Department of Medicine (C5121), St Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
University of Alberta, Edmonton, Canada.
Osteoporos Int. 2017 Sep;28(9):2557-2564. doi: 10.1007/s00198-017-4091-3. Epub 2017 Jun 7.
In a large clinical registry for the province of Manitoba, Canada, FRAX predicted incident MOF and hip fracture from 1 to 15 years following baseline assessment. A simple linear rescaling of FRAX outputs seems useful for predicting both short- and long-term fracture risk in this population.
FRAX® estimates 10-year probability of major osteoporotic fracture (MOF) and hip fracture. We examined FRAX predictions over intervals shorter and longer than 10 years.
Using a population-based clinical registry for Manitoba, Canada, we identified 62,275 women and 6455 men 40 years and older with baseline dual-energy X-ray absorptiometry scans and FRAX scores. Incident MOF and hip fracture were assessed up to 15 years from population-based data. We assessed agreement between estimated fracture probability from 1 to 15 years using linearly rescaled FRAX scores and observed cumulative fracture probability. The gradient of risk for FRAX probability and incident fracture was examined overall and for 5-year intervals.
FRAX predicted incident MOF and hip fracture for all time intervals. There was no attenuation in the gradient of risk for MOF even for years >10. Gradient of risk was slightly lower for hip fracture prediction in years >10 vs years <5, though HRs remained high. Linear agreement was seen in the relationships between observed vs predicted (rescaled) FRAX probabilities (R 0.95-1.00). Among women, there was near-perfect linearity in MOF predictions. Deviations from linearity, with a slightly higher observed than predicted MOF probability, were most evident in the first years following a fracture event and after 10 years for hip fracture prediction in women using FRAX with BMD. Simulations showed that results were robust to large differences in fracture rates and moderate differences in mortality rates.
FRAX predicts incident MOF and hip fracture up to 15 years and could be adapted to predict fracture over time periods shorter and longer term than 10 years in populations with fracture and mortality epidemiology similar to Canada.
在加拿大马尼托巴省的一个大型临床注册中心，使用 Frax 预测基线评估后 1 至 15 年内的 MOF 和髋部骨折。Frax 输出的简单线性重新调整似乎可用于预测该人群的短期和长期骨折风险。
使用加拿大马尼托巴省的一个基于人群的临床注册中心，我们确定了 62275 名女性和 6455 名 40 岁及以上基线双能 X 线吸收法（DXA）扫描和 Frax 评分的男性。从基于人群的数据中评估了 15 年内的 MOF 和髋部骨折。我们评估了使用线性重新调整的 Frax 评分从 1 年到 15 年估计的骨折概率与观察到的累积骨折概率之间的一致性。总体上和每 5 年的间隔评估了 Frax 概率和骨折发生率的风险梯度。
Frax 预测了所有时间间隔的 MOF 和髋部骨折。即使在 10 年以上的时间内，MOF 的风险梯度也没有减弱。与 5 年以下相比，10 年以上髋部骨折预测的风险梯度略低，尽管 HR 仍然很高。在观察到的 vs 预测（重新调整）Frax 概率之间观察到线性关系（R 0.95-1.00）。在女性中，MOF 预测几乎具有完美的线性。在骨折事件后最初几年以及在女性中使用包含 BMD 的 Frax 预测髋部骨折 10 年后，观察到的 MOF 概率略高于预测概率，这表明存在线性偏离。模拟表明，结果对骨折发生率的较大差异和死亡率的中度差异具有稳健性。
Frax 预测 MOF 和髋部骨折发生的时间长达 15 年，并且可以适应于预测比 10 年更短期和长期的骨折风险，前提是具有类似于加拿大的骨折和死亡率流行病学的人群。
