FRAX

The Fracture Risk Assessment Tool , or FRAX for short , is a computer-based algorithm for calculating the risk of suffering an osteoporosis- related fracture in the next ten years , which was developed under the leadership of John A. Kanis at the University of Sheffield and is based on whose homepage is available in six languages. The risk is specified for a femoral neck fracture and for a larger osteoporotic fracture , including a clinically manifest vertebral body fracture, a distal radius fracture, a proximal humerus fracture and a femoral neck fracture.

questionnaire

The analysis is based on clinical risk factors, regional origin and with the help of the results of a bone density measurement of the femoral neck. Since the regional origin is of great importance, regional comparison groups are necessary. Accordingly, the algorithm does not exist for all countries and regions of origin, but is constantly being expanded and in August 2012 was already available in 21 languages. National risk algorithms already exist for Germany, Austria, Switzerland and Belgium. In the USA and Singapore, different comparison groups are defined on the basis of ethnic origin.

The clinical data used are known from osteoporosis research and are established risk factors. In addition to age (between 40 and 90 years of age) and gender, height and weight are also considered. Further questions concern:

• a previous clinically noticeable pathological fracture in adulthood
• a hip fracture in one parent
• current smoking status
• current intake of cortisone
• Rheumatoid arthritis disease
• Other systemic diseases at risk of secondary osteoporosis, such as insulin-dependent diabetes mellitus
• Consumption of an average of at least three alcoholic drinks per day

Furthermore, the bone density of the femoral neck must be specified after selecting the measuring device. However, only the DEXA measurement method is accepted.

application

The algorithm is intended to estimate a possible anti-resorptive osteoporosis therapy and is primarily designed for medical use. While the indication for antiresorptive therapy is usually clear in the case of overt osteoporosis with a t-score of less than −2.5, most fractures occur with osteopenia with a t-score between −1 and −2.5.

The FRAX algorithm is suitable for this limit area. According to current recommendations, which were adopted by the American National Osteoporosis Foundation in its guidelines, but which still lack a correct scientific basis, therapy should be initiated in men over 50 years of age and in women after menopause if the risk of a hip fracture is at least ten years 3% or at least 20% for a larger osteoporotic fracture.

Application limits

Difficulties in using the FRAX algorithm arise particularly with migrants, as it is unclear whether the algorithm of the country of origin or the country of current residence should be used, and there are no reference populations for different ethnicities of the individual countries except for the USA and Singapore . In addition, the previous intake of cortisone is only queried as a binary number , although the risk of osteoporosis depends heavily on the duration and dose of cortisone intake. Furthermore, the procedure is only designed for the bone density on the hip, but not for that of the radius or the lumbar spine , which is a very strong risk factor for further osteoporotic bone fractures. Vitamin D deficiency and previous falls were also not included in the algorithm as risk factors , which, according to the authors, would not improve the accuracy of the method.

Individual evidence

1. ↑ Unnanuntana A, Gladnick BP, Donnelly E, Lane JM: The assessment of fracture risk Archived from the original on May 28, 2010. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: The Journal of Bone and Joint Surgery . 92, No. 3, March 2010, pp. 743-753. PMID 20194335 . Retrieved April 29, 2010. 
2. ↑ RG Middleton, F. Shabani, CE Uzoigwe, A. Shoaib, M. Moqsith, M. Venkatesan: FRAX and the assessment of the risk of developing a fragility fracture. Journal of Bone and Joint Surgery, British Edition, 2012, Volume 94-B, pages 1313-1320

Web links

• FRAX available on Sheffield University website

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !