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FRAX® based intervention thresholds for management of osteoporosis in Singaporean women.
Arch Osteoporos. 2018 11 19; 13(1):130.AO

Abstract

Potential FRAX®-based major osteoporotic fracture (MOF) and hip fracture (HF) intervention thresholds (ITs) for postmenopausal Singaporean women were explored. Age-dependent ethnic-specific and weighted mean ITs progressively increased with increasing age. Fixed ITs were derived via discriminatory value analysis. MOF and HF ITs with highest the Youden index were chosen as optimal.

INTRODUCTION

We aimed to explore FRAX®-based intervention thresholds (ITs) to potentially guide osteoporosis treatment in Singapore, a multi-ethnic nation.

METHOD

One thousand and one Singaporean postmenopausal community-dwelling women belonging to Chinese, Malay and Indian ethnicities underwent clinical risk factor (CRF) and BMD assessment. FRAX® major osteoporotic fracture (MOF) and hip fracture (HF) probabilities were calculated using ethnic-specific models. We employed the translational logic adopted by NOGG (UK), whereby osteoporosis treatment is recommended to any postmenopausal woman whose fracture probability based on other CRFs is similar to or exceeds that of an age-matched woman with a fracture. Using the same logic, ethnic-specific and mean weighted age-dependent ITs were computed. Employing these age-dependent ITs as a reference, the performance of fixed (age-independent) ITs were examined using ROC curves and discriminatory analysis, with the highest Youden index (YI) (sensitivity + specificity - 1) used to identify the optimal MOF and HF ITs.

RESULTS

The mean age was 58.9 (6.9) years. Seven hundred and eighty-nine (79%) women were Chinese, 136 (13.5%) Indian and 76 (7.5%) Malay. Age-dependent MOF ITs ranged from 3.1 to 33%, 2.5 to 17% and 2.5 to 16% whilst HF ITs ranged from 0.7 to 17%, 0.4 to 6% and 0.4 to 6.3% in Chinese, Malay and Indian women, respectively, between the ages of 50 and 90 years. The weighted age-dependent MOF and HF ITs ranged from 2.9% and 0.6%, respectively, at the age of 50, to 28% and 14% at 90 years of age. Fixed MOF/HF ITs of 5.5%/1%, 2.5%/1% and 2.5%/0.25% were identified as the most optimal by the highest YI in Chinese, Malay and Indian women, respectively. Fixed MOFP and HF ITs of 4% and 1%, respectively, were found to be most optimal on the weighted means analysis.

CONCLUSION

The ITs for osteoporosis treatment in Singapore show marked variations across ethnicities. Weighted mean thresholds may overcome the dilemma of intervening at different thresholds for different ethnicities. Choosing fixed ITs may have to involve trade-offs between sensitivity and specificity. FRAX®-based age-dependent or the fixed intervention thresholds suggested as an alternative to be considered for use in Singapore though further studies on the societal and health economic impacts of choosing these thresholds in Singapore are needed.

Authors+Show Affiliations

Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, 20, College Road, Singapore, 169856, Singapore. manju.chandran@singhealth.com.sg.MRC-Arthritis UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK. Metabolic Bone Centre, Northern General Hospital, University of Sheffield, Sheffield, UK.Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore.Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore.Health Services Research Unit (HSRU), Division of Medicine, Singapore General Hospital, Singapore, Singapore.Division of Medicine, Sengkang General Hospital, Singapore, Singapore.Division of Medicine, Singapore General Hospital, Singapore, Singapore.Division of Medicine, Sengkang General Hospital, Singapore, Singapore.Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.Division of Medicine, Sengkang General Hospital, Singapore, Singapore.Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore.Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, 20, College Road, Singapore, 169856, Singapore.Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, 20, College Road, Singapore, 169856, Singapore.Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore.Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30456726

Citation

Chandran, M, et al. "FRAX® Based Intervention Thresholds for Management of Osteoporosis in Singaporean Women." Archives of Osteoporosis, vol. 13, no. 1, 2018, p. 130.
Chandran M, McCloskey EV, Thu WPP, et al. FRAX® based intervention thresholds for management of osteoporosis in Singaporean women. Arch Osteoporos. 2018;13(1):130.
Chandran, M., McCloskey, E. V., Thu, W. P. P., Logan, S., Hao, Y., Tay, D., Ang, W. C., Aung, T. K. K., Choo, K. S., Ali, A., Yan, S. X., Huang, X. F., Liu, X. M., Yong, E. L., & Lekamwasam, S. (2018). FRAX® based intervention thresholds for management of osteoporosis in Singaporean women. Archives of Osteoporosis, 13(1), 130. https://doi.org/10.1007/s11657-018-0542-5
Chandran M, et al. FRAX® Based Intervention Thresholds for Management of Osteoporosis in Singaporean Women. Arch Osteoporos. 2018 11 19;13(1):130. PubMed PMID: 30456726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - FRAX® based intervention thresholds for management of osteoporosis in Singaporean women. AU - Chandran,M, AU - McCloskey,E V, AU - Thu,W P P, AU - Logan,S, AU - Hao,Y, AU - Tay,D, AU - Ang,W C, AU - Aung,T K K, AU - Choo,K S, AU - Ali,A, AU - Yan,S X, AU - Huang,X F, AU - Liu,X M, AU - Yong,E L, AU - Lekamwasam,S, Y1 - 2018/11/19/ PY - 2018/08/27/received PY - 2018/11/07/accepted PY - 2018/11/21/entrez PY - 2018/11/21/pubmed PY - 2019/8/28/medline KW - FRAX KW - Fragility fracture KW - Guidelines KW - Intervention threshold KW - Osteoporosis KW - Singapore KW - Treatment threshold SP - 130 EP - 130 JF - Archives of osteoporosis JO - Arch Osteoporos VL - 13 IS - 1 N2 - : Potential FRAX®-based major osteoporotic fracture (MOF) and hip fracture (HF) intervention thresholds (ITs) for postmenopausal Singaporean women were explored. Age-dependent ethnic-specific and weighted mean ITs progressively increased with increasing age. Fixed ITs were derived via discriminatory value analysis. MOF and HF ITs with highest the Youden index were chosen as optimal. INTRODUCTION: We aimed to explore FRAX®-based intervention thresholds (ITs) to potentially guide osteoporosis treatment in Singapore, a multi-ethnic nation. METHOD: One thousand and one Singaporean postmenopausal community-dwelling women belonging to Chinese, Malay and Indian ethnicities underwent clinical risk factor (CRF) and BMD assessment. FRAX® major osteoporotic fracture (MOF) and hip fracture (HF) probabilities were calculated using ethnic-specific models. We employed the translational logic adopted by NOGG (UK), whereby osteoporosis treatment is recommended to any postmenopausal woman whose fracture probability based on other CRFs is similar to or exceeds that of an age-matched woman with a fracture. Using the same logic, ethnic-specific and mean weighted age-dependent ITs were computed. Employing these age-dependent ITs as a reference, the performance of fixed (age-independent) ITs were examined using ROC curves and discriminatory analysis, with the highest Youden index (YI) (sensitivity + specificity - 1) used to identify the optimal MOF and HF ITs. RESULTS: The mean age was 58.9 (6.9) years. Seven hundred and eighty-nine (79%) women were Chinese, 136 (13.5%) Indian and 76 (7.5%) Malay. Age-dependent MOF ITs ranged from 3.1 to 33%, 2.5 to 17% and 2.5 to 16% whilst HF ITs ranged from 0.7 to 17%, 0.4 to 6% and 0.4 to 6.3% in Chinese, Malay and Indian women, respectively, between the ages of 50 and 90 years. The weighted age-dependent MOF and HF ITs ranged from 2.9% and 0.6%, respectively, at the age of 50, to 28% and 14% at 90 years of age. Fixed MOF/HF ITs of 5.5%/1%, 2.5%/1% and 2.5%/0.25% were identified as the most optimal by the highest YI in Chinese, Malay and Indian women, respectively. Fixed MOFP and HF ITs of 4% and 1%, respectively, were found to be most optimal on the weighted means analysis. CONCLUSION: The ITs for osteoporosis treatment in Singapore show marked variations across ethnicities. Weighted mean thresholds may overcome the dilemma of intervening at different thresholds for different ethnicities. Choosing fixed ITs may have to involve trade-offs between sensitivity and specificity. FRAX®-based age-dependent or the fixed intervention thresholds suggested as an alternative to be considered for use in Singapore though further studies on the societal and health economic impacts of choosing these thresholds in Singapore are needed. SN - 1862-3514 UR - https://www.unboundmedicine.com/medline/citation/30456726/FRAX®_based_intervention_thresholds_for_management_of_osteoporosis_in_Singaporean_women_ L2 - https://dx.doi.org/10.1007/s11657-018-0542-5 DB - PRIME DP - Unbound Medicine ER -