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A FRAX® model for the assessment of fracture probability in Belgium
Johansson, Helena Kanis, John McCloskey, Eugene Oden, Anders Devogelaer, J. P. Kaufman, J-M Neuprez, A. Hiligsmann, Mickaël Bruyère, O. Reginster, Jean Yves
Johansson, Helena
Kanis, John
McCloskey, Eugene
Oden, Anders
Devogelaer, J. P.
Kaufman, J-M
Neuprez, A.
Hiligsmann, Mickaël
Bruyère, O.
Reginster, Jean Yves
Abstract
Summary
A country-specific FRAX® model was developed from the epidemiology of fracture and death in Belgium. Fracture probabilities were identified that corresponded to currently accepted reimbursement thresholds.
Introduction
The objective of this study was to evaluate a Belgian version of the WHO fracture risk assessment (FRAX®) tool to compute 10-year probabilities of osteoporotic fracture in men and women. A particular aim was to determine fracture probabilities that corresponded to the reimbursement policy for the management of osteoporosis in Belgium and the clinical scenarios that gave equivalent fracture probabilities.
Methods
Fracture probabilities were computed from published data on the fracture and death hazards in Belgium. Probabilities took account of age, sex, the presence of clinical risk factors and femoral neck bone mineral density (BMD). Fracture probabilities were determined that were equivalent to intervention (reimbursement) thresholds currently used in Belgium.
Results
Fracture probability increased with age, lower BMI, decreasing BMD T-score and all clinical risk factors used alone or combined. The 10-year probabilities of a major osteoporosis-related fracture that corresponded to current reimbursement guidelines ranged from approximately 7.5% at the age of 50 years to 26% at the age of 80 years where a prior fragility fracture was used as an intervention threshold. For women at the threshold of osteoporosis (femoral neck T-score = −2.5 SD), the respective probabilities ranged from 7.4% to 15%. Several combinations of risk-factor profiles were identified that gave similar or higher fracture probabilities than those currently accepted for reimbursement in Belgium.
Conclusions
The FRAX® tool has been used to identify possible thresholds for therapeutic intervention in Belgium, based on equivalence of risk with current guidelines. The FRAX® model supports a shift from the current DXA-based intervention strategy, towards a strategy based on fracture probability of a major osteoporotic fracture that in turn may improve identification of patients at increased fracture risk. The approach will need to be supported by health economic analyses.
Keywords
10-year fracture probability, clinical risk factors, FRAX®, hip fracture, osteoporotic fracture
Date
2011
Type
Journal article
Journal
Osteoporosis International
Book
Volume
22
Issue
2
Page Range
453-461
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled