“I would practically need a PhD to understand those new rules on osteoporosis screening,” my 58-year-old friend grumbled. She was referring to the revised guidelines from the US Preventive Services Task Force (USPSTF), recommending bone density testing for women age 65 and older as well as for “younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.” Confusing? Let me explain…
Women are at significantly higher risk than men for osteoporosis, the disease that weakens bones and leads to fractures. Risk increases with age. The old USPSTF guidelines, set in 2002, recommended bone density testing to screen all women age 65 and older (that part has not changed), plus women ages 60 to 64 who were at increased risk for osteoporotic fractures. Those guidelines were recently revised to more specifically define the level of risk that merits bone density testing for the age-60-to-64 group and to address the needs of younger women by utilizing a new online fracture risk assessment tool called FRAX.
I spoke with Bruce Ettinger, MD, an emeritus clinical professor of medicine at the University of California Medical Center, San Francisco, and osteoporosis expert whose input helped set the new guidelines. He explained that FRAX prompts you to input your status with regard to various risk factors. These include age… height and weight… ethnicity (since genetic influences put Caucasians at higher risk than Asians, Blacks or Hispanics)… alcohol and tobacco use… diseases or drugs that can affect bones… and personal and family history of fractures. Then the Web-based program instantly calculates your 10-year probability of experiencing a fracture due to osteoporosis.
To use FRAX: Enter the pertinent information into this FRAX calculator and answer simple yes/no questions. The FRAX calculator gives you two percentages. The main number to consider is your risk of having a fracture at any of the four major osteoporotic fracture sites—hip, spine, wrist or upper arm/shoulder—within the next 10 years. Once this risk reaches 9.3%, which is the risk level of a healthy 65-year-old white woman, bone density screening is recommended. (The other percentage given is your 10-year risk of fracturing a hip specifically. Hip fractures are singled out because they are the most serious of the osteoporotic fractures—but since these are rare before age 70 to 75, for younger women it is more useful to consider the combined risk at all four major sites.)
A fair number of women in their 50s do have a FRAX score higher than that of the hypothetical 65-year-old. Dr. Ettinger explained, “If you are 55 and you smoke, are thin and have a parent who had a hip fracture, then you’re more like a typical 65-year-old in terms of osteoporosis risk.”
Bottom line: If your major fracture site FRAX score is…
- Below 9.3%—continue to follow your doctor’s recommendations on diet, exercise and lifestyle habits that protect bones… and complete the FRAX questionnaire again in three to five years. Fracture risk typically doubles every seven to eight years, Dr. Ettinger said, so you can estimate when in the future your score might cross the threshold for bone density testing.
- 9.3% or higher—the recommendation is for your doctor to order a dual-energy X-ray absorptiometry (DEXA) test to measure your bone density. Those results can be entered into the FRAX calculator to further refine your risk level. If your bone density is right at the expected level for your age, your FRAX score won’t change much. But if your bone density is much lower than expected, this new factor could easily double your risk, Dr. Ettinger said. Your doctor will take this into account in determining the next appropriate step in your care.