HIV-seropositive patients had a lower prevalence of localized parenchymal disease and a higher prevalence of disseminated disease at CT.

BackgroundProton pump inhibitors (PPI) are widespread nowadays. Recent concerns have emerged about possible bone complications of long-term use of PPIs, such as low bone mineral density (BMD) and an increased risk of fractures.ObjectivesThe aim of our study was to evaluate the effect of long-term use of PPIs on bone by measuring the BMD in order to estimate the frequency of osteopenia and osteoporosis, and to determine the risk factors associated to this complication.MethodsIt was a prospective study including consecutive patients who where taking proton pump inhibitors for at least one year. In all patients we realized a bone densitometry in order to evaluate the bone strength and we calculated the FRAX score to estimate the risk of osteoporotic fracture at ten years.ResultsWe included 52 patients. The mean age was 49,5 years old. The male-female ratio M/F was 0,48. At least three risk factors were found in more than 50% of the population. The calculated daily calcium intake was insufficient in 94% of the patients. The mean duration of PPIs intake was 45 months. The most frequent indication was gastro esophageal reflux disease (75%). The PPI prescription was appropriate in 94% of the cases. The prevalence of osteopenia and osteoporosis was respectively 52% and 19%. The predictive factors of low BMD were an age ≥50 years old (p=0,03), the menopause (p<0,0001), a calcium intake ≤550 mg/day (p<0,038), and a PPI use duration ≥30 months (p<0,006). The multivariate study could not be undertaken because of co linearity of the factors.ConclusionsThe long term PPI use is associated to the risk of bone complications, especially among patients at risk for osteoporosis. It seems reasonable to be more vigilant in prescribing PPIs and use lowest effective dose for patients with appropriate indications, and to screen these complications if necessary.Disclosure of InterestNone declared

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BackgroundBone loss in autoimmune hepatitis (AIH) is scanty and conflicting. The pathogenic mechanisms are not completely elucidated.ObjectivesThis study aimed to assess the prevalence and risk factors for bone loss in patients with AIH.MethodsBone mineral density (BMD) using X-ray absorptiometry at both lumbar spine and femoral neck sites was measured in patients with AIH. Were excluded patients with diseases disturbing the bone density. Osteopenia was considered if T-score <-1.5 DS and osteoporosis if T-score <-2.5 DS.ResultsTwenty eight patients were enrolled in the study. They were 19 women (sex-ration M/F=0.6), with a mean age of 54 years [extremes: 13 - 73 years]. Most patients had type 1 AIH (89.2%). Seventeen patients were diagnosed at stage of cirrhosis (60.7%). Associated auto-immune manifestations were observed in 42.8% of cases. Overlap syndrome with primary biliary cirrhosis was noted in 21.4% of cases. Fifty five percent of patients were on steroid treatment with or without azathioprine. BMD was low in 9 patients (32%) as fellow: osteopenia in 6 cases and osteoporosis in 3 cases. There was a correlation between bone loss and use of steroid treatment but it wasn't statistically significant (p=0.07).ConclusionsIn our series, the prevalence of bone loss in AIH is high (45%). This data suggests that bone status should be assessed routinely in patients with AIH, especially in those on steroid treatment.Disclosure of InterestNone declared

BackgroundProton pump inhibitors (PPI) are effective in many indications. Nevertheless, some serious adverse effects associated with prolonged exposure, including an increase in fracture risk, have occurred. This would be explained by two main mechanisms: decreased absorption of calcium secondary to decreased gastric acidity and inhibition of proton pump of osteoclasts reducing bone resorption.The Frax score assess the 10-year probability of osteoporotic fracture or hip fracture in subjects older than 40 years.ObjectivesThe aim of our study was to evaluate the usefulness in our practice of this score in patients under long-term PPI.MethodsWe included patients who had been taking PPI for at least one year. In all patients, we specified the indication and duration of PPI. We then looked for the main personal or family risk factors for osteoporosis. Bone mineral density (BMD) was performed in all patients and frax score was calculated for those older than 40 years.ResultsFifty-two patients were included in our study. The mean age was 49.5±14.55 years [21 - 84 years] with a sex ratio of 0.48. Long-term PPI were indicated in 75% (n=39) of patients for gastroesophageal reflux, in 11.5% (n=6) for chronic gastritis with failure of Helicobacter Pylori eradication, in 3.8% (n=2) for persistent epigastralgia, in 5.7% (n=3) for functional dyspepsia and finally in 3.8% (n=2) of patients in prophylaxis of gastroduodenal lesions in chronic use of NSAIDs. The mean duration of intake was 45.4 months [12–240 months]. The main osteoporotic risk factors were tobacco in 25%, alcohol in 12%, physical inactivity in 42% and dysthyroidism in 6% of cases. In our study, 20 women among the 35 included (57% of cases) were already menopausal. An osteoporotic fracture in a first-degree relative was noted in 23% of cases, including one parent reporting two fractures. A history of fragility fracture was observed in 11 patients (21%) including 3 men and 8 women. The mean daily calcium intake was 567.2±327.6 mg /d [230 -2315 mg /d]. Calcium intake was insufficient in 94% of patients. BMD was normal in 15 patients (29% of cases) while 71% (n=37) had low BMD. In our population, age (p=0.02), calcium intake (p=0.029) and menopause (p<0.0001) were significantly related to low BMD. The duration of PPI intake was negatively correlated with BMD. Patients taking PPI for at least 30 months were 6.5 times more likely to have low BMD (95% CI [1.5–27.4]). The mean FRAX score for major osteoporotic fractures in 37 patients older than 40 years was 1.08±0.84% [0.3–3.3%]. For hip fractures, the mean score was 0.26±0.29% [0–1.4%]. There was a significant correlation between mean Frax score and BMD (p<0.0001). None patient had a patent or subclinical fracture during the follow-up period.ConclusionsOur study shows an increased risk of fracture in patients under long-term PPI, especially if they have other osteoporotic risk factors. In this context, Frax score is a simple and non-invasive tool for assessing fracture risk in these patients and to adapt screening strate...

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