IMPACT OF UK NATIONAL GUIDELINES BASED ON FRAX® - COMPARISON WITH CURRENT CLINICAL PRACTICE

Nicola Crabtree (1) , Natalie Bebbington (1) , Deirdre Chapman (1) , Yasmin Wahid (1) , John Ayuk (2) , Chris Boivin (1) , Mark S Cooper (3) , Neil Gittoes (2)

1 Bone Densitometry
2 Endocrinology
3 Institute of Biomedical Research

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). Design, Patients and Measurements: This was a retrospective cohort analysis of 288 patients consecutively referred for 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 210 (72.9%) subjects. Discordance was observed in 78 (27.1%) subjects. In the discordant group, 7 subjects were given lifestyle advice when NOGG recommended treatment, 41 given treatment when NOGG recommended lifestyle advice only, and 30 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%) due to use of lumbar spine 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.

Mots clés: Medicine

Nicola Crabtree, Natalie Bebbington, Deirdre Chapman, Yasmin Wahid, John Ayuk, et al.. IMPACT OF UK NATIONAL GUIDELINES BASED ON FRAX® - COMPARISON WITH CURRENT CLINICAL PRACTICE. Clinical Endocrinology, 2010, ⟨10.1111/j.1365-2265.2010.03844.x⟩. ⟨hal-00553274⟩