Fracture risk assessment in a primary care setting consistent with FRAX indicators
MedWire News: An assessment of 5-year fracture risk in a large, Italian primary care patient population confirms incidence rates and predictors for osteoporotic fracture.
The problems associated with using dual X-ray absorptiometry (DXA) as a diagnostic test for osteoporosis, including cost and low sensitivity, have prompted researchers to look for alternative methods.
Computer-based algorithms, such as FRAX, have been developed to provide 10-year probability of osteoporotic fracture, but their success is dependent on sufficient knowledge of the epidemiology of fragility fractures and the underlying risk factors. The aim of this study, conducted by Francesco Lapi (University of Florence, Italy) and colleagues, was to investigate this within a primary care setting.
The study involved data on 271,121 patients (45.2% male)from the Italian Health Search-CSD Longitudinal Patients Database (HSD). All participants were aged between 50 and 85 years of age, and were followed up until they experienced an osteoporotic fracture, or the end of the 5-year study period was reached.
The results, published in the journal Bone, were consistent with past research. Lapi et al found a significantly higher osteoporotic fracture incidence rate among women compared with men, at 11.56 versus 4.91. This difference remained significant when only considering hip fractures: 3.23 among females and 1.21 among males.
The osteoporotic fracture risk factors they identified reflected a number of predictors that form the FRAX algorithm, such as advanced age, history of fracture, a body mass index less than 20, presence of osteoporosis, gastrointestinal and chronic hepatic disease, and depression.
However, contrary to other studies, smoking habits and asthma were not significant determinants of osteoporotic fracture in this cohort. The researchers recognize that some clinical features identified in 10 year studies could have been missed by their own 5-year assessment.
An alternative explanation might be that patients in the present study cohort were older than those included in past research; "the presence of chronic obstructive pulmonary disease in our predictors could be suggestive of a related respiratory impairment which is more common among elderly than younger patients," say the researchers.
They conclude: "In the light of the clinical utility of a simple risk score for the assessment of absolute fracture risk among osteoporotic patients, its assessment and validation in the Italian HSD could potentially provide an applicable prediction tool in primary care."
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By Chloe McIvor