Original Research Article
Year: 2017 | Month: October | Volume: 7 | Issue: 10 | Pages: 97-101
Osteoporosis- Do We Need to Think Beyond Bone Mineral Density?
Dr Preeti Soni1, Dr Shipra Chaudhary2, Dr U Singh3
1Senior Resident, Delhi State Cancer Institute, Dilshad Garden, New Delhi, India. 110095
2Assistent Professor, PGIMER and Dr RML Hospital, New Delhi, 110001
3Professor and Head, Department of PMR, AIIMS, New Delhi, 110029
Corresponding Author: Dr Preeti Soni
ABSTRACT
Introduction- Fracture is the most concerned clinical outcome of osteoporosis, but recently it has been found that most fragility fracture occurs in patients with either normal or osteopenic Bone Mineral Density (BMD) scans. This warrants us to look for factors beyond BMD alone for bone strength. Country specific WHO-Fracture Risk Assessment Tool (FRAX) has emerged as a promising and validated tool to assess probability of fragility fracture.
Materials and Methods- In this Cross sectional study, eighty patients with BMD prescribed elsewhere or in our OPD were recruited. Ten were excluded on the basis of age being less than 40 years. Demographic data, BMD test report measured by DXA scan and risk factors included in WHO-FRAX tool were recorded for the remaining 70 patients. Ten year probability of major osteoporotic fracture and hip fracture was assessed using country specific WHO-FRAX tool.
Results- Excel 2007 and STATA 14 were used for data analysis and curve comparison. Mean age was– 61.37± 11.06 years and male to female ratio was 1:3. Mean T score at Spine was 1.86±1.72 and Mean T score at Hip was 1.8± 1.12. Out of 15 patients showing normal BMD at hip, 4 (26.7%) had low BMD at spine and out of 55 subjects with low BMD at hip (osteopenia and osteoporosis), FRAX picked up only 2 cases at risk of major osteoporotic fracture in coming ten years.
Discussion- To our knowledge, this is the first gender unbiased report of FRAX score of native Indian population. We found that FRAX is more sensitive to predict treatment threshold in osteoporotic hip rather than osteopenic hip and FRAX under-estimates ten year major osteoporotic fracture risk (including spine fracture) in Indian population.
Conclusion- FRAX has a major role in predicting fracture risk but it has its inherent flaws. It does not replace good clinical judgment by health care practitioner. Besides FRAX, We should always look for other Clinical Risk Factors (CRFs) and guide our treatment accordingly.
Key words: Osteoporosis, Bone mineral density, DXA Scan, India, WHO Fracture Risk Assessment tool.