Abstract
SummaryA surrogate FRAX® model for Pakistan has been constructed using age-specific hip fracture rates for Indians living in Singapore and age-specific mortality rates from Pakistan.IntroductionFRAX models are frequently requested for countries with little or no data on the incidence of hip fracture. In such circumstances, the International Society for Clinical Densitometry and International Osteoporosis Foundation have recommended the development of a surrogate FRAX model, based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country.ObjectiveThis paper describes the development and characteristics of a surrogate FRAX model for Pakistan.MethodsThe FRAX model used the ethnic-specific incidence of hip fracture in Indian men and women living in Singapore, combined with the death risk for Pakistan.ResultsThe surrogate model gave somewhat lower 10-year fracture probabilities for men and women at all ages compared to the model for Indians from Singapore, reflecting a higher mortality risk in Pakistan. There were very close correlations in fracture probabilities between the surrogate and authentic models (r ≥ 0.998) so that the use of the Pakistan model had little impact on the rank order of risk. It was estimated that 36,524 hip fractures arose in 2015 in individuals over the age of 50 years in Pakistan, with a predicted increase by 214% to 114,820 in 2050.ConclusionThe surrogate FRAX model for Pakistan provides an opportunity to determine fracture probability within the Pakistan population and help guide decisions about treatment.
Highlights
In 2008, the WHO Collaborating Centre for Metabolic Bone Diseases at the University of Sheffield, UK, launched the FRAX® tool for the calculation of 10-year fracture probabilities in women and men from readily obtained clinical risk factors (CRFs) and bone mineral density (BMD) measurements at the femoral neck.10 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK11 Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK 34 Page 2 of 6Arch Osteoporos (2021) 16:34The algorithm (FRAX) was based on a series of meta-analyses using primary data from population-based cohorts that examined a list of candidate clinical risk factors for fracture [1, 2]
Such surrogate models are based on age- and sexspecific mortality data from the index country, combined with age-specific, sex-specific rates of fracture derived from a country, usually nearby, where fracture rates are considered to be representative of the index country [5]
In the absence of incidence data for other sites of major osteoporotic fracture, the hip fracture rates were used to estimate these incidences on the assumption that the ratio of hip fracture incidence to these other FRAX outcomes is the same in the index country as that documented in Sweden, Iceland, Canada, Moldova and elsewhere [12,13,14,15]
Summary
Recognizing that data on hip and other fractures are not always available, the International Society for Clinical Densitometry and International Osteoporosis Foundation recommend the development of a surrogate FRAX model to be used until country-specific data are collected and made available. Such surrogate models are based on age- and sexspecific mortality data from the index country, combined with age-specific, sex-specific rates of fracture derived from a country, usually nearby, where fracture rates are considered to be representative of the index country [5]. In the absence of good epidemiological data on fracture [6], the present report describes the development of a surrogate FRAX model for Pakistan
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