WHO absolute fracture risk models (FRAX): Do clinical risk factors improve fracture prediction in older women without osteoporosis?

Teresa A. Hillier, Jane A. Cauley, Joanne H. Rizzo, Kathryn L. Pedula, Kristine E. Ensrud, Douglas C. Bauer, Li Yung Lui, Kimberly K. Vesco, Dennis M. Black, Meghan G. Donaldson, Erin S. Leblanc, Steven R. Cummings

Research output: Contribution to journalArticlepeer-review

65 Scopus citations

Abstract

Bone mineral density (BMD) is a strong predictor of fracture, yet most fractures occur in women without osteoporosis by BMD criteria. To improve fracture risk prediction, the World Health Organization recently developed a country-specific fracture risk index of clinical risk factors (FRAX) that estimates 10-year probabilities of hip and major osteoporotic fracture. Within differing baseline BMD categories, we evaluated 6252 women aged 65 or older in the Study of Osteoporotic Fractures using FRAX 10-year probabilities of hip and major osteoporotic fracture (ie, hip, clinical spine, wrist, and humerus) compared with incidence of fractures over 10 years of follow-up. Overall ability of FRAX to predict fracture risk based on initial BMD T-score categories (normal, low bone mass, and osteoporosis) was evaluated with receiver-operating-characteristic (ROC) analyses using area under the curve (AUC). Over 10 years of follow-up, 368 women incurred a hip fracture, and 1011 a major osteoporotic fracture. Women with low bone mass represented the majority (n=3791, 61%); they developed many hip (n=176, 48%) and major osteoporotic fractures (n=569, 56%). Among women with normal and low bone mass, FRAX (including BMD) was an overall better predictor of hip fracture risk (AUC=0.78 and 0.70, respectively) than major osteoporotic fractures (AUC=0.64 and 0.62). Simpler models (eg, age+prior fracture) had similar AUCs to FRAX, including among women for whom primary prevention is sought (no prior fracture or osteoporosis by BMD). The FRAX and simpler models predict 10-year risk of incident hip and major osteoporotic fractures in older US women with normal or low bone mass.

Original languageEnglish (US)
Pages (from-to)1774-1782
Number of pages9
JournalJournal of Bone and Mineral Research
Volume26
Issue number8
DOIs
StatePublished - Aug 2011

Keywords

  • fracture
  • osteopenia
  • osteoporosis
  • prediction
  • risk

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