This month marks the 10th anniversary of the launch of the Garvan Fracture Risk Calculator – a deceptively simple tool that can uncover whether a person is at high risk of breaking a bone through osteoporosis. The Calculator gets tens of thousands of visits every year and has helped transform the clinical management of osteoporosis worldwide.
The first of its kind in the world, the Calculator is a distillation of decades of research from the Dubbo Osteoporosis Epidemiology Study at the Garvan Institute of Medical Research. Led by Professor John Eisman AO, alongside principal investigators Prof Tuan Nguyen and Prof Jackie Center, the Dubbo Study involves older men and women in the NSW city of Dubbo, and is the world’s largest and longest-running osteoporosis study of its kind.
The Calculator was developed by Professor Tuan Nguyen and Dr Nguyen Nguyen, working with Profs Eisman and Center at Garvan. It was first described in a series of research papers in Osteoporosis International, published 10 years ago this month.
Prof Nguyen says that, before the Calculator was developed, there was little insight into how best to assess the risk of breaking a bone through osteoporosis – and no way to get an accurate assessment of someone’s individualised risk of fracture.
“Ten years ago,” he points out, “we really didn’t even understand what the key risk factors for fracture were.
“We did have a definition of osteoporosis (a bone mineral density below a certain level) and we knew that low bone density was one risk factor for breaking a bone – but we had also discovered that most fractures happen in people who don’t have low bone density, so we knew other risk factors must be at play. It was a puzzle.”
To clarify the key risk factors for fracture, the team carried out sophisticated analyses on the Dubbo Study data. They were able to determine the five key risk factors for fracture – namely a person’s, age, weight, bone mineral density, a history of previous fractures, and a history of falls. In turn, they used this information to construct an algorithm of risk, which formed the basis of the Calculator tool.
The researchers showed that the Calculator could successfully predict a future bone break in 80% of cases – making it a valuable tool for clinicians, who use the Calculator to inform their recommendations to patients.
“Because the Fracture Risk Calculator gives an individualised assessment of fracture risk,” Prof Center says, “it is very important for helping a person to understand whether or not they would benefit from treatment.”
Risk factors for osteoporotic fracture, according to Garvan's Fracture Risk Calculator
In the 10 years since it first launched, the Calculator has been further streamlined and refined. In particular, new findings make it clear that, when an individual’s genetic information is incorporated, the Calculator can predict fracture risk with even greater accuracy.
In 2016, a version of the Calculator was used to underpin Know Your Bones – a consumer-facing app that helps people to assess their own risk of fracture, and supports them to make wise health choices in discussion with their GP. Know Your Bones was developed by Osteoporosis Australia and Garvan.
Prof Eisman says that the Calculator has been a crucial step towards personalised care for osteoporosis.
“Since its launch 10 years ago, Garvan’s Fracture Risk Calculator has been enabling easier and more straightforward clinical decision-making for Australian GPs and Australian people – and that in turn means better outcomes for the 1.2 million Australians living with osteoporosis.”