Rationalisation du remboursement des médicaments de l'ostéoporose : de la mesure isolée de la densité osseuse à l’intégration des facteurs cliniques de risque fracturaire. Validation de l’algorithme FRAX®
Neuprez, Audrey; Johansson, H.; Kanis, J.et al.
2009 • In Revue Médicale de Liège, 64 (12), p. 612-619
Fracture ostéoporotique; Fracture de la hanche; Facteurs cliniques de risque; Probabilité de fracture; FRAX®; Epidémiologie; Osteoporotic fracture; Hip fracture; Clinical risk factors; 10-year fracture probability
Abstract :
[fr] RESUME : Cette étude a pour but d’adapter à la population belge l’algorithme FRAX® récemment publié par l’Organisation Mondiale de la Santé (OMS) et permettant de calculer, dans les deux sexes, le risque absolu de fractures ostéoporotiques, à 10 ans. Nous nous sommes attachés à quantifier le risque fracturaire correspondant aux critères actuellement appliqués, en Belgique, pour le remboursement des médicaments de l’ostéoporose et à identifier les situations cliniques correspondant à une probabilité équivalente de fracture. Les probabilités fracturaires ont été calculées, à partir des incidences de fractures et de décès publiées, pour la population belge. Ces probabilités prennent en considération l’âge, le sexe, l’existence de facteurs cliniques de risque (FCR) et la densité minérale osseuse (DMO), mesurée au niveau de la zone propre du col fémoral. L’algorithme FRAX® permet d’identifier différents scénarios d’intervention, en Belgique, correspondant à un risque fracturaire identique ou supérieur à celui servant de base aux critères actuels de remboursement des médicaments. Il est donc possible de recommander une modification des attitudes actuelles, délaissant une stratégie basée sur une évaluation dichotomique de la DMO, au profit d’une intégration progressive des FCR qui permettra, in fine, une meilleure identification des patients à risque accru de fracture. Cette approche devra être substantiée par des analyses pharmaco-économiques appropriées.
Disciplines :
Public health, health care sciences & services General & internal medicine
Author, co-author :
Neuprez, Audrey ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Johansson, H.
Kanis, J.
McCloskey, E. V.
Oden, A.
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Hiligsmann, Mickaël ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Devogelaer, Jean-Pierre
Kaufmann, J.-M.
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Language :
French
Title :
Rationalisation du remboursement des médicaments de l'ostéoporose : de la mesure isolée de la densité osseuse à l’intégration des facteurs cliniques de risque fracturaire. Validation de l’algorithme FRAX®
Alternative titles :
[en] A FRAX model for the assessment of fracture probability in Belgium
Publication date :
December 2009
Journal title :
Revue Médicale de Liège
ISSN :
0370-629X
eISSN :
2566-1566
Publisher :
Hopital de Baviere, Liège, Belgium
Volume :
64
Issue :
12
Pages :
612-619
Peer reviewed :
Peer reviewed
Commentary :
SUMMARY : The objective of this study was to evaluate a Belgian version of the WHO fracture risk assessment (FRAX®) tool to compute 10-year probabilities of osteoporotic fracture in men and women. A particular aim was to determine fracture probabilities that corresponded to the reimbursement policy for the management of osteoporosis in Belgium and the clinical scenarios that gave equivalent fracture probabilities. Fracture probabilities were computed from published data on the fracture and death hazards in Belgium. Probabilities took account of age, sex, the presence of clinical risk factors and femoral neck BMD. Fracture probabilities were determined that were equivalent to intervention (reimbursement) thresholds currently used in Belgium. Fracture probability increased with age, lower BMI, decreasing BMD T-Score, and all clinical risk factors used alone or combined. The FRAX® tool has been used to identify possible thresholds for therapeutic intervention in Belgium, based on equivalence of risk with current guidelines. The FRAX® model supports a shift from the current DXA based intervention strategy, towards a strategy based on fracture probability of a major osteoporotic fracture that in turn may improve identification of patients at increased fracture risk. The approach will need to be supported by health economic analyses.
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