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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 of osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture based on women at the threshold for the diagnosis of osteoporosis using the criteria of the Japanese Bone Mineral Metabolism Association
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Fig3: Ten-year probability of osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture based on women at the threshold for the diagnosis of osteoporosis using the criteria of the Japanese Bone Mineral Metabolism Association

Mentions: Fracture probabilities were computed in women at the diagnostic threshold recommended in Japan. Thus, the cut-off level of BMD was set at 70% of YAM in women without a previous fracture and at 80% of YAM in those with a previous fragility fracture. In women aged 50, 60, 70 and 80 years without clinical risk factors and with BMD equivalent to 70% of YAM, the 10-year probability was 5.4%, 8.7%, 13.8% and 23%, respectively. In women having BMD equivalent to 80% of YAM and existing fracture but no other clinical risk factors, the 10-year probability was 7.1%, 10.5%, 14.7% and 23.4% at the same ages, respectively. Thus, at each age, the fracture probability was similar using the two diagnostic criteria. In contrast, the fracture probability equivalent to the diagnostic threshold in Japan rose with age, and at the age of 80 years was about four times higher than that at age 50 years (Fig. 3). Similar findings were apparent for hip fracture probability in that probabilities equivalent to the diagnostic threshold in Japan rose with age. The increase with age was more marked than for all major fractures and at the age of 80 years was about 6–40 times higher than that at age 50 years depending on the threshold used (see Fig. 3).Fig. 3


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 of osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture based on women at the threshold for the diagnosis of osteoporosis using the criteria of the Japanese Bone Mineral Metabolism Association
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Ten-year probability of osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture based on women at the threshold for the diagnosis of osteoporosis using the criteria of the Japanese Bone Mineral Metabolism Association
Mentions: Fracture probabilities were computed in women at the diagnostic threshold recommended in Japan. Thus, the cut-off level of BMD was set at 70% of YAM in women without a previous fracture and at 80% of YAM in those with a previous fragility fracture. In women aged 50, 60, 70 and 80 years without clinical risk factors and with BMD equivalent to 70% of YAM, the 10-year probability was 5.4%, 8.7%, 13.8% and 23%, respectively. In women having BMD equivalent to 80% of YAM and existing fracture but no other clinical risk factors, the 10-year probability was 7.1%, 10.5%, 14.7% and 23.4% at the same ages, respectively. Thus, at each age, the fracture probability was similar using the two diagnostic criteria. In contrast, the fracture probability equivalent to the diagnostic threshold in Japan rose with age, and at the age of 80 years was about four times higher than that at age 50 years (Fig. 3). Similar findings were apparent for hip fracture probability in that probabilities equivalent to the diagnostic threshold in Japan rose with age. The increase with age was more marked than for all major fractures and at the age of 80 years was about 6–40 times higher than that at age 50 years depending on the threshold used (see Fig. 3).Fig. 3

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