Nurse helping woman walk with walker

A group of clinician experts in Canada has published a new interactive online tool designed to help clinicians assess individual patient risk of fragility fractures and weigh the pluses and minuses of preventive treatment.

The decision to screen a healthy adult for fracture risk is not always straightforward, and the Fragility Fracture Decision Aid will help in shared decision-making, according to members of the Canadian Task Force on Preventive Health Care.

“Risk assessment first”

The tool was developed as part of a new set of recommendations following systematic reviews. The resulting guideline, published Monday, May 8 in the Canadian Medical Association Journal, recommends a “risk assessment–first” screening process for women 65 years and older, with the understanding that these patients may be able to avoid fracture with screening and preventive medication. Notably, screening is not recommended for females younger than 65 years or males of any age.

Patients can use the Fragility Fracture Decision Aid, which includes data from the Canadian FRAX risk assessment tool, to estimate their individual risk. They should then be engaged by their clinician to decide if they wish to take prescription medication to prevent fractures based on the results, the task force said. 

Calculates potential benefits, harms

The ​​decision aid calculates the potential effect of medication and describes the potential harms. If the risk of fracture is low, for example, it will show that the benefit of treatment is also low.

The authors said they hope that the new tool and guidance will help prevent unnecessary screening and treatment. 

“Not everyone gets the same benefit from preventive medication. In fact, there’s no good evidence to support screening men to prevent fragility fractures,” said co-author Roland Grad, MD, of McGill University in Montreal, Quebec, Canada.

The guidance does not apply to people already taking medication to prevent fracture, they noted.

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