title: Predicting fracture risk in osteoporosis: the use of fracture prediction tools in an osteoporosis clinic population.
abstract: BACKGROUND
  In the UK, the National Institute for Health and Care Excellence recommends either fracture risk assessment tool (FRAX) or QFracture to estimate the 10 year fracture risk of individuals. However, it is not known how these tools compare in determining risk and subsequent treatment using set intervention thresholds or guidelines.
  
  
  METHODS
  The 10 year major osteoporotic (MO) and hip (HI) fracture risks were calculated for 100 women attending osteoporosis clinic in 2010 using FRAX and QFracture, and subsequent agreement to treatment between the tools was looked at using National Osteoporosis Foundation and National Bone Health Alliance thresholds (FRAX-20/3 and QFracture 20/3). We also looked at using these thresholds for QFracture and comparing them with the National Osteoporosis Guideline Group (NOGG) guidelines for FRAX (FRAX-NOGG).
  
  
  RESULTS
  The 10 year risk for MO fracture for FRAX was 17.0% (IQR 10.8-24.0) and that of QFracture was 15.8% (IQR 9.5-27.7) (p=0.732). The 10 year risk for HI fracture for FRAX was 5.0% (IQR 2.1-8.9) and that of QFracture was 8.1% (IQR 2.5-21.6) (p<0.001). The agreement between FRAX-20/3 and QFracture-20/3 was greater than the agreement between FRAX-20/3 and FRAX-NOGG or QFracture-20/3 and FRAX-NOGG.
  
  
  CONCLUSIONS
  The calculated 10 year risk for MO fracture between FRAX and QFracture was similar, whereas that of HI fracture was significantly different. The agreement to treatment between QFracture-20/3 and FRAX-NOGG was only 45%. Treatment decisions can differ depending on the fracture calculation tool used when coupled with certain intervention thresholds or guidelines.
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Aw
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thain
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Aamer
authors.initials: A
authors.lastname: Ali
authors.affiliation: Graduate Medical Education, St Mary's Medical Centre, Long Beach, California, USA.
authors.forename: Thanda
authors.initials: T
authors.lastname: Aung
authors.affiliation: Department of Medicine for the Elderly, Royal Derby Hospital, Derby, UK.
authors.forename: Wei Mei
authors.initials: WM
authors.lastname: Chua
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Opinder
authors.initials: O
authors.lastname: Sahota
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Namal
authors.initials: N
authors.lastname: Weerasuriya
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Marshall
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Kearney
authors.affiliation: Department of Healthcare of the Older Person, Queen's Medical Centre, Nottingham, UK.
authors.forename: Tahir
authors.initials: T
authors.lastname: Masud
mesh_terms: D000368:Aged; D019468:Disease Management; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology; D018579:Patient Selection; D057216:Propensity Score; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
keywords: GERIATRIC MEDICINE; ORTHOPAEDIC & TRAUMA SURGERY