Abstract
Objectives Osteoporosis, in addition to its consequent fracture burden, is a common and costly condition. FRAX® is a well-established, validated, web-based tool which calculates the 10-year probability of fragility fractures. A FRAX model for Ukraine has been available since 2016 but its output has not yet been translated into intervention thresholds for the treatment of osteoporosis in Ukraine; we aimed to address this unmet need in this analysis. Methods In a referral population sample of 3790 Ukrainian women, 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture separately were calculated using the Ukrainian FRAX model, with and without femoral neck bone mineral density (BMD). We used a similar approach to that first proposed by the UK National Osteoporosis Guideline Group, whereby treatment is indicated if the probability equals or exceeds that of a woman of the same age with a prior fracture. Results The MOF intervention threshold in females (the age-specific 10-year fracture probability) increased with age from 5.5% at the age of 40 years to 11% at the age of 75 years where it plateaued and then decreased slightly at age 90 (10%). Lower and upper thresholds were also defined to determine the need for BMD, if not already measured; the approach targets BMD measurements to those at or near the intervention threshold. The proportion of the referral populations eligible for treatment, based on prior fracture or similar or greater probability, ranged from 44% to 69% depending on age. The prevalence of the previous fracture rose with age, as did the proportion eligible for treatment. In contrast, the requirement for BMD testing decreased with age. Conclusions The present study describes the development and application of FRAX-based assessment guidelines in Ukraine. The thresholds can be used in the presence or absence of access to BMD and optimize the use of BMD where access is restricted.
Highlights
A FRAX model for Ukraine has been available since 2016 but its output has not yet been translated into intervention thresholds for the treatment of osteoporosis in Ukraine; we aimed to address this unmet need in this analysis
E starting point is the recognition of the presence of one or more risk factors in an individual which triggers the physician to consider osteoporosis and, more importantly, fracture risk. is case-finding strategy has long been promoted in the majority of osteoporosis guidelines, but in the past led to the advice that bone mineral density (BMD) measurements should subsequently be obtained in all patients, with treatment indicated on the finding of BMD-defined osteoporosis [15]. e role of detecting BMD-defined osteoporosis was twofold
The evidence base for osteoporosis treatments had largely been built on randomized clinical trials with BMD-defined osteoporosis as an entry criterion; this led to the belief by many that treatments would not work in the absence of BMD-defined osteoporosis. is is rightly regarded as an incorrect interpretation of the data with several recent studies confirming that osteoporosis treatments can reduce fracture risk in patients with BMD above the osteoporosis threshold [16]
Summary
Osteoporosis, in addition to its consequent fracture burden, is a common and costly condition. Www.sheffield.ac.uk/FRAX) computes the 10-year probability of a major osteoporotic fracture (MOF, comprising a hip, spine, forearm, or humerus fractures) or hip fracture alone from simple, captured clinical risk factors (CRFs) with the optional incorporation of femoral neck bone mineral density (BMD) measured by dual-energy Y-ray absorptiometry (DXA) [6, 7]. It is increasingly incorporated within national and international guidelines for osteoporosis [8] with some countries providing direct linkages between the FRAX assessment and clinical guidance websites, for example, in the UK [9, 10]. We wished to develop these thresholds for Ukraine and explore their use and impact within a Ukrainian referral population
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