Letter to the Editor
FRAX-based assessment and intervention thresholds in Ecuador
Umbrales de evaluación e intervención basados en FRAX en Ecuador
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array:22 [ "pii" => "S0121812321000013" "issn" => "01218123" "doi" => "10.1016/j.rcreu.2020.11.003" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "1849" "copyright" => "Asociación Colombiana de Reumatología" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Colomb Reumatol. 2022;29:436-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S0121812321000621" "issn" => "01218123" "doi" => "10.1016/j.rcreu.2021.03.008" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "1890" "copyright" => "Asociación Colombiana de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Colomb Reumatol. 2022;29:434-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Interferon therapy: Mechanism of renal thrombotic microangiopathy in multiple sclerosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "434" "paginaFinal" => "435" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia con interferón: mecanismo de microangiopatía trombótica renal en la esclerosis multiple" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mohammad Bahadoram, Bijan Keikhaei, Mohammad-Reza Mahmoudian-Sani, Kosar Alikhani, Ammar Helalinasab" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Mohammad" "apellidos" => "Bahadoram" ] 1 => array:2 [ "nombre" => "Bijan" "apellidos" => "Keikhaei" ] 2 => array:2 [ "nombre" => "Mohammad-Reza" "apellidos" => "Mahmoudian-Sani" ] 3 => array:2 [ "nombre" => "Kosar" "apellidos" => "Alikhani" ] 4 => array:2 [ "nombre" => "Ammar" "apellidos" => "Helalinasab" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0121812321000621?idApp=UINPBA00004N" "url" => "/01218123/0000002900000004/v1_202210190543/S0121812321000621/v1_202210190543/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "FRAX-based assessment and intervention thresholds in Ecuador" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "436" "paginaFinal" => "437" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Enrique López Gavilánez" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Enrique" "apellidos" => "López Gavilánez" "email" => array:1 [ 0 => "enrique_lopezg57@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "AECE Research Group, The Association of Clinical Endocrinologists of Ecuador, Ecuador" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Docente Policía Nacional Guayaquil N<span class="elsevierStyleSup"><span class="elsevierStyleUnderline">o</span></span> 2, Guayaquil, Ecuador" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Umbrales de evaluación e intervención basados en FRAX en Ecuador" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The building of country-specific FRAX models requires the introduction of up-to-date mortality and incidence data on major osteoporotic fractures and hip fractures in each country.</p><p id="par0010" class="elsevierStylePara elsevierViewall">I have read with great interest the paper by Maldonado et al., which was published in June 2020 in the Revista Colombiana de Reumatología.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The objective of the study was to develop intervention and assessment curves based on FRAX Ecuador. This study estimates the probability of major osteoporotic fractures and hip fractures without any risk factor and without the inclusion of bone mineral density (BMD) in the following scenarios: (1) Previous fracture history without the inclusion of BMD, (2) <span class="elsevierStyleItalic">T</span>-score −2.5 SD without other clinical risk factors, and (3) <span class="elsevierStyleItalic">T</span>-score −1.5 SD without other clinical risk factors.</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to Maldonado et al.,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> the probability of major osteoporotic fractures and hip fractures increased with age in women without risk factors, osteoporosis, and osteopenia.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, in August 2019 (9 months earlier) the intervention and assessment thresholds based on the revised FRAX Ecuador model (version 4.1) had already been developed, described, and published by Lopez Gavilanez E., in co-authorship with the researchers who created the FRAX algorithm.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> This article described the characteristics and methods used to build the FRAX Ecuador model and presents the tables of the probability of suffering a major osteoporotic fracture and hip fracture (%) at 10 years in men and women based on the presence of clinical risk factors (CFRs) in the absence of BMD. The graph of the corresponding FRAX-based intervention and assessment threshold curves that were launched in April 2019<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> is presented.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the discussion, Maldonado et al. declares “… which suggests that there has been no modification of the FRAX Ecuador calculator, although it is evident that the model used underestimates the probability of fracture of the Ecuadorian population”. However, the comparison between the two models (old and new) was previously published in WCO-IOF-ESCEO 2019.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> This publication demonstrated differences in the calculated probabilities of risk fractures and concluded that the old model underestimated these probabilities in the Ecuadorian population between 60 and 87 years.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In addition to the prediction of fracture risk, the primary utility of FRAX-based thresholds is to help to select suitable candidates for treatment or BMD assessment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Maldonado et al. did not measure the proportion of women who are eligible for intervention. However, with FRAX Ecuador version 4.1, our group made this calculation and found that the ratio is low, at ≤5% in both sexes and <2% in Ecuadorian women over 60 years of age.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Furthermore, it has consistently been shown that in countries where the incidence of hip fractures is low (<150 per 100,000 inhabitants) the FRAX-based fracture probability is also low (<10%), such as in Middle Eastern countries, Lebanon, Turkey, and Latin America (except Argentina).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> For countries where the proportion of individuals eligible for intervention is low, an alternative is the use of hybrid thresholds that combine age-specific thresholds and fixed thresholds to optimize the selection of eligible candidates for intervention.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack630619" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "FRAX-based assessment and intervention threshold curves for osteoporosis evaluation in Ecuador" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Maldonado" 1 => "M. Intriago" 2 => "R. Guerrero" 3 => "O.D. Messina" 4 => "C. Rios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rcreu.2020.04.004" "Revista" => array:5 [ "tituloSerie" => "Rev Colomb Reumatol" "fecha" => "2020" "volumen" => "27" "paginaInicial" => "155" "paginaFinal" => "160" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessing the risk of osteoporotic fractures: the Ecuadorian FRAX model" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Lopez Gavilanez" 1 => "H. Johansson" 2 => "E. McCloskey" 3 => "N.C. Harvey" 4 => "A. Segale Bajana" 5 => "D. Marriott Blum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11657-019-0644-8" "Revista" => array:5 [ "tituloSerie" => "Arch Osteoporos" "fecha" => "2019" "volumen" => "14" "paginaInicial" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31440846" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Secular changes in hip fracture incidence in Ecuador and implications for FRAX" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Johansson" 1 => "E. Lopez Gavilanez" 2 => "M. Navarro Grijalva" 3 => "E.V. McCloskey" 4 => "N.C. Harvey" 5 => "M. Lorentzon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00198-019-04993-w" "Revista" => array:6 [ "tituloSerie" => "Osteoporos Int" "fecha" => "2019" "volumen" => "30" "numero" => "Suppl. 2" "paginaInicial" => "384" "paginaFinal" => "385" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A decade of FRAX: how has it changed the management of osteoporosis?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Kanis" 1 => "N.C. Harvey" 2 => "H. Johansson" 3 => "E. Liu" 4 => "L. Vandenput" 5 => "M. Lorentzon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40520-019-01432-y" "Revista" => array:6 [ "tituloSerie" => "Aging Clin Exp Res" "fecha" => "2020" "volumen" => "32" "paginaInicial" => "187" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32043227" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of intervention and assessment thresholds based on the FRAX model in Ecuadorian postmenopausal women" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Lopez Gavilanez" 1 => "N. Bautista" 2 => "M. Navarro" 3 => "M. Hernandez" 4 => "J. Valdivieso" 5 => "L. Imaicela" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Osteoporos Int" "fecha" => "2020" "volumen" => "31" "numero" => "Suppl. I" "paginaInicial" => "522" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of hip fracture incidence and probability of fracture worldwide" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Kanis" 1 => "A. Odén" 2 => "E.V. McCloskey" 3 => "H. Johansson" 4 => "D. Wahl" 5 => "C. Cyrus Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00198-012-1964-3" "Revista" => array:6 [ "tituloSerie" => "Osteoporos Int" "fecha" => "2012" "volumen" => "23" "paginaInicial" => "2239" "paginaFinal" => "2256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22419370" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack630619" "titulo" => "Acknowledgments" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The Author wishes to thank ENAGO for professional academic English proofreading.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/01218123/0000002900000004/v1_202210190543/S0121812321000013/v1_202210190543/en/main.assets" "Apartado" => array:4 [ "identificador" => "44920" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas al editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/01218123/0000002900000004/v1_202210190543/S0121812321000013/v1_202210190543/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0121812321000013?idApp=UINPBA00004N" ]
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