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Published in: Calcified Tissue International 5/2016

01-05-2016 | Review

SIGN Guidelines for Scotland: BMD Versus FRAX Versus QFracture

Authors: John A. Kanis, Juliet Compston, Cyrus Cooper, Nicholas C. Harvey, Helena Johansson, Anders Odén, Eugene V. McCloskey

Published in: Calcified Tissue International | Issue 5/2016

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Abstract

Scottish Intercollegiate Guidelines Network (SIGN) recently issued guidance on the management of osteoporosis and the prevention of fragility fractures. The aim of this paper was to critically review the guidance. The SIGN guidance utilises risk factors for fracture as an initial step for assessment, but recommends treatment only in individuals with a T-score of −2.5. There are many problems with the sole use of BMD as the sole gateway to treatment. Moreover, the assessment tools to determine risk (FRAX or QFracture) are not designed to detect osteoporosis but rather fracture risk. Whereas SIGN assumes that FRAX overestimates fracture probability, there are compelling reasons to believe that the disparity is related to the inadequate calibration of QFracture. The disparities make the use of a single threshold for BMD testing problematic. The SIGN guidance for men at high risk of fracture provides a set of confused and inconsistent recommendations that are in direct conflict with regulatory authorizations and is likely to increase further the large treatment gap in men. For women, the number of women eligible for treatment (i.e. with osteoporosis) is 81,700 with the use of FRAX but only 12,300 with QFracture representing 8.2 and 1.2 % of the total population at risk, respectively. We conclude that serious problems with the SIGN guidance preclude its implementation.
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Metadata
Title
SIGN Guidelines for Scotland: BMD Versus FRAX Versus QFracture
Authors
John A. Kanis
Juliet Compston
Cyrus Cooper
Nicholas C. Harvey
Helena Johansson
Anders Odén
Eugene V. McCloskey
Publication date
01-05-2016
Publisher
Springer US
Published in
Calcified Tissue International / Issue 5/2016
Print ISSN: 0171-967X
Electronic ISSN: 1432-0827
DOI
https://doi.org/10.1007/s00223-015-0092-4

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