Original Article

Osteoporosis International

, Volume 21, Issue 1, pp 35-40

The effects of a FRAX® revision for the USA

  • J. A. KanisAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School Email author 
  • , H. JohanssonAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School
  • , A. OdenAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School
  • , B. Dawson-HughesAffiliated withJean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University
  • , L. J. MeltonIIIAffiliated withDivision of Epidemiology, College of Medicine, Mayo Clinic
  • , E. V. McCloskeyAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Summary

A revision (version 3.0) of the fracture risk assessment tool (FRAX®) is developed based on an update of epidemiological information for the USA. With the revised tool, there were strong correlations (r > 0.99) between versions 2.0 and 3.0 for FRAX® estimates of fracture probability, but the revised models gave lower probability estimates.

Introduction

The aim of this study was to determine the effects of a revision of the epidemiological data used to compute fracture probabilities in the USA with FRAX®.

Methods

Models were constructed to compute fracture probabilities based on updated fracture incidence and mortality rates in the USA. The models comprised the ten-year probability of hip fracture and the ten-year probability of a major osteoporotic fracture, both including femoral neck bone mineral density (BMD). For each model, fracture and death hazards were computed as continuous functions. The effect of the revised rates on fracture probability was examined by piecewise linear regression using multiple combinations of clinical risk factors and BMD.

Results

At all ages, there was a strong correlation (r > 0.99) between version 2.0 and revised FRAX® estimates of fracture probability. For a major osteoporotic fracture, the revised model gave lower median probabilities by 13% to 24% in men, depending on age, and by 19% to 24% in women. For hip fracture probability, the revised model gave lower median fracture probabilities by 40% and 27% at the ages of 50 and 60 years in men and by 43% and 30%, respectively, in women. At the ages of 70 years and older the revised model gave similar hip fracture probabilities as version 2.0 in both men and women.

Conclusion

The revised FRAX® model for the USA (version 3.0) does not alter the ranking of fracture probabilities but provides lower probability estimates than version 2.0, particularly, in younger women and men.

Keywords

Clinical risk factors Fracture probability FRAX® Osteoporosis Osteoporotic fracture US