DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20173940

Screening for absolute fracture risk using FRAX tool in men and women within 40-90 years in urban population of Puducherry, India

Amena Firoz, Shishir Suranigi Murugharaj, Ravichandran Kandasamy, Syed Najimudeen

Abstract


Background: Osteoporosis is presently considered as one of the major non-communicable world health hazards. It predominantly affects post-menopausal women, elderly men and women. The aim of the study was to assess fracture risk among men and women within 40-90 years in urban population of Puducherry, India and detect the most prevalent risk factors for fractures.

Methods: This is a cross-sectional study done over a period of two months (July - August 2015) involving a sample size of 500 participants, 250 in each gender. Using the FRAX (Fracture Risk Assessment) tool the major osteoporotic fracture risk percentage (MOFR) and hip fracture risk (HFR) were obtained without femoral neck bone mineral density. Chi-square test was applied to test association and p<0.05 considered statistically significant.

Results: The mean age of males (57.2±12.7 years) was higher than females (52.5±2.6 years). Out of 500 participants, 18 and 95 participants were found to satisfy the criteria of ≥20% MOFR and ≥3% HFR respectively. The average MOFR was 4.5±6.7 and 4.0±4.6 for women and men respectively. The mean HFR was 1.8±4.0 and 1.8±3.3 for women and men respectively. The requirement of treatment did not differ significantly between gender (44 females versus 51 males). Eight male participants and 9 female participants were advised for further evaluation with a DEXA scan.

Conclusions: The FRAX tool provides an aid to enhance patient assessment by the integration of clinical risk factors especially as an osteoporosis screening tool with/without the combination of bone mineral density. It is an effective tool, particularly in developing countries like India, where most of the patients cannot afford expensive investigations like DEXA. People with high risk can be subjected to further evaluation and management, thereby reducing the health resources.


Keywords


FRAX, BMD, Osteoporosis, Risk assessment tools, Hip fracture

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References


Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-33.

Kanis JA, McCloskey EV, Johansson H, Oden A, Strom O, Borgstrom F. Development and use of FRAX in osteoporosis. Osteoporos Int. 2010;21(2):407-13.

Cooley H, Jones G. A population-based study of fracture incidence in southern Tasmania: lifetime fracture risk and evidence for geographic variations within the same country. Osteoporos Int. 2001;12(2):124-30.

Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med. 1989;149(11):2445-8.

Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.

Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359(9321):1929-36.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAXTM and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19(4):385-97.

National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. 2008. Available at: http://www.nof.org/professionals/ cliniciansguide_form.asp. Accessed on 3 March 2017.

Dawson-Hughes B, Tosteson AN, Melton LJ, Baim S, Favus MJ, Khosla S, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19(4):449-58.

Kanis JA, Johnell O, Oden A, Dawson-Hughes B, Melton LJ, McCloskey EV. The effect of a FRAX revision for the USA. Osteoporos Int. 2010;21(1):35-40.

Rajendran K, Suthakaran PK, Nair LDV, Rajaram L, Kalappan M, Sivanesan MK. Evaluation of osteoporosis using calcaneal QUS and FRAX Score as a screening tool in a semi urban tertiary care hospital of South India. Int J Adv Med. 2015;2(4):341-5.

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35:375-82.

Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. 2007;18:1033-46.

Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13.

Nakatoh S, Takemaru Y. Application of the fracture risk assessment tool (FRAX(®)) and determination of suitable cut-off values during primary screening in specific health check-ups in Japan. J Bone Miner Metab. 2013;31(6):674-80.

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513-21.

Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, et al. Bone health in healthy Indian population aged 50 years and above. Osteoporos Int. 2011;22(11):2829-36.

Shetty S, Kapoor N, Naik D, Asha HS, Prabu S, Thomas N, et al. Osteoporosis in Healthy South Indian Males and the Influence of Life Style Factors and Vitamin D Status on Bone Mineral Density. J Osteoporosis. 2014:723238.

Høidrup S, Prescott E, Sørensen TI, Gottschau A, Lauritzen JB, Schroll M, et al. Tobacco smoking and risk of hip fracture in men and women. Int J Epidemol. 2000;29(2):253-9.

Karine B, Christian R. Glucocorticoid- induced osteoporosis. RMD Open. 2015;1(1):14-5.

Kanis JA, on behalf of the World Health Organization Scientific Group Assessment of osteoporosis at the primary health-care level. Technical report University of Sheffield, UK: WHO Collaborating Centre; 2008.

Browner WS. Predicting fracture risk: tougher than it looks. BoneKEy. 2007;4:226-30.