The Clinical Value Of FRAX-RA Tool In Fracture Risk Assessment For Type 2 Diabetes Mellitus

Objective:To evaluate the clinical value of the Fracture Risk Assessment Score algorithm adjusted by rheumatoid arthritis(FRAX-RA)in patients with type 2 diabetes mellitus(T2DM).Methods:In our cross-sectional study,we investigated patients with T2 DM from the inpatient department of endocrinology,the third affiliated hospital of Nanchang university from January 2019 to December 2019.A total of 1047 patients with T2 DM were selected in this study.Gender,age,living habits and disease history of the subjects were collected and recorded using standardized questionnaires.Height,weight and body mass index(BMI)were measured according to unified standards.High performance liquid chromatography was used to detect glycated hemoglobin(HbA1c).Dual-energy X-ray absorptiometry(DXA,Hologic Explorer,USA)was used to measure the bone density(BMD)of the lumbar spine L1-L4 and femur(femoral neck,Wards triangle,and total hip).According to the WHO criteria for the diagnosis of osteoporosis,the subjects were divided into normal bone density,low bone density and osteoporosis,and the clinical data of each group were compared.Rheumatoid arthritis(RA)in the fracture risk factors listed by FRAX algorithm was used as an equivalent variable for type 2 diabetes.FRAX-RA was used to calculate the probability of hip fractures and major osteoporotic fractures in patients over the next 10 years.The 10-year probability of hip fracture ≥ 3% or 10-year probability of major fracture ≥20% was taken as the treatment threshold,and the treatment recommendation was counted.The sensitivity,specificity and Youden index of FRAX-RA for hip fracture and major fracture treatment were calculated.According to the treatment recommendations derived from DXA and FRAX-RA for hip fracture,the subjects were divided into the matched group(the recommendations from DXA and FRAX were same)and the unmatched group,and the clinical data between the two groups were compared.Results:1.The number of females in the osteoporosis group was significantly higher than that in the low-bone density group and the normal bone density group(p<0.001).The sex ratio was not significantly different between the low bone density group and the normal bone density group(male/female: 337/157 cases of vs120/57 cases,p>0.05).There were significant differences in age,weight,height and BMI among the three groups(p<0.001).2.When the 10-year probability of major osteoporotic fractures≥20% was used as the threshold of clinical treatment in T2 DM,the sensitivity,specificity and Youden index of FRAX-RA were 0.0080,1.0000 and 0.0080.When the 10-year probability of hip fracture ≥3% was used,the sensitivity,specificity and Youden index of FRAX-RA were 0.4761,0.9642 and 0.4403.According to the consistency analysis,the consistency between the treatment threshold of the 10-year probability of hip fracture≥3% and DXA were medium(Kappa=0.49).The consistency between the treatment threshold of the 10-year probability of major osteoporotic fractures≥20% and DXA were poor(Kappa=0.01).3.The number of males,BMI and BMD were significantly higher in the matched group.(P<0.001).Age and HbA1 c were not statistically significant between the matched group and the unmatched group(P>0.05).Conclusions:The FRAX-RA had a good ability to assess the risk of hip fracture in type 2 diabetic patients,and was more accurate in predicting type 2 diabetic patients with male,higher BMI,and higher femoral neck bone density.The intervention threshold of the 10-year probability of hip fracture ≥3% in T2 DM has a high clinical value.