Performance of Sri Lankan FRAX algorithm without bone mineral density and with Quantitative Ultrasound data input

Area of Science:

• Osteoporosis research
• Clinical epidemiology
• Medical diagnostics

Background:

• Fracture Risk Assessment Algorithm (FRAX) is a validated tool for predicting fracture risk.
• Access to Dual Energy X-ray Absorptiometry (DXA) for bone mineral density (BMD) measurement is often limited.
• FRAX can estimate fracture risk with or without BMD data.

Purpose of the Study:

• To evaluate the Sri Lankan FRAX algorithm's accuracy for fracture risk prediction without BMD input.
• To assess the feasibility of using Quantitative Ultrasound (QUS) of the radius as a substitute for BMD in FRAX calculations.

Main Methods:

• Collected clinical risk factors from 339 postmenopausal women in Sri Lanka.
• Performed DXA scans on all participants and QUS scans of the radius on a subset (n=207).
• Calculated 10-year risks for major osteoporotic fracture (MOFR) and hip fracture (HFR) using FRAX with BMD, without BMD (FRAX-FN0), and with QUS T-score (FRAX-UST).

Main Results:

• FRAX-FN0 demonstrated 79.2% sensitivity and 80.1% specificity for fracture risk.
• FRAX-UST showed 78.4% sensitivity and 70% specificity.
• Both FRAX-FN0 and FRAX-UST achieved Receiver Operating Characteristic Area Under the Curve (ROC AUC) values above 0.80, with FRAX-FN0 having lower standard errors of estimate.

Conclusions:

• The Sri Lankan FRAX algorithm without BMD is an acceptable tool for fracture risk assessment in settings with limited DXA availability.
• Radial QUS data is not a reliable substitute for BMD in the Sri Lankan FRAX algorithm.
• This study highlights a practical approach to osteoporosis management in resource-limited areas.