| Objective:By applying the Adjusted FRAX(replace rheumatoid arthritis as a risk factor with type2 diabetes)in type 2 diabetes patients in Shanxi Province,the relevant results were analyzed to explore the applicability of the Adjusted FRAX and provide appropriate intervention thresholds.To improve the diagnostic efficacy of osteoporotic fractures in type 2 diabetic patients in Shanxi Province.Methods:1.In this cross-sectional study,a total of 279 patients with type 2 diabetes who were admitted to the Department of Endocrinology of Shanxi Provincial People’s Hospital from November 2021 to November 2022.2.The study data of each patient were recorded,such as gender,age,weight,height,body mass index,menopausal age,fragility fracture history,parental history of hip fracture,smoking status,adrenocortical hormone use status,rheumatoid arthritis status,secondary osteoporosis status,daily drinking if 3 units and above,glycosylated hemoglobin,course of diabetes.3.The bone density and T-score of the patient’s left proximal femur(femoral neck,greater trochanter,intra trochanter,Ward’s triangle,total left proximal femur)and lumbar spine(L1-L4,total lumbar spine)were measured by dual-energy X-ray bone densitometer(DEXA,Hologic Discovery-Wi type).4.Hb A1c was measured by high pressure liquid chromatography with ADAMS A1c HA8180 automatic Hb A1c analysis meter.5.The probability fractures of hip and major parts in the next 10-year(with PHF≥3%or PMOF≥20%as the intervention threshold)was calculated by using the FRAX and the Adjusted FRAX(replace RA with type 2 diabetes).6.The BMD measured by DEXA was the"gold standard",the patients were divided into normal BMD group,low BMD group,osteoporosis group and severe osteoporosis group according to BMD,the data of groups above were recorded.According to the suggested that drug intervention for hip and major fracture of DEXA,FRAX and Adjusted FRAX,the results were divided into agreement and disagreement group,and application of counting method to compare the detection rate of 3 methods in patients with high risk of fractures.7.Statistical software IBM SPSS 29.0 and Excel were used to process the data,the DEXA results were used as the"gold standard"for Kappa analysis,and the area under the ROC curve,sensitivity,specificity and maximum Youden index were calculated as indicators to evaluate the diagnostic ability of Adjusted FRAX;With DEXA results as the state variable,Adjusted FRAX and FRAX results as the test variables,ROC analysis was performed and the cut-off score were calculated to finally determine the corresponding intervention threshold.Results:1.General characteristics of the study subjects.1.1 General characteristics of the subjects after grouping by gender:a total of 279subjects were included in this study,including 133 males(47.67%)and 146 females(52.33%).1.2 General characteristics of the subjects after grouping by age:BMI of age 50-59,60-69,≥70 had no significant difference(p>0.05),but height,weight and BMD of left femoral neck decreased with the increase of age and the prolonging of disease(p<0.05).1.3 The relationship between BMI and the need for drug intervention:as result 1.2showed no statistical significance in BMI difference(p>0.05).IBM SPSS 29.0 was used to draw the"violin chart",which showed:the frequency distribution of the Adjusted FRAX(PHF)was generally consistent with that of DEXA,the frequency distribution of initiation of drug intervention was concentrated when BMI was 20.00?25.00(kg/m~2),while the frequency distribution was scattered when BMI<20.00(kg/m~2)or BMI>25.00(kg/m~2).2.Comparison of clinical characteristics of the study subjects.2.1 PHF and PMOF were calculated using the FRAX and Adjusted FRAX respectively,it turns out that with age increase,both genders in the FRAX and Adjusted FRAX showed an increase in PHF and PMOF;Adjusted FRAX was higher regardless of PHF or PMOF.2.2 Clinical characteristics of different BMD groups:BMD decreased with age;But height,weight and calculated BMI decreased with the decrease of BMD.3.Correlation analysis of the results of Adjusted FRAX assessment in type 2 diabetic patients in Shanxi Province.3.1 DEXA was used as the"gold standard"to diagnose 48 cases with high fracture risk,and the detection rate was 17.20%.Conventional threshold FRAX(PHF≥3%)was used to predict the risk of high hip fracture in 27 cases,with a detection rate of 9.68%,which was lower than DEXA.Conventional threshold Adjusted FRAX(PHF≥3%)predicted 55 cases with a high risk of hip fracture,with a detection rate of 19.71%,which was higher than DEXA.3.2 The detection rate of DEXA was 17.20%.Conventional threshold FRAX(PMOF≥20%)was used to predict the risk of major parts fractures in 1 case,with a detection rate of 0.36%.Conventional threshold Adjusted FRAX(PMOF≥20%)predicted 2 cases with a high risk of main part,with a detection rate of 0.72%,which were significantly lower than DEXA.3.3 Kappa consistency analysis was conducted between Adjusted FRAX(traditional thresholds:PHF≥3%or PMOF≥20%)and"gold standard"(drug intervention depends on DEXA results).The results showed that:determining whether subjects need drug intervention,the Adjusted FRAX(PHF≥3%)had a high consistency with the"gold standard"(Kappa=0.660,p<0.05),and the Adjusted FRAX(PMOF≥20%)had a very poor consistency with the"gold standard"(Kappa=0.067,p<0.05).4.Discussion on the optimal threshold of whether Adjusted FRAX needs drug intervention in Shanxi Province.4.1 Establishment of the optimal threshold of Adjusted FRAX:in view of the fact that the screening of high fracture risk by Adjusted FRAX(PMOF≥20%)is grossly inaccurate and the poor consistency between Adjusted FRAX(PMOF≥20%)and"gold standard"(Kappa=0.067,p<0.05).DEXA results are used as the state variable,Adjusted FRAX(PHF)and Adjusted FRAX(PMOF)as the test variables,respectively with the ROC analysis and calculate the optimal threshold.Results:PHF≥3.05%or PMOF≥5.45%was the optimal threshold for drug intervention in Shanxi Province.4.2 Application of the Adjusted FRAX optimal threshold:Adjusted FRAX(optimal threshold when PHF≥3.05%or PMOF≥5.45%),Adjusted FRAX(traditional threshold when PHF≥3%or PMOF≥20%)and DEXA were used to detect high fracture risk,the results showed that:using the optimal hip fracture threshold PHF≥3.05%and the traditional threshold PHF≥3%,the detection rate of high fracture risk both was 19.71%,which was higher than that of DEXA(17.20%);However,the major parts detection rate of high fracture risk by the optimal threshold PMOF≥5.45%was 34.05%,which was much higher than the traditional threshold PMOF≥20%(0.36%)and higher than DEXA(17.20%).Conclusion:1.With increasing age,PHF and PMOF of both the Adjusted FRAX and FRAX increased,and the Adjusted FRAX performs better.2.The detection rate of Adjusted FRAX(traditional threshold when PHF≥3%)for predicting high hip fracture risk was higher than that of DEXA,and also higher than that of FRAX(traditional threshold when PHF≥3%);The detection rate of Adjusted FRAX(traditional threshold when PMOF≥20%)for predicting the risk of major parts fracture was far less than that of DEXA and was similar that of FRAX(traditional threshold when PMOF≥20%).3.In determining whether subjects need drug intervention:the Adjusted FRAX(traditional threshold when PHF≥3%)has a high consistency with the"gold standard"(drug intervention depends on DEXA results)and the Adjusted FRAX(traditional threshold when PMOF≥20%)has a very poor consistency.4.Bone mineral density measurement underestimates the fracture risk in type 2 diabetic patients aged 50-year and above,and has a great probability of missing patients with fragility fractures;The FRAX and threshold recommended by?The Diagnosis and Treatment of Primary Osteoporosis″are not suitable for type 2 diabetic patients aged 50-year and above in Shanxi Province.Adjusted FRAX(replace RA with type 2 diabetes)has a great application potential with an optimal threshold of PHF≥3.05%or PMOF≥5.45%. |
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