Do we need bone densitometry to estimate osteoporotic fracture risk: A 10-year prospective multicentre validation study

Andréa Marques, Raquel Lucas, Eugénia Simões, Suzanne Verstappen, Johannes W G Jacobs, José António Pereira da Silva

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Evaluate the performance of FRAX®, with and without bone densitometry (BMD), in predicting the occurrence of fragility fractures over 10 years.

Methods: Participants aged ≥40 years at baseline, with a complete set of data and a minimum of 8.5 years of follow-up were identified from 3 cohorts (n =2626). Ten-year fracture risk at baseline were estimated with FRAX® and assessed by comparison with observed fractures and receiver operating caharacteristic analysis.

Results: During a mean (SD) follow up of 9.12 (1.5) years, 178 participants suffered a major osteoporotic (MOP) fracture and 28 sustained a hip fracture. The predictive performance of FRAX® was superior to that of BMD alone for both MOP and hip fractures. The area under the curve (AUC) of FRAX® without BMD was 0.76 (95%CI 0.72–0.79) for MOP fractures and 0.78 (95%CI 0.69–0.86) for hip fractures. No significant improvements were found when BMD was added to clinical variables to predict either MOP (0.78, 95%CI 0.74–0.82, p=0.25) or hip fractures (0.79, 95%CI 0.69–0.89, p=0.72). AUC’s for FRAX® (with and without BMD) were greater for men than for women. FRAX®, with and without BMD tended to underestimate the number of MOP fractures and to overestimate the number of hip fractures in females. In men, the number of observed fractures were within the 95%CI of the number predicted, both with and without BMD.
Conclusion: FRAX® without BMD provided good fracture prediction. Adding BMD to FRAX® did not improve the performance of the tool in the general population.
Original languageEnglish
Article numbere000509
JournalRMD Open
Volume3
Issue number2
DOIs
Publication statusPublished - 2017

Keywords

  • Osteoporosis
  • Epidemiology
  • Outcomes research

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