Setting the new FRAX reference threshold without bone mineral density in Chinese postmenopausal women

Liu, S; Chen, R; Ding, Ning; Wang, Q; Huang, Meng; Liu, Hongyu; Xie, Zhongjian; Ou, Yan; Sheng, Zhi-Feng

doi:10.1007/s40618-020-01315-4

Cited by 13 publications

(14 citation statements)

References 18 publications

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“…As such, the optimal threshold in this study was much lower than the NOF threshold. Liu et al previously found that the sensitivity and specificity of the FRAX with a threshold of 4.95% were 0.76 and 0.69, respectively, which is similar to the results of our study (11). Crandall et al found that the performance of FRAX is unsatisfactory based on dichotomous cut- offs, and threshold-based approaches should be reassessed, particularly in younger women (12).…”

Section: Discussionsupporting

confidence: 91%

“…The FRAX (https://www.sheffield.ac.uk/FRAX) is a computer-based tool used to assess the probability of a 10-year hip fracture or major osteoporotic fracture in male and female patients. Several studies have validated the FRAX for identifying PNOVFs in China, but the optimal threshold varies greatly among previous studies (11,12). Therefore, the use of FRAX in China should be reconsidered.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of four tools to identify painful new osteoporotic vertebral fractures in the postmenopausal population in Beijing

Guo

An²,

Lin³

et al. 2022

Front. Endocrinol.

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ObjectivesTo validate and compare four tools, the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD), Beijing Friendship Hospital Osteoporosis Screening Tool (BFH-OST), Osteoporosis Self-Assessment Tool for Asians (OSTA), and BMD, to identify painful new osteoporotic vertebral fractures (PNOVFs).MethodsA total of 2874 postmenopausal women treated from June 2013 to June 2022 were enrolled and divided into two groups: patients with PNOVFs who underwent percutaneous vertebroplasty (PNOVFs group, n = 644) and community-enrolled females (control group, n = 2230). Magnetic resonance and X-ray imaging were used to confirm the presence of PNOVFs. Dual-energy X-ray absorptiometry was performed to calculate the BMD T-scores. Osteoporosis was diagnosed according to WHO Health Organization criteria. Data on the clinical and demographic risk factors were self-reported using a questionnaire. The ability to identify PNOVFs using FRAX, BFH-OST, OSTA, and BMD scores was evaluated using receiver operating characteristic (ROC) curves. For this evaluation, we calculated the areas under the ROC curves (AUCs), sensitivity, specificity, and optimal cut-off points.ResultsThere were significant differences in FRAX (without BMD), BFH-OST, OSTA, and BMD T-scores (total hip, femoral neck, and lumbar spine) between the PNOVFs and control groups. Compared with BFH-OST, OSTA, and BMD, the FRAX score had the best identifying value for PNOVFs; the AUC of the FRAX score (optimal cutoff =3.6%) was 0.825, while the sensitivity and specificity were 82.92% and 67.09%, respectively.ConclusionFRAX may be the preferable tool for identifying PNOVFs in postmenopausal women, while BFH-OST and OSTA can be applied as more simple screening tools for PNOVFs.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Comparison of four tools to identify painful new osteoporotic vertebral fractures in the postmenopausal population in Beijing

Guo

An²,

Lin³

et al. 2022

Front. Endocrinol.

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“…Among the tools are tested in the present study, FRAX had a higher discriminating ability for identifying PNOVCF, followed by OSTA and BMD. In clinical practice, FRAX needs to include many risk factors and be equipped with corresponding hardware and software, so it has certain limitations [ 26 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Beijing Friendship Hospital Osteoporosis Self-Assessment Tool for Elderly Male (BFH-OSTM) vs Fracture Risk Assessment Tool (FRAX) for identifying painful new osteoporotic vertebral fractures in older Chinese men: a cross-sectional study

Lin

2021

BMC Musculoskelet Disord

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Background To compare the validation of four tools for identifying painful new osteoporotic vertebral compression fractures (PNOVCFs) in older Chinese men: bone mineral density (BMD), Asian osteoporosis self-assessment tool (OSTA), World Health Organization fracture risk assessment tool (FRAX) (without BMD) and Beijing Friendship Hospital Osteoporosis Self-Assessment Tool (BFH-OSTM). Methods A cross sectional study was conducted from 2013 to 2019. A total of 846 men aged ≥50 were included and were divided into two groups: Fracture Group (patients with PNOVCFs underwent percutaneous vertebroplasty surgery) and Non-Fracture Group (community dwelled subjects for healthy examination). All subjects accepted a dual-energy X-ray BMD test and a structured questionnaire. The results of BMD, OSTA, FRAX and BFH-OSTM scores were assessed and receiver-operating characteristic (ROC) curves were generated to compare the validity of four tools for identifying PNOVCFs. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. Results There were significant differences including BMD T score (femoral neck, total hip and L1-L4), OSTA, FRAX and BFH-OSTM scores between Fracture group and Non-fracture group. Compared to BMD and OSTA, BFH-OSTM and FRAX had better predictive value, the sensitivity, specificity and AUC value are 0.841, 81.29%, 70.67% and 0.796, 74.85%, 78.52%, respectively. Compared with FRAX, the BFH-OSTM has a better AUC value. Conclusions Both BFH-OSTM and FRAX can be used to identify POVCFs, However, BFH-OSTM model may be a more simple and effective tool to identify the risk of POVCFs in Chinese elderly men.

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“…One diagnostic criterion of osteoporosis was T-score of BMD measured by DXA in the medial axial skeletons (L1–L4, femoral neck, and total hip) or one-third of the distal radius of ≤−2.5 for postmenopausal women and men aged ≥50 years. 12 According to the AACE/ACE, patients with very low bone mineral density (T-scores <-3) were considered to have very high fracture risk. FRAX was used to determine the 10-year probability of major osteoporotic fractures (MOFs) and hip fractures (HFs).…”

Section: Methodsmentioning

confidence: 99%

Development of a Nomogram for Predicting Very Low Bone Mineral Density (T-Scores

Li¹,

Wang²,

Xu³

et al. 2022

IJGM

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Purpose Fragility fractures, the most serious complication of osteoporosis, affect life quality and increase medical expenses and economic burden. Strategies to identify populations with very low bone mineral density (T-scores <-3), indicating very high fracture risk according to the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), are necessary to achieve acceptable fracture risk levels. In this study, the characteristics of persons with T-scores <−3 were analyzed in the Chinese population to identify risk factors and develop a nomogram for very low bone mineral density (T-scores <-3) identification. Materials and Methods We conducted a cross-sectional study using the datasets of the Health Improvement Program of Bone (HOPE), with 602 men aged ≥50 years and 482 postmenopausal women. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). Data on clinical risk factors, including age, sex, weight, height, previous fracture, parental hip fracture history, smoking, alcohol intake >3 units/day, glucocorticoid use, rheumatoid arthritis, and secondary osteoporosis were collected. A multivariate logistic regression to evaluate the relationship between the clinical risk factors and very low BMD (T-scores <-3) was conducted. Parameter estimates of the final model were then used to construct a nomogram. Results Sixty-three of 1084 participants (5.8%) had BMD T-score <−3. In multivariable regression analysis, age (odds ratio [OR] = 1.068, 95% confidence interval [CI]: 1.037–1.099) and weight (OR = 0.863, 95% CI: 0.830–0.897) were significant factors that were associated with very low BMD (T-scores <-3). These variables were the factors considered in developing the nomogram. The area under the receiver operating characteristic (ROC) curve for the model was 0.861. The cut-off value of the ROC curve was 0.080. Conclusion The nomogram can effectively assist clinicians to identify persons with very low BMD (T-scores <-3) and very high fracture risk in the Chinese population.

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Setting the new FRAX reference threshold without bone mineral density in Chinese postmenopausal women

Cited by 13 publications

References 18 publications

Comparison of four tools to identify painful new osteoporotic vertebral fractures in the postmenopausal population in Beijing

Comparison of four tools to identify painful new osteoporotic vertebral fractures in the postmenopausal population in Beijing

Beijing Friendship Hospital Osteoporosis Self-Assessment Tool for Elderly Male (BFH-OSTM) vs Fracture Risk Assessment Tool (FRAX) for identifying painful new osteoporotic vertebral fractures in older Chinese men: a cross-sectional study

Development of a Nomogram for Predicting Very Low Bone Mineral Density (T-Scores

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