ECTS2013 Poster Presentations Osteoporosis: pathophysiology and epidemiology (49 abstracts)
1Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, UK; 2Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK; 3NHS North of Tyne, Newcastle upon Tyne, UK; 4Newcastle West Clinical Commissioning Group, Newcastle upon Tyne, UK; 5Newcastle North and East Clinical Commissioning Group, Newcastle upon Tyne, UK.
Introduction: Fracture risk assessment using FRAX® estimates 10-year fracture risk (FR10) at major sites (Maj_FR10) and hip (Hip_FR10). In 2012, in Newcastle, UK, a strategy was agreed to share data between General Practice (GP), Clinical Commissioning Groups and local hospitals to identify patients at high FR10.
Methods/design: FRAX® and RAID® (a health reporting, analysis and intelligence delivery tool) were used to assess routine GP data for 120 478 patients (50.2% female), aged 4090 years, from 37 GP practices. FR10 was estimated and Hip_FR10 >10% was used as an indicator of high fracture risk. These data were mapped to prescriptions of bone sparing agents (bisphosphonates, strontium ranelate, raloxifene, denosumab, and teriparatide).
Results: The table presents data for patients on and off bone sparing agents, as mean (range) 10-year fracture risks and mean (range) proportion of patients with 10-year hip fracture risk >10% per GP practice.
On bone sparing agent | Not on bone sparing agent | ||||||
Age | Maj_FR10 | Hip_FR10 | Hip_FR10 >10% | Maj_FR10 | Hip_FR10 | Hip FR10 >10% | |
Yrs | Risk (%) | Risk (%) | (%/GP) | Risk (%) | Risk (%) | (%/GP) | |
F | 59.5 | 22 (1.355) | 11 (049) | 45 (075) | 8 (156) | 3 (047) | 7.6 (0.612.3) |
M | 57.3 | 9 (1.824) | 4 (020) | 9 (067) | 4 (127) | 1 (024) | 0.6 (0.00.9) |
All | 58.4 | 19 (1.355) | 10 (049) | 38 (060) | 6 (156) | 2 (047) | 4.0 (0.26.5) |
Conclusion: Patients at higher fracture risk are being treated, with Maj_FR10 three times and Hip_FR10 five times greater in those on treatment. However, even using these conservative estimates from GP data, patients with Hip_FR10 up to 47% remain untreated. Variations may be due to differences in demography, current case finding strategies or quality of routine data collection. However, using FRAX and RAIDR, we can identify GP practices with poorer data or higher untreated fracture risk (e.g. 6.5% with Hip_FR10>10%) in order to target treatment.