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      Determinación del riesgo de fractura osteoporótica en población laboral española mediante la herramienta FRAX Translated title: Osteoporotic risk of hip fracture calculated using the FRAX tool for the Spanish population

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          Abstract

          RESUMEN Introducción: las fracturas osteoporóticas constituyen una problemática de creciente trascendencia en salud pública, por lo que la utilización de herramientas que permitan una valoración precoz y adecuada del riesgo de fractura y el establecimiento de políticas preventivas deberían ser prioritarios. En este trabajo se valora el riesgo de sufrir diferentes tipos de fractura, tanto en trabajadores varones, como en mujeres menopáusicas y no menopáusicas. Materiales y métodos: se realizó un estudio descriptivo transversal en población general trabajadora del sector socio-sanitario español con edades comprendidas entre 40 y 65 años. El riesgo de fractura de cadera y mayor osteoporótica se calculó mediante la herramienta FRAX para población española. Se incluyeron en el estudio 749 trabajadores seleccionados aleatoriamente: 251 varones, 251 mujeres no menopáusicas y 247 mujeres menopáusicas. Resultados:las edades medias fueron de 46,8 años en varones, 43,9 años en mujeres no menopáusicas y 52,3 años en las menopáusicas. El riesgo medio de fractura de cadera y mayor osteoporótica fue de 2,1±1,33 y de 0,22±0,36 en varones, 2,65±2,16 y 0,27±0,94 en mujeres no menopáusicas y 3,1±2,93 y 0,44±0,88 en mujeres menopáusicas. Presentaron criterios positivos de tratamiento según la National Osteoporosis Foundation el 0,8 % de las mujeres no menopáusicas, un 2 % de las menopáusicas y ninguno de los hombres. Conclusión: el riesgo de sufrir fracturas osteoporóticas en este colectivo es muy bajo, sin embargo, el uso de la herramienta FRAX puede ser muy útil para detectar el riesgo en sus estadios iniciales y establecer políticas de prevención y actuación precoz que permitan un ahorro en costes y mejorar la salud de nuestra población general mediante captación en su etapa laboral.<<

          Translated abstract

          ABSTRACT Purpose:Osteoporotic fractures are a significant growing problem of public health, so the use of tools that allow a proper risk assessment and establishing preventive policies should be a priority. This paper assesses the risk of different types of fractures as much in men as in menopausal and non menopausal women. Patients and methods: A descriptive crosssectional study in working population from the Spanish health system aged between 40 and 65. The risk of increased osteoporotic hip fracture is calculated using the FRAX tool for the Spanish population. 749 randomly selected workers were included in the study, 251 men, 251 non menopausal women and 247 post-menopausal women. Results: Mean ages were 46.8 years in men, 43.9 years in non-menopausal women and 52.3 years in the menopausal. The average risk of hip fracture and major osteoporotic was 2.1 ± 1.33 and 0.22 ± 0.36 in males, 2.65 ± 2.16 and 0.27 ± 0.94 in non-menopausal women 3.1 ± 2.93 and 0.44 ± 0.88 in menopausal women. No men, 0.8 % of menopausal women and 2 % of menopausal treatment had positive criteria for treatment according to the National Osteoporosis Foundation. Conclusion: The risk of osteoporotic fractures in this group is very low, however the use of the FRAX tool can be very useful to detect the risk in its early stages and establishing prevention policies that allow cost savings and improve the health of our workforce.

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          Most cited references61

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          Osteoporosis prevention, diagnosis, and therapy.

          (2001)
          To clarify the factors associated with prevention, diagnosis, and treatment of osteoporosis, and to present the most recent information available in these areas. From March 27-29, 2000, a nonfederal, nonadvocate, 13-member panel was convened, representing the fields of internal medicine, family and community medicine, endocrinology, epidemiology, orthopedic surgery, gerontology, rheumatology, obstetrics and gynecology, preventive medicine, and cell biology. Thirty-two experts from these fields presented data to the panel and an audience of 699. Primary sponsors were the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health Office of Medical Applications of Research. MEDLINE was searched for January 1995 through December 1999, and a bibliography of 2449 references provided to the panel. Experts prepared abstracts for presentations with relevant literature citations. Scientific evidence was given precedence over anecdotal experience. The panel, answering predefined questions, developed conclusions based on evidence presented in open forum and the literature. The panel composed a draft statement, which was read and circulated to the experts and the audience for public discussion. The panel resolved conflicts and released a revised statement at the end of the conference. The draft statement was posted on the Web on March 30, 2000, and updated with the panel's final revisions within a few weeks. Though prevalent in white postmenopausal women, osteoporosis occurs in all populations and at all ages and has significant physical, psychosocial, and financial consequences. Risks for osteoporosis (reflected by low bone mineral density [BMD]) and for fracture overlap but are not identical. More attention should be paid to skeletal health in persons with conditions associated with secondary osteoporosis. Clinical risk factors have an important but poorly validated role in determining who should have BMD measurement, in assessing fracture risk, and in determining who should be treated. Adequate calcium and vitamin D intake is crucial to develop optimal peak bone mass and to preserve bone mass throughout life. Supplementation with these 2 nutrients may be necessary in persons not achieving recommended dietary intake. Gonadal steroids are important determinants of peak and lifetime bone mass in men, women, and children. Regular exercise, especially resistance and high-impact activities, contributes to development of high peak bone mass and may reduce risk of falls in older persons. Assessment of bone mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. Fracture prevention is the primary treatment goal for patients with osteoporosis. Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or consequences of falls. Adults with vertebral, rib, hip, or distal forearm fractures should be evaluated for osteoporosis and given appropriate therapy.
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            Cost-effective osteoporosis treatment thresholds: the United States perspective.

            A United States-specific cost-effectiveness analysis, which incorporated the cost and health consequences of clinical fractures of the hip, spine, forearm, shoulder, rib, pelvis and lower leg, was undertaken to identify the 10-year hip fracture probability required for osteoporosis treatment to be cost-effective for cohorts defined by age, sex, and race/ethnicity. A 3% 10-year risk of hip fracture was generally required for osteoporosis treatment to cost less than $60,000 per QALY gained. Rapid growth of the elderly United States population will result in so many at risk of osteoporosis that economically efficient approaches to osteoporosis care warrant consideration. A Markov-cohort model of annual United States age-specific incidence of clinical hip, spine, forearm, shoulder, rib, pelvis and lower leg fractures, costs (2005 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment ($600/yr drug cost for 5 years with 35% fracture reduction) by gender and race/ethnicity groups. To determine the 10-year hip fracture probability at which treatment became cost-effective, average annual age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until a cost of $60,000 per QALY gained was observed for treatment relative to no intervention. Osteoporosis treatment was cost-effective when the 10-year hip fracture probability reached approximately 3%. Although the RR at which treatment became cost-effective varied markedly between genders and by race/ethnicity, the absolute 10-year hip fracture probability at which intervention became cost-effective was similar across race/ethnicity groups, but tended to be slightly higher for men than for women. Application of the WHO risk prediction algorithm to identify individuals with a 3% 10-year hip fracture probability may facilitate efficient osteoporosis treatment.
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              Clinical use of bone densitometry: scientific review.

              Osteoporosis causes substantial morbidity and costs $13.8 billion annually in the United States. Measurement of bone mass by densitometry is a primary part of diagnosing osteoporosis and deciding a preventive treatment course. Bone mineral densitometry has become more widely available and commonly used in practice. To review evidence about the value of various clinical applications of bone densitometry. A MEDLINE search was performed to update previous meta-analyses of the relationship between various measurements of bone density and risk of vertebral and hip fracture. We used data from the prospective Study of Osteoporotic Fractures to estimate risk of fracture from bone density and age in postmenopausal women. When available, meta-analyses and systematic reviews are emphasized in the review. Bone mineral density (BMD) predicts fracture and can be used in combination with age to estimate absolute risk of fractures in postmenopausal white women. Hip BMD predicts hip fracture more strongly than other measurements of BMD. There are insufficient data to translate BMD results into risk of fracture for men and nonwhite women. The benefits of treatments to prevent fractures depend on BMD: women with osteoporosis have a greater risk of fractures and greater benefit from treatments than women without osteoporosis. Guidelines based on systematic reviews and a cost-effectiveness analysis have suggested that it is worthwhile to measure BMD in white women older than 65 years and perhaps to use risk factors to select younger postmenopausal women for densitometry. Other potential clinical applications of BMD that have not yet been adequately studied include screening men or nonwhite women, monitoring BMD in patients receiving treatment, and using BMD to identify patients who should be evaluated for secondary causes of osteoporosis.
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                Author and article information

                Journal
                cesm
                CES Medicina
                CES Med.
                Universidad CES (Medellín, Antioquia, Colombia )
                0120-8705
                July 2012
                : 26
                : 2
                : 165-174
                Affiliations
                [04] España orgnameGrupo de Investigación en Medicina del Trabajo (GIMT)
                [03] Valencia España orgnameServicio de Prevención Mancomunado MAPFRE orgdiv1Grupo de Investigación en Medicina del Trabajo (GIMT)
                [01] España orgnameServicio de Prevención de GESMA orgdiv1Universidad Illes Balears
                [02] orgnameGrupo de Investigación en Medicina del Trabajo (GIMT) MTVH@ 123456ono.com
                [05] orgnameGrupo de Investigación en Medicina del Trabajo (GIMT)
                [06] orgnameAdministración del Govern de les Illes Balears
                Article
                S0120-87052012000200003 S0120-8705(12)02600203
                a40c67e9-30f7-4045-959e-b3d5e15dc747

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 22 August 2012
                : 31 October 2012
                : 08 November 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 10
                Product

                SciELO Colombia

                Categories
                Artículo de investigación científica o tecnológica

                Occupational Health,Salud laboral,Osteoporosis,Riesgo de fractura,Osteoporotic fracture,Fractura osteoporótica,Fracture risk

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