What is the clinical significance of a high Frax (Fracture Risk Assessment) score and how is it managed?

From the Guidelines

A high FRAX score indicates an elevated risk of osteoporotic fractures over the next 10 years, warranting intervention to prevent fractures. Management typically begins with lifestyle modifications including adequate calcium intake (1000-1200 mg daily), vitamin D supplementation (800-1000 IU daily), weight-bearing exercise, smoking cessation, and limiting alcohol consumption.

Key Considerations

• Pharmacological treatment is recommended when the 10-year probability of major osteoporotic fracture is ≥20% or hip fracture is ≥3% 1.
• First-line medications include bisphosphonates such as alendronate (70 mg weekly), risedronate (35 mg weekly), or zoledronic acid (5 mg IV annually).
• For patients who cannot tolerate bisphosphonates or have very high fracture risk, alternatives include denosumab (60 mg subcutaneously every 6 months), teriparatide or abaloparatide (daily subcutaneous injections for up to 2 years), or romosozumab (210 mg subcutaneously monthly for 12 months) 1.

Fall Prevention and Monitoring

• Fall prevention strategies are also crucial, including home safety assessment, balance training, and review of medications that might increase fall risk.
• Regular monitoring with bone mineral density testing every 1-2 years helps assess treatment response and guide ongoing management decisions.

FRAX Score Interpretation

• The FRAX score is used to estimate 10-year predicted absolute fracture risk, and it can be used with or without bone mineral density (BMD) values 1.
• A high FRAX score indicates a higher risk of osteoporotic fractures, and treatment should be tailored to individual risk factors.
• The ESCEO–IOF has recommended that individuals eligible for treatment be dichotomized into those at a ‘high risk’ and those at a ‘very high risk’ of fracture, with anabolic therapy recommended for those at very high risk 1.

From the FDA Drug Label

The text does not mention Frax score (Fracture Risk Assessment) directly.

The FDA drug label does not answer the question.

From the Research

Clinical Significance of a High Frax Score

A high Frax score indicates an increased risk of osteoporotic fractures, which can have significant clinical consequences, including pain, disability, and increased mortality 2, 3. The Frax score is a useful tool for identifying individuals at high risk of fracture and guiding treatment decisions.

Management of a High Frax Score

Management of a high Frax score typically involves a combination of non-pharmacological and pharmacological interventions. Non-pharmacological interventions include:

• Lifestyle modifications, such as regular exercise and a balanced diet
• Fall prevention strategies, such as removing tripping hazards and improving lighting Pharmacological interventions include:
• Bisphosphonates, which can reduce the risk of vertebral, nonvertebral, and hip fractures by 40-70% 4
• Denosumab, a RANKL inhibitor that can reduce the risk of vertebral, nonvertebral, and hip fractures
• Anabolic therapies, such as teriparatide, which can increase bone mineral density and reduce the risk of vertebral and clinical fractures

Limitations of the Frax Score

While the Frax score is a useful tool for assessing fracture risk, it has several limitations, including:

• It may not accurately predict fracture risk in individuals with certain medical conditions or taking certain medications
• It may not account for all risk factors for fracture, such as falls or poor balance
• It may not provide a complete picture of an individual's overall health and fracture risk 2, 5

Future Developments in Frax Score Management

Future developments in Frax score management may include:

• The use of new biomarkers or imaging techniques to improve the accuracy of fracture risk assessment
• The development of new pharmacological interventions that can more effectively reduce fracture risk
• The use of sequential treatment strategies, starting with a bone-building drug followed by an antiresorptive, to provide better long-term fracture prevention 4
• The incorporation of Frax scores into clinical guidelines and treatment algorithms to improve the management of osteoporosis and reduce fracture risk 3, 6