Expert consensus on relevant risk predictors for the occurrence of osteoporotic fractures in specific clinical subgroups - Delphi survey

Nicolas S Bodmer; Hans Jörg Häuselmann; Diana Frey; Daniel Aeberli; Lucas M Bachmann

doi:10.1186/s41927-019-0099-y

Expert consensus on relevant risk predictors for the occurrence of osteoporotic fractures in specific clinical subgroups - Delphi survey

BMC Rheumatol. 2019 Nov 12:3:50. doi: 10.1186/s41927-019-0099-y. eCollection 2019.

Authors

Nicolas S Bodmer^{1

2}, Hans Jörg Häuselmann³, Diana Frey⁴, Daniel Aeberli⁵, Lucas M Bachmann^{1

2}

Affiliations

¹ Medignition Inc. Medical Research Consultants, Verena Conzett-Strasse 9, 8004 Zurich, Switzerland.
² 5University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland.
³ Center for Rheumatology and Bone Disease, Bellariastrasse 38, 8038 Zurich, Switzerland.
⁴ 3Division of Rheumatology, University Hospital Zurich, Gloriastrasse 25, 8091 Zurich, Switzerland.
⁵ 4Department of Rheumatology and Clinical Immunology/Allergology, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.

Abstract

Background: There is an ongoing discussion about incorporating additional risk factors to established WHO fracture risk assessment tool (FRAX) to improve the prediction accuracy in clinical subgroups. We aimed to reach an expert consensus on possible additional predictive parameters for specific clinical subgroups.

Methods: Two-round modified Delphi survey: We generated a shortlist of experts from the authors' lists of the pertinent literature and complemented the list with experts known to the authors. Participants were asked to name possible relevant risk factors besides the FRAX-parameters for the occurrence of osteoporotic fractures. Experts specified these possible predictors for specific subgroups of patients. In the second round the expert panel was asked to weight each parameter of every subgroup assigning a number between one (not important) to ten (very important). We defined the threshold for an expert consensus if the interquartile range (IQR) of a predictor was ≤2. The cut-off value of the median attributed weights for a relevant predictor was set at ≥7.

Results: Eleven experts of seven countries completed both rounds of the Delphi. The participants agreed on nine additional parameters for seven categories. For the category "secondary osteoporosis", "older adults" and "nursing home patients", there was a consensus that history of previous falls was relevant, while for men and postmenopausal women, there was a consensus that the spine fracture status was important. For the group "primary and secondary osteoporosis" the experts agreed on the parameters "high risk of falls", "lumbar spine bone mineral density (BMD)" and "sarcopenia".

Conclusion: This Delphi survey reached a consensus on various parameters that could be used to refine the currently existing FRAX for specific clinical situations or patient groups. The results may be useful for studies aiming at improving the predictive properties of instruments for fracture prediction.

Keywords: Delphi consensus method; Expert consensus; Fracture prediction; Older adults; Primary osteoporosis; Secondary osteoporosis.