3.2.3 Activity
Use these example patients to generate risk figures using each tool. Go to the sites (links below) and use the clinical information given to fill in the boxes or answer the questions. If information is missing, as it sometimes is in a clinical setting, then assume a negative answer. Your results should look like this:
| Result: | FRAX MOF: | X% | HIP: X% |
| Qfracture MOF: | X% | HIP: X% |
FRAX Fracture risk assessment tool [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]
QFracture 2016 risk calculator
Mr A is 67. He has had Parkinson’s for 9 years, he weighs 60kg, and he is 1m 80. He is a non-smoker and rarely drinks alcohol. He fell twice last year but has never fractured a bone. He has normal cognition but suffers with depression and takes citalopram. He doesn’t think his parents had any fractures.
Mrs B is 74, she was diagnosed with Parkinson’s last year. Her menopause occurred at 42 when she had a hysterectomy. She hasn’t fallen recently. She doesn’t smoke, but drinks about 2−3 bottles of wine per week. She weighs 70kg and is 1m 65 tall. She lives with her husband. She broke her wrist in a fall in her 50s. She thinks that neither parent has broken their hip or had osteoporosis.
If you click the link to NOGG guidance from FRAX, you will see that the graph shows thresholds for intervention, suggesting either lifestyle advice, further investigation with BMD measurement by DXA (if not already done) or treatment. These interventions will be considered in the next section
Activity ii
Redo the examples above using FRAX, and now click the link to NOGG.
Acting on the results.
Once we have assessed fracture risk using these tools, we need to decide what this means for treatment.
The FRAX results offer a link to the NOGG page.
This plots the derived MOF figure on a graph (not the hip figure, though this can be done as ‘manual data entry’ NOGG manual data entry where BMD is known).
What management is suggested for Mr A?
Answer
Based on his MOF score of 5.3%, he is only recommended lifestyle advice.
What management is suggested for Mrs B?
Answer
She is recommended for a DXA, based on her MOF score of 19%.
3.2.2 QFracture