FRAX

One in two women will break a bone in their lifetime due to osteoporosis, which is greater than that of heart attack, stroke, and breast cancer combined.May is National Osteoporosis Month. Osteoporosis afflicts 25 million American women, and results in more than 1.3 million fractures annually in the United States. Because osteoporosis is usually asymptomatic until a fracture occurs, screening and awareness are crucial to intervention.

Osteoporosis is a condition characterized by microarchitectural deterioration of bone tissue leading to decreased bone mass, bone fragility, and often bone fractures. The two major processes responsible for osteoporosis are poor bone mass acquisition during adolescence and accelerated bone loss in the sixth decade during menopause as estrogen levels decrease. Both processes are influenced by genetic and environmental factors. Reduced bone mass is the result of varying combinations of hormone deficiencies, inadequate nutrition (calcium and vitamin D), decreased physical activity, overall health, and the effects of medications used to treat various unrelated medical conditions.

Osteoporosis-related fractures (usually of the hip, vertebrae, wrist, and clavicle) cause substantial disability, health care costs, and mortality among postmenopausal women. Epidemiologic studies indicate that at least half the population burden of osteoporosis-related fractures affects persons with osteopenia (low bone density at a level just before it becomes osteoporosis). Osteopenia is even more common than outright osteoporosis. The public health burden of fractures will fail to decrease unless the subset of patients with low bone density who are at increased risk for fracture are identified and treated. Risk stratification for medically appropriate and cost-effective treatment is facilitated by the World Health Organization (WHO) fracture risk assessment tool (FRAX) algorithm. FRAX uses clinical risk factors, bone mineral density, and country-specific fracture and mortality data to quantify a patient’s 10-year probability of a hip or major osteoporotic fracture. It was developed by the WHO to be applicable to both postmenopausal women and men aged 40 to 90 years. According to the FRAX fracture risk assessment tool, the 10-year fracture risk in a 65-year-old white woman without additional risk factors is 9.3%. Calculate your FRAX score here.

The current National Osteoporosis Foundation Guide recommends treating patients with FRAX 10-year risk scores of 20 percent or more for major osteoporotic fracture. If you’ve had a bone density test (DEXA or DXA) and the T-score is abnormal, treatment may be needed at much lower scores. FRAX scores help you and your healthcare provider determine an appropriate clinical fracture prevention strategy and possible pharmacological treatment. While a FRAX score does not require a bone density test to calculate a risk, according to the USPSTF all women age 65 and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman should have a bone density test.

Do not despair, it is not all ‘sticks and stones’. There are things you can be doing right now to prevent or reduce your risks of osteoporosis. Recognizing the variety of conditions conferring risk of osteoporosis, the National Osteoporosis Foundation makes the following recommendations:

• Get the calcium and vitamin D you need every day (varies by age, check here).
• Do regular weight-bearing and muscle-strengthening exercises.
• Don’t smoke or drink too much alcohol.
• Talk to your healthcare provider about your risks for osteoporosis and ask when you should have a bone density test.
• Take an osteoporosis medication if/when it’s right for you.