Chapter 68 Chapter 68 Fracture Risk Assessment: The Development and Application of FRAX ® Copyright © 2013 Elsevier Inc. All rights reserved

Chapter 68Chapter 68

Fracture Risk Assessment: The Development and Application of

FRAX®

Copyright © 2013 Elsevier Inc. All rights reserved.


FIGURE 68.1 Screenshot of tool for input of data and format of results in the UK version of FRAX® (UK model, version 3.3.). Source: Kanis (2008) [1], with permission from the WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School.

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FIGURE 68.2 The relationship between bone mineral density at the femoral neck expressed as a T-score (with standard deviation (SD)) And hip fracture probability in women from Sweden according to age (years). For any given T-score, the probability of fracture is higher with increasing age. Source: Kanis et al. (2001) [33], with kind permission from Springer Science and Business Media B. V.

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FIGURE 68.3 Relative risk (RR) for hip fracture and 95% confidence intervals comparing men and women (combined) with and without a prior fracture by age. Source: figure from data given in Kanis et al. (2004) [25].

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FIGURE 68.4 Ten-year probability of hip fracture in men and women from Malmo, Sweden. Source: Kanis et al. (2000) [50], with kind permission from Springer Science and Business Media B. V.

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FIGURE 68.5 Ten-year probability of hip fracture in women aged 65 years with a prior fracture and T-score of −2.5 standard deviations (SD) at the femoral neck in the different countries with FRAX® models. [FRAX® version 3.4]. Source: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UK, with permission.

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FIGURE 68.6 Mean bone mineral density at the femoral neck (with 95% confidence intervals) measured with Hologic equipment in randomly selected women aged 75 years or more according to their 10-year probability of a major fracture calculated without BMD. Source: figure from data given in Johansson et al. (2004) [81].

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FIGURE 68.7 Relationship between 10-year probabilities of a major osteoporotic fracture and the efficacy of clodronate to reduce fracture risk (hazard ratio with 95% confidence intervals). The horizontal line represents the hazard ratio of 1. Probabilities shown are calculated with clinical risk factors alone (left panel) and with clinical risk factors combined with femoral neck bone mineral density (BMD) (right panel). Source: McCloskey et al. (2009) [103], with kind permission from Springer Science and Business Media B. V.

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FIGURE 68.8 The risk of hip fracture with age in a model that considers 10-year fracture risk alone (the Garvan tool) and FRAX® which computes the probability of hip fracture from the fracture and death hazards (FRAX®). The T-scores are set differently in the two models so that the risks are approximately equal at the age of 60 years. BMI: Body mass index; SD: Standard deviation. Data are computed from the respective web sites.

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FIGURE 68.9 Ten-year fracture probability for a major fracture derived from the Canadian FRAX® tool with and without bone mineral density (BMD) versus observed 10-year fracture rates (95% confidence interval) by risk category (low, <10%; moderate, 10–20%; high, >20%) with BMD (solid line) and without BMD (dashed line). The dashed line depicts the line of identity. Source: redrawn from Leslie et al. (2010) [123].

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FIGURE 68.10 Management algorithm for the assessment of individuals at risk of fracture. BMD: Bone mineral density; CRF: Clinical risk factor; WHO: World health Organization. Source: Kanis (2008) [1], with permission from the WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School.

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FIGURE 68.11 Assessment guidelines of the National Osteoporosis Guideline Group based on the 10-year probability of a major fracture (%). The dotted line denotes the intervention threshold. Where assessment is made in the absence of bone mineral density (BMD), areal BMD test is recommended for individuals where the probability assessment lies in the mid-region. Source: adapted from Kanis et al. (2008) [11].

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FIGURE 68.12 Hazard ratio between treatments (bazedoxifene versus placebo) with 95% confidence intervals according to values of 10-year probability of a major osteoporotic fracture calculated with bone mineral density. Source: Kanis et al. (2009) [102], with permission from Elsevier.

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FIGURE 68.13 Correlation between the probability of fracture and cost-effectiveness at the age of 50 years in women (body mass index set to 26 kg/m2). The upper panel shows the 10-year probability of hip fracture and the lower panel, the probability of a major osteoporotic fracture. Each point represents a particular combination of bone mineral density and clinical risk factors. The horizontal line denotes the threshold for cost-effectiveness (a willingness to pay of £20,000/quality-adjusted life year (QALY) gained). Source: Kanis et al. (2008) [191], with permission from Elsevier.

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Chapter 68 Chapter 68 Fracture Risk Assessment: The Development and Application of FRAX ® Copyright © 2013 Elsevier Inc. All rights reserved