Who Should Have a Frax Score?

According to the Bone Health and Osteoporosis Foundation, up to one in two women and one in four men over 50 will break a bone due to osteoporosis in their lifetime. This makes understanding fracture risk crucial, and determining who should have a FRAX score is a key part of that process. A FRAX score helps healthcare providers estimate a person's 10-year probability of a major osteoporotic fracture, guiding crucial decisions about screening and treatment.

Quick Summary

Healthcare providers use the FRAX tool to estimate a person's 10-year risk of major osteoporotic fracture. It is recommended for postmenopausal women and men aged 50 and older with certain risk factors, or for those with low bone density (osteopenia) who have not yet received treatment. The score helps determine the need for further testing and intervention to prevent fractures.

Key Points

• Target Population: Postmenopausal women and men aged 50 and older are the primary candidates for a FRAX score, especially those with osteopenia.

• Inclusion Criteria: A FRAX score is used for individuals who have not yet started treatment for osteoporosis.

• Comprehensive Assessment: The FRAX tool combines clinical risk factors (age, previous fracture, parental history, smoking, alcohol use, etc.) with or without bone mineral density (BMD) data.

• Guiding Treatment Decisions: The score helps clinicians determine if further investigation (like a DXA scan) or pharmacologic treatment is needed for high-risk individuals.

• Key Limitations: The tool has limitations, including not accounting for the number of prior fractures, specific glucocorticoid dosage, or falls risk.

• Score Interpretation: A 10-year risk of major osteoporotic fracture >=20% or hip fracture >=3% often indicates a need for treatment.

Understanding the FRAX Tool

The Fracture Risk Assessment Tool (FRAX) is a World Health Organization (WHO) developed algorithm to predict a patient's 10-year probability of hip or major osteoporotic fracture. It combines clinical risk factors, with or without bone mineral density (BMD) from a DXA scan, to estimate risk and guide decisions on lifestyle, testing, or treatment.

Key Populations for a FRAX Score

Guidelines, such as those from the National Osteoporosis Foundation, recommend who should have a FRAX score calculated. The primary groups are adults aged 50 and older who have not begun osteoporosis treatment.

Postmenopausal Women and Men 50 and Older

This demographic is highly recommended for FRAX assessment due to increased fracture risk with age. A score can be calculated with clinical factors alone, but including a recent bone density scan improves accuracy.

Individuals with Low Bone Density (Osteopenia)

FRAX is especially helpful for people over 50 with osteopenia (low bone mass not meeting osteoporosis criteria). It helps identify those who may benefit from treatment by considering other risk factors alongside low BMD.

Patients with Secondary Causes of Osteoporosis

FRAX can account for conditions and medications that increase fracture risk (secondary osteoporosis), such as rheumatoid arthritis, long-term steroid use, untreated hypogonadism, or gastrointestinal malabsorption.

Factors Used in a FRAX Calculation

The FRAX tool utilizes various factors to personalize risk assessment. These include: age (40-90), sex, BMI, prior fracture, parental history (hip fracture), smoking status, alcohol intake (three+ units daily), secondary osteoporosis, glucocorticoid use, and optionally, femoral neck BMD.

FRAX vs. Bone Density (DXA) Scan

FRAX and DXA scans are complementary tools for assessing fracture risk. While FRAX can be used without BMD, its accuracy is improved with it. For a detailed comparison, see {Link: PubMed Central https://pmc.ncbi.nlm.nih.gov/articles/PMC2827823/}.

When is a FRAX Score Not Recommended?

FRAX is not suitable for everyone. It is not recommended for individuals under 40, those already on osteoporosis medication, patients with severe osteoporosis (T-score \<= -2.5), those with a recent fracture (within 2 years), or individuals with a high risk of falling, as FRAX does not account for fall frequency.

Conclusion

The FRAX score is a valuable tool for assessing 10-year fracture risk, particularly for individuals aged 50 and older, especially those with osteopenia. By incorporating personal risk factors and potentially BMD, it aids healthcare providers in identifying individuals who may benefit from further testing or treatment to prevent osteoporotic fractures. Anyone in the recommended age group or with relevant risk factors should discuss FRAX with their doctor. For more information on bone health and osteoporosis, consult the official website for the World Health Organization (WHO) FRAX tool.

How to Interpret Your FRAX Score

Your healthcare provider will interpret your FRAX score using guidelines. In the U.S., a 10-year probability of major osteoporotic fracture >=20% or hip fracture >=3% often suggests treatment is necessary. Your doctor will discuss these results to create a plan.

Frequently Asked Questions

What is the primary purpose of a FRAX score?

The primary purpose of a FRAX score is to estimate a person's 10-year probability of suffering a major osteoporotic fracture, which helps guide a healthcare provider's decisions regarding further testing and treatment.

Does a FRAX score replace a bone density (DXA) scan?

No, a FRAX score does not replace a DXA scan. It is a complementary tool that can incorporate DXA scan results for greater accuracy, and it is particularly useful for assessing risk in individuals with low bone mass (osteopenia).

At what age should people consider getting a FRAX score?

The FRAX tool is validated for use in men and women between the ages of 40 and 90, but it is most commonly recommended for postmenopausal women and men aged 50 and older.

Can I use the FRAX tool if I am already on osteoporosis medication?

No, the FRAX tool is not intended for use in patients who are currently receiving or have previously received pharmacologic treatment for osteoporosis. It is only validated for treatment-naïve individuals.

What information is needed to calculate a FRAX score?

The calculation requires inputs for age, sex, weight, height, previous fractures, parental hip fracture history, smoking status, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, and alcohol consumption. It can also include femoral neck BMD.

What is considered a high FRAX score?

While thresholds vary, a high FRAX score that may warrant treatment is often considered a 10-year probability of a major osteoporotic fracture of 20% or greater, or a 10-year hip fracture probability of 3% or greater.

How often should a FRAX score be reassessed?

The reassessment interval depends on the initial score and clinical judgment, but studies show a need to reassess fracture risk over time, especially for patients with scores below the treatment threshold.