Impact of UK National Guidelines based on FRAX (R)- comparison with current clinical practice

P>Objective To assess whether clinician-determined treatment intervention thresholds are in line with the assessment of fracture risk provided by FRAX (R) and treatment recommendations provided by UK guidelines produced by the National Osteoporosis Guidelines Group (NOGG). Design, Patients and Measurements This was a retrospective cohort analysis of 288 patients consecutively referred for dual-energy X-ray absorptiometry (DXA) scanning from primary care immediately prior to the introduction of the FRAX (R) algorithm. In addition to DXA assessment, patients completed a clinical risk factor questionnaire which included risk factors used in the FRAX (R) algorithm. Initial risk assessment and treatment decisions were performed after DXA. FRAX (R) was used, retrospectively, with femoral neck T-score, to estimate fracture risk which was applied to NOGG to generate guidance on treatment intervention. Clinician- and NOGG-determined outcomes were audited for concordance. Results There was concordance between clinician and NOGG treatment decisions in 215 (74 center dot 6%) subjects. Discordance was observed in 73 (25 center dot 3%) subjects. In the discordant group, seven subjects were given lifestyle advice when NOGG recommended treatment, 42 given treatment when NOGG recommended lifestyle advice only, and 24 were referred to a metabolic bone clinic for further evaluation. The reasons for treatment differences in subjects recommended treatment by clinician but not NOGG were largely (90 center dot 2%) attributed to the use of lumbar spine bone mineral density (BMD). Conclusions There is high concordance between clinician-determined and FRAX (R)-NOGG intervention. The absence of spine BMD from FRAX (R) is the primary source of discrepancy. This study provides some assurance of the validity of the treatment thresholds generated from FRAX (R)-NOGG in 'real-world' usage.