The creators of the FRAX fracture risk calculator for countries with no national reference values (such as Greece) suggest the use of FRAX from a neighboring country.1,2<\/sup> For Greeks (considered to run a high risk for osteoporotic fractures), the Italian FRAX is the suggested choice.2<\/sup> The correlation of FRAX results with and without the use of femoral neck T-scores assessed by DXA is considered to be adequate. The aim of our study was to assess the correspondence of 10-year femoral neck fracture risk with and without the inclusion of femoral neck T-scores implementing the Italian FRAX in Greek women and to evaluate, albeit indirectly, its validity.<\/p>\n We studied 88 consecutive women outpatients (mean age\u00b1SD: 58\u00b18 years) with 0-3 FRAX risk factors. All had neck femoral bone mineral density (BMD) assessed by DXA and received only calcium supplements \u00b1 vitamin D3 (500 mg\/day to1200 mg\/day \u00b1 400 IU\/day to 1200 IU\/day, respectively); all were bisphosphonate-naive. We calculated the 10-year femoral neck fracture risk with and without inclusion of femoral neck T-scores, drafted a Bland-Altman diagram and calculated Cohen\u2019s Kappa coefficient (with the accepted 3% 10-year femoral neck fracture risk as a discriminatory threshold).3,4<\/sup><\/p>\n Based on DXA measurements, 17 women had a BMD within normal limits, 53 had osteopenia and 18 had various degrees of osteoporosis. Inspection of the Bland-Altman diagram showed that although the correlation of FRAX scores was acceptable for most women, there were nevertheless inconsistencies for a substantial number of them (Figure 1). Discrepancies in FRAX scores with clinical importance (based on the accepted 3% 10-year femoral neck fracture risk) were noted in 21\/88 women (24%) (Table 1<\/a> ). The Kappa coefficient was low (0.33).4<\/sup><\/p>\n Figure 1.<\/strong> Bland-Altman plot of FRAX estimated 10-year hip fracture rate with and without the inclusion of BMD results.<\/p>\n The correlation of femoral neck fracture risk in Greek women using the Italian version of FRAX with and without the inclusion of femoral neck T-scores was not satisfactory (76%) and was worse than that reported during the validation of FRAX in other countries (approximately 85%-90%).2 This finding is important in view of the proposed use of FRAX as a means to identify low- or high-fracture risk patients who do not require DXA5 and must be taken into consideration when interpreting results in Greek women. A Greek FRAX appears to be necessary.<\/p>\n All the authors declare no conflict of interest.<\/p>\n REFERENCES<\/strong><\/p>\n 1.\u00a0\u00a0 \u00a0Kanis JA, Hans D, Cooper C, et al, 2011 Interpretation and use of FRAX in clinical practice. Osteoporos Int 22: 2395-2411.![\"](\"\/wp-content\/uploads\/images\/dyn\/last1.jpg\")
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\n2.\u00a0\u00a0 \u00a0Assessment of osteoporosis at the primary health care level. Report of a WHO scientific group. World Health Organization Collaborating Center for Metabolic Bone Diseases. Sheffield UK: University of Sheffield, 2007.
\n3.\u00a0\u00a0 \u00a0Bland JM, Altman DG, 1986 Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327: 307-310.
\n4.\u00a0\u00a0 \u00a0Landis RJ, Koch GG, 1977 The measurement of observer agreement for categorical data. Biometrics 33: 159-174.
\n5.\u00a0\u00a0 \u00a0Leslie WD, Morin S, Lix LM, et al, 2012 Fracture risk assessment without bone density measurement in routine clinical practice. Osteoporos Int 23: 75-85.<\/p>\n<\/div>\n