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Showing content from https://pubmed.ncbi.nlm.nih.gov/37213092 below:

Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women's Health Initiative Study

. 2023 Jul 1;183(7):696-704. doi: 10.1001/jamainternmed.2023.1253. Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women's Health Initiative Study Joseph C Larson², John T Schousboe³, JoAnn E Manson⁴, Nelson B Watts⁵, John A Robbins⁶, Peter Schnatz^{7 8}, Rami Nassir⁹, Aladdin H Shadyab¹⁰, Karen C Johnson¹¹, Jane A Cauley¹², Kristine E Ensrud¹³

Affiliations

¹ Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles.
² Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
³ HealthPartners Institute, Park Nicolette Clinic and University of Minnesota, Minneapolis.
⁴ Division of Preventive Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
⁵ Mercy Health Osteoporosis and Bone Services, Cincinnati, Ohio.
⁶ Center for Healthcare Policy and Research, Department of Medicine, University of California, Davis, Medical Center, Sacramento.
⁷ Department of Obstetrics and Gynecology, Reading Hospital/Tower Health and Drexel University, Philadelphia, Pennsylvania.
⁸ Department of Internal Medicine, Reading Hospital/Tower Health and Drexel University, Philadelphia, Pennsylvania.
⁹ Department of Biochemistry and Molecular Medicine, University of California, Davis.
¹⁰ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.
¹¹ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.
¹² Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
¹³ Division of Epidemiology & Community Health, University of Minnesota Medical School, Minneapolis.

PMID: 37213092
PMCID: PMC10203970
DOI: 10.1001/jamainternmed.2023.1253

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Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women's Health Initiative Study

Carolyn J Crandall et al. JAMA Intern Med. 2023.

. 2023 Jul 1;183(7):696-704. doi: 10.1001/jamainternmed.2023.1253. Authors Carolyn J Crandall¹, Joseph C Larson², John T Schousboe³, JoAnn E Manson⁴, Nelson B Watts⁵, John A Robbins⁶, Peter Schnatz^{7 8}, Rami Nassir⁹, Aladdin H Shadyab¹⁰, Karen C Johnson¹¹, Jane A Cauley¹², Kristine E Ensrud¹³ Affiliations

¹ Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles.
² Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
³ HealthPartners Institute, Park Nicolette Clinic and University of Minnesota, Minneapolis.
⁴ Division of Preventive Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
⁵ Mercy Health Osteoporosis and Bone Services, Cincinnati, Ohio.
⁶ Center for Healthcare Policy and Research, Department of Medicine, University of California, Davis, Medical Center, Sacramento.
⁷ Department of Obstetrics and Gynecology, Reading Hospital/Tower Health and Drexel University, Philadelphia, Pennsylvania.
⁸ Department of Internal Medicine, Reading Hospital/Tower Health and Drexel University, Philadelphia, Pennsylvania.
⁹ Department of Biochemistry and Molecular Medicine, University of California, Davis.
¹⁰ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.
¹¹ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.
¹² Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
¹³ Division of Epidemiology & Community Health, University of Minnesota Medical School, Minneapolis.

PMID: 37213092
PMCID: PMC10203970
DOI: 10.1001/jamainternmed.2023.1253

Item in Clipboard

Abstract

Importance: The best approach to identify younger postmenopausal women for osteoporosis screening is uncertain. The Fracture Risk Assessment Tool (FRAX), which includes self-identified racial and ethnic information, and the Osteoporosis Self-assessment Tool (OST), which does not, are risk assessment tools recommended by US Preventive Services Task Force guidelines to identify candidates for bone mineral density (BMD) testing in this age group.

Objective: To compare the ability of FRAX vs OST to discriminate between younger postmenopausal women who do and do not experience incident fracture during a 10-year follow-up in the 4 racial and ethnic groups specified by FRAX.

Design, setting, and participants: This cohort study of Women's Health Initiative participants included 67 169 women (baseline age range, 50-64 years) with 10 years of follow-up for major osteoporotic fracture (MOF; including hip, clinical spine, forearm, and shoulder fracture) at 40 US clinical centers. Data were collected from October 1993 to December 2008 and analyzed between May 11, 2022, and February 23, 2023.

Main outcomes and measures: Incident MOF and BMD (in a subset of 4607 women) were assessed. The area under the receiver operating characteristic curve (AUC) for FRAX (without BMD information) and OST was calculated within each racial and ethnic category.

Results: Among the 67 169 participants, mean (SD) age at baseline was 57.8 (4.1) years. A total of 1486 (2.2%) self-identified as Asian, 5927 (8.8%) as Black, 2545 (3.8%) as Hispanic, and 57 211 (85.2%) as White. During follow-up, 5594 women experienced MOF. For discrimination of MOF, AUC values for FRAX were 0.65 (95% CI, 0.58-0.71) for Asian, 0.55 (95% CI, 0.52-0.59) for Black, 0.61 (95% CI, 0.56-0.65) for Hispanic, and 0.59 (95% CI, 0.58-0.59) for White women. The AUC values for OST were 0.62 (95% CI, 0.56-0.69) for Asian, 0.53 (95% CI, 0.50-0.57) for Black, 0.58 (95% CI, 0.54-0.62) for Hispanic, and 0.55 (95% CI, 0.54-0.56) for White women. For discrimination of femoral neck osteoporosis, AUC values were excellent for OST (range, 0.79 [95% CI, 0.65-0.93] to 0.85 [95% CI, 0.74-0.96]), higher for OST than FRAX (range, 0.72 [95% CI, 0.68-0.75] to 0.74 [95% CI, 0.60-0.88]), and similar in each of the 4 racial and ethnic groups.

Conclusions and relevance: These findings suggest that within each racial and ethnic category, the US FRAX and OST have suboptimal performance in discrimination of MOF in younger postmenopausal women. In contrast, for identifying osteoporosis, OST was excellent. The US version of FRAX should not be routinely used to make screening decisions in younger postmenopausal women. Future investigations should improve existing tools or create new approaches to osteoporosis risk assessment for this age group.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures
Figure 1.. Study Flow Diagram

BMD indicates…

Figure 1.. Study Flow Diagram

BMD indicates bone mineral density; WHI, Women’s Health Initiative.

Figure 1.. Study Flow Diagram

BMD indicates bone mineral density; WHI, Women’s Health Initiative.

Figure 2.. Receiver Operating Characteristic Curves for…

Figure 2.. Receiver Operating Characteristic Curves for Major Osteoporotic Fractures During 10 Years of Follow-up…
Figure 2.. Receiver Operating Characteristic Curves for Major Osteoporotic Fractures During 10 Years of Follow-up Among Women Aged 50 to 64 Years at Baseline by Race and Ethnicity

For all comparisons of the Fracture Risk Assessment Tool (FRAX) vs the Osteoporosis Self-assessment Tool (OST), P < .001 among all participants, P = .59 among Asian participants, P = .50 among Black participants, P = .35 among Hispanic participants, and P < .001 among White participants (calculated from a χ² statistic on 1 df testing of the difference between each paired group). AUC indicates area under the receiver operating characteristic curve.

Figure 3.. Observed and Expected Major Osteoporotic…

Figure 3.. Observed and Expected Major Osteoporotic Fracture of Estimated Fracture Risk Among Women Aged…
Figure 3.. Observed and Expected Major Osteoporotic Fracture of Estimated Fracture Risk Among Women Aged 50 to 64 Years at Baseline by Race and Ethnicity

Dots represent the intersection of the predicted event and observed event for each quintile; whiskers represent the 95% CIs for the observed event percentage. FRAX indicates Fracture Risk Assessment Tool; OST, Osteoporosis Self-assessment Tool.