What is the fracture risk assessment scale for long-term care patients?

From the Guidelines

The most appropriate fracture risk scale for long-term care patients is the FRAX tool, which should be used in conjunction with clinical judgment to assess fracture risk and guide treatment decisions. The FRAX tool is a widely accepted and validated instrument for assessing fracture risk in adults, and it takes into account various risk factors, including age, gender, previous fractures, and glucocorticoid use 1.

Key Considerations for Fracture Risk Assessment

• The FRAX tool should be used to estimate the 10-year risk of major osteoporotic fracture and hip fracture in adults aged 40 years and older 1.
• For patients receiving glucocorticoids at a dose of ≥7.5 mg/day, the fracture risk generated by FRAX should be increased by a relative 15% for major osteoporotic fracture and 20% for hip fracture risk 1.
• The FRAX tool has limitations, including the fact that it estimates the risk associated with moderate-dose prednisone (2.5–7.5 mg/day) and may not accurately estimate the risk associated with very high-dose glucocorticoid use 1.

Clinical Application of Fracture Risk Assessment

• Healthcare providers should complete all sections of the FRAX assessment, focusing particularly on fall history, transfer ability, and wandering behaviors, which are strong predictors of fracture risk.
• Patients should be categorized into low, moderate, and high-risk groups based on their FRAX scores, with higher scores indicating greater fracture risk.
• For high-risk patients, interventions should include fall prevention strategies, environmental modifications, hip protectors, calcium and vitamin D supplementation, and consideration of osteoporosis medications when appropriate.

Regular Reassessment and Monitoring

• Regular reassessment of fracture risk is recommended every 6-12 months or after significant health status changes 1.
• The FRAX tool should be used in conjunction with clinical judgment to guide treatment decisions and monitor the effectiveness of interventions.

From the Research

Fracture Risk Scale for Long-Term Care Patients

• The Fracture Risk Scale (FRS) is a tool used to assess the risk of fractures in long-term care patients 2.
• A study published in the Journal of the American Medical Directors Association developed a fracture risk Clinical Assessment Protocol (CAP) for long-term care patients, which includes an embedded fracture risk assessment tool 2.
• The CAP was developed using a modified Delphi consensus process, which involved a national panel of experts in osteoporosis, fractures, and long-term care 2.
• The study found that the FRS can be used to guide fracture prevention in long-term care patients, and that it is essential to consider multiple criteria, including life expectancy, when making medication decisions 2.

Assessment of Fracture Risk

• The Fracture Risk Assessment Tool (FRAX) is a widely used tool to assess fracture risk in older adults 3.
• A prospective study published in the Journal of Nutrition, Health & Aging found that FRAX can effectively differentiate fracture risk in long-term care residents, and that it is essential to screen for fracture risk and osteoporosis in this population 3.
• The study found that a significant proportion of long-term care residents are at high risk of fractures, and that osteoporosis is often underdiagnosed and undertreated in this population 3.

Treatment and Prevention of Osteoporosis

• Bisphosphonates, such as alendronate and risedronate, are effective agents for the treatment and prevention of osteoporosis 4, 5.
• A study published in Osteoporosis International found that transitioning from alendronate or risedronate to other therapies, such as zoledronic acid, strontium ranelate, denosumab, or teriparatide, can be effective in maintaining or increasing bone mineral density 6.
• However, the study noted that further long-term studies are needed to assess the efficacy of transitioning therapies in preventing fractures 6.