腎と骨代謝 Vol.24 No.4(1)


特集名 骨粗鬆症診療の進歩
題名 骨粗鬆症における骨折リスクの評価とFRAX®
発刊年月 2011年 07月
著者 藤原 佐枝子 放射線影響研究所臨床研究部
【 要旨 】 骨折高リスク者を効率的に判別して骨粗鬆症治療開始することは,骨折の有効な予防戦略となる.WHO FRAX ®は,骨密度と臨床的危険因子,あるいは臨床的危険因子のみで個人の10年間の骨折確率(%)を求めるツールで,治療介入の必要な骨折高リスク者を判別する目的で作成された.わが国では,『骨粗鬆症の予防と治療ガイドライン2006年版』の薬物治療開始基準に,「骨量減少かつFRAX ®で計算された骨粗鬆症性骨折確率15%以上」を組み込んだ.ただし,これを適応するのは,「男性,75歳未満の女性」という条件が付加された.FRAX ®は,骨密度がなくても,身長,体重および臨床的危険因子を入力すれば,骨折確率を計算できるので,診療現場においても,治療すべき潜在的な骨折高リスク者をみつけるスクリーニングツールとして活用が期待される.
Theme Progress in the management of osteoporosis
Title Assessment of osteoporotic fracture risk and FRAX®
Author Saeko Fujiwara Department of Clinical Studies, Radiation Effects Research Foundation
[ Summary ] Identifying persons at high risk of bone fracture and initiating treatment in these individuals is an effective strategy for prevention of osteoporotic fractures. The WHO's Fracture Risk Assessment Tool (FRAX ®) was developed to identify individuals at high risk of bone fracture, requiring medical intervention. This is accomplished by calculating each individuals' 10‒year probability (%) of bone fractures based on bone mineral density and clinical risk factors, or clinical risk factors alone. The standard definition : "decreased bone density and FRAX‒based probability of osteoporotic fractures of 15 % or more" was added to the intervention criteria in Japan's "Guidelines for Prevention and Treatment of Osteoporosis (2006 version)." However, since more than 90% of elderly women aged 75 years or older have fracture probability of 15 % or higher, a condition has been added to apply this standard to all men and to women younger than 75. Fracture probability can be calculated, even without bone density data, by entering a subject’s height, weight and risk factors using FRAX. Widespread use of FRAX is expected to contribute to fracture prevention in the elderly through identification of potential high fracture risk patients who would benefit from treatment.
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