Summary

The Canadian FRAX® tool used without bone mineral density (BMD) is highly sensitive for identifying individuals qualifying for pharmacotherapy based upon an intervention threshold of 20% for major osteoporotic fracture risk (MOF) computed with BMD.

Introduction

This analysis was performed to inform initial BMD testing as part of Osteoporosis Canada’s Guidelines Update for women and men at average risk, assuming a pharmacotherapy intervention threshold of 20% for FRAX® MOF computed with BMD.

Methods

Women and men age 50 + without previous low-trauma fracture or high-risk medication use were identified in a BMD registry for the province of Manitoba, Canada. Fracture probability assessments with the Canadian FRAX® tool were computed without and with BMD (denoted MOF-clinical and MOF-BMD, respectively).

Results

The study population consisted of 50,700 women (mean age 65.5 ± 9.4 years) and 4152 men (69.2 ± 10.0 years). FRAX MOF-clinical score was > 10% in 33.8% of women and 13.3% of men (P < 0.001). The median (interquartile range [IQR]) age for MOF-clinical to reach 10% in women was 70 (69–72) and 65 years (62–67) years in the absence and presence of additional FRAX clinical risk factors, respectively. In men, comparable ages were 83 years [82–86] and 76 [70–78] years. Using MOF-BMD of 20% as the intervention threshold, 4.3% of women and 0.7% of men qualified for treatment. MOF-clinical > 10% had high sensitivity to identify those qualifying for treatment (99.3% in women and 99.1% in men). An age-based rule (“BMD testing is indicated at age 70 if no additional FRAX clinical risk factors are present, or at age 65 if one or more clinical risk factors exists”) gave similarly high sensitivity (women 99.9% and men > 99.9%).

Conclusions

FRAX without BMD offers an effective strategy to identify individuals meeting the current Canadian treatment threshold based upon FRAX® with BMD (≥ 20%). Moreover, this can be operationalized using simple age cutoffs of 70 years in the absence of additional clinical risk factors and 65 years in the presence of additional clinical risk factors.

中文翻译：

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用于优化加拿大骨折预防的靶向骨密度测试。

概括

不使用骨矿物质密度 (BMD) 的加拿大 FRAX® 工具对于根据 BMD 计算的主要骨质疏松性骨折风险 (MOF) 的 20% 的干预阈值来识别有资格接受药物治疗的个体高度敏感。

介绍

进行该分析的目的是为作为加拿大骨质疏松症平均风险女性和男性指南更新的一部分提供初始 BMD 测试，假设使用 BMD 计算的 FRAX® MOF 的药物治疗干预阈值为 20%。

方法

在加拿大马尼托巴省的 BMD 登记处确定了 50 岁以上没有先前低创伤性骨折或高风险药物使用的女性和男性。使用 Canadian FRAX® 工具进行的骨折概率评估是在没有和有 BMD 的情况下计算的（分别表示为 MOF-clinical 和 MOF-BMD）。

结果

研究人群包括 50,700 名女性（平均年龄 65.5 ± 9.4 岁）和 4152 名男性（69.2 ± 10.0 岁）。FRAX MOF 临床评分 在 33.8% 的女性和 13.3% 的男性中> 10% ( P  < 0.001)。在没有和存在其他 FRAX 临床危险因素的情况下，女性 MOF 临床达到 10% 的中位年龄（四分位距 [IQR]）分别为 70 岁（69-72 岁）和 65 岁（62-67 岁）。在男性中，可比年龄分别为 83 岁 [82-86] 和 76 [70-78] 岁。以 20% 的 MOF-BMD 作为干预阈值，有 4.3% 的女性和 0.7% 的男性有资格接受治疗。MOF-clinical >  10% 对识别符合治疗条件的患者具有高敏感性（女性为 99.3%，男性为 99.1%）。基于年龄的规则（“如果不存在其他 FRAX 临床风险因素，则在 70 岁时进行 BMD 检测，如果存在一个或多个临床风险因素，则在 65 岁时进行”）给出同样高的敏感性（女性 99.9% 和男性 > 99.9%）。

结论

FRAX without BMD 提供了一种有效的策略来识别符合基于 FRAX® with BMD (≥ 20%) 的当前加拿大治疗阈值的个体。此外，这可以在没有其他临床风险因素的情况下使用简单的年龄截止值 70 岁和在存在其他临床风险因素的情况下使用 65 岁来实现。