Background: Lack of access and cost of bone mineral densitometry (BMD) are barriers to osteoporosis screening. Risk-assessment tools may be useful to screen for osteoporosis.

Objectives: Use of GARVAN fracture risk scores (without BMD) to stratify people into low risk (not requiring assessment) moderate risk (requiring BMD) or high risk (requiring preventative treatment without need for BMD).

Methods: A prospective multi-centred cohort study recruited from metropolitan General Practices which identified persons at clinical risk of osteoporosis aged over 70.

Osteoporosis risk assessment using DEXA- BMD scan and health questionnaire. GARVAN ® scores with and without BMD values were calculated for each patient. ROC curves with the area under curve (AUC) were generated to calculate sensitivity and specificity of GARVAN ® (without BMD) in identifying patients with osteoporosis.

Results:

We identified age specific thresholds for identification of patients deemed low risk patients (BMD not required), intermediate risk (requiring BMD) or high risk (treatment recommended without BMD). These thresholds resulted in the correct clinical management decision 89% of the time. Unnecessary BMDs avoided in 350/543 (64%). Osteoporosis was missed in 28/534 (5%). Absolute Positive Predictive value improved (+44.5%) and accuracy improved (+12%) utilising age specific cut-offs compared to the single IOF recommended threshold utilising FRAX ® 10-year Hip fracture risk calculator tool recommended cut-offs.

Conclusions:

Estimating age specific intervention thresholds based on fracture risk score successfully identifies who may or may not require BMD and who to treat. Age specific thresholds appear more accurate than IOF recommended thresholds. At the very least people with an absolute risk below 1.8 and 3.85 for GARVAN ® Hip and Major (without BMD) respectively can safely be reassured without recourse to BMD. The threshold to treat will be influenced by user willingness to pay and risk – benefit.