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Impact of population-based or targeted BMD interventions on fracture incidence

Impact of population-based or targeted BMD interventions on fracture incidence
Impact of population-based or targeted BMD interventions on fracture incidence
Purpose/introduction: to investigate the impact of population level or targeted alterations to BMD on the incidence of fractures.

Methods: we used a simulated cohort of 49,242 women with age and BMI distribution from the UK, and prevalence of other clinical risk factors based on European FRAX® cohorts. Using FRAX probabilities of major osteoporotic fracture (MOF: hip, clinical vertebral, wrist, proximal humerus) and hip fracture, calculated with femoral neck BMD, we determined the expected number of fractures over 10 years, stratified by 10 year age band from 50 years. We then investigated the effect of i: uplifting all individuals with T score below -2.5 to be exactly -2.5 (high-risk strategy); and ii: shifting the entire BMD distribution upwards (population strategy).

Results: overall, the high-risk strategy prevented 573 MOF including 465 hip fractures. Moving the BMD T-score distribution upward by 0.27SD gave an equivalent reduction in numbers of MOF; for hip fractures prevented this was 0.35SD. A global upward 0.25SD BMD shift prevented 524 MOF including 354 hip fractures, with corresponding figures for an increase of 0.5SD being 973 MOF prevented and 640 hip fractures prevented. The ratio of hip fracture to MOF prevented differed by the two approaches, such that for the high-risk strategy the ratio was 0.81, and for the population strategy was 0.68 (0.25SD BMD uplift) and 0.66 (0.5SD BMD uplift). The numbers of fractures prevented by the high-risk strategy increased with age. In contrast the age-related increase in numbers of fractures prevented with the population strategy rose with age, but peaked in the 70-79 year age band and declined thereafter.

Conclusions: both strategies reduced the numbers of expected incident fractures, with contrasting relative impacts by age and fracture site. Whilst the current analysis used UK/European anthropometric/risk factor distributions, further analyses calibrated to the distributions in other settings globally may be readily undertaken. Overall, these findings support the investigation of both population level interventions and those targeted at high fracture risk groups.
0937-941X
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, J A.
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Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
Lorentzon, M.
11692e10-5916-4bb5-86c5-3ff9ccd77af6
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, J A.
55c6bd2c-d653-48de-b4b9-29fe280fb00f
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
Lorentzon, M.
11692e10-5916-4bb5-86c5-3ff9ccd77af6
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691

Harvey, Nicholas, Kanis, J A., Liu, Enwu, Vandenput, Liesbeth, Lorentzon, M., Cooper, Cyrus, McCloskey, E.V. and Johansson, H. (2021) Impact of population-based or targeted BMD interventions on fracture incidence. Osteoporosis International. (In Press)

Record type: Article

Abstract

Purpose/introduction: to investigate the impact of population level or targeted alterations to BMD on the incidence of fractures.

Methods: we used a simulated cohort of 49,242 women with age and BMI distribution from the UK, and prevalence of other clinical risk factors based on European FRAX® cohorts. Using FRAX probabilities of major osteoporotic fracture (MOF: hip, clinical vertebral, wrist, proximal humerus) and hip fracture, calculated with femoral neck BMD, we determined the expected number of fractures over 10 years, stratified by 10 year age band from 50 years. We then investigated the effect of i: uplifting all individuals with T score below -2.5 to be exactly -2.5 (high-risk strategy); and ii: shifting the entire BMD distribution upwards (population strategy).

Results: overall, the high-risk strategy prevented 573 MOF including 465 hip fractures. Moving the BMD T-score distribution upward by 0.27SD gave an equivalent reduction in numbers of MOF; for hip fractures prevented this was 0.35SD. A global upward 0.25SD BMD shift prevented 524 MOF including 354 hip fractures, with corresponding figures for an increase of 0.5SD being 973 MOF prevented and 640 hip fractures prevented. The ratio of hip fracture to MOF prevented differed by the two approaches, such that for the high-risk strategy the ratio was 0.81, and for the population strategy was 0.68 (0.25SD BMD uplift) and 0.66 (0.5SD BMD uplift). The numbers of fractures prevented by the high-risk strategy increased with age. In contrast the age-related increase in numbers of fractures prevented with the population strategy rose with age, but peaked in the 70-79 year age band and declined thereafter.

Conclusions: both strategies reduced the numbers of expected incident fractures, with contrasting relative impacts by age and fracture site. Whilst the current analysis used UK/European anthropometric/risk factor distributions, further analyses calibrated to the distributions in other settings globally may be readily undertaken. Overall, these findings support the investigation of both population level interventions and those targeted at high fracture risk groups.

Text
nch fracture burden BMD FRAX paper 2021_03_01 clean - Accepted Manuscript
Restricted to Repository staff only until 5 March 2022.
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Accepted/In Press date: 5 March 2021

Identifiers

Local EPrints ID: 447645
URI: http://eprints.soton.ac.uk/id/eprint/447645
ISSN: 0937-941X
PURE UUID: f3e28865-e402-48dc-b6d3-bcab5fbb3330
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 17 Mar 2021 17:36
Last modified: 18 Mar 2021 02:38

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Contributors

Author: Nicholas Harvey ORCID iD
Author: J A. Kanis
Author: Enwu Liu
Author: Liesbeth Vandenput
Author: M. Lorentzon
Author: Cyrus Cooper ORCID iD
Author: E.V. McCloskey
Author: H. Johansson

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