FRAX predictior with and without BMD for assessment of osteoporotic fracture risk in the Himalayan state of India: A comparative study

Abstract

Objective: BMD (bone mineral density) testing facilities are not available in every places in India. We compare the predictive ability of FRAX with BMD and FRAX without BMD for major osteoporotic and hip fracture in Himalayan population. Materials and methods: a hospital based cross sectional study was conducted on patients attending the outpatient Department of orthopaedics of SGRRIMHS, and others for a period of 2 years from Aug 2015 to July 2017. A total no. of 125 patients (104 F+ 21M) in the age group 40 -90 years were selected randomly for study. Exclusion criteria were age less than 40 and more than 90 years, confirmed cases of osteoporosis, patients on antiresorptive treatment, cases of surgically removed ovary and uterus, bone metastasis. Dual Energy X-ray Absorptiometry (DXA) scans were obtained to assess presence of low BMD. FRAX calculations with and without addition of femoral neck BMD were done in all patients. Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. Results: Hip fracture probabilities (6.00±10.47% ̴ 5.03±10.26%) and MO fracture probabilities (11.34±12.85% ̴ 11.89±12.87%) were similar with or without inclusion of BMD in FRAX tool respectively. Conclusion: FRAX may be used to assess for 10 year hip and major osteoporotic fracture probabilities status in the absence of DXA facilities or avoiding unnecessary DXA scanning.

FRAX first – Pragmatic approach in resource poor settings

“…[9] An Indian study from the Himalayan state with 125 participants also concluded that FRAX may be used to predict 10-year probability of major osteoporotic fractures and hip fracture in the absence of DXA facility in resource-limited setting. [11] Our study finding also supports this approach. However, another retrospective study from Mumbai showed that the risk of MOF increased slightly and risk of hip fracture increased significantly when BMD was included in FRAX calculation in postmenopausal women.…”

“…Earlier studies have shown that FRAX could produce identical fracture risk prediction like FRAX/BMD. [91011] Hence we aimed to determine if FRAX and FRAX/BMD would produce identical predictions for 10-year probability of hip fracture and MOF in our population. We also intended to identify risk factors that suggest different risk prediction.…”