Performance of FRAX in Predicting Fractures in US Postmenopausal Women with Varied Race and Genetic Profiles

Wu, Qing; Xiao, Xiangxue; Xu, Yingke

doi:10.3390/jcm9010285

Cited by 10 publications

(14 citation statements)

References 37 publications

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“…Results were similar in sensitivity analyses excluding data from women who initiated osteoporosis medication therapy during follow-up. We cannot compare the current results regarding discrimination of FRAX and OST for MOF with those of previously published studies because, to our knowledge, studies that examined FRAX in US study cohorts did not evaluate discrimination of FRAX for MOF according to race and ethnicity …”

Section: Discussionmentioning

confidence: 89%

“…We cannot compare the current results regarding discrimination of FRAX and OST for MOF with those of previously published studies because, to our knowledge, studies that examined FRAX in US study cohorts did not evaluate discrimination of FRAX for MOF according to race and ethnicity. [20][21][22][23][24][25][26] Calibration values quantify how well FRAX estimates of 10-year fracture probability match the actual observed 10-year cumulative probability of that fracture outcome. A systematic review performed for the USPSTF 3,27 identified no published studies that provided results of calibration for the US version of FRAX in the US population.…”

Section: Discussionmentioning

confidence: 99%

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Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study

et al. 2023

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ImportanceThe best approach to identify younger postmenopausal women for osteoporosis screening is uncertain. The Fracture Risk Assessment Tool (FRAX), which includes self-identified racial and ethnic information, and the Osteoporosis Self-assessment Tool (OST), which does not, are risk assessment tools recommended by US Preventive Services Task Force guidelines to identify candidates for bone mineral density (BMD) testing in this age group.ObjectiveTo compare the ability of FRAX vs OST to discriminate between younger postmenopausal women who do and do not experience incident fracture during a 10-year follow-up in the 4 racial and ethnic groups specified by FRAX.Design, Setting, and ParticipantsThis cohort study of Women’s Health Initiative participants included 67 169 women (baseline age range, 50-64 years) with 10 years of follow-up for major osteoporotic fracture (MOF; including hip, clinical spine, forearm, and shoulder fracture) at 40 US clinical centers. Data were collected from October 1993 to December 2008 and analyzed between May 11, 2022, and February 23, 2023.Main Outcomes and MeasuresIncident MOF and BMD (in a subset of 4607 women) were assessed. The area under the receiver operating characteristic curve (AUC) for FRAX (without BMD information) and OST was calculated within each racial and ethnic category.ResultsAmong the 67 169 participants, mean (SD) age at baseline was 57.8 (4.1) years. A total of 1486 (2.2%) self-identified as Asian, 5927 (8.8%) as Black, 2545 (3.8%) as Hispanic, and 57 211 (85.2%) as White. During follow-up, 5594 women experienced MOF. For discrimination of MOF, AUC values for FRAX were 0.65 (95% CI, 0.58-0.71) for Asian, 0.55 (95% CI, 0.52-0.59) for Black, 0.61 (95% CI, 0.56-0.65) for Hispanic, and 0.59 (95% CI, 0.58-0.59) for White women. The AUC values for OST were 0.62 (95% CI, 0.56-0.69) for Asian, 0.53 (95% CI, 0.50-0.57) for Black, 0.58 (95% CI, 0.54-0.62) for Hispanic, and 0.55 (95% CI, 0.54-0.56) for White women. For discrimination of femoral neck osteoporosis, AUC values were excellent for OST (range, 0.79 [95% CI, 0.65-0.93] to 0.85 [95% CI, 0.74-0.96]), higher for OST than FRAX (range, 0.72 [95% CI, 0.68-0.75] to 0.74 [95% CI, 0.60-0.88]), and similar in each of the 4 racial and ethnic groups.Conclusions and RelevanceThese findings suggest that within each racial and ethnic category, the US FRAX and OST have suboptimal performance in discrimination of MOF in younger postmenopausal women. In contrast, for identifying osteoporosis, OST was excellent. The US version of FRAX should not be routinely used to make screening decisions in younger postmenopausal women. Future investigations should improve existing tools or create new approaches to osteoporosis risk assessment for this age group.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study

et al. 2023

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“…FRAX improves fracture prediction over the BMD measurement alone, however, the FRAX performance of predicting fracture risk varies in different study populations. Hence, there is room for further improvement in fracture prediction [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Association of bone-related biomarkers with femoral neck bone strength

Xia¹,

Cai

Wang³

et al. 2022

BMC Musculoskelet Disord

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Background Femoral neck fractures are the worst consequence of osteoporosis (OP), and its early prevention and treatment have become a public health problem. This study aims to investigate the relationship of bone-related biomarkers, femoral neck bone mineral density (BMD) and maximum load (Lmax), selecting the indicator which can reflect femoral neck bone loss and reduced bone strength. Methods A total of 108 patients were recruited from January 2017 to December 2019. Venous blood samples were collected from patients before total hip replacement, and femoral neck samples were collected during the surgery. Femoral neck BMD, femoral neck Lmax, bone-related markers (serum levels of bone turnover markers, protein expression of type I collagen (COL-I) and osteopontin (OPN) in femoral neck) were all measured and analyzed. Results The expression of COL-I in femoral neck were significantly decreased, whereas other markers were all significantly increased with the decreasing of femoral neck BMD and Lmax (P < 0.05). Among them, serum C-terminal telopeptide of type I collagen (CTX) levels and OPN expression of femoral neck were increased in osteopenia. In multiple linear regression analysis, CTX and OPN were both negatively correlated with femoral neck BMD and Lmax, and they were independent factors of femoral neck BMD and Lmax, whereas COL-I was independent factor affecting Lmax (P < 0.05). Besides, CTX was negatively correlated with COL-I (β = -0.275, P = 0.012) and positively correlated with OPN (β = 0.295, P = 0.003). Conclusions Compared with other indicators, serum CTX was more sensitive to differences in bone mass and bone strength of femoral neck, and could be considered as surrogate marker for OPN and COL-I.Early measurement of CTX could facilitate the diagnosis of osteopenia and provide a theoretical basis for delaying the occurrence of femoral neck OP and fragility fractures.

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“…Além disso, o custo de tratamento dessas fraturas para o sistema da saúde é elevado, visto que a chance de complicações é considerável e, em alguns casos, se faz necessário internação e tratamento cirúrgico. 4,5 Além da osteoporose, mais recentemente, a sarcopenia tem sido correlacionada ao aumento da probabilidade de um indivíduo vir a sofrer uma fratura por fragilidade. 6 A sarcopenia é definida por uma diminuição da massa muscular, levando à diminuição da capacidade de desempenho das atividades diárias e aumento na probabilidade de desfechos desfavoráveis como quedas, fraturas e morte.…”

Section: Introductionunclassified

O uso do escore SARC-F como auxiliar na prevenção de fraturas por fragilidade

Martini¹,

Weigert²,

Stiegemaier³

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo O presente estudo teve como objetivo relacionar o escore strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) com a presença ou não de fratura por fragilidade na população acima de 60 anos. Métodos O risco de sarcopenia foi determinado por meio da aplicação do questionário SARC-F, sendo os pacientes divididos em 2 grupos, de acordo com a ocorrência ou não de fratura por fragilidade (n = 100). Resultados Foram levantados 32 casos de fratura de rádio distal e 18 casos de fratura de fêmur proximal. Uma maior pontuação no SARC-F determina bem entre ter ou não ter fratura por fragilidade, estimando que a cada ponto a mais no escore há um acréscimo de 70% na chance de o paciente ter fratura, independentemente da idade, sexo e índice de massa corporal (IMC). Conclusão Houve correlação direta entre uma maior pontuação no SARC-F e aumento na chance de fratura por fragilidade.

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Performance of FRAX in Predicting Fractures in US Postmenopausal Women with Varied Race and Genetic Profiles

Cited by 10 publications

References 37 publications

Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study

Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study

Association of bone-related biomarkers with femoral neck bone strength

O uso do escore SARC-F como auxiliar na prevenção de fraturas por fragilidade

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