Contribution de la microarchitecture osseuse dans la prise en charge de l'ostéoporose du sujet âgé en ambulatoire

Abstract : Introduction: Osteoporosis is a skeletal disease marked by low bone mineral density and micro architectural deterioration of bone, resulting in a loss of strength and therefore increased fracture risk. Half of them occur in patients with normal or osteopenic bone densitometry. Trabecular bone score (TBS) is a texture index used to evaluate bone microarchitecture. The aim of this study is to compare demographic, densitometric and TBS values in elderly patients with a history of falls. Methods: The cohort is an observational cross-sectional study with patients over 75 years old who were treated in an ambulatory service of a hospital in Marseille between September 2016 and December 2017. We performed for each patient a standardized geriatric evaluation, measurements of femoral neck and lumbar spine T-scores, and a TBS and FRAX calculation. Results: We recruited 181 patients aged 75 to 98 years (mean age 86 years). 94 had a severe osteoporotic fracture. The fractured group consisted of thin, small women with a history of falls and sarcopenia. In this group, only half had densitometric osteoporosis and 17% had anti-osteoporosis treatment. In the univariate analysis, TBS was lower in the fractured group (1.242 vs 1.295, p=0.006). However, in the multivariate analysis, only femoral neck T-score (OR: 7, 95% CI: 2.73-19.3) and FRAX (OR: 2.6, 95% CI: 1.84-3.67) were strong risk factors for fractures. Conclusion: This study highlights that a large number of elderly patients suffer from osteoporosis and severe fractures without being treated. We could not prove that TBS improved the diagnosis of osteoporosis in this particular population.
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Mélanie Gomez. Contribution de la microarchitecture osseuse dans la prise en charge de l'ostéoporose du sujet âgé en ambulatoire. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01977149⟩

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