German DVO risk score identified more patients requiring treatment compared to FRAX score in a retrospective analysis of women evaluated for osteoporosis

In a retrospective study of 555 female patients, we compared osteoporosis-specific fracture risk probabilities and treatment recommendations according to the German DVO guidelines with those resulting from the internationally implemented FRAX score. We present the differences between both scores, which also identified different individual patients as in need of therapy. Purpose Fracture risk determination is essential when recommending treatment in osteoporosis management. This study compares and contrasts the risk probabilities of major osteoporotic and hip fractures calculated by the DVO score established in German-speaking countries with those of the FRAX tool. Methods We retrospectively analysed data from 555 female patients (mean age 64.2 ± 10.3 years) evaluated for osteoporosis. For the DVO score, we set the therapy threshold of > 30% for vertebral and hip fractures as suggested by DVO guidelines before 2023. Major osteoporotic fracture (MOF) and hip fracture risk (HF) were calculated based on corresponding FRAX scores. We applied the internationally most common therapy threshold of ≥ 20% for MOF and ≥ 3% for HF and subsequently determined the “DVO-equivalent risk levels” for FRAX-based assessment. Results Based on DVO score, 52.8% of women had a 10-year risk of hip and vertebral fractures > 30%. Most patients were identified by HF ≥ 3% without BMD (56%). The 14.6% of patients identified for treatment only by DVO score presented a higher percentage of spinal fractures (38.3% vs. 18.6%), whereas the 10.6% of patients only identified by FRAX including BMD presented a higher percentage of peripheral fractures (40.7% vs. 29.6%). The thresholds for this “DVO-equivalent risk level” for ‘FRAX with BMD’ would be ≥ 10% for MOF and ≥ 2.6% for HF. Given the differences in the DVO and FRAX scores, it would be highly recommendable to consider both scores when assessing individual women for treatment.