By Darwin Wan

Almost two million osteoporosis-related fractures occur every year in the United States. The cost of fragility hip fractures alone is was estimated to be $12 billion (source: aaos.org). Therefore, predicting the risk of a fragility hip fracture and initiating appropriate preventive therapy should be a major concern for primary care physicians and consulting orthopedic surgeons.

The Fracture Risk Assessment Tool (FRAX) is a set of algorithms developed by the World Health Organization to assess an individual’s ten year probability of fracture. An advantage of this algorithm is the ease with which validated clinical risk factors can be entered into the calculation to estimate the probability of hip and major osteoporotic fracture in the next 10 years. Of note, knowledge of the bone mineral density of the femoral neck is not mandatory for the algorithm.

Doctot’s FRAX app for iPhone takes this formula and puts it into your phone with little else in the way of fluff. By keeping the interface simple and attractive, hopefully it will encourage more physicians to utilize this important set of algorithms.

Upon starting the app, you are asked to enter a name and email address, although it is not clear why this is necessary. Following that, you are then ready to start using the algorithm. I found that although the App Store description claims it is not compatible, the app seems to work on my iPad.

There are multiple parameters in the algorithm that must be entered. The app makes this process less tedious with pleasant graphics, including a sliding scale for the patient’s weight. Shaking your phone resets the scale, but given how little you can mess up for this simple task, this is a fun gimmick at best. Even the yes/no questions have nice graphics to make the experience more pleasant; the downside to these fancy graphics is that one must flip through 14 or so questions on different screens to enter the entire algorithm.

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It would be nice to have a one-page “view all” option where a user could see and enter everything quickly instead of navigating through all these screens. The slider for weight and height could also be replaced with a slider for each digit and decimal place. Speed and efficiency are top priorities when it comes to the overall user experience; while FRAX isn’t slow, the addition of these options would allow the user to glance at all the questions quickly to ensure accuracy.

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After entering all the information, you are presented with a calculated 10 year BMI, major osteoporotic and hip fracture risk. You are able to enter a patient name, save and/or email the scores and data.

Given that one is able to enter patient names (or pseudonyms) into the app, there is a privacy concern should one’s iPhone fall into the wrong hands. To prevent this, there is an option to require one to enter a PIN number upon opening the app. Since the PIN is not required if the app is already running in the background; completely quitting the app (hold the icon down in the tray and press “minus” badge when it wiggles) could  be recommended if privacy is critical.

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My main criticism of this app is its price – a relatively expensive $5.99. This may be due to the niche market that the app is able to reach, but there are many cheaper apps available with a large number of formulas. For practicing physicians who may use this tool frequently, price will not be an issue. But for medical students who will not use the tool often, a free option can be found straight from the source (http://www.shef.ac.uk/FRAX/tool.jsp?locationValue=9).

Likes

  • Attractive graphics makes using the FRAX algorithm less tedious
  • Good add-ons, including PIN security and email option

Dislikes

  • Relatively expensive
  • Could benefit from a “view all” option

Pricing

  • $ 5.99

Conclusion

FRAX is a very simple app that brings the Fracture Risk Assessment Tool to your phone. Extra features include the option to save and email data and a PIN for security. It is relatively expensive, and thus may be better suited for practicing physicians who will use the tool often. A “view all” option may enhance app efficiency. It is recommended for those who will be using the tool frequently in their practice, otherwise a free option is available online.

Darwin Wan, B.Sc(Kin) is a member of Class of 2013, University of Alberta Medical School