Osteoporosis International

, Volume 22, Issue 3, pp 829–837 | Cite as

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

  • L.-A. Fraser
  • L. Langsetmo
  • C. Berger
  • G. Ioannidis
  • D. Goltzman
  • J. D. Adachi
  • A. Papaioannou
  • R. Josse
  • C. S. Kovacs
  • W. P. Olszynski
  • T. Towheed
  • D. A. Hanley
  • S. M. Kaiser
  • J. Prior
  • S. Jamal
  • N. Kreiger
  • J. P. Brown
  • H. Johansson
  • A. Oden
  • E. McCloskey
  • J. A. Kanis
  • W. D. Leslie
  • CaMos Research Group
Original Article



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.


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).


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.


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.


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.


Canada Fracture Fracture prediction FRAX Osteoporosis 



We thank all those participants in CaMos whose careful responses and attendance made this analysis possible. Dr. Fraser is supported by the University of Western Ontario Resident Research Career Development Program. The Canadian Multicentre Osteoporosis Study was funded by the Canadian Institutes of Health Research (CIHR); Merck Frosst Canada Ltd.; Eli Lilly Canada Inc.; Novartis Pharmaceuticals Inc.; The Alliance: sanofi-aventis & Procter and Gamble Pharmaceuticals Canada Inc.; Servier Canada Inc.; Amgen Canada Inc.; The Dairy Farmers of Canada; and The Arthritis Society.

CaMos Research Group

David Goltzman (co-principal investigator, McGill University), Nancy Kreiger (co-principal investigator, Toronto), Alan Tenenhouse (principal investigator emeritus, Toronto)

CaMos Coordinating Centre, McGill University, Montreal, Quebec: Suzette Poliquin (national coordinator), Suzanne Godmaire (research assistant), Claudie Berger (study statistician)

Memorial University, St. John’s Newfoundland: Carol Joyce (director), Christopher Kovacs (co-director), Emma Sheppard (coordinator)

Dalhousie University, Halifax, Nova Scotia: Susan Kirkland, Stephanie Kaiser (co-directors), Barbara Stanfield (coordinator)

Laval University, Quebec City, Quebec: Jacques P. Brown (director), Louis Bessette (co-director), Marc Gendreau (coordinator)

Queen’s University, Kingston, Ontario: Tassos Anastassiades (director), Tanveer Towheed (co-director), Barbara Matthews (coordinator)

University of Toronto, Toronto, Ontario: Bob Josse (director), Sophie A Jamal (co-director), Tim Murray (past director), Barbara Gardner-Bray (coordinator)

McMaster University, Hamilton, Ontario: Jonathan D. Adachi (director), Alexandra Papaioannou (co-director), Laura Pickard (coordinator)

University of Saskatchewan, Saskatoon, Saskatchewan: Wojciech P. Olszynski (director), K. Shawn Davison(co-director), Jola Thingvold (coordinator)

University of Calgary, Calgary, Alberta: David A. Hanley (director), Jane Allan (coordinator)

University British Columbia, Vancouver, British Columbia: Jerilynn C. Prior (director), Milan Patel (co-director),Yvette Vigna (coordinator); Brian C. Lentle (radiologist)

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • L.-A. Fraser
    • 1
  • L. Langsetmo
    • 2
  • C. Berger
    • 2
  • G. Ioannidis
    • 1
  • D. Goltzman
    • 2
  • J. D. Adachi
    • 1
  • A. Papaioannou
    • 1
  • R. Josse
    • 3
  • C. S. Kovacs
    • 4
  • W. P. Olszynski
    • 5
  • T. Towheed
    • 6
  • D. A. Hanley
    • 7
  • S. M. Kaiser
    • 8
  • J. Prior
    • 9
  • S. Jamal
    • 3
  • N. Kreiger
    • 11
  • J. P. Brown
    • 10
  • H. Johansson
    • 12
  • A. Oden
    • 12
  • E. McCloskey
    • 13
  • J. A. Kanis
    • 14
  • W. D. Leslie
    • 15
  • CaMos Research Group
  1. 1.Departments of Clinical Epidemiology and Biostatistics and MedicineMcMaster UniversityHamiltonCanada
  2. 2.CaMos National Coordinating CenterMcGill UniversityMontrealCanada
  3. 3.Department of MedicineUniversity of TorontoTorontoCanada
  4. 4.Faculty of MedicineMemorial University of NewfoundlandSt. John’s NewfoundlandCanada
  5. 5.Department of MedicineUniversity of SaskatchewanSaskatoonCanada
  6. 6.Department of MedicineQueen’s UniversityKingstonCanada
  7. 7.Department of MedicineUniversity of CalgaryCalgaryCanada
  8. 8.Department of MedicineDalhousie UniversityHalifaxCanada
  9. 9.Department of MedicineUniversity of British ColumbiaVancouverCanada
  10. 10.Department of MedicineLaval UniversityQuebec CityCanada
  11. 11.Department of EpidemiologyUniversity of Toronto Cancer Care OntarioTorontoCanada
  12. 12.GothenburgSweden
  13. 13.Osteoporosis CentreNorthern General HospitalSheffieldUK
  14. 14.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  15. 15.Department of Medicine (C5121)University of Manitoba St. Boniface General HospitalWinnipegCanada

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