The intravenous bisphosphonates approved by the U.S. Food and Drug Administration for the treatment of postmenopausal osteoporosis are zoledronic acid (Reclast), 5 mg yearly (shown to decrease vertebral and hip fractures),16,26,36 and ibandronate, 3 mg every three months.37 Although these medications are expensive, they are useful for high-risk patients who are unable to tolerate or adhere to oral therapy. Aerobic exercise programs that do not incorporate strength and balance training should be avoided because of the association with increased fracture risk.19 A thorough assessment of a patient's risks of falling and mitigation of those risk factors have strong evidence of effectiveness in fall prevention.20 A Cochrane review suggested that hip protectors decrease fracture risk.21, Patients should be counseled to quit smoking because it has been shown to decrease BMD at all skeletal sites.22 Heavy alcohol consumption (defined as more than four drinks per day for men or more than two drinks per day for women) is a major risk factor for fracture and should be discouraged.23, Dietary modifications may have a role in optimizing bone health. The FRAX models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. Other factors that may affect risk of fragility fractures GENDER female AGE Calculator About References. The osteoporosis self-assessment tool (OST) 1 in women is a simple formula that predicts risk of osteoporosis for the patient based solely on current weight and age. It is associated with an increased risk of venous thromboembolism and a decreased risk of invasive breast cancer.16 The best candidates for raloxifene are postmenopausal women with osteoporosis who are unable to tolerate bisphosphonates, have no vasomotor symptoms or history of venous thromboembolism, and have a high breast cancer risk score.16,27 Bazedoxifene is a selective estrogen receptor modulator more recently approved for use in the United States for the prevention of osteoporosis as part of a combination therapy with conjugated estrogen (Duavee). The World Health Organization (WHO) 8 has quantified this as forces equivalent to a fall from a standing height or less. We avoid using tertiary references. Cadarette (2004) Osteoporos Int 15(5):361-366 [PubMed] ICD-10. International Index of Erectile Function (IIEF-5) Assess erectile dysfunction. The U.S. Preventive Services Task Force found insufficient evidence to recommend screening for osteoporosis in men; other organizations recommend screening all men 70 years and older. Diabetes medicines also increase fracture risk. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. Youll receive a 10-year risk percentage of a major osteoporotic fracture and a 10-year risk percentage of a hip fracture. Renal insufficiency is a listed caution, but denosumab appears to be safe for patients with chronic kidney disease stages 1 to 3.45, Hormone Therapy. This osteoporosis risk score calculator stratifies osteoporosis risk, especially useful in women with low bone density. A previous fracture denotes more accurately a previous fracture in adult life occurring spontaneously, or a fracture arising from trauma which, in a healthy individual, would not have resulted in a fracture. Summary What it measures: The Fracture Risk Assessment Tool (FRAX) is a fracture risk calculator that estimates an individual's 10-year probability of incurring a hip or other major osteoporotic fracture. The FRAX algorithms give the 10-year probability of fracture. About the bone fracture risk calculator. FRAX Score: Calculator, Meaning, and More. The QFracture and FRAX risk assessment tools predict the absolute risk of hip fracture, and major osteoporotic fractures (spine, wrist, or shoulder) over 10 years. Glucocorticoids No Yes 9. Other perimenopausal or postmenopausal women with risk factors for osteoporosis if willing to consider pharmacologic interventions: Excessive consumption of alcohol (> 2 drinks per day for women), Low body weight (< 58 kg [128 lb] or body mass index < 20 kg per m, Any history of long-term systemic glucocorticoid therapy ( 3 months), American College of Obstetricians and Gynecologists, Bone density screening no more than once every two years beginning at 65 years of age, unless new health risks develop, Selective screening in women younger than 65 years if they are postmenopausal and have other osteoporosis risk factors or fracture, In the absence of new risk factors, DEXA monitoring of therapy should not be repeated after BMD is determined to be stable or improved, In women 65 years and older and in men 70 years and older, In postmenopausal women and men 50 to 69 years of age; recommended based on risk factor profile, With vertebral imaging in those who have had a fracture to determine degree of disease severity, At DEXA facilities using accepted quality assurance measures, In women 65 years and older and in men 70 years and older to diagnose vertebral fractures if T-score is 1.5, In women 70 years and older and in men 80 years and older to diagnose vertebral fractures, regardless of T-score, In postmenopausal women and men 50 years and older with a low-trauma fracture, In postmenopausal women and men 50 to 69 years of age to diagnose vertebral fractures if there is height loss 4 cm (1.5 in), or recent or ongoing long-term glucocorticoid therapy, To check for causes of secondary osteoporosis, BMD testing one to two years after initiating therapy to reduce fracture risk and every two years thereafter, More frequent testing in certain clinical situations, Longer interval between repeat BMD tests for patients without major risk factors and who have an initial T-score in the normal or upper lowbone mass range, Risk factors: glucocorticoid use (> 3 months cumulative therapy in past year), high-risk medication use, hypogonadism or premature menopause (age < 45 years), malabsorption syndrome, hyperparathyroidism, other associated disorders, Low body weight (< 60 kg [132 lb]) or weight loss (> 10% of weight at 25 years of age), Vertebral fracture or osteopenia on radiography, Repeat BMD testing in one to three years and reassess risk in moderate- and high-risk groups, United Kingdom National Osteoporosis Guideline Group, Case finding for BMD assessment is based on risk factor assessment and comparison of risk to age- and sex-specific fracture probabilities, Screen for osteoporosis in women 65 years and older, and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors, Current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men, Central nervous system disorders (e.g., epilepsy, multiple sclerosis, Parkinson disease, spinal cord injury, stroke), Endocrine/metabolic disorders (adrenal insufficiency, athletic amenorrhea, Cushing syndrome, hemochromatosis, homocystinuria, primary hyperparathyroidism, hyperprolactinemia, hyperthyroidism, primary or secondary hypogonadism, premature menopause, thyrotoxicosis, type 1 diabetes mellitus), Gastrointestinal disorders (celiac disease, gastric bypass, inflammatory bowel disease, malabsorption, pancreatic insufficiency, primary biliary cirrhosis), Hematologic disorders (hemophilia, leukemia and lymphomas, monoclonal gammopathies, multiple myeloma, sickle cell disease, thalassemia), Human immunodeficiency virus infection or AIDS, Nutrition disorders (alcoholism, anorexia nervosa/bulimia, malnutrition, vitamin A excess, vitamin D deficiency), Anticonvulsants (e.g., phenobarbital, phenytoin [Dilantin]), Gonadotropin-releasing hormone agonists and antagonists, Thiazolidinediones (e.g., pioglitazone [Actos]), 4 drinks per day for men or 2 drinks per day for women, 2.5 cups of coffee or 5 cups of tea per day, Multicomponent exercise with strength and balance training, Consider drug discontinuation after 5 years in low-risk patients, Small risk of atypical femoral shaft fractures; osteonecrosis of the jaw, Alendronate/cholecalciferol (Fosamax Plus D), Muscular and joint pains; small risk of osteonecrosis of the jaw (especially older women with poor dental hygiene or cancer) Contraindications: hypocalcemia; pregnancy. 24/7 Live Expert. The FRAX calculator for the United States is unique in that there exist distinct databases for ethnic minorities. The FRAX score can help doctors identify people who might need additional support. The most commonly recommended laboratory tests include serum 25-hydroxyvitamin D, calcium, creatinine, and thyroid-stimulating hormone levels.1,14, The National Osteoporosis Foundation recommends treatment of postmenopausal women and men with a personal history of hip or vertebral fracture, a T-score of 2.5 or less, or a combination of low bone mass (T-score between 1 and 2.5) and a 10-year probability of hip fracture of at least 3% or any major fracture of at least 20% as calculated by the FRAX Fracture Risk Assessment Tool.1 [corrected] The WHO recommendations are less specific, stating that persons with or at risk of osteoporosis should be considered for treatment.15 Randomized controlled trials of treatment have shown reduction of fractures for only two groups: those with a T-score of less than 2.5 and those who have already experienced a hip or vertebral fracture.16, Fall prevention is a priority for patients with osteoporosis because falls are more closely associated with fracture risk than is BMD.17 The USPSTF recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older who are at increased risk of falls.18 A multicomponent exercise program that consists of weight-bearing resistance and balance training should be recommended. Getting more exercise, including weight-bearing activities, is helpful too. Raloxifene, a selective estrogen receptor modulator, is approved for treating postmenopausal osteoporosis, and is effective at reducing vertebral fractures only.16,26 Raloxifene is commonly associated with increased vasomotor symptoms. Enter "Yes" if you drink 3 or more alcoholic beverages a day. Male Female Age Fractures since the age of 50 (excluding major trauma, e.g. MDCalc is a 13-year-old medical reference started by two practicing emergency medicine physicians, Dr. Joe Habboushe and Dr. Graham Walker. The FRAX calculator is a major achievement in terms of our understanding of measuring fracture risk. The optimal length of oral bisphosphonate therapy is unknown. If you are younger than 45, click here to take the Bone Health Quiz Do you have a question about how the Fracture Risk Calculator works for you? The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. After your doctor fills in this information, the tool will calculate your FRAX scores. One study suggests that it is advisable to follow teriparatide therapy with bisphosphonate therapy to maintain BMD gains.43, Denosumab. The loss of bone minerals quicker than you can replace them is called bone demineralization, which can lead to other conditions like osteoporosis. Enter "No" if you have other kinds of arthritis, such as osteoarthritis. Your doctor may recommend treatment to reduce your fracture risk. (2017). Your test result is reported using T-scores. Predicts fracture risk in the 6 months after radiotherapy, which may not be relevant for many patients (i.e., if no plans for radiotherapy and/or short life expectancy). Teriparatide is a recombinant human parathyroid hormone with bone anabolic activity. (2017). A FRAX score of more than 5 percent for a hip fracture, at age 70 and beyond, means you should consider treatment along with lifestyle changes. The American Bone Health Fracture Risk Calculator Version 3.0 estimates fracture risk for women and men over age 45. The University of Sheffield launched the FRAX tool in 2008. Purpose: To estimate a patient's 10-year risk for osteoporotic fracture based on the FRAX WHO fracture risk assessment tool of Kanis et al. Inflammation around the joints causes bone loss; pain leads to reduced activity.Enter "Yes" if you have Rheumatoid Arthritis. The ABH FRC will give results with or without a bone density test score. Long-term use of these medications is associated with several serious side effects, including fractures and jawbone deterioration. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. . Find out what it means, how it's calculated. English | Arabic | Bengali | Chinese Simplified | Chinese Traditional | Croatian | Czech | Danish | Dutch | Estonian | Farsi | Finnish | French | Georgian | German | Greek | Icelandic | Italian | Indonesian | Japanese | Korean | Lithuanian | Norwegian | Polish | Portuguese (Portugal) | Portuguese | Romanian | Russian | Serbia | Slovak | Spanish | Swedish | Thai | Turkish | Ukrainian, Individuals with fracture risk assessed since 1st June 2011, Age (between 40 and 90 years) or Date of Birth, Centre for Metabolic Bone Diseases, University of Sheffield, UK. See permissionsforcopyrightquestions and/or permission requests. If ages below or above are entered, the programme will compute probabilities at 40 and 90 year, respectively. Consuming more than 2.5 units of caffeine daily (1 unit = one cup of coffee or two cups of tea) may increase fracture risk.24 Diets with adequate protein intake are necessary for optimal bone health, but the proper amount or source (plant vs. animal) remains controversial. For this reason reliance should not be placed on a patient's report of 'arthritis' unless there is clinical or laboratory evidence to support the diagnosis. You can lower your score and your risk right away by quitting cigarettes and cutting back on your alcohol consumption. Some items on the FRAX score list of risk factors are manageable. A 10-year fracture risk of 10% is considered to be the threshold for arranging a dual-energy X-ray absorptiometry (DXA) scan in men and women. Correlations were calculated between the various methods (Table). These risk factors appear to have a dose-dependent effect, i.e. Calcium is essential for building and maintaining healthy bones at all ages. The site and reference technology is DXA at the femoral neck. The FRAXmodels have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Garvan Institute Assessment Tool They are not currently taking osteoporosis medication. OR Densitometer by DXA GE Lunar by DXA Hologic There has been no demonstrated effectiveness of combination therapy in reducing fractures. For these groups, the International Society for Clinical Densitometry recommends use of the z score (age and sex norms). The FRAX tool has been developed to evaluate fracture risk of patients. You are also at an increased risk of falling and fracturing because of blood sugar levels, declining vision, associated peripheral neuropathy and nerve damage. All Rights Reserved. This is primarily a screening tool and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture [1] and to target anti-osteoporosis treatments [2] . Excess alcohol has a negative effect on bone density, fracture, and fracture healing. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. Have you been diagnosed with diabetes? The QFracture -2016 algorithms have been developed by Julia Hippisley-Cox and Carol Coupland and are based . Multi-Factor Authentication (MFA) is required for all remote users Please install Symantec VIP on your mobile device to avoid any issues or delays with . The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). GlobalRPH has a medcalc for every major clinical specialty including: Cardiology, Critical Care, Dermatology, Endocrinology, Gastroenterology and Hepatology, Geriatrics, Hematology, Infectious Disease, Neurology, Nephrology, Nutrition (TPN, BMR calculators, Fiber), Oncology, Pain Management, Pharmacokinetics, Psychiatry, Rheumatology, Statistics, The tool was developed to evaluate a patient's 10-year probability of hip fracture and major osteoporotic fracture (clinical spine, forearm, hip, or shoulder fracture). The current National Osteoporosis Foundation Guide recommends treating patients with FRAX 10-year risk scores of > or = 3% for hip fracture or > or = 20% for major osteoporotic fracture, to reduce their fracture risk. If your FRAX score is 3% or more for hip fracture, or 20% or more for other major osteoporosis fractures, you may be at increased risk of fracture. Men are also more likely to fracture a bone as they age. Causes, symptoms, risk factors, and treatment. The U.S. Preventive Services Task Force (USPSTF) recommends screening all women 65 years and older.5 DEXA of the hip and lumbar spine is the preferred assessment method. In patients without a BMD test, the field should be left blank (see also notes on risk factors) (provided by Oregon Osteoporosis Center). Enter "No" if you have never smoked or have quit. Had multiple osteoporosis-related fractures. However, osteoarthritis is, if anything, protective. This content is owned by the AAFP. To help determine your risk for such an injury, doctors developed the Fracture Risk Assessment Tool (FRAX). The FRAX models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. Additional risk factors such as frequent falls, not represented in FRAX, warrant individual clinical judgment. Z scores of 2.0 or less are below the expected range for age. They then will be able to recommend treatment or suggest ways of preventing osteoporosis. 2.When you had erections with sexual stimulation, how often were your erections hard enough for penetration? Women younger than 65 years should be screened for osteoporosis if the estimated 10-year fracture risk equals or exceeds that of a 65-year-old white woman with no risk factors. In addition to femoral neck (hip) BMD, age, gender, fracture history and steroid use, FRAX also takes into account other clinical risk factors to calculate the absolute 10-year risk of a hip fracture or other major osteoporotic fracture (spine, forearm, upper arm). The test usually takes less than 15 minutes. FRAX is a sophisticated risk assessment instrument, developed by the University of Sheffield. Please visit our website Medicalalgorithms.com for Description and Interpretation and further algorithms you may want to consider in the next steps of your evaluation. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The formula for measuring your risk uses factors such as: Osteoporosis means porous bone. Bones become more brittle, usually due to hormonal changes or reduced levels of calcium or vitamin D in the body. Welcome to the QRISK 3-2018 Web Calculator. Bisphosphonates should be used as first-line pharmacologic treatment for osteoporosis. The FRAX score (with BMD) identified 46.8% of patients who had DXA suitable for treatment, in contrast to 19.1% by the T-score alone. Combination Therapy. Weight must be between 70 and 300 pounds. The QRISK 3 algorithm calculates a person's risk of developing a heart attack or stroke over the next 10 years. Enter yes where the patient has a confirmed diagnosis of rheumatoid arthritis. Parent Fractured Hip No Yes 7. While the original paper describes the size of the lesion as a percentage of the cortex, in practice it is classified as a percentage of the width (diameter) of the bone at that level. A unit of alcohol varies slightly in different countries from 8-10g of alcohol. Author disclosure: No relevant financial affiliations. MDCalc - Medical calculators, equations, scores, and guidelines Creatinine Clearance (Cockcroft-Gault Equation) Calculates CrCl according to the Cockcroft-Gault equation. Learn strategies you can use today. The lower your T-score, the lower your bone density. Learn which ones and why. Did you recently attend an American Bone Health event? The risk is expressed as a percentage: for example, 10% means 10 people out of a 100, with this level of risk, will develop osteoporosis in the next 10 years. Gaucher disease is an inherited disorder that causes a buildup of GCase in your body. Read our editorial policy. The FRAX tool has been developed to evaluate fracture risk of patients. The filter allows the FRAX score into the DXA report only when the patient does not meet the first two of the NOF treatment criteria (prior hip or vertebral fracture or T-score below 2.5) but could possibly meet the third NOF treatment criterion based on FRAX risk calculation: an untreated postmenopausal woman or man age 50 years or older . 10-Year Fracture Risk Calculator The American Bone Health Fracture Risk Calculator Version 3.0 estimates fracture risk for women and men over age 45. . Oral bisphosphonates inhibit osteoclastic activity and are antiresorptive agents. Do not use dual energy x-ray absorptiometry (DEXA) to screen for osteoporosis in women younger than 65 years or in men younger than 70 years with no risk factors. MDCalc loves calculator creators researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. Height (cm) 5. English | Arabic | Bengali | Chinese Simplified | Chinese Traditional | Croatian | Czech | Danish | Dutch | Estonian | Farsi | Finnish | French | Georgian | German | Greek | Icelandic | Italian | Indonesian | Japanese | Korean | Lithuanian | Norwegian | Polish | Portuguese (Portugal) | Portuguese | Romanian | Russian | Serbia | Slovak | Spanish | Swedish | Thai | Turkish | Ukrainian, Individuals with fracture risk assessed since 1st June 2011, Centre for Metabolic Bone Diseases, University of Sheffield, UK, Professor Emeritus, University of Sheffield, Click here to view the applications available. Be sure to use the minus sign if the T-score is negative. Rheumatoid arthritis No Yes 10. It presents the average risk of people with the same risk factors as those entered for that person. Any references to the WHO tool (Hint: it's not just, Doctors recommend calcium and vitamin D to help protect bone health. MDCalc Your FRAX score is your risk of having an osteoporosis-related fracture in the next 10 years. Objective. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. Excess blood sugar affects collagen in the bones, making them brittle and more likely to break. One drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits (80 proof). Fractions knowledge in grade 5 uniquely predicts student success in Algebra and . 1. See their website for more information and to use the FRAX tool. Receive updates and information about Bone Health, Our Events, and Specialty Programs each month. Personal details (such as height and weight, medication history, smoking history and family history) are entered to predict whether someone is at risk of developing osteoporosis in the next 10 years. Is It Ever Too Late for Osteoporosis Treatment? How Does Resistance Training Prevent Osteoporosis. Comparing Bone Demineralization and Osteoporosis, What to Know About Osteoporosis and Your Spine, What You Need to Know About Gaucher Disease and Osteoporosis, A Complete Guide to Infusions for Osteoporosis, 4 Types of Exercises and Activities to Avoid When You Have Osteoporosis. Disability (pain, disability, complications), Excessive alcohol intake (> 4 drinks per day for men; > 2 drinks per day for women), caffeine intake (> 2.5 units [e.g., cups of coffee] per day), and tobacco use (any smoking), Spinal or hip BMD within 1.0 SD below the young adult female reference mean (T-score 1.0), Spinal or hip BMD between 1.0 and 2.5 SDs below the young adult female reference mean (T-score < 1.0 and > 2.5), Spinal or hip BMD 2.5 SDs below the young adult female reference mean (T-score 2.5), BMD 2.5 SDs below the young adult female reference mean and the presence of one or more fragility fractures, American Association of Clinical Endocrinologists, With a history of fracture(s) without major trauma after 40 to 45 years of age, With osteopenia identified radiographically, Starting or taking long-term systemic glucocorticoid therapy ( 3 months), Patients at increased risk of secondary osteoporosis (e.g., rheumatoid arthritis). Osteoporosis, in which low bone mass and micro-structural deterioration of bone tissue lead to increased bone fragility, is the most common metabolic bone disease in the United States. car accidents) Falls over last 12 months Do you have a Bone Mineral Density (BMD) measurement? Usually these hormone-related therapies accompany other treatments and lifestyle improvements. Randomized clinical trials demonstrate a reduction of vertebral and hip fractures with alendronate (Fosamax) and risedronate (Actonel).16,26 Alendronate and risedronate also decrease vertebral fractures in men30,31 and in patients with glucocorticoid-induced osteoporosis.32,33 Daily and intermittent use of ibandronate (Boniva) have demonstrated effectiveness in reducing fractures of the spine only.34 Weekly and monthly dosing formulations improve adherence.35 Oral bisphosphonates should be taken only with water and a wait of at least 30 minutes before reclining or ingesting other medication or food. hip, wrist, shoulder or spine) fracture or hip fracture alone by answering some simple questions. The same absolute values are used in men. FRAX Score Calculadora de riesgo de fractura mayor osteoportica y fractura de cadera a 10 aos. Its a painless, non-invasive scan that measures bone strength in your hip and spine. All rights reserved. [ 1, 2] Osteoporosis can result in devastating physical, psychosocial, and economic consequences. See Osteoporosis Risk Factors; Where other Osteoporosis risks exist, use FRAX Score or Osteoporosis SCORE Estimation; VI. The American Bone Health Fracture Risk Calculator (ABH FRC) Version 3.0, published 03/04/2021, estimates 10-year fracture risk for postmenopausal women and men age 45 and older who are not receiving treatment for osteoporosis. Fracture probability is also underestimated with multiple fractures. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense, the U.S. Army Medical Corps, or the U.S. Army at large. Methods: Fracture risk was calculated using the different screening tools (FRAX, OST, ORAI, OSIRIS and SCORE) for each woman. Resistance training is one of the best things you can do to manage osteoporosis. CALCIUM - Calcium Calculator | International Osteoporosis Foundation of 2 Are you getting ENOUGH CALCIUM ? the tool is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck it gives the 10 year probability of a fracture - hip fracture and of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) Healthline Media does not provide medical advice, diagnosis, or treatment. In patients who cannot tolerate or whose symptoms do not improve with bisphosphonate therapy, teriparatide (Forteo) and denosumab (Prolia) are effective alternative medications to prevent osteoporotic fractures.
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