Abstract
Fracture risk assessment algorithm (FRAX) is the most validated method available to predict fracture risk. Its use is restricted due to limited availability of Dual Energy X-ray Absorptiometry (DXA). FRAX has the option of assessing facture risk without BMD data. To assess the ability of Sri Lankan FRAX algorithm without BMD input in evaluating fracture risk. The possibility of replacing the BMD input with Quantitative Ultrasound (QUS) data of radius in calculating fracture risk also assessed. Data of clinical risk factors associated with fractures were collected from community dwelling postmenopausal women (n=339). DXA scans were performed in all subjects and QUS scans (in radius) were performed in a randomly selected sample (n=207). Ten-year risks of major osteoporotic fracture (MOFR) and hip fracture (HFR) were calculated with BMD, without BMD (FRAX-FN0) and with US T score instead of BMD (FRAX-UST). Nearly 35.7% had high risk of fractures. FRAX-FN0 had 79.2% sensitivity, 80.1% specificity, 68.8% positive predictive value (PPV) and 87.4% negative predictive value (NPV). FRAX-UST showed 78.4% sensitivity, 70% specificity, 59.8% PPV and 85% NPV. ROC AUCs were above 0.80 in both FRAX-FN0 and FRAX-UST. The standard errors of estimate (SEE) were less in FRAX-FN0 (3.96 and 2.76 for MOFR-FN0 and HFR-FN0 respectively) compared to FRAX-UST (6.13 and 4.83 for MOFR-UST and HFR-UST, respectively). In conclusion, Sri Lankan FRAX without BMD is an acceptable alternative in areas with restricted DXA facility. Radial QUS data cannot be used as a substitute to FN-BMD in Sri Lankan FRAX.
Highlights
Fracture risk assessment algorithm (FRAX) is the most validated method available to predict fracture risk
Radial Quantitative Ultrasound (QUS) data cannot be used as a substitute to femoral neck (FN)-bone mineral density (BMD) in Sri Lankan FRAX
Osteoporosis which is characterized by low bone mineral density (BMD) and microarchitectural deterioration is associated with increased fracture risk especially in elderly [1,2]
Summary
Fracture risk assessment algorithm (FRAX) is the most validated method available to predict fracture risk. FRAX has the option of assessing fracture risk without bone mineral density (BMD) data. Osteoporosis which is characterized by low bone mineral density (BMD) and microarchitectural deterioration is associated with increased fracture risk especially in elderly [1,2]. Though there are many tools available to assess fracture risk, FRAX (Fracture Risk Assessment Tool), is the most validated and widely used. It has been developed based on clinical risk factors which have proven associations with low bone density or occurrence of fractures by large epidemiological studies [9]. FRAX algorithm which can be applied to both men and women between 40-90 years estimates the 10-year probability of both hip and major osteoporotic fractures [9]
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