Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, St Boniface General Hospital, Winnipeg R2H 2A6, Canada.
Arch Osteoporos. 2013;8:145. doi: 10.1007/s11657-013-0145-0. Epub 2013 Aug 9.
We compared the calibration of FRAX tools from Canada, the US (white), UK, Sweden, France, Australia, New Zealand, and China when used to assess fracture risk in 36,730 Canadian women. Our data underscores the importance of applying country-specific FRAX tools that are based upon high-quality national fracture epidemiology.
A FRAX® model for Canada was constructed for prediction of hip fracture and major osteoporotic fracture (MOF) using national hip fracture and mortality data. We examined the calibration of this model in Canadian women and compared it with seven other FRAX tools.
In women aged ≥50 years with baseline bone mineral density (BMD) measures identified from the Manitoba Bone Density Program, Canada (n = 36,730), 10-year fracture probabilities were calculated with and without BMD using selected country-specific FRAX tools. FRAX risk estimates were compared with observed fractures ≤10 years (506 hip, 2,380 MOF). Ten-year fracture risk was compared with predicted probabilities, and proportions exceeding specific treatment thresholds contrasted.
For hip fracture prediction, good calibration was observed for FRAX Canada and most other country-specific FRAX tools, excepting Sweden (risk overestimated) and China (risk underestimated). For MOF prediction, greater between-country differences were seen; FRAX Sweden and FRAX China showed the largest over- and underestimation in this Canadian population. Relative to treatment qualification based upon FRAX Canada, treatment of high-hip fracture probability (≥3%) was greater by FRAX Sweden (ratio 1.41 without and 1.55 with BMD), and markedly less by FRAX China (ratio 0.09 without and 0.11 with BMD). Greater between-country differences were observed for treatment of high MOF (≥20%); FRAX Sweden again greatly increased (ratio 1.76 without and 1.83 with BMD), and FRAX China severely reduced treatment qualification (ratio 0.00 without and 0.01 with BMD).
The use of country-specific FRAX tools, accurately calibrated to the target population, is essential. Relatively small calibration differences can have large effects on high-risk categorization and treatment qualification.
我们比较了加拿大、美国（白人）、英国、瑞典、法国、澳大利亚、新西兰和中国的 FRAX 工具在评估 36730 名加拿大女性骨折风险时的校准情况。我们的数据强调了应用基于高质量国家骨折流行病学的特定国家 FRAX 工具的重要性。
使用全国性髋部骨折和死亡率数据，为加拿大构建了 FRAX®模型，用于预测髋部骨折和主要骨质疏松性骨折（MOF）。我们研究了该模型在加拿大女性中的校准情况，并将其与其他七种 FRAX 工具进行了比较。
在加拿大马尼托巴省骨密度计划（n=36730）中，对基线骨密度（BMD）测量值为 50 岁以上的女性，使用选定的特定国家/地区的 FRAX 工具，分别计算有无 BMD 情况下的 10 年骨折概率。将 FRAX 风险估计与 10 年内观察到的骨折（506 例髋部骨折，2380 例 MOF）进行比较。比较 10 年骨折风险与预测概率，并对比超过特定治疗阈值的比例。
对于髋部骨折预测，FRAX 加拿大和大多数其他特定国家/地区的 FRAX 工具的校准效果良好，除了瑞典（风险高估）和中国（风险低估）。对于 MOF 预测，国家之间的差异更大；在这个加拿大人群中，FRAX 瑞典和 FRAX 中国显示出最大的高估和低估。与基于 FRAX 加拿大的治疗资格相比，FRAX 瑞典（无 BMD 时为 1.41，有 BMD 时为 1.55）治疗高髋部骨折概率（≥3%）的可能性更大，而 FRAX 中国（无 BMD 时为 0.09，有 BMD 时为 0.11）则明显减少。在治疗高 MOF（≥20%）方面，国家之间的差异更大；FRAX 瑞典再次显著增加（无 BMD 时为 1.76，有 BMD 时为 1.83），而 FRAX 中国则严重减少了治疗资格（无 BMD 时为 0.00，有 BMD 时为 0.01）。
使用针对目标人群进行了准确校准的特定国家/地区的 FRAX 工具至关重要。相对较小的校准差异可能对高风险分类和治疗资格产生重大影响。
