ISR Autumn Meeting 2018
2nd Place Poster Award
Dr Leah Rooney
No access to DXA? Try the NOGG guidelines.
Dr. Leah Rooney, Dr. Ramona Valea, Dr. S.A. Ramakrishnan, Dr. Shawn Chavrimootoo.
Rheumatology department, Our Lady’s Hospital, Navan
The NOF (National Osteoporosis Foundation) 2014 guidelines, which are largely used in Ireland, recommended treatment for osteoporosis based on: a diagnosis using BMD, the presence of vertebral or hip fracture, or a diagnosis of osteopenia with a high 10-year fracture risk based on FRAX score (a hip fracture risk ≥3 % or major osteoporosis fracture risk ≥20%).
The NOGG (National Osteoporosis Guideline Group) 2017 guidelines, used in the UK, recommend fracture risk assessment of individuals at risk of osteoporosis before considering a DXA. Based on a FRAX score without BMD, patients are categorised into high, medium, OR low risk (red, yellow, and green). The guidelines recommend treating the high-risk individuals, investigating with a DXA, the intermediate-risk individuals and not treating or investigating the low-risk individuals.
The aim of our study is to compare the NOF and NOGG guidelines using our patient cohort, and to observe the difference in numbers of patients treated for osteoporosis, and, when using the NOGG guidelines, to note the reduction in number of DXA scans.
Over a 6-month period, in a regional centre, data was collected on all patients who had a DXA scan. We calculated a FRAX score with and without BMD using the UK FRAX website and documented the NOGG recommendation for each individual before and after DXA. We also noted the patients who would be treated for osteoporosis based on the NOF guidelines – the number of patients and their personal details and compared this to those who would be treated using the NOGG guidelines.
238 patients over the age of 40 had DXA scans performed over a 6-month period. 163 (68%) females and 75 (32%) males. The median age was 67.
Of the 238, 66 (28%) were given Green NOGG recommendations – recommending no treatment or investigation, 66 (28%) were given red recommendations – recommending treatment without a DXA scan and 103 (44%) were given yellow recommendations – recommending a DXA scan. If the NOGG guidelines had been used in our patient cohort, 131 of the DXA scans would not have been performed over the 6-month period which is 55% of the scans.
Nineteen individuals (7%) had a discrepancy in their recommendations (based on NOGG guidelines) before and after DXA scanning.
Based on the NOF guidelines, 107 patients would have been treated for osteoporosis and based on the NOGG guidelines post DXA, 92 would have been treated.
Amongst our patient cohort, the NOGG compared to the NOF guidelines recommended treatment for more females aged 50-65 and for less individuals aged above 68. Amongst the female patients aged 50-65, a 10 year hip fracture risk ranging 1-2.8% was recommended treatment by the NOGG.
With use of the NOGG guidelines, 55% less DXA scans would have been performed. With little discrepancy (7%) in the NOGG guidelines before and after DXA scan, these guidelines can be used easily in GP surgeries and outpatient departments. In Ireland, the average wait time for a DXA scan, within the public health system, is 20 weeks. The use of the NOGG guidelines would reduce the number of DXA scan requests, reduce the waiting times for those who require the test, and allow earlier treatment for high risk individuals.