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Prediction of major osteoporotic and hip fractures in Australian men using FRAX scores adjusted with trabecular bone score

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Abstract

Summary

There was no significant difference between the areas under receiver operating characteristics (AUROCs) and diagnostic indexes (sensitivity, specificity, positive predictive value, negative predictive value) for either major osteoporotic or hip fracture FRAX scores when comparing the unadjusted and trabecular bone score (TBS)-adjusted scores.

Introduction

FRAX 10-year probability of fracture can be calculated with adjustment for the TBS. Studies have shown that TBS can improve FRAX assessments in some populations. This study aimed to determine if TBS-adjusted FRAX score is better than the unadjusted score for predicting major osteoporotic fracture (MOF) and hip fracture in Australian men.

Methods

This study involved 591 men aged 40–90 years, enrolled in the Geelong Osteoporosis Study. Incident MOF (n = 50) and hip fractures (n = 14) were ascertained using radiological reports. Median follow-up time was 9.5 years (IQR7.5–11.4). Diagnostic indexes were calculated using cut points of ≥20% for MOF and ≥3% for the hip. AUROC curves were also determined for adjusted and unadjusted scores as continuous variables.

Results

Sensitivity was higher in the TBS-adjusted scores (MOF 4%, hip 78.6%) than the unadjusted scores (MOF 2%, hip 57.1%), with a decrease in specificity (MOF 98.9 vs 99.3%; hip 79.9 vs 83.9%). When considering TBS-adjusted and unadjusted FRAX as continuous scores, AUROCs were 0.738 and 0.740, respectively, for MOF and 0.849 and 0.848 for the hip.

Conclusions

Prediction of fractures by MOF or hip FRAX was not substantially improved by TBS adjustment. There was no difference in AUROCs or diagnostic indexes for cut-off points of ≥20 for MOF and ≥3% for hip FRAX.

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Acknowledgements

We thank the Australian Institute for Health and Welfare (AIHW) for providing death data.

Funding

The study was supported by the National Health and Medical Research Council (NHMRC) of Australia (251638, 299831, 628582), the Geelong Regional Medical Foundation, Arthritis Foundation of Australia, and Perpetual Trustees. SLB-O is supported by an NHMRC Career Development Fellowship (1107510). KLH is supported by an Alfred Deakin Postdoctoral Research Fellowship, and NKH is supported by an Australian Postgraduate Award (APA).

Author information

Authors and Affiliations

  1. Deakin University, Geelong, Australia

    K. L. Holloway, M. Mohebbi, A. G. Betson, N. K. Hyde, S. L. Brennan-Olsen, M. A. Kotowicz & J. A. Pasco

  2. Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University,, Health Education and Research Building, PO Box 281, Geelong, VIC, 3220, Australia

    K. L. Holloway

  3. Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland

    D. Hans

  4. The Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia

    S. L. Brennan-Olsen

  5. Australian Institute for Musculoskeletal Science, The University of Melbourne, Melbourne, Australia

    S. L. Brennan-Olsen

  6. Barwon Health, Geelong, Australia

    M. A. Kotowicz & J. A. Pasco

  7. Melbourne Medical School-Western Campus, The University of Melbourne, Melbourne, Australia

    J. A. Pasco

Authors
  1. K. L. Holloway
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  2. M. Mohebbi
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  3. A. G. Betson
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  4. D. Hans
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  5. N. K. Hyde
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  6. S. L. Brennan-Olsen
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  7. M. A. Kotowicz
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  8. J. A. Pasco
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Corresponding author

Correspondence to K. L. Holloway.

Ethics declarations

All participants provided written, informed consent, and the Barwon Health Human Research Ethics Committee approved the study.

Conflict of interest

Didier Hans is co-owner of the TBS patent and has corresponding ownership shares and position at the Medimaps group. Holloway KL, Mohebbi M, Morse AG, Hans D, Hyde NK, Brennan-Olsen SL, Kotowicz MA and Pasco JA have no conflicts of interest to declare.

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Holloway, K.L., Mohebbi, M., Betson, A.G. et al. Prediction of major osteoporotic and hip fractures in Australian men using FRAX scores adjusted with trabecular bone score. Osteoporos Int 29, 101–108 (2018). https://doi.org/10.1007/s00198-017-4226-6

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  • DOI: https://doi.org/10.1007/s00198-017-4226-6

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