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Assessing the risk of osteoporotic fractures: the Ecuadorian FRAX model

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Abstract

Summary

The FRAX tool incorporates data on the incidence of fractures and mortality in each country. The epidemiology of fractures changes over time, this makes it necessary to update the specific FRAX model of each population. It is shown that there are differences between old and new FRAX models in older individuals.

Purpose

A new FRAX® model for Ecuador was released online in April 2019. This paper describes the data used to build the revised model, its characteristics, and how intervention and assessment thresholds were constructed.

Methods

The national rates of hip fracture incidence standardized by age and sex from the age of 40 years for 2016 were used to synthesize a FRAX model for Ecuador. For other major fractures, Ecuadorian incidence rates were calculated using ratios obtained in Malmö, Sweden, for other major osteoporotic fractures. The new FRAX model was compared with the previous model released in 2012. Assessment and intervention thresholds were based on age-specific probabilities of a major osteoporotic fracture equivalent to women with a previous fracture.

Results

Fracture incidence rates increase with age. The probability of hip or major fractures at 10 years increased in patients with a clinical risk factor, lower BMI, female sex, a higher age, and a lower BMD T-score. Compared to the previous model, the new FRAX model gave similar 10-year fracture probabilities in men and women age less than70 years but substantially higher above this age. Notwithstanding, there were very close correlations in fracture probabilities between the two models (> 0.99) so that the revision had little impact on the rank order of risk.

Conclusions

The FRAX tool provides a country-specific fracture prediction model for Ecuador. This update of the model is based on the original FRAX methodology, which has been validated externally in several independent cohorts. The FRAX model is an evolving tool that is being continuously refined, as the databases of each country are updated with more epidemiological information.

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Author information

Authors and Affiliations

  1. AECE Research Group from Association of Clinical Endocrinologists of Ecuador, Avenida de la Américas S/N y E.Noboa, Guayaquil, Ecuador

    Enrique Lopez Gavilanez, Angel Segale Bajana, Denisse Marriott Blum & Mario Navarro Grijalva

  2. Servicio de Endocrinología, Hospital Docente de la Policía Nacional Guayaquil No. 2, Avenida de la Américas S/N y E.Noboa, Guayaquil, Ecuador

    Enrique Lopez Gavilanez

  3. Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Helena Johansson

  4. Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia

    Helena Johansson & John A Kanis

  5. Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK

    Eugene McCloskey

  6. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, S10 2RX, Sheffield, UK

    Eugene McCloskey & John A Kanis

  7. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO17 1BJ, UK

    Nicholas C Harvey

  8. Servicio de Medicina Interna. Hospital Docente de la Policía Nacional Guayaquil No. 2, Guayaquil, Ecuador

    Angel Segale Bajana, Denisse Marriott Blum & Mario Navarro Grijalva

  9. Unidad de Enfermedades Metabólicas Óseas, Fundación Jiménez Diaz, Madrid, Spain

    Manuel Diaz Curiel

Authors
  1. Enrique Lopez Gavilanez
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  2. Helena Johansson
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  3. Eugene McCloskey
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  4. Nicholas C Harvey
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  5. Angel Segale Bajana
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  6. Denisse Marriott Blum
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  7. Mario Navarro Grijalva
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  8. Manuel Diaz Curiel
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  9. John A Kanis
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Corresponding author

Correspondence to Enrique Lopez Gavilanez.

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This study was reviewed and approved by the Ethics Committee of the Teaching Hospital of the National Police Guayaquil No. 2.

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Lopez Gavilanez, E., Johansson, H., McCloskey, E. et al. Assessing the risk of osteoporotic fractures: the Ecuadorian FRAX model. Arch Osteoporos 14, 93 (2019). https://doi.org/10.1007/s11657-019-0644-8

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