title: The Fracture and Immobilization Score (FRISC) for risk assessment of osteoporotic fracture and immobilization in postmenopausal women--A joint analysis of the Nagano, Miyama, and Taiji Cohorts.
abstract: BACKGROUND
  We aimed to (i) explore risk factors for major osteoporotic fracture or immobilization; (ii) develop a prediction model that can be used to assess the risk of fracture and immobilization; and (iii) assess external validity of the final model.
  
  
  METHODS
  A total of 1787 postmenopausal Japanese women were followed in a hospital-based cohort study. Endpoints included the annual incidence of major osteoporotic fracture and immobilization. For each endpoint, multivariate Poisson regression models were fitted separately and risk factors were screened through backward variable selection. The predictive accuracy of the final model (FRISC) was evaluated in two independent community-based cohorts.
  
  
  RESULTS
  Over a median follow-up of 5.3 years, a total of 383 major osteoporotic fractures (279 clinical vertebral, 44 hip, 60 distal forearm) and 83 immobilizations occurred in the developmental dataset. Backward variable selection confirmed that the following are risk factors for major osteoporotic fracture: age, weight, prior fracture, back pain, and lumbar bone mineral density (BMD). Age, prior fracture and dementia were significant risk factors for immobilization. Hosmer-Lemeshow tests did not indicate any significant deviation between the observed fracture frequency and prediction from the FRISC in the independent validation dataset. The C statistic for the FRISC was 0.727 (95% confidence interval: 0.660 to 0.794) and was higher than that for BMD alone significantly (p=0.03).
  
  
  CONCLUSIONS
  We developed a novel prediction model for fracture and immobilization, FRISC, and the clinical risk factors in the FRISC allows better identification of populations at high risk of fracture than BMD alone. A web application is available at http://www.biostatistics.jp/prediction/frisc.
authors.affiliation: Division of Clinical Trial Design and Management, Translational Research Center, Kyoto University, Kyoto, Japan. shiro@kuhp.kyoto-u.ac.jp
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kuroda
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hosoi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Saito
authors.forename: Masataka
authors.initials: M
authors.lastname: Shiraki
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D020407:Internet; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors