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Adjusting conventional FRAX estimates of fracture probability according to the number of prior fractures

Kanis, J. A. (author)
Johansson, H. (author)
Harvey, N. C. (author)
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Gudnason, V. (author)
Sigurdsson, G. (author)
Siggeirsdottir, K. (author)
Lorentzon, Mattias, 1970 (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine
Liu, E. W. (author)
Vandenput, Liesbeth, 1974 (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
McCloskey, E. V. (author)
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 (creator_code:org_t)
2022-09-26
2022
English.
In: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 33:12, s. 2507-2515
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • The risk of a recurrent fragility fracture is high following a first fracture and higher still with more than one prior fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior fractures. Introduction Prior fractures increase subsequent fracture risk. The aim of this study was to quantify the effect of the number of prior fractures on the 10-year probability of fracture determined with FRAX (R). Methods The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of prior osteoporotic fractures over a 20-year interval from the hazards of death and fracture. Fracture probabilities were also computed for a prior osteoporotic fracture irrespective of the number of previous fractures. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures. Results Probability ratios to adjust 10-year FRAX probabilities of a hip fracture and MOF increased with the number of prior fractures but decreased with age in both men and women. Probability ratios were similar in men and women and for hip fracture and MOF. Mean probability ratios according to the number of prior fractures for all scenarios were 0.95, 1.08, 1.21 and 1.35, for 1,2, 3 and 4 or more prior fractures, respectively. Thus, a simple rule of thumb is to downward adjust FRAX-based fracture probabilities by 5% in the presence of a single prior fracture and to uplift probabilities by 10, 20 and 30% with a history of 2, 3 and 4 or more prior fractures, respectively. Conclusion The probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Keyword

FRAX adjustment
Fracture probability
Prior fracture
Risk assessment
clinical-practice guidelines
hip fracture
vertebral fracture
risk
osteoporosis
women
teriparatide
association
prevention
management
Endocrinology & Metabolism

Publication and Content Type

ref (subject category)
art (subject category)

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