Fracture Risk Assessment With FRAX Using Real-World Data in a Population-Based Cohort From Israel

• Published in: American journal of epidemiology Vol. 187; no. 1; pp. 94 - 102
• Main Authors: Goldshtein, Inbal, Gerber, Yariv, Ish-Shalom, Sophia, Leshno, Moshe
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.01.2018; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Area Under Curve; Biomedical materials; Bone Density; Bone mineral density; Confidence intervals; Electronic health records; Electronic Health Records - statistics & numerical data; Electronic medical records; Female; Fractures; Health risk assessment; Hip; Hip Fractures - epidemiology; Hip Fractures - etiology; Humans; Israel - epidemiology; Mathematical analysis; Middle Aged; Osteoporosis; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - etiology; Performance prediction; Predictive Value of Tests; Retrospective Studies; Risk assessment; Risk Assessment - methods; Risk Assessment - statistics & numerical data; Risk Factors; ROC Curve; Israel; aged; FRAX; osteoporosis; fractures; fracture risk
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kwx128

Abstract The predictive value of the World Health Organization’s Fracture Risk Assessment Tool (FRAX) was evaluated using real-world community data. A population-based cohort of 141,320 women aged 50–90 years (median age, 58 years; interquartile range, 54–67) in 2004 was extracted from the central database of a large Israeli health-care services provider and insurer. Retrospective FRAX scores were calculated using computerized health records and compared with actual incidence of major osteoporotic fractures (MOFs) during the following 10 years. Fracture proportions of 6.9% for MOFs and 2.2% for hip fractures were expected, as opposed to 13.5% and 2.9% observed. The area under the receiver operating characteristic curve (AUC) of FRAX scores calculated without the inclusion of bone mineral density (BMD) data was 0.65 (95% confidence interval: 0.65, 0.66) for MOF and 0.82 (95% confidence interval: 0.81, 0.82) for hip fracture. A total of 16,578 subjects had BMD data at the index date, and their risk estimates based solely on BMD exhibited lower predictive performance for both MOFs (AUC = 0.62 vs. 0.65; P = 0.003) and hip fractures (AUC = 0.78 vs. 0.84; P < 0.001) as compared with FRAX. FRAX scores based on electronic health records provided reasonable discrimination despite some underestimation of the absolute risk of nonhip fractures. Integration of FRAX with routine clinical systems could increase implementation in daily practice and improve risk detection, especially for patients without BMD data.