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FRAX With vs Without BMD — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseFRAX With vs Without BMDSCE Rheumatology

A 60-year-old woman undergoes fracture-risk assessment. Her 10-year fracture probability calculated using FRAX without bone mineral density is in the region of the intervention threshold. A DXA scan is performed and FRAX is recalculated using femoral-neck BMD. Which statement best describes the effect of including BMD?

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Correct answer: B — It refines the 10-year fracture probability and may move the patient across the intervention threshold

Including femoral-neck BMD refines, rather than replaces, the FRAX estimate of 10-year hip and major osteoporotic fracture probability. NICE recommends initially assessing risk without BMD and considering DXA when the result is near an intervention threshold. FRAX is then recalculated with BMD because the revised probability may fall above or below that threshold, changing the management decision. BMD therefore can alter the estimate, excluding B. It remains part of risk estimation rather than being reserved solely for monitoring, excluding C. Clinical risk factors remain within FRAX, excluding A. Adding an informative predictor does not inherently make FRAX less accurate, excluding D. The original explanation's fixed claim that approximately 20–30% are reclassified is unnecessary and is not established as a universal UK figure.

Reference: National Institute for Health and Care Excellence. Osteoporosis: assessing the risk of fragility fracture (CG146), recommendations 1.4, 1.6 and 1.7. Published 2012; updated 2019. https://www.nice.org.uk/guidance/cg146/chapter/Recommendations