Clinical Application of FRAX: A Practical Tool for Assessment of the Accuracy of Osteoporosis Fracture Risk.

Abstract

Abstract: Background: Osteoporosis is a chronic systemic skeletal disorder marked by a reduction in bone mineral density and structural deterioration of bone tissue, resulting in a substantially increased risk of fragility fractures. Objective: To assess the accuracy and reliability of the FRAX tool in predicting the 10-year risk of osteoporosis-related fractures, and to determine its potential utility in guiding clinical decisions for fracture prevention and patient management. Method: This case-control study included 100 adult women aged between 40 ≥ 60 years who had been diagnosed with osteoporosis. Participants were grouped by menopausal status (pre- and postmenopausal) and type 2 diabetes status, as well as a healthy control group, resulting in five distinct groups. Measured variables included fasting blood glucose, fasting blood insulin, and HOMA-IR. Bone mineral density (BMD) was assessed for all participants using dual-energy X-ray absorptiometry (DEXA). Additionally, the FRAX tool was employed to estimate the 10-year probability of major osteoporotic and hip fractures. Results: Significant differences were observed among study groups in age, BMI, waist-to-hip ratio, BMD, and FRAX scores (p < 0.05). Diabetic and postmenopausal groups showed higher risks of major osteoporotic and hip fractures. Reduced BMD was significantly associated with higher HbA1c levels and increased insulin resistance. ROC analysis showed that fasting blood glucose (AUC = 0.941) and HOMA-IR (AUC = 0.879) had the highest diagnostic performance. Conclusion: FRAX is significantly associated with clinical and metabolic risk factors; however, its predictive accuracy may be influenced by metabolic disturbances, especially in type 2 diabetes mellitus. Insulin resistance and poor glycemic control are strongly associated with reduced bone mineral density, underscoring the importance of including metabolic parameters in fracture risk assessment.