Is It Possible to Increase the Clinical Effectiveness of the Fracture Risk Assessment Tool in Osteopenia Patients by Taking Into Account Bone Mineral Density Values?

The study aimed to investigate the effectiveness of the clinical use of the Fracture Risk Assessment Tool (FRAX®) developed by the World Health Organization identifying patients at risk of osteoporotic fracture and to evaluate changes in osteoporotic fracture risk prediction according to bone mineral density (BMD) values. We identified the occurrence of osteoporotic fracture among patients whose BMD was measured in our hospital between April 2003 and March 2013. We then analyzed FRAX® scores obtained with or without BMD on the day before the occurrence of an osteoporotic fracture in actual osteoporotic fracture patients. According to the National Osteoporosis Foundation high-risk criteria, we identified the percentage of high-risk patients before the actual fracture. Among 445 osteoporotic fracture patients, when FRAX®-BMD was used, 281 patients (63%) were identified as high-risk before an actual osteoporotic fracture, and when FRAX® without BMD was used, 258 patients (58%) were identified (p = 0.115). In the 84 osteopenia patients, 39 patients (46.4%) were identified as high-risk when FRAX® without BMD was used, and 19 patients (22.6%) were identified when FRAX®-BMD was used (p = 0.001). The use of BMD in FRAX® does not seem to increase the clinical effectiveness of predicting osteoporotic fracture in osteopenia patients.