Department of Public Health and Nursing, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway.
Department of Rheumatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Osteoporos Int. 2017 Oct;28(10):2935-2944. doi: 10.1007/s00198-017-4134-9. Epub 2017 Jul 1.
Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) for hip fracture prediction was validated in a Norwegian population 50-90 years. Fracture risk increased with higher FRAX score, and the observed number of hip fractures agreed well with the predicted number, except for the youngest and oldest men. Self-reported fall was an independent risk factor for fracture in women.
The primary aim was to validate FRAX without BMD for hip fracture prediction in a Norwegian population of men and women 50-90 years. Secondary, to study whether information of falls could improve prediction of fractures in the subgroup aged 70-90 years.
Data were obtained from the third survey of the Nord-Trøndelag Health Study (HUNT3), the fracture registry in Nord-Trøndelag, and the Norwegian Prescription Database (NorPD), including 15,432 women and 13,585 men. FRAX hip without BMD was calculated, and hip fractures were registered for a median follow-up of 5.2 years. The number of estimated and observed fractures was assessed, ROC curves with area under the curve (AUC), and Cox regression analyses. For the group aged 70-90 years, self-reported falls the last year before HUNT3 were included in the Cox regression model.
The risk of fracture increased with higher FRAX score. When FRAX groups were categorized in a 10-year percentage risk for hip fracture as follows, <4, 4-7.9, 8-11.9, and ≥12%, the hazard ratio (HR) for hip fracture between the lowest and the highest group was 17.80 (95% CI: 12.86-24.65) among women and 23.40 (13.93-39.30) in men. Observed number of hip fractures agreed quite well with the predicted number, except for the youngest and oldest men. AUC was 0.81 (0.78-0.83) for women and 0.79 (0.76-0.83) for men. Self-reported fall was an independent risk factor for fracture in women (HR 1.64, 1.20-2.24), and among men, this was not significant (1.09, 0.65-1.83).
FRAX without BMD predicted hip fracture reasonably well. In the age group 70-90 years, falls seemed to imply an additional risk among women.
在挪威 50-90 岁的男性和女性人群中验证不基于骨密度（BMD）的骨折风险评估工具（FRAX）对髋部骨折的预测作用。次要目的：研究在 70-90 岁年龄组中，跌倒信息是否能改善骨折预测。
数据来自挪威特伦德拉格健康研究（HUNT3）的第三次调查、特伦德拉格骨折登记处和挪威处方数据库（NorPD），包括 15432 名女性和 13585 名男性。计算不基于 BMD 的 FRAX 髋部骨折，并对中位随访 5.2 年期间的髋部骨折进行登记。评估估计和观察到的骨折数量、曲线下面积（AUC）的 ROC 曲线以及 Cox 回归分析。对于年龄在 70-90 岁的组，将 HUNT3 前一年的自我报告跌倒纳入 Cox 回归模型。
骨折风险随 FRAX 评分的升高而增加。当 FRAX 组按 10 年髋部骨折百分比风险分为<4、4-7.9、8-11.9 和≥12%时，女性最低组和最高组之间髋部骨折的风险比（HR）为 17.80（95%CI：12.86-24.65），男性为 23.40（13.93-39.30）。观察到的髋部骨折数量与预测数量相当吻合，除了最年轻和最年长的男性。女性的 AUC 为 0.81（0.78-0.83），男性为 0.79（0.76-0.83）。自我报告的跌倒是女性骨折的独立危险因素（HR 1.64，1.20-2.24），而在男性中，这并不显著（1.09，0.65-1.83）。
不基于 BMD 的 FRAX 能较好地预测髋部骨折。在 70-90 岁年龄组中，跌倒似乎是女性骨折的一个额外危险因素。
