FRAX RISK ACCURACY

[Daisi124]

Hi can anybody explain the Frax risk please. I am puzzled on how they come up with the percentage. They ask what your fermoral neck T-score is, in my case it is -2.7, they ask if you have had a fracture, in my case yes (spine). Various other questions on weight height and lifestyle. Once calculated they give the percent which is my case they say is 22% major fracture and 8% hip. I do not understand how they can make a risk assessment without knowing what sort of fracture you had and without knowing the T-score for your spine which in my case is -4.8. Also when assessing the risk do they take into account whether you are taking Osteo meds or not. I have done USA one and they both say the same thing.

[Met00]

I don't know how the FRAX assessment was worked out in the first place, but it was introduced because it was realised that bone density alone isn't a good predictor of future fractures. FRAX takes into account other risk factors, such as fragility fractures, a family history of osteoporosis, certain medical conditions and medications, smoking, excessive alcohol intake etc. It only really works for a population of people. For example, with your scores, what that means is that if 100 people had the same risk factors as you, 8 would fracture a hip in the next 10 years and 22 would have another major fracture. However, FRAX can't predict which 8 and which 22 will have these fractures, so it's been shown to be accurate in a population, but not for an individual. The other thing I like to remember is that you can turn the figures around - so if you have a 22% risk of fracturing, that means you have a 78% risk of not fracturing. On the balance of probabilities, you're unlikely to fracture in the next 10 years, but of course you might be one of the unlucky 22% who do.

I don't think FRAX takes into account whether or not you're on medication. Bisphosphonates reduce your fracture risk by about 50%. That means that if 22 out of 100 people would fracture without medication, 11 will still fracture, despite the medication. That's well explained here: nice.org.uk/guidance/ta464/...

[Daisi124 in reply to Met00]

Thanks me for a very informative reply, it is most helpful. We have spoken before so I will give you an update. I seem to be doing ok at the moment, my spinal fracture seems to have settled down and the pain is considerably less for the time being and I have started gentle walking again most days although I do not go out if it is raining. I am 8 weeks into AA with no obvious side effects so fingers crossed. I have a dental appointment on Monday I want her to assess a slightly loose tooth which I have had for a long time which plays up now and again. I mentioned it to my GP when he prescribed AA but he didn't think it would be an issue and told me to start on AA so I will have to see what she says. I am having trouble sourcing K2 on it's own and can only find one mixed with D3 and K1 it only gives 30% recommended daily allowance. Can you recommend a K2 only one? Thanks for all your help and I hope you are keeping well.

[Met00 in reply to Daisi124]

Good to hear that things are moving in the right direction for you. I'm in the UK so don't know what K2 is available in the US. I've just looked on Amazon.com and you can get Now Supplements and Doctor's Best, both are good brands that do K2-MK7.

[Daisi124 in reply to Met00]

Hi Met, I am in the UK too.

[Met00 in reply to Daisi124]

In that case, another one that comes recommended is Better You (in spray form). Or if you want something cheaper, ZipVit are a good company and do one.

[Daisi124 in reply to Met00]

Thanks Mets I will go and take a look.

[Mark_ABH]

Hi Daisi, American Bone Health developed a similar, scientifically validated risk assessment tool called the American Bone Health Fracture Risk Calculator™ for use by people in the U.S. (I see you are in the UK, so I wouldn't recommend you use it.) We have an FAQ page that might help you with your questions about FRAX: americanbonehealth.org/abou...

In regards to taking into account osteoporosis treatments, here's what it says:

This model is based on fracture rates in untreated women and does not account for osteoporosis treatment effects. Estimates of the fracture risk reduction from regular bisphosphonate therapy are in the order of 25–35%.5,6,10 Recently, Leslie et al11, on the basis of a large population study, conclude that “the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis.” In that study, bisphosphonate use did not substantially change the categorization of women in the population to low, medium, or high risk.

Knowing whether you have had a previous fracture is important because any fracture (besides skull, toes, and a few others) caused by low impact after age 45 predicts increased risk of fractures in the future. Spine fractures are particularly predictive; your risk of further spine fracture increases exponentially with each fracture.

Some perspective about those risk percentages: 8% risk of hip fracture might seem low, but the threshold to consider treatment is only 3%.

Treatment Guidelines

Based on the cost-effectiveness study, the National Osteoporosis Foundation has published treatment guidelines summarized below.

Consider pharmacological therapies based on:

A vertebral or hip fracture

A hip or spine T-score below -2.5

Low bone mineral density (BMD) and a FRAX 10-year risk at least 3% for hip or 20% of any of 4 fractures.

Patient’s preferences

[Daisi124 in reply to Mark_ABH]

Thanks Mark.

[Mahler02]

Here is a link to an open access 2020 paper in Archives of Osteoporosis about the limitations of FRAX: ncbi.nlm.nih.gov/pmc/articl...

"Another important limitation of FRAX, originally intended to identify high fracture risk, is the impact of prior fracture on the calculated absolute fracture risk. Clinicians know that whilst all fractures are important, not all fractures are equal; however, FRAX only accepts a binary input for previous fracture [12]."

My doctor made simple mathematical calculation to my FRAX score to take my spine, which is much worse than my hips, into account (I think it increased my risk by a certain percentage). He also warned that the FRAX is a single number and there are two factors, other than (1) quantity, to consider: (2) quality; and (3) rate of bone loss.

I had a series of blood tests, including CTx, which measures resorption. I will have to have a lateral spinal x-ray to check for vertebral compression fractures and next step is to calculate my TBS score.

Best wishes!