Improving fracture risk classification in Spain: A 10-year evaluation of a modified FRAX-based algorithm

Area of Science:

• Gerontology
• Epidemiology
• Public Health

Background:

• Osteoporotic fractures pose a significant health burden globally.
• The FRAX tool is commonly used for 10-year fracture risk estimation.
• The Spanish version of FRAX has shown underestimation of major osteoporotic fracture (MOF) probability.

Purpose of the Study:

• To evaluate a modified FRAX-based algorithm for improved MOF risk stratification in Spanish postmenopausal women.
• To calibrate the algorithm for the specific Spanish population.
• To categorize women into clinically meaningful risk groups for intervention.

Main Methods:

• Retrospective cohort study of 837 postmenopausal women followed for 10 years.
• Recording of all major osteoporotic fractures (MOF).
• Initial risk categorization using FRAX thresholds (<3.5% low, ≥10% high), with reclassification for intermediate risk (3.5-10%) based on osteoporosis diagnosis or recalculated MOFR including BMD.

Main Results:

• Initial classification: 40% low risk (9.4% incidence), 42% intermediate (16.3% incidence), 18% high risk (23.5% incidence).
• After reclassification: 69% low risk (11.0% incidence), 31% high risk (23.2% incidence).
• The modified algorithm significantly improved risk stratification.

Conclusions:

• The proposed FRAX-based algorithm enhances fracture risk classification accuracy in Spanish women.
• This improved stratification supports more rational decisions regarding bone densitometry and therapeutic interventions.
• The study highlights the importance of population-specific calibration for fracture risk assessment tools.