Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures

Andréa Marques; A M Rodrigues; José Carlos Romeu; Afonso Ruano; Ana Paula Barbosa; Eugénia Simões; Fernanda Águas; Helena Canhão; José António Pereira Delgado Alves; Raquel Lucas; Jaime C. Branco; Jorge Laíns; Mário Mascarenhas; Susete Simões; Viviana Tavares; Oscar Lourenço; José António Pereira da Silva

Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures

Andréa Marques, A M Rodrigues, José Carlos Romeu, Afonso Ruano, Ana Paula Barbosa, Eugénia Simões, Fernanda Águas, Helena Canhão, José António Pereira Delgado Alves, Raquel Lucas, Jaime C. Branco, Jorge Laíns, Mário Mascarenhas, Susete Simões, Viviana Tavares, Oscar Lourenço, José António Pereira da Silva

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Abstract

OBJECTIVE: To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures.

METHODS: A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions.

RESULTS: 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible.

CONCLUSIONS: Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

Original language	English
Pages (from-to)	305-321
Number of pages	18
Journal	Acta Reumatológica Portuguesa
Volume	41
Issue number	4
Publication status	Published - Oct 2016

Keywords

BONE-MINERAL DENSITY
CLINICAL RISK-FACTORS
ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM
OSTEOPOROSIS TREATMENT THRESHOLDS
ANDROGEN-DEPRIVATION THERAPY
POSTMENOPAUSAL WOMEN
INTERVENTION THRESHOLDS
AROMATASE INHIBITORS
OLDER WOMEN
FRAX TOOL

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Marques, A., Rodrigues, A. M., Romeu, J. C., Ruano, A., Barbosa, A. P., Simões, E., Águas, F., Canhão, H., Alves, J. A. P. D., Lucas, R., Branco, J. C., Laíns, J., Mascarenhas, M., Simões, S., Tavares, V., Lourenço, O., & da Silva, J. A. P. (2016). Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures. Acta Reumatológica Portuguesa, 41(4), 305-321. http://actareumatologica.pt/article_download.php?id=1208

@article{4a60985ba25f4550b9bff6bf2f17398f,

title = "Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures",

abstract = "OBJECTIVE: To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures.METHODS: A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions.RESULTS: 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX{\textregistered} (FRAX{\textregistered}Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX{\textregistered} are highlighted and guidance for appropriate adjustment is provided, when possible.CONCLUSIONS: Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.",

keywords = "BONE-MINERAL DENSITY, CLINICAL RISK-FACTORS, ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM, OSTEOPOROSIS TREATMENT THRESHOLDS, ANDROGEN-DEPRIVATION THERAPY, POSTMENOPAUSAL WOMEN, INTERVENTION THRESHOLDS, AROMATASE INHIBITORS, OLDER WOMEN, FRAX TOOL",

author = "Andr{\'e}a Marques and Rodrigues, {A M} and Romeu, {Jos{\'e} Carlos} and Afonso Ruano and Barbosa, {Ana Paula} and Eug{\'e}nia Sim{\~o}es and Fernanda {\'A}guas and Helena Canh{\~a}o and Alves, {Jos{\'e} Ant{\'o}nio Pereira Delgado} and Raquel Lucas and Branco, {Jaime C.} and Jorge La{\'i}ns and M{\'a}rio Mascarenhas and Susete Sim{\~o}es and Viviana Tavares and Oscar Louren{\c c}o and {da Silva}, {Jos{\'e} Ant{\'o}nio Pereira}",

year = "2016",

month = oct,

language = "English",

volume = "41",

pages = "305--321",

journal = "Acta Reumatol{\'o}gica Portuguesa",

issn = "0303-464X",

publisher = "Sociedade Portuguesa de Reumatologia",

number = "4",

}

Marques, A, Rodrigues, AM, Romeu, JC, Ruano, A, Barbosa, AP, Simões, E, Águas, F, Canhão, H , Alves, JAPD, Lucas, R, Branco, JC, Laíns, J, Mascarenhas, M, Simões, S, Tavares, V, Lourenço, O & da Silva, JAP 2016, 'Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures', Acta Reumatológica Portuguesa, vol. 41, no. 4, pp. 305-321. <http://actareumatologica.pt/article_download.php?id=1208>

TY - JOUR

T1 - Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures

AU - Marques, Andréa

AU - Rodrigues, A M

AU - Romeu, José Carlos

AU - Ruano, Afonso

AU - Barbosa, Ana Paula

AU - Simões, Eugénia

AU - Águas, Fernanda

AU - Canhão, Helena

AU - Alves, José António Pereira Delgado

AU - Lucas, Raquel

AU - Branco, Jaime C.

AU - Laíns, Jorge

AU - Mascarenhas, Mário

AU - Simões, Susete

AU - Tavares, Viviana

AU - Lourenço, Oscar

AU - da Silva, José António Pereira

PY - 2016/10

Y1 - 2016/10

N2 - OBJECTIVE: To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures.METHODS: A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions.RESULTS: 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible.CONCLUSIONS: Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

AB - OBJECTIVE: To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures.METHODS: A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions.RESULTS: 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible.CONCLUSIONS: Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

KW - BONE-MINERAL DENSITY

KW - CLINICAL RISK-FACTORS

KW - ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM

KW - OSTEOPOROSIS TREATMENT THRESHOLDS

KW - ANDROGEN-DEPRIVATION THERAPY

KW - POSTMENOPAUSAL WOMEN

KW - INTERVENTION THRESHOLDS

KW - AROMATASE INHIBITORS

KW - OLDER WOMEN

KW - FRAX TOOL

M3 - Article

C2 - 27750276

SN - 0303-464X

VL - 41

SP - 305

EP - 321

JO - Acta Reumatológica Portuguesa

JF - Acta Reumatológica Portuguesa

IS - 4

ER -

Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures

Abstract

Keywords

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