FRAX First - Pragmatic Approach in Resource Poor Settings

Area of Science:

• Osteoporosis and fracture risk assessment.
• Clinical decision support tools in healthcare.

Background:

• The Fracture Risk Assessment Tool (FRAX) predicts fracture risk using clinical factors, with or without bone mineral density (BMD).
• BMD measurement is challenging in resource-limited settings, necessitating evaluation of FRAX without BMD.
• This study compares fracture risk prediction using FRAX with and without BMD.

Purpose of the Study:

• To determine if FRAX and FRAX with BMD (FRAX/BMD) yield identical 10-year hip fracture and major osteoporotic fracture (MOF) predictions.
• To identify risk factors associated with similar risk predictions between FRAX and FRAX/BMD.

Main Methods:

• Retrospective review of 239 patients aged >50 years who underwent BMD measurement and FRAX assessment.
• Patients met World Health Organization (WHO) criteria for osteopenia or osteoporosis.
• FRAX scores were calculated using the FRAX India tool, both with and without BMD.

Main Results:

• 86.61% of subjects (207/239) had identical fracture risk predictions with or without BMD.
• The group with identical predictions had lower mean age and higher BMI, hip BMD, spine BMD, and history of previous fracture.
• Statistical significance was observed for age (P=0.009), BMI (P=0.005), hip BMD (P<0.001), spine BMD (P<0.001), and prior fracture history (P=0.02).

Conclusions:

• FRAX without BMD provides fracture risk predictions comparable to FRAX/BMD in the majority of cases.
• FRAX is effective for predicting osteoporotic fracture risk, particularly in younger individuals with higher BMI.
• FRAX serves as an inexpensive and effective alternative when dual-energy X-ray absorptiometry (DXA) is not accessible.