Abstract
Summary
The introduction of the WHO FRAX® algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. Its use in fracture risk prediction has strengths, but also limitations of which the clinician should be aware and are the focus of this review
Introduction
The International Osteoporosis Foundation (IOF) and the International Society for Clinical Densitometry (ISCD) appointed a joint Task Force to develop resource documents in order to make recommendations on how to improve FRAX and better inform clinicians who use FRAX. The Task Force met in November 2010 for 3 days to discuss these topics which form the focus of this review.
Methods
This study reviews the resource documents and joint position statements of ISCD and IOF.
Results
Details on the clinical risk factors currently used in FRAX are provided, and the reasons for the exclusion of others are provided. Recommendations are made for the development of surrogate models where country-specific FRAX models are not available.
Conclusions
The wish list of clinicians for the modulation of FRAX is large, but in many instances, these wishes cannot presently be fulfilled; however, an explanation and understanding of the reasons may be helpful in translating the information provided by FRAX into clinical practice.
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Acknowledgements
This paper was reviewed and endorsed by the Committee of Scientific Advisors of the IOF. The FRAX Initiative comprised the organisers, task force liaisons, the members of the three Task Forces and the expert panel.
Organisers
Didier Hans (Co-chair), Cyrus Cooper (co-chair), Sanford Baim, Bess Dawson-Hughes, John A Kanis, William D Leslie, Marjory Lucky, Rene Rizzoli, Catalina Poiana, John P Bilezikian (moderator) and Socrates E Papapoulos (moderator).
FRAX Clinical
Eugene McCloskey (Chair); Neil Binkley (Co-chair); Jonathan Adachi and Sanford Baim (programme committee liaison); Dennis Black, Robert Blank, Susan Broy and Bess Dawson-Hughes (programme committee liaison) and Sergio Ortolani, Hans Peter Dimai, Michael Kleerekoper, Marc-Antoine Krieg, Bente Langdahl, Andrew Laster, Edward Leib, Tahir Masud, Mike McClung, Rene Rizzoli, Kenneth Saag and Ethel Siris.
FRAX BMD
E Michael Lewiecki (Chair); Juliet Compston (Co-chair); Jonathan Adachi Judith Adams, Robert Adler, Doug Bauer Glen Blake, Patricia Clark, Adolfo Diez-Perez, Didier Hans and John A Kanis (programme committee liaison); Marc-Antoine Krieg, Didier Hans and William Leslie (programme committee liaison) and Alireza Moayyeri, Robert Josse, David Kendler, Aliya Khan, Brian Lentle, Roman Lorenc, Basel Masri and Paul Miller.
FRAX International
Jane Cauley (Chair); Ghada El-Hajj Fuleihan (Co-chair); Asma Arabi, Andrew Calderon, Zhao Chen, Siok Bee Chinoh, Jeffry Curtis, Michelle Danielson, Saeko Fujiwara, David Hanley, Heikki Kroger, Annie Kung, Olga Lesnyak, Anne Looker and Marjorie Luckey (programme committee liaison); Dan Mellstrom, Jeri Nieves, Wojciech Pluskiewicz, Rola El Rassi and René Rizzoli (programme committee liaison) and Sergio Ragi-Eis, Anna Marie Schott-Pethelaz and Stuart Silverman.
Expert panel
Socrates E Papapoulos (moderator), John P Bilezikian (moderator) and Jonathan Adachi, Robert D Blank, Roland Chapurlat, Wu (Paulo) Chih-Hsing, Edward Czerwinski, Aldolfo Diez-Perez, Hans Peter Dimai, Ghada El-Hajj Fuleihan, Saeko Fujiwara, Ruxandra M Ionescu, John A Kanis, Mike McClung, Paul Miller, Sergio Ragi-Eis, Jan Stepan, Kenneth Saag, John T Schousboe, Wei Yu and Cristiano Zerbini.
Support staff
Peter D. Brown (ISCD), Patrice McKenney (IOF) and Helena Johansson, Judit Nagy, Anders Oden and Denys A Wahl.
Conflicts of interest
S Baim, JP Bilezikian, JE Compston, G El-Hajj Fuleihan, A Oden, B Dawson-Hughes, EM Lewiecki, DA Wahl, H Johansson and D Hans have no competing interests to declare with regard to this manuscript. JA Kanis and E McCloskey: Consulting fees, paid advisory boards, lecture fees, and/or grant support from the majority of companies concerned with skeletal metabolism. WD Leslie: Speaker fees and unrestricted research grants from Amgen and Merck Frosst; unrestricted research grants from Sanofi-Aventis, Warner Chilcott (formerly Procter & Gamble), Novartis, Amgen, Genzyme; advisory boards for Genzyme, Novartis, and Amgen. J Cauley: Consultant to Novartis for the HORIZON steering committee and receives research funding for the HORIZON trial. C Cooper: Consulting fees and paid advisory boards for Alliance for Better Bone Health, Glaxo Smith Kline, Roche, Merck Sharp and Dohme, Lilly, Amgen, Wyeth, Novartis, Servier, and Nycomed. R Rizzoli: Paid advisory boards and lecture fee for Merck Sharp and Dohme, Eli Lilly, Amgen, Wyeth, Novartis, Servier, Nycomed, and Danone. N Binkley: Consulting fees and research support from Amgen, Lilly, Merck and Tarsa. M Luckey: Consulting fees and lecture fees from Merck Sharp and Dohme, Eli Lilly, Amgen, Novartis and Tarsa Pharmaceuticals. C Poiana: Lecture fees and paid advisory boards for Amgen, Merck Sharp and Dohme, Glaxo Smith Kline and Novartis. S Papapoulos: Consulting and/or lecture fees from Alliance for Better Bone Health, Amgen, Eli Lilly, Glaxo Smith Kline, Merck & Co, Novartis and Wyeth.
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Kanis, J.A., Hans, D., Cooper, C. et al. Interpretation and use of FRAX in clinical practice. Osteoporos Int 22, 2395–2411 (2011). https://doi.org/10.1007/s00198-011-1713-z
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DOI: https://doi.org/10.1007/s00198-011-1713-z