Cost effective management of patients using FRAX: The UK example

New method will help physicians better identify patients at high risk of fracture.

Better targeted, more cost-effective osteoporosis management could soon be a reality worldwide. A new method1 for determining more accurately at which point someone needs to be reassured, requires further diagnostic tests, or whether immediate treatment is warranted, has been developed by Professor John A. Kanis and colleagues from the WHO Collaborating Centre for Metabolic Bone Diseases at the University of Sheffield Medical School in the UK, and is supported by the National Osteoporosis Guideline Group in the UK.

Rather than relying primarily on Bone Mineral Density (BMD) measurements, as the majority of current guidelines do, their approach takes into account both the risk of someone suffering a fracture – using the fracture risk assessment tool, FRAX® - as well as whether or not management strategies are likely to be cost-effective. This method already forms the basis of the new clinical guidelines for the management of osteoporosis in the UK. The case finding on the management of osteoporosis with FRAX® has been published in Springer’s journal Osteoporosis International.

Professor Kanis, President of the International Osteoporosis Foundation, comments, “The incorporation of the FRAX risk assessment tool
into practice guidelines in the UK is a key development that will improve patient management and avoid unnecessary treatment in men and women at low risk. I hope that this paper in Osteoporosis International will serve as a template for the development of FRAX-based guidance in other countries.”

The FRAX® tool predicts the ten-year risk of men and women suffering a fracture. An individual’s age, sex, weight, height, and femoral BMD, if available, are entered into the web-based tool, followed by clinical risk factors for osteoporosis including a prior fracture, parental history of hip fracture, smoking, long-term use of glucocorticoids (a type of steroid hormone), rheumatoid arthritis and alcohol consumption. The tool then calculates the likelihood of the individual suffering a fracture in the next ten years.

Because this new method for the management of osteoporosis takes into account the likelihood of someone suffering a fracture, rather than relying solely on BMD, or BMD with one or more recognized clinical risk factors, it is an important milestone towards helping health professionals worldwide to identify patients at high risk of fracture more accurately and treat them cost-effectively.

Kanis JA et al (2008). Case finding for the management of osteoporosis with FRAX® - assessment and intervention thresholds for the UK. Osteoporos Int (2008) 1395-1408.
The full-text article can be accessed [link the Springer website[/link].