Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Nakhon Pathom, Thailand.
Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA.
Osteoporos Int. 2024 Feb;35(2):265-275. doi: 10.1007/s00198-023-06950-0. Epub 2023 Oct 24.
We compared the performance of FRAX according to frailty status in 3554 individuals from the Framingham Study. During 10-year follow-up, 6.9% and 3.0% of participants with and without frailty experienced MOF. Discrimination profiles were lower in participants with frailty compared to those without, but they improved when FRAX included BMD.
Frailty increases fracture risk. FRAX was developed to predict fractures but never validated in individuals with frailty. We aimed to compare the predictive performance of FRAX (v4.3) in individuals with and without frailty.
We conducted a cohort study using the Framingham Heart Study. Frailty was defined by the Fried phenotype. Major osteoporotic fractures (MOF) were ascertained from medical records during 10-year follow-up. To evaluate discrimination and calibration of FRAX, we calculated the area-under-the-receiver-operating characteristics curves (AUC) using logistic regression models and observed-to-predicted fracture probabilities. Analyses were stratified by frailty status.
Frailty was present in 550/3554 (15.5%) of participants. Participants with frailty were older (81.1 vs. 67.6 years), female (68.6% vs. 55.1%), and had greater mean FRAX scores (MOF: 15.9% vs. 10.1%) than participants without frailty. During follow-up, 38 participants with frailty (6.9%) and 91 without (3.0%) had MOFs. The AUC for FRAX (without BMD) was lower in participants with frailty (0.584; 95% CI 0.504-0.663) compared to those without (0.695; 95% CI 0.649-0.741); p value = 0.02. Among participants with frailty, the AUC improved when FRAX included BMD (AUC 0.658, p value < 0.01). FRAX overestimated MOF risk, with larger overestimations in individuals without frailty. Performance of FRAX for hip fracture was similar.
FRAX may have been less able to identify frail individuals at risk for fracture, as compared with individuals without frailty, unless information on BMD is available. This suggests that BMD captures features important for fracture prediction in frail persons. Future fracture prediction models should be developed among persons with frailty.
我们比较了 3554 名弗雷明汉研究参与者中根据虚弱状态的 FRAX 表现。在 10 年随访期间，有和没有虚弱的参与者分别有 6.9%和 3.0%经历了主要骨质疏松性骨折（MOF）。与没有虚弱的参与者相比，虚弱参与者的鉴别特征较低，但当 FRAX 包含 BMD 时，它们会得到改善。
虚弱会增加骨折风险。FRAX 旨在预测骨折，但从未在虚弱个体中得到验证。我们旨在比较 FRAX（v4.3）在有和没有虚弱的个体中的预测性能。
我们使用弗雷明汉心脏研究进行了一项队列研究。虚弱状态由弗里德表型定义。在 10 年的随访期间，从病历中确定了主要骨质疏松性骨折（MOF）。为了评估 FRAX 的鉴别和校准能力，我们使用逻辑回归模型计算了受试者工作特征曲线下的面积（AUC），并观察到预测的骨折概率。分析按虚弱状态分层。
3554 名参与者中有 550 名（15.5%）存在虚弱。与没有虚弱的参与者相比，虚弱的参与者年龄更大（81.1 岁 vs. 67.6 岁）、女性（68.6% vs. 55.1%）、平均 FRAX 评分更高（MOF：15.9% vs. 10.1%）。在随访期间，38 名有虚弱的参与者（6.9%）和 91 名没有虚弱的参与者（3.0%）发生了 MOF。与没有虚弱的参与者相比，FRAX（不包括 BMD）的 AUC 在有虚弱的参与者中较低（0.584；95%CI 0.504-0.663）；p 值=0.02。在有虚弱的参与者中，当 FRAX 包含 BMD 时，AUC 提高（AUC 0.658，p 值<0.01）。FRAX 高估了 MOF 风险，在没有虚弱的参与者中高估程度更大。FRAX 预测髋部骨折的性能相似。
与没有虚弱的参与者相比，FRAX 可能不太能够识别有骨折风险的虚弱个体，除非有 BMD 信息。这表明 BMD 可捕捉到与虚弱者骨折预测相关的重要特征。未来的骨折预测模型应在虚弱者中开发。
