The Clinical Value Of Applying The FRAX Tool To Assess Fracture Risk In Patients With Essential Hypertension

Objective:To evaluate the clinical value of the FRAX tool in assessing fracture risk in patients with essential hypertension.Methods:Based on the detection results of Dual-energy X-ray absorptiometry(DXA,Hologic Explorer,USA),568 patients diagnosed with Essential Hypertension who were hospitalized in The Third Affiliated Hospital of Nanchang University were divided into osteoporosis group,low bone density group and normal bone density group.And the age,height,weight,body mass index(BMI),lumbar spine bone mineral density(BMD)and Calcium(Ca),phosphorus(P),total cholesterol(TC),triglycerides(TG),high-density cholesterol lipoprotein(HDL-C),low-density cholesterol lipoprotein(LDL-C),homocysteine(HCY),fasting blood glucose(FBG)were compared between the groups.The 10-year probability of major osteoporosis fracture(PMOF)and the 10-year probability of hip fracture(PHF)were calculated by using the FRAX tool.PMOF≥20% or PHF≥3% were used as the initiating anti-osteoporosis treatment thresholds.The sensitivity,specificity and Youden index of FRAX tool were calculated,and the consistency of DXA and FRAX was compared.Based on the DXA test results and the calculation results of the FRAX tool,the patients were divided into treatment agreement group and disagreement group,and the clinical datas between the two groups were compared.Results:(1)Osteoporosis accounted for 40.85% of the total,low bone mineral density for28.52% and normal bone mineral density for 30.63%.The proportion of females in the osteoporosis group was significantly higher than that in the normal bone density group and low bone density group(69.4% vs 59.2% vs 50.62%,p=0.001);there was a significant difference in age among the three groups(p<0.001),and BMD tended to decrease as age increased;The BMI of osteoporosis group was significantly lower than that of the normal bone density group and low bone density group(p<0.001).(2)There were significantly differences in P,TC,HDL-C and LDL-C among the three groups(p=0.040,0.031,0.020,0.010);the HCY between the three groups was significantly different(p<0.001),and BMD tended to decrease with the increase of HCY.(3)When the PMOF≥20% as the threshold value to initiate anti-osteoporosis treatment,the sensitivity of FRAX too was 0.0431,specificity of Frax tool was 1,and Youden index was 0.0431;When the PHF≥3% as the threshold value to initiate anti-osteoporosis treatment,the sensitivity of FRAX too was 0.3879,specificity of Frax tool was 0.9911,and Youden index was 0.3790.Consistency analysis showed that the PMOF≥20% as the threshold for initiating anti-osteoporosis treatment had a poor consistency with DXA(kappa=0.051);The PHF≥3% as the threshold for initiating anti-osteoporosis treatment had a medium consistency with DXA(kappa=0.421).(4)The age of the treatment agreement group was lower than that of the treatment disagreement group(p<0.001);and weight,height,BMI,lumbar spine BMD and blood phosphorus levels were higher than tthe treatment disagreement group(p=<0.001,0.004,<0.001,<0.001,0.031).Conclusions:The FRAX tool has a good ability to assess the risk of hip fracture in patients with essential hypertension,with better accuracy especially in younger patients with higher weight,height,lumbar spine BMD and blood phosphorus levels.However,the ability to assess fracture risk at major sites is poor and more clinical studies are stillneeded to refine the FRAX tool and to develop intervention thresholds appropriate for Chinese patients with essential hypertension.