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Prof Nikhil Tandon, New Delhi 17 November 2018
Predictors of osteoporotic fractures include: bone mass - bone mineral density (BMD); clinical risk factors (CRFs) – FRAX (fracture risk assessment tool); bone microarchitecture – Trabecular bone score (TBS). BMD correlates strongly with fracture risk and is a useful tool for treatment monitoring. However, it has a poor sensitivity as most fractures occur in patients with nonosteoporotic BMD. There is a significant BMD overlap in those with and without fractures. FRAX incorporates various CRFs which predict fractures independent of BMD. However, FRAX fails to consider dose effect of CRFs and misses a number of risk factors important for fracture prediction. TBS is a noninvasive method of bone microarchitecture assessment; it has a good correlation with histomorphometry. It has been shown to predict fracture risk independent of BMD and CRFs. There is a relatively limited experience with TBS in men and premenopausal women. There is a need to use different fracture prediction tools complimentary to each other in appropriate clinical settings.
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