Epidemiology of hip fracture and the development of FRAX in Ukraine

Archives of Osteoporosis, Jun 2017

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 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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs11657-017-0343-2.pdf

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 - * 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)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs11657-017-0343-2.pdf

VV Povoroznyuk, NV Grygorieva, JA Kanis, McCloskey EV, H Johansson, NC Harvey, MO Korzh, SS Strafun, VM Vaida, FV Klymovytsky, RO Vlasenko, VS Forosenko. Epidemiology of hip fracture and the development of FRAX in Ukraine, Archives of Osteoporosis, 2017, pp. 53, Volume 12, Issue 1, DOI: 10.1007/s11657-017-0343-2