••• CHAPTER 33^ Menopause^325
❍ How does age relate to fracture risk and T score?
As age increases fracture risk increases at the same T score.
❍ Does the T score fully explain the fracture risk at one particular site?
No. There are other characteristics that impact bone strength that are difficult to measure.
❍ What is the Fracture Risk Assessment tool (FRAX)?
An online tool developed by the World Health Organization to predict an individual’s 10-year fracture risk. It can
be used with or without a bone mineral density result. It is used to help guide in treatment decisions.
❍ What impacts bone strength?
Bone quality, bone turnover, and microarchitecture.
❍ Can you see a normal T score at one site and osteoporosis at another site in the same patient?
Yes.
❍ What T score is considered normal?
Above –1.0 (WHO).
❍ What T scores suggest low bone mass, or osteopenia?
Between –1.0 and –2.5.
❍ What T score represents osteoporosis?
Less than –2.5.
❍ What is severe osteoporosis?
A T score of –2.5 or below with a previous fracture.
❍ When should treatment be started for osteoporosis?
When the T score at the A-P spine or hip is –2.0 or lower without risk factors, or –1.5 or lower with risk factors
(NOF Guidelines).
❍ What are biochemical markers of bone formation?
Bone-specific alkaline phosphatase and osteocalcin.
❍ What are the biochemical markers for bone resorption?
Pyridinoline, N-telopeptides, and c-telopeptides.
❍ Are biochemical markers usually used in individual patients to help diagnose osteoporosis?
No. They are used more in research in large groups of patients to evaluate how effective a drug is regarding its
effect on bone.