García-Sempere Aníbal, Hurtado Isabel, Peiró Salvador, Sánchez-Sáez Francisco, Santaana Yared, Rodríguez-Bernal Clara, Sanfélix-Gimeno Gabriel, Sanfélix-Genovés José
Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain.
Spanish Network for Research in Primary Care and Chronicity (RICAPPS), 46020 Valencia, Spain.
J Clin Med. 2022 Apr 25;11(9):2409. doi: 10.3390/jcm11092409.
In Spain, the Fracture Risk Assessment Tool (FRAX) was adapted using studies with a small number of patients, and there are only a few external validation studies that present limitations. In this prospective cohort study, we compared the performance of FRAX and a simple age and sex model. We used data from the ESOSVAL cohort, a cohort composed of a Mediterranean population of 11,035 women and men aged 50 years and over, followed for up to 8 years, to compare the discrimination, calibration, and reclassification of FRAX calibrated for Spain and a logistic model including only age and sex as variables. We found virtually identical AUC, 83.55% for FRAX (CI 95%: 80.46, 86.63) and 84.10% for the age and sex model (CI 95%: 80.91, 87.29), and there were similar observed-to-predicted ratios. In the reclassification analyses, patients with a hip fracture that were reclassified correctly as high risk by FRAX, compared to the age and sex model, were -2.86%, using either the 3% threshold or the observed incidence, 1.54% (95%CI: -8.44, 2.72 for the 3% threshold; 95%CI: -7.68, 1.97 for the incidence threshold). Remarkably simple and inexpensive tools that are easily transferable into electronic medical record environments may offer a comparable predictive ability to that of FRAX.
在西班牙，骨折风险评估工具（FRAX）是根据少量患者的研究进行调整的，并且仅有少数外部验证研究，但这些研究存在局限性。在这项前瞻性队列研究中，我们比较了FRAX与一个简单的年龄和性别模型的性能。我们使用了ESOSVAL队列的数据，该队列由11035名年龄在50岁及以上的地中海人群（包括男性和女性）组成，随访时间长达8年，以比较针对西班牙校准的FRAX与一个仅将年龄和性别作为变量的逻辑模型的区分度、校准度和重新分类情况。我们发现二者的曲线下面积（AUC）几乎相同，FRAX为83.55%（95%置信区间：80.46, 86.63），年龄和性别模型为84.10%（95%置信区间：80.91, 87.29），并且观察到的与预测的比率相似。在重新分类分析中，与年龄和性别模型相比，FRAX将髋部骨折患者正确重新分类为高风险的比例为 -2.86%，使用3%阈值或观察到的发病率时分别为1.54%（95%置信区间：对于3%阈值为 -8.44, 2.72；对于发病率阈值为 -7.68, 1.97）。非常简单且廉价、易于转换到电子病历环境中的工具可能具有与FRAX相当的预测能力。
