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FRAX without BMD can be used to risk-stratify Veterans who recently sustained a low trauma non-vertebral/non-hip fracture

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Abstract

Summary

We evaluated the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients with a recent low trauma fracture other than hip or vertebral. The concordance, sensitivity, and specificity were 75.6%, 67.3%, and 78.2%, respectively. FRAX without BMD can be used after a fracture to expedite treatment.

Introduction

The objective of this study was to evaluate the performance of the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients who recently sustained a low trauma fracture other than hip or vertebral.

Methods

We utilized a clinical database established by the Fracture Liaison Service at the Durham Veterans Affairs Medical Center to identify male and female Veterans age ≥ 50 years who sustained a low trauma non-hip/non-vertebral fracture and underwent dual-energy x-ray absorptiometry (DXA) between October 2013 and April 2018. FRAX without BMD (FRAX-BMI) and FRAX with BMD (FRAX-BMD) were calculated for the 229 patients identified, and whether or not they met the National Osteoporosis Foundation (NOF) guideline treatment thresholds was compared.

Results

There were 55 (24.0%) patients that met criteria for treatment based on NOF guideline established FRAX-BMD thresholds including 27 (11.8%) patients with osteoporosis by DXA. The concordance of FRAX-BMI in predicting treatment recommendations was 75.6% with a sensitivity of 67.3% and a specificity of 78.2%. The area under the curve (AUC) of FRAX-BMI hip fracture risk was 0.79. Assessment/treatment thresholds for hip fracture risk of 1% < FRAX-BMI < 4% were proposed to maximize sensitivity and specificity.

Conclusion

Among patients who sustained a low trauma non-hip/non-vertebral fracture, FRAX-BMI can be used to stratify risk and identify high-risk patients who could be treated without DXA, low-risk patients who may not need treatment, and intermediate-risk patients to undergo DXA testing.

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Funding

Research reported in this publication was supported by the National Institutes of Health under Award Number T32DK007012 (NS).

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Duke University Medical Center, Box 3924, 200 Trent Drive, Baker House, Room 310, Durham, NC, 27710, USA

    N. Sagalla & R. Lee

  2. Durham Veterans Affairs Medical Center, Durham, NC, USA

    N. Sagalla, C. Colón-Emeric, K. Lyles, J. Vognsen & R. Lee

  3. Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, NC, USA

    C. Colón-Emeric, R. Sloane & K. Lyles

Authors
  1. N. Sagalla
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  2. C. Colón-Emeric
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  3. R. Sloane
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  4. K. Lyles
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  5. J. Vognsen
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  6. R. Lee
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Correspondence to N. Sagalla.

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Conflicts of interest

Kenneth Lyles is a Trustee of the National Osteoporosis Foundation, a consultant for Health Stream, Viking, and founder and equity owner of Faculty Connection, LLC and BisCardia, Inc. Nicole Sagalla, Cathleen Colón-Emeric, Richard Sloane, Julie Vognsen, and Richard Lee declare that they have no conflict of interest.

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Sagalla, N., Colón-Emeric, C., Sloane, R. et al. FRAX without BMD can be used to risk-stratify Veterans who recently sustained a low trauma non-vertebral/non-hip fracture. Osteoporos Int 32, 467–472 (2021). https://doi.org/10.1007/s00198-020-05616-5

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  • DOI: https://doi.org/10.1007/s00198-020-05616-5

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