For clinicians, the biggest change in the new screening
recommendations may be the need to calculate the 10-year fracture risk
in women aged younger than 65 years, two experts suggested in
interviews.
“They will need to know what tools are out there to be
able to figure out whether a younger person is at equal to or greater
risk than a 65-year-old woman with no addition risk factors,” Dr.
Carolyn J. Crandall said.
The online FRAX calculator that was used
by the USPSTF is a “really good tool” for this purpose, said Dr.
Crandall. “Clinicians will have to access that tool in their clinics,
which means they will either need Internet access at some point, or else
they can download versions that are available for iPhone, or print
versions that are available.”
Dr. Edward S. Leib also commended
inclusion of the FRAX tool in the guidelines, but cautioned that it has
some weaknesses that were discussed at a November 2010 “position
development conference” conducted jointly by the International
Osteoporosis Foundation and the International Society for Clinical
Densitometry.
Some important risk factors that could affect the
10-year fracture risk would not necessarily be reflected in the FRAX
calculation, he said. Also, the FRAX tool is based on an international
model, and although it included U.S. databases, the calculations may not
reflect risks in regional populations.
“For example, in a
retrospective review of our population of 15,000 postmenopausal women
having bone density studies over the past 10 years, we did not find a
correlation between history of fracturing and parental history of hip
fractures,” he said.
Both Dr. Crandall and Dr. Leib also commended
the USPSTF for acknowledging the need for more research in men, but Dr.
Leib had hoped for more guidance. “It is known that the fracture risk
in men who are age 75 is about equivalent to women who are age 65. I
would have hoped that the USPSTF would have recommended screening at
that age” despite the lack of primary prevention trials, he said.
DR. CRANDALL is professor of medicine at the University of California, Los Angeles. She said she has no pertinent conflicts of interest. DR. LEIB is professor of medicine at the University of Vermont, Burlington. He said he has no pertinent conflicts of interest.
