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Tools for Assessing Fracture Risk and for Treatment Monitoring

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The Duration and Safety of Osteoporosis Treatment

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Abstract

The suboptimal performance of bone mineral density (BMD) as the sole predictor of fracture risk and treatment decision-making has led to the development of risk prediction algorithms that estimate fracture probability using multiple risk factors for fracture, including basic demographic and physical characteristics, personal and family history, other health conditions, and medication use. This chapter reviews selected risk assessment tools, based upon absolute fracture probability and their potential for treatment decision-making and monitoring. Validated prognostic models for fracture risk assessment can guide clinicians and individuals in understanding the risk of having an osteoporosis-related fracture and inform their decision-making to mitigate these risks. Fracture probability algorithms that have been independently evaluated in at least one other cohort include the World Health Organization FRAX®, the Garvan Fracture Risk Calculator, and the QResearch Database’s QFracture®. The role for risk prediction tools is expanding beyond the initial decision regarding treatment initiation, but data are limited. For example, FRAX appears to be useful in assessing individuals on treatment. However, fracture probability is not particularly responsive to osteoporosis treatments and cannot be recommended as a target for goal-directed therapy. More treatment-responsive measures need to be identified to better inform the osteoporosis management paradigm.

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Notes

  1. 1.

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Sources of Support

LML is supported by a Manitoba Research Chair. SNM is Chercheur-clinicien Boursier des Fonds de la Recherche en Sante du Quebec.

Disclosures

WDL (all fees paid to facility). Speaker bureau: Amgen, Eli Lilly, and Novartis. Research grants: Amgen and Genzyme. SNM: Consultant to Amgen, Novartis, Eli Lilly, and Merck. Speaker bureau: Amgen and Novartis. Research grant: Amgen.

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Authors and Affiliations

  1. Department of Medicine, St. Boniface General Hospital, C5121-409 Tache Ave., Winnipeg, MB, Canada, R2H 2A6

    William D. Leslie MD, MSc

  2. Departments of Medicine and Radiology, University of Manitoba, Winnipeg, MB, Canada

    William D. Leslie MD, MSc

  3. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Lisa M. Lix PhD

  4. Department of Medicine, McGill University Health Center, Montreal, QC, Canada

    Suzanne N. Morin MD, MSc

Authors
  1. William D. Leslie MD, MSc
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  2. Lisa M. Lix PhD
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  3. Suzanne N. Morin MD, MSc
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Correspondence to William D. Leslie MD, MSc .

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Editors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center; University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA

    Stuart Silverman

  2. Institute of Clinical Research; Department of Medicine, Holbæk, Denmark, University of Southern Denmark, Odense Patient Data Explorative Network; Holbæk Hospital, Odense, Denmark

    Bo Abrahamsen

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Leslie, W.D., Lix, L.M., Morin, S.N. (2016). Tools for Assessing Fracture Risk and for Treatment Monitoring. In: Silverman, S., Abrahamsen, B. (eds) The Duration and Safety of Osteoporosis Treatment. Springer, Cham. https://doi.org/10.1007/978-3-319-23639-1_4

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  • DOI: https://doi.org/10.1007/978-3-319-23639-1_4

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