PurposeInvestigate the prevalence of osteoporosis in patients with systemic sclerosis (SSc) and describe alterations of bone tissue with High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT).MethodsThirty-three patients and 33 controls matched on age, body mass index (BMI) and menopause were included. Bone mineral density (BMD) was measured at the lumbar spine (LS), femoral neck (FN) and total hip (TH) by dual energy X-ray absorptiometry. Volumetric BMD (vBMD) and bone microarchitecture were measured by HR-pQCT at tibia and radius.ResultsIn patients, BMI was significantly lower, the prevalence of osteoporosis was significantly higher and HR-pQCT analysis showed a significant alteration of the trabecular compartment with a decrease in trabecular vBMD on both sites than in controls. In multivariate analysis, a low lean body mass, presence of anticentromere antibodies and older age were identified as independent factors for decreased BMD at LS (r²=0.43), FN (r²=0.61) and TH (r²=0.73). History or current digital ulcers were also identified as an independent factor for microarchitecture alteration.ConclusionIn patients an increased prevalence of osteoporosis was found and HR-pQCT showed impaired trabecular bone compartment. Also, low lean body mass, high age, digital ulcers and ACAs were identified as independent risk factors for bone damage.

Despite high levels of knowledge of, and adherence to, recommendations for using TNF inhibitors for SpA, rheumatologists' application was limited because of a lack of human and material resources.

ObjectiveTo investigate the link between bone alteration and micro- and macro-vascular disease in patients with systemic sclerosis (SSc).Results33 SSc patients were included. In univariate analysis, low values of cortical vBMD were significantly associated with a low DBI at the 2nd finger (p = 0.004) and at the 4th (p = 0.002) and with severe capillaroscopic score (p = 0.008). In multivariate analyses, low cortical vBMD was associated with a low DBI at the 4th finger, age and severe capillaroscopic score (adjusted R2 = 0.58; p = < 0.001). Low cortical thickness was associated with a low DBI at the 4th finger, severe capillaroscopic score and age (adjusted R2 = 0.49, p = < 0.001).ConclusionOur study findings showed an association between micro- and macro-vessel damage and altered microarchitectural indices at the radius in SSc.MethodsWe performed a pilot study in female patients with SSc. Microvascular disease was assessed by the capillaroscopic score of Cutolo. Macrovascular involvement was measured by digito-brachial pressure index (DBI) on laser-Doppler at the 2nd and 4th finger. Volumetric bone mineral density (vBMD) and bone microarchitecture involvement were analysed by High-Resolution peripheral Quantitative Computed Tomography (HRpQCT) at the distal radius.

BackgroundBone loss is an important complication for both patients with chronic liver diseases and after orthotopic transplantation. This bone fragility increases the risk of vertebral and non-vertebral fractures, morbidity and mortality [1,2].ObjectivesThe aim of this study was to determine the incidence of non-traumatic vertebral fractures following liver transplantation.MethodsWe performed a prospective, descriptive, cohort study including all the patients with severe chronic liver diseases, who were awaiting liver transplantation. Patients were seen before transplantation (pre-transplant group, visit 1) and ≥ one year after transplantation (post-transplant group, visit 2). At each visit, risk factors of osteoporosis were collected and bone mineral density was assessed. Vertebral fractures were identified using Vertebral Fracture Assessment. Biochemical tests including bone turnover markers were performed at each visit.Results115 patients were in the pre-transplant group and 33 in the post-transplant group. In the pre-transplant group, the prevalence of vertebral fractures and non-vertebral fractures was 24.5% and 17.4%, respectively. The prevalence of osteoporosis was higher at lumbar spine as compared to femoral neck (13.5% versus 8.9%). In the post-transplant group, the prevalence of vertebral fractures at visit 1 and visit 2 was 33.3% and 60.6% respectively, with an incidence of 23.1 fractures per 100 patientyears. Bone mineral density decreased significantly after transplantation (7.97% - 0.075 g/cm2). Markers of bone turn-over suggested a high level of bone remodeling.ConclusionsBone fragility is highly prevalent in patients awaiting liver transplantation and worsens ≥ one year after transplantation. Bone status should be evaluated in all patients with severe liver disease awaiting transplantation to identify patients at high risk of fracture and help clinicians to prescribe appropriate preventive treatment.ReferencesWibaux C, Legroux-Gerot I, Dharancy S, Boleslawski E, Declerck N, Canva V, et al. Assessing bone status in patients awaiting liver transplantation. Joint Bone Spine. 2011;78(4):387-391.Krol CG, Dekkers OM,Kroon HM, Rabelink TJ, van Hoek B, Hamdy NAT. Longitudinal changes in BMD and fracture risk in orthotopic liver transplant recipients not using bone modifying treatment. J Bone Miner Res. 2014;29(8):1763-1769.Disclosure of InterestNone declared

Background In chronic inflammatory rheumatism and also in connective tissue diseases including rheumatoid arthritis and systemic erythematosus lupus, there is an increased risk of osteoporosis and osteoporotic fracture. In contrast, bone involvement in systemic sclerosis (SSc) is still debated. There is currently no recommendation for systematic research of osteoporosis in SSc. Objectives The aim of our study was to investigate the existence of an increased prevalence of osteoporosis in patients with systemic sclerosis (SSc), to describe the qualitative alterations of bone tissue with the High-resolution peripheral quantitative computed tomography (HR-pQCT), comparing these patients to a group of healthy women, and to identify specific factors influencing SSc bone disease. Methods We conducted a cross-sectional study of consecutively including patients with SSc and healthy women, matched on age, body mass index (BMI) and duration of menopause. Risk factors for osteoporosis was collected from all subjects. Bone mineral density (BMD) was measured at the lumbar spine, femoral neck and total hip by dual energy X-ray absorptiometry (DXA). The volumetric bone mineral density (vBMD) and bone microarchitecture parameters were measured by the HR-pQCT at the tibia and radius. Results Thirty-three patients and 33 controls were included. The BMI of the patients was significantly lower (p<0.029). The prevalence of osteoporosis in postmenopausal patients was significantly higher than controls (42.8% versus 10.7%, p<0.05). After adjustment for BMI, BMD at the total hip was significantly lower in patients compared to controls (p<0.015). The HR-pQCT analysis showed a significant alteration of the trabecular compartment in patients, in particular a decrease in trabecular vBMD on both sites (p<0.01). In multivariate analysis, a low lean body mass, the presence of anti-centromere antibodies and older age were identified as independent factors for decreased BMD at the lumbar spine (R2=0.43;p=0.0009), decreased BMD at the femoral neck (R2=0.61;p<0.0001) and decreased BMD at the total hip (R2=0.73;p<0.0001). Digital ulcers were also identified as an independent factor for microarchitecture alteration. Conclusions An increased prevalence of osteoporosis was found in patients with SSc. The HR-pQCT showed impaired trabecular bone compartment in patients. Low lean body mass, high age, digital ulcers and anti-centromere antibodies were identified as independent risk factors for bone damage. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4362

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