de Oliveira Fernando Meireles, Leal Rafaela Martinez Copês, Comim Fabio Vasconcellos, Premaor Melissa Orlandin
Pós-Graduação Em Ciências da Saúde Do Adulto, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Department of Clinical Medicine, Federal University of Santa Maria, Santa Maria, Brazil.
Arch Osteoporos. 2024 Dec 31;20(1):6. doi: 10.1007/s11657-024-01489-x.
The FRAX® algorithm showed good accuracy in women living with DM followed in primary care. There were no differences between the ROC curve with and without adjustments for major and hip fractures. The FRAX® 10-year and FRAX® AR were better calibrated in this population.
An increased risk of fractures in people living with diabetes has been described. Screening instruments to calculate this risk have been proposed, including the FRAX® algorithm. Some studies suggest that minor modifications to this instrument can improve its performance. These modifications work well in other countries, but we do not know if they work in Brazil. The objective of our study was to evaluate the performance of the FRAX® algorithm with and without adjustments for women living with DM (WLDM) in primary care in Brazil.
A cohort study that included post-menopausal women attending primary care in Santa Maria, Brazil, was conducted from 2013 to 2018. The risk for major and hip fractures was calculated using the FRAX® tool. The FRAX® risk was calculated: (1) without adjustments (unadjusted FRAX®); (2) increasing the entered age by 10 years in individuals with DM (FRAX® 10 years); and (3) inserting the diagnosis of DM as rheumatoid arthritis (FRAX® AR).
The accuracy for major fracture was 0.948 (unadjusted FRAX®), 0.947 (FRAX® 10 years), and 0.946 (FRAX® AR). For hip fractures, the accuracies were 0.989 (unadjusted FRAX®), 0.988 (FRAX® 10 years), and 0.988 (FRAX® AR). Furthermore, there were no differences between the area under the ROC curve with and without adjustments for major and hip fractures. Conversely, the FRAX® 10 years and the FRAX® AR were better calibrated, presenting a lower Chi-square.
The FRAX® algorithm showed good accuracy in WLDM followed in primary care. The FRAX® 10 years and FRAX® AR were better calibrated in this population.
FRAX®算法在接受初级保健随访的糖尿病女性中显示出良好的准确性。在对主要骨折和髋部骨折进行调整与未调整的情况下，受试者工作特征（ROC）曲线之间没有差异。FRAX® 10年和FRAX® AR在该人群中校准效果更佳。
已有描述表明糖尿病患者骨折风险增加。已提出用于计算该风险的筛查工具，包括FRAX®算法。一些研究表明，对该工具进行一些小修改可以改善其性能。这些修改在其他国家效果良好，但我们不知道在巴西是否有效。我们研究的目的是评估在巴西初级保健中，对患有糖尿病的女性（WLDM）使用和不使用调整的FRAX®算法的性能。
2013年至2018年在巴西圣玛丽亚进行了一项队列研究，纳入了接受初级保健的绝经后女性。使用FRAX®工具计算主要骨折和髋部骨折的风险。计算FRAX®风险的方法如下：（1）不进行调整（未调整的FRAX®）；（2）将糖尿病患者的输入年龄增加10岁（FRAX® 10年）；（3）将糖尿病诊断输入为类风湿关节炎（FRAX® AR）。
主要骨折的准确性分别为0.948（未调整的FRAX®）、0.947（FRAX® 10年）和0.946（FRAX® AR）。对于髋部骨折，准确性分别为0.989（未调整的FRAX®）、0.988（FRAX® 10年）和0.988（FRAX® AR）。此外，在对主要骨折和髋部骨折进行调整与未调整的情况下，ROC曲线下面积之间没有差异。相反，FRAX® 10年和FRAX® AR校准效果更佳，卡方值更低。
FRAX®算法在接受初级保健随访的WLDM中显示出良好的准确性。FRAX® 10年和FRAX® AR在该人群中校准效果更佳。
