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Impact of population-based or targeted BMD interventions on fracture incidence

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Abstract

Summary

In a simulated population of older women, we demonstrate that an upward shift in the population distribution of BMD by approximately 0.3SD may decrease the risk of incident fractures to the same extent as an intervention targeted to those with T-score less than −2.5.

Introduction

To investigate the impact of population level or targeted alterations to BMD on the incidence of fractures.

Methods

We used a simulated cohort of 49,242 women with age and body mass index distribution from the UK, and prevalence of other clinical risk factors based on European FRAX® cohorts. Using FRAX probabilities of major osteoporotic fracture (MOF: hip, clinical vertebral, distal forearm, proximal humerus) and hip fracture, calculated with femoral neck BMD, we determined the expected number of fractures over 10 years, stratified by 10-year age band from 50 years. We then investigated the effect of (i) uplifting all individuals with T-score below −2.5 to be exactly −2.5 (high-risk strategy) and (ii) shifting the entire BMD distribution upwards (population strategy).

Results

Overall, the high-risk strategy prevented 573 MOF including 465 hip fractures. Moving the BMD T-score distribution upward by 0.27SD gave an equivalent reduction in numbers of MOF; for hip fractures prevented, this was 0.35SD. A global upward 0.25SD BMD shift prevented 524 MOF including 354 hip fractures, with corresponding figures for an increase of 0.5SD being 973 MOF prevented and 640 hip fractures prevented. The ratio of hip fracture to MOF prevented differed by the two approaches, such that for the high-risk strategy, the ratio was 0.81, and for the population strategy was 0.68 (0.25SD BMD uplift) and 0.66 (0.5SD BMD uplift). The numbers of fractures prevented by the high-risk strategy increased with age. In contrast, the age-related increase in numbers of fractures prevented with the population strategy rose with age, but peaked in the 70–79-year age band and declined thereafter.

Conclusions

Both strategies reduced the numbers of expected incident fractures, with contrasting relative impacts by age and fracture site. Whilst the current analysis used UK/European anthropometric/risk factor distributions, further analyses calibrated to the distributions in other settings globally may be readily undertaken. Overall, these findings support the investigation of both population level interventions and those targeted at high fracture risk groups.

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Funding

This work was supported by grants from Medical Research Council (MRC) (4050502589 (MRC LEU)), National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Oxford Biomedical Research Centre, University of Oxford, and supported by the International Osteoporosis Foundation and the UK Royal Osteoporosis Society Osteoporosis and Bone Research Academy.

Author information

Authors and Affiliations

  1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK

    N. C. Harvey & C. Cooper

  2. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK

    N. C. Harvey & C. Cooper

  3. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J. A. Kanis, E. McCloskey & H. Johansson

  4. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

    J. A. Kanis, E. Liu, L. Vandenput, M. Lorentzon & H. Johansson

  5. Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    L. Vandenput & M. Lorentzon

  6. Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    M. Lorentzon

  7. Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden

    M. Lorentzon

  8. NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK

    C. Cooper

  9. Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK

    E. McCloskey

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  1. N. C. Harvey
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  2. J. A. Kanis
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  3. E. Liu
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  4. L. Vandenput
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  5. M. Lorentzon
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  6. C. Cooper
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  7. E. McCloskey
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  8. H. Johansson
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Correspondence to N. C. Harvey.

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Harvey, N.C., Kanis, J.A., Liu, E. et al. Impact of population-based or targeted BMD interventions on fracture incidence. Osteoporos Int 32, 1973–1979 (2021). https://doi.org/10.1007/s00198-021-05917-3

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  • DOI: https://doi.org/10.1007/s00198-021-05917-3

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