Endocrine Abstracts

The SIGN guideline group recently suggested a fracture risk threshold of 10% as an indication for DXA. Patients who do not have a 10 year fracture probability of 10% or more would therefore not meet the criteria for direct access to DXA. In order to assess whether implementing these guidelines would impact overall management, we undertook a prospective audit of our direct access DXA and health promotion service. Charts from 61 consecutive patients were reviewed (54F/7M, Mean age 60.4 years). 18 patients had a history of fragility fracture at time of referral. A range of clinical risk factors (CRFs: 0 n=4; 1 n=28; 2 n=15; 3 n=8; >3 n=6) were observed. Treatments at time of referral were noted and included calcium/vitamin D (n=17), bisphosphonate (n=1), or a combination of both (n=2). None of the 61 referrals to our service included a prospective FRAX score. Retrospective FRAX assessment showed 27/61 patients had a <10% probability of 10 year major fracture risk and would not have met SIGN criteria for DXA. However, direct access DXA identified 25 patients with osteopenia and 18 with osteoporosis. 16/61 patients with low bone mineral density (BMD) might therefore have been excluded from accessing the DXA/ health promotion service using SIGN thresholds. National Osteoporosis Guideline Group (NOGG) management recommendations for our cohort included DXA (30/61), lifestyle advice (18/61) or pharmacological therapy (10/61). This audit has shown low adherence to NICE guidelines for assessment of fracture risk in those referred for direct access DXA. Significantly, our data has highlighted that some patients with modifiable low BMD would have been excluded from scanning using proposed SIGN guidelines on fracture risk thresholds for access to DXA.