J Korean Neurosurg Soc.  2015 Oct;58(4):346-349. 10.3340/jkns.2015.58.4.346.

Usefulness of Fracture Risk Assessment Tool Using Lumbar Bone Mineral Density in Prediction of Osteoporotic Vertebral Fracture

• Lee HS
• Lee SH
• Chung YS
• Yang HJ
• Son YJ
• Park SB

• KMID: 2114371
• DOI: http://doi.org/10.3340/jkns.2015.58.4.346

Abstract

OBJECTIVE
To investigate the value of lumbar bone mineral density (BMD) in fracture risk assessment (FRAX) tool.
METHODS
One hundred and ten patients aged over 60 years were enrolled and divided into 2 groups as non-osteoporotic vertebral fracture (OVF) and OVF groups. The 10-year-risk of major osteoporotic vertebral fracture of each group was calculated by FRAX tool with femoral and lumbar spine BMDs to compare the usefulness of lumbar spine BMD in prediction of OVF. The blood level of osteocalcin and C-terminal telopeptide (CTX) as markers of activities of osteoblast and osteoclast, respectively were analyzed using the institutional database.
RESULTS
In the OVF group, the ratio of patients with previous fracture history or use of glucocorticoid was higher than those in non-OVF group (p=0.000 and 0.030, respectively). The levels of T-score of femur neck and lumbar spine in OVF group were significantly lower than those in non-OVF group (p=0.001 and 0.000, respectively). The risk of OVF in FRAX using femur BMD in non-OVF and OVF groups was 6.7+/-6.13 and 11.4+/-10.06, respectively (p=0.007). The risk of using lumbar BMD in the 2 groups was 6.9+/-8.91 and 15.1+/-15.08, respectively (p=0.002). The areas under the receiver operator characteristic curve in the FRAX risk with lumbar and femur neck BMD were 0.726 and 0.684, respectively. The comparison of osteocalcin and CTX was not significant (p=0.162 and 0.369, respectively).
CONCLUSION
In our study, the 10-year risk of major osteoporotic fracture in the OVF group of our study was lower than the recommended threshold of intervention for osteoporosis. Hence, a lower threshold for the treatment of osteoporosis may be set for the Korean population to prevent OVF. In the prediction of symptomatic OVF, FRAX tool using lumbar spine BMD may be more useful than that using femur neck BMD.

Keyword

Osteoporosis; Spine; Fracture; Femur

MeSH Terms

Bone Density*
Femur
Femur Neck
Humans
Osteoblasts
Osteocalcin
Osteoclasts
Osteoporosis
Osteoporotic Fractures
Risk Assessment*
Spine
Osteocalcin

Figure

• 

  Fig. 1 Receiver Operating Characteristics curves for prediction of osteoporotic vertebral fractures using FRAX tools and lumbar spine and femur neck T-scores. FRAX : fracture risk assessment.

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