title: Comparison of fracture risk prediction among individuals with reduced and normal kidney function.
abstract: OBJECTIVE
  The Fracture Risk Assessment Tool (FRAX) is widely used to predict the 10-year probability of fracture; however, the clinical utility of FRAX in CKD is unknown. This study assessed the predictive ability of FRAX in individuals with reduced kidney function compared with individuals with normal kidney function.
  
  
  METHODS
  The discrimination and calibration (defined as the agreement between observed and predicted values) of FRAX were examined using data from the Canadian Multicentre Osteoporosis Study (CaMos). This study included individuals aged ≥40 years with an eGFR value at year 10 of CaMos (defined as baseline). The cohort was stratified by kidney function at baseline (eGFR<60 ml/min per 1.73 m(2) [72.2% stage 3a, 23.8% stage 3b, and 4.0% stage 4/5] versus ≥60 ml/min per 1.73 m(2)) and followed individuals for a mean of 4.8 years for an incident major osteoporotic fracture (clinical spine, hip, forearm/wrist, or humerus).
  
  
  RESULTS
  There were 320 individuals with an eGFR<60 ml/min per 1.73 m(2) and 1787 with an eGFR≥60 ml/min per 1.73 m(2). The mean age was 67±10 years and 71% were women. The 5-year observed major osteoporotic fracture risk was 5.3% (95% confidence interval [95% CI], 3.3% to 8.6%) in individuals with an eGFR<60 ml/min per 1.73 m(2), which was comparable to the FRAX-predicted fracture risk (6.4% with bone mineral density; 8.2% without bone mineral density). A statistically significant difference was not observed in the area under the curve values for FRAX in individuals with an eGFR<60 ml/min per 1.73 m(2) versus ≥60 ml/min per 1.73 m(2) (0.69 [95% CI, 0.54 to 0.83] versus 0.76 [95% CI, 0.70 to 0.82]; P=0.38).
  
  
  CONCLUSIONS
  This study showed that FRAX was able to predict major osteoporotic fractures in individuals with reduced kidney function; further study is needed before FRAX should be routinely used in individuals with reduced kidney function.
authors: Division of Nephrology, Departments of Epidemiology and Biostatistics and kyla.naylor@lhsc.on.ca.
authors: Kyla L
authors: KL
authors: Naylor
authors: Division of Nephrology, Departments of Epidemiology and Biostatistics and Institute for Clinical Evaluative Sciences, Ontario, Canada;
authors: Amit X
authors: AX
authors: Garg
authors: Division of Nephrology.
authors: Guangyong
authors: G
authors: Zou
authors: CaMos National Coordinating Centre and.
authors: Lisa
authors: L
authors: Langsetmo
authors: Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada;
authors: William D
authors: WD
authors: Leslie
authors: Medicine, Western University, London, Ontario, Canada;
authors: Lisa-Ann
authors: LA
authors: Fraser
authors: Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada;
authors: Jonathan D
authors: JD
authors: Adachi
authors: Department of Medicine, McGill University, Montreal, Quebec, Canada;
authors: Suzanne
authors: S
authors: Morin
authors: Bone and Calcium Research Laboratories, Royal Victoria Hospital, Montreal, Quebec, Canada;
authors: David
authors: D
authors: Goltzman
authors: Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada;
authors: Brian
authors: B
authors: Lentle
authors: Department of Radiology, University of Alberta, Edmonton, Alberta, Canada;
authors: Stuart A
authors: SA
authors: Jackson
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and.
authors: Robert G
authors: RG
authors: Josse
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada.
authors: Sophie A
authors: SA
authors: Jamal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002170:Canada / Q000453:epidemiology; D003661:Decision Support Techniques; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: CKD; Fracture Risk Assessment Tool; clinical epidemiology; epidemiology; fracture; outcomes
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