A new FRAX model for Brazil.

Fracture probabilities derived from the original FRAX model for Brazil were compared to those from an updated model based on more recent regional estimates of the incidence of hip fracture. Fracture probabilities were consistently lower in the updated FRAX model. Despite large differences between models, differences in the rank order of fracture probabilities were minimal. OBJECTIVE: Recent epidemiological data indicate that the risk of hip fracture in Brazil is lower than that used to create the original FRAX model. This paper describes the epidemiology of hip fracture in Brazil and the synthesis of an updated FRAX model with the aim of comparing this new model with the original model. METHODS: Hip fracture rates from three cities in three regions were combined, weighted by the population of each region. For other major fractures, incidence rates for Brazil were estimated using Swedish ratios for hip to other major osteoporotic fracture (humerus, forearm or clinical vertebral fractures). Mortality estimates were taken from the UN. RESULTS: Compared to the original FRAX model, the updated model gave lower 10-year fracture probabilities in men and women at all ages. Notwithstanding, there was a very close correlation in fracture probabilities between the original and updated models (r > 0.99) so that the revisions had little impact on the rank order of risk. CONCLUSION: The disparities between the original and updated FRAX models indicate the importance of updating country-specific FRAX models with the advent of significant changes in fracture epidemiology.

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-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.

Incidence of hip fracture in Brazil and the development of a FRAX model.

UNLABELLED: The Brazilian FRAX model is described and used to determine intervention thresholds for the treatment of osteoporosis. INTRODUCTION: A FRAX model for Brazil was released May 1, 2013. This paper describes the data used to develop the Brazilian FRAX(®) model, illustrates its features and develops intervention thresholds. METHODS: Age- and sex-stratified hip fracture incidence rates were extracted from four regional estimates from the age of 40 years. For other major fractures, Brazilian incidence rates were estimated using Swedish ratios for hip to other major osteoporotic fracture (humerus, forearm or clinical vertebral fractures). Assessment and intervention thresholds were determined using the approach recommended by the National Osteoporosis Guideline Group (UK) applied to the Brazilian FRAX model. RESULTS: Fracture incidence rates increased with increasing age: for hip fracture, incidence rates were higher amongst younger men than women but with a female preponderance from the age of 50 years. Ten-year probability of hip or major fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age and a decreased BMD T-score. Of the clinical risk factors, prior fracture accounted for the greatest increase in 10-year fracture probability at younger ages while a parental hip fracture history was the strongest risk factor at ages 80-90 years. Age-dependent probability-based intervention thresholds were developed equivalent to women with a prior fragility fracture. CONCLUSIONS: The FRAX tool is the first to provide a country-specific fracture prediction model for Brazil. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Brazilian FRAX tool a good candidate for implementation into clinical practice.

Incidence of hip fracture in Barranquilla, Colombia, and the development of a Colombian FRAX model.

A FRAX model for Colombia was released June 30, 2010. This article describes the data used to develop the Colombian FRAX model and illustrates its features compared to other countries. Hip fracture cases aged 50 years or more who were referred to all hospitals serving the city of Barranquilla were identified prospectively over a 3-year period (2004-2006). Age- and sex-stratified hip fracture incidence rates were computed using the 2005 census. Present and future numbers of hip fracture cases in Colombia were calculated from the age- and sex-specific incidence and the national population demography. Mortality rates for 1999 were extracted from nationwide databases and used to estimate hip fracture probabilities. For other major fractures (clinical vertebral, forearm, and humerus), incidence rates were imputed, using Swedish ratios for hip to other major osteoporotic fracture, and used to construct the FRAX model. Incidence of hip fracture increased with age, more markedly in women than in men. Over all ages, the female to male ratio was 1.7. By extrapolation, there were estimated to be 7,902 new hip fracture cases (2,673 men, 5,229 women) in Colombia in 2010, which was predicted to increase to 22,720 cases (7,568 men, 15,152 women) in 2035. The 10-year probability of hip or major fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T score. The remaining lifetime probability of hip fracture at the age of 50 years was 2.5 and 4.7 % in men and women, respectively, which were lower than rates in a Mexican population (3.8 and 8.5 %, respectively) and comparable with estimates for Venezuela (2.4 and 7.5 %, respectively). The FRAX tool is the first country-specific fracture-prediction model available in Colombia. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Colombian FRAX tool a good candidate for implementation into clinical practice.

Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican Institute of Social Security.

UNLABELLED: This study, characterising the incidence of hip fracture in Mexico, showed that age- and sex-specific rates increased between 2000 and 2006. The demographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 in 2050. If the age-specific incidence of hip fracture continues, the number of hip fractures would increase by a further 46%. INTRODUCTION: The aim of the present study was to determine time trends, if any, in hip fracture rates for Mexico and to forecast the number of hip fractures expected in Mexico over the coming years up to 2050. METHODS: All hip fracture cases registered during the years 2000-2006 were collected at all the second and tertiary-care hospitals across the country from one of the largest health systems in Mexico, The Instituto Mexicano del Seguro Social (IMSS). RESULTS: Between the years 2000 and 2006, the age-specific incidence of hip fracture increased significantly both for men and women by 1% per year (p = 0.016 and p < 0.001, respectively). In 2005, there were there were 29,732 hip fractures estimated in Mexico, 68% of which were found in women. Assuming no change in the age- and sex-specific incidence of hip fracture, the number of hip fractures was expected to increase markedly with time to 155,874 in 2050. Assuming that the age-specific incidence continues, the number of hip fractures in men and women would increase by a further 46% to 226,886 in 2050. CONCLUSION: Demographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 expected in 2050. If the age-specific incidence of hip fracture continues to rise, the number of hip fractures would increase by a further 46%.