At what 10-year major fracture risk threshold is treatment for osteopaenia indicated?

At what 10-year major fracture risk threshold is treatment for osteopaenia indicated?

• A. 5%
• B. 10%
• C. 20%
• D. 25%

Answer: (C)

Assessing fracture risk with FRAX guides treatment decisions beyond bone mineral density alone. The important idea is the 10-year probability of experiencing a major osteoporotic fracture (hip, clinical spine, forearm, or shoulder). When this estimated risk reaches 20% or higher, initiating pharmacologic treatment is recommended even if the T-score is in the osteopenic range. This threshold reflects balancing the substantial benefit of antiresorptive therapy against potential risks, aiming to prevent major fractures that cause significant morbidity and mortality. The major fracture risk estimate is driven by age and clinical factors such as prior fracture, smoking, glucocorticoid use, and secondary causes, and can be augmented by BMD if available.

Assessing fracture risk with FRAX guides treatment decisions beyond bone mineral density alone. The important idea is the 10-year probability of experiencing a major osteoporotic fracture (hip, clinical spine, forearm, or shoulder). When this estimated risk reaches 20% or higher, initiating pharmacologic treatment is recommended even if the T-score is in the osteopenic range. This threshold reflects balancing the substantial benefit of antiresorptive therapy against potential risks, aiming to prevent major fractures that cause significant morbidity and mortality. The major fracture risk estimate is driven by age and clinical factors such as prior fracture, smoking, glucocorticoid use, and secondary causes, and can be augmented by BMD if available.