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[null,"Baseline assessment tool for osteoporosis: assessing the risk of fragility fracture  (NICE clinical guideline CG146)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Osteoporosis: assessing the risk of fragility fracture .  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with Osteoporosis: assessing the risk of fragility fracture (NICE clinical guideline CG146)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2019. All rights reserved. Subject to Notice of rights.\n"]

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[null,"Baseline assessment tool for osteoporosis: assessing the risk of fragility fracture  (NICE clinical guideline CG146)"]
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[null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(D8:D995,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F995,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
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[null,"NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"Targeting risk assessment"]
[null,"Consider assessment of fracture risk:\n•\tIn all women aged 65 years and over and all men aged 75 years and over\n•\tin women aged under 65 years and men aged under 75 years in the presence of risk factors, for example:\n-\tprevious fragility fracture\n-\tcurrent use or frequent recent use of oral or systemic glucocorticoids\n-\thistory of falls\n-\tfamily history of hip fracture\n-\tother causes of secondary osteoporosis \n-\tlow body mass index (BMI) (less than 18.5 kg/m2)\n-\tsmoking \n-\talcohol intake of more than 14 units per week for men and women.",1.1000000000000001]
[null,"Do not routinely assess fracture risk in people aged under 50 years unless they have major risk factors (for example, current or frequent recent use of oral or systemic glucocorticoids, untreated premature menopause or previous fragility fracture), because they are unlikely to be at high risk.",1.2]
[null,"Methods of risk assessment"]
[null,"Estimate absolute risk when assessing risk of fracture (for example, the predicted risk of major osteoporotic or hip fracture over 10 years, expressed as a percentage).",1.3]
[null,"Use either FRAX (without a bone mineral density [BMD] value if a dual-energy X-ray absorptiometry [DXA] scan has not previously been undertaken) or QFracture, within their allowed age ranges, to estimate 10-year predicted absolute fracture risk when assessing risk of fracture. Above the upper age limits defined by the tools, consider people to be at high risk.",1.4]
[null,"Interpret the estimated absolute risk of fracture in people aged over 80 years with caution, because predicted 10-year fracture risk may underestimate their short-term fracture risk.",1.5]
[null,"Do not routinely measure BMD to assess fracture risk without prior assessment using FRAX (without a BMD value) or QFracture.",1.6]
[null,"Following risk assessment with FRAX (without a BMD value) or QFracture, consider measuring BMD with DXA in people whose fracture risk is in the region of an intervention threshold for a proposed treatment, and recalculate absolute risk using FRAX with the BMD value.",1.7]
[null,"Consider measuring BMD with DXA before starting treatments that may have a rapid adverse effect on bone density (for example, sex hormone deprivation for treatment for breast or prostate cancer).",1.8]
[null,"Measure BMD to assess fracture risk in people aged under 40 years who have a major risk factor, such as history of multiple fragility fracture, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer).",1.9]
[null,"Consider recalculating fracture risk in the future:\n•\tif the original calculated risk was in the region of the intervention threshold  for a proposed treatment and only after a minimum of 2 years, or\n•\twhen there has been a change in the person’s risk factors.","1.10"]
[null,"Take into account that risk assessment tools may underestimate fracture risk in certain circumstances, for example if a person:\n•\thas a history of multiple fractures\n•\thas had previous vertebral fracture(s)\n•\thas a high alcohol intake\n•\tis taking high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer)\n•\thas other causes of secondary osteoporosis. ",1.1100000000000001]
[null,"Take into account that fracture risk can be affected by factors that may not be included in the risk tool, for example living in a care home or taking drugs that may impair bone metabolism (such as anti-convulsants, selective serotonin reuptake inhibitors, thiazolidinediones, proton pump inhibitors and anti-retroviral drugs).",1.1200000000000001]