Osteoporosis and Metabolic Bone Disease [127142]
Identifieur interne : 001311 ( Istex/Corpus ); précédent : 001310; suivant : 001312Osteoporosis and Metabolic Bone Disease [127142]
Auteurs : Yasser El Miedany ; Maha El Gaafary ; Sally Youssef ; Mathias Toth ; Jessica Weightman ; Madeleine Kelly ; Emma Johnston ; Amanda Stone ; Patricia Harrison ; Peter Bartholomew ; Clive Kelly ; Vipul Vagadia ; Stephen Tuck ; Israa Al-Shakarchi ; Ann Louise Dolan ; Matt J. Bridges ; Sheila Ruddick ; Claire Bracewell ; David Wright ; Terence Aspray ; Gareth M. Hynes ; Karen Jameson ; Avan Aihie Sayer ; Cyrus Cooper ; Elaine Dennison ; Sian Robinson ; Thomas J. Tull ; Ben A. Fisher ; Reza Jenabzadeh ; Justin P. Cobb ; Sonya Abraham ; Gareth M. Hynes ; Karen Jameson ; Nick Harvey ; Avan Aihie Sayer ; Cyrus Cooper ; Elaine Dennison ; Jonathan Cheah ; Sybil Stacpoole ; Dominic Heaney ; John Duncan ; Delnaz Roshandel ; Kate Holliday ; Stephen R. Pye ; Steven Boonen ; Herman Borghs ; Dirk Vanderschueren ; Judith E. Adams ; Kate A. Ward ; Joseph D. Finn ; Ilpo T. Huhtaniemi ; Alan J. Silman ; Frederick C. Wu ; Wendy Thomson ; Terence W. Oneill ; Susanna White ; Simon Shaw ; Charlotte Short ; Yvonne Gilleece ; Martin Fisher ; Karen Walker-Bone ; Chetan B. Narshi ; Rhodri Martin ; Karen Mitchell ; Richard Keen ; Matt J. Bridges ; Sheila Ruddick ; Yasser El Miedany ; Mathias Toth ; Sally Youssef ; Maha El Gaafary ; Daniel Prieto Alhambra ; Rafael Azagra ; Gloria Encabo Duro ; Amada Aguye ; Marta Zwart ; Kassim M. JavaidSource :
- Rheumatology [ 1462-0324 ] ; 2010-04.
Abstract
Background: To assess the validity of a new referral model for DXA scanning, its impact on patients management and whether it meets the targets of the osteoporosis and falls service. Methods: The referral form was developed, including 3 main components: 1. Risk factors for osteoporosis (6 factors). 2. the 8 risk factors identified in FRAX (WHO fracture risk assessment tool) and 3. Risk factors for falls (5 factors). Special icons were used to give clinical hints for vertebral morphometry and tilting table assessment. The model was set up with only ticking the appropriate boxes is required. Validation of the model was done through: 1. comparing the referral form to the medical notes and the patients answers to a pre-scanning questionnaire. 2. Each patient was assessed and management plan (guided by the national guidelines) was considered blindly twice based on the data available in the new referral form in comparison to the old referral form. DXA measurements were then analyzed in relation to self-reported incidence of falls, fractures and the calculated 10-years fracture probability (using FRAX). Results: A total of 264 postmenopausal women (mean age, 68.64.73 years) were included in this work. Osteoporosis was found in 113/264 (42.8) of the patients whereas osteopenia prevalence was 32.1 (86/264). 34.5 (91/264) of the patients had a past history of low trauma fracture and 21.6 (57/264) reported 1 or more falls during the preceding year. Patients treated based on the osteoporosis-falls-FRAX composite were significantly higher (r0.635) than those treated based on the old referral form. Most of these patients were suffering from secondary osteoporosis and their DXA scan revealed borderline osteoporosis/osteopenia. Adjusted risk for age, BMI, bone density and 10-year fracture probability in the past 12 months in patients who reported a fall was 6.0 (95 CI, 3.2-10.5, P<0.001). Compared with women without osteoporosis and without a fall and 10-year fracture probability <10, women with osteoporosis without a fall and 10-year fracture probability <10 had an age- and BMI-adjusted fracture risk of 2.8 (95 CI, 0.7-11.7 P<0.10) and women with osteoporosis and a fall and fracture probability >20 had an adjusted-fracture risk of 24.8 (95 CI, 7.1-78.5; P<0.0001). Conclusions: The developed form is a valid model for DXA scanning and accurate tool for assessment of osteoporosis, falls risks as well as fracture (using FRAX). Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age, bone mineral content and 10-year fracture probability. It is important to have the patients stratified and assessed according to the different osteoporosis and falls risk factors rather than relying on fractures as the corner stone for assessment and management. Disclosure statement: All authors have declared no conflicts of interest.
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DOI: 10.1093/rheumatology/keq723
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Osteoporosis and Metabolic Bone Disease [127142]</title><author><name sortKey="El Miedany, Yasser" sort="El Miedany, Yasser" uniqKey="El Miedany Y" first="Yasser" last="El Miedany">Yasser El Miedany</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="El Gaafary, Maha" sort="El Gaafary, Maha" uniqKey="El Gaafary M" first="Maha" last="El Gaafary">Maha El Gaafary</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Youssef, Sally" sort="Youssef, Sally" uniqKey="Youssef S" first="Sally" last="Youssef">Sally Youssef</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Toth, Mathias" sort="Toth, Mathias" uniqKey="Toth M" first="Mathias" last="Toth">Mathias Toth</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Weightman, Jessica" sort="Weightman, Jessica" uniqKey="Weightman J" first="Jessica" last="Weightman">Jessica Weightman</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Kelly, Madeleine" sort="Kelly, Madeleine" uniqKey="Kelly M" first="Madeleine" last="Kelly">Madeleine Kelly</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Johnston, Emma" sort="Johnston, Emma" uniqKey="Johnston E" first="Emma" last="Johnston">Emma Johnston</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Stone, Amanda" sort="Stone, Amanda" uniqKey="Stone A" first="Amanda" last="Stone">Amanda Stone</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Harrison, Patricia" sort="Harrison, Patricia" uniqKey="Harrison P" first="Patricia" last="Harrison">Patricia Harrison</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Bartholomew, Peter" sort="Bartholomew, Peter" uniqKey="Bartholomew P" first="Peter" last="Bartholomew">Peter Bartholomew</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Kelly, Clive" sort="Kelly, Clive" uniqKey="Kelly C" first="Clive" last="Kelly">Clive Kelly</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Vagadia, Vipul" sort="Vagadia, Vipul" uniqKey="Vagadia V" first="Vipul" last="Vagadia">Vipul Vagadia</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Tuck, Stephen" sort="Tuck, Stephen" uniqKey="Tuck S" first="Stephen" last="Tuck">Stephen Tuck</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Al Shakarchi, Israa" sort="Al Shakarchi, Israa" uniqKey="Al Shakarchi I" first="Israa" last="Al-Shakarchi">Israa Al-Shakarchi</name><affiliation><mods:affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Louise Dolan, Ann" sort="Louise Dolan, Ann" uniqKey="Louise Dolan A" first="Ann" last="Louise Dolan">Ann Louise Dolan</name><affiliation><mods:affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Bridges, Matt J" sort="Bridges, Matt J" uniqKey="Bridges M" first="Matt J." last="Bridges">Matt J. Bridges</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</mods:affiliation></affiliation></author><author><name sortKey="Ruddick, Sheila" sort="Ruddick, Sheila" uniqKey="Ruddick S" first="Sheila" last="Ruddick">Sheila Ruddick</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</mods:affiliation></affiliation></author><author><name sortKey="Bracewell, Claire" sort="Bracewell, Claire" uniqKey="Bracewell C" first="Claire" last="Bracewell">Claire Bracewell</name><affiliation><mods:affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</mods:affiliation></affiliation></author><author><name sortKey="Wright, David" sort="Wright, David" uniqKey="Wright D" first="David" last="Wright">David Wright</name><affiliation><mods:affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</mods:affiliation></affiliation></author><author><name sortKey="Aspray, Terence" sort="Aspray, Terence" uniqKey="Aspray T" first="Terence" last="Aspray">Terence Aspray</name><affiliation><mods:affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</mods:affiliation></affiliation></author><author><name sortKey="Hynes, Gareth M" sort="Hynes, Gareth M" uniqKey="Hynes G" first="Gareth M." last="Hynes">Gareth M. Hynes</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Jameson, Karen" sort="Jameson, Karen" uniqKey="Jameson K" first="Karen" last="Jameson">Karen Jameson</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Aihie Sayer, Avan" sort="Aihie Sayer, Avan" uniqKey="Aihie Sayer A" first="Avan" last="Aihie Sayer">Avan Aihie Sayer</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Dennison, Elaine" sort="Dennison, Elaine" uniqKey="Dennison E" first="Elaine" last="Dennison">Elaine Dennison</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Robinson, Sian" sort="Robinson, Sian" uniqKey="Robinson S" first="Sian" last="Robinson">Sian Robinson</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Tull, Thomas J" sort="Tull, Thomas J" uniqKey="Tull T" first="Thomas J." last="Tull">Thomas J. Tull</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Fisher, Ben A" sort="Fisher, Ben A" uniqKey="Fisher B" first="Ben A." last="Fisher">Ben A. Fisher</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Jenabzadeh, Reza" sort="Jenabzadeh, Reza" uniqKey="Jenabzadeh R" first="Reza" last="Jenabzadeh">Reza Jenabzadeh</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Cobb, Justin P" sort="Cobb, Justin P" uniqKey="Cobb J" first="Justin P." last="Cobb">Justin P. Cobb</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Abraham, Sonya" sort="Abraham, Sonya" uniqKey="Abraham S" first="Sonya" last="Abraham">Sonya Abraham</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Hynes, Gareth M" sort="Hynes, Gareth M" uniqKey="Hynes G" first="Gareth M." last="Hynes">Gareth M. Hynes</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Jameson, Karen" sort="Jameson, Karen" uniqKey="Jameson K" first="Karen" last="Jameson">Karen Jameson</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Harvey, Nick" sort="Harvey, Nick" uniqKey="Harvey N" first="Nick" last="Harvey">Nick Harvey</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Aihie Sayer, Avan" sort="Aihie Sayer, Avan" uniqKey="Aihie Sayer A" first="Avan" last="Aihie Sayer">Avan Aihie Sayer</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Dennison, Elaine" sort="Dennison, Elaine" uniqKey="Dennison E" first="Elaine" last="Dennison">Elaine Dennison</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Cheah, Jonathan" sort="Cheah, Jonathan" uniqKey="Cheah J" first="Jonathan" last="Cheah">Jonathan Cheah</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Stacpoole, Sybil" sort="Stacpoole, Sybil" uniqKey="Stacpoole S" first="Sybil" last="Stacpoole">Sybil Stacpoole</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Heaney, Dominic" sort="Heaney, Dominic" uniqKey="Heaney D" first="Dominic" last="Heaney">Dominic Heaney</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Duncan, John" sort="Duncan, John" uniqKey="Duncan J" first="John" last="Duncan">John Duncan</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Roshandel, Delnaz" sort="Roshandel, Delnaz" uniqKey="Roshandel D" first="Delnaz" last="Roshandel">Delnaz Roshandel</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Holliday, Kate" sort="Holliday, Kate" uniqKey="Holliday K" first="Kate" last="Holliday">Kate Holliday</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Pye, Stephen R" sort="Pye, Stephen R" uniqKey="Pye S" first="Stephen R." last="Pye">Stephen R. Pye</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Boonen, Steven" sort="Boonen, Steven" uniqKey="Boonen S" first="Steven" last="Boonen">Steven Boonen</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Borghs, Herman" sort="Borghs, Herman" uniqKey="Borghs H" first="Herman" last="Borghs">Herman Borghs</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Vanderschueren, Dirk" sort="Vanderschueren, Dirk" uniqKey="Vanderschueren D" first="Dirk" last="Vanderschueren">Dirk Vanderschueren</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Adams, Judith E" sort="Adams, Judith E" uniqKey="Adams J" first="Judith E." last="Adams">Judith E. Adams</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Ward, Kate A" sort="Ward, Kate A" uniqKey="Ward K" first="Kate A." last="Ward">Kate A. Ward</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Finn, Joseph D" sort="Finn, Joseph D" uniqKey="Finn J" first="Joseph D." last="Finn">Joseph D. Finn</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Huhtaniemi, Ilpo T" sort="Huhtaniemi, Ilpo T" uniqKey="Huhtaniemi I" first="Ilpo T." last="Huhtaniemi">Ilpo T. Huhtaniemi</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Silman, Alan J" sort="Silman, Alan J" uniqKey="Silman A" first="Alan J." last="Silman">Alan J. Silman</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Wu, Frederick C" sort="Wu, Frederick C" uniqKey="Wu F" first="Frederick C." last="Wu">Frederick C. Wu</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Thomson, Wendy" sort="Thomson, Wendy" uniqKey="Thomson W" first="Wendy" last="Thomson">Wendy Thomson</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Oneill, Terence W" sort="Oneill, Terence W" uniqKey="Oneill T" first="Terence W." last="Oneill">Terence W. Oneill</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="White, Susanna" sort="White, Susanna" uniqKey="White S" first="Susanna" last="White">Susanna White</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Shaw, Simon" sort="Shaw, Simon" uniqKey="Shaw S" first="Simon" last="Shaw">Simon Shaw</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Short, Charlotte" sort="Short, Charlotte" uniqKey="Short C" first="Charlotte" last="Short">Charlotte Short</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Gilleece, Yvonne" sort="Gilleece, Yvonne" uniqKey="Gilleece Y" first="Yvonne" last="Gilleece">Yvonne Gilleece</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Fisher, Martin" sort="Fisher, Martin" uniqKey="Fisher M" first="Martin" last="Fisher">Martin Fisher</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Walker Bone, Karen" sort="Walker Bone, Karen" uniqKey="Walker Bone K" first="Karen" last="Walker-Bone">Karen Walker-Bone</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Narshi, Chetan B" sort="Narshi, Chetan B" uniqKey="Narshi C" first="Chetan B." last="Narshi">Chetan B. Narshi</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Martin, Rhodri" sort="Martin, Rhodri" uniqKey="Martin R" first="Rhodri" last="Martin">Rhodri Martin</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Mitchell, Karen" sort="Mitchell, Karen" uniqKey="Mitchell K" first="Karen" last="Mitchell">Karen Mitchell</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Keen, Richard" sort="Keen, Richard" uniqKey="Keen R" first="Richard" last="Keen">Richard Keen</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Bridges, Matt J" sort="Bridges, Matt J" uniqKey="Bridges M" first="Matt J." last="Bridges">Matt J. Bridges</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</mods:affiliation></affiliation></author><author><name sortKey="Ruddick, Sheila" sort="Ruddick, Sheila" uniqKey="Ruddick S" first="Sheila" last="Ruddick">Sheila Ruddick</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</mods:affiliation></affiliation></author><author><name sortKey="El Miedany, Yasser" sort="El Miedany, Yasser" uniqKey="El Miedany Y" first="Yasser" last="El Miedany">Yasser El Miedany</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Toth, Mathias" sort="Toth, Mathias" uniqKey="Toth M" first="Mathias" last="Toth">Mathias Toth</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Youssef, Sally" sort="Youssef, Sally" uniqKey="Youssef S" first="Sally" last="Youssef">Sally Youssef</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="El Gaafary, Maha" sort="El Gaafary, Maha" uniqKey="El Gaafary M" first="Maha" last="El Gaafary">Maha El Gaafary</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Alhambra, Daniel Prieto" sort="Alhambra, Daniel Prieto" uniqKey="Alhambra D" first="Daniel Prieto" last="Alhambra">Daniel Prieto Alhambra</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Azagra, Rafael" sort="Azagra, Rafael" uniqKey="Azagra R" first="Rafael" last="Azagra">Rafael Azagra</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Duro, Gloria Encabo" sort="Duro, Gloria Encabo" uniqKey="Duro G" first="Gloria Encabo" last="Duro">Gloria Encabo Duro</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Aguye, Amada" sort="Aguye, Amada" uniqKey="Aguye A" first="Amada" last="Aguye">Amada Aguye</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Zwart, Marta" sort="Zwart, Marta" uniqKey="Zwart M" first="Marta" last="Zwart">Marta Zwart</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Javaid, Kassim M" sort="Javaid, Kassim M" uniqKey="Javaid K" first="Kassim M." last="Javaid">Kassim M. Javaid</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:ED675643FE1E176FADE8396FD83BDC37CC02C6C6</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1093/rheumatology/keq723</idno><idno type="url">https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001311</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Osteoporosis and Metabolic Bone Disease [127142]</title><author><name sortKey="El Miedany, Yasser" sort="El Miedany, Yasser" uniqKey="El Miedany Y" first="Yasser" last="El Miedany">Yasser El Miedany</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="El Gaafary, Maha" sort="El Gaafary, Maha" uniqKey="El Gaafary M" first="Maha" last="El Gaafary">Maha El Gaafary</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Youssef, Sally" sort="Youssef, Sally" uniqKey="Youssef S" first="Sally" last="Youssef">Sally Youssef</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Toth, Mathias" sort="Toth, Mathias" uniqKey="Toth M" first="Mathias" last="Toth">Mathias Toth</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Weightman, Jessica" sort="Weightman, Jessica" uniqKey="Weightman J" first="Jessica" last="Weightman">Jessica Weightman</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Kelly, Madeleine" sort="Kelly, Madeleine" uniqKey="Kelly M" first="Madeleine" last="Kelly">Madeleine Kelly</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Johnston, Emma" sort="Johnston, Emma" uniqKey="Johnston E" first="Emma" last="Johnston">Emma Johnston</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Stone, Amanda" sort="Stone, Amanda" uniqKey="Stone A" first="Amanda" last="Stone">Amanda Stone</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Harrison, Patricia" sort="Harrison, Patricia" uniqKey="Harrison P" first="Patricia" last="Harrison">Patricia Harrison</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Bartholomew, Peter" sort="Bartholomew, Peter" uniqKey="Bartholomew P" first="Peter" last="Bartholomew">Peter Bartholomew</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Kelly, Clive" sort="Kelly, Clive" uniqKey="Kelly C" first="Clive" last="Kelly">Clive Kelly</name><affiliation><mods:affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</mods:affiliation></affiliation></author><author><name sortKey="Vagadia, Vipul" sort="Vagadia, Vipul" uniqKey="Vagadia V" first="Vipul" last="Vagadia">Vipul Vagadia</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Tuck, Stephen" sort="Tuck, Stephen" uniqKey="Tuck S" first="Stephen" last="Tuck">Stephen Tuck</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Al Shakarchi, Israa" sort="Al Shakarchi, Israa" uniqKey="Al Shakarchi I" first="Israa" last="Al-Shakarchi">Israa Al-Shakarchi</name><affiliation><mods:affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Louise Dolan, Ann" sort="Louise Dolan, Ann" uniqKey="Louise Dolan A" first="Ann" last="Louise Dolan">Ann Louise Dolan</name><affiliation><mods:affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Bridges, Matt J" sort="Bridges, Matt J" uniqKey="Bridges M" first="Matt J." last="Bridges">Matt J. Bridges</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</mods:affiliation></affiliation></author><author><name sortKey="Ruddick, Sheila" sort="Ruddick, Sheila" uniqKey="Ruddick S" first="Sheila" last="Ruddick">Sheila Ruddick</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</mods:affiliation></affiliation></author><author><name sortKey="Bracewell, Claire" sort="Bracewell, Claire" uniqKey="Bracewell C" first="Claire" last="Bracewell">Claire Bracewell</name><affiliation><mods:affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</mods:affiliation></affiliation></author><author><name sortKey="Wright, David" sort="Wright, David" uniqKey="Wright D" first="David" last="Wright">David Wright</name><affiliation><mods:affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</mods:affiliation></affiliation></author><author><name sortKey="Aspray, Terence" sort="Aspray, Terence" uniqKey="Aspray T" first="Terence" last="Aspray">Terence Aspray</name><affiliation><mods:affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</mods:affiliation></affiliation></author><author><name sortKey="Hynes, Gareth M" sort="Hynes, Gareth M" uniqKey="Hynes G" first="Gareth M." last="Hynes">Gareth M. Hynes</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Jameson, Karen" sort="Jameson, Karen" uniqKey="Jameson K" first="Karen" last="Jameson">Karen Jameson</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Aihie Sayer, Avan" sort="Aihie Sayer, Avan" uniqKey="Aihie Sayer A" first="Avan" last="Aihie Sayer">Avan Aihie Sayer</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Dennison, Elaine" sort="Dennison, Elaine" uniqKey="Dennison E" first="Elaine" last="Dennison">Elaine Dennison</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Robinson, Sian" sort="Robinson, Sian" uniqKey="Robinson S" first="Sian" last="Robinson">Sian Robinson</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Tull, Thomas J" sort="Tull, Thomas J" uniqKey="Tull T" first="Thomas J." last="Tull">Thomas J. Tull</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Fisher, Ben A" sort="Fisher, Ben A" uniqKey="Fisher B" first="Ben A." last="Fisher">Ben A. Fisher</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Jenabzadeh, Reza" sort="Jenabzadeh, Reza" uniqKey="Jenabzadeh R" first="Reza" last="Jenabzadeh">Reza Jenabzadeh</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Cobb, Justin P" sort="Cobb, Justin P" uniqKey="Cobb J" first="Justin P." last="Cobb">Justin P. Cobb</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Abraham, Sonya" sort="Abraham, Sonya" uniqKey="Abraham S" first="Sonya" last="Abraham">Sonya Abraham</name><affiliation><mods:affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Hynes, Gareth M" sort="Hynes, Gareth M" uniqKey="Hynes G" first="Gareth M." last="Hynes">Gareth M. Hynes</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Jameson, Karen" sort="Jameson, Karen" uniqKey="Jameson K" first="Karen" last="Jameson">Karen Jameson</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Harvey, Nick" sort="Harvey, Nick" uniqKey="Harvey N" first="Nick" last="Harvey">Nick Harvey</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Aihie Sayer, Avan" sort="Aihie Sayer, Avan" uniqKey="Aihie Sayer A" first="Avan" last="Aihie Sayer">Avan Aihie Sayer</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Dennison, Elaine" sort="Dennison, Elaine" uniqKey="Dennison E" first="Elaine" last="Dennison">Elaine Dennison</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Cheah, Jonathan" sort="Cheah, Jonathan" uniqKey="Cheah J" first="Jonathan" last="Cheah">Jonathan Cheah</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Stacpoole, Sybil" sort="Stacpoole, Sybil" uniqKey="Stacpoole S" first="Sybil" last="Stacpoole">Sybil Stacpoole</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Heaney, Dominic" sort="Heaney, Dominic" uniqKey="Heaney D" first="Dominic" last="Heaney">Dominic Heaney</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Duncan, John" sort="Duncan, John" uniqKey="Duncan J" first="John" last="Duncan">John Duncan</name><affiliation><mods:affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Roshandel, Delnaz" sort="Roshandel, Delnaz" uniqKey="Roshandel D" first="Delnaz" last="Roshandel">Delnaz Roshandel</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Holliday, Kate" sort="Holliday, Kate" uniqKey="Holliday K" first="Kate" last="Holliday">Kate Holliday</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Pye, Stephen R" sort="Pye, Stephen R" uniqKey="Pye S" first="Stephen R." last="Pye">Stephen R. Pye</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Boonen, Steven" sort="Boonen, Steven" uniqKey="Boonen S" first="Steven" last="Boonen">Steven Boonen</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Borghs, Herman" sort="Borghs, Herman" uniqKey="Borghs H" first="Herman" last="Borghs">Herman Borghs</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Vanderschueren, Dirk" sort="Vanderschueren, Dirk" uniqKey="Vanderschueren D" first="Dirk" last="Vanderschueren">Dirk Vanderschueren</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Adams, Judith E" sort="Adams, Judith E" uniqKey="Adams J" first="Judith E." last="Adams">Judith E. Adams</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Ward, Kate A" sort="Ward, Kate A" uniqKey="Ward K" first="Kate A." last="Ward">Kate A. Ward</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Finn, Joseph D" sort="Finn, Joseph D" uniqKey="Finn J" first="Joseph D." last="Finn">Joseph D. Finn</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Huhtaniemi, Ilpo T" sort="Huhtaniemi, Ilpo T" uniqKey="Huhtaniemi I" first="Ilpo T." last="Huhtaniemi">Ilpo T. Huhtaniemi</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Silman, Alan J" sort="Silman, Alan J" uniqKey="Silman A" first="Alan J." last="Silman">Alan J. Silman</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Wu, Frederick C" sort="Wu, Frederick C" uniqKey="Wu F" first="Frederick C." last="Wu">Frederick C. Wu</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Thomson, Wendy" sort="Thomson, Wendy" uniqKey="Thomson W" first="Wendy" last="Thomson">Wendy Thomson</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="Oneill, Terence W" sort="Oneill, Terence W" uniqKey="Oneill T" first="Terence W." last="Oneill">Terence W. Oneill</name><affiliation><mods:affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</mods:affiliation></affiliation></author><author><name sortKey="White, Susanna" sort="White, Susanna" uniqKey="White S" first="Susanna" last="White">Susanna White</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Shaw, Simon" sort="Shaw, Simon" uniqKey="Shaw S" first="Simon" last="Shaw">Simon Shaw</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Short, Charlotte" sort="Short, Charlotte" uniqKey="Short C" first="Charlotte" last="Short">Charlotte Short</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Gilleece, Yvonne" sort="Gilleece, Yvonne" uniqKey="Gilleece Y" first="Yvonne" last="Gilleece">Yvonne Gilleece</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Fisher, Martin" sort="Fisher, Martin" uniqKey="Fisher M" first="Martin" last="Fisher">Martin Fisher</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Walker Bone, Karen" sort="Walker Bone, Karen" uniqKey="Walker Bone K" first="Karen" last="Walker-Bone">Karen Walker-Bone</name><affiliation><mods:affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</mods:affiliation></affiliation></author><author><name sortKey="Narshi, Chetan B" sort="Narshi, Chetan B" uniqKey="Narshi C" first="Chetan B." last="Narshi">Chetan B. Narshi</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Martin, Rhodri" sort="Martin, Rhodri" uniqKey="Martin R" first="Rhodri" last="Martin">Rhodri Martin</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Mitchell, Karen" sort="Mitchell, Karen" uniqKey="Mitchell K" first="Karen" last="Mitchell">Karen Mitchell</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Keen, Richard" sort="Keen, Richard" uniqKey="Keen R" first="Richard" last="Keen">Richard Keen</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</mods:affiliation></affiliation></author><author><name sortKey="Bridges, Matt J" sort="Bridges, Matt J" uniqKey="Bridges M" first="Matt J." last="Bridges">Matt J. Bridges</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</mods:affiliation></affiliation></author><author><name sortKey="Ruddick, Sheila" sort="Ruddick, Sheila" uniqKey="Ruddick S" first="Sheila" last="Ruddick">Sheila Ruddick</name><affiliation><mods:affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</mods:affiliation></affiliation></author><author><name sortKey="El Miedany, Yasser" sort="El Miedany, Yasser" uniqKey="El Miedany Y" first="Yasser" last="El Miedany">Yasser El Miedany</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Toth, Mathias" sort="Toth, Mathias" uniqKey="Toth M" first="Mathias" last="Toth">Mathias Toth</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Youssef, Sally" sort="Youssef, Sally" uniqKey="Youssef S" first="Sally" last="Youssef">Sally Youssef</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="El Gaafary, Maha" sort="El Gaafary, Maha" uniqKey="El Gaafary M" first="Maha" last="El Gaafary">Maha El Gaafary</name><affiliation><mods:affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Alhambra, Daniel Prieto" sort="Alhambra, Daniel Prieto" uniqKey="Alhambra D" first="Daniel Prieto" last="Alhambra">Daniel Prieto Alhambra</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Azagra, Rafael" sort="Azagra, Rafael" uniqKey="Azagra R" first="Rafael" last="Azagra">Rafael Azagra</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Duro, Gloria Encabo" sort="Duro, Gloria Encabo" uniqKey="Duro G" first="Gloria Encabo" last="Duro">Gloria Encabo Duro</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Aguye, Amada" sort="Aguye, Amada" uniqKey="Aguye A" first="Amada" last="Aguye">Amada Aguye</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Zwart, Marta" sort="Zwart, Marta" uniqKey="Zwart M" first="Marta" last="Zwart">Marta Zwart</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Javaid, Kassim M" sort="Javaid, Kassim M" uniqKey="Javaid K" first="Kassim M." last="Javaid">Kassim M. Javaid</name><affiliation><mods:affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Rheumatology</title><idno type="ISSN">1462-0324</idno><idno type="eISSN">1462-0332</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-04">2010-04</date><biblScope unit="volume">49</biblScope><biblScope unit="supplement">suppl_1</biblScope><biblScope unit="page" from="80">i80</biblScope><biblScope unit="page" to="86">i86</biblScope></imprint><idno type="ISSN">1462-0324</idno></series><idno type="istex">ED675643FE1E176FADE8396FD83BDC37CC02C6C6</idno><idno type="DOI">10.1093/rheumatology/keq723</idno><idno type="ArticleID">keq723</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1462-0324</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background: To assess the validity of a new referral model for DXA scanning, its impact on patients management and whether it meets the targets of the osteoporosis and falls service. Methods: The referral form was developed, including 3 main components: 1. Risk factors for osteoporosis (6 factors). 2. the 8 risk factors identified in FRAX (WHO fracture risk assessment tool) and 3. Risk factors for falls (5 factors). Special icons were used to give clinical hints for vertebral morphometry and tilting table assessment. The model was set up with only ticking the appropriate boxes is required. Validation of the model was done through: 1. comparing the referral form to the medical notes and the patients answers to a pre-scanning questionnaire. 2. Each patient was assessed and management plan (guided by the national guidelines) was considered blindly twice based on the data available in the new referral form in comparison to the old referral form. DXA measurements were then analyzed in relation to self-reported incidence of falls, fractures and the calculated 10-years fracture probability (using FRAX). Results: A total of 264 postmenopausal women (mean age, 68.64.73 years) were included in this work. Osteoporosis was found in 113/264 (42.8) of the patients whereas osteopenia prevalence was 32.1 (86/264). 34.5 (91/264) of the patients had a past history of low trauma fracture and 21.6 (57/264) reported 1 or more falls during the preceding year. Patients treated based on the osteoporosis-falls-FRAX composite were significantly higher (r0.635) than those treated based on the old referral form. Most of these patients were suffering from secondary osteoporosis and their DXA scan revealed borderline osteoporosis/osteopenia. Adjusted risk for age, BMI, bone density and 10-year fracture probability in the past 12 months in patients who reported a fall was 6.0 (95 CI, 3.2-10.5, P<0.001). Compared with women without osteoporosis and without a fall and 10-year fracture probability <10, women with osteoporosis without a fall and 10-year fracture probability <10 had an age- and BMI-adjusted fracture risk of 2.8 (95 CI, 0.7-11.7 P<0.10) and women with osteoporosis and a fall and fracture probability >20 had an adjusted-fracture risk of 24.8 (95 CI, 7.1-78.5; P<0.0001). Conclusions: The developed form is a valid model for DXA scanning and accurate tool for assessment of osteoporosis, falls risks as well as fracture (using FRAX). Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age, bone mineral content and 10-year fracture probability. It is important to have the patients stratified and assessed according to the different osteoporosis and falls risk factors rather than relying on fractures as the corner stone for assessment and management. Disclosure statement: All authors have declared no conflicts of interest.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Yasser El Miedany</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Maha El Gaafary</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Sally Youssef</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Mathias Toth</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Jessica Weightman</name><affiliations><json:string>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</json:string></affiliations></json:item><json:item><name>Madeleine Kelly</name><affiliations><json:string>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</json:string></affiliations></json:item><json:item><name>Emma Johnston</name><affiliations><json:string>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</json:string></affiliations></json:item><json:item><name>Amanda Stone</name><affiliations><json:string>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</json:string></affiliations></json:item><json:item><name>Patricia Harrison</name><affiliations><json:string>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</json:string></affiliations></json:item><json:item><name>Peter Bartholomew</name><affiliations><json:string>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</json:string></affiliations></json:item><json:item><name>Clive Kelly</name><affiliations><json:string>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</json:string></affiliations></json:item><json:item><name>Vipul Vagadia</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Stephen Tuck</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Israa Al-Shakarchi</name><affiliations><json:string>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</json:string></affiliations></json:item><json:item><name>Ann Louise Dolan</name><affiliations><json:string>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</json:string></affiliations></json:item><json:item><name>Matt J. Bridges</name><affiliations><json:string>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</json:string></affiliations></json:item><json:item><name>Sheila Ruddick</name><affiliations><json:string>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</json:string></affiliations></json:item><json:item><name>Claire Bracewell</name><affiliations><json:string>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</json:string></affiliations></json:item><json:item><name>David Wright</name><affiliations><json:string>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</json:string></affiliations></json:item><json:item><name>Terence Aspray</name><affiliations><json:string>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</json:string></affiliations></json:item><json:item><name>Gareth M. Hynes</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Karen Jameson</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Avan Aihie Sayer</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Cyrus Cooper</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Elaine Dennison</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Sian Robinson</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Thomas J. Tull</name><affiliations><json:string>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</json:string></affiliations></json:item><json:item><name>Ben A. Fisher</name><affiliations><json:string>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</json:string></affiliations></json:item><json:item><name>Reza Jenabzadeh</name><affiliations><json:string>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</json:string></affiliations></json:item><json:item><name>Justin P. Cobb</name><affiliations><json:string>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</json:string></affiliations></json:item><json:item><name>Sonya Abraham</name><affiliations><json:string>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</json:string></affiliations></json:item><json:item><name>Gareth M. Hynes</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Karen Jameson</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Nick Harvey</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Avan Aihie Sayer</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Cyrus Cooper</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Elaine Dennison</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Jonathan Cheah</name><affiliations><json:string>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</json:string></affiliations></json:item><json:item><name>Sybil Stacpoole</name><affiliations><json:string>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</json:string></affiliations></json:item><json:item><name>Dominic Heaney</name><affiliations><json:string>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</json:string></affiliations></json:item><json:item><name>John Duncan</name><affiliations><json:string>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</json:string></affiliations></json:item><json:item><name>Delnaz Roshandel</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Kate Holliday</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Stephen R. Pye</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Steven Boonen</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Herman Borghs</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Dirk Vanderschueren</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Judith E. Adams</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Kate A. Ward</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Joseph D. Finn</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Ilpo T. Huhtaniemi</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Alan J. Silman</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Frederick C. Wu</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Wendy Thomson</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Terence W. ONeill</name><affiliations><json:string>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</json:string></affiliations></json:item><json:item><name>Susanna White</name><affiliations><json:string>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</json:string></affiliations></json:item><json:item><name>Simon Shaw</name><affiliations><json:string>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</json:string></affiliations></json:item><json:item><name>Charlotte Short</name><affiliations><json:string>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</json:string></affiliations></json:item><json:item><name>Yvonne Gilleece</name><affiliations><json:string>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</json:string></affiliations></json:item><json:item><name>Martin Fisher</name><affiliations><json:string>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</json:string></affiliations></json:item><json:item><name>Karen Walker-Bone</name><affiliations><json:string>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</json:string></affiliations></json:item><json:item><name>Chetan B. Narshi</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Rhodri Martin</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Karen Mitchell</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Richard Keen</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</json:string></affiliations></json:item><json:item><name>Matt J. Bridges</name><affiliations><json:string>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</json:string></affiliations></json:item><json:item><name>Sheila Ruddick</name><affiliations><json:string>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</json:string></affiliations></json:item><json:item><name>Yasser El Miedany</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</json:string></affiliations></json:item><json:item><name>Mathias Toth</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</json:string></affiliations></json:item><json:item><name>Sally Youssef</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</json:string></affiliations></json:item><json:item><name>Maha El Gaafary</name><affiliations><json:string>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</json:string></affiliations></json:item><json:item><name>Daniel Prieto Alhambra</name><affiliations><json:string>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Rafael Azagra</name><affiliations><json:string>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Gloria Encabo Duro</name><affiliations><json:string>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Amada Aguye</name><affiliations><json:string>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Marta Zwart</name><affiliations><json:string>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Kassim M. Javaid</name><affiliations><json:string>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Poster Viewing II (Thursday 22 April 2010, 08:30-10:00)</value></json:item></subject><articleId><json:string>keq723</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Background: To assess the validity of a new referral model for DXA scanning, its impact on patients management and whether it meets the targets of the osteoporosis and falls service. Methods: The referral form was developed, including 3 main components: 1. Risk factors for osteoporosis (6 factors). 2. the 8 risk factors identified in FRAX (WHO fracture risk assessment tool) and 3. Risk factors for falls (5 factors). Special icons were used to give clinical hints for vertebral morphometry and tilting table assessment. The model was set up with only ticking the appropriate boxes is required. Validation of the model was done through: 1. comparing the referral form to the medical notes and the patients answers to a pre-scanning questionnaire. 2. Each patient was assessed and management plan (guided by the national guidelines) was considered blindly twice based on the data available in the new referral form in comparison to the old referral form. DXA measurements were then analyzed in relation to self-reported incidence of falls, fractures and the calculated 10-years fracture probability (using FRAX). Results: A total of 264 postmenopausal women (mean age, 68.64.73 years) were included in this work. Osteoporosis was found in 113/264 (42.8) of the patients whereas osteopenia prevalence was 32.1 (86/264). 34.5 (91/264) of the patients had a past history of low trauma fracture and 21.6 (57/264) reported 1 or more falls during the preceding year. Patients treated based on the osteoporosis-falls-FRAX composite were significantly higher (r0.635) than those treated based on the old referral form. Most of these patients were suffering from secondary osteoporosis and their DXA scan revealed borderline osteoporosis/osteopenia. Adjusted risk for age, BMI, bone density and 10-year fracture probability in the past 12 months in patients who reported a fall was 6.0 (95 CI, 3.2-10.5, P>0.001). Compared with women without osteoporosis and without a fall and 10-year fracture probability >10, women with osteoporosis without a fall and 10-year fracture probability >10 had an age- and BMI-adjusted fracture risk of 2.8 (95 CI, 0.7-11.7 P>0.10) and women with osteoporosis and a fall and fracture probability >20 had an adjusted-fracture risk of 24.8 (95 CI, 7.1-78.5; P>0.0001). Conclusions: The developed form is a valid model for DXA scanning and accurate tool for assessment of osteoporosis, falls risks as well as fracture (using FRAX). Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age, bone mineral content and 10-year fracture probability. It is important to have the patients stratified and assessed according to the different osteoporosis and falls risk factors rather than relying on fractures as the corner stone for assessment and management. Disclosure statement: All authors have declared no conflicts of interest.</abstract><qualityIndicators><score>8.5</score><pdfVersion>1.4</pdfVersion><pdfPageSize>612.283 x 790.866 pts</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>1</keywordCount><abstractCharCount>2955</abstractCharCount><pdfWordCount>8032</pdfWordCount><pdfCharCount>50623</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>454</abstractWordCount></qualityIndicators><title>Osteoporosis and Metabolic Bone Disease [127142]</title><genre><json:string>research-article</json:string></genre><host><volume>49</volume><publisherId><json:string>brheum</json:string></publisherId><pages><last>i86</last><first>i80</first></pages><issn><json:string>1462-0324</json:string></issn><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1462-0332</json:string></eissn><title>Rheumatology</title></host><categories><wos><json:string>RHEUMATOLOGY</json:string></wos></categories><publicationDate>2010</publicationDate><copyrightDate>2010</copyrightDate><doi><json:string>10.1093/rheumatology/keq723</json:string></doi><id>ED675643FE1E176FADE8396FD83BDC37CC02C6C6</id><score>0.23349598</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Osteoporosis and Metabolic Bone Disease [127142]</title><title level="a" type="sub">127. Osteoporosis, Falls and Fractures: Three Confounders in One Equation. Development and Validity of a New form for Assessment of Patients Referred for Dxa Scanning</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>OUP</p></availability><date>2010</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Osteoporosis and Metabolic Bone Disease [127142]</title><title level="a" type="sub">127. Osteoporosis, Falls and Fractures: Three Confounders in One Equation. Development and Validity of a New form for Assessment of Patients Referred for Dxa Scanning</title><author xml:id="author-1"><persName><forename type="first">Yasser</forename><surname>El Miedany</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-2"><persName><forename type="first">Maha</forename><surname>El Gaafary</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-3"><persName><forename type="first">Sally</forename><surname>Youssef</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-4"><persName><forename type="first">Mathias</forename><surname>Toth</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-5"><persName><forename type="first">Jessica</forename><surname>Weightman</surname></persName><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation></author><author xml:id="author-6"><persName><forename type="first">Madeleine</forename><surname>Kelly</surname></persName><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation></author><author xml:id="author-7"><persName><forename type="first">Emma</forename><surname>Johnston</surname></persName><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation></author><author xml:id="author-8"><persName><forename type="first">Amanda</forename><surname>Stone</surname></persName><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation></author><author xml:id="author-9"><persName><forename type="first">Patricia</forename><surname>Harrison</surname></persName><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation></author><author xml:id="author-10"><persName><forename type="first">Peter</forename><surname>Bartholomew</surname></persName><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation></author><author xml:id="author-11"><persName><forename type="first">Clive</forename><surname>Kelly</surname></persName><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation></author><author xml:id="author-12"><persName><forename type="first">Vipul</forename><surname>Vagadia</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-13"><persName><forename type="first">Stephen</forename><surname>Tuck</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-14"><persName><forename type="first">Israa</forename><surname>Al-Shakarchi</surname></persName><affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</affiliation></author><author xml:id="author-15"><persName><forename type="first">Ann</forename><surname>Louise Dolan</surname></persName><affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</affiliation></author><author xml:id="author-16"><persName><forename type="first">Matt J.</forename><surname>Bridges</surname></persName><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</affiliation></author><author xml:id="author-17"><persName><forename type="first">Sheila</forename><surname>Ruddick</surname></persName><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</affiliation></author><author xml:id="author-18"><persName><forename type="first">Claire</forename><surname>Bracewell</surname></persName><affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</affiliation></author><author xml:id="author-19"><persName><forename type="first">David</forename><surname>Wright</surname></persName><affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</affiliation></author><author xml:id="author-20"><persName><forename type="first">Terence</forename><surname>Aspray</surname></persName><affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</affiliation></author><author xml:id="author-21"><persName><forename type="first">Gareth M.</forename><surname>Hynes</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-22"><persName><forename type="first">Karen</forename><surname>Jameson</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-23"><persName><forename type="first">Avan</forename><surname>Aihie Sayer</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-24"><persName><forename type="first">Cyrus</forename><surname>Cooper</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-25"><persName><forename type="first">Elaine</forename><surname>Dennison</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-26"><persName><forename type="first">Sian</forename><surname>Robinson</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-27"><persName><forename type="first">Thomas J.</forename><surname>Tull</surname></persName><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation></author><author xml:id="author-28"><persName><forename type="first">Ben A.</forename><surname>Fisher</surname></persName><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation></author><author xml:id="author-29"><persName><forename type="first">Reza</forename><surname>Jenabzadeh</surname></persName><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation></author><author xml:id="author-30"><persName><forename type="first">Justin P.</forename><surname>Cobb</surname></persName><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation></author><author xml:id="author-31"><persName><forename type="first">Sonya</forename><surname>Abraham</surname></persName><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation></author><author xml:id="author-32"><persName><forename type="first">Gareth M.</forename><surname>Hynes</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-33"><persName><forename type="first">Karen</forename><surname>Jameson</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-34"><persName><forename type="first">Nick</forename><surname>Harvey</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-35"><persName><forename type="first">Avan</forename><surname>Aihie Sayer</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-36"><persName><forename type="first">Cyrus</forename><surname>Cooper</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-37"><persName><forename type="first">Elaine</forename><surname>Dennison</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-38"><persName><forename type="first">Jonathan</forename><surname>Cheah</surname></persName><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation></author><author xml:id="author-39"><persName><forename type="first">Sybil</forename><surname>Stacpoole</surname></persName><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation></author><author xml:id="author-40"><persName><forename type="first">Dominic</forename><surname>Heaney</surname></persName><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation></author><author xml:id="author-41"><persName><forename type="first">John</forename><surname>Duncan</surname></persName><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation></author><author xml:id="author-42"><persName><forename type="first">Delnaz</forename><surname>Roshandel</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-43"><persName><forename type="first">Kate</forename><surname>Holliday</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-44"><persName><forename type="first">Stephen R.</forename><surname>Pye</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-45"><persName><forename type="first">Steven</forename><surname>Boonen</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-46"><persName><forename type="first">Herman</forename><surname>Borghs</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-47"><persName><forename type="first">Dirk</forename><surname>Vanderschueren</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-48"><persName><forename type="first">Judith E.</forename><surname>Adams</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-49"><persName><forename type="first">Kate A.</forename><surname>Ward</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-50"><persName><forename type="first">Joseph D.</forename><surname>Finn</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-51"><persName><forename type="first">Ilpo T.</forename><surname>Huhtaniemi</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-52"><persName><forename type="first">Alan J.</forename><surname>Silman</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-53"><persName><forename type="first">Frederick C.</forename><surname>Wu</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-54"><persName><forename type="first">Wendy</forename><surname>Thomson</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-55"><persName><forename type="first">Terence W.</forename><surname>ONeill</surname></persName><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation></author><author xml:id="author-56"><persName><forename type="first">Susanna</forename><surname>White</surname></persName><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation></author><author xml:id="author-57"><persName><forename type="first">Simon</forename><surname>Shaw</surname></persName><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation></author><author xml:id="author-58"><persName><forename type="first">Charlotte</forename><surname>Short</surname></persName><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation></author><author xml:id="author-59"><persName><forename type="first">Yvonne</forename><surname>Gilleece</surname></persName><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation></author><author xml:id="author-60"><persName><forename type="first">Martin</forename><surname>Fisher</surname></persName><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation></author><author xml:id="author-61"><persName><forename type="first">Karen</forename><surname>Walker-Bone</surname></persName><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation></author><author xml:id="author-62"><persName><forename type="first">Chetan B.</forename><surname>Narshi</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-63"><persName><forename type="first">Rhodri</forename><surname>Martin</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-64"><persName><forename type="first">Karen</forename><surname>Mitchell</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-65"><persName><forename type="first">Richard</forename><surname>Keen</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation></author><author xml:id="author-66"><persName><forename type="first">Matt J.</forename><surname>Bridges</surname></persName><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</affiliation></author><author xml:id="author-67"><persName><forename type="first">Sheila</forename><surname>Ruddick</surname></persName><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</affiliation></author><author xml:id="author-68"><persName><forename type="first">Yasser</forename><surname>El Miedany</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation></author><author xml:id="author-69"><persName><forename type="first">Mathias</forename><surname>Toth</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation></author><author xml:id="author-70"><persName><forename type="first">Sally</forename><surname>Youssef</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation></author><author xml:id="author-71"><persName><forename type="first">Maha</forename><surname>El Gaafary</surname></persName><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation></author><author xml:id="author-72"><persName><forename type="first">Daniel Prieto</forename><surname>Alhambra</surname></persName><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation></author><author xml:id="author-73"><persName><forename type="first">Rafael</forename><surname>Azagra</surname></persName><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation></author><author xml:id="author-74"><persName><forename type="first">Gloria Encabo</forename><surname>Duro</surname></persName><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation></author><author xml:id="author-75"><persName><forename type="first">Amada</forename><surname>Aguye</surname></persName><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation></author><author xml:id="author-76"><persName><forename type="first">Marta</forename><surname>Zwart</surname></persName><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation></author><author xml:id="author-77"><persName><forename type="first">Kassim M.</forename><surname>Javaid</surname></persName><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation></author></analytic><monogr><title level="j">Rheumatology</title><idno type="pISSN">1462-0324</idno><idno type="eISSN">1462-0332</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-04"></date><biblScope unit="volume">49</biblScope><biblScope unit="supplement">suppl_1</biblScope><biblScope unit="page" from="80">i80</biblScope><biblScope unit="page" to="86">i86</biblScope></imprint></monogr><idno type="istex">ED675643FE1E176FADE8396FD83BDC37CC02C6C6</idno><idno type="DOI">10.1093/rheumatology/keq723</idno><idno type="ArticleID">keq723</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background: To assess the validity of a new referral model for DXA scanning, its impact on patients management and whether it meets the targets of the osteoporosis and falls service. Methods: The referral form was developed, including 3 main components: 1. Risk factors for osteoporosis (6 factors). 2. the 8 risk factors identified in FRAX (WHO fracture risk assessment tool) and 3. Risk factors for falls (5 factors). Special icons were used to give clinical hints for vertebral morphometry and tilting table assessment. The model was set up with only ticking the appropriate boxes is required. Validation of the model was done through: 1. comparing the referral form to the medical notes and the patients answers to a pre-scanning questionnaire. 2. Each patient was assessed and management plan (guided by the national guidelines) was considered blindly twice based on the data available in the new referral form in comparison to the old referral form. DXA measurements were then analyzed in relation to self-reported incidence of falls, fractures and the calculated 10-years fracture probability (using FRAX). Results: A total of 264 postmenopausal women (mean age, 68.64.73 years) were included in this work. Osteoporosis was found in 113/264 (42.8) of the patients whereas osteopenia prevalence was 32.1 (86/264). 34.5 (91/264) of the patients had a past history of low trauma fracture and 21.6 (57/264) reported 1 or more falls during the preceding year. Patients treated based on the osteoporosis-falls-FRAX composite were significantly higher (r0.635) than those treated based on the old referral form. Most of these patients were suffering from secondary osteoporosis and their DXA scan revealed borderline osteoporosis/osteopenia. Adjusted risk for age, BMI, bone density and 10-year fracture probability in the past 12 months in patients who reported a fall was 6.0 (95 CI, 3.2-10.5, P<0.001). Compared with women without osteoporosis and without a fall and 10-year fracture probability <10, women with osteoporosis without a fall and 10-year fracture probability <10 had an age- and BMI-adjusted fracture risk of 2.8 (95 CI, 0.7-11.7 P<0.10) and women with osteoporosis and a fall and fracture probability >20 had an adjusted-fracture risk of 24.8 (95 CI, 7.1-78.5; P<0.0001). Conclusions: The developed form is a valid model for DXA scanning and accurate tool for assessment of osteoporosis, falls risks as well as fracture (using FRAX). Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age, bone mineral content and 10-year fracture probability. It is important to have the patients stratified and assessed according to the different osteoporosis and falls risk factors rather than relying on fractures as the corner stone for assessment and management. Disclosure statement: All authors have declared no conflicts of interest.</p></abstract><textClass><keywords scheme="keyword"><list><item><term>Poster Viewing II (Thursday 22 April 2010, 08:30-10:00)</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-04">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-14">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element sub-article not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">rheumatology</journal-id><journal-id journal-id-type="publisher-id">brheum</journal-id><journal-title>Rheumatology</journal-title><issn pub-type="ppub">1462-0324</issn><issn pub-type="epub">1462-0332</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/rheumatology/keq723</article-id><article-id pub-id-type="publisher-id">keq723</article-id><article-categories><subj-group><subject>Poster Viewing II (Thursday 22 April 2010, 08:30-10:00)</subject></subj-group></article-categories><title-group><article-title>Osteoporosis and Metabolic Bone Disease [127–142]</article-title><subtitle>127. Osteoporosis, Falls and Fractures: Three Confounders in One Equation. Development and Validity of a New form for Assessment of Patients Referred for Dxa Scanning</subtitle></title-group><contrib-group><contrib contrib-type="author"><name><surname>El Miedany</surname><given-names>Yasser</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>El Gaafary</surname><given-names>Maha</given-names></name><xref ref-type="aff" rid="AFF1"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Youssef</surname><given-names>Sally</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Toth</surname><given-names>Mathias</given-names></name><xref ref-type="aff" rid="AFF1"><sup>3</sup></xref></contrib></contrib-group><aff id="AFF1"><sup>1</sup>Rheumatology, Darent Valley Hospital, Dartford, UK; <sup>2</sup>Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; <sup>3</sup>Geriatrics, Darent Valley Hospital, Dartford, UK</aff><pub-date pub-type="ppub"><month>4</month><year>2010</year></pub-date><volume>49</volume><issue>suppl_1</issue><issue-title>Rheumatology BSR and BHPR Conference Abstracts</issue-title><fpage>i80</fpage><lpage>i86</lpage><abstract><p><bold>Background:</bold> To assess the validity of a new referral model for DXA scanning, its impact on patients’ management and whether it meets the targets of the osteoporosis and falls service.</p><p><bold>Methods:</bold> The referral form was developed, including 3 main components: 1. Risk factors for osteoporosis (6 factors). 2. the 8 risk factors identified in FRAX (WHO fracture risk assessment tool) and 3. Risk factors for falls (5 factors). Special icons were used to give clinical hints for vertebral morphometry and tilting table assessment. The model was set up with only ticking the appropriate boxes is required. Validation of the model was done through: 1. comparing the referral form to the medical notes and the patients’ answers to a pre-scanning questionnaire. 2. Each patient was assessed and management plan (guided by the national guidelines) was considered blindly twice based on the data available in the new referral form in comparison to the old referral form. DXA measurements were then analyzed in relation to self-reported incidence of falls, fractures and the calculated 10-years fracture probability (using FRAX).</p><p><bold>Results:</bold> A total of 264 postmenopausal women (mean age, 68.6 + 4.73 years) were included in this work. Osteoporosis was found in 113/264 (42.8%) of the patients whereas osteopenia prevalence was 32.1% (86/264). 34.5% (91/264) of the patients had a past history of low trauma fracture and 21.6% (57/264) reported 1 or more falls during the preceding year. Patients treated based on the osteoporosis-falls-FRAX composite were significantly higher (r = 0.635) than those treated based on the old referral form. Most of these patients were suffering from secondary osteoporosis and their DXA scan revealed borderline osteoporosis/osteopenia. Adjusted risk for age, BMI, bone density and 10-year fracture probability in the past 12 months in patients who reported a fall was 6.0 (95% CI, 3.2-10.5, <italic>P</italic> < 0.001). Compared with women without osteoporosis and without a fall and 10-year fracture probability < 10%, women with osteoporosis without a fall and 10-year fracture probability < 10% had an age- and BMI-adjusted fracture risk of 2.8 (95% CI, 0.7-11.7 <italic>P</italic> < 0.10) and women with osteoporosis and a fall and fracture probability > 20% had an adjusted-fracture risk of 24.8 (95% CI, 7.1-78.5; <italic>P</italic> < 0.0001).</p><p><bold>Conclusions:</bold> The developed form is a valid model for DXA scanning and accurate tool for assessment of osteoporosis, falls risks as well as fracture (using FRAX). Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age, bone mineral content and 10-year fracture probability. It is important to have the patients stratified and assessed according to the different osteoporosis and falls risk factors rather than relying on fractures as the corner stone for assessment and management.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></article-meta></front><sub-article><front-stub><title-group><article-title>128. Frax Aids Identification of Primary Care Patients with Osteoporosis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Weightman</surname><given-names>Jessica</given-names></name><xref ref-type="aff" rid="AFF2"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kelly</surname><given-names>Madeleine</given-names></name><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Johnston</surname><given-names>Emma</given-names></name><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Stone</surname><given-names>Amanda</given-names></name><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Harrison</surname><given-names>Patricia</given-names></name><xref ref-type="aff" rid="AFF2"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bartholomew</surname><given-names>Peter</given-names></name><xref ref-type="aff" rid="AFF2"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kelly</surname><given-names>Clive</given-names></name><xref ref-type="aff" rid="AFF2"><sup>1</sup></xref></contrib></contrib-group><aff id="AFF2"><sup>1</sup>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; <sup>2</sup>Medical School, HYMS, York, UK</aff><abstract><p><bold>Background:</bold> Primary Care Trusts (PCTs) in the UK are being encouraged to screen for osteoporosis and protocols for how to screen and who to scan have been devised. However, up to 60% of patients referred for bone densitometry (DXA) from primary care are without clinical risk factors. It has been suggested that the most effective use of DXA is to use it selectively based on clinical risk factors and the recently developed FRAX tool encourages this approach. We have examined the effectiveness of our open access DXA service, which is accessed using FRAX, by assessing all GP referrals over a twelve month period. We wished to assess the correlation between predicted 10 year fracture risk from FRAX and absolute BMD at both hip and spine and to calculate the prevalence of bone disease identified in our population by this approach.</p><p><bold>Methods:</bold> We reviewed all DXA scans (Hologic discovery C DEXA) requested from primary care using FRAX over a twelve month period and recorded the absolute BMD, T and Z scores at hip and spine, calculating mean values with reference to the standard hologic normal database. We examined the relationship between the predicted 10 year risk of fracture and the absolute BMD at hip and spine using Spearman rank correlation. We calculated the percentage of patients referred from primary care with osteoporosis (T score < -2.5). We compared data from females in our population to that from a control group of age matched women (mean 65 years) referred for baseline BMD prior to commencing letrazole for breast cancer.</p><p><bold>Results:</bold> We reviewed DXA results from 340 patients referred from primary care, of whom 288 were female. Rank correlation coefficients of 0.41 and 0.47 were found for 10 year fracture risk score against absolute BMD at hip and spine respectively for primary care referrals [<italic>P</italic> = 0.001]. The prevalence of osteoporosis was 33% in females and 21% in men, compared with 20% in the female controls. Mean Z scores at hip (0.02 <sc>s.e.</sc> 0.07) and spine (-0.30 <sc>s.e.</sc> 0.09) were significantly lower than those in the female controls (0.30 <sc>s.e.</sc> 0.11 and 0.09 <sc>s.e.</sc> 0.17) respectively [<italic>P</italic> < 0.05].</p><p><bold>Conclusions:</bold> The use of an open access service to identify individuals with osteoporosis is facilitated by the use of 10 year fracture risk data as calculated by FRAX. This model succesfully identifies significant numbers of both male and female primary care patients with low bone density and the fracture risk correlates well with BMD results. The use of this model appears to be valid within a primary care population with a high prevalence of low bone density.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub><body></body></sub-article><sub-article><front-stub><title-group><article-title>129. Comparision of Frax and Nice Guidance for Management of Osteoporosis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Vagadia</surname><given-names>Vipul</given-names></name></contrib><contrib contrib-type="author"><name><surname>Tuck</surname><given-names>Stephen</given-names></name></contrib></contrib-group><aff>Rheumatology, James Cook University Hospital, Middlesbrough, UK</aff><abstract><p><bold>Background:</bold> NICE osteoporosis guidance suggests using complicated T-score tables broken down by age and clinical risk factors, before they are able to recommend other bisphosphonates such as risedronate and strontium ranelate for primary and secondary prevention of osteoporosis. NICE secondary prevention suggests that patients who are intolerant of alendronate or have a contraindication to it should show deterioration in T-scores before being moved to an alternative drug. FRAX (WHO fracture risk assessment tool) utilizes several known clinical risk factors rather than BMD alone to calculate a patient's 10-year risk of major osteoportic fracture.</p><p><bold>Methods:</bold> We compared the clinical use of NICE primary and secondary osteoporosis prevention guidelines with FRAX tool in the management of osteoporosis at James Cook University Hospital. We undertook a prospective audit of 50 patients, randomly selected from bone clinic and inpatients during 1st June 09 to 30th September 09. Data was collected using patient questionnaire and clinician’s assessment of osteoporosis. Only patients who had a new initiation or change of osteoporosis treatment during this time were included in the analysis. Information on parent’s hip fracture, h/o rheumatoid arthritis, secondary osteoporosis, smoking, alcohol intake was recorded for each patient. Patients on bisphosphonates or strontium were included.</p><p><bold>Results:</bold> 92% patients were female. Among them 20% were > 75 years, 24% were < 55 years and 56% were between 56 and 75 years. 18% had been on long term prednisolone. One patient had a parental h/o hip fracture and 14% had been diagnosed to have rheumatoid arthritis. Secondary osteoprosis was found in 44% (<italic>n</italic> = 22) and the commonest cause was premature menopause 40% (<italic>n</italic> = 9). DEXA confimed 60% patients had osteoporosis, 30% were osteopenic and 10% had a normal DEXA. Fragility fracture was found in 56% (n = 28) and common sites were vertebral (<italic>n</italic> = 9), wrist (<italic>n</italic> = 8) and hip (n = 2). NICE guidance did not recommend starting or changing treatment in 25% (<italic>n</italic> = 7) of patients with a previous fragility fracture but did recommend treatment in 22% (<italic>n</italic> = 5) with no previous fracture when compared with FRAX (Table).</p><p><bold>Conclusions:</bold> NICE guidance does not closely accord with FRAX. NICE guidance leads to potential over treatment in patients with no previous fracture. In patients over 75, NICE recommends treatment without DEXA scan. This may not benefit patients who may be needlessly exposed to potential side-effects.</p><p>FRAX helps to identify men and steroid treated patients with osteoporosis for whom NICE fails to provide guidance. FRAX is easy to use and is amenable to use by all health professionals.</p><p><table-wrap id="T1" position="anchor"><table frame="hsides" rules="groups"><thead align="left"><tr><th></th><th>Fragility Fracture (N = 28)</th><th>No Fracture (N = 22)</th></tr></thead><tbody align="left"><tr><td>FRAX recommends osteoporosis treatment</td><td>26</td><td>4</td></tr><tr><td>NICE recommends change or start of new osteoporosis treatment</td><td>19</td><td>11</td></tr><tr><td>Number of patient currently on osteoporosis treatment</td><td>27</td><td>16</td></tr></tbody></table></table-wrap></p><p>No fracture (<italic>n</italic> = 6) - normal BMD and/or osteopenia. Not recommended treatment by either NICE or FRAX.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p><p><table-wrap id="T2" position="anchor"><caption><p>Overview of Incidence and Type of Fragility Fractures</p></caption><table frame="hsides" rules="groups"><thead align="left"><tr><th>Author / year</th><th>No of patients F/M</th><th>Results</th><th>Distal forearm</th><th>Proximal humerus</th><th>Proximal Femur</th><th>Pelvis</th><th>Vertebra</th></tr></thead><tbody align="left"><tr><td>Hooyman (1984)</td><td>388/0</td><td></td><td>RR 1.27 (95% CI 0.71-2.10)</td><td>RR 1.36 (95% CI 0.62-2.57)</td><td>RR 1.45 (95% CI 0.95-2.13)</td><td>RR 2.61 (95% CI 1.25-4.80)</td><td>32/388 = 8.25%</td></tr><tr><td>Verstraeten (1986)</td><td>104/00</td><td>Fractures in vertebrae or femoral neck occurred in 9.6%</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Spector (1993)</td><td>191/0</td><td>Vertebral fractures increased in RA patients compared with controls (12.1% <italic>vs</italic> 6.2%) (OR 2.1 (95% CI 1.2 - 3.7)</td><td></td><td></td><td></td><td></td><td>OR 2.1 (95% CI 1.2-3.7)</td></tr><tr><td>Peel (1995)</td><td>76/0</td><td></td><td></td><td></td><td></td><td></td><td>OR 6.2 (95% CI 3.2-12.3)</td></tr><tr><td>Cooper (1995)</td><td>240/60 T300</td><td></td><td></td><td></td><td>OR 2.4 (95% CI 1.0-5.4) <italic>P</italic> = 0.04</td><td></td><td></td></tr><tr><td>Furuya (2005)</td><td>1733/0</td><td>Fractures occurred in 131 (7.6%) RA patients studied during the 54 month follow-up period. Vertebral fractures occurred in 33 (1.9% of total), main non-vertebral fractures occurred in 34 (2.0%) any non-vertebral fracture occurred in 98 (5.7%).</td><td>1/1733 = 0.06%</td><td>3/1733 = 0.17%</td><td>14/1733 = 0.81%</td><td>5/1733 = 0.29%</td><td>33/1733 = 1.90%</td></tr><tr><td>Arai (2006)</td><td>117/0</td><td>Vertebral fractures occurred in 21.37% of RA patients <italic>vs</italic> 5% of controls (<italic>P</italic> = <0.05)</td><td></td><td></td><td></td><td></td><td>25/117 = 21.37% (<italic>P</italic> = <0.05)</td></tr></tbody></table></table-wrap></p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>130. Fragility Fractures in Rheumatoid Arthritis - A Systematic Review</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Al-Shakarchi</surname><given-names>Israa</given-names></name><xref ref-type="aff" rid="AFF3"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Louise Dolan</surname><given-names>Ann</given-names></name><xref ref-type="aff" rid="AFF3"><sup>2</sup></xref></contrib></contrib-group><aff id="AFF3"><sup>1</sup>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; <sup>2</sup>Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</aff><abstract><p><bold>Background:</bold> It is widely documented that rheumatoid arthritis (RA) leads to a decrease in bone mineral density (BMD) and an increase in the incidence of osteoporosis. A low BMD translates into a higher fracture risk. The importance of OP to the health economy is well known with costs due to fractures alone of £1.73 billion. With an increasingly ageing population these costs are estimated to double in the coming years. Patients with RA have previously been shown to have a 2- to 3-fold increased risk of vertebral and hip fractures but to date there have been no systematic reviews on this topic. Besides the increased mortality and morbidity of RA itself, RA patients with fractures are at even further risk of disability, dependence and mortality. The objective of the systematic review of the literature was to evaluate the existing evidence on the incidence of fragility fractures in female patients over the age of 45 years with RA and to identify possible factors influencing fracture risk.</p><p><bold>Methods:</bold> Design: Systematic review. Data Sources: Cochrane library, Medline, Embase, National Electronic Library for Health. Review Methods: Systematic review of the literature with evaluation of the methodological quality of the selected papers using defined criteria set out by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.</p><p><bold>Results:</bold> 1145 citations were initially identified. After screening all titles and abstracts 67 full text articles were identified for potential selection. Following detailed review of these full text articles, 7 articles were found to fulfil the inclusion criteria. Of these there were 5 case controls and 2 were prospective studies. All studies had a level of evidence graded at Level III (as per RCP criteria).</p><p><bold>Conclusions:</bold> The results of this systematic review of the literature suggest that female patients with RA are at a substantially increased risk of fractures at the hip, pelvis and vertebrae and confirm that RA is an independent risk factor for FF. The increased risk of fracture was larger in patients with decreased ambulation and functional class, lower BMI and increasing age. Controversy remains as to the risk associated with corticosteroid use and further studies will be required to establish this link firmly.</p></abstract><abstract><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>131. Missed Opportunities: Prevalence of Untreated Fractures Prior to Hip Fracture in Women</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bridges</surname><given-names>Matt J.</given-names></name><xref ref-type="aff" rid="AFF4"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ruddick</surname><given-names>Sheila</given-names></name><xref ref-type="aff" rid="AFF4"><sup>2</sup></xref></contrib></contrib-group><aff id="AFF4"><sup>1</sup>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; <sup>2</sup>Darlington Primary Care Trust, Bishop Auckland, UK</aff><abstract><p><bold>Background:</bold> Low trauma fracture is known to be a significant risk factor for further fracture. However, previous data show that many patients sustaining a low trauma fracture do not receive appropriate bone sparing therapy, potentially placing them at an unnecessarily high risk of subsequent fracture. Both the Royal College of Physicians and the National Osteoporosis Guideline Group suggest that post menopausal women who sustain a low trauma fracture should be considered for bone sparing therapy without the need for bone densitometry assessment.</p><p>We conducted an audit with two aims 1) to determine the prevalence of prior fracture in women who had sustained low trauma hip fracture and 2) to determine what percentage of patients who had had prior fracture had received appropriate secondary prevention.</p><p><bold>Methods:</bold> We retrospectively analysed the data of 310 women who had sustained low trauma hip fracture in order to identify which of these patients had had a previous fracture and to ascertain if this previous fracture had been treated with bone sparing therapy. Patients were identified via a search of electronic records from 12 general practices. All incident hip fractures took place between January 2005 and June 2009. Data collated in addition to patient demographics included; date of hip fracture, date and site of any preceding fracture, date that bone sparing therapy was commenced and the type of bone sparing therapy prescribed.</p><p><bold>Results:</bold> The 310 patients identified had a mean (standard deviation) age of 81 (10.1) years. 138 (45%) had sustained a previous fracture at any site. The site of prior fractures amongst these 138 patients was; 44 (33%) wrist, 30 (21%) hip, 18 (13%) humerus, 14 (10%) ankle and 32 (23%) other. 75 (54%) patients were over 75 years of age at the time of initial fracture. Only 6 (4%) had been investigated with bone densitometry. 25 (18%) of these 138 patients had been prescribed bone sparing therapy following their initial fracture; 3 treated with Calcium / vitamin D alone, 4 with bisphosphonate alone and 18 with bisphosphonate and Calcium / vitamin D.</p><p><bold>Conclusions:</bold> Nearly half of patients presenting with a low trauma hip fracture, had sustained a prior fracture. The majority of these patients had received no investigation or bone sparing therapy following this initial fracture and we suggest that many of the hip fractures could have potentially been prevented if appropriate investigation and management had been initiated.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>132. Uncovering High Rates of Hypovitaminosis D: IV Bisphosphonate Use in Every Day Practice</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bracewell</surname><given-names>Claire</given-names></name><xref ref-type="aff" rid="AFF5"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wright</surname><given-names>David</given-names></name><xref ref-type="aff" rid="AFF5"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Aspray</surname><given-names>Terence</given-names></name><xref ref-type="aff" rid="AFF5"><sup>2</sup></xref></contrib></contrib-group><aff id="AFF5"><sup>1</sup>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; <sup>2</sup>Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</aff><abstract><p><bold>Background:</bold> Bisphosphonates are used widely in the treatment of osteoporosis. IV bisphosphonates are significantly more potent than oral agents and carry an increased risk of side effects, particularly for patients who are vitamin D deplete. High levels of asymptomatic hypovitaminosis D amongst rheumatology outpatients has been recorded.</p><p>We undertook an audit of IV bisphosphonate use over 5 months. The aims were to:</p><p>1. Assess vitamin D status and prevalence of secondary hyperparathyroidism,</p><p>2. Identify changes in calcium and</p><p>3. Observe the relationship between calcium, vitamin D, parathyroid hormone (PTH) and bone turnover markers (C-terminal cross-linking telopeptide or CTX and alkaline phosphatase) pre and post infusions.</p><p><bold>Methods:</bold> Baseline bloods including vitamin D levels, PTH and CTX were checked on the day of the infusion. The patients returned 2 to 4 weeks later, when CTX and routine biochemistry were rechecked.</p><p><bold>Results:</bold> 20 patients were included. 1 patient was treated with zolendronate for Pagets disease and 1 with pamidronate 60 mg for ankylosing spondylitis. 2 patients had pamidronate 30 mg and 16 patients received Ibandronate 3 mg for osteoporosis.</p><p>The mean (<sc>s.d.</sc>) vitamin D3 level was 57.8 (25.4) nmol/L (normal range 75-125 nmol/L). 4 (17%) subjects had a raised PTH (> 6.9 pmol/L) and, in the 15 patients with low vitamin D (< 75 nmol/L), hyperparathyroidism was seen in 20%. There was a statistically significant linear relationship between higher vitamin D levels and lower PTH (<italic>P</italic> < 0.005).</p><p>There was no significant change in bone biochemistry with treatment and no cases of significant hypocalcaemia occurred. In subjects with an initial vitamin D less than 50 nmol/L, corrected calcium decreased by 0.030 mmol/L compared with a rise by 0.01 mmol/L in vitamin D replete subjects. However, this was not statistically significant (<italic>P</italic> = 0.030). CTX decreased by a mean of 24.4% with treatment (<italic>P</italic> < 0.0001). Baseline vitamin D status had no significant effect on this.</p><p>The relative potencies of the agents used are reflected in their effect on CTX, ranging from a 31% decrease for ibandronate, 56% for pamidronate, to a 91% decrease for zoledronate.</p><p><bold>Conclusions:</bold> We found high rates of vitamin D insufficiency and frequently this was despite prescription of supplements. A number of patients had concomitant hyperparathyroidism, probably secondary to vitamin D deficiency. Fortunately occult hypocalcaemia relating to bisphosphonate therapy was not seen. We failed to observe any significant relationships, other than the well-recognized association between vitamin D levels and PTH. Despite small numbers, our data suggest a marked range in potency of the bisphosphonates used.</p><p>This audit has highlighted the presence of occult vitamin D insufficiency of which we were unaware. Moreover, we found that routine bone biochemistry failed to predict this. Nor could we be sure that prescription of supplements would ensure adequate levels. Based upon our findings, we have made a number of recommendations.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>133. Early Life May Interact with Adult Diet to Affect Adult Bone Mass: The Hertfordshire Cohort Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hynes</surname><given-names>Gareth M.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Jameson</surname><given-names>Karen</given-names></name></contrib><contrib contrib-type="author"><name><surname>Aihie Sayer</surname><given-names>Avan</given-names></name></contrib><contrib contrib-type="author"><name><surname>Cooper</surname><given-names>Cyrus</given-names></name></contrib><contrib contrib-type="author"><name><surname>Dennison</surname><given-names>Elaine</given-names></name></contrib><contrib contrib-type="author"><name><surname>Robinson</surname><given-names>Sian</given-names></name></contrib></contrib-group><aff>MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK</aff><abstract><p><bold>Background:</bold> Several studies have shown that early life factors play a powerful role in the determination of bone mass in later life. Further studies have shown that the early environment may also interact with adult lifestyle factors to determine other aspects of adult health. In this study we have examined how early life and adult diet interact to establish adult bone mass.</p><p><bold>Methods:</bold> We studied 498 men and 468 women born in Hertfordshire between 1931-39 who were still resident there in adult life. These individuals attended a local clinic where a health questionnaire was completed, detailed anthropometric data, including height, weight and skin fold measurements were recorded and bone densitometry (DXA) performed at the lumbar spine and femoral neck using a Hologic QDR 4500 instrument. Three aspects of bone mass were measured: bone mineral content (BMC); bone mineral density (BMD); and bone mineral apparent density (BMAD). Dietary information was recorded using a food frequency questionnaire and a 24-h food diary. Full ethical approval and patient consent were obtained.</p><p><bold>Results:</bold> Spinal BMAD in males was significantly associated with birth weight and dairy intake such that those men of low birth weight who had high dairy intake had a BMAD 0.03 g/cm2 higher than those with low birth weight and low dairy intake (<italic>P</italic> = 0.035, adjusted for age, BMI, smoking status, alcohol use, activity). Similar relationships were observed in women: in those individuals of low birth weight, femoral neck BMD increased by 0.05 g/cm<sup>2</sup> from low to high dairy intake (<italic>P</italic> = 0.001). Similar values were seen when birth weight was substituted with weight at one year or conditional growth in the first year. These results were little affected by adjustment for age, BMI, smoking status, alcohol use, activity, years since menopause and HRT use. Analyses that substituted calcium or vitamin D intake for dairy intake were generally non-significant.</p><p><bold>Conclusions:</bold> In this study there was an interaction between birth weight and adult diet in determining adult bone mass. These analyses suggest that early and adult life factors may interact to determine adult bone health. Our finding that dairy intake was significant where calcium intake was not may suggest a role for milk proteins in this relationship.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>134. Bisphoshonate Use in Atypical Femoral Fractures: A Case -Control Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tull</surname><given-names>Thomas J.</given-names></name><xref ref-type="aff" rid="AFF6"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fisher</surname><given-names>Ben A.</given-names></name><xref ref-type="aff" rid="AFF6"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jenabzadeh</surname><given-names>Reza</given-names></name><xref ref-type="aff" rid="AFF6"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cobb</surname><given-names>Justin P.</given-names></name><xref ref-type="aff" rid="AFF6"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Abraham</surname><given-names>Sonya</given-names></name><xref ref-type="aff" rid="AFF6"><sup>1</sup></xref></contrib></contrib-group><aff id="AFF6"><sup>1</sup>Rheumatology, Kennedy Institute of Rheumatology, London, UK; <sup>2</sup>Orthopaedics, Imperial College NHS trust, London, UK</aff><abstract><p><bold>Background:</bold> Recent case series have suggested an association between bisphosphonates and atypical low velocity femoral fractures. The proposed mechanism is an increased propensity to stress fractures in the context of severely suppressed bone turnover (SSBT). This potentially important association is unproven however and further investigation is required.</p><p><bold>Methods:</bold> We conducted a retrospective cohort study comparing bisphosphonate use in patients who presented with femoral shaft, subtrochanteric and comminuted intertrochanteric hip fractures (atypical) between July 2007 and September 2009, with a control group of patients who presented sequentially with neck of femur fractures (typical). Past drug and fracture history were obtained from the medical notes and primary care records. Results were analysed with the Fisher’s Exact and Mann Whitney tests.</p><p><bold>Results:</bold> We identified 21 patients with atypical fractures of which all were low velocity and 3 were excluded as being subsequent to metastatic deposits. Thirty sequential patients with typical fractures were selected but a drug history was only available for 21. There was no difference between the atypical and typical group in terms of age, history of prior fractures or use of proton-pump inhibitors (Table). Prior use of bisphosphonates did not differ between groups. In the atypical subgroup comprising subtrochanteric fractures (<italic>n</italic> = 8), 2 were taking bisphosphonates (<italic>P</italic> = 0.18 compared with typical group). Both of these had multiple risk factors for osteoporotic fracture.</p><p><bold>Conclusions:</bold> We have not demonstrated an association between atypical femoral fractures and bisphosphonate use. Although our study is underpowered to detect a rare association, our findings are supported by a recent large register-based cohort study in which subtrochanteric fractures shared the epidemiology and treatment response of typical hip fractures. However, given the widespread use of bisphosphonates, further study is warranted.</p><p><table-wrap id="T3" position="anchor"><table frame="hsides" rules="groups"><thead align="left"><tr><th></th><th>Atypical (<italic>n</italic> = 18)</th><th>Typical (<italic>n</italic> = 21)</th><th>P-value</th></tr></thead><tbody align="left"><tr><td>Age (IQR)</td><td>81 (65-84)</td><td>78 (67-86)</td><td>0.78</td></tr><tr><td>Prior fracture (%)</td><td>44</td><td>38</td><td>0.75</td></tr><tr><td>PPI (n)</td><td>7</td><td>7</td><td>0.75</td></tr><tr><td>Bisphosphonate (n)</td><td>4</td><td>1</td><td>0.16</td></tr></tbody></table></table-wrap></p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>135. Season of Birth is a Determinant of Bone Mass in Late Adulthood: The Hertfordshire Cohort Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hynes</surname><given-names>Gareth M.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Jameson</surname><given-names>Karen</given-names></name></contrib><contrib contrib-type="author"><name><surname>Harvey</surname><given-names>Nick</given-names></name></contrib><contrib contrib-type="author"><name><surname>Aihie Sayer</surname><given-names>Avan</given-names></name></contrib><contrib contrib-type="author"><name><surname>Cooper</surname><given-names>Cyrus</given-names></name></contrib><contrib contrib-type="author"><name><surname>Dennison</surname><given-names>Elaine</given-names></name></contrib></contrib-group><aff>MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK</aff><abstract><p><bold>Background:</bold> Maternal vitamin D concentration has been shown to be a determinant of offspring bone mass at age 9 years. Exposure to ultraviolet B radiation in late pregnancy was a major determinant of circulating vitamin D concentration at term. Here we investigated whether season of birth (and hence probable maternal UVB exposure) was a predictor of bone mass in late adulthood.</p><p><bold>Methods:</bold> We studied 498 men and 498 women born in Hertfordshire between 1931-39 who were still resident there in adult life. These individuals attended a local clinic where a health questionnaire was completed, detailed anthropometric data, including height, weight and skin fold measurements were recorded and bone densitometry (DXA) was performed at the lumbar spine and femoral neck using a Hologic QDR 4500 instrument. Full ethical approval and patient consent were obtained.</p><p><bold>Results:</bold> The seasons of birth were coded as follows: winter = Dec, Jan, Feb; spring = Mar, April, May; summer = Jun, Jul, Aug; and autumn = Sep, Oct, Nov. For women, those born in the summer had a significantly higher total femur BMD than those born in winter (B = 0.036, <italic>P</italic> = 0.03). This relationship remained significant after adjustment for age, body mass index, social class, smoking, alcohol, activity, calcium, HRT use, but became non-significant after adjustment for years since menopause. For men, those born in the autumn had a significantly lower total femur BMD than those born in winter (B = -0.041, <italic>P</italic> = 0.02); this relationship became non-significant after adjustment for body mass index.</p><p><bold>Conclusions:</bold> Season of birth was a predictor of bone mass in late adulthood in UK men and women, although these relationships were weakened by adjustment for body mass index in men and years since menopause in women.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>136. Are We Measuring the Bone Health of Epilepsy Patients?</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Cheah</surname><given-names>Jonathan</given-names></name><xref ref-type="aff" rid="AFF7"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Stacpoole</surname><given-names>Sybil</given-names></name><xref ref-type="aff" rid="AFF7"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Heaney</surname><given-names>Dominic</given-names></name><xref ref-type="aff" rid="AFF7"><sup>2,3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Duncan</surname><given-names>John</given-names></name><xref ref-type="aff" rid="AFF7"><sup>2,3</sup></xref></contrib></contrib-group><aff id="AFF7"><sup>1</sup>UCL Medical School, London, UK; <sup>2</sup>The National Hospital for Neurology and Neurosurgery, London, UK; <sup>3</sup>Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</aff><abstract><p><bold>Background:</bold> Long-term treatment with anti-epileptic drugs (AEDs), especially enzyme-inducing AEDs have been associated with low serum levels of vitamin D. Vitamin D deficiency is implicated in metabolic bone disease and increased risk of fractures. Injury and bone health are major concerns of individuals with epilepsy. Guidelines from the UK’s National Institute for Health and Clinical Excellence suggest that vitamin D levels should be measured every two to five years in patients taking enzyme-inducing AEDs.</p><p><bold>Methods:</bold> Consecutive follow-up patients attending specialist epilepsy outpatient clinics in London between April and July 2009 were identified retrospectively. AED regime was established through clinic correspondence detailing the use of enzyme-inducing AEDs (phenytoin, phenobarbitone, carbamazepine, oxcarbazepine, primidone). The hospital’s electronic patient record was used to identify whether measurements of serum vitamin D, parathyroid hormone (PTH) or bone densitometry had been performed. If the serum vitamin D level was measured to be less than 75 nmol/L, it was noted whether vitamin D and calcium supplementation had been recommended.</p><p><bold>Results:</bold> 655 patients were identified. 401 (61%) were on at least one enzyme-inducing AED. Serum vitamin D levels were measured in 158 (24%) of patients (115 [29%] of those on enzyme-inducing AEDs and 43 [17%] of those not on enzyme-inducing AEDs). Furthermore, of the patients on enzyme-inducing AEDs, 65 (16%) had a serum PTH measured and 24 (6%) had bone densitometry performed. 123 (31%) of patients receiving enzyme-inducing AEDs had at least one of the three investigations performed. Of patients in whom serum vitamin D level was measured, 142 (90%) had levels below 75 nmol/L and 97 (68%) of those received a follow-up letter to the primary care provider with the recommendation to commence vitamin D and calcium supplementation. Where vitamin D was measured in patients not on enzyme-inducing drugs, > 90% had a level below 75 nmol/L.</p><p><bold>Conclusions:</bold> Overall, we found a measurement of bone health is made in only approximately 30% of patients on enzyme-inducing AEDs. Where investigations were performed, few patients subsequently go on to receive advice about bone protection or further assessment regarding bone health. When measurements of Vitamin D levels are made, they are found to be low independent of type of AED prescribed (enzyme-inducing or non enzyme-inducing), although this finding may represent a biased sample where only patients with other risk factors for vitamin D deficiency were tested as the majority of patients did not undergo blood testing. Recommendations include increased awareness amongst staff and patients regarding the association between epilepsy, AEDs and decreased vitamin D levels, liaison with laboratory staff to reduce turnaround times for relevant investigations and clearer protocols for management of bone health in epilepsy.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>137. Genetic Variation in WDR77 Gene is Associated with Calcaneal Bone Ultrasound Parameters: Results from the European Male Ageing Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Roshandel</surname><given-names>Delnaz</given-names></name><xref ref-type="aff" rid="AFF8"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Holliday</surname><given-names>Kate</given-names></name><xref ref-type="aff" rid="AFF8"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pye</surname><given-names>Stephen R.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Boonen</surname><given-names>Steven</given-names></name><xref ref-type="aff" rid="AFF8"><sup>2,3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Borghs</surname><given-names>Herman</given-names></name><xref ref-type="aff" rid="AFF8"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vanderschueren</surname><given-names>Dirk</given-names></name><xref ref-type="aff" rid="AFF8"><sup>3,4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Adams</surname><given-names>Judith E.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ward</surname><given-names>Kate A.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Finn</surname><given-names>Joseph D.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Huhtaniemi</surname><given-names>Ilpo T.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Silman</surname><given-names>Alan J.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Frederick C.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Thomson</surname><given-names>Wendy</given-names></name><xref ref-type="aff" rid="AFF8"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>O’Neill</surname><given-names>Terence W.</given-names></name><xref ref-type="aff" rid="AFF8"><sup>1</sup></xref></contrib></contrib-group><aff id="AFF8"><sup>1</sup>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; <sup>2</sup>Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; <sup>3</sup>Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; <sup>4</sup>Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; <sup>5</sup>Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; <sup>6</sup>Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; <sup>7</sup>Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</aff><abstract><p><bold>Background:</bold> Quantitative ultrasound (QUS) measurements including broadband ultrasound attenuation (BUA) and speed of sound (SOS) at the calcaneus are associated with an increased risk of hip and spine fracture. A number of single nucleotide polymorphisms (SNPs) have been associated with BUA and SOS in the Framingham 100K genome-wide association study (GWAS), the first GWAS of bone phenotypes; but these findings have yet to be validated. The aim of this study was to determine if these SNPs are associated with QUS measures in a large independent population of European middle-aged and elderly men.</p><p><bold>Methods:</bold> Men aged 40-79 years were recruited from population registers in seven European centres for participation in an observational study of male aging, the European Male Ageing Study (EMAS). Subjects had blood taken for genetic analysis and also calcaneal ultrasound measurements (Sahara Clinical Sonometer [Hologic; Bedford, Massachusetts, USA]) performed. SNPs with minor allele frequency (MAF) ≥ 5%, call rate ≥ 95% and Hardy-Weinberg equilibrium (HWE) <italic>P</italic> ≥ 10-4 associated with BUA or SOS measured by calcaneal QUS in the Framingham study based on generalized estimating equations (GEE) test with <italic>p</italic> ≦ 10-4, were selected for genotyping. SEQUENOM technology was used for genotyping the SNPs. SNPs with call rate ≥ 90% and HWE <italic>p</italic> ≥ 0.05 were included in the analysis. Linear regression was used to test the association between SNPs and BUA and SOS under an additive genetic model adjusting for centre conducted in PLINK (1.05). The same direction of effect and <italic>P</italic> < 0.05 indicated replication.</p><p><bold>Results:</bold> Thirty-eight SNPs were selected for genotyping and 34 were included in the analysis. 2377 subjects, mean (± <sc>s.d.</sc>) age of 60 ± 11 years, contributed data to the analysis. The mean (<sc>s.d.</sc>) of BUA and SOS were 80.09 (19.12) dB/MHz and 155.89 (34.53) m/s, respectively. SOS and BUA were highly correlated (r2 = 0.81, <italic>P</italic> < 0.001). Evidence of replication was observed for a single SNP, rs3754032, which was associated with a higher SOS in EMAS (β coefficient = 2.38; 95% CI = 0.21, 4.55; <italic>P</italic> = 0.032), but not BUA (β coefficient = 0.41; 95% CI = −0.79, 1.60; <italic>P</italic> = 0.505). This SNP was associated with both BUA (<italic>P</italic> = 8.75 x 10-5) and SOS (<italic>P</italic> = 0.01) in the Framingham study. The SNP rs3754032 is located 19 Kb downstream of WDR77 (WD repeat domain 77) also known as androgen receptor cofactor p44.</p><p><bold>Conclusions:</bold> Most of the SNPs identified in the recent Framingham GWAS of bone phenotypes were not associated with calcaneal ultrasound parameters in EMAS. We did, however, confirm a significant association with a SNP located near WDR77.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>138. Bone Mineral Density and Fracture Risk Among a UK Cohort of HIV-Positive Men</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>White</surname><given-names>Susanna</given-names></name><xref ref-type="aff" rid="AFF9"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Shaw</surname><given-names>Simon</given-names></name><xref ref-type="aff" rid="AFF9"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Short</surname><given-names>Charlotte</given-names></name><xref ref-type="aff" rid="AFF9"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gilleece</surname><given-names>Yvonne</given-names></name><xref ref-type="aff" rid="AFF9"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fisher</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="AFF9"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Walker-Bone</surname><given-names>Karen</given-names></name><xref ref-type="aff" rid="AFF9"><sup>1</sup></xref></contrib></contrib-group><aff id="AFF9"><sup>1</sup>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; <sup>2</sup>Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</aff><abstract><p><bold>Background:</bold> HIV is a global pandemic. The advent of highly-active antiretroviral therapy (HAART) has transformed the life expectancy of HIV infected patients but recent data suggest that treatment-controlled HIV is associated with age-related metabolic diseases including possibly osteopenia and osteoporosis. To date however, there are scanty data to suggest increased fracture rates in this population. We investigated the prevalence and risk factors for low bone mass among a cohort of HIV infected men and explored fracture rates in the same population.</p><p><bold>Methods:</bold> We identified a cohort of HIV+ men who had received a DEXA scan as part of usual care between 1/1/1999 and 1/1/2009. For each subject, medical records, DEXA reports and the Trust imaging database were reviewed. Data were collated as to absolute bone mineral density (BMD) (total body, lumbar and total hip); established risk factors for male osteoporosis; HIV-related factors; use of HAART and fracture history (high or low-impact) since diagnosis.</p><p><bold>Results:</bold> We identified 100 HIV+ male subjects who had received a DEXA scan (median age 48, range 22-69 years). 95% were Caucasian. The mode of transmission of HIV was predominantly (93%) men who have sex with men. The median duration of HIV infection was 11.25 years. Using World Health Organization definitions of osteopenia and osteoporosis, 63% had a reduced bone density (44% osteopenia, 19% osteoporosis). The highest prevalence of low bone mass was seen at the lumbar spine.</p><p>A high prevalence of established risk factors for male osteoporosis was shown in this population: 58% had treated or untreated hypogonadism; 55% had smoked cigarettes for > 15 pack-years; 39% were heavy alcohol drinkers; 33% had medicated depression and 18% had ever used glucocorticoids. Despite this, an independent statistically significant effect was seen for ever exposure to HAART (<italic>P</italic> = 0.019). Current use of Tenofovir was also significantly associated (<italic>P</italic> = 0.003). Additionally a novel risk factor, exposure to chemotherapy within 12 months prior to DEXA scan was identified as a significant risk factor (<italic>P</italic> = 0.002).</p><p>Amongst those for whom fracture data were available (<italic>n</italic> = 40), 22.5% had experienced a fracture since HIV diagnosis and 67% of these were fragility fractures.</p><p><bold>Conclusions:</bold> We identified a high prevalence of low BMD and fragility fracture amongst a UK cohort of HIV+ men. Among these subjects, we demonstrated a high prevalence of recognized risk factors for male osteoporosis (hypogonadism; alcohol; cigarette smoking; anti-depressants). However we also found that HAART was significantly associated. History of chemotherapy exposure within 12 months of DEXA was identified as a novel risk factor. Our data suggest that the high risk of low bone mass is accompanied by an associated increase in fracture risk. Given the significant healthcare and psychosocial cost of osteoporosis, there is need to raise physician awareness of the risk of low bone mass amongst treatment-controlled HIV populations.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>139. Has the Introduction of Frax Changed the Pattern of Primary Care Referral for Direct Access DXA Scanning?</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Narshi</surname><given-names>Chetan B.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Martin</surname><given-names>Rhodri</given-names></name></contrib><contrib contrib-type="author"><name><surname>Mitchell</surname><given-names>Karen</given-names></name></contrib><contrib contrib-type="author"><name><surname>Keen</surname><given-names>Richard</given-names></name></contrib></contrib-group><aff>Metabolic Bone Unit, Royal National Orthopaedic Hospital, London, UK</aff><abstract><p><bold>Background:</bold> The World Health Organization Fracture Risk Assessment Tool (FRAX) has been developed to assist in the prediction of fracture risk in patients (www.shef.ac.uk/FRAX). In the UK, the National Osteoporosis Guideline Group (NOGG) have proposed interventional thresholds based on the 10 year risk estimates for patients being referred for DXA scanning and for commencing treatment. FRAX came online from September/October 2008 and we wished to explore whether the availability of this tool in primary care had affected the referral pattern of patients for DXA.</p><p><bold>Methods:</bold> We analysed all GP referrals for a first DXA scan made to the Metabolic Bone Unit in September 2008 (Pre-FRAX) and compared this to referrals made in September 2009 (post-FRAX). We included men and women in the age range 40 to 90 years. Patients could not have received prior treatment for osteoporosis.</p><p><bold>Results:</bold> 57 (mean age 66.1 years) patients were referred Pre-FRAX, compared with 81 patients (mean age 62.9 years) Post-FRAX. The majority of referrals were for female patients: 54 (94.7%) Pre-FRAX and 73 (90.1%) Post-FRAX.</p><p>Using clinical risk factors, patients were divided into high, intermediate and low risk fracture categories (Table).</p><p>The number of high risk patients was low. Mean FRAX estimated 10 year risk of major clinical osteoporotic fracture: pre-FRAX - 14.2% (IQR: 7.7%-19.0%) <italic>vs</italic>. post-FRAX - 12.2% (IQR: 5.4%-16.0%).</p><p>In the intermediate risk group, only a minority of patients were recommended treatment after DXA scanning of their femoral neck: 7 patients (24%) Pre-FRAX and 8 patients (20%) Post FRAX.</p><p><bold>Conclusions:</bold> These data suggest that the introduction of FRAX has not reduced the number of referrals for direct access DXA at a single specialist hospital. Approximately half of all GP referrals for DEXA assessment were inappropriate, according to NOGG guidance and patients could have been given either treatment or lifestyle advice without the need for DXA. The referred patients were of generally low risk and we did not observe any significant change in the pattern of referral pattern one year following the introduction of FRAX. Our results suggest that if FRAX is to become widely used in the management of osteoporosis there is a strong need for education within primary care to increase the awareness of FRAX and NOGG guidelines.</p><p><table-wrap id="T4" position="anchor"><table frame="hsides" rules="groups"><thead align="left"><tr><th></th><th>High Risk “Active Treatment”</th><th>Intermediate Risk “Refer for DXA”</th><th>Low Risk “Reassurance and lifestyle advice”</th></tr></thead><tbody align="left"><tr><td>Pre FRAX</td><td>4 (7%)</td><td>29 (50.9%)</td><td>24 (42.1%)</td></tr><tr><td>Post FRAX</td><td>9 (11.1%)</td><td>39 (48.1%)</td><td>33 (40.7%)</td></tr></tbody></table></table-wrap></p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>140. Peripheral Bone Densitometry in Women Over 75 Years Who have Sustained a Low Trauma Fracture</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bridges</surname><given-names>Matt J.</given-names></name><xref ref-type="aff" rid="AFF10"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ruddick</surname><given-names>Sheila</given-names></name><xref ref-type="aff" rid="AFF10"><sup>2</sup></xref></contrib></contrib-group><aff id="AFF10"><sup>1</sup>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; <sup>2</sup>Darlington Primary Care Trust, Darlington, UK</aff><abstract><p><bold>Background:</bold> Neither National Institute of Clinical Excellence (NICE) technology appraisals, nor National Osteoporosis Guideline Group guidelines advocate the use of bone densitometry in women over 75 years of age who have sustained a low trauma fracture, both suggesting that bone sparing therapy can be initiated without knowledge of bone mineral density (BMD). This is despite recent evidence showing that the majority of these patients do not have osteoporosis, as assessed by axial DEXA scanning. We therefore retrospectively analysed peripheral bone density measurements in a group of women over 75 years who had attended our fracture liaison service.</p><p><bold>Methods:</bold> Data were analysed on 142 women over 75 years of age who had attended our community fracture liaison service after sustaining a low trauma fracture over an 18 month period. Along with assessment of clinical risk factors for fracture, it is standard practice for these patients to undergo heel DEXA scanning (Calscan, Demetech), though patients are usually treated regardless of BMD result, in accordance with NICE guidelines.</p><p><bold>Results:</bold> The 142 women had a mean age (standard deviation) of 80 years (4.5). 82 (58%) had a T-score ≦ -2.5. Since the National Osteoporosis Society now advocates the use of 90% sensitivity and specificity device specific thresholds when using peripheral bone densitometry, we further categorized our patients, according to these thresholds, into three groups; 1) those patients who have peripheral BMD above the 90% sensitivity threshold to identify normal Bone density at the hip or spine, (T-score ≥ -1.7), 2) Those patients who have peripheral BMD reading between the two thresholds, (T-score ≦ -1.8 but ≥ -2.7) and 3) those patients that have peripheral BMD below the 90% specificity threshold to identify osteoporosis at the hip or spine (T-score ≦ -2.8). 25 (18%) women had T-score ≥ -1.7 and 70 (49%) women had T-score ≦ -2.8. 47 (33%) of the women had T-scores between the two thresholds and in these women it is not possible to predict with accuracy whether or not they had osteoporosis at the axial skeleton.</p><p><bold>Conclusions:</bold> Consistent with other data, less than half (49%) of our patients presenting with a low trauma fracture can be reliably said to have axial osteoporosis on the basis of their heel DEXA result. A significant proportion (18%) of them are unlikely to have osteoporosis and may therefore be taking medication from which they are deriving no proven benefit. We feel, therefore, that peripheral or axial bone densitometry should be considered in women aged over 75 years who have sustained a low trauma fracture.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>141. Predictors of Falls Risk among Patients Referred for Dxa Scanning: A Prediction Model</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>El Miedany</surname><given-names>Yasser</given-names></name><xref ref-type="aff" rid="AFF11"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Toth</surname><given-names>Mathias</given-names></name><xref ref-type="aff" rid="AFF11"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Youssef</surname><given-names>Sally</given-names></name><xref ref-type="aff" rid="AFF11"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>El Gaafary</surname><given-names>Maha</given-names></name><xref ref-type="aff" rid="AFF11"><sup>3</sup></xref></contrib></contrib-group><aff id="AFF11"><sup>1</sup>Rheumatology, Darent Valley Hospital, Dartford, UK; <sup>2</sup>Internal Medicine, Darent Valley Hospital, Dartford, UK; <sup>3</sup>Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</aff><abstract><p><bold>Background:</bold> Osteoporotic fractures and falls are as heads and tails of a coin. Among the elderly, the greatest risk of fracture comes from falls, rather than osteoporosis, hence, bone mineral density measurement should not be used alone to estimate fracture risk or guide treatment decisions. Evidence shows that at least 15% of falls in older people can be prevented, with individual trials reporting relative reductions of up to 50%. We developed a model that predicts the falls risk among patients referred for bone mineral density using variables that are easily assessed in clinical practice.</p><p><bold>Methods:</bold> As part of the integrated osteoporosis and falls service, patients admitted to the hospital with low trauma fracture had their bone mineral density assessed. In addition to DXA scanning, fracture risk assessment using FRAX (before and after the occurrence of the fracture), as well as falls risk factors were analyzed. The independent predictive value of the different risk factors for the occurrence of falls was assessed using logistic regression analysis. A prediction scoring system was developed using data from a cohort of 106 patients. 102 osteoporotic patients without history of falls or fracture were also assessed as control group. The diagnostic performance of the prediction model was evaluated using the area under the curve (AUC). The developed prediction model was internally validated.</p><p><bold>Results:</bold> Falls risk was significantly higher among the osteoporotic patients who sustained fractures in comparison to the control group (<italic>P</italic> < 0.01). The risk factors significantly correlated with an increased risk of falls were: history of > 1 fall in the last 12 months (regression coefficient 2.2), slowing of the walking speed/ change of the gait (1.6), impaired vision (1.2), weak grip strength (1.1), loss of balance (1.2). Cut off point of 3.5 achieved the best sensitivity and specificity (0.918 and 0.86 respectively, PPV85.9) and was indicative of high falls risk. A score of 2.0-3.5 was indicative of moderate risk.</p><p><bold>Conclusions:</bold> The findings indicate that evaluation of falls risk based on risk factor profiles of individual patients can help physicians identify high risk osteoporotic patients and assist with decisions concerning falls prevention and patient management. Also, these results emphasize the importance of performing a falls risk assessment for all osteoporotic patients, in parallel with bone mineral density measurement, on regular basis as part of their assessment and management.</p><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article><sub-article><front-stub><title-group><article-title>142. Benefit of Using Frax to Target DXA Use in a Spanish Population</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Alhambra</surname><given-names>Daniel Prieto</given-names></name><xref ref-type="aff" rid="AFF12"><sup>1,2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Azagra</surname><given-names>Rafael</given-names></name><xref ref-type="aff" rid="AFF12"><sup>2,4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Duro</surname><given-names>Gloria Encabo</given-names></name><xref ref-type="aff" rid="AFF12"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Aguye</surname><given-names>Amada</given-names></name><xref ref-type="aff" rid="AFF12"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zwart</surname><given-names>Marta</given-names></name><xref ref-type="aff" rid="AFF12"><sup>2,4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Javaid</surname><given-names>Kassim M.</given-names></name><xref ref-type="aff" rid="AFF12"><sup>1</sup></xref></contrib></contrib-group><aff id="AFF12"><sup>1</sup>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; <sup>2</sup>Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; <sup>3</sup>Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; <sup>4</sup>Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</aff><abstract><p><bold>Background:</bold> Assessment (AT) and intervention thresholds (IT) and management algorithms have been proposed for the UK based on fracture probability from FRAX. A version of it is available for the Spanish population, which we applied, using the UK AT, IT and algorithms, in a sample from Barcelona (Spain) to assess the effect of FRAX in reducing the number of DXA requested.</p><p><bold>Methods:</bold> The FRIDEX database at the Vall d’Hebron Hospital (Barcelona) includes all patients who underwent DXA scanning from 1999. At the time of scanning, questionnaires were administered: age, fractures, smoking, alcohol, family history of hip fracture (HF), rheumatoid arthritis, other secondary causes of osteoporosis and
<table-wrap id="T5" position="anchor"><caption><p>Proportion of women eligible for BMD and for treatment, according to the algorithms proposed for women from the UK.</p></caption><table frame="hsides" rules="groups"><thead align="left"><tr><th></th><th>N</th><th>Prior fracture (%)</th><th colspan="2">> AT and < IT (n, %)<hr></hr></th><th>At least 1 Risk Factor (a)</th><th colspan="2">Total eligible for assessment (n; %) [>AT,<hr></hr></th><th colspan="2">> IT after DXA (n; %)<hr></hr></th><th>>1 Risk Factor (n; %)</th><th colspan="2">Total eligible for treatment (n; %) [Prior Fracture or > T]<hr></hr></th></tr><tr><th></th><th></th><th></th><th>Major</th><th>Hip</th><th></th><th>Major</th><th>Hip</th><th>Major</th><th>Hip</th><th></th><th>Major</th><th>Hip</th></tr></thead><tbody align="left"><tr><td>50-54 years</td><td>173</td><td>28 (16.0%)</td><td>4 (2.3%)</td><td>36 (24.5%)</td><td>24 (14.0%)</td><td>36 (24.5%)</td><td>38 (25.9%)</td><td>2 (1.2%)</td><td>14 (8.1%)</td><td>37 (21.1%)</td><td>28 (16.2%)</td><td>35 (20.2%)</td></tr><tr><td>55-59 years</td><td>204</td><td>45 (17.4%)</td><td>2 (0.8%)</td><td>43 (20.2%)</td><td>17 (6.6%)</td><td>43 (20.2%)</td><td>44 (20.7%)</td><td>6 (2.3%)</td><td>14 (5.5%)</td><td>52 (20.2%)</td><td>47 (23.0%)</td><td>47 (23.0%)</td></tr><tr><td>60-64 years</td><td>277</td><td>71 (25.6%)</td><td>6 (2.2%)</td><td>25 (12.1%)</td><td>11 (4.0%)</td><td>25 (12.1%)</td><td>26 (12.6%)</td><td>1 (0.4%)</td><td>11 (4.0%)</td><td>78 (28.2%)</td><td>71 (25.6%)</td><td>74 (26.7%)</td></tr><tr><td>65-69 years</td><td>206</td><td>54 (25.8%)</td><td>3 (1.5%)</td><td>9 (5.8%)</td><td>9 (4.4%)</td><td>9 (5.8%)</td><td>10 (6.5%)</td><td>5 (2.5%)</td><td>16 (7.8%)</td><td>59 (28.2%)</td><td>54 (26.2%)</td><td>59 (28.6%)</td></tr><tr><td>70-74 years</td><td>177</td><td>42 (23.0%)</td><td>30 (17.2%)</td><td>12 (8.5%)</td><td>57 (32.8%)</td><td>12 (8.5%)</td><td>37 (26.2%)</td><td>1 (0.6%)</td><td>7 (4.0%)</td><td>46 (25.1%)</td><td>42 (23.7%)</td><td>46 (26.0%)</td></tr><tr><td>75-79 years</td><td>183</td><td>71 (37.6%)</td><td>58 (32.4%)</td><td>4 (3.4%)</td><td>69 (38.5%)</td><td>4 (3.4%)</td><td>23 (19.5%)</td><td>4 (2.2%)</td><td>20 (11.2%)</td><td>78 (41.3%)</td><td>72 (39.3%)</td><td>78 (42.6%)</td></tr><tr><td>≥80 years</td><td>97</td><td>47 (46.1%)</td><td>37 (40.2%)</td><td>3 (5.5%)</td><td>29 (31.5%)</td><td>3 (5.5%)</td><td>13 (23.6%)</td><td>3 (3.3%)</td><td>9 (9.8%)</td><td>49 (48.0%)</td><td>47 (48.5%)</td><td>49 (50.5%)</td></tr><tr><td>TOTAL</td><td>1,353</td><td>358 (25.7%)</td><td>140 (10.3%)</td><td>132 (12.8%)</td><td>216 (16.0%)</td><td>132 (12.8%)</td><td>191 (18.5%)</td><td>22 (1.6%)</td><td>91 (6.7%)</td><td>399 (28.6%)</td><td>361 (27.4%)</td><td>388 (29.5%)</td></tr></tbody></table><table-wrap-foot><fn id="TF1"><p>(a) Excludes women with a prior fracture</p></fn></table-wrap-foot></table-wrap>
steroid exposure was collected. Height and weight were measured.All patients then underwent DXA measurement using a Lunar GE “Prodigy Advance”. We used the NOGG UK FRAX to classify patients into low, intermediate and high risk before and after DXA.</p><p><bold>Results:</bold> 1,353 postmenopausal women, ≥50 years,consecutively attended the DXA department (June/2008-May/2009), referred by their GP or an specialist. Mean age: 65.47 yrs ± 9.31, weight: 67.80 ± 37.32 kg and height: 156.12 ± 39.73cms. 159 (11.8%) women had Osteoporosis (OP) at Femoral Neck, and 853 (65.8%) had Osteopenia (T < −1.5).</p><p>358 (25.7%) had a prior fracture at baseline. 56 (4.0%) had a family antecedent of HF, 104 (7.5%) were smokers and none drank ≥3 alcohol units per day. 23 (1.7%) suffered from Rheumatoid Arthritis and 7 (0.5%) from any other condition considered as cause of Secondary OP in FRAX. 61 women (4.5%) had been exposed to oral corticoids and 458 (32.9%) to anti-resortive drugs.</p><p>The median HF probability before DXA was 0.9 ± 2.9 and 0.7 ± 3.0 afterwards. Other major fracture probability was 4.3 ± 5.3 and 4.0 ± 5.1 after DXA.</p><p>Using hip risk probability AT, 18 women changed from low to high risk after DXA and 23 changed from high to low risk. According to other major fractures risk probabilities, only 2 (0.2%) women changed from low to high risk and only 4 were considered as high risk before DXA; from these, 2 changed from high risk pre-DXA to low risk.</p><p><bold>Conclusions:</bold> The use of FRAX would have saved 992 DXA scans and is a useful clinical tool to predict osteoporosis in the Spanish population.</p></abstract><abstract><p><bold>Disclosure statement:</bold> All authors have declared no conflicts of interest.</p></abstract></front-stub></sub-article></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Osteoporosis and Metabolic Bone Disease [127142]</title><subTitle>127. Osteoporosis, Falls and Fractures: Three Confounders in One Equation. Development and Validity of a New form for Assessment of Patients Referred for Dxa Scanning</subTitle></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Osteoporosis and Metabolic Bone Disease [127142]</title><subTitle>127. Osteoporosis, Falls and Fractures: Three Confounders in One Equation. Development and Validity of a New form for Assessment of Patients Referred for Dxa Scanning</subTitle></titleInfo><name type="personal"><namePart type="given">Yasser</namePart><namePart type="family">El Miedany</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Maha</namePart><namePart type="family">El Gaafary</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sally</namePart><namePart type="family">Youssef</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mathias</namePart><namePart type="family">Toth</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jessica</namePart><namePart type="family">Weightman</namePart><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Madeleine</namePart><namePart type="family">Kelly</namePart><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Emma</namePart><namePart type="family">Johnston</namePart><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Amanda</namePart><namePart type="family">Stone</namePart><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Patricia</namePart><namePart type="family">Harrison</namePart><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Peter</namePart><namePart type="family">Bartholomew</namePart><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Clive</namePart><namePart type="family">Kelly</namePart><affiliation>Rheumatology, Queen Elizabeth Hospital, Gateshead, UK; Medical School, HYMS, York, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Vipul</namePart><namePart type="family">Vagadia</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stephen</namePart><namePart type="family">Tuck</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Israa</namePart><namePart type="family">Al-Shakarchi</namePart><affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ann</namePart><namePart type="family">Louise Dolan</namePart><affiliation>Rheumatology, St Peters Hospital, Chertsey, Surrey, UK; Rheumatology, Queen Elizabeth Hospital, Woolwich, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Matt J.</namePart><namePart type="family">Bridges</namePart><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sheila</namePart><namePart type="family">Ruddick</namePart><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Bishop Auckland, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Claire</namePart><namePart type="family">Bracewell</namePart><affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David</namePart><namePart type="family">Wright</namePart><affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Terence</namePart><namePart type="family">Aspray</namePart><affiliation>Rheumatology, Sunderland Royal Hospital, Sunderland, UK; Metabolic Medicine and Care of the Elderly, Sunderland Royal Hospital, Sunderland, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gareth M.</namePart><namePart type="family">Hynes</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karen</namePart><namePart type="family">Jameson</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Avan</namePart><namePart type="family">Aihie Sayer</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Cyrus</namePart><namePart type="family">Cooper</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elaine</namePart><namePart type="family">Dennison</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sian</namePart><namePart type="family">Robinson</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas J.</namePart><namePart type="family">Tull</namePart><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ben A.</namePart><namePart type="family">Fisher</namePart><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Reza</namePart><namePart type="family">Jenabzadeh</namePart><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Justin P.</namePart><namePart type="family">Cobb</namePart><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sonya</namePart><namePart type="family">Abraham</namePart><affiliation>Rheumatology, Kennedy Institute of Rheumatology, London, UK; Orthopaedics, Imperial College NHS trust, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gareth M.</namePart><namePart type="family">Hynes</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karen</namePart><namePart type="family">Jameson</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Nick</namePart><namePart type="family">Harvey</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Avan</namePart><namePart type="family">Aihie Sayer</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Cyrus</namePart><namePart type="family">Cooper</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elaine</namePart><namePart type="family">Dennison</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jonathan</namePart><namePart type="family">Cheah</namePart><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sybil</namePart><namePart type="family">Stacpoole</namePart><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dominic</namePart><namePart type="family">Heaney</namePart><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">John</namePart><namePart type="family">Duncan</namePart><affiliation>UCL Medical School, London, UK; The National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Delnaz</namePart><namePart type="family">Roshandel</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kate</namePart><namePart type="family">Holliday</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stephen R.</namePart><namePart type="family">Pye</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Steven</namePart><namePart type="family">Boonen</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Herman</namePart><namePart type="family">Borghs</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dirk</namePart><namePart type="family">Vanderschueren</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Judith E.</namePart><namePart type="family">Adams</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kate A.</namePart><namePart type="family">Ward</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Joseph D.</namePart><namePart type="family">Finn</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ilpo T.</namePart><namePart type="family">Huhtaniemi</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alan J.</namePart><namePart type="family">Silman</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Frederick C.</namePart><namePart type="family">Wu</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Wendy</namePart><namePart type="family">Thomson</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Terence W.</namePart><namePart type="family">ONeill</namePart><affiliation>arc Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK; Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Susanna</namePart><namePart type="family">White</namePart><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Simon</namePart><namePart type="family">Shaw</namePart><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Charlotte</namePart><namePart type="family">Short</namePart><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yvonne</namePart><namePart type="family">Gilleece</namePart><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Martin</namePart><namePart type="family">Fisher</namePart><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karen</namePart><namePart type="family">Walker-Bone</namePart><affiliation>Rheumatology, Brighton and Sussex Medical School, Brighton, UK; Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chetan B.</namePart><namePart type="family">Narshi</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rhodri</namePart><namePart type="family">Martin</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karen</namePart><namePart type="family">Mitchell</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard</namePart><namePart type="family">Keen</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; 2Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt; 3Geriatrics, Darent Valley Hospital, Dartford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Matt J.</namePart><namePart type="family">Bridges</namePart><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sheila</namePart><namePart type="family">Ruddick</namePart><affiliation>Department of Rheumatology, County Durham and Darlington Foundation Trust, Darlington, UK; Darlington Primary Care Trust, Darlington, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yasser</namePart><namePart type="family">El Miedany</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mathias</namePart><namePart type="family">Toth</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sally</namePart><namePart type="family">Youssef</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Maha</namePart><namePart type="family">El Gaafary</namePart><affiliation>Rheumatology, Darent Valley Hospital, Dartford, UK; Internal Medicine, Darent Valley Hospital, Dartford, UK; Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Daniel Prieto</namePart><namePart type="family">Alhambra</namePart><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rafael</namePart><namePart type="family">Azagra</namePart><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gloria Encabo</namePart><namePart type="family">Duro</namePart><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Amada</namePart><namePart type="family">Aguye</namePart><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marta</namePart><namePart type="family">Zwart</namePart><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kassim M.</namePart><namePart type="family">Javaid</namePart><affiliation>Rheumatology, NIHR Musculoskeletal BRU, University of Oxford, Oxford, UK; Primary Health Care, IDIAP Jordi Gol. Institut Catala de la Salut, Barcelona, Spain; Nuclear Medicine / DXA, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Internal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><topic>Poster Viewing II (Thursday 22 April 2010, 08:30-10:00)</topic></subject><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2010-04</dateIssued><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background: To assess the validity of a new referral model for DXA scanning, its impact on patients management and whether it meets the targets of the osteoporosis and falls service. Methods: The referral form was developed, including 3 main components: 1. Risk factors for osteoporosis (6 factors). 2. the 8 risk factors identified in FRAX (WHO fracture risk assessment tool) and 3. Risk factors for falls (5 factors). Special icons were used to give clinical hints for vertebral morphometry and tilting table assessment. The model was set up with only ticking the appropriate boxes is required. Validation of the model was done through: 1. comparing the referral form to the medical notes and the patients answers to a pre-scanning questionnaire. 2. Each patient was assessed and management plan (guided by the national guidelines) was considered blindly twice based on the data available in the new referral form in comparison to the old referral form. DXA measurements were then analyzed in relation to self-reported incidence of falls, fractures and the calculated 10-years fracture probability (using FRAX). Results: A total of 264 postmenopausal women (mean age, 68.64.73 years) were included in this work. Osteoporosis was found in 113/264 (42.8) of the patients whereas osteopenia prevalence was 32.1 (86/264). 34.5 (91/264) of the patients had a past history of low trauma fracture and 21.6 (57/264) reported 1 or more falls during the preceding year. Patients treated based on the osteoporosis-falls-FRAX composite were significantly higher (r0.635) than those treated based on the old referral form. Most of these patients were suffering from secondary osteoporosis and their DXA scan revealed borderline osteoporosis/osteopenia. Adjusted risk for age, BMI, bone density and 10-year fracture probability in the past 12 months in patients who reported a fall was 6.0 (95 CI, 3.2-10.5, P<0.001). Compared with women without osteoporosis and without a fall and 10-year fracture probability <10, women with osteoporosis without a fall and 10-year fracture probability <10 had an age- and BMI-adjusted fracture risk of 2.8 (95 CI, 0.7-11.7 P<0.10) and women with osteoporosis and a fall and fracture probability >20 had an adjusted-fracture risk of 24.8 (95 CI, 7.1-78.5; P<0.0001). Conclusions: The developed form is a valid model for DXA scanning and accurate tool for assessment of osteoporosis, falls risks as well as fracture (using FRAX). Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age, bone mineral content and 10-year fracture probability. It is important to have the patients stratified and assessed according to the different osteoporosis and falls risk factors rather than relying on fractures as the corner stone for assessment and management. Disclosure statement: All authors have declared no conflicts of interest.</abstract><relatedItem type="host"><titleInfo><title>Rheumatology</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1462-0324</identifier><identifier type="eISSN">1462-0332</identifier><identifier type="PublisherID">brheum</identifier><identifier type="PublisherID-hwp">rheumatology</identifier><part><date>2010</date><detail type="title"><title>Rheumatology BSR and BHPR Conference Abstracts</title></detail><detail type="volume"><caption>vol.</caption><number>49</number></detail><detail type="supplement"><number>suppl_1</number></detail><extent unit="pages"><start>i80</start><end>i86</end></extent></part></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><relatedItem type="references"></relatedItem><identifier type="istex">ED675643FE1E176FADE8396FD83BDC37CC02C6C6</identifier><identifier type="DOI">10.1093/rheumatology/keq723</identifier><identifier type="ArticleID">keq723</identifier><recordInfo><recordContentSource>OUP</recordContentSource></recordInfo></mods></metadata><covers><json:item><original>true</original><mimetype>image/tiff</mimetype><extension>tiff</extension><uri>https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/covers/tiff</uri></json:item></covers><annexes><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/annexes/pdf</uri></json:item></annexes><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">RHEUMATOLOGY</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI><json:item><type>refBibs</type><uri>https://api.istex.fr/document/ED675643FE1E176FADE8396FD83BDC37CC02C6C6/enrichments/refBibs</uri></json:item></enrichments><serie></serie></istex>
