Selection of risk assessment methods for osteoporosis screening in postmenopausal women with low-energy fractures: A comparison of fracture risk assessment tool, digital X-ray radiogrammetry, and dual-energy X-ray absorptiometry

Objectives: Fracture liaison services are designed to identify patients needing osteoporosis treatment after a fracture. Some fracture liaison service designs involve a prescreening step, for example, fracture risk assessment tool (FRAX®). Another possible prescreening tools are bone mass density assessment in the acute setting. The aim of this study was to assess the effectiveness of prescreening tools. Methods: In the present prospective cohort study, women aged >55 years with a radius fracture were included. Patients were recruited at the emergency department after experiencing their fracture. All patients performed fracture risk assessment by fracture risk assessment tool, and bone mass density assessment by digital X-ray radiogrammetry and dual-energy X-ray absorptiometry (prescreening steps) as well as full routine evaluation at the osteoporosis unit (endpoint). The main outcome measures were sensitivity, specificity, predictive values, and area under the curve. Results: Forty-one women were recruited (mean age: 70 ± 8 years). Of these, 54% fulfilled the treatment indication criteria of osteoporosis after a full examination. Fracture risk assessment tool without bone mass density (cutoff ⩾ 15%) for prescreening patients had a high sensitivity (90%) but a low area under the curve (0.50) and specificity (16%). The highest area under the curve (0.73) was found prescreening with bone mass density assessment (dual-energy X-ray absorptiometry or digital X-ray radiogrammetry) having a sensitivity of 59%–86% and specificity of 61%–90%. Conclusion: This study, though small, raises questions regarding the effectiveness of using a prescreening step in fracture liaison services for high-risk individuals. In this cohort, FRAX® without bone mass density had a low precision, with a risk of both underestimating and overestimating patients requiring treatment. Bone mass density assessment in the acute setting could improve the precision of prescreening. Further investigations on the effectiveness and health economics of prescreening steps in fracture liaison services are needed.

Does Fracture Liaison Service Improves Fracture Risk Assessment among Patients with Fragility Fractures? A Systematic Review

Background: The fragility fractures can cause substantial pain, disability, reduced quality of life and mortality. The probability of sustaining subsequent fractures increases up to five times after an initial fragility fracture. The Fracture Liaison Service is a coordinated model of care that aims to bridge the post-fracture care gap by improving subsequent fracture risk assessment and post-fracture management. However, there are very few studies that included fracture risk assessment as a significant outcome of an FLS program. This systematic review aims to evaluate the available evidence on the effect of FLS in improving fracture risk assessment among fragility fracture patients Method: A systematic literature search will be carried out on the major electronic databases including PubMed, Embase, CINAHL Plus, and Cochrane to identify the outcomes of Fracture Liaison Service. The literature search will not be restricted to the context and year of publication. Two researchers will independently conduct the databases search. We will pilot the search strategy to ensure sufficient sensitivity and specificity. The JBI critical appraisal tools will be used to assess methodological quality of all the included studies. Discussion: This review will highlight an urgent need for more studies from different geographical areas to determine best practices for implementing fracture risk assessment globally and guiding clinical decision making for osteoporosis management. The findings of this systematic review will highlight the importance of including fracture risk assessment as a significant parameter to evaluate FLS programs implemented across the globe. Conclusion: This systematic review will provide more information about fracture risk assessments and its reporting. It will also highlight the variations in the methods of performing a fracture risk assessment with and without BMD testing and the impact of the FLS program in improving fracture risk assessment.

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

Chronic 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.

OSTEOPOROSE COMO PREDITOR DE FRATURAS DO COLO FEMORAL POR QUEDAS EM IDOSOS: REVISÃO INTEGRATIVA

Introdução: Em virtude do envelhecimento podem surgir patologias como a osteoporose que atua na redução da massa óssea, favorecendo idosos a ficarem mais suscetíveis a sofrerem quedas e possivelmente fraturas, principalmente do colo femoral. A intervenção cirúrgica precoce no pós-fratura é imprescindível, pois a demora no tempo de internação e realização das cirurgias podem aumentar as taxas de letalidade. Objetivo: Verificar se a osteoporose é um fator predisponente para fraturas do colo femoral por quedas em idosos, se o gênero pode influenciar na progressão da patologia, além das mortalidades. Metodologia: Trata-se de uma revisão integrativa da produção científica, com buscas realizadas na biblioteca virtual da saúde (BVS), com inclusão da LILACS, MEDLINE, e na Cochrane Library no período compreendido entre 2015 e 2020, sendo incluídos 8 estudos nos idiomas inglês, português e espanhol para análises. Resultados e discussão: Foram utilizados diferentes instrumentos como: densitometria óssea, Fracture Risk Assessment Tool (Frax), questionários, softwareTrabecular Bone Score (TBS), e Espectroscopia Dispersiva de raios-x (EDS) para avaliação dos indivíduos, a osteoporose foi observada na maioria dos pacientes, porém nem todos tinham conhecimento do diagnóstico, o gênero feminino prevaleceu devido a diminuição dos níveis de estrogênio. Nas fraturas, as quedas se destacaram, 66,43% necessitaram de apoio instrumental, e 11% foram à óbito dentro de um ano. Conclusão: A osteoporose pode ser considerada uma preditora de fraturas do colo femoral em idosos, principalmente em mulheres, observa-se a necessidade de mais estudos com populações específicas, que evidenciem tais episódios podendo levar a morte.