Czerwiński Edward, Borowy Przemysław, Kumorek Anna, Amarowicz Jarosław, Górkiewicz Maciej, Milert Agata
Jagiellonian University Medical College, Faculty of Health Sciences, Department of Bone and Joint Diseases, Cracow, Poland.
Jagiellonian University Medical College, Faculty of Health Sciences, Epidemiology and Population Studies Department, Cracow, Poland.
Ortop Traumatol Rehabil. 2013 Nov-Dec;15(6):617-28. doi: 10.5604/15093492.1091517.
FRAX is a an algorithm accepted by WHO for evaluating fragility fracture risk of women aged 40 years or more. The aim of this study was to use the FRAX tool to verify the risk of fractures in a population of women from the Cracow region in an 11-year follow-up.
The study was a retrospective cohort survey evaluating the incidence of fragility fractures over 11 years of follow-up. 5,092 women aged 50 years and more were randomly chosen from a group of 100,000 female patients of the Cracow Medical Centre who came to the Centre for densitometric examination between 1997 and 2001. Finally, 1024 patients were randomized into the study. After an average of 11 years a follow-up telephone survey was conducted among a randomly selected group of patients using a questionnaire corresponding to the one applied in the first survey. 10-year fracture risk was calculated for each patient using FRAX based on the BMI (Body Mass Index) and for 886 women using FRAX based on BMD (Bone Mineral Density) at the femoral neck. The Polish version of FRAX was validated by comparing the predicted risk with the actual incidence of fractures during the 11-year follow-up.
The 10-year probability of a major osteoporotic fracture calculated using FRAX based on BMI for the entire group was 5.3% (median, 1st/3rd quartile: 3.5-8.5%) and the probability of a proximal femur (hip) fracture was 1.3% (median, 1st-3rd quartile: 0.7% -2.4%). In 886 women whose BMD T-score at the femoral neck was available, the mean probability of a major osteoporotic fracture was 4.9% (3.3-7.9%) and of a hip fracture 0.9% (0.3-2.3%). The actual absolute fracture risk calculated on the basis of the number of patients who had experienced a fracture during the follow-up was surprisingly much higher than the predicted figure. The risk of a major fracture in the study group was 17.7% and of a proximal femur fracture, 3%.
In our opinion, FRAX is a very good screening tool, but not a precise diagnostic tool.
FRAX是一种被世界卫生组织认可的用于评估40岁及以上女性脆性骨折风险的算法。本研究的目的是使用FRAX工具在11年的随访中验证克拉科夫地区女性人群的骨折风险。
本研究是一项回顾性队列调查，评估11年随访期间脆性骨折的发生率。从1997年至2001年到克拉科夫医疗中心进行骨密度检查的100,000名女性患者中随机选取5,092名年龄在50岁及以上的女性。最终，1024名患者被随机纳入研究。平均11年后，对随机选取的一组患者进行随访电话调查，使用与第一次调查相同的问卷。根据体重指数（BMI）为每位患者计算10年骨折风险，为886名女性根据股骨颈骨密度（BMD）计算10年骨折风险。通过比较预测风险与11年随访期间骨折的实际发生率，验证了波兰版的FRAX。
基于BMI使用FRAX计算的整个组的主要骨质疏松性骨折的10年概率为5.3%（中位数，第1/3四分位数：3.5 - 8.5%），股骨近端（髋部）骨折的概率为1.3%（中位数，第1 - 3四分位数：0.7% - 2.4%）。在886名有股骨颈BMD T值的女性中，主要骨质疏松性骨折的平均概率为4.9%（3.3 - 7.9%），髋部骨折为0.9%（0.3 - 2.3%）。根据随访期间发生骨折患者数量计算的实际绝对骨折风险惊人地高于预测值。研究组中主要骨折的风险为17.7%，股骨近端骨折为3%。
我们认为，FRAX是一个非常好的筛查工具，但不是一个精确的诊断工具。
