Validación de un algoritmo para el cálculo del riesgo absoluto de fracturas no vertebrales por fragilidad en una cohorte de mujeres posmenopáusicas / Validation of an algorithm to calculate the absolute risk of non-vertebral fragility fractures in a cohort of postmenopausal women

Fundamento y objetivo: La estimación del riesgo absoluto de fractura provee información útil para la toma de decisiones. Recientemente este grupo ha descrito un algoritmo para el cálculo del riesgo absoluto de fractura no vertebral en mujeres españolas de 65 o más años de edad, que incluye parámetros clínicos y los valores de la ecografía cuantitativa ósea de calcáneo (URL: www.ecosap.info). Se ha evaluado el comportamiento del algoritmo mediante el análisis estadístico de la bondad del ajuste del modelo. Sujetos y método: El algoritmo fue resultado del análisis prospectivo de 5.201 mujeres que acudieron por cualquier motivo a consulta de atención primaria y a las que se siguió durante 3 años. El ajuste del modelo se evaluó mediante un modelo de calibración, se compararon los casos esperados (E) mediante la ecuación con los casos observados (O), y su precisión para discriminar entre las mujeres que presentaron o no una fractura .Resultados: No se observaron pruebas estadísticamente significativas de mala calibración. El cociente de casos E y de casos O fue de 1,02 (intervalo de confianza del 95%: 0,91 a 1,14). El test de la χ2 de la calibración (diferencias entre lo estimado y lo observado) no alcanzó significación estadística. El área bajo la curva de eficacia diagnóstica fue aproximadamente de 0,67. Conclusión: Los resultados indican una buena calibración del algoritmo propuesto para la predicción de fracturas no vertebrales. Sería necesaria la calibración con una cohorte independiente para comprobar definitivamente su validez externa (AU)

Background and Objectives: Absolute risk estimate for fractures in the individual subject provides meaningful information for interventions. Recently, we have described an algorithm to calculate the absolute risk for non-vertebral fractures in women from Spain, aged 65 years or older, that includes clinical parameters and quantitative bone ultrasound values of the calcaneus (URL: www.ecosap.info). We assessed the performance of the algorithm by means of the statistical analysis of the model calibration. Subjects and Methods: The algorithm was the result of the prospective analysis of 5.195 women who were attended for any reason in Primary Care Centres and followed-up for 3 years. Model calibration was evaluated by comparing number of estimated (E) cases predicted with the equation with the number of observed (O) cases, and its accuracy to discriminate women with and without a new fracture. Results: No evidence of statistically significant miscalibration of the model was observed. The E/O ratio was 1,02 (CI 95%: 0,91–1,14). Calibration χ2 value (difference between the estimated and observed cases) did not reach statistical significance. Area under the curve-ROC was approximately 0.67. Conclusions: These results suggest a good calibration of the proposed algorithm for non-vertebral fracture prediction. It would be desirable to calibrate it with an independent cohort to definitively test its external validity (AU)

[Validation of an algorithm to calculate the absolute risk of non-vertebral fragility fractures in a cohort of postmenopausal women]. / Validación de un algoritmo para el cálculo del riesgo absoluto de fracturas no vertebrales por fragilidad en una cohorte de mujeres posmenopáusicas.

BACKGROUND AND OBJECTIVES: Absolute risk estimate for fractures in the individual subject provides meaningful information for interventions. Recently, we have described an algorithm to calculate the absolute risk for non-vertebral fractures in women from Spain, aged 65 years or older, that includes clinical parameters and quantitative bone ultrasound values of the calcaneus (URL: www.ecosap.info). We assessed the performance of the algorithm by means of the statistical analysis of the model calibration. SUBJECTS AND METHODS: The algorithm was the result of the prospective analysis of 5.201 [corrected] women who were attended for any reason in Primary Care Centres and followed-up for 3 years. Model calibration was evaluated by comparing number of estimated (E) cases predicted with the equation with the number of observed (O) cases, and its accuracy to discriminate women with and without a new fracture. RESULTS: No evidence of statistically significant miscalibration of the model was observed. The E/O ratio was 1,02 (CI 95%: 0,91-1,14). Calibration chi(2) value (difference between the estimated and observed cases) did not reach statistical significance. Area under the curve-ROC was approximately 0.67. CONCLUSIONS: These results suggest a good calibration of the proposed algorithm for non-vertebral fracture prediction. It would be desirable to calibrate it with an independent cohort to definitively test its external validity.

Intravesical ozone therapy for progressive radiation-induced hematuria.

BACKGROUND: Progressive radiation-induced cystitis can become a serious clinical problem the therapeutic solution of which is limited and almost invariably aggressive. Ozone therapy is a nonconventional therapy that has been reported to offer benefits in late-onset wound healing and ischemic disorders. This report describes a patient with progressive radiation-induced hematuria from standard conservative treatment that was further treated with ozone therapy. METHOD: Ozone therapy was achieved by intravesical instillation of ozonized bi-distilled water over a period of 30 minutes, three sessions per week during the first weeks. Later, ozone therapy sessions were decreased and involved ozonized water or direct intravesicular instillation of ozone at 20-25 microg/mL. RESULTS: Hematuria was successfully controlled by intravesical application of ozone therapy. CONCLUSIONS: The successes achieved with this technique suggest that intravesicular instillation of ozonized bi-distilled water or ozone merits further investigation with a view to its application to counter this radiation-induced side-effect.