FRAX Calculated without BMD Resulting in a Higher Fracture Risk Than That Calculated with BMD in Women with Early Breast Cancer

Abstract

Background (and Purpose) The aim of this study was to investigate the importance of including the measurement of bone mineral density (BMD) in reliable fracture risk assessment for women diagnosed with early nonmetastatic breast cancer (EBC) before AI treatment if zoledronic acid is not an option. Material and Methods One hundred and sixteen women with EBC were included in the study before initiating AI treatment. Most participants were osteopenic. The 10-year probability of hip fracture and major osteoporotic fracture was calculated with and without BMD based on clinical information collected at baseline using the fracture risk assessment (FRAX) tool. To compare data, the nonparametric tests were used. Results There was a significant difference (p<0.001) in the number of high-risk and low-risk FRAX score of hip fracture between before and after including BMD values. The high-risk category decreased by 50.9%, while the low-risk category increased by 42.9%. In FRAX score of major osteoporotic the findings were similar (p<0.001): The high-risk and moderate-risk category decreased by 70.4% and 4.9%, respectively, while the low-risk category increased by 43.8% when including BMD value. When stratified by age, patients aged 65 years or older were at a significantly (p<0.001) higher risk of suffering a hip or major osteoporotic fracture, highlighting the importance of including BMD measurements in this age group. Conclusions Our data support that DXA scanning of women with EBC should be performed to avoid overestimation of osteoporosis before AI treatment. It is particularly important in patients older than 65 years of age and when zoledronic acid is not an option.

Assessment of the Fracture Risk Through Fracture Risk Assessment Tool (Frax) in Postmenopausal Women

“…The eff ect of the age on risk assessment with FRAX is consistent with data provided by the National Osteoporosis Group [18]. In a study by Gadam et al, age was the only risk factor in postmenopausal women which diff ered signifi cantly between identical and non-identical predictions [19,20,21,22].…”

Updated guidance on the management of cancer treatment-induced bone loss (CTIBL) in pre- and postmenopausal women with early-stage breast cancer

“…However, a common clinical practice in EBC women is to mark the option “secondary osteoporosis”, only operational in the absence of BMD , in the FRAX® tool to assess the fracture risk which may theoretically lead to fracture underestimation. In contrast, two recent studies found an overestimation of 10-year fracture probability in AIs users if secondary osteoporosis alone is used in the FRAX® tool without BMD [90] , [91] . In addition, FRAX® is not validated in women younger than 40 years old.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Evaluation of bone fragility in endocrine disorders

“…This explains why in these condition the 'secondary osteoporosis' option in the FRAX tool has a much smaller effect on fracture risk than would be expected, and it has been suggested to use the bypass of rheumatoid arthritis in the FRAX tool to correct the estimation of fracture risk (122). Moreover, since BMD in many conditions is not impaired or it is even higher than expected (4,43,84,85,122,123), the fracture risk prediction by FRAX may be improved by excluding BMD in the algorithm computation (4,124,125,126) or by downward adjusting BMD by 0.5 standard deviation (39). Finally the TBS-adjusted FRAX, being TBS an independent fracture risk capturing 'quality' aspects of bone structure, has suggested to possibly improve the absolute fracture risk definition in secondary osteoporosis (114,127,128).…”