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Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment

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Abstract

Summary

We describe the creation of a FRAX® model for the assessment of fracture probability in Canadian men and women, calibrated from national hip fracture and mortality data. This FRAX tool was used to examine possible thresholds for therapeutic intervention in Canada in two large complementary cohorts of women and men.

Objective

To evaluate a Canadian World Health Organization (WHO) fracture risk assessment (FRAX®) tool for computing 10-year probabilities of osteoporotic fracture.

Methods

Fracture probabilities were computed from national hip fracture data (2005) and death hazards (2004) for Canada. Probabilities took account of age, sex, clinical risk factors (CRFs), and femoral neck bone mineral density (BMD). Treatment implications were studied in two large cohorts of individuals age 50 years and older: the population-based Canadian Multicentre Osteoporosis Study (4,778 women and 1,919 men) and the clinically referred Manitoba BMD Cohort (36,730 women and 2,873 men).

Results

Fracture probabilities increased with age, decreasing femoral neck T-score, and number of CRFs. Among women, 10.1–11.3% would be designated high risk based upon 10-year major osteoporotic fracture probability exceeding 20%. A much larger proportion would be designated high risk based upon 10-year hip fracture probability exceeding 3% (25.7–28.0%) or osteoporotic BMD (27.1–30.9%), and relatively few from prior hip or clinical spine fracture (1.6–4.2%). One or more criteria for intervention were met by 29.2–34.0% of women excluding hip fracture probability (35.3–41.0% including hip fracture probability). Lower intervention rates were seen among CaMos (Canadian Multicentre Osteoporosis Study) men (6.8–12.9%), but in clinically referred men from the Manitoba BMD Cohort, one or more criteria for high risk were seen for 26.4% excluding hip fracture probability (42.4% including hip fracture probability).

Conclusions

The FRAX tool can be used to identify intervention thresholds in Canada. The FRAX model supports a shift from a dual X-ray absorptiometry (DXA)-based intervention strategy, towards a strategy based on fracture probability for a major osteoporotic fracture.

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Acknowledgements

The development of FRAX® was in part supported by a non restricted grant from the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. The hip fracture and mortality statistics were generously provided by the Public Health Agency of Canada using manipulated Canadian Institutes of Health Information data. We thank all those participants in CaMos whose careful responses and attendance made this analysis possible. The authors are indebted to Manitoba Health for the provision of data (HIPC File No. 2007/2008-49). The results and conclusions are those of the authors, and no official endorsement by Manitoba Health is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. The analyses and conclusions in this report reflect the opinions of individual experts and not their affiliated organizations.

Conflicts of interest

William D. Leslie

Speaker fees and unrestricted research grants from Merck Frosst Canada Ltd; unrestricted research grants from Sanofi-Aventis, Procter & Gamble Pharmaceuticals Canada, Inc., Novartis, Amgen Pharmaceuticals Canada, Inc., Innovus 3M, Genzyme Canada; advisory boards for Genzyme Canada, Novartis, and Amgen Pharmaceuticals Canada, Inc.

Lisa M. Lix

Unrestricted research grants from Amgen Pharmaceuticals Canada, Inc. and innovus 3M.

David Goltzman

Consultant for Eli Lily, Novartis, Merck, Proctor & Gamble, and Amgen.

David A. Hanley

Consultant and grants from Amgen, Eli Lilly, Merck, Novartis, Proctor & Gamble, Warner-Chilcott, Sanofi-Aventis, Servier, Wyeth-Ayerst, Nycomed.

Jonathan D. Adachi

Consultant/Speaker or research grants from: Amgen, Astra Zeneca, Eli Lilly, GSK, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, Sanofi Aventis, Servier, Wyeth, Bristol-Myers Squibb.

Eugene McCloskey

Speaker fees and/or unrestricted research grants from Novartis, Amgen, AstraZeneca, Pfizer, Bayer, Procter & Gamble, Lilly, Roche, Servier and Hologic.

John A Kanis

Nothing to declare for FRAX and the context of this paper.

Others: None

Sources of support

None.

Author information

Authors and Affiliations

  1. University of Manitoba, Winnipeg, Canada

    W. D. Leslie

  2. University of Saskatchewan, Saskatoon, Canada

    L. M. Lix

  3. McGill University, Montreal, Canada

    L. Langsetmo, C. Berger & D. Goltzman

  4. University of Calgary, Calgary, Canada

    D. A. Hanley

  5. McMaster University, Hamilton, Canada

    J. D. Adachi

  6. Consulting statistician, Gothenburg, Sweden

    H. Johansson & A. Oden

  7. Osteoporosis Centre, Northern General Hospital, Sheffield, UK

    E. McCloskey

  8. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J. A. Kanis

  9. Department of Medicine (C5121), St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6

    W. D. Leslie

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  1. W. D. Leslie
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  2. L. M. Lix
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  7. J. D. Adachi
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  8. H. Johansson
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  9. A. Oden
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  10. E. McCloskey
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  11. J. A. Kanis
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Corresponding author

Correspondence to W. D. Leslie.

Additional information

CaMos Research Group

David Goltzman (co-principal investigator, McGill University), Nancy Kreiger (co-principal investigator, Toronto), Alan Tenenhouse (principal investigator emeritus, Toronto). CaMos Coordinating Centre, McGill University, Montreal, Quebec: Suzette Poliquin (national coordinator), Suzanne Godmaire (research assistant), Claudie Berger (study statistician). Memorial University, St. John’s Newfoundland: Carol Joyce (director), Christopher Kovacs (co-director), Emma Sheppard (coordinator). Dalhousie University, Halifax, Nova Scotia: Susan Kirkland, Stephanie Kaiser (co-directors), Barbara Stanfield (coordinator). Laval University, Quebec City, Quebec: Jacques P. Brown (director), Louis Bessette (co-director), Marc Gendreau (coordinator). Queen’s University, Kingston, Ontario: Tassos Anastassiades (director), Tanveer Towheed (co-director), Barbara Matthews (coordinator). University of Toronto, Toronto, Ontario: Bob Josse (director), Sophie A Jamal (co-director), Tim Murray (past director), Barbara Gardner-Bray (coordinator). McMaster University, Hamilton, Ontario: Jonathan D. Adachi (director), Alexandra Papaioannou (co-director), Laura Pickard (coordinator). University of Saskatchewan, Saskatoon, Saskatchewan: Wojciech P. Olszynski (director), K. Shawn Davison(co-director), Jola Thingvold (coordinator). University of Calgary, Calgary, Alberta: David A. Hanley (director), Jane Allan (coordinator). University British Columbia, Vancouver, British Columbia: Jerilynn C. Prior (director), Milan Patel (co-director),Yvette Vigna (coordinator); Brian C. Lentle (radiologist).

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Leslie, W.D., Lix, L.M., Langsetmo, L. et al. Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos Int 22, 817–827 (2011). https://doi.org/10.1007/s00198-010-1464-2

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  • DOI: https://doi.org/10.1007/s00198-010-1464-2

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