FRAX®: Prediction of major osteoporotic fractures in women from the general population: The OPUS study

Karine Briot (Corresponding Author), Simon Paternotte, Sami Kolta, Richard Eastell, Dieter Felsenberg, David M. Reid, Claus C. Glüer, Christian Roux

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Purposes: The aim of this study was to analyse how well FRAX® predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population. 

Patients and methods: The OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAX® performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI). 

Results: 85 (4.9%) patients had incident major fractures over 6 years. FRAX® with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAX® with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAX®. 

Conclusions: This study shows that FRAX® with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population.

Original languageEnglish
Article numbere83436
Pages (from-to)1-10
Number of pages10
JournalPloS ONE
Issue number12
Publication statusPublished - 30 Dec 2013

Bibliographical note

We would like to acknowledge the contributions of the other members of the OPUS teams at the five participating centres: Rosie Reid (deceased), Lana Gibson and Alison Stewart in Aberdeen; Antonia Gerwinn, Dr. Maren Glüer, Roswitha John, Roswitha Marunde-Ott, Monika Mohr, Regina Schlenger, Pia Zschoche, Dr Reinhard Barkmann, Dr. Carsten Liess, Carsten Rose and Wolfram Timm in Kiel; Therese Kolta, Nathalie Delfau in Paris; Margaret Paggiosi, Nicky Peel, Diane Shutt, Anne Stapleton, Debbie Swindell in Sheffield. We also would like to thank for the support of the equipment manufacturers: DMS, IGEA, OSI/Osteometer Meditech, Quidel/metra.

Funding: The OPUS cohort was sponsored by Eli Lilly, Sanofi-Aventis, Procter and Gamble Pharmaceuticals, Hoffman-La Roche, Pfizer and Novartis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author and coauthors did not receive any funding from these commercial sources.


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