Please answer the questions below to calculate the ten year probability of fracture with BMD.

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Personalized bone health summary and potential options

Date:         

Results

Based on your risk factors, we have estimated your:
                         10-year osteoporotic fracture risk to beand your 10-year hip fracture risk to be.

If you were to take VitD and Calcium, it is estimated to reduce your risk of:
Osteoporotic fractures byand hip fractures by.
This reduces your 10-year osteoporotic fracture risk toand your 10-year hip fracture risk to.

If you were to take a bisphosphonate medication it is estimated to reduce your risk of:
Osteoporotic fractures byand hip fractures by.
This reduces your 10-year osteoporotic fracture risk toand your 10-year hip fracture risk to.

General advice

1. Reduce your risk for falls - having a fall is the single greatest risk for breaking a bone.
Information on ways to limit your fall risk is available for free at the following website:
http://www.cdc.gov/HomeandRecreationalSafety/Falls/WhatYouCanDoToPreventFalls.html

2. Use proper technique when lifting: keep your back straight rather than bent.
Also, consider whether the object to be lifted can be divided into smaller portions before lifting.

3. Maintain an active lifestyle and include activities to improve leg strength and balance
For example by walking 30-60 total minutes daily.

4. Ensure adequate daily intake of both calcium (generally about 1000-1200 total mg/day)
and vitamin D (about 800 IU/day)

Things to consider if you are considering taking a bisphosponate medication:

Biphosphonates must be taken once a week, on an empty stomach in the morning,
while upright (sitting or standing for 30 min), 30 minutes before eating or taking other medicines.

Potential side effects

Abdominal Problems
About 1 in 4 people will have heartburn, nausea, or belly pain. However, it may not be from
the medication. If the medication is the cause, the problem will go away if you stop taking it.
Osteonecrosis of the Jaw
Fewer than 1 in 10,000 (over the next 10 years) will have bone sores of the jaw that may need surgery.
Bone breaks because of the medicine
About 1 in 10,000 people who have used the medicine for more than 5 years will break a bone
in their leg because of the medicine.

Risk factors

For the clinical risk factors a yes or no response is asked for. If the field is left blank, then a "no" response is assumed. See also notes on risk factors.

The risk factors used are the following:

Age	The model accepts ages between 40 and 90 years. If ages below or above are entered, the programme will compute probabilities at 40 and 90 year, respectively.
Sex	Male or female. Enter as appropriate.
Weight	This should be entered in kg.
Height	This should be entered in cm.
Previous fracture	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. Enter yes or no (see also notes on risk factors).
Parent fractured hip	This enquires for a history of hip fracture in the patient's mother or father. Enter yes or no.
Current smoking	Enter yes or no depending on whether the patient currently smokes tobacco (see also notes on risk factors).
Glucocorticoids	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).
Rheumatoid arthritis	Enter yes where the patient has a confirmed diagnosis of rheumatoid arthritis. Otherwise enter no (see also notes on risk factors).
Secondary osteoporosis	Enter yes if the patient has a disorder strongly associated with osteoporosis. 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
Alcohol 3 or more units/day	Enter yes if the patient takes 3 or more units of alcohol daily. A unit of alcohol varies slightly in different countries from 8-10g of alcohol. 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).
Bone mineral density (BMD)	(BMD) Please select the make of DXA scanning equipment used and then enter the actual femoral neck BMD (in g/cm2). Alternatively, enter the T-score based on the NHANES III female reference data. In patients without a BMD test, the field should be left blank (see also notes on risk factors) (provided by Oregon Osteoporosis Center).

Notes on risk factors

Previous fracture

A special situation pertains to a prior history of vertebral fracture. A fracture detected as a radiographic observation alone (a morphometric vertebral fracture) counts as a previous fracture. A prior clinical vertebral fracture or a hip fracture is an especially strong risk factor. The probability of fracture computed may therefore be underestimated. Fracture probability is also underestimated with multiple fractures.

Smoking, alcohol, glucocorticoids

These risk factors appear to have a dose-dependent effect, i.e. the higher the exposure, the greater the risk. This is not taken into account and the computations assume average exposure. Clinical judgment should be used for low or high exposures.

Rheumatoid arthritis (RA)

RA is a risk factor for fracture. However, osteoarthritis is, if anything, protective. 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.

Bone mineral density (BMD)

The site and reference technology is DXA at the femoral neck. T-scores are based on the NHANES reference values for women aged 20-29 years. The same absolute values are used in men.

Setup information for OSCAR

Please read and follow carefully in the correct order!

First: upload the main html to eForms and the images and the css file to images

Second: Setting your default Country. From EVERY computer that will use this tool, click on "Manual Frax Entry" (right side at top of this page) which will take you to the Sheffield University Frax Calculator. Hover over Calculation Tool on the top line and select Canada. Do a test run (you only need to enter age, sex, height and weight and then Calculate). Close out the page.

You can now use this eForm as is, click on "Manual Frax Entry", enter the details and then insert the results into the boxes and "Enter". However you can install a "Calculator Monkey" to do the work for you, but will involve some customisation....

Third (optional): Customising your "Calculator Monkey". Open the greasemonkey script "FraxCalculator.user.js" in a text editor. Look for "https://XXX.XX.XXX.XX:XXXXX/oscar_crossroads/eform/" and customize this first bit only to your corresponding section of URl that you see with this eForm open. You will need TWO customizations- one for remote access use and one for in office use as the URLs are different.

You are now done! If you went with the Calculator Monkey, it needs to be on EVERY computer that uses this form. All you do is open the eForm, complete any missing information and then click "Calculate".