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. 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. 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”. 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.

中文翻译：

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特定临床亚组骨质疏松性骨折发生相关风险预测因素的专家共识——德尔菲调查


目前正在讨论将额外的风险因素纳入已建立的世界卫生组织骨折风险评估工具（FRAX）中，以提高临床亚组的预测准确性。我们的目标是就特定临床亚组可能的额外预测参数达成专家共识。两轮修改后的德尔菲调查：我们从作者的相关文献列表中生成了一份专家候选名单，并用作者已知的专家补充了该列表。除了 FRAX 参数之外，参与者还被要求说出与骨质疏松性骨折发生相关的可能相关风险因素。专家为特定的患者亚组指定了这些可能的预测因素。在第二轮中，专家小组被要求对每个子组的每个参数进行加权，并分配一个介于 1（不重要）到 10（非常重要）之间的数字。如果预测变量的四分位距 (IQR) ≤ 2，我们定义了专家共识的阈值。相关预测变量的中位归因权重的截止值设置为≥7。来自七个国家的 11 名专家完成了两轮德尔菲竞赛。参与者就七个类别的九个附加参数达成了一致。对于“继发性骨质疏松症”、“老年人”和“疗养院患者”类别，一致认为既往跌倒史相关，而对于男性和绝经后女性，一致认为脊柱骨折状况很重要。对于“原发性和继发性骨质疏松症”组，专家们就“跌倒风险高”、“腰椎骨矿物质密度（BMD）”和“肌少症”等参数达成一致。 这项德尔福调查就各种参数达成了共识，这些参数可用于针对特定临床情况或患者群体完善当前现有的 FRAX。该结果可能对旨在提高骨折预测仪器的预测性能的研究有用。