title: Evaluation of three risk assessment tools in discriminating fracture status among Chinese patients undergoing hemodialysis.
abstract: We evaluated three risk assessment tools, including bone mineral density (BMD) measurement by dual energy X-ray absorptiometry (DXA), osteoporosis self-assessment tool for Asians (OSTA), and fracture risk assessment tool (FRAX), for the prediction of fracture status among Chinese patients undergoing hemodialysis. All of the three assessment tools have a reasonable capability in discriminating fractures.
  
  
  
  Fractures are common in hemodialysis patients however insufficiently assessed. Our study aimed to assess the ability of three widely used tools [BMD, OSTA, and FRAX] to discriminate fracture status in patients with renal failure undergoing hemodialysis.
  
  
  
  We enrolled 136 hemodialysis patients in a tertiary teaching hospital setting. BMD was measured using DXA at the lumbar spine and the hip region. OSTA was calculated from weight and age. FRAX score was calculated based upon online availability. Discriminative abilities of BMD, OSTA, and FRAX in fracture status were analyzed by receiver operator characteristic (ROC) curves.
  
  
  
  There were total 16 fractures (11.76 %) identified in 136 hemodialysis patients. BMD at any site (lumbar spine L1-L4, femoral neck, and total hip) was independently associated with fracture. Areas under the curves (AUC) of BMD (lumbar spine L1-L4, femoral neck, total hip), OSTA, FRAX1 (non-BMD model), and FRAX2 (BMD model) were 0.669 (95 % CI 0.583, 0.747), 0.708 ( 95 % CI 0.624, 0.783), 0.736 (95 % CI 0.654, 0.808), 0.686 (95 % CI 0.601, 0.763), 0.715 (95 % CI 0.631, 0.789), and 0.697 (95 % CI 0.613, 0.773), respectively. The differences of their performance were not significant.
  
  
  
  All of the three risk assessment tools had the ability to discriminate fracture status among hemodialysis patients; FRAX BMD model did not improve the discriminative ability of BMD or FRAX non-BMD model alone.
authors.affiliation: Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: A-J
authors.initials: AJ
authors.lastname: Chang
authors.affiliation: Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. qiany69@163.com.|Department of Nephrology, Shanghai Ruijin Hospital, No.197 Ruijin 2nd Road, Luwan District, Shanghai, China. qiany69@163.com.
authors.forename: Q
authors.initials: Q
authors.lastname: Ying
authors.affiliation: Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: X-N
authors.initials: XN
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: W-M
authors.initials: WM
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: N
authors.initials: N
authors.lastname: Chen
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors
keywords: Bone mineral density; FRAX; Fracture; Hemodialysis; OSTA