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A comparison of electronic and manual fracture risk assessment tools in screening elderly male US veterans at risk for osteoporosis

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Abstract

Summary

This study compares four screening tools in their ability to predict osteoporosis. We found that there was no significant difference between the tools. These results provide support for the use of automated screening tools which work in conjunction with the electronic medical record and help improve screening rates for osteoporosis.

Introduction

The purpose of this study is to compare the performance of four fracture risk assessment tools (FRATs) in identifying osteoporosis by bone mineral density (BMD) T-score: Veterans Affairs Fracture Absolute Risk Assessment Tool (VA-FARA), World Health Organization’s Fracture Risk Assessment Tool (FRAX), electronic FRAX (e-FRAX), and Osteoporosis Self-Assessment Screening Tool (OST).

Methods

We performed a cross-sectional analysis of all patients enrolled in the VA Salt Lake City bone health team (BHT) who had completed a DXA scan between February 1, 2012, and February 1, 2013. DXA scan results were obtained by chart abstraction. For calculation of FRAX, osteoporosis risk factors were obtained from a screening questionnaire completed prior to DXA. For VA-FARA and e-FRAX, risk factors were derived from the electronic medical record (EMR). Clinical risk scores were calculated and compared against the gold standard of DXA-based osteoporosis. Sensitivity, specificity, and predictive values were calculated. Receiver operator characteristic (ROC) curves were plotted, and areas under the curve (AUC) were compared.

Results

A cohort of 463 patients met eligibility criteria (mean age 80.4 years). One hundred twelve patients (24%) had osteoporosis as defined by DXA T-score ≤−2.5. Sensitivity, specificity, and predictive values were calculated. ROC statistics were compared and did not reach statistical significance difference between FRATs in identifying DXA-based osteoporosis.

Conclusions

Our study suggests that all FRATs tested perform similarly in identifying osteoporosis among elderly, primarily Caucasian, male veterans. If these electronic screening methods perform similarly for fracture outcomes, they could replace manual FRAX and thus improve efficiency in identifying individuals who should be sent for DXA scan.

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Acknowledgements

This material is based on work supported by Specialty Care Center of Innovation, Veterans Health Administration, Department of Veterans Affairs and Office of Research and Development, and Health Services Research and Development Service (grants CDA 11-210 and I50HX001240).

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Authors and Affiliations

  1. Salt Lake City VA Medical Center and University of Utah Department of Internal Medicine, Salt Lake City, UT, USA

    S. T. Williams

  2. George E. Wahlen VA Medical Center, 500 Foothill Drive, Salt Lake City, UT, 84148, USA

    S. T. Williams

  3. Salt Lake City VA Medical Center and Roseman University of Health Sciences, Salt Lake City, UT, USA

    P. T. Lawrence

  4. Salt Lake City VA Medical Center and University of Utah Division of Rheumatology, Salt Lake City, UT, USA

    K. L. Miller & G. W. Cannon

  5. University of Utah Division of Epidemiology and Salt Lake City VA Medical Center, Salt Lake City, UT, USA

    J. L. Crook & R. E. Nelson

  6. University of Utah Department of Pharmacotherapy and Salt Lake City VA Medical Center, Salt Lake City, UT, USA

    J. LaFleur

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  1. S. T. Williams
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  2. P. T. Lawrence
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  3. K. L. Miller
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  4. J. L. Crook
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  5. J. LaFleur
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  6. G. W. Cannon
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  7. R. E. Nelson
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Correspondence to S. T. Williams.

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Williams, S.T., Lawrence, P.T., Miller, K.L. et al. A comparison of electronic and manual fracture risk assessment tools in screening elderly male US veterans at risk for osteoporosis. Osteoporos Int 28, 3107–3111 (2017). https://doi.org/10.1007/s00198-017-4172-3

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  • DOI: https://doi.org/10.1007/s00198-017-4172-3

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