Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women

BMC Musculoskeletal Disorders

Research Article

Mireia Utzet¹  Juan Carlos Martin-Sánchez²  Emilio Gené³  Rafael Azagra⁴  Marta Zwart⁵  Gloria Encabo⁶  Nuria Puchol-Ruiz⁷  Milagros Iglesias⁷  Paula Gabriel-Escoda⁸  Sergio Ortiz-Alinque⁹  Miguel Angel Diaz-Herrera^1,10  Amada Aguyé^1,11  David Moriña^1,12  Josep Maria Manresa^1,13 

[1] Biostatistics Unit, CUPESSE European Project, Universitat Pompeu Fabra, Ed Jaume I-Campus Ciutadella, 08003, Barcelona, Spain;Department of Basic Sciences, Biostatistics Unit, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain;Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain;Department of Medicine, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain;Urgencies Service, Hospital of Sabadell, Corporació Sanitaria i Universitaria Parc Tauli, 08208, Parc Tauli s/n, Sabadell, Barcelona, Spain;Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain;Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain;QuironSalud-Hospital General de Catalunya, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain;Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain;Health Center Can Gibert del Plà (ICS), Institut Català de la Salut, GROIMAP-USR Girona-IDIAP Jordi Gol, c/San Sebastian 9, 17005, Girona, Spain;Department of Nuclear Medicine, Valle de Hebron Hospital, Institut Català de la Salut, Ps/Valle de Hebron 119-129, 08035, Barcelona, Spain;Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain;Health Center Barberà del Vallès, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Verge de l’Assumpció s/n, 08210, Barberà del Vallès, Barcelona, Spain;Health Center Canaletes, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Ps d’Horta 17, 08290, Cerdanyola del Vallès, Barcelona, Spain;Health Center Cornellà 2 (Sant Ildefons), Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Republica Argentina s/n, 08940, Cornellá, Barcelona, Spain;Health Center Granollers-Centre, Institut Català de la Salut, c/Museu 19, 08400, Granollers, Barcelona, Spain;Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO)-IDIBELL, Av Gran Via, 199-203, 08908, L’Hospitalet de Llobregat, Barcelona, Spain;Departament d’Economia i Història Econòmica, Grups de Recerca d’Àfrica i Amèrica Llatines (GRAAL), Unitat de Fonaments de l’Anàlisi Econòmica, Universitat Autònoma de Barcelona, c/Emprius 2, 08202, Sabadell, Barcelona, Spain;Unitat Supor Recerca Metropolitana Nord, IDIAP Jordi Gol, ctra de Barcelona 473, 08204, Sabadell, Barcelona, Spain;Department of Nursing, Universitat Autònoma de Barcelona, avda Can Domenech s/n, 08193, Cerdanyola del Valles, Barcelona, Spain;

关键词: Osteoporosis;    Fracture;    FRAX;    FRIDEX;    Study cohort;    Algorithm;   

DOI  :  10.1186/s12891-016-1096-6

 received in 2016-02-18, accepted in 2016-05-24,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe FRAX® tool estimates the risk of a fragility fracture among the population and many countries have been evaluating its performance among their populations since its creation in 2007.The purpose of this study is to update the first FRIDEX cohort analysis comparing FRAX with the bone mineral density (BMD) model, and its predictive abilities.MethodsThe discriminatory ability of the FRAX was assessed using the ‘area under curve’ of the receiver operating characteristic (AUC-ROC). Predictive ability was assessed by comparing estimated risk fractures with incidence fractures after a 10-year follow up period.ResultsOne thousand three hundred eight women ≥ 40 and ≤ 90 years followed up during a 10-year period. The AUC for major osteoporotic fractures using FRAX without DXA was 0.686 (95 % CI 0.630–0.742) and using FN T-score of DXA 0.714 (95 % CI 0.661–0.767). Using only the traditional parameters of DXA (FN T-score), the AUC was 0.706 (95 % CI 0.652–0.760). The AUC for hip osteoporotic fracture was 0.883 (95 % CI 0.827–0.938), 0.857 (95 % CI 0.773–0.941), and 0.814 (95 % CI 0.712–0.916) respectively. For major osteoporotic fractures, the overall predictive value using the ratio Observed fractures/Expected fractures calculated with FRAX without T-score of DXA was 2.29 and for hip fractures 2.28 and with the inclusion of the T-score 2.01 and 1.83 respectively. However, for hip fracture in women < 65 years was 1.53 and 1.24 respectively.ConclusionsThe FRAX tool has been found to show a good discriminatory capacity for detecting women at high risk of fragility fracture, and is better for hip fracture than major fracture. The test of sensibility shows that it is, at least, not inferior than when using BMD model alone. The predictive capacity of FRAX tool needs some adjustment. This capacity is better for hip fracture prediction and better for women < 65 years. Further studies in Catalonia and other regions of Spain are needed to fine tune the FRAX tool’s predictive capability.

【 授权许可】

CC BY   
© The Author(s). 2016