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Treat to Target #3 – FRAX

February 9, 2018 @ 5:04 pm
posted by Dr Ginther

Our Target is NO NEW FRACTURES.  The original goal by DXA was a  T-score of -2.4 or better.  But age is a huge factor in actual fracture risk.  The fracture risk of a T-score of -2.5 at age 60 is the same as a T-score of -3.1 at age 50, is the same as a T-score of -1.3 at age 80.

FRAX was developed by WHO and the International Osteoporosis Foundation to take age and other factors into account.  The big 5 risk factors are age, previous fracture, parental hip fracture, smoking, and oral or inhaled corticosteroids.  Rheumatoid arthritis (or diabetes), over 3 doses of alcohol daily, and BMI < 19 or > 35 also count.  Male and Female are different.  Femoral Neck of the hip BMD by DXA is only 30% of the calculation when available.

Treat to Target by FRAX is a “Major Osteoporotic” (wrist, shoulder, hip or clinically noticed spine) Fracture Risk of < 20%.  Alternately a Hip Fracture Risk of < 3.0 is the target.  FRAX identifies a more individualized fracture risk than DXA with or without fragility fracture.

Look up the FRAX tool at

FRAX gives different targets than DXA because it takes additional risk factors into account.  And there have been some refinements added.

Jay Ginther, MD

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