Department of Radiology and Diagnostic Imaging, Division of Endocrinology and Metabolism, 3158University of Alberta, Edmonton, Alberta, Canada.
Department of Radiology and Diagnostic Imaging, 3158University of Alberta, Edmonton, Alberta, Canada.
Can Assoc Radiol J. 2021 Aug;72(3):483-489. doi: 10.1177/0846537120907655. Epub 2020 Mar 12.
The Canadian Association of Radiologists and Osteoporosis Canada currently endorse a fracture risk prediction tool called CAROC. It has been used in Canada since 2005 with an update in 2010. It is an integral part of bone mineral densitometry reporting across the country. New osteoporosis guidelines from Osteoporosis Canada (OC) are expected in the near future. There has been pressure on radiologists to report fracture risk using an alternative fracture risk prediction platform called FRAX. In addition, OC collaborated in the development of the Canadian FRAX model and has been copromoting both FRAX and CAROC, raising the prospect that new guidelines may seek to replace CAROC with FRAX for fracture risk determination. A number of concerns have been raised about FRAX, including: (1) FRAX has not released its algorithms to the public domain with the consequence that it is impossible to verify results for an individual patient; (2) FRAX has incorrectly claimed that it was developed by the World Health Organization (WHO) and has used this affiliation to promote itself until recently ordered by the WHO to desist; (3) FRAX requires collection of additional clinical information beyond that needed for CAROC, and this patient-reported medical data is prone to substantial error; and (4) despite claims to the contrary, there are no valid studies comparing FRAX to CAROC. We believe it is important that radiologists be aware of these issues in order to provide input into future Technical Standards for Bone Mineral Densitometry Reporting of the Canadian Association of Radiologists.
加拿大放射学家协会和加拿大骨质疏松症协会目前支持一种名为 CAROC 的骨折风险预测工具。自 2005 年以来，该工具在加拿大得到使用，并于 2010 年进行了更新。它是全国骨密度计报告的一个组成部分。加拿大骨质疏松症协会（OC）的新骨质疏松症指南预计在不久的将来发布。放射科医生面临使用另一种名为 FRAX 的骨折风险预测平台报告骨折风险的压力。此外，OC 参与了加拿大 FRAX 模型的开发，并共同推广 FRAX 和 CAROC，这使得新的指南可能会寻求用 FRAX 取代 CAROC 来确定骨折风险。人们对 FRAX 提出了一些担忧，包括：（1）FRAX 尚未将其算法公开，因此无法验证个体患者的结果；（2）FRAX 错误地声称它是由世界卫生组织（WHO）开发的，并利用这种关联来推广自己，直到最近才被 WHO 命令停止；（3）FRAX 需要收集比 CAROC 所需的额外临床信息，并且这种患者报告的医疗数据容易出现重大错误；（4）尽管有相反的说法，但没有有效的研究将 FRAX 与 CAROC 进行比较。我们认为，放射科医生了解这些问题非常重要，以便为加拿大放射学家协会的骨矿物质密度计报告技术标准提供意见。
