FRAX TM: construindo uma ideia para o Brasil

Abstract

ResumoDiferenças genéticas, raciais e antropométricas, bem como da composição corporal, densidade óssea, dieta, atividade física e outros hábitos de vida, contribuem para explicar as divergên-cias na incidência e prevalência de baixa densidade óssea e fraturas em diversos países do mundo. Recentemente, foi desenvolvida uma ferramenta, denominada FRAX TM , para aglutinar os fatores clínicos de risco (genéticos e ambientais) e a densidade óssea, a fim de quantificar a probabilidade de fratura osteoporótica nos próximos dez anos. Em breve, ela será utilizada para indicação de tratamento em pacientes de risco. No entanto, atualmente, está disponí-vel somente para uso em algumas populações que possuem banco de dados prospectivos e consistentes -o que não inclui o Brasil. Este estudo teve o objetivo de fazer uma revisão dos estudos epidemiológicos nacionais e internacionais para melhor compreender peculiaridades e diferenças de fatores clínicos de risco, densidade óssea e probabilidade de fratura entre essas populações. Os autores concluíram que se faz necessária a obtenção de mais dados epidemiológicos representativos da população brasileira para utilização da ferramenta FRAX TM . Para isso, os estudos brasileiros deverão possuir características adequadas, como o delineamento prospectivo, avaliação da qualidade de vida, mortalidade e incapacidade física após as fraturas, levando em consideração a expectativa de vida da população brasileira e a análise de custos diretos e indiretos relacionados às fraturas por osteoporose. à luz do conhecimento atual, a utilização de qualquer um dos bancos de dados das populações, disponibilizadas pelo FRAX AbstRActGenetic and racial background, body composition, bone mineral density (BMD), diet, physical activity and life style help to explain the wide difference observed in the world prevalence and incidence of osteoporosis. Recently, a fracture assessment tool, named FRAX TM , was developed to integrate clinical risk factors (genetic and environmental conditions) and BMD, in order to quantify the ten-year probability of an osteoporotic fracture. Shortly, it will be used to indicate treatment for high risk patients. However, this tool is now available only to those populations with known reliable and prospective epidemiologic data of the osteoporotic fractures -fact that does not include the Brazilian population. The aim of this paper was to review the main national and international epidemiologic studies to better understand the differences between the clinical risk factors, BMD and fracture probability of these populations. The authors concluded that, to use the FRAX TM tool, it is necessary more epidemiological data that could characterize the Brazilian population. The future studies should be prospective, evaluate the quality of life, mortality and morbidity after a fracture, as well the life expectancy of the population and the cost-effectiveness and utility related to the osteoporotic fracture. In fact, it is not recommended to use any of the populations available in the FRAX...

Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women

“…Besides, longitudinal and prospective studies should be carried out and the FRAX TM tool should be validated for use in Brazil. 25 Due to its high prevalence and association with mortality and disability, osteoporosis and its main consequence -fracture due to bone frailty -should be considered public health problems in Brazil. The implementation of educational actions is extremely important to prevent high prevalence of osteoporosis related to aging, such as quit smoking, alcohol consumption abuse and promotion of regular physical activities and intake of dairy products.…”

“…However, calculating the absolute risk of fracture depends on the population studied and this tool has not yet been approved for use in Brazil, as there is no reference database. 25 Therefore, further representative epidemiological data on the Brazilian population are needed.…”

Development and validation of a tool for identifying women with low bone mineral density and low-impact fractures: the São Paulo Osteoporosis Risk Index (SAPORI)

“…The FRAX TM tool has recently been used for this purpose and objectively provides a 10-year probability of major hip fractures [20,21]. In Brazil, however, there are no validated measures for the identification of individuals at greater risk, and the FRAX TM tool should not be used, as there are no consistent, specific, and prospective data in the Brazilian population [22]. Performing a BMD and lowimpact fractures' multifactorial analysis from the Brazilian population studied by the Brazilian Osteoporosis Study (BRAZOS) [14], Pinheiro et al found that none of previous tools had good performance for identifying individuals at risk of osteoporotic fracture [22].…”

Asymptomatic vertebral fractures in patients with low bone mineral density

“…are genetically defined, while 30% is potentially modifiable and, thus, has to do with environmental issues. 21 Mean BMI of patients with vertebral fractures was 25.51 compared to the average of 26.44 in those who did not have fractures, although not statistically significant. Increased mechanical load on the skeleton can cause an adjustment in bone tissue to support greater mechanical strength.…”

“…According to Pinheiro et al, there are no studies to support this variable as a risk factor for vertebral fractures in the Brazilian population. 21 The practice of physical activity would impact the increase in BMD, if practiced until reaching a peak in which the individual is subject to gain bone mass. From a certain age, around 30 years, people would only lose bone mass, and physical activity would no longer be relevant.…”