Epidemiology of hip fracture and the development of FRAX in Ukraine
Arch Osteoporos
Epidemiology of hip fracture and the development of FRAX in Ukraine
VV Povoroznyuk 0 1 2 3 4 5
NV Grygorieva 0 1 2 3 4 5
JA Kanis 0 1 2 3 4 5
McCloskey EV 0 1 2 3 4 5
H Johansson 0 1 2 3 4 5
NC Harvey 0 1 2 3 4 5
MO Korzh 0 1 2 3 4 5
SS Strafun 0 1 2 3 4 5
VM Vaida 0 1 2 3 4 5
FV Klymovytsky 0 1 2 3 4 5
RO Vlasenko 0 1 2 3 4 5
VS Forosenko 0 1 2 3 4 5
0 Centre for Metabolic Bone Diseases, University of Sheffield , S10 2RX, Sheffield , UK
1 State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis , Kyiv , Ukraine
2 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust , Tremona Road, Southampton , UK
3 MRC Lifecourse Epidemiology Unit, University of Southampton , Southampton SO16 6YD , UK
4 Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield , Sheffield , UK
5 Institute for Health and Aging, Catholic University of Australia , Melbourne , Australia
Summary A country-specific FRAX model has been developed for the Ukraine to replace the Austrian model hitherto used. Comparison of the Austrian and Ukrainian models indicated that the former markedly overestimated fracture probability whilst correctly stratifying risk. Introduction FRAX has been used to estimate osteoporotic fracture risk since 2009. Rather than using a surrogate model, the Austrian version of FRAX was adopted for clinical practice. Since then, data have become available on hip fracture incidence in the Ukraine. Methods The incidence of hip fracture was computed from three regional estimates and used to construct a country-specific FRAX model for the Ukraine. The model characteristics were
Epidemiology; Hip fractures; Ukraine; FRAX; Austria
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* JA Kanis
compared with those of the Austrian FRAX model, previously
used in Ukraine by using all combinations of six risk factors and
eight values of BMD (total number of combinations =512).
Results The relationship between the probabilities of a major
fracture derived from the two versions of FRAX indicated a
close correlation between the two estimates (r > 0.95). The
Ukrainian version, however, gave markedly lower
probabilities than the Austrian model at all ages. For a major
osteoporotic fracture, the median probability was lower by 25% at age
50 years and the difference increased with age. At the age of
60, 70 and 80 years, the median value was lower by 30, 53 and
65%, respectively. Similar findings were observed for men
and for hip fracture.
Conclusion The Ukrainian FRAX model should enhance
accuracy of determining fracture probability among the
Ukrainian population and help to guide decisions about
treatment. The study also indicates that the use of surrogate FRAX
models or models from other countries, whilst correctly
stratifying risk, may markedly over or underestimate the absolute
fracture probability.
FRAX® is a computer-based algorithm developed by the
former World Health Organization Collaborating Centre for
Metabolic Bone Diseases and first released in 2008. This
algorithm calculates fracture probability from clinical risk
factors in women and men [1, 2]. The output of FRAX is the
10year probability of a major osteoporotic fracture (hip, clinical
spine, humerus or wrist fracture) and the 10-year probability
of hip fracture. Probability is calculated from age, body mass
index (BMI) and dichotomized risk factors comprising prior
fragility fracture, parental history of hip fracture, current
tobacco smoking, long-term oral glucocorticoid use, rheumatoid
arthritis, other causes of secondary osteoporosis and excessive
alcohol consumption. Femoral neck BMD can be optionally
input to enhance fracture risk prediction [3].
The risk of hip fracture and probably of other osteoporotic
fractures varies significantly around the world [4]. The
difference in incidence between countries is much greater than the
difference in incidence between sexes within a country.
Indeed, greater than tenfold differences in hip fracture
incidence have been reported in different countries. For this
reason, FRAX models are calibrated for each country dependent
on the epidemiology of death and fracture (most usually hip
fracture). To date, FRAX models are available for 63 countries
(http://www.shef.ac.uk/FRAX) covering more than 80% of
the world population [5].
All the required information to build a FRAX model is not
available in all countries. In such cases, the use of a surrogate
model has been proposed [6] using the death rate of the index
country and the fracture rate of a country thought to be similar
to the index country in terms of fracture risk. Examples
include Sri Lanka, India [7, 8] and until recently, Armenia. The
Ukrainian Scientific Medical Centre on Osteoporosis
Problems (Kiev) has used FRAX to estimate the osteoporotic
fracture risk since 2009 [9]. Rather than using a surroga (...truncated)