Age specific cut-off for FRAX® without BMD better identifies who to treat or investigate for suspected underlying osteoporosis in a cohort over 70 years age compared to IOF thresholds.

Age specific cut-off for FRAX^® without BMD better identifies who to treat or investigate for suspected underlying osteoporosis in a cohort over 70 years age compared to IOF thresholds.

Age specific cut-off for FRAX^® without BMD better identifies who to treat or investigate for suspected underlying osteoporosis in a cohort over 70 years age compared to IOF thresholds. (#107)

Charles Inderjeeth ¹ , Warren Raymond ²

North Metropolitan Health & University of Western Australia, Nedlands, WA, Australia
North Metropolitan Health and University of Western Australia, Nedlands, WA, Australia

Purpose: Access and cost of DEXA are barriers to osteoporosis screening. Risk-assessment tools may be useful alternatives. The objective was the use of FRAX fracture risk (without BMD) to stratify people into low risk (not requiring assessment), intermediate risk (requiring BMD) or high risk (preventative treatment recommended without BMD).

Methods: A prospective multi-centred cohort study recruited from metropolitan General Practices identified persons deemed to be at clinical risk of osteoporosis or aged over 70. Osteoporosis risk assessment using BMD and health questionnaire. FRAX ® scores with and without BMD values were calculated for each patient. ROC curves with the area under curve (AUC) were generated to calculate sensitivity and specificity of FRAX ® (without BMD) in identifying patients with osteoporosis.

Results: We identified age specific thresholds for identification of patients deemed low risk (BMD not required), intermediate risk (requiring BMD) or high risk (treatment recommended). These thresholds resulted in the correct clinical management decision in 77% of cases. Unnecessary BMDs avoided in 341/543 (63%). Osteoporosis was missed in 51/534 (8%). Absolute Positive Predictive value improved (+41.6%) and accuracy improved (+22%) compared to IOF FRAX 10-year Hip fracture recommended threshold cut-offs.

Conclusions: Age specific intervention thresholds based on fracture risk score is superior to IOF recommended thresholds and may further reduce the number and cost of unnecessary BMDs. It identifies who may require BMD and who to treat. Those with absolute risk below 1.8 (FRAX-Hip) and 3.85 (FRAX-Major) do not require DEXA . The threshold to treat is influenced by user willingness to pay and risk – benefit.

Authors contributing to this presentation.

Inderjeeth, C

Professor Charles Inderjeeth is a Clinical Epidemiologist and Consultant Physician in Rheumatology and Geriatric Medicine. He completed his Masters of Public Health at the University of Western Australia. He is an NHMRC-NICS-DVA Fellow. He is involved in education, research and development of guidelines and publications in the field of Rheumatology, osteoporosis, Vitamin D, Dementia and Geriatric Syndromes. He is involved in Phase 1 – 4 research in Rheumatological diseases including Rheumatoid arthritis, Osteoarthritis and Sjogren’s syndrome, Vitamin D, Osteoporosis, Frailty and Sarcopenia, Falls and Dementia. He received research funding from numerous organisations including the NHMRC-NICS- DVA Fellowship. He supervises Fellows in Training and PhD students through the University of Western Australia. He has numerous Advisory/Executive/Board roles to the Department of Health (WA), the Arthritis Foundation of WA, Osteoporosis Australia, Australian Rheumatology Association, Australian and New Zealand Society of Bone Mineral Research, Australian and New Zealand society for Sarcopenia and Frailty.

Age specific cut-off for FRAX® without BMD better identifies who to treat or investigate for suspected underlying osteoporosis in a cohort over 70 years age compared to IOF thresholds. (#107)

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Inderjeeth, C

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Age specific cut-off for FRAX^® without BMD better identifies who to treat or investigate for suspected underlying osteoporosis in a cohort over 70 years age compared to IOF thresholds. (#107)