Study On The Predictive Value Of Bone Metabolic Index And FRAX Tool For Hip Fracture Risk In Postmenopausal Women

Objective: This study was conducted to investigate the predictive value of bone metabolic indexes and FRAX tool on osteoporotic hip fracture in postmenopausal women by analyzing the correlation between hip fracture and bone metabolic indexes and FRAX tool in some postmenopausal women in Kunming,so as to provide some reference basis for the prevention and treatment of osteoporotic hip fracture in women.Methods: The clinical data of postmenopausal patients with abnormal bone mass who attended our hospital from January 2021 to October 2022 were collected,and 227 cases were screened for inclusion in the study according to the inclusion and exclusion criteria,and divided into fracture and non-fracture groups according to the presence or absence of hip fracture.General clinical data such as age,height,weight,FRAX-related risk factors,femoral neck BMD and fasting bone metabolic index test results were recorded for all patients.The general clinical information and bone metabolism-related indexes and other information of the two groups were compared.The indicators with significant differences were included in the binary logistic regression analysis to analyze and study the independent influencing factors of osteoporotic hip fracture in postmenopausal women(a statistically significant difference was considered at P<0.05).Hip fracture risk values over 10 years were calculated using the FRAX tool,using the immediate time point before the onset of hip fracture: FRAX-FNBMD(with BMD model),and FRAX(without BMD model)in both groups.The FRAX fracture risk values were plotted together with the independent influencing factors screened by regression analysis,and the area under the curve(AUC)was compared to analyze the predictive value of bone metabolism-related indicators and the FRAX tool for osteoporotic hip fracture risk,and to obtain optimal intervention thresholds for fracture risk assessment.Results: The study included 227 postmenopausal patients with reduced bone mass or osteoporosis,including 101 patients in the fracture group with a mean age of71.89 ± 8.70 years and 126 patients in the non-fracture group with a mean age of63.54 ± 9.10 years.The differences between the two groups were statistically significant(P<0.05)in terms of age,femoral neck BMD and bone metabolic indexesβ-CTX,Vit D 25-OH and PTH;in terms of height,weight,age at menopause,history of previous fracture,history of parental hip fracture,history of alcohol consumption,history of smoking,history of rheumatoid arthritis,history of glucocorticoid use,history of secondary osteoporosis and N-MID The differences were not statistically significant(P>0.05).Binary logistic regression analysis showed that age,femoral neck BMD and bone metabolic indexes β-CTX and Vit D 25-OH were the main influencing factors for osteoporotic hip fracture(P<0.05),with regression coefficients and ORs of 0.097(1.102),-0.717(0.488),0.002(-1.002),-0.044(0.957).Using the actual occurrence of hip fracture as a status variable,the subject working characteristic curves for FRAX-FNBMD,FRAX,β-CTX,Vit D 25-OH and femoral neck BMD were plotted,with AUCs of 0.743,0.757,0.699,0.768 and 0.656,respectively,suggesting that the use of the bone metabolism index Vit D 25-OH in Kunming for hip fracture had the best predictive value,and the predictive value using femoral neck BMD was lower.And the optimal intervention thresholds for indicators FRAX-FNBMD,FRAX,β-CTX,Vit D 25-OH and femoral neck BMD were 2.15%,2.05%,493.85 pg/ml,45.25 nmol/L,-2.65,respectively.Conclusion: The FRAX tool,femoral neck BMD,and the bone metabolic indexes β-CTX and Vit D 25-OH were all predictive of osteoporotic hip fracture in postmenopausal women.Advanced age and elevated β-CTX were risk factors for the occurrence of fracture;elevated femoral neck BMD and Vit D 25-OH were protective factors for the occurrence of fracture.The best predictive value for hip fracture in postmenopausal women in Kunming was obtained using the bone metabolic index Vit D 25-OH;the predictive value using femoral neck BMD was lower than that of the FRAX tool and bone metabolic index.And the optimal intervention thresholds for FRAX-FNBMD,FRAX,β-CTX,Vit D 25-OH and femoral neck BMD were 2.15%,2.05%,493.85 pg/ml,45.25 nmol/L and-2.65,respectively.