Abstract
SummaryAssessment and treatment pathways based on age-specific intervention thresholds in Singapore using FRAX paths can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low risk.PurposeIntervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX® has permitted a more accurate assessment of fracture risk. The aim of the present study was to explore treatment paths and characteristics of women selected for treatment in Singapore based on FRAX.MethodsThe approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Singapore. The methodology was applied to women age 50 years or more drawn from the population-based Singapore Chinese Health Study (SCHS) cohort. Missing data for the calculation of FRAX was simulated using data from Chinese cohorts from Hong Kong.ResultsIntervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.9% at the age of 50 years increasing to 32% at the age of 90 years. A total of 1927 of 29,323 women (7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 3019 women (10.3%) would be eligible for treatment on the basis of age-dependent thresholds. The mean BMD T-score of women so selected was −2.94.ConclusionProbability-based assessment of fracture risk using age-specific intervention thresholds was developed for Singapore to help guide decisions about treatment.
Highlights
Osteoporosis is a common, chronic, and costly condition; the annual economic burden in Singapore associated with fragility fractures was estimated at approximately € 118 million in 2017 and is forecast to increase to € 186.9 million by 2035 [1]
Disability due to fragility fractures was greater than that caused by any single cancer, with the exception of lung cancer and was comparable or greater than that caused by a variety of chronic noncommunicable diseases, such as rheumatoid arthritis, asthma, or high blood pressure-related heart disease [3]
The most widely used web-based tool FRAX® meets these requirements and computes the 10-year probability of fragility fractures based on several common clinical risk factors and, optionally, a bone densitometry result obtained from dual xray absorptiometry (DXA) [5, 6]
Summary
Osteoporosis is a common, chronic, and costly condition; the annual economic burden in Singapore associated with fragility fractures was estimated at approximately € 118 million in 2017 and is forecast to increase to € 186.9 million by 2035 [1]. A wide range of treatments is available that improve bone mass and decrease the risk of fractures associated with osteoporosis [4]. The use of such interventions by healthcare practitioners is assisted by instruments that assess patients’ fracture risk to optimize clinical decisions about prevention and treatment. FRAX models are available for 66 countries covering more than 80% of the world population at risk [7] and have been incorporated into more than 100 guidelines worldwide [8]
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