Common Tools Suboptimal for ID’ing Fracture Risk in Younger Postmenopausal Women

MONDAY, June 12, 2023 (HealthDay News) — The Fracture Risk Assessment Tool (FRAX) and the Osteoporosis Self-assessment Tool (OST) have suboptimal performance for predicting 10-year major osteoporotic fracture risk across racial/ethnic categories in younger postmenopausal women; however, the OST has excellent discrimination for identifying osteoporosis, according to a study published online May 22 in JAMA Internal Medicine.

Carolyn J. Crandall, M.D., from the University of California in Los Angeles, and colleagues compared the ability of FRAX versus OST to identify younger postmenopausal women at risk for 10-year incident fracture. The analysis included 67,169 participants in the Women’s Health Initiative (baseline age range, 50 to 64 years) with 10 years of follow-up for major osteoporotic fracture (MOF; including hip, clinical spine, forearm, and shoulder fracture).

The researchers found that for discrimination of MOF, area under the receiver operating characteristic curve values for FRAX were 0.65 for Asian, 0.55 for Black, 0.61 for Hispanic, and 0.59 for White women versus 0.62, 0.53, 0.58, and 0.55, respectively, for OST. However, for OST, discrimination of femoral neck osteoporosis was excellent (range, 0.79 to 0.85), with performance higher than FRAX (range, 0.72 to 0.74) and similar for each racial and ethnic group.

“These findings suggest that within each racial and ethnic category, the U.S. FRAX and OST have suboptimal performance in discrimination of MOF in younger postmenopausal women. In contrast, for identifying osteoporosis, OST was excellent,” the authors write. “The U.S. version of FRAX should not be routinely used to make screening decisions in younger postmenopausal women.”

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