FRAX Tool to Assess Fracture Risk

Here is the link to this test which I have not done in a long time:

http://www.shef.ac.uk/FRAX/tool.jsp

Use the drop down menu to select country and the converters on the right side to convert your weight and height.

Mine showed 20% chance of major osteoporotic fracture and 3.4% chance of hip fracture which I can live with. This is certainly not the imminent risk of fracture some of my doctors over the years have threatened me with if I did not immediately go on medication.

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One thing I do not understand is that I initially did the test for the UK (which is how the original link presented it). My fracture risk would be much lower in the UK (13% chance of major osteoporotic fracture and 1.4% chance of hip fracture).

Given the same input, why would the fracture risk vary so much from one country to the next?

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It would be much higher if you used Sweden. These risks are based on national observational studies and the averages for large populations. It also uses longevity data from actuarial tables. If your life expectancy is less than 10 year from today, your 10 yr risk of hip fracture is actually lower than if you were younger for example.
Mathematically, FRAX assembles a stereotypical hypothetical patient that matches the same inputs that you enter for yourself in that country. So really, it isn't much different than asking why people in the UK tend to have bad teeth. It just is how the math works out. It may also be capturing some risk factors that are not in FRAX, like the risk of falls. Snow and ice are less common in the UK than in half of the US during the winter. Sweden is more icy than the US for longer portions of the year. The more falls, the more hip fractures in people with osteoporosis.

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FRAX is better than T-scores alone, but as I mentioned, it doesn't take into account a number of risks, like falls. It also uses dichotomous responses to smoking, alcohol, and steroid use. Clearly someone who smokes 3 pks a day, downs a six pack of beer a day, AND is on 60 mg a day of prednisone has a different and much higher risk of fracture than someone who smokes 3 cigarrettes a week, 3 glasses of wine after dinner, and took prednisone for asthma 30 years ago as a child and has since grown out of it. Both patients would get the same risk numbers because the reponses are only yes, no.

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One last point, while a 3.4% risk of a hip fracture in the next 10 years doesn't seem that disasterous, be mindful that 25% of patients who suffer a hip fracture will die within the next 6 months. So you have a 0.68% chance (1 in 147) chance of dying from a hip fracture in the next 10 years. So if the odds of losing your life were 1 in 147, and the odds of living were 146/147, and you were in Las Vegas, would you pull the lever on that slot machine?

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Thanks, dxaguru, for all your replies - definitely food for thought.

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Many thanks to you Uma, for your query (your FRAX results are similar to those I calculated for mysel just yesterday) and to you, dexaguru, for providing the quantitative perspective. You've helped me better understand risk. Is there similar quantitative information on risk factor for adverse reactions to medications? My reaction to Fosomax (6 month on it resulted in 18 months of severe muscle and joint pain), has left me thinking trying another med would make as much sense as a game of Russian Roulette.
Not a bet I am willing to take.

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I had this bright idea that if I redid the FRAX at a higher body weight (I'm about 90 pounds now), my risk of fracture would decrease.

Wrong - at both 95 and 100 pounds it actually increased, from 20% to 21% for a major osteoporotic fracture and from 3.4% to 3.5% for a hip fracture.

Maybe this is not statistically significant. In any event, I am sure in the event of a fall, having a little more padding would be a good thing!

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Uma
At 5'2", 104 lbs with -3 range in both hips/spine (fracture free), I continually work on balance to avoid the possibility of a fall. I really don't think much about falling because I also feel that I might not break a bone depending on how I fall. I think death often occurs from other factors like infection; etc that may not be directly caused by having a hip fracture. Also, I know a few woman that have gone through hip fractures in elder years, worked through physical therapist and are doing very well and continued to live in their own homes. "What do we, as doctors tell our 65 yr old patients" .... a comment from my first rheumatologist, a very highly regarded and respected doctor. But I am not going to allow myself to be lumped into a statistic, a number, an age group. And fear will not determine my decisions or dictate my life with osteoporosis. That's not to say I don't get moments .... because my head is not in the sand. I'm well aware of osteoporosis and the possibilities. I know that FRAX can be a good tool, but I'm not interested in FRAX for myself. 20% that I may have a fracture? 80% that I may not have a fracture. We are wired to focus on the 20% .... I prefer to focus on the 80%. And death? Am I really going to spend my time worrying about death? My choice is to wake up every morning with THANKS and live each day BRAVELY and without FEAR .... but how we deal and live with osteoporosis is a choice each person must make for themselves.
Sandi

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I too have chosen to focus on doing all I can to enhance my health, my strength and my balance. At 60 years, 5' 4" and 117lbs with a FRAX hip fracture risk of 3, I have had no fractures, fragile or otherwise. Will I ever regret forgoing medication? No way to know. But I do know I feel great now and won't trade that away for side effects that might debilitate right now.

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Thank you to all who replied. I did this test because my doctor said he was going to ask my DXA facility to do it (which I don't see how they can, given that it requires personal information that they don't have). Since apparently it is important to him, I decided I needed to revisit it.

I do like your perspective, Sandi - thanks for sharing.

Uma

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