FRAX(R) and its applications to clinical practice
WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.Bone (Impact Factor: 3.97). 03/2009; 44(5):734-43. DOI: 10.1016/j.bone.2009.01.373
The introduction of the WHO FRAX (R) algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. FRAX (R) integrates the influence of several well validated risk factors for fracture with or Without the use of BMD, Its use in fracture risk prediction poses challenges for patient assessment, the development of practice guidelines, the evaluation of drug efficacy and reimbursement, as well as for health economics which are the topics outlined in this review. Crown Copyright
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- "Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) is used to predict fracture risk, diagnose osteoporosis, and monitor changes in BMD over time. Other applications of DXA include BMD input into fracture risk algorithms456, vertebral fracture assessment (VFA), analysis of body composition, measurement of hip structural parameters, and derivation of trabecular bone score (TBS). DXA provides a two-dimensional (2D) projection of bone that generates a value for areal BMD in g/cm 2 and T-scores for postmenopausal women and men age 50 years and older. "
ABSTRACT: Dual-energy X-ray absorptiometry (DXA) is a well-established clinical tool for measuring bone mineral density (BMD) in the assessment of patients at risk of fracture. DXA is commonly used to diagnose osteoporosis, assess fracture risk, and assess the skeletal effects of treatment. Non-BMD DXA measurements, such as vertebral fracture assessment, hip access length, and trabecular score, have clinical applications that can guide patient treatment decisions. Quantitative computed tomography (QCT) measures three-dimensional volumetric BMD that is correlated with fracture risk. QCT measurements of the hip can also be used to generate a two-dimensional DXA-equivalent areal BMD and T-score that can be used for diagnosis of osteoporosis and the assessment of fracture risk in the FRAX algorithm. Opportunistic measurements of BMD obtained with CT scans evaluating non-skeletal conditions have potential clinical utility in identifying patients at high risk of fracture. This is a collection of clinical vignettes that illustrate potential applications of non-BMD DXA measurements and CT scanning in the management of patients at risk of fracture.
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- "These findings were also consistent with the main results using the whole population (Table 2), implying no significant effect of the baseline anti-osteoporotic treatment and/or supplementation on the prediction of FRAX and FI in major osteoporotic fracture. Some studies argued that previous falls should be included into FRAX, since previous falls were an independent and significant risk factor for future fractures  . Nevertheless, evidence showed that models incorporating falls as a risk factor may not be superior to FRAX alone in predicting future risk of fractures . "
ABSTRACT: A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3,985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19 - 1.58) and 1.26 (95% CI: 1.12 - 1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18 months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that measures of frailty status may aid in fracture risk assessment and fracture prevention in the elderly. Further evidence from randomized controlled trials of osteoporosis medication interventions is needed to support the FI and FRAX as validated measures of fracture risk. Copyright © 2015. Published by Elsevier Inc.
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- "A growing attention is paid to test the predictive capacity of algorithms based on clinical risk factors, among which the FRAX tool is the most diffused worldwide. It predicts the ten-year probability of either major osteoporotic (a composed endpoint of femur, spine, humerus and forearm fractures) or hip fracture . Noteworthy, T2DM is not included among the primary entry variables of FRAX. "
ABSTRACT: This review focuses on the mechanisms determining bone fragility in patients with type 2 diabetes mellitus (T2DM). Despite bone mineral density (BMD) is usually normal or more often increased in these patients, fracture incidence is high, probably because of altered bone "quality". The latter seems to depend on several, only partly elucidated, mechanisms, such as the increased skeletal content of advanced glycation end-products causing collagen deterioration, the altered differentiation of bone osteogenic cells, the altered bone turnover and micro-architecture. Disease duration, its severity and metabolic control, the type of therapy, the presence or absence of complications, as like as the other known predictors for falls, are all relevant contributing factors affecting fracture risk in T2DM. In these patients the estimate of fracture risk in the everyday clinical practice may be challenging, due to the lower predictive capacity of both BMD and risk factors-based algorithms (e.g. FRAX).
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