Read by QxMD icon Read


Katrin C Reber, Hans-Helmut König, Clemens Becker, Kilian Rapp, Gisela Büchele, Sarah Mächler, Ivonne Lindlbauer
BACKGROUND: In aging societies osteoporotic fractures are a major health problem with high economic costs. Targeting prevention at individuals at high risk is important to reduce the future burden of fractures. Available risk assessment tools (e.g., FRAX®, QFracture, the algorithm provided by the German Osteology Society (DVO-Tool)) rely on self-reported patient information to predict fracture risk. Time and resource constraints, limited access to clinical data, and (un)willingness to participate may hamper the use of these tools...
May 2018: Bone
Margaret L Gourlay, Victor S Ritter, Jason P Fine, Robert A Overman, John T Schousboe, Peggy M Cawthon, Eric S Orwoll, Tuan V Nguyen, Nancy E Lane, Steven R Cummings, Deborah M Kado, Jodi A Lapidus, Susan J Diem, Kristine E Ensrud
Femoral neck bone mineral density (BMD), age plus femoral neck BMD T score, and three externally generated fracture risk tools had similar accuracy to identify older men who developed osteoporotic fractures. Risk tools with femoral neck BMD performed better than those without BMD. The externally developed risk tools were poorly calibrated. INTRODUCTION: We compared the performance of fracture risk assessment tools in older men, accounting for competing risks including mortality. METHODS: A comparative ROC curve analysis assessed the ability of the QFracture, FRAX® and Garvan fracture risk tools, and femoral neck bone mineral density (BMD) T score with or without age to identify incident fracture in community-dwelling men aged 65 years or older (N = 4994) without hip or clinical vertebral fracture or antifracture treatment at baseline...
October 20, 2017: Archives of Osteoporosis
Beatrice J Edwards
Osteoporosis is a silent disease until fractures occur, patient recognition is the greatest clinical challenge. Although more than 20 million women in the US are estimated to have established osteoporosis the majority are not appropriately identified. Bone densitometry is the current gold standard for diagnosis of osteoporosis; but may not be feasible or cost-effective to recommend for all postmenopausal women. Therefore, questionnaires incorporating risk factors have been developed to aid the clinician in identifying women with osteoporosis...
July 2017: Journal of Clinical Densitometry
Ghada El-Hajj Fuleihan, Marlene Chakhtoura, Jane A Cauley, Nariman Chamoun
The substantial increase in the burden of non-communicable diseases in general and osteoporosis in particular, necessitates the establishment of efficient and targeted diagnosis and treatment strategies. This chapter reviews and compares different tools for osteoporosis screening and diagnosis; it also provides an overview of different treatment guidelines adopted by countries worldwide. While access to dual-energy X-ray absorptiometry to measure bone mineral density (BMD) is limited in most areas in the world, the introduction of risk calculators that combine risk factors, with or without BMD, have resulted in a paradigm shift in osteoporosis screening and management...
July 2017: Journal of Clinical Densitometry
John A Kanis, Nicholas C Harvey, Helena Johansson, Anders Odén, Eugene V McCloskey, William D Leslie
The characterization of risk factors for fracture that contribute significantly to fracture risk, over and above that provided by the bone mineral density, has stimulated the development of risk assessment tools. The more adequately evaluated tools, all available online, include the FRAX® tool, the Garvan fracture risk calculator and, in the United Kingdom only, QFracture®. Differences in the input variables, output, and model construct give rise to marked differences in the computed risks from each calculator...
July 2017: Journal of Clinical Densitometry
Sanjay Kalra
This brief article describes risk calculators that are based on populations of Pakistani ethnicity, and can be used for risk stratification in Pakistani and other South Asian clinics. Covering the QRISK, QKidney, QThrombosis, QFracture and QCancer risk calculators, it uses examples to explain how these can be utilized for risk stratification.
December 2016: JPMA. the Journal of the Pakistan Medical Association
Noa Dagan, Chandra Cohen-Stavi, Maya Leventer-Roberts, Ran D Balicer
OBJECTIVE:  To directly compare the performance and externally validate the three most studied prediction tools for osteoporotic fractures-QFracture, FRAX, and Garvan-using data from electronic health records. DESIGN:  Retrospective cohort study. SETTING:  Payer provider healthcare organisation in Israel. PARTICIPANTS:  1 054 815 members aged 50 to 90 years for comparison between tools and cohorts of different age ranges, corresponding to those in each tools' development study, for tool specific external validation...
January 19, 2017: BMJ: British Medical Journal
Sarah Davis, Marrissa Martyn-St James, Jean Sanderson, John Stevens, Edward Goka, Andrew Rawdin, Susi Sadler, Ruth Wong, Fiona Campbell, Matt Stevenson, Mark Strong, Peter Selby, Neil Gittoes
BACKGROUND: Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture. OBJECTIVES: To evaluate the clinical effectiveness and safety of bisphosphonates [alendronic acid (Fosamax® and Fosamax® Once Weekly, Merck Sharp & Dohme Ltd), risedronic acid (Actonel® and Actonel Once a Week® , Warner Chilcott UK Ltd), ibandronic acid (Bonviva® , Roche Products Ltd) and zoledronic acid (Aclasta® , Novartis Pharmaceuticals UK Ltd)] for the prevention of fragility fracture and to assess their cost-effectiveness at varying levels of fracture risk...
October 2016: Health Technology Assessment: HTA
James R Beattie, Niamh M Cummins, Clare Caraher, Olive M O'Driscoll, Aruna T Bansal, Richard Eastell, Stuart H Ralston, Michael D Stone, Gill Pearson, Mark R Towler
Raman spectroscopy was applied to nail clippings from 633 postmenopausal British and Irish women, from six clinical sites, of whom 42% had experienced a fragility fracture. The objective was to build a prediction algorithm for fracture using data from four sites (known as the calibration set) and test its performance using data from the other two sites (known as the validation set). Results from the validation set showed that a novel algorithm, combining spectroscopy data with clinical data, provided area under the curve (AUC) of 74% compared to an AUC of 60% from a reduced QFracture score (a clinically accepted risk calculator) and 61% from the dual-energy X-ray absorptiometry T-score, which is in current use for the diagnosis of osteoporosis...
2016: Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders
Darren Aw, Jennifer Thain, Aamer Ali, Thanda Aung, Wei Mei Chua, Opinder Sahota, Namal Weerasuriya, Lindsey Marshall, Fiona Kearney, Tahir Masud
BACKGROUND: In the UK, the National Institute for Health and Care Excellence recommends either fracture risk assessment tool (FRAX) or QFracture to estimate the 10 year fracture risk of individuals. However, it is not known how these tools compare in determining risk and subsequent treatment using set intervention thresholds or guidelines. METHODS: The 10 year major osteoporotic (MO) and hip (HI) fracture risks were calculated for 100 women attending osteoporosis clinic in 2010 using FRAX and QFracture, and subsequent agreement to treatment between the tools was looked at using National Osteoporosis Foundation and National Bone Health Alliance thresholds (FRAX-20/3 and QFracture 20/3)...
May 2016: Postgraduate Medical Journal
John A Kanis, Juliet Compston, Cyrus Cooper, Nicholas C Harvey, Helena Johansson, Anders Odén, Eugene V McCloskey
Scottish Intercollegiate Guidelines Network (SIGN) recently issued guidance on the management of osteoporosis and the prevention of fragility fractures. The aim of this paper was to critically review the guidance. The SIGN guidance utilises risk factors for fracture as an initial step for assessment, but recommends treatment only in individuals with a T-score of -2.5. There are many problems with the sole use of BMD as the sole gateway to treatment. Moreover, the assessment tools to determine risk (FRAX or QFracture) are not designed to detect osteoporosis but rather fracture risk...
May 2016: Calcified Tissue International
Andréa Marques, Ricardo J O Ferreira, Eduardo Santos, Estíbaliz Loza, Loreto Carmona, José António Pereira da Silva
OBJECTIVES: To identify and synthesise the best available evidence on the accuracy of the currently available tools for predicting fracture risk. METHODS: We systematically searched PubMed MEDLINE, Embase and Cochrane databases to 2014. Two reviewers independently selected articles, collected data from studies, and carried out a hand search of the references of the included studies. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist was used, and the primary outcome was the area under the curve (AUC) and 95% CIs, obtained from receiver operating characteristic (ROC) analyses...
November 2015: Annals of the Rheumatic Diseases
Terry J Aspray
More than half of older women who sustain a fragility fracture do not have osteoporosis by World Health Organization (WHO) bone mineral density (BMD) criteria; and, while BMD has been used to assess fracture risk for over 30 years, a range of other skeletal and nonskeletal clinical risk factors (CRFs) for fracture have been recognized. More than 30 assessment tools using CRFs have been developed, some predicting fracture risk and others low BMD alone. Recent systematic reviews have reported that many tools have not been validated against fracture incidence, and that the complexity of tools and the number of CRFs included do not ensure best performance with poor assessment of (internal or comparative) validity...
February 2015: Therapeutic Advances in Musculoskeletal Disease
Veronica Lyell, Emily Henderson, Mark Devine, Celia Gregson
Parkinson's disease (PD) is associated with substantially increased fracture risk, particularly hip fracture, which can occur relatively early in the course of PD. Despite this, current national clinical guidelines for PD fail to adequately address fracture risk assessment or the management of bone health. We appraise the evidence supporting bone health management in PD and propose a PD-specific algorithm for the fracture risk assessment and the management of bone health in patients with PD and related movement disorders...
January 2015: Age and Ageing
Julia Hippisley-Cox, Carol Coupland, Peter Brindle
OBJECTIVES: To validate the performance of a set of risk prediction algorithms developed using the QResearch database, in an independent sample from general practices contributing to the Clinical Research Data Link (CPRD). SETTING: Prospective open cohort study using practices contributing to the CPRD database and practices contributing to the QResearch database. PARTICIPANTS: The CPRD validation cohort consisted of 3.3 million patients, aged 25-99 years registered at 357 general practices between 1 Jan 1998 and 31 July 2012...
2014: BMJ Open
Eveline van der Veer, Suzanne Arends, Sjoukje van der Hoek, Joris B Versluijs, Jan G R de Monchy, Joanna N G Oude Elberink, Jasper J van Doormaal
BACKGROUND: Fragility fractures (FFxs) and osteoporosis occur frequently in patients with indolent systemic mastocytosis (ISM), even before 50 years of age. OBJECTIVE: We sought to develop a prediction model to identify individual patients with ISM at risk of new FFxs. METHODS: Data on lifetime fractures and trauma circumstances were collected from vertebral morphometry, patients' records, and questionnaires. Clinical, lifestyle, and bone characteristics were measured...
December 2014: Journal of Allergy and Clinical Immunology
Samuel Shribman, Kelli M Torsney, Alastair J Noyce, Gavin Giovannoni, Julian Fearnley, Ruth Dobson
Parkinson's disease (PD) is associated with an increased risk of fragility fracture. FRAX and Qfracture are risk calculators that estimate the 10-year risk of hip and major fractures and guide definitive investigation for osteoporosis using dual X-ray absorptiometry (DEXA) imaging. It is unclear which PD patients should be considered for fracture risk assessment and whether FRAX or Qfracture should be used. Seventy-seven patients with PD were recruited in the movement disorders clinic. Data were collected on PD-related characteristics and fracture risk scores were calculated...
June 2014: Journal of Neurology
Eugene McCloskey
In the past the management of osteoporosis centred on the use of diagnostic thresholds based on bone mineral density (BMD) measured at the spine or hip by dual x-ray absorptiometry (DXA). Previous guidance was based on an opportunistic case-finding strategy whereby the presence of clinical risk factors would prompt clinicians to measure BMD. Those patients with a BMD value that fell within the range of osteoporosis were considered for treatment. More recently it has been found that the presence of several of these risk factors is associated with a fracture risk greater than can be accounted for by BMD alone...
October 2013: Practitioner
Terry J Aspray
Fracture is the clinical outcome of concern in osteoporosis, a disease variably defined over the last 30 years, mostly in terms of bone mineral density (BMD). However, an 'osseocentric' view of the condition may have hampered our understanding of how best to identify patients at the greatest risk of fragility fracture. More recently, the identification of a number of clinical risk factors for fragility fracture and the creation of fracture risk assessment tools, such as FRAX®, QFracture and Garvan have helped in a move towards clinically useful definitions, using the common currency of 10-year major osteoporotic and 10-year hip fracture risks...
September 2013: Age and Ageing
Katrine Hass Rubin, Teresa Friis-Holmberg, Anne Pernille Hermann, Bo Abrahamsen, Kim Brixen
A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence, and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance of each tool was sufficient for practical use, and last, to examine whether the complexity of the tools influenced their discriminative power...
August 2013: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"