Fracture risk tool used by World Health Organisation is not effective

The World Health Organization’s tool for assessing bone fracture risk underestimates the true dangers for people who are younger than 65 years or have been treated for a single broken bone, according to a new study published in the Journal of Clinical Endocrinology & Metabolism.
The Fracture Risk Assessment Tool (FRAX) was designed by the WHO to help predict the likelihood of adults between the ages of 40 years and 90 years breaking a bone. It is supposed to help healthcare professionals identify osteoporosis cases that cannot be easily diagnosed through bone mineral density testing.
But a Canadian study that aimed to gauge fracture risk in 1,399 people who had experienced a fragility fracture found FRAX was not an effective tool.
Before the fracture, only 42.7% of the patients were considered high risk, according to the FRAX tool. Even after sustaining an initial fracture, 24% of the patients remained categorised as low risk and nearly 20% were considered moderate risk.
During a four-year follow-up period, more than one-third of the patients who had recurrent fractures were not categorised as high risk under the Canadian FRAX calculation. In over half of the patients treated for an initial fragility fracture, the FRAX score did not reach the Canadian threshold for preventative treatment.
The risk calculator was most likely to underestimate the likelihood of future broken bones in younger people, men and people with their first fragility fracture.
“Although FRAX is a helpful tool and provides important information, it should not be used as the unique and definitive gold standard for determining whether or not to treat a patient for osteoporosis or weakening bones,” explains Dr Gilles Boire who was involved in the work. “The test fails to identify some patients who would benefit from treatment to prevent future fractures.
“Identifying individual patients at high risk for fractures would allow for more timely and targeted prevention. Physicians should always consider whether osteoporosis treatment would benefit a patient presenting a fragility fracture, regardless of their FRAX or bone mineral density scores.”