One of the most important advances in osteoporosis management of the past decade has been the advent of fracture risk assessment algorithms. Today, rather than relying on bone mineral density values alone, doctors use tools such as FRAX, a widely available calculator, to help identify patients in need of treatment.

A new position paper by the International Osteoporosis Foundation (IOF) Epidemiology and Quality of Life Working Group has assessed the uptake of FRAX worldwide. The study concludes that there were approximately 2.3 million FRAX calculations during a one-year period beginning in May 2012, with enormous variation in worldwide usage.

What is FRAX?

FRAX (WHO Fracture Risk Assessment Tool) calculates an individual's 10-year probability of a major osteoporotic fracture based on clinical risk factors. It integrates the weight of clinical risk factors for fracture and mortality risk, with or without information on bone mineral density (BMD) values. Each calculator is country specific, calibrated to the national epidemiology of fracture and mortality.

Now with specific models for 53 countries, FRAX is widely used by physicians around the world to help assess their patients' fracture risk in the course of a clinical assessment. The use of the tool improves risk assessment compared to the use of BMD alone, allowing physicians to make more informed treatment decisions.

Women who use postmenopausal hormone replacement therapy (HRT) may be at increased risk of acute pancreatitis, found a new study in CMAJ (Canadian Medical Association Journal).

Acute pancreatitis, a sudden inflammation of the pancreas, has symptoms that range from mild discomfort to severe, debilitating pain and may, in some cases, even lead to death.

Although several case reports have indicated that there may be an association between use of HRT and risk of acute pancreatitis, the evidence from large studies is sparse. To understand whether there is an association, the researchers looked at data on 31 494 Swedish postmenopausal women aged 48 years at the start of the 13-year study from 1997 to 2010. At the start of the study, 13 113 (42%) of the women were current users of HRT, 3660 (12%) were previous users, and the remainder had never used the therapy. Of the current users of HRT, 6795 (52%) used systemic therapy for hot flashes, 4148 (32%) used local therapy for vaginal dryness, and 2170 (16%) used both therapies.