Comparison of CAROC and FRAX in fragility fracture patients: agreement, clinical utility, and implications for clinical practice

TitleComparison of CAROC and FRAX in fragility fracture patients: agreement, clinical utility, and implications for clinical practice
Publication TypeJournal Article
Year of Publication2016
AuthorsRotondi, NK, Beaton, DE, Elliot-Gibson, V, Sujic, R, Josse, RG, Sale, JE, Leslie, WD, Bogoch, ER
JournalJournal of RheumatologyJ Rheumatol
Volume43
Issue8
Pagination1593 - 1599
Date Published2016/08//
RefMan ID (Library)47499
Abstract

OBJECTIVE: To examine the level of agreement between 2 fracture risk assessment tools [Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX)] when applied within the context of the Canadian guidelines, in a population of fragility fracture patients. METHODS: The sample consisted of 135 treatment-naive fragility fracture patients aged 50+ years and screened as part of an osteoporosis (OP) program at an urban hospital. Ten-year probabilities of future major osteoporotic fractures were calculated using the FRAX and CAROC. We also integrated additional qualifiers from the 2010 Canadian guidelines that place hip, spine, and multiple fractures at high risk regardless. A quadratic weighted kappa (Kw) and 95% CI were calculated to estimate the chance corrected agreement between the risk assessment tools. Logistic regression was used to evaluate the factors associated with concordance. RESULTS: Among patients with fragility fractures, the agreement between CAROC and FRAX was Kw = 0.64 (95% CI 0.58-0.71), with 45 of 135 cases in the cells reflecting disagreement. Younger persons and males were more likely to be found in discordant cells. CONCLUSION: The level of agreement between 2 commonly used fracture risk assessment tools was not as high in the patients with fragility fractures as it was in general community-based samples. Our results suggest discordance is found in less-typical patients with OP who need more consistency in messaging and direction. Users of these fracture risk tools should be aware of the potential for discordance and note differences in risk classifications that may affect treatment decisions

DOI10.3899/jrheum.151409
Reprint EditionIN FILE
Citation Key47499