Osteoporosis tool assists screening in primary care

More patients at risk of osteoporosis could be identified in primary care with the aid of two new fracture risk algorithms, UK researchers say.

Osteoporotic hip fracture: new tool no substitute for existing FRAX
Osteoporotic hip fracture: new tool no substitute for existing FRAX

The QFractureScores for estimating the risk of osteoporotic fracture or hip fracture over 10 years have been developed using primary care data, and are thus suitable for general practice.

They may be as good as FRAX for estimating hip fracture risk, but with the advantage that they do not require DEXA or other laboratory tests, a validation study has shown.

The researchers analysed data from around 2.4 million men and women aged 30 to 85 years, from 357 general practices in England and Wales, to find factors associated with osteoporotic fracture and hip fracture risk.

HRT use, age, BMI, smoking status and 13 other factors were identified that together could be used to predict 10-year fracture risk, and a separate 10-year risk of hip fracture. Validation showed the hip fracture algorithm to have a level of accuracy comparable to FRAX.

Lead researcher Dr Julia Hippisley-Cox, professor of clinical epidemiology and general practice at the University of Nottingham said: 'The key thing is QFracture can be used to identify those at high risk of fracture who might need further assessment and interventions to reduce the risk of fracture.'

She said the algorithm could be integrated into GPs' clinical IT systems and used either to assess risk for an individual patient, or to risk-stratify an entire practice population.

Oxford GP Dr Sally Hope, a member of the NICE osteoporosis board, agreed that these algorithms could be a useful first-line screening tool for assessing patients' risk of fracture.

But she added that QFracture should not be used as an alternative to FRAX because it cannot be relied on to identify the subgroup of patients with the highest fracture risk - those who have already had a fracture.

'Access to both this screening tool and FRAX from our desktops would be a good thing for osteoporosis care,' she said.

The QFracture tool can be downloaded and integrated into any clinical IT system. More information is available at www.qfracture.org.

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