Archives of Osteoporosis

, 10:25 | Cite as

Validation of a modified FRAX® tool for improving outpatient efficiency—part of the “Catch Before a Fall” initiative

  • Simon Parker
  • Maria Ciaccio
  • Erica Cook
  • Graham Davenport
  • Alun Cooper
  • Simon Grange
  • Peter Smitham
Original Article



We have validated our touch-screen-modified FRAX® tool against the traditional healthcare professional-led questionnaire, demonstrating strong concordance between doctor- and patient-derived results. We will use this in outpatient clinics and general practice to increase our capture rate of at-risk patients, making valuable use of otherwise wasted patient waiting times.


Outpatient clinics offer an opportunity to collect valuable health information from a captive population. We have previously developed a modified fracture risk assessment (FRAX®) tool, enabling patients to self-assess their osteoporotic fracture risk in a touch-screen computer format and demonstrated its acceptability with patients. We aim to validate the accuracy of our tool against the traditional questionnaire.


Fifty patients over 50 years of age within the fracture clinic independently completed a paper equivalent of our touch-screen-modified FRAX® questionnaire. Responses were analysed against the traditional healthcare professional (HCP)-led questionnaire which was carried out afterwards. Correlation was assessed by sensitivity, specificity, Cohen’s kappa statistic and Fisher’s exact test for each potential FRAX® outcome of “treat”, “measure BMD” and “lifestyle advice”.


Age range was 51–98 years. The FRAX® tool was completed by 88 % of patients; six patients lacked confidence in estimating either their height or weight. Following question adjustment according to patient response and feedback, our tool achieved >95 % sensitivity and specificity for the “treat” and “lifestyle advice” groups, and 79 % sensitivity and 100 % specificity in the “measure BMD” group. Cohen’s kappa value ranged from 0.823 to 0.995 across all groups, demonstrating “very good” agreement for all. Fisher’s exact test demonstrated significant concordance between doctor and patient decisions.


Our modified tool provides a simple, accurate and reliable method for patients to self-report their own FRAX® score outside the clinical contact period, thus releasing the HCP from the time required to complete the questionnaire and potentially increasing our capture rate of at-risk patients.


Osteoporosis Osteoporotic fractures World Health Organisation Outpatients Ambulatory care Efficiency Self-assessment 



The Catch Before a Fall project has been funded with a grant from the National Osteoporosis Society (grant number 201).

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • Simon Parker
    • 1
  • Maria Ciaccio
    • 2
    • 3
  • Erica Cook
    • 4
  • Graham Davenport
    • 5
    • 6
  • Alun Cooper
    • 7
    • 8
  • Simon Grange
    • 9
    • 10
  • Peter Smitham
    • 2
    • 3
    • 4
  1. 1.Buckinghamshire Healthcare NHS Foundation TrustLondonUK
  2. 2.Trauma and OrthopaedicsBarnet HospitalBarnetUK
  3. 3.Royal Free London NHS Foundation TrustLondonUK
  4. 4.Royal National Orthopaedic HospitalStanmoreUK
  5. 5.Wrenbury Medical PracticeNantwichUK
  6. 6.Royal College of General PractitionersLondonUK
  7. 7.Bridges Medical CentreCrawleyUK
  8. 8.National Osteoporosis SocietyCamertonUK
  9. 9.Trauma and OrthopaedicsEaling HospitalSouthallUK
  10. 10.University of SouthamptonSouthamptonUK

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