“The judicial protection of possession in the Brazilian legal system reveals itself as an adoption of the absolute normative model of possession protection, in contrast to most European national legal systems, and establishes an independent possessory procedural protection in relation to the right to property” is the hypothesis that is proposed by the present article and validated with the investigation developed with the following objectives: investigate the historical development of the possessory and petitory actions in Roman Law; examine the level of independence and binding between the possessory judgment and the petitory judgment in the national legal systems; and identify particularities of the legal treatment of possession in Brazilian law, as well as the limits of its protection. The methodology used was based on a review of different doctrinal and normative sources with an analytical approach and on the exegesis of the current norms. As results, it was possible to identify and systematize the rules related to the judicial protection of possession that demonstrate that Brazil adopts a more independent and "guarantee" system of possessory protection (normative model of absolute protection of possession), as well as defining some of the singularities of the legal treatment of possession in Brazilian Law. With this, a propositional thesis is presented regarding the functioning and limits of the system of judicial protection of possession in Brazilian Law.

Esta pesquisa examinou o sistema processual de tutela da posse a partir de uma perspectiva reconfiguradora das ações possessórias, classificadas em ações possessórias típicas e atípicas de acordo com a causa petendi e o pedido do autor. Utilizou-se como metodologia a abordagem qualitativa, mediante a revisão bibliográfica de diferentes fontes literárias e normativas, com abordagem analítica e exegese das normas vigentes. Como resultados, constatou-se que tanto o autor como o réu podem apresentar, em ação possessória típica, pedido de tutela possessória fundado no jus possessionis cumulado com o jus possidendi. No caso específico do réu, o seu pedido pode estar fundamentado no jus possessionis ou apenas no jus possidendi. A pesquisa propõe, assim, uma tese propositiva quanto à possibilidade de o réu ou o autor apresentarem pedido subsidiário de tutela possessória na ação de usucapião ou na ação publiciana (ações possessórias atípicas). Tais possibilidades constituem contribuições por representarem soluções mais condizentes com a economia processual, a duração razoável do processo e a eficiência da tutela jurisdicional para situações até então de difícil solução.

Trata-se de pesquisa que pretendeu analisar e confrontar a accessio possessionis e a sucessão inter vivos na posse, para apontar incompatibilidades entre o entendimento que atualmente prevalece na literatura jurídica e nos tribunais brasileiros e os conceitos históricos dos institutos, baseados na teoria das situações jurídicas subjetivas. A análise foi realizada a partir do questionamento se, diante do regime jurídico da aquisição derivada de direitos e da continuidade da posse, o não exercício da faculdade da accessio possessionis pelo adquirente ensejaria um convalescimento ou saneamento da posse do sucessor a título singular. Para realizar esse confronto, a pesquisa utilizou uma metodologia qualitativa de revisão bibliográfica de diferentes fontes literárias e normativas, com enfoque analítico e exegese das normas vigentes. Como resultado, a pesquisa verificou que o não exercício da faculdade da accessio possessionis não causa um convalescimento ou saneamento da posse do sucessor a título singular e que este entendimento é uma interpretação equivocada e contra legem, colidente com regras do regime jurídico brasileiro em matéria possessória. No Brasil, a accessio possessionis acaba por ser confundida com a sucessão singular ou inter vivos na posse. A contribuição da pesquisa consiste na construção de uma tese para orientar as situações jurídicas de continuidade da posse, pois os efeitos jurídicos em matéria possessória são moldados tendo em vista não caráter objetivo da posse (posse justa ou posse injusta), mas o seu caráter subjetivo (posse de má-fé ou posse de boa-fé). Essa linha de entendimento possibilita uma melhor compreensão do regime legal da posse no Brasil, encontrando espeque, inclusive, no Código Civil.

Trata-se de pesquisa que objetiva analisar a formulação normativa do parágrafo único do art. 647 do Código de Processo Civil, para esclarecer os principais pontos controvertidos sobre a natureza da tutela sumária nela prevista e a sua aplicação no âmbito do inventário e da partilha. Foi utilizado como método a abordagem qualitativa, por meio da análise exploratória de bibliografia e de julgados de Tribunais de Justiça e do Superior Tribunal de Justiça. A pesquisa demonstra o modo pelo qual as regras do ordenamento jurídico material dialogam com o processo civil e apresentam os contornos das técnicas procedimentais e jurisdicionais. Ao final, a pesquisa analisa as consequências práticas de cada um dos pontos controvertidos, especialmente quanto à quota do herdeiro beneficiado.

Introduction: Ischiofemoral Impingement occurs due to an abnormal contact between the ischium and the lesser trochanter of the femur, where the tendon of the iliopsoas muscle is inserted and where the quadratus femoris muscle is located.The friction caused by the contact between these bones causes damage to the quadratus femoris muscle, leading to its inflammation or muscle atrophy.The diagnosis is made through clinical history, physical examination and complementary diagnostic tests such as pelvic radiography and magnetic resonance imaging of the coxofemoral joint.Clinical case: Female patient, 59 years old, followed in Rheumatology for Rheumatoid Arthritis since she was 38 years old.She went to the Rheumatology appointment due to pain, with limitation in abduction, internal and external rotations of the right coxofemoral joint and changes in gait pattern.Magnetic resonance imaging (MRI) of the hip joints was requested, which revealed the existence of a significant reduction in the space between the lesser trochanter and the ischial tuberosity, with a significant change in the MRI signal of the right quadratus femoris muscle, showing a SPAIR hypersignal translating edema.Physiatrist appointment were recommended.The patient showed clear improvement with physiotherapy. Discussion:The main causes that lead to Ischiofemoral Impingement are: valgus femur neck, more vertical, bringing the femur closer to the pelvis; sequelae of developmental dysplasia of the hip; total hip arthroplasty; postoperative period of valgus osteotomies, dysmetria of the lower limbs, weakness of the abductor muscles and local tumor.Female morphology, with a wide and shallow pelvis, predisposes to ischiofemoral impingement.Treatment is conservative, except in cases of local tumor. Conclusion:Ischiofemoral Impingement represents one of the etiologies of hip pain.It is difficult to establish its diagnosis since the history and physical examination are imprecise, making it essential to perform magnetic resonance imaging.

BACKGROUND:Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.METHODS:SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.RESULTS:The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

OBJECTIVE To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures. METHODS A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions. RESULTS 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible. CONCLUSIONS Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

Background Treatment of Paget9s Disease of Bone (PDB) has been revolutionized by the use of zolendronic acid (ZA). Patients usually have a dramatic response to treatment with normalization serum alkaline phosphataise (ALP) levels and a longer period of clinical remission, compared with other class agents. Data from long-term use are scarse. Objectives Evaluate the effectiveness and safety of ZA in PDB patients, as well as remission, re-treatment rates and side effects in our outpatient population since 2005. Methods A retrospective study of PDB patients treated with 5 mg ZA intravenous infusion at our day-care center. Follow up time, demographic and clinical characteristics, previous therapeutic agents, rate of response, number and reasons of re-treatment(s) and rates of adverse events were collected. A descriptive statistic analysis was made. Results 48 patients, 60% female, mean age of 75 years, with a median time since the diagnosis of 12.3 years. The disease was poliostotic in 73% of the patients and pelvis (65%), skull (29%) and spine (27%) were the most common pagetic localizations. Deafness was present in 12.5% and 65% had hip involvement. 44% patients had been treated with another biphosphonate agent previously. Response rates were 97.9% at 1 year, 87.2% after 2 years and 95.1% after 3 years. The mean ALP levels before ZA infusion was 290 UI/L and after 112 UI/L. Sixteen patients needed a re-treatment in the period of follow up, minimum of 1 year after the ZA infusion and maximum of 8 years after. 56.3% due to raised of ALP levels and 43.8% due pain/ hip involvement. Four patients needed a third infusion due to hip involvement, and 2 of them a forth infusion due to the same reason. All of the patients re-treated due to hip involvement had severe hip involvement at time of diagnosis. In our population, 2 patients achieved 10 years remission, 5 patients 9 years remission and 10 patients 8 years remission with a single ZA infusion. Recording adverse effects were: 14.6% Flu like symptoms (7 patients), 2% assintomatic hypocalcemia (1 patient) and no reports of osteonecrosis or fractures. All of these effects were reported after the first ZA infusion. Conclusions In our population, we find high long-term sustained remission rate. Only sixteen patients needed re-treatment. Patients maintained sustained remission up to 10 years of a single ZA infusion. Incidence of adverse events was similar to the reported in the literature. References Reid IR, Miller P, Lyles K et al. Comparison of a Single Infusion of Zolendronic Acid with Risendronate for Paget9s Disease. N Eng J Med. 2005 Set:353(9):898–908 Reid IR, Brown JP, Levitt N et al. Re-treatment of relapse Paget9s disease of bone with zolendronic acid: results from an open-label study. Natur BoneKEy Report 2. 2013 Nov: 442: 1–3 Reid IR, Lyles K, Brown JP et al. A Single Infusion of Zolendronic Acid Produces Sustained Remissions in Paget Disease: Data from 6.5 years, JBMR. 2011 Sep 26 (9):2261–70 Devogelaer JP, Geusen P, Daci E et al. Remission over 3 years in patients with Paget disease of bone treated with a single intravenous infusion of 5 mg zolendronic acid. Calcif Tissue Int. 2014 Mar:94(3):311–8 Disclosure of Interest None declared

Background Regardless of epidemiologic evidence suggesting a positive impact of protein dietary intake over bone health, the connection between dietary protein and bone metabolism remains controversial. A hyperproteic diet is linked to increased renal calcium excretion but there is no clear evidence of its relevance in the development of osteoporosis (OP). In the elderly, it is often found a low dietary protein intake and association between low serum albumin levels, femoral neck fracture and post-fracture mortality. A correlation between body composition and fall occurrence is under discussion. Objectives To study the relation between nutritional/biochemical variables and occurrence of falls and fractures. Methods A questionnaire on dietary protein intake was applied to patients at a Rheumatology clinic during 4 non-consecutive weeks from July to September 2013. Nutritional evaluation included body composition (InBody 720). Clinical data collected included: fall occurrence; history of clinical and/or radiologic vertebral fractures; total serum protein, albumin, inorganic phosphate, calcium, parathyroid hormone, vitamin D and calcium urinary excretion levels and neck/lumbar densitometry. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, Qui-Square and Spearman correlation were applied for a significance of p<0,05. Results 196 subjects were included, 88% female, mean age 58 years. The most prevalent rheumatic diseases were: rheumatoid arthritis (RA), osteoarthritis (OA), Sjögren9s syndrome, undifferentiated connective tissue disease, spondyloarthritis, systemic lupus erythematosus (SLE) and fibromyalgia. The average body mass index (BMI) was 27,5 kg/m2, higher in patients diagnosed with SLE, OA and RA. 20 subjects (10,2%) had previous history of fall occurrence, 24 (12,2%) had history of fractures (7 vertebral, 2 femoral neck, 4 wrist). We found correlation between the occurrence of fractures and female gender (25 vs. 0 patients, p=0,046); lower T-score at femoral neck (r=-0,521, p=0,046) and lower total serum protein levels (6,39 vs. 6,69, p=0,018). These variables were also correlated with the number of fractures. Fall occurrence was higher in older subjects (64,8 vs. 57,4 years, p=0,017), and in those with higher T-score at lumbar spine (r=0,663, p=0,014). In subjects over 58 years, we found an association with body percentage and BMI, independent of muscle mass (p<0,05). There were no differences between the groups with and without fracture concerning nutritional parameters or mean age (62 vs.57,7 years, p=0,136). Conclusions In this population, in a rheumatologic setting, fractures were commoner in women, with lower bone mineral density and lower serum protein levels. Higher BMI and body fat percentage may be risk factors for fall occurrence in the elderly, eventually related to a shift in the centre of gravity. Nutritional advice in OP patients should consider these notions. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4357

Background The relationship between protein dietary intake and Bone Mass Index (BMI) is controversial. Hyperproteic diet increases urinary calcium excretion but without obvious impact in Osteoporosis (OP). Sarcopenia in the elderly may be associated with low protein diet. High BMI and with high fat content was considered a protective factor for OP but it may be related to vitamin D deficiency and subclinical hyperparathyroidism. Objectives This study aims to evaluate the relationship between protein diet intake, BMI and and parathyroid hormone (PTH) levels. Methods A questionnaire on dietary protein intake was applied to patients at a Rheumatology clinic during 4 non-consecutive weeks from July to September 2013. Nutritional evaluation included body composition (InBody 720). Clinical data collected included: fall occurrence; history of clinical and/or radiologic vertebral fractures; total serum protein, albumin, inorganic phosphate, calcium, PTH, vitamin D and calcium urinary excretion levels and neck/lumbar densitometry. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, Qui-Square and Spearman correlation were applied for a significance of p<0,05. Results 189 subjects were enrolled, 88% female, mean age 58 years, mean BMI 27kg/m2 (low weight in 1,7%, normal in 33,1%, overweight in 37,7% and obesity in 27,6%). Regarding protein intake, 66,7% drunk milk >5 times/week and 22,2% >2 glasses/day; 61,3% of the patients consumed yogurt 1-3 times/day and 20,6% <1/week; 44% consumed cheese once a day. Lean and fatty fish were consumed weekly in 75% of the subjects and canned fish in up to 86%. Codfish and eggs consumption varied between 1 to 4 times/week in 68% and 77%, respectively. Red meat ingestion was: 2-4 times/week in 51%, <3 times/month in 27%. We found an association between weight (r=-0,131;p=0,043), body fat content (r=-0,174;p=0,007) and higher ingestion of lean fish. Patients with lower body fat content had a higher milk intake (r=-0,274;p=0,001). Higher consumption of red meat was associated with higher muscle mass and protein content (r>0,142;p<0,033). We also found a relation between higher PTH and higher BMI (r=0,310;p=0,034). Conclusions Patients that had a lower BMI and reduced body fat content consumed more lean fish, also those with lower body fat content showed a higher intake of milk. Red meat was associated with higher muscle mass and protein content. High PTH levels were correlated with higher BMI, which is in concordance with new evidence suggesting that overweight and obesity do not protect against OP. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5279

Background Work capacity is primarily assessed by absenteeism and rheumatic patients may experience decreased productivity as well as presenteeism due to their health problems as well as its costs consequences. Objectives To evaluate the relation between work disability, productivity and disease activity, quality of life and functional disability. Methods 242 rheumatic patients were recruited, 33.3% employed (N=81) completed the questionnaires of work disability and productivity: WALS (Workplace Activity Limitations Scale), SPS 6 (Stanford Presenteeism Scale) and WPAI (Work Productivity and Activity Impairment) 4 scores - absenteeism, presenteeism, work and activity impairment. Patient-reported parameters included pain, fatigue, sleep quality and disease activity (VAS). Functional disability and quality of life outcomes were assessed by HAQ-DI, FACIT and SF-12. Data were collected during a 4-week period. The analysis included descriptive statistics, Mann-Whitney test and Spearman correlation, p <.05. Results 81 gainfully employed patients (85% female) had 48±11 years old, with 10±4 schooling years. Mean VAS were: pain 47±32, fatigue 57±33, sleep quality 46±33 and disease activity 43±30; HAQ-DI: 1.76±0.9, FACIT:17±11 and SF-12: 39±13 in PCS and 43±18 in MCS. Productivity assessment revealed limitations in all measured scores: WALS 8±6 [0-25], SPS 6 12±3 [3-15], WPAI work impairment 29±32%, activity impairment 29±29%, absenteeism 2.1±12.3% and presenteeism 28±32%. WALS was positively correlated to HAQ (r=.657, p<.0001), FACIT (r=.720, p<.0001), both SF12 scores (r>.517, p<.0001), all 4 WPAI9s scores (r>.296, p<.01) and inversely with SPS 6 (r= -.341, p=.002). WPAI9s scores were all significantly associated to HAQ, FACIT, SF12 PCS and sick leave in the last 12 months (p<.05). SPS 6 was inversely related to HAQ and FACIT scores, WPAI presenteeism, work and activity impairment (p<.05), but not with absenteeism. Pain and fatigue were significantly higher in patients with higher WALS and WPAI scores, in exception to absenteeism, and pain was associated with SPS 6 (p<.05). Sleep quality was decreased when related to higher WALS and WPAI scores (p<.05). When comparing the employed/unemployed patients, WPAI activity impairment, PCS, MCS, HAQ, FACIT, pain and disease activity (p<.01), we verified significantly higher limitations and impairment in the unemployed group, in exception to SPS 6, fatigue and sleep quality. Conclusions These findings suggest the significant impact of rheumatic disease in productivity losses, and that unemployed patients present worst quality of life and higher levels of pain, fatigue and disability. We found good correlations between the productivity assessment and the SF12, HAQ, FACIT, pain, fatigue, sleep quality and disease activity. This provides information about trend of work restrictions, useful in cost-effectiveness analysis for example of new treatment therapies. Moreover, these issues are particularly important because absenteeism and presenteeism have strong links to health related costs. Prevention of work disability and job changes/adaptations to the individual capabilities would be most effective in reducing socioeconomic and work related impact. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5488

Background Rheumatoid arthritis (RA) patients1 and postmenopausal women2 showed an increased fall risk. Research pointed to some gait biomechanical parameters related with falls (GBPRF)3 and found differences in these parameters between elderly and young: elderly showed higher ratio of head to hip horizontal acceleration and higher heel horizontal velocity at heel contact with the ground3; elderly and young showed similar minimum toe clearance values however elders had greater variability.4 There is strong evidence that balance and coordination exercises (proprioceptive exercises, PE) can reduce fall rates in elderly.5 Objectives Analyze the PE effects in RA postmenopausal women relatively to disease activity, functional capacity and GBPRF. Methods RA postmenopausal women (n=7) participated in a 12-week PE individual program (3 sessions/week, 30 minutes/session). Data collected pre and post-program. DAS28 and HAQ used to evaluate disease activity and functional capacity. Vicon® Motion Capture system recorded kinematics data (9 MX1.3 cameras, 200Hz) synchronized with a force plate (AMTI BP400600-200, 1000Hz). Data analyzed by Vicon® Nexus software (1.7.1) based on an integrated model of 41 reflective markers relocation and subject anthropometric data, developing mechanical segments and joints centers. Subjects performed 14 valid trials (7 left and 7 right foot contacts with AMTI). Results Improvements in HAQ (1.00 to 0.46, t student, p=0.005) and visual analogue scale for pain (4.95 to 2.07 cm, t student, p=0.003). DAS28 results remained statistical unchanged (4.32 to 3.54, t student, p=0.127). GBPRF did not show statistical differences (t student, p<0.05): left and right heel antero-posterior velocity (0.35 to 0.30 m/s, p=0.310; 0.30 to 0.28, p=0.604; respectively); left and right minimum toe clearance (2.07 to 1.86 cm, p=0.113; 1.94 to 1.87 cm, p=0.468); head antero-posterior velocity/hip antero-posterior velocity at 4 crucial gait instants (left heel contact - 0.85 to 0.87, p=0.440; right heel contact - 0.87 to 0.88, p=0.369; left minimum toe clearance - 1.08 to 1.06, p=0.168; right minimum toe clearance - 1.10 to 1.05, p=0.309; left contralateral heel contact - 0.88 to 0.87, p=0.367; right contralateral heel contact - 0.86 to 0.86, p=0.829; left toe off - 1.03 to 1.03, p=0.862; right toe off - 1.00 to 1.02, p=0.588). Conclusions Despite the small number of participants data indicate that PE can improve functional capacity and reduce pain perception in RA postmenopausal women. In addition did not exacerbate disease activity. GBPRF did not show pre and post-program differences however a larger sample may allow observation of differences accompanying observed improvements in functional capacity. References Hayashibara M, Hagino H, Katagiri H, Okada J, Teshima R. Osteoporosis International 2010;21(11):1825–1833 Cangussu L, Nahas-Neto J, Nahas E, Barral A, Buttros D, Uemura G. BMC Musculoskeletal Disorders. 2012;13:2 Winter D. The Biomechanics and motor control of human gait: normal, elderly and pathological. 2nd ed. Waterloo: University of Waterloo Press; 1991:87–94 Barrett R, Mills P, Begg R. Gait & Posture 2010;32(4):429–435 Sherrington C, Whitney J, Lord S, Herbert R, Cumming R, Close J. Journal of the American Geriatrics Society 2008;56:2234–43 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3890

Background Femoral neck fracture is considered as one of the most severe consequence of osteoporosis (OP) due to its high mortality and morbidity, affecting patients’ Health Related Quality of Life (HRQoL) physically, psychologically and socially1. Objectives To evaluate HRQoL and impact of femoral neck fracture in subjects lives in a high risk of fracture (HRF) population with and without self-reported OP. Methods HRQoL was assessed by SF12 scale and subjects perception on their HRQoL before and after the fracture. Cross-sectional survey including a convenience sample of HRF population selected randomly from nursing homes and long-term care facilities in Portugal. Inclusion criteria for subjects were age ≥50 years, history of a low impact femoral neck fracture on the 24 months prior, absence of cognitive limitations. Confidence intervals (CI) of 95% will be determined and calculations were performed assuming a 5% significance level. Results 419 HRF subjects were included, mean age 78.3±7.8, 70.4% female. From these 37.5% (n=157;CI: 32.9%>42.2%) self-reported OP. Mean age for occurrence of a femoral neck fracture was 77.2±8.1, with no significant differences between subjects with and without self-reported OP (77.3±9.6 vs. 76.9±7.4; p=0.656). In a scale of 1 (worst possible) to 10 (better possible), significant differences were found for subjects’ perception about their HRQoL before and after femoral neck fracture (7.0±2.4 vs. 4.2±2.3; p<0.001) and between subjects with and without OP before and after the fracture (With OP: 7.9±1.7 vs. 4.9±2.2; p<0.001; Without OP: 6.8±2.6 vs. 4.1±2.3; p<0.001). In these groups, significant differences were observed before and after fracture (p=0.038). Conclusions Subject’s perceptions of their HRQoL change after a femoral fracture. Lower HRQoL levels are reported by individuals after experiencing a femoral neck fracture. Fracture is a life altering event on people’s lives diminishing their QoL. References Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 2000;11(5):460-6 Disclosure of Interest None Declared

Background The awareness of osteoporosis (OP) symptoms and evolution may impact on patients daily activities. Osteoporosis may cause pain, reduce physical functioning and mobility also resulting in social isolation and depression1. Objectives To evaluate Health Related Quality of Life (HRQoL) and pain in subjects with and without self-reported OP, in the general population and in a high risk of fracture (HRF) population. Methods Cross sectional survey including a representative sample of Portuguese population aged ≥50 years (random route method, door to door) and a HRF population (convenience sample, selected randomly from nursing homes and long term facilities from Portugal). Inclusion criteria for HRF population were age ≥50 years, history of femoral neck fracture on the 24 months prior and absence of cognitive limitations. SF12 scale and ECOS were used. Results Table 1. Quality of Life - SF12 General population HRF Population OP N Mean SD p-value N Mean SD p-value SF12: Physical Function Yes 62 45,2 34,7 <0,001 157 35,6 32,4 0,833 No 1836 72,2 33,0 224 34,8 30,7 SF12: physical role functioning Yes 62 14,5 35,5 <0,001 157 3,2 16,7 0,363 No 1836 39,7 46,8 224 1,8 13,3 SF12: general health perceptions Yes 62 25,9 22,9 <0,001 157 21,0 19,5 0,975 No 1836 45,9 28,6 224 21,1 18,7 SF12: vitality Yes 62 50,0 22,3 <0,001 157 48,2 19,7 0,059 No 1835 63,3 22,7 224 51,9 18,3 SF12: social role functioning Yes 62 58,9 24,4 <0,001 157 45,9 28,3 0,988 No 1836 75,8 22,4 224 46,0 25,5 SF12: emotional role functioning Yes 62 20,2 37,8 <0,001 157 5,4 21,6 0,573 No 1836 45,5 48,2 224 4,2 18,8 SF12: mental health Yes 62 55,5 16,8 <0,001 157 58,6 18,0 0,608 No 1835 67,5 15,9 224 57,7 15,2 From the 2007 subjects of the general population (mean age of 65.3±10.4 years; 55.2% female), 62 (3.1; CI: 2.4%>3.9%) self-reported OP. HRF population included 419 subjects (mean age of 78.3±7.8;70.4% were female), 37.5% (n=157; CI: 32.9%>42.2%) self-reported OP. Significant differences were found for SF12 dimensions between subjects in general population with and without self-reported OP (Table 1). In HRF population no significant differences were found (Table 1). Regarding ECOS, significant differences were found between general population and HRF population with self-reported OP (2.74±0.79 vs. 3.15±0.85, p=0.001). No significant differences were found in ECOS pain items between general population and HRF population with self-reported OP (ECOS items 1 to 5: p=0.410; p=0.134; p=0.086; p=0.323; p=0.144, respectively). Conclusions The evidence suggests that the HRQoL on the general population with self-reported OP was significantly lower in comparison with the population without OP, although no significant differences were found between groups in the HRF population. That could be partial explained by the presence of a low hip fracture in this group. References Bianchi ML, Orsini MR, Saraifoger S, Ortolani S, Radaelli G, Betti S. Quality of life in post-menopausal osteoporosis. Health Qual Life Outcomes 2005;3:78. Disclosure of Interest None Declared

Background Osteoporosis (OP) is a major public health problem with great impact on patient’s quality of life and daily living activities. Knowledge on OP may influence the engagement in preventive measures for the development of the disease and fracture1,2. Objectives To evaluate information sources and knowledge about OP, comparing three populations: general practitioners (GPs), general population and high risk fracture (HRF) population. Methods Cross sectional survey was performed including GPs (convenience sample, contacted via email or telephone), subjects representative of Portuguese population aged ≥50 years (selected by random route method, door to door) and HRF population (convenience sample, selected from nursing homes and long term facilities from Portugal). Inclusion criteria for HRF population were age ≥50 years, history of femoral neck fracture on the 24 months prior, absence of cognitive limitations. Descriptive analysis was performed, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. Results 194 GPs were included (mean age 51.6±9.9 years, 53.1% female). In general population, 2007 subjects were included (mean age of 65.3±10.4 years, 55.2% female). 419 HRF subjects were included (mean age of 78.3±7.8, 70.4% female). GPs mentioned congresses and clinical meetings (88.7%), followed by medical sales representatives (74.7%) as the most common sources of information on OP. General population referred having heard about OP (80.9%), mostly through television (64.8%) and GPs (41.5%). In HRF population, 80.7% referred having heard about OP, being the most referred information sources GPs (57.8%) and television (29.8%). In a TRUE and FALSE questionnaire, all GPs referred as being TRUE OP is more frequent in women after menopause (100%). In general population, 75.4% acknowledged OP is a bone disease, OP is an unavoidable consequence of aging (43.0%) and for the majority of subjects with OP the mean life expectancy is significantly affected (40.1%). For HRF population, the three most frequently indicated as being TRUE were OP is a bone disease (75.2%), OP is an unavoidable consequence of aging (63.7%) and OP is a joint disease (47.7%). GPs considered fracture (94.8%), height decrease (83.0%) and curvature of the spine (79.9%) as the main OP symptoms. 70.3% of general population mentioned at least one disease symptom, being most commonly pointed pain (82.1%). In HRF population, 76.4% indicated at least one OP symptom, with pain (86.3%) and fracture (81.3%) the most common ones. Conclusions Despite the awareness about the existence of the disease, there is still a great gap in the knowledge of OP symptoms, severity and consequences. Both general population and HRF population referred GP has one of their sources of information. Strategies for information dissemination could be developed to help increasing GP awareness for this disease that will also help spreading it to the rest of the population. References von Hurst PR, Wham CA. Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women. Public Health Nutr. 2007;10(7):747-53. Riaz M, Abid N, Patel J, Tariq M, Khan MS, Zuberi L. Knowledge about osteoporosis among healthy women attending a tertiary care hospital. J Pak Med Assoc 2008;58(4):190-4. Disclosure of Interest None Declared

Background Pharmacological treatment in osteoporosis (OP) has been demonstrated as effective in significantly reduction the risk of osteoporotic fracture. However, the effectiveness of this treatment may be compromised by poor treatment compliance and can result in increased rates of fracture1. Objectives To evaluate patients’ compliance for the treatment of OP, comparing patients in the general population and subjects in a high risk of fracture (HRF) population. Methods Cross sectional survey was performed including subjects representative of the Portuguese population ≥50 years (selected by random route method, door to door) and HRF population (convenience sample, selected from nursing homes and long term facilities from Portugal). Inclusion criteria for HRF population are age ≥50 years, history of femoral neck fracture on the 24 months prior and absence of cognitive limitations. The general and HRF population included demographics and clinical variables. Patients’ compliance was evaluated through the Morisky scale (range 0-7). It was performed a descriptive analysis of all variables collected, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. T-test and chi-square test were performed to validate the study hypothesis. All calculations were performed assuming a 5% significance level. Results This analysis included a total of 2007 subjects from the general population (mean age of 65.3±10.4 years, 55.2% female). 3.1% (n=62; CI: 2.4%>3.9%) had self-reported OP. HRF population included 419 subjects (mean age of 78.3±7.8, 70.4%female). From these, 37.5% (n=157; CI: 32.9%>42.2%) had self-reported OP. In general population with self reported OP 67.7% (n=42) referred being medicated and more than half referred to never forget to take their medication (56.5%; n=26). In HRF population 91.1% (n=143) were medicated for OP and the majority of patients reported never forgetting to take their medication (71.6%; n=106). Globally, the results suggest that HRF population is more compliant than the general population with self-reported OP (Morisky scale value 5.9±0.7 vs. 4.1±1.9; p<0.001). The most significant differences found in each item of the Morisky scale were “Do you forget to take your medicine?” (Yes: 46.5% vs. 2.0%; p<0.001); “Did you ever missed your medication during the last 4 weeks?” (Yes: 48.8% vs. 5.4%; p<0.001); “When you travel or go out of home, do you ever forget to take your medication with you?” (Yes: 44.2% vs. 8.1%; p<0.001); and “Do you ever feel that it is hard to follow your treatment plan for OP?” (Yes: 32.6% vs. 4.1%; p<0.001). Conclusions Our study proves that OP treatment is poor; especially the HRF population and that compliance is lower in the general population. This behavior may expose patients to higher risk of developing low bone mass and consequent osteoporotic fractures. Patient and physician awareness and education must be stimulated as a useful way of improving compliance with treatment. References Huas D, Debiais F, Blotman F, Cortet B, Mercier F, Rousseaux C, Berger V, Gaudin AF, Cotté FE. Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment. BMC Womens Health. 2010 Aug 20;10:26. Disclosure of Interest None Declared

Background FRAX tool has been developed by the World Health Organization (WHO) to estimate the 10-year fracture probability in men and women from clinical risk factors, age, sex and body mass index with or without the measurement of femoral neck bone mineral density1. Objectives To evaluate the differences in the Portuguese population in the FRAX 10 year probability of fracture and reported risk factors for osteoporosis (OP), comparing the general population and a high risk fracture (HRF) population. Methods Cross sectional survey was performed including subjects representative of the Portuguese population aged ≥50 years(selected by random route method, door to door) and a HRF population (convenience sample, selected from nursing homes and long term facilities in Portugal). Inclusion criteria for HRF population are age ≥50 years, history of femoral neck fracture on the 24 months prior, absence of cognitive limitations. The overall and HRF population included demographics and clinical variables. The FRAX 10 year probabilities of hip and major osteoporotic fractures were calculated, according to the Spanish algorithm and reported risk factors for OP were collected. Descriptive analysis was performed, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. T-test was performed to validate study hypothesis. Confidence intervals (CI) of 95% will be determined and all calculations were performed assuming a 5% significance level. Results The analyses included 2007 subjects from the general population (mean age of 65.3±10.4 years, 55.2% female). 62 subjects self-reported OP (3.1%; 95% CI: 2.4%>3.9%). The HRF population included 419 subjects (mean age 78.3±7.8, 70.4% female). In general population, the probability of a major osteoporotic fracture was 5.0±5.3 and 2.1±3.7 for hip fracture. This values were statistically higher for subjects in general population with self-reported OP (Major Osteoporotic: 11.0±11.8 vs. 4.8±4.8; p<0.001; Hip Fracture: 6.1±10.6 vs. 1.9±3.1; p=0.003). The probability of a major osteoporotic fracture in HRF population was 20.7±11.4. Considering hip fracture, HRF population had a mean probability of 12.1±9.6. No significant differences were found in the HRF population between subjects with and without self-reported OP. Conclusions As expected, subjects in HRF population (that already had suffered a previous fracture) have a higher risk for major osteoporotic and hip fractures when compared with the general population. References Kanis JA, Oden A, Johansson H, Borgström F, Ström O, McCloskey E. FRAX and its applications to clinical practice. Bone 2009;44(5):734-43. Disclosure of Interest None Declared

Background Osteoporosis (OP) is associated with pain, disability and increased mortality1. For being a silent disease and recognized by the general population as an aging disease2 a population with OP and an older population can be more aware of its severity. Objectives To evaluate subjects’ perceptions on OP including its severity degree, in individuals in the general population and individuals in a high risk of fracture (HRF) population, comparing subjects with and without self-reported OP. Methods A cross sectional survey was performed including a representative sample of the Portuguese population aged ≥50 years (selected by a random route method, door to door) and a HRF population (convenience sample, selected randomly from nursing homes and long term facilities from Mainland Portugal). Inclusion criteria for the HRF population are age ≥50 years, history of femoral neck fracture on the 24 months prior and absence of cognitive limitations. Survey included demographics and clinical variables. A descriptive analysis was performed for all variables, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. T-test was performed for the study hypothesis. 95% Confidence intervals (CI) are determined and all calculations assume a 5% significance level. Results The analyses included 2007 subjects from the general population (mean age 65.3±10.4 years; 55.2% female). 62 subjects self-reported OP (3.1%; 95% CI:2.4%>3.9%). The HRF population included 419 subjects (mean age 78.3±7.8), being 70.4% female. 37.5% self-reported OP (n=157; 95% CI: 32.9%>42.2%). In a scale from 1 (no severity) to 10 (maximum severity), the general population graded OP as 5.7±2.0. Self-reporting OP subjects significantly graded this disease as more severe than the remaining population (7.6±1.9 vs. 5.7±2.0; p<0.001). The HRF population graded OP with a 6.8±2.2 score. Subjects who self-report OP in this population significantly graded this disease as more severe than the remaining subjects (7.9±1.7 vs. 6.4±2.2; p<0.001). The HRF population significantly graded OP as a more severe disease than the general population (5.7±2.0 vs. 6.8±2.2; p<0.001). When asked about their concern regarding OP, in a scale from 1 (no concern) to 10 (maximum concern), the mean level on the general population was 5.7±2.4. Subjects in this population with self-reported OP significantly revealed more concern with this disease than subjects without OP (8.2±2.1 vs. 5.6±2.4; p<0.001). The mean level of concern on the high risk of fracture population was 6.8±2.5. Within this population, subjects who self-reported OP significantly revealed more concern with this disease than subjects without self-reported OP (8.1±2.0 vs. 6.1±2.5; p<0.001). Conclusions The high risk population understands OP as a more severe disease than the general population. Moreover, subjects with self-reported OP tend to grade OP as a more serious disease when comparing with subjects without OP, in both studied populations. Awareness of this disease must be improved in order to trigger prevention measures especially for the general population. References American College of Rheumatology. The Role of Rheumatologists in the Management of Osteoporosis – Position statement. Werner P. Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int 2005;16(2):115-27. Disclosure of Interest None Declared