Fracture risk assessment in home care patients using the FRAX® tool.

Vitor Moraes Rocha,Claudio Flauzino De Oliveira,Heloisa Amaral Gaspar

doi:10.1590/s1679-45082018ao4236

Vitor Moraes Rocha, Claudio Flauzino De Oliveira + Show 1 more

Open Access

https://doi.org/10.1590/s1679-45082018ao4236

Copy DOI

Abstract

ABSTRACTObjective To assess the ten-year risk of hip and osteoporotic fracture in home care patients using the FRAX® tool.Methods A retrospective, cross-sectional observational study including patients aged ≥ 40 and ≤ 90 years and receiving home care from a private provider. The risk of fracture was calculated using an online calculator. High risk was defined as risk of hip fracture greater than 3% or risk of osteoporotic fracture greater than 20%. Data were expressed as absolute number (n), relative frequency (%), mean, standard deviation (±) and probability value (p).Results Eighty-three (37.7%) out of 222 patients were at high risk of fracture. Of these, 81 (36.7%) were at high risk of hip fracture, as follows: 18 patients aged 70-80 years (17 female) and 63 patients aged 80-90 years (51 female). High risk of osteoporotic fracture was limited to two female patients (0.1%) aged over 80 years.Conclusion FRAX® analysis revealed similar fracture risks in the sample and the older adult population overall. Prospective investigation of fracture rates in home care patients, identification of true risk factors and construction of a home care patient-specific clinical score are warranted.

Highlights

Advances in health care and improved life conditions have led to a significant increase in the average life expectancy of the Brazilian population
Likewirse in this study (2.86%), a Canadian cohort study with 133354 patients revealed a 2.4% hip fracture rate among elderly home care patients.[14]. Similar findings regarding hip and osteoporotic fracture risks were reported in a recent US study involving 3127 individuals aged over 50 years, and evaluated using the FRAX® tool (Table 3).(18) To the best of the
In a retrospective cohort study investigating a population living in the state of Ceará, Castro et al, reported annual hip fracture rates of 5.59/10,000 male and 12.4/10,000 female individuals aged over 50 years – lower than figures reported by Komatsu et al, in the Southeast region of the country (12.6/10,000 male and 28.8/10,000 female individuals aged over 60 years).(25,26) Continental size and ethnic heterogeneity may account for varying fracture rates in Brazil

Summary

Introduction

Advances in health care and improved life conditions have led to a significant increase in the average life expectancy of the Brazilian population. Bone fracture is a major cause of hospitalization in elderly patients and has significant negative impacts on patient quality of life.[2] Affected patients often become functionally dependent in the short- or long-run, and approximately 50% do not regain previous levels of mobility.[2,3] Age-related pathophysiological changes, such as decreased bone mineral density (BMD), frequent medication use and specific socioenvironmental conditions increase the risk of fracture in this population.[4,5,6,7] This is a relevant public health issue from the medical, social and economic standpoints. In Brazil, average hospitalization and medication costs reached R$ 70 million in 2006 (potentially underestimated), with 35,490 deaths/year in patients aged over 60 years.[10]

Methods

Results

Discussion

Conclusion