Case finding for the management of osteoporosis with FRAX® -: assessment and intervention thresholds for the UK
Case finding for the management of osteoporosis with FRAX® -: assessment and intervention thresholds for the UK
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DOI：
10.1007/s00198-008-0712-1
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发表时间：
2008-10-01
影响因子：
4
通讯作者：
Oden, A.
中科院分区：
文献类型：
--
作者：
Kanis, J. A.;McCloskey, E. V.;Oden, A.
根据WHO骨折风险评估工具（FRAX（R））的骨折概率，为英国50岁以上男性和绝经后女性制定并提出了评估和干预阈值。介绍FRAX（R）工具最近可用于根据临床风险因素（CRF）计算男性和女性10年骨折概率。有或没有测量股骨颈骨矿物质密度（BMD）。本研究的目的是制定一个病例发现策略，从英国的男性和女性在高风险的骨质疏松性骨折划定骨折的概率，骨密度测试或干预应recommended.Methods骨折概率计算使用FRAX（R）工具校准的流行病学骨折和死亡在英国。成本效益和骨折概率之间的关系使用了来自先前出版物的源数据，该出版物检查了英国通用阿仑膦酸钠的成本效益。干预阈值是根据男性和女性的年龄设定的，其骨折概率与既往有骨质疏松症相关骨折病史的女性的骨折概率相当。此外，还探讨了使用BMD检测的评估阈值。BMD测量的评估阈值遵循现行实践指南，其中在存在一种或多种CRF的情况下，认为个体有资格进行评估。评估阈值上限（即骨折概率，高于此值的患者可以在不求助于BMD的情况下接受治疗）是基于评估工具的阳性预测值的优化。在FRAX（R）模型的开发中，使用临床危险因素和源队列中女性股骨颈BMD的分布来评估评估和干预阈值对BMD测试和干预要求的影响。结果当10年严重骨折的概率超过7%时，治疗在所有年龄段都是成本有效的。50岁时的干预阈值对应于10年内发生严重骨质疏松性骨折的概率为7.5%。随着年龄的增长，这一比例逐渐上升，到80岁时达到30%，因此干预措施在所有年龄段都具有成本效益。BMD测试的评估阈值（50岁时为6-9%）也随年龄增长而上升（80岁时为18-36%）。在病例发现策略中使用这些阈值将确定6-20%的妇女有资格进行BMD测试，23-46%的妇女有资格接受治疗，具体取决于年龄。相同的阈值可以在mense.Conclusion研究提供了一种方法，开发管理算法骨质疏松症的骨折概率的估计，而不是那些基于BMD单独或BMD与单个或多个CRF。
Assessment and intervention thresholds are developed and proposed in men aged over 50 years and postmenopausal women for the UK based on fracture probability from the WHO fracture risk assessment tool (FRAX(R)).Introduction The FRAX(R) tool has recently become available to compute the 10-year probability of fractures in men and women from clinical risk factors (CRFs) with or without the measurement of femoral neck bone mineral density (BMD). The aim of this study was to develop a case-finding strategy for men and women from the UK at high risk of osteoporotic fracture by delineating the fracture probabilities at which BMD testing or intervention should be recommended.Methods Fracture probabilities were computed using the FRAX(R) tool calibrated to the epidemiology of fracture and death in the UK. The relationship between cost effectiveness and fracture probability used the source data from a prior publication that examined the cost effectiveness of generic alendronate in the UK. An intervention threshold was set by age in men and women, based on the fracture probability equivalent to that of women with a history of a prior osteoporosis related fracture. In addition, assessment thresholds for the use of BMD testing were explored. Assessment thresholds for the measurement of BMD followed current practice guidelines where individuals were considered to be eligible for assessment in the presence of one or more CRF. An upper assessment threshold (i.e. a fracture probability above which patients could be treated without recourse to BMD) was based on optimisation of the positive predictive value of the assessment tool. The consequences of assessment and intervention thresholds on the requirement for BMD test and interventions were assessed using the distribution of clinical risk factors and femoral neck BMD for women in the source cohorts used for the development of the FRAX(R) modelsResults Treatment was cost effective at all ages when the 10-year probability of a major fracture exceeded 7%. The intervention threshold at the age of 50 years corresponded to a 10-year probability of a major osteoporotic fracture of 7.5%. This rose progressively with age to 30% at the age of 80 years, so that intervention was cost effective at all ages. Assessment thresholds for testing with BMD (6-9% at the age of 50 years) also rose with age (18-36% at the age of 80 years). The use of these thresholds in a case-finding strategy would identify 6-20% of women as eligible for BMD testing and 23-46% as eligible for treatment, depending on age. The same threshold can be used in men.Conclusion The study provides a method of developing management algorithms for osteoporosis from the estimation of fracture probabilities, rather than those based on BMD alone or BMD with single or multiple CRFs.