Fracture Risk AssessmentHeidi Powell, MD Literature reviewed July 09, 2008. Updated January 22, 2009
Click an answer under each question.
She has osteopenia, not osteoporosis, so is there any indication to start medication to prevent fractures?
- Option A Unclear, because more information about her risk factors is needed.
- Option B No, because her BMD is only -1.7 and treatment is indicated for those with a BMD of -2.5 or lower.
- Option C Yes, recent studies have shown that there may be a benefit to treating women with T scores between -1.5 and -2.5, regardless of risk factors.
Are there other risk factors besides personal history of fracture, smoking, or family history of osteoporosis which would encourage you to screen a postmenopausal woman prior to age 65?
With further questioning, you find out the following about your patient:
- Weight 150 pounds (height 65 inches)
- Alcohol: 3 glasses of wine each night
- No corticosteroid usage (past or present)
- No personal history of a fracture
- Smoking: 1 PPD
- No family history of a hip fracture
You decide to use the FRAX tool to determine her fracture risk given her many risk factors. You have a question about the FRAX tool as you are putting in the data.
Can the total hip BMD rather than the femoral neck BMD be used in the FRAX tool?
The FRAX tool requires either a yes or no response for some of the risk factors and does not allow for a dose or duration response. For example, our patient increased her drinking from one drink per night to 3 drinks per night only in the last 6 months.
How do you answer some of the clinical risk factor questions if you are unsure of the duration or amount?
The FRAX tool shows that her 10-year risk of having a fracture is:
- 14% for any major osteoporotic fracture
- 3.1% of a hip fracture.
Should you consider treating her?
If she were African-American with the same risk factors, would her fracture risk be the same?
If she were African-American, her 10-year hip fracture risk is 1.4 %. Does the cost-effective intervention threshold for osteoporosis treatment differ between races?