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Database: PubMed
Entry: 20499367
LinkDB: 20499367
Original site: 20499367 
PMID:
     20499367
Authors:
     Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA.
Title:
     Independent clinical validation of a Canadian FRAX tool: fracture prediction and 
     model calibration.
Journal:
     J Bone Miner Res. 2010 Nov;25(11):2350-8. doi: 10.1002/jbmr.123.
Abstract:
     A FRAX model for Canada was constructed for prediction of osteoporotic and hip 
     fracture risk using national hip fracture data with and without the use of 
     femoral neck bone mineral density (BMD). Performance of this system was assessed 
     independently in a large clinical cohort of 36,730 women and 2873 men from the 
     Manitoba Bone Density Program database that tracks all clinical dual-energy X-ray 
     absorptiometry (DXA) test results for the Province of Manitoba, Canada. Linkage 
     with other provincial health databases allowed for the direct comparison of 
     fracture risk estimates from the Canadian FRAX model with observed fracture rates 
     to 10 years (549 individuals with incident hip fractures and 2543 with incident 
     osteoporotic fractures). The 10-year Kaplan-Meier estimate for hip fractures in 
     women was 2.7% [95% confidence interval (CI) 2.1-3.4%] with a predicted value of 
     2.8% for FRAX with BMD, and in men the observed risk was 3.5% (95% CI 0.8-6.2%) 
     with predicted value of 2.9%. The 10-year estimate of osteoporotic fracture risk 
     for all women was 12.0% (95% CI 10.8-13.4%) with a predicted value of 11.1% for 
     FRAX with BMD, and in men, the observed risk was 10.7% (95% CI 6.6-14.9%) with a 
     predicted value of 8.4%. Discrepancies were observed within some subgroups but 
     generally were small. Fracture discrimination based on receiver operating 
     characteristic curve analysis was comparable with published meta-analyses with 
     area under the curve for osteoporotic fracture prediction of 0.694 (95% CI 
     0.684-0.705) for FRAX with BMD and for hip fractures 0.830 (95% CI 0.815-0.846), 
     both of which were better than FRAX without BMD or BMD alone. Individual risk 
     factors considered by FRAX made significant independent contributions to fracture 
     prediction in one or more of the models. In conclusion, a Canadian FRAX tool 
     calibrated on national hip fracture data generates fracture risk predictions that 
     generally are consistent with observed fracture rates across a wide range of risk 
     categories.

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