Is the new test for osteoporosis better than a bone density test?
Some doctors believe the Fracture Risk Assessment Tool, or FRAX, will improve their ability to identify patients likely to suffer the worst consequence of osteoporosis - broken bones. The test will "simplify osteoporosis diagnosis for busy primary care physicians," said Mary Bouxsein, who studies the biomechanics of bone strength at Beth Israel Deaconess Medical Center.
Others agree, but say the test won't get at a major problem: Doctors are testing and treating the wrong people for bone loss.
Bone density is only one measure of bone strength. Many women with dense bones still fracture; many with thin bones don't.
FRAX can predict fracture risk more precisely than bone density by considering factors such as age, race, weight, and smoking history, that doctors can enter into an online form. Rather than the bone scan's abstract "T-Score" - which describes how far your bone density is from the ideal - the FRAX calculates a patient's 10-year odds of breaking a bone.
"I think it is good to get away from this narrow focuses on bone density and something like FRAX could be useful if people get a little bit of common sense about when to use drugs," said Cindy Pearson, director of the National Women's Health Network, a Washington DC-based advocacy group. Serious side effects - including bone and joint pain - are now emerging in long term-users of common osteoporosis drugs.
But the FRAX doesn't go far enough in presenting risk in a way that patients can understand, said Dr. Bruce Ettinger, a long-time osteoporosis researcher with Kaiser Permanente now with the University of California at San Francisco.
Ettinger prefers an approach that informs patients that they are at high, moderate, or low chance of breaking a bone.
Still, most agree that the calculator is an improvement over the bone scan alone. The FRAX is only a few months old, and for now, busy primary care doctors will have to find time to enter the data into a computer. But, researchers predict the next generation of bone scanners will come equipped with FRAX calculators.
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Judy Foreman is on vacation. E-mail health questions to foreman@globe.com. 