Available online 10 April 2024, 101494

Author links open overlay panel, , , , ABSTRACTPurpose

Osteoporosis is a pressing public health concern among older adults, contributing to substantial mortality and morbidity rates. Low- to middle-income countries (LMICs) often grapple with limited access to dual-energy X-ray absorptiometry (DXA), the gold standard for early osteoporosis detection. This study aims to assess the performance of the FRAX® score as a population-wide screening tool for predicting osteoporosis risk, rather than fracture, in individuals aged 50 and above within an LMIC context.

Methods

This retrospective cohort study (n=864) assessed the performance of the FRAX® score for predicting osteoporosis risk using comparative c-statistics from Receiver Operating Characteristic (ROC) curves. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated, with p-values <0.05 indicating statistically significant.

Results

The 10-year FRAX® probability for hip fracture, calculated without bone mass density (BMD), exhibited significantly superior performance compared to the 10-year FRAX® probability for major fracture in predicting osteoporosis risk (AUROC: 0.71 versus 0.67, p<0.001). Within 2 to 10 years of follow-up, the 10-year FRAX® probability for hip fracture showed both greater predictive performance and net benefit in the decision curve compared to the FRAX® 10-year probability for major fracture. A newly established cutoff of 1.9% yielded a negative predictive value of 92.9% (95%CI: 90.4-94.8%) for the 10-year FRAX® probability for hip fracture.

Conclusion

The 10-year FRAX® probability for hip fracture estimated without BMD emerges as an effective 10-year screening tool for identifying osteoporosis risk in aged 50 and older, especially when confronted with limited access to DXA scans in LMICs.

MINI ABSTRACT: The Fracture Risk Assessment Tool score performance as an osteoporosis screening tool was assessed in areas with limited dual-energy X-ray access. The hip fracture probability showed better performance than major fracture probability within 2 to 10 years. The tool emerges as effective for screening osteoporosis risk in individuals over 50.

Section snippetsINTRODUCTION

The global demographic shift – driven by rising life expectancies and declining birth rates – has led to a 1.5-fold increase in individuals aged 65 years or older between 1990 and 20191. This age group now constitutes 9% of the world's population1 and it is expected to rise to 17% in the next three decades, encompassing an older population of about 1.5 billion worldwide. However, the pace of this demographic shift varies among nations, with some experiencing a more rapid escalation than others.

Study design and participants

This single-center retrospective cohort sub-study was conducted to evaluate the FRAX® score's utility in predicting osteoporosis in Brazilians aged 50 years or older. Participant were selected based on eligibility criteria between February 2010 and July 2021 at the Military Hospital in Brasília, Brazil, as outlined elsewhere14. The study's primary endpoint was osteoporosis, as defined by the WHO criteria15.

Eight-hundred sixty-four participants were identified based on the inclusion/exclusion

Study Population

A cohort of 864 individuals aged 50 years or older who underwent DXA testing was established according to eligibility criteria. Individuals were stratified into two subgroups based on osteoporosis presence, with detailed clinical and biochemical characteristics in Table 1.

Over an average follow-up of 3.7 ± 3.4 years, 135 individuals (15.6%) met the WHO criterion for osteoporosis. Individuals with osteoporosis were older, more often male, had significantly lower BMI and creatinine clearance,

DISCUSSION

To the best of our knowledge, this study is a pioneering exploration of using the FRAX® score as a screening tool for osteoporosis risk among Brazilians aged 50 years or older. While dual energy X-ray absorptiometry (DXA) scan remains the gold standard for diagnosing osteoporosis10, resource constraints in low- and middle-income countries (LMIC), like Brazil, pose challenges. Hence, our research aimed to assess the FRAX® score's potential for predicting osteoporosis risk and improving screening

AUTHOR CONTRIBUTIONS

Conceptualization and Design: A.M.C.S.

Data collection: A.D.S.; S.C.L.R.

Data analysis: A.D.S.; A.M.C.S.

Writing: A.D.S; A.M.C.S.

Critical review: O.S.N.; L.S.F.C.

USE OF ARTIFICIAL INTELLIGENCE STATEMENT

During the preparation of this work the authors used Claude.ai to improve clarity, coherence, and readability of the manuscript. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

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© 2024 The International Society for Clinical Densitometry. Published by Elsevier Inc.