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A bona fide model for age-related osteoporosis in accelerated aging trichothiodystrophy (TTD) mice
Abstracts / Bone 47 (2010) S72–S241
PP231 Prevalence of vertebral deformities in postmenopausal women by DXA O.V. Baranova1,⁎, E.E. Malevich2, A.N. Mihajlov2 1 Centre of Metabolic Osteopathia and Osteoporosis, Minsk, Belarus 2 Belarusian Medical Academy of Post-Graduate Education, Minsk, Belarus The real prevalence of vertebral fractures, considering their silence, is complicated to estimate in the population. Two thirds of fractures (deformities), which are being detected by means of the radiological assessment, according to the studies, are clinically not diagnosticated. The future vertebral deformities risk increases severalfold when currently present. Materials and methods: 111 postmenopausal women aged 58,30 [54,10:61,00] yrs, duration of menopause 8 [4:11] yrs DXA with LVA were examined. The questioning about presence of risk factors of the osteoporosis, assessment of anthropometric indices: body length, body mass, BMI, were carried out. The criteria for the exclusion were: chronic illnesses and conditions, associated with risk of progression of osteoporosis (OP); contact with preparations, associated with the loss of BMD; clinically detected spinal fractures in the past medical history. The prevalence of these deformities was detected upon the quantity of patients which have had fractures or deformities of 2nd to 3rd degree of at least one vertebral body, excluding other causes, which could lead to similar deformities (Scheuermann disease, traumatic fractures of vertebral bodies etc.). Results: After carrying out the DXA of the axial skeleton OP was revealed in 49% of cases (n = 54), osteopenia in 26% of cases (n = 29), norm in 25% of cases (n = 28). The prevalence of vertebral deformities of 2nd to 3rd degree with OP worked out n = 19 (35,18%), in the group of women with osteopenia n = 7 (24,14%), with normal BMD the deformities only of the 2nd degree were detected n = 5 (17,86%). The deformities were mainly detected in the vertebral bodies L1 of the lumbar spine, Th12, Th11 of the thoracic spine (p = 0,02). Conclusions: The results of the study reveal the high prevalence of deformities of moderate and severe degree of vertebral bodies Th4L4 which worked out n = 31 (28%) among the examined postmenopausal women living in Minsk. Disclosure of Interest: None declared Keywords: vertebral fractures, lateral vertebral assessment doi:10.1016/j.bone.2010.04.367
PP232 Idiopathic osteoporosis in premenopausal women – data from patients treated in a national osteoporosis program C. Barbu1,⁎, M. Gascan2, S. Florea3, C. Poiana4, S. Fica1 1 Elias Hospital Endocrinology, Carol Davila University, Bucharest, Romania 2 Endocrinology, Elias Hopsital, Bucharest, Romania 3 Clinical Laboratory, Elias Hopsital, Bucharest, Romania 4 C. I. Parhon Endocrinology, Carol Davila University, Bucharest, Romania Background: Osteoporosis in premenopausal women and young man is mainly secondary to known or sometimes unknown sistemic diseases at the evaluation moment. The aim of this study was to analyse the prevalence of idiopathic osteoporosis and accesibility to the treatment among a group of patients treated in a national program for osteoporosis.
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Material and Methods: Medical records of 950 patients (840 women and 110 men, mean age of 63 years), receiving treatment in a national program for osteoporosis in two endocrine departments were analysed. All patients had lumbar or/and femural neck DXA evaluation, routine biochemical blood tests, hormonal evaluation, bone turnover biochemical markers (serum osteocalcin and serum crosslaps) and other tests needed for other secondary causes of osteoporosis). The diagnosis of idiopathic osteoporosis was made based on DXA Z score below -2 SD in premenopausal status in women and below 50 yrs age in men. To assess the accesibility to treatment, we compared the data from the treatment database with the data from DXA evaluation. Results: From the 950 patients, after careful evaluation, only 8 women remained with a diagnosis of idiopathic osteoporosis. They had ages between 25 and 42 ( mean of 34.6 ± 7,2 yrs). Two of them had previous fracture in personal history, the other beeing refeered for DXA evaluation for not specific bone pains. None of these patients had an abnormal BMI (range between 20 and 25,7) or delayed puberty. Two of the patients had hypercalciuria (mean of 426,3 mg/day comparing to 122 mg/day in the rest of the group) and one more patient was diagnosed with vertebral fractures on X rays. Mean 25 HOVitamin D level was 38 ng/ml. In terms of bone turnover markers, we were not able to find a significant difference between these patients and our reference data from normal patients. In terms of accesibility to the treatment, in a 15 800 DXA refeered subjects database, we found 201 cases (1.3%) of cases sugessting idiopathic osteoporosis. In our treatment database, we had 4% with similar characteristics, 0.8% beeing confirmed as idiopathic osteoporosis. Conclusions: We found a 0.8% prevalence of idiopathic osteoporosis among 950 patients treated in a national program. Comparing to the prevalence of idiopathic osteoporosis candidates among DXA refeered patients and treated patients, we can conclude that accesibility to treatment is very high among these patients. Disclosure of Interest: None declared Keywords: idiopathic osteoporosis, premenopausal osteoporosis, doi:10.1016/j.bone.2010.04.368
PP233 A bona fide model for age-related osteoporosis in accelerated aging trichothiodystrophy (TTD) mice S.M. Botter1,⁎, I. Van der Pluijm2, S. Gabriëls2, L. Gerris2, J.P. Van Leeuwen3, J.H. Hoeijmakers1 1 Genetics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands 2 DNage BV, Leiden, Netherlands 3 Internal medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands Background: Osteoporosis typically manifests itself at old age. It is thought that aging is caused by DNA damage, which is normally repaired but accumulates in time. By using DNA repair deficient mouse models as a tool, research in our laboratory focuses on the mechanism of aging and the etiology of aging related pathology. In this study, we used a mouse model that closely mimics the human premature aging syndrome trichothiodystrophy (TTD). Much like human TTD patients, these mice show accelerated onset and progression of age-related diseases. The goal of this study was to assess if TTD mice can be used as a model for spontaneous, age-related osteoporosis mimicking the human situation more closely. Methods: From a cohort of 120 female wild type (WT) C57Bl/ 6 and 120 TTD animals groups of mice (n = 10/group) were sacrificed at defined time points (13, 26, 39, 45, 52 and 65 weeks
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of age), followed by dissection of femur and tibia. Separate groups of TTD mice (aged 26-65 weeks) were injected with ALN and PTH, to investigate if these drugs would have the same bone preserving effect in TTD mice as in human osteoporosis patients. Of each mouse, bone phenotype was determined using micro-CT analysis (right femur), bone strength using break tests (left femur), and transcriptional profiling using micro-arrays (tibia's, n = 50). Serum and plasma was collected for future biomarker approaches. Results: At 13 weeks of age, the bone phenotype of WT and TTD animals was not significantly different, but from 26 weeks onwards TTD animals had a faster age-related decline both in trabecular and cortical bone (BV/TV at 65 wks: WT: 12.5 ± 0.5%; TTD: 9.1 ± 0.6%, Ct.Th.: 218.3 ± 3.9 μm, TTD: 194.1 ± 5.9 μm). Bone strength was significantly lower at 65 weeks of age (WT: 97.1 ± 5.7 N/mm, TTD: 53.4 ± 3.6 N/mm). Both ALN and PTH were able to overcome the bone loss and maintain bone strength. Micro-array analysis of bone tissue from untreated TTDs showed that typical bone markers (SOST, Bglap, Coll-1, ALP, Periostin, Runx2 and TRAP) followed a similar downregulated expressional pattern. Conclusion: TTD mice showed accelerated bone loss during aging which could be reversed with drug treatment. At young age their bone phenotype did not differ from WT animals. This makes the TTD mouse model a suitable screening tool for determining bonepreserving qualities of both existing and novel treatments. In addition, its spontaneous development allows the discovery of biomarkers that may predict osteoporosis onset. Disclosure of Interest: S. Botter: None declared, I. Van der Pluijm: None declared, S. Gabriëls Employee of DNage BV, L. Gerris Employee of DNage BV, J. Van Leeuwen: None declared, J. Hoeijmakers Advisory board membership of: Prof. J. Hoeijmakers is member of the Scientific Advisory Board of DNage Keywords: micro CT, osteoporosis model, trichothiodystrophy doi:10.1016/j.bone.2010.04.369
PP234 Prospective study of the role of cortical thickness on the risk of hip fracture K. Briot1,⁎, C. Roux1, C. Benhamou2 1 Paris Descartes University, Rheumatology Department, Cochin Hospital, Paris, France 2 Unité INSERM U 658, Rheumatology Department, CHR d'Orléans, Orléans, France Introduction: Hip fractures are associated with an increased risk of mortality and morbidity. Bone mineral density (BMD) is regarded as the reference method for diagnosis and fracture prediction but it explains only a part of an individual's fracture risk because of the multiple determinants of fragility fracture. Bone geometry parameters could be useful for the prediction of the risk of fracture but the predictive value and the choice of these parameters remain to be determined. Objectives: to study the relationship between the hip structural geometry of the hip derived from DXA and the 5-year risk of hip fractures in postmenopausal osteoporotic women. Patients and methods: Using the 5-year data of the placebo group of the TROPOS study, a double-blind, placebo-controlled, randomized clinical trial of strontium ranelate, we have reanalyzed the hip DXA scans to determine the role of hip geometric parameters measured at baseline on the risk of hip fractures. Included patients were those having BMD measurements on Hologic QDR 4500 device, and with adequate image acquisition. The outcomes included the DXAderived hip structure analysis program by Beck, which calculated
cross-sectional area (CSA), section modulus, cortical thickness, and buckling ratio, measured in cross-sectional regions at femoral neck, intertrochanteric region and proximal shaft. Results: The study population consisted of 636 postmenopausal osteoporotic women (mean age of 77.6 ± 5.5 years) treated with calcium and vitamin D; 28 hip fractures were observed over the 5-year follow-up. Postmenopausal osteoporotic women with hip fracture were significantly older, had a lower total hip BMD, a significantly lower cortical thickness, a lower CSA and a higher buckling ratio at 3 sites. Multivariate analysis showed that after adjustment on age, total hip BMD and BMI, the geometric parameters associated with an increased risk of hip fracture were intertrochanteric CSA (for each decrease of a SD) (OR = 3.06; CI 1.33-7.06 p = 0.009) and femoral shaft cortical thickness (for each decrease of a SD) (OR = 4.44; CI 95% 1.57-12.62; p = 0.005). BMD was not predictive of the risk of fracture in this multivariate model. Conclusion: this study suggests that in postmenopausal osteoporotic women, cortical thickness assessment can improve the prediction of hip fractures independently from BMD. Disclosure of Interest: None declared Keywords: cortical thickness, hip geometry, osteoporosis doi:10.1016/j.bone.2010.04.370
PP235 Referral for DXA scanning: which risk factors are most predictive for osteoporosis J.G. Browne⁎, G. Steen, Z. Toth, M.C. Casey, J.B. Walsh Bone Health and Osteoporosis Unit, MIRA, St James's Hospital, Dublin 8, Ireland Osteoporosis affects both men and women with its prevalence increasing with age. The gold standard for the diagnosis of osteoporosis is dual X-ray absorptiometry (DXA). Previous studies have shown that some risk factors are more associated with osteoporosis compared to others. The aim of this study was to determine which risk factors were more commonly referred for DXA and are more likely to predict a positive DXA for osteoporosis. Our osteoporosis service is an open access service for GPs and hospital consultants. Baseline demographics were recorded with the diagnosis for osteoporosis (OP) as per WHO guidelines using DXA. Risk factors for osteoporosis were recorded in detail in a subset of referrals. 8119 new patients had a DXA performed over a 6-year period between January 2003 and April 2009. Mean age was 64.18 (±16.69)yrs with 80.5% being female. The incidence of osteoporosis increased with age. For patients <60 yrs, 22% had osteoporosis. Patients >70yrs, 58% had osteoporosis whereas patients >80yrs, 75% had osteoporosis. A further subset of 3691 new patient referrals were reviewed. The 4 most common reasons for referral included (Percentage of referrals and those with osteoporosis are included in brackets): (a) History of fracture (27.7%, OP 61.7%), (b) X-ray evidence of Osteopaenia (24.3%, OP 53.1%), (c) Steroid Use >3months (18.6%, OP 44.6%), and (d) Rheumatoid Arthritis (17%, OP 44.4%). Reduced BMI was the most predictive modifiable risk factor for osteoporosis with 67.4% of these cases having osteoporosis. Age is an important risk factor for osteoporosis, with 75% of patients over 80yrs having osteoporosis and a further 20% having osteopaenia. Age, history of fragility fracture, x-ray evidence of osteopaenia, steroid use and rheumatoid arthritis were the most predictive and commonest risk factors for osteoporosis and should be prioritised in an open access DXA service.
PP231 Prevalence of vertebral deformities in postmenopausal women by DXA O.V. Baranova1,⁎, E.E. Malevich2, A.N. Mihajlov2 1 Centre of Metabolic Osteopathia and Osteoporosis, Minsk, Belarus 2 Belarusian Medical Academy of Post-Graduate Education, Minsk, Belarus The real prevalence of vertebral fractures, considering their silence, is complicated to estimate in the population. Two thirds of fractures (deformities), which are being detected by means of the radiological assessment, according to the studies, are clinically not diagnosticated. The future vertebral deformities risk increases severalfold when currently present. Materials and methods: 111 postmenopausal women aged 58,30 [54,10:61,00] yrs, duration of menopause 8 [4:11] yrs DXA with LVA were examined. The questioning about presence of risk factors of the osteoporosis, assessment of anthropometric indices: body length, body mass, BMI, were carried out. The criteria for the exclusion were: chronic illnesses and conditions, associated with risk of progression of osteoporosis (OP); contact with preparations, associated with the loss of BMD; clinically detected spinal fractures in the past medical history. The prevalence of these deformities was detected upon the quantity of patients which have had fractures or deformities of 2nd to 3rd degree of at least one vertebral body, excluding other causes, which could lead to similar deformities (Scheuermann disease, traumatic fractures of vertebral bodies etc.). Results: After carrying out the DXA of the axial skeleton OP was revealed in 49% of cases (n = 54), osteopenia in 26% of cases (n = 29), norm in 25% of cases (n = 28). The prevalence of vertebral deformities of 2nd to 3rd degree with OP worked out n = 19 (35,18%), in the group of women with osteopenia n = 7 (24,14%), with normal BMD the deformities only of the 2nd degree were detected n = 5 (17,86%). The deformities were mainly detected in the vertebral bodies L1 of the lumbar spine, Th12, Th11 of the thoracic spine (p = 0,02). Conclusions: The results of the study reveal the high prevalence of deformities of moderate and severe degree of vertebral bodies Th4L4 which worked out n = 31 (28%) among the examined postmenopausal women living in Minsk. Disclosure of Interest: None declared Keywords: vertebral fractures, lateral vertebral assessment doi:10.1016/j.bone.2010.04.367
PP232 Idiopathic osteoporosis in premenopausal women – data from patients treated in a national osteoporosis program C. Barbu1,⁎, M. Gascan2, S. Florea3, C. Poiana4, S. Fica1 1 Elias Hospital Endocrinology, Carol Davila University, Bucharest, Romania 2 Endocrinology, Elias Hopsital, Bucharest, Romania 3 Clinical Laboratory, Elias Hopsital, Bucharest, Romania 4 C. I. Parhon Endocrinology, Carol Davila University, Bucharest, Romania Background: Osteoporosis in premenopausal women and young man is mainly secondary to known or sometimes unknown sistemic diseases at the evaluation moment. The aim of this study was to analyse the prevalence of idiopathic osteoporosis and accesibility to the treatment among a group of patients treated in a national program for osteoporosis.
S159
Material and Methods: Medical records of 950 patients (840 women and 110 men, mean age of 63 years), receiving treatment in a national program for osteoporosis in two endocrine departments were analysed. All patients had lumbar or/and femural neck DXA evaluation, routine biochemical blood tests, hormonal evaluation, bone turnover biochemical markers (serum osteocalcin and serum crosslaps) and other tests needed for other secondary causes of osteoporosis). The diagnosis of idiopathic osteoporosis was made based on DXA Z score below -2 SD in premenopausal status in women and below 50 yrs age in men. To assess the accesibility to treatment, we compared the data from the treatment database with the data from DXA evaluation. Results: From the 950 patients, after careful evaluation, only 8 women remained with a diagnosis of idiopathic osteoporosis. They had ages between 25 and 42 ( mean of 34.6 ± 7,2 yrs). Two of them had previous fracture in personal history, the other beeing refeered for DXA evaluation for not specific bone pains. None of these patients had an abnormal BMI (range between 20 and 25,7) or delayed puberty. Two of the patients had hypercalciuria (mean of 426,3 mg/day comparing to 122 mg/day in the rest of the group) and one more patient was diagnosed with vertebral fractures on X rays. Mean 25 HOVitamin D level was 38 ng/ml. In terms of bone turnover markers, we were not able to find a significant difference between these patients and our reference data from normal patients. In terms of accesibility to the treatment, in a 15 800 DXA refeered subjects database, we found 201 cases (1.3%) of cases sugessting idiopathic osteoporosis. In our treatment database, we had 4% with similar characteristics, 0.8% beeing confirmed as idiopathic osteoporosis. Conclusions: We found a 0.8% prevalence of idiopathic osteoporosis among 950 patients treated in a national program. Comparing to the prevalence of idiopathic osteoporosis candidates among DXA refeered patients and treated patients, we can conclude that accesibility to treatment is very high among these patients. Disclosure of Interest: None declared Keywords: idiopathic osteoporosis, premenopausal osteoporosis, doi:10.1016/j.bone.2010.04.368
PP233 A bona fide model for age-related osteoporosis in accelerated aging trichothiodystrophy (TTD) mice S.M. Botter1,⁎, I. Van der Pluijm2, S. Gabriëls2, L. Gerris2, J.P. Van Leeuwen3, J.H. Hoeijmakers1 1 Genetics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands 2 DNage BV, Leiden, Netherlands 3 Internal medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands Background: Osteoporosis typically manifests itself at old age. It is thought that aging is caused by DNA damage, which is normally repaired but accumulates in time. By using DNA repair deficient mouse models as a tool, research in our laboratory focuses on the mechanism of aging and the etiology of aging related pathology. In this study, we used a mouse model that closely mimics the human premature aging syndrome trichothiodystrophy (TTD). Much like human TTD patients, these mice show accelerated onset and progression of age-related diseases. The goal of this study was to assess if TTD mice can be used as a model for spontaneous, age-related osteoporosis mimicking the human situation more closely. Methods: From a cohort of 120 female wild type (WT) C57Bl/ 6 and 120 TTD animals groups of mice (n = 10/group) were sacrificed at defined time points (13, 26, 39, 45, 52 and 65 weeks
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of age), followed by dissection of femur and tibia. Separate groups of TTD mice (aged 26-65 weeks) were injected with ALN and PTH, to investigate if these drugs would have the same bone preserving effect in TTD mice as in human osteoporosis patients. Of each mouse, bone phenotype was determined using micro-CT analysis (right femur), bone strength using break tests (left femur), and transcriptional profiling using micro-arrays (tibia's, n = 50). Serum and plasma was collected for future biomarker approaches. Results: At 13 weeks of age, the bone phenotype of WT and TTD animals was not significantly different, but from 26 weeks onwards TTD animals had a faster age-related decline both in trabecular and cortical bone (BV/TV at 65 wks: WT: 12.5 ± 0.5%; TTD: 9.1 ± 0.6%, Ct.Th.: 218.3 ± 3.9 μm, TTD: 194.1 ± 5.9 μm). Bone strength was significantly lower at 65 weeks of age (WT: 97.1 ± 5.7 N/mm, TTD: 53.4 ± 3.6 N/mm). Both ALN and PTH were able to overcome the bone loss and maintain bone strength. Micro-array analysis of bone tissue from untreated TTDs showed that typical bone markers (SOST, Bglap, Coll-1, ALP, Periostin, Runx2 and TRAP) followed a similar downregulated expressional pattern. Conclusion: TTD mice showed accelerated bone loss during aging which could be reversed with drug treatment. At young age their bone phenotype did not differ from WT animals. This makes the TTD mouse model a suitable screening tool for determining bonepreserving qualities of both existing and novel treatments. In addition, its spontaneous development allows the discovery of biomarkers that may predict osteoporosis onset. Disclosure of Interest: S. Botter: None declared, I. Van der Pluijm: None declared, S. Gabriëls Employee of DNage BV, L. Gerris Employee of DNage BV, J. Van Leeuwen: None declared, J. Hoeijmakers Advisory board membership of: Prof. J. Hoeijmakers is member of the Scientific Advisory Board of DNage Keywords: micro CT, osteoporosis model, trichothiodystrophy doi:10.1016/j.bone.2010.04.369
PP234 Prospective study of the role of cortical thickness on the risk of hip fracture K. Briot1,⁎, C. Roux1, C. Benhamou2 1 Paris Descartes University, Rheumatology Department, Cochin Hospital, Paris, France 2 Unité INSERM U 658, Rheumatology Department, CHR d'Orléans, Orléans, France Introduction: Hip fractures are associated with an increased risk of mortality and morbidity. Bone mineral density (BMD) is regarded as the reference method for diagnosis and fracture prediction but it explains only a part of an individual's fracture risk because of the multiple determinants of fragility fracture. Bone geometry parameters could be useful for the prediction of the risk of fracture but the predictive value and the choice of these parameters remain to be determined. Objectives: to study the relationship between the hip structural geometry of the hip derived from DXA and the 5-year risk of hip fractures in postmenopausal osteoporotic women. Patients and methods: Using the 5-year data of the placebo group of the TROPOS study, a double-blind, placebo-controlled, randomized clinical trial of strontium ranelate, we have reanalyzed the hip DXA scans to determine the role of hip geometric parameters measured at baseline on the risk of hip fractures. Included patients were those having BMD measurements on Hologic QDR 4500 device, and with adequate image acquisition. The outcomes included the DXAderived hip structure analysis program by Beck, which calculated
cross-sectional area (CSA), section modulus, cortical thickness, and buckling ratio, measured in cross-sectional regions at femoral neck, intertrochanteric region and proximal shaft. Results: The study population consisted of 636 postmenopausal osteoporotic women (mean age of 77.6 ± 5.5 years) treated with calcium and vitamin D; 28 hip fractures were observed over the 5-year follow-up. Postmenopausal osteoporotic women with hip fracture were significantly older, had a lower total hip BMD, a significantly lower cortical thickness, a lower CSA and a higher buckling ratio at 3 sites. Multivariate analysis showed that after adjustment on age, total hip BMD and BMI, the geometric parameters associated with an increased risk of hip fracture were intertrochanteric CSA (for each decrease of a SD) (OR = 3.06; CI 1.33-7.06 p = 0.009) and femoral shaft cortical thickness (for each decrease of a SD) (OR = 4.44; CI 95% 1.57-12.62; p = 0.005). BMD was not predictive of the risk of fracture in this multivariate model. Conclusion: this study suggests that in postmenopausal osteoporotic women, cortical thickness assessment can improve the prediction of hip fractures independently from BMD. Disclosure of Interest: None declared Keywords: cortical thickness, hip geometry, osteoporosis doi:10.1016/j.bone.2010.04.370
PP235 Referral for DXA scanning: which risk factors are most predictive for osteoporosis J.G. Browne⁎, G. Steen, Z. Toth, M.C. Casey, J.B. Walsh Bone Health and Osteoporosis Unit, MIRA, St James's Hospital, Dublin 8, Ireland Osteoporosis affects both men and women with its prevalence increasing with age. The gold standard for the diagnosis of osteoporosis is dual X-ray absorptiometry (DXA). Previous studies have shown that some risk factors are more associated with osteoporosis compared to others. The aim of this study was to determine which risk factors were more commonly referred for DXA and are more likely to predict a positive DXA for osteoporosis. Our osteoporosis service is an open access service for GPs and hospital consultants. Baseline demographics were recorded with the diagnosis for osteoporosis (OP) as per WHO guidelines using DXA. Risk factors for osteoporosis were recorded in detail in a subset of referrals. 8119 new patients had a DXA performed over a 6-year period between January 2003 and April 2009. Mean age was 64.18 (±16.69)yrs with 80.5% being female. The incidence of osteoporosis increased with age. For patients <60 yrs, 22% had osteoporosis. Patients >70yrs, 58% had osteoporosis whereas patients >80yrs, 75% had osteoporosis. A further subset of 3691 new patient referrals were reviewed. The 4 most common reasons for referral included (Percentage of referrals and those with osteoporosis are included in brackets): (a) History of fracture (27.7%, OP 61.7%), (b) X-ray evidence of Osteopaenia (24.3%, OP 53.1%), (c) Steroid Use >3months (18.6%, OP 44.6%), and (d) Rheumatoid Arthritis (17%, OP 44.4%). Reduced BMI was the most predictive modifiable risk factor for osteoporosis with 67.4% of these cases having osteoporosis. Age is an important risk factor for osteoporosis, with 75% of patients over 80yrs having osteoporosis and a further 20% having osteopaenia. Age, history of fragility fracture, x-ray evidence of osteopaenia, steroid use and rheumatoid arthritis were the most predictive and commonest risk factors for osteoporosis and should be prioritised in an open access DXA service.