Summary

We analyzed the practical consequences of applying an adjusted FRAX® for recent fractures in a FLS. After analyzing 2777 patients, we concluded that the adjusted FRAX® is irrelevant when calculating FRAX® with DXA and is only useful for fractures of the humerus when DXA is not available.

Purpose

A FRAX® adjusted to fractures less than 2 years old has been proposed. The objective of this work was to analyze the clinical implications of applying the adjusted FRAX® instead of the classic FRAX® in a fracture liaison service (FLS) unit.

Methods

Adults aged 50 years or older with fragility fractures (hip, spine, humerus, and forearm) that occurred in the 12 months prior to the baseline visit were included. We recorded demographic data, type of fracture, DXA, classic FRAX®, and FRAX® adjusted for recent fractures and indications for anti-osteoporotic medication (AOM) following the guidelines of the Spanish Society of Rheumatology.

Results

A total of 2777 patients were included, mean age 73 years, 84% women. The type of fracture was as follows: forearm (n = 958; 34.5%), hip (n = 781; 28.1%), humerus (n = 642; 23.1%), and spine (n = 397, 14.3%). DXA was performed in 2134 cases (76.8%). A total of 2522 patients (90.8%) were candidates for AOM (100% involving the hip and spine, 83% forearm, and 85% humerus). FRAX®-hip ≥ 3% increased from 1601 to 1775 cases (57.6 to 64%). The average FRAX®-hip (SD) increased from 5.7 (6) to 7.5 (9) (4.6 to 8.8 in males and 5.9 to 7.3 in females). The percentage of forearm fracture candidates for AOM, with or without DXA, did not change after FRAX®-hip adjustment, while the number of patients with humerus fractures increased from 59 to 80% in those who did not have DXA. In the entire sample, FRAX®-adjusted led to an indication of AOM for 15 additional patients (0.5% of major fractures): 14 with a humerus fracture and 1 with a forearm fracture.

Conclusions

The adjusted FRAX® for recent fractures in an FLS unit in an adjusted FRAX® is irrelevant when calculating FRAX® with DXA; in fact, it is only useful for fractures of the humerus when DXA is not available.

中文翻译：

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针对近期骨折调整的 FRAX® 对 FLS 治疗指征的影响

概括

我们分析了应用调整后的 FRAX® 治疗 FLS 近期骨折的实际结果。在分析了 2777 名患者后，我们得出结论，在使用 DXA 计算 FRAX® 时，调整后的 FRAX® 是无关紧要的，并且仅在 DXA 不可用时才对肱骨骨折有用。

目的

已提议将 FRAX® 调整为小于 2 年的骨折。这项工作的目的是分析在骨折联络服务 (FLS) 单元中应用调整后的 FRAX® 而不是经典 FRAX® 的临床意义。

方法

纳入基线访视前 12 个月内发生脆性骨折（髋部、脊柱、肱骨和前臂）的 50 岁或以上成人。我们根据西班牙风湿病学会的指南记录了人口统计数据、骨折类型、DXA、经典 FRAX® 和根据近期骨折和抗骨质疏松药物 (AOM) 适应症调整的 FRAX®。

结果

共纳入 2777 名患者，平均年龄 73 岁，84% 为女性。骨折类型如下：前臂（n  = 958；34.5%）、髋部（n  = 781；28.1%）、肱骨（n  = 642；23.1%）和脊柱（n = 397, 14.3%)。2134 例 (76.8%) 进行了 DXA。共有 2522 名患者 (90.8%) 是 AOM 的候选者（100% 涉及髋部和脊柱，83% 涉及前臂，85% 涉及肱骨）。FRAX®-hip ≥ 3% 从 1601 例增加到 1775 例（57.6 至 64%）。平均 FRAX®-髋关节 (SD) 从 5.7 (6) 增加到 7.5 (9)（男性为 4.6 至 8.8，女性为 5.9 至 7.3）。在 FRAX®-髋关节调整后，AOM 候选前臂骨折的百分比（有或没有 DXA）没有变化，而没有进行 DXA 的患者中，肱骨骨折患者的数量从 59% 增加到 80%。在整个样本中，经过 FRAX® 调整后，另外 15 名患者（占主要骨折的 0.5%）出现 AOM 指征：14 名肱骨骨折，1 名前臂骨折。

结论

在使用 DXA 计算 FRAX® 时，调整后的 FRAX® 中 FLS 单元近期骨折的调整后 FRAX® 是无关紧要的；事实上，它仅在无法使用 DXA 时对肱骨骨折有用。