Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older

被引:2
|
作者
Ensrud, Kristine E. [1 ,2 ,3 ]
Schousboe, John T. [4 ,5 ]
Crandall, Carolyn J. [6 ]
Leslie, William D. [7 ]
Fink, Howard A. [1 ,2 ,3 ,8 ]
Cawthon, Peggy M. [9 ]
Kado, Deborah M. [10 ,11 ]
Lane, Nancy E. [12 ]
Cauley, Jane A. [13 ]
Langsetmo, Lisa [2 ,3 ]
机构
[1] Univ Minnesota, Sch Publ Hlth, Div Epidemiol & Community Hlth, Minneapolis, MN USA
[2] Univ Minnesota, Dept Med, Minneapolis, MN USA
[3] Vet Affairs Hlth Care Syst, Ctr Care Delivery & Outcomes Res, Minneapolis, MN USA
[4] HealthPartners Inst, Bloomington, MN USA
[5] Univ Minnesota, Sch Publ Hlth, Div Hlth Policy & Management, Minneapolis, MN USA
[6] Univ Calif Los Angeles, Dept Med, Los Angeles, CA USA
[7] Univ Manitoba, Dept Med, Winnipeg, MB, Canada
[8] Vet Affairs Hlth Care Syst, Geriatr Res Educ & Clin Ctr, Minneapolis, MN USA
[9] Calif Pacific Med Ctr Res Inst, San Francisco, CA USA
[10] Stanford Univ, Dept Med, Stanford, CA USA
[11] Vet Affairs Palo Alto Hlth Care Syst, Geriatr Res Educ & Clin Ctr, Palo Alto, CA USA
[12] Univ Calif Davis, Dept Internal Med, Sacramento, CA USA
[13] Univ Pittsburgh, Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA
关键词
PREDICTION; OSTEOPOROSIS; WOMEN; MEN; BMD; VALIDATION; MODEL; FRAX;
D O I
10.1001/jamanetworkopen.2024.18612
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE While adults aged 80 years and older account for 70% of hip fractures in the US, performance of fracture risk assessment tools in this population is uncertain. OBJECTIVE To compare performance of the Fracture Risk Assessment Tool (FRAX), Garvan Fracture Risk Calculator, and femoral neck bone mineral density (FNBMD) alone in 5-year hip fracture prediction. DESIGN, SETTING AND PARTICIPANTS Prognostic analysis of 3 prospective cohort studies including participants attending an index examination (1997 to 2016) at age 80 years or older. Data were analyzed from March 2023 to April 2024. MAIN OUTCOMES AND MEASURES Participants contacted every 4 or 6 months after index examination to ascertain incident hip fractures and vital status. Predicted 5-year hip fracture probabilities calculated using FRAX and Garvan models incorporating FNBMD and FNBMD alone. Model discrimination assessed by area under receiver operating characteristic curve (AUC). Model calibration assessed by comparing observed vs predicted hip fracture probabilities within predicted risk quintiles. RESULTS A total of 8890 participants were included, with a mean (SD) age at index examination of 82.6 (2.7) years; 4906 participants (55.2%) were women, 866 (9.7%) were Black, 7836 (88.1%) were White, and 188 (2.1%) were other races and ethnicities. During 5-year follow-up, 321 women (6.5%) and 123 men (3.1%) experienced a hip fracture; 818 women (16.7%) and 921 men (23.1%) died before hip fracture. Among women, AUC was 0.69 (95% CI, 0.67-0.72) for FRAX, 0.69 (95% CI, 0.66-0.72) for Garvan, and 0.72 (95% CI, 0.69-0.75) for FNBMD alone (FNBMD superior to FRAX, P = .01; and Garvan, P = .01). Among men, AUC was 0.71 (95% CI, 0.66-0.75) for FRAX, 0.76 (95% CI, 0.72-0.81) for Garvan, and 0.77 (95% CI, 0.72-0.81) for FNBMD alone (P < .001 Garvan and FNBMD alone superior to FRAX). Among both sexes, Garvan greatly overestimated hip fracture risk among individuals in upper quintiles of predicted risk, while FRAX modestly underestimated risk among those in intermediate quintiles of predicted risk. CONCLUSIONS AND RELEVANCE In this prognostic study of adults aged 80 years and older, FRAX and Garvan tools incorporating FNBMD compared with FNBMD alone did not improve 5-year hip fracture discrimination. FRAX modestly underpredicted observed hip fracture probability in intermediate-risk individuals. Garvan markedly overpredicted observed hip fracture probability in high-risk individuals. Until better prediction tools are available, clinicians should prioritize consideration of hip BMD, life expectancy, and patient preferences in decision-making regarding drug treatment initiation for hip fracture prevention in late-life adults.
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页数:13
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