What is Your FRAX Score?
Ever wonder why you are taking a medication to strengthen your bones? “Because my doctor told me so” is not a good reason. Many doctors have a knee-jerk reaction of prescribing medications based on a score from a bone density test. That type of treatment decision is called treating the numbers. It’s time to treat you, the individual, the person, the woman or man.
When Fosamax blasted onto the medication scene, the original intent of this new class of medications, the bisphosphonates, was to prevent osteoporotic fractures. But in 1997, the FDA approved the drug for the prevention of osteoporosis. This decision allowed the floodgates to open and profits to flood into the pharmaceutical company’s pocketbook. Not only were those with real osteoporosis candidates for the bisphosphonates; but also, anyone with osteopenia was eligible for these medications in an attempt to prevent osteoporosis.
The idea of taking a medication to prevent a disease is not necessarily a good treatment decision. For example, imagine taking chemotherapy drugs to prevent cancer. No way Chemotherapy drugs are way too risky to give to everybody in order to prevent cancer. Are bisphosphonate drugs too risky to give to all post-menopausal women who have mild osteopenia in order to prevent osteoporosis? Some say yes, some say no; as this controversy rages, the primary care doctor is left to treat the numbers of a bone density test at his or her discretion. Unfortunately, discretion is not always used.
In this over-medicated world, some women who may not need a bisphosphonate medication are placed on one for an indefinite period of time. That would not be a problem if medications had no risk, but these medications do have a risk of many types of side effects. Now is the time to find a method for discretion. Doctors need to carefully choose who needs a bisphosphonate and who does not by using the fracture risk assessment score-the FRAX.
Your bones may not be dense, but that does not make them fragile or at risk for osteoporotic fractures. And there is no reason to take a medication for your bones unless you are truly at risk for a fragile fracture. Hence, the World Health Organization developed the FRAX method for determining fracture risk. What is your risk?
Well, I just turned 40 years old and that is the lowest age for this risk assessment test. So, I gave the FRAX questionnaire a try. The questions are simple to answer and account for age, weight, fracture history, family history, smoking history, steroid use, co-morbid diseases, T-score and alcohol use. With all that information, the calculator gives you a percent chance of (probability of) fracture at the hip and spine in the next 10 years. My score is less than 1%. So even if I did have osteopenia based on a bone density test, I would not be a candidate for a bone medication. Sorry pharmaceutical companies, no money from me.
If your doctor recommends a bisphosphonate or alternative non-bisphosphonate medication, take the FRAX test because only those who are truly at risk for osteoporotic fractures and/or have real osteoporosis should be on these medications. The time for indiscretion and unnecessarily lining the pockets of drug companies is over. The bone density test numbers have no meaning without understanding you and your risk factors.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.