ArticleTherapeutic advances in musculoskeletal disease2026
Underestimation of fracture risk by conventional FRAX thresholds in axial spondyloarthritis: a proposal for disease-specific thresholds.
Article in Therapeutic advances in musculoskeletal disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Impact of biologic and targeted synthetic therapies on bone health in immune-mediated inflammatory diseases: a narrative review.Frontiers in medicine · 2026Review
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Abstract
Background: The Fracture Risk Assessment Tool (FRAX) is widely used as an intervention threshold for postmenopausal osteoporosis but has not been validated specifically for axial spondyloarthritis (axSpA). Objectives: To validate FRAX thresholds and predictive ability for fragility fractures in axSpA patients. Design: A cross-sectional study. Methods: Patients diagnosed with axSpA according to the 2009 ASAS criteria, aged 40-90 years, and treated at Phramongkutklao Hospital between December 2019 and October 2024 were consecutively included. Bone mineral density (BMD), trabecular bone score (TBS), and vertebral fracture assessment were measured using Dual-energy X-ray absorptiometry. The Thai reference database calculated FRAX probabilities for major osteoporotic fracture (MOF) and hip fracture (HF). The predictive performance of FRAX (with and without BMD) was evaluated against actual fracture occurrence, using FRAX thresholds for MOF and HF at 10% and 3%, respectively. Optimal cutoffs for FRAX against fractures were determined using receiver operating characteristic (ROC) curves and the Youden index. Results: Among 125 axSpA patients (73.6% male; mean age 50.9 ± 10.8 years; disease duration 9.7 ± 9.9 years), osteoporotic fractures were found in 24.0%, with vertebral fractures being most common. Patients with fractures had significantly higher disease activity (Bath Ankylosing Spondylitis Disease Activity Index 4.2 vs 2.2, Conclusion: FRAX (without BMD) is a viable predictor of fractures in axSpA, yet its optimal intervention thresholds (⩾4% MOF and ⩾1.5% HF) fall substantially below standard thresholds for postmenopausal women. Adjusting clinical thresholds downward is warranted to ensure timely prevention and better reflect the specific axSpA risk profile.
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