Individualized fracture risk assessment: Progresses and challenges

Nguyen, TV; Center, JR; Eisman, JA

Individualized fracture risk assessment: Progresses and challenges

Nguyen, TV

Center, JR Eisman, JA

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Publication Type:: Journal Article
Citation:: Current Opinion in Rheumatology, 2013, 25 (4), pp. 532 - 541
Issue Date:: 2013-07-01

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Field	Value	Language
dc.contributor.author	Nguyen, TV https://orcid.org/0000-0002-3246-6281	en_US
dc.contributor.author	Center, JR	en_US
dc.contributor.author	Eisman, JA	en_US
dc.date.issued	2013-07-01	en_US
dc.identifier.citation	Current Opinion in Rheumatology, 2013, 25 (4), pp. 532 - 541	en_US
dc.identifier.issn	1040-8711	en_US
dc.identifier.uri	http://hdl.handle.net/10453/31038
dc.description.abstract	PURPOSE OF REVIEW: Fragility fracture is a major public health burden, because it is associated with a substantial morbidity and mortality. Risk prediction models, including the Fracture Risk Assessment Tool (FRAX) and Garvan Fracture Risk Calculator (GFRC), have been developed to provide a useful clinical framework for communicating the risk of fracture. The present review examines the validation of risk prediction models in osteoporosis and identifies some major challenges. RECENT FINDINGS: Recent validation studies suggested that the area under the ROC curve in fracture discrimination ranged from 0.61 to 0.83 for FRAX, and from 0.63 to 0.88 for GFRC, with hip fracture having a better discrimination than fragility fractures as a group. FRAX substantially underestimated the risk of fracture, whereas the predicted risk by GFRC was close to or slightly higher than the actual risk. Results of post-hoc analyses of clinical trials indicated the antifracture efficacy of alendronate, coronate, bazedoxifene, and denosumab was greater in patients with higher predicted risk of fracture. However, there was no correlation between antifracture efficacy and predicted fracture risk among patients on raloxifene and strontium ranelate. SUMMARY: The prognostic performance of FRAX and GFRC for fracture prediction is not perfect, but these predictive models can aid patients and doctors to communicate about fracture risk in the medium term and to make rational decisions. However, the application of these predictive models in making decisions for an individual should take into account the individual's perception of the importance of the risk of fracture and its severity outcomes. © 2013 Wolters Kluwer Health / Lippincott Williams & Wilkins.	en_US
dc.relation.ispartof	Current Opinion in Rheumatology	en_US
dc.relation.isbasedon	10.1097/BOR.0b013e328361ff8c	en_US
dc.subject.classification	Arthritis & Rheumatology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Prognosis	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Biomedical Research	en_US
dc.subject.mesh	Bone Density Conservation Agents	en_US
dc.subject.mesh	Osteoporotic Fractures	en_US
dc.title	Individualized fracture risk assessment: Progresses and challenges	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	25	en_US
utslib.for	0903 Biomedical Engineering	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	25	en_US

Abstract:

PURPOSE OF REVIEW: Fragility fracture is a major public health burden, because it is associated with a substantial morbidity and mortality. Risk prediction models, including the Fracture Risk Assessment Tool (FRAX) and Garvan Fracture Risk Calculator (GFRC), have been developed to provide a useful clinical framework for communicating the risk of fracture. The present review examines the validation of risk prediction models in osteoporosis and identifies some major challenges. RECENT FINDINGS: Recent validation studies suggested that the area under the ROC curve in fracture discrimination ranged from 0.61 to 0.83 for FRAX, and from 0.63 to 0.88 for GFRC, with hip fracture having a better discrimination than fragility fractures as a group. FRAX substantially underestimated the risk of fracture, whereas the predicted risk by GFRC was close to or slightly higher than the actual risk. Results of post-hoc analyses of clinical trials indicated the antifracture efficacy of alendronate, coronate, bazedoxifene, and denosumab was greater in patients with higher predicted risk of fracture. However, there was no correlation between antifracture efficacy and predicted fracture risk among patients on raloxifene and strontium ranelate. SUMMARY: The prognostic performance of FRAX and GFRC for fracture prediction is not perfect, but these predictive models can aid patients and doctors to communicate about fracture risk in the medium term and to make rational decisions. However, the application of these predictive models in making decisions for an individual should take into account the individual's perception of the importance of the risk of fracture and its severity outcomes. © 2013 Wolters Kluwer Health / Lippincott Williams & Wilkins.

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http://hdl.handle.net/10453/31038