Preview

Rheumatology Science and Practice

Advanced search

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. Lesnyak
Mechnikov NorthWestern State Medical University, Ministry of Health of Russia; Clinical Rheumatology Hospital Twenty-Five
Russian Federation

Olga Lesnyak

41, Kirochnaya St., Saint Petersburg 191015; 30, Bolshaya Pod'yacheskaya St., Saint Petersburg 190068


Competing Interests: not


E. N. Gladkova
Mechnikov NorthWestern State Medical University, Ministry of Health of Russia; Clinical Rheumatology Hospital Twenty-Five
Russian Federation

41, Kirochnaya St., Saint Petersburg 191015; 30, Bolshaya Pod'yacheskaya St., Saint Petersburg 190068


Competing Interests: not


O. B. Ershova
Yaroslavl State Medical University, Ministry of Health of Russia
Russian Federation

5, Revolutsionnaya St., Yaroslavl 150000


Competing Interests: not


I. A. Skripnikova
National Medical Center for Preventive Medicine, Ministry of Health of Russia
Russian Federation

10, Petroverigsky Lane, Moscow 101990


Competing Interests: not


O. N. Anoshenkova
Max and K, OOO, Maximum Health Medical Center; Siberian State Medical University, Ministry of Health of Russia
Russian Federation

172/3, Frunze Pr., Tomsk 634021; 2, Moskovsky Road, Tomsk 634050


Competing Interests: not


Yu. R. Akhverdyan
A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology
Russian Federation

76, Zemlyachka St., Volgograd 400138


Competing Interests: not


K. Yu. Belova
Yaroslavl State Medical University, Ministry of Health of Russia
Russian Federation

5, Revolutsionnaya St., Yaroslavl 150000


Competing Interests: not


I. B. Belousova
Lermontov Town Clinical Hospital One Hundred and One, Branch of the North Caucasian Federal Research and Clinical Center, Federal Biomedical Agency
Russian Federation

26, Lenin St., Lermontov 357341


Competing Interests: not


E. V. Bolshakova
Yaroslavl State Medical University, Ministry of Health of Russia
Russian Federation

5, Revolutsionnaya St., Yaroslavl 150000


Competing Interests: not


A. V. Dreval
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

61/2, Shchepkin St., Moscow 129110


Competing Interests: not


B. V. Zavodovsky
A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology
Russian Federation

76, Zemlyachka St., Volgograd 400138


Competing Interests: not


M. V. Ilyin
Yaroslavl State Medical University, Ministry of Health of Russia
Russian Federation

5, Revolutsionnaya St., Yaroslavl 150000


Competing Interests: not


O. V. Kosmatova
National Medical Center for Preventive Medicine, Ministry of Health of Russia
Russian Federation

10, Petroverigsky Lane, Moscow 101990


Competing Interests: not


L. V. Kryukova
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

61/2, Shchepkin St., Moscow 129110


Competing Interests: not


A. A. Latfullin
BARSMED, OOO
Russian Federation

2, Khusain Mavlyutov St., Kazan 420101


Competing Interests: not


E. A. Leikauskene
«Anthurium» Multidisciplinary Medical Clinic, OOO
Russian Federation

17, Sotsialistichesky Prospect, Barnaul 656043


Competing Interests: not


N. V. Leonova
«Anthurium» Multidisciplinary Medical Clinic, OOO
Russian Federation

17, Sotsialistichesky Prospect, Barnaul 656043


Competing Interests: not


Yu. V. Maksimova
Max and K, OOO, Maximum Health Medical Center
Russian Federation

172/3, Frunze Pr., Tomsk 634021


Competing Interests: not


M. A. Myagkova
National Medical Center for Preventive Medicine, Ministry of Health of Russia
Russian Federation

10, Petroverigsky Lane, Moscow 101990


Competing Interests: not


V. E. Novikov
National Medical Center for Preventive Medicine, Ministry of Health of Russia
Russian Federation

10, Petroverigsky Lane, Moscow 101990


Competing Interests: not


A. R. Nuriev
BARSMED, OOO
Russian Federation

2, Khusain Mavlyutov St., Kazan 420101


Competing Interests: not


E. Yu. Polyakova
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

61/2, Shchepkin St., Moscow 129110


Competing Interests: not


Yu. V. Polyakova
A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology
Russian Federation

76, Zemlyachka St., Volgograd 400138


Competing Interests: not


L. E. Sivordova
A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology
Russian Federation

76, Zemlyachka St., Volgograd 400138


Competing Interests: not


V. A. Tavluev
Max and K, OOO, Maximum Health Medical Center
Russian Federation

172/3, Frunze Pr., Tomsk 634021


Competing Interests: not


L. R. Shavalieva
BARSMED, OOO
Russian Federation

2, Khusain Mavlyutov St., Kazan 420101


Competing Interests: not


References

1. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of WHO Study Group. Geneva: World Health Organization; 1994 (WHO Report Series, No. 843).

2. Lesnyak OM, Baranova IA, Belova KYu, et al. Osteoporosis in Russian Federation: Epidemiology, socio-medical and economical aspects (Review). Travmatologiya i Ortopediya Rossii. 2018;24(1):155-68 (In Russ.).

3. Kanis JA, Cooper C, Rizzoli R, Reginster JY, on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30:3-44. doi: 10.1007/s00198-018-4704-5

4. Weinwright SA, Marshall LM, Ensrud KE, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90(5):2787-93. doi: 10.1210/jc.2004-1568

5. Kanis JA, Hans D, Cooper C, et al. Task Force of the FRAX Initiative. Interpretation and use of FRAX in clinical practice. Osteoporos Int. 2011 Sep; 22(9):2395-411. doi: 10.1007/s00198-011-1713-z

6. Melnichenko GA, Belaya ZhE, Rozhinskaya LYa, et al. Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problemy Endokrinologii. 2017;63(6):392-426 (In Russ.).

7. Lesnyak О, Ershova О, Belova К, et al. Epidemiology of fracture in the Russian Federation and the development of a FRAX model. Arch Osteoporos. 2012;7(1-2):67-73. doi: 10.1007/s11657-012-0082-3

8. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359-81. doi: 10.1007/s00198-014-2794-2

9. Papaioannou A, Morin S, Cheung AM, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. Can Med Assoc J. 2010;182(17):1864-73. doi: 10.1503/cmaj.100771

10. Orimo H, Nakamura T, Hosoi T, et al. Japanese 2011 guidelines for prevention and treatment of osteoporosis — executive summary. Arch Osteoporos. 2012;7(1-2):3-20. doi: 10.1007/s11657-012-0109-9

11. Johansson H, Kanis JA, Ljunggren O, et al. FRAX-model for 10-year fracture risk assessment. Support in the treatment of osteoporosis, according to preliminary Swedish guidelines. Lakartidningen. 2011;108(7):336-9.

12. Kanis JA, Harvey NC, Cooper C, et al. A systematic review of intervention thresholds based on FRAX. Arch Osteoporos. 2016;11(1):25. doi: 10.1007/s11657-016-0278-z

13. Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, et al. National Osteoporosis Foundation Guide Committee. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19(4):437-47. doi: 10.1007/s00198-007-0550-6

14. McCloskey E, Kanis JA, Johansson H, et al. FRAX-based assessment and intervention thresholds — an exploration of thresholds in women aged 50 years and older in the UK. Osteoporos Int. 2015;26(8):2091-9. doi: 10.1007/s00198-015-3176-0

15. Skripnikova IA, Myagkova MA, Shalnova SA, et al. Estimation of bone fracture risk using FRAX® model in urban population of Russian Federation. Int J Clin Rheumatol. 2018;13(2):63-70. doi: 10.4172/1758-4272.1000164

16. Nikitinskaya OA, Toroptsova NV. Progress of osteoporosis: stratification of fracture risk. Osteoporoz i Osteopatii. 2018;21(1):4-9 (In Russ.).

17. Harvey NC, McCloskey E, Kanis JA, et al. Cost-effective but clinically inappropriate: new NICE intervention thresholds in osteoporosis (Technology Appraisal 464). Osteoporos Int. 2018;29(7):1511-3. doi: 10.1007/s00198-018-4505-x

18. Borgstrom F, Johnell O, Kanis JA, et al. At what hip fracture risk is it cost-effective to treat? International intervention thresholds for the treatment of osteoporosis. Osteoporos Int. 2006;17(10):1459-71. doi: 10.1007/s00198-006-0107-0

19. Shepstone L, Lenaghan E, Cooper C, et al; SCOOP Study Team. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018;391(10122):741-7. doi: 10.1016/S0140-6736(17)32640-5

20. Dawson-Hughes B, Looker AC, Tosteson AN, et al. The potential impact of the National Osteoporosis Foundation guidance on treatment eligibility in the USA: an update in NHANES 2005-2008. Osteoporos Int. 2012;23(3):811-20. doi: 10.1007/s00198-011-1694-y

21. Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137-41. doi: 10.1002/jbmr.5650090802

22. Kanis JA, Johnell O, Oden A, et al. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. 2000 Nov;27(5):585-90. doi: 10.1016/S8756-3282(00)00381-1

23. Kanis JA, McCloskey EV, Harvey NC, et al. Intervention thresholds and the diagnosis of osteoporosis. J Bone Miner Res. 2015;30(10):1747-53. doi: 10.1002/jbmr.2531


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

Views: 815


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1995-4484 (Print)
ISSN 1995-4492 (Online)