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. 2024 Mar 23;8(5):ziae039.
doi: 10.1093/jbmrpl/ziae039. eCollection 2024 May.

Decomposing and simplifying the Fracture Risk Assessment Tool-a module from the Taiwan-specific calculator

Chia-Chun Li  1   2 , I-Ting Liu  3   4   5 , Tien-Tsai Cheng  6 , Fu-Wen Liang  7 , Zih-Jie Sun  8   9 , Yin-Fan Chang  9 , Chin-Sung Chang  9 , Yi-Ching Yang  2   9 , Tsung-Hsueh Lu  10 , Li-Chieh Kuo  1   11 , Chih-Hsing Wu  2   9   12
Affiliations

Decomposing and simplifying the Fracture Risk Assessment Tool-a module from the Taiwan-specific calculator

Chia-Chun Li et al. JBMR Plus. .

Abstract

The Fracture Risk Assessment Tool (FRAX®) is a widely utilized country-specific calculator for identifying individuals with high fracture risk; its score is calculated from 12 variables, but its formulation is not publicly disclosed. We aimed to decompose and simplify the FRAX® by utilizing a nationwide community survey database as a reference module for creating a local assessment tool for osteoporotic fracture community screening in any country. Participants (n = 16384; predominantly women (75%); mean age = 64.8 years) were enrolled from the Taiwan OsteoPorosis Survey, a nationwide cross-sectional community survey collected from 2008 to 2011. We identified 11 clinical risk factors from the health questionnaires. BMD was assessed via dual-energy X-ray absorptiometry in a mobile DXA vehicle, and 10-year fracture risk scores, including major osteoporotic fracture (MOF) and hip fracture (HF) risk scores, were calculated using the FRAX®. The mean femoral neck BMD was 0.7 ± 0.1 g/cm2, the T-score was -1.9 ± 1.2, the MOF was 8.9 ± 7.1%, and the HF was 3.2 ± 4.7%. Following FRAX® decomposition with multiple linear regression, the adjusted R2 values were 0.9206 for MOF and 0.9376 for HF when BMD was included and 0.9538 for MOF and 0.9554 for HF when BMD was excluded. The FRAX® demonstrated better prediction for women and younger individuals than for men and elderly individuals after sex and age stratification analysis. Excluding femoral neck BMD, age, sex, and previous fractures emerged as 3 primary clinical risk factors for simplified FRAX® according to the decision tree analysis in this study population. The adjusted R2 values for the simplified country-specific FRAX® incorporating 3 premier clinical risk factors were 0.8210 for MOF and 0.8528 for HF. After decomposition, the newly simplified module provides a straightforward formulation for estimating 10-year fracture risk, even without femoral neck BMD, making it suitable for community or clinical osteoporotic fracture risk screening.

Keywords: FRAX®; fracture risk assessment tool; risk of fracture.

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Conflict of interest statement

C.-C.L., I.-T.L., T.-T.C., F.-W.L., Z.-J.S., Y.-F.C., C.-S.C., Y.-C.Y., T.-H.L., and L.-C.K. declare that they have no conflicts of interest. C.-H.W.: honoraria for lectures, attending meetings, research grant or travel from Eli Lilly, Novartis, Roche, Abbott, Pfizer, Boehringer, Bayers, Takeda, Merck, Sanofi-Aventis, GlaxoSmithKline, Servier laboratories, GE Lunar, Schering-Plough, Harvester, TCM Biotch, Alvogen/Lotus, Teijin Pharma, Amgen, Der-Zeng, Sankyo Daiichi, Alnylam, and AstraZeneca. This study was presented in part as a poster at the 2023 IOF-ESCEO World Congress on Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases on May 4, 2023, in Barcelona, Spain.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Scatter plot matrices on MOF/HF and 4 continuous FRAX clinical risk variables. *neck_BMD, femoral neck BMD; MOF, major osteoporotic fracture; HF, hip fracture.
See this image and copyright information in PMC

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