Decision making for osteoporotic treatment using FRAX or DVO risk algorithms in a clinical setting

To evaluate the therapy decisive clinical risk factors (CRFs) in tools provided by WHO (WHO-FRAX) and the Head Osteology Organization of Germany (DVO) in a clinical setting, and, the degree of agreement between them.

Three hundred subjects, 40 to 88 years of age, were consecutively referred for an evaluation of osteoporosis-related fracture risk, and therapy was possibly recommended. The evaluation used the 12 CRFs in the FRAX tool and the 21 CRFs in the DVO tool. We analyzed the degree of agreement and the strength of the CRFs in determining the therapy decision.

Before evaluation, 52 (17.3%) of the patients took anti-osteoporotic medication. The FRAX tool indicated 36 (12.0%) patients suggested for treatment when hip density was included as a CRF, whereas the DVO tool indicated 80 (26.7%) and 91(30.3%), depending on bone density site. The pre- and post-test results agreed poorly to fair, whereas agreement was poor to good within both models and using the plain T-score to define the therapy intervention threshold.

CRFs with debatable evidence reached significant influence on therapy decision. A considerably divergent number of patients were identified as treatment candidates, deserving further investigation to confirm the usefulness of some CRFs.