Age also is a key factor in fracture risk assessment
Gourlay and colleagues more recently conducted a retrospective analysis of new occurrence of treatment-level fracture risk scores in postmenopausal women (50 years of age and older) before they received pharmacologic treatment and before they experienced a first hip or clinical vertebral fracture.
In 54,280 postmenopausal women aged 50 to 64 without a BMD test, the time for 10% to develop a treatment-level FRAX score could not be estimated accurately because of the rarity of treatment-level scores. In 6,096 women who had FRAX scores calculated with their BMD score, the estimated time to treatment-level FRAX was 7.6 years for those 65 to 69 and 5.1 years for 75 to 79 year olds. Furthermore, of 17,967 women aged 50 to 64 with a screening-level FRAX at baseline, only 100 (0.6%) experienced a hip or clinical vertebral fracture by age 65.
The investigators concluded that, “Postmenopausal women with sub-threshold fracture risk scores at baseline were unlikely to develop a treatment-level FRAX score between ages 50 and 64 years. After age 65, the increased incidence of treatment-level fracture risk scores, osteoporosis, and major osteoporotic fracture supports more frequent consideration of FRAX and bone mineral density testing.”
WHAT THIS EVIDENCE MEANS FOR PRACTICE
Many health care providers begin BMD testing early in menopause. Bone mass results may motivate patients to initiate healthy lifestyle choices, such as adequate dietary calcium, vitamin D supplementation, exercise, moderate alcohol use, smoking cessation, and fall prevention strategies. However, providers and their patients should be aware that if the fracture risk is beneath the threshold score at baseline, the risk of experiencing an osteoporotic fracture prior to age 65 is extremely low, and this should be taken into account before prescribing pharmacotherapy. Furthermore, as stated, FRAX can be performed without a DXA score. When the result is beneath a treatment level in a woman under 65, DXA testing may be deferred until age 65.
Many health care providers begin BMD testing early in menopause. Bone mass results may motivate patients to initiate healthy lifestyle choices, such as adequate dietary calcium, vitamin D supplementation, exercise, moderate alcohol use, smoking cessation, and fall prevention strategies. However, providers and their patients should be aware that if the fracture risk is beneath the threshold score at baseline, the risk of experiencing an osteoporotic fracture prior to age 65 is extremely low, and this should be taken into account before prescribing pharmacotherapy. Furthermore, as stated, FRAX can be performed without a DXA score. When the result is beneath a treatment level in a woman under 65, DXA testing may be deferred until age 65.
Continue to: USPSTF offers updated recommendations for osteoporosis screening