Someone recently sent me a New York Times article I’d missed about the controversy over WHO’s FRAX tool. The article makes the point that FRAX uses only a few risk factors and doesn’t account for many, many others — including vitamin D deficiency, use of bone-eroding medications, and amount of physical activity — in determining whether a person should take drugs for their bone health.
I’m glad to finally see this point being made in the mainstream media! While FRAX represented the first step toward the idea that different people have different levels of risk for bone loss, it’s fairly rudimentary — like bashing a nail with a big rock because you don’t have a hammer. Our more comprehensive Bone Health Profile looks not only at the categories FRAX examines (in greater depth, in some cases), but also at diet, other health issues, menopause status (for women), and emotional factors like stress and worry.
Another big concern cited by the article is that FRAX itself was not meant to dictate who should be prescribed bone drugs. WHO left the decision to treat to individual physicians, and in many countries osteoporosis organizations propagated their own guidelines. In the U.S., the National Osteoporosis Foundation (NOF) developed treatment guidelines based on FRAX. The NOF recommends treatment when FRAX projects a 10-year fracture risk of more than 3% for hip fracture, or 20% combined risk of fractured hip, vertebrae, shoulder, or wrist.
At the Center for Better Bones, we see several problems with the NOF guidelines. One is that the cut-off bar for treatment is too low, and even worse, in the doctor’s office “treatment” is almost always defined as drugs (FDA-approved medical therapies)! Further, the NOF guidelines miss the point that one does not have to fracture just because they have a 3% or even 20% risk of doing so over the next 10 years. Seeking out the causes of bone weakness, correcting these causal factors, and undertaking a strong nutrition and lifestyle program, one can build bone strength and avoid needless fracture without pharmacological agents.
We at the Center for Better Bones believe that there are many causes of osteoporosis. Finding these causes and working with nature to correct them are most often the best ways to “treat” those at risk of fracture.When individuals are motivated to take charge of their bone health, they can substantially alter their fracture risk within a few years, never mind an entire decade. That’s what my Better Bones, Better Body book and the Personal Program for Better Bones are all about. I’m sorry to see that the New York Times didn’t make that point — that your risk of fracture isn’t something carved in stone, as FRAX would have you believe. I think physicians really need to understand that instead of offering drugs at the drop of a hat.