FRAX Tool and Osteoporotic Fracture Risk
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Questions and Answers

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?

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

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

    <p>Give lifestyle advice</p> Signup and view all the answers

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

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

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

    <p>To improve balance and muscle strength</p> Signup and view all the answers

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

    <p>To provide a baseline for BMD monitoring</p> Signup and view all the answers

    When is referral to an osteoporosis specialist recommended?

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

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

    <p>It can suggest other conditions such as myeloma or primary hyperparathyroidism</p> 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?

    <p>DEXA applied to the femoral neck</p> 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?

    <p>Postmenopausal women, or man age ≥50 years, with a clinical risk factor for fragility fracture</p> 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?

    <p>Clinical judgement</p> 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?

    <p>Vertebral fracture assessment (VFA)</p> Signup and view all the answers

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

    <p>Renal profile</p> Signup and view all the answers

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

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

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

    <p>Both longer duration of disease and insulin use</p> Signup and view all the answers

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

    <p>The impact on bone health is unknown</p> Signup and view all the answers

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

    <p>Aromatase inhibitors</p> Signup and view all the answers

    What is the relationship between glucocorticoid therapy and fracture risk?

    <p>The risk is not solely dependent upon bone loss and BMD</p> 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?

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

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

    <p>When the spine is differentially affected</p> 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?

    <p>Low body mass index (BMI)</p> Signup and view all the answers

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

    <p>Royal Osteoporosis Society</p> 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?

    <p>Age</p> Signup and view all the answers

    What is the primary purpose of the FRAX tool?

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

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

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

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

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

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

    <p>Because FRAX has a limited input of variables</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>33%</p> Signup and view all the answers

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

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

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

    <p>2.5–7.5 mg daily</p> 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?

    <p>20%</p> 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?

    <p>10%</p> Signup and view all the answers

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

    <p>30%</p> 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?

    <p>Upward revision by 15% and 20% respectively</p> Signup and view all the answers

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

    <p>+30%</p> 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?

    <p>+15%</p> Signup and view all the answers

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

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

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