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Targeted bone density testing for optimizing fracture prevention in Canada.

W D Leslie1, S N Morin2, L M Lix3

  • 1Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada. bleslie@sbgh.mb.ca.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|February 14, 2020
PubMed
Summary
This summary is machine-generated.

The Canadian FRAX® tool without bone mineral density (BMD) effectively identifies individuals needing osteoporosis pharmacotherapy. Simple age cutoffs of 70 or 65 years, based on clinical risk factors, can guide BMD testing.

Keywords:
Clinical practice guidelinesDual-energy X-ray absorptiometryFRAXFracturesOsteoporosis

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Area of Science:

  • Osteoporosis management
  • Clinical decision support tools
  • Fracture risk assessment

Background:

  • Osteoporosis Canada Guidelines recommend pharmacotherapy for individuals with a 20% major osteoporotic fracture (MOF) risk.
  • Bone mineral density (BMD) testing is a key component in assessing osteoporosis risk.

Purpose of the Study:

  • To evaluate the effectiveness of the Canadian FRAX® tool without BMD in identifying individuals eligible for pharmacotherapy.
  • To inform initial BMD testing strategies within Osteoporosis Canada's updated guidelines.

Main Methods:

  • Utilized a BMD registry from Manitoba, Canada, including 50,700 women and 4,152 men aged 50+.
  • Calculated MOF probability with and without BMD (MOF-clinical and MOF-BMD) using the Canadian FRAX® tool.

Main Results:

  • FRAX MOF-clinical score >10% in 33.8% of women and 13.3% of men.
  • MOF-clinical >10% demonstrated high sensitivity (99.3% women, 99.1% men) for identifying those qualifying for treatment based on MOF-BMD ≥20%.
  • Age-based rules (70 years without risk factors, 65 years with risk factors) showed very high sensitivity for indicating BMD testing.

Conclusions:

  • FRAX without BMD is a sensitive and effective tool for identifying individuals meeting the Canadian treatment threshold.
  • Simplified age-based criteria can effectively guide the need for BMD testing in osteoporosis management.