Background/Purpose:

1. To determine whether FRAX can be used for monitoring patients receiving osteoporosis therapy and its clinical implications 2. Study the correlation between the post-treatment FRAX and the incidence of fractures.

Methods:

A total of 1026 women (age ≥ 50 years) diagnosed to have osteoporosis who had baseline risk factors assessment and BMD testing were screened. All the patients were treated according to guidelines. 579 women who were adherent to the prescribed osteoporosis therapy, had FRAX probabilities calculated which were included in this study. All the patients had a follow-up DXA scan at 2 and 5-years of osteoporosis therapy. At both times, re-assessment of the risk factors was carried out and FRAX probabilities were calculated. A subgroup of patients who did not achieve an improvement in their neck of the femur BMD or who sustained a fracture in the first 2-years, had their osteoporosis therapy changed. BMD assessment and FRAX calculation were carried out 3-years after starting the new osteoporosis therapy. The patient subgroup who responded well to therapy and did not sustain a new low trauma fracture in the first 2 years, continued their therapy and had another reassessment in 3-years. 

Results:

During mean 5.3 years of observation, 16.9% individuals sustained incident major osteoporotic fractures, of which 48% were hip fractures. There were also 4.3 % deaths and 2.7% changed their address. 26% were excluded for non-adherence to therapy. A total of 579 women were included in this work. Femoral neck BMD strongly predicted major osteoporotic fractures and hip fractures, and this was unaffected by medication use (P<0.05). Assessment for major osteoporotic fractures and hip fractures showed significant negative correlation with BMD at the neck of the femur at 2-years of therapy (R= -0.218 and -0.445 respectively), as well as at 5-years (R= -0.212 and -0.220 respectively). At both 2 years and 5 years of therapy, there was significant correlation between 10-year fracture probability (both major osteoporosis and hip fractures) and the fracture incidence (P< 0.001). When major fracture probability was assessed with BMD, there was a significant (P< 0.05) difference between the responders and non-responders to osteoporosis therapy.

Conclusion:

This work suggests that the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis. Osteoporosis therapy does not invalidate fracture predictions and FRAX may still have value for guiding the need for continued treatment or treatment withdrawal. There are many differences between subjects in clinical trials and patients being treated in clinical practice. Thus, although defining a clinical practice patient as a “nonresponder” or “suboptimal responder” to treatment is problematic, a pragmatic approach would be to consider evaluation for contributing factors and possible changes in therapy in patients who have a statistically significant decrease in BMD, or have a fracture. Further monitoring of osteoporosis therapy, is necessary and helps the treating clinician to identify early the non-responders to therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/monitoring-osteoporosis-therapy-can-frax-help-to-assess-success-or-failure-in-achieving-treatment-goals/