{
    "abstract": "While adults aged 80 years and older account for 70% of hip fractures in the US, performance of fracture risk assessment tools in this population is uncertain.\nTo compare performance of the Fracture Risk Assessment Tool (FRAX), Garvan Fracture Risk Calculator, and femoral neck bone mineral density (FNBMD) alone in 5-year hip fracture prediction.\nPrognostic analysis of 3 prospective cohort studies including participants attending an index examination (1997 to 2016) at age 80 years or older. Data were analyzed from March 2023 to April 2024.\nParticipants contacted every 4 or 6 months after index examination to ascertain incident hip fractures and vital status. Predicted 5-year hip fracture probabilities calculated using FRAX and Garvan models incorporating FNBMD and FNBMD alone. Model discrimination assessed by area under receiver operating characteristic curve (AUC). Model calibration assessed by comparing observed vs predicted hip fracture probabilities within predicted risk quintiles.\nA total of 8890 participants were included, with a mean (SD) age at index examination of 82.6 (2.7) years; 4906 participants (55.2%) were women, 866 (9.7%) were Black, 7836 (88.1%) were White, and 188 (2.1%) were other races and ethnicities. During 5-year follow-up, 321 women (6.5%) and 123 men (3.1%) experienced a hip fracture; 818 women (16.7%) and 921 men (23.1%) died before hip fracture. Among women, AUC was 0.69 (95% CI, 0.67-0.72) for FRAX, 0.69 (95% CI, 0.66-0.72) for Garvan, and 0.72 (95% CI, 0.69-0.75) for FNBMD alone (FNBMD superior to FRAX, P\u2009=\u2009.01; and Garvan, P\u2009=\u2009.01). Among men, AUC was 0.71 (95% CI, 0.66-0.75) for FRAX, 0.76 (95% CI, 0.72-0.81) for Garvan, and 0.77 (95% CI, 0.72-0.81) for FNBMD alone (P\u2009<\u2009.001 Garvan and FNBMD alone superior to FRAX). Among both sexes, Garvan greatly overestimated hip fracture risk among individuals in upper quintiles of predicted risk, while FRAX modestly underestimated risk among those in intermediate quintiles of predicted risk.\nIn this prognostic study of adults aged 80 years and older, FRAX and Garvan tools incorporating FNBMD compared with FNBMD alone did not improve 5-year hip fracture discrimination. FRAX modestly underpredicted observed hip fracture probability in intermediate-risk individuals. Garvan markedly overpredicted observed hip fracture probability in high-risk individuals. Until better prediction tools are available, clinicians should prioritize consideration of hip BMD, life expectancy, and patient preferences in decision-making regarding drug treatment initiation for hip fracture prevention in late-life adults.",
    "authors": [
        {
            "affiliation": "Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.\nDepartment of Medicine, University of Minnesota, Minneapolis.\nCenter for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota.",
            "firstname": "Kristine E",
            "initials": "KE",
            "lastname": "Ensrud"
        },
        {
            "affiliation": "HealthPartners Institute, Bloomington, Minnesota.\nDivision of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis.",
            "firstname": "John T",
            "initials": "JT",
            "lastname": "Schousboe"
        },
        {
            "affiliation": "Department of Medicine, University of California, Los Angeles.",
            "firstname": "Carolyn J",
            "initials": "CJ",
            "lastname": "Crandall"
        },
        {
            "affiliation": "Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.",
            "firstname": "William D",
            "initials": "WD",
            "lastname": "Leslie"
        },
        {
            "affiliation": "Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.\nDepartment of Medicine, University of Minnesota, Minneapolis.\nCenter for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota.\nGeriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota.",
            "firstname": "Howard A",
            "initials": "HA",
            "lastname": "Fink"
        },
        {
            "affiliation": "California Pacific Medical Center Research Institute, San Francisco.",
            "firstname": "Peggy M",
            "initials": "PM",
            "lastname": "Cawthon"
        },
        {
            "affiliation": "Department of Medicine, Stanford University, California.\nGeriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Palo Alto, California.",
            "firstname": "Deborah M",
            "initials": "DM",
            "lastname": "Kado"
        },
        {
            "affiliation": "Department of Internal Medicine, University of California, Davis, Sacramento.",
            "firstname": "Nancy E",
            "initials": "NE",
            "lastname": "Lane"
        },
        {
            "affiliation": "Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.",
            "firstname": "Jane A",
            "initials": "JA",
            "lastname": "Cauley"
        },
        {
            "affiliation": "Department of Medicine, University of Minnesota, Minneapolis.\nCenter for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota.",
            "firstname": "Lisa",
            "initials": "L",
            "lastname": "Langsetmo"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1001/jamanetworkopen.2024.18612\n10.1001/jama.2009.1462\n10.1007/s00198-017-4345-0\n10.1007/s00198-009-0920-3\n10.1186/s12877-016-0332-0\n10.1093/gerona/glt105\n10.1359/jbmr.061113\n10.1359/JBMR.050304\n10.1007/s00198-007-0343-y\n10.4158/GL-2020-0524SUPPL\n10.1210/jc.2019-00221\n10.1007/s00198-021-05900-y\n10.1210/jc.2011-3045\n10.1001/jama.2019.5453\n10.7326/M22-0684\n10.1007/BF01719664\n10.1016/j.bone.2009.01.373\n10.1136/bmj.i6755\n10.1007/s00198-017-4091-3\n10.1007/s00198-007-0362-8\n10.1177/1536867X0400400201\n10.1080/01621459.1999.10474144\n10.1007/s00198-019-04919-6\n10.1001/archinternmed.2009.404\n10.1007/s00198-012-2215-3\n10.1007/s00198-010-1465-1\n10.1002/jbmr.123\n10.1503/cmaj.100458\n10.1007/s00198-021-06252-3\n10.1002/jbmr.1956\n10.1007/s11657-017-0389-1\n10.1001/jamainternmed.2019.0682\n10.1016/S2666-7568(22)00290-2",
    "journal": "JAMA network open",
    "keywords": [],
    "methods": null,
    "publication_date": "2024-06-28",
    "pubmed_id": "38941095\n19826027\n29282482\n19421703\n27590604\n23873945\n17144789\n15940371\n17323110\n32427503\n30907953\n35478046\n22675062\n31074763\n36592455\n7843344\n19195497\n28104610\n28593449\n17370100\n30877348\n20008691\n23179575\n21161508\n20499367\n21173069\n34839377\n23592255\n29052793\n31206140\n36610448",
    "results": "A total of 8890 participants were included, with a mean (SD) age at index examination of 82.6 (2.7) years; 4906 participants (55.2%) were women, 866 (9.7%) were Black, 7836 (88.1%) were White, and 188 (2.1%) were other races and ethnicities. During 5-year follow-up, 321 women (6.5%) and 123 men (3.1%) experienced a hip fracture; 818 women (16.7%) and 921 men (23.1%) died before hip fracture. Among women, AUC was 0.69 (95% CI, 0.67-0.72) for FRAX, 0.69 (95% CI, 0.66-0.72) for Garvan, and 0.72 (95% CI, 0.69-0.75) for FNBMD alone (FNBMD superior to FRAX, P\u2009=\u2009.01; and Garvan, P\u2009=\u2009.01). Among men, AUC was 0.71 (95% CI, 0.66-0.75) for FRAX, 0.76 (95% CI, 0.72-0.81) for Garvan, and 0.77 (95% CI, 0.72-0.81) for FNBMD alone (P\u2009<\u2009.001 Garvan and FNBMD alone superior to FRAX). Among both sexes, Garvan greatly overestimated hip fracture risk among individuals in upper quintiles of predicted risk, while FRAX modestly underestimated risk among those in intermediate quintiles of predicted risk.",
    "title": "Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older.",
    "xml": "<Element 'PubmedArticle' at 0x788506ca9b70>"
}