Proposed FRAX multipliers overestimate fracture risk for women with recent fracture
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Variables added to adjust the Fracture Risk Assessment Tool for recent fractures overestimated risk in a cohort of older women from Canada, according to a speaker.
The Fracture Risk Assessment Tool (FRAX), used to estimate risk for major osteoporotic fractures, predicted 10-year fracture risks similar to what was observed in a cohort of women from the Manitoba Bone Mineral Density Program registry. However, the FRAX tool overestimated risk when a set of multipliers were applied to account for recent fractures.
“FRAX risk multipliers for recent fracture — in the last 2 years — which were developed to refine fracture prediction, require examination in other cohorts, and meanwhile should be interpreted with caution in clinical practice,” William D. Leslie, MD, MSc, professor of medicine and radiology at the University of Manitoba, told Healio.
Leslie and colleagues analyzed data from 33,465 women aged 40 to 64 years and 33,806 women aged 65 years and older who had a baseline DXA conducted between 1996 and 2016 and a minimum follow-up of 2 years. Previous major osteoporotic fractures were identified and stratified by recency as none, less than 2 years, and 2 years or more. Researchers used FRAX to estimate 10-year cumulative major osteoporotic fracture and hip fracture probability and compared the prediction with the actual subsequent fractures reported in the cohort. For women who had a major osteoporotic fracture within the past 2 years, a set of multipliers adjusting FRAX for fracture site and recency were applied, and the multiplier-adjusted model was compared with observed subsequent fractures and the original FRAX prediction.
Women in the younger age group had increased risk for major osteoporotic fracture if they had any prior fracture within the past 2 years (OR = 2.86; 95% CI, 2.13-3.84; P < .05) or a prior vertebral fracture within the past 2 years (OR = 5.94; 95% CI, 3.72-9.49; P < .001) compared with those with no prior fracture. Women aged at least 65 years and less than 2 years removed from a prior fracture had an increased risk for any major osteoporotic fracture compared with those with no prior fracture (OR = 1.91; 95% CI, 1.32-2.76; P < .05). Women aged at least 65 years also had an increased risk for a hip fracture with a prior major osteoporotic fracture (OR = 2.45; 95% CI, 1.75-3.45; P < .01), hip fracture (OR = 2.99; 95% CI, 1.85-4.83; P < .01) or humerus fracture within the last 2 years (OR = 3.65; 95% CI, 2.09-6.36; P < .05) compared with women with no prior fracture.
Over 10 years, any prior fracture was associated with increased risk for a subsequent fracture for women in both age groups. In women aged 40 to 64 years, a prior fracture within 2 years was associated with a higher 10-year fracture risk compared with those whose previous fracture was longer than 2 years ago. For women aged 65 years or older, no significant difference in 10-year fracture risk was observed with recent or remote prior fracture.
“The risk of re-fracture after a first fracture declined gradually over time but remained elevated in all age and sex subgroups for over 10 years,” Leslie told Healio.
In an analysis of FRAX-predicted fractures, the 10-year fracture probability for FRAX was similar for most observed fractures in both older and younger women with both recent and remote prior fractures. When the proposed multipliers were added to FRAX for women with a recent prior fracture, fracture risk for both major osteoporotic and hip fractures was overestimated in both age groups.
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Leslie WD, et al. Abstract 1029. Presented at: ASBMR Annual Meeting; Oct. 1-4, 2021; San Diego (hybrid meeting).
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