Impact of UK National Guidelines based on FRAX®--comparison with current clinical practice.
OBJECTIVE
To assess whether clinician-determined treatment intervention thresholds are in line with the assessment of fracture risk provided by FRAX® and treatment recommendations provided by UK guidelines produced by the National Osteoporosis Guidelines Group (NOGG).


METHODS
This was a retrospective cohort analysis of 288 patients consecutively referred for dual-energy X-ray absorptiometry (DXA) scanning from primary care immediately prior to the introduction of the FRAX® algorithm. In addition to DXA assessment, patients completed a clinical risk factor questionnaire which included risk factors used in the FRAX® algorithm. Initial risk assessment and treatment decisions were performed after DXA. FRAX® was used, retrospectively, with femoral neck T-score, to estimate fracture risk which was applied to NOGG to generate guidance on treatment intervention. Clinician- and NOGG-determined outcomes were audited for concordance.


RESULTS
There was concordance between clinician and NOGG treatment decisions in 215 (74.6%) subjects. Discordance was observed in 73 (25.3%) subjects. In the discordant group, seven subjects were given lifestyle advice when NOGG recommended treatment, 42 given treatment when NOGG recommended lifestyle advice only, and 24 were referred to a metabolic bone clinic for further evaluation. The reasons for treatment differences in subjects recommended treatment by clinician but not NOGG were largely (90.2%) attributed to the use of lumbar spine bone mineral density (BMD).


CONCLUSIONS
There is high concordance between clinician-determined and FRAX®-NOGG intervention. The absence of spine BMD from FRAX® is the primary source of discrepancy. This study provides some assurance of the validity of the treatment thresholds generated from FRAX®-NOGG in 'real-world' usage.
Crabtree
N J
NJ
Bone Densitometry Endocrinology, Queen Elizabeth Hospital Birmingham, and University of Birmingham, Edgbaston, Birmingham, UK. Nicola.Crabtree@uhb.nhs.uk
Bebbington
N A
NA
Chapman
D M
DM
Wahid
Y S
YS
Ayuk
J
J
Boivin
C M
CM
Cooper
M S
MS
Gittoes
N J L
NJ
D015502:Absorptiometry, Photon; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D006113:United Kingdom