Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women.

BACKGROUND: The FRAX® tool estimates the risk of a fragility fracture among the population and many countries have been evaluating its performance among their populations since its creation in 2007. The purpose of this study is to update the first FRIDEX cohort analysis comparing FRAX with the bone mineral density (BMD) model, and its predictive abilities. METHODS: The discriminatory ability of the FRAX was assessed using the 'area under curve' of the receiver operating characteristic (AUC-ROC). Predictive ability was assessed by comparing estimated risk fractures with incidence fractures after a 10-year follow up period. RESULTS: One thousand three hundred eight women ≥ 40 and ≤ 90 years followed up during a 10-year period. The AUC for major osteoporotic fractures using FRAX without DXA was 0.686 (95 % CI 0.630-0.742) and using FN T-score of DXA 0.714 (95 % CI 0.661-0.767). Using only the traditional parameters of DXA (FN T-score), the AUC was 0.706 (95 % CI 0.652-0.760). The AUC for hip osteoporotic fracture was 0.883 (95 % CI 0.827-0.938), 0.857 (95 % CI 0.773-0.941), and 0.814 (95 % CI 0.712-0.916) respectively. For major osteoporotic fractures, the overall predictive value using the ratio Observed fractures/Expected fractures calculated with FRAX without T-score of DXA was 2.29 and for hip fractures 2.28 and with the inclusion of the T-score 2.01 and 1.83 respectively. However, for hip fracture in women < 65 years was 1.53 and 1.24 respectively. CONCLUSIONS: The FRAX tool has been found to show a good discriminatory capacity for detecting women at high risk of fragility fracture, and is better for hip fracture than major fracture. The test of sensibility shows that it is, at least, not inferior than when using BMD model alone. The predictive capacity of FRAX tool needs some adjustment. This capacity is better for hip fracture prediction and better for women < 65 years. Further studies in Catalonia and other regions of Spain are needed to fine tune the FRAX tool's predictive capability.

Incidencia de la fractura de fémur en España (1997-2010) / Incidence of hip fracture in Spain (1997-2010)

Fundamento y objetivo: Analizar las diferencias en la incidencia de fractura de fémur en mayores de 65 años en las 17 comunidades autónomas (CC. AA.) del estado español en el período de 1997-2010. Material y métodos: Estudio ecológico, observacional y retrospectivo que incluye a las personas ≥ 65 años que han presentado una fractura del tercio proximal de fémur en España durante 14 años. Estos registros provienen del conjunto mínimo básico de datos de los pacientes atendidos en el conjunto de hospitales de España. Resultados: Se analizan 534.043 fracturas de fémur en personas ≥ 65 años (414.518 en mujeres y 119.525 en varones). En ≥ 75 años ocurrieron el 85,4% (86,7% en mujeres; 80,7% en varones). La tasa ajustada/100.000/año fue de 722,6 en mujeres y 284,8 en varones. Por encima de la media en mujeres hay 7 CC. AA., y destacan: Cataluña, Comunidad Valenciana y Castilla-La Mancha. Por debajo de la media hay 6 CC. AA., y destacan: Canarias y Galicia. La diferencia entre CC. AA. con mayor y menor tasa de fractura ajustada por población es un 44% menor en mujeres (Canarias frente a Castilla-La Mancha) y un 50% menor en varones (Galicia frente a Cataluña). Conclusiones: La incidencia de fractura de fémur en España en ≥ 65 años muestra una importante variabilidad entre CC. AA. y, por tanto, entre zonas geográficas. Excepto en Canarias, esta variabilidad es difícil de explicar solo por factores como la edad de la población, la exposición solar o el gradiente norte-sur. Son necesarios estudios que analicen las causas de estas importantes diferencias entre CC. AA. Españolas (AU)

Background and objective: To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. Material and methods: Ecological, observational and retrospective study that includes people ≥ 65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. Results: The analysis include 534,043 hip fractures in ≥ 65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people ≥ 75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). Conclusions: The analysis of the incidence of hip fracture in Spain in people ≥ 65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC (AU)

[Incidence of hip fracture in Spain (1997-2010)]. / Incidencia de la fractura de fémur en España (1997-2010).

BACKGROUND AND OBJECTIVE: To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. MATERIAL AND METHODS: Ecological, observational and retrospective study that includes people≥65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. RESULTS: The analysis include 534,043 hip fractures in≥65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people≥75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). CONCLUSIONS: The analysis of the incidence of hip fracture in Spain in people≥65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC.