Department of Health Systems Administration, Coller School of Management, Tel Aviv University, Tel Aviv, Israel.
Institute for Health Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
Am J Epidemiol. 2018 Jan 1;187(1):94-102. doi: 10.1093/aje/kwx128.
The predictive value of the World Health Organization's Fracture Risk Assessment Tool (FRAX) was evaluated using real-world community data. A population-based cohort of 141,320 women aged 50-90 years (median age, 58 years; interquartile range, 54-67) in 2004 was extracted from the central database of a large Israeli health-care services provider and insurer. Retrospective FRAX scores were calculated using computerized health records and compared with actual incidence of major osteoporotic fractures (MOFs) during the following 10 years. Fracture proportions of 6.9% for MOFs and 2.2% for hip fractures were expected, as opposed to 13.5% and 2.9% observed. The area under the receiver operating characteristic curve (AUC) of FRAX scores calculated without the inclusion of bone mineral density (BMD) data was 0.65 (95% confidence interval: 0.65, 0.66) for MOF and 0.82 (95% confidence interval: 0.81, 0.82) for hip fracture. A total of 16,578 subjects had BMD data at the index date, and their risk estimates based solely on BMD exhibited lower predictive performance for both MOFs (AUC = 0.62 vs. 0.65; P = 0.003) and hip fractures (AUC = 0.78 vs. 0.84; P < 0.001) as compared with FRAX. FRAX scores based on electronic health records provided reasonable discrimination despite some underestimation of the absolute risk of nonhip fractures. Integration of FRAX with routine clinical systems could increase implementation in daily practice and improve risk detection, especially for patients without BMD data.
世界卫生组织的骨折风险评估工具（FRAX）的预测价值是使用真实世界的社区数据进行评估的。从一家大型以色列医疗保健服务提供商和保险公司的中央数据库中提取了 2004 年年龄在 50-90 岁（中位数年龄 58 岁；四分位间距 54-67）的 141320 名女性的基于人群的队列。使用计算机化的健康记录计算回顾性 FRAX 评分，并将其与接下来 10 年内主要骨质疏松性骨折（MOF）的实际发生率进行比较。预计 MOF 的骨折比例为 6.9%，髋部骨折为 2.2%，而观察到的比例分别为 13.5%和 2.9%。不包括骨密度（BMD）数据计算的 FRAX 评分的受试者工作特征曲线下面积（AUC）为 MOF 的 0.65（95%置信区间：0.65，0.66），髋部骨折的 0.82（95%置信区间：0.81，0.82）。共有 16578 名患者在指数日期有 BMD 数据，仅基于 BMD 的风险估计对 MOF（AUC=0.62 比 0.65；P=0.003）和髋部骨折（AUC=0.78 比 0.84；P<0.001）的预测性能均较低。尽管对非髋部骨折的绝对风险存在一定低估，但基于电子健康记录的 FRAX 评分仍提供了合理的区分度。将 FRAX 与常规临床系统相结合，可以增加在日常实践中的实施，并提高风险检测能力，特别是对于没有 BMD 数据的患者。
