Fact: More than half of all bone fractures are in people with osteopenia rather than osteoporosis. May is National Osteoporosis Awareness and Prevention Month and the perfect time to bone up on your potential fracture risk.
If you haven’t heard of FRAX, it stands for Fracture Risk Assessment Tool. It was developed by the World Health Organization (WHO) to estimate a person’s risk of bone fracture due to osteoporosis or thinning of the bones over the next 10 years.
FRAX includes eight risk factors via an online algorithm and converts it into a probability that will help you know your bone fracture risk and hopefully change things that can be changed to lower your risk. The eight risk factors are:
- Prior fracture
- Parental history of hip fracture
- Low body weight or body mass index (BMI)
- Daily use of 5 mg or more of glucocorticoids for 3 months or more
- Rheumatoid arthritis (RA)
- Current cigarette smoking
- Excessive alcohol intake of 3 units or more daily (3 medium glasses of wine or 3 half pints of beer)
The current National Osteoporosis Foundation Guide recommends treating patients with FRAX 10-year risk scores of ≥ 3% for hip fracture or ≥ 20% for major osteoporotic fracture, to reduce their fracture risk. The overall benefit of the test is that it will help doctors know who should potentially get a bone density test, also known as dual-energy x-ray absorptiometry [DXA], and who should potentially get treatment to prevent a bone fracture due to osteoporosis. It isn’t an absolute and it isn’t a replacement for sound clinical judgment, but it is a wonderful tool to serve as a screen and potentially to influence treatment.
Who Needs FRAX. FRAX was developed by the WHO for use in both postmenopausal women and men aged 40 to 90 years, although the National Osteoporosis Foundation Clinician’s Guide focuses on its benefits in postmenopausal women and men aged >50 years. It is only validated for use in patients who are not being treated for osteoporosis.
Benefits of FRAX. With FRAX, you do not need your electronic medical record to take the test and you don’t have to have had a bone density exam to predict your 10-year probability of having any osteoporotic fracture or hip fracture. In fact, FRAX is a great way to determine if you should get a bone density exam (DXA).
Who Needs DXA? All women 65 years and older should have DXA. In addition, younger postmenopausal women who have a low body weight, history of a prior fracture, use high-risk medications (such as steroids, lipitor and tamoxifen), or a disease or condition that predisposes a person to bone loss should also have a bone density exam.
In the United States, the bone density test is the gold standard for diagnosing and treating osteoporosis. Patients with a T-score of less than −2.5 in the hip or spine have osteoporosis and should be treated, but patients who are osteopenic (low bone mass) may benefit from FRAX as a way to determine whether they are at high risk or low risk for a bone fracture. This information is important because it is actionable.
What About Men? Men ≥ 70 years are also at risk for osteoporosis and should get a DXA, along with men younger than 70 years who have the same risk factors as listed above for women 50 to 64.