FRAX and ethnicity
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EDITORIAL
FRAX and ethnicity J. A. Kanis 1,2 & C. Cooper 3,4 & B. Dawson-Hughes 5 & N. C. Harvey 3,6 & H. Johansson 1,2 & M. Lorentzon 1,7 & E. V. McCloskey 2,8 & J.-Y. Reginster 9,10 & R. Rizzoli 11 & on behalf of the International Osteoporosis Foundation Received: 31 August 2020 / Accepted: 1 September 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Introduction A recent article from the New England Journal of Medicine questioned the use of race or ethnicity in assessment algorithms [1]. In the case of osteoporosis, the authors noted that the US FRAX calculator returns a lower fracture risk for women who are Black (by a factor of 0.43), Asian (0.50) or Hispanic (0.53). They conclude that the lower risk for Black, Asian and minority ethnic (BAME) women may delay intervention with osteoporosis therapy. The New York Times goes further in stating that with FRAX (sic) Black women end up having a score that makes them less likely to be prescribed osteoporosis medication than white women who are similar in all other respects [2].
* J. A. Kanis [email protected]; [email protected] C. Cooper [email protected] B. Dawson-Hughes [email protected] N. C. Harvey [email protected]
In the case of osteoporosis and FRAX, the authors do not appear to have grasped the reality of fracture epidemiology and risk assessment. In this editorial, we set out the key messages from the epidemiology of fracture globally, key considerations in building risk assessment tools, the specific contribution of race/ethnicity and practical considerations related to any move to alter race/ethnicity categorisation or remove them entirely.
Heterogeneity of fracture risk Fracture probability varies markedly in different regions of the world due to differences in fracture risk and mortality [3, 4]. In the case of hip fracture, there is a tenfold range in probability
2
Centre for Metabolic Bone Diseases, Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
3
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
4
NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
5
Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
6
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
7
Geriatric Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
8
Mellanby Centre for bone research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
9
Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
10
Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
11
Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
H. Johansson [email protected] M. Lorentz
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