Fracture Risk

“Osteoporosis and resultant fractures of the spine, hip and other sites are important public health problems with significant individual and societal costs. The risk for osteoporotic fracture is based upon low bone density and the presence of one or more clinical risk factors (see Table 1). A history of fracture during adulthood or falls are important clinical factors in determining the risk of future fracture; however, age is the most influential risk factor, such that middle-aged adults with other risk factors are likely to be at low absolute fracture risk in the medium term. Using these clinical risk factors and BMD when available, fracture risk assessment tools (based upon data collected from large prospective observational studies) have been developed to estimate the 5–10 year probability of hip fracture and other fractures in untreated patients. Clinicians should be aware that fracture risk can also be estimated using the FRAX or Garvan tools without BMD data. Chronic glucocorticoid use is an established risk factor for osteoporosis, with studies showing that use of glucocorticoids leads to accelerated bone loss and an increased risk of fracture. Other drugs are increasingly recognized as potential causes of bone loss and fracture, particularly amongst predisposed individuals….”

See the following link for more on other drugs that can cause bone loss and fractures:

http://strontiumforbones.blogspot.com/2015/01/adverse-skeletal-effects-of-drugs.html

Table 1.  Clinical risk factors for fracture

Advancing age

Previous fracture during adulthood

History of a fall or falls in the past 12 months

Glucocorticoid therapy

Parental history of hip fracture

Low body weight

Current cigarette smoking

Excessive alcohol consumption

Medical diseases (e.g. rheumatoid arthritis, hyperparathyroidism, coeliac disease, hypogonadism)

This introduction and table appeared in “Adverse Skeletal Effects of Drugs – Beyond Glucocorticoids,” Susannah O'Sullivan, Andrew Grey, Clin Endocrinol. 2015; 82(1):12-22. 

http://www.medscape.com/viewarticle/837369?src=wnl_edit_tpal&uac=127701PY

Effect of Strontium Ranelate on the Risk of Osteoporotic Fractures

Summary

The aim of the present study was to determine the efficacy of strontium ranelate as a function of baseline fracture risk. Treatment with strontium ranelate was associated with a significant 31% decrease in all clinical osteoporotic fractures (vertebral fractures included). Hazard ratios for the effect of strontium ranelate on the fracture outcome did not change significantly with increasing fracture probability.

Introduction

 Two previous studies have suggested that the efficacy of intervention may be greater in the segment of the population at highest fracture risk as assessed by the FRAX® algorithms. The aim of the present study was to determine whether the anti-fracture efficacy of strontium ranelate was dependent of the level of fracture risk.

Methods

The primary data of the two phase III studies (SOTI and TROPOS) of the effects of strontium ranelate in postmenopausal osteoporosis were combined. Country-specific probabilities were computed using the FRAX® tool (version 2.0). The primary outcome variable comprised all clinical osteoporotic fractures (including clinical vertebral fractures). Interactions between fracture probability and efficacy were explored by Poisson regression.

Results

The 10-year probability of major osteoporotic fractures (with BMD) ranged from 2.5% to 90.8%. FRAX®-based hip fracture probabilities ranged from 0.1% to 90.3%. The incidence of clinical osteoporotic fractures (vertebral fractures excluded) and morphometric vertebral fractures increased with increasing baseline fracture probabilities. Treatment with strontium ranelate was associated with a 31% (95% CI = 20–39%) decrease in osteoporotic clinical fractures and a 40% decrease in vertebral fractures assessed by semiquantitative morphometry (95% CI = 31–48%) Hazard ratios for the effect of strontium ranelate on the fracture outcomes did not change significantly with increasing fracture probability.

Conclusion

Strontium ranelate significantly decreased the risk of osteoporotic clinical fractures, non vertebral fractures and morphometric vertebral fractures in women. Overall, the efficacy of strontium ranelate was not dependent of the level of fracture risk assessed by FRAX.

A meta-analysis of the effect of strontium ranelate on the risk of vertebral and non-vertebral...

 
http://link.springer.com/article/10.1007/s00198-010-1474-0#page-1