ICE/ENDO 2014: 16th International Congress of Endocrinology and The Endocrine Society's 96th Annual Meeting:

FRAX® and Clinical Risk Factors

Steven Wai Ing, MD, MSCE presented Risk Assessment for Osteoporosis: Beyond DEXA during a Meet-the-Professor session held at the Endocrine Society’s Annual Meeting held in Chicago. Dr. Ing is an assistant professor of Endocrinology, Diabetes, and Metabolism at Ohio State University Wexner Medical Center in Columbus, Ohio.

Fracture risk assessment is an important method for clinicians to identify patients at high risk for fracture who might benefit from pharmacological treatment. The FRAX® tool, launched in 2008 from the University of Sheffield,  derived clinical risk factors from data obtained from nine prospective cohort studies (ie, Asia, Australia, Europe, North America).

There were more than 46,000 participants, almost 200,000 person-year time exposure with 850 hip fractures and more than 3,000 other osteoporotic fractures.  The FRAX tool was independently evaluated and approved for use in a variety of countries and subpopulations by the National Institute for Health and Care Excellence in the UK and the US Food and Drug Administration.                      

In addition to age and sex, clinical risk factors include:

  • Body mass index
  • Personal history of fragility and fracture
  • Parental history of hip fracture
  • Current cigarette smoking
  • Corticosteroid overuse
  • Alcohol use
  • Rheumatoid arthritis

Dr. Ing pointed out that it has been known for a long time that bone density is a risk factor for fracture, and it means something different if the patient is young versus old. Considering women, “At age 50, if the patient’s T-score of -1 declines to a -2, her risk for a hip fracture increases four-fold. In contrast, if the patient is an 85-year-old woman whose T-score of -1 declines to -2 her risk for hip fracture is only two-fold,” stated Dr. Ing. However, Dr. Ing added that these risks are relative, not absolute risks. Clinicians know that an 85-year-old patient’s absolute risk for a fracture is much higher than the absolute risk for a 50-year-old woman.

FRAX Limitations
FRAX does not incorporate all the known risk factors in its algorithm. It does not include:

  • Falls
  • Diabetes; although type 1 diabetes is included as a secondary cause of fracture
  • Chronic kidney disease
  • Family history of non-hip fragility fractures  

Therefore, it is important for the clinical to apply their experience to the individual patient and the cost and efficacy of treatment.

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