Dr Brown has served as a consultant to Eli Lilly & Co., Novartis, Procter & Gamble, and Sanofi-Aventis. Dr Leslie has received speaker fees, research honoraria, and research grants from Merck Frosst Canada, in addition to research honoraria and grants from Sanofi-Aventis and Procter & Gamble Pharmaceuticals Canada. Dr Papaloannou has received grants from and served as a consultant to Eli Lilly & Co., Merck, Aventis-Sanofi, Procter & Gamble, Novartis, and Amgen. Dr Hanley holds consultancies with Merck Frosst, Eli Lilly Canada, Procter & Gamble, NPS Pharmaceuticals, Novartis, and Paladin. Dr Adachi has served as a consultant to Amgen, Astra Zeneca, Eli Lilly, Merck, Novartis, Pfizer, Roche, and GlaxoSmithKline. All other authors state that they have no conflicts of interest.
Changes to Osteoporosis Prevalence According to Method of Risk Assessment†
Version of Record online: 13 NOV 2006
Copyright © 2007 ASBMR
Journal of Bone and Mineral Research
Volume 22, Issue 2, pages 228–234, February 2007
How to Cite
Richards, J. B., Leslie, W. D., Joseph, L., Siminoski, K., Hanley, D. A., Adachi, J. D., Brown, J. P., Morin, S., Papaioannou, A., Josse, R. G., Prior, J. C., Davison, K. S., Tenenhouse, A. and Goltzman, D. (2007), Changes to Osteoporosis Prevalence According to Method of Risk Assessment. J Bone Miner Res, 22: 228–234. doi: 10.1359/jbmr.061109
- Issue online: 4 DEC 2009
- Version of Record online: 13 NOV 2006
- Manuscript Accepted: 7 NOV 2006
- Manuscript Revised: 12 OCT 2006
- Manuscript Received: 31 JUL 2006
- absolute risk;
- intervention thresholds;
- fracture probability
The impact of clinical risk factor–based absolute risk methods on the prevalence of high risk for osteoporotic fracture is unknown. We applied absolute risk methods to 6646 subjects and found that the prevalence of elderly women deemed to be at high risk increased substantially, whereas the overall prevalence was highly dependent on the threshold used to designate high risk.
Introduction: Many groups have advocated using absolute risk methods that incorporate clinical risk factors to target patients for osteoporosis therapy. We examined how the application of such absolute risk classification systems influences the prevalence of those considered to be at high risk for osteoporotic fracture and compared these systems to one based solely on BMD.
Materials and Methods: Using 6646 subjects from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective, randomly selected, population-based cohort, we assessed three different systems for determining prevalence of high risk for osteoporotic fracture: a BMD-based system; a simplified risk factor system incorporating age, sex, BMD, and two clinical risk factors; and a comprehensive system, incorporating age, sex, BMD, and seven clinical risk factors. The 10-year absolute risks of incident fragility fracture were compared across systems using three different high-risk thresholds.
Results: The prevalence of a T score ≤ −2.5 was 18.8% (95% CI: 17.7–19.9%) in women and 3.9% (95% CI: 3.0–4.7%) in men. Using a 15% 10-year risk of fracture threshold, the prevalence of women at high risk increased to 46.9% (95% CI: 45.4–48.4) and 42.5% (95% CI: 41.1–43.9) when the comprehensive and simplified risk factor classification systems were used, respectively. Using a 25% 10-year absolute risk threshold, the prevalence of high risk was similar to that of the BMD-based system, whereas the 20% threshold gave intermediate rates. All thresholds analyzed resulted in an increased prevalence of older women at high risk for fracture, whereas only the 15% 10-year risk of fracture threshold resulted in an increase in the prevalence of men at high risk.
Conclusions: The application of risk factor–based systems results in an increased prevalence of older women at high risk. The prevalence of individuals at high risk may increase with changes to the methods used to determine those who are eligible for therapy. These data have important implications for the pattern of care and costs of treating osteoporotic fractures.