The utility of absolute risk prediction using FRAX (R) and Garvan Fracture Risk Calculator in daily practice

T.A.C.M. van Geel, J.A. Eisman, P. Geusens, J.P.W. van den Bergh, J.R. Center, G.J. Dinant

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8 Citations (Scopus)

Abstract

Objectives: There are two commonly used fracture risk prediction tools FRAX (R) and Garvan Fracture Risk Calculator (GARVAN-FRC). The objective of this study was to investigate the utility of these tools in daily practice. Study design: A prospective population-based 5-year follow-up study was conducted in ten general practice centres in the Netherlands. For the analyses, the FRAX (R) and GARVAN-FRC 10-year absolute risks (FRAX (R) does not have 5-year risk prediction) for all fractures were used. Results: Among 506 postmenopausal women aged >= 60 years (mean age: 67.8 +/- 5.8 years), 48 (9.5%) sustained a fracture during follow-up. Both tools, using BMD values, distinguish between women who did and did not fracture (10.2% vs. 6.8%, respectively for FRAX (R) and 32.4% vs. 39.1%, respectively for GARVAN-FRC, p < 0.0001) at group level. However, only 8.9% of those who sustained a fracture had an estimated fracture risk >= 20% using FRAX (R) compared with 53.3% using GARVAN-FRC. Although both underestimated the observed fracture risk, the GARVAN-FRC performed significantly better for women who sustained a fracture (higher sensitivity) and FRAX (R) for women who did not sustain a fracture (higher specificity). Similar results were obtained using age related cut off points. Conclusions: The discriminant value of both models is at least as good as models used in other medical conditions; hence they can be used to communicate the fracture risk to patients. However, given differences in the estimated risks between FRAX (R) and GARVAN-FRC, the significance of the absolute risk must be related to country-specific recommended intervention thresholds to inform the patient. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)174-179
Number of pages6
JournalMaturitas
Volume77
Issue number2
DOIs
Publication statusPublished - Feb 2014

Keywords

  • Fractures
  • Bone (MeSH)
  • Risk assessment (MeSH)
  • Female (MeSH)
  • FRAX (R)
  • Garvan Fracture Risk Calculator
  • POSTMENOPAUSAL WOMEN
  • INDIVIDUALIZING 5-YEAR
  • OLDER WOMEN
  • OSTEOPOROSIS
  • MANAGEMENT
  • VALIDATION
  • DIAGNOSIS
  • NOMOGRAM
  • DISEASE
  • COHORT

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