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NICE consultation opens on assessing risk of fragility fracture in adults

The National Institute for Health and Care Excellence (NICE) today (9 February) opens a consultation on assessing the risk of fragility fracture in adults. The draft short clinical guideline aims to advise on methods to help clinicians assess who might be at risk of a fragility fracture, and will support them in identifying who will benefit from treatments that help prevent such fractures occurring.

Fragility fractures are often linked to osteoporosis - the condition where bone tissue deteriorates and the bone density is lower than normal. This can lead to the bone fracturing as a result of a force that wouldn't normally cause a break in a healthy bone, such as a fall from a standing height or less. Each year in the UK over 300,000 people are seen in hospital because of fragility fractures, with the most common sites for these fractures being the spinal vertebrae, hip and wrist. Osteoporotic fragility fractures can cause a great deal of pain, disability and reduction in quality of life. These fractures can also lead to decreased life expectancy: about 10% of people with a hip fracture die within one month, although most of the deaths are due to associated conditions and not to the fracture itself.

The draft recommendations in the short clinical guideline include:

  • Calculate absolute risk when assessing risk of fracture (for example, the percentage predicted risk of major osteoporotic fracture over 10 years)
  • Use either FRAX[1](without a bone mineral density [BMD] value[2]) or QFracture[3]to calculate 10-year predicted absolute fracture risk in people of between 40 and 84 years
  • Use clinical judgement to assess fracture risk in people of 85 years and over, because predicted 10-year fracture risk may underestimate their short-term fracture risk
  • Do not routinely measure BMD to assess fracture risk without prior assessment using FRAX (without BMD) or QFracture
  • Measure BMD to assess fracture risk in people under 40 years who have a major risk factor, such as history of multiple fragility fractures, major osteoporotic fracture or high-dose oral glucocorticoid use.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice, commented: "There can be difficulty in identifying who might benefit from treatment to help prevent fractures linked to bone tissue deterioration. There are a number of risk assessment tools available to predict likelihood of fragility fracture over a period of time. When finalised, this draft short clinical guideline aims to provide clarity for health professionals on which tools to select and use to determine the risk of fragility fracture in adults. This will assist health professionals in identifying who will benefit from treatments that help prevent this type of fracture.

"We welcome comments from registered stakeholders on the draft recommendations on risk assessment of fragility fracture, and individuals can also comment via relevant registered organisations."

ENDS

Notes to Editors

About this draft short clinical guideline

1. The draft recommendations for Osteoporosis: assessing the risk of fragility fracture are available at: http://guidance.nice.org.uk/CG/Wave25/2. The consultation runs from 9 Feb until 8 March 2012.

2. The main risk factor for fragility fractures is reduced bone density, and other factors that can increase the risk of fracture include age, sex, previous fractures, using glucocorticoids, heavy smoking and drinking and family history of osteoporosis.

3. Direct medical costs from fragility fractures to the UK healthcare economy were estimated at £1.8 billion in 2000, with the potential to rise to £2.2 billion by 2025 with most of these costs relating to hip fracture care.

About published NICE guidance on preventing osteoporotic fracture

4. NICE has published technology appraisal guidance on the primary prevention of osteoporotic fracture, available at: http://www.nice.org.uk/TA160 and guidance on the secondary prevention of osteoporotic fracture, available at: http://www.nice.org.uk/TA161.

NICE has also separately recommended denosumab (Prolia) as a treatment option for certain postmenopausal women who are at increased risk of primary and secondary osteoporotic fractures if other treatments available on the NHS are unsuitable. This guidance is available at: http://guidance.nice.org.uk/TA204.

About NICE

5. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

6. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

7. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.

8. NICEprovides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.



[1] FRAX is a 10-year fracture prediction tool, developed by the World Health Organisation, for use in people aged between 40 and 90

[2] Bone mineral density measurements indicate the amount of calcium in bones, and are determined using a type of X-ray scan

[3] QFracture is another website risk assessment tool, used to estimate an individual's risk of developing hip fracture or osteoporotic fracture over the next 10 years.

This page was last updated: 08 February 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.