title: The utility of absolute risk prediction using FRAX® and Garvan Fracture Risk Calculator in daily practice.
abstract: OBJECTIVE
  There are two commonly used fracture risk prediction tools FRAX(®) and Garvan Fracture Risk Calculator (GARVAN-FRC). The objective of this study was to investigate the utility of these tools in daily practice.
  
  
  METHODS
  A prospective population-based 5-year follow-up study was conducted in ten general practice centres in the Netherlands. For the analyses, the FRAX(®) and GARVAN-FRC 10-year absolute risks (FRAX(®) does not have 5-year risk prediction) for all fractures were used.
  
  
  RESULTS
  Among 506 postmenopausal women aged ≥60 years (mean age: 67.8±5.8 years), 48 (9.5%) sustained a fracture during follow-up. Both tools, using BMD values, distinguish between women who did and did not fracture (10.2% vs. 6.8%, respectively for FRAX(®) and 32.4% vs. 39.1%, respectively for GARVAN-FRC, p<0.0001) at group level. However, only 8.9% of those who sustained a fracture had an estimated fracture risk ≥20% using FRAX(®) compared with 53.3% using GARVAN-FRC. Although both underestimated the observed fracture risk, the GARVAN-FRC performed significantly better for women who sustained a fracture (higher sensitivity) and FRAX(®) for women who did not sustain a fracture (higher specificity). Similar results were obtained using age related cut off points.
  
  
  CONCLUSIONS
  The discriminant value of both models is at least as good as models used in other medical conditions; hence they can be used to communicate the fracture risk to patients. However, given differences in the estimated risks between FRAX(®) and GARVAN-FRC, the significance of the absolute risk must be related to country-specific recommended intervention thresholds to inform the patient.
authors.affiliation: Maastricht University/CAPHRI and NUTRIM, Department of Family Medicine, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: tineke.vangeel@maastrichtuniversity.nl.
authors.forename: Tineke A C M
authors.initials: TA
authors.lastname: van Geel
authors.affiliation: Garvan Institute of Medical Research, Osteoporosis & Bone Biology Program, Sydney, NSW, Australia; St. Vincent's Hospital, University of New South Wales, Sydney, Australia; Sydney School of Medicine, University of Notre Dame, Sydney, Australia.
authors.forename: John A
authors.initials: JA
authors.lastname: Eisman
authors.affiliation: Maastricht University Medical Centre/CAPHRI, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht, The Netherlands; University Hasselt, Biomedical Research Institute, Belgium.
authors.forename: Piet P
authors.initials: PP
authors.lastname: Geusens
authors.affiliation: University Hasselt, Biomedical Research Institute, Belgium; VieCuri Medical Centre Noord-Limburg, Department of Internal Medicine, Subdivision of Endocrinology, Venlo, The Netherlands; Maastricht University Medical Centre/NUTRIM, Maastricht, The Netherlands.
authors.forename: Joop P W
authors.initials: JP
authors.lastname: van den Bergh
authors.affiliation: Garvan Institute of Medical Research, Osteoporosis & Bone Biology Program, Sydney, NSW, Australia; St. Vincent's Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Center
authors.affiliation: Maastricht University/CAPHRI, Department of Family Medicine, Maastricht, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000368:Aged; D015519:Bone Density; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Bone (MeSH); FRAX(®); Female (MeSH); Fractures; Garvan Fracture Risk Calculator; Risk assessment (MeSH)