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Title: The effects of a FRAX revision for the US

Author
item KANIS, JOHN - University Of Sheffield
item JOHANSSON, HELENA - University Of Sheffield
item ODEN, ANDERS - University Of Sheffield
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item MELDTON, L JOSEPH - University Of Sheffield
item MCCLOSKEY, EUGENE - University Of Sheffield

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/30/2009
Publication Date: 1/10/2010
Citation: Kanis, J.A., Johansson, H., Oden, A., Dawson-Hughes, B., Meldton, L., Mccloskey, E.V. 2010. The effects of a FRAX revision for the US. Osteoporosis International. 21:35-40.

Interpretive Summary: In 2008, the World Health Organization released the original version of a calculator called FRAX (registered trademark) that was developed to predict risk of fracture over the next 10 years using information on an individual’s clinical risk factors for osteoporosis and their bone mineral density at the hip. The FRAX (registered trademark) score is an important determinant of who should be considered for pharmacologic treatment to prevent fractures. A revision of the fracture risk assessment tool (FRAX (registered trademark)) has been developed based on an update of the epidemiological information for the US (hip fracture and mortality rates). With the revised tool there were strong correlations (r>0.99) between the original and revised FRAX (registered trademark) estimates of fracture probability, but the revised models gave lower fracture probabilities. The revised version of FRAX (registered trademark) should allow for more accurate prediction of fracture risk.

Technical Abstract: The aim of this study was to determine the effects of a revision of the epidemiological data used to compute fracture probabilities in the US with FRAX (registered trademark). Models were constructed to compute fracture probabilities based on updated epidemiology of fracture in the US. The models comprised the ten-year probability of hip fracture, with femoral neck BMD, and the ten-year probability of a major osteoporotic fracture, with BMD. For each model fracture and death hazards were computed as continuous functions. The effect of the revised epidemiological estimates on fracture probability was examined by piece wise linear regression using multiple combinations of clinical risk factors and BMD. At all ages there was a strong correlation (r>0.99) between the original and revised FRAX (registered trademark) estimates of probability. For a major osteoporotic fracture, the revised model gave lower fracture probabilities by 13% to 24% in men depending on age and by 19% to 24% in women. For hip fracture probability, the revised model gave lower fracture probabilities by 40% and 27% at the ages of 50 and 60 years in men and by 43% and 30%, respectively in women. At the ages of 70 years and older the revised model gave similar hip fracture probabilities as the original version in both men and women. The revised FRAX (registered trademark) model for the US does not alter the ranking of fracture probabilities, but provides lower probability estimates than the original version, particularly in younger men.