Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures

Abstract

A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19-1.58) and 1.26 (95% CI: 1.12-1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that measures of frailty status may aid in fracture risk assessment and fracture prevention in the elderly. Further evidence from randomized controlled trials of osteoporosis medication interventions is needed to support the FI and FRAX as validated measures of fracture risk.

Frailty Change and Major Osteoporotic Fracture in the Elderly: Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton Cohort

“…Nevertheless, the absolute FI measures from the previous year were significantly related with increased risk of MOF, falls, and death in the following year (Tables and 4). Compared with the significant associations between the baseline FI and risk of adverse health outcomes during the 3‐year follow‐up, which had been published elsewhere, this study also found that the FI in the previous year was positively related with risk of fractures, falls, and death in the following 12 months. These findings reinforced the concept of the FI that compared with her peers, an elderly individual with more deficits was always more likely to experience adverse health outcomes independently of age, even though the outcomes were evaluated using annual short‐term intervals.…”

“…All the models were adjusted for age. Results were reported using the per‐0.10 increment of the FI change and the FI absolute measures …”

Frailty as a predictor of fractures among community-dwelling older people: A systematic review and meta-analysis

“…Some studies described frailty using the Frailty Index, an accumulated health deficit model, and examined fracture risk according to graded frailty status [20,21]. These studies could not be incorporated in the meta-analysis only because they did not dichotomize (frailty and nonfrailty) or trichotomize (frailty, prefrailty, and non-frailty) frailty status.…”

“…Fried et al defined frailty as having three or more of the five criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity in the Cardiovascular Health Study (CHS) [13]. Whereas fracture was not examined in this study, several studies have later investigated associations between frailty and fractures and inconsistently shown significant and non-significant results [14][15][16][17][18][19][20][21]. These studies used various frailty criteria and different types of fractures, which makes it difficult to reach the conclusions on frailty as a predictor of fractures.…”

Independent factors associated with serum levels of 25- Hydroxyvitamin D in very elderly Chinese males

“…This questionnaire was designed on the basis of the characteristics of very elderly males, risk factors for osteoporosis [22], and referring to the WHO Fracture Risk Assessment Tool (FRAX ® ) [23]. The detailed questionnaire is as follows ( Table 1).…”