Community-based osteoporosis prescreening using FRAX and portable pulse-echo ultrasound: a pilot study from Western...

A community-based prescreening approach using the Austrian FRAX® model and portable pulse-echo ultrasound identified a substantial proportion of adults with findings that may warrant further osteoporosis evaluation. Our results suggest that local prescreening pathways could support earlier identification and referral, particularly in women.

Early identification of adults at increased osteoporosis risk remains challenging. We evaluated a community-based prescreening approach using Austrian FRAX® and portable pulse-echo ultrasound in adults from Tyrol, Western Austria.

Adults aged 50-90 years voluntarily attended free community screening events. Participants completed the Austrian FRAX questionnaire and underwent tibial pulse-echo ultrasound (Bindex®), from which the density index (DI) was derived. FRAX probabilities were categorized using updated Austrian thresholds, and DI was classified as green (> 0.844), yellow (0.779-0.844), or red (< 0.779). Combined FRAX and DI classifications were used to describe the burden and distribution of findings relevant to further osteoporosis assessment.

A total of 664 adults participated. Women had higher FRAX-estimated fracture probabilities and lower DI values than men. Median 10-year major osteoporotic fracture probability was 6.6% in women and 4.6% in men, and median hip fracture probability was 1.2% and 0.8%, respectively. DI was in the green range in 54.4% of women and 92.9% of men. When FRAX and DI were combined, 30.2% of women had abnormal DI despite FRAX probabilities below Austrian intervention thresholds, whereas discordance was uncommon in men.

Community-based prescreening identified a substantial number of adults who may benefit from formal osteoporosis assessment. In a region with high fracture burden and persistent care gaps, such local pathways could support earlier identification of osteoporosis risk.