Predicting Fracture Risk in Younger Postmenopausal Women: Comparison of the Garvan and FRAX Risk Calculators in the Women’s Health Initiative Study

Carolyn J. Crandall, Joseph Larson, Andrea LaCroix, Jane A. Cauley, Meryl S. LeBoff, Wenjun Li, Erin S. LeBlanc, Beatrice J. Edwards, Jo Ann E. Manson, Kristine Ensrud

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Guidelines recommend fracture risk assessment in postmenopausal women aged 50–64, but the optimal method is unknown. Objectives: To compare discrimination and calibration of the Fracture Risk Assessment Tool (FRAX) and Garvan fracture risk calculator for predicting fractures in postmenopausal women aged 50–64 at baseline. Design: Prospective observational study. Participants: Sixty-three thousand seven hundred twenty-three postmenopausal women aged 50–64 years participating in the Women’s Health Initiative Observational Study and Clinical Trials. Main Measures: Incident hip fractures and major osteoporotic fractures (MOF) during 10-year follow-up. Calculated FRAX- and Garvan-predicted hip fracture and MOF fracture probabilities. Key Results: The observed 10-year hip fracture probability was 0.3% for women aged 50–54 years (n = 14,768), 0.6% for women aged 55–59 years (n = 22,442), and 1.1% for women aged 60–64 years (n = 25,513). At sensitivity thresholds ≥ 80%, specificity of both tools for detecting incident hip fracture during 10 years of follow-up was low: Garvan 30.6% (95% confidence interval [CI] 30.3–31.0%) and FRAX 43.1% (95% CI 42.7–43.5%). At maximal area under the receiver operating characteristic curve (AUC(c), 0.58 for Garvan, 0.65 for FRAX), sensitivity was 16.0% (95% CI 12.7–19.4%) for Garvan and 59.2% (95% CI 54.7–63.7%) for FRAX. At AUC(c) values, sensitivity was lower in African American and Hispanic women than among white women and lower in women aged 50–54 than those 60–64 years old. Observed hip fracture probabilities were similar to FRAX-predicted probabilities but greater than Garvan-predicted probabilities. At AUC(c) values (0.56 for both tools), sensitivity for identifying MOF was also low (range 26.7–46.8%). At AUC(c) values (0.55 for both tools), sensitivity for identifying any clinical fracture ranged from 18.1 to 34.0%. Conclusions: In postmenopausal women aged 50–64 years, the FRAX and Garvan fracture risk calculator discriminate poorly between women who do and do not experience fracture during 10-year follow-up. There is no useful threshold for either tool.

Original languageEnglish (US)
Pages (from-to)235-242
Number of pages8
JournalJournal of general internal medicine
Volume34
Issue number2
DOIs
StatePublished - Feb 15 2019

Fingerprint

Women's Health
Hip Fractures
Osteoporotic Fractures
Area Under Curve
Confidence Intervals
Observational Studies
Hispanic Americans
ROC Curve
African Americans
Calibration
Clinical Trials
Prospective Studies
Guidelines

Keywords

  • FRAX
  • Garvan
  • fracture
  • fracture risk assessment
  • osteoporosis

Cite this

Predicting Fracture Risk in Younger Postmenopausal Women : Comparison of the Garvan and FRAX Risk Calculators in the Women’s Health Initiative Study. / Crandall, Carolyn J.; Larson, Joseph; LaCroix, Andrea; Cauley, Jane A.; LeBoff, Meryl S.; Li, Wenjun; LeBlanc, Erin S.; Edwards, Beatrice J.; Manson, Jo Ann E.; Ensrud, Kristine.

In: Journal of general internal medicine, Vol. 34, No. 2, 15.02.2019, p. 235-242.

Research output: Contribution to journalArticle

Crandall, Carolyn J. ; Larson, Joseph ; LaCroix, Andrea ; Cauley, Jane A. ; LeBoff, Meryl S. ; Li, Wenjun ; LeBlanc, Erin S. ; Edwards, Beatrice J. ; Manson, Jo Ann E. ; Ensrud, Kristine. / Predicting Fracture Risk in Younger Postmenopausal Women : Comparison of the Garvan and FRAX Risk Calculators in the Women’s Health Initiative Study. In: Journal of general internal medicine. 2019 ; Vol. 34, No. 2. pp. 235-242.
@article{e5ce4a27f087403f992ca8f014e37350,
title = "Predicting Fracture Risk in Younger Postmenopausal Women: Comparison of the Garvan and FRAX Risk Calculators in the Women’s Health Initiative Study",
abstract = "Background: Guidelines recommend fracture risk assessment in postmenopausal women aged 50–64, but the optimal method is unknown. Objectives: To compare discrimination and calibration of the Fracture Risk Assessment Tool (FRAX) and Garvan fracture risk calculator for predicting fractures in postmenopausal women aged 50–64 at baseline. Design: Prospective observational study. Participants: Sixty-three thousand seven hundred twenty-three postmenopausal women aged 50–64 years participating in the Women’s Health Initiative Observational Study and Clinical Trials. Main Measures: Incident hip fractures and major osteoporotic fractures (MOF) during 10-year follow-up. Calculated FRAX- and Garvan-predicted hip fracture and MOF fracture probabilities. Key Results: The observed 10-year hip fracture probability was 0.3{\%} for women aged 50–54 years (n = 14,768), 0.6{\%} for women aged 55–59 years (n = 22,442), and 1.1{\%} for women aged 60–64 years (n = 25,513). At sensitivity thresholds ≥ 80{\%}, specificity of both tools for detecting incident hip fracture during 10 years of follow-up was low: Garvan 30.6{\%} (95{\%} confidence interval [CI] 30.3–31.0{\%}) and FRAX 43.1{\%} (95{\%} CI 42.7–43.5{\%}). At maximal area under the receiver operating characteristic curve (AUC(c), 0.58 for Garvan, 0.65 for FRAX), sensitivity was 16.0{\%} (95{\%} CI 12.7–19.4{\%}) for Garvan and 59.2{\%} (95{\%} CI 54.7–63.7{\%}) for FRAX. At AUC(c) values, sensitivity was lower in African American and Hispanic women than among white women and lower in women aged 50–54 than those 60–64 years old. Observed hip fracture probabilities were similar to FRAX-predicted probabilities but greater than Garvan-predicted probabilities. At AUC(c) values (0.56 for both tools), sensitivity for identifying MOF was also low (range 26.7–46.8{\%}). At AUC(c) values (0.55 for both tools), sensitivity for identifying any clinical fracture ranged from 18.1 to 34.0{\%}. Conclusions: In postmenopausal women aged 50–64 years, the FRAX and Garvan fracture risk calculator discriminate poorly between women who do and do not experience fracture during 10-year follow-up. There is no useful threshold for either tool.",
keywords = "FRAX, Garvan, fracture, fracture risk assessment, osteoporosis",
author = "Crandall, {Carolyn J.} and Joseph Larson and Andrea LaCroix and Cauley, {Jane A.} and LeBoff, {Meryl S.} and Wenjun Li and LeBlanc, {Erin S.} and Edwards, {Beatrice J.} and Manson, {Jo Ann E.} and Kristine Ensrud",
year = "2019",
month = "2",
day = "15",
doi = "10.1007/s11606-018-4696-z",
language = "English (US)",
volume = "34",
pages = "235--242",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York LLC",
number = "2",

}

TY - JOUR

T1 - Predicting Fracture Risk in Younger Postmenopausal Women

T2 - Comparison of the Garvan and FRAX Risk Calculators in the Women’s Health Initiative Study

AU - Crandall, Carolyn J.

AU - Larson, Joseph

AU - LaCroix, Andrea

AU - Cauley, Jane A.

AU - LeBoff, Meryl S.

AU - Li, Wenjun

AU - LeBlanc, Erin S.

AU - Edwards, Beatrice J.

AU - Manson, Jo Ann E.

AU - Ensrud, Kristine

PY - 2019/2/15

Y1 - 2019/2/15

N2 - Background: Guidelines recommend fracture risk assessment in postmenopausal women aged 50–64, but the optimal method is unknown. Objectives: To compare discrimination and calibration of the Fracture Risk Assessment Tool (FRAX) and Garvan fracture risk calculator for predicting fractures in postmenopausal women aged 50–64 at baseline. Design: Prospective observational study. Participants: Sixty-three thousand seven hundred twenty-three postmenopausal women aged 50–64 years participating in the Women’s Health Initiative Observational Study and Clinical Trials. Main Measures: Incident hip fractures and major osteoporotic fractures (MOF) during 10-year follow-up. Calculated FRAX- and Garvan-predicted hip fracture and MOF fracture probabilities. Key Results: The observed 10-year hip fracture probability was 0.3% for women aged 50–54 years (n = 14,768), 0.6% for women aged 55–59 years (n = 22,442), and 1.1% for women aged 60–64 years (n = 25,513). At sensitivity thresholds ≥ 80%, specificity of both tools for detecting incident hip fracture during 10 years of follow-up was low: Garvan 30.6% (95% confidence interval [CI] 30.3–31.0%) and FRAX 43.1% (95% CI 42.7–43.5%). At maximal area under the receiver operating characteristic curve (AUC(c), 0.58 for Garvan, 0.65 for FRAX), sensitivity was 16.0% (95% CI 12.7–19.4%) for Garvan and 59.2% (95% CI 54.7–63.7%) for FRAX. At AUC(c) values, sensitivity was lower in African American and Hispanic women than among white women and lower in women aged 50–54 than those 60–64 years old. Observed hip fracture probabilities were similar to FRAX-predicted probabilities but greater than Garvan-predicted probabilities. At AUC(c) values (0.56 for both tools), sensitivity for identifying MOF was also low (range 26.7–46.8%). At AUC(c) values (0.55 for both tools), sensitivity for identifying any clinical fracture ranged from 18.1 to 34.0%. Conclusions: In postmenopausal women aged 50–64 years, the FRAX and Garvan fracture risk calculator discriminate poorly between women who do and do not experience fracture during 10-year follow-up. There is no useful threshold for either tool.

AB - Background: Guidelines recommend fracture risk assessment in postmenopausal women aged 50–64, but the optimal method is unknown. Objectives: To compare discrimination and calibration of the Fracture Risk Assessment Tool (FRAX) and Garvan fracture risk calculator for predicting fractures in postmenopausal women aged 50–64 at baseline. Design: Prospective observational study. Participants: Sixty-three thousand seven hundred twenty-three postmenopausal women aged 50–64 years participating in the Women’s Health Initiative Observational Study and Clinical Trials. Main Measures: Incident hip fractures and major osteoporotic fractures (MOF) during 10-year follow-up. Calculated FRAX- and Garvan-predicted hip fracture and MOF fracture probabilities. Key Results: The observed 10-year hip fracture probability was 0.3% for women aged 50–54 years (n = 14,768), 0.6% for women aged 55–59 years (n = 22,442), and 1.1% for women aged 60–64 years (n = 25,513). At sensitivity thresholds ≥ 80%, specificity of both tools for detecting incident hip fracture during 10 years of follow-up was low: Garvan 30.6% (95% confidence interval [CI] 30.3–31.0%) and FRAX 43.1% (95% CI 42.7–43.5%). At maximal area under the receiver operating characteristic curve (AUC(c), 0.58 for Garvan, 0.65 for FRAX), sensitivity was 16.0% (95% CI 12.7–19.4%) for Garvan and 59.2% (95% CI 54.7–63.7%) for FRAX. At AUC(c) values, sensitivity was lower in African American and Hispanic women than among white women and lower in women aged 50–54 than those 60–64 years old. Observed hip fracture probabilities were similar to FRAX-predicted probabilities but greater than Garvan-predicted probabilities. At AUC(c) values (0.56 for both tools), sensitivity for identifying MOF was also low (range 26.7–46.8%). At AUC(c) values (0.55 for both tools), sensitivity for identifying any clinical fracture ranged from 18.1 to 34.0%. Conclusions: In postmenopausal women aged 50–64 years, the FRAX and Garvan fracture risk calculator discriminate poorly between women who do and do not experience fracture during 10-year follow-up. There is no useful threshold for either tool.

KW - FRAX

KW - Garvan

KW - fracture

KW - fracture risk assessment

KW - osteoporosis

UR - http://www.scopus.com/inward/record.url?scp=85055506648&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055506648&partnerID=8YFLogxK

U2 - 10.1007/s11606-018-4696-z

DO - 10.1007/s11606-018-4696-z

M3 - Article

C2 - 30334182

AN - SCOPUS:85055506648

VL - 34

SP - 235

EP - 242

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 2

ER -