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FRAX-based intervention thresholds for Pakistan

FRAX-based intervention thresholds for Pakistan
FRAX-based intervention thresholds for Pakistan
We compared, for women in Pakistan, the utility of intervention thresholds either at a T-score ≤ - 2.5 or based on a FRAX probability equivalent to women of average body mass index (BMI) with a prior fragility fracture. Whereas the FRAX-based intervention threshold identified women at high fracture probability, the T-score threshold was less sensitive, and the associated fracture risk decreased markedly with age.

Purpose: The fracture risk assessment algorithm FRAX® has been recently calibrated for Pakistan, but guidance is needed on how to apply fracture probabilities to clinical practice.

Methods: The age-specific 10-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of - 2.5. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without bone mineral density (BMD). The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing.

Results: When a BMD T-score ≤ - 2.5 was used as an intervention threshold, FRAX probabilities in women aged 50 years were approximately two-fold higher than in women of the same age but with no risk factors and average BMD. The relative increase 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 was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture, rose with age from 2.1% at the age of 40 years to 17%, at the age of 90 years, and identified women at increased risk at all ages.

Conclusion: Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a 'fracture threshold' target women at high fracture risk.

Keywords: Epidemiology; FRAX; Fracture probability; Guidelines; Intervention threshold; Osteoporosis; Pakistan.
Epidemiology, FRAX, Fracture probability, Guidelines, Intervention threshold, Osteoporosis, Pakistan
0937-941X
Johansson, H.
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Naureen, G.
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Iqbal, R.
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Jafri, L.
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Khan, A.H.
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Umer, M.
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Liu, E.
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Vandenput, Lisbeth
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Lorentzon, M.
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McCloskey, E. V.
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Kanis, J. A.
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Harvey, Nicholas C.
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Johansson, H.
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Naureen, G.
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Iqbal, R.
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Jafri, L.
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Khan, A.H.
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Umer, M.
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Liu, E.
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Vandenput, Lisbeth
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Lorentzon, M.
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McCloskey, E. V.
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Kanis, J. A.
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Harvey, Nicholas C.
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Johansson, H., Naureen, G., Iqbal, R., Jafri, L., Khan, A.H., Umer, M., Liu, E., Vandenput, Lisbeth, Lorentzon, M., McCloskey, E. V., Kanis, J. A. and Harvey, Nicholas C. (2021) FRAX-based intervention thresholds for Pakistan. Osteoporosis International. (doi:10.1007/s00198-021-06087-y).

Record type: Article

Abstract

We compared, for women in Pakistan, the utility of intervention thresholds either at a T-score ≤ - 2.5 or based on a FRAX probability equivalent to women of average body mass index (BMI) with a prior fragility fracture. Whereas the FRAX-based intervention threshold identified women at high fracture probability, the T-score threshold was less sensitive, and the associated fracture risk decreased markedly with age.

Purpose: The fracture risk assessment algorithm FRAX® has been recently calibrated for Pakistan, but guidance is needed on how to apply fracture probabilities to clinical practice.

Methods: The age-specific 10-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of - 2.5. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without bone mineral density (BMD). The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing.

Results: When a BMD T-score ≤ - 2.5 was used as an intervention threshold, FRAX probabilities in women aged 50 years were approximately two-fold higher than in women of the same age but with no risk factors and average BMD. The relative increase 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 was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture, rose with age from 2.1% at the age of 40 years to 17%, at the age of 90 years, and identified women at increased risk at all ages.

Conclusion: Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a 'fracture threshold' target women at high fracture risk.

Keywords: Epidemiology; FRAX; Fracture probability; Guidelines; Intervention threshold; Osteoporosis; Pakistan.

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Pakistan treatment thresholds R1 - Accepted Manuscript
Restricted to Repository staff only until 20 August 2022.
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More information

Accepted/In Press date: 26 July 2021
e-pub ahead of print date: 20 August 2021
Published date: 20 August 2021
Keywords: Epidemiology, FRAX, Fracture probability, Guidelines, Intervention threshold, Osteoporosis, Pakistan

Identifiers

Local EPrints ID: 451115
URI: http://eprints.soton.ac.uk/id/eprint/451115
ISSN: 0937-941X
PURE UUID: a86ac63d-245a-4f2a-8e6d-acf5b275ebea
ORCID for Nicholas C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 08 Sep 2021 16:30
Last modified: 26 Nov 2021 02:48

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Contributors

Author: H. Johansson
Author: G. Naureen
Author: R. Iqbal
Author: L. Jafri
Author: A.H. Khan
Author: M. Umer
Author: E. Liu
Author: Lisbeth Vandenput
Author: M. Lorentzon
Author: E. V. McCloskey
Author: J. A. Kanis

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