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FRAX® assessment of osteoporotic fracture probability in Switzerland

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Abstract

Summary

A Swiss-specific FRAX® model was developed. Patient profiles at increased probability of fracture beyond currently accepted reimbursement thresholds for bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA), and osteoporosis treatment were identified.

Introduction

This study aimed to determine which constellations of clinical risk factors, alone, or combined with BMD measurement by DXA, contribute to improved identification of Swiss patients with increased probability of fracture.

Methods

The 10-year probability of hip and any major osteoporotic fracture was computed for both sexes, based on Swiss epidemiological data, integrating fracture risk and death hazard, in relation to validated clinical risk factors, with and without BMD values.

Results

Fracture probability increased with age, lower body mass index (BMI), decreasing BMD T-score, and all clinical risk factors used alone or combined. Several constellations of risk factor profiles were identified, indicating identical or higher absolute fracture probability than risk factors currently accepted for DXA reimbursement in Switzerland. With identical sex, age and BMI, subjects with parental history of hip fracture had as high a probability of any major osteoporotic fracture as patients on oral glucocorticoids or with a prevalent fragility fracture. The presence of additional risk factors further increased fracture probability.

Conclusions

The customised FRAX® model indicates that a shift from the current DXA-based intervention paradigm, toward a fracture risk continuum based on the 10-year probability of any major osteoporotic fracture may improve identification of patients at increased fracture risk.

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Acknowledgements

We are grateful to Dr. Philippe Kress, Kressmed Glattbrugg Switzerland, for his contribution to the writing of the manuscript. Mrs. Marianne Perez and Dr. Sarah Frankland are acknowledged for secretarial assistance and careful reading of the manuscript, respectively.

Funding

This work was supported by an unrestricted research grant from Amgen (Europe), Zug, Switzerland.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Osteoporosis Policlinic, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland

    K. Lippuner

  2. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

    H. Johansson & J. A. Kanis

  3. Division of Bone Diseases, WHO Collaborating Centre for Osteoporosis Prevention, Department of Rehabilitation and Geriatrics, University Hospital and Medical Faculty of Geneva, Geneva, Switzerland

    R. Rizzoli

Authors
  1. K. Lippuner
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  2. H. Johansson
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  3. J. A. Kanis
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  4. R. Rizzoli
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Corresponding author

Correspondence to K. Lippuner.

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Lippuner, K., Johansson, H., Kanis, J.A. et al. FRAX® assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21, 381–389 (2010). https://doi.org/10.1007/s00198-009-0975-1

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  • DOI: https://doi.org/10.1007/s00198-009-0975-1

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