Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighboring country models

Archives of Osteoporosis, Apr 2018

Summary Fracture probabilities resulting from the newly generated FRAX model for Belarus based on regional estimates of the hip fracture incidence were compared with FRAX models of neighboring countries. Differences between the country-specific FRAX patterns and the rank orders of fracture probabilities were modest. Objective This paper describes the epidemiology of hip fractures in Belarus that was used to develop the country-specific fracture prediction FRAX® tool and illustrates its features compared to models for the neighboring countries of Poland, Russia, and Lithuania. Methods We carried out a population-based study in a region of Belarus (the city of Mozyr) representing approximately 1.2% of the country’s population. We aimed to identify all hip fractures in 2011–2012 from hospital registers and primary care sources. Age- and sex-specific incidence and national mortality rates were incorporated into a FRAX model for Belarus. Fracture probabilities were compared with those derived from FRAX models in neighboring countries. Results The estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 8250 in 2015 and is predicted to increase to 12,918 in 2050. The annual incidence of fragility hip fractures in individuals aged 50 years or more was 24.6/10,000 for women and 14.6/10,000 for men, standardized to the world population. The comparison with FRAX models in neighboring countries showed that hip fracture probabilities in men and women in Belarus were similar to those in Poland, Russia, and Lithuania. The difference in incidence rates between the surveys including or excluding data from primary care suggested that 29.1% of patients sustaining a hip fracture were not hospitalized and, therefore, did not receive specialized medical care. Conclusion A substantial proportion of hip fractures in Belarus does not come to hospital attention. The FRAX model should enhance accuracy of determining fracture probability among the Belarus population and help guide decisions about treatment.

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Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighboring country models

Archives of Osteoporosis Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighboring country models H. Ramanau 0 1 2 3 4 5 6 7 8 I. Chernyanin 0 1 2 3 4 5 6 7 8 E. Rudenka 0 1 2 3 4 5 6 7 8 O. Lesnyak 0 1 2 3 4 5 6 7 8 A. Zakroyeva 0 1 2 3 4 5 6 7 8 J. P. Bilezikian 0 1 2 3 4 5 6 7 8 H. Johansson 0 1 2 3 4 5 6 7 8 N. C. Harvey 0 1 2 3 4 5 6 7 8 E. V. McCloskey 0 1 2 3 4 5 6 7 8 J. A. Kanis 0 1 2 3 4 5 6 7 8 0 Belarusian State Medical University , 83 Dzerzhinski Ave., 220116 Minsk , Belarus 1 Mozyr Central City polyclinic , 14a Kotlovtsa Street, 247760 Mozyr , Belarus 2 Gomel State Medical University , 5 Lange Street, 246050 Gomel , Belarus 3 Centre for Metabolic Bone Diseases, University of Sheffield , Sheffield , UK 4 MRC Lifecourse Epidemiology Unit, University of Southampton , Southampton , UK 5 Institute for Health and Ageing, Catholic University of Australia , Melbourne , Australia 6 College of Physicians & Surgeons, Columbia University , 630 W. 168th Street, New York, NY 10032 , USA 7 Ural State Medical University , 3 Repina Street, Yekaterinburg 620028 , Russia 8 North West State Medical University named after I.I.Mechnikov , 41, Kirochnaya Street, St. Petersburg 191015 , Russia Summary Fracture probabilities resulting from the newly generated FRAX model for Belarus based on regional estimates of the hip fracture incidence were compared with FRAX models of neighboring countries. Differences between the country-specific FRAX patterns and the rank orders of fracture probabilities were modest. Objective This paper describes the epidemiology of hip fractures in Belarus that was used to develop the country-specific fracture prediction FRAX® tool and illustrates its features compared to models for the neighboring countries of Poland, Russia, and Lithuania. Methods We carried out a population-based study in a region of Belarus (the city of Mozyr) representing approximately 1.2% of the country's population. We aimed to identify all hip fractures in 2011-2012 from hospital registers and primary care sources. Age- and sex-specific incidence and national mortality rates were incorporated into a FRAX model for Belarus. Fracture probabilities were compared with those derived from FRAX models in neighboring countries. Results The estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 8250 in 2015 and is predicted to increase to 12,918 in 2050. The annual incidence of fragility hip fractures in individuals aged 50 years or more was 24.6/10,000 for women and 14.6/10,000 for men, standardized to the world population. The comparison with FRAX models in neighboring countries showed that hip fracture probabilities in men and women in Belarus were similar to those in Poland, Russia, and Lithuania. The difference in incidence rates between the surveys including or excluding data from primary care suggested that 29.1% of patients sustaining a hip fracture were not hospitalized and, therefore, did not receive specialized medical care. Conclusion A substantial proportion of hip fractures in Belarus does not come to hospital attention. The FRAX model should enhance accuracy of determining fracture probability among the Belarus population and help guide decisions about treatment. FRAX; Fracture probability; Epidemiology; Hip fracture Introduction The growing worldwide burden of osteoporosis requires predictive tools for an individual fracture risk assessment so that appropriate intervention can be effectively targeted. Of the risk assessment tools available, the most widely used is F R A X ® t h a t w a s r e l e a s e d i n 2 0 0 8 b y t h e W H O Collaborating Centre at Sheffield (https://www.sheffield.ac. uk/FRAX/). At present, FRAX models are available for 63 countries. The FRAX tool computes age-specific fracture probabilities in women and men from readily obtained clinical risk factors (CRFs) and BMD measurements at the femoral neck. The algorithm (FRAX) was based on a series of metaanalyses using the primary data from population-based cohorts that identified several CRFs for fracture [ 1, 2 ]. FRAX models compute the probabilities of major osteoporotic and hip fracture derived from the risk of fracture and the competing risk of death, both of which vary from country to country [3]. To develop country-specific FRAX models, data relevant to both fracture incidence and death should be available [ 4, 5 ]. The aim of this study was to create a FRAX model for Belarus, using recently acquired population-based data of hip fracture rates and to compare this with FRAX models of neighboring counties Poland, Russia, and Lithuania. Methods Belarus is a landlocked upper middle-income country in Eastern Europe with the total area of 207,600 km2 and a current population of 9,505,000. It is bordered by Russia, Ukraine, Poland, Lithuania, and Latvia [ 6 ]. More than 130 ethnic groups live in Belarus of which 83.7% are Belarusi (...truncated)


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H. Ramanau, I. Chernyanin, E. Rudenka, O. Lesnyak, A. Zakroyeva, J. P. Bilezikian, H. Johansson, N. C. Harvey, E. V. McCloskey, J. A. Kanis. Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighboring country models, Archives of Osteoporosis, 2018, pp. 42, Volume 13, Issue 1, DOI: 10.1007/s11657-018-0454-4