Assessing fracture risk in people with MS: a service development study comparing three fracture risk scoring systems

Abstract

Objectives: Suboptimal bone health is increasingly recognised as an important cause of morbidity. Multiple sclerosis (MS) has been consistently associated with an increased risk of osteoporosis and fracture. Various fracture risk screening tools have been developed, two of which are in routine use and a further one is MS-specific. We set out to compare the results obtained by these in the MS clinic population.

Design: This was a service development study. The 10-year risk estimates of any fracture and hip fracture generated by each of the algorithms were compared.

Setting: The MS clinic at the Royal London Hospital.

Participants: 88 patients with a confirmed diagnosis of MS.

Outcome measures: Mean 10-year overall fracture risk and hip fracture risk were calculated using each of the three fracture risk calculators. The number of interventions that would be required as a result of using each of these tools was also compared.

Results: Mean 10-year fracture risk was 4.7%, 2.3% and 7.6% using FRAX, QFracture and the MS-specific calculator, respectively (p<0.0001 for difference). The agreement between risk scoring tools was poor at all levels of fracture risk.

Conclusions: The agreement between these three fracture risk scoring tools is poor in the MS population. Further work is required to develop and validate an accurate fracture risk scoring system for use in MS.

Trial registration: This service development study was approved by the Clinical Effectiveness Department at Barts Health NHS Trust (project registration number 156/12).

Figure 1

(A) Combined scatter and box-and-whisker plot demonstrating a 10-year any fracture risk generated by each of the three risk scoring algorithms. The box represents the 25th–75th centile bisected by the median, with the whiskers the range. (B) 10-year any fracture risks generated by each of the three risk scoring algorithms for those patients aged 40 or over only. The box represents the 25th–75th centile bisected by the median, with the whiskers the range.

Figure 2

(A) Bland-Altman plot comparing FRAX and QFracture scores for 10-year risk of any fracture. (B) Bland-Altman plot comparing FRAX and MS-specific scores for 10-year risk of any fracture.

Figure 3

(A) 10-year hip fracture risks generated by each of the three risk scoring algorithms for all patients. The box represents the 25th–75th centile bisected by the median, with the whiskers the range. (B) 10-year hip fracture risks generated by each of the three risk scoring algorithms for those patients aged 40 or over only. The box represents the 25th–75th centile bisected by the median, with the whiskers the range.