Validation of three tools for identifying painful new osteoporotic vertebral fractures in older Chinese men: bone mineral density, Osteoporosis Self-Assessment Tool for Asians, and fracture risk assessment tool

Abstract

Objective: This cross-sectional study compared three tools for predicting painful new osteoporotic vertebral fractures (PNOVFs) in older Chinese men: bone mineral density (BMD), the Osteoporosis Self-Assessment Tool for Asians (OSTA), and the World Health Organization fracture risk assessment tool (FRAX) (without BMD).

Methods: Men aged ≥50 years were apportioned to a group for men with fractures who had undergone percutaneous vertebroplasty (n=111), or a control group of healthy men (n=385). Fractures were verified on X-ray and magnetic resonance imaging. BMD T-scores were determined by dual energy X-ray absorptiometry. Diagnosis of osteoporosis was determined by a BMD T-score of ≤2.5 standard deviations below the average for a young adult at peak bone density at the femoral neck, total hip, or L1-L4. Demographic and clinical risk factor data were self-reported through a questionnaire. BMD, OSTA, and FRAX scores were assessed for identifying PNOVFs via receiver-operating characteristic (ROC) curves. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined.

Results: Between the men with fractures and the control group, there were significant differences in BMD T-scores (at femoral neck, total hip, and L1-L4), and OSTA and FRAX scores. In those with fractures, only 53.15% satisfied the criteria for osteoporosis. Compared to BMD or OSTA, the FRAX score had the best predictive value for PNOVFs: the AUC of the FRAX score (cutoff =2.9%) was 0.738, and the sensitivity and specificity were 82% and 62%, respectively.

Conclusion: FRAX may be a valuable tool for identifying PNOVFs in older Chinese men.

Keywords: FRAX; OSTA; bone mineral density; male; osteoporosis; vertebral fracture.

Figure 1

The flow diagram of the study. Abbreviations: BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry; OSTA, Osteoporosis Self-Assessment Tool for Asians; FRAX, fracture risk assessment tool.

Figure 2

Proportions of BMD T-scores at different sites in the fracture and control groups, and ROC curve of the BMD measurement at different sites for identifying PNOVFs with optimal cutoff value. Notes: 1: Fracture group; 2: control group. ^*P-value for comparison <0.05. Abbreviations: BMD, bone mineral density; ROC, receiver-operating characteristic; PNOVFs, painful new osteoporotic vertebral fractures.

Figure 3

Comparison of different AUCs (BMD T-score, OSTA, and FRAX for identifying PNOVFs). Abbreviations: BMD, bone mineral density; OSTA, Osteoporosis Self-Assessment Tool for Asians; FRAX, fracture risk assessment tool; PNOVFs, painful new osteoporotic vertebral fractures; AUCs, areas under the receiver-operating characteristic curve.