The characteristics of osteoporotic fractures in the region of Bialystok (BOS-2). The application of the WHO algorithm, FRAX®BMI and FRAX®BMD assessment tools to determine patients for intervention

Abstract

Background: The 2007 WHO guidelines for the treatment of osteoporosis require that we know the population risk of an osteoporotic fracture for each country to classify patients requiring treatment.

Material and methods: Studies have been carried out among a random cohort of 1,608 women over the age of 40 to assess a ten-year absolute risk of main osteoporotic fractures (AR-10 m.o.fx.) and hip fractures (AR-10 h.fx.) by using FRAX®BMI and FRAX®BMD based on the epidemiology of fractures in England.

Results: Both methods gave similar results in assessing the probability of fracture, showing the increase of AR-10 m.o.fx. in subsequent life decades to rise from 5% in the fifth decade to 25% in the ninth, mean result 11%, and AR-10 h.fx. to rise over the same period from 0.5% to 13%, mean result 3%. The number of fractures increases up to the seventh and eighth decades, and decreases according to the number of patients in the age group. The commonest fracture risks reported, other than old age and low BMI, were a prior fracture, a family history of hip fracture and smoking.

Conclusions: Comparative analysis of examined parameters of FRAX between people with and without fractures showed considerable differences only in age and AR-10 m.o.fx. This doubled in people with previous fractures (ca. 18% vs. 9%) and AR-10 h.fx. (ca. 5% vs. 2.5%). The "middle" area between the average population risks (AR-10 m.o.fx. 11% and AR-10 h.fx. 3%) and the risks in patients with fractures (AR-10 m.o.fx. 18% and AR-10 h.fx. 9%) could work as an indicator: below those values the risk is low and no treatment is required; above those values, the risk is high, and intervention is necessary; the middle area implies a BMD examination and reassessment of the fracture risk.