Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): Resultados de una encuesta sobre la práctica clínica en España / Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain

Introducción y objetivos: En cirugía protésica de rodilla y cadera está claro que aún no se ha desarrollado una técnica de cierre estandarizada óptima. A nivel local no existen datos que describan la práctica quirúrgica habitual en cierre de herida. El objetivo de este trabajo es analizar el cierre de herida en cirugía protésica a través de una encuesta sobre una muestra representativa a nivel nacional y así obtener información sobre el contexto del cierre en España. Material y método: Se conforma un grupo ad hoc de especialistas en cirugía protésica. El grupo de expertos, posterior al análisis de la literatura, elabora un cuestionario de 32 preguntas cerradas de opción múltiple, divididas en los siguientes bloques: hemostasia, cierre quirúrgico de la herida y apósitos. Resultados: Un total de 471 cirujanos respondieron la encuesta de forma completa y con información suficiente para efectuar el análisis descriptivo; 79% cree que el ácido tranexámico (ATX) puede influir en la disminución de tasa de infección de sitio quirúrgico; 96% cree que el tipo de cierre profundo a nivel de la artrotomía podría influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 85% cree que el tipo de cierre superficial a nivel subcutáneo puede influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 64% de los cirujanos utiliza la terapia de presión negativa incisional de simple uso para el tratamiento de las complicaciones de la herida quirúrgica (seromas, drenaje prolongado, dehiscencias). Conclusiones: Existe en nuestro entorno una alta variabilidad en el cierre de la herida y una baja inversión en formación sobre este tema. Los autores recomiendan a las diferentes sociedades científicas la inversión de recursos para mejorar la formación en dicho campo y reducir el porcentaje de cirujanos que se consideran inadecuadamente formados, así como adaptar las técnicas de cierre a aquellas consideradas patrón oro según la evidencia.(AU)

Background and objective: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. Method: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. Results: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). Conclusions: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.(AU)

[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain / Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): resultados de una encuesta sobre la práctica clínica en España

Introducción y objetivos: En cirugía protésica de rodilla y cadera está claro que aún no se ha desarrollado una técnica de cierre estandarizada óptima. A nivel local no existen datos que describan la práctica quirúrgica habitual en cierre de herida. El objetivo de este trabajo es analizar el cierre de herida en cirugía protésica a través de una encuesta sobre una muestra representativa a nivel nacional y así obtener información sobre el contexto del cierre en España. Material y método: Se conforma un grupo ad hoc de especialistas en cirugía protésica. El grupo de expertos, posterior al análisis de la literatura, elabora un cuestionario de 32 preguntas cerradas de opción múltiple, divididas en los siguientes bloques: hemostasia, cierre quirúrgico de la herida y apósitos. Resultados: Un total de 471 cirujanos respondieron la encuesta de forma completa y con información suficiente para efectuar el análisis descriptivo; 79% cree que el ácido tranexámico (ATX) puede influir en la disminución de tasa de infección de sitio quirúrgico; 96% cree que el tipo de cierre profundo a nivel de la artrotomía podría influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 85% cree que el tipo de cierre superficial a nivel subcutáneo puede influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 64% de los cirujanos utiliza la terapia de presión negativa incisional de simple uso para el tratamiento de las complicaciones de la herida quirúrgica (seromas, drenaje prolongado, dehiscencias). Conclusiones: Existe en nuestro entorno una alta variabilidad en el cierre de la herida y una baja inversión en formación sobre este tema. Los autores recomiendan a las diferentes sociedades científicas la inversión de recursos para mejorar la formación en dicho campo y reducir el porcentaje de cirujanos que se consideran inadecuadamente formados, así como adaptar las técnicas de cierre a aquellas consideradas patrón oro según la evidencia.(AU)

Background and objective: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. Method: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. Results: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). Conclusions: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.(AU)

[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain.

BACKGROUND AND OBJECTIVE: In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. MATERIAL AND METHOD: An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain. / Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): Resultados de una encuesta sobre la práctica clínica en España.

BACKGROUND AND OBJECTIVE: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. METHOD: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

The impact of hip fracture on health-related quality of life and activities of daily living: the SPARE-HIP prospective cohort study.

PURPOSE: The medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life. METHODS: Design and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50 years old admitted in 48 hospitals in Spain. OUTCOMES: daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture. STATISTICS: Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range). RESULTS: A total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to - 0.01 (- 0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (- 0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively. CONCLUSIONS: Hip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture.

Guía SECOT-GEIOS en osteoporosis y fractura por fragilidad. Actualización / SECOT-GEIOS guidelines in osteoporosis and fragility fracture. An update

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Luxación subaxial cervical inveterada. Discusión de cuál es la mejor estrategia terapéutica / Inveterate subaxial cervical dislocations: a discussion on the best therapeutic strategy

Las luxaciones cervicales inveteradas presentan serias dificultades a la hora de plantear su tratamiento adecuado, por un lado, debido la dificultad de su reducción y, por otro, al riesgo de inducir lesiones iatrogénicas durante su reducción. A este hecho hay que añadir la escasa y controvertida bibliografía existente a la hora de establecer la estrategia quirúrgica más apropiada para su manejo. Presentamos un caso clínico tratado en la Unidad de Raquis del Servicio de Cirugía Ortopédica y Traumatología del Complejo Hospitalario Universitario de Santiago de Compostela, discutiendo las 2 opciones de tratamiento que actualmente se consideran las más utilizadas: el abordaje anterior-posterior-anterior y el posterior-anterior-posterior. Tras el análisis de los datos obtenidos de la revisión de este caso, podríamos concluir que el abordaje quirúrgico de estas lesiones resulta en general difícil, pudiéndose realizar las 2 técnicas anteriormente descritas, pero con la precaución de extirpar siempre la totalidad del disco intervertebral afectado antes de realizar las maniobras de corrección axial, por el riesgo de extrusión del mismo hacia canal medular. Con posterioridad a este gesto quirúrgico, se procedería a una correcta liberación y reducción de las facetas articulares, siendo necesario, en ocasiones, añadir osteotomías en las mismas (AU)

It is difficult to decide the appropriate treatment for inveterate cervical dislocations because of the difficulty of their reduction, as well as due to the risk of inducing iatrogenic injuries during this reduction. The literature on the most appropriate surgical strategy for their management is also limited as well as controversial.We report one clinical case treated in the Spine Unit of the Orthopedic Surgery and Trauma Service of the University Hospital of Santiago de Compostela, discussing the currently most used treatment options, the anterior-posterior-anterior and the posterior-anterior-posterior approach. After analyzing the results, it could be concluded that the surgical approach to these lesions is generally difficult, with any of two techniques described above being suitable, but always with the precaution to remove the entire affected intervertebral disc before axial correction maneuvers, thus avoiding the risk of extrusion into the medullary canal. After the surgical procedure, a proper release and reduction of the joint facets should be performed, sometimes with the need to add osteotomies in them (AU)

[Inveterate subaxial cervical dislocations: a discussion on the best therapeutic strategy]. / Luxación subaxial cervical inveterada. Discusión de cuál es la mejor estrategia terapéutica.

It is difficult to decide the appropriate treatment for inveterate cervical dislocations because of the difficulty of their reduction, as well as due to the risk of inducing iatrogenic injuries during this reduction. The literature on the most appropriate surgical strategy for their management is also limited as well as controversial. We report one clinical case treated in the Spine Unit of the Orthopedic Surgery and Trauma Service of the University Hospital of Santiago de Compostela, discussing the currently most used treatment options, the anterior-posterior-anterior and the posterior-anterior-posterior approach. After analyzing the results, it could be concluded that the surgical approach to these lesions is generally difficult, with any of two techniques described above being suitable, but always with the precaution to remove the entire affected intervertebral disc before axial correction maneuvers, thus avoiding the risk of extrusion into the medullary canal. After the surgical procedure, a proper release and reduction of the joint facets should be performed, sometimes with the need to add osteotomies in them.

Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D / Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon

La deficiencia (insuficiencia o deficiencia) de vitamina D es un problema clínico especialmente prevalente en ancianos con fracturas de baja energía, sobre todo de cadera, aunque también se ha relacionado con fracturas de estrés y de alta energía. Son muchas las evidencias que apoyan la necesidad de mantener unos niveles adecuados de vitamina D en sangre para reducir el número de fracturas por fragilidad, favorecer la consolidación de las mismas, mejorar la función neuromuscular de los pacientes, evitar las caídas, prevenir las infecciones quirúrgicas o mejorar la duración de las artroplastias. Sin embargo, no es habitual que el cirujano ortopédico y traumatólogo considere determinar los valores de vitamina D en este tipo de pacientes e instaurar el tratamiento adecuado. Se recomienda mantener niveles superiores a 30-40ng/ml (75-100nmol/l) de vitamina D y la ingesta, en casi todos los casos, de 800 a 1.000UI/día de vitamina D para alcanzar estos niveles (AU)

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels (AU)

[Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon]. / Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D.

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels.

Fracturas atípicas relacionadas con el uso prolongado de bifosfonatos. Estado de la situación / Atypical fractures associated with the long term use of bisphosphonates. The current situation

Los bifosfonatos son considerados actualmente un tratamiento de primera elección de la enfermedad osteoporótica. Su reconocida eficacia antifractura en todos los tipos de osteoporosis y su presencia en el mercado desde hace varios años, hacen que sean los fármacos de uso más extendido para el tratamiento de la enfermedad. En la última década han aparecido una serie de efectos adversos relacionados con esta medicación que han encendido la voz de alarma sobre la conveniencia o no de mantener el tratamiento continuado con estos fármacos durante un largo período de tiempo. Entre estos efectos se encuentra la aparición de una serie de fracturas consideradas atípicas por su localización y apariencia radiológica que se manifiestan en pacientes tratados de forma crónica con bifosfonatos. Estas fracturas que comparten una serie de características clínicas comunes, no cumplen el clásico perfil de la fractura por fragilidad osteoporótica. La prolongada inhibición del remodelado óseo podría ser el sustento fisiopatológico para su explicación, aunque todavía no está claramente establecida esta relación causal. El objetivo del presente trabajo es doble, por un lado presentar cuatro casos clínicos propios de fracturas atípicas relacionadas con la administración de estos fármacos y, por otro, realizar en base a ellos una revisión bibliográfica de esta entidad patológica, para intentar esclarecer cuál es la situación real del problema y determinar si es necesario establecer algún tipo de recomendaciones terapéuticas, tanto quirúrgicas como no quirúrgicas, ante este tipo de fracturas (AU)

Bisphosphonates are currently considered first choice treatment of osteoporotic disease. Its proven anti-fracture effect in all types of osteoporosis and its presence on the market for many years, make them the most widely used drugs for the treatment of this disease. A number of adverse effects associated with this medication have appeared over the past 10 years or so have caused concern on whether or not to maintain a continued treatment with these drugs over a long period of time. These side effects include a series of fractures, considered atypical because of their location and radiological appearance, which occur in patients treated long-term with bisphosphonates. These fractures, that share a number of common clinical features, do not meet the classic profile of osteoporotic fragility fractures. Prolonged inhibition of bone remodelling could be the pathophysiological basis for his explanation, although this causal relationship is not yet clearly established. The objective of this paper is two-fold, on the one hand to present four clinical cases of atypical fractures related with long-term administration of these drugs and, on the other, to perform a literature review of this pathological entity, in an attempt to clarify what is the real status of this problem and whether it is necessary to establish both surgical and non-surgical therapeutic recommendations for these types of fractures (AU)

Análisis morfológico, biomecánico y textural de imágenes de densitómetro central DEXA como complemento diagnóstico de la osteoporosis / Morphological, textural and biomechanical analysis of central DXA images as a diagnostic complement of osteoporosis

Objetivo: analizar asistido por ordenador, imágenes densitométricas digitalizadas de cadera mediante DEXA, para determinar su utilidad en el análisis textural óptico-fractal del hueso, y diferenciar poblaciones con densidad mineral ósea (DMO) de rango normal, osteopénico u osteoporótico. Una única prueba diagnóstica, obtendría además de la DMO, otros parámetros relacionados con la estructura y resistencia ósea. Material y método: se seleccionaron imágenes densitométricas DEXA de cadera de 18 pacientes con DMO en rango normal, 16 pacientes osteopénicos y otros 16 pacientes osteoporóticos, efectuando sobre ellas un análisis morfológico, biomecánico y textural-fractal mediante el programa informático Q-Bone®. Resultados: Las variables morfológicas y biomecánicas analizadas proporcionan una información complementaria y discriminadora entre los referidos grupos. Sin embargo, el análisis textural fractal uni o multidireccional aportó escasa información adicional, aunque asociado a variables ópticas (densidad lumínica) permitió una mayor capacidad de diferenciación entre grupos de pacientes con DMO en rango normal y patológico

Objective: the computational analysis of digitized hip densitometric DXA images to determining if this type of images are useful for the optical-fractal textural analysis of bone, and, to differentiate better among populations with normal, osteopenic or osteoporótic bone mineral density (BMD) levels. Material and methods: DXA densitometric hip images of 18 patients with normal BMD, 16 patients with osteopenic BMD levels and 16 patients with osteoporotic BMD levels were selected. Morphological, biomechanical and texturalfractal analyses of these images were carried out by means of Q-Bone® software. Results: the analyzed morphological and biomechanical variables give complementary and discriminating information between the referred groups. Nevertheless, the unidirectional and multidirectional fractal textural analysis give only a little additional information, although when associated to optical variables (luminic density) seem to add a greater capacity of differentiation between groups of patients with normal and pathological BMD

Factores determinantes de la resistencia ósea / Bone strength determinants

Hoy en día se considera que la resistencia ósea, entendiendo como tal la fuerza necesaria para desencadenar el fracaso biomecánico de un hueso, es el resultado de la integración de dos variables, la cantidad y la calidad ósea, factores dependientes a su vez del remodelado óseo. Mientras la cantidad de hueso depende directamente de su densidad mineral, la calidad del mismo depende de variables tales como la estructuración jerárquica y la composición química del material que lo forma. Cada uno de estos determinantes primarios de la resistencia ósea comprende a su vez una serie de determinantes secundarios, responsables directos de alguna de las propiedades biomecánicas óseas específicas. En conjunto, determinantes primarios y secundarios ayudan a establecer un hueso sano, resistente y biomecánicamente competente, mientras que sus alteraciones son responsables del desarrollo de osteopatías fragilizantes, procesos fisiopatológicos que incrementan el riesgo de fractura

Nowadays it is considered that bone strength, understanding as so the necessary load to cause a biomechanical failure of bone, it is the result of the integration of two variables, bone mass and bone quality, both related with bone remodelling. While bone mass depends directly on its mineral density, quality of bone depends on variables such as the hierarchic structure and chemical composition of its material. Each one of these bone strength primary determinants include a serial of secondary ones related with some of the specific biomechanical properties of bone. Altogether, primary and secondary determinants, help to establish a healthy, resistant and mechanical competent bone, whereas their alterations produce weakening osteopathies that increase fracture risk

Diagnóstico mediante dexa periférica de la osteoporosis postmenopáusica en la provincia de Orense / Diagnosis by peripheral dexa of postmenopausal osteoporosis in the province of Orense

El tratamiento de la osteoporosis postmenopáusica en Atención Primaria es deficiente y viene condicionado por la dificultad del profesional para acceder a pruebas diagnósticas. Objetivo. Conocer la prevalencia de osteoporosis postmenopáusica en la población femenina de Orense. Ámbito de trabajo. 13.035 medidas de densitometría periférica efectuadas durante 4 años en 63 centros de salud. Diseño. Estudio transversal. Las mediciones se efectuaron con densitómetro periférico de calcáneo (modelo PIXI). Resultados. Edad media 65 años (IC 95 por ciento, 65 a 66). Osteoporosis en menores de 49 años: 4,0 por ciento, de 50 a 59: 5,3 por ciento, de 60 a 69: 14,7 por ciento y en mayores de 70: 36,3 por ciento. Prevalencia total: 21,3 por ciento. En mayores de 50 años: 20,8 por ciento. Conclusiones. Resultados comparables a otros estudios. La densitometría periférica, aunque con menor especificidad que DEXA central, es un buen método de cribado de una población con factores de riesgo, es bien tolerado y aceptado por los médicos (AU)