The WHO FRAX Calculator with and without BMD as an Indicator of Low BMD in Pakistani Women

Aims: BMD (bone mineral density) testing facilities are still scarce in Pakistan. We evaluated the predictive ability of FRAX with BMD (FRAX+) and FRAX without BMD (FRAX-) in a set of Pakistani females to assess their role in BMD assessment.

Study Design: Cross Sectional.

Place and Duration of Study: Department of Nuclear Medicine, Ziauddin hospital, Clifton Campus, Karachi, Pakistan between March and August 2016.

Methods: We enrolled 200 females above 40 years of age. Average age was 60.7 years (±10.52). Gold standard Dual Energy Xray Absorptiometry (DXA) scans were obtained to assess presence of low BMD. FRAX calculations with and without addition of femoral neck BMD were done. Statistical Package for Social Sciences (SPSS) version 20 was used to plot Receiver Operating Characteristics (ROC) and Area under Curve (AUC) was utilized for evaluation of tool’s diagnostic accuracy.

Results: FRAX+ and FRAX- had comparable predictive power having AUC of 0.784 and 0.799 respectively. The Major Osteoporotic (MO) and hip fracture probabilities for FRAX+ and FRAX- showed significant correlation at the 0.001 level.

Conclusion: FRAX- may be utilized to assess BMD status in the absence of DXA facilities and to assess its need to avoid unnecessary scanning.