KANANASKIS, ALTA. — An investigational computer program considers more than just bone mineral density in determining fracture risk, summarizing its findings in a color-coded representation of the patient.
Developed by rheumatologist William Bensen, the Bone DESTINY software program predicts fractures more reliably than do bone mineral density (BMD) assessments alone. Using the Bone DESTINY program achieves prediction accuracy comparable with that attained by following the guidelines developed by Osteoporosis Canada (Can. Assoc. Radiol. J. 2005;56:178–88).
Bone DESTINY software is free to physicians but has not been released for general use yet. Its development has been funded by Dr. Bensen and McMaster University, Hamilton, Ont.
Bone DESTINY begins with bone density, then factors in age, steroid use, propensity to fall, history of previous falls, body mass index, and previous fragility fractures, said Dr. Maggie Larché, a rheumatologist at McMaster.
“These data are plugged into a handheld computer, which then generates a graphic with a color-coded representation of the patient's risk.” The program produces an accompanying text report.
In the first of two studies presented at the annual meeting of the Canadian Rheumatology Association, Dr. Larché and her colleagues at McMaster studied the predictive value of the software program in 14,812 postmenopausal women at least 60 years old. For each patient, treatment recommendations were produced based on BMD alone, Osteoporosis Canada guidelines, or Bone DESTINY results.
Among 7,049 patients aged 60–69 years, BMD analysis alone recommended treatment in 19%. By comparison, 20% were recommended for treatment according to OC guidelines, and 28% according to the software. In 5,252 patients aged 70–79 years, 29% were recommended for treatment based on BMD alone, 43% according to Bone DESTINY, and 51% according to OC guidelines. In 2,511 patients at least 80 years old, 47%, 72%, and 77% would be recommended for treatment according to BMD, OC guidelines, and Bone DESTINY results, respectively.
A second study compared predictive values of the three methods in 572 men and 3,914 women (aged 50 years and older) who had suffered at least one previous fragility fracture.
For all age groups, both Bone DESTINY and OC guidelines recommended treatment in 80% of the women to prevent another fracture; 35% of the women would have received treatment based on BMD alone, Dr. Larché reported.
The most significant difference, however, was observed in men, in whom Bone DESTINY recommended treatment in 73%, compared with 26% by BMD alone and 41% by OC guidelines.
Dr. Larché reported receiving honoraria and/or speakers fees from Amgen, Abbott, BMS, Pfizer, Schering, and GSK.