Article
Author(s):
In 2014, the fracture risk algorithm FRAX celebrated its 20-year anniversary. Developed by a World Health Organization (WHO) study group in 1994, FRAX is a freely available diagnostic tool used to evaluate the 10-year probability of bone fracture risk, mostly for patients with osteoporosis. It is a part of many national health guidelines worldwide.
In 2014, the fracture risk algorithm FRAX celebrated its 20-year anniversary. Developed by a World Health Organization (WHO) study group in 1994, FRAX is a freely available diagnostic tool used to evaluate the 10-year probability of bone fracture risk, mostly for patients with osteoporosis. It is a part of many national health guidelines worldwide.
Because fracture probability and mortality show marked variation between countries, country-specific models have been developed where sufficient information is available. Currently, FRAX models are available for approximately 56 countries. It has also, like any clinical tool worth its salt in 2015, evolved from a paper-based system to a desktop and smart-phone app.
A recent mini-review in Maturitis looked at the current state of clinical use of FRAX, including its strengths and limitations. Traditional bone mineral density (BMD) measurements used in clinical practice show high specificity for prediction of fractures, but their sensitivity is quite low. Fracture risk algorithms such as FRAX improve prediction by including clinical risk factors that act independently of BMD. Further, a number of studies have demonstrated that the majority of fragility fractures occur in postmenopausal women who do not have osteoporosis.
“One reason for this is that some clinical risk factors other than low BMD contribute independently to fracture risk; inclusion of these risk factors significantly improves prediction of fracture and forms the basis of fracture risk algorithms such as FRAX,” noted review author Juliet Compston, MD, Chairman of the UK National Osteoporosis Guideline Group.
Among the limitations Compston cited:
Despite these limitations, Compston suggested that FRAX is still comparable to other algorithms being developed, is freely available, and its questionnaire is easy to use and understand.
“Whether individuals identified at high risk by FRAX have a similar response to bone protective therapy as those selected on the basis of low BMD ±â€…fracture is an important issue for future research,” she concluded.