Das Konzept des DVO Frakturrisikorechners

Zusammenfassung

Die Abschätzung des Frakturrisikos ist eine Kernaufgabe bei der Identifikation Osteoporose gefährdeter PatientInnen. Für diesen Zweck wurden verschiedene Risikorechner entwickelt. Trotz dessen besteht eine erhebliche Unterversorgung von Osteoporosepatient:innen, was auch an unzureichender Identifikation Betroffener liegt. Um hier eine Verbesserung zu erzielen, wurde der DVO Frakturrisiko Rechner entwickelt. In diesem Beitrag werden die Defizite bisheriger Risikorechner aufgeführt, um daraus das Konzept des DVO Frakturrisiko Rechners abzuleiten. Kernaspekte sind i) ein breit gefächertes Casefinding über 33 Evidenz-basiert validierte Frakturrisikofaktoren, ii) der Fokus auf Schenkelhals- und Wirbelkörperfrakturrisiko, iii) eine Berechnung des 3-Jahres Frakturrisikos, optional mit 1-Jahresdaten bei hohem imminenten Frakturrisiko und iv) Osteodensitometrie an Lendenwirbelsäule und proximalem Femur. Die Risikoabschätzung basiert auf deutschen Referenzdaten. Das Frakturrisiko wird aus dem Risiko von Personen, die keine der erhobenen klinischen Risikofaktoren aufweisen, über ein geschlechts-spezifisches multiplikatives Modell, das Alter, die relativen Risiken der zwei stärksten klinischen Risikofaktoren und Osteodensitometrieergebnisse berücksichtigt, ermittelt. Ziel ist die Implementierung als App, die den Osteolog:innen des DVO kostenfrei zur Verfügung gestellt werden soll. Bis zur Zertifizierung der App wird für eine Übergangszeit ein vereinfachtes Modell in Tabellenform angeboten. Risikorechner können die ärztliche Beurteilung nur unterstützen, sie nicht ersetzen, aber der DVO Frakturrisiko Rechner wird hoffentlich dazu beitragen, die Unterversorgung von Osteoporosepatient:innen zu verringern, in dem er hilft, in effektiver Weise Risikopatient:innen zu identifizieren.

Abstract

Summary The estimation of fracture risk is a core task in the care of patients at risk of osteoporosis. Various risk calculators have been developed for this purpose. Despite this, there is a considerable treatment gap of osteoporosis patients, which is also due to insufficient identification of those affected. The DVO Fracture Risk Calculator was developed to improve this situation. In this contribution, the shortcomings of previous risk calculators are listed in order to derive the concept of the DVO Fracture Risk Calculator. Core aspects comprise i) a broad Casefinding strategy via 33 evidence based validated fracture risk factors, ii) the focus on hip and vertebral fracture risk, iii) a calculation of the 3-year fracture risk, optionally with 1-year data in case of high imminent fracture risk, along with iv) bone densitometry at lumbar spine and proximal femur. The risk assessment is based on German reference data. The fracture risk is based on the risk of individuals who do not have any of the clinical risk factors assessed and it is calculated via a sex-specific multiplicative model that takes into account age, the relative risks of the two strongest clinical risk factors and bone densitometry results. The goal is to implement this as an app that will be made available free of charge to DVO osteologists. Until this app is certified, a simplified model in tabular form will be offered for a transitional period. Risk calculators can only support medical expertise of physicians, not replace it, but the DVO Fracture Risk Calculator will hopefully help to reduce the diagnostic gap of osteoporosis patients by helping to identify at-risk patients in an effective way.

Schlüsselwörter

Frakturrisiko - klinischen Risikofaktoren - Osteodensitometrie - Schenkelhalsfrakturen - Wirbelkörperfrakturen

Key words

Fracture risk - clinical risk factors - bone densitometry - hip fracture - vertebral fracture

Publication History

Received: 03 March 2023

Accepted: 06 March 2023

Article published online:
17 April 2023

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