Objectives: To estimate the impact of first major osteoporotic fractures (MOF) on health resource use and healthcare expenditures in people aged >= 50 years in Catalonia, Spain. Design: Observational, retrospective study. The Catalan Health Surveillance System (CHSS) registry was used to obtain sociodemographic, clinical and expenditure data from all public centres in Catalonia (Spain). Setting and participants. Males and females aged >= 50 years who sustained a first major osteoporotic fracture between January 1, 2018, and December 31, 2020. Methods: Data on admissions to the emergency department, hospitalization and skilled nursing facilities, primary and specialized care visits, nonemergency medical transport, outpatient rehabilitation and pharmacy prescriptions were retrieved for each patient. Monthly and yearly mean usage rates, expenditure in euros (euro) and incremental costs one and two years after fracture were calculated. Results: There were 64,403 patients with first MOF: 47,555 females and 16,848 males with a mean age (standard deviation) of 76.5 (12.0) years. The average annual expenditure increased from euro4564 in the year before to euro12,331 in the year following a hip fracture. For forearm fractures, the expenditure increased from euro2511 to euro4251, for vertebral fractures from euro4146 to euro6659, for pelvic fractures from euro4442 to euro7124, for humerus fractures from euro3058 to euro5992, and for multiple fractures from euro4598 to euro12,028. The average cost for overall fractures experienced a 110.3 % increase. The leading cause of health expenditure in the year following MOF was hospital admission. Expenditure in the second year post-fracture returned to pre-fracture levels. The use of some healthcare resources, especially visits to emergency services, increased in the prefracture month. Male sex, older age and high previous comorbidities were associated with a higher expenditure. Conclusions: In people with a first MOF, healthcare expenditure doubled during the first-year post-facture, mostly in relation to inpatient care. The healthcare resource use increased during the previous month. This increase could potentially be attributed to the worsening of pre-existing comorbidities.

To describe the secular trend and seasonality of the incidence of hip fracture (HF) and its relationship with climatic variables during the period 2010–2019 in Catalonia in people aged ≥ 65 years. The results were analyzed by sex, age groups (65–74, 75–84, and ≥ 85), and types of fracture (extracapsular and intracapsular). Data on sex, age, type of fracture, year, and month of hospitalization of patients admitted with a diagnosis of HF between January 1, 2010 and December 31, 2019 were collected. Crude and standardized HF incidence (HFi) rates were obtained. Data on the monthly mean of climatological variables (temperature, insolation, icy days, rain, relative humidity, atmospheric pressure, and wind force) were obtained from the network of meteorological stations in Catalonia. Time series analytical statistics were used to identify trends and seasonality. Linear regression and a seasonal autoregressive integrated moving average (ARIMA) were used to analyze the relationship of each climatic parameter with fracture rates. In addition, generalized additive models were used to ascertain the best predictive model. The total number of HF episodes was 90,149 (74.1% in women and 25.9% in men). The total number of HFs increased by 6.4% between 2010 and 2019. The median age (SD) was 84.5 (7.14) and 54% of patients were ≥ 85 years of age. Extracapsular fractures were the most common (55%). The standardized incidence rates decreased from 728.1/100,000 (95% CI 738.6–769.3) to 624.5/100,000 (95% CI 648.7–677.0), which represents a decrease of 14.2% ( p < 0.05). The decline was greater at older ages. There were seasonal variations, with higher incidences in autumn (27.2%) and winter (25.7%) and lower rates in summer (23.5%) and spring (23.6%). Seasonality was more pronounced in elderly people and men. In the bivariate regression analysis, high temperatures and greater insolation were negatively associated with the HF rate, while the number of icy days, rainy days, and high relative humidity were associated with a higher incidence of fractures in all age groups and sexes. In the regression analysis using the seasonal ARIMA model, only insolation had a consistently significant association with overall HFi, after adjusting by trend and other climatic parameters. While the global number of HFs grew in Catalonia due to increases in the elderly population, the standardized HF rate decreased during the years 2010–2019. There was a seasonal trend, with predominance in the cold months and correlations with climatic parameters, especially with insolation.

OBJECTIVE:To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service. METHODS:Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses. RESULTS:Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case. CONCLUSIONS:The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective.

ObjetivoEvaluar la eficiencia de las Unidades de Coordinación de Fracturas (UCF) frente al manejo clínico estándar (MCE) en la prevención secundaria de las fracturas por fragilidad (FF) desde la perspectiva del financiador (Servei Català de la Salut [CatSalut]).MétodoEvaluación del coste-utilidad a través de un modelo Markov que simuló la progresión de la enfermedad en una cohorte de pacientes candidatos a iniciar tratamiento antiosteoporótico (AOP) tras una FF. Se estableció un horizonte temporal de 10 años y una duración por ciclo de seis meses. Los parámetros clínicos, económicos y de calidad de vida fueron obtenidos de la literatura e información derivada de cuatro unidades de UCF en Cataluña. Se adoptó la perspectiva del CatSalut, considerando costes directos sanitarios expresados en euros del 2022. Se aplicó una tasa de descuento por preferencia temporal del 3% en costes y resultados salud. Se aplicaron múltiples análisis de sensibilidad para evaluar la incertidumbre inherente.ResultadosComparado con el MCE, las UCF promocionarían el inicio y persistencia terapéutica, reduciendo la incidencia y mortalidad asociada a las FF subsiguientes. Dicho beneficio clínico incremental se estimó en 0,055 años de vida y 0,112 años de vida ajustados por calidad (AVAC) por paciente. Ello implicaría un mayor coste (1.073,79 € por paciente), resultando en una razón coste-utilidad incremental (RCUI) de 9.602,72 € por AVAC ganado. Los análisis de sensibilidad realizados resultaron congruentes, corroborando la robustez y carácter conservador del caso base.ConclusionesDesde la perspectiva del CatSalut, la implementación y consolidación de las UCF para la prevención secundaria de las FF representaría una estrategia coste-efectiva.

The aim of this study was to estimate the incidence of major osteoporotic fractures in Catalonia, Spain, in 2018 and 2019 and their association with age, sex, income, climate and a set of comorbidities. Data on age, sex, smoking, alcohol abuse, comorbidities (obesity, Parkinson’s disease, arthritis, chronic kidney disease, hepatic cirrhosis, diabetes, chronic obstructive pulmonary disease, dementia, cerebrovascular disease, hyperthyroidism, multiple myeloma and epilepsy) and income levels in people aged ≥ 50 years with a new diagnosis of major osteoporotic fractures in 2018 and 2019 were collected from the Catalan Health Surveillance System (CHSS). Climatological variables were obtained from the Catalan Meteorological Service. Incidence rates were estimated for five major osteoporotic fractures (MOF). Associations between osteoporotic fractures and age, sex, income, comorbidities and climate variables were ascertained through multilevel generalized linear model analysis (Poisson’s regression). There were 60,671 MOF. The annual incidence rate per 1000 persons/years at risk (PYAR) was 10.6 (3.1 for hip, 2.3 for distal forearm, 2.2 for vertebrae, 1.7 for pelvis and 1.5 for proximal humerus). Female sex, older age, lower income, smoking, alcohol abuse and some common comorbidities were associated with a higher incidence of MOF while obesity was a protective factor. MOF are frequent in the adult Catalan population, especially in older women and people on low incomes. Hip fracture is the most frequent, followed by forearm and vertebral fractures. Smoking, alcohol abuse and some comorbidities were associated with an increased incidence of fracture.

Objectives: Chronic back pain is one of the main health problems reported by the adult population and its prevalence is influenced by different sociodemographic, work and lifestyle-related factors. The aim of this study was to describe the trend in the lifetime prevalence of chronic back pain in the adult Catalan population between 2011 and 2018 and its associated factors. Study design: Cross-sectional study. Secondary analysis of a health survey. Methods: Trend in lifetime prevalence of chronic back pain by age and sex groups was estimated from the Catalan Health Survey. Association of chronic back pain with sex, age, health status, lifestyle factors, comorbidities, socio-economic and work-related variables was analysed. Results: A total of 31,823 people were interviewed between 2011 and 2018. The prevalence of chronic back pain decreased from 29.7% to 24.2% between 2011-2014 and 2015-2018 in the total population with higher prevalence and a greater difference in women (35%-28.50%) than in men (24.2%-19.7%). Factors associated with higher prevalence of chronic back pain were female sex, older age, poor health status, smoking, alcohol consumption, insufficient physical activity, overweight or obesity, mental health problems, lower educational level or social class, dissatisfaction at workplace, poor social support and family financial problems. Conclusions: The analysis shows a decreasing prevalence of chronic back pain from 2011 to 2018 in the adult population of Catalonia in all age groups and more significantly in women. An improvement of healthy lifestyle habits, social and occupational determinants, could have reduced the burden of chronic back pain in our community. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

This article sets out to answer the following clinical questions: Clinical Question 1 and related: Should new fractures be prevented pharmacologically after (repairing) a low intensity hip fracture? Does this preventive treatment affect other outcomes? If so, which drug should be initiated and for how long should it be maintained? Clinical Question 2 and related: Does the early administration of preventive drug treatment (of new fractures) affect hip fracture healing in other outcomes? If not, when should be given the first dose? Methodology: To answer the clinical questions, a systematic review (SR but RS in the Spanish text and tables) of the available scientific literature was carried out, including the assessment of its quality in order to identify studies on the safety and clinical efficacy/effectiveness of anti-osteoporotic treatment in patients with low-intensity hip fracture.

There is little information on how the COVID-19 lockdown influenced the epidemiology of major osteoporotic fractures (MOF). We analyzed the incidence and mortality of MOF in 2020 compared with 2018–2019 in Catalonia, Spain. The incidence of MOF decreased steeply, and post-fracture mortality increased during the lockdown and throughout 2020. To analyze the effect of the COVID-19 pandemic and lockdown on major osteoporotic fracture (MOF) incidence and mortality in Catalonia in 2020 and describe how age, sex, and the prior comorbidity burden influenced the epidemiology of MOF types. In this retrospective observational study, data on age and sex in people aged ≥ 50 years with a new diagnosis of MOF in 2018, 2019, and 2020 were collected. Average daily rates (ADR) were estimated overall and for five MOF: hip, distal forearm, proximal humerus, vertebrae, and pelvis. Morbidity was assessed using Adjusted Morbidity Groups. ADR in 2020 and the previous years were compared for overall and site-specific MOF in four consecutive time periods: pre-confinement, lockdown, deconfinement, and post-confinement. Thirty-day post-fracture mortality was assessed. COVID-19-related mortality was obtained from the Catalan COVID-19 register. From 2018 to 2020, there were 86,412 MOF. The ADR of MOF initially increased in 2020 before the pandemic, decreased steeply during lockdown, and remained lower in the rest of the year. The decrease was steeper in vertebral, pelvic and arm fractures, and lower in hip fractures. Differences were more pronounced in younger age groups and people with fewer comorbidities. Mortality increased throughout 2020, reaching a 2.5-fold increase during lockdown. Excess mortality was directly associated with COVID-19. Mobility restrictions due to COVID-19 were associated with a reduction in MOF incidence in Catalonia, especially in younger people and in non-hip fractures. Post-fracture mortality was higher than in previous years due to the high COVID-19 mortality in the elderly.

Background:Incidence of clinical fractures in rheumatoid arthritis (RA) is not as well-known as hip or vertebral fracture incidence.Objectives:1. To estimate the incidence of clinical fragility fractures in a population of postmenopausal women diagnosed with RA and compare it with that of the general population; 2. To analyze the risk factors for fracture.Methods:330 postmenopausal women with RA from 19 Spanish Rheumatology Departments, randomly selected from the registry of RA patients in each center. The control group consisted of 660 Spanish postmenopausal women from the Camargo Cohort. Clinical fractures during the previous 5 years were recorded. Assessed risk factors for fracture were: sociodemographic characteristics, BMD and variables related to RA.Results:Median age of RA patients was 64 yrs. vs. 63 yrs. in controls (ns). Evolution of the disease was 8 yrs. 78% and 76% had RF and ACPA+, respectively. 69% of patients were in remission or low activity. 85% had received glucocorticoids and methotrexate and 40% at least one biological DMARD. We identified 105 fractures (87 fragility and 18 traumatic) in 75 patients. Fifty-four patients and 47 controls had at least one major fracture (MF) (p< 0.001). Incidence of MF was 3.55 per 100 patient-year in patients and 0.72 in controls. Risk factors for MF in RA patients were age, previous fracture, parental hip fracture, postmenopausal period, hip BMD and cumulative dose of glucocorticoids. In controls, risk factors were age, age at menopause and lumbar BMD.Among RA-associated factors, MFs were associated with erosions, disease activity and disability. Previous fracture in RA patients was a strong risk for MF (HR: 10.37 [95% CI: 2.95-36.41]).Conclusion:Between 3 and 4 of every 100 postmenopausal women with RA have a major fracture per year, four times more than the general population. Disease activity and disability associated with RA, the cumulative dose of glucocorticoids and mainly previous fracture are associated with the development of fragility fractures.References:NoneAcknowledgments:Funded in part by ISCIII (PI18/00762) that included FEDER funds from the EU.Disclosure of Interests:Carmen Gómez Vaquero: None declared, Jose Manuel Olmos: None declared, J. Luis Hernández: None declared, Dacia Cerda: None declared, Cristina Hidalgo: None declared, JA Martínez López: None declared, Luis Marcelino Arboleya Rodríguez: None declared, Javier Aguilar del Rey: None declared, Silvia Martinez Pardo: None declared, Inmaculada Ros: None declared, Xavier Surís: None declared, Dolors Grados Canovas: None declared, Chesús Beltrán Audera: None declared, Evelyn Suero-Rosario: None declared, Inmaculada Gómez Gracia: None declared, Asunción Salmoral: None declared, Irene Martín-Esteve: None declared, Helena Florez: None declared, Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Santos Castañeda: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO, S García Carazo: None declared, Alberto García-Vadillo: None declared, Laura López Vives: None declared, À Martínez-Ferrer: None declared, Helena Borrell Paños: None declared, Pilar Aguado: None declared, Raul Castellanos-Moreira: None declared, Cristian Tebé: None declared, Núria Guañabens: None declared

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27–4.00), glucocorticoids (OR 3.83; 95% CI 1.32–14.09) and falls (OR 3.57; 95% CI 1.91–6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

BackgroundThe relationship between interstitial lung disease (ILD) and rheumatic diseases is well known. Recently, a new clinical entity has been described that relates ILD with autoimmune findings, IPAF (Interstitial Pneumonia with Autoimmune Features), which allows identifying and condensing non-cataloged diseases with pulmonary and rheumatic involvement.ObjectivesOur aim is to establish which patients with ILD have a rheumatic disease, and which of them meet the IPAF criteria. We analyzed the role of nailfold capillaroscopy in these patients.MethodsThis is a prospective descriptive observational study. The observation period was 2 years (2016-2018), in a county university hospital. Patients diagnosed with ILD of unknown etiology, derived from Pneumology Service, were included. A medical history was obtained focused on autoimmune disease, rheumatological evaluation, rheumatological blood markers and nailfold capillaroscopy, in order to establish whether they had a concomitant rheumatic disease.ResultsThirty patients with ILD were evaluated, with a mean age of 70,5 years (53 - 88). Of the 30 subjects, 12 (40%) had usual interstitial pneumonia (UIP), 11 (36.67%) had organizing pneumonia (OP) and 7 (23.33%) had nonspecific interstitial pneumonia (NSIP). Eleven (36,67%) of the 30 patients had an altered capillaroscopy, 6 of them (54,5%) had a rheumatic disease. In our sample, 5 cases meet diagnostic IPAF criteria, 4 OP and 1 UIP, three of them with altered capillaroscopy.ConclusionIn our serie, one third of the patients were diagnosed with rheumatic disease associated with interstitial lung disease. Of the thirty evaluated patients, 36.67% had altered capillaroscopy, 54.5% presenting concomitant rheumatic disease. Following the IPAF classification criteria, we obtained 5 cases in our sample: four OP and one UIP, 3 of them with altered capillaroscopy. It is important to be aware of this association with a multidisciplinary approach for the adequate diagnosis and follow-up of these patients.Disclosure of InterestsVera Ortiz-Santamaria Speakers bureau: GSK, Roche, Pfizer, MSD, Noelí Reguart Oto: None declared, Pau Sendra de Dios: None declared, Noemí Busquets: None declared, Maria Pascual: None declared, Andrés Ponce Speakers bureau: Abbie, Roche, Pfizer, MSD, Xavier Surís Speakers bureau: Lilly, Pfizer, MSD, Yolanda Galea: None declared, Anna Mola: None declared, Marta Torrella: None declared, Julia Tarrega: None declared, Enric Barbeta Speakers bureau: GSK, Boehringer Ingelheim, Roche

Background Rheumatoid arthritis (RA) is a risk factor for the development of fragility fractures, but there is little quality data on its prevalence. Conversely, osteoporosis is one of the most frequent comorbidities of RA. Objectives To determine the prevalence of vertebral fractures in postmenopausal women with RA and to analyse their characteristics and associated risk factors. Methods We included 346 postmenopausal women diagnosed with RA according to the ACR/EULAR 2010 criteria in 19 Spanish Rheumatology Departments, randomly selected from the registry of RA patients in each center, recruited during 2018. Lateral radiographs of the dorsal and lumbar spine were obtained from all patients, to evaluate morphometric vertebral fractures. Expert rheumatologists identified vertebral fractures and classified them into mild (grade 1: reduction of height of 20-25%), moderate (grade 2: reduction of 26-40%) and severe (grade 3: reduction > 40%), according to the Genant grading scale. The spinal deformity index (SDI) was calculated by assigning numbers 1, 2 and 3 to each fractured vertebra and adding the total score of each patient. The study variables were: a) age, body mass index (BMI), b) factors related to RA: time of evolution, FR, ACPA, and c) fracture risk factors: prior fragility fracture, parental hip fracture, glucocorticoids, smoking, alcohol intake ≥3 units daily, secondary osteoporosis and time since menopause. Results The mean age was 66.8 (SD: 10.1) years and the median evolution of the disease, 8.00 [RIQ: 3.00-15.5] years. 77.2% (n: 267) and 75.7% (n: 252) had FR and ACPA +, respectively. The mean duration of the postmenopausal period was 15.0 (SD: 9.6) years. 23.4% (n: 79) of patients had at least one vertebral fracture; 10.7% (n: 36) had a single fracture and 12.7% (n: 43), multiple fractures. The most fractured vertebrae were D12, L1 and L2 (fractured in > 5% of patients). The median SDI was 3 [RIQ: 2-5]. The vertebrae with the highest mean IDE were D8, D10, D11 and L1 (all mean IDE ≥ 2).An association was found between the presence of vertebral fractures and age, height, postmenopausal period, time of disease progression, glucocorticoid treatment and parental hip. No linear association was found between SDI and age, time of evolution of the disease, BMI and time since menopause. Conclusion One out of every 4 postmenopausal women with RA has at least one vertebral fracture. Vertebrae of the dorso-lumbar hinge are the most frequently involved and the magnitude of the spinal deformity is relevant. Vertebral fractures are related to the time of evolution of RA and to the risk factors for fracture. Disclosure of Interests Carmen Gómez Vaquero: None declared, Dacia Cerda: None declared, Cristina Hidalgo: None declared, JA Martínez López: None declared, Luis Marcelino Arboleya Rodríguez: None declared, Javier Aguilar del Rey: None declared, Silvia Martinez Pardo: None declared, Inmaculada Ros: None declared, Xavier Surís Speakers bureau: Lilly, Pfizer, MSD, Dolors Grados: None declared, Chesús Beltrán: None declared, Evelyn Suero-Rosario: None declared, Inmaculada Gómez Gracia: None declared, Asunción Salmoral: None declared, Irene Martín-Esteve: None declared, Helena Florez: None declared, Antonio Naranjo: None declared, Santos Castañeda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Soledad Ojeda Grant/research support from: AMGEN, Speakers bureau: AMGEN, S García Carazo: None declared, Alberto García-Vadillo: None declared, Laura López Vives: None declared, À Martínez-Ferrer: None declared, Helena Borrell: None declared, Pilar Aguado: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Núria Guañabens Consultant for: Advisory Boards from Amgen, Alexion and UCB, Speakers bureau: Fees and lectures from Eli Lilly

To assess the impact of the comprehensive orthogeriatric care model (OGM) on 2-year survival, length of stay (LOS), discharges to nursing homes, and antiosteoporotic treatment (AOT) in patients with hip fracture.

Objectives: to describe the secular trend and seasonal variation in the incidence of hip fracture (HF) over 12 years (2003-2014) in Catalonia, the community with the highest incidence of HF in Spain.Methods: data about age, gender, type of fracture and month of hospitalisation among patients aged 65 years and older discharged with a diagnosis of HF were collected. Crude and age-standardised annual incidence rate were reckoned. To analyse HF trend, the age/sex-adjusted average annual change in incidence (incidence rate ratio, IRR) was calculated.Results: we identified 100,110 HF in the period, with an increase of 16.9% (women 13.4%; men 28.4%). Trochanteric fractures were the most frequent (55.8%). The crude incidence rate (per 100,000 population) decreased from 677.2 (95% confidence interval (95% CI) 662.0-692.7) to 657.6 (95% CI 644.0-671.5). The standardised incidence rate decreased from 754.0 (95% CI 738.6-769.3) to 641.5 (95% CI 627.7-655.3), with a sharp decrease in women (-16.8%) while it was stable in men. The incidence by type of fracture was stable. The trend throughout the period showed a slight decrease with IRR 0.99 (95% CI 0.98-0.99; P = 0.025). The incidence was stable in the oldest group (+85 years), while there was a downward trend in the younger groups. A significant seasonal pattern was observed, with more cases in winter and less in summer (spring as reference).Conclusions: the secular trend reveals a decreasing incidence of HF although the absolute number has increased in the last 12 years in Catalonia. Trochanteric fractures were the most prevalent and a seasonal pattern was observed, with more cases in winter.

Determination of different forms of 25-OHD (total, free and bioavailable) in healthy young women does not offer additional advantages over standard 25-OHDT for evaluating vitamin D deficiency. In these subjects 25-OHDT values <15 ng/ml would be more appropriate for defining this deficiency.

Objectives: Spanish clinical guidelines recommend screening patients for tuberculosis (TB) before TNF inhibitors (TNFi) treatment. Our objective was to estimate the prevalence of TST seroconversion as an estimation of the prevalence of latent TB in patients with rheumatic diseases and TNFi treatment that have already been screened for tuberculosis.Methods: TST, booster and chest x-ray were performed to patients with rheumatic diseases, TNFi treatment, negative tuberculin skin tests before treatment and that were attending the rheumatology Department of three different hospitals in Barcelona. According to the Spanish Society Rheumatology guidelines, these patients had not received TB prophylaxis treatment.Results: One hundred and forty patients were included in the study. The tuberculin skin test was positive in 4.28% (n=6) of the patients. 50% of the patients were undergoing TNFi < 2 years, being two of the patients only one year on the TNFi when a positive TST was detected. This shows that a conversion of the TST can occur even few months or years after the TNFi is started.Conclusions: The present study observed that 4.28% of patients with rheumatic diseases on TNFi who did not have performed a pre-treatment TB prophylaxis, had a conversion of the TST. Moreover, the conversion of the TST had been within the first two years of treatment in half of the patients of our cohort. In spite of these results, false TST positives in the diagnosis of latent TB cannot be excluded as an explanation for our results. (C) 2016 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.

Background Hypo or amyopathic dermatomyositis (DM) represent about 20% of the classic DM. Melanoma differentiation-associated gene 5 antibody or anti-MDA5 antibody, formerly known as anti-CADM140 antibody, has been reported in the last decade. This antibody is detected in more than 50% of patients with hypo or amyopathic DM and it has specific features such as the presence of ulcerative vascular lesions and rapid progression of the interstitial lung disease. Objectives To report anti-MDA5 positive DM cases diagnosed at a university county hospital, between 2012 and 2016. Methods Design: Retrospective descriptive study. Location: University county hospital. Reference area: ?350.000 inhabitants. Clinical manifestations, analytical results, diagnostic approach, treatment administered and follow-up have been exposed. Results We report four anti-MDA5 positive DM with a mean age at diagnosis of 54 years (35–77). Caucasian origin in 2 men and Maghreb origin in 2 women. They had no relevant medical history neither neoproliferative process was detected. ANA were negative and CK values were normal in all the cases. Nailfold capillaroscopy was characteristic of DM pattern. Case B did not present cutaneous manifestations and he was diagnosed as anti-MDA5 DM after his death. Discussion B and C cases showed abnormal heart rhythm that could be related to myocardial involvement, as suggested in a recent publication of anti-MDA5 DM (1). In case C, sinus tachycardia was resolved with the clinical response to treatment. In the literature reviewed, anti-MDA5 positive DM has been reported as a dermato-pulmonary syndrome, but probably the clinical profile of these patients remains to be defined. In our cases, one of them did not present skin lesions and another case did not develop pulmonary involvement 18 months after the diagnosis. Conclusions Keep in mind anti-MDA5 antibody in patients with cutaneous manifestations of DM with vasculopathy lesions, minimal or absent muscular disease, heart rhythm abnormalities not explained by other causes and/or rapidly progressive pulmonary involvement. Anti-MDA5 positive DM may have a poor response to treatment and fatal outcome. It remains to be seen if early diagnosis could improve the life expectancy of these patients. References J Eur Acad Dermatol Venereol 2014; 28: 1097–102. Disclosure of Interest None declared

At present, data comparing the quantification methods for measurement of free vitamin D (direct assay [direct 25-OHDF] and estimated by calculation [calculated 25-OHDF]), are scarce. The aim of this study was to analyse the concordance between these two methods of 25-OHDF analysis (direct vs. calculated). Methods: Serum values of total 25-OHD (25-OHDT), vitamin D binding protein (DBP) (by R & D Systems ELISA), calculated 25-OHDF (by DBP, albumin and 25-OHDT) and direct 25-OHDF (by DlAsource ELISA) were analysed in 173 healthy women (aged 35-45 years). Assessment of concordance was evaluated by the Bland-Altman plot and the total deviation index (TDI). Results: The mean values of calculated and direct 25-OHDF in these subjects were 5.27 +/- 2.5 and 3.83 +/- 1.01 pg/mL, respectively. We found significantly lower values of 25-OHDF on comparing subjects with and without vitamin D deficiency, independently of the method used. The total deviation index evaluated by the Bland-Altman plot showed low concordance for both measurements. Only low 25-OHDF levels were concordant. Conclusions: This study shows that the concordance between these two methods of 25-OHDF analysis is low and has a concentration dependent bias. Further studies are necessary to clarify the reference values and the indications for 25-OHDF m easurement.

RESUMEN Objetivo: Conocer la opinion de los medicos internos residentes (MIR) de Cataluna acerca de la necesidad y utilidad de la formacion recibida en los servicios de urgencias. Metodos: Se envio un cuestionario electronico a los MIR de Cataluna mediante la colaboracion de sus jefes de estudio. El cuestionario contenia variables sociodemograficas, preguntas sobre la predisposicion del residente hacia las urgencias, y variables  relacionadas con la formacion: valoracion de la necesidad de una estancia en urgencias, y conocimientos y aptitudes adquiridos durante la rotacion (historias clinicas, relacion con los familiares, trabajo en equipo, toma de decisiones, identificacion y manejo de pacientes criticos y aprendizaje de tecnicas diagnostico-terapeuticas). Se hicieron analisis descriptivos y se compararon los resultados entre distintas especialidades. Resultados: Se envio el cuestionario a 1431 residentes de 21 hospitales e unidades docentes. Respondieron 427 residentes (29,8%). Tanto la valoracion sobre la necesidad de realizar una formacion en urgencias como sobre los conocimientos adquiridos fueron elevadas (8.9±1.7 y 8.2±1.9 respectivamente). Los aspectos en los cuales habian adquirido mayor conocimiento fueron la toma de decisiones y el manejo de pacientes criticos. Los residentes de familia mostraron mayor predisposicion a escoger la especialidad de urgencias (33.7% vs 6.1%, p Conclusiones: Los MIR de Cataluna opinan que una estancia en urgencias durante su residencia es necesaria y util para su formacion. Los residentes de familia son los que mas valoran esta formacion.

OBJECTIVES To know the opinion of medical residents in hospitals in Catalonia about the need for and usefulness of the training they receive in the emergency department. MATERIAL AND METHODS We sent an electronic questionnaire to all residents in Catalonia, through their cooperating supervisors. The questionnaire contained items to collect information on sociodemographic variables and attitudes toward emergency medicine. Items related to training covered the residents' assessment of the need for a rotation in the emergency department and the knowledge and skills acquired during the rotation (case history writing, relations with patients' relatives, teamwork, decision-making, identifying and managing critical patients, acquisition of diagnostic and therapeutic techniques). We compiled descriptive statistics and compared the results for residents from different specialties. RESULTS Questionnaires were sent to 1431 residents in 21 hospitals and other training facilities. Responses were received from 427 (29.8%). Mean (SD) scores expressed on a scale of 1 to 10 were high for both the need for training in emergency medicine (8.9 [1.7]) and knowledge acquired during the rotation (8.2 [1.9]). The residents reported that they had acquired more knowledge in the areas of decision-making and management of critical patients. Family medicine residents expressed greater interest in choosing the specialty of emergency medicine (33.7% vs 6.1% for other residents, P<.001), and their opinion of the need for training in emergency medicine was also higher than other residents' (9.2 [1.5] vs 8.7 [1.8], P=.006). CONCLUSION Medical residents in Catalonia believe that a rotation in the emergency department provides necessary and useful training. Family medicine residents are the ones who value emergency training most highly.