title: Spine-hip T-score difference predicts major osteoporotic fracture risk independent of FRAX(®): a population-based report from CAMOS.
abstract: The WHO fracture risk assessment tool (FRAX(®)) estimates an individual's 10-yr major osteoporotic and hip fracture probabilities. When bone mineral density (BMD) is included in the FRAX calculation, only the femoral neck measurement can be used. Recently, a procedure was reported for adjusting major osteoporotic fracture probability from FRAX with femoral neck BMD based on the difference (offset) between the lumbar spine and the femoral neck T-score values. The objective of the current analysis was to independently evaluate this algorithm in a population-based cohort of 4575 women and 1813 men aged 50 yr and older from the Canadian Multicentre Osteoporosis Study. For women and men combined, there was a 15% (95% confidence interval 7-24%) increase in major osteoporotic fracture risk for each offset T-score after adjusting for FRAX probability calculated with femoral neck BMD. The effect was stronger in women than men, but a significant sex interaction was not detected. Among the full cohort, 5.5% had their risk category reclassified after using the offset adjustment. Sex- and age-dependent offsets (equivalent to an offset based on Z-scores) showed improved risk classification among individuals designated to be at moderate risk with the conventional FRAX probability measurement. In summary, the T-score difference between the lumbar spine and femoral neck is an independent risk factor for major osteoporotic fractures that is independent of the FRAX probability calculated with femoral neck BMD.
authors: Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. bleslie@sbgh.mb.ca
authors: William D
authors: WD
authors: Leslie
authors: Christopher S
authors: CS
authors: Kovacs
authors: Wojciech P
authors: WP
authors: Olszynski
authors: Tanveer
authors: T
authors: Towheed
authors: Stephanie M
authors: SM
authors: Kaiser
authors: Jerilynn C
authors: JC
authors: Prior
authors: Robert G
authors: RG
authors: Josse
authors: Sophie A
authors: SA
authors: Jamal
authors: Nancy
authors: N
authors: Kreiger
authors: David
authors: D
authors: Goltzman
mesh_terms: D015519:Bone Density; D003936:Diagnosis, Computer-Assisted; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D006620:Hip Fractures / Q000175:diagnosis*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D058866:Osteoporotic Fractures / Q000175:diagnosis*; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors