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SIGN Guidelines for Scotland: BMD Versus FRAX Versus QFracture
Kanis, John A. Compston, Juliet Cooper, Cyrus Harvey, Nicholas C. Johansson, Helena Oden, Anders McCloskey, Eugene V.
Kanis, John A.
Compston, Juliet
Cooper, Cyrus
Harvey, Nicholas C.
Johansson, Helena
Oden, Anders
McCloskey, Eugene V.
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.
Keywords
Assessment guidelines, FRAX, QFracture osteoporosis, Scotland, QFracture
Date
2016
Type
Journal article
Journal
Calcified Tissue International
Book
Volume
98
Issue
5
Page Range
417-425
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
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Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled