title: Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures.
abstract: OBJECTIVE
  To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures.
  
  
  METHODS
  A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions.
  
  
  RESULTS
  10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible.
  
  
  CONCLUSIONS
  Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.
authors.forename: Andréa
authors.initials: A
authors.lastname: Marques
authors.forename: Ana M
authors.initials: AM
authors.lastname: Rodrigues
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Romeu
authors.forename: Afonso
authors.initials: A
authors.lastname: Ruano
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Barbosa
authors.forename: Eugénia
authors.initials: E
authors.lastname: Simões
authors.forename: Fernanda
authors.initials: F
authors.lastname: Águas
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
authors.forename: José Delgado
authors.initials: JD
authors.lastname: Alves
authors.forename: Raquel
authors.initials: R
authors.lastname: Lucas
authors.forename: Jaime Cunha
authors.initials: JC
authors.lastname: Branco
authors.forename: Jorge
authors.initials: J
authors.lastname: Laíns
authors.forename: Mário
authors.initials: M
authors.lastname: Mascarenhas
authors.forename: Susete
authors.initials: S
authors.lastname: Simões
authors.forename: Viviana
authors.initials: V
authors.lastname: Tavares
authors.forename: Oscar
authors.initials: O
authors.lastname: Lourenço
authors.forename: José António Pereira
authors.initials: JA
authors.lastname: da Silva
mesh_terms: D015502:Absorptiometry, Photon; D006801:Humans; D033183:Interdisciplinary Communication; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D011174:Portugal; D017410:Practice Guidelines as Topic