Evidence map›Paper›PMID 21229233›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2011

Guidance for the adjustment of FRAX according to the dose of glucocorticoids.

J A Kanis, H Johansson, A Oden, E V McCloskey

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Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
108citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

108 citing papers in PubMed, 11 syntheses or guidelines pooled it.

  1. Guideline
  2. Guideline
  3. Guideline
  4. Guideline
  5. Guideline
  6. European guidance for the diagnosis and management of osteoporosis in postmenopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019
    Guideline
  7. Incidence of fractures among patients with rheumatoid arthritis: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018
    Pooled it
  8. Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2017
    Guideline
  9. Pooled it
  10. European guidance for the diagnosis and management of osteoporosis in postmenopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2013
    Guideline
  11. A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2012
    Pooled it
  12. Article
  13. Management of glucocorticoid-induced osteoporosis in rheumatic diseases.Best practice & research. Clinical rheumatology · 2026
    Review
  14. [Interpretation of 2024 United Kingdom National Osteoporosis Guideline Group (NOGG) Clinical Guidelines: Prevention and Treatment of Osteoporosis].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2026
    Article
  15. Bone Health in Rheumatoid Arthritis: An Update.Current rheumatology reports · 2026
    Review
  16. Article
  17. Impact of oral glucocorticoids on the effectiveness of romosozumab: the multicenter OASIS cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Observational
  18. Article
  19. Review
  20. Review

48 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

J A KanisWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S102RX, UK. w.j.Pontefract@shef.ac.uk
H Johansson
A Oden
E V McCloskey

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

unlabelledWe examined the effect of glucocorticoid dose on FRAX® derived fracture probabilities in a UK setting. A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.

introductionThe WHO fracture risk assessment (FRAX) tool estimates 10-year probability of fracture based upon multiple clinical risk factors and an optional femoral neck BMD measurement. Ever (past and current) use of systemic glucocorticoids is a dichotomous risk factor (yes/no) and does not therefore take account of the dose of glucocorticoids. The aim of this work was to estimate the adjustment for fracture probability based upon the dose of glucocorticoids.

methodsDose responses for fracture risk during exposure to glucocorticoids were taken from the General Practice Research Database and used to adjust the relative risks for glucocorticoids in FRAX. In addition to fracture risk, a dose response for the death hazard was estimated and both variables were used to populate the FRAX model for the UK.

resultsThe exposure to glucocorticoids was found to significantly affect fracture probability. The following rule was formulated. For low-dose exposure (< 2.5 mg daily of prednisolone or equivalent), the probability of a major fracture is decreased by about 20% depending on age. For medium doses (2.5-7.5 mg daily), the unadjusted FRAX value can be used. For high doses (> 7.5 mg daily), probabilities can be upward revised by about 15%. Conversion factors were also determined for the adjustment of hip fracture probability.

conclusionA relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.

Indexed as

AlgorithmsAdultAgedAged, 80 and overBone DensityFemaleGlucocorticoidsHip FracturesHumansMaleMiddle AgedOsteoporotic FracturesRisk AssessmentRisk FactorsUnited KingdomWorld Health OrganizationGlucocorticoids

Identifiers

PMID21229233

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.