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External validation of FRISBEE 5-year fracture prediction models: a registry-based cohort study

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Abstract

Summary

Five-year fracture risk prediction from the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) models was externally tested in 9716 Canadian women and demonstrated good discrimination but consistently overestimated risk.

Introduction

Five-year risk prediction models for all fractures, major osteoporotic fractures (MOFs) and central fractures (proximal to forearm and ankle) from the FRISBEE cohort demonstrated good performance in the original derivation cohort. Our aim was to externally validate the FRISBEE-based 5-year prediction models in routine practice.

Methods

Using the population-based Manitoba Bone Mineral Density (BMD) registry, we identified women aged 60–85 years undergoing baseline BMD assessment from September 1, 2012 to March 31, 2018. Five-year probabilities of all fractures, MOFs and central fractures were calculated using the FRISBEE prediction models. We identified incident non-traumatic fractures up to 5 years from population-based healthcare data sources. Performance characteristics included area under the receiver operating characteristic curve (AUROC), gradient of risk (hazard ratio [HR] per SD increase and across risk tertiles) from Cox regression analysis, and calibration (ratio 5-year observed cumulative incidence to predicted fracture probability).

Results

We included 9716 women (mean age 70.7 + / − SD 5.3 years). During a mean observation time of 2.5 years, all fractures, MOFs and central fractures were identified in 377 (3.9%), 264 (2.7%) and 259 (2.7%) of the women. AUROC showed significant fracture risk stratification with the FRISBEE models (all fractures 0.69 [95%CI 0.67–0.72], MOFs 0.71 [95%CI 0.68–0.74], central fractures 0.72 [95%CI 0.69–0.75]). There was a strong gradient of risk for predicting fracture outcomes per SD increase (HRs from 1.98 to 2.26) and across risk tertiles (HRs for middle vs lowest from 2.25 to 2.41, HRs for highest vs lowest from 4.70 to 6.50). However, risk was overestimated for all fractures (calibration-in-the-large 0.63, calibration slope 0.63), MOF (calibration-in-the-large 0.51, calibration slope 0.57) and central fractures (calibration-in-the-large 0.55, calibration slope 0.60).

Conclusions

FRISBEE 5-year prediction models were externally validated to stratify fracture risk similar to the derivation cohort, but would need recalibration for Canada as risk was overestimated.

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada

    Arnav Agarwal

  2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Arnav Agarwal

  3. Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    Felicia Baleanu, Laura Iconaru, Rafik Karmali & Jean-Jacques Body

  4. Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    Felicia Baleanu, Alexia Charles, Laura Iconaru, Murielle Surquin, Florence Benoit & Jean-Jacques Body

  5. Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium

    Michel Moreau & Marianne Paesmans

  6. Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    Pierre Bergmann & Jean-Jacques Body

  7. Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    Pierre Bergmann

  8. Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada

    William D. Leslie

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  1. Arnav Agarwal
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  2. Felicia Baleanu
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  11. Jean-Jacques Body
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Contributions

Authors’ roles: conception, design, analysis, drafting the article (AA, WDL), interpretation of data (all authors); critically revising the article for important intellectual content (all authors); final approval of the version to be published (all authors); and agreement to be accountable for all aspects of the work (all authors). WDL had full access to all the data in the study and takes the responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to William D. Leslie.

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Agarwal, A., Baleanu, F., Moreau, M. et al. External validation of FRISBEE 5-year fracture prediction models: a registry-based cohort study. Arch Osteoporos 18, 13 (2023). https://doi.org/10.1007/s11657-022-01205-7

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