The Future of Fracture Risk Assessment in the Management of Osteoporosis

J Clin Densitom. Jul-Sep 2017;20(3):451-457. doi: 10.1016/j.jocd.2017.06.015. Epub 2017 Jul 21.

Abstract

There have been many advances in the field of osteoporosis that add to a greater understanding of skeletal integrity and the adverse effects menopause and aging have on bone. The World Health Organization, the International Osteoporosis Foundation, and numerous additional governmental and privately sponsored organizations, societies, and their respective task forces have provided guidance for the use of appropriate fracture assessment methodologies and fracture risk assessment tools, and for the prevention and management of osteoporosis. Despite these worldwide efforts, a majority of patients at high risk of fracture have not had bone density testing and are not diagnosed or offered osteoporosis treatment before or even after sustaining a fragility fracture. The future of fracture risk assessment and, in general, osteoporosis management requires health-care systems to develop customizable electronic medical record (EMR) systems that incorporate the tools necessary to identify patients at high fracture risk. As provided in the example of an advanced health-care osteoporosis model, an EMR can be fully customizable to identify fractures and patients at high risk of fracture, to assist clinicians in selecting the most efficacious osteoporosis treatments, and to provide long-term follow-up with or without serial bone density testing. Future fracture risk assessment models will likely be further refined by incorporating advanced fracture predictive technologies for integration into algorithms that have improved discrimination, calibration, risk reclassification capabilities, and clinical utility. These models will include accurate and reproducible bone biomarkers and genomic testing that will be automatically integrated into worldwide EMR systems for screening large numbers of at-risk populations and younger patients for future prediction and prevention of disease. The integration of this type of a fracture prediction model into future electronic medical record systems will result in the prevention of osteoporosis fractures.

Keywords: Fracture liaison service; fracture risk; primary fracture prevention; risk assessment tool; secondary fracture prevention.

MeSH terms

  • Absorptiometry, Photon
  • Bone Density
  • Cancellous Bone / diagnostic imaging
  • Delivery of Health Care
  • Electronic Health Records
  • Humans
  • Interdisciplinary Communication
  • Osteoporosis / complications*
  • Osteoporosis / diagnostic imaging*
  • Osteoporosis / drug therapy
  • Osteoporotic Fractures / etiology*
  • Osteoporotic Fractures / prevention & control*
  • Primary Prevention
  • Risk Assessment
  • Risk Factors
  • Secondary Prevention