FRAX

So if someone went to a healthcare professional and said, "I'm worried about my bones," they may well start by asking some of those questions 'cause that gives a good idea of someone's risk.

FRAX is the one that we often use, F-R-A-X.

You know, you can just Google FRAX and it'll, it'll come up and ask you a load of questions.

And if you've got your bone density results, then you can put that in, but it will give you a number, and that is probably the way that a lot of people are trying to manage demand on the service as best they can.

So I'd love to start talking about what you can do, and actually I think this feels like the first place to start with.

Right.

Using the standard FRAX tool blindly when a patient starts steroids.

Oh, we see this constantly.

All the time.

But we are flying blind if we do not manually adjust those outputs.

That’s right.

The critical limitation of FRAX is that when you check that glucocorticoid box, the algorithm automatically assumes the patient is taking a medium dose of steroids.

Right.

Just wanted to take a step back and discuss a little bit about fracture risk because We have a lot of tools, but none of them were really designed with CKD patients in mind.

I'm talking about the FRAX score.

We already discussed the DEXA and also the vertebral fracture assessment.

So what is your practical approach for assessing fracture risk in CKD, either non-dialysis and dialysis, if they are a bit different?

Okay.

She has an elevated FRAX probability, but importantly, she has no recent fractures.

Yeah.

There's no feature indicating an imminent 12-month fracture crisis.

Here's what we might suggest for you from a conventional medicine doctor.

Okay, so a conventional medicine doctor will say, you have osteopenia, but let's run a secondary test called a FRAX test.

And that is spelled F-R-A-X.

It is a free kind of like open source test.

You have osteopenia.

You're, let's say, in your late 50s.

So FRAX will say you have a fairly low risk of fracture, and the doctor will probably tell you what my doctor told me because I had that exact situation.

Exercise, make sure you're getting good nutrition, and we'll check you again in some number of years.

And talk about your bone health early.

So there's something, and you can do a simple FRAX.

It's available online.

You can, it's easier to do it with a healthcare professional, but women can do it themselves, F-R-A-X.