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FRAX and fracture prediction without bone mineral density

FRAX and fracture prediction without bone mineral density
FRAX and fracture prediction without bone mineral density
The major application of FRAX in osteoporosis is to direct pharmacological interventions to those at high risk of fracture. Whereas the efficacy of osteoporosis treatment, with the possible exception of alendronate, is largely independent of baseline bone mineral density (BMD), it remains a widely held perception that osteoporosis therapies are only effective in the presence of low BMD. Thus, the use of FRAX in the absence of BMD to identify individuals requiring therapy remains the subject of some debate and is the focus of this review. The clinical risk factors used in FRAX have high evidence-based validity to identify a risk responsive to intervention. The selection of high-risk individuals with FRAX, without knowledge of BMD, preferentially selects for low BMD and thus identifies a risk that is responsive to pharmacological intervention. The prediction of fractures with the use of clinical risk factors alone in FRAX is comparable to the use of BMD alone to predict fractures and is suitable, therefore, in the many countries where facilities for BMD testing are sparse. In countries where access to BMD is greater, FRAX can be used without BMD in the majority of cases and BMD tests reserved for those close to a probability-based intervention threshold. Thus concerns surrounding the use of FRAX in clinical practice without information on BMD are largely misplaced.
frax, fracture probability, clinical risk factors, intervention thresholds, risk assessment
1369-7137
1-8
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Leslie, W.D.
0c9bc973-969a-4049-aeb0-44a536074fb1
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Leslie, W.D.
0c9bc973-969a-4049-aeb0-44a536074fb1
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de

Kanis, J.A., Harvey, N.C., Johansson, H., Oden, A., Leslie, W.D. and McCloskey, E.V. (2015) FRAX and fracture prediction without bone mineral density. [in special issue: Osteoporosis Special] Climacteric, 18, supplement 2, 1-8. (doi:10.3109/13697137.2015.1092342). (PMID:26489076)

Record type: Article

Abstract

The major application of FRAX in osteoporosis is to direct pharmacological interventions to those at high risk of fracture. Whereas the efficacy of osteoporosis treatment, with the possible exception of alendronate, is largely independent of baseline bone mineral density (BMD), it remains a widely held perception that osteoporosis therapies are only effective in the presence of low BMD. Thus, the use of FRAX in the absence of BMD to identify individuals requiring therapy remains the subject of some debate and is the focus of this review. The clinical risk factors used in FRAX have high evidence-based validity to identify a risk responsive to intervention. The selection of high-risk individuals with FRAX, without knowledge of BMD, preferentially selects for low BMD and thus identifies a risk that is responsive to pharmacological intervention. The prediction of fractures with the use of clinical risk factors alone in FRAX is comparable to the use of BMD alone to predict fractures and is suitable, therefore, in the many countries where facilities for BMD testing are sparse. In countries where access to BMD is greater, FRAX can be used without BMD in the majority of cases and BMD tests reserved for those close to a probability-based intervention threshold. Thus concerns surrounding the use of FRAX in clinical practice without information on BMD are largely misplaced.

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More information

Accepted/In Press date: 10 August 2015
e-pub ahead of print date: 21 October 2015
Published date: December 2015
Keywords: frax, fracture probability, clinical risk factors, intervention thresholds, risk assessment
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 385230
URI: http://eprints.soton.ac.uk/id/eprint/385230
ISSN: 1369-7137
PURE UUID: 20721eaa-80a9-48b8-92a8-00f0c2602dcc
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 18 Jan 2016 13:25
Last modified: 10 Dec 2019 01:45

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Contributors

Author: J.A. Kanis
Author: N.C. Harvey ORCID iD
Author: H. Johansson
Author: A. Oden
Author: W.D. Leslie
Author: E.V. McCloskey

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