Development of a nomogram for individualizing hip fracture risk in men and women

Nguyen, Nguyen D.; Frost, Steven A.; Eisman, John A.; Nguyen, Tuan V.

doi:10.1007/s00198-007-0362-8

Cited by 250 publications

(196 citation statements)

References 32 publications

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“…An Australian study found that frailty-related risk factors such as advanced age, reduced weight, quadriceps weakness, and postural instability were each associated with increased risk of hip fracture. 10 Similarly, our findings have shown that frailty and frailty risk factors are associated with hip fracture risk. The same Australian study reported that combining FNBMD with clinical risk factors, which include age, prior fracture, and falls, provided a nomogram that predicted the risk of sustaining hip fracture over a median follow-up period of 13 years with an area under the ROC curve of 85%.…”

Section: Discussionsupporting

confidence: 74%

“…Other methods for predicting hip fractures, such as the Fracture Risk Assessment (FRAX), have used bone mineral density scores in combination with other selected risk factors, including several demographic characteristics and illnesses. 9,10 Although these methods are more inclusive than FNBMD alone, they still require bone mineral density testing and may require time for the physician to interview the patient and apply the tool. 10,11 There are inherent challenges with implementing ongoing screening programs designed to identify elderly patients with a high risk of hip fracture in the community.…”

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confidence: 99%

“…9,10 Although these methods are more inclusive than FNBMD alone, they still require bone mineral density testing and may require time for the physician to interview the patient and apply the tool. 10,11 There are inherent challenges with implementing ongoing screening programs designed to identify elderly patients with a high risk of hip fracture in the community. The health care system already faces considerable challenges with resource shortages and extreme care demands.…”

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confidence: 99%

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The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

Albaba

Stephen

Takahashi

2012

Mayo Clinic Proceedings

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Objective: To determine whether an Elders Risk Assessment (ERA) index can predict incident hip fractures without the need for physician-patient encounter or bone mineral density testing. Patients and Methods: A retrospective cohort study was conducted in a community-based cohort of 12,650 patients aged 60 years and older. An ERA score was computed for each subject at index time (January 1, 2005). Incidents of hip fracture from January 1, 2005, through December 31, 2006, were obtained from electronic medical records. We divided the cohort into 5 groups, with the lowest ERA scores forming group A (Ͻ15%); 15% to 49%, group B; 50% to 74%, group C; 75% to 89%, group D; and the top 11%, group E. With group A as a reference group, we used logistic regression to compute odds ratios of sustaining hip fracture during a 2-year period (January 1, 2005, through December 31, 2006) for groups B, C, D, and E. Sensitivity and specificity of each possible ERA score were calculated, and a receiver operating characteristic curve was created. Results: Two hundred sixty-five patients (2.1%) sustained at least 1 hip fracture from January 1, 2005, through December 31, 2006. Odds ratios (95% confidence intervals) for groups B, C, D, and E were 1.6 (0.7-3.4), 4.5 (2.2-9.4), 6.9 (3.3-14.3), and 18.4 (8.9-37.9), respectively. The area under the receiver operating characteristic curve was 74.5%. Conclusion: An electronic medical record-based, easily derived ERA index might be useful in hip fracture risk stratification.

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Section: Discussionsupporting

confidence: 74%

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confidence: 99%

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confidence: 99%

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The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

Albaba

Stephen

Takahashi

2012

Mayo Clinic Proceedings

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“…At present, the risk profile is largely based on clinical risk factors such as history of prior fracture, history of a fall, bone mineral density, body weight, and concomitant diseases. (6)(7)(8) Although these clinical risk factors are known to be associated with fracture risk, their ability to discriminate fracture from nonfracture cases is modest, with the AUC value ranging from 0.70 to 0.80. (7,8) Therefore, there is room for further improvement of fracture prognosis, and genetic profiling is potentially an important contributor to the enhancement of fracture risk assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Using established clinical risk factors, a number of prognostic models have been developed and implemented recently. (6)(7)(8) The predictive accuracy of these models has been less than perfect, with the area under the receiver operating characteristic curve (AUC) ranging between 0.70 and 0.80. (7,8) Most prognostic models have low sensitivity and high specificity.…”

Section: Introductionmentioning

confidence: 99%

Genetic profiling and individualized prognosis of fracture

Tran

Nguyen

et al. 2010

Journal of Bone and Mineral Research

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Fragility fracture is a serious public health problem in the world. The risk of fracture is determined by genetic and nongenetic clinical risk factors. This study sought to quantify the contribution of genetic profiling to fracture prognosis. The study was built on the ongoing Dubbo Osteoporosis Epidemiology Study, in which fracture and risk factors of 858 men and 1358 women had been monitored continuously from 1989 and 2008. Fragility fracture was ascertained by radiologic reports. Bone mineral density at the femoral neck was measured by dual-energy X-ray absorptiometry (DXA). Fifty independent genes with allele frequencies ranging from 0.01 to 0.60 and relative risks (RRs) ranging from 1.01 to 3.0 were simulated. Three predictive models were fitted to the data in which fracture was a function of (1) clinical risk factors only, (2) genes only, and (3) clinical risk factors and 50 genes. The area under the curve (AUC) for model 1 was 0.77, which was lower than that of model II (AUC ¼ 0.82). Adding genes into the clinical risk factors model (model 3) increased the AUC to 0.88 and improved the accuracy of fracture classification by 45%, with most (41%) improvement in specificity. In the presence of clinical risk factors, the number of genes required to achieve an AUC of 0.85 was around 25. These results suggest that genetic profiling could enhance the predictive accuracy of fracture prognosis and help to identify high-risk individuals for appropriate management of osteoporosis or intervention. ß

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Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older

Ensrud,

Schousboe,

Crandall

et al. 2024

JAMA Netw Open

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ImportanceWhile adults aged 80 years and older account for 70% of hip fractures in the US, performance of fracture risk assessment tools in this population is uncertain.ObjectiveTo compare performance of the Fracture Risk Assessment Tool (FRAX), Garvan Fracture Risk Calculator, and femoral neck bone mineral density (FNBMD) alone in 5-year hip fracture prediction.Design, Setting and ParticipantsPrognostic analysis of 3 prospective cohort studies including participants attending an index examination (1997 to 2016) at age 80 years or older. Data were analyzed from March 2023 to April 2024.Main Outcomes and MeasuresParticipants contacted every 4 or 6 months after index examination to ascertain incident hip fractures and vital status. Predicted 5-year hip fracture probabilities calculated using FRAX and Garvan models incorporating FNBMD and FNBMD alone. Model discrimination assessed by area under receiver operating characteristic curve (AUC). Model calibration assessed by comparing observed vs predicted hip fracture probabilities within predicted risk quintiles.ResultsA total of 8890 participants were included, with a mean (SD) age at index examination of 82.6 (2.7) years; 4906 participants (55.2%) were women, 866 (9.7%) were Black, 7836 (88.1%) were White, and 188 (2.1%) were other races and ethnicities. During 5-year follow-up, 321 women (6.5%) and 123 men (3.1%) experienced a hip fracture; 818 women (16.7%) and 921 men (23.1%) died before hip fracture. Among women, AUC was 0.69 (95% CI, 0.67-0.72) for FRAX, 0.69 (95% CI, 0.66-0.72) for Garvan, and 0.72 (95% CI, 0.69-0.75) for FNBMD alone (FNBMD superior to FRAX, P = .01; and Garvan, P = .01). Among men, AUC was 0.71 (95% CI, 0.66-0.75) for FRAX, 0.76 (95% CI, 0.72-0.81) for Garvan, and 0.77 (95% CI, 0.72-0.81) for FNBMD alone (P &lt; .001 Garvan and FNBMD alone superior to FRAX). Among both sexes, Garvan greatly overestimated hip fracture risk among individuals in upper quintiles of predicted risk, while FRAX modestly underestimated risk among those in intermediate quintiles of predicted risk.Conclusions and RelevanceIn this prognostic study of adults aged 80 years and older, FRAX and Garvan tools incorporating FNBMD compared with FNBMD alone did not improve 5-year hip fracture discrimination. FRAX modestly underpredicted observed hip fracture probability in intermediate-risk individuals. Garvan markedly overpredicted observed hip fracture probability in high-risk individuals. Until better prediction tools are available, clinicians should prioritize consideration of hip BMD, life expectancy, and patient preferences in decision-making regarding drug treatment initiation for hip fracture prevention in late-life adults.

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Development of a nomogram for individualizing hip fracture risk in men and women

Abstract: The combination of BMD and non-invasive clinical risk factors in a nomogram could be useful for identifying high-risk individuals for intervention to reduce the risk of hip fracture.

Cited by 250 publications

References 32 publications

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

Genetic profiling and individualized prognosis of fracture

Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older

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