Article Figures & Tables
Tables
Feature FRAX* CAROC† Clinical risk factors Age (40–90 yr) Age (> 50 yr) Sex Sex Weight Height Previous fracture in adulthood Fractures since age 40 Parent fractured hip Current smoking Glucocorticoid use‡ Glucocorticoid use§ Rheumatoid arthritis Secondary osteoporosis Consumes ≥ 3 units alcohol per day Bone mineral density Femoral neck BMD optional Femoral neck BMD required¶ Other considerations Incorporates competing risk of mortality No competing risk of mortality Different algorithms can be used for different No different algorithms for different ethnicities ethnicities and countries Involves interactions between variables No interactions between individual variables Type of fractures predicted Hip fracture within 10 years Major osteoporotic fracture within 10 years Osteoporotic fracture within 10 years Note: BMD = bone mineral density, CAROC = Canadian Association of Radiologists and Osteoporosis Canada, FRAX = Fracture Risk Assessment Tool.
↵* FRAX is available at www.sheffield.ac.uk/FRAX.
↵† CAROC is available at https://osteoporosis.ca/health-care-professionals/tools/caroc.
↵‡ FRAX: Exposed to oral glucocorticoids for more than 3 months at a dose of prednisolone of 5 mg daily or more or current use.
↵§ CAROC: History of glucocorticoid use for 3 months or more in the past 1 year at 7.5 mg prednisone equivalent.
↵¶ If fracture risk is low or undefined based on femoral neck BMD, and T-score is ≤ −2.5 at either lumbar spine or total hip, fracture risk is increased to moderate.
- Table 2:
Baseline characteristics of patients referred to a multidisciplinary clinic for postmenopausal osteoporosis
Characteristic Mean ± SD or no. (%)
n = 190*Age, yr 63.2 ± 6.4 Sex, female 190 (100) Height, cm, n = 189 161.7 ± 6.3 Weight, kg, n = 189 63.6 ± 10.6 Body mass index, n = 189 24.3 ± 3.9 Lumbar spine T-score −2.34 ± 0.91 Femoral neck T-score −2.12 ± 0.75 Total hip T-score −1.78 ± 0.76 CAROC risk factors† Previous fracture, n = 187 39 (20.9) Glucocorticoid use, n = 186 1 (0.5) FRAX risk factors† Previous fracture 59 (31.0) Glucocorticoid use, n = 189 3 (1.6) Parental hip fracture,‡ n = 189 38 (20.1) Current smoker‡ 7 (3.7) Rheumatoid arthritis‡ 6 (3.2) Consumes ≥ 3 units alcohol/d‡ 3 (1.6) Ten-year FRAX MOF risk, % 13.6 ± 7.7 Ten-year FRAX hip fracture risk, % 3.2 ± 3.6 Fracture risk on BMD report (using CAROC) High (≥ 20.0%) 34 (17.9) Moderate (10.0%–19.9%) 130 (68.4) Low (< 10.0%) 26 (13.7) Fracture risk on clinic chart (using FRAX) High (≥ 20.0%) 37 (19.5) Moderate (10.0%–19.9%) 72 (37.9) Low (< 10.0%) 81 (42.6) Note: BMD = bone mineral density, CAROC = Canadian Association of Radiologists and Osteoporosis Canada, FRAX = Fracture Risk Assessment Tool, MOF = major osteoporotic fracture, SD = standard deviation.
↵* n = 190 unless stated otherwise.
↵† CAROC risk factors were obtained from BMD reports; FRAX risk factors were obtained from osteoporosis clinic charts.
↵‡ FRAX-specific risk factors (incorporated by FRAX algorithm but not CAROC).
- Table 3:
Comparison of 10-year fracture risk estimates reported in osteoporosis clinic charts (calculated using FRAX) and estimates presented on bone mineral density reports (calculated using CAROC) for 190 patients after menopause
BMD report, no. (%)*† Total discordant Low risk‡
n = 26Moderate risk‡
n = 130High risk‡
n = 34Osteoporosis clinic chart, no. (%)*† Low risk,‡ n = 81 19 (10.0) 57 (30.0) 5 (2.6) 62 (32.6) Moderate risk,‡ n = 72 5 (2.6) 55 (28.9) 12 (6.3) 17 (8.9) High risk,‡ n = 37 2 (1.1) 18 (9.5) 17 (8.9) 20 (10.5) Total discordant 7 (3.7) 75 (39.4) 17 (8.9) 99 (52.1) Note: BMD = bone mineral density, CAROC = Canadian Association of Radiologists and Osteoporosis Canada, FRAX = Fracture Risk Assessment Tool.
↵* Percentages represent the proportion of the total cohort (n = 190).
↵† Shaded cells represent patients whose BMD reports and osteoporosis clinic assessments provided discordant fracture risk classifications (i.e., the 2 estimates placed the patient in different risk categories).
↵‡ Low risk = 10-year osteoporotic fracture risk < 10.0%; moderate risk = 10.0%–19.9%; high risk = ≥ 20.0%.
- Table 4:
Comparison of prior fragility fractures identified in clinic charts (calculated using FRAX) and on bone mineral density reports (calculated using CAROC) among patients after menopause who attended a clinical assessment at an osteoporosis clinic
BMD report, no. (%)*† Fracture reported No fracture reported Osteoporosis clinic chart, no. (%)*† Fracture reported 30 (16.0) 28 (15.0) No fracture reported 9 (4.8) 120 (64.2) Note: BMD = bone mineral density, CAROC = Canadian Association of Radiologists and Osteoporosis Canada, FRAX = Fracture Risk Assessment Tool.
↵* Data were available for 187 patients.
↵† Shaded cells represent patients whose BMD reports and osteoporosis clinic charts provided disagreeing interpretations of fracture history.