# OsteoEd

## Estrogen Therapy: Question Four

Which option below most closely reflects her 5-year risk of hip fracture?

• Option A 10% or higher
• Option B 5%
• Option C 2.5%
• Option D 1% or lower

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## How do you evaluate risk of fracture using the FRACTURE tool?

FRACTURE* Clinical Calculators is a clinical prediction rule that provides an estimate of the 5-year risk of osteoporotic fracture in untreated women 65 and older (1). FRACTURE provides both an absolute 5-year risk of fracture and an index score (between 0-15). A FRACTURE Index score of 6 is used as the threshold for pharmacologic intervention (1). Multiplication of the risk of fracture by the expected relative risk (RR) reduction of antiresorptive therapy, usually RR 0.30 - 0.50, gives a projected absolute risk of fracture on therapy. This information can be used to counsel patients about the expected benefits of therapy.

For example, a 65-year-old woman who weighs 150 lbs, who has no prior fractures, whose fall risk is low (able to rise from a chair without using her arms), and whose mother had a hip fracture at age 75, the model yields the following 5-year risks and Fracture Index Score:

Fracture Index Score 3 Hip fracture 0.9% Vertebral fracture 2.5% Non-vertebral fracture 13.1%

Her fracture index score is 3 and well below the threshold for intervention. This model likely overestimates the risk in women younger than 65, such as the patient in this case. No adequately validated models are available for women less than 65 years of age.

*Users are encouraged to review the original article and those pertaining to the use of clinical decision rules (2).

1. McGinn TG Guyatt GH, Wyer PC, Naylor CD, Stiell IG, Richardson WS. et al. Users' guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group. JAMA 2000; 284: 79-84.

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