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Update of the Fracture Risk Prediction Tool Frax: A Systematic Review of Potential Cohorts and Analysis Plan Publisher Pubmed



Vandenput L1, 2 ; Johansson H1, 3 ; Mccloskey EV3, 4 ; Liu E1 ; Akesson KE5, 6 ; Anderson FA7 ; Azagra R8, 9, 10 ; Bager CL11 ; Beaudart C12 ; Bischoffferrari HA13, 14 ; Biver E15 ; Bruyere O12 ; Cauley JA16 ; Center JR17, 18, 19 Show All Authors
Authors
  1. Vandenput L1, 2
  2. Johansson H1, 3
  3. Mccloskey EV3, 4
  4. Liu E1
  5. Akesson KE5, 6
  6. Anderson FA7
  7. Azagra R8, 9, 10
  8. Bager CL11
  9. Beaudart C12
  10. Bischoffferrari HA13, 14
  11. Biver E15
  12. Bruyere O12
  13. Cauley JA16
  14. Center JR17, 18, 19
  15. Chapurlat R20
  16. Christiansen C11
  17. Cooper C21, 22, 23
  18. Crandall CJ24
  19. Cummings SR25
  20. Da Silva JAP26, 27
  21. Dawsonhughes B28
  22. Diezperez A29
  23. Dufour AB30, 31
  24. Eisman JA18, 19, 32
  25. Elders PJM33
  26. Ferrari S15
  27. Fujita Y34
  28. Fujiwara S35
  29. Gluer CC36
  30. Goldshtein I37, 38
  31. Goltzman D39
  32. Gudnason V40, 41
  33. Hall J42
  34. Hans D43
  35. Hoff M44, 45
  36. Hollick RJ46
  37. Huisman M47, 48
  38. Iki M34
  39. Ishshalom S49
  40. Jones G50
  41. Karlsson MK5, 51
  42. Khosla S52
  43. Kiel DP30, 31
  44. Koh WP53, 54
  45. Koromani F55, 56
  46. Kotowicz MA57, 58, 59
  47. Kroger H60, 61
  48. Kwok T62, 63
  49. Lamy O64, 65
  50. Langhammer A66
  51. Larijani B67
  52. Lippuner K68
  53. Mellstrom D69, 70
  54. Merlijn T33
  55. Nordstrom A71, 72
  56. Nordstrom P73
  57. Oneill TW74, 75
  58. Obermayerpietsch B76, 77
  59. Ohlsson C2, 78
  60. Orwoll ES79
  61. Pasco JA80, 81, 82, 83
  62. Rivadeneira F55
  63. Schei B84, 85
  64. Schott AM86
  65. Shiroma EJ87
  66. Siggeirsdottir K40, 88
  67. Simonsick EM89
  68. Sornayrendu E90
  69. Sund R61
  70. Swart KMA33
  71. Szulc P20
  72. Tamaki J91
  73. Torgerson DJ92
  74. Van Schoor NM47
  75. Van Staa TP93
  76. Vila J94
  77. Wareham NJ95
  78. Wright NC96
  79. Yoshimura N97
  80. Zillikens MC55
  81. Zwart M98, 99, 100
  82. Harvey NC101, 102
  83. Lorentzon M1, 103, 104
  84. Leslie WD105
  85. Kanis JA1, 3, 106
Show Affiliations
Authors Affiliations
  1. 1. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
  2. 2. Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  3. 3. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom
  4. 4. MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, United Kingdom
  5. 5. Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
  6. 6. Department of Orthopedics, Skane University Hospital, Malmo, Sweden
  7. 7. GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, United States
  8. 8. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
  9. 9. Health Center Badia del Valles, Catalan Institute of Health, Barcelona, Spain
  10. 10. GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
  11. 11. Nordic Bioscience A/S, Herlev, Denmark
  12. 12. WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
  13. 13. Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
  14. 14. Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
  15. 15. Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
  16. 16. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, United States
  17. 17. Bone Biology, Healthy Ageing Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia
  18. 18. St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
  19. 19. School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
  20. 20. INSERM UMR 1033, University of Lyon, Hopital Edouard Herriot, Lyon, France
  21. 21. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
  22. 22. National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
  23. 23. National Institute for Health Research Oxford Biomedical Research Unit, University of Oxford, Oxford, United Kingdom
  24. 24. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
  25. 25. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, United States
  26. 26. Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  27. 27. Rheumatology Department, University Hospital and University of Coimbra, Coimbra, Portugal
  28. 28. Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, United States
  29. 29. Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
  30. 30. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
  31. 31. Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
  32. 32. Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
  33. 33. Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
  34. 34. Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
  35. 35. Department of Pharmacy, Yasuda Women’s University, Hiroshima, Japan
  36. 36. Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
  37. 37. Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
  38. 38. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  39. 39. Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
  40. 40. Icelandic Heart Association, Kopavogur, Iceland
  41. 41. University of Iceland, Reykjavik, Iceland
  42. 42. MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
  43. 43. Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
  44. 44. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
  45. 45. Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
  46. 46. Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom
  47. 47. Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
  48. 48. Department of Sociology, VU University, Amsterdam, Netherlands
  49. 49. Endocrine Clinic, Elisha Hospital, Haifa, Israel
  50. 50. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
  51. 51. Department of Orthopaedics, Skane University Hospital, Malmo, Sweden
  52. 52. Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States
  53. 53. Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  54. 54. Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
  55. 55. Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
  56. 56. Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
  57. 57. IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
  58. 58. Barwon Health, Geelong, VIC, Australia
  59. 59. Department of Medicine - Western Health, The University of Melbourne, St Albans, VIC, Australia
  60. 60. Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
  61. 61. Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
  62. 62. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
  63. 63. Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
  64. 64. Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
  65. 65. Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
  66. 66. Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
  67. 67. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  68. 68. Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
  69. 69. Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  70. 70. Geriatric Medicine, Sahlgrenska University Hospital Molndal, Molndal, Sweden
  71. 71. Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
  72. 72. School of Sport Sciences, Arctic University of Norway, Tromso, Norway
  73. 73. Unit of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umea University, Umea, Sweden
  74. 74. National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
  75. 75. Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
  76. 76. Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
  77. 77. Center for Biomarker Research in Medicine, Graz, Austria
  78. 78. Department of Drug Treatment, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden
  79. 79. Department of Medicine, Oregon Health and Science University, Portland, OR, United States
  80. 80. Institute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
  81. 81. Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
  82. 82. Barwon Health, Geelong, Australia
  83. 83. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  84. 84. Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  85. 85. Department of Gynecology, St Olavs Hospital, Trondheim, Norway
  86. 86. Universite Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
  87. 87. Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, United States
  88. 88. Janus Rehabilitation, Reykjavik, Iceland
  89. 89. Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, United States
  90. 90. INSERM Research Unit 1033, Lyon, France
  91. 91. Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
  92. 92. York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
  93. 93. Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
  94. 94. Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
  95. 95. MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
  96. 96. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
  97. 97. Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
  98. 98. Health Center Can Gibert del Pla, Catalan Institute of Health, Girona, Spain
  99. 99. Department of Medical Sciences, University of Girona, Girona, Spain
  100. 100. GROIMAP (Research Group), Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
  101. 101. MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
  102. 102. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
  103. 103. Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
  104. 104. Geriatric Medicine, Region Vastra Gotaland, Sahlgrenska University Hospital, Molndal, Sweden
  105. 105. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
  106. 106. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom

Source: Osteoporosis International Published:2022


Abstract

Summary: We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. Introduction: The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. Methods: A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. Results: Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. Conclusions: These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)). © 2022, International Osteoporosis Foundation and National Osteoporosis Foundation.
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