Application of FRAX to Determine the Risk of Osteoporotic Fractures in the Ukrainian Population

Vladyslav V. Povoroznyuk, Nataliia V. Grygorieva, Eugene V. McCloskey, Helena Johansson and John A. Kanis

Background and Objective: FRAX is the most widely used tool for the assessment of the risk of osteoporotic fractures. The first country-specific FRAX model for Ukraine, calibrated to the total Ukrainian population, was developed in October, 2016. This study aimed to describe the output of the Ukrainian FRAX model and to illustrate its features compared to models for neighbouring countries. Materials and Methods: The development of the Ukrainian model of FRAX was based on two regional epidemiological studies in Ukraine [Vinnitsa city (1997-2002), STOP-study (Uzhgorod city and Vinnitsa area, 2011-2012)], which were performed to derive the incidence of hip fractures in men and women. The construct of the FRAX model for Ukraine required the beta coefficients for risk factors in the original FRAX model and the age and sex-specific incidence rates of hip fracture and mortality for Ukraine. Results: As expected, 10 year probability of hip or major osteoporotic fractures was increased in patients with a clinical risk factor (CRF), female gender, higher age, lower BMI and decreased BMD T-score. Of the CRFs, a prior fracture had greatest effect in the age group 50-70 years and parental hip fracture accounted for the greatest increase in 10-year fracture probability in the age group 80-90 years. Conclusion: The Ukrainian FRAX tool is the first country-specific fracture prediction model available in Ukraine which is based on the original FRAX^® methodology, that has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Ukrainian FRAX tool a good candidate for implementation into clinical practice.

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