Abstract
BackgroundAbsolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort.MethodsThe analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance.ResultsThe incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture.ConclusionsThe Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction.
Highlights
Osteoporotic fractures are an important public health problem
Absolute risk or individualized prognosis is considered to be a preferred approach in the assessment of fracture risk and treatment decision making
It is based on data from the Dubbo Osteoporosis Epidemiology Study (DOES) and integrates sex, age, bone mineral density (BMD), and history of prior fracture and falls into the nomograms
Summary
Osteoporotic fractures are an important public health problem. With increasing aging populations, their number will increase placing an additional burden on individuals and society in terms of functional limitations, morbidity, mortality, and costs [1,2,3]. The Garvan Fracture Risk Calculator (www.fractureriskcalculator.com) was stated as one of the simplest tools for fracture prediction developed in a population-based setting applying proper methodology [5]. It is based on data from the Dubbo Osteoporosis Epidemiology Study (DOES) and integrates sex, age, BMD (or body weight), and history of prior fracture and falls into the nomograms. It includes two nomograms; one for prediction of absolute risk for hip fracture and another for any fragility fracture [8,9]. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort
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