Category: Diagnosis and Risk Assessment

9 - The Impact of Inaccurate Medical Information on FRAX Results and the Resulting Implications

Introduction: If inaccurate medical information is entered into the fracture risk assessment tool (FRAX), it will result in an incorrect calculation of the patient’s fracture risk and could impact treatment decisions. Side effects from pharmaceutical treatment for low bone mineral density (BMD) and a high ten-year probability (%) of fracture have the potential to negatively affect a patient’s health. Conversely, if a patient needs this treatment, it could be detrimental to their health if they do not receive it.

Objective: This study was performed to determine the effect of incorrect answers to the clinical risk factor questions in the FRAX on the ten-year probability (%) of fracture.


Method:
When calculating the fracture risk for this study we used the FRAX developed by the Centre for Metabolic Bone Diseases at the University of Sheffield, with the North American (US Caucasian) calculation tool selected. We changed the answers to the clinical risk factor questions in the FRAX tool to determine the possible impact on the ten-year probability (%) of fracture for both major osteoporotic and hip fractures. We did this for two BMD measurements to see if there was a greater impact on the ten-year probability (%) of fracture at different levels of osteopenia. The clinical risk factors changed in this study include: previous fracture, parental fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, and alcohol consumption of 3 or more drinks per day. We performed calculations for up to 3 “YES” answer combinations.


Results:
The results tables show the ranges of the ten-year probability (%) of fracture from the many different combinations of yes/no answers to the clinical risk factor questions in the FRAX. (Please see attached tables)


Conclusion:
Although physicians and patients may initiate pharmaceutical treatment based on their own judgment or preferences; the recommendations for treatment are as follows: 1) T-score of > -2.5 (after secondary causes are excluded); 2) low bone mass or osteopenia and a ten-year probability (%) of a major osteoporotic fracture of > 20 or hip fracture > 3; or 3) if the patient has had a hip or vertebral fracture . Since the ten-year probability of a major osteoporotic or hip fracture, as predicted by FRAX, are important factors in a treatment decision, data to calculate FRAX must be accurate and entered accurately. We have shown the considerable potential effect on the FRAX results by changing answers entered and the marked variation in the results obtained.

Footnote: Centre for Metabolic Bone Disorders (n.d.). FRAX: Fracture risk assessment tool. University of Sheffield, UK. Retrieved from: http://www.shef.ac.uk/FRAX/tool.aspx?country=9




Dmitry Beyder

Supervisor-Nuclear Medicine/PET
Barnes-Jewish Hospital
St. Louis, Missouri

Keith Fischer

Associate Professor of Radiology
Barnes-Jewish Hospital/Washington University Medical School
St. Louis, Missouri

Martin Scmitt

Charge Technologist PET
Barnes-Jewish Hospital
St. Louis, Missouri

Krista Sievers

Senior Nuclear Medicine Technologist
Barnes-Jewish Hospital
Columbia, Illinois