The study establishes new cut-off values for the FRAX tool to screen for osteoporosis among the Thai geriatric population.
This research aims to improve osteoporosis screening effectiveness, addressing limitations related to conventional criteria.
Identifying osteoporosis is imperative for the prevention of fragility fractures, particularly among older adults. While dual-energy X-ray absorptiometry (DXA) has long stood as the gold standard for osteoporosis diagnosis, its widespread availability and high cost raise challenges for mass screenings. With this backdrop, recent research set out to find effective alternatives, pinpointing the Fracture Risk Assessment Tool (FRAX) as particularly promising.
Conducted from March 2021 to August 2022, the study analyzed data from over 2,900 community-dwelling Thai adults aged 60 and older. The findings indicate several compelling observations, particularly the effective identification of high-risk osteoporosis patients through newly established FRAX cut-off values.
Researchers found the need for conducting this study stemmed from the pressing health issue of osteoporosis, which seriously impacts older populations. The goal was to refine existing screening mechanisms so healthcare providers could identify patients needing dual-energy X-ray absorptiometry more accurately.
"This study identifies FRAX cut-off values able to effectively screen for high-risk osteoporosis in the Thai geriatric population," stated the authors of the article. The research found significant sensitivity and specificity at the proposed cut-off values, with the FRAX index yielding excellent results—a sensitivity of 90.4% accompanied by 89.7% negative predictive value for osteoporosis detection.
Among the 2991 participants evaluated, 29.7% were diagnosed with osteoporosis, with characteristics such as advanced age, female gender, and significant prior fragility fractures observed as common risk indicators. Interestingly, the data also portrayed lower usage rates for smoking and alcohol consumption among those diagnosed with osteoporosis.
The FRAX assessment considered various demographic factors and revealed acceptable discriminative abilities: the area under the receiver operating characteristic curve (AUC) for hip fractures was 0.75 and 0.72 for major osteoporotic fractures. The team established cut-off values of 1.5 for the hip fracture risk and 4.5 for major osteoporotic fractures, optimizing both sensitivity and specificity.
The study sets the stage for enhancing osteoporosis screening protocols, with the FRAX index now offering practical and accessible tools for detecting high-risk patients efficiently. The proposed thresholds are set to complement existing clinical practices, allowing for the identification of osteoporosis risk beyond traditional high-risk populations.
"The proposed high-risk thresholds demonstrated a low false negative rate of approximately 10%, supporting their suitability for identifying patients who would benefit from BMD assessment," the authors observed. Recognizing individuals who require additional bone mineral density evaluation can play a significant role not only in treatment decisions but also in minimizing the risk of future fractures.
This advancement is particularly pertinent for geriatric health care. With growing numbers of elderly patients, effectively identifying those at risk of osteoporosis could lead to timelier interventions and improved outcomes. By linking clinical assessments with bone density testing, we might see meaningful reductions in fragility fractures, which pose significant challenges to health systems worldwide.
Moving forward, future research will build upon these findings by addressing longitudinal data to validate the newly proposed cut-off points and explore their predictive accuracy over time. The study has initiated the discourse on more efficient osteoporosis screening methods and highlighted the importance of considering ethnicity and regional characteristics when implementing screening criteria.