The decision on whether to treat osteoporosis is clear if someone has already sustained a spine or hip fracture, or who has been diagnosed with osteoporosis based on a bone mineral density (BMD) test. What is controversial is whether to treat those with bone thinning, known as osteopenia, diagnosed with a T-score between -1 and -2.5 on a DEXA test.

Many of these women can be young and healthy with low risk for fracture or older women who are reluctant to be treated. I have to admit some of the press on bisphosphonate drugs and their side effects raises concern such as increased risk for osteonecrosis of the jaw and a possible associated risk of femur fractures.
Finally there may be a better way to assess these women (and men) in determining what their 10-year risk of a major osteoporosis-related fracture (hip, spine, forearm and humerus) may be. A fracture prevention algorithm (FRAX) was produced by the World Health Organization in a computer based algorithm that factors risks such as age (age 40-90), body mass index, prior fragility fracture, use of oral glucocorticoids, family history of fracture, smoking, alcohol use, secondary osteoporosis, country of residence, race, gender and BMD into a calculated 10-year absolute fracture risk for a “major” fracture or hip fracture. Remember the mortality rate of a hip fracture is as high as 20%!
According to the National Osteoporosis Foundation (NOF), treatment should be initiated if a person’s 10-year hip probability is >or= to 3% or the risk for a major osteoporosis-related fracture is >or= to 20%. Of course the decision to start pharmaceutical treatment is up to you and your practitioner, but this will encourage a discussion about whether drug therapy is the best choice for you.

You can Google FRAX or check out www.shef.ac.uk/FRAX for more information.

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