Treatment of patients at high risk of osteoporotic fracture in a USF: the importance of FRAX®Port

Authors

  • Carolina Sotana Médica Interna de Medicina Geral e Familiar. USF Jardim dos Plátanos, ULS Lisboa Ocidental. Linda-a-Velha, Portugal.
  • Daniela Ribeiro Médica Interna de Medicina Geral e Familiar. USF Jardim dos Plátanos, ULS Lisboa Ocidental. Linda-a-Velha, Portugal.
  • Joana Azeredo Médica de família. USF Jardim dos Plátanos, ULS Lisboa Ocidental. Linda-a-Velha, Portugal | Nova Medical School, NOVA University of Lisbon. Lisboa, Portugal.
  • Margarida Peixoto Médica Interna de Medicina Geral e Familiar. USF Jardim dos Plátanos, ULS Lisboa Ocidental. Linda-a-Velha, Portugal.
  • Joana Chagas Médica Interna de Medicina Geral e Familiar. USF Jardim dos Plátanos, ULS Lisboa Ocidental. Linda-a-Velha, Portugal.

DOI:

https://doi.org/10.32385/rpmgf.v41i4.13963

Keywords:

Osteoporosis, Osteoporotic fractures, Fracture risk, FRAX, Anti-osteoporotic therapy

Abstract

Introduction: Osteoporosis is a bone disease whose prevalence has been increasing, particularly in elderly females. The main clinical consequence is the fragility fracture, leading to increased morbidity and mortality, and a decreased quality of life for the patient, representing a significant socioeconomic burden. The current challenge is the early identification of individuals at higher risk of fracture who require therapeutic intervention to prevent future fractures.

Objectives: To study the beginning of anti-osteoporotic therapy in female patients at high risk of osteoporotic fracture.

Methods: A cross-sectional study based on the review of medical records and telephone interviews of 50-year-old and older female patients from a Family Health Unit in the Western Lisbon area. The sample size was calculated using the SurveyMonkey website, and the population sample was randomly selected. Fracture risk was calculated using FRAX®Port. The population was stratified based on fracture risk, and therapy initiation was verified in high-risk patients.

Results: A sample of 250 patients was obtained, of which 20.8% (n=52) had a high risk of fracture, 9.2% (n=23) had intermediate fracture risk, and 70% (n=175) had low fracture risk, according to FRAX calculation. Among the patients identified as having a high risk of fracture, 28.8% (n=15) were receiving anti-osteoporotic therapy.

Conclusion: It was found that only 28.8% of patients at high risk of fracture were receiving treatment, highlighting the importance of raising awareness among healthcare professionals for the assessment of osteoporotic fracture risk in Family Medicine appointments and implementing a change in the diagnostic and therapeutic approach to osteoporosis.

Downloads

Download data is not yet available.

References

1. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137-41.

2. Kanis JA, Norton N, Harvey NC, Jacobson T, Johansson H, Lorentzon M, et al. SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos. 2021;16(1):82.

3. Bliuc D, Nguyen ND, Nguyen TV, Eisman JA, Center JR. Compound risk of high mortality following osteoporotic fracture and refracture in elderly women and men. J Bone Miner Res. 2013;28(11):2317-24.

4. Frost SA, Nguyen ND, Center JR, Eisman JA, Nguyen TV. Excess mortality attributable to hip-fracture: a relative survival analysis. Bone. 2013;56(1):23-9.

5. Marques A, Lourenço Ó, Silva JA; Portuguese Working Group for the Study of the Burden of Hip Fractures in Portugal. The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality. Osteoporos Int. 2015;26(11):2623-30.

6. Laires PA, Perelman J, Consciência JG, Monteiro J, Branco JC. Actualização sobre o impacto epidemiológico e socioeconómico das fracturas da extremidade proximal do fémur [Epidemiology of hip fractures and its social and economic impact: an update for 2014]. Acta Reumatol Port. 2015;40(3):223-30. Portuguese

7. Marques A, Rodrigues AM, Romeu JC, Ruano A, Barbosa AP, Simões E, et al. Recomendações multidisciplinares portuguesas sobre o pedido de DXA e indicação de tratamento de prevenção das fraturas de fragilidade [Portuguese recommendations for ordering bone densitometry measurement and indications for treatment to prevent osteoporotic fractures]. Rev Port Med Geral Fam. 2016;32(6):425-41. Portuguese

8. Rodrigues AM, Canhão H, Marques A, Ambrósio C, Borges J, Coelho P, et al. Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis: 2018 update. Acta Reumatol Port. 2018;43(1):10-31.

9. Teixeira FC, Serejo RF, Araújo FC. Osteoporosis in family medicine: are we doing what’s necessary? Gaz Med. 2022;9(2):153-9.

10. Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34(1):195-202.

11. Marques A, Mota A, Canhão H, Romeu JC, Machado P, Ruano A, et al. A FRAX model for the estimation of osteoporotic fracture probability in Portugal. Acta Reumatol Port. 2013;38(2):104-12.

12. Center for Metabolic Bone Diseases. FRAX® Ferramenta de avaliação de risco de fratura [homepage]. University of Sheffield; 2012 [cited 2022 Sep 24]. Available from: https://www.sheffield.ac.uk/FRAX/tool.aspx?lang=pr

13. Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, et al. Interim report and recommendations of the World Health Organization Task-Force for osteoporosis. Osteoporos Int. 1999;10(4):259-64.

14. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis [homepage]. Geneva: WHO; 1994. Available from: https://iris.who.int/handle/10665/39142

15. Odén A, McCloskey EV, Kanis JA, Harvey NC, Johansson H. Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int. 2015;26(9):2243-8.

Published

2025-09-05

How to Cite

Treatment of patients at high risk of osteoporotic fracture in a USF: the importance of FRAX®Port. (2025). Portuguese Journal of Family Medicine and General Practice, 41(4), 338-43. https://doi.org/10.32385/rpmgf.v41i4.13963