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Invited Commentary
December 14, 2009

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

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.

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