Objetivo

The main consequences of osteoporosis are fragility fractures, associated with high morbimortality. The prediction of these fractures can help identify the most-at-risk population and implement preventive measures. The aim of this study was to assess the usefulness of multiple factors in their prevention, comparing the bone mineral density (BMD), the calculation of absolute risk of fracture using the tool FRAX® in the presence and absence of BMD, and the clinical data.

Material and methods

An eight-year-duration longitudinal study was conducted on a postmenopausal female population, with and without osteoporosis. All of them were taken a standardised clinical history, spinal and hip BMD, and FRAX with and without BMD. Eight years later we identified the existent fractures. In addition to a parametric and non-parametric statistic in SPSS 21.1, we used the classification and regression tree (CART) method to assess possible interactions among fracture risk factors.

Results

We studied 276 postmenopausal patients whose average age at the beginning of the study was 61.08±8.43 years-old and had a body mass index (BMI) of 25.67±4.04. 56.5% of the patients (n=156) were diagnosed with osteoporosis before the beginning of our study, and all of them were treated. After eight years of follow-up, 72 patients (24.6%) suffered a fracture and 17 patients (6.2%) also suffered a second one. The results of the CART analysis showed that the main risk factor to suffer an osteoporotic fracture after 8 years of following up is having preceding fractures. Having a femoral neck BMD lower than 0.67 was the main risk factor among those with a previous fracture.

Conclusions

The use of a binary statistical procedure (CART) on a cohort of patients allow us identify those most at risk of fractures, according to clinical parameters and simple additional tests, in order to establish more effective therapeutic measures.

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