Comparison between ultrasound Fragility Score and FRAX® for the assessment of osteoporotic fracture risk

The assessment of osteoporotic fracture risk requires the measurement of bone mineral density (BMD) on reference sites (hip and spine) and the evaluation of clinical risk factors (CRFs) for fracture. The Fracture Risk Assessment algorithm (FRAX®), internationally recognized by official guidelines for osteoporotic patient management, represents a tool for estimating 10-year probability of hip and major fragility fractures by integrating CRFs and femoral neck BMD or T-score, when available. In this work we presented an innovative ultrasound (US)-based method for estimating fracture risk by means of a safe and radiationfree approach. From abdominal ultrasound scans performed on 64 female patients, we defined and quantified a new US diagnostic parameter named Fragility Score (F.S.), which estimates bone fragility. Obtained results showed an high Pearson correlation coefficient between fracture probabilities calculated by FRAX® and F.S. (r up to 0.75 in the case of FRAX® estimates including femoral neck BMD and r=0.71 in the case of FRAX® estimates based on femoral neck T-score). The present study demonstrated the feasibility of a novel US approach for fracture risk prediction and prevention, directly applicable on spine and independent from BMD measurements and CRF assessments. The proposed methodology could represent a valid alternative to both FRAX® and BMD for early assessment of fracture risk.