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New review clarifies use of FRAX in clinical practice
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In a recently published review paper, the International Osteoporosis Foundation and International Society for Clinical Densitometry released recommendations for FRAX — a computer-based algorithm developed by the WHO Collaborating Centre for Metabolic Bone Diseases to help predict the 10-year risk of fragility fracture.
With 34 specific country models, FRAX is being used increasingly by physicians around the world to help assess their patients’ fracture risk in the course of a clinical assessment.
Providing recommendations
In the review paper, the International Osteoporosis Foundation (IOF) and International Society for Clinical Densitometry (ISCD) detailed the findings of a joint task force that met in 2010 for the ISCD IOF FRAX Initiative meeting with the objective of making recommendations on how to improve FRAX and better inform clinicians who use the tool.
“FRAX is a widely accepted reference platform that allows physicians to make more informed clinical assessments of their patients,” co-chair of the FRAX initiative and immediate past president of the ISCD, Didier Hans, PhD, stated in a press release. “Indeed, although FRAX scores provide empirical evidence to better guide intervention, clinical judgment is paramount.”
Strengths and limitations
Among the strengths noted in the review include that FRAX has been validated in 11 independent cohorts covering more than 1 million patient years. Additionally, FRAX models — which determine the predictive importance of each clinical risk factor as well as interactions between risk factors — are based on country-specific data and integrate mortality as well as age-specific fracture rates.
Limitations of the system, the review noted, include FRAX’s inability to take into account all risk variables of which the physician should be aware and the variation of risks associated with the number and type of prior fractures or quantity of alcohol or tobacco consumption.
“The wish list of clinicians for the modulations of FRAX is large, but in many instances, these wishes cannot presently be fulfilled,” the authors wrote. “However, an explanation and understanding of the reasons may be helpful in translating the information provided by FRAX into clinical practice.”
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