Revised FRAX®-based intervention thresholds for the management of osteoporosis among postmenopausal women in Sri Lanka View Full Text


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Article Info

DATE

2019-12

AUTHORS

Sarath Lekamwasam, Manju Chandran, Sewwandi Subasinghe

ABSTRACT

This paper revised the fixed intervention thresholds (ITs) based on the Sri Lankan fracture risk assessment tool (FRAX) published in 2013 and introduced new ITs, hybrid and two-tier, aiming to help clinicians in the management of postmenopausal osteoporosis. The hybrid and two-tier ITs have a better discriminatory power than age-dependent and revised fixed ITs. INTRODUCTION: This study revised the Sri Lankan FRAX®-based intervention thresholds (ITs) previously published in 2013. METHOD: Age-dependent ITs were estimated, from 50-80 years with 5-year intervals, using a Sri Lankan FRAX® algorithm for a woman with a BMI of 24.8 kg/m2 and history of prior fragility fracture without other clinical risk factors. Data of 653 postmenopausal women were used in estimating fixed, hybrid, and two-tier ITs. ITs were determined using the ROC curve and partial Youden index. New ITs were validated using data of 356 postmenopausal women who underwent DXA and 62 women who had a recent fragility fracture. Women in the two groups (n = 653 and n = 356) came from the Southern Province and had undergone DXA in our state-owned tertiary care hospital as a part of their routine clinical assessment. RESULTS: The mean (SD) age and BMI of the subjects (n = 653) were 62 (8) years and 24.8 (1.2) kg/m2, respectively. Age-dependent ITs of major osteoporotic fracture risk (MOFR) and hip fracture risk (HFR) ranged from 2.7 to 18% and from 0.4 to 7.1%. The best fixed ITs for women aged 50-80 years were 9% for MOFR and 3% for HFR. In the hybrid method, MOFR of 6% and HFR of 2% were found appropriate for women aged < 70 years. These were combined with age-dependent ITs for women aged 70 years and above. In the two-tier system, two sets of ITs were calculated (ITs of MOFR/HFR for women aged < 70 years and ≥ 70 years were 6%/2% and 12%/5%, respectively). When age-dependent ITs were considered the reference standard, sensitivities of the fixed, hybrid, and two-tier ITs were 0.63, 0.73, and 0.74, respectively. The specificities were 0.76, 0.86, and 0.80 in the same order. Sensitivities of the age-dependent, fixed, hybrid, and two-tier ITs in identifying a woman with an incident fracture were 26%, 48%, 61%, and 61%, respectively. CONCLUSIONS: The new fixed MOFR is slightly lower than the previous value and hybrid and two-tier ITs perform better than age-dependent and fixed ITs. More... »

PAGES

33

References to SciGraph publications

  • 2012-12. The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study in ARCHIVES OF OSTEOPOROSIS
  • 2014-03. Possible FRAX-based intervention thresholds for a cohort of Chinese postmenopausal women in OSTEOPOROSIS INTERNATIONAL
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  • 2008-04. Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX™) in OSTEOPOROSIS INTERNATIONAL
  • 2013-12. Sri Lankan FRAX model and country-specific intervention thresholds in ARCHIVES OF OSTEOPOROSIS
  • 2012-11. Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland in OSTEOPOROSIS INTERNATIONAL
  • 2018-12. FRAX® based intervention thresholds for management of osteoporosis in Singaporean women in ARCHIVES OF OSTEOPOROSIS
  • 2017-01. The FRAX-based Lebanese osteoporosis treatment guidelines: rationale for a hybrid model in OSTEOPOROSIS INTERNATIONAL
  • 2015-11. FRAX and the effect of teriparatide on vertebral and non-vertebral fracture in OSTEOPOROSIS INTERNATIONAL
  • 2016-12. A systematic review of intervention thresholds based on FRAX in ARCHIVES OF OSTEOPOROSIS
  • 2015-08. FRAX-based assessment and intervention thresholds—an exploration of thresholds in women aged 50 years and older in the UK in OSTEOPOROSIS INTERNATIONAL
  • 2013-02. What was your fracture risk evaluated by FRAX® the day before your osteoporotic fracture? in CLINICAL RHEUMATOLOGY
  • 2014-05. Were you identified to be at high fracture risk by FRAX® before your osteoporotic fracture occurred? in CLINICAL RHEUMATOLOGY
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    http://scigraph.springernature.com/pub.10.1007/s11657-019-0585-2

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    http://dx.doi.org/10.1007/s11657-019-0585-2

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    https://app.dimensions.ai/details/publication/pub.1112634346

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30850909


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    30 schema:description This paper revised the fixed intervention thresholds (ITs) based on the Sri Lankan fracture risk assessment tool (FRAX) published in 2013 and introduced new ITs, hybrid and two-tier, aiming to help clinicians in the management of postmenopausal osteoporosis. The hybrid and two-tier ITs have a better discriminatory power than age-dependent and revised fixed ITs. INTRODUCTION: This study revised the Sri Lankan FRAX®-based intervention thresholds (ITs) previously published in 2013. METHOD: Age-dependent ITs were estimated, from 50-80 years with 5-year intervals, using a Sri Lankan FRAX® algorithm for a woman with a BMI of 24.8 kg/m2 and history of prior fragility fracture without other clinical risk factors. Data of 653 postmenopausal women were used in estimating fixed, hybrid, and two-tier ITs. ITs were determined using the ROC curve and partial Youden index. New ITs were validated using data of 356 postmenopausal women who underwent DXA and 62 women who had a recent fragility fracture. Women in the two groups (n = 653 and n = 356) came from the Southern Province and had undergone DXA in our state-owned tertiary care hospital as a part of their routine clinical assessment. RESULTS: The mean (SD) age and BMI of the subjects (n = 653) were 62 (8) years and 24.8 (1.2) kg/m2, respectively. Age-dependent ITs of major osteoporotic fracture risk (MOFR) and hip fracture risk (HFR) ranged from 2.7 to 18% and from 0.4 to 7.1%. The best fixed ITs for women aged 50-80 years were 9% for MOFR and 3% for HFR. In the hybrid method, MOFR of 6% and HFR of 2% were found appropriate for women aged < 70 years. These were combined with age-dependent ITs for women aged 70 years and above. In the two-tier system, two sets of ITs were calculated (ITs of MOFR/HFR for women aged < 70 years and ≥ 70 years were 6%/2% and 12%/5%, respectively). When age-dependent ITs were considered the reference standard, sensitivities of the fixed, hybrid, and two-tier ITs were 0.63, 0.73, and 0.74, respectively. The specificities were 0.76, 0.86, and 0.80 in the same order. Sensitivities of the age-dependent, fixed, hybrid, and two-tier ITs in identifying a woman with an incident fracture were 26%, 48%, 61%, and 61%, respectively. CONCLUSIONS: The new fixed MOFR is slightly lower than the previous value and hybrid and two-tier ITs perform better than age-dependent and fixed ITs.
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