10-year Probability Of Hip Fracture Research Articles

Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study

The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM. A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72-94.56, n=194), moderate-level (94.56-100.22, n=193), and high-level (100.22-116.45, n=193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan-Meier survival analysis. Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r=0.165, P<0.001) and bone mineral density (BMD) [lumbar spine (LS), r=0.088, P=0.034; femoral neck (FN), r=0.167, P<0.001; total hip (TH), r=0.171, P<0.001]; negatively correlated with MOF (r=-0.105, P=0.012) and HF (r=-0.154, P<0.001). RCS analyses showed that GNRI was inversely S-shaped dose-dependent with a fragility fracture event (P<0.001) and was Z-shaped with the 10-year MOF (P=0.03) and HF (P=0.01) risk assessed by FRAX, respectively. Multivariate Cox regression analysis demonstrated that compared with high-level GNRI, moderate-level [hazard ratio (HR)=1.950; 95% confidence interval (CI)=1.076-3.535; P=0.028] and low-level (HR=2.538; 95% CI=1.378-4.672; P=0.003) had an increased risk of fragility fracture. Stratified analysis exhibited that GNRI was negatively correlated with the risk of fragility fracture, which the stratification factors presented in the forest plot were not confounding factors and did not affect the prediction effect of GNRI on the fragility fracture events in this overall cohort population (P for interaction>0.05), despite elderly females aged ≥70, with body mass index (BMI) ≥24, hypertension, and with or without anemia (all P<0.05). Kaplan-Meier survival analysis identified that the lower-level GNRI group had a higher cumulative incidence of fragility fractures (log-rank, all P<0.001). This study confirms for the first time that GNRI is negatively related to a fragility fracture and the 10-year probability of osteoporotic fragility fractures assessed by FRAX in an inverse S-shaped and Z-shaped dose-dependent pattern in elderly with T2DM, respectively. GNRI may serve as a valuable predictor for fragility fracture risk in elderly with T2DM. Therefore, in routine clinical practice, paying attention to the nutritional status of the elderly with T2DM and giving appropriate dietary guidance may help prevent a fragility fracture event.

Probability of the 10-year Risk of Hip and Major Osteoporotic Fracture in Non-radiographic Axial Spondyloarthritis.

Fracture risk in non-radiographic spondyloarthritis is underestimated. A reliable tool such as the Fracture Risk Assessment tool (FRAX) may assess this risk probability. This study aimed to assess the fracture risk by the FRAX score in patients with nr-axSpA and to determine factors associated with high fracture risk. We conducted a retrospective study of nr-axSpA patients meeting the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for spondyloarthritis. All patients had Bone Mineral Density (BMD) by dual-energy X-ray absorptiometry (DEXA). The 10- year probability of major osteoporotic fracture (MOF) and hip fracture (HF) was calculated using the Fracture Risk Assessment Tool (FRAX). Among 40 patients with nr-axSpA, 27 were women (67.5%). Their mean age was 43.7 ± 12.1 years. The mean disease duration was 3.15 ± 2.7 years. Eighteen patients (45%) had osteopenia, and 12 patients (30%) had osteoporosis. The median HF FRAX was 0% [0-1.2]. The median MOF FRAX was 0.5% [0.3-1.8]. MOF FRAX was positively correlated with age (p = 0.002), disease onset age (p = 0.006), disease duration (p = 0.024), and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) (p < 0.0001), and negatively correlated with daily calcium intake (p < 0.0001). HF FRAX was positively correlated with mSASSS (p < 0.0001) and negatively correlated with daily calcium intake (p = 0.005). Our study confirmed the frequency of bone loss during nr-axSpA and showed that osteoporotic risk fracture was related not only to traditional risk factors for osteoporosis but also to disease-related factors.

Risk of sarcopenia in subjects with osteoporosis and osteoarthritis

The study aimed to determine the relationship between the risk of sarcopenia (SP) and common age-related diseases of the musculoskeletal system, such as osteoporosis (OP) and osteoarthritis (OA). There were examined 460 women aged 50-85 years (mean age 66.4 ± 8.8 years) and they were divided into 4 groups. Group I included 176 women without bone and joint diseases (BJD); Group II included 137 persons with a diagnosis of systemic OP; Group III included 95 subjects with knee and/or hip OA (2nd-3rd degree of Kellgren-Lawrence grades); IV group included 52 females with OP and large joints OA (2nd-3rd degree of Kellgren-Lawrence grades). Bone mineral density (BMD) and trabecular bone score (TBS) were determined in all patients using dual-energy X-ray absorptiometry (DXA), which was subsequently taken into account in the calculation of the 10-year probability of the major osteoporotic fractures according to the Ukrainian version of FRAX®. The following questionnaires were used: SARC-F, IADL, Desmond Fall Risk Questionnaire, and KOOS-12. Also, we used the chair stand test (5 times sit-to-stand) and hand grip dynamometer test. The frequency of persons with risk of SP in Group I was 20.3 %, and it was significantly higher in women with OP (33.5 %, χ2= 6.9 [3.4 – 23.0], p &lt; 0.05), subjects with OA (34.7 %, χ2= 6.7 [3.4 – 25.7], p &lt; 0.05), and women with combined pathology (44.2 %, χ2= 12.1 [9.8 – 38.2], p &lt; 0.05). In patients with OA and risk of SP, pain intensity was significantly higher (43.7 [31.3 – 62.5] points compared to patients with OA without risk of SP - 68.8 [50.0 – 93.8] points, Z = 3.6, p &lt; 0.05), as well as function, and daily living (43.8 [31.3 – 68.8] and 75.0 [56.3 – 100.0] points, respectively, Z = 4.1, p &lt; 0.05 and quality of life 43.8 [37.5 – 62.8] and 75.0 [43.8 – 87.5] points, respectively (Z = 3.0, p &lt; 0.05) according to the KOOS-12. The probability of the major OP fracture was significantly higher in the group of OP and risk of SP (11.0 [8.5 – 12.0] % compared to patients with OP without risk of SP - 8.1 [5.4 – 10.0] %, Z = - 3.8, p &lt; 0.05). The same differences were found for the 10-year probability of hip fracture (5.0 [2.8 – 7.3] and 2.1 [1.5 – 3.5] %, respectively, Z = - 4.9, p &lt; 0.05). High Risk of SP, falls and the need for external assistance were recorded significantly more often in women with OP pathology, and their skeletal muscle strength was significantly lower. Women with a high risk of SP had significantly lower skeletal muscle strength (according to hand grip dynamometry), a higher risk of falls and fractures, and a greater need for assistance. The combination of a risk of SP and OA was associated with more severe joint pain intensity, lower function, and quality of life, and the risk of SP and OP combination was associated with a higher risk of OP fracture. _________________________________________________________________________________________ Keywords: sarcopenia; osteoporosis; osteoarthritis; FRAX; fracture; fall; pain; quality of life.

Sarcopenia in Egypt: epidemiology of sarcopenia risk among older adults presenting with fragility fractures—an initiative by the Egyptian Academy of Bone Health

Purpose(1) This was a multi-center, cross-sectional, observational study. Both old men and postmenopausal women over 50 years old who were admitted with an osteoporotic fracture (whether hip fracture or major osteoporosis) were consecutively recruited for this work and managed under the Fracture Liaison Service. All the patients were assessed for their sarcopenia risk (SARC-F), fracture risk (FRAX), and fall risk (FRAS) as well as functional disability (HAQ). The aim was to assess the prevalence of sarcopenia risk among older adult Egyptians presenting with fragility fractures. (2) To identify the relation between sarcopenia risk with the risk of falling as well as sustaining a fragility fracture.ResultsTwo hundred and thirty-six patients (69 males, 167 females) were included in this work. The mean age was 70.1 (SD = 9.2) years. The prevalence of sarcopenia was 69.7%. The sarcopenia risk score was positively correlated with the FRAX score (p = 0.01). The prevalence of high sarcopenia risk was 78% of the patients presenting with a high 10-year probability of major osteoporosis fracture as well as a 10-year probability of hip fracture. The sarcopenia risk score was positively correlated with the increased fall risk (p = 0.01) as scored by the FRAS scale. There was a significant relation (p < 0.05) between the functional disability score and the SARC-F score. This was persistent when assessed in relation to fall risk.ConclusionThis study highlighted the high sarcopenia risk in the patients presenting with fragility fractures. Identification of patients at increased risk of sarcopenia should be a component of the standard practice.

A diagnostic predictive model for secondary osteoporosis in patients with fragility fracture: a retrospective cohort study in a tertiary care hospital.

Establishing whether a fragility fracture is secondary to a specific cause of osteoporosis is crucial for treatment outcomes. Therefore, this study aimed to develop a simple screening tool for secondary osteoporosis in the elderly initially presented with fragility fractures. A retrospective cohort study including 456 patients with fragility hip and vertebral fractures that occurred between January 2017 and July 2022 was conducted. Demographic, clinical, biochemical, and final diagnostic data were retrieved. Potential predictors for secondary osteoporosis were determined by multivariable logistic regression analysis, and a predictive model for secondary osteoporosis was subsequently developed using identified potential predictors. This study included 343 females and 113 males with a mean age of 76.9 ± 11.0 years. One hundred and twenty-one patients (26.5%) were diagnosed with secondary osteoporosis. Vitamin D deficiency (71.9%) was the most common cause of secondary osteoporosis, followed by glucocorticoid-induced osteoporosis (23.9%) and primary hyperparathyroidism (9.9%). The potential predictors for secondary osteoporosis included in the predictive model were age, body mass index (BMI), corrected calcium, phosphate, thyroid stimulating hormone, and a 10-year probability of hip fractures calculated by BMI-based FRAX®. With a cut-off level of 0.22, the proposed predictive model has an AuROC of 0.75 (95% CI 0.69 to 0.81) with a sensitivity of 77%, a specificity of 66%, and an accuracy of 68.9%. A predictive model for screening secondary osteoporosis was constructed using simple clinical and biochemical parameters. This newly developed predictive model may provide clinicians with guidance to perform further advanced investigations for secondary causes of osteoporosis.

Changes in BMD T-score from pre-to post-treatment with biosimilar teriparatide: A single-arm, multi-center study

IntroductionTeriparatide is a recombinant analog of the parathyroid hormone and an anabolic treatment modality for osteoporosis. This study aimed to evaluate the effectiveness of biosimilar teriparatide (CinnoPar®, CinnaGen Co., Iran) in osteoporotic patients after at least one year of treatment. MethodsIn this multi-center, single-arm study, 239 eligible patients received subcutaneous injections of biosimilar teriparatide 20 μg once daily for at least one year. The main outcome measure was the change in bone mineral density (BMD) T-score from baseline (pre-treatment) to end of the study (post-treatment). In addition, the change in the fracture risk assessment tool (FRAX) score was calculated to estimate the 10-year probability of major and hip fractures pre-and post-treatment. ResultsA total of 239 patients (age, 63 ± 12.14 years; female, 88.28 %) were included, of which 27.62 % (66/239), 14.64 % (35/239), and 57.74 % (138/239) received biosimilar teriparatide for 12–16 months, 17–20 months, and 21–24 months, respectively. From baseline to end of the study, the T-score at the lumbar spine increased from −2.67 ± 1.04 to −2.26 ± 1.11 (mean percent change, 13.07 ± 62.89; p-value<0.001). Similarly, the T-score at femoral neck increased from −2.18 ± 0.87 to −2.09 ± 0.93 (mean percent change, 3.81 ± 31.52; p-value = 0.006). The proportions of patients with maintained or improved BMD T-score at the lumbar spine and femoral neck sites were 85.36 % (204/239) and 69.04 % (165/239), respectively. Similar results were obtained in subgroups of patients with rheumatoid arthritis and those with a history of a previous fracture or parental hip fracture. FRAX scores did not change significantly during the study (p-values of 0.551 and 0.973 at the lumbar spine and femoral neck, respectively). ConclusionWe observed considerable improvements in BMD following treatment with the biosimilar teriparatide for one year or more. The biosimilar teriparatide can be considered as an effective treatment option in female and male patients with osteoporosis.

Association of C-peptide level with bone mineral density in type 2 diabetes mellitus.

To explore the relationship between C-peptide and BMD and fracture risk in T2DM patients. 530 T2DM patients were enrolled and divided into three groups by FCP tertiles, and the clinical data were collected. BMD was measured by dual-energy X-ray absorptiometry (DXA). The 10-year probability of major osteoporotic fractures (MOFs) and hip fractures (HFs) was evaluated by adjusted fracture risk assessment tool (FRAX). In the FCP ≤ 1.14ng/ml group, FCP level was positively correlated with WB, LS, and FN BMD, while FCP was negatively correlated with fracture risk and osteoporotic fracture history. However, FCP was not correlated with BMD and fracture risk and osteoporotic fracture history in the 1.14 < FCP ≤ 1.73ng/ml and FCP > 1.73ng/ml groups. The study has shown that FCP was an independent factor influencing BMD and fracture risk in the FCP ≤ 1.14ng/ml group. There is no significant linear relationship between FCP level and BMD or fracture risk in T2DM patients. In the FCP ≤ 1.14ng/ml group, FCP is positively correlated with WB, LS, and FN BMD and negatively correlated with fracture risk, and FCP is an independent influencing factor of BMD and fracture risk. The findings suggest that FCP may predict the risk of osteoporosis or fracture in some T2DM patients, which has a certain clinical value.

The proportion of Thai postmenopausal women who would be eligible for anti-osteoporosis therapy.

To determine the proportion of postmenopausal Thai women who would be classified as having high risk of fracture and eligible for anti-osteoporosis therapy according to the National Osteoporosis Foundation (NOF) criteria. Postmenopausal Thai women aged 40-90 years who had been screened for osteoporosis during 2014-2019 were recruited. Demographic data and osteoporosis risk factors were collected based on the Fracture Risk Assessment Tool (FRAX) questionnaire. Bone mineral density (BMD) at the femoral neck and lumbar spine measured using dual energy X-ray absorptiometry. Ten-year probabilities of hip and major osteoporotic fracture (MOF) were calculated based on the Thai FRAX model with BMD. The study's protocol was approved by the Institutional Ethical Committee (HE581241). A total of 3,280 postmenopausal women were included. The mean ± SD age was 63.6 ± 10.1 years. A total of 170 (5.2%) participants had a history of hip and/or vertebral fracture. After excluding these participants with fracture history, 699 (21.3%) had osteoporosis, 355 (10.8%) had osteopenia with high risk of fracture (FRAX 10-year probability of hip fracture ≥ 3% and/or MOF ≥ 20%), 1192 (36.3%) had osteopenia with low risk of fracture (FRAX 10-year probability of hip fracture < 3% and MOF < 20%) and 864 (26.3%) had normal BMD. Taken together, a total of 1,224 (37.3%) participants would be eligible for anti-osteoporosis therapy (prior fracture, osteoporosis or osteopenia with high risk of fracture). The prevalence of Thai postmenopausal women who would be eligible for anti-osteoporosis therapy was 37.3%.

Association of Plasma Sex-Related Hormones Levels with Bone Mineral Densities and Risk of Osteoporosis and Osteopenia in Men and Menopausal Women with Type 2 Diabetes Mellitus.

This study aimed to examine associations between plasma sex-related hormones with bone mineral density (BMD) and risks of osteoporosis or osteopenia in men and postmenopausal women patients with type 2 diabetes mellitus (T2DM). Baseline information on an ongoing cohort of 149 men and 102 postmenopausal women with T2DM in Xiamen, China were analyzed. Plasma estradiol (E2), total testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) were measured. BMD of lumbar spine (L2-4), femoral neck (FN) and total hip (TH) were determined by dual-energy X-ray absorptiometry (DXA). Osteoporosis or osteopenia was defined as the minimum T-scores of BMD of these three different sites of -1.0 or below. T2DM patients with osteoporosis/osteopenia (66.4% in men and 79.4% in postmenopausal women), compared to those without, showed significantly decreased level of E2 (75.3±28.9 vs. 107.8±25.9pmol/L and 18.4 (18.4-29.5) vs. 22.8 (18.4-40.5) pmol/L for men and postmenopausal women, respectively, both p-values <0.05), but not other sex-related hormones (including T, FSH, LH, or PRL). For all T2DM patients together and men separately, multivariable linear regression and logistic regression analyses showed that higher E2 levels were significantly associated with higher BMD T-scores in L2-4, FN, TH and minimum of these three different sites, lower 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HFs) estimated by Fracture Risk Assessment Tool score, as well as decreased risk of osteoporosis/osteopenia. As for postmenopausal women T2DM patients, E2 level was positively associated with BMD T-scores in L2-4 and minimum of three different sites but was not independently associated with risk of osteoporosis/osteopenia. Higher plasma E2 was significantly associated with increased BMD and lower risk of osteoporosis or osteopenia in T2DM patients, especially for men. Screening of BMD and estradiol levels as well as evaluating risks of osteoporosis/osteopenia are important for T2DM patients.

Associations between oral health status and risk of fractures in elder adults

Oral health condition, bone mineral density, skeletal muscle mass, fall, fracture, and frailty seem to be strongly interconnected. This study aimed to investigate associations between probability of osteoporotic fractures and oral health in the elderly. In total, 2322 Korean subjects from the 2008—2009 Korea National Health and Nutritional Examination Survey aged over 65 years were included. The 10-year probabilities of major and hip fractures were calculated using the Fracture Risk Assessment (FRAX) tool. Data on anthropometry, skeletal bone mineral density, sociodemographic characteristics, physical activity, individual history of fractures and falls, parental history of osteoporosis, number of teeth, metabolic syndrome, the Decayed, Missing, and Filled permanent Teeth index, and Community Periodontal Index (CPI), were collected. Participants were classified into three groups based on FRAX score for major osteoporotic fractures. A multivariate linear regression analysis was conducted to analyze associations between FRAX scores and oral health-related factors, adjusting for confounding factors. BMI, presence of metabolic syndrome, number of teeth, dental patterns, and CPI score showed significant differences among three groups in males and females. Results from multivariate linear regression analysis demonstrated significant relationships between total tooth number and probabilities of fracture in male and female elderly. The interdisciplinary approach for handling osteoporosis and sarcopenia including dentists, physicians is necessary to facilitate a better quality of life in the elderly.

Prevalence of low bone mineral density at axial sites and fracture risk in Bulgarian population.

Osteoporosis is a common chronic disease characterized by low bone mineral density (BMD) and microarchitectural deterioration of the bone, which are associated with increased risk of fragility fractures. Currently the most popular tool is the fracture risk assessment model FRAX to calculate the 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HF). To investigate the prevalence of low BMD at axial sites and fracture risk in Bulgarian population. We retrospectively analyzed dual energy X-ray absorptiometry (DXA) scan results of 12 478 subjects. Scan results included BMD and T-score assessments of lumbar spine and femoral neck. FRAX major osteoprotic fracture (MOF) and FRAX hip fracture (HF) were assessed in subjects between 40 and 90 years using BMD values. Of total 12478 subjects, 12119 were women and 359 were men. The mean age of the subjects was 61 years (yrs.) ± 10 yrs. The overall prevalence of low BMD at the lumbar spine was 6084/9336 subjects (65.2%). 3502/9336 subjects (37.5%) were considered as osteopenic and 2582/9336 subjects (27.7%) were considered as osteoporotic. The overall prevalence of low BMD at the femoral neck was 2036/3140 (64.8%). 1641/3140 subjects (52.3%) were classified as osteopenic and 395/3 140 subjects (12.6%) were classified as osteoporotic. The mean values of FRAX MOF and FRAX HF increased significantly with increasing the age interval. This study is the largest epidemiological research in Bulgaria up to date about the prevalence of low BMD at axial sites.

Appropriate FRAX® Intervention Threshold for Pharmacological Treatment of Osteoporosis in Thailand

Purpose: The Fracture Risk Assessment Tool (FRAX®) has been recommended and incorporated into osteoporotic guidelines worldwide to assess fracture risk and promptly diagnose osteoporosis when bone mineral density is unavailable. However, a country-specific intervention threshold for Thai patients remains unknown. Therefore, we aimed to identify an appropriate cut-off point for the 10-year probability of hip fracture (HF), specifically in the Thai population. Methods: This retrospective cohort study included members of the Thai population aged 50-90 years, enrolled from January 2018 to January 2020. Analysis of data collected from online FRAX® tool questionnaires was conducted and the receiver operating characteristic (ROC) curve was used to determine a new appropriate cut-off value as the intervention threshold. Results: A total of 1,311 (HF: 422 [32.2%], non-HF: 889 [67.8%]) participants were included. The FRAX® 10-year probability of fracture in patients with HF was significantly higher than in non-HF (5.8% ± 4% vs. 4.7% ± 4.5%, respectively; P &lt; 0.01), whereas the probability of major osteoporotic fracture (MOF) was similar (11.0 ± 5.8% vs. 10.6 ± 6.2%, P = 0.27). The ROC curve revealed a new intervention threshold for the FRAX®-based 10-year risk for HF of 4.3% with a maximum area under the curve (AUC) (95% confidence interval: 0.632 (range: 0.602-0.663; P &lt; 0.001), with sensitivity and specificity of 62.9% and 60.7%, respectively. Conclusions: The intervention threshold cut-off value for osteoporosis treatment among the Thai population was 4.3%, which is higher than the cut-off point recommended in the Thai national guidelines.

Comparative analysis of risk factors for hip fracture in patients of different nationalities living in Kazakhstan

BACKGROUND: Osteoporosis is a multifactorial systemic skeletal disease characterized by a decrease in bone strength leading to an increased risk of fractures. Hip fracture is a serious complication of osteoporosis. It is expected in Kazakhstan by 2050 the annual number of hip fracture will increase by 140% compared to 2015 data and will amount to 28,048 cases. There are differences in the incidence of fractures and low bone mineral density in different ethnic groups. However, low bone mineral density is only one of many risk factors for osteoporotic fractures.&#x0D; AIM: To study the risk factors of osteoporosis and related osteoporotic fractures in patients with hip fracture living in Kazakhstan.&#x0D; MATERIALS AND METHODS: The case-control study included 98 patients with hip fracture of Kazakh (main group, n = 49) and other nationalities (control group, n = 49). In the registration card, risk factors for osteoporosis and osteoporotic fractures from the Fracture Risk Assessment (FRAX) model were distinguished, and the Find cases Assess Confirm Severity algorithm (2019) was used to diagnose sarcopenia. Statistical analysis was carried out using the Statistics 26 (IBM SPSS, США).&#x0D; RESULTS: The groups were comparable in terms of gender, disability, fracture location and functional activity, surgical treatment. An increase in cases of hip fracture at an older age was found in the main group than in the control group (р = 0.035).&#x0D; There were no differences in the groups for clinical risk factors for osteoporotic fractures (body weight, height, history of fractures, family history of fractures, medication, comorbidity), except for smoking (lower in Kazakhs than in the other group) (р = 0.033). Differences in 10-year probability of major osteoporotic fracture and hip fracture between groups (р = 0.34 and р = 0.74) were not found. The proportion of patients who entered the intervention threshold and at low risk did not differ in the groups (р = 0.623).&#x0D; The average SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) score was lower among Kazakhs (р = 0.011), there is a difference between the groups when walking (р = 0.044), climbing stairs (р = 0.003). A decrease of grip strength was noted in the main group (р = 0.008), especially in men (р = 0.011), but low grip strength (р 0.001) and signs of sarcopenia (р 0.001) were determined only by age, not nationality.&#x0D; CONCLUSIONS: The Fracture Risk Assessment (FRAX) model and intervention threshold can be applied to all residents of Kazakhstan.

Serum Insulin-Like Growth Factor 1 Levels, Facture Risk Assessment Tool Scores and Bone Disorders in Patients with Primary Biliary Cholangitis.

Insulin-like growth factor 1 (IGF-1) plays an important role in bone growth and maintenance, and its decreased levels are associated with bone disorders. This study aimed to evaluate the association of serum IGF-1 levels with osteoporosis, prevalent fractures and fracture risk based on the Fracture Risk Assessment Tool (FRAX) in patients with primary biliary cholangitis (PBC). This study included 127 consecutive patients with PBC. Based on the baseline serum IGF-1 levels, the participants were classified into the low (L)-, intermediate (I)- and high (H)-IGF-1 groups. According to the FRAX score, high fracture risk was defined as a 10-year major osteoporotic fracture probability (FRAX-MOF) ≥ 20% or a 10-year hip fracture probability (FRAX-HF) ≥ 3%. The serum IGF-1 levels were positively correlated with bone mineral density, and were negatively correlated with the FRAX-MOF/FRAX-HF. The L-IGF-1 group had the highest prevalence of osteoporosis (58.1%), prevalent fracture (48.4%) and high fracture risk (71.0%). Meanwhile, the H-IGF-1 group had the lowest prevalence of osteoporosis (9.7%), prevalent fracture (12.9%) and high fracture risk (9.7%). The prevalence of these events increased stepwise with decreasing serum IGF-1 levels. The cutoff values of IGF-1 for predicting osteoporosis, prevalent fracture and high fracture risk were 61.5 ng/mL (sensitivity/specificity, 0.545/0.894), 69.5 ng/mL (0.633/0.784) and 61.5 ng/mL (0.512/0.929), respectively. Serum IGF-1 levels were associated with bone disorders and the FRAX-derived fracture risk, and may be a useful indicator for initiating therapeutic intervention to prevent the incidence of fracture in patients with PBC.

Nutritional status and osteoporotic phenotype of body composition in patients with rheumatoid arthritis

Aim. To evaluate the nutritional status and its relationship with osteoporotic phenotype of body composition in women with rheumatoid arthritis (RA).Material and methods. The study included 91 women aged 40 to 75 years with RA according to ACR/EULAR criteria (2010). A questionnaire, laboratory examination and dual X-ray absorptiometry of whole body, lumbar spine and proximal femur were conducted. Nutritional status was assessed using a MNA (Mini Nutricial Assessment) questionnaire.Results. Risk of malnutrition and malnutrition according to the MNA were detected in 42.9 % and 1.1 % of patients with RA, respectively. These patients differed from those with normal nutritional status with a higher risk of osteoporotic hip fracture according to FRAX (p = 0.035), lower appendicular muscle mass (AMM) (p = 0.048) and lower QOL according to VAS (p = 0.012). A positive correlation was established between the nutritional status by MNA and BMI (r = 0.280; p = 0.007), as well as total muscle mass (r = 0.280; p = 0.008), AMM (r = 0.320; p = 0.002) and AMM index (r = 0.280; p = 0.009). In multivariate logistic regression analysis, age above 55 years (OR = 7.76; 95 % CI: 2.17–27.69), nutritional status by MNA (OR = 0.68; 95 % CI: 0.51–0.92) and AMM index less than 6 kg/m2 (OR = 3.43; 95 % CI: 1.16–10.21) were independent factors associated with osteoporotic phenotype in RA patients.Conclusion. Malnutrition occurred in 44.0 % of RA patients. Women at risk of malnutrition had a higher 10-year probability of hip fracture according to FRAX. Age and AMM index were positively associated, while nutrition status according to MNA was negatively associated with osteoporotic phenotype of body composition.

Reverse engineering the FRAX algorithm: Clinical insights and systematic analysis of fracture risk.

The Fracture Risk Assessment Tool (FRAX) is a computational tool developed to predict the 10-year probability of hip fracture and major osteoporotic fracture based on inputs of patient characteristics, bone mineral density (BMD), and a set of seven clinical risk factors. While the FRAX tool is widely available and clinically validated, its underlying algorithm is not public. The relative contribution and necessity of each input parameter to the final FRAX score is unknown. We systematically collected hip fracture risk scores from the online FRAX calculator for osteopenic Caucasian women across 473,088 unique inputs. This dataset was used to dissect the FRAX algorithm and construct a reverse-engineered fracture risk model to assess the relative contribution of each input variable. Within the reverse-engineered model, age and T-Score were the strongest contributors to hip fracture risk, while BMI had marginal contribution. Of the clinical risk factors, parent history of fracture and ongoing glucocorticoid treatment had the largest additive effect on risk score. A generalized linear model largely recapitulated the FRAX tool with an R2 of 0.91. Observed effect sizes were then compared to a true patient population by creating a logistic regression model of the Study of Osteoporotic Fractures (SOF) cohort, which closely paralleled the effect sizes seen in the reverse-engineered fracture risk model. Analysis identified several clinically relevant observations of interest to FRAX users. The role of major osteoporotic fracture risk prediction in contributing to an indication of treatment need is very narrow, as the hip fracture risk prediction accounted for 98% of treatment indications for the SOF cohort. Removing any risk factor from the model substantially decreased its accuracy and confirmed that more parsimonious models are not ideal for fracture prediction. For women 65years and older with a previous fracture, 98% of FRAX combinations exceeded the treatment threshold, regardless of T-score or other factors. For women age 70+ with a parent history of fracture, 99% of FRAX combinations exceed the treatment threshold. Based on these analyses, we re-affirm the efficacy of the FRAX as the best tool for fracture risk assessment and provide deep insight into the interplay between risk factors.

Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan.

The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).

AB1034 FRACTURE RISK BY FRAX WITH AND WITHOUT BONE MINERAL DENSITY, COMPARISON OF FACTORS AFFECTING CONCORDANCE

BackgroundThe Fracture Risk Assessment Tool (FRAX) estimates the 10-year probability of hip (FXC) and major osteoporotic (FXOM) fractures in patients aged 40 to 90 years using important clinical factors, such as bone mineral density (BMD), optional input variables. (1) There is convincing evidence that with or without the use of BMD it provides a well-validated instrument and may be useful in clinical practice for identifying patients at high risk of fracture and informing treatment decisions. (2)ObjectivesThis study aims to determine the concordance between the treatment decision, calculated using FRAX scores with and without BMD, and to identify the risk factors associated with the discordance in patients with autoimmune rheumatic diseases.MethodsA cross-sectional study was carried out in patients with autoimmune rheumatic diseases who had undergone osteoporosis detection (OP) using dual bone densitometry in the Rheumatology service of the University Hospital “Dr. José Eleuterio González” during the period August 2020 - August 2021. The FRAX questionnaire was applied to determine risk factors for OP and the results of the instrument with and without BMD were calculated, the patients were classified as low, intermediate, and high risk.A Student’s t-test, a Wilcoxon rank-sum test, and a Chi-square or Fisher’s exact test were used to compare variables between groups and calculate P-values.ResultsA total of 88 patients were included. Based on FRAX questionnaire responses, 82 (93.18%) patients had at least one risk factor for OP. The FRAX result with or without densitometry resulted in a treatment decision in 48 (54.5%) and 28 (31.8%) patients, respectively. The results were concordant in 65 (73.9%) of the cases. It was found that patients with osteopenia due to BMD had a greater agreement between both measurements (93.3%, p 0.003) than patients with normal BMD (62.5% p 0.001). Likewise, patients with secondary osteoporosis had lower concordance than patients without this diagnosis (25% and 72.5%, respectively, p 0.006).ConclusionThe results of FRAX with and without densitometry were mostly agreeable in predicting the need for treatment according to the 10-year probability of hip fracture, however, this concordance decreased in patients with a previous diagnosis of secondary osteoporosis, no significant difference was found between the risk factors for the concordant and discordant groups. More studies are required to determine the variables that cause a decrease in the concordance of the tests.Table 1.Factors that affect the results between the discordant groups.VariablesConcordant n=65No concordant n=23P valueSex (%)0.078Men8 (12.3%)0 (0%)Women57 (87.7%)23 (100%)Age (years)57.85 ± (11.66)59.2 ± (8.36)0.13&lt;5012 (18.4%)4 (17.3%)50-5924 (36.9%)8 (34.6%)60-6917 (26.1%)9 (39.1%)70-7910 (15.3%)2 (8.7%)&gt;802 (3%)0 (0%)Height (meters)1.52 ± (0.08)1.52 ± (1.06)0.042Weight (kilograms)68.5 (59.5-80.5)68 (64-74)BMI (kg/m 2)28.2 (24.9-33.1)30.9 (29.2-32.5)0.002Normal weight (%)16 (24.6%)3 (13%)0.136Overweight (%)22 (33.8%)5 (21.7%)0.150Obesity (%)27 (41.5%)15 (65.2%)0.051Normal BMD35 (53.84%)21 (93%)0.001Osteopenia28 (43.07%)2 (8.69%)0.003Osteoporosis2 (3.07%)0 (0%)0.395With BMDWithout BMDHip Fracture FRAX Score5.3 (3.62-9.77)1 (0.42-2.67)Major osteoporotic fracture6.2 (4.02-9.85)0.75 (0.3-1.77)Treatment suggested by FRAX48 (54.5%)28 (31.8%)BMI= Body mass index, BMD= Bone mineral density, FRAX= Fracture risk assessment toolReferences[1]Teeratakulpisarn N, Charoensri S, Theerakulpisut D, Pongchaiyakul C. FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais. Archives of Osteoporosis. 2021 Feb 26;16(1).[2]Horta-Baas G, Pérez Bolde-Hernández A, Pérez-Pérez A, Vergara-Sánchez I, Romero-Figueroa M del S. Concordancia del FRAX México con y sin el valor de la densidad mineral ósea en la evaluación del riesgo de fractura en la práctica clínica diaria. Medicina Clínica. 2017 May;148(9):387–93.Disclosure of InterestsNone declared

MO546: Association Between T Scores, FRAX, Frailty, Falls and Fractures in Patients Undergoing Maintenance Hemodialysis

Abstract BACKGROUND AND AIMS Despite the negative impact of fracture in hemodialysis (HD) patients, optimal risk assessment tools in this population are not well explored. Frailty (a syndrome of diminished capacity to respond to health stressors) and falls—known risk factors for fracture—are common in HD patients. While the relationship between T scores in relation to fractures in these patients is recognized, there is a paucity of data to the additional contributions of fracture risk assessment tool (FRAX), frailty and falls in relation to fractures. The clinical, societal and economic impact of fractures necessitates an active response from the HD programs. Therefore, we intended to evaluate the clinical utility of adding these factors to T scores at the femoral neck to determine whether it enhances fracture discrimination in HD patients. METHOD We conducted a cross-sectional study on 131 adult patients receiving HD at two dialysis units in Regina, Saskatchewan, Canada (January 2017–December 2018). After undergoing frailty assessments, patients were referred for dual-energy X-ray absorptiometry (DXA) scans and FRAX questionnaires. They were additionally sent for lumbar X-rays and contacted for a history of falls. The presence of fracture (hips, femur, pelvis, knee, foot, leg, toe, shoulder, elbow, ankle, arm, wrist, spine and lumbar) was documented based on the review of medical charts, self-recall and additionally vertebral fractures were identified by an X-ray. Bone mineral density (BMD) was measured by DXA. FRAX score (the 10-year probability of hip and major osteoporotic fracture) was calculated using an online algorithm based on 11 clinical risk factors with and without the inclusion of BMD. Frailty was assessed using the FRIED criteria (Figure 1). Patients were enquired about the history and frequency of falls. Association between the BMD-T score, FRAX score, frailty status, falls, with fracture were examined with sequential multivariable logistic regression models. The area under the receiver operating characteristic curve analysis was conducted for each model to assess its discrimination ability for fracture outcome (α = 0.05). RESULTS A total of 109 HD patients were included in the data analysis. The composite of fracture occurred in 38% of patients. About 60% were identified as frail, and 29% had at least one fall in the last year. Low T score and FRAX were both independent risk factors in patients on HD therapy. On multivariate analysis, each lower standard deviation in T score was associated with 48% higher odds of fracture [odds ratio (OR) = 1.48; 95% confidence interval (95% CI) 1.20–1.68, P = 0.005]. With the inclusion of FRAX score for hip fracture, the OR for fracture remained significant at 1.38 (OR = 1.38, 95% CI 1.04–1.63, P = 0.04). The addition of frailty status and history of falls did not further improve the model. Model 2 showed better discrimination ability and goodness-of-fit for fracture compared to Model 1 (P = 0.004) (Table). CONCLUSION This is the first study to our knowledge that looked at the independent contribution of frailty and falls in addition to T scores and FRAX in assessing for fractures in patients on HD. Our study showed both BMD measurements by DXA scans and FRAX are useful tools to assess fracture in patients receiving HD. The addition of frailty status and history of falls is not associated with fractures in this population. Results of this study should lead to prospective studies with larger sample sizes prior to DXA scans, FRAX and falls assessment being recommended as standards of care.

Management of Osteoporosis and Spinal Fractures: Contemporary Guidelines and Evolving Paradigms.

Physicians involved in treating spine fractures secondary to osteopenia and osteoporosis should know the pathogenesis and current guidelines on managing the underlying diminished bone mineral density, as worldwide fracture prevention campaigns are trailing behind in meeting their goals. This is a narrative review exploring the various imaging and laboratory tests used to diagnose osteoporotic fractures and a comprehensive compilation of contemporary medical and surgical management. We have incorporated salient recommendations from the Endocrine Society, the American Association of Clinical Endocrinology (AACE), and the American Society for Bone and Mineral Research (ASBMR). The use of modern scoring systems such as Fracture Risk Assessment Tool (FRAX®) for evaluating fracture risk in osteoporosis with a 10-year probability of hip fracture and major fractures in the spine, forearm, hip, or shoulder is highlighted. This osteoporosis risk assessment tool can be easily incorporated into the preoperative bone health optimization strategies, especially before elective spine surgery in osteoporotic patients. The role of primary surgical intervention for vertebral compression fracture and secondary fracture prevention with pharmacological therapy is described, with randomized clinical trial-based wisdom on its timing and dosage, drug holiday, adverse effects, and relevant evidence-based literature. We also aim to present an evidence-based clinical management algorithm for treating osteoporotic vertebral body compression fractures, tumor-induced osteoporosis, or hardware stabilization in elderly trauma patients in the setting of their impaired bone health. The recent guidelines and recommendations on surgical intervention by various medical societies are covered, along with outcome studies that reveal the efficacy of cement augmentation of vertebral compression fractures via vertebroplasty and balloon kyphoplasty versus conservative medical management in the elderly population.