BoneKEy Reports | BoneKEy Watch
FRAX from WHO underestimates fracture risk in diabetes
DOI:10.1038/bonekey.2012.69
The fracture risk assessment tool (FRAX), devised by the World Health Organization (WHO), uses several variables, including age, sex, lifestyle, body mass index and bone mineral density to predict the risk of hip fractures and other major fractures due to osteoporosis. This study examined the use of FRAX in over 3500 patients with diabetes, compared to a control group of non-diabetics (over 36 000), to investigate its reliability.
Although the 10-year risk of major fractures and hip fractures was similar in the two groups, diabetes was a significant independent predictor of bone fracture due to osteoporosis (hazard ratio =1.61, 95% CI 1.42–1.83) after controlling for all of the risk factors considered by FRAX. This shows that use of FRAX may underestimate the risk of osteoporotic and hip fracture in people with diabetes.
The authors propose that diabetes should be considered for inclusion as an independent risk factor for fractures when the FRAX tool is revisited.
Editor's comment: This analysis documents clinical diabetes as a risk factor for fracture, independent of bone mineral density and other clinical risk factors. These data emphasize that estimates of absolute fracture risk by FRAX—or any calculator—are a good starting point for risk assessment but will always need to be filtered using good clinical judgement.
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