Tineke A C M van Geel1, John A Eisman2, Piet P Geusens3, Joop P W van den Bergh4, Jacqueline R Center5, Geert-Jan Dinant6. 1. Maastricht University/CAPHRI and NUTRIM, Department of Family Medicine, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: tineke.vangeel@maastrichtuniversity.nl. 2. Garvan Institute of Medical Research, Osteoporosis & Bone Biology Program, Sydney, NSW, Australia; St. Vincent's Hospital, University of New South Wales, Sydney, Australia; Sydney School of Medicine, University of Notre Dame, Sydney, Australia. 3. Maastricht University Medical Centre/CAPHRI, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht, The Netherlands; University Hasselt, Biomedical Research Institute, Belgium. 4. University Hasselt, Biomedical Research Institute, Belgium; VieCuri Medical Centre Noord-Limburg, Department of Internal Medicine, Subdivision of Endocrinology, Venlo, The Netherlands; Maastricht University Medical Centre/NUTRIM, Maastricht, The Netherlands. 5. Garvan Institute of Medical Research, Osteoporosis & Bone Biology Program, Sydney, NSW, Australia; St. Vincent's Hospital, University of New South Wales, Sydney, Australia. 6. Maastricht University/CAPHRI, Department of Family Medicine, Maastricht, The Netherlands.
Abstract
OBJECTIVES: There are two commonly used fracture risk prediction tools FRAX(®) and Garvan Fracture Risk Calculator (GARVAN-FRC). The objective of this study was to investigate the utility of these tools in daily practice. STUDY DESIGN: A prospective population-based 5-year follow-up study was conducted in ten general practice centres in the Netherlands. For the analyses, the FRAX(®) and GARVAN-FRC 10-year absolute risks (FRAX(®) does not have 5-year risk prediction) for all fractures were used. RESULTS: Among 506 postmenopausal women aged ≥60 years (mean age: 67.8±5.8 years), 48 (9.5%) sustained a fracture during follow-up. Both tools, using BMD values, distinguish between women who did and did not fracture (10.2% vs. 6.8%, respectively for FRAX(®) and 32.4% vs. 39.1%, respectively for GARVAN-FRC, p<0.0001) at group level. However, only 8.9% of those who sustained a fracture had an estimated fracture risk ≥20% using FRAX(®) compared with 53.3% using GARVAN-FRC. Although both underestimated the observed fracture risk, the GARVAN-FRC performed significantly better for women who sustained a fracture (higher sensitivity) and FRAX(®) for women who did not sustain a fracture (higher specificity). Similar results were obtained using age related cut off points. CONCLUSIONS: The discriminant value of both models is at least as good as models used in other medical conditions; hence they can be used to communicate the fracture risk to patients. However, given differences in the estimated risks between FRAX(®) and GARVAN-FRC, the significance of the absolute risk must be related to country-specific recommended intervention thresholds to inform the patient.
OBJECTIVES: There are two commonly used fracture risk prediction tools FRAX(®) and Garvan Fracture Risk Calculator (GARVAN-FRC). The objective of this study was to investigate the utility of these tools in daily practice. STUDY DESIGN: A prospective population-based 5-year follow-up study was conducted in ten general practice centres in the Netherlands. For the analyses, the FRAX(®) and GARVAN-FRC 10-year absolute risks (FRAX(®) does not have 5-year risk prediction) for all fractures were used. RESULTS: Among 506 postmenopausal women aged ≥60 years (mean age: 67.8±5.8 years), 48 (9.5%) sustained a fracture during follow-up. Both tools, using BMD values, distinguish between women who did and did not fracture (10.2% vs. 6.8%, respectively for FRAX(®) and 32.4% vs. 39.1%, respectively for GARVAN-FRC, p<0.0001) at group level. However, only 8.9% of those who sustained a fracture had an estimated fracture risk ≥20% using FRAX(®) compared with 53.3% using GARVAN-FRC. Although both underestimated the observed fracture risk, the GARVAN-FRC performed significantly better for women who sustained a fracture (higher sensitivity) and FRAX(®) for women who did not sustain a fracture (higher specificity). Similar results were obtained using age related cut off points. CONCLUSIONS: The discriminant value of both models is at least as good as models used in other medical conditions; hence they can be used to communicate the fracture risk to patients. However, given differences in the estimated risks between FRAX(®) and GARVAN-FRC, the significance of the absolute risk must be related to country-specific recommended intervention thresholds to inform the patient.
Authors: Georgi Todorov; Susan Brook; Nicole Quah Qin Xian; Sophia Von Widekind; Bernard Freudenthal; Alexander N Comninos Journal: BMJ Open Date: 2022-07-12 Impact factor: 3.006
Authors: Yasmeen Adar Almog; Angshu Rai; Patrick Zhang; Amanda Moulaison; Ross Powell; Anirban Mishra; Kerry Weinberg; Celeste Hamilton; Mary Oates; Eugene McCloskey; Steven R Cummings Journal: J Med Internet Res Date: 2020-10-16 Impact factor: 5.428