Fracture risk assessment by the FRAX model

Abstract

The introduction of the FRAX algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. FRAX integrates the influence of several well-validated risk factors for fracture with or without the use of bone mineral density. Since age-specific rates of fracture and death differ across the world, FRAX models are calibrated with regard to the epidemiology of hip fracture (preferably from national sources) and mortality (usually United Nations sources). Models are currently available for 73 nations or territories covering more than 80% of the world population. FRAX has been incorporated into more than 80 guidelines worldwide, although the nature of this application has been heterogeneous. The limitations of FRAX have been extensively reviewed. Arithmetic procedures have been proposed in order to address some of these limitations, which can be applied to conventional FRAX estimates to accommodate knowledge of dose exposure to glucocorticoids, concurrent data on lumbar spine bone mineral density, information on trabecular bone score, hip axis length, falls history, type 2 diabetes, immigration status and recency of prior fracture.

通过FRAX模型进行骨折风险评估 摘要

FRAX计算工具加强了以骨折概率为基础的骨折风险评估。FRAX与/不与骨密度整合了几个经过充分验证的骨折风险因素的影响。由于世界各地特定年龄段的骨折率和死亡率不同, FRAX模型是根据髋部骨折的流行病学（最好来自国家性资料）和死亡率（通常来自联合国资料）进行校准的。目前有73个国家或地区的模型, 覆盖世界人口的80%以上。尽管用法性质不同, FRAX已被纳入全球80多个指南中。FRAX的局限性也被广泛研究, 为了解决其中的一些局限性, 已经提出了计算程序, 可以应用于传统的FRAX评估, 以考虑到糖皮质激素剂量暴露情况、当前腰椎骨密度、骨小梁评分、髋轴长、跌倒史、2型糖尿病、移民身份和既往骨折的时间。

Keywords:

• FRAX
• fracture probability
• clinical risk factors
• intervention thresholds
• risk assessment

Acknowledgements

Some text is reproduced from Kanis et al. [54,73,74].

Potential conflict of interest

Prof. Kanis led the team that developed FRAX as director of the WHO Collaborating Centre for Metabolic Bone Diseases; he has no financial interest in FRAX. Prof. McCloskey, Prof. Harvey, Dr Johansson, Dr Vandenput and Dr Liu are members of the FRAX team. Prof. Kanis, Prof. Harvey and Prof. McCloskey are members of the advisory body to the NOGG, UK. W. D. Leslie declares no competing interests.

Source of funding

Nil.