There's a new way to calculate long-term risk of hip fracture or other major bone breaks. An online tool created by the World Health Organization takes into account bone density as well as nine specific risk factors, such as smoking, alcohol use and family history.
After Rosemarie Moenster, a 65-year-old teacher in Cincinnati, received her results from a bone-density scan, she was terrified.
"I had this picture of my bones like cottage cheese, just falling apart," she recalls.
Moenster's anxiety was born of one number: a "T-score" reading. This is a measure of an individual's bone-mineral density compared to what is found in a young, normal adult of the same sex.
Moenster's T-score was low enough to justify treatment with osteoporosis drugs. Her physician prescribed two medicines. One was Actonel, which helps to rebuild bone. The other was Evista, a drug that prevents bone loss by changing the way the body responds to hormones. Both are approved by the FDA for the prevention and treatment and osteoporosis.
But when she started experiencing complications, Moenster stopped taking Actonel. She made an appointment to see Dr. Nelson Watts, who directs the Bone Health and Osteoporosis Center at the University of Cincinnati.
During her appointment, Watts asked Moenster a series of questions, touching on nine known risk factors, including smoking, alcohol use, prescription steroid medications, rheumatoid arthritis, untreated thyroid disease and previous fractures as an adult.
Watts also entered into his computer a bone mineral density from a reading in her hip. The computer then ran an algorithm.
"When we push that button that says calculate," he said, "it gives up the 10-year probability of fracture."
The two numbers that appeared on the screen were surprisingly good news for Moenster. Her risk of hip fracture over the next decade is less than 1 percent. For other major breaks, her risk is 12 percent.
"We're getting a thumbs up," Watts said.
"I'm really happy," Moenster said, "because when I came here I was scared to death."
The National Osteoporosis Foundation guidelines call for treating patients with osteoporosis drugs if their 10-year risk of hip fracture is 3 percent or higher, or if their risk of other major fractures in the spine, shoulder or arms is 20 percent or more.
Watts said Monster's numbers clearly fall under these thresholds.
"And so we concluded it was safe for her to stay off the medication she'd stopped," he said.
Moenster decided to continue taking one medicine, Evista. She sees it as an insurance policy. But she adds that with a more accurate analysis of her long-term risks, she no longer pictures her bones turning to cottage cheese.
Watts describes the new risk-fracture algorithm as a step in the right direction in refining the diagnosis and treatment of osteoporosis.
"Bone-density testing is commonly offered to the worried well," he said. Yet, many older adults at higher risk of the disease still go untreated.
The new fracture-risk tool may help assure the "worried well" that they don't need medicines if their risks are low. It may also help people with the highest fracture risk get the treatment they need.