Improving fracture risk classification in Spain: A 10-year evaluation of a modified FRAX-based algorithm

IF 1.3 Q4 RHEUMATOLOGY

Reumatologia Clinica Pub Date : 2025-08-22 DOI:10.1016/j.reuma.2025.501950

Carmen Gomez-Vaquero, Maribel Mora, Xavier González-Giménez, Carla Marco-Pascual, Pilar Medina, Maria Marta Bianchi, Pilar Santo, Joan M. Nolla

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引用次数: 0

Abstract

Objective

Osteoporotic fractures represent a significant clinical and public health burden. Although FRAX is widely used to estimate 10-year fracture risk, its Spanish version underestimates the probability of major osteoporotic fractures (MOF). This study assessed the performance of a modified FRAX-based algorithm, calibrated for the Spanish population, to stratify postmenopausal women into clinically meaningful risk categories.

Methods

We retrospectively followed 837 women (mean age 62 ± 9 years in 2008) referred for bone densitometry. All MOF over a 10-year period were recorded. Women were initially categorized as low risk (MOFR < 3.5%) or high risk (≥10%). Those with MOFR between 3.5% and 10% were reclassified as high risk if they had osteoporosis or if the recalculated MOFR including BMD was ≥7%.

Results

A total of 124 women experienced a MOF (66 vertebral, 39 distal forearm, 10 hip, 9 humerus). Initial risk classification identified 40% of women as low risk (fracture incidence: 9.4%, 95% CI: 6.2–12.5), 42% as intermediate (16.3%, 95% CI: 12.4–20.1), and 18% as high risk (23.5%, 95% CI: 16.7–30.3). After reclassification, 69% were considered low risk (11.0%, 95% CI: 8.4–13.5) and 31% high risk (23.2%, 95% CI: 18.1–28.3).

Conclusions

The proposed FRAX-based algorithm improves fracture risk classification in Spanish women and supports more rational use of bone densitometry and therapeutic interventions.

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改进西班牙骨折风险分类：改进的基于frax算法的10年评估

目的骨质疏松性骨折是严重的临床和公共卫生负担。尽管FRAX被广泛用于估计10年骨折风险，但其西班牙语版本低估了主要骨质疏松性骨折（MOF）的概率。本研究评估了一种改进的基于frax的算法的性能，该算法针对西班牙人群进行了校准，将绝经后妇女分为临床有意义的风险类别。方法回顾性随访837例骨密度测定妇女（2008年平均年龄62±9岁）。记录了10年期间的所有MOF。女性最初被分类为低风险（MOFR < 3.5%）或高风险（≥10%）。MOFR在3.5% - 10%之间的患者如果患有骨质疏松症或重新计算的MOFR包括BMD≥7%，则被重新归类为高风险。结果124例女性发生MOF（66例椎体，39例前臂远端，10例髋关节，9例肱骨）。初始风险分类确定40%的女性为低风险（骨折发生率：9.4%,95% CI: 6.2-12.5）， 42%为中等风险（16.3%,95% CI: 12.4-20.1）， 18%为高风险（23.5%,95% CI: 16.7-30.3）。重新分类后，69%为低风险（11.0%,95% CI: 8.4-13.5）， 31%为高风险（23.2%,95% CI: 18.1-28.3）。结论提出的基于frax的算法改善了西班牙女性骨折风险分类，支持更合理地使用骨密度测量和治疗干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reumatologia Clinica RHEUMATOLOGY-

CiteScore

2.40

自引率

6.70%

发文量

105

审稿时长

54 days

期刊介绍： Una gran revista para cubrir eficazmente las necesidades de conocimientos en una patología de etiología, expresividad clínica y tratamiento tan amplios. Además es La Publicación Oficial de la Sociedad Española de Reumatología y del Colegio Mexicano de Reumatología y está incluida en los más prestigiosos índices de referencia en medicina.