Latin America's population is ageing and as a result the region is facing a rapid increase in the prevalence of osteoporosis and fragility fractures.
The newly published Fracture Risk Assessment Tool (FRAX) -based intervention thresholds for seven Latin American countries represent a substantial advance in the detection of both men and women at high risk of fracture, particularly in the elderly.1
FRAX is used to calculate the ten-year probability of fragility fracture in both men and women, with or without the inclusion of bone mineral density (BMD).2
The new study has used country-specific epidemiological data to compute FRAX-based intervention and BMD assessment thresholds for men and women aged over 40 years, for the following seven countries: Argentina, Brazil, Colombia, Chile, Ecuador, Mexico and Venezuela.
The age-specific intervention thresholds for the seven countries varied considerably, ranging from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively.
Professor Patricia Clark, Head of the Clinical Epidemiology Unit, Hospital Infantil de Mexico, stated:
"Due to the ageing of the population, Latin America is seeing steep increases in the number of individuals suffering fragility fractures. For example, in Mexico, we project a 531% increase in the number of hip fractures between 2005 and 2050, with similar estimates for Brazil. It is therefore of great importance that we are able to accurately estimate patients' risk of fracture in order to take preventive action before potentially devastating fragility fractures occur."
Fractures of the spine and hip have a serious impact on quality of life, with hip fractures in particular resulting in long-term disability and early death for approximately 20-24% of patients within a year of the fracture. For this reason, identifying individuals who are at high risk of suffering future fractures is a first critical step - followed by providing lifestyle and pharmacological therapy to those who benefit most.
Professor John Kanis, Emeritus Professor in Human Metabolism, Director of the Centre for Metabolic Bone Diseases, University of Sheffield, UK, and Professorial Fellow at the Catholic University of Australia (Melbourne), stated:
"The newly established intervention thresholds enhance the utility of the FRAX tool for these seven countries, offering clinicians important information to guide treatment decisions, and providing public health agencies with a framework to develop appropriate prevention programs."
Significantly, the study has revealed great heterogeneity in fracture probabilities and thresholds between the seven countries. The highest probabilities in individuals with prior fracture were seen in Argentina, and the lowest in Ecuador. This confirms that country-specific FRAX models are required, rather than a global regional model.
1. Clark, P., Denova-Gutiérrez, E., Zerbini, C. et al. FRAX-based intervention and assessment thresholds in seven Latin American countries. Osteoporos Int (2017). https://doi.org/10.1007/s00198-017-4341-4 https://link.springer.com/article/10.1007/s00198-017-4341-4
2. FRAX® - Fracture Risk Assessment Tool https://www.sheffield.ac.uk/FRAX/
FRAX® is a simple calculation tool that integrates clinical information in a quantitative manner to predict a 10-year probability of major osteoporotic fracture for both women and men in different countries. The tool was developed at the Centre for Metabolic Bone Diseases, University of Sheffield, UK in collaboration with international researchers. It assists primary health-care providers to better target people in need of interventions to reduce fracture risk, thus improving the allocation of health-care resources towards patients most likely to benefit from treatment. The FRAX calculator is now freely available for 63 countries and in 34 languages. https://www.sheffield.ac.uk/FRAX/
The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as 240 patient, medical and research societies in 99 locations, work together to make fracture prevention and healthy mobility a worldwide heath care priority. http://www.iofbonehealth.org / http://www.facebook.com/iofbonehealth @iofbonehealth