Screening for absolute fracture risk using FRAX tool in men and women within 40-90 years in urban population of Puducherry, India

Abstract

INTRODUCTIONAdvancement in health care sector has resulted in increase of the aging population. This has leaded to increase in the proportion of patients with osteopenia and osteoporosis in both developed and developing countries like India. Osteoporosis is presently considered as one of the major non-communicable world health problem. Throughout the world, osteoporosis is said to cause more than 8.9 million fractures yearly, resulting in an osteoporotic fracture every 3 seconds.1,2 It predominantly affects post-menopausal women, elderly men and women. It is calculated that the residual lifetime risk of experiencing an osteoporotic fracture in men over the age ABSTRACT Background: Osteoporosis is presently considered as one of the major non-communicable world health hazards. It predominantly affects post-menopausal women, elderly men and women. The aim of the study was to assess fracture risk among men and women within 40-90 years in urban population of Puducherry, India and detect the most prevalent risk factors for fractures. Methods: This is a cross-sectional study done over a period of two months (July -August 2015) involving a sample size of 500 participants, 250 in each gender. Using the FRAX (Fracture Risk Assessment) tool the major osteoporotic fracture risk percentage (MOFR) and hip fracture risk (HFR) were obtained without femoral neck bone mineral density. Chi-square test was applied to test association and p<0.05 considered statistically significant. Results: The mean age of males (57.2±12.7 years) was higher than females (52.5±2.6 years). Out of 500 participants, 18 and 95 participants were found to satisfy the criteria of ≥20% MOFR and ≥3% HFR respectively. The average MOFR was 4.5±6.7 and 4.0±4.6 for women and men respectively. The mean HFR was 1.8±4.0 and 1.8±3.3 for women and men respectively. The requirement of treatment did not differ significantly between gender (44 females versus 51 males). Eight male participants and 9 female participants were advised for further evaluation with a DEXA scan. Conclusions:The FRAX tool provides an aid to enhance patient assessment by the integration of clinical risk factors especially as an osteoporosis screening tool with/without the combination of bone mineral density. It is an effective tool, particularly in developing countries like India, where most of the patients cannot afford expensive investigations like DEXA. People with high risk can be subjected to further evaluation and management, thereby reducing the health resources.