Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk

Osteoporos Int. 2024 Sep;35(9):1487-1496. doi: 10.1007/s00198-024-07162-w. Epub 2024 Jul 3.

Abstract

Task Force on 'Clinical Algorithms for Fracture Risk' commissioned by the American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee has recommended that FRAX® models in the US do not include adjustment for race and ethnicity. This position paper finds that an agnostic model would unfairly discriminate against the Black, Asian and Hispanic communities and recommends the retention of ethnic and race-specific FRAX models for the US, preferably with updated data on fracture and death hazards. In contrast, the use of intervention thresholds based on a fixed bone mineral density unfairly discriminates against the Black, Asian and Hispanic communities in the US. This position of the Working Group on Epidemiology and Quality of Life of the International Osteoporosis Foundation (IOF) is endorsed both by the IOF and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Keywords: FRAX adjustment; Fracture probability; Race and ethnicity; Racism.

MeSH terms

  • Algorithms*
  • Bone Density* / physiology
  • Evidence-Based Medicine*
  • Female
  • Humans
  • Osteoporosis / ethnology
  • Osteoporotic Fractures* / ethnology
  • Osteoporotic Fractures* / prevention & control
  • Risk Assessment / methods
  • United States / epidemiology