FRAX for Fracture Risk and Choosing Treatments for Osteopenia

Health Professional

Reader's Question:** I am 56 years old and was recently diagnosed with osteopenia of my hip with a T score of -1.7. My spine was normal. My doctor recommended treatment with medication. Should I start this?**

In the past, the answer to this questions -- how and whether to treat osteopenia -- was not clear. There were previous recommendations to treat this condition at this bone density reading, if osteopenia was present 'with risk factors." However, this recommendation was unclear as many women, especially younger ones, would have a low risk for a fracture of this region and would likely be able to withhold therapy for a few years.

Updated Guidelines for Osteopenia

Recently the National Osteoporosis Foundation (NOF) released its updated guidelines on therapy for osteopenia. The answer to this question may now be clarified.

The information in this guide is based on the long awaited World Health Organization (WHO) algorithm (FRAX ®). This algorithm estimates the likelihood for a person to break a hip or other major bone due to low bone mass or osteoporosis over a period of 10 years. This will, hopefully, considerably change the way we evaluate and treat patients, both men and women, who may be at risk for fractures from osteopenia (low bone mass) or osteoporosis.

What is this formula (FRAX)?

The formula was created using patients not previously treated, and using data from a patient's bone density at the femoral neck (hip region) and evaluating risk factors, age and ethnicity. Putting all this information together, it can be estimated what the patient's risk of fracture will be in the next 10 years. Using the cut off value over 10 years of a ≥ 3% risk of fracture of the hip and ≥ 20% risk of any major osteoporosis related fracture, we can now make a more educated decision regarding therapy.

This formula, since it takes into account specific risk factors, as well as the ethnic background of the patient and the patient's age, makes it a much better estimate of risk. In the past, there was a significant lack of clarity in the decision process as it did not make sense treating all of the patients the same way based on their bone density results. We now have the tools to better evaluate the situation and decide whether to postpone or start treatment with medication.

Using the FRAX Formula

The formula is currently available on the internet at:

However, due to the complexity and time involved to calculate every individual's risk, it is unlikely that your physician will be using this on a regular basis any time soon. Luckily, these formulas are being developed to be placed into the Bone Density (DXA) software and will be calculated automatically at your bone density study in the near future.

As always, guides and algorithms are only part of the evaluation process. One must contact their physician or osteoporosis expert to fully evaluate the need for therapy.