title: Time to Clinically Relevant Fracture Risk Scores in Postmenopausal Women.
abstract: Clinical practice guidelines recommend use of fracture risk scores for screening and pharmacologic treatment decisions. The timing of occurrence of treatment-level (according to 2014 National Osteoporosis Foundation guidelines) or screening-level (according to 2011 US Preventive Services Task Force guidelines) fracture risk scores has not been estimated in postmenopausal women.
  
  
  
  We conducted a retrospective competing risk analysis of new occurrence of treatment-level and screening-level fracture risk scores in postmenopausal women aged 50 years and older, prior to receipt of pharmacologic treatment and prior to first hip or clinical vertebral fracture.
  
  
  
  In 54,280 postmenopausal women aged 50 to 64 years without a bone mineral density test, the time for 10% to develop a treatment-level FRAX score could not be estimated accurately because of rare incidence of treatment-level scores. In 6096 women who had FRAX scores calculated with bone mineral density, the estimated unadjusted time to treatment-level FRAX ranged from 7.6 years (95% confidence interval [CI], 6.6-8.7) for those aged 65 to 69, to 5.1 years (95% CI, 3.5-7.5) for those aged 75 to 79 at baseline. Of 17,967 women aged 50 to 64 with a screening-level FRAX at baseline, 100 (0.6%) experienced a hip or clinical vertebral fracture by age 65 years.
  
  
  
  Postmenopausal women with sub-threshold fracture risk scores at baseline were unlikely to develop a treatment-level FRAX score between ages 50 and 64 years. After age 65, the increased incidence of treatment-level fracture risk scores, osteoporosis, and major osteoporotic fracture supports more frequent consideration of FRAX and bone mineral density testing.
authors.affiliation: Department of Family Medicine, University of North Carolina, Chapel Hill. Electronic address: margaret_gourlay@med.unc.edu.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Gourlay
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Overman
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Fine
authors.affiliation: Department of Medicine, University of California, Los Angeles.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Crandall
authors.affiliation: Department of Internal Medicine, University of California at Davis, Sacramento.
authors.forename: John
authors.initials: J
authors.lastname: Robbins
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: Department of Medicine, Division of Epidemiology, University of Minnesota, Minneapolis; Department of Medicine, Minneapolis VA Health Care System, Minn.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Ore.
authors.forename: Erin S
authors.initials: ES
authors.lastname: LeBlanc
authors.affiliation: Cleveland, Ohio.
authors.forename: Margery L
authors.initials: ML
authors.lastname: Gass
authors.affiliation: Department of Preventive Medicine and Medicine, University of Tennessee Health Science Center, Memphis.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: Department of Preventive Medicine and Medicine, University of Tennessee Health Science Center, Memphis.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Womack
authors.affiliation: Division of Epidemiology, School of Medicine, University of California at San Diego.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D058866:Osteoporotic Fractures / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors
keywords: Bone density; Fractures; Menopausal; Osteoporosis/epidemiology; Risk assessment