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Predictive performance of the Garvan Fracture Risk Calculator: a registry-based cohort study

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Abstract

Summary

The G arvan Fracture Risk Calculator predicts risk of osteoporotic fractures. We evaluated its predictive performance in 16,682 women and 2839 men from Manitoba, Canada, and found significant risk stratification, with a strong gradient across scores. The tool outperformed clinical risk factors and bone mineral density for fracture risk stratification.

Introduction

The optimal model for fracture risk estimation to guide treatment decision-making remains controversial. Our objective was to evaluate the predictive performance of the Garvan Fracture Risk Calculator (FRC) in a large clinical registry from Manitoba, Canada.

Methods

Using the population-based Manitoba Bone Mineral Density (BMD) registry, we identified women and men aged 50–95 years undergoing baseline BMD assessment from September 1, 2012, onwards. Five-year Garvan FRC predictions were generated from clinical risk factors (CRFs) with and without femoral neck BMD. We identified incident non-traumatic osteoporotic fractures (OFs) and hip fractures (HFs) from population-based healthcare data sources to March 31, 2018. Fracture risk was assessed from area under the receiver operating characteristic curve (AUROC). Cox regression analysis and calibration ratios (5-year observed/predicted) were assessed for risk quintiles. All analyses were sex stratified.

Results

We included 16,682 women (mean age 66.6 + / − SD 8.7 years) and 2839 men (mean age 68.7 + / − SD 10.2 years). During a mean observation time of 2.6 years, incident OFs were identified in 681 women and 140 men and HFs in 199 women and 22 men. AUROC showed significant fracture risk stratification with the Garvan FRC. Tool predictions without BMD were better than from age or decreasing weight, and the tool with BMD performed better than BMD alone. Garvan FRC with BMD performed better than without BMD, especially for HF prediction (AUROC 0.86 in women, 0.82 in men). There was a strong gradient of increasing risk across Garvan FRC quintiles (highest versus lowest, hazard ratios women 5.75 and men 3.43 for any OF; women 101.6 for HF). Calibration differences were noted, with both over- and underestimation in risk.

Conclusions

Garvan FRC outperformed CRFs and BMD alone for fracture risk stratification, particularly for HF, but may require recalibration for accurate predictions in this population.

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living or other data providers is intended or should be inferred. SNM is chercheur-boursier des Fonds de Recherche du Québec en Santé. LML is supported by a Tier I Canada Research Chair. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada

    A. Agarwal

  2. Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada

    W. D. Leslie

  3. University of Technology Sydney, Sydney, Australia

    T. V. Nguyen

  4. McGill University, Montreal, Canada

    S. N. Morin

  5. Department Community Healkth Sciences, University of Manitoba, Winnipeg, Canada

    L. M. Lix

  6. Garvan Institute of Medical Research, Sydney, Australia

    J. A. Eisman

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  1. A. Agarwal
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  2. W. D. Leslie
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  3. T. V. Nguyen
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  4. S. N. Morin
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  5. L. M. Lix
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  6. J. A. Eisman
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Corresponding author

Correspondence to W. D. Leslie.

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Ethics approval

The study was approved by the Health Research Ethics Board for the University of Manitoba.

Conflict of interest

AA Agarwal, WD Leslie, LM Lix and SN Morin declare they have no conflict of interest. JA Eisman has consulted for and/or received research funding from Amgen, deCode, Merck Sharp and Dohme and Sanofi-Aventis. TV Nguyen has received honoraria for consulting and symposia from Merck Sharp and Dohme, Roche, Servier, Sanofi-Aventis and Novartis.

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Agarwal, A., Leslie, W.D., Nguyen, T.V. et al. Predictive performance of the Garvan Fracture Risk Calculator: a registry-based cohort study. Osteoporos Int 33, 541–548 (2022). https://doi.org/10.1007/s00198-021-06252-3

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  • DOI: https://doi.org/10.1007/s00198-021-06252-3

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