What FRAX (Fracture Risk Assessment Tool) score indicates the need for osteoporosis treatment?

From the Guidelines

A FRAX score that indicates a 10-year probability of major osteoporotic fracture ≥20% or hip fracture ≥3% generally calls for pharmacological treatment. This is based on the most recent and highest quality study available, which suggests that patients with a FRAX score above this threshold are at increased risk of osteoporotic fractures and may benefit from treatment 1.

Key Considerations

• The FRAX score is a useful tool for assessing the risk of osteoporotic fractures, and treatment decisions should be based on this score, as well as other risk factors, such as previous fragility fractures.
• The goal of treatment is to prevent fractures in individuals at significant risk before they experience bone density that meets the criteria for osteoporosis.
• Medications such as bisphosphonates (alendronate 70mg weekly, risedronate 35mg weekly, or zoledronic acid 5mg IV yearly), denosumab (60mg subcutaneously every 6 months), or other options like raloxifene, teriparatide, or romosozumab may be appropriate for individuals who meet the FRAX thresholds.
• Treatment decisions should also consider other factors, such as patient preference, potential adverse effects, quality of life considerations, adherence, safety, cost, and availability.

Evidence-Based Recommendations

• The American Society of Clinical Oncology (ASCO) recommends that patients with nonmetastatic cancer and osteoporosis (T scores of ≤-2.5 or less in the femoral neck, total hip, or lumbar spine) or those who are at increased risk of osteoporotic fractures based on clinical assessment or risk assessment tools (10-year probability of ≥20% for major osteoporotic fractures or ≥3% for hip fractures based on the US-adapted FRAX tool) be offered bone-modifying agents (BMAs) such as oral bisphosphonates, intravenous (IV) bisphosphonates, or subcutaneous denosumab at the osteoporosis-indicated dosage to reduce the risk of fracture 1.
• The choice of which BMA to offer should be based on several important considerations, including patient preference, potential adverse effects, quality of life considerations, adherence, safety, cost, and availability.

From the Research

Frax Score and Treatment

The Frax score is a tool used to assess the 10-year probability of a hip or major osteoporotic fracture in patients. According to the studies, the following Frax scores call for treatment:

• A 10-year risk score of ≥ 3% for hip fracture or ≥ 20% for major osteoporotic fracture 2 Treatment decisions should be individualized and based on a variety of factors, including underlying fracture risk, medical comorbidities, medication burden, as well as fracture risk reduction profiles, modes of administration, and side effects of treatment options 3.

Factors Influencing Treatment Decisions

Several factors influence treatment decisions, including:

• Underlying fracture risk (high vs very high risk) 3
• Medical comorbidities 3
• Medication burden 3
• Fracture risk reduction profiles 3
• Modes of administration 3
• Side effects of treatment options 3

Treatment Options

Available treatment options for osteoporosis include:

• Antiresorptive agents, such as bisphosphonates and denosumab 4, 5, 6
• Anabolic agents, such as teriparatide and romosozumab 4, 5 The choice of treatment should be based on a careful assessment of the risk:benefit profiles of these drugs in each patient 6.