Independent clinical validation of a Canadian FRAX tool: fracture prediction and model calibration.
Journal article, 2010

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.

physiology

Femur Neck

Risk Assessment

methods

Male

Biological

Middle Aged

physiopathology

Risk Factors

Models

Aged

Proportional Hazards Models

Fractures

Bone

ROC Curve

Humans

Female

Calibration

Bone Density

Canada

physiopathology

Reproducibility of Results

pathology

Author

William D Leslie

Lisa M Lix

Helena Johansson

Eugene McCloskey

John A Kanis

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

1523-4681 (ISSN)

Vol. 25 11 2350-8

Subject Categories

Endocrinology and Diabetes

DOI

10.1002/jbmr.123

PubMed

20499367

More information

Created

10/10/2017