Osteoporosis: assessing the risk of fragility fracture

Recommendation ID: CG146/4
Question: Bone mineral density (BMD) with FRAX:- What is the added prognostic value of BMD in the assessment of fracture risk with FRAX?
Any explanatory notes (if applicable): Why this is important:- The 10-year fracture risk as estimated by FRAX is calculated using clinical risk factors with or without bone mineral density (BMD). The clinical risk factors are routinely available, making calculation of fracture risk possible at the time of consultation. However, refinement of a patient's 10-year fracture risk using BMD requires assessment using dual-energy X-ray absorptiometry (DXA) scanning equipment. Currently, there are no definitive studies in primary or secondary care evaluating whether the addition of BMD to FRAX improves the accuracy of the predicted fracture risk. There is a need for studies to examine whether adding BMD to FRAX results in the correct reclassification of patients from low risk to high risk (and vice-versa). Furthermore, studies are also needed to evaluate the clinical usefulness (net benefit) of adding BMD to FRAX; that is, how many more patients are correctly classified as high risk (true positives) and low risk (true negatives).

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Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	04/09/2012