Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study
Authors' conclusion
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.
Study context
- Population
- Younger postmenopausal women (baseline age 50–64 years), Women's Health Initiative, 40 US clinical centers; mean (SD) age 57.8 (4.1) years; 2.2% Asian, 8.8% Black, 3.8% Hispanic, 85.2% WhiteBone mineral density (BMD) subset 4607
- Participants
- 67,169 women
- Exposure
- FRAX (without BMD) vs OST for discrimination of incident major osteoporotic fracture (MOF), within each racial and ethnic group
- Outcome
- Discrimination (AUC) of incident MOF (hip, clinical spine, forearm, shoulder fracture) by FRAX and OST within each racial and ethnic category
- Follow-up
- 10-year follow-up
Methodological detailsmulticentre, Data collected October 1993 to December 2008; analyzed May 11, 2022, to February 23, 2023
- Multicentre
- Data collected October 1993 to December 2008; analyzed May 11, 2022, to February 23, 2023
Main finding
As reported in the abstract
AUC for discrimination of MOF · 10 years
| Group | AUC, Asian | AUC, Black | AUC, Hispanic | AUC, White |
|---|---|---|---|---|
| FRAX | 0.65 (95% CI, 0.58-0.71) | 0.55 (95% CI, 0.52-0.59) | 0.61 (95% CI, 0.56-0.65) | 0.59 (95% CI, 0.58-0.59) |
| OST | 0.62 (95% CI, 0.56-0.69) | 0.53 (95% CI, 0.50-0.57) | 0.58 (95% CI, 0.54-0.62) | 0.55 (95% CI, 0.54-0.56) |
AUC, Asian
FRAX0.65 (95% CI, 0.58-0.71)
OST0.62 (95% CI, 0.56-0.69)
AUC, Black
FRAX0.55 (95% CI, 0.52-0.59)
OST0.53 (95% CI, 0.50-0.57)
AUC, Hispanic
FRAX0.61 (95% CI, 0.56-0.65)
OST0.58 (95% CI, 0.54-0.62)
AUC, White
FRAX0.59 (95% CI, 0.58-0.59)
OST0.55 (95% CI, 0.54-0.56)
- Women with MOF during follow-up
- 5594
Observational data: associations, not effects.
Further findings
| Outcome | FRAX | OST |
|---|---|---|
| AUC for discrimination of femoral neck osteoporosis | ||
| AUC range across groups | 0.72 [95% CI, 0.68-0.75] to 0.74 [95% CI, 0.60-0.88] | 0.79 [95% CI, 0.65-0.93] to 0.85 [95% CI, 0.74-0.96] |
- AUC for discrimination of femoral neck osteoporosis: BMD subset of 4607 women
AUC for discrimination of femoral neck osteoporosis
- AUC excellent for OST, higher for OST than FRAX, similar in each of the 4 racial and ethnic groups
Original publication
Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study. JAMA Intern Med. Published 1 July 2023. doi:10.
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