Independent external validation of nomograms for predicting risk of low-trauma fracture and hip fracture

Langsetmo, Lisa; Nguyen, Tuan V.; Nguyen, Nguyen D.; Kovacs, Christopher S.; Prior, Jerilynn C.; Center, Jacqueline R.; Morin, Suzanne; Josse, Robert G.; Adachi, Jonathan D.; Hanley, David A.; Eisman, John A.
February 2011
CMAJ: Canadian Medical Association Journal;2/8/2011, Vol. 183 Issue 2, pE107
Academic Journal
Background: A set of nomograms based on the Dubbo Osteoporosis Epidemiology Study predicts the five- and ten-year absolute risk of fracture using age, bone mineral density and history of falls and low-trauma fracture. We assessed the discrimination and calibration of these nomograms among participants in the Canadian Multicentre Osteoporosis Study. Methods: We included participants aged 55- 95 years for whom bone mineral density measurement data and at least one year of follow- up data were available. Self-reported incident fractures were identified by yearly postal questionnaire or interview (years 3, 5 and 10). We included low-trauma fractures before year 10, except those of the skull, face, hands, ankles and feet. We used a Cox proportional hazards model. Results: Among 4152 women, there were 583 fractures, with a mean follow-up time of 8.6 years. Among 1606 men, there were 116 fractures, with a mean follow-up time of 8.3 years. Increasing age, lower bone mineral density, prior fracture and prior falls were associated with increased risk of fracture. For low-trauma fractures, the concordance between predicted risk and fracture events (Harrell C) was 0.69 among women and 0.70 among men. For hip fractures, the concordance was 0.80 among women and 0.85 among men. The observed fracture risk was similar to the predicted risk in all quintiles of risk except the highest quintile of women, where it was lower. The net reclassification index (19.2%, 95% confidence interval [CI] 6.3% to 32.2%), favours the Dubbo nomogram over the current Canadian guidelines for men. Interpretation: The published nomograms provide good fracture-risk discrimination in a representative sample of the Canadian population.


Related Articles

  • Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Nguyen, N. D.; Frost, S. A.; Center, J. R.; Eisman, J. A.; Nguyen, T. V. // Osteoporosis International;Oct2008, Vol. 19 Issue 10, p1431 

    We have developed clinical nomograms for predicting 5-year and 10-year fracture risks for any elderly man or woman. The nomograms used age and information concerning fracture history, fall history, and BMD T-score or body weight. Although many fracture risk factors have been identified, the...

  • Use baseline T-score to decide osteoporosis testing frequency.  // Pulse;5/16/2012, Vol. 72 Issue 18, p6 

    The article discusses a study which suggests baseline T-score as the most essential frequency determinant for testing bone mineral density (BMD) in fracture-risk patients.

  • Fracture risk and antiresorptive medication use in older women in the USA. Gehlbach, S. H.; Avrunin, J. S.; Puleo, E.; Spaeth, R. // Osteoporosis International;Jun2007, Vol. 18 Issue 6, p805 

    Risk of fragility fractures in older women appears to be under-recognized and under treated. Analysis of a national sample of older US women reveals that over 5 million are at high risk of fracture; only one third of these report being told they have osteoporosis and one quarter are receiving...

  • Enhancement of Absolute Fracture Risk Prognosis with Genetic Marker: The Collagen I Alpha 1 Gene. Tran, Bich N. H.; Nguyen, Nguyen D.; Center, Jacqueline R.; Eisman, John A.; Nguyen, Tuan V. // Calcified Tissue International;Nov2009, Vol. 85 Issue 5, p379 

    An important objective of genetic research in osteoporosis is to translate genotype data into the prognosis of fracture. The present study sought to develop a prognostic model for predicting osteoporotic fracture by using information from a genetic marker and clinical risk factors. It was...

  • Recombinant parathormone and osteoporosis: a review article. Larijani, Bagher; Alimadadi, Ashraf // Tehran University Medical Journal;Dec2010, Vol. 68 Issue 9, p497 

    Osteoporosis is a condition characterized with reduced bone density and destruction of the bone structure. The ideal treatment aims to reduce the risk of fracture while improving the density and structure of the bone. Parathormone (PTH) and its main analogue triparatide (rhPTH [1-34]) is a new...

  • Ten-year fracture probability identifies women who will benefit from clodronate therapy–additional results from a double-blind, placebo-controlled randomised study. McCloskey, E. V.; Johansson, H.; Oden, A.; Vasireddy, S.; Kayan, K.; Pande, K.; Jalava, T.; Kanis, J. A. // Osteoporosis International;May2009, Vol. 20 Issue 5, p811 

    Fracture risk prediction can be enhanced by the concurrent assessment of other clinical risk factors. This study demonstrates that the estimation of an individual’s 10-year probability of fracture by the FRAX® algorithm identifies patients at high risk of fracture who will respond to...

  • Osteoporosis: An Overview. Harden, Keisha; Porcena, Marie // Med-Surg Matters;Mar2006, Vol. 15 Issue 2, p1 

    Provides information on osteoporosis, a highly prevalent disorder that is characterized by compromised bone strength, which predisposes individuals to an increased risk of fractures. Major factors that contribute to bone mass; Process involved in the assessment and diagnostics of bone health;...

  • Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: the Eastern European TBS study. Vasic, Jelena; Gojkovic, Filip; Petranova, Tzvetanka; Rashkov, Rasho; Povoroznyuk, Vladyslav; Dzerovych, Nataliia; Barbu, Carmen; Poiana, Catalina; Karadzic, Mirjana; Dimic, Aleksandar; Elez, Jelena; CulaficVojinovic, Violeta; Winzenrieth, Renaud; Hans, Didier // Journal of Bone & Mineral Metabolism;Sep2014, Vol. 32 Issue 5, p556 

    The aim of the study was to assess the clinical performance of the model combining areal bone mineral density (aBMD) at spine and microarchitecural texture (TBS) for the detection of the osteoporotic fracture. The Eastern European Study is a multicenter study (Serbia, Bulgaria, Romania and...

  • The Assessment of Fracture Risk. Unnanuntana, Aasis; Gladnick, Brian P.; Donnelly, Eve; Lane, Joseph M. // Journal of Bone & Joint Surgery, American Volume;Mar2010, Vol. 92-A Issue 3, p743 

    The article discusses the calculation of age-specific fracture probabilities in men and women through the Fracture Risk Assessment Tool (FRAX). Patients with bone mineral density in the osteopenic range usually have fragility fractures. The efficacy of antiresorptive or anabolic therapy can be...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics