Comparing Fracture Absolute Risk Assessment (FARA) Tools: An Osteoporosis Clinical Informatics Tool to Improve Identification and Care of Men at High Risk of First Fracture

Joanne LaFleur, Chandra L. Steenhoek, Julie Horne, Joy Meier, Jonathan R. Nebeker, Scott Mambourg, Arthur L Swislocki, Jannet Carmichael

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Fracture absolute risk assessment (FARA) is recommended for guiding osteoporosis treatment decisions in males. The best strategy for applying FARA in the clinic setting is not known. Objectives: We compared 2 FARA tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture. Tools evaluated were an adaptation of the World Health Organization’s Fracture Risk Assessment Tool used with electronic data (eFRAX) and the Veterans Affairs (VA)-based tool, VA-FARA. Methods: We compared accuracies of VA-FARA and eFRAX for correctly classifying male veterans who fractured and who were seen in the VA’s Sierra Pacific Network in 2002-2013. We then matched those cases to nonfracture controls to compare odds of fracture in patients classified as high risk by either tool. Results: Among 8740 patients, the mean (SD) age was 67.0 (11.1) years. Based on risk factors present in the EHR, VA-FARA correctly classified 40.1% of fracture patients as high risk (33.0% and 34.6% for hip and any major fracture, respectively); eFRAX classified 17.4% correctly (17.4% for hip and 0.2% for any major fracture). Compared with non-high-risk patients, those classified as high risk by VA-FARA were 35% more likely to fracture (95% CI = 23%-47%; P < 0.01) compared with 17% for eFRAX (95% CI = 5%-32%; P < 0.01). Conclusions: VA-FARA is more predictive of first fracture than eFRAX using EHR data. Decision support tools based on VA-FARA may improve early identification and care of men at risk.

Original languageEnglish (US)
Pages (from-to)506-514
Number of pages9
JournalAnnals of Pharmacotherapy
Volume49
Issue number5
DOIs
StatePublished - May 22 2015

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Medical Informatics
Osteoporosis
Veterans
Electronic Health Records
Hip

Keywords

  • absolute risk assessment
  • clinical decision making
  • databases
  • decision analysis
  • electronic information
  • fractures
  • informatics
  • male osteoporosis
  • osteoporosis
  • risk management
  • veterans

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Comparing Fracture Absolute Risk Assessment (FARA) Tools : An Osteoporosis Clinical Informatics Tool to Improve Identification and Care of Men at High Risk of First Fracture. / LaFleur, Joanne; Steenhoek, Chandra L.; Horne, Julie; Meier, Joy; Nebeker, Jonathan R.; Mambourg, Scott; Swislocki, Arthur L; Carmichael, Jannet.

In: Annals of Pharmacotherapy, Vol. 49, No. 5, 22.05.2015, p. 506-514.

Research output: Contribution to journalArticle

LaFleur, Joanne ; Steenhoek, Chandra L. ; Horne, Julie ; Meier, Joy ; Nebeker, Jonathan R. ; Mambourg, Scott ; Swislocki, Arthur L ; Carmichael, Jannet. / Comparing Fracture Absolute Risk Assessment (FARA) Tools : An Osteoporosis Clinical Informatics Tool to Improve Identification and Care of Men at High Risk of First Fracture. In: Annals of Pharmacotherapy. 2015 ; Vol. 49, No. 5. pp. 506-514.
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abstract = "Background: Fracture absolute risk assessment (FARA) is recommended for guiding osteoporosis treatment decisions in males. The best strategy for applying FARA in the clinic setting is not known. Objectives: We compared 2 FARA tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture. Tools evaluated were an adaptation of the World Health Organization’s Fracture Risk Assessment Tool used with electronic data (eFRAX) and the Veterans Affairs (VA)-based tool, VA-FARA. Methods: We compared accuracies of VA-FARA and eFRAX for correctly classifying male veterans who fractured and who were seen in the VA’s Sierra Pacific Network in 2002-2013. We then matched those cases to nonfracture controls to compare odds of fracture in patients classified as high risk by either tool. Results: Among 8740 patients, the mean (SD) age was 67.0 (11.1) years. Based on risk factors present in the EHR, VA-FARA correctly classified 40.1{\%} of fracture patients as high risk (33.0{\%} and 34.6{\%} for hip and any major fracture, respectively); eFRAX classified 17.4{\%} correctly (17.4{\%} for hip and 0.2{\%} for any major fracture). Compared with non-high-risk patients, those classified as high risk by VA-FARA were 35{\%} more likely to fracture (95{\%} CI = 23{\%}-47{\%}; P < 0.01) compared with 17{\%} for eFRAX (95{\%} CI = 5{\%}-32{\%}; P < 0.01). Conclusions: VA-FARA is more predictive of first fracture than eFRAX using EHR data. Decision support tools based on VA-FARA may improve early identification and care of men at risk.",
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AU - Steenhoek, Chandra L.

AU - Horne, Julie

AU - Meier, Joy

AU - Nebeker, Jonathan R.

AU - Mambourg, Scott

AU - Swislocki, Arthur L

AU - Carmichael, Jannet

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AB - Background: Fracture absolute risk assessment (FARA) is recommended for guiding osteoporosis treatment decisions in males. The best strategy for applying FARA in the clinic setting is not known. Objectives: We compared 2 FARA tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture. Tools evaluated were an adaptation of the World Health Organization’s Fracture Risk Assessment Tool used with electronic data (eFRAX) and the Veterans Affairs (VA)-based tool, VA-FARA. Methods: We compared accuracies of VA-FARA and eFRAX for correctly classifying male veterans who fractured and who were seen in the VA’s Sierra Pacific Network in 2002-2013. We then matched those cases to nonfracture controls to compare odds of fracture in patients classified as high risk by either tool. Results: Among 8740 patients, the mean (SD) age was 67.0 (11.1) years. Based on risk factors present in the EHR, VA-FARA correctly classified 40.1% of fracture patients as high risk (33.0% and 34.6% for hip and any major fracture, respectively); eFRAX classified 17.4% correctly (17.4% for hip and 0.2% for any major fracture). Compared with non-high-risk patients, those classified as high risk by VA-FARA were 35% more likely to fracture (95% CI = 23%-47%; P < 0.01) compared with 17% for eFRAX (95% CI = 5%-32%; P < 0.01). Conclusions: VA-FARA is more predictive of first fracture than eFRAX using EHR data. Decision support tools based on VA-FARA may improve early identification and care of men at risk.

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