FRAX Use on the Rise (Elizabeth Hofhienz @ OTW)
FRAX, a fracture risk assessment tool now available in 18 languages, is being used by an increasing number of physicians around the world. The online version alone is used to calculate 10-year probability of fracture in approximately 2.8 million patients annually. FRAX, which is country-specific, can be used with or without the input of bone mineral density (BMD) values measured at the femoral neck. It is available free online at http://www.shef.ac.uk/FRAX/
The recently launched version 3.5 of the tool now includes new models for Ecuador, Norway, Russia, Slovakia and Sri Lanka. The model for Sri Lanka is the first surrogate model, built by combining national mortality data with hip fracture data from a representative, surrogate country. Revised epidemiological data have also been incorporated into the models for Belgium, Czech Republic, Italy and Lebanon.
Dr. Eugene McCloskey, a co-founder of FRAX and Professor in Adult Bone Disease and Honorary Consultant at the Metabolic Bone Centre, University of Sheffield UK, told OTW,
For any new model of FRAX, we need the best available information on the incidence of fractures in men and women within and across age-groups in the population. The most easily collected data usually come from hip fractures as these are usually hospitalised. It is important to exclude double counting (e.g., one hip fracture event counting more than once, for example if admitted in one hospital but transferred to another for therapy). It is also important to know the size and characteristics of the catchment area; this is obviously easier if the hip fracture data are captured at a national level. If not, a judgment has to be made about the repesentativeness of the data compared to national fracture rates. If well-validated information on other fractures is also available, e.g., forearm or humeral fractures, this can also be incorporated in the new model. Finally, the model requires good data on mortality within the population and this is most easily captured at the national level and available through organisations like the UN.
He added, The assessment of fracture risk should be undertaken in all men and women with a prior fracture, especially when aged 50 and over. In older individuals, fracture preventative therapy should be strongly considered as long as no contraindication to therapy exists. In younger individuals, the use of the FRAX tool can target therapy to those at highest risk who will gain the maximum benefit.