Utility of fracture risk calculation by FRAX and Nguyen algorithm for fracture risk assessment and qualification for therapy in Polish women with postmenopausal osteoporosis

Objectives: Identification of clinical risk factors for fracture may help to qualify patients with osteoporosis for treatment. Fracture risk calculators may be of assistance in this respect.

Design : To evaluate the utility of two risk calculators in qualification for anti-fracture treatment.

Materials and methods: The study included 212 women (mean age 67.4 ±8.6 years), patients of the Endocrinology Outpatient Clinic diagnosed with osteoporosis, previously untreated. The group included 143 females with a history of low-energy fracture. All women were interviewed for clinical risk factors for fracture and underwent physical examination. Dual X-ray absorptiometry of the proximal femur was performed (LUNAR). The calculation of 10-year fracture risk was done using two calculators: FRAX (hip/major, UK version), and Nguyen’s. Risk values were referred to thresholds for intervention recommended in Poland: > 3% for hip fracture risk and

> 20% for the absolute fracture risk.

Results: Among women without a history of fracture, hip fracture risk by FRAX-hip and Nguyen was

1.7 ±2.7%, and 3.6 ±3.9%, respectively. Any fracture risk was 8.1 ±4.7% by FRAX, and 14.8 ±7.3% by Nguyen.

In women after fracture, a 20% threshold of fracture risk that qualifies for treatment was met by 9.0% of patients if calculation was done using FRAX major, and 67.8% according to Nguyen total. Conformity – the percentage of women equally eligible to be treated by both methods – was 6.6% with any fracture risk and 22.1% with hip fracture risk.

Conclusions :

1. Falls are a significant risk factor for low-energy fractures, not included in WHO-recommended FRAX calculator.

2. Among Polish postmenopausal women, the fracture risk calculated using the UK version of FRAX allows to indentify only a small percentage of women who, due to a history of fracture, are eligible for anti-osteoporotic treatment.

3. Introduction of the Polish version of a fracture risk calculator is recommended.

4. Conformity of UK-FRAX and Nguyen’s calculators in qualification for the anti-fracture treatment in Poland is low.