Interpretation and use of FRAX in clinical practice

Kanis, J. A.<sup>1</sup>; Hans, D.<sup>2</sup>; Cooper, C.<sup>3,4</sup>; Baim, S.<sup>5</sup>; Bilezikian, J. P.<sup>6</sup>; Binkley, N.<sup>7</sup>; Cauley, J. A.<sup>8</sup>; Compston, J. E.<sup>9</sup>; Dawson-Hughes, B.<sup>10</sup>; El-Hajj Fuleihan, G.<sup>11</sup>; Johansson, H.<sup>12</sup>; Leslie, W. D.<sup>13</sup>; Lewiecki, E. M.<sup>14</sup>; Luckey, M.<sup>15</sup>; Oden, A.<sup>12</sup>; Papapoulos, S. E.<sup>16</sup>; Poiana, C.<sup>17</sup>; Rizzoli, R.<sup>18</sup>; Wahl, D. A.<sup>19</sup>; McCloskey, E. V.<sup>20</sup>

Affiliations

¹WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

²Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland

³MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

⁴NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK

⁵Division of Endocrinology, University of Miami, Miller School of Medicine, Coral Gables, USA

⁶Columbia University College of Physicians and Surgeons, New York, USA

⁷Osteoporosis Clinical Research Program, University of Wisconsin, Madison, USA

⁸Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA

⁹Department of Medicine, Addenbrooke’s Hospital, Cambridge University, Cambridge, UK

¹⁰Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, USA

¹¹WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, Lebanon

¹²Centre for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

¹³University of Manitoba, Winnipeg, Canada

¹⁴New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, USA

¹⁵St. Barnabas Osteoporosis & Metabolic Bone Disease Center, Livingston, USA

¹⁶Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands

¹⁷Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

¹⁸Division of Bone Diseases, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

¹⁹International Osteoporosis Foundation, Nyon, Switzerland

²⁰Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK

Abstract and keywords

Summary: The introduction of the WHO FRAX® algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. Its use in fracture risk prediction has strengths, but also limitations of which the clinician should be aware and are the focus of this review

Introduction: The International Osteoporosis Foundation (IOF) and the International Society for Clinical Densitometry (ISCD) appointed a joint Task Force to develop resource documents in order to make recommendations on how to improve FRAX and better inform clinicians who use FRAX. The Task Force met in November 2010 for 3 days to discuss these topics which form the focus of this review.

Methods: This study reviews the resource documents and joint position statements of ISCD and IOF.

Results: Details on the clinical risk factors currently used in FRAX are provided, and the reasons for the exclusion of others are provided. Recommendations are made for the development of surrogate models where country-specific FRAX models are not available.

Conclusions: The wish list of clinicians for the modulation of FRAX is large, but in many instances, these wishes cannot presently be fulfilled; however, an explanation and understanding of the reasons may be helpful in translating the information provided by FRAX into clinical practice.

Keywords: Bone mineral density; Clinical risk factors; Fracture probability; Risk assessment

Links

DOI: 10.1007/s00198-011-1713-z

PubMed: 21779818

WoS: 000293636500001

History

Received: 2011-05-18

Accepted: 2011-06-07

Online: 2011-07-21

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2018	Trajanoska K, Morris JA, Oei L, Zheng H-F, Evans DM, Kiel DP, Ohlsson C, Richards JB, Rivadeneira F; GEFOS/GENOMOS consortium; 23andMe research team. Assessment of the genetic and clinical determinants of fracture risk: genome wide association and mendelian randomisation study. BMJ. August 29, 2018;362:k3225.
2017	Curtis EM, Moon RJ, Harvey NC, Cooper C. The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Bone. November 2017;104:29-38.
2020	Rajapakse CS, Farid AR, Kargilis DC, Jones BC, Lee JS, Johncola AJ, Batzdorf AS, Shetye SS, Hast MW, Chang G. MRI-based assessment of proximal femur strength compared to mechanical testing. Bone. April 2020;133:115227.
2021	Champakanath A, Keshawarz A, Pyle L, Snell-Bergeon JK, Shah VN. Fracture risk assessment (FRAX) without BMD and risk of major osteoporotic fractures in adults with type 1 diabetes. Bone. February 2021;143:115614.
2021	Shah VN, Pyle L, Snell-Bergeon JK. Response to authors' concern. Bone. February 2021;143:115750.
2023	Alajlouni DA, Bliuc D, Tran TS, Blank RD, Center JR. Muscle strength and physical performance contribute to and improve fracture risk prediction in older people: a narrative review. Bone. July 2023;172:116755.
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2013	Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO); Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. January 2013;24(1):23-57.
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