The impact of the use of multiple risk indicators for fracture on casefinding strategies: a mathematical approach
 Chris De Laet,
 Anders Odén,
 Helena Johansson,
 Olof Johnell,
 Bengt Jönsson,
 John A Kanis
 … show all 6 hide
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The value of bone mineral density (BMD) measurements to stratify fracture probability can be enhanced in a casefinding strategy that combines BMD measurement with independent clinical risk indicators. Putative risk indicators include age and gender, BMI or weight, prior fracture, the use of corticosteroids, and possibly others. The aim of the present study was to develop a mathematical framework to quantify the impact of using combinations of risk indicators with BMD in case finding. Fracture probability can be expressed as a risk gradient, i.e. a relative risk (RR) of fracture per standard deviation (SD) change in BMD. With the addition of other continuous or categorical risk indicators a continuous distribution of risk indicators is obtained that approaches a normal distribution. It is then possible to calculate the risk of individuals compared with the average risk in the population, stratified by age and gender. A risk indicator with a gradient of fracture risk of 2 per SD identified 36% of the population as having a higher than average fracture risk. In individuals so selected, the risk was on average 1.7 times that of the general population. Where, through the combination of several risk indicators, the gradient of risk of the test increased to 4 per SD, a smaller proportion (24%) was identified as having a higher than average risk, but the average risk in this group was 3.1 times that of the population, which is a much better performance. At higher thresholds of risk, similar phenomena were found. We conclude that, whereas the change of the proportion of the population detected to be at high risk is small, the performance of a test is improved when the RR per SD is higher, indicated by the higher average risk in those identified to be at risk. Casefinding strategies that combine clinical risk indicators with BMD have increased efficiency, while having a modest impact on the number of individuals requiring treatment. Therefore, the costeffectiveness is enhanced.
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 Title
 The impact of the use of multiple risk indicators for fracture on casefinding strategies: a mathematical approach
 Journal

Osteoporosis International
Volume 16, Issue 3 , pp 313318
 Cover Date
 20050301
 DOI
 10.1007/s001980041689z
 Print ISSN
 0937941X
 Online ISSN
 14332965
 Publisher
 SpringerVerlag
 Additional Links
 Keywords

 Case finding
 Fractures
 Mathematical model
 Osteoporosis
 Risk
 Industry Sectors
 Authors

 Chris De Laet ^{(1)} ^{(2)}
 Anders Odén ^{(3)}
 Helena Johansson ^{(3)}
 Olof Johnell ^{(4)}
 Bengt Jönsson ^{(5)}
 John A Kanis ^{(6)}
 Author Affiliations

 1. Department of Public Health, Erasmus University Medical Center, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
 2. Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
 3. Consulting Statistician, Gothenberg, Sweden
 4. Department of Orthopaedics, Malmö General Hospital, Malmö, Sweden
 5. Centre for Health Economics, Stockholm, Sweden
 6. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK