Ability of Fracture Risk Assessment Tool and National Osteoporosis Guideline Group Guidance to Stratify People Appropriately Before Fracture

Brewer, Linda; Mellon, Lisa; Duggan, Joseph

doi:10.1111/jgs.12435

Cited by 4 publications

(3 citation statements)

References 10 publications

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Section: Discussionmentioning

confidence: 99%

“…Several authors compare the performance of the tool using different calculation methods, with and without BMD, and to other risk algorithms, showing variability within and between populations [ 33 , 37 , 41 , 43 – 52 ]. Some suggest FRAX performs similarly with and without BMD [ 43 , 46 , 49 , 50 ], and using different calculation methods [ 41 ], while others suggest FRAX without BMD is not sensitive enough to identify those in need of treatment [ 33 , 46 – 48 , 51 , 52 ]. A Japanese study comparing 4 different FRAX calculation methods for several thousand men and women show they provide similar estimates [ 41 ], while a group of Danish authors suggests the addition of BMD may be of limited benefit [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

Yang

Dempsey²,

Brennan³

et al. 2023

Arch Osteoporos

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Summary Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. Purpose FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. Method A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland–Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. Results Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. Conclusions Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

Yang

Dempsey²,

Brennan³

et al. 2023

Arch Osteoporos

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show abstract

“…29 However, one study (n=90) did evaluate the ability of FRAX to correctly classify Irish people for treatment. 30 COHORT DESCRIPTION Patient and public involvement This study was completed without participant involvement. A waiver of consent was granted by the Ethics Committee.…”

Section: Open Accessmentioning

confidence: 99%

The Irish dual-energy X-ray absorptiometry (DXA) Health Informatics Prediction (HIP) for Osteoporosis Project

Erjiang

Wang²,

Yang

et al. 2020

BMJ Open

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PurposeThe purpose of the Irish dual-energy X-ray absorptiometry (DXA) Health Informatics Prediction (HIP) for Osteoporosis Project is to create a large retrospective cohort of adults in Ireland to examine the validity of DXA diagnostic classification, risk assessment tools and management strategies for osteoporosis and osteoporotic fractures for our population.ParticipantsThe cohort includes 36 590 men and women aged 4–104 years who had a DXA scan between January 2000 and November 2018 at one of 3 centres in the West of Ireland.Findings to date36 590 patients had at least 1 DXA scan, 6868 (18.77%) had 2 scans and 3823 (10.45%) had 3 or more scans. There are 364 unique medical disorders, 186 unique medications and 46 DXA variables identified and available for analysis. The cohort includes 10 349 (28.3%) individuals who underwent a screening DXA scan without a clear fracture risk factor (other than age), and 9947 (27.2%) with prevalent fractures at 1 of 44 skeletal sites.Future plansThe Irish DXA HIP Project plans to assess current diagnostic classification and risk prediction algorithms for osteoporosis and fractures, identify the risk predictors for osteoporosis and develop novel, accurate and personalised risk prediction tools, by using the large multicentre longitudinal follow-up cohort. Furthermore, the dataset may be used to assess, and possibly support, multimorbidity management due to the large number of variables collected in this project.

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