Impact of the FRAX[reg] tool and the NOGG guidelines on the indication of bone mineral density in Spanish postmenopausal women

Georgios Kyriakos; Alfonso Vidal Casariego; Dalia Avila Turcios; Ana Hernandez Moreno; Alicia Calleja Fernandez; Ma Dolores Blanco Suarez; Rocio Villar Taibo; Maria D. Ballesteros Pomar; Isidoro Cano Rodriguez

doi:10.1530/endoabs.32.P79

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Endocrine Abstracts (2013) 32 P79 | DOI: 10.1530/endoabs.32.P79

ECE2013 Poster Presentations Bone and Osteoporosis (41 abstracts)

Impact of the FRAX® tool and the NOGG guidelines on the indication of bone mineral density in Spanish postmenopausal women

Georgios Kyriakos ¹ , Alfonso Vidal Casariego ¹ , Dalia Ávila Turcios ¹ , Ana Hernández Moreno ¹ , Alicia Calleja Fernández ¹ , M ^{a Dolores Blanco Suárez} , Rocío Villar Taibo ¹ , María D. Ballesteros Pomar ¹ & Isidoro Cano Rodríguez ¹

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¹Sección de Endocrinología y Nutrición. Complejo Asistencial Universitario de León., León, Spain; ²Servicio de Radiodiagnóstico. Complejo Asistencial Universitario de León, León, Spain.

Introduction: The National Osteoporosis Guideline Group (NOGG) recommends determine BMD in patients who present an intermediate risk of osteoporotic fracture using the FRAX® tool, follow-up for low risk, and treatment for high risk. In 2011, 3163 BMD were performed in the Complejo Asistencial Universitario de León (CAULE). Since the cost for each BMD is 58.6* (BOCYL 31/01/2011), annual spending could rise to *185 352. The aim was to assess whether fracture risk calculation would result in a reduction of BMD measurements made, and therefore in the costs.

Methods: Cross-sectional study in patients referred for BMD measurement in CAULE between April and December 2012. Data of risk factors included in the FRAX® were obtained using a questionnaire completed by the technical staff. The absolute risk of presenting a major or a hip fracture was calculated using the British FRAX® formula and NOGG guidelines. We excluded patients with current or previous treatments for osteoporosis.

Results: We recruited 1163 patients, of whom 542 (46.6%) were untreated. 95% were women, with a median age of 60.2 years (Interquartile Range, IQR=14.44). 20.1% had previous clinical fractures, 17.2% were smokers, 15.3% had parents with hip fractures, 8.3% had rheumatoid arthritis, 15.7% referred risk factors for secondary osteoporosis, 9.4% were on corticosteroids and 2.2% had a high-risk alcohol consumption. The median risk for major fracture was 8.2% (IQR=9), and for hip fracture 1.3% (IQR=3). Applying the FRAX tool in combination with the NOGG guidelines 55.5% had low fracture risk, 34.5% intermediate risk and 10% high risk. Extrapolation of the data shows that 30% of all BMD annually performed in CAULE could be avoided. This would mean a cost reduction of *55 605/year.

Conclusion: The application of the NOGG guidelines led to a decrease in BMD indications, reducing costs and improving the efficiency in management of osteoporosis.