FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort
Background: The WHO has recently published the FRAX (R) tool to determine the absolute risk of osteoporotic fracture at 10 years. This tool has not yet been validated in Spain. Methods/design: A prospective observational study was undertaken in women in the FRIDEX cohort (Barcelona) not receiving bo...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2012 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/126495 |
| Acceso en línea: | https://hdl.handle.net/2445/126495 |
| Access Level: | acceso abierto |
| Palabra clave: | Densitometria òssia Fractures Osteoporosi Bone densitometry Osteoporosis |
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FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohortAzagra Ledesma, RafaelRoca, GenísEncabo, GloriaAguyé, AmadaZwart, MartaGüell, SílviaPuchol, NúriaGene, EmiliCasado, EnriqueSancho, PilarSolà, SilviaTorán, PereIglesias, MilagrosGisbert Revilla, Maria CarmenLópez Expósito, FrancescPujol Salud, JesúsFernandez Hermida, YolandaPuente, AnaRosàs, MireiaBou, VicenteAntón, Juan JoséLansdberg, GustavoMartín Sánchez, Juan CarlosDíez Pérez, AdolfoPrieto Alhambra, DanielDensitometria òssiaFracturesOsteoporosiBone densitometryOsteoporosisBackground: The WHO has recently published the FRAX (R) tool to determine the absolute risk of osteoporotic fracture at 10 years. This tool has not yet been validated in Spain. Methods/design: A prospective observational study was undertaken in women in the FRIDEX cohort (Barcelona) not receiving bone active drugs at baseline. Baseline measurements: known risk factors including those of FRAX (R) and a DXA. Follow up data on self-reported incident major fractures (hip, spine, humerus and wrist) and verified against patient records. The calculation of absolute risk of major fracture and hip fracture was by FRAX (R) website. This work follows the guidelines of the STROBE initiative for cohort studies. The discriminative capacity of FRAX (R) was analyzed by the Area Under Curve (AUC), Receiver Operating Characteristics (ROC) and the Hosmer-Lemeshow goodness-of-fit test. The predictive capacity was determined using the ratio of observed fractures/expected fractures by FRAX (R) (ObsFx/ExpFx). Results: The study subjects were 770 women from 40 to 90 years of age in the FRIDEX cohort. The mean age was 56.8 +/- 8 years. The fractures were determined by structured telephone questionnaire and subsequent testing in medical records at 10 years. Sixty-five (8.4%) women presented major fractures (17 hip fractures). Women with fractures were older, had more previous fractures, more cases of rheumatoid arthritis and also more osteoporosis on the baseline DXA. The AUC ROC of FRAX (R) for major fracture without bone mineral density (BMD) was 0.693 (CI 95%; 0.622-0.763), with T-score of femoral neck (FN) 0.716 (CI 95%; 0.646-0.786), being 0.888 (CI 95%; 0.824-0.952) and 0.849 (CI 95%; 0.737-0.962), respectively for hip fracture. In the model with BMD alone was 0.661 (CI 95%; 0.583-0.739) and 0.779 (CI 95%; 0.631-0.929). In the model with age alone was 0.668 (CI 95%; 0.603-0.733) and 0.882 (CI 95%; 0.832-0.936). In both cases there are not significant differences against FRAX (R) model. The overall predictive value for major fracture by ObsFx/ExpFx ratio was 2.4 and 2.8 for hip fracture without BMD. With BMD was 2.2 and 2.3 respectively. Sensitivity of the four was always less than 50%. The Hosmer-Lemeshow test showed a good correlation only after calibration with ObsFx/ExpFx ratio. Conclusions: The current version of FRAX (R) for Spanish women without BMD analzsed by the AUC ROC demonstrate a poor discriminative capacity to predict major fractures but a good discriminative capacity for hip fractures. Its predictive capacity does not adjust well because leading to underdiagnosis for both predictions major and hip fractures. Simple models based only on age or BMD alone similarly predicted that more complex FRAX (R) models.BioMed Central2012info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/126495Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1186/1471-2474-13-204BMC Musculoskeletal Disorders, 2012, vol. 13, num. 204https://doi.org/10.1186/1471-2474-13-204cc by (c) Azagra et al., 2012http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1264952026-05-27T06:46:51Z |
| dc.title.none.fl_str_mv |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort |
| title |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort |
| spellingShingle |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort Azagra Ledesma, Rafael Densitometria òssia Fractures Osteoporosi Bone densitometry Osteoporosis |
| title_short |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort |
| title_full |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort |
| title_fullStr |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort |
| title_full_unstemmed |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort |
| title_sort |
FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort |
| dc.creator.none.fl_str_mv |
Azagra Ledesma, Rafael Roca, Genís Encabo, Gloria Aguyé, Amada Zwart, Marta Güell, Sílvia Puchol, Núria Gene, Emili Casado, Enrique Sancho, Pilar Solà, Silvia Torán, Pere Iglesias, Milagros Gisbert Revilla, Maria Carmen López Expósito, Francesc Pujol Salud, Jesús Fernandez Hermida, Yolanda Puente, Ana Rosàs, Mireia Bou, Vicente Antón, Juan José Lansdberg, Gustavo Martín Sánchez, Juan Carlos Díez Pérez, Adolfo Prieto Alhambra, Daniel |
| author |
Azagra Ledesma, Rafael |
| author_facet |
Azagra Ledesma, Rafael Roca, Genís Encabo, Gloria Aguyé, Amada Zwart, Marta Güell, Sílvia Puchol, Núria Gene, Emili Casado, Enrique Sancho, Pilar Solà, Silvia Torán, Pere Iglesias, Milagros Gisbert Revilla, Maria Carmen López Expósito, Francesc Pujol Salud, Jesús Fernandez Hermida, Yolanda Puente, Ana Rosàs, Mireia Bou, Vicente Antón, Juan José Lansdberg, Gustavo Martín Sánchez, Juan Carlos Díez Pérez, Adolfo Prieto Alhambra, Daniel |
| author_role |
author |
| author2 |
Roca, Genís Encabo, Gloria Aguyé, Amada Zwart, Marta Güell, Sílvia Puchol, Núria Gene, Emili Casado, Enrique Sancho, Pilar Solà, Silvia Torán, Pere Iglesias, Milagros Gisbert Revilla, Maria Carmen López Expósito, Francesc Pujol Salud, Jesús Fernandez Hermida, Yolanda Puente, Ana Rosàs, Mireia Bou, Vicente Antón, Juan José Lansdberg, Gustavo Martín Sánchez, Juan Carlos Díez Pérez, Adolfo Prieto Alhambra, Daniel |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
Densitometria òssia Fractures Osteoporosi Bone densitometry Osteoporosis |
| topic |
Densitometria òssia Fractures Osteoporosi Bone densitometry Osteoporosis |
| description |
Background: The WHO has recently published the FRAX (R) tool to determine the absolute risk of osteoporotic fracture at 10 years. This tool has not yet been validated in Spain. Methods/design: A prospective observational study was undertaken in women in the FRIDEX cohort (Barcelona) not receiving bone active drugs at baseline. Baseline measurements: known risk factors including those of FRAX (R) and a DXA. Follow up data on self-reported incident major fractures (hip, spine, humerus and wrist) and verified against patient records. The calculation of absolute risk of major fracture and hip fracture was by FRAX (R) website. This work follows the guidelines of the STROBE initiative for cohort studies. The discriminative capacity of FRAX (R) was analyzed by the Area Under Curve (AUC), Receiver Operating Characteristics (ROC) and the Hosmer-Lemeshow goodness-of-fit test. The predictive capacity was determined using the ratio of observed fractures/expected fractures by FRAX (R) (ObsFx/ExpFx). Results: The study subjects were 770 women from 40 to 90 years of age in the FRIDEX cohort. The mean age was 56.8 +/- 8 years. The fractures were determined by structured telephone questionnaire and subsequent testing in medical records at 10 years. Sixty-five (8.4%) women presented major fractures (17 hip fractures). Women with fractures were older, had more previous fractures, more cases of rheumatoid arthritis and also more osteoporosis on the baseline DXA. The AUC ROC of FRAX (R) for major fracture without bone mineral density (BMD) was 0.693 (CI 95%; 0.622-0.763), with T-score of femoral neck (FN) 0.716 (CI 95%; 0.646-0.786), being 0.888 (CI 95%; 0.824-0.952) and 0.849 (CI 95%; 0.737-0.962), respectively for hip fracture. In the model with BMD alone was 0.661 (CI 95%; 0.583-0.739) and 0.779 (CI 95%; 0.631-0.929). In the model with age alone was 0.668 (CI 95%; 0.603-0.733) and 0.882 (CI 95%; 0.832-0.936). In both cases there are not significant differences against FRAX (R) model. The overall predictive value for major fracture by ObsFx/ExpFx ratio was 2.4 and 2.8 for hip fracture without BMD. With BMD was 2.2 and 2.3 respectively. Sensitivity of the four was always less than 50%. The Hosmer-Lemeshow test showed a good correlation only after calibration with ObsFx/ExpFx ratio. Conclusions: The current version of FRAX (R) for Spanish women without BMD analzsed by the AUC ROC demonstrate a poor discriminative capacity to predict major fractures but a good discriminative capacity for hip fractures. Its predictive capacity does not adjust well because leading to underdiagnosis for both predictions major and hip fractures. Simple models based only on age or BMD alone similarly predicted that more complex FRAX (R) models. |
| publishDate |
2012 |
| dc.date.none.fl_str_mv |
2012 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
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article |
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publishedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2445/126495 |
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https://hdl.handle.net/2445/126495 |
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Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Reproducció del document publicat a: https://doi.org/10.1186/1471-2474-13-204 BMC Musculoskeletal Disorders, 2012, vol. 13, num. 204 https://doi.org/10.1186/1471-2474-13-204 |
| dc.rights.none.fl_str_mv |
cc by (c) Azagra et al., 2012 http://creativecommons.org/licenses/by/3.0/es/ info:eu-repo/semantics/openAccess |
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cc by (c) Azagra et al., 2012 http://creativecommons.org/licenses/by/3.0/es/ |
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openAccess |
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application/pdf |
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BioMed Central |
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BioMed Central |
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Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) reponame:Dipòsit Digital de la UB instname:Universidad de Barcelona |
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Universidad de Barcelona |
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Dipòsit Digital de la UB |
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Dipòsit Digital de la UB |
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