Endocrine Abstracts (2017) 49 EP224 | DOI: 10.1530/endoabs.49.EP224

A multidisciplinary clinic for bone metabolism diseases; descriptive analysis of our experience in quiron salud malaga hospital

Araceli Muñoz-Garach1, Maria Carmen Ordoñez-Cañizares2, Ana Nieto-Gonzalez2, Pablo Manzano Fernández-Amigo2 & Jose Manuel García-Almeida1


1Endocrinology and Nutrition Department. Quiron Salud Hospital, Málaga, Spain; 2Rheumatology Department. Quiron Salud Hospital, Málaga, Spain.


Introduction: A multidisciplinary clinic has been developed to optimize the diagnosis and treatment of bone metabolism diseases. Initiated in March 2013, it is carried out simultaneously, once a week by an Endocrinologist and a Rheumatologist.

Objective: To describe the experience of this unit in the last 12 months.

Material and methods: Cross-sectional observational study. 235 patients were attended from December 2015 to December 2016. In the first visit, we carried out a medical record using a checklist form and impedancemetry. We requested a blood test with bone remodeling markers (CTX-I and P1NP), vitamin D, PTH, sex hormones and 24-hour urine with calciuria and phosphaturia, densitometry and dorsum-lumbar spine x-rays. In the following visit the results were evaluated and the team formed by both specialists agreed the protocol of action. Subsequently we studied treatment tolerance and analytical, radiographic and densitometric changes.

Results: 97% were women with a mean age of 60±9.7 years. Weight 66.3±12.7 kg, height 158.2±5.8 cm, BMI 26.6±4.9 kg/m2. Impedancemetry showed mean lean mass was 43.0±5.9 kg and mean fat mass 23.3±10.1 kg. 36.2% and 20% of the patients had a personal and family history of fracture, respectively. 15.2% patients had taken previous corticoid treatment; 9.5% had more than 2 falls in the last year. 5.7% were active smokers. 87.4% had menopause; early menopause in 13.4% and surgical menopause in 10.7%. 60% practiced more than 3 days of physical activity per week, 78.8% sunbathed more than 10 minutes a day and 36.2% took adequate dairy milk consumption. Among the digestive antecedents, 39% had gastroesophageal reflux and 16.2% hiatus hernia. 17.5% have had a vertebral fracture. In the densitometric data according to T-score they had osteoporosis 55.06%; Osteopenia 42.76% and normal 2.24%. The FRAX index was 4.3% for major fracture and 0.9% for hip fracture. Among the treatments received prior to the first consultation, 29.5% took bisphosphonates, 9.5% denosumab, 2.9% PTH. 37.5% calcium plus vitamin D.

Conclusions: A high percentage of patients received treatment before coming to the clinic. The most used was bisphosphonates. The aggregate management by two specialists in the multidisciplinary clinic is beneficial and improves the quality of care in our patients.

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