Morbilidad de las fracturas vertebrales osteoporóticas durante el aislamiento social en la pandemia COVID-19 / Osteoporotic vertebral fractures morbidity during social isolation on COVID-19 pandemic

Introducción: la pandemia por COVID-19 afectó negativamente los sistemas de salud. Las fracturas vertebrales osteoporóticas y el aislamiento social se relacionan con mayor morbimortalidad. Objetivos: caracterizar la morbilidad de las fracturas vertebrales osteoporóticas y evaluar una posible relación entre morbilidad y nivel de aislamiento social se-cundario al estado de pandemia. Material y métodos: estudio observacional, analítico y transversal. Resultados: se incluyeron en el estudio 45 adultos. La fractura fue mayorita-riamente lumbar con una evolución superior de 3 meses. El 35% presentaba seguimiento, el 48% había recibido tratamiento para osteoporosis y el 48% presentaba fracturas previas documentadas. El 46% refirió falta de accesibilidad al sistema. Se evaluó el aisla-miento social con la escala sociofamiliar de Gijón, que evidenció una situación buena en el 75% y un deterioro social intermedio/severo en el 24%. El Índice de Oswestry mostró una discapacidad mínima/moderada en el 66% y severa o mayor en el 33%. Se evaluó el dolor por la Escala análoga visual (VAS) y se obtuvo un VAS mayor de 5 en el 57%. Al comparar el grupo de situación sociofamiliar buena con el de deterioro social intermedio/severo se observó una diferencia en multipli-cidad de fracturas (p 0,030), hipovitaminosis D (p 0,045) y falta de accesibilidad (p 0,029). En discapacidad y dolor no hubo diferencias. Conclusión: el grupo con mayor aislamiento presentó una enfermedad más severa en términos de multiplicidad de fracturas e hipovitaminosis D; esto podría indicar una asociación entre aislamiento social secundario al estado de pandemia y morbilidad por las fracturas vertebrales. (AU)

Introduction: the COVID-19 pandemic had a negative impact on healthcare systems. Osteoporotic vertebral fractures and social isolation have a significant morbidity in our setting. Objectives: to characterize the morbidity of osteoporotic vertebral fractures and evaluate a potential relationship between morbidity and the level of social isolation secondary to the pandemic. Material and methods: observational, analytical and cross-sectional study. Results: forty-five adults were included. Fractures were mostly lumbar with a history of over 3 months. Thirty-five percent (35%) had been followed-up, 48% had been treated for osteoporosis and 48% had previous documented fractures. Forty-six percent (46%) reported lack of accessibility to healthcare. Social isolation was measured using Gijón ́s social-familial evaluation scale, which showed a good situation in 75% of cases and an intermediate/severe social deterioration in 24%. According to the Oswestry index, disability was minimal/moderate in 66% of cases and severe or worse in 33%. Pain was assessed using the Visual Analogue Scale (VAS), with a score greater than 5 recorded in 57% of patients. When comparing the group with a good social-familial situation vs. the group with intermediate/severe social deterioration, differences were found in multiplicity of fractures (p 0.030), hypovitaminosis D (p 0.045) and lack of accessibility (p 0.029). No differences were found in disability and pain. Conclusion: the group with higher levels of isolation exhibited more severe disease in terms of multiplicity of fractures and hypovitaminosis D, which might suggest an association between social isolation secondary to the pandemic and morbidity due to vertebral fractures. (AU)

Use of the SARC-F Score as an Aid in Fragility Fractures Prevention / O uso do escore SARC-F como auxiliar na prevenção de fraturas por fragilidade

Abstract Objective The present study aimed to relate the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) score with the presence or absence of fragility fracture in the population over 60 years of age. Methods The risk of sarcopenia was determined through the application of the SARC-F questionnaire, and the patients were divided into 2 groups, according to the occurrence or not of fragility fracture (n = 100). Results Thirty-two cases of distal radius fractures and eighteen cases of proximal femur fractures were identified. A higher score on the SARC-F is determinant between having or not a fragility fracture, estimating that for each point in the score there is a 70% increase in the chance of a patient having a fracture, regardless of age, gender, and body mass index (BMI). Conclusion There was a direct correlation between a higher score on the SARC-F and an increase in the chance of fragility fracture.

Resumo Objetivo O presente estudo teve como objetivo relacionar o escore strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) com a presença ou não de fratura por fragilidade na população acima de 60 anos. Métodos O risco de sarcopenia foi determinado por meio da aplicação do questionário SARC-F, sendo os pacientes divididos em 2 grupos, de acordo com a ocorrência ou não de fratura por fragilidade (n = 100). Resultados Foram levantados 32 casos de fratura de rádio distal e 18 casos de fratura de fêmur proximal. Uma maior pontuação no SARC-F determina bem entre ter ou não ter fratura por fragilidade, estimando que a cada ponto a mais no escore há um acréscimo de 70% na chance de o paciente ter fratura, independentemente da idade, sexo e índice de massa corporal (IMC). Conclusão Houve correlação direta entre uma maior pontuação no SARC-F e aumento na chance de fratura por fragilidade.

Vertebroplastia percutánea en fracturas vertebrales osteoporóticas / Percutaneous vertebroplasty for osteoporotic vertebral fractures

La osteoporosis es una enfermedad sistémica que deteriora la calidad del hueso y su arquitectura. Como consecuencia, predispone a fracturas por fragilidad, entre las cuales las fracturas vertebrales son frecuentes. Estas se asocian a una gran morbimortalidad. La vertebroplastia ha surgido en 1984 como alter-nativa terapéutica para tratar algunos tumores vertebrales y fracturas vertebrales osteoporóticas dolorosas. Este procedimiento consiste en la inyección de cemento guiado por imágenes, para estabilizar la vértebra fracturada y disminuir el dolor. La vertebroplastia puede ser realizada con anestesia local, sedación o anestesia general. La fuga de cemento fuera de la vértebra es una complicación común; sin embargo esto no suele tener traducción clínica y solamente se trata de un hallazgo imagenológico. En este artículo revisaremos las indicaciones, contraindicaciones, la eficacia, controversias y las complicaciones de la vertebroplastia percutánea. (AU)

Osteoporosis is a systemic disease characterized by bone quality deterioration. As a consequence of this deterioration, osteoporosis results in high fracture risk due to bone fragility. Fractures to the spine are common in this scenario, and relate to an increased morbi-mortality. Vertebroplasty emerged in 1984 as an alternative to treat painful vertebral tumors and osteoporotic vertebral fractures. This procedure relies on image guided cement injection to achieve pain relief and strengthen the vertebral body. Vertebroplasty can be performed under local anesthesia, mild sedation, or general anesthesia. Among its complications, cement leakage is common but it is rarely associated with any symptoms and it is usually an imaging finding. In this article, we will review indications and contraindications, effectiveness, controversies and complications related to percutaneous vertebroplasty. (AU)

Delay in hip fracture surgery and its outcomes. A reflection / Retraso en cirugía de fractura de cadera y sus desenlaces. Una reflexión

Abstract Hip fracture is one of the major public healthcare problems in elderly patients around the world, mainly because of the risk of falls and osteoporosis which are typical during this stage of life, and may be the cause for up to 36% of deaths among those affected. Its management in principle is surgical and the best results are achieved with patients undergoing surgery during the first 24 to 72 hours after the fracture. Any delays in surgery are mostly associated with decompensated personal pathological factors, delays in perioperative assessment, or in presurgical complementary tests; sometimes, the delays are the result of administrative formalities of the healthcare providers. These determining factors may affect both morbidity and mortality, and contribute to functional decline, disability, and reduced quality of life of these patients. A third party intervention is then necessary to improve the preventable factors that delay the osteosynthesis in these types of fractures, in addition to ensuring education, infrastructure, inputs, skilled human resources, and prompt referral of patients from the first level of care. Investigating this scenario and assessing the quality of life impact on these patients should be a priority.

Resumen La fractura de cadera representa uno de los problemas de salud pública más grandes en los pacientes ancianos en todo el mundo, principalmente, por el riesgo de caídas y la osteoporosis típicos en esta etapa de la vida, que puede causar la muerte de hasta el 36 % de los afectados; su manejo es en principio quirúrgico y los mejores resultados se presentan cuando se interviene en las primeras 24 a 72 horas después de la fractura. El retraso en la corrección quirúrgica está asociado principalmente a factores patológicos personales no compensados, demora en la valoración perioperatoria o en los estudios complementarios prequirúrgicos, o por trámites administrativos de las empresas prestadoras de servicios de salud. Estos determinantes pueden afectar la morbimortalidad y contribuir a un deterioro funcional, incapacidad y pérdida de la calidad de vida de estos pacientes. Se hace necesaria una intervención por parte de terceros para mejorar los factores prevenibles que retrasan la osteosíntesis de este tipo de fracturas; además, asegurar educación, infraestructura, insumos, talento humano capacitado y remisión rápida de pacientes desde el primer nivel de atención. Investigar en este escenario y evaluar los efectos en la calidad de vida de estos pacientes debería ser una prioridad.

FRAX-based assessment and intervention threshold curves for osteoporosis evaluation in Ecuador / Curvas de intervención y evaluación basadas en FRAX Ecuador

RESUMEN Introducción: La herramienta FRAX ha sido validada y adaptada a diferentes países, cubriendo a casi el 80% de la población mundial, incluido Ecuador, donde fue adaptada en 2009. El objetivo de este estudio fue elaborar curvas de evaluación e intervención basadas en FRAX Ecuador. Métodos: Utilizando el modelo FRAX Ecuador, calculamos la probabilidad de fractura osteoporótica mayor y fractura de cadera femenina sin ningún factor de riesgo y sin la inclusión de DMO. Las probabilidades se calcularon en intervalos de 5 años de 40 a 90 años. Las probabilidades de fractura mayor y de cadera se calcularon en 3 escenarios diferentes: 1. Historia de fractura previa sin la inclusión de DMO, 2. T-Score de -2,5 SD sin otros factores de riesgo clínico, 3. T-Score -1,5 SD sin otros factores de riesgo clínico. Resultados: En mujeres sin factores de riesgo, la probabilidad de fractura osteoporótica mayor aumentó con la edad del 0,4% a los 40 años al 7,3% a los 90 años. La probabilidad de fractura de cadera aumentó con la edad de 0% a los 40 años a 3,6% a los 90 anos. La probabilidad de fractura osteoporótica mayor aumentó en mujeres con un puntaje T de -2,5 SD de 0,9% a los 40 años a 5,5% a los 90 años; con puntaje T de -1,5 DE, de 0,6% a los 40 años a 3,9% a los 90 anos. Conclusión: Los datos muestran la importancia de aplicar herramientas como FRAX, específicas para cada país y también la creación de curvas de evaluación e intervención que permitan discernir según cada paciente la necesidad de utilizar recursos como DXA y tratamientos específicos.

ABSTRACT Introduction: FRAX has been validated and adapted to different countries, covering almost 80% of the world's population, including Ecuador where it was adapted in 2009. The purpose of this study is to elaborate evaluation and intervention curves based on FRAX Ecuador. Methods: Using the FRAX Ecuador model, we calculated the probability of a major osteoporotic fracture and a female hip fracture without any risk factor and without the inclusion of BMD. The probabilities were calculated in 5-year intervals from 40 to 90 years. The probabilities of major fractures and hip fractures were calculated in 3 different scenarios: 1. History of previous fracture without the inclusion of BMD, 2. T score -2.5 SD without other clinical risk factors, 3. T score -1.5 SD without other clinical risk factors. Results: In women without risk factors, the probability of a major osteoporotic fracture increased with age from 0.4% at 40 years to 7.3% at 90 years. The probability of hip fracture increased with age from 0% at 40 years to 3.6% at 90 years. The probability of a major osteoporotic fracture increased in women with a T score of -2.5 SD from 0.9% at 40 years to 5.5% at 90 years; with a T-score of -1.5 SD, from 0.6% at 40 years to 3.9% at 90 years. Conclusion: Data shows the importance of applying tools such as FRAX, specific for each country and also the creation of evaluation and intervention curves that allow discerning according to each patient the need for the use of resources such as DXA and specific treatments.

Riesgo de fracturas osteoporóticas en adultos mayores / Risk for Osteoporotic Fractures in Aged Adults

Introducción: La medición del Fracture Risk Assessment Tool - FRAX® es útil en Atención Primaria de Salud para evaluar el riesgo de fractura. Objetivo: Determinar el riesgo de fractura osteoporótica en adultos mayores. Métodos: Se realizó un estudio descriptivo de corte transversal, con una muestra de 54 adultos pertenecientes al grupo Club Nueva Vida de la Ciudad de Tunja, primer semestre de 2018, seleccionados por medio de un muestreo no probabilístico a conveniencia. Se empleó la herramienta FRAX®, propuesta por la Organización Mundial de la Salud y se realizó un análisis estadístico con el Chi2 de Pearson y la Razón de Prevalencia. Resultados: El factor de riesgo con mayor presencia fue la osteoporosis secundaria en 51,9 por ciento, donde 13 por ciento reporta FRAX®+ para probabilidad a 10 años de fractura mayor osteoporótica y 14,8 por ciento obtuvo FRAX®+ para probabilidad a 10 años de fractura de cadera sin densitometría ósea. Conclusiones: El FRAX®, es una herramienta útil en la prevención de problemas de salud resultado de fracturas que conllevan a alteraciones en la capacidad funcional y el movimiento(AU)

Introduction: The measurement of the Fracture Risk Assessment Tool - FRAX® is useful in primary healthcare for assessing the risk of fracture. Objective: To determine the risk of osteoporotic fracture in older adults. Methods: A descriptive and cross-sectional study was carried out, with a sample of 54 adults belonging to the Club Nueva Vida group of the City of Tunja, first semester of 2018, selected by means of a nonprobabilistic sampling at convenience. The FRAX® tool, proposed by the World Health Organization, was used, and statistical analysis was performed with Pearson's Chi2 and the prevalence ratio. Results: The risk factor with the highest presence was secondary osteoporosis in 51.9 percent, where 13 percent reported FRAX® + for a 10-year probability of major osteoporotic fracture and 14.8 percent obtained FRAX®+ for a 10-year probability of hip fracture without bone densitometry. Conclusions: FRAX® is a useful tool in the prevention of health problems resulting from fractures that lead to alterations in functional capacity and movement(AU)

Caracterização de mulheres sobre os fatores de risco para osteoporose / Description of women on the risk factors for osteoporosis

Objetivo: Caracterizar mulheres do interior do Piauí sobre os fatores de risco para a osteoporose. Método: Estudo transversal, descritivo, de abordagem quantitativa realizado com 90 mulheres, entre junho de 2018 a junho de 2019, com dados coletados através de formulário adaptado da ferramenta Fracture Risk Assessement Tool e análise descritiva dos dados. Resultados: O intervalo etário variou de 40 e prevalecendo pessoas com ensino fundamental incompleto (27,8%), com renda entre 1 a 2 salários Mínimos (41,1%). Dentre os fatores de risco para osteoporose destacou-se histórico familiar (37,8%), menopausa precoce (38,9%), frequência de fraturas após quedas (33,3%), sedentarismo (47,8%), uso de corticoides (62,2%), dentre outros. Conclusão: O estudo corrobora com conhecimentos sobre a doença que acomete sobretudo mulheres idosas e na idade adulta, vinculando conhecimento a esse público. Aos profissionais de saúde corrobora com informações que ocasionam melhorias de suas práticas assistenciais.

Objective: To characterize women from the interior of Piauí about risk factors for osteoporosis. Method: Cross-sectional, descriptive, quantitative approach study conducted with 90 women, from June 2018 to June 2019, with data collected through a form adapted from the Fracture Risk Assessement Tool and descriptive data analysis. Results: The age range ranged from 40 to 79 years, prevailing people with incomplete elementary school (27.8%), with income between 1 and 2 minimum wages (41.1%). Among the risk factors for osteoporosis were family history (37.8%), early menopause (38.9%), fracture frequency after falls (33.3%), sedentary lifestyle (47.8%), use of corticosteroids (62.2%), among others. Conclusion: The study corroborates with knowledge about the disease that affects mainly elderly and adult women, linking knowledge to this public. Health professionals corroborate information that causes improvements in their care practices

Características y evolución de las fracturas de cadera operadas en el Banco de Prótesis (enero-diciembre 2013) / Characteristics and evolution of hip fractures operated in the Banco de Prótesis between january and december 2013

Introducción: la fractura de cadera por fragilidad es considerada un marcador de enfermedad osteoporótica en la población añosa. Determina una elevada morbimortalidad y altos costos en salud. Objetivos: analizar características y evolución posterior a una fractura de cadera por fragilidad en pacientes >65 años asistidos en el Banco de Prótesis durante el período enero-junio 2013. Método: estudio de seguimiento de cohorte histórica, constituido por 184 pacientes. Los datos se obtuvieron de las historias clínicas y el seguimiento se realizó telefónicamente. El tiempo de seguimiento máximo fue de 84 semanas. Resultados: sexo femenino (82,6%), con una mediana de edad de 80,7 años para los hombres y 82,7 para las mujeres. Las comorbilidades más frecuentes fueron hipertensión arterial y enfermedad cardiovascular. No hubo diferencias en la localización derecha o izquierda, la mayoría correspondió a fracturas de cuello femoral. La mediana del tiempo de resolución fue de 9 días para artroplastia y 11 días para osteosíntesis. La caída fue la determinante en 94,5% de los casos. El 26% de los pacientes tenían fracturas previas por fragilidad. El 85% de los individuos desconocía padecer osteoporosis (OP) y el 69% no recibía tratamiento para esta enfermedad. El 9% fue institucionalizado, 77% logró retomar la deambulación y 15% falleció en el período de seguimiento. Conclusiones: no se reconoce ni se trata la OP en los pacientes con fractura de cadera por fragilidad.

Introduction: hip fracture due to frailty is considered a marker of osteoporotic disease in the elderly population. It determines a high morbidity and mortality and high health costs. Objectives: to analyze characteristics and evolution after a hip fracture due to fragility in patients over 65 years of age assisted in the Banco de Protesis during the January-June 2013 period. Methods: historical cohort follow-up study, consisting of 184 patients. The data was obtained from the medical records and the follow-up was done by telephone. The maximum follow-up time was 84 weeks. Results: 82% of patients were female, with median age of 80.7 years for men and 82.7 for women. The most frequent comorbidities were hypertension and cardiovascular disease. There were no differences in the right or left location, the majority corresponded to femoral neck fractures. The median resolution time was 9 days for arthroplasty and 11 days for osteosynthesis. The fall was the determinant in 94.5% of the cases. Twenty-six percent of the patients had previous fragility fractures. 85% of individuals did not know about osteoporosis (OP) and 69% did not receive treatment for this disease. 9% was institutionalized, 77% managed to resume walking. 15% died in the follow-up period. Conclusions: osteoporosis is not recognized or treated in patients with fragility fracture hip.

Introdução: a fratura de quadril por fragilidade é considerada um marcador de enfermidade osteoporótica em idosos. Determina uma elevada morbimortalidade e altos custos em saúde. Objetivos: analisar as características e a evolução posterior a uma fratura de quadril por fragilidade em pacientes >65 anos atendidos no Banco de Prótesis durante o período janeiro-junho 2013. Métodos: estudo de seguimento de coorte histórica com 184 pacientes. Os dados foram obtidos dos prontuários de pacientes e o seguimento foi feito por via telefônica. O tempo máximo de seguimento foi de 84 semanas. Resultados: 82.6% dos pacientes era do sexo feminino; a mediana de idade foi de 80.7 anos para os homens e 82.7 para as mulheres. As comorbidades mais frequentes foram hipertensão arterial e patologia cardiovascular. Não foram observadas diferenças na localização da fratura - direita ou esquerda sendo a maioria fraturas do colo do fêmur. A mediana do tempo de resolução foi de 9 dias para autoplastia e 11 dias para osteossíntese. A queda foi o fator determinante em 94.5% dos casos. Vinte e seis por cento dos pacientes tinham fraturas previas por fragilidade. 85% dos indivíduos não sabia que era portador de osteoporose (OP) e 69% não recebia tratamento para esta enfermidade. 9% foi institucionalizado, 77% retomou a deambulação e 15% faleceu durante o seguimento. Conclusões: não se reconhece nem se trata a osteoporose nos pacientes com fratura de quadril por fragilidade.

Uso de bifosfonatos en pacientes con osteopenia / Biphosphonates in patients with osteopenia

La osteopenia, una disminución de la densidad mineral ósea de menor severidad que la osteoporosis, definida por valores de T-score entre -1,0 y -2,5 en la densitometría ósea , podría asociarse con un mayor riesgo de fracturas. Motivado por el pedido de una paciente con osteopenia que solicita a su médico algún medicamento que le ayude a disminuir su riesgo de fracturas, el autor se pregunta si los bifosfonatos podrían ser beneficiosos para las pacientes con este factor de riesgo. Luego de realizar una búsqueda bibliográfica y seleccionar la evidencia más reciente y de mejor calidad, se concluye que estos fármacos podrían ser útiles para prevenir fracturas en mujeres mayores de 65 años con elevado riesgo de fractura,independientemente del resultado de la densitometría. (AU)

Osteopenia, a minor decrease in bone mineral density, defined by T-score values between -1.0 and -2.5 in a bone densitometry, is associated with an increased risk of fractures. Moved by the request of a patient with osteopenia who asks her doctor for any medication that may help her reduce his risk of fractures, the author wonders if bisphosphonates could be beneficial for patients with this condition. After conducting a bibliographic search and selecting the most recent and best quality evidence, he concluded that these drugs could be useful to prevent fractures in women older than 65 years with ahigh risk of fracture, regardless of densitometry results. (AU)

Manejo subóptimo de fracturas por fragilidad en el Servicio de Traumatología del Hospital de Antofagasta / Suboptimal management of Frailty fractures in Traumatology Service of the Antofagasta Hospital

Existe escasa información respecto al estudio y manejo de la osteoporosis en los pacientes que han sufrido fractura por fragilidad en Chile. Objetivo: Describir la epidemiologia, aproximación diagnóstica y manejo realizado a pacientes hospitalizados por fractura por fragilidad (muñeca, cadera, columna) que ingresaron al Servicio de Traumatología (ST) del Hospital de Antofagasta (HRA). Método: Estudio retrospectivo, se revisó registros de pacientes hospitalizados en ST y se identificó a pacientes que presentaron fractura por fragilidad. Se revisó sus fichas clínicas (período enero 2015-diciembre 2016). Se analizaron factores de riesgos, exámenes realizados, terapias y controles médicos al alta. Resultados: Fueron 971 ingresos y 100 pacientes con fractura por fragilidad. 88% fueron mujeres cuya edad promedio fue 73,1 años. El factor de riesgo más común fue la postmenopausia y antecedente de fractura previa. Las fracturas se distribuyeron en cadera 64%, muñeca 35% y columna 1%. A solo 3 pacientes se le pidió densitometría ósea. En ninguno fue evaluada vitamina D ni PTH. Al 7% se indicó calcio y vitamina D post fractura, a 4% se indicó antiresortivos. En ningún paciente se promovió el consumo de lácteos. Discusión: Las fracturas osteoporóticas en el HRA son inadecuadamente estudiadas para descarte de factores modificables y son farmacológicamente subtratadas, con el riesgo de nueva aparición de fracturas por fragilidad y morbimortalidad asociada. Es importante reforzar en los servicios de traumatología la importancia del manejo médico postfracturas y eventualmente incorporar la participación de otros especialistas en el manejo de estos pacientes durante la hospitalización y al alta.

We have poor information regarding study and management of osteoporosis in patient who have a fragility fracture in Chile. Objetive: Describe epidemiology, diagnostic approach and management performed on patients hospitalized for fragility fracture in Traumatology Service(ST) of the Antofagasta Hospital(HRA). Method: Retrospective study, we reviewed your clinical record (period January 2015-December 2016). Risk factor, laboratory test performed, therapies and medical controls at discharge were analyzed. Resuls: 971 patient admited to ST, 100 were fragility fracture. 88% were women with average age 73,1 years old. The mosts commons risk factors were chronic kidney failure and anticonvulsants treatment. The fractures were 64% of hip, 35% wrist, and 1% column. Only 3 patients have bone densitometry. None had vitamin D or PTH evaluated. Calcium and vitamin D after fracture were indicated at 7%, antiresorptives were indicated at 4%. In none diary consumption were promoted. Discussion: Osteoporotic fractures in HRA are inadequately studied to rule out modifiable factors and they are pharmacologically subtracted, with risk of new fractures an mobility and mortality. Is important remember in the ST importance of the medical management postfracture and the multidisciplinary work.

Servicio de enlace para pacientes con fracturas por osteoporosis / Osteoporotic fracture liaison service

Los pacientes con fracturas por fragilidad presentan elevadas tasas de morbimortalidad, lo que implica además un alto costo para el erario público. Luego de una fractura por osteoporosis, la mayoría de los pacientes no recibe una adecuada evaluación y tratamiento. Para suplir este vacío de atención médica se crearon distintas políticas; la mejor de ellas son los Servicios de Enlace de Pacientes con Fracturas (Fracture Liaison Service, en inglés). Estos programas tienen una vigencia internacional de más de diez años y son patrocinados por organismos internacionales. La finalidad de estos servicios es la prevención secundaria de fracturas. La modalidad de trabajo tiene como objetivo facilitar y asegurar la rápida identificación, el diagnóstico y la terapéutica de esta población en diferentes contextos asistenciales. La experiencia internacional demuestra que estos servicios son exitosos pues logran incrementar el inicio y la adherencia al tratamiento, disminuir las tasas de mortalidad, de morbilidad y de nuevas fracturas, y son costo-efectivos. En nuestro medio, el inicio de los Servicios de Enlace es reciente. El propósito de esta actualización es realizar una revisión de los fundamentos, características, modalidad operativa y los logros obtenidos por dichos programas. Las fracturas por fragilidad ósea constituyen un problema importante para la salud pública. Esta presentación tiene como objetivo alertar y motivar a la comunidad médica a intervenir de manera sistemática y dinámica para mejorar el cuidado habitual en esta población de pacientes. (AU)

Fragility fractures are associated with increased morbidity and mortality rates and higher costs. After a fracture, most patients do not receive adequate assessment and treatment. To fill this gap in medical care, different policies have been created; the best of them being the Fracture Liaison Services. These programs have been in place for over ten years worldwide and are sponsored by international organisms and societies. The purpose of the Fracture Liaison Services is secondary fracture prevention. Their goal is to ensure the rapid identification, diagnosis and treatment of this population in different clinical contexts. They increase treatment adherence and decrease mortality and morbidity rates and the incidence of new fractures. International experience shows that these services are successful and costeffective. (AU)

Baseline characteristics of postmenopausal women with osteoporosis treated with teriparatide in a real-world setting in Latin America: a subregional analysis from the Asia and Latin America Fracture Observational Study (ALAFOS)

Abstract Background: Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America. Methods: We conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico. Results: The Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40-94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were - 3.02 (1.23) at the lumbar spine and - 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline. Conclusions: This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.

Clinical comparison between a percutaneous hydraulic pressure delivery system and balloon tamp system using high-viscosity cement for the treatment of osteoporotic vertebral compression fractures

OBJECTIVES: Osteoporotic vertebral compression fractures (OVCFs) affect the elderly population, especially postmenopausal women. Percutaneous kyphoplasty is designed to treat painful vertebral compression fractures for which conservative therapy has been unsuccessful. High-viscosity cement can be injected by either a hydraulic pressure delivery system (HPDS) or a balloon tamp system (BTS). Therefore, the purpose of this study was to compare the safety and clinical outcomes of these two systems. METHODS: A random, multicenter, prospective study was performed. Clinical and radiological assessments were carried out, including assessments of general surgery information, visual analog scale, quality of life, cement leakage, and height and angle restoration. RESULTS: Using either the HPDS or BTS to inject high-viscosity cement effectively relieved pain and improved the patients' quality of life immediately, and these effects lasted at least two years. The HPDS using high-viscosity cement reduced cost, surgery time, and radiation exposure and showed similar clinical results to those of the BTS. In addition, the leakage rate and the incidence of adjacent vertebral fractures after the HPDS treatment were reduced compared with those after treatment using the classic vertebroplasty devices. However, the BTS had better height and angle restoration abilities. CONCLUSIONS: The percutaneous HPDS with high-viscosity cement has similar clinical outcomes to those of traditional procedures in the treatment of vertebral fractures in the elderly. The HPDS with high-viscosity cement is better than the BTS in the treatment of mild and moderate OVCFs and could be an alternative method for the treatment of severe OVCFs.

Artroplastía parcial de cadera con banda de tensión en fracturas de fémur proximal en pacientes ancianos / Partial hip arthroplasty with tension band in proximal femur fractures in older patients

RESUMEN: Las fracturas intertrocantéricas en adulto mayor presentan gran dificultad para lograr una cicatrización ósea estable y una fijación en la artroplastía, para la recuperación completa y funcional del anciano. En pacientes adultos mayores sin stock óseo, se recomienda realizar anexo a la artroplastía de cadera, la colocación de una banda de tensión, con la finalidad de brindar mayor estabilidad a los fragmentos y sustentación a la artroplastía primaria, con el objetivo de lograr un retorno a la calidad de vida normal. A las cuatro semanas de la cirugía, se evidencia una mejora en la escala funcional alcanzando una puntuación media de 83, considerandose un buen resultado. En los controles subsecuentes se evidencia una media en la escala de Harris de 87. Los pacientes volvieron a su nivel de actividad preoperatoria, más de la mitad de los pacientes fueron capaces de caminar sin apoyos, y finalmente, no se reportaron complicaciones en los controles postquirúrgicos al seguimiento de un año.

SUMMARY: The intertrochanteric fractures in the elderly are very difficult to achieve stable bone healing and fixation in arthroplasty for complete and functional recovery of the elderly. In elderly patients without bone stock, it is recommended to make an attachment to the hip arthroplasty the placement of tension band with the purpose of providing greater stability to the fragments and support to the primary arthroplasty with the aim of a return to the normal quality of life, in the results at 4 weeks post-surgery an improvement in the functional scale is evidenced having as average score 83 taken as good results. In the subsequent controls a mean on the Harris scale of 87 was evidenced, the patients returned to their level of preoperative activity, more than half of the patients were able to walk without support, no complications were reported in the postoperative follow-up controls. of 1 year of patients.

Riesgo de fractura osteoporótica y factores de riesgo asociados en mujeres postmenopáusicas en atención primaria de salud / Risk of osteoporotic fracture and associated risk factors in postmenopausal women in primary health care

Resumen Objetivo: Analizar el riesgo de fractura osteoporótica y factores de riesgo asociados en mujeres postmenopáusicas bajo control en un Centro de Atención Primaria de Salud. Material y Método: Estudio cuantitativo de corte transversal, selección de muestra de 197 mujeres entre 50 y 64 años, se calculó su riesgo de fractura mediante FRAX, una herramienta predictiva de fractura que incorpora factores de riesgo, y permite determinar la probabilidad a diez años de sufrir riesgo de fractura osteoporótica mayor y de cadera. Resultados: Un promedio de 3,46% ± 3,18% para riesgo de fractura mayor y de 0,84% ± 1,30% para riesgo de fractura de cadera. La categorización del riesgo indicó un 3% con alto riesgo para fractura mayor y un 11,2% alto riesgo para fractura de cadera. La mayor prevalencia de factores de riesgo fueron la osteoporosis secundaria, fumadora activa y fractura previa. Conclusiones: La situación de riesgo de fractura y los factores de riesgo más prevalentes observados, requiere establecer intervenciones preventivas desde el nivel de atención primaria de salud.

Abstract Objective: To analyze the risk of osteoporotic fracture and associated risk factors in postmenopausal women under control in a Primary Health Care Center. Material and Method: A cross-sectional quantitative study, sample selection of 197 women between 50 and 64 years of age, their risk of fracture was calculated using FRAX, a predictive tool for fracture that incorporates risk factors, and allows the probability to be determined ten years Risk of major osteoporotic fracture and hip fracture. Results: A mean of 3.46% ± 3.18% for greater fracture risk and 0.84% ± 1.30% for hip fracture risk. Risk categorization indicated 3% with high risk for major fracture and 11.2% high risk for hip fracture. The highest prevalence of risk factors was secondary osteoporosis, active smoking, and previous fracture. Conclusions: The situation of risk of fracture and the most prevalent risk factors observed requires establishing preventive interventions from the level of primary health care.

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

SUMMARY BACKGROUND Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures. METHODS A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75-84, 85-90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed. RESULTS The age ranges did not show any statistically-significant differences (P<.05; R2=.000-.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011-.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson's disease, aortic stenosis, surgery type, ASA-score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000-.010). CONCLUSION Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

RESUMO CONTEXTO As fraturas do quadril podem ser a maior complicação secundária à doença osteoporótica. O objetivo deste estudo foi determinar a influência da distribuição etária na funcionalidade, comorbidade, complicações e características cirúrgicas de idosos com fratura de quadril. MÉTODOS Um estudo prospectivo de coorte foi realizado de 2013-2014. Uma amostra de 557 adultos mais velhos, com mais de 75 anos, com fratura de quadril osteoporótica foi recrutada na Unidade Ortogeriátrica do Hospital Universitário de León (Espanha). As distribuições de idade de 75-84, 85-90 e >90 anos foram consideradas. Em primeiro lugar, foram coletados dados sociodemográficos, tipo de fratura e dias de permanência hospitalar. Em segundo lugar, foram descritas funcionalidades de base (índice Barthel), ambulação, comprometimento cognitivo e comorbidades. Em terceiro lugar, determinaram-se a intervenção cirúrgica, a urgência, o tipo, os resultados da Associação Americana de Anestesiologistas (ASA), a causa não cirúrgica e os tratamentos farmacológicos iniciais. Finalmente, foram observadas complicações e características na alta hospitalar. RESULTADOS As faixas etárias não mostraram diferenças estatisticamente significativas (P <,05; R2 = ,000-,005) para sexo, tipo de fratura ou dias de permanência hospitalar. Foram apresentadas diferenças estatisticamente significativas (P <,05; R2 = ,011-,247) para o índice de Barthel, comprometimento cognitivo, demência, osteoporose, doença de Parkinson, estenose aórtica, tipo de cirurgia, pontuação ASA, causa não cirúrgica, benzodiazepínicos, antidementia, antiosteoporose, insulina, tratamentos farmacológicos, alteração da função renal, insuficiência cardíaca, destino e características de ambulação entre grupos etários. O restante das medidas não apresentou diferença estatisticamente significativa (P> 0,05; R2 = ,000-,010). CONCLUSÃO As distribuições de idade após 75 anos podem determinar a funcionalidade, comorbidades, características cirúrgicas, tratamentos farmacológicos de base, complicações e características na alta hospitalar de adultos mais velhos que sofrem fratura de quadril.

Relação entre resultados da FRAX-Brasil e de densitometrias ósseas / Relationship between the results of FRAX-Brazil and bone densitometries

OBJETIVO: Comparar resultados de densitometrias ósseas e do risco de fratura pela plataforma Fracture Risk Assessment Tool® (FRAX®). Métodos: Estudo observacional, transversal, de natureza quantitativa, realizado por meio da análise de prontuários de indivíduos que realizaram densitometria óssea e seus respectivos laudos, com cálculo posterior do risco de fratura maior e de quadril nos próximos 10 anos pela FRAX®. RESULTADOS: A média de idade foi de 60,19±9,44 anos, e houve predomínio de mulheres (96,5%). Dos indivíduos, 1,1% foi classificado como com risco de fratura maior e 9,1% com risco de fratura de quadril. A osteoporose foi encontrada em 12,4% da amostra, com predomínio nos pacientes mais idosos, e a coluna foi o sítio mais comum (53,7%). Admitindo-se a densitometria óssea como padrão-ouro para diagnóstico de osteoporose, a sensibilidade da plataforma para detectar risco de fratura maior foi 4,5%. Observou-se correlação positiva entre idade e risco de fratura, e negativa entre idade e T-score. CONCLUSÃO: Foi baixa a sensibilidade da plataforma, e não foi importante a relação entre os resultados da densitometria óssea e da FRAX®, sugerindo que esta ferramenta não se mostrou adequada para ser inserida como método de rastreio para osteoporose na população estudada.(AU)

OBJECTIVES: To compare the results of bone densitometry and fracture risk through the platform Fracture Risk Assessment Tool (FRAX®). METHODS: This is a cross-sectional, observational study of quantitative approach performed through the analyses of medical records of individuals who underwent bone densitometry and their respective reports, with a posterior calculation of the risk of major and hip fracture in the next 10 years through FRAX®. RESULTS: The mean age was 60.19±9.44 years, with a predominance of women (96.5%). Of the individuals, 1.1% were classified as having a major fracture risk, and 9.1% as having a hip fracture risk. Osteoporosis was found in 12.4% of the sample, with predominance in the older patients, and the spine was the most common site (53.7%). Assuming bone densitometry as the gold standard for diagnosis of osteoporosis, the sensitivity of the platform to detect major fracture risk was 4.5%. There was a positive correlation between age and fracture risk, and a negative correlation between age and t-score. CONCLUSION: The platform showed low sensitivity, and the relationship between the results of the bone densitometry and FRAX® was not significant, suggesting that this tool is not adequate to be inserted as a screening method for osteoporosis in the studied population.(AU)

FRAX Tool in Brazil: an integrative literature review following validation / Ferramenta FRAX no Brasil: revisão integrativa da literatura após sua validação

Abstract The present article is an integrative review the objective of which was to assess research carried out with the FRAX tool in Brazil following its validation, and describe the conclusions drawn. Two databases were used to select the articles (the Capes Portal and the Virtual Health Library), and the sample of this review was the only four articles published in Brazil relating to the FRAX tool following its validation in May 2013. After analyzing the articles, the results demonstrated that despite some limitations the FRAX Tool can be used to reduce the prevalence of fractures due to its simplicity of use, with an emphasis on prediction and orientation, allowing early and safe therapeutic decision-making. AU

Resumo O presente artigo é uma revisão integrativa que teve como objetivo investigar o uso da ferramenta FRAX no Brasil após sua validação, sintetizar e apreender os resultados desses estudos e discutir as suas principais indicações e limitações. Para a seleção dos artigos utilizou-se duas fontes de bases de dados, Portal Capes e Biblioteca Virtual em Saúde, e a amostra desta revisão constituiu-se dos únicos quatro artigos publicados no Brasil utilizando a ferramenta FRAX, após sua validação em maio de 2013. Após análise dos artigos incluídos na revisão, os resultados dos estudos demonstraram que a ferramenta FRAX, com ênfase na predição e orientação, apesar de algumas limitações, é uma das estratégias que podem ser usadas na diminuição da prevalência de fraturas pela possibilidade de uso ambulatorial devido à sua simplicidade de aplicação, permitindo uma tomada de decisão terapêutica precoce e segura. AU