Does the Prediction Accuracy of Osteoporotic Fractures by BMD and Clinical Risk Factors Vary With Fracture Site?

Abstract

Several clinical risk factors (CRFs) have been shown to predict the risk of fragility fractures independently of BMD, but their accuracy in the prediction of a particular fracture site has not been extensively studied. In this study based on longitudinal data from the FRISBEE cohort (Fracture Risk Brussels Epidemiological Enquiry), we evaluated if CRFs are specific for sites of incident osteoporotic fractures during follow‐up. We recruited 3560 postmenopausal women, aged 60 to 85 years, from 2007 to 2013, and surveyed yearly for the occurrence of fragility fractures during 6.2 years (median). We analyzed the association between CRFs included in the FRAX (fracture risk assessment tool) model or additional CRFs (falls, sedentary lifestyle, early untreated menopause, diabetes, use of selective serotonin reuptake inhibitors or proton pump inhibitors) and the first incident validated major osteoporotic fracture (MOF; n = 362; vertebra, hip, shoulder, and wrist) or other major fractures (n = 74; ankle, pelvis/sacrum, elbow, knee, long bones). Uni‐ and multivariate analyses using the Cox proportional hazards model were used. For MOFs considered together, the risk of fracture was highly associated in uni‐ and multivariate analyses (p<0.01) with osteoporosis (T‐score < −2.5), prior fracture, age, BMD (assessed by DXA), and fall history (HR 2.34, 1.82,1.71, 1.38, and 1.32, respectively). For each site analyzed separately, prior OF, age, smoking, and total hip BMD remained independent predictors for hip fractures (HR 5.72, 3.98, 3.10, 2.32, and 1.92, respectively); osteoporosis, age, prior OF, glucocorticoids, and spine BMD for vertebral fracture (HR 2.08, 1.87, 1.78, 1.76, and 1.45, respectively); osteoporosis, prior OF, and femoral neck BMD (HR 1.83, 1.60, and 1.56, respectively) for wrist fracture; osteoporosis, prior OF, and spine BMD (HR 2.48, 1.78, and 1.31, respectively) for shoulder fracture; prior OF and diabetes (HR 2.62 and 2.03) for other major fractures. Thus, a prior fracture and BMD were the best predictors of fracture risk at any site. Other CRFs have a weaker predictive value, which is a function of the site of a future fracture. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Development of prediction model for osteoporotic vertebral compression fracture screening without using clinical risk factors, compared with FRAX and other previous models

“…Kanis et al studied the gradient of risk among age between hip fracture and major osteoporotic fracture in the FRAX model. The study revealed that including the clinical risks to BMD, compared to BMD alone, barely increases the risk of other osteoporotic fracture, in contrast to hip fracture, for which an increased [22]. The results from two such studies could imply that the clinical risk factors provided in the FRAX model have little influence on OVCF prediction, except glucocorticoid use being an independent risk factor for spine fractures only [22,23].…”

“…Lconaru revealed that, in the FRAX model, the clinical risk factors described in FRAX are not consistent risks in each fracture site. The study shows that prior osteoporotic fracture, age, smoking, and TH BMD remain independent predictors for hip fractures, whereas osteoporosis, age, prior osteoporotic fracture, glucocorticoids used, and spine BMD are independent predictors for OVCF [ 22 ]. The results from two such studies could imply that the clinical risk factors provided in the FRAX model have little influence on OVCF prediction, except glucocorticoid use being an independent risk factor for spine fractures only [ 22 , 23 ].…”

Independent External Validation of FRAX and Garvan Fracture Risk Calculators: A Sub‐Study of the FRISBEE Cohort

“…develop a fracture risk model in a well-characterized patient population (13,14). Briefly, 3560 postmenopausal, volunteer women, aged 60 to 85 years at baseline, were enrolled between July 2007 and June 2013.…”

Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

“…(5,6) In order to examine how the classification proposed by Borgen and colleagues (1) would change the prediction power of a prevalent fracture for an incident fracture, we analyzed data of our ongoing Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) cohort and compared the hazard ratio (HR) for a MOF or a new central fracture after a first incident fracture.The FRISBEE study is an ongoing prospective epidemiological study in a population-based cohort (Brussels, Belgium) of 3560 postmenopausal women aged 60 to 85 years at baseline. (7,8) Patients were included between July 2007 and June 2013 and are followed annually by phone call interviews. Risk factors and fracture incidence are then collected.All fractures were validated by radiological report.…”

“…The FRISBEE study is an ongoing prospective epidemiological study in a population-based cohort (Brussels, Belgium) of 3560 postmenopausal women aged 60 to 85 years at baseline. (7,8) Patients were included between July 2007 and June 2013 and are followed annually by phone call interviews. Risk factors and fracture incidence are then collected.…”