title: Comparing fracture absolute risk assessment (FARA) tools: an osteoporosis clinical informatics tool to improve identification and care of men at high risk of first fracture.
abstract: BACKGROUND
  Fracture absolute risk assessment (FARA) is recommended for guiding osteoporosis treatment decisions in males. The best strategy for applying FARA in the clinic setting is not known.
  
  
  OBJECTIVE
  We compared 2 FARA tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture. Tools evaluated were an adaptation of the World Health Organization's Fracture Risk Assessment Tool used with electronic data (eFRAX) and the Veterans Affairs (VA)-based tool, VA-FARA.
  
  
  METHODS
  We compared accuracies of VA-FARA and eFRAX for correctly classifying male veterans who fractured and who were seen in the VA's Sierra Pacific Network in 2002-2013. We then matched those cases to nonfracture controls to compare odds of fracture in patients classified as high risk by either tool.
  
  
  RESULTS
  Among 8740 patients, the mean (SD) age was 67.0 (11.1) years. Based on risk factors present in the EHR, VA-FARA correctly classified 40.1% of fracture patients as high risk (33.0% and 34.6% for hip and any major fracture, respectively); eFRAX classified 17.4% correctly (17.4% for hip and 0.2% for any major fracture). Compared with non-high-risk patients, those classified as high risk by VA-FARA were 35% more likely to fracture (95% CI = 23%-47%; P < 0.01) compared with 17% for eFRAX (95% CI = 5%-32%; P < 0.01).
  
  
  CONCLUSIONS
  VA-FARA is more predictive of first fracture than eFRAX using EHR data. Decision support tools based on VA-FARA may improve early identification and care of men at risk.
authors.affiliation: Pharmacotherapy Outcomes Research Center, Salt Lake City, UT, USA George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA joanne.lafleur@pharm.utah.edu.
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
authors.affiliation: Department of Veterans Affairs Sierra Pacific Network (VISN 21), Vallejo, CA, USA.
authors.forename: Chandra L
authors.initials: CL
authors.lastname: Steenhoek
authors.affiliation: James H. Quillen Department of Veterans Affairs Medical Center, Mountain Home, TN, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Horne
authors.affiliation: Department of Veterans Affairs Sierra Pacific Network (VISN 21), Vallejo, CA, USA.
authors.forename: Joy
authors.initials: J
authors.lastname: Meier
authors.affiliation: George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Nebeker
authors.affiliation: Ioannis A. Lougaris VA Medical Center, Reno, NV, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Mambourg
authors.affiliation: Department of Veterans Affairs Northern California Health Care System, VA Martinez Outpatient Clinic, Martinez, CA, USA University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Swislocki
authors.affiliation: Department of Veterans Affairs Sierra Pacific Network (VISN 21), Vallejo, CA, USA.
authors.forename: Jannet
authors.initials: J
authors.lastname: Carmichael
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D016022:Case-Control Studies; D050723:Fractures, Bone / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014728:Veterans
keywords: absolute risk assessment; clinical decision making; databases; decision analysis; electronic information; fractures; informatics; male osteoporosis; osteoporosis; risk management; veterans