Table 3.
Sensitivity, Specificity, and Area Under the Receiver Operating Characteristic Curve (AUC) of the Garvan Tool and Fracture Risk Assessment Tool (FRAX) for Identifying Incident Hip Fracture After 10 Years, Stratified by Age Group, at Thresholds Maximizing the Area Under the Receiver Operating Characteristic Curve (AUC)
| Sensitivity (95% CI) | Specificity (95% CI) | AUC | |
|---|---|---|---|
| All participants (n = 63,621) | |||
| Garvan ≥ 0.462 | 16.0 (12.7–19.4) | 93.5 (93.3–93.7) | 0.58 (0.55–0.60) |
| FRAX ≥ 0.706 | 59.2 (54.7–63.7) | 67.6 (67.2–67.9) | 0.65 (0.62–0.67) |
| Age | |||
| 50–54 (n = 14,768) | |||
| Garvan ≥ 0.462 | 0.0 (0.0–0.0) | 99.7 (99.7–99.8) | 0.54 (0.49–0.60) |
| FRAX ≥ 0.706 | 10.4 (1.5–19.4) | 98.1 (97.9–98.3) | 0.58 (0.52–0.65) |
| 55–59 (n = 22,442) | |||
| Garvan ≥ 0.462 | 5.6 (1.8–9.4) | 96.9 (96.7–97.1) | 0.56 (0.52–0.60) |
| FRAX ≥ 0.706 | 34.3 (26.4–42.1) | 81.2 (80.7–81.7) | 0.61 (0.56–0.65) |
| 60–64 (n = 25,513) | |||
| Garvan ≥ 0.462 | 24.2 (19.1–29.3) | 86.9 (86.5–87.3) | 0.60 (0.57–0.63) |
| FRAX ≥ 0.706 | 80.5 (75.8–85.2) | 37.7 (37.1–38.3) | 0.62 (0.59–0.65) |
| HT use† | |||
| No (n = 27,617) | |||
| Garvan ≥ 0.462 | 13.2 (8.8–17.7) | 93.4 (93.1–93.7) | 0.55 (0.52–0.58) |
| FRAX ≥ 0.706 | 57.3 (50.8–63.8) | 67.7 (67.1–68.2) | 0.63 (0.60–0.67) |
| Yes (n = 35,065) | |||
| Garvan ≥ 0.462 | 18.7 (13.7–23.6) | 93.6 (93.3–93.8) | 0.60 (0.57–0.63) |
| FRAX ≥ 0.706 | 61.0 (54.8–67.2) | 67.5 (67.0–68.0) | 0.66 (0.63–0.70) |
| Years of HT use | |||
| 0 years (n = 12,250) | |||
| Garvan ≥ 0.462 | 16.5 (8.7–24.3) | 92.7 (92.3–93.2) | 0.57 (0.53–0.62) |
| FRAX ≥ 0.706 | 57.1 (46.8–67.5) | 64.0 (63.2–64.9) | 0.63 (0.57–0.68) |
| 5+ years (n = 18,762) | |||
| Garvan ≥ 0.462 | 21.8 (13.0–30.7) | 93.1 (92.8–93.5) | 0.61 (0.57–0.66) |
| FRAX ≥ 0.706 | 64.4 (54.1–74.6) | 65.8 (65.2–66.5) | 0.67 (0.62–0.72) |
| Race/ethnicity | |||
| White (n = 52,536) | |||
| Garvan ≥ 0.462 | 16.2 (12.8–19.7) | 93.2 (93.0–93.5) | 0.57 (0.55–0.60) |
| FRAX ≥ 0.706 | 62.2 (57.7–66.8) | 62.9 (62.5–63.3) | 0.64 (0.61–0.66) |
| African American (n = 5475) | |||
| Garvan ≥ 0.462 | 7.7 (0.0–24.5) | 97.5 (97.0–97.9) | 0.61 (0.48–0.74) |
| FRAX ≥ 0.706 | 0.0 (0.0–0.0) | 96.4 (95.9–96.9) | 0.63 (0.51–0.75) |
| Hispanic (n = 2262) | |||
| Garvan ≥ 0.462 | 12.5 (0.0–42.1) | 94.5 (93.5–95.4) | 0.71 (0.58–0.83) |
| FRAX ≥ 0.706 | 0.0 (0.0–0.0) | 92.8 (91.7–93.8) | 0.71 (0.61–0.81) |
| Other/unknown* (n = 2450) | |||
| Garvan ≥ 0.462 | 20.0 (0.0–50.2) | 89.4 (88.2–90.6) | 0.67 (0.56–0.78) |
| FRAX ≥ 0.706 | 50.0 (12.3–87.7) | 78.8 (77.1–80.4) | 0.74 (0.62–0.86) |
Youden’s J statistic was calculated to identify the cut-point to maximize AUC values for identification of hip fracture (AUC(c))
*Other/unknown category includes American Indian, Asian, and unknown race/ethnicity participants
†Menopausal hormone therapy (HT) status over the interval has varying definitions depending on whether the participant was enrolled in the Women’s Health Initiative Observational Study (OS) or the HT Clinical Trials (CT): OS, Non-HT CT Participants: Status determined by baseline current HT use (yes/no)
HT participants: status determined by HT intervention arm (active/placebo)
OS participants: participants who contributed data for at least 6 of the 8 possible years of self-report covered by WHI were divided into groups. Participants who reported ≥ 50% of study period using HT were included in the 5+ years HT use category. If the participant reported 0% of her time on HT, she was put into the no HT use group
HT participants: active arm participants who were on intervention for 5+ years were put into the 5+ years HT use category. Placebo arm participants who were on placebo for 5+ years and then reported not starting hormones on their post-intervention form were put into the no HT use group
Non-HT, CT participants: not included in analysis