Independent external validation of nomograms for predicting risk of low-trauma fracture and hip fracture

Langsetmo, Lisa; Nguyen, Tuan V.; Nguyen, N.D.; Kovacs, Christopher S.; Prior, Jerilynn C.; Center, Jacqueline R; Morin, Suzanne N; Josse, Robert G.; Adachi, J.D.; Hanley, David A.; Eisman, John A.

doi:10.1503/cmaj.100458

Cited by 55 publications

(47 citation statements)

References 34 publications

(29 reference statements)

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“…Similar to previous validations [13], [14], this study showed very good calibration of the nomograms, particularly in women in the four lower quintiles of risk. Although the nomograms (with BMD or body weight) over-estimated the risk of fracture in high risk individuals, these individuals would be candidates for intervention in any case.…”

Section: Discussionsupporting

confidence: 87%

External Validation of the Garvan Nomograms for Predicting Absolute Fracture Risk: The Tromsø Study

et al. 2014

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BackgroundAbsolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort.MethodsThe analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance.ResultsThe incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture.ConclusionsThe Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction.

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Section: Discussionsupporting

confidence: 87%

External Validation of the Garvan Nomograms for Predicting Absolute Fracture Risk: The Tromsø Study

et al. 2014

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“…Furthermore, most of those without the required follow-up time32 33 40 41 43–45 47–50 53–55 61 62 65 68 70 71 did not perform any statistical adjustments for this, which may have influenced the estimated AUCs.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of osteoporotic fracture risk prediction tools: a systematic review and meta-analysis

et al. 2015

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“…A report suggests good concordance of the tool with the Canadian CaMos study [47]. The high concordance should not be taken as validation in the correct sense of the term.…”

Section: Comparing Other Fracture Risk Prediction Tools With Fraxmentioning

confidence: 99%

Pitfalls in the external validation of FRAX

et al. 2011

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Independent external validation of nomograms for predicting risk of low-trauma fracture and hip fracture

Cited by 55 publications

References 34 publications

External Validation of the Garvan Nomograms for Predicting Absolute Fracture Risk: The Tromsø Study

External Validation of the Garvan Nomograms for Predicting Absolute Fracture Risk: The Tromsø Study

The accuracy of osteoporotic fracture risk prediction tools: a systematic review and meta-analysis

Pitfalls in the external validation of FRAX

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