The diagnostic efficiency and application value of fracture risk assessment tools in maintenance hemodialysis patients

Objective: To compare the diagnostic efficiency and application value of three widely-used fracture risk assessment tools [osteoporosis self-assessment tool for Asians (OSTA), WHO fracture risk assessment tool FRAX1[non-bone mineral density(BMD) model] and FRAX2 (BMD model) to identify fracture status in maintenance hemodialysis (MHD) patients. Methods: A total of 136 patients accepting MHD during December 2014 to December 2016 were enrolled in this study. All patients were divided into fracture group and non-fracture group according to BMD results at lumbar spine and hip region tested with dual-energy X-ray(DXA). OSTA was calculated on weight and age,and FRAX score was obtained through the website. Capacity of BMD, OSTA, FRAX1 and FRAX2 for predicting fracture status were assessed with receiver operator characteristic(ROC) curve analysis. Results: Among 136 MHD patients, the average age was 59(47-67) years and duration of dialysis was 55(26-87) months. There were 16 fractures (11.76%) in those MHD patients. Areas under the curves of BMD (lumbar spine L1-L4, femoral neck, total hip), OSTA, FRAX1 and FRAX2 for predicting fracture were 0.669 (95% CI:0.583-0.747, P=0.0234), 0.708 (95% CI: 0.624-0.783, P=0.0014), 0.736 (95%CI: 0.654-0.808, P=0.0003), 0.686 (95%CI: 0.601-0.763, P=0.0078), 0.715 (95%CI:0.631-0.789, P=0.0004), and 0.697 (95%CI:0.613-0.773, P>0.05), respectively. And cutoff value of BMD of lumbar spine L1-L4, femoral neck, total hip) for predicting fracture were 0.973 g/cm2，0.719 g/cm2，0.859 g/cm2，and while cutoff value of OSTA, FRAX1 and FRAX2 were 0.2,3.3%，2.8%, respectively. Conclusions: BMD, OSTA and FRAX have the same ability to predict fracture status in MHD patients. FRAX2 (BMD model) has no advantage over FRAX1 (non-BMD model) in predicting fracture. OSTA and FRAX1 are able to assess fracture status in MHD patient without BMD detection.