Toronto Rehabilitation Institute, University of Toronto, 160-500 University Ave, Toronto, Ontario M5G 1V7, Canada.
Osteoporos Int. 2013 Mar;24(3):899-905. doi: 10.1007/s00198-012-2111-x. Epub 2012 Aug 29.
As fracture risk assessment is a basis for treatment decisions, accurate risk assessments on bone mineral density (BMD) reports are important. Over 50 % of sampled BMD reports for Ontarians with fracture histories underestimated fracture risk by a single category. Risk assessments in Ontario may not accurately inform treatment recommendations.
The shifting emphasis on fracture risk assessment as a basis for treatment recommendations highlights the importance of ensuring that accurate fracture risk assessments are present on reading specialists' BMD reports. This study seeks to determine the accuracy of fracture risk assessments on a sample of BMD reports from 2008 for individuals with a history of fracture and produced by a broad cross section of Ontario's imaging laboratories.
Forty-eight BMD reports for individuals with documented history of fragility fracture were collected as part of a cluster randomized trial. To compute fracture risk, risk factors, and BMD T-scores from reports were abstracted using a standardized template and compared to the assessments on the reports. Cohen's kappa was used to score agreement between the research team and the reading specialists.
The weighted kappa was 0.21, indicating agreement to be at the margin of "poor to fair." More than 50 % of the time, reported fracture risks did not reflect fracture history and were therefore underestimated by a single category. Over 30 % of the reports containing a "low" fracture risk assessment were assessed as "moderate" fracture risk by the research team, given fracture history. Over 20 % of the reports with a "moderate" fracture risk were assessed as "high" by the research team, given fracture history.
This study highlights the high prevalence of fracture risk assessments that are underestimated. This has implications in terms of fracture risk categorization that can negatively affect subsequent follow-up care and treatment recommendations.
由于骨折风险评估是治疗决策的基础，因此准确评估骨密度（BMD）报告中的骨折风险非常重要。在抽样的安大略省有骨折病史的患者的 BMD 报告中，超过 50%的报告错误地将骨折风险低估了一个等级。安大略省的风险评估可能无法准确提供治疗建议。
随着骨折风险评估作为治疗建议的基础的重要性日益凸显，确保阅读专家的 BMD 报告中存在准确的骨折风险评估变得尤为重要。本研究旨在确定 2008 年针对有骨折病史的个体的 BMD 报告中骨折风险评估的准确性，这些报告来自安大略省的广泛影像学实验室。
作为一项聚类随机试验的一部分，收集了 48 份有明确脆性骨折病史的个体的 BMD 报告。为了计算骨折风险，使用标准化模板从报告中提取风险因素和 BMD T 评分，并与报告中的评估进行比较。使用 Cohen 的 kappa 来评估研究团队和阅读专家之间的一致性。
加权 kappa 值为 0.21，表明一致性处于“差到尚可”的边缘。超过 50%的时间，报告的骨折风险并未反映骨折病史，因此被低估了一个等级。超过 30%的报告中，研究团队评估为“中度”骨折风险的报告，如果考虑骨折病史，则评估为“高”。超过 20%的报告中，研究团队评估为“中度”骨折风险的报告，如果考虑骨折病史，则评估为“高”。
本研究强调了骨折风险评估被低估的高发生率。这对骨折风险分类有影响，可能会对后续的随访护理和治疗建议产生负面影响。
