Discrepancies Between Osteoporotic Fracture Evaluations in Men Based on German (DVO) Osteoporosis Guidelines or the FRAX Score

 

 Permissions and Reprints

Abstract

Introduction Established scores estimate 10-year fracture risk in osteoporosis to assist with treatment recommendations. This study compared the risk probabilities of major osteoporotic and hip fractures calculated by the FRAX tool with those of the DVO score, established in German-speaking countries.

Material and Methods This seven-year retrospective study analyzed data of 125 male patients (mean age: 59.2±10.7 years) evaluated for osteoporosis. For the DVO score, the therapy threshold of>30% for vertebral and hip fractures suggested by DVO guidelines was implemented. We calculated fracture risks based on FRAX scores with aBMD and applied a common therapy threshold of≥3% for hip fracture and subsequently determined the “DVO-equivalent risk level” for FRAX-based assessment that would identify as many male patients as identified by the DVO score.

Results Based on DVO score, 60.0% of patients had a 10-year risk of hip and vertebral fractures>30%. The recommendations for individuals based on FRAX scores for hip fracture with aBMD with risk≥3% overlapped with those based on DVO score in 36% of patients. Patients identified for treatment only by DVO score presented a higher percentage of spine fractures (65 vs. 41%). The thresholds for this “DVO-equivalent risk level” for ‘FRAX with aBMD’ was estimated to be≥6.7% for major osteoporotic fracture and≥2.1% for hip fracture.

This study demonstrates that the DVO score was more sensitive than the FRAX score for patients with prevalent spinal fractures. We suggest considering the appropriate score and therapy threshold carefully in the daily care of male patients.

^* Present affiliation:

Publication History

Received: 09 March 2022
Received: 11 September 2022

Accepted: 09 November 2022

Accepted Manuscript online:
11 November 2022

Article published online:
09 January 2023

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Hernlund E, Svedbom A, Ivergard M. et al. Osteoporosis in the European Union: Medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8: 136 DOI: 10.1007/s11657-013-0136-1.
  CrossrefPubMedGoogle Scholar
• 2 Shariati-Sarabi Z, Rezaie HE, Milani N. et al. Evaluation of bone mineral density in perimenopausal period. Archives Bone Jt Surg 2018; 6: 57-62
  PubMedGoogle Scholar
• 3 Lorentzon M, Cummings SR. Osteoporosis: The evolution of a diagnosis. J Intern Med 2015; 277: 650-661 DOI: 10.1111/joim.12369.
  CrossrefPubMedGoogle Scholar
• 4 Misiorowski W. Osteoporosis in men. Przeglad menopauzalny=Menopause review 2017; 16: 70-73 DOI: 10.5114/pm.2017.68596.
  CrossrefPubMedGoogle Scholar
• 5 Hernlund E, Svedbom A, Ivergård M. et al. Osteoporosis in the European Union: Medical management, epidemiology and economic burden. Arch Osteoporos 2013; 8: 136 DOI: 10.1007/s11657-013-0136-1.
  CrossrefPubMedGoogle Scholar
• 6 Tu KN, Lie JD, Wan CKV. et al. Osteoporosis: A review of treatment options. P T 2018; 43: 92-104
  PubMedGoogle Scholar
• 7 Weaver CM, Gordon CM, Janz KF. et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: A systematic review and implementation recommendations. Osteoporos Int 2016; DOI: 10.1007/s00198-015-3440-3.. doi:10.1007/s00198-015-3440-3
  CrossrefPubMedGoogle Scholar
• 8 NIH Consensus Development Panel on Osteoporosis Prevention D, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001; 285: 785-795
  CrossrefPubMedGoogle Scholar
• 9 WHO Consensus development conference prophylaxis and treatment of osteoporosis. 1991
  PubMed
• 10 Kanis JA, Johnell O, De Laet C. et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004; 35: 375-382 DOI: 10.1016/j.bone.2004.03.024.
  CrossrefPubMedGoogle Scholar
• 11 Kanis JA, Harvey NC, Johansson H. et al. Overview of fracture prediction tools. J Clin Densitom 2017; 20: 444-450 DOI: 10.1016/j.jocd.2017.06.013.
  CrossrefPubMedGoogle Scholar
• 12 2017 LO. DVO Leitlinien 2017 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern.2018.
  PubMed
• 13 Lems WF. Clinical relevance of vertebral fractures. Ann Rheum Dis 2007; 66: 2-4 DOI: 10.1136/ard.2006.058313.
  CrossrefPubMedGoogle Scholar
• 14 Kanis JA, Johansson H, Johnell O. et al. Alcohol intake as a risk factor for fracture. Osteoporos Int 2005; 16: 737-742 DOI: 10.1007/s00198-004-1734-y.
  CrossrefPubMedGoogle Scholar
• 15 Kanis JA, Johansson H, Oden A. et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 2004; 19: 893-899 DOI: 10.1359/jbmr.040134.
  CrossrefPubMedGoogle Scholar
• 16 Kanis JA, Oden A, Johnell O. et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 2007; 18: 1033-1046 DOI: 10.1007/s00198-007-0343-y.
  CrossrefPubMedGoogle Scholar
• 17 Pluijm SM, Koes B, de Laet C. et al. A simple risk score for the assessment of absolute fracture risk in general practice based on two longitudinal studies. J Bone Miner Res 2009; 24: 768-774 DOI: 10.1359/jbmr.081244.
  CrossrefPubMedGoogle Scholar
• 18 Zhang X, Yu Z, Yu M. et al. Alcohol consumption and hip fracture risk. Osteoporos Int 2015; 26: 531-542 DOI: 10.1007/s00198-014-2879-y.
  CrossrefPubMedGoogle Scholar
• 19 Kanis JA, Johansson H, Oden A. et al. A family history of fracture and fracture risk: A meta-analysis. Bone 2004; 35: 1029-1037 DOI: 10.1016/j.bone.2004.06.017.
  CrossrefPubMedGoogle Scholar
• 20 Oden A, McCloskey EV, Kanis JA. et al. Burden of high fracture probability worldwide: Secular increases 2010-2040. Osteoporos Int 2015; 26: 2243-2248 DOI: 10.1007/s00198-015-3154-6.
  CrossrefPubMedGoogle Scholar
• 21 Leslie WD, Lix LM, Johansson H. et al. Independent clinical validation of a Canadian FRAX tool: Fracture prediction and model calibration. J Bone Miner Res 2010; 25: 2350-2358 DOI: 10.1002/jbmr.123.
  CrossrefPubMedGoogle Scholar
• 22 Kanis JA, Oden A, Johansson H. et al. Pitfalls in the external validation of FRAX: Response to Bolland et al. Osteoporos Int 2013; 24: 391-392 DOI: 10.1007/s00198-012-1985-y.
  CrossrefPubMedGoogle Scholar
• 23 Faßbender WJ, Scheidt-Nave C, Pfeilschifter J. Die neuen Leitlinien zur Osteoporose. Dtsch Med Wochenschr 2003; 128: 1615-1617 DOI: 10.1055/s-2003-40930.
  Article in Thieme ConnectPubMedGoogle Scholar
• 24 Raspe A, Matthis C, Scheidt-Nave C. et al. [European Study of Vertebral Osteoporosis (EVOS): Design and implementation in 8 German study centers]. Medizinische Klinik (Munich, Germany: 1983) 1998; 93: 12-16,18 DOI: 10.1007/bf03041993.
  CrossrefPubMedGoogle Scholar
• 25 Hofman A, Breteler MMB, van Duijn CM. et al. The Rotterdam Study: Objectives and design update. Eur J Epidemiol 2007; 22: 819-829 DOI: 10.1007/s10654-007-9199-x.
  CrossrefPubMedGoogle Scholar
• 26 Hadji P, Bock O, Resch H. et al. Reduktion des frakturrisikos unter denosumab bei postmenopausalen frauen in abhängigkeit der behandlungsbedürftigkeit nach DVO-Leitlinien 2009. Osteologie 2013; 1: 39-45
  PubMedGoogle Scholar
• 27 Kanis JA, Harvey NC, Cooper C. et al. A systematic review of intervention thresholds based on FRAX: A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos 2016; 11: 25 DOI: 10.1007/s11657-016-0278-z.
  CrossrefPubMedGoogle Scholar
• 28 El Maghraoui A, Roux C. DXA scanning in clinical practice. QJM 2008; 101: 605-617 DOI: 10.1093/qjmed/hcn022.
  CrossrefPubMedGoogle Scholar
• 29 Harvey NC, Oden A, Orwoll E. et al. Falls predict fractures independently of FRAX probability: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study. J Bone Miner Res 2017; DOI: 10.1002/jbmr.3331.. doi:10.1002/jbmr.3331
  CrossrefPubMedGoogle Scholar
• 30 Marques A, Lucas R, Simoes E. et al. Do we need bone mineral density to estimate osteoporotic fracture risk? A 10-year prospective multicentre validation study. RMD open 2017; 3: e000509 DOI: 10.1136/rmdopen-2017-000509.
  CrossrefPubMedGoogle Scholar
• 31 Valentini A, Cianfarani MA, De Meo L. et al. FRAX tool in type 2 diabetic subjects: The use of HbA(1c) in estimating fracture risk. Acta diabetol 2018; 55: 1043-1050 DOI: 10.1007/s00592-018-1187-y.
  CrossrefPubMedGoogle Scholar
• 32 Leslie WD, Lix LM, Johansson H. et al. Spine-hip discordance and fracture risk assessment: A physician-friendly FRAX enhancement. Osteoporos Int 2011; 22: 839-847 DOI: 10.1007/s00198-010-1461-5.
  CrossrefPubMedGoogle Scholar
• 33 Kanis JA, Johnell O, Oden A. et al. The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int 2006; 17: 527-534 DOI: 10.1007/s00198-005-0014-9.
  CrossrefPubMedGoogle Scholar
• 34 Leslie WD, Lix LM, Tsang JF. et al. Single-site vs multisite bone density measurement for fracture prediction. Arch Intern Med 2007; 167: 1641-1647 DOI: 10.1001/archinte.167.15.1641.
  CrossrefPubMedGoogle Scholar
• 35 Giangregorio LM, Leslie WD, Lix LM. et al. FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res 2012; 27: 301-308 DOI: 10.1002/jbmr.556.
  CrossrefPubMedGoogle Scholar
• 36 Reid IR. A broader strategy for osteoporosis interventions. Nat Rev Endocrinol 2020; 16: 333-339 DOI: 10.1038/s41574-020-0339-7.
  CrossrefPubMedGoogle Scholar
• 37 Sandhu SK, Nguyen ND, Center JR. et al. Prognosis of fracture: Evaluation of predictive accuracy of the FRAX algorithm and Garvan nomogram. Osteoporos Int 2010; 21: 863-871 DOI: 10.1007/s00198-009-1026-7.
  CrossrefPubMedGoogle Scholar