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01-12-2017 | Original Article

Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study

Authors: Margaret L. Gourlay, Victor S. Ritter, Jason P. Fine, Robert A. Overman, John T. Schousboe, Peggy M. Cawthon, Eric S. Orwoll, Tuan V. Nguyen, Nancy E. Lane, Steven R. Cummings, Deborah M. Kado, Jodi A. Lapidus, Susan J. Diem, Kristine E. Ensrud, for the Osteoporotic Fractures in Men (MrOS) Study Group

Published in: Archives of Osteoporosis | Issue 1/2017

Abstract

Summary

Femoral neck bone mineral density (BMD), age plus femoral neck BMD T score, and three externally generated fracture risk tools had similar accuracy to identify older men who developed osteoporotic fractures. Risk tools with femoral neck BMD performed better than those without BMD. The externally developed risk tools were poorly calibrated.

Introduction

We compared the performance of fracture risk assessment tools in older men, accounting for competing risks including mortality.

Methods

A comparative ROC curve analysis assessed the ability of the QFracture, FRAX® and Garvan fracture risk tools, and femoral neck bone mineral density (BMD) T score with or without age to identify incident fracture in community-dwelling men aged 65 years or older (N = 4994) without hip or clinical vertebral fracture or antifracture treatment at baseline.

Results

Among risk tools calculated with BMD, the discriminative ability to identify men with incident hip fracture was similar for FRAX (AUC 0.77, 95% CI 0.73, 0.81), the Garvan tool (AUC 0.78, 95% CI 0.74, 0.82), age plus femoral neck BMD T score (AUC 0.79, 95% CI 0.75, 0.83), and femoral neck BMD T score alone (AUC 0.76, 95% CI 0.72, 0.81). Among risk tools calculated without BMD, the discriminative ability to identify hip fracture was similar for QFracture (AUC 0.69, 95% CI 0.66, 0.73), FRAX (AUC 0.70, 95% CI 0.66, 0.73), and the Garvan tool (AUC 0.71, 95% CI 0.67, 0.74). Correlated ROC curve analyses revealed better diagnostic accuracy for risk scores calculated with BMD compared with QFracture (P < 0.0001). Calibration was good for the internally generated BMD T score predictor with or without age and poor for the externally developed risk tools.

Conclusion

In untreated older men without fragility fractures at baseline, an age plus femoral neck BMD T score classifier identified men with incident hip fracture as accurately as more complicated fracture risk scores.

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Title: Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study
Authors: Margaret L. Gourlay
Victor S. Ritter
Jason P. Fine
Robert A. Overman
John T. Schousboe
Peggy M. Cawthon
Eric S. Orwoll
Tuan V. Nguyen
Nancy E. Lane
Steven R. Cummings
Deborah M. Kado
Jodi A. Lapidus
Susan J. Diem
Kristine E. Ensrud
for the Osteoporotic Fractures in Men (MrOS) Study Group
Publication date: 01-12-2017
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1/2017
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-017-0389-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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