Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Osteoporos Int. 2012 Mar;23(3):861-9. doi: 10.1007/s00198-011-1852-2. Epub 2011 Nov 26.
The FRAX tool has been calibrated to the entire Dutch population, using nationwide (hip) fracture incidence rates and mortality statistics from the Netherlands. Data used for the Dutch model are described in this paper.
Risk communication and decision making about whether or not to treat with anti-osteoporotic drugs with the use of T-scores are often unclear for patients. The recently developed FRAX models use easily obtainable clinical risk factors to estimate an individual's 10-year probability of a major osteoporotic fracture and hip fracture that is useful for risk communication and subsequent decision making in clinical practice. As of July 1, 2010, the tool has been calibrated to the total Dutch population. This paper describes the data used to develop the current Dutch FRAX model and illustrates its features compared to other countries.
Age- and sex-stratified hip fracture incidence rates (LMR database) and mortality rates (Dutch national mortality statistics) for 2004 and 2005 were extracted from Dutch nationwide databases (patients aged 50+ years). For other major fractures, Dutch incidence rates were imputed, using Swedish ratios for hip to osteoporotic fracture (upper arm, wrist, hip, and clinically symptomatic vertebral) probabilities (age- and gender-stratified). The FRAX tool takes into account age, sex, body mass index (BMI), presence of clinical risk factors, and bone mineral density (BMD).
Fracture incidence rates increased with increasing age: for hip fracture, incidence rates were lowest among Dutch patients aged 50-54 years (per 10,000 inhabitants: 2.3 for men, 2.1 for women) and highest among the oldest subjects (95-99 years; 169 of 10,000 for men, 267 of 10,000 for women). Ten-year probability of hip or major osteoporotic fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T-score. Parental hip fracture accounted for the greatest increase in 10-year fracture probability.
The Dutch FRAX tool is the first fracture prediction model that has been calibrated to the total Dutch population, using nationwide incidence rates for hip fracture and mortality rates. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Dutch FRAX tool a good candidate for implementation into clinical practice.
FRAX 工具已针对荷兰全国范围内（髋部）骨折发生率和死亡率统计数据进行校准，以适用于全体荷兰人群。本文介绍了用于荷兰模型的数据。
使用 T 评分进行风险沟通和是否使用抗骨质疏松药物治疗的决策，对患者来说往往不明确。最近开发的 FRAX 模型使用容易获得的临床危险因素来估计个体 10 年内发生主要骨质疏松性骨折和髋部骨折的概率，这对于风险沟通和随后的临床实践决策很有用。截至 2010 年 7 月 1 日，该工具已针对全体荷兰人群进行校准。本文介绍了用于开发当前荷兰 FRAX 模型的数据，并说明了与其他国家相比的特点。
从荷兰全国范围内的数据库（年龄≥50 岁的患者）中提取了 2004 年和 2005 年按年龄和性别分层的髋部骨折发生率（LMR 数据库）和死亡率（荷兰国家死亡率统计数据）。对于其他主要骨折，使用瑞典的髋部骨折与骨质疏松性骨折（上臂、腕部、髋部和有症状的椎体）概率比（按年龄和性别分层）对荷兰的发生率进行了推断。FRAX 工具考虑了年龄、性别、体重指数（BMI）、临床危险因素的存在情况和骨密度（BMD）。
骨折发生率随年龄增长而增加：对于髋部骨折，荷兰患者中年龄 50-54 岁的发生率最低（每 10,000 名居民：男性 2.3 例，女性 2.1 例），年龄最大的患者（95-99 岁）的发生率最高（男性 169 例/10,000，女性 267 例/10,000）。存在临床危险因素、BMI 较低、女性、年龄较大和 BMD T 评分较低的患者，发生髋部或主要骨质疏松性骨折的 10 年概率增加。父母髋部骨折对 10 年骨折概率的影响最大。
荷兰 FRAX 工具是第一个针对全体荷兰人群进行校准的骨折预测模型，使用了全国范围内的髋部骨折发生率和死亡率。它基于原始的 FRAX 方法学，该方法学已在几个独立的队列中得到外部验证。尽管存在一些局限性，但该模型的优势使其成为临床实践中实施的一个很好的候选方案。
