European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Bonemineral density and trabecular bone score in the treatment of
postmenopausal osteoporosis
V. Savinis, V. Alekna, M. Tamulaitiene, A. Mastaviciute. Faculty of
Medicine of Vilnius University, Vilnius, Lithuania
Objectives: To analyse the changes of bone mineral density and
microarchitecture in women with postmenopausal osteoporosis
treated with anti-resorptive medication.
Methods: This retrospective cross-sectional study was performed
on three groups of patients aged 50 years and older treated with
ibandronic acid, alendronate or strontium ranelate. The control group
consisted of untreated women with postmenopausal osteoporosis.
The lumbar spine L1-L4 bone mineral density (BMD) and trabecular
bone score (TBS) was evaluated after 2 years of treatment. Lumbar
spine BMD was examined by dual X-ray absorptiometry (iDXA, Lunar
GE, USA). TBS was calculated using “TBS iNsight®” software. Data was
analyzed using „SPSS 18.0 for Windows ” program.
Results: In total, 63 postmenopausal women were included: 13 sub-
jects were treated with ibandronic acid, 16 women used alendronate,
13 women used strontium ranelate, and 21 women were controls.
After 2 years of therapy with ibandronic acid, the lumbar spine BMD
changed from 0.790 ± 0.112 g/cm 2 to 0.795 ± 0.098 g/cm2 (1 ± 3.6%), in
alendronate group – from 0.805 ± 0.073 g/cm2 to 0.824 ± 0.069 g/cm 2
(2.7 ± 7%), and in strontium ranelate group – from 0.838 ± 0.078 g/cm 2
to 0.901 ± 0.084 g/cm 2 (7.7 ± 5.7%, p < 0.001). TBS changed from
1.152 ± 0.106 to 1.175 ± 0.104 (2.1 ± 4.8%) in women treated with
ibandronic acid, from 1.187 ± 0.076 to 1.202 ± 0.097 (1.3 ± 5%) in
alendronate group, and from 1.213 ± 0.104 to 1.231 ± 0.070 (2.0 ± 7.1%)
in those who used strontium ranelate. In control group BMD change
was from 0.804 ± 0.067 g/cm2 to 0.797 ± 0.059 g/cm2 (0.7 ± 3.6%), and
TBS – from 1.122 ± 0.069 to 1.123 ± 0.065 (0.1 ± 2.8%).
Conclusion: A statistically significant increase in bone mineral density
of 7.7 ± 5.7% was found in osteoporotic women, treated with strontium
ranelate.
P-487
Why do maximum conservative management patients end up on
dialysis?
A. Shrestha, A. Burns. Royal Free Hospital, London
Introduction: Maximum conservative management (MCM) for
chronic kidney disease is a popular option, particularly in co-morbid
or older patients. Some patients appear to change their minds, and the
question of whether dialysis should be initiated arises. We explored
the treatment modality changes in our MCM population, to quantify
how many end up receiving renal replacement therapy (RRT), the
reasons behind why MCM patients end up being dialysed long-term
and the survival in these patients who initially chose MCM then had
dialysis.
Methods: The renal unit’s database was searched (2012–2016) for all
patients who had the modality of MCM at some point which changed
to RRT or death. This generated a list of hospital numbers, which were
reviewed through the database and clinic letters.
Results: 43 of 563 MCM patients changed modality and received RRT,
with median age at initiation of 78 years. 36 commenced haemodi-
alysis, 6 peritoneal dialysis and 1 was transplanted. 5 died within 3
months. Overall median survival was 29 months. 25 patients changed
their modality in hospital (3 by intensive therapy unit); most (12) were
because of fluid overload. 15 changed their modality after clinic
discussion.
Key conclusions: Only 15 patients changed their minds through clinic,
the ideal route for considering dialysis to avoid acute crisis or an
unplanned start. To reduce RRT initiation during hospital admission,
deeper discussions in clinic may be required. Patients should be
allowed to change their mind within reason as median survival of 29
months is considerable.
P-488
Giant insulinoma
B. Ben Dhaou1, Z. Aydi1, I. Rachdi 1, F. Daoud1, L. Baili1, S. Ketari1,
S. Kochbati1, F. Boussema1. 1Internal Medicine Department, Habib
Thameur Hospital, Tunis, Tunisia
Introduction: Islet-cell tumors are the most common neuroendocrine
tumors that arise from the endocrine pancreas. They are typically
benign and sporadic.
Diagnosis is generally established late because clinical signs lack
specificity. The insulinoma is difficult to localize since it is very small in
size, often not exceeding 2 cm.
Case report: We report an exceptional case of giant insulinoma
initially revealed by a pseudo-polycythemia in an 80-year-old man.
He had been treated for hypertension for a few months. Routine
biological investigations showed elevated hematocrit and haemoglo-
bin, suggesting Vaquez disease. History taking revealed recent
episodes of nocturnal agitation. On admission, he had reddish skin
with a suspected enlarged spleen, but total blood volume was normal.
Imaging studies showed a voluminous tumor located between
the pancreas and the spleen. The presence of an insulinoma was
confirmed on the basis of an elevated level of proinsulin at the time of
an asymptomatic episode of hypoglycemia. Spleno-pancreatectomy
was performed. Histopathological examination revealed a malignant,
well-differentiated neuroendocrine malignant tumor.
P-489
Cutaneous symptoms revealing acute myeloid leukemia: a case
report
B.B. Dhaou1, Z. Aydi1, I. Rachdi1, F. Daoud 1, L. Baili 1, M. Somai1,
F. Boussema1. 1Internal Medicine Department, Habib Thameur Hospital,
Tunis, Tunisia
Introduction: Leukemia cutis (LC) is not rare in acute myeloid
leukemia (AML) but exceptionally reveal it. Most authors think that
they have poor prognosis. We report the case of a man with isolated
cutaneous involvement at the time of diagnosis of leukemia.
Case report: A 66-year-oldmanwas admitted for investigation of fever
and generalized cutaneous nodules. One month before, he started to
exhibit temperature elevation, arthralgia and generalized cutaneous
nodules. At the time of admission, he had generalized cutaneous,
erythematosus, not pruriginous nodules; Peripheral blood count
revealed normochromic anaemia at 9.7 g/dL, a leukocyte count of
24,500 with myelemia at 16% and a thrombopenia at 53,000/mm3. He
had also biological inflammatory syndrome with VS at 102 and PCR at
164 mg/L. Serum LDH was elevated at 1,694 UI/L and uricemia at
998 μmol/L. Bone marrow aspiration showed AML M4. The histo-
pathologic examination of the skin lesion confirmed the diagnosis of
leukemia cutis. The patient was dead before any chemotherapy.
Conclusion: Specific skin lesions are usually observed in patients with
an aggressive clinical course and are associated with a poor prognosis.
In some instances, such lesions might provide the initial diagnosis of
leukemia.
P-490
Takayasu’ s disease in elderly women revealed by an inflammatory
syndrome
B.B. Dhaou1, Z. Aydi1, F. Daoud1, I. Rached 1, L. Baili1, F.B. Dahmen1,
F. Boussema1. 1Department of Internal Medicine, Habib Thameur
Hospital, Tunis
Introduction: Takayasu’ s arteritis (TA) is a chronic vasculitis mainly
involving the aorta and its main branches. It commonly affects patients
in 2nd and 3rd decade of life. Females are affected more commonly
than males. The onset of symptoms occurs before 30 years of age in
most patients. It is rare in the elderly and it is a rare cause of fever of
unknown origin.
We report two cases of Takayasu’s disease occurring in elderly women
and revealed by fever and biological inflammatory syndrome.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S158