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Selection for treatment of patients at high risk of fracture by the short versus long term prediction models — data from the Belgian FRISBEE cohort

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Abstract

Summary

Our imminent model was less sensitive but more selective than FRAX® in the choice of treatment to prevent imminent fractures. This new model decreased NNT by 30%, which could reduce the treatment costs. In the Belgian FRISBEE cohort, the effect of recency further decreased the selectivity of FRAX®.

Purpose

We analyzed the selection for treatment of patients at high risk of fracture by the Belgian FRISBEE imminent model and the FRAX® tool.

Methods

We identified in the FRISBEE cohort subjects who sustained an incident MOF (mean age 76.5 ± 6.8 years). We calculated their estimated 10-year risk of fracture using FRAX® before and after adjustment for recency and the 2-year probability of fracture using the FRISBEE model.

Results

After 6.8 years of follow-up, we validated 480 incident and 54 imminent MOFs. Of the subjects who had an imminent fracture, 94.0% had a fracture risk estimated above 20% by the FRAX® before correction for recency and 98.1% after adjustment, with a specificity of 20.2% and 5.9%, respectively. The sensitivity and specificity of the FRISBEE model at 2 years were 72.2% and 55.4%, respectively, for a threshold of 10%.

For these thresholds, 47.3% of the patients were identified at high risk in both models before the correction, and 17.2% of them had an imminent MOF. The adjustment for recency did not change this selection. Before the correction, 34.2% of patients were selected for treatment by FRAX® only, and 18.8% would have had an imminent MOF. This percentage increased to 47% after the adjustment for recency, but only 6% of those would suffer a MOF within 2 years.

Conclusion

In our Belgian FRISBEE cohort, the imminent model was less sensitive but more selective in the selection of subjects in whom an imminent fracture should be prevented, resulting in a lower NNT. The correction for recency in this elderly population further decreased the selectivity of FRAX®. These data should be validated in additional cohorts before using them in everyday practice.

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Acknowledgements

The FRISBEE study is supported by CHU Brugmann and IRIS-Recherche.

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Authors and Affiliations

  1. Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium

    L. Iconaru, F. Baleanu, J. de Filette, R. Karmali & J.J. Body

  2. Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    A. Charles, J.J. Body & P. Bergmann

  3. Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium

    M. Moreau

  4. Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    M. Surquin, F. Benoit, R. Karmali & J.J. Body

  5. Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    P. Bergmann

Authors
  1. L. Iconaru
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  2. A. Charles
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  3. F. Baleanu
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  4. M. Moreau
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  5. M. Surquin
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  6. F. Benoit
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  7. J. de Filette
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  8. R. Karmali
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  9. J.J. Body
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  10. P. Bergmann
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Corresponding author

Correspondence to L. Iconaru.

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Supplementary information

Supplementary file 1

Supplementary Table 1. Distribution of incident fractures in two models: imminent MOFs model and recalculated FRAX® with correction for recency. Supplementary Table 2. Distribution of imminent fractures in two models: imminent MOFs model and recalculated FRAX® with correction for recency

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Iconaru, L., Charles, A., Baleanu, F. et al. Selection for treatment of patients at high risk of fracture by the short versus long term prediction models — data from the Belgian FRISBEE cohort. Osteoporos Int 34, 1119–1125 (2023). https://doi.org/10.1007/s00198-023-06737-3

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  • DOI: https://doi.org/10.1007/s00198-023-06737-3

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