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FRAX-based fracture probabilities in South Africa

FRAX-based fracture probabilities in South Africa
FRAX-based fracture probabilities in South Africa
Summary: the hip fracture rates in South Africa were used to create ethnic-specific FRAX® models to facilitate fracture risk assessment.

Introduction: the aim of this study was to develop FRAX models to compute the 10-year probability of hip fracture and major osteoporotic fracture and assess their potential clinical application.

Methods: age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for the White, Black African, Coloured and Indian population of South Africa. Age-specific 10-year probabilities of a major osteoporotic fracture were calculated in women to determine fracture probabilities at a femoral neck T score of -2.5 SD, or those equivalent to a woman with a prior fragility fracture. Fracture probabilities were compared with those from selected countries.

Results: probabilities were consistently higher in Indian than in Coloured men and women, in turn, higher than in Black South Africans. For White South Africans, probabilities were lower than in Indians at young ages up to the age of about 80 years. When a BMD T score of −2.5 SD was used as an intervention threshold, FRAX probabilities in women age 50 years were approximately 2-fold higher than in women of the same age but with an average BMD and no risk factors. The increment 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 no longer a risk factor. Probabilities equivalent to women with a previous fracture rose with age and identified women at increased risk at all ages.

Conclusions: these FRAX models should enhance accuracy of determining fracture probability amongst the South African population and help guide decisions about treatment.
Epidemiology, FRAX, Fracture probability, Hip fracture, Osteoporosis, South Africa
1862-3522
Johansson, H.
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Dela, Sapna S
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Cassim, Bilkish
dd5001e2-eff9-4254-a369-736621bf724d
Paruk, Farhanah
4d803eaa-cdfe-4029-af69-f2d23b0ba99b
Brown, Susan L
272134e5-a656-4b34-91b9-b6664e20272f
Conradie, Magda
cefc0813-93cc-47cc-8cd5-b12a1a93aed3
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Jordaan, Johannes D
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Kalla, Asgar A
139f21cf-4682-4a6c-8ece-894117866437
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Lukhele, Mkhululi
fa06428a-ce8e-4ec0-9916-b3bc5d8736c9
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Mohamed, Ozayr
5d628f55-5b31-4d8c-983d-c51a64c70f80
Chutterpaul, Pariva
374ec052-0396-41c9-9cf0-9cf379493dd0
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
Kanis, J.A.
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Dela, Sapna S
ff42ce86-d32c-467e-ad52-54425892174c
Cassim, Bilkish
dd5001e2-eff9-4254-a369-736621bf724d
Paruk, Farhanah
4d803eaa-cdfe-4029-af69-f2d23b0ba99b
Brown, Susan L
272134e5-a656-4b34-91b9-b6664e20272f
Conradie, Magda
cefc0813-93cc-47cc-8cd5-b12a1a93aed3
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Jordaan, Johannes D
99cc0908-1d47-4c5f-8297-9ea5a902bf4a
Kalla, Asgar A
139f21cf-4682-4a6c-8ece-894117866437
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Lukhele, Mkhululi
fa06428a-ce8e-4ec0-9916-b3bc5d8736c9
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Mohamed, Ozayr
5d628f55-5b31-4d8c-983d-c51a64c70f80
Chutterpaul, Pariva
374ec052-0396-41c9-9cf0-9cf379493dd0
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
Kanis, J.A.
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d

Johansson, H., Dela, Sapna S, Cassim, Bilkish, Paruk, Farhanah, Brown, Susan L, Conradie, Magda, Harvey, Nicholas, Jordaan, Johannes D, Kalla, Asgar A, Liu, Enwu, Lorentzon, Mattias, Lukhele, Mkhululi, McCloskey, Eugene V., Mohamed, Ozayr, Chutterpaul, Pariva, Vandenput, Liesbeth and Kanis, J.A. (2021) FRAX-based fracture probabilities in South Africa. Archives of Osteoporosis, 16 (1), [51]. (doi:10.1007/s11657-021-00905-w).

Record type: Article

Abstract

Summary: the hip fracture rates in South Africa were used to create ethnic-specific FRAX® models to facilitate fracture risk assessment.

Introduction: the aim of this study was to develop FRAX models to compute the 10-year probability of hip fracture and major osteoporotic fracture and assess their potential clinical application.

Methods: age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for the White, Black African, Coloured and Indian population of South Africa. Age-specific 10-year probabilities of a major osteoporotic fracture were calculated in women to determine fracture probabilities at a femoral neck T score of -2.5 SD, or those equivalent to a woman with a prior fragility fracture. Fracture probabilities were compared with those from selected countries.

Results: probabilities were consistently higher in Indian than in Coloured men and women, in turn, higher than in Black South Africans. For White South Africans, probabilities were lower than in Indians at young ages up to the age of about 80 years. When a BMD T score of −2.5 SD was used as an intervention threshold, FRAX probabilities in women age 50 years were approximately 2-fold higher than in women of the same age but with an average BMD and no risk factors. The increment 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 no longer a risk factor. Probabilities equivalent to women with a previous fracture rose with age and identified women at increased risk at all ages.

Conclusions: these FRAX models should enhance accuracy of determining fracture probability amongst the South African population and help guide decisions about treatment.

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Accepted/In Press date: 1 February 2021
Published date: 1 March 2021
Keywords: Epidemiology, FRAX, Fracture probability, Hip fracture, Osteoporosis, South Africa

Identifiers

Local EPrints ID: 447682
URI: http://eprints.soton.ac.uk/id/eprint/447682
ISSN: 1862-3522
PURE UUID: 30bfc9a2-5929-436f-848c-17957e20ec82
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 18 Mar 2021 17:43
Last modified: 22 Oct 2021 01:38

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Contributors

Author: H. Johansson
Author: Sapna S Dela
Author: Bilkish Cassim
Author: Farhanah Paruk
Author: Susan L Brown
Author: Magda Conradie
Author: Nicholas Harvey ORCID iD
Author: Johannes D Jordaan
Author: Asgar A Kalla
Author: Enwu Liu
Author: Mattias Lorentzon
Author: Mkhululi Lukhele
Author: Eugene V. McCloskey
Author: Ozayr Mohamed
Author: Pariva Chutterpaul
Author: Liesbeth Vandenput
Author: J.A. Kanis

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