The ten-year probability of fractures with the FRAX tool: which threshold for intervention to be used and how?
https://doi.org/10.14412/1995-4484-2019-626-635
Abstract
Objective: to analyze the clinical and organizational feasibility of using different intervention thresholds for the Russian population.
Subjects and methods. The probability of fractures using the Russian FRAX model was calculated on a sample of 3,866 postmenopausal female residents from 6 cities of the Russian Federation. Different intervention thresholds, including fixed (20% for major fractures and 3% for hip fractures), age-dependent (European and Russian) ones, as well as alternative models, were analyzed. The proportion of women to be treated was estimated using different intervention thresholds.
Results and discussion. The analysis of the effectiveness of the thresholds showed that the European threshold was the least appropriate one for the formed sample, since more than half (53.6%) of the women to be treated using the threshold, while the vast majority (90%) of the patients were in the younger age groups (50—54 years). There were very similar results of the effectiveness analysis of the fixed threshold (according to the USA National Osteoporosis Foundation — NOF) recommendations and that of the age-dependent threshold for Russia (in the context of the national clinical recommendations). Using the NOF approach in our sample could identify 47.8% of the postmenopausal women to be treated for osteoporosis. Their proportion rose from 29.6% of the patients aged 50—54 years to 80.6% of those aged 85 years and older. The alternative analyses of age-dependent thresholds showed great effectiveness when the fracture was considered not as a risk factor for future fractures, but as a clinical disease manifestation that was sufficient to recommend that the patient should be treated without FRAX counting. However, with their use, the proportion of older people to be treated remains not high enough. In this connection, there remains a need to search for the more adequate application of the existing intervention threshold or to develop a new, for example, hybrid variant of the age-dependent threshold.
About the Authors
O. M. LesnyakRussian Federation
Olga Lesnyak
41, Kirochnaya St., Saint Petersburg 191015; 30, Bolshaya Pod'yacheskaya St., Saint Petersburg 190068
Competing Interests: not
E. N. Gladkova
Russian Federation
41, Kirochnaya St., Saint Petersburg 191015; 30, Bolshaya Pod'yacheskaya St., Saint Petersburg 190068
Competing Interests: not
O. B. Ershova
Russian Federation
5, Revolutsionnaya St., Yaroslavl 150000
Competing Interests: not
I. A. Skripnikova
Russian Federation
10, Petroverigsky Lane, Moscow 101990
Competing Interests: not
O. N. Anoshenkova
Russian Federation
172/3, Frunze Pr., Tomsk 634021; 2, Moskovsky Road, Tomsk 634050
Competing Interests: not
Yu. R. Akhverdyan
Russian Federation
76, Zemlyachka St., Volgograd 400138
Competing Interests: not
K. Yu. Belova
Russian Federation
5, Revolutsionnaya St., Yaroslavl 150000
Competing Interests: not
I. B. Belousova
Russian Federation
26, Lenin St., Lermontov 357341
Competing Interests: not
E. V. Bolshakova
Russian Federation
5, Revolutsionnaya St., Yaroslavl 150000
Competing Interests: not
A. V. Dreval
Russian Federation
61/2, Shchepkin St., Moscow 129110
Competing Interests: not
B. V. Zavodovsky
Russian Federation
76, Zemlyachka St., Volgograd 400138
Competing Interests: not
M. V. Ilyin
Russian Federation
5, Revolutsionnaya St., Yaroslavl 150000
Competing Interests: not
O. V. Kosmatova
Russian Federation
10, Petroverigsky Lane, Moscow 101990
Competing Interests: not
L. V. Kryukova
Russian Federation
61/2, Shchepkin St., Moscow 129110
Competing Interests: not
A. A. Latfullin
Russian Federation
2, Khusain Mavlyutov St., Kazan 420101
Competing Interests: not
E. A. Leikauskene
Russian Federation
17, Sotsialistichesky Prospect, Barnaul 656043
Competing Interests: not
N. V. Leonova
Russian Federation
17, Sotsialistichesky Prospect, Barnaul 656043
Competing Interests: not
Yu. V. Maksimova
Russian Federation
172/3, Frunze Pr., Tomsk 634021
Competing Interests: not
M. A. Myagkova
Russian Federation
10, Petroverigsky Lane, Moscow 101990
Competing Interests: not
V. E. Novikov
Russian Federation
10, Petroverigsky Lane, Moscow 101990
Competing Interests: not
A. R. Nuriev
Russian Federation
2, Khusain Mavlyutov St., Kazan 420101
Competing Interests: not
E. Yu. Polyakova
Russian Federation
61/2, Shchepkin St., Moscow 129110
Competing Interests: not
Yu. V. Polyakova
Russian Federation
76, Zemlyachka St., Volgograd 400138
Competing Interests: not
L. E. Sivordova
Russian Federation
76, Zemlyachka St., Volgograd 400138
Competing Interests: not
V. A. Tavluev
Russian Federation
172/3, Frunze Pr., Tomsk 634021
Competing Interests: not
L. R. Shavalieva
Russian Federation
2, Khusain Mavlyutov St., Kazan 420101
Competing Interests: not
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Review
For citations:
Lesnyak O.M., Gladkova E.N., Ershova O.B., Skripnikova I.A., Anoshenkova O.N., Akhverdyan Yu.R., Belova K.Yu., Belousova I.B., Bolshakova E.V., Dreval A.V., Zavodovsky B.V., Ilyin M.V., Kosmatova O.V., Kryukova L.V., Latfullin A.A., Leikauskene E.A., Leonova N.V., Maksimova Yu.V., Myagkova M.A., Novikov V.E., Nuriev A.R., Polyakova E.Yu., Polyakova Yu.V., Sivordova L.E., Tavluev V.A., Shavalieva L.R. The ten-year probability of fractures with the FRAX tool: which threshold for intervention to be used and how? Rheumatology Science and Practice. 2019;57(6):626-635. (In Russ.) https://doi.org/10.14412/1995-4484-2019-626-635