Intensive screening for osteoporosis in patients with hip fracture

Amar, Anas Ould Si; Hyldstrup, Lars; Nielsen, Jette; Palm, Henrik; Jensen, Jens–Erik Beck

doi:10.1007/s11657-019-0612-3

Arch Osteoporos

2019

DOI: 10.1007/s11657-019-0612-3

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Intensive screening for osteoporosis in patients with hip fracture

Anas Ould Si Amar

Lars Hyldstrup

Jette Nielsen

et al.

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Cited by 2 publications

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“…For the data in the articles included for analysis, the results are shown in Figure 1 for female patients (24)(25)(26)(27)(28)(29)(30)(31)(32)(33), Figure 2 for male and female patients mixed (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and Figure 3 for male patients (24,(28)(29)(30)32,33,46,47). For the data in Figure 2, females commonly constituted 2/3 of the cases, reflecting that hip fracture prevalence among older women is about double of that among older men.…”

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confidence: 97%

Around the time of a hip fracture, older East Asian female patients tend to measure lower densitometric femoral neck and total hip T-scores than older Caucasian female patients: a literature analysis

Wáng¹

2023

Quant Imaging Med Surg

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The clinical significance of osteoporosis lies in the fractures that occur, and the most important fracture is hip fracture. According to the 1994 World Health Organization (WHO) criteria, the T-score is defined as: (BMD patient -BMD young normal mean )/SD young normal population, where BMD is bone mineral density and SD is the standard deviation. When the femoral neck is measured in adult women, a cutpoint value of patient BMD of 2.5 SD below the BMD young normal mean satisfies that the prevalence of osteoporosis for those aged ≥50 yrs is about 16.2%, the same as the lifetime risk of hip fragility fracture (FF) (1,2). If other sites are also considered, this cutpoint value identifies approximately 30% of postmenopausal women as having osteoporosis, which is approximately equivalent to the lifetime risk of FF at the spine, hip, or forearm. The FF prevalence of older Chinese women is slightly less than half that of Caucasians (3,4). This is the case for hip FF (5-7), radiographic vertebral FF (8), clinical vertebral FF (9-11), and many other FF sites (3,4,12,13). As compared with Caucasians, Chinese demonstrate an overall stronger skeleton property (14). For example, Walker et al. (15) reported that postmenopausal Chinese women have a higher trabecular plate-to-rod ratio and greater whole bone stiffness, translating into a greater trabecular mechanical competence.Following the 1994 WHO definition, densitometric osteoporosis prevalence among a non-Caucasian population should be in proportion to its relative osteoporotic fracture risk with Caucasian data as reference (16). To achieve this goal, various region/ethnic-specific reference BMD databases have been published (3). Furthermore, the cutpoint T-score for defining densitometric osteoporosis should be adjusted according to the osteoporotic fracture risk profile. Based on statistical modeling (3), we proposed that the femoral neck cutpoint T-score is revised from ≤−2.5 to ≤−2.75 for Hong Kong older women when a local BMD reference published by Lynn et al. ( 17) is applied. The same principle can also be applied to Japanese older women if a local BMD reference published by Iki et al. is used (3,18). In an empirical study on women with radiographic vertebral FF as a surrogate clinical endpoint, we recently demonstrated that, at the mean age of around 74, a femoral neck T-score of −2.60 for Italian Caucasians is equivalent to Letter to the Editor

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mentioning

confidence: 97%

Around the time of a hip fracture, older East Asian female patients tend to measure lower densitometric femoral neck and total hip T-scores than older Caucasian female patients: a literature analysis

Wáng¹

2023

Quant Imaging Med Surg

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The observation that older men suffer from hip fracture at DXA T-scores higher than older women and a proposal of a new low BMD category, osteofrailia, for predicting fracture risk in older men

Wáng,

Xiao,

Leung

et al. 2024

Skeletal Radiol

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The clinical significance of osteoporosis lies in the occurrence of fragility fractures (FFx), and the most relevant fracture site is the hip. The T-score is defined as follows: (BMDpatient–BMDyoung adult mean)/SDyoung adult population, where BMD is bone mineral density and SD is the standard deviation. When the femoral neck (FN) is measured in adult Caucasian women, a cutpoint value of patient BMD of 2.5 SD below the young adult mean BMD results in a prevalence the same as the lifetime risk of hip FFx for Caucasian women. The FN T-score criterion for classifying osteoporosis in older Caucasian men has been provisionally recommended to be − 2.5, but debates remain. Based on a systematic literature review, we noted that older men suffer from hip FFx at a FN T-score approximately 0.5–0.6 higher than older women. While the mean hip FFx FN T-score of around − 2.9 for women lies below − 2.5, the mean hip FF FN T-score of around − 2.33 for men lies above − 2.5. This is likely associated with that older male populations have a higher mean T-score than older female populations. We propose a new category of low BMD status, osteofrailia, for older Caucasian men with T-score ≤ − 2 (T-score ≤ − 2.1 for older Chinese men) who are likely to suffer from hip FFx. The group with T-score ≤ − 2 for older Caucasian men is comparable in prevalence to the group with T-score ≤ − 2.5 for older Caucasian women. However, older men in such category on average have only half the FFx risk as that of older women with osteoporotic T-score.

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Intensive screening for osteoporosis in patients with hip fracture

Cited by 2 publications

References 25 publications

Around the time of a hip fracture, older East Asian female patients tend to measure lower densitometric femoral neck and total hip T-scores than older Caucasian female patients: a literature analysis

Around the time of a hip fracture, older East Asian female patients tend to measure lower densitometric femoral neck and total hip T-scores than older Caucasian female patients: a literature analysis

The observation that older men suffer from hip fracture at DXA T-scores higher than older women and a proposal of a new low BMD category, osteofrailia, for predicting fracture risk in older men

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