Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de La Ballena, 35011, Las Palmas, Spain.
University of Las Palmas de Gran Canaria, Las Palmas, Spain.
Arch Osteoporos. 2022 Aug 15;17(1):114. doi: 10.1007/s11657-022-01157-y.
We analyzed the practical consequences of applying an adjusted FRAX® for recent fractures in a FLS. After analyzing 2777 patients, we concluded that the adjusted FRAX® is irrelevant when calculating FRAX® with DXA and is only useful for fractures of the humerus when DXA is not available.
A FRAX® adjusted to fractures less than 2 years old has been proposed. The objective of this work was to analyze the clinical implications of applying the adjusted FRAX® instead of the classic FRAX® in a fracture liaison service (FLS) unit.
Adults aged 50 years or older with fragility fractures (hip, spine, humerus, and forearm) that occurred in the 12 months prior to the baseline visit were included. We recorded demographic data, type of fracture, DXA, classic FRAX®, and FRAX® adjusted for recent fractures and indications for anti-osteoporotic medication (AOM) following the guidelines of the Spanish Society of Rheumatology.
A total of 2777 patients were included, mean age 73 years, 84% women. The type of fracture was as follows: forearm (n = 958; 34.5%), hip (n = 781; 28.1%), humerus (n = 642; 23.1%), and spine (n = 397, 14.3%). DXA was performed in 2134 cases (76.8%). A total of 2522 patients (90.8%) were candidates for AOM (100% involving the hip and spine, 83% forearm, and 85% humerus). FRAX®-hip ≥ 3% increased from 1601 to 1775 cases (57.6 to 64%). The average FRAX®-hip (SD) increased from 5.7 (6) to 7.5 (9) (4.6 to 8.8 in males and 5.9 to 7.3 in females). The percentage of forearm fracture candidates for AOM, with or without DXA, did not change after FRAX®-hip adjustment, while the number of patients with humerus fractures increased from 59 to 80% in those who did not have DXA. In the entire sample, FRAX®-adjusted led to an indication of AOM for 15 additional patients (0.5% of major fractures): 14 with a humerus fracture and 1 with a forearm fracture.
The adjusted FRAX® for recent fractures in an FLS unit in an adjusted FRAX® is irrelevant when calculating FRAX® with DXA; in fact, it is only useful for fractures of the humerus when DXA is not available.
已经提出了一种针对不到 2 年骨折的 Frax®调整。本研究的目的是分析在骨折联络服务（FLS）单位中应用调整后的 Frax®而非经典 Frax®的临床意义。
纳入年龄在 50 岁及以上、在基线就诊前 12 个月内发生脆性骨折（髋部、脊柱、肱骨和前臂）的患者。我们记录了人口统计学数据、骨折类型、DXA、经典 Frax®以及根据西班牙风湿病学会指南进行的最近骨折调整后的 Frax®和抗骨质疏松药物（AOM）指征。
共纳入 2777 例患者，平均年龄 73 岁，84%为女性。骨折类型如下：前臂（n=958；34.5%）、髋部（n=781；28.1%）、肱骨（n=642；23.1%）和脊柱（n=397；14.3%）。2134 例患者进行了 DXA 检查（76.8%）。共有 2522 例患者（90.8%）为 AOM 候选者（100%涉及髋部和脊柱，83%涉及前臂，85%涉及肱骨）。Frax®-髋部≥3%的患者从 1601 例增加至 1775 例（57.6%增至 64%）。平均 Frax®-髋部（SD）从 5.7（6）增加至 7.5（9）（男性 4.6 至 8.8，女性 5.9 至 7.3）。有或无 DXA 的前臂骨折患者的 AOM 候选人数无变化，但无 DXA 的肱骨骨折患者从 59%增至 80%。在整个样本中，调整后的 Frax®导致 15 例额外患者（主要骨折的 0.5%）需要 AOM：14 例肱骨骨折，1 例前臂骨折。
在调整后的 FLS 单位中，最近骨折的调整后的 Frax®与 DXA 计算 Frax®时无关；实际上，只有在没有 DXA 时才对肱骨骨折有用。
