Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk

John A Kanis^{1

2}, Nicholas C Harvey^{3

4}, Mattias Lorentzon^{5

6}, Enwu Liu⁵, Marian Schini⁷, Bo Abrahamsen⁸, Jonathan D Adachi⁹, Majed Alokail¹⁰, Fredrik Borgstrom¹¹, Olivier Bruyère¹², John J Carey¹³, Patricia Clark^{14

15}, Cyrus Cooper^{3

4

16}, Elizabeth M Curtis³, Elaine M Dennison^{3

17}, Manuel Díaz-Curiel¹⁸, Hans P Dimai¹⁹, Daniel Grigorie^{20

21}, Mickael Hiligsmann²², Patricia Khashayar²³, Willem Lems²⁴, E Michael Lewiecki²⁵, Roman S Lorenc²⁶, Alexandra Papaioannou²⁷, Jean-Yves Reginster²⁸, René Rizzoli²⁹, Eric Shiroma³⁰, Stuart L Silverman³¹, Eleanor Simonsick³², Manuel Sosa-Henríquez³³, Pawel Szulc³⁴, Kate A Ward^{3

35}, Noriko Yoshimura³⁶, Helena Johansson^{5

6}, Liesbeth Vandenput⁵, Eugene V McCloskey^{37

7

38}; Board of IOF, and the IOF Working Group on Epidemiology and Quality of Life

Collaborators, Affiliations

Collaborators

Board of IOF, and the IOF Working Group on Epidemiology and Quality of Life:
Celia L Gregson, Edith Lau, Paul Lips, Sergio Ortolani, Alexandra Papaioannou, Bess Dawson-Hughes, Famida Jiwa

Affiliations

¹ Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia. w.j.pontefract@shef.ac.uk.
² Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. w.j.pontefract@shef.ac.uk.
³ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
⁴ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵ Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia.
⁶ Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
⁸ Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁹ Department of Medicine, McMaster University, Hamilton, Canada.
¹⁰ Biochemistry Department, College of Science, Riyadh, Kingdom of Saudi Arabia.
¹¹ Quantify Research, Stockholm, Sweden.
¹² Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹³ School of Medicine, University of Galway, Galway, Ireland.
¹⁴ Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico.
¹⁵ Faculty of Medicine of National Autonomous University of Mexico (Universidad, Nacional Autónoma de México), Mexico City, Mexico.
¹⁶ NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁷ Victoria University of Wellington, Wellington, New Zealand.
¹⁸ Metabolic Bone Diseases Unit, Department of Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.
¹⁹ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Styria, Austria.
²⁰ Carol Davila University of Medicine, Bucharest, Romania.
²¹ Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania.
²² Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
²³ International Institute for Biosensing, University of Minnesota, Minneapolis, USA.
²⁴ Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
²⁵ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
²⁶ Multidisciplinary Osteoporosis Forum, Warsaw, Poland, Poland.
²⁷ McMaster University, Hamilton, ON, Canada.
²⁸ Protein Research Chair, Biochemistry Dept, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
²⁹ Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
³⁰ Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA.
³¹ Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³² Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA.
³³ University of Las Palmas de Gran Canaria, Grand Canaries, Spain.
³⁴ INSERM UMR 1033, University of Lyon, Hospital Edouard Herriot, Lyon, France.
³⁵ MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Banjul, The Gambia.
³⁶ Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
³⁷ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
³⁸ Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.

PMID: 38960982
DOI: 10.1007/s00198-024-07162-w

Free article

Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk

John A Kanis et al. Osteoporos Int. 2024 Sep.

Free article

. 2024 Sep;35(9):1487-1496.

doi: 10.1007/s00198-024-07162-w. Epub 2024 Jul 3.

Authors

Collaborators

Board of IOF, and the IOF Working Group on Epidemiology and Quality of Life:
Celia L Gregson, Edith Lau, Paul Lips, Sergio Ortolani, Alexandra Papaioannou, Bess Dawson-Hughes, Famida Jiwa

Affiliations

¹ Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia. w.j.pontefract@shef.ac.uk.
² Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. w.j.pontefract@shef.ac.uk.
³ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
⁴ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵ Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia.
⁶ Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
⁸ Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁹ Department of Medicine, McMaster University, Hamilton, Canada.
¹⁰ Biochemistry Department, College of Science, Riyadh, Kingdom of Saudi Arabia.
¹¹ Quantify Research, Stockholm, Sweden.
¹² Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹³ School of Medicine, University of Galway, Galway, Ireland.
¹⁴ Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico.
¹⁵ Faculty of Medicine of National Autonomous University of Mexico (Universidad, Nacional Autónoma de México), Mexico City, Mexico.
¹⁶ NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁷ Victoria University of Wellington, Wellington, New Zealand.
¹⁸ Metabolic Bone Diseases Unit, Department of Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.
¹⁹ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Styria, Austria.
²⁰ Carol Davila University of Medicine, Bucharest, Romania.
²¹ Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania.
²² Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
²³ International Institute for Biosensing, University of Minnesota, Minneapolis, USA.
²⁴ Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
²⁵ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
²⁶ Multidisciplinary Osteoporosis Forum, Warsaw, Poland, Poland.
²⁷ McMaster University, Hamilton, ON, Canada.
²⁸ Protein Research Chair, Biochemistry Dept, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
²⁹ Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
³⁰ Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA.
³¹ Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³² Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA.
³³ University of Las Palmas de Gran Canaria, Grand Canaries, Spain.
³⁴ INSERM UMR 1033, University of Lyon, Hospital Edouard Herriot, Lyon, France.
³⁵ MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Banjul, The Gambia.
³⁶ Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
³⁷ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
³⁸ Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.

PMID: 38960982
DOI: 10.1007/s00198-024-07162-w

Abstract

Task Force on 'Clinical Algorithms for Fracture Risk' commissioned by the American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee has recommended that FRAX® models in the US do not include adjustment for race and ethnicity. This position paper finds that an agnostic model would unfairly discriminate against the Black, Asian and Hispanic communities and recommends the retention of ethnic and race-specific FRAX models for the US, preferably with updated data on fracture and death hazards. In contrast, the use of intervention thresholds based on a fixed bone mineral density unfairly discriminates against the Black, Asian and Hispanic communities in the US. This position of the Working Group on Epidemiology and Quality of Life of the International Osteoporosis Foundation (IOF) is endorsed both by the IOF and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Keywords: FRAX adjustment; Fracture probability; Race and ethnicity; Racism.

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References

1. Burnett-Bowie S-AM, Wright NC, Yu EW, Langsetmo L, Yearwood GMH, Crandall CJ, Leslie WD, Cauley JA (2024) The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. J Bone Miner Res 9:zjae048. https://doi.org/10.1093/jbmr/zjae048 - DOI
1. Vyas DA, Eisenstein LG, Jones DS (2020) Hidden in plain sight—reconsidering the use of race correction in clinical algorithms. N Engl J Med 383:874–882 - PubMed - DOI
1. Flanagin A, Frey T, Christiansen SL, AMA Manual of Style Committee (2021) Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA 326:621–627 - PubMed - DOI
1. Reid HW, Selvan B, Batch BC, Lee RH (2021) The break in FRAX: equity concerns in estimating fracture risk in racial and ethnic minorities. J Am Geriatr Soc 69:2692–2695 Erratum in: J Am Geriatr Soc. 2021 Oct 14 - PubMed - PMC - DOI
1. Jain RK, Weiner M, Polley E, Iwamaye A, Huang E, Vokes T (2023) Electronic health records (EHRs) can identify patients at high risk of fracture but require substantial race adjustments to currently available fracture risk calculators. J Gen Intern Med 38:3451–3459 - PubMed - DOI

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Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk

Collaborators

Affiliations

Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk

Authors

Collaborators

Affiliations

Abstract

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical