osteoporosis

Question 1

how can you assess the risk of fragility fractures in old people?

when should this tool be used?

what is the exception to this?

Answer 1

• FRAX/ Fracture tool
• all women >65 and all men >75
• patients who are younger than the above but have certain risk factors

Question 2

what risk factors are there for deciding to assess those <65s need for bone protection?

Answer 2

• smoking history
• alcohol intake (>14 in women >21 in men)
• use of glucocorticoids
• history of falls
• family history of hip fracture
• low BMI
• other causes of secondary osteoporosis

Question 3

how can FRAX be interpreted?

Answer 3

without DEXA scan results:

• low risk: reassure and give lifestyle advice
• intermediate risk: offer BMD test
• high risk: offer bone protection treatment

with DEXA scan:

• reassure
• consider treatment
• offer treatment

Question 4

how should QFracture be interpreted if used?

Answer 4

• patients aren’t risk stratified (e.g. low, med, high)

- data then interpreted according to local/ national guidelines taking into account factors e.g. patients age

Question 5

when do NICE recommend doing a BMD assessment scan over a risk tool like FRAX or QFracture?

Answer 5

• people starting treatments that have effects on bone density e.g. sex hormone deprivation for treatment of breast/ prostate cancer
• people under 40 with a major risk factor:
  > history of fragility fracture
  > major osteoporotic fracture
  >high dose steroids (>7.5mg prednisolone daily)

Question 6

when should you reassess the patients risk?

Answer 6

• after 2 years

- change in the persons risk factors