Common Questions
Is there any indication to start medication in an individual who has osteopenia as defined by a BMD T score that is higher than -2.5 but less than -1.0?
Although an individual may not meet the BMD criteria for osteoporosis, more information needs to be obtained to determine fracture risk. BMD is only one factor that determines an individual's risk for a fracture. They may be a candidate for medication if they have risk factors that put them at high risk for a fracture. Approximately 50% of fractures occur in individuals with bone density that does not meet the criteria for osteoporosis.
The World Health Organization (WHO) has developed a Fracture Risk Assessment Tool called FRAX™ to predict the ten-year risk of both hip and major osteoporotic fractures in men and women (1). The algorithm is constructed from population cohorts from Europe, North America, Asia, and Australia. Clinicians can now determine if it would be cost effective to initiate osteoporosis treatment, especially in individuals who do not meet criteria for osteoporosis by BMD alone. In the past, fracture risk tools have only been valid for white post-menopausal women. This new tool can be used for both men and women over age 40 with different ethnic backgrounds. It also calculates fracture risk without using the BMD which is particularly useful in areas where obtaining a DEXA is not feasible.
This tool is highly recommended for use in clinical decision making by both the International Osteoporosis Foundation and the National Osteoporosis Foundation.
- Kanis JA, Johnell O, Oden A et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis Intl 2008; 19(4): 385-97, Epub 2008 Feb 22.