Adjusting conventional FRAX estimates of fracture probability according to the number of prior fractures
Adjusting conventional FRAX estimates of fracture probability according to the number of prior fractures
Summary: the risk of a recurrent fragility fracture is high following a first fracture and higher still with more than one prior fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior fractures. Introduction: Prior fractures increase subsequent fracture risk. The aim of this study was to quantify the effect of the number of prior fractures on the 10-year probability of fracture determined with FRAX®.
Methods: the study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of prior osteoporotic fractures over a 20-year interval from the hazards of death and fracture. Fracture probabilities were also computed for a prior osteoporotic fracture irrespective of the number of previous fractures. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.
Results: probability ratios to adjust 10-year FRAX probabilities of a hip fracture and MOF increased with the number of prior fractures but decreased with age in both men and women. Probability ratios were similar in men and women and for hip fracture and MOF. Mean probability ratios according to the number of prior fractures for all scenarios were 0.95, 1.08, 1.21 and 1.35, for 1,2, 3 and 4 or more prior fractures, respectively. Thus, a simple rule of thumb is to downward adjust FRAX-based fracture probabilities by 5% in the presence of a single prior fracture and to uplift probabilities by 10, 20 and 30% with a history of 2, 3 and 4 or more prior fractures, respectively.
Conclusion: the probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.
FRAX adjustment, Fracture probability, Prior fracture, Risk assessment
2507-2515
Kanis, John A.
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Johansson, Helena
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Harvey, Nicholas C
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Gudnason, Vilmundur
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Sigurdsson, Gunnar
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Siggeirsdottir, Kristin
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Lorentzon, Mattias
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Liu, Enwu
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Vandenput, Liesbeth
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McCloskey, Eugene V.
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26 September 2022
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas C
ce487fb4-d360-4aac-9d17-9466d6cba145
Gudnason, Vilmundur
75cefe2e-c5f6-4d85-9a92-cd8c29dd6a94
Sigurdsson, Gunnar
53162212-0166-486a-8e94-4647c645d882
Siggeirsdottir, Kristin
bc469433-457c-420a-99c5-ef774c9ae4af
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Kanis, John A., Johansson, Helena, Harvey, Nicholas C, Gudnason, Vilmundur, Sigurdsson, Gunnar, Siggeirsdottir, Kristin, Lorentzon, Mattias, Liu, Enwu, Vandenput, Liesbeth and McCloskey, Eugene V.
(2022)
Adjusting conventional FRAX estimates of fracture probability according to the number of prior fractures.
Osteoporosis International, 33 (12), .
(doi:10.1007/s00198-022-06550-4).
Abstract
Summary: the risk of a recurrent fragility fracture is high following a first fracture and higher still with more than one prior fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior fractures. Introduction: Prior fractures increase subsequent fracture risk. The aim of this study was to quantify the effect of the number of prior fractures on the 10-year probability of fracture determined with FRAX®.
Methods: the study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of prior osteoporotic fractures over a 20-year interval from the hazards of death and fracture. Fracture probabilities were also computed for a prior osteoporotic fracture irrespective of the number of previous fractures. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.
Results: probability ratios to adjust 10-year FRAX probabilities of a hip fracture and MOF increased with the number of prior fractures but decreased with age in both men and women. Probability ratios were similar in men and women and for hip fracture and MOF. Mean probability ratios according to the number of prior fractures for all scenarios were 0.95, 1.08, 1.21 and 1.35, for 1,2, 3 and 4 or more prior fractures, respectively. Thus, a simple rule of thumb is to downward adjust FRAX-based fracture probabilities by 5% in the presence of a single prior fracture and to uplift probabilities by 10, 20 and 30% with a history of 2, 3 and 4 or more prior fractures, respectively.
Conclusion: the probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.
Text
Number of prior fractures OSIN R1109352
- Accepted Manuscript
More information
Accepted/In Press date: 2 September 2022
e-pub ahead of print date: 26 September 2022
Published date: 26 September 2022
Additional Information:
© 2022. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.
Keywords:
FRAX adjustment, Fracture probability, Prior fracture, Risk assessment
Identifiers
Local EPrints ID: 470350
URI: http://eprints.soton.ac.uk/id/eprint/470350
ISSN: 0937-941X
PURE UUID: fac448a1-6c3f-4ebb-82c8-a1ef004aefcb
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Date deposited: 06 Oct 2022 17:10
Last modified: 17 Mar 2024 07:32
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Contributors
Author:
John A. Kanis
Author:
Helena Johansson
Author:
Vilmundur Gudnason
Author:
Gunnar Sigurdsson
Author:
Kristin Siggeirsdottir
Author:
Mattias Lorentzon
Author:
Enwu Liu
Author:
Liesbeth Vandenput
Author:
Eugene V. McCloskey
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