title: Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?
abstract: OBJECTIVE
  To perform an external validation of FRAX algorithm thresholds for reporting level of risk of fracture in Spanish women (low < 5%; intermediate ≥ 5% and < 7.5%; high ≥ 7.5%) taken from a prospective cohort "FRIDEX".
  
  
  METHODS
  A retrospective study of 1090 women aged ≥ 40 and ≤ 90 years old obtained from the general population (FROCAT cohort). FRAX was calculated with data registered in 2002. All fractures were validated in 2012. Sensitivity analysis was performed.
  
  
  RESULTS
  When analyzing the cohort (884) excluding current or past anti osteoporotic medication (AOM), using our nominated thresholds, among the 621 (70.2%) women at low risk of fracture, 5.2% [CI95%: 3.4-7.6] sustained a fragility fracture; among the 99 at intermediate risk, 12.1% [6.4-20.2]; and among the 164 defined as high risk, 15.9% [10.6-24.2]. Sensitivity analysis against model risk stratification FRIDEX of FRAX Spain shows no significant difference. By including 206 women with AOM, the sensitivity analysis shows no difference in the group of intermediate and high risk and minimal differences in the low risk group.
  
  
  CONCLUSIONS
  Our findings support and validate the use of FRIDEX thresholds of FRAX when discussing the risk of fracture and the initiation of therapy with patients.
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall d' Hebron 119, 08135 Barcelona, Spain; Health Center Badia del Valles (ICS), GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214 Badia del Vallés Barcelona, Spain; Idc-Hospital General de Catalunya, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain. Electronic address: rafael.azagra@uab.cat.
authors.forename: R
authors.initials: R
authors.lastname: Azagra
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall d' Hebron 119, 08135 Barcelona, Spain; Health Center Can Gibert del Plà (ICS), USR Girona-IDIAP Jordi Gol, c/San Sebastian 9, 17005 Girona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Zwart
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall d' Hebron 119, 08135 Barcelona, Spain; Health Center Granollers Valles Oriental (ICS), GROIMAP-USR MN-IDIAP Jordi Gol, c/Museu 19, 08400 Granollers, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Aguyé
authors.affiliation: Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195 Sant Cugat del Valles, Barcelona, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Martín-Sánchez
authors.affiliation: Rheumatology Department, Hospital de Sabadell, Consorci Sanitari Parc Taulí, Universitat Autònoma de Barcelona. Parc Tauli s/n, 08208 Sabadell, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Casado
authors.affiliation: Health Center Cornellà-2 (Sant Ildefons), c/República Argentina s/n, 08940 Cornellá, Barcelona, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Díaz-Herrera
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall d' Hebron 119, 08135 Barcelona, Spain; Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública (CIBERESP), Unitat de Fonaments de l'Anàlisi Econòmica, Departament d'Economia i Història Econòmica, Universitat Autònoma de Barcelona, c/Dr. Aiguader 88, 08003 Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Moriña
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall d' Hebron 119, 08135 Barcelona, Spain; Department of Internal Medicine, URFOA, IMIM, Parc de Salut Mar, Ps Maritimo 25-29, 08003 Barcelona, Spain; Red Temática de Envejecimiento y Fragilidad RETICEF, Instituto de Salud Carlos III-FEDER, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Díez-Pérez
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; Victoria University, PO Box 600, Wellington 6140, New Zealand.
authors.forename: E M
authors.initials: EM
authors.lastname: Dennison
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: FRAX thresholds; Osteoporotic fractures