NOTICIAS DIARIAS

Fracture Risk Assessment of Postmenopausal Women

Orthopaedics

Trabecular Bone Score (TBS) is an index of bone microarchitecture that provides additional skeletal information to areal Bone Mineral Density (aBMD). Recently TBS data has been used to optimize the Fracture Risk Assessment Tool (FRAX) predictive value. The aim of this study was to evaluate the clinical value of TBS on FRAX algorithm

Trabecular Bone Score (TBS) is an index of bone microarchitecture that provides additional skeletal information to areal Bone Mineral Density (aBMD). Recently TBS data has been used to optimize the Fracture Risk Assessment Tool (FRAX) predictive value. The aim of this study was to evaluate the clinical value of TBS on FRAX algorithm

Osteoporosis as a leading cause of bone fragility fractures, is a major public health problem mostly affecting postmenopausal women and aging individuals of both sexes. In 1990, the prevalence of fragility fracture was about 1.5 million worldwide and it is estimated to reach three millions by 2025.

Osteoporotic fragility fractures lead to severe mortality and morbidity, a significant burden on society in general, and a huge economic impact. Osteoporosis is a common health problem among Iranian population, as well.

Fracture risk assessment tool

Fracture risk assessment tool (FRAX) is a supportive software in the field of osteoporosis management initially designed to aid in identifying previously untreated patients with low bone density who are at a higher risk of fragility fracture; in fact it particularly provides a quantitative estimate of absolute fracture risk to decide which osteopenic patient most likely benefits from treatment

Among total of 358 postmenopausal Iranian women (mean age 61.3 ± 9.5 years) tested for aBMD and TBS, 184 osteopenic women were identified. Thoracolumbar spine X-ray done in all participants revealed twenty-one vertebral fractures. For the osteopenic group, FRAX and TBS adjusted FRAX (FRAX-TBS) were calculated and compared.

Mean TBS of the patients was 1.31 (±0.11). A significant correlation was found between TBS and spine aBMD (r = 0.50, p < 0.001) and TBS and femoral neck aBMD (r = 0.37, p < 0.0001).

A strong positive correlation was observed between aBMD adjusted FRAX and FRAX-TBS in predicting the risk of major osteoporotic fracture (r = 0.90, p < 0.0001), and hip fracture (r = 0.97, p < 0.0001).

According to the area under the receiver operating characteristics curve, the predictive value of the three different models using aBMD, TBS, and combination of aBMD and TBS were similar (0.765, 0.776, and 0.781, respectively; p = 0.19). The proportion of the women needed treatment remained unchanged using FRAX or FRAX-TBS.

This study showed no clinical benefit for TBS in postmenopausal women. Adding TBS data to aBMD or FRAX neither improved aBMD predictive value for vertebral fracture nor changed the decision on treatment based on FRAX.