OSTEOPOROSIS: ASSESSMENT OF A RISK FOR RECURRENT LOW-TRAUMA FRACTURES IN POSTMENOPAUSAL WOMEN
https://doi.org/10.14412/1995-4484-2016-44-48
Abstract
Objective: to assess a risk for new fractures in a cohort of postmenopausal women who have sustained low-trauma fractures, by using the FRAX® algorithm, and to compare the assessments with data on the fractures have occurred during a prospective follow-up study.
Subjects and methods. The investigation enrolled 128 postmenopausal women (mean age, 64.9±8.3 years) who had sustained low-trauma fractures at five sites (the hip, forearm, humeral neck, vertebral column, and ankle). A ten-year fracture risk was assessed using the FRAX® algorithm with and without regard for bone mineral density (BMD). New osteoporotic fractures were recorded during a three-year prospective follow-up study.
Results and discussion. The average FRAX® algorithm values for all new osteoporotic and hip fractures in the entire group were 18.0±5.6 and 3.7±3.7% (without consideration of BMD), 17.9±6.6 and 3.5±4.0% (with consideration of BMD) (p > 0.05). The true incidence of recurrent fractures over 3 years was 17.2%. During 3 years, the incidence of recurrent fractures in the women who had sustained low-trauma fractures of the proximal hip, humeral neck, and spinal column was 28.6, 25.0, and 22.8%, respectively, which exceeded the estimated 10-year fracture risk for these sites. The history of multiple low-trauma fractures versus single one increased the risk for subsequent fractures by 3.63 and 9.43 times among women with high or low estimated FRAX risk rate, respectively.
Conclusion. The three-year prospective follow-up study has shown that the FRAX® algorithm underestimated the risk associated with the presence of recurrent fractures in the history; moreover, new fractures significantly more commonly occur in persons who have sustained low-trauma fractures in the proximal hip, humoral neck, and vertebral column.
About the Authors
O. V. Dobrovolskaya
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
N. V. Toroptsova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
References
1. Rubin KH, Friis-Holmberg T, Hermann AP, et al. Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? A systematic review. Bone Miner Res. 2013 Aug;28(8):1701-17. doi: 10.1002/jbmr.1956
2. Kannis JA; on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level. Technical Report. Sheffield, UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007.
3. Kanis JA, Borgstrom F, de Laet C, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581-9. doi: 10.1007/s00198-004-1780-5
4. Kannis JA, Johnell O, Oden A, et al. FRAX® и оценка риска перелома у мужчин и женщин в Великобритании. Остеопороз и остеопатии. 2008;2(2):38-44 [FRAX® and assessment of risk of fracture in men and women in the UK. Osteoporoz i osteopatii = Osteoporosis and osteopathy. 2008;2(2):38-44 (In Russ.)].
5. Donaldson MG, Palermo L, Ensrud KE, et al. Effect of alendronate for reducing fracture by FRAX® score and femoral neck bone mineral density: the Fracture Intervention Trial. J Bone Miner Res. 2012 Aug;27(8):1804-10. doi: 10.1002/jbmr.1625
6. Kim K, Svedbom A, Luo X, et al. Comparative cost-effectiveness of bazedoxifene and raloxifene in the treatment of postmenopausal osteoporosis in Europe, using the FRAX® algorithm. Osteoporos Int. 2014 Jan;25(1):325-37. doi: 10.1007/s00198-013-2521-4
7. Fiore CE, Gaudio A. When the FRAX® test is applied to controlled clinical trials. Clin Cases Miner Bone Metab. 2012 Sep;9(3):135-7.
8. Catalano A, Morabito N, Basile G, et al. Fracture risk assessment in postmenopausal women referred to an Italian center for osteoporosis: a single day experience in Messina. Clin Cases Miner Bone Metab. 2013 Sep;10(3):191-4.
9. Pang WY, Inderjeeth CA. FRAX® without bone mineral density versus osteoporosis self-assessment screening tool as predictors of osteoporosis in primary screening of individuals aged 70 and older. J Am Geriatr Soc. 2014 Mar;62(3):442-6. doi: 10.1111/jgs.12696
10. Crandall CJ, Larson J, Gourlay ML, et al. Osteoporosis screening in postmenopausal women 50-64 years-old: Comparison of U.S. preventive services task force strategy and two traditional strategies in the women's health initiative. J Bone Miner Res. 2014;29(7): 1661-6. doi: 10.1002/jbmr.2174
11. Cheung E, Cheung CL, Kung AW, Tan KC. Possible FRAX®-based intervention thresholds for a cohort of Chinese postmenopausal women. Osteoporos Int. 2014 Mar;25(3):1017-23. doi: 10.1007/s00198-013-2553-9
12. Кирпикова МН. Дифференцированный подход к диагностике и лечению постменопаузального остеопороза. Дис. … докт. мед. наук. Иваново; 2011. 222 с. [Kirpikova MN. Differentsirovannyi podkhod k diagnostike i lecheniyu postmenopauzal'nogo osteoporoza. Dis. … dokt. med. nauk [Differentiated approach to the diagnosis and treatment of postmenopausal osteoporosis. Doct dis.]. Ivanovo; 2011. 222 p.].
13. Попов АА, Струнина МВ, Телющенко МВ. Оценка абсолютного риска переломов у пациентов с выявленным остеопорозом дистального отдела предплечья. Остеопороз и остеопатии. 2012:(3):3-6 [Popov AA, Strunina MV, Telyushchenko MV. Evaluation of absolute fracture risk in patients diagnosed with osteoporosis of the distal forearm. Osteoporoz i osteopatii = Osteoporosis and osteopathy. 2012:(3):3-6 (In Russ.)].
14. Никитинская ОА, Торопцова НВ. Социальная программа «Остеоскрининг Россия» в действии. Фарматека. 2012;(6):90-3 [Nikitinskaya OA, Toroptsova NV. Social program «Osteoskrining Russia» in action. Farmateka. 2012;(6):90-3 (In Russ.)].
15. Мешалкина ЛЮ. Сравнительная оценка десятилетней вероятности по шкале FRAX® и реальной частоты переломов у женщин пожилого возраста с остеопорозом. Клиническая геронтология. 2012;18(1-2):19-22 [Meshalkina LYu. Comparative evaluation of the ten-year probability scale FRAX® and the real incidence of fractures in elderly women with osteoporosis. Klinicheskaya gerontologiya. 2012;18(1-2):19-22 (In Russ.)].
16. Azagra R, Roca G, Encabo G, et al. FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort. BMC Musculoskelet Disord. 2012 Oct 22;13:204. doi: 10.1186/1471-2474-13-204
17. Sornay-Rendu E, Munoz F, Delmas PD, Chapurlat RD. The FRAX® tool in French women: How well does it describe the real incidence of fracture in the OFELY cohort? J Bone Miner Res. 2010 Oct;25(10):2101-7. doi: 10.1002/jbmr.106
18. Silverman SL, Calderon AD. The utility and limitations of FRAX®: A US perspective. Curr Osteoporos Rep. 2010 Dec;8(4):192-7. doi: 10.1007/s11914-010-0032-1
19. Donaldson MG, Cawthon PM, Schousboe JT, et al; Study of Osteoporotic Fractures (SOF). Novel methods to evaluate fracture risk models. J Bone Miner Res. 2011;26(8):1767-73. doi: 10.1002/jbmr.371
20. Roux S, Cabana F, Carrier N, et al. The World Health Organization Fracture Risk Assessment Tool (FRAX®) underestimates incident and recurrent fractures in consecutive patients with fragility fractures. J Clin Endocrinol Metab. 2014 Jul;99(7):2400-8. doi: 10.1210/jc.2013-4507
21. Setty N, Leboff MS, Thornhill TS, et al. Underestimated fracture probability in patients with unilateral hip osteoarthritis as calculated by FRAX®. J Clin Densitom. 2011 Oct-Dec;14(4):447-52. doi: 10.1016/j.jocd.2011.06.001
Review
For citations:
Dobrovolskaya O.V., Toroptsova N.V. OSTEOPOROSIS: ASSESSMENT OF A RISK FOR RECURRENT LOW-TRAUMA FRACTURES IN POSTMENOPAUSAL WOMEN. Rheumatology Science and Practice. 2016;54(1):44-48. (In Russ.) https://doi.org/10.14412/1995-4484-2016-44-48
Views:
956
Email this article 