FRAX and Risk of Vertebral Fractures: The Fracture Intervention Trial

Authors

  • Meghan G. Donaldson,

    Corresponding author
    1. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
    • Meghan Donaldson, PhD, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107, USA
    Search for more papers by this author
  • Lisa Palermo,

    1. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
    Search for more papers by this author
  • John T. Schousboe,

    1. Park Nicollet Health Services and Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
    Search for more papers by this author
    • Dr. Schousboe has received research support from Eli Lilly & Company and consulting fees from Roche. Dr. Hochberg has received research support, has consulted for, or received honoraria from Amgen, Eli Lilly & Company, Merck, Novaratis Pharma, Roche Pharmaceutical, Zelos, Procter & Gamble, and GSK. Dr. Cummings has received research support, has consulted for, or received honoraria from Amgen, Eli Lilly & Company, Pfizer, Zelos, Procter & Gamble, and GSK. All other authors state that they have no conflicts of interest.

  • Kristine E. Ensrud,

    1. University of Minnesota and CCDOR VA Medical Center, Minneapolis, Minnesota, USA
    Search for more papers by this author
  • Marc C. Hochberg,

    1. University of Maryland School of Medicine, Baltimore, Maryland, USA
    Search for more papers by this author
  • Steven R. Cummings

    1. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
    Search for more papers by this author

  • Published online on May 4, 2009

Abstract

The validity of the WHO 10-yr probability of major osteoporotic fracture model (FRAX) for prediction of vertebral fracture has not been tested. We analyzed how well FRAX for major osteoporotic fractures, with and without femoral neck BMD (FN BMD), predicted the risk of vertebral fracture. We also compared the predictive validity of FRAX, FN BMD, and prevalent vertebral fracture detected by radiographs at baseline alone or in combination to predict future vertebral fracture. We analyzed data from the placebo groups of FIT (3.8-yr follow-up, n = 3221) with ORs and areas under receiver operating characteristics (ROC) curves (AUC). FRAX with and without FN BMD predicted incident radiographic vertebral fracture. The AUC was significantly greater for FRAX with FN BMD (AUC = 0.71) than FRAX without FN BMD (AUC = 0.68; p = 0.002). Prevalent vertebral fracture plus age and FN BMD (AUC = 0.76) predicted incident radiographic vertebral fracture as well as a combination of prevalent vertebral fracture and FRAX with FN BMD (AUC = 0.75; p = 0.76). However, baseline vertebral fracture status plus age and FN BMD (AUC = 0.76) predicted incident radiographic vertebral fracture significantly better than FRAX with FN BMD (AUC = 0.71; p = 0.0017). FRAX for major osteoporotic fractures (with and without FN BMD) predicts vertebral fracture. However, once FN BMD and age are known, the eight additional risk factors in FRAX do not significantly improve the prediction of vertebral fracture. A combination of baseline radiographic vertebral fracture, FN BMD, and age is the strongest predictor of future vertebral fracture.

Ancillary