Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women [electronic resource] : A meta-analysis of international cohorts

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Tác giả:

Ngôn ngữ: eng

Ký hiệu phân loại: 612 Human physiology

Thông tin xuất bản: Oak Ridge, Tenn. : Distributed by the Office of Scientific and Technical Information, U.S. Dept. of Energy, 2014

Mô tả vật lý: Size: p. 428-435 : , digital, PDF file.

Bộ sưu tập: Metadata

ID: 261371

 There are occasional marked discordances in BMD T-scores at the lumbar spine (LS) and femoral neck (FN). We investigated whether such discordances could contribute independently to fracture prediction using FRAX. In this paper, we studied 21,158 women, average age 63 years, from 10 prospective cohorts with baseline FRAX variables as well as FN and LS BMD. Incident fractures were collected by self-report and/or radiographic reports. Extended Poisson regression examined the relationship between differences in LS and FN T-scores (?LS?FN) and fracture risk, adjusted for age, time since baseline and other factors including FRAX 10-year probability for major osteoporotic fracture calculated using FN BMD. To examine the effect of an adjustment for ?LS?FN on reclassification, women were separated into risk categories by their FRAX major fracture probability. High risk was classified using two approaches: being above the National Osteoporosis Guideline Group intervention threshold or, separately, being in the highest third of each cohort. The absolute ?LS?FN was greater than 2 SD for 2.5 % of women and between 1 and 2 SD for 21 %. ?LS?FN was associated with a significant risk of fracture adjusted for baseline FRAX (HR per SD change = 1.09
  95 % CI = 1.04?1.15). In reclassification analyses, only 2.3?3.2 % of the women moved to a higher or lower risk category when using FRAX with ?LS?FN compared with FN-derived FRAX alone. Adjustment of estimated fracture risk for a large LS/FN discrepancy (>
 2SD) impacts to a large extent on only a relatively small number of individuals. More moderate (1?2SD) discordances in FN and LS T-scores have a small impact on FRAX probabilities. Finally, this might still improve clinical decision-making, particularly in women with probabilities close to an intervention threshold.
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