The Algorhytm: FRAX Brazil - Revista Brasileira de Ginecologia e Obstetrícia
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(8):467-468
The World Health Organization (WHO) defines osteoporosis as a skeletal disorder characterized by low bone mass combined with microarchitetural deterioration of the bone, leading to bone fragility and increased susceptibility to fracture. Its clinical relevance relies on the emerging fracture rate, as well as on the morbidity and mortality associated with hip fractures. Moreover, the WHO objectively defines osteoporosis based on bone mineral density (BMD, [that is, when BMD is ≤ -2.5 standard deviations [SD] below peak bone mass [T-score], as assessed by dual X-ray absorptiometry [DXA]). A T-score between -1.0 and -2.5 means an intermediary condition of bone loss, which is called osteopenia. There is no doubt that the risk of fracture increases significantly with decreasing BMD. In spite of this, it is well known that osteoporotic fractures occur across a wide spectrum of BMD intensity. Actually, the much larger number of persons with osteopenia determines a significant occurrence of fractures in people diagnosed with this condition. There is no global consensus for screening patients at risk of osteoporotic fracture; however, several medical associations recommend a targeted approach to the prevention of osteoporosis based on the 10-year absolute risk of osteoporotic fracture.
The main purpose of the treatments for osteoporosis is to decrease the risk of fragility fractures. Therefore, the capacity to assess the risk of fracture is critical for the identification of patients who are eligible for intervention. The fracture risk assessment tool (FRAX), a computer based algorithm, is the most thoroughly studied and widely used tool to calculate the risk of fracture. The FRAX was released in 2007 by the World Health Organization Collaborating Centre at Sheffield, United Kingdom (UK), to estimate the individualized 10-year probability of hip and major osteoporotic fractures (hip, clinical spine, distal forearm, and proximal humerus). The FRAX tool integrates 8 clinical risk factors (CRFs): previous fragility fracture, parental hip fracture, smoking, systemic glucocorticoid use, excess alcohol intake, body mass index, rheumatoid arthritis, and other causes of secondary osteoporosis); those, in addition to age, sex and BMD at the femoral neck (an optional input) contribute to the 10-year fracture risk estimate. The probability of fracture is computed taking the risk of fracture and the risk of death into account.
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The World Health Organization (WHO) defines osteoporosis as a skeletal disorder characterized by low bone mass combined with microarchitetural deterioration of the bone, leading to bone fragility and increased susceptibility to fracture. Its clinical relevance relies on the emerging fracture rate, as well as on the morbidity and mortality associated with hip fractures. Moreover, the WHO objectively defines osteoporosis based on bone mineral density (BMD, [that is, when BMD is ≤ -2.5 standard deviations [SD] below peak bone mass [T-score], as assessed by dual X-ray absorptiometry [DXA]). A T-score between -1.0 and -2.5 means an intermediary condition of bone loss, which is called osteopenia. There is no doubt that the risk of fracture increases significantly with decreasing BMD. In spite of this, it is well known that osteoporotic fractures occur across a wide spectrum of BMD intensity. Actually, the much larger number of persons with osteopenia determines a significant occurrence of fractures in people diagnosed with this condition. There is no global consensus for screening patients at risk of osteoporotic fracture; however, several medical associations recommend a targeted approach to the prevention of osteoporosis based on the 10-year absolute risk of osteoporotic fracture.
The main purpose of the treatments for osteoporosis is to decrease the risk of fragility fractures. Therefore, the capacity to assess the risk of fracture is critical for the identification of patients who are eligible for intervention. The fracture risk assessment tool (FRAX), a computer based algorithm, is the most thoroughly studied and widely used tool to calculate the risk of fracture. The FRAX was released in 2007 by the World Health Organization Collaborating Centre at Sheffield, United Kingdom (UK), to estimate the individualized 10-year probability of hip and major osteoporotic fractures (hip, clinical spine, distal forearm, and proximal humerus). The FRAX tool integrates 8 clinical risk factors (CRFs): previous fragility fracture, parental hip fracture, smoking, systemic glucocorticoid use, excess alcohol intake, body mass index, rheumatoid arthritis, and other causes of secondary osteoporosis); those, in addition to age, sex and BMD at the femoral neck (an optional input) contribute to the 10-year fracture risk estimate. The probability of fracture is computed taking the risk of fracture and the risk of death into account.
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