The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Comparison of methods for improving fracture risk assessment in Diabetes: The Manitoba BMD Registry

Comparison of methods for improving fracture risk assessment in Diabetes: The Manitoba BMD Registry
Comparison of methods for improving fracture risk assessment in Diabetes: The Manitoba BMD Registry
Type 2 diabetes is a risk factor for fracture independent of FRAX (fracture risk assessment) probability. We directly compared four proposed methods to improve the performance of FRAX for type 2 diabetes by: (1) including the rheumatoid arthritis (RA) input to FRAX; (2) making a trabecular bone score (TBS) adjustment to FRAX; (3) reducing the femoral neck T‐score input to FRAX by 0.5 SD; and (4) increasing the age input to FRAX by 10 years. We examined major osteoporotic fractures (MOFs) and hip fractures (HFs) over a mean of 8.3 years observation among 44,543 women and men 40 years of age or older (4136 with diabetes) with baseline lumbar spine and hip DXA from 1999 through 2016. Controlled for unadjusted FRAX probability, diabetes was associated with an increased risk for MOFs and HFs. All four FRAX adjustments attenuated the effect of diabetes, but a residual effect of diabetes was seen on MOF risk after TBS adjustment, and on HF risk after the RA and TBS adjustments. Among those with diabetes, unadjusted FRAX risk underestimated MOF (observed/predicted ratio 1.15; 95% CI, 1.03 to 1.28), but this was no longer significant after applying the diabetes adjustments. HF risk was more severely underestimated (observed/predicted ratio 1.85; 95% CI, 1.51 to 2.20) and was only partially corrected with the diabetes adjustments (still significant for the RA and TBS adjustments). Among those with diabetes, there was moderate reclassification based upon a fixed MOF cut‐off of 20% (4.1% to 7.1%) or fixed HF cut‐off of 3% (5.7% to 16.5%). Net reclassification improvement increased for MOF with each of the diabetes adjustments (range 3.9% to 5.6% in the diabetes subgroup). In conclusion, each of the proposed methods for addressing limitations in the ability of FRAX to assess fracture risk in individuals with diabetes was found to improve performance, though no single method was optimal in all settings.
0884-0431
1923-1930
Leslie, William D.
5b2dd5d6-4569-40a3-a9b1-95152d11e4f1
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
55c6bd2c-d653-48de-b4b9-29fe280fb00f
Hans, Didier
1a5d8024-c245-4e99-afc6-b9b82d04cb22
Leslie, William D.
5b2dd5d6-4569-40a3-a9b1-95152d11e4f1
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
55c6bd2c-d653-48de-b4b9-29fe280fb00f
Hans, Didier
1a5d8024-c245-4e99-afc6-b9b82d04cb22

Leslie, William D., Johansson, Helena, McCloskey, Eugene V., Harvey, Nicholas, Kanis, John A. and Hans, Didier (2018) Comparison of methods for improving fracture risk assessment in Diabetes: The Manitoba BMD Registry. Journal of Bone and Mineral Research, 33 (11), 1923-1930. (doi:10.1002/jbmr.3538).

Record type: Article

Abstract

Type 2 diabetes is a risk factor for fracture independent of FRAX (fracture risk assessment) probability. We directly compared four proposed methods to improve the performance of FRAX for type 2 diabetes by: (1) including the rheumatoid arthritis (RA) input to FRAX; (2) making a trabecular bone score (TBS) adjustment to FRAX; (3) reducing the femoral neck T‐score input to FRAX by 0.5 SD; and (4) increasing the age input to FRAX by 10 years. We examined major osteoporotic fractures (MOFs) and hip fractures (HFs) over a mean of 8.3 years observation among 44,543 women and men 40 years of age or older (4136 with diabetes) with baseline lumbar spine and hip DXA from 1999 through 2016. Controlled for unadjusted FRAX probability, diabetes was associated with an increased risk for MOFs and HFs. All four FRAX adjustments attenuated the effect of diabetes, but a residual effect of diabetes was seen on MOF risk after TBS adjustment, and on HF risk after the RA and TBS adjustments. Among those with diabetes, unadjusted FRAX risk underestimated MOF (observed/predicted ratio 1.15; 95% CI, 1.03 to 1.28), but this was no longer significant after applying the diabetes adjustments. HF risk was more severely underestimated (observed/predicted ratio 1.85; 95% CI, 1.51 to 2.20) and was only partially corrected with the diabetes adjustments (still significant for the RA and TBS adjustments). Among those with diabetes, there was moderate reclassification based upon a fixed MOF cut‐off of 20% (4.1% to 7.1%) or fixed HF cut‐off of 3% (5.7% to 16.5%). Net reclassification improvement increased for MOF with each of the diabetes adjustments (range 3.9% to 5.6% in the diabetes subgroup). In conclusion, each of the proposed methods for addressing limitations in the ability of FRAX to assess fracture risk in individuals with diabetes was found to improve performance, though no single method was optimal in all settings.

Text
Comparison of Methods for Improving Fracture Risk Assessment in Diabetes-JBMR 2018-04-03-accepted - Accepted Manuscript
Download (139kB)
Text
Comparison of Methods for Improving Fracture Risk Assessment in Diabetes-JBMR 2018-04-14-JBMR-supplemental R2
Restricted to Repository staff only
Request a copy

More information

Accepted/In Press date: 22 June 2018
e-pub ahead of print date: 28 June 2018
Published date: November 2018

Identifiers

Local EPrints ID: 422304
URI: http://eprints.soton.ac.uk/id/eprint/422304
ISSN: 0884-0431
PURE UUID: cdb9441d-82b9-4abb-98f8-86aa1d08240f
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 20 Jul 2018 16:30
Last modified: 26 Nov 2021 05:11

Export record

Altmetrics

Contributors

Author: William D. Leslie
Author: Helena Johansson
Author: Eugene V. McCloskey
Author: Nicholas Harvey ORCID iD
Author: John A. Kanis
Author: Didier Hans

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×