title: Comparing self-perceived and estimated fracture risk by FRAX® of women with osteoporosis.
abstract: In this study, we compared subjective fracture risks of Hungarian women with osteoporosis to FRAX®-based estimates. Patients with a previous fracture, parental hip fracture, low femoral T-score, higher age, and higher BMI were more likely to underestimate their risks. Patients also failed to associate risk factors with an increased risk of fractures.
  
  
  OBJECTIVE
  The main objectives were to explore associations between self-perceived 10-year fracture risks of women with osteoporosis (OP) and their risks calculated by the FRAX® algorithm and to identify determinants of the underestimation of risk.
  
  
  METHODS
  We carried out a cross-sectional study in 11 OP centers in Hungary and collected data on the risk factors considered by the FRAX® calculator. Patients estimated their subjective 10-year probability of any major osteoporotic and hip fracture numerically, in percentages and also on a visual analog scale (VAS). We compared subjective and FRAX® estimates and applied logistic regression to analyze the determinants of the underestimation of risk. Associations between risk factors and subjective risk were explored using linear probability models.
  
  
  RESULTS
  Nine hundred seventy-two OP patients were included in the analysis. Major OP and hip fracture risk by FRAX® were on average 20.1 and 10.5%, while subjective estimates were significantly higher, 30.0 and 24.7%, respectively. Correlations between FRAX® and subjective measures were very weak (r = 0.12-0.16). Underestimation of major OP fracture risk was associated with having had a single previous fracture (OR = 2.0), parental hip fracture (OR = 3.4), femoral T-score ≤-2.5 (OR = 4.2), higher age, body mass index, and better general health state. We did not find significant associations between subjective risk estimates and most of the risk factors except for previous fractures.
  
  
  CONCLUSIONS
  Hungarian OP patients fail to recognize most of the risk factors of fractures. Thus, education of patients about these risk factors would be beneficial especially for the elderly with a low femoral T-score and parental hip fracture history.
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, H-1093, Hungary. petra.baji@uni-corvinus.hu.|CERGE-EI Fellow, Praha 1, Politických věznů 7, 111 21, Prague, Czech Republic. petra.baji@uni-corvinus.hu.
authors.forename: Petra
authors.initials: P
authors.lastname: Baji
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, H-1093, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Gulácsi
authors.affiliation: 1st Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Korányi Sándor u. 2/a, Budapest, H-1083, Hungary.
authors.forename: Csaba
authors.initials: C
authors.lastname: Horváth
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, H-1093, Hungary.
authors.forename: Valentin
authors.initials: V
authors.lastname: Brodszky
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, H-1093, Hungary.
authors.forename: Fanni
authors.initials: F
authors.lastname: Rencz
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, H-1093, Hungary.|Department of Rheumatology, Flór Ferenc Hospital, Semmelweis tér 1, Kistarcsa, Budapest, H-2143, Hungary.
authors.forename: Márta
authors.initials: M
authors.lastname: Péntek
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015519:Bone Density; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008875:Middle Aged; D020380:Needs Assessment; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: FRAX®; Hungary; Osteoporosis; Risk perception; Subjective risk