FRAX® Offline: How Reliable is the Paper-Based Fracture Risk Calculation? A Review of Methods and Analysis of Therapeutic Intervention Thresholds
BACKGROUND . FRAX® is a key tool for fracture risk stratification in osteoporosis. In Russia, both online calculators and paper charts are available, but their comparability has not been studied. Offline settings, remote areas, and high patient flow make paper charts a practical alternative, yet their reliability is uncertain. OBJECTIVE . To assess the concordance between 10-year fracture probabilities calculated using the online FRAX® calculator and paper-based FRAX® charts developed for the Russian population. MATERIALS AND METHODS . This cross-sectional study included 161 patients (65.2% women) aged ≥50 years who were referred for DXA. Ten-year probabilities of major osteoporotic fractures (MOF) and hip fractures were calculated using two methods (online and paper charts), based on bone mineral density or body mass index (BMI). Correlation, regression, Bland–Altman analysis, and agreement on intervention thresholds were performed. RESULTS . No statistically significant differences were found (p > 0.05). The correlation ranged from ρ = 0.927 to 0.957 (p < 0.001) with R ² = 84–90%. The highest Cohen's kappa value was observed for the MOF risk using BMI (k = 0,749). The false-positive intervention threshold rate was 4.9–5.3%. CONCLUSION . Paper-based FRAX® charts show high concordance with the online calculator and can serve as a reliable alternative when internet access is limited or for large-scale screening.