Underestimated fracture risk in postmenopausal women-application of the hybrid intervention threshold

Y Wang; S Yu; C Hsu; C Tsai; T Cheng

doi:10.1007/s00198-019-05201-5

Underestimated fracture risk in postmenopausal women-application of the hybrid intervention threshold

Osteoporos Int. 2020 Mar;31(3):475-483. doi: 10.1007/s00198-019-05201-5. Epub 2019 Nov 6.

Authors

Y Wang¹, S Yu², C Hsu², C Tsai³, T Cheng^{4

5}

Affiliations

¹ Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosung District, 83301, Kaohsiung City, Taiwan.
² Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosung District, 83301, Kaohsiung City, Taiwan.
³ Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosung District, 83301, Kaohsiung City, Taiwan. nick@cgmh.org.tw.
⁴ Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosung District, 83301, Kaohsiung City, Taiwan. tiantsai0919@gmail.com.
⁵ College of Medicine, Chang Gung University, No. 123, Dapi Road, Niaosung District, 83301, Kaohsiung City, Taiwan. tiantsai0919@gmail.com.

PMID: 31696272
DOI: 10.1007/s00198-019-05201-5

Abstract

This study evaluated the fragility fracture risk of Taiwanese postmenopausal women with osteopenia. With the incorporation of FRAX and hybrid intervention threshold (HIT), 25% of the participants had high fracture risk. We suggest intervention for fragility fracture for postmenopausal women should be guided by FRAX and HIT instead of bone mineral density alone.

Introduction: To explore the risk of fragility fracture in Taiwanese postmenopausal women with osteopenia using the hybrid intervention threshold (HIT) and Fracture Risk Assessment tool (FRAX).

Methods: The Taiwan Osteoporosis Association (TOA) conducted a nationwide bone mineral density (BMD) survey between 2008 and 2011 using a bus equipped with a dual-energy X-ray absorptiometry (DXA) machine. All participants completed a structured questionnaire, which included the elements in the FRAX. Based on the results, the group made up of postmenopausal women with osteopenia was identified. In order to explore the risk of fragility fracture by HIT and FRAX among Taiwan postmenopausal women with osteopenia, the 10-year probability of fracture (FRAX score) and individual intervention threshold (IIT) in this group were calculated. If the FRAX score of a participant was higher than or equal to the IIT or fixed intervention threshold (FIT), the participant was considered as above the HIT (HIT could be reached by being over a threshold at either major osteoporotic fracture or hip fracture) and categorized as having a high FRAX fracture risk.

Results: A total of 13,068 postmenopausal women were enrolled in the program. A total of 5743 (43.9%) participants had osteopenia, of which 1434 (25.0%) had high FRAX fracture risk.

Conclusions: One quarter of Taiwanese postmenopausal women with osteopenia had high fragility fracture risk evaluated by FRAX and HIT. Due to the poor sensitivity of BMD for fragility fracture, we suggest that intervention for fragility fracture for postmenopausal women should also be guided by FRAX and HIT instead of BMD alone.

Keywords: FRAX; Intervention threshold; Menopause; Osteopenia.

MeSH terms

Absorptiometry, Photon
Bone Density
Female
Humans
Osteoporosis, Postmenopausal* / complications
Osteoporosis, Postmenopausal* / epidemiology
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / etiology
Postmenopause
Risk Assessment
Risk Factors
Taiwan / epidemiology

Grants and funding

CMRPG8D0651/Chang Gung Memorial Hospital