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Total hip bone area affects fracture prediction with FRAX® in Canadian white women
Leslie, William D. Lix, Lisa Majumdar, S. R. Morin, Suzanne N. Johansson, Helena Oden, Anders McCloskey, Eugene Kanis, John
Leslie, William D.
Lix, Lisa
Majumdar, S. R.
Morin, Suzanne N.
Johansson, Helena
Oden, Anders
McCloskey, Eugene
Kanis, John
Abstract
Context Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area. Objective To examine whether fracture prediction by FRAX® is affected by hip area. Design and Setting Cohort study using a population-based BMD registry. Patients A total of 58,108 white women aged ≥40 years. Main Outcome Measures Incident major osteoporotic fracture (MOF; n = 4913) and hip fracture (n = 1369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL). Results Smaller hip area was associated with younger age and lower FRAX® scores, whereas incident fractures were greater in those with larger hip area (P for trend < 0.001). Larger hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (P for trend < 0.001). Each standard deviation increase in hip area was associated with greater risk for incident MOF [adjusted hazard ratio (HR), 1.08; 95% confidence interval (CI), 1.05 to 1.11] and hip fracture (HR, 1.16; 95% CI, 1.11 to 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated hip fracture risk in the three largest hip area quintiles. Conclusions In Canadian white women, skeletal size based on hip area affects fracture risk assessment based on FRAX® score with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size and provides for more accurate assessment of fracture risk.
Keywords
Date
2017
Type
Journal article
Journal
The Journal of Clinical Endocrinology and Metabolism
Book
Volume
102
Issue
11
Page Range
4242-4249
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
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Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled