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Time to clinically relevant fracture risk scores in postmenopausal women
2017-03-16

Am J Med. 2017 Mar 8. pii: S0002-9343(17)30218-8.

doi: 10.1016/j.amjmed.2017.02.012. [Epub ahead of print]

Author
Gourlay ML1, Overman RA2, Fine JP3, Crandall CJ4, Robbins J5, Schousboe JT6, Ensrud KE7, LeBlanc ES8, Gass ML9, Johnson KC10, Womack CR10, LaCroix AZ11; Women’s Health Initiative Investigators.
 
Author information
1. Department of Family Medicine,. Electronic address: margaret_gourlay@med.unc.edu.

2. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy.

3. Department of Biostatistics, University of North Carolina, Chapel Hill, NC.

4. Department of Medicine, University of California, Los Angeles, Los Angeles, CA.

5. University of California at Davis, Sacramento, CA.

6. Division of Health Policy and Management.

7. Department of Medicine, Division of Epidemiology, University of Minnesota; Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN.

8. Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.

9. Cleveland, OH.

10. Department of Preventive Medicine and Medicine, University of Tennessee Health Science Center, Memphis, TN.

11. Division of Epidemiology, School of Medicine, University of California at San Diego, San Diego, California.

Abstract

BACKGROUND:

Clinical practice guidelines recommend use of fracture risk scores for screening and pharmacologic treatment decisions. The timing of occurrence of treatment-level (according to 2014 National Osteoporosis Foundation guidelines) or screening-level (according to 2011 US Preventive Services Task Force guidelines) fracture risk scores has not been estimated in postmenopausal women.

METHODS:

We conducted a retrospective competing risk analysis of new occurrence of treatment-level and screening-level fracture risk scores in postmenopausal women aged 50 and older, before receipt of pharmacologic treatment and before first hip or clinical vertebral fracture.

RESULTS:

In 54,280 postmenopausal women aged 50 to 64 without a bone mineral density test, the time for 10% to develop a treatment-level FRAX® could not be estimated accurately because of rare incidence of treatment-level scores. In 6096 women who had FRAX scores calculated with bone mineral density, the estimated unadjusted time to treatment-level FRAX ranged from 7.6 years (95% CI, 6.6, 8.7) for those aged 65 to 69 to 5.1 years (95% CI, 3.5, 7.5) for those aged 75 to 79 at baseline. Of 17,967 women aged 50 to 64 with a screening-level FRAX at baseline, 100 (0.6%) experienced a hip or clinical vertebral fracture by age 65.

CONCLUSIONS:

Postmenopausal women with sub-threshold fracture risk scores at baseline were unlikely to develop a treatment-level FRAX score between ages 50 and 64. After age 65, the increased incidence of treatment-level fracture risk scores, osteoporosis and major osteoporotic fracture supports more frequent consideration of FRAX and bone mineral density testing.



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