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.

Diagnosis and treatment of osteoporosis in Brazil.

The definition of Osteoporosis as proposed by WHO is widely accepted amongst Brazilian physicians. The main diagnostic tool in Brazil is Bone Densitometry (DXA). Both public and private health insurance systems reimburse the densitometry test. DXA have been used also for monitoring changes in BMD. Biochemical markers and peripheral methods of bone assessment are not widely used in Brazil. Estrogens, Vitamin D and its metabolites, Salmon Calcitonin, Ipriflavone, Tibolone, Etidronate, Alendronate, Raloxifene and Risendronate are currently available for treating osteoporosis. Since 1995, Brazilian Society of Clinical Densitometry have been educating Bone Densitometry Professionals and all clinicians in order to improve their ability to turn DXA results into adequate clinical decisions.

PROQUAD: accreditation program of the Brazilian society for clinical densitometry.

In 1996, the Brazilian Society for Clinical Densitometry (SBDens) developed an accreditation program to be applied to all densitometry centers, under the supervision of the certified physicians from SBDens. This program is named Programa Nacional de Qualidade em Densitometria (PROQUAD) and was developed to verify at least three aspects of the bone densitometry practice: the functioning of equipment, the methods used by technicians in performing the scans, and how the physicians are analyzing the scans and interpreting the results. From the 360 certified physicians who are members of SBDens, nearly one-third are participating in this program. The final purpose of PROQUAD is to provide approved centers with a seal, to be stamped on their examinations. The seal will signify to referring physicians, and the community, which centers are working under high standards of quality. It has been 2 yr since PROQUAD was established, and the data obtained confirm the improvement of quality in the practice of densitometry in Brazil. Any input from other societies that could improve PROQUAD is welcomed. Ensuring good densitometry practices is a goal for which all densitometry societies must strive.