Fragility Score Research Articles

The effect of incontinence after radical prostatectomy on quality of life and frailty

AbstractThis study aimed to determine the effect of incontinence after radical prostatectomy on quality of life and level of frailty. It is a descriptive study conducted with 107 radical prostatectomy patients who were hospitalized in the Urology Clinic of a training and research hospital in Istanbul between March–August 2021, and met the inclusion criteria. Data were collected using the Patient Identification Form, the International Consultation on Incontinence Questionnaire – Male Lower Urinary Tract Symptoms (ICIQ‐MLUTS), and the Edmonton Frail Scale (EFS). The mean fragility score of the patients was 7.82 ± 2.63, and 27% of them were ‘Mildly Frail’ and 25.2% were ‘Moderately Frail’. The ICIQ‐MLUTS voiding complaints sub‐dimension score of the patients was 8.62 ± 3.48, and the voiding complaints bother score was found to be 24.8 ± 9.85. The ICIQ‐MLUTS storage complaints sub‐dimension score was 12.13 ± 3.05, and the storage complaints bother score was 36.25 ± 9.02. The ICIQ‐MLUTS daytime urinary frequency subdimension score was 2.35 ± 0.93, and the daytime urinary frequency bother score was 6.94 ± 2.17. The ICIQ‐MLUTS nocturnal urinary frequency sub‐dimension score was 2.79 ± 0.88, and the nocturnal urinary frequency discomfort level score was found to be 7.37 ± 2.19. In this study, it was observed that patients' complaints regarding lower urinary tract symptoms and their quality of life were at a moderate level and the frailty levels increased with the increasing severity of incontinence symptoms after radical prostatectomy.

A Case Showing a New Diagnostic Aspect of the Application of Radiofrequency Echographic Multi-Spectrometry (REMS).

Radiofrequency echographic multi-spectrometry (REMS) is an ultrasound technique that has been recently introduced in the medical field to detect osteoporosis and fracture risk at axial sites. The use of sonography to visualize the region of interest (ROI) of the hip neck provides the opportunity to identify occult fractures. A 91-year-old woman with persistent right leg pain was referred to rheumatologist due to a known history of arthritis and osteoporosis. She was able to walk using a crutch, although experiencing an antalgic gait. The patient had recently fallen on her right side from standing height. During the visualization of the ROI of the right femoral neck using REMS, an abrupt break of the femoral cortex suspected to be a fracture was seen; therefore, the measurement of the femoral neck was performed on the left side. The T-score had value of -2.9 SD and the fragility score was 86.7. Due to unclear signs of a fracture after an X-ray of the hip, a computed tomography (CT) exam of the hip was performed, which revealed a femoral neck fracture. Occult fractures of the femoral neck are challenging to diagnose and require numerous radiologic exams. The use of ultrasound as a method to measure bone density allows the simultaneous diagnosis of osteoporosis and detection of fractures.

Effect of the body mass index, basal metabolic rate, and body fat on the radiofrequency echographic multi-spectrometry (REMS)-based bone mineral density and fracture risk: a cross-sectional study.

Radiofrequency echographic multi-spectrometry (REMS) is a method to assess bone mineral density (BMD) of the axial skeleton, fragility score (FS), body mass index (BMI), basal metabolic rate (BMR), and body fat (BF) in %. The aim of the study was to investigate the influence of the BMI, BMR, and BF on the BMD and fracture risk with REMS. We conducted a cross-sectional study among 313 women, aged 20-90years who underwent a screening for osteoporosis with REMS. Kruskal-Wallis was used to analyze the differences in BMI, BMR, and BF between the groups according to the BMD: normal BMD, osteopenia and osteoporosis and differences in the FS, fracture risk assessment (FRAX) for major osteoporotic fractures and for hip fractures (HF) according to the BMI groups: underweight, normal weight, overweight, obese, and extreme obese. Linear regression was used to assess the correlations BMI-BMD, BMR-BMD, and BF-BMD. BMI, BMR, and BF differed significantly between the groups according to the BMD (p < 0.001, p = 0.028, and p < 0.001, respectively). BMR showed high positive correlation to BMD (R = 0.765) with 95% confidence interval (CI) [0.715, 0.807] and significance of p < 0.001. BMI correlated significantly to BMD (p < 0.001), the correlation was low positive (R = 0.362) with 95% CI [0.262, 0.455]. In the BMI groups, there was significant difference in FRAX for HF and FS with p value 0.014 and < 0.001, respectively. Subjects with low BMI, BMR, and BF are at high risk for osteoporosis. Underweight women show significantly high fracture risk, assessed with FRAX and FS.

Fragility Score: a REMS-based indicator for the prediction of incident fragility fractures at 5 years

BackgroundAccurate estimation of the imminent fragility fracture risk currently represents a challenging task. The novel Fragility Score (FS) parameter, obtained during a Radiofrequency Echographic Multi Spectrometry (REMS) scan of lumbar or femoral regions, has been developed for the non-ionizing estimation of skeletal fragility.AimsThe aim of this study was to assess the performance of FS in the early identification of patients at risk for incident fragility fractures with respect to bone mineral density (BMD) measurements.MethodsData from 1989 Caucasians of both genders were analysed and the incidence of fractures was assessed during a follow-up period up to 5 years. The diagnostic performance of FS to discriminate between patients with and without incident fragility fracture in comparison to that of the BMD T-scores measured by both Dual X-ray Absorptiometry (DXA) and REMS was assessed through ROC analysis.ResultsConcerning the prediction of generic osteoporotic fractures, FS provided AUC = 0.811 for women and AUC = 0.780 for men, which resulted in AUC = 0.715 and AUC = 0.758, respectively, when adjusted for age and body mass index (BMI). For the prediction of hip fractures, the corresponding values were AUC = 0.780 for women and AUC = 0.809 for men, which became AUC = 0.735 and AUC = 0.758, respectively, after age- and BMI-adjustment. Overall, FS showed the highest prediction ability for any considered fracture type in both genders, resulting always being significantly higher than either T-scores, whose AUC values were in the range 0.472–0.709.ConclusionFS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk.

Reproducibility and Accuracy of the Radiofrequency Echographic Multi-Spectrometry for Femoral Mineral Density Estimation and Discriminative Power of the Femoral Fragility Score in Patients with Primary and Disuse-Related Osteoporosis.

We aimed to investigate the reproducibility and accuracy of Radiofrequency Echographic Multi-Spectrometry (REMS) for femoral BMD estimation and the reproducibility and discriminative power of the REMS-derived femoral fragility score. 175 patients with primary and disuse-related osteoporosis were recruited: one femoral Dual-energy X-ray Absorptiometry (DXA) scan and two femoral REMS scans were acquired. No significant test—retest differences were observed for all REMS-derived variables. The diagnostic concordance between DXA and REMS was 63% (Cohen’s kappa = 0.31) in patients with primary osteoporosis and 13% (Cohen’s kappa: −0.04) in patients with disuse-related osteoporosis. No significant difference was observed between REMS and DXA for either femoral neck BMD (mean difference between REMS and DXA: −0.015 g/cm2) or total femur BMD (mean difference: −0.004 g/cm2) in patients with primary osteoporosis. Significant differences between the two techniques were observed in patients with disuse-related osteoporosis (femoral neck BMD difference: 0.136 g/cm2; total femur BMD difference: 0.236 g/cm2). Statistically significant differences in the fragility score were obtained between the fractured and non-fractured patients for both populations. In conclusion, REMS showed excellent test-retest reproducibility, but the diagnostic concordance between DXA and REMS was between minimal and poor. Further studies are required to improve the REMS—derived estimation of femoral BMD.

Literature review of Radiofrequency Echographic Multi-Spectrometry (REMS) in the diagnosis of osteoporosis and bone fragility

Background. Osteoporosis is a frequent comorbidity among patients with inflammatory rheumatic diseases, due to the impact of their therapies, the hish systemic inflammation and the large scale use of glucocorticoid treatment. Use of DXA and REMS. Dual X-ray Absorptiometry (DXA) is the “gold standard” for detecting patients with low bone mineral density (BMD), using Z and T scores to define the thresholds for diagnosis of osteopenia and osteoporosis, but this method has proven many disadvantages in time, especially in patients with inflammatory rheumatic diseases, those diagnosed with a disease in the spectrum of spondyloarthritides. Therefore, in the last years, a new method of evaluating bone mineral density (BMD) was developed and benefited from numerous efficiency studies: REMS (Radiofrequency Echographic Multi-Spectrometry). The basis of the method is its ability to identify and analyze native unfiltered ultrasound waves that reflect from the bone surface of the vertebra and femoral neck, the so-called echographic radiofrequency (RF) waves. The analysis of all RF waves spectra allows both a quantitative as well as a qualitative assessment of the bone, thus effectively obtaining estimates of bone resistance and evaluating fracture risk through indirect analysis of bone architecture. Conclusions. The studies concluded that REMS is a method at least as good as DXA in detecting patients with osteoporosis by applying the definitions of the World Health Organization (WHO), and also discovered many advantages of the REMS method, probably the biggest advantages being the ability of this ultrasound method of evaluating bone fragility independent of BMD by introducing the Fragility Score (FS) and the possibility of using the ultrasound method in identifying bone demineralization and fragility in pregnant women. Furthermore, numerous studies begin to recognize the usefulness of REMS in diagnosis and evolution of patients with osteoporosis and inflammatory rheumatic diseases. Discussions. A new concept that should be considered is the fact that REMS could potentially more accurately evaluate BMD and bone fragility through the FS in patients with diseases from the spectrum of spondyloarthritides(especially those with ankylosing spondylitis and psoriatic arthritis).

Changes in Kidney Graft Function in COVID-19 Convalescents

BackgroundKidney transplant recipients (KTRs) are at an increased risk of infection with severe acute respiratory syndrome coronavirus 2, with mortality from 13% to over 30%. However, data concerning the influence of COVID-19 on long-term graft function in convalescents is lacking. The aim of this study was to evaluate the influence of COVID-19 on graft function at 6 months after recovery.MethodsA longitudinal controlled study was conducted in a group of 1058 KTRs. Of 180 patients with COVID-19 in the past, 77 KTRs (45 male) with a mean age 50.57 ± 13.37 years, Charlson Comorbidity Index of 3 (median; interquartile range [IQR], 3-5), Fragility Score of 3 (median; IQR, 3-3), and minimum 6 months after acute COVID-19 were included. The most common symptoms were weakness (75.33%), fever (74.03%), cough (51.95%), and loss of appetite (48.05%). Thirty-three patients were hospitalized; none required invasive ventilation therapy, but 16 required oxygen support. The treatment of COVID-19 included antibiotics (38.96%), thromboprophylaxis (25.97%), and nonsteroidal anti-inflammatory drugs, or paracetamol (25.97%).ResultsThe median (IQR) values of serum creatinine 3 months before the onset and 6 months after COVID-19 were 1.25 (0.98-1.86) and 1.26 (1.03-1.78) mg/dL (nonsignificant difference); in strata analysis, there were also no differences with regards to patients with higher and lower comorbidity (3 < Charlson Comorbidity Index < 3) and fragility (3 < Fragility Score < 3). Furthermore, creatinine concentration in KTRs and controls did not differ.ConclusionsIn the group of KTRs with a mild course of COVID-19, no negative impact of the infection on graft function was observed 6 months after transplantation.

POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)&lt;0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)&lt;0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.

577 Risk Factors Analysis for Contralateral Neck of Femur Fracture in Elderly Population

Abstract Introduction Neck of femur fracture (NOFF) carries significant morbidity, mortality, and cost implication to the health system. Subsequent contralateral fracture(SCNOFF) further decreases patient performance and increases healthcare burden. The aim of this study was to identify and evaluate potential risk factors and effects of SCNOFF. Method Retrospectively analysed NOFF database from 2012 to 2019 was. Inclusion criteria were patients over 60 years with low energy fractures. Polytrauma, pathological and atypical fractures were excluded. Results There were 114 patients (4.18%) with contralateral hip fractures out of 2727 total NOFF patients. Mean age was 82 years old for the first hip fracture and 85 years for the second. Average time interval between fractures was 36 months. During the two admissions, mean decline in Abbreviated Mental Test Score(AMTS) was 0.4, deterioration of Clinical Fragility Score and Charlson Morbidity Index were from 4.5 to 5.9 (P &amp;lt; 0.0001), and from 5.4 to 6.1 respectively. Mobility was dropped by one level. institutional residency was increased from 23 to 46 (P &amp;gt; 0.0014). Conclusions There is a drastic decline in clinical frailty, mobility status and increase residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing preventive measures to reduce the incidence of SCNOFF.

Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Breast Reconstruction.

Frailty can be quantified using an index score to effectively predict surgical outcomes and complications. The modified frailty index (mFI) score includes 5 patient-specific medical history comorbidities including diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease/pneumonia, and nonindependent functional status. The purpose of our study was to apply the 5-item mFI score to predict and minimize complications in patients undergoing breast reconstruction. The National Surgical Quality Improvement Program was queried for all patients undergoing primary breast reconstruction from 2016 to 2018. Patients were divided based on timing of reconstruction and type of reconstruction: immediate or delayed, and implant based or autologous based. A validated modified fragility score was applied to all patients. Patients were stratified by mFI scores of 0 (no comorbidities), 1 (1 comorbidity), and 2+ (2 or more comorbidities). Patient demographics and 30-day complications rates were recorded. A total of 22,700 patients were identified. There were 10,673 patients who underwent immediate breast reconstruction, and 12,027 patients who underwent delayed breast reconstruction. A total of 14,159 patients underwent implant-based, and 8541 underwent autologous-based reconstruction. A total of 16,627 patients had an mFI score of 0, 4923 had a mFI score of 1, and 1150 had a mFI score of 2+. Compared with patients with an mFI score of 0, patients with an mFI score of 2 or greater were more likely to develop a postoperative complication (7.2 vs 12.3; P < 0.0001). Patients undergoing immediate reconstruction were more likely to develop a postoperative complications for every mFI category. The most common complications were wound and hematologic related. Patients with higher mFI scores are likely to have an increase in postoperative complications after breast reconstruction. Increasing body mass index increases postoperative complications independent of frailty index scores. Patients with increasing frailty index scores undergoing immediate breast reconstruction have a significantly higher risk of postoperative complications compared with delayed reconstruction.Patients with increasing frailty index scores undergoing autologous breast reconstruction have a significantly higher risk of postoperative complications compared with implant-based reconstruction. High frailty index scores are associated with a higher risk of postoperative complications, reoperation rates, and readmission rates. Patients with higher mFI scores may benefit from a delayed implant-based reconstruction.

P1201THE AGING OF THE IMMUNE SYSTEM AND FRAGILITY: TWO FEATURES IN PERITONEAL DIALYSIS AND END-STAGE RENAL DISEASE PATIENTS

Abstract Background and Aims Chronic kidney disease (CKD) is associated with premature immune aging and increased inflammatory activity leading into endothelial damage and macrophage senescence (CD14+CD16+). Objective. To evaluate the influence of CKD in senescent immune cells, and its relationship with fragility in patients with nondialysis CKD (ND-CKD) and Peritoneal Dialysis (PD). Method A descriptive transversal study analysing lymphocyte absolute counts and subpopulations in 74 CKD patients (36 DP, 38 ND-CKD) compared with 10 healthy subjects (HS). We also assessed immunoglobulin levels, C3 and C4 fragment complement, Edmonton fragility score and the percentage of proinflammatory blood monocytes with the CD14+CD16+ phenotype. Results PD patients presented more absolute lymphopenia compared with LCC and HS (PD 1194,2, 1589 ND-CKD and 1802 HS; p &amp;lt;0,001, respectively). This lymphopenia is also maintained in CD3, CD4, CD8 and NK cells. Lower CD4 lymphocytes levels were significantly correlated with higher fragility and incidence of peripheral vascular disease in uremic patients. Senescent macrophage was correlated with CD3 and CD4 lymphocytes all the cohorts (ND-CKD, PD and HS). Conclusion PD patients presented changes in immune system compared with healthy population, that could explain accelerated senescence. Accelerated senescence is associated with more fragility and endothelial damage. There are necessary more studies to identify the role premature aging in ND-CKD and to establish the differences between renal replacement modalities.

Derivation and Validation of a Risk Stratification System for Predicting Postoperative Cognitive Impairment

Background To establish and validate a risk stratification scoring system (we name it as PreOp-BFS, which represents Pre-Operative Brain Fragility Score) for postoperative cognitive impairment containing postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) in elderly patients undergoing non-cardiac surgery. Methods We searched for relevant literatures and reviews reported in PubMed and ScienceDirect databases from January 1994 to December 2017. We performed a preoperative risk factor for cognitive impairment in elderly patients (age ≥ 60 years) who underwent non-cardiac surgery, and finally constructed a risk scoring system to predict postoperative cognitive impairment. Results The test data included 49 patients with postoperative cognitive impairment and 31 patients without postoperative cognitive impairment. The postoperative risk scale score ranged from 0 to 8 points. The incidence of postoperative cognitive impairment was 16.2%, 62.9% and 96.2% in the low (0–2 scores), medium (3–4 scores) and high (5–8 scores) risk groups, respectively. In addition, the risk of postoperative cognitive impairment was significantly higher in high and medium risk groups than in low risk group. Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of the risk scoring system was 0.862 [95% CI 0.784–0.941]. Conclusions The preoperative risk stratification scoring system (PreOp-BFS) established in this study had a good prediction effect, which was helpful for rapid identification and screening of high-risk susceptible patients with early postoperative cognitive impairment, and for performing targeted perioperative prevention.

Predictive capacities at the end of hospitalisation in geriatrics of the modified SEGA frailty score: a 6-month prospective study

We performed a prospective, single-center cohort study in patients leaving geriatric hospitalization between July 2016 and February 2017, with follow-up at 6 months. Patients 65 years of age and over, returning home, were included. The primary outcome measure was admission to an institution at 6 months. We realized a Cox model to explore the predictive character of the variables. Thirty-three patients (18.4%), mean age 80.9 years (± 6.5), were not very fragile. At 6 months, 13.5% of the fragile or very fragile patients and 1.2% of the patients who were not very fragile had entered the institution (p = 0.169). Fragility status was statistically significantly associated with rehospitalization at 3 months (p = 0.026) and single or multiple drop at 6 months) month (p = 0.003). The SEGAm grid would predict the occurrence of derogatory events and improve return home.

Deterioration of Cortical and Trabecular Microstructure Identifies Women With Osteopenia or Normal Bone Mineral Density at Imminent and Long-Term Risk for Fragility Fracture: A Prospective Study.

ABSTRACTMore than 70% of women sustaining fractures have osteopenia or “normal” bone mineral density (BMD). These women remain undetected using the BMD threshold of −2.5 SD for osteoporosis. As microstructural deterioration increases bone fragility disproportionate to the bone loss producing osteopenia/normal BMD, we hypothesized that the structural fragility score (SFS) of ≥70 units, a measure capturing severe cortical and trabecular deterioration, will identify these women. Distal radial images were acquired using high‐resolution peripheral quantitative tomography in postmenopausal French women, mean age 67 years (range 42–96 years); 1539 women were followed for 4 years (QUALYOR) and 561 women followed for 8 years (OFELY). Women with osteopenia or normal BMD accounted for ~80% of fractures. Women ≥70 years, 29.2% of the cohort, accounted for 39.2% to 61.5% of fractures depending on follow‐up duration. Women having fractures had a higher SFS, lower BMD, and a higher fracture risk assessment score (FRAX) than women remaining fracture‐free. In each BMD category (osteoporosis, osteopenia, normal BMD), fracture incidence was two to three times higher in women with SFS ≥70 than <70. In multivariable analyses, associations with fractures remained for BMD and SFS, not FRAX. BMD was no longer, or weakly, associated with fractures after accounting for SFS, whereas SFS remained associated with fracture after accounting for BMD. SFS detected two‐to threefold more women having fractures than BMD or FRAX. SFS in women with osteopenia/normal BMD conferred an odds ratio for fracture of 2.69 to 5.19 for women of any age and 4.98 to 12.2 for women ≥70 years. Receiver‐operator curve (ROC) analyses showed a significant area under the curve (AUC) for SFS, but not BMD or FRAX for the women ≥70 years of age. Targeting women aged ≥70 years with osteopenia indicated that treating 25% using SFS to allocate treatment conferred a cost‐effectiveness ratio < USD $21,000/QALY saved. Quantifying microstructural deterioration complements BMD by identifying women without osteoporosis at imminent and longer‐term fracture risk. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Increased Cortical Porosity and Reduced Trabecular Density Are Not Necessarily Synonymous With Bone Loss and Microstructural Deterioration.

Absolute values of cortical porosity and trabecular density are used to estimate fracture risk, but these values are the net result of their growth‐related assembly and age‐related deterioration. Because bone loss affects both cortical and trabecular bone, we hypothesized that a surrogate measure of bone fragility should capture the age‐related deterioration of both traits, and should do so independently of their peak values. Accordingly, we developed a structural fragility score (SFS), which quantifies the increment in distal radial cortical porosity and decrement in trabecular density relative to their premenopausal mean values in 99 postmenopausal women with forearm fractures and 105 controls using HR‐pQCT. We expressed the results as odds ratios (ORs; 95% CI). Cortical porosity was associated with fractures in the presence of deteriorated trabecular density (OR 2.30; 95% CI, 1.30 to 4.05; p = 0.004), but not if trabecular deterioration was absent (OR 0.96; 95% CI, 0.50 to 1.86; p = 0.91). Likewise, trabecular density was associated with fractures in the presence of high cortical porosity (OR 3.35; 95% CI, 1.85 to 6.07; p < 0.0001), but not in its absence (OR 1.60; 95% CI, 0.78 to 3.28; p = 0.20). The SFS, which captures coexisting cortical and trabecular deterioration, was associated with fractures (OR 4.52; 95% CI, 2.17 to 9.45; p < 0.0001). BMD was associated with fracture before accounting for the SFS (OR 5.79; 95% CI, 1.24 to 27.1; p = 0.026), not after (OR 4.38; 95% CI, 0.48 to 39.9; p = 0.19). The SFS was associated with fracture before (OR 4.67; 95% CI, 2.21 to 9.88) and after (OR 3.94; 95% CI, 1.80 to 8.6) accounting for BMD (both ps < 0.0001). The disease of bone fragility is captured by cortical and trabecular deterioration: A measurement of coexisting cortical and trabecular deterioration is likely to identify women at risk for fracture more robustly than absolute values of cortical porosity, trabecular density, or BMD. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research

TCT-187 Correlation Between Psoas Muscle Area and Clinical Fragility Score in Patients Undergoing Transcatheter Aortic Valve Implantation Patients

TCT-187 Correlation Between Psoas Muscle Area and Clinical Fragility Score in Patients Undergoing Transcatheter Aortic Valve Implantation Patients

A quantitative ultrasound approach to estimate bone fragility: A first comparison with dual X-ray absorptiometry

Abstract Aim of this paper was to assess the discrimination power of a novel ultrasound (US) parameter, called the Fragility Score (F.S.), in the early identification of subjects prone to osteoporotic fractures. A total of 102 female patients were recruited: 49 with a recent osteoporotic fracture (“frail” subjects), 53 were controls without fracture history (“non-frail” subjects). All the patients underwent a spinal DXA (dual X-ray absorptiometry) and an abdominal US scan of lumbar vertebrae. Acquired US data were analyzed by a novel algorithm, which calculated the F.S. through spectral and statistical analyses involving both echographic images and corresponding “raw” signals. F.S. showed a good performance in discriminating “frail” from “non-frail” subjects (sensitivity = 76%, specificity = 68%), resulting even slightly more effective than DXA-measured BMD (sensitivity = 73%, specificity = 66%). This methodology has a potential to become an effective tool for the early identification, and timely treatment, of “frail” subjects.

Ultrasound Fragility Score: An innovative approach for the assessment of bone fragility

Aim of this paper was to assess the clinical effectiveness of a novel ultrasound (US) approach for the estimation of bone fragility. A total of 85 female patients (40–80 years) were recruited and underwent conventional DXA investigations of both lumbar spine and proximal femur, an abdominal US scan of the lumbar spine and the FRAX® questionnaire for the calculation of osteoporotic fracture probabilities. Acquired US data were analyzed through an automatic algorithm that calculated the Fragility Score (F.S.), a parameter that estimates skeletal fragility from dedicated spectral and statistical analyses. F.S. showed a good correlation with the most reliable fracture risk predictions obtained by FRAX® (r = 0.71, p < 0.001). Since this correlation level with FRAX® outcomes was much better than lumbar BMD one (|r| = 0.43) and very similar to that obtained for femoral neck BMD (|r| = 0.72), F.S. has the potential to become a simple and non-ionizing method for bone fragility assessment.

New perspectives in echographic diagnosis of osteoporosis on hip and spine.

Currently, the accepted "gold standard" method for bone mineral density (BMD) measurement and osteoporosis diagnosis is dual-energy X-ray absorptiometry (DXA). However, actual DXA effectiveness is limited by several factors, including intrinsic accuracy uncertainties and possible errors in patient positioning and/or post-acquisition data analysis. DXA employment is also restricted by the typical issues related to ionizing radiation employment (high costs, need of dedicated structures and certified operators, unsuitability for population screenings). The only commercially-available alternative to DXA is represented by "quantitative ultrasound" (QUS) approaches, which are radiation-free, cheaper and portable, but they cannot be applied on the reference anatomical sites (lumbar spine and proximal femur). Therefore, their documented clinical usefulness is restricted to calcaneal applications on elderly patients (aged over 65 y), in combination with clinical risk factors and only for the identification of healthy subjects at low fracture risk. Literature-reported studies performed some QUS measurements on proximal femur, but their clinical translation is mostly hindered by intrinsic factors (e.g., device bulkiness). An innovative ultrasound methodology has been recently introduced, which performs a combined analysis of B-mode images and corresponding "raw" radiofrequency signals acquired during an echographic scan of the target reference anatomical site, providing two novel parameters: Osteoporosis Score and Fragility Score, indicative of BMD level and bone strength, respectively. This article will provide a brief review of the available systems for osteoporosis diagnosis in clinical routine contexts, followed by a synthesis of the most promising research results on the latest ultrasound developments for early osteoporosis diagnosis and fracture prevention.

SAT0468 An Innovative Ultrasound-Based Method for the Estimation of Osteoporotic Fracture Risk

BackgroundOsteoporosis affects about 200 million people in the world and is responsible for 8.9 million fractures each year worldwide. Hip fractures are a major public health burden, from both social...