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Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study


Femoral neck bone mineral density (BMD), age plus femoral neck BMD T score, and three externally generated fracture risk tools had similar accuracy to identify older men who developed osteoporotic fractures. Risk tools with femoral neck BMD performed better than those without BMD. The externally developed risk tools were poorly calibrated. Introduction We compared the performance of fracture risk assessment tools in older men, accounting for competing risks including mortality. Methods A comparative ROC curve analysis assessed the ability of the QFracture, FRAX (R) and Garvan fracture risk tools, and femoral neck bone mineral density (BMD) Tscore with or without age to identify incident fracture in community-dwelling men aged 65 years or older (N = 4994) without hip or clinical vertebral fracture or antifracture treatment at baseline. Results Among risk tools calculated with BMD, the discriminative ability to identify men with incident hip fracture was similar for FRAX (AUC 0.77, 95% CI 0.73, 0.81), the Garvan tool (AUC 0.78, 95% CI 0.74, 0.82), age plus femoral neck BMD T score (AUC 0.79, 95% CI 0.75, 0.83), and femoral neck BMD T score alone (AUC 0.76, 95% CI 0.72, 0.81). Among risk tools calculated without BMD, the discriminative ability to identify hip fracture was similar for QFracture (AUC 0.69, 95% CI 0.66, 0.73), FRAX (AUC 0.70, 95% CI 0.66, 0.73), and the Garvan tool (AUC 0.71, 95% CI 0.67, 0.74). Correlated ROC curve analyses revealed better diagnostic accuracy for risk scores calculated with BMD compared with QFracture (P < 0.0001). Calibration was good for the internally generated BMD T score predictor with or without age and poor for the externally developed risk tools. Conclusion In untreated older men without fragility fractures at baseline, an age plus femoral neck BMD T score classifier identified men with incident hip fracture as accurately as more complicated fracture risk scores.

Type Journal
ISBN 1862-3522
Authors Gourlay, M. L.; Ritter, V. S.; Fine, J. P.; Overman, R. A.; Schousboe, J. T.; Cawthon, P. M.; Orwoll, E. S.; Nguyen, T. V.; Lane, N. E.; Cummings, S. R.; Kado, D. M.; Lapidus, J. A.; Diem, S. J.; Ensrud, K. E.; MrOS, Osteoporotic Fractures Men
Responsible Garvan Author (missing name)
Publisher Name Archives of Osteoporosis
Published Date 2017-12-30
Published Volume 12
Published Issue 1
Published Pages 91
Status Published in-print
DOI 10.1007/s11657-017-0389-1
URL link to publisher's version