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FRAX-based intervention and assessment thresholds for osteoporosis in Iran

FRAX-based intervention and assessment thresholds for osteoporosis in Iran
FRAX-based intervention and assessment thresholds for osteoporosis in Iran
Summary

We compared the utility of the current Iranian guidelines that recommend treatment in women with a T-score ≤ − 2.5 SD with a FRAX-based intervention threshold equivalent to women of average BMI with a prior fragility fracture. Whereas the FRAX-based intervention threshold identified women at high fracture probability, the T-score threshold was less sensitive, and the associated fracture risk decreased markedly with age.

Introduction

The fracture risk assessment algorithm FRAX® has been recently calibrated for Iran, but guidance is needed on how to apply fracture probabilities to clinical practice.

Methods

The age-specific ten-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of − 2.5 SD, in line with current guidelines in Iran. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without BMD. The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing.

Results

When a BMD T-score ≤ − 2.5 SD was used as an intervention threshold, FRAX probabilities in women aged 50 years was approximately two-fold higher than in women of the same age but with an average BMD and no risk factors. The relative increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80 years or more, a T-score of − 2.5 SD was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture rose with age from 4.9% at the age of 50 years to 17%, at the age of 80 years, and identified women at increased risk at all ages.

Conclusion

Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a “fracture threshold” target women at high fracture risk.
0937-941X
Khashayar, Patricia
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Keshtkar, Abbasali
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Ostovar, Afshin
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Larijani, Bagher
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Johansson, Helena
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Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, Mattias
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McCloskey, Eugene
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Kanis, John A.
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Khashayar, Patricia
3ae08833-13ad-4848-83bd-e47f46119143
Keshtkar, Abbasali
12d6140d-3e10-484f-833e-57ebe287c250
Ostovar, Afshin
e9e836d8-a9eb-4125-a9b9-20b9d2ca3beb
Larijani, Bagher
019ae6fa-ffe0-446f-b35c-dde583bc352a
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d

Khashayar, Patricia, Keshtkar, Abbasali, Ostovar, Afshin, Larijani, Bagher, Johansson, Helena, Harvey, Nicholas, Lorentzon, Mattias, McCloskey, Eugene and Kanis, John A. (2019) FRAX-based intervention and assessment thresholds for osteoporosis in Iran. Osteoporosis International. (doi:10.1007/s00198-019-05078-4).

Record type: Article

Abstract

Summary

We compared the utility of the current Iranian guidelines that recommend treatment in women with a T-score ≤ − 2.5 SD with a FRAX-based intervention threshold equivalent to women of average BMI with a prior fragility fracture. Whereas the FRAX-based intervention threshold identified women at high fracture probability, the T-score threshold was less sensitive, and the associated fracture risk decreased markedly with age.

Introduction

The fracture risk assessment algorithm FRAX® has been recently calibrated for Iran, but guidance is needed on how to apply fracture probabilities to clinical practice.

Methods

The age-specific ten-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of − 2.5 SD, in line with current guidelines in Iran. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without BMD. The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing.

Results

When a BMD T-score ≤ − 2.5 SD was used as an intervention threshold, FRAX probabilities in women aged 50 years was approximately two-fold higher than in women of the same age but with an average BMD and no risk factors. The relative increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80 years or more, a T-score of − 2.5 SD was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture rose with age from 4.9% at the age of 50 years to 17%, at the age of 80 years, and identified women at increased risk at all ages.

Conclusion

Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a “fracture threshold” target women at high fracture risk.

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FRAX_rev_clean - Accepted Manuscript
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More information

Accepted/In Press date: 1 July 2019
e-pub ahead of print date: 1 August 2019

Identifiers

Local EPrints ID: 433627
URI: http://eprints.soton.ac.uk/id/eprint/433627
ISSN: 0937-941X
PURE UUID: be1c20cf-dcfc-4ee2-9930-9d4824557c65
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 28 Aug 2019 16:30
Last modified: 26 Nov 2021 06:30

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Contributors

Author: Patricia Khashayar
Author: Abbasali Keshtkar
Author: Afshin Ostovar
Author: Bagher Larijani
Author: Helena Johansson
Author: Nicholas Harvey ORCID iD
Author: Mattias Lorentzon
Author: Eugene McCloskey
Author: John A. Kanis

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