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FRAX updates 2016.

Eugene V McCloskey1, Nicholas C Harvey, Helena Johansson

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The Fracture Risk Assessment Tool (FRAX) remains accurate for osteoporosis patients but is not for treat-to-target strategies. New variables may refine fracture risk assessment, especially for immigrants using country-specific models.

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Area of Science:

  • Osteoporosis research
  • Clinical epidemiology
  • Geriatric medicine

Background:

  • The Fracture Risk Assessment Tool (FRAX) has expanded globally with new country models.
  • Evidence suggests additional clinical variables may influence FRAX interpretation.
  • International guidelines increasingly incorporate FRAX, prompting discussions on its use in treated patients and intervention thresholds.

Purpose of the Study:

  • To review recent advancements and considerations regarding the FRAX tool in fracture risk assessment.
  • To explore the utility of FRAX in diverse populations, including immigrants.
  • To evaluate the impact of novel risk factors and treatment strategies on FRAX estimations.

Main Methods:

  • Literature review of recent studies on FRAX tool application.
  • Analysis of factors influencing FRAX estimations in immigrant populations.
  • Evaluation of skeletal and extraskeletal risk factors, including trabecular bone score and falls risk.
  • Assessment of FRAX accuracy in patients undergoing osteoporosis treatment.

Main Results:

  • FRAX accuracy is maintained in patients on osteoporosis treatments.
  • Trabecular bone score and falls risk show potential as additional independent risk factors.
  • FRAX is not suitable for treat-to-target strategies in osteoporosis management.
  • Using the FRAX tool for the country of origin improves fracture risk assessment accuracy in immigrants.

Conclusions:

  • FRAX remains a valuable tool for fracture risk assessment, with potential refinements from additional variables.
  • Further evaluation is needed to understand how new risk variables impact patient recharacterization and intervention thresholds.
  • Optimizing fracture risk assessment in immigrants may involve utilizing country-specific FRAX models.