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Simplified System for Absolute Fracture Risk Assessment: Clinical Validation in Canadian Women
Author(s) -
Leslie William D,
Tsang James F,
Lix Lisa M
Publication year - 2009
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1359/jbmr.081012
Subject(s) - medicine , osteoporosis , population , hip fracture , frax , forearm , risk assessment , surgery , osteoporotic fracture , bone mineral , environmental health , computer security , computer science
Absolute 10‐yr fracture risk based on multiple factors is the preferred method for risk assessment. A simplified risk assessment system from sex, age, DXA, and two clinical risk factors (CRFs)—prior fracture and systemic corticosteroid (CS) use‐has been used in Canada since 2005. This study was undertaken to evaluate this system in the Canadian female population. A total of 16,205 women ≥50 yr of age at the time of baseline BMD (1998–2002) were identified in a database containing all clinical DXA test results for the Province of Manitoba, Canada. Basal 10‐yr fracture risk from age and minimum T‐score (lumbar spine, femur neck, trochanter, total hip) was categorized as low (<10%), moderate (10–20%), or high (>20%). Health service records since 1987 were assessed for prior fracture codes ( N = 5224), recent major CS use ( N = 616), and fracture codes after BMD testing (mean, 3.1 yr of follow‐up) for the hip, vertebrae, forearm, or humerus (designated osteoporotic, N = 757). Fracture risk predicted from age and minimum T‐score alone showed a significant gradient in observed fracture rates (low 5.1 [95% CI, 4.1–6.4], moderate 11.5 [95% CI, 10.1–13.0], high 25.4 [95% CI, 23.2–27.9] per 1000 person‐years; p ‐for‐trend <0.0001). There was an incremental increase in incident fracture rates from a prior fracture (13.9 [95% CI, 11.3–16.4] per 1000 person‐years) or major CS use (11.2 [95% CI, 4.1–18.2] per 1000 person‐years). This simplified fracture risk assessment system provides an assessment of fracture risk that is consistent with observed fracture rates.