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FRAX and the assessment of fracture probability in men and women from the UK.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E - Osteoporos Int (2008)

Bottom Line: For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above.The presence of one or more risk factors increased probabilities in an incremental manner.The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter.

View Article: PubMed Central - PubMed

Affiliation: WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK. w.j.Pontefract@shef.ac.uk

ABSTRACT

Unlabelled: A fracture risk assessment tool (FRAX) is developed based on the use of clinical risk factors with or without bone mineral density tests applied to the UK.

Introduction: The aim of this study was to apply an assessment tool for the prediction of fracture in men and women with the use of clinical risk factors (CRFs) for fracture with and without the use of femoral neck bone mineral density (BMD). The clinical risk factors, identified from previous meta-analyses, comprised body mass index (BMI, as a continuous variable), a prior history of fracture, a parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis and other secondary causes of osteoporosis, current smoking, and alcohol intake 3 or more units daily.

Methods: Four models were constructed to compute fracture probabilities based on the epidemiology of fracture in the UK. The models comprised the ten-year probability of hip fracture, with and without femoral neck BMD, and the ten-year probability of a major osteoporotic fracture, with and without BMD. For each model fracture and death hazards were computed as continuous functions.

Results: Each clinical risk factor contributed to fracture probability. In the absence of BMD, hip fracture probability in women with a fixed BMI (25 kg/m(2)) ranged from 0.2% at the age of 50 years for women without CRF's to 22% at the age of 80 years with a parental history of hip fracture (approximately 100-fold range). In men, the probabilities were lower, as was the range (0.1 to 11% in the examples above). For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above. The presence of one or more risk factors increased probabilities in an incremental manner. The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter.

Conclusion: The models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD.

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Related in: MedlinePlus

Effect of variations in BMI on 10-year hip fracture probability (%) in women aged 65 years. Probabilities with BMD are computed at a T-score of −2.8 SD. [05Ca074]
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Fig7: Effect of variations in BMI on 10-year hip fracture probability (%) in women aged 65 years. Probabilities with BMD are computed at a T-score of −2.8 SD. [05Ca074]

Mentions: The clinical risk factors added to the information provided by BMD. Isopleths for 10-year fracture probability are shown in Fig. 5 for the combination of several of the clinical risk factors. The clinical risk factors were somewhat less predictive in the presence of BMD in the models. For example, in women aged 65 years and a BMI of 20 kg/m2, the 10-year hip fracture probability in the absence of BMD ranged from 2.3% in the absence of clinical risk factors to 27.9% with four risk factors. When BMD was set constant at a T-score of −2.5 SD, the range was from 2.8% with no clinical risk factor to 19.7% with four risk factors (Fig. 6). The effect of variations in BMI was even more markedly affected by BMD. For example, in women aged 65 years the 10-year hip fracture probability was 2.3% at a BMI of 20 kg/m2 and decreased progressively at higher levels of BMI to 0.6% with a BMI of 40 kg/m2. When BMD was fixed, hip fracture probability remained constant irrespective of BMI (Fig. 7).Fig. 5


FRAX and the assessment of fracture probability in men and women from the UK.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E - Osteoporos Int (2008)

Effect of variations in BMI on 10-year hip fracture probability (%) in women aged 65 years. Probabilities with BMD are computed at a T-score of −2.8 SD. [05Ca074]
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2267485&req=5

Fig7: Effect of variations in BMI on 10-year hip fracture probability (%) in women aged 65 years. Probabilities with BMD are computed at a T-score of −2.8 SD. [05Ca074]
Mentions: The clinical risk factors added to the information provided by BMD. Isopleths for 10-year fracture probability are shown in Fig. 5 for the combination of several of the clinical risk factors. The clinical risk factors were somewhat less predictive in the presence of BMD in the models. For example, in women aged 65 years and a BMI of 20 kg/m2, the 10-year hip fracture probability in the absence of BMD ranged from 2.3% in the absence of clinical risk factors to 27.9% with four risk factors. When BMD was set constant at a T-score of −2.5 SD, the range was from 2.8% with no clinical risk factor to 19.7% with four risk factors (Fig. 6). The effect of variations in BMI was even more markedly affected by BMD. For example, in women aged 65 years the 10-year hip fracture probability was 2.3% at a BMI of 20 kg/m2 and decreased progressively at higher levels of BMI to 0.6% with a BMI of 40 kg/m2. When BMD was fixed, hip fracture probability remained constant irrespective of BMI (Fig. 7).Fig. 5

Bottom Line: For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above.The presence of one or more risk factors increased probabilities in an incremental manner.The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter.

View Article: PubMed Central - PubMed

Affiliation: WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK. w.j.Pontefract@shef.ac.uk

ABSTRACT

Unlabelled: A fracture risk assessment tool (FRAX) is developed based on the use of clinical risk factors with or without bone mineral density tests applied to the UK.

Introduction: The aim of this study was to apply an assessment tool for the prediction of fracture in men and women with the use of clinical risk factors (CRFs) for fracture with and without the use of femoral neck bone mineral density (BMD). The clinical risk factors, identified from previous meta-analyses, comprised body mass index (BMI, as a continuous variable), a prior history of fracture, a parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis and other secondary causes of osteoporosis, current smoking, and alcohol intake 3 or more units daily.

Methods: Four models were constructed to compute fracture probabilities based on the epidemiology of fracture in the UK. The models comprised the ten-year probability of hip fracture, with and without femoral neck BMD, and the ten-year probability of a major osteoporotic fracture, with and without BMD. For each model fracture and death hazards were computed as continuous functions.

Results: Each clinical risk factor contributed to fracture probability. In the absence of BMD, hip fracture probability in women with a fixed BMI (25 kg/m(2)) ranged from 0.2% at the age of 50 years for women without CRF's to 22% at the age of 80 years with a parental history of hip fracture (approximately 100-fold range). In men, the probabilities were lower, as was the range (0.1 to 11% in the examples above). For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above. The presence of one or more risk factors increased probabilities in an incremental manner. The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter.

Conclusion: The models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD.

Show MeSH
Related in: MedlinePlus