10-year Probability Of Osteoporotic Fracture Research Articles

Associations of accelerometer-estimated free-living daily activity impact intensities with 10-year probability of osteoporotic fractures in adults

PurposeAccelerometers are used to objectively measure physical activity; however, the relationship between accelerometer-based activity parameters and bone health is not well understood. This study examines the association between accelerometer-estimated daily activity impact intensities and future risk estimates of major osteoporotic fractures in a large population-based cohort. MethodsParticipants were 3165 adults 46 years of age from the Northern Finland Birth Cohort 1966 who agreed to wear a hip-worn accelerometer during all waking hours for 14 consecutive days. Raw accelerometer data were converted to resultant acceleration. Impact magnitude peaks were extracted and divided into 32 intensity bands, and the osteogenic index (OI) was calculated to assess the osteogenic effectiveness of various activities. Additionally, the impact peaks were categorized into three separate impact intensity categories (low, medium, and high). The 10-year probabilities of hip and all major osteoporotic fractures were estimated with FRAX-tool using clinical and questionnaire data in combination with body mass index collected at the age of 46 years. The associations of daily activity impact intensities with 10-year fracture probabilities were examined using three statistical approaches: multiple linear regression, partial correlation, and partial least squares (PLS) regression. ResultsOn average, participants’ various levels of impact were 8331 (SD = 3478) low; 2032 (1248) medium; and 1295 (1468) high impacts per day. All three statistical approaches found a significant positive association between the daily number of low-intensity impacts and 10-year probability of hip and all major osteoporotic fractures. In contrast, increased number of moderate to very high daily activity impacts was associated with a lower probability of future osteoporotic fractures. A higher OI was also associated with a lower probability of future major osteoporotic fractures. ConclusionLow-intensity impacts might not be sufficient for reducing fracture risk in middle-aged adults, while high-intensity impacts could be beneficial for preventing major osteoporotic fractures.

Trabecular bone score, bone mineral density and fracture risk in women with rheumatoid arthritis (pilot study)

The aim – to assess bone mineral density (BMD) and microarchitecture, as well as the risk of fractures in postmenopausal women with rheumatoid arthritis (RA). Materials and methods: 95 postmenopausal women (mean age 62.3±8.1 years) with a confirmed RA were included. All patients underwent a questionnaire, clinical and laboratory examination, dual-energy X-ray absorptiometry (DXA) of the lumbar spine (L1–L4), proximal femur, and trabecular bone score (TBS) assessment. The 10-year probability of osteoporotic fracture was calculated using the FRAX tool without including femoral neck (FN) BMD (BMD–), with FN BMD (BMD +) and additionally adjustment for TBS (BMD + TBS). Results. Osteoporosis (OP) was found in 41 (43.2%) patients: in L1–L4 – in 26,3%, in FN – in 22.1%, and in the total hip (TH) – in 11.6% persons. Degraded microarchitecture according to TBS was found in 38.9% of patients, partially degraded – in 25.3%, and normal – in 35.8% of women with RA. A high risk of fracture according to FRAX BMD– was detected in 49.5% of patients. TBS correlated with age (r=–0.30; p=0.003), duration of postmenopausal period (r=–0.26; p=0.014), cumulative dose of glucocorticoids (GCs) (r=–0.34; p=0.045), FRAX BMD– (r=–0.24; p<0.05) and FRAX BMD+ (r=–0.21; p<0.05); L1–L4 BMD (r=0.43; p<0.001), FN BMD (r=0.21; p=0.038), TH BMD (r=0.23; p=0.02). Low TBS was significantly more often detected in people with a history of fractures compared to people without them (p<0.05). Among RA patients with normal L1–L4 BMD 9.5% of persons had degraded microarchitecture of bone tissue according to TBS. The inclusion of TBS in FRAX increased the risk of fractures to high in 9.5% of patients and reduced it to low in 7.4% of women, due to which the total number of people with RA who had a high risk of fractures became 54.7%. Conclusion. OP was diagnosed in 43.2%, and degraded microarchitecture of bone tissue according to TBS – in 38.9% of postmenopausal women with RA. A high risk of fractures according to FRAX was found in 49.5%. TBS negatively correlated with age, duration of postmenopause, cumulative GCs dose, FRAX fracture risk, and positively correlated with BMD in all measurement sites. The FRAX adjustment by TBS redistributed patients in risk groups, as a result of which 54.7% of RA patients needed anti-osteoporotic treatment.

Optimized calculator for a qualitative risk assessment of osteoporotic fractures for the population of Moscow

BACKGROUND: The FRAX tool (a 10-year fracture risk assessment) is recommended to diagnose osteoporosis and optimize the number of patients who need to undergo X-ray densitometry. Due to various circumstances, the integration of a full-fledged FRAX tool into the digital circuits of the Moscow City Health Department is problematic.
 AIM: The study aimed to develop a calculator of the 10-year probability of osteoporotic fractures to optimize the routing of patients for examination.
 METHODS: An optimized Half-FRAX calculator was created based on the FRAX tool from the University of Sheffield, which was developed using the results of population studies of the Russian Federation. All data used in the original FRAX algorithm, i.e. sex, age, height, weight, and T-criterion (if available) and other important parameters such as a history of fractures, parental hip fractures, smoking, rheumatoid arthritis, secondary osteoporosis, and glucocorticoid and alcohol intake were included in the risk assessment calculator. An algorithm for interaction with the FRAX website was developed and implemented to verify critical levels of patient stratification by multiple consecutive enumerations of different combinations of body mass index (BMI) measurements (0.1 discretization) and age (1-year discretization). Data from clinical guidelines were taken as thresholds.
 RESULTS: When implementing the developed algorithm by modeling various combinations of BMI, T-criterion, and risk factors (RF), the absence of RFs and BMI 25 (upper limit of normal) in women was shown to guarantee the exclusion from the orange zone where densitometry should be performed. In men, BMI was not a RF. If a RF was present, a patient was recommended to consult a doctor. If no T-criterion was present, but a RF was detected, the patient was indicated for densitometry. Similar results were reported for women with the same indices. In the absence of the RF and with a T-criterion 2.5, low fracture risk factor was indicated for both men and women.
 CONCLUSIONS: An optimized Half-FRAX calculator for the 10-year probability of major osteoporotic fractures was developed, which may optimize the routing of patients for densitometry and reduce the burden on radiology departments in Moscow. This will allow patients to be timely referred to the clinical specialists for consultations. Half-FRAX is integrated into the Osteoporosis Digital Platform (https://telemedai.ru/cifrovaya-platforma-osteoporoz/half-frax).

Role of determining trabecular bone score for appointment of osteoporotic therapy (clinical case)

Numerous studies have shown that the trabecular bone score (TBS) in patients with rheumatic diseases and especially in persons receiving glucocorticoids predicts fractures better than the bone mineral density (BMD) of the spine or the value of a 10-year probability of osteoporotic fracture according to the FRAX calculator. This article describes the role of TBS in determining the indications for prescribing anti-osteoporotic treatment on the example of a clinical case of a postmenopausal woman with a confirmed diagnosis of rheumatoid arthritis and a slight decrease in BMD.

Epidemiology of risk factors and estimating 10-year probability of osteoporotic fractures in the Russian Federation.

To investigate the prevalence of osteoporotic fractures (OPF) RFs and estimate absolute risk (AR) of OPF among urban vs rural residents of the Russian Federation. In total, 13,391 Russian women and men 40-69years old from 12 regions participated in the study. Groups of urban (n = 12,237) and rural (n = 1154) subjects were comparable in terms of their age. Participants were interviewed using a standard modular questionnaire. AR of OPF was calculated using the Russian FRAX model. Age-dependent diagnostic and therapeutic intervention thresholds (DIT, TIT) were employed to stratify AR of OPF. Among the OPF RFs, the most common were as follows: previous OPF (16.3%), causes of secondary osteoporosis (20.8%), and current smoking (17.9%). The frequencies of previous OPF and alcohol abuse in rural men were higher than in urban male residents. Urban women, compared with rural females, were characterized by such more frequent RFs as smoking and glucocorticoids' intake. AR increased with age and prevailed in women, compared with men, regardless of their age, region of residence, and settlement type. According to TIT, the frequency of high AR of major OPF in the sample was 7.0%. According to DIT, high, medium, and low AR of major OPF was detected in 3.1%, 42.2%, and 54.7% of participants, respectively. Among urban women compared with rural females, high AR of major OPF was more often detected (p < 0.05), using TIT, whereas there was no such pattern for men. We discovered the territorial variability of RFs and OPF AR. Prevalence of OPF RFs varied in Russia depending on age, gender, constituent entities, and the settlement type. Our data have demonstrated the typical age-gender causation pattern of OPF AR. Over 40% of participants required densitometry and fracture risk reclassification.

Response of Bone Metabolism Markers to Ice Swimming in Regular Practitioners.

Objective: Both exercise and cold exposure cause physiological stress and they often occur in combination. However, the effects of exercise during severe cold on variation in bone metabolism in humans have remained elusive. The aim of this study was to investigate the variations in circulating bone metabolism markers after ice swimming (IS).Methods: Eighty-seven women and men aged 42–84 years old were recruited to perform regular IS activities. Serum parathyroid hormone (PTH), total calcium (Ca2+), total phosphorus (Pi), total magnesium (Mg2+), N-terminal osteocalcin (N-MID), total propeptide of procollagen 1 (TPINP), and C-terminal telopeptide of type 1 collagen (β-CTX) were measured 30 min before and 30 min after IS. Bone mineral content (BMC) and bone mineral density (BMD) were assessed at lumbar spine 1–4 (L1–L4) and femoral neck (FN). The IS habits were obtained from questionnaires and the 10-year probability of osteoporotic fracture was calculated using the FRAX® tool with and without a BMD value of the FN.Results: There were significant increases in PTH (median, 40.120–51.540 pg/mL), Ca2+ (median, 2.330–2.400 mmol/L), and Pi (median, 1.100–1.340 mmol/L) and significant decreases in TPINP (median, 38.190–36.610 ng/mL) and β-CTX (median, 0.185–0.171 ng/mL), while there was a trend for increased serum Mg2+ (P = 0.058) but no significant change in N-MID (P = 0.933) after IS in all subjects. The increases in the proportions of cases of hyperparathyroidemia, hypercalcemia, and hyperphosphatemia in those performing IS were statistically significant. The baseline levels and the changes of bone metabolism markers had associations with osteoporosis and bone status, but these may be age and sex dependent. Finally, there were significant correlations among the bone metabolism markers.Conclusion: IS caused significant alterations in bone metabolic markers, specifically, increases in PTH, Ca2+ and Pi should raise concerns about potential cardiovascular health risks in severe cold exercise. Additionally, a divergence between PTH elevation and a decline in bone turnover, which shown a special change of bone metabolism after IS and may suggest potential therapeutic implications of cold exercise in PTH and bone metabolic disorders.

Associations of the 10-year probability of osteoporotic fractures with the total cardiovascular risk and cardiovascular diseases due to atherosclerosis among urban and rural populations

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Провести анализ взаимосвязей абсолютного риска (АР) остеопорозных переломов (ОПП) с суммарным сердечно-сосудистым риском (ССР) и сердечно-сосудистыми заболеваниями, обусловленными атеросклерозом (ССЗ-АС), среди городского и сельского населения РФ. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включены представительные выборки городского и сельского населения (1821 мужчина и 2427 женщин в возрасте 40—69 лет) из 4 регионов РФ (Республика Карелия, Краснодарский край, Рязанская и Омская области), обследованные в рамках проекта ЭССЕ-РФ2. Оценку 10-летнего АР ОПП проводили с использованием российской модели FRAX без учета минеральной плотности кости. Суммарный ССР определяли у лиц до 65 лет по шкале SCORE для стран с высоким уровнем риска. У больных, имеющих в анамнезе стенокардию, инфаркт миокарда, инсульт, нарушения ритма сердца, изучали связь этих заболеваний с АР ОПП. <h3>РЕЗУЛЬТАТЫ</h3> Среди обследованных частота высокого АР основных ОПП составила 6,4%. Высокий и очень высокий ССР был выявлен у 9,7% лиц в возрасте 40—64 лет, не имеющих в анамнезе ССЗ-АС и сахарный диабет. Среди женщин, проживающих в городе, по сравнению с сельскими жительницами, чаще регистрировался высокий АР основных ОПП (10,5% против 7,5%; <i>p</i>&lt;0,05), при этом у мужчин таких различий отмечено не было. Частота высокого и очень высокого ССР была одинаковой среди городских и сельских жителей и не зависела от пола. Как у женщин, так и у мужчин, независимо от места проживания, была обнаружена достоверная прямая корреляция АР основных ОПП и переломов бедра (ПБ) с ССР. При наличии высокого и очень высокого ССР (≥5%) такая связь была подтверждена и при регрессионном логистическом анализе: АР ПБ ≥1% увеличивался в 1,8 раза (95% ДИ 1,4—2,2; <i>p</i>&lt;0,001), АР основных ОПП ≥10% — в 1,4 раза (95% ДИ 1,2—1,8; <i>p</i>&lt;0,05), высокий АР основных ОПП, согласно порогу терапевтического вмешательства, — в 1,3 раза (95% ДИ 1,2—1,7; <i>p</i>&lt;0,05). Как у городского, так и у сельского населения положительная корреляционная связь всех изучаемых ССЗ-АС с АР основных ОПП и ПБ была выявлена только для женщин, а среди мужчин — только с АР ПБ. <h3>ЗАКЛЮЧЕНИЕ</h3> Показано, что риск ОПП и ССР у мужчин не зависели от типа поселения. У женщин тип поселения влиял на распределение риска переломов, и этот риск был выше у городских женщин по сравнению с жительницами сельской местности. Установлено, что высокий АР основных ОПП и ПБ ассоциировался с высоким и очень высоким ССР независимо от пола. В то же время у женщин взаимосвязь ССЗ-АС была с АР как основных ОПП, так и с ПБ, а у мужчин — только с АР ПБ. Выявленные ассоциации относились как к городскому, так и сельскому населению.

Assesment of osteoporotic fractures risk and osteoporosis prevalence among patients over 50 years old undergoing medical rehabilitation

Background. Back pain, limitation of mobility, spinal deformity, decreased ability to self-care due to osteoporotic fractures (vertebrae, femoral neck, humerus, etc.) are one of the reasons for referring patients to rehabilitation and rehabilitation treatment, which involves the use of physical therapy methods, physiotherapy exercises and mechanotherapy.&#x0D; Objective: to assess the prevalence of osteoporosis (OP), individual risk factors for OP, as well as the proportion of people with high risk of osteoporotic low-energy fractures among patients over 50 years old undergoing treatment according to the medical rehabilitation profile.&#x0D; Methods. The study group comprised of 600 patients (426 women and 174 men) aged 50 to 84 years, average age 64.2510.17 years, undergoing treatment in a rehabilitation department. This was a cross-sectional study in the form of unified questionnaire, including data conserning age, weight, height, BMI, clinical and rehabilitation diagnosis, anamnesis of the main disease, anamnesis vitae, presence of OP diagnosis in the anamnesis, its treatment, OP risk factors estimation. An assessment of 10-year probability of osteoporotic fractures was carried out using Russian model of online FRAX calculator.&#x0D; Results. 41.8% patients in the study sample had OP risk factors, including 31.2% ― 3 risk factors or more. 38% patients over 50 years old undergoing medical rehabilitation showed a high fracture risk according to the FRAX calculator. 34.1% had a diagnosis of OP stated, and 45.8% already had osteoporotic fractures. Among those who did not undergo densitometry examination, 69.9% had a history of low-traumatic fractures, and only 58.5% of patients with an established diagnosis of OP and 26.8% of those at high risk of fractures received effective therapy for OP.&#x0D; Conclusion. Among patients over 50 years old undergoing medical rehabilitation a high frequency of OP and high fracture risk were stated. At the same time, insufficient quality of OP diagnostics and anti-osteoporotic therapy administaration were revealed.

Bone Mineral Density and Risk of Osteoporotic Fractures in Women with Parkinson's Disease.

Osteoporosis and Parkinson's disease (PD) are two important age-related diseases, which have an influence on pain, physical activity, disability, and mortality. The aim of this research was to study the parameters of bone mineral density (BMD), frequency, and 10-year probability of osteoporotic fractures (OFs) in females with Parkinson's disease (PD). We have examined 113 postmenopausal women aged 50–74 years old which were divided into 2 groups (I, control group (CG), n = 53 and II, subjects with PD, n = 60). Bone mineral density of lumbar spine, femoral neck, distal radius, and total body were measured, and quantity and localization of vertebral deformities were performed by the vertebral fracture assessment (VFA). Ten-year probability of OFs was assessed by Ukrainian version of FRAX®. It was established that BMD of lumbar spine, femoral neck, distal radius, and total body in PD women was reliably lower compared to CG. The frequency of OFs in PD subjects was higher compared to CG (51.7 and 11.3%, respectively) with prevalence of vertebral fractures (VFs) in women with PD (52.6% among all fractures). 47.4% of the females had combined VFs: 74.2% of VFs were in thoracic part of the spine and 73.7% were wedge ones. Ten-year probability of major OFs and hip fracture were higher in PD women compared to CG with and without BMD measurements. Inclusion of PD in the FRAX calculation increased the requirement of antiosteoporotic treatment from 5 to 28% (without additional examination) and increased the need of additional BMD measurement from 50 to 68%. Anterior/posterior vertebral height ratios (Th8-Th11) measured by VFA in PD females without confirmed vertebral deformities were lower compared to indices of CG. In conclusion, women with PD have lower BMD indices, higher rate of osteoporosis, and risk of future low-energy fractures that should be taken into account in the assessment of their osteoporosis risk and clinical management.

TOTAL KNEE ARTHROPLASTY AND OSTEOPOROSIS: FRACTURE RISK ASSESSED BY FRAX®.

INTRODUCTION: Osteoporotic fractures increase mortality and morbidity in patients who suffer them. Also, periprosthetic fractures are challenging to treat and have a major impact in our health systems. The FRAX® algorithm is a tool that calculates the 10-year probability of osteoporotic fracture for a given patient. In our study, we used the FRAX® algorithm to assess the risk of osteoporotic fracture in patients who had previously undergone total knee arthroplasty (TKA) or had suffered a periprosthetic fracture involving a TKA. METHODS: We used the FRAX® algorithm to assess the 10-year probability of osteoporotic fracture in patients who were admitted in our hospital for a periprosthetic fracture around the knee and those who underwent TKA and gave consent to enter our study. Patients in the TKA group were separated according to their BMI in two categories (

Progress of osteoporosis: stratification of fracture risk

Background: There are two approaches to identify candidates for the prescription of osteoporosis treatment: identification of patients with low bone mineral density using DEXA of the axial skeleton and calculation of the 10-year probability of major osteoporotic fractures using FRAX®.&#x0D; Aims: to assess the diagnostic accuracy of different FRAX® thresholds in the Russian population.&#x0D; Materials and methods: the value of individual 10-year probability of osteoporotic fracture by FRAX® at the time of inclusion in the study was retrospectively estimated in 224 postmenopausal women, whom the major osteoporotic fractures were recorded over 10 years of prospective observation. The diagnostic accuracy of different thresholds were compared: "European" and Russian age-dependent thresholds, fixed 20% threshold, the average FRAX® of patients who had a major osteoporotic fracture during follow-up (16%), FRAX® value corresponding to the "cut-off point" (12,5%).&#x0D; Results: The Russian FRAX model showed the acceptable diagnostic accuracy of the method (AUC=0.665±0.036; 95% CI 0.595; 0.736). The "European" threshold of therapeutic intervention demonstrated 72% sensitivity and 38% specificity, 20% threshold – 27% and 87%, the Russian threshold – 41% and 77%, 12.5% threshold – 68% and 58%, 16% threshold – 57% and 73%, respectively. The diagnostic precision of the specified thresholds was 54%, 58%, 60%, 63% and 65%, respectively.&#x0D; Conclusions: the Russian age-dependent threshold remains the optimal way to decide whether to initiate anti-osteoporotic therapy based on an assessment of the 10-year probability of fracture by the Russian model for FRAX®.

The Associations Between Hypovitaminosis D, Higher Pth Levels With Bone Mineral Densities, And Risk Of The 10-Year Probability Of Major Osteoporotic Fractures In Chinese Patients With T2Dm

In the current study, we investigated the vitamin D status, and its relationships with parathyroid hormone (PTH) levels, bone mineral density (BMD), and the 10-year probability of fractures in Chinese patients with type 2 diabetes mellitus (T2DM). This was a cross-sectional study of 785 patients. BMDs at the lumbar spine (L2-4), femoral neck (FN), and total hip (TH) were measured by dual-energy X-ray absorptiometry (DXA). Serum levels of 25-hydroxyvitamin D (25(OH)D) and intact PTH were also quantified. The 10-year probability of fracture risk (major osteoporotic fracture [MOF] and hip fracture [HF]) was assessed using the fracture risk assessment tool (FRAX). The prevalence of vitamin D deficiency was 82.3%, and the mean 25(OH)D level was 36.9 ± 15.2 nmol/L. The adequate group had higher BMDs at the FN and TH and lower MOF risk than the inadequate groups. Lower 25(OH)D was associated with higher PTH ( r = -0.126, P<.001). PTH was negatively correlated with BMDs at 3 sites and positively correlated with MOF and HF, but this relationship disappeared in the adequate subgroup. Multivariate stepwise regression analysis revealed that PTH was the determinant of MOF (standard β = 0.073, P = .010) and HF (standard β = 0.094, P = .004). Our results identified a significantly high rate of vitamin D deficiency among Chinese patients with T2DM. PTH is an important risk factor responsible for the higher 10-year probability of osteoporotic fractures in diabetic patients, especially in those with lower vitamin D levels. AKP = alkaline phosphatase; ALB = serum albumin; BMD = bone mineral density; BMI = body mass index; Ca = calcium; CKD = chronic kidney disease; Cr = creatinine; FN = femoral neck; FRAX = fracture risk assessment tool; HbA1c = glycated hemoglobin A1c; HF = hip fracture; L2-4 = lumbar spine; MOF = major osteoporotic fracture; 25(OH)D = 25-hydroxyvitamin D; P = phosphorus; PTH = parathyroid hormone; T2DM = type 2 diabetes mellitus; TH = total hip; UA = uric acid.

Development and application of FRAX in the management of osteoporosis in Ireland

The Irish Fracture Risk Assessment (FRAX) tool is the first fracture prediction model that has been calibrated using national hip fracture incidence data and Irish mortality rates. The Irish FRAX tool can be used to identify intervention thresholds for Ireland based on the fracture probability equivalent to that of a woman with a prior fracture. The objective of the study is to describe the 10-year probability of osteoporotic fracture in men and women in Ireland by using the Irish version of the FRAX tool and to develop FRAX-based intervention thresholds. The FRAX model for Ireland was constructed from the age- and sex-stratified hip fracture incidence rates from 2008 to 2010. For other major osteoporotic fractures, incidence rates were imputed, using age- and sex-specific Swedish ratios for hip to osteoporotic fracture risks. Lifetime fracture probabilities and 10-year probabilities of a major osteoporotic fracture were calculated in women to determine potential intervention thresholds. Based on the incidence of hip fracture and mortality, the average lifetime probability of hip fracture from the age of 50 years was 7.8% in men and 18.2% in women from Ireland. Probability-based intervention threshold derived from BMD T-scores were problematic. When a BMD T-score≤-2.5 standard deviations (SD) was used as an intervention threshold, the increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80 years or more, a T-score of -2.5 SD was protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to that of women with a previous fracture, rose with age, from 3.0% at the age of 40 years to 30% at the age of 90 years, and identified women at increased risk at all ages. The Irish FRAX tool is the first fracture prediction model that has been calibrated using national hip fracture incidence data and Irish mortality rates.

Fracture risk prediction using FRAX®: a 10-year follow-up survey of the Japanese Population-Based Osteoporosis (JPOS) Cohort Study

We evaluated the predictive ability of FRAX® in a cohort of 815 Japanese women. The observed 10-year fracture rate did not differ significantly from that predicted by FRAX®. The predictive ability of FRAX® without femoral neck bone mineral density (BMD) was similar to that with femoral neck BMD. We evaluated the ability of the Japanese version of FRAX®, a World Health Organization fracture risk assessment tool, to predict the 10-year probability of osteoporotic fracture. Self-reported major osteoporotic fracture (N = 43) and hip fracture (N = 4) events were ascertained in the 10-year follow-up survey of the Japanese Population-Based Osteoporosis Cohort Study. Participants were 815 women aged 40-74 years at the baseline survey. Receiver operating characteristic curve analysis compared FRAX® with multiple logistic models based on age, body weight, and femoral neck BMD. The number of observed major osteoporotic or hip fracture events did not differ significantly from the number of events predicted by the FRAX® model (with or without BMD). The area under the curve (AUC) value for FRAX® with BMD for predicting major osteoporotic fractures was similar to that of a logistic model with age, body weight, and BMD (0.69 vs. 0.71, respectively; p = 0.198); the AUC of FRAX® with BMD for predicting hip fractures was similar to that of a model based on age and BMD (0.88 vs. 0.89, respectively; p = 0.164). The AUCs of FRAX® without BMD for predicting major osteoporotic and hip fractures were similar to those with BMD (0.69 vs. 0.67, respectively; p = 0.121; 0.88 vs. 0.86, respectively; p = 0.445). The Japanese version of FRAX® without BMD estimated the 10-year probability of osteoporotic fracture in this population with few clinical risk factors as similar to that of FRAX® with BMD.

Bone mineral density enhances use of clinical risk factors in predicting ten-year risk of osteoporotic fractures in Chinese men: the Hong Kong Osteoporosis Study

SummaryThis prospective study aimed to determine the risk factors and the 10-year probability of osteoporotic fracture in Southern Chinese men. The findings show substantial population differences in fracture incidence and risk prediction compared to the FRAXTM model, and the addition of BMD information to clinical risk factor assessment improved fracture risk prediction in Chinese men.IntroductionClinical risk factors with or without bone mineral density (BMD) measurements are increasingly recognized as reliable predictors of fracture risk. Prospective data on fracture incidence in Asian men remain sparse. This prospective study aimed to determine the risk factors and the 10-year absolute fracture risk in Southern Chinese men.MethodsThis is a part of the Hong Kong Osteoporosis Study. One thousand eight hundred ten (1,810) community-dwelling, treatment-naive men aged 50 years or above were evaluated. Baseline demographic characteristics, clinical risk factors and BMD were recorded. Ten-year risk of osteoporotic fracture was calculated using Cox proportional hazards models.ResultsThe mean age of subjects was 68.0 ± 10.3 years. After a mean follow-up period of 3.5±2.9 years (range 1 to 14 years), 37 incident low-trauma fractures were recorded. The incidence for all osteoporotic fractures and hip fractures was 635/100,000 and 123/100,000 person-years, respectively. The most significant predictors of osteoporotic fracture were history of fall (RR 14.5), femoral neck BMD T-score < −2.5 (RR 13.8) and history of fracture (RR 4.4). Each SD reduction in BMD was associated with a 1.8 to 2.6-fold increase in fracture risk. Subjects with seven clinical risk factors and BMD T-score of −1 had an absolute 10-year risk of osteoporotic fracture of 8.9%, but this increased to 22.7% if they also had a femoral neck BMD T-score of −2.5.ConclusionsThese findings show substantial population differences in fracture incidence and risk prediction. The addition of BMD information to clinical risk factor assessment improved fracture risk prediction in Chinese men.

Estimation of the 10-year Probability of Osteoporotic Fracture in Postmenopausal Taiwanese Women With FRAX

Objective As the proportion of the aging population rises dramatically, osteoporotic fractures among the elderly have become a global health concern. We assessed the prevalence of osteoporosis and estimated the 10-year probability of osteoporotic fractures among postmenopausal women. Materials and Methods Patients who were undergoing a checkup at a teaching hospital in eastern Taiwan were invited to participate in this study. A self-administered questionnaire was used to ascertain their demographics, diet, lifestyle, and reproductive and medical histories. The bone mineral density (BMD) of the posterior-anterior lumbar spine (L1–L4) was measured by dual-energy X-ray absorptiometry. A diagnosis of osteoporosis was made according to World Health Organization (WHO) criteria. The 10-year probability of osteoporotic fracture was computed online without BMD data with the WHO Fracture Risk Assessment Tool (FRAX). Results: In total, 475 postmenopausal women were involved in this study. The prevalence of osteoporosis was 37.2% [95% confidence interval (CI) = 33.2%, 41.5%]. The mean 10-year probabilities of a major osteoporotic or hip fracture were 13.8% (95% CI = 10.7%, 16.9%) and 2.2% (95% CI = 0.8%, 3.5%), respectively. For women aged ≥ 70 years, the mean 10-year probability of an osteoporotic fracture was 24.3% (95% CI = 13.6%, 35.0%). In total, approximately 17.1% (95% CI = 14.0%, 20.5%) of women were at high risk of a major osteoporotic fracture (risk > 20%) and 20.3% (95% CI = 16.1%, 23.9%) were at high risk of a hip fracture (> 3%). Furthermore, one in four osteoporotic women was at high risk of a major osteoporotic fracture. Conclusion Osteoporosis is common among postmenopausal women, and the risk of osteoporotic fracture is of great concern particularly among older women and vegetarians. Ongoing studies of fracture rates should be followed up, and strategies and research directed at fracture prevention should be prioritized as the proportion of the aged population increases.

Ten-year probability of osteoporotic fracture in 2012 Polish women assessed by FRAX and nomogram by Nguyen et al.—Conformity between methods and their clinical utility

Purpose The aim of the cross-sectional study was to establish the degree of conformity between 10-year probability of osteoporotic fracture, assessed by FRAX, and using the nomograms, as proposed by Nguyen at al. Methods Postmenopausal Polish women (2012) were examined in their mean age of 68.5 ± 7.9 years (age range 55–90 years). Fracture probability by FRAX was based on age, BMI, prior fracture, hip fracture in parents, steroid use, rheumatoid arthritis, alcohol use, secondary osteoporosis and T-score for femoral neck BMD. Fracture probability by Nguyen's nomograms was based on age, the number of prior fractures, the number of falls and T-score for femoral neck BMD. Results The mean conformity rate was 79.1% for any fracture risk (for threshold 20%) and 79.5% for hip fracture (threshold 3%). Any and hip fracture risks were significantly higher for both methods in women with fracture history in comparison to those without fracture and increased with ageing. The influence of prior fracture and ageing was more evident in Nguyen's nomograms. ROC analyses of any fracture risk in FRAX and Nguyen's methods demonstrated the area under curve (AUC) at 0.833 and 0.879, respectively. Similar analyses for hip fracture demonstrated AUCs for FRAX and Nguyen's technique at 0.726 and 0.850, respectively. The AUCs for Nguyen's nomograms were significantly larger than the AUCs for FRAX ( p < 0.0001). Conclusion The mean conformity for any fracture risk is 79.1% and 79.5% for hip fracture. Nguyen's nomograms seem to be more efficient in fracture risk assessment, especially for hip fractures, due to a higher accuracy of the method. The information on the number of falls during the last year and multiple fractures ought to be incorporated into the method of fracture risk prediction. Mini-Abstract The degree of conformity was assessed in a group of 2012 women between 10-year FRAX prognosis of fracture and Nguyen et al.'s nomograms. The mean conformity for any fracture risk is 79.1% and 79.5% for hip fracture. Nguyen's nomograms seem to be more efficient in fracture risk assessment due to higher accuracy.

Ten-year fracture probability in Hong Kong Southern Chinese according to age and BMD femoral neck T-scores

This study estimated the 10-year probability of osteoporotic fracture in Hong Kong Southern Chinese based on a simplified model of the recently developed WHO fracture risk prediction tool (FRAX). Thus, the data provides further insights into potential development of a population-specific FRAX model for Hong Kong in the future. The purpose of this paper was to estimate the 10-year probability of osteoporotic fracture in Hong Kong (HK) Southern Chinese according to age and bone mineral density (BMD) T-score at the femoral neck based on the methodology of the FRAX risk assessment tool calibrated to the epidemiology of HK. Hip fracture data was obtained from the Clinical Data Analysis Reporting System (CDAS) of the Hospital Authority of HK and population size and death rates were taken from the HK Government Census and Statistics Department. Fracture probability was calculated using the cut-off values for T-scores derived from the NHANES III data for Caucasian women aged 20-29 years for BMD at the femoral neck. In this study, the 10-year probability of osteoporotic fracture in HK Southern Chinese increased markedly with increasing age and decreasing femoral neck BMD T-scores in both women and men. Interestingly, at low T-scores, the increase in 10-year probability of osteoporotic fracture in women with age was greater than in men. Fracture probabilities were substantially higher than those from mainland China. Based on this evidence, and until we have HK Southern Chinese population-specific information, we recommend the application of the Caucasian risk profile to calculate the absolute fracture risk for HK Southern Chinese subjects.

Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women

Remaining lifetime and absolute 10-year probabilities for osteoporotic fractures were determined by gender, age, and BMD values. Remaining lifetime probability at age 50 years was 20.2% in men and 51.3% in women and increased with advancing age and decreasing BMD. The study validates the elements required to populate a Swiss-specific FRAX model. Switzerland belongs to high-risk countries for osteoporosis. Based on demographic projections, burden will still increase. We assessed remaining lifetime and absolute 10-year probabilities for osteoporotic fractures by gender, age and BMD in order to populate FRAX algorithm for Switzerland. Osteoporotic fracture incidence was determined from national epidemiological data for hospitalised fractured patients from the Swiss Federal Office of Statistics in 2000 and results of a prospective Swiss cohort with almost 5,000 fractured patients in 2006. Validated BMD-associated fracture risk was used together with national death incidence and risk tables to determine remaining lifetime and absolute 10-year fracture probabilities for hip and major osteoporotic (hip, spine, distal radius, proximal humerus) fractures. Major osteoporotic fractures incidence was 773 and 2,078 per 100,000 men and women aged 50 and older. Corresponding remaining lifetime probabilities at age 50 were 20.2% and 51.3%. Hospitalisation for clinical spine, distal radius, and proximal humerus fractures reached 25%, 30% and 50%, respectively. Absolute 10-year probability of osteoporotic fracture increased with advancing age and decreasing BMD and was higher in women than in men. This study validates the elements required to populate a Swiss-specific FRAX model, a country at highest risk for osteoporotic fractures.