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J Gen Intern Med. 2018 Oct 17. doi: 10.1007/s11606-018-4696-z. [Epub ahead of print]

Predicting Fracture Risk in Younger Postmenopausal Women: Comparison of the Garvan and FRAX Risk Calculators in the Women's Health Initiative Study.

Author information

1
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA. ccrandall@mednet.ucla.edu.
2
WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
3
Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA.
4
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
5
Endocrine, Diabetes and Hypertension Division, Brigham and Women's Hospital, Boston, MA, USA.
6
Division of Biomedical Data Science, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
7
Kaiser Permanente Center for Health Research NW, Portland, OR, USA.
8
Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
9
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital 3rd Floor, Harvard Medical School, Boston, MA, USA.
10
Division of Epidemiology & Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.

Abstract

BACKGROUND:

Guidelines recommend fracture risk assessment in postmenopausal women aged 50-64, but the optimal method is unknown.

OBJECTIVES:

To compare discrimination and calibration of the Fracture Risk Assessment Tool (FRAX) and Garvan fracture risk calculator for predicting fractures in postmenopausal women aged 50-64 at baseline.

DESIGN:

Prospective observational study.

PARTICIPANTS:

Sixty-three thousand seven hundred twenty-three postmenopausal women aged 50-64 years participating in the Women's Health Initiative Observational Study and Clinical Trials.

MAIN MEASURES:

Incident hip fractures and major osteoporotic fractures (MOF) during 10-year follow-up. Calculated FRAX- and Garvan-predicted hip fracture and MOF fracture probabilities.

KEY RESULTS:

The observed 10-year hip fracture probability was 0.3% for women aged 50-54 years (n = 14,768), 0.6% for women aged 55-59 years (n = 22,442), and 1.1% for women aged 60-64 years (n = 25,513). At sensitivity thresholds ≥ 80%, specificity of both tools for detecting incident hip fracture during 10 years of follow-up was low: Garvan 30.6% (95% confidence interval [CI] 30.3-31.0%) and FRAX 43.1% (95% CI 42.7-43.5%). At maximal area under the receiver operating characteristic curve (AUC(c), 0.58 for Garvan, 0.65 for FRAX), sensitivity was 16.0% (95% CI 12.7-19.4%) for Garvan and 59.2% (95% CI 54.7-63.7%) for FRAX. At AUC(c) values, sensitivity was lower in African American and Hispanic women than among white women and lower in women aged 50-54 than those 60-64 years old. Observed hip fracture probabilities were similar to FRAX-predicted probabilities but greater than Garvan-predicted probabilities. At AUC(c) values (0.56 for both tools), sensitivity for identifying MOF was also low (range 26.7-46.8%). At AUC(c) values (0.55 for both tools), sensitivity for identifying any clinical fracture ranged from 18.1 to 34.0%.

CONCLUSIONS:

In postmenopausal women aged 50-64 years, the FRAX and Garvan fracture risk calculator discriminate poorly between women who do and do not experience fracture during 10-year follow-up. There is no useful threshold for either tool.

KEYWORDS:

FRAX; Garvan; fracture; fracture risk assessment; osteoporosis

PMID:
30334182
DOI:
10.1007/s11606-018-4696-z

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