Comparison of CAROC and FRAX in Fragility Fracture Patients: Agreement, Clinical Utility, and Implications for Clinical Practice.
To examine the level of agreement between 2 fracture risk assessment tools [Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX)] when applied within the context of the Canadian guidelines, in a population of fragility fracture patients.



The sample consisted of 135 treatment-naive fragility fracture patients aged 50+ years and screened as part of an osteoporosis (OP) program at an urban hospital. Ten-year probabilities of future major osteoporotic fractures were calculated using the FRAX and CAROC. We also integrated additional qualifiers from the 2010 Canadian guidelines that place hip, spine, and multiple fractures at high risk regardless. A quadratic weighted κ (Kw) and 95% CI were calculated to estimate the chance corrected agreement between the risk assessment tools. Logistic regression was used to evaluate the factors associated with concordance.



Among patients with fragility fractures, the agreement between CAROC and FRAX was Kw = 0.64 (95% CI 0.58-0.71), with 45 of 135 cases in the cells reflecting disagreement. Younger persons and males were more likely to be found in discordant cells.



The level of agreement between 2 commonly used fracture risk assessment tools was not as high in the patients with fragility fractures as it was in general community-based samples. Our results suggest discordance is found in less-typical patients with OP who need more consistency in messaging and direction. Users of these fracture risk tools should be aware of the potential for discordance and note differences in risk classifications that may affect treatment decisions.
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery.
Nooshin Khobzi
NK
Rotondi
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery. beatond@smh.ca.
Dorcas E
DE
Beaton
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery.
Victoria
V
Elliot-Gibson
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery.
Rebeka
R
Sujic
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery.
Robert G
RG
Josse
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery.
Joanna E M
JE
Sale
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery.
William D
WD
Leslie
From the Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Occupational Sciences and Occupational Therapy, University of Toronto; Institute of Work and Health; School of Graduate Studies, Rehabilitation Sciences, University of Toronto; Division of Endocrinology and Metabolism, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto; Mobility Program, St. Michael's Hospital; Department of Surgery, University of Toronto, Toronto, Ontario; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.N.K. Rotondi, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Institute of Work and Health; V. Elliot-Gibson, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R. Sujic, MSc, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; R.G. Josse, MD, Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital; J.E. Sale, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; W.D. Leslie, MD, Department of Internal Medicine, University of Manitoba; E.R. Bogoch, MD, Mobility Program, St. Michael's Hospital, University of Toronto, Department of Surgery.
Earl R
ER
Bogoch
D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D015203:Reproducibility of Results; D012306:Risk; D018570:Risk Assessment; D012737:Sex Factors
MEASURE; OSTEOPOROTIC FRACTURE; OUTCOMES; REPRODUCIBILITY OF RESULTS; RISK ASSESSMENT