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The application of FRAX in Saudi Arabia

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Abstract

Summary

Assessment and treatment pathways based on age-specific intervention thresholds in Saudi Arabi can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low fracture risk.

Purpose

Intervention thresholds for the treatment of osteoporosis have historically been based on the measurement of bone mineral density. The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Saudi Arabia based on fracture probabilities derived from FRAX®.

Methods

The 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 Saudi Arabia. The methodology was applied to women age 40 years or more drawn from a tertiary referral population for skeletal assessment. Missing data for the calculation of FRAX was simulated using data from the referral and FRAX derivation cohorts.

Results

Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.0% at the age of 50 years increasing to 7.6% at the age of 70 years. A total of 163 of 1365 women (11.9%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 5 women were eligible for treatment in that MOF probabilities lay above the upper assessment threshold. A BMD test would be recommended for 593 women (43.4%) so that FRAX could be recalculated with the inclusion of femoral neck BMD. Of these, 220 individuals would be eligible for treatment after a BMD test and 373 women categorised at low risk after a BMD test.

Conclusion

Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Saudi Arabia to help guide decisions about treatment.

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Acknowledgements

The authors are grateful the Researchers Supporting Project (RSP-2021/21) in King Saud University, Riyadh, Saudi Arabia, for their support.

Author information

Authors and Affiliations

  1. Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia

    Nasser M. Al-Daghri, Shaun Sabico, Yousef Al-Saleh & Naji J. Aljohani

  2. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia

    Yousef Al-Saleh

  3. King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia

    Yousef Al-Saleh

  4. Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia

    Yousef Al-Saleh

  5. Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia

    Riad Sulimani

  6. Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia

    Naji J. Aljohani

  7. Diabetes Care Center, King Salman Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia

    Eman Sheshah

  8. Department of Family Medicine and Community, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia

    Abdulaziz Alodhayani

  9. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    Nicholas C. Harvey

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

    Enwu Liu, Mattias Lorentzon, Liesbeth Vandenput, Helena Johansson & John A. Kanis

  11. Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Mattias Lorentzon & Helena Johansson

  12. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

    Eugene V. McCloskey, Helena Johansson & John A. Kanis

  13. MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK

    Eugene V. McCloskey

  14. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Liesbeth Vandenput

Authors
  1. Nasser M. Al-Daghri
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  2. Shaun Sabico
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  3. Yousef Al-Saleh
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  6. Eman Sheshah
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  7. Abdulaziz Alodhayani
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  8. Nicholas C. Harvey
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  9. Enwu Liu
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  10. Mattias Lorentzon
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  11. Eugene V. McCloskey
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  12. Liesbeth Vandenput
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  13. Helena Johansson
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  14. John A. Kanis
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Corresponding authors

Correspondence to Nasser M. Al-Daghri or John A. Kanis.

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Al-Daghri, N.M., Sabico, S., Al-Saleh, Y. et al. The application of FRAX in Saudi Arabia. Arch Osteoporos 16, 166 (2021). https://doi.org/10.1007/s11657-021-01024-2

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