Comparison of methods to improve fracture risk assessment in chinese diabetic postmenopausal women: a case-control study.

Zhangxin Wen,Qinyi Wang,Shuyin Liu,Na Ding,Zhifeng Sheng,Rong Chen,Hong Liu

doi:10.1007/s12020-021-02724-y

Abstract

This study evaluated the predictive power of adjusted FRAX and standard FRAX models based on the actual prevalence of osteoporosis in type 2 diabetic (T2DM) postmenopausal women, and to explore the optimal strategy to better predicted fracture risk in postmenopausal women with diabetes in China. We recruited 434 patients from community-medical centers, 217 with T2DM and 217 without T2DM (non-T2DM). All participants completed self-reported questionnaires detailing their characteristics and risk factors. Bone mineral density (BMD) and spinal radiographs were evaluated. The China FRAX model calculated all scores. The area under the receiver operator characteristic curve (ROC-AUC) evaluated the sensitivity, specificity, and accuracy for predicting 10-year risk for major (MOF) and hip (OHF) osteoporotic fractures in T2DM patients. T2DM patients had higher BMD but lower average FRAX values than non-T2DM patients. The unadjusted FRAX ROC-AUC was 0.774, significantly smaller than that for 0.5-unit femoral neck T-score-adjusted FRAX (0.800; p = 0.004). Rheumatoid arthritis (RA; AUC = 0.810, p = 0.033) and T-score (AUC = 0.816, p = 0.002) adjustments significantly improved fracture prediction in T2DM patients. Femoral neck T-score adjustment might be the preferred method for predicting MOF and OHF in Chinese diabetic postmenopausal women, while RA adjustment only effectively predicted HF risk.

Highlights

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue that leads to increased fracture risk [1], disability, financial burden, and mortality [2,3,4,5]
Femoral neck T-score adjustment might be the preferred method for predicting major osteoporotic fractures (MOF) and osteoporotic hip fractures (OHF) in Chinese diabetic postmenopausal women, while Rheumatoid arthritis (RA) adjustment only effectively predicted HF risk
The probability of fractures is based on the anamnestic, clinical factors, and anthropometric parameters, and considers, when available, the femoral neck bone mineral density (BMD) that can improve the accuracy of the fracture risk assessment [6]

Summary

Introduction

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue that leads to increased fracture risk [1], disability, financial burden, and mortality [2,3,4,5]. The most widely used assessment instrument is the Fracture Risk Assessment Tool (FRAX®) This computer-based algorithm predicts the 10-year probability of major osteoporotic fractures (MOF) (hip, clinical spine, forearm, and humerus fracture) and osteoporotic hip fractures (OHF) in the presence of competing mortality. Menopause is a risk factor for diabetes and osteoporosis [8,9], and diabetes mellitus, type 2 diabetes mellitus (T2DM), is a common disease in China. It was estimated in 2017 that the T2DM incidence in China was 10.4% [10]. Evidence suggests that the FRAX algorithm does not reflect the risk of fractures in T2DM patients correctly [16]

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