Original Article

Osteoporosis International

, Volume 22, Issue 3, pp 829-837

Fracture prediction and calibration of a Canadian FRAX® tool: a population-based report from CaMos

  • L.-A. FraserAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University
  • , L. LangsetmoAffiliated withCaMos National Coordinating Center, McGill University
  • , C. BergerAffiliated withCaMos National Coordinating Center, McGill University
  • , G. IoannidisAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University
  • , D. GoltzmanAffiliated withCaMos National Coordinating Center, McGill University
  • , J. D. AdachiAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University
  • , A. PapaioannouAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University
  • , R. JosseAffiliated withDepartment of Medicine, University of Toronto
  • , C. S. KovacsAffiliated withFaculty of Medicine, Memorial University of Newfoundland
    • , W. P. OlszynskiAffiliated withDepartment of Medicine, University of Saskatchewan
    • , T. TowheedAffiliated withDepartment of Medicine, Queen’s University
    • , D. A. HanleyAffiliated withDepartment of Medicine, University of Calgary
    • , S. M. KaiserAffiliated withDepartment of Medicine, Dalhousie University
    • , J. PriorAffiliated withDepartment of Medicine, University of British Columbia
    • , S. JamalAffiliated withDepartment of Medicine, University of Toronto
    • , N. KreigerAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster UniversityDepartment of Epidemiology, University of Toronto Cancer Care Ontario
    • , J. P. BrownAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster UniversityDepartment of Medicine, Laval University
    • , H. JohanssonAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University
    • , A. OdenAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University
    • , E. McCloskeyAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster UniversityOsteoporosis Centre, Northern General Hospital
    • , J. A. KanisAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster UniversityWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield
    • , W. D. LeslieAffiliated withDepartments of Clinical Epidemiology and Biostatistics and Medicine, McMaster UniversityDepartment of Medicine (C5121), University of Manitoba St. Boniface General Hospital Email author 
    • , CaMos Research Group

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Summary

A new Canadian WHO fracture risk assessment (FRAX®) tool to predict 10-year fracture probability was compared with observed 10-year fracture outcomes in a large Canadian population-based study (CaMos). The Canadian FRAX tool showed good calibration and discrimination for both hip and major osteoporotic fractures.

Introduction

The purpose of this study was to validate a new Canadian WHO fracture risk assessment (FRAX®) tool in a prospective, population-based cohort, the Canadian Multicentre Osteoporosis Study (CaMos).

Methods

A FRAX tool calibrated to the Canadian population was developed by the WHO Collaborating Centre for Metabolic Bone Diseases using national hip fracture and mortality data. Ten-year FRAX probabilities with and without bone mineral density (BMD) were derived for CaMos women (N = 4,778) and men (N = 1,919) and compared with observed fracture outcomes to 10 years (Kaplan–Meier method). Cox proportional hazard models were used to investigate the contribution of individual FRAX variables.

Results

Mean overall 10-year FRAX probability with BMD for major osteoporotic fractures was not significantly different from the observed value in men [predicted 5.4% vs. observed 6.4% (95%CI 5.2–7.5%)] and only slightly lower in women [predicted 10.8% vs. observed 12.0% (95%CI 11.0–12.9%)]. FRAX was well calibrated for hip fracture assessment in women [predicted 2.7% vs. observed 2.7% (95%CI 2.2–3.2%)] but underestimated risk in men [predicted 1.3% vs. observed 2.4% (95%CI 1.7–3.1%)]. FRAX with BMD showed better fracture discrimination than FRAX without BMD or BMD alone. Age, body mass index, prior fragility fracture and femoral neck BMD were significant independent predictors of major osteoporotic fractures; sex, age, prior fragility fracture and femoral neck BMD were significant independent predictors of hip fractures.

Conclusion

The Canadian FRAX tool provides predictions consistent with observed fracture rates in Canadian women and men, thereby providing a valuable tool for Canadian clinicians assessing patients at risk of fracture.

Keywords

Canada Fracture Fracture prediction FRAX Osteoporosis