Osteoporosis International

, Volume 22, Issue 3, pp 829–837

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

Authors

  • L.-A. Fraser
    • Departments of Clinical Epidemiology and Biostatistics and MedicineMcMaster University
  • L. Langsetmo
    • CaMos National Coordinating CenterMcGill University
  • C. Berger
    • CaMos National Coordinating CenterMcGill University
  • G. Ioannidis
    • Departments of Clinical Epidemiology and Biostatistics and MedicineMcMaster University
  • D. Goltzman
    • CaMos National Coordinating CenterMcGill University
  • J. D. Adachi
    • Departments of Clinical Epidemiology and Biostatistics and MedicineMcMaster University
  • A. Papaioannou
    • Departments of Clinical Epidemiology and Biostatistics and MedicineMcMaster University
  • R. Josse
    • Department of MedicineUniversity of Toronto
  • C. S. Kovacs
    • Faculty of MedicineMemorial University of Newfoundland
  • W. P. Olszynski
    • Department of MedicineUniversity of Saskatchewan
  • T. Towheed
    • Department of MedicineQueen’s University
  • D. A. Hanley
    • Department of MedicineUniversity of Calgary
  • S. M. Kaiser
    • Department of MedicineDalhousie University
  • J. Prior
    • Department of MedicineUniversity of British Columbia
  • S. Jamal
    • Department of MedicineUniversity of Toronto
  • N. Kreiger
    • Department of EpidemiologyUniversity of Toronto Cancer Care Ontario
  • J. P. Brown
    • Department of MedicineLaval University
  • H. Johansson
  • A. Oden
  • E. McCloskey
    • Osteoporosis CentreNorthern General Hospital
  • J. A. Kanis
    • WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield
    • Department of Medicine (C5121)University of Manitoba St. Boniface General Hospital
  • CaMos Research Group
Original Article

DOI: 10.1007/s00198-010-1465-1

Cite this article as:
Fraser, L., Langsetmo, L., Berger, C. et al. Osteoporos Int (2011) 22: 829. doi:10.1007/s00198-010-1465-1

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

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010