FRAX Index Research Articles

AB0394 Cardiovascular risk factors and their association with bone metabolism and disease activity in patients with early arthritis

BackgroundInflammatory activity in patients with rheumatoid arthritis (RA) is associated with an increased risk for cardiovascular complications (CV). Nevertheless, data on CV risk in patients with early arthritis (EA) are...

AB1063 The use of glucocorticosteroids does not dismiss the lumbar bone mineral density in patients with rheumatoid arthritis, prospective study

BackgroundThe increase of pro-inflammatory cytoquines plays a relevant role in the loss of bone density which is associated to the Rheumatoid Arthritis (RA). The glucocorticosteroids (GC) are in the base...

AB0395 Systemic osteoporosis and its relationship with disease activity in patients with early arthritis

BackgroundThe etiopathogenesis of bone loss seen in patients with rheumatoid arthritis (RA) is multifactorial. Factors that are intrinsic to the individual (age, gender), as well as disease- and treatment-related factors...

Prevalence of thoracic vertebral fractures in Spanish patients hospitalized in Internal Medicine Departments. Assessment of the clinical inertia. (PREFRAMI study)

PurposeTo study the prevalence of vertebral fractures (VF), the associated risk factors and the degree of diagnosis and prescription upon discharge in a series of hospitalized medical patients ≥50years of age. MethodsA cross-sectional, multicentre and observational study in which a prevalence cut-off was carried out concerning patients admitted to six Internal Medicine departments in Malaga (Spain). The main variables were the existence of a fracture in the spine lateral x-ray, the inclusion of the diagnosis of a fracture in the discharge report, and the establishment of anti-osteoporotic treatment at discharge. Results254 patients were included (mean age 66.4±14.9years). The prevalence of VF was of 14.2% (36 cases). Patients with VF presented with a higher mean age, compared to those without VF (70.14 vs. 65.7years) (p=0.035). The means contrast for the FRAX index variable (major osteoporotic and hip fracture), grouping according to the presence of VF, did not show any statistical significance (p=0.369 and p=0.788, respectively). Only in 8.3% of the discharge reports of patients with VF had the diagnosis of VF and/or osteoporosis been recorded and the prescription of anti-osteoporotic drugs been included. ConclusionsA high prevalence of asymptomatic VF is verified in medical inpatients ≥50years of age. The FRAX index did not turn out to be predictive of the presence of VF in this population. There is an underdiagnosis of osteoporotic VF in the coding at hospital discharge. Action protocols are necessary to avoid clinical inactivity regarding this entity.

Premenopausal Osteoporosis: How to Treat?

There is no agreement in defining osteoporosis in premenopausal women and diagnosis must be done carefully and not based on densitometric parameters. One must take into account the presence of other risk factors and history of fragility fractures, diseases or drugs that cause bone loss. Over 50% of premenopausal women with osteoporosis will have a secondary cause, with the remainder diagnosed with idiopathic osteoporosis. Therapeutic considerations are limited by a few studies in this group of patients, especially in regard to the risk of fractures. On the other hand, the FRAX index cannot be applied to premenopausal women. This article will review the measures to apply depending on the type of premenopausal osteoporosis, based on current scientific evidence.

Osteoporosis premenopáusica: ¿cómo tratarla?

There is no agreement in defining osteoporosis in premenopausal women and diagnosis must be done carefully and not based on densitometric parameters. One must take into account the presence of other risk factors and history of fragility fractures, diseases or drugs that cause bone loss. Over 50% of premenopausal women with osteoporosis will have a secondary cause, with the remainder diagnosed with idiopathic osteoporosis. Therapeutic considerations are limited by a few studies in this group of patients, especially in regard to the risk of fractures. On the other hand, the FRAX index cannot be applied to premenopausal women. This article will review the measures to apply depending on the type of premenopausal osteoporosis, based on current scientific evidence.

Utility of FRAX index in the evaluation of type 2 diabetes patients

Utility of FRAX index in the evaluation of type 2 diabetes patients

Aplicación de las guías de prevención secundaria de fractura osteoporótica y del índice FRAX en una cohorte de pacientes con fractura por fragilidad

Background and objectives There are different guidelines for secondary prevention of fractures related with osteoporosis. Our aim is to analyse the appliance of such guidelines in a sample of patients with fragility fracture Patients and methods Adult patients older than 50 years attended in the emergency department with a fragility fracture were invited to participate in a study for secondary prevention. Clinical data and densitometry for the FRAX index were recorded. Current guidelines were employed to calculate the number of patients who needed secondary prevention. Results With the appliance of current guidelines to 380 patients, 54-100% of women and 26-81% of men were candidates for treatment. For hip fractures the percentage was 81-100% and for forearm fractures 36-93%. FRAX index for hip fracture was ≥3% in 35% of patients. The National Institute for Health and Clinical Excellence and the National Osteoporosis Foundation 2009 were the most restrictive guidelines (54% and 57% respectively). On the other hand the National Guideline Clearinghouse (87%) and the National Osteoporosis Guideline Group (93%). Conclusion There are high differences in the percentage of patients who need treatment to prevent new fractures according to the guidelines. Fewer patients require treatment when the FRAX index is included in a guideline.

Variation of trabecular architecture in proximal femur of postmenopausal women

This investigation of microstructure in the human proximal femur probes the relationship between the parameters of the FRAX index of fracture risk and the parameters of bone microstructure. The specificity of fracture sites at the proximal femur raises the question of whether trabecular parameters are site-specific during post-menopause, before occurrence of fragility fracture. The donated proximal femurs of sixteen post-menopausal women in the sixth and seventh decades of life, free of metabolic pathologies and therapeutic interventions that could have altered the bone tissue, constituted the material of the study. We assessed bone mineral density of the proximal femurs by dual energy X-ray absorptiometry and then sectioned the femurs through the center of the femoral head and along the femoral neck axis. For each proximal femur, morphometry of trabeculae was conducted on the plane of the section divided into conventional regions and sub-regions consistent with the previously identified trabecular families that provide regions of relatively homogeneous microstructure. Mean trabecular width and percent bone area were calculated at such sites. Our findings indicate that each of mean trabecular width and percent bone area vary within each proximal femur independently from each other, with dependence on site. Both trabecular parameters show significant differences between pairs of sites. We speculate that a high FRAX index at the hip corresponds to a reduced percent bone area among sites that gives a more homogeneous and less site-specific quality to the proximal femur. This phenomenon may render the local tissue less able to carry out the expected mechanical function.

The relationship between the OSTEODENT index and hip fracture risk assessment using FRAX

The OSTEODENT index is a predicted probability of osteoporosis derived from a combination of an automated analysis of a dental panoramic radiograph and clinical information. This index has been proposed as a suitable case-finding tool for identification of subjects with osteoporosis in primary dental care; however, no data exist on the relationship between OSTEODENT index and fracture risk. The aims of this study were to assess the relationship between the OSTEODENT index and hip fracture risk as determined by FRAX and to compare the performance of the OSTEODENT index and FRAX (without femoral BMD data), in determining the need for intervention as recommended in UK national treatment guidance. The study was a retrospective analysis of data from 339 female subjects (mean age 55.3 years), from 2 centers: Manchester (UK) and Leuven (Belgium). Clinical information and femoral neck BMD were available for FRAX, and dental panoramic radiographic data and clinical information were available to calculate the OSTEODENT index. Subjects were classified into "treat" or "lifestyle advice and reassurance" categories using the National Osteoporosis Guideline Group (NOGG) threshold. The OSTEODENT index result was significantly related to the 10-year probability of hip fracture derived from the reference standard FRAX tool (Rs = 0.67, P < .0001); 84 patients (24.8%) were allocated to the "treat" category on the basis of FRAX and the UK national guidance. Using this "treatment/no treatment" classification as the reference standard, ROC analysis showed no significant difference between areas under the curves for the OSTEODENT index (0.815) and the 10-year probability of hip fracture derived from the FRAX index without BMD (0.825) when used as tests for determining therapeutic intervention. The results suggest that the OSTEODENT index has value in prediction of hip fracture risk. Prospective trials are needed to confirm this finding and to examine the feasibility for its use in primary dental care.