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Jha D, Chandran M, Hong N, Rhee Y, Baek S, Ferguson SJ, Helgason B, Praveen AD. Discriminatory Accuracy of Fracture Risk Assessment Tool in Asian Populations: A Systematic Review and Meta-Analysis. J Bone Metab 2024; 31:296-315. [PMID: 39701109 DOI: 10.11005/jbm.24.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 09/17/2024] [Indexed: 12/21/2024] Open
Abstract
BACKGROUND This review explores the discriminative ability of fracture risk assessment tool (FRAX) in major osteoporotic fracture (MOF) and hip fracture (HF) risk prediction and the densitometric diagnosis of osteoporosis in Asian populations. METHODS We systematically searched the EMBASE, Cochrane, and PubMed databases from the earliest indexing date to January 2024. Studies were included if FRAX was used to identify future osteoporotic fractures or a densitometric diagnosis of osteoporosis in an Asian population and reported the area under the curve (AUC) values. Meta-analyses were conducted after quality assessment for AUC with 95% confidence intervals across the following categories: standard FRAX without/with bone mineral density (BMD), adjusted FRAX, and BMD alone for fracture prediction, as well as standard FRAX for densitometric diagnosis of osteoporosis. RESULTS A total of 42 studies were included. The AUC values for predicting fracture risk using FRAX-MOF with BMD (0.73 [0.70-0.77]) was highest compared to FRAX-MOF without BMD (0.72 [0.66-0.77]), and adjusted FRAX-MOF (0.71 [0.65-0.77]). The AUC values for predicting fracture risk using FRAX-HF with BMD (0.77 [0.71-0.83]) was highest compared to FRAX-HF without BMD (0.72 [0.65-0.80]), and adjusted FRAX-HF (0.75 [0.63-0.86]). The AUC values for BMD alone (0.68 [0.62-0.73]) was lowest for fracture prediction. The AUC values for identifying a densitometric diagnosis of osteoporosis was 0.77 [0.70-0.84] and 0.76 [0.67-0.86] using FRAX-MOF and FRAX-HF, respectively. CONCLUSIONS FRAX with BMD tends to perform more reliably in predicting HF compared to MOF in Asia. However, its accuracy in predicting fracture risk in Asian populations can be improved through region-specific, long-term epidemiological data.
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Affiliation(s)
- Dheeraj Jha
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Institute for Biomechanics, ETH-Zürich, Zürich, Switzerland
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seungjin Baek
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Stephen J Ferguson
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Institute for Biomechanics, ETH-Zürich, Zürich, Switzerland
| | - Benedikt Helgason
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Institute for Biomechanics, ETH-Zürich, Zürich, Switzerland
| | - Anitha D Praveen
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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Yue C, Li YF, Xu LL, Wang QY, Yang YY, Sheng ZF. Develop a bone mineral density T-score distribution nomograms based on osteoporosis risk factors for middle-aged and older adults. Geriatr Nurs 2024; 58:344-351. [PMID: 38875761 DOI: 10.1016/j.gerinurse.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE This study aimed to understand how age, health status, and lifestyle impact bone mineral density (BMD) in middle-aged and older adults, focusing on predicting osteoporosis risk. METHODS This study included 2836 participants aged 50-88 from the Health Improvement Program of Bone (HOPE) conducted from 2021 to 2023. We used logistic regression to make a prediction tool. Then checked its accuracy and reliability using receiver operating characteristic (ROC) and calibration curves. RESULTS Factors like age, body weight, prior fractures, and smoking were independently found to affect BMD T-score distribution in men. In women, age and body weight were identified as independent factors influencing BMD T-score distribution. A nomogram was created to visually illustrate these predictive relationships. CONCLUSIONS The nomogram proved highly accurate in identifying men aged 50 and above and postmenopausal women based on their BMD T-score distribution, improving clinical decision-making and patient care in osteoporosis evaluation and treatment.
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Affiliation(s)
- Chun Yue
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yong-Fang Li
- Department of Metabolism and Endocrinology, Zhuzhou Hospital of Xiangya School of Medicine,Central South University, Zhuzhou, Hunan, China
| | - Lu-Lu Xu
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qin-Yi Wang
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yan-Yi Yang
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhi-Feng Sheng
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Sucharitpongpan W. The optimal cut-off values of FRAX without BMD for predicting osteoporosis fracture risk in the older adults at Nan, Thailand. Osteoporos Sarcopenia 2024; 10:11-15. [PMID: 38690544 PMCID: PMC11056322 DOI: 10.1016/j.afos.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/21/2023] [Accepted: 12/31/2023] [Indexed: 05/02/2024] Open
Abstract
Objectives The World Health Organization developed the Fracture Risk Assessment Tool (FRAX) to assess the risk of having fragility fractures in the next 10 years. The FRAX tool is different by country, race, gender, and age. This study is a community-based study aiming to identify the optimal cut-off values of FRAX for the identification of older individuals who are at high risk of osteoporosis fractures in both genders. Methods This cross-sectional, analytic study was conducted by using health screening data of the older adults aged 60-90 living in the 3 biggest districts of Nan province, Thailand. Validity and optimal FRAX major osteoporotic fracture (MOF) and hip fracture (HF) cut-off values in both genders were determined. Results Of 36,042 older adults included in the study, 1624 older people had a history of fragility fractures. Older females were 3.2 and 2.5 times more likely to have fragility fractures and hip fractures than males, respectively. The optimal cut-off values of FRAX MOF for predicting fragility fractures were 3.0% for males and 6.3% for females. The optimal cut-off values of FRAX HF for predicting hip fractures were 1.1% for males and 3.3% for females. Conclusions A simple screening tool like the FRAX which is available in the annual health screening activities has the potential to be used to predict the risk of developing fragility fractures in rural areas of Thailand. Different cut-off values should be used in females and males because the risk of MOF and HF of both genders is significantly different.
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Luo C, Liu R, Shen X, Zhang G, Liu B. Possible sarcopenia and risk of hip fracture in older adults in China. Arch Gerontol Geriatr 2024; 117:105248. [PMID: 37897854 DOI: 10.1016/j.archger.2023.105248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The Asian Working Group for Sarcopenia (AWGS) introduced the concept of "possible sarcopenia" in 2019. However, the association between possible sarcopenia and hip fracture is not well characterized. Hence, we conducted a study to explore this association in older Chinese adults. METHODS This was a population-based cohort study based on nationally representative data from the China Health and Retirement Longitudinal Study. Individuals aged ≥60 years with no history of hip fracture at baseline (2011-2012) were included and followed up until September 2018. Possible sarcopenia was defined based on the AWGS 2019 criteria during the study period, and the occurrence of hip fractures was monitored. The association between possible sarcopenia and hip fractures was assessed using Cox proportional hazards regression models. RESULTS A total of 4,011 participants were included, of whom 44.8 % had possible sarcopenia. During the 7-year follow-up, 197 individuals experienced hip fractures. Individuals with possible sarcopenia had a significantly higher risk of hip fractures than those without possible sarcopenia (hazard ratio: 2.00, 95 % confidence interval: 1.46-2.75; P < 0.001). The association was consistently observed across various subgroups based on age, sex, and overweight status. CONCLUSIONS This study identified possible sarcopenia as a significant risk factor for hip fractures in older Chinese adults. These findings underscore the importance of addressing possible sarcopenia as a preventive measure to reduce the incidence of hip fractures.
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Affiliation(s)
- Chun Luo
- Department of Endocrinology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Ruiyan Liu
- Wenzhou Medical University Renji College, Wenzhou, China
| | - XiaoYing Shen
- Department of Endocrinology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Guangwu Zhang
- Department of Endocrinology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Bingyang Liu
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.
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Adami G, Biffi A, Porcu G, Ronco R, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Tarantino U, Brandi ML, Corrao G, Rossini M, Michieli R. A systematic review on the performance of fracture risk assessment tools: FRAX, DeFRA, FRA-HS. J Endocrinol Invest 2023; 46:2287-2297. [PMID: 37031450 PMCID: PMC10558377 DOI: 10.1007/s40618-023-02082-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Preventing fragility fractures by treating osteoporosis may reduce disability and mortality worldwide. Algorithms combining clinical risk factors with bone mineral density have been developed to better estimate fracture risk and possible treatment thresholds. This systematic review supported panel members of the Italian Fragility Fracture Guidelines in recommending the use of best-performant tool. The clinical performance of the three most used fracture risk assessment tools (DeFRA, FRAX, and FRA-HS) was assessed in at-risk patients. METHODS PubMed, Embase, and Cochrane Library were searched till December 2020 for studies investigating risk assessment tools for predicting major osteoporotic or hip fractures in patients with osteoporosis or fragility fractures. Sensitivity (Sn), specificity (Sp), and areas under the curve (AUCs) were evaluated for all tools at different thresholds. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2; certainty of evidence (CoE) was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Forty-three articles were considered (40, 1, and 2 for FRAX, FRA-HS, and DeFRA, respectively), with the CoE ranging from very low to high quality. A reduction of Sn and increase of Sp for major osteoporotic fractures were observed among women and the entire population with cut-off augmentation. No significant differences were found on comparing FRAX to DeFRA in women (AUC 59-88% vs. 74%) and diabetics (AUC 73% vs. 89%). FRAX demonstrated non-significantly better discriminatory power than FRA-HS among men. CONCLUSION The task force formulated appropriate recommendations on the use of any fracture risk assessment tools in patients with or at risk of fragility fractures, since no statistically significant differences emerged across different prediction tools.
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Affiliation(s)
- G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | - L Cianferotti
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy.
| | - S Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- Coordinamento Nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, CnAMC, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M L Brandi
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
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Corrao G, Biffi A, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML. Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021. Front Endocrinol (Lausanne) 2023; 14:1137671. [PMID: 37143730 PMCID: PMC10151776 DOI: 10.3389/fendo.2023.1137671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field. Purpose This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline. Methods The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations. Results Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively. Conclusions The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Luisella Cianferotti
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | - Raffaella Michieli
- Italian Society of General Medicine and Primary Care Società Italiana di Medicina Generale e delle cure primarie (SIMG), Florence, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | | | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | - Maria Luisa Brandi
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
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Li YF, Wang QY, Xu LL, Yue C, Hu L, Ding N, Yang YY, Qu XL, Sheng ZF. Development of a Nomogram for Predicting Very Low Bone Mineral Density (T-Scores. Int J Gen Med 2022; 15:1121-1130. [PMID: 35153504 PMCID: PMC8824232 DOI: 10.2147/ijgm.s348947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yong-Fang Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Qin-Yi Wang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Lu-Lu Xu
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Chun Yue
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Li Hu
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Na Ding
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Yan-Yi Yang
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Xiao-Li Qu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- Correspondence: Zhi-Feng Sheng, Tel +86-13574806523, Email
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Guo S, An N, Lin J, Fan Z, Meng H, Yang Y, Fei Q. Comparison of four tools to identify painful new osteoporotic vertebral fractures in the postmenopausal population in Beijing. Front Endocrinol (Lausanne) 2022; 13:1013755. [PMID: 36425464 PMCID: PMC9679524 DOI: 10.3389/fendo.2022.1013755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To validate and compare four tools, the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD), Beijing Friendship Hospital Osteoporosis Screening Tool (BFH-OST), Osteoporosis Self-Assessment Tool for Asians (OSTA), and BMD, to identify painful new osteoporotic vertebral fractures (PNOVFs). METHODS A total of 2874 postmenopausal women treated from June 2013 to June 2022 were enrolled and divided into two groups: patients with PNOVFs who underwent percutaneous vertebroplasty (PNOVFs group, n = 644) and community-enrolled females (control group, n = 2230). Magnetic resonance and X-ray imaging were used to confirm the presence of PNOVFs. Dual-energy X-ray absorptiometry was performed to calculate the BMD T-scores. Osteoporosis was diagnosed according to WHO Health Organization criteria. Data on the clinical and demographic risk factors were self-reported using a questionnaire. The ability to identify PNOVFs using FRAX, BFH-OST, OSTA, and BMD scores was evaluated using receiver operating characteristic (ROC) curves. For this evaluation, we calculated the areas under the ROC curves (AUCs), sensitivity, specificity, and optimal cut-off points. RESULTS There were significant differences in FRAX (without BMD), BFH-OST, OSTA, and BMD T-scores (total hip, femoral neck, and lumbar spine) between the PNOVFs and control groups. Compared with BFH-OST, OSTA, and BMD, the FRAX score had the best identifying value for PNOVFs; the AUC of the FRAX score (optimal cutoff =3.6%) was 0.825, while the sensitivity and specificity were 82.92% and 67.09%, respectively. CONCLUSION FRAX may be the preferable tool for identifying PNOVFs in postmenopausal women, while BFH-OST and OSTA can be applied as more simple screening tools for PNOVFs.
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Wen Z, Ding N, Chen R, Liu S, Wang Q, Sheng Z, Liu H. Comparison of methods to improve fracture risk assessment in chinese diabetic postmenopausal women: a case-control study. Endocrine 2021; 73:209-216. [PMID: 33932202 DOI: 10.1007/s12020-021-02724-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/30/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE This study evaluated the predictive power of adjusted FRAX and standard FRAX models based on the actual prevalence of osteoporosis in type 2 diabetic (T2DM) postmenopausal women, and to explore the optimal strategy to better predicted fracture risk in postmenopausal women with diabetes in China. METHODS We recruited 434 patients from community-medical centers, 217 with T2DM and 217 without T2DM (non-T2DM). All participants completed self-reported questionnaires detailing their characteristics and risk factors. Bone mineral density (BMD) and spinal radiographs were evaluated. The China FRAX model calculated all scores. The area under the receiver operator characteristic curve (ROC-AUC) evaluated the sensitivity, specificity, and accuracy for predicting 10-year risk for major (MOF) and hip (OHF) osteoporotic fractures in T2DM patients. RESULTS T2DM patients had higher BMD but lower average FRAX values than non-T2DM patients. The unadjusted FRAX ROC-AUC was 0.774, significantly smaller than that for 0.5-unit femoral neck T-score-adjusted FRAX (0.800; p = 0.004). Rheumatoid arthritis (RA; AUC = 0.810, p = 0.033) and T-score (AUC = 0.816, p = 0.002) adjustments significantly improved fracture prediction in T2DM patients. CONCLUSIONS Femoral neck T-score adjustment might be the preferred method for predicting MOF and OHF in Chinese diabetic postmenopausal women, while RA adjustment only effectively predicted HF risk.
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Affiliation(s)
- Zhangxin Wen
- Health Management Center; National Clinical Research Center for Metabolic Diseases; Department of Metabolism and Endocrinology; Hunan Provincial Key Laboratory for Metabolic Bone Diseases, the Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Department of Metabolism and Endocrinology, the affiliated Zhuzhou Hospital of Xiangya School of Medicine of Central South University, 116 Changjiang South Road, Zhuzhou, 412007, Hunan, China
| | - Na Ding
- Health Management Center; National Clinical Research Center for Metabolic Diseases; Department of Metabolism and Endocrinology; Hunan Provincial Key Laboratory for Metabolic Bone Diseases, the Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Rong Chen
- Health Management Center; National Clinical Research Center for Metabolic Diseases; Department of Metabolism and Endocrinology; Hunan Provincial Key Laboratory for Metabolic Bone Diseases, the Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Department of Metabolism and Endocrinology, the affiliated Zhuzhou Hospital of Xiangya School of Medicine of Central South University, 116 Changjiang South Road, Zhuzhou, 412007, Hunan, China
| | - Shuyin Liu
- Health Management Center; National Clinical Research Center for Metabolic Diseases; Department of Metabolism and Endocrinology; Hunan Provincial Key Laboratory for Metabolic Bone Diseases, the Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Qinyi Wang
- Health Management Center; National Clinical Research Center for Metabolic Diseases; Department of Metabolism and Endocrinology; Hunan Provincial Key Laboratory for Metabolic Bone Diseases, the Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Zhifeng Sheng
- Health Management Center; National Clinical Research Center for Metabolic Diseases; Department of Metabolism and Endocrinology; Hunan Provincial Key Laboratory for Metabolic Bone Diseases, the Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
| | - Hong Liu
- Department of Metabolism and Endocrinology, the affiliated Zhuzhou Hospital of Xiangya School of Medicine of Central South University, 116 Changjiang South Road, Zhuzhou, 412007, Hunan, China.
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An N, Lin JS, Fei Q. Beijing Friendship Hospital Osteoporosis Self-Assessment Tool for Elderly Male (BFH-OSTM) vs Fracture Risk Assessment Tool (FRAX) for identifying painful new osteoporotic vertebral fractures in older Chinese men: a cross-sectional study. BMC Musculoskelet Disord 2021; 22:596. [PMID: 34182964 PMCID: PMC8240203 DOI: 10.1186/s12891-021-04476-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background To compare the validation of four tools for identifying painful new osteoporotic vertebral compression fractures (PNOVCFs) in older Chinese men: bone mineral density (BMD), Asian osteoporosis self-assessment tool (OSTA), World Health Organization fracture risk assessment tool (FRAX) (without BMD) and Beijing Friendship Hospital Osteoporosis Self-Assessment Tool (BFH-OSTM). Methods A cross sectional study was conducted from 2013 to 2019. A total of 846 men aged ≥50 were included and were divided into two groups: Fracture Group (patients with PNOVCFs underwent percutaneous vertebroplasty surgery) and Non-Fracture Group (community dwelled subjects for healthy examination). All subjects accepted a dual-energy X-ray BMD test and a structured questionnaire. The results of BMD, OSTA, FRAX and BFH-OSTM scores were assessed and receiver-operating characteristic (ROC) curves were generated to compare the validity of four tools for identifying PNOVCFs. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. Results There were significant differences including BMD T score (femoral neck, total hip and L1-L4), OSTA, FRAX and BFH-OSTM scores between Fracture group and Non-fracture group. Compared to BMD and OSTA, BFH-OSTM and FRAX had better predictive value, the sensitivity, specificity and AUC value are 0.841, 81.29%, 70.67% and 0.796, 74.85%, 78.52%, respectively. Compared with FRAX, the BFH-OSTM has a better AUC value. Conclusions Both BFH-OSTM and FRAX can be used to identify POVCFs, However, BFH-OSTM model may be a more simple and effective tool to identify the risk of POVCFs in Chinese elderly men.
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Affiliation(s)
- Ning An
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Ji Sheng Lin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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11
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Lv F, Cai X, Zhang R, Zhou L, Zhou X, Han X, Ji L. Sex-specific associations of serum insulin-like growth factor-1 with bone density and risk of fractures in Chinese patients with type 2 diabetes. Osteoporos Int 2021; 32:1165-1173. [PMID: 33415372 DOI: 10.1007/s00198-020-05790-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
UNLABELLED We evaluated the associations of serum insulin-like growth factor-1 (IGF-1) with bone mineral density (BMD) and risk of fractures in Chinese patients with type 2 diabetes (T2D). We found positive associations between IGF-I and BMD and negative associations between IGF-I and all three modified 10-year probabilities of MOFs and HFs in men, but not in women. INTRODUCTION The objective was to investigate the associations of serum insulin-like growth factor-1 (IGF-1) with bone mineral density (BMD) and risk of fractures in Chinese patients with type 2 diabetes (T2D) in each gender. METHODS This was a cross-sectional, retrospective study that included men over 50 years and postmenopausal women with T2D without medical conditions or medications known to significantly affect BMD or serum IGF-I levels. Data of IGF-1, bone metabolism markers, lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD were obtained; 10-year probability of major osteoporotic fractures (MOFs) and hip fractures (HFs) was calculated and modified with rheumatoid arthritis, femoral neck T-score, and age. Correlations of IGF-1 levels with bone metabolism and risk of fractures were statistically analyzed in men and women, respectively. RESULTS A total of 391 patients, including 226 men and 165 women, were included. The age, serum fasting C-peptide, glycosylated hemoglobin (HbA1c), bone formation marker, and all three modified 10-year probabilities of MOFs and HFs were higher in women than those in men (all p < 0.05). The levels of 25 hydroxyvitamin D (25OHD), IGF-1, and BMD were lower in women than those in men (all p < 0.05). In men, IGF-1 was positively correlated with FN and TH BMD (FN BMD: r = 0.267, p < 0.001; TH BMD: r = 0.235, p < 0.001) and negatively correlated with all three modified 10-year probabilities of MOFs (RA-modified MOFs: r = - 0.289, p < 0.001; age-modified MOFs: r = - 0.237, p < 0.001; FN T-score-modified MOFs: r = - 0.280, p < 0.001) and HFs (RA-modified HFs: r = - 0.291, p < 0.001; age-modified HFs: r = - 0.271, p < 0.001; FN T-score-modified HFs: r = - 0.270, p < 0.001), while no significant correlations were found between serum IGF-I and BMD and three modified 10-year probability in women. CONCLUSIONS According to this study, we found sex differences in the associations of serum IGF-1 with BMD and risk of fractures in Chinese patients with T2D. These results suggested that increasing serum IGF-1 might be a clinical target for protecting fractures in T2D, especially in men.
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Affiliation(s)
- F Lv
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xizhimen South Street No. 11, Beijing, China
| | - X Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xizhimen South Street No. 11, Beijing, China.
| | - R Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xizhimen South Street No. 11, Beijing, China
| | - L Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xizhimen South Street No. 11, Beijing, China
| | - X Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xizhimen South Street No. 11, Beijing, China
| | - X Han
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xizhimen South Street No. 11, Beijing, China
| | - L Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xizhimen South Street No. 11, Beijing, China.
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12
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Dai D, Xu F, Sun R, Yuan L, Sheng Z, Xie Z. Decreased lower-extremity muscle performance is associated with decreased hip bone mineral density and increased estimated fracture risk in community-dwelling postmenopausal women. Arch Osteoporos 2020; 15:173. [PMID: 33141362 DOI: 10.1007/s11657-020-00835-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/01/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED The present study demonstrated that the lower-extremity muscle performance in Chinese community-dwelling postmenopausal women with lower bone mineral density (BMD) was positively associated with hip BMD and negatively associated with estimated fracture risk. PURPOSE Postmenopausal women are at high risk for osteoporotic fractures. It has been shown that decreased lower-extremity muscle performance is associated with osteoporotic fractures. However, the relationship between muscle performance and bone mineral density in postmenopausal women is inconsistent in the literature. The present study was to investigate the relationship between lower-extremity muscle performance and BMD or estimated fracture risk in community-dwelling postmenopausal women. METHODS Two hundred forty-seven postmenopausal women aged 50-85 years were recruited in the study. The short physical performance battery (SPPB) tool including the chair stand test (CST), gait speed test (GST), and balance test (BT) was used to determine lower-extremity functioning and the CST, GST, BT, and SPPB total scores were recorded. The BMD of lumbar spine (LSBMD), femoral neck (FNBMD), and total hip (THBMD) were measured by dual-energy X-ray absorptiometry (DXA), and the vertebral fracture was confirmed by lateral spine X-rays radiographs. In addition, patients' 10-year estimated major osteoporotic fracture risk (MOFR) and hip fracture risk (HFR) were assessed by the Fracture Risk Assessment Tool (FRAX). Linear regression analysis was used to analyze the association between muscle performance and BMD. RESULTS The CST, GST, and SPPB total scores were positively associated with LSBMD, THBMD, and FNBMD before adjustment for age, height, and weight. The SPPB total score was positively associated with FNBMD and THBMD, but not with LSBMD after adjustment for age, height, and weight. The BT score was positively associated with FNBMD and THBMD, but not with LSBMD before and after adjustment for age, height, and weight. Moreover, the CST, GST, BT, and SPPB scores were negatively associated with the FRAX score. CONCLUSION The lower-extremity muscle performance in community-dwelling postmenopausal women is positively associated with FNBMD and THBMD and negatively associated with the FRAX score.
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Affiliation(s)
- Dexing Dai
- National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Feng Xu
- National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Ruoman Sun
- National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Lingqing Yuan
- National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Zhifeng Sheng
- National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Zhongjian Xie
- National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China.
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