Clinical efficacy of FRAX(R)-based hybrid and age-dependent intervention thresholds in the Ecuadorian population

Objetive: To assess the clinical impact of FRAX-based intervention thresholds in Ecuadorian women. Also to test a combination of fixed and age-specific intervention thresholds to optimize the selection of women eligible for intervention. Patients and methods: Transversal study in which 2,283 women aged 60 to 94 years were selected. We calculated the risk of major osteoporotic and femoral neck fractures with the Ecuadorian FRAX model (version 4.1), and calculated the proportion of individuals eligible for treatment and bone mineral density assessment applying age-specific thresholds of 60 to 94 years and a fixed threshold from 75 years. Results: Applying age-specific thresholds, 2% of women qualified for treatment and 73.7% for bone mineral density assessment. Depending on age, women eligible for treatment ranged from 0.7 to 3.8% and those eligible for bone mineral density evaluation from 58.3 to 80.5%. With the fixed threshold, 31% of women qualified for treatment and 76.3% for bone mineral density assessment. Depending on age, women potentially eligible for treatment ranged from 3.8% to 76.5%, and those eligible for bone mineral density assessment from 65.2% to 85.4%. Conclusions: The proportion of women potentially eligible for treatment is low compared to countries with a high risk of fractures. Using a fixed threshold starting at age 75 optimizes the proportion of women eligible for treatment. In low to moderate fracture risk countries with limited resources, a hybrid model may be more appropriate.