1. 
 De Laet, C, et al.
(författare)

The impact of the use of multiple risk indicators for fracture on casefinding strategies: a mathematical approach.
 2005

Ingår i: Osteoporosis international.  0937941X. ; 16:3, s. 3138

Tidskriftsartikel (refereegranskat)abstract
 The value of bone mineral density (BMD) measurements to stratify fracture probability can be enhanced in a casefinding strategy that combines BMD measurement with independent clinical risk indicators. Putative risk indicators include age and gender, BMI or weight, prior fracture, the use of corticosteroids, and possibly others. The aim of the present study was to develop a mathematical framework to quantify the impact of using combinations of risk indicators with BMD in case finding. Fracture probability can be expressed as a risk gradient, i.e. a relative risk (RR) of fracture per standard deviation (SD) change in BMD. With the addition of other continuous or categorical risk indicators a continuous distribution of risk indicators is obtained that approaches a normal distribution. It is then possible to calculate the risk of individuals compared with the average risk in the population, stratified by age and gender. A risk indicator with a gradient of fracture risk of 2 per SD identified 36% of the population as having a higher than average fracture risk. In individuals so selected, the risk was on average 1.7 times that of the general population. Where, through the combination of several risk indicators, the gradient of risk of the test increased to 4 per SD, a smaller proportion (24%) was identified as having a higher than average risk, but the average risk in this group was 3.1 times that of the population, which is a much better performance. At higher thresholds of risk, similar phenomena were found. We conclude that, whereas the change of the proportion of the population detected to be at high risk is small, the performance of a test is improved when the RR per SD is higher, indicated by the higher average risk in those identified to be at risk. Casefinding strategies that combine clinical risk indicators with BMD have increased efficiency, while having a modest impact on the number of individuals requiring treatment. Therefore, the costeffectiveness is enhanced.


2. 
 Johansson, H, et al.
(författare)

Optimization of BMD measurements to identify high risk groups for treatmenta test analysis.
 2004

Ingår i: Journal of bone and mineral research.  08840431. ; 19:6, s. 906

Tidskriftsartikel (refereegranskat)abstract
 The aim of this study was to optimize the use of BMD measurements in case finding strategies. The use of clinical risk factors with and without BMD was explored in a random sample of the Sheffield female population greater than or equal to75 years of age. The use of clinical risk factors alone could identify women well above or well below a threshold of fracture risk. BMD assessment can be confined to a minority of women (similar to20%) in whom the measurement aids in prognostication of fracture.


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4. 
 Kanis, JA, et al.
(författare)

Assessment of fracture risk.
 2005

Ingår i: Osteoporosis international.  0937941X. ; 16:6, s. 5819

Tidskriftsartikel (refereegranskat)


5. 
 Kanis, JA, et al.
(författare)

Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden.
 2005

Ingår i: Osteoporosis international.  0937941X. ; 16:1, s. 6

Tidskriftsartikel (refereegranskat)abstract
 The aim of this study was to determine the threshold of fracture probability at which interventions became costeffective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect for a further 5 years. Sensitivity analyses included a range of effectiveness (1050%) and a range of intervention costs ($200500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for costeffectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was costeffective with a 10year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for costeffectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the costeffectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted costeffectively to individuals at moderately increased fracture risk.

