P175. Increased fracture risk assessed by Fracture Risk Assessment Tool (FRAX) in Greek patients with Crohn's disease
S. Terzoudis1, I. Koutroubakis1, C. Zavos1, J. Damilakis2, J. Nerantzoulakis3, C. Georgousaki1, D.A. Dimitriadi1, E. Kouroumalis1
1Universitry Hospital of Heraklion, Department of Gastroenterology, Greece; 2Universitry Hospital of Heraklion, Department of Medical Physics, Greece; 3Universitry Hospital of Heraklion, Department of Radiology, Greece
Background: Metabolic bone disease is a frequent finding in patients with inflammatory bowel disease (IBD) that affects the bone mineral density (BMD) and increases the risk of osteoporotic fractures. World Health Organization (WHO) has recently developed the FRAX tool based on clinical risk factors and bone mineral density for evaluation of the 10 year probability of a hip or a major osteoporotic fracture.
Methods: Aim: To evaluate the use of the pre-BMD FRAX score in predicting the increased risk of fracture in Greek IBD patients and to examine possible differences between patients with Crohn's disease (CD) and ulcerative colitis (UC).
Methods: FRAX score was applied to one hundred and thirteen IBD patients (60 CD male 31, 53 UC male 32) who underwent DEXA scans at the femoral neck during the period 20092011. All patients were informed for the test and they had written consent. Calculations of the FRAX score were made with a free web based algorithm (http://www.shef.ac.uk/FRAX/) at first without including the BMD scans which were added afterwards in order to define the accuracy of pre BMD score. FRAX scores were correlated with the patients' clinical characteristics.
Results: The median 10-year probability of a major osteoporotic fracture for IBD patients based on clinical data was 7.4% (IQR: 5.010.3) and including the BMD it was 6.3% (4.510.2). The median 10-year probability of hip fracture based on clinical data was 0.8% (0.42.0) and including the BMD it was 0.9% (0.22.6). A significant positive correlation between pre-BMD and including BMD scores was found (r = 0.77, P < 0.0001 and r = 0.77, P < 0.0001 respectively). The clinical FRAX score alone, when compared with the FRAX score including the BMD result, had a sensitivity of 100% and a specificity of 45% in identifying intermediate or high fracture risk patients. The 10-year risk of a major osteoporotic fracture calculated without and with BMD was significantly higher in CD patients compared with UC patients (P = 0.02 and P = 0.004 respectively). Six CD patients (11.2%) had a high risk for a major osteoporotic fracture (10-year probability >20%). No significant associations between FRAX scores and clinical characteristics (localization, history of surgery, treatment) of IBD patients were found.
Conclusions: The clinical FRAX score alone can predict accurately the risk of osteoporotic fracture in Greek IBD patients. CD patients have significantly higher fracture risk compared with UC patients.