A study on WHO Frax score to predict fracture risk in predialysis patients of chronic kidney disease


  • Ramawtar Manda Department of Pharmacology, VMMC, New Delhi, India
  • Shashikant Bhargava Department of Clinical Pharmacology, AIIMS, New Delhi, India




Bone mineral density, Chronic kidney disease, Dual energy X ray absorptiometry, World health organization


Background: Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are an important cause of morbidity and decreased quality of life. These disturbances include renal osteodystrophy and CKD-Mineral and Bone Disorder (CKD-MBD). The Frax tool developed by WHO is an attempt to better estimate the fracture risk. It calculates a 10 year probability of osteoporotic fractures of spine, forearm, hip or shoulder based on clinical risk factors with or without BMD measurements.

Methods: It is a Cross sectional observational study which was done from 01 November 2013 to 31 March 2015. The study group included 60 cases of pre dialysis Chronic Kidney Disease attending OPD, Emergency or admitted in medicine wards of Dr. RML Hospital, New Delhi. Bone mineral density measured by dual-energy X-ray absorptiometry and all patients were classified according to World Health Organization criteria. DEXA SCAN (manufacturer-Hologic INC.) was done of the lumbar spine, radius bone and neck of the femur. Frax score was calculated as per WHO guidelines.

Results: On using the Indian Frax calculator the average 10 year probability for major osteoporotic fractures in stage 4 (9.47±2.62%) was found to be significantly higher (p<0.0001) than that in stage 3 (1.92±0.8%).Similarly, the average 10 year probability for hip fracture in stage 4 (4.61±1.45%) was also found to be significantly higher (p< 0.0001) than that in the stage 3 (0.75±0.49%).

Conclusions: The study confirmed the high incidence of low BMD in patients of CKD. The 10 year fracture risk in these patients as predicted by Frax score was significantly higher in CKD patients irrespective of whether the Chinese or the Indian calculator was used.


Agarwal SK, Srivastava RK. CKD in India: challenges and solutions. Nephron Clin Pract 2009;111:c197-203.

Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence Of chronic kidney disease and decreased kidney function in The adult US population: Third national health and nutrition Examination survey. Am J Kidney Dis 2003;41:1-12.

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038- 47.

Agarwal SK, Dash SC, Irshad M, Raju S, Singh R, Pandey RM. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant 2005;20:1638-42.

Mani MK. Experience with a program for prevention of chronic renal failure in India. Kidney Int Suppl 2005;Apr (94):S75-8.

Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney international. 2006 Jun 1;69(11):1945-53.

Amling M, Grote HJ, Vogel M. Three-dimensional analysis of the spine in autopsy cases with renal osteodystrophy. Kidney Int 1994;46:733-43

Dempster DW, Lindsay R. Pathogenesis of osteoporosis. Llancet.1993

Kanis JA, Johnell O, Odén A, Johansson H, McCloskey EF. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporosis international. 2008 Apr 1;19(4):385-97.

Wright NC, Saag KG. From fracture risk prediction to evaluating fracture patterns: recent advances in the epidemiology of osteoporosis. Curr Rheumatol Rep. 2012 Jun; 14(3):205-19.

Taal MW, Masud T, Green D, Cassidy MJ. Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant. 1999;14(8):1922-8.

Polymeris A, Doumouchtsis K, Grapsa E. Bone mineral density and bone metabolism in hemodialysis patients. Correlation with PTH, 25OHD3 and leptin. Nefrologia. 2012;32(1):73-8. Jabbar Z, Aggarwal PK, Chandel N, Khandelwal N, Kohli HS, Sakhuja V, et al. Noninvasive assessment of bone health in Indian patients with chronic kidney disease. Ind J Nephrol. 2013 May;23(3):161.

Rix M, Andreassen H, Eskildsen P, Langdahl B, Olgaard K. Bone mineral density and biochemical markers of bone turnover in patients with predialysis chronic renal failure. Kidney Int. 1999;56:1084-93.

Bansal B, Bansal S, Mithal A, Kher V, Marwaha R. Vitamin D deficiency in hemodialysis patients. Indian J Endocrinol Metab 2012;16:270-3.

Ghosh B, Brojen T, Banerjee S, Singh N, Singh S, Sharma OP, Prakash J. The high prevalence of chronic kidney disease-mineral bone disorders: A hospital-based cross-sectional study. Ind J Nephrol. 2012 Jul;22(4):285.

Rozita M, Afidza MN, Ruslinda M, Cader R, Halim AG, Kong CT, et al. Serum vitamin D levels in patients with chronic kidney disease. Excli J. 2013;12:511.




How to Cite

Manda, R., & Bhargava, S. (2020). A study on WHO Frax score to predict fracture risk in predialysis patients of chronic kidney disease. International Journal of Research in Medical Sciences, 8(8), 2978–2982. https://doi.org/10.18203/2320-6012.ijrms20203450



Original Research Articles