FRAX™ and the assessment of fracture probability in men and women from the UK

SUMMARY: A fracture risk assessment tool (FRAX) is developed based on the use of clinical risk factors with or without bone mineral density tests applied to the UK. INTRODUCTION: The aim of this study was to apply an assessment tool for the prediction of fracture in men and women with the use of clinical risk factors (CRFs) for fracture with and without the use of femoral neck bone mineral density (BMD). The clinical risk factors, identified from previous meta-analyses, comprised body mass index (BMI, as a continuous variable), a prior history of fracture, a parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis and other secondary causes of osteoporosis, current smoking, and alcohol intake 3 or more units daily. METHODS: Four models were constructed to compute fracture probabilities based on the epidemiology of fracture in the UK. The models comprised the ten-year probability of hip fracture, with and without femoral neck BMD, and the ten-year probability of a major osteoporotic fracture, with and without BMD. For each model fracture and death hazards were computed as continuous functions. RESULTS: Each clinical risk factor contributed to fracture probability. In the absence of BMD, hip fracture probability in women with a fixed BMI (25 kg/m(2)) ranged from 0.2% at the age of 50 years for women without CRF's to 22% at the age of 80 years with a parental history of hip fracture (approximately 100-fold range). In men, the probabilities were lower, as was the range (0.1 to 11% in the examples above). For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above. The presence of one or more risk factors increased probabilities in an incremental manner. The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter. CONCLUSION: The models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD

What's law got to do with it Part 2: Legal strategies for healthier nutrition and obesity prevention

This article is the second in a two-part review of law's possible role in a regulatory approach to healthier nutrition and obesity prevention in Australia. As discussed in Part 1, law can intervene in support of obesity prevention at a variety of levels: by engaging with the health care system, by targeting individual behaviours, and by seeking to influence the broader, socio-economic and environmental factors that influence patterns of behaviour across the population. Part 1 argued that the most important opportunities for law lie in seeking to enhance the effectiveness of a population health approach

Planned retreat as a management response to coastal risk: A case study from the Fleurieu Peninsula, South Australia

Australian coastal areas have been identified as highly vulnerable to climate change, with major projected impacts including sea level rise, extreme weather events, increased erosion, and a change in coastal processes and wave patterns. Such impacts would cause coastal settlements and ecosystems to face increasingly uncertain conditions. In response to increased risk, effective coastal management at local and regional scales is needed, with governing bodies providing significant leadership. This research explores the challenges of applying effective adaptation responses to projected climate change in vulnerable coastal systems on the South Coast of the Fleurieu Peninsula, South Australia. In particular, the option of planned retreat as a management response to coastal risk is critically examined, with the incorporation of learning from Byron Bay, NSW. A mixed methods approach was undertaken by integrating documentary interrogation with the analysis of interview responses from key coastal managers. It was determined that despite the increase in adaptation planning and development of management strategy options to manage sea level rise on the Fleurieu Peninsula, there is a lack of implementation of adaptation responses. In addition, planning seems to focus largely on the implications of sea level rise on infrastructure, often overlooking other risks and possible ecological impacts. Inconsistencies in governance are reflected at all levels, indicating a need for comprehensive improvements to ensure the incorporation of appropriate risk responses into planning decisions. © 2012 Springer-Verlag.Rhiannon J. Niven, Douglas K. Bardsle