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Comparison of strategies for setting intervention thresholds for Chinese postmenopausal women using the FRAX model

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Abstract

Purpose

The two main strategies for managing osteoporosis using the Fracture Risk Assessment (FRAX®) are the fixed-probability threshold of the National Osteoporosis Foundation (NOF) and the age-dependent-probability threshold of the National Osteoporosis Guideline Group (NOGG), but there are no FRAX® Chinese-specific thresholds. This study examined the NOF and NOGG strategies for intervention thresholds using the Chinese FRAX® model for their appropriateness for Chinese postmenopausal women, and explored Chinese-specific thresholds.

Methods

Postmenopausal women (N = 264) >50 years old from community-medical centers in China were randomly selected. They completed a self-report questionnaire and underwent bone mineral density measurements and spinal X-rays. The 10-year risks for a major osteoporosis fracture and hip fracture were calculated using the Chinese FRAX® model. Using an osteoporosis diagnosis as the gold standard, we compared the abilities of the NOF and NOGG thresholds to detect osteoporosis by analyzing their sensitivity, specificity, accuracy, and positive and negative likelihood ratios.

Results

The 10-year risks for hip fracture and a major osteoporotic fracture increased with age. The NOF’s accuracy in detecting osteoporosis was 83.33% and the NOGG’s was 74.24%. The NOF thresholds showed higher accuracy and specificity than the NOGG thresholds.

Conclusion

NOF thresholds are more appropriate for Chinese menopausal women.

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Funding

This work was supported by grants from the National Nature Science Foundation of China [grant numbers 81471091 and 81870622] and the Hunan Nature Science Foundation [grant number 2018JJ2574].

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Authors and Affiliations

  1. Department of Metabolism & Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, PR China

    Shu-Ying Liu, Meng Huang, Rong Chen, Na Ding, Zhong-Jian Xie, Zhi-Feng Sheng & Bi-Hua Luo

  2. National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, PR China

    Shu-Ying Liu, Meng Huang, Rong Chen, Na Ding, Zhong-Jian Xie, Zhi-Feng Sheng & Bi-Hua Luo

  3. Institute of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, PR China

    Shu-Ying Liu, Meng Huang, Rong Chen, Na Ding, Zhong-Jian Xie, Zhi-Feng Sheng & Bi-Hua Luo

  4. Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, PR China

    Shu-Ying Liu, Meng Huang, Rong Chen, Na Ding, Zhong-Jian Xie, Zhi-Feng Sheng & Bi-Hua Luo

  5. Department of Metabolism & Endocrinology, Zhuzhou Central Hospital, Central South University, Zhuzhou, 412000, Hunan, PR China

    Rong Chen & Hong Liu

  6. Hospital Infection Control Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, PR China

    Yang-Na Ou

Authors
  1. Shu-Ying Liu
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  2. Meng Huang
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  4. Na Ding
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  5. Hong Liu
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  7. Zhi-Feng Sheng
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  8. Bi-Hua Luo
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  9. Yang-Na Ou
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Corresponding authors

Correspondence to Zhi-Feng Sheng, Bi-Hua Luo or Yang-Na Ou.

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All research procedures in this study were in accordance with the ethical standards of institutions and with the 1964 Helsinki declaration and its subsequent amendments.

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Liu, SY., Huang, M., Chen, R. et al. Comparison of strategies for setting intervention thresholds for Chinese postmenopausal women using the FRAX model. Endocrine 65, 200–206 (2019). https://doi.org/10.1007/s12020-019-01951-8

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