P101 RESULTS AFTER MULTIDISCIPLINARY TREATMENT IN PATIENTS WITH PRIMARY CHRONIC PAIN, SECUNDARY CHRONIC PAIN AND FIBROMYALGIA A. A. G. Arias Gassol 1, T. R. A. Rodriguez Araya1, L. P. Polino1, X. T. M. Torres Mata1 1HOSPITAL CLINIC BARCELONA, BARCELONA, Spain

Introduction: Chronic pain is the most prevalent pathology in terms of functional disability in our country. Our Primary Chronic Pain Unit manages patients with a variety of chronic pain conditions, including musculoskeletal, visceral, post-oncological pain. This study aims to compare pain, fatigue and functional capacity before and after a multidisciplinary treatment approach (medical, psychological, physical and occupational therapy), using the Fibromyalgia Impact Questionnaire (FIQ) as the measure for functional capacity.

Background and objective: To evaluate the differences in pain, fatigue and functional capacity between patients with Primary Chronic Pain (PCP), Secondary Chronic Pain (SCP), and fibromyalgia (FM) before and afeter multidisciplinary treatment.

Patients and methods: A total of 40 PCP patients, 68 SCP patients and 166 FM patients were enrolled. Pain, fatigue and functional capacity were assessed before and after treatment. All patients received a comprehensive treatment plan involving medical, psychological, physical and occuprational therapy. Pain Visual Analogue Scale (VAS), fatigue VAS anf functional capacity were the primary variables analyzed.

Results: Baseline pain scores were 6.23 for FM, 6.75 for PCP, 6,58 for SCP. After treatment, pain decreased to 3,57 for FM, 1,43 for PCP, and 1,67 for SCP.

Baseline Fatigue scores were 6,46/10 for FM, 5,30 for PCP, and 3,54 for SCP. After treatment, fatigue improved to 4.03 for FM, 1,59 for PCP and 1,91/10 for SCP.

Functional capacity (FIQ) improved from 66,67 to 32.71 in FM, from 59.45 to 12.81 in PCP and from 66.00 to 14.97 in SCP.

Conclusions: Multidisciplinary treatment significantly improved pain, fatigue and functional capacity across all patient groups, demonstrating its effectiveness in managing various chronic pain conditions.

Keywords: Primary Chronic Pain; Secondary Chronic Pain, Fibromyalgia; VAS pain; VAS fatigue; Disability (FIQ).

P102 SARCOPENIA RISK IN WOMEN WITH POSTMENOPAUSAL OSTEOPOROSISB. K. Turan1, A. A. Küçükdeveci 1, Z. Günendi2, A. Yaman3, O. Özdemir4, J. Meray2, Y. G. Kutsal4 1Ankara University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkiye, 2Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkiye, 3Health Science University, Ankara Etlik City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkiye, 4Hacettepe University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkiye

Objective: Osteoporosis and sarcopenia are disorders of bone and muscle, respectively. Studies reported that these disorders were interrelated. However, this relation was explored in older adults and/or with certain comorbidities. Therefore, the aim of this study was to assess the relation between osteoporosis and risk of sarcopenia in postmenopausal women aged ≤ 70 years.

Materials and methods: This multicenter prospective case–control study included 238 postmenopausal women. Dual-energy x-ray absorptiometry was performed to diagnose osteoporosis. Sociodemographic and clinical factors, risk of sarcopenia (SARC-F), muscle strength (grip strength and five-times sit-to-stand test: 5T-STS), and physical activity levels (International Physical Activity Questionnaire-short form) were compared between osteoporotic and non-osteoporotic participants.

Results: No significant differences were observed between participants with or without osteoporosis regarding risk of sarcopenia, skeletal muscle strength, probable sarcopenia, and physical activity level (Table). Osteoporotic group had lower body mass index (BMI) and protein intake. BMD values at L1-4 and femoral neck were not correlated with grip strength and 5T-STS (p > 0.05). The older participants (p = 0.002) with lower physical activity levels (p < 0.001) were found to have higher risk of sarcopenia.

 

Non-osteoporosis (n = 119)

Osteoporosis (n = 119)

p

Age

59 (54–64)

58 (55–63)

0.933a

BMI

31 ± 5

27 ± 5.1

< 0.001b

Educational status (> 5 years)

31.9

49.6

0.006c

Covered clothing (with scarf)

70.6

56.3

0.022c

Menopause age

47 (43–50)

46 (41–50)

0.495a

Number of pregnancies

4 (2–4)

3 (2–4)

0.020a

Current smoking

11.9

22.7

0.028c

Protein intake (g/day)

43 (31–53)

38 (29–49)

0.011a

Risk of sarcopenia (SARC-F ≥ 4)

38.7

48.7

0.117c

5T-STS (sec)

14 (11.7–16)

13.9 (11.7–16)

0.986a

Grip strength (kg)

22 (17.8–26)

23 (18.2–27)

0.329a

Probable sarcopenia (grip strength < 16 kg)

15.3

14.5

0.876c

Physical activity level (MET-minutes per week)

792 (248–2226)

908 (380–1782)

0.983a

aMann Whitney-U test, median (25th–75th percentiles); bIndependent T-test, mean ± SD; cPearson Chi-Square test, percentage

Conclusion: There was no elevated risk of sarcopenia in women with postmenopausal osteoporosis aged ≤ 70 years. Risk of sarcopenia was related to older age and lower physical activity level.

References:

1.

Yu X, et al. Medicine (Baltimore). 2022;101(46):e31692.

2.

Cruz-Jentoft AJ, et al. Age Ageing. 2019;48(1):16–31.

P103 THE STUDY OF VITAMIN D LEVELS IN PATIENTS WITH OBESITY AND OSTEOARTHRITISG. N. Koshukova1, A. A. Zayaeva 1, E. M. Dolya1, V. B. Kaliberdenko1, V. A. Fursova2, N. G. Nikolashina1, E. R. Kulieva1 1V.I. Vernadsky Crimean Federal University, Simferopol, Russia, 2State Budgetary Healthcare Institution of the Republic of Crimea "Republican Clinical Hospital named after N.A. Semashko", Simferopol, Russia

Objective: Among the numerous factors, influencing the intake, synthesis and metabolism of vitamin D, a significant role is given to metabolic disorders like obesity. There are several mechanisms for reducing vitamin D levels in the blood, including the accumulation of 25(OH)D in adipose tissue and decreased synthesis of cholecalciferol in the skin.

Methods: The analysis of the level of vitamin D (intermediate form in its metabolism—calcidiol or 25(OH)D in the blood serum was carried out in 82 patients with obesity and osteoarthritis (27 men, 55 women aged 49–78 years). The normal level of vitamin D was defined as the concentration of 25(OH)D in the blood serum > 30 ng/ml, deficiency—30 to 20 ng/ml and severe deficiency < 10 ng/ml. Body mass index (BMI) was calculated for all patients using the A. Obesity was diagnosed with a BMI ≥ 30 kg/m2. The 46.3% of patients reported regular intake of vitamin D3 at a prophylactic dose of 2000 IU per day.

Results: According to BMI, patients were divided into 4 groups: 25–29.9 kg/m2—overweight (n = 19), 30–34.9 kg/m2—grade 1 obesity (n = 22), 35–39.9 kg/m2—grade 2 obesity (n = 27), 40 kg/m2 and more—grade 3 obesity (n = 14). Most patients in groups 1 and 2 (73.7% and 72.7%) had vitamin D deficiency (25.8 ± 2.6 ng/ml and 23.1 ± 2.8 ng/ml), no significant differences were found between the groups. Among patients in groups 3 and 4, vitamin D deficiency was predominant (16.7 ± 4.1 ng/ml and 14.9 ± 3.8 ng/ml), with a significantly higher number of patients (p < 0.05) with severe vitamin D deficiency. A negative relationship was found between the 25(OH)D level and patients' BMI (r = − 0.12, p = 0.04), which allows us to consider obese patients as a risk group for vitamin D deficiency.

Conclusion: The patients with overweight have a decrease level of vitamin D3, which correlates with the degree of obesity. Thus, it is necessary to identify obese patients as a separate risk group for vitamin D deficiency, determine their serum 25(OH)D levels, and, if a deficiency or deficiency is detected, recommend taking higher doses of cholecalciferol.

P104 THE FEATURES OF OSTEOPOROSIS DEVELOPMENT IN PATIENTS WITH OBESITY AND COMORBID PATHOLOGYG. N. Koshukova1, A. A. Zayaeva 1, V. B. Kaliberdenko1, E. R. Kulieva1, N. G. Nikolashina1, G. V. Nikolashin2 1V.I. Vernadsky Crimean Federal University, Simferopol, Russia, 2St. Luka Multidisciplinary Clinical Hospital of V.I. Vernadsky Crimean Federal University, Simferopol, Russia

Objective: Osteoporosis (OP) and obesity are two common diseases, each of them has own unique characteristics and health consequences. OP characterized by decreased bone density and an increased risk of fractures, is often associated with factors such as age, gender, genetics, and physical activity level. However, in recent decades it has become apparent that obesity also plays a significant role in the development of this disease.

Methods: An analysis of 67 patients aged from 49 to 76 years (mean age 57.1 ± 8.3 years) with excess body weight and a confirmed diagnosis of OP based on X-ray densitometry of the spine and/or proximal femur were identified. At the same time, 62.7% of patients had a high and very high BMI. Among the concomitant diseases, type 2 diabetes mellitus (DM), arterial hypertension, ischemic heart disease, and osteoarthritis were most often noted.

Results: According to the results, osteopenia was prevailed in patients with a BMI of 25.0–29.9 kg/m2, while with a BMI of more than 30.0 kg/m2, there was a tendency for bone mineral density (BMD) to decrease with the development of OP. The fractures of the vertebral bodies and femoral neck were diagnosed in 21 patients (31.3%) mostly with a BMI more than 30.0 kg/m. When assessing comorbid diseases, the lowest manifestations of bone pathology were observed in patients with type 2 diabetes, which did not correspond to a higher incidence of fractures of both the vertebral bodies and the femur in this category of patients. Also, OP was noted in individuals with poorly controlled arterial hypertension, which may be associated with hyperactivation of the sympathetic nervous system and the effect on bone resorption. A higher incidence of OP was noted in patients with polyosteoarthrosis in the late stages.

Conclusion: Thus, the significant disorders of bone metabolism were noted in individuals with BMI more than 30.0 kg/m2 and with poorly controlled arterial hypertension and in the late stages of polyosteoarthrosis. The obtained results require further more detailed study.

P105 INCIDENCE OF FEMUR FRACTURE IN IRAQ AND THE DEVELOPMENT OF NATIONAL IRAQI FRAX MODEL A. Abdulbari 1, N. Jassim2, Y. Motleq1, I. Frax Group3 1Ibn Sina Training Hospital, BAGHDAD, Iraq, 2Baghdad University/college of Medicine, Baghdad, Iraq, 3MOH, BAGHDAD, Iraq

The development of an accurate, country-specific FRAX model requires a reliable estimation of the incidence rate of major osteoporotic fractures, particularly femur (hip) fractures, which are a critical indicator of osteoporosis risk. This Retrospective study aims to calculate the national incidence rate of femur fractures to support the establishment of a precise FRAX model tailored for our population.

This study documented the incidence of hip fractures in Iraq in order to permit the construction of Iraqi FRAX model. The study to define the incidence of hip fracture was developed in collaboration between doctors from institutes belong to Ministry of Health & Ministry of Higher Education to represent by (Iraqi National FRAX Group).Using data from hospital records, databases, and registries, we identified and analyzed cases of femur fractures over 2022 & 2023.

In this study include all the numbers of hip fractures from all Iraqi governates. Data on hip fracture were collected on Iraqi citizens age 40 years and above irrespective of degree of trauma.In both sex, the incidence of hip fracture increased with age as expected. The total incidence of hip fracture in Iraq for 2022 and 2023 Male incidences were higher than females, The incidence in 2023 is higher than in 2022.Mortality rate is higher in male in 2022 & 2023.

This study emphasizes the importance of country-specific data in accurately estimating osteoporosis risk and enhancing preventive strategies through the FRAX tool, ultimately improving patient outcomes and reducing healthcare burdens associated with osteoporotic fractures.

P106 DECODING THE MYSTERY: WHEN RHEUMATOID ARTHRITIS ISN'T WHAT IT SEEMS A. Abdulbari 1, F. F. Jalil2, S. M. Talib3 1Ibn Sina Training Hospital, BAGHDAD, Iraq, 2MOH, BAGHDAD, Iraq, 3Baghdad Teaching Hospital, Baghdad, Iraq

Pachydermoperiostosis (primary hypertrophic osteoarthropathy) is a rare familial autosomal dominant disease. Complete form characterized by triad of skin thickening (pachydermia), skeletal manifestation (periostosis and arthritis), and finger clubbing. Pachydermoperiostosis has been associated with many clinical conditions noted in different case reports, and this include; arthritis and osteoporosis. We report a patient who had complete form of this syndrome in association with Osteoporosis and Rheumatoid arthritis mimic.

Keywords: pachydermoperiostosis, hypertrophic osteoarthropathy, rheumatoid arthritis, tofacitinib.

P107 THE RATE OF BONE MINERAL DENSITY LOSS IN ELDERLY WOMEN WITHOUT BASELINE ANTI-RESORPTIVE THERAPY A. Adamenka 1 1Medical University of Belarus, Minsk, Belarus

Objective: To analyze the rate of age-related bone mineral density (BMD) loss in the central skeleton of elderly women using dual-energy X-ray absorptiometry (DXA).

Materials and methods: a retrospective observational study was conducted over 36 months at the Republican Clinical Medical Center of Belarus. It included 27 postmenopausal women aged 70 years and older (mean age: 75.3 ± 4.5 years) with osteoporosis, who had not undergone anti-resorptive therapy. BMD was assessed at the lumbar spine and proximal femur using a GE Healthcare Lunar Prodigy DXA scanner (2018). Data analysis was performed with STATISTICA 10.0, using parametric statistical methods.

Results

Degenerative changes in the lumbar spine were noted in 48.1% of women, with 37.0% presenting vertebral deformities. Artifacts, such as osteoarthritis and femoral head necrosis, affected 3.7% of femoral scans.

Discussion: The significant difference in the rate of BMD loss between the lumbar spine and femoral regions was influenced by artifacts. Degenerative spinal changes, including vertebral deformities and pathological ossification, falsely elevated lumbar spine BMD values. This highlights the importance of considering artifacts when interpreting DXA results.

Conclusions:

1.

Over 36 months, the average annual BMD loss rates in postmenopausal women aged ≥ 70 years were 0.17% in the lumbar spine, 1.97% in the left femoral neck, and 1.73% in the right femoral neck.

2.

Artifacts, such as vertebral deformities and degenerative changes, contributed to discrepancies in BMD loss rates between the spine and femoral regions.

This study underscores the need for accurate interpretation of DXA results, particularly in older women with osteoporosis, to better evaluate BMD changes and the risk of fractures.

P108 VARIABILITY IN BONE MINERAL DENSITY MEASUREMENTS USING RADIOFREQUENCY ECHOGRAPHIC MULTI-SPECTROMETRY COMPARED TO DUAL-ENERGY X-RAY ABSORPTIOMETRY IN A PATIENT WITH PAGET'S DISEASE A. Asanova 1, E. Pigarova1, L. Dzeranova1, N. Tarbaeva1 1Endocrinology Research Centre, Moscow, Russia

Objective: Dual-Energy X-ray Absorptiometry (DXA) is the standard for evaluating bone mineral density (BMD), but emerging technologies, like Radiofrequency Echographic Multi-Spectrometry (REMS), are gaining attention for assessing bone quality without radiation. This clinical case questions whether REMS can be considered a valid diagnostic technique for various patient groups, including those with Paget’s disease.

Material and methods: A 68-year-old female (weight 90 kg, height 154.8 cm, BMI—37.6 kg/m2) two years ago began experiencing left hip joint pain. A year later, a traumatologist diagnosed left-sided coxarthrosis and prescribed NSAIDs, which moderately reduced pain. MRI from May 2024 showed stage III osteoarthritis in the left hip joint, with diffuse irregularity in the left femur, increased bone volume, and increased cellularity. Laboratory results showed alkaline phosphatase—207 U/L (35–104), B-crosslaps—0.962 ng/mL (< 0.573), total Ca—2.67 mmol/L (2.15–2.55), P—1.32 mmol/L (0.81–1.45), PTH—73.1 pg/mL (15–65) and 25(OH) vitamin D—14.7 ng/mL. Paget's disease of the left femur was confirmed by X-ray of the pelvic bones, CT scan, and a whole-body bone scintigraphy showed a monoossal involvement. The patient underwent two different densitometry modalities, REMS and DXA, that showed principal differences at the site of Paget’s lesion. According to REMS the BMD at the lumbar spine (L2) showed osteopenia (− 2.3 SD by T-score) with normal at the left femoral neck (− 0.4 SD) and the right femoral neck (-0.3 SD).However, DXA at the lumbar spine (− 2.5 SD by T-score in L1–L3) was consistent with osteoporosis, while the left femoral neck and total femur showed values significantly higher than normal— + 6.0 SD and + 9.0 SD by T-score, and the right femoral bone indicated a reduction in bone mass to − 1.4 SD and − 0.8 by T-score, accordingly. The patient was initiated on anti-resorptive therapy with 5 mg intravenous zoledronic acid.

Results and conclusions: REMS is a relatively new method for assessing bone quality and diagnosing osteoporosis. It offers reliable precision, predicts fracture risk and may overcome some DXA limitations. Still, this case highlights the need for further evaluation of REMS’s reliability in different patient groups compared to gold standard methods.

P109 A FEMALE PATIENT WITH LIVER INJURY FOLLOWING ZOLEDRONIC ACID INFUSION FOR OSTEOPOROSIS A. Athanasia 1, Z. Zoe1 11Department of Endocrinology, “Hippokration” General Hospital of Thessaloniki, Thessaloniki, Greece, Thessaloniki, Greece

Introduction: Only a small number of cases have documented liver damage following zoledronic acid (ZOL) infusion.

Purpose: Description of a patient with transient hepatotoxicity following ZOL infusion.

Case description: We present the case of a 60-year-old woman with severe postmenopausal osteoporosis and a history of parathyroidectomy due to primary hyperparathyroidism four years before, who experienced temporary liver toxicity following ZOL treatment. Two days after the ZOL infusion, the patient developed a fever reaching up to 38 °C, and serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT) increased by 3.9, 5, and 1.7 times, respectively, compared to baseline values. Further biochemical and serological testing showed no evidence of any underlying liver or systemic disorder. The levels of ALT, AST, and GGT returned to normal within three weeks after treatment.

Conclusion: Given the limited understanding of ZOL-induced hepatotoxicity and the unclear mechanism, it is essential for clinicians to be aware of this potential risk. Increased vigilance and careful monitoring are crucial to minimizing adverse effects and ensuring patient safety.

P110 LEVERAGING ARTIFICIAL INTELLIGENCE FOR ENHANCED DETECTION OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES: A MULTICENTER EVALUATION A. Ayobi 1, G. Chaix2, P. Champsaur2, C. Castineira1, S. Quenet1, J. Kiewsky1, D. Guenoun2 1Avicenna.AI, La Ciotat, France, 2Department of Radiology, Institute for Locomotion, Sainte-Marguerite Hospital, APHM, Marseille, France

Objective: Vertebral compression fractures (VCFs) are a prevalent yet underdiagnosed manifestation of osteoporosis, significantly contributing to morbidity and mortality. Despite advancements in imaging, many VCFs remain unreported in routine radiological analyses, delaying critical interventions. This study compares the standard of care against opportunistic screening powered by an AI tool to identify moderate-to-severe VCFs from computed tomography (CT) scans performed for various clinical indications.

Materials and methods: A retrospective, cross-sectional, multicenter study analyzed CT scans from patients aged ≥ 50 years, collected over two months across four tertiary hospitals from Assistance Publique des Hôpitaux de Marseille (France). Scans flagged by CINA-VCF Quantix (Avicenna.AI, La Ciotat, France) were reviewed by expert radiologists. Discrepancies between the AI and clinical reports were analyzed to calculate AI false positive rate (FPR), positive predictive value (PPV), overall agreement between AI and experts, and clinical reports’ false negative rate (FNR). Additionally, the number of scans needed to screen (NNS) to detect one additional VCF using the tool compared to the standard of care, was computed.

Results: A total of 2224 cases were analyzed and 489 were flagged as positive by the AI. Of these, 312 were confirmed as true positives, yielding a PPV of 63.8% (95% CI 59.4–68.1%) and a FPR of 36.2% (95% CI 32.0–40.6%). Regarding the clinical reports’ FNR, there were 31.1% [27.0–35.4%] of fractures identified by the AI but missed in initial reports. Per-vertebra agreement was 95.8% [95% CI 95.4–96.3%] with values ranging from 80.3% for L5 to 99.0% for L2. Main causes of FP were Schmorl’s nodes, natural L5 deformities and artifacts from surgical materials. The NNS was estimated at 14.6, indicating that analyzing 14.6 scans with AI detects one additional VCF compared to standard practice.

Conclusion: The AI tool demonstrated strong potential to enhance VCF detection, addressing significant gaps in osteoporosis care. While its integration can streamline workflows and improve FNR, human validation remains crucial to mitigate false positives and ensure clinical relevance. Future research should focus on real-time implementation and assessing impacts on patient outcomes and healthcare resource utilization.

P111 URINARY PENTOSIDINE AS A POTENTIAL BIOMARKER OF IMPAIRED BONE HEALTH: A SYSTEMATIC REVIEW AND META-ANALYSISA. Ghaseminejad-Raeini1, A. Shirinezhad1, A. Azarboo 1, A. Mafhoumi1, M. Islampanah2, S. Mohammadi1, A. H. Hoveidaei3 1School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran, 2Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Mashhad, Iran, 3Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran

Objective: Urinary pentosidine, an advanced glycation end product (AGE), has been proposed as a potential biomarker for impaired bone health, especially in older adults and those with diabetes. This study aimed to systematically review and meta-analyze the association of urinary pentosidine with bone mineral density (BMD), fracture risk, and osteoporosis.

Methods: A comprehensive search of Embase, PubMed, Scopus, and Web of Science databases was conducted and records were gathered from 1960 to February 2024. Relevant papers were screened and data were extracted by two independent reviewers. Hedges' g standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated to compare urinary pentosidine levels between patients with and without fractures.

Results: A total of 12 studies comprising 5,878 participants were included in the systematic review. The meta-analysis revealed that patients with fractures had significantly higher urinary pentosidine levels compared to those without fractures (SMD [95% CI] = 0.53 [0.39–0.68]; I2 = 54%; P < 0.01). In patients with vertebral fractures, pentosidine levels were also elevated (SMD [95% CI] = 0.51 [0.32–0.70]; I2 = 64%; P < 0.01). Additionally, some studies demonstrated that an increase in urinary pentosidine was significantly associated with fracture risk (aHR = 1.20 [95% CI = 1.07–1.33]; P = 0.001) and BMD reduction (β = -0.125 [95% CI = − 0.248, − 0.002]; P = 0.047). However, other studies showed inconsistent results, particularly regarding the association between pentosidine and BMD or fracture risk in non-diabetic populations (aRR [95% CI] = 1.08 [0.79–1.49]; P = 0.6). Diagnostic accuracy analyses revealed a sensitivity of 71.9% and specificity of 61.2% for urinary pentosidine in predicting vertebral fracture in patients with type 2 diabetes mellitus.

Conclusion: This systematic review and meta-analysis demonstrate that elevated urinary pentosidine levels are associated with an increased risk of fractures and, to a lesser extent, reduced bone mineral density. Its diagnostic accuracy improves when integrated with other clinical markers, such as BMD and bone turnover indices. However, due to the variability in results, further research is needed to standardize pentosidine's use as a reliable biomarker for impaired bone health in clinical practice.

Keywords: Urinary pentosidine, bone health, bone mineral density, systematic review, predictive biomarker.

P112 A SYSTEMATIC REVIEW OF THE ASSOCIATION BETWEEN INSULIN RESISTANCE SURROGATE INDICES AND BONE MINERAL DENSITYA. Ghaseminejad-Raeini1, A. Azarboo 1, A. Shirinezhad1, F. Kanaani Nejad2, N. Zareshahi1, S. Mohtasham Amiri3, Y. Tahmasebi1, A. H. Hoveidaei4 1School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran, 2Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz, Iran, 3Department of Medicine, Islamic Azad University Tehran Medical Sciences, Iran, Tehran, Iran, 4Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran

Objective: The relationship of insulin resistance with bone mineral density (BMD) remains unclear, offering an opportunity for novel indices to shed light on the matter. The aim of this review was to evaluate the association between surrogate indices of insulin resistance and BMD.

Methods: A systematic review was conducted to evaluate observational studies that examined the relationship between insulin resistance surrogate indices and BMD in adults. Databases including PubMed, Web of Science, Scopus, and Embase were searched. Quality assessment was performed using Joanna Briggs Institute (JBI) critical appraisal tools.

Results: This systematic review included 27 cohorts and cross-sectional studies with 71,525 participants to assess the potential link between insulin resistance surrogate indices like HOMA-IR, HOMA-β, TyG, TyG-BMI, TyG-WtHR, and TyG-WC, along with METS-IR, and VAI, and BMD at various sites. There seems to be no link between BMD and the HOMA index, despite being extensively studied in various studies (adjusted β ranging from -0.49 to 0.103). Most literature suggests that a higher TyG index is associated with decreased BMD levels (adjusted β ranging from − 0.085 to 0.0124). Despite limited evidence, other insulin resistance indices such as VAI (adjusted β ranging from 0.007 to 0.016), TyG-BMI (adjusted β ranging from 0.002 to 0.415), METS-IR (adjusted β ranging from 0.005 to 0.060), TyG-WtHR (β = 0.012) and TyG-WC (β = 0.0001) have shown a positive association with BMD in a few studies.

Conclusion: This systematic review emphasizes the intricate connection between insulin resistance and BMD. The lack of ability to perform a meta-analysis and the dependence on cross-sectional studies hinder the robustness of the findings, hence necessitating well-designed longitudinal studies.

Keywords: Insulin resistance, Bone mineral density, HOMA-IR, TyG index, VAI, Systematic review, Osteoporosis, BMD, Metabolic health.

P113 APPLICATION OF OSTEOPONTIN (OPN) LEVELS AS A BONE TURNOVER BIOMARKER: A SYSTEMATIC REVIEW AND META-ANALYSIS A. Azarboo 1, A. Ghaseminejad-Raeini1, S. Jalali1, O. Tabatabaei-Malazy2 1School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran, 2Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran

Objective: To evaluate the clinical relevance of osteopontin (OPN) as a bone turnover biomarker by assessing its association with osteoporosis, fractures, and bone mineral density (BMD) through a systematic review and meta-analysis.

Materials and methods: A systematic search was conducted across PubMed, Scopus, Web of Science, Embase, and Cochrane Library for studies published up to October 2024, reporting OPN levels in relation to bone health. Eligible studies included cross-sectional, case–control, and cohort designs. Standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated to assess the association between OPN and outcomes. Random-effects models were employed, and heterogeneity was assessed using the I2 statistic. Subgroup analysis based on study design was conducted. Meta-regression analysis was performed using confounding variables age, female percentage, and body mass index (BMI).

Results: The meta-analysis included 27 studies encompassing 4,062 participants. OPN levels were significantly elevated in patients with osteoporosis when compared with controls (SMD: 0.68 [95% CI 0.45 to 0.91], P < 0.001; I2 = 71%). Also, when comparing patients with fractures vs. controls, OPN levels were analyzed to be statistically significantly higher (SMD: 0.72 [95% CI 0.49 to 0.95], P < 0.001; I2 = 59%). According to some of the included studies, OPN levels were inversely associated with BMD. Subgroup analysis confirmed that cohort studies, similar to cross-sectional designs, demonstrated the observed associations between OPN and bone health outcomes. Meta-regression analysis revealed that heterogeneity in the osteoporosis association with OPN was partially explained by age (P = 0.03) and female percentage (P = 0.02), while BMI did not significantly contribute (P > 0.05). Sensitivity analyses confirmed the robustness of these findings.

Conclusion: This study identifies elevated OPN levels as a strong biomarker for increased risk of osteoporosis, fracture, and lower BMD. Moreover, age and female percentage positively influence the association with osteoporosis. However, further research is needed to explore OPN's role in bone health and its potential clinical applications.

Keywords: Osteopontin (OPN); Bone mineral density (BMD); Osteoporosis; Fracture; Biomarker; Meta-analysis.

P114 BONE METABOLISM DISORDERS IN BREAST CANCER PATIENTS TREATED WITH AROMATASE INHIBITORS A. Bacumova 1, L. Sivordova2, L. Aref'Eva1, J. Polyakova.2 1Volgograd State Medical University, Volgograd, Russia, Volgograd, Russia, 2Federal State Budgetary Institution «Zborovsky Research Institute of Clinical and Experimental Rheumatology», Volgograd, Russia

It is known that bone health is largely determined by the level of human sex hormones. The development of diseases or conditions that disrupt the synthesis of sex hormones contributes to bone metabolism disorders and can lead to osteoporosis (OP) and fractures.

The aim of our study was to investigate the prevalence of osteoporosis among patients with breast cancer (BC) receiving aromatase inhibitors (AI) or tamoxifen, depending on the duration of therapy, and the clinical efficacy of Denosumab, Zoledronic acid and Alendronates in the treatment of osteoporosis.

Materials and methods: The study was performed using a retrospective analysis of outpatient records of 200 patients with BC receiving AI or tamoxifen. Bone density was assessed according to WHO recommendations using dual-energy X-ray osteodensitometry once a year. The level of bone remodeling was assessed by ELISA-test using commercial kits. The level of bone pain was assessed using the Visual Analogue Scale.

Results: The study included 200 patients from 32 to 67 years old (mean age 53.25 ± 11.17 years). The average duration of the disease was 3.96 ± 1.98 years. The study showed that 22% (44 patients) had bone mineral density (BMD) below the age norm already in the first year of therapy. The incidence of osteopenia and osteoporosis directly correlated with the duration of such therapy: among patients in the fifth year of therapy, the prevalence of osteoporosis was 47% (94 patients) (p = 0.001).

During the study, groups of patients were identified who were prescribed antiresorptive therapy: 27 patients (Group I)—Denosumab (60 mg subcutaneously, once every 6 months); 39 patients (Group II) Zoledronic acid (5 mg intravenously, once every 12 months); 28 patients (Group III) Alendronates 70 mg per week per os. The control group consisted of 106 patients with normal BMD or osteopenia, with a low risk of fractures according to the FRAX index, who were recommended calcium preparations and cholecalciferol without antiresorptive drugs. The analysis showed that all antiresorptive drugs contributed to the preservation of bone density and a decrease in bone pain. In the group without antiresorptive therapy, bone density continued to decrease and bone pain persisted.

Discussion and conclusions: In the treatment of breast cancer, aromatase inhibitors and tamoxifen are the most important components of the pathogenetic treatment of the disease. However, such therapy leads to accelerated bone resorption and, therefore, contributes to a decrease in bone mineral density and significantly increases the risk of secondary osteoporosis. According to clinical guidelines, antiresorptive therapy is prescribed to patients who already have osteoporosis, low-energy fractures, or a high risk of fractures according to the FRAX index. To date, there are no recommendations for prescribing antiresorptive therapy for the prevention of osteoporosis. However, there is already some scientific data on the effectiveness of preventive antiresorptive treatment [1,2]. Our study also confirmed the need for such therapy in the pathogenetic treatment of breast cancer using aromatase inhibitors or tamoxifen to prevent bone metabolism disorders.

1.

Galvano A., Gristina V., Scaturro D., et al. The role of bone modifying agents for secondary osteoporosis prevention and pain control in post-menopausal osteopenic breast cancer patients undergoing adjuvant aromatase inhibitors//Front Endocrinol (Lausanne). 2023 Nov 21;14:1297950. https://doi.org/10.3389/fendo.2023.1297950

2.

Scaturro D., de Sire A., Terrana P., et al. Early Denosumab for the prevention of osteoporotic fractures in breast cancer women undergoing aromatase inhibitors: A case–control retrospective study. J Back Musculoskelet Rehabil. 2022;35(1):207–212. https://doi.org/10.3233/BMR-210012

P115 THE KEYSTONE MECHANISM THEORY OF PAIN: MODERNIZED VERSION OF THE BIOPSYCHOSOCIAL MODELC. Walker1, A. Bajaj 2, S. Er3 1Viatris, Hatfield, United Kingdom, 2Viatris, Bengaluru, India, 3Viatris, Turkiye, India

Introduction: The biopsychosocial model (BPSm) has long been discussed in musculoskeletal research and practice and was proposed as an improvement to the biomedical model (BMM). Its applicability is limited due to its wide range of interpretations in clinical scenarios. The putative conclusions from BPSm were thought to deliver disease insights, but they offer limited tools for validating knowledge claims and are assertions on arguments and conceptual errors. This overarching conceptual framework may have paved the way for newer approaches to authenticate its underlying principles and scientific claims.

Enactive modernization of BPSm: Convergence of the “humanistic” interpretation (person and relationship-centeredness) and “causation” interpretation (multifactorial contributors to health and illness) of BPSm leads to the recently discussed “Enactive” approach (Enactivism). The foundation of Enactivism lies in phenomenology, pragmatism, and cognitive sciences properly addressing musculoskeletal pain and the correlation of multiple factors in pain origination and maintenance. Listening and validating a person’s experiences as practical, regardless of an outsider's perspective, may foster clinician-patient trust and mitigate stigmatization.

Beyond BPSm-The Keystone approach: Identifying "keystone" pain mechanisms, which are critical in the pathophysiology of pain, is essential for understanding complex causal factors, including biological, psychological, and social influences. These keystones, like the central stone in an arch, are built upon multiple upstream factors but are crucial for system integrity. This approach moves beyond reductionism and aims to identify key biomarkers that explain treatment response variability across individuals, notable examples include- static and dynamic quantitative sensory testing (QST), neuroimaging, and psychometry. The keystone mechanism model guides interdisciplinary research to identify and measure key pain mechanisms, aiming to develop composite biomarkers that are clinically feasible, cost-effective, and reliable without compromising sensitivity.

Conclusion: BPSm may not be used to define diseases, distinguish disease from non-disease states, or identify genuine cause-effect relationships, nevertheless it may be a useful tool to organize and communicate information about the psychosocial determinants of health. The Keystone approach offers a pragmatic balance and is theoretically and practically beneficial for transitioning from treating populations to individual people, overcoming the shortcomings of current treatments, and mitigating the failure to target the right treatment to the right patient.

P116 ORGAN-ON-CHIP MODELS IN OSTEOARTHRITIS (OA) RESEARCH: STRATEGIES AND APPLICATIONS A. Bajaj 1, C. Walker2 1Viatris, Bengaluru, India, 2Viatris, Hatfield, United Kingdom

Introduction: Despite scientific recognition of Osteoarthritis (OA) as a whole-joint disease, the complexity of the OA pathophenotype is not accurately reflected in current research. Fluidic integration of the joint microenvironment can greatly enhance the existing in vitro OA models, mimicking physiologic tissue environments. These technologies play a transformative role as they enable an accurate depiction of pathogenesis, offering deeper insights into molecular and cellular mechanisms driving the disease, thus accurately resembling joint tissues, and facilitating the study of intricate cellular interactions.

Soluble tissue crosstalk in osteoarthritis: Mechanical stimulation, multi-tissue, and immune cell interactions work together through micro-engineered devices combining biomaterials, 3D cell cultures, and microfluidics within the internal device architecture to regenerate and nudge the native tissue environment in OA and multiple tissue models. Mechanical stimulation in joint-on-a-chip models mimics knee joint forces, influencing chondrocyte behavior via mechanotransduction. Advances in microengineering use PDMS [poly(dimethylsiloxane)] to apply compressive stress, but challenges exist in strain control, imaging, and shear stress effects. Models like the “microJoint” integrate cartilage, bone, synovium, and sensory neurons, enabling the study of interactions, inflammatory responses, and joint pathogenesis. This model also helps integrate macrophages, monocytes, and endothelial cells, replicating immune cell interactions, such as monocyte extravasation, thus helping to study OA pathogenesis.

Bioengineering roadmap and future prospects: Joint-on-chips (JOCs) face key challenges in device engineering, replicating joint physiology, and generating useful readouts. Material selection, manufacturing scalability, and integration of functionality impact device design. Improving cell sourcing, near-native and tissue-specific extracellular matrix, mechanical environments, and collagen fiber arrangements and morphology is crucial for more accurate OA modeling. Advancements like organoids, stem cell differentiation, and 3D bioprinting offer promising solutions, while addressing systemic factors and creating "body-on-a-chip" models can further enhance OA research.

Conclusion: The development of these systems could bridge the gap between in vitro and in vivo studies and help identify effective treatments for OA. Combining the cartilage-on-a-chip system with other musculoskeletal tissues like synovium and subchondral bone will provide a holistic view of tissue-tissue interactions governing OA onset including inflammation, fibrosis, and degradation of joint tissues. However, challenges remain in designing JOCs that replicate the full complexity of joint biology and disease.

References:

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Rothbauer, M., Reihs, E. I., Fischer, A., Windhager, R., Jenner, F., & Toegel, S. (2022). A Progress Report and Roadmap for Microphysiological Systems and Organ-On-A-Chip Technologies to Be More Predictive Models in Human (Knee) Osteoarthritis. Frontiers in bioengineering and biotechnology, 10, 886360. https://doi.org/10.3389/fbioe.2022.886360

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Kahraman, E., Ribeiro, R., Lamghari, M., & Neto, E. (2022). Cutting-Edge Technologies for Inflamed Joints on Chip: How Close Are We?. Frontiers in immunology, 13, 802440. https://doi.org/10.3389/fimmu.2022.802440

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Du, C., Liu, J., Liu, S., Xiao, P., Chen, Z., Chen, H., Huang, W., & Lei, Y. (2024). Bone and Joint-on-Chip Platforms: Construction Strategies and Applications. Small methods, e2400436. Advance online publication. https://doi.org/10.1002/smtd.202400436

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Petta, D., D'Arrigo, D., Salehi, S., Talò, G., Bonetti, L., Vanoni, M., Deabate, L., De Nardo, L., Dubini, G., Candrian, C., Moretti, M., Lopa, S., & Arrigoni, C. (2024). A personalized osteoarthritic joint-on-a-chip as a screening platform for biological treatments. Materials today. Bio, 26, 101072. https://doi.org/10.1016/j.mtbio.2024.101072

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Ong LJY, Fan X, Rujia Sun A, Mei L, Toh YC, Prasadam I. Controlling Microenvironments with Organs-on-Chips for Osteoarthritis Modelling. Cells. 2023 Feb 10;12(4):579. https://doi.org/10.3390/cells12040579. PMID: 36831245; PMCID: PMC9954502.

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Banh, L., Cheung, K. K., Chan, M. W. Y., Young, E. W. K., & Viswanathan, S. (2022). Advances in organ-on-a-chip systems for modelling joint tissue and osteoarthritic diseases. Osteoarthritis and cartilage, 30(8), 1050–1061. https://doi.org/10.1016/j.joca.2022.03.012

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Jeyaraman, M., Jeyaraman, N., Nallakumarasamy, A., Ramasubramanian, S., & Muthu, S. (2024). Beginning of the era of Organ-on-Chip models in osteoarthritis research. Journal of clinical orthopaedics and trauma, 52, 102422. https://doi.org/10.1016/j.jcot.2024.102422

P117 ASSESSMENT OF ADHERENCE TO BISPHOSPHONATE THERAPY AMONG PATIENTS WITH POSTMENOPAUSAL OSTEOPOROSIS DURING WARTIME A. Balian 1 1Rheumatology Department, Khmelnytskyi Regional Hospital, Khmelnytskyi, Ukraine

Objective: To evaluate the adherence to bisphosphonate treatment among patients with postmenopausal osteoporosis during wartime conditions and identify key barriers to sustained therapy.

Methods: A cross-sectional observational study was conducted from March 2023 to November 2024 involving 210 postmenopausal women diagnosed with osteoporosis based on bone mineral density (BMD) (T-score ≤ − 2.5). Participants were recruited from regions affected by the ongoing conflict in Ukraine. Adherence to bisphosphonate therapy was assessed using the Medication Adherence Report Scale (MARS-5) and pharmacy refill data. A structured questionnaire evaluated sociodemographic factors, access to healthcare, and psychological stress during wartime. Adherence was defined as taking ≥ 80% of prescribed doses over the study period. Descriptive and inferential statistics were applied, with subgroup analyses based on geographic location and access to healthcare services.

Results: Only 42.4% (n = 89) of patients demonstrated adherence to bisphosphonate therapy. The most frequently reported barriers were disrupted access to healthcare services (reported by 65% of non-adherent patients), medication shortages (53%), and high levels of psychological stress (48%). Patients residing in conflict zones showed significantly lower adherence rates (26.7%, n = 40) compared to those in more stable areas (62.1%, n = 49; p < 0.001). Among adherent patients, the mean MARS-5 score was 20.3 ± 1.4, while non-adherent patients had a mean score of 12.7 ± 2.8 (p < 0.01). Multivariate analysis identified disrupted healthcare services (OR: 3.5, 95% CI 2.1–5.9) and psychological stress (OR: 2.8, 95% CI 1.6–4.6) as the strongest predictors of non-adherence.

Conclusion: Wartime conditions have a profound negative impact on adherence to bisphosphonate therapy among patients with postmenopausal osteoporosis. With adherence rates below 50%, urgent measures are needed to address barriers such as healthcare disruptions, medication shortages, and mental health challenges. Interventions like telemedicine, mobile healthcare units, and mental health support could significantly improve outcomes in this vulnerable population.

P118 ASSESSMENT OF THE IMPACT OF DEPRESSIVE AND ANXIETY DISORDERS ON TREATMENT ADHERENCE IN PATIENTS WITH KNEE OSTEOARTHRITIS DURING WARTIME A. Balian 1 1Rheumatology Department, Khmelnytskyi Regional Hospital, Khmelnytskyi, Ukraine

Objective: To investigate the influence of depressive and anxiety disorders on treatment adherence in patients with knee osteoarthritis (OA) under wartime conditions and identify associated risk factors.

Methods: A cross-sectional observational study was conducted between April 2023 and August 2024. The study included 175 patients diagnosed with knee OA based on clinical and radiological criteria (Kellgren–Lawrence grades II-III). Participants were recruited from war-affected regions. Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), with scores ≥ 8 indicating clinically significant symptoms. Treatment adherence was evaluated using the Medication Adherence Report Scale (MARS-5), with adherence defined as taking ≥ 80% of prescribed medications and following lifestyle recommendations. Statistical analyses included descriptive statistics, chi-square tests, and multivariate logistic regression to identify predictors of non-adherence.

Results: Adherence to treatment was observed in only 38.3% (n = 67) of patients. Depressive symptoms were present in 54.9% (n = 96) of patients, and anxiety symptoms in 61.7% (n = 108). Patients with clinically significant depressive symptoms had markedly lower adherence rates (23.9%, n = 23) compared to those without depression (55.6%, n = 44; p < 0.001). Similarly, patients with anxiety symptoms showed lower adherence (30.6%, n = 33) compared to non-anxious patients (50.8%, n = 34; p = 0.02). Multivariate analysis revealed depressive symptoms (OR: 3.7, 95% CI 2.1–6.5) and anxiety symptoms (OR: 2.4, 95% CI 1.4–4.2) as strong predictors of non-adherence, along with disrupted healthcare access (OR: 3.2, 95% CI 1.9–5.3).

Conclusion: Depressive and anxiety disorders significantly impair treatment adherence in patients with knee osteoarthritis during wartime. With adherence rates below 40%, addressing mental health is critical for optimizing OA management. Integrating mental health screening and support into routine OA care, especially in war settings, could enhance adherence and improve patient outcomes.

P119 EFFECTS OF DENOSUMAB BEYOND THE BONE RESORPTION: THE ROLE OF SERUM IGF1 A. Barbosa 1, M. Fonseca2, M. Lopes2, I. Cosme1, E. Nobre3, F. Costa2, E. Alves2, F. Sampaio1 11Multidisciplinary Fracturary Osteoporosis Outpatient Clinic. Hospital Santa Maria, ULS Santa Maria, Lisboa 2 Faculty of Medicine of Lisboa, Lisboa, Portugal, 21Multidisciplinary Fracturary Osteoporosis Outpatient Clinic. Hospital Santa Maria, ULS Santa Maria, Lisboa, Lisboa, Portugal, 32 Faculty of Medicine of Lisboa, Lisboa, Portugal

Introduction: In some populations, reduced serum IGF-1 levels has been associated to osteosarcopenia. Osteoporosis and sarcopenia share similar risk factors, highlighting muscle-bone interactions, which may result in debilitating consequences, such as falls and fractures. IGF-1 is the main growth factor in the bone matrix, has a predominant anabolic bone effect and regulates the expression of receptor activator of nuclear factor kappa-Β ligand (RANKL). Denosumab is a monoclonal antibody that binds RANKL preventing osteoclast differentiation, used in the treatment of osteoporosis because it reduces the incidence of fragility fractures.

Aims: To analyze the variation of IGF-1 levels in patients with severe osteoporosis under denosumab and its relationship with bone turnover markers.

Methods: Retrospective single-center analysis of female patients with osteoporosis and fragility fractures treated with denosumab. Data were obtained from electronic health records and included age at the beginning of denosumab, duration of therapy, IGF-1 and bone turnover markers (BTM) [Procollagen-1 N-terminal Propeptide (P1NP), bone alkaline phosphatase (BALP), C-terminal telopeptide (CTX) and osteocalcin] before treatment and at the time of its interruption or at the last appointment.

Results: The study included 37 female patients. The mean age