Letter to the Editor
The application of the FRIDEX calibration of the FRAX tool to determine the absolute risk of osteoporotic fracture among Spanish women
La aplicación de la calibración FRIDEX de la herramienta FRAX® para determinar el riesgo absoluto de fractura osteoporótica en mujeres españolas
Rafael Azagraa,b,c,d,
, Paula Gabriela,b, Amada Aguyée, David Moriñaf,g, GROIMAP
Corresponding author
a Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
b Centro de Atención Primaria Badia del Valles, Institut Català de la Salut, Badia del Vallés, Barcelona, Spain
c GROIMAP-USR MN-IDIAP Jordi Gol, CAP Sant Félix, Sabadell, Barcelona, Spain
d Departament de Medicina, Universitat Internacional de Catalunya Sant Cugat, Barcelona, Spain
e CAP Vallés Oriental, Institut Català de la Salut, Granollers, Barcelona, Spain
f Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
g Departament d’Economia i Història Econòmica, Grups de Recerca d’Àfrica i Amèrica Llatines (GRAAL), Unitat de Fonaments de l’Anàlisi Econòmica, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
Read
3111
Timeswas read the article
1354
Total PDF
1757
Total HTML
Share statistics
array:24 [ "pii" => "S2173574318301758" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.10.003" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1150" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2019;15:e68-e69" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 9 "formatos" => array:2 [ "HTML" => 7 "PDF" => 2 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X17302735" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.10.014" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1150" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2019;15:e68-e69" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 634 "formatos" => array:3 [ "EPUB" => 60 "HTML" => 219 "PDF" => 355 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "La aplicación de la calibración FRIDEX de la herramienta FRAX® para determinar el riesgo absoluto de fractura osteoporótica en mujeres españolas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e68" "paginaFinal" => "e69" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The application of the FRIDEX calibration of the FRAX tool to determine the absolute risk of osteoporotic fracture among Spanish women" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Azagra, Paula Gabriel, Amada Aguyé, David Moriña" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "Azagra" ] 1 => array:2 [ "nombre" => "Paula" "apellidos" => "Gabriel" ] 2 => array:2 [ "nombre" => "Amada" "apellidos" => "Aguyé" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Moriña" ] 4 => array:1 [ "colaborador" => "en representación de GROIMAP" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574318301758" "doi" => "10.1016/j.reumae.2017.10.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301758?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302735?idApp=UINPBA00004M" "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X17302735/v1_201910230648/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574318301746" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.12.006" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1146" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2019;15:e70-e71" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 9 "formatos" => array:2 [ "HTML" => 7 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Osteonecrosis of the Lunate Associated With Systemic Sclerosis: Report of 4 Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e70" "paginaFinal" => "e71" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteonecrosis del semilunar asociada con esclerosis sistémica. Presentación de 4 casos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 624 "Ancho" => 1250 "Tamanyo" => 90365 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Plain X-ray of the left carpus corresponding to case 3 which shows marked sclerosis of the lunate bone (A, arrow). MR of the right carpus (T1 sequence) corresponding to case 2, which shows hypointensity signals in the lunate bone (B, arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sixto Zegarra-Mondragón, María Llop-Vilaltella, Walter Alberto Sifuentes-Giraldo, Carlos de la Puente Bujidos" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Sixto" "apellidos" => "Zegarra-Mondragón" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Llop-Vilaltella" ] 2 => array:2 [ "nombre" => "Walter Alberto" "apellidos" => "Sifuentes-Giraldo" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "de la Puente Bujidos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17302693" "doi" => "10.1016/j.reuma.2017.10.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302693?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301746?idApp=UINPBA00004M" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301746/v1_201910260908/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173574319301339" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.11.007" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1153" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2019;15:e66-e67" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Anti C1q antibodies. A promising biomarker for cocaine-levamisole induced vasculitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e66" "paginaFinal" => "e67" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Anticuerpos anti C1q. Un biomarcador prometedor para la vasculitis inducida por cocaína-levamisol" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José A. Gómez-Puerta, Carlos H. Muñoz, Adriana L. Vanegas-García, Tomás Urrego, Gloria Vásquez, Luis A. González" "autores" => array:6 [ 0 => array:2 [ "nombre" => "José A." "apellidos" => "Gómez-Puerta" ] 1 => array:2 [ "nombre" => "Carlos H." "apellidos" => "Muñoz" ] 2 => array:2 [ "nombre" => "Adriana L." "apellidos" => "Vanegas-García" ] 3 => array:2 [ "nombre" => "Tomás" "apellidos" => "Urrego" ] 4 => array:2 [ "nombre" => "Gloria" "apellidos" => "Vásquez" ] 5 => array:2 [ "nombre" => "Luis A." "apellidos" => "González" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301339?idApp=UINPBA00004M" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574319301339/v1_201910260908/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The application of the FRIDEX calibration of the FRAX tool to determine the absolute risk of osteoporotic fracture among Spanish women" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e68" "paginaFinal" => "e69" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rafael Azagra, Paula Gabriel, Amada Aguyé, David Moriña" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Rafael" "apellidos" => "Azagra" "email" => array:1 [ 0 => "rafael.azagra@uab.cat" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Paula" "apellidos" => "Gabriel" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Amada" "apellidos" => "Aguyé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 3 => array:3 [ "nombre" => "David" "apellidos" => "Moriña" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 4 => array:1 [ "colaborador" => "GROIMAP" ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Atención Primaria Badia del Valles, Institut Català de la Salut, Badia del Vallés, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "GROIMAP-USR MN-IDIAP Jordi Gol, CAP Sant Félix, Sabadell, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departament de Medicina, Universitat Internacional de Catalunya Sant Cugat, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "CAP Vallés Oriental, Institut Català de la Salut, Granollers, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Departament d’Economia i Història Econòmica, Grups de Recerca d’Àfrica i Amèrica Llatines (GRAAL), Unitat de Fonaments de l’Anàlisi Econòmica, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La aplicación de la calibración FRIDEX de la herramienta FRAX® para determinar el riesgo absoluto de fractura osteoporótica en mujeres españolas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the recently published article in your journal by Kyriakos et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> This article contains a cost-effective analysis of applying the intervention thresholds of 2 models for calculating the risk of fracture in osteoporosis management: the FRIDEX<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> calibration, based on the cohort of the same name<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and validated for the Spanish population,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> for the one part and the thresholds of the <span class="elsevierStyleItalic">National Osteoporosis Guideline Group</span> (NOGG)<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a> for the other. Both models use the FRAX® tool (<a href="http://www.shef.ac.uk/FRAX/">http://www.shef.ac.uk/FRAX/</a>), but as highlighted by the authors themselves, the NOGG thresholds are specific to the population of the United Kingdom and their use in the Spanish population would give rise to considerable errors in the calculation of fracture risk.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,7</span></a> The NOGG<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> itself concludes “<span class="elsevierStyleItalic">the use of FRAX</span>®<span class="elsevierStyleItalic">—with fixed or age-dependent thresholds—as a gateway to assessment, identifies high risk individuals with greater efficacy than the use of bone mineral density (BMD). Notwithstanding, the establishment of intervention thresholds should be country</span>-<span class="elsevierStyleItalic">specific</span>”. As a result we understand that they have used NOGG thresholds as a “hypothetical” model so as to have another reference in the analysis of FRIDEX calibration efficiency in our sample.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This study is very interesting because, among other aspects, it analyses the behaviour of the FRIDEX calibration in a specific Spanish autonomous community and because it provides data which confirm several improvable aspects in current medical practice regarding the approach to osteoporosis. For example, it shows that 36% of women with previous fragility fractures do not receive pharmacological treatment (PT) from physicians of different specialties,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,8</span></a> although there is broad consensus that these women are at high risk of fracture.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a> It also indicates that 31.4% of the sample received PT, although here it would be of interest to determine concordance with the densitometry result (DXA) and what happened in each of the 2 models analysed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding more technical aspects, we have a doubt about Figure 1 of Kyriakos et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> where the FRIDEX calibration would indicate PT to 138 women at high initial risk (FRAX®<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>7.5%) plus the 24 cases with osteoporosis in the DXA among the 77 at intermediate risk. This may be interpreted that the 138 cases would pass directly to the final table without applying the result of the DNX to them which the FRIDEX model would advise.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Although this aspect is quoted in the redaction, there is no explicit record of what the result of recalculating FRAX® with the <span class="elsevierStyleItalic">T-score</span> of the neck of the femur (NF) would be in these 138 cases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It could also be interpreted that they all become high risk again on being recalculated with FRAX® and the <span class="elsevierStyleItalic">T-score</span> of the NF. We therefore believe it would be relevant for the authors to clarify this point.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the FRIDEX<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> cohort we observed that 21.4% of initially high risk cases (FRAX®<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>7.5%) became not high risk when FRAX with T-score of the NF was re-calculated. If we apply the same percentage, the group to which the FRIDEX model would indicate a PT to would drop from 26.7% to 21.9%, and healthy lifestyles would be recommended to 78.1%.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Although the conclusions on the number of DXA indicated would not vary, in the case of the PT the results and conclusions could be severely affected in both financial analysis and in the concordance between the models (FRIDEX vs NOGG). The authors conclude that the general application of the FRIDEX calibration thresholds would be cost-effective.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It has yet to be seen, however, whether routine application could imply even greater cost savings in PT.</p><p id="par0025" class="elsevierStylePara elsevierViewall">According to previous experience,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,8</span></a> it would be difficult when requesting a DXA that no cases with an initial FRAX®<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>7.5% appear and without densitometry osteoporosis in the DXA.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2–4</span></a> Some cases would become not high risk and would therefore not imply PT. In the FRIDEX<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a> cohort the saving over regular practice was 28% (3% in the reduction in DXA and 25% in the reduction in PT).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that the readers will be interested in finding out if there are changes or if the results remain the same, in the cost-effective analysis and Cohen's kappa concordance coefficient.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We also wish to take this opportunity to encourage other researchers to carry out further analysis on the FRIDEX calibration of behavioural models in determining absolute risk of fragility fracture in their own populations.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Azagra R, Gabriel P, Aguyé A, Moriña D, en representación de GROIMAP. La aplicación de la calibración FRIDEX de la herramienta FRAX® para determinar el riesgo absoluto de fractura osteoporótica en mujeres españolas. Reumatol Clin. 2018. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.reuma.2017.10.014">https://doi.org/10.1016/j.reuma.2017.10.014</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio comparativo de la aplicación de la calibración FRIDEX y de la guía NOGG en el manejo de la osteoporosis en la práctica clínica habitual" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Kyriakos" 1 => "A. Vidal-Casariego" 2 => "L. Quiles-Sánchez" 3 => "A. Calleja-Fernández" 4 => "D. Ávila-Turciosa" 5 => "J. Urosa-Maggia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2016.05.007" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2017" "volumen" => "13" "paginaInicial" => "258" "paginaFinal" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27373582" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Umbrales de FRAX para identificar a la población de alto o bajo riesgo de fractura" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Azagra" 1 => "G. Roca" 2 => "J.C. Martín-Sánchez" 3 => "E. Casado" 4 => "G. Encabo" 5 => "M. Zwart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2015" "volumen" => "144" "paginaInicial" => "1" "paginaFinal" => "8" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Azagra" 1 => "G. Roca" 2 => "G. Encabo" 3 => "A. Aguyé" 4 => "M. Zwart" 5 => "S. Güell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2474-13-204" "Revista" => array:5 [ "tituloSerie" => "BMC Musculoskelet Disord" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23088223" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Azagra" 1 => "M. Zwart" 2 => "A. Aguyé" 3 => "J.C. Martín-Sánchez" 4 => "E. Casado" 5 => "M.A. Díaz-Herrera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.maturitas.2015.10.002" "Revista" => array:6 [ "tituloSerie" => "Maturitas" "fecha" => "2016" "volumen" => "83" "paginaInicial" => "65" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26546077" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case finding for the management of osteoporosis with FRAX – assessment and intervention thresholds for the UK" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "National Osteoporosis Guideline Group" "etal" => true "autores" => array:6 [ 0 => "J.A. Kanis" 1 => "E.V. McCloskey" 2 => "H. Johansson" 3 => "O. Strom" 4 => "F. Borgstrom" 5 => "A. Oden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00198-008-0712-1" "Revista" => array:6 [ "tituloSerie" => "Osteoporos Int" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "1395" "paginaFinal" => "1408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18751937" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of intervention thresholds based on FRAX: a report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Advisory Board of the National Osteoporosis Guideline Group" "etal" => true "autores" => array:6 [ 0 => "J.A. Kanis" 1 => "N.C. Harvey" 2 => "C. Cooper" 3 => "H. Johansson" 4 => "A. Oden" 5 => "E.V. McCloskey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11657-016-0278-z" "Revista" => array:5 [ "tituloSerie" => "Arch Osteoporos" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27465509" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Precautions required on using the predictive thresholds of the FRAX® tool to decide the need for an axial bone density scan in the Spanish population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Azagra" 1 => "M. Zwart" 2 => "A. Aguyé" 3 => "G. Encabo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aprim.2011.03.012" "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "2012" "volumen" => "44" "paginaInicial" => "183" "paginaFinal" => "184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21855178" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteoporosis management in a real clinical setting: heterogeneity in intervention approach and discrepancy in treatment rates when compared with the NOGG and NOF guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Kyriakos" 1 => "A. Vidal-Casariesgo" 2 => "L.V. Quiles-Sánchez" 3 => "J.A. Urosa-Maggi" 4 => "A. Calleja-Fernández" 5 => "A. Hernández-Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Exp Clin Endocrinol Diabetes" "fecha" => "2016" "volumen" => "124" "paginaInicial" => "466" "paginaFinal" => "473" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301758/v1_201910260908/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000005/v1_201910260908/S2173574318301758/v1_201910260908/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301758?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 2 | 3 |
| 2024 October | 25 | 14 | 39 |
| 2024 September | 43 | 15 | 58 |
| 2024 August | 59 | 35 | 94 |
| 2024 July | 42 | 21 | 63 |
| 2024 June | 38 | 19 | 57 |
| 2024 May | 41 | 26 | 67 |
| 2024 April | 33 | 18 | 51 |
| 2024 March | 36 | 18 | 54 |
| 2024 February | 19 | 22 | 41 |
| 2024 January | 26 | 20 | 46 |
| 2023 December | 27 | 22 | 49 |
| 2023 November | 39 | 25 | 64 |
| 2023 October | 41 | 26 | 67 |
| 2023 September | 58 | 36 | 94 |
| 2023 August | 25 | 11 | 36 |
| 2023 July | 21 | 19 | 40 |
| 2023 June | 23 | 15 | 38 |
| 2023 May | 31 | 16 | 47 |
| 2023 April | 13 | 4 | 17 |
| 2023 March | 34 | 26 | 60 |
| 2023 February | 38 | 21 | 59 |
| 2023 January | 21 | 10 | 31 |
| 2022 December | 40 | 18 | 58 |
| 2022 November | 41 | 29 | 70 |
| 2022 October | 45 | 33 | 78 |
| 2022 September | 26 | 19 | 45 |
| 2022 August | 26 | 36 | 62 |
| 2022 July | 27 | 34 | 61 |
| 2022 June | 27 | 27 | 54 |
| 2022 May | 23 | 41 | 64 |
| 2022 April | 31 | 30 | 61 |
| 2022 March | 34 | 40 | 74 |
| 2022 February | 27 | 27 | 54 |
| 2022 January | 39 | 28 | 67 |
| 2021 December | 32 | 33 | 65 |
| 2021 November | 27 | 42 | 69 |
| 2021 October | 44 | 40 | 84 |
| 2021 September | 39 | 38 | 77 |
| 2021 August | 24 | 33 | 57 |
| 2021 July | 28 | 28 | 56 |
| 2021 June | 18 | 32 | 50 |
| 2021 May | 27 | 28 | 55 |
| 2021 April | 64 | 64 | 128 |
| 2021 March | 44 | 23 | 67 |
| 2021 February | 20 | 20 | 40 |
| 2021 January | 33 | 24 | 57 |
| 2020 December | 24 | 15 | 39 |
| 2020 November | 31 | 14 | 45 |
| 2020 October | 19 | 17 | 36 |
| 2020 September | 27 | 17 | 44 |
| 2020 August | 25 | 22 | 47 |
| 2020 July | 20 | 18 | 38 |
| 2020 June | 33 | 10 | 43 |
| 2020 May | 35 | 17 | 52 |
| 2020 April | 12 | 13 | 25 |
| 2020 March | 4 | 1 | 5 |
| 2019 November | 1 | 0 | 1 |
| 2019 August | 5 | 2 | 7 |
| 2019 January | 1 | 0 | 1 |
Show all
