FRAX-based intervention thresholds for Pakistan.

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.