Table 2.
Sensitivity, Specificity, Positive Predictive Value (PPV), and Area Under the Receiver Operating Characteristic Curve (AUC) of the Garvan Tool and FRAX for Identifying Incident Hip Fracture Over 10 Years of Follow-up Under Various Construct Cut-points (Sensitivity Range of 80–99%)
| Outcome | Tool | ||||
|---|---|---|---|---|---|
| Hip fracture | Garvan | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | AUC (95% CI)* |
| 468 events | ≥ 0.097 | 80.6 (77.0–84.2) | 30.6 (30.3–31.0) | 0.9 (0.8–1.0) | 0.57 (0.55–0.60) |
| ≥ 0.079 | 85.3 (82.0–88.5) | 23.1 (22.7–23.4) | 0.8 (0.7–0.9) | 0.56 (0.54–0.59) | |
| ≥ 0.065 | 90.2 (87.5–92.9) | 17.4 (17.1–17.7) | 0.8 (0.7–0.9) | 0.56 (0.54–0.58) | |
| ≥ 0.036 | 95.1 (93.1–97.1) | 7.3 (7.1–7.5) | 0.8 (0.7–0.8) | 0.53 (0.51–0.56) | |
| ≥ 0.012 | 99.1 (98.3–100.0) | 1.4 (1.3–1.5) | 0.8 (0.7–0.8) | 0.53 (0.51–0.55) | |
| FRAX | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | AUC (95% CI) | |
| ≥ 0.430 | 80.6 (77.0–84.2) | 43.1 (42.7–43.5) | 1.1 (0.9–1.2) | 0.64 (0.61–0.66) | |
| ≥ 0.350 | 85.0 (81.8–88.3) | 33.2 (32.8–33.6) | 0.9 (0.9–1.0) | 0.61 (0.59–0.63) | |
| ≥ 0.280 | 90.0 (87.2–92.7) | 23.7 (23.3–24.0) | 0.9 (0.8–1.0) | 0.59 (0.57–0.61) | |
| ≥ 0.210 | 95.1 (93.1–97.1) | 14.0 (13.7–14.2) | 0.8 (0.7–0.9) | 0.57 (0.55–0.59) | |
| ≥ 0.090 | 99.1 (98.3–100.0) | 1.9 (1.8–2.0) | 0.8 (0.7–0.8) | 0.53 (0.51–0.55) | |
| MOF | Garvan | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | AUC (95% CI) |
| 5332 events | ≥ 7.371 | 80.0 (79.0–81.1) | 27.1 (26.7–27.4) | 9.1 (8.9–9.4) | 0.55 (0.54–0.56) |
| ≥ 6.863 | 85.1 (84.1–86.0) | 19.8 (19.5–20.1) | 8.8 (8.6–9.1) | 0.54 (0.53–0.55) | |
| ≥ 6.365 | 90.0 (89.2–90.8) | 13.1 (12.9–13.4) | 8.7 (8.4–8.9) | 0.53 (0.53–0.54) | |
| ≥ 5.686 | 95.0 (94.4–95.6) | 6.6 (6.4–6.8) | 8.5 (8.3–8.7) | 0.53 (0.52–0.53) | |
| ≥ 4.405 | 99.0 (98.8–99.3) | 1.3 (1.2–1.4) | 8.4 (8.2–8.6) | 0.52 (0.52–0.53) | |
| FRAX | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | AUC (95% CI) | |
| ≥ 4.800 | 80.2 (79.1–81.3) | 28.6 (28.2–28.9) | 9.3 (9.0–9.6) | 0.56 (0.55–0.57) | |
| ≥ 4.330 | 85.2 (84.2–86.1) | 22.8 (22.4–23.1) | 9.2 (8.9–9.4) | 0.56 (0.55–0.56) | |
| ≥ 3.750 | 90.2 (89.4–91.0) | 16.1 (15.8–16.4) | 8.9 (8.7–9.2) | 0.55 (0.54–0.56) | |
| ≥ 2.980 | 95.0 (94.5–95.6) | 9.0 (8.8–9.3) | 8.7 (8.5–9.0) | 0.54 (0.53–0.55) | |
| ≥ 1.790 | 99.0 (98.8–99.3) | 1.8 (1.6–1.9) | 8.4 (8.2–8.7) | 0.53 (0.52–0.53) | |
FRAX denotes the Fracture Risk Assessment Tool. Sensitivity thresholds were chosen to reflect thresholds of clinical relevance (i.e., sensitivity ≥ 80%). Cut-points selected to maximize area under the curve via Youden’s J statistic
*Logistic models to calculate AUC are additionally adjusted for WHI hormone therapy and calcium/vitamin D interventions