Abstract
IntroductionThe FRAX calculator combines a set of clinical risk factors with country-specific incidence rates to determine the ten-year absolute risk of major osteoporotic fracture. However, regional or country-specific databases from Central American countries are not available. We compared the use of various FRAX databases and the Pluijm algorithm in determining risk of fracture.MethodsWe collected clinical risk factor data needed for the FRAX calculator and Pluijm algorithm of Hispanic women in Guatemala and calculated the FRAX absolute risk measures of major osteoporotic fracture and hip fracture. Subjects were postmenopausal women greater than age 40 with no history of using medication that affect bone. A random sample of 204 women in 34 different regions women in Guatemala City was visited in their homes to complete the surveys. The Pluijm risk score and FRAX risk score using the US Hispanic, Spain, and Mexican databases were calculated.ResultsWe used the US NOF guidelines for treatment which suggest a treatment threshold for patients with a 10-year hip fracture probability ≥3% or a 10-year major osteoporotic fracture risk ≥20%. The number of patients meeting the suggested threshold limits for treatment using the Spain and Mexico calculators were identical. There was 100% conformity in threshold limits for both hip and major osteoporotic fracture risk. The mean conformity for any fracture risk between US Hispanic and the other two databases was 97.5%. Conformity was 99.0% based on major osteoporotic fracture and 97.5% based on risk of hip fracture. The Pluijm evaluation shows conformity of 87.2% and 83.3%, respectively, when compared to the US Hispanic and Spain/Mexico FRAX thresholds for risk of fracture.DiscussionAlthough the different FRAX databases provide variations in the absolute risk of fracture, the overall conformity to treatment thresholds amongst the US Hispanic, Spain, and Mexico databases show the database used would have little effect as to the decision to treat. The Pluijm tool conforms to the FRAX thresholds and can be used as well. It does not matter which country-specific calculator or assessment tool is used, as there are a similar number of patients that would meet the intervention threshold.
Highlights
The FRAX calculator combines a set of clinical risk factors with country-specific incidence rates to determine the ten-year absolute risk of major osteoporotic fracture
The WHO Task Force, Garvan Institue, and other researchers have identified a superset of clinical risk factors that can be used alone or in combination with BMD results to predict the absolute risk of hip fracture and/or clinical fracture [1]
These risk factors have been combined with country-specific incidence rates into the web-based Fracture Risk Assessment Tool (FRAX) [2] to determine the ten year absolute risk of major osteoporotic and hip fracture
Summary
The FRAX calculator combines a set of clinical risk factors with country-specific incidence rates to determine the ten-year absolute risk of major osteoporotic fracture. The WHO Task Force, Garvan Institue, and other researchers have identified a superset of clinical risk factors that can be used alone or in combination with BMD results to predict the absolute risk of hip fracture and/or clinical fracture [1]. These risk factors have been combined with country-specific incidence rates into the web-based Fracture Risk Assessment Tool (FRAX) [2] to determine the ten year absolute risk of major osteoporotic (hip, clinical vertebral, forearm, and humerus) and hip fracture. We collected risk factor data from women in Guatemala City to compare the interchangeability of the various internet-based FRAX algorithms and compared them to the simpler manual algorithm developed by Pluijm et al [4]
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