Department of Endocrinology, Christian Medical College, Vellore, India.
Arch Osteoporos. 2020 Jun 1;15(1):82. doi: 10.1007/s11657-020-00756-x.
This study from southern India showed that FRAX® with or without BMD or TBS predicted fragility vertebral fractures at a cut-off of ≥ 9% for major osteoporotic fracture and ≥ 2.5% for hip fracture with sensitivities of 77-88% and specificities of 55-72%.
There is limited information available with regard to utility of Fracture Risk Assessment Tool (FRAX® tool) in predicting fragility fractures in Indian postmenopausal women. We studied the performance of 3 categories: FRAX® (without BMD), FRAX® (with BMD), and FRAX® (with BMD and TBS) in predicting fragility vertebral fractures in rural postmenopausal women.
It was a cross-sectional study conducted at a south Indian tertiary care center. Rural postmenopausal women (n = 301) were recruited by simple random sampling. The risk for major osteoporotic fracture (MOF) and hip fracture (HF) was calculated individually for the 3 categories. The BMD (at lumbar spine and femoral neck) and vertebral fractures were assessed by a DXA (dual energy X-ray absorptiometry) scanner and TBS by TBS iNsight software. ROC curves were constructed, and area under curve (AUC), sensitivity and specificity of FRAX® scores, which would best predict prevalent vertebral fractures (moderate to severe), was computed.
The mean (SD) age was 65.6(5.1) years. The prevalence of osteoporosis at spine was 45%, and femoral neck was 32.6%. Moderate to severe vertebral fractures was seen in 29.2% of subjects. The performance of all 3 categories for FRAX® (MOF) and FRAX® (HF) were good (AUC was 0.798, 0.806, and 0.800, respectively, for MOF) at a cut-off score of ≥ 9, and at a cut-off of ≥ 2.5 for HF, it was 0.818, 0.775, and 0.770, respectively. At these cut-offs, sensitivities were 77-89%, and specificities were 55-72% for predicting prevalent vertebral fractures.
All three categories of FRAX® showed good performance in predicting fractures in Indian postmenopausal women. Thus, it may be utilized for decision regarding treatment and referral for osteoporosis.
本研究来自印度南部，结果表明 FRAX®无论是否结合 BMD 或 TBS 均能预测脆性椎体骨折，主要骨质疏松性骨折的截断值为≥9%，髋部骨折的截断值为≥2.5%，其敏感性为 77-88%，特异性为 55-72%。
目前关于 Fracture Risk Assessment Tool（FRAX®工具）在预测印度绝经后女性脆性骨折中的应用价值的信息有限。我们研究了 3 种分类的表现：FRAX®（不包括 BMD）、FRAX®（包括 BMD）和 FRAX®（包括 BMD 和 TBS）在预测农村绝经后女性脆性椎体骨折中的作用。
这是在印度一家三级保健中心进行的一项横断面研究。通过简单随机抽样招募了 301 名农村绝经后妇女。分别为 3 种分类计算主要骨质疏松性骨折（MOF）和髋部骨折（HF）的风险。通过双能 X 线吸收仪（DXA）扫描仪评估骨密度（腰椎和股骨颈）和椎体骨折，通过 TBS iNsight 软件评估 TBS。构建 ROC 曲线，并计算 FRAX®评分预测现有椎体骨折（中度至重度）的最佳截断值的曲线下面积（AUC）、敏感性和特异性。
平均（SD）年龄为 65.6（5.1）岁。脊柱骨质疏松症的患病率为 45%，股骨颈为 32.6%。29.2%的受试者有中度至重度椎体骨折。所有 3 种分类的 FRAX®（MOF）和 FRAX®（HF）在截断值≥9 时表现良好（AUC 分别为 0.798、0.806 和 0.800，用于 MOF），在截断值≥2.5 时用于 HF，AUC 分别为 0.818、0.775 和 0.770。在这些截断值下，敏感性为 77-89%，特异性为 55-72%，用于预测现有的椎体骨折。
FRAX®的所有 3 种分类在预测印度绝经后妇女骨折方面均表现良好。因此，它可用于治疗决策和骨质疏松转诊。
