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Bone Health
Published in Carolyn Torkelson, Catherine Marienau, Beyond Menopause, 2023
Carolyn Torkelson, Catherine Marienau
After you have your T-score, the next step is to determine your FRAX score, which estimates the probability of a fracture within the next 10 years (by use of a web-based calculator tool). The higher the FRAX score, the greater the risk of fracture. The FRAX score helps guide treatment decisions, specifically if medication is indicated.
Rehabilitation of the osteoporotic patient
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Theodoros H. Tosounidis, Amy Margot Lindh
In the United Kingdom, it is recommended practice to risk assess men older than 75 years and women over 65 years for their fracture risk (11,12). The FRAX tool, developed by the World Health Organization, can be used to calculate 10-year fracture risk of any osteoporotic fracture. For hip fracture, risk assessment is recommended for both sexes older than 50 years if one of the listed risk factors is present, which includes previous fragility fracture. Measurement of BMD is recommended for anyone who has a FRAX risk score that is in the region of an intervention threshold (“consider therapy” category). In postmenopausal women who have sustained a fragility fracture, there is little indication to perform a dual-energy x-ray absorptiometry (DEXA) scan, as at this stage their refracture risk is such that drug therapy is indicated without further investigation (12).
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Due to its popular use in clinical practice and its wide availability, FRAX is considered the de-facto standard in providing treatment advice on an individual basis. It is often incorporated on DXA reports, so that referring clinicians can use the assessment tool in consultation with their patients. To access a fracture probability the clinician needs to enter the hip BMD measurement in the relevant section. On completion of the information the clinician can select and calculate the predictive fracture probability of a major osteoporotic fracture and a hip fracture. This can then be used in conjunction with other patient details such as additional clinical risk factors to predict the patient’s possibility of sustaining a preventable osteoporotic fracture in the future.
Prevalence and influencing factors of spinal cord injury-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury: A cross-sectional, observational study
Published in The Journal of Spinal Cord Medicine, 2023
Kanyanat Mahitthiharn, Apichana Kovindha, Tawikar Kaewchur, Leslie R. Morse, Sintip Pattanakuhar
While fracture risk can be calculated with FRAX® without BMD values, our findings suggest that 7.8% of Thai participants are misclassified as low risk when BMD is not considered in the calculation. Our findings are consistent with Cervinka et al. who reported that adding BMD value to FRAX® calculation results in reclassification of risk in 20% of Canadians with SCI.12 We also found that reclassified participants tended to be male (75%) and were relatively older when compared with non-reclassified participants (48.4 vs 43.6 years). This result addresses the importance of investigating BMD and adding it for FRAX® calculation to avoid an underestimation of fracture risk in people with chronic SCI, especially those who are male and older than 45 years. However, further studies are needed to prove this hypothesis. In addition, the FRAX® score is not developed to be directly used to predict a fracture risk in people with SCI. FRAX® was developed to predict major fracture of the arm, spine, hip, or shoulder in individuals with post-menopausal osteoporosis, as well as drug-induced osteoporosis rather than SCI-related osteoporosis. This might result in an under expected performance of FRAX for predicting fragility fracture presented in this study.
Closing the gap in osteoporosis management: the critical role of primary care in bone health
Published in Current Medical Research and Opinion, 2023
Andrea J. Singer, Anita Sharma, Cynthia Deignan, Liesbeth Borgermans
Fracture risk prediction can be easily performed using online risk assessment tools such as the Fracture Risk Assessment Tool (FRAX), Garvan, American Bone Health (ABH) Fracture Risk Calculator™, and others to help identify patients at increased risk for fracture. These tools appear to perform well and are moderately accurate at predicting fracture risk within a specified time frame43,59. FRAX is the most widely used prediction tool and incorporates risk factors, including age, sex, BMI, fracture history, and others43 with or without BMD measurement, to predict absolute risk as a 10-year probability of major osteoporotic fracture (fracture of the hip, spine [clinical], wrist, or humerus) and hip fracture2,67 (Supplemental Figure 5 in Supplemental Material). Overall, FRAX and other online tools are meant to guide risk stratification, diagnosis, and treatment decisions; however, clinical judgement is important in determining whether or not to treat patients.
A pilot screening study for low bone mass in Singaporean women using years since menopause and BMI
Published in Climacteric, 2022
S. B. Ang, J. Y. Xia, S. J. Cheng, M. T. Chua, L. Goh, S. S. Dhaliwal
The FRAX® is an algorithm developed by the University of Sheffield Medical School for predicting the 10-year probability of hip fracture and major osteoporotic risk using data from multiple cohorts across Europe, North America and Japan, and validated within the same regions [9]. The FRAX® with or without BMD consists of multiple risk factors for osteoporosis, including age, sex, BMI, previous fracture, parental history of fracture, smoking, alcohol intake, use of glucocorticoids, history of rheumatoid arthritis and history of secondary osteoporosis [9]. The score is calculated using an online calculator [22]. It has been reported that the FRAX® major osteoporotic fracture probability (MOFP) has a sensitivity of 78.0% while the FRAX® hip fracture probability (HFP) has a sensitivity of 85.0% in detecting osteoporosis among postmenopausal Singaporean women [15].