La salud de la mujer / Woman's HealthFRAX: detectando el riesgo de fractura osteoporótica
La OMS ha dado a conocer la nueva herramiento para calcular el riesgo de fracturas que se producirán en 10 años en personas con osteoporosis. La herramienta se llama FRAX y se basa en modelos individuales que combinan e integran factores clínicos de riesgo con la densidad mineral ósea (DMO) del cuello femoral.
Los modelos FRAX se han desarrollado a partir del estudio de grupos poblacionales de Europa, América del Norte, Asia y Australia. Se trata de un programa informático que se encuentra disponible en la web. También se pueden descargar otras versiones simplificadas que utilizan los factores de riesgo que haya disponibles. Los algoritmos de FRAX calculan la probabilidad de fractura de cadera y de las fracturas osteoporóticas más importantes a 10 años (fractura clínica vertebral, antebrazo, cadera u hombro).
La osteoporosis es una enfermedad muy frecuente (en España afecta a 2,5 millones de mujeres) que se caracteriza por una disminución de la densidad de los huesos por pérdida del tejido óseo normal. Aunque no es la única enfermedad del metabolismo oseo, sí es la más frecuente. El hueso está correctamente calcificado, pero existe menor cantidad de hueso por unidad de volumen. Esto conlleva una disminución de la resistencia del hueso frente a los traumatismos o la carga, con la consiguiente aparición de fracturas.
Osteoporos Int. 2008 Apr;19(4):385-97. 
FRAX and the assessment of fracture probability in men and women from the UK.
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E.
WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
SUMMARY: A fracture risk assessment tool (FRAX) is developed based on the use of clinical risk factors with or without bone mineral density tests applied to the UK. INTRODUCTION: The aim of this study was to apply an assessment tool for the prediction of fracture in men and women with the use of clinical risk factors (CRFs) for fracture with and without the use of femoral neck bone mineral density (BMD). The clinical risk factors, identified from previous meta-analyses, comprised body mass index (BMI, as a continuous variable), a prior history of fracture, a parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis and other secondary causes of osteoporosis, current smoking, and alcohol intake 3 or more units daily. METHODS: Four models were constructed to compute fracture probabilities based on the epidemiology of fracture in the UK. The models comprised the ten-year probability of hip fracture, with and without femoral neck BMD, and the ten-year probability of a major osteoporotic fracture, with and without BMD. For each model fracture and death hazards were computed as continuous functions. RESULTS: Each clinical risk factor contributed to fracture probability. In the absence of BMD, hip fracture probability in women with a fixed BMI (25 kg/m(2)) ranged from 0.2% at the age of 50 years for women without CRF's to 22% at the age of 80 years with a parental history of hip fracture (approximately 100-fold range). In men, the probabilities were lower, as was the range (0.1 to 11% in the examples above). For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above. The presence of one or more risk factors increased probabilities in an incremental manner. The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter. CONCLUSION: The models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD.
menopausia climaterio
salud de la mujer
women's health
ginecologia
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