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Validation of three tools for identifying painful new osteoporotic vertebral fractures in older Chinese men: bone mineral density, Osteoporosis Self-Assessment Tool for Asians, and fracture risk assessment tool

Authors Lin JS, Yang Y, Fei Q, Zhang XD, Ma Z, Wang Q, Li JJ, Li D, Meng Q, Wang BQ

Received 23 November 2015

Accepted for publication 18 February 2016

Published 22 April 2016 Volume 2016:11 Pages 461—469

DOI https://doi.org/10.2147/CIA.S101078

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Supriya Swarnkar

Peer reviewer comments 2

Editor who approved publication: Professor Zhi-Ying Wu

JiSheng Lin,* Yong Yang,* Qi Fei, XiaoDong Zhang, Zhao Ma, Qi Wang, JinJun Li, Dong Li, Qian Meng, BingQiang Wang

Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China

*These authors contributed equally to this work

Objective: This cross-sectional study compared three tools for predicting painful new osteoporotic vertebral fractures (PNOVFs) in older Chinese men: bone mineral density (BMD), the Osteoporosis Self-Assessment Tool for Asians (OSTA), and the World Health Organization fracture risk assessment tool (FRAX) (without BMD).
Methods: Men aged ≥50 years were apportioned to a group for men with fractures who had undergone percutaneous vertebroplasty (n=111), or a control group of healthy men (n=385). Fractures were verified on X-ray and magnetic resonance imaging. BMD T-scores were determined by dual energy X-ray absorptiometry. Diagnosis of osteoporosis was determined by a BMD T-score of ≤2.5 standard deviations below the average for a young adult at peak bone density at the femoral neck, total hip, or L1–L4. Demographic and clinical risk factor data were self-reported through a questionnaire. BMD, OSTA, and FRAX scores were assessed for identifying PNOVFs via receiver-operating characteristic (ROC) curves. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined.
Results: Between the men with fractures and the control group, there were significant differences in BMD T-scores (at femoral neck, total hip, and L1–L4), and OSTA and FRAX scores. In those with fractures, only 53.15% satisfied the criteria for osteoporosis. Compared to BMD or OSTA, the FRAX score had the best predictive value for PNOVFs: the AUC of the FRAX score (cutoff =2.9%) was 0.738, and the sensitivity and specificity were 82% and 62%, respectively.
Conclusion: FRAX may be a valuable tool for identifying PNOVFs in older Chinese men.

Keywords: osteoporosis, male, vertebral fracture, FRAX, OSTA, bone mineral density
 

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