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. 2022 Dec 17;18(1):11.
doi: 10.1007/s11657-022-01198-3.

An assessment of intervention thresholds for high fracture risk in Chile

Enrique Lopez Gavilanez  1   2 , Imaicela N Luis  1 , Navarro G Mario  1 , Helena Johansson  3   4   5 , Nicholas C Harvey  6   7 , Mattias Lorentzon  3   5 , Enwu Liu  3 , Liesbeth Vandenput  3   5 , Eugene V McCloskey  4   8 , John A Kanis  9   10
Affiliations

An assessment of intervention thresholds for high fracture risk in Chile

Enrique Lopez Gavilanez et al. Arch Osteoporos. .

Abstract

Assessment and treatment pathways using FRAX-based intervention thresholds in Chile can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low fracture risk.

Purpose: The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Chile based on major osteoporotic fracture (MOF) probabilities derived from FRAX®.

Methods: Intervention and assessment thresholds were derived using methods adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Chile. Age-dependent and hybrid assessment and intervention thresholds were applied to 1998 women and 1122 men age 50 years or more drawn from participants in the National Health Survey 2016-2017.

Results: Approximately 12% of men and women had a prior fragility fracture and would be eligible for treatment for this reason. Using age-dependent thresholds, an additional 2.6% of women (0.3% of men) were eligible for treatment in that MOF probabilities lay above the upper assessment threshold. A BMD test would be recommended in 5% of men and 38% of women. With hybrid thresholds, an additional 13% of women (3.6% of men) were eligible for treatment and BMD recommended in 11% of men and 42% of women.

Conclusion: The application of hybrid intervention thresholds ameliorates the disparity in fracture probabilities seen with age-dependent thresholds. Probability-based assessment of fracture risk, including the use of the hybrid intervention thresholds for Chile, is expected to help guide decisions about treatment.

Keywords: FRAX; Fracture risk assessment; Intervention threshold; Osteoporosis.

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