title: 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.
  
  
  CONCLUSIONS
  FRAX may be a valuable tool for identifying PNOVFs in older Chinese men.
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: JiSheng
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Fei
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: XiaoDong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: JinJun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Meng
authors.affiliation: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: BingQiang
authors.initials: B
authors.lastname: Wang
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015519:Bone Density; D016022:Case-Control Studies; D002681:China; D003430:Cross-Sectional Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging*; D010146:Pain / Q000209:etiology; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012647:Self-Assessment; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging*
keywords: FRAX; OSTA; bone mineral density; male; osteoporosis; vertebral fracture