Sri Lankan FRAX model and country-specific intervention thresholds

Area of Science:

• Osteoporosis research
• Public health
• Medical decision-making

Background:

• Osteoporosis management relies on accurate fracture risk assessment.
• The FRAX model provides fracture probability estimates but regional variations exist.
• Establishing appropriate intervention thresholds (ITs) is crucial for timely treatment initiation.

Purpose of the Study:

• To identify suitable fracture probability intervention thresholds for Sri Lanka.
• To evaluate the Sri Lankan FRAX model in comparison to other Asian FRAX models.
• To determine both age-specific and fixed ITs for clinical use.

Main Methods:

• Fracture probabilities were calculated using various Asian FRAX models for a standardized postmenopausal woman.
• Age-specific ITs were derived from the Sri Lankan FRAX model.
• Fixed ITs were estimated based on age-specific ITs to minimize misclassification.

Main Results:

• Significant variations in fracture probabilities were observed across different Asian FRAX models.
• The Sri Lankan FRAX model demonstrated concordance with South Asian models.
• Optimal fixed intervention thresholds were identified as 11% for major osteoporotic fracture probability and 3.5% for hip fracture probability.

Conclusions:

• The Sri Lankan FRAX model aligns with other South Asian FRAX models.
• Clinicians can utilize either fixed or age-specific intervention thresholds for postmenopausal women.
• The cost-effectiveness of implementing these intervention thresholds warrants further investigation.