Introduction

Osteoporosis and the associated fractures are a major global health burden for patients, their social network and societies. Access to quality risk assessment, diagnosis and treatment is heterogeneous and inadequate around the globe. Many algorithms have been developed for deciding who to test, assessing fracture risk, when to intervene, and how to monitor the effects of interventions. FRAX® has become the dominant fracture risk assessment tool worldwide which estimates the average 10 year risk of major osteoporotic fracture risk and hip fracture, and is recommended by our global partners: ISCD and IOF. A particular attraction of the FRAX® algorithm is that on-line calculations can be made with or without DXA testing, which is particularly attractive when access to DXA is limited or non-existent. In our centre public waiting times for non-urgent DXA are up to 10 years, so reducing unnecessary testing is a laudable and overarching service goal. A recent Japanese study comparing 4 FRAX calculation tools suggested little difference exists. However in our unit we have noticed at times very different results when using the Ireland embedded DXA-FRAX® tool to the Web-FRAX® Ireland tool.

Objectives

1) To Compare DXA-FRAX® to Web-FRAX® 10-year estimates for MOF and HF. 2) To Compare Web-FRAX® 10-year estimates for MOF and HF with and without DXA-measured T-scores.

Methods

We used a sub-group of the DXA-HIP Cohort as previously published to gain initial insights into DXA-FRAX® to Web-FRAX® as part of a larger calibration and validation project, which has been approved by our hospitals Ethics and Research Committee. All scans are performed and reported by staff trained to ISCD standards and recommendations. At the time of reporting DXA-FRAX® scores are calculated as part of the analysis as recommended by ISCD and IOF, and more recently Web-FRAX® for Ireland has been calculated and stored with and without BMD data. All data are cleaned, merged, anonymized and stored for analysis. Summary cross-sectional data, and comparison of differences were completed using absolute and relative scales, and Bland-Altman Plots for agreement between measures. Weights were reduced to 125kg for the on-line tool and age to 90 years when values exceeded these thresholds.

Results

Data on 588 adults aged ≥40 years were available of whom 108 (18%) were men. Mean age was 67 years, BMI: 28kg/m2, 249 had a prior fracture, 64 a parental hip fracture, 40 smokers, 42 taking glucocorticoid therapy, 39 had rheumatoid arthritis, 5 were excess alcohol users while 107 had other FRAX®-listed secondary causes of osteoporosis. Mean WF femoral neck BMD T-score was -1.4. Mean MOF DXA-FRAX® was 15.3 (SD:11.1) compared to 12.6 (SD:8.5) for Web-FRAX®, while HF means were 6.7 (SD:8.4) Vs 3.8 (SD:5.5) respectively. Bland-Altman plots showed there was much greater discrepancy for men, and those with higher risk estimates. Comparisons between DXA-FRAX® and Web-FRAX® revealed similar results.

Conclusions

Significant differences exist in results of DXA-FRAX® and Web-FRAX® for Ireland, particularly for men and those with higher risk estimates so these results should be interpreted cautiously. Reassuringly results were similar for those deemed at lower risk and for women.

中文翻译：

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DXA FRAX® 可能与 Web FRAX® 存在显着差异

介绍

骨质疏松症和相关骨折是患者、他们的社交网络和社会的主要全球健康负担。在全球范围内，获得质量风险评估、诊断和治疗的机会不一且不充分。已经开发了许多算法来决定对谁进行测试、评估骨折风险、何时进行干预以及如何监测干预的效果。FRAX® 已成为全球主要的骨折风险评估工具，可估计主要骨质疏松性骨折风险和髋部骨折的平均 10 年风险，并得到我们全球合作伙伴的推荐：ISCD 和 IOF。FRAX® 算法的一个特别吸引人的地方在于，可以使用或不使用 DXA 测试进行在线计算，这在 DXA 访问受限或不存在时特别有吸引力。在我们中心，非紧急 DXA 的公众等待时间长达 10 年，因此减少不必要的测试是值得称赞的首要服务目标。日本最近一项比较 4 种 FRAX 计算工具的研究表明，几乎没有差异。然而，在我们的单元中，我们有时注意到使用 Ireland 嵌入式 DXA-FRAX® 工具与 Web-FRAX® Ireland 工具时的结果非常不同。

目标

1) 比较 DXA-FRAX® 与 Web-FRAX® 对 MOF 和 HF 的 10 年估计。2) 比较使用和不使用 DXA 测量的 T 分数的 MOF 和 HF 的 Web-FRAX® 10 年估计值。

方法

我们使用先前发布的 DXA-HIP 队列的一个子组来初步了解 DXA-FRAX® 到 Web-FRAX® 作为更大校准和验证项目的一部分，该项目已获得我们医院伦理和研究委员会的批准. 所有扫描均由受过 ISCD 标准和建议培训的工作人员执行和报告。在报告时，DXA-FRAX® 分数是作为 ISCD 和 IOF 推荐的分析的一部分计算的，最近，爱尔兰的 Web-FRAX® 已经计算并存储了有和没有 BMD 数据的数据。所有数据都经过清理、合并、匿名化和存储以供分析。使用绝对和相对量表和 Bland-Altman 图完成了汇总横截面数据和差异比较，以确保测量值之间的一致性。

结果

提供了 588 名 ≥ 40 岁的成年人的数据，其中 108 名 (18%) 是男性。平均年龄为 67 岁，BMI：28 公斤/平方米，249 人有骨折史，64 人父母髋部骨折，40 人吸烟，42 人接受糖皮质激素治疗，39 人患有类风湿性关节炎，5 人过度饮酒，而 107 人患有其他 FRAX® 上市骨质疏松症的次要原因。平均 WF 股骨颈 BMD T 评分为 -1.4。与 Web-FRAX® 的 12.6 (SD:8.5) 相比，平均 MOF DXA-FRAX® 为 15.3 (SD:11.1)，而 HF 平均值分别为 6.7 (SD:8.4) 和 3.8 (SD:5.5)。Bland-Altman 图显示，男性和风险估计较高的人之间的差异要大得多。DXA-FRAX® 和 Web-FRAX® 之间的比较显示了类似的结果。

结论

爱尔兰的 DXA-FRAX® 和 Web-FRAX® 的结果存在显着差异，特别是对于男性和风险估计较高的人，因此应谨慎解释这些结果。令人欣慰的是，那些被认为风险较低的人和女性的结果相似。