Expressing fracture risk

Excerpt

We thank Dr. Moayyeri for his interest in our paper [1]. We agree that it is important to consider the public health consequences of improvements in the sensitivity, specificity and positive predictive value of integrating the information derived from bone mineral density (BMD) and the clinical risk factors (CRFs). Our paper had, however, limited aims. A major aim was to determine whether the CRFs chosen added significantly to fracture risk prediction with or without the use of BMD measurements. A second, and perhaps more important aim, was to determine whether the findings in our source cohorts could be reproduced in the independent validation cohorts. Although we agree that the impact of enhanced assessment on fracture probability will be an important measure by which to judge the value of predictive tools, there are additional factors to consider before expressing our findings in a public health dimension. …