I'm delighted to share that, following its launch five months ago, our digital tool BONEcheck [1] has garnered usage from over 15,000 users across 165 countries worldwide. In addition to English, the tool is now accessible in Vietnamese, Thai, and Malay, with plans underway for additional language versions.
BONEcheck stands as an innovative iteration, often referred to as Mark II, of the original Garvan Fracture Risk Calculator (FRC) introduced in 2008. Positioned as an alternative to FRAX, another tool for fracture risk assessment, BONEcheck distinguishes itself with a range of features that cater to the needs of both medical professionals and patients alike.
Five-year frame prediction. Current fracture risk assessment tools typically project a 10-year risk, which may not be practical for individuals in their 70s or 80s. Managing a 5-year risk is more feasible and user-friendly.
Treatment contextualization. Existing antiresorptive and bone-forming therapies effectively reduce fracture risk in patients with fractures or osteoporosis. However, this treatment benefit is often overlooked in current fracture risk assessment tools. BONEcheck incorporates data from randomized controlled trials (RCTs) to inform patients about the specific reduction in fracture risk associated with medication use, tailored to their age and risk profile.
Risk of refracture. Our research has revealed that individuals with a prior fracture face an elevated risk of experiencing another fracture, a factor not accounted for in existing tools. BONEcheck features a dedicated module for predicting the probability of refracture.
Mortality. Fractures, particularly hip fractures, correlate with a significant increase in mortality risk, information often lacking in current tools. BONEcheck draws from previous research to provide users with the risk of mortality following a fracture.
Skeletal Age. BONEcheck introduces the concept of Skeletal Age, representing an individual's skeleton age due to a fracture or exposure to risk factors that heighten fracture risk. This metric aids the public in understanding the impact of fractures on mortality.
Remeasurement of bone mineral density (BMD). BONEcheck incorporates a module predicting the time required to reach osteoporosis in individuals not currently classified as osteoporotic. This feature assists clinicians in advising patients on the timing for repeat BMD measurements.
Predicting osteoporosis. For individuals without BMD data, BONEcheck includes a module to predict the risk of osteoporosis (T-score less than -2.5). This information serves as a valuable screening tool for identifying individuals at high risk of osteoporosis, warranting further BMD assessment.
Preventive information. BONEcheck is designed with a patient-centric approach, aiming to empower individuals with information that enables them to actively reduce their risk of fractures.
The development of fracture risk assessment tools has been marred by controversies involving conflicts of interest [2] and a dearth of transparency [3]. In contrast, the development of BONEcheck / FRC prioritizes transparency, as the predictive equations are openly accessible [4-5]. The detailed procedure and methodology for BONEcheck have been published [1, 4-5], and I encourage you to explore them for a comprehensive understanding.
Numerous validation studies have demonstrated that the FRC, now known as BONEcheck, predicts fracture risk as effectively as or more accurately than FRAX [6-11]. The predicted probability of fracture derived from BONEcheck/FRC also exhibits a high level of concordance with clinical decisions [12-13]. FRC / BONEcheck is recommended by the Royal Australian College of General Practitioners, Healthy Bone Australia, Osteoporosis New Zealand, Asia Pacific Consortium for Osteoporosis for use in clinical practice. Finally, I am pleased to say that BONEcheck is entirely free of charge.
To sum up, my team and I have created and launched a digital tool named 'BONEcheck' for global fracture risk assessment, and it is now accessible to users at no cost. This tool serves to facilitate discussions between doctors and patients regarding fracture risk, clinical implications, and treatment benefits, enabling informed decision-making.
PS: BONEcheck is now accessible to users through multiple platforms. Users can access it directly from our website or download the app from the Apple Store or Google Play. Please click on the links below to start utilizing the BONEcheck tool:
Website: https://bonecheck.org
Apple Store: https://apps.apple.com/app/bonecheck/id6447424513.
Google Play: https://play.google.com/store/apps/details?id=org.saigonmec.bonecheck.
References
[1] Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 2008 Oct;19(10):1431-44.
[2] Järvinen TL, et al. Conflicts at the heart of the FRAX tool. CMAJ 2014 Feb 18;186(3):165-7.
[3] Collins GS, Michaëlsson K. Fracture risk assessment: state of the art, methodologically unsound, or poorly reported? Curr Osteoporos Rep 2012 Sep;10(3):199-207.
[4] Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporosis International. 2007;18:1109–1117. doi: 10.1007/s00198-007-0362-8.
[5] Nguyen DT, Ho-Le TP, Pham L, Ho-Van VP, Hoang TD, Tran TS, Frost S, Nguyen TV. BONEcheck: A digital tool for personalized bone health assessment. Osteoporos Sarcopenia. 2023 Sep;9(3):79-87.
[6] Holloway-Kew KL, Zhang Y, Betson AG, Anderson KB, Hans D, Hyde NK, Nicholson GC, Pocock NA, Kotowicz MA, Pasco JA. How well do the FRAX (Australia) and Garvan calculators predict incident fractures? Data from the Geelong Osteoporosis Study. Osteoporos Int. 2019 Oct;30(10):2129-2139.
[7] Langsetmo L, Nguyen TV, Nguyen ND, Kovacs CS, Prior JC, Center JR, et al. Independent external validation of nomograms for predicting risk of low-trauma fracture and hip fracture. CMAJ. 2011;183(2):E107–E14.
[8] Pluskiewicz W, Adamczyk P, Franek E, Leszczynski P, Sewerynek E, Wichrowska H, et al. Ten-year probability of osteoporotic fracture in 2012 Polish women assessed by FRAX and nomogram by Nguyen et al.-Conformity between methods and their clinical utility. Bone. 2010;46(6):1661–67.
[9] Sandhu SK, Nguyen ND, Center JR, Pocock NA, Eisman JA, Nguyen TV. Prognosis of fracture: evaluation of predictive accuracy of the FRAX algorithm and Garvan nomogram. Osteoporos Int. 2010;21(5):863–71.
[10] van Geel TA, Nguyen ND, Geusens PP, Center JR, Nguyen TV, Dinant GJ, et al. Development of a simple prognostic nomogram for individualising 5-year and 10-year absolute risks of fracture: a population-based prospective study among postmenopausal women. Ann Rheum Dis. 2011;70(1):97–7.
[11] Bolland MJ, Siu AT, Mason BH, et al. Evaluation of the FRAX and Garvan fracture risk calculators in older women. J Bone Miner Res 2011;26(2):420–27. doi: 10.1002/jbmr.215.
[12] Inderjeeth CA, Raymond WD. Case finding with GARVAN fracture risk calculator in primary prevention of fragility fractures in older people. Arch Gerontol Geriatr 2020;86:103940. doi: 10.1016/j.archger.2019.103940.
[13] Pluskiewicz W, Adamczyk P, Franek E, et al. FRAX calculator and Garvan nomogram in male osteoporotic population. Aging Male 2014;17(3):174–82.