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FRAX®: a Tool for Estimating Your Fracture Risk

Postmenopausal osteoporosis is a skeletal disorder in which bone strength has weakened to a point that bone is fragile and at higher risk of fracture. Women undergo a rapid bone loss around the time of menopause due to hormonal changes. This bone loss slows down during the postmenopausal years, but does not stop completely. One in two women over age 50 will have an osteoporosis-related fracture in her lifetime.

Now there is a new Fracture Risk Assessment Tool (FRAX®) for evaluating fracture risk. FRAX was developed by the World Health Organization to evaluate a patient’s 10-year probability of hip fracture and major osteoporotic fracture (clinical spine, forearm, hip, or shoulder fracture). Previously, clinicians could only estimate a 5-year fracture risk.

The assessment is available online. Choose Calculation Tool and select the appropriate category. Please
note that it is valid only for post-menopausal women age 40 and older who are not currently taking a prescription medication for osteoporosis.

The FRAX® assessment includes questions about:

  • age
  • smoking
  • family history of hip fracture
  • glucocorticoid use (eg, Prednisone)
  • arthritis
  • femoral neck bone mineral density (BMD; femoral neck BMD measures the part of the thigh bone that connects to the hip joint)

Taking multiple risk factors into account allows the FRAX formula to make a better estimate of risk for fracture than past methods. In the near future, these results will be incorporated into the standard bone density test results.

There are also several preventive steps women can take to avoid osteoporosis and resulting fractures or to keep osteoporosis from worsening.

Recommendations include:

  • Eat a balanced diet high in fruits, vegetables, calcium, and vitamins.
  • Get enough calcium. The recommended total intake of is 1,200 mg daily; for best absorption, if taking supplements, divide doses into 250-500 mg doses throughout the day. Of the two types of calcium, calcium carbonate is best absorbed when taken with food but calcium citrate can be taken on an empty stomach.
  • Get enough vitamin D. NAMS and the National Osteoporosis Foundation recommend at least 800-1,000 IU per day for women age 50 and over who are at risk of vitamin D deficiency. Vitamin D deficiency can be caused by inadequate sun exposure (for example, those who live in northern latitudes).
  • Avoid alcohol and smoking. Heavy alcohol intake (more than 7 drinks per week) increases the risk of falls and hip fracture and women smokers tend to lose bone more rapidly and have lower bone mass than nonsmokers. Stopping smoking is one of the most important changes women can make to improve their health and decrease risk for disease.
  • Be physically active every day. Weight-bearing exercise (for example, fast walking, hiking, jogging, and weight training) may strengthen bones or slow the rate of bone loss that comes with aging. Balancing and muscle-strengthening exercises can reduce the risk of falling and fracture.
  • Consider therapeutic medications. Currently, several types of effective drugs are available. Healthcare providers can recommend the type most appropriate for each woman.
  • Eliminate environmental factors that may contribute to accidents. Falls cause nearly 90% of all osteoporotic fractures, so reducing this risk is an important bone-health strategy. Measures include ample lighting, removing obstructions to walking, using nonskid rugs on floors, and placing mats and/or grab bars in showers.
  • Be aware of medication side effects. Some common medicines make bones weaker. These include a type of steroid drug called glucocorticoids used for arthritis and asthma, some antiseizure drugs, certain sleeping pills, treatments for endometriosis, and some cancer drugs. An overactive thyroid gland or using too much thyroid hormone for an underactive thyroid can also be a problem. If you are taking these medicines, talk to your doctor about what you can do to help protect your bones.

Visit the National Osteoporosis Foundation.

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