Summary

We evaluated the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients with a recent low trauma fracture other than hip or vertebral. The concordance, sensitivity, and specificity were 75.6%, 67.3%, and 78.2%, respectively. FRAX without BMD can be used after a fracture to expedite treatment.

Introduction

The objective of this study was to evaluate the performance of the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients who recently sustained a low trauma fracture other than hip or vertebral.

Methods

We utilized a clinical database established by the Fracture Liaison Service at the Durham Veterans Affairs Medical Center to identify male and female Veterans age ≥ 50 years who sustained a low trauma non-hip/non-vertebral fracture and underwent dual-energy x-ray absorptiometry (DXA) between October 2013 and April 2018. FRAX without BMD (FRAX-BMI) and FRAX with BMD (FRAX-BMD) were calculated for the 229 patients identified, and whether or not they met the National Osteoporosis Foundation (NOF) guideline treatment thresholds was compared.

Results

There were 55 (24.0%) patients that met criteria for treatment based on NOF guideline established FRAX-BMD thresholds including 27 (11.8%) patients with osteoporosis by DXA. The concordance of FRAX-BMI in predicting treatment recommendations was 75.6% with a sensitivity of 67.3% and a specificity of 78.2%. The area under the curve (AUC) of FRAX-BMI hip fracture risk was 0.79. Assessment/treatment thresholds for hip fracture risk of 1% < FRAX-BMI < 4% were proposed to maximize sensitivity and specificity.

Conclusion

Among patients who sustained a low trauma non-hip/non-vertebral fracture, FRAX-BMI can be used to stratify risk and identify high-risk patients who could be treated without DXA, low-risk patients who may not need treatment, and intermediate-risk patients to undergo DXA testing.

中文翻译：

---

FRAX without BMD 可用于对最近遭受低创伤非椎体/非髋部骨折的退伍军人进行风险分层。

概括

我们评估了没有骨矿物质密度 (BMD) 的骨折风险评估工具 (FRAX) 在预测近期除髋关节或椎骨以外的低创伤骨折患者的治疗建议方面。一致性、敏感性和特异性分别为 75.6%、67.3% 和 78.2%。骨折后可使用不含 BMD 的 FRAX 以加快治疗。

介绍

本研究的目的是评估没有骨矿物质密度 (BMD) 的骨折风险评估工具 (FRAX) 在预测最近发生髋部或椎骨以外的低创伤性骨折的患者的治疗建议方面的性能。

方法

我们利用达勒姆退伍军人事务医疗中心骨折联络处建立的临床数据库来确定年龄 ≥ 50 岁的男性和女性退伍军人，他们遭受低创伤非髋/非椎骨骨折并接受了双能 X 射线吸收测定法(DXA) 2013 年 10 月至 2018 年 4 月。计算了 229 名确定的患者的无 BMD 的 FRAX (FRAX-BMI) 和有 BMD 的 FRAX (FRAX-BMD)，以及他们是否符合国家骨质疏松症基金会 (NOF) 的指导治疗阈值进行了比较。

结果

根据 NOF 指南建立的 FRAX-BMD 阈值，有 55 名 (24.0%) 患者符合治疗标准，其中 27 名 (11.8%) 患者经 DXA 诊断为骨质疏松症。FRAX-BMI 在预测治疗建议方面的一致性为 75.6%，敏感性为 67.3%，特异性为 78.2%。FRAX-BMI髋部骨折风险曲线下面积（AUC）为0.79。建议将髋部骨折风险的评估/治疗阈值设为 1%  <  FRAX-BMI < 4%，以最大限度地提高敏感性和特异性。

结论

在遭受低创伤非髋/非椎体骨折的患者中，FRAX-BMI 可用于对风险进行分层，并确定无需 DXA 即可治疗的高风险患者、可能不需要治疗的低风险患者和中等风险患者。 -风险患者接受 DXA 测试。