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Article: Possible FRAX-based intervention thresholds for a cohort of Chinese postmenopausal women

TitlePossible FRAX-based intervention thresholds for a cohort of Chinese postmenopausal women
Authors
Issue Date2014
PublisherSpringer U K. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/198
Citation
Osteoporosis International: with other metabolic bone diseases, 2014, v. 25 n. 3, p. 1017-1023 How to Cite?
AbstractA total of 2,266 postmenopausal Chinese women were followed for 4.5 years to determine the incidence of new fractures. The positive predictive value, negative predictive value, sensitivity and specificity of different treatment strategies were compared. Using a fixed optimal threshold calculated from receiver operating characteristics (ROC) curve had the highest sensitivity but lowest specificity. INTRODUCTION: There is no specific intervention threshold based on FRAX to guide treatment for Asian populations. This prospective study sought to determine the impact of applying different intervention thresholds to a cohort of Chinese postmenopausal women. METHODS: This study was part of the Hong Kong Osteoporosis Study. A total of 2,266 treatment-naïve postmenopausal women underwent clinical risk factor and BMD assessments. The subjects were followed to assess fractures. We calculated the FRAX probability of major osteoporotic fractures corresponding to women with prior fractures but no other clinical risk factors. Different treatment strategies which include treating women with prior fractures, women with age-specific FRAX probability corresponding to those with prior fractures, women with osteoporosis as well as women with FRAX probability above a fixed cut-off based on optimizing sensitivity and specificity on the ROC curve were compared. RESULTS: The mean age at baseline was 62.1 ± 8.5 years, and the mean follow-up time was 4.5 ± 2.8 years. One hundred six new major osteoporotic fractures were reported. An optimal (FRAX, with BMD) cut-off point of 9.95 % was identified. All strategies had negative predictive value of >90 %. Using a fixed cut-off had the highest sensitivity (62.3 %) but lowest specificity (73.5 %) and positive predictive value (10.3 %). Using a fixed cut-off would direct treatment from younger women with lower absolute risk to elderly women with higher absolute risk. CONCLUSION: Targeting only women with prior fractures is unlikely to reduce fracture burden. Other treatment strategies with higher sensitivity need to be considered but they have different shortcomings.
Persistent Identifierhttp://hdl.handle.net/10722/193879
ISSN
2015 Impact Factor: 3.445
2015 SCImago Journal Rankings: 1.460
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCheung, Een_US
dc.contributor.authorCheung, CLen_US
dc.contributor.authorKung, AWCen_US
dc.contributor.authorTan, KCBen_US
dc.date.accessioned2014-01-28T06:30:45Z-
dc.date.available2014-01-28T06:30:45Z-
dc.date.issued2014-
dc.identifier.citationOsteoporosis International: with other metabolic bone diseases, 2014, v. 25 n. 3, p. 1017-1023en_US
dc.identifier.issn0937-941X-
dc.identifier.urihttp://hdl.handle.net/10722/193879-
dc.description.abstractA total of 2,266 postmenopausal Chinese women were followed for 4.5 years to determine the incidence of new fractures. The positive predictive value, negative predictive value, sensitivity and specificity of different treatment strategies were compared. Using a fixed optimal threshold calculated from receiver operating characteristics (ROC) curve had the highest sensitivity but lowest specificity. INTRODUCTION: There is no specific intervention threshold based on FRAX to guide treatment for Asian populations. This prospective study sought to determine the impact of applying different intervention thresholds to a cohort of Chinese postmenopausal women. METHODS: This study was part of the Hong Kong Osteoporosis Study. A total of 2,266 treatment-naïve postmenopausal women underwent clinical risk factor and BMD assessments. The subjects were followed to assess fractures. We calculated the FRAX probability of major osteoporotic fractures corresponding to women with prior fractures but no other clinical risk factors. Different treatment strategies which include treating women with prior fractures, women with age-specific FRAX probability corresponding to those with prior fractures, women with osteoporosis as well as women with FRAX probability above a fixed cut-off based on optimizing sensitivity and specificity on the ROC curve were compared. RESULTS: The mean age at baseline was 62.1 ± 8.5 years, and the mean follow-up time was 4.5 ± 2.8 years. One hundred six new major osteoporotic fractures were reported. An optimal (FRAX, with BMD) cut-off point of 9.95 % was identified. All strategies had negative predictive value of >90 %. Using a fixed cut-off had the highest sensitivity (62.3 %) but lowest specificity (73.5 %) and positive predictive value (10.3 %). Using a fixed cut-off would direct treatment from younger women with lower absolute risk to elderly women with higher absolute risk. CONCLUSION: Targeting only women with prior fractures is unlikely to reduce fracture burden. Other treatment strategies with higher sensitivity need to be considered but they have different shortcomings.en_US
dc.languageengen_US
dc.publisherSpringer U K. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/198-
dc.relation.ispartofOsteoporosis International: with other metabolic bone diseasesen_US
dc.rightsThe original publication is available at www.springerlink.com-
dc.titlePossible FRAX-based intervention thresholds for a cohort of Chinese postmenopausal womenen_US
dc.typeArticleen_US
dc.identifier.emailCheung, CL: lung1212@hku.hken_US
dc.identifier.emailKung, AWC: awckung@hku.hken_US
dc.identifier.emailTan, KCB: kcbtan@hku.hken_US
dc.identifier.authorityCheung, CL=rp01749en_US
dc.identifier.authorityKung, AWC=rp00368en_US
dc.identifier.authorityTan, KCB=rp00402en_US
dc.identifier.doi10.1007/s00198-013-2553-9-
dc.identifier.pmid24196720-
dc.identifier.scopuseid_2-s2.0-84894578204-
dc.identifier.hkuros227569en_US
dc.identifier.volume25-
dc.identifier.issue3-
dc.identifier.spage1017-
dc.identifier.epage1023-
dc.identifier.isiWOS:000331559200023-
dc.publisher.placeUnited Kingdom-

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