FRAX-based assessment and intervention thresholds-an exploration of thresholds in XXXX aged 50  years and older in the UK.

@entity1 @entity173 @entity174
UNASSIGNED: Under current guidelines, based on prior @entity174 probability thresholds, inequalities in access to therapy arise especially at older ages (>= 70  years) depending on the presence or absence of a prior @entity174 . An alternative threshold (a fixed threshold from the age of 70 years) reduces this disparity, increases treatment access and decreases the need for bone densitometry. INTRODUCTION: Several international guidelines set age-specific intervention thresholds at the 10-year probability of @entity174 equivalent to a @entity1 of average BMI with a prior @entity174 . At older ages (>= 70  years), @entity1 with prior @entity174 selected for treatment are at lower average absolute risk than those selected for treatment in the absence of prior @entity174 , prompting consideration of alternative thresholds in this age group. METHODS: Using a simulated population of 50,633 @entity1 aged 50-90  years in the UK, with a distribution of risk factors similar to that in the European FRAX derivation cohorts and a UK-matched age distribution, the current NOGG intervention and assessment thresholds were compared to one where the thresholds remained constant from 70  years upwards. RESULTS: Under current thresholds, 45.1  % of @entity1 aged >= 70  years would be eligible for therapy, comprising 37.5  % with prior @entity174 , 2.2  % with high risk but no prior @entity174 and 5.4  % selected for treatment after bone mineral density (BMD) measurement. Mean @entity173 probability was 11.3, 23.3 and 17.6  %, respectively, in these groups. Under the alternative thresholds, the overall proportion of @entity1 treated increased from 45.1 to 52.9  %, with 8.4  % at high risk but no prior @entity174 and 7.0  % selected for treatment after BMD measurement. In the latter group, the mean probability of @entity173 was identical to that observed in @entity1 with prior @entity174 (11.3  %). The alternative threshold also reduced the need for BMD measurement, particularly at older ages (>80  years). CONCLUSIONS: The alternative thresholds equilibrate @entity174 risk, particularly @entity173 risk, in those with or without prior @entity174 selected for treatment and reduce BMD usage at older ages.
