FRAX calculated without BMD does not correctly identify Caucasian men with densitometric evidence of osteoporosis

• Published in: Osteoporosis international Vol. 29; no. 4; pp. 947 - 952
• Main Authors: Hamdy, R. C., Seier, E., Whalen, K., Clark, W. A., Hicks, K., Piggee, T. B.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.04.2018; Springer Nature B.V
• Subjects: Aged; Algorithms; Bone Density - physiology; Bone mineral density; Densitometry; Endocrinology; Femur Neck - physiopathology; Fractures; Hip Joint - physiopathology; Humans; Lumbar Vertebrae - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Osteoporosis; Osteoporosis - diagnosis; Osteoporosis - physiopathology; Osteoporotic Fractures - etiology; Osteoporotic Fractures - physiopathology; Osteoporotic Fractures - prevention & control; Patients; Population studies; Retrospective Studies; Rheumatology; Risk assessment; Risk Assessment - methods; ROC Curve; White people; Osteoporosis; FRAX; Bone mineral density; Management; Men
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-017-4368-6

Summary The FRAX algorithm assesses the patient’s probability of sustaining an osteoporotic fracture and can be calculated with or without densitometric data. This study seeks to determine whether in men, FRAX scores calculated without BMD, correctly identify patients with BMD-defined osteoporosis. Introduction The diagnosis of osteoporosis is based on densitometric data, the presence of a fragility fracture or increased fracture risk. The FRAX algorithm estimates the patient’s 10-year probability of sustaining an osteoporotic fracture and can be calculated with or without BMD data. The purpose of this study is to determine whether in men, FRAX calculated without BMD, can correctly identify patients with BMD-defined osteoporosis. Methods Retrospectively retrieved data from 726 consecutive Caucasian males, 50 to 70 years old referred to our Osteoporosis Center. Results In the population studied, 11.8 and 25.3% had BMD-defined osteoporosis when female and male reference populations were used respectively. When the National Osteoporosis Foundation thresholds to initiate treatment are used, only 27% of patients with BMD-defined osteoporosis, but 4% with normal BMD reached/exceeded these thresholds. Lowering the threshold increased sensitivity, but decreased specificity. Conclusions Our results suggest that FRAX without BMD is not sensitive/specific enough to be used to identify Caucasian men 50 to 70 years old with BMD-defined osteoporosis.