New WHO Tool to Assess Osteoporosis Risk - Deciding If You Need a Prescription

"The new fracture-risk tool may help assure the "worried well" that they don't need medicines if their risks are low.  It may also help people with the highest fracture risk get the treatment they need."  -NPR's Allison Aubrey, Your Health-

On Thursday morning, NPR's Morning Edition reported on a new online tool (FRAX) from the World Health Organization to help physicians and patients calculate fracture risk and determine  the need for an osteoporosis prevention prescription, like Actonel or Fosamax.  The tool measures your long-term risk of sustaining a hip fracture or other major bone break.

It uses 9 osteoporosis risk factors, like your family history and alcohol use.  There's a handy-dandy metric converter on the left side of the page to help you convert your height and weight.  You will need the results of a bone density scan, your T-score,  to use the calculator. When you enter your score, be sure to include the minus sign (-) if your T-score is a negative!  I had to do a little hunting to find a copy of my score on the report my doctor sent to me last year.  To try the calculator, click here.  The calculator tool is located on the top of the link, and you choose your country and race before running it.

My T-score is: -2.1 and based on my height, weight, age & risk factors my long-term risk of a hip fracture is 1.9% and my major fracture risk is 12%.  The T-score is a "measure of an individual's bone-mineral density compared to what is found in a young, normal adult of the same sex."

According to the National Osteoporosis Foundation's Clinician's Guidelines for interpreting FRAX scores, I do not need to be on an osteoporosis prevention medication.  Yeah!  I was surprised and happy because my mother had severe undiagnosed osteoporosis.  She suffered painful spinal stress fractures and when she broke her wrist at age 83, her doctor said her bones were like lace. He advised me to have a bone density test.

The NOF recommends treatment when the 10 year hip fracture risk is 3% or higher, or if the risk of other major fractures in the spine, shoulder or arms is 20% or more.

Here's an excerpt from the NOF's Clinician's Guidelines:

In this new Clinician's Guide NOF states that post-menopausal women or men over 50 with a T-score of -2.5 or lower at the hip or spine or with a prior hip or spine fracture should be treated. In addition, based on absolute fracture risk calculation, patients with low bone mass (T-score between -1.0 and -2.5 at the femoral neck, total hip or spine) should be treated when there is a 10-year probability of hip fracture that is > or = to 3% or a 10-year probability of a major osteoporosis-related fracture that is > or = to 20% based on the U.S.-adapted WHO algorithm.  It is important to note that the WHO algorithm is for untreated patients to help decide when to treat, and does not apply to patients already taking an osteoporosis medication.

For NOF osteoporosis guidelines and recommendations click here.

In the NPR Morning Edition story, Rosemarie Moenster, a 65-year old Cincinnati teacher, was being treated with 2 medicines, Actonel to rebuild bone, and Evista, to prevent bone loss.  When she started to experience complications her doctor advised stopping the Actonel.  She was terrified of worsening osteoporosis, but when her doctor, Nelson Watts ran the new FRAX risk tool, the news was good.  Her risk of hip fracture was less than 1%, and the risk of major breaks was 12%.  She could safely stop the Actonel, and is continuing the Evista.

Bone tips from the April 2008 issue of Health:

• In your 30s & 40s be careful of serial dieting if you are taking in fewer calories than you burn.  Too few calories decreases estrogen production, which is harmful to your bones. "A few weeks of dieting are thought to be harmless; any bone mass lost is likely reversible", says Robert Lindsay, MD, PhD, past president of the National Osteoporosis Foundation. "But several months or longer could be harmful."
• Watch out for stress!! When you're chronically stressed your level of cortisol, the stress hormone, is raised and you don't absorb minerals as well.  It begins to waste your calcium, our bone-building mineral.  Cortisol is the natural form of cortisone-based medications, which is one of the top risk factors for osteoporosis.  This one was news to me!
• Watch your alcohol intake.  Any more than 2 drinks a day risks bone loss later in life.  Alcohol is a diuretic & causes bone-building minerals to flush out of your body.
• Weight gain - too much body fat may lead to a decrease in bone production.
• After menopause your need for calcium jumps. Salty foods, protein from meat, and too much caffeine reduces your body's ability to absorb calcium.  3 cups of coffee a day could lead to bone loss.
• Supplement. If you're over 50, be sure you are getting 1200 mg. of calcium a day, and 800-1000 IU of vitamin D3, to help your body absorb the calcium.  To see my vitamin D post for more info on this important vitamin/hormone, click here.
• Work on your balance.  If your balance is good, you won't fall and break a bone.  Unfortunately, our balance gets worse as we age unless we work on it.  Research shows that yoga and Tai Chi definitely improve balance, not to mention, they reduce stress, which will reduce that nasty cortisol.

Comments encouraged.  Let me know how the calculator worked for you.

Comments

[Anonymous]

Hm. I'm not sure about all this. I did this and, using my T-score had results of 10 and 1.6; using my Z-Score it was 11 and 2.1. According to my physician, who acts like I'll fracture any minute now, I expected to be a much higher risk than this, though I am not on any meds at the moment (much to her dismay). And, I KNOW my numbers should be much worse than yours, since I'm overweight and my BMI is high. Let's talk on Monday.... I don't want to leave my name, but, I bet you can guess who this is, since we talk about this stuff all the time.