Frecuencia de fracturas en una población cerrada de Atención Primaria de la Salud (APS) del Distrito Centro de la ciudad de Rosario / Frequency of fractures in a closed Primary Health Care population in the Downtown District of Rosario, Argentina

Con el propósito de determinar la prevalencia de fracturas osteoporóticas en una población cerrada de Atención Primaria de la Salud (APS) correspondiente al Distrito Centro de la ciudad de Rosario, se realizó este estudio observacional transversal. Los datos se obtuvieron de las fichas clínicas de los pacientes correspondientes a los registrosdel consultorio de APS. Se determinó la prevalencia de las fracturas del esqueleto periférico y axial estratificadas poredad y sexo, y se exploró la asociación entre índice de masa corporal y fracturas en esta población y según sexo. Seobtuvo información de 898 pacientes; 662 mujeres (73,7%) y 236 varones (26,3%); la relación mujer/varón fuede 2,8/1. La edad promedio fue de 75 años, y similar en ambos sexos. Los varones habían perdido 4,3±2,9 cm detalla con respecto a su talla histórica (rango: 0-17 cm), y las mujeres 5,7±3,7 cm (rango: 0-19 cm)...

In order to determine the prevalence of osteoporotic fractures in a closed population of Primary Health Care (PHC)corresponding to the Downtown District of the city of Rosario, this cross-sectional observational study was performed. Data were obtained from patients’ clinical records corresponding to PHC office records. The prevalence of axial andperipheral skeletal fractures was determined and the association between fractures and age, sex and body mass index (BMI)was explored. Information was obtained from 898 patients; 662 women (73.7%) and 236 men (26.3%); The male/female ratio was 2.8/1. Mean age was 75 years, and similar in both sexes. Males had lost 4.3±2.9 cm in height withrespect to their historical height (range: 0-17 cm), and females 5.7±3.7 cm (range: 0-19 cm)...

Incidencia de fracturas de cadera en los seis distritos de Rosario / Incidence of hip fracture in the six districts of Rosario city, Argentina

Las tasas de incidencia de fracturas de cadera varían entre países vecinos de un mismo continente, entre distintas regiones de un mismo país, y aún entre distintos barrios de una misma ciudad. El objetivo de este trabajo fue determinar si existían diferencias en las tasas de incidencia de fractura de cadera en los 6 distritos en que se divide la ciudad de Rosario (provincia de Santa Fe, Argentina), con una población de alrededor de un millón de habitantes, y establecer si hay factores ambientales (indicadores sanitarios) o socioeconómicos que pudieran explicar las diferencias. Se realizó un estudio de diseño ecológico. Se calcularon las tasas de incidencia globales, específicas por sexo y grupos etarios, así como las tasas truncadas y ajustadas en cada distrito municipal de Rosario. Los indicadores sociosanitarios estudiados fueron: tasas de mortalidad, necesidades básicas insatisfechas (NBI), habitantes/vivienda, habitantes/hectárea, madres menores de 20 años, nacidos de bajo peso, asentamientos precarios, espacios libres. Se aplicó un análisis multivariado considerando las tasas como variable dependiente y los indicadores sociosanitarios, sexo y grupos de edad como variables independientes, utilizando la regresión de Poisson y calculando el riesgo relativo (razón de tasas). Como resultados de este estudio, concluimos que la incidencia de fractura de cadera no difiere entre los distritos poblacionales de Rosario, y no se individualizaron grupos poblacionales que (de acuerdo a su lugar de residencia, con condiciones sanitarias y socioeconómicas características) presenten un riesgo especial para este tipo de complicación de la osteoporosis.

The incidence rates of hip fractures vary between neighboring countries in the same continent, between different regions of the same country, and even among different neighborhoods in the same city. The aim of this study was to determine whether there were differences in the incidence rates of hip fracture in the 6 districts in which the city of Rosario (province of Santa Fe, Argentina: population 1 million) is divided. We also tried to ascertain whether there are environmental (health indicators) or socioeconomic factors that could explain the differences. The study had an ecological design. Globalincidence rates specific for sex and age groups, and the truncated rates were calculated and adjusted in each municipal district of Rosario. The social health indicators studied were mortality, unmet basic needs, housing, inhabitants/hectare, mothers under age 20, low birth weight, settlements, open spaces. Multivariate analysis considering rates as the dependent variable and social and health indicators, gender and age as independent variables, using Poisson regression and calculating the relative risk (rate ratio) was applied. As results of this study, we conclude that the incidence of hip fracture does not differ between population districts of Rosario, and that no population groups were identified presenting an increased risk for this complication of osteoporosis, based on their place of residence, health conditions or socioeconomic characteristics.

Incidencia de fracturas de cadera en los seis distritos de Rosario / Incidence of hip fracture in the six districts of Rosario city, Argentina

Las tasas de incidencia de fracturas de cadera varían entre países vecinos de un mismo continente, entre distintas regiones de un mismo país, y aún entre distintos barrios de una misma ciudad. El objetivo de este trabajo fue determinar si existían diferencias en las tasas de incidencia de fractura de cadera en los 6 distritos en que se divide la ciudad de Rosario (provincia de Santa Fe, Argentina), con una población de alrededor de un millón de habitantes, y establecer si hay factores ambientales (indicadores sanitarios) o socioeconómicos que pudieran explicar las diferencias. Se realizó un estudio de diseño ecológico. Se calcularon las tasas de incidencia globales, específicas por sexo y grupos etarios, así como las tasas truncadas y ajustadas en cada distrito municipal de Rosario. Los indicadores sociosanitarios estudiados fueron: tasas de mortalidad, necesidades básicas insatisfechas (NBI), habitantes/vivienda, habitantes/hectárea, madres menores de 20 años, nacidos de bajo peso, asentamientos precarios, espacios libres. Se aplicó un análisis multivariado considerando las tasas como variable dependiente y los indicadores sociosanitarios, sexo y grupos de edad como variables independientes, utilizando la regresión de Poisson y calculando el riesgo relativo (razón de tasas). Como resultados de este estudio, concluimos que la incidencia de fractura de cadera no difiere entre los distritos poblacionales de Rosario, y no se individualizaron grupos poblacionales que (de acuerdo a su lugar de residencia, con condiciones sanitarias y socioeconómicas características) presenten un riesgo especial para este tipo de complicación de la osteoporosis. (AU)

The incidence rates of hip fractures vary between neighboring countries in the same continent, between different regions of the same country, and even among different neighborhoods in the same city. The aim of this study was to determine whether there were differences in the incidence rates of hip fracture in the 6 districts in which the city of Rosario (province of Santa Fe, Argentina: population 1 million) is divided. We also tried to ascertain whether there are environmental (health indicators) or socioeconomic factors that could explain the differences. The study had an ecological design. Globalincidence rates specific for sex and age groups, and the truncated rates were calculated and adjusted in each municipal district of Rosario. The social health indicators studied were mortality, unmet basic needs, housing, inhabitants/hectare, mothers under age 20, low birth weight, settlements, open spaces. Multivariate analysis considering rates as the dependent variable and social and health indicators, gender and age as independent variables, using Poisson regression and calculating the relative risk (rate ratio) was applied. As results of this study, we conclude that the incidence of hip fracture does not differ between population districts of Rosario, and that no population groups were identified presenting an increased risk for this complication of osteoporosis, based on their place of residence, health conditions or socioeconomic characteristics. (AU)

Vulnerability of healthy vertebrae in patients with and without previous vertebral fracture.

Vertebral deformities are associated with a marked increase in morbidity, mortality, and burden in terms of sanitary expenditures. Patients with vertebral fractures have a negative impact in their health, less quality of life, and loss of functional capacity and independence. The purpose of this study was to explore the vulnerability of healthy vertebrae in patients who have sustained already a compression fracture and in patients who do not have prevalent fractures in the thoracic spine; and to explore the association of the deformity in healthy vertebrae with different variables, such as bone mineral density (BMD), body mass index, age, loss of height, presence of clinical kyphosis, history of other osteoporotic fractures, and falls occurring during the last year. Clinical data and complementary studies from 175 postmenopausal outpatients were analyzed. These women (age: 69.7±11.1 years) had not received any treatment for osteoporosis. Anteroposterior and lateral radiographs of the thoracic spine and bone densitometry of the hip were obtained; morphometry was performed in 1575 thoracic vertebrae from T4 to T12. The angle of wedging of each vertebral body was calculated using a trigonometric formula. Then, the sum of wedge angles of vertebral bodies (SWA) was determined, and Cobb angle was measured. In patients with vertebral fractures, after excluding the angles of fractured vertebral bodies, the mean wedge angle of the remaining vertebrae (MWAhealthy) was calculated. The same procedure was followed in patients without vertebral fractures. MWAhealthy was considered as an indicator of the structural vulnerability of non-fractured vertebrae. Patients with prevalent fractures had lower BMD, wider Cobb angle, and higher sum of wedge angles than patients without vertebral fractures. The proportion of patients with accentuation of clinical kyphosis was higher in the group with prevalent vertebral fractures. A highly significant difference was found in the MWAhealthy, which was higher in patients with prevalent fractures (4.1±1.3° vs. 3.0±1.1°; p<0.001). Patients showing vertebral fractures had 7.1±4.2 cm height loss in average, significantly superior than that found among non-fractured women (3.6±3.2 cm; p<0.01). In multivariate analysis, the increase of MWAhealthy was associated with advancing age (p<0.02), lower femoral neck BMD (p<0.005), presence of clinical kyphosis (p<0.01) and vertebral fractures (p<0.02). This study presents evidence that a series of factors independently influence the increase in wedging deformity of vertebral bodies that are not fractured yet. These factors could contribute to an increased vulnerability of the vertebrae, making them more susceptible to fracture.