biochemistry of Ankara Training and
HEMODIALYSIS PATIENTS Research Hospital, Ankara, Turkey
S. O. Mazurenko1, K. G. Staroselsky2, A. A. Enkin3, A. N.
Vasiliev4, O. G. Mazurenko5 Objective: Deficiency of vitamin D is becoming a global
1
Saint Petersburg State University, Saint Petersburg, Russian public health problem. Vitamin D plays important roles in
Federation, 2Saint Petersburg Hospital 26, Dialysis Centre, maintaining the balance of calcium and phosphorus me-
Saint Petersburg, Russian Federation, 3Leningrad Regional tabolism and keeping normal BMD levels. Vitamin D
Hospital, Dialysis Centre, Saint Petersburg, Russian Federa- status is affected by many factors such as geographical
tion, 4Saint Petersburg State Medical University, Dialysis environment, physiological factors and lifestyle. The ob-
Centre, Saint Petersburg, Russian Federation, 5Saint Peters- jectives of present study were to estimate the prevalence
burg Sokolov Hospital, Centre for Osteoporosis and Skeleton of vitamin D deficiency among patients attended in the
Metabolic Diseases, Saint Petersburg, Russian Federation outpatients clinic of Physical Medicine and Rehabilitation
(PMR) department.
Objective: Patients with endstage renal disease have in- Material and Methods: This was a retrospective study of 999
creased risk for fracture. This high fracture rate is a conse- patients who presented to the outpatient clinic of PMR
quence of accelerated loss of BMD. Various studies suggest a between January 2011 and April 2013 were recruited
strong association between BMD and survival in patients with consecutively into the study. Biochemical markers of pa-
endstage renal disease. The aim of this study was to investi- tients were measured. Total 25(OH)D was measured from
gate contribution of factures to clinical outcome in hemodial- stored plasma specimens using liquid chromatography-
ysis patients. mass spectrometry. Vitamin D deficiency was defined as
Material and Methods: This prospective study enrolled 640 serum 25(OH)D 20 ng/ml. Sociodemographic characteris-
patients (334 men and 312 women) with stage 5 chronic tics, lifestyle and dietary habits were obtained using
kidney disease receiving hemodialysis who were then follow- questionnaires.
ed for a mean of 49 (range 16–122) months. Among 159 Results: The mean age of the participants was 60.2 (range:
patients (77 men and 82 women) who had fractures, 54 18–97) and 88.7 % were women. The mean serum 25(OH)D
(34 %) patients had fractures of axial skeleton (vertebra, hip, level was 22.5 ng/ml and the prevalence of serum 25(OH)D
pelvis). Lumbar spine, femoral neck, and distal forearm BMD level was in 54.1 % of all patients. The mean level of
were measured by DXA. The Kaplan-Meier estimator of 25(OH)D in women was significantly higher than in men
survival and the Cox proportional hazards model was used (22.9 ng/mL vs. 19.8 ng/mL, p=0.019). The participants aged
to calculate and determine the relations between mortality 60 years and above have highest serum 25(OH) D levels
BMD and fractures. (25.7 ng/ml vs. 18.4 ng/ml, p=0.000).
Results: Patients were followed for 49 months, after which Conclusion: Mean serum 25(OH)D level was close to repre-
time 131 patients (20.5 %) died. The cause of death in 51 % sent range considered to represent vitamin D deficiency. Par-
patients were cardiovascular diseases. The Cox proportional ticipants aged 60 or older showed the highest mean values of
hazards model was used to calculate and determine relations serum 25(OH)D. Future studies are certainly warranted to
between mortality, BMD and fractures. We did not find any understand the prevalence of vitamin D deficiency and
influence of BMD on all- cause mortality of hemodialysis influencing factors.
patients. At the same time low BMD was strongly associated
with cardiovascular mortality. We did not find any influence
of peripheral fractures on mortality, and the same time axial P163
fractures were strongly associated with cardiovascular ONE-YEAR DISEASE-RELATED HEALTHCARE
(p<0.001) and all-cause mortality of hemodialysis patients COSTS OF INCIDENT OSTEOPOROTIC
(p<0.01). VERTEBRAL FRACTURES IN GERMANY
Conclusion: Axial fractures are good independent predictors A. Lange1, J. Zeidler1, S. Braun2
1
of cardiovascular and all-cause mortality in hemodialysis Center for Health Economics Research Hannover, Hannover,
patients. Germany, 2Herescon GmbH, Hannover, Germany
 Osteoporos Int

Objective: Osteoporotic vertebral compression fractures Objective: Atypical femoral fractures (AFF) are rare low-
(OVCF) are among the most common fractures related to energy stress fractures progressing from the lateral femur
osteoporosis. They have been shown to be associated with [1]. However, the aetiology of fracture onset is unclear. We
excess mortality, and meaningful healthcare costs. Costs cal- tested the hypothesis that AFF onset is associated with the
culations have illustrated the significant financial burden to femur strain pattern during walking.
society and national social security systems. However, infor- Material and Methods: Ten volunteers underwent a motion
mation on disease-related costs of OVCF is not available for capture session and a computed tomography (CT) of the thigh
Germany. Therefore, the aim of the present study was to region. A generic musculoskeletal model was scaled to the
estimate the direct disease-related healthcare costs of OVCF volunteers’ anthropometry. Muscle and hip reaction forces
in patients with newly diagnosed fracture in the first year after were calculated using the scaled-generic models, the recorded
index in Germany. skin-marker trajectories and ground reaction forces during
Material and Methods: Claims data of a large German health walking. Hip reaction forces showed consistency with pub-
insurance fund was used for the analyses. Patients older than lished measurements [2]. The femur finite element models
60 years with a new OVCF between 2006 and 2010 were were generated from the CT images using a well-established
studied retrospectively compared to a matched paired OVCF- procedure [3] and subjected to the calculated muscle and hip
free group. All-cause and fracture-specific medical costs were reaction forces to calculate peak principal strains in 4 diaph-
calculated in the 1-year baseline and the 1-year follow-up yseal levels and 4 aspects (anterior, posterior, medial, lateral).
period. A Generalized linear model (GLM) was applied to The median principal tensile and compressive strains, during
estimate adjusted total follow-up healthcare cost. the walking stance phase for the 32 femoral subregions, were
Results: 2,277 pairs of matched OVCF and OVCF-free pa- calculated and compared.
tients were included in the analysis. Baseline costs were Results: The lateral femoral shaft was mainly loaded in ten-
higher in the OVCF group. Mean unadjusted all-cause sion throughout walking, reaching peak strain levels at the
healthcare cost difference in the first year following the index time of peak hip reaction force. The interparticipant average of
date between OVCF and OVCF-free patients was 8200 € the median tensile strain reached 1500 με in the lateral
(p<0.001). Of the difference, one-quarter was attributable to subtrochanteric region and 1000 με in the distal-lateral shaft.
prescription drug costs and almost two-third to inpatient ser- The interparticipant range of the median tensile strain in the
vices. The regression model revealed that OVCF-related costs lateral shaft ranged from 600 με to 2500 με.
in the first year after the index date add up to 6490 € (p<0.001; Conclusion: AFFs are associated with high tensile strain
CI: 5809 €–6731 €). regions occurring cyclically during walking, with the lateral-
Conclusion: Despite limitations of this study, including spec- subtrochanteric region experiencing the higher tensile strain
ificity and sensitivity of claims-based diagnoses, and general- levels. Tensile strain levels vary among subjects and may
izability issues, our results are consistent with other studies explain individual susceptibility to AFFs. Subject-specific
and demonstrate that OVCFs are associated with significant models may help discriminate patients most at risk for AFFs.
excess costs. Against the background of the high and increas- References: 1. Shane et al., JBMR. 2010;25:11
ing incidence and prevalence of these fractures, the results 2. Bergmann et al., J Biomech 1993;34:7
emphasize the importance of research in this field. 3. Schileo et al., J Biomech 2007;40:13
Disclosures: This study was financially supported by Acknowledgements: Australian Research Council
Medtronic International. (DE140101530)

P164
ATYPICAL FEMORAL FRACTURES ARE P165
ASSOCIATED WITH HIGH CYCLIC TENSILE OSTEOPOROSIS IN SAUDI ARABIA: IS IT A
STRAIN REGIONS DURING WALKING PROBLEM?
S. Martelli1,3,4, M. E. Kersh2, P. Pivonka3,4, P. R. Ebeling4,3, J. Palencia1, M. Alhashim1, A. León2
M. G. Pandy2 1
Ortho Department KSMC, Riyadh, Saudi Arabia, 2Servicio
1
Medical Device Research Institute, School of Computer de Traumatología y Cirugía Ortopédica. Hospital Clínico
Science, Engineering and Mathematics, Flinders University, Universitario, Valladolid, Spain
Bedford Park, Australia, 2Department of Mechanical Engineer-
ing, University of Melbourne, Parkville, Australia, 3Australian Objective: The goals of the present study are:
Institute for Musculoskeletal Science, University of Melbourne, - Analysis of the Saudi Arabia osteoporosis prevalence.
St Albans, Australia, 4NorthWest Academic Centre, University - The future expectations of osteoporosis in Saudi Arabia. -
of Melbourne, St Albans, Australia Recommendations and advice.
Osteoporos Int

Material and Methods: - General review about the preva- pneumatic dynamometer (PD); for physical performance
lence of osteoporosis in Saudi Arabia. we used the Short Physical Performance Battery test
- Assuming the expectation of osteoporotic cases in the future. (SPPB) and the walk speed (WS). Eight diagnostic groups
- Recommendations and guidelines for management of oste- were thereby established.
oporosis according to the population culture and food habits. Results: A total of 200 consecutive subjects were recruited in
Results: - Currently, the population in Saudi Arabia is 25.7 an outpatient clinic in Liège, Belgium (62 % of women, mean
million. 10 % of them >50 y.o. and 2 % of them >70 y.o. age: 73.8 years). Prevalence of sarcopenia varied from 8.72 %
- According to the Saudi Reference Data, the prevalence of (BIA-HD-WS) to 28.5 % (DXA-PD-SPPB) depending of the
osteoporosis is 28.2 % in females >50 y.o. and 37.8 % in definition. Regarding muscle mass, it seems that BIA system-
males >50 y.o. The osteopenia is 43.8 % in females >50 y.o. atically underestimate muscle mass compared to DXA (mean
and 54.1 % in males >50 y.o. of prevalence with BIA=13.4 %; mean of prevalence with
- We need to give a solution for this current and future problem. DXA=21.4 %). For muscle strength, the pneumatic dyna-
- The causes of this high prevalence of osteoporosis are: mometer diagnosed twice more sarcopenic subjects than the
1. Low or deficiency of Vitamin D in children and adults hydraulic dynamometer (mean of prevalence with PD =
2. Sedentary lifestyle. Young people don’t reach enough os- 23.2 %; mean of prevalence with HD=11.6 %). Finally, a
seous stock. really small difference of prevalence was observed between
3. Postmenopausal females don’t receive replacement the walk speed and the SPPB test (mean of prevalence with
hormonal therapy WS=17.3 %; mean of prevalence with SPPB=17.6 %).
4. Bad food habits, with low levels of calcium 5. Less sun Conclusion: Within the same definition of sarcopenia, prev-
exposure due to a uniform culture alence of sarcopenia is highly dependent on the diagnostic
6. No well defined management program to osteoporosis tool used. It is necessary to reach a consensus on the recom-
Conclusion: - Osteoporosis is a serious and increasing prob- mended diagnostic tools to be used in order to make studies
lem among Saudi Population. comparable.
- To overcome it, the Health Authorities should perform:
1. Programmes and activities to raise education, level of the
awareness and prevention (guidelines, bulletins, work- P167
shops, etc.) LITERATURE REVIEWAND META-ANALYSIS OF
2. Well developed medicine management protocols with com- PERSISTENCE WITH ORAL BISPHOSPHONATES
bination of The Saudi Osteoporotic Society L. Karlsson1, J. Lundkvist2, E. Psachoulia3, M. Intorcia3,
O. Ström1
1
Quantify Research, Stockholm, Sweden, 2Amgen AB, Solna,
P166 Sweden, 3Amgen (Europe) GmbH, Zug, Switzerland
PREVALENCE OF SARCOPENIA ACCORDING TO
DIFFERENT DIAGNOSTIC TOOLS Objective: Treatment persistence is an important aspect
C. Beaudart1, F. Buckinx 1 , J. Slomian 1 , A. Quabron 1 , of managing chronic illness. In this study, a literature
J. Petermans2, J.-Y. Reginster3, O. Bruyère1, S. Gillain2 review was conducted summarizing published data on
1
Department of Public Health, Epidemiology and Health retrospectively observed persistence with oral bisphosphonates
Economics, University of Liège, Liège, Belgium, 2Geriatric (OBPs).
Department, CHU Liège, Liège, Belgium, 3Bone and Cartilage Material and Methods: A structured literature review of
Metabolism Department, CHU Liège, Liège, Belgium retrospective studies estimating persistence (consistent drug
dispensing, without failing to refill within a study-specific
Objective: Sarcopenia can be defined as a progressive and time period, the permissible gap) with OBPs at 12 and
generalized loss of muscle mass with either a loss of muscle 24 months was conducted using the PubMed database. The
strength or a loss of physical performance. Currently, there is search included articles indexed before 22 November 2013
no recommendation regarding the diagnostic tools to use to with an English abstract. Pooled estimates of persistence
measure these three outcomes. In this cross-sectional study, at 12 and 24 months were calculated using inverse var-
we compared the prevalence of sarcopenia when using differ- iance estimation. In subgroup analyses, these estimates
ent diagnostic tools. were grouped by weekly and daily administration and by
Material and Methods: To measure muscle mass, muscle region. The effect of persistence by varying the permissible
strength and physical performance, we used for each gap was also analyzed.
outcome two different diagnostic tools. For muscle mass, Results: 663 unique articles were identified for title review.
we used DXA and Bio-impedance (BIA); for muscle After applying exclusion criteria, 43 articles were included in
strength, we used a hydraulic dynamometer (HD) and a the final review, with 41 and 18 reporting at least one estimate
 Osteoporos Int

of 12- and 24-month persistence, respectively. Persis- reimbursed in such patients. Other reasons were history of OP
tence at 12 months varied from 10 % to 78 %, with a fracture (22.1 %), multiple risk factors for fracture (20.3 %)
pooled estimate of 44.0 % (CI95: 44.0–44.1 %). Persis- and failure of previous OP therapy (15.3 %). Mean BMD T-
tence at 24 months varied from 16 % to 46 %, with a score was −2.7±0.71 at the femoral neck, −3.2±0.63 at the
pooled estimate of 37.8 % (CI95: 37.7–37.9 %). All lumbar spine and −2.3±0.83 at the total hip. One-third of
studies comparing daily with weekly OBPs reported low- women (31.5 %) had received OP therapy prior to denosumab
er persistence with daily OBPs (12-month persistence initiation. One-quarter (26.6 %) had experienced a previous
pooled estimates: 35.4 % vs. 48.8 %). European studies fracture, with vertebral being the most common type (71.2 %)
reported higher 12-month persistence (pooled estimate: followed by hip fractures (6.8 %) and others (32.2 %, exclud-
46.7 %) compared to North American studies (pooled ing hip). 2.7 % of women received vitamin D only, 5.9 %
estimate: 43.8 %). Studies which varied the permissible calcium supplements only and 35.1 % both.
gap reported a wider gap to be associated with higher Conclusion: Women initiating denosumab in Bulgarian clin-
estimated persistence. ical practice had a mean age of 64.2 year and a low BMD T-
Conclusion: There is a fairly large body of international score (within the OP range) with or without other risk factors.
evidence describing retrospectively measured persistence with Acknowledgements: This study and abstract were funded by
OBPs. This meta-analysis shows that persistence with OBPs Amgen and GSK.
is low with only 44 % of patients persistent at 12 months and
38 % at 24 months.
Acknowledgements: This study and abstract was funded by P169
Amgen and GSK. OXIDATIVE STRESS IN PATIENTS WITH
OSTEOPOROSIS
D. Alhamdany1
1
P168 Mosul University, Mosul, Iraq
CHARACTERISTICS OF POSTMENOPAUSAL
WOMEN WITH OSTEOPOROSIS INITIATING Objective: To assess the oxidative stress and total antioxidant
DENOSUMAB IN BULGARIA status in patients with osteoporosis.
M. Boyanov1, A. Shinkov2, E. Psachoulia3, M. Intorcia3, Material and Methods: Sixty female patients with posi-
R. Petkova4 tive DXA results whose ages range between 50 and
1
University Hospital Alexandrovska, Sofia, Bulgaria, 60 years old were enrolled in the study and were divided
2
University Hospital of Endocrinology Acad. Iv. Penche, into 2 groups, osteopenia and osteoporosis. Another 30
Sofia, Bulgaria, 3Amgen (Europe) GmbH, Zug, Switzerland, apparently healthy females, age matched with the pa-
4
Amgen Bulgaria, Sofia, Bulgaria tients, were considered as a controls. Total antioxidant
status (TAS) and malondyaldehyde (MDA) were mea-
Objective: Describe the characteristics of postmenopausal sured in all groups. A pilot study was designed to com-
women with osteoporosis (OP) and reasons for initiating pare the TAS and MDA between patients with osteopenia
denosumab in routine clinical practice in Bulgaria. and osteoporosis, using the ranges of T-score between
Material and Methods: This retrospective study, conducted the medians of each group (−1.7 to −2.5 and −2.6 to
in 11 Bulgarian practices, included postmenopausal women −3.3,.respectively).
≥50 year old with a clinical diagnosis of OP, who initiated Results: The TAS values of both patients groups (1.59±
denosumab on/after Oct 2011 and received a 2nd injection 0.15 mmol/l and 1.05±0.37 mmol/l, respectively) were sig-
within the next 7 months (and until Aug 2013). All study nificantly lower than that of the control group (2.18 ±
variables (e.g., age, prescribing rationale, etc.) were recorded 0.26 mmol/l) (p<0.001). MDA values of both patients groups
as per routine clinical practice at 1st injection; no other study (osteopenia and osteoporosis) (1.20±0.43 μmol/l and 2.40±
procedures were required. Continuous variables were 0.66 μmol/l, respectively), were significantly higher than that
summarized as mean ± SD. For categorical variables, of the control group (0.47±0.14 μmol/l) (p<0.001). The result
the number and percentage of subjects in each category were of pilot study, showed no difference between these two select-
summarised. ed values groups for TAS and MDA, (p-value <0.1 and 0.07)
Results: 222 women met the eligibility criteria with a mean respectively.
age of 64.2±8.54 year; half (49.5 %) were <65 year old and Conclusion: The present study demonstrated that osteoporo-
only 13.1 % ≥75 year. Mean age at menopause was 48.1± sis patients have higher levels of MDA and lower levels of
3.98 year. The most common reason for prescribing TAS than the control group. There is no difference between
denosumab was a BMD T-score of <-2.5 (98.6 % of patients), osteopenia and osteoporosis regarding oxidative stress in the
reflecting local reimbursement criteria whereby denosumab is pilot study.
Osteoporos Int

1
P170 Bone Metabolism Unit, Endocrinology Division, Hospital
JOINT USE OF VITAMINS D3 AND E PREVENTS Universitario San Cecilio, Granada, Spain, 2Bone Metabolism
BONE AND CARTILAGE DISORDERS CAUSED BY Unit, Endocrinology Division Hospital Universitario San
CORTICOSTEROIDS Cecilio, Granada, Spain
A. V. Kalashnikov1, A. T. Brusko1, E. L. Kusiv1, L. I.
Apukhovskaya2, Y. I. Shchehlova1 Objective: Type 2 diabetes (T2DM) is a risk factor for oste-
1
State Institution, Institute for Traumatology and Orthopae- oporotic fractures and cardiovascular disease. The Wnt sig-
dics of NAMS of Ukraine, Kyiv, Ukraine, 2State Institution, naling pathways are involved in diverse developmental and
Institute for Biochemistry O.V. Palladin of the NAS of physiological processes, including anabolic effects on bone
Ukraine, Kyiv, Ukraine and atherosclerotic disease (AD). Dickkopf-1 (DKK1) is a
potent inhibitor of Wnt signaling. The aims of our study were
Objective: Biochemical and morphological study of vitamins to evaluate serum DKK1 levels in a cohort of T2DM patients
D3 and E effect with underlying use of corticosteroids on bone and to analyze its relationships with bone metabolism and AD.
and cartilage tissue structural changes. Material and Methods: Cross-sectional study including 73
Material and Methods: The study used 68 Wistar rats in 4 patients with T2DM and 54 control subjects. Lumbar spine
series of experiments, 17 rats for each. The first group was and femoral BMD were measured by DXA (Hologic QDR
control one, the second group received 0.5 mg of prednisolone, 4500). The presence of cardiovascular disease (cerebrovascu-
the third –0.5 mg of prednisolone and 100 IU of vitamin D3, and lar disease, peripheral arterial disease, coronary heart disease)
the fourth –0.5 mg of prednisolone, 100 IU of vitamin D3 and was recorded. Intima- media thickness (IMT) was determined
0.726 IU of vitamin E. The agents were administered once daily by Doppler ultrasonography (Toshiba PowerVision 6000) and
intragastrically within a month. Calcium level, activity of total aortic calcification by evaluation of lateral view conventional
alkaline phosphatase and its isoenzymes and 25(OH)D content in X-rays of the thoracic and lumbar spine according to the
blood serum have been determined. After sacrificing the rats method described by Kauppila et al. DKK-1 was measured
pursuant to international ethical standards, bone tissue ash con- by quantitative sandwich ELISA developed by Biomedica
tent and mineral components of the ash have been studied. Bone (Biomedica Medizinprodukte GmbH and Co. KG, Wien, Aus-
tissue was morphologically analyzed by conventional methods. tria), with an intra- and inter-assay variability were of 7 % and
The results have been statistically processed. 9 %, respectively. Results were analysed using SPSS 15.0.
Results: Prednisolone leads to mineral exchange disorders, as Results: There were no differences in DKK-1 according to
evidenced by biochemical indications of calcium level in group. In T2DM group, women had higher DKK-1 concen-
blood, increase of alkaline phosphatase and its isomers levels trations than men: 27.50±17.18 pmol/l vs. 19.41±9.22 pmol/l
and reliable (р<0.05) reduction of 25(ОН)D in blood serum. vs, p=0.019. T2DM with aortic calcifications had higher
Combination of vitamins D3 and E inhibits the negative effect concentrations of DKK-1 27.89±17.13 pmol/l vs. 20.53±
of prednisolone and facilitates mineral exchange normaliza- 11.45 pmol/l vs, p=0.054. In T2DM patients with cardiovas-
tion, although mineral exchange indicators have not reached cular disease DKK-1 concentrations were higher compared to
the levels of the control group at the end of the experiment patients without CV disease: 29.79±16.75 pmol/l vs. 21.47±
(р < 0.05). Morphological data confirmed the results of 12.81 pmol/l vs, p=0.043. There was also a positive relation-
biochemical investigations. The rats, that received D3 and ship between DKK-1 and FN BMD (r 0.305, p=0.003).
E with underlying use of prednisolone mostly preserved Conclusion: Our preliminary data show a relationship be-
their bone tissue and epiphyseal cartilage. tween DKK-1 and vascular disease and bone mass in T2DM.
Conclusion: The study demonstrated that joint use of D3 and
E vitamins facilitates normalization of bone tissue mineral
exchange, prevents bone tissue demineralization and reduces P172
negative effect of prednisolone on bone tissue and cartilage WHAT DOES MULTIPLICATION OF TIDEMARKS
functional and structural conditions. MEAN IN THE OVINE FEMORO-TIBIAL JOINT?
R. Pirson 1 , A. Matagne 1 , J. F. Nisolle 1 , F. Hontoir 1 ,
P. Meirlaan 2 , P. Gustin 2 , N. Kirschvink 1 , P. Clegg 3 ,
P171 J. M. Vandeweerd 1
1
SERUM DICKKOPF1 (DKK1): RELATIONSHIP University of Namur-NARILIS, Namur, Belgium, 2University
WITH BONE METABOLISM AND of Liège, Liège, Belgium, 3University of Liverpool, Namur,
ATHEROSCLEROTIC DISEASE IN TYPE 2 Belgium
DIABETES
R. Reyes-Garcia1, P. Rozas-Moreno1, A. Garcia-Martin2, Objective: One reported histological feature of OA is multi-
B. Garcia-Fontana1, S. Morales-Santana1, M. Muñoz-Torres1 plication of tidemarks. Several studies in animals suggest that
 Osteoporos Int

multiple tidemarks are not necessarily associated with OA. to assess whether cartilage composition varies with anatomi-
The objectives of this study were to assess whether the num- cal regions, age, and histological changes associated with
ber of tidemarks varies with age and histological changes OA;(2) to map the composition of the cartilage, in the ovine
associated with OA in a population of sheep with no clinical FT joint.
signs of OA. Material and Methods: We assessed 70 knees from 8,
Material and Methods: 74 knees from 37 Texel and Ile de 15, and 12 ewes, respectively, aged from 0–3 years old,
France crossed ewes were assessed. There were 8, 15, 12 and 4–6, and 7–8. Osteochondral slabs and cartilage samples
2 animals, respectively, in four categories of age (between 0– were collected in 8 anatomical regions (axial and abax-
3 years old; 4–6; 7 and 8; ≥9). Osteochondral slabs were ial areas of the median part of medial and lateral tibial
collected in 8 anatomical regions (axial and abaxial areas of and femoral condyles). The OARSI criteria were used
the median part of medial and lateral tibial and femoral for histological evaluation. Cartilage samples were
condyles). The OARSI criteria were used for histological weighted before and after freeze drying to determine
evaluation of articular cartilage. The number of tidemarks water content. GAGs content was measured by using
was counted. the dimethylene blue assay, and collagen through the
Results: The OARSI scores were the highest for the axial part hydroxyproline assay.
of the medial femoral (mean 8.7, range 2–20) and tibial (mean Results: Water and GAGs contents were significantly higher
7.1, range 1–24) condyles. This study showed that in the medial condyle than in the lateral condyle both for the
multiplicated tidemarks were present in samples without car- tibia and the femur. GAGs were significantly in higher con-
tilage defect (OARSI score for structure 0 and 1), up to a centration in axial regions than abaxial regions, while collagen
number of 6.7 in older sheep. The number of tidemarks tended to be higher abaxially. Though trends could be identi-
increased significantly with age in samples without any carti- fied, there was no significant influence of age on biochemical
lage defect up to 8 years. While considering all categories of content, except for the axial part of the medial tibial condyle
age together, the number of tidemarks was not significantly where proteoglycans decreased with increasing age. Water
different in samples with intact (OARSI structural score of 0 content increased significantly with increasing OARSI
and 1) and with fibrillated or eroded (OARSI structural scores subscore for structure, while contents in proteoglycans and
higher than 1) cartilage. There was no correlation between the collagen did not vary significantly. A map of biochemical
number of tidemarks and the other subscores of the OARSI contents was designed in function of age and histological
scale. score.
Conclusion: Our study showed that multiplicated tidemarks Conclusion: The current study provided useful reference data.
were present in normal cartilage and was not necessarily Since cartilage has nearly no potential for healing, this study
correlated to other histological changes seen in OA. This will be useful for research in early subclinical stages of OA in
should be taken into account for histological assessment of an ovine model.
cartilage of the ovine knee.

P174
P173 EFFECT OF ZOLEDRONIC ACID ON THE
BIOCHEMICAL COMPOSITION OF CARTILAGE INCREASE IN THE THICKNESS OF THE FEMORAL
WITH NATURALLY OCCURRING DEFECTS IN THE NECK CORTICAL BONE
OVINE FEMORO-TIBIAL JOINT S. S. Rodionova1, A. N. Torgashin1, N. S. Morozova1
A. Matagne1, P. Clegg2, S. Tew2, N. Kirschvink1, P. Gustin3, 1
Federal Scientific Research Institute for Traumatology and
P. Meirlaen3, F. Hontoir1, J. F. Nisolle4, R. Pirson1, J. M. Orthopedics, Moscow, Russian Federation
Vandeweerd1
1
University of Namur-NARILIS, Namur, Belgium, 2Univer- Objective: Assess the impact of a single injection of zoledro-
sity of Liverpool, Liverpool, United Kingdom, 3University of nic acid on thickness of cortical bone of the femoral neck.
Liège, Liège, Belgium, 4University of Louvain-NARILIS, Material and Methods: The study included 20 patients
Louvain-la-Neuve, Belgium (women), the average age of which was 60.5 years they were
divided into two groups: 10 - The study group received
Objective: Biochemical changes of cartilage in OA include zoledronic acid 5 mg once after a hip fracture, and control
degradation of collagen network, loss of glycosaminoglycans group without the use of zoledronic acid. All patients of both
(GAGs), and modification of water content. There is few peer groups received calcium and vitamin D. Using DXA date, we
reviewed information about biochemical changes in the ovine analyzed the hip geometric parameters by HAS software
femoro-tibial (FT) joint model, especially in naturally ageing (Hologic Inc.). The HSA program uses mineral mass and
and deteriorating joints. The objectives of this study were (1) dimensional date from conventional DXA images of the hip
Osteoporos Int

to measure the structural dimensions of bone cross-sections medullary canal expressed (9.1 %) and moderate (27.3 %)
corresponding to 3 thin regions traversing the proximal femur bone formation is less common in most animals (63.6 %) of
(the narrow-neck (NN) region, the intertrochanteric (IT) re- his symptoms were mild. Communication between radiolog-
gion, and the shaft region (FS)). A multivariate analysis was ically determined by reduction of the medullary canal and
performed using the geometric variables statistically signifi- bone formation was significant (p<0.001), a fairly strong
cant in the univariate analysis (p<0.05) by SPSS. (Cramer’s=coefficient of 0.548) and direct (γ=0.777).
Results: Structural analysis of the femur showed that patients Conclusion: We prove that a marked recovery in refractive
treated with zoledronic acid had significantly (p<0.01) imaging medullary canal, with a probability of more than
increase in the thickness cortical bone of the femoral 80 % bone formation predicts moderate or severe intensity.
neck (NN). Average values in the group amounted to
0.171 g/cm2, in the control group 0.162 g/cm2.
Conclusion: Variation in the thickness of cortical bone mea-
sured by software HSA TM (densitometer Hologic) may serve P176
as an additional criterion for evaluating the effectiveness of CORRELATION BETWEEN GENETIC AND
treatment of systemic osteoporosis. BIOCHEMICAL MARKERS IN BELARUSSIAN
WOMEN WITH OSTEOPOROSIS
P. M. Marozik1, I. B. Mosse1, E. V. Rudenka2, A. V.
P175 Rudenka 2 , O. V. Samakhavets 2 , K. V. Zhur 1 , M. D.
CAPABILITIES OF REFRACTIVE IMAGING ON THE Ameliyanovich1
1
SYNCHROTRON RADIATION SOURCE IN THE Institute of Genetics & Cytology NAS Belarus, Minsk,
ASSESSMENT OF NEOGENESIS OF OWN BONE Belarus, 2Belarussian Medical Academy of Postgraduate
TISSUE IN BIOCOMPOSITE MATERIALS Education, Minsk, Belarus
A. N. Torgashin1, K. M. Podurec2, S. S. Rodionova1
1
Federal Scientific Research Institute for Traumatology and Objective: Osteoporosis is a systemic skeletal disease char-
Orthopedics, Moscow, Russian Federation, 2Russian Research acterized by loss of bone mass with increased susceptibility to
Center Kurchatov Institute, Moscow, Russian Federation fracture. It is considered to be a multifactorial disease with
environmental and genetic factors interacting. Genetic factors
Objective: To explore the possibility of refractive imaging at play an important role in the pathogenesis of osteoporosis.
the synchrotron radiation source to assess bone formation. Association analysis of candidate genes is an efficient way to
Material and Methods: As experimental animals used 93 identify the modest but real genetic effects of individual
females of white nonlinear rats who framed bone defect in polymorphisms. In present study, we performed a control-
volume 15–20 mm3 in the field of a tibia diaphysis. Defect case study in order to reveal whether a relationship exists
filling carried out on nondemineralized bone allografts. Ex- between analyzed gene polymorphisms and risk of fracture
periment terms have made 90 days. For estimation of grafts in Belarussian postmenopausal women.
reorganization were used the morphological and radiological Material and Methods: A total of 54 women with severe
methods including a refractive nondestructive testing on syn- postmenopausal osteoporosis (58.3±6.2 years) and 77 women
chrotron radiation. At the synchrotron radiation source were of the control group without osteoporosis (56.7±7.42 years)
evaluated radiological signs such as the presence and severity were included in this study. DXA was used to measure BMD.
of periosteal reaction, the presence of endosteal sclerosis, Polymorphic sites in osteoporosis predisposition genes (ApaI,
restoration of the medullary canal and other. Next conducted BsmI, TaqI and Cdx2 polymorphisms of VDR gene, G2046T
morphological evaluation of bone formation in the area of polymorphism of COL1A1 gene and T-13910C polymor-
tunable transplant. To determine the degree of correlation phism of LCT gene) were determined using polymerase chain
between the test signs used Cramer’s coefficient, which ranges reaction (PCR) analysis.
from 0 (no connection) to 1 (maximum bond), as well as the Results: The data shows that VDR ApaI, BsmI and LCT T-
coefficient γ, which varied from −1 (feedback) to 1 (direct 13910C polymorphisms are likely to influence the risk of
link). Determined coefficient p. SPSS, with a significance postmenopausal osteoporosis and make the greatest contribu-
level of p<0.05. tion to its development in Belarusian population. For the
Results: Revealed that for the prediction of the intensity of the bearers of AA-genotype of VDR ApaI gene polymorphism,
process of bone formation has the greatest significance of the risk of osteoporosis was 3.3 times higher, and for B-allele
radiological signs, as the restoration of the medullary canal. bearers of VDR BsmI, the risk of osteoporosis was 2.6 times
On the background of reduced medullary canal resulted in higher if compared to controls. A statistically significant cor-
significant (49.0 %) or moderate (36.7 %) bone formation, and relation between VDR ApaI and VDR TaqI risk genotypes and
only 14.3 % of its features remained weak. If not restored BMD level was observed.
 Osteoporos Int

Conclusion: By the analysis, we revealed the genetic mech- an important factor that can influence the drug effect on
anisms, determining decrease of BMD, and gene polymor- cartilage volume. X-rays were found to be much less sensitive
phisms, which can be considered as markers of predisposition than MRI at documenting the protective effect of treatment on
to osteoporosis. Screening of these genetic markers in clinics structural changes.
may enable early identification of risk groups to perform Disclosures: Funded in part by Bioiberica. JPP, JMP: consul-
preventive measures. tants for Bioiberica, shareholders in ArthroLab. JPR: consul-
tant for ArthroLab. FA: employee of ArthroLab. CR: bursary
from the Fondation du CHUM.
P177
IMPACT OF MENISCAL EXTRUSION ON THE
PROGRESSION OF KNEE OSTEOARTHRITIS P178
STRUCTURAL CHANGES AND THE EFFECTS OF RISK OF FALLS AND OSTEOPOROTIC FRACTURES
TREATMENT: DATA FROM THE OSTEOARTHRITIS AMONG WOMEN AGED 50 AND ABOVE
INITIATIVE PROGRESSION COHORT O. A. Nikitinskaya1, A. J. Feklistov1, N. V. Toroptsova1
J.-P. Pelletier1, C. Roubille 1 , F. Abram 2 , P. Delorme 1 , 1
FSBI Research Institute of Rheumatology V.A. Nasonova
J. P. Raynauld 1 , J. Martel-Pelletier 1 RAMS, Moscow, Russian Federation
1
Osteoarthritis Research Unit, University of Montreal
Hospital Research Centre (CRCHUM), Montreal, Canada, Objective: To evaluate the frequency of falls and osteo-
2
Medical Imaging Research & Development, ArthroLab porotic fractures among women aged 50 and above in
Inc., Montreal, Canada 1-year prospective study.
Material and Methods: A cohort of 276 women (mean age
Objective: To determine, using data from participants en- 63±7) was randomly chosen among Moscow region popula-
rolled in the progression cohort of the OAI, the effects of tion. The participants completed questionnaire for evaluation
existing meniscal extrusion on the extent of cartilage loss of the 10-year fracture risk (FRAX® tool) and performed Short
and structural changes over time, and response to pharmaco- Physical Performance Battery (SPPB). Telephone contact for
logical treatment including the combination of glucosamine registration of falls and osteoporotic fractures (OPF) was done
and chondroitin sulfate (Glu/CS). in a year.
Material and Methods: Knee osteoarthritis (OA) patients Results: 210 women (76 %) responded after 1 year passed,
were stratified based on the presence/absence of medial among them 65 women (31 %) were in a high 10-year fracture
meniscal extrusion at baseline and on whether or not they risk for any OPF. 35 of Subjects (17 %) reported about falls
received conventional OA pharmacological treatment (anal- during the year after the exam, among them 24 (69 %) had
gesics/NSAIDs) and/or Glu/CS for 24 consecutive months. already a history of falls during 1 year prior to the study. In a
The main outcomes were knee structural changes including group of 175 women without falls only 25(14 %) had past
cartilage volume assessed by MRI and loss of joint space history of falls (p<0.01). Mean SPPB at baseline was lower in
width (JSW). patients who had falls than among those without falls (8.7±
Results: Participants reported taking (+; n=300) or not taking 2.4 vs. 9.5±2.3, respectively). Nine women (4.3 %) had OPF
(−; n=300) OA treatment (analgesics/NSAIDs). Those with during the year: 7–with high FRAX and 2–with low FRAX
meniscal extrusion had more severe disease at baseline. In the value (11 % vs. 1.4 %, p=0.002). Fracture probability was
−analgesics/NSAIDs group with meniscal extrusion, partici- 8.63 times higher in a high FRAX group comparing to the
pants taking Glu/CS had significantly reduced loss of cartilage low-risk group (OR 8.63: 95%CI 1.5; 62.11). In a high-risk
volume at 24 months in the medial tibiofemoral compartment group fractures occurred more often among those who had
(p=0.02) and lateral plateau (p=0.05). No effect of Glu/CS history of OPF comparing to those who had high FRAX, but
was observed in patients without extrusion. In the +analgesic/ did not have OPF in the past (67 % vs. 17 %, p=0.002).
NSAIDs group without meniscal extrusion, those taking Glu/ Fractures in the past and high FRAX increased the risk of
CS had significantly reduced loss of cartilage volume in the OPF in 11 times (OR 11: 95%CI 8.3; 32.5), falls in a year
global knee (p=0.055), medial compartment (p=0.05), lateral before baseline exam and high FRAX–in 5.25 times (OR
plateau (p=0.007), and trochlea (p=0.04). No effect of Glu/ 5.25: 95%CI 0.82; 42.4).
CS treatment occurred in participants with extrusion. No Conclusion: During the year each 6th woman aged 50 and
significant reduction in JSW was found between those taking above had at least one fall, among the fallers each 4th woman
and not taking Glu/CS treatment. had a fracture. High FRAX, history of fractures and falls in the
Conclusion: This study confirms that combined administra- past can be a basis in Russia to start medical treatment of
tion of Glu/CS has significant protective effects on structure in osteoporosis without making such an expensive medical sur-
knee OA. The presence of meniscal extrusion was found to be vey as densitometry.
Osteoporos Int

P179 P180
CORRECTION OF VALGUS HINDFOOT EVOLUTION OVER TWO YEARS OF FUNCTIONAL
DEFORMITY IN SUBTALAR JOINT CONTRIBUTES AND MOTOR ABILITIES AMONG NURSING HOME
TO ANKLE JOINT PAIN RELIEF IN RHEUMATOID RESIDENTS
ARTHRITIS CASES F. Buckinx1, C. Beaudart1, J. Slomian1, D. Maquet2, M.
M. Hirao 1, H. Tsuboi 2, S. Akita 1, M. Matsushita2 , S. Demonceau2, S. Gillain3, J. Petermans3, J.-Y. Reginster1, O.
Ohshima3, Y. Saeki3, J. Hashimoto2 Bruyère1
1 1
Orthopaedics, National Hospital Organization, Osaka Department of Public Health, Epidemiology and Health Eco-
Minami Medical Center, Kawachinagano, Japan, 2Rheumatolo- nomics, University of Liège, Liège, Belgium, 2Department of
gy, National Hospital Organization, Osaka Minami Medical Motricity Sciences, University of Liège, Liège, Belgium,
Center, Kawachinagano, Japan, 3Clinical Research, National 3
Geriatric Department, CHU Liège, Liège, Belgium
Hospital Organization, Osaka Minami Medical Center,
Kawachinagano, Japan Objective: The objective of this study was to observe the
evolution, over a 2-year period, of functional and motor
Objective: We often see painful ankle joint destruction com- abilities among institutionalized elderly people.
plicated with painful subtalar valgus deformity in rheumatoid Material and Methods: A total of 100 subjects were included
arthritis (RA). For such cases, subtalar deformity was firstly in the study and followed prospectively for a 2-year
corrected and fused, and then ankle joint pain has been period to assess the evolution of their functional and
observed. motor skills. The Tinetti test and a quantitative gait
Material and Methods: Two RA women were underwent analysis performed by a triaxial accelerometer test were
correction and fusion surgery in subtalar and performed, in single and dual task, at the beginning and
talonavicular joint, and/or calcaneal osteotomy with au- at the end of the study.
tograft and allograft bone. They had been using wheel- Results: The final tests were performed on 36 subjects (27
chair because of severe painful destruction in ankle joint deceases, 20 physical disability, 12 refusals and 5 relocations).
and hindfoot despite of TCZ (tocilizumab) biologics Patients who completed the final tests showed, at baseline,
therapy. After surgery, teriparatide (PTH) administration clinical characteristics significantly different from patients
and low intensity pulsed ultrasound (LIPUS) irradiation who did not carried out these tests for the dependence score
were performed to promote bone formation and of Katz (13.6±3.7 vs. 17.5±5.1, p=0.0001), the Tinetti score
strengthening in both cases, under keeping nonweight- (21.3±3.8 vs. 17.5±4.5, p=0.00004) and step length (0.79±
bearing with BK casting. After 2 months later, partial 0.24 vs. 0.68±0.27, p=0.03). Gait speed (p=0.0003), step
weight bearing was started, and additional 2 weeks later length (p=0.004) and coefficient of regularity of gait cycles
full weight-bearing was started. (p=0.00002) decreased significantly between the beginning
Results: Of course, both patients complained no pain in and the end of the study. Quantitative gait analysis, measured
subtalar, (case 1: 15 months, case 2: 6 months after sur- by dual task, showed a significant reduction in gait speed
gery), furthermore drastic pain reduction in ankle joint was (p=0.00002) and regularity of gait cycles (p=0.03). The
also observed (VAS; case 1: 15 mm, case 2: 5 mm), con- evolution of the Tinetti score, over a 2-year period, was
sequently they could walk without any support. In addi- not significant (p=0.38) but was significantly correlated
tion, observation of X-ray picture of hip to calcaneus view with changes in step length (r=0.57) and regularity of gait
(HC view) [1] revealed that loading axis of whole lower cycle (r=0.75).
extremities passed more nearly to the center of ankle joint Conclusion: The degradation of some gait parameters is
(case 1: 15 mm preoperative→6.5 mm postoperative, case observed in elderly institutionalized patients followed for a
2: 21 mm preoperative→7 mm postoperative). In the period of 2 years. The evolution of step length and regularity
varus/valgus stress view of X-ray picture, case 1 showed of gait cycles is not correlated to the evolution of the Tinetti
the instability in ankle joint, on the other hand, case 2 test. This test seems to be less sensitive to changes than certain
showed no instability. parameters of quantitative gait analysis.
Conclusion: Correction of valgus hindfoot deformity in
subtalar joint causes the centralization of weight bear-
ing line in ankle joint, so it has effect on not only P181
elimination of subtalar pain, but also ankle pain relief. PROGNOSTIC FACTORS OF DEATH AMONG
From this observation, there is a possibility to pre- NURSING HOMES RESIDENTS FOLLOWED
serve ankle joint under RA tight control without ankle PROSPECTIVELY FOR A PERIOD OF 2 YEARS
surgery. F. Buckinx1, J. Slomian1, D. Maquet2, M. Demonceau2,
References: [1] Haraguchi et al. J Jpn Soc Surg Foot 2010 S. Gillain3, J. Petermans3, J.-Y. Reginster1, O. Bruyère1
 Osteoporos Int

1
Department of Public Health, Epidemiology and Health Eco- Material and Methods: The study was conducted in Arar
nomics, University of Liège, Liège, Belgium, 2Department of central Hospital, Arar, Saudi Arabia. All patients were Saudi
Motricity Sciences, University of Liège, Liège, Belgium, women residing in Arar and have completed 40 years of age.
3
Geriatric Department, CHU Liège, Liège, Belgium A questionnaire containing demographic data, habits, diet,
exercise, medical history and drugs taken was given to the
Objective: The objective of this research was to determine the patients. The vitamin D level <50 nmol/l was considered as
predictors factors of risk of death among nursing homes vitamin D deficiency as per the WHO definition. The BMI
residents, followed prospectively for a 2-year period. was calculated from height in cm. and weight in kg. The BMI
Material and Methods: A total of 100 institutionalized was categorized as follows: <18.5 was considered under-
subjects were included in the study and were followed weight, 18.5–24.9 was considered normal and >30 as obese.
prospectively for 2 years. At the beginning of the monitoring BMD was measured at the femoral neck on the right side and
period, demographics characteristics were collected and func- left side and the lumbar spines L1-L4. To find out whether
tional tests (Tinetti test) and motor analysis (quantitative gait there is any significant association between BMD and
analysis performed using a triaxial accelerometer) were independent factors like age, BMI and exercise, Fisher’s
performed. exact test was used. The level of significance was fixed
Results: At the end of the study period, 27 deaths had oc- at P value <0.05.
curred. The patients who deceased had, compared to subjects Results: Among the 100 female patients selected, 82 % had
still alive, a BMI significantly lower (23.3±4.9 kg/m2 vs. vitamin D deficiency. The BMI was normal in only 6.1 % of
26.5±5.3 kg/m2, p=0.007), a dependence score of Katz the patients while 93.9 % of the patients were overweight or
significantly higher (18.3 ± 4.9 vs. 15.3 ± 4.9, p = 0.009) obese. Only 8.5 % of the patients were in the habit of doing
and a score of Tinetti significantly lower (16.9±4.6 vs. exercise while 91.5 % of the patients were not doing any
19.6±4.4, p=0.008). However, there was no difference exercise. 80 % of the patients with normal body weight had
between these two groups for gender, age, number of low BMD while 50 % of the obese patients had normal BMD.
drugs consumed and the use of a walking support. In Among the patients who did exercise 85.7 % had normal bone
addition, 48.1 % of the deceased had a history of repeated density, 14.3 % had osteopenia.
falls against 24.7 % among the patients still alive (p= Conclusion: The results of the present study show that obesity
0.01). After adjustment on potential confounding vari- is not a protective factor for BMD in women above 40 years of
ables, only BMI was statistically significantly associated age. Exercise, smoking and calcium deficient diet are impor-
with the risk of death with an odds ratio of 0.86 (95%CI: tant factors related to the development of osteoporosis in
0.77–0.96, p=0.04). Saudi women.
Conclusion: A decreased BMI seems to be a predictor of risk Acknowledgements: The authors are grateful to Director
of death among patients living in nursing homes. However, of Arar central Hospital, Deanship of Research, and Dr.
many confounding variables (strength, weakness, etc.) were Zakariya M.S Mohammed for their valuable help in this
not evaluated in this study and therefore these results should project
be interpreted with caution.

P183
HIGH ADHERENCE TO DENOSUMAB THERAPY IN
P182 THE TREATMENT OF POSTMENOPAUSAL
RELATIONSHIP BETWEEN BODY MASS INDEX OSTEOPOROTIC WOMEN IN BULGARIA
AND BONE MINERAL DENSITY IN SAUDI WOMEN P. Solakov1, S. Kuzmanova1
1
ABOVE 40 YEARS WITH VITAMIN D DEFICIENCY Clinic of Rheumatology, Medical University, Plovdiv,
A. Oommen1, I. Alzahrani2, A. Shoro3 Bulgaria
1
Department of Anatomy, Northern Border University, Arar,
Saudi Arabia, 2Department of Pathology, Northern Border Objective: To assess medical adherence of women with
University, Arar, Saudi Arabia,3Department of Radiology, postmenopausal osteoporosis to a long-term treatment
Arar Central Hospital, Arar, Saudi Arabia with denosumab. Also the factors limiting the imple-
mentation of prescribed treatment with denosumab were
Objective: 1) To find out the prevalence of vitamin D analyzed.
deficiency in Saudi women above 40 years of age. 2) Material and Methods: We included 112 postmenopausal
To find out the association, if any, between BMD and women, age from 55 to 80 years, who had been switched to
BMI in Saudi women above 40 years of age who have denosumab after different previous medication with
vitamin D deficiency. bisphosphonates (95 oral and 17 intravenous). This open,
Osteoporos Int

prospective, single- center study were has been to evaluated Conclusion: Vertebral fracture is a common and severe com-
adherence terms of two-yearly injection- based treatment with plication of osteoporosis in the postmenopausal women. It
denosumab 60 mg sc injections every 6 months in osteopo- often occurs earlier than hip fracture and increases the risk
rotic patients in routine clinical care setting. We describe of new vertebral and hip fractures. The drug therapy can
whether positive feedback of OP patients based on measured effectively reduce the risk of new fracture. Early detection of
BMD increases and good safety profile, have an impact on vertebral fracture is important, but the underdiagnosis is
patient’ real life medical adherence. The diagnosis osteoporo- worldwide. DXA VFA improves the detection of vertebral
sis was based on international accepted inclusion criteria were fracture and is lower cost, less radiation and greater patients
BMD value at DXA T- score -2.5 to −4.0 SD. The study was convenience than standard spine radiographs. The vertebral
conducted over 36-month period (2011–2013). fractures were underdiagnosed in 69 % patients before DXA
Results: Patients received denosumab within 24 months VFA in our series and were present in the patients with normal
took a greater medication adherence, in detail: compli- BMD or osteopenia. The vertebral fracture rate was higher in
ance after 12 months was 95.9 %; after 24 months - the postmenopausal women with lower BMD, advancing age
97.3 %; persistence after 12 months was 92.6 %; after and long duration of menopause. The T-score of <−2.5 SD and
24 months - 81.4 %; adherence after 12 months was fragile fracture are frequently used as intervention threshold.
90.2 %; after 24 months - 78.8 %. The patient medical The detection of vertebral fracture is good for the patients to
adherence dropped out because 21 patients gained DXA T- start the therapy for osteoporosis. We recommended that VFA
score<−2.5, and other 3 because of health economic problems. was performed with BMD test for postmenopausal women in
Conclusion: Postmenopausal women with osteoporosis a first check and in check for monitoring the response of the
vastly high degree of medical adherence to treatment to therapy.
denosumab was found. After 12 and more after 24 months
medication adherence was reduce from treated patients which
pass in osteopenia.
P185
FREQUENCY OF POLYMORPHISMS IN
P184 CANDIDATE GENES FOR OSTEOPOROSIS VDR,
DIAGNOSIS OF VERTEBRAL FRACTURE WITH ESR1, LRP5, OPG AND SOST IN PATIENTS FROM
DXA IMAGE IN POSTMENOPAUSALWOMEN CENTRAL MORAVIA, CZ: PART I
Y. Z. Li1, S. Q. Cai2, L. S. Yan2, H. F. Zhuang3 P. Novosadová1, P. Hrdý 1 , P. Fojtik 2 , R. Richterova 3 ,
1
Department of Orthopedics, Second Affiliated Hospital of V. Krišáková 3 , A. Boday 3
Fujian Medical University, Quanzhou,Fujian, China, 2Depart- 1
Mediekos Amb. Ltd., Osteological Centre, Zlín, Czech
ment of Radiology, Second Affiliated Hospital of Fujian Republic, 2 AGEL Research and Training Institute,
Medical University, Quanzhou, Fujian, China, 3Department Ostrava-Vítkovice, Czech Republic, 3AGEL Research
of Orthopedics, Second Affiliated Hospital of Fujian Medical and Training Institute, Nový Jičín, Czech Republic
University, Quanzhou, Fujian, China
Objective: In cohorts examined for osteopenia and osteopo-
Objective: In order to improve the diagnosis of vertebral rosis in different time intervals from 2011 to 2013, we exam-
fracture, vertebral fracture assessment and bone densitometry ined the following polymorphisms: VDR- BsnI(G>A),
were done for the postmenopausal women at the same time. ESR1-(PvuII(T>C) LRP5-(Val667 Met) LRP5-(Ala I 330
Material and Methods: VFA and bone densitometry were Val), OPG 1181G>C, SOST (10565ins/delGGA). In a totally
performed for postmenopausal women aged >50 year. The independent cohort we examined a composition according to
effects of BMD, age and menopause duration on vertebral type Apo E.
fracture were analyzed. Material and Methods: Laboratory methods: DNA was iso-
Results: Vertebral fractures were present in 59 of 217 lated by kit MagAttract DNA Blood Mini M48 using auto-
(27.2 %) patients. Vertebral fracture rate was 21.6 % in 125 mated isolator Biorobot M48 (Qiagen) from 200 μl
patients with normal BMD or osteopenia and 34.8 % in 92 noncoagulable blood samples. Detection of all polymor-
patients with osteoporosis (p<0.05). Vertebral fracture rates phisms was carried out by using a method of real time PCR
increased with age and was 12.5 %, 25.6 % and 44.8 %, using hydrolysation and FRET probes on LC 480 II(Roche).
respectively, in the patients aged 50–59 year, 60–69 year Clinical characteristics: These cohorts are with primary oste-
and >70 year (p<0.05). Vertebral fracture rates increased with oporosis or osteopenia. Probands with secondary osteoporosis
duration of menopause and were 14.6 %, 20.7 % and 45.5 %, or with skeleton damaging medications were excluded. These
respectively, in the patients with menopause duration of 0– were composed of female population including children, age
9 year, 10–19 year and >20 year. was not considered. Average age of all cohorts was 58.5 years.
 Osteoporos Int

Control cohort had 80 probands, average age 59 years. Male or with skeleton damaging medications were excluded.
population was not evaluated. These cohorts were composed of female population
I. n=2127 polymorphisms VDR, ESR 1 including children, age was not considered. Average
II. n=1624 polymorphisms VDR, ESR 1, LRP5(Val667Met), age of all cohorts is 58.5 years. The control cohort
LRP5(Ala I 330Val) had 80 probands, average age 59 years. Male population was
III. n=457 polymorphisms VDR, ESR, OPG, SOST not evaluated.
IV. n=780 according to type Apo E Results: III. cohort n=457 frequency of combinations VDR,
V. n=80 controls with no polymorphisms, with no symptoms ESR, OPG, SOST
of osteoporosis VDR-ESR 15 - 3.15 % VDR-OPG 28 - 5.89 % VDR-SOST 8
Results: Cohort III: VDR - MUT 62 - 13.56 % ESR1 - MUT - 1.68 % ESR-OPG 17 - 3.57 %
110 - 24.07 % OPG - MUT 104 - 21.89 % SOST- MUT 78 - ESR-SOST 21 - 4.42 %
16.42 % (MUT - mutated polymorphism, complete results of IV. cohort n=457 more frequent combinations of mutated
all cohorts in the poster) polymorphisms
Conclusion: The occurrence of polymorphisms which have VDR-ESR1- LRP5 (AlaI 330 Val) -0
an influence on skeletal phenotype in the examined population VDR-ESR-LRP5 (Val667 Met) -0
is biologically and statistically very important. The most fre- VDR-ESR1 - OPG 7 - 1.47 %
quent are heterozygote forms. The importance of this finding VDR-ESR1 - SOST 0
is also intensified by the fact that this is a population we VDR-ESR1- OPG-SOST - 3 - 0.67 % (Complete results in the
commonly meet at our clinics. In the second part of the poster.)
research the cohort was examined to follow the frequency of Conclusion: Based on the results it is possible to state that
combinations of individual polymorphisms. Here we paid biologically significant combinations of mutated gene poly-
attention only to mutated polymorphisms. morphisms are formed by mutated polymorphisms
VDR-ESR-OPG or SOST. The high frequency of OPG
or SOST combinations is relevant; these are genes with
P186 an impact on the controlling axes of bone tissue metabolism
FREQUENCY OF COMBINATIONS OF MUTATED RANK/RANKL/OPG. The statistic importance of the
POLYMORPHISMS IN CANDIDATE GENES FOR influence these mutations make on the bone phenotype
OSTEOPOROSIS VDR, ESR1, LRP5, OPG AND SOST is elaborated mathematically in the third part of this
IN PATIENTS FROM CENTRAL MORAVIA, CZ: PART report.
II
P. Novosadová1, P. Hrdý 1 , P. Fojtik 2 , R. Richterova 3 ,
V. Krišáková 3 , A. Boday 3 P187
1
Mediekos Labor s.r.o., Osteological Centre, Zlín, Czech BONE MICROARCHITECTURE ASSESSMENT BY
Republic, 2 AGEL Research and Training Institute, TRABECULAR BONE SCORE IN PATIENTS WITH
Ostrava-Vítkovice, Czech Republic, 3AGEL Research SYSTEMIC SCLEROSIS
and Training Institute, Nový Jičín, Czech Republic K. Simic-Pasalic1, N. Damjanov1, G. Marinkovic2
1
Institute of Rheumatology, Belgrade, Serbia, 2Health Centar
Objective: In the examined cohort for osteopenia and osteo- Zvezdra, Belgrade, Serbia
porosis we examined the following polymorphisms: VDR-
BsnI(G>A), ESR1-(PvuII(T>C) LRP5-(Val667 Met) Objective: Trabecular bone score (TBS) is a novel software
LRP5-(Ala I 330 Val), OPG 1181G>C, SOST (10565ins/ application for bone quality assessment, in addition to BMD
delGGA). In this work only mutated polymorphisms were measurement. Objective is to examine the microarchitectural
processed. bone status by TBS in SSc patients and its relation to BMD
Material and Methods: Laboratory methods: DNA was iso- and clinical features of the disease.
lated by kit MagAttract DNA Blood Mini M48 using auto- Material and Methods: The cross-sectional study included
mated isolator Biorobot M48(Qiagen) from 200 μl 40 female SSc patients. The parameters of lumbar spine
noncoagulable blood samples. Detection of all polymor- BMD and total body (lumbar spine BMD and T-score and
phisms was carried out by using a method of real time PCR BMC - bone mineral content) were examined by DXA on
using hydrolysation and FRET probes on LC 480 II(Roche). Hologic Discovery device, TBS analysis was carried out
Clinical characteristic of the cohort: These cohorts are by Insight TBS® - MedImaps. Demographic data and
with primary osteoporosis or osteopenia, we gradually clinical characteristics of SSc patients were collected from
examined a given number of polymorphisms, their types the EULAR Scleroderma Trials and Research minimal
and combinations. Probands with secondary osteoporosis essential data set database. SSc activity was determined
Osteoporos Int

using Valentini’s questionnaire (SSAS). We examined the methods. BMD was measured in lumbar spinal column, total
correlation between the TBS and demographic and clinical hip and femoral neck using densitometer (DXA) Lunar iDXA
characteristics of the patients. (GE Healthcare).
Results: The average age of the patients was 57.22 (36–73.2± Results: We studied a group of 596 female patients with
8.69) years, postmenopausal 37/40, duration of disease 9.06 postmenopausal osteoporosis. Above stated polymorphisms
(1–26±6.8) years, BMI 24.42 (17.5 to 37.1±4.3). Diffuse were compared with a level of expression of bone phenotypes
disease subtype (dSSc) had 19/40 (47.5 %), limited (lSSc) in the given individuals. Studied phenotypes are: BMD, lab-
21/40 (52.5 %). The most frequent clinical features were oratory parameters of calcium phosphate metabolism (Ca, P),
Raynaud phenomenon, sclerodactily, digital ulcers, BTM (OC, CTX, bone ALP). From anamnesis we followed
esophageal dysfunction, joint contractures, dyspnea, mainly typical osteoporotic fractures. We managed to prove a
etc. Average disease activity as by SSAS=6.5. Spine significantly lower BMD in the lumbar spine area for geno-
BMD was 1.03±0.321 g/cm2, TBS 1.364±0.034, whole bone type BB SNP Bsml: 0.864 g/cm2 vs. 0.896 g/cm2 (p=0.05).
mineral content 2.25±0.03 kg. There was no statistically Next we proved a significantly lower BMD in the neck of the
significant correlation between the BMD, BMC and TBS. proximal femur for genotype pp SNP Pvull: 0.742 g/cm2 vs.
TBS was inversely correlated with the age and use of GC 0.771 g/cm2 (p<0.05). In individuals with a BB and pp
(r=−0.330, −0.385, p=0.03), while positively correlated with genotype combinations the lowered BMD is also significantly
SSc activity, presence of digital ulcerations and calcinosis (r= lower, approximately by 17 %.
0.342, 0.341, −0.367, respectively; p<0.05). Conclusion: Our observations show a slight but statistically
Conclusion: Lower TBS values are associated with age and significant difference in an amount of bone phenotype BMD
the use of steroids in the treatment. Higher TBS values are expression in observed polymorphisms Bsml and Pvull. In
associated with the presence of digital ulcers, calcinosis and combinations of these selected genotypes the effect of lowered
higher disease activity. BMD is increased. This proves a theory of mutual interactions
of individual genotypes.

P188
RELATION AMONG BONE PHENOTYPES AND P189
GENE POLYMORPHISMS FOR VITAMIN D STATISTICAL SIGNIFICANCE OF INDIVIDUAL
RECEPTOR (VDR) AND ESTROGEN RECEPTOR MUTATED POLYMORPHISMS VDR, ESR1, OPG,
ALPHA (ESRΑ) IN THE CENTRAL MORAVIA SOST AND THEIR COMBINATIONS IN PATIENTS
REGION FROM CENTRAL MORAVIA, CZ: PART III
P. Hrdý1, P. Novosadová1, P. Fojtik2, R. Richterova3, A. P. Novosadová1, P. Hrdý 1 , P. Fojtik 2 , R. Richterova 3 ,
Boday3, P. Horak4 M. Janura 4 , K. Janurová 5
1
Mediekos Ambulance s.r.o., Zlin, Czech Republic, 2AGEL 1
Mediekos Amb. Ltd., Osteological Centre, Zlín, Czech Repub-
Research and Training Institute - Ostrava-Vítkovice Branch, lic, 2AGEL Research and Training Institute, Ostrava-Vítkovice,
Ostrava-Vítkovice Hospital, Centre of Care for GIT, Ostrava, Czech Republic, 3AGEL Research and Training Institute, Nový
Czech Republic, 3AGEL Research and Training Institute - Nový Jičín, Czech Republic, 4Department of Nature Science in
Jičín Branch, AGEL Laboratories, Novy Jicin, Czech Republic, Kinanthropology Faculty of Physical Culture Palacky Univer-
4
University Hospital Olomouc, Olomouc, Czech Republic sity, Olomouc, Czech Republic, 5Department of Applied Math-
ematics, Technical University, Ostrava, Czech Republic
Objective: Characteristics of a bone mineral are described in
bone phenotypes: BMD, bone quality, bone turnover markers Objective: In the examined cohort for osteopenia and osteo-
(BTM). A level of clinical expression of bone phenotypes is porosis we examined the following polymorphisms: VDR -
significantly influenced by genes for osteoporosis. Individual BsmI, ESR1-PvuII, OPG - 1181G>C, SOST - 10565ins GGA
genotypes are determined by combinations of polymorphisms and their combinations for osteological parameters in patients
of these genes. In our work we studied 2 polymorphisms. with osteoporosis and osteopenia.
Material and Methods: DNA was isolated by kit MagAttract Material and Methods: Laboratory methods: DNA was iso-
DNA Blood Mini M48 using automated isolator Biorobot lated by kit MagAttract DNA Blood Mini M48 using automat-
M48(Qiagen) from 200 μl noncoagulable blood samples. ed isolator Biorobot M48 (Qiagen) from 200 μl noncoagulable
We studied 2 polymorphisms: in gene for VDR BsmI blood samples. Detection of all polymorphisms was carried out
(rs1544410,G>A), in gene for ESRα PvuII (rs2234693,T>C). by using a method of real time PCR using hydrolysation and
Osteological parameters were then compared with frequency FRET probes on LC 480 II(Roche). Clinical cohort were com-
of genotype occurrence. BTM as osteocalcin (OC) and β- posed of female population from 45 to 79 years. The control
crosslaps (CTX) were measured using standard biochemical cohort had 63 probands. The total cohort n=213.
 Osteoporos Int

Examined osteological parameters: Examined BMD L- of deficiency was defined by a 25(OH)D level below 20 ng/mL
spine and proximal femur (iDXA GE Lunar) markers for bone and an insufficiency by a level between 20 and 29 ng/mL.
metabolism OC (osteocalcin) and CTX, Vitamin 25OHD3, Results: The mean level of 25(OH)D in patients population
PTH, Ca (total calcium). was 32.5±9.3 ng/mL. The levels of it were not differ among
Results: Statistical method: The normality of data distribution boys (33.7 ± 10.0 ng/mL) and girls (31.7 ± 8.4 ng/mL)
was verified using the Kolmogorov-Smirnov test. The data (p>0.05). Overall, 7 % (n=8) of the pediatric population of
were analyzed using a one-way ANOVA. A Fisher’s least the big city were 25(OH)D deficient and 31.6 % (n=36)
significant difference (LSD) procedure was used for all post insufficient. The levels of 25(OH)D among age group: in boys
hoc pairwise comparisons (Statistica Version 10.0, Stat-Soft, 5-9y -33.5±8.5; 10–13y −31.5±8.3, 14–17y −36.5±12.7 ng/mL
Inc., Tulsa, Oklahoma, USA). The level of significance was set (p>0.05 among groups), in girls 5–9y −35.9±8.8; 10–13y
at 0.05. For statistical processing we used groups where n>8. −30.1±6.6, 14–17y −27.8±7.7 ng/mL (p5-9/10-13<0.05, p5-
9/14-17<0.05). In age 14–17y 25(OH)D was significantly lower
Table. Significant differences among measured groups in girls compare with boys (p<0.05). 70.6 % 14–17y girls were
25(OH)D deficiency or insufficiency.
Parameter significant differences Conclusion: 25(OH)D deficiency and insufficiency is com-
BMD_P 2×8*, 3×8*, 6×8῀, 7×8῀ mon in the general pediatric population of Belarus capital city,
BMD_K 1×6*, 2×6*, 3×6*, 4×6*, 6×7῀, 1×8*, 2×8**, 3×8**, 7×8῀ with more frequency in girls at 14–17 years.
CTx 3×7῀, 4×7῀
PTH 3×8*
Ca 5×8῀
P191
Legend: 1 - ESR; 2 - OPG; 3 - SOST; 4 - VDR, OPG; 5 - ESR, DETECTION OF VERTEBRAL FRACTURES IN DXA
OPG; 6 - ESR, SOST; 7 - OPG, SOST; 8 - control; VFA IMAGES
**p<0.01; *p<0.05; ῀p<0.10 S. Q. Cai1
1
Department of Radiology, Second Affiliated Hospital of
Conclusion: We can find statistical significance of influencing Fujian Medical University, Quanzhou, China
basic osteological parameters even in this smaller statistical
cohort. This conclusion gradually contributes to an approval Objective: For the improvement of the diagnosis of the ver-
for an introduction of some gene examinations in the context tebral fractures, the BMD examination and lateral image of
of individual genomic and personalized medicine in the field thoracolumbar spine were taken through the DXA for the
of osteology. assessment of the vertebral fractures.
Material and Methods: BMD of hip and lateral image of
thoracolumbar spine were taken through DXA for the 204
P190 patients aged >50 year. There were 184 females and 20 males.
PREVALENCE OF 25-HYDROXYVITAMIN D There were 85 patients between 50–60 year, 60 between 61–
DEFICIENCY IN PEDIATRIC POPULATION OF 70 year, and 59 patients aged >70 year. The vertebral fracture
BELARUS CAPITAL CITY assessment was performed.
S. V. Baiko1, A. V. Sukalo1, E. V. Rudenka2 Results: There were 98 fractured vertebrae in 54 of 204
1
Belarusian State Medical University, Minsk, Belarus, patients (26.5 %). The vertebral fracture rate was 16.5 % in
2
Belarussian Medical Academy of Postgraduate Education, the patients aged 50–60 year, 16.7 % in the patients aged 61–
Minsk, Belarus 70 year and 50.8 % in the patients aged >70 year. The
vertebral fractures were present in 3 of 24 patients (12.5 %)
Objective: Vitamin D deficiency is more and more prevalent with normal BMD, 19 of 97 patients (19.6 %) with osteopenia
worldwide whereas current data show that optimal levels should and 32 of 83 patients (38.6 %) with osteoporosis. The verte-
be >30 ng/mL. The aim of this study was to assess vitamin D bral fractures increased with advancing age and lower BMD.
status in health children aged 5–17 years living in metropolis. Conclusion: The vertebral fractures are the most common
Material and Methods: Biomarkers of phosphate/calcium osteoporotic fracture and are the hallmark of osteoporosis. It
metabolism, among them 25-hydroxyvitamin D (25(OH)D), increases with age and with decreased BMD. It is a strong
were measured in a prospective cohort of 114 children (55 predictor of fracture risk. Presence of a vertebral fracture has
boys, age 12.1±3.4, 59 girls age 11.4±3.8), all patents were 5-fold increased risk of new vertebral fracture and 2-fold
divided in age groups: 5–9, 10–13, 14–17. A 25(OH)D increased risk of hip fracture. Effective therapies can reduce
Osteoporos Int

new fractures. The detection of vertebral fractures are critical- 2. Unnanuntana A, et al. J Bone Joint Surg Am 2010;92:743.
ly important, but many studies show that vertebral fractures 3. Boskovic K, et al. Balneoclim 2013;39:281. 4. Boskovic K,
are often not diagnosed and only 30 % of vertebral fractures et al. Med Pregl 2013;66:221.
come to medical attention. Modern DXA image allows for
vertebral fracture assessment at the time of a bone densitom-
etry test. The vertebral fracture rate was 26.5 % in our series
and 64.8 % patients with vertebral fractures were not diag- P193
nosed clinically before DXA VFA. The vertebral fractures HISTORY- AND PHYSICAL EXAMINATION-BASED
increased with advancing age and decreased BMD. DXA MODEL SHOWED GOOD DISCRIMINATION
VFA is effective, rapid, safe and practical. We recommend ABILITY IN FRACTURE PREDICTION
that DXAVFA was performed with bone densitometry test for Y. C. Woo1, H. N. C. Loong1, E. Y. L. Hui2, E. L. Y. Leung1,
the patients aged >50 year who took the BMD test for the first A. W. C. Kung2, K. C. B. Tan2
1
time. Department of Medicine, Queen Mary Hospital, Hong Kong,
Hong Kong, 2Department of Medicine, University of Hong
Kong, Hong Kong, Hong Kong

P192 Objective: To identify the predictors of fracture in Chinese

RISK FACTORS FOR FALL AND EMERGENCE individuals with low BMD and develop a fracture prediction
FRAGILITY FRACTURE model based on parameters and measurements from history
K. Boskovic1, S. Tomasevic-Todorovic1, S. Kevic1, R. Doder1, and physical examination findings.
J. Zvekic-Svorcan2, M. Cvjetkovic-Bosnjak1 Material and Methods: All Southern Chinese subjects re-
1
University of Novi Sad, Faculty of Medicine, Clinical Center ferred for management of low BMD from 2008 to 2012 were
of Vojvodina, Novi Sad, Serbia, 2Rheumatology, Special Hos- recruited for analysis. Systematic assessments including a
pital for Rheumatic Diseases, Novi Sad, Serbia VAS for back pain and thorough investigations were per-
formed in the first visit. The occurrence of incident osteopo-
Objective: Osteoporotic fractures are a significant cause of rotic fracture was determined by subjects’ yearly self-reports
morbidity in the elderly population. The aim of the study was and data retrieved from the hospital’s computer medical sys-
to determine fall risk factors and emergence fragility fractures tem. Subjects with and without fractures were compared.
in women. Variables with statistically significant difference in univariate
Material and Methods: The survey was conducted on a analysis were further assessed in a multiple logistic regression
sample of 124 women, 63 years old, treated at the Clinical model. Area under the receiver operating characteristic (ROC)
Center of Vojvodina, Serbia. Fall risk factors were assessed curve was calculated to assess the discrimination ability of the
with the fracture risk assessment and the Morse fall scale. model constructed by the independent predictors.
Results: The average age of menopause at 48 years, most of Results: 1,702 subjects were included for analysis. 949 fe-
them were born, but they are not breastfed. Fracture previous- male (56 %) and 753 male (44 %) were included in the study.
ly had 56 % of respondents. Only 20 % had a family history of The mean age of the subject was 63.4±8.7 years and median
hip fracture. Arthritis rheumatoid had 26.7 % and secondary duration of follow-up was 3 (interquartile range: 1–4) years.
osteoporosis 20 %. Cognitive impairment (45.6 %), visual Among the study subjects, 70 cases (4.1 %) developed new
impairment (38.7 %), and depression (10 %) were the ob- low-trauma osteoporotic fracture (spine: 24, 1.4 %; hip: 10,
served fall risk factors. Corticosteroid taken 46.7 %, antide- 0.6 %; distal radius: 8, 0.5 %; others: 28, 1.6 %). Logistic
pressants 10 %, and cytostatics 3.3 %. The most number of regression analysis showed that loss in body height
patients had DXA findings in the range of osteopenia. Ac- (OR: 8.14, P < 0.001) and VAS for back pain (1.62,
cording the Morse scale to fall more than 2/3 of the respon- P<0.001) were the independent predictors for incident
dents (73.6 %) had moderate and high risk for a fall. fractures. These two predictors were added to age, gen-
Conclusion: Early menopause, osteoporotic fractures in the der and BMI, which were of clinical relevance, to form
past, use of corticosteroids, cognitive and visual impairment, the final model. The area under the ROC curve of this
the influence of the increased risk of falls and the occurrence model was 0.88.
of fragility fractures. Fracture risk assessment and Morse scale Conclusion: Prediction model based on clinical measures
may be helpful to assess risk factors. showed good discrimination ability for incident fractures. It
References: 1. Summers S, et al. Osteoporosis: assessing the would be of clinical significance in triaging patients with low
risk of fragility fracture. NICE clinical guideline 2012;146 bone mass for appropriate treatment.
 Osteoporos Int

P194 subjects completed a questionnaire. Standard radiographs

SAFETY OF ZOLEDRONIC ACID IN POST- of hands and knees were performed by a single operator
MENOPAUSALWOMEN WITH OSTEOPOROSIS: along with a bone densitometry (Hologic QDR 2000).
A SINGLE CENTER OBSERVATIONAL ONE-YEAR Criteria of the American College of Rheumatology
STUDY (ACR) and radiological Kellgren and Lawrence grade
E. Segal1, M. Nodelman2, S. Ish-Shalom3 for knee osteoarthritis (grade≥II) and of Kellgren and
1
Endocrinology Department, Rambam Health Care Campus, Moore for digital osteoarthritis were adopted. The func-
Haifa, Israel, 2Endocrinology Department, Western Galilee tional status was assessed by functional indices WOMAC
Hospital, Nahariya, Israel, 3Faculty of Medicine, Technion - and Lesquene for knee osteoarthritis and Dreiser index for
Israeli Institute of Technology, Haifa, Israel digital osteoarthritis.
Results: 400 women were included in this study. The preva-
Objective: In clinical trials treatment with zoledronic acid lence of knee osteoarthritis is estimated at 21 % (95%CI: 16–
(ZOL) was reported to induce acute phase reaction in about 26 %), the mean age was 64.6±9.23 years; 19/84 (22.6 %)
15 % of patients after the first infusion. This study was aimed lived in rural areas and 90 % were unemployed. Mean BMI:
to evaluate the incidence of adverse events (AE) in the regular 30.07 ± 5.99 kg/m 2. All women were postmenopausal.
clinical setting. Mean age of menopause was 46.6±5.29 5 years. Densi-
Material and Methods: 215 consecutive patients received IV tometric osteoporosis was found in 30 women (35.7 %),
ZOL 5 mg, of them 52 patients had repeated infusion of ZOL. osteoarthritis known and treated in 69 % of cases. Mean
AE were reported by patients using a detailed form during algo functional WOMAC indices and Lesquene were,
10 days after the infusion. respectively, 26.07±16.12 and 10.07±4.87. Digital osteo-
Results: Women aged 69.7±9.59, (45–100) were included in arthritis was found in 127 women (31.7 %, 95%CI: 29.7–
the study. 151 (70 %) patients were previously treated with: 33.7 %) with a mean Dreise index of 3.2 ± 4.80. Risk
alendronate 65 pts (43 %); raloxifene 9 (5.96 %); risedronate factors associated with the occurrence of osteoarthritis
−31(20.5 %); teriparatide 23(15.2 %); tibolone (0.7 %); calci- were: age (p<0.0016), BMI (p<0.040) and diabetes type
um supplements 133 (61.9 %); vitamin D 147 (68 %). Any II (p<0.05).
AE were reported in 136(63.3 %) and 32(61.5 %) patients: Conclusion: Knee and digital osteoarthritis seem common
fever 69 (50.7 %) and 10 (31.3 %), p=0.024; bone/joint and serious in our study, the prevalence is comparable to
pain/headache 129 (94.8 %) and 0, p<0.0001; weakness 109 estimates from studies in other populations. These risk factors
(80.1 %) 20 (62.5 %), p=0.05; muscles pain 106 (77.9 %) and should be validated by a larger study.
10 (31.3 %), p=0.04; uveitis 2 (1.47 %) and 0 after the first
and second dose respectively. AE duration was 2–5 days with
no correlation to prior treatments. Previous fractures were P196
reported in 114 (53 %) patients. There were 5 (2.3 %) new VERTEBRAL OSTEOPOROTIC FRACTURES
fractures: 3 hip; 2 ramus pubis. ACCORDING TO DIFFERENT MEASUREMENT
Conclusion: Incidence of the acute phase reaction in the study SITES
was higher than previously reported with a significant de- O. Ilic Stojanovic 1 , M. Lazovic 1 , M. Vuceljic 2 , N.
crease after the second dose. Radosavljevic1, M. Hrkovic1, M. Jovicic1
1
Institute for Rehabilitation, Belgrade, Serbia, 2Allabo, Bio-
chemical Laboratory 2, Belgrade, Serbia
P195
PREVALENCE OF KNEE AND DIGITAL Objective: The aim of this study was to evaluate the correla-
OSTEOARTHRITIS IN WOMEN IN DOUERA CITY tion between BMDs measured at different sites and the fre-
(ALGIERS): A POPULATION-BASED STUDY quency of vertebral fractures.
C. Haouichat1, M. F. Aiche1, F. Z. Lekhal1, S. Melal1, Material and Methods: We studied 130 menopausal women
H. Djoudi1, F. Z. Bouzid1 (aged 45–83, 61.9 ± 9.35). Age at menopause ranged
1
EHS de Douéra, Algiers, Algeria from 43 to 58 years (47.9±5.06) with a postmenopausal
duration of 14.27±9.19 years. BMD was measured by
Objective: To determine prevalence of clinical and radiolog- DXA at the distal forearms (DTX-200 Osteometer-
ical knee and digital osteoarthritis in women of 50 years old Denmark), and the hip and lumbar spine using a Lunar
and more in the locality of Douera (Algiers). DPX-L device. Vertebral fractures (VF) were examined
Material and Methods: A cross-sectional epidemiological using thoracic and lumbar radiography.
study using a stratified sampling approach to select wom- Results: T-score reference values were found in 24(18.5 %)
en in the locality of Douera, a semi-urban district. All patients in the dominant (D) forearm, 30(23.6 %) in the
Osteoporos Int

nondominant (ND) forearm, 11(10 %) at the spine, and without metabolic syndrome. The share of patients who had
9(20 %) at the hip. Osteopenia was found in 63(48.5 %), metabolic syndrome was 44 % in the study group. Age,
65(51.2 %), 53(47 %), and in 28(62 %), respectively. weight, waist circumference, blood glucose, triglycerides, C-
Osteoporosis was found in 43(33.1 %), 32(25.2 %), reactive protein, expressed as mean±SD were higher in the
49(43 %) and in 8(18 %), respectively. VF at the thoracic group with metabolic syndrome. Percentage of patients with
and lumbar spine were registered in 35 % of patients. VF hypertension was higher in the group with metabolic syn-
were found in patients with: T-score reference values in drome. Spine and femur BMD was significantly higher in
the D forearm in 22.5 %, in the ND forearm 28.9 %, at the patients with metabolic syndrome. Statistically, C-reactive
spine 9.1 %, and at the hip 11.8 % of cases; osteopenia in protein was not significantly different between the two
the D forearm in 42.5 %, 47.4 %, 36.4 %, and in 58.8 % groups.
of the patients, respectively; osteoporosis at the D forearm Conclusion: Statistical analysis showed that in the first
in 35 %, 23.7 %, 54.5 %, and in 29.4 % of the patients, group, BMD was higher in patients with the combina-
respectively. In patients with reference values of T-score tion of gout and the metabolic syndrome than in the
in forearm and hip, we noticed a T score in all categories second group. Obesity affects the synthesis of estrogen
at the other measurement sites (p< 0.05). Reference T- and testosterone, which in turn has direct effects on
score results at lumbar spine were in correlation with BMD.
values measured at other skeletal sites (p>0.05).
Conclusion: The reduction of BMD varies with the
choice of measurement sites. Using a unique T-score P198
for different sites presents additional difficulties in the HIGH BONE IRON CONTENT IS MORE
diagnosis of osteoporosis by DXA. VFs were noticed in PROMINENT THAN HIGH SERUM FERRITIN IN
all categories of reduced BMD at all measurement sites, PREDICTING LOW BONE MINERAL DENSITY IN
with the highest percentage in patients with osteopenia POSTMENOPAUSALWOMEN WITH HIP
at the hip and forearm, and osteoporosis at the lumbar FRAGILITY FRACTURES
spine. G. Li1, Y. Xu1
1
Department of Orthopaedics, Second Affiliated Hospital of
Soochow University, Suzhou, China
P197
OSTEOPOROSIS IN PATIENTS WITH GOUT Objective: We investigated and compared the association
L. Rotaru1,2, L. Groppa1,2, O. Sarbu2 between femoral head bone iron content and BMD, based
1
Medical Clinic No. 5, Department of Rheumatology and on the data from 202 postmenopausal women with hip fragil-
Nephrology, SUMPh Nicolae Testemiţanu, Chisinau, Repub- ity fractures.
lic of Moldova, 2Laboratory of Rheumatology, Republican Material and Methods: This is a retrospective clinical study
Clinical Hospital, Chisinau, Republic of Moldova from the date of Second Affiliated Hospital of Soochow
University, including 202 postmenopausal women with
Objective: Evaluation of patients with the metabolic syn- hip fragility fractures aged 56–93 years. BMD was mea-
drome and gout assessment of BMD in men. sured using DXA. The bone tissue iron content was
Material and Methods: We studied 75 patients with gout measured by ICP-MS. The iron of bone tissue was
(diagnosis established according to the 1987 ACR criteria), of stained by Prussian blue.
which 61 patients had chronic gout and 14 patients–acute Results: Initially, we divided the subjects into eight age
gout. The age of patients ranged between 25 and 76 years. groups with the interval of 5 years old. During aging, BMD
Patients were surveyed from 2007 to 2012. Disease duration values at all measured sites decreased and serum ferritin
varied between 1 and 35 years. All patients were duly assessed concentrations increased meanwhile. Simultaneously, concur-
(age, weight, waist circumference, BMI), laboratory tests rent but inverse changes occurred between femoral head bone
(general analysis of blood, uric acid in serum and in urine, iron content and BMD values. Multiple regression analysis
lipidogramma, creatinine clearance, blood glucose, C-reactive showed that serum ferritin was inversely associated with
protein) and instrumental examinations (X-rays of the affected BMD values at only one site of five measured sites, while
joints, joint ultrasonography BMD absorptiometry with DXA femoral head bone iron content was inversely associated with
of the lumbar spine and proximal femur). The metabolic BMD values at four sites of five measured sites. Furthermore,
syndrome was defined according to the International Diabetes when we divided these women into bone iron content quar-
Federation criteria. tiles, the odds for prevalent osteoporosis were 5.798-fold
Results: The patients have been divided into 2 groups: those (95%CI=2.328–14.438) higher in subjects in the highest
with gout associated with metabolic syndrome and gout quartile compared with those in the lowest quartile. In
 Osteoporos Int

addition, bone iron Prussian blue staining confirmed the bone Results: Boys rated their health slightly, but significant above
iron content in the corresponding quartile. girls (p=0.004). A higher number of comorbid conditions
were associated with lower SRH among girls (p=0.030), but
not among boys. Increasing obesity was inversely associated
with SRH (p<0.001 and p=0.002 for boys and girls, respec-
tively), but underweight adolescents also scored lower than
counterparts of normal weight. Higher levels of leisure phys-
ical activity were associated with better SRH in both sexes
(p<0.001). On univariate analysis, total hip, femoral neck and
total body BMD were all positively associated with SRH in
boys (p<0.001, p<0.001 and p=0.005, respectively), while
we saw relationships between SRH and femoral neck and total
body BMD in girls (p=0.005 and p=0.018). In both sexes
Conclusion: The bone iron content is associated with BMD, these relationships turned out non-significantly in multiple
and the association maybe more prominent than that between regression models that included BMI and physical activity.
serum ferritin and BMD. Conclusion: Self-rated health is associated with BMD in
Norwegian adolescents, and this relationship is partly ex-
plained by BMI and physical activity.
P199
SELF-REPORTED HEALTH AND BONE MASS IN
ADOLESCENTS: FINDINGS FROM THE TROMSØ
STUDY- FIT FUTURES P200
A. Winther1, C. S. Nielsen2, R. Jorde3,4, G. Grimnes5,4, IS FRACTURE RISK IN PATIENTS WITH
A. S. Furberg6, L. A. Ahmed1, E. M. Dennison7,8, N. Emaus1 OSTEOPOROSIS AND RHEUMATIC DISEASES
1
Department of Health and Care Sciences, UiT, Arctic Uni- INFLUENCED BY POPULATION
versity of Norway, Tromsø, Norway, 2Division of Mental CHARACTERISTICS?
Health, Norwegian Institute of Public Health, Oslo, Norway, D. Nemes1, E. Amaricai1, L. Catan1, D. Popa1, D. Andrei1,
3
Department of Clinical Medicine, UiT, The Arctic University G. Puenea1, M. Cojocaru1
of Norway, Tromsø, Norway, 4Division of Internal Medicine, 1
Medical Rehabilitation, Victor Babes University of Medicine
University Hospital of North Norway, Tromsø, Norway, 5En- and Pharmacy, Timisoara, Romania
docrine Research Group, Department of Clinical Medicine,
UiT, Arctic University of Norway, Tromsø, Norway, 6Depart- Objective: To evaluate a method that can predict osteoporotic
ment of Community Medicine, UiT, Arctic University of patients’ quality of life taking into account their population-
Norway, Tromsø, Norway, 7Victoria University, Wellington, based characteristics. The study hypothesis was to use FRAX-
New Zealand, 8MRC Lifecourse Epidemiology Unit, South- Austria in order to calculate osteoporosis risk in the western
ampton, United Kingdom Romanian population for a more accurate prediction. FRAX-
Romania was designed after assessing the southern Romanian
Objective: Previous studies have suggested relationships be- population. Instead, the western Romanian population is more
tween self-reported health (SRH) and BMD among older related to the Austrian one.
adults, but far fewer data are available in younger populations. Material and Methods: 217 patients with most common
Here we report associations between SRH and BMD among rheumatic diseases and osteoporosis were included and eval-
Norwegian adolescents participating in the Fit Futures study. uated in a 2-year study using both FRAX algorithms for
Material and Methods: In 2010–2011 more than 90 % of all Romania and Austria: group I- 131 patients suffering of
first year comprehensive school students in the Tromsø region rheumatoid arthritis, group II- 29 patients with other inflam-
(a total of 1,038) attended the Fit Futures study, an expansion matory rheumatic diseases and group III- 57 patients with
of the Tromsø study. BMD at total hip, femoral neck and total osteoarthritis.
body was measured as g/cm2 by DXA (GE Lunar prodigy). Results: For all of the study patients the 10-year probability of
Lifestyle variables were collected by self-administered ques- a major fracture and the risk of a major osteoporotic fracture of
tionnaires and interviews, including the question ‘how do you the femoral neck in the next 10 years were significantly higher
in general consider your own health to be?’ Respondents were when using FRAX-Austria (23.38±14.01 %; 13.65±12.03 %)
asked to indicate excellent, good, neither good nor bad, bad or compared with FRAX-Romania (13.09 ± 8.72 %; 7.63 ±
very bad as their answer. The analyses included 464 girls and 7.47 %). For each group the risk of a major osteoporotic
484 boys aged 15–18 years. fracture and the probability of a major osteoporotic fracture
Osteoporos Int

of the femoral neck were also significantly higher when using score=−2.63). In both groups, HAQ scores were correlated
FRAX-Austria. with T-scores.
Conclusion: Patients with rheumatic diseases and osteoporo- Conclusion: BMD influences quality of life in patients with
sis are at risk to develop osteoporosis-related fractures in the radiculopathies due to osteoporotic vertebral compression
next 10 years no matter what FRAX model was used. When fractures. The medical treatment associated with a rehabilita-
applying both algorithms on the western Romanian popula- tion program and home adapted physical activities is abso-
tion we noticed an increased risk of fracture for FRAX- lutely necessary in order to increase the BMD and to improve
Austria. Different FRAX algorithms should be applied in the overall quality of life.
concordance with features of populations belonging to regions
of the same country. Osteoarthritis and inflammatory rheu-
matic diseases such as ankylosing spondylitis, systemic lupus P202
erythematosus, fibromyalgia, increase the risk of developing QUALITY OF LIFE IN PATIENTS WITH
osteoporosis. Besides rheumatoid arthritis, these rheumatic SECONDARY HIP OSTEOARTHRITIS AND
diseases should be included as osteoporotic risk factors. OSTEOPOROSIS WHO FOLLOWED A TOTAL HIP
REPLACEMENT
E. Amaricai1, L. Catan1, D. Popa1, D. Andrei1, G. Puenea1,
P201 M. Cojocaru1, D. Nemes1
1
ROLE OF REHABILITATION IN PREVENTING Medical Rehabilitation, Victor Babes University of Medicine
RADICULOPATHIES DUE TO OSTEOPOROTIC and Pharmacy, Timisoara, Romania
VERTEBRAL COMPRESSION FRACTURES
D. Nemes1, L. Catan1, D. Popa1, E. Amaricai1, D. Andrei1, Objective: To assess the general health status in young and
G. Puenea1 adult patients diagnosed with secondary hip osteoarthritis and
1
Medical Rehabilitation, Victor Babes University of Medicine osteoporosis who followed a total hip replacement and
and Pharmacy, Timisoara, Romania antiosteoporotic treatment.
Material and Methods: 27 patients with secondary hip oste-
Objective: To establish a correlation between BMD and oarthritis and osteoporosis were included into the study. The
quality of life. Another objective is to point out the importance patients had severe hip osteoarthritis due to avascular necrosis
of a long-term rehabilitation in increasing the BMD and and needed a total hip replacement. After the surgery they
quality of life in patients with radiculopathies due to osteopo- also started medical antiosteoporotic treatment with
rotic vertebral compression fractures. BMD score is expressed bisphosphonates. The patients were between 21 and 56 years
by T-score measured by DXA, and quality of life is measured old (mean age 41.3±11.8 years). They were assessed before
by Health Assessment Questionnaire (HAQ). surgery, postoperatively after 6 weeks and after 6 months
Material and Methods: The 2-year study included 134 pa- using the EuroQoL Quality of Life Scale (EQ-5D and EQ
tients, aged between 54 and 87 years, diagnosed with VAS). DXA scores were recorded preoperatively and 6 months
radiculopathies due to vertebral compression fractures. postoperatively.
Ninety-eight of the patients were women and 36 patients were Results: 23 patients completed the study. There were
men. The average T-score was −3.14±0.7. The patients were significant improvements in EQ VAS at intermediate and
divided into two groups according the therapy. Group 1 final assessments (EQ VASinitial: 87.61±13.63; EQ VAS
followed a complex medical treatment (antiosteoporotic ther- 6 weeks: 42.91±12.47; EQ VAS 6 months: 28.94±9.33).
apy with bisphosphonates, antalgics, nonsteroidal anti- Regarding the EQ-5D scale, the most important improve-
inflammatory drugs and trophic products). Group 2 patients ments were found in the dimensions mobility, usual ac-
followed the same medical treatment combined with a reha- tivities and pain/discomfort. There were significant corre-
bilitation program (10 daily sessions every 6 months and a lations between pain/discomfort dimension of EQ-5D and
home adapted exercise program, as well as a thoracolumbar DXA scores both at the beginning and at the end of the
orthosis). All patients were assessed at the beginning of the study. There were also significant correlations between
study, after 1 year and after 2 years measuring total T-score mobility and usual activities dimensions of EQ-5D and
and HAQ score. DXA scores at preoperative evaluation.
Results: The group 2 patients had a statistically significant Conclusion: Total hip arthroplasty and anti-osteoporotic
improvement of BMD at 1-year and 2-year assessments treatment with bisphosphonates lead to significant im-
(p<0.001; T0 score=−3.21; T1 score=−2.06; T2 score=−1.68) provements in quality of life and DXA scores, as well
in comparison to group 1 patients. In group 1 there was also a as in pain relief in patients with avascular hip necrosis
significant increase of BMD but with a high risk of fracture and osteoporosis. Postoperatively, it is necessary an ex-
(p < 0.001; T0 score=−3.19; T1 score=−2.78; T2 tensive period of follow-up (at least 1 year) in order to
 Osteoporos Int

establish possible correlations among the dimensions of Disclosures: This work was sponsored by an educational
EQ-5D and DXA scores. grant of the Medical University Sofia (project 46/2011).

P204
P203 THE STUDY OF BONE’S MINERAL DENSITY IN
IS THERE A CORRELATION BETWEEN HYPERTHYROIDISM
METABOLIC CONTROL AND VITAMIN D STATUS IN S. A. Preda1, M. Bistriceanu2, I. Bistriceanu3, A. Turculeanu4,
TYPE 2 DIABETES PATIENTS ON ORAL D. M. Albulescu5, S. K. Bondari5, A. Covei6, M. L. Riza7, O.
ANTIDIABETIC DRUGS? M. Marioara8
M. A. Boyanov1, D. J. Bakalov1, A. Tsakova2, M. Nikolova3 1
Faculty of Dental Medicine, University of Medicine and
1
Clinic of Endocrinology, Department Internal Medicine, Pharmacy, Craiova, Romania, 2Department of Endocrinology,
Alexandrovska University Hospital, Medical University Sofi, University of Medicine and Pharmacy, Craiova, Romania,
Sofia, Bulgaria, 2Department of Clinical Laboratory and 3
Department of Endocrinology, Emergency Hospital, Craiova,
Clinical Immunology, Alexandrovska University Hospital, Romania, 4Biochemical Department, University of Medicine
Medical University Sofia, Sofia, Bulgaria, 3Department of and Pharmacy, Craiova, Romania, 5Department of Radiology,
Hygiene, Medical Ecology and Nutrition, Medical University University of Medicine and Pharmacy, Craiova, Romania,
6
Sofia, Sofia, Bulgaria Endocrinology Department, Philanthropy Hospital, Craiova,
Romania, 7Department of Urology, University of Medicine
Objective: To describe the correlation between serum and Pharmacy, Craiova, Romania, 8University of Medicine
25(OH)D levels and metabolic parameters in Bulgarian type and Pharmacy, Craiova, Romania
2 diabetes patients on oral antidiabetic drugs.
Material and Methods: One hundred type 2 diabetes patients Objective: Hyperthyroidism represents a complex of clinical
participated – 56 men and 44 women. The mean age and manifestations inducted by the presence of excessive thyroid
diabetes duration of the women was 59 and 9.8 years, of the hormones at tissular level and also at receptor level. The
men – 58 and 7.7, respectively. Complete patient history was illness is considered the fourth cause for the endocrine osteo-
taken and physical examination (body weight, waist circum- porosis. In hyperthyroidism is affected the trabecular bone and
ference, blood pressure) was performed. Body composition also the cortical one and the mechanism seems to be inducted
was measured on a leg-to-leg body impedance analyzer (TBF- in the growth of resorption by acceleration of local turnover.
215, Tanita Corp., Tokyo, Japan). Serum levels of vitamin D Aim was identification of hyperthyroidism cases, evaluation
were measured as 25-(ОН) D Total (Immunotest, Roche Di- of thyroidal hormone status and the study of BMD.
agnostics, Switzerland). Serum and 24 h urine creatinine were Material and Methods: In the study, were included 32 cases
analyzed on a Cobas Integra analyzer, together with glycated with hyperthyroidism, aged between 22 and 54, of that:
hemoglobin A1c, fasting plasma glucose, cholesterol profiles Basedow’s goiter (12), multiheteronodular toxic goiter (17),
and triglycerides. Correlation analysis was performed on a Plummer toxic adenoma (3). In every case were studied: total
SPSS 13.0 for Windows platform and included 10 possible and free serum thyroxine (T4 and FT4), total and free triiodo-
curves. The data were analyzed post hoc separately for men thyronine (T3 and FT3), thyroid-stimulating hormone (THS),
and women as well as subdivided into tertiles of vitamin D titre of antibodies for peroxidase and thyroglobulin. Thyroidal
levels. echo was made in order to determinate gland’s dimension,
Results: The mean serum 25-OH-vitamin D levels were 23.8± homogeneous/nonhomogeneous aspect, the presence of nod-
12.1 nmol/l in women and 33.3±20.0 nmol/l in men. We were ules and the type of vascularisation. In every case, BMD was
unable to find any statistically significant correlation between evaluated by DXA.
serum 25(OH) vitamin D and fasting plasma glucose, glycated Results: Osteodensitometry highlighted the presence of oste-
hemoglobin A1c, total cholesterol, HDL- and LDL-cholesterol, oporosis in all cases with Graves-Basedow Illness, Plummer
triglycerides, systolic/diastolic blood pressure. A very weak toxic adenoma and in 7 cases with the multiheteronodular
positive association was seen with body weight and a stronger toxic goiter (41.1 % from total cases).
one with% fat mass. The subanalyses (men vs. women or Conclusion: 1. For all cases with hyperthyroidism is neces-
according to tertiles of vitamin D) did not produce any addi- sary a hormonal, immunological and osteodensitometry
tional information. evaluation.
Conclusion: The influence of vitamin D on the metabolic 2. The inclusion of synthesis antithyroidal therapy, beta
control in type 2 diabetes might be so weak on an individual blockings and immunosuppressants in association with
level, that it could be demonstrated only in large epidemio- antiresorptive medication, contribution of bone mass growth
logical surveys. and reduction of fragility fractures incidence.
Osteoporos Int

3. Hyperthyroidism is affecting the trabecular bone and corti- Conclusion: The work is suggesting 2 major objectives in
cal one and the mechanism seems to be bound by the resorp- therapeutically strategy of osteoporosis/osteopenia of cases
tion through acceleration of local turnover. with hypogonadotroph hypogonadism: 1. The precocious di-
agnosis of gonadal insufficiency in the purpose of adopting
some prophylaxis measures of bone modifications, since from
P205 prepubertal stage, pubertal or postpubertal for assuring the
EVALUATION OF BIOCHEMICAL MARKERS OF stabilization or growth of bone mass corresponding to sex
BONE TURNOVER IN HYPOGONADOTROPH and age. 2. Is associated the substitution estroprogestative/
HYPOGONADISM androgenic with antiresorptive or proformation medication.
S. A. Preda1, A. M. Marioara2, A. Covei3, D. M. Albulescu4,
S. K. Bondari 5 , D. Bondari 5 , A. Turculeanu 6 , I.
Bistriceanu7, M. Bistriceanu8, M. L. Riza9 P206
1
Faculty of Dental Medicine, University of Medicine and EVALUATION OF BONE MINERAL DENSITY IN
Pharmacy, Craiova, Romania, 2University of Medicine and GONADAL DISGENESIAS
Pharmacy, Craiova, Romania, 3Endocrinology Department, S. A. Preda1, O. M. Marioara2, A. Covei3, D. Bondari4, S. K.
Philanthropy Hospital, Craiova, Romania, 4Department of Bondari5, A. Turculeanu6, D. M. Albulescu5, I. Bistriceanu7,
Radiology, University of Medicine and Pharmacy, Craiova, M. Bistriceanu8, M. L. Riza9
Romania, 5Department of Psychiatry University of Medicine 1
Faculty of Dental Medicine, University of Medicine and
and Pharmacy, Craiova, Romania, 6Biochemical Department, Pharmacy, Craiova, Romania, 2University of Medicine and
University of Medicine and Pharmacy, Craiova, Romania, Pharmacy, Craiova, Romania, 3Endocrinology Department,
7
Department of Endocrinology, Emergency Hospital, Craio- Philanthropy Hospital, Craiova, Romania, 4Department of
va, Romania, 8Department of Endocrinology, University of Psychiatry University of Medicine and Pharmacy, Craiova,
Medicine and Pharmacy, Craiova, Romania, 9Department of Romania, 5Department of Radiology, University of Medicine
Urology, University of Medicine and Pharmacy, Craiova, and Pharmacy, Craiova, Romania, 6Biochemical Department,
Romania University of Medicine and Pharmacy, Craiova, Romania,
7
Department of Endocrinology, Emergency Hospital, Craio-
Objective: The sexoidoprive osteoporosis represents a pro- va, Romania, 8Department of Endocrinology, University of
cess dependant of the deficit or the absence of one or all Medicine and Pharmacy, Craiova, Romania, 9Department of
sexoide hormones. The bone, being a sexualisable organ, is Urology, University of Medicine and Pharmacy, Craiova,
following exactly the process of general sexualisation of the Romania
organism, in its growth and reshuffle. The modification of
bone mass during the osteogenesis is recognizing three Objective: Alteration of gonadogenesis process (the morpho-
phases: growth, consolidation and diminution of it. This phas- logical dysgenesis) has multiples implications: perturbation of
ing process of physiological game of bone mass is directly hormonal biosynthesis process, alteration of structure reactiv-
proportional with gonad’s functional capacity. ity on gonadic hormones and, under clinical aspect, the
Material and Methods: The study was made in 15 cases with perturbing of sexualisation process. The exclusion from the
hypogonadotroph hypogonadism of which: hypopituitary organism economy of sexual hormones is seriously influenc-
dwarfism with sexual infantilism (3 cases), adiposogenital ing the bone structure, being the principal cause of osteopo-
syndrome (8 cases), insufficiency primary pituitary tumor (2 rosis. Identification of cases with alteration of sexualisation
cases), secondary pituitary insufficiency of GnRH deficit (2 process (gonadal dysgenesis), hormonal evaluation on
cases-brothers). Were evaluated hormones on gonadotrope gonadotrope axis and the study of BMD and biochemical
axis and biochemical markers of bone turnover: osteocalcin markers of bone turnover.
and crosslaps. BMD was appreciated by DXA. Material and Methods: The study was done on 24 cases with
Results: Highlighting the low values of hormones on gonadal dysgenesis with ages between 12 and 30 years, from
gonadotrope axis is pleading for hypogonadotroph which: female genotype Turner syndrome (15 cases),
hypogonadism. The 2 cases with hypogonadotroph Klinefelter syndrome (7 cases) and feminine testicle (2
hypogonadism of hypothalamic cause were a positive re- cases-sisters). In the same time with karyotype study of
sponse at simulation test with gonadoliberin. Were highlighted gonadic and gonadotropic hormones were evaluated the bio-
low values for biochemical markers of bone turnover of all chemical markers of bone turnover (serum osteocalcin and
cases included in the study but the osteodensitometry infirmed crosslaps) and BMD was appreciated by DXA.
the presence of osteoporosis of 4 cases with adiposogenital Results: It was highlighted osteoporosis on 12 cases (50 %),
syndrome of which the Z- score was suggestive for osteopenia in 8 cases and the remaining patients (4) biochem-
osteopenia. ical markers and BMD were in normal limits.
 Osteoporos Int

Conclusion: 1. The study of biochemical markers of bone Conclusion: We concluded that his previous brain strokes
turnover and BMD is obligatory for all cases with gonadal were probably unrecognized hypocalcaemic crisis but causes
dysgenesis. of increased vertebral fragility and good response on osteopo-
2. The precocious diagnosis of osteoporosis/osteopenia is rotic therapy remains unclear, probably due to vitamin D
claiming the hormonal substitution specifically to clinical supplementation. Some studies suggest that vertebral fragility
form which represent the therapeutically attitude from the occurs in PhPT despite normal or even high BMD.
main intention.
3. Hormonal substitution in association with therapeutically
means specific to bone remineralisation is preventing the P208
apparition of fragility fractures. IMPORTANT ASPECTS OF GROUP COHESION
WHICH LEAD TO PERSONALITY
STRENGTHENING IN ART THERAPEUTIC
P207 WORKSHOPS FOR PATIENTS WITH
MULTIPLE VERTEBRAL FRACTURES IN PATIENT OSTEOPOROSIS AT OSTEOLOGYACADEMY IN
WITH UNRECOGNIZED HYPOPARATHYROIDISM ZLIN
(PHPT): CASE REPORT H. Atcheson1, J. Přibylová1, P. Novosadová1,1
S. Subin-Teodosijevic1, J. Zvekic-Svorcan2, K. Filipovic2, 1
Osteology Academy Zlín, Zlín, Czech Republic
T. Jankovic2, G. Kozlovacki3, T. Lazic-Cilerdzic4
1
Rheumatology, Internal Department, General Hospital Dj. Objective: In connection with our previous theoretical studies
Joanovic, Zrenjanin, Serbia, 2Rheumatology, Special Hospital where we referred to psychological needs of patients with
for Rheumatic Diseases, Novi Sad, Serbia, 3Nephrology, osteoporosis and means of art therapy for dealing with depres-
Internal Department, General Hospital Dj. Joanovic, sive states, we present here our findings related to group
Zrenjanin, Serbia, 4Endocrinology, Internal Department, cohesion and strengthening of mutual cooperation in group
General Hospital Dj. Joanovic, Zrenjanin, Serbia art therapy. This report has a descriptive and explorative
character and is composed to show a positive outcome of
Objective: In spite of the fact that hypoparathyroidism usu- group art therapy on personal growth in women patients with
ally increases bone density, many studies suggest that PhPT osteoporosis. We follow the ability to find determination for
has a great impact on bone structure which could not be solving problems connected with the illness, strengthening of
necessarily detected by BMD measurements. the sense of belonging and better self- esteem.
Material and Methods: Male patient, age 64, normal BMI, Material and Methods: Group characteristics: Four groups
came into our clinic with pain in thoracic and lumbar spine of 6–8 female members, aged from 56 to 80 years. Regular,
with sudden onset after minor fall. He had history of several one-weekly 2-h sessions, in a period of 6 years. The way
brain strokes and hypertension, without anamnestic risk factors individual members of the groups are involved: common
for osteoporosis. Radiography of spine showed multiple verte- collaboration on artwork, individual solutions of artwork as-
bral fractures (vTh8-vL4), wedge type. We prescribed pain signments and collective interaction with feedback, expres-
killers, spine orthosis and started investigations. Additional find- sion of emotions, confidence in problem solving, acceptance
ings eliminated malignancies. Laboratory findings showed no of others, focusing on making constructive personal changes.
presence of inflammation and hematological abnormalities, nor- Results: We were able to observe gradual changes in group
mal levels of serum proteins, alkaline phosphatase, phosphorus, dynamics from strive for cohesion through regulating tension
liver, kidney, thyroid functions, and low normal levels of total to balanced cooperation. Our findings proved that cohesion is
calcium 2.2 mmol. We started vitamin D and calcium supple- a demonstration of mutual relations and powers which affect
mentation and per oral weekly bisphosphonates and ordered: the group members in a way that they strive for sustaining of
DXA, bone turnover markers, PTH, 25OHD and MRI of spine their group. Group tension is a moving power which supports
but our patient did not perform those tests for another 6 months. individual members strives for change in their attitudes to
Results: When he finally came to control visit he was walking illness and for change of other psychological factors related
with minimal pain in spine. DXA results showed normal to the treatment.
BMD of hip and spine 0.970 g/cm2, normal values of Conclusion: Based on our observations we point out the
osteocalcin and crosslaps, low ionized calcium 1.0 mmol/l, importance of group art therapy for women with osteoporosis
insufficient 25OHD 60 ng/ml and unmeasurable low levels of which leads to better coping with the situations related to the
PTH, below 5 μg/l. MRI of spine confirmed just vertebral osteoporosis treatment. Members of the group mutually sup-
fractures. We discontinued bisphosphonates and referred patient port their will to change the current life situation, to change
to endocrinologist who confirmed hypoparathyroidism and con- their previous attitude to the chronic illness and start being
tinued therapy with calcitriol and calcium supplements. more active in their approach to medical treatment.
Osteoporos Int

P209 Objective: In view of a tissue adhesive effect of OK-432,

CONCEPTUAL FRAME OF PSYCHOTHERAPY FOR which originally developed for the treatment of malignant
PATIENTS WITH OSTEOPOROSIS FROM A POINT tumors, on lymphangioma, we examined a therapeutic effect
OF VIEW OF CLINICAL PSYCHOLOGY of OK-432 as a nonoperative treatment for chronic bursitis.
M. Lhotová1, P. Novosadová1,1, H. Atcheson1, J. Přibylová1 Material and Methods: Twenty-eight patients with chronic
1
Osteology Academy Zlín, Zlín, Czech Republic bursitis were entered into this study. After aspiration of the
contents in the bursa, we injected 5 KE of OK-432 dissolved
Objective: It is known that most of the chronic diseases are in 2 ml of saline for 3 ml of bursal aspirate, followed by a
accompanied with scepticism, anxieties and depressions. Re- compressive dressing for 3–5 days. The OK-432 treatment
actions to the illness are, next to the actual state and its was repeated in the patients who did not show successful
duration, also based on patient’s personal characteristics, frus- results. Further, we collected bursal fluid from 6 patients
tration tolerance, resilience and coherence. Accumulation of before and after the injection of OK-432 and followed time-
depressive symptoms is also one of the risk factors of in- dependent changes of concentrations of pro-inflammatory
creased injury rate. Clinical psychology aims to understand cytokines, IL-1α, -β and TNF-α, and basic fibroblast growth
individual links between psychic and somatic state of a patient factor (bFGF) by enzyme immunoassay.
in adaptation to an illness, motivation for treatment, finding Results: The number of mean treatment of OK-432 was 1.4
personal integrity and looking for life meaningfulness. 1. times. We achieved complete wound healing in 27 patients
Detailed specification of psychotherapeutic care concept and (96 %). The only failure case was a rupture of the bursa.
its effective factors related to characteristics of osteoporotic Additionally, transient skin necrosis was observed as compli-
patients’ personalities and their specific vulnerability to de- cations in 2 patients. All cytokines and bFGF were not detect-
pressive states. 2. Research for comorbidity of osteoporosis ed before the injection of OK-432. In contrast, OK-432 injec-
and depression. tion resulted in a marked increase in contents of the pro-
Material and Methods: Qualitative analysis of research inflammatory cytokines, which reached a peak level on day
realised in years 2012 and 2013 at Osteology Academy (Art 1 and gradually decreased. On the other hand, bFGF level rose
therapy as a therapeutic and preventive care for mental stabil- to a peak level on day 3 after the injection, and then declining
ity of a patient with osteoporosis and Assessment of needs of gradually.
patients with developed osteoporosis as a prerequisite for Conclusion: Pro-inflammatory cytokines, IL-1 and TNF-α,
mental health care). Qualitative analysis of research related are the potent inducers of bFGF which plays an important
to comorbidity of osteoporosis and depression. physiological role in tissue regeneration and wound healing.
Results: Development of depression and anxiety symp- Sequential production of pro-inflammatory cytokines and
toms is connected with a level of unfulfilled needs which bFGF in this study was attributable to OK-432. Consequently,
was in our research probe significantly related to the our data suggest that the production of bFGF mediated by
treatment. Patients require and expect to obtain some OK-432 promotes wound healing of the bursitis.
level of independence, some physical, mental and social
abilities. Restrictions which the patients experience in
connection with the osteoporotic illness are closely related to
the quality of life which may be partly compensated with P211
psychological care. EARLY DIAGNOSIS OF ATYPICAL FEMORAL
Conclusion: Psychological care can be arranged at several FRACTURE USING DXA BY EXTENDING LENGTH
levels: 1. Work targeted to adaptation. OF FEMUR IMAGE
2. Work with developmental themes or tasks of late adulthood, S. Van Der Kamp1, E. Heffernan1, M. J. Mckenna1, C.
early old age and old age, i.e., periods of generativity and Hurson2
1
integrity. 3. Work focused on a relation to person’s body. 4. DXA Unit, St Vincent University Hospital, Dublin, Ireland,
2
Psychological work with pain. Orthopaedic Surgery, St Vincents Hospital, Dublin, Ireland

Objective: Atypical femoral fractures (AFF) are associated

P210 with prolonged bisphosphonate therapy. A major feature of
POSSIBLE INVOLVEMENT OF BFGF PRODUCTION AFF is a localised periosteal reaction: described as a
IN WOUND HEALING OF CHRONIC BURSITIS “beaking” appearance if a fracture line is visible, or as a
AFTER INTRABURSAL INJECTION OF OK-432 “flaring” appearance if a fracture line is not visible.
T. T. Tonai1, T. I. Inoue1, T. S. Sasa1, H. M. Manabe1 McKiernan demonstrated that AFF could be visualised on
1
Dept. of Orthopedic Surgery, Shikoku Med. Cent. for DXA by extending image length. We sought to evaluate the
Children and Adults, Zentsuji City, Japan utility of DXA in the diagnosis of AFF.
 Osteoporos Int

Material and Methods: Patients over age 50 years, who were cytometry analysis (FACS) was performed initially (V1) and
taking bisphosphonates therapy in excess of 5 years, had an 19 days later (V2) to examine intra- and intersubject fluctua-
extended hip scan performed bilaterally. BMD was measured tions of total and surface CaSR expression in HCM and
at spine and hip bilaterally using a Hologic Discovery Model 15 weeks later (V3) to study the effect of vitamin D supple-
A or C. The extended femur scan was performed in array mentation. In vitro experiments were conducted to assess the
mode; the default setting of 15.3 cm was extended to 22 cm. If effects of pro-inflammatory cytokines, calcidiol, calcitriol and
an abnormality was noted on the outer aspect of the femur, Ca2+ on CaSR expression in U937 cell line.
then patients were referred for plain radiograph of pelvis with Results: By FACS analysis, more than 95 % of HCM exhib-
imaging of lateral femurs. ited cell surface CaSR staining. In contrast, CaSR staining
Results: An abnormality was suspected on the DXA image in failed to detect surface CaSR expression in other PBMC.
19 of 257 (7.4 %) of subjects. On radiograph, 7 (2.7 %) After cell permeabilization, total CaSR expression was ob-
showed no abnormality, 7 (2.7 %) showed evidence of AFF, served in more than 95 % of all types of PBMC. Both total and
and 5 (2.0 %) showed an additional abnormality (an surface CaSR expression in HCM showed a high degree of
osteochondroma, an abnormal lucency, and 3 cases of cortical intra-assay reproducibility (<3 %) and a moderate intersubject
thickening). Of the 7 cases with incomplete AFF, 5 had a fluctuation. In response to vitamin D supplementation, there
periosteal flare and 2 had a visible fracture line. The latter 2 was no significant change for both total and surface CaSR
patients both had thigh pain; so they underwent prophylactic expression. In the in vitro study, U937 cells showed strong
intramedullary nail insertion in order to prevent complete total and surface CaSR expression, and both were moderately
femoral fracture. increased in response to calcitriol exposure. Neither total nor
Conclusion: In a prospective survey of 257 patients over age surface CaSR expression was modified by increasing Ca2+
50 years on bisphosphonate therapy for over 5 years, we found concentrations. Total CaSR expression was concentration de-
that 7 (2.7 %) had evidence of AFF with 2 patients needing pendently decreased by TNFα exposure.
prophylactic intramedullary nail insertion. It is feasible to use Conclusion: CaSR expression can be easily measured by
DXA as a means of detecting AFF early. We have now flow cytometry in human circulating monocytes. In the
switched to single-energy imaging. This mode gives superior in vitro study, total and surface CaSR expression in the
image quality, views the full extent of the femur, and is much U937 cell line were increased by calcitriol but total CaSR
faster. It is now easier and more accurate to use DXA as a expression was decreased by TNFα stimulation.
means of diagnosing AFF early.
References: McKiernan FE, J Clin Densitom 2010;13:102.

P213
MAINTENANCE THERAPY WITH GLUCOSAMINE
P212 SULFATE FOR PATIENTS WITH OSTEOARTHRITIS
DETERMINATION AND MODULATION OF TOTAL OF THE HIP
AND SURFACE CALCIUM-SENSING RECEPTOR M. P. Ivanova1
1
EXPRESSION IN MONOCYTES IN VIVO AND IN Ministry of Interior Medical Institute, Sofia, Bulgaria
VITRO
C. B. Boudot1, A. M. Mary1, S. K. Kamel1, T. B. D. Drueke1, Objective: Osteoarthritis of the hip is a chronic progressive
P. F. Fardellone1, Z. M. Massy1, M. B. Brazier1, R. M. disease. It causes chronic pain and damage to the joint carti-
Mentaverri1, J. P. Paccou1 lage. The quality of life of the patients is reduced and they may
1
INSERM U1088, Université de Picardie Jules Verne, become invalid. Three year research is made for the effect of
Amiens, France the maintenance therapy with glucosamine sulfate (GS) and
nonsteroidal anti-inflammatory drugs (NSAIDs) for 179 pa-
Objective: Expression of the calcium-sensing receptor tients with the osteoarthritis of the hip.
(CaSR) has previously been demonstrated in human circulat- Material and Methods: The patients are divided into two
ing monocytes (HCM). The present study was designed to groups. The first group of 87 patients is treated 4 months per
measure CaSR expression in HCM and to examine its poten- year with 1,500 mg GS daily and NSAIDs if it becomes
tial modulation by pro-inflammatory cytokines, Ca2+, vita- necessary and the second group of 92 patients is treated only
min D sterols in U937 cell line. with NSAIDs. The pain was measured in the beginning of the
Material and Methods: Twenty healthy volunteers first and in the end of the third year in compliance with the
underwent blood sampling with subsequent isolation of pe- VAS and Algofunctional Index for osteoarthritis of the hip by
ripheral blood mononuclear cells (PBMC) at 3 visits. Flow Lequesne.
Osteoporos Int

Results: At the end of the third year the pain under VAS in the an in situ catabolic response in chondrocytes from human OA
first group increased with 9.6 mm and for the second group– cartilage. This study also demonstrates that chondrocytes from
with 14.7 mm in comparison to the initial values. low degraded OA cartilage (Grade I) have a stronger catabolic
Algofunctional Index by Lequesne at the end of the third year response than chondrocytes from highly degenerated OA
increased with 1.87 points for the first group and with 2.91 for cartilage (Grade IV) to sBG stimulation.
the second group. Comparing the obtained values, a very Acknowledgements: This study was supportted by Sigris
significant statistical difference (p>0.05) was noticed. Juselius Foundation, Maire Lisko Foundation, Center of In-
Conclusion: The maintenance therapy with GS 1,500 mg ternational Mobility of Finland and The Finnish Society for
daily of patients with osteoarthritis of the hip 4 months per Rheumatology.
year is more effective than the treatment only with NSAIDs.
References: Lequesne MG, J Rheumatol. 1997;24:779.

P215
THERAPEUTICALLYATTITUDES
P214 DIFFERENTIATED IN OSTEOPOROSIS FROM LATE
BIGLYCAN: AN INFLAMMATORY PLAYER IN PUBERTY
OSTEOARTHRITIS S. A. Preda1, M. Bistriceanu2, I. Bistriceanu3
G. Barreto1, A. Soininen2, P. Ylinen2, E. Kaivosoja1, D. 1
Faculty of Dental Medicine, University of Medicine and
Nordström3, Y. Konttinen1 Pharmacy, Craiova, Romania, 2Department of Endocrinology,
1
Institute of Clinical Medicine, Faculty of Medicine, Univer- University of Medicine and Pharmacy, Craiova, Romania,
sity of Helsinki, Helsinki, Finland, 2ORTON Orthopaedic 3
Department of Endocrinology, Emergency Hospital,
Hospital, Helsinki, Finland, 3Helsinki University Central Craiova, Romania
Hospital, Helsinki, Finland
Objective: The late spontaneous debut of the puberty after
Objective: Biglycan is major extracellular matrix (ECM) 16 years old is labelled as being late puberty and is rising to
protein classified as damage-associated molecular pattern or the practitioner difficult problems of etiologic diagnosis. In
alarmin that is released in high amounts into the synovial fluid late puberty are some perturbations of the entire organism and
of osteoarthritis (OA) patients as consequence of the continu- the alteration of sexualisation process is remaining the major
ous degradation of articular cartilage. Our aim was to study if manifestation. An inclined factor for osteoporosis from the
biglycan in its soluble form is able to induce a catabolic late puberty is represented by organism’s failure to obtain an
response in chondrocytes from OA patients. optimal bone mass during the growth and teenage period as a
Material and Methods: Cartilage of tibial plateaus samples consequence of primary ovarian and testicular insufficiency,
from total knee arthroplasty operations from 12 OA patients secondary, congenital or obtained (pre- and postpubertal).
were macroscopic evaluated following the guidelines of the Identification of cases with delay of spontaneous debut of
French Society of Arthroscopy (SFA). Isolated cartilage ex- puberty until 16 years old and evaluation: hormonal on
plants (n=96) were selected from two macroscopic categories: gonadotrope axis, cytogenetic, imagistic.
Grade I and Grade IV. Cartilage explants were stimulated with Material and Methods: Were selected and included in the
sBG (10 μg/ml) for 48 h. Messenger RNA levels of cytokines, study 18 patients with age between 17 and 19. The repartition
cartilage matrix molecules, MMPs and TLRs were determined by clinical forms was: Klinefelter Syndrome (6 cases), func-
with RT-PCR. Proteoglycan content was quantified through tional deficit of GnRH (2), cromofob hipofizar adenoma (4),
safranin O staining intensity of paraffin-embedded (FFPE) functional adipose-genital syndrome (6 cases). Paraclinical
cartilage explants. investigations palette were pointed on: hormonal exploitation
Results: Soluble biglycan caused a significantly in situ up- (LH,FSH, estradiol, progesterone, testosterone, PRL, TSH,
regulation of catabolic markers (MMP-9, ADAMTS-4, FT4), cytogenetic (karyotype, Chromosomal band, Barr chro-
ADAMTS-5, CAT-K and IL-6). The catabolic response was matin), imagistic (standard cranial X-ray and carpal regions
dependent in the stage of OA. Interestingly the anabolic for bone age, CT, RMN). The measuring of mineral bone
marker COL-II was upregulated in Grade I cartilage explants, density was realised by DXA.
while in Grade IV COL-II was downregulated. Stimulation Results: Osteodensitometry highlighted the presence of
with soluble biglycan cause a dramatic 55 % reduction of osteoporosis at 70 % from the cases included in the study
proteoglyan content in OA cartilage. and the rest of patients (6 with functional adipose- genital
Conclusion: The current results show for the first time that syndrome) T-score and Z were suggestive for osteopenia
soluble BG is a powerful inflammatory alarmin able to elicit (−1.70 at 2.30 SD).
 Osteoporos Int

Conclusion: 1. For all cases with late puberty is imposed the in vitro study, total and surface CaSR expression in the
hormonal evaluation, cytogenetic, imagistic and U937 cell line were increased by calcitriol but total CaSR
osteodensitometry. expression was decreased by TNFα stimulation.
2. Estroprogestive hormonal substitution or androgenic in
association with antiresorptive/proformation medication is
contributing at bone mass growth and reduction of fragility P217
fractures incidence. BONE AND NEUROPSYCHIC DISPLAYS IN GRAVES’
DISEASE
S. A. Preda 1 , M. Bistriceanu 2 , I. Bistriceanu 3, O. M.
P216 Marioara4
1
DETERMINATION AND MODULATION OF TOTAL Faculty of Dental Medicine, University of Medicine and
AND SURFACE CALCIUM-SENSING RECEPTOR Pharmacy, Craiova, Romania, 2Department of Endocrinology,
EXPRESSION IN MONOCYTES IN VIVO AND IN University of Medicine and Pharmacy, Craiova, Romania,
3
VITRO Department of Endocrinology, Emergency Hospital,
J. P. Paccou1, C. B. Boudot1, A. M. Mary1, S. K. Kamel1, Craiova, Romania, 4University of Medicine and Pharmacy,
T. B. D. Drueke1, P. F. Fardellone1, Z. M. Massy1, M. B. Brazier1, Craiova, Romania
R. M. Mentaverri1
1
INSERM U1088, Université de Picardie Jules Verne, Objective: Graves’ disease is the most frequent form of
Amiens, France thyrotoxicosis, predominant at females with an autoimmune
pathogenisis. Bone and neuropsychic modifications from thy-
Objective: Expression of the calcium-sensing receptor rotoxicosis are mostly determinate by the increase of the
(CaSR) has previously been demonstrated in human circulat- sensibility of these structures at catecholamines (thyroid hor-
ing monocytes (HCM). The present study was designed to mones) and also by the modifications of bone and cerebral
measure CaSR expression in HCM and to examine its poten- metabolism.
tial modulation by pro-inflammatory cytokines, Ca2+, vita- Identification of cases with Graves’ disease, clinical and bio-
min D sterols in U937 cell line. logical objectification of thyrotoxicosis diagnosis, identifica-
Material and Methods: Twenty healthy volunteers tion of nervous and psychic clinical manifestations, evaluation
underwent blood sampling with subsequent isolation of pe- of BMD by DXA.
ripheral blood mononuclear cells (PBMC) at 3 visits. Flow Material and Methods: Were studied 12 cases with clinical
cytometry analysis (FACS) was performed initially (V1) and diagnosis of Graves’ disease and were made the following
19 days later (V2) to examine intra- and intersubject fluctua- paraclinical investigations: FT4 and TSH dose, thyroidal ech-
tions of total and surface CaSR expression in HCM and o, exoftalmometry, EKG, EEG, EMG and DXA.
15 weeks later (V3) to study the effect of vitamin D supple- Results: The most important nervous manifestations were
mentation. In vitro experiments were conducted to assess the represented by: impatience, exaggerated sensibility, rapid
effects of pro-inflammatory cytokines, calcidiol, calcitriol and thinking process, repetitivity, agitation in gestures,
Ca2+ on CaSR expression in U937 cell line. tachykinesia, neglected writing, and sleeping insomnia. As
Results: By FACS analysis, more than 95 % of HCM exhib- psychical disorders were identified: emotional liability, irrita-
ited cell surface CaSR staining. In contrast, CaSR staining bility, anxiety, depression, euphoria, confusion. At 9 cases the
failed to detect surface CaSR expression in other PBMC. T-score had values of −3.2 to −4.1 SD al lumbar spine level
After cell permeabilization, total CaSR expression was ob- and also at femoral cervix.
served in more than 95 % of all types of PBMC. Both total and Conclusion: 1. Neuropsychic disorders are frequent in
surface CaSR expression in HCM showed a high degree of thyrotoxicosis.
intra-assay reproducibility (<3 %) and a moderate intersubject 2. Bone manifestation are represented by hyperalgic osteopo-
fluctuation. In response to vitamin D supplementation, there rosis, spinal subsidence, scapulohumeral periarthritis.
was no significant change for both total and surface CaSR 3. The therapeutically onset is differentiated by rapport with
expression. In the in vitro study, U937 cells showed strong evolutive stage: medicines, surgical, isotopic by following the
total and surface CaSR expression, and both were moderately efficiency criteria (clinical and biological).
increased in response to calcitriol exposure. Neither total nor
surface CaSR expression was modified by increasing Ca2+
concentrations. Total CaSR expression was concentration de- P218
pendently decreased by TNFα exposure. THE STUDY OF OSTEOPOROSIS INCIDENCE IN
Conclusion: CaSR expression can be easily measured by THE SYNDROME OF PAUPER OVARIES
flow cytometry in human circulating monocytes. In the S. A. Preda1, M. Bistriceanu2, I. Bistriceanu3
Osteoporos Int

1
Faculty of Dental Medicine, University of Medicine and broaching of hypogonadism osteoporosis that is installed
Pharmacy, Craiova, Romania, 2Department of Endocrinology, more precocious in comparing with the menopause
University of Medicine and Pharmacy,, Craiova, Romania, one. Gonadal insufficiency diagnosis and its etiology,
3
Department of Endocrinology, Emergency Hospital, BMD evaluation, adopting differentiated therapeutically
Craiova, Romania measures by rapport with the evolutive stage of bone
mass deficit (osteoporosis/osteopenia) and with hypogonadism
Objective: At patients with premature ovarian insufficiency etiology.
or the syndrome of pauper ovaries, the follicular dower is Material and Methods: Were included in the study 63
much reduced and as a result is the deficiency of ovarian cases with hypogonadotropic or hypogonadotropic
hormonopoiesis. As the number of follicles is lower the hypogonadism with ages 14–31. At all cases BMD was
ovary’s life span is reduced, making the clinical spectrum to evaluated by DXA. The therapeutically options were
be characterized through the absence of puberty sexuality total aiming to: nonpharmacological undertake (a diet with a
or partial until the precocious installation of climacterium. positive level of calcium and vitamin D, modifying the
During the perturbation of hormonal secretion which controls lifestyle and easy physical exercises) and pharmacological
the bone homeostasis, ratio bone formation-resorption is dam- therapy (report difference with hypogonadism etiology in
aged and thus, bone mass decreases and causes osteoporosis, association with antiresorptive agent - ibandronic acid in
which motivates the approach of this subject. 150 mg doses at 30 days).
Material and Methods: The study was performed on 52 Results: Osteoporosis was confirmed at 32 cases and at 9
patients whose ages ranged from 20 to 40 years. Hormonal subjects, T-score suggestive for osteopenia. The efficiency of
investigations focused on the study of FSH, LH, PRL, estra- the treatment with ibandronic acid, after 12 months of admin-
diol, progesterone. The patients underwent utero-ovarian pel- istration, was observed at 85 % of cases with osteoporosis at
vic sonography. BMD was measured by DXA at the spine, lumbar spine level and also at femoral cervix level. It was
pelvis and radius. The biochemical markers of bone turnover observed an increase of BMD with 4.2 % at lumbar spine level
studied were serum osteocalcin and crosslaps by ELISA. and with 2.1 % at femoral cervix level.
Results: Hormonal doses showed low levels of estradiol and Conclusion: 1. The study is confirming the efficiency of
progesterone, instead, gonadotropic hormones were above the ibandronic acid on BMD at lumbar spine level and also at
normal upper limit between 210 and 385. BMD measure- femoral cervix level.
ments revealed the presence of osteoporosis in 24 cases which 2. The differentiate therapeutically study is imposing the
represents 45.1 % of all cases investigated, BMD values association of antiresorption medication with bone
correlate with biochemical markers of bone turnover. remineralisation and gonadic/gonadotropic hormones in re-
Conclusion: 1. Evaluation of BMD and biochemical markers port with hypogonadism etiopathogeny.
of bone turnover in premature ovarian failure must be done
regularly to identify patients who rapidly lose bone mass and
are at increased risk of osteoporosis. P220
2. Estrogen-progesterone substitution is the main and first NEW WAY TREATMENT OF POSTMENOPAUSAL
treatment in premature ovarian failure to prevent osteoporosis, OSTEOPOROSIS
metabolic and visceral complications. V. I. Strukov1
1
3. Patients with osteoporosis will receive antiresorptive agents Penza Institute of Physicians, Penza, Russian Federation
or proformative medication to prevent fragility fractures.
Objective: Development of more effective method of treat-
ment of postmenopausal osteoporosis among women having
P219 androgenic deficiency.
TREATMENT OF IBANDRONIC ACID IN Material and Methods: Treatment of osteoporosis with
HYPOGONADIC OSTEOPOROSIS natural hormones has a number of disadvantages. We
S. A. Preda1, I. Bistriceanu2, M. Bistriceanu3 propose treatment with drone brood hormones (Russian
1
Faculty of Dental Medicine, University of Medicine and Patent No 2497533, 2498811). We investigated 81
Pharmacy, Craiova, Romania, 2Department of Endocrinology, women in the age of 49–77 with postmenopausal oste-
Emergency Hospital, Craiova, Romania, 3Department of En- oporosis, having cavities in trabecular bones. Diagnos-
docrinology, University of Medicine and Pharmacy, Cra- tics was carried out on the basis of clinical, biochemi-
iova, Romania cal, radiographical methods. Hormonal profile was de-
termined on the base of ELISA method. Women were
Objective: Discovering frequently cases with hypogonadism divided into two comparison groups. The first group (39
(feminine or masculine), is motivating the therapeutically women) received calcium citrate 250 mg, vitamin Dз
 Osteoporos Int

150 IU and drone brood 50 mg - 2 tablets in the (IQR, 26.1–12.1) ng/ml. Females had higher 25(OH)D3
morning and 2 tablets in the evening during 10 months. level than males: 19.0 (IQR, 26.3–12.2) ng/ml vs. 17.8
The second group (42) received the same medicine on (IQR, 25.6–12.0) ng/ml, p =0.018. Sufficient level of
the same scheme and dosage but without drone brood. 25(OH)D3 was seen in 17.0 % of the study population,
All patients were investigated before and after 10 months insufficient level in 29.0 % and 37.5 % had 25(OH)D3
course of treatment, including determination of BMD deficiency, but 16.5 % of the study population had
and measurement of bone cavities by X- ray absorption severe deficiency (<10.0 ng/ml). In the age group 18–
osteometry method. The area of cavities and their dy- 49 year 25(OH)D3 level was 19.0 (IQR, 26.9–12.0) ng/ml, in
namics were calculated by means of mathematical image the age group 49–69 year 25(OH)D3 level was 19.0
processing with use of Delphi language. (26.1–12.7) ng/ml. Patients older than 70 year had a
Results: After treatment the concentration of testosterone in lower level 25(OH)D3 - 18 (IQR, 26.0–11.6, p=0.016)
blood serum among the women of first group increased from ng/ml, but there was no difference between females and
1.1±0.4 to 2.5±0.6 nM/l (р<0.05). The X- ray osteometry males in this age group (p=0.571). Analyzing seasonal
picture showed positive changes among 29 patients showed periods 2007–2011, 25(OH)D3 level in winter was 14.0
positive changes (74±8 %), incl. reduction of cavities among (IQR 19.2–9.3) ng/ml, and in summer it was 22.0 (IQR,
19 (49.4±7 %) and closing of cavities among 10 women 29.7–15.0) ng/ml (p<0.001), but in spring 25(OH)D3
(25.6±7 %). level was 15.0 (IQR, 22.3–9.3) ng/ml and in autumn it
In the second group positive changes were recorded among 20 was 22.9 (IQR, 30.2–16.1) ng/ml (p<0.001).
women (47.6±8 %) in comparison with 74±8 % in 1st group Conclusion: Vitamin D insufficiency and deficit were com-
(р<0.05). Closing of cavities occurred 3 times more rarely mon in the study population regardless of gender, season and
among 7 women (18±6 %, р<0.05). age, especially in people older than 70 years.
Conclusion: Drone brood hormones stimulate endogenous
production of androgens, bone mineralization and closing of
bone cavities. It ensures the more effective treatment of post- P222
menopausal osteoporosis. PREDICTION OF FRAGILITY FRACTURE BEYOND
10 YEAR BY DXA IN WOMEN: THE OFELY STUDY
E. Sornay-Rendu 1 , F. Duboeuf 1 , S. Boutroy 1 , R. D.
P221 Chapurlat1
1
VITAMIN D STATUS IN LATVIAN POPULATION: INSERM UMR 1033, Université de Lyon, Hospices Civils
RESULTS FROM LABORATORY DATABASES de Lyon, Hôpital E Herriot, Lyon, France
M. Mukane1, I. Rasa2
1
Int. Med., RECUH, RSU, LOBMDA, Riga, Latvia, Objective: Low BMD is a major determinant of fragility
2
Endocrinology, RECUH, RSU, LOBMDA, Riga, Latvia fractures (Fx), but its very long term prediction is poorly
documented.
Objective: Vitamin D deficiency is much more common than Material and Methods: In the OFELY study, we analyzed
previously thought, especially in the Northern latitude coun- the risk of Fx over 20 year, and specifically beyond
tries. The aim of the study was to evaluate vitamin D 10 year, in women aged 40 year and more at the
(25(OH)D3) status among adults in one of the Northern Eu- inclusion (n=867, mean age 59±10 year), according to
ropean country - Latvia. baseline BMD obtained by DXA, clinical risk factors
Material and Methods: Retrospective study (May 2007– and the FRAX score.
November 2011) included data of 7,869 pts from two Results: During a median (IQ) follow-up of 19.9 (2.9) yrs,
electronic databases (Central Laboratory Ltd and E. 245 women sustained one or more incident fragility Fx.
Gulbja Laboratory Ltd). Sufficient level of 25(OH)D3 Women who sustained Fx beyond 10 years (Fx 10–20, n=
was defined as >30.0 ng/ml, insufficiency as 20.0– 109) were younger and had lower values of FRAX compared
29.9 ng/ml and deficiency as <19.9 ng/ml. To determine with those in the first 10 years (Fx 0–10, n=136). After
the differences of seasonal 25(OH)D3 concentration, as- adjusting for age, Fx 10–20 had greater grip strength and
tronomical seasons were applied. All interval data were spine BMD and used more often HRT, compared with Fx 0–
presented in median values with interquartile range 10 (p=0.01 to 0.03). Parental hip Fx was associated with an
(IQR). increased risk of Fx 10–20 but contrasting with Fx 0–10, the
Results: A total of 7,022 females and 847 males were risk of Fx 10–20 was not associated with age, previous Fx and
studied. Females were older than males (60 (IQR, 69– FRAX except in women younger than 70 year. Each SD
51) yrs vs. 56 (IQR, 67–40) yrs, p=0.001). The median decrease of BMD at the spine, femoral neck, total hip and
serum 25(OH)D3 level in the study population was 18.7 ultradistal radius was associated with an increased risk of
Osteoporos Int

fragility Fx over 20 year with odds ratio [95%CI] of 1.65 patients. Post-treatment unadjusted serum calcium decreased
[1.37–1.99], 1.48 [1.20–1.82], 1.62 [1.32–1.97] and 2.15 slightly at 1 year (10.28 mg/dL vs. 10.88 mg/dL; P=0.0006)
[1.69–2.71], respectively, after adjustment for age, prior Fx, and 2 years (10.35 mg/dl). The small calcium difference in
parental hip Fx, falls and treatment at baseline or during PHPT patients became statistically insignificant in paired
follow-up (HRT, bisphosphonates, etc.). Moreover, the risk values at 2 years. iPTH levels decreased significantly at both
of Fx 10–20 was also significantly increased with adjusted OR 1 year (109.1 pg/ml) and 2 years (100.7 pg/ml). Creatinine
of 1.37 [1.08–1.73], 1.32 [1.02–1.72], 1.39 [1.08–1.79] and remained stable in all patients, and no new cases of
1.82 [1.35–2.48]. Women with osteoporosis had an increased nephrolithiasis or fractures were reported.
risk of both Fx 0–10 and Fx 10–20 compared with women Conclusion: Replacing vitamin D in mild primary hyperpara-
with normal BMD, whereas osteopenia was not associated thyroidism is safe, does not increase serum calcium and sig-
with a higher risk of Fx beyond 10 years. nificantly reduces iPTH levels.
Conclusion: In conclusion, low BMD in women aged 40 year
or more is significantly associated with an increased risk of
fragility fracture over 20 year. Beyond 10 year, the prediction P224
conferred by baseline BMD was better than that from clinical THE PREVALENCE OF ANAEMIA IN HIP
risk factors. FRACTURE PATIENTS: AN OBSERVATIONAL
STUDY
S. W. Frankland1, A. Gupta1
P223 1
Orthogeriatrics, West Wales General Hospital, Carmarthen,
LONG-TERM REPLACEMENT WITH VITAMIN D IN United Kingdom
PATIENTS WITH PRIMARY
HYPERPARATHYROIDISM AND VITAMIN D Objective: The blood loss sustained during hip fracture repair
DEFICIENCY can be significant and is associated with a high risk of postop-
D. Grigorie1, A. Sucaliuc 1, A. Caragheorgheopol 2, C. erative anaemia. Anaemia may exacerbate cardiac and pulmo-
Iordachescu2, A. Diaconescu2 nary conditions suffered by this aging population leading to
1
National Institute of Endocrinology, Carol Davila University increased morbidity and mortality. Our objective was to assess
of Medicine, Bucharest, Romania, 2National Institute of the prevalence and severity of anaemia throughout hospital
Endocrinology, Bucharest, Romania admission in patients admitted with a fractured neck of femur.
Material and Methods: Data for haemoglobin levels of 100
Objective: To evaluate the safety of vitamin D replacement consecutive patients admitted to the acute hip fracture ward in
in patients with vitamin D deficiency and primary a UK district Hospital were collected from a computer blood
hyperparathyroidism. system. Patients’ haemoglobin levels (in g/L) were collected;
Material and Methods: Observational clinical study of 55 on admission, post operatively and predischarge. The WHO
consecutive patients from our osteoporosis department, mean guidelines for diagnosis of anaemia were used for analysis:
age 62.6 years, diagnosed with mild primary hyperparathy- <120 g/L for females and <130 g/L for males; severe anaemia
roidism (mean PTH 162 pg/ml; mean Ca 10.88 mg/dl) and (<80 g/L), moderate (between 80 and 100 g/L), mild (below
vitamin D deficiency (mean 25OHD 12.86 ng/ml), and treated normal range but >100 g/L).
with 1,000 IU of vitamin D daily for 2 years. Osteoporosis Results: Sample: 100 hip fracture patients, 65 % females.
(some of the patients were on treatment with bisphosphonates) Average age: 80 year. Table 1 shows the prevalence and
and nephrolithiasis were present in 80 % and 50 % of patients, severity of anaemia throughout hospital stay. Average
respectively. Data were collected before and after 6 month, 1 haemoglobin reductions of 26.4 g/L postoperatively and
and 2 years of treatment on serum calcium, 25OHD, intact 12.9 g/L on discharge were recorded compared to admission
PTH (iPTH), calciuria, phosphorus, alkaline phosphatase, levels. At discharge, 65 patients had a haemoglobin drop of at
nephrolithiasis and fractures. The control group consisted in least 10 g/L compared to their admission level, 35 suffered a
100 age- and BMI- matched individuals with osteoporosis. 20 g/L reduction or greater.
Results: The prevalence of severe vitamin D deficiency
(<10 ng/ml) was much higher in PHPT patients (45 %) than
in controls (22 %). Following daily treatment with 1,000 IU of
vitamin D serum 25OHD increased significantly, from a base-
line of 12.89 ng/mL to 20.44 ng/mL (p=0.006) after 1 year
and to 22.87 ng/ml (p=0.0005) after 2 years. The increase in Conclusion: Anaemia on admission is common in hip frac-
serum 25OHD was inversely related to its initial concentration ture patients. Postoperative anaemia following hip fracture
(r = −0.673) and the slope was similar with non-PHPT repair is also common, especially moderate anaemia. At
 Osteoporos Int

discharge, high percentages of patients remain anaemic with Public Health and Health Economics, University of Liège,
some suffering substantial reductions in their haemoglobin Liège, Belgium, 3Innovative Therapeutic Pole of Rheumatology,
compared to admission. Further analysis to assess the effect Servier, Suresnes, France, 4Synarc, San Francisco, United States,
5
of anaemia on morbidity, mortality and length of stay is INSERM Unit 433, Lyon, France
required.
Objective: Osteoarthritis (OA) is a common degenerative
joint disease that affects around 80 % of those aged over
P225 75 years. Many factors appear to influence progression, the
EVALUATION OF PERIPHERIC VERTIGO IN rate of which is very variable. Established factors include sex,
POSTMENOPAUSAL OSTEOPOROTIC CASES obesity, and prior knee injuries. While imaging of OA was
OVER 65 YEARS OLD traditionally achieved using radiographs, more recently, a role
S. Atar1, E. Demirhan1, B. Huner1, Y. Atar2, Z. Salturk2 has been established for MRI. In this study we examined the
1
Department of Physical Medicine and Rehabilitation, relationship between bone marrow lesions (BML) visualised
Okmeydani Training and Research Hospital, Istanbul, Turkey, using MRI and subsequent progression of knee OA, using the
2
Department of Otorhinolaryngology, Okmeydani Training placebo arm of a randomised controlled trial of a therapy for
and Research Hospital, Istanbul, Turkey OA.
Material and Methods: 559 men and women over 50 years
Objective: To assess the peripheric vertigo in cases who was with clinical knee OA (K&L 2–3) were recruited to the
over 65 years old postmenopausal women and had vertigo and placebo arm of the SEKOIA study (98 centre; 18 countries).
balance disturbance. Minimal tibiofemoral joint space on plain radiograph of the
Material and Methods: Cases who had T-score of ≥−2.5 by knee was assessed by two independent readers at baseline and
DXA was accepted as osteoporosis. 48 osteoporosis cases yearly follow-up (up to 3 years). In a subset of 176, serial knee
over 65 years and had vertigo was included to study. They MRIs were performed. Individuals with a BML of grade 2 or
were evaluated at ENT clinic and vestibular tests were per- above at the tibiofemoral joint at baseline were classified as
formed. Age, attack frequency and duration, DXA scores, BML positive. Relationships between joint space and risk
diagnosis, and treatment protocols were analyzed. factors were assessed using linear regression.
Results: The mean age of the cases was 69.8±6.2. Duration of Results: The mean (standard deviation (SD)) age of study
the complaints was 2.4±1.5 years. 33 cases had less than 6 participants was 62.8(7.5) years. 73 % were female and the
attacks per year, 17 cases had one attack per month, 8 cases mean(SD) BMI at baseline was 29.8(5.1). Just over one third
had one attack per week, 2 cases had one attack per day. 35 of those studied had BMLs (38.6 %). The prevalence of BMLs
cases had attacks lasting less than a minute, 9 cases had did not differ significantly by age or BMI. On average, joint
vertigo up to 15 min and 3 cases had attacks <1 h. Only 1 space reduced by −0.18(0.30) and −0.13(0.23) mm/year in
patient had attacks lasting 24 h. The mean DXA score was men and women, respectively. Those with BMLs had a sig-
−2.9±0.3. 34 cases were diagnosed as benign paroxysmal nificantly higher level of annualised joint space narrowing
positional vertigo and 6 cases had vertebrobasillary insuffi- (JSN), with the relationship remaining robust after adjustment
ciency. Moreover, 2 possible Meniere’s disease, 1 benign for age, sex and K&L grade; β(95%CI) -0.10(−0.18,−0.02)
intracranial hypertension, and 5 psychological vertigo were mm/year. Age, sex, and baseline K&L grade did not influence
detected. rate of JSN.
Conclusion: Benign paroxysmal positional vertigo was the Conclusion: The rate of JSN was similar in men and women.
most common reason of vertigo in the cases who were over BMLs on knee MRI predicted rate of radiographic JSN. This
65 years and had osteoporosis. relationship was independent of age, sex, and baseline K&L
grade.
Disclosures: C. Cooper has received honoraria and consulting
P226 fees from Amgen, Eli Lilly, Medtronic, Merck, Novartis and
IMPACT OF BONE MARROW LESION ON THE Servier. F. Petit-Dop and P. Belissa are employees of Servier.
PROGRESSION OF KNEE OSTEOARTHRITIS IN
THE SEKOIA STUDY
C. Parsons1, M. H. Edwards1, O. Bruyère2, F. Petit-Dop3,
P. Beliaa3, H. K. Genant 4, A. Guermazi 4, F. Roemer 4, P227
S. Zaim4, R. D. Chapurlat5, J.-Y. Reginster2, E. M. Dennison1, AN OBSERVATIONAL STUDY INVESTIGATING
C. Cooper1 SERUM CREATININE LEVELS IN HIP FRACTURE
1
MRC Lifecourse Epidemiology Unit, Southampton General PATIENTS
Hospital, Southampton, United Kingdom, 2Department of S. W. Frankland1, A. Gupta1
Osteoporos Int

1
Orthogeriatrics, West Wales General Hospital, Carmarthen, Objective: The skeletal system is constantly exposed to me-
United Kingdom chanical loading here on Earth, and lack of loading has drastic
Objective: Kidney dysfunction is common in the elderly effects in skeletal muscles atrophy and bone density loss.
and has been proven to have an association with in- However, little is known about the possible effects of micro-
creased hip fracture incidence. Our objective was to gravity on articular cartilage of the synovial joints, and
assess the renal function of hip fracture patients more importantly, how the changing subchondral bone
throughout their hospital stay using serum creatinine can affect the adjacent cartilage integrity. Changes in
levels as the marker of renal function. subchondral bone density are commonly associated with
Material and Methods: Data on serum creatinine levels cartilage degradation in osteoarthritis (OA), and there-
was collected from records for 100 consecutive patients fore, crosstalk between the two tissues could lead to
admitted to a hip fracture ward in a UK district Hospi- progress of pathological conditions. Understanding the
tal. Patients’ serum creatinine levels were recorded; pre- molecular mechanisms involved in bone and cartilage
admission (from previous blood tests), on admission and mechanotransduction in response to microgravity is cru-
before discharge. Laboratory specific creatinine refer- cial to identify potential therapeutic targets to develop critical
ence ranges were used for analysis; 44–80 μmol/L countermeasures to prevent skeletal degradation during
(females), 62–106 μmol/L (males). Comparisons were spaceflight.
made between levels pre-admission to discharge (PA- Material and Methods: Primary chondrocytes were exposed
DC) and admission to discharge (OA-DC). to simulated microgravity using a rotating wall vessel biore-
Results: 100 hip fracture patients, 65 % females. Average age: actor. Morphological changes of the actin cytoskeleton were
80 years. Table 1 shows creatinine levels in hip fracture evaluated using confocal microscopy. Sclerostin (SOST) ex-
patients. The average creatinine reduction PA- DC was pression levels were examined in chondrocytes exposed to
10.2 μmol/L, OA-DC it was 19.7 μmol/L. A creatinine re- simulated microgravity and compared to levels expressed by
duction of over 20 μmol/L was noted in 26 patients OA-DC control chondrocytes under normal gravity conditions. ELISA
but in only 11 patients PA-DC. was used to measure secreted sclerostin expression in the
media.
Results: Wnt signaling has been shown to be an important
mechanisms in bone mechanostransduction in unloading con-
ditions. Our data also shows changes in Wnt signaling in
response to simulated microgravity in cartilage, however,
Conclusion: This study suggests substantial percentages of Wnt activation and inhibitions have opposite effects on adja-
patients presenting to hospital with a hip fracture have some cent bone and articular cartilage tissues, and therapeutic
degree of renal impairment as defined by a high creatinine targeting against Wnt inhibitors to prevent bone loss needs
level. Many of these patients’ creatinine levels normalise to be further investigated.
during their hospital stay. The greatest reductions in creatinine Conclusion: This is the first study to integrate the interactions
were observed between admission and discharge; this sug- of articular cartilage and bone in spaceflight conditions to
gests a substantial number of patients have acute kidney injury assess synovial joint integrity, and to investigate specific
on admission. As such, reversible causes of renal impairment signaling pathways and mechanisms that result in bone re-
should be actively sought and treated. The contribution of sorption and cartilage degradation.
renal impairment to postoperative outcomes and bone fragility
needs further investigation.
P229
EXCELLENT ADHERENCE TO 6-MONTHLY
P228 DENOSUMAB INJECTIONS DUE TO POSITIVE
EFFECTS OF SPACEFLIGHT ON SUBCHONDRAL FEEDBACK BASED ON 6 AND 12 MONTHS BMD
BONE AND ARTICULAR CARTILAGE HEALTH: INCREASES AND RARE ADVERSE EVENTS IN
ARE THEY GOOD NEIGHBORS? PATIENTS WITH DIFFERENT FORMS OF
L. F. Mellor1, T. Baker 2,3, M. Hiremath3, E. G. Loboa 1, OSTEOPOROSIS
J. T. Oxford 3 J. D. Ringe1, P. Farahmand1
1 1
Joint Department of Biomedical Engineering, North Carolina West German Osteoporosis Center (WOC), Klinikum
State University and UNC Chapel Hill, Raleigh, United Leverkusen, University of Cologne, Leverkusen, Germany
States, 2Biomolecular Research Center, Boise State Universi-
ty, Boise, United States, 3Biomedical Research Center, Boise Objective: About 50 % of osteoporosis patients discontinue
State University, Boise, United States bisphosphonate (BP) therapy within the first year of treatment.
 Osteoporos Int

Denosumab’s (Dmab) longer dosing interval with its s.c. received saline. The experimental protocol complied local
administration every 6 months might result in a better adher- animal experimentation rules and was approved by our ethics
ence than BP treatment regimen. committee. After euthanasia, weight, blood glucose and plas-
Material and Methods: In an open prospective observational matic anticarboximetilisin were analysed. Knee synovial tissues
investigator-initiated trial in routine clinical practice we stud- were included in paraffin, histological sections stained with HE
ied whether a medical explanation of treatment results 6 and and the amount of total collagen, COL I, COL III and COL V
12 months after the first Dmab injection focussing on signif- were evaluated by 4-hydroxyproline analysis, picrosirius red
icant BMD increases, no or only mild and probably not drug staining, immunofluorescence and image analysis.
related AEs and improvement in back pain have effects on Results: Blood glucose was significantly increased in diabetic
patients’ drug perception and future adherence with further groups vs. controls (p<0.005), whereas weight of diabetic
Dmab injections. We included 142 patients (69 with postmen- animals reduced compared to controls (p<0.001). Higher
opausal, 42 with male, and 32 with GC-induced osteoporosis). quantities of COL were observed by 4-hydroxyproline analy-
Results: Overall, 93 % of patients reported no negative chang- sis in G2 vs. C2 (p<0.005), similarly for G1 vs. C1 but
es in their health condition after two injections of Dmab, and without statistical significance. Morphologic analysis demon-
only 7.0 % reported AEs. These were all mild to moderate and strated substitution of the subsynovial layer fat by fibrotic
obviously not drug related. The significant DXA mean BMD tissue in diabetic groups with important deposition of collagen
increase rates for all patients at month 6 were +4.7 % at the fibers around small vessels. Histomorphometry analysis re-
lumbar spine (LS) and +2.1 % at the total hip (TH), and at vealed increased amount of coarse collagen fibers (22.70±
month 12 +7.8 % at the LS site and +3.7 % at the TH area, 8.20) with reduction of fine collagen fibers in G2 (16:29±
respectively. There were only 5 vert. and 4 nonvert. fractures 6:10 %) vs. C2 (14:45±5:39 %, 21:39±6.14, respectively,
during the 142 patient years follow-up. The back pain score p<0.05), similarly to G1 vs. C1 but not significantly. The
measured by VAS 0–10 decreased in all 3 groups significantly analysis of COL I, III and V were statistically higher in G2
after 6 and 12 months. This clinical effect together with the vs. C2 (p<0.05), though not significant in G1 vs. C1.
scarcity of AEs and the positive feedback of a rapid BMD Conclusion: The morphologic changes observed in synovial
increase at both sites resulted for 141 (99 %) patients after tissues from diabetic rats and increased amount of COL fibers
6 months and 139 (97 %) after 12 months in a willingness to deposition in this structure reinforce the concept that COL
accept a further injection. fibers deposition and remodeling may be relevant for the
Conclusion: Our results indicate that the convenient treatment pathogenic pathway progression in diabetic patients joints.
regime together with back pain improvements, very rare ad-
verse events and the consistency of rapid and highly signifi-
cant BMD increases after 6 and 12 months of Dmab therapy P231
used as a positive reinforcement had a significant, positive BONE MASS IS DETERMINED BY NUTRITIONAL
impact on patients’ adherence to continue with the 6-monthly STATUS AND PHYSICAL ACTIVITY IN MALE BUT
s.c. Dmab injections. ER Α PVU II GENOTYPE OUTWEIGH IN FEMALE
IN COMMUNITY-INDWELLING KOREAN
ELDERLY
P230 S. Choi1, N. Kwon2
1
ALTERED COLLAGEN FIBERS DEPOSITION IN College of Nursing, Seoul National University, Seoul,
SYNOVIAL JOINTS OF DIABETIC RATS’ MODEL Republic of Korea, 2College of Natural Science, Hankuk
INDUCED BY STREPTOZOTOCIN University of Foreign Studies, Seoul, Republic of Korea
C. Goldenstein-Schainberg1, E. Parra 1, W. R. Teodoro 1,
V. L. Capelozzi1, S. A. Atayde1, J. Morais1, S. Catanozi1, Objective: To determine the stiffness index (SI) and gender-
A. P. Velosa1, P. C. Andrade1, W. Teodoro1 specific factors that can be related to SI including gene poly-
1
Reumatologia, Faculdade De Medicina, Universidade De morphisms vitamin D receptor gene (Bsm I) and two estrogen
Sao Paulo, Sao Paulo, Brazil receptor (ER) α genes (Xba I and Pvu II) in a Korean elderly
cohort.
Objective: To analyze synovial collagen (COL) fibers in a Material and Methods: Data were collected from two nearby
model of rat diabetic joints induced by streptozotocin and their senior centers in Seoul, South Korea, in January and February
correlation with the temporal evolution of the diabetes. 2009. We investigated socio demographic/lifestyle factors,
Material and Methods: Twenty diabetic Wistar rats induced nutritional status/nutrient intakes, and gene polymorphisms,
by 35 mg/kg streptozotocin infusion were divided in 2 groups: with relation to the SI.
G1 (n=10) was euthanized after 2 week and G2 (n=10) after Results: Of the initial 307 subjects, a total of 261 men and
2 month of induction. Control groups (C1=10 and C2=10) women aged ≥65 years participated in this study. The mean SI
Osteoporos Int

was significantly higher for the men than the women My protocol:
(p<0.001). In multiple regression analysis, among elderly •ZOL 5 mg infusion
men, age (β=−0.306, p<0.001), physical activity (β=0.243, •ZOL infusion followed by PTH For 2 years
p=0.003), and nutritional status (β=0.181, p=0.026) were •2nd dose of ZOL acid at first and second year depending
significant predictors of SI. Among the elderly women, age upon requirement of the patient
(β= −0.252, p= 0.002), drinking alcohol (β= −0.241, p= Results: •BMD increased in all patients
0.003), education level (β=0.234, p=0.005), and PP or Pp •No secondary fracture observed
genotype of ER α gene Pvu II (β=0.206, p=0.011) were •Combination treatments were well tolerated
significant predictors of SI. Low SI was common in both •PTH followed by ZOL acid now extending up to 6–9 years
elderly men and women. Gender differences in factors other PTH followed by Zoledronic acid:
than age can be linked to low SI. In the men, nutritional status • Since 2009
and physical activity were more important factors whereas •After PTH all cases put on ZOL acid - minimum duration
alcohol consumption, educational level, and genetic polymor- 3 years
phism were significant factors predicting low SI in the Conclusion: •These observations in the combination group
women. likely result from
Conclusion: These gender different lifestyles and nutritional •PTH-induced increases in osteoblastic activity, together with
status should be factored into the development of health •Zoledronic acid-induced reductions in bone remodelling and
education programs for osteoporosis prevention in the cortical porosity
elderly. •Combination therapy might therefore be appropriate treat-
ment for patients at with very low hip BMD, high risk for hip
and other fractures, rheumatoid arthritis or patients in whom
P232 rapid response is required.
COMBINATION AND SEQUENTIALTHERAPY FOR
SEVERE OSTEOPOROSIS
S. Marwah1 P233
1
Department of Orthopaedics, Child & Family Research In- BASELINE CHARACTERISTICS OF A
stitute, University of British Columbia, Gurgaon, India PROSPECTIVE OBSERVATIONAL STUDY IN CZECH
REPUBLIC (CZE) AND SLOVAKIA (SVK) TO
Objective: •Concomitant administration of a single infu- DESCRIBE MANAGEMENT OF PATIENTS WITH
sion of intravenous zoledronic acid (5 mg) with daily POSTMENOPAUSAL OSTEOPOROSIS (PMO)
subcutaneous teriparatide (20 μg) yielded larger, more RECEIVING DENOSUMAB (DMAB) IN ROUTINE
rapid increments in both spine and hip BMD than either CLINICAL PRACTICE
agent alone. P. Hrdý1, P. Kasalický2, S. Tomkova3, M. Feudjo-Tepie4,
•Cotreatment with zoledronic acid also prevented the PTH E. Zhang4, L. Kalouche-Khalil5, Z. Killinger6
1
induced increase in cortical porosity, thus strengthening the MEDIEKOS Ambulance, Osteocentrum Zlín, Czech Repub-
cortex, and increased hip BMD beyond values achieved with lic, 2Bone Metabolism Unit, Mediscan Group, Prague, Czech
PTH alone. Republic, 3Osteocentrum, Kosice-Saca, Slovakia, 4Amgen
Material and Methods: My own experience: Ltd, Zug, United Kingdom, 5Amgen (Europe) GmbH, Zug,
•Zoledronic acid infused from 2009 to 2012 August in >300 Switzerland, 65th Department of Internal Medicine, Medical
Patients Faculty of Comenius University, University Hospital,
•Reinfusions done in 100 patients till date Bratislava, Slovakia
•PTH cases 235 (since 2005) and 73 PTH cases initiated
in 2013 which is highest globally in the clinical Objective: Describe the characteristics of PMO women initi-
experience ating DMAb in clinical practice in CZE and SVK.
•Combination PTH followed by ZOL acid 50 patients Material and Methods: The study enrolled PMO women in
• Sequential ZOL acid followed by PTH 100 patients CZE and SVK who had received their first DMab injection in
When do I use combination therapy? the previous 8 weeks. Data recorded as per standard clinical
•Age more than 65 years practice is collected for 2 years after enrolment, with no
•BMD T score<−3.5 additional procedures required. Study outcomes include pa-
•Impending fractures hip and spine tient characteristics and clinical osteoporosis (OP) manage-
•Postoperative implant failure due to severe osteoporosis ment. We report baseline data.
•In rheumatoid arthritis cases Results: As of July 2013, 600 patients had enrolled across 32
Sequential therapy ZOL acid followed by PTH centers (300 patients per country). In both countries, patients
 Osteoporos Int

had multiple co-morbidities (mean [SD] number: CZE, 4.0 immunosuppressants or drugs for cancer. The case/noncase
[2.3]; SVK, 3.2 [2.1]). In CZE, mean (SD) age was 69.0 (8.7) analysis disclosed increased risk of bone loss with glucocor-
yrs and mean BMD T-scores −2.7 (1.0) and −2.0 (1.3) at the ticoids for systemic/dermic or respiratory use, antivirals for
lumbar spine (LS) and total hip (TH), respectively. Two-thirds HIV infection, misoprostol, low molecular weight heparins,
(67 %) of patients had a history of OP fracture; 85 % had etetrinate or acitretine, immunosuppressants, antagonists of
received PMO therapy prior to enrolment, mostly within sexual hormones for cancer treatment, bisphosphonates, anti-
12 months of enrolment (80 % of all patients) and predomi- convulsants and antipsychotics. Patients on misoprostol or
nantly bisphosphonates (BPs). Two- thirds (66 %) of patients immunosuppressants were also frequently co-exposed to glu-
had received oral bisphosphonates (oBPs) and 7 % had re- cocorticoids, which was not the case for the rest of the drugs.
ceived intravenous (IV) zoledronate and/or IV ibandronate. In Conclusion: Bone loss was associated with exposure to sev-
SVK, mean (SD) age was 64.3 (8.6) yrs and mean BMD T- eral drugs, many of whom are well known causes of osteopo-
scores −2.6 (0.8) and −1.3 (0.9) at the LS and TH, respective- rosis in FPVD and FEDRA. Significantly increases risk of
ly. Thirty percent of patients had a history of OP fracture; 49 % bone loss with retinoids was herein observed in a small
had received PMO therapy prior to enrolment, mostly within number of cases, which warrants further exploration.
12 months of enrolment (40 % of all patients) and predomi-
nantly BPs. Approximately one-third (31 %) of patients had
received oBPs and 11 % had received IV zoledronate and/or P235
IV ibandronate. CIRCULATING PERIOSTIN: A NOVEL SERUM
Conclusion: These baseline data provide valuable informa- MARKER OF CORTICAL BONE STRUCTURE IN
tion regarding patients initiating DMAb in routine clinical HUMANS
practice in CZE and SVK. Differences in local reimbursement N. Bonnet1, C. Durosier1, P. Garnero2, S. Ferrari1, R. Rizzoli1
1
guidelines may explain the differences in patient characteris- Service des Maladies Osseuses, Geneva, Switzerland,
2
tics observed between the 2 countries. Future data from this Division of Rheumatology, INSERM UMR 1033,
study will provide additional insights regarding the clinical Université de Lyon, Lyon, France
management of OP in these countries.
Acknowledgements: Amgen/GSK Objective: Periostin is a matricellular protein, which is mainly
expressed by periosteal cells and osteocytes. We previously
reported that circulating periostin levels (cPostn) correlate
P234 with periosteal bone formation and cortical thickness (CtTh)
DRUGS RELATED BONE LOSS: A CASE/NONCASE independently of bone turnover in mice treated with PTH. In
STUDY IN THE FRENCH AND SPANISH the present study, we investigated the relationship between
PHARMACOVIGILANCE DATABASES cPostn and bone structure in humans.
S. Perez-Lloret1, M. E. Salgueiro-Vázquez2, M. V. Rey1, D. Material and Methods: We measured cPostn, bone turnover
Abadie3, G. Manso2, J. L. Montastruc3, H. Bagheri3 markers, aBMD, trabecular and cortical (Ct) parameters at the
1
Catholic University, Buenos Aires, Argentina, 2Pharmacology, distal radius and tibia by HR-pQCT in 242 healthy women
Oviedo, Spain, 3Toulouse University, Toulouse, France and 59 men, aged 64.9±1.4SD years. To test the association
between cPostn and bone parameters, we divided the subjects
Objective: To identify the drugs associated with bone loss in into 3 tertiles of cPostn, and applied an ANCOVA. Multiple
the French or Spanish pharmacovigilance databases (FPVD or regressions were used to assess the relation between cPostn,
FEDRA, respectively). BMD, microstructure and turnover markers.
Material and Methods: Spontaneous reports of bone loss Results: Mean cPostn was 1633±410 ng/ml (min 814, max
(i.e., “osteoporosis”, “osteopenia”, “increased bone resorp- 3,490 ng/ml). cPostn was higher in men than women (+8.6 %,
tion”, “osteomalacia”, “osteolysis”, “bone atrophy”, “osteo- p<0.01), whereas P1NP and CTX were lower in men than
porotic fracture”, “bone loss”, or “bone decalcification”) reg- women (−20 % and −21 %, p<0.01). Distal radius total bone
istered in FPVD and FEDRA between 1982 and 2012 were area, Ct.area and perimeter were higher in the highest vs.
analyzed. All suspected drugs were extracted and coded by lowest tertile (+6.4 %, +7.7 % and +3.8 %, p<0.05;
ATC. Reporting Odds ratios (ROR) and 95 % confidence p=0.12−0.34 after adjustment for gender). BV/TV was
intervals were calculated for drugs with more than 3 reports higher in the highest tertile (+12.4 % vs. low tertile,
in the FPVD or 2 in the FEDRA. p<0.01) and disappeared after sex- adjustment. cPostn
Results: 304 and 51 cases were retrieved from FPVD or positively correlated with Ct.area and Ct. perimeter of
FEDRA, respectively. Drugs most frequently connected with distal radius (r=0.12, p<0.05, both) and tibia (r=0.15,
bone loss in both databases were glucocorticoids, drugs for p<0.05, both). These correlations remained significant
HIV infection, anticonvulsants, antidepressants, antacids, and after adjusting for P1NP, CTX or whole body BMD, but
Osteoporos Int

not for gender. There was no difference in whole body, Conclusion: The 12-month persistence with DMAb among
spine and proximal femur aBMD, PTH, P1NP and CTX patients enrolled in the ProVital program was over 80 %.
between tertiles. Separate analyses per tertile in men Disclosures: MA is an employee of and shareholder in
and women indicated similar, but nonsignificant trends. Amgen, and VP and ME are former Amgen employees. VW
Conclusion: These results recorded in a homogeneous popu- and LB are employees of Optum contracted by Amgen. The
lation of healthy 65-year old subjects indicate a positive following relate to Amgen: AP, AK, WB, DK, JA received
correlation of cPostn with cortical bone structure, indepen- research funding. AP, AB, AK, WB, DK, JA, FT were con-
dently of bone turnover markers as previously observed in sultants. AP, WB, JA, DK, FT were speakers. DK, AB, AK,
mice, but likely through a sex-dependent effect. FT were advisors. AP, AK, DK received honoraria.
Acknowledgements: This study was sponsored by Amgen.
Jesse Potash (Optum) provided writing assistance.

P236
12-MONTH PERSISTENCE WITH DENOSUMAB P237
THERAPYAMONG OSTEOPOROTIC WOMEN IN ELBOWARTHROPLASTY IN COMPLEX
THE CANADIAN PATIENT-SUPPORT PROGRAM OSTEOPOROTIC FRACTURES
A. Papaioannou1, A. Khan1, A. Belanger2, W. Bensen1, D. L. A. Miti1, D. Katusic1, E. Chiarello1
Kendler3, F. Theoret4, M. Amin5, L. Brekke6, M. Erdmann7, 1
Orthopaedic and Traumatologic Unit Ospedale dell’angelo,
V. Popovic7, V. Walker6, J. D. Adachi1 Venezia Mestre, Italy
1
Medicine, McMaster University, Hamilton, Canada, 2Family
Medicine, Courcelette, Canada, 3Medicine, University of Brit- Objective: Osteoporotic elbow fractures (EF) represent a
ish Columbia, Vancouver, Canada, 4 Family Medicine, challenge. Open reduction and internal fixation is hard to
Hawkesbury, Canada, 5Amgen Inc., Mississauga, Canada, achieve due to poor mechanical bone proprieties, for this
6
Optum, Burlington, Canada, 7Formerly Amgen Inc., reason elbow arthroplasty (EA) is increasingly popularity in
Mississauga, Canada case of comminuted fractures of the distal humerus and is
associated with a rapid recovery of elbow motion. The aim of
Objective: To evaluate persistence with denosumab (DMAb) this study is to evaluate clinical outcomes of our series.
among women with osteoporosis participating in the Material and Methods: From September 2007 to March
Canadian patient-support program (ProVital). 2013 we performed 30 EA in 29 patients; 25 females and 4
Material and Methods: DMAb is an injectable therapeutic males. All patients had poor bone quality with a distal humeral
option for osteoporosis that is administered subcutaneously fracture or a complex EF or a terrible triad of the elbow. The
every 6 months. ProVital, a support program in which patients surgical approach used was a universal posterior incision with
voluntarily enrol, provides next injection reminder calls and triceps preservation. At each follow-up we performed x-rays
educational material. A retrospective database analysis of of the elbow and a clinical evaluation with the Mayo Elbow
patient-reported outcomes was conducted among osteoporotic Performance Score.
women aged ≥50 who enrolled in the ProVital program and Results: Mean age was 72 years (range 45–94); we reported
received their 1st DMAb injection between August 2010 and an isolated distal humeral fracture in 15 cases; a complex EF
June 2011. To achieve 12-month persistence, patients had to in 10 and a terrible triad of the elbow in 5. In 2 cases was
receive their 2nd injection no more than 6 months + 8 weeks necessary using a homologous bone graft. In 28 cases a total
following the 1st. EA (18 Coonrad-Morrey TEA Zimmer; and 10 Latitude TEA
Results: A total of 1,676 patients (mean age 74 year) were Toriner); one patient received an hemiarthroplasty (Latitude
included. At baseline, 43 % of patients reported previous humeral component) and in another case a custom-made
fractures; 13 % had a parent with a fracture; 14 % had arthritis; prosthesis was implanted (LINK). In 2 cases a supplementary
2 % had secondary osteoporosis; 10 % used glucocorticoids; osteosynthesis was performed. Good to excellent functional
79 % used a bisphosphonate previously; 51 % had private and results were reported in 24 cases (80 %) and only in 6 cases
37 % public drug coverage. The 12-month persistence was fair and poor results were recorded:3 traumatic periprosthetic
82 % (1367/1676). Of the 1,676 patients, 1,419 received a fractures, one prosthesis loosening due to an insufficient stem
second DMAb injection (mean 192, min 120, max 852 days cementation and 2 superficial infections treated with antibi-
apart). In a multivariate regression model, characteristics that otics. Despite poor biomechanical properties of the osteopo-
predicted persistence were private medication insurance, no rotic bone in elderly patients, our results seem to be slight
glucocorticoid use, and residence in Quebec. Among patients superior to than reported in literature, this can be probably
who discontinued DMAb (136), the most common reason was attributed to the surgical approach that preserves both the
adverse events (69 patients). olecranon and the triceps extensor mechanism.
 Osteoporos Int

Conclusion: In case of complex osteoporotic EF we prefer Disclosures: The study was supported by a grant of
use EA with a triceps preserving approach. laboratoire Servier.

P238 P239
STRONTIUM RANELATE TREATMENT IMPROVES ILIOCOSTAL IMPINGEMENT SYNDROME/FLANK
BONE MATERIAL LEVEL PROPERTIES AND AND BACK PAIN IN OSTEOPOROSIS/OSTEOPENIA:
MICROARCHITECTURE OF HUMAN TRANSILIAC SUCCESSFUL MANAGEMENT THROUGH SPINAL
BONE BIOPSY SPECIMENS PROPRIOCEPTIVE EXTENSION EXERCISE
P. Ammann1, R. Rizzoli1 DYNAMIC (SPEED) PROGRAM
1
Division of Bone Diseases, Department of Internal medicine M. Sinaki1
1
Specialties, University Hospital Geneva, Geneva, Switzerland Mayo Clinc, Rochester, Minnesota, United States

Objective: Bone strength, hence fracture risk, is dependent on Objective: With bone loss spinal deformities develop subse-
bone geometry, microstructure and bone material level prop- quent to the repetitive strain beyond biomechanical compe-
erties. We previously reported that microstructure and material tence of the spine. Among the complications related to Ky-
level properties contribute independently to the increase in phosis we will address flank pain or iliocostal impingement
bone strength of rats treated with strontium ranelate for 2 years, syndrome. There is a paucity of literature on the management
as evaluated by μCT-based finite element analysis. We inves- of this syndrome. Some of the recommended interventions
tigated the effects of strontium ranelate (SrRan) treatment on include injections or bracing.
bone material level properties of transiliac bone biopsy and on Material and Methods: Forty patients with osteopenia or
bone microarchitecture from postmenopausal osteoporotic pa- osteoporosis with flank or back pain or both who had not
tients in three studies. responded to common interventions were included. AP and
Material and Methods: In a longitudinal study, 84 paired lateral spine x-rays were obtained on all patients. Radiographs
biopsies were obtained at baseline, and after 6 or 12 months of revealed kyphosis with reduced space between lower ribs and
treatment with 2 g/day SrRan. In SOTI/TROPOS studies 3 the ilium. All had neurological and musculoskeletal evalua-
paired biopsies were obtained at baseline and after 36 months tions. They were all instructed in a home exercise program,
of treatment. Elastic modulus, hardness and working energy with emphasis on back extensor muscle strengthening in
were blindly analyzed by nanoindentation at the level of the addition to education on the use of a weighted kypho-
interstitial bone of the cortex and of trabecular nodes under orthosis (WKO) to be worn 20–30 min twice to three times
humid conditions. Parameters of microarchitecture were daily until the patient could perform back exercises without
evaluated μCT (Scanco Medical). Values correspond to pain.
differences expressed in percent between 2 paired biopsies. Results: Before enrolment all had a trial of WKO, if their pain
Significance of differences are evaluated by Student’s un- was reduced they were included in the study. Considering the
paired t-test,* <0.05, **p<0.01, ***p<0.001. geographic location 16 were available for follow up assess-
Results: ment and x-ray studies at 1 month while the remaining 24
were reviewed upon data from their routine annual visits. No
new compression fractures were seen. This group showed
statistically significant improvement in pain scale (P =
0.001), height, back strength, level of physical activity
(P<0.001)/quality of life.
Conclusion: Proprioceptive re-education of posture through
application of WKO is effective for static reduction of kypho-
sis and facilitation of back extension exercise program. This
Conclusion: Overall, these results detected in 90 human method is based on spinal facet joint proprioceptive reeduca-
biopsies indicates an early improvement of bone material level tion and kyphosis reductions.
properties followed by later changes on bone References: 1) Sinaki M et al. Mayo Clin Proc 2005;80:849.
microarchitecture in bone specimens collected in patients 2) Sinaki M et al. Osteoporos Int 2005;16:1004.
treated with SrRan. Both effects could contribute to increase 3) Pfeifer M et al. J Bone Miner Res 2004;19:1208.
of bone strength and to fracture risk reduction. These results 4) Sinaki M. Phys Med Rehabil Clin N Am 2007;18:593,
suggest different kinetics of SrRan action on bone xi–xii.
microarchitecture and bone material level properties. 5) Huntoon EA et al. Mayo Clin Proc 2008;83:54.
Osteoporos Int

P240 of L4 on L5 are associated with stability of that seg-

COMPLEX ASSESSMENT OF OSTEOPOROTIC ment, pain is more likely to arise in correlation with the
FEMALES WITH DEGENERATIVE LUMBAR erector vertebral muscle status. Visual observation of the
SPONDYLOLISTHESIS image during contraction indicates that US may be a
R. Traistaru1, O. Rogoveanu1, D. Matei1, R. S. Popescu1 valuable biofeedback tool.
1
University of Medicine and Pharmacy of Craiova, Craiova,
Romania

Objective: Females will develop osteoporosis and degenera- P241

tive spondylolisthesis (DS) over males. DS is a common CORRELATION BETWEEN METABOLIC STATUS
pathologic entity of the lumbar spine. In most females will AND REHABILITATION PARAMETERS IN KNEE
develop osteoporosis and degenerative spondylolisthesis (DS) OSTEOARTHRITIS PATIENTS
over cases of this complex type pathology, certain muscles of R. Traistaru1, D. Trasca1, O. Rogoveanu1, A. Bighea1
1
males. DS is a common pathologic entity of the lumbar spine. University of Medicine and Pharmacy of Craiova, Craiova,
In most cases of this complex type pathology, certain muscles Romania
of the back that stabilize the spine are reflexively inhibited and
do not spontaneously recover, even if patients are pain Objective: Osteoarthritis of the knee (OAK) is reported to be
free with a return to daily activity levels. First, we a major health problem worldwide. OAK has been linked not
investigated the incidence of DS at L4-L5 level in only to obesity but also to other metabolic factors. The adap-
females with osteoporosis and low back pain (LBP). tation of rehabilitation program to the metabolic status of
Second, we assessed the thickness of the erector spinae patient is important for the maintaining of an optimal func-
(ES) muscle in these patients and evaluated the correlation tional status. The aim of this randomized and controlled study
between thickness difference in three different trunk postures was double: 1) to establish the correlation between the meta-
and functional parameters. bolic risk factors and the severity of knee osteoarthritis pro-
The back that stabilize the spine are reflexively inhibited cess, 2) to assess the efficacy of comprehensive rehabilitation
and do not spontaneously recover, even if patients are program associated with viscosupplementation.
pain free with a return to daily activity levels. First, we Material and Methods: 56 patients with OAK were random-
investigated the incidence of DS at L4-L5 level in females ly assigned into studied group (SG - 30 patients) and control
with osteoporosis and low back pain (LBP). Second, we group (CG - 26 patients). All patients were completed
assessed the thickness of the erector spinae (ES) muscle in assessed (clinical, functional, lab and imagistic). SG per-
these patients and evaluated the correlation between formed a rehabilitation program (medication, physical therapy
thickness difference in three different trunk postures and kinetotherapy) followed by joint injection with hyaluronic
and functional parameters. acid. CG stayed at home and followed their individually
Material and Methods: 48 LBP females with osteoporosis prescribed drug therapy. Patients were assessed at baseline
and DS at L4-L5 were enrolled in this observation (week 0), after 2 weeks and during follow-up period at
study. Frontal (AP) and lateral lumbosacral regions were 16 weeks. We monitored the following outcomes: pain
radiological evaluated. Clinical and functional parame- (VAS), BMI, serum level of glucose, lipoprotein profile, and
ters were collected by a physiotherapist and an US WOMAC scale.
examination was performed by a physiatrist within Results: The severity of OAK was correlated with the pres-
72 h of the clinical examination. We performed ultrasonog- ence and number of the risk metabolic factors. Comparing the
raphy to measure the thickness of the ES muscle at L4 and two group differences, the SG was superior to CG in pain
L5 level in maximum flexion, neutral posture, and maximum reduction and in physician’s global assessment at all time
extension. All collected clinical and imagistic data were points. Significant improvement in pain and WOMAC scores
statistically analyzed. were found at week 2 and week 16 in the SG compared to
Results: There was significant correlation between the degree baseline.
of anterior slippage of L4 on L5 and bone density (T-score Conclusion: Our study demonstrated the superiority of reha-
DXA exam). Multivariate analysis showed that thickness bilitation program that included the viscosupplementation
differences between flexed and neutral, and flexed and ex- compared to drug therapy in the treatment of patients
tended maximally positions were correlated statistically with with OAK. The superior efficiency of pain and quality
functional parameters. of life in the metabolic syndrome patients that followed
Conclusion: A relationship between transitional the degree of a complete rehabilitation program confirm the medical
slippage in DS females with vertebral osteoporosis has been data about the chondrocytes disturbances in metabolic
established. Though sacralization and anterior slippage syndrome.
 Osteoporos Int

P242 Acknowledgements: Study supported by Institut de

OSTEOGENIC DIFFERENTIATION AND Recherches Internationals Servier and Technologie Servier.
MINERALIZATION OF ADULT MESENCHYMAL
STEM CELLS ISOLATED FROM HUMAN
PERIODONTAL LIGAMENT
C. Romagnoli1, N. Nuti1, R. Zonefrati1, F. S. Martelli2, P243
M. Martelli2, E. Fanti2, M. Duvina1, P. Tonelli1, L. Cianferotti1, SERUM LEVELS OF PROCOLLAGEN TYPE 1
A. Tanini1, M. L. Brandi1 AMINO-TERMINAL PROPEPTIDE (P1NP) AND RISK
1
University of Florence, Department of Surgery and Transla- OF HIP FRACTURE IN ELDERLY WOMEN. THE
tional Medicine, Florence, Italy, 2I.R.F. in Microdentistry, HORDALAND HEALTH STUDY
Florence, Italy T. E. Finnes1, C. M. Lofthus2, H. E. Meyer3, E. F. Eriksen2,
E. M. Apalset4, G. S. Tell5, K. Holvik4
1
Objective: Periodontal ligament (PDL) is a dynamic Department of Internal Medicine, Innlandet Hospital, Trust,
connective tissue embedded between the cementum and Hamar, Norway, 2Department of Endocrinology, Oslo Uni-
the alveolar bone; its role is to anchor the tooth root versity Hospital, Oslo, Norway, 3Institute of Health and Soci-
within the jaw, cushioning mechanical load that precede ety, University of Oslo, Oslo, Norway, 4Department of Global
from mastication. Since mesenchymal stem cells have Public Health and Primary Care, University of Bergen, Nor-
been isolated from PDL (PDLSCs), they are supposed wegian Institute of Public Health, Oslo, Norway, 5Department
to have a great potential in regenerative dentistry for of Global Public Health and Primary Care, University of
repairing bone defects, caused by periodontal diseases. Bergen, Bergen, Norway
Aim of the study was to isolate PDLSCs and to evalu-
ate their osteogenic potential analyzing the alkaline Objective: Background: The usefulness of bone turnover
phosphatase (ALP) activity and the mineralization markers as determinants of fracture risk in osteoporosis needs
process. further investigations, and IOF/IFCC recommends the bone
Material and Methods: Two primary cultures of PDLSCs, formation marker procollagen type 1 amino-terminal
obtained from extracted healthy human third molars, were propeptide (P1NP) to be used in studies to clarify its utility
induced towards the adipogenic phenotype with the in clinical use. Aim: To investigate the relation between serum
adipogenic medium (AM) (Ham’s F12 Coon’s modification P1NP levels and the risk of subsequent hip fractures in elderly
medium, 10 % FBS, 1 μM dexamethasone, 10 μM bovine women with, and without BMD.
insulin, 0.5 mM isobutylmethylxanthine, 100 μM indometh- Material and Methods: A case-cohort study was performed
acin, 1 % antibiotics). The osteoblastic phenotype was in- in a cohort of 1,817 women born 1924–1927 participating in a
duced with the osteogenic medium (OM) (Ham’s F12 Coon’s health study covering western parts of Norway from 1997 to
modification medium, 10 % FBS, 10 nM dexamethasone, 1999. In a subsample of about 60 % of the women, baseline
10 mM β-glycerophosphate, 50 μg/ml L-ascorbic acid 2- total hip BMD was measured by a DXA (Lunar Expert-XL).
phosphate, 1 % antibiotics). The phenotypes were assessed Information on incident hip fractures was obtained from com-
from 4 to 21 days by cytochemical staining (Oil Red O or Fast puterized discharge diagnoses records from the hospitals serv-
Blue BB/naphthol AS-MX) and microscopic observations. ing the region. P1NP was measured in frozen serum samples
The ALP activity and Ca2+ deposition were quantified by obtained at baseline in all women who suffered a hip fracture,
fluorometric assay. and in a randomly collected subcohort of 9 % of the total
Results: With AM, accumulation of intracellular lipid-filled cohort. P1NP was determined by Multigamma radioimmuno-
droplets after 21 days was observed. With OM, significant assay kit (Orion Diagnostica). The current analyses include
increments of ALP activity at 4 days (+104 %) and women not medication known to influence on the P1NP level,
7 days (+86 %) vs. control were observed, and then and with valid BMD and P1NP measurements. The final data
ALP decreases, while mineralization increases at 14 days set included 72 women, without a hip fracture, from the
(+316 %) and 21 days (+814 %), as demonstrated by a subcohort, and 80 women with a hip fracture. Cox propor-
great deposition of Ca2+ vs. control. tional hazards regression adapted for the case-cohort design
Conclusion: Preliminary data suggest PDL as an optimal was performed with penalized splines of P1NP and with
source of stem cells that can be used for bone regener- tertiles of serum P1NP as explanatory variables. The lowest
ation in dentistry. Studies are in progress to evaluate the hazard ratio (HR) was observed in the 2nd tertile, which was
effect of bioactive factors that could facilitate the used as reference. All analyses were adjusted for age by
process. method.
Osteoporos Int

Results: Serum P1NP levels ranged from 13 to 124 ng/mL 30 pg/ml, respectively), but the differences were not con-
(median 44 ng/mL). Unadjusted spline analysis revealed no firmed statistically. Differences between the groups by other
significant relation between P1NP and the risk of hip fracture. parameters were not identified. Correlation analysis noted a
Compared to the 2nd tertile of P1NP, HR for hip fracture in the similar negative association between vitD and age in both
1st tertile was: 1.26 (95%CI: 0.60–2.65), and in the 3rd tertile: sexes, the relationship of vitD with total Ca, P, PTH, OK,
1.69 (95%CI: 0.53–2.53). Adjusted for baseline BMD, a CTX were unidirectional, but statistically significant only
significant higher risk was seen in the 1st tertile of P1NP, in women, which can be explained by fewer men in the
compared to the 2nd tertile (HR: 3.37 (95%CI: 1.24–8.61), study group. At the same time correlations of vitD and
p=0.012). ionized calcium were reciprocal in men (r = 0.60) and
Conclusion: A weak relation between P1NP and hip women (r=−0.19).
fractures was found in the unadjusted analyses. Adjusted Conclusion: VitD levels significantly lower in men than in
for BMD, the current analyses revealed low P1NP to be women, with gender-related reciprocal relationship between
a risk factor for hip fractures. The mechanisms causing vitD levels and blood ionized calcium.
high fracture risk among those with the lowest P1NP Acknowledgements: This work was supported by the Grant
levels remain to be elucidated. of the President of Russian Federation НШ-4527.2014.7.

P244 P245
GENDER DIFFERENCES IN VITAMIN D STATUS PREDICTORS OF SECOND FRACTURE WHILE ON
AND PARAMETERS OF CALCIUM AND BONE TREATMENT WITH ORAL BISPHOSPHONATES: A
METABOLISM MULTINATIONAL RETROSPECTIVE COHORT
L. Y. Rozhinskaya1, E. A. Pigarova1, L. K. Dzeranova1, STUDY
G. A. Melnichenko2, A. V. Il’in2 S. Hawley1, G. Wallace1, M. K. Javaid1, K. H. Rubin2, A.
1
Neuroendocrinology and Bone Diseases, Endocrinology Judge1, N. K. Arden1, P. Vestergaard3, R. Eastell4, A. Diez-
Research Centre, Moscow, Russian Federation, 2Endocrinology Perez5, C. Cooper6, B. Abrahamsen7, D. Prieto-Alhambra1
1
Research Centre, Moscow, Russian Federation Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford,
Objective: Vitamin D deficiency is widespread in most of the United Kingdom, 2Odense Patient Data Exploratory Network,
world and is associated with low sun exposure and low Institute of Clinical Research, University of Southern Den-
vitamin D intake. Our goal was to identify the gender differ- mark, Odense C, Denmark, 3Department of Endocrinology,
ences in the levels of 25(OH)D and parameters of calcium and Aalborg University Hospital, Aalborg, Denmark, 4Depart-
bone metabolism. ment of Human Metabolism, University of Sheffield, Shef-
Material and Methods: The study included patients (n= field, United Kingdom, 5Hospital del Mar, Barcelona, Spain,
6
163, 30M/133F; mean age 48.5 ± 18 years) in which MRC Lifecourse Epidemiology Unit, University of South-
levels of total 25(OH)D (Liaison, DiaSorin) and PTH ampton, Southampton, United Kingdom, 7Research Centre
were measured during autumn period (September–Octo- for Ageing and Osteoporosis, Department of Medicine M,
ber). In selection of patients we used exclusion criteria: Glostrup Hospital, Glostrup, Denmark
presence of primary hyperparathyroidism, secondary or
tertiary hyperparathyroidism on the background terminal Objective: To identify predictors of inadequate response to
chronic renal failure, hypercortisolism, blood creatinine oral bisphosphonate therapy, defined as the incidence of ≥2
level of >100 mmol/l or GFR <60 ml/min/1.73 m2, fractures while on treatment among incident oral bisphospho-
intake of active vitD metabolites within 1 month prior nate users with high refill compliance (≥80 %).
the blood test. Our lab takes part in the international Material and Methods: Data from computerized records and
program of external control and standardization of vitD pharmacy invoices were obtained from SIDIAP (Catalonia,
in the blood (DEQAS, UK). Spain) and Danish Health Registries (Denmark) for all inci-
Results: In males, levels of vitD were significantly lower than dent users of oral bisphosphonates in 2006–2007 and 2000–
in females (16±5.9 vs. 20±8.5 ng/ml, respectively) despite 2001 respectively. Exclusion criteria were: Paget disease, age
the fact that males were generally younger (mean age 42±18.5 <40 years, anti- osteoporosis treatment in the previous year,
vs. 51±17.8 years old, respectively). There was a noticeable and suboptimal refill compliance (<80 %). Fine and Gray
trend to higher levels of PTH in men (62.6±40 vs. 52.1± survival models accounting for the competing risk of therapy
 Osteoporos Int

cessation were used to identify predictors of ≥2 fractures while Material and Methods: Thirty subjects from each city (total
on treatment after 6 months of treatment initiation. 60, 43 women and 17 men) had 25(OH)D measured in spring,
Results: 7,449/21,385 (34.8 %) and 7,885/13,949 (56.5 %) summer and autumn. Three age groups were defined: 20–44
were compliant oral bisphosphonate users in Catalonia and (n=29), 45–59 (n=20) and ≥60 (n=11).
Denmark respectively. Significant predictors of ≥2 fractures Results: No differences were found between the two cities in the
while on treatment in Catalonia and Denmark were older age, prevalence of vitamin D deficiency in the four seasons except
and history of recent fracture. Sub-hazard ratios (SHRs) for summer. The prevalence of low 25(OH)D was significantly
each of the predictors in each of the datasets are reported in lower in spring, summer and autumn vs. winter (all p>0.05).
Figure 1. In the elderly women in Rousse the deficiency was sustained at
all measurements. The prevalence of D deficiency did not differ
between the genders. The men from both towns and age groups
and the young and middle-aged women from Sandanski had no
deficiency in the summer. No deficiency was found in spring and
autumn among the young and middle-aged subjects with the
exception of the young men in Sandanski. It could be speculated
that the latter related to in-house occupations.
Conclusion: No difference was found between the northern
and southern cities. Sun exposure in both towns is not suffi-
cient to ensure the recommended 25(OH)D levels in round the
year. Probably other factors such as occupation or air pollution
play a role in the cities.

P247
C.O.D.E. STUDY: CONNECTIONS BETWEEN
Figure 1. SHR for the identified key predictors of ≥2 fractures
OUTCOMES OF OSTEOPOROTIC FRACTURES,
while on treatment in Catalonia, Spain (CAT) and Denmark
DEPRESSION, DELIRIUM & DEMENTIA IN THE
(DK).
ELDERLY
Conclusion: Older age and recent fracture history are predic-
A. Metozzi1,2, M. L. Brandi2, D. Black3, A. Fasano4, G. L.
tors of inadequate response as confirmed in two separate
Di Tanna5, P. Piscitelli6, S. Parri2, A. Guazzini7, P. Mecocci8,
cohorts. Monitoring strategies and/or alternative therapies
L. Bonamassa1, I. Prioletta8, C. Ruggiero8, G. Brandi9,
should be considered for these patients.
E. Benvenuti9
1
University of Florence, Department of Surgery and Transla-
tional Medicine, Azienda Ospedaliero-Universitaria Careggi,
P246 Florence, Italy, 2University of Florence, Department of Sur-
PREVALENCE OF VITAMIN D DEFICIENCY IN TWO gery and Translational Medicine, Florence, Italy, 3University
BULGARIAN TOWNS–ROUSSE AND SANDANSKY of California, San Francisco, CA, United States, 4University
(IN THE NORTH AND SOUTH PART OF THE of Toronto, Movement Disorders Centre - Toronto Western
COUNTRY) Hospital, Toronto, Canada, 5Sapienza University of Rome,
A. M. Borissova1, A. Shinkov1, J. Vlahov1, L. Dakovska1, Roma, Italy, 6Euro Mediterranean Scientific Biomedical In-
T. Todorov1, L. Kassabova2, D. Svinarov2 stitute - ISBEM., Brindisi, Italy, 7University of Florence,
1
University Hospital of Endocrinology, Medical University of Department of Science of Education and Psychology, Flor-
Sofia, Sofia, Bulgaria, 2Central Laboratory of Therapeutic Drug ence, Italy, 8Department of Medicine, University of Perugia,
Management and Clinical Pharmacology, Alexander Universi- Gerontology and Geriatric Institute, Department of Clinical
ty Hospital, Medical University - Sofia, Sofia, Bulgaria and Experimental Medicine, Perugia, Italy, 9Local Health
Authority of Florence, ASF, Perugia, Italy
Objective: Bulgaria is situated between 41°N and 44°N and
the climate is characterized by four seasons with different Objective: To evaluate the functional recovery after hip fra-
elevation of the sun over the horizon. The aim of the study gility fracture in persons with major depression, delirium and
was to determine the seasonal changes in the 25(OH)D levels cognitive impairment.
in subjects with confirmed winter vitamin D deficiency Material and Methods: All participants underwent neuro-
25(OH)D <25 nmol/l in two Bulgarian cities–Rousse in the psychological and physical functioning assessment during
north and Sandanski in the south of the country. hospital stay and at 3-, 6- and 12-month follow-up. The
Osteoporos Int

baseline evaluation includes Mini Mental Scale Evaluation SHAM+VR) where they could exercise ad libitum. At
(MMSE), Geriatric Depression Scale (30-GDS), Cognitive 36 weeks all animals were sacrificed. Bone turnover markers
Assessment Method (CAM), Mini International Neuropsychi- were assayed in the serum by ELISA. Both femurs were
atric Interview (MINI) Plus; Barthel Index, for assessing harvested for assessment of bone geometry, proximal and
ability to perform daily living activities; Cumulated Ambula- distal metaphysis trabecular and cortical bone microarchitecture
tion Score (CAS), to evaluate functional recovery in the 1st, by histology, mineralization degree by atomic absorption spec-
2nd–3rd day after surgery. Additional tests were performed at troscopy and biomechanical properties by compression of the
follow-up including Short Physical Performance Battery femoral head. Differences were determined by one-way
(SPPB). ANOVA.
Results: The study sample consists of 442 patients (106 men Results: Running distance was 10-fold lower in OVX+VR
and 336 women) aged 83.4±7.47 years. Depressive symp- compared to SHAM+VR. Although reduced MA and sex
toms and cognitive impairment increased suddenly after hip steroid deficiency (SSD) resulted in decreases in trabecular
fracture. Interestingly, the incidence of cognitive impairment bone volume, decreases in trabecular number were mostly
and the severity of cognitive symptoms decreased while the associated with the direct effect of SSD while decreases in
incidence of depression and the severity of depressive symp- trabecular thickness were mostly associated with reduced
toms increased during the follow-up. The occurrence of de- MA. Changes in cortical bone were mostly influenced by
pressive symptoms during hospital stay was inversely associ- MA while bone turnover rate and bone tissue mineralization
ated with early motor recovery in the 1st, 2nd and 3rd day after degree were primarily affected by SSD, even though they
surgery. The onset of delirium and cognitive impairment did were further aggravated by sedentary behavior. SSD was also
not affected early motor recovery. Major depression and de- the main contributor for increases in femur length while
mentia were associated with a poorer functional recovery and femoral neck length seemed to be influenced equality by both
a higher level of disability. Major depression was also associ- sedentary behavior and SSD. Notably, differences in femoral
ated with poor early motor recovery. neck mechanical properties resulted mostly from differences
Conclusion: Persons affected by major depression or demen- in physical activity.
tia experience poor functional recovery after fragility hip Conclusion: Both the direct effects of SSD and the significant
fracture and develop high level of disability. An early inter- decreases in MA observed following OVX seem to affect the
vention on recovery motivation and an early mobilization are femur material and structural properties somewhat indepen-
very important in fractured persons with depression and/or dently, contributing both in an additive way to OVX induced
cognitive impairment. Appropriate interventions on mood and bone fragility.
cognitive symptoms may be useful to improve the process of Acknowledgements: FCT grants SFRH/BPD/78259/2011,
functional recovery. PTDC/DES/103047/2008 and PEst-OE/SAU/UI0617/2011

P248 P249
SOME FEATURES OF SKELETAL DETERIORATION CAPTURE THE FRACTURE BY SMS: A SWISS
FOLLOWING OVARIECTOMY ARE A DIRECT FEASIBILITY STUDY
CONSEQUENCE OF ESTROGEN LOSS WHILE R. Theiler1
1
OTHERS ARE RELATED TO PHYSICAL Rheumaklinik Triemlispital, Zurich, Switzerland
INACTIVITY
H. Fonseca1, D. Moreira-Gonçalves1, J. L. Esteves2, J. A. Objective: Only a small percentage of patients who suffer
Duarte1 from osteoporotic fractures get an antiosteoporotic drug treat-
1
CIAFEL, Faculty of Sport, University of Porto, Porto, ment after their hospital stay. The aim of this study was to test
Portugal, 2INEGI, Faculty of Engineering, University of the feasibility of an SMS reminder program and its impact on
Porto, Porto, Portugal patient awareness and drug treatment.
Material and Methods: 4 centres in Switzerland (Zurich, St
Objective: Ovarian failure is accompanied by major de- Gallen, Basel, Bern) participated. Patients with osteoporotic
creases in motor activity (MA). As mechanical loading has a fractures over the age of 50 were asked to participate und got a
vital role in skeletal health, our aim was to determine to what reminder to see their GP after the hospital stay. The FRAX
extent were decreases in MA contributing to ovariectomy score was calculated according to the risk profile in each
(OVX) induced bone losses. patient and the medical recommendation was based on the
Material and Methods: Thirty-two Wistar rats were OVX or treatment guidelines according to the SVGO society. Six
sham-operated (SHAM) and housed in standard (OVX+C; months after the SMS reminder patient were asked about the
SHAM+C) or cages with running wheels (OVX+VR; impact of the reminder on the patient and the GP. The project
 Osteoporos Int

was supported by the SVGO and the Qualitouch Foundation clinician. None realize greatness without the courage to rec-
for HC. ognize their limitations. Collaborate–don’t worry, the person
Results: More than 737 patient were asked to participate. deserving of first authorship will become clear.
About 28 % of patient participated. The main reason for Title: Don’t worry about this for now. It will come when the
nonparticipation was that elderly patients had no mobile rest is right.
phones or were not able to use the SMS system. Only a small Aim: This is a general statement of purpose to bring the
percentage of patients has got an antiosteoporotic drug treat- reviewer to the area to be explored.
ment 6 months after the fracture. One of the main reason for Hypothesis: What is the question? Ensure you have an
the nonfunction of the SMS reminder system was mild to answerable question by writing the proposed answer. This
severe cognitive impairment in elderly osteoporotic patients. ‘postulate’ is the ‘hypothesis’. It is written in unambiguous
Conclusion: Elderly osteoporotic patients with fractures and quantifiable terms. With this you have the framework around
signs or symptoms of cognitive impairment should get a which to assemble the application. Without it, you have noth-
parenteral antiosteoporotic treatment (iv or sc) as the SMS ing. We hypothesize that the sky is level 12 (baby) blue. The
reminder system does not work to enhance patient and doctors question then is what is the color of the sky? The Aim of the
awareness in this category of patients. study is to study the color of the sky. At this stage, we don’t
Disclosures: SVGO and Qualtitouch Foundation know why you want to study the color of the sky nor do we
know if it is an important question.
Rationale: For every question there is a second question–why
P250 are you asking? This is the ‘Rationale’ or ‘Background’; it
WRITING A GRANT forms the ‘Introduction’ of the manuscript that will follow and
E. Seeman1 of course will be published in Nature or the New England J of
1
Austin Health, University of Melbourne, Melbourne, Australia Medicine! The rationale is not a literature review. It is an
explanation of why you have decided to spend the next few
Writing a grant proposal is similar to writing a manuscript in years of your life measuring the color of the sky. What is the
several ways; getting started is no fun, in fact, its agony. As problem? Why is it important? Does the color of the sky tell us
Harold Frost told Pierre Meunier, and Pierre told me many something about the weather, if so, so what? What if it tells us
years ago, “Trust your brain”. The same is expressed in about the seasons, temperature levels at different times, timing
‘Finding Forrester’, a film about a famous writer in the last and suitability of soil, growth of food? From this information
years of his life who takes on an insecure young student from the reviewer can start to understood your project, and so will
the Bronx—just sit down and start, write something, anything, you start to understand more than when you started develop-
just write!! (1) ing the Rationale. The same occurs in preparing a manuscript,
Life was not meant to be easy (2). The struggle from chaos to or a lecture–you learn yourself.
order, from confusion to clarity takes time. There is a delight- What is known about the color of the sky–some say its baby
ful music within, but to write it, to enable others hear it blue, others say its navy blue while other investigators say its
distinctly, takes time and an “all too ready self approval” must black and twinkles. Some say its lots of colors while others
be avoided because “no one, not your own self even, will ever say it’s all of the above. You must be fully conversant with all
know the tune that beset you….” (3). of the literature on the topic and you can only achieve this by
Page 1 is particularly difficult. The reviewers, the committee early preparation because the reading must be critical reading.
and chairman are unlikely to work in your specialized field. To You cannot possibly cite all of the literature but by critical
convince this judge and jury of your peers of the worth of your reading you can formulate what is not known, what method-
application, the content of this page—the Title, Aim, Hypoth- ological differences may be explaining or reconciling the
esis, Rationale and Significance must be simple, clear, com- different colors reported; some investigators measured the
prehensible and impactful in a single reading (4). color only at midday, others only at night, others only in the
The first step is to prepare early, a year or more before the morning or evening or only from the North or South Pole. A
application is due! Does anyone do that? Of course! Do most critical reading requires you to have disassembled and then
investigators do it? Of course not! Early preparation is critical reassembled this literature to critically develop this rationale.
for many reasons. Success requires pilot data. Without it, why It should take the reader easily to the question even before
should the reviewer believe you can do what you confidently reading it. The reading teaches you the right question, leads
claim you will do. Success requires collaboration and when- you to the right hypothesis, the significance and the title. This
ever possible, evidence that you and your collaborators have process of critical reading, reorganization in your own mind,
published previously. Surround yourself with investigators and then writing it, is what enables you to know what is
better than yourself: two heads are better than one. A biologist known, and, most importantly, precisely what is not known.
needs a statistician, a biomechanical engineer needs a You have labored and now are now able to design a study
Osteoporos Int

taking into account the factors that contribute to the colors of Division, Chugai Pharmaceutical Co. Ltd, Tokyo, Japan, 7De-
the sky from which you can help the scientific community partment of Obstetrics and Gynecology, Hirosaki University
understand the rotation of the earth, the seasons, and determi- School of Medicine, Hirosaki, Japan
nants of the best time to plant seeds and harvest wheat.
Methods: The content and organization of the Methods sec- Objective: The randomised, double-blind MOVER study
tion must precisely follow the order of the Hypotheses–the compared the efficacy and safety of monthly iv IBN
most important first, then secondary hypotheses follow. Each with daily oral risedronate (RIS) in pts with primary
hypothesis is addressed by a given method–the appropriate osteoporosis. We showed that greater total hip BMD
sample size based on power calculations derived using the increases with IBN at 6 months were associated with
pilot data, appropriate inclusion, exclusion criteria ensuring lower risk of new vertebral fractures [IOF 2013: Abst
the only difference between cases and controls is the intervention 1096]. Here we assess responder rates for pts with
or the effect of exposure to a risk factor you are testing. No BMD increases in the IBN 1 mg/month group and also
measurement (blood test, imaging) should be included that is not describe a nonresponder group.
justified and relevant to testing the hypothesis you have stated. Material and Methods: Ambulatory pts ≥60 year with fragile
Significance: This should be written in clear terms that con- bone fracture, BMD of the lumbar spine L2-L4 or proximal
vey how the results influence longevity, or clinical applica- femur <80 % of the young adult mean and 1–5 vertebral
tions to help individuals or the society. This is the translational fractures in Th4-L4 were enrolled. Non-responders were de-
aspect that demonstrates ‘importance’; there is no point in fined by BMD increases (≤3 % L2-L4 or ≤0 % total hip, ≤0 %
defining the colors of the sky if all you find out is the colors femoral neck) and uCTX reductions (≤50 %) from baseline to
of the sky. Your point is that these colors explain the spin of 1 year.
the planets, the behavior of the weather and provide informa- Results: 1,265 pts were randomised to receive iv IBN
tion concerning the best time to plant seeds, grow crops and 0.5 or 1 mg/month + oral daily placebo, or oral RIS
harvest the fruit and thereby your work will increase exports 2.5 mg/day (licensed Japanese dose) + monthly iv pla-
and provide a solution to world poverty and starvation. Final- cebo. Cumulative incidences of new/worsening vertebral
ly, you you’re your title; The Color of the Sky as a Predictor of fractures over 3 year were 19.9 % (95%CI 15.6–24.1),
Crop Yield. That’s ‘important’. 16.1 % (95%CI 12.2–19.9) and 17.6 % (95%CI 13.6–
References: 1. Finding Forrester.2000 Author Mike Rich, 21.6), respectively. The hazard ratio for new/worsening
director Gus Van Sant. 2. Attributed to M Fraser, 22nd Prime vertebral fractures was 0.88 for IBN 1 mg vs. RIS
Minister of Australia who misquoted it from George Bernard (95%CI 0.61–1.27; primary endpoint), showing both
Shaw’s play Back to Methuselah: “Life is not meant to be IBN doses to be non-inferior to RIS. BMD significantly
easy, my child; but take courage: it can be delightful.” improved from baseline after just 6 months. At 1 year,
3. Marcel Proust. On Art and Literature. Publishers Carroll & responder rates for pts with BMD increases were similar
Graf NY. Ontra Saint-beuve p 276 in all treatment groups. After 3 year, responder rates
4. “I didn’t have time to write a short letter, so I wrote a long were highest with IBN 1 mg at all sites. There were a
one instead.” Mark Twain small number of nonresponders in the IBN 1 mg group:
10 pts with ≤0 % total hip BMD increase and ≤50 %
uCTX reduction from baseline had lower 25OHD levels
P251 than responders, but no differences in kidney function,
HIGHER RESPONSE WITH BONE MINERAL L2-L4 BMD or BTM baseline values.
DENSITY (BMD) INCREASE AND BONE TURNOVER Conclusion: Higher responder rates were reported with
REDUCTION FOLLOWING TREATMENT WITH iv IBN 1 mg/month than with RIS at 3 year. A very
MONTHLY INJECTABLE IBANDRONATE (IBN) FOR small number of nonresponders in the IBN 1 mg
PATIENTS (PTS) WITH OSTEOPOROSIS IN THE group had lower 25OHD baseline levels than re-
MOVER STUDY sponders; comparison with RIS will be further
T. Nakano1, T. Nakamura2, M. Ito3, H. Hagino4, J. Hashimoto5, examined.
M. Tobinai6, H. Mizunuma7 Disclosures: Supported by Chugai Pharmaceutical.
1
Tamana Central Hospital, Kumamoto, Japan, 2National Cen-
ter for Global Health and Medicine, Tokyo, Japan, 3Medical
Work-Life Balance Center, Nagasaki University Hospital, P252
Nagasaki, Japan, 4School of Health Science & Rehabilitation WAYS TO REDUCE OSTEOPOROSIS TREATMENT
Division, Tottori University Faculty of Medicine, Tottori, GAP IN ROMANIA
Japan, 5Project & Lifecycle Management Unit, Chugai D. Grigorie1, A. Sucaliuc1, H. Johansson2, J. A. Kanis2,
Pharmaceutical Co. Ltd, Tokyo, Japan, 6Clinical Development E. V. Mccloskey2
 Osteoporos Int

1
National Institute of Endocrinology, Carol Davila University Tromsø, Norway, 4Department of Global Public Health and
of Medicine, Bucharest, Romania, 2WHO Collaborating Primary Care, University of Bergen, Bergen, Norway, 5Depart-
Centre for Metabolic Bone Diseases, University of Sheffield, ment of Global Public Health and Primary Care, University of
Sheffield, United Kingdom Bergen, Norwegian Institute of Public Health, Oslo, Norway,
6
Tromsø Endocrine Research Group, University of Tromsø,
Objective: In Romania the overwhelming majority of indi- Division of Internal Medicine, University Hospital of North
viduals at high risk of fracture are untreated (86 %; 94 % in Norway, Tromsø, Norway, 7Institute of Public Health
men and 83 % in women). The aim of this study was to and General Practice, NTNU, Trondheim, Norway, 8Institute
identify the causal factors and possible remedies, in the con- of Public Health and General Practice, NTNU, Department of
text of economic crisis. Obstetrics and Gynecology, St. Olav’s University Hospital,
Material and Methods: A panel from Romanian Society of Trondheim, Norway, 9Norwegian Institute of Public Health,
Osteoporosis and Musculoskeletal Diseases was asked to Oslo, Norway
audit the framework of clinical practice of osteoporosis in
Romania, the availability and provision of logistical resources, Objective: Seasonal variation in hip fracture incidence has
the national guidelines, education and proficiency in osteopo- been reported in several studies. The link of this variation to
rosis by family doctors. comorbidity is unknown. The aim of this study was to exam-
Results: Several factors were identified that contributed to the ine the seasonal variation in hip fracture incidence in Norway,
high treatment gap. The cost of medical intervention in Ro- related to age, gender and comorbidity.
mania is high in relation to GDP and even higher in relation to Material and Methods: Our analyses were based on the
the health care spend. Another barrier to treatment is that NOREPOS Hip Fracture Database with hip fractures
reimbursement is only granted where the prescription is issued (139,913) in Norway between 1994 and 2008. Addition-
by a specialist. National guidelines are available but they are al diagnosis and surgical procedure codes were used to
not implemented and updated. The currently accepted criteri- identify incident fractures. Charlson index (0–2), a co-
on for treatment of osteoporosis in Romania is a BMD T- morbidity measure, was calculated based on additional
score≤−2.5 SD, which is also the reimbursement threshold for diagnoses. Winter was defined as December, January
medical intervention and reimbursement of osteoporosis and February and summer as June, July and August.
agents is about 50 %. There is limited access to DXA and Negative binominal models were used in the analyses.
moreover, the reimbursement for DXA is less than the cost of The population at risk was based on data from Statistics
DXA which imposes its own financial constraints on individ- Norway. We also performed analyses by gender and
uals. There are also incompatibilities between recommenda- three age groups: 50–64, 65–79 and >80 years.
tions for risk assessment or treatment with reimbursement Results: 136,140 fractures were eligible for the study
policy. FRAX-based assessment and intervention thresholds (72.5 % women). In men, we found an age-adjusted
are available but not implemented. For example, guidelines relative risk of 1.40 (95%CI: 1.36–1.45) in winter com-
recommend the use of FRAX which is not provided for in pared to summer. This ratio was 1.26 (95%CI: 1.23–
reimbursement provision and specific treatments are recom- 1.28) in women. June had the lowest proportion of
mended but not reimbursed. General practitioners are not fractures in both genders, while January and December
familiarized with risk assessment based on FRAX. were the peak months. Both genders had seasonal var-
Conclusion: Adjusting existing policies in agreement iation in all age groups, but less distinct with increasing
with the current strategy of absolute risk assessment would age. We found a significant interaction between season
be a good low cost first step in addressing the high treatment and comorbidity. After adjustments for age and gender,
gap. winter versus summer incidence was 1.41 (95%CI:
1.30–1.52) in those with no comorbidity (Charlson in-
dex=0), 1.28 (95%CI: 1.19–1.39) in those with some
P253 comorbidity (Charlson index=1), and 1.18 (95%CI:
IMPACT OF SEASON AND COMORBIDITY ON HIP 1.09–1.28) in those with most comorbidity (Charlson
FRACTURE INCIDENCE. A NOREPOS STUDY index=2).
S. M. Solbakken1, J. H. Magnus1, H. E. Meyer2, N. Emaus3, Conclusion: This study demonstrates a clear seasonal
G. S. Tell4, K. Holvik5, G. Grimnes6, S. Forsmo7, B. Schei8, variation in hip fracture incidence, present in all sub-
A. J. Søgaard9, T. K. Omsland1 groups by gender, age or comorbidity. Interestingly, the
1
Institute of Health and Society, University of Oslo, Oslo, seasonal variation was most pronounced in those with
Norway, 2Institute of Health and Society, University of Oslo, least comorbidity. The considerable seasonal variation
Norwegian Institute of Public Health, Oslo, Norway, 3Depart- should be taken into account when planning healthcare
ment of Health and Care Sciences, University of Tromsø, services.
Osteoporos Int

P254 Objective: To investigate bone status and biological mecha-

COMPARATIVE EVALUATION OF KNEE AND nisms involved in the negative impact of anorexia nervosa
ANKLE STRENGTH IN PATIENTS WITH KNEE (AN) on osteogenesis.
OSTEOARTHRITIS AND HEALTHY CONTROLS: A Material and Methods: A cross-sectional study was con-
PILOT STUDY ducted based on a Danish clinical database established at
Y. Erdoğanoğlu1, Y. Yakut2, S. Güneri3, L. Özçakar3 Department of Psychiatry, Aalborg University Hospital. The
1
Okan University-Academy of Health Sciences, İstanbul, database includes biochemical data, bone scans (DXA) as well
Turkey, 2Hacettepe University, School of Physiotherapy as general health and medical information during the period
and Rehabilitation, Ankara, Turkey, 3Hacettepe University 2009–2011. A total of 30 AN patients who underwent bone
Medical School, Ankara, Turkey scans were included in the study.
Results: AN patients had a mean Z-score around −1.5 to −1.6
Objective: Osteoarthritis is characterized by joint pain, local in lumbar spine and total hip, respectively. Hip Z-score
tenderness, limited motions, crepitation, effusion and various decreased with duration of disease, and a positive correla-
degrees local inflammation without systemic findings. The tion between serum 25-hydroxyvitamin D level and spine
aim of this study was to compare the knee and ankle strength Z-score but not hip Z-score was seen. BMD did not seem
values of patients with osteoarthritis and those of healthy to change with time since diagnosis. Additionally, a nega-
controls. tive correlation between serum 25-hydroxyvitamin D
Material and Methods: Six female patients with a mean age levels and serum total alkaline phosphatase levels was
of 66.17±13.73 years and seven female healthy volunteers found. A serum 25-hydroxyvitamin D level below
with a mean age of 57.14±12.5 years were recruited in the 50 nmol/l was associated with increased alkaline phosphatase
study. Knee (flexion/extension) and ankle (plantar/ levels.
dorsiflexion) strength measurements were performed by an Conclusion: Disease duration was the main predictor of bone
isokinetic dynamometer (Biodex System 3). Peak torque/body status rather than clinical measures including BMI and bio-
weight values were taken into the statistical analysis. chemical measures. This implies that long term disease dura-
Results: Neither the knee nor the ankle measurements were tion should be a main factor in selecting patients for referral to
found to be different between the two groups (p>0.05). DXA. Moreover, results from this study indicate normal os-
Conclusion: It seems that further analyses involving wider teoblastic response to malnutrition.
group of individuals are warranted for better estimation of
comparative knee and ankle strength in patients with
osteoarthritis. P256
RECOMMENDATIONS FOR OSTEOPOROSIS
MANAGEMENT AND FRACTURE PREVENTION
P255 FOR THE FRAIL ELDERLY IN LONG-TERM CARE
BONE STATUS IN PATIENTS WITH ANOREXIA (LTC)
NERVOSA AND RELATIONSHIP WITH A. Papaioannou1, N. Santesso2, S. Morin3, A. M. Cheung4, R.
BIOCHEMICAL FINDINGS AND FINDINGS AT G. Crilly5, L. M. Giangregorio6, K. Grady7, S. Jaglal8, R.
PSYCHIATRIC INTERVIEW Jain7, R. Josse4, S. Kaasalainen9, P. Katz10, A. Moser4, L.
S. A. Eriksen1, H. Prietzel2, J. R. Ibsen3, M. B. Lauritsen4, Pickard1, C. J. Skidmore1, H. Weiler11, S. Whiting12, J. D.
P. Vestergaard5, G. K. Telléus6 Adachi1
1 1
Department of Clinical Medicine, Aalborg University, Department of Medicine, McMaster University, Hamilton,
Aalborg, Denmark, 2Clinic for Child and Adolescent Canada, 2Clinical Epidemiology and Biostatistics, McMaster
Psychiatry, Aalborg University Hospital, Aalborg, Denmark, University, Hamilton, Canada, 3Medicine, McGill University,
3
Department of Endocrinology, Aalborg University Hospital, Montreal, Canada, 4Department of Medicine, University of
Aalborg, Denmark, 4Research Unit for Child and Adolescent Toronto, Baycrest, Toronto, Canada, 5Medicine, University of
Psychiatry, Aalborg University Hospital and Clinic for Child Western Ontario, London, Canada, 6Department of Kinesiol-
and Adolescent Psychiatry, Aalborg University Hospital, ogy, University of Waterloo, Waterloo, Canada, 7Osteoporosis
Aalborg, Denmark, 5Department of Clinical Medicine, Canada, Toronto, Canada, 8Department of Physical Therapy,
Aalborg University and Department of Endocrinology, University of Toronto, Toronto, Canada, 9Department of
Aalborg University Hospital, Aalborg, Denmark, 6Department Nursing, McMaster University, Hamilton, Canada,
10
of Clinical Medicine, Aalborg University and Section of Eating Baycrest, Toronto, Canada, 11Dietetics and Human
Disorders, Department of Psychiatry, Aalborg University Nutrition, McGill University, Montreal, Canada, 12Depart-
Hospital and Unit for Psychiatric Research, Aalborg ment of Nutrition and Dietetics, University of Saskatchewan,
University Hospital, Aalborg, Denmark Saskatoon, Canada
 Osteoporos Int

Objective: Clinicians practicing in LTC face unique chal- Merck, Novartis. Dr. Adachi has been on a speakers bureau,
lenges caring for frail elderly individuals including multiple received honoraria and consulting fees from Amgen, Eli Lilly,
comorbidities, polypharmacy, and end of life care, but practice Merck, Novartis, Warner Chilcott. Dr. Adachi is an employee
guidelines typically do not address this population. Guidance of McMaster University.
regarding the management of osteoporosis and fracture pre- Acknowledgements: We would like to thank our consensus
vention in LTC, a high risk population, is needed. panel of 50 LTC stakeholders across Canada.
Material and Methods: The GRADE approach was used. A
survey of LTC physicians informed key questions and out-
comes. Interviews with resident representatives and a litera-
ture review informed values and preferences. The quality of P257
evidence, benefits and harms, costs, resident values and RHEUMATOID ARTHRITIS AND FATIGUE
preferences, and available resources were considered X. Grapton1, P. Khalifa2, D. Leclere3, P. Lemesle4, L. Poulain5,
when making recommendations. P. Renard6
1
Results: For residents at high risk for fracture, we suggest Private Practice, Colombes, France, 2Private Practice, Paris,
multifaceted interventions that are individually tailored to France, 3Private Practice, Suresnes, France, 4Private Practice,
reduce the risk of falls and fractures, and we suggest balance, Bois-Colombes, France, 5Private Practice, La Garenne Co-
strength and functional training exercises only when part of a lombes, France, 6Private Practice, Courbevoie, France
multifaceted intervention. We recommend hip protectors. We
recommend vitamin D3 supplements daily (800–2000 IU) and Objective: To define the profile of tired patients with rheu-
calcium supplementation up to 500 mg daily if unable to meet matoid arthritis (RA) and the influence of treatment, to ana-
recommended dietary allowances through food. We recom- lyze the consequences of fatigue, and to determine the relevant
mend the following therapeutic agents: alendronate, criteria to assess the fatigue.
risedronate, zolendronic acid, or denosumab. Teriparatide is Material and Methods: • 155 cases, 85 % were women,
a suggested option. We suggest raloxifene and etidronate not mean age 58 years, seen by 18 rheumatologists (Rh).
be used. • 2 control groups: RA not tired and tired patients without RA.
Conclusion: These are the first guidelines developed for the • Average duration of history of RA: 10 years.
care of osteoporosis and fracture prevention in LTC using • Degree of severity: light 12 %, moderate 67 %, severe 21 %.
GRADE. In LTC, strategies to prevent fractures and falls must • Progressive nature: low 32 %, moderate 57.5 %, aggressive
consider resident values and preferences, comorbidities, life 10.5 %.
expectancy, and quality of life. • ESR average of 18 mm, mean CRP 8.4.
Disclosures: Dr. Alexandra Papaioannou has received grants/ • 48 % have two DMARDs, 28 % have 1, 24 % 3 or 4.
research support from Amgen, Eli Lilly, Merck and Warner • 81 % are under MTX, 15 % under biotherapy, 49 % under
Chilcott. Dr. Papaioannou has been on a speakers bureau and steroids.
received honoraria from Amgen, Eli Lilly, and Merck. Dr. • 20 % have another cause of fatigue.
Papaioannou has received consulting fees from Amgen, Eli Results: • 66 % of RA patients studied are tired vs. 47 % in the
Lilly and Merck and is an employee of McMaster University. French population and 42 % in the rheumatologic patient data
Nancy Santesso, no conflicts. Dr. Suzanne Morin, has re- base. 67 % spontaneously evoke their fatigue.
ceived grants/research support from Amgen. Dr. Morin has • At D0, 77 % of patients have pains, 43 % are disabled.
received consulting fees for Amgen, Merck and Eli Lilly. Dr. • VAS pain=44 mm, VAS handicap=46 mm, VAS fatigue=
Morin has been on speakers bureau and received honoraria 47 mm.
from Amgen and Eli Lilly. Dr. Angela Cheung has received • In 72 % of cases RA was already tired, sometimes
grants and honorarium from Amgen, Eli Lilly, Merck. Dr. at treatment discontinuation (12 %) or at the intro-
Richard Crilly, no conflicts. Dr. Lora Giangregorio has duction (15 %). Fatigue is the main complaint (38 %).
received grants/research support from Merck. Kerry • It is linked to RA (68 %) and runs in parallel to it
Grady, no conflicts. Dr. Robert Josse has been an advisory (70 %).
board member, received speaker honoraria and/or research • It is more intense and permanent than ordinary fatigue and
grants from Lilly, Amgen, Novartis, Warner Chilcott, occurs without cause.
Merck. Dr. Susan Jaglal, no conflicts. Ravi Jain, no con- • It increases the recovery time (85 %), affects household
flicts. Dr. Sharon Kaasalainen, no conflicts. Dr. Andrea chores (79 %), resulting in daytime sleepiness (60 %).
Moser, no conflicts. Laura Pickard, no conflicts. Carly • It is more physical than moral, but often it is both (64 %).
Skidmore, no conflicts. Dr. Hope Weiler, no conflicts. • 69 % of cases are sad, 63 % unmotivated, and 37 %
Dr. Susan Whiting, no conflicts. Dr. Jonathan Adachi, depressed.
has participated in clinical trials for Amgen, Eli Lilly, • Fatigue affects spare-time (71 %) then work, sex, social life.
Osteoporos Int

• Of 10 criteria, three are relevant to evaluate the fatigue: VAS P259

fatigue >50 mm, recovery time extended by at least 50 %, no THE PHARMACOKINETICS OF ODANACATIB 50
tiring cause. MG ARE NOT AFFECTED BY SEVERE RENAL
• At 3- associated criteria, there is correlation between the INSUFFICIENCY
degree of fatigue, its evocation, evolution of RA, high CRP. S. A. Stoch1, C. Liu1, S. Zajic1, R. Witter1, J. Stone1, A.
• At 2 criteria with anemia, handicap, VAS pain, need to nap, Mehta1, P. Auger2, D. Stypinski2, N. Wang2, A. Hohnstein2,
lack of activities. H. Alcorn3, W. Smith4, T. Marbury5
• There is a parallelism between fatigue and previous RA, 1
Merck & Co., Inc, Whitehouse Station, United States,
2
elevated ESR, disease flare, decreased muscle strength, lack of Celerion, Lincoln, United States, 3DaVita Clinical Research,
energy and mainly improvement thanks to biotherapy. Minneapolis, United States, 4Volunteer Research Group/
• Not tired RA are not very aggressive and frequently with Graduate School of Medicine, University of Tennessee,
MTX alone or biotherapy. Knoxville, United States, 5Orlando Clinical Research Center,
Conclusion: RA tired is often progressive and with elevated Orlando, United States
ESR. Fatigue is both physical and moral. It is permanent,
unusual, intense and debilitating and fades to the introduction Objective: Odanacatib, a selective cathepsin K (CatK) inhibi-
of MTX and/or biotherapy. tor, is in development for the treatment of osteoporosis. Ap-
proximately 10 % of the clearance of odanacatib is believed to
be due to renal elimination. This study was done to determine
the effect of severe renal insufficiency on odanacatib pharma-
P258 cokinetics, pharmacodynamics, and tolerability.
IMPACT OF DEMOGRAPHIC CHARACTERISTICS Material and Methods: In this open-label, single-dose study,
ON BONE MICROARCHITECTURE INDEX (TBS) IN odanacatib was orally administered to subjects (age: 40–
HEALTHY WOMEN IN MENOPAUSE 79 years) with severe renal insufficiency (defined as a Cock-
S. Novkovic1, G. Marinkovic2, M. Prelic1, M. Terek1 croft Gault creatinine clearance of <30 mL/min) and healthy
1
Institute for Rheumatology, Belgrade, Serbia, 2Health Center control subjects (creatinine clearance ≥90 mL/min), matched
Zvezdara, Belgrade, Serbia for age, gender, and BMI. Plasma and urine samples were
collected for the analysis of odanacatib concentrations and
Objective: To assess whether age, duration of menopause, biomarkers at predose and at specified time points over
body weight, height and BMI affect TBS in healthy, postmen- 15 days postdose. An analysis of covariance (ANCOVA)
opausal women. model was used to analyze odanacatib AUC0-∞ on log scale.
Material and Methods: A cross-sectional study included 257 The AUC0-∞ geometric mean ratio (GMR) was determined to
healthy menopausal women, with TBS score measured at the evaluate the similarity of pharmacokinetics between the two
lumbar spine. Subjects with risk factors known to affect bone groups based on the 90 % CI for the GMR contained within
microarchitecture (using steroids, previous fractures, systemic the comparability bounds of (0.40, 2.50). Cmax was analyzed
disease, excessive use of alcohol and cigarettes, and the use of in a similar fashion. Summary statistics were computed for
drugs with a negative impact on bone metabolism) were Tmax and apparent terminal t1/2. Bone biochemical markers
excluded. Statistical analysis was performed in SPSS. (serum NTx and urine NTx/Creatinine) were also assessed to
Results: The average age of patients was 64.3±7.9 years. evaluate pharmacodynamics; a linear mixed effect model was
Menopause occurred in 49.5 (37–60) years. and lasted an used for the analysis of these parameters. Adverse events
average of 15.9±9.5 years. The average body weight was (AEs) were monitored throughout the study and evaluated
69.4±13.0 kg. Body height 159.8±6.7 cm, and BMI 27.2± for severity and relation to study medication at study visits.
4.9. Average TBS was 1.223±0.101. We found a significant Results: The GMRs (90 % CI) for AUC0-∞ and Cmax were
negative correlation between age and TBS (ρ = −0.218, 1.62 (1.17, 2.24) and 1.47 (1.19, 1.80), respectively. The
p<0.01), between the duration of menopause and TBS (r= geometric mean half-life for odanacatib 50 mg was 74.2 h
−0.187, p<0.01), whereas the correlation between the age at subjects with renal impairment and 80 h in the healthy
the time of menopause and TBS was not significant (ρ=0.085, matched controls. At 168 h postdose, least square (LS)
p=0.172). A significant negative correlation was observed mean (95%CI) serum NTx values were −36.5
between TBS and the body weight (r=−0.222, p<0.01), and (−47.30,−23.38) [renal impairment] and −43.2 (−53.39,
the TBS and the BMI (r=−0 268, p<0.01). −30.76) [healthy]; LS Mean (95%CI) urine NTx/Cr values
Conclusion: The value of the bone microarchitecture index were −59.3 (−65.81, −51.51) [renal impairment] and
(TBS) decreases with age, duration of menopause, with an −43.4 (−52.83, −32.08) [healthy]. There were no serious
increase in body weight and BMI. Body height, and age at the AEs or discontinuations due to AEs. Mild headache was
time of onset of menopause did not correlate with TBS. the most common drug-related AE and was reported in
 Osteoporos Int

one patient in the renal impairment group and one patient to the limited use criteria. We identified that 57 % (zole-
in the healthy control group. dronic acid) and 55 % (denosumab) patients persisted
Conclusion: There were no meaningful differences between beyond the first year, and 30 % of zoledronic acid patients
subjects with severe renal impairment compared with healthy- persisted for 3+ years.
matched controls in odanacatib 50 mg pharmacokinetics, as Conclusion: Zoledronic acid and denosumab may be en-
assessed by comparison of AUC0-∞ values, or its pharmaco- ticing options to improve persistence with osteoporosis
dynamics, as assessed by change from baseline in serum NTx therapy. Over half of patients received doses beyond the
and urine NTx/Cr. Odanacatib 50 mg was generally well first year, and more than a third received prior oral ther-
tolerated in patients with severe renal impairment. apy. A provincial formulary modification that broadened
Disclosures: SAS, CL, SZ, RW, JS, AM are employees of and access criteria for zoledronic acid in 2012 significantly
own stock in Merck & Co., Inc, the study sponsor. DS, NW, increased prescribing.
AH are employees of Celerion, which was contracted by
Merck to run the study. HA, WS, and TM were investigators
and received research support from Merck. P261
VITAMIN D SUPPLEMENTATION AFTER
BARIATRIC SURGERY: IS 30 MICROGRAM DAILY
P260 ENOUGH? A TWO-YEAR FOLLOW-UP AFTER
SHINYAND NEW: UPTAKE AND PERSISTENCE GASTRIC BYPASS OR SLEEVE GASTRECTOMY
WITH NON-ORAL OSTEOPOROSIS MEDICATIONS T. A. Pekkarinen1, M. Leivonen 2 , N. Jaser 2 , A. Juuti 2 ,
IN ONTARIO, CANADA T. Sane 3
A. M. Burden1, M. Tadrous1, L. Wong1, A. Calzavara2, Y. Y. 1
Department of Medicine, Division of Endocrinology,
Liu1, S. M. Cadarette1 Helsinki University Hospital, Peijas Hospital, Vantaa,
1
Department of Pharmaceutical Sciences, University of To- Finland, 2 Department of Bariatric Surgery, Helsinki
ronto, Toronto, Canada, 2Institute for Clinical and Evaluative University Central Hospital, Vantaa, Finland, 3Department
Sciences, Toronto, Canada of Medicine, Division of Endocrinology, Helsinki University
Central Hospital, Helsinki, Finland
Objective: Two non-oral osteoporosis drugs were added to
the public drug formulary in Ontario, Canada in the last Objective: Poor vitamin D status in the obese is well docu-
decade: annual zoledronic acid in 2006 (modified in 2012) mented. After bariatric surgery vitamin D deficiency can
and semi-annual denosumab in 2012. We aimed to describe become even worse. Optimal vitamin D supplementation dose
the use and persistence of these new drugs since formulary in the bariatric patients is not known.
addition. Material and Methods: We assessed serum 25OHD 3
Material and Methods: We used Ontario administrative concentration at one and 2 years control in 216 severely
claims data to identify new users of zoledronic acid and obese patients (67 % female, mean age 48 years, mean
denosumab from formulary entry through to 2013. Descrip- BMI 49 kg/m2) who underwent either gastric bypass
tive characteristics of prescribing physicians and patients were (GBP, n = 137) or sleeve gastrectomy (SG, n = 79) at
summarized. The number of new patients and new prescribing Helsinki University Central Hospital, Finland, between
physicians were plotted by month and examined over time. 2008 and 2010. The mean preoperative weight was
Time series analysis was used to examine the impact of the 142 kg (range 92–220). All patients received a prescrip-
formulary change to zoledronic acid in 2012. Persistence with tion of cholecalciferol 30 μg daily at hospital discharge
index therapy and switching to different therapies was exam- and at 1 year control. Serum 25OHD3 was determined
ined over time. by the HPLC method published earlier (Turpeinen et al.
Results: We identified 1,508 zoledronic acid users (86 % 2003).
female, mean age=77) treated by 630 physicians (27 % spe- Results: The mean weight loss at 1 year control was 24.0 %
cialist) and 16,736 denosumab users (97 % female, mean (range 4.2–42.9 %) in the GBP group and 21.6 % (1.8–
age=79) treated by 2,904 physicians (12 % specialist). More 43.6 %) in the SG group, p=0.04, and at 2 year control
denosumab users had prior oral therapy (55 % vs. 34 %), yet 24.3 % (3.6–46.7 %) and 22.2 % (−2.1–50.9 %), p=0.16,
fewer received BMD testing (20 % vs. 33 %). In comparison respectively. At 1 year control, the mean 25OHD3 was
to zoledronic acid (<5 new prescribers and patients), 62.3 nmol/l (21–122) after GBP and 63.8 nmol/l (13–110)
uptake of denosumab was rapid (>450 new prescribers after SG, p=0.27 and at 2 year control 63.8 (14–148) and 72.1
and >1,200 new patients) in the first 2 months on the (24–149), respectively, p=0.03. At 1 year control, serum
formulary. Time series analysis identified a significant 25OHD3 was below 50 nmol/l in 37 (27 %) of the GBP
increase in zoledronic acid use following a modification patients and in 24 (30 %) of the SG patients, p=0.64, and at
Osteoporos Int

2 year control in 24 (18 %) and 10 (13 %) of the patients, p= bone strength, and also that there are many extraskeletal
0.44, respectively. Below 75 nmol/l at 1 year control was 109 factors causing hip fracture.
(80 %) of the GBP patients and 56 (71 %) of the SG patients,
p=0.18, and at 2 year control 99 (78 %) and 41 (59 %), p=
0.005, respectively.
Conclusion: In these bariatric patients using daily 30 μg
vitamin D supplementation, vitamin D status was suboptimal
if level of 75 nmol/l is used as a threshold, but satisfactory if
50 nmol/l is considered optimal for bone health. The GBP
patients are at a higher risk for vitamin D deficiency than the Conclusion: The difference in hip fracture incidence between
SG patients. Hong Kong Chinese and Beijing Chinese women cannot be
References: Turpeinen U et al. Clin Chem 2003;49:1521. explained by difference in BMD. Further research should
focus on better measurement of bone strength in Chinese
women, as well as extraskeletal factors for hip fracture, so
P262 that recommendations can be made to prevent the imminent
HIP FRACTURE INCIDENCE IS MUCH HIGHER IN epidemic of hip fracture in mainland China.
HONG KONG CHINESE WOMEN THAN BEIJING
CHINESE WOMEN DESPITE HIGHER BONE
DENSITY IN HONG KONG WOMEN: MAJOR P263
IMPLICATIONS FOR HIP FRACTURE PREVENTION PRDX2 AS A POSSIBLE PATHOLOGIC MEDIATOR
R. Chung1, E. Lau1, G. Qin2, P. C. Ha2 OF HIP OSTEOARTHRITIS REVEALED BY
1
CCBR (Hong Kong), Hong Kong, Hong Kong, 2CCBR PROTEOMICS
(Beijing), Beijing, China T. Yuasa1, Y. Suehara1, Y. Makino1, K. Kaneko1
1
Department of Orthopaedic Surgery, Juntendo University,
Objective: Hong Kong has the highest incidence of hip Tokyo, Japan
fracture in Asia, while mainland China still has very low
incidence of hip fracture. However, it has been predicted there Objective: To understand the molecular mechanisms of hip
will be a major epidemic of hip fracture in China. The objec- OA and identify pathologic mediators and biomarkers, we
tive of the current study is to compare the BMD at the hip examined the proteomic profile using two- dimensional dif-
between a large population sample of Hong Kong and main- ference gel electrophoresis.
land Chinese women, so that insight can be gained into the Material and Methods: We examined surgical specimens of
etiology of hip fracture. femoral head samples from 20 patients with hip disease
Material and Methods: 7,130 ambulatory Hong Kong (10 OA cases and 10 with femoral neck fractures) who
Chinese women and 7,037 mainland Chinese women underwent surgery at the Juntendo University Hospital
living in Beijing (aged 50–96) were recruited from the consecutively from February 2007 to August 2009. Fro-
community. They volunteered for the study. BMD was zen samples of cartilage and subchondral bone tissue were
measured by Lunar Prodigy Advance Whole Body Bone used for the proteomic analysis, and were available as a
Densitometers. Cross calibration was carried out by a learning set in 16 cases, including 8 OA-hip and 8 N-hip
phantom. The prevalence of osteoporosis was calculated samples. A Western blot analysis was performed on 20
according to the World Health Organization criteria. cases, consisting of the learning set (16 cases) and the
BMD at the total spine and femoral neck were adjusted validation set (four additional cases, including two OA-hip
for age, height and weight and compared between the 2 and two N-hip samples).
populations. Results: We identified 32 protein spots demonstrating a sta-
Results: According to published data, the incidence rate of tistical difference in intensity between femoral heads with hip
hip fracture was 465/100,000 in Hong Kong Chinese women OA (OA-hip) (8 cases) and those from normal hips (N-hip) (8
and 229/100,000 in Beijing Chinese women. The prevalence cases) (p<0.01). We found that peroxiredoxin-2 (PRDX2) had
of osteoporosis at the total hip in our study was 24.8 % in the highest p-value (p=0.00016) and fold difference ratio
Hong Kong Chinese women and 20.0 % in Beijing Chinese (6.22) in 32 spots. Two of the 32 spots that derived from
women, but these did not account for difference in weight and PRDX2 had a higher intensity than that found in the N-hip
height. After adjustment for age, height and weight, the BMD samples. We employed an SDS-PAGE/Western blotting
of Hong Kong Chinese women was 2.8 % higher at the hip test to further examine the relationship of PRDX2 ex-
and 1.5 % higher at the femoral neck than Beijing Chinese pression with the OA-hip and N-hip samples, and
women. This implies that BMD is a poor measurement of showed that PRDX2 expression was higher in the N-
 Osteoporos Int

hip samples in comparison to the OA-hip samples Conclusion: Persistence to DMAb was higher than report-
(p < 0.0001). We used an SDS-PAGE/Western blotting ed previously for BPs. This improved persistence may
test to verify our findings in 4 additional OA-hip (n=2) lead to better outcomes, including increased fracture risk
and N-hip samples (n=2). The samples showed that the reduction.
N-hip samples had higher expression of PRDX2 in comparison References: 1Hadji et al., ECCEO 2013 (BEST); 230-day
to the OA-hip samples. refill gap for weekly and quarterly administration; 90-day
Conclusion: These results establish PRDX2 as a possible gap for yearly administration; 3Hadji et al., ECCEO 2013
pathologic mediator candidate for OA. (GRAND3)
Acknowledgements: Amgen/GSK
P264
GRAND 3 - THE GERMAN RETROSPECTIVE
COHORT ANALYSIS ON NONADHERENCE IN
P265
OSTEOPOROTIC PATIENTS:
PATIENTS WITH OSTEOPOROSIS WHO REMAIN AT
PERSISTENCE-ANALYSIS OF FEMALE PATIENTS
HIGH RISK FOR FRACTURE DESPITE BENEFIT OF
TREATED WITH DENOSUMAB (DMAB)
PRIOR BISPHOSPHONATE TREATMENT: A DANISH
T. Schmid1, P. Hadji2, C. Eisen1, M. Intorcia3, E. Psachoulia3
1 PERSPECTIVE
Amgen GmbH, München, Germany, 2Philipps-University of
L. Hansen1, S. A. Eriksen1, A. Krishna2, A. D. Jorgensen3,
Marburg, Marburg, Germany, 3Amgen (Europe) GmbH, Zug,
P. Vestergaard1
Switzerland 1
Aalborg University, Aalborg, Denmark, 2Merck & Co.,
Whitehouse Station, United States, 3MSD Denmark, Ballerup,
Objective: To be effective, osteoporosis therapy must be
Denmark
taken according to the prescribed dosing regimen. A retro-
spective claims analysis reported low persistence with oral
Objective: To estimate the proportion of osteoporosis patients
and intravenous bisphosphonates (BPs) at 12 and 24 months:
who remain at a high risk for fracture despite being compliant
8.5 %, 23.6 % and 35.0 % for daily, weekly and quarterly
to bisphosphonate treatment.
administration; and 4.7 %, 9.3 %, 13.1 % and 36.0 % for daily,
Material and Methods: This case-control study is based on
weekly, quarterly and yearly administration, respectively1,2.
Danish national health registry data, including data on all
We present persistence data for patients treated with DMAb
hospitalizations, ICD-10 code at admission, and performed
(subcutaneously once every 6 months) in Germany; 12- and
tests. Furthermore, results from BMD scans were collected
24-month data from this study have been reported previously3.
from three of the five Danish regions, and aggregated with
Material and Methods: This retrospective analysis evaluated
data from the registries.
the IMS®LRx-data (06/2010–10/2013; covering filled pre-
The patient group of 2,406 patients (66.3 % women and
scriptions of statutory health insurances [SHI] in Germany).
33.7 % men) was identified as:
DMAb naïve women aged ≥45 year who had received their
initial prescription between 06/2010 and 10/2011 were includ-
& Age ≥ 50 years
ed. Outcome measures were persistence at 12, 18, 24 &
& First bisphosphonate prescription date between 01.01.1996
30 months, defined as receiving follow-up DMAb prescrip-
and 31.12.2008, defined as index date
tions within 30-, 60- and 90-day grace periods after the pre-
& ≥12 months pre- and ≥36 months post-observational data
vious injection.
& A medication possession ratio ≥80 % for 24 months post
Results: The analysis included a total of 6,159 patients. Using
index
a 30 day grace period, approximately 70 % of patients were
& ≥1 claim of BMD test OR a fracture 12 months prior to
persistent at 12 months, 60 % at 24 months and 43 % at
30 days after index date
30 months.
‘High risk’ patients were defined as having the following
outcomes despite compliance for 24 months:
Table. Persistence rates using grace periods of 60 and 90 days
were similar to those for a 30-day gap.
& A fracture at 24–36 months following index OR
& BMD T-score<−2.5 at 24–36 months after index OR

Any drop in BMD between index and 24–36 months A total

of 352 high risk patients were identified, and served as cases.
The remaining 2,054 served as controls.
Osteoporos Int

Results: The proportion of high risk patients despite benefit of Results: Pain was significantly reduced. There was a statisti-
prior bisphosphonate treatment in Denmark is 14.6 % (14.3 % cally significant improvement of SFA Index. 75 % of patients
for women and 15.2 % for men). T-scores were significantly gave a very good and good assessment of efficacy, which
different at both index and follow-up between cases and coincided with the opinion of the physician. 78 % of patients
controls (p<0.001). High risk patients were more likely to had a complete recovery or improved structure of the RC on
smoke (OR: 2.5, p<0.001), have lower plasma calcium and/or second visit which was proved by sonography.
vitamin D (OR: 3.4, p<0.001), and were more frequently Conclusion: Injectable collagen is an innovative approach
diagnosed with anorexia nervosa (OR: 5.9, p=0.045). Fur- with regenerative effect in the treatment of PTT of the
thermore, the high risk patients had a significant higher RC. GUNA MDs significantly reduced pain and increased
Charlson score (p=0.014). functional activity of the shoulder, thereby increasing the
Conclusion: In Denmark, 14.6 % of the osteoporotic patients quality of life. No adverse events were registered during
remained at high risk for fracture despite persistent bisphos- the treatment.
phonate treatment. Although these patients may have benefit- References: 1. Naredo E et al. Ann Rheum Dis 2002;61:132.
ed from their therapy, alternative treatments could be consid-
ered for such patients.
Disclosures: This study was supported by an unrestricted
grant from Merck & Co. AD Jorgensen is an employee of P267
MSD Denmark. A Krishna is an employee of Merck & Co. P PTH TREATMENT INDUCES WNT10B EXPRESSION
Vestergaard: Travel grants from Novartis, Amgen, Servier, IN HUMANS LYMPHOID CELLS
and Eli Lilly. P. D’amelio1, F. Sassi 1 , I. Buondonno 1 , E. Spertino 1 ,
L. D’amico 1 , I. Roato 1 , G. C. Isaia 1
1
Dept. Medical Science University of Torino, Torino, Italy

P266 Objective: Intermittent PTH treatment reduces vertebral frac-

CLINICAL AND SONOGRAPHIC ASSESSMENT OF tures risk in osteoporotic patients. The mechanisms trough
THE EFFECTIVENESS OF COLLAGEN which PTH acts are not completely understood, it has been
INJECTIONS GUNA MDS IN PATIENTS WITH observed to activate Wnt pathways in osteoblasts (OBs).
PARTIALTHICKNESS ROTATOR CUFF TEARS OF Activation of this pathway induces OB proliferation, differen-
THE SHOULDE tiation and prevents apoptosis. Recently it has been demonstrat-
R. Nestorova1, R. Rashkov2, T. Petranova2, N. Nikolov3 ed an increased expression of Wnt10b by T cells during inter-
1
Centre of Rheumatology, Sofia, Bulgaria, 2Clinic of Rheu- mittent PTH, whereas there is no increase in Wnt10b during
matology, Medical University, Sofia, Bulgaria, 3Clinic of continuous PTH infusion in mice. In order to evaluate if PTH
Rheumatology and Cardiology, Pleven, Bulgaria acts on lymphoid cells by increasing Wnt10b expression also in
humans, we measured this molecule at baseline and after PTH
Objective: To evaluate the effectiveness of Injectable treatment in osteoporotic subject and in patients affected by
collagen GUNA MDs regarding pain, functioning and primary hyperparathyroidism before and after surgery.
restoration of periarticular tissues of the shoulder in Material and Methods: We enrolled 40 women with post-
patients with partial thickness tears (PTT) of the rotator menopausal osteoporosis, patients were randomly assigned to
cuff (RC). Musculoskeletal ultrasonography (US) is an therapy for 18 months with: 1-84 PTH 100 μg plus calcium
approved imaging technique for diagnosis of the RC 1,200 mg and vitamin D 800 UI daily, or with calcium
pathology and monitoring of therapy. 1,200 mg and vitamin D 800 UI daily and return for control
Material and Methods: We studied 22 patients with painful visit and exams at 3, 6, 12 and 18 months of therapy. We also
shoulder and sonographic proved PTT of the RC. Clinical enrolled 20 patients affected by primary hyperparathyroidism
assessment included demographic and clinical data, a VAS and subjected to surgical parathyroidectomy; patients were
for pain (0–100) and Shoulder Function Assessment (SFA) evaluated at baseline and 1 month after surgery. Real-time
scale (0–70) on the baseline and on the 60th day. Evaluations PCR for WNT10b was performed on peripheral blood lym-
of the efficacy according to the patient and the physician were phoid cells after red blood cells lysis.
performed. All patients had US of both shoulders with Results: Our data show an increase in WNT10b expression by
Mindray M5 scanner with multifrequency linear transducer lymphoid cells that was maximum (more than 20-fold) after
(7.5–10 MHz). We applied a combination of GUNA MD- 6 months of treatment, after 18 months WNT10b returned to
Shoulder and GUNA MD-Muscle into the subacromial space basal expression. The WNT10b curve acts similarly to the
in a total course of treatment 8 weeks. Physical therapy was osteocalcin one. In patients treated with calcium and vitamin
not administered during the follow-up period. D alone no increase in WNT10b was observed. Also in
 Osteoporos Int

patients affected by hyperparathyroidism there was no differ- respectively. Loss between 52.5 and 77.5 years was 8.96 %, or
ence in WNT10b before and after surgery. 0.36 %/year with a loss of 0.48 %/year between 52.5 and
Conclusion: Our data suggest an effect of intermittent, but not 62.5 years and 0.29 %/year between 62.5 and 77.5 years.
continuous PTH on the expression of WNT10b by lymphoid Changes in TBS between 2 consecutive age gr was still highly
cells, this could be one of the mechanisms trough which PTH significant (p<0.02 - p<0.0001). These results are confirmed
treatment increases OB formation and function. and more pronounced in a sub-analysis including only women
with Voa (with and without exclusion of Voa).
Conclusion: This study confirms the low correlation between
P268 LS TBS and BMD. It shows a double interest in TBS, particularly
INFLUENCE OF DEGENERATIVE DISORDERS ON in the older population: 1) on average, TBS is not affected by
THE LUMBAR SPINE BMD AND TBS WITH AGE: fractures or oa disorders, 2) while BMD increases after 65 years
THE COHORT OSTEOLAUS (moderate degenerative disorders cannot be excluded from the
B. Aubry-Rozier1, D. Stoll1, M. Metzger1, D. Hans1, O. Lamy1, analysis), TBS continues to decline. For the LS evaluation, TBS
I. Padlina1 should play a leading role not only for diagnosis but also for
1
Lausanne University Hospital, Center of Bone Diseases, treatment monitoring in view of its independence to osteoarthritis.
Lausanne, Switzerland Disclosures: Didier Hans: Shareholder of medimaps group

Objective: After menopause, typically, the values of lumbar

spine (LS) BMD and TBS decrease with age. In practice, we P269
are often faced with values of LS BMD “relatively” high for PHYSICAL FITNESS IN CHILDREN TREATED WITH
the age, which can lead to erroneous interpretations GROWTH HORMONE BY JUMPING
(reassuring diagnosis, therapeutic gain). Preliminary studies MECHANOGRAPHY: LEONARDO GROUND
have shown that osteoarthritis (oa) does not influence TBS. REACTION FORCE PLATFORM
The aim of this study was to measure changes in LS BMD and R. S. Lorenc1, A. Kępka1, M. Ginalska-Malinowska1, P.
TBS values in women 50–80 years, taking into account the Pludowski1, J. Łukaszkiewicz2
impact of fractured vertebrae (VFx) and oa (Voa). 1
Children’s Memorial Health Institute, Warsaw, Poland,
Material and Methods: The 1,502 women 50–80 years old 2
Children’s Memorial Health Institute and Jan Kochanowski,
included in the cohort OsteoLaus (Lausanne, Switzerland) have Warsaw, Kielce, Poland
had LS BMD and TBS, and VFA. 46 exams were not inter-
pretable. All exams were analyzed independently by two ex- Objective: Growth hormone therapy is efficient in growth
perts following the guidelines of the ISCD, excluding in par- retardation caused by Turner syndrome (TS) and growth
ticular VFx (2.7 % of participants) and vertebra with >1 SD hormone deficiency (GHD). However it is unknown, if in-
difference with the vertebra immediately adjacent (Voa 16.2 %). creasing of body size is accompanied by adequate increasing
Results: We included 1,456 women: age 66.7±11.7 years, in muscle function. The aim of this study was evaluation of
BMI 25.7±4.4. The correlation between BMD and TBS was changes in physical fitness in children with GHD and TS after
low (r2 =0.16). Participants were divided into six age groups: start of growth hormone therapy.
50–55 years (n=175 gr1), 55–60 (n=229, gr2), 60–65 (n= Material and Methods: The study group comprised of 25
342, gr3), 65–70 (n=325, gr4), 70–75 (n=215, gr5) and 75– children with GHD (11.2±2.9 year) and 8 girls with TS (9.2±
80 years (n=169, gr6). BMD was artificially increased from 2.1 year). Measurements were done before start of growth
1.2 to 3.3 % on average according to the gr before excluding hormone therapy and after 3, 6 and 12 months of therapy.
VFx and Voa (p<0.001). TBS did not change after excluding Physical fitness was evaluated basing on single two leg jump.
VFx and Voa (<0.1 % to 0.3 %, ns). The correlation (Vfx and Leonardo (Novotec Medical GmbH, Germany) was used.
Voa excluded) between age and BMD was −0.03, between age Leonardo measures dynamics of ground reaction forces and
and TBS +0.34. BMD (Vfx and Voa excluded) was for the six calculates two parameters: Efficiency and Esslinger Fitness
age gr: 0.955±0.140 g/cm2, 0.923±0.158, 0.906±0.158, Index, expressed as Z-scores. ANOVA with repeated measure-
0.915±0.166, 0.914±0.165 and 0.934±0.187, respectively. ment was used for analysis of the data.
Loss between 52.5 and 77.5 years was 2.16 %, or 0.09 %/year Results: Before start of the treatment, mean (SD) in children
with a loss of 0.51 %/year from 52.5 to 62.5 years, followed with GHD was −0.99 (1.62) for Efficiency Z-score and −1.88
by a gain of 0.21 %/year between 62.5 and 77.5 years. The (1.42) for Esslinger Fitness Index Z-score; and −2.87 (1.14) and
change in BMD between two consecutive age gr was signif- −1.52 (0.65) in girls with TS, respectively. In children with GHD,
icant only between gr1 and gr2 (p<0.02). TBS (Vfx and Voa mean change after 12 months of therapy was 0.28 (n.s.) for
excluded) was for the six age gr: 1.357±0.093, 1.318±0.100, Efficiency Z-score and 0.47 (p<0.005) for Esslinger Fitness
1.292±0.091, 1.272±0.097, 1.257±0.103 and 1.236±0.099, Index Z-score. In girls with TS mean changes were 1.12
Osteoporos Int

(p<0.05) and 0.41 (n.s.), respectively. In children with GHD after osteoporosis. Assessment of the MBM (OC, β-crosslaps) in
start of growth hormone therapy Efficiency increases as fast as in cases when T-score parameters correspond to norm and
reference data and Esslinger Fitness Index increases even faster osteopenia is less informative.
than in reference data. On the contrary, in girls with TS, Efficien-
cy increases faster than in reference data and Esslinger Fitness
Index increases as fast as in reference data. P271
Conclusion: The data suggests that growth hormone therapy INTERRELATION OF BONE MINERAL DENSITY
significantly attains to catch up of physical fitness. WITH EROSIVE CHANGES AT HAND JOINTS MRI
Acknowledgements: Acquiring of Leonardo was co-financed by IN PATIENTS WITH EARLY RHEUMATOID
ERDF (EU Structural Funds) project POIG.02.01.00-14-059/09 ARTHRITIS
D. Vershynina1, E. Mikhalchenko2, V. Ryzhyk1, I. Golovach3
1
Radiology Department, National Ivano-Frankivsk Medical
P270 University, Ivano-Frankivsk, Ukraine, 2Radiology Department,
MARKERS OF BONY METABOLISM IN PEOPLE Clinical Hospital Feofania, Kyiv, Ukraine, 3Rheumatology De-
WITH POSTINFARCTION CARDIOSCLEROSIS partment, Clinical Hospital Feofania, Kyiv, Ukraine
L. V. Yankouskaya1, I. S. Karpova2
1
Grodno State Medical University, Grodno, Belarus, Objective: To assess changes in BMD in patients with early
2
Republican Scientific-Practical Center Cardiology, rheumatoid arthritis (ERA) and how the BMD is related to the
Chisinau, Republic of Moldova erosive changes of wrist MRI.
Material and Methods: Тhe study involved 56 patients with
Objective: To assess the state of osseous tissue and markers of ERA who had suffered of articular syndrome for 1 year (9.3±
bony metabolism (MBM) in patients with postinfarction 2.4 months). Clinical and laboratory studies included: DAS28,
cardiosclerosis. ESR, RF, anti-CCP, anti-CMV tests. Hands were
Material and Methods: Group I included 16 healthy indi- radiographed at baseline. Distal radius and lumbar spine
viduals (62.3 ± 6.05 years), group II - 29 patients with BMD were assessed by DXA “Challenger” (DMS). MRIs of
postinfarction cardiosclerosis (62.9±5.46 years). Structural the patient’s dominant wrists were obtained using 1.5T MRI
and functional state of osseous tissue was assessed by means “Magnetom Espree”.
of ultrasound densitometry of calcaneus using a Sahara device Results: The DXA showed bone loss in patients with ERA.
(Hologic, USA). Serum level of the marker of bony tissue When analyzing the lumbar spine osteoporosis was found in 3
formation–osteocalcin (OC) and the marker of resorption β- patients and osteopenic syndrome was identified in 21 pa-
crosslaps was determined by the immunoenzymatic method tients. In the study of the distal radius the more substantial
on analyzer «Eleksys 2010». Blood plasma calcium (Ca) and bone loss was established: osteoporosis was diagnosed in 12
phosphorus (P) levels were estimated of the spectrophotome- patients, osteopenic syndrome in 32 patients. The BMD de-
ter. Statistical analysis was done using Statistica 7.0. crease at the distal radius correlated with DAS28. As for BMD
Results: Extrapolated index of calcaneal BMD was in group I of the lumbar spine, only the correlation with DAS28 was
0.516±0.11 g/сm2, in group II - 0.462[0.397; 0.510] g/сm2 found. Bone erosions were identified with standard radiogra-
and differed (p=0.018) between the groups by Median test phy in 12 patients. Detection of erosions on radiographs
(χ2 =5.6). T-score parameter in group II was lower (p<0.05; correlated with the presence of synovitis hand joints, clinically
χ2 =9.01) than in group I and was −1.1[−1.8;−0.8]. Parameters established, DAS28, seropositivity for the three antibodies.
of ultrasound densitometry of calcaneus by T-score in group II MRI of the dominant wrist revealed the next MR symptoms:
corresponding to osteopenia were in 59 % and corresponding swelling of the bone marrow in 54 patients, synovitis in 40,
to osteoporosis - only in 7 %. OC amounted to 14.7 ± erosion in 34. MRI detected the erosions 2.8 times more cases
5.14 ng/ml in group I, and to 17.03±7.83 ng/ml in group II, than the conventional radiography. Erosion was con-
β-crosslaps was 0.214[0.182; 0.349] ng/ml and 0.354 ± firmed in patients with a high rate of DAS28, in sero-
0.17 ng/ml, respectively. The values of MBM didn’t differ positive cases, and those with the synovitis. Strong
between the groups (p>0.05). There was a strong correlation correlation between BMD of the distal radius and the
between OC and β-crosslaps (R=0.86; p<0.05), in all the presence of erosions detected by MRI, and lumbar spine
subjects their values were either within normal limits or re- BMD and erosions was established.
duced and only one patient had elevated β-crosslaps. The Conclusion: The BMD changes can be predicted early by the
groups didn’t differ by levels of Ca and P. development of erosive process in ERA patients. The early
Conclusion: Thus, in patients with postinfarction loss of a wrist bone measured in the first year of the disease
cardiosclerosis findings of ultrasound densitometry of calca- using the DXA is an independent predictor of erosive
neus by T-score most often evidence osteopenia, rarely progression.
 Osteoporos Int

P272 P273
ATYPICAL FEMORAL FRACTURE RISK FACTORS: THE IN VIVO ROLE OF BONE SPECIFIC EPHB4
A POPULATION-BASED CASE-CONTROL RECEPTOR OVEREXPRESSION IN
STUDY OSTEOARTHRITIC SYNOVIAL MEMBRANE
A. L. Adams1, F. Xue2, J. Q. Wang1, R. M. Dell3, S. M. Ott4, J. Martel-Pelletier1, G. Valverde-Franco1, D. Hum1, B.
C. W. Critchlow2 Lussier2, K. Matsuo3, J.-P. Pelletier1, M. Kapoor1
1 1
Kaiser Permanente Southern California, Pasadena, CA, Osteoarthritis Research Unit, University of Montreal Hospital
United States, 2Amgen Inc., Thousand Oaks, CA, United Research Unit (CRCHUM), Montreal, Canada, 2Faculty of
States, 3Kaiser Permanente Southern California, Downey, Veterinary Medicine, Clinical Science, University of Montreal,
CA, United States, 4University of Washington, Seattle, WA, St-Hyacinthe, Canada, 3Laboratory of Cell and Tissue Biology,
United States School of Medicine, Keio University, Tokyo, Japan

Objective: To identify risk factors for atypical femoral frac- Objective: Osteoarthritis (OA) is characterized by joint de-
tures (AFF) in women enrolled in a large integrated health struction including synovial membrane inflammation and ab-
care organization. normalities including fibrosis. Members of the ephrin
Material and Methods: This population-based case- family, the EphB4 receptor and its specific ligand ephrin-B2,
control study included women aged ≥45 years with a were found to positively impact OA subchondral bone and
qualifying fracture between 2007–2011 and ≥6 months cartilage1,2. An in vivo study3 on overexpression of EphB4 in
enrolment in the health plan prior to index. Each bone (TgEphB4) demonstrated a protective effect on
physician-validated AFF case was matched 1:1 on index subchondral bone and cartilage during OA. We further inves-
date and medical center to two control groups: 1) other tigated, in vivo, the effect of TgEphB4 on synovial membrane
subtrochanteric/diaphyseal fractures (SUBTROCH), and during OA.
2) “classic” femoral neck or intertrochanteric hip frac- Material and Methods: Knee OA was surgically induced
tures (HIP). Potential risk factors included demographic (DMM) in 10-week-old male TgEphB4 and wildtype (WT)
characteristics, clinical factors, bisphosphonate (BP) use, mice. Synovial membrane evaluation was performed at
and other pharmacologic exposures up to 3 years prior 12 weeks postsurgery, and factors including fibrotic markers
to index. and signaling molecules were determined.
Results: 115 AFF cases were matched to 107 Results: Data demonstrated a significant decrease in synovial
SUBTROCH and 115 HIP control subjects. Compared membrane thickness (p≤0.02), procollagen type I (p≤0.01),
to SUBTROCH, younger age (median age 70 vs. and fibrin (p≤0.04) in DMM-TgEphB4 compared to DMM-
80 years, p <0.01), Asian race (vs. White, OR 13.0; WT. The expression levels of the fibrotic markers connective
95%CI 3.1–54.8), osteoporosis diagnosis prior to index tissue growth factor (CTGF, p≤0.02), smooth muscle actin α
(OR 2.5; CI 1.2–4.9), active use of BPs at index (OR (SMAα, p≤0.03) and serum cartilage oligomeric matrix pro-
6.4; CI 3.0–13.4) were independent predictors of AFF tein (COMP, p≤0.03) were significantly reduced in DMM-
status. AFF risk increasing monotonically from OR 5.8 TgEphB4 compared to DMM-WT. Although TGF-β was
(CI 1.9–17.2) for BP use <4 years to OR 13.3 (CI 4.2– decreased in the DMM-TgEphB4 mice, statistical significance
42.2) for use ≥8 years (p for trend<0.01). Compared to was not reached. However, the level of TGF-β signaling
HIP, younger age (median age 70 vs. 83 years, p<0.01), profibrotic members, TGFR1/ALK1, pSmad-1 and a member
Asian race (vs. White, OR 11.7; CI 3.6–37.9), osteopo- of the heat shock protein family, HSP90β, known to play a
rosis diagnosis prior to index (OR 2.1; CI 1.1–3.9), crucial role in enhancing TGF-β signaling, were all signifi-
active use of BPs at index (OR 6.8; CI 3.2–14.2), and cantly decreased (p≤0.04) in DMM-TgEphB4.
longer duration of use of BPs (median 6.6 vs. 2.4 years, Conclusion: This is the first in vivo evidence that
p < 0.01) were independent predictors of AFF status. protecting the subchondral bone prophylactically reduces
AFF risk increased from OR 3.3 (CI 1.3–8.8) for the severity of structural and pathological changes in
<4 years of BP use to 10.5 (CI 3.6–30.8) for ≥8 years synovial membrane during the OA process. Moreover,
use (p for trend<0.01). overexpression of bone- specific EphB4 in mice pre-
Conclusion: AFF subjects appear to differ from those vents the development and/or progression of fibrosis in
with other hip/femur fractures by age, race, and patterns OA synovial membrane. This study stresses the in vivo
of BP use prior to fracture. As investigation into the importance of subchondral bone structure/biology in OA
pathophysiology of AFF continues, our findings may joints.
provide insight into the role of potentially modifiable References: 1Kwan Tat et al. Arthritis Rheum 2008;58:3820;
2
risk factors such as BP use. Kwan Tat et al. Arthritis Res Ther 2009;11:R119; 3Valverde-
Disclosures: Study funded by Amgen, Inc. Franco et al. Arthritis Rheum 2012;64:3614.
Osteoporos Int

P274 quality of life of women in the control group (with

NOVEL DIAGNOSTIC TOOL: IN VIVO BONE hypothyreosis) by using a questionnaire to measure the quality
STRONTIUM QUANTIFICATION, RECENT of life of patients with osteoporosis (Qualeffo-41), which
DEVELOPMENTS consists of 41 questions grouped into five domains: pain,
A. Pejovic-Milic1, H. Moise2, D. R. Chettle2 physical function, social function, general health perception,
1
Department of Physics, Ryerson University, Toronto, Canada, and mental function.
2
Medical Physics and Applied Radiation Sciences, McMaster Material and Methods: This is a clinical prospective study
University, Hamilton, Canada conducted in two parallel groups of patients. The first group
consisted of 100 patients having a diagnosis of osteoporosis
Objective: To present a novel diagnostic tool suitable for the (T-score ≤−2.5 SD). Diagnosis using DXA in the office
in vivo bone strontium measurement and it application for osteodensitometry (Discovery™ bone densitometer), Clinical
monitoring osteoporotic patient treated with strontium based Center, Kragujevac. The second group includes 30 patients
medications. with hypothyroidism (control group) and normal bone density
Material and Methods: The in vivo X–ray fluorescence findings (T-score to −1.6).
(IVXRF) based diagnostic tool, with I-125 brachytherapy seeds Results: Between the two groups of women with osteoporosis
as an excitation source and a lithium drifted silicon detector, is and hypothyroidism there was statistically significant higher
in clinical use for the in vivo measurement of strontium [1,2]. values Qualeffo-41 questionnaire on quality of life, in all
Results: The IVXRF was successfully used to measure non- aspects of testing (pain, physical function, social function,
invasively patients self- administrating strontium citrate over general health perception, and mental function) (p<0.001).
4 years [1,2]. The system was sufficiently sensitive to detect In the domain of pain, physical function, social function,
initial strontium levels in all subjects and to demonstrate general health perception the results were worse in the group
increases in bone strontium even during the first week of of patients with osteoporosis indicating poorer quality of life
administration. in these areas, while in the field of mental function quality of
Conclusion: This noninvasive, in vivo and painless diagnos- life was worse in the control group.
tic tool could be used for both clinical use and research into the Conclusion: The overall conclusion is the result of this study
long term effects of strontium in healthy and osteoporotic showing that osteoporosis itself leads to lower quality of life
patients. As strontium bone levels continue to rise after years as measured by Qualeffo-41.
of its administration, the importance of monitoring patients
over a long-term period and the issue of correcting for BMD
test scores in such individuals becomes essential. Consump- P276
tion of strontium medications and supplements for more than VASTUS MEDIALIS MUSCLE FAT CONTENT AS
6 months affects BMD scores for years following the intake, ASSESSED BY MAGNETIC RESONANCE IMAGING
such that BMD scores are falsely increased [3]. Hence, the (MRI) IS A RISK FACTOR FOR KNEE
IVXRF based diagnostic tool emerges as a promising novel OSTEOARTHRITIS PROGRESSION: RELEVANCE IN
diagnostic tool to measure and monitor bone strontium levels, A CLINICALTRIAL
at even lower risk than the conventional BMD method, along J.-P. Pelletier1, J. P. Raynauld1, F. Abram2, M. Dorais3,
with allowing for the correction of BMD scores in patients Y. Wang4, J. Fairley4, F. Cicuttini4, J. Martel-Pelletier1
1
treated with strontium based medications or supplements. Osteoarthritis Research Unit, University of Montreal Hospi-
References: [1] Moise H et al. Bone 2012;51:93. [2] Moise H tal Research Centre (CRCHUM), Montreal, Canada, 2Medical
et al. Bone 2014;doi: 10.1016/j.bone.2014.01.002. [3] Blake Imaging Research & Development, ArthroLab Inc., Montreal,
GM & Fogelman I. J Bone Miner Res 2006;21:1417. Canada, 3StatSciences Inc., Notre-Dame-de-l’Ile-Perrot,
Canada, 4Department of Epidemiology & Preventive
Medicine, School of Public Health & Preventive Medicine,
P275 Monash University, The Alfred Centre, Melbourne, Australia
QUALITY OF LIFE IN PATIENTS WITH
POSTMENOPAUSAL OSTEOPOROSIS Objective: Recent osteoarthritis studies propose vastus
V. Grbovic1, A. Jurisic Skevin2, A. Lucic2, K. Parezanović medialis (VM) muscle surface as a variable associated with
Ilić2 cartilage volume loss (CVL) over time. However, such muscle
1
Clinical Center Kragujevac, Kraujevac, Serbia, 2Faculty of area may also include a significant proportion of fatty infiltra-
Medical Sciences, Kragujevac, Serbia tion (%Fat) which may influence the knee mechanics/
metabolism. We contrasted the muscle %Fat with CVL and
Objective: To investigate the quality of life of patients with changes in bone marrow lesions (BMLs) assessed by MRI
postmenopausal osteoporosis and to compare it with the using data from a recent randomized clinical trial in knee OA1.
 Osteoporos Int

Material and Methods: A subgroup of 143 patients from the dioxygenase (IDO) which might cause the inhibition of in-
ATP population of a 2-year randomized clinical trial evaluat- flammatory cascades and prevent or slow down the tissue
ing the impact of licofelone vs. naproxenand having MRI damage. This research was aimed to evaluate the differences
acquisitions at baseline and 2 years were studied. MR images of kynurenine/tryptophan pathway and their relation to bone
of the VM (mm2) were evaluated semi-automatically and VM metabolism.
%Fat by a fully automated software. Material and Methods: The study group were included 62
Results: The average %Fat/VM surface area was 6.3±3.9 %. patients with osteoporotic hip fracture; 41 female-21 male,
In the VM, the median baseline %Fat (5.1 %) was chosen to mean age was 76.26±6.65–77.28±7.32 years. Twenty-four of
separate patients with high vs. low fat content. Female (p= them (Group 1) had collum femoris fractures and 38 of those
0.004), higher BMI (p=0.0012), and disability (WOMAC (Group 2) had intertrochanteric fractures of hip. All fractures
function, p = 0.04) were associated with a higher %Fat. were due to low energy trauma, simple falls. BMD measure-
Change at 2 years in %Fat was univariately strongly associat- ments were done with Lunar DXA. The measurements were
ed with an increase in the BML score in the global knee (p= performed on the intact side of the hip and measurements were
0.0002) and CVL in the global knee (p=0.01), lateral com- obtained as femoral neck, wards, trochanteric and total BMD
partment (p=0.02), plateau (p=0.01), and medial plateau (p= values. Measurement of tryptophan and kynurenin (Kyn)
0.03). No correlations were found between %Fat change and levels were done by HPLC with UV detection. The eluate
change in symptoms over time. Multivariate analyses was monitored by the programmed wavelength detection
correcting for age, gender, BMI, and meniscal damage re- setting at 360 nm for Kyn and at 278 nm for Trp. The ratio
vealed correlations with %Fat for the CVL of the global knee of kynurenine and tryptophan concentrations was calculated
(p=0.011), plateau (p=0.012), medial plateau (p=0.019), and to estimate the activity of IDO.
condyle (p=0.027). Importantly, %Fat change was indepen- Results: All BMD values were in agreement for osteoporosis
dently and strongly associated with BML change (p<0.0001). and no significant differences between the two groups. The
All the above changes were found irrespective of the treatment mean and standard deviation values for Kyn and Trp levels in
the patients had during the clinical trial. Group 1 (2.657±0.829, 24.990±8.773, respectively) and in
Conclusion: These data demonstrated, for the first time, that Group 2 (2.344±0.803, 30.800±11.902, respectively) were
the %Fat in the VM was strongly associated with CVL and the not different. However the ratio of Kyn and Trp concen-
occurrence and progression of BMLs. trations for Group 1 was 118.20±50.81 and for Group 2 is
References: 1 Raynauld JP et al. Ann Rheum Dis 83.60±34.81 and it was statistically significantly different
2009;68:938. (p=0.011).
Disclosures: JPR: consultant for ArthroLab. JPP, JMP: share- Conclusion: The increased degradation of tryptophan
holders in ArthroLab. FA: employee of ArthroLab. and the ratio of kynurenine/tryptophan may indicate
the immune activation and the increased macrophage
IDO activity of a low energy trauma induced osteoporotic
hip fracture.
P277
THE EVALUATION OF THE TRYPTOPHAN AND
KYNURENINE PATHWAY IN OSTEOPOROTIC HIP
FRACTURES P278
E. V. Dincel1, Y. Ozkan2, M. Sukuroglu3, A. Sepici Dincel4, DENOSUMAB THERAPY FOR THE TREATMENT OF
H. M. Ozsoy1, V. Sepici5 PERSISTENT OR RELAPSED HYPERCALCEMIA OF
1
Clinics of Orthopedics and Traumatology, Ministry of MALIGNANCY (HCM)
Health, Ankara Training and Research Hospital, Ankara, Tur- W. Misiorowski1, M. Hu2, I. Glezerman3, S. Leboulleux4, K.
key, 2Department of Biochemistry, Gazi University, Faculty of Insogna5, R. Gucalp6, B. Yu7, P. Zorsky7, D. Tosi8, A.
Pharmacy, Ankara, Turkey, 3Department of Pharmaceutical Bessudo9, A. Jaccard10, G. Tonini11, W. Ying12, A. Braun12,
Chemistry, Gazi University, Faculty of Pharmacy, Ankara, R. Jain12
Turkey, 4Gazi University Faculty of Medicine, Ankara, Tur- 1
Endocrinology Department, Medical Center for Postgraduate
key, 5Department of Physical Medicine and Rehabilitation, Education, Warsaw, Poland, 2University of Texas, MD An-
Gazi University, Faculty of Medicine, Ankara, Turkey derson Cancer Center, Houston, United States, 3Memorial
Sloan-Kettering Cancer Center and Weill Cornell Medical
Objective: Different studies suggested that the degradation of College, New York, United States, 4Institut Gustave Roussy,
tryptophan could be formed around the inflamed surface and Villejuif, France, 5Yale University, School of Medicine, New
speculated on the altered expression of indolamine 2,3- Haven, United States, 6Montefiore Medical Center-Bronx,
Osteoporos Int

New York, United States, 7Peninsula Regional Medical Cen- Acknowledgements: Albert Rhee (Amgen) provided editing
ter, Salisbury, United States, 8Centre Val d’Aurelle Paul assistance.
Lamarque, Montpellier, France, 9California Cancer Associ-
ates for Research and Excellence, Encinitis, United States, P279
10
Centre Hospitalier Universitaire de Limoges, Hôpital FLAVONOL INHIBITS FORMATION OF
Dupuytren, Limoges, France, 11Policlinico Universitario OSTEOCLASTS IN CULTURE SYSTEM RATHER
Campus Biomedico, Rome, Italy, 12Amgen Inc., Thousand THAN FLAVANONE
Oaks, CA, United States
H. Hagiwara1, K. Nakata1, S. Indah1, K. Yosida1
1
Biomedical Engineering, Toin University of Yokohama,
Objective: HCM, caused primarily by tumor-induced Yokohama, Japan
bone resorption, is often treated with intravenous (IV)
bisphosphonates (BisP). HCM may persist or relapse
Objective: Polyphenol have been reported to have physiolog-
despite such therapy. Denosumab binds to RANK li- ical effects with respect to alleviating diseases such as osteo-
gand (RANKL) to inhibit osteoclast-mediated bone
porosis and osteopetrosis. We recently reported that the olive
resorption.
polyphenol hydroxytyrosol accelerates bone formation both
Material and Methods: In this single-arm, open-label in vivo and in vitro (Eur J Pharmacol 2011;662:78). The
study, patients (pts) with HCM (corrected serum calcium
present study was designed to evaluate the in vitro effects of
[CSC] >12.5 mg/dL) despite IV BisP treatment ≥7 and
flavonoid, such as flavonol and flavanone, on the formation of
≤30 days before screening, received subcutaneous multinucleated osteoclasts in culture system.
denosumab 120 mg on days 1, 8, 15, and 28, then
Material and Methods: Multinucleated osteoclasts were
every 4 weeks. The primary endpoint was the propor-
formed from the mouse splenic cells by coculture system with
tion of pts with CSC ≤11.5 mg/dL within 10 days of ST2 cells stimulated by 100 nM vitamin D3. Osteoclastic cells
denosumab initiation.
were fixed and stained for TRAP activity. TRAP-positive multi-
Results: The study enrolled 33 pts (64 % men; mean age
nucleated cells (five or more nuclei) were counted under a
60 years; 76 % with advanced solid tumors, 39 % with bone
microscope. We used fisetin, quercetin, and rhamnetin as flavo-
metastases [BM]), with a median (25th, 75th percentile [Q1,
nol and hesperetin, naringenin, and sakuranetin as fla-
Q3]) follow-up of 56 (18, 79) days. Median (Q1, Q3) baseline
vanone in this study.
CSC was 13.7 (13.2, 14.2) mg/dL; 19 pts (58 %) had HCM
Results: Fisetin, quercetin, and rhamnetin at 10 μM complete-
symptoms. Median (Q1, Q3) time from last BisP treatment to
ly inhibited the formation of multinucleated osteoclasts. By
first dose was 17 (13, 22) days. By day 10, 21 pts (64 %)
contrast, the weak inhibition of osteoclast formation were ob-
reached CSC ≤11.5 mg/dL, including 7 of 13 pts (54 %) with
served with hesperetin, naringenin, and sakuranetin at 10 μM.
and 14 of 20 (70 %) without bone metastases. Over the course
Conclusion: These results suggested that the hydroxyl group
of the study, 23 pts (70 %) reached CSC ≤11.5 mg/dL. A
at carbon 3-position of flavonol might play a critical role on
complete response (CSC ≤10.8 mg/dL) occurred in 12 pts
inhibition of osteoclast formation.
(36 %) by day 10 and in 21 pts (64 %) over the course of
the study. In pts who reached CSC ≤11.5 mg/dL, the estimated
median duration of response was 104 days. The most
frequently reported serious adverse event were hypercal- P280
cemia (5 pts, 15 %) and dyspnea (3 pts, 9 %) Two pts IDENTIFYING THE CUTOFF POINT OF
had isolated episodes of CSC levels ≤8.0 mg/dL; no pts SUPPRESSION OF EXCESSIVE PTH SECRETION:
had CSC <7.0 mg/dL. No osteonecrosis of the jaw was METHOD OF FINDING THE POINT OF
reported. CORRELATION CHANGE
Conclusion: In pts with HCM despite recent IV BisP treat- L. Y. Rozhinskaya1, E. A. Pigarova1, L. K. Dzeranova1, A. V.
ment, 64 % of pts responded to denosumab within 10 days. Kuznetsova2, O. V. Sen’ko3, E. A. Cherepanova4, G. A.
The sustained duration of response observed is a favorable Melnichenko4
1
outcome in this population. No unexpected safety findings Neuroendocrinology and Bone Diseases, Endocrinology Re-
were identified. Denosumab may offer a new treatment option search Centre, Moscow, Russian Federation, 2Emanuel Insti-
for HCM. tute of Biochemical Physics of Russian Academy of Sciences
Disclosures: Study was Amgen funded. WM, MH, IG: (IBCP RAS), Moscow, Russian Federation, 3Dorodnicyn
Amgen research grants. KI, RG, SL, BY, AB, AJ, GT: no Computing Centre of Russian Academy of Sciences, Moscow,
disclosures. PZ: company stock options. DT: Novartis re- Russian Federation, 4Endocrinology Research Centre, Moscow,
search grant. WY, AB, RJ; Amgen employees. Russian Federation
 Osteoporos Int

Objective: Serum 25(OH)D is the best indicator of the status Objective: It is to evaluate response of risedronate 150 mg
of vitamin D (vitD), but target levels of vitD in the blood are once a month on P1NP, a highly specific marker of bone
still represent a matter of debate. Taking into the consideration formation and its correlation with another high specific mark-
the difficulties of standardization of assays for vitD, the pri- er of bone resorption, C telopeptide after 1 year treatment in
ority arrears of the research are the development of a method- women with low bone mass. This two measurements has been
dependent reference values with the use of biomarkers for suggested by IOF and IFCC as a reliable, specific and repro-
vitD sufficiency. One such widely recognized biomarker is ducible bone markers.
the correlation of vitD with PTH, the main characteristic of Material and Methods: N-terminal propeptide of
which is the “loss” of the correlation, i.e., no increase in PTH procollagen type I (P1NP) and serum β-crosslaps
(and associated mobilization of calcium from the bones) after (CTx) were evaluated in 80 postmenopausic Venezuelan
reaching a certain concentration of vitD, the determination of women with low bone mass (T-score <−1.5) either at
which defined our goal. lumbar spine(LS) or femoral neck(FN) (Lunar Prodigy
Material and Methods: The study included patients (n=163, Advance, CV 1.5 %). P1NP and CTx were measured on
30M/133F; mean age 48.5±18 years) in which levels of fully automated Cobas e411 (Electro-chemiluminescent
total 25(OH)D (Liaison, DiaSorin) and PTH (Elecsys, immunoassay analyzer).
Roche) were measured during autumn period (September– Results: Age was 59.8±8.3, age of menopause 46.8±
October). In selection of patients we used exclusion criteria: 6.3, 26 % had received HRT for a mean of 2.99 years.
presence of primary hyperparathyroidism, secondary or tertia- BMD increased at lumbar spine 3.58 % and 3.45 % at
ry hyperparathyroidism on the background terminal chronic femoral neck. P1NP reduction was: 46.3 % and 54.3 %
renal failure, hypercortisolism, blood creatinine level of more at 3 and 12 months. Serum P1NP decreased more than
than 100 mmol/l or GFR less than 60 ml/min/1.73 m2, intake 10 % in 94.7 % and 95.8 % of patients at 3 and 12 months,
of active vitD metabolites within 1 month prior the blood test. respectively.
Our lab participates in the international program of external
control and standardization of vitD in the blood (DEQAS,
UK).
Results: Threshold of vitD to “plateau” the secretion of
the PTH was 24.8 ng/ml, which separated the correla-
tions between logPTH and vitD, R=−0.31 (p<0.02) and
R = 0.04 (p = 0.04), with also a statistically significant
difference between the coefficients of correlation in
groups on either side of this threshold point at the level
p<0.05.
Conclusion: Thus, the threshold value of vitD in the blood to
suppress excessive secretion of PTH in the group of generally
healthy patients was found to be 24.8 ng/ml.
Acknowledgements: This work was supported by the Grant
of the President of Russian Federation НШ-4527.2014.7

P281 Conclusion: Risedronate 150 mg once a month sup-

SUSTAINED P1NP SUPPRESSION WITH MONTHLY pressed bone remodeling into normal premenopausal
150 MG RISEDRONATE TREATMENT OF reference range measured by 46.3 % reduction on
POSTMENOPAUSALWOMEN WITH LOW BONE P1NP at 3 months and 54.3 % at 12 months. CTx
MASS DURING 1 YEAR TREATMENT ANALYSIS decreased 48 % and 42 % at 3 and 12 months, respec-
AND EVALUATION OF RISK OF FALLING IN tively. Serum P1NP decreased more than 10 % in
POSTMENOPAUSALWOMEN WITH 94.7 % and 95.8 % of patients at 3 and 12 months,
OSTEOPOROSIS respectively. BMD increases 3.58 % at lumbar spine
G. Riera-Espinoza1, Y. Cordero1, S. Mendoza1, Y. Gonzalez1, and 3.45 % at femoral neck. Our data support the use
J. Ramos1 of changes in P1NP as a good indicator of effectiveness
1
Unidad Metabolica, Valencia, Venezuela during, early 3 months or sustained 12 months,
Osteoporos Int

treatment of postmenopausal women with low bone Conclusion: In our study, we have demonstrated insuffi-
mass with risedronate 150 mg once a month. ciency, deficiency in vitamin D3, illustrating this
Acknowledgements: Not restricted grant from Laboratorios through in a sample of patients hospitalized in our
Leti. Venezuela service of Endocrinology. That is an important clinical
problem in the world.

P282 P283
VITAMIN D STATUS IN A POPULATION VIOLATION OF CALCIUM-PHOSPHORUS
HOSPITALISED IN OUR CLINICAL SERVICE METABOLISM AND CALCIUM-REGULATING
C. Galesanu1, I. Grozavu1, A. Loghin1, D. Ungureanu1, HORMONES (CRH) AS A MAJOR DETERMINANT
L. Apostu2 OF OSTEOPOROSIS WHICH ASSOCIATED WITH
1
Endocrinology, University of Medicine and Pharmacy LIVER CIRRHOSIS (LC)
Gr.T.Popa, Iasi, Romania, 2Biochemistry, University of I. Golovach1, Z. Mytnyk2
1
Medicine and Pharmacy Gr.T.Popa, Iasi, Romania Rheumatology, Clinical Hospital Feofania, Kyiv, Ukraine,
2
Gastroenterology, National Institute of Surgery and
Objective: Vitamin D3 is a major factor in bone metab- Transplantology A.А.Shalimov, Kyiv, Ukraine
olism. Vitamin D deficiency has been recognized as a
pandemic with a myriad of health consequences. Vita- Objective: To determine violations of mineral metabolism,
min D deficiency is more common than expected, par- concentration of calcium regulating hormones, as well as to
ticularly among adolescents, women, the elderly or peo- establish influence of disturbances in these systems of osteo-
ple who live in northern regions. Our aim was to porosis associated with LC.
determine plasma levels of vitamin D3 in patients ad- Material and Methods: We observed 172 patients with LC,
mitted in our clinical area for various endocrine pathol- the average age 49.3±7.7 years. There were 108 (62.8 %) men
ogies and postmenopausal osteoporosis. and 64 (37.2 %) women. BMD was determined by DXA
Material and Methods: We evaluated the status of vita- “Challenger” (DMS, France). We also determined the serum
min D3 by measurement of serum 25-hydroxyvitamin concentration of calcium and phosphorus, urinary excretion,
D3 (25OHD3) in 176 patients admitted to our clinical the level of PTH and 25(OH)D.
sector between January–August 2013. The age of pa- Results: We found significant violations of calcium-
tients ranged from 4 to 87 years. Of this total, 59.6 % phosphorus metabolism, changes in the CRH, and reduced
patients were in postmenopause and the diagnosis of BMD in patients with LC, but the severity of the imbalance
osteoporosis has been shown from 45.16 % of them depended on the severity of the disease and correlated with the
using the DXA determination. Serum 25OHD3 concen- main laboratory criteria of liver dysfunction. We observed
tration was measured by chemiluminescence assay with decrease serum concentration of total and ionized calcium,
minimum detection limit of 3.0 ng/ml. Vitamin D3 as well as expressive tendency to hypercalciuria. The concen-
insufficiency has been defined for the serum levels tration of 25(OH)D was 9.88±4.36 ng/ml (in control 26.76±
<20 ng/mL(<50 nmol/L) and Vit. D3 deficiency 9.27 ng/ml; P<0.01). The level of deficit depended on the
<10 ng/mL(<25 nmol/L). degree of liver dysfunction. In the case of compensated of LC
Results: We found a high prevalence of both vitamin D the level of 25(OH)D was 12.93±5.42 ng/ml and decompen-
deficiency:17.14 % and insufficiency:57.86 % in our sated—4.53±1.22 ng/ml (a decrease of 2.8 times). The re-
study population. The mean serum level of 25OHD3 ceived results emphasize that abnormal liver function signif-
was 16.90 ng/mL. In our study, vitamin D deficiency icantly affects formation of 25(OH)D. PTH was elevated in a
was observed in: −16.47 % postmenopausal women, majority of patients. Serum concentrations of PTH were on
−19.05 % patients with osteoporosis, −10 % children average 82.2±5.3 pg/ml in patients with LC. It significantly
and adolescents. Vitamin D insufficiency was observed changed at different degrees of disease activity and severity of
in: −43.53 % postmenopausal women, −61.9 % osteopo- hepatocellular insufficiency. The PTH was 39.8±3.1 pg/ml in
rotic patients, −40 % children and adolescents. 50 % of children compensation stage, 89.8±4.2 pg/ml in subcompensation,
and adolescents were presented vitamin D levels between 20 103.2±11.7 pg/ml in decompensation.
and 30 ng/ml but, none of them had vitamin D levels Conclusion: Thus, in patients with LC, violations of mineral
>30 ng/ml. Vitamin D sufficiency >30 ng/mL was observed metabolism with emergence of resistant hypocalcemia, and
only at 5 % of all study population. lack of active vitamin D metabolites, as well as development
 Osteoporos Int

of secondary hyperparathyroidism, especially in severe liver by numerous factors. In patients with osteoporosis incidence
dysfunction, are observed. These patients are diagnosed with of knee OA was lower compared to women with normal
grave osteoporosis. BMD.

P284 P285
CLINICAL FEATURES OF KNEE OSTEOARTHRITIS RECOGNITION OF OSTEOPOROSIS RISK
(OA) DEPENDING ON THE STATE OF BONE FACTORS IN HIP FRACTURE PATIENTS: FIRST
MINERAL DENSITY (BMD) DATA FROM LATVIA
I. Semeniv1, I. Golovach2, I. Zazirny1, V. Sulyma3 M. Mukane1, I. Rasa1, I. Daukste2, M. Mukans3
1 1
Orthopedics Department, Clinical Hospital Feofania, Kyiv, Riga Stradins University, Riga East Clinical University
Ukraine, 2Rheumatology, Clinical Hospital Feofania, Kyiv, Hospital, Latvian Osteoporosis and Bone Metabolism
Ukraine, 3Orthopedics and Traumatology Department, Diseases Association, Riga, Latvia, 2Latvian Osteoporosis and
National Ivano-Frankivsk Medical University, Ivano- Bone Metabolism Diseases Association, Riga 2nd Hospital,
Frankivsk, Ukraine Riga, Latvia, 3Riga Stradins University, Riga East Clinical
University Hospital, Riga, Latvia
Objective: The aim of the study was to determine the rela-
tionship between the frequencies, clinical characteristics of Objective: Osteoporosis (OP) and its related fractures are
patients with knee OA with different BMD. highly prevalent condition worldwide with known risk fac-
Material and Methods: The study included 103 women with tors. The aim of the study was to analyze recognition of OP
established osteoarthritis of the knee, the average age was risk factors in patients with hip fractures.
67.6±9.8 years. BMD and degree of bone loss was deter- Material and Methods: Retrospective medical record
mined by DXA at the “Challenger” (MSD, France). For analysis of patients (pts) attended to Riga 2nd Hospital
clinical assessment of the joints, Leken’s index, range of specialized in traumatology and orthopaedics. All pts
motion, pain index according to the verbal scale of pain, included in the study were admitted to hospital in
functional index were determined. Knees were radiographed 3 year period (08.12.2009–19.12.2012) and had a hip
at baseline. fracture as a result of low energy trauma. OP risk
Results: The incidence of tibio-femoral and patella-femoral factors such as gender, age, habits, comorbidities, med-
OA was significantly lower in women with osteoporosis than ication, including glucocorticosteroid (GCs) use, previ-
in women with normal bone. Thus, when the probable osteo- ous fracture were analyzed. All interval data were
porosis tibio-femoral OA (TFOA) was diagnosed in 53.3 % of presented in median values with interquartile range
patients, patella-femoral OA (PFOA)–in 13.3 %. At the same (IQR).
time in women with a normal bone state knee OA of sites was Results: A total of 888 pts medical records were analyzed:
diagnosed in 78.6 % and 53.6 %, respectively. In case of predominantly females (73.1 %) older than males 80 (IQR,
identifying the osteopenic syndrome TFOA was diagnosed 86–72) yrs vs. 72 (IQR, 80–61) yrs (p<0.001). Such
in 64.4 % of women and PFOA–in 15.8 %. We have not risk factors were recognized: previous fracture–14.8 %
established the relationship between radiographic OA and (more than one fracture 9.2 %), smoking–12.5 %, alco-
bone loss. In patients with OA of the III stage, osteoporosis hol abuse–7.7 %. Totally 24.4 % of all pts had comor-
and normal bone tissue are discovered with approximately bidities increasing risk of OP (28.0 %–chronic obstruc-
equal frequency. Analysis of the anthropometric charac- tive pulmonary disease or sarcoidosis, 9.9 %–diabetes
teristics revealed significant differences in BMI. In mellitus, 8.7 %–chronic kidney disease, 1.5 %–rheuma-
women with osteoporosis, BMI was significantly lower toid arthritis, 0.7 %–gastrectomy). Only 1.4 % (n=12)
than in patients with normal bone mass. Patients with of all pts used GCs in long-term. Medication increasing
osteoporosis have longer duration of osteoarthritis; their risk of OP (e.g., anticonvulsants, proton pump inhibi-
Leken’s index is more pronounced and their joints func- tors) used 6.2 % (n=55) of all pts. Almost half of the
tional impairment is of a higher degree. There is a pts had at least 1 OP risk factor, 30.6 % of pts had 2
relationship of correlation (r=−0.76; P<0.01) between risk factors, 9.2 % had 3 risk factors, 2.5 %–4 risk
the functional index and BMD. factors and 0.3 %–6 risk factors. Only in 2.8 %
Conclusion: The study revealed that in patients with (n=25) pts OP diagnosis was found in medical records
knee OA of various disorders, marked state of bone and 2.5 % (n=22) pts had recommendations for further
tissue and the degree of reduction in BMD are determined OP evaluation or treatment.
Osteoporos Int

Conclusion: Although most often cause of hip fractures is betic patients. Also the data confirmed bone loss manifesta-
low BMD, especially in elderly, OP risk factors not always are tion in type 2 DM postmenopausal women both at spine and at
recognized in Latvia and, as a result, there are future fractures, femoral neck.
chronic pain and disability.

P287
P286 LIFESTYLE INFLUENCE AND INCIDENCE OF
EXAMINATION OF BONE MINERAL DENSITYAND OSTEOPOROSIS IN THE SEASHORE AREA OF
FAT MASS IN TYPE 2 DIABETES MELLITUS ROMANIA
POSTMENOPAUSAL WOMEN E. Circo1
A. P. Shepelkevich1, V. Labashova1, O. Salko2, N. A. 1
Ovidius University, Constanta, Romania
Vasilieva2
1
Belarusian State Medical University, Minsk, Belarus, Objective: Evaluation of lifestyle and secondary factors and
2
Republican Centre for Medical Rehabilitation and involvements in osteoporosis incidence in postmenopausal
Balneotherapy, Minsk, Belarus women from an area of Romania with a high level of sunny
days by year.
Objective: The metabolic processes occurring in diabetic Material and Methods: The study included 984 postmeno-
postmenopausal women could produce deviations in tis- pausal women, hereupon was evaluated BMD by DXA and
sue distribution and affect the components of body appreciated the T- and Z-scores (by WHO criteria). In Sep-
composition. Several studies indicated that postmeno- tember it was evaluated the serum level of calcidiol (25-OH-
pausal diabetic women have a high risk of osteoporotic vitamin D). The patients answered to a questionnaire about
fractures. Nevertheless the data relating to BMD in this menopause, risk factors and lifestyle.
category of patients are rather contradictable. The cen- Results: Medium age was 61.5± 8.2 years. 503 women
tral distribution of body fat as a predictor of cardiovas- (48.7 %) were diagnosed with osteoporosis (T-score>−2.5),
cular diseases is important for clinicians to accurately 414 with generalized osteoporosis (82 %) and 89 with seg-
measure. The aim of the study was to assess BMD and mentary osteoporosis (18 %). 491 patients (38 %) were with
features of fat mass distribution in women with type 2 osteopenia (T- score between −1/−2.5) and 38 women without
DM in comparison with nondiabetic women of similar osteoporosis (BMD normal). The age of menopause onset was
age and BMI. 44.1±1.8 years at women with osteoporosis, 47.3±1.4 years
Material and Methods: We examined 205 women with type at osteopenia and 49.4±1.4 years at women without osteopo-
2 DM (mean age: 58.32±7.32 year, the duration of DM: rosis. The sun exposure was 25±4.1 days in women with
11.03±5.34 year, age of manifestation: 48.63±8.97 year, osteoporosis and 29±9.6 day in women with osteopenia.
BMI: 32.34 ± 5.16, HbA1c: 9.2± 1.7 %) and 68 age-, 102 patients (20.2 %) with osteoporosis taken calcium and
BMI- matched controls. The investigation involved an- vitamin D and 46 (4.5 %) had secondary causes of
thropometry of patients (height, weight, BMI, waist osteoporosis. The results of questionnaire denoted that
circumference), general clinic examination and DXA only 97 patients (9.7 %) of women with osteoporosis
(including BMD measuring at femoral neck and lumbar and osteopenia had physical activity after menopause,
spine and body composition program). 353 patients (35.5 %) made periodical investigations
Results: BMD (g/cm2) was statistically lower in diabetic and 143 patients had fractures.
patients both at spine (1.01±0.16 vs. 1.13±0.15, p<0.05) Conclusion: The incidence of osteoporosis and
and at femoral neck (0.81±0.164 vs. 0.92±0.153, p<0.05) osteopenia is higher and underestimated, probably, at
in comparison with controls. Fat mass distribution parameters women from seaside area of Romania. The age of
in type 2 DM patients and controls were: Total Body: 38.67± menopause onset is under the medium value from wom-
7.31 % vs. 37.24±6.73 % (p=0.24); Android: 45.06±7.56 % en of European Community. There is a negative corre-
vs. 44.23±8.34 % (p=0.005); Gynoid 39.60±8.04 % vs. lation between Z-score and years from beginning of
40.68±7.54 % (p=0.201); Trunk/Total: 0.57±0.05 vs. 0.51± menopause. The serum level of calcidiol (25-OH-vita-
0.07 (p<0.001);(Arms+Legs)/Total: 0.67±0.18 vs. 0.87±0.28 min D) was slightly elevated although the number of
(p<0.001). sunny days was around 50 % per year. Periodical med-
Conclusion: The results of study revealed the prevalence of ical investigations, medical access information and level
central (android) distribution of body fat among postmeno- of education were superior to women without
pausal women with type 2 DM in comparison with nondia- menopause.
 Osteoporos Int

P288 Objective: To determine the efficacy of hyaluronic acid (HA)

OSTEOPOROSIS IN PATIENTS WITH TOTAL HIP injections Ostenil Tendon concerning pain, functional activity
ARTHROPLASTY of the shoulder and tendon recovery in patients with partial
V. M. Ciortea1, I. M. Borda1, L. Irsay1, R. Ungur1, I. Onac1 thickness tears (PTT) of the supraspinatus tendon (SSP). The
1
Department of Medical Rehabilitation, UMF Iuliu- accuracy of ultrasonography (US) for diagnosis of PTT of the
Hatieganu, Cluj-Napoca, Romania rotator cuff, benefit of performance of US-guided procedures
and monitoring of therapy have been proved.
Objective: The objective of the study is to evidence the role of Material and Methods: 23 patients with painful shoulder and
BMD in the rehabilitation of patients with total hip sonographic proved PTT of the SSP were included. A pain diary
arthroplasty. with a ten point VAS, Shoulder Function Assessment (SFA)
Material and Methods: The study, a representative sample scale (0–70) and questionnaires of the efficacy according to the
analysis, was carried out at the Department of Medical Reha- patient and the physician were evaluated. US examination was
bilitation of the “Iuliu Haţieganu” UMPh Cluj- Napoca, in the provided by Mindray M5 scanner with multifrequency linear
period June–December 2009. The study inclusion criteria transducer (7.5–10 MHz). Ostenil Tendon 40 mg/2.0 ml was
were met by a number of 58 patients aged between 30 and injected around the affected tendon once a week for a total of two
83 years with uni- and bilateral cemented and uncemented injections. All applications were performed under US control.
total hip endoprostheses. A standard study protocol was elab- Results: Pain was significantly reduced after the first injection
orated, which included the measurement of BMD in the spine and this effect was maintained until the end of the observa-
and both hips, using DXA, with the Lunar Prodigy Advance tional period. SFA Index was significantly improved. 76 % of
osteodensitometer, the software for orthopedic prostheses be- patients gave a very good and good assessment of the efficacy,
ing available. The device used en. Core 11.X programs and which coincided with the opinion of the physician. 77 % of
computers with the Windows XP Professional operating sys- patients had a complete recovery or improved structure of the
tem, allowing to determine bone mineral content BMC SSP which was US demonstrated.
(grams) and BMD (g/cm2) in seven different areas around Conclusion: HA Ostenil Tendon led to a relatively rapid and
the endoprosthesis, known as the Gruen zones. The sustained relief of pain and increased functional activity of the
patients were clinically evaluated using two scales: the shoulder. US proved repair process of the tendon structure and
Oxford Hip Score and Qualeffo-41. Statistical calcula- gliding of the SSP as a result of lubricating and viscoelastic
tions were performed using the SPSS13.0 and Microsoft properties of the HA. No adverse events were observed. Injec-
Excel applications. tions under US control were accepted favorable by the patients.
Results: The two scores were significantly correlated
(p < 0.005) with the diagnosis made based on DXA
examination and with the type of hip endoprosthesis P290
(cemented or uncemented); they were higher in the case PROXIMAL FEMUR FRACTURE PATIENTS
of low BMD (osteopenia/osteoporosis) and cemented FEATURES IN A FLS IN BRAZIL
endoprostheses. B. Stolnicki1
1
Conclusion: Low periprosthetic BMD values delay the reha- Prevrefrat Hospital Federal de Ipanema Creb, Rio de Janeiro,
bilitation of patients with total hip endoprostheses. The lower Brazil
the BMD levels in the entire skeleton, the less favorable the
postoperative evolution, which also limited the quality of life Objective: To describe the features of patients who have had
of these patients. proximal femur fractures (PFF) in Prevrefrat–a FLS in Rio
References: Lou XF et al. Zheijang Univ Sci B 2007;8:76. de Janeiro, Brazil.
Material and Methods: 63 patients with minimal trauma PFF
have been followed from February 2011 to November 20013.
P289 The patients features, fractures, risk factors, associated dis-
HYALURONIC ACID “OSTENILTENDON” IN eases, BMD values, seric vitamin D levels, and incidence of
PARTIALTHICKNESS TEARS OF THE new fractures are reported.
SUPRASPINATUS TENDON: CLINICAL AND Results: 57 women and 6 men, from 51 to 95 years old had a
SONOGRAPHIC ASSESSMENT minimal trauma PFF. The main fracture was transtrochanteric
R. Nestorova1, R. Rashkov2, T. Petranova2, Z. I. Kolarov2, I. (30), femoral neck (29) and subtrochanteric (4). 3 women had
Sheytanov2, R. Stoilov2, S. Monov2, Z. Stefanov3 bilateral fractures. 18 patients had only the PFF. 23 had one
1
Centre of Rheumatology, Sofia, Bulgaria, 2Clinic of more fracture and 22 had two or more fractures. 38 patients
Rheumatology, Medical University, Sofia, Bulgaria, had prior vertebral fracture. After DXA scan 49 were classi-
3
Sports Academy, Sofia, Bulgaria fied as osteoporosis and 14 as osteopenia. 44 patients had
Osteoporos Int

vitamin D insufficiency or deficiency, 30 had arterial hyper- Results: Any change in the shape, size, outline or structure of
tension and 6 had diabetes. 45 prior fragility fractures, 19 early a vertebral body should be interpreted in a clinical context.
menopause and 11 with parent fractured hip were the more The majority of osteoporotic fractures are located in the tho-
frequent fracture risk factors. All patients received calcium racic or thoracolumbar region; an osteoporotic fracture above
and vitamin D supplementation. Sixty-two patients received T7 is unusual and the suspicion of malignancy should be
zoledronic acid 5 mg and 1 patient with stage 4 kidney disease eliminated.
received denosumab 60 mg. 3 patients had flu-like symptoms. Conclusion: After 2 weeks of treatment (strontium ranelate
All patients had 100 % of treatment adherence. No new 2 g/day and vitamin D3), we obtained am important improve-
fractures occurred. In all patients, there was no decrease in ment of symptomatology, and 4 weeks after the initiation of
height. treatment, the patient resumed most of her daily activities.
Conclusion: In most cases the patients with minimal trauma
proximal femur fracture had a previous fragility fracture. In
such a group of patients with high risk of new fractures (1), we
prefer not to use oral drugs due to historical poor adherence P292
(2). No new fractures occurred using zoledronic acid and ALVEOLAR BONE LOSS AND BONE METABOLISM
denosumab. IN PREMENOPAUSALWOMEN
References: 1. Johnell O et al. Osteoporos Int 2004;15:175. I. Mazur1, V. Gabal1
1
2. Landfeldt E et al. Osteoporos Int 2012;23:433 Department of Stomatology Institute of Stomatology Shupyk
Disclosures: Speaker: GSK, Sanofi Aventis, Servier, Novartis National Medical Academy of Postgraduate Education, Kiev,
Advisory board: Servier, Novartis Ukraine

Objective: Premenopause period is characterized by a signif-

icant reduction in secretion of estrogen in a woman’s body,
P291 which leads to the disturbance of bone metabolism. The aim
CASE REPORT: OSTEOPOROTIC VERTEBRAL of this study was to investigate the features of periodontal
FRACTURE tissue statement, alveolar process and bone metabolism in
V. M. Ciortea1, M. Nechita1, R. Ungur1, L. Irsay1, I. Onac1, premenopausal women.
I. M. Borda1 Material and Methods: The 94 patients were selected on two
1
Department of Medical Rehabilitation, UMF Iuliu groups: main group (54 women 40–49 years old, mean age
Hatieganu, Cluj-Napoca, Romania 46.7±2.3 years) in premenopause, control group (40 patients
20–39 years old, mean age 31.4±3.4 years). Clinical and
Objective: Osteoporosis is the most frequent metabolic bone radiographic (panoramic X-Ray) conditions of periodontal
disease characterized by: reduction of bone mass, alteration of statement were evaluated. Metabolic processes of bone tissue
bone architecture, deterioration of the quality of bone, and were evaluated by the serum levels of calcium related hor-
increase of the risk of fracture. The frequency of osteoporotic mones (calcitonin PTH) and biochemical marker of bone
vertebral fractures reported by the literature varies between 33 remodeling such as deoxypyridinoline (DPD) in urine.
and 85 %; of these, 25–33 % have a clinical manifestation Results: In premenopausal period the rate of alveolar bone
when they occur. The case report brings into discussion the loss in premenopausal women group 2.53±0.3 mm was sta-
case of a patient in whom vertebral fracture was the first tistically significantly (p<0.05) higher compared with the
clinical manifestation of osteoporosis. control of 1.09±0.4 mm. Increased secretion of PTH in wom-
Material and Methods: Patient LP, aged 57 years, presented en in premenopause period is 45.49±2.12 compared with
to our service in April 2013 for marked pain in the control of 38.33±1.92. Inhibition of secretion of calcitonin
dorsolumbar spine, with onset 3 weeks before, causing her 1.02±0.43 compared to control 3.2±0.34. Unbalanced of
immobilization in bed. Of the patient’s personal history and remodeling processes reinforcing the resorption process
life conditions, we mention the onset of menopause at the age deoxypyridinoline 8.62±0.43 nmol was statistically signifi-
of 39 years, and smoking for approximately 25 years, 20 cantly (p<0.01) higher compared with 6.36±0.41 nmol. Inhi-
cigarettes/day. The objective examination of the patient at bition of the bone formation 18.96±1.54 mmol/l was statisti-
the time of presentation: BMI=23 kg/m2, spontaneous pain cally significantly (p<0.05) higher compared to control 2.01±
on the percussion and mobilization of the dorsolumbar spine, 2.21 mmol/l..
without dural or neurological signs. Dorsolumbar spine X-ray, Conclusion: Homeostasis violation of calcium related hor-
vertebral CT and the measurement of BMD using the method mone reduced secretion of calcitonin and increased parathy-
of DXA allowed to make a positive diagnosis and to initiate roid hormone, misbalanced of the bone tissue remodeling
adequate antiosteoporotic treatment. processes, accelerated the rate of resorption and oppression
 Osteoporos Int

bone forming are a risk factor for resorption of alveolar bone References: 1 Lim S et al Lancet 2012; 2 Johnell O et al J
and reduce the height of it. Bone Miner Res 2005.

P293
WORLDWIDE QUANTITATIVE IMPACT OF BONE P294
MINERAL DENSITY ON HIP FRACTURE VITAMIN D AND PATIENTS WITH PRIMARY
INCIDENCE HYPERPARATHYROIDISM (PHPT): HOSPITAL
L. Sanchez-Riera1, R. Norman2, L. Veerman2, T. Vos3, N. BASED STUDY IN LATVIA
Wilson1, D. Hoy2, E. Smith1, L. March1 G. Avotina1, I. Rasa2
1 1
Institute of Bone and Joint Research, Royal North Shore Riga East Clinical University Hospital, University of Latvia,
Hospital, University of Sydney, Sydney, Australia, 2School Latvian Osteoporosis and Bone Metabolism Diseases Associ-
of Population Health, University of Queensland, Herston, ation, Riga, Latvia, 2Riga East Clinical University Hospital,
Australia, 3Institute for Health Metrics and Evaluation, Seat- Riga Stradins University, Latvian Osteoporosis and Bone
tle, United States Metabolism Diseases Association, Riga, Latvia

Objective: As part of the Global Burden of Diseases Study Objective: Vitamin D deficiency is more frequent con-
2010 the Musculoskeletal Expert Group analysed the world- dition in PHPT patients (pts) than in the general pop-
wide burden of low BMD as a risk factor for fractures using ulation. There is worsening of PHPT when vitamin D
Comparative Risk Assessment (CRA) methodology1. Esti- deficiency coexists. Vitamin D deficiency may worsen
mates on the influence of population BMD levels on the hip manifestations of PHPT by contributing more pro-
fracture incidence by world region are presented. nounced parathyroid gland proliferation. The aim of
Material and Methods: A systematic review was done this study was to analyze vitamin 25(OH)D3 level in
through MEDLINE, EMBASE, CINAHL, CAB abstract, PHPT pts in tertiary care multiprofile hospital in
WHOLIS, and SIGLE to search for population based studies Latvia.
with BMD at femoral neck (FNBMD) measured with DXA, Material and Methods: Hospital based case control ret-
which was analysed as a continuous variable. Age- and sex- rospective study analyzed medical records of pts admit-
specific values of FNBMD (mean and SD) in g/cm2 were ted to the hospital in 4.5 year period (01.01.2009–
extracted, standardized and pooled using a Bayesian meta- 30.06.2013). The statistical data were processed using
regression tool, DisMod-MR, for population aged 50 years SPSS 16.0. All the data were presented in the mean
and over. The CRA methodology was used to estimate the value with standard deviations. Normal range for calci-
proportion of fractures attributable to sub-optimal BMD, um was defined 2.1–2.6 mmol/L, for PTH - 12.0–
using the Potential Impact Fraction (PIF). The sex- and age- 72.0 pg/mL, for phosphorus - 0.8–1.6 mmol/L, for
specific 90th percentile FNBMD from NHANES III was used alkaline phosphatase - <117.0 U/L. Vitamin sufficient con-
as the theoretical minimum exposure risk distribution. From centration defined as >30.0 ng/ml, insufficiency as - 29.9–
the authors of a previous meta-analysis2 we obtained estimates 20.0 ng/ml and deficiency as <19.9 ng/ml.
of the gradient of risk of hip fracture (RR/SD) for BMD Z Results: There were 176 medical records of 140 pts,
scores based on the combined data for men and women, and 37 % of whom had their 25(OH)D3 assessed. Study
converted the RR/SD values into RR/0.1 g/cm2 values. The included 94.2 % females and 5.8 % males. Females
PIFs were estimated for 21 world regions for 1990, 2005 and were older than males, 62.4±12.1 and 56.7±3.8 year,
2010, and expressed on a 0–1 scale. Results for 2005 are respectively (p=0.09). Pts calcium level in the study
shown. population was 2.9±0.4 mmol/L, PTH level - 288.7±
Results: There were large differences across regions. 365.7 pg/mL, phosphorus level - 0.9±0.3 mmol/L, al-
Lowest PIFs were found in North Americans aged 80– kaline phosphatase - 88.6 ± 39.3 U/L. Pts vitamin
84 years both for males (0.412) and females (0.140), 25(OH)D3 level was 15.5±8.9 ng/mL, female - 15.4±
while highest PIFs were found in Sub-Saharan West 9.1 ng/mL, male - 17.7±7.4 ng/mL (p=0.64). For fe-
Africans aged 55–59 years for females (0.871) as well males aged up to menopause (n=5) vitamin 25(OH)D3
as males (0.859). In general PIFs decreased with age level was 3.7 ± 0.7 ng/mL, postmenopausal (n = 44) -
more in females than in males. 16.7±8.6 ng/mL (p=0.002). A higher level of vitamin
Conclusion: The potential impact of BMD on hip fracture D was in postmenopausal females, presumably it could
incidence varies widely among world regions. Influence of be explained by vitamin D supplementation.
BMD on fracture risk decreases with age, particularly in Conclusion: Vitamin 25(OH)D3 deficiency was found in all
women. pts with PHPT in all groups.
Osteoporos Int

P295 with Paget’s disease are asymptomatic. The diagnosis in such

EFFECTS OF PHYSICALTHERAPY IN THE patients is usually made incidentally following the routine
REHABILITATION OF PATIENTS WITH ARTHROSIS chemistry screen showing elevated serum concentration of
OF THE HIP alkaline phosphatase (AP) of bone origin or an imaging study
N. Mandic1, S. Kozomara2, T. Petrusic1, S. Petrovic1 obtained for other reasons that shows Pagetic changes in bone.
1
Dom Zdravlja Nis, Nis, Serbia, 2Institut Niska Banja, Nis, Bisphosphonates are the most widely used antiresorptive
Serbia agents for Paget’s disease and are now considered the first-
choice treatment.
Objective: To present the importance of physical therapy in Material and Methods: Case report: A 65-year old woman
the rehabilitation of patients with arthrosis of the hip. with primary osteoporosis.
Coxarthrosis is one of the most common degenerative rheu- Results: Raloxifene was started in 2003. The treatment failed,
matic diseases of the peripheral joints. It is characterized by as new OP fractures of the vertebras TH 8, TH 11 and L4 were
chronic pain and limited mobility and they are major socio- confirmed in 2008. Raloxifene was stopped and risedronate
medical problem. Arthritis is more common after the age of 40 introduced. New vertebral fractures were confirmed in 2010
and more frequently in women. (TH 1 and TH 5). Teriparatide was suggested, but the patient
Material and Methods: In the period January–October disagreed, so strontium ranelate was started. In 2011, patient
2013 in DZ Nis treated 80 patients, 52 women and 28 decided to take teriparatide, and it was first introduced in
men, mean age 58 years, with a treatment duration of November 2011. From 2003 to 2011, no signs of secondary
14 days. Coxarthrosis was diagnosed history, clinical causes of bone disease were confirmed. At the first follow up
and radiographic findings. In the first group (40 pa- visit in May 2012, elevated AP was first noticed, and this was
tients) applied the IMP, IFS and kinetic therapy, while confirmed 1 month later. The comprehensive diagnostic pro-
the other (40 patients), IFS and kinetic therapy. Assess- cedures were performed. With all tests done we confirmed the
ment of treatment was performed on the basis of mea- elevation of bAP and enhanced radionuclide uptake to the
surements of the volume turns into the hip, gross motor skull and the right distal femur. Subsequently performed plain
strength (GMS) pelvifemoral muscles and the subjective radiography suggested the osteolytic lesions of the skull.
experience of pain (VAS). Teriparatide was discontinued and zolendronic acid (ZA) ini-
Results: In all patients there was an improvement, but the tiated. After one course of the ZA treatment AP normalised
range of motion in a statistically significant only in the first and the lesions on bone scintigraphy and bone radiography
group. Abduction with 20° increased to 35° of flexion with disappeared.
stretched knee to 50° to 70°. The measurement of the exten- Conclusion: Teriparatide treatment is able to unmask the
sion is no statistical significance. GMS muscle actuator of the underlying Paget’s disease. Regular determinations of AP
hip, in the first group increased with 2+ to 3+. When it comes are mandatory during the entire course of teriparatide
to pain according to the VAS scale improvement was present treatment.
in both groups, but the statistical significance of first group
(p<0.05).
Conclusion: Physical therapy consisting of IMP, IFS and P297
kinetic therapy, increases the range of motion of the affected TEN YEARS OF HIP FRACTURES IN ITALY: FOR
the hip, strengthens muscle strength, reduces pain and pro- THE FIRST TIME A DECREASING TREND IN
vides the functionality of the diseased hip and disposed of ELDERLY WOMEN
orthopedic treatment. P. Piscitelli1, A. Distante1, M. L. Brandi2, G. Iolascon3,
S. Parri2, F. M. Liuni1, G. Quarta1, C. Neglia1, E. Gasbarra4,
M. Celi4, C. Rao4, M. Feola4, U. Tarantino4
1
P296 Euro Mediterranean Scientific Biomedical Institute - ISBEM
UNMASKING OF PAGET’S DISEASE AFTER THE Research Centre, Brindisi, Italy, 2Department of Translational
INTRODUCTION OF TERIPARATIDE TREATMENT Medicine, University of Florence, Florence, Italy, 3Depart-
A. Zavratnik1, M. Krajnc1 ment of Orthopaedics and Rehabilitative Medicine, Second
1
Division of Endocrinology and Diabetology, University University of Naples (SUN), Naples, Italy, 4Division of
Medical Centre Maribor, Maribor, Slovenia Orthopaedics and Traumatology, University of Tor
Vergata, Rome, Italy
Objective: Paget’s disease is the focal disorder of bone me-
tabolism characterized by accelerated rate of bone remodeling, Objective: We aimed to evaluate hospitalization rate of fem-
resulting in overgrowth of bone at single or multiple sites and oral neck fractures in the elderly Italian population over
impaired integrity of affected bone. The majority of patients 10 years.
 Osteoporos Int

Material and Methods: We analyzed national hospitaliza- Results: The presence of the mutant allele VDR-FokI was
tions records collected at central level by Ministry of Health detected in 79 % of cases (in 41 % cases as heterozygotes and
from 2000 to 2009. Age- and sex-specific rates of fractures in 38 % as homozygotes). VDR- ApaI SNPs was found in
occurred at femoral neck in people ≥65 years old. We 77 % of cases (in 50 % cases as heterozygotes and in 27 % as
performed a subanalysis over a 3-year period (2007– homozygotes). There was a significant prevalence of low bone
2009), presenting data per 5-year age groups, in order mass among carriers individuals with VDR-FokI SNPs
to evaluate the incidence of the hip fracture in the (30.7 % vs. 14.2 %, p<0.001) and individuals with VDR-
oldest population. Apal SNPs (31.37 % vs. 26.6 %, p<0.001).
Results: We estimated a total of 839,008 hospitalizations due Conclusion: The results of the study reflect the high frequen-
to femoral neck fractures between 2000 and 2009 in people cy of VDR (FokI, ApaI) SNPs and a significant decrease in
≥65, with an overall increase of 29.8 % over 10 years. The bone density in these individuals. VDR gene polymorphisms
incidence per 10,000 inhabitants remarkably increased in seem to play a major role in influencing on bone loss in T1D.
people ≥75, passing from 158.5 to 166.8 (+5.2 %) and from
72.6 to 77.5 (+6.8 %) over the 10-year period in women and
men, respectively. The oldest age group (people >85 years
old) accounted for more than 42 % of total hospital admissions P299
in 2009 (n=39,000), despite representing only 2.5 % of the TOTAL BODY BONE DENSITYAND FAT/LEAN MASS
Italian population. Particularly, women aged >85 accounted DISTRIBUTION IN TYPE 1 DIABETIC PATIENTS
for 30.8 % of total fractures, although they represented just A. P. Shepelkevich1, Y. Dydyshko1, N. A. Vasilieva2
1
1.8 % of the general population. The results of this analysis Department of Endocrinology, Belarusian State Medical
indicate that the incidence of hip fractures progressively in- University, Minsk, Belarus, 2Republic Center of Medical
creased from 2000 to 2009, but a reduction can be observed Rehabilitation, Minsk, Belarus
for the first time in women ≤75 (−7.9 % between 2004 and
2009). Objective: There is epidemiological evidence that reduced
Conclusion: Incidence of hip fractures in Italy are continu- amount and a decline in the quality of muscle mass associated
ously increasing, although women aged 65–74 years old with an increased risk of fracture. The aim of the study was the
started showing a decreasing trend. examination of total body bone density (TBBD) and the
components of body composition in type 1 diabetes mellitus
(DM) patients.
P298 Material and Methods: We studied 66 type 1 DM patients
EVALUATION OF THE ROLE OF VITAMIN D (28 men and 38 women; mean age 31.23±8.41; duration of
RECEPTOR (VDR) GENE POLYMORPHISMS IN the disease 13.40±7.41; НвА1с 8.25±0.95 %). The research
TYPE 1-ASSOCIATED BONE DISORDER involved anthropometry of patients, general clinic examina-
Y. Dydyshko1, A. P. Shepelkevich1, V. Zhukouskaya2 tion, glycated hemoglobin test, DXA performed on “Prodigy
1
Department of Endocrinology, Belarusian State Medical Lunar” using a program “total body” and “body
University, Minsk, Belarus, 2Department of Clinical Science composition”.
and Community Health, Milan, Italy Results: TBBD (g/cm2) (1.156 ± 0.10 vs. 1.194 ± 0.084,
p < 0.01) and total Z-score (−0.15 ± 0.94 vs. 0.72 ± 0.63,
Objective: Low BMD and fracture risk are associated with p<0.001) was statistically lower in diabetic patients in com-
type 1 diabetes (T1D). Vitamin D receptor (VDR) polymor- parison with controls. Fat mass distribution parameters in type
phisms have been suggested to be associated with the diabetic 1 DM patients and controls were: Total Body: 29.63±12.80 %
complications. Therefore, the aim of study was to assess the vs. 30.01±9.68 % (p=0.32); Android: 29.68±12.14 % vs.
association between VDR single nucleotide polymorphisms 29.90 ± 12.7 % (p = 0.50); Gynoid 36.50 ± 13.34 % vs.
(SNPs) in type 1 diabetic patients and low BMD. 36.98 ± 10.88 % (p = 0.09); A/G Ratio: 0.80 ± 0.29 vs.
Material and Methods: We studied 66 T1D patients (28 men 0.87±0.28 (p=0.022); Trunk/Total: 0.46±0.87 vs. 0.48±
and 38 women; mean age 31.23±841; duration of the disease 0.08 (p=0.68); (Arms+Legs)/Trunk: 1.078±0.15 vs. 1.26±
13.40±7.41; НвА1с 8.25±0.95 %). BMD was measured by 0.18 (p = 0.009); Total Body Lean mass: (49963.42 ±
DXA. QIAamp DNA Blood Mini Kit (Qiagen, USA) was 2849.845 g vs. 44057.80±9932.179 g, p<0.001).
used to purify DNA from whole blood, gene polymorphisms Conclusion: The data confirmed low total body bone density
were detected in PCR-RFLP (restriction fragment length poly- in type 1 DM patients. There are changes in total body fat
morphism) analysis. The following restriction enzymes were mass and lean mass among patients with type 1 DM. Thus
used to determine the appropriate polymorphism: VDR-FOKI mechanisms responsible for the formation of healthy bones
- FokI (BseGI), VDR-ApaI - ApaI. require further research.
Osteoporos Int

P300 activity, functional status and spine mobility in patients with

ORAL HEALTH ATTITUDES AND PRACTICES ankylosing spondylitis (AS).
AMONGST PATIENTS WITH OSTEOPOROSIS IN Material and Methods: Our study included 62 patients (49
UNITED KINGDOM males, 9 females), mean age 39.3 ± 11.7 years, with
S. Gupta1, A. Gupta2 diagnosis of AS (modified New York criteria). Mean
1
Dental Sciences, Cardiff, United Kingdom, 2Glangwili age at disease onset was 25.5 ± 8.7 years and mean
Hospital, Carmarthen, United Kingdom disease duration was 13.9 ± 8.2. BMD was measured
using DXA on the hip and the lumbar spine. Low
Objective: Many patients with osteoporosis are elderly and BMD was defined as T-score≤−1 including osteopenia
oral health is an important aspect of patient care especially in and osteoporosis. Clinical (Bath AS Functional Index-
patients on bisphosphonates. Our aim was to determine oral BASFI, Bath AS Disease Activity Index-BASDAI, Bath
health attitudes and practices in patients with osteoporosis AS Metrology index-BASMI) and laboratory data
receiving bisphosphonates. (erythrocyte sedimentation rate-ESR and C reactive
Material and Methods: A questionnaire study was conduct- protein-CRP) were collected. The data of risk factors
ed after informed consent on cognitively intact patients diag- for osteoporosis were also collected (use of corticosteroids,
nosed with osteoporosis who were attending hospital osteo- disease modifying anti-inflammatory drugs (DMARD),
porosis clinic and received bisphosphonate treatments. nonsteroidal anti-inflammatory drugs (NSAID), smoking,
Results: 200 patients age range 50–95 years (average BMI).
70 years) 75 % female. Patients receiving treatments were Results: Osteoporosis on the hip and the lumbar spine was
alendronate (80 %), risedronate (10 %), ibandronate (4 %), found in 14.5 % and 3.2 % patients, respectively, while
zoledronate (6 %). One hundred percent considered care of osteopenia was found in 45.2 % patients on the hip and
teeth is important. Ninety-two percent considered cleaning of 24.2 % patients on the lumbar spine. There was significant
teeth daily is important. Twenty percent considered they do inverse correlation between hip BMD and age at disease onset
not need regular specialist dental care. Ninety percent thought (p=0.032), BASFI (p=0.017) and BASMI (p=0.001), while
tooth loss is normal consequence of ageing. Ninety percent lumbar spine BMD was in inverse correlation only with ESR
considered tooth loss has an association with osteoporosis. (p=0.045). Patients treated with corticosteroids had signifi-
Thirty-two percent felt access to dental services was a barrier cantly more often osteoporosis (p=0.003). No significant
towards improving oral health. Twenty percent used dentures. correlation between BMD and smoking, use of NSAID,
Sixty-five percent had visited dentist in last 1 year. Fifty DMARD, disease duration, BASDAI, CRP and BMI was
percent regularly visit dentist twice a year. Ten percent were found.
not registered with a dentist. Fifty-nine percent clean their Conclusion: In patients with AS low BMD is found more
teeth twice daily. Eighty percent had informed their dentist frequently on the hip and is associated with corticosteroid use.
about osteoporosis medications. Ten percent were aware of No relation with other risk factors for osteoporosis was found.
rare side effect of jaw osteonecrosis. Decreased BMD was associated with decreased functional
Conclusion: This large study shows that most elderly have ability (measured by BASFI) and back mobility (measured
favourable attitudes towards improving their oral health. But by BASMI).
there are gaps in patients knowledge and there is suboptimal
dental access, behaviour and practice amongst a large number
of patients. Further education and improved provision of P302
facilities for dental care is needed. INFLUENCE OF DISEASE ACTIVITY ON PAIN
INTENSITY, FATIGUE AND GENERAL HEALTH
J. Jovanovic1, V. Jovanovic2, M. Stojanovic3, S. Bozilov1,
M. Karadzic1, V. Skakic1
1
P301 Institute for Treatment and Rehabilitation Niska Banja, Nis,
FACTORS ASSOCIATED WITH LOW BONE Serbia, 2Clinic for Orthopedics, Clinical Centre Nis, Nis,
MINERAL DENSITY IN PATIENTS WITH Serbia, 3Faculty of Medicine, Nis, Nis, Serbia
ANKYLOSING SPONDYLITIS
B. Stojic1, I. Jeremic1, S. Janjic1, V. G. Bajec1, N. Djurovic1 Objective: To estimate the influence of disease activity on
1
Institute of Rheumatology, Belgrade, Serbia pain intensity, fatigue and general health in patients with
rheumatoid arthritis.
Objective: To assess the prevalence of low BMD and associ- Material and Methods: The study included 95 patients with
ation between BMD on the hip and the lumbar spine and RA, according to ACR/EULAR criteria, 2010. There were 76
osteoporosis risk factors as well as parameters of disease women and 19 men. The average age was 58.8 years, and the
 Osteoporos Int

average duration of the disease was 10.4 years. Disease activ- for 24 months (second step). At the end of the second step of
ity was measured by an index DAS28SE. Pain, fatigue, and the study, lumbar and femoral BMD were evaluated again.
general health represented by VAS. In relation to disease Results: After 24 months, T-score slightly increased from
activity, patients were divided into three groups: Group I baseline at femoral level (p=0.07, Wilcoxon test) and signif-
DAS28SE <3.1- low disease activity; group II DAS28SE icantly increased at the lumbar spine level (p < 0.001,
3.2–5.1 - moderate disease activity and group III DAS28SE Wilcoxon test). Osteocalcin values displayed a 4.3-fold in-
>5.1 - high disease activity. For statistical analysis of the data crease (ANOVA, p<0.001), from baseline at month 6, and a
we used the analysis of variance (ANOVA), t-test. 5.4, 4.1 and 3.7, at 12, 18 and 24 months, respectively
Results: The patients with high disease activity-Group III had (Bonferroni, p<0.001). β-CTX levels showed a 2.5-fold in-
significantly worse values of pain intensity estimated by VAS crease from baseline at month 6 and a 2.6, 2, 1 and 1.8 at 12,
scale 65.28±12:43 compared to patients with moderate disease 18 and 24 months, respectively (p<0.001). At the end of the
activity Group II 39.2±18.54, p<0.001 and compared to pa- second step of the study, T-scores showed a further significant
tients with low disease activity 8.68±6.05 Group I, p<0.001. increase, only in the group of patients treated with ibandronate
The patients with high disease activity-Group III had signifi- (p<0.05), ranelate (p<0.05), and risedronate (p<0.05). Anal-
cantly worse values of fatigue estimated VAS scale 66.18± ysis of variance showed a significant difference (p=0.008)
15.62 compared to patients with moderate disease activity between risedronate and placebo.
41.56±19.32 Group II, p<0.001 and compared to patients with Conclusion: Our data confirm the efficacy of teriparatide and
low disease activity 12.68±6.52 Group I, p<0.001. The pa- suggest that in severe osteoporosis the treatment of choice should
tients with high disease activity-Group III had significantly include a first 24 month-step with teriparatide, followed by the
worse values of general health estimated by VAS scale 32.24 addition of antiresorptive drugs or strontium ranelate therapy.
±13.22 compared to patients with moderate disease activity
51.86±14.82 Group II, p<0.001 and in compared to patients
with low disease activity 82.10±7.32 Group I, p<0.001. P304
Conclusion: The high disease activity causes higher pain NATIONWIDE COMMUNITY OSTEOPOROSIS
intensity, pronounced fatigue and poor general health in pa- EDUCATION AND SCREENING PROGRAM IN
tients with RA. TAIWAN
R. S. Yang1, D. C. Chan 2 , K. H. Hsu 3 , C. Y. Yang 4 ,
J. F. Chen 5,11 , S. T. Tu6, C. H. Chen7, H. Y. Chiou8,
P303 L. C. Lim9, J. S. Hwang10
1
SEQUENTIALTHERAPY IN SEVERE Department of Orthopaedics, National Taiwan University
OSTEOPOROSIS Hospital, Taipei, Taiwan, Province of China, 2Department of
R. Pastore1, A. Bultrini1, P. Di Giacinto2, A. Cannuccia2, Geriatrics and Gerontology, National Taiwan University Hos-
S. Frontoni2 pital, Taipei, Taiwan, Province of China, 3Laboratory for
1
Ospedale S.Giovanni Calibita, Fatebenefratelli, Isola Epidemiology, Department of Health Care Management,
Tiberina, UOC Endocrinology, Rome, Italy, 2Dept. of Chang Gung University, Taoyuan County, Taiwan, Province
Systems Medicine University of Rome Tor Vergata, of China, 4Department of Public Health, College of Health
Rome, Italy Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan,
Province of China, 5Division of Endocrinology and Metabo-
Objective: Some evidence in literature suggests the utility of lism, Kaohsiung Chang Gung Memorial Hospital, Chang
the addition of antiresorptive drugs, such as bisphosphonates, Gung University, Kaohsiung, Taiwan, Province of China,
6
following teriparatide treatment, in severe osteoporosis. The Superintendent office, Lukang Christian Hospital,
aim of the present study was to evaluate the impact of the Changhwa, Taiwan, Province of China, 7Division of Sport
addition of 5 different treatments, following a 24-month ther- Medicine, Department of Orthopedic Surgery, Taipei Medical
apy with teriparatide, on osteoporosis progression. University Hospital, Taipei, Taiwan, Province of China,
8
Material and Methods: 81 women with severe postmeno- School of Public Health, Taipei Medical University, Taipei,
pausal osteoporosis, were treated for 24 months (first step) Taiwan, Province of China, 9Department of Gerontology and
with teriparatide and serum osteocalcin and ß-CTX and lum- Geriatrics, National Taiwan University Hospital, Taipei, Tai-
bar and femoral BMD changes, evaluated by DXA-BMD, wan, Province of China, 10Division of Endocrinology and
were monitored at 6, 12, 18 and 24 months. After 24 months, Metabolism, Chang Gung Memorial Hospital - Linkou Med-
60 of 81 patients were randomly allocated to receive one of the ical Center, Taoyuan, Taiwan, Province of China, 11Division
following treatments, on top of calcium (1 g/day) and vitamin of Endocrinology and Metabolism, Chang Gung Memorial
D (5,600 IU/week): Alendronate or risedronate weekly, Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan,
ibandronate monthly or strontium ranelate daily or placebo, Province of China
Osteoporos Int

Objective: To report the efforts of a large scale nationwide Objective: It has been demonstrated that hydrotherapy can
community osteoporosis education and screening program in activate the cutaneous circulation by reflexive vasodilatation
Taiwan. and has positive effects on immunoregulation. Even if there
Material and Methods: In 2013, the Wang Jhan-Yang are only a few RCTs or meta-analyses which investigate the
Public Trust Fund (WJYPTF) sponsored a program use of hydrotherapy for osteoarthritis of the hip we designed
with 4 sub-studies from the Taiwanese Osteoporosis this clinical study to find if the effects of alternate cold and
Association (TOA) to conduct series of osteoporosis warm thigh affusions on pain, range of motion and quality of
education and screening courses for the entire country. life are comparable with those of conventional physiotherapy.
Structured educations on osteoporosis and/or fall pre- Material and Methods: In this two-armed study we random-
ventions with brief nutrition assessments were provided ized 30 inpatients with osteoarthritis of the hip. In the first
to all participants. Osteoporosis awareness was group (HTT) 15 patients received hydrotherapy daily with
assessed in most studies. Participants were screened water applied in the form of alternate cold and warm thigh
with different instruments including FRAX®, Osteopo- affusions while patients in the second group (PT) received
rosis Self-Assessment Tool for Asians, One-Minute Os- physiotherapy. The primary outcome measure was intensity of
teoporosis Risk Test, Osteoporosis Self-Assessment pain in the affected hip on a ten-point VAS. The secondary
Tool, and calcaneus quantitative Ultrasounds. High risk outcomes included health related quality of life on Arthritis
individuals (definitions varied by studies) were referred Impact Measurement Scale (AIMS2) and patient mobility and
to hospitals for further osteoporosis and fall assessments and risk of falling through the timed “up and go” (TUG) test.
managements. Results: There was no significant difference between the two
Results: Overall, 74 courses were provided and 4,808 effec- groups at baseline for any of the clinical outcome measures.
tive questionnaires were collected. Mean age varied from 50 Pain intensity improved significantly from baseline to the end
to 70 years of age at different study sites but most participants of the treatment after only 2 weeks in both the hydrotherapy and
were women. Roughly 60–70 % were considered as high- physiotherapy groups (29 % vs. 25 %). At the final assessment,
risks in different studies. Successful referral rate was around the AIMS2 scores significantly declined from baseline in the
15–30 % in studies reported this indicator. Osteoporosis hydrotherapy group, but the change was not significantly dif-
knowledge and awareness were consistently low but ferent between groups (0.56 vs. 0.38). This study has shown
significantly improved after education course when post that both the HTT and PT programmes successfully improved
test data were available. Nutritional assessments showed physical function but the alternate affusions were found to be
that most participants did not have adequate intake of more effective in improving TUG test (−0.9 vs. −0.7 s).
calcium and dairy products. Participant satisfactions Conclusion: Both the hydrotherapy and conventional phys-
were high across studies. iotherapy interventions produce positive functional outcomes
Conclusion: Community education and screening cam- for patients with HOA, are cost effective and without side
paigns were highly appreciated and were able to im- effects.
proved osteoporosis awareness. However, wide varia-
tions existed among study protocols. Efforts should be
made to collect common variables for comparisons P306
across study sites. COMPARATIVE ANALYSIS OF ADHERENCE TO
Acknowledgements: The authors thank the WJYPTF for DIAGNOSING AND TREATMENT OF
sponsoring the study. The sponsor reviewed and approved OSTEOPOROSIS IN PATIENTS WITH LOW-ENERGY
the study protocol but did not interfere with study conduction, FRACTURES IN SAINT PETERSBURG, RUSSIA
data analysis or interpretation. The authors also thank the A. U. Kochish 1 , S. N. Ivanov 1 , E. V. Sannikova 1 ,
TOA for coordinating the study. V. N. Khrulev 1
1
Russian Research Institute of Traumatology and Orthopedics
R.R.Vreden, Saint Petersburg, Russian Federation
P305
A RANDOMIZED CONTROLLED TRIAL Objective: The objective of the research was both to study the
COMPARING HYDROTHERAPYAND adherence to diagnosing of osteoporosis in patients with low-
CONVENTIONAL PHYSIOTHERAPY TO PATIENTS energy fractures of extremities and vertebrae being able to
WITH HIP OSTEOARTHRITIS (HOA) move without assistance and to raise attention of orthopedic
S. Patru1, I. R. Marcu1, A. C. Bighea1, D. Caimac1, R. S. surgeons to prevention of secondary fractures in such patients.
Popescu1, D. Matei1 Material and Methods: The women and the men being able
1
University of Medicine and Pharmacy of Craiova, Craiova, to move without assistance who had turned to the outpatient
Romania trauma departments of the city for low- energy radius, ulna,
 Osteoporos Int

humerus or malleoli fractures as well as compression vertebral Results: In total 7,336 patients were identified, of which
fractures were included into the study. 513 patients were sent 6,614 were women. The prevalence of renal failure (stage 5)
to the Institute by the doctors of 4 trauma outpatient depart- amongst osteoporotic patients was 0.1 %, and the prevalence
ments from March of 2012 to May 2013. 184 of them of an eGFR<35 (‘not recommended for BIS’) was 3.6 %. The
(35.9 %) came to the Institute for the consultation. On the median time from diagnosis of osteoporosis to measurement
basis of personal history of fractures and results of DXA the of eGFR was 7.2 ±5.1 years. The mean age was 72.5±
osteoporosis was diagnosed in all 175 patients. More often we 10.3 years. The age increased significantly with decreasing
used either a combination of alendronic acid and vitamin D3. eGFR from 69.0±10.1 for stage 1 (normal) to 81.5±7.6 for
Results: Obtained results showed the high prevalence of stage 5 (failure) patients (p<0.001). Weight was significantly
osteoporosis in patients with low-energy fractures of men- higher for KDOQI 3 (moderate renal impairment, eGFR 30–
tioned above localizations in comparison with the study we 59) patients (p=0.021), while BMI similarly increased with
carried out formerly (2009–2010) in Petersburg using the decreasing eGFR (p<0.001). For comorbidities diabetes was
same design. We obtained practically the same results of significantly associated with decreased eGFR (p<0.001).
densitometric examination (in the former study the mean Conclusion: Based on eGFR<35, bisphosphonate treatment
value of T-score was −2.4 SD (σ=1.0) in L1-L4 vertebrae would not be recommended in 3.6 % of osteoporotic patients
and -1.6 SD (σ=0.95) in right femoral neck), slightly higher due to renal impairment.
incidence of visits to specialists of patients sent by the doctors Disclosures: This study was supported by an unrestricted
of outpatient departments (from 31.0 to 35.95 %) and more grant from Merck & Co. AD Jorgensen is an employee of
than three times higher attendance at densitometric examina- MSD Denmark. A Krishna is an employee of Merck & Co. P
tion (from 44.0 to 95.1 %). Vestergaard: Travel grants from Novartis, Amgen, Servier,
Conclusion: On the whole we can state that adherence of and Eli Lilly.
patients with low-energy fractures to diagnosing of osteopo-
rosis continues to be low in Saint Petersburg.
P308
IN VIVO QUANTIFICATION OF TRABECULAR
MICROARCHITECTURE IN THE LUMBAR
P307 VERTEBRAE OF HEALTHY VOLUNTEERS BY
DESCRIPTIVE STUDY OF RENAL IMPAIRMENT IN FINESA: A MAGNETIC RESONANCE TECHNIQUE
PATIENTS WITH OSTEOPOROSIS IN DENMARK A. Cox1, J. Rafferty1, R. P. Hugtenburg2
L. Hansen1, S. A. Eriksen1, A. Krishna2, A. D. Jorgensen3, 1
Acuitas Medical, Swansea, United Kingdom, 2College of
P. Vestergaard1 Medicine, Swansea University, Swansea, United Kingdom
1
Aalborg University, Aalborg, Denmark, 2Merck & Co.,
Whitehouse Station, United States, 3MSD Denmark, Ballerup, Objective: Osteoporotic fractures resulted in a higher number
Denmark of DALYs lost in Europe than all types (except lung) of cancer
in 2000. BMD by DXA is widely used to predict fracture risk
Objective: To estimate the prevalence of renal impairment for but cannot predict occurrence of fracture. Trabecular micro-
osteoporotic patients, and compare demographic characteris- structure can provide further information on fracture risk. TBS
tics for osteoporotic patients across level of renal impairment. uses DXA images to indirectly measure microstructure based
Material and Methods: This cohort study is based on on grey level variations which can have many causes. HR-
data from the Danish national health registries and pQCT and μMRI are restricted to peripheral sites by radiation
blood measurements of estimated Glomerular Filtration dose and SNR, respectively, but fragility fractures often occur
Rate (eGFR) from three of five Danish regions. Last at the hip and spine. We thus evaluated fineSA™, an MR
blood measurement of eGFR is used as index-date. The technique, to characterise microstructure in 1.5 min in the
inclusion criteria were: lumbar spine of healthy volunteers in vivo.
Material and Methods: fineSA was run on 13 females aged
& age ≥50 years 30–40 and 25 males aged 30–50 following ethics approval
& AND either diagnosed with osteoporosis from the South West Wales REC. Subjects were assumed to
& OR had a history of fracture have reached peak bone mass and not had significant bone
& OR a BMD t-score of lumbar spine or femoral neck <−2.5. loss based on health questionnaires. Data was acquired in the
medial/lateral direction in 2 regions of 5 lumbar vertebrae
Stages of renal impairment ranged from normal to failure using a Siemens 3T MRI scanner. Ten sets of fineSA data
(KDOQI 1–5) measured by eGFR and a separate category of per subject underwent linear discriminant analysis (LDA)
‘not recommended for BIS treatment’ (eGFR<35). using training data from a prior study of postmenopausal
Osteoporos Int

women. Specificity was calculated for the performance of participants in the statin new-users group and in 2,119 in the
LDA in classifying subjects as having normal microstructure. nonusers. Incident OA rates were 16.3 (95%CI, 15.6–17.1)
Results: Specificity values of 78–94 % for all vertebrae were per 1,000 person-years, in the statin users, and 18.1 (95%CI,
obtained when classifying fineSA data from the central region 17.3–18.8) per 1,000 person-years, in the statin nonusers. HR
of the vertebra using LDA. fineSA data from the anterior for symptomatic knee OA was 0.95 (95%CI:0.89–1.00) for
region of the vertebra showed slightly poorer specificity statin users. No significant interactions between age and sex
(60–91 %) after LDA. were identified.
Conclusion: LDA of fineSA data correctly identified subjects Conclusion: Statins were not associated with a reduction in
as having normal microstructure (specificity 60–94 %). incidence of clinical knee OA in members of the community
Higher specificity was observed for L1 and generally for the aged 40 years or older.
central region of the vertebra. This may be because LDA
training data was from the central region of the L1 vertebra
and the vertebral body is heterogeneous. P310
Disclosures: A. Cox, J. Rafferty are employed by, and R.P. MODERN ASPECTS OF TREATMENT OF
Hugtenburg has consulted for, Acuitas Medical who devel- OSTEOPOROSIS IN POSTMENOPAUSAL AGE IN
oped fineSA. DEVELOPING COUNTRIES
D. Iobashvili1
1
Venus Georgia, Tbilisi, Georgia
P309
STATIN USE AND ONSET OF SYMPTOMATIC KNEE Objective: Based on the study of the dynamics of indicators
OSTEOARTHRITIS: A POPULATION-BASED of quality of life, BMD, vertebrogenic pain and patients’
COHORT STUDY adherence to treatment develop and implement criteria for
D. Prieto-Alhambra1 evaluating clinically significant effect of drug therapy for
1
Nuffield Department of Orthopaedics, Rheumatology and postmenopausal osteoporosis. The problem of osteoporosis
Musculoskeletal Sciences. University of Oxford, Oxford, currently retains its relevance not only in relation to the
United Kingdom seriousness of the complications of this disease, fractures of
the spine and extremities but also because of the steady
Objective: To examine whether statin use is associated with a increase in the number of older people in modern society,
decreased incidence of OA in the community. and age based diseases.
Material and Methods: Data were obtained from the Sistema Material and Methods: Subject: history data, quality of life,
d’Informació pel Desenvolupament de la Recerca en Atenció the data of X-ray densitometry, the level of vertebral pain, test
Primària (SIDIAP) database, which contains anonymized lon- patients’ adherence to treatment, laboratory parameters of
gitudinal patient electronic medical records for a representa- bone metabolism. Object of study: 125 women aged 45–
tive 5 million people in Catalonia, Spain. Men and women 75 years, of which 103 women diagnosed with osteoporosis,
aged 40 years or older registered in SIDIAP from April/2006 including 69 women with osteoporosis postmenopausal aged
to December/2011 were eligible. Statin incident users 50–65 years and 22 women aged 50–65 years without osteo-
(exposure) were defined as participants with at least 6 previ- porosis, comparable social status and comorbidity with a
ous months without any statin dispensation, and with a med- group of postmenopausal osteoporosis.
ication possession ratio of >70 % over the first 6 months after Results: Evaluation of therapy with these instruments is jus-
statin therapy initiation. Incident knee OA cases (study out- tified in 3 months, 6 months and 12 months of treatment, but a
come) were identified using ICD-10 codes recorded in the decision on the correct treatment on the basis of assessment
study period. Propensity scores for statin use (as defined must be carried out after 6 months of treatment with
above) were derived using multivariable logistic regression alendronate (p<0.01) and 12 months of treatment with stron-
models including age, gender, co-morbidities, use of concom- tium ranelate (p<0.01). For clinically significant changes in
itant drugs, and socio-economic status. Statin non-users with QoL at CSI as duration of therapy with alendronate and
comparable characteristics were then matched to the identified strontium ranelate exceed 12 months (p<0.01).
statin users by propensity scores. Time varying conditional Conclusion: The results obtained allowed us to develop long-
Cox models were used to calculate hazard ratios (HR) for risk term monitoring scheme antiosteoporotic therapy and criteria
of incident knee OA according to statin use in the propensity- for evaluating its effectiveness; follow- up examinations with
matched population. the use of the proposed methods provide the opportunity to
Results: There were 26,139 individuals in each cohort: 51 % participate in the evaluation of patients and the treatment of its
were women, mean age 65 years, mean BMI: 29 kg/m2. objective status that will help them improve their adherence to
Median follow-up was 4.8 years. OA occurred in 1,862 treatment.
 Osteoporos Int

1
P311 Physical Medicine, Rheumatology and Rehabilitation De-
ASSOCIATION OF HUMAN MORPHOGENIC partment, Alexandria Faculty of Medicine, Alexandria, Egypt,
2
PROTEIN-4 (BMP 4) GENE POLYMORPHISM WITH Radiodiagnosis Department, Faculty of Medicine, University
CLINICAL INDICATORS OF OSTEOPOROSIS IN of Alexandria, Alexandria, Egypt
POSTMENOPAUSAL SLOVAK WOMEN
V. Krajcovicova1, J. Durisova1, D. Galbavy2, R. Omelka1 Objective: To assess correlation between functional evaluation,
1
Constantine the Philosopher University, Nitra, Slovakia, severity and ultrasonography findings in knee osteoarthritis.
2
Private Orthopedic Ambulance, Nitra, Slovakia Material and Methods: Thirty patients diagnosed with knee
osteoarthritis according to the ACR criteria. Control: 20
Objective: Bone morphogenic protein-4 (BMP4) is a multifunc- healthy age and sex matched individuals. Each patient was
tional growth factor belonging to the TGF-β super family which is subjected to: demographic data collection, clinical examina-
known to play an important role in the determination of osteoblast tion, laboratory investigations, ultrasonographic assessment
phenotype and bone turnover. The aim of the present study was to (concerning: sonographic effusion, cartilage erosion, joint
examine possible associations of T538C (V147A) polymorphism space narrowing, synovitis and osteophytes).
in the BMP4 gene with a variability of femoral, spinal BMD, Results: Subclinical sonographic effusion and synovial thicken-
along with circulating alkaline phosphatase, osteocalcin (formation ing were detected in most of the studied patients. Articular
markers), β- crosslaps (CTx; resorption marker) and fracture cartilage erosions and joint space narrowing were also detected
incidence in 161 Slovak postmenopausal women. by ultrasound. Statistically significant correlation was detected
Material and Methods: Postmenopausal women (63.70± between clinical and ultrasound indices regarding; joint effusion,
0.53 years) were selected according to strict inclusion criteria. synovial thickening, articular cartilage erosion and joint space
Genetic polymorphism was detected by PCR-RFLP method. narrowing. This has been proven in other studies as well. On
Genotype frequencies and frequencies of fractures were tested correlating OARSI-OMERACT Initiative New OA Pain Mea-
using the chi-square test. The differences of quantitative var- sure with clinical and ultrasonographic findings, there was a
iables between the genotypes were analyzed by covariance statistically significant correlation between constant pain score
analysis (GLM procedure) after correction of the measure- and US narrowing, synovitis, clinical effusion and ROM limita-
ments for age and BMI. tion. Statistically there was significant difference between con-
Results: The prevalence of each genotype was 24.22 %, stant pain score and clinical tenderness and clinical effusion.
52.18 % and 23.6 % for CC, TC, and TT genotypes, respec- Conclusion: 1. Musculoskeletal ultrasonography is superior
tively. We reported a statistically significant effect of BMP4 over conventional radiograph in assessing soft tissue and
genotypes on ALP concentrations (P<0.05). Homozygous cartilaginous changes accompanying knee osteoarthritis.
genotype CC was significantly associated with decreased 2. Musculoskeletal ultrasonography is sensitive in detection of
ALP values compared to other genotypes. Similarly, femoral subtle joint effusion and synovial thickening,
(P=0.081) and spinal BMD (P=0.057) values were decreased 3. Sonographic imaging assessment of patients with OA could be
in subjects with CC genotype, which could indicate increased of relevant, practical value, because clinical and conventional
bone resorption rate in this group. Biochemical markers as radiologic findings might be elusive when the disease is in the
osteocalcin and β-crosslaps were not significantly associated early phase.
with BMP4 genotypes as well as fracture incidence. 4. US is a bedside procedure that should be ideally carried out
Conclusion: Our results suggest that BMP4/T538C polymor- by the rheumatologist in the context of traditional clinical
phism could contribute to the genetic regulation of BMD or bone evaluation.
turnover markers in population of Slovak postmenopausal women. 5. The combined assessment of clinical and US data can
All procedures were approved by the Ethical Committee of the radically modify the decision making process
Specialized Hospital of St. Svorad in Nitra (Slovakia).
Acknowledgements: The study was supported by the grant
KEGA 035UKF-4/2013 and UGA VII/60/2013. P313
THE RELATIONSHIP BETWEEN DXA MEASURES
OF MATERNAL, PATERNAL AND OFFSPRING BONE
P312 MASS: FINDINGS FROM THE SOUTHAMPTON
CORRELATION BETWEEN FUNCTIONAL WOMEN’S SURVEY
EVALUATION, SEVERITYAND C. Holroyd1, P. Taylor2, S. C. Crozier1, H. M. Inskip1, K. M.
ULTRASONOGRAPHY FINDINGS IN KNEE Godfrey1, C. Cooper1, N. C. Harvey1
1
OSTEOARTHRITIS MRC Lifecourse Epidemiology Unit, Southampton General
D. Mohasseb1, A. M. Helal1, A. Naguib1, A. H. Abdullah2, Hospital, Southampton, United Kingdom, 2Southampton
A. El-Belasy1 General Hospital, Southampton, United Kingdom
Osteoporos Int

Objective: There is evidence that bone mass may be partly in patients with COPD. Osteoporosis is highly prevalent
inherited, but scant data from which to elucidate the indepen- among older COPD patients, however, little is known of the
dent influences of mother and father. We examined the rela- usefulness of bone remodeling markers in the diagnosis of
tionships between childhood and parental bone mass, using osteoporosis in these patients. To evaluate the prevalence of
the Southampton Women’s Survey (SWS). osteoporosis in smokers with COPD and its association with
Material and Methods: The SWS is a prospective cohort of bone remodeling markers.
from which 3,156 pregnancies were followed. DXA assess- Material and Methods: A pilot study was performed in 16
ment of bone mass was obtained in the child (8–9 year) and patients attending the Neumology Department of the Clinic
both parents. Measurements included bone area (BA), bone University of Navarra, 8 smokers with COPD (FEV1/FVC
mineral content (BMC), areal BMD (aBMD) and size- postbronchodilatator <0.7) in spirometry and 8 smokers with-
corrected BMC at whole body minus head (WB), lumbar out COPD (FEV1/FVC postbronchodilatator >0.7), matched
spine (LS) and total hip sites. Correlation and linear regression by age, BMI and amount of cigarettes. A bone densitometry
were used to assess relationships. by DXA was performed and patients were diagnosed of oste-
Results: Data were available for 126 parent-offspring trios. oporosis according to the criteria of the WHO. Levels of
Strong positive associations were observed between parental calcium, β- CTX, osteocalcin and propeptide of procollagen
WB, hip and LS measures (BA, BMC, BMD) and the corre- type I were measured by immunoassay.
sponding offspring indices (maternal β=0.17–0.39; all p<0.001; Results: The prevalence of osteoporosis in the smokers pop-
paternal β=0.09–0.21; all p<0.01). Associations for scBMC at ulation was 37.5 %. Higher prevalence of osteoporosis was
each site were weaker, but remained significant (p<0.01). In found in smokers with COPD than in those without (12.5 %
multivariate modelling, independent relationships were observed vs. 62.5 % Pearson X2 P=0.039). Patients with COPD present
between either parent and the offspring (mother-child β=0.10– lower BMD compared with patients without COPD (0.946±
0.33, p<0.05; father-child β=0.09–0.18, p<0.05). Larger effect 0.14 vs. 0.926±0.14 g/cm2) and T-score (-1.000±0.47 vs.
sizes were observed for maternal than paternal-offspring relation- −1.243±0.57) in lumbar spine. And also in the forearm:
ships for WB BMD (β=0.21, p<0.01 vs. β=0.12, p<0.05), LS BMD (0.989 ± 0.02 vs. 0.856 ± 0.06 g/cm2) and T-score
BA (β=0.30, p<0.001 vs. β=0.15, p<0.05), and hip BA (β= (0.338±0.19 vs. −0.650±0.400, P=0.045). Moreover, pa-
0.33, p<0.001 vs. β=0.11, p<0.05). tients with COPD tend to have higher levels of bone remod-
Conclusion: We observed independent associations between eling markers: β-CTX (0.25±0.04 vs. 0.31±0.06 ng/mL) and
offspring bone mass, and corresponding measures in both P1NP (25.8±7.0 vs. 35.7±8.7 ng/mL), which became signif-
parents, with evidence of a greater maternal than paternal effect icant for osteocalcin (14.24±2.2 vs. 21.08±3.0 ng/mL, P=
for whole body BMD and BA at the LS and hip. Although 0.029). ROC curves indicate that β-CTX and osteocalcin
direct genetic inheritance offers a mechanistic explanation, the show adequate analytical performance for the diagnosis of
low proportion of variance in bone mass explained by known osteoporosis in smokers (AUC=0.81, p=0.047 and AUC=
genetic polymorphisms, increasing understanding of epige- 0.94, p=0.024, respectively).
netics, and disparity between maternal and paternal associations Conclusion: Prevalence of osteoporosis in smokers with
suggest that such relationships could be partly underpinned by COPD is higher than in smokers without COPD, and associ-
gene-environment interactions in early life. ates with increased levels of bone remodeling markers. Future
studies will be needed to elucidate the role of bone remodeling
markers in the diagnosis of osteoporosis in COPD.
P314
BONE REMODELLING MARKERS IN CHRONIC
OBSTRUCTIVE PULMONARY DISEASE P315
P. Restituto1, J. P. De Torres2, P. Rivera2, A. Calleja3, I. CLINICAL EFFECTS OF DIFFERENT MODALITIES
Colina4, J. I. Monreal1, N. Varo1 OF LOW-LEVEL LASEROTHERAPY ON
1
Department of Clinical Biochemistry, Clínica Universidad de FUNCTIONAL STATUS IN CHRONIC
Navarra, Navarra, Spain, 2Department of Neumology, Clínica INFLAMMATION OF THE SUPRASPINATUS
Universidad de Navarra, Navarra, Spain, 3Department of En- TENDON
docrinology, Clínica Universidad de Navarra, Navarra, Spain, V. G. Bajec1, L. Konstantinovic2, S. Janjic1, B. Stojic1, O.
4
Department of Internal Medicine, Clínica Universidad de Stankovic1, G. Radunovic1, M. Svenda1
1
Navarra, Navarra, Spain Institute of Rheumatology, Belgrade, Serbia, 2Clinic for Re-
habilitation, Medical University, Belgrade, Serbia
Objective: Chronic obstructive pulmonary disease (COPD), a
leading cause of morbidity and mortality worldwide, is not Objective: 1. To establish therapeutic effects of laserotherapy
just a lung-specific disease as other comorbidities are common and laseropunctura on functional status in chronic painful
 Osteoporos Int

shoulder syndrome caused by tendinitis supraspinatus. 2. To associate to main NVF. The main fracture was distal radius
compare effects of the two methods. (51 %), proximal humerus (23 %) and others (26 %). No face,
Material and Methods: Randomised prospective clinical hand and foot fractures were included. After DXA scan 60 %
study included 24 patients with acute shoulder pain, compa- were classified as osteoporosis and 40 % as osteopenia. 78 %
rable with regard to sex, age and concomitant diseases. Diag- of patients had vitamin D insufficiency or deficiency. Beside
nosis was made with regard to clinical, radiological and ultra- the prior fragility fracture, 25 % had early menopause and
sonographic examination. Patients were divided in the two 19 % had a parent with fractured hip were the more frequent
therapeutic groups. I group: patients, aged 55.57±6.24 treated fracture risk factors. 82 % of the patients had complete treat-
with laserotherapy, Midlaser Irradia, λ904 ηm, f5000 Hz. Ten ment adherence. In the group had only a minimal trauma NVF
points of the body located on anatomical projection inflamed as the main fracture, 45 % were classified as osteoporosis and
region, treated by accumulative daily D 10 J/cm2. X therapies. 55 % as osteopenia. 73 % had vitamin D insufficiency or
II group, patients aged 53.70 ± 5.83 treated with deficiency. Parent with fractured hip was the most frequent
laseropunctura (LP). Acupuncture points (AP): LI 4, G 38, clinical risk factor. In the group had a vertebral fracture
UB 57, LI 11, LI 15 i LI 16 and four painful points (PP) associated to a minimal trauma NVF as the main fracture,
located on anatomical projection inflamed region were treat- 69.5 % were classified as osteoporosis and 30.5 % as
ed. AP were treated by f 70 Hz, λ 780 nm, dose of 0.6 J /cm2 osteopenia. 83 % had vitamin D insufficiency or deficiency.
per point, PP were treated by f 2,500 Hz, λ 780, D 2.1 J /cm2, Early menopause was the most frequent clinical risk factor.
X therapies. All of the patients were given exercises for Conclusion: Distal radius was the most frequent NVF follow-
chronic phase of the tendinitis supraspinatus. Measured pa- ed by proximal humerus fracture. Women who had a vertebral
rameters were: local functional status, measured with fracture associate to main NVF showed high percentage of
Constant- Murley functional scale. Wilcoxon, Kruscal-Wallis densitometric osteoporosis, vitamin D insufficiency or defi-
and Mann Whitney tests (T) were used for the statistical ciency and parents with fractured hip than women with NVF
analysis. only. No differences in adherence to treatment.
Results: 1. Highly significant statistical difference was forti- Disclosures: Bernardo Stolnicki - Speaker: GSK, Sanofi
fied before and after the treatment in the I and II therapeutic Aventis, Servier, Novartis; Advisory board: Servier, Novartis
groups, concerning functional status (Wilcoxon, p<0.001).
2. Significant difference was fortified comparing functional
status improvement among therapeutic groups (Kruscal Wal- P317
lis, p<0.05). The best functional status improving were found HYPOPHOSPHATEMIC RICKETS: CASE REPORT
in group II (Mann-Whitney, p<0.05). L. Brunerova1
1
Conclusion: In patients with chronic inflammation of the Mediscan Euromedic and 3rd Faculty of Medicine, Charles
supraspinatus tendon laserotherapy and laseropuncture are University, Prague, Czech Republic
highly effective for functional status improving, but among
the two investigated modalities of therapy laseropunctura had Objective: Hypophosphatemic rickets is a genetic form of
the better effect. rickets (X-linked mutation of PHEX gene) characterized by
low serum phosphate and resistance to vitamin D treatment.
Diagnosis is based on clinical presentation usually in child-
P316 hood and confirmed by hypophosphatemia,
NONVERTEBRAL FRACTURE PATIENTS hyperphosphaturia, normal serum calcium, 25-OH vitamin
FEATURES IN A FLS IN BRAZIL D and typical radiographs. Treatment options in children
B. Stolnicki1, R. Galdino De Paula1 include calcitriol, growth hormone, phosphate supplementa-
1
Prevrefrat Hospital Federal de Ipanema Creb, Rio de Janeiro, tion, and thiazide diuretics acting as anticalciurics. However,
Brazil the treatment in adult patients is controversial.
Material and Methods: A case of a man (born 1971) first
Objective: To describe the features of women, above 60 years examined in 2011 is presented. He was of a disproportionate
of age, who have had as main fracture a nonvertebral fracture short stature (160 cm, 89 kg) and complained of dental prob-
(NVF) in Prevrefrat–a FLS in Rio de Janeiro, Brazil. lems and long bone pain. Lab tests showed findings typical for
Material and Methods: 86 women above 60 years old with hypophosphatemic rickets (S-phosphate 0.63 mmol/l, phos-
minimal trauma NVF have been followed from February 2011 phaturia 68 mmol/day), lower 25-OH vitamin D and mild
to November 20013. The patients features, fractures, risk secondary hyperparathyroidism. Densitometry revealed
factors, BMD values, seric vitamin D levels are reported. osteopenia in forearm (T/Z- score −2.2/−2.2) and proximal
Results: 40 women had only a minimal trauma NVF as the femur (−1.6/−1.5). Therapy with rocaltrol in daily dose of
main fracture. Forty-six women had vertebral fracture 1.5 mg and supplementation of phosphate (Natrii
Osteoporos Int

hydrogenphosphate 390.9 g, phosphoric acid 378 ml and A pilot study was conducted to pre-select circulating miRNAs
Aauae ad 1,000 ml in dose 3 spoons daily) was introduced. based on assay sensitivity and biological relevance for bone
Results: After the treatment, significant improvement in den- metabolism. This resulted in a panel of 384 miRNAs, which
tal problems (implants finally healed, no abscesses) and sig- was subsequently analyzed in a case/control cohort
nificantly decreased pain symptoms were reported by the representing 40 subjects with low-trauma osteoporotic frac-
patient. Lab tests did not show any increase in phosphatemia tures and 40 control subjects. Individual miRNAs that exhib-
(0.6 mmol/l) either decrease in phosphaturia (71 mmol/day) or ited differential expression as well as combinations of these
any changes in increased bone turnover (β-crosslaps 673 pg/ were analyzed for their sensitivity and specificity in predicting
ml and PINP 60.55 ng/l), however vitamin D and PTH levels fracture risk. In addition in vitro experiments were performed
normalized. In 20 months, significant improvement was ob- to study the effect of miRNA overexpression and knockdown
served in densitometry (proximal femur 0.6/0.6 a forearm on osteoblast differentiation and osteoclast activation.
−0.5/−0.5). Results: Our data suggest that specific miRNAs correlate with
Conclusion: Phosphate supplementation in an adult patient fracture risk during the progression of osteoporosis. These
with hypophosphatemic rickets led to significant clinical and miRNAs regulate the molecular signalling events that underlie
densitometry improvement, despite no laboratory changes. osteogenesis as well as osteoclastogenesis.
Thus, phosphate might be considered in treatment of adult Conclusion: We provide proof-of-principle that miRNAs
patients with hypophosphatemic rickets. might serve as a diagnostic and therapeutic targets in
osteoporosis.

P318
CIRCULATING MICRORNAS IN BONE DISEASE P319
M. Hackl1, S. Weilner2, S. Skalicky2, E. Schraml3, U. EFFECTS OF LASER THERAPY IN GONARTHROSIS
Heilmeier4, T. Link4, H. Redl5, P. Dovjak6, P. Pietschmann7, TREATMENT
R. Grillari-Voglauer2, J. Grillari3 S. Janjic1, V. G. Bajec1, B. Stojic1, S. Dolijanovic Pavlov1
1
TAmiRNA GmbH, Vienna, Austria, 2Evercyte GmbH, Vien- 1
Institute of Rheumatology, Belgrade, Serbia
na, Austria, 3Department of Biotechnology, University of
Natural Resources and Life Sciences, Vienna, Austria, 4De- Objective: To compare the therapy with laser application on
partment of Radiology and Biomedical Imaging, University painful areas of the affected ankles with laser application on
of California, San Francisco, San Francisco, United States, acupunctural points on pain relief and ankle flexion amplitude
5
Ludwig Boltzmann Institute for Experimental and Clinical in patients with gonarthrosis.
Traumatology, Vienna, Austria, 6Salzkammergut-Klinikum Material and Methods: 46 patients (30 women and 16 men)
Bad Ischl, Gmunden, Vöcklabruck, Gmunden, Austria, 7De- aged 60–76 were included and prospectively followed during
partment of Pathophysiology, Medical University Vienna, gonarthrosis treatment. Diagnosis was made on ACR criteria
Vienna, Austria lasted from 4 to 20 years. Pain was measured by VAS scale
before and after therapy. Ankle movement was measured with
Objective: Osteoporosis is a bone disorder characterized by arthrometer in degrees before and after completion of therapy.
the systemic loss of bone mass due to alterations of the Patients were randomly assigned in two groups: First group
homeostasis of bone metabolism, which increases the risk of with 18 women and 6 man and second group with 12 woman
severe bone fractures. Recently, it was discovered that and 10 men aged. Both groups were comparable in age,
microRNAs (miRNAs), which are small non-coding RNAs gender distribution and gonarthrosis duration. Laser used in
that regulate gene expression, play an important role in bone this study was Mediclaser 637 Electronic design. First group
metabolism by controlling osteogenesis (bone formation) as of patients was treated with Laser beam applied on painful
well as osteoclastogenesis (bone resorption). It is also known areas with 70 mW, freq. of 2,500 Hz and energy absorption 3
that miRNAs are selectively secreted into the bloodstream times a week, in 10 consecutive doses. Patients in second
from malignant as well as normal cell types. This insight has group were treated with laser applied on acup. points VF41,
opened up a novel area of research, where circulating VU40, VF34, H8, G34, G35, PE31, PE32, with freq. of
miRNAs are investigated as predictive and prognostic bio- 70 Hz, power of 40 mW, 0,6 J/cm2 energy absorption in
markers of disease. The objective of this work was the sys- 30 s, 3 times a week with 10 consecutive doses.
tematic analysis of the clinical utility of circulating Results: 1. It estimated high statistical significance in both
microRNAs for the diagnosis of fracture risk and acceleration groups, Kruscal Wallis, p<0.001.
of bone healing in the context of osteoporosis. 2. High statistical significance is achieved also in improve-
Material and Methods: We established a qPCR-based ment of ankle flexion amplitude in both groups Kruscal Wallis
workflow for analysis of circulating miRNA levels in serum. test, p<0.001.
 Osteoporos Int

3. Significantly better pain relief and increased knee flexion Conclusion: The BMD in patients with high activity of RA,
was detected in group II- Laser acupuncture application taking rituximab within 12 months, remained stable regardless
Mann-Whitney, p<0.05. of the received total dose of a drug. Studying of a contribution
Conclusion: Analysis clearly shows positive impact of Laser of other factors, which influence on BMD change, requires
therapy in pain relief, and ankle movement amplitude, with carrying out more careful analysis.
better results of laser applications on acupunctural points
during treatment.
P321
THE RISK OF OSTEOPOROTIC FRACTURES BY
PROGRAM FRAX IN MEN WITH LONG
P320 EXPERIENCE OF SMOKING
THE INVESTIGATION OF INFLUENCE OF THE E. Kochetova1
1
TREATMENT WITH ANTI-CD20 ANTIBODIES Petrozavodsk State University, Petrozavodsk, Russian Fed-
(RITUXIMAB) ON BONE MINERAL DENSITY IN eration
PATIENTS WITH RHEUMATOID ARTHRITIS
P. Dydykina1, I. Dydykina1, A. Devyataikina1, G. Lukina1, A. Objective: To study the risk of osteoporotic fractures and
Smirnov1, E. Nasonov1 exercise tolerance in patients with chronic obstructive pulmo-
1
Federal State Budgetary Institution, Research Institute of nary disease (COPD).
Rheumatology V.A.Nasonova, Russian Academy of Medical Material and Methods: 125 patients with COPD were ob-
Sciences, Moscow, Russian Federation served. The investigated group was made by the men having
the long experience of smoking. Smoker index was 240. The
Objective: To access the dynamics of BMD after 12-months experience of smoking (packs/year) was 40(30–47). The av-
rituximab treatment in patients with rheumatoid arthritis (RA). erage age was 61.4±6.4 years. The patients received basic
The disease activity in RA is the one of significant reasons of therapy system glucocorticoids have been excluded from the
increasing bone resorption and decreasing BMD. The control research. Research of function of external breath was studied
of inflammation activity by biologics, including anti-CD20 with multimodular installation of type «Master-Lab/Jaeger».
antibodies (rituximab), can be considered as possibility to Research of mineral density of a bone fabric was studied with
decrease bone resorption and stabilize BMD. the method x-ray absorptiometry with the densitometer Lunar
Material and Methods: A retrospective study of 54 women DPX-NT. The assessment of risk of osteoporotic fractures
with Rahman (SD) age at start of rituximab treatment was were calculated by means of the computer program FRAX.
48.6±13.4 years, mean duration of disease 9.2±7.6 years. The For calculation of risk by the procedure FRAX was used T-
high activity of RA (DAS-28) was in 50(93 %) patients, criteria of femoral neck. Tolerance Exercise test was deter-
moderate - in 4(7 %). The BMD was assessed by DXA at mined the 6-min walk distance (6MWD).
baseline and 12 months after at least in one of following sites: Results: The highest absolute risk of hip fracture 4.3 (1.45–
L1-L4 (n=45), hip neck (n=39) and hand (n=20). The DXA 8.25) and the highest absolute risk of major fractures 7.4 (5–
was performed at Hologic Discovery A. 11) were detected in patients with COPD of 4 stage. The
Results: Depending on the received dose of rituximab within absolute risk of hip fracture in patients with COPD 3 stage
12 months of treatment patients were distributed in three was 2.35(0.95–5.3). Patients with COPD 3–4 stages have a
groups: the 1 group (n=20) received totally 500–1,900 mg reliably higher risk of fractures compared with patients with
of rituximab; the 2 group (n=26) received 2,000 mg; the 3 COPD stage 2. The absolute risk of hip fracture was minimal
group (n=8) received 2,500–4,000 mg. In the 1 group the in patients with COPD 2 stage 0.7(0.4–1.9). Decrease in
mean BMD L1-L4 (n=14) before/after the treatment was exercise tolerance was associated with worsening stage
respectively: 0.889±0.119 g/cm2 and 0.883±0.152 g/cm2; at of COPD. The lowest level of 6MWD was noted in
hip neck (n=12) 0.680±0.091 g/cm2 and 0.651±0.075 g/cm2; patients with 4 stage COPD. 6MWD in patients with
at hand (n=7) 0.466±0.065 g/cm2 and 0.423±0.062 g/cm2. 2 COPD 4 stage was 233.75 ± 117.34. The best result
group: mean BMD L1-L4 (n=23) was respectively: 0.951± 6MWD was in patients with COPD 2 stage 386.57±
0.148 g/cm2 and 0.960±0.124 g/cm2; at hip neck (n=20) 100.53. The correlation coefficient between 6MWD and
0.729±0.121 g/cm2 and 0.688±0.131 g/cm2; at hand (n=9) risk of major osteoporotic fracture was −0.46 (p<0.005),
0.505±0.128 g/cm2 and 0.473±0.074 g/cm2. 3 group: mean the correlation coefficient between 6MWD and the risk
BMD L1-L4 (n=8) was respectively: 1.017±0.164 g/cm2 and of hip fracture was −0.46 (p<0.005).
1.011±0.148 g/cm2; at hip neck (n=7) 0.746±0.157 g/сm2 Conclusion: The highest risk of fractures and the lowest level
and 0.745±0.144 g/сm2; at hand (n=5) 0.523±0.065 g/сm2 of exercise tolerance was detected in patients with COPD 4
and 0.519±0.074 g/сm2. stage.
Osteoporos Int

P322 P323
IN VIVO CARTILAGE-SPECIFIC DELETION OF OSTEOPOROTIC FRACTURES AND THE
EPHRIN-B2 IN MICE RESULTS IN BONE SEVERITY OF BRONCHIAL OBSTRUCTION IN
DEVELOPMENT LEADING TO OSTEOARTHRITIS PATIENTS WITH COPD
FEATURES E. Kochetova1
J. Martel-Pelletier1, G. Valverde-Franco1, B. Lussier2, D. 1
Petrozavosk State University, Petrozavodsk, Russian
Hum1, J. Wu3, J.-P. Pelletier1, M. Kapoor1 Federation
1
Osteoarthritis Research Unit, University of Montreal Hospi-
tal Research Centre (CRCHUM), Montreal, Canada, 2Faculty Objective: To study the risk of osteoporotic fractures and
of Veterinary Medicine, Clinical Science, University of Mon- severity of bronchial obstruction in patients with COPD.
treal, Saint-Hyacinthe, Canada, 3Laboratory of Immunology, Material and Methods: 125 patients with chronic obstructive
University of Montreal Hospital Research Centre (CRCH pulmonary disease (COPD) were observed. The investigated
UM), Montreal, Canada group was made by the men having the long experience of
smoking. Smoker index was 240. The experience of smoking
Objective: Ephrins and their receptors have been implicated (packs/year) was 40(30−47). The average age was 61.4±
in mediating developmental events. We demonstrated that a 6.4 years. The patients received basic therapy system gluco-
member of the ephrin family, ephrin-B2, plays a role in corticoids have been excluded from the research. Research of
osteoarthritis (OA) knee joint pathology1−3. This study aimed function of external breath was studied with multimodular
to comprehensively delineate the in vivo role of ephrin-B2 in installation of type “Master-Lab/Jaeger”. Research of mineral
musculoskeletal growth and development using cartilage- density of a bone fabric was studied with the densitometer
specific ephrin-B2 knockout (ephrin-B2KO col) mice. Lunar DPX-NT. The assessment of risk of osteoporotic frac-
Material and Methods: The skeletal development of the tures were calculated by means of the computer program
ephrin-B2KOcol mice was evaluated on postnatal days (P)0, FRAX.
P15, P21, and at 8 weeks and 1 year old. The ephrin-B2f/f Results: Bronchial obstruction progressed with worsening of
littermates were used as controls. stage of COPD. FEV1 in COPD patients 2 stage was 61.3±
Results: Ephrin-B2KOcol mice exhibited reduced size post- 6.06 %, FEV1 in COPD patients 3 stage was 38.59±8.45 %,
natally, and at P15 and P21 reduced weight (p<0.01) and FEV1 in COPD patients 4 stage was 24.89±2.89 % (p<0.05).
length (p<0.01). At 8 weeks, ephrin-B2KOcol mice had sig- The number of patients with a high risk hip fracture increased
nificantly shorter femur (p<0.03) and tibia length (p<0.01) with the progression of bronchial obstruction. Among patients
and reduced BMD in the total skeleton (p<0.04), femur with FEV1<50 % the high absolute risk of hip fracture was
(p<0.03) and spine (p<0.009). μCT analyses revealed that detected in 48.05 % of patients in this group. Among patients
the distal femur and proximal tibia in KO mice had decreased with FEV1>50 % the high absolute risk of hip fracture was
bone volume (p<0.03) and trabecular thickness (p<0.02), detected in 12.77 % of patients in this group (p<0.05). The
increased trabecular separation (p<0.05), and reduction in correlation coefficient between SaO2 and risk of osteoporotic
mineralized cartilage matrix at the chondro- osseous junction fractures was −0.34.
of the growth plate. At 1 year, ephrin-B2KOcol mice demon- Conclusion: Among COPD patients with severe bronchial ob-
strated OA features in both knee and hip. The ephrin-B2KOcol struction was detected the increase in risk of osteoporotic
mice exhibited a hip- associated locomotory defect as soon as fractures.
they walked. At 8 weeks the hip of the KO mice displayed
abnormalities related to a smaller pelvic bone (p<0.01) and
canal width (p<0.03); this was not found at 1 year. The P324
proximal femoral head with respect to the acetabular param- HISTORY OF FRACTURE AND CHRONIC WHOLE
eters did not show major differences, suggesting that the BODY PAIN: FINDINGS FROM UK BIOBANK
locomotory defect is not due to a developmental hip G. Ntani1, K. Walker-Bone1, G. T. Jones2, C. Cooper1, N. C.
abnormality. Harvey1
1
Conclusion: This study was the first to show that in vivo MRC Lifecourse Epidemiology Unit, University of South-
ephrin-B2 is essential for normal bone growth and develop- ampton, Southampton, United Kingdom, 2Musculoskeletal
ment and that cartilage-specific ephrin-B2 deficiency leads to Research Collaboration (Epidemiology Group), University
significant long bone alterations, dysregulation of mineraliza- of Aberdeen, Aberdeen, United Kingdom
tion, and OA features.
References: 1Kwan Tat et al. Arthritis Rheum 2008:58:3820; Objective: We explored the association between chronic
2
Kwan Tat et al. Arthritis Res Ther 2009:11:R119; 3Valverde- “pain all over the body”, as a marker of chronic widespread
Franco et al. Arthritis Rheum 2012:64:3614. pain, and fractures in the UK Biobank cohort.
 Osteoporos Int

Material and Methods: UK Biobank is a large prospective Strength measures were performed with bending load at load-
cohort comprising 500,000 men and women aged 40– ing rate of 0.25 mm/min up to destruction.
69 years, with detailed assessment at baseline. Specifically Results: After discontinue of epichlorohydrin inhalation
data relating to past fracture [upper limb (UL), hip, spine] over breaking point and fracture energy of humerus in young
the last 5 years, and the presence of “pain all over the body” animals were lower than those of controls by 14.16 % and
>3 months duration (PATB) as a marker of chronic wide- 16.57 %, in adult—by 12.70 % and 15.67 % and in old—by
spread pain, were obtained. Poisson regression models with 10.17 % and 8.31 %, respectively. Same characteristics of the
robust confidence intervals were used to explore associations mandible were lower by 14.60 % and 14.04 %, 12.73 % and
between presence of PATB and fracture in the past 5 years, 15.72 % and 10.01 and 11.05 %, respectively. In readaptation
with adjustment for confounding factors. Results are present- period young animals exhibited fast bone strength recovery
ed as risk ratios (RR). while in adults strength decrease kept at the same level up to
Results: The mean (SD) age of participants was 57 (8.1) years the 15th day of observation yet significant changes were
and just over half were female (54 %). The overall prevalence observed up to the 60th day of observation. In old animals
of PATB was 1.4 %, but was higher amongst those with a bone strength recovery of both mandible and humerus was not
previous fracture (2.2 % for UL, 4.1 % for hip and 4.4 % for observed. Administration of thiotriazoline or ET reduced neg-
spine). After adjustment for demographic characteristics, ative effects of epichlorohydrin during inhalation and after it.
PATB was most strongly associated with spine fracture Thiotriazoline appeared to be more effective than ET.
(RR:3.2), then hip (RR:3.0) and UL (RR:1.5) (all p<0.001). Conclusion: 60-day inhalation of epichlorohydrin results in
Associations were somewhat attenuated by adjustment for decrease of strength and increase of fragility of both humer-
lifestyle, socio- economic factors and psychological indices us and mandible in rats of different ages. Deviations
(spine: RR=2.37, hip: RR=2.16, UL: RR=1.27, all p<0.01). degree and recovery rate depend on age of animals. Applica-
Conclusion: In this large cohort, history of fracture was tion of thiotriazoline or ET reduces negative effects of
associated with increased risk of PATB, particularly for spine epichlorohydrin.
and hip more than upper limb fractures, even after adjustment
for confounders. These results require replication in other
settings, but raise the possibility that fracture may predispose P326
to chronic widespread pain, perhaps differentially by fracture THREE YEARS FOLLOW UP FOR FRACTURES IN
type, possibly through perturbation of the HPA axis, or psy- ELDERLY WOMEN WITH OSTEOPOROTIC
chological stressors. VERTEBRAL FRACTURES
M. S. Karadzic1
1
Institute Niska Banja, Nis, Serbia
P325
STRENGTH FEATURES OF THE HUMERUS AND Objective: Prospective follow up with 3 years of examination
MANDIBLE AFTER LONG TERM INHALATION OF of patients with vertebral fractures treated with
EPICHLOROHYDRIN bisphosphonates on the incidence of new fractures.
V. I. Luzin1, A. N. Skorobogatov1, V. A. Gavrilov1, D. A. Material and Methods: 77 postmenopausal women older
Astrakhantsev1 than 65, having osteoporosis, have been analysed. Upon the
1
State Institution, Lugansk State Medical University, Lu- made densitometric examination of lumbosacral part of the
gansk, Ukraine spine L1-L4 and the hip, which helped to identify osteoporo-
sis, X-ray test of the Th4 - L5 portion of the spine was made in
Objective: To examine strength features of humerus and all the patients, aimed at detecting vertebral fractures, AP and
mandible in rats after 60 day inhalation of epichlorihydrin profile, which have been analysed by semi-quantitative meth-
and correction of its negative effects with thiotriazoline and od (Genant) the analysis was made by a radiologist. Patient
Echinaceae Tinctura (ET). were treated with weekly 87 % and monthly 13 %
Material and Methods: The experiment involved 420 male bisphosphonates, 5,600 weekly vitamin D3 supplementation
rats (young, mature and old): intact animals, animals that and calcium carbonate 500 IU daily. During 3 years of treat-
received daily epchlorohydrin inhalations as a single 5-h ment follow up was done for vertebral fractures any new
exposure to 10 MPC for 60 day and the groups 3 and 4 fractures, BMD changes.
received 2.5 % solution of thiotriazoline in dosage 117.r mg/ Results: Vertebral fractures were found out in 21 patients.
kg of body weight or per os ET in dosage of 0.1 mg of active Symptomatic fractures were reported by 4 patients whereas 17
component per 100 g of body weight. The animals were patients had the asymptomatic ones. One fracture was regis-
withdrawn from the experiment by the 1st-60th days after tered with 11 patients 2 fractures with 6 and 3 and more
discontinue of 60 d cycle of epichlorohydrin inhalations. fractures with 4 patients. 1st degree fractures were found out
Osteoporos Int

in 12, 2nd degree fractures were registered with 8 patients and patients with RA. Therefore, it is of great importance its
3rd degree fractures with 1 patient. Study was finished after prevention, early diagnosis and treatment through regular
3 years, and same diagnostic procedures was done. On follow determination of BMD and redesigning GK therapy.
up there were 71 patients, one developed colon carcinoma, 2 References: 1. Jankovic T et al. Osteoporos Int 2013;24:165
died from cardiovascular death, and 3 left study due to gas- 2. Zvekic-Svorcan J et al. MD-Medical Data 2013;5:235
trointestinal reasons 3.8 %. As it concerns fractures one had
fracture of femur (1.3 %), two (2.7 %) fractures of radius loco
typico, and there were no new vertebral fractures. P328
Conclusion: The results obtained from research indicate a EFFECT OF RISK FACTORS ON PROBABILITY OF
high percentage of asymptomatic vertebral fractures in the OSTEOPOROSIS DEVELOPMENT IN WOMEN
examined group of elderly postmenopausal women having J. Zvekic-Svorcan1, T. Jankovic1, K. Filipovic1, J. Vasic2, K.
osteoporosis. After 3 years of treatment that had low percent Boskovic3, S. Tomasevic-Todorovic3
1
of new fractures, there were increase of BMD registered, no Rheumatology, Special Hospital for Rheumatic Diseases,
new vertebral fractures, and three new nonvertebral fractures. Novi Sad, Serbia, 2Physical Medicine and Rehabilitation,
Railway Healthcare Center, Belgrade, Serbia, 3Rheumatology,
Clinic for Medical Rehabilitation, Clinical Center of Vojvodi-
P327 na, Novi Sad, Serbia
INCIDENCE AND LOCALIZATION OF FRACTURES
IN GLUCOCORTICOID INDUCED OSTEOPOROSIS Objective: To assess effect of several risk factors on proba-
IN PATIENTS WITH RHEUMATOID ARTHRITIS bility that female patients develop osteopenia/osteoporosis.
T. Jankovic1, M. Lazarevic1, S. Subin-Teodosijevic2, K. Material and Methods: The study encompassed 1,268 wom-
Boskovic3, J. Zvekic-Svorcan1 en with average 64.2±7.03 years of age, examined at the
1
Special Hospital for Rheumatic Diseases, Rheumatology, DXA of the Special Hospital for Rheumatic Diseases, Novi
Novi Sad, Serbia, 2General Hospital Dr Djordje Joanović, Sad, Serbia. They were also asked identical questions regard-
Rheumatology, Zrenjanin, Serbia, 3Clinic for Medical Reha- ing risk factors that may be responsible for development of
bilitation, Clinical Center of Vojvodina, Novi Sad, Serbia osteoporosis: early menopause, BMI, previous fractures, his-
tory of fractures in a family, treatment by glucocorticoids,
Objective: To determine the frequency and localization of smoking and alcohol consumption. For statistical analysis
fractures in glucocorticoid-induced osteoporosis in patients we used binear logistic regression.
with RA. Results: The only factor for development of osteopenia at the
Material and Methods: The 1-year study included 210 patients hip is the low BMI, increasing risk for osteopenia develop-
with RA, 175 women (83.3 %) and 35 men (16.7 %) of median ment for 52 % (OR 1.126; 95%CI 1.410–2.273). The most
age 58.3 with average disease duration of 8.7 years. All patients important predictor of osteoporosis at the hip is the early
were on methotrexate in the average weekly dose of 15 mg, and menopause, which increases osteoporosis development risk
prednisone in doses greater than 7.5 mg for longer than 3 months. for 39 % (OR 0.663; 95%CI 1.051–2.175), then follow glu-
The patients were undertaken to osteodensitometric examination. cocorticoids with 29 % (OR 0.421; 95%CI 1.262–4.513) and
The incidence of fractures was based on anamnesis and radio- previous fractures with 28.5 % (OR 0.415; 95%CI 1.716–
logical findings. Statistical analyses were done in the Statistical 3.949). The complete model with all predictors was significant
Package for The Sciences 20.0 program. (χ2 =47.77; p<0.01), i.e., it distinguishes patients having
Results: Of 210 patients, 87 patients had osteoporosis osteopenia and osteoporosis at the lumbar level. The only
(41.4 %), 100 osteopenia (47.6 %) and normal findings were significant factor is the low BMI, increasing chances for
noted in 23 patients (11 %). Fractures had 79 patients development of osteopenia for 52 % (OR 1.127; 95%CI
(37.6 %). In the group of patients with osteoporosis, partici- 1.091–1.165). In women, predictor for incidence of
pation of fractures was 54 % (47/87) and with osteopenia osteopenia at the spine is the early menopause, which in-
32 % (32/100). The most common were vertebral fractures creases chances for development of this disease for 33 %
53.1 % (42/79) mostly localized in the area of TH10 and Th12 (OR 0.519, 95%CI 0.393–0.687). After that, autoimmune
vertebra. Two patients had a hip fracture (2.6 %), while the diseases follow with 32 % (OR 0.517; 95%CI 0.320–0.837)
nonvertebral fractures were 44.3 % (35/79) mostly localized and previous fractures with 26 % (OR 0.359; 95%CI 0.270–
in the region of the forearm. One fracture was detected in 0.476) increase of chances for development of spine
22.8 % (18/79), two in 40.5 % (32/79) and multiple fractures osteoporosis.
in 36.7 % (29/79) of patients. Conclusion: Besides the osteodensitometric tests in diagnos-
Conclusion: The use of glucocorticoids leads to changes in ing osteoporosis, risk factors are also of importance and
the properties of the bones and increases the risk of fractures in should be sought actively.
 Osteoporos Int

References: 1. Boskovic K et al. Osteoporos Int 2012;23:189 Preventive Medicine, Prahran, Australia & Baker-IDI Heart
2. Zvekic-Svorcan J et al. MD-Medical Data 2013;5:217. and Diabetes Institute, Melbourne, Australia

Objective: Osteoporosis (OP), in terms of reduced BMD, and

P329 fractures are a well- known complication of stroke. Purpose:
BONE QUALITY IN MIDDLE AGED CUBAN MEN to determine the level of BMD in patients with stroke and to
WITH DIABETES MELLITUS 2 assessment the association of motor and functional recovery
M. Diaz-Curiel1 and BMD.
1
Universidad Autonoma Madrid, Madrid, Spain Material and Methods: We studied 74 patients with first
stroke (<1 year post stroke), and mean age of 66.59 ±
Objective: Identify bone quality in middle aged Cuban men 9.607 year who had been examined in Clinic for Medical
with diabetes mellitus 2 (DM2). Rehabilitation, Clinical Center of Vojvodina. BMD was mea-
Material and Methods: Subjects: We evaluates 105 middle sured at lumbar spine (L1-4) and at proximal femur by DXA.
aged (40–59 years old) men, 50 with DM2 without invalid Osteoporosis was defined as BMD >−2.5 T-score. The clinical
complications nor kidney damage that were recruited on severity of the hemiplegia was evaluated with Signe
Arnaldo Milian Hospital, and 55 healthy men living in Brunnstrom staging classification, and the functional status
Revoluciton Square Municipality. Methods: Each subject was evaluated with Barthel index (BI) and Rivermead Mobil-
was clinically evaluated and performed DXA (Lexxos, ity Index (RMI).
France, on lumbar column (L1-L4) and left hip (WHO criteria Results: There were 27 (36.5 %) right-sided and 47 (63.5 %)
for evaluated results). In diabetic patients we determined left-sided patients with stroke. The frequency of osteoporosis
glycatd HB (HbA1c <6 % as good control criteria) and in the whole sample was 10 (13.51 %). The paretic side had
microalbuminuria (24 h). In all subjects plasma levels of significantly lower BMD than the nonparetic side (0.809±
testosterone (RIA 10–14 nmol normal range). Statistical anal- 0.107 g/cm2 vs. 0.917±0.135 g/cm2; P<0.001). There was a
ysis: We used frequency, media and standard deviation, chi2 positive correlation between S. Brunnstrom stage, BI, RMI
test (quality variables) and T Students Test (quantitative var- and total BMD at proximal femur in the affected side
iables), simple correlations, and ANOVA (p<0.05). (p<0.05).
Results: Both groups were formed principally of Caucasians, Conclusion: Stroke is a risk factor for the development of
aged 48.26 years old (diabetics) and 50.10 years old (control osteoporosis and increased bone loss at the paretic side. This
group), consume alcohol 7.7 % of diabetics vs. 20 % of risk for osteoporosis in patients with stroke increases more
healthy subjects (p<0.05). Diabetic patients were obese with worse motor recovery and functional status.
(872.5 %), with <10 years of DM (64 %) and with worse
metabolic control (52 %). Poor bone quality/low bone mass +
osteoporosis in total hip occurred on 53 % of healthy subjects P331
vs. 33 % of DM2 patients (p<0.05) while in lumbar column PREVALENCE OF OSTEOPOROSIS IN ALBANIAN
was 20 and 25 %, respectively. Low levels of testosterone POSTMENOPAUSALWOMEN: BMD AND T-SCORE
were found on 15 % os diabetes patients vs. 36 % of healthy MEAN VARIATION AGE RELATED
group (p<0.05). A. Kollcaku1, J. Kollcaku2
1
Conclusion: In spite of a few number of subjects (limitants) in University Hospital Center Mother Teresa, Tirana, Albania,
2
this report we did not find that DM affect bone quality in Polyclinic 3, Tirana, Albania
middle aged men with DM2.
Objective: To measure BMD at the calcaneus bone and to
find out the prevalence of osteoporosis and osteopenia, and t-
P330 score mean results variation according to the age and disease
BONE MINERAL DENSITY IN PATIENTS WITH status in Albanian postmenopausal women.
STROKE Material and Methods: It is a cohort prospective study. Bone
S. Tomasevic-Todorovic1, K. Boskovic1, K. Filipovic2, J. mass measurement was performed by QUS at the calcaneus
Zvekic-Svorcan2, M. Grajic3, F. Hanna4 bone. 637 postmenopausal women subjects were seen to be
1
University of Novi Sad, Faculty of Medicine, Clinical Center study eligible and all of them were enrolled on it.
of Vojvodina, Novi Sad, Serbia, 2Rheumatology, Special Hos- Results: Osteoporosis was prevalent 5.024 %, and osteopenia
pital for Rheumatic Diseases, Novi Sad, Serbia, 3University of was prevalent 54.79 %. Older people were at higher risk of
Belgrade, Faculty of Medicine, Clinic for Physical Medicine osteoporosis than younger. Important statistical difference on
and Rehabilitation, Clinical Center of Serbia, Belgrade, Ser- the mean age was found between osteoporosis and
bia, 4Monash University, Department of Epidemiology and nonosteoporosis group (p<0.001). Mean age of osteoporosis
Osteoporos Int

group was found 70 years old, and 60.79 it was on the normal P333
BMD group. Important statistical difference was found on t- KALSIS AS PROTECTION OF BONE MASS DURING
score mean results between osteoporosis and nonosteoporosis MENOPAUSALTRANSITION
group (p<0.001). All cases with osteoporosis had a mean t- M. Diaz-Curiel1
1
score result lower than normal group. Universidad Autonoma de Madrid, Madrid, Spain
Conclusion: The older postmenopausal women were seen to
be in higher risk of osteoporosis than younger and lower t- Objective: To propose a protocol for prevention of postmen-
score mean result was found on them vs. normal BMD group. opausal osteoporosis based on basic and clinical results.
Material and Methods: Analysis of results of effect of sele-
nium principal element of Kalsis on bone metabolism. Kalsis
P332 is a nutriceutical that contains selenium, vitamin E and mag-
EVOLUTION OF BONE MINERAL DENSITY (BMD) nesium. Selenium has a mitochondrial effect that facilitates
BEYOND HORMONE REPLACEMENT THERAPY: calcium absorption and incorporation into bone tissue. Vita-
THE OSTEOCLAST DOES NOT MAKE HOLIDAYS min E retarad oxidation of unsaturated fatty acids and to create
M. Guinot Gasull1, M. Campillo Ajenjo 1, S. Martínez peroxide. Magnesium is necessary in the stabilization of cell
García1, I. J. Gich Saladich2, J. Calaf Alsina1 membranes. In rats with osteopenia induced by oophorectomy
1
Department of Obstetrics and Gynecology, Hospital de la (Montero M, Diez Perez A, et al) demonstrated reduces par-
Santa Creu i Sant Pau, Barcelona, Spain, 2Department of tially loss of bone mineral content (BMC). In women aged
Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, 20–40 years, with osteopenia associated with the use of sup-
Barcelona, Spain pressive doses of levothyroxine (Turcios S, Rodriguez A) and
in postmenopausal women (Navarro D, Triana M) aged 40–
Objective: To assess the evolution of BMD after stopping 59 years old, Kalsis partially reduces the loss of BMC.
hormone replacement therapy (HRT). The influence of subse- Results: Kalsis is useful for reduce the loss of BMC, so that
quent osteoprotective treatments in maintaining BMD will be for preserve bone mass.
also studied. Conclusion: As an expression of hypoestrogenism during
Material and Methods: A retrospective study was performed menopause transition an increase in the annual rate of BMC
in 168 postmenopausal patients undergoing HRT. BMD loss occurs, which could favor fragility fractures in later
(g/cm2) was determined at lumbar spine (L1-L4) and femoral stage of women life. Our proposition is use this nutri-
neck by DXA technique, before and after completion of the ceutical in the stages of life when peak bone mass is
HRT. The impact on the maintenance of bone mass with formed (adolescent) and/or in the years around menopause
osteoprotective treatments leaving HRT was also assessed. may be an option with less undesirables long terms effects,
Data were analysed by Student’s t-test and ANOVA; p-value and better adhesion than therapeutical drugs using for osteo-
<0.05 was considered statistically significant. porosis treatment.
Results: After stopping HRT, a decrease in bone mass in both
lumbar spine (0.884 g/cm2 to 0.852 g/cm2, 3.2 %), and fem-
oral neck (0.772 g/cm2 to 0.757 g/cm2, 1.5 %) was observed
(p<0.001). This decrease was observed even if a subsequent P334
alternative treatment was instituted. In 47.6 % of patients DISPLACEMENT OF THE TRANSITIONAL ZONES
hygiene and dietetic measures were introduced with a de- (TZ) AT THE SUBCHONDRAL BONE (SB) LAYERS IN
crease bone mass of 3.8 % at lumbar spine (p<0.001) and AN EXPERIMENTAL MODEL OF OSTEOPOROSIS
1.8 % at femoral neck (p<0.05). The other 52.4 % of patients (OP) AND OSTEOARTHRITIS (OA) IN RABBITS
required another posterior treatment: 20.2 % of them raloxi- S. Castañeda1, D. Guede2, J. R. Caeiro2, J. A. Román-Blas3,
fene and 17.3 % bisphosphonates. In this case, the results R. Largo3, G. Herrero-Beaumont3
1
showed that the vertebral bone mass decreased a 4.1 % with Rheumatology Service, Bone and Joint Research Laboratory,
raloxifene and a 4.5 % with bisphosphonates (p<0.001). At Fundación Jiménez Díaz, Universidad Autónoma, Madrid,
the femoral neck the decrease was 3.4 % and 1.5 % (p<0.05) Spain, Spain, 2Trabeculae S.L. Parque Tecnológico de Gali-
with the above mentioned treatments, respectively. Neverthe- cia, San Cibrao das Viñas, Ourense, Spain, 3Bone and Joint
less, no statistically significant differences were observed in Research Unit, Service of Rheumatology. Bone and Joint
the evolution of bone mass as was the treatment given. Research Laboratory, Fundación Jiménez Díaz, Universidad
Conclusion: After the HRT, the rate of bone loss return to Autónoma, Madrid, Spain, Spain
normal postmenopausal levels. Alternative treatments do not
reach the same degree of bone protection that is achieved with Objective: To analyze, through μCT, the microstructural
HRT. characteristics of the SB layers in an experimental model of
 Osteoporos Int

OP and OA to determine the effect of the SB microarchitecture Material and Methods: This prospective study included 36
in the OA severity. female total hip replacement patients with the mean age of
Material and Methods: Experimental OA was induced in 12 64 years (41–78). Radiostereometric analysis (RSA) was used
female NZ white rabbits (8 month old) by ACLT and partial to measure the 3D migration of cementless hydroxyapatite
medial meniscectomy (OA) in the left knees. In 6 of them, OP coated cups with ceramic-ceramic bearings. The inclusion
was previously induced by bilateral oophorectomy and sub- criteria included a generally healthy woman with age of
sequent prednisolone administration (OPOA knees). Right <80 years with advanced hip osteoarthritis and signed in-
knees of OPOA were used as OP knee controls, while right formed consent. Exclusion criteria comprised of inflammatory
knees of OA group were used as healthy knees. After sacri- arthritis, untreated parathyroid disease, severe undiagnosed
fice, knees of both groups were carefully dissected and cylin- osteoporosis (T-score<−3.5) and ongoing osteoporosis or cor-
drical samples of SB (4 mm in diameter by 9 mm in length) ticosteroid therapy. Ten patients (28 %) had normal and 26
were extracted from femoral condyles. The microarchitectural patients (72 %) had low systemic BMD (osteopenia or osteo-
characteristics of the samples were studied using μCT with a porosis) based on preoperative DXA. The patients were
SkyScan 1172 (Bruker μCT NV). Statistical comparison was followed with repeated RSA for 2 years.
performed using the Kruskal-Wallis H test, and post-hoc Results: The patients with low BMD showed significantly
analysis using Dunn’s test (SSPS vs. 19). greater proximal migration of the acetabular cups than patients
Results: According to the bone area fraction (B.Ar/T.Ar) with normal BMD (p<0.007). Based on the perceived risk of
profile at least three bone layers can be clearly characterized cup revision (2), there were no cases of unacceptable migra-
at SB: the SB plate (SBP), a dense trabecular bone (trabecular tion (proximal migration more than 1 mm). However, there
SB) and the subarticular trabecular bone. Furthermore, two were 15 (68 %) cases of patients at risk (proximal translation
different TZ between these layers could be distinguished. SBP of 0.2–1.0 mm) in the low BMD group, while there were only
thickness was diminished in OP, OA and OPOA groups with two such cases among patients with normal BMD (p=0.021).
respect to healthy (p<0.05). Some of the other variables There has not been any radiographic loosening or revisions of
analyzed (Tb.Th, Tb.Sp, Tb.N, polar moment of inertia and the cups to date.
Tb.Pf) show the same behavior. As well, the dispersion curves Conclusion: This study represents the first evidence of de-
of the parameters analyzed showed a consistent displacement layed stabilization of uncemented cups in female patients with
of the TZ toward the joint surface in all the groups. low systemic BMD.
Conclusion: In this work, it seems to predict the existence at References: (1) Aro et al. Acta Orthop 2012; 83:107, (2) Pijls
least of three different microstructural layers at SB level and et al. Acta Orthop 2012; 83:583.
two different TZ between them. As well, there was a clear and Acknowledgements: The study was supported by the Acad-
concordant displacement toward the superficial areas of the emy of Finland.
joint in all experimental groups, transforming the biomechan-
ics of SB that might partially explain the OA aggravation in
rabbits with previous OP. P336
EFFECT OF ADJUVANT THERAPY ON BONE
MINERAL DENSITY IN PATIENTS WITH BREAST
P335 CANCER
FEMALE PATIENTS WITH LOW SYSTEMIC BMD M. Tsagareli1, E. Giorgadze2, N. Khachidze3, N. Sharikadze4,
EXHIBIT AN INCREASED CUP MIGRATION AFTER N. Dolidze2, T. Sulikashvili1, N. Jeiranashvili1
1
TOTAL HIP REPLACEMENT Skeletal Endocrinology Unit, National Institute of Endocri-
H. T. Aro1, S. Finnilä2, E. Svedström3, N. Moritz2 nology, Tbilisi, Georgia, 2National Institute of Endocrinology,
1
Department of Orthopaedic Surgery, Turku University Hos- Tbilisi, Georgia, 3Clinic Curatio, Tbilisi, Georgia, 4Clinic
pital, Turku, Finland, 2Orthopaedic Research Unit, University MediClub, Tbilisi, Georgia
of Turku, Turku, Finland, 3Department of Diagnostic Radiol-
ogy, Turku University Hospital, Turku, Finland Objective: To assess the effect of aromatase inhibitors (AIs)
and selective estrogen receptor modulators (SERMs) on BMD
Objective: Osteoporosis may jeopardize initial stability of in patients with breast cancer.
cementless components in total hip replacement of postmen- Material and Methods: 38 Caucasian women (41–78 years)
opausal women. Indeed, low systemic BMD and age-related were enrolled in the study. Twenty-one patients were receiving
geometric changes of the proximal femur have been found to AIs, 17 patients - SERMs (tamoxifen). We have measured
increase initial migration of cementless femoral stems in fe- BMI, calcium ionized (Ca++); lumbar spine (LS) and proxi-
male patients (1). It is possible that low BMD compromises mal femur (PF) BMD values were obtained using DXA.
the early stability of cementless acetabular cups as well. Twenty-one women on AIs therapy were grouped in two
Osteoporos Int

major subgroups - 11 women, who were diagnosed to have in DK men per period. The corresponding IRR per birth
Osteopenia and started with OB (oral bisphosphonate) and 10 cohort ranged from 1.15–3.13 in SE women, 1.07–1.78 in
women - normal BMD, no particular therapy aimed to BMD SE men, 1.07–1.67 in DK women and 0.85–1.14 in DK men.
values. Seventeen women receiving tamoxifen with normal Relative period effects increased with successive period for
BMD on DXA were not given any antiresorptive medication. men and women in SE and described a convex curve for both
DXA BMD values were assessed in two points of research men and women in Denmark with higher than expected risk in
before and after therapy with the interval of 12 months. the periods in the middle of the examination years. Relative
Results: After 2 years interval in AIs group BMD loss was cohort effects were increasing with successive birth cohort for
calculated in 11 women (with osteopenia and treated with OB) both genders in both countries but with markedly lower risks
- DXA bone loss estimated to 1.7 %, 10 women not treated for DK women born 1925–44 and DK men born 1929–52 and
with antiresorptive agents showed bone loss up to 5 % (lumbar a lower risk for SE women born 1933–44.
spine - median loss 4.2 %, total hip median loss 3.8 %). In 17 Conclusion: Cohort and period effects were different in SE
women treated with SERMs - tamoxifen positively affected and DK. This may in part be referred to differences in general
BMD - in lumbar spine 2.1 %, and total hip 1.3 %, respectively. health as evident in differences in life expectancy and to
Conclusion: An AI treatment is associated with significant differences in exposure to war and famine as well as differ-
BMD loss (5 %). Nonsignificant BMD increase was observed ences in use of osteoporosis drugs.
in patients who had been receiving SERMs (tamoxifen).

P338
P337 SCLEROSTIN SERUM LEVELS ACCORDING TO
HIP FRACTURES IN SWEDEN AND DENMARK GENDER IN TYPE 1 DIABETES MELLITUS:
1987–2010: PERIOD AND COHORT EFFECTS ASSOCIATIONS WITH BONE MASS, TURNOVER
B. Abrahamsen1, C. Cooper2, J. Bjork3, B. Rosengren4 MARKERS AND CLINICAL FEATURES
1
Research Centre for Ageing and Osteoporosis, Department A. Catalano1, N. Morabito1, B. Pintaudi1, G. Di Vieste1, A. Di
of Medicine M, Glostrup Hospital, Glostrup, Denmark, Benedetto1, A. Lasco1
2 1
MRC Lifecourse Epidemiology Unit, Southampton General University of Messina, Department of Clinical and Experi-
Hospital, Southampton, United Kingdom, 3Unit for Medical mental Medicine, Messina, Italy
Statistics and Epidemiology at R&D Centre Skane, Skane
University Hospital Lund, Lund, Sweden, 4Clinical and Mo- Objective: SOST gene product, sclerostin, is an osteocyte-
lecular Osteoporosis Research Unit, Department of Orthope- derived glycoprotein which works as inhibitor of the Wnt/β
dics and Clinical Sciences, Skane University Hospital Malmo, Catenin signaling, a critical pathway for osteoblast prolifera-
Lund University, Malmo, Sweden tion and activity. Published data on sclerostin levels in type 1
diabetes mellitus (T1DM) are few. Aims of our research were
Objective: The reasons for the recent decrease in hip fracture to investigate gender differences in sclerostin serum levels,
rates remain unclear. While current antiosteoporosis efforts and the associations between sclerostin, bone mass, bone
are important also factors earlier in life seem essential and we metabolism and the main clinical characteristics of subjects
examined age-period-cohort (APC) effects in hip fracture with T1DM.
incidence in the Sweden (SE) and Denmark (DK). Material and Methods: Sixty-nine T1DM Caucasian sub-
Material and Methods: We studied the entire populations jects (mean age 33.7±8.1; 51 % females) were consecutively
aged ≥50 years from 1987 to 2010 in SE and DK and enrolled in this study and evaluated for the presence of dia-
ascertained acute hip fractures in nationwide discharge regis- betic related complications. BMD was measured by quantita-
ters using diagnosis and surgical procedure codes for proximal tive ultrasound (QUS) at phalangeal site. Markers of bone
femoral fracture. APC effects were evaluated country specific resorption (PYR, D-PYR, OH-PRO) and bone formation (B-
by log likelihood estimates in Poisson regression models (with ALP and BGP) were assessed in addition to sclerostin.
adjustment for sex and a scale parameter included to account Results: D-PYR and sclerostin were significantly higher in
for overdispersion). Results are presented as Incidence Rate women in comparison to men (P=0.04). In the whole study
Ratios (IRR) compared to the most recent 3-year period population, a disease duration greater than 15 years was associ-
(2008–2010) or 6 year birth cohort (1953–60). ated to higher sclerostin levels (P=0.03). Bone turnover markers
Results: During the examined years there were 399,596 hip and QUS parameters were not correlated to sclerostin. A signif-
fractures in SE and 207,304 in DK. The combined period and icant negative correlation was observed between QUS parame-
cohort effects were generally stronger in SE than DK and in ters, BMI and OH-PRO. Sclerostin serum levels correlated with
women than men. IRR ranged from 1.05–1.30 in SE women, homocysteine (r=−0.34; P=0.005) and vitamin B12 (r=−0.31;
1.04–1.18 in SE men, 1.21–1.11 in DK women and 0.95–1.11 P = 0.02). Generalized linear model showed that
 Osteoporos Int

macroangiopathy was the only predictor of sclerostin serum Conclusion: Osteoporosis and osteoarthritis can coexist. An
levels (beta=−11.8, 95%CI from −21.9 to −1.7; P=0.02). inverse association between severity of osteoarthritic impair-
Conclusion: Our data demonstrate that T1DM women exhibit ment and mean femoral neck T-score. After pooling, mean
higher sclerostin levels than men, and that circulating sclerostin is lumbar spine or femoral neck T-scores of patients with severe
not associated with bone turnover markers and phalangeal QUS osteoarthritic impairment were significantly lower than those
measurements. Macroangiopathy predicted sclerostin levels, sug- of patients with less impairment.
gesting a role for sclerostin in vascular pathophysiology.

P340
PREVALENCE OF VITAMIN D INADEQUACY IN
P339 EUROPEAN WOMEN AGED OVER 80 YEARS
OSTEOARTHRITIS SYMPTOMS ARE NEGATIVELY O. Bruyère1, J. Slomian1, C. Beaudart1, F. Buckinx1, E.
CORRELATED WITH BMD IN POSTMENOPAUSAL Cavalier2, S. Gillain3, J. Petermans3, J.-Y. Reginster1
1
WOMEN University of Liège, Liège, Belgium, 2Department of Clinical
G. Lyritis1, M. Mpallas2, E. Chronopoulos3, A. Galanos4, C. Chemistry, University of Liege, CHU Sart-Tilman, Liège,
Sfontouris2, S. Rizou1, I. Dontas4 Belgium, 3Geriatric Department, CHU Liège, Liège, Belgium
1
Hellenic Osteoporosis Foundation, Athens, Greece,
2
Evangelismos General Hospital, Athens, Greece, Objective: Inadequate vitamin D level is associated with sec-
3
Konstantopoulion Hospital, Athens, Greece, 4Laboratory for ondary hyperparathyroidism and increased bone turnover and
the Research of the Musculoskeletal System, Athens, Greece bone loss, which in turn increases fracture risk. The objective of
this study is to assess the prevalence of inadequate serum vitamin
Objective: The relationship between severity of symptoms of D levels in European women aged over 80 years.
osteoarthritis with T- score at the spine and femoral neck is Material and Methods: Assessments of 25-hydroxyvitamin D
examined in postmenopausal osteoporotic or osteopenic women. levels [25(OH)D] were performed on 8,532 European women
Material and Methods: The severity of osteoarthritic pain with osteoporosis or osteopenia of which 1984 were aged over
and functional disability of a randomly selected population of 80 years. European countries included in the study were: France,
postmenopausal women with osteopenia or osteoporosis was Belgium, Denmark, Italy, Poland, Hungary, United Kingdom,
prospectively investigated. Participants with recent injury, Spain and Germany. Two cut-offs of 25(OH)D inadequacy were
inflammatory arthritis or malignancies of the musculoskeletal fixed: <75 nmol/L (30 ng/ml) and <50 nmol/L (20 ng/ml).
system were excluded. The number of symptomatic joints and Results: Mean (SD) age of the patients was 83.4 (2.9) years,
the degree of osteoarthritic impairment (none, mild, moderate, BMI was 25.0 (4.0)kg/m2 and level of 25(OH)D was 53.3
severe) at the knee, hip, neck or hand were recorded. Site- (26.7)nmol/L (21.4 [10.7] ng/ml). There was a highly signif-
specific internationally validated osteoarthritis questionnaires icant difference of 25(OH)D level across European countries
are used (for the knee and hip used Lequesne, for the cervical (p<0.0001). In these women aged over 80 years, the preva-
spine Vernon Mior and for the hands Michigan). IBM SPSS lence of 25(OH)D inadequacy was 80.9 % and 44.5 % when
17 software was used for statistical analysis. considering cutoffs of 75 and 50 nmol/L, respectively. In the
Results: Of the 3,900 women screened, 3,000 met the inclu- 397 (20.0 %) patients taking supplemental vitamin D with or
sion criteria. An inverse relationship between severity of without supplemental calcium, the mean serum 25(OH)D
osteoarthritic impairment and mean femoral neck and spine level was significantly higher than in the other patients (65.2
T-score was observed (Figure 1). There was a significant (29.2) nmol/L vs. 50.3 (25.2) nmol/L; P<0.001).
difference in mean femoral neck T-score between patients Conclusion: This study indicates a high prevalence of vitamin
with severe osteoarthritic impairment and those with no, mild, D [25(OH)D] inadequacy in old European women. The prev-
or moderate impairment (all p<0.005). alence could be even higher in some particular countries.
Figure 1: Relationship between mean lumbar spine T-score
(A) and mean femoral neck (B) T-score and osteoarthritis pain
and functional disability score. P341
TRABECULAR BONE LOSS IS UNDERESTIMATED
IN POSTMENOPAUSALWOMEN: HOW TO
IMPROVE THE ASSESSMENT–THE OFELY STUDY
R. Ellouz1, R. D. Chapurlat1, E. Sornay-Rendu1, P. Szulc1, S.
Boutroy1
1
INSERM UMR 1033, Université de Lyon, Hôpital E Herriot,
Lyon, France
Osteoporos Int

Objective: Definition of cortical (Ct) and trabecular (Tb) Material and Methods: The period from 1.3.2011 to
compartments is crucial for bone loss assessment. Age- 1.3.2012 in the department of physical medicine and rehabil-
related Ct thinning produces remnants that are artefactually itation in Nis R Serbia, trial included 298 elderly patients over
considered as Tb bone. In longitudinal studies, accurate as- 75 diagnosed with osteoporosis 10 years ago, based on
sessment of Ct and Tb bone loss in their original compart- osteodensitometry (T-score −2.5), clinical features, the pres-
ments would permit to determine true bone loss. Our goal was ence of more than two risk factors. The analyze of the found
to compare Ct and Tb bone loss assessed by HR-pQCT at the out that in 88 (29.53 %) patients reported a fracture in less
distal radius over 6 years, using standard procedures and trauma or spontaneously without trauma compression fracture
baseline-defined compartments after 3D registration. of the vertebrae also occur repeated breaks of a few months or
Material and Methods: Forty-six postmenopausal women years.
(60±7 year) were measured by HR-pQCT at the distal radius Results: Results of the work of the total number of respon-
at baseline and after 6 year. The longitudinal analysis was dents 298, no fracture was 210 (70.47 %) patients, while
performed using three methods: osteoporotic fracture occurred in 88 (29.53 %) and in 83
- Method 1: Standard software: volume of interest (VOI) iden- (94.21 %) representative from the female population and in
tified by cross-sectional area (CSA) matching, Ct and Tb bone 5 (5.69 %) men.
separated by filtering and thresholding. - Method 2: VOI based Conclusion: Osteoporotic fractures were low-energy frac-
on CSA matching and double contouring of the Ct bone tures that occur spontaneously (vertebra) or in the fall (hip).
- Method 3: VOI based on 3D registration and double Osteoporosis is a significant risk factor for Op Fx (osteopo-
contouring of the baseline compartment used for all scans. rotic fractures). Op Fx may be symptomatic or even asymp-
Results: Tb bone volume (Tb.TV) increased with methods 1 tomatic. Op Fx may be symptomatic or even asymptomatic.
and 2 (2.6 and 2.1 %, p<0.001) confirming that Ct remnants Op Fx have their medical socio-economic implications. Op Fx
are considered as Tb bone during follow-up. Tb BMD de- are accompanied by difficulties in activities of modern life,
creased by −4 % and −3 % (p<0.005) with those methods but and only a third of patients reach prefracture quality of life.
was not significantly different between the two methods. The main risk factors for Fx are female sex, age, estrogen
Albeit both significant, decrease in Ct thickness was lower deficit, low weight and BMI, osteoporosis in the family,
using method 2 than method 1 (−6 % vs. −15 %; p<0.001). smoking, and previous Fx. Low BMD, decrease in physical
When Tb.TV was kept constant with method 3, the decrease strength and bone geometry, gracility. The biggest socio-
in Tb BMD was markedly higher than those obtained with economic problems are hip fractures with significant mortality
methods 1 and 2 (−10 % vs. −4 % and −3 %, respectively, of 12–20 % in the first year and major disability over 50 %.
p<0.01). Moreover, the increase in Ct porosity (Ct.Po) was
greater (92 vs. 65 %, p<0.01) and consistent with a greater
decrease in Ct BMD (−6 % vs. −5 %; p<0.01) than that
obtained with method 2. P343
Conclusion: With an accurate registration technique, Tb and SERUM PERIOSTIN IS INDEPENDENTLY
Ct bone loss can be assessed in their original compartments, ASSOCIATED WITH OSTEOPOROSIS- RELATED
therefore precluding the artefactual underestimation of Tb FRACTURE RISK AMONG POSTMENOPAUSAL
bone loss and Ct.Po increase observed with standard WOMEN: THE CEOR STUDY
procedures. M. S. M. Ardawi1, A. A. Rouzi2, S. A. Al-Sibiani2, N. S.
Senani2
1
Center of Excellence for Osteoporosis Research and Depart-
P342 ment of Clinical Biochemistry, Faculty of Medicine, King
THE PREVALENCE OF OSTEOPOROTIC Abdulaziz University Hospital, King Abdulaziz University,
FRACTURES IN THE ELDERLY POPULATION Jeddah, Saudi Arabia, 2Center of Excellence for Osteoporosis
T. Petrusic1, N. Mandic1 Research and Department of Obstetrics and Gynecology,
1
Dom Zdravlja Nis, Nis, Serbia Faculty of Medicine, King Abdulaziz University Hospital,
King Abdulaziz University, Jeddah, Saudi Arabia
Objective: Osteoporosis is a metabolic bone disease that
results in fractures and occurs in women of postmenopausal Objective: Periostin (POSTN) is a secreted extracellular ma-
age and men over 60. Osteoporosis follows encumbered mo- trix protein preferentially expressed in bone by osteocytes and
bility, pain in the lower back and joint pain, spasms and periosteal osteoblasts. Decreased POSTN expression may
weakness and muscle, decrease body height, increase the risk affect osteoblast differentiation and collagen type 1 synthesis
of bone fractures and spontaneous fracture. BMD, bones predisposing to low BMD, osteoporosis and increased risk of
become porous and brittle and break easily. fracture. We therefore hypothesized that postmenopausal
 Osteoporos Int

women with increased circulating POSTN levels have a great- primary care records, hospital admissions, and pharmacy
er risk for osteoporosis-related fractures (ORFs). invoice data for >5 million patients (80 % of the population)
Material and Methods: We examined the association be- in Catalonia, Spain. We selected all newly diagnosed T2DM
tween circulating POSTN [measured by ELISA method, patients registered in SIDIAP in 2006–2010. Up to 2 diabetes-
(USCNK-Life Science Inc., China)] levels and the risk of free controls were matched to each T2DM participant on age,
ORFs in 707 postmenopausal women, 50 years of age or older gender, and primary care center. Main outcome was incident
in a population-based study with a mean follow-up period of hip fracture in 2006–2011, using ICD10 codes. We used Fine
5.2±1.3 years. Multivariate Cox proportional- hazards regres- and Gray survival modelling to estimate risk of hip fracture
sion models were used for analysis of the risk of fracture with according to T2DM status accounting for competing risk with
adjustment for age, body-mass index and other potential risk death. Multivariate models were adjusted for BMI, previous
factors that may be associated with the risk of fracture or with fracture and use of oral corticosteroids.
higher circulating levels of serum POSTN. Results: We identified 58,483 T2DM patients and 113,448
Results: High serum POSTN levels were associated with an controls, who were observed for a median (interquartile range)
increased risk of ORFs. Following adjustment for age and of 2.63 (2.93) years. 444 (0.8 %) T2DM patients sustained a
other confounders, the relative risk of ORFs for each incre- hip fracture in the study period (incidence rate 2.7/1,000
ment of 1 SD in POSTN level was about 2.3-fold among person-years) compared to 776 (0.7 %) matched controls
postmenopausal women [RR=2.36 (95%CI: 1.13–3.66)]. (2.4/1,000). This is equivalent to an unadjusted (age and
Further, women in the highest quartile of POSTN levels had gender-matched) SHR 1.11 [0.99–1.24], and adjusted SHR
an increase in the risk of ORFs so that the risk was 3.6-fold for 1.20 [1.06–1.35]. In stratified analyses, the excess risk asso-
POSTN. The risk of ORFs that was attributable to POSTN ciated with T2DM was highest amongst T2DM patients with
levels (in the highest quartile) was estimated at 35.8 %. The prevalent IHD (adjusted SHR 1.39 [0.98 to 1.98]), CKD
association between POSTN levels and the risk of fracture (adjusted SHR=1.26 [1.03 to 1.55]) or grade 2 obesity (ad-
seems to be independent of BMD and other confounding risk justed SHR 1.37 [0.92 to 2.06]).
factors for fracture. Conclusion: Newly diagnosed T2DM patients are at a 20 %
Conclusion: Higher serum POSTN levels are associated with increased risk of hip fracture even in early stages of disease.
a greater risk of ORFs independent of several other risk factors More data is needed on the causes for an increased fracture
among postmenopausal women. Serum POSTN measurement risk in T2DM patients as well as on the predictors of osteo-
could be useful to improve fracture risk assessment. porotic fractures among these patients.

P344
HIP FRACTURE RISK IN INCIDENT TYPE 2 P345
DIABETIC PATIENTS: A POPULATION-BASED STUDY OF THE CORRELATION BETWEEN ANTH
PARALLEL COHORT STUDY ROPOMETRIC INDICATORS AND TRIGLYCERIDE
D. Martinez-Laguna1, C. Tebé2, C. Carbonell-Abella1, A. LEVELS IN POSTMENOPAUSALWOMEN
Conesa-Garcia1, X. Nogués-Solan3, A. Diez-Perez4, D. PARTICIPANTS OF THE PHYSICAL EXERCISE
Prieto-Alhambra5 PROGRAM FOR OSTEOPOROSIS
1
Institut Catala de La Salut, Barcelona, Spain, 2AQuAS, Bar- O. Matos1, C. Orsso1, P. Miranda1
celona, Spain, 3Department of Internal Medicine, Hospital del 1
Biochemistry and Densitometry Laboratory, Federal Techno-
Mar-IMIM and Autonomous University of Barcelona, Barce- logical University of Paraná (UTFPR), Curitiba, Brazil
lona, Spain, 4Hospital del Mar-IMIM-Autonomous Universi-
ty of Barcelona, Barcelona, Spain, 5Nuffield Department of Objective: To evaluate the correlation between anthropomet-
Orthopaedics, Rheumatology and Musculoskeletal Sciences. ric indicators of total and central obesity and triglyceride
University of Oxford, Oxford, United Kingdom levels in physically active postmenopausal women.
Material and Methods: We evaluated 47 postmenopausal
Objective: Type 2 diabetes (T2DM) and osteoporosis are two women, aged 60±6.1 years, participants of the Physical Ex-
prevalent chronic diseases. Data on the association between ercise Program for Osteoporosis. Triglyceride levels were
T2DM and osteoporotic fractures is controversial. We esti- measured by colorimetric assays (Mindray) after 12 h fasting.
mated hip fracture rates in newly diagnosed T2DM patients, Total obesity was assessed using BMI and the percentage of
and compared these to matched nondiabetic peers. total body fat was measured with DXA (Hologic Discovery
Material and Methods: We conducted a population-based A). Central obesity was assessed from the waist hip ratio
parallel cohort study using data from the SIDIAP Database (WHR), abdominal circumference (AC) and abdominal fat
(www.sidiap.org). SIDIAP contains clinical information from percentage measured with DXA. Person’s test was used.
Osteoporos Int

Results: The mean value of BMI (27.2±5.1 kg/m2) classified protective effects of EEA on trabecular bone. EEA tended to
the group as pre- obese, while the percentage of total fat increase in trabecular thickness (Tb.Th) and trabecular bone
indicated high values 38.2±4.4 %. All central obesity indica- volume fraction (BV/TV). Treatment with EEA significantly
tors showed high values: WHR 0.84 ± 0.07; AC 95.7 ± decreased the level of trabecular spacing (Tb.Sp).
12.4 cm; abdominal fat percentage 37.4±6.7 %. The percent- Conclusion: These findings indicate that EEA could be de-
age of total body fat was strongly correlated with BMI veloped as a potential therapeutic agent for inflammation and
(0.751); abdominal fat percentage was positively correlated osteoarthritis.
with WHR (0.588) and a strong correlation with AC (0.712). Acknowledgements: This research was supported by a grant
Only 14.9 % of the sample had elevated triglyceride levels from the Next- Generation BioGreen 21 Program (No.
(≥150 mg/dL), and the mean values (96.4±37.2 mg/dL) were PJ009551), Rural Development Administration, Republic of
reflected below the expected values for this age group. Tri- Korea.
glyceride levels showed positive but weak correlation only
with WHR (0.390 p=0.007).
Conclusion: The triglyceride levels had a weak but statisti- P347
cally significant correlation only with WHR, showing that this CONTRIBUTION OF BONE ARCHITECTURE TO
can be a good indicator of fat in the abdominal region. Low FRACTURE RISK EVALUATION
levels of triglycerides can be explained by the use of lipid- S. Cappelle1, A. Peretz1, R. Karmali1, S. Rozenberg2, C.
lowering drugs and physical exercise. Both obesity indicators Muhire1, M. Moreau3, M. Paesmans3, P. Bergmann4, J. J.
denoted that the group had high fat levels, more than the ideal Body1
1
for the age, increasing the development of heart diseases. Department of Medicine, CHU-Brugmann, ULB, Brussels, Bel-
However, this overweight provides a protective effect in the gium, 2Department of Obstetrics & Gynaecology, CHU Saint-
bones of this population, since a higher overload on them Pierre, Free University of Brussels, Brussels, Belgium, 3Data
prevents the decrease of the BMD. Center - Institut J. Bordet - ULB, Brussels, Belgium, 4Department
of Nuclear Medecine and Laboratory Experimental Medecine
- CHU Brugmann - ULB, Brussels, Belgium
P346
EFFECTS OF ETHANOL EXTRACT OF AMOMUM Objective: The WHO FRAX is the most used of fracture risk
TSAO-KO ON ANTI- INFLAMMATORYAND models though it does not include some significant risk factors
ANTI-OSTEOARTHRITIC ACTIVITIES IN VITRO and its predictive value remains suboptimal. One of the vari-
AND IN VIVO ables which could influence significantly fracture prediction is
Y. J. Park1, E.-K. Ahn1, S. S. Hong1, J. S. Oh2 bone geometry and architecture. The aim of this project is to
1
Natural Products Research Institute, Gyeonggi Institute of examine if bone architecture and resistance parameters mea-
Science & Technology Promotion, Suwon-si, Republic of sured by HR-pQCT in a subgroup of women who have
Korea, 2 College of Pharmacy, Dankook University, undergone a fragility fracture to a control group without
Cheonan-si, Republic of Korea fracture but with the same level of absolute fracture risk by
the FRAX model.
Objective: Amomum tsao-ko is well known to use in tradi- Material and Methods: This ongoing project is a nested case
tional medicine for the treatment of stomach inflammation and control study carried out within the Fracture RISk Brussels
lipid problems. Epidemiological Enquiry (FRISBEE study) on postmeno-
Material and Methods: This study was investigated to de- pausal and senile osteoporosis. FRISBEE is a prospective
termine whether the ethanol extract of Amomum tsao-ko observational study including 3,578 women of the Brussels
(EEA) influenced on inflammation reaction in lipopolysac- area, aged from 60 to 85 years, recruited since 5 years (2007–
charide (LPS)-stimulated RAW264.7 murine macrophages 2013) who will be followed up for 10 years. BMD and clinical
and the temporal changes in the tibial subchondral bone risk factors (CRFs) (included or not in the FRAX) were
architecture in monosodium- iodoactate(MIA)-induced osteo- recorded at inclusion, with the aim of building a risk model
arthritis rat model. allowing absolute fracture risk prediction and comparing the
Results: The results showed that EEA inhibits lipopolysac- weight of the different CRFs. A fragility fracture was already
charide (LPS)-induced nitric oxide (NO) and prostaglandin E2 reported in 144 women included during the first 3 years. Three
release through down-regulation of NO synthase and controls are selected for each fracture case to match the FRAX
cyclooxygenase-2, respectively. In addition, treatment with estimation of fracture risk. All subjects have a HR-pQCT
EEA suppressed the expression of LPS-induced inflammatory (Scanco Medical AG, Bassedorf, Switzerland) at the radius
cytokines such as IL-6, IL-10, and TNF-α in LPS-stimulated and tibia, as well as a second DXA and a complete re-
RAW264.7 cells. In animal study, μCT analysis showed evaluation of their CRFs.
 Osteoporos Int

Results: Several studies have demonstrated that some structural Objective: Pregnancy and lactation have been related with
parameters, from morphometry and from the Finite Element temporary decreases in maternal BMD. Nutrition during these
Analysis, can discriminate patients with fragility fracture. Condi- periods could be key on maternal bone preservation. Long-
tional logistic regression models will be used to estimate whether chain polyunsaturated fatty acids (LCPUFAs) and prebiotic
the HR-pQCT parameters as well as other CRFs (not included in have been shown to have healthy effects on age-associated
the FRAX) contribute significantly to the risk of fracture. bone loss. Currently, maternity is becoming closer to
Conclusion: This study should demonstrate if HR-pQCT the perimenopause period with the subsequent negative
derived morphometric parameters and bone strength predict effect of increasing the risk of bone loss associated to
fracture risk independently of DXA and FRAX score. the onset of menopause. Therefore, strategies addressed
to reduce maternal bone loss are crucial to delay bone
deterioration later in life. The aim of this study was to
P348 compare the effectiveness of calcium fortification vs.
EXPRESSION OF GAP JUNCTION PROTEINS prebiotic supplementation or LCPUFAs fortification in
CONNEXINS 26, 30, AND 43 pregnant rats as a nutritional approach to reduce bone
L. A. Holzer1, A. Cör2, G. Holzer3 loss produced during gestation and lactation.
1
1Department of Orthopaedic Surgery, Medical University of Material and Methods: Pregnant Sprague Dawley rats were
Graz, Graz, Austria, 2Faculty of Health Sciences, University divided into four groups: Control group (CC group) was fed
of Primorska, Izola, Slovenia, 3Department of Orthopaedics, with a standard semipurified diet until the end of the lactation
Medical University of Vienna, Vienna, Austria period. Ca group, Pre group and LCPUFAs were fed with the
same diet fortified with 0.5 % calcium carbonate (total calci-
Objective: Dupuytren’s disease (DD) is a benign um content 1 %), supplemented with an inulin-type fructans
fibroproliferative process of the palmar aponeurosis showing (7.5 % of the total carbohydrate) or fortified with LCPUFAs
similarities to wound healing. Communication of cells involved (3.5 % Eupoly-DHA®), respectively. At the end of the lacta-
in wound healing is mediated by the composition of gap junction tion, BMD and bone mineral content (BMC) were determined
(GJ) proteins. We investigated the expression of 3 GJ proteins, by DXA; bone volume fraction as well as 3D parameters of
connexins 26, 30, and 43 (Cx26, Cx30, and Cx43) in DD. trabecular architecture (trabecular number, thickness, separa-
Material and Methods: Fragments of Dupuytren’s tissue tion and connectivity density) were analyzed by μCT.
from 31 patients (mean age 56 (30–76) years, 24 male) were Results: In appendicular bones, higher BMD and BMC
analyzed immunohistochemically and compared to control were found for Pre and LCPUFAs groups as compared
tissue for expression of the GJ proteins Cx26, Cx30, and with calcium fortified group. Furthermore μCT data
Cx43 and also alfa-smooth muscle actin (α-SMA). showed that Pre and LCPUFAs groups had an increase
Results: 14 of 31 samples could be attributed to the involu- in bone volume/tissue volume, trabecular thickness, tra-
tional phase (α-SMA positive) whereas 17 samples had to be becular number and connectivity density value, with a
considered cords in the residual phase (α- SMA negative). concomitant reduction in the trabecular separation as
Expression of Cx26 and Cx43 was seen in 12 of the 14 compared not only with control but also and with cal-
samples from the involutional phase, and Cx30 was seen in cium fortification group.
7 of these. Only 4 of the 17 samples from the residual phase Conclusion: Based on our data, both prebiotic supple-
showed any Cx, and there was none in the controls. mentation as well as LCPUFAs fortification exert a
Conclusion: The high expression of GJ proteins Cx26, Cx30, protection on maternal skeleton during pregnancy and
and Cx43 in α-SMA positive myofibroblast-rich nodules, lactation. The beneficial effect may delay the onset of
which are characteristic of the active involutional phase of osteoporosis and its deleterious derived- consequences
DD, suggests that connexins could be a novel treatment target later in life.
for the treatment of DD.

P350
P349 CHEMICAL COMPOSITION OF BONES AND
NUTRITIONAL STRATEGY TO PROTECT LOWER INCISOR DENTIN IN MATURE RATS
MATERNAL BONE LOSS DURING GESTATION AND AFTER 60-DAYADMINISTRATION OF SODIUM
LACTATION AS AN APPROACH TO PREVENT BENZOATE
OSTEOPOROSIS LATER IN LIFE L. Galina1, L. Vladyslav2, T. Alexey2, M. Vitaly2
P. Bueno-Vargas1, M. Manzano1, M. L. Jiménez1, R. Rueda1, 1
National University of Physical Education and Sport of
J. M. Lopez-Pedrosa1 Ukraine, Kiev, Ukraine, 2Lugansk State Medical University,
1
Discovery R&D, Abbott Nutrition, Granada, Spain Lugansk, Ukraine
Osteoporos Int

Objective: To investigate of chemical composition of hip lower dose protocol with 90 kV and 150 mAs. Reconstruction
bone, mandible and lower incisor dentin in mature white rats diameter was 15 cm, slice thickness 1.3 mm, and convolution
after 60-day administration of sodium benzoate. kernel was ‘B’ for both scans. A BDC calibration phantom
Material and Methods: For the purposes of study we select- (QRM Möhrendorf, Germany) was used for conversion of HU
ed 105 rats with initial body weight of 200–210 g. The control to BMD values. MIAF-Spine was used to analyze total verte-
group received per os sodium chloride daily in dosage of 1 ml bral body volume and BMD. Additionally, mean and standard
of 0.9 % solution throughout 60-day observation period. The deviation of the HU values obtained in the three cylindrical
rest of the animals received per os sodium benzoate (SB) daily phantom inserts (0, 100, and 200 mg/cm3) were measured in
in dosage of 500 or 1,000 mg per 1 kg of body weight as 1 ml each of the 27 dataset pairs. All parameters were compared
of solution (groups B1 and B2, respectively). At the end of the between the two scans using matched pair t-tests (Wilcoxon
cycle of administration investigated the chemical composition signed rank test for the volume) and Pearson correlations
of the hip bone, mandible, and lower incisor dentin by gravi- coefficients (r). Dose reduction was estimated using
metric method. ImpactDose software (CT Imaging, Erlangen).
Results: By the 3rd day after the end of SB administration Results: Effective dose values for 90 kV are approximately
mineral content of hip bone and body of mandible in B1 group 60 % lower compared to 120 kV. BMD values were highly
was lower than that of the control group by 7.45 % and 8.27 % correlated but a significant offset (p<0.001) indicates differ-
and organic substances content—by 8.56 % and 6.54 %, ences in field inhomogeneity; segmented volume was not
respectively. The lower incisor dentin these deviations affected by the lower kV (p>0.5). All correlation coefficients
amounted to 5.88 % and 8.36 %. In readaptation period of were significant (p<0.001). Noise in the images assessed by
group B1 changes remained significant up to 15th day, when the standard deviation of the HU values of the phantom inserts
the share of mineral component was reduced by 5.29 % and of the vertebrae were significantly higher in the 90 kV scans:
4.83 %, while the proportion of organic substances—by 20.8±4.7 HU vs. 16.2±3.0 HU, 22.0±4.9 HU vs. 17.1±2.9
4.38 % and 5.29 %. Higher dose of SB (1,000 mg/kg) resulted HU, and 23.3±5.0 HU vs. 18.0±3.1 HU in the phantom insert
in more expressed changes—by the 3rd day after the end of with 0, 100, and 200 mg/cm3, respectively.
medication in the group B2 mineral content in the hip bone Conclusion: As expected, noise values were higher in the
and organic substances content decreased by 8.69 % and 90 kV protocol. However, increased noise had no effect on
9.24 %. In the readaptation period of group B2 revealed segmentation. The difference in calibrated BMD values indi-
changes recovered more slowly than in group B1: in the hip cates differences in the scan field inhomogeneity at 90 and
bone and the mandible deviation persisted up to 24th days, 120 kV requiring different corrections. As the correlation
and in the incisor dentin mineral content remained by 3.85 % between BMD values at 90 and 120 kV was very high, a
lower than the control. linear correction approach, e.g., based on the scans of the ESP
Conclusion: Daily per os SB in dosage of 500 mg/kg of body will suffice to obtain the same BMD results at 90 and 120 kV.
weight accompanied by a decrease of organic and mineral Acknowledgements: supported by BMBF Bioasset
substances in the hip bone, the body of the mandible, as well 01EC1005
as in lower incisor dentin. When increasing the dosage of SB
to 1,000 mg/kg, the severity of the changes increases.
P352
THE GROWTH HORMONE RECEPTOR GENE
P351 EXON 3 DELETION POLYMORPHISM HAVE
A LOW DOSE 3D QCT PROTOCOL FOR THE SPINE INFLUENCE ON IGF-1 LEVELS IN CHILDREN
K. Engelke1, A. Heinemann2, M. Krause3, O. Museyko1, C. TREATED WITH RHGH
C. Glüer4 W. Lepionka1, J. Łukaszkiewicz2, M. Kruk1, M. Jaworski1, E.
1
Institute of Medical Physics, University of Erlangen, Erlang- Czekuć-Kryśkiewicz1, M. Szalecki3, B. Parafiniuk1, E.
en, Germany, 2Institute for Forensic Medicine, University of Karczmarewicz1, A. Kępka1, P. Płudowski1, R. S. Lorenc1
Hamburg, Hamburg, Germany, 3Institute for Osteology and 1
Department of Biochemistry, Radioimmunology and Exper-
Biomechanics, University of Hamburg, Hamburg, Germany, imental Medicine, The Children’s Memorial Health Institute,
4
Biomedical Imaging, Diagnostic Radiology, University of Warsaw, Poland, 2Department of Biochemistry, Faculty of
Kiel, Kiel, Germany Pharmacy, Medical University of Warsaw, Warsaw, Poland,
3
Clinic of Endocrinology and Diabetology, The Children’s
Objective: To develop a low dose in vivo 3D QCT protocol Memorial Health Institute, Warsaw, Poland
for the spine.
Material and Methods: In 27 cadavers T6-L4 were scanned Objective: Patients treated with recombinant human growth
twice on a Philips MX8000: with 120 kV and 100 mAs and a hormone present interindividual variability regarding
 Osteoporos Int

responses to this therapy. The aim of the study was to verify a Objective: Secondary osteoporosis still remains
relationship between GHR exon 3 deletion polymorphism or subdiagnosed entity. The aim of this study was to analyze
other genetic factors in GHR gene promoter and effectiveness the pattern of hospital patients who have had the diseases
of rhGH therapy. where development of secondary osteoporosis is expected.
Material and Methods: Children (n=30) aged 3–16 years Material and Methods: Out of all medical records of the
old with somatotrophin pituitary insufficiency (n=20) and patients who were treated at the inpatient Clinic of Physical
Turner Syndrome (n=10), which began rhGH therapy and and Rehabilitation Medicine (n=531) in 1 year period, the
received the same rhGH doses for 3 months. After 3rd month patients who have had the diseases where development of
some doses was modified to ensure therapy safety for all secondary osteoporosis is expected were selected. Patients
children. Exon 3 deletion GHR gene polymorphism was de- were divided in two groups. The first group consisted of
tected by multiplex-PCR reaction and correlated with clinical patients whom secondary osteoporosis was diagnosed and
factors, which were measured after 3rd, 6th and 12th month. treated, and the second group consisted of patients whom
Statistical analyses for genetic associations (ANOVA) were diagnostic procedures for secondary osteoporosis presence
conducted with SPSS Statistics for Windows. were not performed.
Results: Patients homozygous d3/d3 (n=3) presented signif- Results: Out of total number of hospitalized patients (n=531),
icantly lower increases of IGF-1 (p = 0.028; 30.58 ± 13.2 % (n=70) have had the diseases where development of
34.06 ng/ml), than fl/d3 (n=10; 191.13±66.33 ng/ml) and fl/ secondary osteoporosis is expected. Secondary osteoporosis
fl (n=17; 122.31±105.92 ng/ml) genotypes after 3-month was diagnosed and treated in 20 % of these patients (n=14),
therapy. Exclusion of puberty patients and all children above and they presented the first group. In this group the most
13 years old made this relationship even more significant (p= frequent disease was spinal lesion, presented by 57.1 % (n=
0.005; p=0.0180, respectively). We did not observe any as- 8), followed by multiple sclerosis and rheumatoid arthritis
sociations between GHR genotypes and growth increases or with 14.3 % (n=2) each, than renal failure and malignoma
growth velocity as well as biochemical markers of bone with 7.1 % (n=1) each. Male patients formed 42.8 % (n=6) of
metabolism levels (CTx, PINP, PIIINP, NT- proCNP). Patients this group. The second group was presented by 80 % of
with at least one d3 allele (n=13) presented lower spin BMC selected patients (n=56). In this group the most frequent
and total body BMC after 12-month therapy (p=0.054; 19.02 disease was multiple sclerosis, presented by 39.3 % (n=22),
±6.06 %; p=0.059; 16.82±5.24 %, respectively). Sequence followed by malignoma with 26.76 % (n=15), than spinal
analysis of GHR gene promoter region did not show any lesion and diabetes mellitus with 10.7 % (n=6) each, and
polymorphisms or mutations which could influence on re- rheumatoid arthritis with 3.6 % (n=2). Ratio between males
sponse variability. and females was 1:1.
Conclusion: The genetic factors have significant influence on Conclusion: Patients with certain diseases, like multiple scle-
effectiveness of rhGH therapy. Exon 3 deletion GHR gene rosis, spinal cord lesion, diabetes mellitus, rheumatoid arthritis
polymorphism might determine IGF-1 level increase after 3- and malignoma, regardless on stage and time of disease oc-
month therapy, though it did not correlate with growth veloc- currence, demand higher attention for secondary osteoporosis
ity and growth increase. The further studies are required. diagnostic processing.
Acknowledgements: Financial support: CMHI Internal
Grants: 183/07. Acquiring of KingFisher mL
(ThermoScientific), ultra-low temperature freezers MDF- P354
U500Vx (Sanyo), Varioscan Flash (ThermoScientific), BONE MINERAL DENSITY OF PATIENTS WITH
Thermocycler C1000 (BioRad), electrophoresis system LOW-ENERGY FRACTURES
OWL D3-14, electrophoresis power supply EC 3000 XL N. Dedukh1, E. Pobel2, V. Maltseva1
1
(ThermoScientific), biological safety cabinet ESCO II Morphological Connective Tissue Laboratory, Institute Spine
(Labculture) and Captairbio were cofinanced by ERDF (EU and Joint Pathology National Academy of Medical Science,
Structural Funds) project POIG.02.01.00-14-059/09. Kharkov, Ukraine, 2Zaporozhye Medical Academy of Post-
graduate Education, Zaporozhye, Ukraine

P353 Objective: Osteoporotic fractures are a serious complication

SECONDARY OSTEOPOROSIS IN HOSPITAL of osteoporosis, however, a fracture that occurs at different
SAMPLE stages of life, can also affect on bone health and it can be a risk
K. M. Miladinovic1, N. V-H. Vavra-Hadziahmetovic1, D. C. factor for osteopenia and osteoporosis. Objective was to esti-
Celik1 mate BMD of patients with a history of low-energy fractures
1
Clinic of Physical and Rehabilitation Medicine, University before peak bone formation, physiological stability (up to
Clinical Centre, Sarajevo, Bosnia and Herzegovina 40 years) and after 40 years.
Osteoporos Int

Material and Methods: BMD was assessed by DXA (Ex- of secondary osteoporotic fracture prevention. After the rele-
plorer QDR, Hologic) of lumbar spine in three groups of vant literature search an assessment of the current healthcare
women with any location fractures: 1) n=42, median age system in Croatia and specifically of the University Hospital
51.19±1.83, fracture was in age 14.74±0.88; 2) n=32, medi- Centre Sestre milosrdnice in Zagreb was performed and mul-
an age 49.31±1.51, fracture was in age 33.72±0.73 and 3) n= tidisciplinary team was built. The programme was put forward
202, median age 62.23±0.58, fracture was in age 55.72±0.6. to the broader audience at the symposium which was held for
BMI was similar in all groups (27.71±0.86; 29.05±1.30; 29.6 the World Osteoporosis Day. The conclusions of the meetings
±0.37). were transformed into the action plan and implemented in
Results: BMD on the osteoporosis level was present in the everyday practice.
first group in 11.9 % of patients, on the osteopenia level in Results: A need for a systematic approach, where capture of
35.7 % and regular T-score was present in 52.4 % of patients; patients is automatic, a major involvement of the orthopaedic
in the second group was present osteoporosis level - 12.5 %, surgeon and a coordinator-based service were appreciated
osteopenia - 43.75 %, normal value - 43.75 %; in the third during the development of this secondary prevention pro-
group: osteoporosis - 39.1 %, osteopenia - 38.6 %, normal gramme. We set our goals, identified the patients with fragility
value - 22.27 %. The comparison of the T-score (one way hip fractures to be more appropriate for intervention, we
ANOVA) of three groups patients, it was found that the lowest agreed on the roles assigned for each member of the team
rates T-score (−1.89±0.09; p<0.05) was found for the third (including three dedicated nurses at the orthopedic surgeons’
group, the differences between the first and the second groups wards as coordinators), developed a questionnaire in order to
were not detected. In the third group of women risk factor is assess the risks for fragility fractures as a basis for cycle goals
menopause. and measurement what was done, looked for improvement
Conclusion: Patients with history of prior fracture have high risk and determined the evolving actions until goals are met. The
of developing osteopenia and osteoporosis. The results of our implementation of the programme started with no major dif-
study have important significance for clinical practice, because ficulties and the level of compliance is high.
patients with prior fracture need for osteoporosis prevention. Conclusion: We developed and implemented the coordinator-
based programme of secondary fractures. In this still ongoing
fracture liaison service we have seen that the system with
P355 dedicated coordinators is effective in our University Hospital
SETTING THE SECONDARY FRACTURE LIAISON Centre and is a potential model to become a standard of care
PROGRAMME AT THE UNIVERSITY HOSPITAL for patients with fragility fractures in Croatia.
CENTRE AS AN EXAMPLE FOR THE NATIONWIDE
SERVICE IN CROATIA
S. Grazio1, A. Matejcic2, D. Durdevic2, T. Nikolic1, M. P356
Punda3, D. Balen1, G. Tajsic1, M. Mustapic4, D. Miklic2, D. EFFECTIVENESS OF REHABILITATION PROGRAM
Car2, V. Altabas5, T. Nemcic1, F. Grubisic1, R. Kolundzic2, A. ON LOWER LIMB FUNCTIONAL STATUS AFTER
Muljacic2 KNEE ARTHROPLASTY
1
University Department of Rheumatology, Physical and Re- D. Matei1, A. Bighea1, S. Patru1, R. Traistaru1, R. S. Popescu1
1
habilitation Medicine, Clinical Hospital Centre Sestre University of Medicine and Pharmacy of Craiova, Craiova,
milosrdnice, Zagreb, Croatia, 2University Department of Romania
Traumatology, Clinical Hospital Centre Sestre milosrdnice,
Zagreb, Croatia, 3University Department of Nuclear Medicine Objective: To evaluate if the rehabilitation treatment can
and Oncology, Clinical Hospital Centre Sestre milosrdnice, improve pain control, improve muscle strength and ambula-
Zagreb, Croatia, 4Clinical Department of Diagnostic and In- tion in patients with knee arthroplasty (KA).
terventional Radiology, Clinical Hospital Centre Sestre Material and Methods: 27 subjects with recent total knee
milosrdnice, Zagreb, Croatia, 5University Department of In- arthroplasty were randomly assigned to either a group with
ternal Medicine, Clinical Hospital Centre Sestre milosrdnice, rehabilitation program started immediately after surgical in-
Zagreb, Croatia tervention (n=14), who received 12 supervised rehabilitation
sessions combined with exercises at home after KA, or to a
Objective: To plan, elaborate and apply a multidisciplinary control group (n=13), who received standard care. All partic-
secondary fracture liaison programme at the University Hos- ipants were evaluated at baseline (2 weeks after KA), 1 and
pital Centre in Croatia, as an example for the nationwide 6 months later. The patients’ functional status was evaluated
service in Croatia. by VAS for pain, the lower limb main muscle strength; also
Material and Methods: At the initiation meeting medical the 6-min walk test (6MWT) and quality of life (SF-36)
doctors of different specialties were informed on the concept assessed were performed at 6 month after KA.
 Osteoporos Int

Results: Subjects in the rehabilitation program group walked less mature (p < 0.013) than in non-inflammatory
longer distances using 1 cane (range, 20–24 m) in 6 min at the incuses.
2nd evaluation than subjects in the control group. At the Conclusion: Bone quality of stiffen incuses is well
second and third evaluation we found significantly lower adapted to their specific function. Inflammation de-
average pain scores and higher overall satisfaction than the grades architecture, increases microhardness and chang-
control group; the same patients also had less difficulty in es material characteristics; this partly explains the de-
performing daily activities. cline of hearing.
Conclusion: Complex rehabilitation programme appears to References: 1Kanzaki et al. 2006, Bone 39:414; 2Boivin et al.
be beneficial to patients with arthroplasty of the knee. The 2008, Bone 43:532; 3 Farlay et al. 2011, PLoS ONE
programme was effective in improving the short-term lower 6(12):e287; 4Farlay et al. 2010, J Bone Miner Metab 28:433.
leg functional ability. More intensive rehabilitation should be
promoted in all KA patients, to optimize functional outcomes
after surgery. P358
EFFECTIVENESS OF KINETOTHERAPY IN
PATIENTS WITH OSTEOARTHRITIS OF HIP
P357 D. Matei1, R. S. Popescu1, A. Bighea1, R. Traistaru1, S. Patru1
1
BONE QUALITYAND BIOMECHANICAL University of Medicine and Pharmacy of Craiova, Craiova,
FUNCTION: A LESSON FROM HUMAN OSSICLES Romania
F. Duboeuf1, B. Burt-Pichat1, D. Farlay1, P. Suy2, E. Truy2, G.
Boivin1 Objective: To determine the effects of therapeutic exercises
1
INSERM UMR 1033, Université de Lyon, Lyon, France, on the functional status of the hip, whether the effects of an
2
Pavillon U, ORL, Hôpital Edouard Herriot, Lyon, France exercise programme are sustained at 6 months’ follow up and
also the place of kinetotherapy in the complex rehabilitation
Objective: Human middle ear contains 3 ossicles (mal- program in patients with hip osteoarthritis (OA).
leus, incus and stapes) with a mechanical property high- Material and Methods: Twenty-five patients with prim-
ly specific (transmission of vibrations)1. In normal ossi- itive bilateral hip OA (1–3 Plain film grading) were
cles and in cases with inflammatory disease leading to a divided into 2 random groups. The patients in group I
decline in hearing (cholesteatoma), the bone quality of received medication (supplements, such as glucosamine
ossicles was rarely studied. Our purpose was to assess and chondroitin, NSAIDs or acetaminophen) and
the intrinsic bone quality and the mechanical properties nonpharmacologic therapies (lose weight through diet,
of incuses. rest of hip from overuse, electrotherapy); group II re-
Material and Methods: Thirteen inflammatory incuses from ceived the same treatment and kinetotherapy: low-
13 patients [12 cholesteatoma (54±20 year), 1 chronic otitis impact aerobics and strength training for the muscles
(30 year)], 15 non-inflammatory ones from 15 patients with- around the hip joint. Exercise programs were
out bone pathology (35±32 year), and human control cortical individualised to the patient’s specific needs, abilities
femoral samples, were used. Bones were analyzed by μCT, and preferences (resistance training, aerobic exercise
histology, microhardness2 and Fourier Transform InfraRed and flexibility exercises) and were continued by patients
Microspectroscopy (FTIRM)3–4. at home, daily. The patients’ functional status was eval-
Results: Incuses were compact without bone marrow and uated by VAS for pain, muscle strength across the hip
with sparse vessels. As the final size of incuses was and knee, ambulation speed before and at 6 months
obtained early during modeling, remodeling activity was later.
rarely observed (few osteoclasts, osteoblasts and osteoid Results: The results showed that the patients in each treated
tissue). In ossicles with either woven or lamellar tex- group had significant improvement in pain reduction com-
tures, many periosteocytic lacunae, sometimes empty, pared with their initial status. In the second group, the muscle
were present. Architecture of inflammatory incuses was strength was significantly improved (p<0.01), as were walk-
degraded. BMD of non-inflammatory incuses was higher ing time and speed (21 %, 32 %, respectively) and pain (10 %)
than that of control bone (p=0.003) and inflammatory after treatment and at 6 months later.
incuses (p=0.0001). Non-inflammatory incuses were less Conclusion: We found a stronger favorable effect on the level
hard than both control cortical bone (p = 0.003) and of pain when kinetotherapy was associated with pharmaco-
inflammatory incuses (p = 0.0001). Incuses were more logical treatment but therapeutical exercise associated to the
mineralized and less mature than control bone other nonpharmacological treatment had the greatest effect on
(p<0.001). Moreover, mineral of inflammatory incuses walking speed and also in decreasing of disability also at
was more carbonated (p = 0.011) and collagen matrix 6 months later.
Osteoporos Int

P359 Objective: To estimate the rate of oral bisphosphonate

THE PLACE OF KINETOTHERAPY IN compliance among Danish women and to examine the
REHABILITATION PROGRAM OF KNEE association of noncompliance with health care resource
OSTEOARTHRITIS PATIENTS use and cost.
D. Matei1, A. Bighea1, S. Patru1, R. Traistaru1, R. S. Popescu1 Material and Methods: Women aged 55 and over with a
1
University of Medicine and Pharmacy of Craiova, Craiova, prescription claim for the oral bisphosphonates alendronate,
Romania risedronate, or ibandronate were identified from the Danish
national health registries between 2003 and 2008. First pre-
Objective: To investigate the effects of therapeutic exercises scription claim was defined as index. Compliance was mea-
on the functional status of knee and also the place of sured as the medication possession ratio (MPR) during the
kinetotherapy in the complex rehabilitation program in pa- first 12 months post-index. Cost and health care resource use
tients with knee osteoarthritis (OA). was collected for the following 12 months.
Material and Methods: Sixty-two patients with primitive Results: Among the 38,234 women meeting the study inclu-
bilateral knee OA (I-III stage) were divided into two sion criteria, 29.9 % were noncompliant (MPR <70 %). Com-
random groups. The patients in group I received medi- pliance rates were 69.8 %, 66.5 %, and 77.3 %, respectively, in
cation (supplements, such as glucosamine and chondroi- patients taking alendronate, risedronate, and ibandronate.
tin, NSAIDs or acetaminophen) and nonpharmacologic Younger age was associated with higher odds of compli-
therapies (lose weight through diet, electrotherapy); ance (OR [95%CI] 1.22 [1.15–1.29] for ages 55–64 and
group II received the same treatment and kinetotherapy: 1.18 [1.12–1.24] for ages 65–74; reference age group
low- impact aerobics and strength training for the mus- ≥75 years). Rates of all-cause health care resource use
cles around the joint (increases stability and decreases were significantly higher in noncompliant subjects:
the likelihood of additional joint damage). The thera- 28.9 % vs. 23.0 % had inpatient admissions, 16.5 % vs.
peutic exercise were continued daily by patients, at 13.0 % had emergency room visits, and 48.7 % vs.
home. The patients’ functional status was evaluated by 43.3 % used outpatient services; P<0.001 for all compar-
VAS for pain, muscle strength across the knee (exten- isons. The total mean (SD) osteoporosis-related and all-
sion and flexion), ambulation speed, and Lequesne in- cause cost per patient (excluding office visits) was €626
dex before and 6 months later. (2344) and €4178 (7854), respectively. Compliant subjects
Results: The results showed that the patients with OA in each accrued significantly lower all-cause and OP- related cost
treated group had significant improvement in pain reduction than noncompliant subjects (Figure).
and in walking speed after treatment compared with their
initial status. In the second group, the muscle strength was
significantly improved (p<0.05), as were walking time (18 %)
and pain (21 %) after treatment and at 6 months later.
Conclusion: Therapeutical exercise associated to the other
nonpharmacological treatment had the greatest effect on pain
reduction after treatment and caused the greatest increase of
walking speed and decrease of disability at 6 months later after
treatment.

P360
COST AND HEALTH CARE RESOURCE USE
ASSOCIATED WITH NONCOMPLIANCE WITH
ORAL BISPHOSPHONATE THERAPY: AN ANALYSIS Conclusion: Approximately 30 % of the Danish female pop-
USING DANISH HEALTH REGISTRIES ulation over age 55 is noncompliant with bisphosphonate
J. Kjellberg1, A. Jorgensen2, P. Vestergaard3, R. Ibsen4, A. therapy. Noncompliance was significantly associated with
Krishna5 increased health care resource use and cost.
1
KORA - National Institute for Municipalities’ and Regions’ Disclosures: This study was supported by an unrestricted
Analysis and Research, Copenhagen, Denmark, 2MSD Den- grant from Merck & Co. AD Jorgensen is an employee of
mark, Ballerup, Denmark, 3Aalborg University, Aalborg, MSD Denmark. A Krishna is an employee of Merck & Co. P
Denmark, 4 iTracks, Århus, Denmark, 5 Merck & Co., Vestergaard: Travel grants from Novartis, Amgen, Servier,
Whitehouse Station, United States and Eli Lilly.
 Osteoporos Int

P361 Objective: Osteoporosis is defined as a reduction in bone

EFFECT OF SELECTED ANTIDEPRESSANT DRUGS mineral mass and bone quality, resulting in increased bone
ON RAT BONE LEVELS OF SCLEROSTIN AFTER fragility and increased fracture risk. Aim: To estimate the
ORCHIDECTOMY frequency of vertebral and nonvertebral fractures considering
V. Palicka1, S. Fekete1, M. Mzik1, I. Karesova1, P. Zivny1, H. the age.
Zivna2 Material and Methods: 763 examinees participated in the
1
Osteocentre, Charles University, University Hospital and study which was conducted from January to June 2013. 748 or
School of Medicine, Hradec Kralove, Czech Republic, 2Ra- 98 % were women and 15 or 2 % were men. Bone density of
dioisotope Laboratories and Vivarium, Charles University, the all participants was measured by DXA, by Hologic Dis-
School of Medicine, Hradec Kralove, Czech Republic covery C (S/N 83200) apparatus. Measures were done at the
femoral neck and lumbar spine (L1-L4). The existence of
Objective: Antidepressant drugs have a negative effect on vertebral and nonvertebral fractures was confirmed by the
bone metabolism. Sclerostin is a protein, which is produced radiography.
by osteocytes. Sclerostin works by inhibiting the Wnt and Results: The average age of the examinees was 65.02±9.31.
bone morphogenetic protein signaling pathways that are crit- Based on the value of T-score (spine/hip) 244 or 32 % of the
ical for osteoblast proliferation and activity. We determined examinees had the osteoporosis, 481 or 63 % had osteopenia
the effect of mirtazapin, trazadone and venlafaxin on bone and 38 or 5 % had a normal value of BMD. 176 or 46.24 % of
levels of sclerostin in the orchidectomized rats. the examinees had vertebral fractures and the total number of
Material and Methods: Rats were divided into five groups, the fractures was 189. 205 or 53.8 % of the examinees had
eight rats in each group. The sham-operated control group nonvertebral fractures and the total number of these fractures
(SHAM) and the control group after orchidectomy (ORX). The was 257. There were two examinees in the group under
three experimental groups after orchidectomy (ORX) received 40 years whom the fractures weren’t found. In the group
standard laboratory diet (SLD) enriched with mirtazapine - 40–50 years old, there were 33 examinees who did not have
ORX+MIRTA (1.98 mg/25 g of the diet), trazadone - ORX+ vertebral fractures and 4 nonvertebral fractures or 10.28 %
TRA (12 mg/25 g of the diet) and venlafaxin - ORX+VENLA were confirmed. There were 225 examinees from the age of
(12 mg/25 g of the diet) for 12 weeks. The levels of sclerostin 50–60 in the study who had 34 vertebral or 17.9 % and 47
were measured in a bone homogenates using the ELISA method. nonvertebral fractures or 18.3 %. From the age of 60–70
Results: Levels of sclerostin in ORX (0.249 ng/ml, n=8) was group, 60 (31.7 %) of 273 examinees had vertebral and 96
lower vs. SHAM (0.415 ng/ml, n=8). In ORX+MIRTA (37.35 %) nonvertebral fractures. 209 examinees belonged to
(0.389 ng/ml, n=8) and ORX+VENLA (0.339 ng/ml, n=8) the 70–80 group and 80 of them or 42.3 % had vertebral and
was higher vs. control group ORX with borderline statistical 95 or 36.9 % nonvertebral fractures. The last age group was
significance (p<0.05). In ORX+TRA (0.245 ng/ml, n=8) beyond 80 and there were 21 examinees, 15 of them or 7.9 %
levels of sclerostin were unchanged vs. control ORX group. had vertebral and 15 or 15.8 % nonvertebral fractures.
Conclusion: The results suggest that mirtazapin a velnafaxin Conclusion: The highest incidence of the vertebral fractures
have a negative effect on bone metabolism by inhibiting the 42.3 % was in the age group 70–80. In the age group 60–70
Wnt signaling pathway. Further studies will be needed to there was the highest incidence of the nonvertebral fractures
confirm these findings. 37.35 %.
Acknowledgements: The study was supported by a Research
Project of PRVOUK 37/11 Charles University in Prague
Project and MH CZ - DRO (UHHK, 00179906). P363
EFFECTS OF TRAINING WITH JUMPS IN THE
MECHANICAL PROPERTIES AND MINERAL BONE
P362 DENSITY OF OSTEOPENIC RATS
INCIDENCE OF VERTEBRAL AND G. R. Yanagihara1, A. G. Paiva1, A. P. Macedo1, A. B.
NONVERTEBRAL FRACTURES IN RELATION TO Morgenstern1, A. C. O. Penoni1, J. A. Tida1, G. A. Gasparini1,
AGE J. B. Volpon1, A. C. Shimano1
V. Culafic Vojinovic1, J. Vasic2, F. Gojkovic2, J. Elez1, N. 1
University of São Paulo, Ribeirão Preto, Brazil
Paunović3, J. Zvekic-Svorcan4
1
Internal Medicine, Railway Healthcare Center, Belgrade, Objective: To evaluate the effect of physical training jump
Serbia, 2Physical Medicine and Rehabilitation, Railway exercise on the mechanical properties and BMD of bone of
Healthcare Center, Belgrade, Serbia, 3Railway Healthcare rats submitted to tail suspension.
Institute, Belgrade, Serbia, 4Rheumatology, Special Hospital Material and Methods: 30 female Wistar rats were divided
for Rheumatic Diseases, Novi Sad, Serbia into three groups: Control Group (Gc), Suspension Group
Osteoporos Int

(GS), Suspension and Training Group (GST). The animals increase in fracture risk, and this effect may be mediated by
remained suspended all day for 3 weeks, being removed from an increase in bone turnover and in the rate of bone loss.
the suspension apparatus only once a day, for training, 20 Material and Methods: Measurements of bone turnover
jumps/day, 5 day/week. The animals were euthanized by markers for the bone substudy have been completed for a
overdose of anesthesia and femur and tibia were dissected. sub-set of postmenopausal women from the bone study, which
Mechanical tests were performed on the femur (flexion-com- included 1,410 postmenopausal women aged 40–70 years at
pression, 0.5 mm/min) and tibia (3-point bend test, 1.0 mm/ increased risk of breast cancer. Women were stratified by T-
min), to evaluate the maximum load and stiffness. To evaluate score at baseline; if the spine and hip T-score were both equal
the BMD we used DXA. or above −1.0, women were not offered any bisphosphonate
Results: The maximum load of the femur and tibia of the Gc (Stratum I), but advised to take calcium and vitamin D sup-
(105.61±8.43 N and 62.15±8.67 N) were similar (p>0.05) to plementation. Bone resorption by N-telopeptide of type I
the GST (91.74±14.18 N and 63.69±10.88 N) and these groups collagen (NTX) expressed as a ratio to creatinine (from a
were higher (p<0.01) compared to the GS (80.03±11.86 N and second morning void urine sample) were measured at base-
46.50±10.09 N). The stiffness of the femur was not different line, 6 months and year 1, and for 289 women bone turnover
between groups (p>0.05). The stiffness of the tibia of the Gc marker results were available for all three time points. Lumbar
(107.31±30.05 N/mm) was similar (p>0.05) to the GST (97.55± spine and total hip BMD were measured by DXA (Hologic or
13.46 N/mm) and these groups were higher than the GS (72.90± GE Lunar) at baseline, 1 and 3 years.
8.56 N/mm). The BMD of the femur and tibia of the Gc (0.22± Results: 289 postmenopausal women with normal BMD at
0.01 and 0.18±0.02 g/cm2) was similar (p>0.05) to the GST baseline (T-score≥−1.0) were included in this analysis
(0.21±0.01 and 0.17±0.01 g/cm2) and these groups were higher (anastrozole=142, placebo=147). The median annual rate of
(p<0.01) than the GS (0.18±0.01 and 0.14±0.01 g/cm2). bone loss was much greater at the total hip (−1.3 % vs.
Conclusion: The high-impact training with jumps generated −0.4 %) and lumbar spine (−1.3 % vs. −0.2 %) for women
positive effects on the mechanical properties and densitometry receiving anastrozole compared to placebo (P<0.0001)
of the femur and tibia of rats subjected to tail suspension. Rats (Table 1).
suspended by the tail without performing training showed
lower mechanical properties and BMD, but this deleterious
effect can be prevented with high-impact exercises (jump).
Acknowledgements: Coordination for the Improvement of
Higher Education Personnel and National Council for Scien-
tific and Technological Development

Conclusion: This is the first report of a large placebo-

P364 controlled trial investigating an aromatase inhibitor to show
EFFECT OF AROMATASE INHIBITION ON BONE a significant bone loss in women taking anastrozole, which is
DENSITYAND BONE TURNOVER IN HEALTHY likely due to an increase in bone resorption.
POSTMENOPAUSALWOMEN: RESULTS OF THE Disclosures: RE served as a consultant for AstraZeneca and
INTERNATIONAL BREAST CANCER received grant funding.
INTERVENTION STUDY II (IBIS-II)
R. Eastell1, I. Sestak2, F. Gossiel1, R. Patel3, G. Blake4, R.
Coleman5, A. Howell6, M. Dowsett7, J. F. Forbes8, S. Singh2, P365
J. Cuzick2 LONGITUDINAL CHANGES IN BMD-LEVELS OVER
1
Department of Human Metabolism, University of Sheffield, 2 YEARS IN NORWEGIAN ADOLESCENTS: THE
Sheffield, United Kingdom, 2Queen Mary University, Lon- TROMSØ STUDY, FIT FUTURES
don, United Kingdom, 3Imperial College, London, United O. A. Nilsen1, L. A. Ahmed1, A. Winther1, A. S. Furberg2, G.
Kingdom, 4King’s College, London, United Kingdom, 5Uni- Grimnes3, R. Jorde3, E. M. Dennison4, N. Emaus1
versity of Sheffield, Sheffield, United Kingdom, 6University 1
Department of Health and Care Sciences, UiT, Arctic Uni-
of Manchester, Manchester, United Kingdom, 7 Royal versity of Norway, Tromsø, Norway, 2Department of Com-
Marsden Hospital, London, United Kingdom, 8University of munity Medicine, The Arctic University of Norway, Tromsø,
Newcastle, Australia, Australia Norway, 3Division of Internal Medicine, University Hospital
of North Norway, Tromsø, Norway, 4MRC Lifecourse Epide-
Objective: The inhibition of aromatase in postmenopausal miology Unit, Southampton General Hospital, Southampton,
women with breast cancer has been associated with an United Kingdom
 Osteoporos Int

Objective: BMD is a strong indicator of fracture risk. Maxi- QUS technique, of random people above 30 year. and their
mization of the genetic potential for BMD during growth may name and other details were registered and regular follow up
prevent primary osteoporosis later in life. Studies exploring was advised. Along with this health education was provided in
the timing of peak bone mass in adolescents are scarce. The the form of information about food stuff rich in calcium and
aim of this population-based longitudinal study was to de- also ways and means to increase the nutritional content of
scribe changes in BMD-levels over 2 years in Norwegian food items. In village1 free calcium supplements were also
adolescents aged 15–17 years at baseline and to examine the provided to all the registered patients. All the patients were
achievement of peak bone mass during this period. regularly followed up with the help of weekly camps along
Material and Methods: In 2010–2011 we invited all first with visits to the homes of the registered patients if they did
comprehensive school students in Tromsø to the Fit Futures not reach the camp to avoid dropouts and ensure full follow
study and 1,038 adolescents (93 %) attended. We measured ups. Health camps were organised every week for the entire
total body (TB), total hip (TH), and femoral neck (FN) BMD village. The BMD was assessed after 4 months and compared
as g/cm2 by DXA (GE Lunar prodigy). Two years later, in to the initial value.
2012–2013, we invited all participants to a follow-up survey Results: 150 patients each from village1 and village2 were
and 820 adolescents attended, providing 688 repeated mea- taken up for study out of which during the initial screening
sures of BMD. Data was analysed using paired sample t-test 107 were found to be in the category of osteoporosis and
and one- way ANOVA. We calculated annual BMD changes osteopenia in village1 as compared to 103 in village2. Eleven
at each sites and included 372 girls and 316 boys in the patients from village1 and 7 patients from village2 were lost to
analysis. follow up. The BMD taken after 4 months was slightly in-
Results: Mean follow-up time was 2 years (SD 0.2). In the creased as compared to the initial value. The percent of
overall study-population BMD increased significantly increase in the BMD of village1 was found to be greater than
(p<0.05) at all sites in both sexes. Mean annual percentage that of village2.
increase for FN, TH and TB was 0.3, 0.5, 0.8 in girls and 1.5, Conclusion: The bone health of the two villages increased
1.0 and 2.0 in boys, respectively (p< 0.05). In one-way during the 4 months when the study was conducted. The
ANOVA analyses, the differences in changes between age village in which calcium supplementation was given, village1,
groups were significant (p<0.008) at all sites except at the had a greater increase in the BMD as compared to the village
TH in boys. The annual BMD accrual decreased successively in which only health education was provided. This proves that
at all sites from 15 to 17 years. In girls, aged 17 years at calcium supplementation is helpful in improving the bone
baseline FN BMD even decreased significantly (−0.7 %, health of the people. Also the generalised bone health was
p<0.009) and so did TH BMD (−0.2 %), but nonsignificantly. increased.
Conclusion: Overall, BMD levels are still increasing in ado-
lescents aged 15–17 years, but our analysis suggest that BMD
accrual is slowing down during this period. Further analyses P367
should explore the effect of initial BMD and lifestyle factors INSIGHT INTO THE ROLE OF MENISCAL
on these changes. EXTRUSION AND BONE MARROW LESIONS IN
Acknowledgements: The authors are grateful to the staff at KNEE OA PROGRESSION AND THEIR IMPACT ON
the Centre and Clinical Research and Education, University RESPONSE TO STRONTIUM RANELATE
hospital of North Norway and the Fit Futures research staff. TREATMENT IN A SUBSET OF PATIENTS FROM
THE SEKOIA STUDY
J.-P. Pelletier1, C. Roubille1, F. Abram2, M. Dorais3, P.
P366 Delorme1, J. P. Raynauld1, J. Martel-Pelletier1
1
ROLE OF CALCIUM SUPPLEMENTATION AND Osteoarthritis Research Unit, University of Montreal Hospital
HEALTH EDUCATION IN BONE HEALTH IN RURAL Research Centre (CRCHUM), Montreal, Canada, 2Medical Im-
INDIA aging Research & Development, ArthroLab Inc., Montreal, Can-
V. Khanna1 ada, 3StatSciences Inc., Notre-Dame-de-l’Ile-Perrot, Canada
1
Orthopaedics, Ranjana Hospital, Allahabad, India
Objective: To evaluate the role of meniscal extrusion (mExt)
Objective: To assess the role of calcium supplementation in on knee osteoarthritis (OA) progression and its impact on
the bone health of rural India and also provide health educa- response to strontium ranelate (SrRan) treatment assessed by
tion to improve the bone health in rural India. X-ray (change in JSW) and qMRI (cartilage volume loss
Material and Methods: 2 villages about 30 km apart were [CVL]) in the medial compartment at 36 months (M36) in
selected for the study, Village1 and village2. On the first visit subjects with (mExt+) or without (mExt-) mExt, in association
in both the villages initial BMD was assessed, with the help of (+) or not (−) with bone marrow lesions (BML).
Osteoporos Int

Material and Methods: Patients from the qMRI substudy of Material and Methods: A cross-sectional study was made
the SEKOIA trial (modified ITT, n=330) were stratified based based on the neonatology tracking outpatient program (nicu
on whether mExt (mExt+, n=60; mExt−, n=270) and BML graduates) at Hospital Infantil de Mexico Federico Gómez
were present or not (BML+, n=84; BML−, n=246) and on (Mexico City). Complete somatometry was performed and
their association in the medial compartment at baseline. SoS measurement by ultrasound (Sunlight Omnisense®
Results: In the placebo group, mExt+ patients had signifi- 8,000 s), with 2 transducers: CM 6823 (in over 10 kg), CS
cantly more JSW loss (p=0.002) and CVL in the medial 6616 (under 10 kg) at midshaft of the tibia, from January to
compartment than mExt- patients. mExt−/BML+ patients June 2013. Patients were classified into the following groups:
(n=18) had significantly more JSW loss (p=0.003) and a 1: pulmonary pathology (RDS, BPD, pneumonia), Group 2:
trend (p=0.09) toward more CVL compared to mExt-/BML- congenital heart disease (CHD), 3: abdominal pathology (AP)
patients (n=68). mExt+/BML+ patients (n=12) had a trend (NEC III and surgical patients), 4: Neonatal sepsis, 5
toward more CVL in the medial compartment (p=0.10) than hyperbilirubin group AND 6 Healthy newborns. Then, asso-
mExt+/BML- (n=14), while JSW change showed no differ- ciation of SOS in between the different groups was made with
ence. Importantly, in the medial compartment, the JSW loss analysis of co-variance (ANCOVA) adjusted by age, gesta-
and CVL were greater when mExt and BML were simulta- tional age and height.
neously present. In mExt+ patients, while no difference was Results: We evaluated 198 patients, 98 were female (49.5 %),
found in the JSW loss between groups, SrRan at 2 g/day classified according to gestational age: 159 term newborn and
reduced CVL in the plateaus (p=0.007) with a trend toward 26 preterm infants. With median of age of 36 (interquartile
decrease in the medial plateaus (p=0.081) compared to pla- range 30–270) days. The SoS Adjusted by were group 1
cebo. In mExt+/BML+ patients, SrRan 2 g/day significantly Pulmonary pathology: 3124±39 m/s, G2 CHD: 3075±38 m/s,
reduced CVL in the medial plateaus (p=0.046), whereas there G3 Abdominal Pathology: 3072±37 m/s, G4 Neonatal sepsis:
was no difference in JSW loss. 3045±37 m/s, G5 hyperbilirrubin: 2981±41 m/s and G6
Conclusion: Progression of knee OA assessed both by Healthy: 3141±17 m/s. There were differences between healthy
X-ray and qMRI was greater in mExt+ patients and and all pathologic groups (p=0.006)
further increased when co-localized with BML. Based Conclusion: Bone accretion measured with QUS is dismissed
on qMRI, SrRan 2 g/day showed beneficial DMOAD in high-risk patients with different pathologies during the
structural effects in mExt+ and mExt+/BML+ patients, neonatal period compared with healthy term infant newborns.
targeting a subpopulation at higher risk of knee OA NICU patients are a high risk population for osteopenia. This
progression, while JSW loss was not sensitive enough NICU graduates persist with bone alterations during the first
to provide evidence of such effects. days of life.
Disclosures: Funded in part by Servier. CR: bursary from the
Fondation du CHUM. JMP, JPP: shareholders in ArthroLab.
FA: employee of ArthroLab. JPR: consultant for ArthroLab. P369
PRODUCTIVITY LOSS AMONG WORKING
PATIENTS WITH KNEE OSTEOARTHRITIS IN
P368 REPUBLIC OF MOLDOVA
BONE ACCRETION IN HIGH RISK NEWBORNS V. Salaru1, C. Baerwald2, L. Mazur-Nicorici1, N. Revenco1,
ASSESSED BY QUALITATIVE ULTRASOUND D. Bartos3, M. Mazur1
R. Rivas-Ruiz1, D. Villanueva2, M. Segundo2, D. Ibarra2, D. 1
State University of Medicine and Pharmacy Nicolae
O. Castelán-Martínez3, P. Clark3, F. Rodriguez Islas3, J. Testemitanu, Chisinau, Republic of Moldova, 2Uniklinikum
Zayas1 Leipzig, Sektion Rheumatologie, Department für Innere
1
Centro de Adiestramiento en Investigación Clínica, IMSS, Medizin, Leipzig, Germany, 3UMF “Carol Davila”, Bucuresti,
México City, Mexico, 2Neonatology, Hospital Infantil de Romania
México, Mexico City, Mexico, 3Clinical Epidemiology Unit,
Hospital Infantil de México, Federico Gómez, Mexico City, Objective: To assess the health-related quality of life (QoL)
Mexico and work productivity in correlation with clinical pattern in
patients with knee osteoarthritis (OA).
Objective: To detect bone accretion deficit through quantita- Material and Methods: Retrospective, cross-sectional study
tive ultrasound (QUS) by measuring the speed of sound (SoS) was performed. There were 93 patients that fulfilled the ACR
in tibia of newborn patients at high risk of osteopenia with criteria for knee OA (1991). Productivity loss was measured
different pathologies during the neonatal period. To compared by Work Productivity and Impairment questionnaires (WPAI-
the bone accretion deficit between healthy vs. different pa- OA) that recorded days off work (absenteeism) and reduced
thologies of newborns. productivity at work (presenteeism) for previous 7 days. The
 Osteoporos Int

QoL was assessed by KOOS- Knee injury and Osteoarthritis metabolism by bone turnover markers—osteocalcin (OC),
Outcome Score. CTx (C-terminal telopeptide of collagen type I). We also
Results: In the study were included 93 employed patients; 72 measured serum levels of 25-hydroxycholecalciferol. For sta-
(77.4 %) females, the mean age±SD 56.7±6.9 (range 37–65) tistical evaluation, we used the Pearson correlation coefficient.
years. Disease duration±SD 5.6±4.0 (range 1–21) years. The Results: We have shown a statistically significant negative
KOOS results showed that the QoL was 43, 3 %, qualified as correlation between disease activity and levels of vitamin D
low. The level of activity in daily living was 52.9 %, lower (p<0.001). Relationship between osteomarkers and DAS28
than the level of pain (61.4 %) or other symptoms (69.1 %). score not reached statistical significance, however, we ob-
The level of pain by VAS±SD was high 62.2±1.8 mm. Over served a trend in bone turnover increase with increased activ-
the 12-month follow up period, 63 (67.7 %) participants ity of RA.
reported one or more days off work due to knee problems, Conclusion: Vitamin D plays an important role in immune
the mean value being 13.8±3.2 days. The level of absenteeism regulation. Some studies suggest that individuals with low
was 10, 0 %; meanwhile 84 patients (90.3 %) reported reduced serum levels of vitamin D have a higher incidence of RA. In
productivity at work (63.4 %). The presenteeism showed a our study, the severity of vitamin D deficiency correlated with
close correlation with VAS pain (r 009, p<0.0001) and deter- activity of RA. This relationship may indicate the need of
mine a poor QoL (r-0.4, p<0.0001). The painful knee induce a adequate supplementation of vitamin D in patients with RA.
diminution of productivity in daily activities for 93 (98.9 %) Sufficient concentrations of vitamin D may have a positive
patients, mean value 65.9±18.1 %. We established moderate effect on the activity of RA and also contribute to slower
correlations between the WPAI- OA absenteeism and func- development in secondary osteoporosis.
tion, pain, and disease severity (r 0.3–0.4). Therefore
presenteeism was strongly correlated with health outcomes
(r 0.7–0.9). P371
Conclusion: Patients with knee OA have been impaired QoL. OSTEOPRTEGERIN, SOLUBLE RANK LIGAND AND
For the employees with knee osteoarthritis, the work produc- THEIR CORRELATION WITH BONE MINERAL
tivity reduced is mostly due to presenteeism rather absentee- DENSITY IN PATIENTS WITH TYPE 1 DIABETES
ism. The level of pain was the most important factor for loss MELLITUS
productivity in patients with knee OA. N. P. Botushanov1, M. M. Orbetzova1, A. N. Botushanov1
1
Medical University- Clinic of Endocrinology, Plovdiv,
Bulgaria
P370
RELATIONSHIP BETWEEN ACTIVITY OF Objective: To evaluate a possible relationship between the
RHEUMATOID ARTHRITIS, PARAMETERS OF serum OPG and sRANKL and BMD in patients with type 1
BONE METABOLISM AND VITAMIN D diabetes mellitus (DM).
L. Sterancakova1, K. Brazdilova1, Z. Killinger1, J. Payer1, D. Material and Methods: 162 patients with type 1 DM (97
Cierny1 females and 65 males) age 29.17 year (20–40) and 200 (100
1
5th Department of Internal Medicine, Medical Faculty of women and 100 men) age- and sex-matched healthy controls
Comenius University, University Hospital, Bratislava, were analyzed for BMD of lumbar spine and femoral neck by
Slovakia DXA using Lunar DPX-A. Serum levels of OPG and
sRANKL were determined using ELISA. We performed sta-
Objective: Rheumatoid arthritis (RA) is a chronic inflamma- tistical analysis (t-test, ANCOVA), Spearman’s rank correla-
tory disorder. It is well known that RA is also associated with tion, data are expressed as mean±SD and as percentages.
decreased BMD and development of osteoporosis. High in- Results: BMD in type 1 DM showed statistically significant
flammatory disease activity and serum concentration of vita- lower levels both for lumbar spine L1-L4- men (1.21±0.15 g/
min D3 are believed to be involved in the pathophysiology of cm2 DM vs. 1.33±0.16 g/cm2 controls, P<0.05) and L1-L4
RA-associated osteoporosis. Our objective was to determine women (1.10±0.12 g/cm2 DM vs. 1.19±0.12 g/cm2 controls,
the relationship between activity of RA with selected labora- P<0.05) and femoral neck - men (0.91±0.21 g/cm2 DM vs.
tory parameters of bone metabolism and vitamin D3 serum 0.98± 0.15 g/cm2 controls, P <0.05) and women (0.86 ±
concentration. 0.12 g/cm2 DM vs. 0.92±0.14 g/cm2 controls, P<0.05). Se-
Material and Methods: We examined 43 patients with dif- rum OPG levels were significantly lower in diabetic patients
ferent levels of RA activity. The mean age of patients was (37.57±21.76 pg/ml) than in control group (43.58±23.71 pg/
52.4 years, female to male ratio was 3.3:1. Patients was not ml p=0.029). Serum sRANKL did not differ significantly
taking any antiporotic drugs or vitamin D. Disease activity between both groups (0.39 ± 0.21 pmol/L vs. 0.491 ±
was evaluated by DAS28 score (disease activity score), bone 0.23 pmol/l, p=0.16). However sRANKL/OPG ratio (0.011
Osteoporos Int

±0.08 vs. 0.065±0.013, p=0.034) was significantly lower in an intertrochanteric fracture per fall will rise with age in
DM group than in the controls. We observed positive correla- women. Frailty, a condition seen mostly in institution-
tion between serum OPG and sRANKL/OPG levels and alized people, does not appear to influence the type of
BMD (r=0.54; P=0.03 and r=0.34; P=0.13 resp.) and weak hip fracture.
negative correlation between BMD and sRANKL.
Conclusion: BMD measured at lumbar spine and femoral
neck was significantly lower in patients with type 1 DM than
in age-and sex matched controls. Decreased levels of OPG P373
and sRANKL/OPG ratio may be the cause for increased bone RADIOGRAPHIC CHARACTERIZATION OF THE
resorption and decreased BMD in patients with type 1 DM. BONE HEALING PROCESS AFTER PROTEIN
OPG and/ sRANKL system may play role in the bone remod- APPLICATION EXTRACTED FROM HEVEA
eling in concert with other factors influencing bone changes in BRASILIENSIS
diabetes mellitus type 1. B. G. Dos Santos Kotake1, A. A. Ferreira De Carvalho2, L. M.
Pescinini Salzedas2, E. Ervolino2, M. Gonçalves Gonzaga1,
M. Mizusaki Iyomasa1, J. Ramos1, D. Mizusaki Iyomasa1, J.
P372 P. M. Issa1
1
HIP FRACTURE TYPES IN CANADIAN MEN AND University of São Paulo, Ribeirão Preto, Brazil, 2Paulista
WOMEN CHANGE DIFFERENTLY WITH AGE State University, Araçatuba, Brazil
M. Kloseck1, R. G. Crilly2, S. Mequanint2
1
Faculty of Health Sciences, University of Western Ontario, Objective: Current literature has shown that the protein
London, Ontario, Canada, 2Department of Medicine, Univer- extracted from the rubber tree, Hevea brasiliensis, has
sity of Western Ontario, London, Ontario, Canada interesting properties regarding to tissue repair, especial-
ly for soft tissues, biocompatible and with angiogenic
Objective: There is evidence that the type of hip fracture, properties. The aim of this study was to study radio-
intertrochanteric (IT) versus subcapital (SC), changes differ- graphically the bone healing process in rat skulls, using
ently with age in men and women. We have explored this in a different types of bone grafts and protein extracted from
Canadian population and looked at community dwelling and Hevea brasiliensis.
institutionalized seniors to see if frailty plays a role. Material and Methods: For this work, 112 albino Wistar rats
Material and Methods: Three years of hip fracture data (~250 g) were divided into eight groups, waiting in each one
(2007–2009) were obtained from the Canadian Institute for for sacrifice, 4 and 6 weeks. The groups are the following: AT:
Health Information for all Canada excluding Quebec, and Particulate autologous bone graft; HOM: Particulate homolo-
stratified by age and gender. Statistical Analysis Logistic gous bone graft; HET: Particulate heterologous bone graft
regression was used to test for a significant interaction be- (lyophilized bovine bone); ATP1: Particulate autologous bone
tween age and gender on the likelihood of sustaining one graft + 5 μg protein; HOMP1: Particulate homologous bone
fracture type compared to the other. graft + 5 μg protein; HETP1: Particulate heterologous bone
Results: The database contained a total of 18,316 (28 %) hip graft (lyophilized bovine bone) + 5 μg protein; P1: 5 μg of
fractures in men (mean age 78.48±10.90) and 47,343 (72 %) protein; DO: bone defect only. Images of the samples were
in women (82.08±9.63). Overall the prevalence of the IT obtained using the X-ray machine GE-100 (General Electric,
fracture rises with age, but when analyzed by gender, Milwaukee, USA), operating at 50 Kvp, 10 mA, 8 pulses,
intertrochanteric fractures rose in women (p<0.05), from handled by the digital system (Soredex, Orion Corporation,
35.9 % in the youngest category to 50.7 % in the oldest, but Helsinki, Finland), Digora software for Windows 1.51. Data
not in men. For each year of age the odds of sustaining an IT were subjected to statistical analysis, ANOVA and Tukey test
fracture vs. a SC fracture rises by 2.7 % in women. Analysis of (p<0.05).
community and institutionalized subjects showed no differ- Results: Results showed that at 4 weeks, the DO data were
ence between them. statistically different than AT and HET (p<0.05), and the last
Conclusion: Results confirm the proportion of the two main one was different than HOMP1, AUTP1 (p< 0.05). For
hip fracture types changes differently in men and women with 6 weeks, the P1, AT, ATP1, HOMP1 data were statistically
age. Previously identified risk factors for subcapital fractures different than DO (p<0.05).
include unchanging structural factors (neck length, neck/shaft Conclusion: According to obtained data, we can suppose
angle) so the risk of a subcapital hip fracture in a fall will that this protein, at 6 weeks, was able to improve the
remain constant and be determined by the frequency of falling. bone healing process in this experimental model using
Intertrochanteric fractures are better predicted by trabecular this methodology.
bone mass, loss of which is greater in women. Thus the risk of Acknowledgements: FAPESP: 2012/03310-8
 Osteoporos Int

P374 P375
COST-EFFECTIVENESS OF TOTAL HIP HYDROXYAPATITE AND FIBRIN SEALANT FOR
REPLACEMENTS: A COMPREHENSIVE MODEL BONE REPAIR IN RATS
R. Pinedo-Villanueva1, D. Turner2, J. P. Raftery3, C. Cooper4, M. Rodrigues Da Cunha1, F. A Menezes1, G. R Dos Santos2,
N. K. Arden1, The Coast Group1 V. C Amaro Martins3, S. A Yoshioka3, A. M. G Plepis3, R. S
1
Nuffield Department of Orthopaedics, Rheumatology and Ferreira Junior4, J. P. M. Issa5
1
Musculoskeletal Sciences, University of Oxford, Oxford, UniAnchieta, Jundiai, Brazil, 2Faculty of Medicine, Jundiai,
United Kingdom, 2Norwich Medical School, University of Brazil, 3University of São Paulo, São Carlos, Brazil, 4Paulista
East Anglia, Norwich, United Kingdom, 3Faculty of Medi- State University, Botucatu, Brazil, 5University of São Paulo,
cine, University of Southampton, Southampton, United King- Ribeirão Preto, Brazil
dom, 4University of Southampton, Southampton, United
Kingdom Objective: To evaluate the bone healing process in rat skull
defects grafted with porous hydroxyapatite and fibrin sealant
Objective: Total hip replacements (THRs) have been derived from snake venom.
widely reported to be highly cost-effective interventions. Material and Methods: A skull defect was performed surgi-
However, most economic models of THRs have as- cally in 40 rats and these animals were divided into four
sumed that, unless a revision surgery is performed, the groups: G1 (control, no graft); G2 (defect grafted with hy-
outcome of the primary would be the same and excel- droxyapatite); G3 (defect grafted with fibrin sealant), and G4
lent for all patients. We aimed to build a comprehensive (defect grafted with hydroxyapatite and sealant). The animals
economic model to assess the cost-effectiveness of were euthanized after 2 and 6 weeks of the surgery and the
THRs in the UK. samples submitted to macroscopic, radiologic and histological
Material and Methods: A life-time cohort Markov model analyses. The newly formed bone was quantified based on the
was developed including two outcome categories after principle of Delesse and the results were compared by
primary and revision surgeries. Preoperative transition ANOVA and the Tukey test (p<0.05).
probabilities were obtained from an expert elicitation Results: Macroscopic analysis showed absence of inflammatory
exercise and postoperative probabilities from HES- signs, characteristic of rejection of the employed biomaterial.
PROMs. Data from HES-PROMs were also used to Radiographical analysis showed a radiolucency inside of the
estimate quality-adjusted life years (QALYs). Surgery bone defects. In animals sacrificed after 2 weeks, immature
costs were estimated from HES data combined with trabecular bone was formed from the borders of the defect. In
NHS healthcare resource groups. Primary care costs G2 and G4, qualitative histological aspects showed few hydroxy-
were estimated based upon resource use data obtained apatite particles surrounded by new bone. After 6 weeks, the new
from GPRD extracts, which were combined with pre- bone tissue showed mature aspects, and surrounded several
liminary results from the COASt cohort to estimate hydroxyapatite particles in G4, without connective tissue inter-
postoperative values by outcome category. position. The relative volume (%) and standard deviation for new
Results: Current practice is associated with both higher bone tissue in the surgical area after 2 weeks was 5.66±0.57,
costs and higher QALYs compared to not performing 6.66±0.57, 20±1.0 and 21±1.0 in G1, G2, G3 and G4, respec-
THRs. For women 45 years of age, current practice of tively. There was no significant difference between G1 and G2 or
conducting THRs would represent discounted costs of between G3 and G4. After 6 weeks, the new bone tissue volume
£11,500 and 14.5 QALYs over lifetime. If THRs were and the standard deviation were respectively, 10.66±0.57, 20.66
not performed, costs would drop to £4,300 and so ±1.15, 29.66±1.52 and 53.66±0.57.
would QALYs to 6.7, producing an incremental cost- Conclusion: The fibrin sealant derived from snake venom,
effectiveness ratio (ICER) of £928 per QALY gained. according to the limitations of this study showed positive
Results varied only slightly between genders but quite properties for biocompatibility and was able to improve the
significantly with patients’ age entering the model. bone healing process when combined to hydroxyapatite.
Conclusion: THRs are highly cost-effective even when
distinguishing between very good and fair outcomes after
surgery and accounting for corresponding primary care costs. P376
The significant improvement in the quality of life of patients LEAD CHARACTERIZATION IN BLOOD AND TIBIA
undergoing the procedure is at the heart of these results. The SAMPLES IN RATS EXPOSED TO 30 MG/L OF LEAD
intervention is more cost- effective for younger patients and IN DRINKING WATER
not much difference is reported between genders other than F. A. Tocchini De Figueiredo1, M. A. Veiga1, F. V. Nakadi1, J.
higher QALY gains for women given their lower mortality Ramos1, E. R. Kawakita1, R. F. Gerlach1, J. P. M. Issa1
1
rate. University of São Paulo, Ribeirão Preto, Brazil
Osteoporos Int

Objective: Bone is considered the best marker for lead expo- osteoporosis or if a different etiology, such as trauma, could be
sure, and bone lead determinations can be easily made. Even the cause. In this study, we explored the nature of VF in the
so, most animals studies carried out nowadays only determine two hip fracture populations.
whole blood lead concentrations. The aim of this study was to Material and Methods: This was an analysis of 120 patients:
observe whether there would be differences in whole blood 40 with SC fractures and VF, 40 with IT fractures and VF, and
versus tibia lead concentrations over time in growing rats for comparison, 40 osteoporotic patients with VF alone. Based
when these were exposed to relatively low lead prenatally on Genant’s semiquantitative assessment method, the distri-
until days 28 and 60. bution, type and severity of each patient’s vertebral fractures
Material and Methods: Lead was given in the drinking water were described1.
at 30 mg/L from the time the dams were pregnant until Results: Patients with SC fractures had significantly fewer
offspring was 28 or 60 days old. Male Wistar rats were used total VF (p=0.005 and p=0.019), fewer fractures from T4-
in this study. Concentrations of lead were measured in whole T10 (p=0.005 and p=0.042), than patients with IT fractures
blood and in bone (tibia) after 28 (28D) and 60 days (60D) in and those with VF alone. The number of VF from T11-L4 and
control (C) and in lead exposed animals (Pb). Calcium and at the T12-L1 peak did not differ among the groups. Patients
Lead were measured by Flame and Graphite Furnace Atomic with SC fractures were more likely to have only one VF
Absorption Spectrometry. (p<0.001). The distribution of VF in those with IT fractures
Results: Whole blood lead in the Pb-28D animals was 8.0 μg/ and VF and in those with VF alone was similar and signifi-
dl (±1.1), and in the Pb-60D, 7.2 μg/dl (±0.89) (p>0.05 for cantly correlated (r=0.6496, p=0.009).
difference between these groups), while control animals lead Conclusion: Patients with IT fractures and VF closely resem-
levels were 0.2 μg / dl (±0.4) (p<0.001 for comparison with ble the spinal osteoporotic patients in number and distribution
respective age groups). There was a significant difference of the VF. The distribution of VF in patients with SC fractures
between the tibia masses of the C-60D group (0.86±0.13 g) and VF differs from the other fracture groups in being usually
and the ones of the Pb-60D (0.61±0.11 g) (p=0.0004), a 25 % single and concentrated in the lower spine, suggesting a
decrease in tibia bone mass. Bone lead concentrations were different etiology. The SC and VF of some of these patients
8.02 μg/g (±1.12) in the Pb-28D, and 43.3 μg/g (±13.26) in may be a consequence of trauma and not osteoporosis.
the Pb-60D (p<0.01 for difference between these groups), References: 1. Genant HK et al. J Bone Miner Res
while the C-28D and C-60D showed tibia lead concentrations 1996;11:984
<1 μg/g (p < 0.001 for comparison with respective age
groups).
Conclusion: The five times higher amount of lead found in P378
the bone of older animals (Pb-60D vs. Pb-28D)(when no NORMAL AND ANIONIC COLLAGEN MEMBRANES
differences in lead in whole blood were observed) reinforces IN AN EXPERIMENTAL MODEL FOR BONE
the importance of using bone lead as an exposure biomarker, HEALING PROCESS
instead of blood, particularly when studying the effects of M. Silva Pettian1, G. R Dos Santos1, V. C Amaro Martins2, S.
lower lead levels. Furthermore, in this study lead exposure A Yoshioka2, A. M. G Plepis2, J. P. M. Issa3, M. Rodrigues Da
decreased the mass of tibial bone in the Pb-60D, but not in the Cunha4
1
Pb-28D group. Faculty of Medicine, Jundiai, Brazil, 2University of São
Acknowledgements: FAPESP Paulo, São Carlos, Brazil, 3University of São Paulo, Ribeirão
Preto, Brazil, 4UniAnchieta, Jundiai, Brazil

P377 Objective: Biomaterials constituted by extracellular matrix

DISTRIBUTION OF VERTEBRAL FRACTURES components have osteogenic properties that are important
VARIES AMONG PATIENTS ACCORDING TO HIP for the bone repair. Materials composed by collagen derived
FRACTURE TYPE from pericardium or bovine intestinal serosa are been used in
J. Watt1, R. G. Crilly1, L. Cox1 many regenerative therapies. Therefore, the aim of this study
1
Division of Geriatric Medicine, University of Western On- was to evaluate the osteogenic capacity of natural collagen
tario, London, Ontario, Canada membranes (native) and anionic collagen obtained by alkaline
hydrolysis, both derived from bovine serosa.
Objective: Of the two main types of hip fractures: Material and Methods: Fifty Wistar rats were submitted to
intertrochanteric (IT) and subcapital (SC) either can have surgical skulls defects. The animals were then divided into
associated vertebral fractures (VF) but they are fewer in the five groups: group 1, empty defect; group 2, defect filled with
SC patients who also tend to have better bone density. This nonmineralized native membrane; group 3, defect filled with
raises the question of whether VF in the SC patients indicate mineralized native membrane; group 4, defect filled with non-
 Osteoporos Int

mineralized anionic membrane; and group 5, defect filled with (p<0.000). For histological analysis, according to quantifica-
mineralized anionic membrane. The animals were sacrificed tion of trabecular bone microarchitecture, the OVX group had
after 2 and 6 weeks, and the samples were submitted to lower values than SHAMC, OVXM, SHAMCM and
macroscopic, radiologic and histological analyses. OVXCM, and OVXCM and SHAMCM groups having supe-
Results: Macroscopic and radiologic analyses revealed the rior results than SHAM, SHAMM and OVXC (p<0.001).
integrity of bone tissue in the surgical area and in adjacent Conclusion: It is concluded that the physical exercise and the
areas, without signs of pathological alterations. Histologically, employed medicine, changes to better the biomechanical
the new bone tissue projected from the margins of the defect in properties of bone of ovariectomized rats. The risedronate
all groups, and the newly formed bone matrix exhibited good has no benefits on primary prevention and the quantification
birefringence of type I collagen fibers and immunoexpression of bone trabecular, the medicine was more effective in relation
of osteocalcin. Morphometric analysis showed a greater con- to race in ovariectomized groups, and when associated, the
centration of bone matrix in the groups that received the treatments were more effective.
anionic membranes.
Conclusion: In conclusion, the anionic collagen membrane
presented better osteogenic properties for this experimental P380
design model, however, was not sufficient for complete bone EVALUATION OF THE TIBIAL BONE STRUCTURE
healing, considered the short period of time used in this study. IN RATS SUBMITTED TO THE TAIL SUSPENSION
Acknowledgements: FAPESP AND TREATED WITH SWIMMING EXERCISES
J. B. Volpon1, A. Valadares Da Silva1, M. José Falcai1, M. J.
Quirino Louzada1, B. G. Dos Santos Kotake1, J. P. M. Issa1
1
P379 University of São Paulo, Ribeirão Preto, Brazil
ACTION OF PHYSICAL EXERCISE COMBINED
WITH RISEDRONATE IN OSTEOPENIC BONE Objective: This study investigated the effectiveness of swim-
USING EXPERIMENTAL ANIMAL MODEL ming in the recovery of bone quality assessed in the tibia of
R. Carminati Shimano1, A. P. Macedo1, M. José Falcai1, R. rats with induced osteopenia by tail suspension.
Antônio Andraus1, A. C. Shimano1, J. P. M. Issa1 Material and Methods: 50 Wistar rats were divided into 5
1
University of São Paulo, Ribeirão Preto, Brazil experimental groups (n=10 each). Group suspended by the
tail for 21 consecutive days (S) and its control remained in
Objective: This study evaluated the effects of physical train- cages for the same period (CI). Group suspended and trained,
ing associated with the risedronate, as prophylactic and ther- remained in suspension during 21 day and then underwent 30
apeutic environment in osteopenic bones. sessions of swimming (ST). Suspended for 21 day and re-
Material and Methods: 48 rats were divided into 8 groups: leased after 30 day in cages (SNT). In the control group II rats
sedentary for 12 weeks and ovariectomized (OVX); ovariec- were observed during 51 day without intervention (CII). Bone
tomized and the 12 weeks following administered risedronate quality assessment was made by DXA and mechanical tests
(OVXM); ovariectomized and physical training on the tread- on the right tibia, and in the proximal metaphyseal region of
mill during 12 weeks (OVXC); ovariectomized and 12 weeks the left tibia was performed the histomorphometric study.
following administered risedronate associated with physical Results: Mechanical tests showed that for the group S values
training on the treadmill (OVXCM); simulated surgery and of maximum force (-14.03 %, p = 0.0003), stiffness
sedentary for 12 weeks (SHAM); simulated surgery, and the (−21.68 %, p=0.0055), BMD (−17.62 %, p=0.019) and per-
12 weeks following administered risedronate (SHAMM); centage of trabecular bone (−57.2 %, p=0.0001) decreased
simulated surgery followed by physical training on the tread- significantly as compared with the IC group. The simul-
mill during 12 weeks (SHAMC); simulated surgery, and the taneous comparison of mechanical properties between
12 weeks following administered Risedronate associated with groups evaluated after 51 day (STxCIIxSNT) showed
physical training on the treadmill (SHAMCM). After 12 weeks significant differences between groups for peak force
of the experiments, tibias were surgically dissected and ana- (p = 0.0014), stiffness (p = 0.0010), BMD (p = 0.0095)
lyzed by different methodologies. and the percentage of trabecular bone (p<0.0001). The
Results: We obtained as a result of mechanical tests regarding ST group showed an increase in maximum force (+
the stiffness, the SHAMM group with values below the 10.23 %, p < 0.05), stiffness (+21.91 %, p < 0.001),
OVXM (p=0.001); at maximum strength full, the SHAMM BMD (+9.46 %, p<0.05) and the percentage of trabec-
group also with values below the OVXM and OVXCM (p= ular bone (+48.82 %, p<0.001) compared to the SNT
0.002), the global densitometry showed no statistical differ- group. The groups SNT and CII also decreased signifi-
ence between the groups, since the proximal densitometry, the cantly (−14.4 %, p<0.05) for maximum strength, stiff-
OVX group with values less than SHAMM and SHAMCM ness (−25.21 %, p<0.005), BMD (−13.34 %, p<0.05)
Osteoporos Int

and the percentage of trabecular bone (−52.06 %, P382

p < 0.001). Finally, the comparison between the SNT ADMINISTRATION OF PROTON PUMP INHIBITORS
and CII groups showed no significant difference IN LONG-TERM DECREASES BONE MINERAL
(p>0.05) for the values of maximum strength, stiffness, DENSITY OF THE FEMUR OF ADULT RATS
and BMD percentage of trabecular bone. A. C. O. Penoni1, G. R. Yanagihara1, R. Annoni2, A. G.
Conclusion: The swimming reversed the osteopenic deterio- Paiva1, M. P. Neto3, L. H. L. Torres4, M. J. Quirino Louzada5,
ration caused by hypoactivity, with complete and quickly A. C. Shimano1
1
recovery of bone quality. Department of Biomechanics, Medicine and Rehabilitation
of the Locomotor System, Ribeirão Preto, Ribeirão Preto,
Brazil, 2University of São Paulo, Faculty of Medicine, Uni-
P381 versity of São Paulo, Department of Pathology, São Paulo,
WHETHER WE COULD PREDICT HIP FRACTURE Brazil, 3University of Vale do Sapucaí, UNIVAS, Pouso
M. Kocic1, L. Dimitrijevic1, I. Stankovic1, M. Spalevic1, V. Alegre, Brazil, 4University of São Paulo, Faculty of Pharma-
Zivkovic1, A. Stankovic1 ceutical Sciences, São Paulo, Brazil, 5University of São Paulo,
1
Clinical Center Nis, Clinic of Physical Medicine and Reha- Ribeirão Preto, Brazil
bilitation, Nis, Serbia
Objective: To assess BMD of rats that were subjected to the
Objective: Hip fracture is a serious medical and socioeco- use of omeprazole in the long term.
nomic issue. Hip fractures occur in the low trauma in patients Material and Methods: Fifty Wistar rats, adult male of
with osteoporosis. The FRAX questionnaire is designed to average weight between 200 and 240 g were equally distrib-
identify patients with an increased risk of fractures in general uted (n=10): 1) OMP300 Group - intake of omeprazole at
and risk of hip fracture. Objective: To determine whether 300 μmol/kg; 2) OMP200 Group - intake of omeprazole dose
patients who have sustained a hip fracture had an increased of 200 μmol/kg; 3) OMP40 group - intake of omeprazole at
risk of hip fracture based on FRAX calculator. 40 μmol/kg;4) OMP10 group - intake of omeprazole at
Material and Methods: The study included 50 patients aged 10 μmol/kg; and 5) CONT group - control group, only intake
over 60 who have suffered a hip fracture to a small trauma and of vehicle dilution. For 90 day the animals of the experimental
are operated at the Orthopedic Clinic in Nis. None of the groups received orally, their respective doses of omeprazole
patients were analyzed regarding the risk of fractures by and control animals receiving vehicle dilution, compound
FRAX Calculator prior to the fracture incident. Only three doses natrosol solubilized in sodium bicarbonate. After eutha-
of all the patients had undergone bone densitometry which nasia, the right femurs were dissected and subjected to anal-
showed presence of osteopenia in one of the patients and ysis of BMD in a densitometer dual X-ray emission, DPX-
osteoporosis in two of them. Subsequently after the surgery alpha, Lunar®.
all patients were analyzed by FRAX questionnaire calculator Results: The bone density of OMP300 (0.20±0.008 g/cm2)
to determine whether they had had an increased risk of hip group was lower than the CONT group (0.22±0.107 g/cm2, p=
fracture. 0.006). There was no difference in the comparison between the
Results: The patients were divided according to age in 3 control group (0.22±0.107 g/cm2) and the other groups: OMP200
groups: 60–69 years old (12 patients), 70–79 (29 pa- (0.21±0.019 g/cm2, p=0.644), OMP40 (0.21±0.015 g/cm2, p=
tients) 80 and over (9 patients). As regarding the pres- 0.305) and OMP10 (0.21±0.016 g/cm2, p=0.410).
ence of other risk factors in addition to age and female Conclusion: With these results, we observed that the relation-
gender, 39 patients had no other risk factors, 10 patients ship between the use of PPIs with bone tissue is true, as the
had one, and only one patient had 2 additional risk BMD has changed over use of the highest dose.
factors. In the age group of 60–69 only 1 patient had
a risk of a hip fracture greater than 3 which requires
introduction of therapy for osteoporosis. In the 70–79
age group, 27 out of 29 patients had a risk factor of 3 P383
or more as well as all of patients in the 80 and older USING TRABECULAR BONE SCORE IN
age group. MONITORING OF THE OSTEOPOROSIS
Conclusion: Our results showed that almost all women aged TREATMENT EFFECT
over 70 had a risk factor of over 3 and that they needed M. Kuzma1, L. Sterancakova1, D. Holovacova1, P. Jackuliak1,
treatment for osteoporosis, which could reduce the risk of Z. Killinger1, J. Payer1
1
hip fracture. Also, in patients under 70 years of age, the 5th Department of Internal Medicine, Comenius University
current issues FRAX questionnaire were not sufficient for Faculty of Medicine and University Hospital, Bratislava,
determining increased risk for hip fracture. Slovakia
 Osteoporos Int

Objective: BMD as a widely used quantitative bone param- Objective: GIOP is the most frequent and severe form of
eter does not bring whole information about real bone status. secondary osteoporosis. The rate of bone loss is greatest in
Therefore, bone quality shows as main determinant of bone the first year and the first osteoporotic fracture occur as early
strength, fracture prediction and treatment effect monitoring. as in first 3–6 months of hypercorticism. One of the treatment
A method to assess bone quality through the grey-level texture modalities is osteoanabolic treatment. The primary outcomes
analysis from lumbar spine DXA scan is trabecular bone score were defined as changes of BMD and BTM after 12 M and
(TBS). The aim of our study was to evaluate the effect of 18 M. Secondary outcomes included prevalence of clinical
strontium ranelate (SRn), denosumab(DMAb) and fractures, tolerability and safety of the treatment.
teriparatide (TPT) using TBS in comparison to the effect on Material and Methods: Prospective, open label, non-
BMD. randomized, 18 M study. The inclusion criteria: (1) T-score<
Material and Methods: Noncontrolled comparative analysis −2.9 or ≥1 fracture, (2) use of 5 mg corticoids for >3 M.
of 3 osteoporosis treatment modalities in our osteocentrum. Patients were treated 20 μg of rhPTH(1–34) s.c. All patients
All patients included were naive. TBS from lumbar spine received 500–1,000 mg of calcium and 400–800 IU of Vita-
DXA scans using TBS INsight® (Med-Imaps) software was min D. The register has 186 pts (150 women and 36 men,
evaluated during the 4-years of treatment, annually. Bone mean age 58.3 year). The measurement was at baseline, 6, 12
turnover was assessed using CTx - bone resorption marker and 18 M. Statistical analyses were performed according to
and osteocalcin (OC) - bone formation marker. A standard the intention-to-treat principle. T- test was used to determine
dose (800 IU/day) of 25-OH-D3 and oral calcium (1,000 mg/ the changes in BMD and BTM in 6, 12 and 18 M compared to
day) has been administered to the patients. baseline.
Results: A total of 245 patients (SRn: N=113; mean age Results: TPTD treatment resulted in increase of BMD total
72 year; DMAb: N=74; 71.7 year; TPT: N=58; 76.2 year) hip after 12 M (+3.8 %, p=0.035) and 18 M (+3.4 %, p=
were included. After 1 year in SRn subgroup BMD increased 0.135). The most significant increase was found in LS, +4.8 %
4.8 % (p<0.007) vs. 0.5 % (NS) increase in TBS; DMAb (p<0.001) during 12 M of treatment and an increase of 9.8 %
subgroup: BMD + 3.8 % (p=0.003) vs. TBS +2.43 % (p= after 18 M of treatment with TPT (p<0.001). 18 M of TPTD
0.001); TPT subgroup: +2.05 % (NS) vs. +3.1 % (p=0.03). therapy led to significant increase of CTx and OC. The in-
After 2 year: SRn subgroup: BMD +6.5 % (p<0.001) vs. TBS crease of CTx was 169 % after 6 M and 183 % after 12 M
+2.5 % (NS); DMAb subgroup was not analysed; TPT sub- (p<0.001). As for OCn, the increase represented 242 % after 6
group: BMD + 5.9 % (NS) vs. TBS +6.1 % (NS). After year 3 and 257 % after 12 M (p<0.001). Treatment was well toler-
and 4 was analysed only SRn subgroup with maximum in- ated and no serious side effects were observed. Borderline
crease after 4 year (BMD +13.4 % (p<0.001) vs. TBS +7.2 % asymptomatic hypercalcemia was present in 5.3 % of patients.
(p=0.01)). Interesting finding was low levels of 25-OH-D (<30 ng/ml) in
Conclusion: Despite lack of long-term results for DMAb and 82.9 % of patients after 18 M of treatment.
TPT we have observed positive effect of all three treatment Conclusion: Osteoanabolic treatment using teriparatide was
modalities on trabecular bone architecture. According to pre- effective, well tolerated and safe. Main problem is prevalent
vious data seems SRn, DMAb and TPT as 3 most effective hypovitaminosis D during treatment period because of lower
treatment options positively influencing bone supplementation dosage to avoid severe hypercalcemia.
microarchitecture which results in improvement of bone
quality.
P385
EQ-5D AND QUALITY OF LIFE OF OSTEOPOROSIS
P384 AT-RISK PATIENTS IN A SWEDISH OSTEOPOROSIS
OSTEOANABOLIC TREATMENT OF PATIENT REGISTRY
GLUCOCORTICOID INDUCED OSTEOPOROSIS: A. Krishna1, D. Mellström 2, Z. Li 3, C. P. S. Fan3, S.
RESULTS FROM SLOVAK NATIONAL REGISTRY Salomonsson4, E. Waern2
J. Payer1, Z. Killinger1, P. Jackuliak1, S. Tomkova2, P. 1
Merck & Co., Inc., Whitehouse Station, United States, 2Cen-
Vanuga3, P. Masaryk4, A. Letkovska4, Z. Kmecova5 tre for Bone and Arthritis Research at Sahlgrenska Academy,
1
5th Department of Internal Medicine, Comenius University University of Gothenburg, Göteborg, Sweden,
3
Faculty of Medicine and University Hospital, Bratislava, Slo- AsclepiusAnalytics Ltd., Hong Kong, Hong Kong, 4Merck
vakia, 2Osteocentrum, Kosice-Saca, Slovakia, 3National Insti- & Co., Inc., Solna, Sweden
tute of Endocrinology and Diabetology, Lubochna, Slovakia,
4
National Institute of Rheumatic Diseases, Piestany, Slovakia, Objective: To assess health-related quality of life (HRQoL)
5
Osteocentrum of Faculty Hospital F.D. Roosevelt, Banska using EQ-5D questionnaires and identify factors associated
Bystrica, Slovakia with HRQoL in a Swedish osteoporosis (OP) patient registry.
Osteoporos Int

Material and Methods: The OP registry collected patient sectional study there were taken measurements of lumbar
information in an outpatient clinic in Göteborg region from spine and femoral neck bone mineral densities using DXA,
1991 to 2009. New patients were referred to the clinic for OP values of TSH and thyroid hormones levels. The obtained
assessment and BMD measurement (new patients). Patients results were compared with those provided by a control ref-
with prior osteoporotic BMD (T-score≤−2.5) or OP diagnosis erence population of similar age and sex with the first two
may return for follow-ups (returning patients). Each patient groups (n=61).
filled the EQ-5D questionnaire once, which covered mobility, Results: In the group of patients with frank hyperthyroidism
self-care, usual activities, pain/discomfort and anxiety/ results showed a decrease of bone mineral densities in
depression. Responses were aggregated into a HRQoL index, 89.74 % of cases, indicating a significant difference from the
between −0.074 (worst) and 1 (best), using the European sex and age-matched reference population (p<0.001). In pa-
formula. Descriptive and multivariable analyses were used tients with subclinical hyperthyroidism, bone mineral densi-
to identify factors associated with patients’ HRQoL. ties for all the scanned sites were decreased in 71.87 % of
Results: 3,240 patients completed the EQ-5D questionnaire. cases. The decrease of BMD was more marked in the post-
89 % were female, average age was 66 [SD=11.9]. 48.4 % menopausal women (p<0.001) than in the premenopausal
were new patients, 51.6 % were returning. 34.1 % reported women (p<0.05). Even so, statistical calculus shows that in
problems in mobility, 8.0 % in self-care, 27.8 % in usual premenopausal women with subclinical hyperthyroidism
activities, 74.7 % in pain/discomfort, and 43.3 % in anxiety/ there is a 3.2 higher risk of osteopenia and a 1.9 higher risk
depression. Average HRQoL was 0.7 [SD=0.2]. Patients with for osteoporosis then in the control reference population
a history of fractures had lower HRQoL than those without (p<0.001).
fractures (0.69 vs. 0.71; p<0.01). Among those with fractures, Conclusion: This study indicates that frank or subclinical
lower HRQoL was indicated in patients with hip (0.62), hyperthyroidism significantly influences the BMD. This phe-
vertebral (0.63) and arm (0.66) fractures. Compared with nomenon is more obvious in postmenopausal women. Sub-
patients receiving OP medication (bisphosphonates, raloxi- clinical hyperthyroidism may be considered a risk factor to
fene, teriparatide, estrogen), those without reported more pain develop osteoporosis even in premenopausal women. To
or discomfort (77 % vs. 73 %; p=0.01). New patients had avoid premature BMD decrease or its complications, prophy-
lower HRQoL than returning patients (0.68 vs. 0.72; p<0.01). lactic measures should be taken that involve evaluation of
Other factors affecting HRQoL included elder age, history of TSH and thyroid hormonal levels to identify thyroid
falls and comorbidities (hypertension, arthritis, and asthma). dysfunction.
Conclusion: In a Swedish OP registry, average HRQoL based
on EQ-5D was 0.7. 75 % patients reported pain/discomfort
and 43 % reported anxiety/depression. Factors affecting P387
HRQoL included age, history of fractures and/or falls, INDEX OF OSTEOPOROTIC RISK IN THE
comorbidities. EVALUATION OF THE DENOSUMAB TREATMENT
Disclosures: This study was funded by Merck & Co., Inc S. Shubeska-Stratrova1
1
Clinic of Endocrinology, Diabetes and Metabolic Disorders,
Medical Faculty, Skopje, Former Yugoslav Republic of
P386 Macedonia
STUDY REGARDING THE INFLUENCE OF FRANK
AND SUBCLINICAL HYPERTHYROIDISM ON BONE Objective: Predomination of bone resorption compared to
MINERAL DENSITY bone formation in postmenopausal osteoporotic women and
A. Chereji1, F. Cioara2 inversion of this relation during denosumab treatment (DT),
1
University of Oradea, Oradea, Romania, 2Medical Rehabili- indicated the need to discover their relationship as an index of
tation, University of Medicine and Pharmacy Oradea, Oradea, the osteoporotic risk (IOR). Osteocalcin and CTX reduction
Romania and IOR increase were determined after 3 and 6 months of DT.
Material and Methods: Bone turnover markers N-MID
Objective: To evaluate the incidence and risk of osteopenia/ osteocalcin (O) and β- crosslaps (CTX) were determined, as
osteoporosis in women with frank and subclinical well as their ratio IOR=O/CTX, and their post- treatment
hyperthyroidism. values. O and CTX levels were expressed in ng/ml. The mean
Material and Methods: The study was performed at the percentage (%) of O and CTX reduction and IOR increase
County Hospital of Oradea, in premenopausal and postmeno- from the basal levels was also determined during DT.
pausal women (between 42 and 76 years of age), divided in 2 Results: Pretreatment mean O levels were 20±4.23 ng/ml,
groups: patients with frank hyperthyroidism (n=39) and pa- and lowered to 14 ± 4.09 ng/ml (p < 0.007) and 12.58 ±
tients with subclinical hyperthyroidism (n=32). In this cross- 3.53 ng/ml (p<0.0001), after 3 and 6 months of DT as well
 Osteoporos Int

as the correspondent CTX levels 0.37±0.06 ng/ml, 0.1± not significantly different (p=0.07) as well as the correspon-
0.06 ng/ml and 0.04±0.009 ng/ml (p<0.0001). Pretreatment dent CTX levels, CTX-IT (0.094±0.07 ng/ml), CTX-DT3
IOR mean levels were 63.45±19.56, and increased to 163.25 (0.054±0.014 ng/ml) and CTX-DT6 (0.052±0.03 ng/ml)
±82.22 and 249.25±93.85 (p<0.0001) after 3 and 6 months of (p=0.27). The reduction of O and CTX remained nonsignif-
DT. The mean% of CTX reduction for the first 3 months was icant and stable at months 3 and 6. Calcium levels remained
74.17±12.96 %, and for 6 months 88.16±2.74 %. The mean% stable after 3 and 6 months of DT (2.45±0.05 mmol/l; 2.35±
of O reduction for the first 3 months was 29.06±35.48 % and 0.08 mmol/l) compared to Ca levels before the DT (2.4±
for 6 months 35.48±16.87 %. The mean% of IOR increase for 0.08 mmol/l).
the first 3 months was 154.71±135.56, and for 6 months Conclusion: Transitioning of intravenous ibandronate thera-
330.63±303.07. py to denosumab therapy was associated with no significant
Conclusion: Significant O decrease, highly more significant difference in O-I, O-DT3 and O-DT6 values as well as the
CTX and CTX% decrease, IOR significant increase con- correspondent values of CTX, CTX-DT3, CTX-DT6. This
firmed bone formation predomination compared to bone re- indicated not significant change of bone turnover markers as
sorption, decreased bone turnover, which indicates lower bone a result of the treatment with the two different medicines, and
loss, reduced osteoporotic risk in postmenopausal women and it confirmed the efficacy of consecutive continuous osteopo-
reduced fracture risk as a result of DT. Determination of the rotic denosumab therapy, which is very important especially
relation of the two processes, bone resorption and bone for- in bisphosphonates resistant states.
mation through IOR will greatly assist in the conduction and
evaluation of clinical trials, and follow up of the level of the
osteoporotic risk and the efficacy of the treatment. IOR con- P389
firmed very high efficacy of DT in postmenopausal MALE OSTEOPOROSIS AND TYPE 2 DIABETES
osteoporosis. MELLITUS
M. Hernández Bonilla1, K. Guerrero Franco2, N. Bautista
Litardo3, M. Navarro Chavez4, A. Segale Bajana2, E. López
P388 Gavilanez1
1
DENOSUMAB THERAPY IN CONTINUATION TO Servicio Endocrinología, Hospital Docente Policía Nacional
IBANDRONATE THERAPY Guayaquil No. 2, Guayaquil, Ecuador, 2Servicio Medicina
S. Shubeska-Stratrova1 Interna, Hospital Docente Policía Nacional Guayaquil No. 2,
1
Clinic of Endocrinology, Diabetes and Metabolic Dis- Guayaquil, Ecuador, 3Servicio Endocrinología, Hospital
orders, Medical Faculty, Skopje, Former Yugoslav Re- Clínica Kennedy Alborada, Guayaquil, Ecuador, 4Servicio
public of Macedonia Medicina Interna, Hospital Luis Vernaza, Guayaquil, Ecuador

Objective: Patients treated with bisphosphonates for osteopo- Objective: To determine the prevalence of osteoporosis
rosis may require a switch to other therapies. The outcomes (OSP) and osteopenia (OST) in a sample of male patients with
after changing therapies are important to investigate. The T2DM, evaluated in the Teaching Hospital National Police
present study was conducted in postmenopausal women (HDPN-G No. 2).
(PM) previously treated with ibandronate to evaluate the Material and Methods: We selected 110 males, aged
effects of transitioning to denosumab therapy (DT) on bio- 50 years, who came to control the T2DM to the Endocrinol-
chemical bone turnover markers (BTM), in comparison with ogy Outpatient Clinic HDPN-G No. 2, during the period
branded ibandronate therapy (IT). January-September 2013. We measured BMD at lumbar spine
Material and Methods: Biochemical BTM of bone forma- (LS) and femoral neck (FN) with DXA (Hologic Discovery
tion osteocalcin (O) and β- Crosslaps (CTX) as a marker of W®). We use the densitometric criteria developed by WHO to
bone resorption were determined in PM receiving i.v. classify osteoporosis. Data treatment and analysis were per-
ibandronate 150 mg every 3 months for 1 year (O-IT and formed by computer support, using the Epidat program v.3.1
CTX-IT). Subjects continued without pause with subcutane- for Windows.
ous denosumab 60 mg and were followed for 6 months. O Results: Mean age 64.8±9.22 (n=110). We found that in LS 9
values were determined after 3 (O-DT3) and 6 months DT (O- (8.3 %) had OSP, 31 (28.4 %) OST and 68 (62.4 %) were in
DT6), as well as the correspondent CTX values (CTX-DT3 ranges of normal (N). In FN: 41 (37.6 %) had OST, 5 (4.6 %)
and CTX-DT6). O and CTX levels were expressed in ng/ml. had OSP, and 63 (57.8 %) were in the normal range. The
Higher reduction of CTX values in comparison to O levels prevalence of bone disease in the age groups 65–74 and over
indicates better treatment effect. 75 years was 27.3 % and 14.5 % in the group aged 50–64 years.
Results: O-IT levels were 15.7±3.78 ng/ml, O-DT3 were Conclusion: In this sample of diabetic men skeletal involve-
11.9±3.78 ng/ml and O- DT6 (11.8±3.49 ng/ml) and were ment is high. (LS=36.7 % and 42.2 % FN). The highest
Osteoporos Int

prevalence was found in the older age groups (65–74) and the P391
group aged 75 years, and the lowest in the younger age group. ONCE-WEEKLY TERIPARATIDE REDUCES
Osteoporosis remains underdiagnosed in men, so we recom- VERTEBRAL FRACTURE RISK: SUBGROUP
mend screening programs for osteoporosis in our entire male ANALYSIS FROM THE TERIPARATIDE ONCE
population. WEEKLY EFFICACY RESEARCH (TOWER) TRIAL
Y. Nakamura1, T. Kuroda1, T. Sugimoto2, M. Shiraki3, T.
Nakano4, H. Kishimoto5, M. Ito6, M. Fukunaga7, H. Hagino8,
P390 T. Sone7, T. Nakamura9
1
DEVELOPMENT OF THE ASSAY METHOD Asahi Kasei Pharma Corporation, Tokyo, Japan, 2Shimane
DETECTING THE SUPPRESSION OF University, Izumo, Japan, 3Research Institute and Practice for
GASTROINTESTINAL MOVEMENT BY Involutional Diseases, Nagano, Japan, 4Tamana Central Hos-
TERIPARATIDE USING POSITRON EMISSION pital, Tamana, Japan, 5Nojima Hospital, Yonago, Japan, 6Na-
TOMOGRAPHY IMAGING ANALYSIS gasaki University Hospital, Nagasaki, Japan, 7Kawasaki Med-
N. Kato1, T. Shingaki2, Y. Katayama2, T. Okauchi2, E. ical School, Kurashiki, Japan, 8Tottori University, Yonago,
Hayashinaka2, Y. Wada2, Y. Cui2, T. Kuroda1, Y. Watanabe2 Japan, 9National Center for Global Health and Medicine,
1
Project for Bone Metabolic Disease, Asahi Kasei Pharma Tokyo, Japan
Corporation, Tokyo, Japan, 2RIKEN Center for Life Science
Technologies, Kobe, Japan Objective: We analyzed the effects of once-weekly
teriparatide (human PTH1-34) injection on incident vertebral
Objective: During an osteoporosis treatment, patients occasion- fracture in various subgroups using data from the TOWER
ally feel discomfort such as nausea and vomiting after receiving trial (2012 JCEM).
the medication such as teriparatide. Although side effects have Material and Methods: Antifracture efficacy with weekly
been reported due to the suppression of gastrointestinal 56.5 mg teriparatide injection was examined in a randomized,
motility, the care for the abdominal discomfort has not double-blind, placebo-controlled trial of 542 Japanese patients
been clarified yet. The aim of this study is to develop the with osteoporosis (65–95 years). Patients were divided by
method detecting the suppression of gastrointestinal move- baseline age, number or deformity grade of prevalent vertebral
ment by teriparatide for exploring the antiemetic reagent giv- fractures, BMD level, bone turnover marker levels, and level
ing a relief to patients. of renal function using estimated glomerular filtration rate
Material and Methods: Rats subcutaneously received low or (eGFR). Relative risk (RR) was calculated using Cox regres-
high dose of teriparatide (5 or 50 μg/kg, respectively) or only sion analysis.
vehicle as a control group 30 min before oral administration of Results: Significant fracture risk reductions were observed in
2-deoxy-2-[18F]-D-glucose ([18F]FDG). Under the awaking the subgroup of subjects <75 years (RR, 0.06; p=0.007) and
condition of rat, positron emission tomography (PET) was ≥75 years (RR, 0.32; p=0.015). For prevalence of vertebral
performed on the abdominal region for 90 min by a μPET fractures, a significant risk reduction was observed in the
Focus220 scanner (Siemens, Knoxville, TN) designed for subgroup with 1 vertebral fracture (RR, 0.08; p=0.015) and
laboratory animals immediately after oral administration of in those with ≥2 vertebral fractures (RR, 0.29; p=0.009). In
[18F]FDG. Blood samples were also taken at appropriate time the subgroup based on deformity of vertebral fracture, a
points. The quantitative PET imaging data analysis was car- significant risk reduction was observed in subjects with grade
ried out for the evaluation of pharmacokinetic parameters. 3 deformity (RR, 0.26; p=0.003). Significant risk reduction
Results: The absorption rate constant of [18F]FDG obtained was observed in the subgroup with lumbar BMD <−2.5 SD
from the time- radioactivity in blood curve significantly de- (RR, 0.25; p=0.035). No incident vertebral fracture was ob-
creased after both teriparatide groups. PET imaging data anal- served in the subgroups with no prevalent vertebral fractures,
ysis revealed that the residual radioactivity in the forestomach with vertebral deformity grade 0–2, and with lumbar BMD
increased in both teriparatide groups. Moreover, area under ≥−2.5 SD in the teriparatide group. Significant risk reductions
the time- radioactivity curve on the duodenum was signifi- were observed in the subgroups over/under the median value
cantly elevated on the high dose teriparatide group compared for each bone turnover marker. The subgroups over/under the
with the control group. eGFR levels: 70 ml/min/1.73 m2 showed a significant reduc-
Conclusion: The suppression of gastrointestinal movement was tion in fracture risk (RR, 0.13, p=0.001; RR, 0.31; p=0.004,
detected by pharmacokinetic PET imaging data analysis on the respectively).
abdominal region in rat, indicating that PET may be able to solve Conclusion: Once-weekly 56.5 mg teriparatide injection re-
the vomiting process induced by teriparatide. The molecular duced the vertebral fracture risk in patients with varying
imaging technique using PET is applicable to explore the anti- degrees of fracture risk, age, vertebral fracture number and
emetic reagents to ease drug induced nausea and vomiting. grade, bone turnover level, and renal function.
 Osteoporos Int

P392 P393
PROSPECTIVE COMPARISON OF QCT BMD CORRELATION OF BMD AND FRACTURES WITH
MEASUREMENT USING EITHER ASYNCHRONOUS DIETARY INTAKE OF CALCIUM : A BRIEF
OR SIMULTANEOUS CALIBRATION AT THE ANALYSIS OF COLLECTIVE DATAWITHIN A
FEMORAL NECK AND LUMBAR SPINE METROPOLITAN HOSPITAL IN SOUTH
G. Bodeen1, J. K. Brown1, A. Brett1 BANGALORE
1
Mindways Software, Inc, Austin, United States M. Shankar1
1
ISBMR & Apollo Hospitals, Bangalore, India
Objective: Conventional QCT calibration requires si-
multaneous scanning of patient and phantom. We com- Objective: To correlate BMD levels using DXA and history
pared BMD estimates using conventional versus asyn- of dietary intake of calcium intake.
chronous QCT calibration, in which the calibration Material and Methods: Osteopenia and osteoporosis was
phantom is scanned separately from the patient. Ad- evaluated among adult patient (>18 years) population of a
vantages of this method include simplification of midsized hospital in a metropolitan city Bangalore, South
workflow, dual-use of CT studies, and retrospective India. A case matched control (age and sex) were enrolled.
analysis of images. BMD results, using DXA, estimated and T-score & Z-score
Material and Methods: IRB approval was obtained for a derived.
prospective study of measurement bias between asynchronous Results: Of 75 case-patients who underwent routine or refer-
and simultaneous QCT BMD estimates. The study was ral testing, the median age was 61 years (range: 27–87 year),
powered to detect a 1 % bias relative to mean young normal 82 % were females 18 % male. The 50 control patients (with
BMD. Three clinical sites recruited 43 subjects (ages 44–80). no fractures) who also underwent BMD testing were in the
Each subject received two QCT scans: with and without a median age of 58 (range: 28–80), 86 % female and 14 % male.
calibration phantom present. Of them risk factors were present in 48 % of the fracture group
Results: Regression analysis shows that the lumbar spine (40 % of females and 8 % of males), and 96 % of patients in
measurements are strongly correlated (R>0.97) with small the case matched control group with no fractures (84 % fe-
standard error (SEE)=5.98 mg/cm3. A paired t-test indicates males and 12 % males). The most common risk factor was
the means are significantly different (P<10−6), with a differ- menopause in females and smoking in males and site of
ence of means of 3.7 mg/cm3 or 0.14 T-Scores. Linear regres- fracture was the hip in both. In the fracture group, the lowest
sion at the femoral neck shows strong correlation (R=0.96) T- score was estimated at the hip at −7.3 with a corresponding
with small standard error (SEE)=0.025 g/cm2. A paired t- test BMD value of 0.105. And the Lowest BMD was documented
did not indicate a significant difference in mean BMD (P= at the spine 0.04. with a T score of - 5.2. 9 patients (12 %) gave
0.47). history of gave intake of calcium rich history and 24 (32 %) of
them were on calcium supplementation. In the group with no
fractures, both the lowest BMD and T-score were in the same
patient at −0.358 and −5.7, respectively, at forearm. 17 of
them (34 %) gave history of good calcium intake in their diet
and 5 (1 %) were on calcium supplementation.
Conclusion: Detailed analysis of data show that group of
patients with fractures higher number of patients (88 %) had
lower dietary calcium intake and amongst the group of pa-
tients with no fractures lesser number of patients (1 %) re-
quired calcium supplementation. This also suggests that pres-
ence of fracture was a prelude for the further management of
Conclusion: No bias was found in proximal femur osteoporosis and therefore calcium supplementation.
aBMD estimates. A small bias was found in lumbar
spine vBMD estimates in the presence versus absence
of a CT calibration phantom. This bias is considerably P394
less than the error usually associated with BMD mea- REFERENCE INTERVALS FOR BONE TURNOVER
surement, typically±0.4 T-scores for DXA, and is there- MARKERS IN SPANISH PREMENOPAUSALWOMEN
fore very unlikely to be clinically significant. This N. Guañabens1, X. Filella2, A. Monegal1, C. Gómez-Vaquero3,
workflow change could greatly enhance osteoporosis M. Bonet4, D. Buquet5, E. Casado6, D. Cerdà7, A. Erra8,
screening since BMD can be easily measured regardless S. Martínez9, N. Muntalà10, C. Pitarch11, E. Kanterewickz12,
of the clinical indication for CT scanning. M. Sala13, X. Surís14, F. Torres15
Osteoporos Int

1
Rheumatology, Hospital Clínic, Barcelona, Spain, 2Labora- P395
tory, Hospital Clínic, Barcelona, Spain, 3Rheumatology, Hos- EFFECTS OF ANTIHYPERTENSIVE AND
pital Bellvitge, L’Hospitalet, Spain, 4Rheumatology, Hospital LIPID-LOWERING THERAPY ON BONE MASS
de l’Alt Penedés, Vilafranca del Penedés, Spain, 5Rheumatol- DEPENDING ON THE RISK FACTORS OF
ogy, Hospital Arnau de Vilanova, Lleida, Spain, 6Rheumatol- OSTEOPOROSIS
ogy, Hospital Parc Taulí, Sabadell, Spain, 7Rheumatology, I. A. Skripnikova1, K. E. Sobchenko1, E. S. Abirova1, V. E.
Hospital Moisés Broggi, Barcelona, Spain, 8Rheumatol- Novikov1, L. M. Murashko1, P. A. Alyasova1
ogy, Hospital Sant Rafael, Barcelona, Spain, 9Rheuma- 1
Research Center for Preventive Medicine, Moscow, Russian
tology, Hospital Mútua de Terrassa, Terrassa, Spain, Federation
10
Rheumatology, Hospital Santa Maria, Lleida, Spain,
11
Rheumatology, Hospital Esperit Sant, Santa Coloma Objective: To investigate the effect of treatment with β-
de Gramenet, Spain, 12Rheumatology, Hospital de Vic, blockers (β-AB), inhibitors of angiotensin converting enzyme
Vic, Spain, 13 Rheumatology, Hospital de Figueres, (ACEI) and statins on BMD depending on the risk factors
Figu ere s, S pa in, 1 4 R h e u m a t o l o g y, H o s p i t a l de (RF) of osteoporosis.
Granollers, Granollers, Spain, 15Universitat Autònoma Material and Methods: In a retrospective study included
de Barcelona, Bellaterra, Spain 1,163 outpatients (1,121 women) aged over 40 years, who
had the first DXA examination prior to start of the treatment
Objective: Bone turnover markers (BTMs) are used in for osteoporosis. Baseline characteristics of pts. including data
clinical practice for assessing patients with osteoporosis on osteoporosis risk factors (RF) and medication were obtain-
and their treatment. In Spain it is necessary to fine ed at the initial visit which had taken place between 2001 and
tune the reference intervals, since they were established 2011. BMD at the lumbar spine (LS), femoral neck (FN) and
years ago in a low number of individuals. The aims of total hip (TH) were measured by DXA (Hologic Delphi W).
this study were to establish robust reference intervals 418 pts. have been taking β-AB, ACEI, statins and their
for BTMs in healthy young premenopausal Spanish combination not less than 6 months before the DXA exami-
women and to investigate the factors influencing nation (“users group”), 745 pts. have not been receiving any
BTMs. therapy (“nonusers group”).
Material and Methods: We included 185 women; aged 35– Results: In the “users group” risk of reduction of BMD was
45 year, from 13 centres in Catalonia. Period: February–June lower than in the nonusers [RR=1.6 (95%CI 1.25–2.022)
2013. Blood and second-void urine samples were collected p<0.001], osteoporosis was diagnosed 1.3 times less frequent-
between 8 and 10 a.m. after an overnight fast. Serum PINP ly, and the BMD in LS, FN and TH were significantly higher
and βCTX were measured by two automated methods than these parameters in “nonusers group”. The highest BMD
(Elecsys, Roche a and IDS-ISYS, Immunodiagnostic were noted in pts. on combined therapy with statins. The risk
Systemsb), bone ALP by ELISA (IDS, Vitro), osteocalcin by of BMD reduction not depends in both groups on RF such as
IRMA (Cis Bio) and urinary NTX by ELISA (Osteomark, age, postmenopause duration, presence of early or surgical
Vitro). PTH and 25OHD levels were measured in all partici- menopause, low body weight, physical inactivity, previous
pants, who completed a questionnaire on lifestyle factors. A fractures, fractures in relatives, rheumatoid arthritis, glucocor-
quantile regression was fit to estimate the 5 %, 50 % and 95 % ticoid use or alcohol abuse. In multivariate regression analysis
percentiles for the BMTs, and the Fisher’s exact test and non- after adjustment with these RF, BMD at all measured locations
parametric tests were used to assess the influence of factors on in users group maintained significantly higher than in non-
BTMs. users. There was no correlation between BMD and duration of
Results: The median (P5-P95) for BTMs were: bone β-AB, ACEI and statins therapy.
ALP 9.3 (6.0–13.8) ng/ml, PINPa 35.9 (20.8–60.6) ng/ Conclusion: Prolonged use of β-AB, ACEI and statins in
ml, PINPb 35.8 (20.8–64.9) ng/ml, NTX 32.7 (19.3– combination as well as monotherapy could has a protective
68.9) nM/mM, CTXa 0.250 (0.137–0.480) ng/ml, CTXb effect on bone mass regardless of osteoporosis risk factors.
0.246 (0.107–0.541), osteocalcin 14.0 (8.0–23.0) ng/ml.
Oral contraceptive pills (OCPs) were reported in 10.9 %
of participants, mean BMI was 23 and 60 % had P396
25OHD levels lower than 20 ng/ml. Women on OCPs COMPLIANCE, PERSISTENCE AND PREFERENCES
had lower PINP levels (p=0.007). 25OHD levels didn’t TOWARDS OSTEOPOROSIS TREATMENT AMONG
influence BTMs, but low BMI was associated with POST-MENOPAUSAL ISRAELI WOMEN DURING
higher levels of almost all BTMs. ACTIVE THERAPY OR DRUG HOLIDAY
Conclusion: Robust reference intervals for BTMs in a south- P. Rotman Pikielny1, A. Amitai2, M. Maram Edry3, S.
ern European country are provided. Yosselson Superstine4, A. Eliasaf2
 Osteoporos Int

1
Bone Health Service, Endocrine Unit, Department of Medi- P397
cine E, Meir Medical Center, affiliated to Sackler Faculty of LOW BONE MINERAL DENSITY IN SWEDISH MEN
Medicine, Tel-Aviv University, Kfar-Saba, Israel, 2Division of WITH DISTAL RADIUS FRACTURE
Clinical Pharmacy, Pharmacy Services, Meir Medical Center, K. Akesson1, L. Egund1, F. E. Mcguigan1, K. Onnby1
1
affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Clinical and Molecular Osteoporosis Research Unit, Depart-
Kfar-Saba, Israel, 3 Medical Management Department, Meir ment of Clinical Sciences, Lund University, Malmo, Sweden
Medical Center, affiliated to Sackler Faculty of Medicine, Tel-
Aviv University, Kfar-Saba, Israel, 4Division of Clinical Phar- Objective: Distal radius (DR) fracture is a predictor of future
macy, School of Pharmacy, Hebrew University of Jerusalem, osteoporosis risk in women. However, this has not been
Jerusalem, Israel extensively studied in men. Only a small portion of men with
DR fracture are evaluated for osteoporosis and even fewer
Objective: Adherence to osteoporosis treatments after 1 year receive treatment. The purpose of this study is to evaluate
is only about 50 % and is related to increased risk of fractures. BMD of adult Swedish men of all ages with DR fracture
Our study objectives were to determine compliance and per- compared to the background population.
sistence with osteoporosis therapy and attitudes regarding Material and Methods: This cross sectional study recruited 233
resuming treatment among patients of a metabolic bone clinic adult men from Malmö, Sweden, with a DR fracture in two ways:
on active therapy or drug holiday. Understanding possible 1. All men who fractured in 1999–2000 (n=288) were invited
reasons for low compliance can provide a basis for a strategic to participate in 2003
plan to improve compliance. 2. Men who fractured in 2003–2007 (n=460) were invited to
Material and Methods: Compliance was assessed by the prospective study-arm and followed during the first year
medication possession ratio (MPR), representing the postfracture
number of doses dispensed in relation to those pre- Male controls from the same geographical area were randomly
scribed. Persistence was defined as continuation of treat- selected from the population registry. BMD was measured by
ment without a >30-day gap in refills. Data were col- DXA (femoral neck (FN), total hip (TH) and lumbar spine
lected by personal interviews. (LS)). Medical history and risk factors were obtained by
Results: Of 100 patients interviewed (70.2±7.7 years old), questionnaire. To evaluate mean BMD levels participants
55 % were taking medication; 60 % oral medication, mostly a were grouped by age at fracture: 20–39, 40–64 and ≥65 year
bisphosphonate. MPR≥80 % was found in 82 % of patients and in 10-year age-bands.
and <50 % in 13 %. MPR was 100 % for zoledronate, Results: Mean age at fracture was 52.2 y. Distribution by age
denosumab and raloxifene, and 92 %, 89 % and 71 % for group was 27 %, 44 % and 29 %. Men with DR-fracture had
teriparatide, oral bisphosphonates and strontium ranelate, re- lower BMD (p<0.001) than controls (FN: 40–64 y: 0.936 vs.
spectively. Of 27 patients who took oral bisphosphonates, 1.004; ≥65 y: 0.839 vs. 0.941); (TH: 40–64 y: 0.993 vs. 1.059;
63 % Persisted with treatment. Of patients on oral ≥65 y: 0.898 vs. 1.019); (LS: 40–64 y: 1.161 vs. 1.228, ≥65 y:
bisphosphonates, 87 % took them as directed, compared to 1.109 vs. 1.286). The proportion with osteoporosis at any site
25 % of 8 patients taking strontium ranelate. Of 40 patients on was higher at all ages: 20–39 y: 8.5 % vs. 1.5 %; 40–64 y:
a scheduled medication break, 20 % expressed concern about 16.8 % vs. 5.1 %; ≥65 y: 23.3 % vs. 8.3 % (p=0.023; <0.001;
resuming treatment, while 65 % expressed confidence in their 0.005). The corresponding T-score difference was 0.4–0.8
physician’s treatment choice. (FN) and 0.5–0.9 (TH). Compared to controls, this equates
Conclusion: Compliance among our patients was higher to 6.3–6.7 % lower BMD in patients 40–64 y and 10.7–11.9 %
than reported in the literature. MPR for bisphosphonate in ≥65 y, while not significant <40 y.
treatment was high; lower for strontium ranelate. We Conclusion: In this study, to our knowledge the largest on
found a high rate of taking oral bisphosphonates as men with DR fracture, those with fracture have significantly
directed, compared with lower rates for strontium lower BMD at all sites. Interestingly, compared to controls the
ranelate. Compliance with percutaneous treatments difference in BMD becomes more pronounced with higher
(zoledronate and denosumab) was 100 %. High persis- age, but is already evident from middle age.
tence and compliance may be specific to patients from a
dedicated bone diseases clinic. This study provides new
information about the attitudes of osteoporosis patients P398
on a scheduled drug holiday. Most were not concerned SCREENING FOR OSTEOPOROSIS WITH HEEL
about resuming treatment and did not have a preferred ULTRASOUND IN A SAMPLE OF ELDERLY WOMEN
medication. These results indicate that a trusting rela- WITH A HIGH PREVALENCE OF FALLS
tionship between doctor and patient seems to be an K. Thomsen1, J. Ryg2, L. Matzen2, A. P. Hermann3, T.
important factor in medication compliance. Masud4
Osteoporos Int

1
Institute of Clinical Research, University of Southern Den- Objective: Osteoarthritis (OA) is a common disease that
mark, Department of Geriatric Medicine, Odense University affects articular tissues. The obesity showed strong link with
Hospital, Odense, Denmark, 2Department of Geriatric Medi- OA in multiple studies (Coggon et al, 2001). Relationship
cine, Odense University Hospital, Odense, Denmark, 3Depart- between obesity, gender, and degenerative changes in the
ment of Endocrinology, Odense University Hospital, Odense, spine varies in different studies and countries (Zukowski
Denmark, 4Nottingham University Hospitals, NHS Trust, De- et al, 2012). Objective: To determine the association of spinal
partment of Geriatric Medicine, Odense University Hospital, OA with obesity, gender and age within adult population of
Nottingham, United Kingdom Banjaluka region.
Material and Methods: The study included a retrospective
Objective: Falls are common in older people and cause much analysis of 7,089 medical records of patients with established
morbidity including fragility fractures. Assessment for osteo- diagnosis of OA. We used the electronic data base of primary
porosis is important in fallers. Currently DXA is the preferred care and CBR units. Analyzed parameters were: age, gender
method. Heel ultrasound (QUS) is an alternative technique for and BMI in patients with OA. The obesity was classed as
assessing bone fragility. However, few studies have focused BMI>30.0 kg/m2 (NIH, 2009). The baseline characteristics of
on older fallers. The objective of this study was to investigate the participants are presented as means (SD) and percentages
the ability of QUS to identify women with osteoporosis in a in relation to BMI and age. Association between OA and
sample of elderly women with a high prevalence of falls. BMI, and OA and age were assessed by a chi-square test with
Material and Methods: A total of 221 women were assessed significance threshold of 0.05. All statistical analyses were
with DXA of hip and spine (Hologic Discovery) and QUS of the performed using SPSS software version 15.0 (SPSS
heel (Achilles Lunar). Using QUS we measured broadband Inc.2006).
ultrasound attenuation (BUA). We defined osteoporosis as Results: Out of 7,089 patients with OA (mean age 50.6±14.2;
DXA T-score ≤−2.5 at the hip or spine. Sensitivity, specificity, age range 19–91), the number of spinal OA was 5,918, with
positive and negative predictive values (PPV, NPV) and receiver significant increase with age (p<0.01). The number of cervi-
operator characteristics (ROC) curve for QUS were calculated. cal OA was 1,211 (65.2 % in women and 34.8 % in men; χ2 =
The optimal cutoff for QUS was identified using Youden index. 0.48; p>0.05). Lumbar OA was presented in 4,707 partici-
Applying a triage approach, as recommended by UK National pants (52.6 % women and 47.4 % men; χ2 =39.66; p<0.01).
Osteoporosis Society, we identified the cut-offs for 90 % sensi- Obesity was most evident at age >50 years. From a total of
tivity and 90 % specificity and calculated the proportion of 1,787 OA in obese subjects, percentage of spinal OA was
women who would not need further examination with DXA. 77.9 %. The correlation of obesity and lumbar OA was statis-
Results: Median age was 80 years [IQR 75–86, range 65–98]. tically significant (χ2 =18.9; p<0.01). No statistical signifi-
135 (61.1 %) reported at least one fall within the last 12 months. cance was fond with obesity and cervical OA (χ2 =3.6;
Prevalence of osteoporosis was 45.2 % (100/221). Area under the p>0.05).
ROC-curve (AUC) was 0.811 (95%CI 0.755–0.868). The optimal Conclusion: Aging and female gender have a high statistical
cutoff (BUA=93.88) yielded a sensitivity of 74.0 % and speci- significance in the development of OA at all sites (p<0.01).
ficity of 78.5 %, PPV 74.0 % and NPV 78.5 %. At the cut-offs of There was a high statistical significance between obesity and
90 % sensitivity (BUA=105.98) and 90 % specificity (BUA= OA of lumbar spine (p<0.01), but not with obesity and
86.63) 69 women would be diagnosed as non-osteoporotic, 62 cervical OA (p>0.05).
women osteoporotic. 131 women (59.3 %) would not need
further examination with DXA at the expenses of 10 (4.5 %)
women being false negative and 12 (5.4 %) false positive. P400
Conclusion: In a two-step triage approach heel ultrasound EVALUATION OF TOPICAL ALENDRONATE ON
performs well in diagnosing osteoporosis among older women SUCCESS OF MAXILLARY SINUS ELEVATION IN
with falls. CASES OF ALENDRONATE TREATED AND
NONTREATED OSTEOPOROSIS
S. Adarnli1,2, Y. Al Moudallal3, N. Kochaji4
1
P399 Damascus University, Faculty of Dentistry, Damascus, Syri-
ASSOCIATION OF SPINAL OSTEOARTHRITIS an Arab Republic, 2Member of the Syrian National Osteopo-
WITH OBESITY rosis Society (SYNOS), Damascus, Syrian Arab Republic,
G. Stefanovski1, Z. Banjanin2 3
Oral & Maxillofacial Surgery, Faculty of Dentistry, Damas-
1
IPRM Dr Miroslav Zotović, Banja Luka, Bosnia and Herze- cus University, Damascus, Syrian Arab Republic, 4Oral Pa-
govina, 2Department of Public Health and Primary Care, thology, Oral Histology and Pathology Department, Faculty
University of Cambridge, Laktasi, Banja Luka, Bosnia and of Dentistry, Damascus University, Damascus, Syrian Arab
Herzegovina Republic
 Osteoporos Int

Objective: Previous experimental and clinical studies results application of alendronate 10−8 M/L helps in increasing
showed that osteoporosis negatively affects bone grafts bone grafts healing in maxillary sinus in cases of
healing, the aim of this study is to evaluate the effect of alendronate treated and non-treated osteoporosis and
osteoporosis on the healing of maxillary sinus grafts, and to also in normal bone.
evaluate the effect of topical application 10−8 M/L of
alendronate on the healing of maxillary sinus grafts.
Material and Methods: Study was performed on 34 adult
New Zeeland females rabbits, Rabbits were divided into 3 P401
groups: rabbits of normal bone “10 rabbits”, osteoporotic CHANGES IN BONE MINERAL DENSITY IN
rabbits treated with subcutaneous alendronate 50 mg/week PATIENTS WITH SERUM POSITIVE OR NEGATIVE
“12 rabbits”, nontreated osteoporotic rabbits “12 rabbits”. RHEUMATOID ARTHRITIS
Osteoporosis was induced via bilateral ovariectomy in addi- N. Ganea1, L. Groppa1, E. Russu1
1
tion to intramuscular injection of prednisolone 1 mg/kg/day Rheumatology and Arthrology Laboratory, Clinical Repub-
for 1 month, and it was confirmed through the evaluation of lican Hospital, Chisinau, Republic of Moldova
femur and vertebral bone density on CT scan, and the evalu-
ation of serum CTX. A bilateral sinus lifting procedures were Objective: To examine variables associated with BMD in
performed for all experimental animals with the application of patients with positive or negative rheumatoid factor rheuma-
topical alendronate with the bone graft in the left side, while toid arthritis (RA).
saline was used with the bone graft in left side “control Material and Methods: We investigated 72 patients with
group”, sacrificing the animals and obtaining histologic biop- low to moderately active positive or negative rheuma-
sies of the whole maxillary sinus with surrounding bone was toid factor RA. Demographic and clinical data were
performed 2 months after surgery. Sagittal and cross sectional collected. BMD was measured by means of DXA. As-
sections were prepared for each biopsy, and all sections were sociations between demographic and clinical measure-
stained with H&E, Masson’s trichrome, and TRAP stains. ments on the one hand and BMD on the other were
Bleeding, inflammation, bone formation, and osteoclasts pres- investigated in regression analyses.
ence were evaluated on H&E sections, Osteoblast activity was Results: The patient group consisted of middle aged,
evaluated on sections stained with Masson’s trichrome, and mainly female, patients. The median (interquartile range)
osteoclast activity was evaluated on sections stained with disease duration was 5.4 (3.2–9.8) years, the mean
TRAP immune technique. Histomorphometric study was per- disease activity score (SD) was 4.7 (1.1). Of the group,
formed for both sagittal and cross sectional sections stained 57 % was rheumatoid factor positive, and 86 % (n= 62)
with H&E to evaluate and compare the healing process be- had never used corticosteroids. The median Larsen score
tween different groups and between the experimental and of hands and feet was 32 (9–59). Greater age and low
control samples within each group. BMI were related to low BMD at the hip and spine.
Results: Histologic study for H&E sagittal and cross sectional High Larsen score for hands and feet was significantly
sections showed no differences between topical alendronate associated with low BMD at the hip. Joint damage at
and control samples within each group concerning the bleed- baseline and joint damage progression according to the
ing and inflammation, while bone formation was higher in Sharp-van der Heijde score were independently associ-
topical Alendronate samples in both H&E and Masson’s ated with more BMD loss after 1 year. The use of
trichrome sections, no differences in osteoclast presence were corticosteroids was not independently associated with
found on H&E sections, while osteoclasts counts and activity BMD. Median BMD loss after 1 year was 0.8 % and
were lesser in topical Alendronate group in comparing to 1.0 % of baseline in the spine and the hip, respectively.
control group on TRAP. Histomorphometric study results No significant differences between positive or negative
showed that the ratio of newly formed bone in control group rheumatoid factor groups were observed with regard to
of rabbits of normal bone was greater than the ratio of newly BMD loss after 1 year of treatment.
formed bone in control group of treated and non-treated Conclusion: BMD data of patients with low to moder-
osteoporotic bone, and the ratio of newly formed bone in ately active positive or negative rheumatoid factor RA
sinuses in which topical alendronate was applied with bone demonstrated an association between high radiological
graft was greater than the ratio of newly formed bone in RA damage and low BMD at the hip, which suggests
sinuses in which saline was applied with bone graft in the an association between the severity of RA and the risk
whole study group. of generalized bone loss, which also occurred in corti-
Conclusion: Both treated and non-treated osteoporosis affects costeroid naive patients. There were no significant dif-
the healing of bone grafts in maxillary sinus negatively and ferences between positive or negative rheumatoid factor
this effect present as a reduction in newly formed ratio, topical groups in BMD loss after 1 year of treatment.
Osteoporos Int

P402 Material and Methods: We analyzed 333 patients (263

THE RELATIONSHIPS BETWEEN PHYSICAL women; 70 men) with a mean age of 67.9±5 years. Among
PERFORMANCE VARIABLES AND BONE MINERAL them, 139 subjects sustained no fracture (WFx). Subjects with
DENSITY IN A GROUP OF YOUNG LEBANESE fracture were stratified by fracture type: lumbar (L, n=62)-;
ADULTS thoracic (T, n=97) or with fracture in both sectors (TL, n=35);
E. Zakhem1, G. Zunquin2, D. Theunynck2, R. El Hage1 b y T B S : n o r m a l ( N , T B S > 1 . , 3 5 0 ) , p a r t i a l ( P,
1
Department of Physical Education, University of Balamand, 1.200<TBS≤1.,350) or severe (S,TBS≤1.200) and by BMD
Kelhat, Lebanon, 2Department STAPS, URePSSS-EA 4110, (WHO recommendation).
EA448, ULCO, Dunkerque, France Results: WFx: 36 % and 34 % of subjects without
fractures had normal BMD or normal TBS; Dorsal
Objective: To explore the relationships between performances Fractures: 85/97 (87.62 %) of patient had osteopenia
in different physical tests and bone parameters (bone mineral or osteoporosis; 94/97 (96.9 %) had TBS altered (P-
content (BMC) and BMD) in a group of young Lebanese adults. S); Lumbar fractures: 16/62 (25.8 %) patients had
Material and Methods: 100 young Lebanese adults (42 osteopenia or osteoporosis while 61/62 (98.4 %) had
women and 58 men) whose ages range from 17 to 34 years TBS altered (P-S). Only one of them showed a normal
participated in this study. Weight and height were measured, TBS. Considering Thoracic-lumbar fractures, 28/35
and BMI was calculated. Daily calcium intake (DCI), daily (80 %) had osteopenia or osteoporosis, whereas all
protein intake (DPI) and physical activity level (h/week) were these patient had TBS in pathological range (P-S). Re-
evaluated using validated questionnaires. Physical perfor- sults are presented in the table below:
mance variables were measured using several physical tests:
vertical jump test, standing long jump test, 3-jump-test, 5-
jump-test and 1-RM half-squat. Body composition, BMC and
BMD at whole body (WB), lumbar spine (L2-L4), total hip
(TH) and femoral neck (FN) were measured by DXA.
Results: In women, weight, height, lean mass, and performances
in vertical jump test, standing long jump test, 3- jump-test, 5-
jump-test and 1-RM half-squat were positively correlated to
BMC and BMD values. In men, weight, height, BMI, DCI,
DPI, lean mass and performances in standing long jump test
Conclusion: This results showed, for the first time, that TBS
and 1-RM half-squat were positively correlated to BMC and
evaluated in lumbar region permit to detect patients with
BMD values.
thoracic fractures. In addition, TBS thoracic and lumbar frac-
Conclusion: This study suggests that lean mass and maxi-
ture sensitivities are similar (96.9 vs. 98.4 % considering the P
mum strength obtained in the half-squat test are positive
and S zones). For the TL fracture group, TBS exhibits the best
determinants of BMC and BMD in young Lebanese adult.
sensitivity. The evaluation of TBS in lumbar spine can be used
Our findings may have practical implications in the field of
to screen patient and choose to perform a VFA.
prevention of osteoporosis.
Disclosures: R. Winzenrieth is Senior Scientist at Med-Imaps.

P403
IS TBS ABLE TO IDENTIFY THORACIC P404
VERTEBRAL FRACTURE AS WELL AS LUMBAR KNEE JOINT BIOMECHANICS DURING STAIR
ONES? DESCENT IN PATIENTS WITH KNEE
L. Del Rio1, E. Bonel1, M. García1, R. Winzenrieth2, S. Di OSTEOARTHRITIS VS. CONTROLS
Gregorio3 K. Doslikova1, C. N. Maganaris2, V. Baltzopoulos3, S. M. P.
1
CETIR Centre Mèdic, Barcelona, Spain, 2R&D Department, Verschueren4, F. P. Luyten4, M. J. Callaghan5, R. K. Jones6,
Med-Imaps, Bordeaux, France, 3CETIR Grup Medic, D. T. Felson7, N. D. Reeves1
1
Barcelona, Spain Manchester Metropolitan University, Manchester, United
Kingdom, 2Liverpool John Moores University, Liverpool,
Objective: Establish the useful of TBS to identified subject United Kingdom, 3Brunel University, London, United King-
with altered bone structure, which could explain the vertebral dom, 4Katholieke Universiteit Leuven, Leuven, Belgium,
5
fractures in subject categorized as normal by BMD. Evaluate a University of Manchester, Manchester, United Kingdom,
6
new method combining information on BMD and TBS to University of Salford, Manchester, United Kingdom, 7Bos-
improve the identify subject with high risk. ton University, Boston, United States
 Osteoporos Int

Objective: To investigate biomechanical differences at the treatment even with good adherence. Moreover, there is de-
knee between knee osteoarthritis (OA) and healthy control bate on the effects of long-term BP on bone quality. Bone
participants during stair descent. microindentation estimates bone material strength (BMS)
Material and Methods: Thirty male and female participants in vivo. We aim to compare BMS values in patients on long-
(58.9±7.7 years) with patellofemoral and medial tibiofemoral term BP with and without incident fractures while on treat-
OA and thirty age- and BMI-matched control participants ment with good adherence
were recruited. Participants descended a 7-step staircase at a Material and Methods: Case-control study of postmeno-
standardised speed. Kinematic data were obtained by tracking pausal women with osteoporosis, on treatment with oral BP
the movement of rigid clusters and markers using a 10-camera for >4 y, with good adherence. DXA (Hologic) and
motion analysis system (Vicon) and a modified 6° of freedom microindentation with an Osteoprobe™ (Active Life Sci, S
full body model. Ground reaction forces (GRF) were mea- Barbara, CA) at the anterior midtibia after local anesthesia, at
sured from force platforms embedded into 4 steps. Joint a force of 20 N making 8 measurements were performed.
moments were calculated through inverse dynamics tech- BMS units express 100× the ratio indentation distance into a
niques by combining kinematic and GRF data. Pain was calibration PMMA/ indentation distance into the bone. Inci-
assessed using a VAS. An independent t-test was used to test dent fractures on treatment were validated
for differences between groups. Values are mean±SD. Results: 40 female patients were included (age 70.0±6.8 y,
Results: The OA group had a significantly reduced minimal time on BP 4–14 y). BMS values were lower in the 22 cases of
knee flexion angle [OA: 13.0±3.3°; control: 16.4±3.5°] and incident fracture while on BP (81.65±6.26) than in the 18
internal peak knee extension moment [OA: 0.96±0.23 Nm/ without (72.17±9.78) (mean±SD). These differences were
kg; control: 1.16±0.19 Nm/kg] during the stance phase com- significant after adjusting by age, BMI, lumbar BMD and
pared to controls. Additionally, compared to controls during years on BP treatment (p=0.01). The risk of suffering a
the stance phase, the OA group had a significantly increased fracture while on BP decreased with increased BMS (OR
maximal knee adduction angle [OA: 5.9±5.8°; control: 2.8± 0.79, 95%CI 0.68,0.93 per each BMS unit increase). Discrim-
5.2°]. The OA group descended stairs in significantly more ination between incident fracture and no-fracture yielded an
pain [OA: 32±29 mm on a 0–100 VAS; control: 0±0 mm], at AUC of 0.82 (95%CI 0.69, 0.95) for microindentation’ BMS
a slower gait speed [OA: 0.49±0.06 m/s; control: 0.52± values while for BMD ranged between 0.63 and 0.69 for the
0.03 m/s] and with a wider stride width [OA: 0.15±0.02 m; different measured regions.
control: 0.14±0.03 m] compared to controls. Conclusion: BMS at a tissue level is a strong conditioning
Conclusion: Stair descent is a challenging activity for people factor of suffering incident fractures in treated patients with
with knee OA affecting knee biomechanics as proven by our oral BP. Microindentation can detect cases in which tissue
findings of a reduced knee flexion, increased knee adduction, level properties are not fully restored by the treatment. Future
lower knee extension moment, slower pace and wider stride agents might target some BMD-independent aspects of bone
width, which may all together be results of the pathology strength to further increase the efficacy of the treatments.
while experiencing more pain during the task. Disclosures: A Diez-Perez owns stocks of Active Life Sci.
Acknowledgements: Funding: European Commission via Acknowledgements: RETICEF, Instituto Carlos III, Spanish
MOVE-AGE (2011–2015). Ministry of Economy and Innovation

P405 P406
BONE MATERIAL STRENGTH IN LONG-TERM 3D-DXA: A 3D MODELLING METHOD OF THE
BISPHOSPHONATE USERS IS DECREASED IN PROXIMAL FEMUR INTEGRATED IN DMS DXA
PATIENTS THAT SUFFER FRACTURES WHILE ON DEVICE
TREATMENT L. Humbert1, Y. Martelli1, S. Di Gregorio2, L. Der Río
X. Nogués-Solan1, D. Prieto-Alhambra2, E. Torres1, L. Vilaplana1, Barquero2
R. Güerri-Fernandez1, L. Mellibovsky1, A. Diez-Perez1 1
Galgo Medical, Barcelona, Spain, 2CETIR Grup Medic,
1
Department of Internal Medicine, Hospital del Mar-IMIM Barcelona, Spain
and Autonomous University of Barcelona, Barcelona, Spain,
2
Nuffield Department of Orthopaedics, Rheumatology and Objective: To present the 3D-DXA technology: a 3D model-
Musculoskeletal Sciences. University of Oxford, Oxford, ling method of the proximal femur embedded in Stratos dR
United Kingdom DXA device (DMS, Montpellier, France); and evaluates its
accuracy in comparison with QCT.
Objective: Bisphosphonates (BP) reduce fracture risk in pa- Material and Methods: The 3D-DXA technology relies on a
tients with osteoporosis but some still suffer fractures while on 3D statistical model constructed from a dataset of QCT scans
Osteoporos Int

and describing the statistical variations in shape and BMD 2009–2012 were performed 66 surgeries that targeted reduc-
distribution. A 3D subject-specific model is subsequently tion and internal fixation of calcaneal fractures. Patients were
obtained by registering the statistical model onto the 2D aged between 25 and 65 years. Sex ratio M/F=40/26. In 29
DXA image of the patient so that the projection of the model cases underwent open reduction and internal fixation with
matches the DXA image. The 3D modelling process is fully- osteosynthesis outbreak being made with plates and screws
automated. 3D modelling accuracy was evaluated by compar- or Kirschner wires and in 37 cases underwent minimally
ing 3D subject- specific models reconstructed from DXA invasive reduction and osteosynthesis technique Essex
images (Stratos dR, DMS) with QCT acquisitions. The study Lopresti. Fracture diagnosis and postoperative follow up as-
involved 40 patients, including patient with osteoporosis, sumed clinical examination and radiological incidents both
osteopenia and normal bone density (mean age: 53±12 years, axial and profile.
range: 23–84 years). Results: Postoperatively no patient walked on the operated
limb for 6 weeks then those who underwent open reduction
and fixation with plate and screws were loaded gradually
reaching full load after 10 weeks postoperatively. Postoperative
recovery was excellent in 30 cases operated minimally invasive
and 20 cases who underwent open reduction. No patient who
underwent minimally invasive reduction had skin lesions, but
showed pain following injury occurrence subtalar joint arthro-
sis. 4 patients who underwent open reduction and internal
fixation had postoperative wound infections, skin necrosis
and 2 of them had skin necrosis which delayed healing.
Conclusion: Given that you can get an accurate reduction of
the articular surface of the calcaneus avoiding invasion of soft
tissues and joints, consider that minimally invasive
Results: Mean computing time was 2 min. on an Intel Xeon, osteosynthesis is the method of choice in fractures of the
3.40GHz, 8GB of RAM, 64bit platforms. Mean shape accu- calcaneus, postoperative recovery is encumbered with fewer
racy evaluated on the 40 patients was 0.9 mm. Volumetric complications resulting absolutely favorable long term.
BMD and BMC reconstructed by 3D-DXA were highly cor-
related with Volumetric BMD and BMC computed from QCT
(r=0.94 and r=0.98, respectively, p<0.001). P408
Conclusion: This method presents a high potential for clinical PREFERENCES OF PATIENTS FOR OSTEOPOROSIS
routine use, by providing 3D models of shape and vBMD of DRUG TREATMENT: A CROSS-EUROPEAN
the femur while maintaining DXA as the current standard DISCRETE CHOICE EXPERIMENT
modality. This should potentially improve the diagnosis of M. Hiligsmann1, B. G. Dellaert2, C. D. Dirksen1, T. Van Der
osteoporosis and fracture prevention. Weijden1, V. Watson3, S. Goemaere4, J.-Y. Reginster5, C.
Roux6, B. Mcgowan7, C. Silke7, B. Whelan7, A. Diez-
Perez8, E. Torres8, G. Papadakis9, R. Rizzoli9, C. Cooper10,
P407 G. Pearson10, A. Boonen1
1
COMPLICATIONS AFTER LOW Maastricht University, Maastricht, Netherlands, 2Erasmus
MINIMALLY-INVASIVE FIXATION OF CALCANEUM Rotterdam University, Rotterdam, Netherlands, 3University
FRACTURE of Aberdeen, Aberdeen, United Kingdom, 4Ghent University
R. Ene1, A. Cursaru1, C. Cirstoiu1 Hospital, Ghent, Belgium, 5University of Liège, Liège, Bel-
1
Ortopaedics and Traumatology Department, Emergency Uni- gium, 6Paris Descartes Université, Paris, France, 7Our Lady’s
versity Hospital of Bucharest, Bucharest, Romania Hospital, Manorhamilton, Ireland, 8Hospital del Mar-IMIM
and RETICEF, Barcelona, Spain, 9Geneva University Hospi-
Objective: Fractures of the calcaneus is still a delicate point tals, Geneva, Switzerland, 10University of Southampton,
regarding the indication for osteosynthesis. Knowing the poor Southampton, United Kingdom
vascularization of the back leg skin we face trying to choose
between an open outbreak invasive osteosynthesis and correct Objective: To evaluate the preferences of European patients
reduction or minimally invasive osteosynthesis, preserving with, or at risk of, osteoporosis for medication attributes, and
the quality of the soft parts. to establish how they trade between these attributes.
Material and Methods: In the traumatology and orthopedic Material and Methods: A discrete choice experiment was
clinic of the Emergency University Hospital of Bucharest in conducted using a questionnaire in Belgium, France, Ireland,
 Osteoporos Int

Spain, Switzerland and United Kingdom. Patients were asked main method of diagnosis in 64 cases, and in the other 22
to choose between two hypothetical unlabelled drug treat- cases an MRI examination was used. The surgical intervention
ments (and an opt-out option) that vary in several attributes: was performed for all 86 patients at more than 3 weeks from
efficacy in reducing the risk of fracture, type of potential the occurrence of the trauma which caused the ACL injury.
common side effects, mode and frequency of administration Results: Postoperative pain is greatly reduced due to the
and out-of-pocket costs (only in countries with patients’ con- minim-invasive character of the surgical intervention:
tribution on the cost of treatment). An efficient design was
used to construct the treatment option choice sets and a mixed • The neoligament is more resistant due to its thickness and
logic model was used to estimate patients’ preferences. means of attachment.
Results: A total of 1,124 patients completed the experiment, • Recovery is early, after 24 h or immediately after the
with at least 100 patients per country. As expected, patients removal of the drainage tube.
preferred treatment with higher effectiveness and lower cost. • Good mobility of the knee is obtained very fast, approx-
In all countries, patients preferred 6-month subcutaneous in- imately 60° of flexion after the first 72 h.
jection above weekly oral tablets. In most countries, patients • The active mobilization of the patient is early.
also preferred oral monthly tablet and yearly intravenous • Through the faster postoperative recovery and the signif-
injections above weekly oral tablets. Patients disliked being icant decrease of the postinterventional pain, the hospi-
at risk of gastro-intestinal disorders more than being at risk of talization costs are substantially decreased by reducing
skin reactions and flu-like symptoms. There was significant the period of hospitalisation.
variation in preferences across the sample for most attributes.
Conclusion: This study revealed that European osteoporotic Conclusion: Arthroscopic ACL reconstruction with autograft
patients prefer 6-month subcutaneous injection above weekly from the semitendinosus and gracilis muscles provides early
oral tablets. In most countries, they also prefer oral monthly recovery with minimum postinterventional pain, increased mo-
tablets and yearly intravenous above weekly oral tablets, and bility of the knee as early as the first 2 weeks postoperatively and
they dislike gastro-intestinal disorders. Patients are willing to significant decrease of the hospitalization duration and costs.
trade efficacy (or cost) for their preferred outcomes. We found
differences in preferences across patients which highlight the
potential importance of clinical decision-making taking indi- P410
vidual preferences into account to improve osteoporosis care. ATYPICAL FRACTURES OF FEMUR IN PATIENTS
Disclosures: Unrestricted educational grant from Amgen TREATED BY BISPHOSPHONATES
V. Vyskocil1, T. Pavelka1
1
Department of Orthopaedic Surgery, Charles University Hos-
P409 pital PLZEN, Czech Republic
RECOVERYASPECTS IN ACL RECONSTRUCTION
WITH SEMITENDINOUS AND GRACILIS TENDONS Objective: Prevention of atypical fracture requires careful
R. Ene1, A. Cursaru1, C. Cirstoiu1 attention to the symptoms that precede a fracture. Additional
1
Orthopaedics and Traumatology Department of Emergency medication is considered as a risk factor, usually glucocorti-
University Hospital of Bucharest, Bucharest, Romania coids, proton pump inhibitors and bisphosphonates (BF).
Material and Methods: 4,213 patients treated with BFs;
Objective: ACL reconstruction is the surgical intervention 2,147 patients were treated with original alendronate and
used to replace the damaged ACL with a bone-patella 2,066 with original ibandronate. Totally 15 fractures were
tendon-bone (BTB) graft or with soft parts (semitendinosus - found in the alendronate group (2 in adult patients with
gracilis muscles (ST-G) - a method more frequently used osteogenesis imperfecta) and 14 in the ibandronate group (1
nowadays). Our purpose was to highlight how to optimize in adult patients with osteogenesis imperfecta). All radio-
postoperative recovery after ACL reconstruction using a min- graphic examinations of any fracture in the study group were
imally invasive approach compared with BTB technique. subjected to the retrospective analysis of fracture type identi-
Material and Methods: During the period 2010–2012, a fication including fractures of femur and humerus.
number of 64 arthroscopic ACL reconstructions with ST-G Results: In the alendronate group 4 pertrochanteric, 6 diaphysis of
muscles were studied and a number of 22 B-T-B ACL recon- femur, 2 subtrochanteric and 2 periprothetic fractures were identi-
struction, all performed to treat ACL isolated injuries or fied. No fracture of femur was found in this group. Based on
injuries associated with complex trauma of the knee. Most radiography analysis 3 fractures met the criteria for AF in the
of the patients were male (72) and aged between 17 and alendronate group. In the ibandronate group 4 pertrochanteric, 2
39 years (arthroscopic ACL reconstruction) and 19 male subtrochanteric, 5 fractures of femur diaphysis and 2 peripathetic
patients for the B-T-B reconstruction. Arthroscopy was the fractures in patients with endoprothesis (which were implanted
Osteoporos Int

before BF treatment) were identified. Again, there was no fracture onwards. TBS rapidly reacts to the changing hormonal status
of femur found. Only 1 fracture met the criteria for AF in the which is observed during menopause, and significantly de-
ibandronate group. Markers of bone remodeling were examined in clines after 3 years. Duration of RA influences only BMD, and
the study group - serum osteocalcin, PINP, PTH, ALP and CTX. its significant decrease is observed when the disease lasts for
Conclusion: From the whole study group of 4,213 patients more than 5 years.
only 4 AFs were identified. Patients with AF were treated with
BF for 7–10 years on average. Two patients were treated with
glucocorticoids and 3 with proton pump inhibitors through the P412
whole course of BF treatment. The authors discuss the early INFLUENCE OF GLUCOCORTICOIDS ON
identification of risk factors, especially the difference between TRABECULAR BONE SCORE IN PATIENTS WITH
mechanic and anatomic axis of femur. Emergence of AF is RHEUMATOID ARTHRITIS
primarily related to inadequate therapy decision or to mislead- V. V. Povoroznyuk1, T. A. Karasevska1, B. Aubry-Rozier2, R.
ing interpretation of risk factors after 5 years of BF treatment. V. Povoroznyuk1, D. Hans2, N. I. Dzerovych1
1
Institute of Gerontology NAMS Ukraine, Kiev, Ukraine,
2
Center of Bone Diseases, Lausanne University Hospital,
P411 Lausanne, Switzerland
TRABECULAR BONE SCORE IN PATIENTS WITH
RHEUMATOID ARTHRITIS Objective: To evaluate the influence of GC on the trabecular
V. V. Povoroznyuk1, T. A. Karasevska1, B. Aubry-Rozier2, D. bone score (TBS), BMD and TBS dynamics during 1 year in
Hans2, R. V. Povoroznyuk1 patients with RA.
1
Institute of Gerontology NAMS Ukraine, Kiev, Ukraine, Material and Methods: 134 examined women with RA (age
2
Center of Bone Diseases, Lausanne University Hospital, 52.5±12.8 years; height 162.6±6.4 cm, weight 68.2±13.7 kg)
Lausanne, Switzerland were divided into three groups: first group, G1, includes 37
patients who did not use GC, second group, G2 - 50 patients
Objective: To evaluate influence of age, duration of postmeno- who used GC in a dose of more than 5 mg of prednisolone for
pausal period (PMP) and duration of disease on trabecular bone more than 3 years, third one, G3 - 47 patients who took GC only
score (TBS) and BMD of women with rheumatoid arthritis (RA). at the exacerbated stage for less than 6 month. All the patients
Material and Methods: 129 women with RA aged 21– had been taking methotrexate as a basic treatment. BMD of total
83 years were examined (age 52.4±12.7 year; height 162.6± body, PA lumbar spine, proximal femur and forearm were mea-
6.4 cm; weight 68.5±13.8 kg; duration of disease 9.1± sured using the DXA method (Prodigy, GEHC Lunar, Madison,
7.6 years). BMD of lumbar spine, proximal femur and total WI, USA) and PA spine TBS was assessed by means of TBS
radius were measured using the DXA method (Prodigy, iNsight® software package installed on our DXA machine (Med-
GEHC Lunar, Madison, WI, USA) and PA spine TBS was Imaps, Pessac, France). Evaluation of TBS dynamics in the
assessed by means of TBS iNsight® software installed on our patients of G1 & G2 groups during the year was conducted on
DXA machine (Med-Imaps, Pessac, France). the background of ongoing therapy which included doses of GC
Results: We have observed a significant decrease of TBS in and/or without any osteotropic treatment.
50 year-old women with RA as compared to women aged 30– Results: The 3 groups did not differ as to age, basic anthro-
39 years (p=0.001)/ The same was true of BMD of lumbar pometric parameters, duration of disease and duration of
spine (p=0.04), femur neck (p=0.02), total radius (p=0.04). postmenopausal period in these groups. TBS in G2 was sig-
TBS is significantly lower in patients with a PMP duration of nificantly lower compared to G1 (TBSL1-L4: 1.147±0.168
more than 3 years, as compared to women who were still vs. 1.250±0.135; t=-3.07; p=0.003), and G3 compared to G1
menstruating (p=0.007). Femoral neck (FN) BMD significant- (TBS L1-L4: 1.274±0.138; t=3.95; p=0.0002). However,
ly decreased when PMP duration was 5–10 years, as compared there were no differences of BMD of PA spine and hip among
to women without menopause (p=0.0004). A similar trend was groups. Only forearm BMD in the second group was signif-
observed in case of spine BMD (p=0.001) and total radius, icantly lower compared to the first one (0.583±0.176 g/cm2
(p=0.001) when the duration of PMP was more than 10 years. vs. 0.675±0.229 g/cm2; t=−2.18; p=0.032). Spine TBS de-
Duration of disease did not influence TBS (p=0.336). Howev- creased by 1.4 % after 1 year for G1 and by 5.8 % for G2.
er, Total Radius BMD (p=0.03) significantly decreased when Conclusion: For patients who are GC-users, TBS, but not
RA lasted more than 3 years, spine (p=0.008) and FN (p= BMD, reflects bone microarchitecture deterioration which is
0.04) BMD when RA lasted more than 10 years, as compared an indicator for those patients to of a higher vertebrae and
to patients whose duration of RA did not exceed 3 years. nonvertebral risk of fracture. TBS is a determinant of bone
Conclusion: Age influences both TBS and BMD to the same state and must be monitored during the long-term treatment
extent, these parameters significantly decrease from 50 years with GC.
 Osteoporos Int

P413 P414
IMPACT OF COMPONENTS OF THE METABOLIC BONE MINERAL DENSITY IN PEDIATRIC
SYNDROME ON PROGRESSION OF KNEE PATIENTS WITH CHRONIC KIDNEY DISEASE
OSTEOARTHRITIS IN THE SEKOIA STUDY V. V. Povoroznyuk1, T. V. Budnik2, N. I. Balatska1
C. Parsons1, M. H. Edwards1, F. Eymard2, J.-Y. Reginster3, O. 1
Institute of Gerontology NAMS Ukraine, Kiev, Ukraine, 2SI
Bruyère3, F. Petit-Dop4, P. Richette5, X. Chevalier2, E. M. Lugansk State Medical University, Lugansk, Ukraine
Dennison1, C. Cooper1
1
MRC Lifecourse Epidemiology Unit, University of South- Objective: Chronic kidney disease (CKD) is associated with
ampton, Southampton, United Kingdom, 2Department of increased fracture risk and skeletal deformities one hand and
Rheumatology, AP-HP Henri Mondor Hospital, Créteil, vitamin D (VD) by known hormonal effects may well take
France, 3Department of Public Health and Health Economics, place in renoprotective events on the other hand. Aim: Bone
University of Liege, Liege, Belgium, 4Innovative Therapeutic mineral status in children with chronic kidney disease (CKD)
Pole of Rheumatology, Servier, Suresnes, France, 5Depart- stages I-III.
ment of Rheumatology, AP-HP Lariboisière Hospital, Paris, Material and Methods: The main group were exam-
France ined 32 children aged 10–17 years. The control group
(n=45) consisted of patients without CKD of the same
Objective: Recent studies have suggested that components of age. Methods conducted chemiluminescent content of 25
the metabolic syndrome might be involved in the pathophys- OH vitamin D and PTH, ultrasound densitometry. The
iology of osteoarthritis (OA). However, their impact on joint results are statistically processing using the program
space narrowing in patients with established OA is unknown. Statistica 6.0.
We investigated the impact of each component of the meta- Results: In the main group of patients the mean serum
bolic syndrome on knee joint space narrowing. levels of 25 OH VD was 27.5±16.5 nmol/L, which was
Material and Methods: 559 men and women aged over not statistically different with the control group (24.4±
50 years with clinical knee OA (K&L 2-3) were recruited to 19.9 nmol/L, p>0.05) and match a condition VD defi-
the placebo arm of the SEKOIA study (98 centres; 18 coun- ciency level below 37.5 nmol/L. Number of children
tries). The presence or absence of type 2 diabetes, hyperten- with CKD with deficiency VD was 91.2 % vs.
sion, and hyperlipidaemia was determined at baseline inter- 82.9 % (p < 0.05). In VD state failure (range 38–
view. Height and weight were measured and BMI calculated. 74 nmol/L) was 9.8 % of children with CKD vs.
Minimal tibiofemoral joint space on plain radiographs of the 15.9 % (p<0.05). Children with CKD and normal VD
knee was assessed by two independent readers at baseline and were not found (vs. 1.2 %). The content of PTH in the
then yearly for up to 3 years. mean group was 30.8±10.6 pg/ml vs. 24.4±19.9 pg/ml
Results: The mean(SD) age of participants was 62.8(7.5) years. (p>0.05). The index of the strength of bone densitom-
A total of 43.8 % had a BMI>30, 6.6 % had type 2 diabetes, etry to match a state of osteopenia in 10.2 % of chil-
45.1 % hypertension and 27.6 % hyperlipidaemia. Those with dren with CKD vs. 8.7 % (p>0.05), of osteoporosis - in
type 2 diabetes had significantly faster rates of joint space loss 3.1 % of children with CKD (control group these chil-
over the duration of the study than those without (0.26 and dren were not).
0.14 mm/year, respectively; p=0.01). This relationship also held Conclusion: Children with CKD stages I-III had low BMD
true for an annualised assessment of joint space narrowing. No and VD status. How much VD replacement therapy will
evidence of an association was found between the remaining improve the prognosis of CKD remains to be explored.
components of the metabolic syndrome (obesity, hypertension
and hyperlipidaemia) and the rate joint space narrowing. The
relationship between type 2 diabetes and joint space loss P415
remained statistically significant after adjustment for BMI. When DISCRIMINATION OF HIP FRACTURE IN
sexes were examined separately, type 2 diabetes was a significant POSTMENOPAUSALWOMEN USING A 3D
predictor of joint space loss in men but not women. RECONSTRUCTION METHOD FROM 2D DXA
Conclusion: Type 2 diabetes was a predictor of the rate of joint A. Bagué1, L. Del Rio2, S. Di Gregorio2, Y. Martelli3, X.
space narrowing in individuals with established knee OA. No Sevillano4, M. A. González Ballester1,5, L. Humbert3
1
such relationships were found for obesity, hypertension, and SIMBioSys - Simulation, Imaging and Modelling for Bio-
hyperlipidaemia. Further studies are required to replicate these medical Systems, Universitat Pompeu Fabra, Barcelona,
findings and to explore a biological explanation. Spain, 2CETIR Centre Mèdic, Barcelona, Spain, 3Musculo-
Disclosures: C Cooper has received honoraria and consulting skeletal Unit, GALGO Medical S.L., Barcelona, Spain, 4Grup
fees from Amgen, Eli Lilly, Medtronic, Merck, Novartis and de Recerca en Tecnologies Mèdia, La Salle, Universitat
Servier. F Petit-Dop is an employee of Servier. Ramón Llull, Barcelona, Spain, 5ICREA, Barcelona, Spain
Osteoporos Int

Objective: Evaluate the hip fracture discriminative power of P416

3D volumetric BMD (vBMD) computed over 3D shape and SECONDARY FRACTURE PREVENTION AFTER
density models reconstructed from 2D DXA. HIP FRACTURE: A QUALITATIVE STUDY OF THE
Material and Methods: A retrospective study was carried EXPERIENCES OF CLINICIANS AND SERVICE
out to collect 86 DXA scans of postmenopausal Cauca- MANAGERS OF MAKING BUSINESS CASES FOR A
sian women (CETIR Grup Mèdic, Barcelona). Selection FRACTURE PREVENTION SERVICE
criteria included: (1) No osteoporotic fracture at base- S. Drew1, R. Gooberman-Hill2, L. Graham3, M. K. Javaid1, C.
line, (2) femoral fracture between 1 and 7 years from Cooper4
1
basal scan for half of the patients (fracture group) and Oxford NIHR Musculoskeletal Biomedical Research Unit,
(3) no osteoporotic fracture during at least a 7 years of Nuffield Department of Orthopaedics, Rheumatology and
follow-up from basal scan (control group). 3D patient- Musculoskeletal Sciences, University of Oxford, Southamp-
specific femurs were obtained from baseline DXA scans ton, United Kingdom, 2School of Clinical Sciences, Bristol,
by registering a 3D active appearance model of the United Kingdom, 3Oxford University Hospitals NHS Trust,
femoral shape and density onto each patient DXA im- Oxford, United Kingdom, 4MRC Lifecourse Epidemiology
age. vBMD in the neck, shaft, trochanter and total Unit, Southampton, United Kingdom
femur regions were computed over those 3D patient-
specific models. Discrimination ability between fracture Objective: To better understand the challenges healthcare
and control group was computed for each parameter. professionals face when making business cases to develop a
Results: Area under the receiver operative curve (AUC) of fracture prevention service (FPS) and the strategies they use to
vBMD, before and after age-adjustment, measured over 3D construct them effectively.
femur reconstructed, and areal BMD measured over 2D DXA Material and Methods: Patients with hip fracture are at a
at the neck, trochanter, shaft and total hip regions are shown high risk of subsequent osteoporotic fractures. However, only
below in Table 1. a third of hospitals in England have a FPS. To develop
services healthcare professionals may submit business cases
to managerial bodies within the Trust. Final funding approval
may be required by their local Clinical Commissioning
Group(s). We have conducted 42 interviews with healthcare
professionals involved in delivering FPS within nine NHS
Acute Trusts. These have explored their experiences of mak-
ing business cases, views on what informs decisions to intro-
duce new services and ways of making business cases effec-
tively. Interviews have been audio-recorded, transcribed,
anonymised and coded using NVivo software. A framework
approach is being used.
Results: Participants reported several challenges in making
business cases. Clinicians felt that they lacked the skills and
did not receive enough managerial support. Cost savings were
seen as the most important factor in making decisions to
introduce new services whilst National Guidelines and
improvements in patient care were seen as less so. The
challenges of budget compartmentalisation, the need to
demonstrate immediate cost savings, the vested interests
of commissioners and the low profile of osteoporosis
were highlighted. A number of strategies were identified
Conclusion: Higher AUC values are consistently obtain- for making effective business cases, including citation
ed by vBMD in neck, trochanter, shaft and total hip of successful models, published research and audit data.
regions, which suggests that vBMD computed over 3D Building support networks and involving stakeholders in
reconstructed femur from 2D DXA potentially provides service design were advocated.
a better discrimination between hip fracture cases and Conclusion: Participants identified a number of challenges
controls than densitometry measures computed from 2D when making business cases and strategies they used to con-
DXA image. This will potentially improve fracture risk struct them effectively. Stakeholders may find knowledge of
estimation while maintaining DXA as the current stan- these of benefit when considering how best to develop busi-
dard modality. ness cases in the future.
 Osteoporos Int

P417 P418
EARLYAND PROFOUND DETERIORATION OF GOUT IS ASSOCIATED WITH AN EXCESS RISK OF
BONE QUALITY IN PATIENTS INITIATING OSTEOPOROTIC FRACTURE: FINDINGS FROM A
GLUCOCORTICOIDS IS PREVENTED BY DANISH REGISTRY
TREATMENTS E. M. Dennison1, K. Hass Rubin2, N. C. Harvey1, K. Walker-
L. Mellibovsky 1 , D. Prieto-Alhambra 2 , E. Torres 1 , L. Bone1, P. Schwarz2, C. Cooper1, B. Abrahamsen2
Vilaplana1, R. Güerri-Fernandez 1, F. Mellibovsky3, X. 1
MRC Lifecourse Epidemiology Unit, Southampton General
Nogués-Solan1, A. Diez-Perez1 Hospital, Southampton, United Kingdom, 2Research Centre
1
Hospital del Mar-IMIM and RETICEF, Barcelona, Spain, for Ageing and Osteoporosis, Department of Medicine M,
2
Nuffield Department of Orthopaedics, Rheumatology and Glostrup Hospital, Copenhagen, Denmark
Musculoskeletal Sciences. University of Oxford, Oxford,
United Kingdom, 3ETSEIB, UPC, Barcelona, Spain Objective: Although metabolic syndrome is common in
gout patients, recent reports that BMD may actually be
Objective: Fracture risk increases early after starting gluco- reduced (and falls common) in this group have led
corticoids (GC). Microindentation detects changes in bone researchers to hypothesise that osteoporotic fracture
material strength (BMS) related with fracture (JBMR 2010). may be more common in subjects with gout than in
We assess early BMS changes in patients initiating GC and healthy controls. We tested this hypothesis in a national
response to treatment. Danish registry.
Material and Methods: 35 patients within 4 weeks of Material and Methods: We identified subjects as new users
starting GC. General laboratory and BMD were performed. of allopurinol, a proxy for gout, for the years 1996–2010.
BMS measurement at the anterior midtibia were made with an Each incident user was assigned up to 10 age- and gender
Osteoprobe® (Active Life Sci S Barbara CA). Measurements matched controls. We used propensity score matching to
were done at baseline, after 7±1.5 weeks (V1) and at week 18 identify a highly matched control population. Patients with a
(V2). Treatment with Ca+vitD3 (Ca+D) alone, or with diagnosis of malignancy in the year prior to the first allopuri-
bisphosphonates (BP) or teriparatide (TPTD) was started ac- nol prescription were excluded. A final propensity score mod-
cording to risk categories following Spanish guidelines. Lin- el included hospital diagnoses since 1994; Charlson index
ear regression was used adjusting by age, gender, and cumu- components; and prior osteoporotic fractures; use of drugs
lative dose of GC. (including osteoporosis medication, prednisolone and HRT)
Results: BMS declined by 10.5 % after 7 weeks in 17 cases in the last year. Conditional Cox regression modelling was
on Ca+D, did not change in the 13 on BP and increased undertaken.
significantly by 12.6 % in the 5 participants on TPTD. Results: We studied 86,129 patients and the same number of
These differences stood for multivariate adjustment for controls (58,129 men and 28,000 women). Thirteen thousand
potential confounders (Table). At visit 2 all these chang- and ninety one cases and 12,188 controls sustained any
es remained although cases on Ca+D that declined (10/ osteoporotic fracture; the number of major osteoporotic
17) were switched to active treatment group and exclud- fractures was 5,574 in the cases and 4,893 in the control
ed, as pre specified by ethics requirements. No changes group. We found a modest adjusted effect of allopurinol
in BMD were observed prescription on major osteoporotic fractures; an association
with hip fractures just failed to attain statistical signifi-
Baseline(V0) 7 weeks(V1) 18 weeks(V2) cance (see table). Among patients who were incident
Mean(SD) Mean(SD) Ad Mean(95%CI)* Mean(SD)BMS allopurinol users and who also had at least one hospital
Ca+D 81.6 (6.3) 72.8 (10.6) Ref group 76.3 (9.0) contact with a gout diagnosis (about 20 % of allopurinol
BP 82.9 (12.1) 83.9 (12.7) 10.5 (1.6–19.3)¥ 85.3 (10.2)
users, median number of allopurinol prescriptions 12 vs. 6
TPTD 68.7 (5.3) 83.9 (12.7) 23.7 (11.3–36.1)§ 87.7 (5.9)
in nonhospital group), we found stronger associations.

*BMS loss differences; ¥p=0.022;;§p=0.001

Conclusion: BMS declines very early, after only 7 weeks
on GC. BP prevent this decline whereas teriparatide
significantly increases this bone tissue quality parame-
ter. These changes persist after 4.5 months. BMD Conclusion: These data suggest that gout requiring allopuri-
measurements are insensitive to these changes. nol prescription is a risk factor for osteoporotic fracture.
Microindentation might monitor changes induced by Disclosures: Lilly, Amgen, Novartis, Merck, Alliance for
GC and their treatments well beyond what BMD cur- Better, Glaxo Smith Kline, Roche, Merck, Wyeth, Servier,
rently allows. Nycomed, Takeda
Osteoporos Int

1
P419 Center of Excellence for Osteoporosis Research and Depart-
LOW BONE MINERAL DENSITY IS PRESENT IN ment of Clinical Biochemistry, Faculty of Medicine, KAU
YOUNG CHILDREN (<18Y) OF MEN WITH Hospital, King Abdulaziz University, Jeddah, Saudi Arabia,
2
IDIOPATHIC OSTEOPOROSIS Center of Excellence for Osteoporosis Research and Depart-
C. Uvin1, S. Vandewalle1, B. Lapauw1, S. Goemaere2, G. ment of Obstetrics and Gynecology, Faculty of Medicine,
Roef1, K. Toye1, J. De Schepper3, J.-M. Kaufman1 KAU Hospital, King Abdulaziz University, Jeddah, Saudi
1
Department of Endocrinology, Ghent University Hospital, Arabia, 3Center of Excellence for Osteoporosis Research
Ghent, Belgium, 2Unit for Osteoporosis & Metabolic Bone and Department of Haematology, Faculty of Medicine, KAU
Diseases, Ghent University Hospital, Ghent, Belgium, 3De- Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
partment of Pediatrics, Brussels University Hospital, Brussels,
Brussels, Belgium Objective: In vivo and in vitro studies showed that sphingo-
sine 1-phosphate (S1P) to act as a coupling factor stimulating
Objective: Previous research in adult men with idiopathic osteo- osteoclastogenesis and controlling the migration of osteoclast
porosis (IO) and their adult sons has provided indirect evidence precursors between blood and bone compartments. Also, S1P
that the condition is caused by a deficient bone mass acquisition. is known to stimulate osteoblasts proliferation, migration and
To investigate if a low bone mass is already present in childhood, survival. We hypothesized that postmenopausal women with
we studied the young children (<18 y) of men with IO. increased plasma S1P levels have a greater risk for
Material and Methods: 38 male children of IO men (defined osteoporosis-related fractures (ORFs).
as Z-score<−2 on the lumbar spine or hip) aged 6–19 years old Material and Methods: We examined, the association be-
and 38 healthy age-matched controls were included in this tween circulating S1P [measured by ELISA kit (Echelon
cross-sectional study. Whole body and lumbar areal (aBMD) Biosciences Inc., USA)] and ORF risk in 707 postmenopausal
were determined by DXA. Trabecular (distal site) and cortical women (age ≥50 year), in a population-based study with a
(proximal site) volumetric BMD (vBMD) were assessed at the mean follow-up period of 5.2±1.3 years. Multivariate Cox
nondominant forearm and leg using peripheral QCT. proportional-hazards regression models were used to analyze
Results: Compared to age-matched controls, children of men fracture risk, adjusted for age, BMI, and other confounding
with IO have a significant lower median z-score (P25/P75) at risk factors.
the lumbar spine (−0.9 (−1.2/−0.27) vs. −0.4 (−0.8/0.19); Results: Plasma S1P levels (μmol/L) were significantly
p<0.01) and whole body (−1.0 (−2.0/−0.1) vs. −0.1(−0.7/ higher in women with ORFs (7.23±1.79) than in those with-
0.4); p<0.05). In absolute values, children of IO men have a out ORFs (5.02±1.51) (P<0.0001). High S1P levels were
lower median aBMD (P25-P50) at the whole body (0.86 (0.80– strongly associated with increased fracture risk. After adjust-
0.95) vs. 0.95 (0.85–1.1) g/cm2; p<0.05), a lower median ment for age and other confounders, the relative risk was >6.2-
trabecular vBMD at the radius (170 (154–200) vs. 192 (169– fold among postmenopausal women for each 1-SD increment
212) mg/cm3; p<0.05) and a lower median trabecular vBMD at increase in plasma S1P level. Women in the highest quartile of
the tibia (189 (168–199) vs. 226 (194–242) mg/cm3; p<0.001). S1P levels had a 10-fold increase in fracture risk. Results were
aBMD at the lumbar spine was also lower in the children of similar when we compared S1P at the 1-year visit to an
men with IO (0.67 (0.56–0.86) vs. 0.85 (0.60–0.89) g/cm2) average of 2–3 measurements. Fracture risk attributable to
however, significance was not reached. Cortical density at the S1P levels was 41.5 % in the highest quartile. Associations
radius and tibia was similar in both groups. Studying line plots, between S1P levels and fracture risk were independent of
the differences in whole body and lumbar spine aBMD become BMD and other confounding risk factors.
more apparent from the age of 11–12 years onwards. Conclusion: High plasma S1P levels are a strong and inde-
Conclusion: Low BMD is present in children of men with pendent risk factor for ORFs among postmenopausal women
idiopathic osteoporosis at different skeletal sites. There are and could be a useful biomarker to improve fracture risk
indications that the deficit develops during puberty. In order to assessment.
confirm our findings and unravel the underlying mechanisms,
prospective longitudinal study is required.

P421
P420 BONE MICROARCHITECTURE ASSESSED BY
PLASMA SPHINGOSINE 1-PHOSPHATE LEVELS HIGH RESOLUTION PERIPHERAL QUANTITATIVE
AND THE RISK OF OSTEOPOROTIC FRACTURES: COMPUTED TOMOGRAPHY IS ASSOCIATED WITH
THE CEOR STUDY FRACTURE STATUS IN OLDER MEN AND WOMEN
M. S. M. Ardawi1, A. A. Rouzi2, S. A. Al-Sibiani2, N. S. M. H. Edwards1, K. A. Ward2, C. Parsons1, J. Thompson2, E.
Senani2, M. H. Qari3 M. Dennison1, C. Cooper1
 Osteoporos Int

1 1
MRC Lifecourse Epidemiology Unit, University of South- Oxford NIHR Musculoskeletal Biomedical Research Unit,
ampton, Southampton, United Kingdom, 2MRC Human Nu- Nuffield Department of Orthopaedics, Rheumatology
trition Research, University of Cambridge, Cambridge, Unit- and Musculoskeletal Sciences, University of Oxford,
ed Kingdom Oxford, United Kingdom, 2Oxford NIHR Musculoskel-
etal Biomedical Research Unit, Oxford, United King-
Objective: Assessment of BMD by DXA is the accepted dom, 3MRC Lifecourse Epidemiology Unit, Southamp-
method for osteoporosis diagnosis and is used in fracture risk ton General Hospital, Southampton, United Kingdom,
4
prediction. However, half of fragility fractures occur in Department of Primary Care Health Sciences Universi-
nonosteoporotic women. Bone microarchitecture from HR- ty of Oxford, Oxford, United Kingdom, 5School of
pQCT also contributes to bone strength. We compared Clinical Sciences, University of Bristol, Bristol, United
microarchitecture in older men and women with and without Kingdom
prevalent fractures.
Material and Methods: 180 men and 165 women, aged Objective: This study aims to identify and describe
72.1–80.9 years, from the Hertfordshire Cohort Study were healthcare professionals’ views on effective care for
studied. HR-pQCT (XtremeCT) images (voxel 82 μm) were hip fracture, focusing on prevention of secondary
acquired from the distal radius and tibia. Standard analyses fractures.
were performed for assessment of macrostructure, densitom- Material and Methods: Patients with hip fracture are at
etry, cortical porosity and trabecular microarchitecture. Fem- a high risk of subsequent osteoporotic fractures. While
oral neck (FN) BMD and vertebral fracture assessments were the NHS recommends effective fracture prevention ser-
completed using DXA (Lunar Prodigy Advanced). vices, there is wide variation in service organisation. 42
Nonvertebral fracture status was obtained from participant semistructured interviews have been conducted with
interviews. healthcare professionals involved in delivering fracture
Results: Forty five men (25 %) and 51 women (31 %) had preventions services (FPS) in nine NHS Acute Trusts.
prevalent fractures. In both sexes, cortical thickness and den- These explored their views on the best models of care
sity were lower in fracture cases (tibial cortical thickness, for the four components of a FPS: (1) case finding, (2)
mean±SD: fracture 0.86±0.20, no fracture 0.95±0.18 mm, osteoporosis assessment, (3) treatment initiation, and (4)
p=0.004 in women; fracture 1.13±0.27 mm, no fracture monitoring (treatment adherence) and care coordination.
1.24±0.26 mm, p=0.014 in men). Trabecular density, num- Interviews were audio-recorded, transcribed, anonymised
ber, and thickness also tended to be lower in those with and coded using NVivo software. A framework ap-
prevalent fractures but these differences only reached statisti- proach is being used.
cal significance in women. In men, total and trabecular area Results: Case finding: A number of approaches were
were greater in those that had fractured (tibial total area: discussed. Using multiple methods ensured that there
fracture 961± 157 mm2, no fracture 893 ± 138 mm2, p= was a ‘backstop’ if patients were overlooked. Osteopo-
0.006). After adjustment for FN BMD, relationships with rosis assessment: There was no consensus on who
cortical and trabecular microarchitecture were partially atten- should conduct this. The location of the DXA scanner
uated but associations in men between fracture status and both was seen to influence the likelihood of patients receiv-
total and trabecular area were maintained. ing a scan. Treatment initiation: It was felt this was best
Conclusion: This study is the first to show that patterns of done in an inpatient setting rather than in outpatients
radial and tibial bone microarchitecture by fracture status or primary care. In primary care this was reliant on
differ in men and women. Most associations are maintained comprehensive discharge summaries. Monitoring
after adjustment for BMD and are therefore likely to add to (adherence): Adherence was a major concern and par-
fracture prediction by DXA. ticipants felt more monitoring could be conducted in
Disclosures: C Cooper has received honoraria and consulting secondary care. Coordination of care: Participants advo-
fees from Amgen, Eli Lilly, Medtronic, Merck, Novartis and cated using dedicated coordinators and formal and in-
Servier. formal methods of communication. A gap between pri-
mary and secondary care was identified, and strategies
suggested for addressing this.
P422 Conclusion: A number of ways of organising effective
SECONDARY PREVENTION OF FRACTURES fracture prevention services after hip fracture were
AFTER HIP FRACTURE: A QUALITATIVE STUDY identified. It is hoped that this will help healthcare
OF EFFECTIVE SERVICE DELIVE professionals to identify gaps in care and provide them
S. Drew1, A. Judge2, M. K. Javaid1, C. Cooper3, A. Farmer4, with the information to develop their services in the
R. Goobermen-Hill5 future.
Osteoporos Int

1
P423 Calcium Metabolism and Osteoporosis Program,
INFLUENCE OF BALNEOPHYSICALTHERAPY ON American University of Beirut, Beirut, Lebanon, 2Phar-
FUNCTIONAL STATUS OF HAND IN PATIENTS macology & Toxicology, American University of Bei-
WITH RHEUMATOID ARTHRITIS rut, Beirut, Lebanon, 3Pathology and Laboratory Med-
D. Pavlović1, S. Prodanović1, J. Paunović1, A. Jurisic icine, American University of Beirut, Beirut, Lebanon,
Skevin2, K. Parezanović Ilić2 4
Rheumatology, Saint Joseph University, Beirut, Leba-
1
Specialized Hospital for Rehabilitation Bukovicka Banja non, 5Endocrinology, Saint Joseph University, Beirut,
Arandjelovac, Arandjelovac, Serbia, 2Faculty of Medical Sci- Lebanon
ence, Kragujevac, Kragujevac, Serbia
Objective: To study the association between variability
Objective: Rheumatoid arthritis is an inflammatory systemic in 25(OH) vitamin D levels (25-OHD) and polymor-
(organ nonspecific), autoimmune disease of unknown cause with phisms in four single nucleotides (SNP) of CYP2R1
chronic course that leads to progressive destruction of articular gene, in 250 Lebanese elderly (109 men and 141 wom-
and periarticular structures. The aim of this study was to evaluate en) aged ≥65 years (71.0±4.7), participating in an on-
the influence of balneophysical therapy on functional status of going randomized controlled trial evaluating the impact
wrists in patients with moderate active rheumatoid arthritis. of two doses of vitamin D on musculoskeletal outcomes
Material and Methods: The research included 33 patients: 29 and nonclassical parameters.
(87.7 %) women and 4 (12.3 %) men, average age 64.78 Material and Methods: Genotyping was performed for
(ranges 40–81),mean duration of illness was 22.06 years rs12794714, rs10741657, rs1562902, rs10766197 SNPs
(ranges 8–30). Between October 2010 and February 2013, all using Real-Time PCR. Blinded duplicate sample analy-
the patients were referred for 28 days to the Specialized Hos- ses were performed for all assays. 25-OHD levels were
pital for Rehabilitation Bukovicka banja of Arandjelovac. measured by chemiluminescent platform Liaison assay
They underwent treatment with mineral peloid therapy DiaSorin.
(36 °C to 1 h), local baths (35 °C to 20 min), electrotherapy Results: The mean age was 71.0 ± 4.7 year, mean BMI
(dyadinamic currents CP3′±LP3′±), magnetotherapy (10 mT, 30.0 ± 4.5 kg/m2, mean 25-OHD level 18.4 ± 7.6 ng/ml.
50 Hz, 30 min), individual kinesiotherapy. The assessment of Genotype frequencies were in Hardy-Weinberg equilib-
disease activity was performed at the beginning and after the rium. There was a significant difference in 25-OHD
rehabilitation through the calculating DAS28. Majority of pa- levels between genotypes. For rs10741657 and
tients (84.92 %) had moderate active disease activity DAS28 rs1562902 SNPs, the mutant genotype had the highest
(3.2–5.1). Physical therapy was performed 24 days. Statistical levels compared to wild and heterozygous genotypes.
analysis was performed by descriptive methods (mean, SD, Conversely, for rs10766197 SNP, the wild genotype
SE) while significance was tested using Student’s t-test. had the highest levels. After adjustment for age, sea-
Results: Results of rehabilitation are objectified following son, gender and BMI, mutant genotype had 25-OHD
measurements: pain intensity was measured by VAS length levels higher by 4.8 and 4.3 ng/ml than wild genotype
in cm. Joint mobility was determined by the patient’s ability to for rs10741657 SNP and for rs1562902 SNP respec-
form a fist and by the patient’s ability to bring the thumb away tively (p < 0.01). Conversely, for rs10766197 SNP, mu-
from the palm as much as possible with following scale: 0-no tant and heterozygous genotypes had 25-OHD levels
restriction, 1-low to moderate restriction, 2-severe restriction. lower by 3.6 and 2.7 ng/ml, respectively, compared to
Ritchie index was used to assessment of joint tenderness. Grip wild genotype ( p < 0.01). Mutant genotype for
strength was measured by using a dynamometer. rs12794714 SNP had levels lower by 3 ng/ml com-
Conclusion: Balneophysical therapy leads to reduction of pared to wild genotype (p = 0.02). Subgroup analyses
pain, improves the joints mobility and the grip strength in by gender revealed comparable results for rs10741657
patients with moderate active rheumatoid arthritis. SNP in men and for rs1562902 and rs10766197 SNPs
in women.
Conclusion: This study showed a difference in 25-
P424 OHD levels between CYP2R1 genotypes that equates
CYP2R1 GENETIC POLYMORPHISMS ARE a daily supplementation of 200–400 IU vitamin D.
ASSOCIATED WITH VARIABILITY IN This underscores possible genetic causes for the high
25-HYDROXYVITAMIN D LEVELS IN THE prevalence of hypovitaminosis D in the Middle East.
ELDERLY LEBANESE Acknowledgements: The study was funded by:
A. Arabi1, N. Khoueiry-Zgheib2, R. Mahfouz3, Z. Awada2, R. Lebanese National Council for Scientific Research,
Baddoura4, G. Halaby5, M. Rahme1, K. Firikh1, M. Hoteit1, American University of Beirut, and Saint Joseph
G. El-Hajj Fuleihan1 University.
 Osteoporos Int

1
P425 Unidade de Biotecnologia Ambiental (UBiA), Departamento
INCREASED LOW-DENSITY LIPOPROTEIN de Ciências e Tecnologia da Biomassa, Faculdade de Ciências
CHOLESTEROL LEVEL IS ASSOCIATED WITH e Tecnologia da Universidade Nova de Lisboa, Lisbon, Por-
NONVERTEBRAL FRACTURES IN tugal, 2Pharmacological Sciences Unit, iMed.ULisboa,
POSTMENOPAUSALWOMEN Faculdade de Farmácia, Universidade de Lisboa,
M. Yamauchi1, T. Yamaguchi1, K. Nawata2, S. Takaoka1, T. Departamento de Ciências Farmacológicas, Faculdade de
Sugimoto1 Farmácia da Universidade de Lisboa, Lisbon, Portugal,
1 3
Internal Medicine 1, Shimane University Faculty of Medi- Clinica Veterinária de Colares, Sintra, Portugal, 4Rheumatol-
cine, Shimane, Japan, 2Health and Nutrition, University of ogy Research Unit, Instituto de Medicina Molecular,
Shimane, Matsue, Japan Faculdade de Medicina da Universidade de Lisboa, Lisbon,
Portugal, 5Pharmacological Sciences Unit, iMed.ULisboa,
Objective: Although a high serum low-density lipoprotein Faculdade de Farmácia, Universidade de Lisboa, Portugal
cholesterol (LDL-C) level is an established risk factor for Departamento de Ciências Farmacológicas, Faculdade de
atherosclerosis, it is unclear whether it is associated with Farmácia da Universidade de Lisboa, Lisbon, Portugal,
6
osteoporosis. In this study, the associations between the serum Unidade de Biotecnologia Ambiental (UBiA), Departamento
LDL-C level and BMD, bone metabolic markers, and the de Ciências e Tecnologia da Biomassa, Faculdade de Ciências
presence of prevalent vertebral or nonvertebral fractures were e Tecnologia da Universidade Nova de Lisboa, Departamento
examined. de Ciências Farmacológicas, Faculdade de Farmácia da
Material and Methods: We enrolled 211 postmenopausal Universidade de Lisboa, Lisbon, Portugal
women, who were undergoing examination for osteoporosis.
Serum levels of total cholesterol (TC), high-density lipopro- Objective: Osteoporosis is a common bone disease. Deficien-
tein cholesterol (HDL-C), LDL-C, triglyceride, Ca, P, Cr, cy of 17-β estradiol, caused either by menopause or ovariec-
PTH, 25-hydroxyvitamin D {25(OH)D}, N-terminal tomy, results in accelerated bone loss and bone mass decline.
propeptide of type I collagen (PINP) and C-terminal Osteopenia is recognized in diabetic patients but there is
crosslinked telopeptide of type I collagen (CTX) were mea- controversy about its effects on bone remodelling. The degree
sured. The BMD of the lumbar spine and femoral neck was of bone loss differs between type 1 and type 2 diabetes (1). In
measured using DXA, the presence or absence of morpholog- some studies, type 2 diabetes has been associated with an
ical vertebral fracture was determined. increase in BMD in postmenopause women (2). Our aim
Results: Prevalent vertebral and non-vertebral fractures were was to compare the effects of ovariectomy, in bone structure
found in 49 (23.2 %) and 36 (17.1 %) subjects, respectively. and bone turnover, both in healthy and diabetic type 2 Wistar
Simple regression analyses showed that the serum LDL-C level rats.
was not significantly correlated with lumbar or femoral BMD or Material and Methods: 3 month old rats (n28) were divided
serum levels of PINP or CTX. Logistic regression analyses into 4 equal groups: control (C); ovariectomized (OV); diabe-
adjusted for age and BMI showed that the serum LDL-C level tes mellitus induced by streptozotocin (DM); diabetes
was significantly and positively associated with prevalent mellitus+ovariectomized (DM+OV). Serum glucose, triglyc-
nonvertebral fractures [odds ratio 1.50 (1.03–2.18), p=0.034], erides (TG), cholesterol, Ca, E2, CTX, and PINP were esti-
but not with vertebral fractures. This result was still significant mated on day 56 postovariectomy. Body weight and bone
after additional adjustments for bone markers, BMD, serum vertebral histomorphometry were evaluated. Data were ana-
25(OH)D, grip strength, tandem gait test, and use of drugs for lyzed using Mann-Whitney nonparametric test (statistical sig-
hyperlipidemia [odds ratio 1.69 (1.11–2.58), p=0.015]. nificance considered at 0.05 level).
Conclusion: These findings suggest that a high serum LDL-C Results: Glucose and TG levels were higher in DM rats
level may be a risk factor for prevalent non-vertebral fractures (p<0.05). A significant increase in bone turnover was ob-
independent of bone turnover, bone mass, vitamin D insuffi- served in ovariectomized groups (OV & OV+DM) (p<0.05)
ciency, or frail status in postmenopausal women, and that it when compared to C group, but not between DM and C.
may be detrimental to bone, as well as blood vessels. However the ratio PINP/CTX was higher in DM compared
to OV and C group (p< 0.05) pointing to an unbalance
formation/resorption, favouring formation. A similar trend
P426 was observed in OV+DM group. Histomorphometric data
IS BONE STRUCTURE AND BONE TURNOVER OF were consistent with these results.
OESTROGEN DEFICIENT RATS AFFECTED BY Conclusion: Diabetic rats were less prone to bone fragility
DIABETES? when exposed to ovariectomy compared to nondiabetic OV
A. Agripino1, C. De Mello-Sampayo2, D. Stilwell3, B. Vidal4, rats, which is consistent with studies referring an increase in
A. Lopes4, H. Canhão4, B. Silva-Lima5, M. C. Marques6 BMD in type 2 diabetic women with osteoporosis.
Osteoporos Int

References: (1) Vestergaard P. Osteoporos Int 2007;18:427. II, III. Serum [c] of IL-17 correlated negative with OPG in CU
(2) Rubin RM et al. Exp Rev Endocrinol Metab 2013;8:423 group and correlated negative with Z-score L2-L4 in all
Acknowledgements: Grant PEst-OE/SAU/UI4013/2011 persons.
sponsored by the Portuguese Foundation for the Science and Conclusion: Prevalence of osteopenia and osteoporosis in
Technology (FCT) patients with IBD is frequent and IL-17 and IL-1β may
decrease BMD by modulation OPG.
Acknowledgements: This work was financed by the Grant:
P427 NN 402 481 737
INTERLEUKIN-17, INTERLEUKIN-1BETA,
OSTEOPROTEGERIN, SRANKL IN PATHOLOGY OF
BONE METABOLISM IN PATIENTS WITH P428
LEŚNIOWSKI-CROHN DISEASE AND ULCERATIVE SHOULD PTH SERUM LEVEL IN
COLITIS POSTMENOPAUSAL OSTEOPOROTIC WOMEN BE
I. Krela-Kaźmierczak1, L. Łykowska-Szuber1, A. Szymczak1, ROUTINELY EXAMINED?
P. Eder1, M. Michalak2, E. Wysocka3, K. Stawczyk-Eder1, K. A. Wawrzyniak 1 , M. Marcinkowska 1 , M. Ignaszak-
Klimczak1, K. Linke1, W. Horst-Sikorska4 Szczepaniak1, W. Nosowicz1
1 1
Department of Gastroenterology and Human Nutrition, Uni- Department of Family Medicine Poznan University of Med-
versity of Medical Sciences, Poznań, Poland, 2Department of ical Sciences, Poznan, Poland
Computer Science and Statistics, University of Medical Sci-
ences, Poznań, Poland, 3Department of Clinical Biochemistry Objective: Primary hyperparathyroidism (PHP) is a rare dis-
and Laboratory Medicine, University of Medical Sciences, ease. However, its frequency might be underestimated in
Poznań, Poland, 4Department of Family Medicine University specific populations, e.g., patients with osteoporosis,
of Medical Sciences, Poznań, Poland nephrolithiasis, some gastrointestinal abnormalities. The aim
of this paper was to assess the validity of PTH serum assess-
Objective: Inflammatory bowel disease (IBD) are pathology ment in differential diagnosis in osteoporosis in postmeno-
related to bone resorption cased osteoporosis. IL-17 induces pausal women, particularly in order to recognize PHP.
bone destruction and is strongly mediated by loss of the local Material and Methods: The study group comprised 326
RANKL/OPG balance. IL-17 induces proinflammatory cyto- postmenopausal women aged 46–92 (mean 70.5 years) with
kines IL-1β and TNF-α and RANKL. IL-17 can synergize confirmed osteoporosis (WHO criteria/previous low-energy
with these cytokines (IL-1, TNF-α, and RANKL). IL-1β is fracture), treated in osteoporotic outpatient clinic, (Poznan,
stimulator of bone resorption and has been implicated in the Poland). Following medical history and physical examination,
pathogenesis of high bone turnover and osteoporosis. differential diagnosis in terms of secondary osteoporosis was
Material and Methods: Evaluation of BMD by DXA, serum performed (i.e., serum level of calcium, iPTH, 25-OH- D).
concentrations [c] of IL-17, IL-1β, sRANKL and OPG by Results: 76 subjects (23.3 % of the whole group) were shown
ELISA in patients with IBD and in control group and evalu- to have serum level of PTH beyond upper range norm
ation correlation between IL-17, IL-1β and OPG, s-RANKL (≥65 pg/ml). PHP was further confirmed in seven patients
and BMD. (2 % of the whole group). Secondary hyperparathyroidism
Results: Group: Leśniowski-Crohn (I:L-C) n=37 mean age (due to malabsorption syndrome and/or kidney disease) was
31.7 years SD 8.0, 15 female and 22 male, in ulcerative colitis recognized in 63 (19.3 %) patients, osteomalacia in 5 (1.5 %),
(II:CU) n=37 mean age 40.6 years SD 15.1 21 female and 16 and Paget’s disease in one patient.
male and control (III:C) n=37 mean age 29.6 years SD 8.0, 18 Conclusion: Diagnosis of osteoporosis gives a rationale to
female, 19 male. Mean BMD (g/cm2) in group I - L-C in L2- routinely evaluate serum PTH, as the PHP might be treated
L4: 1.109±0.193 in neck: 0.922±0.202, II-CU in L2-L4: causally and therefore complications might be prevented.
1.168±0.155 in neck: 0.965±0.160, III-C in L2-L4: 1.224±
0.084 in neck: 1.0859±0.159. Prevalence of osteoporosis and
osteopenia in I - L-C - 18.92 % and 32.43 % in L2-L4; P429
13.51 % and 35.13 % in neck, II - CU - 2.7 % and 37.84 % CORRELATIONS BETWEEN CLINICAL AND
in L2-L4; 2.7 % and 29.73 % in neck. Mean serum [c] of: IL- FUNCTIONAL STATUS IN PATIENTS WITH
17 (pg/ml), IL-1β (pg/ml), OPG (pmol/l), s-RANKL (pmol/l): RHEUMATOID ARTHRITIS
I - L-C: 7.71±6.77; 0.73±1.18; 8.76±3.22; 284.87±213.05, R. S. Popescu1, D. Matei1, A. C. Bighea1, S. Patru1, R.
II -CU: 8.86±7.85; 0.56 v 0.48; 6.02±2.51; 223.81±118.14 Traistaru1
1
III-C: 5.32±2.01; 0.51±1.51; 9.42±2.10; 236.84±111.63. University of Medicine and Pharmacy of Craiova, Craiova,
Serum [c] of IL-1β and OPG differ significantly in group I, Romania
 Osteoporos Int

Objective: To determine the importance of correlations be- Amsterdam, Netherlands, 11Alfried Krupp Krankenhaus, De-
tween clinical parameters and functional disability in patients partment of Internal Medicine III, Essen, Germany, 12Depart-
with rheumatoid arthritis (RA). ment of Rheumatology, University of Verona, Verona, Italy,
13
Material and Methods: We observed 48 patients with RA Paris Descartes University, Cochin Hospital, Paris, France,
14
during 2 years (RA was diagnosed based on 1987 ACR University of Alabama-Birmingham, Birmingham, Ala-
revised criteria): mean age 46.23; mean disease duration bama, United States, 15Department of Rheumatology,
48.36 months; 79 % from patients are rheumatoid factor Cedars-Sinai/UCLA, Los Angeles, CA, United States,
16
positive; functional disabilities were classified based on Bone Health and Osteoporosis Center, University of
1991 ACR Functional Classification. The patients were labo- Cincinnati, Cincinnati, Ohio, United States, 17University
ratory evaluated by complete blood count, ESR, CRP and RF. of Pittsburgh, Pittsburgh, Pennsylvania, United States,
18
The results were analyzed with the medical statistics pro- Helen Hayes Hospital and Columbia University, West
gramme SPSS. Haverstraw, New York, United States, 19 Faculty of
Results: The most common clinical manifestations were Medicine and Department of Public Health, University
morning stiffness (100 %), hands arthritis (88.6 %) and rheu- of Sydney, Sydney, Australia, 20Musculoskeletal Re-
matoid nodules were on found in 7.5 % of patients; systemic search Unit, University of Bristol, Avon Orthopaedic
and extra articular manifestations were: underweight Centre, Southmead Hospital, Bristol, United Kingdom,
(BMI≤20 kg/m 2 ) (32.5 %), anemia (34.6 %), and 21
Center for Outcomes Research, University of Massa-
thrombocytosis (29.2 %). The functional capacity assessed chusetts, Medical School, Worcester, Massachusetts,
(HAQ) was significantly determined by disease duration (r United States, 22Institute of Musculoskeletal Sciences,
0.680), age (r 0.442), ESR and CRP (r 0.384), age of onset (r University of Oxford, Oxford, United Kingdom
0.324), and rheumatoid factor (r 0.313), respectively.
Conclusion: We concluded that, for our patients, dura- Objective: Traditionally the use of antiosteoporosis
tion of RA, age of patient, ESR, age of onset and medication (AOM) is low following fracture, with typ-
rheumatoid factor can be considered as risk factors for ical reported 1 year compliance rates of 10–30 % in
functional status in RA. women adhering to therapy at 1 year postfracture. We
considered whether a woman’s self-perception of her
own fracture risk (SPR) might influence the initiation
P430 and continued use of AOM, and investigated this using
ANTIOSTEOPOROSIS MEDICATION USE REMAINS the GLOW study.
LOWAFTER FRACTURE BUT IS RELATED TO SELF Material and Methods: GLOW is an international co-
PERCEIVED FRACTURE RISK: FINDINGS FROM hort study involving 723 physician practices across 10
THE GLOW STUDY countries in Europe, North America and Australasia.
E. Dennison1, J. E. Compston2, J. Flahive3, E. S. Siris4, J. D. Sixty thousand three hundred ninety-three women aged
Adachi5, R. D. Chapurlat6, A. Diez-Perez7, F. H. Hooven8, A. ≥55 years completed baseline questionnaires detailing
Z. Lacroix9, J. Coen Netelenbos10, J. Pfeilschifter11, M. medical history, including comorbidities, fractures and
Rossini12, C. Roux13, K. G. Saag14, S. Silverman15, N. B. SPR, defined as much or a little lower than average;
Watts16, S. L. Greenspan17, J. Nieves18, L. March19, C. L. about the same; much or a little higher than average.
Gregson1,20, S. H. Gehlbach21, C. Cooper1,22 Annual follow-up determined self-reported incident frac-
1
MRC Lifecourse Epidemiology Unit, University of South- tures and AOM use.
ampton, Southampton General Hospital, Southampton, Unit- Results: Of the 16,491 women with a low baseline
ed Kingdom, 2School of Clinical Medicine, Addenbrooke’s SPR, 5,516 (11 %) were taking AOM at baseline while
Hospital, University of Cambridge, Cambridge, United King- of the 8,389 women with a high SPR, 3,773 (45 %)
dom, 3University of Massachusetts Medical School, Worces- were taking AOM at baseline. There were 780 incident
ter, MA, United States, 4Department of Medicine, Columbia fractures by 1 year. Women not using AOM at baseline
University Medical Center, New-York, NY, United States, 5St. who incurred a fracture were more than twice as likely
Joseph’s Hospital, McMaster University, Hamilton, Ontario, to start AOM, than women without a fracture. Women
Canada, 6INSERM U831, Université de Lyon, Division of already on AOM at baseline exhibited no further in-
Rheumatology, Hôpital E. Herriot, Lyon, France, 7Hospital creased use after fracture, but usage was already high
del Mar-IMIM-Autonomous University of Barcelona, Barce- (83 %, 85 %, and 90 % use at baseline in the 3 risk
lona, Spain, 8Center for Outcomes Research, UMASS Medi- groups). At 1 year, the proportion of women who had
cal School, Worcester, MA, United States, 9Fred Hutchinson sustained a fracture that started AOM was higher among
Cancer Research Center, Seattle, WA, United States, 10De- women with a high SPR compared with those with a
partment of Endocrinology, VU University Medical Center, low SPR. More women with a high SPR remained on
Osteoporos Int

treatment at 1 year as compared with women with a low possible. If everyone respects the kinetic principles of the
SPR, as displayed below. rehabilitation program (including occupational therapy), that
are associated with the correct pharmacological treatment, all
patients have optimal prehension and adequate quality of life.

P432
FRACTURE PREDICTION IN ECUADORIAN MEN
Conclusion: While SPR does appear to be associated with WITH THE FRAX TOOL
AOM uptake, these figures suggest that a low proportion of E. López Gavilanez1, M. Hernández Bonilla1, N. Bautista
women who sustain a fracture are commenced on AOM. Our Litardo2, K. Guerrero Franco3, M. Navarro Chavez4, A.
results highlight the need for secondary fracture prevention Segale Bajana3
1
initiatives. Servicio Endocrinología, Hospital Docente Policía Nacional
Disclosures: The authors have the following disclosures: Guayaquil No. 2, Guayaquil, Ecuador, 2Servicio Endocrinología,
Servier, Shire, Nycomed, Novartis, Amgen, Procter & Gam- Hospital Clínica Kennedy Alborada, Guayaquil, Ecuador,
3
ble, Wyeth, Pfizer, The Alliance for Better Bone Health, Servicio Medicina Interna, Hospital Docente Policía Nacional
Roche, GlaxoSmithKline; Eli Lilly, Merck, Sanofi, Astra Guayaquil No. 2, Guayaquil, Ecuador, 4Servicio Medicina
Zeneca, Bristol-Myers Squibb, Maxence Pharma, Kyphon, Interna, Hospital Luis Vernaza, Guayaquil, Ecuador
GE Lunar, Orion Pharma.
Acknowledgements: All GLOW participants and Objective: The FRAX® tool has been widely used in the
investigators prediction of osteoporotic fractures. In Ecuador the usefulness
of this instrument is unknown. Objectives: To study the utility
of FRAX in predicting osteoporotic fractures in a group of
P431 Ecuadorian men with type 2 diabetes mellitus.
EFFECTIVENESS OF REHABILITATION PROGRAM Material and Methods: We included 207 Ecuadorian men with
OF THE HAND IN RHEUMATOID ARTHRITIS type 2 diabetes mellitus, aged 50 years, without previous treat-
PATIENTS ment of osteoporosis. Bone density was measured at the femoral
R. S. Popescu1, D. Matei1, A. C. Bighea1, R. Traistaru1, S. neck with DXA (Hologic Discovery W®), and values are
Patru1 expressed as units T-score (T-DOF). The risk of hip fracture
1
University of Medicine and Pharmacy of Craiova, Craiova, (FRAX-FN) and major osteoporotic (FRAX-M) was calculated
Romania using the FRAX tool with data generated for the Ecuadorian
population (<ahref="http://www.shef.ac.uk/FRAX/tool">www.
Objective: To verify how the rehabilitation programme can shef.ac.uk/FRAX/tool</a>.Aspx?Country=3). Treatment and
improve the functional status of the hand in rheumatoid ar- analysis of data was performed using computerized format by
thritis (RA) patients and to assess the clinical and functional using the EPIDAT program v.3.1 for Windows.
evolution of the hand complex in correlation with pain. Results: Mean age 64.5±8.7 years (range 50–99); BMI 28±4;
Material and Methods: 76 RA patients were complete eval- 51 men had osteopenia, 5 had osteoporosis, and 151 had T-
uated (clinical and functional, lab and imagistic assessments). DOF in normal ranges, mean T-DOF -0.61 ± 1.14;mean
Average age of patients was 43.2 (SD=5.57) and duration of FRAX-FN 0.18±0.33, mean FRAX-M 0.72±0.5; only 3
disorder was 7,8 years. All patients performed a complete men (1.4 %) developed FRAX values >3 % for hip fractures,
rehabilitation program (including occupational therapy), twice no male presented FRAX values >20 % for major osteoporotic
daily, 5 day/week, 4 weeks and completed the VAS and HAQ fractures. The FRAX sensitivity was 25 %, CI (95 %) 0.00–
scales and Lee index, at the beginning (T1 - time1) and after 79.93; specificity 99.49 %, CI (95 %) 98.24–100.00. The
4 weeks (T2 - time2). positive predictive value 50 %, CI (95 %) 0.0–100 and neg-
Results: The median Lee and HAQ values in T2 (Lee index=16.5; ative predictive value 98.48 %, CI (95 %) 96.53–100.00. The
HAQ score=18.1) were significantly correlated with the prevalence 2 %, CI (95 %) 0.0–4.19. Using ROC curves, the
median corresponding scores in T1 (r=0.887, p<0.001) (Lee area under the curve was 0.622, CI (95 %) 0.377–0.867.
index=14.3; HAQ score=15.1). The presence of ultrasound Conclusion: According to the FRAX tool, the risk of osteo-
pathologic aspects of the soft tissues into hypothenar and porotic fractures in this group is low, no male had a positive
thenar eminences was significantly correlated with the median FRAX for major osteoporotic fractures, and 3 (1.4 %) men
VAS and HAQ scores. had a positive FRAX for hip fractures. The umbral of the
Conclusion: The rehabilitation programme in RA is complex FRAX tool for therapeutic intervention and evaluation with
and multidisciplinary and it must be initiated as soon as DXA has not been established in our population.
 Osteoporos Int

P433 P434
OSTEOPOROSIS SCREENING SELF-ASSESSMENT A META-ANALYSIS OF REFERENCE MARKERS OF
TOOL FOR PREDICTION OF LOW BONE MASS IN BONE TURNOVER FOR PREDICTION OF
ECUADORIAN MEN FRACTURE
E. López Gavilanez1, M. Hernández Bonilla1, N. Bautista E. V. McCloskey1, H. Johansson1, A. Odén1, J. A. Kanis1, H.
Litardo2, K. Guerrero Franco3, M. Navarro Chavez4, A. A. Morris2, C. Cooper3, S. Vasikaran4
Segale Bajana5 1
WHO Collaborating Centre for Metabolic Bone Diseases, Uni-
1
Servicio Endocrinología, Hospital Docente Policía Nacional versity of Sheffield, Sheffield, United Kingdom, 2School of
Guayaquil No. 2, Guayaquil, Ecuador, 2 Servicio Pharmacy and Medical Sciences, University of South Australia,
Endocrinología, Hospital Clínica Kennedy Alborada, Guaya- Adelaide South Australia, Australia, 3MRC Lifecourse Epidemi-
quil, Ecuador, 3Servicio Medicina Interna, Hospital Docente ology Unit, Southampton General Hospital, Southampton, Unit-
Policía Nacional Guayaquil No. 2, Guayaquil, Ecuador, ed Kingdom, 4Department of Core Clinical Pathology and Bio-
4
Servicio Medicina Interna, Hospital Luis Vernaza, Guaya- chemistry, PathWest Laboratory Medicine, Royal Perth Hospital,
quil, Ecuador, 5Servicio Medicina Interna, Hospital Docente Perth, WA, Australia and School of Pathology and Laboratory
Policía Nacional Guayaquil N°2,, Guayaquil, Ecuador Medicine, University of Western Australia, Nedlands, Australia

Objective: The score OST [self-assessment Osteoporosis Objective: The IFCC/IOF recently recommended s-PINP and
Screening Tool] is a tool to estimate the risk of osteoporosis s-CTX as the primary candidates for reference markers of
by means of simple clinical variables. Objectives: To estimate bone turnover. The aim of this report was to summarise the
the risk of low bone mass in men by the score OST, as a way clinical performance of two reference bone turnover markers
of screening for osteoporosis in a group of Ecuadorian men. (BTMs) in the prediction of fracture risk.
Material and Methods: 208 men who attended from 1 June Material and Methods: We used an updated systematic review
to 30 December 2013 to control their type 2 diabetes in the to examine the performance characteristics of s-PINP and s-CTX
Teaching Hospital of the National Police No. 2 were included. in fracture risk prediction in untreated individuals in prospective
All were measured BMD at the femoral neck and lumbar cohort studies. Ten potentially eligible publications were identi-
spine using DXA (Hologic Discovery W®). The OST score fied and six included in meta-analysis.
was calculated using the formula: 0.2 × (weight in kg - age in Results: There was a significant association between s-PINP
years). OST score of <2 indicated reduced bone mass (osteo- and the risk of fracture. The hazard ratio per SD increase in s-
porosis + osteopenia) and corresponded to a T-score of ≤−1 PINP (gradient of risk: GR) was 1.23 (95%CI: 1.09–1.39) for
(Table 1). We use the T-score of BMD in the femoral neck (T- men and women combined, unadjusted for BMD. There was
DOF) as the reference test. The processing and analysis of also a significant association between s-CTX and risk of
data was performed using computerized format by using the fracture, GR 1.18 (95%CI: 1.05–1.34) unadjusted for BMD
EPIDAT program v.3.1 for Windows. (Figure). For the outcome of hip fracture, the association
Results: The sensitivity OST was 65 %, CI (95 %) 53.92– between s-CTX and risk of fracture was slightly higher 1.23
76.08; specificity 72.6 %, CI (95 %) 64.54–80.77. The posi- (95%CI: 1.04–1.47).
tive predictive value 59.77 %, CI (95 %) 48.89–70.65 and
negative predictive value 76.86 %, CI (95 %) 68.93–84.79.
The prevalence 38.46 %, CI (95 %) 31.61–45.31. Using ROC
curves, the area under the curve was 0.68; CI (95 %) 0.62–
0.75.
Table 1

Score OST
Number of patients (n=208) T-DOF ≤−1 (With osteopenia + osteoporo-
sis) T-DOF>-1
(Without osteopenia + osteoporosis)
<2 52 35 ≥2 28 93

Conclusion: In men 50 years and older, the OST score is easy

to identify men at risk for osteoporosis/osteopenia and refer to
the DXA method for confirmation. The OST seems to be an
excellent method to identify men at high and low risk of <p style="margin-right:41 pt">Figure. Forest plot for the re-
osteoporosis. lationship between s- CTX and fracture risk.
Osteoporos Int

Conclusion: There is a modest but significant association P436

between BTMs and risk of future fractures. Whether this INCIDENCE OF OSTEOPOROSIS AMONG TWO
predictive ability remains significant following adjustment ENDOGAMOUS POPULATIONS OF INDIA
for other risk factors is unknown. G. Chelluri1, S. Amara2
1
Human Genetics, V.S.lakshmi Degree & PG College, Kakina-
da, India, 2V.S.Lakshmi Degree & PG College, Kakinada, India

P435 Objective: Osteoporosis is a multifactorial disease which is

EARLY EFFICACYAND SAFETY OF HYALURONIC characterized by low bone mass and micro-architectural deterio-
ACID OF DIFFERENT MOLECULAR WEIGHTS IN ration of bone tissue with increased susceptibility to fracture.
KNEE OSTEOARTHRITIS BMD, the net result of bone mass achieved in early adult life
N. V. Vaskova1 and bone loss later in life, is a measurable predictor of bone mass.
1
Department of Family Medicine, Urals State Medical Uni- Both genetic and nongenetic factors are involved in maintenance
versity, Ekaterinburg, Russian Federation of bone mass. BMD is one of the major determinant of osteopo-
rotic fracture risk. The present study includes two endogamous
Objective: Evaluation the efficacy and safety of intra-articular populations of East Godavari District of Andhra Pradesh. All
therapy of hyaluronic acid derivative Rusvisk, “Rusvisk”, subjects were interviewed using a structured schedule and tested
Russia, MW 3.5 million Da, in comparison with Ostenil, for BMD using speed of sound (SOS) at calcaneum by QUS
Chemedica, Germany, MW 1.2–1.4 million Da, in reducing (qualitative ultrasound) method and two endogamous postmen-
symptoms of knee OA. opausal women were compared for incidence of osteoporosis.
Material and Methods: 50 patients (25 Rusvisk group Material and Methods: Subjects: The present study was
and 25 Ostenil group) were included in a randomized, conducted in East Godavari region, Andhra Pradesh, India.
double-blind, parallel-group study and received a course For the study, two endogamous populations kapu & koppula
of 3 intra-articular injections. Inclusion criteria: knee velama were tested using SOS at calcaneum by QUS method
OA stage II-III, Lequesne index score ≥ 4 and ≤ 12. to determine the BMD. BMD Analysis: Bone mass was
Exclusion criteria: OA stage IV; BMI≥35 kg/m2; inflam- assessed by SOS (m/s) at the calcaneus using QUS device. It
matory diseases; trauma target joint history; intra- measures bone mass in the form of T-score which is calculated
articular injection of corticosteroids and physical therapy by using peak speed of sound value for a defined population
within the last 3 months. The WOMAC index, pain on of young adults, and its standard deviation. Based on T-score
VAS, an overall assessment of the effectiveness of ther- values of QUS device subjects were classified in to normal
apy the patient were evaluated after the end of treatment (>−1), osteopenia (−1 to −2. 5) and osteoporosis (<−2.5).
(4 weeks from first injection) and after 8 and 12 weeks Results: BMD Koppula Velama Kapu
and 6 months after treatment (not presented here). Normal 22 % 5 %
Results: The intensity of weight-bearing pain VAS Osteopenia 26 % 39 %
after 4 weeks from first injection decreased signifi- Osteoporosis 51 % 55 %
cantly in both groups: group Rusvisk from 52 mm to Conclusion: Among two endogamous populations, koppula
16, group Ostenil from 56 mm to 25 mm. The total velama whose main occupation is agricultural labourer were
WOMAC index decreased in the group Rusvisk 56 %, showing more percentage of normal BMD postmenopausal
in the group Ostenil 65 %. Differences between women when compared with kapu endogamous population.
groups were not statistically significant (p = 0.59 and Acknowledgements: This study was funded by Women Sci-
0.63 respectively). In the group Rusvisk answer entist Scheme-A (Wos- A), Department of Science &Technol-
“much improved” and “improved” gave 21 of the 25 ogy, Government of India.
patients, which was higher than in the group receiving
Ostenil: 14 of 25 (p = 0.003). Tolerability was satis- P437
factory and did not differ significantly between the SUPPRESSION OF UNDERCARBOXYLATED
groups. No case of acute pseudoseptic arthritis was OSTEOCALCIN BYALENDRONATE IS ASSOCIATED
observed. WITH A TRANSIENT DECREASE OF INSULIN
Conclusion: For short-term observation efficacy and safety of SENSITIVITYAND ADIPONECTIN IN WOMEN
intra-articular therapy intermediate molecular weight WITH OSTEOPOROSIS
hyaluronate is comparable to that of low molecular weight T. Kocjan1, M. Jensterle Sever1, M. Pfeifer1, A. Sabati Rajic1,
hyaluronate. At the same regimen both reduced the pain K. Bajuk Studen1, J. Prezelj1
1
intensity at movement and improved functional Department of Endocrinology, Diabetes and Metabolic Dis-
characteristics. eases, University Medical Centre Ljubljana, Ljubljana, Slovenia
 Osteoporos Int

Objective: Undercarboxylated osteocalcin (ucOC), the active Material and Methods: The incidence of hip, clinical spine,
form of osteocalcin (OC), promotes insulin sensitivity (IS) and distal forearm and humerus fracture was determined in the
secretion in rodents, whereas its impact on glucose homeostasis prospective and ongoing population based Reykjavik Study with
in humans needs further clarification. We examined the associa- follow up of 257,001 person-years. The incidence of a first major
tion of decrease in ucOC levels on IS and adiponectin in osteo- fracture was compared with the correction factors used in FRAX
porotic women on antiresorptive therapy with alendronate. to adjust the incidence of several fracture outcomes for double
Material and Methods: 30 postmenopausal women (mean±SD, counting. In addition the incidence of a major osteoporotic
aged 68.1±11.4 years, with BMI 26.9±4.4 kg/m2) with newly fracture estimated from the Icelandic hip fracture rates was
diagnosed primary osteoporosis and normal glucose homeostasis compared with the Malmo ratios used in FRAX.
had anthropometric measurements and fasting venous blood Results: The adjustments necessary to account for multiple
sample taken for the determination of ucOC, intact OC, blood fracture outcomes were similar to those previously derived
glucose, insulin, and adiponectin. IS was assessed by glucose to from Sweden (Figure). Additionally incidence of a first major
insulin (G/I) ratio. All the measurements were repeated at 6 and osteoporotic fracture was similar to that derived for FRAX
12 months of newly introduced treatment with fixed dose com- models.
bination alendronate 70 mg plus D3 5,600 IU once weekly tablet.
Results: As expected, ucOC (mean±SD; baseline: 4.0±
1.5 ng/mL, 6 months: 2.8±1.4 ng/mL, 12 months: 2.4±1.1 ng/
mL; p<0.001) and intact OC (baseline: 7.5±3.9 ng/mL,
6 months: 2.6±1.1 ng/mL, 12 months: 2.0±0.8 ng/mL;
p<0.001) values continuously decreased during treatment inter-
vention. Significant changes in fasting insulin (baseline: 6.9±
3.3 mU/L, 6 months: 9.4±3.9 mU/L; p=0.029), G/I ratio (me-
dian (Q25; Q75); baseline: 0.78 (0.61; 0.95), 6 months: 0.62
(0.50; 0.80); p=0.032) and adiponectin (baseline: 16.6 (11.55;
20.15) mg/L, 6 months: 11.39 (6.85; 14.82) mg/L; p=0.024)
levels were detected only at 6 months, whereas at 12 months the
changes from baseline were not significant anymore.
Conclusion: Decreases of ucOC levels caused by alendronate
are accompanied with a transient decrease of IS and
adiponectin in osteoporotic postmenopausal women with nor-
mal glucose homeostasis. Further studies are needed to clarify
the escape of glucose metabolism parameters almost back to
baseline at 12 months of treatment.

Figure The incidence of a first major osteoporotic fracture (per

P438 100,000 person years), by age and sex observed in the present
THE INCIDENCE OF A FIRST MAJOR study and that computed from Malmo.
OSTEOPOROTIC FRACTURE IN ICELAND AND Conclusion: The findings of the present study support the
IMPLICATIONS FOR FRAX algorithms used in FRAX to estimate the incidence of a first
H. Johansson 1 , K. Siggeirsdottir 2 , T. Aspelund 2 , E. major fracture and the predictive value of hip fracture for other
Gudmundsson 2 , B. Mogensen 3 , B. Y. Jonsson 4 , V. major fractures.
Gudnason2, E. V. McCloskey1, G. Sigurdsson2, J. A. Kanis1
1
WHO Collaborating Centre for Metabolic Bone Diseases,
University of Sheffield, Sheffield, United Kingdom, 2Icelan-
dic Heart Association Research Institute, Kopavogur, Iceland, P439
3
University of Iceland, Reykjavik, Iceland, 4Skane University PRELIMINARY RESULTS FROM A
Hospital, Department of Orthopaedics, Malmö, Sweden RETROSPECTIVE PILOT DATABASE STUDY IN
SWEDEN (SWE) AND NETHERLANDS (NED) TO
Objective: The construct for FRAX models depends on algo- EXPLORE METHODS FOR COMPARING
rithms to adjust for double counting of fracture outcomes in some FRACTURE RATES ACROSS ANTIRESORPTIVE
models, and in others to estimate the incidence of a major fracture THERAPIES
from hip fracture rates. The aim of the present study was to test O. Ström1, J. Mesterton1, L. Karlsson1, I. Ferreira2, M.
the validity of these algorithms in a large prospective cohort. Intorcia3, J. Overbeek4, M. Feudjo-Tepie2
Osteoporos Int

1
Quantify Research, Stockholm, Sweden, 2Amgen Ltd, Zug, Objective: The age and gender dependency of symptom
Switzerland, 3Amgen (Europe) GmbH, Zug, Switzerland, experience in the general population has been investigated at
4
Pharmo Institute for Drug Outcomes Research, Utrecht, the domain level using two modified osteoarthritis (OA) spe-
Netherlands cific PROMs. While domain-level analyses have been infor-
mative (Bellamy et al. Inflammopharmacology 2009), we
Objective: Examine differences in patient (pt) characteristics have recently investigated the relationship between age, gen-
across antiresorptive therapies; explore methods to adjust for der, and self-reported difficulty in performing 69 individual
these when comparing fracture rates. activities of daily living.
Material and Methods: For women initiating alendronate or Material and Methods: Using the physical function item banks
risedronate (oral bisphosphonates [OBPs]), or zoledronate from the WOMAC (n=37) and AUSCAN (n=32) Indices, and
(ZOL) in SWE and NED from 2006 to 2011, medication data removing attribution statements to arthritis, a scannable question-
(SWE prescription register/NED PHARMO data) were linked naire containing health status and demographic questions was
to death dates, outpatient (SWE only) and inpatient care. Pts developed, pretested and distributed by Australia Post to a ran-
were followed for up to 6 years. Pts dispensed both OBP and dom sample of 24,000 members of the Australian general public,
ZOL were allocated to ZOL and prior OBP use accounted for. generated by the Australian Electoral Commission (AEC).
Relative fracture risk (ZOL vs. OBP) was measured in crude WOMAC and AUSCAN item responses were scaled on 0–10
and adjusted survival models adjusted for pt characteristics, Numerical Rating Scales [0=none, 10=extreme].
prior fracture, comorbidities, prior osteoporosis (OP) treat- Results: In this analysis, 50th and 75th percentiles for age and
ment and concomitant therapies. In a second approach, a pt gender-specific profiles were estimated, for 32 upper and 37
was used as their own control and their fracture risk over the lower extremity physical function items, based on data from
first 90 days of therapy compared with their risk thereafter. approximately 5,500 respondents. The data indicate that the
Results: ZOL pts had higher prevalence of prior OP treatment degree of difficulty in performing physical function activities
(SWE: 52 % vs. 3 %; NED: 43 % vs. 2 %), and prior fracture is gender-specific, varies with age group and differs between
(SWE: 24 % vs. 19 %; NED: 9 % vs. 6 %). In SWE, 199 and items. Lower extremity items such as “squatting”, “kneeling”,
2,775 fractures were observed for ZOL and OBPs; in NED, 5 “jumping” and “running” and upper extremity items such as
and 898 were observed. Results of Cox proportional hazard “picking up large heavy objects” are associated with higher
models are shown below. Results of other models were sim- degrees of difficulty in the general population.
ilar. In SWE, hip fracture rates for ZOL (based on 24 fractures) Conclusion: The observed age-associated differences in
were 1.36 pt-years over the first 90 days of therapy and 0.74 physical function profiles for different items, indicate that
thereafter, vs. 1.07 and 1.17 for OBPs. composite physical function scores and global function scores
reflect a complex phenomenon in which different activities of
daily living are associated with differing degrees of difficulty
for men and women at various stages of life. These observa-
tions have important implications for benchmarking health
status in OA, particularly in older respondents.

Conclusion: Pt characteristics differ between women receiv- P441

ing ZOL and OBPs. In SWE, risk of new fracture was signif- RISEDRONATE FOR PREVENTION OF STEROID
icantly higher for ZOL. The HR remained >1 in adjusted INDUCED OSTEOPOROSIS IN RHEUMATOID
models, likely due to nonavailability of key baseline data, ARTHRITIS PATIENTS
e.g., BMD. The own-control analysis is a promising approach S. Stoica1, G. Zugravu2
1
but requires a larger sample. Emergency Hospital Elena Beldiman, Barlad, Romania, 2Re-
Disclosures: Amgen/GSK habilitation Hospital, Iasi, Romania

Objective: Corticosteroids are widely used to suppress hyper-

P440 active inflammation in rheumatoid arthritis (RA). Bone loss is
AN EVALUATION OF THE AGE, GENDER AND ITEM a serious side effect of this therapy. Risedronate is frequently
SPECIFICITY OF DIFFICULTY IN PHYSICAL used for prevention and treatment for corticosteroid induced
FUNCTIONING osteoporosis. The objective of this study is to assess the effects
N. Bellamy1 of risedronate for the prevention and treatment of corticoste-
1
School of Medicine, University of Queensland, Brisbane, Australia roid induced osteoporosis.
 Osteoporos Int

Material and Methods: The study includes 42 RA postmen- Objective: Statistical shape modeling (SSM), a technique to
opausal women aged between 54 and 62 years which require quantify hip shape, can predict the need for total hip replace-
long-term corticosteroid therapy at >5 mg/day prednisolone ment (THR) within a cohort, but the validity of the predictive
daily. All RA patients fulfilled the 1987 American College of shape variants between different cohorts is unknown. The
Rheumatology (ACR) revised criteria for RA. All patients aims of this study were to investigate which shape variants
were interviewed and examined for the gathering of informa- can predict the need for THR in women, and to validate the
tion on disease and treatment history. All patients received resulting shape variants in the prediction of THR.
risedronate (35 mg/week),elemental calcium (1,000 mg/day) Material and Methods: Hip shape on baseline
and vitamin D (800 U/day) for 12 months. BMD (lumbar anteroposterior pelvic radiographs was assessed using SSM.
spine, hip and whole body) and bone turnover markers (urine Female participants from the CHECK cohort without radio-
deoxypyridinoline, serum osteocalcin) were assessed at base- graphic OA (K&L<2) at baseline were included (1,100 hips);
line, month 6 and month 12. Plain radiographs of the thoracic 22 hips had a THR within 5 years follow-up. For the
and lumbar spine for fractures were taken at baseline and Chingford cohort, with only female participants, hips without
month 12. Patients with gastrointestinal disease and neo- radiographic OA at baseline were selected and a nested case-
plasms were excluded. control design was used, with 19 THR cases within 19 years
Results: The duration and dose of prednisolone received by follow-up and 95 controls matched for age and BMI. The
the participants was 18.4±20 months. Osteopenia or osteopo- association between each shape variant and THR was calcu-
rosis (T-scores<−1.0) of the lumbar spine and the hip occurred lated by logistic regression.
in 74 % at baseline. The BMI of the participants was 21.9± Results: In the CHECK and Chingford cohorts, the re-
2.3 kg/m2. At month 12, a significant gain in BMD at the spective mean(SD) age was 55.8(±5.1) and 53.6(±5.4), and
lumbar spine (+1.3±2.4 %; p=0.005) and the hip (+1.1± BMI 26.14(±4.3) and 25.7(±3.3). Multiple modes of shape
2.6 %; p=0.01) was observed. No new fracture was reported. variation could predict (p<0.05) the need for THR both in
4 patients were withdrawn from the study because non- com- the CHECK cohort (mode 4,11,15,17, and 22) and in the
pliance to treatment (N=3) and adverse events - dyspepsia Chingford cohort (mode 2 and 17). However, only mode
(N=1). 17, representing a flattened head-neck junction and flat
Conclusion: Risedronate is effective for preventing and major trochanter(fig1), could be validated in the Chingford
treating bone loss at the lumbar spine and femoral neck after cohort.
12 months treatment in RA postmenopausal women receiving
long-term glucocorticoids.

P442
VALIDATION OF STATISTICAL SHAPE MODELING
TO PREDICT HIP OSTEOARTHRITIS IN FEMALES:
DATA FROM TWO PROSPECTIVE COHORT
STUDIES (CHECK AND CHINGFORD)
R. Agricola1, K. M. Leyland2, S.M.A. Bierma-Zeinstra3, G. E.
Thomas2, T. D. Spector4, H. Weinans5, J. H. Waarsing1, N. K.
Arden2
1
Department of Orthopaedics, Erasmus University Medical Conclusion: Several shape variants can predict THR within a
Centre, Rotterdam, Netherlands, 2Nuffield Department of Or- cohort. One predictive shape variant in the CHECK cohort
thopaedics, Rheumatology and Musculoskeletal Sciences, could be validated in the Chingford cohort. SSM is not easily
NIHR Musculoskeletal Biomedical Research Unit, University transferable between cohorts; reasons may include differences
of Oxford, Nuffield Orthopaedic Centre, Oxford, United in participant characteristics, radiographic protocol, and
Kingdom, 3Department of Orthopaedics and Department of follow-up time.
General Practice, Erasmus University Medical Centre, Rotter-
dam, Netherlands, 4Department of Twin research and Genetic
Epidemiology, King’s College, London, United Kingdom, P443
5
Department of Orthopaedics and Department of Rheumatol- DECLINING HIP FRACTURE RISK IN SWEDEN
ogy, University Medical Centre Utrecht and Department of A. Odén1, E. V. McCloskey1, H. Johansson1, J. A. Kanis1
1
Biomechanical Engineering, Delft University of Technology, WHO Collaborating Centre for Metabolic Bone Diseases,
Delft, Utrecht, Netherlands University of Sheffield, Sheffield, United Kingdom
Osteoporos Int

Objective: Secular changes in hip fracture incidence are de- A device and hypovitaminosis D (serum 25-OHD level below
scribed in many regions of the world. The objective of this 75 nmol/L) who were monitored for 2 years for incidence of
study was to determine long term trends in hip fracture inci- T2DM. During that time, once monthly oral dose of
dence in Sweden. ibandronate 150 mg followed by calcium (1,000 mg) and
Material and Methods: The fracture hazard function was 25-OHD (800 IU) supplementation was administered to all
estimated between 1987 and 2009 by Poisson regression patients with strict instructions for use. Statistical analysis was
including the variables sex, age, latitude, population density, performed using SPSS ver.12 for Win software package.
and day of the year. Logistic regression analysis was used to establish an associa-
Results: Women contributed 38.4 million person years and tion and prognostic value of vitamin D to the onset of T2DM.
264,362 hip fractures and men 33.3 million person years and Serum level of 25-OHD was measured using
104,888 fractures. In women, there was a minor reduction of immunochemiluminescence in March and April 2011.
the risk with time (Table). For the period 1994–2001, for Results: Out of the 97 patients (mean age 51.64±5.86 years,
example, the change in risk corresponded to a reduction of range 36.0–73.0), 21 (21.65 %) were diagnosed with T2DM
1.27 years of age. Thus, at the end of the period the hip during the observational period. Increased amounts of 25-
fracture risk of a lady of the age 81.50 years was the same OHD significantly reduced the probability of T2DM occur-
as the risk of a lady of the age 81.50–1.27=80.23 years 8 years rence (p<0.05). Study showed that patients with low levels of
earlier. For men there was an increase of the risk during the vitamin D were more susceptible to being diagnosed with
period 1987–1993. T2DM (OR=0.958). The cut-off value of the vitamin D below
which postmenopausal women with OS have a greater
chances to develop T2DM using ROC curve was
62.36 nmol/L with sensitivity of 39.5 % and specificity of
90.5 %.
Conclusion: Our study showed that in patients with postmen-
opausal OS, serum level of 25-OHD has an predictive poten-
tial in the onset of T2DM with an increased risk for those with
Conclusion: There has been a small decrease in the age and hypovitaminosis D.
sex specific incidence of hip fracture for women since 1987 Acknowledgements: We are grateful to pharmaceutical com-
and in men since 1994. pany Hoffmann-La Roche, Podgorica, Montenegro for pro-
viding us with technical support during the study.

P444
HYPOVITAMINOSIS D AND TYPE 2 DIABETES P445
MELLITUS IN POSTMENOPAUSALWOMEN WITH PREOPERATIVE DETECTION OF PARATHYROID
OSTEOPOROSIS ADENOMAS WITH 3T MRI IN PATIENTS WITH
S. Vujosevic1, S. Borozan1, S. Aligrudic2, N. Radojevic3, S. HYPERPARATHYROIDISM
Kavaric1, K. Kazic2, N. Miketic2, O. Boskovic4, D. Bozovic5 D. Diacinti1, R. Argiro’2, B. Sacconi2, C. Cipriani3, A.
1
Department of Endocrinology, Clinical Centre Montenegro, Iannarelli 2 , D. Pisani 4, E. Fratini 3 , E. Romagnoli 3, S.
Faculty of medicine, University of Montenegro, Podgorica, Minisola3
Serbia, 2Department of Rheumatology, Clinical Centre Mon- 1
Department of Radiological Sciences, University Sapienza 2,
tenegro, Podgorica, Serbia, 3Clinical Centre Montenegro, Fac- Rome, Italy, 2Department of Radiological, Oncological And
ulty of medicine, University of Montenegro, Podgorica, Ser- Patological Sciences University, Rome, Italy, 3Department of
bia, 4Department of Endocrinology, Clinical Centre Montene- Clinical Sciences, University Sapienza, Rome, Italy, 4Depart-
gro, Podgorica, Serbia, 5Clinical Biochemistry, Clinical Cen- ment of Clinical and Molecular Medicine University
tre Montenegro, Podgorica, Serbia Sapienza, Rome, Italy

Objective: To investigate an association between the serum Objective: To assay the role of a fast protocol with a 3T MR
level of 25-hydroxivitamin D (25-OHD) and incidence of type unit in the localization of hyperfunctioning parathyroid in
2 diabetes mellitus (T2DM) in postmenopausal women with order to propose, in the near future, the potential use of MRI
osteoporosis (OS). as second level imaging technique as alternative or substitute
Material and Methods: Prospective observational study in- to CT in case of discordant US and 99-Tc sestamibi scans.
volved 97 postmenopausal Caucasian women with OS: T- Material and Methods: 24 patients (7 M and 17 F) affected
score of spine (L1-L4) and hip of 2.5 SD or more below the by primary hyperparathyroidism with both positive US and
mean peak bone mass measured by DXA, Hologic Discovery Tc-99 sestamibi scan underwent to MR examination with a 3T
 Osteoporos Int

unit (Discovery MR750, GE) using a dedicated protocol: T2 younger people because of the way of life, reduced tannin and
IDEAL on three-plane, axial T2 FS BH and axial T1 IDEAL bad eating habits.
before and after administration of 10 ml of gadolinium. Two Material and Methods: 37-year-old female patient was ad-
radiologists in consensus identified five features suggestive mitted in hospital because of pain in bones, weakness, head-
for parathyroid adenomas in controls: homogenous or mar- ache and cough.
bled hyperintense signal on T2 IDEAL or on T2 Breath-Hold; Results: In the laboratory examination find anemia (Hgb
Indian ink artefact on T2 outphase IDEAL; rapid enhance- 10.8 g/L), elevated serum proteins 84 g/L without hypoalbu-
ment in post-contrast T1-weighted images. MRI localization minemia, with elevated IgA 28.02 g/L and the restriction of
of parathyroid adenomas was graded in high (presence of 4–5 IgM and IgG. There’s not found kidney and liver disease, the
features), medium (2–3 features) or low (1 feature) positivity entire electrolyte status is regular, only higher serum values
and negativity (no features). All patients with negative MRI for C-reactive protein 2.40 mg/L and sedimentation SE
exam underwent to a further CT scan. 80 mm/h. On CT scans of the thorax were found enlarged
Results: All parathyroid adenomas were correctly identified lymphatic glands. In myelogram was found 30 % plasma cells.
in the proper location showed by US and Tc-99 sestamibi scan Electrophoresis of serum proteins found in the β2 zone
(100 %). Average lesion size was 14.8×8.7 mm (range 5– paraprotein 30.5 g/l and immunofixation of serum proteins
33 mm). All the lesions were located in the classical anatomic IgA monoclonal lambda type chains was found. Bence-Jones
site. The two radiologist detected hyperintensity of the lesions protein are negative, β-2 microglobulin 1.47 mg/l. On X-rays
on T2-weighted sequences in 29/29 cases (100 %); marbled were not found changes in the bone structure of the skull, pelvis
aspect in 23/29 cases (79.3 %); oblong morphology in 26/29 and spine that indicate underlying disease. Bone marrow biop-
cases (89.7 %), clevage plane between adenomas and thyroid sies performed with the IHC, which indicates the monoclonal
in 23/29 (79.3 %) and rapid enhancement in 9/29 cases plasma cell infiltration from about 40 %, thus confirming the
(31 %). diagnosis of multiple myeloma. Bone mineral loss evaluated by
Conclusion: This study demonstrates clear localization by DXA on lumbar (BMD 0.894 g/cm2; Z-score -1.2SD) with
MRI of parathyroid adenomas, in most of cases, also in the greater loss on femoral neck (BMD 0.718 g/cm2; Z-score
pre-contrast sequences. It could be of benefit to patients with -1.0SD). Low bone mass is the result of vitamin D deficiency
chronic kidney failure. Therefore we suggest MRI as second (25OHD3 7.50 nmol/L) with relative hyperparathyroidism
level imaging technique as substitute to CT in case of discor- 69.56 pg/ml, but with normal range of β-crosslaps 0.450 ng/ml.
dant US and 99-Tc sestamibi scans. Conclusion: This report highlights a causes and conse-
quences of vitamin D deficiency in multiple myeloma. Since
vitamin D deficiency is a widespread public health issue
P446 linked to cancer and other health risks, healthcare providers
VITAMIN D DEFICIENCY: CAUSES AND should not ignore this condition. Therefore, evaluation of
CONSEQUENCES vitamin D levels and vitamin D supplementation especially
M. Vuksanovic1, B. Arsenovic1, T. Beljic Zivkovic2, Z. in younger population should be taken into consider-
Milojevic3, K. Markovic3 ation, promoting bone health and potentially reducing
1
Osteoporosis Unit, Clinical Department of Endocrinology, cancer risks.
Diabetes and Metabolism, Zvezdara University Medical Cen-
ter, Belgrade, Serbia, 2Faculty of Medicine at the Belgrade
University, School of Medicine, Belgrade, Serbia, 3Depart- P447
ment of Clinical Hematology, Zvezdara University Medical HOW WELL DOES SELF-PERCEPTION OF
Center, Belgrade, Serbia FRACTURE RISK RELATE TO FRACTURE
PROBABILITY USING FRAX? FINDINGS FROM
Objective: Vitamin D has an important role in the organism. THE GLOW STUDY
Adequate levels of vitamin D are essential for the maintenance E. M. Dennison1, J. E. Compston2, A. Wyman3, E. S. Siris4, S. H.
and preservation of good health. A vitamin D deficiency Gehlbach3, J. D. Adachi5, R. D. Chapurlat6, A. Diez-Perez7, F.
(vitamin D deficiency syndrome, VDDs) is defined when a H. Hooven 8, A. Z. Lacroix9, J. C. Netelenbos10, J.
patient has a plasma concentration of 25(OH)D of <50 nmol/ Pfeilschifter11, M. Rossini12, C. Roux13, K. G. Saag14, S.
L. Vitamin D deficiency is considered to be a major cause of Silverman15, N. B. Watts16, S. L. Greenspan17, J. Nieves18,
occurrence of the pathology in different types of cancer, heart L. March19, C. L. Gregson1,20, C. Cooper1,21
1
disease, hypertension, autoimmune disease, diabetes, depres- MRC Lifecourse Epidemiology Unit, University of South-
sion, chronic pain, osteoarthritis, osteoporosis, muscle weak- ampton, Southampton General Hospital, Southampton, Unit-
ness, muscle loss. Vitamin D deficiency is very common ed Kingdom, 2School of Clinical Medicine, Addenbrooke’s
among older adults but it is not rare nowadays even among Hospital, University of Cambridge, Cambridge, United
Osteoporos Int

Kingdom, 3Center for Outcomes Research, University of aligned. In a model containing both FRAX risk and SPR both
Massachusetts Medical School, Worcester, Massachusetts, were significant (p<0.0001).
United States, 4Department of Medicine, Columbia Uni-
versity Medical Center, New-York, NY, United States,
5
St. Joseph’s Hospital, McMaster University, Hamilton,
Ontario, Canada, 6INSERM U831, Université de Lyon,
Division of Rheumatology, Hôpital E. Herriot, Lyon,
France, 7Hospital del Mar-IMIM- Autonomous Univer-
sity of Barcelona, Barcelona, Spain, 8Center for Out-
comes Research, UMASS Medical School, Worcester,
Massachusetts, United States, 9Fred Hutchinson Cancer
Research Center, Seattle, WA, United States, 10Depart-
ment of Endocrinology, VU University Medical Center, Conclusion: These observational data suggest that SPR offers
Amsterdam, Netherlands, 11Alfried Krupp Krankenhaus, a further contribution to fracture prediction, independent of
Department of Internal Medicine III, Essen, Germany, fracture prediction algorithms such as FRAX.
12
Department of Rheumatology, University of Verona, Disclosures: The authors have the following disclosures:
Verona, Italy, 13Paris Descartes University, Cochin Hos- Servier, Shire, Nycomed, Novartis, Amgen, Procter & Gam-
pital, Paris, France, 1 4 University of Alabama- ble, Wyeth, Pfizer, The Alliance for Better Bone Health,
Birmingham, Birmingham, Alabama, United States, Roche, GlaxoSmithKline; Eli Lilly, Merck, Sanofi, Astra
15
Department of Rheumatology, Cedars- Sinai/UCLA, Zeneca, Bristol-Myers Squibb, Maxence Pharma, Kyphon,
Los Angeles, California, United States, 16Bone Health GE LUNAR, Orion Pharma.
and Osteoporosis Center, University of Cincinnati, Cin- Acknowledgements: All GLOW participants and
cinnati, Ohio, United States, 17University of Pittsburgh, investigators.
Pittsburgh, Pennsylvania, United States, 18Helen Hayes
Hospital and Columbia University, West Haverstraw,
New York, United States, 19Faculty of Medicine and
Department of Public Health, University of Sydney, P448
Sydney, Australia, 20Musculoskeletal Research Unit, IS THERE ANY NEUROPATHIC COMPONENT OF
University of Bristol, Avon Orthopaedic Centre, PAIN IN KNEE OSTEOARTHRITIS?
Southmead Hospital, Bristol, United Kingdom, 21Insti- Z. Eğilmez1, A. Icagasioglu1, S. Murat1, E. Mesci1
tute of Musculoskeletal Sciences, University of Oxford, 1
Medeniyet University Goztepe Training and Research Hos-
Oxford, United Kingdom pital Physical Medicine and Rehabilitation Department, Istan-
bul, Turkey
Objective: Among women participating in Global Longitu-
dinal study of Osteoporosis in Women (GLOW), increased Objective: Osteoarthritis(OA)-related pain has long been con-
self-perceived fracture risk is associated with incident fracture sidered as nociceptive pain caused by local tissue injury. In
rates. Here we investigate how self-perception of risk (SPR) in recent data suggest that people with OA can experience pain
this group aligns with risk as assessed in fracture prediction due to not only nociceptive also neuropathic mechanisms. Our
tools such as FRAX. objective was to investigate the existence of a neuropathic
Material and Methods: GLOW is an international cohort component to the pain of OA knee using the neuropathic pain
study involving 723 physician practices across 10 coun- (NP) questionnaires.
tries in Europe, North America and Australasia. Sixty Material and Methods: 71 patients with knee OA were
thousand three hundred ninety-three women aged evaluated in this study. Data on sociodemographic factors,
≥55 years completed baseline questionnaires detailing pain scores using VAS, WOMAC, Lequesne Index, Neuro-
medical history, including co-morbidities, fractures and pathic Pain Diagnostic Questionnaire (DN4), severity of OA
self-perceived fracture risk, defined as much or a little using the Kellgren- Lawrence (KL) system scored by radiol-
lower than average; about the same; much or a little ogist were obtained and evaluated DN4 scores and correla-
higher than average. Annual follow-up determined self- tions with other parameters.
reported incident fractures. We calculated FRAX risk Results: Our study identified 26.8 % of our knee OA patients
without BMD measurement. as likely to have NP. DN4 score was significantly correlated
Results: Of the 27,623 women with complete follow-up data, with Lequesne (p=0.01) and WOMAC (p=0.001) pain sever-
1,625 (5.9 %) sustained an incident major fracture over 5 years ity. Compared with DN4, there was positive correlation with
of follow-up. Table 1 below shows how SPR and FRAX risk
 Osteoporos Int

KL grade and VAS score but the correlations were not PTH-C1 stably transfected clones can be a good model
significant. to study parathyroid gland physiology and pathology.
Conclusion: DN4 scores identified one quarter of patients
with knee OA pain as NP. This is important rate to consider
existence of NP and identification of neuropathic component
in coming days may lead to new treatment strategies of knee P450
OA. HEALTH CARE RELATED NEEDS 36 MONTHS
AFTER VERTEBRAL AND DISTAL FOREARM
FRACTURE: RESULTS FROM ICUROS IN
LITHUANIA
P449 V. Alekna1, V. Sinkeviciene1, D. Kalibatiene1, F. Borgström2,
A PARATHYROID CELL LINE WITH STABLE M. Tamulaitiene1
1
EXPRESSION OF CASR AND PTH GENES Medical Faculty, Vilnius University, Vilnius, Lithuania,
A. R. Gomes1, S. Fabbri1, C. Mavilia1, R. Zonefrati1, G. 2
LIME/MMC, Karolinska Institute, Stockholm, Sweden
Galli1, A. Tanini1, M. L. Brandi1
1
University of Florence, Department of Surgery and Transla- Objective: To evaluate the changes of health care related
tional Medicine, Florence, Italy needs in 36 months after clinical vertebral and distal forearm
fracture.
Objective: To stably overexpress calcium-sensing receptor Material and Methods: Patients aged 50 years and
(CaSR) and PTH genes in a rat parathyroid cell line named older, with vertebral fracture (VFx) or distal forearm
PTH-C1 and to study the role of CaSR in parathyroid fracture (FFx) enrolled and observed for 18 months in
tumourigenesis. the International Costs and Utilities Related to Osteopo-
Material and Methods: CaSR and PTH genes were inserted rotic fractures Study (ICUROS) in Lithuania, were fur-
in two separate pcDNA3.1/Zeo(+) plasmid expression vectors ther interviewed in 24 and 36 months after the fracture.
and cells were subsequently transfected. Stably transfected In this study, visits to health care specialists due to the
cells were selected with zeocin and were cloned by serial fracture were analyzed. Exclusion criteria were: other
dilutions afterwards. Stable integration of CaSR and PTH fractures or conditions, which could significantly change
genes at mRNA and protein level was verified by PCR and the health status. The McNemar test was used to com-
immunocytochemistry, respectively. Study of cell prolifera- pare dichotomous variables between time periods. The
tion was performed at 1,2 mM calcium (Ca2+), with growth chi-square test was used to determine p-value between
curves, by direct cell counting of growth plates in a groups.
LSM510META Microscope every day, during 4–5 days. Results: In total, 256 persons were included in this study: 65
Results: Transfection allowed obtaining: 2 clones stably over- subjects with VFx (51 women and 14 men) and 191 subjects
expressing CaSR gene, 4 clones stably overexpressing with FFx (179 women and 12 men). The age did not differ
both CaSR and PTH genes and 9 clones stably overex- significantly between the groups (p=0.346). Our results
pressing PTH gene. PCR results showed stable integra- showed that 29.9 % of patients with FFx and 60.3 % of
tion of CaSR and PTH genes at mRNA level. Immuno- patients with VFx were hospitalized in connection to the
cytochemistry allowed to confirm CaSR and PTH ex- fracture. In all patients an x-ray was used. Just after the
pression at protein level. Study of cell proliferation fracture, surgery was performed in 17.1 % of patient with
showed a statistical significant higher population dou- forearm fracture and in 2.2 % of patients with VFx; 2.9 % of
bling time for one of the clones stably transfected with patients with FFx underwent the repeated surgery during the
CaSR gene, named clone B6, when compared with the following 5–12 months. During the first year after fracture, the
non-transfected PTH-C1 cells, which have low endoge- health care specialists were visited more frequently, than
nous expression of CaSR and PTH genes. during the second and third years (p<0.001), in both groups.
Conclusion: CaSR and PTH genes were successfully stably During 25–36 months, GPs were visited more frequently by
transfected in PTH-C1 cell line. Both genes are patients with FFx than patients with VFx (35.9 % and 14.4 %,
expressed at mRNA and protein level and population respectively). In average, more physiotherapy procedures per
doubling times of the clones were determined with patient were performed in the cases of VFx comparing to FFx
growth curves at 1.2 mM Ca2+. The higher population (p<0.001). 36 months after the FFx, the procedures of occu-
doubling time showed by clone B6, with stable overex- pational therapy were still needed in 1.6 % of patients.
pression of CaSR gene, could support a role for CaSR Conclusion: There is still a need of fracture related health care
in inhibiting PTH-C1 cell proliferation, as seen in nor- during the third year after a vertebral or a distal forearm
mal parathyroid glands. Obtained results indicate that fracture.
Osteoporos Int

P451 P452
DEFINING A MUSCULOSKELETAL FOOT AND GENOME-WIDE ASSOCIATION STUDY OF
ANKLE ASSESSMENT PROTOCOLTO BE USED OSTEOARTHRITIS IN A GREEK (THESSALY)
WITHIN THE INVESTIGATION OF LOWER LIMB POPULATION OF 399 INDIVIDUALS
OSTEOARTHRITIS: RESULTS OF AN D. Kafetzopoulos1, L. Takacs1, K. Kalantzaki2, V. Gkretsi3, C.
INTERNATIONAL CONSENSUS STATEMENT Zoumadakis1, E. S. Bei2, M. Zervakis2, A. Tsezou3
L. Gates1, C. J. Bowen1, L. Mcculloch2, N. K. Arden3 1
FORTH IMBB, Heraklion Crete, Greece, 2Department of
1
Faculty of Health Sciences, University of Southampton, Electronic and Computer Engineering, TUC, Chania,
Southampton, United Kingdom, 2Dorset HealthCare Univer- Greece, 3University of Thessaly School of Medicine,
sity NHS Foundation Trust, Dorset, United Kingdom, 3Mus- Larissa, Greece
culoskeletal Biomedical Research Unit, University of Oxford,
Oxford, United Kingdom Objective: Osteoarthritis (OA) is known to be caused
by both environmental and genetic factors, and there
Objective: The focus of evidence of knee and hip oste- have been several large-scale genome-wide association
oarthritis is such that we now have a good understand- studies (GWAS) 1,2,3,4 aiming to detect gene targets to
ing of pathology, mechanisms and cost effectiveness of be used for either susceptibility identification or treat-
interventions. However such evidence for foot and ankle ment. The current study focuses on identifying OA-
osteoarthritis is lacking. An absence of agreement for associated single nucleotide polymorphisms and their
the ideal methods of assessing the physical musculo- respective genes, in the Greek (mostly Thessaly) pop-
skeletal status of the foot and ankle is a fundamental ulation, by studying a cohort of 399 individuals,
limitation for clinical investigations. The objective of whose family history and medical records are
this study was to define a core set of standard clinical available.
foot and ankle measures to be used within clinical Material and Methods: The genotyping platforms
investigations. used were the Affymetrix Human Mapping 250K
Material and Methods: An expert derived core set of Nsp Array, and the Affymetrix Genome-Wide Human
musculoskeletal foot and ankle measures was developed SNP Array 6.0. The odds ratio (OR) statistical test
using an evidence driven approach via: 1) A systematic was used to detect and evaluate statistically signifi-
literature review to identify and evaluate current foot cant polymorphisms between the OA and control
and ankle musculoskeletal assessments 2) A Delphi samples.
exercise, including international foot and ankle experts Results: The SNPs with the strongest observed OA associa-
from a variety of professions, to gain consensus on foot tion were rs8713 (CAV1, OR=0.38, p=3.4×10−6), rs3213031
and ankle assessment measures to include in a protocol (CDK1, OR=0.33, p=2.5×10−6), rs5968981 (DACH2, OR=
3) An expert meeting to ascertain future research 5.35, p=4.2×10−6) and rs10501580 (DLG2, OR=2.84, p=
agendas 4) Strength of recommendation values for each 7.8×10−6).
agreed measure. Conclusion: Based on other detected significant polymor-
Results: Systematic review: There was an absence of phisms, as well as support from literature5,6, we are currently
agreement for current foot and ankle assessment mea- focusing our research in genes CAV1, TGF-a, DOCK, and
sures, with considerable variation in reliability and a RHOCK1 which are currently being validated via biochemi-
lack of robust validity testing. Delphi: Via four rounds cal and immunohistochemical methods and proteomics
of a Delphi exercise, 20 foot and ankle assessment analysis.
measures were identified. Expert meeting: Agreement References: 1. Nakajima M et al. (2010) PLoS One
was made that the set of measures should be used for 5:e9723
clinical and research screening purposes. Strength of 2. Evangelou E et al. (2011) Ann Rheum Dis 70:349
recommendation: Clinical and research strength of rec- 3. Panoutsopoulou K et al. (2011) Ann Rheum Dis
ommendation values were established for each measure. 70:864
Scores were consistently wide and predominantly higher 4. Nakajima M et al. (2012) J Orthop Res 30:1244
for clinical than research use. 5. Yudoh K et al. (2009) Int J Rheum Dis 12:90
Conclusion: The results of the study form the first stage 6. Riancho JA et al. (2012) Eur J Endocrinol 166:69
in a process towards developing a novel musculoskeletal Acknowledgements: This research has been co-financed
foot and ankle assessment tool applicable for both clin- by the European Union and Greek national funds
ical and research purposes. Future work is required to through the Operational Programme «Competitiveness
validate these measures against outcomes of disease and Entrepreneurship» of GSRT Cooperation project:
severity, pain and function. OASYS 09ΣΥΝ-13-705.
 Osteoporos Int

P453 Medicine, Shimane, Japan, 7Department of

THE BENEFITS OF STRETCHING IN THE Pharmacoepidemiology, Graduate School of Medicine and
TREATMENT OF OSTEOPOROSIS Public Health, Kyoto University, Kyoto, Japan, 8WHO Col-
C. Nistor-Cseppento1, L. Lazar1, M. Cevei1, L. Vicas1, M. laborating Centre for Metabolic Bone Diseases, University of
Stoicescu1, F. Marcu1 Sheffield, Sheffield, United Kingdom
1
Medical Rehabilitation, University of Medicine and Pharma-
cy Oradea, Oradea, Romania Objective: Teriparatide has been shown to significantly de-
crease the risk of vertebral fractures in Japanese patients with
Objective: Osteoporosis is one of the most common osteoporosis. The aim of this study was to evaluate the effi-
metabolic bone disease, is responsible for a high per- cacy of teriparatide on fracture outcomes as a function of
centage of all fractures occur. Physical therapy is im- fracture risk.
portant in both the prevention and treatment of osteo- Material and Methods: The phase III study was a double-
porosis. Bone forming activity is stimulated by muscle blind, placebo-controlled randomized, 72 week study that
tension through a mechanism still unknown. Prolonged enrolled 542 Japanese men and women aged 65–95 years with
inactivity is a leading cause muscle atrophy and bone a prevalent vertebral fracture and low BMD. The active arm of
loss. Statistics show that women who did aerobic exer- the study received weekly sc injections of teriparatide 56.5 μg
cise is quite had higher bone mass than those who and the effect on morphometric vertebral fracture was com-
practiced only walking as physical activity. pared with placebo. The relationship between 10-year fracture
Material and Methods: We included a total of 26 women probabilities (FRAX) and efficacy was examined by an ex-
aged between 58 and 72 years, diagnosed with osteoporosis, tension of Poisson regression.
T-score between −2.5 and −2.8 being. Patients were divided Results: 44 incident vertebral fractures occurred during a
into two groups. We conducted four assessments of pain using follow up of up to 72 weeks. Overall, teriparatide was associ-
VAS score initially 2 weeks of initiating treatment, at 6 months ated with a significant decrease in incident morphometric
and 1 year, when he again led the T-score. Treatment was vertebral fractures compared to placebo (hazard ratio HR=
followed by anti-resorptive patients with physiotherapy. 0.21; 95%CI=0.09–0.48). Baseline 10 year probability of a
Group I followed a special training with stretching torso and major osteoporosis fracture (FRAX) calculated without
legs twice a week throughout the study, and the second group BMD was available in all individuals, mean age
continued normal living arrangements. 75 years. For FRAX without BMD there was no signif-
Results: T score: media group I was −2.68 initially, after 1 year icant interaction with the effect of the treatment (p=
the average reaches −2.33 , group II: mean of −2.89 −2.91 0.28). 346 (64 %) participants had FRAX calculated
reach. with BMD and there was a small but significant inter-
Conclusion: The results are as expected, in the case of patients action (p=0.028) between efficacy and baseline fracture
undergoing complex treatment, both medical and physical train- probability. For example, at the 25th percentile of
ing T-score values corresponding condition improves. FRAX probability calculated without BMD, teriparatide
References: Revista Medicalå Românå - Vol. Lv, Nr. 1, 2008, was associated with a HR of 0.13 (95%CI=0.03–0.49)
Pg34 for vertebral fractures and for the 75th percentile it was
0.29 (95%CI = 0.11–0.73). The corresponding HR for
FRAX with BMD was 0.05 (95%CI= 0.01–0.37) and
P454 0.21 (95%CI=0.06–0.72).
EFFICACY OF TERIPARATIDE ON THE RISK OF Conclusion: Weekly teriparatide significantly decreased the
VERTEBRAL FRACTURE AND THE INTERACTION risk of morphometric vertebral fractures. Overall, the efficacy
WITH FRAX of weekly teriparatide was not significantly dependent on the
E. V. McCloskey8, A. Odén8, T. Nakamura1,4, T. Kuroda2, M. level of fracture risk assessed by FRAX calculated without
Eto3, M. Shiraki5, T. Sugimoto6, S. Tanaka7, J. A. Kanis8, H. BMD.
Johansson8
1
Project for Bone Metabolic Diseases, Asahi Kasei Pharma
Corporation, Chiyoda-ku, Tokyo, Japan, 2Project for Bone P455
Metabolic Disease, Asahi Kasei Pharma Corporation, Tokyo, OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID
Japan, 3Portfolio Management & Strategy Department, Asahi ARTHRITIS: METHOTREXATE COMPARED WITH
Kasei Pharma Corporation, Tokyo, Japan, 4National Center LEFLUNOMIDE TREATMENT ALONE
for Global Health and Medicine, Tokyo, Japan, 5Research N. Ganea1, L. Groppa1, E. Russu1
1
Institute and Practice for Involutional Diseases, Nagano, Ja- Rheumatology and Arthrology Laboratory, Clinical Repub-
pan, 6Internal Medicine 1, Shimane University Faculty of lican Hospital, Chisinau, Republic of Moldova
Osteoporos Int

Objective: To examine the effect of methotrexate (MTX) baseline and at 1 year after treatment initiation complex,
compared with leflunomide (LF) on bone loss in patients with antiresorptive and therapist.
rheumatoid arthritis (RA) in a randomised study design. Results: The first evaluation: The mean VAS score was 48,
Material and Methods: All 40 patients with RA (20 patients the average major FRAX fracture was 13. At the second
in each treatment group) had active RA. BMD was assessed at evaluation after 1 year, the average VAS values were 39, and
the hand, lumbar spine (L2-4) and hip by DXA at baseline and the average value of fracture risk for major fractures was 12.
12 months’ follow-up. Clinical data were collected at regular Conclusion: The results are as expected, in the case of pa-
visits. tients undergoing complex treatment, both medical and phys-
Results: Demographics showed: mean (SD) age 48.4 (16.3) ical training properly illness, pain values to decrease in paral-
years, BMI 24.9 (5.1) kg/m2, and median (range) disease lel with the decrease in fracture risk.
duration 3.2 (0.1–5.0) years. BMD loss was significantly
reduced in the MTX group compared with the LF group at
the femoral neck (−0.42 % vs. −3.12 %, p= 0.01), total hip P457
(−0.31 % vs. −3.02 %, p= 0.02) and spine (−0.63 % vs. THERAPEUTIC MEASURES TO IMPROVE
−2.56 %, p=0.01), but not at the hand (−2.1 % vs. −2.3 %, QUALITY OF LIFE IN PATIENTS WITH
p= 0.76). Measures of disease process and joint damage were OSTEOPOROSIS
found to be independently associated with bone loss. At the L. Vicas1, F. Cioara1, C. Nistor-Cseppento1
end of the study mean BMD was reduced by −2.2 % at the 1
Medical Rehabilitation, University of Medicine and Pharma-
femoral neck, −1.1 % at the total hip, and −1.0 % at the spine cy Oradea, Oradea, Romania
L2-4 in both groups. In subgroups BMD increased in patients
treated with bisphosphonates (femoral neck +1.6 %, total hip Objective: To evaluate the effectiveness of balneo-kineto
+3.2 %, spine L2-4 +4.5 %), whereas BMD decreased at all therapy in improving the quality of life in patients with oste-
sites in patients not treated with antirersorptive treatment, both oporosis type I.
for users MTX (femoral neck −4.4 %, total hip −2.4 %, spine Material and Methods: We conducted a prospective study
L2-4 −2.1 %) or LF (femoral neck −4.2 %, total hip −2.6 %, using a sample of 53 female patients, aged between 56 and
spine L2-4 −2.4 %). 64 years old diagnosed with osteoporosis type I, divided into
Conclusion: This study provides strong evidence of a causal two groups. Group I consists of 23 patients with a mean age of
link between DMARD therapy and bone loss in RA. LF 61.32 years old. Group II consists of 30 patients with a mean
induce more expressive osteoporosis from the very beginning age of 58.69 years old. The monitoring was carried out over a
of the treatment in comparison with MTX, but in time, after period of 1 year. Patients received a treatment based on
9 months the osteoporosis was expressed the same in both specific kinetic and balneo-kinetic therapy means specific
groups. from Felix Spa Resort in Romania, combined with drug
therapy. We evaluated the quality of life by applying standard-
ized questionnaire Qualeffo-41. We also apply tests the high-
light the diminishing functionality of legs, an important factor
P456 in falls (Tandem Standing, Up & Go, Chair Rising Test).
CORRELATIONS OF FRAX SCORE WITH PAIN Results: Outcomes assessed before and at the end of the
SCORE monitoring showed improvement of the scores that reach
C. Nistor-Cseppento1, L. Lazar1, F. Cioara1, M. Cevei1 statistical borderline significance (p≤0.05) at the motivated
1
Medical Rehabilitation, University of Medicine and Pharma- group to perform physical therapy. Benefits of regularly prac-
cy Oradea, Oradea, Romania ticed exercise are associated with weight loss. There is a great
receptivity and efficiency in the elderly, proving the undeni-
Objective: BMD measured at the spine and hip using a device able value of complex functional recovery as a possibility of
DPX-α, which cause T-score on DXA osteoporosis is defined maintaining, strengthening or developing the remaining func-
when T-score at least 2.5 SDs below the young adult and tionality.
values between −1 and −2.5 is increased in osteopenia. Aim Conclusion: Physical exercises, especially those with loading
of the study was to track the correlation of pain with fracture and resistance, have a beneficial effect on quality of life
risk in patients with osteoporosis and osteopenia. contributing among other factors to the prevention of worsen-
Material and Methods: We included a total of 20 women, ing of osteoporosis and falls, especially in elderly women.
aged between 50 and 65 years, with a mean age of 63 years, External cure with oligo-thermal spa water influences body
diagnosed with osteoporosis. Average T-score (determined by reactivity and the positive state of mind that the patient feels
DXA machine) was −2.8. Based on height, weight, age, due to natural factors of therapy and contributes to the
calculated FRAX score. We conducted two evaluations at reaching of the proposed therapy objectives.
 Osteoporos Int

References: Påun R.- Tratat de Reumatologie - Bucureşti, above median may contribute to the therapeutic decision in
1999 Quality of Life Questionnaire, Qualeffo 41, <ahref="http:// this context.
www.osteofound.org">www.osteofound.org</a>.

P458 P459
NORMOCALCEMIC PRIMARY RISK FRACTURE TOOLS IN ELDERLY
HYPERPARATHYROIDISM: BMD GAIN AT THE POPULATION: A MISSED OPPORTUNITY FOR
INDIVIDUAL PATIENT LEVEL AFTER PARAT TREATMENT?
HYROIDECTOMY A. González Ramírez1, C. Pablos Hernández1, M. A. García
E. Koumakis1, J. C. Souberbielle2, J. Payet1, E. Sarfati3, D. Iglesias 2 , J. F. Jiménez Viseu Pinheiro 3 , J. M. Julián
Borderie4, A. Kahan1, C. Cormier1 Enríquez3, D. Pescador Hernández3, J. F. Blanco3
1 1
Rheumatology Department, Cochin Hospital, Paris, France, Department of Geriatrics, Hospital Universitario de Salaman-
2
Explorations Fonctionnelles, Hôpital Necker Enfants ca, Salamanca, Spain, 2Public Health Service, Valladolid,
Malades, Paris, France, 3Chirurgie Générale et Endocrinienne, Spain, 3Department of Traumatology, Hospital Universitario
Hôpital Saint-Louis, APHP, Paris, France, 4Laboratoire de de Salamanca, Salamanca, Spain
Biochimie Générale et Spécialisée, Hôpital Cochin, APHP,
Paris, France Objective: To assess the reliability of 2 common risk scales
(FRAX index, QFracture) for the evaluation of patients with
Objective: To assess BMD gains after parathyroidectomy no previous treatment for osteoporosis admitted in an
(PTX) in normocalcemic primary hyperparathyroidism orthogeriatric unit with a major osteoporotic fracture. Would
(PHPT) at the individual level and to identify predictors of they have received treatment with an assessment made the day
BMD gain after PTX in this context. before the fracture? Would they have been treated using these
Material and Methods: Longitudinal cohort study of 55 same scales 10 years ago?
PHPT patients referred for low bone mass and mild abnor- Material and Methods: Retrospective epidemiological study
malities of calcium/phosphorus metabolism, and successfully of patients admitted in an Orthogeriatric Unit with major
treated by PTX. BMD was assessed at the spine, hip and osteoporotic fracture (Jul 2013-Jan 2014). Statistical analysis
forearm before and 1 year after PTX using QDR 4500 SPSS 15.0.
(Hologic). To determine the impact of PTX on BMD at the Results: 106 patients (women 79.2 %, mean age 85.21) with
individual level, the mean difference between pre and post- major osteoporotic fracture (pertrochanteric 53.8 %,
PTX BMD values was calculated (g/cm2). BMD gain at 1 year subcapital hip fracture 34 %, others 11.2 %). No previous
was considered significant if ≥0.030 g/cm2 at one site or more, osteoporosis treatment: 100 %. Ten years ago (valid n=105):
without any equivalent BMD loss at another site. A logistic according to FRAX for major fractures, 56.6 % of women and
regression analysis was performed to identify predictive fac- 9.1 % of men from our sample should have received treat-
tors of individual gain. ment; according to FRAX for hip fracture, 67.5 % of women
Results: Among the 55 PHPT included, 36 patients with and 45.5 % of men should have been treated. Regarding
normocalcemic PHPT, defined by normal pre-PTX serum QFracture global risk for women, 59 % of them should have
total (albumin-corrected) calcium (tCa), were identified. At been treated (for men 73.3 %) Regarding QFracture hip frac-
1 year of PTX, an individual gain was observed in 44.4 % of ture risk, 60.2 % of women and 81.8 % of men should have
normocalcemic patients. In univariate analysis, PHPT patients received treatment. Nowadays, with the same scales for the
with a significant BMD gain were more likely to have lower suitable population (26 patients excluded due to age over
pre-PTX eGFR (72.8±18.6 vs. 79.9±13.4 ml/min/1.73 m2, 91 years), should have been treated: 83.9 % of women,
p=0.02), tended to have higher pre-PTX alkaline phosphatase 18.8 % of men (FRAX major fracture); 87.3 % of women,
activity (ALP) (79.1±30.7 vs. 65.1±23.1 UI/l, p=0.06), and 75 % of men (FRAX hip); 95.2 % of women, 100 % of men
higher pre-PTX serum tCa (2.56±0.14 vs. 2.51±0.12 mmol/l, (QFracture global); 100 % of women and men (QFracture
p=0.07). Multivariate analysis revealed that ALP levels above hip).
median were predictive of BMD gain, both in the overall Conclusion: 1. Risk fracture assessment tools are a highly
cohort (OR=4.9, 95%CI 1.3–18.9), and in the normocalcemic effective method for detecting people with osteoporosis at risk
group: OR=8.4, 95%CI 1.4–56.6. No association was identi- that should have been received treatment.
fied with any other pre-PTX characteristic. 2. Ten years ago, near 2/3 of our patients would have been
Conclusion: Successful PTX is followed at 1 year by a treated. The day before the fracture, between 70.5 and 91.1 %
significant individual BMD gain in nearly half of of our global sample would have received pharmacological
normocalcemic PHPT patients with osteoporosis. ALP levels therapy.
Osteoporos Int

3. In global terms for elderly men of our sample, QFracture Mechanical Engineering and Bioengineering, University of
seems to be more suitable for the detection of osteoporosis that California, Berkeley, United States, 4Department of Orthopae-
should be treated without further additional tests. dics and Rehabilitation, University of Vermont College of
Medicine, Burlington, United States

P460 Objective: The economic and clinical burden of osteoporosis

OSTEOPOROSIS IN MEN: HOW TO TREAT? is large and growing. We evaluated the effects on BMD and
L. A. Kilasonia1, N. Kirvalidze1, L. Lagvilava1 bone strength of a novel local osteo- enhancement procedure
1
Department of Rheumatology, THVC, Tbilisi, Georgia with a synthetic bone graft substitute injected into the proxi-
mal femur of osteoporotic patients. Adverse events were
Objective: Our research studied 205 male patients (aged 40– tracked.
70) with osteoporosis who have been on strontium ranelate Material and Methods: In this prospective, single-cohort
treatment for 3 years, with the standard scheme—daily 2.0 mg pilot study, 12 postmenopausal women with osteoporosis
Ca and D3 with combined drugs. Osteoporosis was diagnosed (DXA T-score≤−2.5 at femoral neck or total hip) received
through X-ray densitometry method (Hologic-100). unilateral injections of the graft material in the left femoral
Material and Methods: On selecting strontium ranelate as a neck, their noninjected right hip serving as a pairwise control.
basic medication, its pathogenesis, its anabolic effect on oste- All patients were maintained on their current osteoporosis
oblasts and an antiresorptive effect caused by influencing on treatments. Femoral BMD was measured at baseline and at
RANKL in OPG conditions; BMD basic index was also 1, 6, 12, 18, and 24 week and 12, 18, and 24 months postin-
considered in the studied category. Despite the clinical form jection. Femoral strength was estimated by nonlinear finite
of the disease, average index of T- criteria in spinal ribs and element analysis (FEA) conducted on quantitative CT scans
hip fluctuated between 2.5 SD and 2.7 SD, which is more taken preoperatively and 12 and 24 week post injection (per-
likely to be related to the empirically higher peek bone mass formed by O.N. Diagnostics, Berkeley, CA). The study was
index in males. In 68 cases out of 205 patients, IRB- approved; subjects gave written informed consent.
hypogonadotropic hypogonadism was verified; 52 patients Results: Baseline BMD of treated and control hips did not
were with thyroid gland diseases; 48 patients with diabetes differ. At 12 months, the graft material had been substantially
mellitus; 37 patients with rheumatoid arthritis. resorbed as observed on both X-ray and CT. Median (range)
Results: As a result of densitometric study after 3 year treat- changes from baseline in femoral neck BMD were
ment, it was established that: 1) BMD in the treated patients 67.1 %(38.0, 95.3) and −2.3 %(−8.5, 8.5) in the treated and
increased, in 62 % of cases reaching 7.2 % in hip proximal control hips, respectively, at 12 months (P<0.01), and
part, while it was 4.8 % in 51 % of patients. Bone increase was were maintained at 62.4 %(18.0, 94.6) and −2.2 %(−8.4,
identified in spinal ribs. 2) Our data proves that besides 10.8) at 24 months (P < 0.01). Consistent with these
antiosteoporotic effect, strontium ranelate has analgesic effect changes, mean (±SD) FEA-estimated femoral strength
too which was identified in 70 % of patients. 3) All patients of treated hips in fall loading increased 69.0±29.0 %
underwent the treatment well, without possible undesirable and 60.7±30.2 % from baseline at 12 and 24 weeks,
complications. respectively (P<0.05). No serious procedure-related ad-
Conclusion: The positive treatment effect of strontium verse events were reported.
ranelate among the osteoporotic men, and perfect tolerability, Conclusion: Osteoporotic patients treated with a novel local
proves that strontium ranelate has priority effect and can be osteo-enhancement procedure demonstrated substantial in-
selected as a basic medication for treatment of male creases in DXA-measured hip BMD and FEA- estimated
osteoporosis. femoral strength. Given these results and the favorable safety
profile, further evaluation of the effects of this novel proce-
dure is warranted.
P461 Disclosures: This study was sponsored by Wright Medical
SUBSTANTIAL INCREASES IN FEMORAL BMD Technology. B.M. Huber: Consultant with Equity Interest and/
AND STRENGTH IN POSTMENOPAUSALWOMEN or Stock Options and/or Research Grant (AgNovos
WITH OSTEOPOROSIS AFTER A LOCAL Healthcare and Conformis); Consultant (Videoscope,
OSTEO-ENHANCEMENT PROCEDURE Covidien, and Arthrocare); Research Grant (Stryker). M.L.
B. M. Huber1, M. L. Bouxsein2, T. M. Keaveny3, J. G. Howe4 Bouxsein: Consultant (AgNovos Healthcare). T.M. Keaveny:
1
Orthopaedic Surgery and Rehabilitation Services, Copley Equity Interest (O.N. Diagnostics); Consultant (AgNovos
Hospital, Morrisville, United States, 2Beth Israel Deaconess Healthcare, Merck, Amgen, O.N. Diagnostics). J.G. Howe:
Medical Center and Department of Orthopedic Surgery, Har- Company Employee and Equity Interest (AgNovos
vard Medical School, Boston, United States, 3Departments of Healthcare).
 Osteoporos Int

P462 Objective: To evaluate the effects of treadmill training on

FEMORAL CORTICAL INDEX AS A SPY OF BONE BMD and mechanical properties of bone from ovariectomized
FRAGILITY IN PATIENTS WITH HIP FRACTURE rats.
M. Feola1, C. Rao1, V. Tempesta1, M. Celi1, F. M. Liuni1, E. Material and Methods: 40 female Wistar rats were divided
Gasbarra1, U. Tarantino1 into 4 groups: OVXS: ovariectomized rats and sedentary;
1
Division of Orthopaedics and Traumatology, University of OVXE: ovariectomized rats with training; SHAMS: rats sub-
Tor Vergata, Rome, Italy mitted sham surgery and sedentary; and SHAME: rats sub-
mitted sham surgery with training. The ovariectomy and sham
Objective: The femoral cortical index (FCI) uses the ratio surgery with expose of ovaries were performed bilaterally.
between the diameter of the femoral shaft and the thickness of After surgery the animals in the sedentary groups were placed
the cortical bone calculated 10 cm distal to the small trochan- individually in plastic boxes with limited space, with the aim
ter in an AP view X-Ray of the femur. Aim of our study is to of reducing their movement, making them sedentary. The
evaluate a possible association among low values of FCI, risk animals in groups (OVXE and SHAME) underwent treadmill
factors, comorbidities and serum 25-hydroxyvitamin D levels training. The initial phase of adaptation was 2 weeks and a
and to establish the importance of FCI as a potential predictor phase of gradual evolution speed to be achieved the speed of
of a new fracture. 17 m/min lasting 60 min. The training was conducted 5 day/
Material and Methods: We conducted a retrospective study week. After 12 weeks the animals were euthanized. The
on 160 consecutive patients (44 men and 116 women, range femurs were dissected, cleaned of soft tissues, weighed and
60–103 ya) surgically treated for hip fractures in 2012. FCI has subjected to analysis of BMD in the proximal parts. Subse-
been calculated by routine clinical radiographs of the pelvis quently, the mechanical test flexion-compression of the head
both on fractured femur and on the opposite side. For each of each femur was performed. The speed of application of
patient, we analyzed the presence of comorbidities (such as force was 1 mm/min. The mechanical properties evaluated
diabetes, hypertension, IRC, rheumatoid arthritis),osteoporosis were: the maximum load (N) and stiffness (N/mm).
risk factors and blood levels of vitamin D, usually evaluated in Results: The weight of the femurs showed a significant dif-
our patients with fragility fractures. ference between the types of treatment (p=0.035), with great-
Results: Average values of FCI were 0.42 (range 0.18–0.58) er weight to the bones of trained animals. The BMD of the
at the fractured femur and 0.48 at the opposite side (range OVX groups was lower (p<0.000) than the SHAM groups,
0.25–0.66) with a statistically significant difference (p= and trained groups are higher (p=0.005) than the sedentary
0.002). At the fractured side an average value of 0.45 was groups. The maximum load of SHAME group was higher
found in men, and of 0.40 in women. Patients with severe than the SHAMS (p=0.011) and it was observed that SHAM
hypovitaminosis D (serum concentration <12 ng/ml) had a groups showed higher stiffness compared to the OVX group
minor FCI compared to those with a moderate deficiency and this difference was significant (p=0.015).
(0.41 vs. 0.46, P<0.01). The presence of comorbidities or Conclusion: The ovariectomy caused a decrease and physical
osteoporosis risk factors had a different influence on the training with treadmill improved densitometry and mechani-
values of FCI. cal properties of femurs.
Conclusion: In our study, we found a correlation among Acknowledgements: National Council for Scientific and
low values of FCI, clinical factors related to bone Technological Development
fragility and severe hypovitaminosis D in elderly pa-
tients with hip fractures. As described in the literature
regard DXA limitations in elderly, FCI could be an P464
useful tool in terms of bone fragility evaluation and BONE MINERAL DENSITYAFTER OSTEOTOMY
fracture risk prediction. As osteoporosis causes a corti- AND IMMOBILIZATION: AN EXPERIMENTAL
cal bone trabecolarization that leads to fracture, FCI can STUDY IN OSTEOPENIC RATS
therefore give a measure of specific cortical bone at low A. G. Paiva1, G. R. Yanagihara1, V. A. Castania1, T. T.
cost using a X-ray standard examination. Bernardo1, J. A. Tida1, A. C. O. Penoni1, F. H. B. Amorim1,
A. P. Macedo1, J. B. Volpon1, A. C. Shimano1
1
University of São Paulo, Ribeirão Preto, Brazil
P463
EFFECTS OF TRAINING AND SEDENTARISM ON Objective: To analyze the effects of different times of immo-
BONES OF OVARIECTOMIZED RATS bilization on fracture healing osteopenic rats by densitometric
A. P. Macedo1, J. A. Tida1, D. F. Tafarel1, R. C. Shimano1, J. analysis.
P. M. Issa1, A. C. Shimano1 Material and Methods: 24 female Wistar rats were random-
1
University of São Paulo, Ribeirão Preto, Brazil ized into four groups: OL2: free rats and, after osteotomy,
Osteoporos Int

were immobilized for 2 weeks; OS2: osteopenic rats and after proposed by D. Sillence, patients were divided in 3 types: OI I
osteotomy were immobilized for 2 weeks; OL6: free rats and type -11 (52.4 %), OI III type - 7 (33.3 %) OI IV type - 3
after osteotomy were immobilized for 6 weeks; OS6: (14.3 %). Due to limited number of participants all patients
osteopenic rats and after osteotomy were immobilized for were divided in 2 groups: mild to moderate (OI I type) and
6 weeks. The animals in groups OS2 and OS6 were subjected moderate-to severe (III and IV types). The standard protocol
to tail suspension, initially for 3 weeks to installation of with cyclic PAM infusions (3 consequent days 3–4 times in a
osteopenia and during immobilization, while those groups year) was applied in annual cumulative dose ranged from 9 to
OL2 and OL6 were free throughout the experiment. After 12 mg/kg. All children received vitamin D and calcium sup-
3 weeks, was performed in all groups, partial osteotomy in plementation in physiological doses. Observation period was
the medial region of the right tibia. Immediately after surgery, 36 months. Bone mineralization parameters were detected by
the limb was immobilized with an orthesis designed specifi- DXA of lumbar spine L1-L4 (densitometer Hologic QDR
cally for this study, by 2 or 6 weeks, as specified in the groups. 4500C, with pediatric reference database). We evaluated
The right tibias were dissected for densitometric evaluation of BMD Z-score, measured in standard deviations and deficien-
calluses. cy in percentages.
Results: The statistical results for the values of BMD showed Results: The age of initiation of PAM infusions depended on
significant differences, being lower in the group OL2 (0.164± type of OI: 9.6 (4.5; 12.7) years in I type and 0.56 (0.24; 7.9)
0.014 g/cm2) when compared at OL6 (0.191±0.010 g/cm2) years in III+IV types (p=0.01). There were no differences in
with p=0.013. Similarly, the group OS2 (0.154±0.009 g/cm2) bone mineral accrual between types of OI. The maximum
was lower than the OS6 (0.218±0.009 g/cm2) with p=0.004. efficacy in bone mineral accrual was observed in first year
However, the group OL2 (0.164±0.014 g/cm2) was higher (+32.9 %) and second year (+22.1 %) and no real improve-
than the OS2 (0.154±0.009 g/cm2), but no showed statistical ment in BMD in third year. Reduction of fractures in OI I
difference. Already the group OL6 (0.191±0.010 g/cm2) was types was from 0.87 (0.64; 1.08) to 0 (0.0; 0.5) fractures per
lower than the OS6 (0.218±0.009 g/cm2) with p=0.005, year (p=0.09). In severe OI group fracture reduction was more
statistically significant result. impressive: from 28.5 (4.6; 56.2) to 1.1 (0.86; 2.6) fractures
Conclusion: The calluses of animals 2 weeks of immobiliza- per year (p=0.02). No side effects besides “flu-like” syndrome
tion had lower BMD than 6 weeks, both for the free animals as were observed.
for the suspended animals. The suspension and immobiliza- Conclusion: PAM treatment was effective in bone mineral
tion for 6 weeks of an osteopenic bone, submitted the accrual and fracture reduction. The maximum efficacy in bone
osteotomy caused a higher BMD in their callus. mineral accrual was observed in first 2 years.
Acknowledgements: The State of São Paulo Research Foun-
dation (FAPESP) and National Council for Scientific and
Technological Development (CNPq). P466
ZOLEDRONIC ACID IN OSTEOPOROSIS
SECONDARY TO MASTOCYTOSIS
P465 L. Idolazzi1, R. Zanotti2, A. Artuso2, G. Tripi1, O. Perbellini2,
BONE MINERAL ACCRUAL AND FRACTURE O. Viapiana1, D. Gatti1, M. Bonifacio2, M. Rossini1, S.
OUTCOMES IN CHILDREN WITH OSTEOGENESIS Adami1
1
IMPERFECTA TREATED BY PAMIDRONATE: Department of Medicine, Rheumatology Unit, University of
SINGLE CENTER EXPERIENCE Verona, Verona, Italy, 2Department of Medicine, Hematology
M. Kostik1, I. Chikova1, N. Buchinskaya1, O. Kalashnikova1, Unit, University of Verona, Verona, Italy
L. Scheplyagina2, V. Larionova3
1
St. Petersburg State Pediatric Medical University, Saint- Objective: Osteoporosis is the prevalent manifestation of
Petersburg, Russian Federation, 2Moscow Scientific and Re- bone involvement in patients with systemic mastocytosis.
search Clinical Institute M.F. Vladimirskiy, Moscow, Russian Mastocytosis-related osteoporosis is characterized by both
Federation, 3Turner’s Scientific and Research Institute for absolute and relative prevalence of osteoclastic activity, con-
Children’s Orthopedics, St. Petersburg, Russian Federation sistent with the positive results reported in small series of
patients with antiresorptive drugs, such as bisphosphonates.
Objective: To evaluate the bone mineral accrual and fracture Aim of this study is to investigate the efficacy of zoledronic
outcomes in children with osteogenesis imperfecta treated by acid (ZOL) in patients with mastocytosis-related osteoporosis.
pamidronate (PAM). Material and Methods: Twenty five patients with osteopo-
Material and Methods: In our retrospective study 21 chil- rosis secondary to indolent systemic mastocytosis (ISM) were
dren with different types of OI were included: 7 boys (33.3 %) given a single intravenous (iv) infusion of 5 mg ZOL dis-
and 14 girls (66.7 %). According to clinical OI classification solved in 100 mL of 0.9 % saline over 60 min.
 Osteoporos Int

Results: After 1 year the mean increase in BMD was 6.0± Results: Using MMR, we found a high covariation between
4.4 % at the spine and 2.7±3.2 % at the total hip. Serum levels tibial shape and microstructure (R2 =0.55). The outcomes of
of bone turnover markers (BTMs) decreased vs. baseline: the PLS additionally show that a decrease in bone volume
bone alkaline phosphatase −34 % and −35 %, and C- fraction, as seen in old individuals, correlates with a flattening
terminal telopeptide −68 % and −56 % at 6 and 12 months, and broadening of the proximal tibia. These findings may
respectively. None of the patients reported new fractures dur- reflect age- related structural adaptations in the knee due to
ing the year of follow-up. In all the first 20 treated patients a cartilage damage in aged individuals showing OA.
transitory acute phase response was observed but this was Conclusion: Using this new approach it is possible to estimate
prevented in 4 out of 5 subsequent patients in whom acet- structural parameters in the tibia according to its geometry.
aminophen was systematically given during the 3 days This method may assist in the clinical diagnosis of tibial bone
postinfusion. degradation and delivers anatomical information that may be
Conclusion: A single 5 mg ZOL iv infusion in patients with of great value in the design of custom knee implant
osteoporosis secondary to ISM is associated with significant components.
increases in spine and hip BMD and decreases of BTMs over Acknowledgements: Supported by the project HMV-3D fi-
a least 1 year. Yearly ZOL might represent a therapeutic option nanced by “Regio13-Regionale Wettbewerbsfähigkeit” of the
for ISM associated osteoporosis. European Commission and the Government of Upper Austria.

P467 P468
ESTIMATION OF MICROSTRUCTURAL THE MINERAL DENSITY OF THE BONE
PARAMETERS IN THE PROXIMALTIBIA BY DEPENDING ON ANKYLOSING SPONDYLITIS
MEANS OF SHAPE REGRESSION: COMBINING FORM IN MEN
HIGH RESOLUTION X-RAY COMPUTED T. A. Raskina1, O. A. Pirogova1, O. S. Malyshenko1, V. B.
TOMOGRAPHYAND GEOMETRIC Fanaskov2
1
MORPHOMETRICS Kemerovo State Medical Academy, Kemerovo, Russian Fed-
S. Senck1, M. Coquerelle2, G. W. Weber3, S. G. Hofstaetter4, eration, 2Clical Hospital, Kemerovo, Russian Federation
J. Kastner1
1
University of Applied Sciences Upper Austria, Wels, Austria, Objective: To estimate BMD in men with ankylosing spon-
2
Department of Stomatology, University Rey Juan Carlos, dylitis (AS) depending on a disease form.
Madrid, Spain, 3Department of Anthropology, University of Material and Methods: Under supervision there were 70 male
Vienna, Vienna, Austria, 4 Orthopädische Abteilung, patients with the diagnosis the AS (according to the modified
Klinikum Wels-Grieskirchen, Wels, Austria New York criteria of 1984). The average age 43.2±9.1 years.
Among 70 surveyed sick 62.8 % had only axial defeat. In
Objective: In order to contribute to the pre-surgical diagnosis 60.0 % of cases at a X-ray analysis of a backbone came to light
of bone degradation, we investigate patterns of variation and sindesmofit, from them in lumbar department at 52.3 % of
covariation between the shape and microstructure of the prox- patients, in the chest - 45.2 % and in cervical - 35.7 %.
imal tibia. The general objective of this pilot study is the Sindesmofita in two departments of a backbone came to light
prediction of bone microstructure in aged and osteoarthritis at 35.7 %, and in all departments - at 15 % of patients, up to
(OA) individuals based on the estimation of microstructural symptom formation “a bamboo stick”. Damage of peripheral
parameters via the external shape of the tibia. joints had 26 (37.1 %) patients. More often joints of the bottom
Material and Methods: Our sample comprises 32 dried extremities - 35.7 % of cases, in 25.7 % - joints of the top
human tibiae (age range: from 20 to 80 years), including nine extremities were surprised. 65 % of patients had clinical signs of
cases of moderate osteoarthritis. The microstructural parame- damage of coxofemoral joints (pain and/or function restriction),
ters were obtained from high resolution X-ray computed and 45.7 % from them had bilateral localization. BMD was
tomography (CT) images (isometric voxel size of 50 μm) measured by the two-power x-ray densitometry method (densi-
and include relative bone volume, mean trabecular thickness, tometer Exceell XR-46, Norland, USA). BMD and Z - criteria
number, and spacing. The shape of the tibiae is captured by was estimated at the femoral neck and lumbar spine.
dense CT-derived meshes that were processed by geometric Results: At patients with peripheral arthritis decrease in BMD
morphometric methods. Patterns of variation and covariation came to light authentically more often than at patients with
between proximal tibial shape and microstructural parameters mainly axial defeat (p<0.05).
were estimated via multiple multivariate regression (MMR) Conclusion: Damage of peripheral joints associates with de-
and two-block partial least squares (PLS) analyses. crease in BMD at patients with the AS.
Osteoporos Int

P469 P470
THE DYNAMICS OF CHANGES IN BONE MINERAL MORTALITY RATE AND RISK FACTOR OF
DENSITY IN PATIENTS WITH RHEUMATOID PATIENTS WITH FRAGILE HIP FRACTURE
ARTHRITIS T. Sangkomkamhang1, U. Swadpanich Sangkomkamhang2
O. Alekseeva1, I. Dydykina1, A. Smirnov1, M. Podvorotova1, 1
Department of Orthopedic, Khon Kaen Regional Hos-
E. Petrova1, P. Dydykina1, E. Taskina1, L. Alekseeva1, E. pital and Academic Center, Khon Kaen, Thailand, 2De-
Nasonov1 partment of Obstetrics and Gynecology, Khon Kaen
1
Federal State Budgetary Institution, Research Institute of Regional Hospital and Academic Center, Khon Kaen,
Rheumatology V.A.Nasonova, Russian Academy of Medical Thailand
Sciences, Moscow, Russian Federation
Objective: To evaluate the effects of history, fracture
Objective: To get data about dynamics in BMD in type, method of treatment and complications on the
patients with long-term duration of rheumatoid arthritis mortality risk in elderly patients with fragile hip
(RA). fracture.
Material and Methods: Retrospective study of the Material and Methods: The 418 patients (306 women
BMD dynamics included 129 women with RA, age and 112 men) who older than 60 years who underwent
18–75 years. In all patients it was performed DXA with surgery for fracture around hip at the Khon Kaen
Hologic Discovery A with the BMD assessment at the Hospital between January 2010 and October 2012.
lumbar spine (L1-L4) and femoral neck (FN); conducted The follow-up ranged from 12 to 36 months. The
clinical and laboratory examination, including data following was recorded: age, gender, underlying dis-
about treatment of RA and osteoporosis (OP). Patients eases, pre-injury status, fracture type (AO classifica-
were divided into 3 groups: group1 (n=67) - dynamics tion), time between injury and surgery, anesthesia tech-
of BMD in 3 years, group2 (n=34) - 4 years, group3 nique, surgical technique and instruments, complica-
(n=28) - 5 years. tions and death. Statistical significance at the 95%CI
Results: Average age of the patients of the group1 was was using for analyzed variables by multivariate
43.1(19–75) years, the group2 - 42.0(21–67) years, the analysis.
group3 - 41.3(18–67) years, duration of RA: 10.8(2–40) Results: The average age was 76 years. Overall 1-
years, 13.7(5–31) years and 14.1(5–34) years, respec- year postoperative mortality was 28 % and mortality
tively. Steroid therapy has been taken by 15(22 %), after hip fracture at the end of the follow-up was
11(32 %) and 12(43 %) patients, respectively; 43 %. The increase in age, the shorter of survival
20(30 %), 16(47 %) and 14(50 %) patients, respectively, time as each additional year reduced survival by
took the disease-modifying antirheumatic drugs 7.12 %. The male gender, two and more underlying
(DMARDs); biological drugs - 40(60 %), 18(53 %) diseases in the patient’s medical history, the com-
and 10(36 %) patients, respectively; drugs for the pre- plications, failed instrumentation; revision surgery
vention and treatment of OP - 25(37 %), 17(50 %) and and the time between injury and surgery was a risk
10(36 %) patients, respectively. BMD at L1-L4 in the factor for shorter survival. The patient who can
group1 was 0.9571±0.237 g/cm2, then became 0.971± move without walking support before injury, the
0.198 g/cm2; in group2 - 0.882±0.185 g/cm2 vs. 0.930± survival was significantly longer than in a patient
0.202 g/cm2; in group3 - 0.827±0.230 g/cm2 vs. 1.114± using a walking or in a bedridden patient. The
0.287 g/cm2. BMD at FN in group1 was 0.747±0.145 g/cm2, fracture type, type of anesthesia, surgical technique,
then became 0.817±0.138 g/cm2, in group2 - 0.703±0.120 g/ type of implant were not significant for the length
cm2 vs. 0.803±0.138 g/cm2; in group3 - 0.753±0.120 g/cm2 of survival.
vs. 0.915±0.136 g/cm2. Differences were not significant. Conclusion: In the patients who aged over 60 years,
Number of patients with OP at L1-L4 in the group1 a significantly shorter time was related with many
was 5(8 %), became 19(29 %); 2nd group - 5(16 %) vs. factors, for example increase age, male gender, mul-
4(13 %) and in 3rd - 3(18 %) vs. 3(18 %). Number of tiple morbidity, less mobility status before injury,
patients with OP at FN in group1 was 19(29 %), became development of postoperative complication (pressure
15(23 %); group2 - 5(16 %) vs. 9(28 %) and in 3rd- 3(20 %) sores), failed instrumentation with revision surgery
vs. 5(33 %). and time between injury and surgery. No relation to
Conclusion: BMD in RA patients with long-term monitoring significantly survival was found for the following
remained stable on the background of anti-inflammatory and factors: type of fracture, type of anesthesia and oper-
antiosteoporotic therapy. ative technique.
 Osteoporos Int

P471 P472
DIFFERENTIAL EXPRESSION OF BMD, TBS AND FRACTURE ASSESSMENT IN
INFLAMMATION- AND REGENERATION- WOMEN UNDER CHRONIC GLUCOCORTICOID
ASSOCIATED MARKERS OF TREATMENT
MACROPHAGE-POLARIZATION (M1 VS. M2) IN T. Petranova1, I. Sheytanov1, S. Monov1, R. Nestorova2, D.
BISPHOSPHONATE RELATED OSTEONECROSIS Kalinova1, R. Rashkov1
1
OF THE JAW (BRONJ) AND Clinic of Rheumatology, Medical University, Sofia, Bulgaria,
2
OSTEORADIONECROSIS (ORN) Center of Rheumatology St. Irina, Sofia, Bulgaria
F. W. Wehrhan1, M. W. Weber1, P. M. Moebius1, R. P. Preidl1,
P. S. Stockmann1, F. W. N. Neukam1, K. Amann1 Objective: To assess BMD and bone microarchitecture
1
Department of Oral and Maxillofacial Surgery, University of changes, evaluated by trabecular bone score (TBS), such as
Erlangen-Nuremberg, Erlangen, Germany their relations to the osteoporotic fractures in women under
chronic glucocorticoid (GC) treatment.
Objective: Suppression of the local osseous remodeling Material and Methods: The study group consisted of 109
and inflammation of jaw bone are involved in the path- patients (pts) - 37 premenopausal and 72 postmenopausal
ogenesis of BRONJ. ORN has been described to be women, who received ≥5 mg/day of GCs for at least 1 year.
related to chronic inflammation and fibrotic bone re- Lumbar and hip BMD was measured by DXA (Prodigy, GE)
modeling. Inflammatory processes are mediated by and TBS values were assessed using TBS iNsight software
M1-polarized macrophages (CD68-, iNOS-expression), (Med-Imaps, France). X-ray of thoracic and lumbar spine
whereas M2 macrophages (CD163-expression) are criti- were made to identify vertebral fractures. For the 72 subjects
cal for tissue regeneration. Aminobisphosphonates were in the group of the postmenopausal women, TBS L1-L4
shown to shift macrophage polarization towards the M1- values of a corresponding reference group were obtained by
type. It is unknown, if BRONJ and ORN differ regard- BMD L1-L4 /normal, osteopenia, osteoporosis/ and age-
ing the polarization of involved osteoclasts and macro- matching. Statistical analysis was performed by
phages. The aim of this study was to compare the M1- Kolmogorov- Smirnov Test, Paired samples Test or Wilcoxon
and M2-polarization of osteoclasts and macrophages in Signed Ranks Test using the SPSS 13.0 for Windows.
BRONJ and ORN by immunohistochemistry analysis Results: GCs-treated postmenopausal women showed signif-
compared to healthy jaw bone (NB). icant decrease of TBS (p<0.0001) compared with the values
Material and Methods: 15 specimens of BRONJ-associated of the reference group. This data were confirmed for the entire
bone, 15 of ORN-bone and 15 of healthy jaw bone were population as well for the subgroups of the osteoporotic and
processed for immunohistochemistry (Peroxidase/DAB+, osteopenic women. Vertebral fractures were found in 11 pts
DAKO Autostainer). A staining of polarization markers (31 %) with osteopenia and 5 pts (31 %) with normal BMD,
(M1: CD 68; iNOS; M2: CD163) was performed. The spec- but low TBS. In the group of the premenopausal women bone
imens were completely digitalized in 400× magnification microarchitecture deterioration (low TBS) was found in 17 pts
using “Whole-Slide-Imaging” and in each case the three fields (46 %), while only 9 pts (24 %) exhibited low BMD. Vertebral
of view with the highest expression level within the bone fractures were detected in 7 pts with normal BMD, but with
tissue were selected for cell counting (cells/mm2, ANOVA- low TBS.
Test). Conclusion: Chronic GC treatment leads to significant deg-
Results: A significantly (p<0.05) increased CD68-expression radation of bone microarchitecture and higher susceptibility to
was seen in ORN compared to BRONJ and NB. Additionally fractures, independent of the changes in BMD. TBS is a good
a significantly (p<0.05) increased expression of CD163- noninvasive technique for assessment of bone quality in GC
positive cells was seen in ORN compared to BRONJ. The treated patients, giving additional information about vertebral
iNOS-expression in BRONJ-specimens was significantly fracture risk. It could be used for decision taking about starting
(p<0.05) higher than in ORN samples. with bone protection or treatment.
Conclusion: The results indicate a differential polariza-
tion of osteoclasts and macrophages in BRONJ- and
ORN-affected bone. Compared to ORN, BRONJ sam- P473
ples show an increased M1- and a reduced M2- IMPACTS OF OBESITY ON PAIN THRESHOLD,
polarization. These findings are a possible explanation DEPRESSION AND QUALITY OF LIFE
for the clinically and histopathologically observed fi- S. Turan Turgut1, R. S. Atlig2, S. Senturk3, A. Oguz4
1
brotic tissue remodelling processes in ORN compared Karaman State Hospital, Department of Physical Medicine
to the dramatically impaired tissue proliferation and and Rehabilitation, Karaman, Turkey, 2Avicenna Umut Hos-
regeneration in BRONJ affected bone. pital, Department of Physical Medicine and Rehabilitation,
Osteoporos Int

Istanbul, Turkey, 3Medeniyet University Goztepe Training Objective: Osteoanabolic treatment is highly effective for
and Research Hospital, Department of Radiology, Istanbul, severe PMO, GIOP and OP in man, but after discontinuation
Turkey, 4Medeniyet University Goztepe Training and Re- is there a decline of BMD leading to an increased risk of
search Hospital, Department of Internal Medicine, Istanbul, fracture. Therefore is an urgent need to continue with other
Turkey treatment. Meaningful and recommended are antiresorptive
drugs. We present a register of patients treated with zoledronic
Objective: To assess the effects of obesity on pain threshold, acid after PTH treatment. The outcome was to define the
depression and quality of life. BMD and BTM changes.
Material and Methods: The study was designed as a cross- Material and Methods: In 2013 started a register of pts treated
sectional observational study and carried out on 80 adult obese with ZOL after PTH. First infusion was applied 60 days after
and nonobese people aged between 18 and 40 years who were termination of PTH treatment. All patients were supplemented
admitted to the obesity and metabolic syndrome outpatient with calcium (avg. 723 mg) and vitamin D (avg. 736 IU). In all
clinics. The subcutaneous adipose tissue thickness was mea- patients were recorded changes in BTM (osteocalcin, CTx,
sured for rectus femoris, triceps muscle, and umbilicus by P1NP), calcium, vitamin D and creatinine after 3 M and then
using ultrasonography. The pressure pain thresholds in 3 in yearly period. Measurement of BMD (lumbar spine, femoral
muscles including the deltoid, tibialis anterior, and first neck and total hip) is planned in yearly intervals.
interosseus dorsalis muscle of the hand were measured by Results: At this time we present baseline characteristic and
using a digital pressure algometer. The subjects were evaluat- effect of treatment by ZOL on BTM after 3 M with focus on
ed by VAS when a pressure was applied on the first distal patients with GIOP. Totally 68 pts were enrolled (17 males)
phalanx (FDP) at a rate of 25 Newton. Depression level of the with average age 69 year. Average length of PTH treatment
subjects were evaluated by the Beck Depression Inventory was 556 days. From the whole group of patients 39 were with
(BDI). Quality of life was evaluated by Short Form 36. PMO, 14 with OP in man and 15 with GIOP. Patients with
Results: The mean pain threshold values showed no statisti- GIOP were younger than whole population (average 63 year).
cally significant difference between groups (p>0.05). The Average Prednisolone-equivalent dose usage was 9 mg/day,
mean values of adipose thickness were significantly higher what corresponds to 3.28 g/year. Length of corticoid treatment
in the obese group (p<0.01). No statistically significant dif- was 113 days. For all GIOP patients baseline densitometry
ference was determined between the groups in terms of DP was performed: BMD (g/cm2) at LS 0.841; Total Hip 0.731
VAS scores (p>0.05). The obese group had significantly and Femoral neck 0.597, what was lower than for whole
higher BDI scores than the control group (p<0.01). All pa- population. 3 M after ZOL infusion BTM were reduced
rameters of SF-36 were significantly lower in obese individ- (47 % for OC, 30 % for CTx and 52 % for P1NP). Only 1
uals (p<0.01). new fracture was recorded during course of PTH treatment
Conclusion: Our findings suggest no significant correlation and no during 3 M of ZOL follow-up.
between obesity and pain threshold. But we found strong Conclusion: According of mode of action and dosage regi-
relationship between obesity and both for depression and ment zoledronic acid represent a suitable treatment for patients
quality of life. after osteoanabolic treatment. Longer follow up of patients in
References: 1. Dodet P et al. Clin J Pain 2013;29:43 this registry is necessary for more conclusions.
2. Maffiuletti NA et al. Muscle Nerve 2011;44:202

P475
SERUM 25-HYDROXYVITAMIN D LEVELS OF
P474 HEALTHYADULTS IN GREECE
SLOVAK REGISTER OF PATIENTS TREATED BY E. Grigoriou1, G. Trovas2, D Dontas2, N. A. Papaioannou2,
ZOLEDRONIC ACID AFTER OSTEOANABOLIC M. Stathopoulou3, G. Dedoussis1
1
TREATMENT Department of Dietetics-Nutrition, Harokopio University,
P. Vanuga1, S. Tomkova2, P. Masaryk3, A. Letkovska3, Z. Athens, Greece, 2Laboratory for Research of the Musculo-
Kmecova4, Z. Killinger5, P. Jackuliak5, J. Payer5 skeletal System, School of Medicine, University of Athens,
1
National Institute of Endocrinology and Diabetology, Athens, Greece, 3UMR U 1122, INSERM, Nancy, France
Lubochna, Slovakia, 2Osteocentrum, Kosice-Saca, Slovakia,
3
National Institute of Rheumatic Diseases, Piestany, Slovakia, Objective: To identify the prevalence of vitamin D deficiency
4
Osteocentrum of Faculty Hospital F.D. Roosevelt, Banska in healthy adults in Greece, as reflected by the levels of 25-
Bystrica, Slovakia, 55th Department of Internal Medicine, hydroxyvitamin D (25(OH)D), since recent data indicate that
Comenius University Faculty of Medicine and University vitamin D deficiency can be common in countries previously
Hospital, Bratislava, Slovakia considered as low risk (e.g., Mediterranean countries).
 Osteoporos Int

Material and Methods: A population of 974 community 94 years with nonvertebral fractures and 232 controls in
dwelling adults (134 males, 840 females) was recruited at Tromsø, Norway. Odds ratio (OR) for fracture was calculated
the health promotion events carried out by the Hellenic Soci- using logistic regression analysis.
ety for the Support of Patients with Osteoporosis in rural and Results: Women with fracture had lower serum levels of
urban areas throughout Greece. Serum total calcium (Ca), Vitamin D (76.4 vs. 82.9 nmol/L), and higher PTH (4.58 vs.
phosphorus (P), creatinine, PTH and 25(OH)D were mea- 4.13 pmol/L), and total calcium (2.43 vs. 2.35 mmol/L) than
sured. The study was approved by the Ethics Committee of controls, all p<0.05. In addition, cases had higher porosity
Harokopio University. within each of the cortical compartments; compact appearing
Results: The mean age of the population was 49.58 years, cortex (32.7 vs. 31.5 %), outer transitional zone (45.5 vs.
(range, 18–86 years) while 87.2 % were 18–65 years old. 44.5 %), and inner transitional zone (79.4 vs. 78.6 %), reduced
Mean serum 25(OH)D was 20.38 ng/mL, mean PTH was cortical thickness (4.06 vs. 4.36 mm) and lower trabecular
41.24 pg/mL and mean Ca, P and creatinine were 9.97, 3.57 vBMD (117.9 vs. 126.6 mg HA/cm3), all p<0.01. Each stan-
and 0.79 mg/dL, respectively. Concerning the vitamin D dard deviation decrease in vitamin D and increase in PTH and
levels, 53.6 % of the subjects had deficient (0–19.9 ng/mL), calcium were associated with increased risk of fracture (OR
34.4 % had insufficient (20–29.9 ng/mL) and only 12.0 % had 1.38 95%CI (1.10–1.72), 1.31 (1.03–1.65) and 1.77 (1.38–
adequate (30–150 ng/mL) levels, while 8.0 % had vitamin D 2.27), respectively, all p<0.05) after adjustment for age,
levels ≤10 ng/mL. PTH was at normal range (15–65 pg/mL) height, weight, FN aBMD, femoral subtrochanteric cortical
for 89.7 % of the population and 8.2 % had high PTH (>65 pg/ porosity, cortical thickness and trabecular vBMD.
mL). The levels of serum Ca, P, and creatinine, were within Conclusion: Calciotropic hormones are associated with in-
the normal range. creased risk of fracture, independent of the cortical
Conclusion: The majority of Greek adults (88 %) in this study microarchitecture and trabecular density.
had vitamin D levels below 30 ng/mL. Given that low levels Disclosures: R Zebaze is inventor of the StrAx1.0 software.
of 25(OH)D are associated with increased risk for fractures
and exacerbate bone loss, this study highlights the emerging
issue of 25(OH)D insufficiency in Greek population and the P477
need for targeted interventions even in age groups not previ- FRACTURES IN PATIENTS WITH ENDOGENOUS
ously considered as at risk. CUSHING’S SYNDROME AND THEIR INFLUENCE
Acknowledgements: The study was supported by the Hellen- ON QUALITY OF LIFE AND FUNCTIONAL
ic Society for the Study of Bone Metabolism. PERFORMANCE
N. V. Dragunova1, Z. E. Belaya1, A. G. Solodovnikov2, L. Y.
Rozhinskaya1, G. A. Melnichenko1
1
P476 National Research Center for Endocrinology, Moscow, Rus-
SERUM VITAMIN D, PARATHYROID HORMONE sian Federation, 2Ural State Medical Academy, Ekaterinburg,
AND CALCIUM ARE ASSOCIATED WITH Russian Federation
NONVERTEBRAL FRACTURE INDEPENDENT OF
PROXIMAL FEMUR MICROARCHITECTURE Objective: Endogenous Cushing’s syndrome (CS) character-
Å. Bjørnerem1, R. Zebaze2, R. Shigdel1, R. Joakimsen1, E. F. izes by numerous severe complications one of which is low
Eriksen3, L. A. Ahmed1 traumatic fractures. This study evaluates the difference in
1
UiT - Arctic University of Norway, Tromsø, Norway, 2Uni- quality of life and functional performance of patients with
versity of Melbourne, Melbourne, Australia, 3Oslo University active Cushing’s syndrome who sustained low traumatic frac-
Hospital, Oslo, Norway tures as compared to those who did not.
Material and Methods: 139 consecutive patients with active
Objective: Vitamin D deficiency and hyperparathyroidism is CS fulfilled EQ-5D and ECOS-16 questionnaires. They per-
associated with bone loss. However, it is less clear whether the formed “up-and-go”, “tandem” and “chair- rising” tests. All
serum levels of vitamin D and PTH are associated with risk of patients underwent lateral thoracic and lumbar X-Ray to re-
fracture. We therefore hypothesized that lower vitamin D veal vertebral fractures and were interviewed on the recent
levels and higher PTH and calcium levels are associated with low-traumatic fractures. The level of free urinary cortisol (24 h
nonvertebral fracture. UFC) was measured on a Vitros ECi, reference range 59.2–
Material and Methods: We measured serum 25(OH) vitamin 413 nmol/24 h.
D, PTH and total calcium, femoral neck (FN) areal BMD Results: Among 139 patients (35 (26–47) y.o.; 115 females;
(aBMD), and femoral subtrochanteric microarchitecture as 24 males; 24hUFC-1470 (856–2937) nmol/24 h) fractures
cortical porosity and thickness, and trabecular volumetric were diagnosed in 61 cases (43.9 %): in 55 cases vertebral
BMD (vBMD) in 211 postmenopausal women aged 54– (43 - multiple) and in 17 cases cured nonvertebal fractures.
Osteoporos Int

Patients with CS who sustained fractures reported more lim- Conclusion: Patients with recurrent depressive disorder
itation in their usual activity (1.48 (0.57) vs. 1.25 (0.48) p= have reduced bone cell metabolism in which the most
0.02) and suffered from more severe pain and discomfort pronounced decrease 25OHD3. BMD was less reduced
(1.42(0.53) vs. 1.23 (0.42) p=0.03) than patients with active in patients who were treated with the SSRI with respect
CS without fractures. All others dimensions of EQ-5D were to the treated SNRB.
not different. The results of VAS showed that patients with References: 1. Cvjetkovic-Bosnjak M et al. HealthMED
fractures estimated their health status of being worse as com- 2013;7:139
pared with patients without fractures: 46.7 (17.8) vs. 55.4 2. Boskovic K et al. Balneoclimatologia 2013;39:281
(19.9) p=0.01. The total score of ECOS-16 was higher in
patients with CS suffering from low-traumatic fractures 2.83
(0.79) vs. 2.30 (0.70) p<0.001. Patients with fractures per- P479
formed worse in a “tandem” test 24 (7–30) vs. without frac- PREDICTIVE MATHEMATICAL MODEL FOR THE
tures 30 (15–30) s, but did not differ in up-and-go 11 (8–13) ASSESSMENT OF COMORBIDITIES IN PATIENTS
vs. 9(7–11) p=0.41 or chair-rising 14 (8–18) vs.12(9–14) s p= WITH DIFFUSE IDIOPATHIC SKELETAL
0.28 tests. HYPEROSTOSIS: MULTIFACTOR REGRESSION
Conclusion: Patients with CS complicated with a history of ANALYSIS
fractures have more limited usual activities and balance per- M. Geneva-Popova1, A. Batalov1, V. Popova1, S. Tersyiska1,
formance, suffer from more pain than patients with CS and R. K. Karalilova1, P. Selimov2, S. Popova2, I. Jkov2
1
other complications. Medical University Plovdiv, UMHAT, Plovdiv, Bulgaria,
2
Medical University Plovdiv, Plovdiv, Bulgaria

Objective: The importance of cardiovascular changes,

P478 osteoporosis and metabolic diseases in the
IF TREATMENT OF DEPRESSION WITH etiopathogenesis of diffuse idiopathic skeletal hyperos-
SELECTIVE SEROTONIN REUPTAKE INHIBITORS tosis (DISH) is undeniable. The aim of the report is to
INCREASED RISK FOR OSTEOPOROSIS analyze the importance of the most common diseases of
K. Boskovic1, S. Tomasevic-Todorovic1, T. Jankovic2, R. the cardiovascular system and metabolic diseases system
Doder1 as a risk factor as an element for multifactor analyze for
1
Medical Faculty, Novi Sad, Serbia, 2Special Hospital for the development of DISH.
Rheumatic Diseases, Novi Sad, Serbia Material and Methods: 124 patients were analyzed with
DISH, hospitalized in the Clinic of Rheumatology
Objective: Selective serotonin reuptake inhibitors (SSRIs) are UMHAT Sv. Georgi, Plovdiv or visited rheumatologic
most prescribed of all antidepressants in Europe, but this fact practice of Medical centre Sv.Vrach, Plovdiv because
in future can be relativised as results of some studies suggest- of complications of the diseases of the cardiovascular
ing that SSRIs may lower BMD. system and metabolic disease and the receiving treat-
Material and Methods: BMD by DXA and biochemical ment for them. Control group analyzed 270 individ-
markers of bone metabolism were measured in 44 wom- uals with proven spondylosis. Methods used are inter-
en with recurrent depressive disorder, age 44,5 years, views, instrumental and paraclinical results for the
the SSRI group treated with SSRI (n = 23) and the collection of information. Risk assessment is made
SNRB group treated with selective reuptake noradrena- by a multifactor regression analysis computer program
lin blockers (n=21). Average daily doses of antidepres- SPSS 19.
sants were compared to maprotiline 88.5 mg/die and Results: Regression analysis demonstrated the importance of
sertraline 75 mg/die. the most important diseases that participate in this model - the
Results: Of the total sample of 25 % of the patients with most important in hypertension (RR 62.62, 95%CI 10.542;
central DXA method lower BMD. In the SSRI group of 372.02), ischemic heart disease (RR 62.62, 95%CI 10.542;
patients treated with sertraline, in 6 patients with diagnosed 372.02), TIA (RR 45.606, 95%CI 58.44; 355.81), proven
osteopenia, the level of 25-hydroxycholecalciferol (25OHD3) osteoporosis (RR 14.618, 95%CI3.312; 64.561).
was on average 23±3.4 nmol, osteocalcin 18.2±0.4, β- Conclusion: Multifactor regression analysis demonstrated the
crosslaps 371±16.2, ionized calcium 0.96±0.2. In the SNRB importance of the most important diseases for the develop-
group of patients treated with maprotiline, in 5 patients were ment of DISH.
diagnosed osteoporosis, the average levels of 25OHD3 were References: Zincarelli C et al. Arthritis Care Res
both 25±2.2 nmol/l; osteocalcin 19.8±0.9, β-crosslaps 310± 2012;64:1765. Wesrerveld L et al. Rheumatology
20.6; ionized calcium 1.01±0.4. 2009;48:1133.
 Osteoporos Int

P480 Hospital of Bucharest over a period of 7 years (2006–2012).

CORRELATION OF RADIAL BONE FRACTURE AND 21 patients were diagnosed with septic knee arthroplasty (a
OSTEOPOROSIS IN POSTMENOPAUSAL PATIENTS frequency of 2.1 %), and of these 13 were treated with hand-
T. Vrga1, R. Čizmić2, R. Čop3, T. Šimunić1, T. Cikač4 made antibiotic-impregnated articulating cement spacers, 2
1
Department of Physical Medicine and Rehabilitation, Gener- patients with arthrodesis and 6 cases of debridement and
al Hospital Dr. Ivo Pedišić, Sisak, Croatia, 2Clinics of Rheu- implant preservation. The surgical procedure consisted of
matoid Diseases, Physical Medicine and Rehabilitation Dr. debridement, removal of all components of prosthesis and
Drago Čop, Zagreb, Croatia, 3Healthcare institution Zagreb cement, followed by custom-made mobile cement spacers
Center, Physical Medicine and Rehabilitation, Zagreb, Croa- loaded with antibiotic according to the antibiogram.
tia, 4Department of General Practice, Varaždin, Croatia Results: All patients were followed from the time of interven-
tion with removal of prosthesis until the time of revision
Objective: The goal of investigation is, in a routine practice of prosthesis implant. Rate of success was 84.6 % (11 cases), 2
physiatric clinics, establish the link between radial bone frac- patients still with increased inflammatory tests. The average
ture in typical site and osteoporosis in postmenopausal pa- post- revision follow-up was 2.3 years (between 1 and 3 years).
tients, and to stress the need for diagnostics of osteopenia/ Of the 13 patients, 8 were women and 5 men, aged 62–
osteoporosis as early as possible. 76 years old, mean 68.6. the Interval elapsed since primary
Material and Methods: In time interval from beginning of arthroplasty to the manifestation of a septic phenomenon was
January to the end of June 2013, we observed the targeted on average 1.2 years (between 14 days and 3 years). The
group of 115 examinees aged 55–80 years with radial bone diagnosis of infection was made on the following criteria:
fracture in typical site. 42 of these examinees had proven inflammatory markers, culture from the puncture fluid. The
osteopenia, at 73 examinees analysis of bone density was quantity of cement required for the intraoperative hand-made
not performed earlier. of spacers was 3 envelopes in 11 cases, and only 2 in 2 other
Results: In 73 patients radiologic densitometry was per- cases. The antibiotic used for loading cement was gentamicin
formed, with that osteoporosis was verified in 41 examinees 2.5 % (9 cases) and vancomycin (3 cases), which are used
(56.2 %), osteopenia in 20 patients (27.2 %), while in only 12 according to the antibiogram. The amount of vancomycin was
examinees (16.4 %) decrease of bone density was not within 2–4 g per 40 g of cement powder.
established. In patients with verified osteoporosis and Conclusion: Intraoperative handmade spacers with antibiotic
osteopenia, with fracture in predilected site, adequate medica- load represent a reliable approach in the management of septic
mentous therapy was introduced on an individual basis. knee arthroplasty treatment and their cost is low compared
Targeted medical rehabilitation was performed, with stress on with prefabricated spacers. The custom-made of spacers
medical gymnastics, and education for prevention of falling. doesn’t require a laborious technique and can be made on a
Conclusion: Achieved results point to the necessity for properly adapted size opposed to prefabricated spacers. The
performing mineral density of bones analysis at all postmeno- antibiotic used to load the spacer observes the result of the
pausal women, and if need be, as soon as possible, start the antibiogram.
adequate treatment in goal of prevention and diminishing the
number of further fractures, that is, improvement of life quality.
P482
BONE MINERAL DENSITY IN PATIENTS WITH
P481 PRIMARY HYPERPARATHYROIDISM AFTER
MANAGEMENT OF PERIPROSTHETIC KNEE PARATHYROIDEСTOMY
INFECTIONS WITH HANDMADE A. P. Shepelkevich1, E. V. Brutskaya-Stempkovskaya1, E. V.
ANTIBIOTIC-IMPREGNATED ARTICULATING Kliausova1, N. A. Vasilieva2
1
CEMENT SPACER Belarusian State Medical University, Minsk, Belarus, 2Re-
A. Cursaru1, R. Ene1, C. Cirstoiu1 public Center of Medical Rehabilitation, Minsk, Belarus
1
University Emergency Hospital of Bucharest, Bucharest,
Romania Objective: To study BMD in patients with PHPT after 1 year
of surgery.
Objective: To follow the efficacy of custom-made cement Material and Methods: We studied 63 patients with PGPT
antibiotic-loaded mobile cement spacers in the treatment of (100 % of men were in the age group up to 50 years, 14
periprosthetic knee infections. women were of childbearing age and 47 postmenopausal
Material and Methods: A retrospective study included pa- women) general medical examination has been made, indica-
tients who were hospitalized and diagnosed with tors of calcium-phosphorus metabolism (PTH, Ca, Ca2+, P)
periprosthetic knee infection in Emergency University bone markers (alkaline phosphatase, osteocalcin, β-CTX),
Osteoporos Int

sonography of the thyroid and PTG, scintigraphy PTG, BMD correlated with total body, fat and lean mass (p<0.05). After
was also examined. BMD was measured by DXA. Patients 4 month of supplementation, total 25(OH)D and Bio-25D
with comorbidities and conditions associated with low BMD increased (p<0.001) by 14.2 [1.3] and 1.7 [0.2] ng/mL, re-
were excluded from the study. spectively. No age-group effect on the total or Bio-25D in-
Results: In the group of postmenopausal women low BMD crease was observed. Changes in total and Bio-25D at 4 month
was detected in of 83 %. In the lumbar spine low bone mass were unrelated to fat, lean or total body mass. At baseline and
was 74.4 % (1 year after parathyroidectomy positive trend was 4 month, total 25(OH)D but not Bio-25D was negatively
observed in 44.8 %, 2 % - no changes, 2 % noted progression correlated with PTH (p<0.05).
of osteoporosis). In 59.5 % of patient low bone mass localized Conclusion: Age and body composition were unrelated
at the femoral neck with the positive dynamics after parathy- to the total 25(OH)D or Bio-25D increase. Unexpected-
roidectomy in 100 %. In fertile women low bone mass was ly, serum PTH was negatively associated with total, but
registered in 14 % of cases, increase of bone density was noted not bioavailable 25(OH)D. Further evaluation of the
in 100 % after surgery. In men younger than 50 years low bone importance of Bio-25D on health status and the mech-
mass was registered in 100 %, increasing bone density was anism(s) underlying differences in total 25(OH)D and
noted in 100 % after the operation. Bio-25D increase following oral D supplementation are
Conclusion: The findings suggest that the combined lesions needed.
of the axial skeleton in PHPT preferentially localized low
bone mass in the lumbar spine in postmenopausal women
and the high efficiency of surgical treatment. P484
STUDY OF MEASURING THE SERUM LEVELS OF
S-RANKL ON PATIENTS WITH DIFFUSE
P483 IDIOPATHIC SKELETAL HYPEROSTOSIS,
SERUM PTH CONCENTRATION IS RELATED TO ANKYLOSING SPONDYLITIS AND SPONDYLOSIS
TOTAL, BUT NOT BIOAVAILABLE, M. Geneva-Popova1, A. Batalov1, V. Popova1, S. Tersyiska1,
25-HYDROXYVITAMIN D R. K. Karalilova1, P. Selimov2, S. Popova2
N. Binkley1, D. Krueger1, E. Fidler1, G. Borchardt1, D. 1
Medical University Plovdiv, UMHAT, Plovdiv, Bulgaria,
Wiebe1, I. Haller2 2
Medical University Plovdiv, Plovdiv, Bulgaria
1
University of Wisconsin, Madison, Wisconsin, United States,
2
Essentia Institute of Rural Health, Duluth, Minnesota, United Objective: S-RANKL, one of the basic markers for bone
States metabolism, has not been thoroughly studied on patients with
DISH and AS. The aim of the study is to estimate the serum
Objective: Recent work suggests that measurement of levels of s-RANKL on patients with diffuse idiopathic skeletal
albumin-bound plus free 25-hydroxyvitamin D [25(OH)D], hyperostosis (DISH), ankylosing spondylitis (AS) and
i.e., “bioavailable” 25(OH)D [Bio-25D], may improve assess- spondylosis (SP).
ment of vitamin D (D) status. Substantial variability exists in Material and Methods: s-RANKL is estimated on 55 pa-
the total 25(OH)D increase following D supplementation. The tients with DISH, 25 patients with AS, 50 patients with
cause(s) of such variability is not well understood, but may be spondylosis and 15 particularly healthy people aged 55–65,
related to age, body size/body fat and efficiency of absorption/ 10 particularly healthy people aged 20–25. The measuring of
rate of degradation. Whether similar variation occurs with the s- RANKL is done by ELISA sandwich method, with a kit
Bio-25D has received limited study. of eBioscience, Austria. The statistic processing is done with
Material and Methods: This randomized trial evaluated the SPSS 19 programme (p<0.001).
relationship of total and Bio-25D with PTH and also the effect Results: Results: The average measurements of s-RANKL of
of age and body composition on total and Bio-25D increase patients with DISH and SP are higher in comparison with the
following daily intake of D3-fortified food. Ninety-nine wom- results of patients with AS and healthy people, regardless of
en in 3 age groups (20–30, 55–65 and 75+ years) received their age (p<0.05). S-RANKL in patients with DISH was
either a chocolate disk fortified with D3 2,300 IU or a 197.00±35.9, in patients with SP 200.6±66.1 pg/ml, in pa-
matching placebo daily for 4 month. Body composition was tients with AS 90.8±18.5 pg/ml in controls 83.00±14.98 pg/
determined at baseline by total body DXA. Serum total ml.
25(OH)D, Bio-25D and PTH were measured/determined at Conclusion: S-RANKL is significantly increased on patients
baseline and 4 month. with DISH and SP in comparison with the results of patients
Results: Baseline total 25(OH)D and Bio-25D (mean [SEM]) with AS and healthy people, but it is really hard to explain the
were 31.1 [1.0] and 3.7 [0.2] ng/mL, respectively; neither reason why at the present moment. Measuring the levels of s-
differed by age. At baseline, total 25(OH)D was negatively RANKL can be used for early diagnose of DISH due to
 Osteoporos Int

a difference between the serum levels on patients with P486

DISH and AS, with which differential diagnose is mostly PREVALENCE AND RISK FACTORS OF
done. OSTEOPOROSIS IN ALBANIAN
POSTMENOPAUSALWOMEN
A. Kollcaku1, J. Kollcaku2, V. Duraj1, E. Petrela3
1
Rheumatology Clinic, University Hospital Center Mother
P485 Teresa, Tirana, Albania, 2Polyclinic 3, Tirana, Albania, 3Sta-
HIP FRACTURE AND SARCOPENIA: A MODEL OF tistical Department, Medicine Faculty, Tirana, Albania
OSTEOPOROSIS-RELATED MUSCLE LOSS
M. Celi1, J. Baldi1, C. Rao1, M. Feola1, G. Di Pietro2, S. Objective: To measure BMD at the calcaneus bone in Alba-
Capuani2, U. Tarantino1 nian postmenopausal women, and to evaluate the influence of
1
Division of Orthopaedics and Traumatology, University of risk factors of osteoporosis on BMD changes.
Tor Vergata, Rome, Italy, 2Physics Department, Sapienza Material and Methods: Bone mass measurement was per-
University of Rome, Rome, Italy formed by quantitative ultrasound at the calcaneus bone. A
detailed questionnaire for determination of risk factors for
Objective: p>To evaluate the degree of muscular atrophy by osteoporosis (number of children born; menopause age, coffee
using diffusion tensor imaging (DTI) in osteoporotic patients and tea consumption, smoking, corticosteroids, rheumatic
and to determine the role of IGF-1/PI(3)/Akt signaling path- diseases, BMI, lifestyle, etc.) was administered to all subjects
ways in the genesis of muscle atrophy. enrolled in this study. 507 postmenopausal ambulatory wom-
Material and Methods: We performed vastus lateralis en were seen to be study eligible.
biopsy in 25 women with osteoporosis (OP) undergoing Results: Osteoporosis was prevalent 4.73 %. Osteopenia was
surgery for hip fracture and in 25 age matched women prevalent 25.27 %. Important statistical relationships were
undergoing arthroplasty for hip osteoarthritis (OA) with found by Kendal’s correlation coefficient between menopause
no significant functional limitations. All patients gave and changes on BMD (r=0.174; p=0.001), and BMD chang-
informed consent. We evaluated the DTI protocol with es and BMI (r=0.111; p=0.003). Through multiple regression
magnetic resonance system operating at 9.4 T the Frac- analysis were found important relationships between BMD
tional Anisotrophy (FA), the mean Diffusivity (MD) and changes (dependent variable) and number of children born
the three eigen values (λ1>λ2>λ3). All computation was (p=0.003), coffee consumption (p=0.048), treatment with
made using an homemade script in Matlab ® . Mean diuretics (p=0.050), rheumatoid arthritis (p=0.035).
values and standard deviation were obtained for each Conclusion: Responsible factors for changes on BMD in
variable for OP and OA subjects. Albanian post menopause women, except menopause, are
Results: Our findings revealed a high percentage of coffee consumption, BMI, number of children born, treatment
atrophic type II fibers (37 %) in OP, whereas in OA with diuretics and rheumatoid arthritis.
lower figures were observed (12 %). Furthermore, we
show that: 1) in OP, atrophic type II fibers a) are3-fold
more frequent than atrophic type I fibers (p<0.01), b) P487
significantly correlate with the degree of OP(p<0.05); ALTERNATIVES FOR CHRONIC LUMBAR PAIN
2) in OA, type II fibers atrophy a) is 1.5-fold more M. Brotat Rodríguez1, B. García Medrano1, M. Martínez
frequent than type I atrophy (p<0.001), b) significantly Ibeas1, L. García Flórez1
1
correlates with type I fiber atrophy, disease duration, Hospital Clínico Universitario de Valladolid, Valladolid,
degree of pain and functional impairment of hip joint. Spain
The average values of Akt in OP, the most affected by
atrophy of type II muscle fibers, is two and a half times Objective: The high of osteoporosis in the general population,
(60 %) lower (p<0.01) than all Akt OA subjects, where limited diagnostic capacity and controversy about the most
the muscle fibers of type II are almost normal. FA was appropriate treatment have caused new therapeutic options.
significantly higher in OA compared to OP (P=0.022) Material and Methods: A 71 year old woman with history of
while MD, λ2 and λ3 were lower in OA compare to OP significant osteoporosis, morbid obesity that goes to clinics
(P=0.039, P=0.040, P=0.022, respectively). because of lumbar pain of years of evolution. A L4-L5 de-
Conclusion: The reduction of Akt in osteoporotic muscle may compression and circumferential fusion with interbody peek
be one of the possible moments of compromise in intracellular implants and pedicle screws was done 5 years ago. Three
IGF-1/PI(3)/Akt signaling pathway that is likely to stimulate months after surgery the patient continues with the same
protein synthesis and cell survival as a result of activation of symptoms. It was decided to perform another intervention
the complex mTOR/p70S6K22. by withdrawing the screws on the right side, noting significant
Osteoporos Int

fibrosis and releasing L4-L5 roots. TAC is requested and Results: The average age was 59.04±6.71. Women were
shows how interbody implants protrude into the channel more frequent (88.50 %). The average BMI was 27.86±
obliterating the foramina of conjunction. 2.11 kg/m2 and a greater number of patients had second
Results: It is decided to perform another operation, left ped- radiological degree by the Kellgren-Lawrence score
icle screws are removed although it is impossible to remove (76.92 %). The patients were approximately evenly involve-
the interbody implant because of fibrosis and the important ment of the left and right knees and at 36.5 % were affected
risk of dural and root injury. It Is performed an instrumented both. In patients with primary knee OA, WOMAC pain was
posterolateral fusion with grafts. Due to the persistence of pain 10.63±4:34; WOMAC stiffness was 3.0±2:09, WOMAC
it was decided to place a neurostimulator at the level of D9- function 31.42±13:43 and total WOMAC was 45.05±18:42.
D10-D11. Despite the initial success, the psychosocial prob- The average Lequesne index was 9.91±3.13. There was a
lems of the patient difficult current valuation. statistically significant correlation between the total WOMAC
Conclusion: Osteoporosis, in recent decades, has become a score and Lequesne index (r=0.64, p<0.01).
major problem and due to the increase in life expectancy is Conclusion: WOMAC significantly correlates with the
likely to increase the incidence. Other pathologies such as low Lequesne index and the use of both is justified in the osteoar-
back pain secondary to disc degeneration is also a major thritis of the knee.
challenge in our profession. Surgery has been used for de- References: Filipovic K et al. Timocki medicinski glasnik
cades in the treatment of degenerative disc disease. However, 2011;36:208
the disparity between clinical results presents difficult choice
in cases where the source of pain is not clearly identified.
Although good results have been observed, there are still no
conclusive evidence of effectiveness of neurostimulators. P489
However, they are increasingly used as an alternative in those CARDIOVASCULAR DISEASE ASSOCIATED WITH
patients in which salvage surgery is no longer an option. LOW BONE MINERAL DENSITY IN OLDER MEN
I. Bancu1, E. Deseatnicova1, I. Popovici2, L. Groppa1
1
Medical Clinic No. 5, Department of Rheumatology and
P488 Nephrology, SUMPh Nicolae Testemiţanu, Chisinau, Repub-
THE CORRELATION BETWEEN WOMAC AND lic of Moldova, 2Republican Scientific-Practical Center Car-
LEQUESNE INDEX IN PATIENTS WITH PRIMARY diology, Chisinau, Republic of Moldova
KNEE OSTEOARTHRITIS
K. Filipovic1, J. Zvekic-Svorcan1, N. Naumovic2, B. Bobic1, Objective: To investigate lumbar spine and femoral neck
D. Demeši Drljan3 BMD and T score particularities in documented coronary
1
Rheumatology, Special Hospital for Rheumatic Diseases, artery disease (CAD) men.
Novi Sad, Serbia, 2Physiology, Medical Faculty, Novi Sad, Material and Methods: The association between CAD,
Serbia, 3Institute for Child and Youth Health Care of Vojvo- BMD, and fracture risk in older men is uncertain. We studied
dina, Novi Sad, Serbia spine and femoral neck BMD in 47 angiographically docu-
mented coronary artery disease male patients and 31 men with
Objective: To determine the correlation between WOMAC normal angiography by DXA. Patients age varies from 64 to
and Lequesne index in patients with knee osteoarthritis. 73 years.
Material and Methods: The analysis included 52 patients Results: The mean age was 69.5±4.3 years. In multiple
with knee osteoarthritis. The criterion for inclusion was regression analysis, after adjustment of age, sex and
the duration of the disease (up to 5 years). All patients BMI, severity of coronary artery disease was indepen-
filled WOMAC and Lequesne index. WOMAC ques- dently correlated with BMD of lumbar spine. BMD was
tionnaire consisted of three parts: WOMAC pain, significantly lower in patient with coronary artery dis-
WOMAC stiffness and WOMAC function. For each ease (P=0.04). Prevalence of spine osteopenia and os-
listed parts of the WOMAC was calculated the total, teoporosis in patients with coronary artery disease was
then the average value for each part of the question- 44.3 % whereas 20.8 % of men with normal angiogra-
naire. Lequesne index was divided into three groups. phy had femur osteoporosis or osteopenia (P = 0.01,
First part included questions related to the sensation of OR=4.37; CI95%, 1.29–14, 77).
pain and discomfort. In the second part relating to the Conclusion: A negative correlation between CVD and BMD
maximum distance walked and last part included ques- in elder men was demonstrated in our results. A suggestion of
tions related to activities of daily living. Filling in both bone status evaluation should be considered in patients with
questionnaires was performed by patients selecting one vascular disease for earlier diagnosis and prevention of oste-
of the answers to the above explanation of doctors. oporosis and osteoporotic fractures.
 Osteoporos Int

1
P490 Department of Gastroenterology and Human Nutrition, Uni-
FAILURE IN CERVICAL INSTRUMENTATION versity of Medical Sciences, Poznań, Poland, 2Department of
M. Brotat Rodríguez1, B. García Medrano1, M. Martínez Computer Science and Statistics, University of Medical Sci-
Ibeas1, L. García Flórez1, M. Á. Martín Ferrero1 ences, Poznań, Poland, 3Department of Clinical Biochemistry
1
Hospital Clínico Universitario de Valladolid, Valladolid, and Laboratory Medicine, University of Medical Sciences,
Spain Poznań, Poland, 4Department of Family Medicine University
of Medical Sciences, Poznań, Poland
Objective: Osteoporosis is a widespread disease of the skel-
etal system characterized by loss of bone mass and Objective: Inflammatory bowel disease (IBD) is pathology
microarchitectural deterioration of bone tissue that compro- related to bone loss and osteoporosis. IL-4 is a pleiotropic
mises bone strength and conditions an increased bone fragil- immune cytokine that is closely related to IL-13. Both cyto-
ity, susceptibility to fractures and an increased risk of mobili- kines bind to receptor IL-4Rα. IL-4 regulates bone metabo-
zation of osteosynthesis material. lism by effects on osteoclast interfering with NF-κB and
Material and Methods: This is an 82 years old woman who calcium signaling. IL-4 and IL-13 increase OPG expression
has HTA, right inguinal hernia repair, intestinal occlusion and and decrease RANKL expression. Evaluation of BMD by
T9 fracture who goes to clinics because of progressive gait DXA, serum concentrations [c] of IL-13, IL-4, sRANKL
disturbance with hypoesthesia in both upper limbs. On exam- and OPG by ELISA in patients with IBD and in control group
ination we can observe strength 4+/5 in all cervical roots and evaluation correlation between IL-4, IL-13 and OPG, s-
without motor impairment of the lumbar roots. Hypoesthesia RANKL and BMD.
is observed innervated territories by C6, C7 and T8 of both Material and Methods: Group: Leśniowski-Crohn (I:L-C)
upper limbs without changes in reflexes or in sphincters n=37 mean age 31.7 years SD 8.0, 15 female and 22 male, in
control. Severe cervicoarthrosis in cervical segment corre- ulcerative colitis (II:CU) n=37 mean age 40.6 years SD 15.1,
sponding to C3-C6 is seen in radiographs. MRI confirms 21 female and 16 male and control (III:C) n=37 mean age
degenerative in stenosis at these levels especially in C3-C4 29.6 years SD 8.0, 18 female, 19 male. Mean BMD (g/cm2) in
where there are myelopathy signs. There is also a decrease in group I:L-C in L2-L4: 1.109±0.193 in neck: 0.922±0.202,
disc height and posterior osteodiscal bulging and degenerative II:CU in L2-L4: 1.168±0.155 in neck: 0.965±0.160, III:C in
changes are also noted in uncovertebral joints. L2-L4: 1.224±0.084 in neck: 1.0859±0.159. Prevalence of
Results: On 07/06/2010 is operated performing anterior osteoporosis and osteopenia in I:L-C - 18.92 % and 32.43 %
approach, C4 and C5 corpectomy and replacement with in L2-L4; 13.51 % and 35.13 % in neck, II:CU - 2.7 % and
mesh filled with graft, discectomy C6-C7 and placement 37.84 % in L2-L4; 2.7 % and 29.73 % in neck. Mean serum
of anterior plate C3-C7. During the immediate postop- [c] of: IL-13 (pg/ml), IL-4 (pg/ml), OPG (pmol/l), s-RANKL
erative period it is observed distal screws and mesh (pmol/l): I:L-C: 65.85±48.61; 0.06±0.12; 8.76±3.22; 284.87
mobilization. Five days later, reoperation is performed. ± 213.05, II:CU: 109.36 ± 42.84; 0.26 ± 0.36; 6.02 ± 2.51;
Mobilized osteosynthesis material is removed and a 223.81±118.14 III:C: 5.32±2.01; 0.51±1.51; 9.42±2.10;
longer mesh is placed with iliac crest graft and a new 236.84±111.63.
longer plate with six cancellous screws. Results: Serum [c] of IL-13 and OPG differ significantly in
Conclusion: The percentage of mobilization of cervical in- group I, II, III. Serum [c] of IL-4 correlated negative with BMD
strumentation is very high in patients suffering from osteopo- L2-L4 in L-C group and IL-13 correlated negative with neck
rosis especially if multiple corpectomies are made, most oc- BMD in all person. OPG correlated negative with IL-13 in all
curring in the first 6 weeks. For this reason, it would be person. s-RANKL correlated negative with IL-4 in CU group.
desirable to consider the combination with posterior instru- Conclusion: Osteopenia and osteoporosis in patients with
mentation for best results and avoid further surgeries. IBD are frequent. IL-13 and IL-4 may decrease BMD in
IBD by modulation OPG and sRANKL.
Acknowledgements: NN 402 481 737
P491
INTERLEUKIN-13, INTERLEUKIN-4 AND
OSTEOPROTEGERIN AND SRANKL IN P492
PATHOLOGY OF BONE METABOLISM IN PATIENTS BONE METABOLISM AND ADIPOSE TISSUE
WITH LEŚNIOWSKI-CROHN DISEASE AND EXPRESSION OF ADIPOCYTES IN CHRONIC
ULCERATIVE COLITIS OBSTRUCTIVE PULMONARY DISEASE
I. Krela-Kaźmierczak1, L. Łykowska-Szuber1, A. Szymczak1, E. Kochetkova1, L. Ugay2, Y. Maistrovskaiy2
P. Eder1, M. Michalak2, E. Wysocka3, K. Stawczyk-Eder1, K. 1
Centre de Pharmacovigilance, Strasbourg, France, 2Therapy,
Klimczak1, K. Linke1, W. Horst-Sikorska4 Vladivostok, Russian Federation
Osteoporos Int

Objective: To investigate the serum adiponectin, leptin and chronic back pain. On examination we observe general pain in
osteoprotegerin (OPG) levels and its expressions in the adi- lumbar region and negative Lassegue and Bragard signs.
pose tissue, and their relationships with bone metabolism and There is a dorsolumbar scoliosis with right- left curve struc-
in patients with severe COPD. tures. There is no involvement of strength or feeling in both
Material and Methods: Serum leptin, adiponectin, OPG, the lower limb and sphincters are not affected. Lumbar scoliosis is
receptor activator of nuclear factor-kB ligand (RANKL) and confirmed in radiographs and in MRI marked degenerative
bone turnover markers (osteocalcin and type I collagen C- changes in vertebral bodies are seen with decreasing height
telopeptide (CTx)) were determined in 52 patients with severe and anterior wedging mainly in level D11, L1 and L5.
COPD and 42 age- and sex-matched healthy controls. BMD Results: On 27/03/12 he was operated doing a decompression
and body composition was assessed by DXA at the lumbar and fusion with cemented screws from D11 to S1 using a
spine (LS) and left femur neck (FN). Subcutaneous adipose posterior approach. During the postoperative period she pre-
tissue samples were analyzed by immunocytochemical sents febrile syndrome with MRSA bacteremia treated with
analyses. Rifampin and Linezolid which is solved after several months
Results: Adipose tissue expression of leptin (LepR) was low of treatment. The patient reports pain relief allowing her to
and adipose tissue expression of adiponectin (AdipoR1) was perform works of daily living.
higher in COPD group than in control. Compared to patients Conclusion: Vertebral fractures are the most common type of
without osteoporosis, those with the disease had significantly osteoporotic fractures. Most fractures happen at the
lower serum leptin, OPG levels and LepR, in association with thoracolumbar junction and are associated with low bone
increased serum CTx, RANKL, adiponectin and AdipoR1 density. However it has been found that other factors are also
expressions (p<0.05). LepR was inversely related to serum important as bone disease (osteogenesis imperfecta in our
CTx (p<0.01), and directly to serum leptin (p<0.01), to fat case), activities of daily life or trauma. It is important to make
free mass (FFM) (r=0.44, p<0.01) and to BMD FN and BMD an early diagnosis since it has been observed that these frac-
LS (p<0.05 for all relationships). Serum leptin was correlated tures cause significant reductions in quality of life and in-
positively with OPG (p<o.05) and negatively with RANKL creased mortality.
(p<0.05); serum adiponectin was negative association with
serum OPG (p<0.05) and positive correlation with RANKL
(p<0.05) in severe COPD. AdipoR1 expression was negative- P494
ly related to FFM (r<-0.51, p=0.01) and directly to serum INTERLEUKIN-10, TNF-α, OSTEOPROTEGERIN,
adiponectin and CTx (p<0.01). Adipose tissue OPG expres- SRANKL IN PATHOLOGY OF BONE METABOLISM
sion was related to BMD FN only (p<0.05). IN PATIENTS WITH LEŚNIOWSKI-CROHN DISEASE
Conclusion: Our results suggest that adipose tissue leptin, AND ULCERATIVE COLITIS
adiponectin and OPG expressions are related to development I. Krela-Kazmierczak1, L Lykowska-Szuber1, A Szymczak1,
of osteoporosis in severe COPD, and appear to act as media- P. Eder1, M. Michalak2, E. Wysocka3, K. Stawczyk-Eder1, K.
tors between fat mass and bone density. Klimczak1, K. Linke1, W. Horst-Sikorska4
1
Department of Gastroenterology and Human Nutrition, Uni-
versity of Medical Sciences, Poznań, Poland, 2Department of
P493 Computer Science and Statistics, University of Medical Sci-
IMPACT OF OSTEOPOROSIS IN SPINAL ences, Poznań, Poland, 3Department of Clinical Biochemistry
FRACTURES and Laboratory Medicine, University of Medical Sciences,
M. Brotat Rodríguez1, B. García Medrano1, M. Martínez Poznań, Poland, 4Department of Family Medicine University
Ibeas1, L. García Flórez1, M. Á. Martín Ferrero1 of Medical Sciences, Poznań, Poland
1
Hospital Clínico Universitario de Valladolid, Valladolid,
Spain Objective: Evaluation of BMD by DXA, serum concentra-
tions of IL-10, TNF-α sRANKL and OPG by ELISA in
Objective: Osteoporosis is an important problem of great patients with IBD and in control group and evaluation corre-
social impact represents a high health care spending. Although lation between IL-10, TNF-α, OPG, s-RANKL and BMD.
the incidence of osteoporotic fractures is lower in men (39 % Evaluation of influence disease duration and number of hos-
of the total), morbidity and mortality is higher so early diag- pitalization on BMD.
nosis is critical. Material and Methods: Group: Leśniowski-Crohn (I:L-C)
Material and Methods: This is a 62 years old man with n=37 mean age 31.7 years SD 8.0, 15 female and 22 male, in
history of hypertension, hypertensive heart disease, osteogen- ulcerative colitis (II:CU) n=37 mean age 40.6 years SD 15.1,
esis imperfecta, rheumatoid arthritis, complete thrombosis of 21 female and 16 male and control (III:C) n=37 mean age
internal carotid and facial paralysis which goes to clinics for 29.6 years SD 8.0, 18 female, 19 male.
 Osteoporos Int

Results: Mean BMD (g/cm2) in group I - L-C in L2-L4: 1.109 quantitative ultrasound technique Sunlight Omnisense
±0.193 in neck: 0.922±0.202, II - CU in L2-L4: 1.168±0.155 7000S. Results were interpreted in accordance with criteria
in neck: 0.965±0.160, III-C in L2-L4: 1.224±0.084 in neck: adopted by the WHO by T-score. In both groups BMD was
1.0859±0.159. Prevalence of osteoporosis and osteopenia in I studied before and after one year of medication with supple-
- L-C - 18.92 % and 32.43 % in L2-L4; 13.51 % and 35.13 % mental calcium and vitamin D; in the II group patients were
in neck, II - CU - 2.7 % and 37.84 % in L2-L4; 2.7 % and received intravenous injections of ibandronate 3 mg/3 ml
29.73 % in neck. BMD Neck and T-score in I-L-C differ every 3 months.
significantly with III-C (p<0.05=0.0007) but not differ with Results: In both groups of women with Crohn’s disease
II-CU. Mean serum concentration of: IL-10 (pg/ml), TNF-α before medication the mean BMD was decreased. I group T-
(pg/ml), OPG (pmol/l), s-RANKL (pmol/l): I - L- C- 1.67± score: distal 1/3 radius −1.6±0.06; midshaft tibia −1.7±0.06;
3.69; 4.62±5.16 8.76±3.22; 284.87±213.05, II - CU- 5.97± proximal phalanx- 2.0±0.08; II group T-score: −2.7±0.07;
22.80; 3.82±4.54; 6.02±2.51; 223.81±118.14, III-C - 0.84± −2.5±0.05; −2.8±0.06. After one year medication in both
1.78; 2.04±0.81; 9.42±2.10; 236.84±111.63. Serum concen- groups of women BMD was increased: I group T-score:
trations of IL-10 correlated negative with OPG in all patients. −1.2±0.06; −0.5±0.06; −1.4±0.08; II group T-score: −2.0±
Serum concentration of cytokines differ between group but we 0.08; −1.6±0.06; −1.6±0.07, respectively.
didn’t observe any correlation with BMD. In CU group we Conclusion: Patients with Crohn’s disease are at increased
observed positive correlation between TNF-α and OPG. Du- risk of developing disturbances in bone and mineral metabo-
ration of disease (in years) were: I - L-C -8.05±5.29, II - CU lism because of several factors. All patients with Crohn’s
8.03±7.92 and correlated with neck T-score and Z-score. disease should be screened for OP by means of a BMD
Similar correlation was for number of hospitalizations. measurement in addition to full correction of any potential
Conclusion: Prevalence of osteopenia and osteoporosis in calcium and vitamin D deficiency.
patients with IBD increase with disease duration and number
of hospitalizations. Patients with Leśniowski-Crohn disease
have higher probability of bone resorption. Interleukin-10 and P496
TNF-α may modulated BMD by OPG. Acknowledgements: NEW POINT OF CARE METHOD FOR
NN 402 481 737 OSTEOPOROSIS DIAGNOSTICS IN US
J. P. Karjalainen1, O. Riekkinen1, J Schousboe2
1
Bone Index Finland Ltd., Kuopio, Finland, 2Park Nicollet
P495 Institute, Minneapolis, United States
BONE LOSS IN WOMEN WITH CROHN’S DISEASE
MI Zodelava1, NG Tskhovrebashvili1, NS Tatishvili2, TN Objective: Currently, majority of the osteoporotic patients are
Mamaladze1, MG Tskhovrebashvili3 not diagnosed (1). A new ultrasound based device (Bindex®)
1
Department of Osteoporosis and Diabetic Foot, Clinic of has been recently introduced for osteoporosis (OP) screening
Aesthetic, Reconstructive and Plastic Surgery, Caraps Medline, and diagnostics at primary healthcare (2). Bindex® measures
Tbilisi, Georgia, 2Department of Rheumatology, Central Clin- cortical thickness and determines parameter called density
ical Hospital, Tbilisi, Georgia, 3Center of Endocrinology, index (DI). Thresholds for DI in OP assessment have been
Metabology and Dietology Enmedic, Tbilisi, Georgia determined in Finnish-Caucasian (F- C) population (n=448)
along the International Society of Clinical Densitometry
Objective: Gastrointestinal disease is often overlooked as a (ISCD) guidelines (3). In this study, these thresholds are tested
cause of osteoporosis (OP). Gastrointestinal diseases associ- in American- Caucasian (A-C) population.
ated with OP include early onset of disease (and, therefore, Material and Methods: A total of 221 A-C females partici-
prolonged exposure to risk factors for developing OP, partic- pated the study (age 69.7±9.4 years). Subjects were measured
ularly with inflammatory bowel disease), malabsorption, and with DXA to determine BMD at proximal femur. Further, the
maldigestion of nutrients necessary for bone health and main- cortical thickness was measured at three locations (distal
tenance (calcium, vitamin D), as well as the impact of gluco- radius, distal and proximal tibia) with Bindex®. Subjects were
corticoids. The aim of this study was to investigate the BMD diagnosed with OP when T- score at femoral neck or total
in patients with Crohn’s disease to propose some strategies for proximal femur was below −2.5 (NHANES III). DI was
management OP. calculated either by using measurement at one location (DI1,
Material and Methods: Two groups of women with Crohn’s proximal tibia) or all three locations (DI3). By using the
disease were studied: I group 11 premenopausal women in the diagnostic thresholds, subjects were classified as healthy, os-
age 25–45 years; II group 13 postmenopausal women aged of teoporotic or in need of DXA examination to verify diagnosis.
45–65 years. All patients were treated periodically with glu- Results: A total of 74.2 % and 73.8 % of the subjects could be
cocorticoids. BMD measurements were accomplished by directly diagnosed by using Bindex® measurement, with DI1
Osteoporos Int

and DI3, respectively. Both parameters showed significant 1st and 2nd groups. The level of PTH decreased during COPD
linear correlation with total proximal femur BMD (r=0.62– progression: in the control - 38.5 (35.6; 46.7) pg/ml; 1st group
0.70). Sensitivity in OP diagnostics was 80.9 % and 89.7 % - 32.5 (24.6; 41.3); 2nd- 26.6 (22.3; 33.6) and 3rd group - 24.9
for DI1 and DI3, respectively. Specificity was 86.9 % and (19.0; 35.4); p<0.05 control vs. the 1st and 2nd groups.
84.3 % for DI1 and DI3, respectively. OP was diagnosed in Conclusion: Bone metabolic imbalance caused predominant-
68 subjects in total. ly disturbance of bone formation then increasing bone resorp-
Conclusion: In this study, fewer subjects would have needed tion in men with COPD. This is supported by a significant
additional DXA examination to verify diagnosis when com- number of patients (43 %) with a marked reduction of
pared to previous findings. The correlation between BMD and osteocalcin as compared with patients (9 %) with higher level
DI was similar than previously observed. These results sug- of b-crosslaps (χ2 =2035, p<0.001). The observed reduction
gest that F-C thresholds may be applicable for A-C of osteocalcin against reduction of serum level of PTH indi-
population. cated the predominance of the anabolic effect of PTH in men
References: 1. Nguyen, Med J Aust.,20014 with COPD.
2. Karjalainen JP, ASBMR, Baltimore, 2013
3. Hans, J Clin Densitom., 2008
Disclosures: 1. Nguyen, Med J Aust 20014 P498
2. Karjalainen JP, ASBMR, Baltimore, 2013 EFFECTS OF ANTIRESORPTIVE OSTEOPOROSIS
3. Hans, J Clin Densitom 2008 THERAPY ON SPINE BMD AND TRABECULAR
BONE SCORE (TBS) IN POSTMENOPAUSAL
WOMEN
P497 G. Bonaccorsi1, A. Poggi2, E. Fila1, S. Ferrazzini1, M. C.
MARKERS OF BONE METABOLISM Castaldini1, M. Giganti3, A. Capatti1
(OSTEOCALCIN AND Β-CROSSLAPS (Β- CTX)) AND 1
Menopause and Osteoporosis Center, University of Ferrara,
PARATHYROID HORMONE IN MEN WITH Ferrara, Italy, 2Department of Morphology, Surgery and Ex-
CHRONIC OBSTRUCTIVE PULMONARY DISEASE perimental Medicine, Section of Obstetrics and Gynecology,
(COPD) (AGED 40–70 YEARS) University of Ferrara, Ferrara, Italy, 3Department of Morphol-
S. S. Lemiasheuskaya1, A. E. Makarevich1 ogy, Surgery and Experimental Medicine, Laboratory of Nu-
1
Department of Internal Medicine No. 1, Belarusian State clear Medicine, University of Ferrara, Ferrara, Italy
Medical University, Minsk, Belarus
Objective: BMD measurements (DXA) is the reference stan-
Objective: COPD and osteoporosis are strongly associated. dard for diagnosing osteoporosis. TBS, a new grey-level
Our aim was to study the imbalance of markers of bone texture measurement that can be extracted from DXA, is an
metabolism in men with COPD. index of bone microarchitecture independent of BMD and
Material and Methods: Serum PTH was determined by the several studies have documented its value for fracture risk
enzyme-linked immunosorbent assay. Bone markers were assessment. To date there are no conclusive data on the role of
determined by the electrochemiluminiscence immunoassays. TBS in the monitoring of antifracture treatment The aim of
We examined 3 groups of patients and control group (15 this study was to assess the effects of antiresorptive therapy on
healthy men with mean age 56 year, mean BMI 26 kg/m2). lumbar spine BMD and TBS in postmenopausal women.
The COPD pts were subdivided into groups according to Material and Methods: A group of untreated Caucasian wom-
COPD severity: the 1st was made of 20 men; GOLD I degree; en (age 49–83 years) were candidate for treatment (oral
mean age 55 years; FEV1 78 %, the 2nd included 43 patients; bisphosphonates 94 % and raloxifene 6 %), if osteoporotic
GOLD II degree; mean age 57; FEV1 63 %; the 3d -20 pts; (64 %) or osteopenic (36 %) with high fracture risk (FRAX).
GOLD III degree; mean age 60; FEV1 41 %. All patients received vitamin D and calcium supplements. We
Results: The level of b-CTX increased during COPD pro- performed DXA examination (Hologic Explorer) before and after
gression: in the control −0.29 ng/ml; 1st group - 0.30; 2nd- a treatment period of 24 months. TBS was calculated for each
0.40 and 3rd group - 0.37; p<0.05 vs. the control and the 1st lumbar spine exam. The correlations between lumbar spine BMD
group. b-crosslaps was elevated in 5 % patients in the 1st and TBS and between FRAX (total) and TBS were examined.
group, in 24 % patients in the 2nd group. Increased b- Results: N 150 women (mean age 64, menopause mean age
crosslaps was noted in 11 % patients in the 3rd group, but 50) completed the study, the adherence was >75 %. A weak
without significant differences with 1st and 2nd groups. correlation was seen between BMD and TBS values before
Osteocalcin level was decreased in 32 % pts in the 1st group (r=0.39) and after therapy (r=0.32).A significant difference
and 45 % in the 2nd group. Osteocalcin was reduced in 47 % (p=0.019) were observed for the mean value of FRAX (total)
pts in the 3rd group, but with no significant differences with among patients in the lowest quartile of TBS (n.38 cases)
 Osteoporos Int

1
compared to those in the higher quartiles. After therapy, we Traumatology and Orthopaedic Department Hospital Clinico
observed a significant increase in mean spine BMD (0.072± Universitario Valladolid, Valladolid, Spain, 2Hospital Clínico
0.08 gr/cm2 vs. 0.806±0.09 gr/cm2, p<0.001) and a, not Universitario de Valladolid, Valladolid, Spain
significant increase in mean TBS (1.074±0.13 vs. 1.180±
0.11). Objective: The fractures of vertebral bodies in aged patients
Conclusion: Our data suggest a weak sensitivity of TBS to are really common after making a small effort or activity due
detect the effects of osteoporosis treatment in postmenopausal to the poor bone quality, and a second cause a hemangioma or
women over a period of 2 years. The results are consistent any other benign or malignant process. They can lead to
w i t h t h e kn o w n e ffe c t o f m a i n t en a n c e o f b o n e chronic lumbar pain and other complications. Kyphoplasty
microarchitecture of antiresorptive agents. Additional longi- is a good treatment to restore the shape and volume of the
tudinal studies are required to clarify the role of TBS changes vertebra and to get good functional results in aged patients.
in the monitoring of various osteoporosis therapies. Material and Methods: An 81 years old female patient
presented an increase of her lumbar pain not irradiated to
lower extremities and with no neurological deficiencies after
P499 a small effort. The examination showed lumbar pain, Lasegue
OSTEOPOROTIC OR METASTATIC VERTEBRAL and Bragard signs were negative. A small compression frac-
COLLAPSE IN ONCOLGY: WHAT IS THE ture in L1 was demonstrated in the X-ray and confirmed with
CONTRIBUTION OF THE SPECT/CT? a TC. The TC also showed a hemangioma in the body of L1
H. Chorfi1 and a low bone density.
1
Nuclear Medicine, University Hospital Hassan II, Fes, Mo- Results: A kyphoplasty of L1 was made percutaneously with
rocco an expansive device and posterior cement augmentation with
X-ray control. Lumbar pain was controlled with analgesics
Objective: Differentiation of benign and malignant causes of and ceased 3 days later. After one year follow-up the patient
vertebral collapse can be difficult because both of them occur does not have back pain, she realizes the basic dairy activities
in an elderly population with no notion of trauma. The aim of by herself and do not require analgesics.
our study is to determine the contribution of SPECT/CT as a Conclusion: Lumbar fractures in patients with low bone mass
complement of planar bone scintigraphy in the identification are really common and can be produce by small efforts or
of benign and malignant causes of vertebral collapses. daily activities. A hemangioma in an osteoporotic lumbar
Material and Methods: Our study included 10 patients re- spine is a bigger risk for this kind of fractures. The back pain
ferred to the department of nuclear medicine for the staging caused can be very invalidating and kyphoplasty is a good
assessment of their primitive neoplasy. Planar bone scintigra- treatment reaching a full recovery and a total reincorporation
phy showed spinal hot spots. The complement SPECT/CT to the daily activities.
revealed a vertebral collapse.
Results: All patients included in our study had a known
malignancy. Sex ratio H/F: 0.25, the mean age of the patients P501
was 61.4 years. The location of spinal hot spots was classified PROGRESSIVE NEUROLOGICAL DEFICIENCY
as panvertebral in 9 cases and hemivertebral in one case. The AFTER AN OSTEOPOROTIC VERTEBRAL
complement SPECT/CT highlighted a vertebral collapse that FRACTURE
interested the lumbar spine in 6 cases and the thoracic spine in M. Brotat Rodríguez1, B. García Medrano1, L. García Flórez1,
4 cases. The aetiology of vertebral collapse was osteoporotic M. Á. Martín Ferrero1
1
in 8 cases and metastatic in just 2 cases. Hospital Clínico Universitario de Valladolid, Valladolid,
Conclusion: Planar bone scintigraphy is very sensitive to Spain
evolutive vertebral lesions, however, it has a very weak spec-
ificity. Therefore, the SPECT/CT is useful in the distinction Objective: The neurological deficiency can be the first dem-
between the benign and malignant cause of vertebral onstration of nondiagnosed osteoporotic vertebral fracture and
collapses. it is not very common. The neurological deficiency can be
recovered depending on the time of evolution, the progression
of the symptoms and an adequate surgical treatment.
P500 Kyphoplasty combined with lumbar fusion is a good treat-
VERTEBRAL FRACTURE ASSOCIATED TO ment to relieve pain and obtain good clinical results.
OSTEOPOROSIS AND HEMANGIOMA Material and Methods: An 88 years old female patient
B. García Medrano1, M. Brotat Rodríguez2, L. García Flórez2, presented an increase in her chronic lumbar pain with pro-
M. Á. Martín Ferrero2 gressive neurological deficiency in her inner extremities
Osteoporos Int

without previous trauma for a week. The examination showed operatively and 54 conservatively. There was a lethal outcome
a diminished force in her limbs, hypoesthesia in L4, L5 and S1 in 8 patients (2 of which were treated operatively and 6
dermatomes, inability to stand up and could not control conservatively).
sphincters. X-ray demonstrated a compression fracture of Conclusion: Results of this analysis indicate that greater care
T12 and L3 and an osteoporotic lumbar spine, confirmed by in early detection of osteoporosis is a serious task for both
capting image in T2 sequence of MRI as acute T12 fracture individuals, family, health institutions and the society in gen-
and spinal cord compression at this level. eral. Such behavior would also help in prevention of the most
Results: Initial treatment with intravenous corticoids were severe osteoporotic complication - hip fracture.
unsuccessful. A percutaneous kyphoplasty combined with a
T11-L2 decompression and fusion were made. Back pain
diminished after surgery and a bilateral anti-echinus braces P503
were used to controlled the residual echinus. After a 6-moth APPROPRIATENESS OF OSTEOPOROSIS
followed-up the patient has no back pain, does not need anti- TREATMENT WITHIN A MEDICAL INPATIENT
echinus braces, walks with help and has regained control of POPULATION IN AWELSH DISTRICT GENERAL
bladder and anal sphincters. HOSPITAL
Conclusion: Undiagnosed osteoporotic vertebral fractures in K. V. Siddarth1, S. Manupati2, A. Gupta3
1
aged people can developed as a first symptom a neurological Orthopaedics, West Wales General Hospital, Carmarthen, Unit-
deficiency. MRI has great utility in diagnosis of acute verte- ed Kingdom, 2Geriatric Medicine, West Wales General Hospital,
bral fractures and spinal cord compression. An emergency Carmarthen, United Kingdom, 3Orthogeriatric Medicine, West
surgical treatment is elective to achieve a recovery of the Wales General Hospital, Carmarthen, United Kingdom
neurological symptoms. The percutaneous kyphoplasty and
vertebral fusion in aged patients is a good treatment to mini- Objective: To assess the pharmacological management of
mize opened surgery risks, and the results are very similar to osteoporosis in a cohort of hospitalized medical in-patient
the ones obtained by open surgery. within a Welsh district general hospital.
Material and Methods: We collected data using medical
records on a structured proforma as a point prevalence study
P502 targeting medical inpatients aged fifty and above in an admit-
ANALYSIS OF PATIENTS TREATED AT THE ted hospital cohort.
INSTITUTE FOR ORTHOPEDIC SURGERY Results: All of the 117 patients studied (100 %) had at least 2
“BANJICA” FOR MOST SEVERE OSTEOPOROTIC or more risk factors. 83 (71 %) of them had >3 risk factors. 28
COMPLICATIONS (24 %) of the inpatients were on any form of treatment for
L. Urosevic1, V. Jovanovic1 osteoporosis and an equal number (i.e.24 %) had undergone a
1
Institute for Orthopedic Surgery Banjica, Belgrad, Serbia fracture risk assessment. Only 16 (13.6 %) of them were on
both calcium-vitamin D3 and a bisphosphonate. 25 (21.4 %)
Objective: Hip fractures are the most severe complications of them were receiving calcium and vitamin D3. 19 (16.%) of
related to osteoporosis. The aim of this study was to make a them were on bisphosphonates [17 on alendronate, 1 on
retrospective analysis of patients with hip fracture that were denosumab, 1 on risedronate]. 8 (6.8 %) of them had contra-
treated at our Institute. indications to bisphosphonates and among them only 4 of
Material and Methods: 110 patients hospitalized for hip frac- them were on calcium and vitamin D3.
tures in the geriatrics department of the Institute for orthopedic Conclusion: A significant percentage of hospitalized inpa-
surgery during 2012–2013 were studied. The following param- tients have risk factors for osteoporosis. Several of them have
eters are presented: age of the patient, level of the fracture, multiple risk factors but are inadequately treated for osteopo-
number of days spent in the hospital, previously made diagno- rosis. Creating an awareness in this aspect among health
sis of osteoporosis, presence of simultaneous multiple fractures, professionals for identifying and adequately treating patients
as well as result of the treatment at the end of hospital stay. with osteoporosis would be a step towards reducing the bur-
Results: 110 female patients whose mean age was 74.66 years den of this chronic and treatable condition.
were treated (the youngest patient had 55 years and the oldest
had 92 years). Fracture level: 56 patients had fracture of the
femoral neck, 45 patients had intertrochanteric fractures of the P504
hip and 9 patients had subtrochanteric fractures. Mean time DECREASED OPG LEVELS IN THE SERUM OF
spent in the hospital was 28.49 days (min. 4, max. 82 days). BORRELIA AFZELII SEROPOSITIVE PATIENTS
Only four patients had osteoporosis diagnosed before frac- E. Nagy 1,2 , G. Tripon 2 , E. Csifo 1 , B. Kovacs 1 , A.
tures and were on medication therapy. 56 patients were treated Crihalmeanu3, J. Kolozsi3, E. Horvath4, I. Kezdi5
 Osteoporos Int

1 1
Department of Pharmaceutical Biochemistry, U.M.Ph., Targu Servicio Endocrinología. Hospital Docente Policía Nacional
Mures, Romania, 2Laboratory of Medical Analyses, Mures Guayaquil No. 2, Guayaquil, Ecuador, 2 Servicio
Clinical County Hospital, Targu Mures, Romania, 3Department Endocrinología Hospital Clínica Kennedy Alborada, Guaya-
of Laboratory Medicine, U.M.Ph., Targu Mures, Romania, 4De- quil, Ecuador, 3Servicio Medicina Interna. Hospital Luis
partment of Pathology, U.M.Ph., Targu Mures, Romania, 5I. Vernaza, Guayaquil, Ecuador, 4Servicio Medicina Interna.
Clinic of Infectious Disease, U.M.Ph., Targu Mures, Romania Hospital Docente Policía Nacional Guayaquil No. 2, Guaya-
quil, Ecuador, 5Servicio Endocrinología. Hospital Docente
Objective: Borrelia infection has a colorful symptomatology, Policía Nacional #2, Guayaquil, Ecuador
which due to colonization of various tissues span from ery-
thema migrans, arthritis, carditis to various neurological Objective: To analyze the OST score (self-assessment
symptoms. Recently, some Borrelia surface antigens, namely Osteoporosis Screening Tool) as a screening method for oste-
OspA, DbpA, and BBA64 antigens have been identified as oporosis and predict fracture risk osteoporotic calculated by
determinants of cellular adherence. As arthritis characterizes the FRAX® tool to a group of Ecuadorian men and women.
60 % of cases, it might be of interest to find its predictive Material and Methods: 286 patients, 206 men and 80 wom-
biomarkers. Osteoprotegerin (OPG) became our target as its en were included. All patients were given a bone densitometry
administration in mice proved to be protective against carti- in lumbar spine and hip with a Hologic Discovery W® densi-
lage destruction and prevented chondrocyte apoptosis. tometer. The OST score was calculated using the formula: 0.2
Material and Methods: An overall of 76 Borrelia afzelii × (weight in kg - age in years). A OST score <2 indicated
seropositive patients (18 with IgM/IgG, 31 IgM, 27 IgG osteoporosis and corresponded to a T-score in femoral neck of
positivity) and 44 seronegative controls have been tested for ≤−2.5. The risk of major and hip osteoporotic fracture was
serum OPG levels. Samples were drawn from individuals who calculated using the FRAX tool with data generated for the
visited our ambulatory service for recent tick-bite or serolog- Ecuadorian population.
ical follow-up after treatment. Borrelia afzelii IgM and IgG Results: Men: mean age 64.5±8.7 years; mean FRAX hip
has been measured by commercially available ELISA assays 0.18 ± 0.32; Sensitivity 25 % (0.00–79.93); Specificity
(Sekisui Virotech, Germany), OPG was determined by a 99.49 % (98.24–100); Positive predictive value 50 % (0.0–
sandwich ELISA applying the OPG Duoset kit (R&D Sys- 100); Negative predictive value 98.48 % (96.53–100); Area
tems, DY805). under the ROC curve 0.622 (0.377–0.867). Mean OST 2.3±
Results: All seropositive groups had significantly lower OPG 2.98; sensitivity 100 % (90–100); specificity 59.60 % (52.51–
levels than the control group. The highest OPG values have 66.68); positive predictive value 5.88 % (0.29–11.47); nega-
been detected at the control group, 3.12±0.21 ng/mL, while tive predictive value 100 % (99.58–100); area under the ROC
the double positive group showed the lowest levels of 1.57± curve 0.79 (0.763–0.832). Women: mean age women 61.9±
0.20 ng/mL. IgM and IgG seropositive cases possessed similar 11 years; mean FRAX hip 0.64±0.30; sensitivity 28.57 %
OPG levels of 2.18±0.17 vs. 2.20±0.18 ng/mL. (6.87–50.27); specificity 100 % (99.09–100); positive predic-
Conclusion: The significant decrease of OPG levels in tive value 100 % (91.67–100); negative predictive value
Borrelia afzelii seropositive patients may suspend its protec- 78.57 % (68.24–88.90); area under the ROC curve 0.64
tive effect on the cartilage tissue and could contribute to the (0.050–0.543). Mean OST 0.31±0.05; sensitivity 94 % (82–
formation and progression of Lyme arthritis. For this consid- 100); specificity 42.11 % (28.41–55.8); positive predictive
eration, OPG should be considered as a new predictive marker value 35.9 % (21.20–49.39); negative predictive value 96 %
of arthritis related to tick- borne disease. (86.32–100); area under the ROC curve 0.68 (0.601–0.766).
Acknowledgements: This paper is partly supported by the Conclusion: Score OST has a high sensibility for screening to
Sectorial Operational Programme Human Resources Devel- osteoporosis in both Ecuadorian, men and women. We con-
opment (SOPHRD), financed from the European Social Fund sider that the version for the Ecuador of the FRAX tool,
and by the Romanian Government under the contract number underestimate the probability of fracture osteoporotic. FRAX
POSDRU 80641. cutoffs for assessment with DXA and therapeutic intervention
has not been established in our population.

P505
OSTEOPOROSIS SCREENING AND RISK OF P506
FRACTURE PREDICTION TOOLS IN THE LITERATURE REVIEW OF THE LOCKED
ECUADORIAN POPULATION METACARPOPHALENGEAL JOINT
E. López Gavilanez1, N. Bautista Litardo2, M. Navarro A. Akel1, S. T. Elhadidy1
Chavez3, K. Guerrero Franco4, M. Hernández Bonilla5, A. 1
Orthopedic and Trauma Surgery, Jordan University Hospital,
Segale Bajana4 Amman, Jordan
Osteoporos Int

Objective: in this presentation our aim is to focus on the XCT2000 (Orthometrix, White Plains, NY) on 1 day. Whole
differentiation between two different pathologies, stenosing tibia CT was 120 kVp, 1 mm slices and 0.5 mm pixels;
flexor tenosynovitis and the locked MCP, with literature re- 2.3 mm pQCT slices were at 3 % proximal to the distal physis,
view of this entity. 0.4 mm voxels. Volumetric integral BMD (vBMD) was com-
Material and Methods: A case repot is presented with the pared by matching bone cross-sectional area (CSA) of XCT
initial presentation, with its management, followed by time scans with QCT slices correcting for resolution difference.
sequence literature review of this entity from its initial emer- Cross-calibration was by linear least- squares.
gence, with exploration of the etiological classification system Results: The effective “boundary layer” for maximum corre-
for the locked MCP. lation when comparing CSAs from the two methods was
Results: Locked MCP joint of long fingers refers to loss of active ~0.4 mm (see graph). Using this thickness, a linear correlation
and passive extension of the MCP joint without loss of flexion for vBMD was found with R=0.990 and a standard error
and with a normal mobility of the interphalengeal (IP) joints, as (SEE) of 4.6 mg/cm3. A linear cross-calibration equation for
defined by Posner. In this presentation our aim is to focus on the vBMD was determined as XCT=0.96 * QCT + 75 mg/cm3.
differentiation between two different pathologies, stenosing flexor
tenosynovitis and the locked MCP, with literature review of this
entity. A case repot is presented with the initial presentation, with
its management, followed by time sequence literature review of
this entity from its initial emergence, with exploration of the
etiological classification system for the locked MCP.
Conclusion: Locked MCP joint of long fingers refers to loss
of active and passive extension of the metacarpophalengeal
Joint without loss of flexion and with a normal mobility of the
IP joints, as defined by Posne; in this presentation our aim is to Conclusion: A strong correlation in vBMD estimates was
focus on the differentiation between two different pathologies, observed with a an offset of −75 mg/cm3 consistent with
stenosing flexor tenosynovitis and the locked MCP, with Stratec machines using fat as the zero for BMD while
literature review of this entity. A case repot is presented with Mindways uses water. The SEE of 4.6 mg/cm3 is much less
the initial presentation, with its management, followed by time than expected normal- population vBMD dispersion esti-
sequence literature review of this entity from its initial emer- mates. The observed cross-calibration equation could be used
gence, with exploration of the etiological classification system to convert whole-body CT derived vBMD estimates for com-
for the locked MCP. parison to existing Stratec reference data.
References: Langeskiold A. Chir Scand 1950;99:73 References: [1] Engelke et al. Bone 2009;45:110

P507
CROSS-CALIBRATION OF BMD MEASUREMENT P508
BETWEEN A DEDICATED PQCT SCANNER AND RELATION AMONG ANTHROPOMETRIC
QCT OF PERIPHERAL SITES USING A CLINICAL VARIABLES, SARCOPENIA AND BONE MINERAL
WHOLE-BODY HELICAL CT SCANNER DENSITY IN POSTMENOPAUSAL ADULT WOMEN
G. Bodeen1, S. Mahboubi2, J. K. Brown1, B. S. Zemel2, A. M. N. K. Kochi1, G. C. Costa2, J. G. Reis1, F. J. A. De Paula3,
Brett1, M. B. Leonard2 D. C. C. De Abreu2
1
Mindways Software, Inc, Austin, United States, 2Children’s 1
Department of Biomechanics, Medicine and Rehabilitation
Hospital of Philadelphia, Philadelphia, PA, United States of Locomotor System, Ribeirao Preto, Brazil, 2Department of
Biomechanics, Medicine and Rehabilitation of Locomotor
Objective: Dedicated pQCT scanners have restricted avail- System, Medical School of Ribeirao Preto, University of
ability, require minutes of scanning time often causing motion Sao Paulo, Ribeirao Preto, Brazil, 35th Department of Internal
artefact, and image isolated slices. Whole- body helical CT Medicine, Medical School of Ribeirao Preto, University of
scanners are widely available and require only seconds per Sao Paulo, Ribeirao Preto, Brazil
scan. A previous study has explored the use of whole-body
scanners for pQCT [1] but the provision of pediatric normal Objective: To evaluate the relation among anthropometric
data has not been addressed. variables, sarcopenia and BMD at lumbar spine (LS) in post-
Material and Methods: Our 287 M & F subjects (14.4± menopausal adult women.
2.7 years; range 8–23) cohort had tibia CT imaging with QCT Material and Methods: There were selected by convenience
calibration (Mindways, Austin, TX) and pQCT using Stratec 39 postmenopausal women until 60 years old, all attending the
 Osteoporos Int

Public Hospital of Ribeirão Preto. Data were collected at smoking (17), excess alcohol use (9). Secondary causes of
Laboratory of Balance Evaluation and Rehabilitation of the osteoporosis (68) were chronic kidney disease (25), insulin
Medical School at the University of São Paulo. The subjects dependent diabetes mellitus (8), rheumatoid arthritis (7), hor-
were classified according to World Health Organization: mone therapy for breast cancer/prostate cancer (5), inflamma-
G1(T-score>−1 SD): normal BMD, G2(-1<T-score<−2.5 tory bowel disease (5), chronic liver disease (5), hyperthyroid-
SD): osteopenia and G3 (T-score<−2.5 SD): osteoporosis. ism (2), hyperparathyroidism (1), premature menopause (1)
All were submitted to LS and whole-body DXA to determine and Paget’s disease of bone (1). 14 were on long term oral
BMD and relative skeletal muscle index (RSMI). The Timed steroids. 71 % were at high risk for osteoporosis with more
up and Go Test (TUG), Handgrip Test (HG) and anthropo- than three risk factors.
metric variables measured and BMI calculated. The groups Conclusion: Identification of clinical risk factors is a recom-
were compared using t-test/Mann- Whitney test with differ- mended case finding strategy for osteoporosis. Our study
ences considered significant p≤0.05. The correlations be- shows that clinical risk factors for osteoporosis are common.
tween variables were assessed using Pearson’s analysis. Majority of them had multiple risk factors. Screening
Results: The LS BMD showed the prevalence of 39.5 % with hospitalised patients for osteoporosis can be utilised as an
normal BMD (n=15), 50 % with osteopenia (n=19) and additional opportunity to identify and treat the disease and
10.5 % osteoporosis (n=4). As only 4 women presented thereby reduce the burden of osteoporosis related falls and
osteoporosis, the statistical comparisons were done between fractures. Ideally, all the patients at high risk clinically should
G1 and G2. No differences were found for variables age, age be offered further assessment for osteoporosis. The literature
of menopause, weight, height, BMI, RSMI, TUG and HG suggests an additive effect for risk factors and guides us to
(P>0.05). Only 13.3 % of G1 and 5.3 % of G2 reached the prioritise patients who would need a DXA scan thus enabling
RSMI cutoff of 5.5 kg/m2 for sarcopenia. There were moder- an efficient use of scarce resources.1
ate correlation between LS BMD and RSMI (r=−0.34; p= References: 1. Lydick E et al. Am J Manag Care 1998;4:37
0.05) and between RSMI and TUG (r=0.39; p=0.06), but a
strong correlation between RSMI and weight (r = 0.73;
p<0.0001). P510
Conclusion: The results shown that 60 % of women presented OSTEOPOROTIC AXIS FRACTURE: DECISIONS
decrease of LS BMD, which corroborate with studies that AND COMPLICATIONS
shown changes in BMD before 65 years. Also, results suggest B. García Medrano1, M. Brotat Rodríguez1, M. Martínez
that lean mass could affect the spine BMD and the protective Ibeas1, L. García Flórez1, M. Á. Martín Ferrero1
1
factor of weight on BMD may be associated to lean mass. The Hospital Clínico, Valladolid, Spain, Valladolid, Spain
cutoff 5.5 kg/m2 for RSMI may not be appropriate for the
evaluated sample. Objective: An older person usually sustains a type II odontoid
fracture in a fall from standing or a seated height. Cervical
spine fractures in the elderly are potentially life threatening.
P509 The best treatment remains unclear because of the morbidity
OSTEOPOROSIS RISK ASSESSMENT IN AWELSH associated with prolonged cervical immobilisation versus the
DISTRICT GENERAL HOSPITAL risks of surgical intervention. Special situation would be an
S. Manupati1, K. V. Siddarth2, A. Gupta1, S. Chenna1 osteoporotic axis fracture in which first fixation could be
1
Orthogeriatrics, West Wales General Hospital, Carmarthen, complicated with another pathologies or the synthesis failure.
United Kingdom, 2Orthopaedics, West Wales General Hospi- Material and Methods: Man of 80 years old who suffered an
tal, Carmarthen, United Kingdom acute pain in his neck after a minimal effort and small fall
down, with cervical trauma. He had a 15 points Glasgow
Objective: To determine the prevalence of clinical risk factors scale, without discovering any alteration in his physical ex-
for osteoporosis in medical inpatients. amination. After X-ray and TC study, a C2 fracture was
Material and Methods: Data was collected on a patient discovered: Anderson and D’Alonzo type II odontoid fracture.
questionnaire through a point prevalence study targeting pa- The injury was reduced by open reduction and synthesis with
tients aged fifty and above. one central screw; this technique was completed by anterior
Results: 117 patients (62 female; 55 male) met the age approach and the use of an intraoperative 3D image-TC (O-
criteria. Nonmodifiable risk factors were white/Caucasian race arm).
(117), age 75 years and above (77), female sex (62), previous Results: C2/C3 joint seemed to be stable after that surgical
fragility fracture (16) family history of osteoporosis and fra- treatment; C3/C4 became to be dislocated after a discitis. It
gility fractures (4). Potentially modifiable risk factors were was decided to remove the infection soft tissue inside C3 and
restricted mobility (63), low BMI (33), frequent falls (20), C4 disc space and vertebral bodies, and replace it for two
Osteoporos Int

titanium implants and an anterior plate with screws. After Conclusion: Recognizing we studied only iDXAs, these
completing antibiotic treatment, actual outcomes offer the data suggest the BioClinica TBP behaves similar to
patient stable fixation, with normal analytic parameters and human in vivo measurements for densitometer cross-
without any radiological sign of failure. Anti-resorptive treat- calibration. Additionally, although falling within the
ment was ordered for medical support. recommended 1 % BMD and BMC, spine phantoms
Conclusion: Older patients seem to sustain Type II odontoid did not detect substantial differences in lean and fat
fractures because, during a simple fall, the rotation of the head mass observed with the TBP and in vivo assessments.
produces torque force on the osteoporotic dens-body junction. Consequently, spine phantoms alone are not adequate
Some authors defend immediate single-stage anterior- to assure whole body composition DXA cross-
posterior reduction, instrumentation, and arthrodesis, directly. calibration.
Cement- augmented screw could prevent osteoporotic failure
or collapse. O-arm offers high-resolution 2D/3D images that
facilitate the accurate and safe insertion of CPS via high
quality navigation. P512
SPONTANEOUS BONE EDEMAVS. KNEE
TRANSIENT OSTEOPOROSIS
P511 B. García Medrano1, M. Brotat Rodríguez1, M. Martínez
SPINE PHANTOMS ARE INADEQUATE FOR DXA Ibeas1, L. García Flórez1, M. Á. Martín Ferrero1
1
WHOLE BODY COMPOSITION Hospital Clínico, Valladolid, Spain, Valladolid, Spain
CROSS-CALIBRATION
D. Krueger1, J. Libber1, J. Sanfillippo1, H. J. Yu2, C. Miller2, Objective: Temporary or transient osteoporotic bone
N. Binkley1 edema is a rare disease of unknown etiology self-
1
University of Wisconsin, Madison, WI, United States, limited course, with only three cases reported in the
2
BioClinica, Newtown, PA, United States knee joint. It generates MRI hyperintensive images on
T2, suggesting spontaneous osteonecrosis. It could be,
Objective: Patient assessment continuity requires measure- in some cases, similar to algodystrophy or reflex sym-
ments be consistent between densitometers; consequently, pathetic dystrophy.
cross-calibration is necessary. To this end, when replacing a Material and Methods: 52 year old woman with right knee
DXA unit with the same model, ISCD recommends scanning pain nontraumatic NSAIDs partially sagging. Pressure pain in
phantoms 10 times on each instrument and states spine BMD medial femoral condyle. No single radiologic bone disease.
should be within 1 %, while %fat, lean and fat mass should be But the MRI shows extensive edema in the medial femoral
within 2 % of the prior instrument. We report a total body condyle bone irregularities in the subchondral bone. With the
cross-calibration experience with phantoms and humans. diagnosis of spontaneous idiopathic osteoporosis is indicated
Material and Methods: Cross-calibration between an NSAIDs and bisphosphonates; unloaded and early ambulation
existing and new Lunar iDXA was performed using 3 encap- of magnet.
sulated spine phantoms (GE-Lunar, BioClinica & Hologic), Results: After 3 months, clinically asymptomatic. A new
one body composition phantom (BioClinica) and 30 human control MRI shows decreased bone edema, with mild
volunteers. Thirty scans of each phantom and a total body subchondral lesion, informed as “suggestive of osteonecrosis
scan of human volunteers were obtained on each instrument. in evolution”. Start full charge, continuing the pattern of
Results: All spine phantom BMD means were similar (within diphosphonates. Complete recovery from pain and radiologi-
1 %) between existing and new unit, −0.010 g/cm2 bias. The cal edema sign after 15 months of follow-up and a new MRI
total body phantom (TBP) BMD and BMC values were within control.
2 % with biases of 0.005 g/cm2 and 3.3 g. However, lean, fat Conclusion: The etiology of idiopathic transient osteo-
and %fat mass measurements differed by 4.6 to 7.8 % with porosis is still unknown, although some authors relate it
biases of +463 g, −496 g and −2.8 %. In vivo comparison with microvascular injury and tissue ischemia, second-
verified TBP data; BMD/BMC were within ~2 % but lean, fat ary to trauma or vitamin C deficiency. The transient
and %fat differed from 1.6 to 4.9 % with biases of +833 g, demineralization is a self-limited, with osteoclastic ac-
−860 g and −1.2 %. As all body composition values exceeded tivity inhibited by bisphosphonates. His knowledge is
the recommended 2 %, the new instrument was recalibrated to important to avoid misunderstood, especially comple-
conform with existing scanner. Post recalibration analysis of mentary imaging tests.
in vivo scans revealed reduced bias for lean and fat; −22.7 g References: 1. Ververidis AN et al. Knee Surg Sports
and −4.6 g, reducing difference to 0.1 %. Similarly, agreement Traumatol Arthrosc 2009;17:1061
of TPB lean and fat improved. 2. Gaeta M et al. Eur Radiol 2002;12 Suppl 3:S40
 Osteoporos Int

P513 P514
CLINICAL INTERVENTION IN PATIENTS WITH HIP WHY NOT USE RESORBIBLE CEMENT IN
FRACTURE IN THE ORTHOPEDIC UNIT OF OSTEOPOROTIC YOUNG PEOPLE FRACTURES?
THE UNIVERSITY HOSPITAL OF CANARY B. García Medrano1, M. Brotat Rodríguez1, M. Martínez
ISLANDS Ibeas1, L. García Flórez1, M. Á. Martín Ferrero1
J. Alvisa Negrín 1 , A. Pérez Ramirez 1 , E. Rodriguez- 1
Hospital Clínico, Valladolid, Spain, Valladolid, Spain
Rodriguez1, O. Elvira-Cabrera1, C. Martin-Gonzalez1, J. Viña
Rodríguez1, R. Ros Vilamajó1, F. Santolaria Fernández1, M. Objective: Consequences of a bad reduction of a vertebral
Herrera Perez2, L. Lorenzo De La Peña1 osteoporotic fracture will be observed over time. The use of
1
Internal Medicine, La laguna, Tenerife, Spain, 2Servicio de acrylic cements during the fixation keeps reducing, but does
Traumatología y Cirugía Ortopédica. Hospital Universitario not eliminate the risk of late collapse at 100 % and has no
de Canarias, La laguna, Tenerife, Spain biological properties.
Material and Methods: We compared two cases of men
Objective: To evaluate bone metabolism markers, vitamin D under 50 years with vertebral fractures. Man of 22, with
status and osteoporosis treatment of elderly patients with traumatic crushing fracture A1 of L1 with the subsequent wall
fragility hip fractures admitted to the Traumatology Unit of condition and fracture A1 of T10 and T11 bodies. Reduction
our Hospital between January 1, 2011 and December 30, of L1 fracture is carried on through kyphoplasty Spine-Jack
2011. and instrumentation USS T12-L2. Election of a resorbable
Material and Methods: 103 elderly patients with hip frac- ceramic cement of calcium sulphate, injected under x-ray
tures admitted during the study period in our orthopedic unit control. Forty-seven years-old male with back pain after a
were included. Demographic data, comorbidities, nutritional minimal effort. Height loss of vertebral bodies L3, L5, and
status, previous diagnosis of osteopenia or osteoporosis and D12. After rejecting serious underlying pathology, D12 and
osteoporosis treatment were analyzed. Vitamin D levels (25- L5, the most severe levels, were fixed by reduction and
hydroxyvitamin D) and bone metabolism markers were conventional cement balloon kyphoplasty, recovering 40 %
studied. and 30 % loss of height, respectively. Biopsy and X-Ray
Results: 103 patients were included with a mean age of 78± absorptiometry were decisive to confirm osteoporosis
12 year-old, 23 % male and 77 % women. Mean level etiology.
of 25-hydroxyvitamin D was 33±18 ng/ml. We found Results: The evolution was favorable describing rapid im-
vitamin D insufficiency in 77 % of patients (22.1 ± provement in pain. No radiological signs of vertebral bodies
3.5 ng/dl) and was more frequent among patients with collapse or alignment deformity in any case. X- Ray and CT at
dementia. Previous diagnosis of osteoporosis were 18 months, in the first man, denoted a positive osseo-
established in 20 % of patients. However less than integration of cement; the biomaterial began to deteriorate
9 % were taken calcium or vitamin D and only 5 % and the radiographic image showed that the radiopacity was
of patients received bisphosphonates before the fracture. becoming more tenuous, indicating reabsorption.
No relationship among vitamin D concentrations, falls Conclusion: The vertebral fracture status is a powerful and
and fractures were found in this population. Proximal independent risk factor for all new fractures, which is a great
femur fractures were present in 82.7 % of patients (hip health care problem. Our goal is the anatomical reduction. The
fractures 73.7 %). Hip fractures were more frequent in mechanism of pain relief of percutaneous kyphoplasty is
women (p=0.03). Clinical evaluation and medical care related to the stabilization of micromovements, the prevention
during hospitalization was performed by an internist of progressive collapse by cement augmentation, and to ther-
assigned to the orthopedic service. Secondary prevention mal and chemical nerve ablation. Consolidation will deter-
of fractures was initiated before discharge in 70.4 % of mine the prognosis. We will make progress in the study of
patients with calcium-vitamin D and bisphosphonates in biocompatible materials with osteogenic capacity.
34 % of patients.
Conclusion: In this population mean levels of 25-
hydroxyvitamina D were normal and no relationship
with fractures or falls were found. Clinical intervention P515
during hospitalization performed by an internist REGULATION OF OSTEOCLAST
achieved an increased rate of prescription of anti- DIFFERENTIATION AND FUNCTION BY
osteoporotic treatment after admission. Interventions to MICRORNA-124
improve early diagnostic and treatment of osteopenia- Y. Lee1
1
osteoporosis and management post-fracture need to be Department of Biochemistry, School of Dentistry,
developed and implemented. Kyungpook National University, Daegu, Republic of Korea
Osteoporos Int

Objective: Osteoclasts are specialized cells for bone- of 25(OH)D was determined in 1,226 participants (1,106
resorption originated from precursors of macrophage/ adults and 120 children/adolescents) by chemiluminiscent
monocyte lineage. The receptor activator of NFκB ligand method on AbbottArchitect 8000 (USA) with commercial
(RANKL) initiates osteoclast differentiation, in which nuclear reagents (Abbot, USA). Were used different vitamin D defi-
factor of activated T cell cytoplasmic 1 (NFATc1) plays a key ciency criteria (Institute of Medicine (IOM), 2011 and Endo-
role as a master transcription factor. MicroRNAs are small crine Society (ES), 2011).
RNAs involved in numerous cellular functions. However, Results: The serum 25(OH)D level was from 9.8 to
their role in osteoclastogenesis have been rarely studied. 147.5 nMol/L: main level in adults St. Petersburg population
Material and Methods: Osteoclasts were differentiated −54.8± 0.7 nMol/L, in Petrozavodsk population −49.6±
in vitro from mouse bone marrow macrophages in the pres- 1.6 nMol/L, in children/adolescents −46.8±1.6 nMol/L. The
ence of M-CSF and RANKL. The expression and the role of 25(OH)D in women was lower than in men (53.9±0.8 nMol/
miR-124 were investigated by real-time RT-PCR, western blot L, 67.2±2.2 nMol/L, accordingly; p<0.01). Overweight and
analysis, and osteoclast migration assays. obese people had lower 25(OH)D level than one with normal
Results: In the present report, we show that microRNA-124 BMI (44.8±2.0 nMol/L and 52.5±2.8 nMol/L, p<0.05). We
(miR-124) regulates osteoclastogenesis of mouse bone mar- found negative correlations between serum 25(OH)D and
row macrophages by suppressing NFATc1 expression. On the BMI in adults and children (r=−0.17, p=0.03 and r=−0.41,
other hand, synthetic inhibitor that binds specifically to miR- р=0.03) and WC (r=−0.15, p=0.02) (only for adults). We
124 enhanced osteoclast differentiation and NFATc1 expres- found high prevalence of vitamin D deficiency. When apply-
sion. The overexpression of a constitutively active form of ing ES criteria for vitamin D deficiency we revealed that
NFATc1 prevented the inhibitory effect of miR-124 on osteo- 16.8 % of the all study population had a normal vitamin D
clastogenesis. Finally, miR-124 also affected the proliferation level, up to 37.5 % had insufficiency and 45.7 % deficiency of
and motility of osteoclast precursors, the latter coinciding with vitamin D. On the other hand when applying the IOM criteria,
the reduced expression of RhoA and Rac1. 49.6 % showed to have normal level, 40.0 % were insufficient
Conclusion: These findings not only reveal unprecedented and only 10.4 % were deficient in vitamin D.
role of miR-124 in osteoclastogenesis but also suggest a novel Conclusion: The results of this study showed high prevalence
mode of regulation of NFATc1 in osteoclasts. vitamin D insufficiency and deficiency in residents of the
Acknowledgements: This work was supported by a grant of northwest region of Russian Federation.
the Korea Healthcare Technology R&D project, Ministry of Acknowledgements: Russian Ministry Health program 2012-
Health and Welfare, Republic of Korea (A120195, Y.L.) and 14, #01201254545
by the National Research Foundation of Korea (NRF) funded
by the Ministry of Science, ICT & Future Planning
(2012M3A9B6055415, Y.L.). P517
OSTEOPROTECTIVE EFFECT AND SUSTENANCE
OF TRABECULAR MICRO-ARCHITECTURE BY
P516 LIPOSOME-GLYCOL-CHITOSAN BASED
PREVALENCE OF VITAMIN D DEFICIENCY IN DELIVERY SYSTEM OF WITHAFERIN A
RESIDENTS OF NORTHWEST RUSSIAN REGION V. Khedgikar1, P. Kushwaha1, J. Gautam1, A. Verma2, S.
T. L. Karonova1, I. L. Nikitina1, A. T. Andreeva2, P. V. Globa2, Sharma2, N. S. Sangwan3, P. Trivedi4, P. Ranjan Mishra2, R.
E. V. Tsvetkova1, E. Y. Vasilieva1, E. N. Grineva1 Trivedi1
1 1
Federal Scientific R esearching Medical Centre Division of Endocrinology, Central Drug Research Institute,
V.A.Almazov, St. Petersburg, Russian Federation, 2St. Peters- CSIR-CDRI, Lucknow, India, 2Division of Pharmaceutics,
burg State Medical University I.P.Pavlov, St. Petersburg, Rus- Central Drug Research Institute, CSIR-CDRI, Lucknow, In-
sian Federation dia, 3CSIR-Central Institute of Medicinal and Aromatic
Plants, Lucknow, India, 4Plant Gene Expression Laboratory,
Objective: Recent studies suggest high prevalence of vitamin CSIR-National Botanical Research Institute, Lucknow, India
D deficiency in the world. Russian Federation has geographic,
demographic and economic preconditions for development of Objective: To enhance the osteoprotective effect of withaferin
vitamin D insufficiency and deficiency. We examined resi- A (WFA) by formulating WFA with liposomes-glycol chito-
dents from northwest region of Russia Federation (St. Peters- san delivery system. The efficacy of this formulation was
burg and Petrozavodsk) and analysed serum 25(OH)D level to assessed after treatment and withdrawal in a rodent model
study a prevalence of vitamin D deficiency. for postmenopausal osteoporosis.
Material and Methods: Were examined 1,654 residents (in- Material and Methods: liposome based formulation was
cluding 1,349 adults and 120 children and adolescents). Level developed using DSPC, Soya PC and cholesterol (7:3:3 mols).
 Osteoporos Int

Formulated WFA was administrated in rodent model at multivariable analysis, no significant or monotone association
10 mg/kg dose and plasma was withdrawn for bioavailability. was observed between persistence and hip fracture incidence,
For postmenopausal model, Balb/c mice were bilaterally where patients with PDC of 20–79 % demonstrated reduced
ovariectomized and kept for 8 weeks to achieve osteopenic risk compared to nonpersistent patients (<20 %) with HR of
condition. After 8 weeks the mice were administrated with 0.84 (95%CI: 0.56–1.26) and patients with PDC≥80 % ex-
different doses (WFA, WFA+formulation and PTH) for hibited increased risk with HR of 1.22 (95%CI: 0.84–1.80)
8 weeks. For withdrawal studies treated mice were analyzed compared to non-persistent. Hip fractures were significantly
at day 15 and day 30 using μCT. associated with age, diabetes, and use of benzodiazepines and
Results: Developed formulation (WFA/GC-Lip) showed en- glucocorticoids.
hanced WFA bioavailability in rodent against plain WFA at Conclusion: These results indicate that persistence to
the same dose 10 mg/kg. WFA/GC-Lip promotes bone mar- bisphosphonates therapy among postmenopausal women is
row cell differentiation by enhancing expression osteogenic inadequate, with no evidence of a negative association be-
molecular markers. As a result of enhanced differentiation of tween persistence and hip fracture risk. Further study is in
cells, there was increased bone marrow osteoprogenitor cell place to examine alternative methodology to quantify expo-
mineralization, new bone formation and improved trabecular sure instead of PDC, and gain a better understanding of the
micro-architecture in osteopenic bones. Withdrawal of formu- mechanisms of action of bisphosphonates.
lated WFA show sustainment of bone trabecular micro-
architecture up to day 15 and gradually decreases at day 30
comparable to FDA approved bone anabolic drug iPTH. P519
Conclusion: Overall, our results show that WFA/GC-Lip CHONDROCYTE HYPERTROPHY, MEASURED BY
formulation modulated the pharmacokinetic parameters of THE SECRETION OF COLLAGEN TYPE X, IS
existing drugs by providing mucoadhesive properties that ASSOCIATED WITH CARTILAGE DEGRADATION
resulted in the increased plasma concentration as well as the AND SYSTEMIC INFLAMMATION IN
half-life of WFA. This novel formulation based strategy pro- OSTEOARTHRITIS
vides preclinical data for reducing risk of fracture, improving A. C. Bay-Jensen1, Y. He1, K. K. Petersen2, O. Simonsen2, L.
bone health in postmenopausal osteoporosis and maintains its Lindhardt Egsgaard3, T. Eskehave3, H. C. Hoeck3, M. A.
effect after withdrawal of treatment comparable to iPTH. Karsdal4
1
Rheumatology, Nordic Bioscience, Herlev, Denmark, 2Dept.
Orthopedic Surg, Aalborg, Denmark, 3Center for Clinical and
P518 Basic Research and C4Pain, Aalborg, Denmark, 4Rheumatol-
REAL-WORLD DATA ON PERSISTENCE WITH ogy, Herlev, Denmark
BISPHOSPHONATES THERAPYAND THE RISK OF
HIP FRACTURES Objective: Osteoarthritis (OA) is the most common degener-
I. Goldshtein1, V. Shalev1, C. Weil1, Y. Sharon2, Y. Weisman3, ative joint disease, of which the pathogenesis is inadequately
G. Chodick1 understood. Hypertrophic changes have been observed in the
1
Medical Division, Maccabi Healthcare Services, Tel Aviv, initiation and progression of OA. The aim of this study was to
Israel, 2Sackler Faculty of Medicine, Tel Aviv, Israel, 3Bone investigate the relationships of chondrocyte hypertrophy, car-
Disease Unit, Tel Aviv Medical Center, Tel Aviv, Israel tilage degradation and systemic inflammation by measuring
three biomarkers in serum of OA patients.
Objective: To provide real-world data on the long-term effec- Material and Methods: A competitive ELISA, C-Col10, was
tiveness of bisphosphonates therapy for reducing the risk of developed as a marker of chondrocyte hypertrophy. C-Col10,
hip fractures in postmenopausal women. C2M (MMP fragments of type II collagen) and hsCRP were
Material and Methods: The computerized databases of quantified by ELISA in 271 patients, stratified by Kellgren-
Maccabi Healthcare Services in Israel were used to retrospec- Lawrence (KL) score 0–4. Pearson correlations were done
tively follow women aged 60 –75 who initiated comparing the levels of the biomarkers. The data is shown
bisphosphonates therapy in 2002–2007. Study outcomes were as mean [95 %-CI]. Full-depth cartilage biopsies from OA
diagnosis and/or surgery for hip fracture. Persistence with patients with different disease stages were stained for ColX
bisphosphonates was assessed by calculating the proportion and C2M.
of days covered (PDC). Results: There was a trend towards increasing C-Col10 levels
Results: During the study follow-up (50,630 person-years, with increasing KL score: KL0 52[24–80] pg/ml (n=10); KL1
median follow-up of 6 years), 218 incident hip fractures were 65[54–76] pg/ml (n=59); KL2 86[73–98] pg/ml (n=144);
documented among the study population (n=8563). 40 % KL3 80[60–101] pg/ml (n=36); and KL4 87[47–127] pg/ml
were persistent with bisphosphonates (PDC≥80 %). In a (n=22). There was a significant correlation of levels between
Osteoporos Int

C-Col10 and hsCRP (r=0.23, P<0.0001), and C2M (r=0.55, Conclusion: Our data highlights vitamin D toxicity as an
P<0.0001). OA patients with elevated levels of hsCRP (>5) emerging and potentially fatal health problem related to indis-
showed increased C-Col10 independent of cartilage degrada- criminate and inappropriate therapeutic use of vitamin D.
tion. The immunolocalization showed that ColX was in the
deep zone around the pre- hypertrophic chondrocytes in mild
OA and around chondrocyte clusters. C2M was observed in
all layers of the OA cartilage. P521
Conclusion: Serum C-Col10 levels were significantly higher EVALUATION OF TREATMENT EFFICACY OF
in patients with above normal hsCRP levels, suggesting that ORLISTAT IN OBESE WOMEN WITH KNEE
inflammation is associated with chondrocyte hypertrophy. OSTEOARTHRITIS
Correlation between C-Col10 and cartilage degradation indi- E. Strebkova1, I. Solovyeva2, E. Sharapova1, A. Mkrtumyan2,
cated that chondrocyte hypertrophy may be involved in the L. Alekseeva1
1
cartilage degradation. The data show that chondrocyte hyper- Federal State Budgetary Institution, Research Institute of
trophy is an essential step in the pathogenesis of OA. Rheumatology V.A. Nasonova, Russian Academy of
Acknowledgements: The study was supported by Danish Medical Sciences, Moscow, Russian Federation, 2Mos-
Advanced Technology Foundation. cow State University of Medicine and Dentistry, Mos-
cow, Russian Federation

P520 Objective: Osteoarthritis (OA) is an important social and

IS INCREASED AWARENESS OF VITAMIN D medical problem. Obesity is an significant modifiable risk
DEFICIENCY RESULTING IN AN EPIDEMIC OF factor for the development and progression of knee OA.
VITAMIN D TOXICITY? Material and Methods: The study included 50 women, aged
S. K. Mishra1, P. Kaur1, A. Dasgupta1, A. Mithal1 45–65 years with knee OA stage II-III Kellgren-Lawrence and
1
Endocrinology & Diabetes, Gurgaon, India obesity (BMI>30 kg/cm2). Obese patients were randomized
into 2 groups. Group 1 (25 patients) took orlistat a dose of
Objective: Widespread prevalence of vitamin D deficiency 120 mg 3 times daily for 6 months in combination with a low
has been reported from India across all ages and regions. calorie diet and physical activity. Group 2 (25 patients)
Increased awareness of vitamin D deficiency related health nonpharmacological therapy of obesity (hypocaloric diet and
problems among health professionals and general population physical activity). Functional index WOMAC, quality of life
has resulted in ordering of a greater number of serum 25(OH) according to VAS were evaluated.
vitamin D test. Further it has led to availability of numerous Results: Weight reduction was more signified in the group of
vitamin D formulations (oral and intramuscular) for treatment. patients on orlistat therapy by 9.05 %, compared with patients
There is thus increased usage of vitamin D preparations by all who were only on a hypocaloric diet where the weight has
medical specialties in India. decreased by 2.54 %. WOMAC pain for patients who are on
Material and Methods: We analyzed our hospital database orlistat therapy decreased by 48.7 % and was significantly
for serum 25(OH) vitamin D performed over 3 years (2011– lower (p=0.012) than in the second group, where the rate
2013). declined by only 32.2 %. Similar changes were observed in
Results: During this period 46,348 tests were performed for functional failure: the dynamics of this index in the first group
serum 25(OH) vitamin D. The number has increased 6-fold was significantly lower than in the second group (p=0.004) (a
from 3,874 (2011) to 25,332 (2013). The proportion of pa- decrease of 49.75 % and 32.77 %, respectively). After
tients with vitamin D deficiency (<20 ng/ml) was 52–56 %. Of 6 months against the background of the weight reduction the
the total 46,348 tests, 226 had serum 25(OH) vitamin D level total index WOMAC decreased in both groups (at 49.31 %
above 150 ng/ml. During this period 20 cases of vitamin D and 32.9 %, respectively), but was significantly lower in the
toxicity related hypercalcemia were managed at our center. group treated with orlistat (p=0.006). Moreover, in this group
Azotemia was recorded in 9 cases, neurological manifesta- revealed a significant improvement of life quality compared
tions were seen in 5 cases and 2 had pancreatitis. Of the with those with a smaller weight loss (p<0.001).
patients who presented with vitamin D toxicity related hyper- Conclusion: Our study demonstrated that weight loss, espe-
calcemia, 18 cases had received frequent intramuscular vita- cially while taking drugs that reduce weight by obese patients
min D formulations and 2 had long term high dose oral with knee OA leads to a reduction in the clinical developments
preparations. Hypercalcemia management resulted in normal- of knee OA: relieve pain and improve the functional state of
ization of calcium and improvement in clinical status in all the knee. In this connection, drugs that affect the weight loss
except one case where death occurred because of aspiration should be included in the treatment regimen of patients with
pneumonia. OA and obesity.
 Osteoporos Int

P522 Lyon, France, 5INSERM UMR 970 - Service de Néphrologie,

COMPREHENSIVE TREATMENT OF Hôpital Européen Georges Pompidou, Paris, France,
6
OSTEOPOROSIS WITH KNEE OSTEOARTHRITIS INSERM UMR 1059-Université de Saint Etienne, Saint
J. Yang1, G. Wang1, Y. Zhu1 Etienne, France, 7Departement de Néphrologie - CARMEN,
1
Putian First Affiliated Hospital of Fujian Medical University, INSERM UMR 1060-Université de Lyon, Lyon, France
Putian, China
Objective: Hemodialysis (HD) patients have a high cardiovascu-
Objective: Through to the knee osteoarthritis patients with lar mortality risk. Severe abdominal aortic calcifications (AAC) are
osteoporosis with comprehensive treatment, the treatment was predictive of cardiovascular morbidity. In chronic kidney disease
observed. patients, bone biopsies showed that higher AAC score was asso-
Material and Methods: From June 2009 to March 2009 ciated with lower bone turnover. The Wnt inhibitor sclerostin
admitted to our department, 86 cases of knee osteoarthritis acting on osteoblast to reduce bone formation, may favor adynam-
with osteoporosis patients, 23 cases of male, female 63 cases, ic bone. Thus we hypothesized that higher sclerostin may be
48–91 years old, mean age 58.18±17.25 years, all of the associated with higher AAC score in HD patients.
patients had the symptom such as knee joint swelling and Material and Methods: Morning fast serum before HD were
tenderness, the X-ray, CT and/or MRI examination confirmed used to assay sclerostin and other parameters. Framingham
that osteoarthritis, BMD instrument detection in the diagnosis score was computed for each patient. HR-pQCT was per-
of osteoporosis, 86 patients were randomly divided into treat- formed at the tibia. AAC score was assessed according to
ment group and control group (n=43), the control group given Kauppila method on lateral spine imaging using DXA. Our
cervus and cucumis polypeptide Injection 160–200 mg/day; primary criterion was the high AAC score corresponding to
calcitriol, 0.25 QD; glucosamine hydrochloride capsule 0.24 the highest quartile of AAC score.
TID; celecoxib,0.2, QD; 2 weeks treatment. The treatment Results: Fifty three HD patients, aged 53 [35–63] median
group with subcutaneous injection with calcitonin 50 units, [Q1-Q3] were included. In univariate analysis, sclerostin, age,
QD, for 2 weeks treatment, the Lysholm knee score before and high Framingham score and cortical thickness were associated
after treatment in both groups, joint pain intensity evaluation with an increased risk of high AAC score. In multivariate,
method (VAS) to evaluate the curative effect. Using SPSS association between serum sclerostin and high AAC score
software for data analysis, all dose data expressed as a mean remained significant after adjustment on age, HD duration,
standard deviation. Measurement data between the two groups diabetes, smoking, 25OH-vitamin D, CRP and cortical thick-
of mean more use of two independent sample t-test; Group ness (OR[95%CI]=9.62 [1.40–66.05]; p=0.02). In a cardio-
before and after treatment of measurement data of mean vascular perspective, we performed another model adjusted
compare with paired t-test; P0.05 significant for differences. on high Framingham score and previous confounders.
Results: Two groups of patients after treatment Lysholm knee Sclerostin remained associated with high AAC score (OR=
score and pain in the knee joint were improved P<0.05, and 12.96 [2.12–79.14]; p=0.006) whereas cortical thickness was
the treatment group effect better P<0.05. protective (OR=0.13 [0.02–0.98]; p=0.048).
Conclusion: Cervus and cucumis polypeptide, calcitriol, glu- Conclusion: Sclerostin is associated with AAC in HD pa-
cosamine hydrochloride and celecoxib comprehensive treat- tients. Sclerostin may contribute directly or indirectly to the
ment with calcitonin for knee osteoarthritis can rapidly im- bone-vascular axis in renal deficiency.
prove symptoms, improve patient quality of life, worthy of
clinical popularization and application.
P524
THE RELATIONSHIP BETWEEN
P523 25-HYDROXYVITAMIN D AND PTH AND BONE
SCLEROSTIN AND CORTICALTHICKNESS ARE MINERAL DENSITY IN HEALTHY PEOPLE IN
ASSOCIATED WITH SEVERE VASCULAR PUTIAN AREA IN FUJIAN
CALCIFICATIONS IN HEMODIALYSIS PATIENTS G. Wang1, J. Yang1
C. B. Confavreux1, S. Pelletier2, J. Haesebaert3, M. C. 1
Orthopedics, Gerontology Department, Fujian Fist Affiliated
Carlier4, G. London5, M. H. Lafage6, R. D. Chapurlat1, D. Hospital of Fujian Medical University, Putian, China
Fouque7
1
INSERM UMR1033 - Université de Lyon, Lyon, France, Objective: Through the investigation of Fujian Putian area
2
INSERM UMR1033 - Université de Lyon - Departement Chinese healthy people serum 25-hydroxyvitamin D(25OHD)
de Néphrologie, Lyon, France, 3Pôle Information Médicale and PTH levels and BMD, analysis of healthy people in Putian
Evaluation Recherche, Hospices Civils de Lyon, Lyon, area and to evaluate its relationship with BMD in winter
France, 4Fédération de Biochimie, Hospices Civils de Lyon, vitamin D status
Osteoporos Int

Material and Methods: In 2010, October to December, the enrolled. Patients with restricted joint movement or acute knee
investigation of 613 cases of healthy people, male 183 cases, pain which could affect physical activity level were excluded.
female 430 cases, age 10–94 years, mean age 55.96±15.51. VAS was used for assessment of pain severity. International
Apparatus and reagents used Roche, blood examination of Physical Activity Questionnaire-Short Form (IPAQ-SF), Beck
serum 25OHD, PTH. At the same time, the United States Depression Inventory (BDI), Pittsburgh Sleep Quality Index
Osdeometer application Medi Tech company production of (PSQI) and SF-36 Health Survey were completed for all
type DTX-200 bone density measurement, the radial forearm patients. Based on IPAQ-SF scores, patients with a score equal
distal ulna 1/3 BMD. The levels of serum 25OHD were to or lower than 600 MET-min/week were included in inade-
divided into severe deficiency as 25OHD less 25OHD more quate activity group (IAG) (n=28) and those with greater
than 20 ng/ml and less than 30 ng/ml, and sufficiency as scores included in physically active group (PAG) (n=27).
25OHD more than 30 ng/ml. Results: There was no significant difference between IAG
Results: 613 cases of serum 25OHD measuring average value and PAG in mean age (72.7±5.9 and 69.8±4.6, respectively),
of 15.76±8.88 ng/ml, serum 25OHD had no relationship with average pain rating by VAS (7.2±1.9 and 6.6±2.3) and BMI
gender or age. It positively related to BMD and had no relation (28.8±4.3 and 27.2±4.1 kg/m2) (all p>0.05). Mean BDI score
with PTH. The number of people with severe deficiency, of IAG (15.6±9.8) was significantly greater than that of PAG
deficiency, relatively insufficiency, and sufficiency was 122 (10.2±5) (p=0.015). However, mean PSQI score of IAG (7±
(19.9 %), 237 (38.66 %), 197 (32.14 %) and 57 (9.3 %), 4.5) was not significantly different from that of PAG (5.5±
respectively. The total 25OHD deficiency and insufficiency 3.5) (p=0.242). IAG had significantly lower SF-36 scores in
accounted for 90.7 %. physical health domain (33.7±11.3 and 42±13.3) (p=0.016),
Conclusion: In healthy population in Putian in the winter of physical role subscale (27.7±43.8 and 63.9±47.2) (p=0.008)
the lack of vitamin D, vitamin D nutritional status was signif- and physical functioning subscale (46.6±25 and 61.5±28.4)
icantly associated with BMD, and PTH was not related. BMD (p=0.04) compared to those achieved in PAG.
associated with vitamin D is consistent with the Changchun Conclusion: Among patients with chronic knee OA with
City Zhang Mengmeng reported, and PTH is not obvious, and comparable pain severity, those with greater physical activity
the city of Shanghai Wang pure reported no correlation is were found to have a better quality of life and low tendency to
consistent. In this study, the serum levels of 25OHD with an develop depression. Regular physical activity should not be
average of 15.76±8.88 ng/ml, its value is Chongqing hospital neglected during management of knee OA.
patients is high, but compared to Shanghai’s low. Vitamin D
deficiency is a risk of osteoporosis and osteoporotic fracture
factors is important and independent risk factors, which af-
fected by the impact of sunshine, exercise and nutrition P526
factors. BONE MINERAL DENSITY IN GRAVIDA: EFFECT
OF PREGNANCIES AND BREASTFEEDING IN
WOMEN OF DIFFERING AGES AND PARITY
P525 D. Elstein1, Y. Mishukov2, L. Babchenko1, A. Samueloff 3, A.
RELATION OF PHYSICAL ACTIVITY LEVELWITH Zimran1, E. Lebel2
1
QUALITY OF LIFE, SLEEP AND DEPRESSION IN Gaucher Clinic, Shaare Zedek Medical Center affiliated with
PATIENTS WITH KNEE OSTEOARTHRITIS Hebrew University-Hadassah School of Medicine, Jerusalem,
E. Mesci1, A. Icagasioglu1, N. Mesci2, S. Turan Turgut3 Israel, 2Orthopedic Surgery/Shaare Zedek Medical Center,
1
Medeniyet University, Göztepe Training and Research Hos- Jerusalem, Israel, 3Obstetrics & Gynecology/Shaare Zedek
pital, Department of Physical Medicine and Rehabilitation, Medical Center, Jerusalem, Israel
İstanbul, Turkey, 2Haydarpaşa Numune Training and
Research Hospital, Department of Physical Medicine Objective: To evaluate BMD in women of differing parity
and Rehabilitation, İstanbul, Turkey, 3Karaman State and lactation histories immediately post-partum to ascertain
Hospital, Department of Physical Medicine and Rehabil- whether there is a quantitative and/or qualitative difference in
itation, Karaman, Turkey BMD (based on T-scores and Z-scores) based on the cumula-
tive months of pregnancies and approximate cumulative
Objective: Knee osteoarthritis (OA) represents a major cause months of breastfeeding based on parity and/or age.
of morbidity due to associated pain and physical disability. We Material and Methods: All women still in hospital postpar-
aimed to evaluate the effects of physical activity on quality of tum were asked to participate. BMD was performed on a
life, depression and sleep in patients with chronic knee OA. standard DXA machine (Hologic, Bedford MA USA) by a
Material and Methods: Fifty-five patients (30 females, 25 single technician. Results included BMD, T-scores, and Z-
males) fulfilling ACR diagnostic criteria for knee OA were scores at femoral neck (FN) and lumbar spine (LS).
 Osteoporos Int

Results: IRB (Helsinki Committee) approval was received. Conclusion: These results can be explained with improving
Of 132 women who participated, 73 (55.3 %) were ≤30 years; the knowledge about Gemmotherapy, which use only embry-
27 (20.5 %) were primiparous; 36 (27.3 %) were grand- onic tissues of plants. These embryonic tissues macerated in a
multiparous; 35 (26.5 %) never breastfed. Mean FN T-scores mixture of water, alcohol and glycerine, are used to manufac-
and Z- scores were higher than respective mean LS scores, but ture solutions in which active principles of plants are concen-
all means for the group were within the normal range. Mean trated, so have higher therapeutic efficiency.
LS T-scores Z-scores were highest in the grand- multiparas.
Only 2 (1.5 %) outliers with low Z-scores might have transient
osteoporosis.
Conclusion: In a large cohort of Israeli women with BMD P528
parameters assessed by DXA within 2 days postpartum, mean TOTAL SERUM 25(OH)D LEVELS MISCLASSIFY
T-scores and Z-scores at both the LS and FN were within VITAMIN D STATUS IN SAUDI MEN AND WOMEN:
normal range regardless of age (20–46 years), parity (1–13 THE ROLE OF VITAMIN D-BINDING PROTEIN
viable births), and history of prolonged months of lactation M. S. M. Ardawi1, A. A. Rouzi2, M. H. Qari3, A. Y. Ali4, G. Y.
(up to 11.25 years). Refai4, S. A. Mousa5
1
Center of Excellence for Osteoporosis Research and Depart-
ment of Clinical Biochemistry, Faculty of Medicine, King
P527 Abdulaziz University Hospital, King Abdulaziz University,
DEVELOPMENT OF USE HERBAL REMEDIES FOR Jeddah, Saudi Arabia, 2Center of Excellence for Osteoporosis
POSTMENOPAUSAL OSTEOPOROSIS Research and Department of Obstetrics and Gynecology, Fac-
A. Pallag1, F. Cioara2, N. R. Suciu3, A. Honiges4 ulty of Medicine, King Abdulaziz University Hospital, King
1
University of Oradea, Faculty of Medicine and Pharmacy, Abdulaziz University, Jeddah, Saudi Arabia, 3Center of Ex-
Romania, Oradea, Romania, 2Medical Rehabilitation, Univer- cellence for Osteoporosis Research and Department of
sity of Medicine and Pharmacy Oradea, Oradea, Romania, Haematology, Faculty of Medicine, KAU Hospital, King
3
Medical Rehabilitation Hospital, Oradea, Romania, 4Vasile Abdulaziz University, Jeddah, Saudi Arabia, 4Center of Ex-
Goldis Western University of Arad, Romania, Arad, Romania cellence for Osteoporosis Research, King Abdulaziz Univer-
sity, Jeddah, Saudi Arabia, 5Pharmaceutical Research Insti-
Objective: The study represents an analysis on the use and tute, Albany College Pharmacy and Health Sciences, New
evolution of using the herbal remedies in postmenopausal York, United States
osteoporosis in last 3 years (2011–2013).
Material and Methods: Herbal remedies offers natural and Objective: Low levels of total 25-hydroxyvitamin-D
noninvasive solutions for patients. Phytotherapy in the treat of [25(OH)D] are highly prevalent among Saudi men and wom-
the postmenopausal osteoporosis focuses on the use of plants en, most were classified as vitamin D deficient. We hypothe-
whose main functions are to help calcium absorption and have sized that changes in the levels of vitamin D-binding protein
estrogenic properties that compensate for the loss of the estro- (VDBP) may explain vitamin D deficiency (VDD) in Saudi
gen. More clinical trials indicate that phytotherapy may be a men and women. The aim of the present study was to deter-
potential treatment for postmenopausal osteoporosis and cur- mine whether variations in circulating levels of VDBP and/or
rent evidence suggests that phytotherapy may possess a sim- genotypes contribute to the observed high prevalence of VDD
ilar effect on BMD values but is not associated with a high among Saudi men and women.
incidence of uterine bleeding and breast pain as is hormonal Material and Methods: A total of 1985 healthy Saudi men
therapy. In postmenopausal osteoporosis phytotherapy recom- (n=960) and women (n=1025) (age range: 25–60 years) liv-
mends tincture of Anethum graveolens, tincture of ing in the Jeddah area were randomly selected and studied
Glycyrrhiza glabra, tincture of Salvia officinalis, tincture of during a health survey. Anthropometric parameters, socioeco-
Urtica dioica, tincture of Valeriana officinalis, tincture of nomic status, together with serum total 25(OH)D, VDBP,
Melissa officinalis Equisetum arvense herba, gemoderivates PTH, Ca and PO4 level measurements were recorded. BMD
of Pinus silvestris (pine buds), gemoderivates of Rubus was measured by DXA. We genotyped participants for two
idaeus, gemoderivates of Rubus fructicosus, gemoderivates common polymorphisms in the VDBP gene (namely: rs7041
of Rosa canina (rosehip buds), gemoderivates of Pinus mon- and rs4588). Bioavailabe 25(OH)D was estimated.
tana (juniper buds) gemoderivates of Rosmarinus officinalis. Results: The serum level of VDBP was low due to the high
Results: Our results show a continuous increase in the use of prevalence (65.0 %) of the common genetic variant (rs7041)
herbal products, but especially in the use of gemoderivates, among Saudi men and women. Subjects classified with VDD
which is observed an increase of 26 % in 3 years. In the same showed lower levels of VDBP (μmol/L) [(2.71±0.82) and
time all herbal products consumption increases with 20 %. women (2.66 ± 0.89)] resulting in levels of bioavailable
Osteoporos Int

25(OH)D similar to those considered vitamin D sufficient the ones with worst persistence: adjusted SHR 1.45 [95%CI
according to total 25(OH)D level classification. 1.42–1.47], 1.46 [1.42–1.48], and 1.73 [1.57–1.87] for stron-
Conclusion: The results suggest that low serum total tium ranelate, daily raloxifene, and daily risedronate,
25(OH)D levels do not uniformly indicate VDD and call into respectively.
question routine supplementation in subjects with low serum Conclusion: 5-year persistence with available therapies for
25(OH)D and VDBP levels. Racial differences in the preva- Osteoporosis is very low. Whilst only monthly risedronate has
lence of common genetic polymorphisms of VDBP may lower cessation rates, all daily drugs have up to 70 % higher
contribute to such misclassification of vitamin D status among cumulative discontinuation rates than alendronate.
Saudi men and women. Disclosures: Partial (unrestricted) support from Amgen
Spain.

P529
LONG-TERM (UP TO 5 YEARS) PERSISTENCE P530
WITH DIFFERENT ANTI-OSTEOPOROSIS BONE MICROARCHITECTURE (TBS) AND BONE
MEDICATIONS IN CATALONIA (SPAIN): A MASS DEVELOPMENT DURING CHILDHOOD AND
POPULATION-BASED COHORT STUDY ADOLESCENCE IN A SPANISH POPULATION
C. Carbonell-Abella1, X. Nogues2, A. Pages-Castella3, A. GROUP
Diez-Perez2, D. Prieto-Alhambra4 L. Del Rio1, S. Di Gregorio2, R. Winzenrieth3
1 1
Institut Catala de la Salut and IDIAP Jordi Gol, Barcelona, CETIR Grup Medic, Barcelona, Spain, 2CERIR Grup Mèdic,
Spain, 2Musculoskeletal Research Unit, IMIM-Parc Salut Barcelona, Spain, 3R&D Department, Med-Imaps, Bordeaux,
Mar, Barcelona, Spain, 3IDIAP Jordi Gol, Barcelona, Spain, France
4
NDORMS, University of Oxford, IMIM-Parc Salut Mar, and
IDIAP Jordi Gol, Barcelona, Spain Objective: To evaluate bone microarchitectural texture as
assessed by trabecular bone score (TBS) and bone mass
Objective: Most of reports from different countries suggest modification at spine in children of both sexes.
very low persistence with oral bisphosphonates, but there is a Material and Methods: The study group was composed by
scarcity of data regarding other anti-osteoporosis (OP) medi- 4,126 children and adolescents of both sexes. (2,606 girls and
cations. Our aim was to compare persistence to all available 1,520 boys). Age range 0–19 years. Height, weight and BMI
outpatient oral anti-OP drugs up to 5 years after therapy Z-scores were evaluated and compared with Spain growth
initiation. standards. Pubertal stage was evaluated using Tanner score.
Material and Methods: Population-based retrospective co- TBS was evaluated using TBS iNsight v2.0 (Medimaps,
hort study using data from primary care computerized records France) from standard DXA spine scanfiles. The areal BMD
in SIDIAP (www.sidiap.org). SIDIAP comprises of primary (aBMD) was assessed at spine L1-L4 using GE-Lunar DXA
care electronic medical records and pharmacy invoice data devices. Pseudo 3D BMD (vBMD) was calculated based on
for >5 million people in Catalonia (North-East Spain). We cylindrical model proposed by Kroeger et al. (Bone Miner,
included all SIDIAP participants starting an anti-OP drug 1992). The LMS statistical method proposed by Cole and
at any time between 1/1/2007 and 30/06/2011. Users of Green (Stat Med, 1992) was used to drawn TBS, aBMD and
any of these drugs in the previous 2 years were excluded. vBMD age-related curves using R software (v2.15.3).
We analysed persistence, rates of discontinuation and Results: Positive significant correlations (p<0.05) exists be-
switching to alternative therapies at up to 5 years tween TBS and age, BMI, aBMD and vBMD (r=0.45, 0.32,
follow-up. Fine and Gray survival modelling was used to 0.56 and 0.55, respectively). Height, weight and BMI follow-
estimate risk of therapy discontinuation (sub-hazard ratios= ed normal pattern with age according the standards of Spanish
SHR) for each drug compared to weekly alendronate, after population. aBMD increases with the growth with an acceler-
adjustment for: age, gender, fracture history, Charlson ation at the puberty. When normalized by the 3D volume,
Index, use of oral glucocorticoids, of aromatase inhibitors, effect of puberty on vBMD is more visible. Before the puber-
smoking, alcohol drinking, and BMI. ty, vBMD trend seems to be flat. Concerning TBS, we ob-
Results: We identified 124,827 patients who started any anti- served that maximum value is reached in the first days of life
osteoporotic drug in the study period. The most commonly with similar value in both sexes. Surprisingly, was observed a
prescribed drug was weekly alendronate (N=55,399). Persis- decreasing phase, reaching a minimum TBS values between
tence at 5 years ranged from 9.3 % (strontium ranelate) to 6–8 years in girls and 8–10 years in boys. The texture im-
26.7 % (monthly risedronate). Only monthly risedronate had proves again in both sexes up to 19 years.
better persistence than weekly alendronate at 5 years: adjusted Conclusion: DXA can be used to assess trabecular bone
SHR 0.80 [95%CI 0.86–0.92]. Conversely, daily drugs were microarchitectural texture, as assessed by TBS, in children
 Osteoporos Int

with a high degree of reliability. Age-related TBS curve can be P532

useful, in complement to the BMD curve, to help clinician to ONE YEAR AROMATASE INHIBITORS TREATMENT
identify children with bone microarchitectural modifications EFFECT ON BONE MINERAL DENSITY: IS IT
induced by chronic diseases or drug therapies. SIGNIFICANT?
C. G. Barbu1, D. Mocanu2, S. Fica1
1
Endocrinology Department, Elias Hospital, Carol Davila
P531 University, Bucharest, Romania, 2Academica Medical Center,
A SINGLE-DOSE STUDY OF DENOSUMAB IN Bucharest, Romania
PRIMARY HYPERPARATHYROIDISM PATIENTS
D. Grigorie1, A. Sucaliuc1, A. Caragheorgheopol 2, A. Objective: To assess the densitometric changes in women
Diaconescu2 treated with aromatase inhibitors in the first year of treatment.
1
National Institute of Endocrinology, Carol Davila University Material and Methods: Subjects were 32 women aged from
of Medicine, Bucharest, Romania, 2National Institute of En- 60 to 76 years with breast cancer recent history, referred for
docrinology, Bucharest, Romania bone densitometry assessment at the beginning of the adjuvant
therapy with aromatase inhibitors. Lumbar spine and femoral
Objective: Denosumab is a monoclonal antibody that inhibits neck DXA (Lunar GE Prodigy) was performed at the baseline
osteoclast activity through inhibition of receptor activator of and after 1 year of treatment with letrozolum.
nuclear factor κB ligand (RANKL). We have previously Results: At baseline evaluation, 11 women had osteoporosis
shown that serum RANKL levels were variably increased in by densitometric criteria, of whom one had a prevalent fore-
patients with primary hyperparathyroidism (PHPT) and cor- arm fracture. After 1 year of letrozol treatment, mean lumbar
related with both markers of bone turnover and bone loss. BMD decreased by 2.3 % (NS) with high variability among
Aim: to observe the effects of denosumab on BMD, bone subjects. Femoral neck BMD decreased by 0.8 % (NS). Re-
turnover markers and serum calcium in patients with PHPT. garding the densitometric criteria for osteoporosis, 7 more out
Material and Methods: Five consecutive patients with PHPT of the 32 patients became osteoporotic during follow up. From
were administrated a single subcutaneous injection of the 11 osteoporotic women at the baseline, only 4 experienced
denosumab, 60 mg. The patients (mean age 69.6 year) BMD decrease and from those with normal BMD at baseline
were 1–4 years since diagnosis (mean serum total Ca only 3. No significant changes of estimated fat mass was
10.6 mg/dl; mean serum PTH 134 pg/ml) and were observed in this group.
previously treated with various bisphosphonates (BP) Conclusion: During the first year of treatment with letrozol,
for osteoporosis (mean LS BMD =0.818 g/cm2; mean 14 out of 32 women experienced decrease in BMD either at
FN BMD=0.694 g/cm2). Mean serum 25OHD was nor- lumbar spine or femoral neck site. In spite of not significance of
mal at baseline (32.4 ng/ml) and during the follow-up. the lumbar BMD or femoral neck BMD decrease at the group
Subjects were followed up to 6 months as follows: level, a highly variable evolution was noticed, with increase of
serum Ca on days 1, 3, 7, 14, 30 and at 3 month and osteoporosis prevalence from 11 to 18 out of 32 women during
6 month; serum intact PTH, C-telopeptide and N-mid the follow up. Our results, in spite of the low number of
osteocalcin (by chemiluminescence) at 3 month and subjects, suggests particular response in some individuals with
6 month. BMD at the hip (FN) and lumbar spine (LS) determinants which might be interesting to be revealed.
were measured at baseline and at 6 month using a GE-
iDXA machine.
Results: At 6 month mean LS BMD increased by 4.37 % and P533
FN BMD by 1.86 %. Serum CTX decreased by 90 % at PSYCHOLOGICAL EFFECTS FROM
3 months, and by 45 % at 6 months; the similar changes for REHABILITATION TREATMENT IN PATIENTS
serum osteocalcin were 45 % and 41 %, respectively. In the WITH A SPINAL CORD INJURIES
first 2 weeks, serum total Ca decreased vs. baseline by 0.79– A. Matica1, F. Cioara2, L. Lazar2
1
1 mg/dl in four out of five patients. At 6 months mean total Medical Rehabilitation Hospital Baile Felix, Oradea, Roma-
serum Ca was significantly increased vs. baseline (11.6 mg/dl nia, 2Medical Rehabilitation, University of Medicine and
vs. 10.6 mg/dl, p=0.01). Intact PTH levels increased by Pharmacy Oradea, Oradea, Romania
around 50 pg/ml at 3 mo and decreased marginally at 6 mo
vs. baseline. Objective: Spinal cord injury represents a major event with
Conclusion: These are the first published observations on devastating implications on all aspects of an individual’s life.
denosumab effects in patients with PHPT and they suggest Spinal cord injury to an individual subject to increased risk of
the potential use of this drug in increasing BMD and decreas- negative psychological effects including mood disorders such
ing bone turnover. as depression and low self-esteem.
Osteoporos Int

Material and Methods: The study systematically examined: 212.4 N, CS with TCP; 75.2 N and 396 N, CS with PMMA;
changing negative psychological states in two groups of pa- 101.2 N and 528.8 N, CS FT II; 13.8 N and 339.8 N.
tients with spinal cord injury: the first batch that followed in Conclusion: Augmentation of CS with TCP or PMMA would
the Medical Rehabilitation Hospital Baile Felix comprehen- be essential in SOP bones. On osteopenic bone model, al-
sive recovery program that contains various procedures such though anchor fixation augmented with PMMA is the best
as physiotherapy, occupational therapy, psychotherapy elec- fixation method, CS augmented with TCP cement or CS-FT II
trotherapy, hydrokinetotherapy, massage therapy, without any need for augmentation may also be used as an
thermotherapy, and the second group whose program includes alternative
extra assistance recuperatoriu robotic locomotion (using gait
rehabilitation robotic device). These programs aim at enhanc-
ing patient recovery through developing functional structures, P535
adaptive. PAIN SYNDROME, FUNCTIONAL ACTIVITYAND
Results: Results were quantified by assessing the patient’s QUALITY OF LIFE IN POSTMENOPAUSALWOMEN
quality of life, self-esteem and depressive mood level. WITH KNEE OSTEOARTHRITIS DEPENDING ON
Conclusion: Although no significant differences in the two THE STRUCTURAL-FUNCTIONAL PARAMETERS
groups of patients with spinal cord injury, recovery programs OF BONE
made by combining medical and psychological measures N. V. Grygorieva1, S. P. Krochak1, A. A. Tkachuk1, V. V.
psychologically significant improvements including: in- Povoroznyuk1
1
creased quality of life, self-esteem and reduced provision Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine
depression.
Objective: To evaluate the features of pain syndrome in knee
joints, functional activity and quality of life in patients with
P534 knee osteoarthritis (КОА) depending on the structural-
SUTURE ANCHOR FIXATION STRENGTH WITH OR functional state (SFS) of bone.
WITHOUT AUGMENTATION IN OSTEOPENIC AND Material and Methods: We examined 90 postmenopausal
SEVERELY OSTEOPOROTIC BONES IN ROTATOR women aged 50–79 years with KOA of II-III degree, divided into
CUFF REPAIR: A BIOMECHANICAL STUDY age groups: the 50–59, 60–69 and 70–79 years old. The diagno-
M. S. Er1, L. Altinel1, M. Eroglu2, O. Verim3, T. Demir4, H. sis of KOA was performed according to the criteria of ACR
Atmaca1 (1995), the stage by Кеllgren-Lawrence classification. The pa-
1
Orthopaedics and Traumatology, Akdeniz University, School rameters of pain syndrome in knee joints and functional activity
of Medicine, Antalya, Turkey, 2 Orthopaedics and were assessed by VAS, index Lequense, static balancing and 15-
Traumatology, Afyon Kocatepe University, School of Medi- m test; the quality of life was determined by Euro-Qol-5D. BMD
cine, Afyon, Turkey, 3Department of Mechanical Engineer- was measured by DXA (Prodigy). To analyze the performance it
ing, Faculty of Technology, University of Afyon Kocatepe, has been allocated the following groups: 1 - patients with oste-
Afyon, Turkey, 4Department of Biomedical Engineering, oporosis and 2 - with normal bone parameters.
TOBB University of Economics and Technology, Ankara, Results: In patients with osteoporosis in the age group 60–69
Turkey it was found significantly higher levels of pain in the knee
joints and lower parameters of functional activity compared
Objective: To compare the results of various types of anchor with women with normal bone. Thus, the baseline values of
applications with or without augmentation in both osteopenic pain were 4.1±0.8 and 2.5±0.2 points accordingly (F=5.83,
and severely osteoporotic bone models. p=0.02), pain during long-term walking - 3.2±1.2 and 2.3±
Material and Methods: Two different types of suture anchors 0.2 points (F=5.75, p=0.018), pain during upstairs walking -
were tested in severely osteoporotic (SOP) and osteopenic 5.9±1.1 and 3.7±0.3 points (F=5.23, p=0.024), Lequense
polyurethane (PU) foam blocks using an established protocol. index - 13.9±1.4 and 11.2±0.4 points, respectively (F=3.07,
An Instron machine applied tensile loads parallel to the axis of p=0.05). Similar data we did not find in the age groups 50–59
insertion until failure, and mean anchor failure strengths were and 70–79. All age groups with patients with KOA didn’t
calculated. The mode of failure (anchor pullout, suture break- significantly differ in data of static balancing, 15-m test and
age) was recorded. Anchors tested included the corkscrew (CS) quality of life depending on the status of bone.
(without augmentation, polymethilmetacrylate (PMMA) aug- Conclusion: SFS of bone in women aged 60–69 years with
mented and bioabsorbable tricalcium phosphate (TCP) cement КОА of II-III degree significantly affect the data of pain
augmented), and corkscrew FT II (CS FT II) 5.5 mm. syndrome and functional activity. Intensified pain syndrome
Results: Mean failure loads for both SOP and osteopenic PU and limitation of functional activity in patients with KOA and
foam blocks, respectively, were as follows: CS; 16.2 N and osteoporosis should be considered during treatment.
 Osteoporos Int

P536 P537
IS FOOT PAIN CONSIDERED IN THE DECISION TO SYNOVIAL FLUID FROM BILATERAL OSTEOARTH
TREAT KNEE OSTEOARTHRITIS WITH RITIS PATIENTS REVEALED IL-1Β AS THE
ARTHROPLASTY? PRINCIPLE MODULATOR FOR CARTILAGE
D. J. Culliford1, L. S. Gates2, C. J. Bowen2, C. Ball3, K. DEGENERATION AND INFLAMMATION
Chan4, C. Cooper5, N. K. Arden6 P. Kulkarni1, A. Harsulkar1, S. Koppikar1, S. Deshpande2, N.
1
Faculty of Medicine, University of Southampton, Southamp- Wagh2
ton, United Kingdom, 2Faculty of Health Sciences, University 1
Cell and Molecular Biology, Interactive Research School For
of Southampton, Southampton, United Kingdom, 3University Health Affairs (IRSHA), Pune, India, 2Department of Ortho-
Hospital Southampton NHS, Southampton, United Kingdom, pedics, Bharati Hospital, Pune, India
4
Cancer Research UK, University College London Cancer
Trials Centre, London, United Kingdom, 5 MRC Objective: Inflammation and oxidative stress are closely in-
Lifecourse Epidemiology Unit, University of Southamp- tegrated processes in osteoarthritis (OA), however, pathogen-
ton, Southampton, United Kingdom, 6NIHR Musculo- esis of synovitis remains largely unknown. To understand
skeletal Biomedical Research Unit, University of Ox- disease associated local flares, we enrolled 7 bilateral OA
ford, Oxford, United Kingdom patients and aspirated synovial fluid (SF) was analysed for
different biomarkers. We claim this to be the first report on
Objective: The decision to treat knee osteoarthritis bilateral SF analysis in Indian demography and uniquely
(KOA) with arthroplasty is based on severity of knee reveal correlation of cartilage degeneration, inflammation
symptoms. The influence of other symptomatic joints and histopathologies involved.
upon this decision has not yet been evidenced. The Material and Methods: Inflammatory biomarkers like IL-
objective of this study is to describe the variation in 1β, nitric oxide (NO) were estimated using kits. Glycosami-
pre-operative knee pain and function for different levels noglycan (GAG) was measured as cartilage degradation indi-
of foot pain. cator by DMMB based dye binding assay. Antioxidants
Material and Methods: In a prospective cohort study nitrate/nitrite were estimated using plate based activity assays.
of patients awaiting knee arthroplasty, a subcohort of Results: NO, nitrate/nitrites and GAG values remained com-
N = 147 underwent foot, ankle and knee examination. parable for both knees of all patients. Interestingly, a 68 years
Various measures of pain and function were measured old lady revealed higher IL-1β in right knee SF (SF-R 118.64
for the index limb. Descriptive summaries and plots ±16.8, SF-L 30.45±2.3 pg/ml). These values were well cor-
were produced for these continuous variables based related with radiography and histopathology, showing more
on the appropriate statistical method for the distribu- cartilage degradation in right knee.
tion of each variable. These variables were then com- Conclusion: IL-1β was estimated high in all the patients and
pared using a t-test or Mann-Whitney test, as remained comparable for both knees while above described
appropriate. patient has showed a differential degree of cartilage loss in her
Results: Oxford Knee Score (OKS) was significantly worse knees. IL-1β has multiple actions in OA pathology, including
(mean difference=4.2, 95%CI:0.9–7.6, p = 0.014) for synovitis, leading to accelerated cartilage loss. Elevated IL-1β
those with foot pain (N=55) compared to those without hampers chondrocyte compensatory mechanism, inhibiting
(N=63). None of the other index limb variables (knee cartilage repair. The degenerating cartilage is further respon-
flexion range, PainDetect score, Knee pain VAS, Knee sible for inducing secondary inflammation, mainly restricted
fixed flexion deformity) showed significant differences to local tissue. The differential IL-1β levels and variation in
between the two levels of foot pain (none vs. any), but cartilage degradation observed in this case both as atypical
the direction of association for all variables was the features of OA. To conclude, among various biomarkers as-
same as for OKS (worse in foot pain group). sociated with OA pathology, IL-1β suggests strong linkage
Conclusion: Early findings suggest that patients with with synovitis. Its correlation with GAG reflects association
foot pain awaiting knee arthroplasty have worse knee between inflammation and cartilage loss which will be
severity symptoms than those without foot pain. The discussed with the aid of histopathology slides and flow chart.
influence of foot pain on the outcome of surgery is
not yet known, however these findings suggest the
decision to treat KOA with arthroplasty may be taken P538
without consideration of foot pain. Further analysis will THE RELATIONSHIP BETWEEN ULTRASOUND
be carried out on this cohort after postoperative mea- DIAGNOSED NAFLD AND FEMORAL NECK BONE
sures have been collected in order to assess the influ- MINERAL DENSITY: A NHANES III STUDY
ence of foot pain on knee arthroplasty outcomes. E. Cheung1, C. L. Cheung2
Osteoporos Int

1
Department of Medicine and Geriatrics, United Chris- P539
tian Hospital, Kowloon, Hong Kong, 2Department of TREATMENT OF LOWER LIMB’S FRACTURES
Medicine, University of Hong Kong, Hong Kong, Hong NONUNION BY STRONTIUM RANELATE
Kong F. Z. Bouzid1, C. Haouichat2, Y. Belbegra3, B. Boulanane3, Y.
Guenane3, N. Zaabat2, D. Acheli2, H. Djoudi2
1
Objective: There have been data, mainly from Asia and Department of Rheumatology, Public Health Establishment
Middle East populations, supporting the inverse relation- of Boumerdes, Algiers, Algeria, 2EHS de Douéra, Algiers,
ship between BMD and nonalcoholic fatty liver disease Algeria, 3Orthopaedic Service, EPH Thénia-Boumerdes, Al-
(NAFLD). However, this relationship has not been in- giers, Algeria
vestigated in US population. We therefore investigated
this relationship in a national representative sample of Objective: Nonunion is a fracture that does not consolidate in
US adults. time (beyond 6 months). Strontium ranelate is a molecule used
Material and Methods: Data was taken from the third in the treatment of osteoporosis, it has a bone formation and
NHANES database (1998–1994). Fourteen thousand antiresorptive on bone. The objective of this study was to
seven hundred ninety-seven participants, aged 20–74, evaluate the efficacy of strontium ranelate on the nonunion
received ultrasound examinations. Thirteen thousand fracture of the lower limb.
eight hundred fifty-six were diagnosed to have NAFLD. Material and Methods: Prospective study on eight cases of
Some participants were excluded due to the following nonunion member lower evolving for more than 6 months,
reasons: without valid femoral neck (FN) BMD mea- regardless of the etiology of thereof and the previous treatment
surement (n=2545), excessive alcohol consumption (>21 received. We excluded patients with infected nonunion and
drinks/week in men and >14 drinks/week in women), evaluation criterion focuses on the formation of a callus on
being hepatitis B or C carrier and transferrin saturation pain (VAS) and function. Strontium ranelate at a dose of 2 g/
≥50 %. We further excluded 656 participants with miss- day was administered to patients associated with a vitamin and
ing data in the multivariable model. Ten thousand six calcium treatment.
hundred fifty-five participants were included in the final Results: Seven men (87.5 %) and one woman are included.
analysis. Ultrasound video images were reviewed by 3 Nonunion seat femur in 62.5 % and leg bones in 37.5 %.
board-certified radiologists specialized in hepatic imag- Mean age of patients was 42±14 years (range: 20–62). The
ing. NAFLD was categorized into normal versus any length of the fracture is an average of 20±10.4 months (range:
degree of steatosis (mild, moderate, or severe). BMD 8–42 months). All patients were treated by osteosynthesis
was measured using Hologic QDR-100 x-ray bone within 4 days after the fracture average. In 75 % of the trauma
densitometer. is severe (traffic accident), 25 % is moderate trauma (fall
Results: Among participants with NAFLD (N=3853), 34.6 % height). The average duration of treatment with strontium
and 3 % of them had osteopenia and osteoporosis (vs. 37.9 % ranelate is 9.87 months (range: 2–17 months). At baseline
and 3.4 % in participants without NAFLD). Logistic regres- the patients moved using two crutches unable to support the
sion showed that NAFLD was significantly associated with affected limb. Pain (VAS) is on average 46±12. Patients
reduced odds of osteopenia (OR=0.645; 95%CI: 0.56–0.743; (87.5 %) treated over a period of 03 months improvement in
P<0.001) and osteoporosis (OR=0.657; 95%CI: 0.477– pain of 50 % (VAS) and function, walking is possible using a
0.904; p = 0.011), after adjustment for age, sex, and single rod. Among those with a decrease of 6 months of
race/ethnicity. After further adjusted for BMI, education, treatment is 87.5 %: pain increased on average 10±5. At
physical activity, smoking and drinking status in the full 12 months and more in all patients walking without a cane,
multivariable model, the association became insignificant for the pain is absent, walking is done with slight limp. Radio-
osteopenia (OR=0.931; 95%CI: 0.791–1.096; P=0.384) and logically there is a beginning of consolidation or early healing
osteoporosis (OR=1.194; 95%CI: 0.815–1.749; p=0.357). of the nonunion in 05 patients.
Analysis stratified by sex revealed similar results. When the Conclusion: Strontium ranelate appears promising in non-
group without steatosis was compared to those with union. Further studies are needed to confirm this hypothesis.
severe steatosis, the results were also similar. Among
participants with NAFLD, NAFLD fibrosis score was
positively associated with FN BMD. However, the as- P540
sociation became insignificant after further adjustment in A DECADE OF IRANIAN OSTEOPOROSIS
the full multivariable model. OUTPATIENT STUDY (IROSTEOPS): T-SCORE
Conclusion: Ultrasound-diagnosed NAFLD and fibrosis DISCORDANCE
score in NAFLD are not associated with FN BMD in US P. Khashayar1, A. Keshtkar1, M. Ebrahimi1, Z. Mohammadi1,
adults. B. Larijani2
 Osteoporos Int

1
Osteoporosis Research Center, Endocrinology and Metabo- country not many studies have assessed its efficacy. The
lism Research Institute, Tehran, Islamic Republic of Iran, present study was therefore conducted to assess the efficacy
2
Endocrinology and Metabolism Research Institute, Tehran, of fortified vitamin D milk in improving vitamin D levels.
Islamic Republic of Iran This is the first study to compare the effectiveness of fortifi-
cation with two different doses of vitamin D in a group of both
Objective: Considering the fact that the rate of bone loss guidance and high school students.
differs at different sites, the importance of discordance, de- Material and Methods: The cluster randomized trial
fined as the presence of different categories of T-scores in two (CITFOMIST) was conducted on 15–19 years old guidance
skeletal sites of a single patient, has been highlighted as it can and high school students of both genders from different dis-
affect diagnosis and treatment plans. Given this background tricts of the Iranian Capital, Tehran. A mixed sampling meth-
and considering the need for the estimation of the impact of od consisted of stratified random and 2-stage cluster sampling
this phenomenon in our country, the present study was devel- method was applied. First, Tehran was divided into three strata
oped to assess the prevalence of T-score discordance and its based on the socio-economic status using the Urban Health
risk factors in a large sample of female Iranian population. Equity Assessment and Response Tool Study. Then a propor-
Material and Methods: The retrospective observational de- tional to size allocation method was used to select the boys
scriptive analytical Iranian Osteoporosis Outpatient Study and girls guidance and high schools in the districts, taking into
(IROSTEOPS) was conducted on a database of 13,523 pa- effect the design effect of 1.85. As a result 36 schools were
tients referred to a community-based outpatient BMD center included. Six thousand two hundred fifty-seven students were
between 2000 and 2011. All the individuals underwent BMD recruited to study compliance with milk consumption among
using Lunar densitometer (Lunar DPXM, Lunar, 1999). Mi- adolescents. 25(OH)D levels were measured in 468 of them at
nor discordance happens when the different diagnostic classes two point before and after the milk consumption. The students
are adjacent (osteoporosis in one site and osteopenia in the were randomly classified to receive simple milk, milk fortified
other or osteopenia in one site and normal in the other). If the by 600 unit vitamin D3/L and milk fortified by 1,000 unit
patient is diagnosed with osteoporosis in one site and normal vitamin D3/L for a month.
at the other, the discordance however falls into the major class. Results: Baseline mean serum 25(OH)D concentration of the
Results: 8,146 postmenopausal women with the mean age of students was 26.2±16.9 nmol/L. Serum levels of vitamin D
59.0±8.6 years were included. Discordance was noted in increased after milk consumption in all the three groups. The
3,741 (45.9 %) of these individuals; from among which about increase was significantly higher in the group who used for-
91 % were categorized as minor discordance. Regression tified milk but there was no difference between the two dosing
analysis revealed that older ages, higher BMI, higher number (simple: 20.3 vs. 23.5; 600 IU: 22.5 vs. 34; 1,000 IU: 26.2 vs.
of parities, and the use of hormone replacement therapy were 40.1). The overall milk consumption in this study was poor.
linked to higher risk of discordance. This is while sun expo- Conclusion: Milk fortification is an effective strategy in im-
sure, higher age at menopause and menarche, the use of proving vitamin D deficiency among adolescents.
corticosteroids and breastfeeding however were not signifi-
cantly associated with a higher discordance risk in this group.
Conclusion: The agreement between bone loss rates at dif- P542
ferent anatomic sites is low and thus performing DXA at a VITAMIN D STATUS OF IRANIAN ADULTS: A
single site is not adequate. 10-YEAR NATIONWIDE STUDY
B. Larijani1, M. Dini2, K. Etemad2, M. Ramezani3, H.
Nabavi4, A. A. Keshtkar5, M. Ebrahimi5, Z. Mohammadi5,
P541 P. Khashayar5
1
EFFICIENCY OF FORTIFIED VITAMIN D MILK IN Endocrinology and Metabolism Research Institute, Tehran,
ADOLESCENTS: THE COMMUNITY Islamic Republic of Iran, 2Iranian Ministry of Health and
INTERVENTIONALTRIAL (CITFOMIST) Medical Education, Tehran, Islamic Republic of Iran,
A. Keshtkar1, P. Khashayar1, Z. Mohammadi1, M. Ebrahimi1, 3
Baghiatollah Hospital, Tehran, Islamic Republic of Iran,
B. Larijani2 4
Kordistan University of Medical sciences, Sannandaj, Islam-
1
Osteoporosis Research Center, Endocrinology and Metabo- ic Republic of Iran, 5Osteoporosis Research Center, Endocri-
lism Research Institute, Tehran, Islamic Republic of Iran, nology and Metabolism Research Institute, Tehran, Islamic
2
Endocrinology and Metabolism Research Institute, Tehran, Republic of Iran
Islamic Republic of Iran
Objective: Several studies have assessed the prevalence of
Objective: In Iran fortification is not a routine strategy and vitamin D deficiency in the Iranian population in the past
despite the high prevalence of vitamin D deficiency in the years. The present study was conducted to compare the data
Osteoporos Int

obtained in the first phase of the Iranian Multicenter Osteo- Kellgren-Lawrence (KL) scale. Different biomarkers were
porosis Study (IMOS) conducted in 2000 and that of the third assessed for comparison.
phase performed in 2012. Material and Methods: Inflammatory potential of 10 SF
Material and Methods: IMOS is a population-based study samples (9 OA and 1 non-OA), was assessed using a novel
conducted by the Osteoporosis Research Center of the Endo- cell-challenge experiment. Cultured rat synoviocytes fibro-
crinology and Metabolism Research Institute affiliated with blast (RSF) were challenged with SFs and released NO was
Tehran University of Medical Sciences in collaboration with recorded for inflammatory response. This enabled us to esti-
the Iranian Ministry of Health and Medical Education in mate the cumulative action of different factors present in SF.
different phases to assess bone health and the prevalence of Pretreated cells with IL-1β or lipopolysaccharide (LPS) was
vitamin D deficiency in different parts of the country. Each further challenged with SFs to study sustenance of inflamma-
phase was conducted in different provinces with various alti- tion. SFs were analyzed for levels of biomarkers like IL-1β,
tudes, latitudes and lifestyle habits, so that the results could be Nitric oxide (NO) and glycosaminoglycans (GAG).
generalized to the country. The first was conducted in five Results: We found unique trends in levels of inflammatory
main Iranian cities: Tehran - Shiraz - Bushehr - Mashhad - biomarkers and patient’s KL grade. Elevated levels of IL-1β,
Tabriz in 2000. The third phase was conducted some 10 years NO and its derivatives were found in grade-3 and grade-2
later in 2012 in Arak and Sanandaj. patients whereas GAG level increased in KL-grade-3 SFs. In
Results: While about 28 % of the individuals suffered from our cell-challenge experiment, NO release was increased by 5-
vitamin D deficiency in phase one, the rate had increased to and 4-fold after 48 and 72 h, respectively, by SFs from KL-
82.6 % in phase three. Based on the results, younger individ- grade-2 patients. Cells pretreated with IL-1β and challenged
uals of both genders had lower vitamin D levels in both phases by SF showed 11-fold increase NO (KL-2). Highest NO
(women: 62.99 nmol/L in phase 1 vs. 17.31 nmol/L in phase 3 release after LPS pretreatment was recorded by KL-3 patient’s
- men: 70.34 nmol/L in phase 1 vs. 28.14 nmol/L in phase 3). SFs. Unexpectedly, SFs from KL-grade-1 and 0 reduced
In other words more than 95 % of 20–34 year old women and released NO, indicating a potential buffering action against
90 % of men of the same age group were vitamin D deficient. the inflammatory factors. SF from grade-4 patients failed to
Conclusion: The prevalence of vitamin D deficiency has increase NO with or without pre-treatment of IL-1β or LPS.
worsened during years in Iran despite nationwide education Conclusion: SFs from KL-grade-2 and 3 patients induced
programs held across the country, pointing out the need for the more inflammation in cultured RSF as compared to grade-4
implementation of nationwide strategies such as fortification and 1. Similar trend was observed in cells pre- treated with
to fight the condition. The statistics also show that the severity either IL-1β or LPS suggesting that SFs from grade-2 and 3
of the condition is poles apart in different parts of the country patients maximally accumulate factors responsible to induce
mainly due to their diverse environmental, genetics and life- and sustain inflammation. Interestingly, SFs from grade 1 and
style characteristics. 0, presumably contain factors tolerating inflammation induced
by IL-1β and LPS.

P543 P544
CELL MEDIATED ASSAY REVEALED EFFECTS OF TREATMENT WITH PTH(1-84) OR
INFLAMMATORY POTENTIAL OF SYNOVIAL STRONTIUM RANELATE ON BONE
FLUID OBTAINED FROM OSTEOARTHRITIS BIOMECHANICS IN AN EXPERIMENTAL MODEL
PATIENT IN ACCORDANCE WITH THE DISEASE OF MALE OSTEOPOROSIS
SEVERITY D. Guede1, M. Permuy2, M. Martín-Fernández3, M. López-
S. Koppikar1, P. Kulkarni1, D. Ingale1, D. Shinde2, S. Peña 2 , F. Muñoz 2 , C. De La Piedra 3 , A. González-
Deshpande3, A. Harsulkar1 Cantalapiedra2, J. R. Caeiro4
1 1
Department of Cell and Molecular Biology, Interactive Re- Trabeculae, S.L., Ourense, Spain, 2Universidade de Santiago
search School for Health Affairs (IRSHA), Bharati de Compostela, Lugo, Spain, 3Instituto de Investigación San-
Vidyapeeth University, Pune, India, 2 Department of itaria Fundación Jiménez Díaz, Madrid, Spain, 4Complexo
Kayachikisa, Bharati Ayurvedic Hospital, Bharati Vidyapeeth Hospitalario Universitario de Santiago de Compostela, Santi-
University, Pune, India, 3Department of Orthopedics, Bharati ago de Compostela, Spain
Hospital, Bharati Vidyapeeth University, Pune, India
Objective: Both strontium ranelate (SrR) and PTH(1-84)
Objective: A novel cell-challenge experiment was designed have demonstrated their ability to improve BMD and
to evaluate inflammatory potential of synovial fluids (SF) microarchitecture reducing the risk of fracture in postmeno-
obtained from knee osteoarthritis (OA) patients graded using pausal osteoporosis (OP). Their effects on male OP are less
 Osteoporos Int

well studied. The aim of this study was to evaluate the effects Excellence for Osteoporosis Research, King Abdulaziz Uni-
of PTH(1-84) and SrR on bone biomechanics in an experi- versity, Jeddah, Saudi Arabia, 5Pharmaceutical Research In-
mental model of male OP. stitute, Albany College Pharmacy and Health Sciences, New
Material and Methods: Sixty 6-month-old male Sprague York, United States
Dawley rats were divided into 6 groups: SHAM (simulated
intervention); OQX (orchiectomized); OQX+PTH50 (OQX Objective: The role of maternal vitamin D status in pregnancy
treated with PTH 50 μg/kg/day SC); OQX+PTH10 (OQX as a determinant of bone mineral content (BMC) in offspring
treated with PTH 10 μg/kg/day SC); OQX+SrR900 (OQX is controversial. The aim of the present study was to examine
treated with SrR 900 mg/kg/day VO); and OQX+SrR450 the associations between maternal vitamin-D status during
(OQX treated with SrR 450 mg/kg/day VO). Treatments pregnancy and offspring BMC at 7–8 year of age among a
started 6 months after orchiectomy and lasted 45 days (SrR) population-based cohort.
and 90 days (PTH). After sacrifice, right femora were subject- Material and Methods: The study population included 1,024
ed to three-point bending mechanical testing and L5 vertebrae mother-child pairs living in Jeddah, Saudi Arabia as part of the
to compression tests. “Bone Health Study in Pregnancy” (BHSP) at CEOR. An-
Results: In the vertebrae, orchiectomy caused a general wors- thropometric measurements, dietary intake, lifestyle measures
ening of the intrinsic and extrinsic mechanical properties, for mothers during pregnancy were recorded. At 7–8 year of
particularly noticeable in the values of work to failure and age, anthropometric measurements, dietary intake, and total
toughness. In the femurs, however, the parameter showing the body (minus head) (TBLH) bone area (BA), BMC and areal
greatest decrease in OQX versus SHAM is extrinsic stiffness. BMD (aBMD) by DXA were also collected. Statistical anal-
SrR treated groups showed similar values to OQX group in all ysis were used to assess the possible associations between
determined mechanical parameters, not being able to improve maternal serum 25(OH)D (at 3rd trimester of pregnancy) and
the biomechanical strength in compression or bending. The childhood bone indices.
lower dose of PTH has not been able to cause remarkable Results: A total of 605 (59.1 %) mothers had deficient, 258
changes in mechanical properties compared to OQX group, (25.0 %) insufficient, and 161 (15.7 %) sufficient 25(OH)D
but the higher dose increased the values of many mechanical levels in 3rd trimester of pregnancy. The mean offspring age
parameters. was 7.4 years. The TBLH and spinal BMC did not differ
Conclusion: None of the tested doses of SrR neither the lower among offspring of mothers in the deficient or insufficient as
dose of PTH were able to modify the negative effects of compared with sufficient group as indicated by serum
orchiectomy on mechanical properties in this model of male 25(OH)D levels. Maternal 25(OH)D levels in 3rd trimester
OP. However, the highest dose of PTH have demonstrated of pregnancy, was not associated with BMC of offspring or
ability to improve femoral and lumbar mechanical properties, other variable recorded. Multivariate associations of the ma-
reaching values even higher than SHAM group. ternal groups as per 25(OH)D levels [presented as adjusted
Acknowledgements: Partially supported by Axencia Galega mean difference in outcome (95%CI) per unit change in serum
de Innovación, Xunta de Galicia (10CSA004E). 25(OH)D levels] in TBLH BMC (g) [−0.4 (−2.1,2.4); 0.5
(−3.4,5.2)]; TBLH BMD (g/cm2) [(−0.031,0.006); −0.046
(−0.11;0.08)]; spine BMD (g/km2) [0.001 (−0.009, 0.007);
P545 −0.021 (−0.016,0.013)], as compared with sufficient group,
ASSOCIATION OF MATERNALVITAMIN D STATUS respectively.
DURING PREGNANCY WITH BONE MINERAL Conclusion: We found no significant association between
CONTENT IN OFFSPRING: THE BHSP-CEOR maternal vitamin D status at 3rd trimester of pregnancy among
STUDY Saudi women and their offspring BMC or other bone indices
M. S. M. Ardawi1, A. A. Rouzi2, M. H. Qari3, A. Y. Ali4, G. Y. measured at 7–8 year of age.
Refai4, F. S. Maky4, H. A. Yousif4, S. A. Mousa5
1
Center of Excellence for Osteoporosis Research and Depart-
ment of Clinical Biochemistry, Faculty of Medicine, King P546
Abdulaziz University Hospital, King Abdulaziz University, PARQVE - EDUCATIONAL PROGRAM: 1 YEAR
Jeddah, Saudi Arabia, 2Center of Excellence for Osteoporosis RESULTS
Research and Department of Obstetrics and Gynecology, Fac- M. U. Rezende1, M. I. Hissadomi1, R. Frucchi1, T. Pasqualin1,
ulty of Medicine, King Abdulaziz University Hospital, King G. C. Campos1, N. L. R. Brito1, A. Pailo1, O. F. N. Santana1,
Abdulaziz University, Jeddah, Saudi Arabia, 3Center of Ex- M. M. Moreira1, C. G. Strutz1, N. B. S. Mattos1, O. P.
cellence for Osteoporosis Research and Department of Camargo1
1
Haematology, Faculty of Medicine, KAU Hospital, King Instituto de Ortopedia e Trauamtologia - Hospital das
Abdulaziz University, Jeddah, Saudi Arabia, 4Center of Clínicas - Universidade de São Paulo, São Paulo, Brazil
Osteoporos Int

Objective: To evaluate the effects (changes in BMI, pain, Objective: A wide care gap exists between the healthcare
function and quality of life) of an educational program admin- needs of older persons with fragility fractures and the diag-
istered to patients with knee osteoarthritis (KOA). nostic and therapeutic answers they receive for fracture sec-
Material and Methods: 202 patients with knee OA were ondary prevention. The Fracture Unit (FU) is a model of care
evenly allocated in four groups. Three groups had 2 days of tailored to bridge the osteoporosis care gap. The aim of this
lectures on OA. All groups received printed material to read study is to investigate the impact of the activation of a FU
and a video with all the lectures. Groups 1, 2, and 3, had model for the secondary prevention of fragility fractures.
lectures 1, 2 and 3 months apart, respectively. Group 4 re- Material and Methods: This is a prospective observational
ceived the educational material only. VAS, WOMAC, study with a pre- and post-intervention phase. Eligible persons
Lequesne and SF-36 questionnaires were applied at baseline, are those aged >65 years who underwent fragility hip fracture
4 and 12 months after lectures and educational material surgery. The clinical setting is an orthopaedic acute ward. The
retrieval. Weight and height were measured at baseline FU is a multidisciplinary intervention to optimize the identi-
and at 1 year after the educational program. BMI was fication of persons with fragility fracture, to improve their
calculated. Schooling years and a coping scale were evaluation through BMD testing and to initiate an osteoporot-
verified. Participants were asked to diet and to exercise ic treatment, when appropriate. In the pre-intervention phase,
at least three times a week. the records of 172 participants admitted before activation of
Results: BMI was significantly higher in the group 4 with an FU were evaluated. In the implementing phase, the FU holds
average BMI of 36.4, while groups 1 to 3 showed BMI of multidisciplinary meetings focusing on the diagnostic and
34.3, 32.8 and 30.1, respectively. All groups that therapeutic approaches to fragility fractures and activates spe-
attended classes diminished BMI. Group 4 increased cific diagnostic-therapeutic pathways for fracture secondary
BMI. BMI reduction did not correlate with pain and prevention. In the post-intervention phase, data from 211
functional results although among those that reduced participants were gathered. All participants underwent tele-
BMI, there were a greater number of patients with phone follow-up at 12 months. Descriptive analyses and sta-
improved function (WOMAC) than among those that tistical comparisons between participants enrolled before and
did not reduce BMI. Patient’s schooling did not correlate with after the FU implementation are presented.
pain and functional results. At 4 months functional (WOMAC Results: Compared to the pre-intervention phase, participants
and Lequesne), pain (VAS and WOMAC pain) and quality of enrolled in the post-intervention phase have higher probability
life (SF-36) improvements were better than at 1 year being to receive lab diagnostic investigations during hospital stay
statistically significant (WOMAC, p=0.006; WOMAC pain, (from 0 to 44 %, p<0.0001), and indications at discharge for
p=0.034, SF-36 MCS, p=0.009 and SF-36 PCS, p=0.044) BMD testing (from 14 to 49 %, p<0.0001), bone specialist
whereas at 1 year they were not. A positive correlation was evaluation (from 2.3 to 52 %, p<0.0001), Ca/vitamin D
found between coping skills focused on the problem and supplementation (from 15 to 48 %, p<0.0001) and anti-
improvement in the Lequesne functional score at 1 year fracture drug prescription (from 16 to 48 %, p<0.0001). In
(p=0.05). addition, the FU improves 12 month patient’s adherence to
Conclusion: The educational program changed habits of pa- diagnostic and therapeutic indications received at hospital
tients increasing exercise and reducing BMI, improving pain discharge.
and function. Conclusion: The FU is a multidisciplinary health care model
Acknowledgements: TRB Pharma Brasil - financial support effective and efficient to optimize the identification, evalua-
tion and treatment of older persons at the highest risk of
fragility fracture.
P547
THE FRACTURE UNIT TO BRIDGE THE
OSTEOPOROSIS CARE GAP IN ITALY
C. Ruggiero1, E. Zampi2, M. Baroni2, P. Mecocci1, G. P548
Rinonapoli3, A. Caraffa3, F. Conti4, M. L. Brandi5 EFFECT OF RITUXIMAB THERAPY ON LIFE
1
Department of Medicine, University of Perugia, Gerontology QUALITY WITH RHEUMATOID ARTHRITIS
and Geriatric Institute, Department of Clinical and Experi- PATIENTS
mental Medicine, Perugia, Italy, 2Department of Medicine, M. V. Koroleva1, T. A. Raskina1
University of Perugia, Perugia, Italy, 3Department of Ortho- 1
Kemerovo State Medical Academy, Kemerovo, Russian
paedics, University of Perugia, Perugia, Italy, 4Department of Federation
Medicine, University La Sapienza, Roma, Italy, 5University of
Florence, Department of Surgery and Translational Medicine, Objective: To evaluate the effect of rituximab on the life
Florence, Italy quality with rheumatoid arthritis (RA) patients according to
 Osteoporos Int

the results of the overall EQ-5D questionnaire and a specific DXA method (Prodigy, GEHC Lunar, Madison, WI, USA)
questionnaire HAQ. and PA spine TBS were assessed by the TBS iNsight® soft-
Material and Methods: We observed 98 patients with a ware package installed on our DXA machine (Med-Imaps,
documented diagnosis of RA. All patients were randomized Pessac, France).
into two groups, depending on the basic therapy variant: Results: We observed a significant decrease of TBS (L1-L4)
Group 1 (n=56) - patients with the combined therapy of as a function of age (40–49 year - 1.161±0.022; 50–59 year -
methotrexate and rituximab; Group 2 (n=42) - patients with 1.108±0.018; 60–69 year - 1.114±0.016; 70–79 year - 1.061
methotrexate therapy only. Follow-up was 24 months. To ±0.024; 80–87 year - 1.105±0.049; F=2.49; p=0.04). We
assess life quality (LQ) questionnaires EQ-5D and HAQ were also found the decrease of BMD of lumbar spine (40–49 year
used. - 1.186±0.003 g/cm2; 50–59 year - 1.128±0.021 g/cm2; 60–
Results: While filling in the EQ-5D questionnaire at baseline, 69 year - 1.224±0.026 g/cm2; 70–79 year - 1.247±0.034 g/
all RA patients noted health problems in varying degrees. cm2; 80–87 year - 1.131±0.064 g/cm2; F=3.25; p=0.01) and
After a year of therapy a statistically significant increase in proximal femur (40–49 year - 1.050±0.021 g/cm2; 50–59 year
the health index was established both in the group 1 and group - 0.996±0.018 g/cm2; 60–69 year - 1.032±0.018 g/cm2; 70–
2 - 0.61±0.04 and 0.63±0.07 (p<0.05 and p<0.05, respec- 79 year - 1.004±0.021 g/cm2; 80–87 year - 0.879±0.050 g/
tively). A statistically significant increase was found with the cm2; F=3.34; p=0.01) with age. Significant correlation was
VAS RA patients in group 1 in 12 months (46.7±6.3 mm, observed between TBS and BMD of lumbar spine (TBS=
p<0.05) and in 24 months (49.3±11.4 mm, p<0.05) on the 1.017+0.079×BMD (L1-L4); r=0.11; t=1.90; p<0.05) and
initial data. In assessing the HAQ index in 12 months a lean (TBS=1.441–0.000006×Lean mass (g); r=−0.25; t=
statistically significant reduction was revealed in the group −4.50; p=0.00001) and fat (TBS=1.33–0.000009×Fat mass
of patients treated with rituximab, relative benchmarks - 1.125 (g); r=−0.54; t=−11.04; p<0.001) masses.
±0.08 g/cm2 (p<0.05). In the group of patients receiving Conclusion: TBS and BMD in examined men significantly
methotrexate monotherapy, a statistically significant change decreased with ageing. We have also found a significant
in HAQ index was not obtained. Similar patterns persisted correlation of TBS and BMD of lumbar spine, lean and fat
through 24 months. masses.
Conclusion: By EQ-5D questionnaire satisfactory therapeutic
effect was observed in the group of the patients with a com-
bined therapy of methotrexate and rituximab, while in the P550
group with MTX only–it’s minimal one. When evaluating BMI AND EDUCATION IN KNEE OSTEOARTHRITIS
the HAQ index a pronounced clinical benefit was noted in M. U. Rezende1, N. L. R. Brito1, M. I. Hissadomi1, G. C.
the group of the patients receiving rituximab while in the Campos1, A. F. Pailo1, T. Pasqualin1, R. Frucchi1, O. P.
group with MTX only–it is a minimal one. Camargo1
1
Instituto de Ortopedia e Trauamtologia - Hospital das
Clínicas - Universidade de São Paulo, São Paulo, Brazil
P549
TRABECULAR BONE SCORE, BONE MINERAL Objective: To evaluate the effects of an educational program
DENSITYAND BODY COMPOSITION IN MEN OF of patients with knee osteoarthritis (KOA) by means of BMI
DIFFERENT AGES change.
V. V. Povoroznyuk1, A. S. Musiienko1, R. V. Povoroznyuk1, Material and Methods: 205 patients with knee OA were
N. I. Dzerovych1, D. Hans2 evenly allocated in four groups. Three groups had 2 days of
1
Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine, lectures on OA. All groups received printed material to read
2
Center of Bone Diseases, Lausanne University Hospital, and a video with all the lectures. Groups 1, 2, and 3, had
Lausanne, Switzerland lectures 1, 2 and 3 months apart respectively. Group 4 re-
ceived the educational material only. Half of the patients
Objective: To evaluate the trabecular bone score (TBS), (subgroups A) received four telephone calls (3 months apart)
BMD and body composition in men of various ages. after the final lecture or after receiving the educational mate-
Material and Methods: 300 men aged 40–87 years (mean rial (Group 4). Weight, height, were measured at baseline and
age - 60.5±0.6 year; mean height - 1.61±0.003 m; mean at 1 year after the educational program. BMI was calculated.
weight - 84.1±0.9 kg) were examined. The patients were Participants were encouraged to maintain a balanced diet and
divided into the following age-dependent groups: 40–49 year to exercise at least three times a week.
(n=52), 50–59 year (n=90), 60–69 year (n=88), 70–79 year Results: All groups were similar in age, BMI was significant-
(n=58), 80–87 year (n=12). The BMD of total body, PA ly different in the group that did not attend classes (Group 4).
lumbar spine and proximal femur were measured by the Table 1 shows changes in BMI. All groups that attended
Osteoporos Int

classes (Groups 1 to 3) diminished BMI. Group 3 (higher 0.020 g/cm2; F=20.09; p<0.001) decrease with age. Signifi-
baseline BMI) decreased BMI the most. Group 4 (educational cant correlation was observed between TBS and BMD of
material only) increased BMI changing from obesity grades I lumbar spine (TBS=0.93+0.26×BMD(L1-L4); r=0.37; t=
and II, at baseline, to obesity grades II and III (morbid obesity) 8.61; p<0.001), proximal femur (TBS=0.97+0.27×BMD
in 1 year. Among those who lost weight, the higher initial (L1-L4); r=0.29; t=6.61; p<0.001) and lean (TBS=1.34–
BMI, the greater initial weight loss (p=0.03). Differences 0.000003×Lean mass (g); r=−0.11; t=−2.47; p=0.01) and
were significant between groups: fat (TBS = 1.25–0.000003 × Fat mass (g); r = −0.100; t =
(1–3) mean=− 1.64, 95%CI (−6.50, −0.77), p=0.006 −2.200; p=0.03) masses.
(1–4) mean=−3.55, 95%CI (−6.27, −0.83), p=0 Conclusion: TBS and BMD of the examined women signif-
(2–4) mean=−4.60, 95%CI (−7.35, −1.849), p=0 icantly decreased with ageing. We have also found a signifi-
(3–4) mean=−7.19, 95%CI (−9.94, −4.44), p=0.00 cant correlation of TBS and BMD of lumbar spine and prox-
Conclusion: The educational program with its clarification imal femur, lean and fat masses.
about the importance of healthy eating and exercise improved
anthropometric parameters of this population, which adhered
to the guidelines.
Acknowledgements: We would like to thank TRB Pharma P552
Brasil for the financial support. FUNCTIONAL IMPROVEMENT BY HOME
EXERCISE AND EDUCATIONAL PROGRAM:
PARQVE
P551 M. U. Rezende1, F. E. S. Farias1, C. H. A. Cernigoy1, C. A. C.
TRABECULAR BONE SCORE, BONE MINERAL Silva1, O. P. Camargo1
1
DENSITYAND BODY COMPOSITION IN WOMEN Instituto de Ortopedia e Traumatologia, Hospital das
OF DIFFERENT AGES Clínicas, Unversidade de São Paulo, São Paulo, Brazil
V. V. Povoroznyuk1, N. I. Dzerovych1, R. V. Povoroznyuk1,
A. S. Musiienko1, D. Hans2 Objective: Evaluate the improvement of function and balance
1
Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine, in patients with OA undergoing an educational program of a
2
Center of Bone Diseases, Lausanne University Hospital, day with multidisciplinary.
Lausanne, Switzerland Material and Methods: 202 patients with knee OA were
submitted to two tests: Timed and Go (TUG) and Five Times
Objective: The aim of this study was to evaluate the trabec- Sit to Stand Test (FTSST) at enrolment and 1 year after an
ular bone score (TBS), BMD and body composition in women educational program (PARQVE). Patients were divided in
of various ages. four groups and received take home written and audiovisual
Material and Methods: 494 women aged 41–89 years (mean material on OA. Groups 1 to 3 had 2 days of lectures with
age - 63.6±0.4 year; mean height - 1.61±0.003 m; mean orthopedic surgeons, physical therapists, psychologists, occu-
weight - 74.0±0.6 kg) were examined. The patients were pational therapists, nutritionist, physical educators, social
divided into the following age-dependent groups: 40–49 year workers. Group 4 received the written and audio material.
(n=35), 50–59 year (n=130), 60–69 year (n=177), 70–79 year All patients were oriented to exercise at least three times a
(n=128), 80–88 year (n=24). BMD of total body, PA lumbar week. Each group was subdivided in A (received bimonthly
spine and proximal femur were measured by the DXA method telephone calls) and B (no telephone calls).
(Prodigy, GEHC Lunar, Madison, WI, USA) and PA spine Results: All groups improved in TUG irrespective of the
TBS were assessed by the TBS iNsight® software package group they were in with no significant difference between
installed on our DXA machine (Med-Imaps, Pessac, France). them (p=0.097). When considering only groups 1 to 4, (irre-
Results: We observed a significant decrease of TBS (L1-L4) spective of telephone calls) FTSST showed a difference be-
as a function of age (40–49 year - 1.321±0.021; 50–59 year - tween groups (p=0.037), however ANOVA could not show
1.245±0.012; 60–69 year - 1.189±0.011; 70–79 year - 1.166 what group was different. But when comparing groups that
±0.001; 80–88 year - 1.114±0.033; F=14.28; p<0.001). We had classes (1+2+3) with the group that just received the
also found the lumbar spine BMD (40–49 year - 1.156± educational material (4), TUG showed trends of difference
0.038 g/cm2; 50–59 year - 1.068±0.018 g/cm2; 60–69 year - p=0.066 and FTSST improved significantly in the class group
1.022±0.016 g/cm2; 70–79 year - 1.003±0.001 g/cm2; 80– p=0.012.
89 year - 1.007±0.037 g/cm2; F=5.11; p=0.0005) and prox- Conclusion: Patients improve function and balance with ed-
imal femur BMD (40–49 year - 1.012±0.037 g/cm2; 50– ucation and attention.
59 year - 0.940±0.013 g/cm2; 60–69 year - 0.923±0.011 g/ Acknowledgements: We would like to thank TRB Pharma
cm2; 70–79 year - 0.843±0.012 g/cm2; 80–89 year - 0.741± Brasil for financial support.
 Osteoporos Int

1
P553 Department of Rheumatology, Mafraq Hospital, Abu Dhabi,
ANTHROPOMETRIC CHARACTERISTICS OF United Arab Emirates
POSTMENOPAUSALWOMEN DEPENDING ON
APPENDICULAR SKELETAL MASS Objective: Diagnostic discordance for osteoporosis is the
V. V. Povoroznyuk1, N. I. Dzerovych1, R. V. Povoroznyuk1 presence of different T-scores in two skeletal sites in the same
1
Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine subject leading to different WHO diagnostic categories. Dis-
cordance is defined as minor when the difference between two
Objective: To evaluate the anthropometric characteristics in sites is no more than one WHO diagnostic class and major
postmenopausal women depending on appendicular skeletal when one site is osteoporotic and the other is normal. To
mass. determine the percentage of minor and major diagnostic dis-
Material and Methods: We examined 8,882 women aged cordance and identify associated factors in patients diagnosed
20–89 years (mean age - 56.7±0.14 year; mean height - 162.5 with osteoporosis.
±0.07 cm; mean weight - 73.5±0.16 kg), among them anthro- Material and Methods: All Emirati patients ≥50 years old
pometric measures were performed in 79 postmenopausal seen in rheumatology clinics of our hospital from 2011 to
women aged 40–82 year (mean age - 63.53±1.08 year, mean 2013 diagnosed with osteoporosis were identified through an
height - 157.54±0.79 cm, mean weight - 74.75±1.68 kg). internal audit. Details of the first DXA during the study period
Appendicular skeletal mass (ASM) was measured in all four were extracted, including weight, height, T-score at femoral
limbs with DXA. We also calculated the appendicular skeletal neck and total hip in the right side (RFN, RTH) and left side
mass index (ASMI) as ASM/height (kg/m2). During quartile (LFN, LTH) and T-score at lumbar spine (LS). Differences in
analysis depending on ASMI the examined women were T-scores and degree of discordance between sites were calcu-
divided on following groups: Q1 - ASMI<6.38 kg/m2 (n= lated. Age, weight, height and BMI were analysed as contrib-
20), Q2 - ASMI=6.38–6.83 kg/m2 (n=20), Q3 - ASMI= uting factors.
6.84–7.36 kg/m2 (n=20), Q4 - ASMI>7.36 kg/m2 (n=19). Results: One hundred patients with osteoporosis and DXA
Anthropometric characteristics of the women were evaluated test were identified. The mean age was 64.2 (±9.4 SD) and
by the method of Bunak V.V. (1941) in the modification 88 % were females. Diagnostic agreement among all skeletal
Shaparenko P.F. (1994). Lean and fat masses were measured sites was found in 15 % of patients, while 30 % and 55 %
by DXA using a densitometer Prodigy, GE. showed at least one major or minor discordance, respectively.
Results: Frequency of sarcopenia in women aged 65 year and No significant correlation with age, weight, height or BMI
older was 7 %. Quartile analysis (depending on ASMI) shows was found. Maximum concordance was found between RFN
that women of Q1 and Q2 groups had significantly lower the and LFN (80 %) and minimum (29 %) between LS and LTH
following anthropometric characteristics: weight (F=5.24; р= or RFN. Minor discordance was present in about half of the
0.002), neck circumference (F=5.68; р=0.001), abdomen patients when comparing spine to any hip site, and around one
circumference (F=11.52; р<0.0001), shoulder width (F= third when comparing ipsilateral TH and FN sites. Major
2.22; р=0.09), narrow tibia circumference (F=6.44; р= discordance in LS compared to RTH or LTH was found in
0.0006). We also observed the significantly lower thorax 23 % of patients, and in 15 % and 13 % when comparing LS to
circumference in women of Q1 group (F=3.82; р=0.01) in RFN and LFN, respectively.
comparison with women of Q4 group (F=3.82; р=0.01). Conclusion: Spine-hip major and minor discordance is high
Conclusion: Women with lower ASMI (Q1 and Q2 groups) in patients diagnosed with osteoporosis, consistent with pre-
had the significantly lower following anthropometric charac- vious reports. Multiple site measurements seem mandatory for
teristics: weight, neck circumference, abdomen circumfer- osteoporosis diagnosis.
ence, shoulder width, narrow tibia circumference. Thus, we
can use the anthropometric measures for determining the
groups with the relative risk of sarcopenia and its P555
complications. COULD OVARIECTOMY EXERT DIFFERENT
EFFECTS ON BIOMECHANICAL PROPERTIES OF
DIABETIC AND NONDIABETIC RAT BONES?
A. Agripino1, C. De Mello-Sampayo2, D. Stilwell3, B. Vidal4,
P554 A. Lopes4, M. P. Vaz5, A. C. Vale5, H. Canhão6, B. Silva-
HIP-SPINE DIAGNOSTIC DISCORDANCE IN THE Lima7, M. C. Marques8
1
UNITED ARAB EMIRATES Unidade de Biotecnologia Ambiental (UBiA), Departamento
N. Wilson1, L. Sanchez Riera1, I. Hussein1, S. Nuhaily1, N. de Ciências e Tecnologia da Biomassa, Faculdade de Ciências
Qahtani1, N. Ibrahim1, R. Aneja1, T. Khan1, H. Maashari1, S. e Tecnologia da Universidade Nova de Lisboa, Lisbon, Por-
Waheeduddin1, S. Gonuguntla1, M. Al Maini1 tugal, 2Pharmacological Sciences Unit, iMed.ULisboa,
Osteoporos Int

Faculdade de Farmácia, Universidade de Lisboa bone changes induced by rheumatoid arthritis(1) in mice and
Departamento de Ciências Farmacológicas, Faculdade de by tocotrienols supplementation in rats(2).
Farmácia da Universidade de Lisboa, Lisbon, Portugal, References: 1) Caetano-Lopes et al. Clin Experim Rheumatol
3
Clinica Veterinária de Colares, Sintra, Portugal, 4Rheumatol- 2009;27:475. 2) Shuid et al. J Bone Miner Metab
ogy Research Unit, Instituto de Medicina Molecular, 2010;28:149.
Faculdade de Medicina da Universidade de Lisboa, Lisbon, Acknowledgements: Grant PEst-OE/SAU/UI4013/2011 by
Portugal, 5Instituto de Ciência e Engenharia de Materiais e the Portuguese Foundation for the Science and Technology
Superfícies, Instituto Superior Técnico, Universidade de Lis- (FCT)
boa, Lisbon, Portugal, 6 Rheumatology Research Unit,
Instituto de Medicina Molecular, Faculdade de Medicina da
Universidade de Lisboa, Lisbon, Portugal, 7Pharmacological
Sciences Unit, iMed.ULisboa, Faculdade de Farmácia, P556
Universidade de Lisboa, Portugal Departamento de Ciências BODY COMPOSITION AND BONE MINERAL
Farmacológicas, Faculdade de Farmácia da Universidade de DENSITY IN POSTMENOPAUSALWOMEN
Lisboa, Lisbon, Portugal, 8 Unidade de Biotecnologia V. V. Povoroznyuk1, N. I. Dzerovych1, R. V. Povoroznyuk1
1
Ambiental (UBiA), Departamento de Ciências e Tecnologia Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine
da Biomassa, Faculdade de Ciências e Tecnologia da
Universidade Nova de Lisboa Departamento de Ciências Objective: To evaluate the peculiarities of body composition
Farmacológicas, Faculdade de Farmácia da Universidade de in postmenopausal women depending on BMD.
Lisboa, Lisbon, Portugal Material and Methods: We examined 8,882 women aged
20–89 year (mean age - 56.7±0.14 year; mean height - 162.5
Objective: Osteoporosis is associated with an increased risk ±0.07 cm; mean weight - 73.5±0.16 kg). Anthropometric
of bone fractures. This study used an animal model of diabetes measures were performed in 80 postmenopausal women aged
and osteoporosis to evaluate the impact of diabetes on biome- 40–82 year (mean age - 63.53±1.08 year, mean height -
chanical properties of bone. 157.54±0.79 cm, mean weight - 74.75±1.68 kg), who were
Material and Methods: Wistar rats (3 month-old) were di- divided on the following groups depending on BMD: 1.(N) -
vided into 4 equal groups (n=28): sham (SH); ovariectomized 32 women with normal BMD, 2.(OSN) - 28 women with
(OV); diabetes mellitus induced by streptozotocin (DM) and osteopenia; 3.(OSP) - 20 women with osteoporosis. Anthro-
diabetes mellitus+ovariectomized (DM+OV). CTX and PINP pometric characteristics of the women were evaluated by the
serum concentrations were estimated on day 56 post ovariec- method of Bunak V (1941) in the modification Shaparenko P
tomy. Body weight and bones diameters were measured. (1994). Lean and fat masses, BMD were measured by DXA
Femoral bones biomechanical properties were evaluated by using a densitometer Prodigy, GE.
bending tests. Data were analyzed using Mann-Whitney non- Results: Frequency of sarcopenia in women aged 65 year and
parametric and Spearman correlation tests (statistical signifi- older was 7 %. We found that women with osteoporosis had
cance ≤0.05). significantly lower the following anthropometric characteris-
Results: Body weight increased in all groups compared to tics: weight (N - 81.50 kg, OSN - 72.5 kg, OSP - 69.4 kg; F=
sham (SH) (p<0.005), being the gain higher in ovariecto- 5.62; р=0.005), head circumference (N - 558 mm, OSN -
mized groups (OV and OV+DM). A significant increase in 558 mm, OSP - 541 mm; F=4.59; p=0.01), circumference of
bone turnover was observed in the OV groups when compared the forearm widest part (N - 272 mm, OSN - 252 mm, OSP -
to the SH. The ratio PINP/CTX was higher in the DM when 246 mm; F=9.41; p=0.0002), calf diameter (N - 110 un.,
compared to OV and SH group (p<0.05). A similar trend was OSN - 107 un., OSP - 98 un.; F=3.90; p=0.02), shoulder
observed in the OV+DM group, suggesting an increased bone width (N - 89 un., OSN - 82 un., OSP - 80 un.; F=4.09; p=
formation in diabetic rats. The increased mechanical 0.02), transverse diameter of the chest (N - 310 un., OSN - 292
strength (evaluated by the yield stress and ultimate un., OSP - 278 un.; F=4.69; p=0.01). We observed that
stress) observed in the DM group did correlate positive- women with osteoporosis had significantly lower lean (N -
ly with registered bone turnover biomarkers changes. 43382 g, OSN - 40042 g, OSP - 40702 g; F=3.73; p=0.03)
When bone diameter was taken into account on bone and fat (N - 36826 g, OSN - 31160 g, OSP - 27323 g; F=6.03;
mechanical measured parameters no significant differ- p=0.004) masses.
ences were detected between groups. Conclusion: Women with osteoporosis had significantly low-
Conclusion: These results show that the increased bone turn- er weight, head circumference, circumference of the forearm
over observed in diabetic rats produces strengthen bones. widest part, calf diameter, shoulder width, transverse diameter
Furthermore, changes on cortical bone due to osteoporosis of the chest and lean and fat masses in comparison with
might not be detect by normalised bending tests used to detect women with normal BMD. Thus, we can form the
 Osteoporos Int

“anthropometric portrait” of women suffering from osteopo- of Galectin-3 by MSC and therefore contributing to
rosis and sarcopenia. impaired osteogenesis with age.

P557
AGE-DEPENDENT LOSS OF MICROVESICULAR P558
GALECTIN-3 AND ITS CONSEQUENCES ON BONE COMBINING BINDEX® AND FRAX® IN
FORMATION IN VITRO AND IN VIVO TREATMENT DECISION PATHWAY FOR
S. Weilner1, P. Heimel2, V. Keider1, E. Schraml1, F. Weiß1, R. OSTEOPOROSIS
Grillari-Voglauer3, H. Redl2, H. Y. Chen4, J. Grillari1 J. P. Karjalainen1, O. Riekkinen1, H. Kröger2
1 1
Department of Biotechnology, University of Natural Re- Bone Index Finland Ltd., Kuopio, Finland, 2Department of
sources and Life Sciences Vienna, Vienna, Austria, 2Ludwig Orthopaedics, Traumatology and Hand Surgery/Kuopio Uni-
Boltzmann Institute for Experimental and Clinical versity Hospital, Kuopio, Finland
Traumatology, Vienna, Austria, 3Evercyte GmbH, Vienna,
Austria, 4Institute of Biomedical Sciences, Academia Sinica, Objective: According to National Osteoporosis Foundation
Taipei, Taiwan, Province of China (NOF) guidelines, treatment is recommended for osteo-
porotic patients and patients with osteopenia and high
Objective: Mesenchymal stem cells (MSCs) counteract fracture probability (FRAX with BMD over 3 % for hip
the decline of physiologic functions but their regenera- and/or over 20 % for other fractures). In this study, a
tive power decreases with age. In particular osteogenic pocket size pulse-echo (PE) ultrasound (US) device and
differentiation capacity of MSCs has been shown to FRAX with BMI is used in treatment pathway analysis
decrease with age thereby contributing to slowed down and compared to NOF guidelines.
bone formation and osteoporosis. While much is known about Material and Methods: Elderly Caucasian woman (n=427,
cellular aging of MSCs, little is known about extrinsic factors age=69±9 years) were examined using Bindex® device.
influencing their functionality. Here we set out to identify Bindex® reports a diagnostic parameter, density index, DI2.
circulating factors of the aged systemic environment that Previously, the 90 % sensitivity and specificity thresholds for
influence osteogenesis. DI were determined along ISCD guidelines3 in diagnostics of
Material and Methods: - osteoporosis. By using these thresholds, subjects were classi-
Results: While searching for factors extracellular vesicles fied as healthy (green), osteoporotic (red) or in need of DXA
(EVs) were found. Exposition of MSCs to EVs isolated from examination to verify diagnosis (yellow). Osteoporosis was
plasma of human elderly donors failed to induce osteogenesis assessed by proximal femur axial DXA. In addition, FRAX
compared to EVs of young donors raising the question which scores with BMD (FRAXBMD) and with BMI (FRAXBMI)
age-dependent secreted vesicular components impact on were determined.
MSCs functionality. We identified vesicular Galectin-3 as an Results: A total of 173 subjects (73 osteoporotic) were select-
influential component. Plasma and vesicular Galectin-3 levels ed to be treated along NOF guidelines. FRAXBMI was ana-
were reduced in elderly compared to young human donors and lyzed for patients with DI value in yellow or green area.
we could demonstrate that vesicular Galectin-3 levels indeed Subjects with red DI value and yellow DI value with
impact on osteogenic differentiation capacity of MSCs. Over- FRAXBMI over 20 % were selected to be treated. Subjects
expression of Galectin-3 in MSCs was shown to boost osteo- with yellow DI value and FRAXBMI under 20 % or
genic differentiation capacity while reducing its protein ex- green DI value and FRAXBMI over 20 % were selected
pression by siRNA inhibited osteogenesis in vitro. Moreover for additional DXA measurement. The patients with green DI
intracellular Galectin-3 levels of MSCs correlated with their value and FRAX under 20 % were considered healthy. The
osteogenic differentiation potential. NanoCT scan on sensitivity and specificity of treatment decisions were 84 %
Galectin-3 knockout mice revealed a reduction of femoral and 93 %, respectively. Only 31 % of the patients were found
cortical as well as trabecular thickness compared to wild type to require additional DXA measurement to verify the treat-
littermates. ment decision.
Conclusion: We showed that the composition of circulating Conclusion: The present results demonstrate that the ultra-
EVs changes with age and that they deliver factors impacting portable US instrument with FRAXBMI shows strong agree-
on the osteogenic differentiation capacity of MSCs. Among ment (89 %) with treatment decisions using NOF guidelines.
other factors vesicular Galectin-3 was shown to be enriched References: [1]Nguyen, Med J Aust., 2004. [2]Karjalainen,
within EVs isolated from young human donors and to Osteoporos Int., 2012. [3]Hans, J Clin Densitom., 2008.
enhance osteogenesis. Reduction in vesicular Galectin-3 Disclosures: Karjalainen JP and Riekkinen O are employees
plasma levels with age might lead to a reduced uptake at Bone Index Finland Ltd.
Osteoporos Int

1
P559 Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine
CORRELATION BETWEEN QUALITY OF LIFE,
STRESS AND SELF ESTEEM IN PATIENTS WITH Objective: The aim of the research is to determine the fre-
OSTEOPOROSIS quency of vitamin D deficiency and its influence on bone
D. M. Farcas1, F. Marc2, A. I. Gasparik3, C. Suteu4, C. turnover markers in men of different ages.
Moldovan2 Material and Methods: There were examined 215 men, aged
1
Physical Rehabilitation, Faculty of Medicine and Pharmacy, (54.33±1.74) years. The level of 25(OH)D, iPTH, bone turn-
ASPOR, Oradea, Romania, 2Internal Medicine, Faculty of over markers (osteocalcin - marker of turnover rate, β-СТх -
Medicine and Pharmacy, Oradea, Romania, 3ASPOR, Tirgu marker of resorption, and P1NP - marker of bone formation)
Mures, Romania, 4Occupational Medicine, Faculty of Medi- were evaluated by electrochemiluminescence method
cine and Pharmacy, Oradea, Romania (Elecsys 2010, Roche). Vitamin D deficiency was de-
fined as a 25(OH)D below 20 ng/ml (50 nmol/L), and
Objective: To assess quality of life, stress and self-esteem in vitamin D insufficiency as 25(OH)D of 21–29 ng/ml
patients with osteoporosis, and the correlations among them. (50.1–74.9 nmol/L).
Material and Methods: Our study consisted in assessing Results: Only 6.0 % of examined men had optimal 25(OH)D
patients with osteoporosis. We divided the patients in two level. Vitamin D insufficiency was diagnosed in 18.7 %, and
groups, first group of 25 women, second group of 25 men. vitamin D deficiency was recorded in 75.3 % observed pa-
The entire group of patients were recruited from ambulatory tients. Severe vitamin D deficiency (25(OH)D level is below
system Bihor county, Romania. The mean age in the group of 25 nmol/L) was registered in 31.6 %. All observed men were
women was 63.24±5.31 and in the group of men was of 69.92 divided into 4 groups according 25(OH)D level: the 1st group
±4.49. The main characteristics of the groups, included edu- included patients with severe vitamin D deficiency, 2nd group
cational level were similar in both groups. The inclusion - with 25(OH)D level 25–50 nmol/L, 3rd group - with vitamin
criteria were: fulfilling the WHO criteria for osteoporosis, D insufficiency, and 4th group - with optimal 25(OH)D level.
complying with the principles of medical ethics. The exclu- iPTH level was lower in men of 2nd group [37.80 [25.83;
sion criteria were: severe diseases, noncompliance. All the 45.33] pg/mL, and significantly higher in observed with opti-
patients were assessed for osteoporosis using DXA method. mal 25(OH)D level [43.15 [26.03; 45.90] pg/mL (p<0.05). It
We used Qualeffo 41 questionnaire for assessing quality of hasn’t been found the significant difference in osteocalcin
life, Levenstein Index for stress and Rosenberg Self Esteem level and bone formation marker (P1NP) in observed men
Scale for self-esteem. All the questionnaires that we used were with different 25(OH)D level. The concentration of β-СТх
validated in international studies. was lower in patients with optimal 25(OH)D level (0.351
Results: Quality of life was low in both groups, but in the [0.251; 0.493]) ng/mL and significantly higher in group with
group of women with osteoporosis was lower than in men sever vitamin D deficiency (0.545 [0.400; 0.680]) ng/mL
with osteoporosis. The mean stress value was almost similar (p<0.05).
in both groups, and the mean self-esteem value was lower in Conclusion: Only 6.0 % of Ukrainian men has optimal
the group of women than in the group of men with osteopo- level of 25(OH)D in blood serum. Decreasing concen-
rosis. We found also correlations between quality of life and tration of 25(OH)D in blood serum leads to increasing
stress and self-esteem. the markers of bone resorption. High level of vitamin
Conclusion: Our study showed that patients with osteoporo- D deficiency makes doctors to search the effective
sis, both women and men have an impaired quality of life, in treatment and prevention methods of revealed
different degrees. Psychological well-being was also affected disorders.
by osteoporosis. We found also correlations between quality
of life and some psychological factors like self-esteem and
stress in patients with osteoporosis. Further studies should be P561
done to develop strategies to cope with stress and low self- INFLUENCE OF VITAMIN D DEFICIENCY TO
esteem as part of psychological wellbeing and health related STRUCTURAL AND FUNCTIONAL STATE OF BONE
quality of life in patients with osteoporosis. TISSUE IN SCHOOLCHILDREN
V. V. Povoroznyuk1, O. V. Tyazhka2, N. I. Balatska1, T. V.
Budnik3, I. V. Kubey4, N. B. Haliyash4
1
P560 Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine,
2
INFLUENCE OF VITAMIN D DEFICIENCY ON BONE Bogomolets National Medical University, Kyiv, Ukraine,
3
TURNOVER MARKERS IN MEN OF DIFFERENT Lugansk State Medical University, Lugansk, Ukraine, 4I.Y.
AGE Horbachevsky Ternopil State Medical University, Ternopil,
V. V. Povoroznyuk1, N. I. Balatska1 Ukraine
 Osteoporos Int

Objective: To determine the influence of vitamin D deficien- Results: 152 subjects with hip fractures were admitted to our
cy on BMD in schoolchildren. institution from September 2012 to September 2013. Mean
Material and Methods: There were examined 304 children age 77.7 years. 138/152 (91 %) had serum vitamin D levels
aged 10–18 years. The boys consisted 55.0 %. The average performed. Mean level was 41.7 nmol/L. Median 32 nmol/L.
age of boys was 12.9±0.2 and girls 12.4±0.2 year old. Re- 90/138 (65 %) were vitamin D deficient with levels <50 nmol/
searches included ultrasound densitometry of calcaneus by L. 68 subjects (49 %) had levels under 30 nmol/L. Secondary
SAHARA (Hologic), blood chemistry, 25(OH)D and intact hyperparathyroidism was also evident in this latter group with
PTH (iPTH) in plasma were determined by Elecsys 2010. mean serum PTH levels of 76 pg/ml (15–65) compared to
Also, it was evaluated the average content of calcium and 63 pg/ml in the total study population. 35 subjects were
vitamin D in the diet form the products consumption frequen- prescribed vitamin D supplementation for known osteoporosis
cy questionnaire. preadmission. 10 (29 %) of these had levels <50 nmol/L
Results: Vitamin D deficiency was founded in 92.2 % of suggesting they may not have been compliant.
schoolchildren, and vitamin D insufficiency was diagnosed Conclusion: Vitamin D deficiency is widespread in an older
in 6.1 % of cases. Secondary hyperparathyroidism was veri- population presenting with hip fracture. Supplementation is
fied in 0.9 % of children. The average level of consumption of not. Compliance is poor in those who are on supplementation.
calcium and vitamin D in children was below recommended All subjects in this study had vitamin D supplements pre-
data, and consisted (Me 649 [488.7; 691.86]) mg/day for scribed by our bone health team during admission for hip
calcium and (Me 68.69 [58.45; 117.3]) IU/day for vitamin fracture. Our next step is to review compliance and vitamin
D. Children with vitamin D insufficiency had significantly D levels in these subjects when they return for review and
higher data of structural and functional state of bone tissue in DXA.
comparison with the data of pupils with severe deficiency of
vitamin D: stiffness index 105.03±6.12 vs. 93.7±2.51 %
(p<0.02); BMD 0.574±0.024 vs. 0.528±0.019 (p<0.02) P563
and speed of sound 1573.61±6.70 vs. 1557.2±5.41 (p<0.01). MEDICATION USE BEFORE AND AFTER HIP
Conclusion: High level of vitamin D deficiency (92.2 %), FRACTURE: A POPULATION-BASED COHORT
secondary hyperparathyroidism (0.9 %), low data of ultra- STUDY
sound densitometry in severe vitamin D deficient children L. Idolazzi 1, M. Rossini 1, S. Buda2, O. Viapiana1, C.
make doctors to research the effective methods of treatment Veronesi2, D. Gatti1, L. Degli Esposti2, M. Risoli1, S. Adami1
1
and prophylactics of revealed disorders. Department of Medicine, Rheumatology Unit, University of
Verona, Verona, Italy, 2CliCon S.r.l. Health, Economics &
Outcomes Research, Ravenna, Italy
P562
VITAMIN D IN ACUTE HIP FRACTURE Objective: To investigate the changes of concomitant treat-
R. Lannon1, E. Lynn1, P. Mccauley1, B. Mccarthy1, N. ments observed before and after hip fracture in the elderly
Fallon1, M. C. Casey1, J. B. Walsh1 population, in comparison with a matching cohort of subjects
1
Bone Health Unit, St James Hospital, Dublin, Ireland without hospitalisation for fractures.
Material and Methods: Design: The data of the study pop-
Objective: Vitamin D is considered an important therapy in ulation has been extracted from a large population-based
prevention of fracture in known osteoporosis. Hip fracture is administrative database of the Italian National Health Author-
one of the most serious fractures than can occur and confers ities. Participants: A retrospective analysis was conducted
significant morbidity and mortality. Supplementation in those involving female patients (6,431) aged ≥65 years and
who are not known to be osteoporotic is controversial though hospitalised for a hip fracture. The control group comprised
generally recommended in the elderly, institutionalised or age-matched subjects (38,586) not hospitalised for fracture.
known vitamin D deficiency. However vitamin D deficiency Measurements: Changes in drug prescriptions 1 year before
itself is not widely screened for. In this study we aimed to and 1 year after hip fracture and differences vs. controls.
establish the prevalence of vitamin D deficiency in consecu- Results: Prior to the fracture, patients were taking more anti-
tive admissions with hip fracture. We also looked at vitamin D Parkinsons, antidepressants, medications for chronic obstruc-
levels in those already prescribed supplements for known tive pulmonary disease (COPD), bisphosphonates and
osteoporosis as a reflection of persistence and efficacy. calcium-vitamin D supplements, although the intake of the
Material and Methods: Consecutive hip fracture admissions routinely monitored drug classes were significantly infre-
who were seen by our bone health team had serum vitamin D quent. As compared to controls polypharmacy was less fre-
levels, serum PTH and calcium levels checked. Preadmission quent in fractured women before fracture (22 % vs. 25 %,
medications are also documented. respectively; P<0.001), but it was more frequent (30 %,
Osteoporos Int

P<0.001) post fracture. The incident fracture was associated 1st year of treatment were 1.3 billion HUF with compliant
with a significant increase in the use of a number of drug observations contributing 26.6 % of these. Mean cost per fx-
classes: insulin, nonsteroidal anti-inflammatory drugs or anal- related hospitalisation was 16.5 % lower for a compliant vs. a
gesics, gastroprotectors, loop diuretics, β-blockers, antide- noncompliant observation (687 k vs. 823 k HUF). Mean cost
pressants, anti- Parkinsons, antiepileptics and drugs for per observation was 51.8 % lower for a compliant vs. a
COPD. noncompliant observation (3719 vs. 7710 HUF).
Conclusion: Our study confirms a strong association between Conclusion: Patients compliant to PMO therapy have fewer
the use of some drugs (antidepressants, anti-Parkinsons, drugs fx and fx-related hospitalisations and lower fx-related
for COPD) with the risk of hip fracture, but drug use is hospitalisation costs than noncompliant patients.
globally less common than in controls. Hip fracture is associ- Acknowledgements: This study and abstract were funded by
ated with a significant increase in drug use suggesting a global Amgen and GSK.
deterioration of health conditions.

P565
P564 INTER-METHOD VARIABILITY IN BONE
ASSOCIATION OF TREATMENT COMPLIANCE ALKALINE PHOSPHATASE MEASUREMENT:
WITH FRACTURE (FX)-RELATED CLINICAL IMPACT ON THE MANAGEMENT OF
HOSPITALISATIONS AND THEIR ASSOCIATED DIALYSIS PATIENTS
COSTS AMONG HUNGARIAN WOMEN WITH E. Cavalier1, P. Delanaye2
1
POSTMENOPAUSAL OSTEOPOROSIS (PMO) Department of Clinical Chemistry, University of Liege, CHU
P. Lakatos 1 , P. Rakonczai 2 , Z. Cina 2 , B. Nagy 2 , E. Sart-Tilman, Liège, Belgium, 2Department of Nephrology,
Psachoulia3, M. Intorcia3 Liège, Belgium
1
Semmelweis University, Budapest, Hungary, 2Healthware
Consulting Ltd, Budapest, Hungary, 3Amgen (Europe) Objective: Bone-specific alkaline phosphatase (BAP) is now
GmbH, Zug, Switzerland recommended to assess bone turnover in hemodialysis (HD)
patients. However, little is known about potential variability
Objective: Low compliance to PMO therapy is associated between methods available to measure BAP.
with increased risk of fx and fx-related hospitalisation. We Material and Methods: We measured BAP in 76 HD patients
studied the association of compliance with fx-related with six different assays (Beckman-Coulter Ostase IRMA,
hospitalisation costs during the 1st year of PMO therapy in IDS iSYS Ostase, IDS Ostase enzyme immunoassay,
Hungarian women. DiaSorin Liaison Ostase and Quidel MicroVue BAP).
Material and Methods: From the ‘National Health Insurance Results: We observed a high correlation between all the
Fund Administration’ database, we included women ≥50 years assays ranging from 0.9948 (IDS iSYS vs. IDS EIA) to
old with an osteoporosis diagnosis, who started PMO treat- 0.9215 (DiaSorin Liaison vs. Quidel Microvue). However,
ment during 2007–2012. Each patient could have ≥1 obser- using the regression equations, the equivalent concentration
vation, with a non-treatment period ≥13 months between each of a Beckman-Coulter Access value of 10 μg/L can range to
observation. For each observation, compliance was measured 7.7–14.4 μg/L and of 20 μg/L can range to 16.9–27.9 μg/L
using medication possession ratio (MPR); MPR≥80 % con- with other assays. According to Beckman-Coulter Access,
sidered compliant. From the database, fx-related 13 %, 50 % and 37 % of the patients presented BAP values
hospitalisation costs were measured for 1 year after treatment ≤10, between 10–20 and ≥20 μg/L, respectively. Discrepan-
initiation. Mean costs were calculated per fx-related cies are observed when other assays are used (concordance
hospitalisation, and per observation (i.e., denominator=number from 10 to 100 %).
of observations reporting a hospitalisation, and number of Conclusion: Analytical problems leading to inter-method
observations, respectively). variation should be overcome to improve the usefulness of
Results: 185,759 women with 215,376 observations met the this marker in clinical practice. According to correlation re-
inclusion criteria; 42.9 % of all observations met the compli- sults, recalibration of BAP assays is necessary but should not
ance definition. During the 1st year of treatment, 3.5 % of all be a major issue.
observations had a fx, 21.8 % of which resulted in
hospitalisation. Compliant observations accounted for
27.1 % of all fx and 30.2 % of all hospitalisations. Compliant P566
compared to noncompliant observations had half the proba- HYPERURICEMIA, BONE MINERAL DENSITYAND
bility of fx (2.23 % vs. 4.49 %) and fx-related hospitalisation TBS OF UKRAINIAN MEN
(0.54 % vs. 0.94 %). Total fx-related hospitalisation costs for V. V. Povoroznyuk1, H. S. Dubetska1
 Osteoporos Int

1
Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine ±0.018 g/cm2, T-score -2.05±0.15 SD, group 2 - BMD
0.7877±0.02 g/cm2, T-score -1.87±0.18 SD). After 3 years
Objective: To determine the prevalence of hyperuricemia of follow up, a statistically significant increase of BMD and T-
affecting the Ukrainian men in relation to BMD and TBS. criterion of the femoral neck with patients treated with ritux-
Material and Methods: Ukrainian men (n=132), age of the imab, relative to benchmarks are received (BMD 0.8381±
examined patients from 50 to 80 years. Average age of exam- 0.0210 g/cm2, T-score -1.56±0.15 SD, р=0.033 and р=
ined patients was 58.2±1.3 years. According to the levels of 0.022). In the group of patients treated with methotrexate only,
uric acid in the blood serum, all patients were divided in four a statistically significant change in densitometric parameters
quartiles. Uric acid level in blood plasma was determined by of the femoral neck is not received. A similar positive BMD
the uricase-peroxidase method, BMD by means of the Prodigy trend was observed in 4 years of the therapy with rituximab
unit (CE Medical systems, model 8743, 2005). The TBS was and methotrexate (BMD 0.8422±0.023 g/cm2, T-score -1.58
evaluated using the installed TBS iNsight® software for an X- ±0.16 SD, р=0.045 and р=0.048).
ray densitometer (Med-Imaps, Pessac, France). Conclusion: The positive impact of rituximab on BMD of the
Results: The rate of hyperuricemia affecting the Ukrainian femoral neck was significantly determined after three courses
men was 23 % in the age group of 50–59 year-olds, 33 % in of application and maintained after the fourth course.
the age group of 60–69 year-olds, 29 % in the age group of
70–79 year-olds. The frequency of osteoporosis in men with
hyperuricemia was lower compared with men who had a P568
normal level of uric acid (4 % and 17 % at the level of the EVALUATION OF AUTOMATED IMMUNOASSAYS
lumbar spine, and 4 % and 15 % at the level of femoral neck). FOR 25(OH)-VITAMIN D DETERMINATION IN
BMD was significantly higher in case of men having the DIFFERENT CRITICAL POPULATIONS BEFORE
highest levels of uric acid in the lumbar spine (F=2.78; p= AND AFTER STANDARDISATION OF THE ASSAYS
0.04), radius 33 % (F=3.96; p=0.01) and total body (F=2.70; E. Cavalier1, P. Delanaye2
p=0.04). TBS was significantly higher in the patients who had 1
Department of Clinical Chemistry, University of Liege, CHU
the lowest levels of uric acid compared with the patients who Sart-Tilman, Liège, Belgium, 2Department of Nephrology,
had the highest level of uric acid (Q1=1.17±0.02, Q4=1.04± Liège, Belgium
0.02; p<0.05).
Conclusion: We determined that men with the low levels of Objective: Standardisation of immunoassays for 25(OH)-vi-
uric acid had the significantly lower levels of BMD, but the tamin D determination is a major problem in clinical practice.
TBS in men who have the highest levels of uric acid is higher. A worldwide standardisation program has started to address
this and will reduce the bias observed between immunoassays.
We aimed to calibrate 5 immunoassays on a LC-MS/MS
P567 traceable to the SRM 2972 and the ID-LC-MS/MS
THE EFFECT OF RITUXIMAB THERAPY ON BONE 25(OH)D Reference Method Procedure to see if the
MINERAL DENSITY WITH RHEUMATOID restandardization would be efficient in a population of 3rd
ARTHRITIS PATIENTS trimester pregnant women (PW), hemodialysis (HD) and os-
M. V. Koroleva1, T. A. Raskina1 teoporosis (OP) patient.
1
Kemerovo State Medical Academy, Kemerovo, Russian Fed- Material and Methods: 184 serum samples (25(OH)D: 8.4–
eration 87 ng/ml) were selected to calibrate the immunoassays (Ab-
bott-Architect, Roche-Elecsys, DiaSorin-Liaison, Siemens-
Objective: Assess the impact of rituximab treatment on BMD Centaur and IDS-iSYS). Chromsystems MassChrom method
of the femoral neck with rheumatoid arthritis (RA) patients was used as the referenced. Serum obtained in 34 PW, 25 HD
after 4 years of observation. and 34 OP patients were used as comparatives.
Material and Methods: We observed 92 patients with a Results: After adjusting to LC-MS/MS, immunoassays had
documented diagnosis of RA. The patients were randomized regression slopes nearly identical to 1.0 with intercepts
into two groups, depending on the basic therapy variant: <0.5 ng/ml. However, in special populations, a systematic
group 1 (n=52) - patients who received combined therapy bias was still observed, excepted for iSYS. Conclusions: re-
with methotrexate and rituximab, group 2 (n=40) - patients standardisation of 25(OH)D immunoassay will globally im-
with methotrexate only. BMD was measured by DXA with prove the differences. However, patients with different serum
steady bone densitometer Exceell XR-46 (Norland, USA) matrix will still present significantly different results when
once a year for 4 years. they will be run with different methods. For those patients,
Results: Found that the patients in both groups showed a LC-MS/MS method seems to be the method of choice, even if
decrease BMD of the femoral neck (group 1 - BMD 0.7779 some immunoassays are less influenced than others.
Osteoporos Int

Conclusion: After adjusting to LC-MS/MS, immunoassays bone ultrasound in Spanish osteoporotic women undergoing
had regression slopes nearly identical to 1.0 with intercepts treatment.
<0.5 ng/ml. However, in special populations, a systematic bias Material and Methods: We followed 184 women aged >50
was still observed, excepted for iSYS. Conclusions: re- for 5 years. Participants completed health history and food
standardisation of 25(OH)D immunoassay will globally im- frequency questionnaires and underwent BMD testing by
prove the differences. However, patients with different serum DXA. Quantitative ultrasound (QUS) measurements were
matrix will still present significantly different results when performed using a DBM Sonic Bone Profiler. We studied
they will be run with different methods. For those patients, the rate of bone loss over the 5 years. At the baseline, all the
LC-MS/MS method seems to be the method of choice, even if participants were osteoporotic were under treatment.
some immunoassays are less influenced than others. Results: Calcium and vitamin D intakes did not increase/
changed over time. In the whole sample, significant changes
of BMD were found in trochanter (P<0.001), L3 (P=0.025),
L4 (P=0.001) and L2-L4 (P=0.007). We did not observe
P569
changes in femoral neck (P=0.123) and L2 (P=0.094). Sig-
MOBILITYAND BALANCE TRAINING IN OLDER
nificant changes were also detected in QUS (P<0.001). The
FEMALE PATIENTS WITH HIP AND KNEE
rate of BMD change were respectively of +1.33 %, +0.67 %, +
OSTEOARTHRITIS
0.71 % and +0.71 % per year for trochanter, L3, L4 and spine.
A. Totorean1, R. Onofrei1, A. Nita1, O. Suciu1
1 respectively. QUS decreased −0.48 %/year in our sample.
Victor Babes University of Medicine, Timisoara, Romania
After further grouping for Ca intake (<800 mg/day; 800–
1,200 mg/day; >1,200 mg/day) no significant changes in
Objective: To improve functional mobility and balance in
BMD were detected in the hip, but increased up to 1.44 %/
older female patients with hip and/or knee osteoarthritis.
year in the spine for women with 800–1,200 mg Ca/d intake a
Material and Methods: 30 female patients with hip and knee
figure that doubled the observed for the whole population. A
osteoarthritis were evaluated for mobility and balance deficits.
decrease in QUS figures were detected in the <800 mg Ca/d
23 patients (mean age 66.73±5.24 years) were enrolled and
group (−0.62 %) and in the >1,200 mg (−0.65 %) that repre-
participated in a mobility and balance training program, for
sent a relative increase of 32.29 % in the bone ultrasound loss
5 months. Patients were evaluated using Timed Up&Go Test,
when the Ca intake is out of the requirements. At baseline,
Manual Timed Up&Go and the Four Square Step Test.
calcium and vitamin D intake were respectively 1233.19±
Results: All patients had a significant improvement in func-
529.73 mg/day and 424.28±763.16 UI/day.
tional mobility and balance after the 5 months of training.
Conclusion: Although total intakes were out of the recom-
Although an improvement was recorded, results showed that
mendations we found some positive associations between
patients over 70 years still had a functional deficit, with an
total calcium and vitamin D intake and bone health in Spanish
increased risk of falling compared with patients under
osteoporotic women undergoing treatment, mostly in the
70 years.
spine, when the calcium intake is within the recommended
Conclusion: A mobility and balance training program will
ranges.
improve functional status and reduce the risk of falling in
older patients with hip and knee osteoarthritis.
P571
INFORMATIVE VALUE OF DIFFERENT FRAX
P570 MODELS FOR ESTIMATION OF OSTEOPOROTIC
LONGITUDINAL CHANGES IN CALCIUM AND FRACTURE RISK IN UKRAINIAN WOMEN
VITAMIN D INTAKES, AND RELATIONSHIP TO V. V. Povoroznyuk1, N. V. Grygoryeva1
1
BONE MINERAL DENSITYAND BONE Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine
ULTRASOUND AFTER FIVE YEARS FOLLOW-UP IN
SPANISH OSTEOPOROTIC WOMEN UNDERGOING Objective: In the recent years worldwide, the FRAX is an
TREATMENT important tool for assessment of the risk of fragile fractures.
J. M. Moran1, R. Roncero-Martin1, J. M. Lavado-Garcia1, M. Data of the preliminary studies revealed that the FRAX scores
L. Canal-Macias1, P. Rey-Sanchez1, J. D. Pedrera-Zamorano1 used in the NOF guidelines as the criteria set for the treatment
1
Metabolic Bone Disease Research Group, University of Ex- initiation could not be used for the estimation of fracture risk
tremadura, Caceres, Spain and for treatment initiation in the Ukrainian women, because
with different models for the postmenopausal women in
Objective: To study changes in calcium and vitamin D intakes Ukraine who require treatment the target scores were signifi-
over time, and their longitudinal associations with BMD and cantly lower. With the aim to collect the normative data for
 Osteoporos Int

FRAX algorithm we’ve examined 3,757 women aged 40–89. Infectiology and Immunology, Medical University, Vienna,
We estimated 10-years risk for all fractures and hip osteopo- Austria, 9Department of Pathophysiology, Medical University
rotic fractures in particular using the FRAX algorithm, Vienna, Vienna, Austria
applying different country models for analysis (Austria,
Sweden, Germany, Hungary, Czech Republic, Turkey, Objective: Aging is a complex process that results in the decline
Russian Federation, the United States (Caucasians), of physiologic functions due to accumulation of damage in cells
France, Spain, Poland). and tissues. Mesenchymal stem cells (MSCs) counteract this
Material and Methods: All women were assigned to 2 decline but their regenerative power decreases with age. In
groups regarding their need for treatment, according to the particular osteogenic differentiation potential of MSCs has been
NOF Guidelines (2013). Analysis of the results shows a wide shown to decrease with age thereby contributing to slowed down
range of scores both among the healthy subjects and among bone formation and osteoporosis. While much is known about
the patients who require an antiosteoporotic treatment, al- cellular aging of MSCs, little is known about factors of the aged
though a non-significant overlapping of the low and high systemic environment influencing their functionality.
quartiles in studied groups could prove the sufficiency of Material and Methods: Isolation of extracellular vesicles by
sensitivity and specificity scores of the models. differential centrifugation followed my immunopurification. De-
Results: Thereby, analysis of the obtained results suggests it is termination of miRNA-31 levels by quantitative real time PCR.
possible to estimate osteoporotic fracture risk in the Results: While searching for extrinsic factors of the aged
population of Ukrainian women based on the different systemic environment that influence osteogenesis of MSCs ex-
FRAX models; only target points determined in process tracellular vesicles (EVs) were found. Exposition of MSCs to
of the study are important for the treatment initiation. EVs secreted by senescent endothelial cells (senECs), which
Age features of the FRAX scores, when different were shown to accumulate with age in vivo, or isolated from
models were used, suggest the necessity of a differential plasma of human elderly donors failed to induce osteogenesis
approach towards the FRAX scores in the antiosteoporotic compared to MSCs incubated with secreted EVs of young
treatment initiation. endothelial cells or plasma derived EVs of young donors. We
Conclusion: Variability analysis of FRAX-all and FRAX-hip, attributed the age-dependent impairment of osteogenesis by EVs
sensitivity and specificity scores also allowed to choose the to vesicular miR-31 which was shown to be enriched within EVs
Austrian model as a priority one to estimate risk of the of senECs and within plasma derived EVs of elderly donors but
osteoporotic fractures in Ukrainian women. also in EVs of patients suffering from osteoporosis. Overexpres-
sion of miR-31 in MSCs reduced osteogenic differentiation
capacity while inhibiting miR-31 enhanced osteogenesis
P572 in vitro. MiR-31s underlying molecular inhibitory effect was
LEVELS OF CIRCULATING VESICULAR illuminated by demonstrating that miRNA-31 targets FZD3, a
MICRORNA-31 INCREASE WITH AGE AS WELL AS factor necessary for osteogenic differentiation. Finally we were
IN THE CASE OF OSTEOPOROSIS AND INHIBIT able to rescue MSCs from the inhibitory effect of EVs isolated
OSTEOGENIC DIFFERENTIATION CAPACITY OF from senECs or from plasma of elderly donors by transfecting
MESENCHYMAL STEM CELLS them with a miR-31 inhibitor.
S. Weilner1, E. Schraml2, K. Wassermann1, M. Wieser3, P. Conclusion: Summarizing our data suggest that vesicular
Messner1, K. Schneider4, L. Micutkova5, K. Fortschegger6, A. miR-31 is enriched within EVs of elderly donors as well as
B. Maier7, R. Westendorp7, H. Resch8, S. Wolbank4, H. Redl4, in the case of osteoporosis and that it is able to inhibit osteo-
P. Jansen-Dürr5, P. Pietschmann9, R. Grillari-Voglauer3, J. genesis. Thus it might serve as a diagnostic and therapeutic
Grillari1 target whenever osteogenesis is a limiting factor.
1
Department of Biotechnology, University of Natural Re-
sources and Life Sciences Vienna, Vienna, Austria, 2Depart-
ment of Biotechnology, University of Natural Resources and P573
Life Sciences, Vienna, Austria, 3Evercyte GmbH, Vienna, ASSESSMENT OF THE POSSIBLE USE OF THE
Austria, 4Ludwig Boltzmann Institute for Experimental and AUSTRIAN MODEL OF FRAX ALGORITHM TO
Clinical Traumatology, Vienna, Austria, 5Institute of Biomed- PREDICT FRAGILITY FRACTURE RISK FACTORS
ical Aging Research, Austrian Academy of Sciences, Inns- IN UKRAINIAN WOMEN
bruck, Austria, 6Children’s Cancer Research Institute (CCRI), V. V. Povoroznyuk1, N. V. Grygoryeva1
St. Anna Kinderkrebsforschung, Vienna, Austria, 7Depart- 1
Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine
ment of Gerontology and Geriatrics, Leiden University Med-
ical Center, Leiden, Netherlands, 8Department of Pathophys- Objective: In the recent years worldwide the FRAX algorithm
iology and Allergy Research, Center of Pathophysiology, is used more extensively to estimate the risk of fragility
Osteoporos Int

fractures. Since 2009, the Ukrainian Scientific Medical Centre (EPOSA), a study involving six European cohort studies on
on Osteoporosis has been extensively using the FRAX algo- ageing. The project focuses on the personal and societal
rithm to estimate the fragility fracture risk. The aim of the burden of OA in older persons. EPOSA is an observational
study was to establish the normative data for the Austrian study on older community-dwelling persons aged 65 to
model of FRAX algorithm. 85 years. The interview and the clinical examination included
Material and Methods: We examined 3,405 women aged demographic information, both self-reported and clinical OA
40–89. For the statistical analysis of results the Statistica-7.0 determinations (knee, hip and hand), body composition eval-
and SPSS-17 softwares were used. uation, psychosocial domain and physical functioning (self-
Results: Analyzing the relationship between FRAX-1 and reported activity limitations and physical performance), med-
FRAX-2 scores for all fragility fractures and hip fractures ications. Self-reported and objectively measured diseases
we found strong correlations for different subgroups, the were considered as comorbidities. A follow-up evaluation
results suggest that the FRAX model without the BMD scores was performed 12–18 months after baseline. To evaluate the
has a sufficient informative value and could be used in the association between OA and functional limitations, logistic
decision making on treatment initiation. The analysis of regression analyses were performed. Analyses were adjusted
FRAX scores revealed that FRAX-all and FRAX-hip scores for age, sex, country, education and number of diseases.
of 11.5 and 2.5, respectively, when the Austrian model is Results: 2,942 persons with a mean age of 74.2 years were
applied to the postmenopausal women, are the criteria for included in the baseline assessment. 26.5 % of participant
the osteoporotic treatment initiation. FRAX-all and FRAX- were affected by 3 or more comorbidities. 31.7 % of the
hip scores of 7.0 and 1.5, respectively, are the criteria for a overall sample was affected by any of hand, hip or knee
further investigation with DXA scan. This set of criteria could clinical OA. The analyses revealed a significant association
be used in decision making on the antiosteoporotic therapy between hip or knee clinical OA and self-reported functional
initiation, especially if DXA scan is not available. However, limitations. This association was only partially affected by the
the researchers should remember that the BMD score is a comorbidity [(3 or more diseases) OR=19.9, 95%CI=15.3–
significant characteristic of the bone tissue state that could 25.9)], while it was strongly reduced by self-reported pain
be used in monitoring effectiveness of the treatment. (OR=2.2, 95%CI=1.5–3.2).
Conclusion: The results of our study have defined a new Conclusion: A strong association between hip or knee clinical
approach toward an antiosteoporotic treatment initiation in OA and functional limitations was observed in these popula-
the Ukrainian women, however, the limitation of this study tions. The analysis showed that pain had a significant medi-
is explained by using the models developed for different ating role in this association.
populations, and it could be a source of system error due to
the regional features of osteoporosis and its complications in
the Ukrainian population. It was a reason to start a multicenter P575
epidemiological survey on fragility fractures prevalence. RELATIONSHIP BETWEEN THE LEVEL OF
URINARY CALCIUM EXCRETION AND LEVELS OF
BONE TURNOVERS AND 25(OH)D AMONG WOMEN
P574 WITH POSTMENOPAUSAL OSTEOPOROSIS
OSTEOARTHRITIS, COMORBIDITIES AND K. Vasilenko1, E. Rudenka1
1
FUNCTIONAL LIMITATIONS IN ACTIVITIES IN Minsk City Center of Osteoporosis, Minsk, Belarus
OLDER POPULATIONS: RESULTS FROM THE
EUROPEAN PROJECT ON OSTEOARTHRITIS Objective: Urinary excretion of calcium is the result of the
STUDY (EPOSA) complex interplay of the gastrointestinal tract, the kidney and
A. Gesmundo1, P. Siviero1, S. Zambon2, F. Limongi1, M. bone and is regulated by multiple hormones. The aim of this
Noale1, S. Maggi1, G. Crepaldi1 study was to examine the relationship between the level of
1
CNR, Neuroscience Institute - Aging Branch, Padova, Italy, urinary calcium excretion and levels of bone turnovers among
2
Department of Medicine, University of Padova, Padova, Italy women with postmenopausal osteoporosis.
Material and Methods: 44 women with postmenopausal
Objective: Osteoarthritis (OA) and comorbidities are impor- osteoporosis were examined. Median age and BMI were
tant contributors to functional impairment in older persons. 63.1±7.79 years and 26.9±3.68 kg/m2, respectively. Exclu-
The objective of this study was to analyze the role of comor- sion criteria were the history of any kind of proved endocrine
bidities and the effect of pain in the association between OA or rheumatologic disease and calcium supplementation. All
and functional limitations in older European individuals. the examined were divided into 2 groups according to their
Material and Methods: The analyses are performed on the levels of urinary calcium excretion: group I (n=23) had
baseline data from the European Project on OsteoArthritis normocalciuria=0.34 [4.15:6.74] mmol/day, group II (n=21)
 Osteoporos Int

had hypercalciuria=9.6 [8.78:10.9] mmol/day. Hypercalciuria lower TBS (1.31±0.04). There was no difference in the mean
is defined as a urinary concentration of more than 8.0 mmol/ levels of physical activity (work and leisure) between EDS
day, while patients are on their usual diet. We measured serum women and normal control women.
levels of calcium, phosphorus, PTH, 25(OH)D, osteocalcin, Conclusion: This clinical study identifies a low bone mass in
β- crosslaps. patients with EDS. Results also suggest that patients with EDS
Results: Group II showed a significantly higher serum level also have an abnormal trabecular bone structure.
of calcium 2.52 [2.42:2.68] mmol/l than group I, where serum
level of calcium was 2.45 [2.38:2.53] mmol/l (p=0.036).
There were no statistical differences between the groups of
P577
normocalciuria and hypercalciuria for serum levels of phos-
INFLUENCE OF SNPS VIA THE WNT-Β-CATENIN
phorus, PTH, 25(OH)D, osteocalcin and β-crosslaps
PATHWAY ON THE PHENOTYPE OF
(p>0.05).
OSTEOPOROTIC PATIENTS
Conclusion: Postmenopausal women with osteoporosis and
B. Szili1, P. Horvath1, P. Lakatos1, I. Takács1
hypercalciuria showed significantly higher serum levels of 1
Semmelweis University, 1st Department of Internal Medi-
calcium than women with normocalciuria.
cine, Budapest, Hungary

Objective: To identify relationships between the single nucle-

P576
otide polymorphisms (SNPs) in the genes of the Wnt-β-
BONE DENSITY IN EHLERS-DANLOS SYNDROME
catenin pathway, and the BMD of postmenopausal women.
J.-P. Devogelaer1, M. Vikkula2, D. Hans3, D. H. Manicourt1
1 Material and Methods: During the research, the DNA sam-
Rheumatology, UCL 5390, University Hospital St Luc, Brus-
ples of 932 Hungarian postmenopausal women were studied.
sels, Belgium, 2Human Genetics, De Duve Institute, UCL,
First, their BMD values at different sites (spine, femur neck)
Brussels, Belgium, 3Centre des Maladies Osseuses, Centre
were measured, using a Lunar Prodigy DXA scanner. There-
Hospitalo-Universitaire de Lausanne, Lausanne, Switzerland
after, T-score values and the patients’ BMIs were calculated,
while information about the fracture history of the sample
Objective: We know little about BMD in Ehlers-Danlos
population was also collected. We genotyped eleven SNPs
syndrome (EDS). This case-control design study investigated
of the following three genes: LRP5, GPR177 and SP7, using a
whether 20–45 years-old women with type III EDS and nor-
Sequenom MASSarray Analyzer 4 instrument. The genomic
mal BMI had differences in bone mass and trabecular bone
DNA samples used for genotyping were extracted from the
score (TBS) compared with age and BMI-matched controls.
buccal mucosa of the subjects. Statistical analyses were car-
Material and Methods: Twenty-four women were within the
ried out using STATISTICA 11 and R.
20–34 years age group, and 19 were within the 35–45 years
Results: The results of this analysis showed a significant
age group. We observed mild scoliosis (<20°) in 17 subjects,
correlation between SNPs rs599083 of LRP5 and patients’
but none of included women had spine X-ray osteoarthritic
femoral T-score values.
changes. As observed in control subjects, patients had a mean
Conclusion: Therefore, our findings demonstrate the relation-
calcium intake above 1 g/day; their caffeine intake was <1 g/
ship between LRP5 and bone phenotype, which can be used to
day and their alcohol intake less than 3 units a week. We
reinforce the results of a previous GWAS study. However, our
measured by DXA (Hologic Discovery A) their BMD at the
research was unable to reveal an interaction between geno-
lumbar spine L1-4, left hip, and femoral neck. TBS iNsight
types of GPR177 and SP7 and bone phenotype in our clinical
program computed the trabecular bone score (TBS), a param-
samples.
eter that reflects the average thickness and volume fraction of
trabecular bone microarchitecture. Normal reference values
are those obtained in cohorts of age-matched normal women
included in previous bone density and metabolic studies. P578
Statistics included t-tests and ANOVA with a 0.05 level of BONE MINERAL DENSITY IN THYROID CANCER
significance. PATIENTS ON SUPRAPHYSIOLOGIC DOSES OF
Results: In the 20–34 years age group, EDS women had a THYROXIN: AN INSTITUTIONAL REVIEW
significantly (p<0.05) lower mean BMD (g/cm2) in the lum- M. Razi1, S. Riaz1, H. Bashir1, A. Hassan1, M. K. Nawaz1, S.
bar spine (1.005±0.08), the hip (0.891±0.08) and the femoral A. Raza2
1
neck (0.805±0.08) as well as a lower TBS (1.32±0.04). In the Nuclear Medicine Department, Shaukat Khanum Memorial
35–45 years age group, EDS also had a significantly (p<0.05) Cancer Hospital & Research Center, Lahore, Pakistan, 2Inter-
lower mean BMD (g/cm2) of the lumbar spine (0.935±0.091), nal Medicine Department, Shaukat Khanum Memorial Cancer
hip (0.845±0.010) and femoral neck (0.746±0.11) as well as a Hospital & Research Center, Lahore, Pakistan
Osteoporos Int

Objective: Thyroid hyperfunction is associated with osteopo- Kellgren-Lawrence classification. Assessment of functional
rosis. Most differentiated thyroid cancer (DTC) patients are status was performed according to the Oxford knee score.
put on long term supra-physiologic doses of thyroxin to The degree of pain was estimated with VAS.
achieve thyroid stimulating hormone (TSH) suppression. We Results: In A group, the average value of pain according VAS
present a cross-sectional review of the BMD, assessed by was 8 before, and 6 after the treatment. The average value of
DXA of DTC patients, at various stages of treatment and the functional score was 22 before and 31 after. In B group, the
follow up, at our tertiary care cancer center. WHO criteria average value of pain was 9 before and 4 after. The average
was applied to define osteopenia and osteoporosis. functional status was 20 before and 39 after. In group C, the
Material and Methods: Electronic Hospital information sys- average of pain was 9 before and 7 after. The average func-
tem (HIS) was used to identify 59 thyroid cancer patients who tional status was 20 before and 23 after treatment.
underwent DXA scanning for BMD assessment between Sep- Conclusion: Patients who received 1 % hyaluronic acid ia
tember 2012 and December 2013 at the department of Nuclear injections and then performed physical th have a significant
Medicine. reduction in pain as well as improvement in functional status.
Results: Out of 59, 48 (81 %) were females consistent with
the higher incidence of thyroid cancer in women. Mean age of
females was 48.4±11.5 years and males was 43±14.5 years. P580
Out of 59, 23 (39 %) patients had abnormal BMD results. IDENTIFICATION OF OSTEOARTHRITIS PATIENTS
Patients were divided into three groups: premenopausal fe- WITH INFLAMMATION DRIVEN JOINT
males (n: 24), postmenopausal (n: 24) and males (n: 11). Each DESTRUCTION: POSSIBLY ELIGIBLE FOR AN
of these groups was further subdivided on the basis of time ANTI-INFLAMMATORY TREATMENT
since on supraphysiologic thyroxin: 3 years, 6 years or M. A. Karsdal 1 , A. S. Siebuhr 2 , H. C. Hoeck 3 , C.
>6 years. In the postmenopausal group 17/24 (71 %) patients Christiansen1, A. C. Bay-Jensen2
1
had abnormal BMD (osteopenia=11 patients, osteoporosis=6 Biomarker and Research, Nordic Bioscience, Herlev, Den-
patients). In the premenopausal group 3/24 (12 %) patients mark, 2Rheumatology, Nordic Bioscience, Herlev, Denmark,
3
had abnormal BMD (all 3 had osteopenia). Amongst the Center for Clinical and Basic Research and C4Pain, Aalborg,
males 4 (36 %) patients had low BMD (osteopenia=3, osteo- Denmark
porosis=1). Out of the 7 osteoporotic patients 5 (71 %) have
been on thyroxin for more than 6 years and all belonged to the Objective: A subpopulation of osteoarthritis (OA) patients
postmenopausal group, along with the one male patient. Out experiences chronic tissue inflammation and may benefit from
of the 16 patients with osteopenia 11 (69 %) have been on anti-inflammatory treatment. The inflammation marker C-
thyroxin for <6 years. reactive protein (CRP) has shown limited use in predicting
Conclusion: Based on our preliminary data, post-menopausal progression or response to anti-inflammatory treatment. The
females on prolonged thyroxin therapy are more prone to aim of this study was to segregate patients into groups depen-
developing osteoporosis. BMD screening in newly diagnosed dent on the present/absence of systemic or chronic tissue
post-menopausal thyroid cancer patients should be inflammation and describe these groups by novel serum
considered. markers of matrix metalloproteinase-mediated joint
destruction.
Material and Methods: The serum markers were measured
P579 in a cross-sectional study including 281 patients with symp-
ANALYSIS OF DIFFERENT THERAPIES IN THE tomatic knee OA (KL0, n=12; KL1-2, n=202; KL3-4, n=57),
TREATMENT OF KNEE OSTEOARTHRITIS 60 OA patients undergoing TKR and 30 healthy controls:
S. Kevic1 hsCRP and CRPM (systemic and chronic tissue inflamma-
1
Clinic for Medical Rehabilitation, Clinical Center of Vojvo- tion), MMP-mediated fragments of type I, II and III collagen;
dina, Novi Sad, Serbia C1M (connective tissue), C2M (cartilage) and C3M
(synovium). Patients were divided in quartiles (Q1; low-low
Objective: To determine the efficiency of applied th and and Q4 high-high) based on cut-off values: CRPM
functional status of patients depending on the implemented. 12 ng/mL and hsCRP 5 μg/mL. Data are shown as
Material and Methods: The study included 90 patients with mean [95 %-CI].
OA. Group A-30 patients, in which we conducted outpatient Results: hsCRP was only elevated in TKRs (5.9 [3.6–8.2] μg/
physical th over a period of 8 weeks. Group B-30 patients, mL) compared to controls. The mean CRPM levels were twice
who received three applications of ia 1 % hyaluronic acid as high in the OA group (10–14 ng/mL) than the controls
injections. Group C-30 patients, treated with hondroprotrktory (5 ng/mL). C1M and C2M, but not C3M, were significantly
per os for 8 weeks. RTG changes were assessed according to elevated in the TKRs compared to KL1-2 (p<0.001) and
 Osteoporos Int

KL3-4 (p<0.01). Patients in Q4 had significantly higher KL 37.4 % for women. Mean Oswestry score of patients who
than patients in Q1 (p<0.0001), Q2 (P =0.017) and Q3 did not have other comorbidities also revealed a moderate
(p<0.0001). C1M, C2M and C3M were lower in Q1 com- disability, with 32.6 % deficit.
pared to all other quartiles. Conclusion: Patients with low back pain often have associat-
Conclusion: OA patients could be divided into quartiles: i) ed degenerative diseases. Functional impact of low back pain
those who may benefit from anti-inflammatory treatment (Q3, was moderate in all cases, even in those without comorbidities
Q4), and ii) those eligible for a tissue centric treatment (Q1, revealing the disabling potential of low back pain.
Q2). Patients with high chronic tissue inflammation (Q2 and
Q4) had higher levels of the tissue degradation markers sug-
gesting that they had elevated tissue turnover. In alignment, P582
those OA patients undergoing TKR had even higher levels of PAIN ASSESSMENT ACCORDING TO ONSET OF
tissue turnover markers, suggesting a distinct TKR serological LOW BACK PAIN
phenotype. D. Stoicanescu1, M. Cevei2
1
Microscopic Morphology Department, University of Medi-
cine and Pharmacy Victor Babes, Timişoara, Romania,
2
P581 Psychoneuro Sciences and Rehabilitation Department, Fac-
FUNCTIONAL IMPACT OF LOW BACK PAIN AND ulty of Medicine & Pharmacy, University of, Oradea, Roma-
COMORBIDITIES nia
M. Cevei1, D. Stoicanescu2
1
University of Oradea, Faculty of Medicine and Pharmacy, Objective: To assess pain in patients with different duration
Psychoneurosciences and Rehabilitation Departament, Ora- from the onset of low back pain.
dea, Romania, 2University of Medicine and Pharmacy “Victor Material and Methods: Between January and December
Babes” Timisoara, Microscopic morphology Departament, 2013 we conducted an observational study on 190 patients,
Timişoara, Romania all Caucasians, diagnosed with low back pain according to
ACR criteria and treated in the Medical Rehabilitation Clini-
Objective: To establish the functional impact of low back cal Hospital Baile Felix, Romania. Pain assessment was per-
pain in patients who associate other chronic disorders. formed with VAS scale.
Material and Methods: Between January 2013 and Decem- Results: There were 60 % men and 40 % women, mean age
ber 2013 we conducted an observational study on 190 pa- 54.88±13.86 years. X-rays revealed dorsolumbar advanced
tients, all Caucasians, diagnosed with low back pain according spondylosis in 17.89 % patients, moderate form in 13.68 %,
to ACR criteria and treated in the Medical Rehabilitation early form in 33.68 %, idiopathic scoliosis in 3.15 %, anky-
Clinical Hospital Baile Felix, Romania. Information on co- losing hyperostosis (Forestier’s disease) in 5.26 % cases and
morbidities was collected from each patient using the Cumu- vertebral anomalies in 15.78 %, of which half were sacraliza-
lative Illness Rating Scale. Pain assessment was performed tion of L5. Evaluation of pain revealed: pain now (baseline
with VAS scale. There were 60 % men and 40 % women, 5.87±2.32 and 4.37±2.38 after therapy), maximum pain dur-
mean age 54.88±13.86 years. ing last 4 weeks was 7.22±2.19 and mean pain during last
Results: Lumbar disc hernia was confirmed by MRI 9.47 % 4 weeks 5.89±2.15. Medical rehabilitation ameliorated pain,
of cases and two cases had lumbar canal stenosis. X rays as demonstrated by VAS index evolution. Mean value for
revealed dorsolumbar advanced spondylosis in 17.89 % pa- duration of pain was 142.38±128.46 months. We divided
tients, moderate form in 13.68 %, early form in 33.68 %, the study lot into 4 subgroups according to duration of pain,
idiopathic scoliosis in 3.15 %, ankylosing hyperostosis group 1 with a duration under 35 months, group 2 with
(Forestier’s disease) in 5.26 % cases and vertebral anomalies duration between 36 and 71 months, group 3 with duration
in 15.78 %, of which half were sacralization of L5. 88.94 % of between 72 and 107 months and group 4 with duration over
the patients had at least one associated disorder. Morbidity 108 months. Mean pain during last 4 weeks had increasing
count was 518. Mean number of comorbidities was 2.77± values, with the increasing of disease duration: 4.6±2.29 in
2.05. The most common comorbidities were obesity and group 1, followed by 5.6±1.53, 6.11±2.52 and 6.13±2.16.
overweight (74.44 %), other musculoskeletal diseases Evaluation of pain in women revealed: pain now 6.18±2.28,
(47.93 %), hypertension (36 %), chronic venous disease maximum pain during last 4 weeks 7.59±2.10 and mean pain
(16.8 %), soft tissue rheumatism (15.2 %). To highlight the during last 4 weeks 6.21.89±2.23. In men these values were
impact of low back pain on functionality and activities of daily pain now 5.63±2.35, maximum pain during last 4 weeks 6.96
living we used Oswestry disability questionnaire. Mean ±2.14 and mean pain during last 4 weeks 5.62±1.96.
Oswestry score revealed a moderate disability, with 34 % Conclusion: Pain was not concordant with the severity of X-
deficit. Mean Oswestry score was 28.8 % for men and ray changes. Slightly higher VAS values were noticed in
Osteoporos Int

women. Pain increased with the duration of disease, even in P584

the presence of rehabilitation treatment, which was effective BISPHOSPHONATES AND THE RISK OF BREAST
for short-term. CANCER IN OSTEOPOROTIC WOMEN: A
POPULATION-BASED STUDY
V. Rouach1, I. Goldstein2, G. Chodick2, N. Stern1, R. Catane3,
D. Cohen4
1
P583 Institute of Endocrinology, Tel Aviv Souraski Medical Cen-
MANAGEMENT OF AROMATASE ter, Tel Aviv, Israel, 2Medical Division, Maccabi Healthcare
INHIBITORS—INDUCED BONE LOSS IN Services, Tel Aviv, Israel, 3Sheba Medical Center, Institute of
POSTMENOPAUSALWOMEN WITH HORMONE Oncology, Ramat Gan, Israel, 4Tel Aviv University, School of
RECEPTOR POSITIVE BREAST CANCER Public Health, Tel Aviv, Israel
R. Karalilova1, A. Batalov1, Z. Batalov1
1
Clinic of Rheumatology, Medical University, Plovdiv, Objective: Bisphosphonates (BP) are widely used in osteo-
Bulgaria porosis treatment. By inhibiting the mevalonate pathway,
bisphosphonates may affect cell function and survival, includ-
Objective: In postmenopausal women the use of aromatase ing the viability of tumor cells. Recently, a protective effect of
inhibitor (AI) increases bone turnover and induces bone loss, bisphosphonates on breast cancer risk has been suggested by
leading to an increase of fracture incidence compared to that, several studies, which were unable to exclude the possibility
seen during tamoxifen use. The bone loss is much more of a confounder effect due to low cumulative exposure to
marked in young women with treatment-induced ovarian estrogen in osteoporotic women versus controls. The objec-
suppression followed by AI therapy. This therapy is tive of the present study is to assess the association between
well established in postmenopausal women with hor- different levels of bisphosphonate exposure and breast cancer
mone receptor-positive breast cancer. The aim of the incidence in a cohort of osteoporotic postmenopausal women.
study is to investigate the ability of oral bisphosphonates Material and Methods: This historical prospective study was
(ibandronic acid), intravenous bisphosphonates (zolendronic conducted using the computerized databases of Maccabi
acid) and denosumab, to protect against AI-induced bone loss. Healthcare Services (MHS). Included in the study were
Material and Methods: Eligible 98 women with hormone cancer-free women aged 55–75 who started bisphosphonate
receptor-positive nonmetastatic breast cancer treated with ad- therapy between 1998 and 2012. Bisphosphonate exposure
juvant AI therapy were stratified by duration of AI therapy was expressed in quintiles of proportion of days covered with
(>6 months), received supplemental calcium and vitamin D, BP during follow-up period (PDC). Cancer incidence was
and received oral bisphosphonates (ibandronic acid) (n=42), ascertained by the Israel National Tumor Registry.
intravenous bisphosphonates (zolendronic acid) (n=30) Results: A total of 16,628 eligible MHS members were
or subcutaneous denosumab 60 mg (n=26). At enrol- identified and 275 cases of breast cancer diagnosed during a
ment, all patients were required to have evidence of low total follow-up period of 76,710 person-years. Compared to
bone mass. The primary end point was percentage women with a PDC with bisphosphonates of 20 % or lower,
change from baseline at month 24 in lumbar spine and the hazard ratio for breast cancer were HR=0.89 (p=0.74),
total hip BMD. HR=0.74 (p=0.38), HR=0.71 (p=0.29) and HR=1.38 (p=
Results: At 24 month, lumbar spine BMD, respectively total 0.21) among women with 20–40 %, 40–60 %, 60–80 %, and
hip increased by 2.73 % and 0.95 % in the oral 80 % or higher, respectively.
bisphosphonates group, 5.09 % and 2.3 % in the intravenous Conclusion: In the present study, we did not find any signif-
bisphosphonates group and 7.2 % and 3.8 % in the denosumab icant negative association between persistence with
group. bisphosphonates and risk of breast cancer.
Conclusion: All patients receiving denosumab gained the
highest both lumbar spine and total hip BMD compared to
oral and intravenous bisphosphonates groups. Such ther-
apy led to significant increases in BMD over 24 months P585
at trabecular and cortical bone and was well tolerated. CORRELATION OF CIRCULATING ADIPOKINES
The early therapy seems to be the preferred treatment WITH BONE MINERAL DENSITY IN PATIENTS
strategy vs. delayed administration, as it significantly WITH TERMINAL STAGE OF CHRONIC
and progressively increases BMD in postmenopausal RESPIRATORY FAILURE
women with an early breast cancer. Unsatisfactory in- E. Kochetkova1, L. Ugay2, Y. Maistrovskaiy2, T. Sourovenko2
1
crease of BMD after 24 months on oral bisphosphonates Centre de Pharmacovigilance, Strasbourg, France, 2Therapy,
should switch to i.v. bisphosphonate. Vladivostok, Russian Federation
 Osteoporos Int

Objective: To investigate the role of adipokines in formation diabetes, preterm birth with low birth weight babies. There
of osteoporosis in the patients with terminal stage of chronic is neither local or national data concerning vitamin D status
respiratory failure during pregnancy, nor national recommendations for vitamin
Material and Methods: Adipokines, osteopontin, osteopro- D supplementation during this very important period. The aim
tegerin (OPG), RANKL and bone biomarkers were deter- of the study is to assess 25(OH)D status of mothers and their
mined in 82 patients with end-stage of chronic respiratory preterm neonates. To evaluate seasonal variations in 25(OH)D
failure and 74 healthy. BMD, body composition was mea- plasma levels in this population.
sured by DXA at the lumbar spine (LS) and left femoral neck Material and Methods: 95 mothers and their 108 babies born
(FN). before 32 weeks of gestation were included in this prospective
Results: Procollagen type I amino-terminal propeptide study held between 09.2011 and 09.2013 in the University
(P1NP) was higher in lung diseases and osteocalcin was Hospital of Obstetrics and Gynaecology. Blood samples were
similar between patients and controls. Type I collagen C- taken from the mother and babies umbilical cord at birth. The
telopeptide (CTx) was higher in lung group and was inversely 25(OH)D serum levels were measured using immunoassay
related to FN (r=−0.64, p<0.01) and was a direct relationship ECLIA and defined as sufficient >30 ng/ml; insufficient 20–
with P1NP (r=0.71, p<0.001). The adiponectin, resistin, 30 ng/ml and deficient <20 ng/ml.
visfatin, TNF-α, IL-6, osteopontin, RANKL were higher; Results: At delivery 25(OH)D deficiency was estimated in
leptin, OPG was low in lung pathology. Where was positive 66.3 % of women and 66.6 % of premature newborns with
correlation between leptin (r = 0.62, p < 0.001; r = 0.54, average serum levels of 11.03 ng/ml±−4.9 and 14.39 ng/ml±
p < 0.01) and negative between adiponectin (r = −0.49, 9.8, respectively. A strong correlation was observed between
p<0.01; r=−0.42, p=0.01), TNF-α (r=−0.43, p<0.05; r= maternal and infant 25(OH)D concentrations (r=0.516, P=
−0.41, p<0.01) and BMD in FN and LS; positive correlation 0.002). There is a clear seasonal variations in the 25(OH)D
between resistin (r=0.53, p<0.01) in L2-L4 only. Omentin-1 serum levels-mothers delivered in the winter were with lower
were correlated with BMD at the FN (r=0.46, p<0.05), BMI 25(OH)D levels than mothers and babies born in August–
(r=0.51, p<0.01), osteopontin (r=0.46, p<0.05), OPG and October period.
osteocalcin (r = 0.52, p < 0.05) and RANKL (r = −0.54, Conclusion: There is a need of systematic screening for
p<0.05) in lung patients. No correlations were found between 25(OH)D status in pregnant women in the country. Keeping
visfatin, biochemical, and BMD in both groups. Both total 25(OH)D serum levels in normal limits during pregnancy will
ghrelin (p<0.01) and active ghrelin (p<0.01) were higher in have positive influence on the rate of prematurity and on
pulmonary group and were associated negatively with BMI mothers and newborn health. Especially in winter period
(total ghrelin: r=−0.56, p<0.01; active ghrelin: r=−0.47, supplementation will be most important.
p<0.05). Resistin showed inverse correlations with FEV1%; Acknowledgements: This study was supported by the Med-
FEV1/FVC% and positive with BMI. Visfatin was correlated ical University - Sofia, Council of Medical Science, Project 71
with FEV% (r=0.39, p<0.05) and TNF-α in lung group (r= Grand/2011; Project 36 Grand/ 2013 and by Company
0.44, p<0.05). There was no significant correlation between MERCK
visfatin, BMI, body composition and BMD.
Conclusion: Results show possible role of adipokines in the
increasing of bone loss at the terminal stage of chronic respi-
ratory failure. P587
DISABILITY INDICATORS IN LOW BACK PAIN OF
DISK ETIOLOGY
P586 R. N. Suciu 1 , C. Nistor-Cseppento 2 , M. Cevei 3 , D.
SEASONALVARIATIONS IN VITAMIN D LEVELS IN Stoicanescu4
1
PREGNANT WOMEN AND THEIR VERY LOWAND Medical Rehabilitation, University of Medicine and Pharma-
EXTREMELY LOW BIRTH WEIGHT INFANTS cy, Oradea, Romania, 2Medical Rehabilitation, University of
A. Popivanova1, S. Hitrova1, L. Vakrilova1, N. Yarakova1, B. Medicine and Pharmacy Oradea, Oradea, Romania,
Slancheva1, A. Nikolov1, P. Popivanov2 3
Psychoneuro Sciences and Rehabilitation Department, Fac-
1
University Hospital of Ob. & Gyn., Sofia, Bulgaria, 2Uni- ulty of Medicine & Pharmacy, University of, Oradea, Roma-
versity Hospital Alexandrovska, Sofia, Bulgaria nia, 4Microscopic Morphology Department, University of
Medicine and Pharmacy Victor Babes, Timişoara, Romania
Objective: Vitamin D has multiple functions critical in
growth and development. Increasingly research has revealed Objective: Over 60 % of the patients with lumbar disk hernia
that vitamin D deficiency is associated with a lot of health confirmed by MRI get late in a neurosurgery or orthopedics
problems during pregnancy: preeclampsia, gestational service for surgical intervention. The aim of the study was to
Osteoporos Int

establish the functional impact of lumbar disk hernia related to Results: To date, 33 patients have responded to the survey but
its treatment. the survey is ongoing. The average age of respondents is
Material and Methods: The study lot was formed by 206 57.7 years, 54.5 % of them are still professionally active. All
patients, mean age 48.44±8.55 years, ranging from 21 to women are using the Internet; 54.5 % of them use it every day
75 years, who met the inclusion criteria, selected from 667 and 97.0 % of them use it at least two to three times per week.
cases diagnosed with low back pain, examined in the Medical About 75 % of the women reported at least one health prob-
Rehabilitation Clinical Hospital Baile-Felix, between January lem. In this population, 97.0 % of them seek additional infor-
and December 2013. 61.16 % were men and only 32.03 % mation to that given by their doctors and 78.1 % of them say
cases were retired. All patients were investigated by MRI, they use the Internet to search information about their health.
which confirmed the clinical diagnosis and established the Whatever the means of information, once informed, 87.1 % of
level of disk herniation. We used Oswestry questionnaire for them need to talk about this with their relatives, friends or
lumbar pain and disability assessment. physicians. They allocated an average score of 6.4/10 regard-
Results: According to the applied treatment we have divided ing the consistency of information found on the Internet. The
these patients into two lots: lot I 54.37 % of cases, with use of Internet to search for health information was found to
conservative treatment and lot II with surgical treatment, but be unrelated to age, socio-economic status or number of health
having lumbar pain±residual radiculopathy. Mean Oswestry problem.
score was 49.36 % in group I and 48.43 % in lot II, revealing Conclusion: Menopausal women seem to need to be in-
severe disability in both groups, differences between them not formed about their health. They are in a period of their life
statistically significant. Lumbar pain caused severe disability where they could be more physically and mentally frail. In this
related to all investigated domains, except personal care ac- population, 100 % of them use the Internet and 70 % of them
tivities in lot I, the most important deficits were noticed for already do it to obtain information on their health. Therefore,
pain intensity 68.2 % and weightlifting 62.1 %. Pain intensity the use of a social network on an Internet platform dedicated
ameliorated in lot II (59.1 %), but important deficits were to Health could be a good way to inform and empower women
noticed for weightlifting −66 %, sitting 51.9 % or social life about their health.
51.1 %.
Conclusion: Lumbar pain affects wellbeing, causing severe
disability, the deficit in lot I patients was over two thirds higher P589
than in cases with surgery. Pain caused the most important FUNCTIONAL IMPACT OF LOW BACK PAIN AND
deficit, almost equal in the two groups, followed by lifting COMORBIDITIES
weights and sitting in lot I, but after surgery weight lifting M. Cevei1, D. Stoicanescu2
1
deficit became more important than pain in lot II. Differences Psychoneuro Sciences and Rehabilitation Department, Fac-
between deficits of the items investigated with Oswestry score ulty of Medicine & Pharmacy, University of Oradea, Oradea,
in the two lots were not statistically significant. Romania, 2Microscopic Morphology Department, University
of Medicine and Pharmacy Victor Babes, Timişoara, Romania

Objective: This study aimed to establish the functional impact

P588 of low back pain in patients who associate other chronic
COULD INTERNET USE BE PROMISING IN disorders.
HEALTH PREVENTION AND PROMOTION IN Material and Methods: Between January and December
MENOPAUSALWOMEN? A PRELIMINARY REPORT 2013 we conducted an observational study on 190 patients,
J. Slomian1, S. Streel1, G. Appleboom2, C. Beaudart3, F. all Caucasians, diagnosed with low back pain according to
Buckinx3, J.-Y. Reginster3, O. Bruyère1 ACR criteria and treated in the Medical Rehabilitation Clini-
1
Support Unit in Epidemiology and Biostatistics, University cal Hospital Baile Felix, Romania. Information on comorbid-
of Liège, Liège, Belgium, 2Neurodigital Laboratory, Colum- ities was collected from each patient using the Cumulative
bia University, New York, United States, 3Department of Illness Rating Scale. Pain assessment was performed with
Public Health, Epidemiology and Health Economics, Univer- VAS scale.
sity of Liège, Liège, Belgium Results: There were 60 % men and 40 % women, mean age
54.88±13.86 years. Lumbar disc hernia was confirmed by
Objective: To assess the interest and the level of Internet use MRI 9.47 % of cases and two cases had lumbar canal stenosis.
of women regarding menopause health issues. X-rays revealed dorsolumbar advanced spondylosis in
Material and Methods: Self-administered questionnaires 17.89 % patients, moderate form in 13.68 %, early form in
were distributed in a menopause centre (Liège, Belgium) in 33.68 %, idiopathic scoliosis in 3.15 %, ankylosing hyperos-
order to collect the necessary information. tosis (Forestier’s disease) in 5.26 % cases and vertebral
 Osteoporos Int

anomalies in 15.78 %, of which half were sacralization of L5. emotional problems 51.51 %, physical function 48.08 %,
88.94 % of the patients had at least one associated disorder. social function 39.68 %, body pain 37.88 %, general health
Morbidity count was 518. Mean number of comorbidities was 29.28 %, mental health 9.24 %, vitality 7.71 %. Women from
2.77±2.05. The most common comorbidities were obesity lot I have greater activity restriction, except physical function
and overweight (74.44 %), other musculoskeletal diseases than men. Men from lot II have higher deficits than women,
(47.93 %), hypertension (36 %), chronic venous disease for the items body pain, general health, social function, limi-
(16.8 %), soft tissue rheumatism (15.2 %). To highlight the tations due to health problems, mental health. Cases over
impact of low back pain on functionality and activities of daily 50 years who had conservative treatment presented, as expect-
living we used Oswestry disability questionnaire. Mean ed, more severe disabilities than those under this age.
Oswestry score revealed a moderate disability, with 34 % Conclusion: Investigated areas revealed greater impact on
deficit. Mean Oswestry score was 28.8 % for men and quality of life in cases with surgical treatment, except mental
37.4 % for women. Mean Oswestry score of patients who wellbeing item. Therapeutical approach in low back pain of
did not have other comorbidities also revealed a moderate disk etiology has different influences on the two genders.
disability, with 32.6 % deficit.
Conclusion: Patients with low back pain often have associat-
ed degenerative diseases. Functional impact of low back pain P591
was moderate in all cases, even in those without comorbidities BONE MINERAL DENSITYAND VITAMIN D LEVEL
revealing the disabling potential of low back pain. IN PATIENTS WITH CORONARYARTERY DISEASE
AFTER MYOCARDIAL INFARCTION
I. Bancu1, E. Deseatnicova1, I. Popovici2, L. Groppa1
1
P590 Medical Clinic no. 5, Department of Rheumatology and
QUALITY OF LIFE IN LOW BACK PAIN OF DISK Nephrology, SUMPh Nicolae Testemiţanu, Chisinau, Repub-
ETIOLOGY lic of Moldova, 2Republican Scientific-Practical Center Car-
M. Cevei1, D. Stoicanescu2, F. Cioara3 diology, Chisinau, Republic of Moldova
1
Psychoneuro Sciences and Rehabilitation Department, Fac-
ulty of Medicine & Pharmacy, University of, Oradea, Roma- Objective: To study 25-hydroxyvitamin D (25-OHD) and
nia, 2Microscopic Morphology Department, University of BMD values in patients with angiographically documented
Medicine and Pharmacy Victor Babes, Timişoara, Romania, coronary artery disease (CAD) and previous myocardial in-
3
Medical Rehabilitation, University of Medicine and Pharma- farction (MI).
cy Oradea, Oradea, Romania Material and Methods: Epidemiological observations sug-
gest links between low BMD, low level of vitamin D and risk
Objective: The aim of the study was to establish the compare of acute cardiovascular events and vice versa. We performed
quality of life in patients with lumbar disk hernia treated by an investigation of BMD, T-score by DXA and blood vitamin
conservative methods vs. surgery. D level in the group of 44 CAD patients with the history of MI
Material and Methods: The study lot was formed by 206 and in the control group of 42 healthy participants.
patients, 61.16 % men, mean age 48.44±8.55 years, examined Results: We evaluated women and men aged 55–79 years.
in the Clinical Rehabilitation Hospital Baile-Felix, between Patients from study group had a documentary support of MI,
January and December 2013, investigated by MRI. According an angiography report and were treated in Cardiological Re-
to the applied treatment we have lot I 54.37 % of cases, with publican Clinic. Patients with comorbidities that could influ-
conservative treatment (subdivided in two groups, depending ence BMD results were excluded. After adjustment of age, sex
on the presence or absence of radiculopathy) and lot II with and BMI, severity of coronary artery disease was indepen-
surgical treatment with lumbar pain±residual radiculopathy. dently correlated with low BMD (odds ratio 1.28, [95%CI,
We used SF-36 for life quality assessment. 1.11–1.62] p=0.04) and low level of 25-OHD (odds ratio
Results: Mean SF-36 score in lot I revealing a loss of 46.3 % 1.22, [95%CI, 1.23–1.69] p=0.03). Our results showed a
and in lot II 60.8 %, revealed a severely impaired quality of significant association between self- reported myocardial in-
life, statistically significant differences (p<0.05). Lumbar disc farction and low lumbar spine BMD (odds ratio 1.27, [95%CI,
hernia (lot I) affects quality of life, in descending order, by 1.01–1.73] p=0.03). Lower 25-OHD concentration was asso-
limitations due to physical health 50.64 %, body pain ciated with severity of coronary artery disease (odds ratio
35.02 %, physical function 21.56 %, general health 21.17 %, 1.25, [95%CI, 1.19–1.67] p=0.03).
limitations due to emotional problems 18.8 %, social function Conclusion: Our investigation confirms the connection be-
17.01 %, mental wellbeing 11.84 %, vitality 7.06 %. In lot II tween cardiovascular disease (especially CAD and MI) and
quality of life was affected, in descending order, by: limita- low spine BMD. The findings suggest that bone status evalu-
tions due to physical health - 72.92 %, limitations due to ation should be done in cardiovascular patients in order to
Osteoporos Int

identify candidate patients for preventive and therapeutic P593

measures. Also, larger trials and studies are necessary to INTRAARTICULAR HYALURONIC ACID
assess the effect of vitamin D therapy on prevention of CAD TREATMENT IN OSTEOARTHRITIS OF THE KNEE
in patients with vitamin D insufficiency. V. Skakic1, J. Jovanovic1, A. Skakic2
1
Institute for Treatment and Rehabilitation, Niska Banja, Ser-
bia, 2Klinicki Centar Nis, Nis, Serbia

P592 Objective: To show our experience in order to determine the

PATELLOFEMORAL OSTEOARTHRITIS AND effectiveness and possible side effects of intraarticular appli-
RADIOLOGICAL PARAMETERS IN AN ASIAN cation of hyaluronic acid (HA) in patients with osteoarthritis
POPULATION of the knee (OAK).
W. L. B. Tan1, S. L. Low1, L. Shen2, S. Das De1 Material and Methods: Twenty consecutive patients OAK
1
National University Hospital, Singapore, Singapore, have been treated with intraarticular HA of the same manu-
2
National University of Singapore, Singapore, Singapore facturer. We selected patients who had second and third stages
of Kellgren-Lawrence classification on radiographs. Admin-
Objective: To analyse the prevalence, severity and treatment istration of the HAwas once a week, 3 weeks in a row. Patients
modalities involved in knee patellofemoral osteoarthritis in an were evaluated for pain on the VAS (0–10), and the presence
Asian population, and to provide basic demographic radiolog- of synovitis (effusion and/or synovial hypertrophy) using
ical measurements. musculoskeletal ultrasound (MSUS). Patients were examined
Material and Methods: Surgical cases aged 40 and above before and after 6 months of HA application. Statistical anal-
who underwent tibial tubercle elevation and discharged from ysis was performed using Student’s t-test.
our institution were enrolled. Pre-operative radiographs were Results: The average age of our patients was 62 years (49–78),
reviewed for radiological degree/severity of tibiofemoral & 15 (75 %) persons were females. After 6 months there was a
patellofemoral osteoarthritis, Sulcus and Merchant congru- statistically significant reduction in VAS pain scale from 6.1 to
ence angles were measured for both knees. Clinical data in 4.8 (p<0.006) and decrease in synovitis from 56 to 45 %, which
terms of surgical treatment employed was also recorded. was not statistically significant (p=0.54). Patients were divided
Results: There were a total of 21 cases enrolled (7 male, 14 into two groups according to the age: 11 (56 %) over 65 years
female; 16 Chinese, 3 Malay and 2 Indian). Radiological and 9 (44 %) under 65 years. Pain intensity on the VAS scale in
PFOA was seen in 19 cases for the Right knee, 20 cases in the older group before treatment was 6.2 compared to the youn-
the Left knee. Radiological tibiofemoral OA was seen in 19 ger in which pain intensity was 5.9, which was not statistically
cases for the right knee and 19 cases in the left. Mean right significant. After 6 months, pain intensity in older and younger
knee sulcus angle was 135.6°, left knee 136.4°, and mean right age group was 4.9 and 4.2, respectively. We had no side effects.
knee Merchant congruence angle was 19.5°, left knee 25.6°. Conclusion: Our experience shows that HA
Stratified according to Race, Mean sulcus & merchant angles viscosupplementation has an impact on the reduction of pain
were as follows: in patients with OAK. This allow patients in longer period to
Chinese - 135.4, 23.6 (right); 136.8, 28.9 (left) reduce the dose of NSAIDs or completely suspended them.
Malay - 137.6, 8.6 (right); 135.1, 16.2 (left) Indian - 134.9, 5.1 This is particularly significant in the group of elderly patients
(right); 135.7, 13.9 (left) Male - 134.6, 10.4 (right); 134.7, with gastrointestinal and cardiovascular comorbidities.
14.3 (left)
Female - 136.2, 24.4 (right); 137.3, 31.3 (left)
Based on analysis, increased knee PFOA grade resulted in a P594
greater Merchant angle for both knees (right: p =0.000, 25-HYDROXYVITAMIN D AND CENTRAL DXA
Spearman’s correlation coefficient 0.824; left: p =0.004, EVALUATION: A STUDY IN 505 POSTMENOPAUSAL
Spearman’s 0.655). Race, gender the presence/degree of WOMEN
tibiofemoral OA were not statistically significant in determin- C. Poiana1, M. Carsote1, V. Radoi2, A. Mihai3, A. Geleriu4, C.
ing sulcus or merchant angles. Capatana1
1
Conclusion: Patellofemoral osteoarthritis is a frequent condi- Endocrine/I.Parhon/Davila UMPh, Bucharest, Romania,
2
tion seen in the Asian population and may occur in the Davila UMPh, Bucharest, Romania, 3Endocrine/I.Parhon,
absence of significant tibiofemoral osteoarthritis. This Bucharest, Romania, 4Endocrine/I.Parhon, Bucharest,
is the first recent Southeast Asian study to show basic Romania
radiological measurements for patients with PFOA, and
future studies are planned to evaluate surgical outcome Objective: The low level of vitamin D as pointed by serum
and treatment options. 25-hydroxyvitamin D (25-OH D) is very frequent, especially
 Osteoporos Int

in postmenopause. It is difficult to establish if the vitamin D ovariectomized rats with high fat diet, SHAMC- sham rats
deficient is more frequent in patients with low BMD, regard- with standard diet and SHAMH - sham rats with high fat diet.
less the age and geographic area. We analyze the levels of 25- Bilateral ovarian removal was performed in groups OVXC
OH D in menopausal women with different WHO DXA and OVXH and sham surgery with bilateral exposures of the
groups in order to find out if any group of patients is at higher ovaries in groups SHAMH and SHAMC. After surgery the
risk of D hypovitaminosis. animals were individually placed in plastic boxes with small
Material and Methods: This is a cross-sectional study in space, making them sedentary. Standard diet was used in the
Romanian population. The patients were women in meno- groups OVXC and SHAMC, and standard diet with added
pause, evaluated between 2009 and 2013. The bone assess- 30 % of lipids in the groups OVXH and SHAMH. After
ment included clinical parameters generally correlated with 12 weeks, the animals were killed and the tibiae were re-
fracture risk; 25-OH D assay as well as central DXA (Lunar), moved, subjected to analysis of BMD and mechanical tor-
at least at lumbar site. The exclusion criteria were previous sional test at high speed impact. The test parameters used
therapy for osteoporosis or fracture risk reduction at any were: 25 cJ impact energy at a speed of 11.5 rads/s, were
moment of life. No patient with secondary causes of osteopo- obtained the fracture angle (°) and the maximum torque
rosis was included. The statistical analysis was performed in (N.cm).
SPSS 21 and the statistical significance was at p value <0.05. Results: The mean and standard deviation of BMD (g/cm2)
Results: 505 women were admitted. The mean age was was: OVXP (0.173±0.011), OVXH (0.170±0.009), SHAMP
57.8 years (ranges 40–80 years). The median 25-OH D was (0.172±0.012), SHAMH (0.173±0.014); the angle of fracture
15 ng/mL (normal levels <30 ng/mL). Less than one third was (°): OVXP (19.2±4.1), OVXH (20.8±3.2), SHAMP (13.9±
smokers and mean menopause age was 47 years. The WHO 4.4), SHAMH (15.3±4.8); and maximum torque (N.cm):
DXA groups were: normal DXA (n=161), osteopenia (227), OVXP (0.21±0.05), OVXH (0.23±0.04), SHAMP (0.17±
osteoporosis (n=117). The mean lumbar BMD according to 0.06) and SHAMH (0.18±0.05). The ovariectomy influenced
DXA was: 1.2 g/cm2 (normal DXA group), 1.01 g/cm2 and resulted in a statistical difference in the angle of fracture
(osteopenia group), and 0.8 g/cm2 (osteoporosis). The differ- (p<0.000) and the maximum torque (p=0.009), but not in
ence of 25-OH D between these three groups was not statis- BMD. The diets did not influence any of the variables studied.
tical significant. Conclusion: Therefore, it is concluded that for sedentary rats,
Conclusion: Based on our observations, an overall prevalence the decrease in estrogen levels after ovariectomy alters bone
of D vitamin deficiency was registered. We mention that the strength, but the diet with 30 % fat does not change bone
population was not preselected regarding the vitamin D and properties studied.
calcium supplements. All the 25-OH D assays were per- Acknowledgements: This study was supported by a Grant
formed at the same laboratory from CI Parhon National Insti- from the National Council for Scientific and Technological
tute of Endocrinology. Despite the fact that the parathormone Development.
(iPTH) was evaluated in a collateral analysis in less than half
of these patients, no relationship could be established between
iPTH and 25-OH D. Also, the D hypovitaminosis is very P596
frequent in postmenopausal women; there is not a specific NOVEL MODELS OF OSTEOPOROSIS IN
prevalence in groups with different levels of BMD (normal/ TRANSGENIC MICE OVEREXPRESSING HUMAN
osteopenia/osteoporosis). RANKL
E. Douni1, R. Dacquin2, N. Bonnet3, P. Jurdic2, S. Ferrari3, V.
Rinotas1
1
P595 Department of Biotechnology, Agricultural University of
EFFECT OF HIGH FAT DIET ON BONE SEDENTARY Athens/BSRC Al. Fleming, Athens, Greece, 2Institut de
OVARIECTOMIZED RATS G é n o m i q u e F o n c t i o n n e l l e d e Ly o n , U M R 5 2 4 2
A. P. Macedo1, R. C. Shimano1, D. T. Ferrari1, A. A. Jordão CNRS/INRA/UCBL/ENS Ecole Normale Supérieure de Ly-
Jr1, J. P. Mardegan Issa1, A. C. Shimano1 on, Lyon, France, 3Department of Rehabilitation and Geriat-
1
University of São Paulo, Ribeirão Preto, Brazil rics, Geneva University Hospital and Faculty of Medicine,
Geneva, Switzerland
Objective: The aim of this study was to evaluate the effects of
high fat diet on BMD and physical properties of bones from Objective: Receptor activator of nuclear factor-κB ligand
ovariectomized sedentary rats. (RANKL) is a central regulator of bone remodeling by mediat-
Material and Methods: 40 female Wistar rats, 8 weeks old ing osteoclast-induced bone resorption. Overproduction of
and weighing 200 g, were divided into 4 groups (n=10): RANKL is implicated in a variety of degenerative bone diseases
OVXC - ovariectomized rats with standard diet, OVXH - such as osteoporosis. We have recently generated transgenic
Osteoporos Int

mice overexpressing human RANKL (TghuRANKL) in order P598

to model human RANKL-mediated pathologies. BONE MINERAL DENSITY IN DIABETIC PATIENTS
Material and Methods: To achieve a correct pattern of WITH CHRONIC KIDNEY DISEASE
human RANKL expression in the mouse, a 200 kb genomic O. Vasilkova1, K. Zekenova2, M. Zshmailik2, T. Mokhort3
1
fragment containing the whole human RANKL gene was used Department of Endocrinology, Gomel State Medical Univer-
as a transgene. sity, Gomel, Belarus, 2Department of Endocrinology, Repub-
Results: TghuRANKL mice of both sexes developed early- lican Research Center for Radiation and Human Ecology,
onset bone loss and the levels of huRANKL expression were Gomel, Belarus, 3Department of Endocrinology, Belarusian
correlated with disease severity. Low copy Tg5516 mice State Medical University, Minsk, Belarus
expressing huRANKL at low levels displayed a mild osteo-
porotic phenotype as shown by trabecular bone loss and Objective: Epidemiological studies indicate that many pa-
reduced biomechanical properties. Overexpression of tients with osteoporosis are characterized by diminished
huRANKL, in the medium copy Tg5519 line, resulted in glomerular filtration rate (GFR), which indicates various
severe early-onset osteoporosis characterized by lack of tra- degrees of chronic kidney disease (CKD). This study
becular bone, destruction of the growth plate, increased oste- evaluated BMD in diabetic patients with early stages of
oclastogenesis, bone marrow adiposity, increased bone re- CKD.
modeling and severe cortical bone porosity accompanied by Material and Methods: A total of 59 (26 male and 33
decreased bone strength. Notably, TghuRANKL mice rescued female) adult cases with diabetes type 2 and 16 control sub-
the osteopetrotic phenotype of mutant mice expressing an jects were enrolled for our study. BMD, serum creatinine and
inactive form of endogenous RANKL, showing that the hu- other measures were obtained. GFR was estimated using the
man RANKL protein is fully active in the mouse. Interesting- Cockcroft-Gault formula, with adjustment for body surface
ly, treatment of TghuRANKL mice with known antiresorptive area. BMD was measured by DXA at the lumbar spine and the
drugs effectively inhibited bone resorption proving the signif- proximal femur.
icance of such mice in preclinical evaluation studies of novel Results: The prevalence of T-scores≤−2.5 SD in the group of
antiosteoporotic compounds. patients over 50 years was 15.2 % in females and 12.5 % in
Conclusion: These novel human RANKL transgenic models males. We found a reduction of BMD in comparison with
of osteoporosis represent a unique tool for understanding the gender- and age-matched normal population values at the total
pathogenic mechanisms in bone resorption as well as for the hip (Z-score=−0.27±1.11) and the femoral neck (T-score=
preclinical evaluation of novel inhibitors that target human −0.23±1.12). After adjustment for all variables, multiple re-
RANKL and osteoclasts. gression analysis showed that BMD in the total femur and
References: Rinotas V et al. J Bone Miner Res 2013;doi:10. lumbar spine were positively associated with eGFR in both
1002/jbmr.2112. males and females.
Conclusion: Our preliminary data showed that diabetic pa-
tients with early stages of CKD may be at higher risk of
P597 osteoporosis. However, larger prospective cohort studies are
STRONTIUM RANELATE IMPROVED BONE needed to confirm the etiologic importance of reduced GFR
HEALING IN PATIENT WITH RHEUMATOID and bone density.
ARTHRITIS AND FRACTURE OF TIBIA: A CASE
REPORT
T. M. T. Mai1 P599
1
E Hospital, Hanoi, Viet Nam PREVALENCE OF OSTEOPOROSIS AND HIP
FRACTURES IN FEMALE-PATIENTS WITH
Objective: Evaluation improve bone healing of strontium SYSTEMIC SCLEROSIS AND RHEUMATOID
ranelate in the patient rheumatoid arthritis and fracture of tibia. ARTHRITIS
Material and Methods: A female patient, 50 years old, C. Criveanu1, F. A. Vreju1, I. Cojocaru-Gofita1, M. Florea1, A.
30 years of rheumatoid arthritis and fractured tibia (right). L. Barbulescu1, A. Rosu1, P. Ciurea1
1
X-ray the leg bone (right), before and after treatment with Department of Rheumatology, University of Medicine and
strontium ranelate 2 g/day, patients treated for 18 consecutive Pharmacy of Craiova, Craiova, Romania
months.
Results: After 18 months of treatment strontium ranelate Objective: To analyse the results of bone densitometry and to
patients and improve patient advocacy will be strengthened. evaluate the related-fractures in systemic sclerosis (SSc) in
Conclusion: Strontium ranelate may be improve bone healing comparison to age in female-patients with rheumatoid arthritis
in patients with rheumatoid arthritis and fracture of tibia. (RA).
 Osteoporos Int

Material and Methods: The study group included 25 patients Results: Results shown in Table.
with SSc and 43 patients with RA, all postmenopausal. All
patients were evaluated for their BMD T-score at the lumbar
spine and total hip by DXA.
Results: All patients were women, mean age-58 years, mean
disease duration in SSc-18.9 years, in RA-23.6 years,
mean menopause duration-8.6 years. There were no
differences in BMD measurements between patients
with diffuse and limited SSc. Lumbar spine BMD and
T-score were similar between groups. Total hip BMD
and T-score were significant lower in patients with SSc
vs. RA. Hip fractures were lower in SSc group in
comparison to RA patients.
Conclusion: Age, disease severity, prolonged menopause and
disease duration were identified as risk-factors of hip fractures
in SSc patients, comparing to age and corticosteroid treatment
that were associated with osteoporosis and hip fractures in RA
patients.

Conclusion: SE-femur scans are a promising point-of-care

diagnostic tool for detecting incomplete AFFs.
P600
DETECTION OF INCOMPLETE NONDISPLACED
ATYPICAL FEMUR FRACTURES BY P601
DENSITOMETER SKIN AUTOFLUORESCENCE, A NONINVASIVE
A. M. Cheung1, R. Bleakney2, G. Tomlinson1, L. Tile1, H. MARKER FOR AGE ACCUMULATION, IS
Mcdonald-Blumer1, R. Ridout1, H. K. Genant3 ASSOCIATED WITH BONE MINERAL DENSITY IN
1
University Health Network, Toronto, Canada, 2Mount Sinai TYPE 2 DIABETIC PATIENT
Hospital, Toronto, Canada, 3University of California San D. Gogas Yavuz1, D. Yazıcı1, O. Kocakaya2, Y. Sertbaş3, O.
Francisco, San Francisco, United States Deyneli4, S. Akalin1
1
Marmara University School of Medicine, Department of
Objective: DXA scanners have been used to screen for ver- Endocrinology and Metabolism, İstanbul, Turkey, 2Marmara
tebral fractures using single energy scan mode. We conducted University School of Medicine, İstanbul, Turkey, 3Uskudar
a cross-sectional study to test the operating characteristics of Devlet Hastanesi, İstanbul, Turkey, 4Marmara University
single energy femur (SE-femur) scans to detect incomplete School of Medicine Department of Endocrinology and Me-
atypical femur fractures (AFFs), using conventional radio- tabolism, İstanbul, Turkey
graphs as a gold standard.
Material and Methods: Patients from the Ontario AFF co- Objective: Although risk of bone fracture increased, BMD is
hort study as well as patients screened from 3 bone increased rather than decreased in type 2 diabetes.
density laboratories were included. All patients received A c c u m u l a t i n g e v i d e n c e s u gg e s t th a t a d v an c e d
an SE-femur scan using Hologic Discovery A densitom- glycation end products (AGEs) could adversely affect
eters, scanning from above the lesser trochanter to the the fracture resistance of bone in type 2 diabetic
medial condylar flare, and a plain radiograph of the patients. Skin autofluorescence (SAF) is a validated
affected femur. Two musculoskeletal radiologists blinded noninvasive measure of tissue AGEs. We hypothe-
to patient identifiers read the SE-femur scans and radio- sized that SAF is associated with low BMD in type
graphs independently in 2 batches, with discussion be- 2 diabetic patients.
tween batches to fine-tune the process. Using plain Material and Methods: This case-control study was per-
radiographs as the reference standard, the diagnostic formed in 766 type 2 diabetic patients (F/M: 365/401,
accuracy of SE-femur scans was assessed separately 54.4±15 year) and age and sex matched 100 controls
for each reader and then averaged. For each abnormal (F/M: 58/42, 52.6±11 year). Skin autofluorescence is a
finding, inter-rater agreement on SE-femur scans and method used to detect the accumulation of AGEs in
plain radiographs were measured with the kappa skin collagen using AGE Reader (DiagnOptics B.V.,
statistic. Groningen, The Netherlands). BMD was measured with
Osteoporos Int

DXA (Hologic), HbA1c was measured by HPLC DiaDENS-PC apparatus-placebo. Procedures were ac-
method. complished daily or every other day. The course
Results: SAF was higher in diabetic patients (2.1±0.01) consisted of 10 procedures.
arbitrary Units (AU) compared with controls (1.7 ± Results: There was improvement in total Qualeffo score in the
053 AU) (p=0.001). The mean values of SAF for sub- main group from 51.3 to 46.3 after course, p=0.002,
jects with femur neck BMD T-scores<−2.5 SD was 2.82 and there were no change in the control group (from
±0.57 AU, and 2.22±0.49 AU for those with normal T- 51.1 to 51.4, p=0.12). In the main group quality of life
scores, a significant difference (P<0.05). BMD of femur improved in domains: “pain” from 57.8 to 44.9, p=
neck was not different between the groups. (0.880 ± 0.001, “activities of daily living” from 33.3 to 24.2,
0.32 g/cm 2 vs. 0.885 ± 0.17 g/cm 2 ). Femur neck T- p <0.001, “mobility” from 41.0 to 35.6, p= 0.001. In
score<−2.5 have higher SAF than normal BMD diabetic the control group no changes found in none of the
patients. Correlation analysis showed a negative correla- domains. There were significant between-group differ-
tion between SAF and femur neck BMD (r = −0.23, ences in the domains “pain” and “activities of daily
p<0.0001), L1-4 BMD (r=−0.21, p=0.003), Femur neck T- living” after course. VAS of back pain decreased in
score (r=−0.22, p<0.0001) and a positive correlation between main group from 61.1 to 45.1, p<0.0001. In the control
SAF and HbA1c (r=0.32, p=0.002). group VAS of back pain statistically significantly not
Conclusion: Accumulation of skin AGEs is increased changed.
in diabetic patients. Higher skin fluorescence and Conclusion: DENS reduces a pain, improves quality of life of
lower BMD indicating a relationship between AGE patients with osteoporotic spine fractures.
accumulation and bone strength in diabetic patients.
A long-term prospective study is needed to clarify the
causality. P603
TBS NOMOGRAN: A NEW PROPOSED APPROACH
TO CATEGORIZE PATIENTS FRACTURE RISK
P602 COMBINING BMD WITH MICROARCHITECTURE
RANDOMIZED PLACEBO CONTROLLED TRIAL ANALYSIS
OF DYNAMIC ELECTRONEUROSTIMULATION L. Del Rio1
1
EFFICIENCY IN PATIENTS WITH OSTEOPOROTIC CETIR Centre Mèdic, Barcelona, Spain
SPINE FRACTURES
L. Evstigneeva1, T. Polyanskaya2, A. Vlasov2 Objective: To develop a method that displays graphically and
1
Sverdlovsk Regional Clinical Hospital #1, Ekaterinburg, in combination the status of bone mass and
Russian Federation, 2Corporation DENAS MS, Ekaterinburg, microarchitecture in patients. The diagnosis of osteopo-
Russian Federation rosis prior to fragility bone fractures is based on aerial
BMD measurements using DXA. The trabecular bone
Objective: Patients with osteoporotic spine fractures score (TBS) is a new parameter that is determined from
have chronic pain syndrome and functional limitations gray-level analysis of DXA images. Major clinical frac-
which decrease quality of life. Dynamic ture trials confirm that combining the TBS trabecular
electroneurostimulation (DENS) is non-drug treatment texture index along with BMD improves dramatically
of pain. Aim was to evaluate DENS influence on back fracture prediction in osteoporotic patients.
pain and quality of life of patients with osteoporotic Material and Methods: A Cartesian coordinate system was
spine fractures designed to allow graphic display with combining BMD vs.
Material and Methods: 60 postmenopausal women with TBS data. This nomogram representing the differences be-
vertebral fractures were randomized into the main group tween patient data matched from reference values using stan-
(n=30) and placebo group (n=30). The mean age was dard deviation as units.
71.7±7.5 SD years. All women had at least one osteo- Results: The horizontal axis display the spine BMD T-score
porotic vertebral fracture and suffered from chronic back and the vertical axis the corresponding TBS relative
pain. Baseline variables in Qualeffo score and VAS value, calculated comparing the patient result with the
scale of back pain were not significantly different be- maximum value reached in the reference population
tween groups. Intervention: Мain group - DiaDENS-PC (TBS=1.385). We have taken as risk thresholds in the
device. An application was carried out in the area of X-axis, the BMD T-score WHO diagnostic criteria. On
maximal painfulness with 10 Hz frequency during the Y-axis the following classification are displayed:
5 min and then in 77 Hz frequency during next Normal microarchitecture pattern TBS T-score>−0.4
15 min. Control group–an imitation of DENS-effect by (TBS=1.350); partially degraded pattern −0.4≥TBS T-
 Osteoporos Int

score>−2.25 and significantly degraded pattern TBS T- of pain in the upper limbs. The Stanford Health Assess-
score≤−2.25 (TBS=1.200). ment Questionnaire instruments (HAQ), Disabilities of the
Arm, Shoulder and Hand (DASH), grip strength and fin-
ger pinch were applied and upper limbs pain symptoms
were verified at baseline and at 1 year after the educa-
tional program.
Results: HAQ of patients who did not alter or increased BMI
worsened global strength and was statistically worse
from those of patients who had a reduction in BMI
(which improved global strength) (p = 0.041). DASH
results, and right and left tripod grip strength showed
statistically significant mean improvement in all pa-
tients, irrespective of BMI change (p < 0.05). The oth-
er force measurements improved but were not statis-
tically significant throughout the study or between
groups of BMI variation (p > 0.05). DASH and tripod
grip values had an average improvement throughout
the study irrespective of the variation in BMI
(p < 0.05).
Conclusion: The educational program for patients
Conclusion: The new graphic method may provide a better
with OA improved upper limb strength and function
understanding of the patient’s bone status for clinical users by
of patients regardless irrespective of BMI change.
combining in a nomogram information on BMD and TBS.
Patients who decreased BMI improved global
This approach could be used to build dedicated nomogram for
strength.
treatment effects and monitoring.
Acknowledgements: We thank TRB Pharma Brasil for finan-
cial support.

P604
INCIDENCE OF UPPER LIMBS COMPLAINTS IN P605
PATIENTS WITH KNEE OSTEOARTHRITIS: ARTHROSCOPIC DEBRIDEMENT &
CORRELATION BETWEEN FUNCTIONALITY, PAIN VISCOSUPPLEMENTATION: DO THEY HAVE A
AND GRIP STRENGTH VS. CHANGES IN BODY ROLE IN MANAGING EARLY OSTEOARTHRITIS
MASS INDEX IN A EDUCATIONAL PROGRAM OF OF THE KNEE JOINT?
OSTEOARTHRITIS K. Acharya1
M. U. Rezende1, D. S. Scarcella1, R. M. Suzuki1, L. C. 1
Sports & Arthroscopy unit, Orthopaedics, Kasturba Medical
Almeida1, N. L. R. Brito1, O. P. Camargo1 College, Manipal University, Manipal, India
1
Instituto de Ortopedia e Traumatologia - Hospital das
Clínicas - Universidade de São Paulo, São Paulo, Brazil Objective: To study the effectiveness of viscosupplementation
3 weeks following a checklist based arthroscopic de-
Objective: One hundred ninety-six (50 men and 146 women) bridement in select patients with symptomatic knee os-
patients with KOA were submitted to an education teoarthritis by means of a prospective, randomized con-
program in OA. Age ranged from 25 to 90 years. Of trol study.
the 196 patients, 168 (85.71 %) complained of pain in Material and Methods: The study included 123 patients who
the upper limbs. The Stanford Health Assessment Ques- had symptomatic knee osteoarthritis (Kellgren Lawrence
tionnaire instruments (HAQ), Disabilities of the Arm, grade I, II & III; VAS score more than four). Patients
Shoulder and Hand (DASH), grip strength and finger were studied in three subsets. First subset (n=41): pa-
pinch were applied and upper limbs pain symptoms tients who opted for nonoperative management. Second
were verified at baseline and at 1 year after the educa- subset (n=41):cases who underwent a checklist based
tional program. arthroscopic debridement. Third subset: arthroscopic de-
Material and Methods: One hundred ninety-six (50 men and bridement with viscosupplementation (single intra artic-
146 women) patients with KOA were submitted to an ular injection of Hylan G-F 20), at 3 weeks following
educational program in OA. Age ranged from 45 to arthroscopy (n=41). Evaluations were made preopera-
90 years. Of the 196 patients, 168 (85.71 %) complained tively, at 3,6, 12,24 and 52 weeks postinjection, using
Osteoporos Int

a patient satisfaction questionnaire, VAS, and the Results: BMD and TBS evolution irrespectively to the treat-
WOMAC osteoarthritis index. ment are presented Table 1.
Results: Mean age: 55 ± 5 years. Percentage of change
in VAS was maximum in cases with arthroscopy with
viscosupplementation subset. Following viscosupple-
mentation, patient satisfaction, WOMAC and VAS
scores were significantly improved in comparison
with no injection group. Adverse events were noted
in nonoperative subset (gastritis, diarrhea, noncom-
pliance for bracing). No significant adverse events
were noted in other subsets. beneficial effects of
arthroscopy were prolonged with addition of
viscosupplementation.
Conclu sion: At the end of 1 year suggest that
viscosupplementation following a checklist based arthro-
scopic debridement is an effective treatment option for
select patients with knee osteoarthritis. Beneficial effects
of arthroscopic debridement alone are the best at 6–
24 weeks postoperatively. The beneficial effects of ar-
throscopic debridement were prolonged following addi-
Conclusion: Non correlated effects have been observed on
tional viscosupplementation. Nonoperative management
BMD and TBS irrespectively to the treatment. As expected
has the risk of noncompliance to the prescribed medi-
from the literature, TBS of non-treated subjects decreased
cations or bracing, adverse events and dependency on
with age. Among these treatments, patients under denosumab
analgesics.
exhibit a significant TBS increase whereas no significant
effects have been observed under risedronate and alendronate
which is consistent with previous presented data. TBS could
be better to select patient’s treatment.
P606
IS THE TBS USEFUL FOR TREATMENT
FOLLOW-UP?
S. Di Gregorio1 P607
1
CETIR Grup Medic, Barcelona, Spain CAN TRABECULAR BONE SCORE DIFFERENTIATE
WOMEN WITH AND WITHOUT FRAGILITY FRACT
Objective: Facing osteoporosis, clinicians have a huge thera- URES?
peutic arsenal available to them. Monitoring treatment M. R. Mascarenhas1, A. P. Barbosa1, A. A. Gonçalves2, V.
effects is the key point for patient care. These treat- Simões3, D. Hans4, M. Bicho5
1
ments can boost BMD, bone microstructure or both. Endocrinology, Diabetes & Metabolism Department, Santa
Until recently, only the BMD evaluation was used to Maria University Hospital, CHLN, Lisboa, Portugal, 2Endo-
monitor treatment effects. TBS is an index of bone crinology, Diabetes & Metabolism Department, Santa Maria
microarchitectural texture extracted from DXA related University Hospital / CHLN, EPE, Lisboa, Portugal, 3Endo-
to bone microarchitecture status. The objective of the crinology and Metabolic Diseases of Lisbon’s Faculty of
study is to assess longitudinal effects of different oste- Medicine, CEDML - Lisbon’s Endocrinology, Diabetes and
oporosis treatments on lumbar spine. Metabolism Clinic (Osteoporosis Unit), Lisboa, Portugal,
4
Material and Methods: We analyzed 301 subjects with basal Center of Bone Diseases, Lausanne University Hospital,
scan and at least one scan in follow-up with the same Lausanne, Switzerland, 5Endocrinology and Metabolic Dis-
treatment. We excluded 31 subjects because they have eases of Lisbon’s Faculty of Medicine (Genetic Lab), Lisboa,
inconsistent data. Finally we analyzed 271 patients Portugal
(men: 78; women: 193). We divided by treatment
groups (Age-years; and Follow-up-months showed in Objective: Bone mass and microarchitecture can influence
Table). The follow-up changes were analyzed by T- bone strength. The extreme fragility of the bones due to the
Test. Variation in% from baseline were assessed and diminished mass and the deterioration of microarchitecture
normalized at 24 months. (statistical significance was may originate an augmented risk of osteoporotic fractures,
set at p<0.05) mainly at the distal radius, at the spine and at the hip, also
 Osteoporos Int

associated with increased morbidity and mortality. At this after the 6 months joint pain (VAS), functional capacity index
date, DXA scan is the gold standard to measure BMD, in HAQ and WOMAC were assessed.
order to diagnose preciously osteoporosis and estimate frac- Results: After 6 months from VAS decreased 2.8 times to
ture risk. The decrease in the BMD is positively related to the 37.9±10.7 mm in OA group and 2.5 times at 32.1±19.3 mm
risk of osteoporotic fractures. TBS, a novel gray-level mea- (p<0.05) in patients with RA. HAQ decreased from 1.4±0.7
surement of lumbar spine DXA image texture, is related to to 0.9±0.6 (p<0.05) in the first group and from 1.6±0.9 to 1.0
microarchitecture and fracture risk independently of BMD. ±0.8 (p<0.05) in the second group, WOMAC score was
The aim of this study was to compare the lumbar spine bone significantly (p<0.05) decreased from 55.1±9.1 to 18.8±
microarchitecture as estimated by TBS with the spine BMD 12.1 and 53.1±10.7 to 18.3±11.8 to the first and second
scans and the correlation between spine TBS and BMD in groups, respectively. In patients with primary OA receiving
post-menopausal women with and without fragility fractures. NSAIDs before surgery, a positive trend in relation to pain and
Material and Methods: BMD (g/cm2) at the lumbar spine joint function was greater, but not significantly. In patients
was measured by DXA (Discovery W, Hologic Inc., USA) in with RA treated with NSAIDs in the preoperative period, a
155 women with (fracture group) and without osteoporotic VAS decrease was −36.8±18.9 mm, HAQ=−0.7±0.3, which
fractures (no fracture group). Site matched spine TBS was significantly (p<0.05) compared VAS those treated with
derived for each lumbar spine DXA scan (TBS iNsight soft- NSAIDs alone after surgery on demand pain VAS=−27.9±
ware, Medimaps, France). Adequate statistical tests were used 19.7 mm, HAQ=−0.5±0.2. Postoperative complications were
with the significance level at P<0.05. recorded.
Results: No significant difference was detected between the Conclusion: Total knee prosthesis is an effective method to
two groups for the mean age, mean height, mean weight and improve functional capacity, relief of pain in both primary and
mean BMI. The mean BMD was identical between these secondary gonarthrosis. Preventive NSAID analgesia has ad-
groups of women, while the TBS was lower in the fracture vantages over NSAIDs only after demand operation, especial-
group, as compared with the other group. No significant ly when the secondary gonarthrosis amidst inflammation in
relationship between spine TBS and BMD, in the fracture rheumatoid joints.
group was detected.
Conclusion: In the osteoporotic fracture group the lumbar
spine TBS was significantly low; however, an overlap of the P609
BMD values was observed in both groups, not differentiating INDICATORS OF PHYSICAL ACTIVITYAND THEIR
women with and without fragility fractures. These data may INFLUENCE ON MORTALITY OF PATIENTS WITH
indicate that TBS can complement the BMD lumbar spine HIP FRACTURES
scans in the clinical routine osteoporosis management. O. Ershova1, O. Ganert2, A. Degtyarev1, K. Belova1, M.
Belov1, O. Sinitsyna2, M. Romanova3
1
Solovev’s Hospital, Yaroslavl, Russian Federation,
2
P608 Yaroslavl Medical Academy, Yaroslavl, Russian Federation,
3
THE RESULTS OF TOTAL KNEE PROSTHESIS IN Regional Hospital, Yaroslavl, Russian Federation
PATIENTS WITH GONARTHROSIS
S. Lapshina 1 , I. Akhtyamov 1 , L. Myasoutova 1 , I. Objective: The analysis of indicators of physical activity and
Gilmutdinov2 its influence on survival during 1 year after a hip fracture in
1
Kazan State Medical University, Kazan, Russian Federation, patients 50 years and older.
2
Republican Clinical Hospital, Kazan, Russian Federation Material and Methods: A prospective study included all
inhabitants of Yaroslavl at the age of 50 years and older, with
Objective: To analyze the results of total knee prosthesis TKP hip fractures occurred from 01.09.2010 to 31.08.2011. Indi-
in patients with rheumatic diseases. cators of physical activity were walking duration per day, and
Material and Methods: 48 patients (42 women, 6 men) with also according to the questionnaire by Katz Activities of daily
3–4 radiographic stage of gonarthrosis and persistent joint living (ADL). For an assessment of survival Kaplan-Mayer’s
pain, average age 63.7±19.9 years. The first group consisted method was used.
of 24 patients with primary osteoarthritis (OA). The second Results: The study included 446 patients: 334 (74.88 %)
(n=24) group with knee OA on the background of rheumatoid women, 112 (25.12 %) men (middle age was 76.83 ±
arthritis (RA). In each group, 12 (50 %) patients were treated 10.32 years). The general mortality during 12 months was
with nonsteroidal anti-inflammatory drugs (NSAIDs), course 37.54 %. The mortality was higher at patients who could walk
2 days before surgery and after surgery in a stable average ≤30 min/day before the fracture (p=0.02), ≤30 min/day after a
daily dose of diclofenac, the other half of patients received trauma (p<0.0001), had low values on a scale of daily activity
NSAIDs on demand only after surgery. Before surgery, and of Katz (p<0.0001). Among the survived patients confined to
Osteoporos Int

a bed after during 1 year were 20 (8.90 %), among died fiber was significantly positively associated with total body
patients 61 (81.30 %) people, p<0.05. Among the survived lean mass (r=0.86, p=0.02), leg muscle mass (r=0.84, p=
patients could go outside 127 (56.95 %), among died patients 0.03) and weakly associated with total hip BMD (r=0.08, p=
nobody could go outside, p<0.05. Among those who went 0.05). No correlations between fat mass and skeletal muscle
outside to a trauma, 109 (68.60 %) patients returned to former histomorphometric indices were found. There was no corre-
level of activity, confined to a bed remained 9 (5.66 %) lation between fiber type and body composition in men with
patients. Among the patients who were not going outside age-related sarcopenia.
before the trauma, in 1 year confined to a bed were 14 Conclusion: Our findings demonstrate that cross-sectional
(20.89 %) patients (p<0.05), 40 (59.7 %) returned to former area of muscle fiber of musculus vastus lateralis is positively
level of activity (p<0.05). The share of the patients with daily associated with total body lean mass, leg muscle mass, and
activity corresponded as levels A and B (independence in the weakly associated with total hip BMD in men with age-related
majority of functions on self-service) in 3 months was sarcopenia.
50.00 %, and in 12 months - 77.02 %, p<0.05. Acknowledgements: We would like to thank Elvyra
Conclusion: The mortality among the patients with hip frac- Stapcinskiene, Audrone Misiunaite and Edita Merkeliuniene
tures during a year was 37.54 %. Higher rates of mortality was for valuable assistance in this study.
connected with low level of physical activity. Indicators of
physical activity were higher at the patients who were going
outside before fracture. P611
RELATIONSHIP BETWEEN PHYSICAL ACTIVITY,
HANDGRIP STRENGTH, FEAR AND RISK OF
P610 FALLING IN INSTITUTIONALIZED OLDER ADULTS
ASSOCIATION BETWEEN SKELETAL MUSCLE M. Tamulaitiene1, A. Mastaviciute1, V. Strazdiene2, A.
MORPHOMETRIC INDICES AND BODY Cernovas3, V. Alekna1
1
COMPOSITION IN MEN WITH SARCOPENIA Faculty of Medicine, Vilnius University, Vilnius, Lithuania,
A. Mastaviciute 1 , V. Alekna 1 , M. Tamulaitiene 1 , A. 2
National Osteoporosis Center, Vilnius, Lithuania, 3Health
Laurinavicius2, D. Petroska2, V. Strazdiene3 and Sport Centre, Vilnius University, Vilnius, Lithuania
1
Faculty of Medicine, Vilnius University, Vilnius, Lithuania,
2
National Center of Pathology, Vilnius, Lithuania, 3National Objective: To investigate relationship between physical ac-
Osteoporosis Center, Vilnius, Lithuania tivity, handgrip strength, fear and risk of falling in institution-
alized older adults.
Objective: Sarcopenia is important cause of frailty, disability Material and Methods: This cross-sectional study was con-
and loss of independence in the elderly. There are not suffi- ducted on nursing home residents (in Vilnius, Lithuania) aged
cient data about muscle fiber composition and morphology in 65 years and older. Exclusion criteria were musculoskeletal or
elderly men with sarcopenia. The aim of the study was to nervous system diseases or conditions that restricted move-
analyze the associations of histomorphometric indices of skel- ments in the upper or lower extremities. Physical activity was
etal muscle with body composition in men with age-related assessed using Rapid Assessment of Physical Activity
sarcopenia. (RAPA) questionnaire. Muscle strength was assessed by
Material and Methods: This is a cohort study on men aged handgrip strength (HGS) which was measured using a hand-
70 years and more. Total fat mass, lean mass, and BMD were held dynamometer. Fear and risk of falling were measured
estimated by iDXA (GE Lunar). Sarcopenia was defined as using Falls Efficacy Scale-International (FES-I) and Morse
appendicular skeletal muscle mass divided by stature squared Fall Scale (MFS). Data were analyzed using SPSS 18.0 for
<7.26 kg/m2. Skeletal muscle needle biopsy (16 gauge) was Windows program.
taken to analyse possible morphological and histochemical Results: The study population consisted of 20 men and 37
changes in myocites. Samples were frozen and stored in women with a mean age of 80.5±6.8 years, the youngest
liquid nitrogen, the sections were made by cryostat. participant was 67 years old, the oldest—95 years old. In
Stainings with haematoxylin/eosin (H/E), oil red O order to compare different level of HGS the score cutpoint
(ORO), acid phosphatase (AF), cytochromoxydase/ of 50th percentile was established. According to this cutpoint
succinildehidrogenase (COX/SDH), and adenosine men and women were divided into a weak (men ≤20 kg,
triphosphatase (ATP) were made. women ≤10 kg) and strong (men ≥20 kg, women ≥10 kg)
Results: Thirty skeletal muscle microbiopsies were per- HGS groups. The significant differences of MFS score be-
formed on sarcopenic men. On average, the sample was tween weak and strong HGS women groups (p=0.05) was
chosen for further analysis of 100 fibers. The average cross- found greater MFS score in weak group. The study data
sectional area - 2110±125.6 μm2. The cross-sectional area of showed positive correlation between age and FES-I score in
 Osteoporos Int

women (r=0.35, p=0.04). In women with weak HGS, nega- P613

tive strong (r=−0.57, p=0.01) correlation between RAPA and CARTILAGE-SPECIFIC DELETION OF MTOR
MFS scores was observed. In men with weak HGS, negative UPREGULATES AUTOPHAGYAND PROTECTS
strong correlation (r=−0.64, p=0.03) between RAPA and age MICE FROM OSTEOARTHRITIS
was found. M. Kapoor1, F. Vasheghani1, Y. Li1, M. Blati1, H. Fahmi1, B.
Conclusion: Our study showed the positive correlation be- Lussier1, J.-P. Pelletier1, J. Martel-Pelletier1, Y. Zhang1
1
tween age and fear of falling in women, and negative correla- Osteoarthritis Research Unit, University of Montreal
tion between age and physical activity in men with weak Hospital Research Centre (CRCHUM), Montreal,
handgrip strength. Negative strong correlation between phys- Quebec, Canada
ical activity and risk of falling was observed in women with
weak handgrip strength. Objective: mTOR (a serine/threonine protein kinase) is a
Acknowledgements: We would like to thank nursing home major repressor of autophagy, a cell survival mecha-
“Antaviliai” staff for assistance of this study. nism. The specific in vivo mechanism of mTOR signal-
ling in OA pathophysiology is not fully characterised.
We determined the expression of mTOR and known
autophagy genes in human OA cartilage as well as
P612 mouse and dog models of experimental OA. We created
TREATMENT OF POSTMENOPAUSAL cartilage-specific mTOR knockout (KO) mice to deter-
OSTEOPOROSIS: STATE OF THE PROBLEM IN mine the specific role of mTOR in OA pathophysiology
BELARUS and autophagy signalling in vivo.
A. V. Rudenka1, A. Adamenka2 Material and Methods: Inducible cartilage-specific
1
Belarussian Medical Academy of Postgraduate Education, mTOR KO mice were generated and subjected to
Minsk, Belarus, 2Minsk City Center of Osteoporosis, Minsk, mouse model of OA. Human OA chondrocytes were
Belarus treated with rapamycin and transfected with Unc-51-
like kinase 1 (ULK1) SiRNA to determine mTOR
Objective: To investigate the characteristics of the treatment signalling.
of postmenopausal osteoporosis in Belarus. Results: mTOR is overexpressed in human OA cartilage as
Material and Methods: 376 postmenopausal women (mean well as mouse and dog experimental OA. Upregulation
age 61.1±8.35 years) living in different regions of the country of mTOR expression co-relates with increased chondro-
were randomly chosen for participation in the study. Measure- cyte apoptosis and reduced expression of key autophagy
ment of BMD at lumbar spine and femurs was performed by genes during OA. Subsequently, we show for the first
the method of DXA (Lunar Prodigy, GE, USA). Evaluation of time that cartilage-specific ablation of mTOR results in
risk factors of osteoporosis and fragility fractures was per- increased autophagy signalling and a significant protec-
formed by questioning. tion from destabilization of medial meniscus (DMM)-
Results: According to the obtained clinical and instrumental induced OA associated with a significant reduction in
data 195 (51.9 %) of the examined had osteoporosis, 69 the articular cartilage degradation, apoptosis and syno-
(18.4 %) - osteopenia and normal showings of BMD vial fibrosis. Furthermore, we show that regulation of
were detected in 112 (29.7 %) women. 85 (22.6 % of ULK1/adenosine monophosphate-activated protein ki-
all the examined and 43.6 % of osteoporotic women) nase (AMPK) signalling pathway by mTOR may in part
had low-energy fractures in anamnesis. The proportion be responsible for regulating autophagy signalling and
of patients with a history of fragility fractures, to whom the balance between catabolic and anabolic factors in
antiosteoporotic treatment was prescribed, was 50.5 % the articular cartilage.
(43 patients). Among all the patients with diagnosed Conclusion: This study provides a direct evidence of the role
osteoporosis only 73 (37.5 %) received antiosteoporotic of mTOR and its downstream modulation of autopha-
treatment, 43 (58.9 %) of them were receiving only gy in articular cartilage homeostasis. Targeting cellu-
calcium and vitamin D supplementation, 2 (2.7 %) - lar homeostasis mediators, such as mTOR and its
calcium with strontium ranelate and 28 (38.3 %) - downstream signaling by autophagy pathway may be
calcium and bisphosphonates. a promising therapeutic strategy to achieve
Conclusion: The majority of postmenopausal women with chondroprotection and correct the imbalance between
established osteoporosis in Belarus do not receive catabolic and anabolic processes during OA and re-
antiosteoporotic drugs, and more than 50 % of patients lated disorders.
assigned to treatment only take calcium supplements in com- Acknowledgements: This work was performed with CIHR
bination with vitamin D. Operating Grant Funded to Mohit Kapoor.
Osteoporos Int

P614 Material and Methods: There were examined 14,947 pa-

EFFECT OF COFFEE AND CALCIUM tients aged over 50 years, 13,886 (92.9 %) women and 1,061
ADMINISTRATION IN THE BONE QUALITY (7.1 %) men. T-score was assessed with DXA by Lunar
A. C. O. Penoni1, B. E. B. Hilário2, M. M. Borges2, D. P. Prodigy in LS (L1-L4) and FN. The response variable Т-score
Alvarenga2, G. R. Yanagihara1, A. C. Shimano1, M. J. Quirino was assessed by the method of multiple linear regression with
Louzada3, B. R. S. Oliveira4, P. F. P. Goulart5 stepwise inclusion in the model and test for colinearity using
1
Department of Biomechanics, Medicine and Rehabilitation of test Durbin-Watson according to the known values of several
the Locomotor System, Ribeirão Preto, Brazil, 2Department of predictor variables, selected using correlation analysis.
Physiotherapy, University Center of Lavras, Lavras, Brazil, 3Uni- Results: Mean age in the examined women was 65.6±
versity of São Paulo, Ribeirão Preto, Brazil, 4State University 9.6 years (95%CI 65.0; 662), and in men - 65.4±9.0 years
Paulista - UNESP - Araçatuba Faculty of Veterinary Medicine, (95%CI 65.3; 65.6). 23.3 % of patients were diagnosed to
Araçatuba, Brazil, 5University Center of Lavras, Lavras, Brazil have osteoporosis, 48.1 % - osteopenia and 28.6 % had
normal values of BMD. The anthropometric data in men and
Objective: To verify if coffee intakes in moderate shots women had statistically significant differences in height
change bone remodeling, what it would impact on BMD, in (169.9±7.1 vs. 157.7±6.3; р<0.001), and weight (80.0±
biochemical and biomechanical characteristics of bone tissue. 14.9 vs. 74.7±14.4; р<0.001), thus the regression analysis
Material and Methods: 24 male rats 60 days old Wistar were was performed separately by gender. Constructed multiple
divided by three experimental groups, making the treatment: linear regression model revealed the relationship between
Group 1 (control), Group 2 (coffee - 3 ml/kg), Group 3 (coffee the values of T-score and anthropometric data. The variability
- 3 ml/kg + 5 mg calcium) and Group 4 (5 mg calcium). After of the values of LS T- score can be explained by the meanings
56 days of tests, the animals were anesthetized, it was collected of height, weight and age in men and women by 19 % and
5 ml of blood trough cardiac puncture and analyzed the values of 21 %, respectively. The calculated predictive value of LS T-
glucose and ionized calcium. After procedure, the animals were score in women was (−4.944) + 0.009*height, cm +
euthanized and necropsied, dissecting both femurs. The left 0.046*weight, kg - 0.018*age, years; in men - (−6.702) -
femurs were submitted to analysis densitometric and right to 0.001*height, cm + 0.055*weight, kg + 0.031*age, years.
bending of head flexion and compression of middle third. Bio- The variability of FN T-score was determined by 20 % and
mechanically, it determined maximum strength and rigidity. 36 % in men and women with the same predictor variables.
Results: The results showed smaller ionic calcium concentra- Predictive value of FN Т-score in women was (−2.803) +
tion in the ionic Group in relation to experimental (p=0.0000). 0.016*height, cm + 0.028*weight, kg - 0.046*age, years; in
The studied glycemic analysis and biomechanical variables had men - (−3.197) + 0.003*height, cm + 0.032*weight, kg -
not showed significant differences between the groups. It con- 0.019*age, years.
cludes that coffee intakes in moderate shots can take to BMD Conclusion: The proposed model allows to predict the values
diminish without changing bone biomechanical properties and of LS and FN T-score on the basis of anthropometric data in
simultaneous calcium consumption does not change this result. persons aged over 50 years of both sexes.
Conclusion: The daily calcium consumption tends to keep
ionic calcium level lower, however it is not determinant to
interfere beneficially on BMD.
P616
CHANGES IN APPENDICULAR BODY
COMPOSITION CAN BE DETECTED BY
P615 PERIPHERAL COMPUTED TOMOGRAPHY
THE RELATIONSHIP BETWEEN HEIGHT, WEIGHT, ALREADYAT THE INITIAL STAGE OF
AGE AND T-SCORE IN PATIENTS 50 YEARS AND RHEUMATOID ARTHRITIS
OLDER R. Müller1, M. Kull1, A. Aart1, M. Lember1, R. Kallikorm1
H. Ramanau1, E. V. Rudenka2, N. Predko2, A. V. Rudenka2, 1
University of Tartu, Tartu, Estonia
O. Fomin3
1
Gomel State Medical University, Gomel, Belarus, 2Belarus- Objective: Rheumatoid arthritis (RA) causes persistent de-
sian Medical Academy of Postgraduate Education, Minsk, structive changes in joints and bone. Detection of early struc-
Belarus, 3Clinical Hospital No. 1, Minsk, Belarus tural damage is vital to predict further joint destruction. In the
course of RA a shift in body composition (BC) occurs—lean
Objective: To examine the relationship between Т-score of tissue is substituted with fat while maintaining stable body
lumbar spine (LS) and femoral neck (FN) and anthropometric weight. Our objective was to assess the ability of pQCT to
data in patients of both sexes aged over 50 years. detect a change and quantify the effect of RA on BMD and
 Osteoporos Int

hand BC parameters in a prospective study of early RA patients (20 %) - osteopenia. Showings of BMD in control
patients. group were normal. Mean levels of 25(OH)D in patients with
Material and Methods: We recruited 32 patients with early PsA were 18.44 [9.90; 27.73] ng/ml and 21.31 [15.79; 30.39]
RA into the study. Radius trabecular BMD and area, cortical ng/ml in control group, but the differences were not statisti-
BMD and area, muscle and fat tissue density, cross-sectional cally significant. Vitamin D deficiency was found in 66 (92 %)
area and ratio were measured with Stratec XCT2000 pQCT of PsA patients and in 61 (80 %) of controls. Serum CTX,
machine (Germany) twice (at diagnosis and 1 year follow-up). ALP, Ca were not significantly different in arthritic patients
Patients underwent a laboratory panel and thorough physical and controls (p>0.05). There were no revealed any correla-
examination. DAS 28(CRP) value was used to categorize tions between vitamin D levels disease activity and BMD. In
patients to moderate-high (>3.2) and low (<3.1) disease activ- patients with PsA, the duration of arthritis was negatively
ity groups. Changes in and differences between patient groups correlated with BMD values of lumbar spine and total femur
were assessed by Wilcoxon signed-rank test. The study was and serum CTX levels, suggesting an association of increased
IRB approved. demineralization with the duration of joint disease.
Results: Mean patient age was 51.8 years (range 23–80), Conclusion: Patients with PsA and longer duration of joint
median time from symptom onset 91 (range 9–900) days, disease may be at risk for osteoporosis, which can require
82 % were female. A 25 % increase in fat area (p=0.01) and preventative treatment efforts.
11 % decrease in fat/muscle ratio (p=0.03) was seen in the
moderate-to-high disease activity group. No BC changes were
detected in low disease activity group. Trabecular density was P618
the sole bone parameter where decrements during the first UNDERSTANDING BETWEEN PHYSICIAN AND
year after disease onset could be detected (−3.5 %, p=0.05). PATIENT WITH OSTEOARTHRITIS AS A KEY
Conclusion: pQCT detects significant body composition FACTOR IN INCREASING THE EFFECTIVENESS OF
changes (most significant in the body fat compartment) in THERAPY
early RA patients already 1 year after diagnosis. S. Lapshina1, L. Myasoutova1
1
Kazan State Medical University, Kazan, Russian Federation

P617 Objective: To identify the most significant problems for the

BONE MINERAL DENSITY, 25(OH)D AND BONE patient with osteoarthritis (OA) in order to create a system of
TURNOVER MARKERS IN PATIENTS WITH effective interaction between physician and patient in future.
PSORIATIC ARTHRITIS Material and Methods: 50 patients with confirmed OA
V. Samakhavets1, E. V. Rudenka1 diagnosis (the average duration of the disease 1245 ±
1
City Centre of Osteoporosis, Minsk, Belarus 5.53 years, the average age of patients 49.5±15.82 years)
responded to 10 questions concerning their relationship to
Objective: The aim of this study was to assess BMD and bone the disease and the impact on the daily life with the need to
turnover markers in patients with PsA, and to investigate the evaluate the importance of each question on a scale from 1 to
relationship between clinical parameters and markers of bone 10. Rheumatologists (n=10) and physicians (n=40) answered
turnover. the same questions from their point of view, what is important
Material and Methods: 71 patients with PsA (32 men and 39 for patients. Responses were ranked and compared.
women; mean age 49.22±10.34 years; mean duration of PsA Results: Physicians and patients opinions coincided in an-
9.4±5.9 years) without the history of any treatment including swering the most important question—the forecast for the
glucocorticoid intake and 76 healthy controls (28 men, 48 future in relation to the possibility of movement and overall
women, mean age 47.8±9.43 years) were included in the health. The second most important for patients was the cost of
study. Laboratory assessment included evaluation of ECR treatment, the third—understanding the causes of the disease
and C-reactive protein, serum Ca, P, alkaline phosphatase and its consequences. Thereafter, patients worried about con-
(ALP), serum type I collagen cross-linked C telopeptide stant pain and the need to constantly take drugs and possible
(CTX), and 25(OH)D level. Serum levels of 25(OH)D and side effects. In contrast, doctors believed that patients are
bone turnover markers were determined using the chemilumi- worried about limitations in everyday life and disability, per-
nescent assay (analyzer - Cobas e 411). BMD was measured sistent pain. To a lesser extent they are concerned about the
by DXA at lumbar spine (anterior-posterior projection at L1- causes of disease and the cost of therapy.
L4) and femurs. Statistical analysis was performed using the Conclusion: Understanding the patients opinion to their dis-
program Statistica 8. ease will allow to restructure the communication with the
Results: Decreased BMD was detected in 33 patients with patient, educational programs for them. Physician must pay
PsA: 18 patients (25 % of total) had osteoporosis and 15 more attention to the explanation of the causes of disease, the
Osteoporos Int

effectiveness and safety of therapy that will improve the P620

quality of life of patients. EPIDEMIOLOGY OF OSTEOPOROSIS AND RISK OF
FRACTURES IN REPUBLIC OF BELARUS
H. Ramanau1, E. V. Rudenka2
1
Gomel State Medical University, Gomel, Belarus, 2Belarus-
P619 sian Medical Academy of Postgraduate Education, Minsk,
LEFLUNOMIDE TREATMENT AND ITS EFFECTS Belarus
ON SERUM 25-(OH)D LEVELS IN WOMEN WITH
RHEUMATOID ARTHRITIS Objective: The objective of this study was to define the
V. tepa1, L. Groppa2, E. Russu2, N. Ganea3 incidence of osteoporosis and risk of fractures by age and
1
Department of Rheumatology and Nephrology of The State BMD for Belarusian population.
University of Medicine and Pharmacy, Chisinau, Republic of Material and Methods: The measurements of BMD were
Moldova, 2Department of Rheumatology and Nephrology, done in the lumbar spine (LS) and femoral neck (FN) by DXA
SMPU, Chisinau, Republic of Moldova, 3Rheumatology and (Lunar Prodigy, GE, USA) for 14,947 individuals of 50 years
Arthrology Laboratory, Clinical Republican Hospital, and older.
Chisinau, Republic of Moldova Results: It was revealed 1,003 vertebral (VF) and 2,636
nonvertebral fractures (NF) in the study group. Osteoporosis
Objective: Leflunomide is an immunomodulatory drug that was verified in 24.1 % of patients: at the age group 50–
inhibits dihydroorotate dehydrogenase (an enzyme involved 60 years in 13.3 % cases, 60–70 years - 22.2 %, 70–80 years
in pyrimidine synthesis), and is used for the treatment of in 34.0 % and for patients aged over 80 years in 47.6 % cases.
patients with moderate to severe rheumatoid arthritis (RA). The frequency of VF by age groups 50–60, 60–70, 70–80 and
The aim of this study was to assess the effects of DMARD 80+ years old was 3.1 %, 6.2 %, 12.0 % and 14.8 %, respec-
treatment with Leflunomide on serum concentrations of 25- tively. The odds ratio (OR) of VF for patients with normal
hydroxyvitamin D (25-(OH)D). BMD in different age groups was 2.25 (95%CI 1.34–3.72),
Material and Methods: Thirty-five women were included in 3.33 (95%CI 1.90–5.80) and 2.97 (95%CI 1.08–10.56) in
the study, mean age 48.4 years, mean disease duration comparison with patients of 50–60 years. The risk of VF
8.6 years. All of them received leflunomide treatment. increase for patient with OP depending on age: for age group
Blood samples were taken and the following indices 50–60 OR=5.71 (95%CI 3.44–9.31), 60–70 years OR=9.48
assessed before treatment and at 6 months: serum (95%CI 6.04–14.44), 70–80 years OR=14.31 (95%CI 9.27–
25-(OH)D, C-reactive protein (CRP), rheumatoid factor 21.32) and the highest OR=15.79 (95%CI 9.73–24.92) for
(RF) and anticyclic citrullinated peptide (anti-CCP). patients aged over 80 years. The NF frequency is higher that
During the clinical examination at the 2 checkpoints VF and was 15.0 %, 23.9 %, 30.8 % and 35.2 %, respectively,
DAS-28 was calculated. Radiographic images before by different age groups. The odds ratio (OR) of NF for patients
treatment and at 6 months were assessed using the with normal BMD in different age group was 1.39 (95%CI
Sharp van der Heijde Score for joint damage 1.10–1.74), 1.49 (95%CI 1.13–1.98) и 1.75 (95%CI 0.97–
progression. 3.36) in comparison with patients aged 50–60. The risk of NF
Results: As was to be expected, after 6 months of DMARD for patient with OP by age groups is 2.45 (95%CI 1.90–3.15),
treatment DAS-28, CRP, anti-CCP and RF concentrations 3.42 (95%CI 2.77–4.22), 3.74 (95%CI 3.07–4.56) and for
decreased considerably. Sharp van der Heijde Score showed patients aged over 80 years OR=3.75 (95%CI 2.82–4.99).
no significant changes after 6 months of leflunomide treat- Conclusion: The prevalence of OP in the Republic of Belarus
ment. All 35 patients had decreased 25-(OH)D serum levels in patients over the age of 50 years is 24.1 % with a maximum
(below 50 nmol/l) before starting DMARD therapy. No sta- frequency at the age of 80 years and older. The age and BMD
tistically significant difference was found in comparing are significant risk factors for vertebral and nonvertebral frac-
25-(OH)D serum levels before and after 6 months of tures, which should be considered for predicting fractures and
Leflunomide therapy. After second assessment the majority determining the treatment plan.
of them had to be considered for supplementation in order to
avoid complications.
Conclusion: This study showed that 6 months Leflunomide P621
treatment had an insignificant effect on serum 25-(OH)D THE INFLUENCE OF UPPER LIMBS DISORDERS
levels. No other associations between 25-(OH)D levels and ON SELF ESTEEM AND QUALITY OF LIFE
markers as CRP, RF or anti-CCP were found. Further studies C. Suteu1, D. M. Farcas2
1
using larger patient lots could show different results, and are Occupational Medicine, Faculty of Medicine and Pharmacy,
needed for a definite conclusion. Oradea, Romania, 2Physical Rehabilitation, Faculty of
 Osteoporos Int

Medicine and Pharmacy, Oradea, Romania when the clinician confirmed the presence of self-reported
OA, previously undiagnosed OA when the clinician diag-
Objective: To assess self-esteem and quality of life in patients nosed OA and the participant was unaware of the disease,
with upper limbs disorders. and over-reported OA when the participant reported a prior
Material and Methods: Our group of study consisted in 108 diagnosis but there was no clinical confirmation. We estimated
patients with upper limbs disorders. It was divided in two the risk of misdiagnosis for specific patient characteristics
subgroups, first of 54 patients (29 women/25 men), mean using multinomial logistic regression. We present odds ratios
age 48.2±11.4 who underwent a complex rehabilitation treat- (OR) and their 95 % confidence intervals (CI95%), adjusted for
ment and the second subgroup of 54 patients (28 women/26 age, sex, education and BMI.
men), mean age 49.7±3.4, with no treatment. All patients Results: Among all participants clinically-diagnosed, 41.4 %
were recruited from ambulatory system Bihor county, Roma- were unaware of the condition. As expected, these had less
nia. The main characteristics of the groups were similar in severe radiographic changes and complaints than those who
both groups. The inclusion criteria were: active subjects with accurately reported OA. In participants with clinical disease,
specific jobs, complying with the principles of medical ethics. underdiagnosed subjects had lower BMI (AdjOR =3.30,
The exclusion criteria were: retired subjects, severe diseases, CI95%: 1.29–8.45, reference: BMI≥30 kg/m2) and younger
noncompliance. All the patients were assessed with Short age (AdjOR = 1.89, CI 95% : 1.01–3.57, reference: age ≥
Form 36 Questionnaire and Rosenberg Self Esteem Scale at 70 years) than those previously diagnosed. Sex, education,
the entrance in the study and 6 months later. socioeconomic status and healthcare utilization did not predict
Results: In the subgroup of patients who underwent rehabil- underdiagnosis. Participants over-reporting OA were not sig-
itation program both Physical Component Summary and nificantly different from confirmed cases.
Mental Component Summary of the SF 36 improved at Conclusion: Narrowing the diagnostic gap to improve man-
6 months than in the second subgroup of sedentary patients agement is likely to require searching for less severe cases of
which showed no improvement in quality of life. Also self- patients without classical risk factors such as old age and
esteem improved in the group of patients included in rehabil- obesity.
itation program after 6 months than in the sedentary group of
patients which did not modify at the end of the study.
Conclusion: Our study showed that patients with upper limbs P623
disorders have a low self-esteem and an impaired quality of THE RESULTS OF TOTAL HIP PROSTHESIS IN
life. Rehabilitation program played a beneficial role on both RHEUMATOID ARTHRITIS PATIENTS WITH
self-esteem and quality of life of such patients. SECONDARY COXARTHROSIS
I. Akhtyamov 1 , S. Lapshina 1 , L. Myasoutova 1 , I.
Gilmutdinov2
1
P622 Kazan State Medical University, Kazan, Russian Federation,
2
KNEE OSTEOARTHRITIS DIAGNOSTIC GAP: Republican Clinical Hospital, Kazan, Russian Federation
MOVING BEYOND CLASSICAL RISK FACTORS
D. Simões1, R. André2, L. Carmona3, R. Lucas1 Objective: To review the results of total hip prosthesis ac-
1
Institute of Public Health of the University of Porto (ISPUP), cording to baseline disease activity.
Porto, Portugal, 2Hospital Beatriz Ângelo, Loures, Portugal, Material and Methods: Total hip prosthesis was used on 36
3
Institute for Musculoskeletal Health, Madrid, Spain RA patients (32 women, 4 men), mean age of 49.5 ±
15.82 years (disease duration - 12.45±5.53 years). High dis-
Objective: To study determinants of misdiagnosis in knee ease activity by DAS28 was observed in 10 patients (27.8 %),
osteoarthritis (OA). moderate - in 19 (52.8 %), low - in 7 (19.4 %) patients, the
Material and Methods: We used data from a national health mean DAS28 4.5±1.7. At the time of surgery (before and
survey (Portugal, 2005–2008). Subjects were inquired about after), 24 (66.7 %) of the patients continued to take basic
knee OA diagnosis by self-report. Subsequently, each partic- antirheumatic drugs (DMARDs) - (methotrexate 7.5–15 mg
ipant answered 6 questions about nontraumatic joint pain. per week - 15, leflunomide - 7, sulfasalazine - 2). 6 (16.6 %)
These items were used to build a validated algorithm to select patients received biological therapy: infliximab - 2,
participants for evaluation by a rheumatologist. Evaluation adalimumab - 1, rituximab - 3, which were cancelled before
comprised clinical history, physical examination and radio- the operation in accordance with the terms specified in the
graphic evaluation. Individuals were classified according to national guidelines. 19 (52.8 %) patients received steroids, of
the American College of Rheumatology clinical criteria for which, in combination with DMARDs - 7 (19.4 %). Before
OA. From the original sample, 265 participants were classi- the surgery, in the postoperative period and after 6 months
fied into one of the following groups: accurately reported OA VAS, DAS28, index HAQ have been evaluated.
Osteoporos Int

Results: For 6 months after surgery VAS decreased to 31.7± nine patients (18.4 %) had monoarthritis and 3 patients
19.4 mm (p<0.05), disease activity decreased (high - 4 (6.1 %) had oligoarthritis. Complete recovery was observed
(11.1 %), moderate 17 (47.2 %), low -15 (41.7 %)). in all patients based on clinical and serological evaluations.
DAS28=1.1±0.7, HAQ index decreased from 1.63±0.91 to During follow-up visits up to 12 months, none of the patients
1.04±0.78 (p<0.05). VAS in patients receiving steroids alone had recurrence.
(n=12) was - 24.9±18.6 mm, steroids + DMARD (n=7) - Conclusion: Brucellosis should be considered in the differen-
29.1±19.7 mm, only DMARDs (n=11) 34.8±18.9 mm, bio- tial diagnosis of the rheumatic diseases, mainly
logical therapy + DMARD (n=6) 37.4±20.8 mm. DAS28 - spondyloarthropathies. When administered for a sufficient
did not depend from treatment. HAQ in patients in the group period of time, DR combination is a powerful therapeutic
(n=17), receiving DMARDs with or without biological ther- option for patients with osteoarticular brucellosis including
apy (D HAQ=−0.69±0.34) compared to patients receiving those with spondylitis.
steroids without basic therapy (n=12) - D HAQ=−0.48±0.31
was significantly better improved (p<0.05).
Conclusion: Total hip prosthesis is an effective way to im- P625
prove functional capacity, to relieve pain and to reduce the SERUM SCLEROSTIN IN HEPATITIS C VIRUS
activity of RA. Functional ability after surgery is higher in INFECTED PATIENTS
patients using DMARDs continuously and receiving biologi- R. Pelazas González1, J. Alvisa Negrín1, R. Hernández Luis1,
cal therapy compared to patients receiving steroids. C. Jorge Ripper1, E. González Reimers1, D. García Rosado1,
C. Fernández Rodríguez1, O. Pérez Hernández1, Y. Lalondriz
Bueno1, G. Quintero Platt1, C. Martin González1
1
P624 Internal Medicine, La Laguna, Tenerife, Spain
MAY DOXYCYCLINE-RIFAMPICIN COMBINATION
BE THE FIRST-LINE THERAPY FOR Objective: Sclerostin is an endogenous inhibitor of the Wnt/
OSTEOARTICULAR BRUCELLOSIS? β-catenin pathway secreted by osteocytes. It inhibits osteo-
Ş. Hocaoğlu1, E. Mesci2 blast function, differentiation, and survival. Theoretical-
1
Kayseri Training and Research Hospital, Department of ly, sclerostin tends to decrease bone mass, although
Physical Medicine and Rehabilitation, Kayseri, Turkey, several studies show opposite results. In addition, it
2
Medeniyet University, Göztepe Training and Research Hos- may be related to insulin resistance and carbohydrate
pital, Department of Physical Medicine and Rehabilitation, metabolism, as osteocalcin. Hepatitis C virus (HCV)-
İstanbul, Turkey infected patients may present osteoporosis, and frequent-
ly show liver steatosis, in relation with insulin resis-
Objective: Brucellosis is an infectious disease which can tance. The behaviour of sclerostin in these patients is
mimic rheumatoid diseases due to its osteoarticular (OA) unknown. The aim of this work was to analyse the
involvements. Treatment failure and recurrences have not relationship between serum sclerostin and osteocalcin
been completely eliminated yet in patients with OA brucello- levels and BMD, liver function derangement, the inten-
sis. This study aimed to investigate rheumatologic manifesta- sity of liver steatosis and biochemical markers of bone
tions observed in patients with OA brucellosis and the out- homeostasis and insulin resistance in HCV-infected
comes of combination therapy with doxycycline and rifampi- patients.
cin (DR) in such patients. Material and Methods: Forty HCV patients and 20 age and
Material and Methods: The study enrolled patients who sex-matched controls were included and underwent bone
were diagnosed with brucellosis based on blood cultures and densitometry. Serum sclerostin, osteocalcin, collagen
serological examinations conducted for differential diagnosis telopeptide, adiponectin, leptin, insulin, resistin,
due to presence of rheumatologic symptoms. Serological tests TNF-α, and IL-6 were determined. Liver fat was
and radiological examinations were performed for diagnosis histomorphometrically assessed.
of the OA involvements. As for treatment, DR therapy was Results: Sclerostin levels were slightly higher in patients than
given for 45 days to patients with OA involvement other than in controls, and were directly related to BMD at different parts
spondylitis and for 12 weeks to patients with spondylitis. of the skeleton, to serum telopeptide, and to liver steatosis and
Clinical and serological evaluations were repeated at 2 weeks TNF-α. On the contrary, osteocalcin showed a significant
and 1, 2, 3, 6 and 12 months after treatment initiation. direct relationship with serum adiponectin, and an inverse
Results: Mean age of the 49 patients enrolled in the study was one with IL-6.
44.08±13.04 years. The most common osteoarticular mani- Conclusion: Therefore, serum sclerostin levels were raised in
festation was spondylitis which was observed in 17 patients HCV patients, and correlated directly with BMD and serum
(34.7 %). In addition, 14 patients (28.6 %) had sacroiliitis, telopeptide. In addition direct relationships of sclerostin, but
 Osteoporos Int

inverse ones of osteocalcin, with variables associated with References: 1. Terslev L et al. Ann Rheum Dis 2004;63:644
insulin resistance suggest a role of bone on intermediary
metabolism.
P627
DIAGNOSTIC ACCURACY OF A NOVEL
P626 ULTRASOUND-BASED METHODOLOGY FOR
THE INFLUENCE OF SUBCUTANEOUS SPINAL DENSITOMETRY ON A COHORT OF
DENOSUMAB ON THE PERIOSTEUM IN PATIENTS FEMALE PATIENTS (45–65 Y)
WITH POSTMENOPAUSAL OSTEOPOROSIS: F. Conversano1, M. Muratore2, R. Franchini1, E. Casciaro1, F.
PRELIMINARY RESULTS Chiriacò1, M. D. Renna1, A. Greco1, L. Quarta2, E. Quarta2, S.
V. Cazac1, L. Groppa1, E. Russu1, A. Zoltur-Mosneaga2 Casciaro1
1 1
Department of Rheumatology and Nephrology, SMPU National Research Council, Institute of Clinical Physiology,
Nicolae Testemitanu, Scientifico-practical Laboratory of Lecce, Italy, 2O.U. of Rheumatology, Galateo Hospital, San
Rheumatology and Arthrology of the Republican Clinical Cesario di Lecce, ASL-LE, Lecce, Italy
Hospital, Chisinau, Republic of Moldova, 2Excellence Med-
ical Center, Chisinau, Republic of Moldova Objective: To test the diagnostic accuracy of a novel ultra-
sound (US)-based method to perform spinal densitometry
Objective: To assess the influence of denosumab treatment on without employing X-rays.
the periosteum in patients with postmenopausal osteoporosis. Material and Methods: A cohort of 345 female patients was
Material and Methods: A group of 27 patients with post- recruited according to the following criteria: 45–65 years,
menopausal osteoporosis, confirmed by lumbar spine and hip BMI <25 kg/m2, no severe deambulation impairments, med-
DXA, with a T-score of maximum −2.5 was selected. Patients ical prescription for a spinal DXA, signed informed consent.
were evaluated clinically, after which they underwent All the enrolled patients underwent two examinations: a
ultrasound examination of the calcaneal periosteum. conventional spinal DXA (Hologic Discovery) and an
Using colour and spectral Doppler, the colour fraction US scan of lumbar spine. US data were analyzed by a
and resistance index (an intramuscular thenar artery - novel algorithm that processed both echographic images
sample) were obtained, both at baseline - prior to 60 mg and “raw” radiofrequency signals and calculated the
of denosumab, and 6 months after the injection. The same diagnostic parameters provided by DXA (BMD,
normal ranges were adopted from data obtained by T-score, Z-score). Diagnostic accuracy of obtained re-
Terslev L. et al (1). Also a group of 12 healthy female sults was evaluated through a direct comparison with
controls were examined at baseline in a similar manner. DXA output as a function of patient age.
Statistical analysis was performed using the software Results: For 88.1 % of the patients US diagnosis (osteoporot-
StatSoft 9.0. A Student’s t-test was used for data eval- ic, osteopenic, healthy) was the same of the corresponding
uation. The level of significance was p=0.05. DXA one. In particular, diagnostic accuracy showed the fol-
Results: In 51.8 % patients at baseline calcaneal periosteal lowing behavior as a function of patient age range:
hypoechoic thickening was detected, as well as accuracy was 95.0 % in 45–50 year, 88.9 % in 50–
hypervascularization in 62.9 % patients from the study group. 55 year, 92.0 % in 55–60 year and 78.6 % in 60–
In controls, 8.3 % patients had calcaneal periosteal 65 year. Pearson correlation coefficient (r) between
thickening, and 16.6 % had periosteal DXA and US measurements was also evaluated for each
hypervascularization. The mean colour fraction in the diagnostic parameter (BMD, T-score, Z-score) for pa-
study group was 0.047±0.16 (range=0.26–0.75) at base- tients in the same age range: all the obtained values
line, compared to a mean of 0.005±0.01 (range=0–0.04) of r were within the interval 0.63–0.84 (p<0.001) and
in controls. The mean resistance index was 0.27±0.45 their trends against age qualitatively reflected the ob-
(range=0.1–1) at baseline, compared to a mean of 0.95± served diagnostic accuracy profile.
0.09 (range=0.71–1) in controls. The ultrasound analysis Conclusion: The proposed US approach to spinal bone den-
performed at re-evaluation yielded a significantly lower sitometry showed a very good agreement with DXA diagno-
mean colour fraction of 0.32±0.12 (range=0.2–0.61), p= ses. This new nonionizing method has the potential for being
0.047, and a significantly higher mean resistance index extremely useful for early osteoporosis diagnosis through
of 0.54±0.25 (range=0.2–1), p=0.049. population mass screenings and for therapeutic outcome
Conclusion: Our preliminary data show that treatment monitoring.
with denosumab in patients with osteoporosis has a Acknowledgements: This work was partially funded by
beneficial effect on periosteum, reducing its degree of FESR P.O. Apulia Region 2007–2013 - Action 1.2.4, grant
vascularization. n. 3Q5AX31.
Osteoporos Int

P628 algorithm pointed statistical significant differences be-

PREVALENT FRAGILITY FRACTURES IN 498 tween women with and without prevalent fragility frac-
MENOPAUSALWOMEN AND SKELETON tures, but the bone resorption markers were not
ASSESSMENT different.
M. Carsote1, R. Dusceac2, D. Niculescu1, C. Capatana1, R.
Danciulescu Miulescu1, D. Opris3, C. Poiana1
1
Endocrine/I.Parhon/Davila UMPh, Bucharest, Romania,
2
Endocrine/I.Parhon, Bucharest, Romania, 3Rheumatology/ P629
Sf. Maria Hospital/Davila UMPh, Bucharest, Romania EFFICACYAND SAFETY OF STRONTIUM
RANELATE IN THE TREATMENT OF KNEE
Objective: The fragility (osteoporotic) fractures represent an OSTEOARTHRITIS
economical issue, especially in menopausal women. The S. Lapshina1, L. Myasoutova1
1
different fracture risk evaluation tools for a future Kazan State Medical University, Kazan, Russian Federation
(potential) fragility fracture vary from golden standard
DXA, based on BMD to new tools as 10-year absolute Objective: To evaluate the efficacy and tolerability of stron-
risk of major or hip fracture based on FRAX model tium ranelate in patients with gonarthrosis.
(MF or HF). We analyzed the risk of fracture in patients Material and Methods: 40 patients with a documented
with or without prevalent fractures based on DXA, diagnosis of gonarthrosis: women - 32 (80 %), men - 8
FRAX, and bone metabolism profile. (20 %), mean age - 57.4 years (range 49–72 years).
Material and Methods: The study design is cross- Comorbidities: hypertension - 24 (60 %), ischemic heart
sectional study. The studied population is Romanian disease - in 6 (15 %), chronic gastro - 18 (45 %). All
women in menopause (for at least 1 year of meno- patients had severe pain: VAS 61.2±10.9 mm, WOMAC
pause). The persons with previous medication for oste- - 42.9 ± 12.4. All patients received analgesics and
oporosis as bisphosphonates, SERMs or teriparatide, NSAIDs. Patients were divided into two groups matched
denosumab, etc. were not included. Neither was the for the main parameters: age, sex, pain intensity, dura-
subjects preciously known with the diagnosis of osteo- tion of the disease, received therapy. The first group of
porosis. The skeleton assessment consisted in: lumbar patients (n = 20) was appointed as strontium ranelate at
DXA (L1-4), with a GE Lunar Prodigy device; MF or a dose 2 g/day in daily intake, the second group of 20
HF was calculated based on FRAX for Romania (with- people received supplementation of chondroitin sul-
out BMD); serum 25-hydroxyvitamin D (25-OH D); the phate 2 g/day. Efficacy was assessed in terms of the
bone formation marker serum osteocalcin (OC), and the joint syndrome, WOMAC index after 3 months of
bone resorption markers serum alkaline phosphatase therapy.
(AP), as well as serum crosslaps (CL). The prevalent Results: After 3 months of treatment with strontium ranelate
fractures were already known from patients’ medical patients showed a significant (p<0.05) reduction in pain dur-
history. The statistical significance (SS) was at p<0.05. ing movement (VAS 23.2±7.2 mm), WOMAC (24.3±9.0).
Results: 498 women were enrolled. The studied group Dynamics of pain was significantly lower in the group
included women with fractures (n = 69); the control of patients receiving chondroitin sulphate. The effect of
group (fracture free) included 429 women. The patients’ treatment was evaluated as good (pain reduction of
age and time period in menopause was SS higher in 50 % or more) in 12 (60 %) of patients receiving
group 1 (59.4 vs. 57 years; and 13 vs. 10 years). The strontium ranelate and in 10 (50 %) - the control group,
lumbar BMD was SS lower in group 1 (0.96 vs. 1.02 g/ satisfactory (pain reduction of 20–50 %) in 7 (35 %)
cm2, p=0.02); one third of the women with fractures and 8 (40 %), no effect in 1 (5 %) and 2 (10 %)
had osteoporosis and half of them osteopenia. The bone patients. After 1 month of treatment 10 patients
markers were not SS different between the groups. (50 %) of each group did not use NSAIDs and 2
Neither was the 25-OH D, the median value for both (10 %) of first and 3 (15 %) patients of the second
groups were in D deficiency area: 14 ng/mL, respective 15 ng/ group - continued to take NSAIDs in the same dosage.
mL. The HF was SS higher in group 1 (3 % vs. 0.9 %, Serious adverse effects, worsening of comorbidities
p<0.0005), and also the MF (9 % vs. 4 %, p<0.0005). As were not registered.
limits of the study we mention that fact that we did not take Conclusion: By observing the results of strontium
into account the number of previous fractures, neither the time ranelate has a pronounced analgesic effect which may
since the fracture. be caused by the action of the subchondral bone.
Conclusion: Based on our observations, both DXA and Strontium ranelate is safe in the treatment of knee
10-year absolute risk of fracture based on FRAX osteoarthritis.
 Osteoporos Int

P630 Conclusion: Our results indicate that teriparatide may have

EFFECT OF TERIPARATIDE ON BONE MINERAL differing effects on peripheral sites such as the tibia, and
MASS, VOLUMETRIC BONE MINERAL DENSITY provide evidence of endosteal apposition mainly in elder
AND BONE GEOMETRY IN POSTMENOPAUSAL patients that could explain the mechanism of bone formation
WOMEN WITH ESTABLISHED OSTEOPOROSIS: A induced by the drug in long bones.
TIBIA PERIPHERAL QUANTITATIVE COMPUTED
TOMOGRAPHY (PQCT) STUDY
K. Stathopoulos 1 , E. Damianou 1 , I. Bournazos 1 , A. P631
Partsinevelos1, E. Atsali1, I. Dionysiotis1, A. B. Zoubos1, P. MCPIP1 IS A REGULATOR OF INTERLEUKIN-6
Papaggelopoulos1, G. Skarantavos1 EXPRESSION IN HUMAN OSTEOARTHRITIS
1
Bone Metabolic Unit, 1st Department of Orthopedics, Uni- CHONDROCYTES
versity of Athens, School of Medicine, Attikon University T. Haqqi1, A. Haseeb1, M. S. Makki1
1
General Hospital, Athens, Greece Anatomy & Neurobiology, Northeast Ohio Medical Univer-
sity, Rootstown, United States
Objective: We assessed the effect of inj. teriparatide
20 mg s.c. daily for 18 months on bone mineral mass Objective: MCPIP1 or ZC3H12A is a novel protein with
(BMC), volumetric BMD and bone geometry in postmeno- CCCH-type zinc-finger domain and a PIN-like RNase domain.
pausal women with established osteoporosis using pQCT of Osteoarthritis (OA) is a leading cause of disability worldwide and
the tibia. has complex pathophysiology. IL-6 has recently gained attention
Material and Methods: We reviewed medical records of 76 in OA pathophysiology because of its high levels in synovial fluid
postmenopausal women with established osteoporosis. and ability to induce MMP-13. In the present study we deter-
Inclusion criteria: 1) Age >50 year, 2) Established mined whether MCPIP1 regulates IL-6 expression in OA.
osteoporosis as defined by DXA T-score<−2.5 SD Material and Methods: Human chondrocytes were prepared
(spine/hip) plus at least one vertebral morphometric from OA cartilage by the enzymatic digestion. RNA fluores-
low energy fracture, 3) pQCT of the tibia at baseline cent in situ hybridization (ISH) for IL-6 and MCPIP1 expres-
and 18 months after therapy with teriparatide sion was performed using RNAScope. Wildtype or mutant
20 μg s.c. Exclusion criteria: 1) Bone metabolic dis- MCPIP1 was overexpressed in chondrocytes. Knockdown of
orders or conditions affecting bone other than post- IL-6 and MCPIP1 was by using siRNAs. For RNA immuno-
menopausal osteoporosis, 2) Malignancies, 3) High- precipitation, chondrocytes were stimulated with IL-1ß
energy fractures. All patients underwent pQCT of the (1 ng/ml) for 12 h and then treated with 1 % formaldehyde
tibia (XCT 2000 scanner, Stratec Medicintechnic, Ger- to cross link protein-RNA complexes. Cell lysates were incu-
many). We assessed parameters of trabecular bone bated overnight with isotype control IgG or with anti-MCPIP1
(BMC, BMD and area) at the 4 % slice, and param- antibody. Gene expression of IL-6, MCPIP1 & IL-6 targeting
eters of subcortical and cortical bone at the 14 % and miRNAs was assessed using TaqMan assays.
38 % slice (BMC, BMD, cortical area, cortical thick- Results: IL-1ß induced high levels of IL-6 mRNA in
ness, periosteal and endosteal circumference). We per- chondrocytes which peaked at 8 h poststimulation while ex-
formed statistical analysis and data is expressed as pression of MCPIP1 mRNA peaked at 6 h poststimula-
mean±SD. tion. Using multiplex RNA FISH, expression of both
Results: 26/76 patients fulfilled all inclusion and exclusion IL-6 and MCPIP1 mRNAs were localized in the nuclei
criteria. 11 women were <70 year (55–69) and 15 and in the cytoplasm with distinct speckle patterns. Overex-
>70 year (70–85). 5/26 women had been previously pression of wild type MCPIP1 but not of mutant MCPIP1
treated with bisphosphonates (mean 2.5 year, range 1– reduced the expression of IL-6 mRNA while siRNA mediated
4 year). We found no statistically significant differences knockdown of MCPIP1 elevated the IL-6 mRNA expression.
after 18 m of teriparatide concerning parameters of Analysis of the immunoprecipitated mRNAs showed that
trabecular bone, with a tendency for improvement of anti- MCPIP1 antibody pulled down larger amount of IL-6
BMC and BMD. Volumetric Cortical BMD was signif- mRNA than control IgG. In majority of cartilage samples
icantly lower after treatment (1095.40±50.70 vs. 1077.1 analyzed MCPIP1 expression was downregulated in damaged
±49.4, p=0.005). Endosteal circumference was found to cartilage but the expression of IL-6 was high.
be reduced in all patients after treatment and the effect Conclusion: Expression of MCPIP1 in human cartilage and
was more pronounced in women >70 year (46.19±4.87 chondrocytes is shown. Taken together, our data suggests that
vs. 45.49±4.59, p=0.09). No other statistically signifi- MCPIP1 may be an important player in OA pathogenesis.
cant differences in subcortical and cortical bone were Acknowledgements: NIH (AT003267; AT005520;
observed. AT007373) and Neomed.
Osteoporos Int

P632 Objective: Patients with rheumatic disease (RD) have long

A NEW METHOD TO ESTIMATE THE GENERAL been recognized to suffer a greater burden of serious infection.
OSTEOPOROTIC FRACTURE RISK FROM AN Risk of serious and non-serious bacterial infections increases
ULTRASOUND SPINAL SCAN during treatment with systemic medications. In most cases,
S. Casciaro1, F. Conversano1, P. Pisani1, A. Greco1, R. antibiotic treatment is ineffective in these patients. The most
Franchini1, E. Casciaro1, E. Quarta2, L. Quarta2, M. Muratore2 important rheumatologic emergencies comprise septic arthri-
1
National Research Council, Institute of Clinical Physiology, tis, gout, etc. The goal of our study was to increase the
Lecce, Italy, 2O.U. of Rheumatology, Galateo Hospital, San effectiveness of treatment of opportunistic infections in pa-
Cesario di Lecce, ASL-LE, Lecce, Italy tients with RD using bacteriophages.
Material and Methods: The study involved 15 patients, 8
Objective: To evaluate the performance of a new ultrasound men and 7 women with diagnosis of rheumatoid arthritis (5
(US)-based method for the prediction of generic osteoporotic persons) and gout (10 people), aged 32–57 years. All patients
fractures. had an exacerbation in the form of synovitis of the knee or hip.
Material and Methods: 58 female patients (50–70 years; Verification of diagnosis, joint aspiration and treatment was
BMI ≤30 kg/m2) were enrolled, 28 with a recent nonvertebral performed under ultrasound guidance. To determine the bacte-
fragility fracture and 30 controls without fracture history. All the rial pathogen using real-time PCR. By using PCR patients’
patients underwent two examinations: a conventional spinal blood were identified Staphylococcus aureus, Streptococcus
DXA (Hologic Discovery) and an abdominal US scan of lumbar spp., Borrelia burgdorferi, etc. In all patients with gout PCR
vertebrae. US data were analyzed by an innovative algorithm that of blood and synovial fluid were identified Mycoplasma
processed both echographic images and “raw” radiofrequency hominis. The problem was solved using the method of treat-
signals providing as final output a new parameter named Fragil- ment of synovitis, comprising a puncture of synovial cavity,
ity Score (FS), whose value is proportional to the skeletal fragility aspiration of its contents and the introduction into the cavity of
and, consequently, to the fracture risk. Fracture discrimination polyvalent bacteriophage in volume, slightly smaller than the
power of FS was compared with DXA-measured BMD by extracted effusion.
calculating areas under the receiver operating curve (AUC) and Results: The process was completely arrested after 2 injections
using unpaired two-sided Student t-test. of bacteriophage into the joint cavity in cases of 7 patients (47 %)
Results: Both FS and BMD discriminated significantly between with synovitis, for the rest of patients - after 3 or 4 intraarticular
fractured and nonfractured women: FS values found in the frac- procedures. In heavy cases, treatment was performed by integra-
tured patients (56.8±15.2) were significantly higher than the cor- tion using a antibiotics corresponding diagnosed pathology.
responding values found in the control group (46.6±9.3, p<0.01) Polyvalent bacteriophage has a strong analgesic and anti-
and BMD values of the fractured group (0.846±0.143 g/cm2) inflammatory effect. Pain in the joint passes after 3–24 h after
were significantly lower than the corresponding values found in injection.
non-fractured women (0.971±0.139 g/cm2, p<0.01). The com- Conclusion: Intraarticular injection of bacteriophage in pa-
parison between the AUC values indicated that BMD (AUC= tients with RA and gout gives stable positive effect. In all
0.73) performed only slightly better than FS (AUC=0.71). cases, treatment with bacteriophages not led to the exacerba-
Conclusion: The proposed US approach showed a good tion primary disease.
performance in the discrimination between fractured and
nonfractured patients and, therefore, has the potential to be-
come an innovative tool for the estimation of osteoporotic P634
fracture risk through early identification of frail patients. BODY MASS INDEX AND HEEL QUANTITATIVE
Acknowledgements: This work was partially funded by ULTRASOUND/DUAL X-RAYABSORPTIOMETRY:
FESR P.O. Apulia Region 2007–2013 - Action 1.2.4, grant THE RELATIONSHIP IN MENOPAUSALWOMEN
n. 3Q5AX31. M. Carsote1, V. Radoi2, R. A. Trifanescu1, D. Peretianu3, I.
Baciu1, D. Opris4, C. Poiana1
1
Endocrine/I.Parhon/Davila UMPh, Bucharest, Romania,
2
P633 Davila UMPh, Bucharest, Romania, 3Endocrine/SCM
EFFECTIVE TREATMENT OF OPPORTUNISTIC Povernei, Bucharest, Romania, 4RheumatologyI/Sf. Maria
INFECTIONS IN PATIENTS WITH RHEUMATOID Hospital/Davila UMPh, Bucharest, Romania
ARTHRITIS AND GOUT USING BACTERIOPHAGES
A. G. Shusharin1, M. P. Polovinka1 Objective: Menopausal status is associated with increased
1
Institute of Chemical Biology and Fundamental Medicine, risk of bone loss. One of the most interesting factors associ-
Siberian Branch of the Russian Academy of Sciences ated with the fracture risk (up to some point) is BMI. The
(ICBFM SB RAS), Novosibirsk, Russian Federation fracture risk is evaluated by traditional methods as heel
 Osteoporos Int

quantitative ultrasound (QUS) which is still useful especially Objective: Several studies suggest a critical role of oxidative
in countries with low socio-economic profile or by DXA. Our stress (OxS) in the development of postmenopausal osteopo-
aim is to analyze the correlation between BMI and QUS, on rosis (PO). Indeed, our previous published data showed a
one hand, and DXA, on the other hand. correlation between OxS and bone loss. The aim of the present
Material and Methods: The design of the study is transver- research was to evaluate whether the enrichment in antioxi-
sal. The population is represented by unselected subjects dant content of the habitual diet could positively influence
admitted at Parhon National Institute of Endocrinology, from bone metabolism in untreated osteopenic or osteoporotic post-
Bucharest, Romania, between 2008–2013, for different diag- menopausal women with low risk fracture.
nosis but not for previously osteoporosis. Women older than Material and Methods: Twenty-five women (mean age 58,
40 years and having at least 12 months of menopause were mean BMI 24 kg/m2) were enrolled for this study, and, the
included if they have never been treated with drugs targeting habitual diet was modified in order to achieve a priori
osteoporosis or osteoporotic fracture risk. BMI was calculated established threshold of antioxidants (vitamin A, E and C,
(kg/m2). Left QUS (GE Achilles Insight) was performed: two etc.). The adherence to the prescribed new dietetic regimen
measurements, used as mean for stiffness index (STI). DXA was checked by regular and standardized interviews. The
was assessed (Lunar Prodigy). Statistical analyses used BMD. diagnosis of osteopenia or osteoporosis were made by DXA
The database was created in Excel and the statistical data were and the risk fracture was evaluated with FRAX. To verify the
obtained using SPSS 21 (statistical significance at p<0.05). effects of the prescribed diet on oxidative stress and bone,
Results: The mean age was 57.1 years. The mean BMI in serum markers of OxS (hydroperoxides and total antioxidant
subjects with normal DXA/osteopenia/osteoporosis was: power) as well as BAP and CTX-1 were measured at baseline
30.5/28.5/19.4 kg/m2. The mean STI was 78±17. The linear and after 8 weeks.
regression coefficient between STI and BMI was r=0.24 Results: 54 % of the sample subjects showed a significant
(p<0.0005). The curbilinear correlation using the third grade improvement in systemic oxidative balance (increase in serum
equation (y=39.14+1.39x+0.017x2 −0.000055x3) had a r antioxidant and/or decrease in hydroperoxides), 26 % exhib-
value of 0.07, (p<0.0005). The mean lumbar BMD was ited no variations while only in 20 % the OxS appeared worse.
1.03 ± 0.19 g/cm2.The linear regression between lumbar The level of BAP was found to be significantly decreased and
BMD and BMI was r=0.12 (p=0.03). The regression using remained stable in 40 % and 32 % of women, respectively,
a cubic third grade equation provided a coefficient of correla- whereas CTX-1 was decreased in 27 % and remained unvar-
tion of r=0.2 (p=0.0005). The femoral neck BMD was 0.89 g/ ied in 30 % of women, respectively.
cm2. The linear regression coefficient between femoral neck Conclusion: Taken together, our preliminary data suggest that
BMD and BMI was r=0.27 (p<0.0005). The simple regres- dietetic intervention used in our study may improve the oxi-
sion coefficient between hip BMD (mean of 0.96 g/cm2) and dative balance status and, in the same time, influence bone
BMI was r=0.32 (p<0.0005). health. Thus, this approach could be proposed as a
Conclusion: BMI and QUS or BMI and DXA have similar nonpharmacological lifestyle intervention in the prevention
statistical significant, modest, positive coefficients of correla- of osteoporotic risk, particularly in “early” postmenopausal
tion. The mean BMI decreases from normal DXA to osteopo- women.
rosis (from obese to normal weight). Among central DXA
sites, the strongest correlation with BMI is for total hip.
P636
VERTEBRAL SIZE AND LOW ENERGY
P635 VERTEBRAL FRACTURES IN POSTMENOPAUSAL
EFFECTS OF A DIET RICH IN ANTIOXIDANTS ON WOMEN
BONE METABOLISM IN POSTMENOPAUSAL D. Donchovska 1 , M. Iliev 1 , A. Debreshlioska 2 , S.
WOMEN Donchovska1
G. Bonaccorsi1, A. Romani2, E. Fila1, M. Biasiolo1, E. 1
PHI Clinical Hospital Shtip, Shtip, Former Yugoslav Repub-
Cremonini2, C. Cervellati2, M. C. Castaldini1, S. Ferrazzini1, lic of Macedonia, 2Goce Delchev University, Medical Faculty,
M. Squerzanti2, B. Ravani3, E. Canducci3, L. Massari4 Shtip, Former Yugoslav Republic of Macedonia
1
Menopause and Osteoporosis Center, University of Ferrara,
Ferrara, Italy, 2Dept. of Biomedical and Specialist Surgical Objective: The clinical importance of osteoporosis as a skel-
Sciences, University of Ferrara, Ferrara, Italy, 3Dept. of Med- etal disease lays in the increased risk of fragility fractures.
ical Sciences, Section of Internal and Cardiopulmonary Med- Although BMD is an important predictor of bone strength,
icine University of Ferrara, Ferrara, Italy, 4Dept. of Morphol- other bone characteristics, such as micro- and
ogy, Surgery and Experimental Medicine, Section of Ortho- macroarchitecture also play a role in determining bone quality
paedic Clinic, University of Ferrara, Ferrara, Italy and its susceptibility to fracture. Some studies on vertebral
Osteoporos Int

fractures show statistically significant difference of vertebral context PTH was performed and its value was 522.9 pg/ml.
size and geometry between fractured and non-fractured 25(OH)Vit D was 14.5 ng/ml and DXA showed lumbar T-
groups, suggesting that vertebral size may be an important score: −0.8 SD, left hip T-score: −1.5 SD and third distal
risk factor for vertebral fracture.1 Aim of this study was to radius T-score: −3.2 SD. Parathyroid scan with 99mTc
assess the difference between vertebral size measured with Sestamibi showed uptake in the inferior projection area of
DXA in patients with and without low energy vertebral right thyroid lobe and the diagnosis of primary hyperparathy-
fractures. roidism was made. Total thyroidectomy and right inferior
Material and Methods: 61 postmenopausal women with low parathyroidectomy were performed but the value of serum
energy vertebral fractures identified on Th4-L4 thoracolumbar calcium and PTH have not decreased after surgery (serum
X-rays and 59 postmenopausal women without vertebral frac- calcium: 13.9 md/dl, PTH: 370 pg/ml) and there was no
ture (confirmed on thoracolumbar X-rays) were included in paraneoplasic syndrome. Parathyroid scan was performed
the study. L1-L4 DXA scans were performed on a Lunar DPX after surgery but there was no uptake of 99mTc Sestamibi.
NT machine for all patients. Data for vertebral dimensions Computer tomography of
was extracted from DXA reports. Results: We recommend surgical exploration of the 6.5/4.2/
Results: Average age was 60.8 years in nonfracture group and 6 mm. Head and medistinum showed right paratracheal nod-
68.6 in fracture group (p<0.05). There was no statistically ule of parathyroid glands and paratracheal area, with the removal
significant difference in BMI between groups. L1-L4 verte- of paratraheal nodule and all the suspicious looking parathy-
brae were 0.14 cm higher in the nonfractured group compared roid glands or if no suspicious parathyroid glands are discov-
to nonfractured vertebrae in the fracture group. Difference was ered the removal of all parathyroid glands and the implanta-
statistically significant for p<0.05. Difference between verte- tion of one of them in the forearm.
bral area or width was not statistically significant. There was Conclusion: It is an interesting case in which hyperthyroidism
significant difference between stature adjusted T-scores for and hyperparathyroidism were associated making the case
vertebral height in nonfracture (T-score -0.47) and fracture more difficult to manage.
(−1.23) group with excluded fractured vertebrae. Vertebral
height might be an independent risk factor for low energy
vertebral fracture. P638
Conclusion: Vertebral height might be an independent risk DEVELOPING A BASELINE PICTURE OF THE
factor for low energy vertebral fracture. BONE HEALTH OF ADULTS WITH AN
References: 1. Link TM Osteoporos Int 2000;11:304 INTELLECTUAL DISABILITY IN IRELAND
E. Burke1, J. B. Walsh2, P. Mccallion3, M. Mccarron4
1
School of Nursing and Midwifery Trinity College Dublin,
P637 Dublin, Ireland, 2Bone Health Unit, St James Hospital, Dub-
ASSOCIATED HYPERPARATHYROIDISM AND lin, Ireland, 3Center for Excellence in Aging Services, Uni-
HYPERTHYROIDISM: CASE REPORT versity of Albany NY, New York, United States, 4Faculty of
R. Petris1, C. Poiana1, M. Carsote1, A. Dragutescu2, R. Health Science, Trinity College Dublin, Dublin, Ireland
Danciulescu3, D. Constantin1, D. Paun1
1
National Institute of Endocrinology, Bucharest, Romania, Objective: To develop a baseline picture of the bone health
2
Medlife, Bucharest, Romania, 3UMF Carol Davila Bucha- status of older adults with an intellectual disability.
rest, Bucharest, Romania Material and Methods: Osteoporosis is a systemic skeletal
disease and a source of mortality and morbidity throughout
Objective: Along with the development of exploratory tech- the world. People with an intellectual disability (ID) have been
niques increased the incidence of primary hyperparathyroid- reported to present with greater risk for poor bone health. This
ism although it was initial known as a rare condition. study examines first wave data from the 753 nationally repre-
Material and Methods: We report the case of a 53 years old sentative participants in the Intellectual Disability Supplement
woman which has presented for endocrinological evaluation to The Irish Longitudinal Study on Ageing (IDS-TILDA).
accusing weight loss, sweating, muscle pain. From her per- There is self-report data on physician diagnosed chronic
sonal antecedents we retain toxic multinodular goiter which health conditions, health care utilisation and screening, dietary
was treated 7 years ago with antithyroid drugs and total intake and frequency, medication use and activity levels.
hysterectomy for uterine leiomyoma without significant Results: Of the sample (N=753) just 8 % (n=60) reported a
heredocollateral antecedents. At this presentation she has diagnosis of osteoporosis. However only 425 answered a
multinodular goiter supressed TSH, high fT4, hypercalcemia question on DXA screening (N=425) with 16.6 % of those
(total calcium:), hypophosphatemia and slightly elevated gly- reporting having completed a DXA scan. High levels of
cemia. Thyroid scintigraphy showed cold nodules. In this modifiable risk factors were also evident with 69 % (n=519)
 Osteoporos Int

reporting they never or rarely participated in moderate exer- the femoral neck) was observed in 19 (27.1 %) patients (13
cise and 38 % (n=284) never or rarely drank milk. The (37.1 %) of 35 women and 6 (17.1 %) of 35 men). 10-year
prevalence of epilepsy at 30 % (n=229) and the high levels probability of hip fracture over 3 % (adjusted for BMD at the
of antiepileptic medication (38.1 %) indicate further increased femoral neck) was observed in 20 (28.6 %) patients (13
risk for poor bone health. (34.3 %) of 35 women and 7 (20 %) of 35 men).
Conclusion: The reported low levels of diagnosed osteopo- Conclusion: FRAX program to evaluate a 10-year prob-
rosis was inconsistent with reported diet, sedentary lifestyle, ability of osteoporotic fractures and determine the
documented epilepsy levels and medication use risks, raising threshold of intervention in individuals at risk. The
concerns that prevalence of this debilitating condition is hid- advantage of this program is the ability to determine
den for people with ID. Communications difficulties experi- the likelihood of fractures in the absence of data on
enced by people with an ID also suggest that reporting of BMD at the femoral neck.
symptoms may be low meaning the prevalence of osteoporo-
sis is far greater. There is a need for further objective investi-
gation of osteoporosis among people with ID.
Acknowledgements: Special thanks to the participants in the P640
study, their family members, staff and service providers who COMPARISON BETWEEN PERIPHERAL BLOOD
gave so willingly of their time to support the study. AND SYNOVIAL FLUID MIRNA EXPRESSION IN
PATIENTS WITH OSTEOARTHRITIS IN REGARD
TO THEIR USE AS BIOMARKERS IN CLINICAL
P639 PRACTICE
10-YEAR PROBABILITY OF OSTEOPOROTIC R. Shumnalieva 1 , D. Kachakova 2 , S. Monov 1 , V.
FRACTURE USING FRAX PROGRAM Shoumnalieva-Ivanova3, R. Kaneva2, Z. l. Kolarov1, R.
A. Vasilyev 1 , L. Myasoutova 2 , D. Abdulganieva 2 , S. Rashkov1
Lapshina2 1
Department of Internal Medicine, Medical University, Clinic
1
City Centre of Osteoporosis, Kazan, Russian Federation, of Rheumatology, Sofia, Bulgaria, 2Molecular Medicine Cen-
2
Kazan State Medical University, Kazan, Russian Federation ter, Medical University, Sofia, Bulgaria, 3Alexandrovska Hos-
pital, Medical University, Sofia, Bulgaria
Objective: To assess the 10-year probability of osteoporotic
fracture using the program FRAX. Objective: Recently several reports have shown that osteoar-
Material and Methods: The study included 90 patients thritis (OA) is related to abnormal microribonucleic acid
(25 men and 65 women) aged 40–90 years who have (miRNA) expression both in synovial membrane and in joint
applied to the largest clinics in Kazan, for various cartilage. miRNAs play a role in regulating the osteoclasto-
reasons during the period from January to June 2013. genesis and the expression of matrix metalloproteinases. The
In each of the five clinics (by districts) were randomly aim of the study is to compare the expression of certain
selected 30 patients (10 men and 20 women). All pa- microRNA in peripheral blood and synovial fluid in patients
tients included in the study were invited to visit Kazan with OA in regard to their clinical presentation and laboratory
OP centre to perform risk assessment and calculation of data.
the 10-year probability of osteoporotic fractures (femoral Material and Methods: Peripheral blood (PB) and syno-
neck and total) through FRAX (www.shef.ac.uk/FRAX), vial fluid (SF) were collected from 30 OA patients and
validated for this purpose. All patients underwent DXA 30 healthy controls (HCs). The PB samples were col-
with determination of BMD at the femoral neck BMD. lected in PAX gene tubes and SF samples were collect-
Continue to seek a 10-year fracture probability-adjusted ed and stored with RNeasy Protect Cell Mini kit (ac-
BMD at the femoral neck. Intervention threshold (be- cording to manufacturer’s protocol). MicroRNAs from
ginning antiosteoporotic therapy) considered the 10-year the samples were isolated and PCR was further per-
probability of fracture more than 20 % of all sites for formed. The results were analyzed in regard to the
fractures and/or >3 % for hip fractures. clinical picture, ultrasound findings, radiographic stage
Results: 10-year probability of fracture in all locations more and laboratory data for each patient.
than 20 % was observed in 15 (21.4 %) patients (11 (31.4 %) Results: Our preliminary data showed differences in the
of 35 women and 4 (11.4 %) of the same number of men). 10- expression of the chosen miRNAs between PB and SF
year probability of hip fracture over 3 % was observed in 13 in OA patients compared to HCs. The miRNA expres-
(18.5 %) patients (10 (28.6 %) of 35 women and 3 (8.6 %) of sion was related to the clinical picture in these patients
35 men). After the X-ray densitometry 10-year probability of as well as to the disease stage and activity according to
fracture in all locations more than 20 % (adjusted for BMD at the radiographic and ultrasound findings. The further
Osteoporos Int

statistical analysis will show if these microRNAs could P642

be used as biomarkers in OA. HEARING IMPAIRMENT SEEMS TO BE
Conclusion: Correlations between microRNAs expression in ASSOCIATED TO A HIGHER DISEASE ACTIVITY IN
PB and SF and patient’s clinical presentation will eventually RHEUMATOID ARTHRITIS PATIENTS. A CASE
show if microRNAs could be reliable biomarkers for disease CONTROL STUDY
activity and severity in OA. Future studies of the functional role R. Ilham1, R. Hanan2, E. A. Ali1, T. Dakka3, L. Essakalli1, N.
of microRNA will reveal potentially new therapeutic targets. Hajjaj Hassouni4
1
ORL and Maxillofacial Surgery Department, Specialties’
Hospital, University Hospital Rabat-Salé, Rabat, Moroc-
P641 co, 2Rheumatology Department, El Ayachi Hospital,
UREA AND RELATED VALUES OF ANALYSIS AND University Hospital Rabat-Salé, Physiology Laboratory,
ITS APPLICATIONS IN GOUTYARTHROPATHY Faculty of Medicine and Pharmacy, University Moham-
M. Nicolov1, M. Cevei2 med Vth Souissi, Rabat, Morocco, 3Physiology Labora-
1
University of Medicine and Pharmacy Victor Babes, Timi- tory, Faculty of Medicine and Pharmacy, University
soara, Romania, 2Psychoneuro Sciences and Rehabilitation Mohammed Vth Souissi, Rabat, Morocco, 4Rheumatol-
Department, Faculty of Medicine & Pharmacy, University ogy Department, El Ayachi Hospital, University Hospi-
of, Oradea, Romania tal Rabat-Salé, Rabat, Morocco

Objective: Acute gouty arthritis is thought to be an inflamma- Objective: The aim of this study was to evaluate the pattern of
tory response to microcrystals of monosodium urate that precip- hearing impairment in rheumatoid arthritis (RA) patients com-
itate in joint tissues from supersaturated body fluids or are shed pared to healthy controls and to examine associations between
from preexisting articular deposits. Gout is a metabolic disease hearing impairment and disease activity of RA assessed by the
characterised by recurrent episodes of arthritis associated with the disease activity index-DAS 28.
presence of monosodium urate crystals in the tissue or synovial Material and Methods: This is a cross-sectional study with 2
fluid during the attack. Gout may be associated with other groups: 22 RA patients (20 women and 2 men, mean age of
inflammatory, endocrine diseases. Urea values and comorbidities 44.2 years, disease duration median of 41 months (21, 141))
were analyzed for the patients having gout arthropathies. and 17 healthy subjects (13 women and 4 men, mean age of
Material and Methods: The present study was done for 102 41 years) appraised for age and sex. No subject of the 2 groups
patients, 81 male and 21 female, hospitalized in Medical has had any abnormalities at otoscopic examination. Hearing
Rehabilitation Clinical Hospital Felix Spa for gout in different impairment was evaluated by pure tone audiometry and
forms, mean age 60.67±7.69 with age limits in between 44 tympanometry including the static compliance, middle ear
and 74. Gouty arthropathy, gouty spondiloarthopathy, uric pressure, stapedial reflex threshold test. RA disease activity
arthropathy were studied. Urea and other related analysis were was assessed using the DAS28 (remission was defined by a
investigated. DAS 28<2.6).
Results: Morbidity count was 513, and the mean number of Results: Conductive hearing loss (CHL) was found in 14
comorbidities were 5.02±1.81. The diagnosis of gout was patients vs. 2 controls (p=0.05). The stapedial reflex was absent
established by an average of 55.85±66.54 months ago. For in 10 RA patients vs. none in healthy controls (p=0.04). Sen-
the patients investigated the average values for uric acid was sorineural hearing loss (SNHL) was found in 4 patients and
7.09±2.30 mg for 100 ml and all the values were higher than none in controls. Mixed hearing loss was found in 4 patients but
usual. But for 17.36 % cases of patients urea was higher than none in controls. Hearing loss in RA was more prevalent in RA
average, respectively 37.91±11.49 mg for 100 ml., 8.8 % patients with an active disease (p=0.04).
from the studied patients had increased value of creatinine Conclusion: This study suggests that hearing loss risk is
and 26.4 % had increased value for cholesterol, higher than higher in RA patients compared to healthy controls and seems
the average 219.905±39.56 mg for 100 ml. 47 % from the to be associated to disease activity. Audiological evaluation
studied patients had higher level of triglyceride which average should be performed periodically to identify possible audio-
levels is 195.61±81.26 mg for 100 ml, 28.58 % were with logical damage. Nevertheless, those results should also be
higher glucose level than normal, 29.41 % cases with higher confirmed by larger studies.
level of glutamate pyruvate transaminase and glutamate oxa-
late transaminase.
Conclusion: Patients with gout have multiple comorbidities P643
that complicate the course of treatment. Urea appears to be ADHERENCE TO BISPHOSPHONATES
increased in cases with gout and there is consistent with TREATMENT OF OSTEOPOROSIS
duration of disease. S. Stoica1, G. Zugravu2
 Osteoporos Int

1
Emergency Hospital Elena Beldiman, Barlad, Romania, 2Re- information on fracture probability beyond that provided by
habilitation Hospital, Iasi, Romania the FRAX variables; (b) to construct a probability model for
incorporating TBS in MOF prediction.
Objective: Osteoporosis is a serious public health concern and Material and Methods: We studied 33,368 women age 40–
bisphosphonates (BPS) are the most common medications used 100 year (mean 63) with baseline spine and hip DXA (Prod-
in its treatment, whose main objective is to reduce the risk of igy, GE Healthcare), FRAX MOF probability estimates (Ca-
fractures. The aim of this study was to explore the experiences nadian tool, version 3.7), blinded lumbar spine TBS measure-
and perceptions of postmenopausal women regarding strategies ment (TBS iNsight® version 1.8, Med-Imaps), and outcomes
to improve adherence to osteoporosis therapy. to March 31, 2008. The association between TBS, FRAX
Material and Methods: A total of 87 postmenopausal wom- variables and risk of fracture or death was examined using
en between 45 and 70 years old with osteoporosis, currently an extension of the Poisson regression model.
taking BSP (30 with alendronate 70 mg/week, 28 with Results: During mean 4.7 year, 1,758 women died and 1,875
risedronate 35 mg/ week and 29 with ibandronate 150 mg/ women sustained one or more MOFs. For each SD reduction
month). All patients were interviewed and examined for the in TBS, there was a 33 % increase in risk of MOF (HR 1.33,
gathering of information on perceptions of their osteoporosis 95%CI 1.28–1.39, p<0.001) and a 31 % increase in death (HR
medications, their reasons for adherence and nonadherence to 1.31, 95%CI 1.26–1.37, p<0.001). When fully adjusted for
therapy, and the effectiveness of strategies they had tried to significant clinical risk factors and femoral neck T-score, TBS
improve adherence at baseline, month 6 and month 12. Dura- was still a statistically significant predictor of MOF (HR 1.19,
tion of therapy was measured by the count of days of therapy 95%CI 1.14–1.25) and death (HR 1.21, 95%CI 1.15–1.27). An
without of interruption of drug purchases greater than 2 weeks. adjustment ratio for 10 year major osteoporotic fracture prob-
Treatment compliance was evaluated with the Morisky ability was derived by comparing fracture probability calculat-
Medication-taking Adherence Scale. ed with TBS versus without TBS. A significant age interaction
Results: One year after initiating treatment for osteoporosis, between age and TBS was identified, and was incorporated into
79.6 % of patients with monthly bisphosphonates and 67.0 % the final adjustment: Adjustment ratio=4.807 − 0.0342 × age −
of patients with weekly bisphosphonates were not continuing 2.801 × TBS + 0.0235 × age × TBS. The adjustment ratio
to fill prescriptions. Six variables were associated with com- increases with lower TBS, but has a greater effect in younger
pliance: treatment administration frequency, perceptions of than older woman. For example, in a woman age 80 year with
long-term treatment acceptability, perceptions of health con- femoral neck T-score -2 and no additional risk factors, the 10-y
sequences of osteoporosis, perceptions of knowledge about major osteoporotic fracture probability is 16.0 %. Low TBS (10th
osteoporosis, exercise and mental quality of life. In multivar- percentile) would increase this to 17.7 %, whereas high TBS
iate analyses, the risk of adherence failure was higher for (90th percentile) would reduce this to 11.3 %.
weekly BPS versus monthly BPS therapy (HR=2.7, p<0.01). Figure Adjustment ratio to 10 year MOF probability (calculated
Conclusion: Compliance to antiosteoporosis treatments is with vs without TBS) for a woman aged 50, 70 or 90 years.
poor. The monthly dosage is associated with greater adherence
compared to weekly dosage.

P644
DERIVATION OF A LUMBAR SPINE TRABECULAR
BONE SCORE (TBS) ADJUSTMENT RATIO FOR
FRAX: THE MANITOBA BMD COHORT
H. Johansson1, W. D. Leslie2, J. A. Kanis1, O. Lamy3, A.
Odén1, E. V. Mccloskey1, D. Hans3
1
WHO Collaborating Centre for Metabolic Bone Diseases,
Sheffield, United Kingdom, 2University of Manitoba, Winni-
peg, Canada, 3Lausanne University Hospital, Center of Bone
Diseases, Lausanne, Switzerland

Objective: TBS, derived from lumbar spine DXA image

texture, is related to microarchitecture and fracture risk inde-
pendently of BMD. FRAX estimates the 10-y probability of
hip and major osteoporotic fracture (MOF). Our aim was: (a)
to determine whether the TBS provides independent
Osteoporos Int

Conclusion: Lumbar spine TBS is a risk factor for MOF and a P646
risk factor for death. TBS is able to predict incident MOF UNTREATED MALE OSTEOPOROSIS: CASE
independent of FRAX clinical risk factors and femoral neck REPORT
BMD even after accounting for the increased death hazard. If P. S. Pantelic1
1
validated in other prospective cohorts, a relatively simple IOHB, Belgrade, Serbia
arithmetic adjustment to FRAX probability, incorporating
lumbar spine TBS and age, may be clinically useful for Objective: To underline problems connected with osteoporo-
enhancing fracture prediction from FRAX. sis in men through case report. There are need to clarify the
Disclosures: Didier Hans: TBS patent: co-owner. Stock op- pathogenesis of osteoporosis and fractures in men and to
tions or royalties: Med- Imaps. develop diagnostic criteria as well as establish most effective
treatment.
Material and Methods: After low intensive trauma 64 years
old man had back pain and pain in left forearm. X-ray show
P645 fractures of Th 12 and L2 vertebrae and left forearm. In his
EFFECTIVENESS OF EDUCATIONAL ACTIVITIES personal history there is also after low intensive trauma elbow
FOR PATIENTS WITH OSTEOPOROSIS and hip fracture in ages of 52 and 53. There are no other risk
L. Myasoutova1, S. Lapshina1 factor in personal and family history. DXA evaluation results:
1
Kazan State Medical University, Kazan, Russian Federation T-score total LS vertebrae −4.7 SD and T-score total −2.4
healthy hip. Laboratory tests: high rate of thyroid hormone
Objective: To evaluate the effectiveness of educational activ- and low rate of 25OH vitamin D. We started with treatment.
ities (schools) for patients with osteoporosis (OP). Results: Osteoporosis is leading causes of morbidity and
Material and Methods: 55 patients with OP from primary mortality in elderly. “ Silent disease” progress without symp-
group were trained in the schools (4 sessions per year), 40 toms until a fractures occurred. Hip fracture is very serious
patients with OP were in control group, which only visited complication. One fifth of it occurred in men but it rise about
rheumatologist 4–5 times a year. The groups were matched by 10 years later than in woman. In 65–70 ages men loosing bone
sex, age, structure (primary and secondary) and the severity of mass at the same rate as woman and the absorption of calcium
OP, the presence of fractures, received therapy. At baseline decrease in both sex. For men before 65 years and high risk
and after 6 months pain intensity on VAS back pain, adher- men recommendation is to begin periodic osteoporotic risk
ence to treatment were determined. At baseline and after assessment and performing DXA. When we have diagnosis it
12 months determination of BMD was measured by DXA. is important to consider and exclude secondary causes of bone
Results: After 6 months of training intensity of back pain was loss. It is almost certain lifestyle, diseases and medications.
significantly (p<0.01) decreased by 2.5 times in the primary More than 40 % are primary or idiopathic osteoporosis in
group and by 1.5 times fold in control, 52 % of patients from men. Careful history, physical examination and laboratory
the primary group, and 37.5 %—in the control wore an tests are enough component for making decision about treat-
orthopedic corset. 95.8 % of patients who visited schools ment. Except medication men should be educated about ade-
and 90 % of patients in the control group were continuously quate lifestyle measures as the prevention.
taking calcium and vitamin D during 6 months, after Conclusion: Osteoporosis in men is an important and often
12 months—93.7 % and 85 %, respectively. Pathogenetic overlooked problem. The consequences of it are
therapy was applied to all patients, initially these drugs began underestimated and the condition is often unrecognised and
to take 97.9 % of the study group and 92.5 % of the control untreated. There is no sufficient scientific based evidence for
group patients, after 6 months of continuous administration of men osteoporosis. It is still an important public health
drugs 89.5 % from group trained patients and 67.5 %—the problem.
control group continued treatment, after 12 months commit-
ment to therapy was 87.5 % and 42.5 % in the test and control
groups, respectively. Densitometry results in dynamics after
12 months showed that the increase in BMD was significantly P647
(p<0.05) higher in the group that has been schooled for the BALNEARY PHYSICAL KINETIC THERAPY
patients and was 5.6±6.2 % at the spine, 4.2±4.5 % at the EFFECTS OVER GONARTHROSIS SYMPTOMS
femoral neck in the main group, 3.1±4.8 % and 1.9±3.2 %, F. Cioara1, S. D. Birsan1, L. Vicas1, C. Nistor-Cseppento1, M.
respectively, in the control group. Rus2, L. Lazar1
1
Conclusion: Educational programs improve functional status Medical Rehabilitation, University of Medicine and Pharma-
and quality of patients life, increase commitment to cy Oradea, Oradea, Romania, 2University of Medicine and
treatment. Pharmacy Oradea, Oradea, Romania
 Osteoporos Int

Objective: The aim of the study is to evaluate the effects of Material and Methods: The Moroccan versions of WOMAC
balneary physical kinetic therapy on clinical and functional and OAKHQOL were administered to Moroccan patients with
parameters in patients with knee osteoarthritis compared with symptomatic knee OA, fulfilling the revised criteria of the
administration of therapies based on electrotherapy and kinet- American College of Rheumatology. Because of the high
ic therapy. percentage of illiteracy in Moroccan population, OA patients
Material and Methods: We conducted the study on two were interviewed individually (using face-to-face technique).
groups of patients similar in terms of disease severity via Results: Fifty women with knee OA women were enrolled in
Kellgren-Lawrence staging, for Lequesne index and quality this study (mean disease duration of 24 months (12.72). The
of life. Also the lots are homogeneous in terms of age (65– mean VAS pain (0–100) was 54.6[10–80]±21.2. The average
75 years), gender, lifestyle, environment of origin and associ- WOMAC score was 34[3–93]±16.9. The mean Lequesne
ated diseases. The first group made electrotherapy and phys- score was 10.1[3–19] ± 4.2. The average scores of the
ical therapy program and the second received additional spe- OAKHQOL domains were as following: social support 44.5,
cific thermal water balneotherapy in Felix Thermal Water social functioning 45.8, physical activities 47, mental health
Resort in Romania. Rehabilitation program was performed 62.2 and pain 62.3. Correlation analysis showed fair to good
in two courses of 3 weeks, with an interval of 3 months. correlation between 3 dimensions of OAKHQOL (physical
Evaluation was performed at the beginning and in the end of activities, mental health, pain) and VAS pain, Lequesne and
monitoring. We assessed pain by VAS divided into 100 steps; WOMAC scores (p<0.05).
we performed pain and functional Lequesne index, quality of Conclusion: This data describe a burden of knee OA on QoL
life and perception of patients and physicians over the disease in patients suffering from nonendstage knee OA. A fair to a
status. strong correlation was found between 3 dimensions of
Results: The outcomes assessed before and at the end of the OAKHQOL (physical activities, mental health, pain) and
monitoring showed improvement of scores that reach the limit VAS pain, Lequesne and WOMAC scores. These results
of statistical significance (p≤0.05) in the group that carried out should be confirmed by larger studies.
the recovery program including balneotherapy.
Conclusion: The study demonstrated the superiority of reha-
bilitation means in knee osteoarthritis that includes balneary P649
physical kinetic therapy in thermal water. The benefits of MANAGEMENT OF MYOFASCIAL SYNDROME IN
exercise that is practiced regularly are associated with weight OSTEOPOROSIS
loss. There is an openness and greater efficiency for the S. D. Birsan1, F. Cioara1
1
elderly, proving the undeniable value of complex functional Medical Rehabilitation, University of Medicine and Pharma-
recovery as being possible to maintain, strengthen and defeat cy Oradea, Oradea, Romania
the lack of functionality.
Objective: Myofascial pain syndrome is a painful muscle
condition characterized by chronic pain or radiation located
at the level of point-to-trigger, comprising a muscle or group
P648 of muscles. Myofascial pain occurs very frequently and al-
IMPACT OF KNEE OSTEOARTHRITIS ON QUALITY most as eCare man develops trigger points at some stage of
OF LIFE life. Myofascial syndrome is the most common cause of pain
R. Hanan1, L. Touria2, B. Imane2, A. Souad2, H. H. Najia2 in the upper portions of the column vertebral, due to insuffi-
1
Rheumatology Department, Mohamed Vth University cient understanding of the pathophysiology of muscle pain but
Souissi, El Ayachi Hospital, Salé, Ibn Sina University Hospi- often remain undiagnosed in the osteoporosis.
tal, Laboratory of Physiology, Faculty of Medicine and Phar- Material and Methods: Myofascial syndrome is explained
macy, Mohamed Vth University Souissi, Rabat, Morocco, by exceeding the limits of normal physiological responsive-
2
Rheumatology Department, Mohamed Vth University ness to stress factors. Trigger points are discrete points focal
Souissi, El Ayachi Hospital, Salé, Ibn Sina University Hospi- hyperirritable with typical location strained muscle fiber.
tal, Rabat, Morocco Results: The pain caused by trigger points, causing decreased
muscle length at rest and reduced joint mobility. Vasoconstric-
Objective: The purpose of this study was to investigate the tion generate muscle spasm, localized ischemia, occurring
influence of knee osteoarthritis (OA) on the quality of life metabolites nerve irritation properties.
(QoL) in patients with nonendstage knee OA using the Mo- Conclusion: Informing patients and awareness of the corre-
roccan version of the OA knee and hip QoL questionnaire lation between stress and muscle tension, between muscle
(OAKHQOL). We suggest also to examine factors associated tension and pain can improve their condition and complex
to different domains of QOL assessed by OAKHQOL. approach to the problem by rheumatologists, general
Osteoporos Int

practitioners, medical and psychological rehabilitation would calcitriol (both p<0.001), respectively. At Mo 12, 25(OH)D
lead to optimize the treatment of patients with myofascial was <15 ng/mL in 1.0 % (ALN/D5600) vs. 25.5 % (calcitriol)
syndrome is a condition miofascial. Myofacial syndrome is (p<0.001). Between-group differences in P1NP and s-CTx
not fatal but can reduce significantly the quality of life and mean% changes from baseline at Mo 6 were −42.37 % and
also are a major cause of limiting the ability employment of −52.03 %, respectively (greater with ALND/5600, p<0.001).
people affected, causing great economic damage to society. Overall safety profile was similar between groups. Incidence
of hypercalciuria (24-h urine Ca >300 mg) was 8.4 % (ALN/
D5600) vs. 13.9 % (calcitriol) (p=NS) over 12 month. One
P650 patient (calcitriol) had hypercalcemia.
ALENDRONATE SODIUM/VITAMIN D3 Conclusion: ALN/D5600 produced greater increases in BMD
COMBINATION TABLET VS. CALCITRIOL FOR at the lumbar spine, greater decreases in bone turnover
OSTEOPOROSIS IN CHINESE POSTMENOPAUSAL markers, and less vitamin D insufficiency vs. calcitriol in
WOMEN: A RANDOMIZED, OPEN-LABEL STUDY osteoporotic Chinese women. Safety was similar and consis-
Z. L. Zhang1, E. Y. Liao2, W. B. Xia3, H. Lin4, Q. Cheng5, L. tent with established profiles.
Wang6, Y. Q. Hao7, D. C. Chen8, H. Tang9, Y. D. Peng10, L. Disclosures: Funding: Merck & Co., Inc., Whitehouse Sta-
You10, L. He11, Z. H. Hu12, C. L. Song13, F. Wei14, J. Wang14, tion, NJ, USA. Employee: MSD China (FW, JW, LZ), Merck
L. Zhang14, A. C. Santora15 Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.,
1
Shanghai Sixth People’s Hospital, Shanghai Jiaotong Uni- Whitehouse Station, NJ USA (ACS). Stock: FW, LZ, ACS
versity School of Medicine, Shanghai, China, 2The Second (Merck). Research support: ZLZ, EYL, WBX, HL, DCC
Xiangya Hospital of Central South University, Changsha, (Merck). Consultant: ZLZ, EYL, WBX, HL, DCC, HT
China, 3Peking Union Medical College Hospital, Beijing, (Merck).
China, 4Nanjing Drum Tower Hospital, Nanjing, China,
5
Huadong Hospital Affiliated to Fudan University, Shanghai,
China, 6TianJin Hospital, Tianjin, China, 7Shanghai Ninth P651
People’s Hospital, Shanghai, China, 8West China School of PHYSICAL PERFORMANCE DOES NOT DIFFER
Medicine, West China Hospital, Sichuan University, Cheng- BETWEEN RIGHT AND LEFT FOOTED YOUNG
du, China, 9Beijing Friendship Hospital, Capital Medical Uni- SOCCER PLAYERS: FIELD AND ISOKINETIC TESTS
versity, Beijing, China, 10Shanghai First People’s Hospital, ANALYSIS
Shanghai, China, 11Beijing Jishuitan Hospital, Beijing, China, R. Hanan1, A. Abdellatif2, A. Souad2, E. Leila2, B. Imane3, E.
12
Peking University People’s Hospital, Beijing, China, 13Pe- A. El Mustapha4, H. H. Najia3, D. Taoufiq2
king University Third Hospital, Beijing, China, 14Global 1
Laboratory of Physiology, Faculty of Medicine and Pharma-
Medical Affairs, Merck Sharp & Dohme China, Shanghai, cy, Mohammed Vth University Souissi, Rheumatology De-
China, 15Merck Research Laboratories, Rahway, NJ, United partment, El Ayachi hospital, Ibn Sina University Hospital,
States Mohammed Vth University Souissi, Rabat, Morocco, 2Labo-
ratory of Physiology, Faculty of Medicine and Pharmacy,
Objective: To investigate efficacy and safety of alendronate Mohammed Vth University Souissi, Rabat, Morocco, 3Rheu-
70 mg/vitamin D3 5,600 IU combination tablets (ALN/ matology Department, El Ayachi hospital, Ibn Sina University
D5600) vs. calcitriol in osteoporotic Chinese postmenopausal Hospital, Mohammed Vth University Souissi, Rabat, Moroc-
women. co, 4Rehabilitation Department, Military Hospital Moham-
Material and Methods: A 6-month, randomized, open label, med V, Mohammed Vth University Souissi, Rabat, Morocco
active-comparator study with 6-month extension
(clinicaltrials.gov NCT01350934). Postmenopausal women Objective: To compare physical performance using field tests
aged >55 years with osteoporosis (low BMD with/without and isokinetic muscle strength between right and elite young
prior nonpathological fracture) from 13 centers in China. soccer players.
Patients were randomized to ALN/D5600 once weekly or Material and Methods: Forty-nine young, healthy, male
calcitriol 0.25 μg daily. Primary efficacy endpoint:% change soccer players (mean±SD age:±, range: to) who were schol-
from baseline in lumbar spine BMD at Mo 6. Hypercalcemia arship holders of the Moroccan academy Mohammed VI of
and hypercalciuria were safety events of special interest. soccer served as subjects in this study. Players were divided
Results: 219 patients (ALN/D5600 n=111; calcitriol n=108) into 2 groups: right dominant limb (group 1) and left dominant
were randomized. Baseline characteristics were similar, limb (group 2). All participants received the same entrainment
30.3 %: baseline 25(OH)D ≤15 ng/mL. At Mo 6 and 12, schedule.
changes in lumbar spine BMD from baseline were 3.54 % Soccer players underwent a clinical examination (weight,
vs. 1.59 % and 5.17 % vs. 2.26 % for ALN/D5600 vs. height and BMI), field tests (30 M sprint, TUB II and vertical
 Osteoporos Int

jump) and evaluation of knee flexor and extensor muscle withdrawal were fulfilled only by 28 postmenopausal women
strength of their dominant limb on an isokinetic dynamometer. treated in accordance with good clinical practice.
To ensure consistent and accurate measurements, each param- Results: Bone resorption marker B-crosslaps (CTX) was 598
eter was evaluated by the same examiner utilizing the same ±230 ng/l before treatment initiation, at the moment of
methods. ibandronate withdrawal 220±105 ng/l and 1 year after the
Results: Field tests results show no differences between withdrawal 363±112 ng/l. One year after ibandronate with-
players of the 2 groups. Muscular strength did not differ drawal CTX increased in 65 % in comparison with the level at
between right and left footed as well at low as at speed the end of long term ibandronate therapy (p<0.000001) and
velocities. they remain at 61 % of initial levels (before the treatment was
Conclusion: This study highlights that physical performance introduced).
tests, including field tests and isokinetism, did not differ Conclusion: Bone resorption does not remain deeply sup-
between right and left footed young soccer players. During pressed 1 year after ibandronate withdrawal which should be
the 90-min of soccer game, numerous explosive bursts of considered in the post-withdrawal management of the patients
activity are required, including jumping, kicking, tackling, and in assessment of the safe length of drug holiday.
turning, sprinting, changing pace, and sustaining forceful
contractions to maintain balance and control of the ball against
defensive pressure. Briefly, soccer performance improves P653
need not only physical but also technical and tactical devel- DIAGNOSIS OF LOW VITAMIN D AMONG SAUDI
opment. Further studies on large samples should be conduct- ARABIANS: DID WE OVERSHOOT THE RUNWAY?
ed. It’s extremely important that those studies integrate a M. Sadat-Ali1, A. M. Al-Elq2, H. A. Al-Turki3, A. K. Al-Ali4
1
complete analysis of soccer performance including physical, University Department of Orthopaedic Surgery, College of
technical/biomechanical, tactical and mental proprieties. Medicine, University of Dammam. King Fahd Hospital of the
Then, we can get out the independent factors eventually University, AlKhobar, Saudi Arabia, 2University Department
associated with better performance in soccer players accord- of Internal Medicine, College of Medicine, University of
ing their side lateral dominance. Dammam. King Fahd Hospital of the University, AlKhobar,
Dammam, Saudi Arabia, 3University Department of Obstet-
rics and Gynecology, College of Medicine, University of
P652 Dammam. King Fahd Hospital of the University, AlKhobar,
ASSESSMENT OF BONE RESORPTION AFTER AlKhobar, Saudi Arabia, 4University Department of Bio-
WITHDRAWAL OF LONG TERM IBANDRONATE chemistry, College of Medicine, University of Dammam,
THERAPY Alkhobar, Saudi Arabia
P. Kasalický1, L. Brunerova1, S. Skacelova1
1
Bone Metabolism Unit, Mediscan Group, Prague, Czech Objective: Reports indicate that deficiency of vitamin D in
Republic the Saudi Arabian population is reaching an epidemic. Our
objective was to compare the accuracy of three commonly
Objective: There is a controversial question in the length of used 25-OHD assays among sample of Saudi population.
bisphosphonate treatment. The concept of drug holiday has Material and Methods: This cross-sectional study was car-
been introduced from medical (prevention of “frozen bone”) ried out during the period between January 2011 and Decem-
and economic reasons as well. International guidelines discuss ber 2012. After an informed consent, blood samples for mea-
the length of the treatment and recommendations after with- surement of 25-OHD level was extracted from 200 adult
drawal for alendronate and risedronate, respectively. Howev- patients attended the outpatients clinics of King Fahd Hospital
er, a few data is available for assessment of bone resorption of the University, AlKhobar. Patients receiving vitamin D
after long term ibandronate treatment and for the management supplements and those with advanced organ failure were
(laboratory and densitometry follow up) after its withdrawal excluded. Vitamin D level of each patients was determined
and for safe duration of drug holiday, respectively. The aim of using chemiluminescence immunoassay (CLIA), Radioim-
our study was to assess the degree of suppressed bone remod- munoassay (RIA) and liquid chromatography-tandem mass
eling after withdrawal of long term therapy with ibandronate. spectrometry (LC-MS/MS) methods. Between assay agree-
Material and Methods: Ibandronate administration (150 mg ment was examined using regression analysis and Bland-
p.o. once monthly) was introduced in our bone metabolism Altman plots. Assays were also compared using commonly
unit in autumn 2006. Since that time 2,402 patients have been used cut points for classification of vitamin D deficiency.
treated with ibandronate. However, the criteria of at least Results: The average age of all patients was 45.7±16.1 years.
5 year treatment and bone remodeling markers available be- There were 50 males (48.1±17.1 years) and 150 females (44.8
fore treatment initiation and 1 year after ibandronate ±15.7 years) patients. Significant difference between the three
Osteoporos Int

assays was found. The mean 25-OHD levels were highest for Conclusion: Functional recovery by physical methods has its
the LC-MS/MS (21.65 ng/mL, 95%CI 19.74–23.56), inter- well defined role in completing the treatment phase after
mediate for RIA (16.607 ng/mL, 95%CI 14.8718.32) and exceeding orthopedic surgery.
lowest for CLIA method (13.864 ng/mL, 95%CI 12.109–
15.618). Using a 30 ng/mL as cut-off value, 6 %, 9 % and
22 % were found to have normal levels of 25-OHD using P655
CLIA, RIA and LC-MS/MS, respectively. STUDY OVER PHONOPHORESIS WITH CAPSAICIN
Conclusion: This study revealed that levels of 25-OHD and IN KNEE OSTEOARTHRITIS
the prevalence of vitamin D deficiency are dependent on the S. D. Birsan1, F. Cioara1
1
assay used. The reported high prevalence of hypovitaminosis Medical Rehabilitation, University of Medicine and Pharma-
D among Saudi population possibly related to the use of an cy Oradea, Oradea, Romania
assay which underestimates the vitamin D level, due to false
positive results of deficiency. Objective: There are numerous methods of administering
Acknowledgements: The study was completed by the grant drugs to the body, both passive and active. A recent review
by the Deanship of Scientific Research, University of of the literature on phonophoresis reports that 75 % of the
Dammam, Dammam, Saudi Arabia. studies reviewed reported positive effects, ultrasound energy
with drugs like gel or cream can travel through body tissue.
Capsaicin was the active ingredient in hot chilli peppers has
P654 selection actions on unmyelinated C fibres and thinly myelin-
THE BENEFITS OF REHABILITATION PROGRAM ated A primary sensory neurons. We underwent an observa-
IN POST-TRAUMATIC PATHOLOGY OF THE HIP tional prospective study to propose measurement of
F. Cioara1, N. R. Suciu2, A. Pallag3, S. D. Birsan1, C. Nistor- phonoporesis with capsaicin on pain of the knee, in compar-
Cseppento1, N. Pascalau4 ison with phonoporesis with ketoprofen applications.
1
Medical Rehabilitation, University of Medicine and Pharma- Material and Methods: The study included 60 patients aged
cy Oradea, Oradea, Romania, 2Medical Rehabilitation Hospi- 45 years and over with clinical and radiological osteoarthritis
tal, Oradea, Romania, 3University of Oradea, Faculty of Med- of knee according to ACR criteria. All the patients were
icine and Pharmacy, Romania, Oradea, Romania, 4Medical included in the standard therapy program (drugs and rehabil-
Rehabilitation / University of Medicine and Pharmacy, Ora- itation) over a period of 10 days. Group A - 30 patients was
dea, Romania taken phonoporesis with capsaicin and Group B - 30 patients
was taken phonoporesis with ketoprofen, both intensity was
Objective: Lately, the hip is developing a new category of 0.6 W/cm2 on the knee, 6 min every day. The assessed
“traumatic injury” and that is balance operated. Rapid increase parameters at hospitalization and discharge were pain, joint
in the number of orthopedic interventions did that after frac- mobility, muscle strength and WOMAC scale.
ture surgery have the highest incidence. The present study was Results: In group A patients presented a significant improve-
to evidence the benefits of the rehabilitation program in pa- ment of pain according VAS scale, on the other group B who
tients with post-traumatic pathology of the hip. present an insignificant improvement of pain for the short
Material and Methods: We introduced a study of 55 patients time.
with traumatic hip pathologies, resulting from sprains, frac- Conclusion: We can consider phonoporesis with capsaicin a
tures or acquired postoperative recovery that followed treat- significant method of therapy in knee osteoarthritis with an
ment in Felix Medical Rehabilitation Hospital. Evaluation of important benefit towards long term pain relief for the patient.
patients was done on day 0 and after 3 weeks. The objectives
of rehabilitation therapy were: pain control, maintaining and
strengthening the hip stability, maintain and increase joint P656
mobility. QUANTITATIVE ULTRASONOMETRY OF THE
Results: Pain relief, assessed subjectively by the patient, PHALANGES IN POSTMENOPAUSALWOMEN
increase joint stability, assessed objectively by muscle testing, WITH TYPE 2 DIABETES MELLITUS: THE FIRST
increase joint mobility, assessed objectively by joint testing. RESULTS OF A THREE-YEAR LONGITUDINAL
Pain score decreased from 7.46 to 5.22 (percentage of im- STUDY
provement being 30.02 %). Average cumulative physical dys- C. Neglia1, N. Agnello2, G. Chitano2, A. Argentiero2, M. E.
function shows an improvement of 14.99 %. Average im- Gianicolo2, R. Ciccarese2, A. Vigilanza2, V. Denetto2, G.
provement was 24.22 % disability. The overall score is statis- Quarta2, L. Nibio2, A. Caretto3, A. Distante2, P. Piscitelli1
1
tically significantly improves the rate of improvement being University of Salento - DiSTeBA (Biological and Environ-
24.12. mental Sciences and Technologies Department, Lecce, Italy,
 Osteoporos Int

2
ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), common form of inflammatory arthritis. The aim of this study
Brindisi, Italy, 3Health Local Authority of Brindisi - Depart- is to assess osteoporosis and its risk factors in RA female
ment of Endocrinology, Brindisi, Italy patients.
Material and Methods: A cross-sectional study was per-
Objective: Type 2 diabetes mellitus (T2DM) is associated to formed during the period of time 2012–2013 on 60 women
higher risk of fractures despite a normal or increased BMD with RA, from 48 to 65 years old. Based on their BMD status,
[1]. The purpose of this 3-year longitudinal study was to they were separated in two groups: with and without osteopo-
assess the changes of quantitative ultrasound (QUS) parame- rosis. All the evidence of OP and its presumable risk factors
ters in a group of postmenopausal women with T2DM and in were registered. In addition, in order to compare the two
healthy controls. groups, the T-test was utilized for quantitative variables and
Material and Methods: The analyses were performed on a χ2 for qualitative variables.
group of 35 postmenopausal women attending to the Results: The patients had the average age 52.7±9.1. The
OSTEOLAB at ISBEM Research Institute (Brindisi, Italy) disease had lasted 10.1±6 years. The T-score≤−2.2 was found
within the PROF project (Prevention of Osteoporosis and in 39 of patients (65 %) respectively (60.1 %) in the lumbar
Fracture) in collaboration with the Local Health Authority of spine and (39.9 %) in the femoral neck region. The cardinal
Brindisi. We selected 17 women affected by T2DM and 18 factors related to OP were the age (p=0.02) and BMI p=0.01.
healthy controls, aged 55–70 years old. Subjects had baseline In patients with hysterectomy and oophorectomy, the meno-
and 40 months follow-up measurements of phalangeal pause induced by these interventions was conversely related
ultrasonometry performed by using DBM Sonic Bone Profiler to OP of femoral neck (p=0.03). Principally, OP in femoral
1200 (Igea®) as well as information about medical history, neck region was associated with seropositivity for RF (p=
current drug therapy and risk factors for fractures. 0.05) and BMI (p=0.02). The correlation between fractures of
Results: At the baseline, only ultrasound bone profile index femoral neck and osteoporosis was p=0.02.
(UBPI) was significantly lower in T2DM group (p<0.05). In Conclusion: OP was found in more patients than it was
this latter group, we found at follow up (40 months) a signif- thought. Aging, low BMI, menopause and seropositivity were
icantly lower bone transmission time (BTT) (p<0.01) and the most important risk factors of osteoporosis.
amplitude- dependent speed of sound (AD-SoS) (p<0.02).
During the study period, we found a decrease of both BTT
and UBPI, which was significantly higher in T2DM group P658
(p=0.01 and p=0.03, respectively). STUDYABOUT INFLUENCE OF ULTRASOUND
Conclusion: Diabetic and control patients did not show any THERAPY FOR TREATING PES ANSERINE
difference in AD-SoS, the ultrasound parameter which is BURSITIS
usually associated to BMD, thus representing the most used S. D. Birsan1, F. Cioara1
1
predictor parameter of fractures risk in clinical practice. At the Medical Rehabilitation, University of Medicine and Pharma-
opposite, BTT and UBPI, that give information about bone cy Oradea, Oradea, Romania
mineral quality, resulted decreased in T2DM subjects, pre-
senting a possible future role in the clinical practice for the Objective: Inflammation of the conjoined insertion of the
diagnosis of alterations of bone micro-architecture in T2DM sartorius, gracilis and semitendinosus muscles along the prox-
subjects. imal medial aspect of the tibia is recognized as pes anserine
References: 1. Leslie WD et al. J Bone Miner Res bursitis and was first described almost 70 years ago. These
2012:11:2231. muscles are primarily flexors of the knee and have a secondary
internal rotational influence on the tibia, protecting the knee
against rotatory as well as valgus stress. The purpose of this
P657 study was to determine the role of ultrasonotherapy in pes
OSTEOPOROSIS AND ITS RISK FACTORS IN anserine bursitis.
RHEUMATOID ARTHRITIS FEMALE PATIENTS Material and Methods: 15 patients with pes anserine bursitis
V. Duraj1, A. Kollcaku1, T. Backa1, A. Bano2, A. Tafaj1 were studied (9 females and 6 males, mean age 50.4 years)
1
Rheumatology Clinic, University Hospital Center, Tirana, between March and August 2008. Patients presenting knee
Albania, 2Internal Medicine Clinic, University Hospital Cen- pain suspected to be due to internal derangement and detected
ter, Tirana, Albania on MRI. The commonest clinical presentation was pain along
the medial joint line mimicking a medial meniscal tear. For
Objective: Rheumatoid arthritis (RA) is very often compli- evaluated the long effect we used a 10-point categorical scale,
cated with osteoporosis (OP). About 0.5–1 % of the popula- asking patient to appreciate the level of pain after 10
tion in the whole world suffers from RA, which is the most ultrasonotherapy applications.
Osteoporos Int

Results: 10 patients reported diminuated pain and 5 reported Reports which give no association probably comes from
no pain relief. inaccuracy of the assays in the assessment of vitamin D levels.
Conclusion: An accurate diagnosis of pes anserine bursitis on
MRI and initiate early treatment will help prevent unnecessary
arthroscopy.
P660
REHABILITATION AFTER A DISTAL RADIUS
FRACTURE EPIPHYSES IN PATIENTS WITH
OSTEOPOROSIS
P659
F. Cioara1, A. Venter2, S. D. Birsan1, F. Bodog2, M. Rus2
PARATHYROID GLANDS RESPONSE TO LOW 1
Medical Rehabilitation, University of Medicine and Pharma-
VITAMIN D LEVELS IN HEALTHYADULTS: A
cy Oradea, Oradea, Romania, 2University of Oradea, Faculty
CROSS-SECTIONAL STUDY
of Medicine and Pharmacy, Oradea, Romania
M. Sadat-Ali1, A. S. Al-Omran2, H. A. Al-Turki3
1
University Department of Orthopaedic Surgery, King Fahd
Objective: Osteoporotic fractures represent one of the most
Hospital of the University, AlKhobar, Saudi Arabia, 2Univer-
common cause of disability and one of the major voice in the
sity Department of Orthoapedic Surgery, College of Medicine,
health economic budget in many countries of the world. The
University of Dammam, King Fahd Hospital of the Universi-
present study was to evidence the importance of the rehabil-
ty, AlKhobar, Saudi Arabia, 3University Department of Ob-
itation program in patients with distal radius fracture
stetrics and Gynecology, College of Medicine, University of
epiphyses.
Dammam, King Fahd Hospital of the University, AlKhobar,
Material and Methods: Our study included 20 outpatients
Saudi Arabia
attending to Medical Rehabilitation Hospital Felix with distal
fracture epiphyses. The parameters studied were: age, joint
Objective: To assess the correlation of serum PTH and vita-
testing, muscle testing, using VAS pain, response to balneo-
min D (25OHD) levels of healthy Saudi Arabians living in
kinetictherapy. Data were analyzed using SPSS pack and tests
east coast.
of statistical significance by Student method (t test) and χ2.
Material and Methods: A cross-sectional study was con-
We used 10 days cure period with balneokinetic therapy in
ducted in 200 patients (150 women and 50 men) between
oligomineral thermal water specific of Baile Felix Resort,
January 2011 and December 2012, in the age group of (18–
antialgic electrotherapy, thermo therapy, and physical
69 years) attending outpatients clinics of King Fahd Hospital
exercise.
of the University, AlKhobar. Serum calcium, phosphorous,
Results: They observed an improvement of the functional
alkaline phosphatase, PTH and 25OHD were performed. 25-
tests during the observed period, improvement that is obtained
OHD was assessed using levels using chemiluminescence
only with a continuous and systematic practice of physical
immunoassay (CLIA), Radioimmunoassay using Wallac
therapy (p<0.05) and the occupational therapy. The physical
1470 Gamma Counter and HPLC -LC.MS/MS (high perfor-
training centered on customary gestures with occupationally
mance liquid chromatography- liquid chromatography with
therapy obtained the biggest improvement and 100 %
mass spectrometry. The data was collected and entered in the
compliancy.
database and analyzed using SPSS Inc Version 14.
Conclusion: Rehabilitation program is of utmost importance
Results: The mean age was 45.8±15.8 (18–74) years, Calci-
in distal radius fracture epiphyses so it should be applied soon
um Level was 9.09±0.63 mg/dl. Alkaline Phosphatase was
after the orthopedic treatment.
88.91±35.94 (34–302) IU, Parathormone 6.7±3.06 (1.35–
21.2) (1.3–6.8 pmol/L). 188 were either insufficient or defi-
cient CLIA 11.85±6.14 (2–29.6) and 91 (48.4 %) of them had
secondary hyperparathyroidism 9.48 ± 4.55 pc/L (CLIA P661
25OHD normal levels had normal PTH levels, insufficiency CARDIOVASCULAR RISK FACTORS IN PATIENTS
4/21 (19 %) had raised PTH levels and 81/166 (48.79 %) WITH PRIMARY HYPERPARATHYROIDISM
deficiency had raised levels), whereas with HPLC 156 were R. A. Trifanescu1, M. Carsote1, D. Soare1, C. Popa2, L.
either insufficient or deficient 97 (with PTH level of 7.41± Procopiuc2, C. Poiana1
1
4.2.). Patients with Insufficiency by HPLC-LC MS-MS 13 /41 Dept. of Endocrinology, Carol Davila University of Medicine
(31.7 %) had raised PTH. All patients with vitamin D defi- and Pharmacy, Bucharest, Romania, 2C. I. Parhon National
ciency as diagnosed by HPLC-LC-MS/MS had secondary Institute of Endocrinology, Bucharest, Romania
hyperparathyroidism.
Conclusion: The association of secondary hyperparathyroid- Objective: To assess cardiovascular risk factors in patients
ism and Vitamin D deficiency is common and definite. with primary hyperparathyroidism.
 Osteoporos Int

Material and Methods: 64 consecutive patients (4M/60F), between QUS and 10-year absolute risk of fragility fractures
aged 56.8±12.2 years were retrospectively assessed. Serum based on FRAX results in menopausal women.
intact PTH was measured by immunoradiometric assay and Material and Methods: This is a retrospective analysis in
25OH vitamin D by radioimmunoassay. Resting ECG was women. The inclusion criteria were menopausal status; at least
performed. Statistical analysis: independent sample t-test and one evaluation of clinical fracture risks as pointed by FRAX, a
Pearson correlation test were used. central DXA assessment (at least femoral neck, a Lunar Prod-
Results: Average total calcium serum levels at diagnosis were igy device), and heel QUS (Achilles Insight device) available
11.3±1.3 mg/dL (range 9.3–18.4), median PTH level was data. The exclusion criteria were pretherapy for osteoporosis
147.7 pg/mL (range 64.2–1982.3). Average 25OH vitamin or osteoporotic fractures at any moment of life. The statistics
D was 16.6±8.7 ng/dL (range 4–36.2);. 16 out of 64 patients used SPSS 21, with statistical significance at p<0.05. The
(25 %). showed asymptomatic primary hyperparathyroidism patients’ data were from 2008 to 2013. Since Romanian data
and were conservatory treated. In the whole series, average in the FRAX model were provided from 2011, we retrospec-
BMI was 27.2±4.9 kg/m2; 29 patients (45.3 %) were over- tively calculated the 10-year absolute fracture risk of major
weight and 12 patients were obese (18.8 %). Age at diagnosis fractures (MOF) and hip fractures (HIF) based on FRAX in
positively correlated with BMI (r=0.335, p=0.007). Type 2 patients enrolled before this.
diabetes mellitus was recorded in 3 patients (4.7 %), dyslip- Results: 197 women in menopause were included (median of
idemia in 34 cases (53.1 %). PTH levels positively correlated 57 years, ranges between 41 and 79 years). Some of the risk
with triglycerides (r=0.374, p=0.006); PTH negatively cor- factors included in FRAX were: 4 % previous prednisone use,
related with HDL-cholesterol (r=−0.415, p=0.016). Arterial 30 % smokers, 15 % with prevalent fragility fractures. The
hypertension was present in 37 patients (57.8 %). Hyperten- linear correlation between stiffness index (QUS) and MOF
sive patients were significantly older than normotensive ones was r=−0.3 (p<0.0005) or r2 =0.1 (p<0.0005). The simple
(59.4±11.5 vs. 53.4±12.4 years, p=0.05). In hypertensive correlation between stiffness index and HIF was r=−0.3
patients, serum calcium and PTH levels tends to be higher (p<0.005) or r2 =0.2 (p<0.0005). The same correlations were
than in normotensive ones, and 25OH vitamin D tends to be analyzed after adjusting for years of life: for MOF r=−0.2
lower. Pheochromocytoma was associated in one case and (p<0.0005), respective for HIF r=−0.2 (p<0.0005); and after
ACTH independent Cushing syndrome due to bilateral adre- triple controlling for age (years), period of time in menopause
nal hyperplasia in one patient. Ischemic heart disease with (years) and BMI for MOF r=−0.18 (p=0.01), and for HIF r=
resting ECG signs was present in 14 patients (21.9 %). Ar- −0.14 (p=0.04).
rhythmia was present in 5 patients (7.8 %). Conclusion: Week, negative, statistically significant correla-
Conclusion: There is a high prevalence in cardiovascular risk tions were found between stiffness index provided by heel
factors in patients with primary hyperparathyroidism, espe- QUS and 10-year absolute risk of fracture based on FRAX
cially in elderly ones and in patients with high PTH levels. model. The correlation does not improve when adjusting for
age, years since menopause, BMI. The data were similar for
major osteoporotic fracture risk as well as hip fracture risk.
P662
10-YEAR ABSOLUTE RISK OF FRACTURE BASED
ON FRAX AND QUANTITATIVE ULTRASOUND IN
ROMANIAN POSTMENOPAUSALWOMEN P663
M. Carsote1, V. Radoi2, A. Mihai3, A. Geleriu3, C. G. Barbu4, DO DEPRESSIVE SYMPTOMS IMPACT
D. Paun1, C. Poiana1 FUNCTIONAL OUTCOME IN HIP FRACTURE
1
Endocrine/I.Parhon/Davila UMPh, Bucharest, Romania, PATIENTS?
2
Davila UMPh, Bucharest, Romania, 3Endocrine/I.Parhon, E. Dubljanin Raspopovic1, S. Tomanovic Vujadinovic1, N.
Bucharest, Romania, 4Endocrine/Elias Hospital/Davila Krstic1, N. Ilic1, S. Stojicic1, U. Nedeljkovic1
1
UMPh, Bucharest, Romania Clinic for Physical Medicine and Rehabilitation, Clinical
Center of Serbia, Faculty of Medicine, University of Belgrade,
Objective: The relationship between a traditional method of Belgrade, Serbia
fracture risk assessment as heel quantitative ultrasound (QUS)
and a new method as the 10-year probability of fracture based Objective: Depression is the most common of mood disorders
on FRAX model is complex since the methods are indepen- in elderly people, and one of the most prevalent comorbidities
dent. This aspect might have a good economical profile espe- in older people with hip fracture. The aim of the present study
cially in regions with socio-economic issues since the methods was to evaluate if depressive symptoms assessed on hospital
are especially useful in screening population at high risk of admission impact early functional outcome after hip fracture
fracture as women in menopause. We analyze the correlation surgery.
Osteoporos Int

Material and Methods: We studied 112 patients who correlation has been found between the progression and low
underwent surgery for hip fracture during a 6 month period. formation markers. At time 0 serum markers of bone forma-
Depressive symptoms were assessed on admission to the acute tion alkaline phosphatase, osteocalcin (OC) and of bone re-
setting using the 30-item Geriatric Depression Scale (GDS). sorption desoxipiridoline (DPD). Between 1st and 3rd month
Multidimensional assessment included sociodemographic within the consolidation process, OC initially peaked in TPTD
characteristics, general health status, cognitive status, func- group decreases, while those in RIS group and SR group
tional status prior to injury, and perioperative variables. The remained significantly lower. DPD remained high in TPTD
primary outcome measure was motor-FIM at discharge. group, while in the others significantly reduced in 6 months.
Results: Adjusted multivariate regression analysis revealed Conclusion: In recent osteoporotic VCF a divergence be-
that presence of moderate to severe depressive symptoms tween the formation and resorption markers has been revealed
(GDS ≥20), older age, and female gender were independently between antiosteoporotic therapies with a different radio-
related to motor FIM at discharge. graphic progression. The clinical relevance is the possibility
Conclusion: Adjusted multivariate regression analysis re- of choice different antiosteoporotic treatments on radiographic
vealed that presence of moderate to severe depressive symp- and metabolic behaviour of VCF.
toms (GDS ≥20), older age, and female gender were indepen- References: Corradini C. Aging Clin Exp Res 2011;23:45.
dently related to motor FIM at discharge.
References: 1. Iolascon G et al. Clin Cases Miner Bone
Metab 2011;8:49. 2. Holmes JD, House AO. Age Ageing P665
2000;29:537. FACTORS INFLUENCING BALANCE
3. Voshaar RC et al. Am J Geriatr Psychiatry 2007;15:807. 4. RESTORATION IN ELDERLYAFTER HIP
Sharp LK, Lipsky MS. Am Fam Physician 2002;66:1001. FRACTURE
5. Lenze EJ et al. Int J Geriatr Psychiatry 2004;19:472. N. Radosavljevic 1 , M. Lazovic 1 , D. Nikolic 2 , Z.
Radosavljevic3
1
Institute for Rehabilitation, Belgrade, Serbia, 2Physical Med-
P664 icine and Rehabilitation Department, University Children’s
PROGRESSION OF VERTEBRAL COMPRESSION Hospital, Belgrade, Serbia, 3General Hospital, Mladenovac,
FRACTURES IN THE FIRST SIX MONTHS OF Serbia
ANTIOSTEOPOROTIC THERAPY
C. Corradini1, S. Pasqualotto1, F. Boisio1, V. Macchi1 Objective: The risks of second fracture among patients with
1
Department of Biomedical and Surgical Sciences, State Uni- initial brittle fracture are substantial. Secondary prevention is
versity of Milan c/o Orthopaedic Institute G. Pini, Milan, Italy very important as treatment of osteoporosis and also as bal-
ance restoring, motor functional rehabilitation and fall-down
Objective: In the conservative treatment of a vertebral com- prevention training. The purpose of this study was to evaluate
pression fracture (VCF) in postmenopausal women, an anti- effectiveness of our rehabilitation program in balance im-
osteoporotic drug is recommended. But their relationships provement measured by Berg Balance Scale (BBS) and to
with healing processes are still debated. The aim of this determine factors of influence on balance restoration after hip
prospective study was the evaluation of radiographic progres- fracture in patients above 65 years.
sion of one or more VCF during assumption of risedronate, Material and Methods: We have evaluated 203 patients that
strontium ranelate or teriparatide. were referred to Institute for Rehabilitation in Belgrade for
Material and Methods: Women with recent osteoporotic rehabilitation treatment after hip fracture. Eligible participants
VCF verified through magnetic resonance were assigned to were evaluated by BBS at admission, at discharge, 3 month
receive either risedronate (RIS group, n=26) or strontium post discharge and 6 months post discharge. We observed
ranelate (SR group, n=22) or teriparatide (TPTD group, n= balance improvement by BBS regarding age, sex, duration
34) following guidelines of Italian regulatory agency. Serum of time from operation to admission, comorbidity measured
and urinary bone turnover markers and lateral thoracolumbar by Cumulative Illness Scale for Geriatrics (CIRS-G), type of
spine X-rays were obtained at 0, 1, 3 and 6 months of therapy. fracture (femoral neck or trochanteric region), type of opera-
Morphometric parameters were digitally acquired with spe- tion (osteosynthesis or endoprothesis) and type of rehabilita-
cialized software. Lumbar BMD was measured by DXA tion program (with or without hydrotherapy).
before and 6 months after treatment initiation. Results: There is significant increase (p<0.001) in balance
Results: Lumbar BMD increased at 6 month in all groups and measured by BBS in observed period (admission-24.61±
significantly in TPTD group. An inconstant progression in 14.94; discharge −34.1±7.47; after 3 month R-37.98±10.09,
VCF on radiograms were detected in RIS and SR groups. The after 6 months-39.44±11.08). We found out significant corre-
D7 and D12-L1 were more involved of others. A significant lation between increase of BBS and age (R −0.3628, p=
 Osteoporos Int

0.0004), comorbidity measured by total score of CIRS-G (R 0.13 vs. 2.39±0.12 mmol/L; p=0.01). No differences in
−0.4675, p=0.0005), duration of time from operation to ad- 25OHD concentrations between the groups were observed.
mission (R −0.4617, p=0.0004) ad type of rehabilitation (R Conclusion: Chronic low-grade inflammation with altered
−0.5632, p=0.0000). adipokine levels may be responsible for inadequate bone
Conclusion: We have demonstrated that our inpatient reha- metabolism in childhood obesity. Higher PTH and calcium
bilitation program significantly improves balance in elderly concentrations may reflect moderate parathyroid hyperactivity
after hip fractures. Younger patients with less comorbidity, as a potential mechanism responsible for bone resorption in
started with rehabilitation earlier after operation, and included obese individuals.
in rehabilitation program with hydrotherapy has better
chances to restore their balance and to prevent fall-down and
second osteoporotic fractures.
P667
PHYSICALTHERAPY IN TREATMENT OF PATIENTS
WITH GLENOHUMERAL OSTEOARTHRITIS
P666 M. Kocic1, L. Dimitrijevic1, I. Stankovic1, M. Spalevic1, H.
CHRONIC INFLAMMATION IS THE KEY Colovic1, A. Stankovic1
1
MECHANISM RESPONSIBLE FOR DETERIORATED Clinical Center Nis, Clinic of Physical Medicine and Reha-
BONE METABOLISM IN CHILDHOOD OBESITY bilitation, Nis, Serbia
J. Konstantynowicz1, P. Abramowicz1, J. Jamiolkowski2, J. D.
Piotrowska-Jastrzebska1 Objective: A large number of patients develop glenohumeral
1
Dept. of Pediatrics and Developmental Disorders, Medical osteoarthritis (OA) after dislocation or fracture of a shoulder
University, Bialystok, Poland, 2Dept. of Public Health, Med- and are treated with different physical therapy modalities. We
ical University, Bialystok, Poland evaluated the effect of different combinations of physical
therapy modalities on pain and shoulder range of motion in
Objective: Some reports show a beneficial role of adiposity in patients with glenohumeral OA.
maintenance of skeletal mass, whereas others demonstrate an Material and Methods: 30 patients with moderate
increased fragility related to overweight. The aim of this cross- glenohumeral OA with pain and reduced forward flexion
sectional study was to evaluate effect of adipokines and in- and abduction, were randomly allocated to two groups with
flammation on bone metabolism and bone mass in obesity. 15 in each. Group A had exercises and breaststroke swim-
Material and Methods: In 40 obese boys and girls aged 7.1– ming, with galvanic current therapy and paraffin therapy for a
17.6 y (BMI SDS: 3.12±1.6) and 30 non-obese controls (BMI period of 3 weeks. Group B had exercises and breaststroke
SDS: −0.31±0.7), total and lumbar BMD and body fat/ lean swimming with low level laser therapy (LLLT) and transcu-
mass were determined using DXA. Serum lipids, calcium taneous electrical nerve stimulation (TENS) for a period of
(Ca), 25-hydroxyvitamin D (25OHD), PTH, insulin and glu- 3 weeks. Patients were not allowed to use paracetamol or
cose (HOMA-IR), leptin, adiponectin, osteocalcin (OC), os- NSAIDs. The outcome assessment was performed before
teoprotegerin (OPG), RANK-ligand (RANKL) and high- and after treatment using: 1) VAS for pain evaluation and 2)
sensitivity CRP (hsCRP), reflecting inflammation, were measurements of shoulder range of forward flexion and
measured. abduction.
Results: Increased levels of leptin, hsCRP, Ca, PTH (all Results: Group A included 7 women and 8 men with a mean
p<0.001) were found in obese children. Adiponectin and age of 59.3±6.2. Group B included 5 women and 10 men,
OC were lower in obese individuals (p=0.005), with simulta- with a mean age of 56.2±8.1. The groups were comparable
neous increased RANKL/OPG ratio (0.51±0.5 vs. 0.32±0.5; with regard to pain and forward shoulder flexion and abduc-
p=0.01). Bone mineral apparent density (BMAD) adjusted for tion before therapy (p>0.05). Both groups showed statistically
skeletal size and body composition in obese children was significant improvement for pain (p<0.01), forward flexion
lower than in normal weight individuals (0.080 vs. 0.084 g/ (p<0.001) and abduction (p<0.01) after therapy, compared to
cm3). There was an association between excessive adiposity basic values. Statistical analyses showed more improvement
and hsCRP level which correlated with RANKL (r=0.61, in group B than in group A for pain (p<0.05), and there was
p<0.001) and RANKL/OPG ratio (r=0.49, p=0.003). Inflam- no difference between groups for forward shoulder flexion
mation, ascertained with composite models including BMI, and abduction (p>0.05).
FM and LM, was an independent risk factor of increased bone Conclusion: Both combination of physical therapy modalities
resorption (β=0.415, p=0.001). In obese individuals, hsCRP led to a significant decrease in pain and increased in shoulder
was associated with a higher PTH (52.5±17.9 vs. 32.0± range of motion in patients with glenohumeral OA, but related
10.0 pg/ml; p<0.001) and higher serum Ca levels (2.47± to the pain application of LLLT and TENS was more effective
Osteoporos Int

than the application of galvanic current therapy and paraffin as the dual endothelin receptor antagonist bosentan have been
therapy. introduced in the management of digital ulcers in patients with
systemic sclerosis. The aim was to present the experience
within a single center in the management of patients with
P668 systemic sclerosis and digital ulcers.
FUNCTIONAL ASSESSMENT IN POSTTRAUMATIC Material and Methods: Within a period of 1 year, 8 patients,
ANKLE OSTEOARTHRITIS 5 with systemic sclerosis and 3 with limited scleroderma, aged
A. Totorean1, O. Suciu1, R. Onofrei1, A. Nita1 37–68 years, mean age 55.1 years, 7 female and 1 male, were
1
Victor Babes University of Medicine, Timisoara, Romania studied. All patients developed digital ulcers.
Results: All patients received bosentan 62.5 mg twice daily
Objective: The objective of this paper was to assess a lot of initially increasing to 125 mg twice daily. In all patients digital
patients with posttraumatic ankle osteoarthritis before and ulcers improved over a period of a year. In 2 patients a rapid
after rehabilitation treatment. Our purpose was also to study response to the treatment with bosentan was observed. In
the effect of an individualized treatment on patients with the some of the patients iloprost iv was simultaneously adminis-
mentioned pathology. tered and in some hyperbaric oxygen was also applied.
Material and Methods: We evaluated 50 patients with post- Conclusion: Systemic sclerosis is a multisystem disorder
traumatic ankle osteoarthritis. All patients were evaluated which was treated symptomatically until recently. Digital
before and after rehabilitation treatment clinically and func- ulcers, which may appear during the course of the disease,
tionally using Ankle Osteoarthritis Scale (AOS). The rehabil- are resistant to treatment and even if treated they may recur.
itation treatment was 6 months long and involved physical New therapeutic achievements, such as the dual endothelin
therapy and exercises (kinetotherapy). Every patient had an receptor antagonist bosentan have made possible the success-
individualized rehabilitation treatment according to age, phys- ful treatment of digital ulcers in patients with systemic sclero-
ical possibilities, traumatic lesion which caused the osteoar- sis. In some of the cases described the rapid response of the
thritis, other pathologies and the functional assessment made. digital ulcers to the administration of bosentan is noted.
Results: After 6 months of treatment the total AOS score
decreased significantly (p=0.04). The pain subscale score
improved more than dysfunction subscale score. The subjec- P670
tive functional scale and the clinical assessment showed sig- WNT SIGNALING IS INVOLVED IN HUMAN
nificant improvements. After rehabilitation treatment patients ARTICULAR CHONDROCYTE
still had some problems with climbing and descending stairs. DEDIFFERENTIATION IN VITRO
Conclusion: The rehabilitation treatment mainly based on L. Laadhar1, N. Sassi1, M. Allouche1, M. Kallel-Sellami1, S.
individualized kinetotherapy and physical therapy is impor- Makni1, S. Sellami1
1
tant in patients with posttraumatic ankle osteoarthritis decreas- Immuno-rheumatology Research Laboratory, Tunis, Tunisia
ing pain as well as dysfunction.
Objective: Osteoarthritis is the most prevalent form of arthri-
tis in the world. Certain signaling pathways, such as the wnt
P669 pathway, are involved in cartilage pathology. Osteoarthritic
DIGITAL ULCER MANAGEMENT IN SYSTEMIC chondrocytes undergo morphological and biochemical chang-
SCLEROSIS: A SINGLE CENTER EXPERIENCE es that lead to chondrocyte dedifferentiation. We investigated
P. Athana ssiou 1 , I. K osto glo u-Athanassiou 2 , D . whether the Wnt pathway is involved in dedifferentiation of
Basdragianni1, N. Kalaycheva1, A. Spyridis1 human articular chondrocytes in vitro.
1
Department of Rheumatology, St. Paul’s Hospital, Material and Methods: Human articular chondrocytes were
Thessaloniki, Greece, 2Department of Endocrinology, Red cultured for four passages in the presence or absence of IL-1 in
Cross Hospital, Athens, Greece monolayer or micromass culture. Changes in cell morphology
were monitored by light microscopy. Protein and gene expres-
Objective: Systemic sclerosis is a multisystem disorder of sion of chondrocyte markers and Wnt pathway components
unknown aetiology. Pulmonary and cutaneous manifestations were determined by western blotting and qPCR after culture.
of the disease cause significant morbidity, affect quality of life Results: After culturing for four passages, chondrocytes ex-
and are resistant to therapeutic interventions. Digital ulcers in hibited a fibroblast-like morphology. Collagen type II (col II)
systemic sclerosis remain a significant problem. They tend to and aggrecan protein and gene expression decreased, while
recur and are difficult to treat. Recently, there have been collagen type I (Col I), matrix metalloproteinase (MMP) 13,
advances in the management of digital ulcers in systemic and nitric oxide synthase (eNOS) expressions increased. Wnt
sclerosis. In particular, new therapeutic developments such molecule expression profiles changed; Wnt5a protein
 Osteoporos Int

expression, the Wnt target gene, c-jun, and the Wnt pathway CTX-1 was significantly lower in D2J compared to WT mice.
regulator, sFRP4 increased. Treatment with IL-1 caused chon- Differentiation of D2J OCs was substantially increased,
drocyte morphology to become more filament-like. This marked by OC number, TRAP activity and surface area,
change in morphology was accompanied by extinction of compared to WT. In addition, qPCR analysis showed upreg-
col II expression and increased col I, MMP13 and eNOS ulated expression of TRAP and key regulators of OC. More-
expression. Changes in expression of the Wnt pathway com- over, the survival of mature OCs was improved in D2J marked
ponents were also observed. Wnt7a decreased significantly, by reduced caspase-3/7.
while Wnt5a, LRP5, β-catenin and c-jun expressions Conclusion: Taken together, these data suggest that OA/
increased. Gpnmb acts as a negative regulator of osteoclast differentia-
Conclusion: Culture of human articular chondrocytes with or tion and survival by inhibiting the ERK/AKT signaling
without IL-1 not only induced chondrocyte de-differentiation, pathways.
but also changed the expression profiles of Wnt components,
which suggests that the Wnt pathway is involved in chondro-
cyte dedifferentiation in vitro.
P672
THE ROLES OF CANONICAL AND
P671 NONCANONICALWNT SIGNALING IN HUMAN
MUTATION IN OSTEOACTIVIN ENHANCES DEDIFFERENTIATED ARTICULAR
RANKL-MEDIATED SIGNALING, PROMOTING CHONDROCYTES
OSTEOCLAST DIFFERENTIATION AND SURVIVAL L. Laadhar1, N. Sassi1, M. Allouche1, M. Kallel-Sellami1, S.
S. M. Abdelmagid1, G. Sondag2, F. M. Moussa2, M. Khol2, C. Sellami1, S. Makni1
1
Fulp2, F. F. Safadi2 Immuno-rheumatology Research Laboratory, Tunis, Tunisia
1
Anatomy and Neurobiology, Neomed, Rootstwon, United
States, 2Anatomy and Neurobiology, Neomed, Rootstown, Objective: Osteoarthritis is the most prevalent form of arthri-
United States tis in the world and it is becoming a major public health
problem. Osteoarthritic chondrocytes undergo morphological
Objective: The novelty of osteoactivin (OA) in bone regen- and biochemical changes that lead to dedifferentiation. The
eration has been characterized and reported by our group. involvement of signaling pathways, such as the Wnt pathway,
Recent study demonstrated that OA/Gpnmb is highly during cartilage pathology has been reported. Wnt signaling
expressed by osteoclasts (OCs) in vitro. To specify the critical regulates critical biological processes. Wnt signals are trans-
role and mechanism of action of OA in osteoclastogenesis, we duced through at least three intracellular signaling pathways
characterized the osteoclastic phenotype in a mouse model including the canonical Wnt/β-catenin pathway, the Wnt/Ca2
with natural mutation in the OA gene. We hypothesized that pathway and the Wnt/planar cell polarity pathway. We inves-
mutation of OA increases OC formation and decreases its tigated the involvement of the Wnt canonical and non-
activity. canonical pathways in human articular chondrocyte dediffer-
Material and Methods: For our purpose, we used a geneti- entiation in vitro.
cally modified D2J mouse model at age of 8 weeks. D2J mice Material and Methods: Human articular chondrocytes were
are mutant for OA. Mouse femurs were evaluated by μCT, cultured through four passages with no treatment, or with
histology and histomorphometric analyses. Mice sera were sFRP3 treatment, an inhibitor of Wnt pathways, or with
examined by ELISA for bone resorption markers. Bone DKK1 treatment, an inhibitor of the canonical pathway.
marrow-derived hematopoietic stem cells were differentiated Chondrocyte- secreted markers and Wnt pathway components
into osteoclasts using RANKL and MCSF. OC differentiation were analyzed using western blotting and qPCR.
was evaluated by TRAP activity and staining. OC resorptive Results: Inhibition of the Wnt pathway showed that the
function was examined using corning disc osteoassay. For canonical Wnt signaling is probably responsible for inhibition
osteoclast survival, cells were cultured for two additional days of collagen II expression, activation of metalloproteinase 13
in the presence of RANKL. Markers of OC differentiation expression and regulation of Wnt7a and c-jun expression
were tested by qPCR. MAPK and AKT signaling pathways in during chondrocyte dedifferentiation in vitro. Our results also
osteoclast were examined by western blot analysis. Statistical suggest that expressions of eNOS, Wnt5a and cyclinE1 are
analysis was carried out by student-t-test. regulated by noncanonical Wnt signaling.
Results: μCT analysis of D2J femur diaphysis showed in- Conclusion: Understanding the exact role that each wnt path-
creased cortical thickness, while cortical bone surface as well ways plays in osteoarthritis is of major importance. This will
as porosity were reduced in comparison to WT. Serum ELISA clarify what role of each of these molecules during the pro-
of TRAP and RANKL/OPG ratio were not altered, however cesses of proliferation, differentiation or de-differentiation.
Osteoporos Int

P673 Material and Methods: Chondrocytes derived from OA

EFFECT OF HYDROTHERAPY VS. patients (n=14) were stimulated with IL-1β (5 ng/ml) or
CONVENTIONAL LAND-BASED EXERCISE IN Actinomycin D or NF-кB inhibitor SC514 or a JNK inhibitor.
PATIENTS WITH HIP ARTHROPLASTY FOR Total RNA was used to quantify ZCCHC6 or IL-6 mRNA
OSTEOARTHRITIS expression using TaqMan assays. SiRNA-mediated knock-
I. R. Marcu1, S. Patru1, A. Bighea1, R. S. Popescu1, A. M. down of ZCCHC6 was used to study the effect on inflamma-
Bumbea1 tory cytokine expression using a cytokine array. Protein ex-
1
University of Medicine and Pharmacy, Craiova, Romania pression of ZCCHC-6 and IL-6 was studied using western
immunoblotting and by ELISA.
Objective: Hydrotherapy (HT) is usually employed in phys- Results: Expression of ZCCHC6 and IL-6 was high in dam-
ical medicine and rehabilitation. Underwater exercises aged cartilage compared to unaffected OA cartilage. IL-1β
strengthen weak muscles, restore joint motion and pain. The stimulation showed significant increase in the expression of
study evaluated the functional outcome following hip ZCCHC6 and IL-6 mRNA and protein in chondrocytes.
arthroplasty in patients who underwent hydrotherapy 6 months ZCCHC6 depletion significantly decreased IL-6 mRNA and
after discharge from a rehabilitation unit. protein expression in IL-1β-stimulated chondrocytes. Cyto-
Material and Methods: A total of 58 patients with recent hip kine array analysis of culture supernatants from control or
arthroplasty (<14 days) for osteoarthritis were referred to our ZCCHC6 siRNA treated and IL-1β-stimulated chondrocytes
rehabilitation unit. All participants were discharged and showed a substantial decrease in a subset of cytokines includ-
returned to their home at the end of the rehabilitation program ing IL-6. In chondrocytes with depleted ZCCHC6 IL-6
(12 days). Twenty-eight participants were randomly assigned mRNAs had shorter poly-A tails and also showed a decrease
into the hydrotherapy group and thirty participants into the in constitutive IL-6 mRNA and protein expression. Inhibition
conventional exercise group. Participants were interviewed of NF-кB had no effect on ZCCHC6 expression but inhibition
with WOMAC Index at admission, at discharge and after of JNK blocked ZCCHC6 expression in OA chondrocytes.
6 months. Conclusion: Taken together our results demonstrate that
Results: The WOMAC subscales for pain, stiffness and func- ZCCHC6 is highly expressed in damaged OA cartilage and
tion improved in both groups. Statistical analysis indicates modulates IL-6 expression at the post-transcriptional level by
that scores on all subscales were significantly lower for the possibly influencing cytokine mRNA stability. These results
hydrotherapy group. The benefits gained by the time of dis- identify ZCCHC6 as a potential therapeutic target for the
charge were still found after 6 months. treatment of OA.
Conclusion: In this trial, hydrotherapy proved to be a better Disclosures: Grants from NIH (RO1 AT-003267, RO1 AT-
treatment than conventional exercise for patients with hip 005520, RO1 AT-007373) and funds from Neomed
arthroplasty, since pain, stiffness and function impairment University.
were significantly lower for the hydrotherapy group.

P675
P674 INFLUENCE OF VITAMIN D STATUS ON
REGULATION OF INTERLEUKIN-6 EXPRESSION FRACTURES IN SPANISH ELDERLY WITH HIGH
BYA RIBONUCLEOTIDYLTRANSFERASE ZCCHC6 PARATHYROID HORMONE LEVELS
IN HUMAN CHONDROCYTES R. Roncero-Martin1, J. M. Moran1, R. Ortés-Gómez1, F. J.
T. Haqqi1, A. Arida1, N. Akhtar1 Rodriguez-Velasco1, G. Gil-Fernandez1, J. F. Calderon-
1
Anatomy and Neurobiology, Neomed, Rootstown, United Garcia1, J. D. Pedrera-Zamorano1
1
States Metabolic Bone Diseases Research Group, University of
Extremadura, Caceres, Spain
Objective: Interleukin (IL)-1β is the major cytokine involved
in osteoarthritis (OA) pathogenesis and induces the high levels Objective: To analyze whether there is an association be-
expression of IL-6. Ribonucleotidyl transferases catalyze the tween serum PTH and the prevalence of fractures and to assess
addition of nucleotides to the 3′ end of mRNAs. However, the influence of serum 25-hydroxyvitamin D (25OHD).
their expression or role in cytokine regulation in OA is un- Material and Methods: A total of 248 Spanish elderly (149
known. We investigated whether ribonucleotidyl transferase females and 98 males) were recruited. Serum PTH and
ZCCHC6 is expressed in OA cartilage and whether ZCCHC6 25OHD concentrations, as well as fracture prevalence were
is involved in the regulation of IL-6 expression in OA recorded. Serum PTH was divided into quartiles, and elderly
chondrocytes. were grouped into those in the highest quartile (>132.8 pg/ml)
 Osteoporos Int

and those below. Serum 25OHD levels were stratified in 4 and 24. The patients had to answer an adverse event (AE)
categories (>40, 20–40, 10–20, <10 ng/ml). questionnaire and the WOMAC OA Index questionnaire at
Results: Mean PTH and 25OHD values were similar between each visit. The WOMAC total score and the three WOMAC
males and females (103.5±65.4 vs. 107.6±65.3 for PTH and subscores (pain, stiffness and physical function) were ana-
11±7 vs. 12±8 for 25OHD (P>0.05 both)). Values lower than lyzed. All analgesics, nonsteroidal anti-inflammatory drugs
10 ng/ml 25OHD were found in the 34.6 % of the males and in or corticosteroids were suspended up to the end of the study.
the 65.4 % of the females. Within the males the prevalence of Results: The WOMAC score was significantly reduced after
fractures was of 43.8 % in the 10–20 ng/ml, 48.8 % in the 2 weeks of treatment (from 4.32±1.85 to 3.65±1.96, p=
<10 ng/ml and 12.5 % within the 20–40 ng/ml 25OHD 0.011), decreased by the end of the injection series (2.67±
groups, respectively. In the female group, prevalence of frac- 1.91; p<0.0001) and maintained during the follow-up (2.35±
tures increases to 47.1 % in the <10 ng/ml, with lower figures 1.1.68; p<0.0001). The WOMAC subscores were also signif-
of 25.6 % for both the 20–40 ng/ml and the 10–20 ng/ml icantly reduced from week 2 for pain and from week 5 for
25OHD groups, respectively. Stratification of males by PTH stiffness and physical function. The most frequent AE was
levels showed the highest prevalence in the 10–20 ng/ml pain at the injection site (6.2 % of the injections).
25OHD within the top quartile of serum PTH with a 66.7 % Conclusion: These results confirm the evidence of efficacy
vs. 38.5 % observed in those below. The highest prevalence in and safety of efficacy and safety of intra-articular hyaluronic
women was observed in the <10 ng/ml 25 OHD group with a acid in the treatment of symptomatic knee osteoarthritis.
50 % of the fractures within the highest quartile group of PTH
with similar figures (45.8 %) in those below. No significant
increases in fracture risk were observed in patients with high P677
PTH levels (P>0.05 in all cases). After further stratification ANALYSIS OF TWO FUNCTIONAL
by 25OHD levels, lack of increased risk was also observed POLYMORPHISMS IN THE LRP5 GENE IN
(P>0.05 in all cases). RELATION TO BONE MINERAL DENSITYAND
Conclusion: Elevated PTH levels are not associated with FRACTURE RISK IN MALTESE POSTMENOPAUSAL
increased prevalence of fractures in Spanish elderly. Our WOMEN
results indicate that most of the fractured patients had vitamin M. Formosa1, A. Xuereb Anastasi1
1
D insufficiency/deficiency, suggesting that his condition may Department of Applied Biomedical Science, Faculty of
be closely associated with fracture in elderly people. Health Sciences, University of Malta, Msida, Malta

Objective: The low-density lipoprotein receptor-related pro-

P676 tein 5 (LRP5) is involved in osteoblast differentiation and
EFFICACY OF VISCOSUPPLEMENTATION WITH bone formation, making it an important determinant of bone
INTRA-ARTICULAR HYALURONIC ACID IN KNEE mass and strength. The influence of two functional missense
OSTEOARTHRITIS single nucleotide polymorphisms (SNPs) A1330V
I. R. Marcu1, S. Patru1, A. Bighea1, R. S. Popescu1, A. M. (rs3736228; C>t) and V667M (rs4988321; G>a) were
Bumbea1 analysed in relation to BMD and different low-trauma frac-
1
University of Medicine and Pharmacy of Craiova, Craiova, tures in Maltese postmenopausal women.
Romania Material and Methods: 1,040 women aged 40 to 79 years
were recruited and their BMD measurements were performed
Objective: The standard pharmacological treatment of osteo- by dual-energy X-ray absorptiometry. Subjects without a his-
arthritis with nonsteroidal anti-inflammatory drugs is essen- tory of a fragility fracture were subdivided in three groups:
tially symptomatic, aiming at relieving pain. normal (n=228), osteopenic (n=266) or osteoporotic (n=280)
Viscosupplementation with intra-articular hyaluronic acid is according to their BMD results. Women with a fracture history
an alternative to the treatment of symptomatic knee osteoar- were classified as cases (n=266). Genotyping of the A1330V
thritis. The aim of this study was to assess the safety and polymorphism was performed by PCR followed by restriction
tolerability profile of intra-articular sodium hyaluronate in enzyme digest, whereas real-time PCR was performed for the
patients with symptomatic knee osteoarthritis over 24 weeks. V667M SNP.
Material and Methods: The study included 56 patients (36 Results: Using logistic regression analysis adjusted for age,
women and 20 men), aged between 42 and 76 years, with the A1330V SNP was associated with reduced BMD at the
confirmed primary or secondary knee osteoarthritis. All pa- lumbar spine (TT: p=0.02; CT: p=0.01) and to a lesser extent
tients underwent weekly intra-articular injections with reduced femoral neck BMD (TT: p=0.07; CT: p=0.01). Frac-
hyaluronic acid for 5 consecutive weeks and were followed ture cases carrying one or both copies of the minor allele T had
up for 19 additional weeks with control visits at week 6, 12, 18 an increased fracture risk compared to women with the CC
Osteoporos Int

genotype (CT: p=0.04; TT: p=0.05). The TT genotype was Conclusion: Our findings show that low bone mass is accom-
the most common among subjects with a wrist, humerus or panied by an impairment of bone histomorphometrical prop-
hip fracture; nonetheless the difference was not significant erties, which were comparable between osteoporotic OA pa-
(p>0.05). The haplotype with both risk alleles (AT) was tients and subjects with femoral fracture. This study support
associated with reduced BMD (p=0.05) as opposed to the evidence from the recent studies indicating impaired bone
haplotype-reference (GC) which was strongly linked to a high quality in OA and absence of protective effect against OP.
BMD (p=0.002).
Conclusion: The results indicate that the A1330V and
V667M polymorphisms within the LRP5 gene are associated
with reduced BMD and/or increased fracture susceptibility in P679
Maltese postmenopausal women. MECHANICAL AND STRUCTURAL PROPERTIES
OF HUMAN FEMORAL HEADS IN DIFFERENT
STAGES OF OSTEOARTHROSIS
M. Kozuń1, P. Gabryś2, S. Dragan2, A. Nikodem1
1
P678 Department of Biomedical Engineering, Mechatronics and
CLINICAL AND HISTOMORPHOMETRICAL Theory of Mechanism, Wroclaw University of Technology,
ASSESSMENT OF BONE QUALITY IN HIP Wroclaw, Poland, 2Department and Clinic of Orthopaedic and
OSTEOARTHRITIS AND OSTEOPOROSIS Traumatologic Surgery, Wrocław Medical University,
C. Rao1, M. Feola1, M. Celi1, F. M. Liuni1, E. Gasbarra1, U. Wroclaw, Poland
Tarantino1
1
Division of Orthopaedics and Traumatology, University of Objective: Structure and mechanical properties of human
Tor Vergata, Rome, Italy bone tissue adjust to changing load conditions. The structure
of bone tissue is related to mechanical properties and adjust-
Objective: Osteoarthritis (OA) and osteoporosis (OP) are two ment of mechanical properties to changing load conditions
diseases characterized by the alteration of bone quality that causes changes in the bone tissue structure. The knowledge of
affect mainly elderly people reducing their quality of life. those properties is important to understand the mechanism of
Although an inverse relationship between has been shown pathological bone changes. The main purpose of the conduct-
by some studies, other reports supported the coexistence of ed studies was to determine a correlation between structural
these pathologies. In this study we combined clinical (Harris and mechanical properties of human trabecular bones with
Hip Score) and structural features (BMD and bone osteoarthrosis (OA).
histomorphometry) to clarify the relationship between OA Material and Methods: The subject of the studies was eleven
and OP. human femoral heads. The material was divided into 3 sepa-
Material and Methods: Among all the patients who rate groups, based on classification of OA proposed by
underwent a total hip arthroplasty in our hospital between Outerbridge. In order to determine both structural and me-
June 2011 and March 2013, we selected 120 patients divided chanical properties 60 cubic specimens (10×10×10 mm) of
into 4 groups according to BMD values and diagnosis, fem- cancellous bone were prepared from each head. Mechanical
oral neck fractures (n=30, mean age 71.9) or OA (n=90, with properties were measured in uniaxial compression test using
normal/osteopenic/osteoporotic BMD; mean age 72.1 years). material testing machine 858 MTS MiniBionix with strain rate
X-rays of the hips were also taken to establish the grade of OA 0.01 s−1. Additionally, for each of the specimen the physical
through the Kellgren-Lawrence scale and OA patients were density was determined using electronic weighing machine
also evaluated by HHS to assess the functionality of the hip. RADWAG. To find correlation between mechanical and struc-
During surgery, a double osteotomy of the femoral head was tural properties we conducted linear and multilinear regression
performed and the samples were used for histomorphometry analysis.
through Bio Quant software. Results: Our results show strong correlation between physical
Results: Clinical and histomorphometric features were com- density and strength (R2 =0.8) The highest values of structural
pared between fractured patients and OA patients stratified and mechanical properties were obtained for specimens with
according to BMD values. Histomorphometrical analysis III grade of OA. The femoral heads from this group were also
show that bone volume fraction (BV/TV) was significantly characterized by loss of cartilage to the subchondral bone and
lower in subjects with femoral neck fracture (20.77±4.33 %) deterioration of bone. In this case we observed appearance of
than subjects with OA and normal BMD (36.49±7.73 %; cysts as well as bone remodeling.
P<0.01) or osteopenic BMD (32.92±6.82 %; P<0.01), while Conclusion: The results show that values of structural and
no difference between fractured subjects and those with com- mechanical properties depend on the grade of osteoarthritis. In
bined OA and OP (20.71±5.23 %) was detected. the case of femoral head with III grade of OA we obtained the
 Osteoporos Int

highest values of physical density, strength and Young’s mod- has been now been described also in adults and is known as
ulus even in comparison with healthy bone tissue. adult Still’s disease. The aim was to describe the case of a
Acknowledgements: This work was supported by the Na- patient with adult Still’s disease who was successfully treated
tional Science Centre grant no. N N518 505139. by the administration of canakinumab.
Material and Methods: A female patient, aged 38, presented
with adult Still’s disease. During the 31st week of a pregnancy
P680 she developed dyspnea, intense cough and fever. She was
BILATERAL FEMORAL NECK INSUFFICIENCY submitted to caesarean section and gave birth to a healthy
FRACTURES: AN UNEXPECTED CAUSE OF PAIN IN infant. Subsequently, she developed fever, cholestasis, in-
A POSTMENOPAUSALWOMAN creased liver enzymes, arthralgias, myalgias, a salmon colored
T. Nakajima1, K. Tanabe1, S. Yagi1 rash and enlarged lymph nodes.
1
Nisninomiya Municipal Central Hospital, Nishinomiya, Results: Methylprednisolone was administered at a dose of
Hyogo, Japan 32 mg daily with partial remission of the disease. She was then
given anakinra 100 mg sc daily, however the rash recurred.
Objective: Older patients tend to suffer from osteoporosis. In Subsequently canakinumab 180 mg/month was administered.
such cases, several types of fractures can easily occur. We Complete remission of the disease was induced and the dose
report a case of bilateral femoral neck insufficiency fractures of corticosteroids was reduced.
in a postmenopausal woman. Conclusion: Adult Still’s disease may respond to anti-
Material and Methods: We report a case of bilateral femoral inflammatory drugs as well as to corticosteroids. However, in
neck insufficiency fractures in a postmenopausal woman di- cases of disease resistant to treatment new agents are being
agnosed in our hospital. applied. The recombinant human monoclonal antibody to
Results: The patient is 79 years old postmenopausal woman and interleukin-1β canakinumab induced remission in this case of
in osteoporotic condition, suffered from the unknown sudden adult Still’s disease.
onset hip pain and edema of lower extremities more than a month
before our first examination. She complained of the bilateral hip
pain when she move her hip joint, especially when she stand up
or walk, but it became less when they lay down. Not only the P682
patient herself but also her families were all fear of some kind of MECHANICAL AND STRUCTURAL DEGREE OF
malignant disease. At first examination by X-ray and MRI, there ANISOTROPY OF HUMAN OSTEOARTHRITIC
was no obviously clear cause of pain. Because of her persisted TRABECULAR BONE
pain, 2 weeks later, we took second X-ray and found bilateral M. Kozuń1, M. Tomanik1, A. Nikodem1
1
femoral neck fracture (Garden Stage IV). We performed bilateral Department of Biomedical Engineering, Mechatronics and
bipolar hip arthroplasty and her quality of life was improved. Theory of Mechanisms, Wroclaw University of Technology,
Conclusion: When older patients complain of any discomfort Wroclaw, Poland
around their hip joint without any injury, femoral neck insuf-
ficiency fractures must be considered. If the diagnosis were Objective: It is a common knowledge that the cancellous
delayed, it is better to take care that femoral head dislocation bone changes its structure when exposed to external loads.
might occur secondly. The patients with femoral neck insuf- Osteoarthritis (OA) is degenerative joint disease caused by the
ficiency fracture suffered from osteoporosis, so other fractures breakdown of cartilage and is most frequent in hips. As OA
on their pelvic ring might be easily occurred. progress the mechanical stress on joint increases, cause degener-
ation and deformation of a femur head. Due to changes of
mechanical conditions in the joint the structure of bone adapts
P681 to new loads. The main purpose of the study was to investigate
ADULT STILL’S DISEASE: SUCCESSFUL the mechanical and structural properties of the human femoral
TREATMENT WITH CANAKINUMAB bone tissue in different stages of osteoarthritis in order to deter-
P. Athanassiou 1 , D. Basdragianni 1 , A. Tzanavari 1 , E. mine correlation between the degree of mechanical anisotropy
Triantafyllidou1, I. Kostoglou-Athanassiou2 (DMA) and the structural anisotropy (DA).
1
Department of Rheumatology, St. Paul’s Hospital, Material and Methods: The material study consisted of 26
Thessaloniki, Greece, 2Department of Endocrinology, Red human femoral heads in different stages of OA that were divided
Cross Hospital, Athens, Greece into two groups: form region under the cartilage C and distal D,
the nominal size of specimens was 10×10×10 mm.
Objective: Adult Still’s disease is a systemic inflammatory Structural measurements were conducted using X-rays scans
disorder. Still’s disease was first described in children, but it from microtomography SkyScan1172, Bruker ®, while the
Osteoporos Int

mechanical degree of anisotropy was determined by uniaxial the dorsal and lumbar spine was obtained in all patients before
compression test in three orthogonal axis. treatment to assess VF and kyphosis, as well as a DXA scan.
Results: Results show that the degree of structural anisotropy Results: 7.4 % of X-rays displayed at least one VF (9/121): two
of the trabecular bone specimens from under the cartilage is at T7 (grades IC and IIIC), one at T8 (IC), one at T12 (grade IA),
grater then the degree of mechanical anisotropy. With the two at L1 (grades IIA and IIB), one at L2 (grade IIC), one at L4
progression of the disease distinction between DA and (grade IIA) and one with multiple fractures at L1, L3 and L5.
DMA from region C and D became lower. 38.8 % of all the patients had a normal bone mass, 43.8 % had
osteopenia and 17.4 % osteoporosis by OMS criteria. Fractures
before treatment were more prevalent in women older than
65 years (16 % vs. 1.4 %, p=0.004). All women with VF had
abnormal bone mass: osteoporosis (5/9) or osteopenia (4/9) (p=
0.001). Women with VF before treatment had a nonsignificant
trend towards diminished lumbar bone mass (p=0.052), whereas
the bone mass at the femoral neck and total hip was significantly
decreased. 8 of the 9 patients with VF (6.6 % of all X-rays)
showed some degree of kyphosis (median 11°, 5–20). One of the
VF patients had 0° kyphosis.
Conclusion: Our prevalence of VF is slightly lower than that
of general population of a similar age. All women with VF had
low hip bone mass. The lack of significance of the decreased
lumbar bone mass may come from the reduction in vertebral
body height in cases with VF. Our results highlight the rele-
vance of this problem in this specific subset of patients who
may already have low bone mass and VF before beginning AI.

Conclusion: Results unveil strong correlation between me-

chanical and structural parameters of the osteoarthritic trabec- P684
ular in all stages of the OA. VITAMIN D DEFICIENCYAND ITS RELATION TO
Acknowledgements: This work was supported by the Na- PHYSICAL CAPACITY IN PATIENTS WITH
tional Science Centre grant no. N N518 505139. CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD)
S. H. Scharla1, U. G. Lempert1, K. Schultz2
1
P683 Endocrine Practice, Bad Reichenhall, Germany, 2Klinik Bad
PREVALENCE OF OSTEOPOROSIS/OSTEOPENIA, Reichenhall, Bad Reichenhall, Germany
VERTEBRAL FRACTURES AND KYPHOSIS IN
PATIENTS WITH NONADVANCED BREAST CANCER Objective: Osteoporosis is an important comorbidity in pa-
DUE TO RECEIVE AROMATASE INHIBITORS tients with chronic obstructive pulmonary disease (COPD).
L. Brage1, R. Hernandez-San Gil2, H. Roldan1, E. Rodriguez- One important risk factor is Vitamin D deficiency. Vitamin D
Rodriguez3, A. Perez- Ramirez3, J. Cruz-Jurado2, V. Rocha1, status was associated with BMD and functional exercise ca-
V. Hernandez-Hernandez1, I. Ceballos2, M. J. Sanchez-Perez3 pacity in COPD patients in a previous study in the Netherlands
1
Neurosurgery Department, Hospital Universitario de (Romme et al. 2012). Therefore, we studied the prevalence of
Canarias, La Laguna Tenerife, Spain, 2Oncology Department, vitamin D deficiency and its possible relationship with phys-
Hospital Universitario de Canarias, La Laguna Tenerife, ical function in German COPD patients.
Spain, 3Internal Medicine, Hospital Universitario de Canarias, Material and Methods: We recruited consecutive patients
La Laguna Tenerife, Spain with COPD who were admitted to the Klinik Bad Reichenhall
(a specialized hospital with rehabilitation therapy) from Feb-
Objective: The treatment with aromatase inhibitors (AI) may ruary to November 2013 (informed consent). Blood samples
reduce bone mass and increase the risk of vertebral fractures and physical function data were obtained at the beginning of
(VF). Our aim was to analyze the prevalence of osteoporosis/ the hospital stay. 25-hydroxyvitamin D (25-OH-D) was mea-
osteopenia, VF and kyphosis in women with non-advanced sured in serum by an automated method (Roche Diagnostics).
breast cancer who were to receive AI. Further, all participants were tested for the maximum inspira-
Material and Methods: 121 women (median age 62 years, 34– tion force (PI) and for the 6-Minute-Walking-Distance
80) were prospectively included in the study. A lateral X-ray of (6MWD).
 Osteoporos Int

Results: 376 participants were studied (245 males, 131 fe- males. Comparing sexes, there were differences for all groups
males). The serum 25-OH-D was 40±30 nmol/l (nM), mean except for the control group (p>0.01).
±SD. The minimum was 5 nM and the maximum 169 nM. Conclusion: BMD of rats was unaffected by coffee or soft
There was no gender difference and no significant correlation drinks. For females BMD was significantly affected by soft
with age. 73 % of the participants had vitamin D deficiency drinks and coffee intake being the coffee which caused more
(defined as a serum 25-OH-D concentration below 50 nM). bone reduction, thus representing a risk factor for bone quality
25-OH-D exhibited a slight seasonal variation (32±30 nM in of the femoral region studied.
winter vs. 48±28 nM in summer, p<0.05). There was no References: 1- Lacerda AS et al. Braz Dent J 201;21:199. 2-
significant association of 25-OH-D with 6MWD (p=0.33). Sarazin M et al. Joint Bone Spine 2000;67:408. 3- Tsuang YH
However, the patients with vitamin D deficiency (25-OH-D et al. J Orthop Surg 2006;7:1.
<50 nM) exhibited a positive association between serum 25- Acknowledgements: CAPES-Brazil
OH-D and maximum inspiration force (PI), p<0.01.
Conclusion: We found a high prevalence of Vitamin D defi-
ciency in German COPD patients. This is not only important P686
for the risk of secondary osteoporosis, but probably also for OSTEOPOROSIS PROGRESSION AT PATIENTS
the pulmonary function. Vitamin D deficiency was associated WITH RHEUMATOID ARTHRITIS IN DIFFERENT
with less inspiration force. However, a causal relationship has TYPES OF TREATMENT—EXTENSIVE STUDY
yet to be proved. A. M. Bumbea1, R. Traistaru1, A. C. Bighea1, R. S. Popescu1
1
References: Romme et al. Ann Med 2013;45:91 University of Medicine and Pharmacy, Craiova, Romania

Objective: We evaluated the progression of osteoporosis at

patients with rheumatoid arthritis and osteoporosis in therapy
P685 with bisphosphonates at two groups of patients; one in
BONE MINERAL DENSITY EVALUATION IN RATS remissive treatment with leflunomid or methotrexate versus
SUBMITTED TO DAILY DIET OF COFFEE AND biological agent, in a retrospective study for a 6-year period of
SOFT DRINKS time, 2007–2013.
M. B. Carrazzone Cal Alonso1, A. I. Vespasiano Silva1, J. F. Material and Methods: We have analyzed a number of 54
Quirino Luzada2, P. C. Aranha Watanabe3, F. Haiter-Neto1 patients split in two homogeneous groups - each with 27 patients;
1
Department of Oral Diagnosis and Dental Radiology- all the patients have been diagnosed with osteoporosis. The A
Piracicaba Dental School - University of Campinas Group has received a treatment with 20 mg of leflunomid daily
(UNICAMP), Piracicaba, Sao Paulo, Brazil, 2Department of and non steroidal anti-inflammatory drugs or methotrexate,
Stomatology, Public Health and Forensic Dentistry - Ribeirão 20 mg per week. The B Group has received a treatment with
Preto School of Dentistry - University of São Paulo (USP), biological agents. Both groups have received bisphosphonates in
Ribeirão Preto, Sao Paulo, Brazil, 3Department of Support, therapeutic doses being evaluated for osteoporosis. We also
Product and Animal Health, medicine Veterinarian School of mention that at 12 patients treated with leflunomid there was
Araçatuba (UNESP), Araçatuba, Sao Paulo, Brazil necessary corticosteroids therapy in doses of 16 mg/day with a
diminishing level of 8 mg on a period of 2 up to 6 months; the
Objective: To investigate and compare the effects of coffee patients with methotrexate did not need corticoids therapy during
and soft drinks (Coca-Cola and Guaraná) in bone metabolism the study. Patients in biological therapy did not need corticoste-
in male and female rats, by assessing BMD. roids therapy.
Material and Methods: A total of 80 rats (Rattus norvegiau Results: The A group of study presented the maintenance of
Albinus, Wistar), 40 males and 40 females were used, 8 median of T-score at −2.9 SD. The B Group of study presented
groups of 10 animals each were divided into: Group 1 and the diminishing of the level of osteoporosis from a T-score from
2: control group which received only water, Groups 3 and 4: −3.9 to 3.0. These levels showed osteopenia in the witness group
water management and coffee; Groups 5 and 6: water and a T-score from −1.8 to −2.4 with a passing to osteoporosis at 6
Coca-Cola soft drink; Groups 7 and 8: water and guaraná soft patients who needed to receive bisphosphonates.
drink. All the left femora from each animal were dissected and Conclusion: The diminishing level of osteoporosis with 0.2
examined by DXA and the BMD was obtained. Data were SD per year at the group of patients in therapy with biologic
tabulated and statistical analysis was performed using agents as compared to the group treated with leflunomid
ANOVA and Tukey test. proves the fact that despite the beginning of the first group
Results: For females, significant differences were found when with lower values it obtained better results in both reducing
all groups except for Coca-Cola X guarana (p>0.01) were the level of disease activity and the pathogenic immune in-
evaluated. No differences between groups were found for flammatory context. The patients treated with methotrexate
Osteoporos Int

have received the same result as group threated with biolog- P688
ical therapy. BONE MASS AND FRACTURE RATE IN PATIENTS
WITH INFLAMMATORY BOWEL DISEASE
C. Horvath1, A. Tabak1, D. Marton1, S. Meszaros1, V.
Ferencz1, K. Bors2, P. L. Lakatos1, P. Miheller3, E. Hosszu4
1
P687 Semmelweis University, 1st Department of Internal Medi-
CHANGES IN BONE MASS, VERTEBRAL cine, Budapest, Hungary, 2Rehabilitation Hospital, Visegrad,
FRACTURES AND KYPHOSIS IN PATIENTS WITH Hungary, 32nd Department of Internal Medicine, Semmelweis
NONADVANCED BREAST CANCER TREATED WITH University, Budapest, Hungary, 42nd Department of Pediat-
AROMATASE INHIBITORS, CALCIUM, VITAMIN D rics, Semmelweis University, Budapest, Hungary
AND IBANDRONATE
H. Roldan1, R. Hernandez-San Gil2, L. Brage1, E. Rodriguez- Objective: Patients with inflammatory bowel disease (IBD)
Rodriguez3, L. M. Rodriguez-Rodriguez2, J. Alvisa Negrín3, suffer 20 % more fractures than healthy people. The risk of
J. Plata-Bello1, E. Martin-Ponce3, M. Monereo3, J. M. fracture in IBD increased by 59 % for hip and 74 % for vertebral
Gonzalez-Perez3 fractures, but the pathomechanism of these fractures has not yet
1
Neurosurgery Department, Hospital Universitario de been clarified. Our study aimed to study the bone mineral mass in
Canarias, La Laguna Tenerife, Spain, 2Oncology Department, IBD patients and looking for the role of low bone density in the
Hospital Universitario de Canarias, La Laguna Tenerife, increased fragility.
Spain, 3Internal Medicine, La laguna, Tenerife, Spain Material and Methods: 110 IBD patients (54 men and 56
women, aged 35.2±17 years) with IBD (80 colitis ulcerosa
Objective: Aromatase inhibitors (AI) can decrease bone mass and 30 Crohn’s disease) were involved into the study. 110 age-
and increase the risk of vertebral fractures (VF). This second- and sex-matched patients with suspected metabolic bone dis-
ary effect can be prevented at least partially with a concomi- ease due to other reasons and regularly referred for BMD
tant treatment with calcium, vitamin D and bisphosphonates. measurement were used for comparison. BMD of the lumbar
Our aim was to study the evolution of bone mass, VF and spine, hip and proximal forearm were measured by Prodigy
kyphosis in women with nonadvanced breast cancer who had (GE Lunar) densitometer, and Z-scores were evaluated. Pre-
begun AI and calcium, vitamin D plus monthly ibandronate. vious low- trauma fractures were also registered.
Material and Methods: 118 women (median age 62 years, Results: 23 patients with IBD has suffered fractures (RR: 1.41,
34–80) were prospectively included in the study. A lateral CI 1.27–1.56). Normal bone density was found in the total IBD
dorsal and lumbar spine X-ray and a DXA-scan were obtained group (Z-scores as follows: spine: −0.67, femoral neck: −0.44,
at the onset of treatment and after 1 year. Differences in bone total hip: −0.51, radius: −0.48, p>0.1) as well as in the 31 IBD
mass between patients with or without VF, changes in VF patients of age more than 40 years (Z: −0.65, −0.38, −0.25,
pattern and kyphosis progression were studied. −0.39, respectively, p>0.1). Bone mass of IBD patients with
Results: Treatment adherence was 99 %. Baseline lumbar, fractures showed a borderline decrease of BMD (Z: −0.79,
femoral neck and total hip bone mass increased significantly −0.57, −0.67, −0.55, respectively, p=0.05). Patients with
(p<0.0001) after 1 year of treatment without significant differ- suspected other bone diseases had significantly lower BMD for
ences between patients with and without VF (P=NS). Women spine, femoral neck and radius than that of IBD patients.
with baseline VF exhibit a higher risk of subsequent fractures in Conclusion: IBD patients have normal BMD, in spite of their
the X-ray at 1 year (77.8 % vs. 22.2 %, p<0.0001). Two X-rays higher fracture rate. Compared to other metabolic bone dis-
(1.7 %) displayed VF not present in baseline X-ray (one at L1 eases, IBD produces higher fragility by a different mechanism
grade IIB and one at L3 grade IIC). Two (1.7 %) X-rays showed which seems to be independent of bone mineral mass.
progression in fracture grade (from IA to IIA, from IC to IIIC)
and three demonstrated increase of the degree of kyphosis.
Globally, five patients showed new fractures or some kind of
fracture worsening. P689
Conclusion: The treatment with calcium, vitamin D and MORBID OBESITY, VITAMIN D DEFICIENCYAND
ibandronate increases bone mass in patients with nonadvanced DESTRUCTIVE OSTEOARTHRITIS
breast cancer treated with AI. Despite that fact, two patients had I. Kostoglou-Athanassiou1, P. Athanassiou2, E. Xanthakou3,
new VF and about one third of our patients with previous VF A. Gkountouvas4
1
exhibited fracture worsening. These data can be useful both in Department of Endocrinology, Red Cross Hospital, Athens,
primary and secondary prevention in this specific subset of Greece, 2Department of Rheumatology, St. Paul’s Hospital,
patients, including other therapies like preventive vertebral body Thessaloniki, Greece, 3Endocrinologist, Sparti, Greece, 4En-
cementation in women with fractures at the onset of treatment. docrinologist, Pireaus, Greece
 Osteoporos Int

Objective: Morbid obesity is known to be associated with im- Metabolism Clinic (Osteoporosis Unit), Lisbon, Portugal,
3
paired glucose tolerance, arterial hypertension and fatty liver infil- CEDML, Lisbon’s Endocrinology, Diabetes and Metabolism
tration. Morbid obesity is, however, also associated with musculo- Clinic (Osteoporosis Unit), Lisbon, Portugal, 4Endocrinology,
skeletal disorders, in particular destructive inflammatory osteoar- Diabetes & Metabolism Department, Santa Maria University
thritis. The aim was to describe a cohort of 10 patients with morbid Hopistal, CHLN-EPE, Lisbon, Portugal
obesity, vitamin D deficiency and destructive osteoarthritis.
Material and Methods: All patients were women, 3 premeno- Objective: Hyperthyroidism associates to reduced BMD and/
pausal, 7 postmenopausal. All had morbid obesity, BMI>40 and or osteoporosis and to fragility fractures. In subclinical hyper-
metabolic syndrome. All had vitamin D deficiency. Rheumatoid thyroidism (normal thyroid hormones, suppressed TSH), bone
factor was negative and C-reactive protein was mildly increased. deleterious effects can already be detected due to both bone
Results: All had destructive inflammatory osteoarthritis man- formation and resorption inhibition by the TSH alone. More-
ifesting with severe pain and causing mobility impairment. In over, the negative impact of the disease on the lean mass can
2 of the patients successful dieting had as a result weight loss. worsen the risk of falls, which is crucial in the physiopathol-
Subsequently painful inflammatory osteoarthritis went into ogy of osteoporotic fractures. Evaluation of the subclinical
remission. The patients were able to stop the anti- and overt hyperthyroidism effects on the BMD and in the
inflammatory and analgesic agents they were taking. body soft tissue composition of elderly men.
Conclusion: We hypothesize that the adipose tissue, especially Material and Methods: A group of 86 men older than 50 years
the abdominal adipose tissue, produces inflammatory cytokines were divided in the subclinical (n=13), the overt hyperthyroid-
which are responsible for the development of severe destructive ism (n=30) and two control groups (n=13 and n=30). The BMD
inflammatory generalized osteoarthritis. Additionally, in these (g/cm2) at the lumbar spine (L1-L4), at the hip, at the distal radius
patients vitamin D deficiency is observed, which may be due (1/3 or 33 %) and at the whole body, as well as the total body soft
to the acute inflammatory response observed in patients with tissue composition (lean and fat masses, kg) were evaluated by
morbid obesity and may contribute to the painful musculoskel- DXA (Hologic QDR Discovery W). Fasting blood collection
etal disorder. was performed to measure: TSH, FT4, FT3, pituitary hormones
levels and bone remodelling markers. The hyperthyroid sub-
groups were paired to otherwise normal men (control sub-
P690 groups). No patient was previously treated for hyperthyroidism
CLINICAL AND SUBCLINICAL or low bone mass/osteoporosis. Descriptive, Anova and regres-
HYPERTHYROIDISM IN ADULT MEN: IMPACT ON sion analysis statistical tests were used.
THE BONE MINERAL DENSITYAND SOFT TISSUE Results: The means of the total body masses and the BMD
COMPOSITION between the subclinical hyperthyroidism and the control were
A. P. Barbosa1,2,3,4, M. R. Mascarenhas1,2,3,4, M. Bicho2, I. Do identical. Overt hyperthyroidism subgroup, the mean BMD in
Carmo1,2,4 all skeletal regions except L1-L4 (total hip g/cm2 1.019 (±0.1)
1
Endocrinoly, Lisbon’s Endocrinology, Diabetes and Metab- vs. 0.934 (±0.1) p0.0053; distal radius g/cm2 0.762 (±0.05) vs.
olism Clinic (Osteoporosis Unit), Lisbon, Portugal, 2Environ- 0.706 (±0.08) p0.0086); the mean total lean mass (57.4 (±8.2)
mental Health Institute, Lisbon’s Endocrinology, Diabetes and vs. 53.1 (±6.1) kg, p0.0337) were significantly lower.

Conclusion: The results of this study suggest that the body similar to normal, while in the overt hyperthyroidism there are
composition in a group of subclinical hyperthyroid adult men is significant decreases in the cortical bone and in the lean mass.
Osteoporos Int

P691 P692
VITAMIN D DEFICIENCY IN HUNGARIAN CINACALCET IN THE TREATMENT OF PRIMARY
CHILDREN WITH TYPE 1 DIABETES MELLITUS HYPERPARATHYROIDISM
OR IMPAIRED GLUCOSE TOLERANCE I. Kostoglou-Athanassiou1, P. Athanassiou2, E. Xanthakou3,
E. Hosszu1, B. Menczel1, S. Meszaros2, V. Ferencz2, K. Bors3, A. Gkountouvas4, P. Kaldrymides5
E. Csupor4, C. Horvath2 1
Department of Endocrinology, Red Cross Hospital,
1
2nd Department of Pediatrics, Semmelweis University, Bu- Athens, Greece, 2 Department of Rheumatology, St.
dapest, Hungary, 2Semmelweis University, 1st Department of Paul’s Hospital, Thessaloniki, Greece, 3Endocrinologist,
Internal Medicine, Budapest, Hungary, 3Rehabilitation Hos- Sparti, Greece, 4Endocrinologist, Pireaus, Greece, 5De-
pital, Visegrad, Hungary, 4Budavar Endocrine Unit, Budapest, partment of Endocrinology, Metaxa Hospital, Pireaus,
Hungary Greece

Objective: A growing body of data suggest that vitamin Objective: Primary hyperparathyroidism is currently rec-
D status has a significant impact not only for bone ognized with increasing frequency by routine calcium
health but also for the general health, including the measurement in biochemical examinations. Primary hy-
avoiding of some malignancies, autoimmune or meta- perparathyroidism may be due to a parathyroid adeno-
bolic diseases. Diabetes mellitus is one of the largest ma, parathyroid hyperplasia and, rarely, parathyroid car-
social-medical problem worldwide, and vitamin D status cinoma. Cinacalcet is used in the medical management
probably plays an important role in the development of of primary hyperparathyroidism. The aim was to assess
this disease. The aim of our study was to estimate the the role of cinacalcet in the treatment of primary
occurrence of vitamin D deficiency in Hungarian chil- hyperparathyroidism.
dren with type 1 diabetes mellitus (DM-T1) and in Material and Methods: Patients with primary hyperpara-
impaired glucose tolerance (IGT). thyroidism (n = 20) (aged 56–85 years) were studied.
Material and Methods: 180 children (healthy, DM-T1 or Amongst them 4 patients had parathyroid hyperplasia
IGT) of both genders between 4 and 18 years of age and 16 had a parathyroid adenoma. Calcium and PTH
were involved into the study (BMI 3-97 percentiles). levels were increased in all patients. All patients had
Fasting serum level of 25OHD3 was determined in all ultrasonography and a 99mTc-Sestamibi scan. In 16 pa-
cases. BMD for lumbar spine and for total body were tients a parathyroid adenoma was observed either on
also measured by a Hologic Discovery bone ultrasound or on scanning or in both. In 4 of the
densitometer. patients a parathyroid adenoma was not localized by
Results: Normal 25OHD levels (>30 ng/ml) were found imaging.
in 17 % of healthy, 18 % of IGT and 18 % of DM-T1 Results: Cinacalcet was used in all 16 parathyroid
children. Insufficient vitamin D status (25OHD: 20– adenoma patients to normalize serum calcium levels
30 ng/ml) was found in 83 %, 31 % and 44 %, respec- prior to surgery. In 10 of the parathyroid adenoma
tively. Vitamin D deficiency (25OHD <20 ng/ml) was patients the adenoma was surgically excised, in a
not detected among healthy children while it occurred in female aged 56, hyperparathyroidism recurring a year
42 % of IGT and 36 % of DM-T1 participants. Severe after surgery. Sequentially, cinacalcet was adminis-
vitamin D deficiency was found in 5 % of IGT and 2 % tered at a dose of 30 mg twice daily and serum
of DM-T1. All differences were significant between the calcium levels normalized. Within the group of pa-
pathologic and the healthy groups while no difference tients with a parathyroid adenoma 6 were elderly,
was shown between the IGT and DM-T1 groups. BMD aged >75 years, with comorbidity and cinacalcet was
Z-scores were found below −2 in 37 % of IGT and in administered at a dose of 30 mg twice daily in 3 and
25 % of DM-T1 but only 0.3 % in healthy children. 60 mg twice daily in 1 to avoid surgery. In the group
Relationship between vitamin D status and bone mass is of patients with parathyroid hyperplasia cinacalcet
under evaluation. was used for the treatment of hypercalcemia. Within
Conclusion: These results provide further argument that the whole group, 2 patients experienced mild gastro-
vitamin D deficiency has harmful potential to the de- intestinal symptoms, but discontinuation of the drug
velopment of DM-T1 not only in adults but in child- could be avoided.
hood as well. Parallel detection of low bone mineral Conclusion: Cinacalcet may be used for the treatment of
mass suggest that these pathologic conditions in the primary hyperparathyroidism. It can be used for the
period of body and bone development can play an normalization of serum calcium prior to surgery, if
important role in the higher fragility observed in adults surgery is not an option, in the event of recurrence after
with diabetes mellitus. surgery and in parathyroid hyperplasia.
 Osteoporos Int

P693 Objective: Osteoarticular fungal infections are rare. Their

JAW OSTEONECROSIS IN A PATIENT WITH occurrence is favored by invasive procedures, surgery, diabe-
POSTMENOPAUSAL OSTEOPOROSIS ON tes, broad spectrum antibiotics and immunosuppression.
ANTIRESORPTIVE TREATMENT Material and Methods: We report a case of chronic osteo-
I. Kostoglou-Athanassiou1, P. Athanassiou2, E. Xanthakou3, myelitis of the leg to Candida albicans in a young immuno-
P. Kaldrymides4 competent patient.
1
Department of Endocrinology, Red Cross Hospital, Athens, Results: Z.S. 37 years old, with a history of Crohn’s disease,
Greece, 2Department of Rheumatology, St. Paul’s Hospital, adrenal insufficiency, chronic osteomyelitis of the left fibula in
Thessaloniki, Greece, 3Endocrinologist, Sparti, Greece, 4De- 2003, a bone graft in 2011 and a bacterial bone infection in
partment of Endocrinology, Metaxa Hospital, Pireaus, Greece 2013, was hospitalized for fever, bone pain at the left leg.
Physical examination is a painful inflammatory closet at the
Objective: Postmenopausal osteoporosis is a common condi- outer side of the left leg with a fistula making welling of
tion affecting many women. Management of postmenopausal yellowish serous fluid. Biologically, she had leukopenia
osteoporosis involves the administration of vitamin D, calci- 3,600/mm3, CRP 36 mg/l. Radiography of the leg showed
um and antiresorptive agents. The long-term management of images of osteolysis and a periosteal reaction to the tibial and
postmenopausal osteoporosis with antiresorptive agents may fibular level. The diagnosis of bacterial osteomyelitis was
present some dangers and adverse effects such as bone necro- raised and the patient was treated with two antibiotics (cefo-
sis or atypical bone fractures. The aim was to describe the case taxime and fosfomycin). The evolution was marked by per-
of a female patient with postmenopausal osteoporosis who sistent fever with worsening local inflammatory signs. The
presented with acute pain in the jaw and was diagnosed with patient was then operated. The mycological examination of
jaw osteonecrosis. intraoperative specimen isolated Candida albicans. Antifun-
Material and Methods: A female patient, aged 68, presented gal therapy (fluconazole) at a dose of 400 mg/day for a total
with acute pain in the left side of the mandible after a tooth period of 6 months was established. The outcome was
extraction. X-ray examination revealed jaw osteonecrosis. favorable.
The patient had postmenopausal osteoporosis. She had pre- Conclusion: Bone and joint infections due to Candida are
sented with premature menopause at the age of 40 and had rare. They are dominated by spondylodiscitis. The osteitis of
been treated with oestrogens. Thereafter alendronate had been long bones are less frequent. Their clinical presentation is
administered. Alendronate was discontinued and a year later nonspecific. Their diagnosis is often delayed. The prognosis
denosumab was initiated. The patient presented with acute jaw depends on the terrain and the time of initiation of appropriate
pain lasting for a month. As she had periodontitis, she attrib- antifungal therapy.
uted the pain to this affliction.
Results: CT examination revealed osteonecrosis of the man-
dible. Antibiotics were administered and oral hygiene with
chlorhexidine was instructed. The patient adhered and the pain P695
improved, not ceasing, however, completely. THE RISK OF OSTEONECROSIS OF THE JAW IN
Conclusion: Jaw osteonecrosis is a rare adverse effect of TAIWANESE OSTEOPOROTIC PATIENTS TREATED
antiresorptive therapy for postmenopausal osteoporosis. It is WITH ORAL ALENDRONATE OR RALOXIFENE
known to occur especially in patients with poor oral hygiene W.-Y. Chiu1, J.-Y. Chien2, W.-S. Yang3, J.-M. J. Juang2, J.-J.
and may be related to excessive suppression of bone turnover. Lee4, K.-S. Tsai1
1
It can cause diagnostic difficulties as the intense pain may be Division of Endocrinology and Metabolism, Department of
attributed to various dental problems that the patient may be Internal Medicine, National Taiwan University Hospital, Tai-
experiencing. Management of jaw osteonecrosis involves the pei, Taiwan, Province of China, 2Department of Internal Med-
administration of antibiotics, oral hygiene with chlorhexidine icine, National Taiwan University Hospital, Taipei, Taiwan,
and in some cases surgical removal of the affected bone. Province of China, 3Graduate Institute of Clinical Medicine,
College of Medicine, National Taiwan University, Taipei,
Taiwan, Province of China, 4Division of Oral and Maxillofa-
P694 cial Surgery, Department of Dentistry, National Taiwan Uni-
CHRONIC OSTEITIS DUE TO CANDIDA ALBICANS versity Hospital, Taipei, Taiwan, Province of China
IN AN IMMUNOCOMPETENT PATIENT
L. A. Fatma1, B. S. Wafa1, A. Wafa1, C. Wafa1, L. Chawki2, S. Objective: To explore the possible association between
Mohamed Habib1 osteonecrosis of the jaw (ONJ) and oral alendronate or ralox-
1
Tahar Sfar Hospital, Mahdia, Tunisia, 2Fattouma Bourguiba ifene used for osteoporosis and to estimate its absolute and
Hospital, Monastir, Tunisia attributable risks in Taiwanese population.
Osteoporos Int

Material and Methods: Using an electronic medical records each method (0.142–1.351 ng/mL and 16–96 μg/L, for CTX
system and manual confirmation of ONJ, we identified pa- and P1NP, respectively). Correlation between both BTMs was
tients who began taking alendronate or raloxifene for osteo- high (r=0.72). Both BTMs are correlated with alkaline phos-
porosis and developed ONJ between January 2000 and April phatase: CTX (r=0.36) and P1NP (r=0.46). Negative corre-
2012. lations were noted between CTX (r=−0.20, p<0.001) and
Results: The frequency of ONJ related to oral alendronate P1NP (r=−0.18, p=0.001) with lumbar spine T-score. CTX
over a 12-year period was 0.54 %. The incidence rate of ONJ (r=−0.13, p<0.001) and P1NP (r=−0.12, p=0.001) were
attributed to alendronate exposure was 280 per 100,000 per- correlated with age.
sons per year. On multivariate Cox proportional analysis, Conclusion: Median BTMs were in the normal range. Nega-
adjusting for the potential confounders, alendronate remains tive correlation between BTMs and lumbar spine and age was
an independent predictor for ONJ occurrence (HR 7.38 [1.01– found. These values can help as a Brazilian reference database
53.78]) compared with raloxifene. Advanced age, drug dura- for postmenopausal women with low bone mass.
tion, coexisting diabetes and rheumatoid arthritis are contrib- Disclosures: Dr. Chiang is Eli Lilly’s employee.
uting factors to the development of oral alendronate-related
ONJ.
Conclusion: We provided the evidence to support the associ- P697
ation of ONJ with oral alendronate used in treating or ANALYTICAL STUDY ON JAPANESE HEALTH
preventing osteoporosis. EDUCATION TEXTBOOKS FOR ELEMENTARYAND
HIGH SCHOOL STUDENTS ON OSTEOPOROSIS
S. Iwanaga1, M. Noami1, K. Kusaka1, K. Harano2, M. Tanaka3,
P696 K. Satomura1, T. Nakahara1
1
SERUM CTX AND P1NPAND THEIR CORRELATION Department of Public Health, Faculty of Medicine, Kyoto
WITH BMD IN POSTMENOPAUSALWOMEN WITH University, Kyoto, Japan, 2Embassy of Japan, Rwanda, Kiga-
LOW BONE MASS: DATA FROM ARZOXIFENE li, Rwanda, 3Osaka City Mental Health Center, Osaka, Japan
GENERATION TRIAL
H. P. Arantes1, A. Y. Chiang2, J. P. Bilezikian3, M. Lazaretti- Objective: As appropriate habits and behaviors from a young
Castro1 age can help prevention of osteoporosis, school health educa-
1
UNIFESP, Sao Paulo, Brazil, 2Eli Lilly, Indianapolis, United tion is important. We observed and evaluated the description
States, 3Columbia University, New York, NY, United States content on osteoporosis in Japanese health education textbooks.
Material and Methods: All the health education textbooks in
Objective: Bone turnover markers (BTMs) have been used in use in elementary, junior and senior high schools in Japan
clinical trials to understand the therapeutic agents’ mechanism were analyzed for comparison.
of action, to evaluate adherence to treatment, predictors of Results: All the textbooks for lower grades of elementary
changes in BMD loss and fracture risk. The objective of this students (ages 9–10) devote 2–3 pages for a unit named
study was to evaluate serum BTMs in postmenopausal Bra- “Better Body Growth” which contains the sentences, “calcium
zilian women with low bone mass. makes the bone and tooth” and “exercise makes bone strong”,
Material and Methods: The source was a subset from the those basic and important facts. There is nothing described in
phase III trial of Arzoxifene Generation Trial (n=619), com- the textbooks for higher grades of elementary students (ages
prised of low bone mass patients, 60–85 years old. Measure- 11–12) on bone health. All the textbooks for junior high
ments of serum P1NP (Orion Diagnostica, Espoo, Finland), students (ages 13–15) have 2 pages each for “diet and health”
serum CTX (Crosslaps ELISA Nordic Bioscience Diagnostics and “exercise and health”, there contains the sentences, “ex-
AS, Herlev, Denmark), alkaline phosphatase, ionized calcium, ercise increases bone mass/density”, “young time behavior
creatinine and baseline BMD (lumbar spine, neck and total dictates bone growth” and 3 out of 4 of them shows figures
hip) were measured. Statistical analysis was performed by of osteoporosis bone, but only one textbook describes the
program SPSS 17.0. Median (minimum and maximum) were word “osteoporosis”. All the senior high textbooks have the
calculated for all parameters and Spearman correlation, when word “osteoporosis” related with aging or life time health.
appropriate, as well as distribution of BTMs. Calcium deficiency is mentioned in two textbooks of each
Results: Median (minimum and maximum) for age, CTX and high school, and two of senior high textbooks are mentioned
P1NP were, respectively, 66.0 (60–85) years, 0.580 (0.099– “phosphorus prevents absorption of calcium”. Figure of oste-
1.929 ng/mL) and 47.9 (8–158.0 μg/L). Distribution of CTX oporosis bone is not found in the senior high textbooks.
and P1NP with percentiles 5, 25, 50, 75 and 95 % was, Conclusion: Very basic issues of bone development both on
respectively, 0.24, 0.42, 0.58, 0.78, 1.15 and 24.1, 36.9, nutrition and exercise are described for the lower primary
47.9, 61.7, 90.3. Both BTMs were in the normal range of students which should be valued for the early education.
 Osteoporos Int

And also there are not a little scientific description on bone WOMAC score values were 10.9±3.7 for pain, 4.5±1.9 for
health in high school textbooks relevant to many aspects of the stiffness, 36.4±12.8 for physical function. The total WOMAC
life stage. Although uninterrupted education supposed be score was 51.9±16.9 (0–96). The mean value EQ-VAS health
considered in higher grades of elementary years which is was 64.9 (mean)±16.2 (SD).
important period for the bone growth. There was no difference in the two age groups. Mean EQ-VAS
value and WOMAC were not statistically different between
the various KL-score groups:
P698
RADIOLOGICAL AND CLINICAL PROFILE OF
OSTEOARTHRITIC PATIENTS UNDERGOING
TOTAL KNEE REPLACEMENT SURGERY
A. Neuprez1, G. François1, W. Kurth2, T. Thirion2, C. Daniel2,
J. P. Huskin2, P. Gillet2, J.-Y. Reginster1
1
Department of Public Health, Epidemiology and Health Eco-
nomics, Liège, Belgium, 2Orthopaedic Surgery CHU, Liège,
Belgium

Objective: Arthritic conditions are extremely painful for the

patient and are associated with a significant reduction in health
related quality of life (HRQOL), mainly in term of physical Conclusion: We concluded that patients undergoing total
and functional impairment. Therefore, the demand for total knee replacement in a University setting, in Belgium, do
joint replacement (TJR) is increasing. The objective of the present with a moderate to severe radiological OA. Indepen-
present study was to access the demographic information, dently of the age and the radiographic stage, all patients
radiological and clinical presentation of osteoarthritic patients undergoing total joint replacement have similar symptomatic
undergoing of total knee replacement surgery. features. The patients aged <65 years had higher BMI and
Material and Methods: We analyzed the demographic infor- longer duration of complaints. Surgical decision process is
mation, preoperative radiologic (Kellgren-Lawrence score) mainly related to impairment of pain and function.
and clinical status (HRQOL - EQ-VAS) of 279 consecutive
patients undergoing total knee replacement for symptomatic
osteoarthritis of the knee. We compared also the clinical P699
parameters in 2 groups according to age (≤ or >65 years). TRABECULAR BONE SCORE (TBS) IMPROVES
Specific HRQOL was assessed with the WOMAC Index and IDENTIFICATION OF OSTEOPENIC
the health with the EQ-VAS. These questionnaires were ad- POSTMENOPAUSALWOMEN SUSCEPTIBLE TO
ministered preoperatively. Student t-tests were used to com- OSTEOPOROTIC FRACTURES: POLISH STUDY
pare mean values of BMI, duration of complaints, EQ-VAS M. Ignaszak-Szczepaniak1, A. Wawrzyniak2, M. Michalak3
1
and WOMAC in the two age groups. ANOVA was performed Poznan University of Medical Sciences, Laboratory of Met-
to compare mean values of EQ-VAS and WOMAC according abolic Bone Diseases, Poznan, Poland, 2Department of Fam-
to the Kellgren-Lawrence score. ily Medicine Poznan University of Medical Sciences, Poznan,
Results: Our cohort included 127 men and 152 women aged Poland, 3Department of Computer Science and Statistics,
from 39 to 86 years (mean 66.8±8.9 (SD)) and with a BMI of University of Medical Sciences, Poznań, Poland
29.3±4.7. 123 of them received left knee prosthesis and 126
of them right knee prosthesis. 124 (44.4 %) were ≤65 years Objective: Most osteoporotic fractures occurs in patients
and 155 (55.6 %) were >65 years. classified as osteopenia according to WHO definition. The
The mean duration of complaints was 3889.2 days±3890.8 or aim was to assess whether TBS can differentiate postmeno-
10.7 years±10.7 years. They were all diagnosed with primary pausal osteopenic women with previous osteoporotic fractures
OA following the ACR criteria. Mean BMI and mean duration from those without and to estimate how TBS can improve
of complaints were statistically different (higher in patient’s assessment of fracture risk in these patients.
group ≤65 years) in the two age groups. 272 pre-operative X- Material and Methods: 392 female patients of Osteoporosis
ray assessments were available and analyzed. Out of the 272, Specialty Outpatient Clinic in Poznan, Poland were recruited
4.4 % (n=12) were presenting with a KL-score of 1; 15.8 % to the study. For each of them fracture status was reviewed in
(n=43) were presenting with a KL-score of 2; 68.8 % (n=187) medical record and vertebral fractures (VFs) were identified
with a KL-score of 3 and 11 % (n=30) with a KL-score of 4. by VFA. Spine DXA images of all subjects (Lunar Prodigy)
There was no difference in the two age groups. The mean were reanalyzed using TBS iNsight software. Further analysis
Osteoporos Int

considered only women with -1.0<T-scores<−2.5, who were Clinical evaluation was performed at the baseline, after 1 month
compared in terms of TBS, fracture status and location. 3 and 6 months later. To assess the functional state used the
recommended thresholds of TBS were applied. Lequesne index. For statistical analysis of data there were applied
Results: In 145 osteopenic women aged 50–92 (mean SPSS Windows 16.
70.1 years), we identified 50 previous major osteoporotic frac- Results: In both groups of patients after a month of therapy,
tures (osteoFx), including 24 VFs Genant grade 2/3. Mean TBS there was statistically significant improvement of Lequesne
for osteoFx was 1.13 vs. 1.21 for nonfractured (p=0.005); In index p<0:000. Significant remission was maintained after
VFs, patients mean TBS was 1.08 vs. 1.20 in women without 6 months I group p<0.002 and II group p<0.000. Comparing
VFs (p<0.0003). 68 % of osteoFx subjects were below the the results between I and II groups using Pearson correlation
lowest TBS tertile and 10 % were over the highest one. In women test, II group showed statistically better value p<0.005.
with VFs 87.5 % had TBS<1.200 and only 4 % TBS>1.350. The Conclusion: Analysis of the data showed that infiltration of
difference was significant (p=0.0005). Comparing women with hyluronan was significantly better in patients with knee OA in
and without osteoFx depending on TBS thresholds, ORs were II and III stage of disease by Kellgren-Lawrence and signifi-
respectively: 3.6 for L vs. H tertile (p=0.014) and 2.7 for L vs. M cantly improves the functional capacity of the knee joint and
tertile (p=0.016). Risk of VFs was 9.90 for L vs. H tertile (p= thereby reducing the progression of the disease.
0.009) and 8.52 when compared L vs. M tertile (p=0.001). There
was no difference between tertiles M and G.
Conclusion: 1. The relationship between TBS and fractures in P701
women with osteopenia is significant - the probability of INFLUENCE OF THE SHARED EPITOPE IN BONE
fracture increases with TBS decrease. MINERALE DENSITY IN RHEUMATOID ARTHRITIS
2. TBS improves fracture risk assessment in osteopenic fe- S. Boussaid1
1
male patients, particularly identification of women susceptible Habib Thameur Hospital, Tunis, Tunisia
to vertebral fractures.
3. In osteopenia TBS<1.200 is related to 10 times higher risk Objective: The most important genetic risk factor for rheu-
of vertebral fracture as compared to TBS>1.350. matoid arthritis (RA) is the HLA-class II alleles. In particular,
the HLA-DRB1 alleles. The aim of this study is to focus on
the association between RA, HLA class II gene (DRB1 and
P700 DQB1) and osteoporosis.
THERAPEUTIC EFFECT VISCOSUPLEMENTA AND Material and Methods: This prospective study was per-
LOCAL INFILTRATION OF CORTICOSTEROID IN formed on a total of 81 Tunisian patients with RA including
PATIENTS WITH KNEE OSTEOARTHRITIS 67 women and 14 men (sex ratio 4.78). All patients fulfilled
M. Jeremic1 the American College of Rheumatology (ACR 1987) criteria
1
Institute of Rheumatology, Belgrade, Serbia for RA. RA associated with other auto-immune pathologies
have been excluded from the study. For each patient BMD
Objective: To evaluate the therapeutic effects of infiltration was measured in lumbar spine, femoral neck, trochanter, and
corticosteroids (C) and hyaluronan sodium in patient suffering Ward’s triangle. The DNA was extracted from lymphocytes
from knee osteoarthritis. using a commercial kit (Qiagen). The HLA class II (DQB1
Material and Methods: Clinical study included 45 patients and DRB1) was performed by PCR technique specifying-
(27 women and 8 men) between the ages of 41–68 year, an sequence primers (PCR-SSP). The specific products of PCR
average of 54.5±8.2 treated at the Institute of rheumatology. The were analyzed by 2.5 % agarose gel electrophoresis.
duration of illness ranged from 0.6 to 5 years, the average 2.8.g. Results: Demographic traits of the patients were: mean age
(3.1±0.5). Length of the last deterioration was 2–7 months (6.2± 49.17±11.21 years (age 24–78). The disease average duration
1.2). The study included patients with knee osteoarthrosis II and was 7.44±2.12 years (4 months–29 years), 82.71 % were
III level by Kellgren-Lawrence without effusion, who previously women and 17.29 % men. Seropositive RA were 80.24 %,
did not have a positive therapeutic response to analgesics and and 71 % of RA have anti CCP positive antibody.
NSAIDs or physiotherapy. The diagnosis was based on clinical, HLADQ*0201, *0301, *0501 and *0601 were associated
X-ray and ultrasound examination. The patients were based on with seropositive RA. HLADQB1*0401 and *0302 were also
clinical findings randomly divided into two groups: Group I associated with seropositive RA, but with less significance.
included 20 patients who received local intraarticular infiltration Four DRB1*0401 were homozygotes and all of them were
of corticosteroid (dyprophos amp. 7 mg/ml betamethasone) at seropositive RA. The occurrence of osteoporosis is not corre-
baseline. II group of 25 patients received intraarticular infiltration lated with the presence of shared epitope (p=0.6). However,
of lubricant (GO- ON 25 mg/2.5 ml sodium hyaluronate for three the number of patients carrying the shared epitope and with
consecutive weeks). Both groups had the same exercises therapy. osteoporosis is much lower than in patients without (41
 Osteoporos Int

patients against 9). The shared epitope in single dose P703

appears to be a protective factor against osteoporosis PHYSICAL FUNCTION OF PATIENTS WITH KNEE
(p<0.001). OSTEOARTHRITIS AFTER ARTHROPLASTY
Conclusion: Our results indicate that, in addition to HLA- Z. Jovicic1
1
BRB1 alleles, HLA-DQB1 alleles also augments the genetic Department of Orthopaedic Surgery, Institute for Rehabilita-
susceptibility to seropositive RA. tion Dr Miroslav Zotovic, Banjaluka, Bosnia and Herzegovina

Objective: Osteoarthritis of the knee is one of the leading

causes of disability in the elderly population. Total knee
P702 arthroplasty has been shown to be an effective procedure in
ANATOMICAL DAMAGE OF WRISTS AND BONE improving of physical function of these patients. Clinical
MINERAL DENSITY IN FEMALE PATIENTS assessment of patients before knee arthroplasty could predict
SUFFERING FROM RHEUMATOID ARTHRITIS physical function of patients with knee osteoarthritis after
N. Krstic1 arthroplasty. The aim of this study was to establish correlation
1
Clinical Centre of Serbia, Department of Physical Medicine between physical function 6 weeks after knee arthroplasty and
and Rehabilitation, Belgrade, Serbia early rehabilitation with clinical parameters (age, BMI, phys-
ical function, pain and stiffness) before arthroplasty.
Objective: To study the level of anatomical damage on wrists Material and Methods: Prospective research includes 96
and BMD in female patients suffering from RA, and then to patients (average age 67.5±9.2 years, range of 45–78 years)
study as to whether there is a correlation between these that underwent total knee arthroplasty after preoperative reha-
changes. bilitation. Early program of kinesitherapy and occupational
Material and Methods: The cross-sectional study covered therapy was performed. Instrument used for assessment of the
100 female patients suffering from RA, who were treated on physical function, pain and stiffness is modified version of
the Institute of Rheumatology, Nov 2006–Nov 2007. On all WOMAC Index. All patients completed the questionnaires
the female patients osteodensitometry was performed in the preoperatively and 6 weeks postoperatively. Pearson test of
first year after the diagnosis had been made and X-ray images correlation was used to analyze numerical data.
of wrists were also made. The level of anatomical damage on Results: Physical function 6 weeks after arthroplasty shows
wrists was monitored and assessed applying the Larsen meth- significant correlation with physical function preoperatively
od. A higher value of the Larsen index indicated a poorer (r=0.219, p<0.05), but with age, BMI, pain and stiffness was
condition of the analyzed wrists. Thereafter, a correlation was not.
made between the values of the T-score and the values of the Conclusion: Results of our research show that physical func-
Larsen index. tion of the patients with knee osteoarthritis before arthroplasty
Results: In the studied sample of female patients, the total influences on the level of physical function after total knee
value of the Larsen score was 40.46±18.38. By strati- arthroplasty. These findings can be important for creating the
fication of the values of the scores for the left and the program of preoperative rehabilitation and for assessment of
right wrist, it was noticed that the value of the left wrist indications for knee arthroplasty.
Larsen score was 20.11±9.27 and, of the right one, it
was 20.35±9.44, without a statistically significant dif-
ference (t =−0.696, p = 0.488). The total value of the
Larsen index was 2.05±1.02. By stratification of the P704
values of the scores for the left and the right wrist, it RHUPUS: THE COEXISTENCE OF SYSTEMIC
was noticed that the value of the left wrist Larsen index LUPUS ERYTHEMATOSUS AND RHEUMATOID
was 2.23±1.03 and, of the right one, it was 2.26±1.05. ARTHRITIS
BMD was measured in all the female patients and, in P. Athanassiou1, A. Tzanavari1, N. Kalaycheva1
1
32 (32 %), osteoporosis was established (the T-score - Department of Rheumatology, St. Paul’s Hospital,
3.35±1.35). From the moment of verification of osteo- Thessaloniki, Greece
porosis, 3.41±1.80 years (from 1 to 5 years) passed on
average. Objective: The term rhupus is traditionally used for descrip-
Conclusion: Osteoporosis was diagnosed in 32 female pa- tion of the coexistence of systemic lupus erythematosus (SLE)
tients suffering from rheumatoid arthritis. The Larsen index is and rheumatoid arthritis (RA). Within a group of 103 SLE
statistically highly significantly correlated with the values of cases 10 had rhupus. In 5 of these patients lupus characteris-
the T-score. tics appeared first and arthritis followed whereas in the rest
References: Larsen A. J Rheumatol 1995;22:1974 arthritis appeared either simultaneously or before lupus
Osteoporos Int

characteristics. The aim was to describe two cases of patients from lymphocytes using a commercial kit (Qiagen). The HLA
with coexistence of SLE and RA or rhupus syndrome. DRB1 was performed by PCR technique specifying-sequence
Material and Methods: Two cases of rhupus, coexistence of primers (PCR-SSP). The specific products of PCR were ana-
SEL and RA are described. Both patients were female, aged lyzed by 2.5 % agarose gel electrophoresis. All tests include
43 and 57 years, respectively. The first patient had the typical positive and negative controls appropriate for each blood
clinical picture of RA for 15 years, ulnar hand deviation and sample.
typical radiologic RA characteristics. She developed protein- Results: Demographic traits of the patients were: mean age
uria, hematuria, leucopenia, low complement C3 and C4 levels 49.17±11.21 years (age 24–78). The disease average duration
and positive ANA and anti-dsDNA. Renal biopsy revealed was 7.44±2.12 years (4 months–29 years), 82.71 % were
hyperplastic glomerulonephritis. The second patient had SLE women and 17.29 % men. Seropositive RA were 80.24 %,
for 20 years with positive ANA, light sensitivity, fatigue and and 71 % of RA have anti CCP positive antibody. Four
diffuse arthralgias. She had taken low dose corticosteroids and DRB1*0401 were homozygotes and all of them were sero-
hydroxychloroquine. Approximately 6 months ago she ap- positive RA. The occurrence of osteoporosis is not correlated
peared with the clinical picture of seropositive RA with sym- with the presence of shared epitope (p=0.6). However, the
metric polyarthritis and positive anti-CCP antibodies. number of patients carrying the shared epitope and with
Results: In the first patient, with the appearance of SLE and osteoporosis is much lower than in patients without (41 pa-
glomerulonephritis, methylprednisolone and cyclophospha- tients against 9). The shared epitope in single dose appears to
mide pulse therapy was administered with good response. be a protective factor against osteoporosis (p<0.001).
Subsequently, low dose corticosteroids orally and mycophe- Conclusion: Our results indicate that, the shared epitope
nolate mofetil were given. Arthritis remitted. In the second alleles augments the genetic susceptibility to seropositive RA.
patient, with the appearance of RA methotrexate 7.5 mg/week
and golimumab 50 mg/4 week sc were administered. The
patient is now well and inflammation indices are negative. P706
Conclusion: Two cases of rhupus syndrome are described. In IMPACT OF THE SHARED EPITOPE IN THE
the first RA appeared first and SLE features with renal in- PRESENCE OF ANTI CITRULLINATED PEPTIDE IN
volvement appeared many years later, whereas in the second RHEUMATOID ARTHRITIS
SLE features appeared first and RA characteristics appeared B. S. Boussaid1, K. S. Kochbatti1, B. L. Baili1, B. D. Ben
20 years later. In patients with rhupus arthritis is a predomi- Dhaou1, B. F. Boussema1
1
nant feature. Habib Thameur Hospital, Tunis, Tunisia

Objective: To focus in the association between the shared

P705 epitope (SE) and rheumatoid arthritis (RA), and to investigate
IMPACT OF THE SHARED EPITOPE ON THE BONE the involvement of these antigens in predisposition to RA, in
MINERAL DENSITY IN RHEUMATOID ARTHRITIS the severity of the RA and in the production of anti-CCP
B. S. Boussaid1, K. S. Kochbatti1, B. D. Ben Dhaou1, B. L. antibodies.
Baili1, B. F. Boussema1 Material and Methods: This prospective study was per-
1
Habib Thameur Hospital, Tunis, Tunisia formed on a total of 81 Tunisian patients with RA including
67 women and 14 men (sex ratio 4.78). All patients fulfilled
Objective: It is at present widely accepted that both genetic the American College of Rheumatology (ACR 1987) criteria
and environmental factors contribute to the susceptibility and for RA. RA associated with other auto-immune pathologies
severity of the disease. Indeed, HLA genes have been impli- have been excluded from the study. For each patient BMD
cated in one third to one half of RA cases. In particular, the was measured in lumbar spine, femoral neck, trochanter, and
HLA-DRB1 alleles encoding for the shared epitope (SE). The Ward’s triangle. The DNA was extracted from lymphocytes
aim of this study is to focus on the association between RA, using a commercial kit (Qiagen). The HLA DRB1 was per-
the shared epitope and osteoporosis. formed by PCR technique specifying-sequence primers
Material and Methods: This prospective study was per- (PCR-SSP). The specific products of PCR were analyzed by
formed on a total of 81 Tunisian patients with rheumatoid 2.5 % agarose gel electrophoresis. All tests include positive
arthritis including 67 women and 14 men (sex ratio 4.78). All and negative controls appropriate for each blood sample. The
patients fulfilled the American College of Rheumatology phenotypes of patients were obtained through the Software
(ACR 1987) criteria for RA. RA associated with other auto- One Lambda DNA/Software (SSP2L-generic DRB).
immune pathologies have been excluded from the study. For Results: Through this work we have confirmed the involve-
each patient BMD was measured in lumbar spine, femoral ment of the SE in the susceptibility to RA. We also proved that
neck, trochanter, and Ward’s triangle. The DNA was extracted there is a strong correlation between the alleles carrying the SE
 Osteoporos Int

(DRB1*0101, *0401) and the presence of anti-CCP. This P708

correlation is particularly strong for HLA-DRB1*0401. BONE MINERAL DENSITY IN PATIENTS WITH
Conclusion: Through this work we confirmed the involve- PRIMARY HYPERPARATHYROIDISM AFTER
ment of the SE in the susceptibility to RA. We also demon- PARATHYROIDEСTOMY
strated that there is a strong correlation between the alleles A. P. Shepelkevich1, E. V. Brutskaya-Stempkovskaya1, E. V.
carrying the shared epitope (DRB1*0101, 0401) and the Kliausova1, N. A. Vasilieva2
1
presence of anti-CCP. This correlation is particularly strong Belarusian State Medical University, Minsk, Belarus, 2Re-
for the HLA-DRB1*0401 allele. public Center of Medical Rehabilitation, Minsk, Belarus

Objective: Low BMD and osteoporosis in PHPT is the result

of the acceleration of bone metabolism with overproduction of
P707 parathyroid hormone and the rate of resorption exceeds
INCREASING TRENDS AND SIGNIFICANCE OF bone formation. Progressive decrease in BMD with
HYPOVITAMINOSIS D: A POPULATION-BASED microarchitectonics deterioration increased bone fragility
STUDY IN THE KINGDOM OF SAUDI ARABIA and risk of fracture. Objective: studying bone mineral density
A. Hussain1, M. Shaker1, H. Raef1, A. Gabr1 in patients with PHPT after 1 year of surgery.
1
KFSHRC, Riyadh, Saudi Arabia Material and Methods: We studied 63 patients with PGPT
(100 % of men were in the age group up to 50 years, 14 women
Objective: To determine the prevalence and significance of were of childbearing age and 47 postmenopausal women) gen-
Vitamin D deficiency in Saudi population and to help develop eral medical examination has been made, indicators of calcium-
national consensus for its prevention, screening, and phosphorus metabolism (PTH, Ca, Ca2+, P) bone markers (alka-
management. line phosphatase, osteocalcin, β-CTX), sonography of the thy-
Material and Methods: This was a retrospective observa- roid and PTG, scintigraphy PTG, BMD was also examined.
tional study which involved 10,709 patients, recruited from BMD was measured by DXA. Patients with comorbidities and
the department of Family Medicine & Polyclinic, King Faisal conditions associated with low BMD were excluded from the
Specialist Hospital and Research Centre (KFSH&RC), Saudi study.
Arabia, over a period of 5 years. The endpoints included Results: In the group of postmenopausal women low BMD was
overall status of vitamin D level and severity of vitamin D detected in of 83 %. In the lumbar spine low bone mass was
d e f i c i e n c y. S e r u m m e a s u r e m e n t s i n c l u d e d 2 5 - 74.4 % (1 year after parathyroidectomy positive trend was ob-
hydroxyvitamin D (25(OH)D), parathormone, calcium, phos- served in 44.8 %, 2 % - no changes, 2 % noted progression of
phate, alkaline phosphatase, albumin levels, eGFR levels, osteoporosis). In 59.5 % of patient low bone mass localized at the
BMD. femoral neck with the positive dynamics after parathyroidectomy
Results: A total of 10,709 patients were analyzed; 31.4 % in 100 %. In fertile women low bone mass was registered in 14 %
were males and 68.6 % were females, with a preponderance of of cases, increase of bone density was noted in 100 % after
Saudis (68.5 %) compared to Non-Saudis (31.5 %). The surgery. In men younger than 50 years low bone mass was
prevalence of vitamin D deficiency was 83.6 % registered in 100 %, increasing bone density was noted in
(31.9 % severe, 32.0 % moderate and 19.7 % mild), 100 % after operation.
when cut points of less than 25, 50 and 75 nmol/l, Conclusion: The findings suggest that the combined lesions
respectively, were used. Mean serum 25(OH)D was of the axial skeleton in PHPT preferentially localized low
44.58 ± 34.80 nmol/l. There was significant difference bone mass in the lumbar spine in postmenopausal women
in severity of Vit D deficiency stratified by age, gender and the high efficiency of surgical treatment.
and nationality. More females had severe 25(OH)D de-
ficiency compared to males (35.6 vs. 23.7 %, p<0.000).
Severe 25(OH)D deficiency was markedly high among P709
adolescents as compared to other age groups (49.2 % VITAMIN D IS A REGULATOR OF ENDOTHELIAL
vs. 30.9 %, p<0.000). More Saudis were found to be NITRIC OXIDE SYNTHASE AND ARTERIAL
vitamin D deficient compared to Non-Saudis (37.2 % STIFFNESS IN MICE
vs. 20.3 %, p<0.000). S. Slavic1, O. Andrukhova1, U. Zeitz1, S. C. Riesen2, T. D.
Conclusion: The prevalence of hypovitaminosis D is signif- Ambrisko2, M. Markovic2, W. M. Kuebler3, R. G. Erben1
1
icantly high among Saudi population, especially among wom- Department for Biomedical Sciences/Institute of Physiology,
en, despite abundant sunshine. Vitamin D screening is strong- Pathophysiology and Biophysics/University of Veterinary
ly recommended at an earlier age especially among women Medicine, Vienna, Vienna, Austria, 2Department for Compan-
and children. ion Animals and Horses, University of Veterinary Medicine,
Osteoporos Int

Vienna, Vienna, Austria, 3Institute of Physiology, Charité, 1

Rheumatology/University of Medicine and Pharmacy Craio-
Berlin, Germany va, Craiova, Romania, 2Department of Rheumatology, Uni-
versity of Medicine and Pharmacy of Craiova, Craiova, Ro-
Objective: Epidemiological data in humans have shown that mania, 3Rheumatology/Emergency County Hospital Craiova,
vitamin D insufficiency is associated with hypertension, left Craiova, Romania
ventricular hypertrophy, and increased arterial stiffness. How-
ever, the underlying pathophysiological mechanisms remain Objective: To compare the femoral cartilage thickness values
largely unexplained. We aimed here to further elucidate the in patients with osteoarthritis (OA), rheumatoid arthritis (RA),
role of vitamin D in the regulation of cardiovascular function. systemic lupus erythematosus (SLE) and ankylosing spondy-
Material and Methods: We examined male 3- and 9-month- litis (AS) using ultrasonography.
old mice with a nonfunctioning vitamin D receptor (VDRΔ/Δ). Material and Methods: Twelve patients with OA, 10 patients
To normalize mineral homeostasis, the mice were kept lifelong with RA, 7 patients with SLE and 6 patients with AS were
on a rescue diet enriched with calcium, phosphate, and lactose. enrolled in this cross-sectional study. The mean age was 63.41
Central arterial pressure, arterial stiffness and cardiac hemody- ±5.03 in OA group, 50.1±10.32 in the RA group, 38.71±6.01
namics were assesed using a SPR-671NR pressure catheter. in SLE group and 42.83±4.35 in the AS group. The thickness
Serum and urinary nitric oxide (NO) concentration was assesed of femoral articular cartilage was measured using an ultra-
by colorimetric assay (Cayman). mRNA and protein levels of sound high frequency linear probe, having the patient in
endothelial NO synthase (NOS3) were analysed in aortic mate- supine position, with knees fully flexed, taking three midpoint
rial using a quantitative RT-PCR and western blotting. Direct measurements: at the lateral condyle, intercondylar area, and
effects of vitamin D signaling on NOS3 transcriptional activity medial condyle.
was asssed in HEK cells after double transient transfection with Results: The SLE and AS patients had thicker cartilage values
human VDR and NOS3 plasmids. than the RA and OA groups at all measurement sites. There
Results: Elderly but not young VDRΔ/Δ mice showed increased was a correlation between the presence of the corticosteroid
heart/body weight ratio and left ventricular muscle mass. Mean treatment and the cartilage thickness values in RA and SLE
arterial pressure as well as renal renin expression and serum patients. Patients with RA, without CS treatment tend to have
aldosterone were unchanged in young and older VDRΔ/Δ mice a thinner cartilage, comparable to patients in OA group.
on rescue diet. However, arterial catheterization revealed pro- Conclusion: These findings could be explained by the fact
foundly increased central pulse pressure together with increased that the mean age of the SLE and AS patients is lower than in
arterial stiffness, increased aortic impedance, structural remodel- the other groups and by the fact that the corticosteroid use
ing of the aorta, and impaired systolic and diastolic heart function could be protective for the cartilage and could lead to an
in elderly, but not in young VDRΔ/Δ mice. Furthermore, young increased thickness, probable through favorable effects on
and older VDRΔ/Δ mice were characterized by lower bioavail- chondrogenesis.
ability of the vasodilator NO, and showed decreased aortic
expression of endothelial NOS3, the main regulator of vascular
NO levels. Conversely, incubation of mouse aortic rings with P711
1,25(OH)2D3 increased NOS3 mRNA abundance in vitro. Final- OSTEOPOROSIS ASSESSMENT IN PATIENTS WITH
ly, stimulation with 1,25(OH)2D3 significantly increased NOS3 KNEE OSTEOARTHRITIS
expression in HEK cells transfected with human VDR and NOS3 F. A. Vreju1, P. Ciurea1, I. Cojocaru-Gofita1, B. A. Chisalau2,
plasmids indicating that 1,25(OH)2D3 is a direct transcriptional M. Ivan2
1
regulator of NOS3. Department of Rheumatology, University of Medicine and
Conclusion: Our data demonstrate the importance of intact Pharmacy of Craiova, Craiova, Romania, 2Rheumatology/
VDR signaling in the preservation of vascular function, and Emergency County Hospital Craiova, Craiova, Romania
may provide a mechanistic explanation for epidemiological
data in humans showing that vitamin D insufficiency is asso- Objective: Taking into consideration the fact that osteoarthri-
ciated with hypertension and endothelial dysfunction. tis (OA) and osteoporosis (OP) can lead to important change
in the quality of patient’s life and to increased medical care
costs, a possible relation between them is highly relevant for
P710 the appropriate management. Aim: To measure BMD in pri-
ULTRASONOGRAPHYAS A TOOL IN THE mary knee osteoarthritis and to detect if there is difference
ASSESSMENT OF FEMORAL CARTILAGE IN between mild and severe deforming symptomatic OA.
RHEUMATOLOGY PATIENTS Material and Methods: This is a cross-sectional study which
F. A. Vreju1, P. Ciurea2, I. Cojocaru-Gofita2, M. Ivan3, B. A. involved 30 consecutive patients diagnosed with primary knee
Chisalau3, C. Criveanu2 OA. Using a Kellgren-Lawrence score on the bilateral
 Osteoporos Int

anteroposterior weight bearing position knee radiographs, the scores increased significantly top both in relation with first
OA was classified based on joint space width in medial measure, but in case of the women with thyroid dysfunction
compartment as follows: mild knee OA when the space is positive evolution of BMD is shows only in the area of the hip
>1.5 mm and advanced knee OA, when the space is <1.5 mm. (femoral neck BMD, p=0.017 and hip T-score, p=0.043).
All the patients were assessed by DXA in the lumbar spine, Normal women also increased lumbar column. Type of treat-
femoral neck and arm. ment not differ in both groups. Treatment in osteoporotic
Results: Based on the joint space we had 21 patients with women with hypothyroidism is effective, but has a lower
mild knee OA and 9 patients with severe knee OA, with mean sensitivity.
age of 63.0±6.66 and 72.11±11.06 years. When evaluating Conclusion: The differences in body composition may be
the osteoporosis in the femoral neck, we took into consider- affecting BMD and thus the frequency of osteoporosis in
ation the side with highest T-score. In patients with mild OA, women with hypothyroidism, affecting the sensitivity of the
the T-score in the femoral neck was −2.18±0.7 and −2.88± treatment of osteoporosis.
0.78 in severe OA. Mean lumbar spine T-score in mild OA
group was −1.93±0.61 and −2.3±0.32 in severe osteoarthritis
respectively. DXA of the arm showed a T-score of −1.96±
0.56 in the mild OA and - 2.03±0.46 in the severe OA. P713
Conclusion: Femoral neck was significantly more osteopo- THE INFLUENCE OF VITAMIN D STATUS ON THE
rotic in severe osteoporosis by T-score possibly due to inac- VALUE OF ΒETA-CROSSLAPS IN WOMEN WITH
tivity of the limbs induced by pain and deformity. We found a POSTMENOPAUSAL OSTEOPOROSIS
significant correlation between severe knee OA and BMD of S. Milenkovic1, I. Aleksic1, V. Zivkovic1, B. Stamenkovic1, S.
femoral neck and lumbar spine, but no significant relation Stojanovic1
1
between the severity of the knee OA and BMD in the arm. Institute for Treatment and Rehabilitation Niska Banja, Nis,
In this way a diagnosis of severe OA of the knee should Serbia
always point to an assessment of the osteoporosis.
Objective: The aim of this research was that women with
newly diagnosed postmenopausal osteoporosis to determine
P712 vitamin D status and the level of initial influence of vitamin D
EFFICIENCY OF TREATMENTS FOR THE on the value of β-crosslaps during 12 months of bisphospho-
OSTEOPOROSIS IN WOMEN WITH AND WITHOUT nate therapy.
THYROID DYSFUNCTION IN RELATION WITH Material and Methods: The study included 121 patients with
WEIGHT AND SOMATIC SITUATION newly diagnosed postmenopausal osteoporosis. Determined: β-
C. Prado1, M. Diaz-Curiel2, V. Calabria3 crosslaps (β-CTx) and levels of 25(OH)D in serum, BMD at the
1
Departamento de Biología - Facultad de Ciencias, lumbar spine and hip. During the 12 months followed the
Universidad Autónoma de Madrid, Madrid, Spain, patients were treatment: bisphosphonate (alendronate 70 mg/
2
Departamento de Metabolismo óseo, Hospital Universitario week), 800 IU vitamin D per day, and 500 mg Ca per day. The
Fundación Jimenez Díaz de la Universidad Autonoma, Ma- group consisted of 108 patients with postmenopausal osteoporo-
drid, Spain, 3Departamento de Biología - Facultad de sis and insufficiency and deficiency of vitamin D. The control
Ciencias, Universidad Autónoma de Madrid, Madrid, Spain group consisted of 13 patients with normal status of vitamin D.
Results: Normal vitamin D status was found in 13 subjects,
Objective: Attending to somatic and corporal composition, vitamin D insufficiency in 97, deficiency of vitamin D in 11.
the study focus in efficiency of osteoporosis treatments in Value β-crosslaps in patients with vitamin D deficiency before
women with normality or thyroid dysfunction. therapy averaged 1.100±0.49 ng/ml after 3 months was sig-
Material and Methods: Study realized at Foundation nificantly decreased to 0.700±0.40 ng/ml, and after 12 months
Jiménez-Díaz of Madrid on 381 women. The IBP have 0.600±0.40 ng/ml. Women with vitamin D insufficiency av-
followed, for the anthropometric measures, tetrapolar erage the level of β-crosslaps was 0.800±0.34 ng/ml, after
bioimpedance to study body composition, the BMD has been 3 months was significantly decreased to 0.400±0.10 ng/ml,
realized by DXA, with reference to lumbar column (L2-L4) and after 12 months decreased to 0.300±0.10 ng/ml. In pa-
and neck of femur the categories according with T-score tients with normal vitamin D status an average level of β-
values. Two successive measurements spaced 12 months crosslaps was 0.700±0.31 ng/ml, 0.300±0.20 ng/mL after
was made. 3 months and 0.200±0.12 ng/ml after 12 months of treatment.
Results: The presence of hypothyroidism is 16.8 %. Hypo- In all three measurements of the levels of β-crosslaps a
thyroid women have significant major muscular mass women with vitamin D deficiency was highest, in the group
(p>0.017), fat mass (p>0.05). The values of BMD and T- of patients with normal vitamin D status of the lowest, but the
Osteoporos Int

differences between the examined groups were not statistical- Viseu Pinheiro 3 F. J. Domínguez Hernández 3 J. F.
ly significant (p>0.05). Blanco Blanco3
1
Conclusion: The negative correlation of vitamin D status with Department of Geriatrics, Hospital Universitario de
values β-crosslaps. Greatest decrease in the value of β- Salamanca, Salamanca, Spain, 2 Public Health Service,
crosslaps was in patients with normal vitamin D status Valladolid, Spain, 3 Department of Traumatology, Hos-
but no statistical significance between the groups were pital Universitario de Salamanca, Salamanca, Spain
compared.
Objective: To describe the clinical and functional profile of
oldest old patients (patients of 85 years and more) with major
osteoporotic fracture; to analyze the similarities and differ-
P714
ences compared to young old (65-74) and middle old patients
STRONTIUM RANELATE ACCELERATES MLOY4
(75-84).
OSTEOCYTE LINEAGE WOUND HEALING
Material and Methods: Retrospective epidemiological study
H. Toumi1, P. Aveline1, C. Leduc2, E. Lespessailles1, C.
concerning patients admitted in an Orthogeriatric Unit due to
Pichon2, C. L. Benhamou1
1 major osteoporotic fracture (Jul 2013-Jan 2014). Statistical
EA 4708 I3MTO, France Centre Hospitalier Régional
analysis SPSS 15.0.
D’Orléans CHR ORLEANS, Orléans, France, 2CBM Orléans,
Results: 106 patients (women 79.2%; mean age 85.21
CNRS UPR4301, Orléans, France
±7.92). 58.5% of our sample over 85 years. Major
osteoporotic fracture type: pertrochanteric 53.8%,
Pre-osteocyte wound healing plays an important role in bone
subcapital hip fracture 34%, proximal humerus fracture
fracture or microcrack repair. We have recently settled a wound
7.5%, others 3.8%. Previous fracture: 40.6%. Diabetes
healing experiment on in vitro cell culture. This experiment
Mellitus type 2: 14.2%. Cardiovascular events (stroke,
permits subsequent study of cell proliferation and migration
angina, myocardial infarction): 23.6%. Cognitive im-
during the healing process. Strontium Ranelate (SrRan) is
pairment: 31.6%. History of previous falls: 72.6%.
known to act on the bone forming lineage. Purpose: The aim
80.6% of our sample with polypharmacy (according
of the present study was to investigate the wound healing
to MHO criteria). No statistically significant differ-
process on MLOY4 cell culture with or without SrRan. Meth-
ences among young old, middle old and oldest old
od: Osteocyte woung healing was analysed by a MLOY4 cell
patients. Functional assessment: Katz index: 1.54±2.33
culture in 24-well plates each containing inserts (Wound
(young old); 1.89±1.95 (middle old); 2.45±1.83 (oldest
healing assay kit, Cell Biolabs). Cells were incubated 3 days
old). No statistically significant differences among the
with or without SrRan (0, 0.1, 1 and 5 mM) before removing
three groups. Barthel Index: 84.23±26.83 (young);
insert to generate a wound field. 2 pictures per well were taken
78.25±24.76 (middle); 69.41±25.10 (oldest) (p value
every hour during 72 h. Changes in cells density between T0h
less than 0.05). Lawton Index: 4.23±3.21 (young);
and T48h were avaluated by counting the number of cells per
3.88±2.79 (middle); 2.26±2.64 (oldest) (p value less
well. Results: MLOY4 cells were multiplied by 5.7 and 4.8 at
than 0.05). Red Cross Index: 1±1.18 (young); 1.81
T48h compared to T0h respectively for 0 and 0.1 mM groups
±1.03 (middle); 2.30±1.09 (oldest) (p value less than
and by 3.4 for both 1 and 5 mM groups. Concerning MLOY4
0.05).
culture healing, all wound fields with SrRan were closed at
Conclusion: 1. Due to high life expectancy, oldest
T35h after baseline. While, the control group (0 mM) was not
old are usual patients in our wards. Despite they
completely haeled at T35h nor at T48h. The healing kinetics
commonly suffer higher rates of comorbidity and
showed a dose effect of SrRan. Conclusions: SrRan has a
chronic diseases, patients with major osteoporotic
positive dose dependent effect on wound healing and negative
fracture in our sample have the same rates of diabe-
dose response on cell density in MLOY4 cell cultures. Whether
tes, cardiovascular events and cognitive impairment
this effect is related to proliferation or migration (or change in
compared with younger groups. 2. It is remarkable
their balance) remains to be evaluated.
the high prevalence of recurrent falls and previous
fractures in our sample. This could be explained due
to the good prior functional status of these patients,
P715 with no differences regarding age. 3. In our study
MAJOR OSTEOPOROTIC FRACTURE IN OLDEST there are no significant differences between the three
OLD PATIENTS: FUNCTIONALAND CLINICAL groups for basic activities performance (using Katz
DIFFERENCES WITH YOUNGER POPULATION Index), but we find significant worst functional out-
C. Pablos Hernández1, A. González Ramírez1, M. A. comes in Barthel and Lawton Indexes for the oldest
García Iglesias2, J. M. Julián Enríquez3, J. F. Jiménez old.
 Osteoporos Int

P716 osteoporotic patients on healing of aseptic delayed or non-

EFFICACY OF A 6-MONTH TREATMENT WITH united fractures of the limbs or of the clavicle.
STRONTIUM RANELATE 2G/DAY IN
OSTEOPOROTIC PATIENTS IN THE
IMPROVEMENT OF LONG BONE FRACTURES P717
WITH DELAYED UNION OR NON-UNION CUMULATIVE EFFECTS OF LOW DOSE OF
J. M. Feron1, V. Vyskocil2, C. V. Albanese3, L. A. T. Russo4, J. ANTI-SCLEROSTIN ANTIBODYAND PHYSICAL
D. Laredo5 ACTIVITY ON BONE REMODELLING AND
1
Service de chirurgie orthopédique et traumatologique, STRENGTH IN OVARIECTOMIZED RATS
Hôpital Saint Antoine, GHU Est , AP-HP, Paris, France, H. Toumi1, D. Benaitreau1, S. Pallu1, M. Mazor1, Z. Achiou1,
2
Osteocentrum, 3. interní klinika, Všeobecná fakultní M. S. Ominsky2, E. Lespessailles1
nemocnice, Praha, Czech Republic, 3Dipertimento di Scienze 1
EA4708, IPROS, CHRO, Orléans, France, 2Metabolic Dis-
Radiologiche, Università degli studi « la sapienza », orders, Amgen Inc, Thousand Oaks, CA, United States
Policlinico Umberto I, Rome, Italy, 4CCBR Brasil, Rio de
Janeiro, Brazil, 5Hopital Lariboisière, Service Radiologie Sclerostin antibody represents a promising new therapeutic
Ostéo-Articulaire, Paris, France approach for medical conditions such as in fracture healing
and osteoporosis. Bone formation, and, consequently, BMD
Objective: In an open label study, strontium ranelate has been are enhanced by physical activity, and sclerostin expression
suggested to improve fracture healing. In this complementary has been reported to be affected by the mechanical load.
analysis, the efficacy of strontium ranelate 2 g/day was Purpose: Investigated the effects of a combination of small
assessed in a subgroup of osteoporotic patients with aseptic dose of Scl-Ab and physical activity on bone formation.
delayed union or non-union. These fractures are of particular Methods: Sixty female Wistar rats, aged 8 months were
clinical importance as they are causes of high disability and randomly assigned to five groups: (1) (SH): sedentary
pain in this elderly population. rats injected twice a week with saline, (2) (OVX):
Material and Methods: International, phase III, open label ovariectomized rats injected twice a week with saline,
single arm study with a treatment duration of 6 months. Pri- (3) (OVX+E): ovariectomized rats injected twice a week
mary endpoint was the qualitative radiological status of the with saline and trained on a treadmill (5 times/week,
fracture (progress to union, union, failure to union) assessed one hour/day), (4) (OVX+E+S): ovariectomized rats
by two independent central readers (Pr Feron, Pr Laredo, injected twice a week with 5mg/kg Scl-Ab and trained
France). The assessment criteria established that if the two on a treadmill and (5) (OVX+S): ovariectomized rats,
central readers reported an identical evaluation, this would be injected twice a week with Scl-Ab. After 14 weeks of
the results considered. In case of differences the two central treatment, body composition and areal BMD were de-
readers will meet to decide which one will be considered. termined by DXA and serum were collected for analy-
Results: 22 patients were osteoporotic at inclusion 6 males sis. Bone microarchitecture were analysed at the distal
and 16 females. Mean age at inclusion was 62.6±12.4 years. femur metaphysis using µCT. Osteocalcin and NTX
Among them 13 (59.1 %) patients had a delayed union frac- were measured in the serum by ELISA. Bone bending
tures and 9 patients (40.9 %) had a non-union fracture. The strength was assessed at the femur midhshaft.
qualifying fracture was localised for 15 patients in the lower Results: Ovariectomy decreased whole body and femur areal
limb, and for 7 patients in the upper limb/clavicle. The mean BMD. Only Scl-Ab prevented these effects and increased
duration of the qualifying fracture was 24±37 months. areal BMD. OCN was significantly higher in all groups com-
Seventeen osteoporotic patients were included in the ITT pared to Sham. Only Scl-Ab prevented the OVX-mediated
population. The majority of osteoporotic patients improved decrease in ultimate load and stiffness. However, only exer-
(12 patients; 70.6 %), with 8 patients (47.1 %) reaching a full cise reduced NTX.
union and 4 patients (23.5 %) improving and rated as of Conclusion: Low dose of Scl-Ab resulted in similar
progress to union over 6 months. increases in bone formation, bone mass, and bone
Patients reported a trend toward a decrease in pain, with a mean strength in OVX rats with or without exercise. Exercise
decrease in VAS from baseline (41±28 mm) to last post-baseline did not alter the effects of Scl-Ab treatment, suggesting
value of −10±22 mm (p=0.0885) and a trend toward improve- that although sclerostin expression may have changed in
ment in quality of life assessed by the EQ5D© (p=0.0797). response to mechanical stress, it did not significantly
Conclusion: This open label study suggests a beneficial effect affect the ability for Scl-Ab to increase bone formation
of a 6-month treatment with strontium ranelate (2 g/day) in in this model.
Osteoporos Int
DOI 10.1007/s00198-014-2641-5

World Congress on Osteoporosis, Osteoarthritis

and Musculoskeletal Diseases (WCO-IOF-ESCEO 2014):
Satellite Symposium Abstracts

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Innovative Therapeutic Strategies for Patients with Osteo- 4. Formulate treatment regimens for fragility fracture pa-
porosis and Fragility Fractures tients that involve combination or sequential treatment
Sponsor : Eli Lilly to reduce the risk for future fractures, increase bone
strength, and improve quality of life
SY1
INNOVATIVE THERAPEUTIC STRATEGIES FOR Hypophosphatasia : evolving our understanding of this se-
PATIENTS WITH OSTEOPOROSIS AND FRAGILITY rious and complex disease
FRACTURES Sponsor: Alexion

Abstracts not available.

Supported by Eli Lilly and Company, this educational sym-
posium is entitled “Innovative Therapeutic Strategies for Pa-
tients with Osteoporosis and Fragility Fractures”. The 90-min Efficacy and utility of glucosamine sulfate and hyaluronic
programme, comprised of didactic slide presentations, will acid in the management of osteoarthritis
emphasise the critical parameters that contribute to bone Sponsor: Rottapharm / Madaus
structure and strength, and their role in the reduction of
fragility fractures incidence; anti- osteoporosis medication Abstracts not available.
with antiresorptive and anabolic effects, with a focus on their
effects on cortical bone; and the role of combination or se-
quential treatment in the therapeutic strategies of patients with Management of severe osteoporosis : a call for action
severe osteoporosis. Sponsor: Servier
An internationally renowned faculty expert panel will consist
of Adolfo Diez-Perez, MD (Chair), Erik Fink Eriksen, MD, Abstracts not available.
and Jacques P. Brown, MD.
At the conclusion of this programme, attendees will be better
prepared to: Treatment needs in postmenopausal osteoporosis
Sponsor: Amgen
1. Describe parameters that comprise bone strength includ-
ing bone mineral density and bone quality Abstracts not available.
2. Understand the peculiar effects of bone forming
agents vs. antiresorptive agents on bone tissue, in partic-
ular on cortical bone. Consider the limitations of tech- Interactive Discussion on the Management of Osteoporosis :
niques for the evaluation of bone mass and strength at the Signaling a Change in the Conversation
cortical bone. Sponsor: MSD
3. Evaluate the clinical profiles of antiresorptive and
anabolic medications Abstracts not available.
 springerprotocols.com

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015418x
 FACULTY TO INCLUDE:

Bo Abrahamsen Jane Lian

(Copenhagen, Denmark) (Burlington, USA)
Tim Arnett Cesar Libanati
(London, UK) (Amgen, Thousand Oaks, USA)
VENUE: Illaria Bellantuono Ken Lyles
(Sheffield, UK) (Durham, USA)
ST CATHERINE'S COLLEGE, OXFORD, UK
Chas Bountra Jack Martin
(Oxford UK) (Melbourne, Australia)
Henry Bryant Joan McGowan

6th International Workshop

(Eli Lilly, Indianapolis, USA) (NIAMS, Bethesda, USA)
Alex Bullock Charles McKenna
(Oxford, UK) (Los Angeles, USA)

on Advances in the
Nessa Carey Marie Migaud
(London, UK) (Belfast, UK)
Andy Carr Paul Miller

Molecular Pharmacology and

(Oxford, UK) (Colorado, USA)
Philippe Clézardin Ralph Müller
(Lyon, France) (Zurich, Switzerland)

Therapeutics of Bone Disease

Rob Coleman Jeffrey Neighbors
(Sheffield, UK) (Terpenoid Therapeutics,
Iowa, USA)
Cyrus Cooper
(Oxford & Southampton, UK) Udo Oppermann
(Oxford, UK)
Tim Cundy
28 JUNE – 2 JULY 2014 (Auckland, New Zealand) Henrik Ørum
(Santaris Pharma,
Kay Davies
Hørsholm, Denmark)
(Oxford, UK)
MEETING CHAIRMAN: Ron Dhindsa John Potts
The workshop will take place within the (Washington, USA)
(Massachusetts, USA)

delightful surroundings of St Catherine’s Graham Russell Jo Price

(Oxford & Sheffield, UK) Gordon Duff
(Bristol, UK)
(Sheffield, UK)
College, Oxford. Stuart Ralston
CO-CHAIRS: Richard Eastell
(Edinburgh, UK)
(Sheffield, UK)
The programme is led by a faculty of Cyrus Cooper Ian Reid
Hal Ebetino
international leaders from academia (Oxford & Southampton, UK) (Rochester, USA)
(Auckland, New Zealand)

Richard Eastell David Roodman

and industry, who will describe recent Claire Edwards
(Indianapolis, USA)
(Sheffield, UK) (Oxford, UK)
advances in drug discovery and the Hal Ebetino Erik Eriksen Cliff Rosen
(Maine, USA)
(Oslo, Norway)
molecular mechanisms underlying current (Rochester, USA)
Graham Russell
Serge Ferrari
and future therapies for diseases of bone Jack Martin (Geneva, Switzerland)
(Oxford & Sheffield, UK)
(Melbourne, Australia) Gudrun Stenbeck
and the musculoskeletal system. Roger Francis
(London, UK)
Udo Oppermann (Newcastle-upon-Tyne, UK)
Larry Suva
The meetings are highly acclaimed not only (Oxford, UK) Francis Glorieux (Little Rock, USA)
(Montreal, Canada)
for their scientific quality, but for the Stuart Ralston Peter Taylor
(Edinburgh, UK) Andreas Grauer
(Oxford, UK)
excellent opportunities for productive Peter Taylor
(Amgen, Thousand Oaks, USA)
Raj Thakker
Philippa Hulley
interactions among faculty and participants. (Oxford, UK) (Oxford, UK)
(Oxford, UK)
Estelle Trifilieff
Kassim Javaid
A number of free registration packages for (Oxford, UK)
(Novartis, Basle, Switzerland)

PhD students will be offered. Tom Kirkwood Tonia Vincent

(Oxford, UK)
(Newcastle-upon-Tyne, UK)
In association with Michael Whyte
Gordon Klein (St Louis, USA)
FURTHER INFORMATION AND (Galveston, USA)
Andrew Wilkie
REGISTRATION ON THE WEB AT Michaela Kneissel
(Oxford, UK)
(Novartis, Basle, Switzerland)
Gary Krishnan
www.oxfordbonepharm.org (Eli Lilly, Indianapolis, USA)
 springerimages.com

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 14
5th Asia-Pacific Osteoporosis Meeting
NOVEMBER 14-17, 2014 t TAIPEI, CHINESE TAIPEI Taipei
SAVE THE DATE!
Don’t miss your chance to attend this exciting event,
spotlighting the latest developments in the bone field.

www.iofbonehealth.org/taipei-2014
Osteoporos Int
DOI 10.1007/s00198-014-2660-2

Author index

# International Osteoporosis Foundation and National Osteoporosis Foundation 2014

A Menezes, F. P375 Akesson, K. OC19, P397 AlZahrani, I. P182

A Yoshioka, S. P375, P378 Akhtar, N. P674 Amann, K. P471
A. Tocchini De Figueiredo, F. P376 Akhtyamov, I. P608, P623 Amara, S. P436
A. Veiga, M. P376 Akita, S. P179 Amaricai, E. P200, P201, P202
Aart, A. P616 Al Attia, H.M. P111, P112, P119 Ambrisko, T.D. P709, P714
Abadie, D. P234 Al Maini, M. P554 Ameliyanovich, M.D. P176
Abdellatif, A. P651 Al Moudallal, Y. P400 Ameye, G. P716
Abdelmagid, S.M. P671 Al-Ali, A.K. P653 Amin, M. P236
Abdulfatah, M.E. P102 Al-Elq, A.M. P653 Amitai, A. P396
Abdulganieva, D. P639 Al-Hayani, A.A. P118 Ammann, P. P238
Abdullah, A.H. P312 Al-Omran, A.S. P659 Amorim, F.H.B. P464
Abirova, E.S. P395 Al-Sibiani, S.A. P343, P420 Anderson, F.A. OC1, OC22
Abrahamsen, B. P245, OC14, P337, Al-Turki, H.A. P653, P659 Andrade, P.C. P230
P418 Albanese, C.V. P719 André, W. P716
Abram, F. P177, P276, OC6, P367 Albulescu, D.M. P204, P205, P206 André, R. P622
Abramowicz, P. P666 Alcorn, H. P259 Andreeva, A.T. P516
Acharya, K. P605 Alekna, V. P450, OC5, P610, P611 Andrei, D. P200, P201, P202
Acheli, D. P539 Aleksandersen, P.A. OC9 Andrukhova, O. P709, P714
Achiou, Z. P718 Alekseeva, L. P145, P469, P521 Aneja, R. P554
Adachi, J.D. OC1, OC22, MTE8, PL2, Alekseeva, O. P110, P469 Annoni, R. P382
P236, P256, OC39, P430, P447, OC41 Aleksic, I. P713 Antoine-Poirel, H. P716
Adamenka, A. P612 Alexey, T. P350 Antônio Andraus, R. P379
Adami, S. OC1, OC22, P466, P563 Alhamdany, D. P169 Aouassar, N. P716
Adams, A.L. P272 Alhashim, M. P165 Apalset, E.M. P243
Adarnli, S. P400 Ali, E.A. P642 Apostu, L. P282
Adib, G. MTE11 Ali, A.Y. P528, P545 Appleboom, G. OC57, P588
Afif, H. P127 Aligrudic, S. P444 Apukhovskaya, L.I. P152, P170
Agnello, N. P656 Allouche, M. P670, P672 Arabi, A. P424
Agricola, R. P442 Almaghrabi, M.M. P102 Aranha Watanabe, P.C. P685
Agripino, A. P426, P555 Almansouri, A.Y. P102 Arantes, H.P. P696
Ahmed, L.A. OC49, P199, OC29, Almeida, L.C. P604 Ardawi, M.S.M. P102, P343, P420,
P365, P476 Altabas, V. P355 P528, P545
Ahn, E.-K. P346 Altas, E.U. P122 Arden, N.K. P106, P245, P374, P442,
Aiche, M.F. P121, P195 Althubaiti, A.M. P102 P451, P536, OC35, SE15
Aihie Sayer, A. OC12 Altinel, L. P534 Arden, C.P.A. OC35
Akalin, S. P601 Alvarenga, D.P. P614 Argentiero, A. P656
Akarirmak, U. OC52 Alvisa Negrín, J. P513, P625, P687 Argiro’, R. P445
Akel, A. P506 Alyasova, P.A. P395 Arida, A. P674
 Osteoporos Int

Aro, H.T. P335 Barreto, G. P214 Bjørnerem, Å. OC29, P476

Arsenovic, B. P446 Barthe, Y. P715 Black, D. P247
Artuso, A. P466 Bartos, D. P369 Blahos, J. OC56
Ashe, M.C. OC48 Basdragianni, D. P669, P681 Blake, G. P364
Aspelund, T. P438 Bashir, H. P578 Blanco Blanco, J.F. P459, P719
Astrakhantsev, D.A. P325 Batalov, A. P479, P484, P583 Blati, M. P613
Atar, S. P225 Batalov, Z. P583 Bleakney, R. OC41, P600
Atar, Y. P225 Bauer, D.C. OC2 Bobic, B. P488
Atayde, S.A. P230 Bautista Litardo, N. P389, P432, P433, Boday, A. P185, P186, P188
Atcheson, H. P208, P209 P505 Bodeen, G. P392, P507
Athanassiou, P. P669, P681, P689, Bay-Jensen, A.C. P519, OC24, OC4, Bodog, F. P660
P692, P693, P704 P580 Body, J.J. P347
Atlig, R.S. P473 Baykal, T. P122 Bogoch, E. OC41
Atmaca, H. P534 Beaudart, C. OC20, P166, P180, OC3, Boisio, F. P664
Atsali, E. P630 P340, OC57, P588 Boivin, G. P357
Aubry-Rozier, B. P268, P411, P412 Bei, E.S. P452 Bolognese, M.A. OC18
Auger, P. P259 Belanger, A. P236 Bonaccorsi, G. P498, P635
Austin, M. OC30, OC18 Belaya, Z.E. P477 Bonamassa, L. P247
Aveline, P. P717 Belbegra, Y. P539 Bondari, S.K. P204, P205, P206
Avotina, G. P294 Beliaa, P. P226 Bondari, D. P205, P206
Awada, Z. P424 Beljic Zivkovic, T. P446 Bone, H.G. OC21
Bellamy, N. P440 Bonel, E. P403
Baaqil, O.H. P102 Belov, M. P609 Bonet, M. P394
Babchenko, L. P526 Belova, K. OC47, P609 Bonifacio, M. P466
Baciu, I. P634 Ben Dhaou, B.D. P705, P706 Bonjour, J.P. OC11
Backa, T. P657 Ben Sedrine, W. OC7 Bonnet, N. P235, P596
Badawoud, M.H. P118 Benaitreau, D. P718 Boonen, A. P408
Baddoura, R. P424 Benhamou, C.L. OC31, P717 Boonen, S. OC1, OC22, P135
Baerwald, C. P369 Bensen, W. P236 Borchardt, G. P483
Bagheri, H. P234 Benvenuti, E. P247 Borda, I.M. P288, P291
Bagué, A. P415 Berenbaum, F. SE16, P715, MTE2 Borderie, D. P458
Baiko, S.V. P190 Bergmann, P. P347 Borges, M.M. P614
Baili, B.L. P705, P706 Bernardo, T.T. P464 Borgström, F. P450, OC5
Bajec, V.G. P301, P315, P319 Bertholon, C. P159 Borissova, A.M. P246, OC53
Bajuk Studen, K. P437 Bessudo, A. P278 Borman, P. P162
Bakalov, D.J. P203 Bianchi, M.L. OC5 Borozan, S. P444
Baker, T. P228 Biasiolo, M. P635 Bors, K. P688, P691
Bakheet, A.A. P102 Bicho, M. P607, P690 Boskovic, K. P117, P192, P327,
Balatska, N.I. P414, P560, P561 Bierma-Zeinstra, S.M.A. P442 P328, P330, P478
Baldi, J. P485 Bighea, A.C. P241, P305, P356, P358, Boskovic, O. P444
Balen, D. P355 P359, P429, P431, P673, P676, P686 Botushanov, A.N. P371
Ball, D. P128 Bihlet, A.B. OC9 Botushanov, N.P. P371
Ball, C. P536 Bijlsma, J. P125 Boudot, C.B. P212, P216
Baltzopoulos, V. P404 Bilezikian, J.P. P696 Boulanane, B. P539
Bancu, I. P489, P591 Binkley, N. P483, P511 Bournazos, I. P630
Banjanin, Z. P399 Birsan, S.D. P647, P649, P654, P655, Boussaid, B.S. P705, P706
Bano, A. P657 P658, P660 Boussaid, S. P701
Bao, L. P154 Bistriceanu, I. P204, P205, P206, P215, Boussema, B.F. P705, P706
Barbosa, A.P. P607, P690 P217, P218, P219 Boutroy, S. P158, P222, OC36, P341
Barbu, C.G. P532, P662 Bistriceanu, M. P204, P205, P206, Bouxsein, M.L. P461
Barbulescu, A.L. P599 P215, P217, P218, P219 Bouzid, F.Z. P195, P539
Baron, R. P134 Biver, E. OC15, OC37 Bowen, C.J. P451, P536
Baroni, M. P547 Bjork, J. P337 Boyanov, M. P168
Osteoporos Int

Boyanov, M.A. P203 Calaf Alsina, J. P332 Cernigoy, C.H.A. P552

Boyce, R.W. P134 Calderon-Garcia, J.F. P675 Cernovas, A. P611
Boyd, S.K. P148 Callaghan, M.J. P404 Cervellati, C. P635
Bozilov, S. P302 Calleja, A. P314 Cevei, M. P453, P456, P581, P582,
Bozovic, D. P444 Calmy, A. OC15 P587, P589, P590, P641
Brage, L. P683, P687 Calzavara, A. P260 Chakhtoura, M. OC27
Brandi, G. P247 Camargo, O.P. P546, P550, P552, P604 Chan, K. P536
Brandi, M.L. P242, SE1, P247, SE23, Caminis, J. SE7 Chan, D.C. P113, P156, P304
P297, OC21, P449, OC38, P547 Campillo Ajenjo, M. P332 Chang, J. OC41
Braun, A. P278 Campos, G.C. P546, P550 Chapurlat, R.D. OC1, OC22, P157,
Braun, S. P163 Canal-Macias, M.L. P570 P158, P159, P222, P226, SE11, OC36,
Brazdilova, K. P370 Canducci, E. P635 P341, P430, P447, OC23, P523
Brazier, M.B. P212, P216 Canhão, H. P426, P555 Chevalier, X. P413
Brekke, L. P236 Cannuccia, A. P303 Chawki, L. P694
Brett, A. P392, P507 Capatana, C. P594, P628 Chelluri, G. P436
Brito, N.L.R. P546, P550, P604 Capatti, A. P498 Chen, J.S. OC34
Brix, T.H. OC14 Capelozzi, V.L. P230 Chen, D.C. P650
Brotat Rodríguez, M. P487, P490, P493, Cappelle, S. P347 Chen, J.F. P113, P304
P500, P501, P510, P512, P514 Capra, P. OC42 Chen, C.H. P304
Brown, J.K. P392, P507 Capuani, S. P485 Chen, H.Y. P557
Brown, J.P. OC18 Car, D. P355 Cheng, Q. P650
Brunerova, L. P317, P652 Caraffa, A. P547 Cheng, X. P154
Brusko, A.T. P170 Caragheorgheopol, A. P223, P531 Cheng, B.C. P113
Brutskaya-Stempkovskaya, E.V. P482, Carbonell-Abella, C. P344, P529 Cheng, T.T. P113
P708 Cardew, S. OC41 Chenna, S. P509
Bruyère, O. OC20, P166, P180, P181, Caretto, A. P656 Chereji, A. P386
OC3, P226, MTE12, P340, P413, Carlier, M.C. P523 Cherepanova, E.A. P280
OC57, P588, OC7 Carminati Shimano, R. P379 Chettle, D.R. P274
Buchebner, D. OC19 Carmona, L. P622 Cheung, A.M. OC30, OC48, P256,
Buchinskaya, N. P465 Carpenter, L. OC8 OC41, P600, OC27
Buckinx, F. OC20, P166, P180, P181, Carrat, F. P715 Cheung, E. P538
OC3, P340, OC57, P588 Carrazzone Cal Alonso, M.B. P685 Cheung, C.L. P538
Buda, S. P563 Carsote, M. P594, P628, P634, P637, Chevalley, T. OC11, OC37
Budnik, T.V. P414, P561 P661, P662 Chiang, A.Y. P696
Bueno-Vargas, P. P349 Casado, E. P394 Chiarello, E. P237, OC42
Bultrini, A. P303 Casciaro, S. P627, P632 Chien, J.-Y. P695
Bumbea, A.M. P673, P676, P686 Casciaro, E. P627, P632 Chikova, I. P465
Bunger, L. P128 Casey, M.C. P562 Chiou, H.Y. P304
Buondonno, I. P267 Casey, R. OC23 Chiriacò, F. P627
Buquet, D. P394 Castaldini, M.C. P498, P635 Chiriti, G. P136, P137
Burden, A.M. P260 Castañeda, S. P334 Chisalau, B.A. P710, P711
Burke, E. P638 Castania, V.A. P464 Chislari, L. P124, P130
Burt, L.A. P148 Castelán-Martínez, D.O. P101, P368 Chitano, G. P656
Burt-Pichat, B. P357 Catalano, A. P338 Chiu, W.C. P113
Byrjalsen, I.B. OC9 Catan, L. P200, P201, P202 Chiu, W.-Y. P695
Catane, R. P584 Chodick, G. P518, P584
C Amaro Martins, V. P375, P378 Catanozi, S. P230 Choi, S. P231
Cadarette, S.M. P260 Cavalier, E. OC20, P340, P565, P568 Chokkatiwat, T. P142
Cadet, C. P715 Cazac, V. P130, P626 Chorfi, H. P499
Caeiro, J.R. P334, P544 Ceballos, I. P683 Chou, A.C.C. P149
Cai, S.Q. P184, P191 Celi, M. P297, P462, P485, P678 Christiansen, C. OC24, OC9, P580
Caimac, D. P305 Celik, D.C. P353 Chronopoulos, E. P339
Calabria, V. P712 Cerdà, D. P394 Chua, D.T.C. P149
 Osteoporos Int

Chung, R. P262 Crihalmeanu, A. P504 Dellaert, B.G. P408

Cianferotti, L. P242 Crilly, R.G. P256, P372, P377 Delloye, C. P716
Ciccarese, R. P656 Critchlow, C.W. P272 Delorme, P. P177, OC6, P367
Cicuttini, F. P276 Criveanu, C. P599, P710 Demeši Drljan, D. P488
Cierny, D. P370 Crozier, S.C. OC12, P313 Demir, T. P534
Cikač, T. P480 Cruz-Jurado, J. P683 Demir, G. P162
Cina, Z. P564 Csifo, E. P504 Demirhan, E. P225
Cioara, F. P386, P456, P457, P527, Csupor, E. P691 Demonceau, M. P180, P181, OC3
P533, P590, P647, P649, P654, Cui, Y. P390 Dempster, D. P134
P655, P658, P660 Culafic Vojinovic, V. P114, P115, Denetto, V. P656
Ciortea, V.M. P288, P291 P116, P362 Dennison, E.M. OC49, P199, P226,
Cipriani, C. P445 Culliford, D.J. P536 P365, OC33, P413, P418,
Circo, E. P287 Cursaru, A. P407, P409, P481 P421, P430, P447
Cirstoiu, C. P407, P409, P481 Cuzick, J. P364 Der Río Barquero, L. P406
Ciurea, P. P599, P710, P711 Cvjetkovic-Bosnjak, M. P192 Deseatnicova, E. P489, P591
Civitelli, R. PL7 Czekuć-Kryśkiewicz, E. P352 Deshpande, S. P537, P543
Čizmić, R. P480 Czerwinski, E. OC21 Devogelaer, J.-P. P576
Clark, P. P101, P368, OC5 Devyataikina, A. P320
Clegg, P. P172, P173 D’Amelio, P. P267 Deyneli, O. P601
Coen Netelenbos, J. P430 D’Amico, L. P267 Dhanwal, D. P160
Cohen, D. P584 Dacquin, R. P596 Dharmshaktu, P. P160
Cojocaru, M. P200, P202 Daizadeh, N. OC39, OC21 Di Benedetto, A. P338
Cojocaru-Gofita, I. P599, P710, P711 Dakin, P. P135 Di Giacinto, P. P303
Cole, Z.A. OC12 Dakka, T. P642 Di Gregorio, S. P403, P406, P415,
Coleman, R. P364 Dakovska, L. P246, OC53 P530, P606
Colina, I. P314 Damianou, E. P630 Di Pietro, G. P485
Colovic, H. P667 Damjanov, N. P187 Di Tanna, G.L. P247
Compston, J.E. OC1, OC22, IOF2, Danciulescu, R. P637 Di Vieste, G. P338
P430, P447 Danciulescu Miulescu, R. P628 Diacinti, D. P445
Conesa-Garcia, A. P344 Daneault, A. P144 Diaconescu, A. P223, P531
Confavreux, C.B. OC23, P523 Daniel, C. OC10, P698 Diaz-Curiel, M. P329, P333, OC5, P712
Constantin, D. P637 Das De, S. P592 Diez-Perez, A. OC1, OC22, P245,
Conti, F. P547 Dasgupta, A. P520 MTE7, P344, P405, P408,
Conversano, F. P627, P632 DaSilva, C. OC31 P417, P430, P447, P529
Cooper, C. P125, OC1, OC22, OC12, Daukste, I. P285 Dimai, H.P. OC5
PL1, P226, SE6, P245, SE10, IOF1, Davies, J.H. OC12 Dimitrijevic, L. P381, P667
P313, P324, P337, P374, P408, OC33, Dawson-Hughes, B. PL5 Dimitriu, A.L. P109
P413, P416, P418, P421, P422, P430, de Abreu, D.C.C. P508 Dimulescu, D.M. P136, P137
P434, P447, P536, OC25 de la Piedra, C. P544 Dincel, E.V. P277
Čop, R. P480 de Mello-Sampayo, C. P426, P555 Dini, M. P542
Coquerelle, M. P467 de Paula, F.J.A. P508 Dionysiotis, I. P630
Cör, A. P348 De Schepper, J. P419 Dirksen, C.D. P408
Cordero, Y. P281 De Torres, J.P. P314 Distante, A. P297, P656
Cormier, C. P458 de Vries, F. P125 Dixey, J. OC8
Corradini, C. P664 Debreshlioska, A. P636 Dixit, V. P160
Costa, G.C. P508 Dedoussis, G. P475 Djoudi, H. P121, P195, P539
Costes, S. P107 Dedukh, N. P354 Djurovic, N. P301
Covei, A. P204, P205, P206 Degli Esposti, L. P563 do Carmo, I. P690
Cox, L. P377 Degtyarev, A. P609 Docquier, P.-L. P716
Cox, A. P308 Del Rio, L. P403, P415, P530, P603 Doder, R. P192, P478
Coxam, V. P144 Delanaye, P. P565, P568 Dolidze, N. OC44, P336
Cremonini, E. P635 Delhumeau, C. OC15 Dolijanovic Pavlov, S. P319
Crepaldi, G. P574 Dell, R.M. P272 Domínguez Hernández, F.J. P719
Osteoporos Int

Donchovska, S. P636 Elez, J. P114, P115, P116, P362 Fekete, S. P361

Donchovska, D. P636 ElHadidy, S.T. P506 Feklistov, A.J. P178
Dontas, I. P339 Eliasaf, A. P396 Felson, D.T. P404
Dontas, D. P475 Ellouz, R. P341 Feola, M. P297, P462, P485, P678
Dorais, M. P276, OC6, P367 Elstein, D. P526 Ferencz, V. P688, P691
Dorosty Motlagh, A.R. P153 Elvira-Cabrera, O. P513 Fernández Rodríguez, C. P625
dos Santos Kotake, B.G. P373, P380 Emaus, N. OC49, P199, P253, P365 Feron, J.M. P719
Doslikova, K. P404 Ene, R. P407, P409, P481 Ferrari, S. P235, PL4, SE9, SE18,
Douni, E. P596 Engelke, K. P135, OC18, P351 OC11, OC39, OC37, P596
Dovjak, P. P318 Enkin, A.A. P161 Ferrari, D.T. P595
Dowsett, M. P364 Er, M.S. P534 Ferrazzini, S. P498, P635
Dragan, S. P679 Erben, R.G. P709, P714 Ferreira, I. P439
Dragunova, N.V. P477 Erdeljan, B. P123 Ferreira de Carvalho, A.A. P373
Dragutescu, A. P637 Erdmann, M. P236 Ferron, M. P128
Drew, S. P416, P422 Erdoğanoğlu, Y. P254 Feudjo-Tepie, M. P233, P439
Drueke, T.B.D. P212, P216 Eriksen, E.F. P243, OC29, P476 Fica, S. P532
Duarte, J.A. P248 Eriksen, S.A. P255, P265, P307 Fidler, E. P483
Dubetska, H.S. P566 Eroglu, M. P534 Fielding, R. PL3
Dubljanin Raspopovic, E. P663 Erra, A. P394 Fila, E. P498, P635
Duboeuf, F. P222, P357 Ershova, O. OC47, P609 Filella, X. P394
Dufrane, D. P716 Ervolino, E. P373 Filip, M. OC56
Duraj, V. P486, P657 Eskehave, T. P519 Filipovic, K. P117, P207, P328,
Durdevic, D. P355 Eskiyurt, N. OC52 P330, P488
Durisova, J. P311 Esmailzadeh, A. P153 Finck, H. P129
Durosier, C. P235, OC15, OC37 Essakalli, L. P642 Finnes, T.E. P243
Dusceac, R. P628 Esteves, J.L. P248 Finnilä, S. P335
Duvina, M. P242 Estublier, C. P157, P159 Firikh, K. P424
Dydykina, P. P110, P145, P320, P469 Etemad, K. P542 Fisher, A. P143
Dydykina, I. P110, P145, P320, P469 Eto, M. P454 Fisher, M. OC16
Dydyshko, Y. P298, P299 Evstigneeva, L. P602 FitzGerald, G. OC22
Dzeranova, L.K. P244, P280 Eymard, F. P413 Flahive, J. OC1, P430
Dzerovych, N.I. P412, P549, P551, Florea, M. P599
P553, P556 F. Gerlach, R. P376 Fojtik, P. P185, P186, P188, P189
Fabbri, S. P449 Fomin, O. P615
Eastell, R. P245, P364 Fabien-Soulé, V. P144 Fonseca, H. P248
Ebeling, P.R. P164, MTE5 Fahmi, H. P127, P613 Forbes, J.F. P364
Ebrahimi, M. P540, P541, P542 Fahrleitner-Pammer, A. P150 Formosa, M. P677
Eder, P. P427, P491, P494 Fairley, J. P276 Forsmo, S. P253
Edwards, M.H. P226, OC33, P413, Fallon, N. P562 Fortschegger, K. P572
P421 Fan, C.P. S. P385 Fouque, D. P523
Edwards, K. OC35 Fanaskov, V.B. P468 Franceschelli, F. OC38
Eğilmez, Z. P448 Fanti, E. P242 Franchini, R. P627, P632
Egund, L. P397 Farahmand, P. P229 François, G. OC10, P698
Einhorn, T. MTE1 Farcas, D.M. P559, P621 Franek, E. OC21
Eisen, C. P264 Fardellone, P.F. P212, P216 Frankland, S.W. P224, P227
El Hage, R. P402 Farias, F.E.S. P552 Fratini, E. P445
El Mansouri, F.E. P127 Farlay, D. P357 Frederiksen, H. P151
El Mustapha, E.A. P651 Farmer, S. P151 Frontoni, S. P303
El-Bardawil, M. P108 Farmer, A. P422 Frucchi, R. P546, P550
El-Belasy, A. P312 Farquharson, C. P128 Fuerst, T. P135
El-Hajj Fuleihan, G. P424, OC27 Fasano, A. P247 Fukunaga, M. P391
Elders, P. P125 Fatma, L.A. P694 Fulp, C. P671
Eldevik, P. OC29 Favors, K. OC13 Furberg, A.S. OC49, P199, P365
 Osteoporos Int

G Plepis, A.M. P375, P378 Gilmutdinov, I. P608, P623 Guañabens, N. P394

Gabal, V. P292 Gilsanz, V. P131 Guazzini, A. P247
Gabr, A. P707 Ginalska-Malinowska, M. P269 Gucalp, R. P278
Gabryś, P. P679 Giorgadze, E. OC44, P336 Gudmundsson, E. P438
Galanos, A. P339 Gkountouvas, A. P689, P692 Gudnason, V. P438
Galbavy, D. P311 Gkretsi, V. P452 Guede, D. P334, P544
Galdino de Paula, R. P316 Glezerman, I. P278 Guenane, Y. P539
Galesanu, C. P282 Globa, P.V. P516 Guermazi, A. P226
Galina, L. P350 Glüer, C.C. P351, OC2 Guerrero Franco, K. P389, P432, P433,
Galli, G. P449 Godfrey, K.M. OC12, P313 P505
Ganea, N. P401, P455, P619 Goemaere, S. OC18, P408, P419 Güerri-Fernandez, R. P405, P417
Ganert, O. OC47, P609 Gogas Yavuz, D. P601 Guillemin, F. SE22
García, M. P403 Gojkovic, F. P114, P115, P116, P362 Guinot Gasull, M. P332
García Flórez, L. P487, P490, P493, Goldenstein-Schainberg, C. P230 Güneri, S. P254
P500, P501, P510, P512, P514 Goldshtein, I. P518, P584 Gupta, A. P224, P227, P300,
García Iglesias, M.A. P459, P719 Golovach, I. P271, P283, P284 P503, P509
García Medrano, B. P487, P490, P493, Gomes, A.R. P449 Gupta, S. P300
P500, P501, P510, P512, P514 Gómez-Vaquero, C. P394 Gurner, D. OC31
García Rosado, D. P625 Gonçalves, A.A. P607 Gustin, P. P172, P173
Garcia-Fontana, B. P171 Gonçalves Gonzaga, M. P373
Garcia-Gil, M. P106 Gonuguntla, S. P554 Ha P.C. P262
Garcia-Martin, A. P171 Gonzalez, Y. P281 Hackl, M. P318
Garnero, P. P235 González Ballester, M.A. P415 Hadji, P. P150, P264
Gasbarra, E. P297, P462, P678 González Ramírez, A. P459, P719 Haesebaert, J. P523
Gasparik, A.I. OC46, P559 González Reimers, E. P625 Hagino, H. P251, P391
Gasparini, G.A. P363 González-Cantalapiedra, A. P544 Hagiwara, H. P279
Gates, L.S. P451, P536 Gonzalez-Perez, J.M. P687 Haiter-Neto, F. P685
Gatti, D. P466, P563 Gooberman-Hill, R. P416, P422 Hajjaj Hassouni, N. P642
Gautam, J. P517 Gossiel, F. P364 Halaby, G. P424
Gavin, M. OC21 Goudable, J. OC23 Haliyash, N.B. P561
Gavrilov, V.A. P325 Goulart, P.F.P. P614 Haller, I. P483
Gayko, G.V. P152 Grady, K. P256 Halse, J. OC31
Gehlbach, S.H. OC1, OC22, P430, Graham, L. P416 Hammad, L.F. P146
P447 Grajic, M. P330 Hammoumraoui, N. P121
Geleriu, A. P594, P662 Grapton, X. P257 Hanan, R. P642, P648, P651
Geller, M. OC40 Grauer, A. OC18, SE7 Hangartner, T.N. P131
Genant, H.K. P135, P226, MTE13, Grazio, S. P355 Hanley, D.A. P148
OC18, P600 Grbovic, V. P275 Hanna, F. P330
Geneva-Popova, M. P479, P484 Greco, A. P627, P632 Hans, D. OC30, P268, OC36, P411,
Gerdhem, P. OC19 Greenspan, S.L. OC1, OC22, P430, P412, OC2, P549, P551,
Gesmundo, A. P574 P447 P576, P607, P644
Ghasem-Zadeh, A. OC29 Gregson, C.L. P430, P447 Hansen, S. P151
Giangregorio, L.M. OC48, P256 Grigorie, D. P223, P252, P531 Hansen, L. P265, P307
Gianicolo, M.E. P656 Grigoriou, E. P475 Hao, Y.Q. P650
Giannini, S. OC42 Grillari, J. P318, P557, P572 Haouichat, C. P121, P195, P539
Gich Saladich, I.J. P332 Grillari-Voglauer, R. P318, P557, P572 Haqqi, T. P631, P674
Gielen, E. P150 Grimnes, G. OC49, P199, P253, P365 Harano, K. P697
Giganti, M. P498 Grineva, E.N. P516 Harsulkar, A. P537, P543
Gil-Fernandez, G. P675 Groppa, L. P124, P130, P197, P401, Hart, A.R. P129
Gillain, S. OC20, P166, P180, P181, P455, P489, P591, P619, P626 Harvey, N.C. P125, OC12, MTE6,
OC3, P340 Grozavu, I. P282 P313, P324, P418
Gilleece, Y. OC16 Grubisic, F. P355 Haseeb, A. P631
Gillet, P. P698 Grygoryeva, N.V. P535, P571, P573 Hashad, D. P108
Osteoporos Int

Hashemi, R. P153 Horvath, E. P504 Inskip, H.M. OC12, P313

Hashimoto, J. P179, P251 Hosmer, D.W. OC1 Insogna, K. P278
Hass Rubin, K. P418 Hosszu, E. P688, P691 Intorcia, M. P167, P168, P264,
Hassan, S.M. P118 Hoteit, M. P424 P439, P564
Hassan, M. P108 Howe, T.S. P149 Iobashvili, D. P310
Hassan, A. P578 Howe, J.G. P461 Iolascon, G. P297
Hawley, S. P245 Howell, A. P364 Iordachescu, C. P223
Hayashinaka, E. P390 Hoy, D. P293 Irsay, L. P288, P291
He, Y. P519 Hrdý, P. P185, P186, P188, OC56, Isaia, G.C. P267
He, L. P650 P189, P233 Ish-Shalom, S. P194
Heffernan, E. P211 Hrkovic, M. P196 Ito, M. P251, P391
Hegedüs, L. OC14 Hsu, C.Y. P113 Ivan, M. P710, P711
Heilmeier, U. P318 Hsu, K.H. P304 Ivanov, S.N. P306
Heimel, P. P557 Hu, H. OC41 Ivanova, M.P. P133, P213
Heinemann, A. P351 Hu, Z.H. P650 Ivey, K.L. OC34
Heinonen, A. OC48 Hu, M. P278 Iwanaga, S. P697
Helal, A.M. P312 Huang, H.Y. P113
Hermann, A.P. P151, P398 Huber, B.M. P461 Jaccard, A. P278
Hernández Bonilla, M. P389, P432, Hudson, D. P132 Jackuliak, P. P383, P384, P474
P433, P505 Huebner, J.L.H. OC4 Jaglal, S. P256
Hernández Luis, R. P625 Huesa, C. P128 Jain, R. OC48, P256, P278
Hernandez-Hernandez, V. P683 Hugtenburg, R.P. P308 Jamal, S. OC41
Hernandez-San Gil, R. P683, P687 Hui, E.Y.L. P193 Jamiolkowski, J. P666
Herrera Perez, M. P513 Huitrón, G. P101 Jamjoom, G.A. P102
Herrero-Beaumont, G. P334 Hum, D. P273, P322 Janjic, S. P301, P315, P319
Herrmann, F. OC37 Humbert, L. P406, P415 Jankovic, T. P117, P123, P207,
Heshmat, R. P153 Huner, B. P225 P327, P328, P478
Hesse, B. OC32 Hunter, D.J. OC35 Jansen-Dürr, P. P572
Hilário, B.E.B. P614 Hurson, C. P211 Janura, M. P189
Hiligsmann, M. P408, OC7 Huskin, J.P. OC10, P698 Janurová, K. P189
Hirao, M. P179 Hussain, A. P707 Jaser, N. P261
Hiremath, M. P228 Hussein, I. P554 Javaid, M.K. P245, P416, P422
Hissadomi, M.I. P546, P550 Hwang, J.S. P113, P156, P304 Jaworski, M. P352
Hitrova, S. P586 Jayawardana, R.A.D. P105
Ho, P.R. OC40 Iannarelli, A. P445 Jeholet, P. OC7
Hocaoğlu, Ş. P624 Ibarra, D. P368 Jeiranashvili, N. OC44, P336
Hochberg, M.C. SE21, OC6, OC13 Ibrahim, N. P554 Jennings, A. P129
Hoeck, H.C. P519, P580 Ibrahim, M.A. P119 Jensen, S. OC21
Hofstaetter, S.G. P467 Ibsen, R. P360 Jensterle Sever, M. P437
Hohnstein, A. P259 Ibsen, J.R. P255 Jeremic, M. P700
Holovacova, D. P383 Icagasioglu, A. P448, P525 Jeremic, I. P301
Holroyd, C. P313 Idolazzi, L. P466, P563 Jiménez, M.L. P349
Holvik, K. P243, P253 Ignaszak-Szczepaniak, M. P428, P699 Jiménez Viseu Pinheiro, J.F. P459,
Holzer, L.A. P348 Ikegami, S. P155 P719
Holzer, G. P348 Il’in, A.V. P244 Jkov, I. P479
Hong, S.S. P346 Ilham, R. P642 Joakimsen, R. OC29, P476
Honiges, A. P527 Ilic, N. P663 Johansson, H. P252, P434, P438,
Hontoir, F. P172, P173 Ilic Stojanovic, O. P196 P443, OC28, P454, OC2, P644, OC25
Hooven, F.H. OC1, OC22, P430, P447 Iliev, M. P636 Jones, R.K. P404
Horak, P. P188 Imane, B. P648, P651 Jones, G.T. P324
Horst-Sikorska, W. P427, P491, P494 Indah, S. P279 Jonsson, B.Y. P438
Horvath, C. P688, P691 Ingale, D. P543 Jordan, F. OC17
Horvath, P. P577 Inoue, T.I. P210 Jordan, J.M. OC35
 Osteoporos Int

Jordão Jr, A.A. P595 Karesova, I. P361 Kirschvink, N. P172, P173

Jorde, R. OC49, P199, P365 Karinkanta, S. OC50 Kirvalidze, N. P460
Jorge Ripper, C. P625 Karjalainen, J.P. P496, P558 Kishimoto, H. P391
Jorgensen, A.D. P265, P307, P360 Karlsson, L. P167, P439 Kjellberg, J. P360
Jose, S. OC16 Karlsson, M. OC28 Kliausova, E.V. P482, P708
José Falcai, M. P379, P380 Karmali, R. P347 Klimczak, K. P427, P491, P494
Josse, R. P256, OC41 Karonova, T.L. P516 Klop, C. P125
Jovanovic, J. P302, P593 Karpova, I.S. P270 Kloseck, M. P372
Jovanovic, V. P302, P502 Karsdal, M.A. P519, OC24, OC4, Kmecova, Z. P384, P474
Jovicic, Z. P703 OC9, P580 Kocakaya, O. P601
Jovicic, M. P196 Karsenty, G. P128 Kochaji, N. P400
Juang, J.-M.J. P695 Kasalický, P. P233, P652 Kochbatti, K.S. P705, P706
Judge, A. P245, P422 Kassabova, L. P246, OC53 Kochetkova, E. P492, P585
Julián Enríquez, J.M. P459, P719 Kastner, J. P467 Kochetova, E. P321, P323
Jurdic, P. P596 Katayama, Y. P390 Kochi, M.N.K. P508
Jurisic Skevin, A. P275, P423 Kato, N. P390 Kochish, A.U. P306
Juuti, A. P261 Kato, H. P155 Kocic, M. P381, P667
Jørgensen, H.L. OC14 Katusic, D. P237 Kocjan, T. P437
Katz, P. P256 Koh, J.S.B. P149
Kaasalainen, S. P256 Kaufman, J.-M. OC26, P419, MTE3, Kolarov, Z.I. P289, P640
Kachakova, D. P640 SE8, SE20 Kollcaku, A. P331, P486, P657
Kafetzopoulos, D. P452 Kaur, P. P520 Kollcaku, J. P331, P486
Kahan, A. P458 Kavaric, S. P444 Kolozsi, J. P504
Kaivosoja, E. P214 Kazic, K. P444 Kolpinskiy, G.I. P141
Kalantzaki, K. P452 Kearns, A. OC30 Kolundzic, R. P355
Kalashnikov, O.V. P152 Keaveny, T.M. P135, P461 Konstantinovic, L. P315
Kalashnikov, A.V. P152, P170 Keider, V. P557 Konstantynowicz, J. P666
Kalashnikova, O. P465 Keller, H. OC48 Konttinen, Y. P214
Kalaycheva, N. P669, P704 Kendler, D.L. P135, P236, OC39, OC21 Koppikar, S. P537, P543
Kaldrymides, P. P692, P693 Kępka, A. P269, P352 Koroleva, M.V. P548, P567
Kalibatiene, D. P450 Kersh, M.E. P164 Kostenuik, P. P134
Kalinova, D. P472 Keshtkar, A.A. P540, P541, P542 Kostik, M. P465
Kalkwarf, H.J. P131 Kevic, S. P192, P579 Kostoglou-Athanassiou, I. P669, P681,
Kallel-sellami, M. P670, P672 Kezdi, I. P504 P689, P692, P693
Kallikorm, R. P616 Khachidze, N. P336 Kotb, M.M. P102
Kalouche-Khalil, L. P150, P233 Khalifa, P. P257 Koumakis, E. P458
Kamel, S.K. P212, P216 Khan, T. P554 Kovacs, B. P504
Kamimura, M. P155 Khan, A. P236, IOF3, OC41 Kozlovacki, G. P207
Kaneko, K. P263 Khanna, V. P120, P366 Kozomara, S. P295
Kaneva, R. P640 Khashayar, P. P540, P541, P542 Kozuń, M. P679, P682
Kanis, J.A. PL6, SE6, P252, P434, Khaw, K.T. P129, OC2 Krajcovicova, V. P311
P438, P443, OC28, P454, OC2, Khedgikar, V. P517 Krajnc, M. P296
OC5, P644, OC27, OC25 Khol, M. P671 Kraus, V.K. OC4
Kanterewickz, E. P394 Khoueiry-Zgheib, N. P424 Krause, M. P351
Kapoor, M. P127, P273, P322, P613 Khrulev, V.N. P306 Krela-Kazmierczak, I. P427, P491,
Kaptoge, S.K. OC2 Kiely, P. OC8 P494
Karadzic, M.S. P302, P326 Kilasonia, L.A. P460 Krieg, M.A. OC2
Karagoz, A. P162 Killinger, Z. P233, P370, P383, Krišáková, V. P185, P186
Karahan, A.Y. P126 P384, P474 Krishna, A. P265, P307, P360, P385
Karalilova, R. P583 Kim, J.D. P104 Krochak, S.P. P535
Karalilova, R.K. P479, P484 Kim, C.H. P104 Kröger, H. P558
Karasevska, T.A. P411, P412 Kim, Y.G. P140 Kroon, R. OC31
Karczmarewicz, E. P352 King, G. OC17 Krstic, N. P663, P702
Osteoporos Int

Krueger, D. P483, P511 Lebel, E. P526 Liu, G. P147

Kruk, M. P352 Leboulleux, S. P278 Liu, D.H. P113
Kubey, I.V. P561 Leclere, D. P257 Liu, Y.Y. P260
Kucuk, A. P126 Leduc, C. P717 Liuni, F.M. P297, P462, P678
Kuebler, W.M. P709, P714 Lee, Y. P140, P515 Loboa, E.G. P228
Kulkarni, P. P537, P543 Lee, J.-J. P695 Lofthus, C.M. P243
Kull, M. P616 Leila, E. P651 Loghin, A. P282
Kung, A.W.C. P193 Leivonen, M. P261 London, G. P523
Kuroda, T. P390, P391, P454 Lekhal, F.Z. P195 Loong, H.N.C. P193
Kurth, W. OC10, P698 Lember, M. P616 Lopes, A. P426, P555
Kusaka, K. P697 Lemesle, P. P257 López Gavilanez, E. P389, P432,
Kushwaha, P. P517 Lemiasheuskaya, S.S. P497 P433, P505
Kusiv, E.L. P170 Lempert, U.G. P684 Lopez-Pedrosa, J.M. P349
Kuzma, M. P383 Lems, W.F. MTE14, SE12 López-Peña, M. P544
Kuzmanova, S. P183 Lentjes, M.A. P129 Lorenc, R.S. P269, P352
Kuznetsova, A.V. P280 León, A. P165 Lorentzon, M. OC28
Kwok, A. OC2 Leonard, M.B. P507 Lorenzo de la Peña, L. P513
Kwon, N. P231 Leoncini, G. OC38 Low, S.L. P592
Kwon, O.J. P104 Lepionka, W. P352 Luben, R.N. P129
Leslie, W.D. P644, OC27 Lucas, R. P622
Laadhar, L. P670, P672 Lesnyak, O. OC5 Luciani, D. OC42
Labashova, V. P286 Lespessailles, E. P717, P718 Lucic, A. P275
LaCroix, A.Z. OC1, OC22, P430, P447 Letkovska, A. P384, P474 Lukina, G. P320
Lafage, M.H. P523 Leufkens, H.G.M. P125 Lundkvist, J. P167
Lagvilava, L. P460 Leung, E.L.Y. P193 Lupescu, O. P109
Lakatos, P.L. OC21, P564, P577, P688 Leung, A. OC31 Lupescu, D. P109
Lakehal, F.Z. P121 Lewiecki, E.M. OC39, OC21 Lussier, B. P273, P322, P613
Lalondriz Bueno, Y. P625 Lewis, J.R. OC34 Luyten, F.P. P404
Lamy, O. P268, P644 Leyland, K.M. P442, OC35 Luzin, V.I. P325
Lange, A. P163 Lhotová, M. P209 Lykowska-Szuber, L. P494
Langer, M. OC32 Li, G. P198 Lynn, E. P562
Lannon, R. P562 Li, Y. P613 Lyritis, G. P339
Lapauw, B. P419 Li, Z. P385
Lappe, J.M. P131, OC34 Li, H. P138 M. Issa, J.P. P373, P375, P376, P378,
Laprade, J. OC48 Li, Y.Z. P184 P379, P380, P463
Lapshina, S. P608, P618, P623, P629, Liao, E.Y. P650 Maashari, H. P554
P639, P645 Libanati, C. P134, P135, OC30, Macchi, V. P664
Laredo, J.D. P719 OC18, OC39 Macdonald, H.M. P148
Largo, R. P334 Libber, J. P511 Macedo, A.P. P363, P379, P463,
Larijani, B. P540, P541, P542 Lim, W.F. P139 P464, P595
Larionova, V. P465 Lim, L.C. P156, P304 MacIntyre, N.J. OC48
Lasco, A. P338 Limongi, F. P574 MacRae, V.E. P128
Lau, E. P262, OC2 Lin, H. P138, P650 Madani, B.M. P102
Laulund, A.S. OC14 Lin, K.M. P113 Madani, T.A. P102
Laurinavicius, A. P610 Lin, C.J.F. OC30, OC21 Maganaris, C.N. P404
Lauritsen, M.B. P255 Lin, K. P138 Maggi, S. P574
Lavado-Garcia, J.M. P570 Lindhardt Egsgaard, L. P519 Magnus, J.H. P253
Lazar, L. P453, P456, P533, P647 Lindsay, R. OC22 Mahboubi, S. P507
Lazaretti-Castro, M. P696 Link, T. P318 Maheu, E. P715
Lazarevic, M. P117, P327 Linke, K. P427, P491, P494 Mahfouz, R. P424
Lazic-Cilerdzic, T. P207 Linzer, P. OC56 Mai, T.M.T. P597
Lazovic, M. P196, P665 Lippuner, K. OC39, OC21 Maier, A.B. P572
Le Huec, J.C. P107 Liu, C. P259 Maistrovskaiy, Y. P492, P585
 Osteoporos Int

Makarevich, A.E. P497 Masi, L. OC38 Mequanint, S. P372

Makino, Y. P263 Masri, B. MTE11 Mesci, E. P448, P525, P624
Makki, M.S. P631 Massari, L. P635 Mesci, N. P525
Makni, S. P670, P672 Massy, Z.M. P212, P216 Messner, P. P572
Maky, F.S. P545 Mastaviciute, A. P610, P611 Mesterton, J. P439
Maltseva, V. P354 Masud, T. OC17, P398 Meszaros, S. P688, P691
Malyshenko, O.S. P468 Matagne, A. P172, P173 Metozzi, A. P247
Mamaladze, T.N. P495 Matei, D. P240, P305, P356, P358, Metzger, M. P268
Manabe, H.M. P210 P359, P429, P431 Meyer, H.E. P243, P253
Mandic, N. P295, P342 Matejcic, A. P355 Michalak, M. P427, P491, P494, P699
Manicourt, D.H. P576 Matica, A. P533 Micutkova, L. P572
Manso, G. P234 Matos, O. P345 Mihai, A. P594, P662
Manupati, S. P503, P509 Matsuo, K. P273 Mihailov, M. OC51
Manzano, M. P349 Matsushita, M. P179 Miheller, P. P688
Maquet, D. P180, P181, OC3 Mattos, N.B.S. P546 Miketic, N. P444
Maram Edry, M. P396 Matzen, L. P398 Mikhalchenko, E. P271
Marbury, T. P259 Mautalen, C. OC18, OC21 Miklic, D. P355
Marc, F. P559 Mavilia, C. P449 Miladinovic, K.M. P353
March, L. OC1, OC22, P293, P430, P447 Mazor, M. P718 Milenkovic, S. P713
Marchand, F. P157, P159 Mazur, M. P369 Millán, J.L. P128
Marcinkowska, M. P428 Mazur, I. P292 Miller, C. P511
Marcu, F. P453 Mazur-Nicorici, L. P369 Miller, P.D. OC39, OC31
Marcu, I.R. P305, P673, P676 Mazurenko, O.G. P161 Milojevic, Z. P446
Mardegan Issa, J.P. P595 Mazurenko, S.O. P161 Minisola, S. OC21, P445
Marin, F. OC2 McAlindon, T. SE17 Miossec, P. SE14
Marinkovic, G. P187, P258 McCallion, P. P638 Miranda, P. P345
Marioara, O.M. P204, P206, P217 McCarron, M. P638 Mishra, S.K. P520
Marioara, A.M. P205 McCarthy, B. P562 Mishukov, Y. P526
Markovic, K. P446 McCauley, P. P562 Misiorowski, W. P278
Markovic, M. P709, P714 McCloskey, E.V. MTE4, P252, SE19, Misson, V. OC7
Marozik, P.M. P176 P434, P438, P443, OC28, P454, Mithal, A. P520
Marques, M.C. P426, P555 OC2, OC5, P644, OC27, OC25 Miti, A. P237
Martel-Pelletier, J. P127, P177, P273, McClung, M.R. P135, OC27 Mizunuma, H. P251
P276, P322, OC6, P367, OC13, P613 McCulloch, L. P451 Mizusaki Iyomasa, D. P373
Martelli, S. P164 McDonald-Blumer, H. OC41, P600 Mizusaki Iyomasa, M. P373
Martelli, M. P242 McGill, S. OC48 Mkrtumyan, A. P521
Martelli, Y. P406, P415 McGowan, B. P408 Mocanu, D. P532
Martelli, F.S. P242 McGuigan, F.E. OC19, P397 Moebius, P.M. P471
Martín Ferrero, M.Á. P490, P493, McKenna, M.J. P211 Mogensen, B. P438
P500, P501, P510, P512, P514 Mecocci, P. P247, P547 Mohamed Habib, S. P694
Martín-Fernández, M. P544 Mehta, A. P259 Mohammadi, Z. P540, P541, P542
Martin-González, C. P513, P625 Meirlaen, P. P172, P173 Mohasseb, D. P108, P312
Martin-Ponce, E. P687 Melal, S. P195 Moise, H. P274
Martínez, S. P394 Mellibovsky, F. P417 Mokhort, T. P598
Martínez García, S. P332 Mellibovsky, L. P405, P417 Moldovan, C. P559
Martínez Ibeas, M. P487, P490, P493, Mellor, L.F. P228 Mologhianu, G. P136
P510, P512, P514 Mellström, D. P385, OC28 Monegal, A. P394
Martinez-Laguna, D. P344 Melnichenko, G.A. P244, P280, P477 Monereo, M. P687
Marton, D. P688 Ménard, A.L. P148 Monov, S. P289, P472, P640
Marwah, S. P232 Menczel, B. P691 Monreal, J.I. P314
Mary, A.M. P212, P216 Méndez-Sánchez, L. P101 Montastruc, J.L. P234
Masaryk, P. P384, P474 Mendoza, S. P281 Moon, R.J. OC12
Mascarenhas, M.R. P607, P690 Mentaverri, R.M. P212, P216 Morabito, N. P338
Osteoporos Int

Morais, J. P230 Nakano, T. P251, P391 Novkovic, S. P258

Morales-Santana, S. P171 Nakata, K. P279 Novosadová, P. P185, P186, P188,
Moran, J.M. P570, P675 Nasir, S. P111, P112 OC56, P189, P208, P209
Moreau, M. P347 Nasonov, E. P110, P145, P320, P469 Ntani, G. P324, OC33
Moreira, M.M. P546 Naumovic, N. P488 Nuhaily, S. P554
Moreira-Gonçalves, D. P248 Navarro Chavez, M. P389, P432, P433, Nuti, N. P242
Morgenstern, A.B. P363 P505 Nybo, M. OC14
Morin, S. P256, OC41 Nawata, K. P425
Moritz, N. P335 Nawaz, M.K. P578 Oberfield, S. P131
Morozova, N.S. P174 Nebbaki, S.S. P127 Odén, A. P434, P443, OC28, P454,
Morris, H.A. P434 Nechita, M. P291 OC2, P644, OC25
Morrison, A. IOF4 Nedeljkovic, U. P663 Oguz, A. P473
Morton, N.M. P128 Neglia, C. P297, P656 Oh, J.S. P346
Mosekilde, L. OC34 Nelson, A.E. OC35 Ohshima, S. P179
Moser, A. P256 Nemcic, T. P355 Okauchi, T. P390
Mosli, H.H. P102 Nemes, D. P200, P201, P202 Okumus, M. P162
Mosse, I.B. P176 Nestorova, R. P266, P289, P472 Oldknow, K.J. P128
Mousa, S.A. P528, P545 Netelenbos, J.C. OC1, OC22, P447 Oliveira, B.R.S. P614
Moussa, F.M. P671 Neto, M.P. P382 OMalley, C. OC39
Mpallas, M. P339 Neukam, F.W.N. P471 Omelka, R. P311
Muhire, C. P347 Neuprez, A. OC10, P698 Ominsky, M.S. P134, P718
Mukaiyama, K. P155 Nevitt, M. OC35 Omsland, T.K. P253
Mukane, M. P221, P285 Ng, A.C.M. P149 Onac, I. P288, P291
Mukans, M. P285 Nibio, L. P656 Onnby, K. P397
Muljacic, A. P355 Nicolov, M. P641 Onofrei, R. P569, P668
Müller, R. P616 Niculescu, D. P628 Oommen, A. P182
Muñoz, F. P544 Nielsen, C.S. P199 Opris, D. P628, P634
Muñoz-Torres, M. P171 Nieves, J.W. OC1, P430, P447 Orbetzova, M.M. P371
Munshi, R. OC45 Nikcevic, L.J. P114 Orsso, C. P345
Muntalà, N. P394 Nikiphorou, E. OC8 Ortés-Gómez, R. P675
Murashko, L.M. P395 Nikitina, I.L. P516 Orwoll, E.S. OC2
Murat, S. P448 Nikitinskaya, O.A. P178 Osteoporosis Society, OC52
Muratore, M. P627, P632 Nikodem, A. P679, P682 Ott, S.M. P272
Museyko, O. P351 Nikolic, T. P355 Overbeek, J. P439
Musiienko, A.S. P549, P551 Nikolic, D. P665 Oxford, J.T. P228
Mustapic, M. P355 Nikolov, N. P266 Özçakar, L. P254
Muts, V. OC55 Nikolov, A. P586 Ozgun, T. P162
Myasoedova, S. P145 Nikolova, M. P203 Ozkan, Y. P277
Myasoutova, L. P608, P618, P623, Nilsen, O.A. OC49, P365 Ozsoy, H.M. P277
P629, P639, P645 Nisolle, J.F. P172, P173 O’Neill, T.W. OC2
Mytnyk, Z. P283 Nistor-Cseppento, C. P453, P456, P457,
Mzik, M. P361 P587, P647, P654 Pablos Hernández, C. P459, P719
Nita, A. P569, P668 Paccou, J.P. P212, P216
Nabavi, H. P542 Noale, M. P574 Padlina, I. P268
Nagea, M. P109 Noami, M. P697 Paesmans, M. P347
Naguib, A. P312 Nodelman, M. P194 Pages-Castella, A. P529
Nagy, E. P504 Nogues, X. P529 Pailo, A.F. P546, P550
Nagy, B. P564 Nogués-Solan, X. P344, P405, P417 Paiva, A.G. P363, P382, P464
Najia, H.H. P648, P651 Nonckreman, S. P716 Palamar, D. OC52
Nakahara, T. P697 Nordström, D. P214 Palencia, J. P165
Nakajima, T. P680 Norman, R. P293 Palicka, V. P361
Nakamura, T. P251, P391, P454 Nosowicz, W. P428 Pallag, A. P527, P654
Nakamura, Y. P155, P391 Novikov, V.E. P395 Pallu, S. P718
 Osteoporos Int

Pandy, M.G. P164 Pescador Hernández, D. P459 Popovic, V. P236

Pantelic, P.S. P646 Pescinini Salzedas, L.M. P373 Popovici, I. P489, P591
Papadakis, G. P408 Peshekhonov, D. P145 Poulain, L. P257
Papaggelopoulos, P. P630 Petermans, J. OC20, P166, P180, Povoroznyuk, V.V. P411, P412, P414,
Papaioannou, A. P236, OC48, P256, P181, OC3, P340 P535, P549, P551, P553, P556, OC55,
OC41 Petersen, K.K. P519 P560, P561, P566, P571, P573
Papaioannou, N.A. P150, P475 Petit-Dop, F. P226, P413 Povoroznyuk, R.V. P411, P412, P549,
Papapoulos, S. PL8, OC40, OC21 Petkova, R. P168 P551, P553, P556
Parafiniuk, B. P352 Petranova, T. P266, P289, P472 Prado, C. P712
Parezanović Ilić, K. P275, P423 Petrela, E. P486 Preda, S.A. P204, P205, P206, P215,
Park, Y.J. P346 Petris, R. P637 P217, P218, P219
Park, S.E. P104 Petroska, D. P610 Predko, N. P615
Parra, E. P230 Petrova, E. P110, P145, P469 Preidl, R.P. P471
Parri, S. P247, P297 Petrovic, S. P295 Prelic, M. P258
Parsons, C. P226, OC33, P413, P421 Petrusic, T. P295, P342 Prentice, R.L. OC34
Partsinevelos, A. P630 Peyrin, F. OC32 Prezelj, J. P437
Pasalar, P. P153 Pfeifer, M. P437 Přibylová, J. P208, P209
Pascalau, N. P654 Pfeilschifter, J. OC1, OC22, P430, P447 Prieto-Alhambra, D. P106, P245,
Pasqualin, T. P546, P550 Pichon, C. P717 P309, P344, P405, P417, P529
Pasqualotto, S. P664 Pickard, L. P256 Prietzel, H. P255
Pastore, R. P303 Pietschmann, P. P318, P572 Prince, R.L. OC34
Patel, R. P364 Pigarova, E.A. P244, P280 Prioletta, I. P247
Patru, S. P305, P356, P358, P359, Pinedo-Villanueva, R. P374 Procopiuc, L. P661
P429, P431, P673, P676 Pintaudi, B. P338 Prodanović, S. P423
Patru, C. P109 Piotrowska-Jastrzebska, J.D. P666 Psachoulia, E. P167, P168, P264, P564
Paun, D. P637, P662 Pire, G. OC7 Puenea, G. P200, P201, P202
Paunović, J. P423 Pirogova, O.A. P468 Punda, M. P355
Paunović, N. P362 Pirson, R. P172, P173 Płudowski, P. P352
Pavelka, T. P410 Pisani, D. P445
Pavlović, D. P423 Pisani, P. P632 Qahtani, N. P554
Payab, M. P153 Piscitelli, P. P247, P297, P656 Qari, M.H. P420, P528, P545
Payer, J. P370, P383, P384, P474 Pitarch, C. P394 Qin, G. P262
Payet, J. P458 Pivonka, P. P164 Quabron, A. P166
Pearson, G. P408 Plata-Bello, J. P687 Quarta, G. P297, P656
Pearson, R. OC17 Pludowski, P. P269 Quarta, E. P627, P632
Pedrera-Zamorano, J.D. P570, P675 Png, M.A. P149 Quarta, L. P627, P632
Pejovic-Milic, A. P274 Pobel, E. P354 Quintero Platt, G. P625
Pekkarinen, T.A. P261 Podurec, K.M. P175 Quirino Louzada, M.J. P380, P382,
Pelazas González, R. P625 Podvorotova, M. P110, P145, P469 P614
Pelletier, S. P523 Poggi, A. P498 Quirino Luzada, J.F. P685
Pelletier, J.-P. P127, P177, SE4, P273, Poiana, C. P594, P628, P634, P637,
P276, P322, OC6, P367, OC13, P613 P661, P662 R dos Santos, G. P375, P378
Peng, Y.D. P650 Polovinka, M.P. P633 R. Kawakita, E. P376
Penoni, A.C.O. P363, P382, P464, P614 Polyanskaya, T. P602 Rabenda, V. OC20
Perbellini, O. P466 Popa, D. P200, P201, P202, OC51 Radavelli-Bagatini, S. OC34
Peretianu, D. P634 Popa, C. P661 Radoi, V. P594, P634, P662
Peretz, A. P347 Popescu, R.S. P240, P305, P356, P358, Radojevic, N. P444
Pérez Hernández, O. P625 P359, P429, P431, P673, P676, P686 Radosavljevic, N. P196, P665
Pérez Ramirez, A. P513 Popescu, G.H. P109 Radosavljevic, Z. P665
Perez-Lloret, S. P234 Popivanov, P. P586 Radunovic, G. P315
Perez-Ramirez, A. P683 Popivanova, A. P586 Raef, H. P707
Perkins, A. OC17 Popova, S. P479, P484 Rafferty, J. P308
Permuy, M. P544 Popova, V. P479, P484 Raftery, J.P. P374
Osteoporos Int

Rahme, M. P424 Rivera, P. P314 Ryg, J. P398

Rajaratne, A.A.J. P105 Riza, M.L. P204, P205, P206 Ryzhyk, V. P271
Rajoanah, S. P128 Rizou, S. P339
Rakonczai, P. P564 Rizzoli, R. P235, P238, SE2, SE6, S Ferreira Junior, R. P375
Ramanau, H. P615, P620 OC11, OC15, OC37, Saag, K.G. OC1, OC22, SE13, P430,
Ramezani, M. P542 P408, OC31, OC25 P447
Ramos, J. P281, P373, P376 Roato, I. P267 Sabati Rajic, A. P437
Ramos, R. P106 Robinson, S.M. OC12 Sabin, C. OC16
Ranjan Mishra, P. P517 Rocha, V. P683 Sacconi, B. P445
Rao, C. P297, P462, P485, P678 Rodionova, S.S. P174, P175 Sadat-Ali, M. P653, P659
Rasa, I. P221, P285, P294 Rodrigues da Cunha, M. P375, P378 Saeki, Y. P179
Rashkov, R. P266, P289, P472, P640 Rodriguez Islas, F. P368 Safadi, F.F. P671
Raskina, T.A. P468, P548, P567 Rodriguez Portales, J.A. OC31 Sala, M. P394
Raum, K. OC32 Rodriguez-Rodriguez, E. P513, P683, Salaru, V. P369
Ravani, B. P635 P687 Salgueiro-Vázquez, M.E. P234
Raynauld, J.P. P177, P276, OC6, P367 Rodriguez-Rodriguez, L.M. P687 Salko, O. P286
Raza, S.A. P578 Rodriguez-Velasco, F.J. P675 Salmeron-Castro, J. P101
Razi, M. P578 Roef, G. P419 Salomonsson, S. P385
Recknor, C. P135, OC18 Roemer, F. P226 Salturk, Z. P225
Redl, H. P318, P557, P572 Rogoveanu, O. P240, P241 Samakhavets, V. P617
Reeve, J. OC2 Roldan, H. P683, P687 Samakhavets, O.V. P176
Reeves, N.D. P404 Romagnoli, C. P242 Samarawickrama, A. OC16
Refai, G.Y. P528, P545 Romagnoli, E. P445 Samueloff, A. P526
Reginster, J.-Y. OC20, P166, P180, Román-Blas, J.A. P334 Sanchez, M.T. P106
P181, OC3, P226, SE6, SE5, OC39, Romani, A. P635 Sanchez-Perez, M.J. P683
P340, OC21, P408, P413, OC57, Romanova, M. OC47, P609 Sanchez-Riera, L. P293, P554
P588, OC10, OC7, P698, OC25 Roncero-Martin, R. P570, P675 Sanchez-Santos, M.T. OC35
Reid, I. OC31 Ros Vilamajó, R. P513 Sanders, K.M. OC5
Reis, J.G. P508 Rosengren, B. P337 Sane, T. P261
Rejnmark, L. OC34 Rossini, M. OC1, OC22, P430, Sanfillippo, J. P511
Renard, P. P257 P447, P466, P563 Sangkomkamhang, T. P470
Renna, M.D. P627 Rosu, A. P599 Sangwan, N.S. P517
Resch, H. P572 Rotaru, L. P197 Sannikova, E.V. P306
Restituto, P. P314 Rotman Pikielny, P. P396 Santana, O.F.N. P546
Revenco, N. P369 Rouach, V. P584 Santesso, N. P256
Rey, M.V. P234 Roubille, C. P177, OC6, P367 Santolaria Fernández, F. P513
Rey-Sanchez, P. P570 Roux, C. OC1, OC22, OC21, P408, Santora, A.C. P650
Reyes-Garcia, R. P171 P430, P447 Sarbu, O. P197
Rezende, M.U. P546, P550, P552, P604 Rouzi, A.A. P343, P420, P528, P545 Sarfati, E. P458
Riaz, S. P578 Rozas-Moreno, P. P171 Saridogan, M. OC52
Richette, P. P413 Rozenberg, S. MTE9, P347 Sasa, T.S. P210
Richterova, R. P185, P186, P188, P189 Rozhinskaya, L.Y. P244, P280, P477 Sassi, N. P670, P672
Ridderstråle, M. OC19 Rubin, K.H. P245 Sassi, F. P267
Ridout, R. OC41, P600 Rudenka, A.V. P176, P612, P615 Satomura, K. P697
Riekkinen, O. P496, P558 Rudenka, E.V. P176, P190, P615, Scarcella, D.S. P604
Riera-Espinoza, G. P281 P617, P620, P575 Scharla, S.H. P684
Riesen, S.C. P709, P714 Rueda, R. P349 Schei, B. P253
Riis, B.J.R. OC9 Ruggiero, C. P247, P547 Scheplyagina, L. P465
Ringe, J.D. P229 Rus, M. P647, P660 Scher, J. OC41
Rinonapoli, G. P547 Rusimov, V.L. P103 Schibler, U. SERVIER HONORARY
Rinotas, V. P596 Ruskina, T. P145 LECTURE
Risoli, M. P563 Russo, L.A.T. P719 Schmid, T. P264
Rivas-Ruiz, R. P101, P368 Russu, E. P401, P455, P619, P626 Schneider, K. P572
 Osteoporos Int

Schousboe, J. P496 Shrimal, V. P120 Solodovnikov, A.G. P477

Schraml, E. P318, P557, P572 Shrivastava, C. P120 Solovyeva, I. P521
Schultz, K. P684 Shubeska-Stratrova, S. P387, P388 Sondag, G. P671
Schwarz, P. P418 Shumnalieva, R. P640 Sone, T. P391
Seeman, E. P250, OC29 Shusharin, A.G. P633 Song, C.L. P650
Seferoglu, B. P122 Siassi, F. P153 Soong, Y.K. P113
Segal, E. P194 Sibilla, F. P107 Sorkin, J. OC13
Segale Bajana, A. P389, P432, P433, Siddarth, K.V. P503, P509 Sornay-Rendu, E. P222, P341
P505 Siddhanti, S. OC40 Souad, A. P648, P651
Segundo, M. P368 Siebuhr, A.S. OC24, P580 Souberbielle, J.C. P458
Selimov, P. P479, P484 Sievänen, H. OC50 Sourovenko, T. P585
Sellami, S. P670, P672 Siggeirsdottir, K. P438 Spalevic, M. P381, P667
Semeniv, I. P284 Sigurdsson, G. P438 Spector, T.D. P442, OC35
Sen’ko, O.V. P280 Silke, C. P408 Spertino, E. P267
Senani, N.S. P343, P420 Silva, C.A.C. P552 Spyridis, A. P669
Senck, S. P467 Silva Pettian, M. P378 Squerzanti, M. P635
Senel, K. P122 Silva-Lima, B. P426, P555 Stamenkovic, B. P713
Senturk, S. P473 Silverman, S. OC1, OC22, P430, Stankovic, I. P381, P667
Sepici, V. P277 P447 Stankovic, A. P381, P667
Sepici Dincel, A. P277 Simic-Pasalic, K. P187 Stankovic, O. P315
Sertbaş, Y. P601 Simões, D. P622 Staroselsky, K.G. P161
Sestak, I. P364 Simões, V. P607 Stathopoulos, K. P630
Sevillano, X. P415 Simonsen, O. P519 Stathopoulou, M. P475
Sfontouris, C. P339 Simpson, J.M. OC34 Stawczyk-Eder, K. P427, P491, P494
Shaker, M. P707 Šimunić, T. P480 Stefanov, Z. P289
Shalev, V. P518 Sinaki, M. P239 Stefanovski, G. P399
Shanbhogue, V. P151 Sinenko, A. P145 Stehman-Breen, C. OC40
Shane, E. OC30 Singh, S. P364 Ștepa, V. P619
Shankar, M. P393 Sinitsyna, O. OC47, P609 Sterancakova, L. P370, P383
Sharapova, E. P521 Sinkeviciene, V. P450 Stern, N. P584
Sharikadze, N. P336 Siris, E.S. OC1, OC22, P430, P447 Stilwell, D. P426, P555
Sharma, S. P517 Siviero, P. P574 Stoch, S.A. P259
Sharon, Y. P518 Skacelova, S. P652 Stockmann, P.S. P471
Shchehlova, Y.I. P170 Skakic, A. P593 Stoica, S. P441, P643
Shen, L. P592 Skakic, V. P302, P593 Stoicanescu, D. P581, P582, P587,
Shepelkevich, A.P. P286, P298, P299, Skalicky, S. P318 P589, P590
P482, P708 Skarantavos, G. P630 Stoicescu, M. P453
Shepherd, J.A. P131 Skidmore, C.J. P256 Stoilov, R. P289
Sheytanov, I. P289, P472 Skorobogatov, A.N. P325 Stojanovic, M. P302
Shibu, P.K. P132 Skripnikova, I.A. P395 Stojanovic, S. P713
Shigdel, R. OC29, P476 Slancheva, B. P586 Stojic, B. P301, P315, P319
Shimano, A.C. P363, P379, P382, Slavic, S. P709, P714 Stojicic, S. P663
P463, P464, P595, P614 Slomian, J. OC20, P166, P180, P181, Stoll, D. P268
Shimano, R.C. P463, P595 OC3, P340, OC57, P588 Stolnicki, B. P290, P316
Shinde, D. P543 Smirnov, A. P110, P145, P320, P469 Stone, A. P139
Shingaki, T. P390 Smith, W. P259 Stone, J. P259
Shinkov, A. P168, P246, OC53 Smith, E. P293 Strazdiene, V. P610, P611
Shipp, K. OC48 Soare, D. P661 Strebkova, E. P521
Shiraki, M. P391, P454 Sobchenko, K.E. P395 Streel, S. OC57, P588
Shkaraburov, A.S. P141 Soininen, A. P214 Ström, O. P167, P439
Shoro, A. P182 Sokolovic, S. OC54 Strukov, V.I. P220
Short, D.F. P131 Solakov, P. P183 Strutz, C.G. P546
Shoumnalieva-Ivanova, V. P640 Solbakken, S.M. P253 Stypinski, D. P259
Osteoporos Int

Subin-Teodosijevic, S. P117, P207, P327 Taylor, P. P313 Tripi, G. P466

Sucaliuc, A. P223, P252, P531 Tebé, C. P344 Tripon, G. P504
Suciu, R.N. OC51, P527, P587, P654 Tedesco, G. OC42 Trivedi, R. P517
Suciu, O. P569, P668 Tekin, A.N. P126 Trivedi, P. P517
Suehara, Y. P263 Tekin, L. P126 Trovas, G. P475
Sugimoto, T. P391, P425, P454 Tell, G.S. P243, P253 Truy, E. P357
Sukalo, A.V. P190 Telléus, G.K. P255 Tsagareli, M. OC44, P336
Sukuroglu, M. P277 Tempesta, V. P462 Tsai, K.-S. P156, P695
Sulikashvili, T. OC44, P336 Teodoro, W. P230 Tsakova, A. P203
Sulyma, V. P284 Teodoro, W.R. P230 Tsezou, A. P452
Surís, X. P394 Tepie, M.F. P150 Tskhovrebashvili, M.G. P495
Suteu, C. P559, P621 Terek, M. P258 Tskhovrebashvili, N.G. P495
Suy, P. P357 Tersyiska, S. P479, P484 Tsuboi, H. P179
Suzuki, R.M. P604 Tew, S. P173 Tsvetkova, E.V. P516
Svedbom, A. OC5 The Coast Group, P374 Tu, S.T. P304
Svedström, E. P335 Theiler, R. P249 Turan Turgut, S. P473, P525
Svenda, M. P315 Theoret, F. P236 Turculeanu, A. P204, P205, P206
Svinarov, D. P246, OC53 Theunynck, D. P402 Turki, S.A. P102
Swadpanich Sangkomkamhang, U. Thirion, T. OC10, P698 Turner, D. P374
P470, OC43 Thomas, G.E. P442 Tuzun, S. OC52
Syed, K. OC41 Thomas, T. OC30, OC5 Tyazhka, O.V. P561
Szalecki, M. P352 Thompson, J. OC33, P421 Tzanavari, A. P681, P704
Szili, B. P577 Thomsen, K. P398
Szpalski, M. P107 Tida, J.A. P363, P463, P464 Uchiyama, S. P155
Szulc, P. P157, P158, P159, OC36, Tile, L. OC41, P600 Ugay, L. P492, P585
P341, OC23 Tkachuk, A.A. P535 Ungur, R. P288, P291
Szymczak, A. P427, P491, P494 Tobinai, M. P251 Ungureanu, D. P282
Søgaard, A.J. P253 Todorov, T. P246 Urosevic, L. P502
Tomanik, M. P682 Ushakova, G.A. P141
T’Sjoen, G. OC26 Tomanovic Vujadinovic, S. P663 Uvin, C. P419
Tabak, A. P688 Tomasevic-Todorovic, S. P192, P328,
Tadrous, M. P260 P330, P478 V. Nakadi, F. P376
Taes, Y. OC26 Tomkova, S. P233, P384, P474 Vakrilova, L. P586
Tafaj, A. P657 Tomlinson, G. P600 Valadares da Silva, A. P380
Tafarel, D.F. P463 Tonai, T.T. P210 Vale, A.C. P555
Tajsic, G. P355 Tonelli, P. P242 Valverde-Franco, G. P273, P322
Takács, I. P577 Tonini, G. P278 van Caenegem, E. OC26
Takacs, L. P452 Torgashin, A.N. P174, P175 van der Kamp, S. P211
Takaoka, S. P425 Toroptsova, N.V. P178 van der Weijden, T. P408
Talavera, J.O. P101 Torres, E. P405, P408, P417 van Rietbergen, B. OC11
Tamayo, J. P101 Torres, L.H.L. P382 Vandewalle, S. OC26, P419
Tamulaitiene, M. P450, OC5, P610, P611 Torres, F. P394 Vandeweerd, J.M. P172, P173
Tan, W.L.B. P147, P592 Törring, O. OC39 Vanuga, P. P384, P474
Tan, K.C.B. P193 Tosi, D. P278 Varennes, A. OC23
Tanabe, K. P680 Totorean, A. P569, P668 Varga, P. OC32
Tanaka, M. P697 Toumi, H. P717, P718 Varo, N. P314
Tanaka, S. P454 Touria, L. P648 Vasheghani, F. P613
Tang, H. P650 Toye, K. OC26, P419 Vasic, J. P114, P115, P116, P117,
Tanini, A. P242, P449 Traistaru, R. P240, P241, P356, P358, P328, P362
Taoufiq, D. P651 P359, P429, P431, P686 Vasikaran, S. P434
Tarantino, U. P297, P462, P485, P678 Trasca, D. P241 Vasilenko, K. P575
Taskina, E. P110, P145, P469 Triantafyllidou, E. P681 Vasiliev, A.N. P161
Tatishvili, N.S. P495 Trifanescu, R.A. P634, P661 Vasilieva, E.Y. P516
 Osteoporos Int

Vasilieva, N.A. P286, P299, P482, P708 Walker, V. P236 Wong, H.K. P147
Vasilkova, O. P598 Walker-Bone, K. P324, P418, OC16 Wong, L. P260
Vasilyev, A. P639 Wallace, G. P245 Woo, Y.C. P193
Vaskova, N.V. P435 Walsh, J.B. P562, P638 Wu, J. P322
Vavra-Hadziahmetovic, N.V-H. P353 Walsh, D.A. OC8 Wyman, A. OC22, P447
Vaz, M.P. P555 Wang, Y. P276 Wysocka, E. P427, P491, P494
Veerman, L. P293 Wang, G. P522, P524
Velosa, A.P. P230 Wang, J.Q. P272 Xanthakou, E. P689, P692, P693
Venter, A. P660 Wang, N. P259 Xia, W.B. P650
Verhaeghe, L. P716 Wang, A. P135, OC39, OC21 Xu, Y. P198
Verim, O. P534 Wang, J. P650 Xu, X. P154
Verma, A. P517 Wang, L. P650 Xue, F. P272
Veronesi, C. P563 Ward, K.A. OC33, P421 Xuereb Anastasi, A. P677
Verschueren, S.M.P. P404 Wark, J.D. OC48
Vershynina, D. P271 Wassermann, K. P572 Yadav, M.C. P128
Vespasiano Silva, A.I. P685 Watanabe, Y. P390 Yagi, S. P680
Vestergaard, P. P245, P255, P265, Watson, V. P408 Yakut, Y. P254
P307, P360 Watt, J. P377 Yamaguchi, T. P425
Vestergaard, H. P151 Wattanapanom, P. P142 Yamauchi, M. P425
Vetkova, E. P110, P145 Watts, N.B. OC1, OC22, OC40, Yan, L.S. P184
Viapiana, O. P466, P563 P430, P447 Yanagihara, G.R. P363, P382, P464,
Vicas, L. P453, P457, P647 Wawrzyniak, A. P428, P699 P614
Vidal, B. P426, P555 Weber, M.W. P471 Yang, R.S. P113, P156, P304
Vienney, C. P107 Weber, G.W. P467 Yang, Y.C. OC18
Vigilanza, A. P656 Wehrhan, F.W. P471 Yang, J. P522, P524
Vikkula, M. P576 Wei, F. P650 Yang, W.-S. P695
Vilaplana, L. P405, P417 Weil, C. P518 Yang, C.Y. P304
Villanueva, D. P368 Weiler, H. P256 Yankouskaya, L.V. P270
Viña Rodríguez, J. P513 Weilner, S. P318, P557, P572 Yarakova, N. P586
Visvanathan, R. P132 Weinans, H. P442 Yazıcı, D. P601
Vitaly, M. P350 Weinman, J. SE3 Ying, W. P278
Vladyslav, L. P350 Weiß, F. P557 Yip, A. OC13
Vlahov, J. P246, OC53 Weisman, Y. P518 Ylinen, P. P214
Vlasov, A. P602 Welch, A.A. P129 Yosida, K. P279
Volpon, J.B. P363, P380, P464 Welsing, P. P125 Yosselson Superstine, S. P396
Vos, T. P293 Westendorp, R. P572 You, L. P650
Vreju, F.A. P599, P710, P711 Whelan, B. P408 Young, A. OC8
Vrga, T. P480 Whiting, S. P256 Yousif, H.A. P545
Vuceljic, M. P196 Wiebe, D. P483 Yu, S.F. P113
Vujosevic, S. P444 Wierckx, K. OC26 Yu, H.J. P511
Vuksanovic, M. P446 Wieser, M. P572 Yu, B. P278
Vyskocil, V. P410, P719 Williams, P. OC8 Yuasa, T. P263
Williams, A. OC17
Waarsing, J.H. P442 Williams, R. OC8 Zaabat, N. P539
Wada, Y. P390 Wilson, N. P293, P554 Zaim, S. P226
Waern, E. P385 Winer, K. P131 Zajic, S. P259
Wafa, B.S. P694 Winther, A. OC49, P199, P365 Zakharov, I.S. P141
Wafa, A. P694 Wintzell, V. OC5 Zakhem, E. P402
Wafa, C. P694 Winzenreith, R. P107 Zambon, S. P574
Wagh, N. P537 Winzenrieth, R. OC36, P403, P530 Zampi, E. P547
Wagman, R.B. P134, OC40, OC39, Witter, R. P259 Zanchetta, J.R. OC30, MTE10
OC21 Wittrant, Y. P144 Zanotti, R. P466
Waheeduddin, S. P554 Wolbank, S. P572 Zapalowski, C. P135, OC39
Osteoporos Int

Zavodovski, B. P145 Zhang, Y. P613 Zoltur-Mosneaga, A. P626

Zavratnik, A. P296 Zhang, L. P650 Zonefrati, R. P242, P449
Zawadynski, S. OC15 Zhang, Z.L. P650 Zorsky, P. P278
Zayas, J. P368 Zhigulin, V. P145 Zoubos, A.B. P630
Zazirny, I. P284 Zhu, X. P138 Zoumadakis, C. P452
Zebaze, R. OC29, P476 Zhu, Y. P522 Zshmailik, M. P598
Zeidler, J. P163 Zhuang, H.F. P184 Zugravu, G. P441, P643
Zeitz, U. P709, P714 Zhukouskaya, V. P298 Zunquin, G. P402
Zekenova, K. P598 Zhur, K.V. P176 Zvekic-Svorcan, J. P114, P115,
Zemel, B.S. P131, P507 Zimran, A. SE24, P526 P116, P117, P123, P192,
Zenalabdeen, A. P108 Zivkovic, V. P381, P713 P327, P328, P330, P362, P488
Zerbini, C.A.F. MTE10 Zivna, H. P361 Zvekic–Svorcan, J. P207
Zervakis, M. P452 Zivny, P. P361 Łukaszkiewicz, J. P269, P352
Zhang, E. P150, P233 Zodelava, M.I. P495 Łykowska-Szuber, L. P427, P491
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