The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Reassessment intervals for transition from low to high fracture risk among adults older than 50 years of age.

Reassessment intervals for transition from low to high fracture risk among adults older than 50 years of age.
Reassessment intervals for transition from low to high fracture risk among adults older than 50 years of age.
Importance:Fracture risk scores are used to identify individuals at high risk of major osteoporotic fracture or hip fracture for antiosteoporosis treatment. For those not meeting treatment thresholds at baseline, the optimal interval for reassessing fracture risk is uncertain.Objective:To examine reassessment intervals for transition from low to high fracture risk under guidelines-defined treatment thresholds.Design, Setting, and Participants:This retrospective cohort study included persons aged 50 years or older with fracture risk below treatment thresholds at baseline who had fracture risk reassessed at least 1 year later. Data were obtained from a population-based bone mineral density registry (baseline assessment during 1996-2015; reassessment to 2016) in the Province of Manitoba, Canada. Primary analysis was performed from May to June 2019. Analysis for the revision was performed in October 2019.Main Outcomes and Measures:The primary outcome was time to transition from low (below the treatment threshold) to high fracture risk (treatment-qualifying risk score using osteoporosis clinical practice guidelines strategies for Canada, the United States, and the United Kingdom).Results:The study population consisted of 10 564 individuals (94.1% women; mean [SD] age at baseline, 63.2 [8.2] years). At the time of reassessment (a mean [SD] interval of 5.2 [2.9] years between initial and subsequent fracture risk assessment), 690 (6.6%) had reached the fixed major osteoporotic fracture treatment threshold of 20%, 1546 (16.2%) had reached the fixed hip treatment threshold of 3%, and 932 (9.4%) had reached the age-dependent major osteoporotic fracture treatment threshold. Among those below 25% of the treatment threshold at baseline for each guideline, few (0%-3.0%) reached guidelines-defined high fracture risk at follow-up. In contrast, among those at the upper end of the scale for each guideline (75%-99% of the treatment threshold at baseline), 30.6% to 74.4% reached guidelines-defined high fracture risk. An increased number of clinical risk factors was associated with increased likelihood of reaching guidelines-defined high fracture risk (range for 3 guidelines, 17.1%-28.2%) compared with unchanged or decreased clinical risk factors (range for 3 guidelines, 3.3%-12.8%) (P < .001). Estimated time for 10% of the population to reach treatment-qualifying high fracture risk ranged from fewer than 3 years to more than 15 years.Conclusions and Relevance:The findings suggest that baseline fracture risk (as a fraction of the treatment threshold) and change in clinical risk factors can identify individuals with low and high probability of guidelines-defined high fracture risk during follow-up, thereby potentially helping to inform the reassessment interval.
1-12
Leslie, William D.
5b2dd5d6-4569-40a3-a9b1-95152d11e4f1
Morin, Suzanne N
68489af8-f604-4f28-88e0-60add9fde4ae
Lix, Lisa M.
2fb61783-047d-4a4b-a45d-e09ac0763a7b
Martineau, Patrick
dbd7ccec-32e2-4120-b7df-dc0c2504828a
Bryanton, Mark
da507d1a-079a-4d7b-8278-15f795f4095b
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Leslie, William D.
5b2dd5d6-4569-40a3-a9b1-95152d11e4f1
Morin, Suzanne N
68489af8-f604-4f28-88e0-60add9fde4ae
Lix, Lisa M.
2fb61783-047d-4a4b-a45d-e09ac0763a7b
Martineau, Patrick
dbd7ccec-32e2-4120-b7df-dc0c2504828a
Bryanton, Mark
da507d1a-079a-4d7b-8278-15f795f4095b
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d

Leslie, William D., Morin, Suzanne N, Lix, Lisa M., Martineau, Patrick, Bryanton, Mark, McCloskey, Eugene, Johansson, Helena, Harvey, Nicholas and Kanis, John A. (2020) Reassessment intervals for transition from low to high fracture risk among adults older than 50 years of age. JAMA Network Open, 3 (1), 1-12. (doi:10.1001/jamanetworkopen.2019.18954).

Record type: Article

Abstract

Importance:Fracture risk scores are used to identify individuals at high risk of major osteoporotic fracture or hip fracture for antiosteoporosis treatment. For those not meeting treatment thresholds at baseline, the optimal interval for reassessing fracture risk is uncertain.Objective:To examine reassessment intervals for transition from low to high fracture risk under guidelines-defined treatment thresholds.Design, Setting, and Participants:This retrospective cohort study included persons aged 50 years or older with fracture risk below treatment thresholds at baseline who had fracture risk reassessed at least 1 year later. Data were obtained from a population-based bone mineral density registry (baseline assessment during 1996-2015; reassessment to 2016) in the Province of Manitoba, Canada. Primary analysis was performed from May to June 2019. Analysis for the revision was performed in October 2019.Main Outcomes and Measures:The primary outcome was time to transition from low (below the treatment threshold) to high fracture risk (treatment-qualifying risk score using osteoporosis clinical practice guidelines strategies for Canada, the United States, and the United Kingdom).Results:The study population consisted of 10 564 individuals (94.1% women; mean [SD] age at baseline, 63.2 [8.2] years). At the time of reassessment (a mean [SD] interval of 5.2 [2.9] years between initial and subsequent fracture risk assessment), 690 (6.6%) had reached the fixed major osteoporotic fracture treatment threshold of 20%, 1546 (16.2%) had reached the fixed hip treatment threshold of 3%, and 932 (9.4%) had reached the age-dependent major osteoporotic fracture treatment threshold. Among those below 25% of the treatment threshold at baseline for each guideline, few (0%-3.0%) reached guidelines-defined high fracture risk at follow-up. In contrast, among those at the upper end of the scale for each guideline (75%-99% of the treatment threshold at baseline), 30.6% to 74.4% reached guidelines-defined high fracture risk. An increased number of clinical risk factors was associated with increased likelihood of reaching guidelines-defined high fracture risk (range for 3 guidelines, 17.1%-28.2%) compared with unchanged or decreased clinical risk factors (range for 3 guidelines, 3.3%-12.8%) (P < .001). Estimated time for 10% of the population to reach treatment-qualifying high fracture risk ranged from fewer than 3 years to more than 15 years.Conclusions and Relevance:The findings suggest that baseline fracture risk (as a fraction of the treatment threshold) and change in clinical risk factors can identify individuals with low and high probability of guidelines-defined high fracture risk during follow-up, thereby potentially helping to inform the reassessment interval.

Text
FRAX and Rescreening_2019-10-27_JAMA.R1 main - Accepted Manuscript
Download (2MB)
Text
leslie_2020_oi_190712 - Version of Record
Available under License Creative Commons Attribution.
Download (2MB)
Slideshow
FRAX and Rescreening Figure 2
Download (1MB)
Text
FRAX and Rescreening_2019-10-27_supp
Download (1MB)
Slideshow
FRAX and Rescreening Figure 1
Download (212kB)

Show all 5 downloads.

More information

Accepted/In Press date: 4 November 2019
e-pub ahead of print date: 10 January 2020

Identifiers

Local EPrints ID: 437196
URI: http://eprints.soton.ac.uk/id/eprint/437196
PURE UUID: 7ad6f0be-726f-4e7e-862a-226319c00508
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 21 Jan 2020 17:35
Last modified: 26 Nov 2021 02:48

Export record

Altmetrics

Contributors

Author: William D. Leslie
Author: Suzanne N Morin
Author: Lisa M. Lix
Author: Patrick Martineau
Author: Mark Bryanton
Author: Eugene McCloskey
Author: Helena Johansson
Author: Nicholas Harvey ORCID iD
Author: John A. Kanis

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×