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

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The utility of absolute risk prediction using FRAX (R) and Garvan Fracture Risk Calculator in daily practice. / van Geel, T.A.C.M.; Eisman, J.A.; Geusens, P.; van den Bergh, J.P.W.; Center, J.R.; Dinant, G.J.

In: Maturitas, Vol. 77, No. 2, 02.2014, p. 174-179.

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@article{69255ba966b44edf8024952efb639e7c,
title = "The utility of absolute risk prediction using FRAX (R) and Garvan Fracture Risk Calculator in daily practice",
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.",
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",
author = "{van Geel}, T.A.C.M. and J.A. Eisman and P. Geusens and {van den Bergh}, J.P.W. and J.R. Center and G.J. Dinant",
year = "2014",
month = "2",
doi = "10.1016/j.maturitas.2013.10.021",
language = "English",
volume = "77",
pages = "174--179",
journal = "Maturitas",
issn = "0378-5122",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

RIS

TY - JOUR

T1 - The utility of absolute risk prediction using FRAX (R) and Garvan Fracture Risk Calculator in daily practice

AU - van Geel, T.A.C.M.

AU - Eisman, J.A.

AU - Geusens, P.

AU - van den Bergh, J.P.W.

AU - Center, J.R.

AU - Dinant, G.J.

PY - 2014/2

Y1 - 2014/2

N2 - 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.

AB - 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.

KW - Fractures

KW - Bone (MeSH)

KW - Risk assessment (MeSH)

KW - Female (MeSH)

KW - FRAX (R)

KW - Garvan Fracture Risk Calculator

KW - POSTMENOPAUSAL WOMEN

KW - INDIVIDUALIZING 5-YEAR

KW - OLDER WOMEN

KW - OSTEOPOROSIS

KW - MANAGEMENT

KW - VALIDATION

KW - DIAGNOSIS

KW - NOMOGRAM

KW - DISEASE

KW - COHORT

U2 - 10.1016/j.maturitas.2013.10.021

DO - 10.1016/j.maturitas.2013.10.021

M3 - Article

VL - 77

SP - 174

EP - 179

JO - Maturitas

T2 - Maturitas

JF - Maturitas

SN - 0378-5122

IS - 2

ER -