Skip to main content
Top
Published in: Archives of Osteoporosis 1/2017

01-12-2017 | Original Article

Evaluation of clinical risk factors for osteoporosis and applicability of the FRAX tool in Joinville City, Southern Brazil

Authors: Dalisbor Marcelo Weber Silva, Victoria Zeghbi Cochenski Borba, John A. Kanis

Published in: Archives of Osteoporosis | Issue 1/2017

Login to get access

Abstract

Summary

Clinical risk factors for fracture in Southern Brazil are similar to those used in Fracture Risk Assessment Tool (FRAX®). Age-dependent intervention thresholds had higher accuracy than a fixed cut-off point.

Introduction

Access to bone mineral density testing is wanted for a large part of the Brazilian population. The FRAX® has an option to calculate the risk of fracture without this costly evaluation but relies on the clinical risk factors (CRFs) identified in the source cohorts used to generate FRAX.

Objective

The aims of this study were to determine whether the CRFs used in FRAX are also risk indicators for individuals in Southern Brazil and to evaluate possible intervention thresholds for treatment in Brazil.

Methods

We determined the CRFs for hip fractures in women and men aged 50 years and more with a hip fracture and controls in Joinville, Southern Brazil (April 1, 2010, and March 31, 2012). For intervention thresholds, we determined the accuracy of using the fixed thresholds of National Osteoporosis Foundation (NOF), USA, compared with the age-dependent thresholds of the National Osteoporosis Guideline Group (NOGG), UK.

Results

CRFs that were significant for hip fracture were very similar to FRAX, apart from chronic obstructive pulmonary disease and malabsorptive intestinal disease. FRAX based on the NOGG and NOF models had an accuracy of 64.2 and 58.7%, respectively.

Conclusion

CRFs used in FRAX® were similar to those in the Southern Brazil. The NOGG model seems to be more accurate to discriminate patients with increased fracture risk in this population compared to the NOF model, but not significantly.
Appendix
Available only for authorised users
Literature
2.
go back to reference Kanis JA (2008) On behalf of the WHO Scientific Group. Assessment of osteoporosis at the primary health-care level. WHO Collaborating Centre, University of Sheffield, UK, Technical Report. Sheffield http://www.shef.ac.uk/FRAX Kanis JA (2008) On behalf of the WHO Scientific Group. Assessment of osteoporosis at the primary health-care level. WHO Collaborating Centre, University of Sheffield, UK, Technical Report. Sheffield http://​www.​shef.​ac.​uk/​FRAX
6.
go back to reference Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jónsson PV, Poór G, Sisson de Castro JA, Xu L, Matkin CC, Nelson LM, Heyse SP (1999) International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization program for research on aging. Osteoporos Int 9(3):242–253. https://doi.org/10.1007/s001980050144 CrossRefPubMed Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jónsson PV, Poór G, Sisson de Castro JA, Xu L, Matkin CC, Nelson LM, Heyse SP (1999) International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization program for research on aging. Osteoporos Int 9(3):242–253. https://​doi.​org/​10.​1007/​s001980050144 CrossRefPubMed
9.
go back to reference Komatsu RS, Ramos LR, Szejnfeld VL (2004) Incidence of proximal femur fractures in Marilia, Brazil. J Nutr Health Aging 8(5):362–367PubMed Komatsu RS, Ramos LR, Szejnfeld VL (2004) Incidence of proximal femur fractures in Marilia, Brazil. J Nutr Health Aging 8(5):362–367PubMed
13.
go back to reference Xu L, Cummings SR, Qin M, Zhao X, Chen X, Nevitt M, Stone K (2000) Vertebral fractures in Beijing, China: the Beijing Osteoporosis Project. J Bone Miner Res 15(10):2015–2019 Xu L, Cummings SR, Qin M, Zhao X, Chen X, Nevitt M, Stone K (2000) Vertebral fractures in Beijing, China: the Beijing Osteoporosis Project. J Bone Miner Res 15(10):2015–2019
14.
go back to reference Lunt M, Felsenberg D, Reeve J, Benevolenskaya L, Cannata J, Dequeker J, Dodenhof C, Falch JA, Masaryk P, Pols HAP, Poor G, Reid DM, Scheidt-Nave C, Weber K, Varlow J, Kanis JA, O'Neill TW, Silman AJ (1997) Bone density variation and its effects on risk of vertebral deformity in men and women studied in thirteen European centers: the EVOS study. J Bone Miner Res 12(11):1883–1894. https://doi.org/10.1359/jbmr.1997.12.11.1883 CrossRefPubMed Lunt M, Felsenberg D, Reeve J, Benevolenskaya L, Cannata J, Dequeker J, Dodenhof C, Falch JA, Masaryk P, Pols HAP, Poor G, Reid DM, Scheidt-Nave C, Weber K, Varlow J, Kanis JA, O'Neill TW, Silman AJ (1997) Bone density variation and its effects on risk of vertebral deformity in men and women studied in thirteen European centers: the EVOS study. J Bone Miner Res 12(11):1883–1894. https://​doi.​org/​10.​1359/​jbmr.​1997.​12.​11.​1883 CrossRefPubMed
15.
go back to reference Compston J, Bowring C, Cooper A, Cooper C, Davies C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P, National Osteoporosis Guideline Group (2013) National Osteoporosis Guideline Group. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75(4):392–396. https://doi.org/10.1016/j.maturitas.2013.05.013 CrossRefPubMed Compston J, Bowring C, Cooper A, Cooper C, Davies C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P, National Osteoporosis Guideline Group (2013) National Osteoporosis Guideline Group. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75(4):392–396. https://​doi.​org/​10.​1016/​j.​maturitas.​2013.​05.​013 CrossRefPubMed
16.
go back to reference Kanis JA, Harvey NC, Cyrus Cooper C, Johansson H, Odén A, McCloskey EV, the Advisory Board of the National Osteoporosis Guideline Group (2016) A systematic review of intervention thresholds based on FRAX. A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos. 11(1):25 Kanis JA, Harvey NC, Cyrus Cooper C, Johansson H, Odén A, McCloskey EV, the Advisory Board of the National Osteoporosis Guideline Group (2016) A systematic review of intervention thresholds based on FRAX. A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos. 11(1):25
18.
go back to reference Gallagher JC, Melton LJ, Riggs BL, Bergstralh E (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res 150:163–171 Gallagher JC, Melton LJ, Riggs BL, Bergstralh E (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res 150:163–171
22.
go back to reference Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China: the Beijing Osteoporosis Project. Am J Epidemiol 144(9):901–907CrossRefPubMed Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China: the Beijing Osteoporosis Project. Am J Epidemiol 144(9):901–907CrossRefPubMed
26.
go back to reference Guimarães SVM, Fuchs SC, Vanni BF, Silva BH, Castro JAS (2002) Predictors of total body bone mass in pre-menopausal women of Southern Brazil: a population-based study. Reprod Clim 17(2):112–117 Guimarães SVM, Fuchs SC, Vanni BF, Silva BH, Castro JAS (2002) Predictors of total body bone mass in pre-menopausal women of Southern Brazil: a population-based study. Reprod Clim 17(2):112–117
27.
go back to reference Black DM, Palermo L, Pearson J, Abbott T, Johnell O (1998) A simple, useful risk factor system can identify the large majority of women with osteoporosis. Bone 23(Suppl. 5):605 Black DM, Palermo L, Pearson J, Abbott T, Johnell O (1998) A simple, useful risk factor system can identify the large majority of women with osteoporosis. Bone 23(Suppl. 5):605
28.
go back to reference Cadarette SM, Jaglal SB, Krieger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 162(9):1289–1294PubMedPubMedCentral Cadarette SM, Jaglal SB, Krieger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 162(9):1289–1294PubMedPubMedCentral
31.
go back to reference Dargent-Molina P, Douchin MN, Cormier C, Meunier PJ, Bréart G (2002) EPIDOS Study Group. Use of clinical risk factors in elderly women with low bone mineral density to identify women at higher risk of hip fracture: the EPIDOS prospective study. Osteoporos Int 13(7):593–599. https://doi.org/10.1007/s001980200078 CrossRefPubMed Dargent-Molina P, Douchin MN, Cormier C, Meunier PJ, Bréart G (2002) EPIDOS Study Group. Use of clinical risk factors in elderly women with low bone mineral density to identify women at higher risk of hip fracture: the EPIDOS prospective study. Osteoporos Int 13(7):593–599. https://​doi.​org/​10.​1007/​s001980200078 CrossRefPubMed
35.
go back to reference Wardlaw GM (1996) Putting body weight and osteoporosis into perspective. Am J Clin Nutr 63(3 Suppl):433S–436SCrossRefPubMed Wardlaw GM (1996) Putting body weight and osteoporosis into perspective. Am J Clin Nutr 63(3 Suppl):433S–436SCrossRefPubMed
36.
go back to reference Hans DB, Kanis JA, Baim S, Bilezikian JP, Binkley NB, Cauley JA, Compston JE, Cooper C, Dawson-Hughes B, Fuleihan GE, Leslie WD, Lewiecki EM, Luckey MM, McCloskey EV, Papapoulos SE, Poiana C, Rizzoli R (2011) On behalf of the FRAX® Position Development Conference Members. Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J Clin Densitom 14(3):171–180. https://doi.org/10.1016/j.jocd.2011.05.007 CrossRefPubMed Hans DB, Kanis JA, Baim S, Bilezikian JP, Binkley NB, Cauley JA, Compston JE, Cooper C, Dawson-Hughes B, Fuleihan GE, Leslie WD, Lewiecki EM, Luckey MM, McCloskey EV, Papapoulos SE, Poiana C, Rizzoli R (2011) On behalf of the FRAX® Position Development Conference Members. Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J Clin Densitom 14(3):171–180. https://​doi.​org/​10.​1016/​j.​jocd.​2011.​05.​007 CrossRefPubMed
41.
go back to reference Romme EA, Smeenk FW, Rutten EP, Wouters OF (2013) Osteoporosis in chronic obstructive pulmonary disease. Expert Rev Respir Med 7(4):397–410CrossRefPubMed Romme EA, Smeenk FW, Rutten EP, Wouters OF (2013) Osteoporosis in chronic obstructive pulmonary disease. Expert Rev Respir Med 7(4):397–410CrossRefPubMed
43.
go back to reference Silva O (2015) Prevention and treatment of bone fragility in cancer patient. Clin Cases Miner Bone Metab 12(2):116–129 Silva O (2015) Prevention and treatment of bone fragility in cancer patient. Clin Cases Miner Bone Metab 12(2):116–129
44.
go back to reference Reyes C, Estrada P, Nogués X, Orozco P, Cooper C, Díez-Pérez A, Formiga F, González-Macías J, Prieto-Alhambra D (2014) The impact of common co-morbidities (as measured using the Charlson index) on hip fracture risk in elderly men: a population-based cohort study. Osteoporos Int 25(6):1751–1758. https://doi.org/10.1007/s00198-014-2682-9 CrossRefPubMed Reyes C, Estrada P, Nogués X, Orozco P, Cooper C, Díez-Pérez A, Formiga F, González-Macías J, Prieto-Alhambra D (2014) The impact of common co-morbidities (as measured using the Charlson index) on hip fracture risk in elderly men: a population-based cohort study. Osteoporos Int 25(6):1751–1758. https://​doi.​org/​10.​1007/​s00198-014-2682-9 CrossRefPubMed
Metadata
Title
Evaluation of clinical risk factors for osteoporosis and applicability of the FRAX tool in Joinville City, Southern Brazil
Authors
Dalisbor Marcelo Weber Silva
Victoria Zeghbi Cochenski Borba
John A. Kanis
Publication date
01-12-2017
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2017
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-017-0405-5

Other articles of this Issue 1/2017

Archives of Osteoporosis 1/2017 Go to the issue