Vertebral fracture clinical decision tool for older women with back pain (Vfrac) – a feasibility study.


National Institute for Health and Care Research, Research for Patient Benefit.

What is the problem?

Osteoporosis (weak bones) is one of the most common musculoskeletal conditions in older women. Osteoporotic vertebral fractures (broken bones in the back due to osteoporosis) are particularly important because they identify people at high risk of breaking more bones. However, less than a third of people with vertebral fractures are correctly diagnosed and treated. The main reason for this failure is difficulty understanding who should have spinal X-rays. The Vfrac tool is a simple questionnaire developed carefully by research involving women with and without osteoporotic vertebral fractures. Vfrac is for healthcare professionals in GP practices to complete for women aged over 65 with backpain. The output of Vfrac indicates whether or not they should have a spinal X-ray.

What is the aim of the research?

Vfrac has never been tested in a real-world situation to find out if it works and is likely to be cost effective for the NHS. This real-world testing will be a large study involving many GP practices and will look at whether Vfrac improves the treatment of older people with osteoporosis. Before we can design this study, we need information to plan:

  1. The size and process of the study, based on information including numbers of women who attend their GP with backpain, and the average time it takes for X-ray results to get back to the GP.
  2. IT requirements, based on what different IT systems GP practices use.
  3. How Vfrac is used, based on which healthcare professionals see older people with backpain in primary care.
  4. Whether we need to change the tool based on understanding patient and healthcare professionals’ views and experiences of using Vfrac.
  5. Whether we can use Vfrac over the telephone (remote consultation).

How will this be achieved?

We will:

(A) Use a database that collects patient data from GP practices across the UK to calculate the size and design of the large study.

(B) Ask six GP practices to be involved in this study and get half of them to use Vfrac for 12 months. This will help us understand IT requirements. We will ask patients and healthcare professionals about their views of Vfrac and identify factors that make it easier or more difficult to use. We will test it face-to-face and over the telephone/video.

(C) Do a nationwide survey of GP practices to describe which type of healthcare professionals see older people with backpain.

Patients and the public have been involved throughout planning and delivery of the research projects that led up to Vfrac. Two people with osteoporotic vertebral fractures have agreed to continue involvement – they will be on the steering committee of this proposal. Our award-winning Patient Experience Partnership in Research helped write this case for support.

Who is leading the research?

Professor Emma Clark, Professor of Clinical Musculoskeletal Epidemiology, Bristol Medical School, University of Bristol.

Further information:

Professor Emma Clark

For more information or to get involved in this project, please contact

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.