Case finding for the primary prevention of fragility fractures with FRAX (without BMD) in those over 70 years: reducing the reliance on BMD as the primary tool

Objective(s): To develop and evaluate age-stratified fracture risk score thresholds without dual X-ray absorptiometry (DXA) to manage osteoporosis.
Methods: A multi-centered cohort study of persons over 70 years recruited from metropolitan General Practices. Participants had osteoporosis risk assessment, DXA, health questionnaire, and FRAX Hip (HF) and Major Osteoporotic fracture (MOF) risk scores without DXA T-scores. Age-stratified fracture risk score thresholds (low, moderate and high risk of osteoporosis) were compared with measured BMD based guidelines for osteoporosis management.
Results: 130/531 (24.5%) participants had osteoporosis. Our thresholds achieved a correct clinical decision compared to BMD in 83-84% of cases; avoided 249 (56%) of unnecessary DXAs; and, missed osteoporosis in 5-6% of cases. The FRAX HF and MOF were +30% and +7% more accurate than recommended guidelines in detecting osteoporosis.
Conclusions: For those over 70 years of age, our proposed fracture risk score thresholds can reasonably guide osteoporosis management and reduce unnecessary DXA.