Better targeted, more cost-effective osteoporosis treatment could soon be a reality worldwide
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A new method for determining more accurately at which point someone needs further diagnostic tests, or when immediate treatment is warranted, has been developed by The National Osteoporosis Guideline Group in the UK.
Rather than relying primarily on Bone Mineral Density (BMD) measurements, as the majority of current guidelines do, their approach takes into account both the risk of someone suffering a fracture - using the WHO’s fracture risk assessment tool, FRAX - as well as whether or not treatment is likely to be cost-effective. This new method, developed by Professor John A. Kanis and colleagues from the WHO Collaborating Centre for Metabolic Bone Diseases at the University of Sheffield Medical School in the UK, already forms the basis of the new clinical guidelines for the management of osteoporosis in the UK. The case finding on the management of osteoporosis with FRAX has been published in Springer’s journal Osteoporosis International.
Professor Kanis, President of the International Osteoporosis Foundation, comments: “The incorporation of the WHO risk assessment tool FRAX into practice guidelines in the UK is a key development that will target treatment more accurately to those in need and avoid unnecessary treatment in men and women at low risk. I hope that this paper in Osteoporosis International will serve as a template for the development of FRAX-based guidance in other countries.”
The FRAX tool predicts the ten-year risk of men and women suffering a fracture. An individual’s age, sex, weight, height, and femoral BMD, if available, are entered into the web-based tool, followed by clinical risk factors for osteoporosis including a prior fracture, parental history of hip fracture, smoking, long-term use of glucocorticoids (a type of steroid hormone), rheumatoid arthritis and alcohol consumption. The tool then calculates the likelihood of the individual suffering a fracture in the next ten years.
Because this new method for the management of osteoporosis takes into account the likelihood of someone suffering a fracture, rather than relying solely on BMD, or BMD with one or more recognized clinical risk factors, it is an important milestone towards helping health professionals worldwide to identify patients at high risk of fracture more accurately and treat them cost-effectively.
Cuts to Medicare reimbursement of DXA undermine efforts to properly diagnose and treat osteoporosis and diminish quality of patient care. According to a paper published in the November issue of the Springer journal Osteoporosis International, Medicare reimbursement for dual-energy X-ray absorptiometry (DXA) has been cut to levels substantially below the cost to perform the procedure.
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