Fracture prediction and calibration of a Canadian FRAX® tool: a population-based report from CaMos

Fraser, Lisa-Ann; Langsetmo, Lisa; Berger, Claudie; Ioannidis, George; Goltzman, David; Adachi, Jonathan D.; Παπαϊωάννου, Αλεξάνδρα; Josse, Robert G.; Kovacs, Christopher S.; Olszynski, W. P.; Towheed, Tanveer; Hanley, David A.; Kaiser, Stéphanie; Prior, Jerilynn C.; Jamal, Sophie A.; Kreiger, Nancy; Brown, Jacques P.; Johansson, Helena; Odén, Anders; McCloskey, Eugène; Kanis, John А.; Leslie, William D.

doi:10.1007/s00198-010-1465-1

Cited by 167 publications

(116 citation statements)

References 43 publications

(54 reference statements)

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“…Fracture ascertainment from administrative data sources may be incomplete, particularly for vertebral fractures, although similar algorithms have proven useful for both vertebral and nonvertebral fracture identification. (37,38) We used a FRAX tool that has been directly validated in the Canadian population, (26,27) but there was incomplete information on some of the baseline clinical risk factors (eg, parental hip fracture), and for others proxies were used (eg, smoking, alcohol intake) as previously described. (25) Despite these limitations, predicted 10-year fracture probability agreed very closely with the observed fracture incidence estimated to 10 years among untreated women, suggesting reasonably complete ascertainment of fractures and risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…The Canadian FRAX tool has been previously shown to accurately predict fracture risk in the Canadian population in two large independent cohort studies. (26,27) In sensitivity analyses we also assessed fracture probability generated with the U.S. White FRAX tool (version 3.1). (28,29) Ascertainment of incident fractures was performed using previously reported methods.…”

Section: Bone Density Measurementsmentioning

confidence: 99%

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Does osteoporosis therapy invalidate FRAX for fracture prediction?

Leslie

Lix

Johansson

et al. 2012

Journal of Bone and Mineral Research

114

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Ten-year fracture risk assessment with the fracture risk assessment system (FRAX) is increasingly used to guide treatment decisions. Osteoporosis pharmacotherapy reduces fracture risk, but the effect is greater than can be explained from the increase in bone mineral density (BMD). Whether this invalidates fracture predictions with FRAX is uncertain. A total of 35,764 women (age !50 years) and baseline BMD testing (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) had FRAX probabilities retroactively calculated. A provincial pharmacy database was used to identify osteoporosis medication use. Women were categorized as untreated, current high adherence users [medication possession ratio (MPR) !0.80 in the year after BMD testing], current low adherence users (MPR <0.80), and past users. Fractures outcomes to 10 years were established form a population-based health data repository. FRAX and femoral neck BMD alone stratified major osteoporotic and hip fracture risk within untreated and each treated subgroup (all p-values <0.001) with similar area under the receiver operating characteristic curve. In untreated and each treated subgroup, a stepwise gradient in observed 10-year major osteoporotic and hip fracture incidence was found as a function of the predicted probability tertile (all p-values <0.001 for linear trend). Concordance (calibration) plots for major osteoporotic fractures and hip fractures showed good agreement between the predicted and observed 10-year fracture incidence in untreated women and each treated subgroup. Only in the highest risk tertile of women highly adherent to at least 5 years of bisphosphonate use was observed hip fracture risk significantly less than predicted, though major osteoporotic fracture risk was similar to predicted. In summary, this work suggests that the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis. Although FRAX should not be used to assess the reduction in fracture risk in individuals on treatment, it may still have value for guiding the need for continued treatment or treatment withdrawal. ß

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Section: Discussionmentioning

confidence: 99%

Section: Bone Density Measurementsmentioning

confidence: 99%

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Leslie

Lix

Johansson

et al. 2012

Journal of Bone and Mineral Research

114

View full text Add to dashboard Cite

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“…It was derived from nine prospective cohorts (which included 5-year data from CaMos) and was validated in 11 different population-based prospective cohorts from Europe, the USA, Australia, and Japan [16]. Recent work has validated calibration and discrimination of the Canadian FRAX tool using 10-year CaMos data and the Manitoba Bone Density Program [35,36]. Our study does not indicate that the additional clinical risk factors used in FRAX are unimportant, as the derivation meta-analyses and a recent report work in the Manitoba cohort show independent contributions to fracture risk prediction in individuals with those risk factors [15,16,36].…”

Section: Discussionmentioning

confidence: 99%

Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts

et al. 2010

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“…(26) FRAX estimates with the Canadian tool agree closely with observed fracture rates in the Canadian population. (9,27) Ten-year MOF probabilities from FRAX with BMD were categorized as low (<10%), moderate (10% to 19%), or high (!20%), in accordance with national guidelines. (28,29) Assessing effect of IBD on fracture risk…”

Section: Calculation Of Frax Probabilitymentioning

confidence: 99%

Inflammatory bowel disease and the risk of fracture after controlling for FRAX

Targownik

Bernstein

Nugent

et al. 2012

Journal of Bone and Mineral Research

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Subjects with inflammatory bowel disease (IBD) are at increased risk for hip and other major osteoporotic fractures. However, previous analyses have not fully accounted for differences in bone mineral density (BMD) and other clinical factors that affect the risk of fracture. The World Health Organization Fracture Risk Assessment tool (FRAX) can be used to predict the 10-year fracture risk from BMD and clinical risk factors. A population-based database containing clinical information on all IBD subjects in the province of Manitoba, Canada, was linked with the Manitoba Bone Mineral Density Database, which contains results of all dual X-ray absorptiometry (DXA) scans in the province. FRAX probabilities were calculated for all subjects aged 50 years or more undergoing baseline DXA testing. Subjects were followed for occurrence of major osteoporotic fractures (MOF; hip, clinical spine, wrist, humerus). Cox proportional hazards models were used to determine whether IBD was independently predictive of MOF or hip fracture. After controlling for FRAX fracture probability computed with BMD, IBD was not associated with a significantly increased risk for MOF (hazard ratio [HR] ¼ 1.12, 95% confidence interval [CI], 0.83-1.55) but was associated with an increased risk for hip fracture (HR ¼ 2.14; 95% CI, 1.26-3.65). The addition of femoral neck T-score to FRAX probability without knowledge of BMD had a negligible effect on the estimated HRs for IBD, suggesting that IBD mediates any effect on fracture risk independently of femoral neck BMD. After controlling for FRAX probability, subjects with IBD are not at an increased risk for overall MOF, but may be at increased risk of hip fracture. ß

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Fracture prediction and calibration of a Canadian FRAX® tool: a population-based report from CaMos

Cited by 167 publications

References 43 publications

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts

Inflammatory bowel disease and the risk of fracture after controlling for FRAX

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