OBJECTIVE: To develop a simple and easy-to-use tool for identifying osteoporotic women (femoral neck bone mineral density [BMD] Tscores À 2.5) in Latin America. DESIGN:Retrospective study involving review of medical records.SETTING: Osteoporosis clinics in 6 Latin American countries. PATIENTS:Postmenopausal women ages ! 50 in Latin America who had femoral neck BMD measurements. MEASUREMENTS AND MAIN RESULTS:A risk index was developed from 1,547 patients based on least square regression using age, weight, history of fractures, and other variables as predictors for BMD T-score. The final model was simplified by reducing the number of predictors; sensitivity and specificity were evaluated before and after reducing the number of predictors to assess performance of the index. The final model included age, weight, country, estrogen use, and history of fractures as significant predictors for T-score. The resulting scoring index achieved 91% sensitivity and 47% specificity. Simplifying the index by using only age and weight yielded similar performance (sensitivity, 92%; specificity, 45%). Three risk categories were identified based on OsteoRisk, the index using only age and body weight: high-risk patients (index o =À 2; 65.6% were osteoporotic), moderate-risk patients ( À 2o index o =1; 26.7% were osteoporotic), and low-risk patients (index41; 8% were osteoporotic). Similar results were seen in a validation sample of 279 women in Brazil.CONCLUSION: Age and weight alone performed well for predicting the risk of osteoporosis among postmenopausal women. The OsteoRisk is an easy-to-use tool that effectively targets the vast majority of osteoporotic patients in Latin America for evaluation with BMD. Although patients with fracture should automatically be considered for treatment for osteoporosis, and assessment of bone mineral density (BMD) using dual energy x-ray absorptiometry (DXA) is the standard for diagnosing osteoporosis prior to fracture, facilities for DXA measurements remain limited in Latin America and certain other parts of the world, and this poses a serious challenge for diagnosing osteoporosis in patients without prior fracture.Some researchers have examined the relationship between clinical variables and bone mass in the hope of targeting BMD measurements to patients who are more likely to have osteoporosis.14-20 Lydick et al. 17 developed a model that accurately identifies 90% of subjects with low bone mass and 40% of subjects with normal bone mass. Recently, Koh et al. 18 developed an index, the Osteoporosis Self-assessment Tool for Asians (OSTA), for identifying women at increased risk of osteoporosis in a population of Asian patients other than Japanese. The OSTA is based only on age and weight and achieved a sensitivity of 91% for identifying women with osteoporosis; it was further validated in a cohort of Japanese women, with a sensitivity of 98%. 19 The Osteoporosis Self-assessment Tool (OST) was derived from the OSTA by altering the risk category ranges, and performed well in identifying women at...
In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model.
Objective This study aimed to evaluate platelet counts at delivery in uncomplicated pregnancies between 37 and 41 weeks of gestation. Study Design Platelet counts in women 16 to 45 years of age from August 1, 2011, through May 15, 2018, with a singleton pregnancy that delivered from 370/7 to 416/7 weeks of gestation. Women with pregnancy-related complications, preexisting disorders, or on medications that could affect platelet counts were excluded. Results A total of 18,526 women had uncomplicated pregnancies with mean platelet count from 370/7 to 416/7 weeks of gestation of 220 × 109/L. The lower limit 95th percentile (2.5% quantile) was 120 × 109/L. Platelet counts decreased weekly from 37 to 41 weeks of gestation, becoming significant at 39 weeks of gestation and beyond, compared with 37 weeks (p < 0.01). Mean platelet counts: 225 × 109/L at 37 weeks, 223 × 109/L at 38 weeks, 219 × 109/L at 39 weeks, 218 × 109/L at 40 weeks, and 216 × 109/L at 41 weeks of gestation. Platelet counts of less than 150 × 109/L occurred in 9.7%. Conclusion Platelet counts in uncomplicated pregnancies decrease weekly from 37 to 41 weeks of gestation. This will be important to consider when serial platelet values are monitored for other indications.
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