Appropriate FRAX® Intervention Threshold for Pharmacological Treatment of Osteoporosis in Thailand

Authors

DOI:

https://doi.org/10.56929/jseaortho-022-0158

Keywords:

FRAX® intervention threshold, Osteoporosis, Thailand, Major osteoporotic fracture, hip fracture

Abstract

Purpose: The Fracture Risk Assessment Tool (FRAX®) has been recommended and incorporated into osteoporotic guidelines worldwide to assess fracture risk and promptly diagnose osteoporosis when bone mineral density is unavailable. However, a country-specific intervention threshold for Thai patients remains unknown. Therefore, we aimed to identify an appropriate cut-off point for the 10-year probability of hip fracture (HF), specifically in the Thai population.

Methods: This retrospective cohort study included members of the Thai population aged 50-90 years, enrolled from January 2018 to January 2020. Analysis of data collected from online FRAX® tool questionnaires was conducted and the receiver operating characteristic (ROC) curve was used to determine a new appropriate cut-off value as the intervention threshold.

Results: A total of 1,311 (HF: 422 [32.2%], non-HF: 889 [67.8%]) participants were included. The FRAX® 10-year probability of fracture in patients with HF was significantly higher than in non-HF (5.8% ± 4% vs. 4.7% ± 4.5%, respectively; P < 0.01), whereas the probability of major osteoporotic fracture (MOF) was similar (11.0 ± 5.8% vs. 10.6 ± 6.2%, P = 0.27). The ROC curve revealed a new intervention threshold for the FRAX®-based 10-year risk for HF of 4.3% with a maximum area under the curve (AUC) (95% confidence interval: 0.632 (range: 0.602-0.663; P < 0.001), with sensitivity and specificity of 62.9% and 60.7%, respectively.

Conclusions: The intervention threshold cut-off value for osteoporosis treatment among the Thai population was 4.3%, which is higher than the cut-off point recommended in the Thai national guidelines.

Metrics

Metrics Loading ...

References

Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006;17:1726-33. DOI: https://doi.org/10.1007/s00198-006-0172-4

Mithal A, Bansal B, Kyer CS, et al. The Asia-Pacific Regional Audit-Epidemiology, Costs, and Burden of Osteoporosis in India 2013: A report of International Osteoporosis Foundation. Indian J Endocrinol Metab 2014;18: 449-54. DOI: https://doi.org/10.4103/2230-8210.137485

Chotiyarnwong P, Harvey NC, Johansson H, et al. Temporal changes in access to FRAX® in Thailand between 2010 and 2018. Arch Osteoporos 2019;14:66. DOI: https://doi.org/10.1007/s11657-019-0613-2

Kanis JA, Cooper C, Rizzoli R, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019;30:3-44. DOI: https://doi.org/10.1007/s00198-018-4704-5

Kanis JA, Harvey NC, Cooper C, et al. A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos 2016;11:25. DOI: https://doi.org/10.1007/s11657-016-0278-z

Chao AS, Chen FP, Lin YC, et al. Application of the World Health Organization Fracture Risk Assessment Tool to predict need for dual-energy X-ray absorptiometry scanning in postmenopausal women. Taiwan J Obstet Gynecol 2015;54:722-5. DOI: https://doi.org/10.1016/j.tjog.2015.10.005

Gadam RK, Schlauch K, Izuora KE. Frax prediction without BMD for assessment of osteoporotic fracture risk. Endocr Pract 2013;19: 780-4. DOI: https://doi.org/10.4158/EP12416.OR

Pongchaiyakul C, Leerapun T, Wongsiri S, et al. Value and validation of RCOST and TOPF clinical practice guideline for osteoporosis treatment. J Med Assoc Thai 2012;95:1528-35.

Kallner A. Formulas. In: Kallner A, editor. Laboratory Statistics (Second Edition): Elsevier; 2018. p. 1-140. DOI: https://doi.org/10.1016/B978-0-12-814348-3.00001-0

Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract 2020; 26(Suppl 1):1-46.

Pouresmaeili F, Kamalidehghan B, Kamarehei M, et al. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag 2018;14:2029-49. DOI: https://doi.org/10.2147/TCRM.S138000

McCloskey E, Kanis JA, Johansson H, et al. FRAX-based assessment and intervention thresholds--an exploration of thresholds in women aged 50 years and older in the UK. Osteoporos Int 2015;26:2091-9. DOI: https://doi.org/10.1007/s00198-015-3176-0

Sribenjalak D, Charoensri S, Pongchaiyakul C. An optimal intervention threshold of FRAX in postmenopausal Thai women. Arch Osteoporos 2022;17:21 DOI: https://doi.org/10.1007/s11657-022-01058-0

Cheung E, Cheung C-L, C Kung AW, et al. Possible FRAX-based intervention thresholds for a cohort of Chinese postmenopausal women. Osteoporos Int 2014;25:1017-23. DOI: https://doi.org/10.1007/s00198-013-2553-9

Fujiwara S, Nakamura T, Orimo H, et al. Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX). Osteoporos Int 2008;19:429-35. DOI: https://doi.org/10.1007/s00198-007-0544-4

Lekamwasam S. Sri Lankan FRAX model and country-specific intervention thresholds. Arch Osteoporos 2013;8:148. DOI: https://doi.org/10.1007/s11657-013-0148-x

Hwang J-S, Chan D-C, Chen J-F, et al. Clinical practice guidelines for the prevention and treatment of osteoporosis in Taiwan: summary. J Bone Miner Metab 2014;32:10-6. DOI: https://doi.org/10.1007/s00774-013-0495-0

Liu S-Y, Huang M, Chen R, et al. Comparison of strategies for setting intervention thresholds for Chinese postmenopausal women using the FRAX model. Endocrine 2019;65:200-6. DOI: https://doi.org/10.1007/s12020-019-01951-8

Yeap SS, Hew FL, Lee JK, et al. The Malaysian Clinical Guidance on the management of postmenopausal osteoporosis, 2012: a summary. Int J Rheum Dis 2013;16:30-40. DOI: https://doi.org/10.1111/1756-185x.12037

Downloads

Published

2022-10-08

How to Cite

1.
Amphansap T, Phan-udom C, Chotiyarnwong P, Stitkitti N, Therdyothin A. Appropriate FRAX® Intervention Threshold for Pharmacological Treatment of Osteoporosis in Thailand. JseaOrtho [Internet]. 2022 Oct. 8 [cited 2023 Feb. 3];47(1):11-7. Available from: https://www.jseaortho.org/index.php/jsao/article/view/158

Issue

Section

Original Articles