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Med Clin (Barc). 2015 Jan 6;144(1):1-8. doi: 10.1016/j.medcli.2013.11.014. Epub 2014 Jan 24.

[FRAX® thresholds to identify people with high or low risk of osteoporotic fracture in Spanish female population].

[Article in Spanish]

Author information

1
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Medicina de Familia, CAP Badía del Vallés, Institut Català de la Salut (ICS), USR MN-IDIAP Jordi Gol, Barcelona, España; Departamento de Medicina, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, España. Electronic address: rafael.azagra@uab.cat.
2
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Medicina de Familia, CAP Sant Llàtzer, Corporació Sanitària de Terrassa, Terrassa, Barcelona, España.
3
Bioestadística, Departamento de Ciencias Básicas, Universitat Internacional de Catalunya, Campus Sant Cugat, Sant Cugat del Vallés, Barcelona, España.
4
Reumatología, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
5
Medicina Nuclear, Hospital Universitari Vall d'Hebron, Institut Català de la Salut (ICS), Barcelona, España.
6
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Medicina de Familia, CAP Girona-2, Institut Català de la Salut (ICS)-USR Girona, IDIAP Jordi Gol, Girona, España.
7
Medicina de Familia, CAP Granollers Centre, Institut Català de la Salut (ICS), Granollers, Barcelona, España.
8
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Departamento de Medicina Interna, URFOA, IMIM, Parc de Salut Mar, Barcelona, España; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III-FEDER, Madrid, España.

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% CI12.9-33.2). 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:

Absorciometría dual de rayos X; Cost-effectiveness; Coste-efectividad; Dual-energy X-ray absorptiometry; FRAX(®); Fractura osteoporótica; Osteoporosis; Osteoporotic fracture

PMID:
24461732
DOI:
10.1016/j.medcli.2013.11.014
[Indexed for MEDLINE]
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