Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study

Abstract

Context Individualized fracture risk may help to select patients requiring a pharmacological treatment for osteoporosis. FRAX and the Garvan fracture risk calculators are the most used tools, though their external validation has shown significant differences in their risk prediction ability. Objective and Methods Using data from the FRISBEE study, a cohort of 3560 post-menopausal women aged 60-85 years, we aimed to construct original 5-year fracture risk prediction models using validated clinical risk factors (CRFs). Three models of competing risk analysis were developed to predict major osteoporotic fractures (MOFs), all fractures and central fractures (femoral neck, shoulder, clinical spine, pelvis, ribs, scapula, clavicle, sternum). Results Age, a history of fracture and hip or spine BMD were predictors common to the three models. Excessive alcohol intake, and the presence of comorbidities were specific additional CRFs for MOFs, a history of fall for all fractures and rheumatoid arthritis for central fractures. Our models predicted the fracture probability at 5-years with an acceptable accuracy (Brier scores ≤ 0.1) and had a good discrimination power (area under the receiver operating curve of 0.73 for MOFs and 0.72 for central fractures) when internally validated by bootstrap. Three simple nomograms, integrating significant CRFs and the mortality risk were constructed for different fracture sites. In conclusion, we derived three models predicting fractures with an acceptable accuracy, particularly for MOFs and central fractures. The models are based on a limited number of CRFs and we constructed nomograms for use in clinical practice.

Derivation and validation of the CFracture competing risk fracture prediction tool compared with QFracture in older people and people with comorbidity: a population cohort study

“…Discrimination and calibration of both QFracture and CFracture in the overall population cohort with complete case analysis was similar to the main results (appendix pp [24][25].…”

“…23 Another competing risk model used to predict fracture risk showed good discrimination and calibration, but was only derived and validated for use in post-menopausal women. 24 Despite similar discrimination to QFracture, CFracture reclassified different patients around thresholds of predicted risk. Compared with QFracture, CFracture classified more women below a potential 10% risk threshold when predicting major osteoporotic fracture, similar numbers of women when predicting hip fracture, and fewer men for both major osteoporotic fracture and hip fracture.…”

Surgical management of spiral oblique fractures of the fifth metatarsal leads to faster return to play in athletes: A systematic review

“…Conversely, in the more advanced cohort, the fracture typically occurs as a fragility fracture following a fall. There was a higher prevalence of dancer's fractures amongst the female population (74.9%) due to the higher participation rates of females in dancing‐based sports and the biological predilection of females for fragility fractures [3]. This fracture pattern is an uncommon injury compared to fractures of the base of the fifth metatarsal, with reported prevalence rates of 5% [4].…”

A Comparison of Ankle Fractures Relative to Other Fragility Fractures: A Review and Analysis of the American Orthopaedic Association’s Own the Bone Database

“…This is not surprising, as postmenopause is a predictor of future osteoporotic fractures. 2,8,13 However, patients with AFX are younger compared to patients with NAFX (Table 1). In addition to poor bone quality, another explanation is that ankle fractures are not directly related to a decrease in BMD, advanced age, and frailty, but rather biomechanical forces unique to the ankle, activity level, and medical comorbidities such as diabetes, peripheral arterial disease, poor nutritional status, obesity, and tobacco use.…”