9.6 Patient Education & Reevaluation
Key Takeaways
A T-score and a 10-year fracture probability answer different questions.
Express model estimates with a time horizon and denominator. Hip fracture is included in major osteoporotic fracture.
Agree on achievable prevention steps, who will follow up and which interval events warrant clinical review.
Use teach-back to see whether the explanation and plan are clear.
Start with what the patient wants to know
Ask what the patient understands about the scan or fracture and what they are concerned about. Use the valid skeletal region and the relevant DXA classification when discussing the result. Osteoporosis affects skeletal strength. Lower BMD is one contributor to risk, and age, prior fractures and falls can change the clinical picture. A T-score expresses how far the measured BMD is from the young-adult reference mean in standard deviations. It does not express the patient's chance of fracturing or the proportion of bone they have lost.
Explain an individual probability
Suppose a patient with low bone mass has a reported 12% 10-year probability of major osteoporotic fracture and a 3% 10-year probability of hip fracture on the appropriate FRAX model. Explain the estimated chances using a common denominator. “Over the next ten years, the estimate is about 12 in 100 for a major osteoporotic fracture, including hip fractures. The estimate for hip fracture specifically is about 3 in 100.” The major fracture endpoint also includes clinical vertebral, forearm and proximal humerus fractures. The two percentages describe overlapping outcomes. Adding them would count hip fracture risk twice.
Describe the model's limits in plain language. The estimates use the information entered and the population model selected. An individual may have clinically important details, such as frequent falls, that are not fully represented in standard FRAX. Discuss these alongside the model result. If treatment is discussed, keep baseline probability, any trial outcome and the expected benefit distinct. The Osteoporosis Choice randomized trial evaluated using individualized risk and treatment information during clinical decisions. It found better patient knowledge and engagement with the aid. That result does not allow precise predictions of benefit for every patient.
Agree on prevention and follow-up
| Part of the conversation | What to cover |
|---|---|
| Current risk | Connect valid DXA, any previous fracture and other risks. Ask about falls, medicines and functional concerns. |
| Prevention | Discuss accessible sources of calcium and vitamin D as appropriate, an achievable activity plan and practical fall prevention. Agree on one action the patient can start. |
| Treatment | Describe the options under consideration and their expected benefits, risks, administration and follow-up. Check whether timing, side effects or access would interfere. |
| Reevaluation | Agree who will review the results and when. Explain which new events should prompt contact before the planned visit. |
For a patient who has had two falls and is afraid to walk outside, address that concern before prescribing a generic activity target. Agree on a gait and balance review and identify a safe way to stay active. If a patient is considering a medication, discuss the indication and ask about route, schedule and access. Use the medication-specific instructions. For example, for a patient already receiving denosumab, discuss how to keep scheduled doses and whom to contact if a dose may be delayed. Arrange a clinician-guided transition if stopping is considered.
Explain that follow-up DXA is useful when the result could change care, and that the timing depends on treatment, clinical risk and expected change. A new low-trauma fracture, significant new back pain, new falls or height loss may warrant earlier contact or clinical assessment. A scan scheduled for next year does not replace assessment of an interval event. Agree on whom the patient should contact and document the plan. Keep the patient informed about who will interpret the scan and discuss the clinical decisions.
Check understanding with teach-back
Ask the patient to explain in their own words what the result means and what they will do next. For example, “How would you explain what the 3 in 100 means, and who would you call if you had another fall with persistent pain?” If the patient says the risk is 3% each year, explain the ten-year time horizon again and ask them to restate it. If they cannot name the follow-up contact, write it down and confirm how to reach them. Offer an interpreter or accessible written summary where helpful. The goal is to verify the clarity of the explanation and make the agreed plan actionable.
ISCD Adult Official Positions · FRAXplus calculator and risk factors · BHOF Clinician’s Guide · Osteoporosis Choice trial · AHRQ teach-back tool · Prolia prescribing information
A patient’s FRAX report gives 12% major osteoporotic and 3% hip fracture probabilities. Which explanation is accurate?
About 12 in 100 over ten years for major osteoporotic fracture and 3 in 100 for hip fracture. Hip is included in the major fracture endpoint.
About 15 in 100 over ten years because the two outcomes do not overlap.
The chance of a hip fracture is 3% in each of the next ten years.
The probabilities express how much bone density the patient has lost.
A patient says they will wait until next year’s DXA even if they develop persistent back pain after a fall. How should the plan be clarified?
Confirm that reassessment must wait until the DXA appointment.
Tell them that back pain can never be related to skeletal fragility.
Explain whom to contact for earlier clinical assessment after an interval fall with persistent pain, then use teach-back.
Advise them to stop all osteoporosis medicines after any fall.
A patient says a T-score of −2.6 means they have lost 26% of their bone. What explanation is appropriate?
It represents a 26% ten-year fracture risk.
It describes the BMD difference from a reference mean in standard deviations. Review the clinical risk separately.
It represents the absolute reduction in BMD from the patient’s own previous DXA.
It is a measure of the proportion of trabeculae that have fractured.
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