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Inicio Medicina Clínica (English Edition) FRAX® thresholds to identify people with high or low risk of osteoporotic fract...
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Vol. 144. Issue 1.
Pages 1-8 (January 2015)
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Vol. 144. Issue 1.
Pages 1-8 (January 2015)
Original article
DOI: 10.1016/j.medcle.2013.11.001
FRAX® thresholds to identify people with high or low risk of osteoporotic fracture in Spanish female population
Umbrales de FRAX® para identificar personas con alto o bajo riesgo de fractura osteoporótica en población femenina española
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Rafael Azagraa,b,c,
Corresponding author
rafael.azagra@uab.cat

Corresponding author.
, Genís Rocaa,d, Juan Carlos Martín-Sáncheze, Enrique Casadof, Gloria Encabog, Marta Zwarta,h, Amada Aguyéi, Adolf Díez-Péreza,j,k, representing the research group GROIMAP
a Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
b Medicina de Familia, CAP Badía del Vallés, Institut Català de la Salut (ICS), USR MN-IDIAP Jordi Gol, Barcelona, Spain
c Departamento de Medicina, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
d Medicina de Familia, CAP Sant Llàtzer, Corporació Sanitària de Terrassa, Terrassa, Barcelona, Spain
e Bioestadística, Departamento de Ciencias Básicas, Universitat Internacional de Catalunya, Campus Sant Cugat, Sant Cugat del Vallés, Barcelona, Spain
f Reumatología, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
g Medicina Nuclear, Hospital Universitari Vall d’Hebron, Institut Català de la Salut (ICS), Barcelona, Spain
h Medicina de Familia, CAP Girona-2, Institut Català de la Salut (ICS)-USR Girona, IDIAP Jordi Gol, Girona, Spain
i Medicina de Familia, CAP Granollers Centre, Institut Català de la Salut (ICS), Granollers, Barcelona, Spain
j Departamento de Medicina Interna, URFOA, IMIM, Parc de Salut Mar, Barcelona, Spain
k Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III-FEDER, Madrid, Spain
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Figures (2)
Tables (4)
Table 1. Profile of the FRIDEX cohort with 816 women with 10-year follow-up.
Table 2. Risk factors in the groups of women with fracture and without fracture in the FRIDEX cohort without treatment during the 10 years.
Table 3. Risk groups, FRAX® threshold values that define them, situation during reevaluation with FRAX® with bone mineral density, and final result in low/high risk after reevaluation.
Table 4. Cost-effectiveness parameters of the threshold values for the Spanish population and the traditional model.
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Abstract
Background and objective

To detect FRAX® threshold levels that identify groups of the population that are at high/low risk of osteoporotic fracture in the Spanish female population using a cost-effective assessment.

Patients and methods

This is a cohort study. Eight hundred and sixteen women 40–90 years old selected from the FRIDEX cohort with densitometry and risk factors for fracture at baseline who received no treatment for osteoporosis during the 10 year follow-up period and were stratified into 3 groups/levels of fracture risk (low <10%, 10–20% intermediate and high >20%) according to the real fracture incidence.

Results

The thresholds of FRAX® baseline for major osteoporotic fracture were: low risk <5; intermediate ≥5 to <7.5 and high ≥7.5. The incidence of fracture with these values was: low risk (3.6%; 95% CI 2.2–5.9), intermediate risk (13.7%; 95% CI 7.1–24.2) and high risk (21.4%; 95% CI 12.9–33.2). The most cost-effective option was to refer to dual energy X-ray absorptiometry (DXA-scan) for FRAX®5 (Intermediate and high risk) to reclassify by FRAX® with DXA-scan at high/low risk. These thresholds select 17.5% of women for DXA-scan and 10% for treatment. With these thresholds of FRAX®, compared with the strategy of opportunistic case finding isolated risk factors, would improve the predictive parameters and reduce 82.5% the DXA-scan, 35.4% osteoporosis prescriptions and 28.7% cost to detect the same number of women who suffer fractures.

Conclusions

The use of FRAX® thresholds identified as high/low risk of osteoporotic fracture in this calibration (FRIDEX model) improve predictive parameters in Spanish women and in a more cost-effective than the traditional model based on the T-score−2.5 of DXA scan.

Keywords:
Osteoporosis
Osteoporotic fracture
FRAX®
Dual-energy X-ray absorptiometry
Cost-effectiveness
Resumen
Fundamento y objetivo

Detectar los umbrales de la herramienta FRAX® que determinen los grupos de riesgo alto/bajo de fractura osteoporótica en la población femenina española y su valoración coste-efectiva.

Pacientes y métodos

Estudio de cohortes. Ochocientas dieciséis mujeres de 40-90 años de la cohorte FRIDEX con densitometría basal, factores de riesgo de fractura y sin tratamiento para la osteoporosis en los 10 años de seguimiento. Se estratificaron en 3 grupos/niveles de riesgo de fractura principal (bajo<10%, intermedio 10-20% y alto>20%) según la incidencia real de fractura, y se buscaron los puntos de corte equivalentes de FRAX® basal.

Resultados

Los umbrales de FRAX® basal para fractura principal fueron: riesgo bajo<5; intermedio5 y <7,5 y alto7,5. La incidencia real de fractura con estos valores fue: riesgo bajo (3,6%; IC 95% 2,2-5,9); intermedio (13,7%; IC 95%7,1-24,2), y alto (21,4%; IC 95% 12,9-33,2). La opción más coste-efectiva fue realizar una dual energy X-ray absorptiometry (DXA, «absorciometría dual de rayos X») para FRAX®5 (riesgo intermedio y alto) para reclasificar los casos mediante FRAX® con DXA en riesgo alto/bajo. Así se seleccionarían 17,5% de las mujeres para DXA y 10% para tratamiento. Con estos umbrales calibrados de FRAX®, comparados con la estrategia tradicional basada en la DXA, se mejoran los parámetros predictivos y se reducen las DXA (82,5%), los tratamientos (35,4%) y el coste global (28,7%) para detectar al mismo número de mujeres que tuvieron fracturas.

Conclusiones

La utilización de los umbrales de FRAX® identificados como alto/bajo riesgo de fractura osteoporótica en la presente calibración (modelo FRIDEX) mejorarían los parámetros predictivos en mujeres españolas y de una forma más coste-efectiva que el modelo tradicional basado en el T-score ≤ -2,5 de la DXA.

Palabras clave:
Osteoporosis
Fractura osteoporótica
FRAX®
Absorciometría dual de rayos X
Coste-efectividad

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