Position Development PaperJoint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®: Executive Summary of the 2010 Position Development Conference on Interpretation and Use of FRAX® in Clinical Practice
Introduction
The International Society for Clinical Densitometry (ISCD) is an international non-profit professional society linking multiple disciplines with an interest in bone mass measurement and assessment of skeletal integrity. The ISCD's mission is to advance excellence in skeletal health assessment by: promoting education and a broader understanding of the clinical applications of bone mass measurement and other skeletal health assessment technologies; assuring proficiency and quality in the assessment of skeletal health through certification and accreditation; supporting clinical and scientific advances in the diagnosis and treatment of osteoporosis; and promoting appropriate patient access to bone mass measurement and other skeletal health assessment technologies. As skeletal health assessment evolves, differences develop in technologies, acquisition techniques, reference databases, reporting methods, terminology and osteoporotic fracture prediction. These differences may result in adverse effects on patient care and the exchange of scientific information. To address these issues, the ISCD periodically holds Position Development Conferences (PDCs), a process whereby an international panel of experts makes recommendations based on reviews of the scientific literature by ISCD Task Forces. Recommendations that are approved by the ISCD Board of Directors become Official Positions of the ISCD. Official Positions resulting from prior PDCs held biannually from 2001–2007 have previously been reported 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29.
The International Osteoporosis Foundation (IOF) is a non-profit, non-governmental umbrella organization dedicated to the worldwide fight against osteoporosis, the disease known as “the silent epidemic”. The IOF’s members – committees of scientific researchers, patients, medical and research societies and industry representatives from around the world – share a common vision of a world without osteoporotic fractures. The IOF now represents 195 societies in 93 locations.
The ultimate aim of the clinician in the management of osteoporosis should be to reduce the risk of fractures. Treatment decisions should be made through good clinical judgment and improved identification of patients at high risk. FRAX® (http://www.shef.ac.uk/FRAX) is a simple computer-based tool that integrates clinical information and femoral neck BMD as an option to predict the 10-year probability of major osteoporotic fracture and hip fracture 30, 31. It can be customized for use in both women and men over the age of 40 years and for different countries based upon local epidemiology of fracture and death. Developed at the World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK, in collaboration with other scientific societies, the tool assists primary health care providers to better target patients for pharmacological intervention, ultimately improving the allocation of scarce healthcare resources for patients most likely to benefit from treatment.
FRAX is being used by an increasing number of clinicians around the world. However, the widespread application of FRAX in clinical practice has raised numerous questions regarding the information selected for input and the possible underestimation or overestimation of fracture risk in specific instances. In order to assist clinicians in deriving the greatest possible clinical value from using FRAX, the ISCD, in collaboration with the IOF, convened the FRAX PDC in Bucharest, Romania, on November 14, 2010, following a two-day collaborative meeting of the ISCD and IOF - “Interpretation and Use of FRAX in Clinical Practice.” These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, clarified a number of important issues pertaining to the interpretation and use of FRAX in clinical practice.
This report describes the methodology and results of the 2010 Bucharest, Romania ISCD-IOF PDC that was dedicated to FRAX.
The ISCD Official Positions resulting from a PDC are established in order to enhance the quality and clinical utility of skeletal assessment worldwide. However because the skeletal assessment field is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is appropriate to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider further research to resolve areas of ambiguity and/or ongoing controversy.
The ISCD and IOF wish to acknowledge the extraordinary efforts of the PDC Task Force Chairpersons and members, who represented a distinguished group of international experts. The dedication of these individuals for the past two years is exemplary.
Section snippets
Topic Selection
Topics addressed at the 2010 PDC were selected by the ISCD Board of Directors (BOD), Scientific Advisory Committee (SAC) and the PDC Steering Committee according to criteria used for prior PDCs 1, 2, 14. The topics selected were reviewed by and had the full scientific participation of the executive committee of the IOF. Each topic selected had been judged to be clinically relevant with a perceived need for an Official Position due to lack of overwhelming medical evidence or due to its
Participants
The FRAX Initiative was comprised of the Organizers, Task Force liaisons, the three Task Forces, Moderators and the Expert Panel. Details of the participants can be found in Appendix.
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2019, AACE Clinical Case ReportsCitation Excerpt :Fracture risk is dose-dependent, and FRAX may underestimate risk since it incorporates the equivalent of a prednisone dose of 2.5 to 7.5 mg/day. It is also difficult to quantify risk for frequent intermittent use of high-dose glucocorticoids or high-dose inhaled glucocorticoids (18). Inflammation-mediated osteoporosis poses unique challenges.