PittsburghV1, France, Analysis, bibRecord, 000649

Predicting Fractures in an International Cohort Using Risk Factor Algorithms Without BMD

Identifieur interne : 000649 ( France/Analysis ); précédent : 000648; suivant : 000650

Predicting Fractures in an International Cohort Using Risk Factor Algorithms Without BMD

Auteurs : Philip N. Sambrook [Australie] ; Julie Flahive [États-Unis] ; Fred H. Hooven [États-Unis] ; Steven Boonen [Belgique] ; Roland Chapurlat [France] ; Robert Lindsay [États-Unis] ; Tuan V. Nguyen [Australie] ; Adolfo Diez-Perez [Espagne] ; Johannes Pfeilschifter [Allemagne] ; Susan L. Greenspan [États-Unis] ; David Hosmer [États-Unis] ; J. Coen Netelenbos [Pays-Bas] ; Jonathan D. Adachi [Canada] ; Nelson B. Watts [États-Unis] ; Cyrus Cooper [Royaume-Uni] ; Christian Roux [France] ; Maurizio Rossini [Italie] ; Ethel S. Siris [États-Unis] ; Stuart Silverman [États-Unis] ; Kenneth G. Saag [États-Unis] ; Juliet E. Compston [Royaume-Uni] ; Andrea Lacroix [États-Unis] ; Stephen Gehlbach [États-Unis]

Source :

Journal of bone and mineral research : (Print) [ 0884-0431 ] ; 2011.

RBID : Pascal:12-0031293

Descripteurs français

Pascal (Inist)
- Fracture, Facteur risque, Postménopause, Femelle, Prédiction, Modèle, Mammalia, Système ostéoarticulaire.

English descriptors

KwdEn :
- Female, Fracture, Mammalia, Models, Osteoarticular system, Postmenopause, Prediction, Risk factor.

Abstract

Clinical risk factors are associated with increased probability of fracture in postmenopausal women. We sought to compare prediction models using self-reported clinical risk factors, excluding BMD, to predict incident fracture among postmenopausal women. The GLOW study enrolled women aged 55 years or older from 723 primary-care practices in 10 countries. The population comprised 19,586 women aged 60 years or older who were not receiving antiosteoporosis medication and were followed annually for 2 years. Self-administered questionnaires were used to collect data on characteristics, fracture risk factors, previous fractures, and health status. The main outcome measure compares the C index for models using the WHO Fracture Risk (FRAX), the Garvan Fracture Risk Calculator (FRC), and a simple model using age and prior fracture. Over 2 years, 880 women reported incident fractures including 69 hip fractures, 468 "major fractures" (as defined by FRAX), and 583 "osteoporotic fractures" (as defined by FRC). Using baseline clinical risk factors, both FRAX and FRC showed a moderate ability to correctly order hip fracture times (C index for hip fracture 0.78 and 0.76, respectively). C indices for "major" and "osteoporotic" fractures showed lower values, at 0.61 and 0.64. Neither algorithm was better than the model based on age + fracture history alone (C index for hip fracture 0.78). In conclusion, estimation of fracture risk in an international primary-care population of postmenopausal women can be made using clinical risk factors alone without BMD. However, more sophisticated models incorporating multiple clinical risk factors including falls were not superior to more parsimonious models in predicting future fracture in this population.

Affiliations:

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Le document en format XML

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<author><name sortKey="Nguyen, Tuan V" sort="Nguyen, Tuan V" uniqKey="Nguyen T" first="Tuan V." last="Nguyen">Tuan V. Nguyen</name>
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<author><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name>
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<wicri:noRegion>Alfried Krupp Krankenhaus</wicri:noRegion>
<wicri:noRegion>Essen</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Greenspan, Susan L" sort="Greenspan, Susan L" uniqKey="Greenspan S" first="Susan L." last="Greenspan">Susan L. Greenspan</name>
<affiliation wicri:level="4"><inist:fA14 i1="09"><s1>Department of Medicine, University of Pittsburgh</s1>
<s2>Pittsburgh, PA</s2>
<s3>USA</s3>
<sZ>10 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><settlement type="city">Pittsburgh</settlement>
<region type="state">Pennsylvanie</region>
</placeName>
<orgName type="university">Université de Pittsburgh</orgName>
</affiliation>
</author>
<author><name sortKey="Hosmer, David" sort="Hosmer, David" uniqKey="Hosmer D" first="David" last="Hosmer">David Hosmer</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Center for Outcomes Research, University of Massachusetts Medical School</s1>
<s2>Worcester, MA</s2>
<s3>USA</s3>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>23 aut.</sZ>
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<country>États-Unis</country>
<wicri:noRegion>Worcester, MA</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Netelenbos, J Coen" sort="Netelenbos, J Coen" uniqKey="Netelenbos J" first="J. Coen" last="Netelenbos">J. Coen Netelenbos</name>
<affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Department of Endocrinology, VU University Medical Center</s1>
<s2>Amsterdam</s2>
<s3>NLD</s3>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Pays-Bas</country>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Adachi, Jonathan D" sort="Adachi, Jonathan D" uniqKey="Adachi J" first="Jonathan D." last="Adachi">Jonathan D. Adachi</name>
<affiliation wicri:level="4"><inist:fA14 i1="11"><s1>Department of Medicine, St Joseph's Hospital, McMaster University</s1>
<s2>Hamilton, Ontario</s2>
<s3>CAN</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
<country>Canada</country>
<placeName><settlement type="city">Hamilton (Ontario)</settlement>
<region type="state">Ontario</region>
</placeName>
<orgName type="university">Université McMaster</orgName>
</affiliation>
</author>
<author><name sortKey="Watts, Nelson B" sort="Watts, Nelson B" uniqKey="Watts N" first="Nelson B." last="Watts">Nelson B. Watts</name>
<affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Bone Health and Osteoporosis Center, University of Cincinnati</s1>
<s2>Cincinnati, OH</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Cincinnati, OH</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name>
<affiliation wicri:level="1"><inist:fA14 i1="13"><s1>MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital</s1>
<s2>Southampton</s2>
<s3>GBR</s3>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<wicri:noRegion>Southampton</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name>
<affiliation wicri:level="3"><inist:fA14 i1="14"><s1>Department of Rheumatology, Paris Descartes University, Cochin Hospital</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name>
<affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Department of Rheumatology, University of Verona, Ospedale</s1>
<s2>Verona, Valeggio</s2>
<s3>ITA</s3>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>Italie</country>
<wicri:noRegion>Verona, Valeggio</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Siris, Ethel S" sort="Siris, Ethel S" uniqKey="Siris E" first="Ethel S." last="Siris">Ethel S. Siris</name>
<affiliation wicri:level="1"><inist:fA14 i1="16"><s1>Department of Medicine, Columbia University Medical Center</s1>
<s2>New York, NY</s2>
<s3>USA</s3>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>New York, NY</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name>
<affiliation wicri:level="1"><inist:fA14 i1="17"><s1>Division of Rheumatology, Cedars-Sinai Medical Center</s1>
<s2>Los Angeles, CA</s2>
<s3>USA</s3>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Los Angeles, CA</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="18"><s1>UCLA School of Medicine</s1>
<s2>Los Angeles, CA</s2>
<s3>USA</s3>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>UCLA School of Medicine</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G." last="Saag">Kenneth G. Saag</name>
<affiliation wicri:level="1"><inist:fA14 i1="19"><s1>Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham</s1>
<s2>Birmingham, AL</s2>
<s3>USA</s3>
<sZ>20 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Birmingham, AL</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Compston, Juliet E" sort="Compston, Juliet E" uniqKey="Compston J" first="Juliet E." last="Compston">Juliet E. Compston</name>
<affiliation wicri:level="1"><inist:fA14 i1="20"><s1>Cambridge University Hospitals NHS Foundation Trust</s1>
<s2>Cambridge</s2>
<s3>GBR</s3>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<wicri:noRegion>Cambridge University Hospitals NHS Foundation Trust</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lacroix, Andrea" sort="Lacroix, Andrea" uniqKey="Lacroix A" first="Andrea" last="Lacroix">Andrea Lacroix</name>
<affiliation wicri:level="1"><inist:fA14 i1="21"><s1>Public Health Sciences Division, Center for Health Studies, Group Health Cooperative of Puget Sound, Fred Hutchinson Cancer Research Center</s1>
<s2>Seattle, WA</s2>
<s3>USA</s3>
<sZ>22 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Seattle, WA</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Gehlbach, Stephen" sort="Gehlbach, Stephen" uniqKey="Gehlbach S" first="Stephen" last="Gehlbach">Stephen Gehlbach</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Center for Outcomes Research, University of Massachusetts Medical School</s1>
<s2>Worcester, MA</s2>
<s3>USA</s3>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Worcester, MA</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Journal of bone and mineral research : (Print)</title>
<title level="j" type="abbreviated">J. bone miner. res. : (Print)</title>
<idno type="ISSN">0884-0431</idno>
<imprint><date when="2011">2011</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Journal of bone and mineral research : (Print)</title>
<title level="j" type="abbreviated">J. bone miner. res. : (Print)</title>
<idno type="ISSN">0884-0431</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Female</term>
<term>Fracture</term>
<term>Mammalia</term>
<term>Models</term>
<term>Osteoarticular system</term>
<term>Postmenopause</term>
<term>Prediction</term>
<term>Risk factor</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Fracture</term>
<term>Facteur risque</term>
<term>Postménopause</term>
<term>Femelle</term>
<term>Prédiction</term>
<term>Modèle</term>
<term>Mammalia</term>
<term>Système ostéoarticulaire</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Clinical risk factors are associated with increased probability of fracture in postmenopausal women. We sought to compare prediction models using self-reported clinical risk factors, excluding BMD, to predict incident fracture among postmenopausal women. The GLOW study enrolled women aged 55 years or older from 723 primary-care practices in 10 countries. The population comprised 19,586 women aged 60 years or older who were not receiving antiosteoporosis medication and were followed annually for 2 years. Self-administered questionnaires were used to collect data on characteristics, fracture risk factors, previous fractures, and health status. The main outcome measure compares the C index for models using the WHO Fracture Risk (FRAX), the Garvan Fracture Risk Calculator (FRC), and a simple model using age and prior fracture. Over 2 years, 880 women reported incident fractures including 69 hip fractures, 468 "major fractures" (as defined by FRAX), and 583 "osteoporotic fractures" (as defined by FRC). Using baseline clinical risk factors, both FRAX and FRC showed a moderate ability to correctly order hip fracture times (C index for hip fracture 0.78 and 0.76, respectively). C indices for "major" and "osteoporotic" fractures showed lower values, at 0.61 and 0.64. Neither algorithm was better than the model based on age + fracture history alone (C index for hip fracture 0.78). In conclusion, estimation of fracture risk in an international primary-care population of postmenopausal women can be made using clinical risk factors alone without BMD. However, more sophisticated models incorporating multiple clinical risk factors including falls were not superior to more parsimonious models in predicting future fracture in this population.</div>
</front>
</TEI>
<affiliations><list><country><li>Allemagne</li>
<li>Australie</li>
<li>Belgique</li>
<li>Canada</li>
<li>Espagne</li>
<li>France</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region><li>Auvergne-Rhône-Alpes</li>
<li>Catalogne</li>
<li>Hollande-Septentrionale</li>
<li>Ontario</li>
<li>Pennsylvanie</li>
<li>Rhône-Alpes</li>
<li>Île-de-France</li>
</region>
<settlement><li>Amsterdam</li>
<li>Barcelone</li>
<li>Hamilton (Ontario)</li>
<li>Lyon</li>
<li>Paris</li>
<li>Pittsburgh</li>
</settlement>
<orgName><li>Université McMaster</li>
<li>Université de Pittsburgh</li>
</orgName>
</list>
<tree><country name="Australie"><noRegion><name sortKey="Sambrook, Philip N" sort="Sambrook, Philip N" uniqKey="Sambrook P" first="Philip N." last="Sambrook">Philip N. Sambrook</name>
</noRegion>
<name sortKey="Nguyen, Tuan V" sort="Nguyen, Tuan V" uniqKey="Nguyen T" first="Tuan V." last="Nguyen">Tuan V. Nguyen</name>
</country>
<country name="États-Unis"><noRegion><name sortKey="Flahive, Julie" sort="Flahive, Julie" uniqKey="Flahive J" first="Julie" last="Flahive">Julie Flahive</name>
</noRegion>
<name sortKey="Gehlbach, Stephen" sort="Gehlbach, Stephen" uniqKey="Gehlbach S" first="Stephen" last="Gehlbach">Stephen Gehlbach</name>
<name sortKey="Greenspan, Susan L" sort="Greenspan, Susan L" uniqKey="Greenspan S" first="Susan L." last="Greenspan">Susan L. Greenspan</name>
<name sortKey="Hooven, Fred H" sort="Hooven, Fred H" uniqKey="Hooven F" first="Fred H." last="Hooven">Fred H. Hooven</name>
<name sortKey="Hosmer, David" sort="Hosmer, David" uniqKey="Hosmer D" first="David" last="Hosmer">David Hosmer</name>
<name sortKey="Lacroix, Andrea" sort="Lacroix, Andrea" uniqKey="Lacroix A" first="Andrea" last="Lacroix">Andrea Lacroix</name>
<name sortKey="Lindsay, Robert" sort="Lindsay, Robert" uniqKey="Lindsay R" first="Robert" last="Lindsay">Robert Lindsay</name>
<name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G." last="Saag">Kenneth G. Saag</name>
<name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name>
<name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name>
<name sortKey="Siris, Ethel S" sort="Siris, Ethel S" uniqKey="Siris E" first="Ethel S." last="Siris">Ethel S. Siris</name>
<name sortKey="Watts, Nelson B" sort="Watts, Nelson B" uniqKey="Watts N" first="Nelson B." last="Watts">Nelson B. Watts</name>
</country>
<country name="Belgique"><noRegion><name sortKey="Boonen, Steven" sort="Boonen, Steven" uniqKey="Boonen S" first="Steven" last="Boonen">Steven Boonen</name>
</noRegion>
</country>
<country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Chapurlat, Roland" sort="Chapurlat, Roland" uniqKey="Chapurlat R" first="Roland" last="Chapurlat">Roland Chapurlat</name>
</region>
<name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name>
</country>
<country name="Espagne"><region name="Catalogne"><name sortKey="Diez Perez, Adolfo" sort="Diez Perez, Adolfo" uniqKey="Diez Perez A" first="Adolfo" last="Diez-Perez">Adolfo Diez-Perez</name>
</region>
</country>
<country name="Allemagne"><noRegion><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name>
</noRegion>
</country>
<country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Netelenbos, J Coen" sort="Netelenbos, J Coen" uniqKey="Netelenbos J" first="J. Coen" last="Netelenbos">J. Coen Netelenbos</name>
</region>
</country>
<country name="Canada"><region name="Ontario"><name sortKey="Adachi, Jonathan D" sort="Adachi, Jonathan D" uniqKey="Adachi J" first="Jonathan D." last="Adachi">Jonathan D. Adachi</name>
</region>
</country>
<country name="Royaume-Uni"><noRegion><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name>
</noRegion>
<name sortKey="Compston, Juliet E" sort="Compston, Juliet E" uniqKey="Compston J" first="Juliet E." last="Compston">Juliet E. Compston</name>
</country>
<country name="Italie"><noRegion><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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Predicting Fractures in an International Cohort Using Risk Factor Algorithms Without BMD

Predicting Fractures in an International Cohort Using Risk Factor Algorithms Without BMD

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