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Osteoporosis International

, Volume 23, Issue 3, pp 907–915 | Cite as

A comparison of case-finding strategies in the UK for the management of hip fractures

  • H. Johansson
  • J. A. Kanis
  • A. Oden
  • J. Compston
  • E. McCloskeyEmail author
Original Article

Abstract

Summary

Treatment criteria published by the National Osteoporosis Guideline Group (NOGG) in the UK make more efficient use of bone mineral density (BMD) resources than the previous Royal College of Physicians (RCP) guideline.

Introduction

We compared the effectiveness of the RCP case-finding strategy previously used in the UK and the updated guideline published by NOGG, which incorporates the FRAX® fracture probability tool.

Methods

Comparisons were made by simulating population samples of 1000 women at ages between 50 and 85 years, using age-specific prevalence of risk factors and UK-derived fracture and mortality rates. Comparators comprised the number identified at high risk, the incidence of hip fracture and the femoral neck BMD in those identified, the number needed to scan to identify a hip fracture, the acquisition cost and the cost per hip fracture averted

Results

Compared with the RCP strategy, NOGG identified slightly reduced numbers of women at high risk (average 34.6% vs. 35.7% across all ages), but with lower numbers of scans required at each age. For example, NOGG required only 3.5 scans at the age of 50 years to identify one case of hip fracture, whereas RCP required 13.9. At 75 years, the corresponding numbers were 0.9 and 1.5. Thus, the acquisition costs for identifying a hip fracture case and the total costs (acquisition and treatment) per hip fracture averted were lower.

Conclusion

Compared to the RCP strategy, the FRAX-based NOGG strategy uses BMD resources more efficiently with lower acquisition costs and lower costs per hip fracture averted.

Keywords

Fracture FRAX Guideline Number needed to scan Treatment threshold UK 

Notes

Acknowledgements

We thank the Alliance for Better Bone Health, Amgen, Hologic, IGEA, Lilly, Lunar, Novartis, Pfizer, Roche and Wyeth for their unrestricted support of this work. We are also grateful to the EU (FP3/5), the International Osteoporosis Foundation, the International Society for Clinical Densitometry and the National Osteoporosis Foundation for supporting this study.

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • H. Johansson
    • 1
  • J. A. Kanis
    • 2
  • A. Oden
    • 1
  • J. Compston
    • 3
  • E. McCloskey
    • 2
    • 4
    Email author
  1. 1.Consulting StatisticiansGothenburgSweden
  2. 2.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  3. 3.Department of MedicineUniversity of Cambridge School of Clinical Medicine and Addenbrooke’s NHS TrustCambridgeUK
  4. 4.WHO Collaborating Centre for Metabolic Bone Diseases, Metabolic Bone Centre, Sorby WingNorthern General HospitalSheffieldUK

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