Background The Fracture Risk Assessment Tool (FRAX) has been developed as an algorithm to evaluate the 10-year risk of hip and major osteoporotic fractures, based on clinical risk factors, with or without bone mineral density (BMD) at the femoral neck. In a context where costs are increasingly taken into account, the availability of such tool which requires no costs (when performed without BMD) comes up as a valuable resource that weights greatly on the clinicians’ decision to treat a patient with an antiosteoporotic drug.
The FRAX tool has recently been validated for the Portuguese population.
Objectives With this work, the authors intended to assess FRAX accuracy when retrospectively performed in patients with hip fracture.
Methods A retrospective cohort study was run, in which 100 patients with hip fracture randomly selected from an Orthopedics Department were enrolled. FRAX tool (without BMD) was performed and patients were questioned about previous or current treatment with antiosteoporotic drugs.
Results From the 100 patients enrolled, 31 couldn’t cooperate (because of dementia or other medical intercurrences). Amongst the 69 patients who could collaborate, 15 were male and 55 were female; mean age was 77.4±9.1 years; mean body mass index (BMI) was 25.9±4.6 kgs/m2. 21 patients had a history of previous fracture; 5 patients reported parents hip fracture; 2 patients were current smokers and 5 were current alcohol drinkers; 4 patients had systemic corticosteroid therapy history and 4 had secondary osteoporosis; none of the patients had rheumatoid arthritis. Only 8 patients were under treatment with antiosteoporotic drugs.
Mean risk for major osteoporotic fracture at 10 years was 14.9±9.7% and for hip fracture was 8.0±8.4%. 55 patients had a risk for major osteoporotic fracture <20% and 15 patients had a mean risk for hip fracture at 10 years <3%. All treated patients had a FRAX calculated risk for hip fracture at 10 years >3%.
Conclusions In this cohort, established threshold for high risk for hip fracture FRAX algorithm missed 21.7% of the patients who actually had a hip fracture. However, our cohort was small and the study was retrospective, which were the main limitations of this study.
Only 14.8% of the patients with high risk for hip fracture were already being treated with antiosteoporotic drugs. This number demonstrates that clinicians are underdiagnosing and undertreating osteoporosis, and the use of FRAX in clinical practice – especially in primary healthcare – could improve the intervention on these patients.
Kanis JA et al. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19:1395–1408
Disclosure of Interest None Declared