This article is more than 5 years old. Information may no longer be current.
WHO fracture risk assessment tool underestimates danger for some
Click Here to Manage Email Alerts
A tool developed by WHO to assess bone fracture risk underestimates the vulnerability in certain age groups and circumstances, according to a study published in The Journal of Clinical Endocrinology & Metabolism.
The Fracture Risk Assessment Tool (FRAX) — created to predict the likelihood that adults aged 40 to 90 years will break a bone in a fragility fracture (FF) and designed to help physicians identify osteoporosis cases not diagnosed through bone mineral density tests — fails to show risks in people younger than 65 years and those treated for a single broken bone, researchers in Canada found.
“Although FRAX is a helpful tool and provides important information, it should not be used as the unique and definitive gold standard for determining whether or not to treat a patient for osteoporosis or weakening bones,” Gilles Boire, MD, of the University of Sherbrooke in Quebec, Canada, said in a press release. “The test fails to identify some patients who would benefit from treatment to prevent future fractures.”
In a prospective cohort, Boire and colleagues gauged 10-year fracture risks among 1,399 patients identified as having a FF at older than 50 years. They used a Canadian form of the tool called BMI-FRAX, which incorporates national data on fracture rates, and scores were calculated before and after FF. Recurrent FF were recorded for 4 years.
Results showed high BMI-FRAX scores for 42.7% of patients before FF and 56.4% after FF. Most participants at low or moderate risk before their initial FF were men younger than 65 years or without previous FF. Follow-up showed recurrent FF in 108 patients. Sensitivity of post-FF FRAX to predict a recurrent incident was 71.3% and specifically lower in patients younger than 65 years (13%) and without previous FF (63%) at inclusion.
“The FRAX-BMI scores were below the Canadian threshold for treatment in more than half the patients at the time of a FF and in close to a third of patients with recurrent FF,” the researchers wrote. “FRAX-BMI severely underestimates the FF risk in patients under 65 years old, and after a single FF.”
Disclosure: Researchers received lecture fees or advisory board fees from Merck Canada, Procter&Gamble Canada, sanofi-aventis Canada, Amgen Canada, Novartis Canada Inc., Eli Lilly Canada and Servier Canada Inc. One researcher is an employee of Merck Canada. See study for full list of funding.
Click Here to Manage Email Alerts