A surrogate FRAX model for Pakistan

G. Naureen, H. Johansson, R. Iqbal, L. Jafri, A. H. Khan, M. Umer, E. Liu, L. Vandenput, M. Lorentzon, N. C. Harvey, E. V. McCloskey, J. A. Kanis

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7 Citations (Scopus)


Summary: A surrogate FRAX® model for Pakistan has been constructed using age-specific hip fracture rates for Indians living in Singapore and age-specific mortality rates from Pakistan. Introduction: FRAX models are frequently requested for countries with little or no data on the incidence of hip fracture. In such circumstances, the International Society for Clinical Densitometry and International Osteoporosis Foundation have recommended the development of a surrogate FRAX model, based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country. Objective: This paper describes the development and characteristics of a surrogate FRAX model for Pakistan. Methods: The FRAX model used the ethnic-specific incidence of hip fracture in Indian men and women living in Singapore, combined with the death risk for Pakistan. Results: The surrogate model gave somewhat lower 10-year fracture probabilities for men and women at all ages compared to the model for Indians from Singapore, reflecting a higher mortality risk in Pakistan. There were very close correlations in fracture probabilities between the surrogate and authentic models (r ≥ 0.998) so that the use of the Pakistan model had little impact on the rank order of risk. It was estimated that 36,524 hip fractures arose in 2015 in individuals over the age of 50 years in Pakistan, with a predicted increase by 214% to 114,820 in 2050. Conclusion: The surrogate FRAX model for Pakistan provides an opportunity to determine fracture probability within the Pakistan population and help guide decisions about treatment.

Original languageEnglish
Article number34
JournalArchives of Osteoporosis
Issue number1
Publication statusPublished - Dec 2021


  • Epidemiology
  • FRAX
  • Fracture probability
  • Hip fracture
  • Pakistan
  • Singaporean Indians
  • Surrogate


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