Comparison of selected methods for fracture risk assessment in postmenopausal women. Analysis of the Łódź population in the EPOLOS study

INTRODUCTION: The major challenge when administering osteoporosis treatment is to identify patients with the highest fracture risk. FRAX is a new algorithm that integrates clinical risk factors of fracture and the results of densitometry. OBJECTIVES: The aim of the study was to evaluate the use of FRAX in identifying patients that should receive osteoporosis treatment and compare it with other methods of fracture risk assessment. PATIENTS AND METHODS: The study involved a random sample of 94 postmenopausal women, aged 55 to 79 years, who had not been previously treated for osteoporosis (a part of the EPOLOS [European Polish Osteoporosis Study] population recruited from the region of Łódź, Poland). Clinical risk factors were evaluated and densitometry of the femoral neck was performed. Patients were eligible for treatment on the basis of previous osteoporotic fractures, densitometry results, semiquantitative tabular method (SQM) (according to the Osteoporosis Society of Canada Recommendations for Bone Mineral Density Reporting), and a 10-year fracture risk (calculated with the British FRAX tool, using different thresholds). RESULTS: Using the FRAX method, between 5.2% to 52% of the examined women would be eligible for treatment, depending on the threshold applied. If the treatment decision was based on a history of vertebral fractures, 4.2% of women would be eligible for treatment, and if other fractures were considered - 20.2%. If the decision was based on densitometry results, 8.5% of women would be eligible for treatment. We observed a high fracture risk in 7%, moderate risk in 19%, and low risk in 74% of women examined by the SQM. CONCLUSIONS: Proper use of FRAX in Poland requires determination of the intervention threshold. Use of FRAX changes the demographic profile of women eligible for therapy, increasing their number in older age groups.