Why is fracture risk so important?
For many years we have known that there is more to fracture risk than just bone density. There are many factors that explain why in two individuals with the same bone density, one might break a bone and the other may not. The World Health Organization compiled data from all over the world to determine how to best “weigh” all the risk factors and to calculate fracture risk. Using fracture risk will help doctors better tell which patients need treatment.
Where does the FORE Fracture Risk Calculator come from?
This calculator uses several standard risk factors to calculate 10-year fracture risk. We start with your age and the fracture rate expected for women/men like you. We then examine whether you are at higher (or lower) risk based on comparing your risk factors.
Why use 10 year risk?
Doctors use risk-assessment for other diseases like breast cancer1 and heart disease.2 These are widely used to help decide whether treatment (usually drugs) is needed. We are now able to use a similar method for osteoporosis and have treatment recommendations based on the results.3
How do I use the graph?
The FORE Fracture Risk Calculator gives you two numbers: 1) your 10-year risk of having a hip fracture and 2) your 10-year risk of having any one of 4 fractures (hip, wrist, shoulder, or spine). Your risk is plotted on the graph (blue box) and is compared to the expected risk (grey dashed line). Your risk level can be at low (green), medium (yellow), or high (red).
What are the four fractures reported?
Hip, spine, upper arm or wrist.
Do the types of fractures change with age?
The mix of fractures changes with age: at 45-49 years, hip fractures constitute only 7% but increase to 50% at 75 years.7 In contrast, the proportion of wrist fractures decreases with age, from 60% among the younger group to 26% among the older.
How did you determine what risk factors to include?
The calculator uses the most common and best understood risk factors.
Should I use the clinical version?
There is a professional version of the FORE FRC at www.fore.org that incorporates additional data such as dose of steroid medication and the presence of spine fractures. These additional risk factors have a marginal increase on overall risk.
How will fracture risk help me and my doctor?
This calculator will raise awareness of the need for treatment in women and men who have a number of risk factors but are not obviously suffering from osteoporosis. Some of these risk factors can be improved (e.g. smoking, drinking heavily). Also, changes in diet and exercise can help reduce fracture risk. For older women and men with moderate or high risk, doctors can more accurately tell patients what their risk are without and with treatment; for example, instead of saying that a drug reduces risk by 50%, they can say, “without drug treatment the risk will be 20% and if the drug is taken the risk will be 10%.
What if I am being treated for osteoporosis?
This calculator is based on fracture rates in individuals who are not taking bone drugs. If you are on an osteoporosis drug you can expect that you will have a lower risk than the numbers you get from the model–perhaps to one-half the risk.3,4,6
What about falls and frailty?
This calculator does not address the additional risks imposed by falling and frailty because it is intended as a guide to drug therapy. Unfortunately, there are not yet any current drugs that modify falls or frailty.
Why were low, moderate, high thresholds chosen?
Guidelines have recently been published3, 4 that recommend treatment if, in the next 10 years, the risk of hip fracture is more than 3% or the risk of any major fracture is more than 20%. The graph shows rates for the major (any one of 4) fracture risk: above the 20% threshold is high risk (red zone), rates between 10-20% is moderate risk (yellow zone), and <10% is low risk (green zone). Providing a risk category allows you to make better informed decisions about your bone health.7
Validation studies on FRC tool
- Benichou J. A computer program for estimating individualized probabilities of breast cancer. Comput Biomed Res 1993; 26:373-82.
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-97.
- Tosteson ANA, Melton II LJ, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, Lindsay RL. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int DOI 10:1007/s00198-007-0550-6.
- Dawson-Hughes B, Tosteson ANA, Melton III LJ, Baim S, Favus ML, Khosla S, Lindsay RL. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int DOI 10:1007/s00198-008-0559-5.
- Ettinger B, Hillier TA, Pressman AR, Che M, Hanley DA. Simple computer model for calculating 5-year osteoporotic fracture risk in postmenopausal women. J Women’s Health 2005; 14:159-171.
- Kanis JA, Borgstrom F, Zethraeus N, Johnell O, Oden A, Jonsson B. Intervention thresholds for osteoporosis in the UK. Bone 2005; 36: 22-32.
- Hux JE, Naylor CD. Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients’ acceptance of treatment? Med Decis Making 1995; 15:152-7.