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WHO absolute fracture risk models (FRAX): Do clinical risk factors improve fracture prediction in older women without osteoporosis?

Hillier, TA and Cauley, JA and Rizzo, JH and Pedula, KL and Ensrud, KE and Bauer, DC and Lui, LY and Vesco, KK and Black, DM and Donaldson, MG and Leblanc, ES and Cummings, SR (2011) WHO absolute fracture risk models (FRAX): Do clinical risk factors improve fracture prediction in older women without osteoporosis? Journal of Bone and Mineral Research, 26 (8). 1774 - 1782. ISSN 0884-0431

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Bone mineral density (BMD) is a strong predictor of fracture, yet most fractures occur in women without osteoporosis by BMD criteria. To improve fracture risk prediction, the World Health Organization recently developed a country-specific fracture risk index of clinical risk factors (FRAX) that estimates 10-year probabilities of hip and major osteoporotic fracture. Within differing baseline BMD categories, we evaluated 6252 women aged 65 or older in the Study of Osteoporotic Fractures using FRAX 10-year probabilities of hip and major osteoporotic fracture (ie, hip, clinical spine, wrist, and humerus) compared with incidence of fractures over 10 years of follow-up. Overall ability of FRAX to predict fracture risk based on initial BMD T-score categories (normal, low bone mass, and osteoporosis) was evaluated with receiver-operating-characteristic (ROC) analyses using area under the curve (AUC). Over 10 years of follow-up, 368 women incurred a hip fracture, and 1011 a major osteoporotic fracture. Women with low bone mass represented the majority (n=3791, 61%); they developed many hip (n=176, 48%) and major osteoporotic fractures (n=569, 56%). Among women with normal and low bone mass, FRAX (including BMD) was an overall better predictor of hip fracture risk (AUC=0.78 and 0.70, respectively) than major osteoporotic fractures (AUC=0.64 and 0.62). Simpler models (eg, age+prior fracture) had similar AUCs to FRAX, including among women for whom primary prevention is sought (no prior fracture or osteoporosis by BMD). The FRAX and simpler models predict 10-year risk of incident hip and major osteoporotic fractures in older US women with normal or low bone mass. Copyright © 2011 American Society for Bone and Mineral Research.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Hillier, TA
Cauley, JAJCauley@edc.pitt.eduJCAULEY
Rizzo, JH
Pedula, KL
Ensrud, KE
Bauer, DC
Lui, LY
Vesco, KK
Black, DM
Donaldson, MG
Leblanc, ES
Cummings, SR
Date: 1 August 2011
Date Type: Publication
Journal or Publication Title: Journal of Bone and Mineral Research
Volume: 26
Number: 8
Page Range: 1774 - 1782
DOI or Unique Handle: 10.1002/jbmr.372
Schools and Programs: Graduate School of Public Health > Epidemiology
Refereed: Yes
ISSN: 0884-0431
Date Deposited: 03 Apr 2015 16:36
Last Modified: 04 Feb 2019 20:55


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