What is the FRAX threshold for pharmacologic therapy in terms of 10-year fracture risk?

What is the FRAX threshold for pharmacologic therapy in terms of 10-year fracture risk?

• A. A 10-year hip fracture risk ≥3% or major osteoporotic fracture risk ≥20%
• B. A 10-year hip fracture risk ≥5% or major osteoporotic fracture risk ≥25%
• C. A 10-year hip fracture risk ≥1% or major osteoporotic fracture risk ≥10%
• D. A 10-year hip fracture risk ≥2% or major osteoporotic fracture risk ≥15%

Answer: (A)

FRAX estimates a person’s 10-year risk of hip fracture and of a major osteoporotic fracture (clinical spine, hip, forearm, or shoulder) using clinical factors, with or without including femoral neck BMD. The question hinges on what risk levels trigger pharmacologic therapy. Guidelines commonly state that treatment is warranted when the 10-year hip fracture risk is at least 3% or when the 10-year major osteoporotic fracture risk is at least 20%. These thresholds are set to treat individuals at meaningful risk where benefits of antiresorptive therapy are likely to outweigh risks. Including BMD in the calculation can refine the risk estimate and may push someone over these thresholds if their bone density is low.

FRAX estimates a person’s 10-year risk of hip fracture and of a major osteoporotic fracture (clinical spine, hip, forearm, or shoulder) using clinical factors, with or without including femoral neck BMD. The question hinges on what risk levels trigger pharmacologic therapy. Guidelines commonly state that treatment is warranted when the 10-year hip fracture risk is at least 3% or when the 10-year major osteoporotic fracture risk is at least 20%. These thresholds are set to treat individuals at meaningful risk where benefits of antiresorptive therapy are likely to outweigh risks. Including BMD in the calculation can refine the risk estimate and may push someone over these thresholds if their bone density is low.