Guidance for the adjustment of FRAX according to the dose of glucocorticoids.
Summary of "Guidance for the adjustment of FRAX according to the dose of glucocorticoids."
We examined the effect of glucocorticoid dose on FRAX® derived fracture probabilities in a UK setting. A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.
INTRODUCTION:
The WHO fracture risk assessment (FRAX) tool estimates 10-year probability of fracture based upon multiple clinical risk factors and an optional femoral neck BMD measurement. Ever (past and current) use of systemic glucocorticoids is a dichotomous risk factor (yes/no) and does not therefore take account of the dose of glucocorticoids. The aim of this work was to estimate the adjustment for fracture probability based upon the dose of glucocorticoids.
METHODS:
Dose responses for fracture risk during exposure to glucocorticoids were taken from the General Practice Research Database and used to adjust the relative risks for glucocorticoids in FRAX. In addition to fracture risk, a dose response for the death hazard was estimated and both variables were used to populate the FRAX model for the UK.
RESULTS:
The exposure to glucocorticoids was found to significantly affect fracture probability. The following rule was formulated. For low-dose exposure (<2.5 mg daily of prednisolone or equivalent), the probability of a major fracture is decreased by about 20% depending on age. For medium doses (2.5-7.5 mg daily), the unadjusted FRAX value can be used. For high doses (>7.5 mg daily), probabilities can be upward revised by about 15%. Conversion factors were also determined for the adjustment of hip fracture probability.
CONCLUSION:
A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.
Affiliation
WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK, w.j.Pontefract@shef.ac.uk.
Journal Details
This article was published in the following journal.
Name: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and
ISSN: 1433-2965
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21229233
- DOI: http://dx.doi.org/10.1007/s00198-010-1524-7
Medical and Biotech [MESH] Definitions
Lethal Dose 50
The dose amount of poisonous or toxic substance or dose of ionizing radiation required to kill 50% of the tested population.
Receptors, Glucocorticoid
Cytoplasmic proteins that specifically bind glucocorticoids and mediate their cellular effects. The glucocorticoid receptor-glucocorticoid complex acts in the nucleus to induce transcription of DNA. Glucocorticoids were named for their actions on blood glucose concentration, but they have equally important effects on protein and fat metabolism. Cortisol is the most important example.
Social Adjustment
Adaptation of the person to the social environment. Adjustment may take place by adapting the self to the environment or by changing the environment. (From Campbell, Psychiatric Dictionary, 1996)
Maximum Tolerated Dose
The highest dose of a biologically active agent given during a chronic study that will not reduce longevity from effects other than carcinogenicity. (from Lewis Dictionary of Toxicology, 1st ed)
Risk Adjustment
The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)
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