An illustrative 3D image of a spinal cross-section reveals bone deterioration due to osteoporosis. This degenerative bone disease, often presenting low bone density and a heightened fracture risk, predominantly impacts the elderly, especially postmenopausal women. Given its largely asymptomatic nature until a fracture emerges, early diagnosis and preventive action are vital to manage this disease.
The Fracture Risk Assessment Tool (FRAX), a widely-used fracture risk tool, incorporates personal race and ethnicity information. However, it was discovered to perform unsatisfactorily in precisely determining the risk of major osteoporotic fractures among younger postmenopausal women from various racial and ethnic groups.
Conversely, the Osteoporosis Self-Assessment Tool (OST), which omits race and ethnicity considerations, displayed superior efficiency in recognizing individuals with osteoporosis in each racial and ethnic group.
Background
The research aimed to contrast the abilities of FRAX and OST in predicting fracture risk among postmenopausal women aged 50 to 64 years across four racial/ethnic categories: Asian, Black, Latino, and white. The U.S. Preventive Services Task Force recommends both tools to identify younger women who should undertake bone mineral density testing. FRAX’s requirement for racial/ethnic selection in its risk prediction tool is subject to considerable controversy and ongoing debate.
Methodology
From May to August 2022, the researchers analyzed a decade’s worth of follow-up data from nearly 67,200 younger postmenopausal participants in the Women’s Health Initiative for major osteoporotic fractures. Among them, nearly 5,600 had experienced a fracture. The researchers evaluated a subset of 4,600 participants for bone mineral density.
Impact
The researchers recommend against the routine use of the U.S. version of FRAX, which requires race/ethnicity data, for screening younger postmenopausal women. Neither OST nor FRAX successfully identified women who sustained a fracture over the following decade. However, OST was highly effective in recognizing women with osteoporosis-level bone mineral density, thus highlighting their fracture risk, while FRAX fell short.
Commentary
“Identifying osteoporotic women through bone density screenings is key, as these women may be candidates for osteoporosis drug therapy,” Dr. Carolyn Crandall, Professor of Medicine at the David Geffen School of Medicine at UCLA and lead author of the study, stated. She emphasized that for this purpose, OST outperforms FRAX, offering a simpler usage without the need for racial or ethnic data.
The research paper, “Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study,” was published in JAMA Internal Medicine on May 22, 2023. DOI: 10.1001/jamainternmed.2023.1253
The National Institutes of Health’s National Heart, Lung, and Blood Institute provides funding for the Women’s Health Initiative program.
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Table of Contents
Frequently Asked Questions (FAQs) about Osteoporosis Risk Assessment Tools
What was the main finding of the study?
The main finding of the study was that the Fracture Risk Assessment Tool (FRAX), a commonly used tool for assessing the risk of osteoporosis-related fractures, performed suboptimally in accurately predicting fracture risk among younger postmenopausal women across different racial and ethnic groups. In contrast, the Osteoporosis Self-Assessment Tool (OST) showed excellent efficacy in identifying individuals with osteoporosis within each racial and ethnic category, despite not considering race or ethnicity.
Who conducted the research?
The research was conducted by a team of researchers led by Dr. Carolyn Crandall, a professor of medicine at the David Geffen School of Medicine at UCLA.
Which tool is recommended based on the research?
The researchers recommend the use of the Osteoporosis Self-Assessment Tool (OST) over FRAX for screening younger postmenopausal women. The OST was found to be more effective in identifying women with osteoporosis-level bone mineral density, which puts them at risk for fractures.
How were the tools evaluated in the study?
The researchers analyzed 10 years of follow-up data from nearly 67,200 younger postmenopausal participants in the Women’s Health Initiative. They looked at occurrences of major osteoporotic fractures and also evaluated bone mineral density in a subset of participants.
What are the implications of these findings?
The findings suggest that race and ethnicity data may not be essential for effective osteoporosis risk assessment. They also underscore the importance of tool selection in screening and early detection of osteoporosis, which can lead to better patient outcomes.
Where was the research published?
The research was published in the JAMA Internal Medicine journal on May 22, 2023.
More about Osteoporosis Risk Assessment Tools
- Women’s Health Initiative Study
- Fracture Risk Assessment Tool (FRAX)
- Osteoporosis Self-Assessment Tool (OST)
- Osteoporosis
- U.S. Preventive Services Task Force Recommendations
- David Geffen School of Medicine at UCLA
- National Institutes of Health’s National Heart, Lung, and Blood Institute
5 comments
Really interesting research! It’s kinda surprising to know that a widely used tool like FRAX isn’t as reliable as we thought, huh?
didn’t know there were tools like OST and FRAX before…makes me think more about bone health. And well done to those researchers.
Wait, so FRAX isn’t great but OST is? even tho OST doesn’t consider race or ethnicity? Feels like we still got lot to learn about osteoporosis
This makes sense. Good to know the OST does a better job. Health is so complicated, isn’t it?
Who knew osteoporosis was such a hot topic! So much debate just about risk assessment tools. Science never stops i guess.