The Clinical Study Using FRAX Tool To Predict Fracture Risk Of Patients With Type 2 Diabetes Mellitus Who From Different Ethnic Groups In Qinghai Region

Objective:To explore the clinical applicability of fracture risk assessment tool(FRAX)in fracture risk assessment of patients from Han,Hui,and Tibetan with type 2diabetes(T2DM)in Qinghai Province,and use FRAX to predict the fracture risk of T2 DM patients of Han,Hui,and Tibetan in the region.To provide a treatment threshold for the prevention and treatment of osteoporotic fractures in T2 DM patients in this region,so as to provide a certain reference for the prevention and treatment of osteoporotic fractures(OF)in patients with type 2 diabetes in Han,Hui,and Tibetan in the region.Methods:Selected 324 patients with type 2 diabetes who were treated at the Department of Endocrinology of the Affiliated Hospital of Qinghai University from December 2018 to October 2020 as the research objects.All patients were between 40-90 years old and had undergone ipsilateral(left)femoral neck bone mineral density(BMD)measurement.The bone mineral density was expressed as the transformed T value(BMD-T).Select the relevant data of the patient such as gender,age,weight,height,history of previous fractures,current smoking history and other FRAX related fracture risk factors.The bone density value in FRAX can be optionally substituted or not substituted,enter the relevant indicators in FRAX,and calculate the hip fracture probability(PHF)and major osteoporotic fracture probability(PMOF)in the next 10 years for the three groups of patients with and without femoral neck BMD-T,and then perform statistical analysis on the related data,and finally come to a conclusion.Results: A statistical analysis of the probability of major osteoporotic fracture risk(PMOF)and probability of hip fracture(PHF)in the next 10 years substituted with BMD-T was did in the three ethnic groups of Han,Hui,and Tibetan,and found that there was a statistical difference in PHF among male patients,P<0.05,and no statistical difference in PMOF,P>0.05;while there was no statistical difference in PMOF and PHF among the three groups of postmenopausal female patients,P>0.05.After comparison and statistics between the groups,found that male patients of Han had the highest risk of hip fracture,and there was no significant difference between Hui and Tibetan.The differences of PMOF and PHF between the three groups with and without BMD-T were compared,and statistical tests showed that there were statistical differences in PMOF and PHF between the three groups with and without BMD-T,P<0.05,which can be considered that BMD-T has an important influence on the prediction results of FRAX.According to China’s 2017 version of the primary osteoporosis diagnosis and treatment guidelines,FRAX predicts that the diagnosis and treatment threshold PMOF ≥ 20% or PHF ≥ 3% requires anti-osteoporosis treatment,which is listed as the new standard,and BMD-T ≤-2.5 is the gold standard for treatment.Check the consistency of the two,when BMD-T is substituted,Kappa value=0.720,P<0.001,and when BMD-T is not substituted,Kappa value=0.328,P<0.001;therefore,the FRAX substituted into BMD-T can more accurately predict the fracture risk of T2 DM patients in the region,and the FRAX without the BMD-T still have a certain value in guiding treatment,but the accuracy is lower than the FRAX with BMD-T of femoral neck.The ROC curve was used to determine the treatment threshold of fracture risk for T2 DM patients in Qinghai.When the femoral neck BMD-T is substituted,FRAX predicts that the area under the ROC curve of PMOF in the next 10 years is 0.986(P<0.001),the sensitivity is 100%,and the specificity is 90.60 %,the cutoff value is 3.80%,the area under the ROC curve of PHF is 0.993(P<0.001),the sensitivity is 100%,the specificity is 96.98%,and the cutoff value is 2.00%.Conclusion:1.In Qinghai,male from Han population with type 2 diabetes had the highest PHF in the three ethnic groups.There was no statistical difference between the Hui and Tibetan ethnic groups in PHF.There was no difference in PMOF among the three ethnic groups.There was no difference in PMOF and PHF among the three ethnic groups of postmenopausal female patients.2.Substituting the BMD-T of the femoral neck in FRAX can more accurately predict the risk of major osteoporotic fracture probability and hip osteoporotic fracture probability in patients with T2 DM from three ethnic groups and guide clinical treatment.The FRAX prediction results without the femoral neck bone mineral density still have a certain value in guiding treatment,but the accuracy is lower than the FRAX prediction results with BMD-T of the femoral neck.3.To determine the treatment threshold for fracture risk of T2 DM patients in Qinghai area,when the femoral neck bone mineral density is substituted into FRAX,intervention is required when the main site fracture risk is higher than3.8%,and the hip fracture probability is higher than 2.0%.