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Letter to the Editor
Fracture risk assessment tool (FRAX) re-aim framework
Evaluación del riesgo de fractura (FRAX). Redefinir marco de referencia
Héctor Eloy Tamez-Péreza,
Autor para correspondencia
hectoreloytp@gmail.com

Corresponding author.
, Andrea Lisset Tamez-Gómezb
a Subdirección de Investigación, Facultad de Medicina y Hospital Universitario UANL, Monterrey, Nuevo León, Mexico
b Facultad de Ingeniería, Instituto Tecnológico y de estudios superiores de Monterrey, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoporotic fractures represent an important health problem due to their consequences on morbidity&#44; mortality&#44; and the generation of high sanitary costs&#46; Although we have adequate techniques for diagnosis and treatment in order to reduce risk of fracture &#40;RF&#41; we consider that osteoporosis is under diagnosed and therefore undertreated&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The FRAX is an online tool developed by the University of Sheffield &#40;2008&#41;&#44; sponsored by the WHO&#44; that calculates the RF from some clinical data&#44; and with which densitometry&#39;s values are not indispensible for results&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Given the quality of the variables and the methodology used&#44; this tool is highly recommended for the determination of RF&#44; supplying additional information that is independent of bone mineral density&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> therefore offering a useful tool for identifying high risk patients for opportune treatment&#44; as well as giving options to patients with low risk when indicating a densitometry&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> However&#44; it has limitations and clinical judgment remains fundamental&#46; It is accepted that the use of FRAX constitutes a valuable algorithm for decision making&#59; the variables to be introduced contain general and other dichotomous data&#44; except the densitometry&#46; The use of steroids is considered as RF and at the moment there is no mention of the possibility of other drugs having a negative impact on bone density&#59; thus&#44; for example&#44; having an inadequate thyroid hormone substitution treatment can increase RF&#46; Furthermore&#44; a recent study concluded that the lowest normal level of TSH and the highest normal level of T4 among euthyroid adults increase RF&#44; suggesting that it is necessary to redefine the optimal ranges of thyroid function tests&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> SGLT2 drugs &#40;especially canagliflozin&#41;&#44; widely used in the control of patients with diabetes mellitus&#44; could have deleterious effects on bone quality and increase RF&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Interestingly&#44; the recent publication suggests that anti-diabetic GLP-1 therapy may benefit the growing number of elderly patients with diabetes mellitus&#44; osteoporosis and high RF&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With previous knowledge&#44; our suggestion is that if the patient is using any of these drugs they should add them to the corresponding box&#44; since until now only the use of glucocorticoids was contemplated&#44; and so physicians could consider the FRAX in their clinical decisions&#46; We consider this aspect of great importance since primary hypothyroidism and type 2 diabetes mellitus in our country have a high prevalence and great morbidity and mortality&#59; hence&#44; we must be alert to this possibility and offer our patients optimal follow-up and an approach to perform a true personalized and accurate medicine in the real world&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> This knowledge should be disseminated in all continuing training courses&#44; and counting medical education programs&#46;</p></span>"
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