Osteoporosis International

, Volume 19, Issue 4, pp 459–463

Absolute fracture risk reporting in clinical practice: A physician-centered survey

  • W. D. Leslie
  • for the Manitoba Bone Density Program
Short Communication

Abstract

Summary

Non-expert clinical practitioners who had received bone density reports based on 10-year absolute fracture risk were surveyed to determine their response to this new system. Absolute fracture risk reporting was well received and was strongly preferred to traditional T-score-based reporting. Non-specialist physicians were particularly supportive of risk-based bone mineral density (BMD) reporting.

Introduction

Absolute risk estimation is preferable to risk categorization based upon BMD alone. The objective of this study was to specifically assess the response of non-expert clinical practitioners to this approach.

Methods

In January 2006, the Province of Manitoba, Canada, started reporting 10-year osteoporotic fracture risks for patients aged 50 years and older based on the hip T-score, gender, age, and multiple clinical risk factors. In May 2006 and October 2006, a brief anonymous survey was sent to all physicians who had requested a BMD test during 2005 and 206 responses were received.

Results

When asked whether the report contained the information needed to manage patients, the mean score for the absolute fracture risk report was higher than for the T-score-based report (p < 0.0001). When asked whether the report was easy to understand, the mean score for the absolute fracture risk report was again higher than for the T-score-based report (p < 0.0001). Non-specialists gave a higher ranking than specialists to the absolute fracture risk information (p < 0.05).

Conclusions

Absolute fracture risk reporting is well-received by physicians and is strongly preferred to traditional T-score-based reporting. Non-specialist physicians are particularly supportive of risk-based BMD reporting.

Keywords

Bone densitometry Dual energy X-ray absorptiometry Fractures Osteoporosis Risk assessment 

References

  1. 1.
    Kanis JA, Oden A, Johnell O et al (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427PubMedCrossRefGoogle Scholar
  2. 2.
    Kanis JA, Borgstrom F, De Laet C et al (2005) Assessment of fracture risk. Osteoporos Int 16:581–589PubMedCrossRefGoogle Scholar
  3. 3.
    Fogelman I, Blake GM (2005) Bone densitometry: an update. Lancet 366:2068–2070PubMedCrossRefGoogle Scholar
  4. 4.
    Report of a WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser 843:1–129Google Scholar
  5. 5.
    Leslie WD, Metge C (2003) Establishing a regional bone density program: lessons from the Manitoba experience. J Clin Densitom 6:275–282PubMedCrossRefGoogle Scholar
  6. 6.
    Kanis JA, Johnell O, Oden A et al (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995PubMedCrossRefGoogle Scholar
  7. 7.
    Leslie WD, Tsang JF, Lix L (2007) Validation of ten-year fracture risk prediction in a large clinical cohort. J Bone Miner Res 22 [Suppl 1]:S22Google Scholar
  8. 8.
    Baltzan MA, Suissa S, Bauer DC et al (1999) Hip fractures attributable to corticosteroid use. Study of Osteoporotic Fractures Group. Lancet 353:1327PubMedCrossRefGoogle Scholar
  9. 9.
    Black DM, Steinbuch M, Palermo L et al (2001) An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 12:519–528PubMedCrossRefGoogle Scholar
  10. 10.
    Leslie WD, Metge C, Salamon EA et al (2002) Bone mineral density testing in healthy postmenopausal women. The role of clinical risk factor assessment in determining fracture risk. J Clin Densitom 5:117–130PubMedCrossRefGoogle Scholar
  11. 11.
    Siminoski K, Leslie WD, Frame H et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56:178–188PubMedGoogle Scholar
  12. 12.
    Grundy SM, Pasternak R, Greenland P et al (1999) AHA/ACC scientific statement: Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 34:1348–1359PubMedCrossRefGoogle Scholar
  13. 13.
    Kanis JA, Oden A, Johnell O et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046PubMedCrossRefGoogle Scholar
  14. 14.
    Cummings SR (1998) Prevention of hip fractures in older women: a population-based perspective. Osteoporos Int 8 [Suppl 1]:S8–S12PubMedGoogle Scholar
  15. 15.
    Cranney A, Jamal SA, Tsang JF et al (2007) Low bone mineral density and fracture burden in postmenopausal women. CMAJ 177:575–580PubMedGoogle Scholar
  16. 16.
    Stone KL, Seeley DG, Lui LY et al (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18:1947–1954PubMedCrossRefGoogle Scholar
  17. 17.
    McCombs JS, Thiebaud P, Laughlin-Miley C et al (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48:271–287PubMedCrossRefGoogle Scholar
  18. 18.
    Pickney CS, Arnason JA (2005) Correlation between patient recall of bone densitometry results and subsequent treatment adherence. Osteoporos Int 16:1156–1160PubMedCrossRefGoogle Scholar
  19. 19.
    Silverman S (2006) Adherence to medications for the treatment of osteoporosis. Rheum Dis Clin North Am 32:721–731PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • W. D. Leslie
    • 1
  • for the Manitoba Bone Density Program
  1. 1.Department of MedicineUniversity of ManitobaWinnipegCanada

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