Identifying individuals at risk for fracture in Guatemala.

INTRODUCTION: The FRAX calculator combines a set of clinical risk factors with country-specific incidence rates to determine the ten-year absolute risk of major osteoporotic fracture. However, regional or country-specific databases from Central American countries are not available. We compared the use of various FRAX databases and the Pluijm algorithm in determining risk of fracture. METHODS: We collected clinical risk factor data needed for the FRAX calculator and Pluijm algorithm of Hispanic women in Guatemala and calculated the FRAX absolute risk measures of major osteoporotic fracture and hip fracture. Subjects were postmenopausal women greater than age 40 with no history of using medication that affect bone. A random sample of 204 women in 34 different regions women in Guatemala City was visited in their homes to complete the surveys. The Pluijm risk score and FRAX risk score using the US Hispanic, Spain, and Mexican databases were calculated. RESULTS: We used the US NOF guidelines for treatment which suggest a treatment threshold for patients with a 10-year hip fracture probability ≥ 3% or a 10-year major osteoporotic fracture risk ≥ 20%. The number of patients meeting the suggested threshold limits for treatment using the Spain and Mexico calculators were identical. There was 100% conformity in threshold limits for both hip and major osteoporotic fracture risk. The mean conformity for any fracture risk between US Hispanic and the other two databases was 97.5%. Conformity was 99.0% based on major osteoporotic fracture and 97.5% based on risk of hip fracture. The Pluijm evaluation shows conformity of 87.2% and 83.3%, respectively, when compared to the US Hispanic and Spain/Mexico FRAX thresholds for risk of fracture. DISCUSSION: Although the different FRAX databases provide variations in the absolute risk of fracture, the overall conformity to treatment thresholds amongst the US Hispanic, Spain, and Mexico databases show the database used would have little effect as to the decision to treat. The Pluijm tool conforms to the FRAX thresholds and can be used as well. It does not matter which country-specific calculator or assessment tool is used, as there are a similar number of patients that would meet the intervention threshold.

Comparison of FRAX Scores of Southern California Females of Mexican Descent Using US Hispanic and Mexico Database.

Introduction. Regional differences for fracture risk of US Hispanics may vary by national origin. In California, where a majority of the Hispanic population is of Mexican descent, it is of interest to compare the FRAX absolute risk using the US Hispanic and Mexico databases. Methods. We collected FRAX risk factor data from 134 women of Mexican descent in southern California. The FRAX risk score was calculated using the US Hispanic and Mexican databases, using the NOF guidelines for osteoporosis to compare the number of patients that would be selected for treatment. Results. The 10-year absolute risk of major osteoporotic fracture among women of Mexican descent using the US Hispanic database was 4.82 ± 5.03 (95% CI 3.97-5.67) compared to 4.86 ± 4.72 (CI 3.98-5.44) using the Mexico database (P = .94). The 10-year risk for hip fracture was 0.86 ± 1.78 (CI .56-1.16) compared to 1.12 ± 1.97 (CI .79-1.45, P = .26). The mean conformity for meeting the interventional threshold by either risk score was 94.8%. Conclusion. The comparison between the FRAX databases demonstrates a similarity in the absolute risk of major osteoporotic fracture. Differences are noted in the absolute number of hip fracture subjects at risk, but there is a high rate of conformity.