Fragility Fractures: Introduction
Image1. WHO definition of osteoporosis
Figure 2. Considerations for bone mineral density testing.
QFracture was developed in the UK in 2009 and calculates 10 year hip and major fracture risk without BMD testing. It is applicable to people aged 30-85 and also includes clinical risk factors, similar to FRAX. The clinical risk factors included in the QFracture algorithm in men and women are: age, sex, BMI, smoking, alcohol intake, glucocorticoids, asthma, cardiovascular disease, history of falls, chronic liver disease, rheumatoid arthritis, type 2 diabetes and tricyclic antidepressants. Additional factors used in women only are: hormone replacement therapy, parental history of hip fracture, menopausal symptoms, gastrointestinal malabsorption and other endocrine disorders. The algorithm was undergone updates with the most recent in 2016 and is readily available online (https://qfracture.org/).
Figure 3. Capture the fracture framework breakdown (capturethefracture.org)
Summary. In summary, It is widely accepted that bone health and osteoporosis have a significant impact on our current healthcare landscape. Roughly two million fractures attributed to osteoporosis occur each year in the United States and estimates show this problem will continue to grow (2). Bone strength for individuals at risk is typically determined by bone mineral density and determined by DXA. Tools, such as the FRAX and QFracture have been developed to determine 10 year risk of major fractures to help determine who needs treatments for either primary or secondary prevention. Programs such as Own the Bone and Capture the Fracture have also been started to document fractures and educate both providers and patients on fragility fractures.