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Headline

Primary care osteoporosis screening 'could prevent a quarter of hip fractures'

Comment

While I do not want to be anti-academics all the time , there are some very practical issues on the frontline: (1) National Osteoporosis Society advocated the use of FRAX scoring to assess risk of fragility fracture . FRAX scores are both available with and without DEXA scan results (hence , T-scores). The fracture risk calculated are to be projected on the treatment graph(10 year probability of major osteoporotic fracture in %) and treatment e.g.bisphosphonates is recommended if the risk exceeded a the treatment threshold line and this is related to the actual age of an individual patient. So it could be a threshold of about 7% for a 45 years old as opposed to about 20% in a 70 years old . This approach is sensible to me. (2) But what did our NICE guys say ? Simply commence biphosphonates if the risk is above 1% . Use either Qfracture( which does not need to include T score) OR FRAX. Potentially, we will treat a lot of elderly patients with biphosphonates for argument sake. (3) I yet to get an automatic calculator on EMIS for Qfracture or FRAX although both are READ CODES by default. Time is a resource here and quite rightly, this work is unfunded considering one has to follow up and review medication for biphosphonates as they are not without side effects and a treatment holiday may be necessary after 3 to 5 years . I just wish before academics want to fulfill their mission of bringing ‘changes’ with guidances , talk to grass root GPs in the frontline first.

Posted date

16 Dec 2017

Posted time

10:09am

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