Predicting Fracture Risk in Younger Postmenopausal Women: Comparison of the Garvan and FRAX Risk Calculators in the Women's Health Initiative Study
Authors
Crandall, Carolyn J.Larson, Joseph
LaCroix, Andrea
Cauley, Jane A.
LeBoff, Meryl S.
Li, Wenjun
LeBlanc, Erin S.
Edwards, Beatrice J.
Manson, JoAnn E.
Ensrud, Kristine
UMass Chan Affiliations
Prevention Research CenterDivision of Biomedical Data Science, Department of Medicine
Document Type
Journal ArticlePublication Date
2018-10-17Keywords
FRAXGarvan
fracture
fracture risk assessment
osteoporosis
Community Health and Preventive Medicine
Health Services Administration
Health Services Research
Musculoskeletal Diseases
Musculoskeletal System
Preventive Medicine
Women's Health
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Show full item recordAbstract
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.Source
J Gen Intern Med. 2018 Oct 17. doi: 10.1007/s11606-018-4696-z. [Epub ahead of print] Link to article on publisher's site
DOI
10.1007/s11606-018-4696-zPermanent Link to this Item
http://hdl.handle.net/20.500.14038/44526PubMed ID
30334182Related Resources
ae974a485f413a2113503eed53cd6c53
10.1007/s11606-018-4696-z
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