Validation of three tools for identifying painful new osteoporotic vertebral fractures in older Chinese men: bone mineral density, Osteoporosis Self-Assessment Tool for Asians, and fracture risk assessment tool

Figures & data

Figure 1 The flow diagram of the study.

Abbreviations: BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry; OSTA, Osteoporosis Self-Assessment Tool for Asians; FRAX, fracture risk assessment tool.

Table 1 Summary of descriptive characteristics of the fracture and control groupsa

Characteristics	Fracture	Control	P (t/χ^2)
Subjects, n	111	385
Height, cm	169.10±6.297	170.52±5.396	0.032 (2.163)
Weight, kg	66.73±12.233	70.41±10.178	0.004 (2.897)
BMI, kg/m^2	23.31±4.024	24.20±3.191	0.034 (2.133)
Previous fracture	67 (60.4%)	53 (13.8%)	<0.001 (101.99)
BMD, g/cm^2
Femoral neck	0.663±0.140	0.773±0.130	<0.001 (7.670)
Total hip	0.776±0.146	0.887±0.135	<0.001 (7.479)
L1–L4	0.840±0.163	0.965±0.165	<0.001 (7.035)
Family history	15 (13.5%)	37 (9.6%)	0.237 (1.399)
Current smoker	19 (17.1%)	99 (25.7%)	0.061 (3.512)
Alcohol 30 g/db	16 (14.4%)	73 (19.0%)	0.271 (1.210)
Rheumatoid arthritis	2 (1.8%)	10 (2.6%)	0.474 (1.210)
Glucocorticoidsc	3 (2.7%)	21 (5.5%)	0.897 (0.017)

Notes:

a Data are presented as n (%) or mean ± standard deviation.

b Consuming 30 g or more of alcohol daily (equivalent to three units of alcohol in the present study).

c Taking oral glucocorticoids for >3 months; prednisolone ≥5 mg daily.

Abbreviations: BMD, bone mineral density; BMI, body mass index.

Table 2 BMD T-score, OSTA, and FRAX scores of the fracture and control groups

Parameter	Fracture	Control	z/t	P-value
Subjects, n	111	385
BMD, T-score,
mean ± SD
Total hip	−1.78±1.20	−0.88±1.12	−7.356	<0.001
Femoral neck	−2.12±1.21	−1.17±1.13	−7.666	<0.001
L1–L4	−1.51±1.39	−0.44±1.41	−7.059	<0.001
OSTA, mean ± SD	−0.95±3.76	1.01±2.91	−5.829	<0.001
FRAX (%)	4.30 (3.20, 5.20)	2.60 (2.00, 3.65)	−7.636	<0.001

Abbreviations: BMD, bone mineral density; OSTA, Osteoporosis Self-Assessment Tool for Asians; FRAX, fracture risk assessment tool.

Figure 2 Proportions of BMD T-scores at different sites in the fracture and control groups, and ROC curve of the BMD measurement at different sites for identifying PNOVFs with optimal cutoff value.

Notes: 1: Fracture group; 2: control group. *P-value for comparison <0.05.
Abbreviations: BMD, bone mineral density; ROC, receiver-operating characteristic; PNOVFs, painful new osteoporotic vertebral fractures.

Table 3 AUC and sensitivity and specificity values of the FRAX, BMD T-score, and OSTA for identifying PNOVFs

Parameter	AUC (95% CI)	Z	P-value	Cutoff	Sensitivity, %	Specificity, %	+LR, %	−LR, %
FRAX	0.738 (0.697–0.776)	8.954	<0.001	>2.7	82.88	55.32	1.86	0.31
				>2.8	82.88	57.40	1.95	0.30
				>2.9*	81.98	62.08	2.16	0.29
				>3.0	77.48	65.45	2.24	0.34
				>3.1	75.68	67.27	2.31	0.36
T-score
Total hip	0.711 (0.669–0.751)	7.687	<0.001	−1.4	67.57	65.45	1.96	0.50
Femoral neck	0.706 (0.664–0.746)	7.339	<0.001	−2.5	42.34	89.87	4.18	0.64
Lumbar spine	0.706 (0.664–0.746)	7.215	<0.001	−1.6	52.25	77.14	2.29	0.62
OSTA	0.661 (0.618–0.703)	4.997	<0.001	−1.2	53.15	76.88	2.30	0.61

Notes:

* Optimal FRAX cutoff; +LR: positive likelihood ratio; −LR: negative likelihood ratio.

Abbreviations: BMD, bone mineral density; OSTA, Osteoporosis Self-Assessment Tool for Asians; FRAX, fracture risk assessment tool; AUC, area under the receiver-operating characteristic curve; PNOVFs, painful new osteoporotic vertebral fractures; CI, confidence interval.

Figure 3 Comparison of different AUCs (BMD T-score, OSTA, and FRAX for identifying PNOVFs).

Abbreviations: BMD, bone mineral density; OSTA, Osteoporosis Self-Assessment Tool for Asians; FRAX, fracture risk assessment tool; PNOVFs, painful new osteoporotic vertebral fractures; AUCs, areas under the receiver-operating characteristic curve.