Fracture prevention is critical for avoiding the significant morbidities resulting from osteoporotic fractures. In 2008, The University of Sheffield launched the fracture risk assessment tool (FRAX). Around the same time the Garvan Fracture Risk Calculator was launched. These tools, along with others, use clinical risk factors and bone mineral density (BMD) to predict the risk of fracture within 10 years. This has changed the way osteoporosis is managed around the world, aiding physicians in decision making for osteoporosis treatment.
Last month, Danielle Whittier et al. published a new fracture risk tool in the Journal of Bone and Mineral Research, the microarchitecture fracture risk assessment calculator (μFRAC). The difference from earlier tools, is that μFRAC uses high-resolution peripheral quantitative compute tomography (HR-pQCT) data that are known to correlate to bone strength, including volumetric bone density and 3D structure. While the tool incorporates clinical risk factors (sex, age, height, weight, and prior adulthood fracture), these are not required for accurate fracture risk prevention and only minimally improve the predictive accuracy.
Perhaps not surprisingly, the use of more advanced bone architecture parameters captured by HR-pQCT meant that in their study μFRAC modestly outperformed FRAX. This provides incentive for using higher resolution techniques for predicting risk of fracture, where available. In particular, this can improve reliability of fracture risk predication in cases where clinical risk factors are not available avoiding biases from patient recall. The model is based on patient cohorts across North America and Europe, and as yet it is not clear whether μFRAC will also improve fracture risk prevention in other parts of the world.