title: Assessing fracture risk in people with MS: a service development study comparing three fracture risk scoring systems.
abstract: OBJECTIVE
  Suboptimal bone health is increasingly recognised as an important cause of morbidity. Multiple sclerosis (MS) has been consistently associated with an increased risk of osteoporosis and fracture. Various fracture risk screening tools have been developed, two of which are in routine use and a further one is MS-specific. We set out to compare the results obtained by these in the MS clinic population.
  
  
  METHODS
  This was a service development study. The 10-year risk estimates of any fracture and hip fracture generated by each of the algorithms were compared.
  
  
  METHODS
  The MS clinic at the Royal London Hospital.
  
  
  METHODS
  88 patients with a confirmed diagnosis of MS.
  
  
  METHODS
  Mean 10-year overall fracture risk and hip fracture risk were calculated using each of the three fracture risk calculators. The number of interventions that would be required as a result of using each of these tools was also compared.
  
  
  RESULTS
  Mean 10-year fracture risk was 4.7%, 2.3% and 7.6% using FRAX, QFracture and the MS-specific calculator, respectively (p<0.0001 for difference). The agreement between risk scoring tools was poor at all levels of fracture risk.
  
  
  CONCLUSIONS
  The agreement between these three fracture risk scoring tools is poor in the MS population. Further work is required to develop and validate an accurate fracture risk scoring system for use in MS.
  
  
  BACKGROUND
  This service development study was approved by the Clinical Effectiveness Department at Barts Health NHS Trust (project registration number 156/12).
authors.affiliation: Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Dobson
authors.forename: Sara Geraldine
authors.initials: SG
authors.lastname: Leddy
authors.forename: Sunay
authors.initials: S
authors.lastname: Gangadharan
authors.forename: Gavin
authors.initials: G
authors.lastname: Giovannoni