Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older
Authors' conclusion
In this prognostic study of adults aged 80 years and older, FRAX and Garvan tools incorporating FNBMD compared with FNBMD alone did not improve 5-year hip fracture discrimination. FRAX modestly underpredicted observed hip fracture probability in intermediate-risk individuals. Garvan markedly overpredicted observed hip fracture probability in high-risk individuals.
Study context
- Population
- Adults aged 80 years or older attending an index examination (1997 to 2016) in 3 prospective cohort studies; mean (SD) age 82.6 (2.7) years; 55.2% women4,906 women
- Participants
- 8,890 adults
- Comparison
- FRAX vs Garvan Fracture Risk Calculator vs femoral neck BMD alone for 5-year hip fracture prediction
- Outcome
- 5-year hip fracture prediction: discrimination (AUC) and calibration (observed vs predicted within predicted risk quintiles)
- Follow-up
- 5 years
Methodological detailsanalysis of 3 prospective cohort studies, Data analysed March 2023 to April 2024, Participants contacted every 4 or 6 months after index examination
- Analysis of 3 prospective cohort studies
- Data analysed March 2023 to April 2024
- Participants contacted every 4 or 6 months after index examination
Performance
As reported in the abstract
AUC for 5-year hip fracture, women
| Test or model | Value | AUC |
|---|---|---|
| FRAX | 0.69 (95% CI 0.67–0.72) | 0.69 |
| Garvan | 0.69 (95% CI 0.66–0.72) | 0.69 |
| Femoral neck bone mineral density (FNBMD) alone | 0.72 (95% CI 0.69–0.75) | 0.72 |
Value
FRAX0.69 (95% CI 0.67–0.72)
Garvan0.69 (95% CI 0.66–0.72)
Femoral neck bone mineral density (FNBMD) alone0.72 (95% CI 0.69–0.75)
AUC
FRAX0.69
Garvan0.69
Femoral neck bone mineral density (FNBMD) alone0.72
- FNBMD alone vs FRAX: P = 0.01 — FNBMD superior to FRAX
- FNBMD alone vs Garvan: P = 0.01 — FNBMD superior to Garvan
Further findings
| Outcome | FRAX | Garvan | FNBMD alone | P value |
|---|---|---|---|---|
| AUC for 5-year hip fracture, men · 5 yearsGarvan vs FRAX · Garvan and FNBMD alone superior to FRAX | P < 0.001 | |||
| AUC | 0.71 | 0.76 | 0.77 | |
| AUC for 5-year hip fracture, men · 5 yearsFNBMD alone vs FRAX · Garvan and FNBMD alone superior to FRAX | P < 0.001 |
- Incident hip fracture during 5-year follow-up: Women 6.5%
- Incident hip fracture during 5-year follow-up: Men 3.1%
- Death before hip fracture: Women 16.7%
- Death before hip fracture: Men 23.1%
Calibration, both sexes
- Garvan greatly overestimated hip fracture risk in upper quintiles of predicted risk
- FRAX modestly underestimated risk in intermediate quintiles of predicted risk
Original publication
Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older. JAMA Netw Open. Published 3 June 2024. doi:10.
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