ASSESSMENT OF FRACTURES RISK USING THE FRAX® TOOL (A TEN-YEAR RETROSPECTIVE STUDY)

Background: Application of the Russian FRAX® tool for solving a problem of antiosteoporotic therapy administration is urgent for our country. However today, there is no information confirming its high prognostiс value for wide clinical practice. Aim: Assessment of sensitivity and specificity of the Russian FRAX® tool in therapy of women aged 50 years and above. Materials and methods: Our pilot investigation involved 117 women of 50 to 79 years (mean age 64±7.1 years), examined in Nasonova Research Institute of Rheumatology in 2003. All patients filled in a FRAX® questionnaire to reveal absolute risk of fractures within a 10-year period of time. The risk of the most common osteoporotic fractures was assessed according to the threshold of the therapeutic treatment urgency brought forward by the Russian Association on Osteoporosis in 2012, with and without the Bone Mineral Density (BMD) taken into account. In 2003, the telephone questioning of patients was carried out to register possible fractures within the past decade. Results: During the 10-year period studied, the fractures of a minimal traumatic level were noted in 67 (57%) women (fractures of fingers, toes, and skull were ignored). The mean FRAX® score for the most common osteoporotic fractures, regardless of BMD, was higher in women with subsequent fractures than in those without them (p=0.005). The difference between mean FRAX® scores for hip fractures in these groups of women was statistically insignificant. When BMD measures of the hip neck were included into the FRAX® tool, the data obtained were similar. FRAX® tool scores, regardless of BMD, above the threshold of therapeutic treatment urgency were revealed in 41 (35%) women. The differences in prevalence of the high FRAX® scores for both most common osteoporotic fractures and hip fractures alone were absent among both the women with subsequent fractures and those without them. Sensitivity of the Russian FRAX® tool, regardless of BMD values, for the most common osteoporotic fractures formed 42%, and specificity – 74%. Given BMD values of the hip neck, sensitivity of the FRAX® tool for the most common osteoporotic fractures diminished to 28% but specificity grew to 84%. Presence of fractures in patients’ history increased for them the risk of the subsequent fractures 2.7 fold (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.21-6.28, p=0,02) independently of the FRAX® score. When FRAX® score is higher than the threshold of the therapeutic treatment urgency, the risk of subsequent fractures in women who had them in the past increased 10.8 fold (OR = 10.78; 95% CI = 2.48-55.97; p=0.0001). Smoking, early menopause, hip fracture in parents associated with a high FRAX® score of a patient didn’t additionally increase the risk of subsequent fractures. Conclusion. The preliminary data obtained are indicative of the low sensitivity and specificity of the present version of therapeutic treatment urgency threshold of the Russian FRAX®  tool for the most common osteoporotic fractures. Further epidemiological investigations are needed for correction of this version.