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Cedeno-Veloz B, López-Dóriga Bonnardeauxa P, Duque G. [Osteosarcopenia: A narrative review]. Rev Esp Geriatr Gerontol 2019; 54:103-108. [PMID: 30471719 DOI: 10.1016/j.regg.2018.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/04/2018] [Accepted: 09/13/2018] [Indexed: 06/09/2023]
Abstract
Osteosarcopenia is a phenotype resulting from the combination of sarcopenia and low bone mineral density. Based on the relationship between bone and muscle, this phenotype is associated with a higher risk of falls, fractures, dependence, and health care costs than its individual components. Given its characteristics, it can be considered as a new geriatric syndrome. Therefore, understanding its pathophysiology and diagnosis, as well as its non-pharmacological and pharmacological management is a task of great importance. The problem in addressing this phenotype arises from the tradition of managing sarcopenia and osteoporosis separately. There is also a lack of consensus on what to call it (sarco-osteopenia, sarco-osteoporosis, osteosarcopenia). The aim of this review is to outline the epidemiology, pathophysiology, diagnoses, adverse events, and management of osteosarcopenia.
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Affiliation(s)
- Bernardo Cedeno-Veloz
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia; Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia; Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | | | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia; Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
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Azagra R, López-Expósito F, Martin-Sánchez JC, Aguyé A, Moreno N, Cooper C, Díez-Pérez A, Dennison EM. Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int 2014; 25:1267-74. [PMID: 24322478 PMCID: PMC4890654 DOI: 10.1007/s00198-013-2586-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/18/2013] [Indexed: 01/08/2023]
Abstract
UNLABELLED Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. INTRODUCTION The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. METHODS Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥ 65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). RESULTS There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2) over 10 years, the crude incidence rate/100,000 inhabitant/year increased an average of 2.3%/year in men and 1.4% in women. After adjustment, the rate increased an average of 0.4%/year in men (p < 0.0001), but decreased 0.2%/year in women (p < 0.0001). In men, younger than 85, the decrease was not significant except in 70-74 years, and from 80 years, the adjusted rate increases significantly (p < 0.0001). In women under 80 years of age, the decrease in adjusted rate was significant; there was no change in 80-84 years, and the adjusted rate increased significantly in individuals 85 years and older (p < 0.0001). Mortality rates declined by 22% in both sexes, and the index of overaging population rises 30.1 % in men and 25.2% in women. CONCLUSIONS This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure.
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Affiliation(s)
- R Azagra
- Department of Medicine, Universitat Autònoma de Barcelona, ps/ Vall d' Hebron 119, 08135, Barcelona, Spain,
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Azagra R, Zwart M, Martín-Sánchez JC, Aguyé A. La herramienta FRAX® en la prevención de fracturas asociadas al tratamiento de privación androgénica en el cáncer de próstata. Med Clin (Barc) 2014; 142:231-2. [PMID: 24018248 DOI: 10.1016/j.medcli.2013.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 05/30/2013] [Accepted: 06/06/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Rafael Azagra
- Equip d'Atenció Primària Badia del Vallès, Servei d'Atenció Primària Vallès Occidental-Institut Català de la Salut, Unitat de Suport a la Recerca Metropolitana Nord, Institut d'Investigació en Atenció Primària Jordi Gol, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Departamento de Medicina, Universitat Internacional de Catalunya, Barcelona, España.
| | - Marta Zwart
- Equip d'Atenció Primària Girona-2, Institut Català de la Salut, Unitat de Suport a la Recerca-Girona, Intitut d'Investigació en Atenció Primària Jordi Gol, Girona, España
| | - Juan Carlos Martín-Sánchez
- Bioestadística, Departamento de Ciencias Básicas, Facultad de Medicina, Campus Sant Cugat, Universitat Internacional de Catalunya, Barcelona, España
| | - Amada Aguyé
- Equip d'Atenció Primària Vallès Oriental-Granollers Centre, Servei d'Atenció Primària Vallès Oriental-Institut Catalá de la Salut, Barcelona, España
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Jiménez-Núñez FG, Manrique-Arija S, Ureña-Garnica I, Romero-Barco CM, Panero-Lamothe B, Descalzo MA, Carmona L, Rodríguez-Pérez M, Fernández-Nebro A. Reducing the need for central dual-energy X-ray absorptiometry in postmenopausal women: efficacy of a clinical algorithm including peripheral densitometry. Calcif Tissue Int 2013; 93:62-8. [PMID: 23608922 DOI: 10.1007/s00223-013-9728-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 03/06/2013] [Indexed: 11/24/2022]
Abstract
We evaluated the efficacy of a triage approach based on a combination of osteoporosis risk-assessment tools plus peripheral densitometry to identify low bone density accurately enough to be useful for clinical decision making in postmenopausal women. We conducted a cross-sectional diagnostic study in postmenopausal Caucasian women from primary and tertiary care. All women underwent dual-energy X-ray absorptiometric (DXA) measurement at the hip and lumbar spine and were categorized as osteoporotic or not. Additionally, patients had a nondominant heel densitometry performed with a PIXI densitometer. Four osteoporosis risk scores were tested: SCORE, ORAI, OST, and OSIRIS. All measurements were cross-blinded. We estimated the area under the curve (AUC) to predict the DXA results of 16 combinations of PIXI plus risk scores. A formula including the best combination was derived from a regression model and its predictability estimated. We included 505 women, in whom the prevalence of osteoporosis was 20 %, similar in both settings. The best algorithm was a combination of PIXI + OST + SCORE with an AUC of 0.826 (95 % CI 0.782-0.869). The proposed formula is Risk = (-12) × [PIXI + (-5)] × [OST + (-2)] × SCORE and showed little bias in the estimation (0.0016). If the formula had been implemented and the intermediate risk cutoff set at -5 to 20, the system would have saved <euro>4,606.34 in the study year. The formula proposed, derived from previously validated risk scores plus a peripheral bone density measurement, can be used reliably in primary care to avoid unnecessary central DXA measurements in postmenopausal women.
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Gómez-Vaquero C, Roig-Vilaseca D, Bianchi M, Santo P, Narváez J, Nolla JM. Evaluación de una propuesta de criterios de indicación de densitometría ósea en mujeres posmenopáusicas españolas basados en la herramienta FRAX®. Med Clin (Barc) 2013; 140:439-43. [DOI: 10.1016/j.medcli.2012.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/26/2012] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
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Azagra R, López-Expósito F, Aguyé A, Encabo G. [Prediction of frailty fractures or prediction of densitometric osteoporosis. That is the question!]. Med Clin (Barc) 2013; 141:43-4. [PMID: 23490485 DOI: 10.1016/j.medcli.2012.11.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/15/2012] [Indexed: 01/14/2023]
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Sanfélix-Genovés J, Sanfélix-Gimeno G, Peiró S, Hurtado I, Fluixà C, Fuertes A, Campos JC, Giner V, Baixauli C. Prevalence of osteoporotic fracture risk factors and antiosteoporotic treatments in the Valencia region, Spain. The baseline characteristics of the ESOSVAL cohort. Osteoporos Int 2013; 24:1045-55. [PMID: 22618269 DOI: 10.1007/s00198-012-2018-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED This study provides information on the prevalence of the most important risk factors for osteoporosis and osteoporotic fracture in a large sample of women and men from the Valencia region and also provides the FRAX 10-year major and hip fracture risks for this population, as well as data about the use of diagnostic tests and antiosteoporotic treatments. INTRODUCTION The purpose of this study was to describe demographic characteristics, osteoporosis risk factors, the 10-year risk of osteoporotic fracture, and the use of densitometry and antiosteoporotic treatments in the Valencia region, Spain. METHODS A cross-sectional study using the ESOSVAL cohort baseline data was conducted. We analyze the data from 5,310 women and 5,725 men aged 50 and over who attended to 272 collaborating primary care centers in 2009-2010. We collected the demographic, anthropometric, clinical, and pharmacy data from the electronic medical record. RESULTS The mean age of participants was 64.3 years old for women and 65.6 years old for men. The most frequent fracture risk factors were sedentary life (22.2 %) and previous fracture (15.8 %) in women and low calcium intake (21.4 %) and current smoker (20.9 %) in men. According to FRAX(®), the 10-year risk of presenting a major fracture was 5.5 % for the women and 2.8 % for the men. The 10-year risk for hip fracture was 1.9 and 1.1 % for the women and the men, respectively; 23.8 % of the women and 5.2 % of the men had a densitometry test, 27.7 % of the women and 3.5 % of the men were taking calcium and/or vitamin D supplements, and 28.2 % of the women (22.0 % in the 50-64 age group) and 2.3 % of the men were taking antiosteoporotic drugs. CONCLUSIONS The prevalence of certain fracture risk factors not included in the FRAX tool (sedentary life, falls, low calcium intake) is high. In young women, their low risks estimated by FRAX contrast with the high figures for densitometry testing and treatment.
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Affiliation(s)
- J Sanfélix-Genovés
- Health Services Research Unit, Centro Superior de Investigación en Salud Pública, Avda de Cataluña 21, 46020 Valencia, Spain.
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Sanfélix-Gimeno G, Sanfelix-Genovés J, Hurtado I, Reig-Molla B, Peiró S. Vertebral fracture risk factors in postmenopausal women over 50 in Valencia, Spain. A population-based cross-sectional study. Bone 2013; 52:393-9. [PMID: 23103928 DOI: 10.1016/j.bone.2012.10.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/22/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to estimate the prevalence of risk factors for osteoporotic vertebral fracture and analyze the possible associations between these factors and the presence of densitometric osteoporosis and prevalent morphometric vertebral fracture. METHODS Data from a population-based cross-sectional sample of 804 postmenopausal women over the age of 50 years old living in the city of Valencia (Spain) were used. The women were interviewed to identify the prevalence of osteoporotic fracture risk factors and underwent a densitometry and a dorsolumbar spine X-ray. RESULTS The most prevalent risk factors were densitometric osteoporosis (31.7%), history of parental hip fracture (19.4%), hypoestrogenism (19%), and body mass index (BMI) ≥ 30 kg/m(2) (35.2%). After adjusting for all covariables, densitometric osteoporosis was associated with increased age [odds ratio (OR)(65-69 years): 2.84, 95% confidence interval (CI): 1.75-4.61; OR(70-74 years): 4.01, 95% CI: 2.47-6.52; OR(75+years): 5.96, 95% CI: 3.27-10.87] and inversely associated with high BMI (OR(25.0-29.9): 0.51, 95% CI: 0.34-0.76; OR(≥ 30): 0.30, 95% CI: 0.19-0.46). Morphometric vertebral fracture was associated with age (OR(65-69 years): 2.04, 95% CI: 1.03-4.05; OR(70-74 years): 4.05, 95% CI: 2.11-7.77; OR(75+years): 8.43, 95% CI: 3.97-17.93), poor educational level (OR: 1.70, 95% CI: 1.06-2.72) and with densitometric osteoporosis and BMI ≥ 30 kg/m(2) (OR: 3.35, 95% CI: 1.85-6.07). CONCLUSIONS The most prevalent osteoporotic fracture risk factors were having a high BMI and the presence of densitometric osteoporosis. A higher risk of morphometric vertebral fracture in women with both low bone mineral density and high BMI was found. This association, if confirmed, has important implications for clinical practice and fracture risk tools. We also found a higher risk in women with a poor educational level. More attention should be addressed to these populations in order to control modifiable risk factors.
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Affiliation(s)
- Gabriel Sanfélix-Gimeno
- Centro Superior de Investigación en Salud Pública (CSISP), Avda. Cataluña 21, 46020 Valencia, Spain.
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Azagra R, Roca G, Encabo G, Aguyé A, Zwart M, Güell S, Puchol N, Gene E, Casado E, Sancho P, Solà S, Torán P, Iglesias M, Gisbert MC, López-Expósito F, Pujol-Salud J, Fernandez-Hermida Y, Puente A, Rosàs M, Bou V, Antón JJ, Lansdberg G, Martín-Sánchez JC, Díez-Pérez A, Prieto-Alhambra D. FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort. BMC Musculoskelet Disord 2012; 13:204. [PMID: 23088223 PMCID: PMC3518201 DOI: 10.1186/1471-2474-13-204] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/09/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The WHO has recently published the FRAX® tool to determine the absolute risk of osteoporotic fracture at 10 years. This tool has not yet been validated in Spain. METHODS/DESIGN A prospective observational study was undertaken in women in the FRIDEX cohort (Barcelona) not receiving bone active drugs at baseline. Baseline measurements: known risk factors including those of FRAX® and a DXA. Follow up data on self-reported incident major fractures (hip, spine, humerus and wrist) and verified against patient records. The calculation of absolute risk of major fracture and hip fracture was by FRAX® website. This work follows the guidelines of the STROBE initiative for cohort studies. The discriminative capacity of FRAX® was analyzed by the Area Under Curve (AUC), Receiver Operating Characteristics (ROC) and the Hosmer-Lemeshow goodness-of-fit test. The predictive capacity was determined using the ratio of observed fractures/expected fractures by FRAX® (ObsFx/ExpFx). RESULTS The study subjects were 770 women from 40 to 90 years of age in the FRIDEX cohort. The mean age was 56.8 ± 8 years. The fractures were determined by structured telephone questionnaire and subsequent testing in medical records at 10 years. Sixty-five (8.4%) women presented major fractures (17 hip fractures). Women with fractures were older, had more previous fractures, more cases of rheumatoid arthritis and also more osteoporosis on the baseline DXA. The AUC ROC of FRAX® for major fracture without bone mineral density (BMD) was 0.693 (CI 95%; 0.622-0.763), with T-score of femoral neck (FN) 0.716 (CI 95%; 0.646-0.786), being 0.888 (CI 95%; 0.824-0.952) and 0.849 (CI 95%; 0.737-0.962), respectively for hip fracture. In the model with BMD alone was 0.661 (CI 95%; 0.583-0.739) and 0.779 (CI 95%; 0.631-0.929). In the model with age alone was 0.668 (CI 95%; 0.603-0.733) and 0.882 (CI 95%; 0.832-0.936). In both cases there are not significant differences against FRAX® model. The overall predictive value for major fracture by ObsFx/ExpFx ratio was 2.4 and 2.8 for hip fracture without BMD. With BMD was 2.2 and 2.3 respectively. Sensitivity of the four was always less than 50%. The Hosmer-Lemeshow test showed a good correlation only after calibration with ObsFx/ExpFx ratio. CONCLUSIONS The current version of FRAX® for Spanish women without BMD analysed by the AUC ROC demonstrate a poor discriminative capacity to predict major fractures but a good discriminative capacity for hip fractures. Its predictive capacity does not adjust well because leading to underdiagnosis for both predictions major and hip fractures. Simple models based only on age or BMD alone similarly predicted that more complex FRAX® models.
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Affiliation(s)
- Rafael Azagra
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Psg Vall d’Hebrón 119-129, 08035, Barcelona, Spain
- Badia del Vallès Health Centre, Catalan Health Institute. USR-MN-IDIAP Jordi Gol. c/ Bética s/n, 08214, Barcelona, Badia del Vallès, Spain
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona (UAB). Psg Vall d’Hebrón 119–129, 08035, Barcelona, Spain
| | - Genís Roca
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona (UAB). Psg Vall d’Hebrón 119–129, 08035, Barcelona, Spain
- Sant Llàtzer Health Centre, Sanitary Consortium of Terrassa. c/ de la Riba 62, 08221, Barcelona, Terrassa, Spain
| | - Gloria Encabo
- Nuclear Medicine Service, Vall d’Hebrón University Hospital. Psg Vall d’Hebrón 119–129, 08035, Barcelona, Spain
| | - Amada Aguyé
- Granollers Centre Health Centre, Catalan Health Institute. c/ Museu 19, 08400, Barcelona, Granollers, Spain
| | - Marta Zwart
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona (UAB). Psg Vall d’Hebrón 119–129, 08035, Barcelona, Spain
- Can Gibert del Plà-Girona-2 Health Centre, Catalan Health Institute. c/ Sant Sebastià 50, 17005, Girona, Spain
| | - Sílvia Güell
- Montcada i Reixach Health Centre, Catalan Health Institute. Psg de Jaume I s/n, 08110, Barcelona, Montcada i Reixac, Spain
| | - Núria Puchol
- Badia del Vallès Health Centre, Catalan Health Institute. USR-MN-IDIAP Jordi Gol. c/ Bética s/n, 08214, Barcelona, Badia del Vallès, Spain
| | - Emili Gene
- Emergency Department, Hospital de Sabadell, Sanitary Consortium of Parc Taulí, Universitat Autònoma de Barcelona. Parc Tauli s/n, 08208, Barcelona, Sabadell, Spain
- Universitat Internacional de Catalunya (UIC), c/ Josep Trueta s/n 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Enrique Casado
- Rheumatology Department, Hospital de Sabadell, Sanitary Consortium of Parc Taulí, Universitat Autònoma de Barcelona. Parc Tauli s/n, 08208, Barcelona, Sabadell, Spain
| | - Pilar Sancho
- Corbera de Llobregat Health Centre, Catalan Health Institute. c/ Buenos Aires, 9, 08757, Barcelona, Corbera de Llobregat, Spain
| | - Silvia Solà
- Emergency Department, University Hospital of Bellvitge, Catalan Health Institute. University of Barcelona. c/ de la Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Pere Torán
- Primary Health Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Rambla 227, 08223, Barcelona, Sabadell, Spain
| | - Milagros Iglesias
- Badia del Vallès Health Centre, Catalan Health Institute. USR-MN-IDIAP Jordi Gol. c/ Bética s/n, 08214, Barcelona, Badia del Vallès, Spain
| | - Maria Carmen Gisbert
- Cabrils Health Centre, Catalan Health Institute. c/ Cal Batalló 3, 08348, Cabrils, Barcelona, Spain
| | - Francesc López-Expósito
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Psg Vall d’Hebrón 119-129, 08035, Barcelona, Spain
- Bon Pastor Health Centre. Health Institute. c/ Mollerussa s/n, 08030, Barcelona, Spain
| | - Jesús Pujol-Salud
- Balaguer Health Centre, Catalan Health Institute. Universitat de Lleida. c/ Àngel Guimerà, 24 25600, Lleida, Balaguer, Spain
| | - Yolanda Fernandez-Hermida
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona (UAB). Psg Vall d’Hebrón 119–129, 08035, Barcelona, Spain
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Ana Puente
- Taradell Health Centre, Catalan Health Institute, C. Passeig del Pujaló, 5, 08552, Barcelona, Taradell, Spain
| | - Mireia Rosàs
- Granollers Centre Health Centre, Catalan Health Institute. c/ Museu 19, 08400, Barcelona, Granollers, Spain
| | - Vicente Bou
- Sanllehy Health Centre. Catalan Health Institute. Av. Mare de Déu de Montserrat, 16–18, 08024, Barcelona, Spain
| | - Juan José Antón
- Poble Sec 3B Health Centre, CAP Manso. Catalan Health Institute. c/ Manso, 19–27, 08015, Barcelona, Spain
| | - Gustavo Lansdberg
- Universidade de José do Rosàrio Vellano. UNIFENAS, Belo Horizonte. Rua Libano - Bairro Itapoã 66, Belo Horizonte, 31710-030, Minas Gerais, Brasil
| | - Juan Carlos Martín-Sánchez
- Universitat Internacional de Catalunya (UIC), c/ Josep Trueta s/n 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Adolf Díez-Pérez
- Institut Municipal d'Investigacions Mèdiques (IMIM)-Parc de Salut Mar, URFOA, Internal Medicine, Universitat Autònoma de Barcelona. Psg Marítim 25, 08003, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
- Institut Municipal d'Investigacions Mèdiques (IMIM)-Parc de Salut Mar, URFOA, Internal Medicine, Universitat Autònoma de Barcelona. Psg Marítim 25, 08003, Barcelona, Spain
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Gómez-Vaquero C, Bianchi M, Santo P, Roig-Vilaseca D, Narváez J, Nolla JM. The activity of a Spanish bone densitometry unit revisited under the point of view of FRAX. ACTA ACUST UNITED AC 2012; 8:179-83. [PMID: 22608955 DOI: 10.1016/j.reuma.2012.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 11/16/2022]
Abstract
UNLABELLED In March 2008, FRAX, developed by Kanis and collaborators in the University of Sheffield and supported by the World Health Organization, became available online to calculate absolute risk of osteoporotic fracture in the next 10 years. OBJECTIVE To analyze the risk of fracture calculated by FRAX and its determinants in the patients sent to a densitometry unit for bone mineral density (BMD) testing. METHODS All the patients submitted by Primary Care to the Densitometry Unit for BMD testing underwent a self administered questionnaire to assess the clinical risk factors included in FRAX and a bone densitometry of lumbar spine and proximal femur with a DXA densitometer Hologic QDR 4500. They were classified as having a normal BMD, osteopenia or osteoporosis along with the recommendations of the International Society for Clinical Densitometry. As the reference population to calculate the T and Z scores, we used the one from the NHANES III study for femoral neck and total hip and the one from the Study of the Spanish Population for total spine. With the data of the questionnaire, we calculated, by FRAX, the absolute risk in the next ten years of having a major fracture (MFR) or a hip fracture (HFR). Both risks were calculated with or without the inclusion in the algorithm of BMD: MFR+, MFR-, HFR+ and HFR-. The results were recorded in an Access 2003 database and analyzed with the statistical package SPSS 15.0 for Windows. RESULTS We analyzed the data from 853 women with a mean age of 61.9 (8.9) years and a mean body mass index of 27.0 (4.2)kg/m(2). Mean BMD at lumbar spine was 0.873 (0.127)g/cm(2); at femoral neck, 0.704 (0.105)g/cm(2); and at total hip, 0.817 (0.107)g/cm(2). Twenty percent of the patients had a normal BMD, 55% had osteopenia and 25%, osteoporosis. Yet excluding age and body mass index, the number of fracture risk factors seems low: 31% of the patients had no risk of fracture; 40%, had one; 22%, two; 6%, three; 1%, four; and one patient had five. Mean MFR+ was 5.4 (4.8)%; mean MFR-, 6.3 (5.5)%; mean HFR+, 1.5 (2.9)%; and HFR-, 2.1 (3.3)%. When BMD was included in the algorithm for the calculation of the risk of fracture, the risk was statistically lower (p<0.001), especially in patients with better BMD. CONCLUSIONS The risk of fracture calculated by FRAX in the patients sent to a densitometry unit for bone BMD testing seems low and, probably, a better selection of the patients would detect a higher risk of fracture population. When the fracture risk is calculated with the introduction of BMD in the algorithm, it is lower than without including BMD.
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Affiliation(s)
- Carmen Gómez-Vaquero
- Rheumatology Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain.
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Sastre García JF, Carbayo García JJ, Criado-Álvarez JJ, de la Iglesia López MB. Concordancia de las herramientas FRAX y Fracture Index en la predicción de riesgo de fractura por osteoporosis en mujeres posmenopáusicas. Med Clin (Barc) 2012; 138:225-6. [DOI: 10.1016/j.medcli.2011.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 06/20/2011] [Accepted: 06/21/2011] [Indexed: 11/16/2022]
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[New evidence on the discriminant and predictive capacity of the FRAX(®) tool in a Spanish female population]. Aten Primaria 2011; 44:297-9. [PMID: 22019062 DOI: 10.1016/j.aprim.2011.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 09/05/2011] [Indexed: 11/22/2022] Open
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Zwart M, Azagra R, Encabo G, Aguye A, Roca G, Güell S, Puchol N, Gene E, López-Expósito F, Solà S, Ortiz S, Sancho P, Abado L, Iglesias M, Pujol-Salud J, Diez-Perez A. Measuring health-related quality of life in men with osteoporosis or osteoporotic fracture. BMC Public Health 2011; 11:775. [PMID: 21981790 PMCID: PMC3209463 DOI: 10.1186/1471-2458-11-775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 10/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoporosis is a serious health problem that worsens the quality of life and the survival rate of individuals with this disease on account the osteoporotic fractures. Studies have long focused on women, and its presence in men has been underestimated. While many studies conducted in different countries mainly assess health-related quality of life and identify fracture risks factors in women, few data are available on a Spanish male population. METHODS/DESIGN Observational study. STUDY POPULATION Men ≥ 40 years of age with/without diagnosed osteoporosis and with/without osteoporotic fracture included by their family doctor. MEASUREMENTS The relationship between customary clinical risk factors for osteoporotic fracture and health-related quality of life in a Spanish male population. A telephone questionnaire on health-related quality of life is made. STATISTICAL ANALYSIS The association between qualitative variables will be assessed by the Chi-square test. The distribution of quantitative variables by Student's t-test. If the conditions for using this test are not met, the non-parametric Mann-Whitney's U test will be used.The validation of the results obtained by the FRAX™ tool will be performed by way of the Hosmer-Lemeshow test and by calculating the area under the Receiver Operating Characteristic (ROC) curve (AUC). All tests will be performed with a confidence intervals set at 95%. DISCUSSION The applicability and usefulness of Health-related quality of life (HRQOL) studies are well documented in many countries. These studies allow implementing cost-effective measures in cases of a given disease and reducing the costly consequences derived therefrom. This study attempts to provide objective data on how quality of life is affected by the clinical aspects involved in osteoporosis in a Spanish male population and can be useful as well in cost utility analyses conducted by health authorities.The sample selected is not based on a high fracture risk group. Rather, it is composed of men in the general population, and accordingly comparisons should not lead to erroneous interpretations.A possible bias correction will be ensured by checking reported fractures against healthcare reports and X-rays, or by consulting health care centers as applicable.
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Affiliation(s)
- Marta Zwart
- EAP Can Gibert del Plà- Girona-2 Health Centre, Catalan Health Institute, Carrer Sant Sebastià 50, 17005 Girona, Spain.
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Azagra R, Zwart M, Aguyé A, Encabo G. [Precautions required on using the predictive thresholds of the FRAX® tool to decide the need for an axial bone density scan in the Spanish population]. Aten Primaria 2011; 44:183-4. [PMID: 21855178 DOI: 10.1016/j.aprim.2011.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 03/21/2011] [Indexed: 10/17/2022] Open
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Azagra R, Roca G, Zwart M, Encabo G. [Differences in the predictive values of the FRAX™ tool between the Spanish and United Kingdom population and considerations about the intervention threshold]. Med Clin (Barc) 2011; 137:713-4. [PMID: 21601890 DOI: 10.1016/j.medcli.2011.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/15/2011] [Indexed: 11/18/2022]
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Sosa Henríquez M, Gómez de Tejada Romero MJ. ¿Hay vida más allá de la densitometría ósea? Med Clin (Barc) 2011; 136:623-4. [DOI: 10.1016/j.medcli.2010.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 11/11/2010] [Indexed: 11/25/2022]
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