John A Kanis

..Current and past use of corticosteroids was an important predictor of fracture risk that was independent of prior fracture and BMD...

..These findings need to be validated in other cohorts at different ages and from different regions of the world...

..Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk of fractures due to osteoporosis...

..The incorporation of FRAX into assessment guidelines is likely to redirect treatments for osteoporosis from younger women at low risk to elderly women at high fracture risk...

..There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries...

..The decrease in relative risk with age is, however, associated with an increase in absolute risk. Thus, for clinical use, the expression of absolute risks may be preferred to relative risks...

..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..

..Recent studies have evaluated the performance of FRAX® in independent cohorts. The interpretation of most is problematic for reasons summarised in this perspective...

..Its identification on an international basis supports the use of this risk factor in case-finding strategies...

..Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold...

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..Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis...

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..The competitive price of generic bisphosphonates has had a marked effect on practice guidelines, but an increasing body of evidence suggests that they have more limited effectiveness than generally assumed...

..We conclude that a minority of deaths following hospitalization for vertebral fracture are attributable to the fracture itself under the assumptions we used...

..The aims of this study were to determine the magnitude of the increase in fracture risk after hospitalization for stroke, and in particular to determine the time course of this risk...

..Many treatments can be provided cost-effectively to men and women if hip fracture probability over 10 years ranges from 2% to 10% dependent on age...

..Hip fracture was a more common cause for mortality than pancreatic or stomach cancer. Thus, interventions that decreased hip fracture rate by, say, 50% would avoid 0.75% or more of all deaths...

..Denosumab significantly decreased the risk of clinical osteoporotic fractures in postmenopausal women. Overall, the efficacy of denosumab was greater in those at moderate to high risk of fracture as assessed by FRAX...

..This synthesis was presented to the expert panel and constitutes the data on which the subsequent Official Positions are predicated. A summary of the Clinical Task Force composition and charge is presented here...

..We conclude that reported intake of alcohol confers a risk of some importance beyond that explained by BMD. The validation of this risk factor on an international basis permits its use in case-finding strategies...

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..We conclude that a self-reported low intake of milk is not associated with any marked increase in fracture risk and that the use of this risk indicator is of little or no value in case-finding strategies...

..Having multiple vertebral fractures was associated with greater risk of incident osteoporotic fractures and hip fractures...

..5 SD or more below the average for young adult women. The adoption of DXA as a reference standard provides a platform on which the performance characteristics of less well established and new methodologies can be compared...

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..Notwithstanding, the present models provide an aid to enhance patient assessment by the integration of clinical risk factors alone and/or in combination with BMD...

..There was no significant effect on non-vertebral fracture...

..This brief review addresses the development of FRAX since then and describes some of the issues that continue to be discussed as FRAX plays an increasing role in clinical practice...

..No significant effect was noted on the risk of clinical fractures, but fracture risk reduction was reported in a post hoc subgroup analysis in a high risk group categorised on the basis of BMD and prior fracture...

..The categorization of hip fracture probabilities can be used to adjust intervention thresholds based on age, sex, and relative risk from a reference population such as Sweden...

..Notwithstanding, the present models provide an aid to enhance patient assessment by the integration of clinical risk factors alone and/or in combination with BMD. This article describes the steps undertaken in the development of FRAX...

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..The tool increases sensitivity without trading specificity, and is now being used in the reappraisal of clinical guidelines...

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..The effect occurred in the absence of systematic calcium and vitamin D supplementation and was observed across a wide range of BMDs...

..The incidence of vertebral fractures was significantly reduced by 46%. The effect was not modified by the underlying cause of osteoporosis or other baseline factors including bone mineral density, QUS, weight, and smoking...

..More research is clearly required to address these deficiencies before biochemical markers might contribute a useful independent risk factor for inclusion in FRAX(®)...

..We conclude that osteoporosis accounts for approximately half of all hip fractures. Strategies to prevent osteoporosis could save up to 50 % of all hip fractures...

..The gender-related differences reported in this analysis should be taken into account when designing screening and treatment strategies for prevention of hip fracture in men...

..4; 95% CI, 0.93, 6.23). CONCLUSIONS: Prevalent vertebral fractures in osteoporotic patients are associated with increased mortality. Other known predictors of mortality can explain a significant proportion of the excess risk...

..0 (95% CI;2.6, 6.0)). In summary, the risk of a subsequent vertebral fracture in individuals with preexisting deformities is importantly influenced by the characteristics of these deformities...

..A pharmaco-economic model that used individualized risks for fractures was developed in order to take into account patient heterogeneity...

..Its validation on an international basis permits its use in case finding strategies. Its use should, however, take account of the variations in predictive value with age and BMD...

..006) and lower LS BMD values (p = 0.008) at baseline. These data suggest that the efficacy of raloxifene in reducing vertebral fractures is largely independent of the presence of clinical risk factors for osteoporotic fractures...

..In women, early menopause, current smoking, and walking aid use are additional independent risk factors for incident vertebral fractures...

..Case-finding strategies that combine clinical risk indicators with BMD have increased efficiency, while having a modest impact on the number of individuals requiring treatment. Therefore, the cost-effectiveness is enhanced...

..The Multiple Outcomes of Raloxifene Evaluation (MORE) study showed that treatment with raloxifene reduces the risk of vertebral fracture and breast cancer in postmenopausal women with osteoporosis...

..5% in Mexican women and 3.8% in Mexican men. We conclude that hip fractures are an important health problem in Mexico and that Mexican health authorities should consider public health programs to prevent hip fractures...

..9% to 26.6% and from 52.6% to 70.5% for SI Z-scores of +2 and -3, respectively. The combined use of CRFs and QUS SI is a promising tool to assess hip fracture probability in elderly women, especially when access to DXA is limited...

..Given to patients with primary breast cancer, clodronate might reduce the subsequent incidence of bone metastases...

..In conclusion, limited HRT administered in the early postmenopausal years offers long-lasting benefits for the prevention of postmenopausal bone loss and osteoporotic fracture...

..The guidelines should be harmonized between European and American regulatory authorities to ensure comparability of results of studies and to foster global harmonization of regulatory requirements...

..The purpose of the study was to assess the cost effectiveness of hormone therapy (HT) for postmenopausal women without menopausal symptoms at an increased risk of fracture in Sweden, the UK and the US...

..We conclude that alendronate is a cost-effective agent for the prevention and treatment of fractures associated with osteoporosis. These findings, suitable for informing practice guidance, contrast with recent appraisals from NICE...

..The study design should be randomized, parallel, double-blind, and placebo-controlled, and all fracture subjects should receive a standardized method of fracture fixation, defined as Standard of Care...