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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2020

Open Access 01-12-2020 | Osteoporosis | Original Article

Use of age-dependent FRAX-based intervention thresholds for Singapore

Authors: John A. Kanis, Manju Chandran, Siok Bee Chionh, Ganga Ganeson, Nicholas C Harvey, Woon-Puay Koh, Timothy Kwok, Tang Ching Lau, Enwu Liu, Mattias Lorentzon, Eugene V McCloskey, Kelvin Bryan Tan, Liesbeth Vandenput, Helena Johansson

Published in: Archives of Osteoporosis | Issue 1/2020

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Abstract

Summary

Assessment and treatment pathways based on age-specific intervention thresholds in Singapore using FRAX paths can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low risk.

Purpose

Intervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX® has permitted a more accurate assessment of fracture risk. The aim of the present study was to explore treatment paths and characteristics of women selected for treatment in Singapore based on FRAX.

Methods

The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Singapore. The methodology was applied to women age 50 years or more drawn from the population-based Singapore Chinese Health Study (SCHS) cohort. Missing data for the calculation of FRAX was simulated using data from Chinese cohorts from Hong Kong.

Results

Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.9% at the age of 50 years increasing to 32% at the age of 90 years. A total of 1927 of 29,323 women (7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 3019 women (10.3%) would be eligible for treatment on the basis of age-dependent thresholds. The mean BMD T-score of women so selected was −2.94.

Conclusion

Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Singapore to help guide decisions about treatment.
Appendix
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Metadata
Title
Use of age-dependent FRAX-based intervention thresholds for Singapore
Authors
John A. Kanis
Manju Chandran
Siok Bee Chionh
Ganga Ganeson
Nicholas C Harvey
Woon-Puay Koh
Timothy Kwok
Tang Ching Lau
Enwu Liu
Mattias Lorentzon
Eugene V McCloskey
Kelvin Bryan Tan
Liesbeth Vandenput
Helena Johansson
Publication date
01-12-2020
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-020-00782-9

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