FRAX Accurately Identifies Women at Risk for Vertebral Fracture

By Will Boggs MD

December 01, 2014

  

NEW YORK (Reuters Health) - The WHO fracture risk assessment tool FRAX is better than lumbar spine and femoral neck T-scores at identifying women with vertebral fractures, researchers from Morocco report.

"An elevated FRAX score may be used as a screening tool to indicate bone mineral density (BMD) measurement and vertebral fracture assessment (VFA) at the same time," Dr. Abdellah El Maghraoui from Military Hospital Mohammed in Rabat, Morocco, told Reuters Health. "The cut-off of what is an elevated FRAX has to be determined in different populations."

"Vertebral fractures (VFs) are the most common type of osteoporotic fractures in older adults," Dr. Maghraoui explained. "It has been shown that VFs are usually asymptomatic (only one-fourth to one-third of these fractures come to medical attention). The identification of asymptomatic VFs is of primordial importance especially in patients without densitometric osteoporosis, a common situation where all experts agree to recommend treatment."

Dr. Maghraoui's team developed a Moroccan model based on FRAX and evaluated the performance of FRAX scores in comparison with BMD measurement in identifying women with prevalent asymptomatic vertebral fractures.

Their cross-sectional study included 908 menopausal women aged 50 years and older. Of these women, nearly a third had osteoporosis and 44% had osteopenia.

Vertebral fractures were present in 382 (42.1%) of women, the researchers report in BMC Musculoskeletal Disorders, online November 4.

FRAX without BMD provided the best method of predicting vertebral fracture in these women, and there was no improvement when BMD was added to the model.

A FRAX cutoff of 3%, for example, yielded 57% sensitivity, 78% specificity, 40% positive predictive value, and 2.68 positive likelihood ratio for predicting major fractures.

"The FRAX tool is not designed to examine the risk of asymptomatic vertebral fractions," the researchers say. "However, we performed this analysis because of the importance of this kind of fracture in the outcome of osteoporosis."

"A woman with elevated FRAX should be evaluated further: DXA with VFA, biological exams including vitamin D, iPTH, etc., and in some cases bone turnover markers," Dr. Maghraoui said. "Other factors not included in FRAX should be evaluated such as the risk of fall."

"VFA can easily be performed at the same time of bone mineral density (BMD) measurement, allowing integration of BMD and VF information in the clinical care of patients evaluated for osteoporosis," Dr. Maghraoui concluded. "Advantages of VFA compared with spine radiographs include greater patient convenience (VFA can be done in association with BMD testing by DXA), smaller dose of ionizing radiation, and lower cost."
http://www.medscape.com/viewarticle/835572?src=wnl_edit_tpal&uac=127701PY



For the abstract of this article, see http://strontiumforbones.blogspot.com/2014/12/frax-identifies-women-with-prevalent.html
For the original article, follow either of these two links:

http://bit.ly/1yMo74D
http://www.biomedcentral.com/1471-2474/15/365

Three Quarters of Hip Fracture Patients are Vitamin D Deficient

New Delhi researchers show that vitamin D levels may be a useful index for the assessment of hip fracture risk in elderly people.

A study in New Delhi India has revealed high rates of vitamin D deficiency among hip fracture patients, confirming the conclusions of similar international studies which point to vitamin D deficiency as a risk factor for hip fracture.

A group of 90 hip fracture patients was compared to a matched control group of similar age, sex and co-morbidity. Of the patients who had suffered hip fractures, 76.7% were shown to be vitamin D deficient as measured by serum 25(OH)D levels of less than 20 ng/ml. In addition, 68.9% had elevated PTH levels. In comparison, only 32.3% of the controls had vitamin D deficiency and 42.2% had elevated PTH levels (secondary hyperparathyroidism).

Vitamin D deficiency has been linked to the pathogenesis of osteoporosis and is increasingly thought to play a role in muscle strength, certain cancers, multiple sclerosis and diabetes. Vitamin D levels are very low in the Indian population in all age groups, and could be explained by skin pigmentation, traditional clothing and the avoidance of sunlight.

The results of the New Delhi study confirm that serum 25 (OH)D levels may be a useful index for the assessment of risk of hip fracture in elderly people.

The study (OC13) was presented at the IOF Regionals – 1st Asia-Pacific Regional Osteoporosis Meeting being held in Singapore from December 10-13, 2010.
 

All abstracts from the meeting have been published in Osteoporosis International, Vol. 21, Suppl. 5, 2010.

http://www.iofbonehealth.org/news/indian-study-reveals-three-quarters-hip-fracture-patients-are-vitamin-d-deficient

FRAX Identifies Women with Prevalent Asymptomatic Vertebral Fractures

Abstract

Background

A Moroccan model for the FRAX tool to determine the absolute risk of osteoporotic fracture at 10 years has been established recently. The study aimed to assess the discriminative capacity of FRAX in identifying women with prevalent asymptomatic vertebral fractures (VFs).

Methods

We enrolled in this cross-sectional study 908 post-menopausal women with a mean age of 60.9 years ±7.7 (50 to 91) with no prior known diagnosis of osteoporosis. Subjects were recruited from asymptomatic women selected from the general population. Lateral VFA (vertebral fracture assessment) images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genantsemiquantitative (SQ) approach and morphometry. We calculated the absolute risk of major fracture and hip fracture with and without bone mineral density (BMD)using the FRAX website.The overall discriminative value of the different risk scores was assessed by calculating the areas under the ROC curve (AUC).

Results

VFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF. The group of women with VFs had a statistically significant higher FRAX scores for major and hip fractures with and without BMD, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF. The AUC ROC of FRAX for major fracture without BMD was 0.757 (CI 95%; 0.718-0.797) and 0.736 (CI 95%; 0.695-0.777) with BMD, being 0.756 (CI 95%; 0.716-0.796) and 0.747 (CI 95%; 0.709-0.785), respectively for FRAX hip fracture without and with BMD. The AUC ROC of lumbar spine T-score and femoral neck T-score were 0.660 (CI 95%; 0.611-0.708) and 0.707 (CI 95%; 0.664-0.751) respectively.

Conclusion

In asymptomatic post-menopausal women, the FRAX risk for major fracture without BMD had a better discriminative capacity in identifying the women with prevalent VFs than lumbar spine and femoral neck T-scores suggesting its usefulness in identifying women in whom VFA could be indicated. 

To read the full research article by Abdellah El Maghraoui, Siham Sadni, Nabil Jbili, Asmaa Rezqi, Aziza Mounach and Imad Ghozlani click on this link:

 http://www.biomedcentral.com/1471-2474/15/365