Ramón Mazzucchelli

Second Hip Fracture: Incidence, Trends, and Predictors

Older persons who have suffered a hip fracture (HFx) are at increased risk of subsequent hip fractures. The cumulative incidence of a second hip fracture (SHFx) has been estimated in 8.4%; however, no studies have been carried out in our country, and the information on risk markers of SHFx is limited. The aim of this study was to estimate the incidence, explore trends, and examine predictors of SHFx in a suburban population of Spain. An observational longitudinal retrospective study was performed in a universal health coverage setting (Alcorcón, 1999–2011). Data were obtained from the area hospital discharge database. Annual incidence of HFx was estimated over 100,000 population (general and persons with HFx), and median time to SHFx by Kaplan–Meier tables. Cox regression was used for the analysis of association between SHFx and baseline predictors, measured by hazard ratio (HR). Among the 3430 patients who suffered a first HFx in the study period, 255 (7.4%) experienced a SHFx (4.5% of men and 8.5% of women). Median time between the first and second HFx was 3.7xa0years (SD 3.2). Annual incidence of HFx in population over 45 was 290.5 per 100,000 inhabitants (131.03 in men and 433.11 in women). Annual incidence of SHFx among persons with a HFx was 956.7 per 100,000 (1052.1 in women and 595.5 in men). There was a decline trend along the study period with an annual reduction of 10.4% (95% CI 7.7–13.0%; pxa0<xa00.001) in both sexes. The following associations were found: female sex (HR 1.41, 95% CI 0.97–2.02), age (HR 1.03, 95% CI 1.01–1.04), living in a nursing house (HR 1.46, 95% CI 1.10–1.94), and moderate to severe liver disease (HR 4.96, 95% CI 1.23–20.06). In our environment the occurrence of a SHFx is 7.4%, three-fold risk compared to no previous HFx. Being woman, elderly, living in a nursing home, and having severe to moderate liver disease may be important predictors of a SHFx. There seems to be adequate time between the first and the SHFx for interventions that may reduce the risk.

Lumbalgia inflamatoria en varón de 44 años

The patient in question is a 44 year old male with a history of alcohol abuse. He came to the consultation due to episodes of mono/oligoarthritis of the hands and ankles, recurring every week for 5 years, and inflammatory back pain of 10 years of evolution, with alternating buttock pain. He reported no other accompanying symptoms. Examination revealed the presence of arthritis of the right wrist, left 4th and 5th PIP with accompanying nodules. Laboratory tests showed uric acid 13.2 mg/dl, ESR 44 mm/h (0–20) CRP 15 mg/l (<5 mg/l) and a Mantoux test of 20 mm. The remaining tests (CBC, TSH, CPK, rheumatoid factor, HLA-B27, anticitrullinated-peptide antibodies, immunoglobulins, antibodies for hepatotropic virus, HIV, syphillis, Brucella, renal function, liver, urine sediment and uricosuria 24 h) were normal. Chest, hands and feet X rays showed no pathological findings. The lumbar spine radiograph (Fig. 1) demonstrated left sacroiliitis stage II and right sacroillitis stage III. Examination with magnetic resonance imaging (MRI) of the lumbar spine was normal and sacroiliac MRI (Fig. 2) demonstrated irregularities and erosions in both sacroiliac joints observed in the T1 sequence. STIR detected subchondral bone marrow edema, markedly in the ilium and left sacral bone, with the right sacroiliac joint being less involved.

High Reproducibility of an Automated Measurement of Mobility for Patients with Axial Spondyloarthritis

Objective. Conventional measures of spinal mobility used in the assessment of patients with axial spondyloarthritis (axSpA), such as the Bath Ankylosing Spondylitis Metrology Index and its components, are subject to interobserver variability. The University of Córdoba Ankylosing Spondylitis Metrology Index (UCOASMI) is a validated composite index based on a motion video-capture system, UCOTrack. Our objective was to assess its reproducibility in clinical practice settings. Methods. We carried out an observational study of repeated measures in 3 centers. Video-capture systems were installed and adapted to clinical rooms. Patients with axSpA and stable disease were selected by consecutive stratified sampling [disease duration, sex, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. Intraobserver reliability of the UCOASMI and of conventional measures was tested 3–5 days apart. For interobserver reliability, 3 patients from each center were evaluated in the other centers, within 3–7 days. The intraclass correlation coefficients (ICC) were calculated. Results. Thirty patients were included (73% men, mean age 53 yrs, mean BASDAI 3.0). Interobserver and intraobserver ICC of the UCOASMI was 0.98. Conventional measurements showed lower but adequate reproducibility as well, except for interobserver reliability of lateral flexion (0.41), cervical rotation (0.61), and Schöber test (0.07), and intraobserver reliability of tragus-to-wall distance (0.30). Conclusion. Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility.

Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015). TREND-AR study

Purpose To analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years). Methods This observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends. Results Between 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001). Conclusion In Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.

Short-term association between outdoor air pollution and osteoporotic hip fracture

SummaryThis study examines the association of the levels of different airborne pollutants on the incidence of osteoporotic hip fracture in a southern European region. Association was detected between SO2 and NO2 and hospital admissions due to hip fracture.IntroductionTo examine the short-term effects of outdoor air pollution on the incidence of osteoporotic hip fracture in a southern European region.MethodsThis is an ecological retrospective cohort study based on data obtained from three databases. In a time-series analysis, we examined the association between hip fracture incidence and different outdoor air pollutants (sulfur dioxide (SO2), monoxide (NO), nitrogen dioxide (NO2), ozone (O3), and particulate matter in suspension <u20092.5 (PM2.5) and <u200910-μm (PM10) conditions by using general additive models (Poisson distribution). The incidence rate ratio (IRR), crude and adjusted by season and different weather conditions, was estimated for all parameters. Hip incidence was later analyzed by sex and age (under or over age 75) subgroups. The main outcome measure was daily hospital admissions due to fracture.ResultsHip fracture incidence showed association with SO2 (IRR 1.11 (95% CI 1.04–1.18)), NO (IRR 1.01 (95% CI 1.01–1.02)), and NO2 (IRR 1.02 (95% CI 1.01–1.04)). For O3 levels, this association was negative (IRR 0.97 (95% CI 0.95–0.99)). The association persisted for SO2 and NO2 when the models were adjusted by season. After adjusting by season and weather conditions, the association persisted for NO2. When participants were stratified by age and sex, associations persisted only in women older than 75xa0years.ConclusionsA short-term association was observed with several indicators of air pollution on hip fracture incidence. This is the first study that shows these associations.

Weather conditions and their effect on seasonality of incident osteoporotic hip fracture

SummaryOur aim was to analyze the seasonality and the effect of weather conditions on the incidence of osteoporotic hip fracture in a Southern European region.IntroductionThe objective of this work is to evaluate seasonality and the effect of weather conditions on the incidence of osteoporotic hip fracture in a Southern European region.MethodsThis retrospective cohort study included all patients admitted to Alcorcón Foundation University Hospital with a diagnosis of osteoporotic hip fracture between the years 1999 and 2015. In a time series analysis, we examined the association between hip fracture incidence and different weather conditions and seasonality using general additive models (with Poisson distribution). The incidence rate ratio (IRR) crude and adjusted by season was estimated for all parameters. Hip incidence was further analyzed by sex and age (below or over 75) subgroups.ResultsFour thousand two hundred seventy-one patients with an osteoporotic hip fracture were included (79% females, mean age 83.8). Season fracture rate was significantly higher in fall and winter (67.06 and 64.41 fractures/season) compared to summer and spring (59.71 and 60.06; pxa0<u20090,001). Hip fracture incidence was 15% greater in autumn and winter than in spring and summer. Fog [IRR 1.15 (95% CI: 1.003–1.33)], atmospheric pressure (per 100xa0mb) [IRR 1.05 (95% CI: 1.004–1.114)], and frost [IRR 1.15 (95% CI: 1.03–1.30)] were significantly associated with increased hip fracture. Haze [IRR 1.10 (95% CI: 0.99–1.23)] showed a trend without statistical significance. Daily average temperature (per 5xa0°C) [IRR 0.98 (95% CI: 0.957–0.996)], rain (per 10xa0ml) [IRR 0.99 (95% CI: 0.981–1.0)], wind speed [IRRu2009=u20090.952, (95% CI: 0.907–0.998)], and daily ultraviolet radiation (per 100xa0joules) [IRR 0.998 (95% CI: 0.996–1.0)] were negatively associated with fracture. After adjusting by season and trend, all these associations disappear.ConclusionsIn this Southern region, hip fracture incidence exhibits a seasonal pattern different from those communicated in Northern regions. There is short-term association with different weather conditions that partly explain this seasonal pattern.

OP0068 Short term effects of ambient air pollution on osteoporotic hip fracture. an ecological study in a period of 16 years

Objectives To examine the short-term effects of outdoor air pollution on the incidence of osteoporotic HFx in a southern European region. Methods This is a retrospective cohort study based on data from three databases. Daily HFx incidence was calculated using discharge data from the hospital of Alcorcón for the period 2000–2015. Daily weather conditions were compiled from records of the national meteorological station (AEMET). Daily air pollutant levels (mcg/m3) were calculated from data from the Ministry of Environment for the Madrid Community: sulfur dioxide (SO2), nitrogen monoxide (NO), nitrogen dioxide (NO2), ozone (O3) and particulate matter in suspension <2.5u2009µm (PM2.5) and <10u2009µm (PM10), for the same period. Pollutant concentrations were categorised into quartiles (Q1 to Q4, lowest to highest). Associations between HFx incidence and air pollutant levels were examined through Ggeneralized Additive Models (GAM) at a daily level with Poisson link function. Models were adjusted for a penalised spline function of time. Main outcome measures Daily hospital admissions for hip fracture. Results HFx incidence showed a direct association with NO, NO2, PM2.5 and PM10 and inverse association with O3 levels. Incidence rate ratios for Q1vsQ2, Q1vsQ3 and Q1vsQ4 respectively were: 1.171 (1.103–1.244), 1.245 (1.173–1.322) and 1.331 (1.253–1.414) for NO; 1.057 (0.996–1.122), 1.185 (1.116–1.259) and 1.276 (1.199–1.357) for NO2; 1.028 (0.943–1.12), 1.092 (1.006–1.185) and 1.146 (1.049–1.253) for PM2.5; 1.083 (1.016–1.155), 1.099 (1.034–1.168) and 1.213 (1.136–1.294) for PM10; and 0.975 (0.914–1.04), 0.868 (0.815–0.924) and 0.814 (0.765–0.867) for O3. These associations persisted when the models were corrected for season, day of the week and weather conditions. When participants were stratified by age and sex, associations persisted only in women older than 75 years. Conclusions A short-term effect was observed of several indicators of air pollution on hip fracture incidence. This is the first study that finds this association. Disclosure of Interest None declared

SAT0141 Trends in the incidence of lymphomas and leukemias in patients with rheumatoid arthritis in spain: an observational cohort study of hospital discharges from 1999 to 2015 (TREND-AR STUDY)

Background: Oncohematological diseases have an increased incidence in Rheumatoid Arthritis (RA) patients. However, their trend in RA in Spain is unknown Objectives: To analyze the incidence and trend of hospital admissions for lymphomas and leukemias in RA patients in Spain from 1999–2015 Methods: We performed an observational retrospective population study analyzing the spanish administrative database that includes a Minimun Basic Data Set (MBDS) of hospital admissions of RA patients from 1999–2015. We selected MBDSs for lymphomas and leukemias. Cases were identified by the presence in primary/secondary diagnosis of ICD9 codes. The population at risk was estimated with a prevalence of RA of 0,5% (0,8% women and 0,2% men). Crude and adjusted rates were calculated, and the trend was analyzed using the Generalized Linear Model with the year as the analysis variable. SPSS version 20 (Chicago, IL) was used Results: 338.343 RA hospital admissions were detected, being 3561(1,1%) lymphomas (61,5% women, 38,5% men) and 1664(0,5%) leukemias (52,3% women, 47,7% men). Mean age 68,94(SD 11,38) in lymphomas and 71,46(SD 11,24) in leukemias. Age-adjusted rate during the period for lymphoma was 152,19/105 inhab/year (92,05 women and 240,14 men). Lymphoma age-adjusted rate increased from 52,46/105 inha/year in 1999 to 187,57 in 2015, both women (from 42,74 to 142,95) and men (from 280,77 to 326,63). An annual increase in lymphoma rate of 6,9% is estimated (RRI 1,069; CI 95% 1,054–1,085). Age-adjusted rate during the period for leukemia was 90,87/105 inhab/year (37,09 women and 144,65 men). Leukemia age-adjusted rate increased from 18,86/105 inhab/year in 1999 to 94,05 in 2015, both women (13,80 in 1999 to 65,93 in 2015) and men (38,70 in 1999 to 204,84 in 2015). An annual increase in leukemia rate of 8,2% is estimated (RRI 1,083; CI 95% 1,069–1,097). Conclusions: In Spain from 1999–2015 lymphoma and leukemia hospital admissions in RA patients increased, with an estimation of 6,9% and 8,2% annual increase respectively. Disclosure of Interest: None declared

FRI0067 Trends in the incidence of felty’s syndrome in patients with rheumatoid arthritis in spain: an observational cohort study of hospital discharges from 1999 to 2015 (TREND-AR STUDY)

Background Felty’s syndrome (FS) is an unfrequent entity realted to Rheumatoid Arthritis (RA) but it’s unknown the trend of FS in Spain. Objectives To analyse the incidence and trend of hospital admissions for FS in RA patients in Spain from 1999 to 2015. Methods We performed an observational retrospective population study analysing the spanish administrative database that includes a Minimun Basic Data Set (MBDS) of hospital admissions of RA patients from 1999 to 2015. We selected the MBDSs for FS. Cases were identified by the presence in primary and secondary diagnosis of its ICD9 code. The population at risk was estimated with an estimated prevalence of RA of 0,5% (0,8% women and 0,2% men). Crude and adjusted rates were calculated, and the trend was analysed using the Generalised Linear Model (GLM) with the year as the analysis variable. SPSS version 20 (SPSS Inc, Chicago, IL) was used. Results 338.343 RA hospital admissions were detected, being 802 (0,2%) due to FS, 455 (56,7%) women and 347 (43,3%) men. Mean age was 67,94(SD 13,76). There were 61 (7,6%) deaths. Age-adjusted rate during the period was 42,19/105 inhab. per year (19,76 women and 64,61 men). FS age-adjusted rate decreased from 25,90/105 inhab. per year in 1999 to 17,20 in 2015, both women (12,85 in 1999 to 11,75 in 2015) and men (80,15 in 1999 to 38,75 in 2015). An annual decrease in the FS rate of 0,5% is estimated (RRI 0,995; CI 95% 0,976–1,014). Conclusions In Spain FS hospital admissions in patients with RA decreased between 1999–2015 with an estimation of 0,5% annual reduction not statistically significative. Disclosure of Interest None declared

Coxalgia derecha en una mujer de 65 años de edad

Para llegar al diagnostico definitivo se determino el acido homogentisico en orina de 24 h por fotometria, que mostro un valor de 1.175 mg/l (0-0 mg/l) y confirmo el diagnostico de ocronosis. Se observo que la orina tornaba a color oscuro con la exposicion al sol (fig. 4). Se completo el estudio con un ecocardiograma en el que se objetivo esclerosis valvular aortica, densitometria osea con T score de columna lumbar de –3,24 desviaciones estandar (DE) y de cuello femoral de –1,51 DE y un estudio otorrinolaringologico que evidencio hipoacusia bilateral. Se le implanto una protesis total de cadera derecha, con buena evolucion y a los 8 meses se le coloco una protesis total de cadera izquierda por destruccion articular rapidamente progresiva.