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Pitfalls in the external validation of FRAX
Kanis, John A. Oden, Anders Johansson, Helena McCloskey, Eugene
Kanis, John A.
Oden, Anders
Johansson, Helena
McCloskey, Eugene
Abstract
Summary: Recent studies have evaluated the performance of FRAX® in independent cohorts. The interpretation of most is problematic for reasons summarised in this perspective. Introduction: FRAX is an extensively validated assessment tool for the prediction of fracture in men and women. The aim of this study was to review the methods used since the launch of FRAX to further evaluate this instrument. Methods: This covers a critical review of studies investigating the calibration of FRAX or assessing its performance characteristics in external cohorts. Results: Most studies used inappropriate methodologies to compare the performance characteristics of FRAX with other models. These included discordant parameters of risk ( comparing incidence with probabilities ), comparison with internally derived predictors and inappropriate use and interpretation of receiver operating characteristic curves. These deficits markedly impair interpretation of these studies. Conclusion: Cohort studies that have evaluated the performance of FRAX need to be interpreted with caution and preferably re-evaluated.
Keywords
clinical risk factors, fracture probability, FRAX, osteoporotic fracture, receiver operating characteristics
Date
2012
Type
Journal article
Journal
Osteoporosis International
Book
Volume
23
Issue
2
Page Range
423-431
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
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Open Access Status
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Controlled