Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Feb;23(2):423-31.
doi: 10.1007/s00198-011-1846-0. Epub 2011 Nov 26.

Pitfalls in the external validation of FRAX

J A Kanis  1 , A Oden, H Johansson, E McCloskey
Affiliations
Review

Pitfalls in the external validation of FRAX

J A Kanis et al. Osteoporos Int. 2012 Feb.

Abstract

Summary: Recent studies have evaluated the performance of FRAX® in independent cohorts. The interpretation of most is problematic for reasons summarised in this perspective.

Introduction: FRAX is an extensively validated assessment tool for the prediction of fracture in men and women. The aim of this study was to review the methods used since the launch of FRAX to further evaluate this instrument.

Methods: This covers a critical review of studies investigating the calibration of FRAX or assessing its performance characteristics in external cohorts.

Results: Most studies used inappropriate methodologies to compare the performance characteristics of FRAX with other models. These included discordant parameters of risk (comparing incidence with probabilities), comparison with internally derived predictors and inappropriate use and interpretation of receiver operating characteristic curves. These deficits markedly impair interpretation of these studies.

Conclusion: Cohort studies that have evaluated the performance of FRAX need to be interpreted with caution and preferably re-evaluated.

PubMed Disclaimer

Comment in

References

    1. J Bone Miner Res. 2011 Aug;26(8):1774-82 - PubMed
    1. CMAJ. 2011 Feb 8;183(2):E107-14 - PubMed
    1. Maturitas. 2010 Feb;65(2):143-8 - PubMed
    1. Am J Clin Nutr. 1979 Mar;32(3):540-9 - PubMed
    1. J Bone Miner Res. 2003 Nov;18(11):1955-63 - PubMed

LinkOut - more resources