ICE/ENDO 2014: 16th International Congress of Endocrinology and The Endocrine Society's 96th Annual Meeting:

FRAX® and Clinical Risk Factors

Steven Wai Ing, MD, MSCE presented Risk Assessment for Osteoporosis: Beyond DEXA during a Meet-The-Professor session held at The Endocrine Society’s Annual Meeting held in Chicago. Dr. Ing is Assistant Professor in the Division of Endocrinology, Diabetes and Metabolism at The Ohio State University, Wexner Medical Center.

Fracture risk assessment is important for clinicians to identify in patients at high risk for fracture for pharmacological treatment. The FRAX® tool has been available since 2008. The World Health Organization(WHO) derived clinical risk factors from data obtained from nine prospective cohort studies (ie, Asia, Australia, Europe, North America). There were more than 46,000 participants, almost 200,000 person-year time exposure with 850 hip fractures and more than 3,000 other osteoporotic fractures.  

In addition to age and sex, clinical risk factors include:

  • Body mass index
  • Personal history of fragility and fracture
  • Parental history of hip fracture
  • Current cigarette smoking
  • Corticosteroid overuse
  • Alcohol use
  • Rheumatoid arthritis

Dr. Ing pointed out that it has been known for a long time that bone density is a risk factor for fracture, and it means something different if the patient is young versus old. Considering women, “At age 50, if the patient’s T-score of -1 declines to a -2, her risk for a hip fracture increases four-fold. In contrast, if the patient is an 85-year-old woman whose T-score of -1 declines to -2 her risk for hip fracture is only two-fold,” stated Dr. Ing. However, Dr. Ing added that these risks are relative, not absolute risks. Clinicians know that an 85-year-old patient’s absolute risk for a fracture is much higher than the absolute risk for a 50-year-old woman.

FRAX Limitations
FRAX does not incorporate all the known risk factors in its algorithm. It does not include:

  • Falls
  • Diabetes; although type 1 diabetes is included as a secondary cause of fracture
  • Chronic kidney disease
  • Family history of non-hip fragility fractures  

Therefore, it is important for the clinical to apply their experience to the individual patient and the cost and efficacy of treatment.

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