Comparison of screening tools for optimizing fracture prevention in Canada
- PDF / 308,184 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 67 Downloads / 190 Views
ORIGINAL ARTICLE
Comparison of screening tools for optimizing fracture prevention in Canada William D. Leslie 1
&
Lisa M. Lix 2 & Neil Binkley 3
Received: 25 June 2020 / Accepted: 20 October 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary The best screening strategy to identify treatment qualification based upon indicators of high fracture risk (low-trauma fractures of the hip, spine, or multiple fracture episodes at other sites; high fracture probability with the Canadian fracture risk assessment [FRAX®] tool major osteoporotic fracture [MOF] computed with bone mineral density [BMD] > 20%; or vertebral fracture on vertebral fracture assessment [VFA]) was FRAX-MOF without BMD using a cutoff of ≥ 10%. Purpose To inform clinical practice guidelines in Canada, we compared multiple screening tools using the population-based Manitoba BMD Program registry. Methods The study populations consisted of (a) 28,906 individuals > 50 years or older, and (b) 15,429 women age > 65 years undergoing baseline BMD assessment (2010–2018). We considered two treatment qualifications: Treatment Approach 1: prior high-risk fracture, high fracture probability (FRAX-MOF with BMD > 20%), or vertebral fracture on VFA; Treatment Approach 2: Approach 1 or an osteoporotic BMD T score. Candidate screening tools were FRAX-MOF without BMD, age alone, weight alone, SCORE, ORAI, SOFSURF, OSIRIS, ABONE, and OST. Healthcare records were assessed for the presence of incident fracture diagnoses. Results Among all individuals, FRAX-MOF without BMD demonstrated the best ability to identify those satisfying Treatment Approach 1 (area under the curve [AUC 0.863]) and was significantly better than all other screening tools (P < 0.001). For identification of individuals satisfying Treatment Approach 2, FRAX-MOF without BMD showed moderate stratification (AUC 0.735), slightly lower than OSIRIS (AUC 0.752, P < 0.05), similar to SCORE (AUC 0.739, P > 0.05) and significantly better than all other screening tools (P < 0.05). For prediction of incident MOF, FRAX-MOF without BMD achieved the highest performance (AUC 0.652), and was significantly better than all other screening tools except OSIRIS. AUCs among women age > 65 years tended to be greater with a similar ranking, and no tool outperformed FRAX-MOF without BMD. Based upon a summary score, the highest ranked strategy was FRAX-MOF without BMD using a cutoff of 10%. Conclusions All screening tools show some ability to identify individuals qualifying for treatment and stratify risk for incident fracture. For treatment based upon indicators of high fracture risk, the best performing strategy was FRAX-MOF without BMD using a cutoff of ≥ 10%. Keywords Osteoporosis . Fractures . Clinical practice guidelines . Dual-energy x-ray absorptiometry . Screening . FRAX
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11657-02000846-w. * William D. Leslie [email protected] Lisa M. Lix lisa.lix@umanito
Data Loading...
