Diagnostic accuracy of FRAX in predicting the 10-year risk of osteoporotic fractures using the USA treatment thresholds: A systematic review and meta-analysis.

Authors

Xuezhi Jiang, Reading Hospital, Thomas Jefferson UniversityFollow
Morgan Gruner, Reading Hospital
Florence Trémollieres, Centre de Ménopause, Hôpital Paule de Viguier, Toulouse, France
Wojciech Pluskiewicz, Department and Clinic of Internal Diseases, Diabetology and Nephrology-Metabolic Bone Diseases Unit, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
Elisabeth Sornay-Rendu, INSERM Research UMR 1033, Université de Lyon, Lyon, France
Piotr Adamczyk, Department and Clinic of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
Peter F. Schnatz, Reading Hospital, Thomas Jefferson University

Document Type

Poster Presentation

Publication Date

12-2015

Abstract

Objective: The aim of this study is to conduct a systematic review and meta-analysis on the performance of the WHO’s Fracture Risk Assessment (FRAX) instrument for predicting 10-year risk of Major Osteoporotic Fractures (MOF) and Hip Fractures (HF) in populations other than their derivation cohorts. Design: PubMed, Google Scholar, Embase, Cochrane Library, and MEDLINE were searched for the English-language literature from 2008 to 2015. Limiting our search to articles that analyzed only MOF and / or HF as an outcome, 7 longitudinal cohorts from 5 countries (USA, Poland, France, Canada, New Zeland) were identified and included in the meta-analysis. SAS NLMIXED procedure (SAS v 9.3) was applied to fit the Hierarchical Summary Receiver Operating Characteristics (HSROC) model for meta-analysis. Forest plot and HSROC plot was generated by Review Manager (RevMan v 5.3). Results: Seven studies (n=57,027) were analyzed to assess diagnostic accuracy of FRAX in predicting MOF. Using 20% as the 10-year fracture risk threshold, the mean sensitivity, specificity, and diagnostic odds ratio (DOR) along with their 95% confidence intervals (CI) are 10.25% (3.76% - 25.06%), 97.02% (91.17% - 99.03%) and 3.71 (2.73 – 5.05), respectively. For HF prediction, using 3% as the 10-year fracture risk threshold, six studies (n=50,944) were analyzed. The mean sensitivity, specificity, and DOR along with their 95% confidence intervals (CI) are 45.70% (24.88% - 68.13%), 84.70% (76.41% - 90.44%) and 4.66 (2.39 – 9.08), respectively. Conclusion: Overall, FRAX performs better in identifying patients who will not have a MOF or HF within 10 years. However, a substantial number of patients who developed fractures, especially MOF within 10 years of follow up, were missed by the baseline FRAX assessment using the 10 year intervention thresholds of 20% for MOF and 3% for HF.

Publication Title

Menopause (New York, N.Y.)

Volume

22

Issue

12

Comments

Presented at the North American Menopause Society's 26th Annual Meeting
September 30-October 2, 2015
Las Vegas, NV

Recommended Citation

Jiang, X., Gruner, M., Trémollieres, F., Pluskiewicz, W., Sornay-Rendu, E., Adamczyk, P., & Schnatz, P. F. (2015). Diagnostic accuracy of FRAX in predicting the 10-year risk of osteoporotic fractures using the USA treatment thresholds: A systematic review and meta-analysis.. Menopause (New York, N.Y.), 22 (12) https://doi.org/10.1097/GME.0000000000000563