Should there be a fracas over FRAX and other fracture prediction tools?: Comment on 'A comparison of prediction models for fractures in older women'.

摘要

Clinical practice guidelines regarding when to initiate osteoporosis treatment have evolved from the use of bone mineral density (BMD) thresholds to a more complex consideration of the patient's 10-year absolute fracture risk. There are sound reasons for this shift: most fractures occur in patients with BMD T scores above -2.5, and other clinical risk factors, especially age, affect fracture risk. Assuming equal relative treatment efficacy, prescribing therapy for a patient with a higher 10-year fracture risk will result in a greater absolute fracture reduction and be more cost-effective for society.The World Health Organization's FRAX tool was developed to help clinicians calculate the 10-year fracture risk for individual patients. In the United Kingdom, fracture risk thresholds identify those who should be referred for BMD testing and those in whom treatment decisions can be made without using BMD testing.