FRAX-based intervention thresholds in eight Eurasian countries: Armenia, Belarus, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, the Russian Federation, and Uzbekistan.

Age-specific intervention and assessment thresholds based on FRAX® were developed for eight Eurasian countries participating in the EVA study (Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan). The intervention thresholds (major osteoporotic fracture) ranged from 3.6 (Armenia and Georgia) to 12.3% (Uzbekistan) for people at age 50 years, and from 16 (Armenia) to 27% (Belarus) at the age of 90 years. These thresholds enable a substantial advance in the ease of detection of individuals at high fracture risk. INTRODUCTION: The purpose of this study was to derive and compare FRAX-based intervention and BMD assessment thresholds for 8 Eurasian countries in the EVA study. METHODS: The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF), calculated without BMD, equivalent to a woman with a prior fragility fracture but no other clinical risk factors, and a body mass index (BMI) of 25.0 kg/m2. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI of 25.0 kg/m2, without previous fracture or other clinical risk factors. The upper assessment threshold was set at 1.2 times the IT. RESULTS: The age-specific intervention thresholds ranged from 3.6 (Armenia and Georgia) to 12.3% (Uzbekistan) for men and women at the age of 50 years and from 16 (Armenia) to 27% (Belarus) at the age of 90 years. The difference between countries was most evident at younger ages and become progressively less with advancing age. CONCLUSIONS: For the 8 Eurasian countries, the newly established FRAX-based intervention thresholds provide an opportunity to improve the clinical detection of both men and women with a high risk of fracture and improve treatment rates.

Report on the Audit on Burden of Osteoporosis in Eight Countries of the Eurasian Region: Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan.

The audit provides a detailed analysis of the burden of osteoporosis and differences between Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan with regard to prevalence of osteoporosis and incidence of osteoporotic fractures, future demographic changes, diagnostic resources, and treatment availability. PURPOSE: This paper describes the results of the Audit on Burden of Osteoporosis in Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan. METHODS: We carried out a review of the available literature and a survey of the representatives of the national osteoporosis societies. All the information available in English, Russian, or national languages including the publications of local or regional importance was analyzed. RESULTS: The expected number of osteoporosis patients varies from 240,000 in Armenia to 16 million in Russia. Low-energy fractures are a serious health problem in all countries with the highest incidence in Kazakhstan and Russia. The rate of hip fracture patients' hospitalization in the majority of countries is low (33-80%). In the coming decades the populations, in particular, in Uzbekistan, Kazakhstan, and Kyrgyzstan, will continue to show increases in life expectancy with a corresponding increase in the number of fractures in older people. Thus, in 2050, the number of hip fractures in these countries will increase by 2.5-3.5 times. However, the availability of DXA devices in the region is low (0.2-1.3 per million), and DXA tests are expensive. Almost all modern treatments for osteoporosis are available, but the costs are high even for alendronate. Urgent action is needed at the national level in each country including recognition of osteoporosis as a priority health issue. CONCLUSION: Osteoporosis is an important health problem in the countries of the Eurasian region that will only get worse in the future due to expected demographic changes.

Epidemiology of osteoporotic fracture in Moldova and development of a country-specific FRAX model.

Retrospective population-based survey in 2 regions of the Republic of Moldova determined the incidence of fractures at the hip, proximal humerus and distal forearm. The estimated number of such fractures nationwide for 2015 was 11,271 and is predicted to increase to 15,863 in 2050. The hip fracture rates were used to create a FRAX model to help guide decisions about treatment. OBJECTIVE: This paper describes the epidemiology of osteoporotic fractures in Republic of Moldova that was used to develop the country-specific fracture prediction FRAX® tool. METHODS: We carried out a retrospective population-based survey in 2 regions of the Republic of Moldova (Anenii Noi district and Orhei district) representing approximately 6% of the country's population. We identified hip, forearm and humerus fractures in 2011 and 2012 from hospital registers and primary care sources. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Moldova. Fracture probabilities were compared with those from neighbouring countries having FRAX models. RESULTS: The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 3911 and is predicted to increase by 60% to 6492 in 2050. Hip fracture incidence was a good predictor of forearm and humeral fractures. FRAX-based probabilities were higher in Moldova than neighbouring countries (Ukraine and Romania). CONCLUSION: The FRAX model should enhance accuracy of determining fracture probability among the Moldavan population and help guide decisions about treatment.

Training Russian family physicians in mental health skills.

OBJECTIVE: This paper describes the setting up of training for family physicians in mental health skills, with the results obtained for the first 75 doctors who attended the course, in the city of Ekaterinburg, Russian Federation. METHODS: Instruction was by lectures, discussion groups, and role-plays, initially using the World Psychiatric Association's (WPA) training materials on mental health skills for general medical practitioners, dubbed into Russian. This represented the first time that formal teaching on depression and unexplained somatic symptoms (USS) had been offered to these doctors. Teaching was initially by English teachers, but is now led by a Russian family physician using videotaped recordings of local doctors speaking in Russian. All doctors were tested for both knowledge and clinical practice before the course and 3 months after the course was completed. RESULTS: Older doctors started the course from a lower knowledge base than younger doctors, but acquired more knowledge. Theoretical knowledge of both depression and USS increased dramatically, and great changes occurred in the way that these patients are managed. CONCLUSION: Mental health skills training has been provided to Russian family physicians with a positive impact on theoretical knowledge and self-reported management. The course has now been expanded, and more Russian teachers are involved.