Ab1220 vertebral fracture characteristics in an fls unit according to the identification method; emergency list, outpatient clinic or vfa.

Background The risk o subsequent fracture is very high after a vertebral fracture (VF) Objectives To analyze the characteristics of patients with VF seen in a Fracture Liaison Service (FLS). Methods Our FLS cares for patients from the emergency list (URG), referred by hospital or primary care doctors (HPC) with VF <12 months, and captured by DXA-VFA (Densitometry - VF Assessment) in patients with non-VF. The database included the FRAX items plus previous treatment and DXA results. Traumatic VFs or VFs with a known age > 1 year, infiltrative or neoplastic diseases, and patients with contraindications for treatment were excluded. The number and grade of VF (Genant’s scale) were analyzed. Results 570 patients have been included (Table 1). The most frequent route of identification was HPCfollowed by the emergency registry and detection by DXA-VFA. The patients identified by VFA did not report a previous VF, as did 25 of the HPC cases, referred by a report of fracture by the radiologistst or by detection in the consultation by the rheumatologist. Figure 1 shows the identification of patients over the years. Figure 1. We observed a higher percentage of grade 3 fractures in those identified in the emergency registry. Those identified by HPC had a higher average number of fractures and a higher percentage of osteoporosis by DXA. In this group there was a greater frequency of previous fracture, as well as rheumatoid arthritis and glucocorticoid use. Patients referred through HPC had a higher adherence to treatment compared with the other groups. The 69 patients detected by DXA-VFA consisted of 30 humerus fractures, 1 pelvic, and 38 forearm, mostly women with a single fracture and lower percentage of osteoporosis by DXA. The adherence to treatment has changed over the years. In 2021 and 2022 it was 93%, compared to 79% in 2012-2020. Table 1. - Distribution according to identification group. Results represent n (%) and mean (SD) unless expressly indicated. All patients N=570 Emergency registry N=198 Outpatient N=303 VFA N=69 p Age 73.6 (9.7) 75.5 (9.4) 72.6 (9.9) 72.4 (8.8) 0.003 Women 480 (84.2) 156 (78.7) 261 (86.1) 63 (91.3) 0.020 Time from fracture to visit (weeks ) Mean 17 (11) 13 (8) 20 (12) 13 (8) 0.02 Median (IQR) 13 (8-20) 12 (8-16) 13 (8-28) 12 (8-16) <12 weeks 214 (37) 83 (42) 101 (33) 30 (43) 0.08 Vertebral fractures Number of VF mean 2.0 (1.6) 1.76 (1.4) 2.35 (1.8) 1.22 (0.5) 0.000 median (IQR) 1 (1-2) 1 (1-2) 2 (1-3) 1 (1-1) Only fractures grade 1 24 (4.2) 3 (1.5) 20 (6.6) * 0.007 ≥ 2 VF** 259 (45.7) 78 (39.3) 169 (56.1) 12 (17.4) 0.000 At least one grade 3 fracture*** 274 (48.8) 124 (63.9) 141 (47.3) 9 (12.0) 0.000 Risk factors for fracture Previous fracture 155 (27.2) 51 (25.8) 89 (29.3) 15 (20.0) 0.362 Parental hip fracture 51 (8.9) 20 (10.1) 25 (8.2) 6 (8.0) 0.775 Active smoking 67 (11.7) 21 (10.6) 34 (11.2) 12 (16.0) 0.294 Glucocorticoids 51 (8.9) 9 (4.5) 40 (13.2) 2 (2.7) 0.001 Rheumatoid arthritis 22 (3.8) 5 (2.5) 17 (5.6) 0 0.045 Secondary osteoporosis 86 (15.0) 37 (18.6) 36 (11.8) 13 (17.3) 0.075 Alcohol 21 (3.6) 9 (4.5) 10 (3.3) 2 (2.7) 0.712 BMI 27.5 (5.0) 28.5 (4.7) 26.2 (5.3) 28.7 (5.1) 0.000 FRAX major 12.7 (8.6) 13.3 (9.6) 13.0 (11.0) 10.8 (7.9) 0.156 FRAX hip 5.6 (6.6) 6.0 (7.9) 5.9 (4.0) 4.3 (6.6) 0.231 DXA # Normal 46 (8.6) 18 (10.0) 18 (6.3) 10 (13.3) 0.000 Osteopenia 175 (32.8) 69 (38.5) 75 (26.3) 31 (41.3) Osteoporosis 312 (58.5) 92 (51.3) 192 (67.3) 28 (37.3) T-score lumbar -2.29 (2.0) -2.0 (1.7) -2.5 (2.3) -1.4 (1.5) 0.000 T-score femoral hip -1.91 (1.0) -1.8 (1.2) -2.0 (1.0) -1.5 (0.9) 0.003 Treatment & Previous treatment 124 (21.8) 35 (17.6) 80 (28.0) 9 (12.0) 0.012 Start within 6 months of the visit 474 (83.1) 161 (81.3) 265 (87.4) 48 (69.5) 0.001 * Only grade 2 and 3 fractures were considered. ** Available in 567 patients. ***Available in 561 patients. # Available in 533 patients. & Bisphosphonate, denosumab, SERM or teriparatide. Conclusion All the ways to identify VF are important. The training campaign carried out in the healthcare area, including radiologists, has allowed us to improve the standard. The results will be helpful in the implementation and consolidation of the model based on FLS. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.