New fracture risk algorithm

This is what you get when a car swerves into your bike lane.

This is my first post on the new blog (old blog is here, with most posts migrated to this one and deleted). In yesterday’s Medscape news, they reviewed a study in the BMJ about a new set of algorithms for predicting osteoporotic fractures. According to the authors of the study, QFractureScores shows evidence of improved calibration and discrimination over FRAX (another algorithm – by the WHO and available here) for estimating the 10-year absolute risk for osteoporotic fracture and hip fracture.

The QFractureScore includes risk factors for men (age, smoking status, cardiovascular disease, body mass index, alcohol use, rheumatoid arthritis, asthma, liver disease, DM2, use of tricyclic antidepressants, history of falls) and women (age, BMI, use of HRT, alcohol use, cardiovascular disease, DM2, smoking status, parental history of osteoporosis, asthma, rheumatoid arthritis, use of corticosteroids, tricyclic antidepressants, history of falls, menopausal symptoms, GI malabsorption and other endocrine disorders, chronic liver disease).

QFractureScores does not require lab tests or clinical measurements such as a DEXA scan, and it has the ability to discriminate between those who then have a fracture vs those who do not according to the authors.

You can read the full study on the BMJ website (an Open Access article), and the QFractureScores algorithm is here.

ADDENDUM (12/5): on the SOG listserve someone pointed out that when she entered in her own data she got very different numbers (with FRAX being more conservative giving her a greater chance of fractures; she having osteoporosis), and that FRAX takes into account where you live and your ethnicity, and that QFracture does not take into account bone density.

It is true that QFracture was developed in the UK  (from the webpage: “the algorithms have been specifically developed by doctors and academics for use in the UK“, emphasis mine) and would benefit from a comparison study to other geographic areas (and the website would benefit from a conversion calculator for height and weight).  However, it doesn’t require a DEXA scan and thus can be used in the primary care setting (and given the push for healthcare reform I think there will be more of a focus on algorithms and clinical prediction rules rather than expensive tests), it uses variables that FRAX does not such as HRT (which has shown a protective effect), and it showed to be more discriminative than FRAX in the UK.  Hopefully someone in the US will do a validation study and be able to offer further refinement of the algorithm.  Thank you to the person who commented for pointing out the geographic issue – I should have been more critical in the post for this one rather than just reporting it and causing confusion.  In light of that I too would stick with FRAX for now, but QFracture shows promise with no need for lab tests, taking more variables into account, and being more discriminative.

Picture credit: This is what you get when a car swerves into your bike lane.,
originally uploaded by


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