Automated link to national intervention guidance helps doctors interpret FRAX results

This is a sample calculation for 70-year old woman in Lebanon. Credit: FRAX

The fracture risk assessment tool FRAX, promoted and supported by the International Osteoporosis Foundation (IOF), has become an important aid in the clinical assessment of osteoporotic fracture risk in patients aged 40 to 90 years. However, while a FRAX calculation is quick and simple, interpretation of the results in order to make treatment decisions can be a challenge for physicians.

The UK FRAX calculator pioneered an automated link to its national NOGG guidance in 2008. Now, doctors in Finland and Lebanon will also benefit from an automated link to their respective national intervention guidance.

FRAX co-developer Dr. Eugene McCloskey, Professor in Adult Bone Disease and Honorary Consultant at the Metabolic Bone Centre, University of Sheffield UK, stated, "Treatment decisions should always be based on good clinical judgment, which includes an assessment of individual . Successful use of FRAX in clinical practice is enhanced by the automated link to the respective national intervention and assessment guidance. We hope that more countries will work with us to integrate their FRAX calculators with the respective national assessment recommendations."

The FRAX output gives a patient's 10-year probability of a hip fracture and of a major osteoporotic fracture (hip, clinical vertebral, humerus or wrist fracture) based on specific clinical risk factors, with or without bone mineral density (BMD). When linked automatically to guidance pages, the output is then plotted on country-specific intervention threshold graphs. The colour coded graph can indicate a number of actions including whether to treat, undertake a testing or to simply give lifestyle advice and reassurance.

This is an assessment threshold graph showing results for 70-year old woman in Lebanon based on national guidance. Credit: FRAX

Dr Heikki Kröger, Professor, Department of Surgery/Orthopaedics Kuopio University Hospital stated, "We are very pleased that doctors in Finland will now have national guidance at their fingertips as this will aide in decision making in the course of a for fracture risk. Osteoporotic fractures cost our health care system more than € 383 million annually – not counting the immense cost to the patients in terms of lost quality of life and long-term disability. It is therefore important that doctors identify and treat high-risk individuals before debilitating fractures occur."

"FRAX Lebanon was launched on-line in September 2009 and has become an important tool for physicians in our country", stated Dr. Ghada El-Hajj Fuleihan, Professor of Medicine, Director of the Calcium Metabolism and Osteoporosis Program & WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Lebanon.

She added, "This tool has had a great impact on addressing the heavy toll incurred by the steady increase in in our country. It has allowed the development of FRAX-based national osteoporosis guidelines, that were unanimously endorsed by eight concerned national scientific societies, the Lebanese national task force for osteoporosis, and health authorities. Having our national FRAX linked to our FRAX-based guidelines will greatly enhance their application and substantially optimize patient care, targeting therapy to high risk individuals."

More information: FRAX is available as a free online calculator at www.shef.ac.uk/FRAX , as an iPhone App itunes.apple.com/us/app/frax/id847593214?ls=1&mt=8 and as a Desktop application www.who-frax.org/

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