Rafael Azagra1, Genís Roca2, Juan Carlos Martín-Sánchez3, Enrique Casado4, Gloria Encabo5, Marta Zwart6, Amada Aguyé7, Adolf Díez-Pérez8. 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.
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.
Authors: John A Kanis; Nicholas C Harvey; Cyrus Cooper; Helena Johansson; Anders Odén; Eugene V McCloskey Journal: Arch Osteoporos Date: 2016-07-27 Impact factor: 2.617
Authors: Jonatan Miguel-Carrera; Carlos García-Porrua; Francisco Javier de Toro Santos; Jose Antonio Picallo-Sánchez Journal: Aten Primaria Date: 2017-06-17 Impact factor: 1.137