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
. 2017 Jul-Sep;20(3):444-450.
doi: 10.1016/j.jocd.2017.06.013. Epub 2017 Jul 14.

Overview of Fracture Prediction Tools

John A Kanis  1 , Nicholas C Harvey  2 , Helena Johansson  3 , Anders Odén  4 , Eugene V McCloskey  4 , William D Leslie  5
Affiliations
Review

Overview of Fracture Prediction Tools

John A Kanis et al. J Clin Densitom. 2017 Jul-Sep.

Abstract

The characterization of risk factors for fracture that contribute significantly to fracture risk, over and above that provided by the bone mineral density, has stimulated the development of risk assessment tools. The more adequately evaluated tools, all available online, include the FRAX® tool, the Garvan fracture risk calculator and, in the United Kingdom only, QFracture®. Differences in the input variables, output, and model construct give rise to marked differences in the computed risks from each calculator. Reasons for the differences include the derivation of fracture probability (FRAX) rather than incidence (Garvan and QFracture), limited calibration (Garvan), and inappropriate source information (QFracture). These differences need to be taken into account in the evaluation of assessment guidelines.

Keywords: Calibration; FRAX; Garvan fracture risk calculator; QFracture; fracture risk.

PubMed Disclaimer

Conflict of interest statement

Competing Interests

Professor Kanis led the team that developed FRAX as director of the WHO Collaborating Centre for Metabolic Bone Diseases; he has no financial interest in FRAX. Professors McCloskey, Oden, Harvey and Dr Johansson are members of the FRAX team. Professors Kanis, Harvey and McCloskey are members of the advisory body the National Osteoporosis Guideline Group. Professor Leslie led the team that developed the Canadian FRAX tool and co-led the Osteoporosis Canada guidelines that endorsed the use of FRAX.

Figures

Figure 1
Figure 1
The risk of hip fracture with age in a model that considers 10-year fracture risk alone (the Garvan tool) and FRAX which computes the probability of hip fracture from the fracture and death hazards (FRAX). The T-scores are set differently in the two models so that the risks are approximately equal at the age of 60 years. Data are computed from the respective web sites. [27] with kind permission from Springer Science+Business Media B.V]
Figure 2
Figure 2
Comparison of the risk of a hip fracture using the Garvan calculator, FRAX and QFracture in women with a prior fracture from the UK by age. Height was set at 165cm (QFracture and FRAX) and weight at 65kg (all models).
Figure 3
Figure 3
Comparison of the risk of any fragility fracture using the Garvan calculator, and the risk of a major osteoporotic fracture with FRAX and QFracture in women with a prior fracture from the UK by age. Height was set at 165cm (QFracture and FRAX) and weight at 65kg (all models).
Figure 4
Figure 4
Comparison of the distribution of FRAX and QFracture (QF) model output by decile of risk in women for hip fracture (left panel [12] and major fracture (right panel) [33]. The diagonal line shows the line of identity. [ with kind permission from Springer Science+Business Media B.V].
See this image and copyright information in PMC

References

    1. Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA) Arch Osteoporos. 2013;8:136. - PMC - PubMed
    1. Kanis JA, Borgström F, Compston J, et al. SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos. 2013;8:144. - PMC - PubMed
    1. Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 2004;15:767–778. - PubMed
    1. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359:1929–36. - PubMed
    1. Hui SL, Slemenda CW, Johnston CC., Jr Age and bone mass as predictors of fracture in a prospective study. J Clin Invest. 1988;81:1804–9. - PMC - PubMed