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Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study

Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study
Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study
We identified large between-ethnicity calibration differences in the Canadian FRAX® tool which substantially overestimated the major osteoporotic fracture (MOF) risk in Asian women and Black women, and overestimated hip fracture risk in Asian women.

Purpose: FRAX® is calibrated using population-specific fracture and mortality data. The need for FRAX to accommodate ethnic diversity within a country is uncertain. We addressed this question using the population-based Manitoba Bone Mineral Density (BMD) Program registry and self-reported ethnicity.

Methods: the study population was women aged 40 years or older with baseline FRAX assessments (Canadian and other ethnic calculators), fracture outcomes, and self-reported ethnicity (White N = 68,907 [referent], Asian N = 1910, Black N = 356). Adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to MOF and hip fracture were estimated. We examined candidate variables from DXA that might contribute to ethnic differences including skeletal size, hip axis length (HAL), trabecular bone score (TBS), and estimated body composition.

Results: adjusted for baseline risk using the Canadian FRAX tool with BMD, Asian women compared with White women were at much lower risk for MOF (HR 0.46, 95% CI 0.35-0.59) and hip fracture (0.16, 95% CI 0.08-0.34). Black women were also at lower MOF risk (HR 0.58, 95% CI 0.32-1.00); there were no hip fractures. The US ethnic-specific FRAX calculators accounted for most of the between-ethnicity differences in MOF risk (86% for Asian, 92% for Black) but only partially accounted for lower hip fracture risk in Asian women (40%). The candidate variables explained only a minority of the effect of ethnicity. Gradient of risk in analyses was similar (p-interactions ethnicity*FRAX non-significant).

Conclusions: we identified significant ethnic differences in performance of the Canadian FRAX tool with fracture probability overestimated among Asian and Black women. The US ethnic calculators helped to address this discrepancy for MOF risk assessment, but not for hip fracture risk among Asian women.
0937-941X
Leslie, William D.
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Morin, Suzanne N
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Lix, Lisa M.
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McCloskey, Eugene V.
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Johansson, Helena
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Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
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Leslie, William D.
5b2dd5d6-4569-40a3-a9b1-95152d11e4f1
Morin, Suzanne N
68489af8-f604-4f28-88e0-60add9fde4ae
Lix, Lisa M.
2fb61783-047d-4a4b-a45d-e09ac0763a7b
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d

Leslie, William D., Morin, Suzanne N, Lix, Lisa M., McCloskey, Eugene V., Johansson, Helena, Harvey, Nicholas and Kanis, John A. (2020) Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study. Osteoporosis International. (doi:10.1007/s00198-020-05594-8).

Record type: Article

Abstract

We identified large between-ethnicity calibration differences in the Canadian FRAX® tool which substantially overestimated the major osteoporotic fracture (MOF) risk in Asian women and Black women, and overestimated hip fracture risk in Asian women.

Purpose: FRAX® is calibrated using population-specific fracture and mortality data. The need for FRAX to accommodate ethnic diversity within a country is uncertain. We addressed this question using the population-based Manitoba Bone Mineral Density (BMD) Program registry and self-reported ethnicity.

Methods: the study population was women aged 40 years or older with baseline FRAX assessments (Canadian and other ethnic calculators), fracture outcomes, and self-reported ethnicity (White N = 68,907 [referent], Asian N = 1910, Black N = 356). Adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to MOF and hip fracture were estimated. We examined candidate variables from DXA that might contribute to ethnic differences including skeletal size, hip axis length (HAL), trabecular bone score (TBS), and estimated body composition.

Results: adjusted for baseline risk using the Canadian FRAX tool with BMD, Asian women compared with White women were at much lower risk for MOF (HR 0.46, 95% CI 0.35-0.59) and hip fracture (0.16, 95% CI 0.08-0.34). Black women were also at lower MOF risk (HR 0.58, 95% CI 0.32-1.00); there were no hip fractures. The US ethnic-specific FRAX calculators accounted for most of the between-ethnicity differences in MOF risk (86% for Asian, 92% for Black) but only partially accounted for lower hip fracture risk in Asian women (40%). The candidate variables explained only a minority of the effect of ethnicity. Gradient of risk in analyses was similar (p-interactions ethnicity*FRAX non-significant).

Conclusions: we identified significant ethnic differences in performance of the Canadian FRAX tool with fracture probability overestimated among Asian and Black women. The US ethnic calculators helped to address this discrepancy for MOF risk assessment, but not for hip fracture risk among Asian women.

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FRAX and Ethnicity_2020-06-28_OSIN.R1 main-accepted - Accepted Manuscript
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Accepted/In Press date: 7 July 2020
e-pub ahead of print date: 17 August 2020

Identifiers

Local EPrints ID: 443563
URI: http://eprints.soton.ac.uk/id/eprint/443563
ISSN: 0937-941X
PURE UUID: abe2b8fa-9cc6-49ce-89b6-8545b5b58f6b
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 01 Sep 2020 16:32
Last modified: 17 Aug 2021 04:01

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Contributors

Author: William D. Leslie
Author: Suzanne N Morin
Author: Lisa M. Lix
Author: Eugene V. McCloskey
Author: Helena Johansson
Author: Nicholas Harvey ORCID iD
Author: John A. Kanis

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