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Introduction: FRAX®, an assessment algorithm for estimating fracture probability, has been widely used for the evaluation of osteoporosis since 2008. Its clinical use requires that osteoporotic fracture probability is established at which treatment can be recommended., Objectives: The aim of the present study was to explore possible treatment thresholds for Poland., Patients and Methods: The FRAX-based probabilities were calculated in 1608 unselected postmenopausal women from Białystok using the British model (version 3.1). Intervention thresholds were set at fracture probability equal to women with a bone mass density (BMD) T-score of -2.5 standard deviation (criterion A), equal to women with a prior fracture using a fixed threshold irrespective of age (criterion B), or an age-dependent threshold (criterion C). Additionally, we assumed that all women with a prior fracture would be eligible for treatment plus those with a fracture probability equal to women with a prior fracture using a fixed threshold (criterion D)., Results: Mean 10-year probability of a major osteoporotic fracture was 10.9% when BMD was not included in the FRAX calculation and 11.6% with BMD included. In women with a prior fragility fracture, the respective probabilities were 18.0% and 17.4%. For criterion A, 39% women aged 50 years or more would be eligible for treatment, for criterion D--35%, and for criteria B and C--16%. For criteria B and C, women with higher risk would be eligible for treatment compared with criteria A and D. Assuming a relative fracture risk reduction of 30%, the number needed to treat (NNT) to prevent a major fracture was lower for criteria B and C (NNT = 13 and 14, respectively) than for criteria A and D (NNT = 18)., Conclusions: The use of intervention thresholds based on the probabilities equal to women with a prior fracture is most efficient. The use of an age-specific threshold may be more clinically appropriate than a fixed probability threshold for all ages.

Background: The 2007 WHO guidelines for the treatment of osteoporosis require that we know the population risk of an osteoporotic fracture for each country to classify patients requiring treatment., Material and Methods: Studies have been carried out among a random cohort of 1,608 women over the age of 40 to assess a ten-year absolute risk of main osteoporotic fractures (AR-10 m.o.fx.) and hip fractures (AR-10 h.fx.) by using FRAX®BMI and FRAX®BMD based on the epidemiology of fractures in England., Results: Both methods gave similar results in assessing the probability of fracture, showing the increase of AR-10 m.o.fx. in subsequent life decades to rise from 5% in the fifth decade to 25% in the ninth, mean result 11%, and AR-10 h.fx. to rise over the same period from 0.5% to 13%, mean result 3%. The number of fractures increases up to the seventh and eighth decades, and decreases according to the number of patients in the age group. The commonest fracture risks reported, other than old age and low BMI, were a prior fracture, a family history of hip fracture and smoking., Conclusions: Comparative analysis of examined parameters of FRAX between people with and without fractures showed considerable differences only in age and AR-10 m.o.fx. This doubled in people with previous fractures (ca. 18% vs. 9%) and AR-10 h.fx. (ca. 5% vs. 2.5%). The "middle" area between the average population risks (AR-10 m.o.fx. 11% and AR-10 h.fx. 3%) and the risks in patients with fractures (AR-10 m.o.fx. 18% and AR-10 h.fx. 9%) could work as an indicator: below those values the risk is low and no treatment is required; above those values, the risk is high, and intervention is necessary; the middle area implies a BMD examination and reassessment of the fracture risk.