For many who take the diligent step of undergoing a bone densitometry scan to learn about the status of their bone health, the test can provide answers - and more questions. For a T-score greater than -2.5, which is considered a diagnosis of osteoporosis, the consensus among most doctors is that treatment is necessary. But for a vast number of women and men diagnosed with osteopenia, or diminished bone mass defined as a T-score of -1 to -2.5, the ideal course of action can be less well defined.
Osteopenia and Fracture Risk
Osteopenia is a serious condition, which if left untreated can result in further bone loss. Of even greater concern is that more than half of fractures occur in individuals with osteopenia rather than full-fledged osteoporosis. Yet prescription osteoporosis medication can be expensive, onerous to take, and have unpleasant or even painful side effects.
The most commonly prescribed drugs, bisphosphonates such as Fosamax, Boniva and Actonel, require remaining upright for at least half an hour after taking the medication, and have been associated with gastrointestinal discomfort such as heartburn or difficulty swallowing.
To Treat Osteopenia, What's the Best Choice?
Many individuals who have osteopenia do not go on to experience further bone loss or a related fracture, even without treatment. If the risk of breaking a bone is considered minute, taking drugs to increase bone mass may be unnecessary; a healthy lifestyle with adequate consumption of calcium and Vitamin D may be sufficient instead. But how do we know if this is indeed the case?
In the past, determining the right treatment plan for those in the gray area - an estimated 30 million individuals are believe to have osteopenia nationwide - depended on a doctor's subjective judgment after weighing the T-score along with other known risk factors for the disease, such as family history, a sedentary routine, smoking, excessive alcohol intake and other medical conditions known to affect bone health. But now physicians have access to a powerful new tool to assist in making the best call for a particular patient.
The FRAX Algorithm and Fracture Risk
FRAX is an algorithm developed by the World Health Organization to determine absolute fracture risk, or the probability that a given person will suffer a hip or other major osteoporosis-related fracture (in the vertebra, hip, forearm or upper arm) during the next 10 years. It incorporates data on thousands of people from around the world to calculate the chance of breaking a bone based on the T-score combined with other known factors that can contribute to osteoporosis. A health professional can then use this tool to make a more informed recommendation than would be possible with just the results of a bone densitometry test, commonly known as a DXA scan.
FRAX is a tool that "allows us to talk to patients about their risk... who needs treatment beyond the universal recommendations of calcium, Vitamin D and exercise," says Dr. Ethel S. Siris, an endocrinologist who serves as a president of the National Osteoporosis Foundation.