Osteoporos Sarcopenia.  2020 Sep;6(3):106-110. 10.1016/j.afos.2020.07.001.

Ability of FRAX Sri Lanka adjusted for trabecular bone score to discriminate between postmenopausal women with a recent fracture and without a fracture

Affiliations
  • 1Population Health Research Center, Department of Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka
  • 2Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Sri Lanka
  • 3Osteoporosis and Bone Metabolism Unit, Singapore General Hospital, Singapore
  • 4Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Sri Lanka
  • 5Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka

Abstract


Objectives
We evaluated the ability of fracture risk assessment tool (FRAX) Sri Lanka to discriminate between women with a recent fracture and without a fracture, when trabecular bone score (TBS) is added to the calculation.
Methods
We studied 394 women without previous fractures and 87 women who underwent dual energy X-ray absorptiometry within 3 months after the first fragility fracture. Fracture probabilities (FP) were estimated with and without TBS using Sri Lankan FRAX model and their ability to discriminate those with and without fracture was tested.
Results
Women without fractures had higher bone mineral densities (BMDs) and lower FPs, compared to those with a recent fracture. Area under curves of receiver operating characteristic for FPs unadjusted were not different from those adjusted for TBS. The odd ratios of FPs unadjusted were not different from those of adjusted. The FPs estimated with TBS were higher, hence the intervention thresholds (ITs) were higher compared to FPs estimated without TBS. Thirty-two percent of women without previous fracture were above the ITs and the inclusion of TBS increased this to 36%. The integrated discriminatory index analysis showed a 8% increase in the discriminatory slope.
Conclusions
The inclusion of TBS to Sri Lankan FRAX did not show an added advantage in discriminating between postmenopausal women with a recent fracture and without a fracture. TBS inclusion in fracture risk calculation among those without previous fractures, however, showed a marginal increase in the number of women above ITs.

Keyword

Bone density; Osteoporosis; Risk assessment; Trabecular bone score; Sri Lanka
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