FRI0492 CALCULATING FRAX SCORE IN CLINICAL PRACTICE: PITFALLS AND PROBLEMS
Authors: Navneet Kaur, Barbara Mendez, Avneet Vig, Beverly Johnson, Tony Francis
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Osteoporosis related fractures cause significant morbidity and mortality. FRAX score uses clinical risk factors and country-specific data in addition to Bone Mineral Density (BMD) to assess patients with high 10-year risk of hip (&gt;3%) or major osteoporotic (&gt;20%) fracture. We noticed discrepancies between radiologist reported and physician calculated FRAX scores at our hospital. We hypothesized that providers are calculating FRAX score differently as BMD in the FRAX calculator is an optional input variable. <h3>Objectives</h3> This study was initiated to see the differences in results when FRAX score is calculated using T-score, BMD and no BMD and how this difference can influence treatment. <h3>Methods</h3> Retrospective chart review of 1200 DEXA reports from 2013 to 2015 was done. Patients between ages of 40-90 years with T-score ranging from &lt; -1 to &gt;-2.5 at femoral neck were included in the study. Patients already on osteoporosis therapy and/or with T-score &lt; -2.5 or &gt;-1 were excluded. Pertinent risk factors were obtained from chart review. 237 patients met inclusion criteria and 3 separate FRAX scores were calculated using a) Femoral neck BMD b) T-score c) no BMD value. FRAX score reported by radiologist in the chart was also reviewed. Subsequently, FRAX scores obtained using T-score, no BMD value and radiology reported scores were compared against FRAX score calculated using femoral neck BMD (gold standard) <h3>Results</h3> When FRAX score calculated using BMD was compared with FRAX score calculated without BMD, number of patients with high 10-year fracture probability decreased from 49 to 11 patients, which was a statistically significant decrease of 77.6% (p&lt;0.001). When data was stratified according to age, there was significant overestimation of risk in patients &gt;65 years(p&lt;0.0001) when FRAX was calculated without BMD. <h3>Conclusion</h3> FRAX score calculation without BMD leads to both statistically and clinically significant overdiagnosis especially in elderly. Interchanging T score and BMD to calculate FRAX score leads to same treatment decision. Further education of providers regarding FRAX score is needed. Many providers are not aware that if BMD column is left blank, it defaults the calculation to no BMD. A pop up alerting the user "no machine was selected so the calculation will default to no BMD which can lead to overestimation of risk" in FRAX tool might be helpful to avoid miscalculation. <h3>References</h3> [1] https://www.sheffield.ac.uk/FRAX/tool.jsp [2] Prawiradilaga, RS, et al., "FRAX Calculated without BMD Resulting in a Higher Fracture Risk Than That Calculated with BMD in Women with Early Breast Cancer," Journal of Osteoporosis, vol. 2018, Article ID 4636028. <h3>Disclosure of Interests</h3> Navneet Kaur: None declared, Barbara Mendez: None declared, Avneet Vig: None declared, Beverly Johnson Shareholder of: ownership of johnson and johnson stock over 10,000 USD, Consultant for: I am a consultant for the rheumatology education group, Employee of: I have been paid indirectly by pharma as a consultant for the rheumatology education group, Tony Francis: None declared