Beyond FRAX®: It's Time to Consider “Sarco-Osteopenia”

A dictionary definition of ‘‘frail’’ includes easily broken, fragile, and physically weak, the descriptors often used to explain osteoporotic bone. However, physicians recognize that it is not simply bone abnormalities, but rather the simultaneous presence of muscle and bone weakness, often associated with overall frailty, which contributes to high fracture risk in their older patients. How can clinicians optimally identify which patients are at highest risk for fracture? Bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) has been a key advance in care for patients at risk for fragility fracture. Although DXA-measured BMD is excellent at identifying those at higher risk, its use alone is not optimal and including clinical factors improves fracture risk estimation. To this end, the World Health Organization (WHO) FRAX tool improves targeting of pharmacologic therapy by combining clinical risk factors and estimating 10-yr fracture probability. Clearly, fracture risk increases dramatically with advancing age (1); that this risk markedly increases at the same BMD is easily quantified using FRAX (depicted in Fig. 1). We recognize the major contribution of FRAX to patient care and further suggest, in addition to using FRAX , that the time has come for clinicians to consciously recognize muscle weakness as a