New Program Helps Simplify Prediction of Fracture Risk

KANANASKIS, ALTA. — Physicians looking for a quick and easy way to predict fracture risk may need to look no further than a new computer program that considers more than just bone mineral density in making such determinations and summarizes its findings in a vivid, color-coded representation of the patient.

Developed by rheumatologist William Bensen, the Bone DESTINY software program predicts fractures more reliably than do bone mineral density (BMD) assessments alone. Use of the Bone DESTINY program achieves prediction accuracy comparable to that attained by following the guidelines developed by Osteoporosis Canada (Can. Assoc. Radiol. J. 2005;56:178–88).

Bone DESTINY is free to physicians and is currently being used in the Hamilton, Ont., area. It has not been released for general use yet, but there are plans to make it available throughout Canada, the United States, and Europe. It has been funded by Dr. Bensen and the division of rheumatology at McMaster University, Hamilton.

“Bone DESTINY begins with bone density, then adds a number of other important risk factors,” said Dr. Maggie Larché, a rheumatologist at McMaster University. “These include age, steroid use, propensity to fall, history of previous falls, body mass index, and previous fragility fractures.

“These data are plugged into a handheld computer, which then generates a neat graphic with a color-coded representation of the patient's risk.” The program's five color codes represent fracture risk; patients at high (red) or very high (purple) risk for fracture are recommended for treatment. The program also produces an accompanying text report.

In the first of two studies presented at the annual meeting of the Canadian Rheumatology Association, Dr. Larché and her colleagues at McMaster studied the predictive value of the Bone DESTINY program in 14,812 postmenopausal women at least 60 years old. For each patient, a set of treatment recommendations was produced based on BMD alone, on Osteoporosis Canada guidelines, or on Bone DESTINY results.

Among 7,049 patients aged 60–69 years, BMD analysis alone recommended treatment in 19%. By comparison, 20% were recommended for treatment according to OC guidelines, and 28% according to Bone DESTINY. In 5,252 patients aged 70–79 years, 29% were recommended for treatment based on BMD alone, 43% according to Bone DESTINY, and 51% according to OC guidelines. In 2,511 patients at least 80 years old, 47%, 72%, and 77% would be recommended for treatment according to BMD, OC guidelines, and Bone DESTINY results, respectively.

A second study compared predictive values of the three methods in 572 men and 3,914 women (50 years and older) who had suffered at least one previous fragility fracture.

For all age groups, both Bone DESTINY and OC guidelines recommended treatment in 80% of the women to prevent another fracture; 35% of the women would have received treatment based on BMD alone, Dr. Larché reported.

The most significant difference, however, was observed in men, in whom Bone DESTINY recommended treatment in 73%, compared with 26% by BMD alone and 41% by OC guidelines.

In an interview, Dr. Larché said these differences may be explained by the weighting of such risk factors as history of falls and propensity to fall, which the OC guidelines do not consider. “We feel they are underestimating rather than we are overestimating the fracture risk, but that's still to be determined.

“In the end, Bone DESTINY has a very similar outcome to OC guidelines, but has the advantage of being very user-friendly,” she added. “The primary care physicians absolutely adore it, as do we.”

Dr. Larché reported receiving honoraria and/or speakers fees from Amgen, Abbott, BMS, Pfizer, Schering, and GSK.

KANANASKIS, ALTA. — Physicians looking for a quick and easy way to predict fracture risk may need to look no further than a new computer program that considers more than just bone mineral density in making such determinations and summarizes its findings in a vivid, color-coded representation of the patient.

Developed by rheumatologist William Bensen, the Bone DESTINY software program predicts fractures more reliably than do bone mineral density (BMD) assessments alone. Use of the Bone DESTINY program achieves prediction accuracy comparable to that attained by following the guidelines developed by Osteoporosis Canada (Can. Assoc. Radiol. J. 2005;56:178–88).

Bone DESTINY is free to physicians and is currently being used in the Hamilton, Ont., area. It has not been released for general use yet, but there are plans to make it available throughout Canada, the United States, and Europe. It has been funded by Dr. Bensen and the division of rheumatology at McMaster University, Hamilton.

“Bone DESTINY begins with bone density, then adds a number of other important risk factors,” said Dr. Maggie Larché, a rheumatologist at McMaster University. “These include age, steroid use, propensity to fall, history of previous falls, body mass index, and previous fragility fractures.

“These data are plugged into a handheld computer, which then generates a neat graphic with a color-coded representation of the patient's risk.” The program's five color codes represent fracture risk; patients at high (red) or very high (purple) risk for fracture are recommended for treatment. The program also produces an accompanying text report.

In the first of two studies presented at the annual meeting of the Canadian Rheumatology Association, Dr. Larché and her colleagues at McMaster studied the predictive value of the Bone DESTINY program in 14,812 postmenopausal women at least 60 years old. For each patient, a set of treatment recommendations was produced based on BMD alone, on Osteoporosis Canada guidelines, or on Bone DESTINY results.

Among 7,049 patients aged 60–69 years, BMD analysis alone recommended treatment in 19%. By comparison, 20% were recommended for treatment according to OC guidelines, and 28% according to Bone DESTINY. In 5,252 patients aged 70–79 years, 29% were recommended for treatment based on BMD alone, 43% according to Bone DESTINY, and 51% according to OC guidelines. In 2,511 patients at least 80 years old, 47%, 72%, and 77% would be recommended for treatment according to BMD, OC guidelines, and Bone DESTINY results, respectively.

A second study compared predictive values of the three methods in 572 men and 3,914 women (50 years and older) who had suffered at least one previous fragility fracture.

For all age groups, both Bone DESTINY and OC guidelines recommended treatment in 80% of the women to prevent another fracture; 35% of the women would have received treatment based on BMD alone, Dr. Larché reported.

The most significant difference, however, was observed in men, in whom Bone DESTINY recommended treatment in 73%, compared with 26% by BMD alone and 41% by OC guidelines.

In an interview, Dr. Larché said these differences may be explained by the weighting of such risk factors as history of falls and propensity to fall, which the OC guidelines do not consider. “We feel they are underestimating rather than we are overestimating the fracture risk, but that's still to be determined.

“In the end, Bone DESTINY has a very similar outcome to OC guidelines, but has the advantage of being very user-friendly,” she added. “The primary care physicians absolutely adore it, as do we.”

Dr. Larché reported receiving honoraria and/or speakers fees from Amgen, Abbott, BMS, Pfizer, Schering, and GSK.

KANANASKIS, ALTA. — Physicians looking for a quick and easy way to predict fracture risk may need to look no further than a new computer program that considers more than just bone mineral density in making such determinations and summarizes its findings in a vivid, color-coded representation of the patient.

Developed by rheumatologist William Bensen, the Bone DESTINY software program predicts fractures more reliably than do bone mineral density (BMD) assessments alone. Use of the Bone DESTINY program achieves prediction accuracy comparable to that attained by following the guidelines developed by Osteoporosis Canada (Can. Assoc. Radiol. J. 2005;56:178–88).

Bone DESTINY is free to physicians and is currently being used in the Hamilton, Ont., area. It has not been released for general use yet, but there are plans to make it available throughout Canada, the United States, and Europe. It has been funded by Dr. Bensen and the division of rheumatology at McMaster University, Hamilton.

“Bone DESTINY begins with bone density, then adds a number of other important risk factors,” said Dr. Maggie Larché, a rheumatologist at McMaster University. “These include age, steroid use, propensity to fall, history of previous falls, body mass index, and previous fragility fractures.

“These data are plugged into a handheld computer, which then generates a neat graphic with a color-coded representation of the patient's risk.” The program's five color codes represent fracture risk; patients at high (red) or very high (purple) risk for fracture are recommended for treatment. The program also produces an accompanying text report.

In the first of two studies presented at the annual meeting of the Canadian Rheumatology Association, Dr. Larché and her colleagues at McMaster studied the predictive value of the Bone DESTINY program in 14,812 postmenopausal women at least 60 years old. For each patient, a set of treatment recommendations was produced based on BMD alone, on Osteoporosis Canada guidelines, or on Bone DESTINY results.

Among 7,049 patients aged 60–69 years, BMD analysis alone recommended treatment in 19%. By comparison, 20% were recommended for treatment according to OC guidelines, and 28% according to Bone DESTINY. In 5,252 patients aged 70–79 years, 29% were recommended for treatment based on BMD alone, 43% according to Bone DESTINY, and 51% according to OC guidelines. In 2,511 patients at least 80 years old, 47%, 72%, and 77% would be recommended for treatment according to BMD, OC guidelines, and Bone DESTINY results, respectively.

A second study compared predictive values of the three methods in 572 men and 3,914 women (50 years and older) who had suffered at least one previous fragility fracture.

For all age groups, both Bone DESTINY and OC guidelines recommended treatment in 80% of the women to prevent another fracture; 35% of the women would have received treatment based on BMD alone, Dr. Larché reported.

The most significant difference, however, was observed in men, in whom Bone DESTINY recommended treatment in 73%, compared with 26% by BMD alone and 41% by OC guidelines.

In an interview, Dr. Larché said these differences may be explained by the weighting of such risk factors as history of falls and propensity to fall, which the OC guidelines do not consider. “We feel they are underestimating rather than we are overestimating the fracture risk, but that's still to be determined.

“In the end, Bone DESTINY has a very similar outcome to OC guidelines, but has the advantage of being very user-friendly,” she added. “The primary care physicians absolutely adore it, as do we.”

Dr. Larché reported receiving honoraria and/or speakers fees from Amgen, Abbott, BMS, Pfizer, Schering, and GSK.