Fracture risk prediction based on multivariable diagnostic models incorporating dual-energy X-ray absorptiometry based bone mineral density, trabecular bone score, and clinical risk factors in women aged ≥ 50 years: a prospective study
Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland.
Abstract
According to the available reports, there is a major treatment gap in the management of osteoporotic fractures in Poland. It is crucial to identify those at high risk of low-energy fractures who ought to be treated. The study aimed to assess the diagnostic value of dual-energy X-ray absorptiometry (DXA) and the DXA-derived trabecular bone score (TBS) in fracture risk prediction in Polish women ≥ 50 years of age at risk of osteoporosis. Additional measures included the analysis of how incorporating other risk factors may improve the fracture prediction model.
From a database of 5,000 randomly selected women, a total of 411 women aged ≥ 50 years were finally included – those who had a DXA examination followed by a complete medical questionnaire performed. After 5–9 years of observation, participants completed a follow-up questionnaire similar to the baseline questionnaire. In addition, TBS analysis was performed retrospectively using lumbar spine DXA scans. Then their fracture risk was calculated using the FRAX algorithm.
Most patients with osteoporotic fractures were in a group with a degraded bone microarchitecture and a diagnosis of osteoporosis. Fracture patients without osteoporosis (T-score > –2.5) were mostly (73%) characterised by a partially or significantly degraded bone microarchitecture. The highest predictive value (AUC 0.6) was observed in relation to the models FRAX BMD and FRAX BMD-TBS (p < 0.05), which included both skeletal and other clinical risk factors. Also, the outcomes for all other analysed models (FRAX BMI + TBS, FRAX BMD + TBS, FRAX BMI + BMD spine + TBS) were statistically significant.
Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland. Further studies on fracture prediction models in patients with osteopenia are required.
The study indicates that lower BHI SDS values are associated with increased fracture risk in children with classical OI and indicates that BHI may represent a clinically useful complementary tool for fracture risk stratification in young children with OI, particularly where DXA is unavailable or technically limited, including infancy.
Ruggero Lanzafame, Alistair D Calder, B. Crowe et al.· Journal of Clinical Endocrin...· 0 citations
Osteoporosis is the most prevalent metabolic bone disease and is associated with an increased risk of fragility fractures. Current guidelines recommend bone mineral density (BMD) assessment by DXA primarily in women aged ≥65 years or in younger women with clinical risk factors. However, DXA is frequently performed in women under 65 years without guideline-based indications. Objective: To describe the prevalence of densitometric osteoporosis in women under 65 years undergoing DXA in the absence of clinical risk factors. Methods: A descriptive cross-sectional study was conducted at a referral center. Women aged 40–65 years consecutively referred for DXA between February and September 2024 were included. Participants with FRAX® clinical risk factors, major osteoporotic fractures, secondary metabolic bone diseases, or dietary restrictions were excluded. BMD was assessed at the lumbar spine, total hip, and femoral neck. Osteoporosis was defined as a T-score ≤ -2.5. Results: A total of 119 women were included (mean age 53 years; range 43-62). Mean T-scores were -0.9±1.3 at the lumbar spine, -0.9±1.1 at the total hip, and -1.0±1.0 at the femoral neck. BMD values within the osteoporotic range was observed in 13% (n=15) at the lumbar spine and in 7% (n=8) at both the total hip and femoral neck. Overall, 17% (n=20) had BMD values within the osteoporotic range at at least one skeletal site. Conclusion: Densitometric osteoporosis was identified in a relevant proportion of women younger than 65 years without traditional risk factors, supporting an individualized approach to bone health assessment.
Josefina Rosmino, M. Pavlove, M. L. Brance et al.· EndoAr· 0 citations
Background: Whether routinely available laboratory measures are associated with longitudinal bone mineral density (BMD) change in clinical practice remains uncertain, particularly when treatment exposure and other major skeletal determinants are incompletely recorded. This study examined BMD trajectories and incident osteoporosis in a Saudi dual-energy X-ray absorptiometry (DXA) cohort. Anti-osteoporosis therapy, glucocorticoid exposure and menopausal status were unavailable, limiting causal interpretation. Methods: This retrospective longitudinal cohort included DXA examinations performed at King Saud University Medical City (KSUMC), Riyadh, from 2016 to 2021. The trajectory analysis comprised 2147 patients with at least two scans and a minimum one-year interval. Diagnostic category was based on the lowest T-score across the lumbar spine, bilateral femoral necks and distal radius. Twenty linear mixed-effects (LME) models evaluated time-by-biomarker interactions with Benjamini–Hochberg correction. Cox proportional hazards (PH) regression was the primary analysis of incident osteoporosis among 789 patients without osteoporosis at baseline. Results: During 2045 person-years of observation, 107 patients developed osteoporosis (5.2 events per 100 person-years). No event occurred among 124 patients with normal baseline BMD, compared with 107 events among 665 patients with baseline osteopenia (log-rank p < 0.001). In the complete-case Cox model (n = 384; 53 events; C-index = 0.679), baseline osteopenia had a hazard ratio (HR) of 3.12 (95% Confidence interval (CI) 0.89–10.97; p = 0.076); no modelled covariate reached statistical significance. None of the 20 time-by-biomarker interactions remained significant after multiplicity correction (smallest q = 0.214). Four nominal terms with raw p < 0.10 were below the measurement-based clinical threshold and were compatible with chance variation. Conclusions: No routinely measured biomarker demonstrated clinical utility for identifying BMD trajectory in this cohort. Baseline DXA category separated the observed progression pattern, although this partly reflects the distance from the diagnostic threshold and should not be interpreted as a validated prediction model. The principal contribution is a carefully characterised null result. Prospective studies with explicit treatment tracking and repeated bone-turnover measurements are required for confirmation.
L. Jambi, S. Kabrah· Journal of Clinical Medicine· 0 citations
Age, number of operated vertebrae, cement leakage, PINP, 25(OH)D, and BMD are closely associated with and are independent risk factors for secondary fractures after PVP/PKP in OTF patients, and the nomogram model based on these factors has high value.
Jiawei Fu, Guanhua Xu, Jia-jia Chen et al.· Frontiers in Surgery· 0 citations
There is no unified approach to screening for high fracture risk in international practice.
Objective
: to evaluate the efficacy of a population-based screening program for osteoporosis and high fracture risk using the FRAX tool in postmenopausal women and men aged 40 years and older in real-world primary healthcare practice.
Material and methods
. A single-center prospective case-control cohort study included 34,357 individuals aged 40 years and older. In the screening group (n=10,743), primary care physicians assessed the 10-year probability of fractures using the FRAX calculator in 2018. High fracture risk was defined as exceeding the Russian FRAX intervention threshold and/or having a history of a low-energy fracture. The control group consisted of unscreened individuals (n=23,614). Screening efficacy was assessed based on changes in the incidence of osteoporotic fractures during 3 years of follow-up (2019–2021).
Results and discussion
. High fracture risk was identified in 16.8% of patients in the screening group. In this group, the incidence of all fractures decreased by 33.8% (from 21.0 to 13.9 per 1,000 population; p<0.001), whereas in the control group this indicator increased by 26.7% (from 8.6 to 10.9 per 1,000; p=0.012). In the subgroup of high-risk patients who received treatment, fracture incidence decreased 3.1-fold (p<0.001).
Conclusion
. Screening based on FRAX and a history of previous fractures is an effective strategy for reducing fracture rates in real-world clinical practice and may therefore be recommended for widespread use in primary healthcare.
E. Gladkova, V. Tanaev, D. A. Shimanski et al.· Modern Rheumatology Journal· 0 citations
The findings suggest that the clinical role of TBS in the assessment of pediatric bone health remains to be established, and that larger prospective studies are needed to clarify the clinical value of TBS for fracture risk assessment in pediatric autoimmune gastrointestinal diseases.
Anna Łupińska, Sara Aszkiełowicz, Arkadiusz Zygmunt et al.· Nutrients· 0 citations