Deakin University
Browse

File(s) under permanent embargo

How well do the FRAX (Australia) and Garvan calculators predict incident fractures? Data from the Geelong Osteoporosis Study

Version 2 2024-06-06, 00:18
Version 1 2019-07-25, 08:35
journal contribution
posted on 2024-06-06, 00:18 authored by KL Holloway-Kew, Y Zhang, Amelia BetsonAmelia Betson, KB Anderson, D Hans, Natalie HydeNatalie Hyde, GC Nicholson, NA Pocock, MA Kotowicz, Julie PascoJulie Pasco
Summary: This study reports that both FRAX and Garvan calculators underestimated fractures in Australian men and women, particularly in those with osteopenia or osteoporosis. Major osteoporotic fractures were poorly predicted, while both calculators performed acceptably well for hip fractures. Introduction: This study assessed the ability of the FRAX (Australia) and Garvan calculators to predict fractures in Australian women and men. Methods: Women (n = 809) and men (n = 821) aged 50–90 years, enrolled in the Geelong Osteoporosis Study, were included. Fracture risk was estimated using FRAX and Garvan calculators with and without femoral neck bone mineral density (BMD) (FRAXBMD, FRAXnoBMD, GarvanBMD, GarvannoBMD). Incident major osteoporotic (MOF), fragility, and hip fractures over the following 10 years were verified radiologically. Differences between observed and predicted numbers of fractures were assessed using a chi-squared test. Diagnostics indexes were calculated. Results: In women, 115 MOF, 184 fragility, and 42 hip fractures occurred. For men, there were 73, 109, and 17 fractures, respectively. FRAX underestimated MOFs, regardless of sex or inclusion of BMD. FRAX accurately predicted hip fractures, except in women with BMD (20 predicted, p = 0.004). Garvan underestimated fragility fractures except in men using BMD (88 predicted, p = 0.109). Garvan accurately predicted hip fractures except for women without BMD (12 predicted, p < 0.001). Fractures were underestimated primarily in the osteopenia and osteoporosis groups; MOFs in the normal BMD group were only underestimated by FRAXBMD and fragility fractures by GarvannoBMD, both in men. AUROCs were not different between scores with and without BMD, except for fragility fractures predicted by Garvan in women (0.696, 95% CI 0.652–0.739 and 0.668, 0.623–0.712, respectively, p = 0.008) and men, which almost reached significance (0.683, 0.631–0.734, and 0.667, 0.615–0.719, respectively, p = 0.051). Analyses of sensitivity and specificity showed overall that MOFs and fragility fractures were poorly predicted by both FRAX and Garvan, while hip fractures were acceptably predicted. Conclusions: Overall, the FRAX and Garvan calculators underestimated MOF and fragility fractures, particularly in individuals with osteopenia or osteoporosis. Hip fractures were predicted better by both calculators. AUROC analyses suggest that GarvanBMD performed better than GarvannoBMD for prediction of fragility fractures.

History

Journal

Osteoporosis International

Volume

30

Pagination

2129-2139

Location

England

ISSN

0937-941X

eISSN

1433-2965

Language

English

Notes

In press

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2019, International Osteoporosis Foundation and National Osteoporosis Foundation

Issue

10

Publisher

SPRINGER LONDON LTD