THE NEW PARADIGM IN DIAGNOSIS AND TREATMENT OF OSTEOPOROSIS: PREDICTION OF A 10-YEAR ABSOLUTE RISK OF FRACTURE (CALCULATOR FRAX)

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Abstract


New tool to assess fracture probability — the 10-year absolute fracture risk (calculator FRAX), released by WHO in 2008 - is discussed in this review. Dual-energyX-rays absorptiometry (DXA) is considered as a gold standard of diagnosis of osteoporosis. The goal of FRAX was to improve the prognostic performance of densitometry in assessing fracture risk through adding the information on different clinical risk factors independent of bone mineral density. The methodology used in searching for the risk factors included in FRAX is reviewed. Disadvantages and limitations of FRAX as well as ways of it implementation in clinical practice are discussed.

About the authors

O. M. Lesnyak

Email: olga.m.lesnyak@yandex.ru
kafedra semeynoy meditsiny FPK i PP

References

  1. Лесняк О.М. Аудит состояния проблемы остеопороза в странах Восточной Европы и Центральной Азии 2010. Остеопороз и остеопатии, 2011, № 2, с. 3—6.
  2. Lewiecki E.M. Fracture Risk Assessment in Clinical Practice: T-scores, FRAX., and Beyond. Clinic Rev Miner Metab 2010; 8: 101—112.
  3. Marshall D., Johnell O., Wedel H. Meta-analysis of how well measures of bone mineral density predict occurence of osteoporotic fractures. BMJ 1996; 312 (7041): 1254—9.
  4. Bouxsein M.L., Delmas P.D. Considerations for development of surrogate endpoints for antifracture efficacy of new treatments in osteoporosis: a perspective. J. Bone Miner Res 2008; 23 (8): 1155—67.
  5. Cummings S.R., Bauer D.C. Filtering FRAX. Osteoporos Int 2010; 21: 537—541.
  6. Weinwright S.A., Marshall LM., Ensrud K.E. et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab, 2005; 90 (5): 2787—93.
  7. Sanders K.M., Nicholson G.C., Watts J.J. et al. Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective? Bone. 2006; 38(5): 694—700.
  8. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation; 2008.
  9. Kanis J.A., Oden A., Johnell O. et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 2007; 18: 1033—1046.
  10. Kanis J.A., Johnell O., Oden A. et al. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001; 12: 989—995
  11. De Laet C., Kanis J.A., Oden A., Johansson H. et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 2005; 16(11): 1330—1338.
  12. Kanis J.A., Johnell O., De Laet C. et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004; 35 (2): 375—382.
  13. Kanis J.A., Johansson H., Oden A., et al. A family history of fracture and fracture risk: a meta-analysis. Bone, 2004; 35 (5): 1029—1037.
  14. Blank R.D. on behalf of the FRAX Position Development Conference Members. Official Positions for FRAX Clinical Regarding Prior Fractures. J Clin Densitom 2011; 14 (3): 205—211.
  15. Kanis J.A., on behalf of the World Health Organization Scientific Group. 2007 Assessment of osteoporosis at the primary health-care level. Technical report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK: Printed by the University of Sheffield.
  16. Dimai H.P., Chandran M. on behalf of the FRAX Position Development Conference Members. Official Positions for FRAX Clinical Regarding Smoking. J Clin Densitom 2011; 14 (3): 190—193.
  17. Leib E.S., Saag K.G., Adachi J.D., et al. on behalf of the FRAX Position Development Conference Members. Official Positions for FRAX Clinical Regarding Glucocorticoids: The Impact of the Use of Glucocorticoids on the Estimate by FRAX of the 10 Year Risk of Fracture. J Clin Densitom 2011; 14 (3): 212—219.
  18. Kanis J.A., Oden A., McCloskey E.V. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 2011; 22(3): 809—816.
  19. Van Staa T.P., Geusens P., Bilsma J.W.J. et al. Clinical assessment of long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006; 54 (10): 3104—3112.
  20. Kim S.Y., Schneeweiss S., Liu J. et al. Risk of osteoporotic fracture in a large population based cohort of patients with rheumatoid arthritis. Arthritis Res and Ther 2010; 12: R154.
  21. Broy S.B., Tanner S.B. on behalf of the FRAX Position Development Conference Members. Official Positions for FRAX Clinical Regarding Rheumatoid Arthritis. J Clin Densitom 2011; 14 (3): 184—189.
  22. Hoidrup S., Gronbaek M., Gottschau A. et al. Alcohol intake, beverage preference, and risk of hip fracture in men and women. Copenhagen centre for Prospective Population Studies. Am. J. Epidemiol. 1999; 149 (11): 993—1001.
  23. Lewiecki E.M., Compston J.E., Miller P.D. et al. on behalf of the FRAX Position Development Conference Members. Official Positions for FRAX Bone Mineral Density and FRAX Simplification. J Clin Densitom 2011; 14 (3): 226—236.
  24. Masud T., Binkley N., Boonen S., Hannan M. on behalf of the FRAX Position Development Conference Members. Official Positions for FRAX Clinical Regarding Falls and Frailty: Can Falls and Frailty be Used in FRAX? J Clin Densitom 2011; 14 (3): 194—204.
  25. Vasikaran S., Eastell R., Bruyere O. for the IOF-IFCC Bone Marker Standards Working Group. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 2011; 22: 391—420.
  26. Johansson H., Kanis J.A., Oden A., Johnell O., McCloskey E. BMD, Clinical risk factors and their combination for hip fracture prevention. Osteoporos Int 2009; 20: 1675—1682.
  27. Siris E., Delmas P.D. Assessment of 10-year absolute fracture risk: a new paradigm with worldwide application. Osteoporos Int 2008; 19: 383—384.
  28. McCloskey E.V., Johansson H., Oden A. et al. Ten-year fracture probability identifies women who will benefit from clodronate therapy — additional results from a double-blind, placebo-controlled randomized study. Osteoporos Int. 2009; 20(5): 811—7.
  29. Kanis J.A., Johansson H., Oden A., McCloskey E.V. Bazodoxifene reduces vertebral and clinical fractures in postmenopausal women at high risk assessed with FRAX. Bone 2009; 44(6): 1049—54.

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