Biases in the performance of FRAX without BMD in predicting fracture risk in a multiethnic population with diabetes: the Diabetes and Aging Study
Authors' conclusion
While the discriminatory performance of FRAX without BMD was good overall in patients with diabetes, it underestimated risk in Hispanic women, Black men, those with long duration of diabetes, and in the oldest patients with diabetes.
Study context
- Population
- Patients aged 65–89 with diabetes, Kaiser Permanente Northern California Diabetes Registry, not taking osteoporosis medications; 47.0% female
- Participants
- 96,914 patients
- Outcome
- Predictive performance of FRAX without BMD for MOF and hip fracture: discrimination (AUC) and calibration (observed-to-predicted ratio, O/P)
- Follow-up
- Mean 4.3 yr
Methodological detailsprognostic performance study, multiethnic
- Prognostic performance study
- Multiethnic
Main finding
As reported in the abstract
Performance of FRAX without BMD (overall)
- Major osteoporotic fracture (MOF) events
- 5383 (5.6%)
- Hip fracture events
- 1767 (1.8%)
- AUC for MOF
- 0.72
- AUC for hip fracture
- 0.77
- O/P for MOF and hip fracture (FRAX mildly underestimated rates)
- 1.2 for both
Observational data: associations, not effects.
Further findings
Discrimination by subgroup
- AUC worse in those over age 75
- < 0.7
- Discrimination similar by race and ethnicity and diabetes duration
Calibration by subgroup (O/P for MOF and hip fracture, respectively)
- Hispanic women
- 1.8 and 1.5
- Black men
- 1.5 and 1.8
- Diabetes duration ≥20 yr
- 1.6 and 1.5
- Age over 80
- 1.4 and 1.2
Original publication
Biases in the performance of FRAX without BMD in predicting fracture risk in a multiethnic population with diabetes: the Diabetes and Aging Study. J Bone Miner Res. Published 29 January 2025. doi:10.
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