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GPs urged to screen older patients for fracture risk

NICE guidelines have proposed GPs estimate the 10-year risk of fragility fractures in all older patients and middle-aged patients with risk factors, in guidance that could boost prevalence rates.

The draft guidelines say practices should consider assessing fracture risk in all women over 65 and men over 75, and in patients under this age if they have any risk factor, such as previous fragility fracture, any use of oral glucocorticoids, a history of falls, low BMI, or high smoking or alcohol intake.

The institute recommends FRAX or QFracture scores should be used to calculate the 10-year risk, and then bone mineral density (BMD) should be used only if the calculated risk is close to a treatment intervention threshold, or before starting a treatment that can affect bone density.

Patients under 50 should not be routinely assessed unless they have major risk factors such as current or regular oral glucocorticoid use, untreated premature menopause or previous fragility fracture.

Dr Alun Cooper, an osteoporosis GPSI in Crawley, West Sussex, welcomed the draft guidance: ‘This is a major advance, incorporating 10-year risk into NICE guidelines and this will help us to select patients for a DEXA scan.'

‘May be this will be the start of GPs getting involved in reducing the burden of osteoporosis.

He added that practices could use the guidance to boost their QOF osteoporosis prevalence rates for 2012/13.

‘QOF is based very much on old NICE guidance – to put it politely it is a bit dated. This new guidance will feed through to QOF indicators.

‘It should be encouraged to new CCGs, as fragility fracture occupies more hospital bed days than any other area.'

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