Total Hip Bone Area Affects Fracture Prediction with FRAX® in Canadian White Women.

Total Hip Bone Area Affects Fracture Prediction with FRAX® in Canadian White Women.

J Clin Endocrinol Metab. 2017 Sep 19;:

Authors: Leslie WD, Lix LM, Majumdar SR, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA

Abstract
Context: Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to FRAX® but it is unknown whether performance is impacted by hip area.
Objective: To examine whether fracture prediction by FRAX® is affected by hip area.
Design and Setting: Cohort study using a population-based BMD registry.
Patients: 58,108 White women aged >40 y.
Main Outcome Measures: Incident major osteoporotic fracture (MOF, N=4,913) and hip fracture (HF, N=1,369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL).
Results: Smaller hip area was associated with younger age and lower FRAX® scores, while incident fractures were greater in those with larger hip area (p-trend <0.001). Larger hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (p-trend <0.001). Each standard deviation increase in hip area was associated with greater risk for incident MOF (adjusted HR 1.08, 95% CI 1.05 - 1.11) and hip fracture (HR 1.16, 95% CI 1.11 - 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated HF risk in the three largest hip area quintiles.
Conclusions: In Canadian White women, skeletal size based on hip area affects fracture risk assessment based upon FRAX® with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size, and provides for more accurate assessment of fracture risk.

PMID: 29092086 [PubMed - as supplied by publisher]

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