Fracture risk assessment based on FRAX scores and Polish guidelines in patients with newly diagnosed osteopaenia

A densitometric diagnosis of osteoporosis qualifies patients to a diagnostic-therapeutic process, but densitometric evaluation may not be sufficient for osteopaenic patients. Therefore, it is essential to assess osteoporosis risk factors, fracture history, and 10-year fracture risk, and classify patients into low-, medium-, high-, or very high-risk categories. In our study, we aimed to assess the risk of fractures in patients with newly diagnosed osteopaenia and determine the percentage of patients at high and very high risk of fracture.

The study included 89 postmenopausal women with newly diagnosed osteopaenia as determined by a T-score of the femoral neck and/or lumbar spine from dual-energy X-ray absorptiometry (DXA) scans between -1.0 and -2.5 standard deviations (SD). Demographic data and laboratory tests were collected. Additionally, based on the Fracture Risk Assessment Tool (FRAX-PL) calculator including bone mineral density (BMD), 10-year fracture risk was calculated for major osteoporotic fractures (FRAX MOF) and hip fractures (FRAX HF). Each patient was then classified into particular risk groups based on FRAX and modified fracture risk assessment criteria.

Our study found the most common risk factors to be glucocorticoid intake (47.19%), parental hip fracture (46.07%), and smoking (39.33%). In the general population, 56.6% of subjects had at least one fracture in adulthood. The FRAX calculator showed that 39.33% of the patients had a very high risk of HF and 34.83% had a very high risk of major osteoporotic fractures (MOF). A high fracture risk for hip fractures (HF) and MOF was noted in 11.24% and 40.45% of the patients, whereas a medium and low risk of MOF was seen in 17.98% and 6.74%, respectively. Significantly more subjects (53.93%) had been classified as being at very high risk of fracture, based on the expanded criteria than on the basis of FRAX alone. Of these, 48.31% met the criteria of FRAX > 15% for MOF or > 4.5% for HF, and 7.87% had multiple (≥ 2) major fractures. Women aged 70-75 years were at the highest risk of fracture.

Our findings highlight the importance of categorising fracture risk in osteopaenic patients, and show that the number of patients at very high fracture risk increases when the expanded criteria from the latest Polish guidelines are applied.