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Title: Evaluation of FRAX® score use in Maltese osteoporosis management guidelines
Authors: Brincat, Mark R.
Galea, Raymond P.
Borg, Eleanor
Keywords: Fractures, Bone -- Malta
Risk assessment
Osteoporotic fractures
Bone mineral density -- Malta
Issue Date: 2015
Publisher: Malta Medical Journal
Citation: Malta Medical Journal. 2015, Vol. 27(4), p. 8-12
Abstract: Objectives: Recent years have brought a shift towards evidence-based fracture risk engines. Fracture Risk Assessment Tool (FRAX®) is one such diagnostic tool used to evaluate the ten-year probability of osteoporotic fracture risk. The aim of this study was to evaluate the Maltese FRAX® score-based osteoporosis management guidelines and identify the suitability of using such a risk factor engine-based protocol. Study design: Data from 702 patients presenting for bone mineral density (BMD) estimation in 2010- 2011 were collected. In this period, local guidelines were devised but not yet put into practice so all referred patients underwent BMD estimation. These patients were below 65 years of age and above the minimum age for FRAX® use: 40 years. Data included Age, Weight, Height, BMI and the presence of any risk factor components of the FRAX® score tool. BMD was assessed using Norland/Hologic densitometers. FRAX® scores (excluding BMD) for each patient were calculated using the online tool as accessed in 2014. The resulting major osteoporotic fracture risk was compared to age-specific assessment thresholds as set by Kanis et al. (2013). Thus the appropriateness (or otherwise) of densitometry measurements as dictated by local guidelines was determined. Main outcome measures: The main outcome measures in this study were the femoral neck and vertebral body BMD. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of using the FRAX®-based guidelines in under 65 year olds were calculated. Results: Local guidelines for managing <65 year olds were found to have a PPV of 11.26% and a NPV of 94.38 % Conclusion: FRAX®-guided local guidelines are well suited at excluding non-osteoporotic patients (False omission rate of 5.62 %). Positive likelihood ratio for the protocol was found to be 1.27. This means that 1 in every 8.8 patients that would have been referred for BMD estimation were actually osteoporotic.
Appears in Collections:MMJ, Volume 27, Issue 4
MMJ, Volume 27, Issue 4

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