The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study
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ORIGINAL ARTICLE
The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study Sansin Tuzun & Nurten Eskiyurt & Ulku Akarirmak & Merih Saridogan & Helena Johansson & Eugene McCloskey & John A. Kanis & Turkish Osteoporosis Society
Received: 2 July 2012 / Accepted: 30 July 2012 / Published online: 22 September 2012 # International Osteoporosis Foundation and National Osteoporosis Foundation 2012
Abstract Introduction With the development of country-specific FRAX® tools to estimate fracture probability, guidance is required on the fracture probability at which treatment can be recommended. Objectives The aim of the present study was to determine FRAX-based intervention thresholds in men and women from Turkey and determine their population impact. Turkish Osteoporosis Society: T. Arasil, F. Atalay, G. Dincer, B. Durmaz, O. El, Y. Kirazli, Y.G. Kutsal, S. Oncel, and O. Peker S. Tuzun (*) : U. Akarirmak : M. Saridogan Department of Physical Medicine and Rehabilitation, Cerrahpaşa School of Medicine, University of Istanbul, Istanbul, Turkey e-mail: [email protected] N. Eskiyurt Department of Physical Medicine and Rehabilitation, İstanbul School of Medicine, University of Istanbul, Istanbul, Turkey e-mail: [email protected] H. Johansson : E. McCloskey : J. A. Kanis (*) WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK e-mail: [email protected] H. Johansson e-mail: [email protected]
Patients and methods Intervention thresholds for treatment and assessment thresholds for measuring BMD were devised using the strategy adopted by the National Osteoporosis Guideline Group of the UK but applied to the fracture probabilities in Turkey. The number of men and women potentially eligible for treatment was determined from the distribution of FRAX-based probabilities of a major fracture (Turkish model, version 3.6) in a representative sample of 26,394 men and women aged 50 years or more. Results Intervention thresholds, set at the probability equivalents of a woman with a prior fragility fracture rose with age from 7.0 % at the age of 50 years to 31 % at the age of 90 years. Approximately 8.6 % of the female Turkish population aged 50 years or more had a prior fragility fracture and would be eligible for treatment. A further 13.6 % without a prior fracture would be eligible for treatment. In contrast, the number of men aged 50 years or more eligible for treatment was 3.1 % Conclusions FRAX-based guidelines can be developed and are expected to avoid unnecessary treatment of individuals at low fracture risk and direct treatments to those at high risk. The adoption of FRAX-based intervention thresholds will demand a reappraisal of the criteria for reimbursement of interventions and health economic assessment. Keywords FRAX . Fracture probability . Intervention threshold . Clinical guidelines . BMD . Assessment thresholds
E. McCloskey e-mail: [email protected] S. Tuzun : N. Eskiyurt : U. A
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