PURPOSE The usefulness of FRAX in predicting major bone fractures in patients with end-stage kidney disease on maintenance hemodialysis treatment has been confirmed in previous studies. For meaningful clinical use, the prognostic and intervention FRAX thresholds need to be established. METHODS The primary aim of our study was to calculate the optimal cut-off point of FRAX for the best prediction of an increased bone fracture risk in dialysis patients and additionally, to propose its intervention threshold, indicating the need for antifracture pharmacological treatment. The study included 718 hemodialysis patients, who were followed up for two years. Thirty low-energy major bone fractures were diagnosed during the study period. We used the Polish version of FRAX (without the DXA examination) and some particular variables of the FRAX calculator. The optimal cut-off point for prediction of an increased major bone fracture risk was based on the analysis of the sensitivity and specificity curves of FRAX. RESULTS The analysis revealed FRAX >5% (sensitivity of 70.0%, specificity of 69.8%) as the prognostic threshold for major bone fractures. Its sensitivity for bone fracture prediction was significantly higher, but specificity lower than those of FRAX ≥10%, used in general Polish population. The reason for this can be an underestimation of bone fracture risk with FRAX in dialysis patients. CONCLUSIONS We conclude that the FRAX prognostic threshold for identification of an increased risk of major bone fractures in hemodialysis patients is >5%. We propose to use this specific value of FRAX as an intervention threshold for pharmacological antifracture treatment in hemodialysis patients.

中文翻译：

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血液透析患者重大骨折管理中的 FRAX 预后和干预阈值：一项为期两年的前瞻性多中心队列研究

目的 FRAX 在预测接受维持性血液透析治疗的终末期肾病患者严重骨折方面的有用性已在先前的研究中得到证实。对于有意义的临床应用，需要建立预后和干预 FRAX 阈值。方法我们研究的主要目的是计算 FRAX 的最佳截止点，以最好地预测透析患者骨折风险增加，此外，提出其干预阈值，表明需要抗骨折药物治疗。该研究包括 718 名血液透析患者，他们随访了两年。在研究期间诊断出 30 例低能量重大骨折。我们使用了波兰版的 FRAX（没有 DXA 考试）和 FRAX 计算器的一些特定变量。预测主要骨折风险增加的最佳截止点是基于对 FRAX 的敏感性和特异性曲线的分析。结果 分析显示 FRAX > 5%（敏感性为 70.0%，特异性为 69.8%）作为主要骨折的预后阈值。其对骨折预测的敏感性显着较高，但特异性低于 FRAX ≥10%，用于一般波兰人群。其原因可能是低估了透析患者使用 FRAX 的骨折风险。结论 我们得出的结论是，用于识别血液透析患者主要骨折风险增加的 FRAX 预后阈值 > 5%。我们建议使用 FRAX 的这个特定值作为血液透析患者药物抗骨折治疗的干预阈值。