From the Guidelines
Treatment for osteoporosis based on FRAX score is typically recommended when the 10-year probability of a major osteoporotic fracture is ≥20% or the 10-year probability of hip fracture is ≥3%. These thresholds are based on the most recent guidelines, including the 2022 update from the American College of Radiology 1. The FRAX tool is a widely accepted method for assessing fracture risk, taking into account factors such as hip BMD, age, sex, height, weight, family history of hip fracture, smoking, steroid use, rheumatoid arthritis, and alcohol use.
- Key factors influencing treatment decisions include:
- Bone mineral density (BMD) measurements, with T-scores ≤ -2.5 indicating osteoporosis
- Age, with older patients generally being at higher risk of fractures
- Previous fractures, which can significantly increase the risk of future fractures
- Other clinical factors, such as family history, smoking, and steroid use
- First-line medications for osteoporosis treatment include oral bisphosphonates, such as alendronate (70mg weekly), risedronate (35mg weekly), or ibandronate (150mg monthly) 1. For patients who cannot tolerate oral bisphosphonates, alternatives include denosumab (60mg subcutaneously every 6 months), zoledronic acid (5mg IV yearly), or teriparatide (20mcg subcutaneously daily for up to 2 years).
- It's essential to note that the FRAX score is just one tool used in assessing fracture risk, and treatment decisions should be individualized based on a comprehensive evaluation of each patient's risk factors and clinical profile, as recommended by the National Osteoporosis Foundation (NOF) 1.
From the Research
Frax Score on Dexa for Treatment
The Fracture Risk Assessment Tool (FRAX) is used to determine the 10-year probability of major osteoporotic fracture and hip fracture in men and women. According to the studies, the following FRAX scores on Dexa call for treatment:
- A 10-year probability of hip fracture ≥3% 2, 3, 4, 5
- A 10-year probability of major osteoporotic fracture ≥20% 2, 3, 4
Factors Influencing Frax Score
The FRAX score is influenced by several clinical risk factors, including:
- Femoral neck bone mineral density
- Prior fractures
- Parental hip fracture history
- Age
- Gender
- Body mass index
- Ethnicity
- Smoking
- Alcohol use
- Glucocorticoid use
- Rheumatoid arthritis
- Secondary osteoporosis 2, 3
Treatment Thresholds
The National Osteoporosis Foundation recommends treating patients with FRAX 10-year risk scores of ≥3% for hip fracture or ≥20% for major osteoporotic fracture 2, 3. These treatment thresholds are used to identify patients who will benefit from osteoporosis therapy 6.
Diagnostic Accuracy of Frax
The diagnostic accuracy of FRAX in predicting the 10-year risk of osteoporotic fractures has been evaluated in several studies. The results show that FRAX performs better in identifying patients who will not have a fracture within 10 years than those who will 4. The sensitivity, specificity, and diagnostic odds ratio of FRAX vary depending on the population and the fracture type being predicted 4.
Prevalence of Elevated Frax Probabilities
The prevalence of elevated FRAX probabilities (≥3% for hip fracture and ≥20% for major osteoporotic fracture) varies by age, sex, and race/Hispanic origin 5. An estimated 19% of adults aged 50 and over have an elevated hip fracture probability, and 8% have an elevated major osteoporotic fracture probability 5.