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Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX).

Fujiwara S, Nakamura T, Orimo H, Hosoi T, Gorai I, Oden A, Johansson H, Kanis JA - Osteoporos Int (2008)

Bottom Line: There were small differences in T-scores between those used for the model and those derived from a Japanese reference population.The approach will need to be supported by appropriate health economic analyses.However, when applying the FRAX model to Japan, T-scores and Z-scores should be converted to those derived from the international reference.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan. fujiwara@rerf.or.jp

ABSTRACT

Unlabelled: The present study estimated the 10-year probability using the Japanese version of WHO fracture risk assessment tool (FRAX) in order to determine fracture probabilities that correspond to intervention thresholds currently used in Japan and to resolve some issues for its use in Japan.

Introduction: The objective of the present study was to evaluate a Japanese version of the WHO fracture risk assessment (FRAX) tool to compute 10-year probabilities of osteoporotic fracture in Japanese men and women. Since lumbar spine bone mineral density (BMD) is used preferentially as a site for assessment, and densitometers use Japanese reference data, a second aim was to investigate the suitability and impact of this practice in Japan.

Methods: Fracture probabilities were computed from published data on the fracture and death hazards in Japan. Probabilities took account of age, sex, the presence of clinical risk factors and femoral neck BMD. Fracture probabilities were determined that were equivalent to intervention thresholds currently used in Japan. The difference between T-scores derived from international reference data and that using Japanese-specific normal ranges was estimated from published sources. The gradient of risk of BMD for fracture in Japan was compared to that for BMD at the lumbar spine in the Hiroshima cohort.

Results: The 10-year probabilities of a major osteoporosis-related fracture that corresponded to current intervention thresholds ranged from approximately 5% at the age of 50 years to more than 20% at the age of 80 years. The use of femoral neck BMD predicts fracture as well as or better than BMD tests at the lumbar spine. There were small differences in T-scores between those used for the model and those derived from a Japanese reference population.

Conclusions: The FRAX mark tool has been used to determine possible thresholds for therapeutic intervention, based on equivalence of risk with current guidelines. The approach will need to be supported by appropriate health economic analyses. Femoral neck BMD is suitable for the prediction of fracture risk among Japanese. However, when applying the FRAX model to Japan, T-scores and Z-scores should be converted to those derived from the international reference.

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Related in: MedlinePlus

Ten-year probability for osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture (%) according to the presence of a clinical risk factor, in women at the age of 65 years and with a BMI of 23.4 kg/m2
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Fig2: Ten-year probability for osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture (%) according to the presence of a clinical risk factor, in women at the age of 65 years and with a BMI of 23.4 kg/m2

Mentions: The contribution of clinical risk factors to fracture probability is shown in Fig. 2 for women aged 65 years with a BMI of 23.4 kg/m2. In women without clinical risk factors, the 10-year probability for an osteoporosis-related fracture was 7.5%. The 10-year probability was higher in the presence of clinical risk factors. Smoking and alcohol were relatively weak risk factors, the use of long-term glucocorticoids of intermediate weight, and a parental history of hip fracture or a prior fragility fracture were associated with the highest risks. For example, the 10-year probability was 8.1% for smokers and 14.5% for individuals with a prior fracture. The 10-year probability for hip fracture was 1.1% in women without a clinical risk factor, 1.6% in smokers and 2.7% in women with a previous fracture (see Fig. 2).Fig. 2


Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX).

Fujiwara S, Nakamura T, Orimo H, Hosoi T, Gorai I, Oden A, Johansson H, Kanis JA - Osteoporos Int (2008)

Ten-year probability for osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture (%) according to the presence of a clinical risk factor, in women at the age of 65 years and with a BMI of 23.4 kg/m2
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2267486&req=5

Fig2: Ten-year probability for osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture (%) according to the presence of a clinical risk factor, in women at the age of 65 years and with a BMI of 23.4 kg/m2
Mentions: The contribution of clinical risk factors to fracture probability is shown in Fig. 2 for women aged 65 years with a BMI of 23.4 kg/m2. In women without clinical risk factors, the 10-year probability for an osteoporosis-related fracture was 7.5%. The 10-year probability was higher in the presence of clinical risk factors. Smoking and alcohol were relatively weak risk factors, the use of long-term glucocorticoids of intermediate weight, and a parental history of hip fracture or a prior fragility fracture were associated with the highest risks. For example, the 10-year probability was 8.1% for smokers and 14.5% for individuals with a prior fracture. The 10-year probability for hip fracture was 1.1% in women without a clinical risk factor, 1.6% in smokers and 2.7% in women with a previous fracture (see Fig. 2).Fig. 2

Bottom Line: There were small differences in T-scores between those used for the model and those derived from a Japanese reference population.The approach will need to be supported by appropriate health economic analyses.However, when applying the FRAX model to Japan, T-scores and Z-scores should be converted to those derived from the international reference.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan. fujiwara@rerf.or.jp

ABSTRACT

Unlabelled: The present study estimated the 10-year probability using the Japanese version of WHO fracture risk assessment tool (FRAX) in order to determine fracture probabilities that correspond to intervention thresholds currently used in Japan and to resolve some issues for its use in Japan.

Introduction: The objective of the present study was to evaluate a Japanese version of the WHO fracture risk assessment (FRAX) tool to compute 10-year probabilities of osteoporotic fracture in Japanese men and women. Since lumbar spine bone mineral density (BMD) is used preferentially as a site for assessment, and densitometers use Japanese reference data, a second aim was to investigate the suitability and impact of this practice in Japan.

Methods: Fracture probabilities were computed from published data on the fracture and death hazards in Japan. Probabilities took account of age, sex, the presence of clinical risk factors and femoral neck BMD. Fracture probabilities were determined that were equivalent to intervention thresholds currently used in Japan. The difference between T-scores derived from international reference data and that using Japanese-specific normal ranges was estimated from published sources. The gradient of risk of BMD for fracture in Japan was compared to that for BMD at the lumbar spine in the Hiroshima cohort.

Results: The 10-year probabilities of a major osteoporosis-related fracture that corresponded to current intervention thresholds ranged from approximately 5% at the age of 50 years to more than 20% at the age of 80 years. The use of femoral neck BMD predicts fracture as well as or better than BMD tests at the lumbar spine. There were small differences in T-scores between those used for the model and those derived from a Japanese reference population.

Conclusions: The FRAX mark tool has been used to determine possible thresholds for therapeutic intervention, based on equivalence of risk with current guidelines. The approach will need to be supported by appropriate health economic analyses. Femoral neck BMD is suitable for the prediction of fracture risk among Japanese. However, when applying the FRAX model to Japan, T-scores and Z-scores should be converted to those derived from the international reference.

Show MeSH
Related in: MedlinePlus