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Calibration of FRAX (R) 3.1 to the Dutch population with data on the epidemiology of hip fractures

Calibration of FRAX (R) 3.1 to the Dutch population with data on the epidemiology of hip fractures
Calibration of FRAX (R) 3.1 to the Dutch population with data on the epidemiology of hip fractures
Summary
The FRAX tool has been calibrated to the entire Dutch population, using nationwide (hip) fracture incidence rates and mortality statistics from the Netherlands. Data used for the Dutch model are described in this paper.
Introduction
Risk communication and decision making about whether or not to treat with anti-osteoporotic drugs with the use of T-scores are often unclear for patients. The recently developed FRAX models use easily obtainable clinical risk factors to estimate an individual's 10-year probability of a major osteoporotic fracture and hip fracture that is useful for risk communication and subsequent decision making in clinical practice. As of July 1, 2010, the tool has been calibrated to the total Dutch population. This paper describes the data used to develop the current Dutch FRAX model and illustrates its features compared to other countries.
Methods
Age- and sex-stratified hip fracture incidence rates (LMR database) and mortality rates (Dutch national mortality statistics) for 2004 and 2005 were extracted from Dutch nationwide databases (patients aged 50+ years). For other major fractures, Dutch incidence rates were imputed, using Swedish ratios for hip to osteoporotic fracture (upper arm, wrist, hip, and clinically symptomatic vertebral) probabilities (age- and gender-stratified). The FRAX tool takes into account age, sex, body mass index (BMI), presence of clinical risk factors, and bone mineral density (BMD).
Results
Fracture incidence rates increased with increasing age: for hip fracture, incidence rates were lowest among Dutch patients aged 50–54 years (per 10,000 inhabitants: 2.3 for men, 2.1 for women) and highest among the oldest subjects (95–99 years; 169 of 10,000 for men, 267 of 10,000 for women). Ten-year probability of hip or major osteoporotic fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T-score. Parental hip fracture accounted for the greatest increase in 10-year fracture probability.
Conclusion
The Dutch FRAX tool is the first fracture prediction model that has been calibrated to the total Dutch population, using nationwide incidence rates for hip fracture and mortality rates. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Dutch FRAX tool a good candidate for implementation into clinical practice.
0937-941X
861-869
Lalmohamed, A.
b3bef1c3-1d0f-4e3d-b999-a00b16aff528
Welsing, P.M.
3f264c6d-3e5f-4a46-b468-6f36120fe7d0
Lems, W.F.
f9b48664-e72e-4c09-8a27-03eae2517883
Jacobs, J.W.
c829d758-755b-42e3-9a05-bdfae0cfaf07
Kanis, J.A.
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Johansson, H.
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de Boer, A.
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de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
Lalmohamed, A.
b3bef1c3-1d0f-4e3d-b999-a00b16aff528
Welsing, P.M.
3f264c6d-3e5f-4a46-b468-6f36120fe7d0
Lems, W.F.
f9b48664-e72e-4c09-8a27-03eae2517883
Jacobs, J.W.
c829d758-755b-42e3-9a05-bdfae0cfaf07
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
de Boer, A.
5621b588-a1e0-4827-8940-89efef278f13
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613

Lalmohamed, A., Welsing, P.M., Lems, W.F., Jacobs, J.W., Kanis, J.A., Johansson, H., de Boer, A. and de Vries, F. (2012) Calibration of FRAX (R) 3.1 to the Dutch population with data on the epidemiology of hip fractures. Osteoporosis International, 23 (3), 861-869. (doi:10.1007/s00198-011-1852-2). (PMID:22120910)

Record type: Article

Abstract

Summary
The FRAX tool has been calibrated to the entire Dutch population, using nationwide (hip) fracture incidence rates and mortality statistics from the Netherlands. Data used for the Dutch model are described in this paper.
Introduction
Risk communication and decision making about whether or not to treat with anti-osteoporotic drugs with the use of T-scores are often unclear for patients. The recently developed FRAX models use easily obtainable clinical risk factors to estimate an individual's 10-year probability of a major osteoporotic fracture and hip fracture that is useful for risk communication and subsequent decision making in clinical practice. As of July 1, 2010, the tool has been calibrated to the total Dutch population. This paper describes the data used to develop the current Dutch FRAX model and illustrates its features compared to other countries.
Methods
Age- and sex-stratified hip fracture incidence rates (LMR database) and mortality rates (Dutch national mortality statistics) for 2004 and 2005 were extracted from Dutch nationwide databases (patients aged 50+ years). For other major fractures, Dutch incidence rates were imputed, using Swedish ratios for hip to osteoporotic fracture (upper arm, wrist, hip, and clinically symptomatic vertebral) probabilities (age- and gender-stratified). The FRAX tool takes into account age, sex, body mass index (BMI), presence of clinical risk factors, and bone mineral density (BMD).
Results
Fracture incidence rates increased with increasing age: for hip fracture, incidence rates were lowest among Dutch patients aged 50–54 years (per 10,000 inhabitants: 2.3 for men, 2.1 for women) and highest among the oldest subjects (95–99 years; 169 of 10,000 for men, 267 of 10,000 for women). Ten-year probability of hip or major osteoporotic fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T-score. Parental hip fracture accounted for the greatest increase in 10-year fracture probability.
Conclusion
The Dutch FRAX tool is the first fracture prediction model that has been calibrated to the total Dutch population, using nationwide incidence rates for hip fracture and mortality rates. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Dutch FRAX tool a good candidate for implementation into clinical practice.

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Published date: March 2012
Organisations: Faculty of Medicine

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Local EPrints ID: 336689
URI: http://eprints.soton.ac.uk/id/eprint/336689
ISSN: 0937-941X
PURE UUID: 7339ad2d-d756-4565-9688-fe730a6107ad

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Date deposited: 03 Apr 2012 09:14
Last modified: 16 Jul 2019 22:08

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Contributors

Author: A. Lalmohamed
Author: P.M. Welsing
Author: W.F. Lems
Author: J.W. Jacobs
Author: J.A. Kanis
Author: H. Johansson
Author: A. de Boer
Author: F. de Vries

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