FRAX® with or without BMD and TBS predicts fragility fractures in community-dwelling rural southern Indian postmenopausal women

.Summary This study from southern India showed that FRAX (R) with or without BMD or TBS predicted fragility vertebral fractures at a cut-off of >= 9% for major osteoporotic fracture and >= 2.5% for hip fracture with sensitivities of 77-88% and specificities of 55-72%. Purpose There is limited information available with regard to utility of Fracture Risk Assessment Tool (FRAX (R) tool) in predicting fragility fractures in Indian postmenopausal women. We studied the performance of 3 categories: FRAX (R) (without BMD), FRAX (R) (with BMD), and FRAX (R) (with BMD and TBS) in predicting fragility vertebral fractures in rural postmenopausal women. Material and methods It was a cross-sectional study conducted at a south Indian tertiary care center. Rural postmenopausal women (n=301) were recruited by simple random sampling. The risk for major osteoporotic fracture (MOF) and hip fracture (HF) was calculated individually for the 3 categories. The BMD (at lumbar spine and femoral neck) and vertebral fractures were assessed by a DXA (dual energy X-ray absorptiometry) scanner and TBS by TBS iNsight software. ROC curves were constructed, and area under curve (AUC), sensitivity and specificity of FRAX (R) scores, which would best predict prevalent vertebral fractures (moderate to severe), was computed. Results The mean (SD) age was 65.6(5.1) years. The prevalence of osteoporosis at spine was 45%, and femoral neck was 32.6%. Moderate to severe vertebral fractures was seen in 29.2% of subjects. The performance of all 3 categories for FRAX (R) (MOF) and FRAX (R) (HF) were good (AUC was 0.798, 0.806, and 0.800, respectively, for MOF) at a cut-off score of >= 9, and at a cut-off of >= 2.5 for HF, it was 0.818, 0.775, and 0.770, respectively. At these cut-offs, sensitivities were 77-89%, and specificities were 55-72% for predicting prevalent vertebral fractures. Conclusion All three categories of FRAX (R) showed good performance in predicting fractures in Indian postmenopausal women. Thus, it may be utilized for decision regarding treatment and referral for osteoporosis.