FRAX Tool in Brazil: an integrative literature review following validation

The present article is an integrative review the objective of which was to assess research carried out with the FRAX tool in Brazil following its validation, and describe the conclusions drawn. Two databases were used to select the articles (the Capes Portal and the Virtual Health Library), and the sample of this review was the only four articles published in Brazil relating to the FRAX tool following its validation in May 2013. After analyzing the articles, the results demonstrated that despite some limitations the FRAX Tool can be used to reduce the prevalence of fractures due to its simplicity of use, with an emphasis on prediction and orientation, allowing early and safe therapeutic decision-making.

Keywords:
FRAX; Osteoporotic Fractures; Diagnosis; Mass Screening; Diagnostic Techniques and Procedures; Brazil

Authorship

Cristina de Jesus Sousa

Universidade Católica de Brasília, Escola de Saúde e Medicina, Programa de Pós-graduação Stricto Sensu em Gerontologia. Brasília, DF, Brasil.Universidade Católica de BrasíliaBrazilBrasília, DF, BrazilUniversidade Católica de Brasília, Escola de Saúde e Medicina, Programa de Pós-graduação Stricto Sensu em Gerontologia. Brasília, DF, Brasil.

Maria Liz Cunha de Oliveira

Correspondence Cristina de Jesus Sousa E-mail: cristinadejesussousa@msn.com

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Tables

Tables (2)

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Chart 1
Description of articles included in integrative review.

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Chart 2
Designs and aims of articles.

Chart 1 Description of articles included in integrative review.

	Study title	Title of Periodical	Authors	Language/ Year	Institution
A1	Correlation between osteoporotic fracture risk in Brazilian postmenopausal women calculated using the FRAX with and without the inclusion of bone densitometry data	Arch Osteoporos	Bastos-Silva,Y, et al.	English/2016	Universidade de Campinas
A2	Low health related quality of life associated with fractures in obese postmenopausal women in Santa Maria, Brazil	Bone Reports	Copês, R.M. et al.	English/2017	Universidade Federal de Santa Maria
A3	Low self-awareness of osteoporosis and fracture risk among postmenopausal women	Arch Osteoporos	Langer, F. W.et al.	English/2016	Universidade Federal de Santa Maria
A4	Incidence of hip fracture in Brazil and the development of a FRAX model.	Arch Osteoporos	Zerbini, C. A. F. et al.	English/2015	Centro Paulista de Investigação clínica e outros

Chart 2 Designs and aims of articles.

	Study design	Aims	Results	Recommendations
A1	Cohort study, exploratory and comparative design.	To assess the degree of agreement between the risk of fractures in the next ten years in menopausal women calculated by the FRAX tool with and without inclusion of bone mineral density	FRAX represents a good alternative for predicting fracture risk, identifying patients that should be treated even without knowledge of bone mineral density, avoiding the need to submit patients to densitometry, which is unavailable in several regions	It is necessary to define the threshold for initiating pharmacological treatment based on the FRAX risk rate for use in the Brazilian population.
A2	Cohort study, exploratory and comparative design.	To explore the effect of both obesity and fractures on self-reported quality of life	Lower rates of self-reported quality of life were found in obese women with fractures in comparison with obese women without fractures and non-obese women with fractures	The FRAX tool should be modified as it does not effectively measure risk in obese people, underestimating the probability of fractures and leaving them untreated. In addition, there is a need for studies to evaluate the efficacy of the anti-fracture effect of different medications in obese patients.
A3	Cohort study, exploratory and comparative design.	To evaluate the concordance between self-perception of osteoporosis and risk of fracture with the risk of fracture in the next ten years calculated by the FRAX Tool	There is no agreement between the self-perception of fracture risk and the risk calculated by FRAX. A total of 79.3% of the women identified as having a high risk of fractures by FRAX perceived themselves as having low risk	Need for educational measures on osteoporosis in postmenopausal patients
A4	Cohort study, exploratory design.	To calculate the mean age and gender referring to rates of femur fractures in Brazil for the creation of the Brazilian FRAX Tool and to be able to perform interventions.	The incidence of fractures increases with age, with a preponderance in men when young and in women when over 50 years. The probability of bone fracture was higher in patients with clinical risk factors such as parents with femoral fractures, lower bone density, low BMI, women with a history of previous bone fracture and advanced age.	Interventions should be applied in elderly women with a history of previous fractures. The FRAX tool is the first model for the prediction of fracture risk specific to Brazil based on the original method and has been validated by several independent cohort studies. Despite some limitations, it is effective for use in clinical practice.

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FRAX Tool in Brazil: an integrative literature review following validation

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[1] Correspondence Cristina de Jesus Sousa E-mail: cristinadejesussousa@msn.com