Abstract
ObjectiveWe examined what was known about individuals in Canada who were assessed as being at moderate risk for future fracture.MethodsA scoping review was conducted. Eligible articles were Canadian studies published from 2010 onwards reporting on primary data that included patients at moderate risk for future fracture. We limited the search to Canada as fracture risk categorization is unique to each country. Studies were identified by searching relevant databases. Two reviewers independently reviewed titles and abstracts to determine each study’s eligibility. General information about each study, demographic information about the moderate risk groups (including tool used to determine moderate risk (Fracture Risk Assessment Tool (FRAX), Canadian Association of Radiologists and Osteoporosis Canada (CAROC)), and outcomes (number of patients: recommended treatment, prescribed treatment, initiating treatment, persisting with treatment after six months, who re-fractured, who died) were documented.ResultsWe identified 1193 papers which were further screened for eligibility. Of the 1193 identified, 7 were eligible for the review but only 4 articles contained demographic or outcome data on moderate risk patients. In one study, 1.8% of moderate risk patients died over a mean 5.3 years of observation and in three studies, the risk of fracture was 5.9% over a median of 3 years of follow-up, 8.3% over a mean of 5.4 years, and 14.7% over 10 years of follow-up.ConclusionThere is a wide knowledge gap in the literature concerning individuals who are assessed as moderate risk for future fracture in Canada.
Highlights
Recent years have seen a shift in treatment guidelines from a diagnosis of osteoporosis (OP) to fracture risk
In the United Kingdom, the National Osteoporosis Guideline Group recommends that fracture risk is calculated first using the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) to categorize low, intermediate or high risk probabilities for fractures at ten years [1] [2]
FRAX with BMD is used to further classify patients with intermediate risk to the low or high risk group; treatment guidance does not apply to intermediate risk patients
Summary
Recent years have seen a shift in treatment guidelines from a diagnosis of osteoporosis (OP) to fracture risk. In the United Kingdom, the National Osteoporosis Guideline Group recommends that fracture risk is calculated first using the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) to categorize low, intermediate or high risk probabilities for fractures at ten years [1] [2]. FRAX with BMD is used to further classify patients with intermediate risk to the low or high risk group; treatment guidance does not apply to intermediate risk patients. In Canada, the 2010 Clinical Practice Guidelines for the Diagnosis and Management of OP [3] recommend that patients are assessed by considering a number of clinical factors and using either FRAX [4] or the revised tool by the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) [5] to determine fracture risk. Management of the majority of fragility fracture patients in Canada relies primarily on clinical judgment, rather than evidence
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