Application Study Of FRAX Tool For Assessment Of Osteoporotic Fracture Risk In Maintenance Hemodialysis Patients Combined With DXA

Objective:To investigate the applicability of fracture risk assessment tool(FRAX)combined with dual energy x-ray absorptiometry(DXA)in evaluating the fracture risk of maintenance hemodialysis(MHD)patients in hechi.Methods:From October 2020 to March 2021,a total of 75 MHD patients in hechi people’s hospital were selected.The information was collected in the form of questionnaire,and then input into the FRAX tool calculator to obtain the probability of major osteoporotic fracture(MOF)and hip fracture(HF)in the next 10 years.According to the with and without BMD,four groups of probability values can be obtained:the probability of major osteoporotic fracture without BMD,the probability of major osteoporotic fracture with BMD,the probability of hip fracture without BMD,and the probability of hip fracture with BMD.Making groups comparison according to gender,fracture and osteoporosis(OP).Finally,the HSA Parameters of cross-surface area(CSA),cross-sectional moment of inertia(CSMI),cross-sectional modulus(Z),cortical thickness(CT)and buckling ratio(BR)with narrow neck(NN),intertrochanteric(IT)and femur shaft(FS)related to HF and its threshold were obtained by multiple stepwise regression analysis and diagnostic analysis.The test level isα=0.05.Results:(1)The study included 75 patients,including 38 males and 37 females,Osteopenia in 39 cases and osteoporosis in 33 cases.There were 18 patients with previous fractures,including 14 patients with major fractures,4 patients with hip fractures and 57patients without fractures.(2)Through diagnostic test analysis,the AUC area for recognition of major fracture by the FRAX tool with or without BMD were 0.86 and 0.81,and the AUC area for recognition of hip fractures were 0.77 and 0.62 in two models.According to age,gender and osteoporosis diagnosis,all patients were divided into groups.In all groups,there was no significant difference between the two models at the age of≥70 years(P>0.05).In the gender and osteoporosis subgroups,There is no difference in BMD-HF and HF without BMD between female group and non-osteoporosis group(P>0.05).There were significant differences among other groups in the age groups of<50 years,50-59 years and 60-69years(P<0.05).In addition,according to the fracture states,there was no significant difference between BMD-HF and HF without BMD in hip fracture group(P>0.05),while there were significant differences between the two modes in other fracture group(P<0.05).(3)By multiple stepwise regression analysis,the strong collinearity among independent variables was removed,and two parameters related to HF were obtained,which were NN-CSA and NN-BR.By ROC diagnostic analysis,the thresholds of NN-CSA and NN-BR were 2.35(cm~2)and 18.40.Conclusion:(1)The FRAX tool is suitable for the assessment of fracture risk in MHD patients.The evaluation efficiency of FRAX tool with BMD is better than that without BMD.It is recommended that MHD patients younger than 70 years old should use FRAX tool combined with BMD obtained by DXA measurement to evaluate fracture risk.(2)FRAX tool(with BMD)combined with HSA to analyze the risk of hip fracture in MHD patients is helpful to improve the accuracy of evaluation in theory.