A lower FRAX score, but at a younger age, may also require treatment or at least a doctors supervision. Healthline Media does not provide medical advice, diagnosis, or treatment. Calcs that help predict probability of a disease, Subcategory of 'Diagnosis' designed to be very sensitive, Disease is diagnosed: prognosticate to guide treatment. This T-score shows how much your bone density is compared to a healthy 30-year-old adult. Osteoporosis, in which low bone mass and micro-structural deterioration of bone tissue lead to increased bone fragility, is the most common metabolic bone disease in the United States. Cadarette (2004) Osteoporos Int 15(5):361-366 [PubMed] The FRAX questionnaire includes only 12 items. We avoid using tertiary references. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. A DEXA scan measures your bone mineral density (BMD). If you are shorter or taller, enter the minimum or maximum, knowing that the results will be an estimate. Enter yes if the patient is currently exposed to oral glucocorticoids or has been exposed to oral glucocorticoids for more than 3 months at a dose of prednisolone of 5mg daily or more (or equivalent doses of other glucocorticoids) (see also notes on risk factors). MDCalc - Medical calculators, equations, scores, and guidelines Creatinine Clearance (Cockcroft-Gault Equation) Calculates CrCl according to the Cockcroft-Gault equation. This may be asking you to have a bone scan, or talking to you about measures that can help prevent osteoporosis. The osteoporosis self-assessment tool (OST) 1 in women is a simple formula that predicts risk of osteoporosis for the patient based solely on current weight and age. Other types of DEXA scans check a few bones, such as the hips, wrist, and spine. MDCalc loves calculator creators researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. If no medical conditions, click next. Height (cm) 5. (type 1 or type 2). Assessment of absolute fracture risk, using either the Garvan Fracture Risk Calculator or the Fracture Risk Assessment Tool (www.shef.ac.uk/FRAX) may be useful in assessing the need for treatment in individuals who do not clearly fit established criteria. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. MDCalc. Causes, symptoms, risk factors, and treatment. Shown to have greater variability in agreement when scored by medical and radiation oncologists, to whom these patients are most likely to present. address 95 Aldwych, London WC2B 4JF, United Kingdom. MICHAEL P. JEREMIAH, MD, BRIAN K. UNWIN, MD, MARK H. GREENAWALD, MD, AND VINCENT E. CASIANO, MD. The FRAXtool has been developed to evaluate fracture risk of patients. The tool was developed to evaluate a patient's 10-year probability of hip fracture and major osteoporotic fracture (clinical spine, forearm, hip, or shoulder fracture). WebMD does not provide medical advice, diagnosis or treatment. This is not taken into account and the computations assume average exposure. During the test, you lie down and a scanner passes over your body. RA is a risk factor for fracture. By checking this box, you are confirming that you live in the US and you are opting in to receive your Fracture Risk Calculator results and information about managing bone health via email. Follow this link for information on the tool:http://www.garvan.org.au/bone-fracture-risk/, Osteoporosis, New Zealand, Age (between 40 and 90 years) or Date of Birth Age: Date of Birth: Y: M: D: 2. Your FRAX score is your risk of having an osteoporosis-related fracture in the next 10 years. Bisphosphonates. A fracture detected as a radiographic observation alone (a morphometric vertebral fracture) counts as a previous fracture. nof.org/preventing-fractures/general-facts/bone-basics/are-you-at-risk/, nof.org/patients/diagnosis-information/bone-density-examtesting/, iofbonehealth.org/diagnosing-osteoporosis, menopause.org/for-women/menopauseflashes/bone-health-and-heart-health/frax-sup-sup-a-tool-for-estimating-your-fracture-risk, mayoclinic.org/diseases-conditions/osteoporosis/diagnosis-treatment/drc-20351974, 7 Things You Can Do Today to Prevent Osteoporosis. The impact of fractures includes loss of function, significant costs, and increased mortality. . Dr. John A Kanis Professor Emeritus, University of Sheffield Randomized clinical trials demonstrate a reduction of vertebral and hip fractures with alendronate (Fosamax) and risedronate (Actonel).16,26 Alendronate and risedronate also decrease vertebral fractures in men30,31 and in patients with glucocorticoid-induced osteoporosis.32,33 Daily and intermittent use of ibandronate (Boniva) have demonstrated effectiveness in reducing fractures of the spine only.34 Weekly and monthly dosing formulations improve adherence.35 Oral bisphosphonates should be taken only with water and a wait of at least 30 minutes before reclining or ingesting other medication or food. For the FRAX calculator, answer "yes" if you generally drink more than 2 drinks/day. This is a corrected version of the article that appeared in print. Low insulin levels in childhood or adolescence may lead to weaker bones and an increased risk of fractures in adulthood. The FRAX calculator is a major achievement in terms of our understanding of measuring fracture risk. Professional Reference tools are designed for health professionals to use. Consuming more than 2.5 units of caffeine daily (1 unit = one cup of coffee or two cups of tea) may increase fracture risk.24 Diets with adequate protein intake are necessary for optimal bone health, but the proper amount or source (plant vs. animal) remains controversial. Genetics is one of the most important factors that determine your risk of fractures. However, osteoarthritis is, if anything, protective. Fracture probability is also underestimated with multiple fractures. Personal details (such as height and weight, medication history, smoking history and family history) are entered to predict whether someone is at risk of developing osteoporosis in the next 10 years. Enter "Yes" if you currently smoke any quantity of cigarettes, cigars, or pipes. In patients with newly diagnosed osteoporosis, suggested laboratory tests to identify secondary causes include serum 25-hydroxyvitamin D, calcium, creatinine, and thyroid-stimulating hormone. if you break any bone (except fingers and toes) from a trip or fall on level ground after age 45, you are twice as likely to break another bone! This content is owned by the AAFP. or to the WHO Collaborating Centre after it finished its work in 2010 are incorrect. In their most sophisticated form, the FRAXtool is computer-driven and is available on this site. Copyright 2015 by the American Academy of Family Physicians. If you are younger than 45, click here to take the Bone Health Quiz, If you are a Health Care Professional filling this out. Renal insufficiency is a listed caution, but denosumab appears to be safe for patients with chronic kidney disease stages 1 to 3.45, Hormone Therapy. Male Female Age Fractures since the age of 50 (excluding major trauma, e.g. The FRAX tool has been developed to evaluate fracture risk of patients. Learn about infusion options for treating osteoporosis and how they compare to other treatment options. 3. Clinical judgment should be used for low or high exposures. You can learn more about how we ensure our content is accurate and current by reading our. For this reason reliance should not be placed on a patient's report of 'arthritis' unless there is clinical or laboratory evidence to support the diagnosis. If you are thinner or heavier, enter the minimum or maximum, knowing that the results will be an estimate. Bisphosphonates should be used as first-line pharmacologic treatment for osteoporosis. 1.3 Estimate absolute risk when assessing risk of fracture (for example, the predicted risk of major osteoporotic or hip fracture over 10 years, expressed as a percentage). Had multiple osteoporosis-related fractures. And if youve been taking glucocorticoids for a long time, talk with your doctor about whether you can cut back or stop taking those medications altogether. Explaining annual updates We release a new version of QRISK every spring, usually in April. English | Arabic | Bengali | Chinese Simplified | Chinese Traditional | Croatian | Czech | Danish | Dutch | Estonian | Farsi | Finnish | French | Georgian | German | Greek | Icelandic | Italian | Indonesian | Japanese | Korean | Lithuanian | Norwegian | Polish | Portuguese (Portugal) | Portuguese | Romanian | Russian | Serbia | Slovak | Spanish | Swedish | Thai | Turkish | Ukrainian, Individuals with fracture risk assessed since 1st June 2011, Age (between 40 and 90 years) or Date of Birth, Centre for Metabolic Bone Diseases, University of Sheffield, UK. You are also at an increased risk of falling and fracturing because of blood sugar levels, declining vision, associated peripheral neuropathy and nerve damage. A FRAX score of more than 5 percent for a hip fracture, at age 70 and beyond, means you should consider treatment along with lifestyle changes. Family history of broken bones means you are at higher risk. Check all that apply.Check all that apply. One study suggests that it is advisable to follow teriparatide therapy with bisphosphonate therapy to maintain BMD gains.43, Denosumab. Standardized osteoporosis risk factor calculator - The z-score is the number of standard deviations away from the average value they calculate the risk of. In a dose of 60 mg given subcutaneously every six months for three years, it significantly increased BMD in postmenopausal women compared with weekly dosing of alendronate.44 Denosumab has been shown to decrease hip, vertebral, and nonvertebral fractures compared with low doses of calcium and vitamin D. It appears to be a reasonable alternative for persons whose condition does not improve with bisphosphonates. If you do not know your Femoral Neck T-score, leave this field blank and click next. 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). The U.S. Preventive Services Task Force recommends using dual energy x-ray absorptiometry to screen all women 65 years and older, and younger women who have an increased fracture risk as determined by the FRAX Fracture Risk Assessment Tool. official version of the modified score here. 1. Has your mother or father had a hip fracture? These include type I (insulin dependent) diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition, or malabsorption and chronic liver disease. Do not routinely repeat dual energy x-ray absorptiometry (DEXA) scans more often than once every two years. All rights reserved. This osteoporosis risk score calculator stratifies osteoporosis risk, especially useful in women with low bone density. The filter allows the FRAX score into the DXA report only when the patient does not meet the first two of the NOF treatment criteria (prior hip or vertebral fracture or T-score below 2.5) but could possibly meet the third NOF treatment criterion based on FRAX risk calculation: an untreated postmenopausal woman or man age 50 years or older . International Index of Erectile Function (IIEF-5) Assess erectile dysfunction. English | Arabic | Bengali | Chinese Simplified | Chinese Traditional | Croatian | Czech | Danish | Dutch | Estonian | Farsi | Finnish | French | Georgian | German | Greek | Icelandic | Italian | Indonesian | Japanese | Korean | Lithuanian | Norwegian | Polish | Portuguese (Portugal) | Portuguese | Romanian | Russian | Serbia | Slovak | Spanish | Swedish | Thai | Turkish | Ukrainian, Individuals with fracture risk assessed since 1st June 2011, Centre for Metabolic Bone Diseases, University of Sheffield, UK, Professor Emeritus, University of Sheffield, Click here to view the applications available. Upgrade to Patient Pro Medical Professional? If you do not know your Femoral Neck T-score, leave this field blank and click next. To help determine your risk for such an injury, doctors developed the Fracture Risk Assessment Tool (FRAX). These risk factors appear to have a dose-dependent effect, i.e. Glucocorticoids No Yes 9. Preventing osteoporosis can help you prevent fractures and maintain strength as you age. Women younger than 65 years should be screened for osteoporosis if the estimated 10-year fracture risk equals or exceeds that of a 65-year-old white woman with no risk factors. Long-term use of these medications is associated with several serious side effects, including fractures and jawbone deterioration. Better validated than the earlier Harrington Criteria. All information should be verified by a qualified health professional, and all use is subject to Medicalalgorithms.com Terms and Conditions. See permissionsforcopyrightquestions and/or permission requests. Once you have a BMD measurement, you can get a FRAX score. 24/7 Live Expert. A previous fracture denotes more accurately a previous fracture in adult life occurring spontaneously, or a fracture arising from trauma which, in a healthy individual, would not have resulted in a fracture. ICD-10. After initiation of treatment, the need for follow-up bone density testing is uncertain. A "standard drink" in the USA is 14 g. The FRAX asks for 3 or more units = 24 g, which is slightly less than 2 US drinks/day (28g). Usually these hormone-related therapies accompany other treatments and lifestyle improvements. People with a high. See their website for more information and to use the FRAXtool. FRAX is a clinical tool for assessing the risk of fractures in people with osteoporosis. References. Purpose: To estimate a patient's 10-year risk for osteoporotic fracture based on the FRAX WHO fracture risk assessment tool of Kanis et al. American Bone Health4208 Six Forks RoadSuite 1000Raleigh, NC 27609. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. Garvan Institute Assessment Tool The University of Sheffield launched the FRAX tool in 2008. (BMD) Please select the make of DXA scanning equipment used and then enter the actual femoral neck BMD (in g/cm2). 2005-2023 Healthline Media a Red Ventures Company. Learn strategies you can use today. Your doctor will order a bone density test. Its a painless imaging test that uses low levels of radiation. The site and reference technology is DXA at the femoral neck. The FRAX tool has been developed to evaluate fracture risk of patients. In patients without a BMD test, the field should be left blank (see also notes on risk factors) (provided by Oregon Osteoporosis Center). The current National Osteoporosis Foundation Guide recommends treating patients with FRAX 10-year risk scores of > or = 3% for hip fracture or > or = 20% for major osteoporotic fracture, to reduce their fracture risk. How Does Resistance Training Prevent Osteoporosis. Previous Fracture No Yes 6. The National Osteoporosis Foundation also recommends screening all men 70 years and older, based on the assumption that this group has a similar osteoporotic fracture risk and treatment effectiveness as 65-year-old white women.1, Primary osteoporosis is related to aging and loss of gonadal function. Thus the current osteoporosis definition is a BMD that lies 2.5 standard deviations or more below the average value for . CALCIUM - Calcium Calculator | International Osteoporosis Foundation of 2 Are you getting ENOUGH CALCIUM ? This is equivalent to a standard glass of beer (285ml), a single measure of spirits (30ml), a medium-sized glass of wine (120ml), or 1 measure of an aperitif (60ml) (see also notes on risk factors). Garvan - This Fracture Risk Calculator was developed using data collected in the internationally renowned Dubbo Osteoporosis Epidemiology Study conducted by the Bone and Mineral Research Program of Sydney's Garvan Institute of Medical Research. The U.S. Preventive Services Task Force found insufficient evidence to recommend screening for osteoporosis in men; other organizations recommend screening all men 70 years and older. What is osteoporosis and what causes it? MDCalc. FRAX: A tool for estimating your fracture risk. Several simplified paper versions, based on the number of risk factors are also available, and can be downloaded for office use. The intravenous bisphosphonates approved by the U.S. Food and Drug Administration for the treatment of postmenopausal osteoporosis are zoledronic acid (Reclast), 5 mg yearly (shown to decrease vertebral and hip fractures),16,26,36 and ibandronate, 3 mg every three months.37 Although these medications are expensive, they are useful for high-risk patients who are unable to tolerate or adhere to oral therapy. Men are also more likely to fracture a bone as they age. In general, a bone density test is recommended for women starting at age 65 and men at age 70. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients. To compare the power of FRAX without bone mineral density (BMD) and simpler screening tools (OST, ORAI, OSIRIS, SCORE and age alone) in predicting fractures. MDCalc loves calculator creators - researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. Privacy Policy. Inflammation around the joints causes bone loss; pain leads to reduced activity.Enter "Yes" if you have Rheumatoid Arthritis. [corrected] Although guidelines are lacking for rescreening women who have normal bone mineral density on initial screening, intervals of at least four years appear safe. . If left untreated, this can lead to bone diseases like. How to Interpret FRAX Score for Canada. The need for follow-up bone mineral density testing in patients receiving treatment for osteoporosis is uncertain. There is, however, an increase in vertebral fractures.38 Osteonecrosis of the jaw and atypical femoral fractures are rare complications of bisphosphonate therapy that are associated with longer duration of use.39,40 Clinicians should consider discontinuing bisphosphonate therapy after five years in women without a personal history of vertebral fractures. Do not use dual energy x-ray absorptiometry (DEXA) to screen for osteoporosis in women younger than 65 years or in men younger than 70 years with no risk factors. A decrease in BMD could suggest treatment nonadherence, inadequate calcium or vitamin D intake, an unidentified secondary cause of osteoporosis, or treatment failure.48 However, a single-institution study found that although follow-up DEXA scanning for patients with osteoporosis was performed often, this rarely led to changes in treatment, even in patients found to have decreased BMD.49. The tool can be used for the following US . Enter weight in whole pounds, rounding to the nearest pound. Cortisol and parathyroid level is increased in alcoholics and leads to calcium malabsorption. A recent survey by EB Medicine has shown that MDCalc's . - http://www.garvan.org.au/bone-fracture-risk Previously, clinicians could only estimate a 5-year fracture risk. Reduce bone loss and build stronger muscles. Patients Perspectives as a Catalyst for Action to Improving Osteoporosis Care, https://www.bonehealthandosteoporosis.org/medical-disclaimer/. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. The formula for measuring your risk uses factors such as: Osteoporosis means porous bone. Bones become more brittle, usually due to hormonal changes or reduced levels of calcium or vitamin D in the body. [ 1, 2] Osteoporosis can result in devastating physical, psychosocial, and economic consequences. Low risk - QRISK2 score of less than 10% This means that you have less than a one in ten chance of having a stroke or heart attack in the next 10 years. For the FRAX score calculator, you'll have to answer several questions about habits such as alcohol intake and other disorders you may have that are linked to osteoporosis, such as type 1. The factors include: After you or your doctor fills in all your information on the questionnaire, your FRAX score will be calculated. FRAX is a sophisticated risk assessment instrument, developed by the University of Sheffield. Search dates: April and July 2014, and May 2015. They are not currently taking osteoporosis medication. Can only be used to predict fracture risk in long bones (i.e., not in vertebral mets). Because of the bone-weakening effects of menopause, 1 out of 2 women over the age of 50 will have a fracture related to osteoporosis. Youll receive a 10-year risk percentage of a major osteoporotic fracture and a 10-year risk percentage of a hip fracture. Calculation assumes no other risk factors for Osteoporosis. Alcohol 3 or more units/day No Yes 12. These factors include: BMI (weight to height ratio calculation) Current Smoking No Yes 8. Objective. FRAX is administered by a health care provider and can be used for those who meet certain conditions: For the FRAX score calculator, youll have to answer several questions about habits such as alcohol intake and other disorders you may have that are linked to osteoporosis, such as type 1 diabetes. For these groups, the International Society for Clinical Densitometry recommends use of the z score (age and sex norms). The QRISK 3 algorithm calculates a person's risk of developing a heart attack or stroke over the next 10 years. [corrected] Although guidelines for rescreening women with normal initial screening results are lacking, recent evidence suggests that intervals of at least four years appear safe.8,9, The USPSTF found insufficient evidence to recommend routine screening for osteoporosis in men.5 Men with a minimal trauma fracture who are older than 50 years or those with secondary causes associated with bone loss could be considered for screening. Your test result is reported using T-scores. GlobalRPH has a medcalc for every major clinical specialty including: Cardiology, Critical Care, Dermatology, Endocrinology, Gastroenterology and Hepatology, Geriatrics, Hematology, Infectious Disease, Neurology, Nephrology, Nutrition (TPN, BMR calculators, Fiber), Oncology, Pain Management, Pharmacokinetics, Psychiatry, Rheumatology, Statistics, Inflammatory diseases like Lupus and Rheumatoid Arthritis that require more than 5 milligrams/day of steroids cause rapid bone loss by affecting the bone remodeling process. Otherwise enter no (see also notes on risk factors). Did you recently attend an American Bone Health event? While the original paper describes the size of the lesion as a percentage of the cortex, in practice it is classified as a percentage of the width (diameter) of the bone at that level. About 60% of your bone density is a result of genetics. Height must be between 4 feet 8 inches and 6 feet 4 inches. You can lower your score and your risk right away by quitting cigarettes and cutting back on your alcohol consumption. Other perimenopausal or postmenopausal women with risk factors for osteoporosis if willing to consider pharmacologic interventions: Excessive consumption of alcohol (> 2 drinks per day for women), Low body weight (< 58 kg [128 lb] or body mass index < 20 kg per m, Any history of long-term systemic glucocorticoid therapy ( 3 months), American College of Obstetricians and Gynecologists, Bone density screening no more than once every two years beginning at 65 years of age, unless new health risks develop, Selective screening in women younger than 65 years if they are postmenopausal and have other osteoporosis risk factors or fracture, In the absence of new risk factors, DEXA monitoring of therapy should not be repeated after BMD is determined to be stable or improved, In women 65 years and older and in men 70 years and older, In postmenopausal women and men 50 to 69 years of age; recommended based on risk factor profile, With vertebral imaging in those who have had a fracture to determine degree of disease severity, At DEXA facilities using accepted quality assurance measures, In women 65 years and older and in men 70 years and older to diagnose vertebral fractures if T-score is 1.5, In women 70 years and older and in men 80 years and older to diagnose vertebral fractures, regardless of T-score, In postmenopausal women and men 50 years and older with a low-trauma fracture, In postmenopausal women and men 50 to 69 years of age to diagnose vertebral fractures if there is height loss 4 cm (1.5 in), or recent or ongoing long-term glucocorticoid therapy, To check for causes of secondary osteoporosis, BMD testing one to two years after initiating therapy to reduce fracture risk and every two years thereafter, More frequent testing in certain clinical situations, Longer interval between repeat BMD tests for patients without major risk factors and who have an initial T-score in the normal or upper lowbone mass range, Risk factors: glucocorticoid use (> 3 months cumulative therapy in past year), high-risk medication use, hypogonadism or premature menopause (age < 45 years), malabsorption syndrome, hyperparathyroidism, other associated disorders, Low body weight (< 60 kg [132 lb]) or weight loss (> 10% of weight at 25 years of age), Vertebral fracture or osteopenia on radiography, Repeat BMD testing in one to three years and reassess risk in moderate- and high-risk groups, United Kingdom National Osteoporosis Guideline Group, Case finding for BMD assessment is based on risk factor assessment and comparison of risk to age- and sex-specific fracture probabilities, Screen for osteoporosis in women 65 years and older, and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors, Current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men, Central nervous system disorders (e.g., epilepsy, multiple sclerosis, Parkinson disease, spinal cord injury, stroke), Endocrine/metabolic disorders (adrenal insufficiency, athletic amenorrhea, Cushing syndrome, hemochromatosis, homocystinuria, primary hyperparathyroidism, hyperprolactinemia, hyperthyroidism, primary or secondary hypogonadism, premature menopause, thyrotoxicosis, type 1 diabetes mellitus), Gastrointestinal disorders (celiac disease, gastric bypass, inflammatory bowel disease, malabsorption, pancreatic insufficiency, primary biliary cirrhosis), Hematologic disorders (hemophilia, leukemia and lymphomas, monoclonal gammopathies, multiple myeloma, sickle cell disease, thalassemia), Human immunodeficiency virus infection or AIDS, Nutrition disorders (alcoholism, anorexia nervosa/bulimia, malnutrition, vitamin A excess, vitamin D deficiency), Anticonvulsants (e.g., phenobarbital, phenytoin [Dilantin]), Gonadotropin-releasing hormone agonists and antagonists, Thiazolidinediones (e.g., pioglitazone [Actos]), 4 drinks per day for men or 2 drinks per day for women, 2.5 cups of coffee or 5 cups of tea per day, Multicomponent exercise with strength and balance training, Consider drug discontinuation after 5 years in low-risk patients, Small risk of atypical femoral shaft fractures; osteonecrosis of the jaw, Alendronate/cholecalciferol (Fosamax Plus D), Muscular and joint pains; small risk of osteonecrosis of the jaw (especially older women with poor dental hygiene or cancer) Contraindications: hypocalcemia; pregnancy. It uses risk factors in addition to DXA measurements for improved fracture risk estimation. Check all that apply. However, the addition of ethnic databases may not fully distinguish the variability of racial, ethnic, and national origins of the Hispanic community in the Unites States. The American Bone Health Fracture Risk Calculator Version 3.0 estimates fracture risk for women and men over age 45. A diagnosis of osteoporosis isnt a guarantee that youll have a fracture. It has been shown to decrease the occurrence of vertebral compression fractures only.16,26 Although calcitonin has modest analgesic properties in the setting of acute and chronic vertebral compression fracture, it is not considered first-line treatment for osteoporosis because more effective medications are available.16,41 There have also been reports of increased cancer rates associated with use of calcitonin.42, Teriparatide. Enter "No" if you have other kinds of arthritis, such as osteoarthritis. 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