Predictive performance of the Garvan Fracture Risk Calculator: a registry-based cohort study.

Area of Science:

• Gerontology
• Epidemiology
• Medical Informatics

Background:

• Osteoporotic fracture risk estimation is crucial for guiding treatment decisions.
• The optimal predictive model for fracture risk remains a subject of ongoing research and debate.
• The Garvan Fracture Risk Calculator (FRC) offers a potential tool for improving fracture risk assessment.

Purpose of the Study:

• To evaluate the predictive performance of the Garvan Fracture Risk Calculator (FRC).
• To assess the FRC's accuracy in a large clinical registry from Manitoba, Canada.
• To compare the FRC's performance against traditional clinical risk factors and bone mineral density (BMD).

Main Methods:

• Utilized the Manitoba Bone Mineral Density (BMD) registry, including 16,682 women and 2839 men aged 50-95.
• Generated 5-year Garvan FRC predictions using clinical risk factors (CRFs) with and without femoral neck BMD.
• Identified incident osteoporotic fractures (OFs) and hip fractures (HFs) and assessed risk using area under the receiver operating characteristic curve (AUROC) and Cox regression analysis.

Main Results:

• The Garvan FRC demonstrated significant risk stratification capabilities for both OFs and HFs.
• The FRC with BMD outperformed BMD alone and CRFs alone, particularly for hip fracture prediction.
• A strong gradient of increasing fracture risk was observed across FRC quintiles, with hazard ratios up to 101.6 for hip fractures in women.

Conclusions:

• The Garvan FRC is a valuable tool for osteoporotic fracture risk stratification, outperforming clinical risk factors and BMD alone.
• The calculator shows particular strength in predicting hip fractures.
• Recalibration of the Garvan FRC may be necessary to ensure accurate predictions within the studied Canadian population.