Original Article

Osteoporosis International

, Volume 22, Issue 6, pp 1873-1883

Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts

  • W. D. LeslieAffiliated withDepartment of Medicine, University of ManitobaDepartment of Medicine (C5121), St. Boniface General Hospital, 409 Tache Avenue Email author 
  • , C. BergerAffiliated withCaMos National Coordinating Centre, McGill University
  • , L. LangsetmoAffiliated withCaMos National Coordinating Centre, McGill University
  • , L. M. LixAffiliated withSchool of Public Health, University of Saskatchewan
  • , J. D. AdachiAffiliated withDepartment of Clinical Epidemiology and Biostatistics, McMaster University
  • , D. A. HanleyAffiliated withDepartments of Medicine and Community Health Sciences, University of Calgary
  • , G. IoannidisAffiliated withDepartment of Clinical Epidemiology and Biostatistics, McMaster University
  • , R. G. JosseAffiliated withDepartment of Medicine, University of Toronto
  • , C. S. KovacsAffiliated withDiscipline of Medicine, Memorial University, St. John’s
    • , T. TowheedAffiliated withDepartment of Medicine, Queen’s University
    • , S. KaiserAffiliated withDepartment of Medicine, Dalhousie University
    • , W. P. OlszynskiAffiliated withDepartment of Medicine, University of ManitobaDepartment of Medicine, University of Saskatchewan
    • , J. C. PriorAffiliated withDepartment of Medicine, University of ManitobaDepartment of Medicine and Endocrinology, University of British Columbia
    • , S. JamalAffiliated withDepartment of Medicine, University of Toronto
    • , N. KreigerAffiliated withDepartment of Medicine, University of ManitobaSchool of Public Health, University of SaskatchewanDepartment of Public Health Sciences, University of Toronto
    • , D. GoltzmanAffiliated withDepartment of Medicine, University of ManitobaSchool of Public Health, University of SaskatchewanDepartment of Medicine, McGill University
    • , Canadian Multicentre Osteoporosis Study (CaMos) Research Group

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Abstract

Summary

A procedure for creating a simplified version of fracture risk assessment tool (FRAX®) is described. Calibration, fracture prediction, and concordance were compared with the full FRAX tool using two large, complementary Canadian datasets.

Introduction

The Canadian Association of Radiologists and Osteoporosis Canada (CAROC) system for fracture risk assessment is based upon sex, age, bone mineral density (BMD), prior fragility fracture, and glucocorticoid use. CAROC does not require computer or web access, and categorizes 10-year major osteoporotic fracture risk as low (<10%), moderate (10–20%), or high (>20%).

Methods

Basal CAROC fracture risk tables (by age, sex, and femoral neck BMD) were constructed from Canadian FRAX probabilities for major osteoporotic fractures (adjusted for prevalent clinical risk factors). We assessed categorization and fracture prediction with the updated CAROC system in the CaMos and Manitoba BMD cohorts.

Results

The new CAROC system demonstrated high concordance with the Canadian FRAX tool for risk category in both the CaMos and Manitoba cohorts (89% and 88%). Ten-year fracture outcomes in CaMos and Manitoba BMD cohorts showed good discrimination and calibration for both CAROC (6.1–6.5% in low-risk, 13.5–14.6% in moderate-risk, and 22.3–29.1% in high-risk individuals) and FRAX (6.1–6.6% in low-risk, 14.4–16.1% in moderate-risk, and 23.4–31.0% in high-risk individuals). Reclassification from the CAROC risk category to a different risk category under FRAX occurred in <5% for low-risk, 20–24% for moderate-risk, and 27–30% for high-risk individuals. Reclassified individuals had 10-year fracture outcomes that were still within or close to the original nominal-risk range..

Conclusion

The new CAROC system is well calibrated to the Canadian population and shows a high degree of concordance with the Canadian FRAX tool. The CAROC system provides s a simple alternative when it is not feasible to use the full Canadian FRAX tool.

Keywords

Bone mineral density Canada CAROC Fracture risk prediction FRAX Osteoporosis