Osteoporosis International

, 21:35 | Cite as

The effects of a FRAX® revision for the USA

  • J. A. Kanis
  • H. Johansson
  • A. Oden
  • B. Dawson-Hughes
  • L. J. MeltonIII
  • E. V. McCloskey
Original Article



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.


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®.


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.


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.


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.


Clinical risk factors Fracture probability FRAX® Osteoporosis Osteoporotic fracture US 


  1. 1.
    Kanis JA, on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UKGoogle Scholar
  2. 2.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397CrossRefPubMedGoogle Scholar
  3. 3.
    World Health Organization (2007) Assessment of osteoporosis at the primary health care level. WHO, Geneva. www.who.int/chp/topics/rheumatic/en/index.html. Accessed 1 May 2009
  4. 4.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–486CrossRefPubMedGoogle 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 18:1033–1046CrossRefPubMedGoogle Scholar
  6. 6.
    Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Oglesby A (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244CrossRefPubMedGoogle Scholar
  7. 7.
    Melton LJ III, Crowson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: Comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9:29–37CrossRefPubMedGoogle Scholar
  8. 8.
    Melton LJ III, Kearns AE, Atkinson EJ et al (2009) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20:687–694CrossRefPubMedGoogle Scholar
  9. 9.
    Zingmond DS, Melton LJ III, Silverman SL (2004) Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 15:603–610CrossRefPubMedGoogle Scholar
  10. 10.
    Hiebert R, Aharonoff GB, Capla EL et al (2005) Temporal and geographic variation in hip fracture rates for people aged 65 or older, New York State, 1985–1996. Am J Orthop 34:252–255PubMedGoogle Scholar
  11. 11.
    Kung HC, Hoyert DL, Xu J, et al. (September 2007) Deaths: Preliminary Data for 2005. Health E-Stats. http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm. Accessed 21 April 2009
  12. 12.
    Ettinger B, Black D, Dawson-Hughes B, Pressman AR, Melton LJ III (2009) Updated fracture incidence rates for the US version of FRAX®. Osteoporos Int. doi:10.1007/s00198-009-1032-9 PubMedGoogle Scholar
  13. 13.
    Burge R, Dawson-Hughes B, Solomon DH et al (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475CrossRefPubMedGoogle Scholar
  14. 14.
    Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427CrossRefPubMedGoogle Scholar
  15. 15.
    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 19:449–458CrossRefPubMedGoogle Scholar
  16. 16.
    Melton LJ 3rd, Kanis JA, Johnell O (2005) Potential impact of osteoporosis treatment on hip fracture trends. J Bone Miner Res 20:895–897CrossRefPubMedGoogle Scholar
  17. 17.
    Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674CrossRefPubMedGoogle Scholar
  18. 18.
    Binkley N, Kiebzak GM, Michael Lewiecki EM E et al (2005) Recalculation of the NHANES Database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res 20:195–201CrossRefPubMedGoogle Scholar
  19. 19.
    Kanis JA, Borgstrom F, Zethraeus N, Johnell O, Oden A, Jonsson B (2005) Intervention thresholds for osteoporosis in the UK. Bone 36:22–32CrossRefPubMedGoogle Scholar
  20. 20.
    Kanis JA, Johnell O, Oden A, Borgstrom F, Johansson H, De Laet C et al (2005) Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int 16:6–14CrossRefPubMedGoogle Scholar
  21. 21.
    Borgstrom F, Johnell O, Kanis JA, Jonsson B, Rehnberg C (2006) At what hip fracture risk is it cost-effective to treat? International Intervention thresholds for the treatment of osteoporosis. Osteoporos Int 17:1459–1471CrossRefPubMedGoogle Scholar
  22. 22.
    Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, National Osteoporosis Guideline Group (2008) Case finding for the management of osteoporosis with FRAX®—assessment and intervention thresholds for the UK. Osteoporos Int 19:1395–1408 Erratum Osteoporos Int 2009;20: 499–502CrossRefPubMedGoogle Scholar
  23. 23.
    Tosteson AN, Melton LJ III, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, National Osteoporosis Foundation Guide Committee et al (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19:437–447CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • J. A. Kanis
    • 1
  • H. Johansson
    • 1
  • A. Oden
    • 1
  • B. Dawson-Hughes
    • 2
  • L. J. MeltonIII
    • 3
  • E. V. McCloskey
    • 1
  1. 1.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  2. 2.Jean Mayer US Department of Agriculture Human Nutrition Research Center on AgingTufts UniversityBostonMAUSA
  3. 3.Division of EpidemiologyCollege of Medicine, Mayo ClinicRochesterUSA

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