Preventing Osteoporosis Risk in Cardiovascular Disease​ Using the FRAX® Score

Introduction:

Many journals and articles have mentioned the correlation between bone health and cardiovascular health. There are many overlapping lifestyles and a comorbidity history. We are using the FRAX score as we use it in patients presenting with falls risk and fractures to assess osteoporosis risk in patients with cardiovascular disease. 

Aims and objectives:

To assess osteoporosis risk in patients aged 75 years and above admitted to cardiology, using the FRAX score. 

1. Osteoporosis risk using the FRAX score
2. Correlation of FRAX score with coronary artery disease, heart failure and similar.

Methods:

This was a retrospective study involving 143 patients admitted to the cardiovascular care unit from April 2024 to March 2025. We used ICD codes to identify these cases: I11.0 Hypertensive heart disease with (congestive) heart failure; I25.5 Ischaemic cardiomyopathy; I42.0 Dilated cardiomyopathy; I42.9 Cardiomyopathy, unspecified; I50.0 Congestive heart failure; I50.1 Left ventricular failure; I50.9 Heart failure, unspecified; I24.9 Acute ischaemic heart disease, unspecified.

The data was collected using CERNER and LPRES (healthcare records). Data collected for age, ethnicity, lifestyle (smoking, alcohol), body weight, BMI low/ high, family history of fracture, previous fracture(s), comorbidities; Type 1 or 2 diabetes mellitus, secondary causes for osteoporosis, rheumatological conditions, use of steroids, chemotherapy.

Once this data was collected, the online FRAX score calculator was used to determine the percentages for 10-year probability of fracture risk for major osteoporotic fracture < 20% or > 20%, and hip fracture risk of <3% or > 3% and NOGG advice on lifestyle vs. bone mineral density vs treatment for osteoporosis were captured. 

Inclusion criteria

Patients admitted to the CCU who were 75 years and above, male or female, with ICD codes as mentioned in the methods and excluded anyone below 75 years. 

Results: The majority of cases were men, admitted under the cardiac care unit of white British ethnicity. The lifestyle and co-morbidity history revealed 45.6% were smokers or ex-smokers, with alcohol consumption of around 14%, many had high BMI (41.2%), cases with a history of diabetes mellitus were 26.5%, only a fraction had previous fragility fractures (11.8%), very small number had rheumatological conditions.

On performing the FRAX score, the 10-year fracture probability of:

• Major Osteoporosis risk of <20% in 72% and > 20 % in 23.5%
• Hip fracture risk of <3 % in 21.7% and > 3% in 76.9%

FRAX score advice:

• 41.3% lifestyle advice
• 42% Measure BMD
• 13.3% to treat
• Not applicable on small percentage 

Discussion

• Is the FRAX score useful to predict fracture and osteoporosis risk in patients with cardiovascular conditions?
• Can this be used as a preventative measure to reduce fracture risk and improve bone health? 

Plans:

Train to use the FRAX score and use it regularly in our services, MfOP and cardiology.

Educating the team on the importance of preventing osteoporosis in cardiovascular diseases with shared risk factors. 

Conclusion: 

FRAX score is a useful tool to identify osteoporosis risk in medical conditions with overlapping risk factors (lifestyles and multiple co-morbidities). The advice for BMD scan on the FRAX score suggests that we need to consider bone health in this group of patients. 

The FRAX score can be embedded as a part of holistic assessment by the primary, secondary, or tertiary care services, and if the BMD scans suggest a T-score in the osteoporosis range, to refer to the appropriate bone health clinic for further advice, treatment and management. 

References 

1. Darren E R Warburton 1, Crystal Whitney Nicol, Stephanie N Gatto, Shannon S D Bredin.  Cardiovascular disease and osteoporosis: Balancing risk management. Vascular Health Risk Management; Vascular Health Risk Management 2007;3(5):673-89.
2. Yulu Yang 1, Yun Huang 1. Association between bone mineral density and cardiovascular disease in older adults (Front Public Health. 2023 Jun 23)
3. Ghada N Farhat, Jane A Cauley, The link between osteoporosis and cardiovascular disease. Clinical Cases Mineral Bone Metabolism. 2008 Jan-Apr;5(1):19–34
4. Sy-Jou Chen 1, Chin-Sheng Lin 1, Cheng-Li Lin 1, Chia-Hung Kao 1. Osteoporosis Is Associated with High Risk for Coronary Heart Disease, 2015 article. A Population-Based Cohort Study. Medicine (Baltimore) 2015 Jul 13;94(27): e1146
5. Tzyy-Ling Chuang 1 2 3, Yi-Da Li 4, Fu-Tsung Hsiao 5, Mei-Hua Chuang 6, Yuh-Feng Wang 1 FRAX® Fracture Risks Are Associated with Coronary Artery Calcification Score. Dis Markers 2017:2017:1592598. doi: 10.1155/2017/1592598. Epub 2017 Dec 20
6. FRAX score