Common Questions
What absolute 10-year risk of a hip fracture or a major osteoporotic fracture should you consider osteoporosis treatment?
It is important to discuss treatment options when an individual has ≥ 3% 10-year risk of hip fracture or ≥ 20% 10-year risk of a major osteoporotic fracture.
A US specific cost-effectiveness analysis found that an absolute 3% 10-year risk of hip fracture or a 20% 10-year risk of any major osteoporosis related fracture was generally required for osteoporosis treatment to be cost effective (1). This study included the cost and health consequences of clinical fractures of the hip, spine, forearm, shoulder, rib, pelvis and lower leg and was done for cohorts as defined by age, sex, and race/ethnicity. It assumed a cost of $600/yr for 5 years and a 35% fracture reduction using a bisphosphonate.
The decision to treat should always be individualized and other risk factors that are not included in the FRAX™ algorithm should also be taken into account when counseling a patient. For example, muscle strength, gait, balance, and other factors influence fall risk. However, fall risk is not used in the model but is a very important factor that would influence the decision to treat. Once all available information has been considered, shared decision making between the physician and patient regarding treatment can be made.
- Tosteson ANA, Melton III LJ, Dawson-Hughes B, Baim S, Favus MJ, Khosia S, Lindsay RL. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporosis International 2008; 19: 437-448.