Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts

Leslie, William D.; Berger, Claudie; Langsetmo, Lisa; Lix, Lisa M.; Adachi, Jonathan D.; Hanley, David A.; Ioannidis, George; Josse, Robert G.; Kovacs, Christopher S.; Towheed, Tanveer; Kaiser, Stéphanie; Olszynski, Wojciech P.; Prior, Jerilynn C.; Jamal, Sophie A.; Kreiger, Nancy; Goltzman, David

doi:10.1007/s00198-010-1445-5

Cited by 105 publications

(107 citation statements)

References 37 publications

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“…The FRAX tool itself, has certain limitations,such as being un-able to discriminate between heavy and moderate smokers or between high and low glucocorticoid dosage and that only the femoral neck T-score can be applied. In this study the sensitivity analysis against model risk stratification FRIDEX of FRAX Spain shows no significant -(**): Following other international considerations 10 .…”

Section: Discussionmentioning

confidence: 62%

“…Despite the significant influence of BMD on the overall risk of fracture, several studies have shown that taken in isolation, it fails to deliver a cost-effective population screening test [7][8][9] . The current practice in most developed countries is to identify patients at high risk of fragility fractures taking into account the presence of other risk factors besides densitometric osteoporosis [9][10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?

Azagra¹,

Zwart

Aguyé

et al. 2016

Maturitas

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?

Azagra¹,

Zwart

Aguyé

et al. 2016

Maturitas

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“…Fracture ascertainment from administrative data sources may be incomplete, particularly for vertebral fractures, although similar algorithms have proven useful for both vertebral and nonvertebral fracture identification. (37,38) We used a FRAX tool that has been directly validated in the Canadian population, (26,27) but there was incomplete information on some of the baseline clinical risk factors (eg, parental hip fracture), and for others proxies were used (eg, smoking, alcohol intake) as previously described. (25) Despite these limitations, predicted 10-year fracture probability agreed very closely with the observed fracture incidence estimated to 10 years among untreated women, suggesting reasonably complete ascertainment of fractures and risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…The Canadian FRAX tool has been previously shown to accurately predict fracture risk in the Canadian population in two large independent cohort studies. (26,27) In sensitivity analyses we also assessed fracture probability generated with the U.S. White FRAX tool (version 3.1). (28,29) Ascertainment of incident fractures was performed using previously reported methods.…”

Section: Bone Density Measurementsmentioning

confidence: 99%

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Leslie

Lix

Johansson

et al. 2012

Journal of Bone and Mineral Research

115

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Ten-year fracture risk assessment with the fracture risk assessment system (FRAX) is increasingly used to guide treatment decisions. Osteoporosis pharmacotherapy reduces fracture risk, but the effect is greater than can be explained from the increase in bone mineral density (BMD). Whether this invalidates fracture predictions with FRAX is uncertain. A total of 35,764 women (age !50 years) and baseline BMD testing (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) had FRAX probabilities retroactively calculated. A provincial pharmacy database was used to identify osteoporosis medication use. Women were categorized as untreated, current high adherence users [medication possession ratio (MPR) !0.80 in the year after BMD testing], current low adherence users (MPR <0.80), and past users. Fractures outcomes to 10 years were established form a population-based health data repository. FRAX and femoral neck BMD alone stratified major osteoporotic and hip fracture risk within untreated and each treated subgroup (all p-values <0.001) with similar area under the receiver operating characteristic curve. In untreated and each treated subgroup, a stepwise gradient in observed 10-year major osteoporotic and hip fracture incidence was found as a function of the predicted probability tertile (all p-values <0.001 for linear trend). Concordance (calibration) plots for major osteoporotic fractures and hip fractures showed good agreement between the predicted and observed 10-year fracture incidence in untreated women and each treated subgroup. Only in the highest risk tertile of women highly adherent to at least 5 years of bisphosphonate use was observed hip fracture risk significantly less than predicted, though major osteoporotic fracture risk was similar to predicted. In summary, this work suggests that the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis. Although FRAX should not be used to assess the reduction in fracture risk in individuals on treatment, it may still have value for guiding the need for continued treatment or treatment withdrawal. ß

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“…GC use is also utilized in fracture risk assessment tools in determining 10-year absolute fracture risk [9][10][11][12]. The fracture risk assessment tool (FRAX) developed by the World Health Organization, considers ever use (current or past) of GC as a part of the algorithm to calculate the 10-year fracture risk [9,10].…”

Section: Introductionmentioning

confidence: 99%

Glucocorticoids predict 10-year fragility fracture risk in a population-based ambulatory cohort of men and women: Canadian Multicentre Osteoporosis Study (CaMos)

et al. 2014

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Summary-We determined the prospective 10-year association among incident fragility fractures and four glucocorticoid (GC) treatment groups (Never GC, Prior GC, Baseline GC, and Ever GC). Results showed that GC treatment is associated with increased 10-year incident fracture risk in ambulatory men and women across Canada.Purpose-Using the Canadian Multicentre Osteoporosis Study dataset, we determined the prospective 10-year association between incident fragility fractures and GC treatment.Methods-We conducted a 10-year prospective observational cohort study at nine sites across Canada. A total of 9,263 ambulatory men and women 25 years of age and older were included in the analysis. Multivariable Cox proportional hazards analyses were conducted to determine the relationship among GC treatment groups in four levels that included Never GC, Prior GC, Baseline GC, and Ever GC (combined baseline and prior groups) and time to fracture.Results-In each of the Never GC, Prior GC, Baseline GC, and Ever GC treatment groups, the number of participants were 8,832 (95.4 %), 303 (3.3 %), 128 (1.4 %), and 431 (4.7 %), respectively. Of the 9,263 individuals enrolled, incident fragility non-spine, hip, spine, and any fractures were experienced by a total of 896 (9.67 %), 157 (1.69 %), 130 (1.40 %), and 1,102 (11.90 %) over 10-years, respectively. For men and women combined, prior GC treatment was associated with a higher hazard ratio (HR) for time to incident non-vertebral (HR=1.5, 95 % confidence interval [CI]=1.1, 2.0), hip (HR=2.1, 95 % CI=1.1, 4.0), and any fracture (HR=1.4, 95 % CI=1.0, 1.8) compared with never GC treatment.Conclusions-GC treatment is associated with increased 10-year incident fracture risk; this highlights the importance of considering therapy to prevent GC-induced fractures for patients who are using GC for various medical conditions.

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Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts

Abstract: Summary-A procedure for creating a simplified version of fracture risk assessment tool (FRAX®) is described. Calibration, fracture prediction, and concordance were compared with the full FRAX tool using two large, complementary Canadian datasets.

Cited by 105 publications

References 37 publications

Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?

Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Glucocorticoids predict 10-year fragility fracture risk in a population-based ambulatory cohort of men and women: Canadian Multicentre Osteoporosis Study (CaMos)

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