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01-10-2019 | Osteoporosis | Original Article

How well do the FRAX (Australia) and Garvan calculators predict incident fractures? Data from the Geelong Osteoporosis Study

Authors: K. L. Holloway-Kew, Y. Zhang, A. G. Betson, K. B. Anderson, D. Hans, N. K. Hyde, G. C. Nicholson, N. A. Pocock, M. A. Kotowicz, J. A. Pasco

Published in: Osteoporosis International | Issue 10/2019

Abstract

Summary

This study reports that both FRAX and Garvan calculators underestimated fractures in Australian men and women, particularly in those with osteopenia or osteoporosis. Major osteoporotic fractures were poorly predicted, while both calculators performed acceptably well for hip fractures.

Introduction

This study assessed the ability of the FRAX (Australia) and Garvan calculators to predict fractures in Australian women and men.

Methods

Women (n = 809) and men (n = 821) aged 50–90 years, enrolled in the Geelong Osteoporosis Study, were included. Fracture risk was estimated using FRAX and Garvan calculators with and without femoral neck bone mineral density (BMD) (FRAX_BMD, FRAX_noBMD, Garvan_BMD, Garvan_noBMD). Incident major osteoporotic (MOF), fragility, and hip fractures over the following 10 years were verified radiologically. Differences between observed and predicted numbers of fractures were assessed using a chi-squared test. Diagnostics indexes were calculated.

Results

In women, 115 MOF, 184 fragility, and 42 hip fractures occurred. For men, there were 73, 109, and 17 fractures, respectively. FRAX underestimated MOFs, regardless of sex or inclusion of BMD. FRAX accurately predicted hip fractures, except in women with BMD (20 predicted, p = 0.004). Garvan underestimated fragility fractures except in men using BMD (88 predicted, p = 0.109). Garvan accurately predicted hip fractures except for women without BMD (12 predicted, p < 0.001). Fractures were underestimated primarily in the osteopenia and osteoporosis groups; MOFs in the normal BMD group were only underestimated by FRAX_BMD and fragility fractures by Garvan_noBMD, both in men. AUROCs were not different between scores with and without BMD, except for fragility fractures predicted by Garvan in women (0.696, 95% CI 0.652–0.739 and 0.668, 0.623–0.712, respectively, p = 0.008) and men, which almost reached significance (0.683, 0.631–0.734, and 0.667, 0.615–0.719, respectively, p = 0.051). Analyses of sensitivity and specificity showed overall that MOFs and fragility fractures were poorly predicted by both FRAX and Garvan, while hip fractures were acceptably predicted.

Conclusions

Overall, the FRAX and Garvan calculators underestimated MOF and fragility fractures, particularly in individuals with osteopenia or osteoporosis. Hip fractures were predicted better by both calculators. AUROC analyses suggest that Garvan_BMD performed better than Garvan_noBMD for prediction of fragility fractures.

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Title: How well do the FRAX (Australia) and Garvan calculators predict incident fractures? Data from the Geelong Osteoporosis Study
Authors: K. L. Holloway-Kew
Y. Zhang
A. G. Betson
K. B. Anderson
D. Hans
N. K. Hyde
G. C. Nicholson
N. A. Pocock
M. A. Kotowicz
J. A. Pasco
Publication date: 01-10-2019
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Osteoporosis International / Issue 10/2019
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-019-05088-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

How well do the FRAX (Australia) and Garvan calculators predict incident fractures? Data from the Geelong Osteoporosis Study

Abstract

Summary

Introduction

Methods

Results

Conclusions

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Abstract

Summary

Introduction

Methods

Results

Conclusions

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