Key result
The FRAX tool calibrated for Spain demonstrated virtually identical discrimination for fracture risk compared to a simple age and sex model (AUC 83.55% vs 84.10%).
Why the study?
In Spain, the FRAX tool was adapted using studies with small sample sizes, and existing external validation studies have limitations.
Does the FRAX tool calibrated for Spain improve fracture risk prediction compared to a simple age and sex model in adults aged 50 years and over?
Cohort (n=11,035)
Does the FRAX tool calibrated for Spain improve fracture risk prediction compared to a simple age and sex model in adults aged 50 years and over?
Absolute Event Rate: 83.55% vs 84.1%
A simple age and sex model offers comparable predictive ability for hip fracture risk to the FRAX tool calibrated for Spain.
FRAX adds no predictive value over age and sex alone for hip fracture; leaves open its incremental utility in Spanish adults and requires prospective validation.
In Spain, the Fracture Risk Assessment Tool (FRAX) was adapted using studies with a small number of patients, and there are only a few external validation studies that present limitations. In this prospective cohort study, we compared the performance of FRAX and a simple age and sex model. We used data from the ESOSVAL cohort, a cohort composed of a Mediterranean population of 11,035 women and men aged 50 years and over, followed for up to 8 years, to compare the discrimination, calibration, and reclassification of FRAX calibrated for Spain and a logistic model including only age and sex as variables. We found virtually identical AUC, 83.55% for FRAX (CI 95%: 80.46, 86.63) and 84.10% for the age and sex model (CI 95%: 80.91, 87.29), and there were similar observed-to-predicted ratios. In the reclassification analyses, patients with a hip fracture that were reclassified correctly as high risk by FRAX, compared to the age and sex model, were -2.86%, using either the 3% threshold or the observed incidence, 1.54% (95%CI: -8.44, 2.72 for the 3% threshold; 95%CI: -7.68, 1.97 for the incidence threshold). Remarkably simple and inexpensive tools that are easily transferable into electronic medical record environments may offer a comparable predictive ability to that of FRAX.
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García‐Sempere et al. (2022) conducted a cohort in Fracture risk (n=11,035). FRAX tool calibrated for Spain vs. Age and sex logistic model was evaluated on Discrimination (AUC). The FRAX tool calibrated for Spain demonstrated virtually identical discrimination for fracture risk compared to a simple age and sex model (AUC 83.55% vs 84.10%).
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