By Dr Laure Chapuis, Rheumatologist Hospital of Vitré, Rennes, France
Patient Clinical Background
Menopause at 55
Height: 147 cm
Weight: 60 Kg
Substitutive hormonal therapy: during 10 years; stopped
No bone treatment
History of fracture: 0
Fall in last 12 months: 0
Other risk factors: Primary hyperparathyroidism for 10 years with no indication for surgery (no apparent adenoma);
FRAX® 10-year fracture risk:
FRAX MOF (major osteoporotic fracture): 7,5%
FRAX Adjusted for TBS MOF: 13%
Bone Assessment & Analysis Images
Osteoporotic BMD Spine T-score (L1-L4 ): -3,8
Hip Total T-score: -2
Very low TBS Spine TBS (L1-L4): 0,919
FRAX 10-year & FRAX Adjusted for TBS Assessments
The 10 year probability of fracture (%) Adjusted for TBS
Major Osteoporotic Fracture : 13 %
* Intervention threshold based on the French «GRIO» recommendations.
Conclusion & Patient Management Decision
In this patient case, FRAX® is highly underestimated, as the lowest BMD measurement is of lumbar spine. TBS value is very low, therefore FRAX Adjusted for TBS is increased significantly, reflecting this highest risk. This leads to a change in the therapy and indication to go for surgery if possible for this patient.
In this case, TBS also replaces forearm measurement that is generally less reliable in case of osteoporosis with primary hyperparathyroidism.