Bone Abstracts

Introduction: Current Canadian clinical practice guidelines recommend the FRAX or Canadian Association of Radiologists and Osteoporosis Canada (CAROC) fracture risk assessment tools to report 10-year fracture risk in an individual. CAROC considers sex, age, BMD and previous fracture as risk factors. It is unknown whether one reporting system is more effective in helping general practitioners (GPs) identify individuals who should be recommended for pharmacological treatment. We hypothesized that the FRAX report would result in better identification of patients who should be pharmacologically treated by GPs as compared to the CAROC report.

Methods: Individuals ≥50 years old with a distal radius fracture were included provided they had no previous osteoporosis diagnosis and were not taking any osteoporosis medication. Participants underwent a DXA scan and answered questions about fracture risk factors. Each participant’s GP was randomized to receive either a FRAX report or a CAROC report. Both tools categorize patients as being at low (<10%), moderate (10–20%) or high (>20%) fracture risk. The FRAX report, which was pilot tested with six GPs, included a statement recommending treatment for high risk participants. No treatment recommendations were stated on the CAROC report. After 3 months, all participants were called and asked if they were contacted by their GP and if they were recommended for treatment. GP’s treatment decisions were compared to recommendations of a rheumatologist (gold standard).

Results: Sixty non-consecutive participants were enrolled (n=31 FRAX, 11 low, 16 mod, 4 high risk; n=30 CAROC; 22 mod, 9 high risk). Of 31 FRAX participants, 45.2% were contacted by their family physicians to discuss their results compared to 28.2% of CAROC participants. Kappa statistics of agreement in treatment recommendation between the rheumatologist and GPs were 0.64 for FRAX and 0.32 for CAROC participants. The FRAX report was preferred by GPs.

Conclusions: FRAX reporting resulted in better post-fracture follow-up and treatment recommendations that substantially agree with a specialist in osteoporotic care. Treatment recommendations stated on the FRAX report may have been an important factor in helping GPs make treatment decisions.