Risk Assessment Of Osteoporosis And Osteoporotic Fractures Among The Elderly In Shanghai Community

Objective: 1.To evaluate the risk of osteoporosis among the elderly in Shanghai community applying osteoporosis self-assessment tool for Asians(OSTA)tool,and the effect of the screening tool;2.To predict the risk of osteoporotic fracture among the elderly in Shanghai community applying FRAX tool,and analysis of the risk factors of osteoporotic fracture.Methods:1.(1)3284 cases of clinical data in Shanghai community were collected,the application of OSTA to calculate the risk of osteoporosis;(2)200 cases of the elderly received DXA to measure femoral neck BMD,evaluation of OSTA in screening osteoporosis through statistical indicators.2.(1)Collection of 1300 cases of clinical data such as age、gender、height、weight、previous fracture、parent fractured hip、current smoking、glucocorticoids、rheumatoid arthritis、secondary osteoporosis、drinking、hypertension、type 2 diabetes、coronary heart disease、falls in Shanghai community for retrospective analysis,to calculate ten year probability of the major osteoporotic and hip fracture applying FRAX tool;(2)Application of statistical analysis discussing the relationship between different risk factors and the fracture risk,and analysis of the major risk factors of osteoporotic fracture for the elderly in Shanghai community.(3)Assessment of FRAX with BMD calculated 10-year risk of fracture,comparing the differences of fracture risk calculated between FRAX(BMI)and FRAX(BMD).Results:1.(1)The average OSTA index was-2.1 ± 2.8 in the elderly,the OSTA index of elderly men from 60 to 69 years、70 to 79 years、≥80 years was 0.5 ± 2.1,-1.2 ± 2.1,-4.0 ± 2.1,and the elderly women was-1.3 ± 1.9,-3.2 ± 2.1,-5.5 ± 2.1.The ratio of low-risk,medium-risk group,high-risk group according to OSTA index were 34.4%、40.0%、25.6%,respectively;The risk of osteoporosis in elderly women is significantly higher than older men;(2)The BMD measured in lumbar spine(L2-L4),total hip,femoral neck was positively correlated with OSTA index(r=0.391,P<0.01;r=0.368,P<0.01;r=0.507,P<0.01),respectively;The area under receiver operating characteristic curve(ROC)of OSTA for diagnosing osteopenia and osteoporosis was 0.779、0.731(P<0.01).Taking-1 as cutoff value,the sensitivity and specificity of OSTA in diagnosis of osteoporosis was 94.9% and 32.3%,respectively;Taking-4 as cutoff value,the sensitivity and specificity of OSTA in diagnosis of osteoporosis was 59.0% and 72.7%.2.(1)The ten year probability of the major osteoporotic fracture applying FRAX tool was(6.0 ± 3.6)%,the probability of hip fractures was(2.8 ± 2.4)%.The risk of the major osteoporotic fracture among 60-69 years,70-79 years,≥80 years was(4.9 ± 3.2)%,(6.2 ± 3.3)%,(7.2 ± 3.9)%,hip fracture was(1.5 ± 1.4)%,(3.2 ± 2.2)%,(4.0 ± 2.9)%.(2)Correlation analysis showed that in addition to the risk factors involved in the FRAX tool,falls had significant correlation with ten year probability of fracture(r=0.134,P<0.01;r=0.124,P<0.01).Multivariate analysis showed that age,gender,BMI,previous fracture,parent fractured hip,glucocorticoids,rheumatoid arthritis,secondary osteoporosis,drinking,smoking,falls are the main risk factors for osteoporotic fractures of the elderly in Shanghai community.(3)In the BMD subgroup,for the patients of osteoporosis,no significant difference in the probability with or without BMD,while in the osteopenia and normal group,the probability of calculated risk FRAX(BMI)was higher than FRAX(BMD)(P<0.01).Conclusion: OSTA and FRAX tool can be used as an effective index for screening of osteoporosis and osteoporotic fracture in the elderly in Shanghai community.