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Validation of the Taiwan FRAX® calculator for the prediction of fracture risk

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Abstract

Summary

The Taiwan FRAX® calculator was validated to predict incident fractures preliminarily. Cutoffs of FRAX probability for predicting major osteoporotic fracture and hip fracture were proposed as 9.5% and 4% in Taiwanese individuals.

Purpose

FRAX® is an algorithm used to calculate fracture probabilities based on clinical risk factors (CRFs) and bone mineral density (BMD). The country-specific Taiwan FRAX calculator has not been validated since its establishment in 2010. The aim of the present study is to evaluate the predictive performance of the Taiwan FRAX calculator using longitudinal fracture data.

Methods

A total of 1975 subjects, aged ≧ 40 years old, from Yunlin and Tianliao cohorts in Taiwan during the period 2009–2010, were identified and completely connected with the 2008–2016 National Health Insurance Research Database.

Results

During the average 6.8 ± 1.1 years of follow-up, 160 incident major osteoporotic fractures (MOFs) were identified. The predictive ability assessing based on the observed to expected fractures (O/E) ratio calculated with the FRAX probability adjusted for 6.8 years were 1.19 (95%CI 1.02–1.39) for MOF, and 1.07 (95%CI 0.82–1.39) for hip fractures. In the discriminative statistics, the AUC for prediction of major osteoporotic fractures using FRAX was 0.75 without and 0.77 with BMD (AUC for hip fracture was 0.75 without and 0.77 with BMD). The optimal cutoff value was 9.5% of the FRAX score with BMD for all major osteoporotic fractures, with good sensitivity (76.9%) and specificity (65.3%). For hip fractures, the optimal cutoff point for the FRAX probability with BMD was 4.0%, and the sensitivity and specificity were 74.4% and 68.3%, respectively.

Conclusion

The Taiwan FRAX® calculator was validated to predict incident fractures preliminarily. Cutoffs are proposed for predicting fracture risk in Taiwanese individuals.

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Abbreviations

FRAX:

Fracture risk assessment

BMD:

Bone mineral density

MOF:

Major osteoporotic fracture

CRF:

Clinical risk factor

NHI:

National Health Insurance

NHIRD:

National Health Insurance Research Database

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Acknowledgements

The authors wish to acknowledge the administrative and technical support received from the National Cheng Kung University Hospital Dou-Liou Branch, Yun-Lin county; Tian Liao District Public Health Center, Kaohsiung City; the National Health Insurance Research Database, the Center for Medical Informatics and Statistics, Kaohsiung Medical University, and National Cheng Kung University Hospital. Finally, we are grateful to the Health Data Science Center, the National Cheng Kung University Hospital, for providing administrative and technical support.

Funding

This research was funded by research grants MOST106-2314-B-006–064-MY2 and MOST 108–2314-B-006–043-MY2 from the Ministry of Science and Technology and grants from NCKUH-10909042. This work was also partially supported by research grant DOH-98HP-A9802-6, from the Bureau of Health Promotion, Taiwan.

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Author notes

  1. I-Ting Liu and Fu-Wen Liang contributed equally to this work

Authors and Affiliations

  1. Department of Family Medicine, E-DA Hospital, Kaohsiung, Taiwan

    I.-Ting Liu

  2. Department of Geriatric Medicine, E-DA Hospital, Kaohsiung, Taiwan

    I.-Ting Liu

  3. School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan

    I.-Ting Liu

  4. Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan

    Fu-Wen Liang

  5. Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Fu-Wen Liang

  6. Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chia-Chun Li

  7. Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 70403, Taiwan

    Chia-Chun Li, Yin-Fan Chang, Zih-Jie Sun, Chin-Sung Chang & Chih-Hsing Wu

  8. Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Tsung-Hsueh Lu

  9. Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chih-Hsing Wu

  10. Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chih-Hsing Wu

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  1. I.-Ting Liu
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Contributions

Conception and design of the study: ITL, FWL, YFC, CSC, CHW. Statistical analyses: ITL, CHW, CCL, FWL. Research data interpretation: all coauthors. Acquisition of data: YFC, CSC, ZJS, CHW. Suggestions and discussion: THL, CSC. Drafting of the article: ITL, CHW. Critical revision of the manuscript: all coauthors. Final approval of the manuscript: all coauthors.

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Correspondence to Chin-Sung Chang or Chih-Hsing Wu.

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Liu, IT., Liang, FW., Li, CC. et al. Validation of the Taiwan FRAX® calculator for the prediction of fracture risk. Arch Osteoporos 17, 27 (2022). https://doi.org/10.1007/s11657-022-01068-y

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