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Published in: Archives of Osteoporosis 1-2/2012

01-12-2012 | Original Article

The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study

Authors: Sansin Tuzun, Nurten Eskiyurt, Ulku Akarirmak, Merih Saridogan, Helena Johansson, Eugene McCloskey, John A. Kanis, Turkish Osteoporosis Society

Published in: Archives of Osteoporosis | Issue 1-2/2012

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Abstract

Introduction

With the development of country-specific FRAX® tools to estimate fracture probability, guidance is required on the fracture probability at which treatment can be recommended.

Objectives

The aim of the present study was to determine FRAX-based intervention thresholds in men and women from Turkey and determine their population impact.

Patients and methods

Intervention thresholds for treatment and assessment thresholds for measuring BMD were devised using the strategy adopted by the National Osteoporosis Guideline Group of the UK but applied to the fracture probabilities in Turkey. The number of men and women potentially eligible for treatment was determined from the distribution of FRAX-based probabilities of a major fracture (Turkish model, version 3.6) in a representative sample of 26,394 men and women aged 50 years or more.

Results

Intervention thresholds, set at the probability equivalents of a woman with a prior fragility fracture rose with age from 7.0 % at the age of 50 years to 31 % at the age of 90 years. Approximately 8.6 % of the female Turkish population aged 50 years or more had a prior fragility fracture and would be eligible for treatment. A further 13.6 % without a prior fracture would be eligible for treatment. In contrast, the number of men aged 50 years or more eligible for treatment was 3.1 %

Conclusions

FRAX-based guidelines can be developed and are expected to avoid unnecessary treatment of individuals at low fracture risk and direct treatments to those at high risk. The adoption of FRAX-based intervention thresholds will demand a reappraisal of the criteria for reimbursement of interventions and health economic assessment.
Literature
1.
go back to reference Kanis JA on behalf of the World Health Organization Scientific Group (2008a) Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK. http://www.shef.ac.uk/FRAX/index.htm. Accessed 3 Mar 2012 Kanis JA on behalf of the World Health Organization Scientific Group (2008a) Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK. http://​www.​shef.​ac.​uk/​FRAX/​index.​htm. Accessed 3 Mar 2012
2.
go back to reference Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995PubMedCrossRef Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995PubMedCrossRef
3.
go back to reference Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19:1431–1444PubMedCrossRef Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19:1431–1444PubMedCrossRef
4.
go back to reference Hippisley-Cox J, Coupland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractures Scores. Br Med J 339:b4229CrossRef Hippisley-Cox J, Coupland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractures Scores. Br Med J 339:b4229CrossRef
5.
go back to reference Kanis JA, Hans D, Cooper C, Task Force of the FRAX Initiative (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22:395–411 Kanis JA, Hans D, Cooper C, Task Force of the FRAX Initiative (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22:395–411
6.
go back to reference Kanis JA, Johnell O, Oden A, Johansson H, McCloskey EV (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRef Kanis JA, Johnell O, Oden A, Johansson H, McCloskey EV (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRef
7.
go back to reference 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 18:1033–1046PubMedCrossRef 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 18:1033–1046PubMedCrossRef
8.
go back to reference Kanis JA, Odén A, McCloskey EV, IOF Working Group on Epidemiology and Quality of Life et al (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. doi:10.1007s00198-012-1964-3 Kanis JA, Odén A, McCloskey EV, IOF Working Group on Epidemiology and Quality of Life et al (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. doi:10.​1007s00198-012-1964-3
9.
go back to reference Elffors I, Allander E, Kanis JA et al (1994) The variable incidence of hip fracture in Southern Europe: the MEDOS Study. Osteoporosis Int 4:253–263CrossRef Elffors I, Allander E, Kanis JA et al (1994) The variable incidence of hip fracture in Southern Europe: the MEDOS Study. Osteoporosis Int 4:253–263CrossRef
10.
go back to reference Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H et al (2012) Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 23:949–955PubMedCrossRef Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H et al (2012) Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 23:949–955PubMedCrossRef
11.
go back to reference Compston J, Cooper A, Cooper C, on behalf of the National Osteoporosis Guideline Group (NOGG) et al (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108PubMedCrossRef Compston J, Cooper A, Cooper C, on behalf of the National Osteoporosis Guideline Group (NOGG) et al (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108PubMedCrossRef
12.
go back to reference Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, the 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 2009 Osteoporos Int 20, 499-502PubMedCrossRef Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, the 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 2009 Osteoporos Int 20, 499-502PubMedCrossRef
13.
go back to reference Papaioannou A, Morin S, Cheung AM et al (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873PubMedCrossRef Papaioannou A, Morin S, Cheung AM et al (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873PubMedCrossRef
14.
go back to reference Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D, on behalf of the European Foundation for Osteoporosis and Bone Disease (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7:390–406PubMedCrossRef Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D, on behalf of the European Foundation for Osteoporosis and Bone Disease (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7:390–406PubMedCrossRef
15.
go back to reference Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, Rizzoli R, 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 19:399–428PubMedCrossRef Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, Rizzoli R, 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 19:399–428PubMedCrossRef
16.
go back to reference National Osteoporosis Foundation (2008) Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation. www.nof.org National Osteoporosis Foundation (2008) Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation. www.nof.org
17.
go back to reference European Community (1998) Report on osteoporosis in the European Community. 1998. EC, Strasbourg European Community (1998) Report on osteoporosis in the European Community. 1998. EC, Strasbourg
18.
go back to reference Royal College of Physicians (1999) Osteoporosis: clinical guidelines for the prevention and treatment. Royal College of Physicians, London Royal College of Physicians (1999) Osteoporosis: clinical guidelines for the prevention and treatment. Royal College of Physicians, London
19.
go back to reference Brixen K (2002) Consensus report on osteoporosis. Ugeskrift for Laeger, 2002, Suppl. 10. Brixen K (2002) Consensus report on osteoporosis. Ugeskrift for Laeger, 2002, Suppl. 10.
20.
go back to reference Hellenic Foundation for Osteoporosis (2004) Kateufunthries gpammes gia th diagnwsh kai antimetwpisnh ths Osteopowshs sthn Ellada 2004 [Guidelines for diagnosis and management of osteoporosis in Greece 2004]. Athens Hellenic Foundation for Osteoporosis (2004) Kateufunthries gpammes gia th diagnwsh kai antimetwpisnh ths Osteopowshs sthn Ellada 2004 [Guidelines for diagnosis and management of osteoporosis in Greece 2004]. Athens
21.
go back to reference Collegio dei Reumatologi Ospedalieri (CROI), Società Italiana dell’Osteoporosi e delle Malattie del Metabolismo Minerale e Scheletrico (SIOMMMS), Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Società Italiana di Medicina Interna (SIMI), Società Italiana di Ortopedia e Traumatologia (SIOT), Società Italiana di Radiologia Medica (SIRM), Società Italiana di Reumatologia (SIR). (2006) Linee guida per la diagnosi, prevenzione e terapia dell’osteoporosi [Guidelines for the diagnosis, prevention and treatment of osteoporosis] Pavia, SINOSSI. EDIMES Collegio dei Reumatologi Ospedalieri (CROI), Società Italiana dell’Osteoporosi e delle Malattie del Metabolismo Minerale e Scheletrico (SIOMMMS), Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Società Italiana di Medicina Interna (SIMI), Società Italiana di Ortopedia e Traumatologia (SIOT), Società Italiana di Radiologia Medica (SIRM), Società Italiana di Reumatologia (SIR). (2006) Linee guida per la diagnosi, prevenzione e terapia dell’osteoporosi [Guidelines for the diagnosis, prevention and treatment of osteoporosis] Pavia, SINOSSI. EDIMES
22.
go back to reference Pols HA, Wittenberg J (2002) CBO guideline: osteoporosis. Nederlands Tijdschrift voor Geneeskunde 2002(146):1359–1363 Pols HA, Wittenberg J (2002) CBO guideline: osteoporosis. Nederlands Tijdschrift voor Geneeskunde 2002(146):1359–1363
23.
go back to reference Sociedad Española de Investigaciones Óseas Y Metabolismo Mineral (SEIOMM) (2003) Guía de Práctica: osteoporosis posmenopáusica [Practice guidelines:postmenopausal osteoporosis]. Revista Clinica Española, 203: 496–506. www.seiomm.org. Accessed 14 Nov 2006 Sociedad Española de Investigaciones Óseas Y Metabolismo Mineral (SEIOMM) (2003) Guía de Práctica: osteoporosis posmenopáusica [Practice guidelines:postmenopausal osteoporosis]. Revista Clinica Española, 203: 496–506. www.​seiomm.​org. Accessed 14 Nov 2006
24.
go back to reference SIGN (2003) Management of osteoporosis. Edinburgh, Scottish Intercollegiate Guidelines Network. www.sign.ac.uk. Accessed 14 Nov 2006 SIGN (2003) Management of osteoporosis. Edinburgh, Scottish Intercollegiate Guidelines Network. www.​sign.​ac.​uk. Accessed 14 Nov 2006
25.
go back to reference Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M (2007) Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 11:1–256 Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M (2007) Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 11:1–256
26.
go back to reference Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, National Osteoporosis Foundation Guide Committee et al (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19:437–447PubMedCrossRef Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, National Osteoporosis Foundation Guide Committee et al (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19:437–447PubMedCrossRef
27.
go back to reference Lekawasam S, Adachi JD, Agnusdei D F et al. for the Joint IOF-ECTS GIO Guidelines Working Group (2012) A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int (in press) Lekawasam S, Adachi JD, Agnusdei D F et al. for the Joint IOF-ECTS GIO Guidelines Working Group (2012) A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int (in press)
28.
go back to reference Johansson H, Oden A, Johnell O et al (2004) Optimisation of BMD measurements to identify high risk groups for treatment—a test analysis. J Bone Miner Res 19:906–913PubMedCrossRef Johansson H, Oden A, Johnell O et al (2004) Optimisation of BMD measurements to identify high risk groups for treatment—a test analysis. J Bone Miner Res 19:906–913PubMedCrossRef
30.
go back to reference Kobak S (2011) Demographic, clinical, and serological features of Turkish patients with rheumatoid arthritis: evaluation of 165 patients. Clin Rheumatol 30:843–847PubMedCrossRef Kobak S (2011) Demographic, clinical, and serological features of Turkish patients with rheumatoid arthritis: evaluation of 165 patients. Clin Rheumatol 30:843–847PubMedCrossRef
32.
go back to reference Kanis JA McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) (2012) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int (in press) Kanis JA McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) (2012) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int (in press)
33.
go back to reference Johansson H, Kanis JA, Oden A, Johnell O, McCloskey E (2009) BMD, clinical risk factors and their combination for hip fracture prevention. Osteoporos Int 20:1675–1682PubMedCrossRef Johansson H, Kanis JA, Oden A, Johnell O, McCloskey E (2009) BMD, clinical risk factors and their combination for hip fracture prevention. Osteoporos Int 20:1675–1682PubMedCrossRef
34.
go back to reference Johansson H, Kanis JA, Oden A, Johnell O, Compston J, McCloskey EV (2012) A comparison of case finding strategies in the UK for the management of hip fractures. Osteoporos Int 23:907–915PubMedCrossRef Johansson H, Kanis JA, Oden A, Johnell O, Compston J, McCloskey EV (2012) A comparison of case finding strategies in the UK for the management of hip fractures. Osteoporos Int 23:907–915PubMedCrossRef
35.
go back to reference Leslie WD, Lix LM, Majumdar SR et al (2011) High fracture probability with FRAX® usually indicates densitometric osteoporosis: implications for clinical practice. Osteoporos Int 23:391–397PubMedCrossRef Leslie WD, Lix LM, Majumdar SR et al (2011) High fracture probability with FRAX® usually indicates densitometric osteoporosis: implications for clinical practice. Osteoporos Int 23:391–397PubMedCrossRef
36.
go back to reference Leslie WD, Lix LM, Morin S, Johnansson H, Odén A, McCloskey E, Kanis JA (2012) Fracture risk assessment without bone density measurement in routine clinical practice. Osteoporos Int 23:75–85PubMedCrossRef Leslie WD, Lix LM, Morin S, Johnansson H, Odén A, McCloskey E, Kanis JA (2012) Fracture risk assessment without bone density measurement in routine clinical practice. Osteoporos Int 23:75–85PubMedCrossRef
37.
go back to reference Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD (2012) FRAX® with and without BMD. Calcif Tiss Int 90:1–13CrossRef Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD (2012) FRAX® with and without BMD. Calcif Tiss Int 90:1–13CrossRef
38.
go back to reference Kanis JA, Oden A, Johansson H, McCloskey E (2012) Pitfalls in the external validation of FRAX. Osteoporos Int 23:423–431PubMedCrossRef Kanis JA, Oden A, Johansson H, McCloskey E (2012) Pitfalls in the external validation of FRAX. Osteoporos Int 23:423–431PubMedCrossRef
39.
go back to reference Kanis JA, Adams J, Borgström F, Cooper C, Jönsson B, Preedy D et al (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42:4–15PubMedCrossRef Kanis JA, Adams J, Borgström F, Cooper C, Jönsson B, Preedy D et al (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42:4–15PubMedCrossRef
Metadata
Title
The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study
Authors
Sansin Tuzun
Nurten Eskiyurt
Ulku Akarirmak
Merih Saridogan
Helena Johansson
Eugene McCloskey
John A. Kanis
Turkish Osteoporosis Society
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Archives of Osteoporosis / Issue 1-2/2012
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-012-0101-4

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