Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
Curr Opin Rheumatol. 2013 Jul;25(4):532-41. doi: 10.1097/BOR.0b013e328361ff8c.
Fragility fracture is a major public health burden, because it is associated with a substantial morbidity and mortality. Risk prediction models, including the Fracture Risk Assessment Tool (FRAX) and Garvan Fracture Risk Calculator (GFRC), have been developed to provide a useful clinical framework for communicating the risk of fracture. The present review examines the validation of risk prediction models in osteoporosis and identifies some major challenges.
Recent validation studies suggested that the area under the ROC curve in fracture discrimination ranged from 0.61 to 0.83 for FRAX, and from 0.63 to 0.88 for GFRC, with hip fracture having a better discrimination than fragility fractures as a group. FRAX substantially underestimated the risk of fracture, whereas the predicted risk by GFRC was close to or slightly higher than the actual risk. Results of post-hoc analyses of clinical trials indicated the antifracture efficacy of alendronate, coronate, bazedoxifene, and denosumab was greater in patients with higher predicted risk of fracture. However, there was no correlation between antifracture efficacy and predicted fracture risk among patients on raloxifene and strontium ranelate.
The prognostic performance of FRAX and GFRC for fracture prediction is not perfect, but these predictive models can aid patients and doctors to communicate about fracture risk in the medium term and to make rational decisions. However, the application of these predictive models in making decisions for an individual should take into account the individual's perception of the importance of the risk of fracture and its severity outcomes.
脆性骨折是一个主要的公共健康负担，因为它与大量的发病率和死亡率有关。风险预测模型，包括骨折风险评估工具（FRAX）和加文骨折风险计算器（GFRC），已经被开发出来，为沟通骨折风险提供了一个有用的临床框架。本综述检查了骨质疏松症中风险预测模型的验证，并确定了一些主要的挑战。
最近的验证研究表明，FRAX 的骨折鉴别ROC 曲线下面积范围为 0.61 至 0.83，GFRC 的为 0.63 至 0.88，髋部骨折的鉴别能力优于脆性骨折组。FRAX 大大低估了骨折风险，而 GFRC 预测的风险接近或略高于实际风险。临床试验的事后分析结果表明，阿伦膦酸盐、考来替兰、巴多昔芬和地舒单抗的抗骨折疗效在骨折风险预测较高的患者中更大。然而，在使用雷洛昔芬和雷奈酸锶的患者中，抗骨折疗效与预测骨折风险之间没有相关性。
FRAX 和 GFRC 对骨折预测的预后性能并不完美，但这些预测模型可以帮助患者和医生在中期就骨折风险进行沟通，并做出合理的决策。然而，在为个人做出决策时，应用这些预测模型应考虑个人对骨折风险的重要性及其严重后果的看法。
