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vol. 14
Clinical research

Evaluation of the validity of treatment decisions based on surrogate country models before introduction of the Polish FRAX and recommendations in comparison to current practice

Wojciech M. Glinkowski, Jerzy Narloch, Bożena Glinkowska, Małgorzata Bandura

Arch Med Sci 2018; 14, 2: 345–352
Online publish date: 2016/06/23
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Introduction: Patients diagnosed before the Polish FRAX was introduced may require re-evaluation and treatment changes if the diagnosis was established according to a surrogate country FRAX score. The aim of the study was to evaluate the validity of treatment decisions based on the surrogate country model before introduction of the Polish FRAX and to provide recommendations based on the current practice.

Material and methods: We evaluated a group of 142 postmenopausal women (70.7 ±8.9 years) who underwent bone mineral density measurements. We used 22 country-specific FRAX models and compared these to the Polish model.

Results: The mean risk values for hip and major osteoporotic fractures within 10 years were 4.575 (from 0.82 to 8.46) and 12.47% (from 2.18 to 21.65), respectively. In the case of a major fracture, 94.4% of women would receive lifestyle advice, and 5.6% would receive treatment according to the Polish FRAX using the guidelines of the National Osteoporosis Foundation (NOF). Polish treatment thresholds would implement pharmacotherapy in 32.4% of the study group. In the case of hip fractures, 45% of women according to the NOF would require pharmacotherapy but only 9.8% of women would qualify according to Polish guidelines. Nearly all surrogate FRAX calculator scores proved significantly different form Polish (p > 0.05).

Conclusions: More patients might have received antiresorptive medication before the Polish FRAX. This study recommends re-evaluation of patients who received medical therapy before the Polish FRAX was introduced and a review of the recommendations, considering the side effects of antiresorptive medication.

FRAX, recommendations, pharmacotherapy, osteoporosis

Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9: 1137-41.
Kanis JA, Gluer CC. An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Intern 2000; 11: 192-202.
Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004; 35: 375-82
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008; 19: 385-97.
Czerwinski E, Badurski J, Lorenc R, Osieleniec J. Guidelines on the Diagnosis of Osteoporosis and Assessment of Fracture Risk in Poland of III Central European Congress on Osteoporosis and Osteoarthritis, XV Congress of the Polish Osteoarthrology Society and Polish Foundation of Osteoporosis. Ortopedia Traumatologia Rehabilitacja 2010; 12: 194-200.
Czerwinski E, Kanis JA, Osieleniec J, et al. Evaluation of FRAX to characterize fracture risk in Poland. Osteoporos Int 2011; 22: 2507-12.
Lorenc RS, Resch H; the Members of the „2nd Summit on O-C, Eastern E (2009) Management of osteoporosis in central and eastern Europe (CEE): conclusions of the „2nd Summit on Osteoporosis-CEE”, 2-22 November 2008, Warsaw, Poland. Arch Osteoporosis 2008; 4: 1-8.
Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 2002; 17: 1237-44.
Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, et al. National Osteoporosis Foundation Guide C. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 2008; 19: 437-47.
Dawson-Hughes B, Tosteson AN, Melton LJ 3rd, et al. National Osteoporosis Foundation Guide C. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int 2008; 19: 449-58.
Gluszko P, Lorenc RS, Karczmarewicz E, Misiorowski W, Jaworski M. Polish guidelines for the diagnosis and management of osteoporosis: a review of 2013 update. Pol Archiwum Med Wewn 2014; 124: 255-63.
McCloskey E, Kanis JA. FRAX updates 2012. Curr Opin Rheumatol 2012; 24: 554-60.
Leslie WD, Majumdar SR, Lix LM, et al. High fracture probability with FRAX usually indicates densitometric osteoporosis: implications for clinical practice. Osteoporos Int 2012; 23: 391-7.
Kanis JA, Johansson H, Oden A, Cooper C, McCloskey EV. Epidemiology, quality of life Working Group of IOF. Worldwide uptake of FRAX. Arch Osteoporos 2014; 9: 166.
Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD. FRAX((R)) with and without bone mineral density. Calcif Tissue Int 2012; 90: 1-13.
Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A. National Osteoporosis Guideline G. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int 2008; 19: 1395-408.
Lewiecki EM, Compston JE, Miller PD, et al. Members FPDC FRAX((R)) Bone Mineral Density Task Force of the 2010 Joint International Society for Clinical Densitometry & International Osteoporosis Foundation Position Development Conference. J Clin Densitom 2011; 14: 223-5.
Hans DB, Kanis JA, Baim S, et al. Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX((R)). Executive Summary of the 2010 Position Development Conference on Interpretation and use of FRAX(R) in clinical practice. J Clin Densitom 2011; 14: 171-80.
Kanis JA, Hans D, Cooper C, et al. Interpretation and use of FRAX in clinical practice. Osteoporos Int 2011; 22: 2395-411.
Leslie WD, Lix LM, Johansson H, et al. Independent clinical validation of a Canadian FRAX tool: fracture prediction and model calibration. J Bone Miner Res 2010; 25: 2350-8.
Lewiecki EM, Compston JE, Miller PD, et al. Official Positions for FRAX(R) Bone Mineral Density and FRAX(R) simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(R). J Clin Densitom 2011; 14: 226-36.
Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005; 20: 1185-94.
Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 1998; 8: 468-89.
Stone KL, Seeley DG, Lui LY, et al. Osteoporotic Fractures Research G. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 2003; 18: 1947-54.
Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA. Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int 2011; 22: 839-47.
Mann E, Meyer G, Haastert B, Icks A. Comparison of hip fracture incidence and trends between Germany and Austria 1995-2004: an epidemiological study. BMC Public Health 2010; 10: 46.
Czerwinski E, Kanis JA, Trybulec B, Johansson H, Borowy P, Osieleniec J. The incidence and risk of hip fracture in Poland. Osteoporos Int 2009; 20: 1363-7.
Jaworski M, Lorenc RS. Risk of hip fracture in Poland. Med Sci Monitor 2007; 13: CR 206-10.
Lukaszkiewicz J, Karczmarewicz E, Pludowski P, et al. Feasibility of simultaneous measurement of bone formation and bone resorption markers to assess bone turnover rate in postmenopausal women: an EPOLOS study. Med Sci Monitor 2008; 14: PH 65-70.
Fujiwara S, Kasagi F, Yamada M, Kodama K. Risk factors for hip fracture in a Japanese cohort. J BoneMiner Res 1997; 12: 998-1004.
Melton LJ 3rd, Crowson CS, O’Fallon WM, Wahner HW, Riggs BL. Relative contributions of bone density, bone turnover, and clinical risk factors to long-term fracture prediction. J Bone Miner Res 2003;18: 312-8.
Nadalin V, Bentvelsen K, Kreiger N Reliability of self-reports: data from the Canadian Multi-Centre Osteoporosis Study (CaMos). Chronic Diseases in Canada 2004; 25: 28-31.
Nguyen T, Sambrook P, Kelly P, et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ 1993; 307: 1111-5.
Stewart A, Felsenberg D, Eastell R, Roux C, Gluer CC, Reid DM. Relationship between risk factors and QUS in a European Population: the OPUS study. Bone 2006; 39: 609-15.
Johansson H, Kanis JA, Oden A, et al. Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women: a meta-analysis of international cohorts. Calcif Tissue Int 2014; 95: 428-35.
Badurski JE, Kanis JA, Johansson H, et al. The application of FRAX(R) to determine intervention thresholds in osteoporosis treatment in Poland. Pol Arch Med Wewn 2011; 121: 148-55.
Watts NB, Lewiecki EM, Miller PD, Baim S. National Osteoporosis Foundation 2008 Clinician’s Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J Clin Densitom 2008; 11: 473-7.
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.
Johansson H, Kanis JA, McCloskey EV, et al. A FRAX(R) model for the assessment of fracture probability in Belgium. Osteoporos Int 2011; 22: 453-61.
Compston J, Bowring C, Cooper A, et al. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 2013; 75: 392-6.
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