title: Appropriate osteoporosis treatment by family physicians in response to FRAX vs CAROC reporting: results from a randomized controlled trial.
abstract: Canadian guidelines recommend either the FRAX or the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) fracture risk assessment tools to report 10-yr fracture risk as low (<10%), moderate (10%-20%) or high (>20%). It is unknown whether one reporting system is more effective in helping family physicians (FPs) identify individuals who require treatment. Individuals ≥50 yr old with a distal radius fracture and no previous osteoporosis diagnosis or treatment were recruited. Participants underwent a dual-energy x-ray absorptiometry scan and answered questions about fracture risk factors. Participants' FPs were randomized to receive either a FRAX report or the standard CAROC-derived bone mineral density report currently used by the institution. Only the FRAX report included statements regarding treatment recommendations. Within 3 mo, all participants were asked about follow-up care by their FP, and treatment recommendations were compared with an osteoporosis specialist. Sixty participants were enrolled (31 to FRAX and 29 to CAROC). Kappa statistics of agreement in treatment recommendation were 0.64 for FRAX and 0.32 for bone mineral density. The FRAX report was preferred by FPs and resulted in better postfracture follow-up and treatment that agreed more closely with a specialist. Either the clear statement of fracture risk or the specific statement of treatment recommendations on the FRAX report may have supported FPs to make better treatment decisions.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: karen.beattie@camris.ca.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Beattie
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Ioannidis
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.affiliation: Department of Surgery, Western University, St. Joseph's Health Centre, London, ON, Canada.
authors.forename: Ruby
authors.initials: R
authors.lastname: Grewal
authors.affiliation: Department of Medicine, McMaster University, St. Peter's Hospital, Hamilton, ON, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: Department of Medicine, Western University, St. Joseph's Health Centre, London, ON, Canada.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Hodsman
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging*; D010821:Physicians, Family; D011237:Predictive Value of Tests; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Bone mineral density; FRAX; decision making; fracture risk; osteoporosis; treatment recommendation