Assessment of fracture risk based on FRAX score and Polish guidelines in patients with newly diagnosed osteoporosis.

Abstract

Introduction: The authors of the latest recommendations state that osteoporosis diagnosis should not rely solely on densitometric (DXA) criteria. Fracture risk assessment is crucial for determining diagnosis and intervention thresholds. Comprehensive assessment of fracture risk requires consideration of bone mineral density (BMD) results, use of risk calculators like Fracture Risk Assessment Tool (FRAXTM), and analysis of clinical and lifestyle factors. Experts highlight the need to identify patients at very high fracture risk to justify starting anabolic therapy. This retrospective study assessed fracture risk in newly diagnosed osteoporosis patients, identifying those at high and very high risk.

Material and methods: The study included 159 postmenopausal women with newly diagnosed osteoporosis, identified by a T-score of ≤ -2.5 standard deviations (SD) from DXA scans of the femoral neck and/or lumbar spine. Demographic data and laboratory tests were collected, and the 10-year fracture risk for major osteoporotic fractures (FRAX MOF) and hip fractures (FRAX HF) was calculated using the FRAX-PL calculator, which included femoral neck BMD. Each patient was then classified into a risk group based on modified fracture risk assessment criteria.

Results: The study found that the most common risk factor for osteoporosis was a previous fracture (56.6%). Other common risk factors included smoking (21.38%), parental hip fracture (13.21%), and glucocorticoid use (10.70%). The FRAX calculator showed that 47.80% of patients were at very high risk for HF and 23.90% for MOF. A high HF risk was present in 10.06% of patients, and high MOF risk in 34.59%, whereas a medium and low MOF risk concerned 25.79% and 15.72% of the subjects, respectively. With expanded criteria, 72.33% of patients were classified at very high risk, compared to 23.90% for MOF and 47.80% for HF based solely on FRAX. Most patients met the T-score ≤ -3.0 SD criterion (52.20%) and FRAX > 15% for MOF or FRAX > 4.5% for HF (52.20%). Women aged 65-70 and 70-75 years are at the highest risk and qualify for anabolic therapy.

Conclusions: Our study highlights the importance of stratifying patients by fracture risk, showing that more individuals are identified at very high risk when using the expanded assessment criteria from the latest Polish guidelines.