Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study

Abstract

Purpose-FRAX ® is calibrated using population-specific fracture and mortality data. The need for FRAX to accommodate ethnic diversity within a country is uncertain. We addressed this question using the population-based Manitoba Bone Mineral Density (BMD) Program registry and self-reported ethnicity.Methods-The study population was women age 40 years or older with baseline FRAX assessments (Canadian and other ethnic calculators), fracture outcomes and self-reported ethnicity (White N=68,907 [referent], Asian N=1,910, Black N=356). Adjusted hazard ratios (HR) with 95 % confidence intervals (CI) for time to MOF and hip fracture were estimated. We examined candidate variables from DXA that might contribute to ethnic differences including skeletal size, hip axis length (HAL), trabecular bone score (TBS), and estimated body composition.

Fragility fracture prevalence among elderly Chinese is no more than half of that of elderly Caucasians

“…By analysing the Canadian population-based Manitoba bone mineral density (BMD) Program registry data, in 2021 Leslie et al (8) reported a study that included 68,907 Caucasian women (mean age: 64.7±10.9 years) and 1,910 Asian women (mostly Chinese and Filipino, mean age: 62.8±9.9 years). During a follow-up period of 8.8±5.1 years for Caucasians and 6.5±5.0 years for Asians, incident hip fracture rate per 1,000 person-years was 0.6 [95% confidence interval (CI): 0.2-1.0] for Asians and 3.6 (95% CI: 3.5-3.8) for Caucasians (Asian vs. Caucasian ratio: 0.17).…”

“…In 2021, by analysing the above-mentioned Manitoba BMD Program registry data, Leslie et al (8) reported that, at baseline prior fracture history was recorded in 20.1% of the Caucasian women (total included n=68,907, mean age: 64.7±10.9 years) and 11.7% of the Asian women (total: n=1,910, mostly Chinese and Filipino, mean age: 62.8±9.9 years). During the follow-up of 8.8±5.1 years for Caucasians and 6.5±5.0 years for Asians, the incident rate for major osteoporotic fracture (MOF; a composite of hip, humerus, forearm, and clinical vertebral fractures) per 1,000 person-years was 11.4 (95% CI: 11.2-11.7) for Caucasians and 5.0 (95% CI: 3.8-6.2) for Asians.…”

Establishment of a preliminary FRAX®-based intervention threshold for rheumatoid arthritis–associated fragility fracture: a 3-year longitudinal, observational, cohort study

“…It is widely acknowledged that the application of FRAX® should be country-specific. However, as FRAX® has progressively become more widely utilized globally, it was realized that the use of FRAX® not only should be ethics-specific 27 but also should be disease-specific 28 – 30 when applied in precision medicine. As previously mentioned, RA has been incorporated as a dichotomous predictor in the FRAX®; however, no RA-specific guidelines or recommendations, as of GIOP, 13 , 14 based on FRAX® are available currently.…”

Fine-tuning the cutpoint T-score as an epidemiological index with high specificity for osteoporosis: methodological considerations for the Chinese population

“…The principle presented here can also apply to osteoporosis in men and other BMD measure sites such as the lumbar spine. In recent Canadian studies, it is noted that East Asians are more likely to be diagnosed with osteoporosis based on BMD (6,8).…”