Knowledge Engineering for Decision Support in Osteoporosis

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Project Details -
Completed

Despite the availability of effective treatments for men to prevent osteoporotic fractures, rates of diagnosis, screening, and treatment remain low. Both the National Osteoporosis Foundation and the Endocrine Society recommend universal bone densitometry in men over 70, with treatment for both those with osteoporosis and osteopenia as guided by fracture absolute risk assessment (FARA). The overall objective of this project was to develop a Veterans Affairs (VA)-optimized fracture absolute risk assessment (VA-FARA) rule for identifying males at highest risk of osteoporotic fracture.

The specific aims of the project were as follows:

  • Develop a VA-optimized risk stratification rule for fracture. 
  • Develop a VA-optimized clinical decision rule. 
  • Develop a decision support tool designed to facilitate appropriate prophylaxis of osteoporotic fractures. 

The investigators developed, validated, and calibrated the rule using national VA datasets of risk factors collected as a routine part of health care operations. The rule was piloted in one of the Veterans Integrated Service Networks, where they compared clinical strategies for the rule at different absolute risk thresholds. In addition, the investigators conducted clinician focus groups to identify implementation barriers of the rule. 

The investigators found that the rule was superior for identifying highest-risk patients and that treating high-risk patients regardless of bone mineral density was most effective and least costly. However, the focus groups indicated that there may be resistance to implementing this strategy, as there was low clinical acceptance of treating high-risk patients before they developed osteoporosis.