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Can the FRAX tool be a useful aid for clinicians in referring women for periodontal care?

Alli, Foluke MD, NCMP1; Bhandal, Gazabpreet K. DDS2; Thacker, Holly L. MD, NCMP, FACP1; Palomo, Leena DDS, MSD2


In multiple issues of Menopause , several articles and abstracts regarding information published about the FRAX osteoporotic fracture tool and the World Health Organization (WHO) were incorrect. FRAX was developed by researchers at the University of Sheffield; although the department was designated as a WHO Collaborating Centre, this tool was not developed nor endorsed by WHO.

WHO has asked us to correct the public record (supplemental content 1, ). They have further explained that:

WHO published a full statement about this matter in the Editorial “Clarifying WHO's position on the FRAX tool for fracture prediction” in Bulletin of the World Health Organization 2016;94:862. doi: .

The Menopause articles to be corrected by this erratum are:

Menopause. 24(12):1414-1415, December 2017.

doi: 10.1097/GME.0000000000000272
Original Articles

Objective This study aims to compare periodontitis severity in postmenopausal women whose FRAX (World Health Organization Fracture Risk Assessment Tool) scores indicate a major risk for osteoporotic fracture (OPF) versus controls.

Methods Participant charts from the Case/Cleveland Clinic Postmenopausal Wellness Collaboration 853-sample database were selected based on the following inclusion criteria: (1) aged between 51 and 80 years; (2) menopause for more than 1 year but less than 10 years; (3) nonsmoker; (4) hemoglobin A1c less than 7; and (5) no glucocorticoid, hormone, RANKL (receptor activator of nuclear factor-κB ligand) inhibitor, or bisphosphonate therapy within 5 years. FRAX score was calculated, and participants were organized into two groups: women with major OPF risk (FRAX scores >20%) and controls. Periodontal data were obtained from the charts. T test was used to assess differences in periodontal parameters between groups.

Results Ninety participants had FRAX scores higher than 20% and were considered to have high OPF risk; 98 participants served as controls. Probing depth (mean [SD], 2.75 [0.66] vs 2.2 [0.57]), clinical attachment loss (3.15 [0.78] vs 2.73 [0.66]), alveolar bone height (0.58 [0.03] vs 0.60 [0.02]), and tooth loss (5.6 [1.96] vs 3.84 [1.94]) were significantly different between groups, whereas plaque score and bleeding on probing were not.

Conclusions Postmenopausal women whose FRAX scores suggest major OPF risk have significantly more severe periodontitis endpoints than controls even though oral hygiene scores do not significantly differ. These findings suggest to clinicians treating women after menopause that referral to a periodontist for disease screening may be appropriate for those women with high fracture risk based on FRAX scores.

From the 1Center for Specialized Women’s Health, Women’s Health Institute, Cleveland Clinic, Cleveland, OH; and 2Department of Periodontology, Case School of Dental Medicine, Case Western Reserve University, Cleveland, OH.

Received March 3, 2014; revised and accepted April 10, 2014.

Funding/support: None.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Leena Palomo, DDS, MSD, DMD Periodontics, Case Western Reserve University, Cleveland, OH. E-mail:

© 2015 by The North American Menopause Society.