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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