title: Discriminative value of FRAX for fracture prediction in a cohort of Chinese postmenopausal women.
abstract: We followed 2,266 postmenopausal Chinese women for 4.5 years to determine which model best predicts osteoporotic fracture. A model that contains ethnic-specific risk factors, some of which reflect frailty, performed as well as or better than the well-established FRAX model.
  
  
  BACKGROUND
  Clinical risk assessment, with or without T-score, can predict fractures in Chinese postmenopausal women although it is unknown which combination of clinical risk factors is most effective. This prospective study sought to compare the accuracy for fracture prediction using various models including FRAX, our ethnic-specific clinical risk factors (CRF) and other simple models.
  
  
  METHODS
  This study is part of the Hong Kong Osteoporosis Study. A total of 2,266 treatment naïve postmenopausal women underwent clinical risk factor and bone mineral density assessment. Subjects were followed up for outcome of major osteoporotic fracture and receiver operating characteristic (ROC) curves for different models were compared. The percentage of subjects in different quartiles of risk according to various models who actually fractured was also compared.
  
  
  RESULTS
  The mean age at baseline was 62.1 ± 8.5 years and mean follow-up time was 4.5 ± 2.8 years. A total of 106 new major osteoporotic fractures were reported, of which 21 were hip fractures. Ethnic-specific CRF with T-score performed better than FRAX with T-score (based on both Chinese normative and National Health and Nutrition Examination Survey (NHANES) databases) in terms of AUC comparison for prediction of major osteoporotic fracture. The two models were similar in hip fracture prediction. The ethnic-specific CRF model had a 10% higher sensitivity than FRAX at a specificity of 0.8 or above.
  
  
  CONCLUSIONS
  CRF related to frailty and differences in lifestyle between populations are likely to be important in fracture prediction. Further work is required to determine which and how CRF can be applied to develop a fracture prediction model in our population.
authors.affiliation: Department of Medicine, United Christian Hospital, Hong Kong, China. cheunyne@ha.org.hk
authors.forename: E Y N
authors.initials: EY
authors.lastname: Cheung
authors.forename: C H
authors.initials: CH
authors.lastname: Bow
authors.forename: C L
authors.initials: CL
authors.lastname: Cheung
authors.forename: C
authors.initials: C
authors.lastname: Soong
authors.forename: S
authors.initials: S
authors.lastname: Yeung
authors.forename: C
authors.initials: C
authors.lastname: Loong
authors.forename: A
authors.initials: A
authors.lastname: Kung
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D044466:Asian People / Q000523:psychology / Q000706:statistics & numerical data; D015519:Bone Density / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008019:Life Style / Q000208:ethnology; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D018570:Risk Assessment / Q000379:methods