Riesgo de refractura según el FRAX score en pacientes mayores de 50 años que sufren una fractura por un mecanismo de bajo impacto / Risk of refracture according to the FRAX score in patients older than 50 years who suffer a fracture by a low-impact mechanism

Resumen: Introducción: a medida que se invierte la pirámide poblacional vamos a ver más pacientes que sufren fracturas por mecanismos de bajo impacto y no todos los hospitales cuentan con un densitómetro para hacer el diagnóstico definitivo. Sin embargo, se cuenta con herramientas clínicas que nos apoyan para iniciar con un tratamiento oportuno. Objetivo: reconocer el riesgo de refractura que existe en pacientes mayores de 50 años dentro de nuestra población. Material y métodos: se incluyeron a pacientes > 50 años que sufrieron de una fractura de bajo impacto en el Hospital Ángeles Mocel. Usando el FRAX score México para medir el riesgo de sufrir una fractura. Se dividió la muestra en dos grupos, utilizando una p < 0.05 para considerar estadísticamente significativa con un IC de 95%. Resultados: se incluyeron 69 pacientes, 47.8% ya habían sufrido de alguna fractura previa, 10% de ellos tienen tratamiento para la osteopenia. El riesgo de sufrir una fractura mayor osteoporótica en 10 años se observó en 50.7% de los pacientes. El riesgo de sufrir una fractura de cadera en 10 años se encontró en 75% de los pacientes. A ningún paciente se le dio tratamiento, ya sea modificadores del estilo de vida o tratamiento farmacológico para osteopenia/osteoporosis a su egreso hospitalario. Conclusión: hay una deficiencia en el manejo inmediato de los cirujanos ortopedistas para prevenir en pacientes futuras refracturas de bajo impacto.

Abstract: Introduction: as the population pyramid inverts, we'll see more old patients suffering a fracture secondary to a low impact mechanism and not all hospitals have a densitometer to make a definitive diagnosis. Nevertheless, we have clinical tools that can help us to start an early treatment. Objective: to recognize the risk of re-fracture of patients older than 50 years in our population. Material and methods: we included all patients older than 50 that suffered a low impact fracture in the Ángeles Mocel Hospital. We used Mexico FRAX score tool to determine de risk of suffering a fracture. The sample was divided in two groups. Utilizing p < 0.05 and a CI of 95%. Results: 69 patients where included. 47.8% had past fractures and only 10% of those had preventive osteoporotic treatment. 50.7% of the patients have a high risk of suffering a mayor osteoporotic fracture in 10 years and 75% of suffering a hip fracture in 10 years. None of the patients received a treatment, either lifestyle modifiers or specific osteoporosis pharmacotherapy at hospital discharge. Conclusion: there is a deficiency in the early preventive management of osteoporosis in patients suffering a low impact fracture by orthopedic surgeons.

Diabetes and bone

Abstract Globally, one in 11 adults has diabetes mellitus of which 90% have type 2 diabetes. The numbers for osteoporosis are no less staggering: 1 in 3 women has a fracture after menopause, and the same is true for 1 in 5 men after the age of 50 years. Aging is associated with several physiological changes that cause insulin resistance and impaired insulin secretion, which in turn lead to hyperglycemia. The negative balance between bone resorption and formation is a natural process that appears after the fourth decade of life and lasts for the following decades, eroding the bone structure and increasing the risk of fractures. Not incidentally, it has been acknowledged that diabetes mellitus, regardless of whether type 1 or 2, is associated with an increased risk of fracture. The nuances that differentiate bone damage in the two main forms of diabetes are part of the intrinsic heterogeneity of diabetes, which is enhanced when associated with a condition as complex as osteoporosis. This narrative review addresses the main parameters related to the increased risk of fractures in individuals with diabetes, and the mutual factors affecting the treatment of diabetes mellitus and osteoporosis. Arch Endocrinol Metab. 2022;66(5):633-41

Performance of the Fracture Risk Assessment Tool Associated with Muscle Mass Measurements and Handgrip to Screen for the Risk of Osteoporosis in Young Postmenopausal Women / Desempenho da ferramenta de avaliação de risco de fraturas associada à medida de massa muscular e à preensão manual no rastreio de risco de osteoporose em mulheres jovens pós-menopáusicas

Abstract Objective To evaluate the improvement in screening accuracy of the Fracture Risk Assessment Tool (FRAX) for the risk of developing osteoporosis among young postmenopausal women by associating with it clinical muscle mass measures. Methods A sample of postmenopausal women was submitted to calcaneal quantitative ultrasound (QUS), application of the FRAX questionnaire, and screening for the risk of developing sarcopenia at a health fair held in the city of São Bernardo do Campo in 2019. The sample also underwent anthropometric measurements, muscle mass, walking speed and handgrip tests. A major osteoporotic fracture (MOF) risk ≥ 8.5% on the FRAX, a classification of medium risk on the clinical guideline of the National Osteoporosis Guideline Group (NOGG), and a QUS T-score ≤ -1.8 sd were considered risks of having low bone mass, and QUS T-score ≤ -2.5sd, risk of having fractures. Results In total, 198 women were evaluated, with a median age of 64±7.7 years, median body mass index (BMI) of 27.3±5.3 kg/m2 and median QUS T-score of -1.3±1.3 sd. The accuracy of the FRAX with a MOF risk ≥ 8.5% to identify women with T-scores ≤ -1.8 sd was poor, with an area under the curve (AUC) of 0.604 (95% confidence interval [95%CI]: 0.509-0.694) for women under 65 years of age, and of 0.642 (95%CI: 0.571-0.709) when age was not considered. Including data on muscle mass in the statistical analysis led to a significant improvement for the group of women under 65 years of age, with an AUC of 0,705 (95%CI: 0.612-0.786). The ability of the high-risk NOGG tool to identify T-scores ≤ -1.8 sd was limited. Conclusion Clinical muscle mass measurements increased the accuracy of the FRAX to screen for osteoporosis in women aged under 65 years.

Resumo Objetivo Avaliar a melhora da precisão da Fracture Risk Assessment Tool (Ferramenta de Avaliação do Risco de Fraturas, FRAX, em inglês) no rastreio do risco de desenvolver osteoporose em mulheres jovens pós-menopáusicas com a associação de medidas clínicas de massa muscular e preensão manual. Métodos Uma amostra de mulheres pós-menopáusicas foi submetida a ultrassom quantitativo (USQ) de calcâneo, à aplicação do questionário FRAX, e rastreadas quanto ao risco de desenvolver sarcopenia em uma feira de saúde realizada em 2019 em São Bernardo do Campo. Alémdisso, a amostra tambémfoi submetida a antropometria, e a testes de massa muscular, velocidade de marcha, e preensão manual. Um risco de grandes fraturas osteoporóticas (GFOs) ≥ 8,5% no FRAX, classificação de médio risco nas diretrizes clínicas do National Osteoporosis Guideline Group (NOGG), e T-score no USQ ≤ -1,8 dp foram considerados riscos de ter baixa massa óssea, e T-score no QUS ≤ -2,5 sd, risco de ter fraturas. Resultados Ao todo, 198 mulheres foram avaliadas, com idade média de 64±7,7 anos, índice de massa corporal (IMC) médio de 27,3±5,3 kg/m2, e T-score médio no USQ de -1,3±1,3 sd. A precisão do FRAX comumrisco de GFO≥ 8,5% para identificar mulheres com T-score ≤ -1,8 dp foi precária, com uma área sob a curva (ASC) de 0,604 (intervalo de confiança de 95% [IC95%]: 0,509-0,694), para mulheres menores de 65 anos de idade, e de 0,642 (IC95%: 0,571-0,709) quando a idade não foi considerada. A inclusão de dados da massa muscular na análise estatística levou a uma melhora significativa no grupo menor de 65 anos de idade, com uma ASC de 0,705 (IC95%: 0,612-0,786). A habilidade da ferramenta NOGG de alto risco para identificar T-scores ≤ -1,8 dp foi limitada. Conclusão As medidas clínicas da massa muscular aumentaram a precisão do FRAX no rastreio de osteoporose em mulheres menores de 65 anos de idade.

Ostéoporose et évaluation du risque fracturaire par l'outil frax chez des patients Congolais présentant un rhumatisme axial Une série des cas multicentriques

Contexte et objectif. L'enjeu majeur dans le management de l'ostéoporose est l'identification des sujets à risque par la quantification du risque fracturaire. L'objectif de l'étude était d'évaluer le risque fracturaire chez les patients ayant consulté pour douleur du squelette axial. Méthodes. Il s'agissait d'une série des cas multicentriques menée sur des patients recrutés dans 8 hôpitaux de Kinshasa. Les paramètres d'intérêt comme l'âge, le sexe, l'alcoolisme, le tabagisme, la fracture de hanche chez un parent de 1er degré ou une fracture personnelle de fragilité ont été collectés auprès de chaque patient. La mesure de la densité osseuse avait été réalisée par absorptiométrie biphotonique à rayons X. Le risque fracturaire a été évalué par le calcul de l'indice fracturaire FRAX. Ce risque était élevé lorsque la probabilité de survenue de fracture de hanche était ≥ 3% et/ou des fractures ostéoporotiques majeures ≥ 20%. Des tests statistiques usuels ont été utilisés pour l'analyse des résultats. Résultats. 90 patients dont 75 femmes étaient inclus. Leur âge moyen était de 63, 5±12ans.L'ostéoporoseétaitdiagnostiquée chez 34,4% des patients, l'ostéopénie chez 43,9% et 16,7% avaient une densité minérale osseuse normale. Aucune fracture ostéoporotique n'a été observée dans la présente étude, mais près de 30% de l'ensemble de l'échantillon avaient un risque fracturaire élevé. L'ostéoporose était associée, dans environ 80% des cas (p<0,005), à un risque fracturaire élevé. Conclusion. La présente étude a montré que le risque fracturaire était élevé chez les patients atteints d'ostéoporose. Elle met en lumière la nécessité d'un dépistage précoce de cette pathologie.

El FRAX como herramienta para evaluar el riesgo de fracturas en población general y grupos especiales de riesgo / FRAX as a tool to assess the risk of fractures in the general population and special risk groups

El FRAX es una herramienta que mide el riesgo de fractura y cuenta con un algoritmo computarizado desarrollado por la Organización Mundial de la Salud, basado en modelos globales de cohortes de población, combinados con factores de riesgo clínico. La herramienta fue diseñada inicialmente para su aplicación por los médicos de atención primaria en mujeres posmenopáusicas y hombres sobre 50 años, aunque es válida en general entre 40-90 años. Nos propusimos desarrollar un estudio epidemiológico-clínico sobre osteoporosis y fracturas en la población general y algunos grupos especiales de riesgo que incluyen mujeres posmenopáusicas, pacientes con afecciones reumáticas, endocrinas, cáncer y con infección por VIH, así como describir el papel desempeñado por FRAX como herramienta de medición del riesgo de fractura a los 10 años de ocurrida. Asimismo, constituye un gran reto conocer e identificar los principales grupos vulnerables o de riesgo para osteoporosis y fracturas en la población cubana. Esta aplicación nos resulta prioritaria en los grupos identificados, pues permitirá conocer los riesgos de fracturas a corto y largo plazos e implementar correcta y racionalmente los estudios DXA, disponibles en el país para la toma de decisiones terapéuticas(AU)

The FRAX is a tool that has a computerized algorithm developed by the World Health Organization, based on global models of population cohorts, combined with clinical risk factors, which measures the risk of fracture. The tool was initially designed for use by primary care physicians in postmenopausal women and men over 50 years of age, although it is generally valid between 40-90 years. We set out to develop a clinical epidemiological study on osteoporosis and fractures in the general population and some special risk groups that include post-menopausal women, patients with rheumatic, endocrine, cancer and HIV-infected conditions, as well as the role played by FRAX as a measurement tool. The ten-year risk of fracture related to the importance of knowing and identifying the main vulnerable or risk groups for osteoporosis and fractures in the Cuban population constitutes a great challenge. This application is a priority for those groups previously identified as it will allow us to know the short and long-term risks of fractures and implement the correct use of DXA studies, available in the country with a rational use and therapeutic decision-making(AU)

FRAX-based assessment and intervention threshold curves for osteoporosis evaluation in Ecuador / Curvas de intervención y evaluación basadas en FRAX Ecuador

RESUMEN Introducción: La herramienta FRAX ha sido validada y adaptada a diferentes países, cubriendo a casi el 80% de la población mundial, incluido Ecuador, donde fue adaptada en 2009. El objetivo de este estudio fue elaborar curvas de evaluación e intervención basadas en FRAX Ecuador. Métodos: Utilizando el modelo FRAX Ecuador, calculamos la probabilidad de fractura osteoporótica mayor y fractura de cadera femenina sin ningún factor de riesgo y sin la inclusión de DMO. Las probabilidades se calcularon en intervalos de 5 años de 40 a 90 años. Las probabilidades de fractura mayor y de cadera se calcularon en 3 escenarios diferentes: 1. Historia de fractura previa sin la inclusión de DMO, 2. T-Score de -2,5 SD sin otros factores de riesgo clínico, 3. T-Score -1,5 SD sin otros factores de riesgo clínico. Resultados: En mujeres sin factores de riesgo, la probabilidad de fractura osteoporótica mayor aumentó con la edad del 0,4% a los 40 años al 7,3% a los 90 años. La probabilidad de fractura de cadera aumentó con la edad de 0% a los 40 años a 3,6% a los 90 anos. La probabilidad de fractura osteoporótica mayor aumentó en mujeres con un puntaje T de -2,5 SD de 0,9% a los 40 años a 5,5% a los 90 años; con puntaje T de -1,5 DE, de 0,6% a los 40 años a 3,9% a los 90 anos. Conclusión: Los datos muestran la importancia de aplicar herramientas como FRAX, específicas para cada país y también la creación de curvas de evaluación e intervención que permitan discernir según cada paciente la necesidad de utilizar recursos como DXA y tratamientos específicos.

ABSTRACT Introduction: FRAX has been validated and adapted to different countries, covering almost 80% of the world's population, including Ecuador where it was adapted in 2009. The purpose of this study is to elaborate evaluation and intervention curves based on FRAX Ecuador. Methods: Using the FRAX Ecuador model, we calculated the probability of a major osteoporotic fracture and a female hip fracture without any risk factor and without the inclusion of BMD. The probabilities were calculated in 5-year intervals from 40 to 90 years. The probabilities of major fractures and hip fractures were calculated in 3 different scenarios: 1. History of previous fracture without the inclusion of BMD, 2. T score -2.5 SD without other clinical risk factors, 3. T score -1.5 SD without other clinical risk factors. Results: In women without risk factors, the probability of a major osteoporotic fracture increased with age from 0.4% at 40 years to 7.3% at 90 years. The probability of hip fracture increased with age from 0% at 40 years to 3.6% at 90 years. The probability of a major osteoporotic fracture increased in women with a T score of -2.5 SD from 0.9% at 40 years to 5.5% at 90 years; with a T-score of -1.5 SD, from 0.6% at 40 years to 3.9% at 90 years. Conclusion: Data shows the importance of applying tools such as FRAX, specific for each country and also the creation of evaluation and intervention curves that allow discerning according to each patient the need for the use of resources such as DXA and specific treatments.

Riesgo de fracturas osteoporóticas en adultos mayores / Risk for Osteoporotic Fractures in Aged Adults

Introducción: La medición del Fracture Risk Assessment Tool - FRAX® es útil en Atención Primaria de Salud para evaluar el riesgo de fractura. Objetivo: Determinar el riesgo de fractura osteoporótica en adultos mayores. Métodos: Se realizó un estudio descriptivo de corte transversal, con una muestra de 54 adultos pertenecientes al grupo Club Nueva Vida de la Ciudad de Tunja, primer semestre de 2018, seleccionados por medio de un muestreo no probabilístico a conveniencia. Se empleó la herramienta FRAX®, propuesta por la Organización Mundial de la Salud y se realizó un análisis estadístico con el Chi2 de Pearson y la Razón de Prevalencia. Resultados: El factor de riesgo con mayor presencia fue la osteoporosis secundaria en 51,9 por ciento, donde 13 por ciento reporta FRAX®+ para probabilidad a 10 años de fractura mayor osteoporótica y 14,8 por ciento obtuvo FRAX®+ para probabilidad a 10 años de fractura de cadera sin densitometría ósea. Conclusiones: El FRAX®, es una herramienta útil en la prevención de problemas de salud resultado de fracturas que conllevan a alteraciones en la capacidad funcional y el movimiento(AU)

Introduction: The measurement of the Fracture Risk Assessment Tool - FRAX® is useful in primary healthcare for assessing the risk of fracture. Objective: To determine the risk of osteoporotic fracture in older adults. Methods: A descriptive and cross-sectional study was carried out, with a sample of 54 adults belonging to the Club Nueva Vida group of the City of Tunja, first semester of 2018, selected by means of a nonprobabilistic sampling at convenience. The FRAX® tool, proposed by the World Health Organization, was used, and statistical analysis was performed with Pearson's Chi2 and the prevalence ratio. Results: The risk factor with the highest presence was secondary osteoporosis in 51.9 percent, where 13 percent reported FRAX® + for a 10-year probability of major osteoporotic fracture and 14.8 percent obtained FRAX®+ for a 10-year probability of hip fracture without bone densitometry. Conclusions: FRAX® is a useful tool in the prevention of health problems resulting from fractures that lead to alterations in functional capacity and movement(AU)

Combination of hip geometry mechanics and fracture risk assessment tool to predict fracture risk in middle-aged and elderly women / 中国组织工程研究

BACKGROUND: Hip geometric mechanics indicates a mechanical study of hip structure (cortical thickness) based on dual energy X-ray absorptiometry images, which is a better compensation for the deviation of bone density. The fracture risk assessment tool (FRAX) can combine fracture probability with multiple clinical risk factors and bone density of the femoral neck to predict the probability of hip fracture within 10 years and the probability of major osteoporotic fractures (spine, forearm, hip or shoulder fracture). OBJECTIVE: To analyze the hip geometry mechanics and the correlation between the FRAX@ tool and fractures in middle-aged and elderly women, and to explore the clinical significance of the combination method to predict the risk of fragility fracture in middle-aged and elderly women. METHODS: A retrospective study of 1 089 middle-aged female subjects was conducted. According to the questionnaire, there were 225 cases of fractures and 864 cases of non-fractures. Bone mineral density was measured using a dual-energy X-ray absorptiometry, and hip geometrical parameters were analyzed using HSA software: cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), cross-sectional modulus (Z), cortical bone thickness (Cort) and the buckling ratio (BR) value. The FRAX@ tool was used to calculate the fracture rate at the main site and hip fracture rate over the next 10 years. The study was approved by the Ethics Committee of Fujian Institute of Traditional Chinese Medicine. RESULTS AND CONCLUSION: The age of the fracture group was significantly higher than that of the non-fracture group. The hip geometrical parameters of the two groups were compared: lumbar vertebra bone density, femoral neck bone density, CSA, CSMI, Cort, Z were significantly higher in the non-fracture group than the fracture group, while BR was lower in the non-fracture group than the fracture group. Logistic regression analysis of hip geometry mechanics indicated that Cort was a possible protective factor for fracture (odds ratio=0.000, 95% confidence interval: 0.000-0.000). FRAX calculation and analysis of different age groups indicated that the fracture rate at the main site and hip fracture rate of the fracture group were significantly higher than those of the non-fracture group in the next 10 years. In conclude, there is a significant correlation between hip geometric mechanics and fracture. The Cort of the femoral neck is a possible protective factor for fracture, and FRAX@ has a clinical guiding value for predicting fracture. The combination of the two can better predict osteoporotic fracture.

Bone health among older persons in medical clinic: A clinical audit

@#Osteoporosis is commonly underdiagnosed and undertreated. We performed a clinical audit to assess the risk factors and clinical care for osteoporosis among older persons who attended medical clinic during a 4-week period in August 2013. There was a total of 128 patients with a mean age of 73.1±5.8 years, and 20.3%. had a history of fall. Fracture Risk Assessment Tool (FRAX) scores assessment showed 14.2% and 68.8% had a 10-year risk of major osteoporotic and hip fractures respectively. Only 6.3% underwent Dual-energy X-ray absorptiometry (DXA) and 73.4% did not receive any preventive treatment for osteoporosis. Older persons attending medical clinic at high risk of osteoporosis fractures did not receive appropriate screening and treatment. There is a need to improve the suboptimal care for bone health among older persons.

Evaluating the predictive quality of the Chapman bone algorithm using aggregated data sets

Background: Due to an aging population, osteoporosis has become an increasingly prevalent metabolic bone disorder that is largely undiagnosed worldwide because of inaccessible and expensive DXA machines. The Chapman bone algorithm (CBA), a mathematical treatment that enables osteoporosis determination by using simply-assayed bone metabolites from blood serum, has been previously presented as a cheaper and feasible alternative for analyzing bone health. The CBA has a sensitivity of 1.0 and a specificity of 0.83, with an area under the Receiver Operating Characteristic curve of 0.93. Our goal was to utilize existing data from primary literature sources to determine if the CBA could be applied with similar or equal fidelity.Methods: We obtained mean values from analyses of serum Osteocalcin (s-OC) and serum Pyridinoline (s-PYD) markers in conjunction with patient age from various large-sample data sets available in primary literature.Results: Following analyses of aggregated mean values from the literature, we found that 60% of studies predicted the presence or absence of osteoporosis with the same degree of accuracy between FRAX and CBA methods. Osteoporosis was defined as having a t-score of <-2.5 (FRAX) or surpassing the threshold p-value of >0.035 (CBA).Conclusions: We expected higher agreement between the FRAX scores and our CBA, but this may be due to the aggregated nature of the data. Our findings indicated the need to advance the CBA in analyzing larger-scale primary data sets, underscoring the importance of raw data analysis, to determine the full efficacy of this diagnostic tool.

Advances in Predicting Fracture Risk Based on Hip Bone Properties / 医用生物力学

With the increasing life span of the population and the increasing proportion of the elderly population, the elderly with osteoporosis are prone to hip fractures, which brings heavy economic burdens to the family and society. The progress in predicting hip fractures from the aspects of the proximal femur geometry, bone mineral density (BMD), fracture risk assessment tool (FRAX) and finite element analysis (FEA) based on computed tomography (CT) imaging was reviewed, in order to understand the influencing factors of fracture risk, improve the accuracy of hip fracture risk prediction for the elderly, detect the high fracture risk group at an early stage, and hence to reduce the occurrence of fractures with appropriate preventing measures, and provide theoretical references for the prevention and treatment of hip fractures.

Postmenopausal Osteoporosis: Diagnosis, FRAX® and Management

@#Osteoporosis-related fractures are increasing at a rapid rate, especially in Asia due to the ageing population. This would result in increased morbidity and mortality of the seniors as well as creating a strain on the healthcare system. Efforts should be made to prevent osteoporosis, screen for osteoporosis early and timely treatment to reduce the risk of fractures. As falls are a major risk factor for fracture in osteoporotic patients, management of osteoporosis should include efforts to reduce falls. Using a population-wide strategy for women 65 years old couple with high-risk population screening using a combination of tools such as FRAX® and OSTA as well as clinical risk factors for women below 65 years old can detect osteoporosis early for intervention. Treatment options for osteoporosis include bisphosphonates, denosumab, teriparatide, raloxifene, menopausal hormone therapy and tibolone. Drug choices should be individualised to the patient, balancing the risk/benefit ratio.

FRAX-based intervention and assessment thresholds in seven Latin American countries

Age-specific intervention and assessment thresholds were developed for seven Latin American countries. The intervention threshold ranged from 1.2% (Ecuador) to 27.5% (Argentina) at the age of 50 and 90 years, respectively. In the Latin American countries, FRAX offers a substantial advance for the detection of subjects at high fracture risk.INTRODUCTION:Intervention thresholds are proposed using the Fracture Risk Assessment (FRAX) tool. We recommended their use to calculate the ten-year probability of fragility fracture (FF) in both, men and women with or without the inclusion of bone mineral density (BMD). The purpose of this study is to compute FRAX-based intervention and BMD assessment thresholds for seven Latin American countries in men and women ≥ 40 years.METHODS:The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF) equivalent to a woman with a prior FF and a body mass index (BMI) equal to 25.0 kg/m2 without BMD or other clinical risk factors. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI equal to 25.0 kg/m2, no previous fracture and no clinical risk factors. The upper assessment threshold was set at 1.2 times the IT.RESULTS:For the seven LA countries, the age-specific IT varied from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively.CONCLUSIONS:In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model (AU)

FRAX Tool in Brazil: an integrative literature review following validation / Ferramenta FRAX no Brasil: revisão integrativa da literatura após sua validação

Abstract The present article is an integrative review the objective of which was to assess research carried out with the FRAX tool in Brazil following its validation, and describe the conclusions drawn. Two databases were used to select the articles (the Capes Portal and the Virtual Health Library), and the sample of this review was the only four articles published in Brazil relating to the FRAX tool following its validation in May 2013. After analyzing the articles, the results demonstrated that despite some limitations the FRAX Tool can be used to reduce the prevalence of fractures due to its simplicity of use, with an emphasis on prediction and orientation, allowing early and safe therapeutic decision-making. AU

Resumo O presente artigo é uma revisão integrativa que teve como objetivo investigar o uso da ferramenta FRAX no Brasil após sua validação, sintetizar e apreender os resultados desses estudos e discutir as suas principais indicações e limitações. Para a seleção dos artigos utilizou-se duas fontes de bases de dados, Portal Capes e Biblioteca Virtual em Saúde, e a amostra desta revisão constituiu-se dos únicos quatro artigos publicados no Brasil utilizando a ferramenta FRAX, após sua validação em maio de 2013. Após análise dos artigos incluídos na revisão, os resultados dos estudos demonstraram que a ferramenta FRAX, com ênfase na predição e orientação, apesar de algumas limitações, é uma das estratégias que podem ser usadas na diminuição da prevalência de fraturas pela possibilidade de uso ambulatorial devido à sua simplicidade de aplicação, permitindo uma tomada de decisão terapêutica precoce e segura. AU

APPROACH AND ASSESSMENT OF OSTEOPOROSIS: IDENTIFYING AND MANAGING RISK

With an ageing population, the incidence of osteoporoticfractures leading to deaths and impairment in quality oflife. However, despite the availability of effectivetreatments, osteoporosis is often under-diagnosed andunder-treated. Primary fracture prevention meansdetection of osteoporosis early with timely appropriatetreatment to improve the bone and lifestyle andenvironment optimisation to reduce falls. We propose apopulation-based combined with high-risk prescreeningfor measurement of bone mineral density (BMD) toreduce the incidence of fractures in the population.

Individualized fracture risk assessment: State-of-the-art and room for improvement

Fragility fracture is a serious clinical event, because it is associated with increased risk of mortality and reduced quality of life. The risk of fracture is determined by multiple risk factors, and their effects may be interactional. Over the past 10 years, a number of predictive models (e.g., FRAX, Garvan Fracture Risk Calculator, and Qfracture) have been developed for individualized assessment of fracture risk. These models use different risk profiles to estimate the probability of fracture over 5- and 10-year period. The ability of these models to discriminate between those individuals who will and will not have a fracture (i.e., area under the receiver operating characteristic curve [AUC]) is generally acceptable-to-good (AUC, 0.6 to 0.8), and is highly variable between populations. The calibration of existing models is poor, particularly in Asian populations. There is a strong need for the development and validation of new prediction models based on Asian data for Asian populations. We propose approaches to improve the accuracy of existing predictive models by incorporating new markers such as genetic factors, bone turnover markers, trabecular bone score, and time-variant factors. New and more refined models for individualized fracture risk assessment will help identify those most likely to sustain a fracture, those most likely to benefit from treatment, and encouraging them to modify their risk profile to decrease risk.

Quantificação do risco de fraturas através da ferramenta FRAX em pacientes com doença renal crônica em hemodiálise / Quantification of the risk of fractures through the FRAX tool in patients with chronic renal disease in hemodialysis

As fraturas são as complicações mais temidas da osteoporose e tornam-se prováveis quanto menor a densidade mineral óssea. Além da densidade mineral óssea, outros fatores clínicos independentes podem influenciar no risco de fratura. Em 2008, a OMS juntamente com a Universidade de Sheffield, desenvolveram a ferramenta FRAX (Fracture Risk Assessment Tool), a qual estima o risco de fraturas maiores e de quadril em 10 anos. O presente trabalho estimou o risco de fraturas relacionadas à osteoporose, através da ferramenta, em pacientes com doença renal crônica, em hemodiálise; comparou o risco de fratura entre os gêneros, entre as diferentes faixas etárias e entre os diferentes IMC; avaliou as diferenças na estimativa de risco de acordo com o tempo de início do tratamento dialítico e avaliou se há diferença significativa na estimativa de risco de fraturas se considerada a insuficiência renal crônica como fator de risco para osteoporose. Realizou-se um estudo transversal entrevistando 93 pacientes. Foi utilizado a ferramente Microsoft Excel. Foi realizada análise de variância e quando o teste F foi significativo, foi utilizado o teste de Tuley. O risco estimado de fraturas maiores, nos pacientes estudados, foi de 4,4%, enquanto o risco de fraturas de quadril foi de 1,6%. Quando considerada a IRC associada à osteoporose secundária, observou-se um risco significativamente maior apenas para fraturas maiores, quando analisados todos os pacientes do estudo. Analisando apenas os pacientes sem outras doenças associadas à osteoporose secundária, o risco foi significativamente maior para ambos tipos de fraturas.

The fractures are the most dreaded complications of osteoporosis and become likely as bone mineral density decreases. In addition to bone mineral density, other independent clinical factors may influence the risk of fracture. In 2008, WHO together with the University of Sheffield, developed FRAX tool (Fracture Risk Assessment Tool), which estimates the risk of further major fractures and hip in 10 years. This study estimated the risk of osteoporosis-related fractures, through the tool, in patients with chronic kidney disease on hemodialysis; It compared the risk of fracture between the sexes, between different age groups and between different BMI; assessed the differences in the risk assessment in accordance with the beginning of the dialysis treatment time, and assessed if there is a significant difference in the estimation of fracture risk when considered chronic kidney disease as a risk factor for osteoporosis. It was conducted a cross-sectional study interviewing 93 patients. Microsoft Excel tool was used. Analysis of variance was performed and when the F test was significant, was used Tuley's test. The estimated risk of further major fractures in patients was 4.4%, while the risk of hip fractures was 1.6%. When considering the CKD associated with secondary osteoporosis, was observed a significantly higher risk for major fractures only, considering all patients in the study. Analyzing only patients with no other illnesses associated with secondary osteoporosis, the risk was significantly higher for both types of fractures.

The Effect of FRAX on the Prediction of Osteoporotic Fractures in Urban Middle-aged and Elderly Healthy Chinese Adults

OBJECTIVE: We aimed to analyze the applicability of a fracture risk assessment tool for the prediction of osteoporotic fractures in middle-aged and elderly healthy Chinese adults. METHODS: A standard questionnaire was administered, and bone mineral density was measured in residents visiting the Dongliu Street Community Health Service Center. Paired t-tests were used to compare the FRAX-based probabilities of fractures estimated with and without consideration of bone mineral density. Risk stratification and partial correlation analyses were applied to analyze the associations between FRAX-based probabilities and body mass index or bone mineral density at different sites. RESULTS: A total of 444 subjects were included in this study. Of these subjects, 175 (39.59%) were diagnosed as osteoporotic, and 208 (47.06%) were diagnosed as osteopenic. The Kappa value for the detection of osteoporosis at the L1-L4 lumbar spine and femoral neck was 0.314. The FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated without considering bone mineral density were 4.93% and 1.64%, respectively; when estimated while considering bone mineral density, these probabilities were 4.97% and 1.54%, respectively. A significant positive association was observed between the FRAX-based fracture probabilities estimated with and without consideration of bone mineral density, while significant negative associations between body mass index and the estimated FRAX-based fracture probabilities after adjustment for age and the estimated FRAX-based fracture probabilities and femoral neck bone mineral density were identified. These results remained the same after controlling for lumbar spine bone mineral density. CONCLUSIONS: The Chinese FRAX model could predict osteoporotic fracture risk regardless of whether bone mineral density was considered and was especially appropriate for predicting osteoporotic fractures of the femoral neck.

Relationship between the FRAX® score and falls in community-dwelling middle-aged and elderly people

OBJECTIVES: Falls is a risk factor for fracture. The FRAX® predicts fractures. Whether the FRAX® is associated with fall in both gender is inconclusive. The aim of our study is to evaluate the association between FRAX scores and falls. METHODS: The cross-sectional study set from 2009 to 2010 included 1200 community-dwelling people who were systematically sampled in central Taiwan. The 1200 participants (men: 524; women: 676; ≥40 years old) completed questionnaires about socioeconomic status; lifestyle; medical and fall history were completed. FRAX scores with and without bone mineral density (BMD) were calculated by using the Taiwan calculator. RESULTS: A total of 19.8% participants fell down. Binary regression models showed that diabetes mellitus history (OR: 1.61; 95% CI: 1.03–2.52), the FRAX without BMD in a continuous major score (OR: 1.06; 95% CI: 1.03–1.09), continuous hip score (OR: 1.11; 95% CI: 1.05–1.16), categorical major score ≥ 10% (OR: 1.81; 95% CI: 1.25–2.61), and categorical hip score ≥ 3% (OR: 1.80; 95% CI: 1.30–2.50) were independent risk factors for falls. FRAX with BMD in a continuous major score (OR: 1.04; 95% CI: 1.02–1.06), continuous hip score (OR: 1.06; 95% CI: 1.02–1.09), categorical major score ≥ 10% (OR: 1.52; 95% CI: 1.09–2.12), and categorical hip score ≥ 3% (OR: 1.53; 95% CI: 1.13–2.09) were also independent risk factors. CONCLUSIONS: We concluded that FRAX® scores with and without BMD were unanimously correlated with falls in community-dwelling middle-aged and elderly males and females.

Comparación entre score de frax sin densidad mineral ósea y los criterios propuestos por la sociedad Argentina de osteoporosis para el uso de tratamiento antirresortivo en mujeres postmenopáusicas

Identificar pacientes con alto riesgo de fractura utilizando factores de riesgo clínicos podría reducir los gastos en salud derivados de la realización de una densitometría ósea. El objetivo de este estudio fue comparar el score de FRAX sin determinación de densidad mineral ósea (DMO) con los criterios propuestos por la Sociedad Argentina de Osteoporosis (SAO), para considerar el inicio de tratamiento antirresortivo. Realizamos un estudio observacional, transversal. Se incluyeron 330 mujeres postmenopáusicas entre 40 y 90 años de edad. Se determinó la cantidad de tratamientos indicados según se utilice la herramienta FRAX sin DMO, o los criterios de la SAO. Utilizando los criterios de la SAO, 85 (25.8%) pacientes recibirían tratamiento, mientras que si se utilizara la herramienta FRAX sin DMO, lo harían 15 (4.5%) pacientes (p = 0.0019). De los 67 pacientes con diagnóstico de osteoporosis por densitometría ósea, todas recibirían tratamiento utilizando los criterios de la SAO y solo 10 (15%) lo harían si utilizáramos el score de FRAX sin DMO (p = 0.011). La utilización del score de FRAX sin DMO reduce en forma significativa la cantidad de pacientes tratables en comparación con los criterios actuales de la SAO. En pacientes con diagnóstico de osteoporosis por DMO, el score de FRAX subestima los pacientes a tratar.

To identify patients at high risk of fracture using clinical risk factors could reduce health costs arising from the realization of a bone densitometry. The aim of this study was to compare the FRAX score without bone mineral density (BMD) with the criteria proposed by the Argentine Society of Osteoporosis (SAO) to consider starting antiresorptive treatment. We conducted an observational, cross-sectional study where 330 postmenopausal women between 40 and 90 years of age were included. The number of treatments given if the FRAX tool without BMD had been followed was compared with the number of treatments indicated using the SAO criteria. Using the SAO criteria, 85 (25.8%) patients would initiate antiresorptive treatment compared with 15 (4.5%) using the FRAX without BMD (p = 0.0019). Among the 67 patients with a diagnosis of osteoporosis by BMD determination, all of them (100%) would have received treatment by using the SAO criteria compared with 10 (15%) using the FRAX score (p = 0.011). The use of FRAX without BMD significantly underestimates the number of patients who should receive antiresorptive treatment. In patients diagnosed with osteoporosis by BMD, the FRAX score underestimates the number of patients to be treated.