Fracture risk prediction with FRAX in Slovak postmenopausal women

Némethová, Eva; Killinger, Zdenko; Payer, Juraj

doi:10.2478/s11536-013-0205-2

Cited by 2 publications

(2 citation statements)

References 28 publications

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“…A similar 10-year major osteoporotic fracture risk threshold of 20 % is recommended by some national societies in Slovakia [31], Slovenia [32], Hungary [33], Portugal [34], Spain [35,36], Greece [37], Austria [38] and Belgium [39].…”

Section: Discussionmentioning

confidence: 99%

Українська Версія FRAX: Критерії Діагностики Й Лікування Остеопорозу

Povoroznyuk¹,

Grygorieva²,

Kanis

et al. 2021

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Background. Nowadays, FRAX® algorithm is an informative method for evaluation of the risk of osteoporotic fractures, implemented in European and American guidelines for osteoporosis management. However, there are differences in "intervention thresholds" for antiosteoporotic treatment, which depend on the country, the model of health care system and the reimbursement for treatment. Ukrainian version of FRAX appeared in Ukraine in 2016, but the thresholds for intervention have not yet been developed. The purpose of the study was to determine the "thresholds" for the pharmacological treatment of osteoporosis and for additional diagnostic examination of Ukrainian population using national FRAX model. Materials and methods. 3790 outpatients aged 40-90 years (mean age 61.9 ± 10.0 years) were examined. The development of the "thresholds" for intervention and additional assessment of the bone using dual-energy X-ray densitometry (DXA) based on the methodology adopted by the Natio nal Osteoporosis Guideline Group in UK, which is further used in European guidelines. Results. There was an increase of the "thre shold" for pharmacological intervention ("upper threshold") with age from 6.6 % at the age of 40 to 13 % at the age of 75-85 years. The "lower threshold" (threshold for additional examination) increased significantly from 2.4 % at the age of 40 to 6.9 % in wo men aged 85 years. The evaluation strategy begins with an analysis of the history of low-traumatic fracture. In its presence, a decision to start antiosteoporotic treatment without DXA should be made. In patients without history of fracture, calculation of fracture risk according to FRAX is required. When the risk exceeds the limit of the "upper threshold" antiosteoporotic treatment without DXA is recommended, when its values below the limit of "lower thre shold" -additional examination or treatment is not required. In case of intermediate risk of fracture a DXA should be conducted with a reassessment of fracture risk and management tactics. Conclusions. The effectiveness of FRAX principles which uses in European guideline, but with particularities of the epidemiology of osteoporotic fractures in Ukraine, has been proved. Although this approach is cost-effective in other countries, its use in Ukraine may differ and may need to be further explored with an economic assessment of costs and benefits.

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Section: Discussionmentioning

confidence: 99%

Українська Версія FRAX: Критерії Діагностики Й Лікування Остеопорозу

Povoroznyuk¹,

Grygorieva²,

Kanis

et al. 2021

PJS

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“…Canadian guidelines [1, 73], as well as those developed in several other countries (e.g., Austria [74], Greece [75], Hungary [76], Malaysia [77, 78], Mexico [79], the Philippines [80], Saudi Arabia [81], Poland [82], Slovakia [83], Slovenia [84], Spain [85–87], Taiwan [88], Thailand [89]), that are based on country-specific FRAX models, use a fixed 20% 10-year probability of major osteoporotic fracture as a treatment threshold [56]. In many (but not all) cases, the choice of the 20% intervention threshold is without a specific rationale, but instead based on the threshold used in the United States.…”

Section: Introductionmentioning

confidence: 99%

Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review

et al. 2019

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Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. Electronic supplementary material The online version of this article (10.1186/s13643-019-1094-5) contains supplementary material, which is available to authorized users.

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Fracture risk prediction with FRAX in Slovak postmenopausal women

Abstract: Abstract

Cited by 2 publications

References 28 publications

Українська Версія FRAX: Критерії Діагностики Й Лікування Остеопорозу

Українська Версія FRAX: Критерії Діагностики Й Лікування Остеопорозу

Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review

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