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Designing an Iran FRAX model and defining intervention and assessment thresholds for osteoporosis

Designing an Iran FRAX model and defining intervention and assessment thresholds for osteoporosis
Designing an Iran FRAX model and defining intervention and assessment thresholds for osteoporosis

Background and Objectives: The purpose of this study was to adopt and calibrate the fracture risk assessment algorithm FRAX® for the Iranian population and to provide the required guidance on how to apply it in clinical practice. Methods: The age-specific ten-year probability of major osteoporotic fractures was calculated in women with an average BMI to determine the fracture probability at two potential intervention thresholds. The first threshold was the age-specific fracture probability associated with a femoral neck T-score of -2.5 SD and the other was age-specific fracture probability in women with a history of fracture without BMD. Current Iranian guidelines were used to define these thresholds. The effect of adding BMD values to the assessment of these thresholds was also evaluated separately. Results: Similar to women with a previous fracture, the 10-year probability of a major osteoporotic fracture increased from 4.9% at the age of 50 years to 17% at the age of 80 years. When using a BMD T-score of ≤−2.5 SD as the intervention threshold, the FRAX probability was twice as high in women aged 50 years as in women of the same age with an average BMD and no risk factor. The FRAX probability increased with age but a T-score of -2.5 SD was actually protective after 80 years or age. Conclusion: Intervention thresholds based on BMD alone cannot effectively identify high-risk women for fracture, particularly in advanced ages. Using fracture probability based on ‘fracture threshold’ can help to improve the identification of these women.

FRAX, Fracture probability, Guidelines, Intervention threshold, Iran, Osteoporosis
296-304
Khashayar, Patricia
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Keshtkar, Abbasali
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Ostovar, Afshin
e9e836d8-a9eb-4125-a9b9-20b9d2ca3beb
Larijani, Bagher
019ae6fa-ffe0-446f-b35c-dde583bc352a
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, M.
11692e10-5916-4bb5-86c5-3ff9ccd77af6
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Kanis, J.A,
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d
Khashayar, Patricia
3ae08833-13ad-4848-83bd-e47f46119143
Keshtkar, Abbasali
12d6140d-3e10-484f-833e-57ebe287c250
Ostovar, Afshin
e9e836d8-a9eb-4125-a9b9-20b9d2ca3beb
Larijani, Bagher
019ae6fa-ffe0-446f-b35c-dde583bc352a
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, M.
11692e10-5916-4bb5-86c5-3ff9ccd77af6
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Kanis, J.A,
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d

Khashayar, Patricia, Keshtkar, Abbasali, Ostovar, Afshin, Larijani, Bagher, Johansson, H., Harvey, Nicholas, Lorentzon, M., McCloskey, E.V. and Kanis, J.A, (2021) Designing an Iran FRAX model and defining intervention and assessment thresholds for osteoporosis. Iranian Journal of Epidemiology, 16 (4), 296-304.

Record type: Article

Abstract

Background and Objectives: The purpose of this study was to adopt and calibrate the fracture risk assessment algorithm FRAX® for the Iranian population and to provide the required guidance on how to apply it in clinical practice. Methods: The age-specific ten-year probability of major osteoporotic fractures was calculated in women with an average BMI to determine the fracture probability at two potential intervention thresholds. The first threshold was the age-specific fracture probability associated with a femoral neck T-score of -2.5 SD and the other was age-specific fracture probability in women with a history of fracture without BMD. Current Iranian guidelines were used to define these thresholds. The effect of adding BMD values to the assessment of these thresholds was also evaluated separately. Results: Similar to women with a previous fracture, the 10-year probability of a major osteoporotic fracture increased from 4.9% at the age of 50 years to 17% at the age of 80 years. When using a BMD T-score of ≤−2.5 SD as the intervention threshold, the FRAX probability was twice as high in women aged 50 years as in women of the same age with an average BMD and no risk factor. The FRAX probability increased with age but a T-score of -2.5 SD was actually protective after 80 years or age. Conclusion: Intervention thresholds based on BMD alone cannot effectively identify high-risk women for fracture, particularly in advanced ages. Using fracture probability based on ‘fracture threshold’ can help to improve the identification of these women.

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Accepted/In Press date: 5 March 2021
Published date: 1 June 2021
Additional Information: Publisher Copyright: © 2021, Iranian Epidemiological Association. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: FRAX, Fracture probability, Guidelines, Intervention threshold, Iran, Osteoporosis

Identifiers

Local EPrints ID: 452151
URI: http://eprints.soton.ac.uk/id/eprint/452151
PURE UUID: 6dceaf63-0c84-4289-9229-777976fca01d
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 25 Nov 2021 21:41
Last modified: 04 Aug 2022 01:40

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Contributors

Author: Patricia Khashayar
Author: Abbasali Keshtkar
Author: Afshin Ostovar
Author: Bagher Larijani
Author: H. Johansson
Author: Nicholas Harvey ORCID iD
Author: M. Lorentzon
Author: E.V. McCloskey
Author: J.A, Kanis

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