Accuracy of the Fracture Risk Assessment Tool for judging pharmacotherapy initiation for primary osteoporosis.

INTRODUCTION: This study aimed to determine whether the Fracture Risk Assessment Tool (FRAX®) is useful in assessing the criteria for the initiation of pharmacotherapy for primary osteoporosis based on the current diagnostic criteria in Japan. MATERIALS AND METHODS: We enrolled 614 patients aged ≥ 40 years (average, 77.0 years) who were eligible for primary osteoporosis evaluation. Bone mineral density measurements of the lumbar spine, total hip, and femoral neck using ALPHYS LF (FUJIFILM, Tokyo, Japan) and imaging studies involving the lumbar spine were obtained and the FRAX® scores of each patient were calculated with and without the T-score of the femoral neck. The receiver operating characteristic curve analysis method was used to calculate the cut-off FRAX® scores with reference to the criteria for initiating pharmacotherapy for osteoporosis; the accuracies of both FRAX® scores were compared. RESULTS: The FRAX® score calculated with the T-score was more accurate for hip fracture risk assessment [cut-off value 5.5%; the area under the curve (AUC) 0.946] than for major osteoporotic fracture risk assessment (cut-off value 17.0%; AUC 0.924) in judging the criteria (p = 0.001). Conversely, the FRAX® score calculated without the T-score was equally accurate for hip fracture risk assessment (AUC 0.796) and major osteoporotic fracture risk assessment (AUC 0.806) (p = 0.23). CONCLUSION: The FRAX® score can accurately assess the criteria for initiating pharmacotherapy for primary osteoporosis based on the current Japanese diagnostic criteria, especially when the T-score is used.

Status of fracture risk assessment and osteoporosis treatment in Japanese patients with rheumatoid arthritis.

OBJECTIVES: This study aimed to investigate the prevalence of patients with rheumatoid arthritis (RA) at a high risk of major osteoporosis (OP)-related fractures and the status of OP-related medical treatment for these patients. METHODS: We enrolled 120 patients aged ≥40 years (average, 69.1 years) with RA. The Fracture Risk Assessment Tool (FRAX®) was used to evaluate the fracture risk. Of the 120 patients, the femoral neck bone mineral density (BMD) was evaluated in 102 patients, and their FRAX® scores were calculated alongside the BMD values. Patients observed to be at a high risk of a major OP-related fracture (10-year probability >20% or hip fracture risk >3%), according to FRAX®, were identified as those requiring OP treatment; medication ratio for OP (percentage of patients actually receiving medication among patients requiring OP treatment) was assessed. RESULTS: OP treatment was indicated in 75 (63%) patients; the medication ratio for OP was 49%. The use of biological disease-modifying anti-rheumatic drugs and corticosteroids showed a positive effect; however, the use of methotrexate showed a negative effect on the medication ratio. CONCLUSION: The number of potential patients requiring OP treatment is underestimated. All patients with RA should be assessed to determine their eligibility for OP treatment.