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Use of age-dependent FRAX-based intervention thresholds for Singapore

Use of age-dependent FRAX-based intervention thresholds for Singapore
Use of age-dependent FRAX-based intervention thresholds for Singapore
Summary
Assessment and treatment pathways based on age-specific intervention thresholds in Singapore using FRAX paths can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low risk.

Purpose: Intervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX® has permitted a more accurate assessment of fracture risk. The aim of the present study was to explore treatment paths and characteristics of women selected for treatment in Singapore based on FRAX.

Methods: The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Singapore. The methodology was applied to women age 50 years or more drawn from the population-based Singapore Chinese Health Study (SCHS) cohort. Missing data for the calculation of FRAX was simulated using data from Chinese cohorts from Hong Kong.

Results: Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.9% at the age of 50 years increasing to 32% at the age of 90 years. A total of 1927 of 29,323 women (7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 3019 women (10.3%) would be eligible for treatment on the basis of age-dependent thresholds. The mean BMD T-score of women so selected was -2.94.

Conclusion: Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Singapore to help guide decisions about treatment.
FRAX, Fracture risk assessment, Intervention threshold, Osteoporosis
1862-3522
1-10
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Chionh, Siok Bee
f7de0af1-db72-4b1b-8957-bcb09177b603
Manju Chandran, Manju
0906289a-b6cb-47ea-836e-5bb8ec4bd7db
Ganesan, Ganga
f96f8d50-d9dc-4f34-8cbc-29bc95a23d2e
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kwok, Timothy
88a3ef90-93a0-4d8a-9c87-9a4945f307c5
Lau, Tang Ching
c1b202c0-d308-4ba9-962c-99d07ccb0520
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Tan, Kelvin Bryan
90c7c5b6-05ea-4818-8f1a-76be434aa59c
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Chionh, Siok Bee
f7de0af1-db72-4b1b-8957-bcb09177b603
Manju Chandran, Manju
0906289a-b6cb-47ea-836e-5bb8ec4bd7db
Ganesan, Ganga
f96f8d50-d9dc-4f34-8cbc-29bc95a23d2e
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kwok, Timothy
88a3ef90-93a0-4d8a-9c87-9a4945f307c5
Lau, Tang Ching
c1b202c0-d308-4ba9-962c-99d07ccb0520
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Tan, Kelvin Bryan
90c7c5b6-05ea-4818-8f1a-76be434aa59c
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215

Kanis, John A., Chionh, Siok Bee, Manju Chandran, Manju, Ganesan, Ganga, Harvey, Nicholas, Kwok, Timothy, Lau, Tang Ching, Liu, Enwu, Lorentzon, Mattias, McCloskey, Eugene V., Tan, Kelvin Bryan, Vandenput, Liesbeth and Johansson, Helena (2020) Use of age-dependent FRAX-based intervention thresholds for Singapore. Archives of Osteoporosis, 15 (1), 1-10, [104]. (doi:10.1007/s11657-020-00782-9).

Record type: Article

Abstract

Summary
Assessment and treatment pathways based on age-specific intervention thresholds in Singapore using FRAX paths can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low risk.

Purpose: Intervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX® has permitted a more accurate assessment of fracture risk. The aim of the present study was to explore treatment paths and characteristics of women selected for treatment in Singapore based on FRAX.

Methods: The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Singapore. The methodology was applied to women age 50 years or more drawn from the population-based Singapore Chinese Health Study (SCHS) cohort. Missing data for the calculation of FRAX was simulated using data from Chinese cohorts from Hong Kong.

Results: Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.9% at the age of 50 years increasing to 32% at the age of 90 years. A total of 1927 of 29,323 women (7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 3019 women (10.3%) would be eligible for treatment on the basis of age-dependent thresholds. The mean BMD T-score of women so selected was -2.94.

Conclusion: Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Singapore to help guide decisions about treatment.

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More information

Accepted/In Press date: 30 June 2020
e-pub ahead of print date: 22 July 2020
Published date: 2020
Keywords: FRAX, Fracture risk assessment, Intervention threshold, Osteoporosis

Identifiers

Local EPrints ID: 442935
URI: http://eprints.soton.ac.uk/id/eprint/442935
ISSN: 1862-3522
PURE UUID: 38b8f531-5be2-4922-8091-06503a78fd7e
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 03 Aug 2020 16:30
Last modified: 26 Nov 2021 02:48

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Contributors

Author: John A. Kanis
Author: Siok Bee Chionh
Author: Manju Manju Chandran
Author: Ganga Ganesan
Author: Nicholas Harvey ORCID iD
Author: Timothy Kwok
Author: Tang Ching Lau
Author: Enwu Liu
Author: Mattias Lorentzon
Author: Eugene V. McCloskey
Author: Kelvin Bryan Tan
Author: Liesbeth Vandenput
Author: Helena Johansson

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