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

  • Y. Wang
  • S. Yu
  • C. Hsu
  • C. TsaiEmail author
  • T. ChengEmail author
Original Article
  • 27 Downloads

Abstract

Summary

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 

Notes

Acknowledgments

We are indebted to the TOA for authorizing the use and management of the database. We are also grateful to the Merck Sharp & Dohme pharmaceutical company (Taiwan) for allowing us to use the mobile DXA machine during the recruitment period. We also appreciate the help of Hsu MC in performing the statistical analyses.

Funding information

Funding for this work was provided through grant CMRPG8D0651 from the Chang Gung Memorial Hospital (https://www.cgmh.org.tw/)

Compliance with ethical standards

This study was approved by the local Institutional Review Board of Chang Gung Memorial Hospital (102-1878B). All participants provided written informed consent prior to participating in this program.

Conflicts of interest

None.

Supplementary material

198_2019_5201_MOESM1_ESM.docx (1.3 mb)
ESM 1 (DOCX 1371 kb)

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyKaohsiung Chang Gung Memorial HospitalKaohsiung CityTaiwan
  2. 2.Division of Rheumatology, Allergy, and Immunology, Department of Internal MedicineKaohsiung Chang Gung Memorial HospitalKaohsiung CityTaiwan
  3. 3.College of MedicineChang Gung UniversityKaohsiung CityTaiwan

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