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Performance of the Garvan Fracture Risk Calculator in Individuals with Diabetes: A Registry-Based Cohort Study

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Abstract

Diabetes increases fracture and falls risks. We evaluated the performance of the Garvan fracture risk calculator (FRC) in individuals with versus without diabetes. Using the population-based Manitoba bone mineral density (BMD) registry, we identified individuals aged 50–95 years undergoing baseline BMD assessment from 1 September 2012, onwards with diabetes and self-reported falls in the prior 12 months. Five-year Garvan FRC predictions were generated from clinical risk factors, with and without femoral neck BMD. We identified non-traumatic osteoporotic fractures (OF) and hip fractures (HF) from population-based data to 31 March 2018. Fracture risk stratification was assessed from area under the receiver operating characteristic curves (AUROC). Cox regression analysis was performed to examine the effect of diabetes on fractures, adjusted for Garvan FRC predictions. The study population consisted of 2618 women with and 14,064 without diabetes, and 636 and 2201 men with and without the same, respectively. The Garvan FRC provided significant OF and HF risk stratification in women with diabetes, similar to those without diabetes. Analyses of OF in men were limited by smaller numbers; no significant difference was evident by diabetes status. Cox regression showed that OF risk was 23% greater in women with diabetes adjusted for Garvan FRC including BMD (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01–1.49), suggesting it slightly underestimated risk; a non-significant increase in diabetes-related HF risk was noted (HR 1.37, 95% CI 0.88–2.15). Garvan FRC shows similar fracture risk stratification in individuals with versus without diabetes, but may underestimate this risk.

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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. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. SNM is chercheur-boursier des Fonds de Recherche du Québec en Santé. LML is supported by a Tier I Canada Research Chair. TVN is supported by an Australian National Health and Medical Research Council Investigator Grant APP1195305.

Funding

No funding support was received for this research.

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Authors and Affiliations

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

    Arnav Agarwal

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

    William D. Leslie & Lisa M. Lix

  3. University of Technology Sydney, Ultimo, Australia

    Tuan V. Nguyen

  4. School of Population Health, UNSW Medicine, UNSW Sydney, Kensington, Australia

    Tuan V. Nguyen

  5. McGill University, Montreal, Canada

    Suzanne N. Morin

  6. Garvan Institute of Medical Research, Sydney, Australia

    John A. Eisman

  7. University of New South Wales Sydney, Sydney, Australia

    John A. Eisman

  8. St Vincent’s Hospital and School of Medicine Sydney, University of Notre Dame, Sydney, Australia

    John A. Eisman

Authors
  1. Arnav Agarwal
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  2. William D. Leslie
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  3. Tuan V. Nguyen
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  4. Suzanne N. Morin
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  5. Lisa M. Lix
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  6. John A. Eisman
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Contributions

AA and WDL involved in conception, design, analysis, and drafting the article; all authors involved in interpretation of the data and critically revising the article for important intellectual content, final approval of the version to be published and agreement to be accountable for all aspects of the work. WDL had full access to all the data in the study and took the responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to William D. Leslie.

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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 research funding from Amgen and honoraria for consulting and symposia from Merck Sharp and Dohme, Roche, Servier, Sanofi-Aventis and Novartis.

Human and Animal Rights

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration.

Informed Consent

Informed consent was waived in accordance with provisions in the Manitoba Personal Health Information Act (PHIA) for approved research involving deidentified data.

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Agarwal, A., Leslie, W.D., Nguyen, T.V. et al. Performance of the Garvan Fracture Risk Calculator in Individuals with Diabetes: A Registry-Based Cohort Study. Calcif Tissue Int 110, 658–665 (2022). https://doi.org/10.1007/s00223-021-00941-1

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  • DOI: https://doi.org/10.1007/s00223-021-00941-1

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