Challenges and opportunities for quality densitometry in Latin America

Maeda, Sérgio Setsuo; LLibre, Ramiro Da Silva; Arantes, Henrique Pierotti; Souza, Guilherme Cardenaz de; Molina, Francisco Fidencio Cons; Wiluzanski, Diana; Taborda, Jorge Antonio Cedeño; Montaño, Claudia Campusano; Vargas, Tatiana Maida; Lopez, Guillermo Luis Feldmann; Neira, Luis Vidal; Uribe, Gustavo Adolfo Molina; Sálica, Daniel; Bencosme, Ascanio; Pérez, Sonia Cerdas; Acosta, Carlos R. Ríos; Carey, John J.; Borges, João Lindolfo Cunha

doi:10.1007/s11657-021-00892-y

Cited by 11 publications

(3 citation statements)

References 26 publications

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“…Por otro lado, existen limitados recursos para la adquisición de equipo especializado para su diagnóstico, siendo que el mismo es costoso. Un estudio 17 realizado en Latinoamérica, indica que el acceso y la calidad para el estudio de DMO son desafíos importantes, con una clara tendencia a concentrarse en los servicios de densitometría en las ciudades más grandes, por lo que es necesario actuar con urgencia para hacer frente al rápido aumento de la carga de OP en esta región. Se estima que para el año 2050 se producirán 6,3 millones de fracturas por año en todo el mundo, de las cuales la mitad se darán en América Latina y Asia.…”

Section: Criterios De La Organización Mundial De Launclassified

Evaluación de la densidad mineral ósea en adultos de 40 años y más, Honduras 2022

Hernández,

Lanza,

García

et al. 2023

Rev. chil. nutr.

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Section: Criterios De La Organización Mundial De Launclassified

Evaluación de la densidad mineral ósea en adultos de 40 años y más, Honduras 2022

Hernández,

Lanza,

García

et al. 2023

Rev. chil. nutr.

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“…Strengths of the FRAX algorithm include the availability of an online calculation option, with or without DXA testing, and the ability to include additional risk factors such as glucocorticoids, secondary causes, and a parental history of hip fracture [ 26 , 29 ]. This is particularly attractive when access to DXA is limited [ 14 , 20 , 26 , 29 ], such as in our center, where reducing unnecessary testing is important [ 25 , 30 ]. Irish legislation governing the justification of the risks associated with exposure to ionizing radiation prohibits undertaking such exposures if alternative methods are available which can achieve the same objectives [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

Yang

Dempsey²,

Brennan³

et al. 2023

Arch Osteoporos

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Summary Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. Purpose FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. Method A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland–Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. Results Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. Conclusions Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.

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“…However, a majority of patients with fragility fractures have a T-score higher than the threshold defined by the World Health Organization (WHO), i.e., T-score = -2.5 [5]. Moreover, the accessibility to DXA is limited, usually restricted to larges cities, in numerous countries such as in Latin America [6]. That is why, several alternatives have been proposed.…”

Section: Introductionmentioning

confidence: 99%

Bi-Directional Axial Transmission measurements applied in a clinical environment

Minonzio

Ramiandrisoa²,

Schneider

et al. 2022

PLoS ONE

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Accurate measurement of cortical bone parameters may improve fracture risk assessment and help clinicians on the best treatment strategy. Patients at risk of fracture are currently detected using the current X-Ray gold standard DXA (Dual XRay Absorptiometry). Different alternatives, such as 3D X-Rays, Magnetic Resonance Imaging or Quantitative Ultrasound (QUS) devices, have been proposed, the latter having advantages of being portable and sensitive to mechanical and geometrical properties. The objective of this cross-sectional study was to evaluate the performance of a Bi-Directional Axial Transmission (BDAT) device used by trained operators in a clinical environment with older subjects. The device, positioned at one-third distal radius, provides two velocities: VFAS (first arriving signal) and VA0 (first anti-symmetrical guided mode). Moreover, two parameters are obtained from an inverse approach: Ct.Th (cortical thickness) and Ct.Po (cortical porosity), along with their ratio Ct.Po/Ct.Th. The areal bone mineral density (aBMD) was obtained using DXA at the femur and spine. One hundred and six patients (81 women, 25 men) from Marien Hospital and St. Anna Hospital (Herne, Germany) were included in this study. Age ranged from 41 to 95 years, while body mass index (BMI) ranged from 16 to 47 kg.m−2. Three groups were considered: 79 non-fractured patients (NF, 75±13years), 27 with non-traumatic fractures (F, 80±9years) including 14 patients with non-vertebral fractures (NVF, 84±7years). Weak to moderate significant Spearman correlations (R ranging from 0.23 to 0.53, p < 0.05) were found between ultrasound parameters and age, BMI. Using multivariate Partial Least Square discrimination analyses with Leave-One-Out Cross-Validation (PLS-LOOCV), we found the combination of VFAS and the ratio Ct.Po/Ct.Th to be predictive for all non traumatic fractures (F) with the odds ratio (OR) equals to 2.5 [1.6-3.4] and the area under the ROC curve (AUC) equal to 0.63 [0.62-0.65]. For the group NVF, combination of four parameters VA0. Ct.Th, Ct.Po and Ct.Po/Ct.Po, along with age provides a discrimination model with OR and AUC equals to 7.5 [6.0-9.1] and 0.75 [0.73-0.76]. When restricted to a smaller population (87 patients) common to both BDAT and DXA, BDAT ORs and AUCs are comparable or slightly higher to values obtained with DXA. The fracture risk assessment by BDAT method in older patients, in a clinical setting, suggests the benefit of the affordable and transportable device for the routine use.

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Challenges and opportunities for quality densitometry in Latin America

Cited by 11 publications

References 26 publications

Evaluación de la densidad mineral ósea en adultos de 40 años y más, Honduras 2022

Evaluación de la densidad mineral ósea en adultos de 40 años y más, Honduras 2022

Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

Bi-Directional Axial Transmission measurements applied in a clinical environment

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