Fracture Risk Assessment

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Bone Densitometry (DEXA) Fracture Risk Assessment (FRAX)

The FRAX evaluation tool or fracture risk assessment was created by the World Health Organization to determine the patients who would benefit from medication to further prevent and treat bone loss to osteoporotic fracture. It is calculated from the bone densitometry value and clinical risk factors, family history, and medications that are associated with bone loss. In patients with established osteoporosis, the decision to treat to reduce fracture risk and improve bone mass is an easy one. However, in patients with osteopenia or low bone mass, the question of who and when to treat is a more difficult one.

Age and mineral bone density are major independent determinants of fracture risk. This means that low bone mass in a younger patient would not necessarily indicate treatment. However, the same bone mass in a patient who is 20-30 years older can indicate that a treatment intervention is necessary. The World Health Organization established a group to study fracture risk reporting. They used data from over 60,000 patients and 12 large observational studies in Europe, North America, Asia and Australia to identify the clinical risk factors that increase fracture risks. The committee then developed a statistical tool known as FRAX. FRAX is used to calculate the 10 year probability of an osteoporotic fracture occurring in an individual patient. Risk factors included in the FRAX questionnaire include a history of prior fracture, maternal history of hip fracture, current smoking or clinical steroid use, alcohol intake of more than 2 units daily or rheumatoid arthritis. The individual components of bone mineral density and clinical risk factors, along with population components related to the actual country of the patient being studied, are used to calculate the FRAX 10 year probability of fracture. This approach measures both the risks of major osteoporotic fractures in the hip, wrist or spine and the risk for hip fracture alone.

Here at Women First of Louisville, we calculate a fracture risk on all patients on all patients with low bone mass—also known as osteopenia. If a patients bone density study indicates osteoporosis, a FRAX is not clinically indicated because treatment will be initiated regardless of that value. Your clinician will be happy to discuss low bone mass and fracture risk with you. It has been clinically proven that interventions for low bone mass and osteoporosis decrease fractures and the health complications and problems related to them.

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