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FRAX-based intervention thresholds for Pakistan
H Johansson1,2,3, G Naureen4,5, R Iqbal6
1Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Summary
FRAX probability thresholds better identify women at high fracture risk than T-score alone, especially in older Pakistani women. T-score thresholds are less sensitive and can be misleading in elderly populations.
Area of Science:
- Osteoporosis research
- Clinical risk assessment
- Public health interventions
Background:
- The Fracture Risk Assessment Tool (FRAX®) algorithm is crucial for osteoporosis management.
- FRAX has been calibrated for Pakistan, but practical application guidance is needed.
- Current clinical practice often relies on bone mineral density (BMD) T-scores for intervention.
Purpose of the Study:
- To compare the effectiveness of T-score thresholds versus FRAX probability thresholds for identifying women at high fracture risk in Pakistan.
- To evaluate the utility of different intervention strategies for osteoporosis management in Pakistani women.
Main Methods:
- Calculated age-specific 10-year major osteoporotic fracture probabilities for women with average body mass index (BMI).
- Determined fracture probabilities at two thresholds: T-score ≤ -2.5 and FRAX probability equivalent to a prior fragility fracture.
- Explored the parsimonious use of BMD by calculating assessment thresholds for BMD testing.
Main Results:
- A T-score threshold of ≤ -2.5 showed significantly higher FRAX probabilities in 50-year-old women compared to those with average BMD and no risk factors.
- The relative increase in risk associated with the BMD threshold decreased with age, becoming protective in women aged 80 and over.
- FRAX-based thresholds, equivalent to a previous fracture, identified women at increased risk across all ages, rising from 2.1% at age 40 to 17% at age 90.
Conclusions:
- Bone mineral density (BMD) thresholds alone are insufficient for effectively targeting women at high fracture risk, particularly the elderly.
- Intervention thresholds based on FRAX fracture probabilities, equivalent to a 'fracture threshold,' are more effective in identifying high-risk individuals.
- FRAX-based risk assessment provides a more reliable strategy for guiding osteoporosis interventions in Pakistani women.
