T Cervinka1, C L Lynch2,3, L Giangregorio2,3, J D Adachi4, A Papaioannou4,5, L Thabane5, B C Craven1,2,3,6. 1. Department of Research, Neural Engineering and Therapeutics Team, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada. 2. Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada. 3. Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada. 4. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 5. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. 6. Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
STUDY DESIGN: Cross-sectional. OBJECTIVES: The objective of the study was to determine and report agreement in fracture risk stratification of adults with spinal cord injury (SCI) using (1) Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX) tools with and without areal bone mineral density (aBMD) and (2) SCI-specific fracture thresholds. SETTING: Tertiary rehabilitation center, Ontario, Canada. METHODS: Community-dwelling adults with chronic SCI (n=90, C2-T12, AIS A-D) consented to participation. Femoral neck aBMD values determined 10-year fracture risk (CAROC and FRAX). Knee-region aBMD and distal tibia volumetric BMD values were compared to SCI-specific fracture thresholds. Agreements between CAROC and FRAX risk stratifications, and between fracture threshold risk stratification, were assessed using prevalence- and bias-adjusted Kappa statistics (PABAK). RESULTS: CAROC and FRAX assessment tools showed moderate agreement for post-menopausal women (PABAK=0.56, 95% confidence interval (CI): 0.27, 0.84) and men aged ⩾50 years (PABAK=0.51, 95% CI: 0.34, 0.67), with poor agreement for young men and pre-menopausal women (PABAK⩽0). Excellent agreement was evident between FRAX with and without aBMD in young adults and in those with motor incomplete injury (PABAK=0.86-0.92). In other subgroups, agreement ranged from moderate to substantial (PABAK=0.41-0.73). SCI-specific fracture thresholds (Eser versus Garland) showed poor agreement (PABAK⩽0). CONCLUSION: Fracture risk estimates among individuals with SCI vary substantially with the risk assessment tool. Use of SCI-specific risk factors to identify patients with high fracture risk is recommended until a validated SCI-specific tool for predicting fracture risk is developed.
STUDY DESIGN: Cross-sectional. OBJECTIVES: The objective of the study was to determine and report agreement in fracture risk stratification of adults with spinal cord injury (SCI) using (1) Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX) tools with and without areal bone mineral density (aBMD) and (2) SCI-specific fracture thresholds. SETTING: Tertiary rehabilitation center, Ontario, Canada. METHODS: Community-dwelling adults with chronic SCI (n=90, C2-T12, AIS A-D) consented to participation. Femoral neck aBMD values determined 10-year fracture risk (CAROC and FRAX). Knee-region aBMD and distal tibia volumetric BMD values were compared to SCI-specific fracture thresholds. Agreements between CAROC and FRAX risk stratifications, and between fracture threshold risk stratification, were assessed using prevalence- and bias-adjusted Kappa statistics (PABAK). RESULTS: CAROC and FRAX assessment tools showed moderate agreement for post-menopausal women (PABAK=0.56, 95% confidence interval (CI): 0.27, 0.84) and men aged ⩾50 years (PABAK=0.51, 95% CI: 0.34, 0.67), with poor agreement for young men and pre-menopausal women (PABAK⩽0). Excellent agreement was evident between FRAX with and without aBMD in young adults and in those with motor incomplete injury (PABAK=0.86-0.92). In other subgroups, agreement ranged from moderate to substantial (PABAK=0.41-0.73). SCI-specific fracture thresholds (Eser versus Garland) showed poor agreement (PABAK⩽0). CONCLUSION:Fracture risk estimates among individuals with SCI vary substantially with the risk assessment tool. Use of SCI-specific risk factors to identify patients with high fracture risk is recommended until a validated SCI-specific tool for predicting fracture risk is developed.
Authors: Alexandra Papaioannou; Suzanne Morin; Angela M Cheung; Stephanie Atkinson; Jacques P Brown; Sidney Feldman; David A Hanley; Anthony Hodsman; Sophie A Jamal; Stephanie M Kaiser; Brent Kvern; Kerry Siminoski; William D Leslie Journal: CMAJ Date: 2010-10-12 Impact factor: 8.262
Authors: Laura Carbone; Amy S Chin; Todd A Lee; Stephen P Burns; Jelena N Svircev; Helen Hoenig; Titilola Akhigbe; Fridtjof Thomas; Lauren Bailey; Frances Weaver Journal: Am J Phys Med Rehabil Date: 2013-12 Impact factor: 2.159
Authors: Brian Lentle; Angela M Cheung; David A Hanley; William D Leslie; David Lyons; Alexandra Papaioannou; Stephanie Atkinson; Jacques P Brown; Sidney Feldman; Anthony B Hodsman; Abida Sophina Jamal; Robert G Josse; Stephanie M Kaiser; Brent Kvern; Suzanne Morin; Kerry Siminoski Journal: Can Assoc Radiol J Date: 2011-11 Impact factor: 2.248
Authors: W D Leslie; C Berger; L Langsetmo; L M Lix; J D Adachi; D A Hanley; G Ioannidis; R G Josse; C S Kovacs; T Towheed; S Kaiser; W P Olszynski; J C Prior; S Jamal; N Kreiger; D Goltzman Journal: Osteoporos Int Date: 2010-10-22 Impact factor: 4.507
Authors: Jill M Slade; C Scott Bickel; Christopher M Modlesky; Sharmila Majumdar; Gary A Dudley Journal: Osteoporos Int Date: 2004-08-28 Impact factor: 4.507
Authors: L R Morse; R A Battaglino; K L Stolzmann; L D Hallett; A Waddimba; D Gagnon; A A Lazzari; E Garshick Journal: Osteoporos Int Date: 2008-06-26 Impact factor: 4.507
Authors: Lisa Langsetmo; David Goltzman; Christopher S Kovacs; Jonathan D Adachi; David A Hanley; Nancy Kreiger; Robert Josse; Alexandra Papaioannou; Wojciech P Olszynski; Sophie A Jamal Journal: J Bone Miner Res Date: 2009-09 Impact factor: 6.741
Authors: Lars Ung; Malte Ohlmeier; Birger Jettkant; Dennis Grasmücke; Mirko Aach; Renate Meindl; Volkmar Nicolas; Thomas A Schildhauer; Mustafa Citak Journal: Global Spine J Date: 2019-08-19
Authors: Matthias Walle; Francisco C Marques; Nicholas Ohs; Michael Blauth; Ralph Müller; Caitlyn J Collins Journal: Front Bioeng Biotechnol Date: 2021-06-25
Authors: Prince Thakkar; Naveen B Prakash; George Tharion; Sahana Shetty; Thomas V Paul; Joseph Bondu; Bijesh Yadav Journal: Asian Spine J Date: 2019-11-05