Still on the Fence About FRAX

Image courtesy of Flickr user Beezum (CC)

Image courtesy of Flickr user Beezum (CC)

from the annual meeting of the American Society for Bone Mineral Research in Denver

It seems that it’s not just the big names in bone mineral research and fracture risk who are divided over the utility of the WHO‘s FRAX fracture risk assessment tool, as suggested in a recent New York Times article.  The rank and file physicians are too, judging from a automated poll at this afternoon’s session on FRAX.

The tool calculates an adult’s 10-year risk of an osteoporotic fracture and a major fracture.  FRAX incorporates not only femoral neck bone mineral density (BMD) but also history of fracture, whether the parents had any fractures, current smoking, the use of glucocorticoids, a diagnosis of rheumatoid arthritis or secondary osteoporosis, and alcohol consumption.

While some physicians have welcomed the tool because it includes factors beyond BMD, others see the tool as flawed, by not including additional factors that also affect bone mineral density.  Some object that the algorithm has not been released and that it lacks validation. Others object that the tool is being used to treat patients when it’s not necessary.

Today’s audience of several hundred was evenly divided over the use of FRAX: 36% said they currently do use the tool and 36% said they do not (the remainder did not see patients).  Numbers like those make FRAX seem as contentious as health care reform.

—Kerri Wachter, @knwachter on Twitter

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2 Comments

Filed under Endocrinology, Diabetes, and Metabolism

2 responses to “Still on the Fence About FRAX

  1. Catherine Hackett

    Telling post, Kerri. Is it true that the fact that algorithm itself is not public also contributes to skepticism about FRAX’s usefulness?

  2. Kerri Wachter

    Yes. Several physicians in the audience expressed concern about there not being any outside validation of the algorithm.

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