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Setting the new FRAX reference threshold without bone mineral density in Chinese postmenopausal women

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Abstract

Purpose

Despite the large number of osteoporosis patients in China, the diagnosis and treatment rates remain low. The Fracture Risk Assessment Tool (FRAX) can be used to effectively evaluate fracture risk. In this study, we explored the Chinese-specific thresholds of FRAX without the T-score.

Methods

In all, 264 postmenopausal women aged > 50 years were randomly recruited from community-medical centers. All subjects completed self-reported questionnaires, BMD measurements, and spinal radiographs. The 10-year hip and major osteoporotic fracture risks were calculated by FRAX. A new threshold for both 10-year hip and major osteoporotic fracture risk was explored with receiver operating characteristic (ROC) curve analysis.

Results

Overall, 92 subjects were diagnosed with osteoporosis. Among them, 14 participants with T-score > − 2.5 were diagnosed with osteoporosis based on clinical fractures. ROC analysis showed the cut-off value of the 10-year hip osteoporotic fracture for detecting osteoporosis was 0.95%, while that of 10-year major osteoporotic fracture was 4.95%. The sensitivity and specificity of the 10-year hip osteoporotic fracture probability for detecting osteoporosis were 0.86 and 0.59, respectively, while the guideline-recommended threshold had a sensitivity of 0.49 and specificity of 0.83. The sensitivity and specificity of the 10-year major osteoporotic fractures with the new threshold were 0.76 and 0.69, respectively, while the recommended threshold had a sensitivity of 0 and specificity of 1.

Conclusion

Current guideline-recommended FRAX thresholds without BMD showed low sensitivity. Therefore, 10-year osteoporotic hip fracture probability ≥ 0.95% and 10-year osteoporotic major fracture probability ≥ 4.95% are recommended as the new thresholds.

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Funding

Zhifeng Sheng received funding from the National Nature Science Foundation of China (81471091 and 81870622), the Hunan Nature Science Foundation (2018JJ2574), and Bethune Charitable Foundation (G-X-2019-1107-3). All other authors received no financial support for the research, authorship, and/or publication of this article.

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Author notes

  1. S. Liu and R. Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People’s Republic of China

    S. Liu, R. Chen, N. Ding, Q. Wang, M. Huang, Z. Xie & Z. Sheng

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

    S. Liu, R. Chen, N. Ding, Q. Wang, M. Huang, Z. Xie & Z. Sheng

  3. Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People’s Republic of China

    S. Liu, R. Chen, N. Ding, Q. Wang, M. Huang & Z. Sheng

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

    S. Liu, R. Chen, N. Ding, Q. Wang, M. Huang, Z. Xie & Z. Sheng

  5. Hospital Infection Control Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People’s Republic of China

    Y. Ou

  6. Department of Metabolism and Endocrinology, The Affiliated Zhuzhou Hospital Of XiangYa School Of Medicine, Central South University, Changjiang South Road116, Zhuzhou, 412007, Hunan, People’s Republic of China

    R. Chen & H. Liu

Authors
  1. S. Liu
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  2. R. Chen
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  3. N. Ding
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  4. Q. Wang
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  5. M. Huang
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  6. H. Liu
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  7. Z. Xie
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  8. Y. Ou
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  9. Z. Sheng
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Corresponding author

Correspondence to Z. Sheng.

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The authors declare that they have no conflict of interest.

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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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Informed consent was obtained from all individual participants included in the study.

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Liu, S., Chen, R., Ding, N. et al. Setting the new FRAX reference threshold without bone mineral density in Chinese postmenopausal women. J Endocrinol Invest 44, 347–352 (2021). https://doi.org/10.1007/s40618-020-01315-4

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  • DOI: https://doi.org/10.1007/s40618-020-01315-4

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