Observational Study
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World J Rheumatol. Jul 12, 2014; 4(2): 14-21
Published online Jul 12, 2014. doi: 10.5499/wjr.v4.i2.14
Monitoring osteoporosis therapy: Can FRAX help assessing success or failure in achieving treatment goals?
Yasser El Miedany, Maha El Gaafary, Ahmed El Yassaki, Sally Youssef, Annie Nasr, Ihab Ahmed
Yasser El Miedany, Ahmed El Yassaki, Sally Youssef, Rheumatology and Rehabilitation Department, Ain Shams University, Cairo 11381, Egypt
Yasser El Miedany, Darent Valley Hospital, Kent, DA2 8DA, United Kingdom
Maha El Gaafary, Environmental and Occupational Medicine, Ain Shams University, Cairo 11381, Egypt
Annie Nasr, Radiology, Ain Shams University, Cairo 11381, Egypt
Ihab Ahmed, Internal Medicine, Cairo University, Cairo 11381, Egypt
Author contributions: All authors had a substantial contribution to the conception and design of the study, drafting/revising of the article and final approval of the version to be published.
Correspondence to: Yasser El Miedany, MD, FRCP, Consultant Rheumatologist, Darent Valley Hospital, Dartford, Kent, DA2 8DA, United Kingdom. miedanycrd@yahoo.com
Telephone: +44-013-22428420 Fax: +44-013-22428415
Received: April 9, 2014
Revised: June 21, 2014
Accepted: July 5, 2014
Published online: July 12, 2014

AIM: To assess: (1) Whether the World Health Organization fracture risk assessment tool (FRAX) can be used for monitoring osteoporosis patients receiving treatment as well as its clinical implications; and (2) The relation between fracture incidence and post-treatment FRAX.

METHODS: Five hundred and seventy-nine osteoporotic women known to be adherent to the prescribed osteoporosis medication, had dual-energy X-ray absorptiometry scan and fracture probability calculated at baseline, 2 and 5-year of osteoporosis treatment. Those patients who responded to treatment and did not sustain a new low trauma fracture during the first 2 years, continued their treatment and were re-assessed 3-year later. The patient subgroup who did not achieve an improvement in their bone mineral density (BMD) or sustain any fracture within the first 2-year, had their osteoporosis treatment changed. Outcome measures included BMD and FRAX assessment calculated 3-year after commencing new osteoporosis treatment.

RESULTS: There was a significant negative correlation between 10-year probability of major osteoporotic and hip fractures and BMD at the total proximal femur at 2-year of treatment (R = -0.449 and -0.479 respectively), and at 5-year (R = -0.489 and -0.594 respectively). At both 2 years and 5 years of treatment, the 10-year fracture probability showed significant correlation with the incidence of fracture (P < 0.01). On comparing fracture probability, there was a significant difference (P < 0.05) between the responders and non-responders to osteoporosis treatment.

CONCLUSION: In women currently or previously treated for osteoporosis, the FRAX tool can be used to predict fracture probability. Osteoporosis treatment does not annul prediction of fractures. FRAX tool may be of value in guiding clinicians towards the need for continuation or withdrawal of treatment.

Keywords: The World Health Organization fracture risk assessment tool, Osteoporosis, Fracture, Dual-energy X-ray absorptiometry

Core tip: Treatment of osteoporosis should assure that the patient benefits from the treatment without experiencing undue harm. Monitoring of patients treated for osteoporosis has been recommended and so far dual-energy X-ray absorptiometry has been recognized as the tool to monitor osteoporosis therapy by several clinical practice guidelines. Recently, the duration of osteoporosis therapy became a research question with the possibility of having a drug holiday. However, more research is still needed to adequately assess when to stop the osteoporosis therapy and what is the optimal duration of the drug holiday. This work was carried out aiming at determining whether the World Health Organization fracture risk assessment tool can be used as a tool to monitor patients receiving osteoporosis treatment and to evaluate its ability to predict new low trauma fractures.