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.

An assessment of intervention thresholds for very high fracture risk applied to the NOGG guidelines: a report for the National Osteoporosis Guideline Group (NOGG)

An assessment of intervention thresholds for very high fracture risk applied to the NOGG guidelines: a report for the National Osteoporosis Guideline Group (NOGG)
An assessment of intervention thresholds for very high fracture risk applied to the NOGG guidelines: a report for the National Osteoporosis Guideline Group (NOGG)
Summary
The National Osteoporosis Guideline Group (NOGG) has developed intervention thresholds based on FRAX® to characterise patients at high and very high risk of fracture.

Introduction
Guidelines for the assessment of fracture risk have begun to categorise patients eligible for treatment into high and very high risk of fracture to inform choice of therapeutic approach. The aim of the present study was to develop intervention thresholds based on the hybrid assessment model of NOGG.

Methods
We examined the impact of intervention thresholds in a simulated cross-sectional cohort of women age 50 years or more from the UK with the distribution of baseline characteristics based on that in the FRAX cohorts. The prevalence of very high risk using the hybrid model was compared with age-dependent thresholds used by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (IOF/ESCEO). The appropriateness of thresholds was tested based on the populations treated with anabolic agents.

Results
With an upper intervention threshold using the IOF/ESCEO criteria, 56% of women age 50 years or more would be characterised at very high risk. This compares with 36% using the IOF/ESCEO criteria and an age-specific intervention threshold over all ages. With an upper intervention threshold of 1.6 times the pre-existing intervention threshold, 10% of women age 50 years or more would be characterised at very high risk. The data from phase 3 studies indicate that most trial participants exposed to romosozumab or teriparatide would fall into the very high-risk category.

Conclusions
Proposals for FRAX-based criteria for very high risk for the NOGG hybrid model categorise a small proportion of women age 50 years or more (10%) in this highest risk stratum. The level of risk identified was comparable to that of women enrolled in trials of anabolic agents.
Anabolic treatments, Assessment guidelines, High risk, Intervention thresholds, Very high risk
0937-941X
1-10
Kanis, J.A,
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Kanis, J.A,
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de

Kanis, J.A,, Johansson, Helena, Harvey, Nicholas, Lorentzon, Mattias, Liu, Enwu, Vandenput, Liesbeth and McCloskey, E.V. (2021) An assessment of intervention thresholds for very high fracture risk applied to the NOGG guidelines: a report for the National Osteoporosis Guideline Group (NOGG). Osteoporosis International, 32 (10), 1-10. (doi:10.1007/s00198-021-05942-2).

Record type: Article

Abstract

Summary
The National Osteoporosis Guideline Group (NOGG) has developed intervention thresholds based on FRAX® to characterise patients at high and very high risk of fracture.

Introduction
Guidelines for the assessment of fracture risk have begun to categorise patients eligible for treatment into high and very high risk of fracture to inform choice of therapeutic approach. The aim of the present study was to develop intervention thresholds based on the hybrid assessment model of NOGG.

Methods
We examined the impact of intervention thresholds in a simulated cross-sectional cohort of women age 50 years or more from the UK with the distribution of baseline characteristics based on that in the FRAX cohorts. The prevalence of very high risk using the hybrid model was compared with age-dependent thresholds used by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (IOF/ESCEO). The appropriateness of thresholds was tested based on the populations treated with anabolic agents.

Results
With an upper intervention threshold using the IOF/ESCEO criteria, 56% of women age 50 years or more would be characterised at very high risk. This compares with 36% using the IOF/ESCEO criteria and an age-specific intervention threshold over all ages. With an upper intervention threshold of 1.6 times the pre-existing intervention threshold, 10% of women age 50 years or more would be characterised at very high risk. The data from phase 3 studies indicate that most trial participants exposed to romosozumab or teriparatide would fall into the very high-risk category.

Conclusions
Proposals for FRAX-based criteria for very high risk for the NOGG hybrid model categorise a small proportion of women age 50 years or more (10%) in this highest risk stratum. The level of risk identified was comparable to that of women enrolled in trials of anabolic agents.

Text
NOGG UIT report v547179 - Accepted Manuscript
Restricted to Repository staff only until 4 April 2022.
Request a copy

More information

Accepted/In Press date: 26 March 2021
e-pub ahead of print date: 4 April 2021
Keywords: Anabolic treatments, Assessment guidelines, High risk, Intervention thresholds, Very high risk

Identifiers

Local EPrints ID: 448238
URI: http://eprints.soton.ac.uk/id/eprint/448238
ISSN: 0937-941X
PURE UUID: 7c9db254-a849-41d9-be69-50ec567d888d
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 15 Apr 2021 16:34
Last modified: 22 Nov 2021 02:50

Export record

Altmetrics

Contributors

Author: J.A, Kanis
Author: Helena Johansson
Author: Nicholas Harvey ORCID iD
Author: Mattias Lorentzon
Author: Enwu Liu
Author: Liesbeth Vandenput
Author: E.V. McCloskey

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.

×