Frailty plus trabecular bone score fails to improve fracture risk prediction
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Combining indices of frailty and trabecular bone score did not yield improved predictive accuracy for major osteoporotic fracture risk when compared with frailty alone or trabecular bone score alone, according to findings published in the Journal of Bone and Mineral Research.
“Combining frailty and trabecular bone score could not help improve predictive accuracy in risk of major osteoporotic fractures,” Guowei Li, PhD, MBBS, MSc, associate director of the Center for Clinical Epidemiology and Methodology at Guangdong Second Provincial General Hospital in China and assistant professor in the department of Health Research Methods, Evidence and Impact at McMaster University in Hamilton, Ontario, Canada, told Healio. “Given the suboptimal predictive power in fracture risk assessment with the current prediction tools, combining two independent predictors — frailty and trabecular bone score — from different dimensions might significantly enhance predictive accuracy for fracture risk to help with assessment, treatment, management and decision-making; nevertheless, our results showed that combining frailty and trabecular bone score could not improve predictive accuracy in fracture risk, indicating further endeavors are needed to enhance predictive power for fracture risk assessment and management in osteoporosis.”
Li and colleagues analyzed data from 2,730 adults participating in the Canadian Multicenter Osteoporosis Study, a 5year prospective study of the skeletal health of an unselected population (mean age, 69 years; 70% women). Researchers estimated trabecular bone score values using lumbar spine DXA images; frailty was evaluated by a frailty index of deficit accumulation. Outcome was time to first incident major osteoporotic fracture (upper arm or shoulder, forearm or wrist, spine or hip) during follow-up. All incident fractures were self-reported. Researchers used Cox proportional hazard models to investigate the relationship between trabecular bone score and frailty index and risk for major osteoporotic fractures. The Akaike information criterion, likelihood ratio test, and net reclassification improvement (NRI) were used to compare models combining frailty and trabecular bone score, frailty index alone and trabecular bone score alone.
During a mean follow-up of 7.5 years, researchers observed 243 (8.9%) major osteoporotic fractures. Participants with major osteoporotic fractures had a higher frailty index (mean, 0.24 vs. 0.2) and lower trabecular bone score (mean, 1.231 vs. 1.285) compared with those who did not sustain a major osteoporotic fracture.
Researchers found that each standard deviation increase in frailty index was associated with major osteoporotic fracture risk in a model adjusted for FRAX with bone mineral density and other covariates (HR = 1.26; 95% CI, 1.11-1.43), as was each SD increase in trabecular bone score (HR = 1.38; 95% CI, 1.21-1.59). Independent associations between frailty index, trabecular bone score and major osteoporotic fracture were similar in the combined model, with HRs of 1.24 for frailty index (95% CI, 1.09-1.41) and 1.35 for trabecular bone score (95% CI, 1.17-1.56)
Researchers found that the combined model did not statistically significantly improve prediction when compared with frailty index alone (NRI = 2.1%) or with trabecular bone score alone (NRI = 2.9%), with similar results observed in age-adjusted models and the fully-adjusted models.
“All these findings indicated that combining frailty and trabecular bone score did not yield clinical improvement of predictive power regarding risk of major osteoporotic fracture when compared with the models that used them separately,” the researchers wrote. – by Regina Schaffer
For more information:
Guowei Li, PhD, MBBS, MSc, can be reached at Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main St. West, Hamilton, ON, Canada L8S 4L8; email: lig28@mcmaster.ca.
Disclosures: Li reports he received the Michael G. DeGroote Fellowship Award in Clinical Research from McMaster University, the Post-doctoral Fellowship Award from the Research Institute of St. Joe’s Hamilton, and research grants from the Science Foundation of Guangdong Second Provincial General Hospital. Please see the study for all other authors’ relevant financial disclosures.
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