How to decide who to treat

Kanis, J.A.; McCloskey, E.V.; Johansson, H.; Strom, O.; Borgstrom, F.; Oden, A.

doi:10.1016/j.berh.2009.09.002

« Previous Next »Best Practice & Research Clinical Rheumatology
Volume 23, Issue 6 , Pages 711-726, December 2009

How to decide who to treat

J.A. Kanis, MD, FRCP, FRCPath (Emeritus professor)
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
- Corresponding author. Tel.: +44 114 285 1109; Fax: +44 114 285 1813.
E.V. McCloskey, MD, FRCP (Reader)
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
- Osteoporosis Centre, Northern General Hospital, Sheffield, UK
H. Johansson, MSc (Statistician)
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
O. Strom, PhD (Health Economist)
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
F. Borgstrom, PhD (Health Economist)
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
A. Oden, PhD (Statistician)
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK

Fractures are the clinical consequence of osteoporosis and are a major cause of morbidity and mortality worldwide. Although treatments are available that have been shown to decrease the risk of fracture, problems arise in identifying individuals at high risk of fracture so that intervention can be effectively targeted. Practice guidelines, available in many countries, differ markedly in approach, but generally recommend treatments on the basis of a previous fragility fracture and a defined threshold for bone mineral density (BMD). Recent developments in fracture risk assessment include the availability of the FRAX^® tool by the World Health Organization (WHO) Collaborating Centre for Metabolic Bone Diseases at Sheffield, UK, that integrates the weight of clinical risk factors for fracture risk with or without information on BMD and computes the 10-year probability of fracture. The tool increases sensitivity without trading specificity and is now being used in the re-appraisal of clinical guidelines.

Keywords: case-finding, FRAX, fracture probability, clinical guidelines, intervention threshold