FRAX-based intervention thresholds in eight Eurasian countries: Armenia, Belarus, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, the Russian Federation, and Uzbekistan

Lesnyak, Olga; Zakroyeva, Alla; Babalyan, Varta; Cazac, Victor; Gabdulina, Gulzhan; Ismailov, Said; Лобанченко, Ольга Валерьевна; Rudenka, Ema; Tsagareli, Marina; Johansson, Helena; Harvey, Nicholas C.; McCloskey, Eugène; Kanis, John А.

doi:10.1007/s11657-021-00962-1

Cited by 14 publications

(3 citation statements)

References 27 publications

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“…By design, this fracture threshold increases with age with a plateau or decline at older ages due to the competing hazard of death. Age-dependent thresholds have since been adopted into European guidelines [ 51 , 91 ] and elsewhere [ 67 , 92 , 93 ]. The same intervention threshold is applied to men, since the effectiveness and cost-effectiveness of interventions in men are broadly similar to that in women for equivalent risk [ 94 ].…”

Section: Results-criterion Reviewmentioning

confidence: 99%

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

et al. 2022

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Summary The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. Introduction The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. Methods The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation’s Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. Results and Conclusion The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.

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Section: Results-criterion Reviewmentioning

confidence: 99%

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

et al. 2022

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“…FRAX is the most used fracture risk calculator incorporated into guidelines for the management of osteoporosis. In Brazil, as in many countries of Europe and Latin America, the approach used to define pharmacological treatment intervention with FRAX is based on an age-dependent intervention threshold adopted by the National Osteoporosis Guideline Group (NOGG) ( 52 - 55 ). Recently, the International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (IOF-ESCEO) have published guidance recommending the use of FRAX to define a very high fracture risk ( 13 ).…”

Section: Methodsmentioning

confidence: 99%

Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO)

Silva¹,

Madeira²,

d’Alva³

et al. 2022

Archives of Endocrinology and Metabolism

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“…The same age-dependent thresholds are also applied to men, since the effectiveness and cost-effectiveness of interventions in men are broadly similar to that in women for equivalent risk [58]. This approach to intervention thresholds has since been incorporated into guidelines across Europe, Eurasia, Middle East and Latin America [59–64] (A. Naseri, M. Bakhshayeshkaram, S. Salehi, et al ., in preparation). The NOGG thresholds were subsequently revised to flatten the threshold from the age of 70 years, as the previous thresholds required a higher risk of fracture, particularly hip fracture, for treatment to be indicated in women aged at least 70 years without a prior fracture, than those qualifying on the basis of fracture alone [47].…”

Section: Intervention Thresholds Based On Fracture Riskmentioning

confidence: 99%

Update on fracture risk assessment in osteoporosis

McCloskey,

Tan,

Schini

2024

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review The assessment of fracture risk is playing an ever-increasing role in osteoporosis clinical management and informing international guidelines for osteoporosis. FRAX, a fracture risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used since 2008. In this review, we recap the development and limitations of intervention thresholds and the role of absolute fracture risk. Recent findings There is an increasing awareness of disparities and inequities in the setting of intervention thresholds in osteoporosis. The limitations of the simple use of prior fracture or the DXA-derived BMD T-score threshold are increasingly being discussed; one solution is to use fracture risk or probabilities in the setting of such thresholds. This approach also permits more objective assessment of high and very high fracture risk to enable physicians to make choices not just about the need to treat but what agents to use in individual patients. Summary Like all clinical tools, FRAX has limitations that need to be considered, but the use of fracture risk in deciding who to treat, when to treat and what agent to use is a mechanism to target treatment equitably to those at an increased risk of fracture.

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FRAX-based intervention thresholds in eight Eurasian countries: Armenia, Belarus, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, the Russian Federation, and Uzbekistan

Cited by 14 publications

References 27 publications

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO)

Update on fracture risk assessment in osteoporosis

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