A bone mineral density (BMD) test
measures how much calcium and other types of minerals are in an area of your
bone. This test helps to
estimate the density of your bones and your chance of breaking a bone. Analysis
of clinical documents such as bone mineral density (BMD) reports is an
important component of program evaluation because it can provide insights into
the accuracy of assessment of fracture risk communicated to patients and
practitioners. In this paper, the authors aimed to compare fracture risk
calculations from BMD test reports to those based on the 2010 Canadian
guidelines.
The authors
retrieved BMD reports from fragility fracture patients screened through a
community hospital fracture clinic participating in Ontario’s Fracture Clinic
Screening Program. Fracture risk was determined according to the 2010 Canadian
guidelines using age, sex, and T-score at the femoral neck, in addition to
three clinical factors. Three researchers classified patients’ fracture risk
until consensus was achieved. They retrieved reports for 17 patients from nine
different BMD clinics in the Greater Toronto Area. Each patient had a different
primary care physician and all BMD tests were conducted after the 2010 Canadian
guidelines were published.
The fracture risk
of 10 patients was misclassified with 9 of the 10 reports underestimating
fracture risk. Nine reports acknowledged that the prevalence of a fragility
fracture raised the risk category by one level but only four of these reports
acknowledged that the patient had, or may have sustained, a fragility fracture.
When we raised fracture risk by one level according to these reports, eight
patients were still misclassified. Fracture risk in the majority of these
patients remained underestimated. Inconsistent classification was found in the
majority of cases where reports came from the same clinic. Four reports
described risk levels for two different types of risk.
In conclusion, more
than half of patients received BMD reports which underestimated fracture risk. Thus,
if family physicians and bone health specialists rely on BMD reports alone to
make treatment decisions, screening programs will fail to prevent future hip
and vertebral fractures.
Article by Joanna E. M. Sale, et al, from
Canada.
Full access: http://t.cn/EcmrhzV
Image
from efwrad.com
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