porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo2012238-44porozendo-4046Research ArticleСтатьиArticlesFRAX - НОВЫЙ ИНСТРУМЕНТ ДЛЯ ОЦЕНКИ РИСКА ПЕРЕЛОМА: ПРИМЕНЕНИЕ В КЛИНИЧЕСКОЙ ПРАКТИКЕ И ПОРОГОВЫЕ УРОВНИ ДЛЯ ВМЕШАТЕЛЬСТВАFRAX - A NEW TOOL FOR THE ASSESSMENT OF FRACTURE RISK: APPLICATION IN CLINICAL PRACTICE AND THRESHOLDS FOR INTERVENTIONKanisJ A-OdenA-JohanssonH-BorgstromF-StromO-McCloskeyI V-201215082012152№2 (2012)3844Copyright © Kanis J.A., Oden A., Johansson H., Borgstrom F., Strom O., McCloskey I.V., 20122012Kanis J.A., Oden A., Johansson H., Borgstrom F., Strom O., McCloskey I.V.Kanis J.A., Oden A., Johansson H., Borgstrom F., Strom O., McCloskey I.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/4046

ФРАКС (FRAX®) - активно разрабатываемый метод, который по мере появления новых данных по эпидемиологии и клиническим факторам риска переломов будет обновляться с целью расширения возможностей и повышения надежности оценки... Выбор клинических факторов риска, используемых в алгоритме ФРАКС, основывается на целом ряде мета-анализов, в которых были выявлены факторы, независимо влияющие на риск остеопорозного перелома. В этих мета-анализах использовались индивидуальные данные практически для 60 тыс. мужчин и женщин. ФРАКС (FRAX®) (http: //www.shef.ac.uk/FRAX) — это реализованный на web-сайте метод, разработанный Сотрудничающим центром Всемирной организации здравоохранения (ВОЗ) по метаболическим заболеваниям скелета (Университет Шеффилд, Великобритания), в основу которого положены модели оценки вероятности перелома у мужчин и женщин. Эти модели, созданные на основании исследований в популяционных когортах в Европе, Северной Америке, Азии и Австралии, были тщательно проверены в дополнительных популяционных когортах с объемом данных более 1 млн. пациентов в год. Алгоритмы ФРАКС интегрируют хорошо проверенные клинические факторы риска, такие как возраст, индекс массы тела, и некоторые дихотомические переменные (например, перелом в анамнезе, курение, лечение кортикостероидами, ревматоидный артрит), как с учетом минеральной плотности костной ткани (МПК), так и без нее. В моделях используется регрессия Пуассона для вычисления рисков смерти или перелома в зависимости от исходных данных, а конечный результат выводится в виде 10-летних вероятностей событий (те перелома бедра, основного остеопорозного перелома [бедра, позвонка, плеча или предплечья]). Эти модели более точно настроены для ряда стран, которые предоставили эпидемиологические данные по переломам. В настоящем обзоре рассматриваются практические аспекты разработки рекомендаций по диагностике и лечению, в которых методика ФРАКС будет признана необходимым компонентом определения риска переломов у пациентов, наблюдающихся в учреждениях первичного звена здравоохранения. Основные области применения ФРАКС включают выявление пациентов, нуждающихся в определении МПК и медикаментозном лечении (в ряде случаев для этого достаточно данных о клинических факторах риска). В практических рекомендациях, в которые уже включена методика ФРАКС, также указаны пороговые уровни для начала лечения, варьирующие в зависимости от страны (ввиду не только клинических, но и экономических соображений). Что касается самой методики ФРАКС, работа над ней продолжается, и появление новых данных о многих клинических факторах риска позволит обогатить ее алгоритмы, что приведет только к увеличению надежности, точности и значимости прогностической оценки.

ReferencesKanis J.A.; on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level. Technical Report. Sheffield, UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007.Kanis J.A.; on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level. Technical Report. Sheffield, UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007.Wainwright S.A., Marshall L.M., Ensrud K.E., et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab.2005; 90: 2787—2793.Wainwright S.A., Marshall L.M., Ensrud K.E., et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab.2005; 90: 2787—2793.Kanis J.A., Borgstrom F., De Laet C., et al. Assessment of fracture risk. Osteoporos int. 2005; 16: 581—589.Kanis J.A., Borgstrom F., De Laet C., et al. Assessment of fracture risk. Osteoporos int. 2005; 16: 581—589.Hofman A., Grobbee D.E., de Jong P.T., van den Ouweland F.A. Determinants of disease and disabity in the elderly: the Rotterdam Ederly Study. Eur J Epidemiol. 1991; 7: 403—422.Hofman A., Grobbee D.E., de Jong P.T., van den Ouweland F.A. Determinants of disease and disabity in the elderly: the Rotterdam Ederly Study. Eur J Epidemiol. 1991; 7: 403—422.De Laet C.E., Van Hout B.A., Burger H., Weel A.E., Hofman A., Pols H.A. Hip fracture predicton in elderly men and women: validation in the Rotterdam study. J Bone Miner Res. 1998; 13: 1587—1593.De Laet C.E., Van Hout B.A., Burger H., Weel A.E., Hofman A., Pols H.A. Hip fracture predicton in elderly men and women: validation in the Rotterdam study. J Bone Miner Res. 1998; 13: 1587—1593.O’Neil T.W., Felsenberg D., Varlow J., Cooper C., Kanis J.A., Silman A.J. The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res. 1996; 11: 1010—1018.O’Neil T.W., Felsenberg D., Varlow J., Cooper C., Kanis J.A., Silman A.J. The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res. 1996; 11: 1010—1018.Ismail A.A., Pye S.R., Cockerill W.C., et al. Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos int. 2002; 13: 565—571.Ismail A.A., Pye S.R., Cockerill W.C., et al. Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos int. 2002; 13: 565—571.Melton L.J. III., Crowson C.S., O‘Fallon W.M., Wahner H.W., Riggs B.L. Relative contributions of bone density, bone turnover, and clinical risk factors to long-term fracture prediction. J Bene Miner Res. 2003; 18: 312—318.Melton L.J. III., Crowson C.S., O‘Fallon W.M., Wahner H.W., Riggs B.L. Relative contributions of bone density, bone turnover, and clinical risk factors to long-term fracture prediction. J Bene Miner Res. 2003; 18: 312—318.Melton L.J. III., Atkinson E.J., O‘Connor M.K., O‘Falon W.M., Riggs B.L. Bone density and fracture risk in men. J Bone Miner Res. 1998; 13: 1915—1923.Melton L.J. III., Atkinson E.J., O‘Connor M.K., O‘Falon W.M., Riggs B.L. Bone density and fracture risk in men. J Bone Miner Res. 1998; 13: 1915—1923.Johansson H., Oden A., Johnell O., et al. Optimization of BMD measurements to identify high risk groups for treatment — a test analysis. J Bene Miner Res. 2004; 19: 906—913.Johansson H., Oden A., Johnell O., et al. Optimization of BMD measurements to identify high risk groups for treatment — a test analysis. J Bene Miner Res. 2004; 19: 906—913.Jones G., Nguyen T., Sarrbrook P.N., Kely P.J., Gibert C., Eisman J.A. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos int. M 1994; 4: 277—282.Jones G., Nguyen T., Sarrbrook P.N., Kely P.J., Gibert C., Eisman J.A. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos int. M 1994; 4: 277—282.Dargent-Molna P., Favier F., Grandjean H., et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet. 1996; 348: 145—149.Dargent-Molna P., Favier F., Grandjean H., et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet. 1996; 348: 145—149.Chapurlat R.D., Garnero P., Breart G., Meunier P.J., Delmas P.D. Serum estradiol and sex hormone-binding globulin and the risk of hip fracture in elderly women: the EPIDOS study. J Bone Miner Res. 2000; 15: 1835—1841.Chapurlat R.D., Garnero P., Breart G., Meunier P.J., Delmas P.D. Serum estradiol and sex hormone-binding globulin and the risk of hip fracture in elderly women: the EPIDOS study. J Bone Miner Res. 2000; 15: 1835—1841.Garnero P., Sornay-Rendu E., Claustrat B., Delmas P.D. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res. 2000; 15: 1526—1536.Garnero P., Sornay-Rendu E., Claustrat B., Delmas P.D. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res. 2000; 15: 1526—1536.Honkanen R., Tuppurainen M., Kroger H., Alhava E., Saankoski S. Relationships between risk factors and fractures differ by type of fracture: a population-based study of 12,192 perimenopausal women. Osteoporos int. 1098; 8: 25—31.Honkanen R., Tuppurainen M., Kroger H., Alhava E., Saankoski S. Relationships between risk factors and fractures differ by type of fracture: a population-based study of 12,192 perimenopausal women. Osteoporos int. 1098; 8: 25—31.Svanborg A. Seventy-year-old people in Gothenburg a population study in an industrialized Swedish city. II. General presentation of social and medical conditions. Acta Med Scand Suppl. 1977; 611: 5—37.Svanborg A. Seventy-year-old people in Gothenburg a population study in an industrialized Swedish city. II. General presentation of social and medical conditions. Acta Med Scand Suppl. 1977; 611: 5—37.Johansson C., Black D., Johnell O., Oden A., Mellstrom D. Bone mineral density is a predictor of survival. Calcif Tissue Int. 1998; 63: 190—196.Johansson C., Black D., Johnell O., Oden A., Mellstrom D. Bone mineral density is a predictor of survival. Calcif Tissue Int. 1998; 63: 190—196.Fujwara S., Kasagi F., Yamada M., Kodama K. Risk factors for hip fracture in a Japanese cohort. J Bone Miner Res. 1997; 12: 998—1004.Fujwara S., Kasagi F., Yamada M., Kodama K. Risk factors for hip fracture in a Japanese cohort. J Bone Miner Res. 1997; 12: 998—1004.Kanis J.A., Johnel O., De Laet C., Jonsson B., Oden A., Ogelsby A.K. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002; 17: 1237—1244.Kanis J.A., Johnel O., De Laet C., Jonsson B., Oden A., Ogelsby A.K. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002; 17: 1237—1244.Kanis J.A., Delmas P., Burckhardt P., Cooper C., Torgerson D. Guideines for dag-nosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Ostecpcros Int. 1997; 7: 390—406.Kanis J.A., Delmas P., Burckhardt P., Cooper C., Torgerson D. Guideines for dag-nosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Ostecpcros Int. 1997; 7: 390—406.Kanis J.A., Burlet N., Cooper C., et al. European guidance for the diagnosis and managennent of osteoporosis in postmenopausal women. Osteopcros Int 2008; 19: 399—428.Kanis J.A., Burlet N., Cooper C., et al. European guidance for the diagnosis and managennent of osteoporosis in postmenopausal women. Osteopcros Int 2008; 19: 399—428.Royal College of Physicians. Osteoporosis: clinical guidelines for the prevention and treatment. 1999.Royal College of Physicians. Osteoporosis: clinical guidelines for the prevention and treatment. 1999.Royal College of Physicians and Bone and Tooth Society of Great Britain. Update on pharmacological interventions and an aigorithm for management. 2000.Royal College of Physicians and Bone and Tooth Society of Great Britain. Update on pharmacological interventions and an aigorithm for management. 2000.Royal College of Physicians. Glucocorticcid-induced osteoporosis. Guidelines on prevention and treatment. Bone and Tooth Society of Great Britan. National Osteoporosis Society, and Royal College of Physicians, 2002.Royal College of Physicians. Glucocorticcid-induced osteoporosis. Guidelines on prevention and treatment. Bone and Tooth Society of Great Britan. National Osteoporosis Society, and Royal College of Physicians, 2002.European Community. Report on osteoporosis in the European Community. 1998.European Community. Report on osteoporosis in the European Community. 1998.National Osteoporosis Foundation. Physicians guide to prevention and treatment of csteoporcsis. 2003.National Osteoporosis Foundation. Physicians guide to prevention and treatment of csteoporcsis. 2003.Kanis J.A. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002; 359: 1929—1936.Kanis J.A. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002; 359: 1929—1936.Hui S.L., Slemenda C.W., Johnston C.C. Jr, Age and bone mass as predctors of fracture in a prospective study. J Clin invest. 1988: 81: 1804—1809.Hui S.L., Slemenda C.W., Johnston C.C. Jr, Age and bone mass as predctors of fracture in a prospective study. J Clin invest. 1988: 81: 1804—1809.Kanis J.A., Johnell O., Oden A., Dawson A., De Laet C., Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostc thresholds. Osteoporos Int. 2001; 12: 989—995.Kanis J.A., Johnell O., Oden A., Dawson A., De Laet C., Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostc thresholds. Osteoporos Int. 2001; 12: 989—995.Kanis J.A., Johnell O., Oden A., et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005; 16: 155—162.Kanis J.A., Johnell O., Oden A., et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005; 16: 155—162.Kanis J.A., Johansson H., Johnell O., et al. Alcohol intake as a risk factor for fracture. Ostecporos Int. 2005; 16: 737—742.Kanis J.A., Johansson H., Johnell O., et al. Alcohol intake as a risk factor for fracture. Ostecporos Int. 2005; 16: 737—742.van Staa T.P., Leufkens H.G., Abenhaim L., Zhang B., Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000; 39: 1383—1389.van Staa T.P., Leufkens H.G., Abenhaim L., Zhang B., Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000; 39: 1383—1389.Delmas P.D., Genant H.K., Crans G.G., et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 2003; 33: 522—532.Delmas P.D., Genant H.K., Crans G.G., et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 2003; 33: 522—532.Lunt M., O‘Neil T.W., Felsenberg D., et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study {EPOS}. Bone. 2003; 33: 505—513.Lunt M., O‘Neil T.W., Felsenberg D., et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study {EPOS}. Bone. 2003; 33: 505—513.Kanis J.A., Johnel O., Oden A., Johansson H., McCloskey E.V. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008; 19: 385—397.Kanis J.A., Johnel O., Oden A., Johansson H., McCloskey E.V. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008; 19: 385—397.Kanis J.A., Johansson H., Oden A., et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Pes. 2004; 19: 893—899.Kanis J.A., Johansson H., Oden A., et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Pes. 2004; 19: 893—899.Kans J.A., McCloskey E.V., Johansson H., Oden A., Melton L.J. III., Khataev N. A reference standard for the description of osteoporosis. Bone. 2008; 42: 467—475.Kans J.A., McCloskey E.V., Johansson H., Oden A., Melton L.J. III., Khataev N. A reference standard for the description of osteoporosis. Bone. 2008; 42: 467—475.Kanis J.A., Black D., Cooper C., et al. A new approach to the development of assessment guidelines for ostsoporosis. Ostecporos Int. 2002; 13: 527—536.Kanis J.A., Black D., Cooper C., et al. A new approach to the development of assessment guidelines for ostsoporosis. Ostecporos Int. 2002; 13: 527—536.Delmas P.D., Eastell R., Garnero P., Seibel M.J., Stepan J. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos InL 2000; 11 (suppl 6): S2—S17.Delmas P.D., Eastell R., Garnero P., Seibel M.J., Stepan J. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos InL 2000; 11 (suppl 6): S2—S17.Giuer C.C. Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group. J Bone Miner Res. 1997; 12: 1280—1288.Giuer C.C. Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group. J Bone Miner Res. 1997; 12: 1280—1288.Genant H.K., Engelke K., Prevrhal S., Advanced CT bone imaging in osteoporosis. Rheumatology (Oxford). 2008; 47{suppl 4): iv9—iv16.Genant H.K., Engelke K., Prevrhal S., Advanced CT bone imaging in osteoporosis. Rheumatology (Oxford). 2008; 47{suppl 4): iv9—iv16.Marshall D., Johnell O., Wedel H. Meta-analysis of how well measures of bone mineral density predmct occurrence of osteoporotic fractures. BMJ. 1996; 312: 1254—1259.Marshall D., Johnell O., Wedel H. Meta-analysis of how well measures of bone mineral density predmct occurrence of osteoporotic fractures. BMJ. 1996; 312: 1254—1259.Kanis J.A., McCloskey E.V., Johansson H., Strom O., Borgstrom R., Oden A. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int 2008; 19: 1395—1408.Kanis J.A., McCloskey E.V., Johansson H., Strom O., Borgstrom R., Oden A. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int 2008; 19: 1395—1408.Kanis J.A., Stovenson M. McCloskey E.V., Davis S., Lloyd-Jones M. Glucocorticotd-hduced osteoporosis: a systematic review and cost-utlity analyse. Health Technol Assess. 2007; 11: iii-iv, ix-xi,1—231.Kanis J.A., Stovenson M. McCloskey E.V., Davis S., Lloyd-Jones M. Glucocorticotd-hduced osteoporosis: a systematic review and cost-utlity analyse. Health Technol Assess. 2007; 11: iii-iv, ix-xi,1—231.Orimo H., Hayashi Y., Fukunaga M., et al. Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab. 2001; 19: 331—337.Orimo H., Hayashi Y., Fukunaga M., et al. Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab. 2001; 19: 331—337.National Osteoporosis Guideline Group; on behalf of the Bone Research Society. Osteoporosis: Clinical guideline for prevention and treatment. Sheffield, UK: University of Sheffield Press; 2008.National Osteoporosis Guideline Group; on behalf of the Bone Research Society. Osteoporosis: Clinical guideline for prevention and treatment. Sheffield, UK: University of Sheffield Press; 2008.Siminoski K., Leslie W.D., Frame H., et al. Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment. J Clin Densitom. 2007; 10: 120—123.Siminoski K., Leslie W.D., Frame H., et al. Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment. J Clin Densitom. 2007; 10: 120—123.Gzerwinski E., Badurski J.E., Marcinowska-Suchowierska E., Osieleniec J. Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Orthop Traumatol Rehabil. 2007: 9: 337—356.Gzerwinski E., Badurski J.E., Marcinowska-Suchowierska E., Osieleniec J. Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Orthop Traumatol Rehabil. 2007: 9: 337—356.Tsang S.W., Kung A.W., Kanis J.A., Johansson H., Oden A. Ten-year fracture probabiity in Hong Kong Southern Chinese according to age and BMD femoral neck T-scores. Osteoporos Int. 2009; 20: 1939—1945.Tsang S.W., Kung A.W., Kanis J.A., Johansson H., Oden A. Ten-year fracture probabiity in Hong Kong Southern Chinese according to age and BMD femoral neck T-scores. Osteoporos Int. 2009; 20: 1939—1945.Lippuner K., Johansson H., Kanis J.A., Rizzoli R. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos int 2009; 20: 1131—1140.Lippuner K., Johansson H., Kanis J.A., Rizzoli R. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos int 2009; 20: 1131—1140.Kurth A.A., Pfeilschifter J. [Diagnosis and treatment of postmenopausal osteoporosis and osteoporosis in men. German Guidelines Update 2006]. Qrthopade 2007; 36: 683—690.Kurth A.A., Pfeilschifter J. [Diagnosis and treatment of postmenopausal osteoporosis and osteoporosis in men. German Guidelines Update 2006]. Qrthopade 2007; 36: 683—690.Kanis J.A., Buriet N., Cooper C., et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2008; 19: 399—428.Kanis J.A., Buriet N., Cooper C., et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2008; 19: 399—428.Fujiwara S., Nakamura T., OrimoH., et al. Development and applcaiton of a Japanese model of the WHO fracture risk assessment tool (FRAX). Osteoporos Int 2008; 19: 429—435.Fujiwara S., Nakamura T., OrimoH., et al. Development and applcaiton of a Japanese model of the WHO fracture risk assessment tool (FRAX). Osteoporos Int 2008; 19: 429—435.Locker A.C., Wahner H.W., Dunn W.L., et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 1998; 8: 468—489.Locker A.C., Wahner H.W., Dunn W.L., et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 1998; 8: 468—489.

The authors declare that there are no conflicts of interest present.