The clinical utility of FRAX to discriminate fracture status in men and women with chronic kidney disease
- 761 Downloads
We assessed the ability of the World Health Organization’s fracture risk assessment tool (FRAX), bone mineral density (BMD), and age to discriminate fracture status in adults with pre-dialysis chronic kidney disease (CKD). In adults with CKD, FRAX was able to discriminate fracture status but performed no better than BMD alone.
Patients with CKD are at increased risk for fracture but the best method to assess fracture risk is not known.
We assessed the ability of the World Health Organization’s FRAX, compared with BMD at the femoral neck (FN), and age to discriminate fracture status (prevalent clinical nonspine and/or morphometric vertebral) in men and women, 18 years and older with pre-dialysis CKD. Results are presented as area under receiver operator characteristic curves (AUC) with 95 % confidence intervals (CI).
We enrolled 353 subjects; mean age was 65 ± 14 years; weight was 79 ± 18 kg, and estimated glomerular filtration rate was 28 ml/min/1.73 m2. About one third of the subjects had a prevalent clinical nonspine and/or morphometric vertebral fracture. FRAX was able to discriminate among those with prevalent clinical nonspine fractures (AUC, 0.72; 95 % CI, 0.65–0.78), morphometric vertebral fractures (AUC, 0.66; 95 % CI, 0.59–0.73), and any fracture (AUC, 0.71; 95 % CI, 0.65–0.77). The discriminative ability of BMD at the FN alone was similar to FRAX for morphometric vertebral and any fractures; FRAX performed better than BMD for prevalent clinical nonspine fractures (AUC for BMD alone, 0.66; 95 % CI, 0.60–0.73). Compared to FRAX, the AUC for age alone was lower for all fracture types.
Among men and women with CKD, FRAX is able to discriminate fracture status but performs no better than BMD alone.
KeywordsBone mineral density Chronic kidney disease Fracture Fracture discrimination FRAX
The Toronto site was supported by grants from The Kidney Foundation of Canada, The Physicians’ Services Incorporated Foundation, and the Canadian Institutes of Health Research (FRN: 93785). The New York site was supported by grants from the National Institutes of Health (K23 DK080139); Amgen, Young Investigator Award; and the International Society for Clinical Densitometry, Special Projects Award and a Columbia University Herbert Irving Scholar Award.
Conflicts of interest
- 16.(2008) FRAX WHO Fracture Risk Asssessment Tool. In. World Health Organization, Geneva, SwitzerlandGoogle Scholar
- 19.National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266Google Scholar
- 20.(1994) Assessment of osteoporotic fracture risk and its role in screening for postmenopausal osteoporosis. WHO Technical Series GenevaGoogle Scholar
- 23.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, Gluer 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