Inclusion of Additional Clinical Factors Does Not Improve FRAX Performance in Postmenopausal Women

Woman has fallen in bathroom, resulting in pain in leg
Fall in bathroom
Researchers sought to assess the ability of the Fracture Risk Assessment Tool to discriminate between women who do and do not experience major osteoporotic fractures.

The inclusion of additional clinical factors, such as vasomotor symptoms and self-reported physical function score, did not improve the performance of the Fracture Risk Assessment Tool (FRAX) in discriminating postmenopausal women who will experience a major osteoporotic fracture, according to results from a study presented at the North American Menopause Society Annual Meeting, held September 25 to 28, 2019, in Chicago, Illinois.

Researchers used data from postmenopausal women aged 50 to 79 years at baseline (n=99,413) from the Women’s Health Initiative study. Incident major osteoporotic fractures were assessed every year for 10 years. Area under the curve (AUC) and net reclassification index were used to measure performance of FRAX alone, as well as FRAX with additional risk factors (type 2 diabetes, frequent falls, vasomotor symptoms, self-reported physical function score, and lumbar spine bone mineral density), in predicting incident major osteoporotic fractures. High risk for fracture was defined as predicted major osteoporotic fracture risk ≥20%.

The AUC for FRAX without patient bone mineral density information was 0.65. The AUC value was not improved by the addition of vasomotor symptoms, diabetes, or frequent falls, but was minimally increased with the inclusion of physical function score (AUC, 0.66). The net reclassification index of FRAX with additional variables compared with FRAX alone was 5.7% among fracture cases and -1.7% among cases without fracture.

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“Additional variables…did not yield meaningful improvements in [net reclassification index] or discrimination of FRAX for [major osteoporotic fractures],” the researchers concluded. “Tools other than FRAX may provide superior discrimination for prediction of [fracture].”


Crandall CJ, Larson J, Cauley J, et al. Do additional clinical risk factors improve the performance of Fracture Risk Assessment Tool (FRAX) among postmenopausal women? Findings from the Women’s Health Initiative Study. Presented at: North American Menopause Society 2019 Annual Meeting; September 25-28; Chicago, IL. Poster P-13.

This article originally appeared on Clinical Advisor