Osteoporotic Fractures, DXA, and Fracture Risk Assessment: Meeting Future Challenges in the Eastern Mediterranean Region

AbstractChronic glucocorticoid therapy is associated with osteoporosis and can cause fractures in up to 50% of patients. Increased risk of fractures in patients with glucocorticoid-induced osteoporosis does not result only from the decreased bone mineral density (BMD) but also bone microarchitecture deterioration. Trabecular bone score (TBS) is a method complementary to DXA, providing additional information about trabecular bone structure. The aim of this study was to assess the clinical utility of TBS in fracture risk assessment of patients treated with glucocorticoids. Patients with rheumatic diseases treated with glucocorticoids for at least 3 months were enrolled. All recruited patients underwent DXA with additional TBS assessment. We analyzed the frequency of osteoporosis and osteoporotic fractures and assessed factors that might be associated with the risk of osteoporotic fractures. A total of 64 patients were enrolled. TBS and TBS T-score values were significantly lower in patients with osteoporosis compared to patients without osteoporosis. Low energy fractures occurred in 19 patients. The disturbed bone microarchitecture was found in 30% of patients with fractures without osteoporosis diagnosis based on BMD. In the multivariate analysis, only TBS and age were significantly associated with the occurrence of osteoporotic fractures. TBS reflects the influence of glucocorticoid therapy on bone quality better than DXA measured BMD and provides an added value to DXA in identifying the group of patients particularly prone to fractures.

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PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region

PLoS ONE ◽

10.1371/journal.pone.0189389 ◽

2017 ◽

Vol 12 (12) ◽

pp. e0189389 ◽

Cited By ~ 7

Author(s):

Nizal Sarrafzadegan ◽

Razieh Hassannejad ◽

Hamid Reza Marateb ◽

Mohammad Talaei ◽

Masoumeh Sadeghi ◽

...

Keyword(s):

Risk Assessment ◽

Cardiovascular Diseases ◽

Mediterranean Region ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Risk Charts

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Fracture risk assessment (FRAX) without BMD and risk of major osteoporotic fractures in adults with type 1 diabetes

Bone ◽

10.1016/j.bone.2020.115614 ◽

2021 ◽

Vol 143 ◽

pp. 115614 ◽

Cited By ~ 2

Author(s):

Anagha Champakanath ◽

Amena Keshawarz ◽

Laura Pyle ◽

Janet K. Snell-Bergeon ◽

Viral N. Shah

Keyword(s):

Risk Assessment ◽

Type 1 Diabetes ◽

Fracture Risk ◽

Osteoporotic Fractures ◽

Fracture Risk Assessment ◽

Major Osteoporotic Fractures

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Can FRAX Tool be Used for Determination of Risk Score for Osteoporosis Fractures in a Financially Constrained Society Like Bangladesh?

BIRDEM Medical Journal ◽

10.3329/birdem.v8i1.35031 ◽

2017 ◽

Vol 8 (1) ◽

pp. 9-15

Author(s):

Nazma Akter ◽

Nazmul Kabir Qureshi ◽

Zafar Ahmed Latif

Keyword(s):

Risk Assessment ◽

Hip Fracture ◽

Fracture Risk ◽

Risk Score ◽

Osteoporotic Fractures ◽

Fracture Risk Assessment ◽

Assessment System ◽

Risk Scores ◽

Assessment Scores ◽

History Of

Background: This study was designed to assess the effectiveness of use of the fracture risk assessment system (FRAX) as risk assessment tool for osteoporosis risk score scale in Bangladeshi subjects and to assess how the results of the tools correlate with each other.Methods: This cross-sectional study was conducted between January 2016 to August 2016. The study population was randomly collected 600 Bangladeshi subjects; who attended outpatient department (OPD) of MARKS Medical College & Hospital, Dhaka, Bangladesh. The age range of the subjects was between 40 to 75 years. The subjects had not done a bone mineral density (BMD) score. None of them were previously diagnosed or got treatment for osteoporosis. A questionnaire was designed to complete the osteoporosis specific risk score sheet. Major osteoporotic and hip fracture incidence to 10-years as a function of the FRAX probability was calculated by using fracture risk assessment system.Results: A total of 600 subjects were included. Among them, 59.2% and 40.8%were male and female respectively. Mean age (Mean ± SD) of the study, subjects were 52.16±7.96 years. Among study subjects, mean BMI was more in females in comparison to males (p<0.05). The FRAX predicted 10-year risk assessment scores of major osteoporotic fractures were significantly more in females than males (p<0.02). Risk assessment scores of both major osteoporotic fractures and hip fractures showed significant association in post-menopausal women when compared with there who were not menopausal (p<0.05). Risk assessment factors for risk scores did differ significantly among male and female subjects and among postmenopausal and non-menopausal women. Among risk assessment factors, subjects having finally history of fracture hip, glucocorticoids, rheumatoid arthritis showed strong association with presence of ≥20% risk scores for major osteoporotic fracture (p<0.05) and ≥ 3% for hip fracture (p<0.05). Subjects having history of previous fracture and secondary osteoporosis showed only significant association with ≥3% risk scores for hip fracture (p<0.05).Conclusion: The public health burden of fractures will fail to compromise unless the subset of patients who are at increased risk for fracture are identified and treated. Ten-year fracture risk assessment with the fracture risk assessment system is increasingly used to guide for treatment decisions. It is an effective tool to predict fracture probability, particularly in developing countries like Bangladesh, where most of the patients cannot afford expensive dual energy x-ray absorptiometry scans.Birdem Med J 2018; 8(1): 9-15

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POS1108 THE ACCURACY OF OSTEOPOROTIC FRACTURE RISK PREDICTION IN PATIENTS WITH RHEUMATOID ARTHRITIS USING THE PREDICTIVE MODEL DEVELOPED AT V.A. NASONOVA REASEARCH INSTITUTE OF RHEUMATOLOGY (RUSSIA) AND FRACTURE RISK ASSESSMENT TOOL (FRAX)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1717 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 834.2-835

Author(s):

P. Kozhevnikova ◽

P. Kovalenko ◽

S. Glukhova ◽

I. Dydykina ◽

A. Lila

Keyword(s):

Risk Assessment ◽

High Risk ◽

Fracture Risk ◽

Predictive Model ◽

Osteoporotic Fracture ◽

Assessment Tool ◽

Osteoporotic Fractures ◽

Fracture Risk Assessment ◽

Risk Assessment Tool ◽

Fracture Risk Assessment Tool

Background:FRAX is a computer-based algorithm that calculates the 10-year probability of a major osteoporotic fracture and the 10-year probability of hip fracture. However, FRAX has several limitations in assessing the risk of fracture in patients with rheumatoid arthritis (RA).In 2013 V.A. Nasonova Reasearch Institute of Rheumatology (Russia) developed a predictive mathematical model for assessing the risk of osteoporotic fractures in RA, which includes 2 main risk factors: cumulative glucocorticoid dose (GC), decrease in BMD in the femoral neck to osteoporosis, and 2 additional factors: for patients under 65 years of age - the presence of ischemic heart disease, and for people over 65 - a history of gastric ulcer or duodenal ulcer.Objectives:To compare accuracy of osteoporotic fracture risk prediction in patients with RA using the predictive model developed at V.A. Nasonova Reasearch Institute of Rheumatology (IR) and FRAX.Methods:This monocentric (single-center) prospective study included 70 patients with RA, aged 40 to 80 years. The follow-up period - 8.0 ± 1.2 years; mean age at the baseline was 55.4±7.8 years old; the mean disease duration at the baseline - 14,7±10,2 years. All patients retrospectively calculated the 10-year probability of fractures and prognostic model developed by the IR.Results:According to the Fracture Risk Assessment Tool, 32 (46%) patients had a low risk of osteoporotic fractures, 38 (54%) had a high risk. According to the predictive model of IR 33 (47%) patients had a low risk of osteoporotic fractures, 37 (53%) had a high risk. During the follow-up period, osteoporotic fractures were occurred in 18 (26%) patients: 14 (78%) of them had a high risk of fractures according to the predictive IR model, and 13 (72%) patients - according to the Fracture Risk Assessment Tool. Positive and negative predictive value of the Fracture Risk Assessment Tool was 34% and 84%, respectively, of the predictive model of IR - 38% and 88%, respectively. Prognosis of the predictive model of IR in 73% cases coincided with assessing the 10-year probability of fracture.Conclusion:The predictive model developed at V.A. Nasonova Reasearch Institute of Rheumatology (Russia) showed a higher sensitivity and specificity in determining the risk of osteoporotic fractures in RA patients vs FRAX algorithm.Disclosure of Interests:None declared.

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Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases

Lupus ◽

10.1177/0961203319855122 ◽

2019 ◽

Vol 28 (8) ◽

pp. 945-953 ◽

Cited By ~ 4

Author(s):

E -L Lai ◽

W -N Huang ◽

H -H Chen ◽

C -Y Hsu ◽

D -Y Chen ◽

...

Keyword(s):

Risk Assessment ◽

Autoimmune Diseases ◽

Fracture Risk ◽

Osteoporotic Fracture ◽

Lupus Erythematosus ◽

Assessment Tool ◽

Osteoporotic Fractures ◽

Fracture Risk Assessment ◽

Risk Scores ◽

Mineral Density

The Fracture Risk Assessment Tool (FRAX) has been used universally for the purpose of fracture risk assessment. However, the predictive capacity of FRAX for autoimmune diseases remains inconclusive. This study aimed to compare the applicability of FRAX for autoimmune disease patients. This retrospective study recruited rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS) patients with bone mineral density (BMD) tests. Patients with any osteoporotic fractures were identified. Taiwan-specific FRAX with and without BMD were then calculated. In total, 802 patients (451 RA, 233 SLE and 118 pSS) were enrolled in this study. The cumulative incidences of osteoporotic fractures in the RA, SLE and pSS patients were 43.0%, 29.2% and 33.1%, respectively. For those with a previous osteoporotic fracture, T-scores were classified as low bone mass. Overall, the patients’ 10-year probability of major fracture risk by FRAX without BMD was 15.8%, which then increased to 20.3% after incorporation of BMD measurement. When analyzed by disease group, the fracture risk in RA patients was accurately predicted by FRAX. In contrast, current FRAX, either with or without BMD measurement, underestimated the fracture risk both in SLE and pSS patients, even after stratification by age and glucocorticoid treatment. For pSS patients with major osteoporotic fractures, FRAX risks imputed by RA were comparable to major osteoporotic fracture risks of RA patients. Current FRAX accurately predicted fracture probability in RA patients, but not in SLE and pSS patients. RA-imputed FRAX risk scores could be used as a temporary substitute for SLE and pSS patients.

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