Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark
Objective: To evaluate the added predictive accuracy of bone mineral density (BMD) to fracture risk assessment.Design Prospective cohort study using data between 01 January 2010 and 31 December 2012. Setting: North Denmark Osteoporosis Clinic of referred patients presenting with at least one frac...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group Ltd
2018
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| Online Access: | https://eprints.nottingham.ac.uk/51211/ |
| _version_ | 1848798443592482816 |
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| author | Dhiman, Paula Andersen, Stig Vestergaard, Peter Masud, Tahir Qureshi, Nadeem |
| author_facet | Dhiman, Paula Andersen, Stig Vestergaard, Peter Masud, Tahir Qureshi, Nadeem |
| author_sort | Dhiman, Paula |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Objective: To evaluate the added predictive accuracy of bone mineral density (BMD) to fracture risk assessment.Design Prospective cohort study using data between 01 January 2010 and 31 December 2012.
Setting: North Denmark Osteoporosis Clinic of referred patients presenting with at least one fracture risk factor to the referring doctor.Participants Patients aged 40–90 years; had BMD T-score recorded at the hip and not taking osteoporotic preventing drugs for more than 1 year prior to baseline.
Main outcome measures: Incident diagnoses of osteoporotic fractures (hip, spine, forearm, humerus and pelvis) were identified using the National Patient Registry of Denmark during 01 January 2012–01 January 2014. Cox regression was used to develop a fracture model based on predictors in the Fracture Risk Assessment Tool (FRAX®), with and without, binary and continuous BMD. Change in Harrell’s C-Index and Reclassification tables were used to describe the added statistical value of BMD.
Results: Adjusting for predictors included in FRAX®, patients with osteoporosis (T-score ≤−2.5) had 75% higher hazard of a fracture compared with patients with higher BMD (HR: 1.75 (95% CI 1.28 to 2.38)). Forty per cent lower hazard was found per unit increase in continuous BMD T-score (HR: 0.60 (95% CI 0.52 to 0.69)).Accuracy improved marginally, and Harrell’s C-Index increased by 1.2% when adding continuous BMD (0.76 to 0.77). Reclassification tables showed continuous BMD shifted 529 patients into different risk categories; 292 of these were reclassified correctly (57%; 95% CI 55% to 64%). Adding binary BMD however no improvement: Harrell’s C-Index decreased by 0.6%.
Conclusions: Continuous BMD marginally improves fracture risk assessment. Importantly, this was only found when using continuous BMD measurement for osteoporosis. It is suggested that future focus should be on evaluation of this risk factor using routinely collected data and on the development of more clinically relevant methodology to assess the added value of a new risk factor. |
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| format | Article |
| id | nottingham-51211 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T20:19:51Z |
| publishDate | 2018 |
| publisher | BMJ Publishing Group Ltd |
| recordtype | eprints |
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| spelling | nottingham-512112018-04-18T08:56:29Z https://eprints.nottingham.ac.uk/51211/ Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark Dhiman, Paula Andersen, Stig Vestergaard, Peter Masud, Tahir Qureshi, Nadeem Objective: To evaluate the added predictive accuracy of bone mineral density (BMD) to fracture risk assessment.Design Prospective cohort study using data between 01 January 2010 and 31 December 2012. Setting: North Denmark Osteoporosis Clinic of referred patients presenting with at least one fracture risk factor to the referring doctor.Participants Patients aged 40–90 years; had BMD T-score recorded at the hip and not taking osteoporotic preventing drugs for more than 1 year prior to baseline. Main outcome measures: Incident diagnoses of osteoporotic fractures (hip, spine, forearm, humerus and pelvis) were identified using the National Patient Registry of Denmark during 01 January 2012–01 January 2014. Cox regression was used to develop a fracture model based on predictors in the Fracture Risk Assessment Tool (FRAX®), with and without, binary and continuous BMD. Change in Harrell’s C-Index and Reclassification tables were used to describe the added statistical value of BMD. Results: Adjusting for predictors included in FRAX®, patients with osteoporosis (T-score ≤−2.5) had 75% higher hazard of a fracture compared with patients with higher BMD (HR: 1.75 (95% CI 1.28 to 2.38)). Forty per cent lower hazard was found per unit increase in continuous BMD T-score (HR: 0.60 (95% CI 0.52 to 0.69)).Accuracy improved marginally, and Harrell’s C-Index increased by 1.2% when adding continuous BMD (0.76 to 0.77). Reclassification tables showed continuous BMD shifted 529 patients into different risk categories; 292 of these were reclassified correctly (57%; 95% CI 55% to 64%). Adding binary BMD however no improvement: Harrell’s C-Index decreased by 0.6%. Conclusions: Continuous BMD marginally improves fracture risk assessment. Importantly, this was only found when using continuous BMD measurement for osteoporosis. It is suggested that future focus should be on evaluation of this risk factor using routinely collected data and on the development of more clinically relevant methodology to assess the added value of a new risk factor. BMJ Publishing Group Ltd 2018-04-12 Article PeerReviewed application/pdf en cc_by https://eprints.nottingham.ac.uk/51211/1/Dhiman%20BMJ%20Open%202018.pdf Dhiman, Paula, Andersen, Stig, Vestergaard, Peter, Masud, Tahir and Qureshi, Nadeem (2018) Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark. BMJ Open, 8 . e018898/1-e018898/8. ISSN 2044-6055 http://bmjopen.bmj.com/content/8/4/e018898 doi:10.1136/bmjopen-2017-018898 doi:10.1136/bmjopen-2017-018898 |
| spellingShingle | Dhiman, Paula Andersen, Stig Vestergaard, Peter Masud, Tahir Qureshi, Nadeem Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark |
| title | Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark |
| title_full | Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark |
| title_fullStr | Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark |
| title_full_unstemmed | Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark |
| title_short | Does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in Northern Denmark |
| title_sort | does bone mineral density improve the predictive accuracy of fracture risk assessment?: a prospective cohort study in northern denmark |
| url | https://eprints.nottingham.ac.uk/51211/ https://eprints.nottingham.ac.uk/51211/ https://eprints.nottingham.ac.uk/51211/ |