Mobile Device to Help FRAX® Screening
Condition: Osteoporosis; Fracture
MeSH terms: Osteoporosis; Fractures, Bone
Study type: Observational

Summary: 
      Background: The Taiwanese FRAX® (Fracture Risk Assessment Tool) calculator is available
      online for clinical use. Our Taiwanese Osteoporosis Clinical Treatment Guidelines suggests
      using the American high risk cut-points for considering treatment but also suggests deriving
      domestic cut-points from cost-effective approach. Establishing cost-effective domestic
      cut-points for policy suggestions coupled with mobile devices with wireless access would
      potentially increase the usage of FRAX® tool.

      Objectives: 1) Using literature review to establish cost-effectiveness FRAX® cut-points. 2)
      To assess the effectiveness of mobile devices assisted FRAX® tool based osteoporosis
      diagnostic and management model. 3) To provide FRAX® based reimbursement policy suggestions.

      Methods: 1) Investigators will use FRAX®, cost-effectiveness and other key words to search
      Pubmed and international osteoporosis guidelines to better understand the clinical
      applications of FRAX® in other countries. Investigators will also search epidemiological data
      for osteoporosis, facture, quality of life and cost to establish domestic cost-effeteness,
      and translational approach FRAX® cut-points. 2) Three targeting populations from National
      Taiwan University Hospital (NTUH) are selected for prospective study (Group A: geriatric
      health exam clinics with American cut-points, group B: orthopedic clinics with translational
      approach cut-points and group C: endocrine clinics with cost-effectiveness cut-points,). A
      mobile device with app application coupled with the FRAX® tool is used by a trained research
      assistant during clinic waiting periods to screen and enroll high risk (75 from each clinic)
      adults with informed consents. Participants are referred to geriatric clinics for systemic
      osteoporosis diagnoses and managements. Percentage of participants that meet the current NHI
      medication reimbursement regulation and percentage of self-pay medications are calculated.
      Analysis is stratified by age and gender. 3) The impacts of 3 different cut-points on
      increment NHI reimbursement are estimated. An osteoporosis expert group meeting is to be held
      for FRAX® based osteoporosis medication reimbursement modifications to the NHI and the
      Department of Health.

      Expected Outcomes: 1) To establish the mobile device assisted FRAX® based osteoporosis
      screening and management model. 2) Base on the study results and expert consensus,
      investigators will provide policy suggestions of FRAX® based reimbursement modifications.
    

Detailed description: 
      This is an observational study. The study outcomes might base on clinical physician opnions
      to provide policy suggestion of FRAX® at which cut-point is considering for treatment.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adults visitng geraitric health exam clinics, orthopedic clinic, and endocrinology clinic
      
Keywords: osteoporisis; fracture; risk; cost effectiveness; FRAX; mobile device