THU0416 Vertebral fracture prevalence and measurement of the scanographic bone attenuation coefficient on ct scan in 70 patients with systemic scleroderma

Abstract

BackgroundOsteoporosis screening is not systematic in sclerodermic patients but some studies demonstrated a similar risk between rheumatoid arthritis and systemic scleroderma.1,2,3 Thoracic and/or TAP (thoraco-abdomino-pelvic) CT (Computed Tomography) scans are classically performed in the follow-up of scleroderma, mainly to evaluate lung involvement.ObjectivesTo study vertebral fracture (VF) prevalence and the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) on CT scans in systemic scleroderma patients. Secondary objectives are to study specific risk factors of SBAC-L1 ≤145 Hounsfield Units (HU) and to evaluate SBAC-L1 measurements reliability.MethodsThis monocentric retrospective study included patients followed from 2000 to 2014 and fulfilling ACR/EULAR 2013 criteria for systemic scleroderma and who underwent a thoracic or TAP CT scan. Osteoporotic risk factors, Dual Energy X-ray Absorptiometry (DXA) measurements and clinical characteristics were collected. For CT scan, the VFs were determined according to Genant’s classification on sagittal sections. The SBAC-L1 was measured in Hounsfield Units (HU) on axial section of L1 in a Region of Interest drawed in trabecular bone. Intra- and inter-reader reliabilities for SBAC-L1 were calculated. An SBAC-L1 ≤145 HU (fracture threshold) was used to define patients at risk of VF.4 Predictive factors for VF or SBAC-L1 ≤145 HU were studied.ResultsA total of 70 patients were included (mean age: 62.3 (±15.6) years, women 88.5%, diffuse scleroderma 22.9% (n=16)) in the study. Sixty patients (85.7%) presented with at least one clinical risk factor for osteoporosis. Eighteen patients (25.7%) received vitaminocalcic supplementation and 10 (14.3%) received antiresorptive therapy. DXA was only performed on 30 patients (42.8%), and 5 (16.7%) of them presented a T-score ≤−2.5 DS. 3 VFs were detected in 3 patients (4.3%). The mean SBAC-L1 was 157.26 HU (±52.1), and 35 patients (50%) presented a SBAC-L1 ≤145 HU. SBAC-L1 measurements were highly reliable (Kappa >0.9 for both intra- and inter-reader reliability). For the univariate analysis, a SBAC-L1 ≤145 HU was significantly associated with age (OR=1.09, CI 95%: 1.04–1.13), calcinosis (OR=6.3, CI 95%: 1.61–24.75) and periarticular calcifications (OR=3.22, CI 95%: 1.06–9.77). For the multivariate analysis, age (especially patients older than 63 years), calcinosis and acro-osteolysis were independently associated with a SBAC-L1 ≤145 HU.ConclusionsOn a large sample of sclerodermic patients with clinical risks of osteoporosis, only 42.8% were screened for DXA and 16.7% of them were osteoporotic. The VF prevalence on CT scan was 4.3% and the SBAC-L1 measurement identified 50% of the population at the fracture threshold. The presence of calcinosis, periarticular calcifications or acro-osteolysis should lead to an osteoporosis screening, especially for patients under 63 years old.References[1] Avouac J. Arthritis Care Res (Hoboken). 2012Dec;64(12):1871–8.[2] Yuen SY. J Rheumatol. 2008June;35(6):1073–8.[3] Kili...

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“…Intra-and inter-reader reliabilities for SBAC-L1 were calculated. An SBAC-L1 £145 HU (fracture threshold) was used to define patients at risk of VF 4. Predictive factors for VF or SBAC-L1 £145 HU were studied.…”