Comparison of prediction models for fractures in older women

January 01, 0001

Comparison of prediction models for fractures in older women

A Web-based risk assessment tool (FRAX) using clinical risk factors with and without femoral neck bone mineral density (BMD) has been incorporated into clinical guidelines regarding treatment to prevent fractures. These Us authors conducted a prospective cohort study in 6252 women 65 years or older to compare the value of FRAX models that include BMD with that of parsimonious models based on age and BMD alone for prediction of fractures. They also compared FRAX models without BMD with simple models based on age and fracture history alone.

They found: “The AUC {area under the curve} comparisons showed no differences between FRAX models with BMD and simple models with age and BMD alone in discriminating hip (AUC, 0.75 for the FRAX model and 0.76 for the simple model), major osteoporotic (AUC, 0.68 for the FRAX model and 0.69 for the simple model), and clinical fracture (AUC, 0.64 for the FRAX model and 0.63 for the simple model). Similarly, performance of parsimonious models containing age and fracture history alone was nearly identical to that of FRAX models without BMD. The proportion of women in each quartile of predicted risk who actually experienced a fracture outcome did not differ between FRAX and simple models.”

The authors concluded: ”Simple models based on age and BMD alone or age and fracture history alone predicted 10-year risk of hip, major osteoporotic, and clinical fracture as well as more complex FRAX models.”

Age and fracture history, and perhaps BMD, appear to be sufficient to predict fracture risk in older women.

For the full abstract, click here.

Arch Intern Med 169(22):2087-2094, December 14/28 2009. © 2009 To the American Medical Association.
A Comparison of Prediction Models for Fractures in Older Women-Is More Better? Kristine E. Ensrud, Li-Yung Lui, Brent C. Taylor, et al. Correspondence to Dr. Ensrud: [email protected]

Category M. Musculoskeletal. Keywords: osteoporosis, older women, fracture, risk, prospective cohort study
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 27 January 2010

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