Predictive capacity of FRAX in a spanish region with a hip fracture rate close to the national mean

BACKGROUND

It is known that standardized incidence rates of hip fracture vary among older people in Spain. So far, the results published on the validation of the FRAX® tool in Spain have suggested that the major osteoporotic fractures (MOFs) risk in our country is underestimated. These studies have practically been based on Spanish cohorts evaluated in Catalonia, a higher hip fracture rate area. The purpose of this study is to analyse the ability of the FRAX® in a Spanish mid-fracture rate population.

METHODS

Study design: Retrospective cohort study.

MEASURES

MOFs: hip, humerus, wrist, spine fractures. Risk of fracture assessed by calculating odds ratios (ORs). Predictive capacity of FRAX® according to the osteoporotic fractures observed between 2009 and 2018 (ObsFr) to predicted by FRAX® without densitometry in 2009 (PredFr) ratio.

RESULTS

285 participants (156 women, 54.7%) with a mean ± SD of 61.5 ± 14 years. Twenty-four people sustained 27 fractures (15 MOFs). Significant ORs were observed for an age ≥ 65 (2.92; 95% CI, 1.07-7.96), female sex (3.18; 95% CI, 1.24-8.16), rheumatoid arthritis (0.62; 95% CI, 2.03-55.55), proton pump (2.71; 95% CI, 1.20-6.09) and serotonin reuptake (2.51; 95% CI, 1.02-6.16) inhibitors. The ObsFr/PredFr ratio in women were 1.12 (95% CI, 0.95-1.29) for MOFs and 0.47 (95% CI, 0-0.94) for hip fractures. Men had a ratio of 0.57 (95% CI, 0.01-1.14) for MOF, no hip fractures were observed. The ratios for the overall group were 1.29 (95% CI, 1.12-1.48) for MOFs and 0.70 (95% CI, 0.22-1.17) for hip fractures.

CONCLUSIONS

FRAX® accurately predicted MOFs in women population with a hip fracture incidence rate close to the national mean compared to previous studies conducted in higher incidence regions in Spain.

[Cystatin C and cardiovascular risk in the general population]

INTRODUCTION AND OBJECTIVES

Cystatin C has been proposed as a novel marker of renal function and as a predictor of cardiovascular risk in the elderly. The aim of this study was to determine the prevalence of an elevated cystatin C level in the general population and its relationship with cardiovascular risk factors and disease.

METHODS

This descriptive epidemiologic cross-sectional study involved a simple randomized sample of individuals aged >49 years from the general population, and was based on personal health records. From the final selection of 415 individuals, 359 underwent cystatin C measurement using a immunonephelometric assay. The cut-point used was that recommended for the method in adults.

RESULTS

Of the 359 individuals (mean+/-standard deviation age, 64+/-10 years, 63.5% female) studied, 17.3% (95% confidence interval [CI] 13.4%-21.2%) had an elevated cystatin C level. The mean level was 0.81+/-0.21 mg/L, and increased with age. Elevation of the cystatin C level was associated with: older age (P< .0001); high measures of systolic blood pressure (P< .0001), hemoglobin A1c (P=.031), triglycerides (P=.019), homocysteine (P< .0001), C-reactive protein (P=.015), fibrinogen (P=.006) and microalbuminuria (P=.001); and a low high-density lipoprotein cholesterol level (P=.021) and estimated glomerular filtration rate (P< .0001). Associated cardiovascular diseases included coronary heart disease (P=.013) and heart failure (P=.038). The main factors independently associated with an elevated cystatin C level were diabetes (odds ratio [OR]=5.37), male sex (OR=4.91) and decreased glomerular filtration (OR=0.83).

CONCLUSIONS

The prevalence of an elevated cystatin C level in the general population was found to be high and was associated with the presence of classical cardiovascular risk factors such as diabetes, hypertension and chronic renal disease, along with higher levels of C-reactive protein, homocysteine and fibrinogen.