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Journal article
Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women's Health Initiative Study
JAMA internal medicine, v 183(7), pp 696-704
03 Jul 2023
PMID: 37213092
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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.
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.
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.
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.
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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Details
- Title
- Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women's Health Initiative Study
- Creators
- Carolyn J Crandall - University of California, Los AngelesJoseph C Larson - Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WashingtonJohn T Schousboe - HealthPartnersJoAnn E Manson - Harvard UniversityNelson B Watts - Mercy HealthJohn A Robbins - University of California Davis Medical CenterPeter Schnatz - Department of Internal Medicine, Reading Hospital/Tower Health and Drexel University, Philadelphia, PennsylvaniaRami Nassir - Department of Biochemistry and Molecular Medicine, University of California, DavisAladdin H Shadyab - Human LongevityKaren C Johnson - University of Tennessee Health Science CenterJane A Cauley - University of PittsburghKristine E Ensrud - University of Minnesota Medical Center
- Publication Details
- JAMA internal medicine, v 183(7), pp 696-704
- Publisher
- American Medical Association
- Number of pages
- 9
- Grant note
- 75N92021D00002 / NHLBI NIH HHS 75N92021D00003 / WHI NIH HHS R21 AR078905 / NIAMS NIH HHS 75N92021D00001 / NHLBI NIH HHS 75N92021D00005 / WHI NIH HHS 75N92021D00004 / WHI NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine; Obstetrics and Gynecology
- Web of Science ID
- WOS:000996524500004
- Scopus ID
- 2-s2.0-85164209828
- Other Identifier
- 991021864116804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Endocrinology & Metabolism