Absolute fracture risk reporting in clinical practice: a physician-centered survey

Abstract

Non-expert clinical practitioners who had received bone density reports based on 10-year absolute fracture risk were surveyed to determine their response to this new system. Absolute fracture risk reporting was well received and was strongly preferred to traditional T-score-based reporting. Non-specialist physicians were particularly supportive of risk-based bone mineral density (BMD) reporting.

Introduction: Absolute risk estimation is preferable to risk categorization based upon BMD alone. The objective of this study was to specifically assess the response of non-expert clinical practitioners to this approach.

Methods: In January 2006, the Province of Manitoba, Canada, started reporting 10-year osteoporotic fracture risks for patients aged 50 years and older based on the hip T-score, gender, age, and multiple clinical risk factors. In May 2006 and October 2006, a brief anonymous survey was sent to all physicians who had requested a BMD test during 2005 and 206 responses were received.

Results: When asked whether the report contained the information needed to manage patients, the mean score for the absolute fracture risk report was higher than for the T-score-based report (p<0.0001). When asked whether the report was easy to understand, the mean score for the absolute fracture risk report was again higher than for the T-score-based report (p<0.0001). Non-specialists gave a higher ranking than specialists to the absolute fracture risk information (p<0.05).

Conclusions: Absolute fracture risk reporting is well-received by physicians and is strongly preferred to traditional T-score-based reporting. Non-specialist physicians are particularly supportive of risk-based BMD reporting.