Predictive Performance of the FRAX Tool Calibrated for Spain vs. an Age and Sex Model: Prospective Cohort Study with 9082 Women and Men Followed for up to 8 Years

Abstract

In Spain, the Fracture Risk Assessment Tool (FRAX) was adapted using studies with a small number of patients, and there are only a few external validation studies that present limitations. In this prospective cohort study, we compared the performance of FRAX and a simple age and sex model. We used data from the ESOSVAL cohort, a cohort composed of a Mediterranean population of 11,035 women and men aged 50 years and over, followed for up to 8 years, to compare the discrimination, calibration, and reclassification of FRAX calibrated for Spain and a logistic model including only age and sex as variables. We found virtually identical AUC, 83.55% for FRAX (CI 95%: 80.46, 86.63) and 84.10% for the age and sex model (CI 95%: 80.91, 87.29), and there were similar observed-to-predicted ratios. In the reclassification analyses, patients with a hip fracture that were reclassified correctly as high risk by FRAX, compared to the age and sex model, were −2.86%, using either the 3% threshold or the observed incidence, 1.54% (95%CI: −8.44, 2.72 for the 3% threshold; 95%CI: −7.68, 1.97 for the incidence threshold). Remarkably simple and inexpensive tools that are easily transferable into electronic medical record environments may offer a comparable predictive ability to that of FRAX.

High rates of vitamin D insufficiency among patients presenting for total knee arthroplasty

“…Multiple diagnostic tests can be performed to assess bone health, including laboratory studies, dual X-ray absorptiometry (DXA), and Fracture Risk Assessment Tool (FRAX). [2][3][4] Vitamin D deficiency is only one of many pathologies that contribute to poor bone quality, though treatment of this is simple and cost-effective. 3,[5][6][7][8][9] It is defined as serum 25-hydroxyvitamin-D3 assay levels that are <20 ng/mL in healthy individuals.…”

“…While evaluating bone health is standard of care in patients with fragility fractures, it is not routine in patients presenting for TJA. Multiple diagnostic tests can be performed to assess bone health, including laboratory studies, dual X‐ray absorptiometry (DXA), and Fracture Risk Assessment Tool (FRAX) 2–4 …”