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The Clinical Value of the RA-Adjusted Fracture Risk Assessment Tool in the Fracture Risk Prediction of Patients with Type 2 Diabetes Mellitus in China

Authors Hu L, Li T, Zou Y, Yin XL, Gan H

Received 8 December 2020

Accepted for publication 8 January 2021

Published 29 January 2021 Volume 2021:14 Pages 327—333

DOI https://doi.org/10.2147/IJGM.S296399

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Ling Hu,* Ting Li,* Yi Zou, Xiao-Ling Yin, Hui Gan

Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, Nanchang 330000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ling Hu
Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, No. 128 of Xiangshan North Road, Donghu District, Nanchang 330000, People’s Republic of China
Tel +86 13970075119
Email drhu_hl1172@163.com

Objective: This study aimed to explore the clinical value of the fracture risk assessment tool (FRAX) in the fracture risk prediction of Chinese patients after replacing rheumatoid arthritis (RA) with type 2 diabetes mellitus (T2DM) in the FRAX algorithm.
Methods: A total of 1,047 patients with T2DM from the Endocrinology Department of the Third Affiliated Hospital of Nanchang University were enrolled in this study. Dual-energy X-ray absorptiometry (DXA) was then used to detect their bone density. RA in the FRAX algorithm was replaced with T2DM, and the new RA-adjusted FRAX was used to assess the fracture risk of the patients.
Results: The sensitivity, specificity, and Youden’s index of the RA-adjusted FRAX to the treatment opinions on T2DM-associated hip fractures were 0.4761, 0.9642, and 0.4403, respectively, while the sensitivity, specificity, and Youden’s index of RA-adjusted FRAX to the treatment opinions on T2DM-associated major bone osteoporotic fractures were 0.0080, 1.0000, 0.0080, respectively. The DXA and RA-adjusted FRAX both showed acceptable consistency in the treatment recommendations for hip fractures in patients with T2DM (κ = 0.49) but had poor consistency in treatment recommendations for major bone osteoporotic fractures (κ = 0.010). The body mass index (BMI) scores, femoral neck-bone mineral densities, and number of males in the same treatment opinion group were significantly higher than in the different treatment opinions group (P < 0.001).
Conclusion: RA-adjusted FRAX is a useful clinical tool for evaluation of hip fracture risk for Chinese patients with T2DM, and the accuracy of fracture risk prediction for male patients with T2DM and patients with T2DM with high BMI scores or high femoral neck-bone mineral density is higher.

Keywords: type 2 diabetes mellitus, FRAX, fracture risk, bone mineral density, osteoporosis

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