Summary

Fracture risk calculators may not be accurate for all ethnicity groups. The Manitoba bone density registry was used to test the Canadian CAROC tool for predicting fracture risk in Asian-Canadian women. The tool significantly over-estimated fracture risk, suggesting that it may not be ideal for Asian-Canadian patients.

Purpose

Health risk prediction tools based on largely White populations may lead to treatment inequity when applied to non-White populations where outcome rates differ. We examined the calibration of the Canadian Association of Radiologists-Osteoporosis Canada (CAROC) fracture risk prediction tool in self-identified Asian-Canadian women.

Methods

Retrospective cohort study of women over age 50 using the Manitoba BMD Registry. At first BMD, the intake questionnaire collected self-identification of ethnicity and fracture risk factors. 10-year fracture risk was estimated using CAROC and categorized into low, medium, or high fracture risk. Linked administrative databases identified incident osteoporotic fractures. Observed fracture rates were compared between White and Asian-Canadians and compared to the original CAROC risk stratification.

Results

There were 63,632 and 1703 women who self-identified as White-Canadian or Asian-Canadian, respectively, covering approximately 600,000 patient-years follow-up. There were 6588 incident fractures; a similar percentage of patients were assigned to each risk stratum at baseline by CAROC. A progressive rise in 10-year observed fracture rates occurred for each CAROC stratum in the White-Canadian population but much lower fracture rates than predicted in Asian-Canadian patients (p < 0.001). Fracture incidence rate ratios were 1.9–2.6 fold higher in White- vs Asian-Canadian patients for all strata (p < 0.001). In the CAROC moderate and high-risk categories, observed fracture rates in Asian-Canadian patients were typically lower than predicted, indicating poor model calibration.

Conclusion

In Asian-Canadian women, observed osteoporosis fracture rates are lower than predicted when using the CAROC tool. Over-estimation of fracture risk may influence shared decision-making discussions.

中文翻译：

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亚裔加拿大女性的骨折风险被加拿大放射学家协会显着高估 - 加拿大骨质疏松症风险预测工具：回顾性队列研究

概括

骨折风险计算器可能并不适用于所有种族群体。马尼托巴骨密度登记系统用于测试加拿大 CAROC 工具预测亚裔加拿大女性的骨折风险。该工具显着高估了骨折风险，表明它可能不适合亚裔加拿大患者。

目的

当应用于结果率不同的非白人人群时，主要基于白人人群的健康风险预测工具可能会导致治疗不公平。我们检查了加拿大放射科医生协会 - 加拿大骨质疏松症协会 (CAROC) 骨折风险预测工具在自我认同的亚裔加拿大女性中的校准情况。

方法

使用 Manitoba BMD Registry 对 50 岁以上女性进行的回顾性队列研究。在最初的 BMD 中，摄入问卷收集了种族和骨折危险因素的自我认同。使用 CAROC 估算 10 年骨折风险，并将其分为低、中或高骨折风险。链接的管理数据库确定了骨质疏松性骨折事件。观察到的骨折率在白人和亚裔加拿大人之间进行了比较，并与最初的 CAROC 风险分层进行了比较。

结果

分别有 63,632 名和 1703 名女性自称是加拿大白人或亚裔加拿大人，随访时间约为 600,000 患者年。有 6588 人发生骨折；CAROC 在基线时将相似百分比的患者分配到每个风险层。加拿大白人人群中每个 CAROC 阶层的 10 年观察到的骨折率逐渐上升，但骨折率远低于亚裔加拿大患者的预测值 ( p  < 0.001)。所有阶层的白人患者与亚裔加拿大人患者的骨折发生率比高 1.9-2.6 倍 ( p  < 0.001)。在 CAROC 中度和高风险类别中，观察到的亚裔加拿大患者的骨折率通常低于预测值，表明模型校准不佳。

结论

在亚裔加拿大女性中，使用 CAROC 工具观察到的骨质疏松症骨折率低于预测值。骨折风险的高估可能会影响共同决策的讨论。