German DVO risk score identified more patients requiring treatment compared to FRAX

Fracture risk determination is essential when recommending treatment in osteoporosis management. We calculated the risk probabilities of major osteoporotic and hip fractures using the DVO score established in German-speaking countries and the FRAX tool.

We retrospectively analysed data from 555 female patients (mean age 64.2 ± 10.3 years) evaluated for osteoporosis. As suggested by DVO guidelines before 2023, we set the therapy threshold of >30% for vertebral and hip fractures. Major osteoporotic fracture (MOF) and hip fracture risk (HF) were calculated based on corresponding FRAX scores. We applied the internationally most common therapy threshold of ≥20% for MOF and ≥3% for HF and determined the 'DVO-equivalent risk levels' for FRAX-based assessment.

The DVO score identified 52.8% of women as having a 10-year risk of hip and vertebral fractures >30%. FRAX score for HF ≥ 3% without bone mineral density (BMD) identified the highest number of patients (56%). The proportion of female patients identified for treatment only by DVO score (14.6%) were more likely to present spinal fractures (38.3 vs 18.6%), whereas the 10.6% of patients only identified by FRAX including BMD presented more peripheral fractures (40.7 vs 29.6%). The thresholds for this 'DVO-equivalent risk level' for 'FRAX with BMD' would be ≥10% for MOF and ≥2.6% for HF.

Given the differences in the DVO and FRAX scores, we highly recommend considering both scores when assessing individual women for treatment.