Osteoporos Int (2015) 26 (Suppl 1):S397–S401 DOI 10.1007/s00198-015-3073-6

World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2015): Committee of National Societies Abstracts

# International Osteoporosis Foundation and National Osteoporosis Foundation 2015

OCs1 HEALTHY LIFE, HEALTHY BONES M. Tsagareli1, E. Giorgadze2, N. Dolidze2, T. Sulikashvili1, N. Jeiranashvili1 1 Skeletal Endocrinology Unit, National Institute of Endocrinology, Tbilisi, Georgia, 2National Institute of Endocrinology, Tbilisi, Georgia Objective: We intended to raise awareness towards healthy lifestyle habits in Georgian population as it is the main determinant of healthy bones. Materials and methods: Patients examined in our clinic with variety of diagnosis concerning bone health were involved in a project—Healthy Bones. The program was specifically created to increase patients awareness towards bone health and prevent diagnosed low bone mass progression into osteoporosis and osteoporotic fracture. Patients were handed brochure “You Have Osteoporosis-First Steps Towards Fighting It”. Besides we have chosen patients for the detailed instructions on osteoporosis prevention and care through dietary lifestyle and physical activity habit modification. Georgian Association of Skeletal Metabolism Diseases has worked on interpretation of IOF patient’s brochure on male osteoporosis “Real Men Build their Strength from Within” possibly seen on IOF website. Georgian Association of Skeletal Metabolism Diseases has actively participated in creation of Georgian National Guidelines on Osteoporosis Management and Prevention. The recommendations besides pharmacologic intervention emphasizes universal guidance on preventive measures of both: nutritional support and physical activity. In order to increase awareness not only among patients but also among primary care physicians we are continuing lecturing on topics of osteoporosis. Association members are presenting lectures at the local polyclinics of urban and rural areas of Georgia. At the end of each lecture session we are handing special book focused on nutrition and bone health issues. Results: Patients involved in the program have showed high motivation to change lifestyle and develop good dietary habits

for the prevention or treatment of established bone mass decrease. Primary care physicians are actively participating in management and prevention of osteopenia and osteoporosis.

OCs2 A POPULATION-BASED ANALYSIS OF THE POST-FRACTURE CARE GAP IN HONG KONG: THE SITUATION IS NOT IMPROVING A. W. H. Ho1, S. H. Wong2 1 Department of Orthopedics and Traumatology, Caritas Medical Centre, Hong Kong, Hong Kong, 2Department of Orthopaedics and Traumatology, Caritas Medical Centre, Hong Kong, Hong Kong Patients who sustain an osteoporotic fracture are at increased risk of sustaining further osteoporotic fracture. There are different guidelines internationally to close this post-fracture care gap. However there is no such guideline in Hong Kong and the practice varies between different hospitals and departments. The aim of this study is to determine the current situation and practice of secondary drug prevention of fragility fracture after osteoporotic hip fracture. Materials and methods: We retrieved dispensation of osteoporosis drug record from patients with new fragility hip fractures aged 65 or above, from 2009 to 2012 using Hospital Authority clinical data analysis and report system. Those who took anti-osteoporotic drugs before the fracture and those with pathological fractures were excluded. Results: 15,866 osteoporotic hip fracture patients who met the criteria were included. Based on the record of osteoporosis medicines initiation, only 9–15 % of fracture patients who are eligible for treatment of osteoporosis received medicines within 1 year after their hip fracture. Orthopaedic Surgeons initiate 63 % of osteoporosis medicines, whereas physician initiated 37 %. The drugs of choice in descending order are alendronate (76 %), ibandronate (12 %), strontium (5 %), zoledronate (4 %), and others (3 %).


Conclusion: There is a huge post fracture care gap in secondary prevention for osteoporotic hip fracture patient in Hong Kong. Majority of the patients are neither diagnosed nor being tested for osteoporosis. Most remained untreated for 1 year after the osteoporotic hip fracture. The Government needs to allocate more resources to implement the best practices framework to those high risk post hip fracture patients before they go on to break another bone. By reducing the number of subsequent osteoporotic fractures, the Government can get significant cost savings that can be utilized in other valuable healthcare program.

OCs3 “LET’S HOLD THE BONE TOGETHER”: ORTHOPEDIC-METABOLIC COLLABORATIVE MANAGEMENT FOR OSTEOPOROTIC HIP FRACTURE P. Rotman-Pikielny1, M. Frankel1, O. Tel-Levanon1, M. Tamar1, E. Yakobi1, D. Nabriski1, D. Netzer1, Y. Brin1, M. Niska1 1 Meir Medical Center, Kfar Saba, Israel Osteoporotic hip fractures are associated with increased morbidity and mortality in older adults. Appropriate metabolic treatment can reduce the risk of future fractures. Only 30 % of patients receive calcium and vitamin D supplementation, and 10–15 % osteoporosis-specific treatment. Previous research indicated that involvement of a multidisciplinary professional team can improve the quality of care for hip fracture patients. Methods: An Orthopedic-Metabolic team was established at a university-affiliated hospital in Israel, for managing hip fracture patients. The intervention included staff educational activities, a structured, in-hospital treatment protocol, and a collaborative follow-up clinic. An observational study evaluated the impact of the intervention. Results: During 7 months, 222 patients with osteoporotic hip fractures were operated. Thirty died within 6 months of surgery and were excluded. Among the remaining 192 patients, 80 % had vitamin D levels tested on the ward (mean 44 nmol/ L); over 84 % began calcium and vitamin D supplementation; 79 and 47 % came to follow-up Orthopedic and Metabolic Clinic, respectively. Of patients that came to the metabolic clinic, 46 % started pharmacological therapy at the first visit, while others needed vitamin D loading or additional investigation. Attending a follow-up clinic visit correlated with competent cognitive state, home residency and Clalit HMO (health management organization) membership. Conclusion: An Orthopedic-Metabolic team can effectively improve quality of care for patients with osteoporotic hip fractures. Yet, only 50 % of the patients arrived for a follow-up metabolic visit, and of those, only half received specific

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treatment recommendations at that visit. Additional research is required to enhance adherence to follow-up visits and treatment decision-making during visits.

OCs4 HANDGRIP STRENGTH PREDICTS ABILITY TO FUNCTION IN ACTIVITIES OF DAILY LIVING: A PROSPECTIVE STUDY OF 193 WOMEN WITH HIP FRACTURE M. Di Monaco1, C. Castiglioni1, E. De Toma2, L. Gardin2, S. Giordano2, R. Tappero1 1 Osteoporosis Research Center, Presidio San Camillo, Fondazione Opera San Camillo, Torino, Italy, 2Service of Occupational Therapy, Presidio San Camillo, Fondazione Opera San Camillo, Torino, Italy Objective: To investigate the independent contribution of handgrip strength in predicting the functional outcome after hip fracture in women. Design: We prospectively investigated white women (N=193 of 207) who were consecutively admitted to our rehabilitation hospital after a hip fracture. We measured handgrip strength with a Jamar dynamometer on admission to rehabilitation. Ability to function in activities of daily living was assessed by the Barthel Index both on discharge from rehabilitation and at a 6-month follow-up. Results: We found significant correlations between handgrip strength measured before rehabilitation and Barthel index scores assessed both on discharge from rehabilitation (ρ= 0.52; p Conclusion: Handgrip strength assessed before rehabilitation independently predicted the functional outcome both after inpatient rehabilitation and at a 6-month follow-up in hip fracture women.

OCs5 RECENT TREND IN THE INCIDENCE OF HIP FRACTURE IN TOTTORI, JAPAN H. H. Hagino1, Y. T. Tsukutani2, M. O. Osaki3, N. H. Nagashima2 1 School of Health Science, Tottori University, Yonago, Japan, 2 Department of Orthopedic Surgery, Tottori University, Yonago, Japan, 3Rehabilitation Division, Tottori University, Yonago, Japan Objective: It has been reported that the incidence of hip fracture among Asians is lower than that among Caucasians in North America or North Europe. It has also been reported that the age-adjusted incidence rate in Japan has been increasing from 1998 to 2006. The purpose of this study was to

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investigate the recent trend in the incidence of hip fracture in Tottori Prefecture, Japan. Material and Methods: Tottori Prefecture is located in midwestern Japan and its population was 581,870 in 2012. The percentage of the total population aged 65 years and over was 27.0 % in 2012. A survey of all hip fractures in patients 35 years old and over during 2010–2012 was performed in all hospitals in Tottori Prefecture. Registration information included gender, age, date of fracture, type of fracture, and treatment. Patients residing in other prefectures were excluded. The age- and gender-specific incidence rates (per 100,000 person-years) were calculated based on the population of Tottori Prefecture in each year. We compared the data with the results of the same survey we performed before in Tottori Prefecture. Results: Registered numbers of patients were 197, 249, and 233 for men, and 892, 842, and 944 for women in 2010, 2011, and 2012, respectively. The mean age- and gender-specific incidence rates for men in 2010–2012 were 265, 496, and 1014 in the age groups of 75–79, 80–84 and over 84, respectively, while those for women were 566, 1181, and 2302, respectively. The incidences for men increased compared with those in 2004–2006; however, the increase was small. Those for women showed no increase compared with those in 2004– 2006. Conclusion: With this data, we can see that the incidence of hip fractures has reached a plateau in Tottori Prefecture, Japan. References: Hagino H et al., Osteoporos Int 2009;20:543.

OCs6 ACCUMULATED ONE YEAR HEALTH UTILITY LOSS AFTER SUSTAINING A HIP FRACTURE IN MEXICO P. C. Clark1, L. Girant2, F. Carlos3, A. Svedbom4, F. Borgström5, J. A. Kanis6 1 Clinical Epidemilogy Unit, Hosptial Infantil Federico Gomez-Faculty of Medicine UNAM, Mexico City, Mexico, 2 Industrial Engineering, ITAM (Instituto Tecnologico Autonomo de Mexico), Mexico City, Mexico, Mexico City, Mexico, 3R A C Salud Consultores, S.A. de C.V., Mexico City, Mexico, Mexico City, Mexico, 4Department of Medicine, Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden, 5Medical Management Centre, Karolinska Institutet, Stockholm, Sweden, 6WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom Objective: Hip fractures are common in older people and incur substantial pain and suffering, disability, increased risk of death and high costs. The burden of hip fractures is expected to grow considerably during next years due to population aging. We aimed to describe the health-related quality of life


(HRQoL) and the determinants in patients sustaining a hip fracture in Mexico. Methods: Data from Mexican patients enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was gathered. Patients had to be diagnosed with a low-energy-induced hip fracture and to be at least 50 years old. HRQoL was prospectively collected in three phases over 12 months after fracture using the EQ-5D instrument. The UK preference weights were used to determine health utility at different times. The accumulated HRQoL loss in the first year after fracture was calculated using the trapezoid method. Multivariate regression analysis was conducted to identify determinants of HRQoL reductions. Results: Two hundred patients were evaluated. Mean (±SD) age was 77.4±9.9 years. Eighty percent were women. 15.5 % of the sample reported a prior fracture in last 5 years; 54 % had a job before fracture and 78 % were classified into the low level of income category. Mean (95%CI) utility value before fracture was 0.64 (0.59–0.68). Utility dropped to 0.01 (0.01– 0.02) immediately after fracture and then improved to 0.46 (0.42–0.50) and 0.59 (0.55–0.63) at month 4 and 12 postfracture, respectively. Accumulated utility loss over the first year was 0.35 (0.31–0.39). HRQoL before hip fracture and age at fracture were the two most relevant characteristics associated with the accumulated utility loss. Conclusion: Hip fractures impair HRQoL in a significant way leading to utility values close to death shortly after fracture. Mean utility value elicited after 1 year follow-up was lower than before sustaining the fracture.

OCs7 RHEUMATOID CACHEXIA, OSTEOPOROSIS AND VERTEBRAL FRACTURES A. El Maghraoui1, S. Sadni1, A. Rezqi1, A. Bezza1, L. Achemlal1, A. Mounach1 1 Rheumatology Department, Military Hospital Mohammed V, Rabat, Morocco Objective: To assess the prevalence and risk factors of cachexia and evaluate its relationship with osteoporosis and vertebral fractures (VFs) in patients with rheumatoid arthritis (RA). Patients and methods: We enrolled in a cross-sectional study 178 consecutive patients with RA (female: 82.6 %), who fulfilled the ACR criteria for the classification of RA with a mean age of 54.1±11.5 (25 to 82) years. Body composition, Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using DXA. Rheumatoid cachexia was defined by a fat free mass (FFM) index below the 10th percentile and a fat mass (FM) index above the 25th percentile compared to a reference population. VFs were defined using Genant semiquantitative approach.


Results: Rheumatoid cachexia was observed in 96 patients (53.9 %) and osteoporosis in 52 patients (29.2 %). Comparison between women with and without cachexia showed that women with cachexia had a longer disease duration, higher disease activity parameters, higher steroid cumulative dose, and higher proportion of patients with erosive arthritis than women without cachexia. They had lower total hip BMD and T-score than women without cachexia while comparison in men found only BMI to be significantly lower in men with cachexia. Regression logistic analysis showed an independent and significant association between rheumatoid cachexia and age and disease activity in women. Conclusion: Our study showed that half of the patients with RA may have rheumatoid cachexia, a condition that was significantly associated to disease activity and low hip BMD but not to vertebral fractures.

OCs8 PSYCHOLOGICAL WELL BEING AND QUALITY OF LIFE ASSESSMENT OF WORKING WOMEN WITH OSTEOPOROSIS VERSUS RETIRED WOMEN WITH OSTEOPOROSIS D. M. Farcas1, F. Marc1, C. Suteu1, A. I. Gasparik2, L. Sachelarie3 1 University of Oradea, Faculty of Medicine and Pharmacy, Oradea, Romania, 2ASPOR, University of Medicine and Pharmacy Targu Mures, Targu Mures, Romania, 3University Apollonia, Iasi, Romania Aim: To assess and compare self esteem, anxiety and quality of life among women with osteoporosis. Material and method: We studied patients women with osteoporosis. First group consisted of 58 working—active women with osteoporosis, second group of 58 retired women with osteoporosis. All the patients were recruited from ambulatory system Bihor county, Romania. The mean age in the first group was 60.31 ± 2.43 and in the second group was of 60.97±3.26. Both groups had similar educational level. The main inclusion criteria were: fulfilling the WHO criteria for osteoporosis, complying with the principles of medical ethics. The exclusion criteria were: chronic severe diseases, noncompliance. All of the patients were assessed by DXA method for osteoporosis. We used Rosenberg Self Esteem Scale for self esteem, Hamilton Anxiety Rating Scale for anxiety and Qualeffo-41 Questionnaire for quality of life for all the subjects in our study. Results: The mean self esteem value was lower in the group of retired women than in the group of active women with osteoporosis. The mean anxiety value was higher in the group of retired women with osteoporosis than in the group of active women with osteoporosis Quality of life was lower in the group of retired women with osteoporosis then in the group

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of active women with osteoporosis. We found also correlations between quality of life self esteem and anxiety in patients in our study. Conclusion: Our study underline that osteoporosis itself has an impact on patient’s psychological well being and quality of life. It seems that working activities play an important role in achieving a better quality of life in women with osteoporosis versus retired women with osteoporosis. By promoting an active life and including healthy habits in everyone’s life we could help improving psychological wellbeing and quality of life of patients with osteoporosis.

OCs9 CAFFEINE, COFFEE AND TEA IN RELATION TO RISK OF HIP FRACTURE IN THE SINGAPORE CHINESE HEALTH STUDY W.-P. Koh1, Z. J. Dai2 1 Duke-NUS Graduate Medical School Singapore, Singapore, Singapore, 2Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Objective: The relationship between dosage of caffeine or coffee and risk of osteoporotic hip fractures is unclear. In this study, we examined the associations between caffeine or coffee intake and risk of hip fracture in the Singapore Chinese Health Study. Methods: This is a prospective cohort of 63,257 Chinese men and women (ages 45–74 years) recruited during 1993–1998 in Singapore. At baseline, habitual diet, including coffee and tea, was assessed by a validated food frequency questionnaire. Multivariate Cox proportional regression model was used to estimate hazard ratio (HR) and its 95%CI with adjustment of other risk factors of hip fracture, including demographic, dietary and lifestyle factors. Results: During a mean follow-up of 9.9 years, we identified 1630 incident cases of hip fracture. There were 450 cases among 27,913 men and 1180 cases among 35,241 women. Compared with those drinking coffee Conclusion: We concluded that daily caffeine 200-

OCs10 RISK FACTOR FOR THE FIRST-INCIDENT HIP FRACTURE IN POSTMENOPAUSAL WOMEN F. P. Chen1, Y. C. Lin2 1 CGMH, Department of OB/GYN, Keelung, Taiwan, Province of China, 2Department of Radiology, Keelung Chang Gung Memorial Hospital, Keelung and Chang Gung University, Keelung, Taiwan, Province of China Objective: To identify the risk factors resulting in the first occurrence of hip fracture in Taiwanese postmenopausal women.

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Methods: This project is a prospective cohort study and designed for a period of 1 year to enroll 50 postmenopausal women admitted to Keelung Chang Gung hospital for an accidental first-incident hip fracture as patient group and 50 agematched postmenopausal (without hip fracture) as control group. The evaluation includes questionnaire and interview to record the risk factors, and examination to test the body height, body weight, and BMD of hip and spine by DXA. Results: The mean age of patients with an accidental firstincident hip fracture is 79.6 years of old. Compared to the control group, the potential risk factors of the first-incident hip fracture in Taiwanese postmenopausal women include age of menopause, body height, level of education, chronic disease (including coronary heart disease, renal disease, epilepsy, Parkinson’s disease, or cancer), eye disease (cataracts or glaucoma), weight-bearing exercise, and BMD of femoral neck. Low bone masses were noted up to 95 % in both of the control and patient groups. Conclusion: Most of hip fracture occurred in older postmenopausal women. Although low BMD were noted in most of these older women, several modifiable risk factors and decreased BMD of femoral neck increase an older woman’s risk of developing a first-incident hip fracture.

OCs11 NATIONAL BONE HEALTH ALLIANCE: A MULTISECTOR PUBLIC-PRIVATE PARTNERSHIP WORKING TOGETHER TO IMPROVE AMERICA’S BONE HEALTH D. Lee1 1 National Bone Health Alliance, Washington, United States The National Bone Health Alliance (www.nbha.org) is a public-private partnership launched in late 2010 that brings together the expertise and resources of its members to collectively promote bone health and prevent disease; improve diagnosis and treatment of bone disease; and enhance bone research, surveillance and evaluation. NBHA currently includes 56 participating organizations (35 nonprofit member organizations, 17 member companies and liaisons representing CDC, FDA, NASA and NIH). The concept for NBHA stems from the 2004 Bone Health and Osteoporosis: A Report of the Surgeon General and the June 2008 Summit for a National Action Plan for Bone Health. NBHA’s “20/20 vision” is to reduce the incidence of hip and other bone breaks 20 % by the year 2020. NBHA provides a platform for its collective voice to weigh in on subjects important to bone health, particularly vitamin D, calcium, BMD reimbursement and utilization and the risks and benefits of the use of bone health therapies; communication among organizations interested in bone


health; shared priorities to become reality through pooled funding; and working together towards the goals and recommendations of the National Action Plan. Activities for 2015 i n c l u d e : F r a c t u r e P r e v e n t i o n C E N T R A L ( w w w. FracturePreventionCENTRAL.org) provides tools to health professionals, health insurers, hospitals and other sites interested in implementing this model of care. Bone Turnover Marker Standardization Project: NBHA is leading the effort to standardize U.S. bone marker sample collection procedures, establish a U.S. reference range for one bone formation and one bone resorption marker and standardize bone turnover marker assays. FLS Demonstration Study: The Bone Health Collaborative has launched a cloud-based study that will provides study sites with the FLS model of care and a cloud-based platform, to assess adoption and implementation of a Fracture Liaison Service. 2Million2Many Public and Health Professional Awareness Campaign is educates about the 2 million bone breaks in the U.S. each year that are not accidents but signs of osteoporosis.

OCs12 OVERWEIGHT AND OBESITY AND RISK FRACT URE STUDY IN POSTMENOPAUSAL WOMEN FROM HAVANA AND MADRID M. Diaz Curiel1, D. Navarro Despaigne2, C. Prado Martinez3 1 Jimemez diaz Foundation, Madrid, Spain, 2National Institute Endocrinology, La Havana, Cuba, 3Autonomous University Of Madrid, Madrid, Spain Obesity and osteoporosis are chronic disorders with increasing prevalence worldwide with a relationship not well established as a risk factor. The aim of this study was to investigate the association between BMI and bone mineral content (BMC) in postmenopausal women from Madrid, and La Habana. A cross-sectional study included 250 women aged ≥55 years: 196 from Madrid (Jimenez Diaz Foundation) and 155 from Clinic of menopause and osteoporosis, La Havana. In all women we determined BMI and osteoporosis with DXA study in lumbar column according to diagnostic criteria established by WHO protocol. Results: According to age group the values of BMI were 26.94 (4.2) and 25.93 (4.3) for women aged between 45 and 59 years and over 60 years, respectively. BMI were 25.9 (5.5) kg/m2, respectively. No association were found between BMI and BMC, although, we found tendency to higher values of BMI with lower bone mineral content. Our results support the view that obesity is a risk factor for both cardiovascular disease for fragility fracture.

World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2015): Committee of National Societies Abstracts.

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