Fracture risk prediction using FRAX®: a 10-year follow-up survey of the Japanese Population-Based Osteoporosis (JPOS) Cohort Study
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We evaluated the predictive ability of FRAX® in a cohort of 815 Japanese women. The observed 10-year fracture rate did not differ significantly from that predicted by FRAX®. The predictive ability of FRAX® without femoral neck bone mineral density (BMD) was similar to that with femoral neck BMD.
We evaluated the ability of the Japanese version of FRAX®, a World Health Organization fracture risk assessment tool, to predict the 10-year probability of osteoporotic fracture.
Self-reported major osteoporotic fracture (N = 43) and hip fracture (N = 4) events were ascertained in the 10-year follow-up survey of the Japanese Population-Based Osteoporosis Cohort Study. Participants were 815 women aged 40–74 years at the baseline survey. Receiver operating characteristic curve analysis compared FRAX® with multiple logistic models based on age, body weight, and femoral neck BMD.
The number of observed major osteoporotic or hip fracture events did not differ significantly from the number of events predicted by the FRAX® model (with or without BMD). The area under the curve (AUC) value for FRAX® with BMD for predicting major osteoporotic fractures was similar to that of a logistic model with age, body weight, and BMD (0.69 vs. 0.71, respectively; p = 0.198); the AUC of FRAX® with BMD for predicting hip fractures was similar to that of a model based on age and BMD (0.88 vs. 0.89, respectively; p = 0.164). The AUCs of FRAX® without BMD for predicting major osteoporotic and hip fractures were similar to those with BMD (0.69 vs. 0.67, respectively; p = 0.121; 0.88 vs. 0.86, respectively; p = 0.445).
The Japanese version of FRAX® without BMD estimated the 10-year probability of osteoporotic fracture in this population with few clinical risk factors as similar to that of FRAX® with BMD.
KeywordsFRAX® Japanese women Osteoporotic fracture Prospective cohort study
This study was conducted by the JPOS Study Group, comprising Fumiaki Marumo (Chairman of the Study Group, Professor Emeritus, Tokyo Medical and Dental University), Toshihisa Matsuzaki (Co-chairman of the Study Group, Institute of Comprehensive Community Care), Tomoharu Matsukura (Kanazawa University), and Takashi Yamagami (Hokuriku Health Service Association), along with the authors. Financial support for the baseline survey was provided by the Japan Milk Promotion Board and the Japan Dairy Council. The follow-up surveys were supported by Grants-in-aid for Scientific Research (B#10470114, 1998–2000, B #14370147, 2002–2003, B#18390201, 2006–2008, and C#18590619, 2006-9) from the Japanese Society for the Promotion of Science, a grant in 2000–2002 from the Research Society for Metabolic Bone Diseases, Japan, and a Grand-in-Aid to study Milk Nutrition (2006) from the Japan Dairy Association. The authors wish to express special thanks to the personnel of the health departments of Miyako-jima City, Sanuki City, and Nishi-Aizu Town for their excellent support of the study, and to those from SRL, Tokyo, Japan; Toyo Medic, Osaka, Japan; and Toyukai Medical Corporation, Tokyo, Japan, for their technical assistance with the surveys.
Conflicts of interest
- 2.Report of a WHO Scientific Group (2003) Prevention and management of osteoporosis. WHO technical report series 921. World Health Organization, Geneva, p 37Google Scholar
- 3.National Institute of Population and Social Security Research (2010) Population Projections for Japan—A Supplement to the 2006 Revision-, Health and Welfare Statistics Association. Tokyo, p 105Google Scholar
- 4.Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046PubMedCrossRefGoogle Scholar
- 5.Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK, p189-217. http://www.shef.ac.uk/FRAX/pdf/WHO_Technical_Report.pdf
- 8.Pluskiewicz W, Adamczyk P, Franek E, Leszczynski P, Sewerynek E, Wichrowska H, Napiorkowska L, Kostyk T, Stuss M, Stepien-Klos W, Golba KS, Drozdzowska B (2010) Ten-year probability of osteoporotic fracture in 2012 Polish women assessed by FRAX and nomogram by Nguyen et al.—conformity between methods and their clinical utility. Bone 46:1661–1667PubMedCrossRefGoogle Scholar
- 11.Iki M, Morita A, Ikeda Y, Sato Y, Akiba T, Matsumoto T, Nishino H, Kagamimori S, Kagawa Y, Yoneshima H, JPOS Study Group (2006) Biochemical markers of bone turnover predict bone loss in perimenopausal women but not in postmenopausal women—the Japanese Population-Based Osteoporosis (JPOS) Cohort Study. Osteoporos Int 17:1086–1095PubMedCrossRefGoogle Scholar
- 14.Akaike H (1973) Information theory and an extension of the maximum likelihood principle. In: Petrov BN, Csaki F (eds) Proceedings of the Second International Symposium on Information Theory. Akademiai Kiado, Budapest, pp 267–281Google Scholar
- 15.Sakamoto Y, Ishiguro M, Kitagawa G (1986) Akaike information criterion statistics. D. Reidel, Dordrecht, pp 56–85Google Scholar
- 18.Ensrud KE, Lui LY, Taylor BC, Schousboe JT, Donaldson MG, Fink HA, Cauley JA, Hillier TA, Browner WS, Cummings SR, Study of Osteoporotic Fractures Research Group (2009) A comparison of prediction models for fractures in older women: is more better? Arch Intern Med 169:2087–2094PubMedCrossRefGoogle Scholar
- 21.Ismail AA, O’Neill TW, Cockerill W, Finn JD, Cannata JB, Hoszowski K, Johnell O, Matthis C, Raspe H, Raspe A, Reeve J, Silman AJ (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group. European Prospective Osteoporosis Study Group. Osteoporos Int 11:248–254PubMedCrossRefGoogle Scholar
- 22.Siggeirsdottir K, Aspelund T, Sigurdsson G, Mogensen B, Chang M, Jonsdottir B, Eiriksdottir G, Launer LJ, Harris TB, Jonsson BY, Gudnason V (2007) Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based fracture registry. Eur J Epidemiol 22:631–639PubMedCrossRefGoogle Scholar
- 24.Ministry of Health, Labour and Welfare of Japan (1998) National health and nutrition survey in Japan, 1996. Dai-Ichi shyuppan, Tokyo, p 52Google Scholar