Division of Clinical Medicine, School of Medicine and Population Health.
Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
Curr Opin Endocrinol Diabetes Obes. 2024 Aug 1;31(4):141-148. doi: 10.1097/MED.0000000000000871. Epub 2024 May 29.
The assessment of fracture risk is playing an ever-increasing role in osteoporosis clinical management and informing international guidelines for osteoporosis. FRAX, a fracture risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used since 2008. In this review, we recap the development and limitations of intervention thresholds and the role of absolute fracture risk.
There is an increasing awareness of disparities and inequities in the setting of intervention thresholds in osteoporosis. The limitations of the simple use of prior fracture or the DXA-derived BMD T -score threshold are increasingly being discussed; one solution is to use fracture risk or probabilities in the setting of such thresholds. This approach also permits more objective assessment of high and very high fracture risk to enable physicians to make choices not just about the need to treat but what agents to use in individual patients.
Like all clinical tools, FRAX has limitations that need to be considered, but the use of fracture risk in deciding who to treat, when to treat and what agent to use is a mechanism to target treatment equitably to those at an increased risk of fracture.
骨折风险评估在骨质疏松症临床管理中发挥着越来越重要的作用，并为骨质疏松症国际指南提供信息。FRAX 是一种骨折风险计算器，可提供 10 年内髋部和主要骨质疏松性骨折的个体概率，自 2008 年以来已被广泛应用。在这篇综述中，我们回顾了干预阈值的发展和局限性以及绝对骨折风险的作用。
人们越来越意识到在骨质疏松症的干预阈值设定方面存在差异和不平等。人们越来越多地讨论了单纯使用既往骨折或 DXA 骨密度 T 评分阈值的局限性；一种解决方案是在这种阈值下使用骨折风险或概率。这种方法还可以更客观地评估高和极高骨折风险，使医生不仅能够选择是否需要治疗，还能够为个别患者选择使用哪种药物。
像所有临床工具一样，FRAX 有其局限性，需要加以考虑，但使用骨折风险来决定谁需要治疗、何时治疗以及使用哪种药物是一种将治疗公平地针对那些骨折风险增加的患者的机制。
