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Adjusting conventional FRAX estimates of fracture probability according to the number of prior fractures

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Abstract

Summary

The risk of a recurrent fragility fracture is high following a first fracture and higher still with more than one prior fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior fractures.

Introduction

Prior fractures increase subsequent fracture risk. The aim of this study was to quantify the effect of the number of prior fractures on the 10-year probability of fracture determined with FRAX®.

Methods

The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of prior osteoporotic fractures over a 20-year interval from the hazards of death and fracture. Fracture probabilities were also computed for a prior osteoporotic fracture irrespective of the number of previous fractures. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.

Results

Probability ratios to adjust 10-year FRAX probabilities of a hip fracture and MOF increased with the number of prior fractures but decreased with age in both men and women. Probability ratios were similar in men and women and for hip fracture and MOF. Mean probability ratios according to the number of prior fractures for all scenarios were 0.95, 1.08, 1.21 and 1.35, for 1,2, 3 and 4 or more prior fractures, respectively. Thus, a simple rule of thumb is to downward adjust FRAX-based fracture probabilities by 5% in the presence of a single prior fracture and to uplift probabilities by 10, 20 and 30% with a history of 2, 3 and 4 or more prior fractures, respectively.

Conclusion

The probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.

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Acknowledgements

We thank the participants in the Reykjavik Study for their valuable contribution.

Author information

Authors and Affiliations

  1. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

    John A. Kanis, Helena Johansson, Mattias Lorentzon, Enwu Liu & Liesbeth Vandenput

  2. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    John A. Kanis, Helena Johansson & Eugene V. McCloskey

  3. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

    John A. Kanis

  4. MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK

    Nicholas C. Harvey

  5. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Nicholas C. Harvey

  6. Icelandic Heart Association Research Institute, Kopavogur, Iceland

    Vilmundur Gudnason, Gunnar Sigurdsson & Kristin Siggeirsdottir

  7. University of Iceland, Reykjavik, Iceland

    Vilmundur Gudnason

  8. Geriatric Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Mattias Lorentzon

  9. Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Liesbeth Vandenput

  10. Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK

    Eugene V. McCloskey

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  1. John A. Kanis
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  2. Helena Johansson
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  3. Nicholas C. Harvey
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  8. Enwu Liu
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  10. Eugene V. McCloskey
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Corresponding author

Correspondence to John A. Kanis.

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Ethics approval

The study was approved by the National Bioethics Committee and the Data Protection Authority in Iceland. All participants gave informed written consent.

Conflict of interest

V. Gudnason, G. Sigurdsson, K. Siggeirsdottir, E. Liu, L. Vandenput and H. Johansson declare no competing interests.

N. Harvey has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, UCB, Kyowa Kirin, Consilient Healthcare, Radius Health and Internis Pharma.

E. V. McCloskey has received consultancy/lecture fees/grant funding/honoraria from AgNovos, Amgen, AstraZeneca, Consilient Healthcare, Fresenius Kabi, Gilead, GSK, Hologic, Internis, Lilly, Merck, Novartis, Pfizer, Radius Health, Redx Oncology, Roche, SanofiAventis, Servier, Synexus, UCB, Viiv, Warner Chilcott, I3 Innovus and Unilever.

J. A. Kanis is the architect of FRAX but has no financial interest.

M. Lorentzon has received lecture fees from Amgen, Lilly, Meda, Renapharma, UCB Pharma and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma and Consilient Health, all outside the presented work.

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Kanis, J.A., Johansson, H., Harvey, N.C. et al. Adjusting conventional FRAX estimates of fracture probability according to the number of prior fractures. Osteoporos Int 33, 2507–2515 (2022). https://doi.org/10.1007/s00198-022-06550-4

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