Fracture risk in early postmenopausal women assessed using FRAX

To evaluate FRAX 10-year fracture probabilities depending on the recommended management strategy in early postmenopausal women who were untreated at baseline.

We conducted a descriptive study in 494 untreated women aged 45-60 years seen for the first time at a menopause clinic. Risk factors, physical findings, and bone mineral density (BMD) values determined by dual-energy X-ray absorptiometry were collected. At the end of the clinic visit, 128 (26%) women were prescribed medications. Then, the 10-year fracture probability was estimated using the FRAX tool.

The mean FRAX probability was 3.9%+/-2% for major osteoporotic fractures and 0.8%+/-0.9% for hip fractures. Women who were prescribed medications had significantly (P<0.001) higher probabilities than the other women. The proportion of women prescribed medications increased significantly (P<0.0001) with the FRAX probability, from 7.8% in the lowest quintile (Q1) to 50.5% in Q5. Hormone replacement therapy or raloxifene contributed 92% of the prescriptions in patients with FRAX probabilities in the first four quintiles and bisphosphonates 70% of prescriptions in patients with probabilities in Q5.

Early postmenopausal women had low to moderate fracture risks (FRAX, 3-4%). The indications and type of drugs prescribed correlated with FRAX probabilities. Treatment thresholds should be defined to optimize the management of osteoporosis. In early postmenopausal women, treatment thresholds may vary with the type of treatment.