Estimating osteoporotic fracture risk following a wrist fracture: a tale of two systems.

Karen Beattie,George Ioannidis,Joy Macdermid,Ruby Grewal,Alexandra Papaioannou,Anthony B Hodsman,Jonathan Adachi,William D Leslie

doi:10.1007/s11657-015-0218-3

Karen Beattie, George Ioannidis + Show 6 more

Open Access

https://doi.org/10.1007/s11657-015-0218-3

Copy DOI

Abstract

SummaryThe WHO fracture risk assessment (FRAX) and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools can both be used to determine an individual’s 10-year risk of osteoporotic fracture. However, these tools differ in their risk calculation. For participants <65 years with a wrist fracture, FRAX provides a lower fracture risk estimate than CAROC resulting in fewer decisions to initiate therapy.PurposeThe purpose of the current report is to compare fracture risk prediction rates using the CAROC and the FRAX® tools.MethodsIndividuals ≥50 years with a distal radius fracture resulting from a fall from standing height or less were recruited from a single orthopedic clinic. Participants underwent a DXA scan of their lumbar spine and hip. Femoral neck (FN) bone mineral density (BMD) and fracture risk factors were used to determine each participant’s 10-year fracture risk using both fracture risk assessment tools. Participants were categorized as low (<10 %), moderate (10–20 %), or high (>20 %) risk. Stratified by age (<65 years, >65 years), the proportion of participants in each category was compared between the tools.ResultsAnalyses included 60 participants (mean age 65.7 ± 9.6 years). In those <65 years (n = 26), the proportion of individuals at low, moderate, and high risk differed between the FRAX and CAROC tools (p < 0.0001). FRAX categorized 69 % as low (CAROC 0 %) and 3 % as high (CAROC 12 %) risk. For individuals >65 years, almost all were at least at moderate risk (FRAX 79 %, CAROC 53 %), but fewer were at high risk using FRAX (18 vs. 47 %, p < 0.0003).ConclusionFor participants <65 years with a wrist fracture, FRAX provides a lower estimate of 10-year fracture risk than CAROC resulting in fewer decisions to initiate therapy. However, almost all participants >65 years were at moderate or high risk under both FRAX and CAROC and should at least be considered for pharmacotherapy.

Highlights

Following publication of the 2010 clinical practice guidelines (CPG) for the diagnosis and management of osteoporosis in Canada [1], Osteoporosis Canada emphasized the need to evaluate future fracture risk in all older individuals who experience a major Bfragility^ fracture typically associated with osteoporosis.In Canada, two fracture risk prediction tools exist to determine an individual’s 10-year risk of osteoporotic fracture
Almost all participants >65 years were at moderate or high risk under both FRAX and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and should at least be considered for pharmacotherapy
Given that the study’s primary goal was to observe the response of family physicians to the patients’ fracture risk reported by CAROC or FRAX, participants who had not previously been diagnosed with osteoporosis or who had not been treated for osteoporosis were the target study population [14]

Summary

Introduction

In Canada, two fracture risk prediction tools exist to determine an individual’s 10-year risk of osteoporotic fracture. Canada (CAROC) tool stratifies women and men >50 years into three categories of osteoporotic fracture risk: low (20 %) [2]. Baseline risk is assessed using age, sex, and femoral neck T-score. The presence of a prior fragility fracture after age 40 [3] or recent prolonged use of systemic glucocorticoids increases fracture risk into the highest category independent of bone mineral density (BMD). The World Health Organization Fracture Risk Assessment (FRAX©) tool uses additional risk factors over and above those used in CAROC (e.g., parental history of hip fracture) [4].

Objectives

Results

Conclusion