Clinical practice guidelines regarding when to initiate osteoporosis treatment have evolved from the use of bone mineral density (BMD) thresholds to a more complex consideration of the patient's 10-year absolute fracture risk.1 There are sound reasons for this shift: most fractures occur in patients with BMD T scores above −2.5, and other clinical risk factors, especially age, affect fracture risk.1 Assuming equal relative treatment efficacy, prescribing therapy for a patient with a higher 10-year fracture risk will result in a greater absolute fracture reduction and be more cost-effective for society.
Colón-Emeric CS, Lyles KW. Should There Be a Fracas Over FRAX and Other Fracture Prediction Tools?Comment on “A Comparison of Prediction Models for Fractures in Older Women”. Arch Intern Med. 2009;169(22):2094-2095. doi:10.1001/archinternmed.2009.2094