Fracture assessment tool risk scores in bone density reports do not change physician prescribing behavior for osteoporosis.

INTRODUCTION: Prevention of osteoporotic fractures is desirable to decrease morbidity, mortality and health care costs. The World Health Organization Fracture Assessment Tool (FRAX) enhances physician treatment decisions by combining epidemiologic fracture risk calculations with bone density. The authors sought to determine the effect of reporting FRAX results and treatment recommendations in bone density reports on clinician prescribing behavior.
METHODS: Retrospective review of adherence to treatment recommendations for 368 osteopenic patients at a VA Medical Center 7 months before (pre-FRAX) and after (post-FRAX) inclusion of fracture risk assessment data into the dual energy X-ray absorptiometry. Only osteopenic patients were included (T score: -1.0<T<-2.5). Demographic information, provider type, dual energy X-ray absorptiometry results and the decision to prescribe a Food and Drug Administration-approved drug within 6 months of the report were captured. Data were analyzed using χ test.
RESULTS: There were 178 pre-FRAX and 192 post-FRAX patients. In the pre-FRAX group, 14.8% of osteopenic patients were treated based on clinical judgment. In the post-FRAX group, FRAX identified 63 high-risk osteopenic patients for treatment. Of these, only 31.7% were treated. Eleven of the 129 osteopenic patients not recommended for treatment were treated. There was no difference in physician decision to treat or seek subspecialty consultation before and after reporting of FRAX data (14.8% pre-FRAX versus 16.2% post-FRAX; P = 0.682).
CONCLUSIONS: Despite the potential benefit of using FRAX, the authors found that: (1) prescribing behavior was not influenced by including FRAX in the bone density report and (2) increased education of FRAX fracture risk assessment is needed.