A FRAX Experience in Korea: Fracture Risk Probabilities with a Country-specific Versus a Surrogate Model
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background: Recently, a Korean fracture-risk assessment tool (FRAX) model has become available, but large prospective cohort studies, which are needed to validate the model, are still lacking, and there has been little effort to evaluate its usefulness. This study evaluated the clinical usefulness of the FRAX model, a FRAX developed by the World Health Organization, in Korea. Methods: In 405 postmenopausal women and 139 men with a proximal femoral fracture, 10-year predicted fracture probabilities calculated by the Korean FRAX model (a country-specific model) were compared with the probabilities calculated with a FRAX model for Japan, which has a similar ethnic background (surrogate model). Results: The 10-year probabilities of major osteoporotic and hip fractures calculated by the Korean model were significantly lower than those calculated by the Japanese model in women and men. The fracture probabilities calculated by each model increased significantly with age in both sexes. In patients aged 70 or older, however, there was a significant difference between the two models. In addition, the Korean model led to lower probabilities for major osteoporotic fracture and hip fracture in women when BMD was excluded from the model than when it was included. Conclusions: The 10-year fracture probabilities calculated with FRAX models might differ between country-specific and surrogate models, and caution is needed when applying a surrogate model to a new population. A large prospective study is warranted to validate the country-specific Korean model in the general population.
Abstract
Background: Recently, a Korean fracture-risk assessment tool (FRAX) model has become available, but large prospective cohort studies, which are needed to validate the model, are still lacking, and there has been little effort to evaluate its usefulness. This study evaluated the clinical usefulness of the FRAX model, a FRAX developed by the World Health Organization, in Korea. Methods: In 405 postmenopausal women and 139 men with a proximal femoral fracture, 10-year predicted fracture probabilities calculated by the Korean FRAX model (a country-specific model) were compared with the probabilities calculated with a FRAX model for Japan, which has a similar ethnic background (surrogate model). Results: The 10-year probabilities of major osteoporotic and hip fractures calculated by the Korean model were significantly lower than those calculated by the Japanese model in women and men. The fracture probabilities calculated by each model increased significantly with age in both sexes. In patients aged 70 or older, however, there was a significant difference between the two models. In addition, the Korean model led to lower probabilities for major osteoporotic fracture and hip fracture in women when BMD was excluded from the model than when it was included. Conclusions: The 10-year fracture probabilities calculated with FRAX models might differ between country-specific and surrogate models, and caution is needed when applying a surrogate model to a new population. A large prospective study is warranted to validate the country-specific Korean model in the general population.
참고문헌 (27)
- Braithwaite RS, "Estimating hip fracture morbidity, mortality and costs", J Am Geriatr Soc, 51, pp.364~370 (2003)
- Miller PD, "Bone densitometry : the best way to detect osteoporosis and to monitor therapy", J Clin Endocrinol Metab, 84, pp.1867~1871 (1999)
- Siris ES, "Bone mineral density thresholds for pharmacological intervention to prevent fractures", Arch Intern Med, 164, pp.1108~1112 (2004)
- Schuit SC, "Fracture incidence and association with bone mineral density in elderly men and women : the Rotterdam Study", Bone, 34, pp.195~202 (2004)
- Kanis JA, "Assessment of fracture risk", Osteoporos Int, 16, pp.581~589 (2005)
- Kanis JA, "International variations in hip fracture probabilities : implications for risk assessment", J Bone Miner Res, 17, pp.1237~1244 (2002)
- Kanis JA, "FRAX and its applications to clinical practice", Bone, 44, pp.734~743 (2009)
- Kanis JA, "A systematic review of hip fracture incidence and probability of fracture worldwide", Osteoporos Int, 23, pp.2239~2256 (2012)
- Kanis JA, "A new approach to the development of assessment guidelines for osteoporosis", Osteoporos Int, 13, pp.527~536 (2002)
- So GY, "Feasibility of FRAX for Prediction of Osteoporotic Vertebral Fractures in Korea", Asian Spine J, 6, pp.22~28 (2012)
- Lim S, "Incidence of hip fractures in Korea", J Bone Miner Metab, 26, pp.400~405 (2008)
- Orimo H, "The 4th nationwide survey for hip fracture in Japan", Jpn Med J, 4180, pp.25~30 (2006)
- Fujiwara S, "Development and application of a Japanese model of the WHO fracture risk assessment tool(FRAX)", Osteoporos Int, 19, pp.429~435 (2008)
- Park C, "The incidence and residual lifetime risk of osteoporosis-related fractures in Korea", J Bone Miner Metab, 29, pp.744~751 (2011)
- Hagino H, "Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan", Osteoporos Int, 20, pp.543~548 (2009)
- Kanis JA, "FRAX and the assessment of fracture probability in men and women from the UK", Osteoporos Int, 19, pp.385~397 (2008)
- "Vital statistics: Age-specific death rate" (2005)[URL]
- Kanis JA, "Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies", Bone, 30, pp.251~258 (2002)
- Kim JW, "Validation of FRAX without BMD: an age-related analysis of the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-1, 2010)", Bone, 75, pp.27~31 (2015)
- Tamaki J, "Fracture risk prediction using FRAX(R) : a 10-year follow-up survey of the Japanese Population-Based Osteoporosis(JPOS)Cohort Study", Osteoporos Int, 22, pp.3037~3045 (2011)
- Ensrud KE, "A comparison of prediction models for fractures in older women: is more better?", Arch Intern Med, 169, pp.2087~2094 (2009)
- Leslie WD, "Comparison between various fracture risk assessment tools", Osteoporos Int, 25, pp.1~21 (2014)
- Choi YJ, "The prevalence of osteoporosis in Korean adults aged 50 years or older and the higher diagnosis rates in women who were beneficiaries of a national screening program: the Korea National Health and Nutrition Examination Survey 2008-2009", J Bone Miner Res, 27, pp.1879~1886 (2012)
- Silverman SL, "The utility and limitations of FRAX: A US perspective", Curr Osteoporos Rep, 8, pp.192~197 (2010)
- Watts NB, "FRAX facts", J Bone Miner Res, 24, pp.975~979 (2009)
- González-Macías J, "Probability of fractures predicted by FRAX(R) and observed incidence in the Spanish ECOSAP Study cohort", Bone, 50, pp.373~377 (2012)
- Ettinger B, "Performance of FRAX in a cohort of community-dwelling, ambulatory older men: the Osteoporotic Fractures in Men (MrOS) study", Osteoporos Int, 24, pp.1185~1193 (2013)