Adjusting FRAX Estimates of Fracture Probability Based on a Positive Vertebral Fracture Assessment
Authors' conclusion
Results of this prognostic study suggest that FRAX underestimated fracture risk in patients with VFA-identified fractures.
Study context
- Population
- Individuals who underwent a DXA Vertebral Fracture Assessment (VFA) between March 31, 2010, and March 31, 2018, in the Manitoba Bone Mineral Density Registry
- Participants
- 11,766 individuals
- Comparison
- FRAX-predicted fracture probability with vs without VFA results, compared with observed 10-year probability
- Developmentn = 7,854
- Validationn = 3,912
- Outcome
- Calibration of FRAX: observed 10-year MOF and hip fracture probability vs FRAX-predicted probability with and without VFA results, and recalibrated FRAX from derived multipliers
- Follow-up
- 10 years
Methodological detailsregistry-based, development and validation cohorts (random allocation), Mean (SD) observation time 3.8 (2.3) years; longest 7.5 years
- Registry-based
- Development and validation cohorts (random allocation)
- Mean (SD) observation time 3.8 (2.3) years; longest 7.5 years
Performance
As reported in the abstract
No prior clinical fracture, positive VFA: 10-year MOF probability and recalibration multipliers
- FRAX-predicted major osteoporotic fracture (MOF) probability without VFA information
- 16.3% (95% CI, 15.7%-16.8%)
- FRAX-predicted MOF probability with VFA information
- 23.4% (95% CI, 22.7%-24.1%)
- Observed 10-year probability (MOF)
- 26.9% (95% CI, 26.0%-27.8%)
- Observed 10-year probability (hip fracture)
- 11.2% (95% CI, 10.3%-12.1%)
- Recalibration multiplier, MOF
- 1.15 (95% CI, 0.87-1.43)
- Recalibration multiplier, hip fracture
- 1.31 (95% CI, 0.75-1.87)
Further findings
Prior clinical fracture, positive VFA: 10-year MOF and hip fracture probability and recalibration multipliers
- FRAX-predicted MOF probability
- 25.0% (95% CI, 24.2%-25.7%)
- FRAX-predicted hip fracture probability
- 9.3% (95% CI, 8.7%-10.0%)
- Observed MOF probability
- 38.1% (95% CI, 37.0%-39.1%)
- Observed hip fracture probability
- 16.4% (95% CI, 15.4%-17.4%)
- Recalibration multiplier, MOF
- 1.53 (95% CI, 1.10-1.96)
- Recalibration multiplier, hip fracture
- 1.76 (95% CI, 1.17-2.35)
Calibration with derived multipliers in validation cohort
- Good calibration confirmed
- >0.90
Original publication
Adjusting FRAX Estimates of Fracture Probability Based on a Positive Vertebral Fracture Assessment. JAMA Netw Open. Published 1 August 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →