Toggle Main Menu Toggle Search

Open Access padlockePrints

FRAX-based assessment and intervention thresholds-an exploration of thresholds in women aged 50 years and older in the UK

Lookup NU author(s): Emeritus Professor Roger Francis


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


A Summary Under current guidelines, based on prior fracture probability thresholds, inequalities in access to therapy arise especially at older ages (a parts per thousand yen70 years) depending on the presence or absence of a prior fracture. An alternative threshold (a fixed threshold from the age of 70 years) reduces this disparity, increases treatment access and decreases the need for bone densitometry.Introduction Several international guidelines set age-specific intervention thresholds at the 10-year probability of fracture equivalent to a woman of average BMI with a prior fracture. At older ages (a parts per thousand yen70 years), women with prior fracture selected for treatment are at lower average absolute risk than those selected for treatment in the absence of prior fracture, prompting consideration of alternative thresholds in this age group.Methods Using a simulated population of 50,633 women aged 50-90 years in the UK, with a distribution of risk factors similar to that in the European FRAX derivation cohorts and a UK-matched age distribution, the current NOGG intervention and assessment thresholds were compared to one where the thresholds remained constant from 70 years upwards.Results Under current thresholds, 45.1 % of women aged a parts per thousand yen70 years would be eligible for therapy, comprising 37.5 % with prior fracture, 2.2 % with high risk but no prior fracture and 5.4 % selected for treatment after bone mineral density (BMD) measurement. Mean hip fracture probability was 11.3, 23.3 and 17.6 %, respectively, in these groups. Under the alternative thresholds, the overall proportion of women treated increased from 45.1 to 52.9 %, with 8.4 % at high risk but no prior fracture and 7.0 % selected for treatment after BMD measurement. In the latter group, the mean probability of hip fracture was identical to that observed in women with prior fracture (11.3 %). The alternative threshold also reduced the need for BMD measurement, particularly at older ages (> 80 years).Conclusions The alternative thresholds equilibrate fracture risk, particularly hip fracture risk, in those with or without prior fracture selected for treatment and reduce BMD usage at older ages.

Publication metadata

Author(s): McCloskey E, Kanis JA, Johansson H, Harvey N, Oden A, Cooper A, Cooper C, Francis RM, Reid DM, Marsh D, Selby P, Thompson F, Hewitt S, Compston J

Publication type: Article

Publication status: Published

Journal: Osteoporosis International

Year: 2015

Volume: 26

Issue: 8

Pages: 2091-2099

Print publication date: 01/08/2015

Online publication date: 16/06/2015

Acceptance date: 13/05/2015

ISSN (print): 0937-941X

ISSN (electronic): 1433-2965

Publisher: Springer


DOI: 10.1007/s00198-015-3176-0


Altmetrics provided by Altmetric


Funder referenceFunder name
MC_UP_A620_1014Medical Research Council
MR/K006312/1Medical Research Council
MR/K006312/1Medical Research Council
MC_UU_12011/1Medical Research Council