FRAX(®) with and without bone mineral density.

Area of Science:

• Osteoporosis Management
• Clinical Epidemiology
• Pharmacotherapy Efficacy

Background:

• The Fracture Risk Assessment Tool (FRAX) is widely used for fracture risk prediction.
• Its utility, especially without bone mineral density (BMD) measurements, remains a topic of discussion.
• This review focuses on the role of FRAX in clinical decision-making for osteoporosis.

Purpose of the Study:

• To evaluate the validity and clinical utility of FRAX, with and without BMD.
• To assess FRAX's ability to identify patients who benefit from pharmaceutical interventions.
• To determine FRAX's suitability in diverse healthcare settings, including those with limited DXA access.

Main Methods:

• Evidence-based assessment of clinical risk factors within the FRAX algorithm.
• Review of treatment effects in relation to FRAX-identified risk.
• Comparative analysis of fracture prediction using FRAX (with/without BMD) versus BMD alone.

Main Results:

• FRAX clinical risk factors demonstrate high validity and identify risks responsive to treatment.
• Treatment benefits are largely independent of baseline BMD, confirming FRAX's ability to target effective interventions.
• FRAX without BMD preferentially identifies individuals with low BMD and offers fracture prediction comparable to BMD alone.
• FRAX is suitable for use in countries with sparse DXA facilities and can guide BMD testing in resource-rich settings.

Conclusions:

• FRAX is a well-validated instrument for identifying patients most likely to benefit from osteoporosis interventions.
• Its use, with or without BMD, is effective in targeting high-risk individuals for treatment.
• FRAX provides a practical approach to fracture risk assessment and management globally.