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Abstract(s)
Introdução: A prevenção das fraturas osteoporóticas passa pela identificação dos indivíduos com fatores de risco clínicos para fratura, realização criteriosa da absorciometria de raio X de dupla energia (DEXA), tratamento anti-osteoporótico e follow-up dos doentes. Criada em 2008, validada para Portugal em 2012, a ferramenta FRAX® (WHO Fracture Risk Assessment Tool) calcula o risco de fratura da anca e de fratura major a 10 anos, ao integrar múltiplos fatores de risco. A National Osteoporosis Foundation (NOF) determinou dois limiares de alto risco, ≥3% e ≥20% respetivamente, que indicam a conduta para o tratamento farmacológico da osteopororse (OP), nos EUA. A adequação desses limiares tem sido objetivo de estudo por outros autores, mas não existem estudos na população portuguesa. O objetivo principal deste estudo foi determinar qual o limiar de risco, calculado através do FRAX®, que permite identificar com elevada sensibilidade os indivíduos com alto risco de fratura da anca, em Portugal.
Métodos: De agosto a novembro de 2012, foi realizado um questionário e colheita de dados do processo clínico, de pacientes com pelo menos 50 anos, com fratura não traumática da extremidade proximal do fémur, internados no Serviço de Ortopedia do Hospital Pêro da Covilhã, do Hospital Sousa Martins e do Hospital Amato Lusitano. O risco de fratura da anca e o de fratura major foi calculado para cada paciente, através do FRAX® clínico (sem densidade mineral óssea - DMO) aferido para a população Portuguesa. Analisámos os limiares de risco FRAX® correspondentes a uma sensibilidade de 95% e 80% para a fratura incidente da anca.
Resultados: Foram incluídos 138 doentes com fratura não traumática da anca. A média de idade foi 83,5±7,4 anos (81,2% mulheres). Os fatores de risco mais prevalentes foram: sexo feminino, idade superior a 65 anos, antecedentes pessoais e familiares de fratura de fragilidade e as causas de OP secundária. 91,2% dos doentes nunca tinham realizado uma DEXA e 89,8% não tinham realizado previamente medicação para a prevenção de fraturas. Os limiares de risco de FRAX® clínico de fratura da anca com sensibilidade de 80% e 95% para a fratura incidente da anca foram ≥5,5% e ≥3%, respetivamente.
Conclusões: Identificámos os limiares adequados de alto risco para fratura osteoporótica da anca do instrumento FRAX® clínico numa população Portuguesa. Estes têm uma importante aplicação na prática clínica, pois permitem a melhor identificação dos indivíduos em risco, para seleção criteriosa dos que devem realizar ou não DEXA e tratamento farmacológico.
Introduction: The prevention of osteoporotic fractures involves the identification of the individuals with clinical risk factors for fracture, judicious performing of dual-energy x-ray absorptiometry (DXA), anti-osteoporotic treatment and patients’ follow-up. Created in 2008, validated for Portugal in 2012, the FRAX® tool (WHO Fracture Risk Assessment Tool) gives the 10-year probability of hip and major fracture, integrating multiple risk factors. The National Osteoporosis Foundation (NOF) determined two thresholds of high risk, ≥ 3% and ≥ 20% respectively, which indicates the treatment intervention of the OP, in USA. The adequacy of these thresholds has been the object of studies by other authors, but there aren’t any studies regarding the portuguese population. The main objective of this study was to determine the risk threshold, calculated using the FRAX® tool, which allows high sensitivity to identify individuals at high risk of hip fracture, in Portugal. Methods: From August to November 2012, a questionnaire and data collection from clinical process were performed to patients at least 50 years old, with nontraumatic hip fracture, admitted to the Orthopedics Service in Hospital Pêro da Covilhã, Hospital Sousa Martins and Hospital Amato Lusitano. The risk of hip fracture and the one of major fracture were calculated for each patient using the clinical FRAX® (without bone mineral density - BMD) measured for the Portuguese population. We analyzed the thresholds for risk FRAX® corresponding to a sensitivity of 95% and 80% for the incident hip fracture. Results: There were included 138 patients with non-traumatic hip fracture. The mean age was 83.5± 7.4 years (81.2% women). The most prevalent risk factors were: female gender, age over 65 years old, personal and parental history of fragility fracture and causes of secondary OP. 91.2% of patients had never performed DXA and 89.8% hadn’t previously made anti-osteoporotic treatment. The thresholds for high risk of hip fracture, by clinical FRAX®, with a sensitivity of 80% and 95% for the incident hip fracture were ≥5,5% and ≥3%, respectively. Conclusions: We identified appropriate thresholds at high risk for osteoporotic hip fracture, using FRAX® tool in the Portuguese population. These have an important application in clinical practice, as it allows a better identification of individuals at risk for careful selection of those who should perform DEXA and pharmacological treatment.
Introduction: The prevention of osteoporotic fractures involves the identification of the individuals with clinical risk factors for fracture, judicious performing of dual-energy x-ray absorptiometry (DXA), anti-osteoporotic treatment and patients’ follow-up. Created in 2008, validated for Portugal in 2012, the FRAX® tool (WHO Fracture Risk Assessment Tool) gives the 10-year probability of hip and major fracture, integrating multiple risk factors. The National Osteoporosis Foundation (NOF) determined two thresholds of high risk, ≥ 3% and ≥ 20% respectively, which indicates the treatment intervention of the OP, in USA. The adequacy of these thresholds has been the object of studies by other authors, but there aren’t any studies regarding the portuguese population. The main objective of this study was to determine the risk threshold, calculated using the FRAX® tool, which allows high sensitivity to identify individuals at high risk of hip fracture, in Portugal. Methods: From August to November 2012, a questionnaire and data collection from clinical process were performed to patients at least 50 years old, with nontraumatic hip fracture, admitted to the Orthopedics Service in Hospital Pêro da Covilhã, Hospital Sousa Martins and Hospital Amato Lusitano. The risk of hip fracture and the one of major fracture were calculated for each patient using the clinical FRAX® (without bone mineral density - BMD) measured for the Portuguese population. We analyzed the thresholds for risk FRAX® corresponding to a sensitivity of 95% and 80% for the incident hip fracture. Results: There were included 138 patients with non-traumatic hip fracture. The mean age was 83.5± 7.4 years (81.2% women). The most prevalent risk factors were: female gender, age over 65 years old, personal and parental history of fragility fracture and causes of secondary OP. 91.2% of patients had never performed DXA and 89.8% hadn’t previously made anti-osteoporotic treatment. The thresholds for high risk of hip fracture, by clinical FRAX®, with a sensitivity of 80% and 95% for the incident hip fracture were ≥5,5% and ≥3%, respectively. Conclusions: We identified appropriate thresholds at high risk for osteoporotic hip fracture, using FRAX® tool in the Portuguese population. These have an important application in clinical practice, as it allows a better identification of individuals at risk for careful selection of those who should perform DEXA and pharmacological treatment.
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Keywords
Osteoporose - Prevenção Fracturas osteoporóticas - Factores de risco - FRAX Fractura do colo do fémur - FRAX
Citation
Publisher
Universidade da Beira Interior