Optimized calculator for a qualitative risk assessment of osteoporotic fractures for the population of Moscow

BACKGROUND: The FRAX tool (a 10-year fracture risk assessment) is recommended to diagnose osteoporosis and optimize the number of patients who need to undergo X-ray densitometry. Due to various circumstances, the integration of a full-fledged FRAX tool into the digital circuits of the Moscow City Health Department is problematic.

AIM: The study aimed to develop a calculator of the 10-year probability of osteoporotic fractures to optimize the routing of patients for examination.

METHODS: An optimized Half-FRAX calculator was created based on the FRAX tool from the University of Sheffield, which was developed using the results of population studies of the Russian Federation. All data used in the original FRAX algorithm, i.e. sex, age, height, weight, and T-criterion (if available) and other important parameters such as a history of fractures, parental hip fractures, smoking, rheumatoid arthritis, secondary osteoporosis, and glucocorticoid and alcohol intake were included in the risk assessment calculator. An algorithm for interaction with the FRAX website was developed and implemented to verify critical levels of patient stratification by multiple consecutive enumerations of different combinations of body mass index (BMI) measurements (0.1 discretization) and age (1-year discretization). Data from clinical guidelines were taken as thresholds.

RESULTS: When implementing the developed algorithm by modeling various combinations of BMI, T-criterion, and risk factors (RF), the absence of RFs and BMI >25 (upper limit of normal) in women was shown to guarantee the exclusion from the “orange zone” where densitometry should be performed. In men, BMI was not a RF. If a RF was present, a patient was recommended to consult a doctor. If no T-criterion was present, but a RF was detected, the patient was indicated for densitometry. Similar results were reported for women with the same indices. In the absence of the RF and with a T-criterion >–2.5, low fracture risk factor was indicated for both men and women.

CONCLUSIONS: An optimized Half-FRAX calculator for the 10-year probability of major osteoporotic fractures was developed, which may optimize the routing of patients for densitometry and reduce the burden on radiology departments in Moscow. This will allow patients to be timely referred to the clinical specialists for consultations. Half-FRAX is integrated into the Osteoporosis Digital Platform (https://telemedai.ru/cifrovaya-platforma-osteoporoz/half-frax).