Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women.
The FRAX® tool estimates the risk of a fragility fracture among the population and many countries have been evaluating its performance among their populations since its creation in 2007. The purpose of this study is to update the first FRIDEX cohort analysis comparing FRAX with the bone mineral density (BMD) model, and its predictive abilities.



The discriminatory ability of the FRAX was assessed using the 'area under curve' of the receiver operating characteristic (AUC-ROC). Predictive ability was assessed by comparing estimated risk fractures with incidence fractures after a 10-year follow up period.



One thousand three hundred eight women ≥ 40 and ≤ 90 years followed up during a 10-year period. The AUC for major osteoporotic fractures using FRAX without DXA was 0.686 (95 % CI 0.630-0.742) and using FN T-score of DXA 0.714 (95 % CI 0.661-0.767). Using only the traditional parameters of DXA (FN T-score), the AUC was 0.706 (95 % CI 0.652-0.760). The AUC for hip osteoporotic fracture was 0.883 (95 % CI 0.827-0.938), 0.857 (95 % CI 0.773-0.941), and 0.814 (95 % CI 0.712-0.916) respectively. For major osteoporotic fractures, the overall predictive value using the ratio Observed fractures/Expected fractures calculated with FRAX without T-score of DXA was 2.29 and for hip fractures 2.28 and with the inclusion of the T-score 2.01 and 1.83 respectively. However, for hip fracture in women < 65 years was 1.53 and 1.24 respectively.



The FRAX tool has been found to show a good discriminatory capacity for detecting women at high risk of fragility fracture, and is better for hip fracture than major fracture. The test of sensibility shows that it is, at least, not inferior than when using BMD model alone. The predictive capacity of FRAX tool needs some adjustment. This capacity is better for hip fracture prediction and better for women < 65 years. Further studies in Catalonia and other regions of Spain are needed to fine tune the FRAX tool's predictive capability.
Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain.|Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain.|QuironSalud-Hospital General de Catalunya, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain.
Rafael
R
Azagra
Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain. mzwart.girona.ics@gencat.cat.|Health Center Can Gibert del Plà (ICS), Institut Català de la Salut, GROIMAP-USR Girona-IDIAP Jordi Gol, c/San Sebastian 9, 17005, Girona, Spain. mzwart.girona.ics@gencat.cat.
Marta
M
Zwart
Department of Nuclear Medicine, Valle de Hebron Hospital, Institut Català de la Salut, Ps/Valle de Hebron 119-129, 08035, Barcelona, Spain.
Gloria
G
Encabo
Health Center Granollers-Centre, Institut Català de la Salut, c/Museu 19, 08400, Granollers, Barcelona, Spain.
Amada
A
Aguyé
Department of Basic Sciences, Biostatistics Unit, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain.
Juan Carlos
JC
Martin-Sánchez
Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain.
Nuria
N
Puchol-Ruiz
Health Center Barberà del Vallès, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Verge de l'Assumpció s/n, 08210, Barberà del Vallès, Barcelona, Spain.
Paula
P
Gabriel-Escoda
Health Center Canaletes, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Ps d'Horta 17, 08290, Cerdanyola del Vallès, Barcelona, Spain.
Sergio
S
Ortiz-Alinque
Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain.|Department of Medicine, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain.|Urgencies Service, Hospital of Sabadell, Corporació Sanitaria i Universitaria Parc Tauli, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain.
Emilio
E
Gené
Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain.
Milagros
M
Iglesias
Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO)-IDIBELL, Av Gran Via, 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.|Departament d'Economia i Història Econòmica, Grups de Recerca d'Àfrica i Amèrica Llatines (GRAAL), Unitat de Fonaments de l'Anàlisi Econòmica, Universitat Autònoma de Barcelona, c/Emprius 2, 08202, Sabadell, Barcelona, Spain.
David
D
Moriña
Health Center Cornellà 2 (Sant Ildefons), Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Republica Argentina s/n, 08940, Cornellá, Barcelona, Spain.
Miguel Angel
MA
Diaz-Herrera
Biostatistics Unit, CUPESSE European Project, Universitat Pompeu Fabra, Ed Jaume I-Campus Ciutadella, 08003, Barcelona, Spain.
Mireia
M
Utzet
Unitat Supor Recerca Metropolitana Nord, IDIAP Jordi Gol, ctra de Barcelona 473, 08204, Sabadell, Barcelona, Spain.|Department of Nursing, Universitat Autònoma de Barcelona, avda Can Domenech s/n, 08193, Cerdanyola del Valles, Barcelona, Spain.
Josep Maria
JM
Manresa
D015502:Absorptiometry, Photon; D000368:Aged; D000465:Algorithms; D019540:Area Under Curve; D015519:Bone Density; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
Algorithm; FRAX; FRIDEX; Fracture; Osteoporosis; Study cohort