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• W2064039116 abstract "Introduction: The stages of change model suggests that patients move through five distinct stages of change (pre-contemplation, contemplation, preparation, action and maintenance) when adopting a new health behavior such as treatment initiation. The purpose of this study is to examine whether this model is applicable to osteoporosis (OP) treatment initiation in a cohort of fragility fracture patients. Methods: This prospective cohort study uses self-reported data collected as part of a provincial OP screening initiative targeting low trauma fracture patients over the age of 50. We examined the distribution of stages of change at baseline and follow up. Logistic regressionwas used to identify baseline factors associated with patients moving from the first stage at baseline tomore advanced stages at follow up.Results:At baseline, 93% (883/ 952) of patients were in the pre-contemplation stage. This first stage is characterized by a lack of awareness of OP and its treatment or a decision against the treatment. Of baseline pre-contemplators, 76% remained at the same stage at follow up, 2% moved to contemplation and preparation while 22% jumped to either action (stage in which a significant effort to change behavior has been made within the previous 6 months) or maintenance (themost advanced stage inwhichpatients sustaineda behavior change for a period of at least 6 months). Those who jumped from pre-contemplation to action or maintenance shared the following baseline characteristics: previous fracture OR 2 (1.4– 2.8),maternal historyof fracturesOR1.5 (1.1–2.2); theywere less likely to believe that they were taking toomanymedicationsOR0.6 (0.4–0.9) and theyperceived their bones as ‘thin’ at baseline OR 2.1 (1.3–3.4). Conclusion: The distribution of stages found in our sample suggests that the stages of change model may not be applicable to the initiation of OP treatment in post-fracture population: contrary to what the model would predict, most patients occupied the first stagewhile thosewho changed stages jumped from the first to the last two stageswithout occupying themiddle stages. The fact thatmost patients stayed in the first stage points to the need for more patient education on OP and treatment risks and benefits. Modifiable factors that we identified as predictors of change could be used in post-fracture interventions to facilitate this change. This article is part of a Special Issue entitled ECTS 2012. Disclosure of interest: R. Sujic: none declared, D. Beaton: none declared, M. Slater: none declared, E. Bogoch grant/research support from Alliance for Better Bone Health, Amgen Canada, consulting fees from Warner Chilcott, and Merck Frosst Canada Ltd. doi:10.1016/j.bone.2012.02.075 OC05/AHP05 Gestational exposure to urban air pollution is associated with lower vitamin D levels in newborns J.D. Wark⁎, N. Baiz, P. Dargent-Molina, I. Annesi-Maesano, R. Salma EDEN Mother–Child Cohort Study Group Medicine, University of Melbourne, Parkville, Australia Bone and Mineral Service, Royal Melbourne Hospital, Parkville, Australia Medicine, Inserm InstitutNational de la Sante et de la ReschercheMedicale, Paris, France Faculte de Medecine de Saint-Antoine, UPMC Univ6, Paris, France Universite J. Fourier Grenoble, Grenoble, France Inserm, U823, Team “Environmental Epidemiology Applied to Reproduction and Respiratory Health”, Institut Albert Bonniot, Grenoble, France Epidemiology of Allergic and Respiratory (EPAR, Inserm, Institut National de la Sante et de la Recherche Medicale), France Universite J. Fourier Grenoble, UPMC Univ6, Paris, France Inserm, U823, Team “Environmental EpidemiologyApplied to Reproduction and Respiratory Health”, Institut Albert Bonniot, Grenoble, France Abstract: Vitamin D deficiency is implicated in the risk for several diseases. Exposure to air pollution has been suggested as one of the factors that may contribute to vitamin D deficiency. However, studies examining the effects of air pollution on vitamin D status are few and never focused on prenatal life. Our aim was to investigate the associations between maternal exposure to urban air pollutants during pregnancy and 25-hydroxyvitamin D cord blood level in mother–child pairs of the EDEN birth Vitamin D deficiency is implicated in the risk for several diseases. Exposure to air pollution has been suggested as one of the factors that may contribute to vitamin D deficiency. However, studies examining the effects of air pollution on vitamin D status are few and never focused on prenatal life. Our aim was to investigate the associations between maternal exposure to urban air pollutants during pregnancy and 25-hydroxyvitamin D cord blood level in mother–child pairs of the EDEN birth cohort. The study population comprised 375 mother–child pairs. The ADMS-Urban pollution model, a validated dispersion model combining data on traffic conditions, topography, meteorology and background pollution, was used to assess concentrations of two major urban pollutants, particulate matter less than 10 μm in diameter (PM10) and nitrogen dioxide (NO2), at the mother's home address during pregnancy. Cord blood samples were collected at birth and were analyzed for levels of 25hydroxyvitamin D [25(OH) D]. 99.73% of mothers had levels of NO2 exposure below the WHO guideline value (40 μg/m) during their entire pregnancy, and 34.4% had average PM10 concentrations above the WHO guideline value (20 μg/m. Applying a multivariate linear regression model, maternal exposure to NO2 and PM10 during pregnancy was a strong predictor of low vitamin D status in newborns: significant decreases in 25(OH) D cord blood concentrations were observed for a 10 μg/m increase in NO2 (p=0.047) and PM10 (p=0.037) levels respectively after adjusting for confounders. The association was highly significant during the third trimester of gestation (β=−0.21, p=0.0003 and β=−0.43, p=0.004 for NO2 and PM10 respectively). Other determinants of low cord blood 25(OH) D included winter and spring births (p=0.0002), passive smoking during pregnancy (p=0.03) and low household income (p=0.01). Our data suggest that maternal exposure to low-moderate levels of urban air pollution during pregnancy and especially during late gestation contributes significantly to vitamin D deficiency in offspring thus increasing the child's risk of developing diseases later in life, including osteoporosis, asthma and allergies. Possible mechanisms include reduction in ground level UVB exposure and toxic effects of pollutants (epigenetic, hepatic, intestinal, placental). These findings support the need for further consideration of vitamin D supplementation in pregnant women. This article is part of a Special Issue entitled ECTS 2012. Disclosure of interest: J. Wark grant/research support from the French Agency for Environmental Security (AFFSET), N. Baiz grant/research support from the French Agency for Environmental Security (AFFSET), P. Dargent-Molina grant/research support from the French Agency for Environmental Security (AFFSET), I. AnnesiMaesano grant/research support from the French Agency for Environmental Security (AFFSET), and R. Salma grant/research support from the French Agency for Environmental Security (AFFSET). doi:10.1016/j.bone.2012.02.076 OC06/AHP06 Results of treating vertebral body fractures with radiofrequency kyphoplasty versus conservative care R. Bornemann⁎, L. Otten, J.D. Muller-Broich, D.C. Wirtz, R. Pflugmacher Orthopadie und Unfallchirurgie, Universitatsklinikum Bonn, Bonn, Germany Abstract: Purpose: There is controversy about how to treat vertebral fractures. Conservative care is the default approach, despite lack of evidence. Radiofrequency kyphoplasty uses ultrahigh viscosity cement to restore spinal posture and stabilize the fracture. The aims of this study were to compare radiofrequency kyphoplasty to conservative care and assess the usual algorithm of starting all patients on conservative care for 6 weeks before offering surgery. Methods: Elderly patients with painful osteoporotic vertebral compression fractures were all treated with 6 weeks of Purpose: There is controversy about how to treat vertebral fractures. Conservative care is the default approach, despite lack of evidence. Radiofrequency kyphoplasty uses ultrahigh viscosity cement to restore spinal posture and stabilize the fracture. The aims of this study were to compare radiofrequency kyphoplasty to conservative care and assess the usual algorithm of starting all patients on conservative care for 6 weeks before offering surgery. Methods: Elderly patients with painful osteoporotic vertebral compression fractures were all treated with 6 weeks of conservative care (analgesics, bracing, and physiotherapy). They were then offered the choice of continuing conservative care or crossing over to radiofrequency kyphoplasty, at 6 and 12 weeks. Clinical success was defined as: 1) VAS pain improvement≥2, 2) final VAS pain≤5, and 3) no functional worsening on ODI. Results: After the initial 6 weeks of conservative care, only 1 of 65 patients met the criteria for clinical success, and median VAS improvement was 0. After 12 weeks of conservative care, only 5 of 38 patients met the criteria for clinical success, and median VAS improvement was 1. At Abstracts S30" @default.
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• W2064039116 title "Predicting patient's readiness to accept osteoporosis treatment: Application of the stages of change model to post fracture context" @default.
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