title: Application of the World Health Organization Fracture Risk Assessment Tool to predict need for dual-energy X-ray absorptiometry scanning in postmenopausal women.
abstract: OBJECTIVE
  To evaluate the efficacy of the World Health Organization Fracture Risk Assessment Tool, excluding bone mineral density (pre-BMD FRAX), in identifying Taiwanese postmenopausal women needing dual-energy X-ray absorptiometry (DXA) examination for further treatment.
  
  
  METHODS
  The pre-BMD FRAX score was calculated for 231 postmenopausal women who participated in public health education workshops in the local Keelung community, Taiwan. DXA scanning and vertebral fracture assessment (VFA) were arranged for women classified as intermediate or high risk for fracture using the pre-BMD FRAX fracture probability.
  
  
  RESULTS
  Pre-BMD FRAX classified 26 women as intermediate risk and 37 as having high risk for fracture. Subsequent DXA scans for these 63 women showed that 36 were osteoporotic, 19 were osteopenic, and eight had normal bone density. Concurrent VFA revealed 25 spine factures in which 14 were osteoporotic, seven were osteopenic, and four had normal bone density. The efficacy of the pre-BMD FRAX score to identify those patients with low bone mass by DXA was 87.3% (55/63). When VFA was combined with BMD to identify those patients with high risk (osteopenia, osteoporosis, or spinal fracture), the efficacy of the pre-BMD score increased to 93.7% (59/63). According to the National Osteoporosis Foundation, the overall concordance between pre-BMD FRAX and BMD, expressed through the kappa index, was 0.967. Compared with the evaluation when BMD was used alone, there was a significant increase in efficacy in identifying women who need treatment using BMD plus VFA or FRAX plus BMD. Furthermore, the highest efficacy was achieved when FRAX with BMD and VFA was used.
  
  
  CONCLUSIONS
  The pre-BMD FRAX score not only efficiently predicts postmenopausal patients who are potentially at risk and might require treatment but also reduces unnecessary DXA use. Concurrent VFA during DXA use increases spine fracture detection. This improvement in diagnostic efficacy allows clinicians to provide the most appropriate therapeutic recommendation.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan.
authors.forename: An-Shine
authors.initials: AS
authors.lastname: Chao
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan. Electronic address: fangping@cgmh.org.tw.
authors.forename: Fang-Ping
authors.initials: FP
authors.lastname: Chen
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan.
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan.
authors.forename: Ting-Shuo
authors.initials: TS
authors.lastname: Huang
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Fan
authors.affiliation: Department of Medical Research and Development, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan.
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Yu
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000517:prevention & control*; D017698:Postmenopause; D018570:Risk Assessment / Q000379:methods*; D016103:Spinal Fractures / Q000175:diagnosis; D013624:Taiwan; D019564:Unnecessary Procedures
keywords: Fracture Risk Assessment Tool; bone mineral density; dual-energy X-ray absorptiometry; osteoporosis; vertebral fracture assessment