Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures

Kanis, J. A.; Johansson, H.; Harvey, N. C.; Gudnason, V.; Sigurdsson, G.; Siggeirsdottir, K.; Lorentzon, M.; Liu, E.; Vandenput, L.; McCloskey, E. V.

Affiliations

¹Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

²Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

³MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

⁴NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

⁵Icelandic Heart Association Research Institute, Kopavogur, Iceland

⁶University of Iceland, Reykjavik, Iceland

⁷Geriatric Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

⁸Department of Internal Medicine and Clinical Nutrition, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

⁹Mellanby Centre for bone research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

Abstract and keywords

Summary: The risk of a recurrent fragility fracture is particularly high immediately following the fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the site of a recent fracture.

Introduction: The recency of prior fractures affects subsequent fracture risk. The aim of this study was to quantify the effect of a recent sentinel fracture, by site, on the 10-year probability of fracture determined with FRAX.

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. Fracture probabilities were determined after a sentinel fracture (humeral, clinical vertebral, forearm and hip fracture) from the hazards of death and fracture. Fracture probabilities were computed on the one hand for sentinel fractures occurring within the previous 2 years and on the other hand, probabilities for a prior osteoporotic fracture irrespective of recency. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures.

Results: Probability ratios to adjust 10-year FRAX probabilities of a major osteoporotic fracture for recent sentinel fractures were age dependent, decreasing with age in both men and women. Probability ratios varied according to the site of sentinel fracture with higher ratios for hip and vertebral fracture than for humerus or forearm fracture. Probability ratios to adjust 10-year FRAX probabilities of a hip fracture for recent sentinel fractures were also age dependent, decreasing with age in both men and women with the exception of forearm fractures.

Conclusion: The probability ratios provide adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures.

Keywords: Fracture probability; FRAX adjustment; Imminent risk; Prior fracture; Risk assessment; Sentinel fracture

Links

DOI: 10.1007/s00198-020-05517-7

PubMed: 32613411

WoS: 000544869900002

History

Received: 2020-05-08

Accepted: 2020-06-01

Online: 2020-07-01

Cited Works (23)

Year	Entry
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2022	Iconaru L, Charles A, Baleanu F, Surquin M, Benoit F, Mugisha A, Moreau M, Paesmans M, Karmali R, Rubinstein M, Rozenberg S, Body J-J, Bergmann P. Prediction of an imminent fracture after an index fracture: models derived from the Frisbee cohort. J Bone Miner Res. January 2022;37(1):59-67.
2022	Leslie WD, Morin SN, Lix LM, McCloskey EV, Johansson H, Harvey NC, Kanis JA. The effect of fracture recency on observed 10-year fracture probability: a registry-based cohort study. J Bone Miner Res. May 2022;37(5):848-855.
2023	Axelsson KF, Litsne H, Lorentzon M. The importance of recent prevalent fracture site for imminent risk of fracture: a retrospective, nationwide cohort study of older Swedish men and women. J Bone Miner Res. June 2023;38(6):851-859.
2021	Sapkota HR, Nune A, Bateman J, Venkatachalam S. A pragmatic proposal for triaging DXA testing during the COVID-19 global pandemic. Osteoporos Int. January 2021;32(1):1-6.
2021	Kanis JA, Johansson H, Harvey NC, Gudnason V, Sigurdsson G, Siggeirsdottir K, Lorentzon M, Liu E, Vandenput L, Leslie WD, McCloskey EV. The use of 2-, 5-, and 10-year probabilities to characterize fracture risk after a recent sentinel fracture. Osteoporos Int. January 2021;32(1):47-54.
2021	Lems WF, Paccou J, Zhang J, Fuggle NR, Chandran M, Harvey NC, Cooper C, Javaid K, Ferrari S, Akesson KE; International Osteoporosis Foundation Fracture Working Group. Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services. Osteoporos Int. March 2021;32(3):399-411.
2021	Söreskog E, Lindberg I, Kanis JA, Åkesson KE, Willems D, Lorentzon M, Ström O, Berling P, Borgström F. Cost-effectiveness of romosozumab for the treatment of postmenopausal women with severe osteoporosis at high risk of fracture in Sweden. Osteoporos Int. March 2021;32(3):585-594.