Agreement of Mexican FRAX with and without the value of bone mineral density in assessing the risk of fracture in daily clinical practice

Abstract

IntroductionThe use of FRAX without the inclusion of bone mineral density (FRAX-BMI) may be useful in clinical practice to identify patients at high risk of fracture and inform treatment decisions, but its usefulness is debated. The aim of the study is to evaluate the agreement between the risk of fracture calculated by FRAX with or without bone mineral density (BMD). Patients and methodsA cross-sectional study was conducted with 431 women (40–90 years) without treatment. The concordance of the probability of fracture was assessed by the concordance correlation coefficient (CCC), and by Bland–Altman method. The kappa index was used to evaluate the agreement between treatment indications. ResultsThe difference between the risks of a major osteoporosis fracture (MOFR) was 1.02±1.40% (95% CI −2 to 1.90) and −0.03±0.51% (95% CI −1.18 to 1.32) for the hip fracture risk (HFR). Agreement between MOFR and HFR FRAX scores was good (CCC 0.879, 95% CI 0.85–0.90 and CCC 0.821, 95% CI 0.79–0.85, respectively). The correlation between BMD of the femoral neck and fracture risk calculated by FRAX-BMI was a moderate, MOFR (r=−0.55, p<0.001) and HFR (r=−0.54, p<0.001). The agreement between the recommendations of treatment was 87% (kappa 0.61). ConclusionsThe good agreement between the risk of fracture obtained suggests that FRAX-BMI allows us to provide an estimate of risk in most cases.