Early postmenopausal women have low fracture risk
MedWire News: The World Health Organization-developed FRAX (Fracture Risk Assessment) tool estimates a low to moderate 10-year fracture risk in early postmenopausal French women, according to research published in the journal Joint Bone Spine.
"Managing the fracture risk during the first 10 years after the menopause is often challenging, as overprescription of unnecessary and costly drugs must be avoided without inappropriately restricting treatment to women with prior fractures," note Florence Trémollieres and colleagues from Hôpital Paule-de-Viguier in Toulouse, France.
The FRAX tool, which uses bone mineral density (BMD) and clinical risk factors to predict 10-year fracture probabilities, may help rationalize the use of osteoporosis medications based on uniform and reproducible criteria, say the researchers.
In the present study, they compared FRAX probabilities in 494 early postmenopausal women for whom treatment decisions had been made before the tool was used.
All women (mean age 54.8 years) were attending their first visit to a menopause clinic, where 128 (26%) were prescribed osteoporosis medication based on risk factors, physical findings, and BMD values. After the treatment decision was taken, their 10-year fracture probability was estimated using the FRAX tool.
The researchers report that the mean FRAX probability was 3.9% for major osteoporotic fractures and 0.8% for hip fractures. Most (62%) of the women had FRAX probabilities for major osteoporotic fractures in the 2-4% range.
Women who were prescribed medication had significantly higher FRAX probabilities than untreated women for both major osteoporotic fractures (5.1% vs 3.5%) and for hip fractures (1.4% vs 0.5%).
Furthermore, the proportion of women prescribed medication increased significantly with the FRAX probability, from 7.8% in the lowest quintile to 50.5% in the highest quintile (fifth)).
Hormone replacement therapy or raloxifene made up 92% of the prescriptions in patients with FRAX probabilities in the first four quintiles, whereas bisphosphonates made up 70% of prescriptions in patients in the fifth quintile.
Trémollieres and co-authors conclude that treatment thresholds should be defined to optimize the management of osteoporosis. They suggest that the FRAX tool could be used for this purpose.
However, the team warns that in early postmenopausal women, the treatment threshold may be drug-dependent and have country-specific economic, and health-policy considerations.
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By Laura Dean