Department of Medicine, Division of Endocrinology, Duke University Medical Center, Box 3924, 200 Trent Drive, Baker House, Room 310, Durham, NC, 27710, USA.
Durham Veterans Affairs Medical Center, Durham, NC, USA.
Osteoporos Int. 2021 Mar;32(3):467-472. doi: 10.1007/s00198-020-05616-5. Epub 2020 Sep 4.
We evaluated the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients with a recent low trauma fracture other than hip or vertebral. The concordance, sensitivity, and specificity were 75.6%, 67.3%, and 78.2%, respectively. FRAX without BMD can be used after a fracture to expedite treatment.
The objective of this study was to evaluate the performance of the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients who recently sustained a low trauma fracture other than hip or vertebral.
We utilized a clinical database established by the Fracture Liaison Service at the Durham Veterans Affairs Medical Center to identify male and female Veterans age ≥ 50 years who sustained a low trauma non-hip/non-vertebral fracture and underwent dual-energy x-ray absorptiometry (DXA) between October 2013 and April 2018. FRAX without BMD (FRAX-BMI) and FRAX with BMD (FRAX-BMD) were calculated for the 229 patients identified, and whether or not they met the National Osteoporosis Foundation (NOF) guideline treatment thresholds was compared.
There were 55 (24.0%) patients that met criteria for treatment based on NOF guideline established FRAX-BMD thresholds including 27 (11.8%) patients with osteoporosis by DXA. The concordance of FRAX-BMI in predicting treatment recommendations was 75.6% with a sensitivity of 67.3% and a specificity of 78.2%. The area under the curve (AUC) of FRAX-BMI hip fracture risk was 0.79. Assessment/treatment thresholds for hip fracture risk of 1% < FRAX-BMI < 4% were proposed to maximize sensitivity and specificity.
Among patients who sustained a low trauma non-hip/non-vertebral fracture, FRAX-BMI can be used to stratify risk and identify high-risk patients who could be treated without DXA, low-risk patients who may not need treatment, and intermediate-risk patients to undergo DXA testing.
本研究旨在评估不基于骨密度（BMD）的骨折风险评估工具（FRAX）在预测除髋部或椎体以外发生低创伤性骨折的患者的治疗建议方面的表现。
我们利用 Durham Veterans Affairs Medical Center 的骨折联络服务建立的临床数据库，确定了年龄≥50 岁、发生低创伤性非髋部/非椎体骨折且在 2013 年 10 月至 2018 年 4 月期间接受双能 X 线吸收法（DXA）检查的男性和女性退伍军人。对确定的 229 名患者计算了不基于 BMD 的 FRAX（FRAX-BMI）和基于 BMD 的 FRAX（FRAX-BMD），并比较了他们是否符合国家骨质疏松基金会（NOF）指南治疗阈值。
根据基于 DXA 确定的骨质疏松症的 NOF 指南 FRAX-BMD 阈值，有 55 名（24.0%）患者符合治疗标准，包括 27 名（11.8%）患者。FRAX-BMI 预测治疗建议的一致性为 75.6%，灵敏度为 67.3%，特异性为 78.2%。FRAX-BMI 髋部骨折风险的曲线下面积（AUC）为 0.79。提出 FRAX-BMI 髋部骨折风险的评估/治疗阈值为 1%<FRAX-BMI<4%，以最大限度地提高灵敏度和特异性。
在发生低创伤性非髋部/非椎体骨折的患者中，FRAX-BMI 可用于分层风险，确定可在不进行 DXA 检查的情况下进行治疗的高危患者、可能不需要治疗的低危患者和需要进行 DXA 检查的中危患者。
