Osteoporosis International

, Volume 29, Issue 4, pp 947–952 | Cite as

FRAX calculated without BMD does not correctly identify Caucasian men with densitometric evidence of osteoporosis

  • R. C. HamdyEmail author
  • E. Seier
  • K. Whalen
  • W. A. Clark
  • K. Hicks
  • T. B. Piggee
Original Article



The FRAX algorithm assesses the patient’s probability of sustaining an osteoporotic fracture and can be calculated with or without densitometric data. This study seeks to determine whether in men, FRAX scores calculated without BMD, correctly identify patients with BMD-defined osteoporosis.


The diagnosis of osteoporosis is based on densitometric data, the presence of a fragility fracture or increased fracture risk. The FRAX algorithm estimates the patient’s 10-year probability of sustaining an osteoporotic fracture and can be calculated with or without BMD data. The purpose of this study is to determine whether in men, FRAX calculated without BMD, can correctly identify patients with BMD-defined osteoporosis.


Retrospectively retrieved data from 726 consecutive Caucasian males, 50 to 70 years old referred to our Osteoporosis Center.


In the population studied, 11.8 and 25.3% had BMD-defined osteoporosis when female and male reference populations were used respectively. When the National Osteoporosis Foundation thresholds to initiate treatment are used, only 27% of patients with BMD-defined osteoporosis, but 4% with normal BMD reached/exceeded these thresholds. Lowering the threshold increased sensitivity, but decreased specificity.


Our results suggest that FRAX without BMD is not sensitive/specific enough to be used to identify Caucasian men 50 to 70 years old with BMD-defined osteoporosis.


Bone mineral density FRAX Management Men Osteoporosis 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    NIH Consensus Development Panel on Osteoporosis Prevention (2001) Diagnosis and therapy. JAMA 285(6):785–795. CrossRefGoogle Scholar
  2. 2.
    Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren l, Berger ML (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164(10):1108–1112. CrossRefPubMedGoogle Scholar
  3. 3.
    Siris ES, Adler R, Bilezekian JP et al (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25:1439–1443CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kanis JA (2013) FRAX®: assessment of fracture risk. In: Rosen CJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism. Eighth Edition, pp 289–296. CrossRefGoogle Scholar
  5. 5.
    Kanis JA, Johansson H, Oden A, McCloskey EV (2009) Assessment of fracture risk. Eur J Radiol 71(3):392–397. CrossRefPubMedGoogle Scholar
  6. 6.
    National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington Google Scholar
  7. 7.
    Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 ISCD position development conference on bone densitometry. JCD 16(4):455–467. CrossRefGoogle Scholar
  8. 8.
    US Preventive Services Task Force (2011) Screening for osteoporosis: US Preventive Services Task Force recommendation statement. Ann Intern Med 154:356–364CrossRefGoogle Scholar
  9. 9.
    Sandhu SK, Nguyen ND, Center JR, Pocock NA, Eisman JA, Nguyen TV (2010) Prognosis of fracture: evaluation of predictive accuracy of the FRAX algorithm and Garvan nomogram. Osteoporos Int 21(5):863–871. CrossRefPubMedGoogle Scholar
  10. 10.
    Bolland MJ, Siu AT, Mason BH et al (2011) Evaluation of the FRAX and Garvan fracture risk calculators in older women. J Bone Miner Res 26(2):420–427. CrossRefPubMedGoogle Scholar
  11. 11.
    Kuruvilla K, Kenny AM, Raisz LG, Kerstetter JE, Feinn RS, Rajan TV (2011) Importance of bone mineral density measurements in evaluating fragility bone fracture risk in Asian Indian men. Osteoporos Int 22(1):217–221. CrossRefPubMedGoogle Scholar
  12. 12.
    Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, Nevitt MC, Suryawanshi S, Cummings SR, Fracture Intervention Trial (2000) Fracture risk reduction with alendronate in women with osteoporosis: fracture intervention trial – FIT. J Clin Endocrinol Metab 85(11):4118–4124. CrossRefPubMedGoogle Scholar
  13. 13.
    McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344(5):333–340CrossRefPubMedGoogle Scholar
  14. 14.
    Chesnut CH III, Skag A, Christiansen C et al (2004) Effects of oral ibandronate on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19(8):1241–1249CrossRefPubMedGoogle Scholar
  15. 15.
    Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR, HORIZON Pivotal Fracture Trial (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356(18):1809–1822. CrossRefPubMedGoogle Scholar
  16. 16.
    Neer RM, Arnaud CD, Zanchetta JR et al (2001) Effect of parathyroid hormone (1-34) on fractures and BMD in postmenopausal women with osteoporosis. N Engl J Med 344(19):1434–1441. CrossRefPubMedGoogle Scholar
  17. 17.
    Cummings SR, San Martin J, McClung MR et al (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361(8):756–765CrossRefPubMedGoogle Scholar
  18. 18.
    Chesnut CH III, Silverman S, Andriano K et al (2000) A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med 109(4):267–276CrossRefPubMedGoogle Scholar
  19. 19.
    Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE). JAMA 282(7):637–645. CrossRefPubMedGoogle Scholar
  20. 20.
    Austin M, Yand Y-C, Vittinghoff E et al (2012) Relationship between bone mineral density changes with denosumab treatment and risk reduction for vertebral and nonvertebral fractures. J Bone Miner Res 27(3):687–693. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Small RE (2005) Uses and limitations of bone mineral density measurements in the management of osteoporosis. MedGenMed 7(2):3–12PubMedPubMedCentralGoogle Scholar
  22. 22.
    Compston J, Bowring C, Cooper A, Cooper C, Davies C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P, National Osteoporosis Guideline Group (2013) Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75(4):392–396. CrossRefPubMedGoogle Scholar
  23. 23.
    Kanis JA, McCloskey EV, Johansson H et al (2013) European Guidance for the Diagnosis and Management of Osteoporosis in postmenopausal women. Osteoporosis Int 24(1):23–57. CrossRefGoogle Scholar
  24. 24.
    Cauley JA, Fuleihan GE, Arabi A et al (2011) Official positions for FRAX clinical regarding international differences. J Clin Densitom 14(3):240–262. CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • R. C. Hamdy
    • 1
    Email author
  • E. Seier
    • 2
  • K. Whalen
    • 1
  • W. A. Clark
    • 3
  • K. Hicks
    • 1
  • T. B. Piggee
    • 1
  1. 1.Osteoporosis CenterEast Tennessee State UniversityJohnson CityUSA
  2. 2.Department of Mathematics and StatisticsEast Tennessee State UniversityJohnson CityUSA
  3. 3.College of Clinical and Rehabilitative Health Sciences, Department of Allied Health SciencesEast Tennessee State UniversityJohnson CityUSA

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