Osteoporosis Risk Assessment
FRAX: World Health Organization's Tool to Assess Risk for Fractures
Sep 18, 2008
All adults lose bone mass as they age. For some, this loss results in thin, fragile bones prone to fractures, the most serious of which is a fractured hip. According to Prevention and Management of Osteoporosis, a 2003 report published by the World Health Organization, hip fractures kill one out of every five victims, and leave another fifty percent permanently disabled.
FRAX, an Osteoporosis Risk Assessment Tool is Free and On-line
To help doctors determine a patient's risk for hip fractures and other bone breaks, the World Health Organization released an on-line, trademarked assessment tool called FRAX, in February of 2008. The FRAX calculator is simple, free, and can be used by anyone.
FRAX is Adjusted for Risk Factor by Country of Origin
To calculate the probability of suffering a fracture caused by low bone density, the user must choose a country of origin. Currently only a handful of countries are listed, but the FRAX instructions recommend picking a country with risk factors similar to the patient’s home country. In the model the USA and Sweden represent countries with high risk factors, France, Spain, China and Japan represent countries with moderate risk factors, and Turkey represents countries with a low risk factors.
Answer FRAX Questions Related to Risk Factors
After choosing a country, the user must answer twelve questions. Seven of the questions require only a yes or no answer, for example:
- Previous fractures?
- Currrently smoking?
- Parental Hip Fracture?
T-score or Z-Score is Required
The remaining 5 questions ask for the patient’s age, height, weight, gender, and femoral neck bone density, expressed as either a T-score or Z-score. (The T or Z score is obtained from a bone mass densitometry report.) When all the information is entered, the user clicks “calculate,” and two numbers appear. The first number gives a ten-year probability for any bone fracture, and the second number gives the probability for a hip fracture in the next ten years. Both numbers are expressed as percentages.
FRAX for Decision Making
Based on the FRAX results, patients and doctors can make better decisions about whether or not to begin treatment options such as hormone replacement therapy or bisphosphonate products like Foxamax or Boniva. People with osteoporosis are routinely offered these treatment options, but for patients with low bone density but not osteoporosis, the risks and treatment options were less clear until FRAX.
When to Consider Preventative Treatment for Patients with Low Bone Density?
The US National Osteoporosis Foundation recommends offering treatment choices to anyone with low bone density (also called osteopenia) whose FRAX score for hip fractures is 3% or greater, or whose risk for other bone fractures is greater than 20%.
Treatments for bone loss have risks and side effects. The decision to delay or begin these treatments is easier now with a FRAX score.
 |
