In 2005, Osteoporosis Canada, in association with the Canadian Association of Radiologists, launched the 10-year absolute fracture risk assessment – CAROC.
In addition to BMD (lowest T-score of hip and lumbar spine), age, gender, fracture history and steroid use are taken into consideration to determine an individual’s 10-year risk of fracture.
The presence of both a fragility fracture and steroid use puts the patient at high fracture risk regardless of BMD result.
Version 2, now available for Canadian physicians, uses only femoral neck (hip) BMD rather than the lowest of hip and lumbar spine.
Table 1 – 10 year fracture risk for women
Table 2 – 10 year fracture risk for men
The 10-year fracture risk will change with advancing age or with the development of new risk factors. Repeat assessment is appropriate in five to 10 years in those with low risk and in one to five years in those with moderate risk.
In 2008, the World Health Organization (WHO) launched the FRAX tool (Fracture Risk Assessment) – www.shef.ac.uk/FRAX. In 2010 Canadian data were added to this tool. In addition to femoral neck (hip) BMD, age, gender, fracture history and steroid use, FRAX also takes into account other clinical risk factors to calculate the absolute 10-year risk of a hip fracture or other major osteoporotic fracture (spine, forearm, upper arm). These factors include:
BMI (weight to height ratio calculation)
Parental hip fracture
Other secondary conditions that contribute to bone loss
Alcohol intake (three or more drinks per day)
The FRAX system is based upon a more complete set of clinical risk factors and it can be used without BMD results; but it requires access to FRAX software, website or paper chart.
CAROC is less complete but captures the major risk factors for fracture and is easy to use.
For the majority of people, the results are the same regardless of which of these tools is used. Therefore the choice of FRAX or CAROC by the clinician is a matter of personal preference and convenience.