Kline Gregory A, Lix Lisa M, Morin Suzanne N, Leslie William D
Department of Medicine, Cumming School of Medicine, University of Calgary, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada.
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Arch Osteoporos. 2022 Oct 6;17(1):133. doi: 10.1007/s11657-022-01173-y.
Fracture risk calculators may not be accurate for all ethnicity groups. The Manitoba bone density registry was used to test the Canadian CAROC tool for predicting fracture risk in Asian-Canadian women. The tool significantly over-estimated fracture risk, suggesting that it may not be ideal for Asian-Canadian patients.
Health risk prediction tools based on largely White populations may lead to treatment inequity when applied to non-White populations where outcome rates differ. We examined the calibration of the Canadian Association of Radiologists-Osteoporosis Canada (CAROC) fracture risk prediction tool in self-identified Asian-Canadian women.
Retrospective cohort study of women over age 50 using the Manitoba BMD Registry. At first BMD, the intake questionnaire collected self-identification of ethnicity and fracture risk factors. 10-year fracture risk was estimated using CAROC and categorized into low, medium, or high fracture risk. Linked administrative databases identified incident osteoporotic fractures. Observed fracture rates were compared between White and Asian-Canadians and compared to the original CAROC risk stratification.
There were 63,632 and 1703 women who self-identified as White-Canadian or Asian-Canadian, respectively, covering approximately 600,000 patient-years follow-up. There were 6588 incident fractures; a similar percentage of patients were assigned to each risk stratum at baseline by CAROC. A progressive rise in 10-year observed fracture rates occurred for each CAROC stratum in the White-Canadian population but much lower fracture rates than predicted in Asian-Canadian patients (p < 0.001). Fracture incidence rate ratios were 1.9-2.6 fold higher in White- vs Asian-Canadian patients for all strata (p < 0.001). In the CAROC moderate and high-risk categories, observed fracture rates in Asian-Canadian patients were typically lower than predicted, indicating poor model calibration.
In Asian-Canadian women, observed osteoporosis fracture rates are lower than predicted when using the CAROC tool. Over-estimation of fracture risk may influence shared decision-making discussions.
骨折风险计算器可能并非对所有种族群体都准确。马尼托巴骨密度登记处被用于测试加拿大CAROC工具在预测亚裔加拿大女性骨折风险方面的效果。该工具显著高估了骨折风险，这表明它可能对亚裔加拿大患者并不理想。
基于主要为白人人群的健康风险预测工具，应用于结局发生率不同的非白人人群时，可能导致治疗不平等。我们研究了加拿大放射学家协会 - 加拿大骨质疏松症协会（CAROC）骨折风险预测工具在自我认定的亚裔加拿大女性中的校准情况。
使用马尼托巴骨密度登记处对50岁以上女性进行回顾性队列研究。在首次骨密度测量时，通过摄入问卷收集种族自我认定和骨折风险因素。使用CAROC估计10年骨折风险，并将其分为低、中或高骨折风险。通过关联行政数据库确定骨质疏松性骨折事件。比较白人和亚裔加拿大女性的观察到的骨折率，并与原始CAROC风险分层进行比较。
分别有63,632名和1703名女性自我认定为加拿大白人或亚裔加拿大女性，涵盖约600,000患者年的随访。共有6588例骨折事件；CAROC在基线时将相似比例的患者分配到每个风险分层。在加拿大白人人群中，每个CAROC分层的10年观察到的骨折率呈逐步上升趋势，但亚裔加拿大患者的骨折率远低于预测值（p < 0.001）。所有分层中，白人患者与亚裔加拿大患者的骨折发病率比高1.9 - 2.6倍（p < 0.001）。在CAROC中度和高风险类别中，亚裔加拿大患者观察到的骨折率通常低于预测值，表明模型校准不佳。
在亚裔加拿大女性中，使用CAROC工具时观察到的骨质疏松性骨折率低于预测值。骨折风险的高估可能会影响共同决策讨论。
