Background Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Case finding strategies form the basis of current clinical practice in identifying those patients who are at risk of osteoporotic fracture and would most benefit from preventative treatment. WHO guidelines using BMD (via DEXA scan) to stratify risk categories underpin clinical decision making and National Institute of Clinical Excellence (NICE) Technology Appraisals (TAs) define treatment options using this process. FRAX is a risk assessment tool which can be used without BMD assessment in a variety of clinical settings to define absolute fracture risk over a 10 year period. This, together with NOGG, is used to define whether patients should receive treatment, have further investigation with DEXA scan or receive lifestyle advice only. The recent NICE Clinical Guidelines (CG 146) promotes the initial use of FRAX (or QFracture) in the majority of patients at risk of osteoporotic fracture rather than referring them for DEXA scanning. This study compares the two methodologies of FRAX and DEXA in 355 patients who recently attended the osteoporosis service at Princess of Wales Hospital, Bridgend.
Objectives To find out if FRAX is a reliable alternative to DEXA in assessing fracture risk
Methods We included 355 patients with confirmed osteoporosis (T score ≤ -2.5 at total hip or total spine) on DEXA scan. We used their details from the CELLMA database to calculate FRAX and then compared with DEXA.
Results 355 patients were included in the study (313 female and 42 male).
- DEXA scan was recommended in 57% of the patients.
- In 14% treatment was recommended.
- In 29% of all patients, lifestyle advice alone would have been suggested.
- 81% of the male patients would have only been given lifestyle advice.
- 10% of the patients with established or severe osteoporosis (i.e. those with prevalent low trauma fractures in addition to osteoporotic T scores on DEXA scan) would not have been recommended for treatment using FRAX alone.
Conclusions 29% of total patients with confirmed Osteoporosis on DEXA scan would have only been given lifestyle advice. 81% of males would have been missed by using FRAX tool alone. Of most concern is the 10% of patients with severe osteoporosis (recognized to have the highest risk of further fracture). The recent Clinical Guidelines from NICE recognize that an underestimate of fracture risk may occur if FRAX assessment alone is used to identify osteoporotic risk. This has been borne out by the above study.
References NICE Clinical Guidelines (CG146)
Disclosure of Interest None Declared