OsteoEd

Practice Cases

Fracture Risk Assessment

Heidi Powell, MD Literature reviewed July 09, 2008. Updated January 22, 2009
A 58-year-old Caucasian woman presents to you with a DEXA scan obtained by a mobile bone density testing unit. She has a T-score of -1.7 of the total hip. She has been healthy most of her life and has no medical problems or active complaints. She takes vitamins but no other medications.

Click an answer under each question.

  1. She has osteopenia, not osteoporosis, so is there any indication to start medication to prevent fractures?

    • Option A Unclear, because more information about her risk factors is needed.
    • Option B No, because her BMD is only -1.7 and treatment is indicated for those with a BMD of -2.5 or lower.
    • Option C Yes, recent studies have shown that there may be a benefit to treating women with T scores between -1.5 and -2.5, regardless of risk factors.

  2. Are there other risk factors besides personal history of fracture, smoking, or family history of osteoporosis which would encourage you to screen a postmenopausal woman prior to age 65?

  3. With further questioning, you find out the following about your patient:

    • Weight 150 pounds (height 65 inches)
    • Alcohol: 3 glasses of wine each night
    • No corticosteroid usage (past or present)
    • No personal history of a fracture
    • Smoking: 1 PPD
    • No family history of a hip fracture

    You decide to use the FRAX tool to determine her fracture risk given her many risk factors. You have a question about the FRAX tool as you are putting in the data.

    Can the total hip BMD rather than the femoral neck BMD be used in the FRAX tool?

    • Option A No, you must use total hip BMD
    • Option B Yes, these are interchangeable
    • Option C Yes, but these are only interchangeable for women and not for men
    • Option D No, it is best to leave it blank

  4. The FRAX tool requires either a yes or no response for some of the risk factors and does not allow for a dose or duration response. For example, our patient increased her drinking from one drink per night to 3 drinks per night only in the last 6 months.

    How do you answer some of the clinical risk factor questions if you are unsure of the duration or amount?

    • Option A Answer No if you are not certain about its clinical significance.
    • Option B Answer Yes but keeping in mind that this will influence your interpretation of the results.

  5. The FRAX tool shows that her 10-year risk of having a fracture is:

    • 14% for any major osteoporotic fracture
    • 3.1% of a hip fracture.

    Should you consider treating her?

    • Option A No, because her BMD is not -2.5 or lower.
    • Option B Yes, because her hip fracture risk is greater than 3%.
    • Option C Yes, because her risk for any type of major osteoporotic fracture is greater than 10%.
    • Option D No, because her risk of any type of fracture is low.

  6. If she were African-American with the same risk factors, would her fracture risk be the same?

  7. If she were African-American, her 10-year hip fracture risk is 1.4 %. Does the cost-effective intervention threshold for osteoporosis treatment differ between races?

    • Option A No, it is about the same.
    • Option B Yes, the threshold varies depending on the ethnic group.
Key Points
Last edited July 03, 2009