[FRAX® thresholds to identify people with high or low risk of osteoporotic fracture in Spanish female population].
OBJECTIVE
To detect FRAX(®) threshold levels that identify groups of the population that are at high/low risk of osteoporotic fracture in the Spanish female population using a cost-effective assessment.


METHODS
This is a cohort study. Eight hundred and sixteen women 40-90 years old selected from the FRIDEX cohort with densitometry and risk factors for fracture at baseline who received no treatment for osteoporosis during the 10 year follow-up period and were stratified into 3 groups/levels of fracture risk (low<10%, 10-20% intermediate and high>20%) according to the real fracture incidence.


RESULTS
The thresholds of FRAX(®) baseline for major osteoporotic fracture were: low risk<5; intermediate ≥ 5 to <7.5 and high ≥ 7.5. The incidence of fracture with these values was: low risk (3.6%; 95% CI 2.2-5.9), intermediate risk (13.7%; 95% CI 7.1-24.2) and high risk (21.4%; 95% CI12.9-33.2). The most cost-effective option was to refer to dual energy X-ray absorptiometry (DXA-scan) for FRAX(®)≥ 5 (Intermediate and high risk) to reclassify by FRAX(®) with DXA-scan at high/low risk. These thresholds select 17.5% of women for DXA-scan and 10% for treatment. With these thresholds of FRAX(®), compared with the strategy of opportunistic case finding isolated risk factors, would improve the predictive parameters and reduce 82.5% the DXA-scan, 35.4% osteoporosis prescriptions and 28.7% cost to detect the same number of women who suffer fractures.


CONCLUSIONS
The use of FRAX ® thresholds identified as high/low risk of osteoporotic fracture in this calibration (FRIDEX model) improve predictive parameters in Spanish women and in a more cost-effective than the traditional model based on the T-score ≤ -2.5 of DXA scan.
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Medicina de Familia, CAP Badía del Vallés, Institut Català de la Salut (ICS), USR MN-IDIAP Jordi Gol, Barcelona, España; Departamento de Medicina, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, España. Electronic address: rafael.azagra@uab.cat.
Rafael
R
Azagra
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Medicina de Familia, CAP Sant Llàtzer, Corporació Sanitària de Terrassa, Terrassa, Barcelona, España.
Genís
G
Roca
Bioestadística, Departamento de Ciencias Básicas, Universitat Internacional de Catalunya, Campus Sant Cugat, Sant Cugat del Vallés, Barcelona, España.
Juan Carlos
JC
Martín-Sánchez
Reumatología, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
Enrique
E
Casado
Medicina Nuclear, Hospital Universitari Vall d'Hebron, Institut Català de la Salut (ICS), Barcelona, España.
Gloria
G
Encabo
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Medicina de Familia, CAP Girona-2, Institut Català de la Salut (ICS)-USR Girona, IDIAP Jordi Gol, Girona, España.
Marta
M
Zwart
Medicina de Familia, CAP Granollers Centre, Institut Català de la Salut (ICS), Granollers, Barcelona, España.
Amada
A
Aguyé
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Departamento de Medicina Interna, URFOA, IMIM, Parc de Salut Mar, Barcelona, España; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III-FEDER, Madrid, España.
Adolf
A
Díez-Pérez
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D015992:Body Mass Index; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009862:Online Systems; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D018579:Patient Selection; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D014807:Vitamin D / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium
Absorciometría dual de rayos X; Cost-effectiveness; Coste-efectividad; Dual-energy X-ray absorptiometry; FRAX(®); Fractura osteoporótica; Osteoporosis; Osteoporotic fracture