Osteoporosis International

, Volume 23, Issue 1, pp 391–397

High fracture probability with FRAX® usually indicates densitometric osteoporosis: implications for clinical practice

  • W. D. Leslie
  • S. R. Majumdar
  • L. M. Lix
  • H. Johansson
  • A. Oden
  • E. McCloskey
  • J. A. Kanis
  • for the Manitoba Bone Density Program
Short Communication

Abstract

Summary

Most patients designated as high risk of fracture using fracture risk assessment tool (FRAX®) with femoral neck bone mineral density (BMD) (i.e., 10-year major osteoporotic fracture probability exceeding 20% or hip fracture exceeding 3%) have one or more T-scores in the osteoporotic range; conversely, almost no high risk patients have normal T-scores at all bone mineral density measurement sites.

Introduction

We determined the agreement between a FRAX® designation of high risk of fracture [defined as 10-year major osteoporotic fracture probability (≥20%) or hip fracture probability (≥3%)] and the WHO categorizations of bone mineral density according to T-score.

Methods

Ten-year FRAX® probabilities calculated with femoral neck BMD were derived using both Canadian and US white tools for a large clinical cohort of 36,730 women and 2,873 men age 50 years and older from Manitoba, Canada. Individuals were classified according to FRAX fracture probability and BMD T-scores alone.

Results

Most individuals designated by FRAX as high risk of major osteoporotic fracture had a T-score in the osteoporotic range at one or more BMD measurement sites (85% with Canadian tool and 83% with US white tool). The majority of individuals deemed at high risk of hip fracture had one or more T-scores in the osteoporotic range (66% with Canadian tool and 64% with US white tool). Conversely, there were extremely few individuals (<1%) who were at high risk of major osteoporotic or hip fracture with normal T-scores at all BMD measurement sites.

Conclusions

A FRAX designation of high risk of fracture is usually associated with a densitometric diagnosis of osteoporosis.

Keywords

Bone mineral density Clinical risk factors Fracture prediction FRAX® Osteoporosis 

References

  1. 1.
    Kanis JA, Melton LJ III, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141PubMedCrossRefGoogle Scholar
  2. 2.
    Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489PubMedCrossRefGoogle Scholar
  3. 3.
    Kanis JA, McCloskey EV, Johansson H et al (2008) A reference standard for the description of osteoporosis. Bone 42:467–475PubMedCrossRefGoogle Scholar
  4. 4.
    Cranney A, Jamal SA, Tsang JF et al (2007) Low bone mineral density and fracture burden in postmenopausal women. CMAJ 177:575–580PubMedCrossRefGoogle Scholar
  5. 5.
    Kanis JA, Oden A, Johnell O et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046PubMedCrossRefGoogle Scholar
  6. 6.
    Kanis JA, Oden A, Johansson H et al (2009) FRAX and its applications to clinical practice. Bone 44:734–743PubMedCrossRefGoogle Scholar
  7. 7.
    Dawson-Hughes B (2008) A revised clinician’s guide to the prevention and treatment of osteoporosis. J Clin Endocrinol Metab 93:2463–2465PubMedCrossRefGoogle Scholar
  8. 8.
    Dawson-Hughes B, Tosteson AN, Melton LJ III et al (2008) Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int 19:449–458PubMedCrossRefGoogle Scholar
  9. 9.
    Kanis JA, Johnell O, Oden A et al (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRefGoogle Scholar
  10. 10.
    Kanis JA, McCloskey EV, Johansson H et al (2008) Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos Int 19:1395–1408PubMedCrossRefGoogle Scholar
  11. 11.
    Lippuner K, Johansson H, Kanis JA et al (2010) FRAX assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21:381–389PubMedCrossRefGoogle Scholar
  12. 12.
    Kanis JA, Burlet N, Cooper C et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428PubMedCrossRefGoogle Scholar
  13. 13.
    Fujiwara S, Kasagi F, Masunari N et al (2003) Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 18:1547–1553PubMedCrossRefGoogle Scholar
  14. 14.
    Papaioannou A, Morin S, Cheung AM et al (2010) 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873PubMedCrossRefGoogle Scholar
  15. 15.
    Grossman JM, Gordon R, Ranganath VK et al (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 62:1515–1526CrossRefGoogle Scholar
  16. 16.
    Siminoski K, Leslie WD, Frame H et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56:178–188PubMedGoogle Scholar
  17. 17.
    Kanis JA, Johansson H, Oden A et al (2009) Bazedoxifene reduces vertebral and clinical fractures in postmenopausal women at high risk assessed with FRAX. Bone 44:1049–1054PubMedCrossRefGoogle Scholar
  18. 18.
    McCloskey EV, Johansson H, Oden A et al (2009) Ten-year fracture probability identifies women who will benefit from clodronate therapy—additional results from a double-blind, placebo-controlled randomised study. Osteoporos Int 20:811–817PubMedCrossRefGoogle Scholar
  19. 19.
    Kanis JA, Johansson H, Oden A et al (2010) A meta-analysis of the efficacy of raloxifene on all clinical and vertebral fractures and its dependency on FRAX. Bone 47:729–735PubMedCrossRefGoogle Scholar
  20. 20.
    Leslie WD, MacWilliam L, Lix L et al (2005) A population-based study of osteoporosis testing and treatment following introduction of a new bone densitometry service. Osteoporos Int 16:773–782PubMedCrossRefGoogle Scholar
  21. 21.
    Leslie WD, Caetano PA, MacWilliam LR et al (2005) Construction and validation of a population-based bone densitometry database. J Clin Densitom 8:25–30PubMedCrossRefGoogle Scholar
  22. 22.
    Binkley N, Kiebzak GM, Lewiecki EM et al (2005) Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res 20:195–201PubMedCrossRefGoogle Scholar
  23. 23.
    Hansen KE, Binkley N, Christian R et al (2005) Interobserver reproducibility of criteria for vertebral body exclusion. J Bone Miner Res 20:501–508PubMedCrossRefGoogle Scholar
  24. 24.
    Leslie WD (2006) The importance of spectrum bias on bone density monitoring in clinical practice. Bone 39:361–368PubMedCrossRefGoogle Scholar
  25. 25.
    Roos NP, Shapiro E (1999) Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system. Med Care 37:JS10–JS14PubMedCrossRefGoogle Scholar
  26. 26.
    Leslie WD, Tsang JF, Caetano PA et al (2007) Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice. J Clin Endocrinol Metab 92:77–81PubMedCrossRefGoogle Scholar
  27. 27.
    WHO Collaborating Centre for Drug Statistics Methodology (eds) (2005) Guidelines for ATC classification and DDD assignment. OsloGoogle Scholar
  28. 28.
    Leslie WD, Lix LM, Johansson H et al (2010) Independent clinical validation of a Canadian FRAX tool: fracture prediction and model calibration. J Bone Miner Res 25:2350–2358PubMedCrossRefGoogle Scholar
  29. 29.
    Watts NB, Siris ES, Cummings SR et al (2010) Filtering FRAX. Osteoporos Int 21:537–541PubMedCrossRefGoogle Scholar
  30. 30.
    McCloskey E, Compston J, Cooper C (2010) The US FRAX filter: avoiding confusion or hindering progress? Osteoporos Int 21:885PubMedCrossRefGoogle Scholar
  31. 31.
    Leslie WD, Lix LM, Langsetmo et al. (2011) Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos Int [in press]Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • W. D. Leslie
    • 1
    • 7
  • S. R. Majumdar
    • 2
  • L. M. Lix
    • 3
  • H. Johansson
    • 4
  • A. Oden
    • 4
  • E. McCloskey
    • 5
  • J. A. Kanis
    • 6
  • for the Manitoba Bone Density Program
  1. 1.University of ManitobaWinnipegCanada
  2. 2.University of AlbertaEdmontonCanada
  3. 3.University of SaskatchewanSaskatoonCanada
  4. 4.GothenburgSweden
  5. 5.Osteoporosis CentreNorthern General HospitalSheffieldUK
  6. 6.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  7. 7.Department of Medicine (C5121)St. Boniface General HospitalWinnipegCanada

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