Robert P. Kauffman, MD
In older women, do simple models predict 10-year fracture risk as accurately as more complex FRAX models?
Prospective cohort study with 10 years of follow-up.
Population-based study in the USA.
6252 women ≥ 65 years of age (mean age 71 y) who were enrolled in the Study of Osteoporotic Fractures and had data available for all FRAX clinical risk factors and femoral neck bone mineral density (BMD) (64% of original study participants). Exclusion criteria included black race, inability to walk without assistance, and bilateral hip replacement.
The World Health Organization Web-based risk assessment tool, FRAX, includes 10 items: age, sex, fracture history, use of oral glucocorticoids, presence of rheumatoid arthritis, presence of conditions associated with secondary osteoporosis, parental history of hip fracture, smoking status, alcohol intake, and body mass index; femoral neck BMD may also be included (www.shef.ac.uk/FRAX). The FRAX model with BMD was compared with a simple model that included only age and femoral neck BMD; the FRAX model without BMD was compared with a simple model that included only age and fracture history.*
Hip fracture, major osteoporotic fracture (hip, clinical vertebral, wrist, or humerus), and any clinical fracture (self-report confirmed by review of radiographic reports).
At 10 years, 6.2% of woman had had hip fracture, 17% major osteoporotic fracture, and 31% any clinical fracture. For accuracy in predicting fracture and proportion of women in each quartile of predicted risk who actually had a fracture, the simple model with age and BMD did not differ from the FRAX model with BMD, and the simple model with age and fracture history did not differ from the FRAX model without BMD (Table).
In older women, simple models involving only age and femoral neck bone mineral density or age and fracture history predicted 10-year fracture risk as accurately as more complex FRAX models.
FRAX risk assessment models vs simple models to predict 10-year fracture risk in older women†
†BMD = femoral head bone mineral density, ROC = receiver-operating characteristic.
Kauffman RP. Simple models predicted 10-year fracture risk in older women as accurately as more complex FRAX models. Ann Intern Med. ;152:JC3–13. doi: 10.7326/0003-4819-152-6-201003160-02013
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Published: Ann Intern Med. 2010;152(6):JC3-13.
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