Top

Archives of Osteoporosis

Published in:

01-12-2021 | Osteoporosis | Original Article

FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais

Authors: Napassorn Teeratakulpisarn, Suranut Charoensri, Daris Theerakulpisut, Chatlert Pongchaiyakul

Published in: Archives of Osteoporosis | Issue 1/2021

Abstract

Summary

We investigate the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD. We found that predictions were concordant in 83.8% of patients. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD.

Introduction

The Fracture Risk Assessment Tool (FRAX) is used to calculate the 10-year probability of fracture using important clinical factors, with bone mineral density (BMD) as an optional input variable. We aimed to determine the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD and to identify relevant clinical risk factors associated with discordance.

Methods

This was a cross-sectional study conducted in patients between 40 and 90 years of age who were screened for osteoporosis by BMD measurement using dual energy X-ray absorptiometry (DXA) from 2010 to 2018 at a university hospital in Thailand. A FRAX questionnaire was administered to determine demographic data and osteoporotic risk factors. FRAX scores with and without BMD were calculated for each participant using the Thai reference, and patients were categorized into either the treatment or non-treatment group based on a cut-off of 3% 10-year probability of hip fracture. When FRAX scores with and without BMD results were consistent, they were considered concordant. Otherwise, they were deemed discordant. Clinical risk factors were compared between the concordant and discordant groups.

Results

A total of 3545 participants were included in the study. The majority (83.8%) were in the concordant group. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were significantly associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD.

Conclusion

FRAX scores with and without BMD yielded concordant predictions regarding the 10-year probability of hip fracture suggesting pharmacological treatment. However, this concordance declined in elderly and osteoporotic participants and in those with FRAX without BMD around intervention threshold. BMD data may be required in these populations in order to facilitate accurate risk assessment.

(2001) NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000: highlights of the conference. S Med J 94:569–573

Kanis JA, Melton LJ, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141. https://doi.org/10.1002/jbmr.5650090802CrossRefPubMed

Limpaphayom KK, Taechakraichana N, Jaisamrarn U et al (2001) Prevalence of osteopenia and osteoporosis in Thai women. Menopause 8:65–69. https://doi.org/10.1097/00042192-200101000-00011CrossRefPubMed

Vaseenon T, Luevitoonvechkij S, Wongtriratanachai P, Rojanasthien S (2010) Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand. J Clin Densitom 13:63–67. https://doi.org/10.1016/j.jocd.2009.10.003CrossRefPubMed

Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, Hochberg MC, Vogt MT, Orwoll ES, Study of Osteoporotic Fractures Research Group (2005) Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 90:2787–2793. https://doi.org/10.1210/jc.2004-1568CrossRefPubMed

Songpatanasilp T, Sritara C, Kittisomprayoonkul W, Chaiumnuay S, Nimitphong H, Charatcharoenwitthaya N, Pongchaiyakul C, Namwongphrom S, Kitumnuaypong T, Srikam W, Dajpratham P, Kuptniratsaikul V, Jaisamrarn U, Tachatraisak K, Rojanasthien S, Damrongwanich P, Wajanavisit W, Pongprapai S, Ongphiphadhanakul B, Taechakraichana N (2016) Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis. Osteoporos Sarcopenia 2:191–207. https://doi.org/10.1016/j.afos.2016.10.002CrossRefPubMedPubMedCentral

Kanis JA, Harvey NC, Johansson H, Odén A, Leslie WD, McCloskey EV (2017) FRAX update. J Clin Densitom 20:360–367. https://doi.org/10.1016/j.jocd.2017.06.022CrossRefPubMed

Pongchaiyakul C, Leerapun T, Wongsiri S, Songpattanasilp T, Taechakraichana N (2012) Value and validation of RCOST and TOPF clinical practice guideline for osteoporosis treatment. J Med Assoc Thail 95:1528–1535

Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381. https://doi.org/10.1007/s00198-014-2794-2CrossRefPubMedPubMedCentral

10.

Yoo J-H, Moon S-H, Ha Y-C et al (2015) Osteoporotic fracture: 2015 position statement of the Korean Society for Bone and Mineral Research. J Bone Metab 22:175–181. https://doi.org/10.11005/jbm.2015.22.4.175CrossRefPubMedPubMedCentral

11.

Lu Y, Genant HK, Shepherd J, Zhao S, Mathur A, Fuerst TP, Cummings SR (2001) Classification of osteoporosis based on bone mineral densities. J Bone Miner Res 16:901–910. https://doi.org/10.1359/jbmr.2001.16.5.901CrossRefPubMed

12.

Kanis JA, Oden A, Johnell O, Johansson H, de Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg MA, la Croix A, McCloskey E, Mellstrom D, Melton LJ III, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046. https://doi.org/10.1007/s00198-007-0343-yCrossRefPubMed

13.

Johansson H, Oden A, Johnell O, Jonsson B, de Laet C, Oglesby A, McCloskey EV, Kayan K, Jalava T, Kanis JA (2004) Optimization of BMD measurements to identify high risk groups for treatment--a test analysis. J Bone Miner Res 19:906–913. https://doi.org/10.1359/jbmr.2004.19.6.906CrossRefPubMed

14.

Compston J, Cooper A, Cooper C, Francis R, Kanis JA, Marsh D, McCloskey E, Reid DM, Selby P, Wilkins M, National Osteoporosis Guideline Group (NOGG) (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108. https://doi.org/10.1016/j.maturitas.2008.11.022CrossRefPubMed

15.

Gadam RK, Schlauch K, Izuora KE (2013) Frax prediction without BMD for assessment of osteoporotic fracture risk. Endocr Pract 19:780–784. https://doi.org/10.4158/EP12416.ORCrossRefPubMedPubMedCentral

16.

Sadiq M, Hassan N, Sattar S, Hussain R, Naqvi M (2016) The WHO FRAX calculator with and without BMD as an indicator of low BMD in Pakistani women. Br J Med Med Res 18:1–7. https://doi.org/10.9734/BJMMR/2016/30003CrossRef

17.

Bastos-Silva Y, Aguiar LB, Pinto-Neto AM, Baccaro LF, Costa-Paiva L (2016) Correlation between osteoporotic fracture risk in Brazilian postmenopausal women calculated using the FRAX with and without the inclusion of bone densitometry data. Arch Osteoporos 11:16. https://doi.org/10.1007/s11657-015-0255-yCrossRefPubMed

18.

Strugala C, Sobala W, Szubert Z, Hanke W (2013) Evaluation of osteoporotic fractures in the group of woman over 50 years of age--comparison of tools FRAX BMD versus FRAX BMI. Med Pr 64:327–333PubMed

19.

Imerci A, Yalın Kılınç C, Aydogan NH, Karalezli MN, Savran A (2018) Fracture Risk Assessment Tool (FRAX®) results calculated with and without bone mineral density values for the evaluation of fracture risk in postmenopausal women with osteopenia. J Clin Densitom 21:464–471. https://doi.org/10.1016/j.jocd.2017.06.027CrossRefPubMed

20.

Kanis JA, Harvey NC, Johansson H, Odén A, Leslie WD, McCloskey EV (2015) FRAX and fracture prediction without bone mineral density. Climacteric 18(Suppl 2):2–9. https://doi.org/10.3109/13697137.2015.1092342CrossRefPubMed

21.

Crandall CJ, Larson J, Cauley JA, Schousboe JT, LaCroix AZ, Robbins JA, Watts NB, Ensrud KE (2019) Do additional clinical risk factors improve the performance of Fracture Risk Assessment Tool (FRAX) among postmenopausal women? Findings from the Women’s Health Initiative observational study and clinical trials. JBMR Plus 3:e10239. https://doi.org/10.1002/jbm4.10239CrossRefPubMedPubMedCentral

22.

Bow CH, Tsang SWY, Loong CHN, Soong CSS, Yeung SC, Kung AWC (2011) Bone mineral density enhances use of clinical risk factors in predicting ten-year risk of osteoporotic fractures in Chinese men: the Hong Kong Osteoporosis Study. Osteoporos Int 22:2799–2807. https://doi.org/10.1007/s00198-010-1490-0CrossRefPubMedPubMedCentral

23.

Dhiman P, Andersen S, Vestergaard P, Masud T, Qureshi N (2018) Does bone mineral density improve the predictive accuracy of fracture risk assessment? A prospective cohort study in Northern Denmark. BMJ Open 8:e018898. https://doi.org/10.1136/bmjopen-2017-018898CrossRefPubMedPubMedCentral

24.

Chen J-F, Yu S-F, Hsu C-Y, Chiu WC, Wu CH, Lai HM, Chen YC, Su YJ, Chen JF, Cheng TT (2019) The role of bone mineral density in therapeutic decision-making using the Fracture Risk Assessment Tool (FRAX): a sub-study of the Taiwan OsteoPorosis Survey (TOPS). Arch Osteoporos 14:101. https://doi.org/10.1007/s11657-019-0653-7CrossRefPubMed

25.

Hamdy RC, Seier E, Whalen K, Clark WA, Hicks K, Piggee TB (2018) FRAX calculated without BMD does not correctly identify Caucasian men with densitometric evidence of osteoporosis. Osteoporos Int 29:947–952. https://doi.org/10.1007/s00198-017-4368-6CrossRefPubMed

26.

Premaor M, Parker RA, Cummings S, Ensrud K, Cauley JA, Lui LY, Hillier T, Compston J, for the Study of Osteoporotic Fractures (SOF) Research Group (2013) Predictive value of FRAX for fracture in obese older women. J Bone Miner Res 28:188–195. https://doi.org/10.1002/jbmr.1729CrossRefPubMed

Title: FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais
Authors: Napassorn Teeratakulpisarn
Suranut Charoensri
Daris Theerakulpisut
Chatlert Pongchaiyakul
Publication date: 01-12-2021
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-021-00911-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Urban versus rural differences of hip fractures among the elderly in Kyoto, Japan: a 10-year study

The reliability and validity of the Turkish version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis-31 (QUALEFFO-31)

Textbook process as a composite quality indicator for in-hospital hip fracture care

Joint position statement on management of patient with osteoporosis during COVID-19 contingency from the AMMOM, CONAMEGER, FELAEN, FEMECOG, FEMECOT, and ICAAFYD

Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among women in China: a simulation projection model from 2020 to 2040

A 2-year longitudinal study of bone health in adolescent patients with axial spondyloarthritis