TY - JOUR
T1 - Comparison of fracture risk assessment tools in older men without prior hip or spine fracture
T2 - the MrOS study
AU - for the Osteoporotic Fractures in Men (MrOS) Study Group
AU - Gourlay, Margaret L.
AU - Ritter, Victor S.
AU - Fine, Jason P.
AU - Overman, Robert A.
AU - Schousboe, John T.
AU - Cawthon, Peggy M.
AU - Orwoll, Eric S.
AU - Nguyen, Tuan V.
AU - Lane, Nancy E.
AU - Cummings, Steven R.
AU - Kado, Deborah M.
AU - Lapidus, Jodi A.
AU - Diem, Susan J.
AU - Ensrud, Kristine E.
N1 - Publisher Copyright:
© 2017, International Osteoporosis Foundation and National Osteoporosis Foundation.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Abstract: Summary: 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® and Garvan fracture risk tools, and femoral neck bone mineral density (BMD) T score 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.
AB - Abstract: Summary: 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® and Garvan fracture risk tools, and femoral neck bone mineral density (BMD) T score 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.
KW - Bone density
KW - Fractures
KW - Male
KW - Osteoporosis
KW - Risk assessment
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U2 - 10.1007/s11657-017-0389-1
DO - 10.1007/s11657-017-0389-1
M3 - Article
C2 - 29052793
AN - SCOPUS:85032208852
SN - 1862-3522
VL - 12
JO - Archives of Osteoporosis
JF - Archives of Osteoporosis
IS - 1
M1 - 91
ER -