Limits...
The discriminative ability of FRAX, the WHO algorithm, to identify women with prevalent asymptomatic vertebral fractures: a cross-sectional study.

El Maghraoui A, Sadni S, Jbili N, Rezqi A, Mounach A, Ghozlani I - BMC Musculoskelet Disord (2014)

Bottom Line: The group of women with VFs had a statistically significant higher FRAX scores for major and hip fractures with and without BMD, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF.The AUC ROC of lumbar spine T-score and femoral neck T-score were 0.660 (CI 95%; 0.611-0.708) and 0.707 (CI 95%; 0.664-0.751) respectively.In asymptomatic post-menopausal women, the FRAX risk for major fracture without BMD had a better discriminative capacity in identifying the women with prevalent VFs than lumbar spine and femoral neck T-scores suggesting its usefulness in identifying women in whom VFA could be indicated.

View Article: PubMed Central - PubMed

Affiliation: Rheumatology department, Military Hospital Mohammed V, PO Box: 1018, Rabat, Morocco. aelmaghraoui@gmail.com.

ABSTRACT

Background: A Moroccan model for the FRAX tool to determine the absolute risk of osteoporotic fracture at 10 years has been established recently. The study aimed to assess the discriminative capacity of FRAX in identifying women with prevalent asymptomatic vertebral fractures (VFs).

Methods: We enrolled in this cross-sectional study 908 post-menopausal women with a mean age of 60.9 years ± 7.7 (50 to 91) with no prior known diagnosis of osteoporosis. Subjects were recruited from asymptomatic women selected from the general population. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genantsemiquantitative (SQ) approach and morphometry. We calculated the absolute risk of major fracture and hip fracture with and without bone mineral density (BMD)using the FRAX website.The overall discriminative value of the different risk scores was assessed by calculating the areas under the ROC curve (AUC).

Results: VFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF. The group of women with VFs had a statistically significant higher FRAX scores for major and hip fractures with and without BMD, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF. The AUC ROC of FRAX for major fracture without BMD was 0.757 (CI 95%; 0.718-0.797) and 0.736 (CI 95%; 0.695-0.777) with BMD, being 0.756 (CI 95%; 0.716-0.796) and 0.747 (CI 95%; 0.709-0.785), respectively for FRAX hip fracture without and with BMD. The AUC ROC of lumbar spine T-score and femoral neck T-score were 0.660 (CI 95%; 0.611-0.708) and 0.707 (CI 95%; 0.664-0.751) respectively.

Conclusion: In asymptomatic post-menopausal women, the FRAX risk for major fracture without BMD had a better discriminative capacity in identifying the women with prevalent VFs than lumbar spine and femoral neck T-scores suggesting its usefulness in identifying women in whom VFA could be indicated.

Show MeSH

Related in: MedlinePlus

Receiver Operating Characteristic (ROC) curves for prediction of vertebral fractures using FRAX tools and T-scores. *MF: major fracture; HF: hip fracture, LS: lumbar spine; FN: femoral neck.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4226884&req=5

Fig1: Receiver Operating Characteristic (ROC) curves for prediction of vertebral fractures using FRAX tools and T-scores. *MF: major fracture; HF: hip fracture, LS: lumbar spine; FN: femoral neck.

Mentions: The AUCs are reported in Table 2 and depicted in Figure 1. A model with no utility in predicting fracture would have an AUC of 0.50 (i.e., no better than flipping a coin or chance alone); AUC was greater than 0.50 for all models. The highest AUC was observed for FRAX risk without BMD which was significantly higher than the AUC for lumbar spine (p = 0.0005) and femoral neck (p = 0.048) T-scores. Analysis did not show significant improvement when parity was added to FRAX risk with or without BMD. None of our subjects had a FRAX risk with or without BMD ≥20%.Table 2


The discriminative ability of FRAX, the WHO algorithm, to identify women with prevalent asymptomatic vertebral fractures: a cross-sectional study.

El Maghraoui A, Sadni S, Jbili N, Rezqi A, Mounach A, Ghozlani I - BMC Musculoskelet Disord (2014)

Receiver Operating Characteristic (ROC) curves for prediction of vertebral fractures using FRAX tools and T-scores. *MF: major fracture; HF: hip fracture, LS: lumbar spine; FN: femoral neck.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4226884&req=5

Fig1: Receiver Operating Characteristic (ROC) curves for prediction of vertebral fractures using FRAX tools and T-scores. *MF: major fracture; HF: hip fracture, LS: lumbar spine; FN: femoral neck.
Mentions: The AUCs are reported in Table 2 and depicted in Figure 1. A model with no utility in predicting fracture would have an AUC of 0.50 (i.e., no better than flipping a coin or chance alone); AUC was greater than 0.50 for all models. The highest AUC was observed for FRAX risk without BMD which was significantly higher than the AUC for lumbar spine (p = 0.0005) and femoral neck (p = 0.048) T-scores. Analysis did not show significant improvement when parity was added to FRAX risk with or without BMD. None of our subjects had a FRAX risk with or without BMD ≥20%.Table 2

Bottom Line: The group of women with VFs had a statistically significant higher FRAX scores for major and hip fractures with and without BMD, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF.The AUC ROC of lumbar spine T-score and femoral neck T-score were 0.660 (CI 95%; 0.611-0.708) and 0.707 (CI 95%; 0.664-0.751) respectively.In asymptomatic post-menopausal women, the FRAX risk for major fracture without BMD had a better discriminative capacity in identifying the women with prevalent VFs than lumbar spine and femoral neck T-scores suggesting its usefulness in identifying women in whom VFA could be indicated.

View Article: PubMed Central - PubMed

Affiliation: Rheumatology department, Military Hospital Mohammed V, PO Box: 1018, Rabat, Morocco. aelmaghraoui@gmail.com.

ABSTRACT

Background: A Moroccan model for the FRAX tool to determine the absolute risk of osteoporotic fracture at 10 years has been established recently. The study aimed to assess the discriminative capacity of FRAX in identifying women with prevalent asymptomatic vertebral fractures (VFs).

Methods: We enrolled in this cross-sectional study 908 post-menopausal women with a mean age of 60.9 years ± 7.7 (50 to 91) with no prior known diagnosis of osteoporosis. Subjects were recruited from asymptomatic women selected from the general population. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genantsemiquantitative (SQ) approach and morphometry. We calculated the absolute risk of major fracture and hip fracture with and without bone mineral density (BMD)using the FRAX website.The overall discriminative value of the different risk scores was assessed by calculating the areas under the ROC curve (AUC).

Results: VFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF. The group of women with VFs had a statistically significant higher FRAX scores for major and hip fractures with and without BMD, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF. The AUC ROC of FRAX for major fracture without BMD was 0.757 (CI 95%; 0.718-0.797) and 0.736 (CI 95%; 0.695-0.777) with BMD, being 0.756 (CI 95%; 0.716-0.796) and 0.747 (CI 95%; 0.709-0.785), respectively for FRAX hip fracture without and with BMD. The AUC ROC of lumbar spine T-score and femoral neck T-score were 0.660 (CI 95%; 0.611-0.708) and 0.707 (CI 95%; 0.664-0.751) respectively.

Conclusion: In asymptomatic post-menopausal women, the FRAX risk for major fracture without BMD had a better discriminative capacity in identifying the women with prevalent VFs than lumbar spine and femoral neck T-scores suggesting its usefulness in identifying women in whom VFA could be indicated.

Show MeSH
Related in: MedlinePlus