FRAX Tool and Osteoporotic Fracture Risk

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What is the purpose of the NOGG 2021 Guideline?

To identify a group at low fracture risk

To ensure equal access to treatment for older patients with and without fracture (correct)

To provide recommendations for BMD measurement

To recommend lifestyle changes for older patients

What action is recommended for patients at very high risk of fracture according to the NOGG 2021 Guideline?

Measure Bone Mineral Density (BMD)

Give lifestyle advice

Consider specialist referral and treatment (correct)

Reassess in 5 years

When should lifestyle advice be given to patients under the NOGG 2021 Guideline?

When new clinical risk factors develop

When BMD measurement is not practical

When both the Major Osteoporotic Fracture (MOF) and Hip fracture probabilities fall below the treatment threshold (correct)

When patients are at intermediate risk of fracture

What is the recommendation for patients at intermediate risk of fracture under the NOGG 2021 Guideline?

Measure Bone Mineral Density (BMD) and recalculate fracture risk Signup and view all the answers

What should be done if BMD measurement is not practical for a patient under the NOGG 2021 Guideline?

Give lifestyle advice Signup and view all the answers

What is the recommendation for treating glucocorticoid-induced osteoporosis in high-risk patients?

Offer oral bisphosphonates (alendronate or risedronate) as a first-line treatment option Signup and view all the answers

Why is it important to assess falls risk in patients with osteoporosis and offer an exercise programme?

To improve balance and muscle strength Signup and view all the answers

What is the purpose of measuring BMD in patients with high fracture risk?

To provide a baseline for BMD monitoring Signup and view all the answers

When is referral to an osteoporosis specialist recommended?

Consideration of parenteral treatment in very high-risk cases Signup and view all the answers

What is the significance of hypercalcemia in the context of osteoporosis investigations?

It can suggest other conditions such as myeloma or primary hyperparathyroidism Signup and view all the answers

What is the recommended reference technology for measuring bone mineral density (BMD) according to the WHO and the International Osteoporosis Foundation?

DEXA applied to the femoral neck Signup and view all the answers

In which group of individuals is a FRAX assessment recommended to guide BMD measurement and prompt referral and/or drug treatment?

Postmenopausal women, or man age ≥50 years, with a clinical risk factor for fragility fracture Signup and view all the answers

When using FRAX to calculate the probability of fracture, what is needed when clinical risk exceeds those factors able to be entered into FRAX?

Clinical judgement Signup and view all the answers

What is indicated in postmenopausal women, and men age ≥50 years, if there is a history of ≥4cm height loss, kyphosis, recent or current long-term oral glucocorticoid therapy, a BMD T-score ≤-2.5 at either the spine or hip, or in cases of acute onset back pain with risk factors for osteoporosis?

Vertebral fracture assessment (VFA) Signup and view all the answers

Which test should be performed in patients with osteoporosis and/or a fragility fracture to investigate underlying causes?

Renal profile Signup and view all the answers

What is the relationship between alcohol intake and fracture risk according to the text?

Alcohol intake increases fracture risk in a dose-dependent manner Signup and view all the answers

Which factor increases the risk of hip and non-vertebral fracture in individuals with type 2 diabetes?

Both longer duration of disease and insulin use Signup and view all the answers

What is the impact of sex steroids on bone health in transgender individuals based on the information provided?

The impact on bone health is unknown Signup and view all the answers

Which medication is known to increase hip fracture risk for individuals with breast cancer?

Aromatase inhibitors Signup and view all the answers

What is the relationship between glucocorticoid therapy and fracture risk?

The risk is not solely dependent upon bone loss and BMD Signup and view all the answers

What is the recommended reference range for calculating femoral neck and total hip T-scores for men, women, and transgender individuals in the US?

NHANES III survey for white women age 20-29 years Signup and view all the answers

In which situation can spine BMD measurements be used for diagnosis when hip BMD measurement is not possible?

When the spine is differentially affected Signup and view all the answers

What has been identified as a significant risk factor for hip fracture, but its value in predicting other fractures diminishes when adjusted for BMD?

Low body mass index (BMI) Signup and view all the answers

Which organization has published standards for reporting DXA scans to ensure the validity of BMD measurements?

Royal Osteoporosis Society Signup and view all the answers

What contributes to fracture risk independently of BMD and can improve the performance characteristics of BMD assessment when considered concurrently with clinical risk factors?

Age Signup and view all the answers

What is the primary purpose of the FRAX tool?

To compute the 10-year probability of hip fracture and/or of major osteoporotic fracture Signup and view all the answers

Why can the calculators FRAX and QFracture not be used interchangeably?

They yield different outputs, with FRAX accounting for mortality risk and QFracture providing cumulative risk of fracture Signup and view all the answers

What clinical risk factors are specifically included in the FRAX assessment of fracture probability?

Age, sex, body mass index, previous fragility fracture, parental history of hip fracture, current glucocorticoid treatment, and others listed in Table 1 Signup and view all the answers

Why is it not possible to model all scenarios within the FRAX algorithm?

Because FRAX has a limited input of variables Signup and view all the answers

What information can be adjusted using relatively simple arithmetic procedures available for conventional FRAX estimates?

All of the above Signup and view all the answers

What is the suggested increase in FRAX probability when uplifting the original probability of 30% by 10%?

33% Signup and view all the answers

Under what conditions should downward adjustment to FRAX probabilities be made?

In the context of a reliable high lumbar spine BMD measurement Signup and view all the answers

What is the assumed minimum requirement for FRAX calculation in terms of daily oral glucocorticoid doses?

2.5–7.5 mg daily Signup and view all the answers

How much are major osteoporotic fracture (MOF) probabilities upward revised for high doses (>7.5 mg daily) of oral glucocorticoids?

20% Signup and view all the answers

According to the information provided, how much does each rounded T-score difference between lumbar spine (LS) and femoral neck (FN) result in an increase or decrease in MOF probability?

10% Signup and view all the answers

How much does each standard deviation (SD) decrease in Trabecular bone score (TBS) increase MOF probability?

30% Signup and view all the answers

What should be done to hip and non-vertebral fracture probabilities on the FRAX website for individuals with high doses (>7.5 mg daily) of oral glucocorticoids?

Upward revision by 15% and 20% respectively Signup and view all the answers

What is the effect on MOF probability for each standard deviation (SD) decrease in Trabecular bone score (TBS)?

+30% Signup and view all the answers

What is the approximate adjustment to MOF probability for medium and high dose exposure to oral glucocorticoids as per the information provided?

+15% Signup and view all the answers

What should be done for each rounded T-score difference between lumbar spine (LS) and femoral neck (FN)?

Increase/decrease MOF probability by 10% Signup and view all the answers