Margaret L Gourlay1, Robert A Overman2, Jason P Fine3, Carolyn J Crandall4, John Robbins5, John T Schousboe6, Kristine E Ensrud7, Erin S LeBlanc8, Margery L Gass9, Karen C Johnson10, Catherine R Womack10, Andrea Z LaCroix11. 1. Department of Family Medicine, University of North Carolina, Chapel Hill. Electronic address: margaret_gourlay@med.unc.edu. 2. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. 3. Department of Biostatistics, University of North Carolina, Chapel Hill. 4. Department of Medicine, University of California, Los Angeles. 5. Department of Internal Medicine, University of California at Davis, Sacramento. 6. Division of Health Policy and Management, University of Minnesota, Minneapolis. 7. Department of Medicine, Division of Epidemiology, University of Minnesota, Minneapolis; Department of Medicine, Minneapolis VA Health Care System, Minn. 8. Center for Health Research, Kaiser Permanente Northwest, Portland, Ore. 9. Cleveland, Ohio. 10. Department of Preventive Medicine and Medicine, University of Tennessee Health Science Center, Memphis. 11. Division of Epidemiology, School of Medicine, University of California at San Diego.
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 years and older, prior to receipt of pharmacologic treatment and prior to first hip or clinical vertebral fracture. RESULTS: In 54,280 postmenopausal women aged 50 to 64 years without a bone mineral density test, the time for 10% to develop a treatment-level FRAX score 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% confidence interval [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 years. 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 years. 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.
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 years and older, prior to receipt of pharmacologic treatment and prior to first hip or clinical vertebral fracture. RESULTS: In 54,280 postmenopausal women aged 50 to 64 years without a bone mineral density test, the time for 10% to develop a treatment-level FRAX score 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% confidence interval [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 years. 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 years. 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.
Authors: Margaret Lee Gourlay; Robert A Overman; Jason P Fine; Kristine E Ensrud; Carolyn J Crandall; Margery L Gass; John Robbins; Karen C Johnson; Erin S LeBlanc; Catherine R Womack; John T Schousboe; Andrea Z LaCroix Journal: Menopause Date: 2015-06 Impact factor: 2.953
Authors: Carolyn J Crandall; Joseph C Larson; Nelson B Watts; Margaret L Gourlay; Meghan G Donaldson; Andrea LaCroix; Jane A Cauley; Jean Wactawski-Wende; Margery L Gass; John A Robbins; Kristine E Ensrud Journal: J Clin Endocrinol Metab Date: 2014-12 Impact factor: 5.958
Authors: E Michael Lewiecki; Juliet E Compston; Paul D Miller; Jonathan D Adachi; Judith E Adams; William D Leslie; John A Kanis; Alireza Moayyeri; Robert A Adler; Didier B Hans; David L Kendler; Adolfo Diez-Perez; Marc-Antoine Krieg; Basel K Masri; Roman R Lorenc; Douglas C Bauer; Glen M Blake; Robert G Josse; Patricia Clark; Aliya A Khan Journal: J Clin Densitom Date: 2011 Jul-Sep Impact factor: 2.617
Authors: Carolyn J Crandall; Joseph Larson; Margaret L Gourlay; Meghan G Donaldson; Andrea LaCroix; Jane A Cauley; Jean Wactawski-Wende; Margery L Gass; John A Robbins; Nelson B Watts; Kristine E Ensrud Journal: J Bone Miner Res Date: 2014-07 Impact factor: 6.741
Authors: William D Leslie; Suzanne N Morin; Lisa M Lix; Patrick Martineau; Mark Bryanton; Eugene V McCloskey; Helena Johansson; Nicholas C Harvey; John A Kanis Journal: JAMA Netw Open Date: 2020-01-03
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