The improved clinical use of trabecular bone score adjusted FRAX® to predict major osteoporotic fractures in Chinese older people
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AbstractAim
There is a clinical need to find additional measures to improve the riskprediction of osteoporotic fracture as defined by the areal bone mineral density (aBMD) or FRAX®. Since the 10-year fracture probability (FRAX® adjusted by aBMD and TBS) can be calculated on FRAX® website now, its utility need to be widely validated in different population. Moreover, the improved performance of TBS adjusted FRAX® compared with FRAX® has never been evaluated based on clinical intervention decisions for Chinese population. So, we would like to evaluate the added
predictive value of TBS to FRAX® on 10-year major osteoporotic fractures (MOFs) for clinical use in older Chinese people.

Methods
Four thousand community-dwelling Chinese men and women aged ≥ 65 years were followed up for an average period of 9.94 and 8.82 years, respectively. Areal BMD measurements were carried out, TBS was calculated for the lumbar spine, and FRAX® (TBS adjusted or not) for 10-year risk of MOFs (hip, clinical spine, shoulder, and wrist) was estimated at baseline. Cox regression model was used to evaluate the associations between TBS and FRAX®
with the MOFs risk. The area under receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI) and category-based net reclassification improvement (NRI) were applied to evaluate the improved
prediction ability of TBS adjusted FRAX®.

Results
During the follow-up, 126 men and 215 women had at least one incident MOF. Both the FRAX® (adjusted aBMD) score and the FRAX® (adjusted aBMD and TBS) score showed significant association with incident MOFs, with HR/SD (95%CI) of 1.58 (1.40, 1.79) and 1.65 (1.45, 1.86) for men, and 1.35 (1.23, 1.48) and 1.39 (1.27, 1.52) for women, respectively. Probabilities of 10-year MOFs risk calculated from FRAX® (adjusted aBMD) and FRAX® (adjusted aBMD and TBS) were showed significant predictive value in MOFs risk with mean AUC of 0.682 and 0.694 in men, and with mean AUC of 0.627 and 0.633 in women, respectively. When compared with the reference model of FRAX® (adjusted aBMD), the prediction model of FRAX® (adjusted aBMD and TBS) showed significant increment of AUC in men, but not in women. The test for IDI showed that model of FRAX® (adjusted aBMD and TBS) brought significant improvement of average sensitivity with 0.002 in men on the MOFs prediction. Using specific intervention thresholds, the overall NRI was significantly increased in men, that the TBS adjusted FRAX® could bring about 5% overall correct reclassification for MOFs prediction than FRAX®. The increased correct MOFs risk classifications were not significant in older women.

Conclusions
TBS adjusted FRAX® may contribute to a more accurate prediction of fracture risk in older Chinese men, particularly
when specific risk thresholds are used.
Acceptance Date23/08/2016
All Author(s) ListYi Su, Jason Leung, Didier Hans, Olivier Lamy, Timothy Kwok
Name of ConferenceIOF Regionals – 6th Asia-Pacific Osteoporosis Meetin
Start Date of Conference04/11/2016
End Date of Conference06/11/2016
Place of ConferenceSingapore
Country/Region of ConferenceSingapore
Proceedings TitleOsteoporosis International
Year2016
Month11
Volume Number27
Issue NumberSuppl 3
PublisherSpringer
Pages699 - 708
ISSN0937-941X
eISSN1433-2965
LanguagesEnglish-United Kingdom

Last updated on 2020-19-09 at 03:25