Ajust de l'eina que permet calcular el risc de fractura per fragilitat

A les societats occidentals, les fractures per fragilitat augmenten en números absoluts associades a l'augment de l'esperança de vida. L'OMS va publicar el 2008 una eina per tal d'identificar adequadament la població de major risc de fractura per fragilitat i prioritzar accions preventives sobre els col·lectius més fràgils. Aquesta tesi doctoral proposa un calibratge d'aquesta eina per a la població femenina espanyola que permetria reduir les proves realitzades i els tractaments farmacològics i, per tant, la despesa sanitària.En las sociedades occidentales, las fracturas por fragilidad aumentan en números absolutos asociadas al aumento de la esperanza de vida. La OMS publicó en 2008 una herramienta para identificar adecuadamente a la población de mayor riesgo de fractura por fragilidad y priorizar acciones preventivas sobre los colectivos más frágiles. Esta tesis doctoral propone una calibración de esta herramienta para la población femenina española que permitiría reducir las pruebas realizadas y los tratamientos farmacológicos y, por tanto, el gasto sanitario.In Western societies, fragility fractures are increasing in absolute numbers and are associated with the increase in life expectancy. The WHO published in 2008 a tool to properly identify the population's increased risk of fragility fracture and prioritise preventative actions among the most vulnerable groups. This thesis proposes a calibration of this tool for the Spanish female population which would reduce tests and pharmacological treatment and, therefore, health expenditure

Web 2.0

131 p. gráf. 23 cm.Libro ElectrónicoAnálisis de oportunidades que brindan los espacios virtuales de la Web 2.0, conceptos de los blog, análisis del concepto social que brinda la web 2.01. INTRODUCCIÓN 1.1. Una definición 1.2. Un poco de tecnología 1.3. Enredando con lo social 2. EL CONTEXTO 2.1. Un espacio virtual de oportunidades 2.2. La elasticidad sociotécnica de la WebNG 2.3. Nuevo Entorno Tecnosocial 2.4. La Web 2.0 a través del ‘NEToscopio’ 2.5. El universo blog Un fenómeno sustantivo Entendiendo la blogosfera 3. LA WEB SOCIAL 3.1. Software social 3.2. Los nativos digitales 4. CREACIÓN COLECTIVA 4.1. Los wikis y la tradición enciclopédica 4.2. La innovación y la legalidad vigente 4.3. Una virtualidad muy rea

Relationship Between Bioimpedance Vector Displacement and Renal Function After a Marathon in Non-elite Runners

Purpose: This study investigates the relationship between whole-body bioimpedance vector displacement, using bioelectrical impedance vector analysis (BIVA), and renal function through serum biomarkers [creatinine, urea, sodium, C-reactive protein (CRP), and creatine kinase] and urine biomarkers after a marathon. Methods: Bioimpedance measurements were taken among 19 non-elite runners at 24 h pre-race, immediately post-race, and at 48 h post-race. The bioimpedance measurements were analyzed by BIVA using the Hotelling's T2 test. The runners were divided according to a cutoff of serum creatinine level immediately post-race in G1 (<1.2 mg/dl of serum creatinine level) and G2 (≥1.2 mg/dl of serum creatinine level). The increase of the serum creatinine levels in 83% of G2 runners was related to acute kidney injury (AKI) stage 1. Results: Neither G1 nor G2 showed a creatinine clearance rate (CCr) lower than 60 ml/min. G2 showed a significant increase in CRP values at 48 h post-race vs baseline compared to G1 (P < 0.05), with over 5 mg/L (6.8-15.2) in 92% of the runners, and in CK values with over 215 U/L (282-1,882) at 48 h post-race in 100% of the runners. By BIVA, the 95% confidence ellipses of G2 showed shorter bioimpedance vectors than G1, with a noticeable minor Xc/H (P < 0.01), indicating an expansion on extracellular water and inflammation. The runners with 48 h post-race Xc/H values ≤30.5 Ω, with a decrease from −3 to −12% with respect to the Xc/H value at 24 h pre-race, indicated AKI stage 1 with 85.7% sensitivity and 91.7% specificity, with a direct correlation between AKI stage 1 with greater CRP values at 48 h post-race and bioimpedance vector displacement, but not with CK values at 48 h post-race. Conclusion: Through this data collection, it was evidenced that a transient reduction in renal function is more related to inflammatory factors than muscle damage. The BIVA method along with serum biomarkers could be used to follow up the kidney function in runners

Altered GDF15 and FGF21 Levels in Response to Strenuous Exercise: A Study in Marathon Runners

Background: Recreational marathon runners face strong physiological challenges. Assessment of potential biomarkers for the biological responses of runners will help to discriminate individual race responsiveness and their physiological consequences. This study sought to analyze the changes in the plasma levels of GDF15 and FGF21, novel endocrine factors related to metabolic stress, in runners following the strenuous exercise of a marathon race. Methods: Blood samples were obtained from eighteen male runners (mean ±SD, age: 41.7 ±5.0 years, BMI: 23.6 ± 1.8) 48 h before, immediately after, and 48 h after a marathon race, and from age-matched sedentary individuals. The level of GDF15, FGF21, and 38 additional biochemical and hematological parameters were determined. Results: The basal levels of GDF15 and FGF21 did not differ between runners before the race and sedentary individuals. Significant increases in the mean levels of GDF15 (4.2-fold) and FGF21 (20-fold) were found in runners immediately after the race. The magnitudes of these increases differed markedly among individuals and did not correlate with each other. The GDF15 and FGF21 levels had returned to the basal level 48 h post-race. The post-race value of GDF15 (but not FGF21) correlated positively with increased total white cell count (r = 0.50, P = 0.01) and neutrophilia (r = 0.10, P = 0.01). Conclusion: GDF15 and FGF21 are transiently increased in runners following a marathon race. The induction of GDF15 levels is associated with alterations in circulating immune cells levels

Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain

Background: Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age. Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years. Methods/Design: To assess the predictive power of the WHO FRAX (TM) tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. Study population: Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA) measurement and one extensive questionnaire related to fracture risk factors. Measurements: At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX (TM) tool from the official web site. Discussion: Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to low BMD. The extension of a method for calculating the risk (probability) of fractures using the FRAX (TM) tool is foreseeable in Spain and this would justify a study such as this to allow the necessary adjustments in calibration of the parameters included in the logarithmic formula constituted by FRAX (TM

Measuring health-related quality of life in men with osteoporosis or osteoporotic fracture

<p>Abstract</p> <p>Background</p> <p>Osteoporosis is a serious health problem that worsens the quality of life and the survival rate of individuals with this disease on account the osteoporotic fractures. Studies have long focused on women, and its presence in men has been underestimated. While many studies conducted in different countries mainly assess health-related quality of life and identify fracture risks factors in women, few data are available on a Spanish male population.</p> <p>Methods/Design</p> <p>Observational study.</p> <p>Study population</p> <p>Men ≥ 40 years of age with/without diagnosed osteoporosis and with/without osteoporotic fracture included by their family doctor.</p> <p>Measurements</p> <p>The relationship between customary clinical risk factors for osteoporotic fracture and health-related quality of life in a Spanish male population. A telephone questionnaire on health-related quality of life is made.</p> <p>Statistical analysis</p> <p>The association between qualitative variables will be assessed by the Chi-square test. The distribution of quantitative variables by Student's t-test. If the conditions for using this test are not met, the non-parametric Mann-Whitney's U test will be used.</p> <p>The validation of the results obtained by the FRAX™ tool will be performed by way of the Hosmer-Lemeshow test and by calculating the area under the Receiver Operating Characteristic (ROC) curve (AUC). All tests will be performed with a confidence intervals set at 95%.</p> <p>Discussion</p> <p>The applicability and usefulness of Health-related quality of life (HRQOL) studies are well documented in many countries. These studies allow implementing cost-effective measures in cases of a given disease and reducing the costly consequences derived therefrom. This study attempts to provide objective data on how quality of life is affected by the clinical aspects involved in osteoporosis in a Spanish male population and can be useful as well in cost utility analyses conducted by health authorities.</p> <p>The sample selected is not based on a high fracture risk group. Rather, it is composed of men in the general population, and accordingly comparisons should not lead to erroneous interpretations.</p> <p>A possible bias correction will be ensured by checking reported fractures against healthcare reports and X-rays, or by consulting health care centers as applicable.</p

Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis.

PURPOSE: The authors evaluated the impact of acute exercise and 24-hour recovery on serum concentration of cardiac troponins T and I (cTnT and cTnI) and N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) in healthy children and adolescents. The authors also determined the proportion of participants exceeding the upper reference limits and acute myocardial infarction cutoff for each assay. METHOD: Web of Science, SPORTDiscus, MEDLINE, ScienceDirect, and Scopus databases were systematically searched up to November 2017. Studies were screened and quality-assessed; the data was systematically extracted and analyzed. RESULTS: From 751 studies initially identified, 14 met the inclusion criteria for data extraction. All 3 biomarkers were increased significantly after exercise. A decrease from postexercise to 24 hours was noted in cTnT and cTnI, although this decrease was only statistically significant for cTnT. The upper reference limit was exceeded by 76% of participants for cTnT, a 51% for cTnI, and a 13% for NT-proBNP. Furthermore, the cutoff value for acute myocardial infarction was exceeded by 39% for cTnT and a 11% for cTnI. Postexercise peak values of cTnT were associated with duration and intensity (Q(3) = 28.3, P < .001) while NT-proBNP peak values were associated with duration (Q(2) = 11.9, P = .003). CONCLUSION: Exercise results in the appearance of elevated levels of cTnT, cTnI, and NT-proBNP in children and adolescents. Postexercise elevations of cTnT and NT-proBNP are associated with exercise duration and intensity

Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain

<p>Abstract</p> <p>Background</p> <p>Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age.</p> <p>Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years.</p> <p>Methods/Design</p> <p>To assess the predictive power of the WHO FRAX™ tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. Study population: Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA) measurement and one extensive questionnaire related to fracture risk factors. Measurements: At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX™ tool from the official web site.</p> <p>Discussion</p> <p>Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to low BMD. The extension of a method for calculating the risk (probability) of fractures using the FRAX™ tool is foreseeable in Spain and this would justify a study such as this to allow the necessary adjustments in calibration of the parameters included in the logarithmic formula constituted by FRAX™.</p

Adequació de l'eina FRAX per determinar el risc de fractura osteoporòtica en població femenina espanyola: anàlisi de la seva capacitat diagnòstica (discriminativa i predictiva) i calibració en la població femenina espanyola

Les fractures per fragilitat a Espanya, com a la resta de les societats occidentals, augmenten en números absoluts, associades a l’augment de l’esperança de vida. Es necessari identificar adequadament la població de major risc per fractura per fragilitat i prioritzar accions preventives sobre els col·lectius més fràgils. L’OMS va publicar el 2008 l’eina FRAX per a un número creixent de països. És un algoritme online per calcular el risc absolut de fractura principal a 10 anys, però que necessita ajustos o calibracions a cada país per a la seva validació. El conjunt dels quatre estudis publicats resumeix el procés que finalitza en una proposta de calibració de FRAX per a la població femenina espanyola. El primer article descriu la cohort FRIDEX formada per dones adreçades des de l’any 2000 per determinar la DMO. Se’ls va determinar la DMO per densitometria tipus DXA, les mesures antropomètriques i un qüestionari ampli sobre factors de risc (FR). L’estudi descriu i quantifica en percentatge la presència dels FR inclosos a FRAX, l’edat, el pes, etc. i els tractaments farmacològics rebuts per a l’osteoporosi. Així queda descrit l’estat basal de FRIDEX, cohort prospectiva de dones espanyoles. El segon article mostra l'anàlisi de 770 dones de FRIDEX, d’entre 40 a 90 anys en el moment basal. Aquestes complien els criteris de no estar prenent tractament en el moment de l’ingrés en la cohort i van estar seguides durant 10 anys. Els FR que es varen associar al risc de fractura van ser: l’edat, les fractures prèvies, l’artritis reumatoide, tenir osteoporosi en la DXA basal i una major freqüència de caigudes en l’any previ. Les anàlisis també mostraren que la capacitat discriminativa de FRAX, mesurada per l'AUC-ROC amb i sense DMO, era moderada, però no inferior a la DMO amb criteris d’osteoporosi (OMS 1994). Per altra banda, l’anàlisi de la capacitat predictiva, mesurada de forma global amb la ràtio FxObs/FxEsp, va ser de 2,4 amb FRAX sense DMO per fractura principal i 2,8 per fractura de maluc. La prova de Hosmer-Lemeshow va mostrar una bona correlació només després de la calibració amb els resultats de la ràtio FxObs/FxEsp. El tercer article fa una anàlisi dels valors de FRAX resultants d’analitzar els casos de la cohort FRIDEX en la pàgina web per població espanyola comparats amb els resultats de fer-ho en la pàgina web del Regne Unit. Aquest estudi va ser motivat perquè algunes publicacions orientaven l’ús d’aquesta web en no ajustar-se adequadament FRAX en població femenina espanyola. Els resultats varen mostrar diferències de 2,2 vegades més gran la probabilitat per fractura principal i d'1,6 per maluc del Regne Unit respecte d’Espanya. Els resultats van suggerir que no era aconsellable aquesta pràctica i que calia disposar de llindars d'intervenció ajustats a la població espanyola, d'acord amb els promotors de FRAX. El quart article proposa un model amb els punts de tall de FRAX que permeten estratificar la cohort en tres grups de risc de patir una fractura principal. Aquest s’estableix en base als resultats reals de fractura soferta durant 10 anys (baix 20%) i també en la valoració cost-efectiva comparant el model amb la pràctica clínica habitual. Els punts llindars de FRAX que estableixen el model més cost-efectiu són: <5 risc baix; ≥ 5 i <7,5 risc intermedi; ≥ 7,5 risc alt. Utilitzar aquest model amb els llindars calibrats de FRAX permetria reduir un 82% les DXA i un 35% els tractaments farmacològics, reduint la despesa un 29% per detectar el mateix nombre de dones que pateixen fractura durant 10 anys que en el model de practica mèdica actual.Fragility fractures in Spain, as in other Western societies, are increasing in absolute numbers, associated with the increase in life expectancy and it is necessary to properly identify the population at risk of fragility fracture and to prioritize preventive actions on the most vulnerable groups. In 2008, the WHO published the FRAX tool for a growing number of countries. This is an online algorithm to calculate the absolute risk of fracture for 10 years, but it needs some adjustments or calibrations in each country for validation. The set of four published studies summarizes the process that ends as a FRAX tool calibration proposal for Spanish female population. The first article describes FRIDEX cohort comprised by women from the year 2000 aimed to determine the bone mineral density (BMD). They were determined BMD by DXA scan, anthropometric measures and an extensive questionnaire on risk factors (RF). The study describes and quantifies in percentages the presence of the RF included in the FRAX tool, as well as the age profile, weight, etc. and also pharmacological treatments received for osteoporosis. Thus it is established the baseline of a prospective cohort. The second paper shows the analysis of 770 women of the FRIDEX cohort aged between 40 to 90 years old at baseline. These women who met the criteria of not being taking treatment at the time of entry into the cohort have been monitored for 10 years. The RF associated with the risk of fracture were: age, previous fractures, suffering from rheumatoid arthritis, having osteoporosis at the DXA baseline and a higher frequency of falls in the previous year. The analysis also showed that the discriminative capacity of FRAX, as measured by AUC-ROC with and without BMD was moderate, but not lower than BMD criteria for osteoporosis (WHO 1994). On the other hand, the analysis of the predictive ability, as measured globally with the ObsFx /EspFx ratio was 2.4 with FRAX without BMD for major osteoporotic fracture and 2.8 for hip fracture. The Hosmer-Lemeshow test proved a good correlation only after calibration with the results of the ObsFx / EspFx ratio. The third article is an analysis of the resulting values of FRAX after analysing cases in the cohort FRIDEX website for Spanish population compared with the results of doing so on the website of the United Kingdom. This study was motivated because some publications guiding the use of this website did not fit properly in FRAX Spanish female population. The results showed differences of 2.2 times more likely to have major fracture and 1.6 to have hip fracture of the UK compared to Spain. The results suggested that this practice was not advisable and necessary intervention thresholds have to be adapted to the Spanish population, according to the developers of FRAX. The fourth article proposes a model with thresholds that allow FRAX stratify the cohort into three groups of risk of major osteoporotic fracture. These are set based on actual results of fractures suffered for 10 years (low 20%) and also on cost-effective evaluation comparing the model with the clinical practice. The FRAX thresholds that establish the most cost-effective model are: <5 low risk; ≥ 5 to <7.5 intermediate risk; High risk ≥ 7.5. Using this model with calibrated FRAX thresholds would reduce by 82% DXA and by 35% of pharmacological treatments, reducing spending by 29% to detect the same number of women who suffer fractures in the current model of common medical practice