Intervention Threshold of FRAX® Without Bone Mineral Density in Healthy Postmenopausal Women in Wuxi Area Based on ROC Curve

LIAO Yitao; ZHANG Xian; QIU Feng; LIU Xiaofeng; LI Chao

doi:10.13730/j.issn.2097-2148.2024.01.007

Abstract：Objective To explore the optimal intervention threshold of FRAX® for postmenopausal women with relative health in Wuxi area without using bone mineral density,aiming to effectively identify potential populations with osteoporosis(OP)without wasting too many resources.Methods A total of 124 healthy postmenopausal women aged 50 years and above who met the inclusion criteria were randomly recruited from the author's hospital,they were divided into the 50-65-year-old group(n=86)and＞65-year-old group(n=38)taking the age of 65 as the cutoff point.Personal in-formation such as age,body mass index(BMI),history of osteoporotic fractures and history of chronic diseases were col-lected from the subjects.The FRAX® software was used to calculate the probability of hip fractures(PHF)and probabil-ity of major osteoporotic fractures(PMOF)for the subjects.Using whether the T-score of bone density was less than-2.5 as the state variable and the PHF and PMOF without incorporating the T-score of bone mineral density as the diag-nostic variables,the receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the efficiency of clinical screening for OP and determine the optimal intervention threshold for middle-aged and elderly postmenopausal women with relative health in Wuxi area.Results There were 39 patients with OP(45.35％)in the 50-65-year-old group and 23 patients with OP(60.53％)in the＞65-year-old group.ROC curve showed that AUC of PHF in 50-65-year-old group was 0.771,the sensitivity was 0.718,the specificity was 0.681 and the best threshold value was 0.7％;the AUC of PMOF was 0.748,the sensitivity was 0.667,the specificity was 0.723 and the best threshold was 3.4％.The AUC of PHF in＞65-year-old group was 0.554,the sensitivity was 0.783 and the specificity was 0.400;the AUC of PMOF was 0.546,the sensitivity was 0.826 and the specificity was 0.400,the AUC of PHF and PMOF in＞65-year-old group was nearly 0.5,which indicating that the accuracy of the prediction was low.According to Guidelines for the Diagnosis and Treatment of Primary Osteoporosis,the threshold of PHF and PMOF were recommended to determine the risk of fracture,all the patients in 50-65-year-old group were at low risk of fracture,there were 30 patients at low risk of fracture and 8 patients at high risk of fracture in＞65-year-old group,the fracture risk of the patients in this study was underestimated.Conclusion PHF 0.7％and PMOF 3.4％are recommended as FRAX® intervention thresholds for healthy postmenopausal women aged 50-65 in Wuxi area,if the threshold is higher than this value,bone mineral density testing is recommended and appropriate treatment measures are underwent;for postmenopausal women aged over 65 with relative health,it is recommended to directly undergo bone mineral density test.