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

for the Osteoporotic Fractures in Men (MrOS) Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article number91
JournalArchives of Osteoporosis
Volume12
Issue number1
DOIs
StatePublished - Dec 1 2017

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Bone Density
Hip
Spine
Femur Neck
Area Under Curve
ROC Curve
Hip Fractures
Independent Living
Osteoporotic Fractures
Calibration
Mortality

Keywords

  • Bone density
  • Fractures
  • Male
  • Osteoporosis
  • Risk assessment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Comparison of fracture risk assessment tools in older men without prior hip or spine fracture : the MrOS study. / for the Osteoporotic Fractures in Men (MrOS) Study Group.

In: Archives of Osteoporosis, Vol. 12, No. 1, 91, 01.12.2017.

Research output: Contribution to journalArticle

for the Osteoporotic Fractures in Men (MrOS) Study Group. / Comparison of fracture risk assessment tools in older men without prior hip or spine fracture : the MrOS study. In: Archives of Osteoporosis. 2017 ; Vol. 12, No. 1.
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abstract = "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{\circledR} 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.",
keywords = "Bone density, Fractures, Male, Osteoporosis, Risk assessment",
author = "{for the Osteoporotic Fractures in Men (MrOS) Study Group} and Gourlay, {Margaret L.} and Ritter, {Victor S.} and Fine, {Jason P.} and Overman, {Robert A.} and Schousboe, {John T.} and Cawthon, {Peggy M.} and Orwoll, {Eric S.} and Nguyen, {Tuan V.} and Lane, {Nancy E} and Cummings, {Steven R.} and Kado, {Deborah M.} and Lapidus, {Jodi A.} and Diem, {Susan J.} and Ensrud, {Kristine E.}",
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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.

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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