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Possible FRAX-based intervention thresholds for a cohort of Chinese postmenopausal women

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Abstract

Summary

A total of 2,266 postmenopausal Chinese women were followed for 4.5 years to determine the incidence of new fractures. The positive predictive value, negative predictive value, sensitivity and specificity of different treatment strategies were compared. Using a fixed optimal threshold calculated from receiver operating characteristics (ROC) curve had the highest sensitivity but lowest specificity.

Introduction

There is no specific intervention threshold based on FRAX to guide treatment for Asian populations. This prospective study sought to determine the impact of applying different intervention thresholds to a cohort of Chinese postmenopausal women.

Methods

This study was part of the Hong Kong Osteoporosis Study. A total of 2,266 treatment-naïve postmenopausal women underwent clinical risk factor and BMD assessments. The subjects were followed to assess fractures. We calculated the FRAX probability of major osteoporotic fractures corresponding to women with prior fractures but no other clinical risk factors. Different treatment strategies which include treating women with prior fractures, women with age-specific FRAX probability corresponding to those with prior fractures, women with osteoporosis as well as women with FRAX probability above a fixed cut-off based on optimizing sensitivity and specificity on the ROC curve were compared.

Results

The mean age at baseline was 62.1 ± 8.5 years, and the mean follow-up time was 4.5 ± 2.8 years. One hundred six new major osteoporotic fractures were reported. An optimal (FRAX, with BMD) cut-off point of 9.95 % was identified. All strategies had negative predictive value of >90 %. Using a fixed cut-off had the highest sensitivity (62.3 %) but lowest specificity (73.5 %) and positive predictive value (10.3 %). Using a fixed cut-off would direct treatment from younger women with lower absolute risk to elderly women with higher absolute risk.

Conclusion

Targeting only women with prior fractures is unlikely to reduce fracture burden. Other treatment strategies with higher sensitivity need to be considered but they have different shortcomings

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Acknowledgments

We would like to acknowledge the staff of the Osteoporosis Centre, Queen Mary Hospital, and the Osteoporosis and Endocrine Research Fund, University of Hong Kong. We would also like to thank Xiao SM for statistical support.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Medicine, United Christian Hospital, Hong Kong, China

    E. Cheung

  2. Department of Medicine, The University of Hong Kong, Hong Kong, China

    C.-L. Cheung, A. W. C. Kung & K. C. B. Tan

  3. Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China

    E. Cheung

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  1. E. Cheung
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  2. C.-L. Cheung
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  3. A. W. C. Kung
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  4. K. C. B. Tan
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Correspondence to E. Cheung.

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Cheung, E., Cheung, CL., Kung, A.W.C. et al. Possible FRAX-based intervention thresholds for a cohort of Chinese postmenopausal women. Osteoporos Int 25, 1017–1023 (2014). https://doi.org/10.1007/s00198-013-2553-9

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  • DOI: https://doi.org/10.1007/s00198-013-2553-9

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