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SIGN Guidelines for Scotland: BMD versus FRAX versus QFracture

SIGN Guidelines for Scotland: BMD versus FRAX versus QFracture
SIGN Guidelines for Scotland: BMD versus FRAX versus QFracture
Scottish Intercollegiate Guidelines Network (SIGN) recently issued guidance on the management of osteoporosis and the prevention of fragility fractures. The aim of this paper was to critically review the guidance. The SIGN guidance utilises risk factors for fracture as an initial step for assessment, but recommends treatment only in individuals with a T-score of ?2.5. There are many problems with the sole use of BMD as the sole gateway to treatment. Moreover, the assessment tools to determine risk (FRAX or QFracture) are not designed to detect osteoporosis but rather fracture risk. Whereas SIGN assumes that FRAX overestimates fracture probability, there are compelling reasons to believe that the disparity is related to the inadequate calibration of QFracture. The disparities make the use of a single threshold for BMD testing problematic. The SIGN guidance for men at high risk of fracture provides a set of confused and inconsistent recommendations that are in direct conflict with regulatory authorizations and is likely to increase further the large treatment gap in men. For women, the number of women eligible for treatment (i.e. with osteoporosis) is 81,700 with the use of FRAX but only 12,300 with QFracture representing 8.2 and 1.2 % of the total population at risk, respectively. We conclude that serious problems with the SIGN guidance preclude its implementation.
assessment guidelines, FRAX, QFracture osteoporosis, scotland, QFracture
0171-967X
1-9
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Compston, J.
b64c0d0e-97dd-44c8-97ba-f756f0bc966d
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Compston, J.
b64c0d0e-97dd-44c8-97ba-f756f0bc966d
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de

Kanis, J.A., Compston, J., Cooper, C., Harvey, N.C., Johansson, H., Oden, A. and McCloskey, E.V. (2015) SIGN Guidelines for Scotland: BMD versus FRAX versus QFracture. Calcified Tissue International, 1-9. (doi:10.1007/s00223-015-0092-4). (PMID:26650822 )

Record type: Article

Abstract

Scottish Intercollegiate Guidelines Network (SIGN) recently issued guidance on the management of osteoporosis and the prevention of fragility fractures. The aim of this paper was to critically review the guidance. The SIGN guidance utilises risk factors for fracture as an initial step for assessment, but recommends treatment only in individuals with a T-score of ?2.5. There are many problems with the sole use of BMD as the sole gateway to treatment. Moreover, the assessment tools to determine risk (FRAX or QFracture) are not designed to detect osteoporosis but rather fracture risk. Whereas SIGN assumes that FRAX overestimates fracture probability, there are compelling reasons to believe that the disparity is related to the inadequate calibration of QFracture. The disparities make the use of a single threshold for BMD testing problematic. The SIGN guidance for men at high risk of fracture provides a set of confused and inconsistent recommendations that are in direct conflict with regulatory authorizations and is likely to increase further the large treatment gap in men. For women, the number of women eligible for treatment (i.e. with osteoporosis) is 81,700 with the use of FRAX but only 12,300 with QFracture representing 8.2 and 1.2 % of the total population at risk, respectively. We conclude that serious problems with the SIGN guidance preclude its implementation.

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More information

Accepted/In Press date: 21 November 2015
e-pub ahead of print date: 9 December 2015
Keywords: assessment guidelines, FRAX, QFracture osteoporosis, scotland, QFracture
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 386847
URI: http://eprints.soton.ac.uk/id/eprint/386847
ISSN: 0171-967X
PURE UUID: dcdf9869-abb4-4b61-8e6e-962115283daa
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 03 Feb 2016 14:17
Last modified: 17 Dec 2019 01:57

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Contributors

Author: J.A. Kanis
Author: J. Compston
Author: C. Cooper ORCID iD
Author: N.C. Harvey ORCID iD
Author: H. Johansson
Author: A. Oden
Author: E.V. McCloskey

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