Top

Osteoporosis International

Published in:

01-03-2011 | Original Article

Guidance for the adjustment of FRAX according to the dose of glucocorticoids

Authors: J. A. Kanis, H. Johansson, A. Oden, E. V. McCloskey

Published in: Osteoporosis International | Issue 3/2011

Abstract

Summary

We examined the effect of glucocorticoid dose on FRAX® derived fracture probabilities in a UK setting. A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.

Introduction

The WHO fracture risk assessment (FRAX) tool estimates 10-year probability of fracture based upon multiple clinical risk factors and an optional femoral neck BMD measurement. Ever (past and current) use of systemic glucocorticoids is a dichotomous risk factor (yes/no) and does not therefore take account of the dose of glucocorticoids. The aim of this work was to estimate the adjustment for fracture probability based upon the dose of glucocorticoids.

Methods

Dose responses for fracture risk during exposure to glucocorticoids were taken from the General Practice Research Database and used to adjust the relative risks for glucocorticoids in FRAX. In addition to fracture risk, a dose response for the death hazard was estimated and both variables were used to populate the FRAX model for the UK.

Results

The exposure to glucocorticoids was found to significantly affect fracture probability. The following rule was formulated. For low-dose exposure (<2.5 mg daily of prednisolone or equivalent), the probability of a major fracture is decreased by about 20% depending on age. For medium doses (2.5–7.5 mg daily), the unadjusted FRAX value can be used. For high doses (>7.5 mg daily), probabilities can be upward revised by about 15%. Conversion factors were also determined for the adjustment of hip fracture probability.

Conclusion

A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.

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, UK. Accessed at www.shef.ac.uk/FRAX/

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 19:385–397CrossRefPubMed

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 18:1033–1046CrossRefPubMed

Kanis JA, Burlet N, on behalf of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428CrossRefPubMed

Fujiwara S, Nakamura T, Orimo H et al (2008) Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX™). Osteoporos Int 19:429–448CrossRefPubMed

Dawson-Hughes B (2008) A revised clinician’s guide to the prevention and treatment of osteoporosis. J Clin Endocrinol Metab 93:2463–2465CrossRefPubMed

National Osteoporosis Foundation (2008) Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation. www.nof.org

Neuprez A, Johansson H, Kanis JA et al (2009) Rationalisation du remboursement des médicaments de l’ostéoporose : de la mesure isolée de la densité osseuse à l’intégration des facteurs cliniques de risque fracturaire. Validation de l’algorithme FRAX®. La Revue Médicale de Liège 64 : 12 : 612–619

Lippuner K, Johansson H, Kanis JA, Rizzoli R (2010) FRAX® assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21:381–390CrossRefPubMed

10.

Czerwinski E, Kanis JA, Trybulec B, Johansson H, Borowy P, Osieleniec J (2009) The incidence and risk of hip fracture in Poland. Osteoporos Int 20:1363–1368CrossRefPubMed

11.

Berry SD, Kiel DP, Donaldson MG, Cummings SR, Kanis JA, Johansson H, Samelson EJ (2010) Application of the national osteoporosis foundation guidelines to postmenopausal women and men: the Framingham osteoporosis study. Osteoporos Int 21:53–60CrossRefPubMed

12.

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) 62:1515–1526CrossRef

13.

Papaioannou A, Morin S, Cheung AM et al (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873.

14.

Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A (2008) Case finding for the management of osteoporosis with FRAX®-assessment and intervention thresholds for the UK. Osteoporos Int 19:1395–1408CrossRefPubMed

15.

Compston J, Cooper A, Cooper C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P, Wilkins M; on behalf of the National Osteoporosis Guideline Group (NOGG) (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108CrossRef

16.

Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E (2009) FRAX® and its applications to clinical practice. Bone 44:734–743CrossRefPubMed

17.

Roux C, Thomas T (2009) Optimal use of FRAX. Joint Bone Spine 76:1–3CrossRefPubMed

18.

Kayan K, Johansson H, Oden A et al (2009) Can fall risk be incorporated into fracture risk assessment algorithms: a pilot study of responsiveness to clodronate. Osteoporos Int 20:2055–2062CrossRefPubMed

19.

Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. Br Med J 315:841–846

20.

Kanis JA, Johnell O, Oden A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–162CrossRefPubMed

21.

Kanis JA, Johansson H, Johnell O et al (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16:737–742CrossRefPubMed

22.

Delmas PD, Genant HK, Crans GG et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532CrossRefPubMed

23.

Lunt M, O’Neill TW, Felsenberg D et al (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513CrossRefPubMed

24.

Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRefPubMed

25.

Hodsman AB, Leslie WD, Tsang JF, Gamble GD (2008) 10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the manitoba bone density program. Arch Intern 168:2261–2267CrossRef

26.

Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000CrossRefPubMed

27.

Van Staa TP, Leufkens HGM, Abenhaim L, Zhang B, Cooper C (2000) Fracture and oral corticosteroids: relationship to daily and cumulative dose. Rheumatol 39:1383–1389CrossRef

28.

Van Staa TP, Abenhaim L, Cooper C, Zhang B, Leufkens HG (2001) Public health impact of adverse bone effects of oral corticosteroids. Br J Clin Pharmacol 51:601–607CrossRefPubMed

29.

Van Staa TP, Leufkens HGM, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787CrossRefPubMed

30.

DeLusignan S, Valentin T, Chan T et al (2004) Problems with primary care data quality: osteoporosis as an exemplar. Inform Prim Care 12:147–156

31.

Steinbuch M, Youket T, Cohen S (2004) Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 15:323–328CrossRefPubMed

32.

Kanis JA, Johansson H, Oden A et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899CrossRefPubMed

33.

Schols AMWJ, Wesseling G, Kester ADM, de Vries G, Mostert R, Slangen J, Wouters EFM (2001) Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids. Eur Respir J 17:337–342CrossRefPubMed

34.

Sihvonen S, Korpela M, Mustonen J, Huhtala H, Karstila K, Pasternack A (2006) Mortality in patients with rheumatoid arthritis treated with low-dose oral glucocorticoids. A population-based cohort study. J Rheumatol 33:1740–6PubMed

35.

Wei L, MacDonald TM, Walker BR (2004) Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med 141:764–770PubMed

36.

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 17:1237–1244CrossRefPubMed

Title: Guidance for the adjustment of FRAX according to the dose of glucocorticoids
Authors: J. A. Kanis
H. Johansson
A. Oden
E. V. McCloskey
Publication date: 01-03-2011
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 3/2011
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-010-1524-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Guidance for the adjustment of FRAX according to the dose of glucocorticoids

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2011

Cost-effectiveness of bazedoxifene incorporating the FRAX® algorithm in a European perspective

Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis

Use of proton pump inhibitors and risk of hip/femur fracture: a population-based case-control study

Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: a systematic review

Maternal vitamin D status affects bone growth in early childhood—a prospective cohort study

Bone quality is partially recovered after the discontinuation of RANKL administration in rats by increased bone mass on existing trabeculae: an in vivo micro-CT study