A importância da utilização do escore do osso trabecular (TBS) e do fracture assessment tool (FRAX) na prevenção de fraturas da população masculina em processo de envelhecimento

Abstract

Introduction: Population aging is an inexorable reality. Therefore, the number of studies related to common pathologies in the elderly, such as osteoporosis, tends to increase. Osteoporosis is a disease characterized by increased bone fragility, increasing the risk of fracture. Although it is a pathology that predominates in women, studies that evaluate the male population have aroused interest in the scientific community. However, there is still no consensus on the best way to estimate the risk of fracture. Bone densitometry (DXA), FRAX and TBS ( Trabecular Bone Score) assessment are available alternatives for diagnosis and prognosis. Objective: The present study had the general objective of clinically evaluating male patients over 50 years of age, correlating data that point to the existence of osteoporosis, the result of the TBS and FRAX score, as a proposal for preventive diagnosis of fragility fractures. The secondary objectives were: to determine the importance of adding the TBS and FRAX scores to patients who will be assessed by DXA; to determine the prevalence of patients with fractures, even with a densitometric diagnosis of osteopenia and / or osteoporosis. Methods: A descriptive and observational, cross-sectional cohort study was conducted, with retrospective data collection. The sample of this study was composed of male individuals, aged 50 years and over who attended the Clinoson Imaging Clinic to perform the DXA between the years 2016 to 2019. Considering a level of significance of 5%, accuracy of the TBS score and modified FRAX estimated at a minimum of 70%, with a margin of error of 5%, a minimum necessary total of 323 patients was obtained. Quantitative variables were described as mean and standard deviation or median and interquartile range. Categorical variables were described by absolute and relative frequencies. The analysis of the association between categorical variables was assessed by Pearson's chi-square test in conjunction with the analysis of adjusted residuals. Results: The average age was 70 years old, with approximately 7.5% of cases with fractures. The average BMI of the population was 27 kg / m2. We found an incidence of osteoporosis of around 10%, with an incidence of osteopenia of 43%. Analysis by the TBS score showed 13% of patients with degraded bone resistance and 17.5% with partially degraded bone resistance. There was an association between changes in densitometry and TBS score. Older patients with lower BMI had a higher incidence of osteoporosis. Frax's analysis of the studied population estimated an average risk of 2.6% for fractures in 10 years in relation to major fractures (FM) and 0.7% for neck fractures. Therefore, we noticed that men with an FM risk score greater than or equal to 3.4% had a fracture probability 4.5 times greater than those with a score below 3.4%. Regarding treatment, we observed that patients who do not use it have a 9 times higher risk of fractures. Conclusion: Most of our data were in accordance with the poor literature on the subject. The association of the TBS score with bone density is useful to better estimate the risk of fracture. In turn, FRAX is recommended as a prognostic factor. In fact, our study seems to have found a cutting bridge useful when using this tool. Finally, further research must be carried out on this subject in order to optimize the diagnosis of osteoporosis and the prevention of fractures.