Disruption of bone densitometry practice in a Northern Italy Orthopedic Hospital during the COVID-19 pandemic.

We report the impact of the COVID-19 pandemic on bone densitometry practice in a Northern Italy Orthopedic Hospital, comparing the first 4 months of 2020 with the corresponding period of 2019. COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry (about - 50% of examinations). INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic radically changes hospital organization to guarantee patient and staff safety, with the unavoidable cessation of normal outpatient activities. We report the impact of the COVID-19 pandemic on dual energy x-ray absorptiometry (DXA) testing in a Northern Italy Orthopedic Hospital. METHODS: We analyzed the number of DXA examinations performed at our Institution before, during the lockdown, and immediately after outpatient practice reopening (January 24th to May 27th, 2020), comparing them with the corresponding period of 2019. RESULTS: The number of DXA examinations showed a tremendous reduction from n = 1247 performed from January to May 2019 to n = 623 of 2020 (- 49.9%). No exams were performed in April 2020 (- 100%). On May 2020, a faint resume was observed, with n = 43 DXA (- 84.4% compared to 2019). CONCLUSION: COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry with DXA. After reopening, we observed a persistence of DXA examination reduction, confirming the fact that returning to normality will probably be a slow process.

Incidence and Predictors of Repeat Bone Mineral Densitometry: A Longitudinal Cohort Study.

BACKGROUND: Existing guidelines for repeat screening and treatment monitoring intervals regarding the use of dual-energy x-ray absorptiometry (DXA) scans are conflicting or lacking. The Choosing Wisely campaign recommends against repeating DXA scans within 2 years of initial screening. It is unclear how frequently physicians order repeat scans and what clinical factors contribute to their use. OBJECTIVE: To estimate cumulative incidence and predictors of repeat DXA for screening or treatment monitoring in a regional health system. DESIGN: Retrospective longitudinal cohort study PARTICIPANTS: A total of 5992 women aged 40-84 years who received initial DXA screening from 2006 to 2011 within a regional health system in Sacramento, CA. MAIN MEASURES: Two- and five-year cumulative incidence and hazard rations (HR) of repeat DXA by initial screening result (classified into three groups: low or high risk of progression to osteoporosis, or osteoporosis) and whether women were prescribed osteoporosis drugs after initial DXA. KEY RESULTS: Among women not treated after initial DXA, 2-year cumulative incidence for low-risk, high-risk, and osteoporotic women was 8.0%, 13.8%, and 19.6%, respectively, increasing to 42.9%, 60.4%, and 57.4% by 5 years after initial screening. For treated women, median time to repeat DXA was over 3 years for all groups. Relative to women with low-risk initial DXA, high-risk initial DXA significantly predicted repeat screening for untreated women [adjusted HR 1.67 (95% CI 1.40-2.00)] but not within the treated group [HR 1.09 (95% CI 0.91-1.30)]. CONCLUSIONS: Repeat DXA screening was common in women both at low and high risk of progression to osteoporosis, with a substantial proportion of women receiving repeat scans within 2 years of initial screening. Conversely, only 60% of those at high-risk of progression to osteoporosis were re-screened within 5 years. Interventions are needed to help clinicians make higher-value decisions regarding repeat use of DXA scans.

Utilidad de la densitometría como método de valoración del estado nutricional del deportista. Comparación con el índice de masa corporal / The usefulness of densitometry as a method of assessing the nutritional status of athletes. Comparison with body mass index

El índice de masa corporal (IMC) es utilizado para valorar el estado nutricional. En los deportistas su resultado puede estar sobreestimado por un aumento de la masa muscular. Objetivo. Valorar la utilidad de la determinación mediante densitometría de los índices de masa grasa (IMG) y magra (IMM) como indicadores del estado nutricional, comparando los resultados con el IMC. Material y métodos. Se estudiaron 28 deportistas aficionados, jugadores de rugby, de sexo masculino. Tras ser sometidos a una densitometría de cuerpo entero mediante absorciometría dual de rayos X se determinaron, entre otros parámetros, la masa grasa y magra del cuerpo. Se calcularon los IMG (grasa en kg/talla en metros2), IMM (magra en kg/talla en metros2) y el índice de masa muscular apendicular (IMMA, musculatura en brazos y piernas en kg/talla en metros2). Resultados. Utilizando el IMC, 18 jugadores presentaban sobrepeso y 4 obesidad de tipo i . Al considerar el IMG, 7 de estos deportistas presentaban valores normales con IMM e IMMA elevados, uno pasaba de obesidad a sobrepeso y otro de sobrepeso a obesidad. De los 6 jugadores con IMC normal, uno de ellos mostraba exceso de grasa y otro defecto. Los resultados cambiaron la valoración del estado nutricional en el 39% de los jugadores estudiados. Conclusiones. Aunque para la población general el IMC es un parámetro adecuado para la valoración del estado nutricional, en los deportistas debe tenerse en cuenta el porcentaje de grasa y de musculatura determinando sus índices correspondientes. La densitometría de cuerpo entero resulta ser una técnica fiable y sencilla para este propósito(AU)

The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass. Objective. To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI. Material and methods. We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters2), LMI (lean in kg/height in meters2) and appendicular muscle mass index (AMMI, arms and legs musculature in kg/height in meters2) were calculated. Results. Using BMI, 18 players were overweight and 4 obese type I. Considering FMI, 7 of them had normal values and high LMI and AMMI, one of them changed from overweight to obese and another one from obese to overweight. Of the 6 players with normal BMI, one of them showed fat excess and another one fat defect. The results changed the assessment of nutritional status in 39% of players. Conclusions. Although BMI is an appropriate parameter in general population for the assessment of nutritional status, in athletes should be taken into account fat and muscle body percentage and their corresponding indexes. The whole body densitometry appears to be a simple and reliable technique for this purpose(AU)

Osteoporosis posmenopáusica: prevención primaria o medicación excesiva / Postmenopausal osteoporosis: primary prevention or excessive use of medications

Objetivo. Estimar el porcentaje del uso excesivo de fármacos (bifosfonatos/ranelato de estroncio/raloxifeno) en la prevención de fracturas por fragilidad en las mujeres posmenopáusicas. Material y métodos. Estudio descriptivo transversal en un centro de salud urbano en Vitoria. Las participantes fueron mujeres de entre 50 y 70 años tratadas con alguno de los fármacos en estudio en el año 2010 (253). Cinco excluidas (3 fallecidas, 2 traslados), una no colaboró y otra no pudo ser localizada (246 mujeres). Se determinó si el tratamiento estaba indicado o no según las indicaciones de las guías de práctica clínica (ESCEO, NAMS, NOF). Los datos (antecedentes de fracturas por fragilidad, densitometría realizada, diagnósticos densitométricos, fármaco prescrito, médico prescriptor) se buscaron en las historias clínicas informatizadas Osabide y Global Clinic. En 72 casos se realizaron entrevistas para completar la información. Resultados. La edad media de las pacientes fue de 60,5±4,9 años y al 91,5% (225) se les había realizado densitometría. El 75,1% (169) tenía diagnóstico de osteoporosis y el 4,4% (11) presentaba historia personal de fracturas. El 27,6% (68) de los tratamientos no tenían indicación, variando según el médico prescriptor (8,5% médicos de familia/58,5% traumatólogos) (p<0,001). Uso del fármaco de elección (alendronato) en un 29,7%, con claras diferencias entre atención primaria (59,3%) y el resto. Conclusiones. Un alto porcentaje de mujeres está excesivamente medicada, exponiéndose a efectos secundarios potencialmente graves. Los médicos de familia manejan correctamente la osteoporosis, con un gran porcentaje de tratamientos indicados, y un uso racional del medicamento, optando mayoritariamente por el alendronato como primera opción (AU)

Objetive. Estimate the percentage of excessive use of medicines (bisphosponates, strontium ranelate and raloxifene) in the prevention of fragility fractures in postmenopausal women. Material and methods. A descriptive study conducted in an urban health centre in Vitoria-Gasteiz. The participants were women aged between 50 and 70, treated during 2010 with some of aforementioned medicines. Out of the 253 women included, three died, two moved, one did not want to sake part, and another one could not be found, leaving 246 participants. It was determinated if the treatment was or not indicated, as recommended in the ESCEO, NAMS and NOF clinical practice guides. A data search, including fragility fracture history, densitometry performed, densitometry diagnoses, prescribed medicines and prescribing doctor, was carried out by looking in the Osabide and Global Clinic digital clinic records. Interviews were carried out with 72 patients for a more complete information. Results. The mean patient age was 60.5 ± 4.9 years, and 91,5% of them (225) had undergone a densitometry. Three-quarters (75.1%, 169) had a diagnosis of osteoporosis and 4,4% (11) had previous history of fractures. More than a quarter (27.0%, 68) of treatments had no indication, and varied depending of the prescribing doctor (family doctors: 8.5%/ traumatologists: 58.5%) (p<0.001). The use of the medicine of choice, alendronate in 29.7% of cases, Was significantly higher (59.3%) in Primary Care than in other specialties. Conclusions. A high percentage of women are given excessive medication, exposing them to potentially severe secondary damages. Family doctors deal correctly with osteoporosis, with a high percentage of indicated treatments and a rational use of medicines, with alendronate as the first choice in the majority of cases (AU)

The activity of a Spanish bone densitometry unit revisited under the point of view of FRAX

Objetivo. Analizar el riesgo de fractura calculado por FRAX y sus determinantes en los pacientes remitidos a una unidad de densitometría ósea para evaluación de la densidad mineral ósea (DMO). Métodos. Los pacientes remitidos desde Atención Primaria a la Unidad de Densitometría para evaluación de la DMO rellenaron un cuestionario autoadministrado acerca de los factores de riesgo clínicos incluidos en el FRAX; se les realizó una densitometría ósea. Con los datos del cuestionario, se analizó el riesgo absoluto de presentar una fractura mayor (MFR) y de cadera (HFR). Ambos riesgos se calcularon con o sin la inclusión de la DMO en el algoritmo: MFR+, MFR-, HFR+ y HFR-. Resultados. Se analizaron los datos de 853 mujeres con una edad media de 61,9 (8,9) años y un índice de masa corporal medio de 27,0 (4,2) kg/m2. El 20% de las pacientes tenía una DMO normal, el 55% tenía osteopenia y el 25%, osteoporosis. Excluyendo la edad y el índice de masa corporal, el número de factores de riesgo de fractura fue bajo. El MFR+ medio fue de 5,4 (4,8)%; el MFR- de 6,3 (5,5)%; el HFR+, de 1,5 (2,9)%; y el HFR- de 2,1 (3,3)%. Cuando se incluyeron los valores densitométricos en el algoritmo de cálculo del riesgo de fractura, éste fue significativamente menor (p < 0,001), especialmente en pacientes con mejor DMO. Conclusiones. En nuestro medio, el riesgo de fractura calculado por FRAX en las pacientes remitidas a la unidad de densitometría para evaluación de la DMO es bajo. El riesgo de fractura es inferior cuando se introduce la DMO en el algoritmo de cálculo (AU)

In March 2008, FRAX, developed by Kanis and collaborators in the University of Sheffield and supported by the World Health Organization, became available online to calculate absolute risk of osteoporotic fracture in the next 10 years. Objective. To analyze the risk of fracture calculated by FRAX and its determinants in the patients sent to a densitometry unit for bone mineral density (BMD) testing. Methods. All the patients submitted by Primary Care to the Densitometry Unit for BMD testing underwent a self administered questionnaire to assess the clinical risk factors included in FRAX and a bone densitometry of lumbar spine and proximal femur with a DXA densitometer Hologic QDR 4500. They were classified as having a normal BMD, osteopenia or osteoporosis along with the recommendations of the International Society for Clinical Densitometry. As the reference population to calculate the T and Z scores, we used the one from the NHANES III study for femoral neck and total hip and the one from the Study of the Spanish Population for total spine. With the data of the questionnaire, we calculated, by FRAX, the absolute risk in the next ten years of having a major fracture (MFR) or a hip fracture (HFR). Both risks were calculated with or without the inclusion in the algorithm of BMD: MFR+, MFR−, HFR+ and HFR−. The results were recorded in an Access 2003 database and analyzed with the statistical package SPSS 15.0 for Windows. Results. We analyzed the data from 853 women with a mean age of 61.9 (8.9) years and a mean body mass index of 27.0 (4.2)kg/m2. Mean BMD at lumbar spine was 0.873 (0.127)g/cm2; at femoral neck, 0.704 (0.105)g/cm2; and at total hip, 0.817 (0.107)g/cm2. Twenty percent of the patients had a normal BMD, 55% had osteopenia and 25%, osteoporosis. Yet excluding age and body mass index, the number of fracture risk factors seems low: 31% of the patients had no risk of fracture; 40%, had one; 22%, two; 6%, three; 1%, four; and one patient had five. Mean MFR+ was 5.4 (4.8)%; mean MFR−, 6.3 (5.5)%; mean HFR+, 1.5 (2.9)%; and HFR−, 2.1 (3.3)%. When BMD was included in the algorithm for the calculation of the risk of fracture, the risk was statistically lower (p<0.001), especially in patients with better BMD. Conclusions. The risk of fracture calculated by FRAX in the patients sent to a densitometry unit for bone BMD testing seems low and, probably, a better selection of the patients would detect a higher risk of fracture population. When the fracture risk is calculated with the introduction of BMD in the algorithm, it is lower than without including BMD (AU)

Osteoporosis premenopáusica: ¿ cómo tratarla? / Premenopausal osteoporosis: how to treat?

No existe un acuerdo para definir la osteoporosis en mujeres premenopáusicas y el diagnóstico debe realizarse cuidadosamente y sin basarse únicamente en parámetros densitométricos. Hay que tener en cuenta la presencia de otros factores de riesgo como los antecedentes de fracturas por fragilidad, enfermedades o fármacos osteopenizantes. Más del 50% de las mujeres con osteoporosis premenopáusica van a presentar una causa secundaria, el resto serán diagnosticadas de osteoporosis idiopática. Las consideraciones terapéuticas están limitadas por los escasos estudios en este grupo de pacientes, sobre todo en lo que se refiere al riesgo de fracturas. Por otro lado, no disponemos del índice de FRAX, ya que no se puede aplicar a pacientes premenopáusicas. Este artículo pretende realizar una revisión sobre la actitud que se debe seguir según el tipo de osteoporosis premenopáusica basándonos en la evidencia científica actual (AU)

There is no agreement in defining osteoporosis in premenopausal women and diagnosis must be done carefully and not based on densitometric parameters. One must take into account the presence of other risk factors and history of fragility fractures, diseases or drugs that cause bone loss. Over 50% of premenopausal women with osteoporosis will have a secondary cause, with the remainder diagnosed with idiopathic osteoporosis. Therapeutic considerations are limited by a few studies in this group of patients, especially in regard to the risk of fractures. On the other hand, the FRAX index cannot be applied to premenopausal women. This article will review the measures to apply depending on the type of premenopausal osteoporosis, based on current scientific evidence (AU)

Sensibilidad, especificidad y valor predictivo positivo y negativo de los criterios de indicación de densitometría ósea de la agencia de evaluación de tecnologías e investigación médicas de cataluña / Sensitivity, specificity, positive and negative predictive values of the criteria for indicating a bone densitometry in the evaluation of medical techniques and research in cataluña

Objetivo. La Agencia de Evaluación de Tecnologías e Investigación Médicas (AETIM) de Cataluña propuso en 2001 unos criterios de indicación de densitometría ósea (DO) para su uso en la consultas del sistema sanitario público. El objetivo fue conocer la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de los criterios de indicación de DO de la AETIM. Material y método. Cinco grupos de voluntarios (mujeres premenopáusicas de 46 a 65 años, posmenopáusicas de 46 a 65 años y posmenopáusicas de > 65 años, y varones de 46 a 65 años y de > 65 años) a los que se realizó DO y una encuesta sobre factores de riesgo. Se calcularon la sensibilidad, la especificidad, el VPP y el VPN de los criterios de la AETIM, y los resultados se compararon con los criterios de indicación de DO propuestos por la Organización Mundial de la Salud (en 1999 y 2003), la National Osteoporosis Foundation (en 1998 y 2010) y el Comité Internacional de Guías Clínicas en Osteoporosis. Resultados. Los criterios de la AETIM tienen una baja sensibilidad tanto para detectar baja masa ósea (índice T<−1) como osteoporosis (índice T<−2,5); la especificidad varía según el grupo. El VPP es bajo, pero el VPN para osteoporosis es alto en todos los grupos (excepto el de mujeres posmenopáusicas > 65 años). El resto de los criterios tienen un VPN alto y, en mujeres, buena sensibilidad y muy baja especificidad, especialmente para identificar pacientes con osteoporosis. Conclusiones. Los criterios de la AETIM son útiles para seleccionar pacientes a los que no sería necesario realizar una DO, pero carecen de sensibilidad suficiente para identificar individuos con baja masa ósea. El resto de criterios tienen también un VPN alto para osteoporosis y una sensibilidad algo mejor (AU)

The Catalan Agency for Health Technology Assessment and Research (AETIM) proposed, in 2001, criteria for performing a bone densitometry (BD) for use in the consultations of the public health system. Objective. To determine the sensitivity, specificity, positive predictive value and negative predictive value of the criteria to indicate BD. Material and methods. Five groups of volunteers (premenopausal women aged 46 to 65 years, postmenopausal women aged 46 to 65 years, postmenopausal women aged> 65 years and men 46 to 65 years and> 65 years) underwent BD and a questionnaire on risk factors. The results obtained with the AETIM criteria are related to criteria for indication of BD proposed by the World Health Organization (1999 and 2003 criteria), the National Osteoporosis Foundation (1998 amd 2010 criteria) and the International Committee of Clinical Guidelines on Osteoporosis. Results. Criteria from the Catalan Agency have low sensitivity to detect both low bone mass (T index<−1) and osteoporosis (T index<−2.5), specificity varied according to the group. The positive predictive value is low, but the negative predictive value for osteoporosis is high in all groups (except for postmenopausal women aged> 65 years). The remaining criteria have a high negative predictive value and, in women, good sensitivity and low specificity, especially for identifying patients with osteoporosis. Conclusion. Catalan Agency criteria are useful for selecting patients who would not need BD, but lack sufficient sensitivity to identify individuals with low bone mass. The other criteria also have a high negative predictive value for osteoporosis, and a better sensitivity (AU)

Mujer con artralgias y aumento de tamaño de miembros superiores / No disponible

No disponible

Enfermedad celiaca: formas de presentación en el adulto / Are hepatocellular carcinoma surveillance programs effective at improving the therapeutic options?

Introducción: la enfermedad celiaca (EC) es una enfermedadcrónica que afecta al intestino delgado, causada por intolerancia algluten cuyas manifestaciones clínicas son muy variables incluyendosíntomas extraintestinales y formas asintomáticas.Objetivo: nuestro objetivo es describir la incidencia y manifestacionesclínicas de la EC del adulto.Métodos: estudio retrospectivo de los pacientes mayores de18 años diagnosticados de EC entre enero-1990 y diciembre-2008 mediante test serológicos y biopsia duodenal.Resultados: se incluyeron 68 pacientes con una mediana deedad de 33 años (18-65); 50 (74%) mujeres. Las manifestacionesclínicas fueron: diarrea en 38 (55%), dolor abdominal en 27(40%), pérdida de peso en 15 (22%), dispepsia en 13 (19%) y 3dermatitis herpetiforme. Los principales datos analíticos fueron:aumento de transaminasas en 26 (38%), anemia ferropénica en33 (48,5%), hipotiroidismo subclínico en 3 (4,5%) y déficit de ácidofólico en 16 (23,5%) casos. Casi todos los pacientes han sidodiagnosticados entre los años 2000 y 2008: 60 (87%). La incidenciade EC en adultos ha aumentado desde 0,7-2/100.000 habitantespor año en la década de los 90 hasta 10,3/100.000 habitantespor año en 2008.Conclusiones: la EC puede aparecer a cualquier edad con unamplio espectro de manifestaciones clínicas, las cuales pueden seratípicas en muchos casos. En aquellos pacientes con anemia ferropénicay respuesta negativa al tratamiento o con elevacióninexplicable de transaminasas se debe realizar cribado para EC.Las manifestaciones atípicas y un bajo índice de sospecha, puedenretrasar el diagnóstico durante años. Existe un aumento marcadoen la incidencia de EC en los adultos en los últimos años(AU)

Introduction: coeliac disease (CD) is a chronic disease of thesmall intestine, which is caused by gluten intolerance, producingmalabsorption of nutrients and vitamins. Clinical manifestations ofCD in adults are highly variable, including intestinal and extra-intestinalsymptoms. The disease may also occur in individuals whoare asymptomatic.Objective: our objective is to describe the incidence and clinicalmanifestations of CD in adults.Material and methods: a retrospective study was carried outin patients diagnosed of CD between January 1990 and December2008. Diagnosis was based on serologic tests and duodenalbiopsy, which were compatible with CD in all of them.Results: sixty eight adult patients were diagnosed of CD inthis period. Mean age was 33 (18-65) years and 50 (74%) werewomen. The clinical manifestations were diarrhoea in 38 (55%),abdominal pain in 27 (40%), loss of weight in 15 (22%), dyspepsiain 13 (19%). Analytical results showed a slight increase oftransaminases in 26 (38%), ferropenic anaemia in 33 (48.5%)cases, sub-clinical hypothyroidism in 3 (4.5%) patients, and folicacid deficiency in 16 (23.5%) cases. Almost all patients were diagnosedbetween 2000 and 2008: 60 (87%). Population-based incidenceof CD in adults had increased from 0.7-2/100,000 peryear in the nineties to 3.5-10.3/100,000 in the last years.Conclusions: CD can appear at any age and with a widemanifestation spectrum, which can be atypical in some cases. Patientswith ferropenic anaemia and a negative response to treatmentor those with an unexplained increase in transaminasesshould be screening for CD. Atypical manifestations and low suspectindex can delay diagnosis even during years. There is amarked increase in the incidence-rates of CD in adults over time(AU)

Elaboración, implantación y seguimiento de un protocolo de osteoporosis posmenopáusica: colaboración entre Atención Primaria y el Servicio de Reumatología / Elaboration, implementation and follow-up of a postmenopausal osteoporosis protocol: Collaboration between the Primary care and Rheumatology departments

Objetivo Con el objetivo de mejorar la gestión clínica de la osteoporosis posmenopáusica, se ha realizado una intervención basada en la implantación y seguimiento de un protocolo consensuado entre la Atención Primaria y la Especializada de la Mútua de Terrassa. Métodos Estudio descriptivo y de intervención. La intervención consistió en la elaboración de un protocolo consensuado, que fue presentado en todos los centros. Los datos se han evaluado a partir de densitometrías óseas solicitadas por los médicos de familia durante 1 año. Resultados Se han solicitado un total de 1.165 densitometrías, de las cuales 689 son para diagnóstico de nuevas pacientes. Para la evaluación del protocolo se han obtenido datos de 560. 502 densitometrías realizadas (89,6%, IC95%: 87,1–92,2) cumplían con los criterios de indicación marcados por el protocolo. Del total de pacientes que recibieron tratamiento con fármacos antirresortivos (43 osteopénicas y 167 osteoporóticas), el 83,7% (IC95%: 69,3–93,2) y el 89,8% (IC95%: 85,2–94,4), respectivamente, cumplía con las recomendaciones de primera elección. El consumo de fármacos durante el año 2007 se ha reducido en 152.745 euros (−6,3%), aunque el número de pacientes tratadas ha aumentado en 565 (+4,9%) respecto al año anterior. 442 (78,9%, IC95%: 75,6–82,3) densitometrías presentaron un resultado de osteopenia u osteoporosis. Se observan diferencias estadísticamente significativas de los resultados según la edad de las pacientes y el motivo de solicitud. Conclusiones La puesta en marcha del protocolo ha permitido gestionar de forma eficiente el proceso clínico de la osteoporosis en nuestro ámbito (AU)

Objective To improve the clinical management of postmenopausal osteroporosis, an intervention based on the implementation of a guideline agreed to between the Primary Care and Specialized departments of all centers at “Mutua of Terrassa” was carried out. Methods Descriptive and interventional study. The intervention consisted of the elaboration of a consensus guideline that was presented in all centers. Results were assessed from bone densitometry studies requested by family physicians over 1 year. Results 1.165 densitometric studies were requested, of which 689 were for the diagnosis of new patients. For the evaluation of the guidelines, details were obtained from 560. 502 studies (89,6% IC95% 87,1–92,2) complied with indication criteria established in the guideline. Of the total of patients who received bisphosphonates and other drugs affecting bone metabolism (43 osteopenic and 167 osteoporotic), 83,7% (IC95% 69,3–93,2) and 89,8% (IC95% 85,2–94,4) respectively complied with drug recommendations. Drug consumption during the year 2007 was reduced by 152.745 euros (−6,3%) although the number of patients increased in 565 (+4,9%) with respect to the previous year. 442 (78,9% IC95% 75,6–82,3) densitometries presented a result in the osteopenia or osteroporosis category. There were statistically significant differences of the results according to the patients' age and the motive for the bone densitometry request. Conclusions Implementation of the guideline allowed for the effective management of the clinical process of osteroporosis in our field (AU)

Aplicabilidad de la herramienta FRAX® en pacientes con Osteporosis / Applicability of FRAX® tool in osteoporotic patients

Objetivo. Describir las características de los pacientes en tratamiento para la osteoporosis que no recibirían dicho tratamiento basándose en los resultados del FRAX®. Diseño. Estudio observacional descriptivo transversal. Emplazamiento. Atención Primaria - Centro de Especialidades de Toledo. Participantes. Pacientes diagnosticados de osteoporosis en tratamiento con fármacos antirresortivos, osteoformadores o mixtos vistos en las consultas de Reumatología (Metabolismo Óseo) en abril y mayo de 2009. Intervenciones. Revisión de historias clínicas obteniendo los datos del momento en que se inició el tratamiento antiosteoporótico, aplicando el índice de riesgo FRAX® con y sin densitometría (en los casos en que la tengan). Mediciones y resultados. 99 pacientes (88,9% mujeres), edad media (± desviación estándar) 62,3 ± 9,33 años. 62,6% presentaban un índice FRAX® < 20%/3%, siendo más jóvenes (58,95 vs. 67,92 años; p<0,001), y sin diferencias por sexo e IMC. Los pacientes “FRAX® (-)” tenían menor porcentaje de fracturas previas (33,9% vs. 83,8%; p<0,001), sobre todo vertebrales y de húmero, en menor número (0,55 vs. 1,75; p<0,001) y a edad más temprana (54,88 vs. 63 años; p=0,02). Además, tenían una puntuación T en cuello femoral superior (-1,87 vs. -2,50; p<0,001). La probabilidad de fractura a 10 años era menor en los pacientes “FRAX® (-)” sin densitometría (4,18% vs. 12,72% en fractura osteoporótica mayor; p<0,001; 0,91% vs. 5,43% en fractura de cadera; p<0,001) y con densitometría (4,70 vs. 14,30 en fractura osteoporótica mayor; p<0,001; 1,14 vs. 6,62 en fractura de cadera; p<0,01). La densitometría no afecta significativamente el porcentaje de pacientes que supera el límite del 20%/3%. Conclusiones. La herramienta FRAX® puede tener relativa utilidad en Atención Primaria, especialmente en aquellos pacientes sin osteoporosis densitométrica o establecida. Sin embargo, no parece que el criterio de coste-efectividad obtenido por los anglosajones pueda adoptarse de forma directa y única en nuestro medio (AU)

Aim. To describe the characteristics of the patients treated for osteoporosis that could not been treated according to FRAX® scores. Design. Observational, descriptive, cross-sectional study. Setting. Primary Care – Toledo Speciality Centre. Participants. Outpatients with osteoporosis diagnosis treated with antirresortive, osteogenic or mixed drugs and visited in Rheumatology Service (Bone Metabolism) in april-may 2009. Intervention. Clinical charts review extracting the data from the antiosteoporotic treatment starting date, and applying the FRAX® risk index with and without bone densitometry (in that patients with it). Measurements and results. 99 patients (88.9% women), medium age (± standard deviation) 62.3 ± 9.33 years old. 62.6% had a FRAX® index <20%/3%; these patients were younger (58.95 vs. 67.92 years old) than those with a FRAX® ≥20%/3%, with neither gender nor BMI differences. “FRAX® (-)” patients had less previous fractures (33.9% vs. 83.8%; p<0.001), specially from spine and humerus; these patients also had a smaller fracture number (0.55 vs. 1.75; p<0.001), and their fractures were produced at a younger age (54.88 vs. 63% years old; p=0.02). Also, their T-score of hip was bigger (-1.87 vs. -2.50; p<0.001). The 10-year probability of fracture was smaller in the “FRAX® (-)” patients without densitometry (4.18% vs. 12.72% in major osteoporotic fracture; p<0.001; 0.91% vs. 5.43% in hip fracture; p<0.001) and with it (4.70% vs. 14.30% in major osteoporotic fracture; p<0.001; 1.14% vs. 6.62% in hip fracture; p<0.01). Bone densitometry does not significantly affect the percentage of patients that surpass the 20%/3% limit. Conclusions. The FRAX® tool can be relatively useful in Primary Care, especially in those patients without densitometry or established osteoporosis. However, the NOF cost-effectivity criteria cannot be adopted directly in our environment (AU)

Interpretación de la densitometría ósea / Interpretation of bone mineral densitometry

La densitometría ósea es la técnica diagnóstica de elección en el estudio de la osteoporosis que en el momento actual aporta ventajas sobre las otras pruebas existentes.ResumenSe trata de una técnica con buenos resultados de precisión y fiabilidad, pero cuyo mayor rendimiento práctico se consigue en las personas con mayor riesgo de fracturas, lo que determina sus indicaciones y la no realización de cribado en la población general.ResumenLa interpretación de sus resultados está marcada por los criterios diagnósticos de la OMS, que a través de la T-Score permiten estratificar el riesgo de fractura, y por las limitaciones del propio método, entre los que destaca la baja capacidad predictiva de fractura a nivel individual (AU)

Bone mineral densitometry (BMD) is the diagnostic technique of choice in the study of osteoporosis at present and has advantages over other existing methods.AbstractThis is a technique with good results for precision and reliability, however, its best practical performance is achieved in those having increased risk of fractures, which determine their indications, and not carrying out screening in the general population.AbstractThe interpretation of its results is marked by the WHO diagnostic criteria, which, using the T-Score, makes it possible to stratify the risk of fracture, and by the limitations of the method, among them the low predictive ability of the individual fracture (AU)

Changes in distribution of bone densitometry equipment from 1996 to 2006 in Japan.

Many types of bone densitometry equipment are available in Japan, but the numbers of such machines and the numbers of institutions that offer bone densitometry have not been clarified. We analyzed the data from annual surveys conducted by the Japan Osteoporosis Foundation from 1996 to 2006, and we obtained the following results on the use of densitometry equipment: (1) In 1996 there were 6,687 units of bone densitometry equipment in 6,483 institutions in Japan; in 2006 there were 16,371 units in 15,020 institutions. (2) In 2006, of the types of institutions with bone densitometry equipment, the number of clinics was the highest, followed in order by general hospitals, other types of institutions, screening institutions and university hospitals. Rates of increase in the installation of equipment in clinics and other types of institutions were high during the 11-year period from 1996. (3) From 1996 to 2006 the region of interest most frequently used for bone densitometry was the radius. However, during the 11-year period, the proportion of radial densitometry equipment in all institutions with bone densitometry equipment decreased, whereas the proportion of calcaneal densitometry equipment increased. (4) The number of dual-energy X-ray absorptiometry (DXA) units was the highest from 1996 to 2006. However, the proportion of DXA machines in all institutions with bone densitometry equipment decreased over the 11-year period, whereas the proportion of quantitative ultrasound (QUS) machines increased. (5) In 2006, bone densitometry equipment was available in 118 institutions per million Japanese people. Central DXA (spine/hip) equipment was available in 15 per million, radial DXA equipment in 63 per million, and calcaneal QUS equipment in 44 per million. (6) In 2006, among those places with bone densitometry equipment, 46% of university hospitals, 14% of general hospitals, 12% of screening institutions, 5% of clinics, and 6% of other types of institutions possessed more than one type of densitometry equipment. (7) In 2006, central DXA (spine/hip) was frequently available in university hospitals, radial densitometry equipment in general hospitals and clinics, and calcaneal densitometry equipment in screening institutions and other types of institutions.

Advances in osteoporosis imaging.

In the assessment of osteoporosis, the measurement of bone mineral density (BMD(a)) obtained from dual energy X-ray absorptiometry (DXA; g/cm(2)) is the most widely used parameter. However, bone strength and fracture risk are also influenced by parameters of bone quality such as micro-architecture and tissue properties. This article reviews the radiological techniques currently available for imaging and quantifying bone structure, as well as advanced techniques to image bone quality. With the recent developments in magnetic resonance (MR) techniques, including the availability of clinical 3T scanners, and advances in computed tomography (CT) technology (e.g. clinical Micro-CT), in-vivo imaging of the trabecular bone architecture is becoming more feasible. Several in-vitro studies have demonstrated that bone architecture, measured by MR or CT, was a BMD-independent determinant of bone strength. In-vivo studies showed that patients with, and without, osteoporotic fractures could better be separated with parameters of bone architecture than with BMD. Parameters of trabecular architecture were more sensitive to treatment effects than BMD. Besides the 3D tomographic techniques, projection radiography has been used in the peripheral skeleton as an additional tool to better predict fracture risk than BMD alone. The quantification of the trabecular architecture included parameters of scale, shape, anisotropy and connectivity. Finite element analyses required highest resolution, but best predicted the biomechanical properties of the bone. MR diffusion and perfusion imaging and MR spectroscopy may provide measures of bone quality beyond trabecular micro-architecture.

Bone densitometry: current status and future perspectives.

In this chapter we discuss the concept of what determines bone strength and fracture risk and how this can be quantified using current technologies. We describe bone densitometry measurement techniques that are currently available and consider the strengths and limitations of each technique, with particular relevance to paediatric scanning. Magnetic resonance imaging is reviewed as one of the newer technologies applied to the assessment of the growing skeleton. The role of dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) in the clinical assessment of bone health in children is considered and current diagnostic application reviewed.

Quantitative ultrasound in the assessment of skeletal status.

Quantitative ultrasound (QUS) is a non-invasive technique for the investigation of bone tissue in several pathologies and clinical conditions, especially in the field of osteoporosis. The versatility of the technique, its low cost and lack of ionising radiation have led to the diffusion of this method worldwide. Several studies have been conducted in the last years to investigate the potential of QUS in multiple areas with promising results; the technique has been applied in the prediction of osteoporotic fractures, in monitoring therapies, in the investigation of secondary osteoporosis, in paediatrics, neonatology and genetics. Our review article gives an overview of the most relevant developments in the field of quantitative ultrasound, both in clinical and in experimental settings.

Epidemiología de la osteoporosis / No dispoinble

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