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Siminoski K, O'Keeffe M, Akincioglu C, Ganguli SN, Levesque J, Raaphorst P, Tarulli G, Thurston W, Lyons D. Controversies Surrounding the BMD Reporting Standard for the Determination of 10-Year Absolute Fracture Risk: A Canadian Perspective. Can Assoc Radiol J 2020; 72:483-489. [PMID: 32162532 DOI: 10.1177/0846537120907655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Canadian Association of Radiologists and Osteoporosis Canada currently endorse a fracture risk prediction tool called CAROC. It has been used in Canada since 2005 with an update in 2010. It is an integral part of bone mineral densitometry reporting across the country. New osteoporosis guidelines from Osteoporosis Canada (OC) are expected in the near future. There has been pressure on radiologists to report fracture risk using an alternative fracture risk prediction platform called FRAX. In addition, OC collaborated in the development of the Canadian FRAX model and has been copromoting both FRAX and CAROC, raising the prospect that new guidelines may seek to replace CAROC with FRAX for fracture risk determination. A number of concerns have been raised about FRAX, including: (1) FRAX has not released its algorithms to the public domain with the consequence that it is impossible to verify results for an individual patient; (2) FRAX has incorrectly claimed that it was developed by the World Health Organization (WHO) and has used this affiliation to promote itself until recently ordered by the WHO to desist; (3) FRAX requires collection of additional clinical information beyond that needed for CAROC, and this patient-reported medical data is prone to substantial error; and (4) despite claims to the contrary, there are no valid studies comparing FRAX to CAROC. We believe it is important that radiologists be aware of these issues in order to provide input into future Technical Standards for Bone Mineral Densitometry Reporting of the Canadian Association of Radiologists.
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Affiliation(s)
- Kerry Siminoski
- Department of Radiology and Diagnostic Imaging, Division of Endocrinology and Metabolism, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Margaret O'Keeffe
- Department of Radiology and Diagnostic Imaging, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Cigdem Akincioglu
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - S Nimu Ganguli
- Department of Medical Imaging, 60407William Osler Health System, Brampton, Ontario, Canada
| | - Jacques Levesque
- Department of Radiology, 4440Laval University, Quebec City, Quebec, Canada
| | - Peter Raaphorst
- Department of Physics, 6339Carleton University and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Giuseppe Tarulli
- Department of Medical Imaging, 8534Humber Regional Hospital, Toronto, Ontario, Canada
| | - Wendy Thurston
- Department of Diagnostic Imaging, Unity Health, 153170St. Joseph's Health Centre, Toronto, Ontario, Canada
| | - David Lyons
- Department of Diagnostic Imaging, 103409Deep River and District Hospital, Deep River, Ontario, Canada
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