From the Guidelines
The FRAX score is a crucial clinical tool that predicts a patient's 10-year probability of experiencing a major osteoporotic fracture or hip fracture, and a score above 20% for major osteoporotic fracture or above 3% for hip fracture generally indicates the need for osteoporosis treatment. The FRAX score evaluates risk by analyzing clinical factors including age, sex, BMI, previous fractures, parental hip fracture history, smoking status, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, and alcohol consumption 1.
When a FRAX score suggests high risk, treatment typically includes bisphosphonates like alendronate (70mg weekly), risedronate (35mg weekly), or zoledronic acid (5mg IV yearly), or alternatives such as denosumab (60mg subcutaneously every 6 months) along with calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplementation 1. The FRAX tool is particularly valuable because it helps identify patients who would benefit from treatment even before they develop osteoporosis by bone density criteria alone, allowing for earlier intervention to prevent debilitating fractures.
Some key points to consider when using the FRAX score include:
- The score's ability to guide clinical decision-making about when to initiate treatment based on individualized fracture risk rather than relying solely on bone mineral density measurements 1
- The importance of adjusting the FRAX score for glucocorticoid use, with a correction factor of 1.15 for major osteoporotic fracture and 1.2 for hip fracture 1
- The use of multipliers specific to age, sex, and fracture site to modify FRAX probability, enabling the physician to accommodate the excess risk associated with recency and particular fracture types 1
Overall, the FRAX score is a significant clinical tool that helps predict a patient's 10-year probability of experiencing a major osteoporotic fracture or hip fracture, and its use can guide clinical decision-making about when to initiate treatment based on individualized fracture risk.
From the Research
Frax Score Significance
The Frax score is a significant tool in assessing the 10-year probability of major osteoporotic fractures, including hip and vertebral fractures, in men and women aged 40 and over 2, 3, 4. The score is calculated based on clinical risk factors, such as prior fractures, parental hip fracture history, age, gender, body mass index, ethnicity, smoking, alcohol use, glucocorticoid use, and rheumatoid arthritis, as well as bone mineral density measurements 2, 4.
Key Findings
- The Frax score has been shown to be a useful tool in identifying individuals at increased risk for osteoporotic fractures, with a 10-year probability of hip fracture of 3% or greater, or a 10-year probability of major osteoporotic fracture of 20% or greater, being considered elevated 2, 3, 4.
- Studies have demonstrated that the Frax score is strongly predictive of overall fracture risk, with a mean sensitivity of 10.25% and specificity of 97.02% for major osteoporotic fractures, and a mean sensitivity of 45.70% and specificity of 84.70% for hip fractures 5.
- The Frax score has limitations, including the fact that it may not capture all relevant risk factors, such as frequent falls, and may not be applicable to all populations, such as those with secondary osteoporosis 2, 4.
- A hybrid system that combines femoral neck and lumbar spine bone density measurements has been shown to improve fracture risk prediction, particularly in cases where there is spine-hip discordance 6.
Clinical Applications
- The Frax score can be used to guide treatment decisions, with individuals having a Frax score above the treatment threshold being considered candidates for pharmacological therapy for osteoporosis 2, 4.
- The Frax score can also be used to monitor the effectiveness of treatment and to adjust treatment plans as needed 4.
- Clinicians should be aware of the limitations of the Frax score and use clinical judgment when interpreting the results, taking into account additional risk factors and individual patient characteristics 2, 4.