Objective:

to evaluate the application of intervention thresholds based on FRAX in Chilean women. Recategorize the risk of osteoporotic fracture to optimize the selection of eligible women for intervention.

Methods:

we selected 1782 women aged 50 and older from the 2016-2017 National Health Survey (third version). We estimated the probability of major osteoporotic fractures and hip fractures using the Chilean FRAX model. We estimated the percentage of women eligible for treatment and assessment of bone mineral density by applying specific intervention thresholds by age from 50 to 90 years and a hybrid threshold that combines age-dependent thresholds up to 75 years and, thereafter, a fixed threshold with a single fracture probability up to 90 years.

Results:

twenty-two women (1.23 %) had a previous fracture and were eligible for treatment for this reason. Using age-specific thresholds, another 33 women were eligible for treatment because the probability of major osteoporotic fracture was above the upper assessment threshold. In 1107 (62.12 %) women, bone mineral density measurement is recommended to recalculate FRAX with the inclusion of femoral neck bone mineral density. With the hybrid threshold, an additional 44 (3.69 %) women were eligible for treatment, and bone density measurement was advised in 1169 women (65.50 %). If treatment was assigned based on FRAX without bone mineral density alone, the number of women eligible for treatment was 70 (5.15 %) with an age-specific intervention threshold and 120 (6.72 %) with the hybrid threshold.

Conclusions:

the hybrid threshold identifies more women eligible for treatment compared to age-specific thresholds. The average fracture probability was higher with the hybrid threshold. Based on this, our position is to recommend the hybrid threshold.

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