R. Aguiar

A7.6 Neuropathic pain in rheumatic diseases: a cross-sectional study

Introduction Pain is the most common symptom in rheumatic diseases. In its pathophysiology there is usually a disturbance in nociceptive perception by tissue damage, that evolve often to features of central pain, with characteristics of neuropathic pain (NP). Neuropathic pain in rheumatic diseases is a topic rarely addressed in the literature. Objectives Determine, in a cohort of patients with rheumatoid arthritis (RA), osteoarthritis (OA) axial (a-SpA) and peripheral (p-SpA) spondylarthritis, the prevalence of DN, correlations between NP and activity and disease duration. Compare the prevalence of DN with control group. Materials and Methods Cross-sectional study. Variables analysed: sex, age, duration of illness, medication. All patients answered VAS of pain, DN4 and EQol-5D. In patients with RA and p-SpA we determined DAS28, BASDAI and BASFI in a-SpA and WOMAC in OA. Control group of healthy subjects randomised with patients in age and sex responded DN4. Statistical analysis using SPSS 18. Results 216 patients enrolled (80RA, 48p-SpA, 46a-SpA, 42OA), 85 men and 131 women, with mean age 55.27 ± 14.62 years, mean disease duration 10 ± 11.87years. 48patients had ≥4 DN4, only 3 were on medication to NP. The NP prevalence was 40.47% in OA (p < 0.01), 18.75% RA, 23.91% a-SpA and 10:42% p-SpA. The prevalence of DN was higher in patients compared with controls, in OA (OR = 23.12% CI 95 (2.88–185.41) and SPA´s (OR = 8.62 CI 95% (1.1–67.25). Despite the increasing prevalence of DN with duration of disease, this difference was not statistically significant. Regarding disease activity, we found that DN increases with BASDAI (p < 0:02) in a-SpA and DAS28 in RA (p < 0.02). Higher values of VAS were found in patients with DN4 ≥4 (p < 0.001). Conclusion This study reveals an important neuropathic component in our cohort of patients. The disease with the highest prevalence of DN was OA, which meets the data found in the literature. This discrepancy in prevalence, lower in inflammatory conditions, though chronic, certainly needs further study, placing the use of more aggressive therapy in these patients, like DMARDs, as a plausible hypothesis. This study demonstrates the need for a better understanding of the mechanisms and types of pain in rheumatic patients, with nociceptive pain only part of the spectrum of pain. Additional studies are needed to investigate the importance of neuropathic pain in rheumatic diseases, and its relation with the evolution of the underlying disease.

AB0399 Rheumatoid Arthritis Impact of Disease: A Global Disease Assessment Index that Correlates with Activity and Function in RA Patients

Background Pain is a major feature in rheumatoid arthritis (RA), often occurring with other symptoms and functional impairment, which are difficult to assess. An increasing interest has been dedicated to the patient perspective in the assessment of RA, by using indexes that approach other health domains such as fatigue, well-being and sleep disturbance. Rheumatoid Arthritis Impact of Disease (RAID) includes seven domains (pain, function, fatigue, sleep disturbance, physical and psychological wellbeing, sleep disturbance and coping), which enable the assessment of the global impact of the disease, through the patient perspective. Objectives To compare, in a cohort of patients with rheumatoid arthritis, the impact of the disease assessed with RAID questionnaire and Health Assessment Questionnaire (HAQ), and to identify possible association with disease activity (as assessed by DAS28-3v). Methods Cross-sectional study, enrolling outpatients attending a Rheumatology Department, diagnosed with RA. All patients answered both HAQ and RAID at the same visit; DAS28-3v was determined. Statistical analysis with SPSS, version 18; a p value <0.05 with a 95% confidence interval was assumed. Results Among the 68 patients enrolled, 45 were male; age was 61.15±13.6 years. Mean RAID value was 3.59±2.24; in 21 patients, RAID was ≥5. As expected, the question with higher mean value was that referring to pain (3.93±2.64). Mean HAQ value was 0.3±0.47 and mean DAS28-3v was 2.74±1.06 (corresponding to low disease activity). In our cohort, the increase in RAID value is significantly correlated with an increase in HAQ value – particularly when RAID≥4 (p=0.01). All items assessed by RAID are significantly associated with HAQ value – being the highest correlation identified for functional impairment (p=0.009). RAID value was also associated with DAS28-3v (p=0.02). No correlation was found between RAID and age and no significant difference between genders was identified. Conclusions This work demonstrates the usefulness of RAID in the assessment of RA, presenting a good correlation with HAQ, that assesses functional impairment - being this correlation stronger for higher RAID values. In our cohort, there was also a correlation between RAID and disease activity, as assessed using DAS28-3v. The evaluation of RA patients should include autofill indexes that assess global impact of the disease; RAID gathers the features to be included among those indexes. References Dougados M, Brault Y, Logeart I, van der Heijde D, Gossec L, Kvien T. Defining cut-off values for disease activity states and improvement scores for patient-reported outcomes: the exemple of the Rheumatoid Arthritis Impact of Disease (RAID). Arthritis Res Ther. 2012 May 30;14(3). Disclosure of Interest None declared

AB0555 Cardiovascular Risk Assessment in A SLE Cohort – Where do We Stand?

Background The pathogenesis of cardiovascular risk in Systemic Erythematosus Lupus (SLE) is the result of a complex interaction between traditional risk factors, disease specific factors and chronic inflammation. To minimize de cardiovascular risk in these patients, doctors should control every risk as possible, to avoid an increase in the mortality and morbidity. Objectives In order to implement a follow-up protocol in our SLE patients, the authors made a transversal assessment on cardiovascular risk factors, and how they are controlled, or not, in a SLE cohort. Methods A convenient sample of outpatients with SLE attending our Rheumatology Clinic was recruited. Clinical and laboratorial data were collected using the hospital information records. Statistical analysis was performed using Excel. Results 60 patients were enrolled (54 women and 6 men), with a mean age of 41,1 years and a mean disease duration of 7,4 years. Mean SLEDAI was 2.86±3.36. 13 patients had smoking habits and 22 patients were overweight, but there were no available data of the weigh or height of 21 patients. 12 patients had a blood pressure superior to 130/80 mmHg. Only 5 patients were insulin resistant, none was diabetic. Mean creatinine was 0,81 mg/dl and albumin 3,9 g/dl. 25 patients had proteinuria >300mg/24 hours. Mean C-reactive protein was 0,73 mg/dl. Concerning cholesterol levels in this SLE patients cohort: 21 had LDH>100 mg/dl, 12 total cholesterol>200 mg/dl, 7 HDL<40 mg/dl and 5 had triglycerides>150 mg/dl. 7 patients had no lipid profile in the last year. 12 patients were medicated with statins and 28 with angiotensin –converting enzyme inhibitors or angiotensin receptor blockers. The mean dose of corticosteroid was 5.6 mg pd. In this SLE cohort, there were 8 thrombotic vascular events but 5 of these patients had also antiphospholipid syndrome. Conclusions The results reinforce the importance of a protocolled follow-up that could avoid the lack of some important clinical and laboratorial data and a better/more efficient control of co-morbidities in SLE patients. References Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupuserythematosus. Am J Epidemiol. 2012 Oct 15;176(8):708-19 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4626

AB0729 Functional Impact of Neck Pain in Axial Spondyloarthritis

Background Some functional limitations caused by axial spondyloarthritis (aSpa) are difficult to assess. The most widely used function and activity scores (BASFI and BASDAI, respectively) include some questions related to neck pain and disability; nevertheless, they are far from specific to assess this peculiar aspect. In literature, references concerning evaluation of neck symptoms and their potential functional impact in Spa are scarce. Neck Disability Index (NDI) is a questionnaire that targets functional assessment of patients with neck pain and, so far, it has not been applied to Spa patients in any study. Objectives To evaluate, in a cohort of patients with aSpa, the functional impact of neck pain, and its relation with disease duration and activity and function indexes. Methods Cross sectional study. Analyzed variables: gender, age, disease duration. BASDAI, BASFI and NDI were assessed in all patients, as well as mSASSS and tragus-to-wall distance. Statistical analysis performed with SPSS® version 18.0. Results Sixty six patients were enrolled (48 males, 18 females); mean age was 45±15.2 years old and mean disease duration was 9.92±10. Mean BASDAI and BASFI were, respectively, 3.53±2.53 and 3.22±2.6. Mean mSASSS was 11.65±16.34 and mean trags-to-wall distance was 12.96±4.66cm. Mean NDI value was 20.41±12.65; according to severity classification, 5 patients (7.57%) presented “no disability”, 23 patients (34.85%) had a “mild disability”, 14 patients (21.21%) had “moderate disability”, “severe disability” was noted in 14 patients (21.21%) and 10 patients were classified as having “complete disability”. Although a tendency to higher values of NDI in patients with higher values of BASDAI and BASFI was observed, those correlations were not statistically significant. On the other hand, a statistically significant positive correlation between disease duration and NDI value was identified (p=0,011), and also – as expected - between tragus-to-wall distance and NDI value (p=0.02). No relation was found between NDI value and radiological damage (assessed by mSASSS) and there was no significant difference in both genders. Conclusions In this study, we found that the majority of patients presented some degree of disability related to neck pain, which was moderate to total in more than half of them. We also concluded that this functional impairment increases with disease duration (as suggested by previous literature data) and is also more prominent in patients with greater tragus-to-wall distance. The fact that the usually assessed disease activity and function indexes include few questions regarding cervical spine, therefore diluting its impact in total index score, might explain why no correlation was found between them and NDI. References Holden W, Taylor S, Stevens H, Wordsworth P, Bowness P. Neck pain is a major clinical problem in ankylosing spondylitis, and impacts on driving and safety. Scand J Rheumatol. 2005;34(2): 159-60 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3881

AB0730 Evaluation of Neuropathic Pain in A Spondyloarthritis Cohort

Background Pain is the most common symptom in rheumatic diseases. Its physiopathology generally involves a disturbance in nociceptive perception by tissue damage that often evolves to central pain with features of neuropathic pain (NP). When both components of pain coexist in the same patient, its differentiation is clinically important, since they demand different therapeutical approaches, under the penalty of unsuccessful efforts to relieve pain. NP in spondyloartrhritis remains a scarcely addressed topic. Objectives To determine the prevalence of NP in a cohort of patients with axial spondyloarthritis (aSpa) and peripheral spondyloarthritis (pSpa) and to assess possible correlations between its presence and disease duration and activity and function indexes. Methods Cross-sectional study. Analyzed variables: gender, age, disease duration, medication and comorbidities. Pain VAS, DN4 and EQ-5D were assessed in all patients. In patients with aSpa, BASDAI and BASFI were obtained, as well as DAS28 in patients with pSpa. Control group: healthy individuals, adjusted by gender and age to patients. Statistical analysis with SPSS® version 18.0. Results Ninety four patients were enrolled (46 with aSpa, 48 with pSpa); 54 were males; mean age was 47.87±14.32 years old and mean disease duration was 9.24±10.29 years. Sixteen patients presented DN4≥4 (11 with aSpa and 5 with pSpa); however, only 3 were under medication for that purpose. Mean pain VAS was 4.24±2.5, mean EQ-5D was 7.03±2.09. In aSpa patients, mean BASDAI was 4.34±2.35 and mean BASFI was 3.79±2.64. In pSpa patients, mean DAS28 was 2.59±1.22. The prevalence of NP was higher in patients comparing to controls (OR=8.62 CI95% (1.1-67.25)). Although NP prevalence increased with disease duration, that difference was only statistically significant in aSpa patients (p=0,034). NP prevalence increases with BASDAI (p=0.0169) in aSpa, the same not being true about BASFI. No relation was found with DAS28 in pSpa. As expected, higher values of pain VAS and EQ-5D were found in patients with DN4≥4 (p<0,02). No statistically significant differences were found in the prevalence of NP in both genders. Conclusions This study reveals an important neuropathic component in our cohort, superior to control group. NP is present in a significant percentage of patients with aSpa and pSpa, and most of them are not under any medication to target it, hampering an adequate control of symptoms. This work highlights the need of a deeper insight into pain mechanisms and types in Spa patients, since nociceptive pain might be just a part of it. References Wu Q, Inman R, Davis KD. Neuropathic Pain in Ankylosing Spondylitis; Arthritis Rheum 2013; 65(6): 1494–1503 Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states – maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011; 25(2): 141–154 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3885

AB0745 Arthro-Perception: Patient versus Physician's Disease Status Assessment in Rheumatoid and Psoriatic Arthritis

Background Joint counts performed by rheumatologists, included in indices such as DAS (Disease Activity Score), are the main measure of disease activity in patients with Rheumatoid and Psoriatic Arthritis with peripheral joint disease. Nevertheless, self-reported outcomes are also used to assess disease activity and treatment response. Some authors defend that involving patients in disease activity assessment may enhance self-management behavior and improve health outcomes.1 Several studies have focused on the validity of self-reported joint counts. In a recent meta-analysis, authors concluded that in patients with Rheumatoid Arthritis (RA), self-reported tender joint count has moderate to marked correlation with those performed by a trained assessor; in contrast, swollen joint counts demonstrate lower levels of correlation.2 A recent study in Psoriatic Arthritis (PsA) suggested that patients self-report has a poor correlation with physicians assessment.1 Objectives To compare the correlation between patient and physicians assessment in RA and PsA. Methods A convenient sample of outpatients with RA and PsA attending a Rheumatology clinic was recruited. They were asked to fill out a questionnaire while they were in the waiting area. This included a disease activity visual analog scale (VAS) and three homunculi, in which the patients were asked to point tender, swollen and deformed joints out of 44 possible locations. After this, participants were examined by rheumatologists who also recorded tender, swollen and deformed joints, as well as disease activity VAS in physicians opinion. Statistical analysis was performed using IBM® SPSS® Statistics version 20. Spearman correlation coefficient (rs) was used to examine correlation between patient and physicians joint counts. The strength of the correlation is described as weak if rs<0.40, moderate for rs between 0.40 e 0.60, and strong if rs>0.60. Statistical significance was set at 0.05. Results 114 patients were included, 68 with RA (75% females) and 46 with PsA (70% males).Mean age was 59±13 years in RA and 50±11 in PsA patients. Median disease duration was 4 years in both groups (interquartile range 2-9 in RA; 2-7.5 in PsA) and median DAS 28 (3) was 3.06 (2.06-3.93) in RA and 2.52 (1.67-3.43) in PsA. In RA group, the number of self-reported tender joints had moderate correlation with physicians assessment - rs=0.42, whereas swollen and deformed joint counts showed only weak correlation - rs=0.35 and 0.38 respectively. In PsA group, self-reported joint counts had moderate to strong correlation with physicians assessment. Spearman correlation coefficients were 0.62 for tender, 0.54 for swollen and 0.44 for deformed joints. Conclusions The correlation between patient and physicians joint counts was stronger in PsA versus RA patients, contrary to reports in literature. The concordance was higher for tender joints in both groups. References Chaudhry, SR; Thavaneswaran, A; Chandran, V and Gladman, DD. Physician scores vs patient self-report of joint and skin manifestations in psoriatic arthritis, Rheumatol. Oxf. Engl., 2013; 52 (4): 705–711. Barton, JL; Criswell, LA; Kaiser, R; Chen,Y-H and Schillinger, D. Systematic review and metaanalysis of patient self-report versus trained assessor joint counts in rheumatoid arthritis, J. Rheumatol., 2009; 36 (12): 2635–2641. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4591

AB0525 Sarcospa - evaluation of sarcopenia in patients with spondylarthritis, a case-control study

Background The loss of muscle mass (MM) is a serious problem which may cause serious illness and premature death. Several studies show that about two-thirds of Rheumatoid Arthritis (RA) patient’s have loss of MM, known as Rheumatoid Cachexia. Many factors were identified in the pathogenesis of this process: excessive production of cytokines TNF-α, low physical activity and reduction of the peripheral action of insulin. It is known that RA patients have higher rates of proteins degradation and it is thought that the TNF-α stimulates muscle catabolism, been described as a “sarcoactive” cytokine. The elevation of pro-inflammatory cytokines is also present in spondyloarthritis (Spa) so, like in RA, loss of MM may occur. There are few studies about the association between loss of MM and Spa and the results are discrepant so, the effect of chronic inflammation and disease activity in body composition is still unknown. Objectives Assess muscle mass index (MMI) in patients with Spa; verify if they have higher risk of sarcopenia and if the MMI is related with disease activity, functional impairment and duration of the illness. Methods Case-control study, in a population of patients with Spa (axial or peripheral). The control group were users of a Family Health Unit. Variables: sex; age; height; weight, duration of disease, pathological antecedents, chronic medication, MMI, disease activity (BASDAI and/or DAS28); BASFI and HAQ. The MMI was determinated, from the value of MM, using Lee’s equation. Results A sample of 60 patients was obtained; 52% were female. The average age was 45.5 years (± 13.4), and the average duration of the disease 10.9 years (± 11.6), 40% of patients met criteria for psoriatic arthritis (PsA). According to the classification of the MMI, 62% of the patients had sarcopenia. There was a statistically significant difference between MMI of the Spa group and the control group (7.12 ± 0.99 vs. 7.8 ± 0.93; p < 0.05). The Odds ratio between cases and controls with and without sarcopenia was 2.1. In the group of patients with ankylosing spondylitis no association was found between MMI and BASFI, BASDAI, or duration of the disease. However, in the subgroup of patients with PsA with axial involvement, a very strong negative correlation was found between MMI and the BASFI (rho =- 0.823; p < 0.05). Sex, concomitant medication and pathological history doesn’t seem to influence the degree of sarcopenia. Conclusions This study shows that the risk of sarcopenia in Spa patients is twice than in the control group. It hasn’t possible to identify the factors associated with that loss of MM, with the exception of a small group of patients with axial PsA, where a worse functional capacity was related with higher levels of sarcopenia. The limitations of this study were: use of a non validated equation to calculate MM, small number of the sample and the bias of measurement. References Binymin K, Herrick A, Carlson G, Hopkins S. The effect of disease activity on body composition and resting energy expenditure in patients with rheumatoid arthritis. J Inflamm Res 2011; 4:61-66. Beserra SR, Cavalcanti SV, Rocha Júnior LF et al. Caquexia reumatoide - como diagnosticar. RBM 2010: 67: 20-27. Marcora S, Casanova F, Williams E, et al. Preliminary evidence for cachexia in patients with well-established ankylosing spondylitis. Rheumatology 2006; 45:1385-1388. Disclosure of Interest None Declared

AB0557 Assessing the sexual impact of rheumatic disease in spondyloarthritis patients – where do we stand?

Background The impact of rheumatic diseases on patients’ sexuality has been, for a long time, an ignored topic. As quality of life in these patients became more valorized, sexuality, as a major aspect for the individual’s well being, arised as a subject to be considered over the last decade1. The awareness of the physicians for the problem is of great importance, since the impact in sexual life might be a major concern and still, a quite uncomfortable topic for the patient – both with healthcare professionals and partners. Objectives To analyze the approach by the healthcare service and/or partners on the patients’ perspective of the impact of the rheumatic disease in their sexual activity. Methods An anonymous questionnaire was performed, consisting in demographic data (sex, age, disease duration, civil status, professional status and educational level), and questions related to the importance attributed to sexual activity, as well as to the approach of the topic by the patient and healthcare professionals, with multiple choice questions and questions to be answered through a visual analogical scale. A descriptive study was performed. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. Most of patients were married (56) or common law married (8); 19 patients had completed primary school only and less than one quarter were graduate or higher. In a visual analogical scale, mean importance give to sexual capacity was 74.67±24.55. Among the 76 patients, only 35 stated they talked about the subject with their partner; however, the great majority (66 patients) said they had the partner’s understanding towards their limitations in sexual activity. The perception of conditioning in the conjugal relationship was, in a visual analogical scale, 33.68±31.56. 58 patients had never talked about it with anyone else and 65 had never been questioned by any health professional (rheumatologist, general practitioner or nurse). Conclusions This work emphasizes that the impact of spondyloarthritis on sexual activity is a topic rarely approached either by the patients, either by health professionals. Since patients valorize a lot their sexual capacity and seem not to talk about the limitations imposed by their disease, this subject might deserve a greater attention, including from rheumatologists and other healthcare professionals. References Helland Y, Kjeken I, Steen E, Kvien TK, Hauge MI, Dafinrud H. Rheumatic Diseases and Sexuality: Disease Impact and Self-Management Strategies. Arthritis Care & Res 2011;5:743–750 Disclosure of Interest None Declared

AB0556 Reumasex – sexual satisfaction and factors limiting sexual activity in patients with spondyloarthritis

Background The impact of rheumatic diseases on patients’ sexual life has been gathering the attention of the scientific community over the last decade1. However, specific assessemnt tools are scarce and there are few existing studies, specially those related to spondyloarthritis2 and particularly to psoriatic arthritis. In fact, several factors may condition sexual function in these patients: pain, stiffness, decreased range of motion, joint swelling and extraarticular features such as fatigue, enthesopathy and, in the case of psoriatic arthritis, cutaneous lesions. Objectives To assess sexual satisfaction in a cohort of patients with spondyloarthritis; to identify the limitation imposed by different factors related to the disease in sexual activity; to search for relations between those limitation and quality of life and disease activity and function indexes. Methods An anonymous questionnaire was performed, consisting in two parts. One part consisted in a questionnaire filled by the physician with data on the disease – affected joints, extraarticular features, comorbidities, current treatment, metrology in patients with axial involvement, disease activity (BASDAI and/or DAS28) and function (BASFI and HAQ) indexes and quality of life index (ASQoL). The other part consisted in a questionnaire filled by the patient, with demographic data (sex, age, disease duration, civil status, professional status and educational level), multiple choice questions and questions to be answered through a visual analogical scale, including items approached in some validated indexes of sexual function and satisfaction assessment. Statistical treatment was performed using SPPS system, version 17.0. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. In a visual analogical scale, the mean sexual satisfaction level was 52.28±30.99; the perception of conditioning in the conjugal relationship was 33.68±31.56; limitation on sexual activity was 32.72±31.06; limitation by pain, joint swelling, fatigue, stiffness, decreased range of motion, decreased libido and psoriasis lesions varied from 29.17±28.51 (swelling) e 46.94±32.31 (fatigue), and there was no significant difference between sexes, diagnoses and type of involvement. A strong correlation was identified between most of these factors and ASQoL and HAQ values, but not between them and activity indexes. The presence of comorbidities did not influence the obtained values in a statistically significant way. Conclusions This work highlights the impact of spondyloarthritis on patients’ sexual function. Fatigue was mentioned as the most limiting factor in sexual activity, and the values obtained had a strong correlation with quality of life index in ankylosing spondylitis and with function index in psoriatic arthritis. The type of disease and joint involvement didn’t imply statistically significant differences on the analyzed parameters in this cohort of patients. References Tristano AG. The impact of rheumatic diseases on sexual function. Rheumatol Int 2009;29:853–60. Bal S et al. Sexual functions in ankylosing spondylitis. Rheumatol Int 2011;31(7):889-94. Disclosure of Interest None Declared

AB0621 Fraxture – does frax reflect the risk of fracture in real practice?

Background The Fracture Risk Assessment Tool (FRAX) has been developed as an algorithm to evaluate the 10-year risk of hip and major osteoporotic fractures, based on clinical risk factors, with or without bone mineral density (BMD) at the femoral neck. In a context where costs are increasingly taken into account, the availability of such tool which requires no costs (when performed without BMD) comes up as a valuable resource that weights greatly on the clinicians’ decision to treat a patient with an antiosteoporotic drug. The FRAX tool has recently been validated for the Portuguese population. Objectives With this work, the authors intended to assess FRAX accuracy when retrospectively performed in patients with hip fracture. Methods A retrospective cohort study was run, in which 100 patients with hip fracture randomly selected from an Orthopedics Department were enrolled. FRAX tool (without BMD) was performed and patients were questioned about previous or current treatment with antiosteoporotic drugs. Results From the 100 patients enrolled, 31 couldn’t cooperate (because of dementia or other medical intercurrences). Amongst the 69 patients who could collaborate, 15 were male and 55 were female; mean age was 77.4±9.1 years; mean body mass index (BMI) was 25.9±4.6 kgs/m2. 21 patients had a history of previous fracture; 5 patients reported parents hip fracture; 2 patients were current smokers and 5 were current alcohol drinkers; 4 patients had systemic corticosteroid therapy history and 4 had secondary osteoporosis; none of the patients had rheumatoid arthritis. Only 8 patients were under treatment with antiosteoporotic drugs. Mean risk for major osteoporotic fracture at 10 years was 14.9±9.7% and for hip fracture was 8.0±8.4%. 55 patients had a risk for major osteoporotic fracture <20% and 15 patients had a mean risk for hip fracture at 10 years <3%. All treated patients had a FRAX calculated risk for hip fracture at 10 years >3%. Conclusions In this cohort, established threshold for high risk for hip fracture FRAX algorithm missed 21.7% of the patients who actually had a hip fracture. However, our cohort was small and the study was retrospective, which were the main limitations of this study. Only 14.8% of the patients with high risk for hip fracture were already being treated with antiosteoporotic drugs. This number demonstrates that clinicians are underdiagnosing and undertreating osteoporosis, and the use of FRAX in clinical practice – especially in primary healthcare – could improve the intervention on these patients. References Kanis JA et al. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19:1395–1408 Disclosure of Interest None Declared