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

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

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

Lupus ◽  
2019 ◽  
Vol 28 (8) ◽  
pp. 945-953 ◽  
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.

The Ten Year Probability of Hip Fracture in Thai Population By WHO Fracture Risk Assessment Tool

2010 ◽  
Vol 13 (1) ◽  
pp. 119
Author(s):  
Thananit Sangkomkamhang ◽  
Ussanee Swadpanich Sangkomkamhang ◽  
Prasit Hanpinichsak ◽  
Somkid Lerdsinudom ◽  
Tanawat Vaseenon
Keyword(s):  
Risk Assessment ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Assessment Tool ◽  
Fracture Risk Assessment ◽  
Risk Assessment Tool ◽  
Thai Population ◽  
Fracture Risk Assessment Tool

scholarly journals MON-389 Fracture Risk Assessment Models for Patients With T2DM

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Andreea Maria Banica ◽  
Luciana Mihaela Oprea ◽  
Iuliana Ilie ◽  
Viviana Elian ◽  
Andra Caragheorgheopol ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Osteoporotic Fracture ◽  
Fracture Risk Assessment ◽  
Diabetic Patients ◽  
Major Osteoporotic Fracture ◽  
Hip Fracture Risk ◽  
Diabetic Population ◽  
The Impact

Abstract Introduction Bone mineral density (BMD) measurement, a tool used to diagnose osteoporosis (OP) and to predict fracture risk, has not been found very useful in type 2 diabetic (T2DM) patients. They have a 69% higher fracture risk despite having higher hip and lumbar spine BMD than the non-diabetic population. The aim of this study was to examine the impact of 3 different fracture risk assessment (FRAX) models using surrogate adjustments for T2DM in predicting osteoporotic fracture risk over 10 years. Material and Methods Observational retrospective study included 98 patients with OP or osteopenia: 94 women and 4 men admitted in the National Institute of Endocrinology between 2011-2019. 50 % (n= 49) of the patients had T2DM, while the other half were non-diabetic patients. BMI, BMD, lipid profile, serum creatinine, calcium, phosphorus, 25(OH)vitamin D, HbA1c were assessed. BMD was measured on a GE Lunar osteodensitometer. The risk of major osteoporotic fracture in 10 years was assessed with FRAX adjusted for Romania. For diabetic patients, FRAX was adjusted by adding 10 years to patients’ age (model 1), by using rheumatoid polyarthritis as a substitute for T2DM (model 2) or by lowering T score with 0.5 DS (model 3). Results Non-diabetic patients had a lower BMI (p=0.001) and a lower BMD (p=0.03) than diabetic patients. A higher BMI correlated with a higher hip BMD (p=0.004). For diabetic patients, FRAX risk without adjustment was statistically significant lower than FRAX risk calculated with model 1 and 2 (p&lt; 0.001) for both major and hip fracture risk. Unadjusted FRAX risk was lower than the one calculated with model 3 only for hip fracture risk (p&lt;0.001). Model 1 FRAX adjustment led to a statistically significant risk of both major osteoporotic fracture (p= 0.004) and hip fracture (p=0.04) over 10 years in diabetic patients than non-diabetic patients, though diabetic patients had higher BMD. The same observation was made when FRAX was adjusted by model 2 (p=0.001) or by model 3 (p=0.001). HbA1c correlated inversely with FRAX adjusted with all three models. Discussion FRAX calculator does not include T2DM among secondary causes of OP and this precludes a proper risk assessment independent of BMD. Trabecular bone assessment (TBS) captures a larger portion of the diabetes-associated fracture risk than BMD, however TBS it is not fully independent of the BMD. We examined 3 models of adjusted FRAX in T2DM patients that showed an important increase in fracture risk prediction when adding BMD - independent risk factors into FRAX calculator. Conclusion T2DM patients have a greater risk of major osteoporotic fracture in 10 years at the same BMD compared with non-diabetic population. New models of FRAX adjusted for T2DM are needed in assessing the intervention threshold for OP/osteopenia of patients with T2DM.

49 Falls and the Prediction of Fragility Fractures

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Celia Gregson
Keyword(s):  
Risk Assessment ◽  
Fracture Risk ◽  
Fragility Fractures ◽  
Fracture Risk Assessment ◽  
Assessment Tools ◽  
Health And Social Care ◽  
European Working ◽  
Risk Assessment Tools ◽  
History Of ◽  
Risk Factors For Falls

Abstract Fragility fractures carry high health and social care costs for patients, families, and health systems. Falls are a fundamental risk factor for sustaining a fragility fracture, and hence fracture risk assessment is an intrinsic component of any falls evaluation. I will review the relationship between falls and incident fracture and outline strategies for assessing fracture risk. I will review the different fracture risk assessment tools available, including FRAX. I will discuss approaches to fracture risk assessment in the context of falls. Sarcopenia is an important risk factors for falls. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) updated their diagnostic criteria for sarcopenia, placing a greater emphasis on muscle strength and physical performance. Whilst measures of muscle mass may not add to the clinical prediction of fractures over an above a tool such as FRAX, I will discuss the value of tests of muscle function, impairment of which characterises sarcopenia, in the prediction of fracture risk. I will further present data on patient’s own perception of fracture risk and how this might be influenced by a history of falls.

Development and Validation of a Risk Score to Predict the First Hip Fracture in the Oldest Old: A Retrospective Cohort Study

2019 ◽  
Vol 75 (5) ◽  
pp. 980-986 ◽  
Author(s):  
Ming-Tuen Lam ◽  
Chor-Wing Sing ◽  
Gloria H Y Li ◽  
Annie W C Kung ◽  
Kathryn C B Tan ◽  
...  
Keyword(s):  
Hong Kong ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Risk Score ◽  
Validation Cohort ◽  
Oldest Old ◽  
Community Dwelling ◽  
Risk Scores ◽  
Derivation Cohort

Abstract Background To evaluate whether the common risk factors and risk scores (FRAX, QFracture, and Garvan) can predict hip fracture in the oldest old (defined as people aged 80 and older) and to develop an oldest-old-specific 10-year hip fracture prediction risk algorithm. Methods Subjects aged 80 years and older without history of hip fracture were studied. For the derivation cohort (N = 251, mean age = 83), participants were enrolled with a median follow-up time of 8.9 years. For the validation cohort (N = 599, mean age = 85), outpatients were enrolled with a median follow-up of 2.6 years. A five-factor risk score (the Hong Kong Osteoporosis Study [HKOS] score) for incident hip fracture was derived and validated, and its predictive accuracy was evaluated and compared with other risk scores. Results In the derivation cohort, the C-statistics were .65, .61, .65, .76, and .78 for FRAX with bone mineral density (BMD), FRAX without BMD, QFracture, Garvan, and the HKOS score, respectively. The category-less net reclassification index and integrated discrimination improvement of the HKOS score showed a better reclassification of hip fracture than FRAX and QFracture (all p &lt; .001) but not Garvan, while Garvan, but not HKOS score, showed a significant over-estimation in fracture risk (Hosmer–Lemeshow test p &lt; .001). In the validation cohort, the HKOS score had a C-statistic of .81 and a considerable agreement between expected and observed fracture risk in calibration. Conclusion The HKOS score can predict 10-year incident hip fracture among the oldest old in Hong Kong. The score may be useful in identifying the oldest old patients at risk of hip fracture in both community-dwelling and hospital settings.

scholarly journals ABSOLUTE FRACTURE RISK ASSESSMENT IN OUTPATIENTS WITH DISTAL RADIUS OSTEOPOROSIS

2012 ◽  
Vol 15 (3) ◽  
pp. 3-6
Author(s):  
A A Popov ◽  
M V Strunina ◽  
M V Telyushchenko
Keyword(s):  
Risk Assessment ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Osteoporotic Fracture ◽  
Clinical Decision Making ◽  
Absolute Risk ◽  
Fracture Risk Assessment ◽  
Mineral Density ◽  
Major Osteoporotic Fracture ◽  
Test Sensitivity

Objectives: to assess the absolute fracture risk in outpatients with osteoporosis (OP) at distant radius. Methods: individual absolute fracture risk was assessed using FRAX tool without hip neck bone mineral density (BMD) input in 3082 subsequent subjects (2911 females and 171 males) aged from 40 to 95 (median age 60), calculated by Finnish population data. Distant radius BMD was estimated in all patients by DTX200. Results: 774 (25.1 %) patients had had history of low traumatic fractures. BMD≤- .5 SD was detected in 1659 cases, fracture history in 558 (33.6%) of them (OR = 2.21; 95 % CI 1.93-2.55). Median 10-year probability of a major osteoporotic fracture was 4.90 % (25- 75 %; 1.10 - 55.0) and 10-year probability of a hip fracture was 0.8 % (0 - 46), absolute risk 10 % and higher was detected in 434 (64,3 %) patients. Calculated 10-year probability of a major osteoporotic fracture > 10 % was associated with previous low traumatic fractures: OR = 4,55; 95 % CI 4,06- 5,10, test sensitivity being 56.1 % with specificity 89.6 % . The same association was found for 10-year probability of hip fracture >3 %: OR = 3.57 (3.19 - 4.00), test sensitivity being 51,6 % with specificity 86,7 %. Conclusion: FRAX tool for individual absolute fracture risk assessment should be introduced into general practice for clinical decision making in prophylaxis of OP associated fractures.

scholarly journals Clinical Utility of Trabecular Bone Score (TBS) in Fracture Risk Assessment of Patients with Rheumatic Diseases Treated with Glucocorticoids

2021 ◽  
Vol 53 (08) ◽  
pp. 499-503
Author(s):  
Anna Nowakowska-Płaza ◽  
Jakub Wroński ◽  
Iwona Sudoł-Szopińska ◽  
Piotr Głuszko
Keyword(s):  
Risk Assessment ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Rheumatic Diseases ◽  
Clinical Utility ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Osteoporotic Fractures ◽  
Fracture Risk Assessment ◽  
Glucocorticoid Therapy

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.

scholarly journals Evaluation of Cardiovascular Diseases Risk in the Iranian Population

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Meisam Akhlaghdoust ◽  
Davoud Pirani ◽  
Mohamad Nasiri ◽  
Sahar Lashkari Ahangarani ◽  
Nazgol Haghsetan ◽  
...  
Keyword(s):  
Family History ◽  
Cardiovascular Diseases ◽  
Risk Score ◽  
Smoking Status ◽  
Positive Family History ◽  
Iranian Population ◽  
Risk Scores ◽  
Cvd Risk ◽  
Assessment Scores ◽  
History Of

Background: Cardiovascular diseases (CVDs) are among the leading causes of death and morbidity around the world. Risk score assessment can assist in anticipating a person's CVD risk over the next five years. Objectives: This study aimed to investigate the risk of CVDs in the general Iranian population. Methods: This study was conducted in September 2020, and 5324 participants aged 35 to 74 years were registered from 95 metro stations throughout Tehran. Participants' demographics (ie, age, gender, current smoking and exercise habits, and family history of hypertension, CVDs, and diabetes) were collected by in-person interviews, and their body mass index (BMI) and systolic blood pressure (SBP) were measured. The five-year risk of CVDs was estimated and categorized into low (< 10%), some risk (10 - 20%), moderate (21 - 30%), increased (31 - 40%), and high (> 40%) groups, and its association with the participants’ demographics was evaluated by SPSS version 21. Results: The mean age of 5324 participants was 45.3 ± 14.8 years, and 64% were male. The frequency of CVD risk scores was as follows: low (54%), some risk (17.5%), moderate (15.4%), increased (5.7%), and high (3.5%), which were significantly associated with gender (P < 0.001), smoking status (P = 0.048), exercise (P = 0.014), and family history of diseases (all P < 0.001). Age (β = 0.774, P < 0.001) increased the odds of CVD, while other variables had small or no effects on CVD. Conclusions: This study found a high prevalence of high-risk CVD in the Iranian population, emphasizing the importance of risk score assessment, which should include not only basic non-laboratory risk assessment scores, but also exercise and a positive family history of associated diseases.

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