J Bone Metab.  2015 Aug;22(3):113-118. 10.11005/jbm.2015.22.3.113.

A FRAX Experience in Korea: Fracture Risk Probabilities with a Country-specific Versus a Surrogate Model

• Min YK
• Lee DY
• Park YS
• Moon YW
• Lim SJ
• Lee YK
• Choi D
• Yoon BK

• KMID: 2170107
• DOI: http://doi.org/10.11005/jbm.2015.22.3.113

Abstract

BACKGROUND
Recently, a Korean fracture-risk assessment tool (FRAX) model has become available, but large prospective cohort studies, which are needed to validate the model, are still lacking, and there has been little effort to evaluate its usefulness. This study evaluated the clinical usefulness of the FRAX model, a FRAX developed by the World Health Organization, in Korea.
METHODS
In 405 postmenopausal women and 139 men with a proximal femoral fracture, 10-year predicted fracture probabilities calculated by the Korean FRAX model (a country-specific model) were compared with the probabilities calculated with a FRAX model for Japan, which has a similar ethnic background (surrogate model).
RESULTS
The 10-year probabilities of major osteoporotic and hip fractures calculated by the Korean model were significantly lower than those calculated by the Japanese model in women and men. The fracture probabilities calculated by each model increased significantly with age in both sexes. In patients aged 70 or older, however, there was a significant difference between the two models. In addition, the Korean model led to lower probabilities for major osteoporotic fracture and hip fracture in women when BMD was excluded from the model than when it was included.
CONCLUSIONS
The 10-year fracture probabilities calculated with FRAX models might differ between country-specific and surrogate models, and caution is needed when applying a surrogate model to a new population. A large prospective study is warranted to validate the country-specific Korean model in the general population.

Keyword

Hip fractures; Japan; Osteoporotic fractures; Republic of Korea; Risk assessment

MeSH Terms

Asian Continental Ancestry Group
Cohort Studies
Female
Femoral Fractures
Hip
Hip Fractures
Humans
Japan
Korea*
Male
Osteoporotic Fractures
Prospective Studies
Republic of Korea
Risk Assessment
World Health Organization

Figure

• 

  Fig. 1 Mean 10-year fracture probabilities using the Korean and Japanese fracture-risk assessment tool (FRAX) models in relation to age in women and men. (A) Major osteoporotic fracture (MOF) and (B) hip fracture in women, (C) MOF and (D) hip fracture in men. In both models, the fracture probabilities increased significantly in relation to age in both sexes (P<0.001, ANOVA). KOR, Korean; JPN, Japanese; *P<0.05 by t-test or Mann-Whitney test, as indicated.

• 

  Fig. 2 Mean 10-year fracture probabilities using (A) the Korean model and (B) the Japanese model with and without the inclusion of BMD values in women. The probabilities without BMD values were significantly lower for both major osteoporotic fracture and hip fracture. BMD, bone mineral density; *P<0.05, t-test.

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