FRAX Accurately Identifies Women at Risk for Vertebral Fracture

By Will Boggs MD

December 01, 2014

NEW YORK (Reuters Health) - The WHO fracture risk assessment tool FRAX is better than lumbar spine and femoral neck T-scores at identifying women with vertebral fractures, researchers from Morocco report.

"An elevated FRAX score may be used as a screening tool to indicate bone mineral density (BMD) measurement and vertebral fracture assessment (VFA) at the same time," Dr. Abdellah El Maghraoui from Military Hospital Mohammed in Rabat, Morocco, told Reuters Health. "The cut-off of what is an elevated FRAX has to be determined in different populations."

"Vertebral fractures (VFs) are the most common type of osteoporotic fractures in older adults," Dr. Maghraoui explained. "It has been shown that VFs are usually asymptomatic (only one-fourth to one-third of these fractures come to medical attention). The identification of asymptomatic VFs is of primordial importance especially in patients without densitometric osteoporosis, a common situation where all experts agree to recommend treatment."

Dr. Maghraoui's team developed a Moroccan model based on FRAX and evaluated the performance of FRAX scores in comparison with BMD measurement in identifying women with prevalent asymptomatic vertebral fractures.

Their cross-sectional study included 908 menopausal women aged 50 years and older. Of these women, nearly a third had osteoporosis and 44% had osteopenia.

Vertebral fractures were present in 382 (42.1%) of women, the researchers report in BMC Musculoskeletal Disorders, online November 4.

FRAX without BMD provided the best method of predicting vertebral fracture in these women, and there was no improvement when BMD was added to the model.

A FRAX cutoff of 3%, for example, yielded 57% sensitivity, 78% specificity, 40% positive predictive value, and 2.68 positive likelihood ratio for predicting major fractures.

"The FRAX tool is not designed to examine the risk of asymptomatic vertebral fractions," the researchers say. "However, we performed this analysis because of the importance of this kind of fracture in the outcome of osteoporosis."

"A woman with elevated FRAX should be evaluated further: DXA with VFA, biological exams including vitamin D, iPTH, etc., and in some cases bone turnover markers," Dr. Maghraoui said. "Other factors not included in FRAX should be evaluated such as the risk of fall."

"VFA can easily be performed at the same time of bone mineral density (BMD) measurement, allowing integration of BMD and VF information in the clinical care of patients evaluated for osteoporosis," Dr. Maghraoui concluded. "Advantages of VFA compared with spine radiographs include greater patient convenience (VFA can be done in association with BMD testing by DXA), smaller dose of ionizing radiation, and lower cost."


BMC Musc Disord 2014.


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