Do we need another Osteoporosis risk tool? Making the case for DXA-MAP

<ns3:p>Background Despite Ireland having one of the largest osteoporosis burdens in Europe, it remains without a national programme or a screening strategy. This is contributing to poor quality low value care, and failure to implement accepted clinical standards. For example, although Ireland has a high number of Dual-energy X-ray Absorptiometry (DXA) scans, these remain underused in many high-risk groups, and overused in low-risk groups, further exacerbated by poor scan quality or reporting. This often results in inappropriate prescribing for low risk individuals, while many at-risk individuals remain untested and untreated. Clinicians lack familiarity with risk tools, and how to communicate the importance of osteoporosis screening and fracture risk. Our experience of running osteoporosis services for 20 years in Ireland is that while risk tools exist for identifying those with low bone mass or osteoporosis, or for predicting fracture, their use in clinical practice remains limited. Clear, quick and understandable risk-communication tools are urgently needed. Methods This paper presents summary findings from four larger studies on: (1) retrospective model development and validation (internal and external) using DXA data (n=4,787); (2) audit of all DXA referrals in our centre, since 2021; (3) GP survey (n=26); and (4) public engagement pilot studies to assess usability and impact of the DXA-MAP tool (n=129). Results An audit of more than 10,000 referrals since we published the validity of the OST(Osteoporosis Self-Assessment Tool) tool showed none included the OST tool, while <1% included any other clinical tool such as FRAX®, QRisk® or others. Our novel DXA-MAP model and the OST model show comparable performance in identifying healthy adults with osteoporosis across datasets. A GP survey found nearly 90% self-reported they would use an accessible, validated tool. Public survey polls demonstrate concern about osteoporosis is high osteoporosis, particularly among older women. Results show improvements in understanding and reductions in worry following use of the DXA-MAP tool. Feedback was very positive from members of the public and healthcare professionals for enhancing communication through its multimodal presentation of personalised risk (i.e. quantitatively, qualitatively and visually). Conclusions Although several osteoporosis risk tools are available, they are not in widespread use in Ireland. Availability, interpretation and risk communication are key challenges. A novel DXA-MAP tool can address these challenges through its robust validity for our population and multimodal presentation of risk. Preliminary feedback from members of the public and healthcare professionals suggest it could be a very useful tool and help bridge the osteoporosis care gap in Ireland.</ns3:p>