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Zhang J, Xia L, Zhang X, Liu J, Tang J, Xia J, Liu Y, Zhang W, Liang Z, Tang G, Zhang L. Development and validation of a predictive model for vertebral fracture risk in osteoporosis patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3242-3260. [PMID: 38955868 DOI: 10.1007/s00586-024-08235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/22/2024] [Accepted: 03/17/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This study aimed to develop and validate a predictive model for osteoporotic vertebral fractures (OVFs) risk by integrating demographic, bone mineral density (BMD), CT imaging, and deep learning radiomics features from CT images. METHODS A total of 169 osteoporosis-diagnosed patients from three hospitals were randomly split into OVFs (n = 77) and Non-OVFs (n = 92) groups for training (n = 135) and test (n = 34). Demographic data, BMD, and CT imaging details were collected. Deep transfer learning (DTL) using ResNet-50 and radiomics features were fused, with the best model chosen via logistic regression. Cox proportional hazards models identified clinical factors. Three models were constructed: clinical, radiomics-DTL, and fusion (clinical-radiomics-DTL). Performance was assessed using AUC, C-index, Kaplan-Meier, and calibration curves. The best model was depicted as a nomogram, and clinical utility was evaluated using decision curve analysis (DCA). RESULTS BMD, CT values of paravertebral muscles (PVM), and paravertebral muscles' cross-sectional area (CSA) significantly differed between OVFs and Non-OVFs groups (P < 0.05). No significant differences were found between training and test cohort. Multivariate Cox models identified BMD, CT values of PVM, and CSAPS reduction as independent OVFs risk factors (P < 0.05). The fusion model exhibited the highest predictive performance (C-index: 0.839 in training, 0.795 in test). DCA confirmed the nomogram's utility in OVFs risk prediction. CONCLUSION This study presents a robust predictive model for OVFs risk, integrating BMD, CT data, and radiomics-DTL features, offering high sensitivity and specificity. The model's visualizations can inform OVFs prevention and treatment strategies.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Clinical Medical College of Nanjing Medical University, 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
- Department of Radiology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, 211002, Jiangsu, People's Republic of China
| | - Liang Xia
- Department of Radiology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, 211002, Jiangsu, People's Republic of China.
| | - Xueli Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Jiayi Liu
- Department of Radiology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, 211002, Jiangsu, People's Republic of China
| | - Jun Tang
- Department of Radiology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, 366 Taihu Road, Taizhou, 225300, Jiangsu, People's Republic of China
| | - Jianguo Xia
- Department of Radiology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, 366 Taihu Road, Taizhou, 225300, Jiangsu, People's Republic of China.
| | - Yongkang Liu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing, 210004, Jiangsu, People's Republic of China
| | - Weixiao Zhang
- Department of Radiology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, 211002, Jiangsu, People's Republic of China
| | - Zhipeng Liang
- Department of Radiology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, 211002, Jiangsu, People's Republic of China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital, Clinical Medical College of Nanjing Medical University, 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China.
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China.
| | - Lin Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China.
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Cheung CL. Enhancing osteoporosis management through risk assessment tools. Osteoporos Sarcopenia 2024; 10:45-46. [PMID: 39035226 PMCID: PMC11260003 DOI: 10.1016/j.afos.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 07/23/2024] Open
Affiliation(s)
- Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong Special Administrative Region, China
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Sheng YH, Wu TY, Liaw CK, Hsiao SH, Kuo KL, Tsai CY. Real world fracture prediction of fracture risk assessment tool (FRAX), osteoporosis self-assessment tool for Asians (OSTA) and one-minute osteoporosis risk test: An 11-year longitudinal study. Bone Rep 2024; 20:101742. [PMID: 38404728 PMCID: PMC10884405 DOI: 10.1016/j.bonr.2024.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Fractures affect people's quality of life especially in the elders. One of the most important risk factors is osteoporosis. There are many screening tools to predict osteoporosis and fractures. We aimed to compare the predictive validity of three commonly used screening tools: fracture risk assessment tool (FRAX), osteoporosis self-assessment tool for Asians (OSTA) and one-minute osteoporosis risk test. Among them, OSTA and one-minute osteoporosis risk test were originally developed to predict osteoporosis risks and FRAX was to predict fracture risks. Methods This is an 11-year longitudinal study. We enrolled 708 senior people from health examinees in Taiwan in 2010. A standardized questionnaire and blood tests were provided. Annual telephone interview was conducted to assess the real fracture status. We calculated risk scores of FRAX, OSTA, and one-minute osteoporosis risk test and compared with real-world fracture records. Results The mean age of the participants were 74.9 (SD 6.4). There were 356 (50.3 %) men. From 2010 to 2020, a total of 105 (14.8 %) persons suffered from fractures. Compared to people without fractures, people with fractures had higher FRAX major osteoporotic fracture risk scores (14.0 % ± 7.6 % vs.11.3 % ± 5.7 %), higher hip fracture risk scores, and higher OSTA risk (5.9 % ± 1.4 % vs. 5.3 % ± 1.3 %). Cox regression analysis showed that hazard ratios for fracture of high FRAX risk was 1.53 (95 % confidence interval (CI) 1.05-2.21), and for high OSTA risk was 1.37 (95 % CI 1.04-1.82). Conclusions Only OSTA and FRAX scores were satisfactory in predicting 10-year fractures.
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Affiliation(s)
- Yueh-Hsuan Sheng
- Department of Family Medicine, Renai Branch, Taipei City Hospital, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, No. 145, Zhengzhou Rd., Datong Dist., Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City, Taiwan
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe Dist., New Taipei City, Taiwan
- Research Center of Biomedical Device, College of Biomedical Engineering, Graduate Institute of Biomedical Optomechatronics, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, Taiwan
- TMU Biodesign Center, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, Taiwan
| | - Sheng-Huang Hsiao
- Department of Neurosurgery, Taipei City Hospital, Renai Branch, No. 10, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City, Taiwan
- Department of Psychology, National Chengchi University, No. 64, Sec. 2, Zhinan Rd., Wenshan Dist., Taipei City, Taiwan
| | - Kuan-Liang Kuo
- Department of Family Medicine, Renai Branch, Taipei City Hospital, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City, Taiwan
- The Bachelor's Program in Medical Informatics and Innovative Applications, Fu Jen University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, Taiwan
| | - Ching-Yao Tsai
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, Taiwan
- Department of Ophthalmology, Taipei City Hospital, No. 145, Zhengzhou Rd., Datong Dist., Taipei City, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City, Taiwan
- Department of Business Administration, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, Taiwan
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Chong JW, Chan TS, Lee JC. Identification of people with high risk of osteoporosis in Asia. Osteoporos Sarcopenia 2023; 9:112. [PMID: 37941535 PMCID: PMC10627864 DOI: 10.1016/j.afos.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 11/10/2023] Open
Affiliation(s)
- Jia Wen Chong
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Tik S Chan
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Joseph C Lee
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
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Pisani P, Conversano F, Muratore M, Adami G, Brandi ML, Caffarelli C, Casciaro E, Di Paola M, Franchini R, Gatti D, Gonnelli S, Guglielmi G, Lombardi FA, Natale A, Testini V, Casciaro S. Fragility Score: a REMS-based indicator for the prediction of incident fragility fractures at 5 years. Aging Clin Exp Res 2023; 35:763-773. [PMID: 36752950 PMCID: PMC10115670 DOI: 10.1007/s40520-023-02358-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Accurate estimation of the imminent fragility fracture risk currently represents a challenging task. The novel Fragility Score (FS) parameter, obtained during a Radiofrequency Echographic Multi Spectrometry (REMS) scan of lumbar or femoral regions, has been developed for the non-ionizing estimation of skeletal fragility. AIMS The aim of this study was to assess the performance of FS in the early identification of patients at risk for incident fragility fractures with respect to bone mineral density (BMD) measurements. METHODS Data from 1989 Caucasians of both genders were analysed and the incidence of fractures was assessed during a follow-up period up to 5 years. The diagnostic performance of FS to discriminate between patients with and without incident fragility fracture in comparison to that of the BMD T-scores measured by both Dual X-ray Absorptiometry (DXA) and REMS was assessed through ROC analysis. RESULTS Concerning the prediction of generic osteoporotic fractures, FS provided AUC = 0.811 for women and AUC = 0.780 for men, which resulted in AUC = 0.715 and AUC = 0.758, respectively, when adjusted for age and body mass index (BMI). For the prediction of hip fractures, the corresponding values were AUC = 0.780 for women and AUC = 0.809 for men, which became AUC = 0.735 and AUC = 0.758, respectively, after age- and BMI-adjustment. Overall, FS showed the highest prediction ability for any considered fracture type in both genders, resulting always being significantly higher than either T-scores, whose AUC values were in the range 0.472-0.709. CONCLUSION FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk.
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Affiliation(s)
- Paola Pisani
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | | | | | - Giovanni Adami
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, Verona, Italy
| | | | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Ernesto Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Marco Di Paola
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Roberto Franchini
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | | | | | - Valentina Testini
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Sergio Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy.
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Cheung CL, Li GHY, Li HL, Mak C, Tan KCB, Kung AWC. Development and validation of the Chinese osteoporosis screening algorithm (COSA) in identification of people with high risk of osteoporosis. Osteoporos Sarcopenia 2023; 9:8-13. [PMID: 37082357 PMCID: PMC10111958 DOI: 10.1016/j.afos.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
Objectives To enhance the public awareness and facilitate diagnosis of osteoporosis, we aim to develop a new Chinese Osteoporosis Screening Algorithm (COSA) to identify people at high risk of osteoporosis. Methods A total of 4747 postmenopausal women and men aged ≥ 50 from the Hong Kong Osteoporosis Study were randomly split into a development (N = 2373) and an internal validation cohort (N = 2374). An external validation cohort comprising 1876 community-dwelling subjects was used to evaluate the positive predictive value (PPV). Results Among 11 predictors included, age, sex, weight, and history of fracture were significantly associated with osteoporosis after correction for multiple testing. Age- and sex-stratified models were developed due to the presence of significant sex and age interactions. The area under the curve of the COSA in the internal validation cohort was 0.761 (95% CI, 0.711-0.811), 0.822 (95% CI, 0.792-0.851), and 0.946 (95% CI, 0.908-0.984) for women aged < 65, women aged ≥ 65, and men, respectively. The COSA demonstrated improved reclassification performance when compared to Osteoporosis Self-Assessment Tool for Asians. In the external validation cohort, the PPV of COSA was 40.6%, 59.4%, and 19.4% for women aged < 65, women aged ≥ 65, and men, respectively. In addition, COSA > 0 was associated with an increased 10-year risk of hip fracture in women ≥ 65 (OR, 4.65; 95% CI, 2.24-9.65) and men (OR, 11.51; 95% CI, 4.16-31.81). Conclusions We have developed and validated a new osteoporosis screening algorithm, COSA, specific for Hong Kong Chinese.
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Affiliation(s)
- Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
- Corresponding author. Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Gloria HY. Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
| | - Hang-Long Li
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Constance Mak
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Kathryn CB. Tan
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Annie WC. Kung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
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Yang JJ, Yen HK, Li CY, Chen HJ, Liou HH, Fu SH, Wang CY. Ten existing osteoporosis prediction tools for the successful application of National Health Insurance-reimbursed anti-osteoporosis medications in long-term care residents in Taiwan. J Formos Med Assoc 2023; 122:139-147. [PMID: 36041990 DOI: 10.1016/j.jfma.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/01/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND/PURPOSE Osteoporotic fracture introduce enormous societal and economic burden, especially for long-term care residents (LTCRs). Although osteoporosis prevention for LTCRs is urgently needed, obstacles such as frail status and inconvenient hospital visits hurdled them from necessary examinations and diagnoses. We aimed to test 10 existing osteoporosis screening tools (OSTs), which can be easily used in institutions and serve as a prediction, for accurately determining the outcome of a Taiwan's National Health Insurance (NHI)-reimbursed anti-osteoporosis medications (AOMs) application for LTCRs. METHODS This prospective analysis recruited 444 patients from LTC institutions between October 2018 and November 2019. Predictions of whether the NHI-reimbursed AOMs criteria was met were tested for 10 OSTs. The results of OSTs categorized into self-reported or validated based on previous fracture history were self-reported by LTCRs or validated by imaging data and medical records, respectively. The receiver operating characteristic curve and the optimal cut-off points for LTCRs based on Youden's index were explored. RESULTS Overall, the validated OSTs had a higher positive predictive value (PPV) and negative predictive value (NPV) summation than the corresponding reported OSTs. The validated FRAX-Major was the best OST (PPV = 63.6%, NPV = 82.4% for the male group and, PPV = 78.8%, NPV = 90.0% for the female group). After applying the optimum cut-off derived from Youden's index, the validated FRAX-Major (PPV = 75.4%, NPV = 92.0%)) remained performed best for men. In female population, validated FRAX-Major (PPV = 87.2%, NPV = 84.1%) and validated osteoporosis prescreening risk assessment (OPERA; PPV = 96.1%, NPV = 79.7%)) both provided good prediction results. CONCLUSION FRAX-Major and OPERA have better prediction ability for LTCRs to acquire NHI-reimbursed AOMs. The validated fracture history and adjusted cut-off points could prominently increase the PPV during prediction.
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Affiliation(s)
- Jiun-Jen Yang
- Department of Medical Education, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hung-Kuan Yen
- Department of Medical Education, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chung-Yi Li
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Hong-Jhe Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Horng-Huei Liou
- Department of Neurology, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Shau-Huai Fu
- Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan.
| | - Chen-Yu Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yun-Lin County, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Mustamsir E, Irsan II, Huwae TECJ, Yudistira A, Pradana AS, Sugiarto MA, Siahaan LD, Rahmad. Study epidemiology of risk fracture in osteoporosis based on frax score, and osta score, with risk of fall using Ontario score in elderly Indonesia. J Public Health Res 2022; 11:22799036221115777. [PMID: 36147208 PMCID: PMC9486270 DOI: 10.1177/22799036221115777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Osteoporosis is characterized by a low bone mass of bone tissue. If
osteoporosis is not treated properly, it will increase the high risk of
fracture. The common causes of fracture on osteoporosis condition due to
falls. This study aims to find the correlation between the risk of
osteoporosis with fall risk (ONTARIO) based on osteoporosis fracture risk
(FRAX) Methods: This study is an analytic study with a cross-sectional method. We collected
the sample using random cluster sampling in the six primary health care in
Malang on different times service since August–September 2021. Total patient
139, however only 132 patients were included in this study. After collecting
data is complete, we analyze using Chi-square tests. Results: The mean age of participants was 63.9 ± 7.14. with the age group was
dominated by the range of 60–64. It was found that the result of the FRAX
SCORE had a low-risk category for major fracture osteoporosis and risk hip
fracture. In contrast, from the OSTA score in this study, more than 68
participants (50.8%) were found medium and high-risk scores. Then, in
ONTARIO score of the risk fall assessment, and high score in 57 participants
(43.2%). If compared between OSTA and ONTARIO, there was a significant
relationship between OSTA score and ONTARIO score
(p < 0.000) with high-risk OSTA have a significant
relationship with a high risk of falling and vice versa. Conclusion: In this study, there was a relationship between the risk of high osteoporosis
and the risk of falling.
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Affiliation(s)
- Edi Mustamsir
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Istan Irmansyah Irsan
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Thomas E C J Huwae
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Andhika Yudistira
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Ananto Satya Pradana
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Muhammad Alwy Sugiarto
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Lasa Dhakka Siahaan
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Rahmad
- Physical Medicine and Rehabilitation Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
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Tay CL, Ng WL, Beh HC, Lim WC, Hussin N. Screening and management of osteoporosis: a survey of knowledge, attitude and practice among primary care physicians in Malaysia. Arch Osteoporos 2022; 17:72. [PMID: 35474021 PMCID: PMC9041673 DOI: 10.1007/s11657-022-01111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/18/2022] [Indexed: 02/03/2023]
Abstract
We surveyed primary care physicians in Malaysia for their knowledge, attitude and practice in screening and managing osteoporosis. We found a low level of screening and active management of osteoporosis in the primary care setting despite positive attitudes towards them. We advocate for the active management of osteoporosis at the primary care level. INTRODUCTION Prevention of osteoporotic fracture is important in primary healthcare for healthy ageing. Little is known about the knowledge, attitude, practice and barriers in the screening and managing osteoporosis among primary care doctors. METHODS A cross-sectional study, using an online pre-tested questionnaire after face and content validation, was conducted for primary care doctors from 1 June to 30 July 2021 across Malaysia. Pearson's chi-square test and logistic regression were employed. RESULTS A total of 350 primary care doctors in Malaysia, consisting of 113 (32.3%) family medicine specialists (FMS) and 237 (67.7%) medical officers, participated in this study. The mean ± SD score of osteoporosis knowledge was 50.46 ± 15.09 with minimum and maximum values of 0 and 83.64%, respectively. One hundred and ten (31.4%) respondents achieved a satisfactory overall knowledge score of ≥ 60%, 156 (44.6%) were confident in advising patients for initiation of anti-osteoporotic medication, and 243 (69.4%) perceived that bisphosphonate should be made available in health clinics. Only 97 (27.7%) practised osteoporosis screening. Inaccessibility of bone mineral densitometry (BMD) (90.6%), inadequate knowledge (87.7%) and inaccessibility of pharmacotherapy (87.1%) are perceived modifiable barriers to osteoporosis screening and management. Factors associated with a satisfactory knowledge of osteoporosis are designation as a family medicine specialist (AOR 3.034, p = 0.002), attendance at an osteoporosis management update course (AOR 2.095, p = 0.034) and the practice of osteoporosis screening for the elderly (AOR 2.767, p = 0.001). CONCLUSION Given the insufficient knowledge and low level of osteoporosis screening, there is a need for a national structured health programme to address the knowledge gap, increase screening practices and enhance accessibility to BMD and anti-osteoporosis medication in primary care.
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Affiliation(s)
- Chai Li Tay
- Simpang Health Clinic, Health District Office of Larut, Matang and Selama, Ministry of Health Malaysia, Perak, Malaysia
| | - Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Hooi Chin Beh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wan Chieh Lim
- Geriatric Medicine Unit, Department of Internal Medicine, Taiping Hospital, Ministry of Health Malaysia, Perak, Malaysia
| | - Narwani Hussin
- Clinical Research Centre, Taiping Hospital, Ministry of Health Malaysia, Perak, Malaysia
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Bui MH, Dao PT, Khuong QL, Le PA, Nguyen TTT, Hoang GD, Le TH, Pham HT, Hoang HXT, Le QC, Dao XT. Evaluation of community-based screening tools for the early screening of osteoporosis in postmenopausal Vietnamese women. PLoS One 2022; 17:e0266452. [PMID: 35381025 PMCID: PMC8982873 DOI: 10.1371/journal.pone.0266452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Osteoporosis affects people worldwide. However, there are few validated tools for the early screening of osteoporosis in Vietnam. We set out to evaluate the performance of the osteoporosis self-assessment tool for Asians (OSTA) and the osteoporosis screening tool for Chinese (OSTC) for the early screening of osteoporosis in postmenopausal Vietnamese women. Methods We analyzed retrospective data from 797 postmenopausal Vietnamese women. The bone mineral density (BMD) in the lumbar vertebrae (L1–L4) and the left and right femoral necks of all participants were measured using dual-energy X-ray absorptiometry (DXA). Osteoporosis was defined as the BMD (T-score) < -2.5. The OSTA and OSTC scores were calculated from the age and weight of participants. Receiver operating characteristic analysis was conducted to compare the performance of the two tools with the BMD measurements by DXA at different anatomical sites. Results The rates of osteoporosis determined by BMD varied between anatomical sites, and ranged from 43.4% to 54.7% in the lumbar vertebrae and 29.2% and 8.9% in the left and right femoral necks, respectively. For the vertebrae, the area under the curve (AUC) for OSTA ranged from 70.9% to 73.9% and for OSTC ranged from 68.7% to 71.6%. The predictive value of both tools was higher for femoral necks, with the AUC of OSTA for the left and right femoral necks being 80.0% and 85.8%, respectively. The corresponding figures for OSTC were 80.5% and 86.4%, respectively. The highest sensitivity and specificity of OSTA were 74.6% and 81.4%, while these figures for OSTC were 73.9% and 82.6%, respectively. Conclusion OSTA and OSTC were shown to be useful self-assessment tools for osteoporosis detection in Vietnam postmenopausal women. Further research is encouraged to determine the applicability of tools for other populations and settings.
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Affiliation(s)
- My Hanh Bui
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Phuoc Thang Dao
- Interactive Research and Development, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Tu Hoang Le
- Viet Duc Hospital, Hoan Kiem, Hanoi, Vietnam
| | - Hoai Thu Pham
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | | | - Xuan Thanh Dao
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
- * E-mail:
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11
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E E, Wang T, Yang L, Dempsey M, Brennan A, Yu M, Chan WP, Whelan B, Silke C, O'Sullivan M, Rooney B, McPartland A, O'Malley G, Carey JJ. Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project. J Clin Densitom 2021; 24:516-526. [PMID: 33789806 DOI: 10.1016/j.jocd.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/11/2022]
Abstract
Many algorithms have been developed and publicised over the past 2 decades for identifying those most likely to have osteoporosis or low BMD, or at increased risk of fragility fracture. The Osteoporosis Self-assessment Tool index (OSTi) is one of the oldest, simplest, and widely used for identifying men and women with low BMD or osteoporosis. OSTi has been validated in many cohorts worldwide but large studies with robust analyses evaluating this or other algorithms in adult populations residing in the Republic of Ireland are lacking, where waiting times for public DXA facilities are long. In this study we evaluated the validity of OSTi in men and women drawn from a sampling frame of more than 36,000 patients scanned at one of 3 centres in the West of Ireland. 18,670 men and women aged 40 years and older had a baseline scan of the lumbar spine femoral neck and total hip available for analysis. 15,964 (86%) were female, 5,343 (29%) had no major clinical risk factors other than age, while 5,093 (27%) had a prior fracture. Approximately 2/3 had a T-score ≤-1.0 at one or more skeletal sites and 1/3 had a T-score ≤-1.0 at all 3 skeletal sites, while 1 in 5 had a DXA T-score ≤-2.5 at one or more skeletal sites and 5% had a T-score ≤-2.5 at all 3 sites. OSTi generally performed well in our population with area under the curve (AUC) values ranging from 0.581 to 0.881 in men and 0.701 to 0.911 in women. The performance of OSTi appeared robust across multiple sub-group analyses. AUC values were greater for women, proximal femur sites, those without prior fractures and those not taking osteoporosis medication. Optimal OSTi cut-points were '2' for men and '0' for women in our study population. OSTi is a simple and effective tool to aid identification of Irish men and women with low BMD or osteoporosis. Use of OSTi could improve the effectiveness of DXA screening programmes for older adults in Ireland.
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Affiliation(s)
- Erjiang E
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lan Yang
- Department of Industrial Engineering, Tsinghua University, Beijing, China; School of Engineering, National University of Ireland, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Bryan Whelan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Carmel Silke
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Miriam O'Sullivan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Bridie Rooney
- Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - Aoife McPartland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Gráinne O'Malley
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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12
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Ang SB, Xia JY, Cheng SJ, Chua MT, Goh L, Dhaliwal SS. A pilot screening study for low bone mass in Singaporean women using years since menopause and BMI. Climacteric 2021; 25:163-169. [PMID: 33928868 DOI: 10.1080/13697137.2021.1908989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Current risk assessment tools for osteoporosis have inconsistent performance across different cohorts, making them difficult for clinical practice. This study aimed to evaluate a simple screening index comprising years since menopause (YSM) and body mass index (BMI) that identifies postmenopausal Singaporean women with a greater likelihood of low bone mass. METHODS The study used data from 188 treatment-naïve postmenopausal women. The associations between low bone mass and different demographic variables, including age, YSM and BMI, were assessed using multivariable logistic regression. Diagnostic performance of the calculated screening index was compared to the Osteoporosis Self-Assessment Tool for Asians (OSTA) and the Fracture Risk Assessment Tool (FRAX®). RESULTS YSM and BMI were significantly associated with low bone mass. The area under the receiver operating characteristic curves was 0.803 for the screening index, 0.759 for the OSTA, 0.683 for the FRAX® (major osteoporotic fracture probability [MOFP]) and 0.647 for the FRAX® (hip fracture probability [HFP]). Non-parametric Spearman's correlation between the screening index and the other models was 0.857 with the OSTA score, 0.694 with the FRAX® (HFP) and 0.565 with the FRAX® (MOFP) (p < 0.0005). CONCLUSIONS The diagnostic performance of the screening index comprising YSM and BMI was equivalent to the OSTA and the FRAX®. A risk chart was developed for clinicians to identify and recommend subjects for a further dual-energy X-ray absorptiometry scan. Validation of this model in larger and more diverse cohorts is required.
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Affiliation(s)
- S B Ang
- Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Menopause Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - J Y Xia
- Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - S J Cheng
- Menopause Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - M T Chua
- Menopause Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - L Goh
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - S S Dhaliwal
- Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Menopause Unit, KK Women's and Children's Hospital, Singapore, Singapore.,Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia, Australia
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13
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Lulla D, Teo CW, Shen X, Loi ZBJ, Quek KW, Lis HLA, Koh SA, Chan ET, Lim SWC, Low LL. Assessing the knowledge, attitude and practice of osteoporosis among Singaporean women aged 65 years and above at two SingHealth polyclinics. Singapore Med J 2021; 62:190-194. [PMID: 33948668 DOI: 10.11622/smedj.2021039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Singapore has one of the world's most rapidly ageing populations. Osteoporosis is associated with significant morbidity and mortality from hip fractures in the elderly. This pilot study aims to evaluate the knowledge, attitude and practice of osteoporosis among Singaporean women aged ≥ 65 years, and assess barriers to osteoporosis screening. METHODS We conducted a cross-sectional survey of 99 English-speaking women aged ≥ 65 years at two SingHealth polyclinics by convenience sampling. The validated Osteoporosis Prevention and Awareness Tool was used to assess their knowledge about osteoporosis prevention and awareness and perceived barriers to osteoporosis screening. Osteoporosis health education was provided, and bone mineral density (BMD) screening was offered to all participants. RESULTS The response rate was 91.6%. The majority of the participants (54.5%) had low knowledge of osteoporosis, and only 12.1% had high knowledge scores. Higher education levels were associated with higher knowledge scores (p = 0.018). Although participants with higher knowledge scores were more willing to undergo osteoporosis screening, these findings did not reach statistical significance (p = 0.067). The top reasons for declining BMD testing were misconceptions that lifestyle management is sufficient to prevent osteoporosis, poor awareness and knowledge of the disease, and the perceived high cost of BMD testing. CONCLUSION Interventions should focus on osteoporosis education and, eventually, BMD screening for less-educated patients. Health education should rectify common misconceptions of the disease, increase awareness of osteoporosis and improve screening rates.
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Affiliation(s)
- Dypti Lulla
- SingHealth Polyclinics - Marine Parade, Singapore
| | | | - XiaoYou Shen
- SingHealth Polyclinics - Marine Parade, Singapore
| | | | | | | | | | | | | | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
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Chandran M, Ganesan G, Tan K, Reginster JY, Hiligsmann M. Cost-effectiveness of FRAX®-based intervention thresholds for management of osteoporosis in Singaporean women. Osteoporos Int 2021; 32:133-144. [PMID: 32797250 PMCID: PMC7755873 DOI: 10.1007/s00198-020-05536-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
UNLABELLED Cost-effectiveness analysis of FRAX® intervention thresholds (ITs) in Singaporean women > 50 years of age showed that generic alendronate was cost-effective at age-dependent major osteoporotic fracture (MOF) IT from the ages of 65 years for both full and real-world adherence whilst hip fracture (HF) ITs were cost-effective from the ages of 60 and 65 years. Alendronate was cost-effective irrespective of age only at fixed MOF IT of 14% and HF IT of 3.5%. INTRODUCTION FRAX®-based intervention thresholds (ITs) were recently identified for osteoporosis management in Singapore. This study aimed to assess the cost-effectiveness of ITs in Singaporean women over the age of 50 years. METHODS A validated Markov microsimulation model was used to estimate the lifetime healthcare costs (SGD2019) per quality-adjusted life-years (QALY) of generic alendronate compared with no treatment. Cost-effectiveness of age-dependent FRAX® major osteoporotic fracture (MOF) and hip fracture (HF) ITs was explored. In addition, ITs that would lead to cost-effectiveness were computed. Fracture incidence and cost data were obtained from the Ministry of Health and a previously published Singaporean study. A cost-effectiveness threshold of SGD 62,500/QALY gained was used, based conservatively on 0.7 times the Singapore GDP per capita. RESULTS Generic alendronate was shown to be cost-effective at MOF ITs from the ages of 65 years, while HF ITs were cost-effective from the ages of 60 and 65 years, assuming full and real-world adherence, respectively. A 14% MOF and a 3.5% HF ITs were required for alendronate to be cost-effective above 50 years. CONCLUSION This study suggests that the treatment of Singaporean women with alendronate is cost-effective at age-dependant FRAX® intervention thresholds at 65 years and older. Furthermore, identifying women at any age above 50 years with a 10-year risk of MOF or HF of 14% or 3.5% would lead to efficient use of resources. Cost-effective access to therapy for patients at high fracture probability based on FRAX® could contribute to reduce the growing burden of osteoporotic fractures in Singapore.
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Affiliation(s)
- M. Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - G. Ganesan
- Ministry of Health, Singapore, Singapore
| | - K.B. Tan
- Ministry of Health, Singapore, Singapore
- School of Public Health, National University of Singapore, Singapore, Singapore
| | - J.-Y. Reginster
- Center for Investigation in Bone and Articular Cartilage, University of Liege, Liège, Belgium
| | - M. Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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