title: Agreement of Mexican FRAX with and without the value of bone mineral density in assessing the risk of fracture in daily clinical practice.
abstract: BACKGROUND
  The use of FRAX without the inclusion of bone mineral density (FRAX-BMI) may be useful in clinical practice to identify patients at high risk of fracture and inform treatment decisions, but its usefulness is debated. The aim of the study is to evaluate the agreement between the risk of fracture calculated by FRAX with or without bone mineral density (BMD).
  
  
  METHODS
  A cross-sectional study was conducted with 431 women (40-90 years) without treatment. The concordance of the probability of fracture was assessed by the concordance correlation coefficient (CCC), and by Bland-Altman method. The kappa index was used to evaluate the agreement between treatment indications.
  
  
  RESULTS
  The difference between the risks of a major osteoporosis fracture (MOFR) was 1.02±1.40% (95% CI -2 to 1.90) and -0.03±0.51% (95% CI -1.18 to 1.32) for the hip fracture risk (HFR). Agreement between MOFR and HFR FRAX scores was good (CCC 0.879, 95% CI 0.85-0.90 and CCC 0.821, 95% CI 0.79-0.85, respectively). The correlation between BMD of the femoral neck and fracture risk calculated by FRAX-BMI was a moderate, MOFR (r=-0.55, P<.001) and HFR (r=-0.54, P<.001). The agreement between the recommendations of treatment was 87% (kappa 0.61).
  
  
  CONCLUSIONS
  The good agreement between the risk of fracture obtained suggests that FRAX-BMI allows us to provide an estimate of risk in most cases.
authors.affiliation: Servicio de Reumatología, Hospital General Regional 220, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México. Electronic address: gabho@hotmail.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Horta-Baas
authors.affiliation: Servicio de Reumatología, Hospital General Regional 220, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México.
authors.forename: Arturo
authors.initials: A
authors.lastname: Pérez Bolde-Hernández
authors.affiliation: Servicio de Reumatología, Hospital General Regional 220, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México.
authors.forename: Argelia
authors.initials: A
authors.lastname: Pérez-Pérez
authors.affiliation: Servicio de Pediatría, Neurología Pediátrica, Hospital General Regional 1, Instituto Mexicano del Seguro Social, Mérida, Yucatán, México.
authors.forename: Imelda
authors.initials: I
authors.lastname: Vergara-Sánchez
authors.affiliation: Coordinación de Investigación en Salud, Delegación Estado de México Poniente, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México.
authors.forename: María Del Socorro
authors.initials: MDS
authors.lastname: Romero-Figueroa
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008800:Mexico; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: Agreement; Concordancia; Evaluación del riesgo; FRAX; Fractura osteoporótica; Osteoporosis; Osteoporotic fracture; Risk assessment