Confused about FRAX scores

[Grandk23sc]

As I review fracture score I'm confused.

Original dexascan from 2016 prior to treatment states My 10 year fracture risk assessment for major osteoporotic fracture: 9.6%. Hip fracture 1.8%.

2022 dexascan after 7 doses of Prolia My 10 year fracture risk assessment: 12% for major osteoporotic fracture and 2.7% for hip fracture. The BMD has improved .

I'm confused as to the increase in spite of the treatment with Prolia the BMD is improved but shouldnt the Fracture risk assessment be going down?

I also see that the reference for T-scores are based on the NHANES reference values for women aged 20-29 years. How can this be?

Thanks.

[Met00]

The FRAX risk assessment takes into account a variety of factors, including things like fractures (have you had any since 2016?), certain medications and health conditions (any changes since 2016?), age and BMI. I think fracture risk increases with age, but, if your bone density has improved, you would expect one to offset the other. Has your neck of femur bone density improved in that time, as that's the measurement they use in FRAX? You could run your own FRAX calculation to check for yourself, in fact you could do it with the relevant data for both 2016 and 2022. Here's the link: frax.shef.ac.uk/frax/. Click on Calculation Tool at the top, choose your country and go from there.

[Grandk23sc in reply to Met00]

Thanks! I haven't had any fractures or any other changes since the first scan but the frax score was calculated without taking medication into account!

[yogalibrarian in reply to Grandk23sc]

I don't think that osteoporosis medication vector is in FRAX 1. I hope it will be in FRAX 2 when it becomes widely available.

The medication vector is in American Bone Health's calculator.

I'm not sure that technicians always understand the nuances of FRAX, ask the right questions, or probe enough on the answers they get. For example parental hip fracture makes a big difference in the calculation.

[FrogLeg in reply to yogalibrarian]

Is FRAX 2 any different than FRAXplus? Thanks!

[yogalibrarian in reply to FrogLeg]

It's the same. I just depends on which document you look at.

[yogalibrarian]

Bone density is only one of a large number of factors that contributes to fracture risk. Age is one of the other the big ones. For example, in general, your fracture risk increases as you age.

The research has shown that taking an osteoporosis medicine can lower your fracture risk 30–70%. (If you use the American Bone Health (BHOF) Fracture Risk Calculator that info will appear in the fracture risk results.)

How much of a decrease in fracture risk also depends on a number of factors. (Which medication, dosage and duration, your other risk factors, etc.) That makes it far too complex to calculate a specific decrease in the FRAX or FRC.

So I think most calculators give you your risk score based on their general criteria but add a note about reduced risk in the results for someone taking one of the meds.

A clinician who has a lot of experience with risk calculators can probably give you a better estimate.

Congratulations on taking the osteoporosis medication and increasing your bone density and lowering your fracture risk.

P.S. T-scores are calculated against "peak bone mass" -- the bone mass at age 30. So you can think of your T-score after about age 45 as a statistical calculation of your decrease in your all-time high.

[Grandk23sc in reply to yogalibrarian]

Thank you- FYI The flax score is calulated before treatment- per my endocrinologist. " As you are older, that risk increases (even if the bone density might be better). However, what we know from the research of these agents is that your fracture risk is actually lowered by around 60% or so when there is treatment with Prolia. "

[Grandk23sc in reply to yogalibrarian]

Thank you for the information.. It really helps to understand the intricacies of this condition and the treatment. The radiologist who did the frax score did not take medication into the calculation so I have learned to clarify everything.

[RubymyT]

Grandk,

I'm glad you wrote this, I have no idea what my Frax score is , but I have just become aware of the side effects . Please don't stop suddenly using it. Not good.

I am wondering if you have any side effects.

I have unbelievable muscle and leg and foot pain after first dose, its bad enough that it's really cut down the amount of walking I can do. Had second doe and now have pretty bad jaw pain too. So I know the side effects are real. I was never told about them , were you ?

When I became aware of the reasons not to discontinue , that really freaked me out. Doctors aren't even aware of them, at least mine wasn't ,it actually caused an argument. I suppose since you're not able to walk , you are taking less of a chance falling.

If you aren't satisfied with your results ask about them. I am going to insist on seeing a rheumatologist . I had a doctor once that at one time was a coroner , he told me if you want to know ANYTHING about medications , don't ask your doctor , ask a pharmacist.

Maybe your meds aren't doing what their supposed to

Good Luck , keep us up to date.

Arla

[Grandk23sc]

Thank you! Ive learned a lot from the members of this group. I do have side effects but they are manageable and I have resigned myself that they are a necessary evil. Joint pain and back pain are the constant and do my best to work through them. I find keeping active, in spite of the discomfort ,is the key for me. These side effects were never discussed in depth but I recognize that all medications have side effects. I believe the Prolia is working and I have another 4 doses before the Dr. will consider discontinuing it. I wish you health! C