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Interpretation and use of FRAX in clinical practice

Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The introduction of the WHO FRAX® algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. Its use in fracture risk prediction has strengths, but also limitations of which the clinician should be aware and are the focus of this review

Introduction

The International Osteoporosis Foundation (IOF) and the International Society for Clinical Densitometry (ISCD) appointed a joint Task Force to develop resource documents in order to make recommendations on how to improve FRAX and better inform clinicians who use FRAX. The Task Force met in November 2010 for 3 days to discuss these topics which form the focus of this review.

Methods

This study reviews the resource documents and joint position statements of ISCD and IOF.

Results

Details on the clinical risk factors currently used in FRAX are provided, and the reasons for the exclusion of others are provided. Recommendations are made for the development of surrogate models where country-specific FRAX models are not available.

Conclusions

The wish list of clinicians for the modulation of FRAX is large, but in many instances, these wishes cannot presently be fulfilled; however, an explanation and understanding of the reasons may be helpful in translating the information provided by FRAX into clinical practice.

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References

  1. Hans D, Kanis JA, Baim S et al, on behalf of the FRAX Position Conference Members (2011) Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J Clin Densitom (in press)

  2. World Health Organization (2007) Assessment of osteoporosis at the primary health care level. WHO, Geneva. www.who.int/chp/topics/rheumatic/en/index.html

  3. Kanis JA, on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care level. Technical report. WHO Collaborating Centre, University of Sheffield, UK. Available at http://www.shef.ac.uk/FRAX/index.htm

  4. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey EV (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397

    Article  PubMed  CAS  Google Scholar 

  5. Kanis JA, Oden A, Johnell O et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046

    Article  PubMed  CAS  Google Scholar 

  6. Hippisley-Cox J, Copuland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ 339:b4229

    Article  PubMed  Google Scholar 

  7. Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19:1431–1444

    Article  PubMed  CAS  Google Scholar 

  8. De Laet C, Oden A, Johansson H, Johnell O, Jonsson B, Kanis JA (2005) The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach. Osteoporos Int 16:313–318

    Article  PubMed  Google Scholar 

  9. Kanis JA, Johnell O, Oden A, De Laet C, Jonsson B, Dawson A (2002) Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 30:251–258

    Article  PubMed  CAS  Google Scholar 

  10. Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Oglesby A (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244

    Article  PubMed  Google Scholar 

  11. Kanis JA, Oden A, Johansson H, Borgström F, Ström O, McCloskey E (2009) FRAX® and its applications to clinical practice. Bone 44:734–743

    Article  PubMed  Google Scholar 

  12. Kanis JA, McCloskey E, Jönsson B, Cooper A, Ström O, Borgström F (2010) An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women. Arch Osteoporos 5:19–48

    Article  Google Scholar 

  13. National Osteoporosis Foundation (2008) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC. www.nof.org

  14. Compston J, Cooper A, Cooper C, on behalf of the National Osteoporosis Guideline Group (NOGG) et al (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108

    Article  PubMed  CAS  Google Scholar 

  15. Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, National Osteoporosis Guideline Group (2008) Case finding for the management of osteoporosis with FRAX®—assessment and intervention thresholds for the UK. Osteoporos Int 19:1395–1408, Erratum 2009 Osteoporos Int 20, 499–502

    Article  PubMed  CAS  Google Scholar 

  16. Neuprez A, Johansson H, Kanis JA et al (2009) Rationalisation du remboursement des médicaments de l’ostéoporose: de la mesure isolée de la densité osseuse à l’intégration des facteurs cliniques de risque fracturaire. Validation de l’algorithme FRAX®. La Revue Médicale de Liège 64:612–619

    CAS  Google Scholar 

  17. Fujiwara S, Nakamura T, Orimo H, Hosoi T, Gorai I, Oden A et al (2008) Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX™). Osteoporos Int 19:429–448

    Article  PubMed  CAS  Google Scholar 

  18. Lippuner K, Johansson H, Kanis JA, Rizzoli R (2010) FRAX® assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21:381–390

    Article  PubMed  CAS  Google Scholar 

  19. Association Suisse contre l‘Ostéoporose (2011) Ostéoporose: recommandations 2010. ASCO, Lausanne

    Google Scholar 

  20. Czerwinski E, Kanis JA, Trybulec B, Johansson H, Borowy P, Osieleniec J (2009) The incidence and risk of hip fracture in Poland. Osteoporos Int 20:1363–1368

    Article  PubMed  CAS  Google Scholar 

  21. Kanis JA, Burlet N, Cooper C, on behalf of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428

    Article  PubMed  CAS  Google Scholar 

  22. Grossman JM, Gordon R, Ranganath VK et al (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 62:1515–1526

    Article  Google Scholar 

  23. Papaioannou A, Morin S, Cheung AM et al (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873

    Article  PubMed  Google Scholar 

  24. Socialstyrelsen (2010) Nationella riktlinjer för rörelseorganens sjukdomar 2010—stöd för styrning och ledning. Preliminär version. Artikelnr 2010-11-15. Publicerad www.socialstyrelsen.se

  25. Dawson-Hughes B, National Osteoporosis Foundation Guide Committee (2008) A revised clinician’s guide to the prevention and treatment of osteoporosis. J Clin Endocrinol Metab 93:2463–2465

    Article  PubMed  CAS  Google Scholar 

  26. U.S. Preventive Services Task Force (2011) Screening for osteoporosis: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 154:356–364

    Google Scholar 

  27. Johansson H, Kanis JA, McCloskey EV, Odén A, Devogelaer J-P, Kaufman J-M, Neuprez A, Hiliigsmann M, Bruyere O, Reginster JY (2011) A FRAX® model for the assessment of fracture probability in Belgium. Osteoporos Int 22:453–461

    Article  PubMed  CAS  Google Scholar 

  28. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828

    Article  PubMed  CAS  Google Scholar 

  29. Lunt M, O'Neill TW, Felsenberg D et al (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513

    Article  PubMed  Google Scholar 

  30. Delmas PD, Genant HK, Crans GG et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  PubMed  CAS  Google Scholar 

  31. Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770

    Article  PubMed  CAS  Google Scholar 

  32. Puisto V, Heliovaara M, Impivaara O et al (2010) Severity of vertebral fracture and risk of hip fracture: a nested case–control study. Osteoporos Int 22:63–68

    Article  PubMed  Google Scholar 

  33. Blank R, on behalf of the FRAX Position Conference Members et al (2011) Official positions for FRAX clinical regarding prior fractures. J Clin Densitom (in press)

  34. Leib ES, Saag KG, Adachi JD, on behalf of the FRAX Position Conference Members et al (2011) The impact of the use of glucocorticoids on the estimate by FRAX of the 10 year risk of fracture. J Clin Densitom (in press)

  35. Kanis JA, Johansson H, Oden A et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899

    Article  PubMed  Google Scholar 

  36. van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000

    Article  PubMed  Google Scholar 

  37. van Staa TP, Leufkens HGM, Abenhaim L, Zhang B, Cooper C (2000) Fracture and oral corticosteroids: relationship to daily and cumulative dose. Rheumatol 39:1383–1389

    Article  Google Scholar 

  38. van Staa TP, Abenhaim L, Cooper C, Zhang B, Leufkens HG (2001) Public health impact of adverse bone effects of oral corticosteroids. Br J Clin Pharmacol 51:601–607

    Article  PubMed  Google Scholar 

  39. Kanis JA, Johansson H, Oden A, McCloskey EV (2010) Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 22:809–816

    Article  Google Scholar 

  40. Etminan M, Sadatsafavi M, Ganjizadeh Zavareh S, Takkouche B, FitzGerald JM (2008) Inhaled corticosteroids and the risk of fractures in older adults: a systematic review and meta-analysis. Drug Saf 31:409–414

    Article  PubMed  Google Scholar 

  41. van Staa TP, Leufkens HG, Cooper C (2001) Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 16:581–588

    Article  PubMed  Google Scholar 

  42. Kanis JA, Johansson H, Johnell O et al (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16:737–742

    Article  PubMed  Google Scholar 

  43. Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA Jr, Malik R, Arnsten JH (2008) Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med 121:406–418

    Article  PubMed  CAS  Google Scholar 

  44. Vestergaard P, Langdahl B (2010) Alcohol. ISCD/IOF FRAX Clinical Task Force, Report prepared for the FRAX initiative

  45. Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773

    Article  PubMed  CAS  Google Scholar 

  46. Fox KM, Cummings SR, Powell-Threets K, Stone K (1998) Family history and risk of osteoporotic fracture. Study of Osteoporotic Fractures Research Group. Osteoporos Int 8:557–562

    Article  PubMed  CAS  Google Scholar 

  47. Kanis JA, Johansson H, Oden A et al (2004) A family history of fracture and fracture risk: a meta-analysis. Bone 35:1029–1037

    Article  PubMed  CAS  Google Scholar 

  48. Kanis JA, Johnell O, Oden A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–162

    Article  PubMed  CAS  Google Scholar 

  49. Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture; recognition of a major effect. Br Med J 315:841–846

    CAS  Google Scholar 

  50. Vestergaard P, Mosekilde L (2003) Fracture risk associated with smoking: a meta-analysis. J Intern Med 254:572–583

    Article  PubMed  CAS  Google Scholar 

  51. Dimai HP, Chandran M, on behalf of the FRAX Position Conference Members (2011) Official positions for FRAX clinical regarding smoking. J Clin Densitom (in press)

  52. Broy B, Tanner B, Krieg M-A, on behalf of the FRAX® Position Development Conference Members (2011) Official positions for FRAX clinical regarding rheumatoid arthritis. J Clin Densitom (in press)

  53. Confavreux CB, Chapurlat RD (2011) Systemic bone effects of biologic therapies in rheumatoid arthritis and ankylosing spondylitis. Osteoporos Int 22:1023–1036

    Article  PubMed  CAS  Google Scholar 

  54. Office of the Surgeon General (US) (2004) Bone health and osteoporosis: a report of the surgeon general. Office of the Surgeon General (US), Rockville

    Google Scholar 

  55. Lakatos P, Balogh A, Czerwinski E et al (2010) New considerations on the management of osteoporosis in Central and Eastern Europe (CEE): summary of the “3rd Summit on Osteoporosis—CEE”. Arch Osteoporos. doi:10.1007/s11657-010-0048-2

  56. Dam TT, Harrison S, Fink HA, Ramsdell J, Barrett-Connor E, Osteoporotic Fractures in Men (MrOS) Research Group (2010) Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma. Osteoporos Int 21:1341–1349

    Article  PubMed  Google Scholar 

  57. Kjensli A, Falch JA, Ryg M et al (2009) High prevalence of vertebral deformities in COPD patients: relationship to disease severity. Eur Respir J 33:1018–1024

    Article  PubMed  CAS  Google Scholar 

  58. Masud T, Binkley N, Boonen S, Hannan MT, on behalf of the FRAX Position Conference members (2011) Can falls and frailty be used in FRAX? J Clin Densitom (in press)

  59. Oliver D, Britton M, Seed P, Martin FC, Hopper AH (1997) Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ 315:1049–1053

    PubMed  CAS  Google Scholar 

  60. Toyabe S (2010) World Health Organization fracture risk assessment tool in the assessment of fractures after falls in hospital. BMC Health Serv Res 10:106, PubMed PMID: 20423520; PubMed Central PMCID: PMC2868843

    Article  PubMed  Google Scholar 

  61. McCloskey EV, Beneton M, Charlesworth D et al (2007) Clodronate reduces the incidence of fractures in community dwelling elderly women unselected for osteoporosis: results of a double-blind, placebo-controlled randomized study. J Bone Miner Res 22:135–141

    Article  PubMed  CAS  Google Scholar 

  62. Kayan K, Johansson H, Oden A et al (2009) Can fall risk be incorporated into fracture risk assessment algorithms: a pilot study of responsiveness to clodronate. Osteoporos Int 20:2055–2061

    Article  PubMed  CAS  Google Scholar 

  63. McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340

    Article  PubMed  CAS  Google Scholar 

  64. Gillespie LD, Robertson MC, Gillespie WJ et al (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009, Issue 2. Art.No.: D007146. doi:10.1002/14651858.CD007146.pub2

  65. Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N (2010) Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 1:CD005465

    PubMed  Google Scholar 

  66. Chang JT, Morton SC, Rubenstein L, Mojica W, Maglione M, Suttorp M, Roth E, Shekelle P (2004) Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 328:680

    Article  PubMed  Google Scholar 

  67. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692. doi:10.1136/bmj.b3692

    Article  PubMed  CAS  Google Scholar 

  68. Vasikaran S, Eastell R, Bruyère O et al (2011) Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 22:391–420

    Article  PubMed  CAS  Google Scholar 

  69. Vasikaran SD (2008) Utility of biochemical markers of bone turnover and bone mineral density in management of osteoporosis. Crit Rev Clin Lab Sci 45:221–258

    Article  PubMed  CAS  Google Scholar 

  70. Bergmann P, Body JJ, Boonen S et al (2009) Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club. Int J Clin Pract 63:19–26

    Article  PubMed  CAS  Google Scholar 

  71. Brown JP, Albert C, Nassar BA et al (2009) Bone turnover markers in the management of postmenopausal osteoporosis. Clin Biochem 42:929–942

    Article  PubMed  CAS  Google Scholar 

  72. Szulc P, Delmas P (2008) Biochemical markers of bone turnover: potential use in the investigation and management of postmenopausal osteoporosis. Osteoporos Int 19:1683–1704

    Article  PubMed  CAS  Google Scholar 

  73. Orimo H, Nakamura T, Fukunaga M (2006) Japanese guidelines for the prevention and treatment of osteoporosis, Translated Abridged Edition. Life Science, Tokyo

    Google Scholar 

  74. Baim S, Binkley N, Bilezikian JP et al (2008) Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 11:75–91

    Article  PubMed  Google Scholar 

  75. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475

    Article  PubMed  CAS  Google Scholar 

  76. Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  PubMed  Google Scholar 

  77. Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  PubMed  CAS  Google Scholar 

  78. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259

    PubMed  CAS  Google Scholar 

  79. Stone KL, Seeley DG, Lui LY et al (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18:1947–1954

    Article  PubMed  Google Scholar 

  80. Faulkner KG, von Stetten E, Miller P (1999) Discordance in patient classification using T-scores. J Clin Densitom 2:343–350

    Article  PubMed  CAS  Google Scholar 

  81. Lewiecki EM, Compston JE, Miller PD, on behalf of the FRAX Position Conference members et al (2011) J Clin Densitom (in press)

  82. Kanis JA, Johnell O, Oden A et al (2006) The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int 17:527–534

    Article  PubMed  CAS  Google Scholar 

  83. Blake GM, Patel R, Knapp KM, Fogelman I (2003) Does the combination of two BMD measurements improve fracture discrimination? J Bone Miner Res 18:1955–1963

    Article  PubMed  Google Scholar 

  84. Leslie WD, Tsang JF, Caetano PA, Lix LM (2007) Number of osteoporotic sites and fracture risk assessment: a cohort study from the Manitoba Bone Density Program. J Bone Miner Res 22:476–483

    Article  PubMed  Google Scholar 

  85. Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2011) Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int 22:839–847

    Article  PubMed  CAS  Google Scholar 

  86. Adams J, Moayyeri A, Adler R, Lentle B, Blake G (2010) Can QUS of the calcaneus be used to assess fracture risk with FRAX? ISCD/IOF FRAX BMD Task Force, Middletown

    Google Scholar 

  87. Hans D, Durosier C, Kanis JA, Johansson H, Schott-Pethelaz AM, Krieg MA (2008) Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 elderly women. J Bone Miner Res 23:1045–1051

    Article  PubMed  Google Scholar 

  88. Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2010) Does osteoporosis therapy invalidate FRAX for fracture prediction? J Bone Miner Res 25(Suppl 1):S60, Abstract 1199

    Google Scholar 

  89. Levine S, Makin M, Menczel J, Robin G, Naor E, Steinberg R (1970) Incidence of fractures of the proximal end of the femur in Jerusalem: a study of ethnic factors. J Bone Joint Surg Am 52:1193–1202

    PubMed  CAS  Google Scholar 

  90. Cauley JA, El-Hajj Fuleihan G, Luckey M, on behalf of the FRAX Position Conference Members et al (2011) Official positions for FRAX clinical regarding international differences. J Cin Densitom (in press)

  91. Wittich A, Bagur A, Mautalen C et al (2010) Epidemiology of hip fracture in Tucuman, Argentina. Osteoporos Int 21:1803–1807

    Article  PubMed  CAS  Google Scholar 

  92. Elffors I, Allander E, Kanis JA et al (1994) The variable incidence of hip fracture in southern Europe: the MEDOS Study. Osteoporos Int 4:253–263

    Article  PubMed  CAS  Google Scholar 

  93. Jonsson B, Gardsell P, Johnell O, Redlund-Johnell I, Sernbo I (1992) Differences in fracture pattern between an urban and a rural population: a comparative population-based study in southern Sweden. Osteoporos Int 2:269–273

    Article  PubMed  CAS  Google Scholar 

  94. Finsen V, Benum P (1987) Changing incidence of hip fractures in rural and urban areas of central Norway. Clin Orthop Relat Res 218:104–110

    PubMed  Google Scholar 

  95. Bulajic-Kopjar M, Wiik J, Nordhagen R (1998) Regional differences in the incidence of femoral neck fractures in Norway. Tidsskr Nor Laegeforen 118:30–33

    PubMed  CAS  Google Scholar 

  96. Kaastad TS, Meyer HE, Falch JA (2008) Incidence of hip fracture in Oslo, Norway: differences within the city. Bone 22:175–178

    Article  Google Scholar 

  97. Chevalley T, Herrmann FR, Delmi M et al (2002) Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly. Osteoporos Int 13:113–118

    Article  PubMed  CAS  Google Scholar 

  98. Matković V, Kostial K, Simonović I, Buzina R, Brodarec A, Nordin BE (1979) Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr 32:540–549

    PubMed  Google Scholar 

  99. Madhok R, Melton LJ 3rd, Atkinson EJ, O'Fallon WM, Lewallen DG (1993) Urban vs rural increase in hip fracture incidence. Age and sex of 901 cases 1980–89 in Olmsted County, U.S.A. Acta Orthop Scand 64:543–548

    Article  PubMed  CAS  Google Scholar 

  100. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1990) Regional variation in the incidence of hip fracture. US white women aged 65 years and older. JAMA 264:500–502

    Article  PubMed  CAS  Google Scholar 

  101. Ross PD, Norimatsu H, Davis JW et al (1991) A comparison of hip fracture incidence among native Japanese, Japanese Americans, and American Caucasians. Am J Epidemiol 133:801–809

    PubMed  CAS  Google Scholar 

  102. Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J (1998) Hip fracture incidence among elderly Hispanics. Am J Public Health 88:1245–1247

    Article  PubMed  CAS  Google Scholar 

  103. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, and the IOF CSA Working Group on Fracture Epidemiology (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288

    Article  Google Scholar 

  104. Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fractures. Osteoporos Int 7:407–413

    Article  PubMed  CAS  Google Scholar 

  105. Zingmond DS, Melton LJ 3rd, Silverman SL (2004) Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 15:603–610

    Article  PubMed  Google Scholar 

  106. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427

    Article  PubMed  CAS  Google Scholar 

  107. Bow CH, Cheung E, Cheung CL et al (2011). Ethnic difference of clinical vertebral fracture risk. Osteoporos Int (in press)

  108. Melton LJ, Crowson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban and with rural rates and changes in urban rates over time. Osteoporos Int 9:29–37

    Article  PubMed  Google Scholar 

  109. Singer BR, McLauchlan CJ, Robinson CM, Christie J (1998) Epidemiology of fracture in 15.000 adults. The influence of age and gender. J Bone Joint Surg 80B:234–238

    Google Scholar 

  110. Lippuner K, von Overbeck J, Perrelet R, Bossard H, Jaeger P (1997) Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Sweden. Osteoporos Int 7:414–425

    Article  PubMed  CAS  Google Scholar 

  111. Sanders KM, Pasco JA, Ugoni AM et al (1998) The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the Geelong Osteoporosis Study. J Bone Miner Res 13:1337–1342

    Article  PubMed  CAS  Google Scholar 

  112. Baron JA, Barrett J, Malenka D et al (1994) Racial differences in fracture risk. Epidemiol 5:42–47

    Article  CAS  Google Scholar 

  113. Melton LJ (1995) Epidemiology of fractures. In: Riggs BL, Melton LJ (eds) Osteoporosis: etiology, diagnosis and management, 2nd edn. Lippincott-Raven, Philadelphia, pp 225–227

    Google Scholar 

  114. Johnell O, Gullberg B, Kanis JA (1997) The hospital burden of vertebral fracture. A study of national register sources. Osteoporos Int 7:138–144

    Article  PubMed  CAS  Google Scholar 

  115. Kanis JA, Johansson H, Oden A, Dawson-Hughes B, Melton LJ 3rd, McCloskey EV (2010) The effects of a FRAX revision for the USA. Osteoporos Int 21:35–40

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This paper was reviewed and endorsed by the Committee of Scientific Advisors of the IOF. The FRAX Initiative comprised the organisers, task force liaisons, the members of the three Task Forces and the expert panel.

Organisers

Didier Hans (Co-chair), Cyrus Cooper (co-chair), Sanford Baim, Bess Dawson-Hughes, John A Kanis, William D Leslie, Marjory Lucky, Rene Rizzoli, Catalina Poiana, John P Bilezikian (moderator) and Socrates E Papapoulos (moderator).

FRAX Clinical

Eugene McCloskey (Chair); Neil Binkley (Co-chair); Jonathan Adachi and Sanford Baim (programme committee liaison); Dennis Black, Robert Blank, Susan Broy and Bess Dawson-Hughes (programme committee liaison) and Sergio Ortolani, Hans Peter Dimai, Michael Kleerekoper, Marc-Antoine Krieg, Bente Langdahl, Andrew Laster, Edward Leib, Tahir Masud, Mike McClung, Rene Rizzoli, Kenneth Saag and Ethel Siris.

FRAX BMD

E Michael Lewiecki (Chair); Juliet Compston (Co-chair); Jonathan Adachi Judith Adams, Robert Adler, Doug Bauer Glen Blake, Patricia Clark, Adolfo Diez-Perez, Didier Hans and John A Kanis (programme committee liaison); Marc-Antoine Krieg, Didier Hans and William Leslie (programme committee liaison) and Alireza Moayyeri, Robert Josse, David Kendler, Aliya Khan, Brian Lentle, Roman Lorenc, Basel Masri and Paul Miller.

FRAX International

Jane Cauley (Chair); Ghada El-Hajj Fuleihan (Co-chair); Asma Arabi, Andrew Calderon, Zhao Chen, Siok Bee Chinoh, Jeffry Curtis, Michelle Danielson, Saeko Fujiwara, David Hanley, Heikki Kroger, Annie Kung, Olga Lesnyak, Anne Looker and Marjorie Luckey (programme committee liaison); Dan Mellstrom, Jeri Nieves, Wojciech Pluskiewicz, Rola El Rassi and René Rizzoli (programme committee liaison) and Sergio Ragi-Eis, Anna Marie Schott-Pethelaz and Stuart Silverman.

Expert panel

Socrates E Papapoulos (moderator), John P Bilezikian (moderator) and Jonathan Adachi, Robert D Blank, Roland Chapurlat, Wu (Paulo) Chih-Hsing, Edward Czerwinski, Aldolfo Diez-Perez, Hans Peter Dimai, Ghada El-Hajj Fuleihan, Saeko Fujiwara, Ruxandra M Ionescu, John A Kanis, Mike McClung, Paul Miller, Sergio Ragi-Eis, Jan Stepan, Kenneth Saag, John T Schousboe, Wei Yu and Cristiano Zerbini.

Support staff

Peter D. Brown (ISCD), Patrice McKenney (IOF) and Helena Johansson, Judit Nagy, Anders Oden and Denys A Wahl.

Conflicts of interest

S Baim, JP Bilezikian, JE Compston, G El-Hajj Fuleihan, A Oden, B Dawson-Hughes, EM Lewiecki, DA Wahl, H Johansson and D Hans have no competing interests to declare with regard to this manuscript. JA Kanis and E McCloskey: Consulting fees, paid advisory boards, lecture fees, and/or grant support from the majority of companies concerned with skeletal metabolism. WD Leslie: Speaker fees and unrestricted research grants from Amgen and Merck Frosst; unrestricted research grants from Sanofi-Aventis, Warner Chilcott (formerly Procter & Gamble), Novartis, Amgen, Genzyme; advisory boards for Genzyme, Novartis, and Amgen. J Cauley: Consultant to Novartis for the HORIZON steering committee and receives research funding for the HORIZON trial. C Cooper: Consulting fees and paid advisory boards for Alliance for Better Bone Health, Glaxo Smith Kline, Roche, Merck Sharp and Dohme, Lilly, Amgen, Wyeth, Novartis, Servier, and Nycomed. R Rizzoli: Paid advisory boards and lecture fee for Merck Sharp and Dohme, Eli Lilly, Amgen, Wyeth, Novartis, Servier, Nycomed, and Danone. N Binkley: Consulting fees and research support from Amgen, Lilly, Merck and Tarsa. M Luckey: Consulting fees and lecture fees from Merck Sharp and Dohme, Eli Lilly, Amgen, Novartis and Tarsa Pharmaceuticals. C Poiana: Lecture fees and paid advisory boards for Amgen, Merck Sharp and Dohme, Glaxo Smith Kline and Novartis. S Papapoulos: Consulting and/or lecture fees from Alliance for Better Bone Health, Amgen, Eli Lilly, Glaxo Smith Kline, Merck & Co, Novartis and Wyeth.

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Kanis, J.A., Hans, D., Cooper, C. et al. Interpretation and use of FRAX in clinical practice. Osteoporos Int 22, 2395–2411 (2011). https://doi.org/10.1007/s00198-011-1713-z

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