Comparison between real-world practice and application of the FRAX algorithm in the treatment of osteoporosis

Abstract

Background and aims The most recent guidelines suggest treating patients whose FRAX 10-year fracture risk scores are ≥ 20%. However, this method of evaluation does not take into account parameters that are nonetheless relevant to the therapeutic choice. Our aim was to compare the therapeutic choices for treatment based on a wider assessment (real-world practice) with those based on FRAX scores, taking 20% as the cut-off score. Methods We obtained the medical history, bone mineral density (BMD) values, and the presence of major fragility fractures in a sample of 856 postmenopausal women. The 10-year FRAX risk of major osteoporotic fracture was calculated, and patients were grouped into risk classes (“FRAX < 20%” = low, “FRAX ≥ 20%” = high); we then compared the treated and untreated patients in each class. After an average interval of 2.5 years, changes in lumbar and femoral BMD and appearances of new fragility fractures were recorded. Results 83% of high-risk patients and 57% of low-risk patients were treated. The therapeutic decision was based mainly on densitometric values and the presence of vertebral fractures. At the 2.5 year follow-up, lumbar spine and femur BMD had decreased in the untreated group; 9.9% of the treated patients developed new vertebral fragility fractures, compared with 5.3% of the untreated patients. Discussion and conclusions Our wider assessment designated as at high fracture risk a group of patients who had not been identified by the FRAX assessment. FRAX could underestimate the risk of fracture in older people, for which the therapeutic choice should consider a broader approach, also based on individual patient’s needs.

Patients’ preferences for fracture risk communication: the Risk Communication in Osteoporosis (RICO) study

“…An awareness of all these patient preferences in fracture risk communications could help in the progress of new patient-decision tools. Participants were interested in the development of an online tool that could visually represent their individual fracture risk, as measured with fracture risk calculators such as the FRAX® tool [ 5 , 10 ]. Because participants also expressed a willingness to talk directly with their healthcare professionals, the use of such an online tool should take place in an environment where patients and healthcare professionals work together to ensure a thorough understanding of the patient’s fracture risk and develop a treatment plan appropriate to the individual patient's situation, needs, and preferences.…”

“…Available data revealed that osteoporosis patients are frequently dissatisfied with the information they receive from health professionals [ 9 ]. Studies also reported that patients often have a poor understanding of osteoporosis, the risk and consequences of fractures, and strategies for managing their disease in everyday life [ 7 , 10 ].…”