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Time to Clinically Relevant Fracture Risk Scores in Postmenopausal Women.

Margaret L Gourlay1, Robert A Overman2, Jason P Fine3

  • 1Department of Family Medicine, University of North Carolina, Chapel Hill.

The American Journal of Medicine
|March 13, 2017
PubMed
Summary

Postmenopausal women aged 50-64 rarely develop high fracture risk scores. After age 65, consider more frequent fracture risk assessment and bone density testing for osteoporosis screening.

Keywords:
Bone densityFracturesMenopausalOsteoporosis/epidemiologyRisk assessment

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Area of Science:

  • Gerontology
  • Epidemiology
  • Public Health

Background:

  • Clinical guidelines recommend fracture risk scores for osteoporosis screening and treatment decisions.
  • The timing of fracture risk score development in postmenopausal women is not well-established.

Purpose of the Study:

  • To estimate the incidence and timing of treatment-level and screening-level fracture risk scores in postmenopausal women.
  • To inform osteoporosis screening and management strategies.

Main Methods:

  • Retrospective competing risk analysis of fracture risk scores in postmenopausal women aged 50+.
  • Analysis focused on women prior to pharmacologic treatment and major fracture events.

Main Results:

  • In women 50-64 without bone density testing, treatment-level FRAX scores were too rare to estimate incidence.
  • For women with bone density testing, time to treatment-level FRAX varied by age, e.g., 7.6 years for ages 65-69.
  • By age 65, 0.6% of women 50-64 with screening-level FRAX experienced a major fracture.

Conclusions:

  • Postmenopausal women with sub-threshold fracture risk scores are unlikely to reach treatment-level FRAX between ages 50-64.
  • Increased incidence of treatment-level FRAX, osteoporosis, and fractures after age 65 supports more frequent FRAX and bone density testing.