Prof. Eugene McCloskey's presentation from Osteoporosis 2016: Assessment and intervention thresholds for FRAX probabilities in the UK- Impact on the need for BMD in older women with prior fracture Find out more at: https://nos.org.uk/conference

1. Assessment and intervention
thresholds for FRAX probabilities in the
UK
Impact on the need for BMD in older women with prior
fracture
Eugene McCloskey, Helena Johansson, Anders Oden,
Nicholas Harvey, Juliet Compston, John Kanis

2. Management of patients with prior
fracture
NICE TA161: However, the diagnosis
may be assumed in women aged 75
years or older if the responsible
clinician considers a DXA scan to be
clinically inappropriate or unfeasible.
Woman, aged 77 years, prior fracture, BMI 24, no other risk factors
0
5
10
15
20
25
30
35
40
45
40 45 50 55 60 65 70 75 80 85 90
Age (years)
10 -year probability of major osteoporotic fracture (%)
Treat
Measure BMD
Lifestyle advice
and reassure

3. 0
5
10
15
20
25
30
35
40
45
40 45 50 55 60 65 70 75 80 85 90
Age (years)
10-year probability of major osteoporotic fracture (%)
Treat
Measure BMD
Lifestyle advice
and reassure
Alternative NOGG Assessment Thresholds

4. Study design
• A simulated population of over 50,600 women aged 50-90
years in the UK
o distribution of risk factors similar to that in the European FRAX
derivation cohorts
o UK-matched age distribution
• Current and alternative NOGG thresholds compared to
determine:
o Proportions of population over 70 years with fracture
recommended for treatment before and after BMD

5. Characteristics of the simulated UK
sample (n=50,633)
Age
group
% of
population
Low
BMI
Prior
fracture
Current
smoking
Alcohol
intake
Parental
hip
fracture
Rheum.
arthritis
Glucocorticoid
use
Sec.
osteoporosis
Any
CRF
50-54 17.4 1.2 22.3 21.5 12.0 5.8 4.7 5.1 22.3 61.0
55-59 16.6 0.9 24.9 18.4 11.0 5.6 5.4 5.1 20.2 60.1
60-64 16.9 0.9 27.8 16.4 11.0 5.9 5.4 6.6 19.5 61.2
65-69 13.2 0.9 29.8 12.9 10.1 6.4 5.7 7.1 17.0 60.4
70-74 11.4 0.8 33.8 11.3 10.1 6.0 5.6 7.4 16.3 60.6
75-79 9.4 0.7 36.4 9.1 9.8 6.8 5.5 8.8 14.9 62.0
80-84 7.5 0.9 38.9 7.7 9.8 7.4 5.7 9.6 12.8 63.1
85-90 7.6 1.9 42.9 6.5 9.5 7.3 5.4 10.7 11.3 64.7
≥50 100 1.0 30.1 14.5 10.6 6.2 5.4 7.0 17.9 61.3
Subsequent analysis confined to women aged 70-90 years

6. Impact of alternative threshold in
women aged 70+ with prior fracture

7. Impact of alternative threshold in
women with prior fracture
Age

8. Conclusion
• Guidelines advocate consideration of treatment in most, if
not all, older women with a prior fracture
• The current NOGG threshold would advocate treatment in
approximately half of women aged 70+ years when their
prior fracture is used as a risk factor
• The alternative NOGG threshold would advocate
treatment in 79% of such women with prior fracture, rising
to over 90% in women aged 80+ years
o The role for BMD in fracture risk assessment in very old women
with fracture is limited