Less strict intervention thresholds for the FRAX and TBS-adjusted FRAX predict clinical fractures in osteopenic postmenopausal women with no prior fractures.

Détails

ID Serval
serval:BIB_8B5479B577B3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Less strict intervention thresholds for the FRAX and TBS-adjusted FRAX predict clinical fractures in osteopenic postmenopausal women with no prior fractures.
Périodique
Journal of bone and mineral metabolism
Auteur(s)
Kužma M., Hans D., Koller T., Némethová E., Jackuliak P., Killinger Z., Resch H., Payer J.
ISSN
1435-5604 (Electronic)
ISSN-L
0914-8779
Statut éditorial
Publié
Date de publication
09/2018
Peer-reviewed
Oui
Volume
36
Numéro
5
Pages
580-588
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Little is known about the clinical relevance of treating post-menopausal women with no prior history of fragility fracture and bone mineral densities (BMD) within the osteopenic range. In recent years, in addition to BMD and FRAX fracture probability assessments, a surrogate measure of bone micro-architecture quality, called the trabecular bone score (TBS), has been proven to predict future fragility fractures independently of both BMD and the FRAX. In this retrospective analysis of a follow-up study, we compared three risk assessment instruments-the FRAX, the TBS, and a TBS-adjusted FRAX score-in their ability, to predict future fragility fractures over a minimum of five years of follow-up among post-menopausal osteopenic women with no prior fragility fractures. We also sought to determine if more- versus less-stringent criteria were better when stratifying patients into higher-risk patients warranting osteoporosis-targeted intervention versus lower-risk patients in whom intervention would usually be deemed unnecessary. Over a mean 5.2 years follow-up, 18 clinical fragility fractures were documented among 127 women in the age 50 years and older (mean age = 66.1). On multivariate analysis utilizing regression models and Kaplan-Meier curve analysis, less-stringent criteria for the FRAX and TBS-adjusted FRAX were capable of predicting future fractures (with sensitivity/specificity of 83/31; 39/77 and 78/50% for TBS, FRAX and TBS-adjusted FRAX, respectively), while more-stringent criteria were incapable of doing so (with sensitivity/specificity of 56/60; 39/77 and 39/74 for TBS, FRAX and TBS-adjusted FRAX, respectively). Neither TBS threshold alone was a significant predictor of future fracture in our study. However, hazard ratio analysis revealed slight superiority of the TBS-adjusted FRAX over the FRAX alone (HR = 3.09 vs. 2.79). Adjusting the FRAX tool by incorporating the TBS may be useful to optimize the detection of post-menopausal osteopenic women with no prior fractures who warrant osteoporosis-targeted therapy.
Mots-clé
Aged, Bone Diseases, Metabolic/complications, Bone Diseases, Metabolic/pathology, Cancellous Bone/pathology, Female, Follow-Up Studies, Fractures, Bone/complications, Fractures, Bone/pathology, Humans, Kaplan-Meier Estimate, Middle Aged, Multivariate Analysis, Postmenopause/physiology, Probability, Retrospective Studies, Risk Assessment, FRAX, TBS-adjusted FRAX, Thresholds, Trabecular bone score (TBS)
Pubmed
Web of science
Création de la notice
28/09/2017 8:36
Dernière modification de la notice
20/08/2019 14:50
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