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Ministers to consider overhaul of medical indemnity for GPs

A simple new risk scoring system could substantially cut fractures in patients on ster-oids by addressing the under-use of bone protection therapy, researchers conclude.

The system allows GPs to calculate the precise absolute risk of fracture for an individual patient on oral steroids, reducing the need for a DEXA scan to support treatment decisions.

Research leader Professor Cyrus Cooper, director of the MRC epidemiology resource centre, said he expected the system to be factored in to new NICE guidance on the prevention of osteoporotic fractures, due next February.

Researchers analysed notes of almost 200,000 patients from the UK general practice research database. They calculated individual risk scores for a range of factors, including age, gender, smoking, BMI and recent hospitalisation, and read the combined score from graphs to calculate absolute risk.

Professor Cooper said fracture risks associated with steroid use were 'remarkably high' and that there was

'no question' bisphosphonates were under-used.

'The difficulty is most people would want to first test bone mineral density and DEXA scanning is not widely enough available to do that,' he said. 'But this allows us to identify much more accurately those people using steroids who should be on treatment to prevent osteoporosis.'

Dr Nick Summerton, reader in public health and primary care at the University of Hull and a GP in the city, was sceptical that using risk scores would be feasible in a busy surgery.

'My approach to people on steroids is to minimise treatment and put them on bone protection anyway,' he said.

But Professor Cooper insisted GPs would be able to use simple computer tools to identify patients at risk and calculate risk scores.

The study was published in QJM (March).

By Cato Pedder

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