Investigation of fracture rate, fractural risk factor due to osteoporosis and predicting facture risk by frax and garvan models

Nội dung text: Investigation of fracture rate, fractural risk factor due to osteoporosis and predicting facture risk by frax and garvan models

1. Journal of military pharmaco-medicine n o2-2018 INVESTIGATION OF FRACTURE RATE, FRACTURAL RISK FACTOR DUE TO OSTEOPOROSIS AND PREDICTING FACTURE RISK BY FRAX AND GARVAN MODELS Hoang Ngoc Tang*; Pham Thanh Binh*; Doan Van De* SUMMARY Objectives: To determine fracture rate, fractural risk factor, result of predicting the risk of femoral fracture by FRAX and GARVAN model. Subjects and method: We performed studying on 206 women over 40 years old including 176 in the community and 30 had fracture who lived in the Rachgia city, Kiengiang province. On each women, we performed clinical examination, found the fracture risk factors due to osteoporosis and measured bone mineral density by DEXA method on Osteocore Station Mobile machine, then we used FRAX and GARVAN model to determine level of neck femoral facture risk and other fracture risks. Result: In fracture risk factors, proportion of high age was the highest (91.7%), BMI < 18.5% was the lowest (2.4%). 2.4% of patients didn’t have risk factors fracture. Patients have more than 2 factors accounted for high rate. Osteoporosis and ages are significant to predict neck of femoral fracture in FRAX and GARVAN model. BMI is valid for predicting neck of femur in FRAX model but isn’t valid for predicting in GARVAN model. Conclusion: In the fracture risk factors, age accounted for the highest proportion and BMI account for the lowest proportion. A number of patients has 4 risk factors accounted for the highest proportion. FRAX and GARVAN model has valid for prognosing the risk of femoral neck fracture after 10 years. * Keywords: Osteoporosis; FRAX and GARVAN model. INTRODUCTION neck fracture, wristbone neck fracture (Colles Osteoporosis is a dysmetabolic of bones and Smiths fracture) are considered as causing losing intact of bone quantity, the special types of fracture due to decreasing bone density and leading to osteoporosis. In fact, studies have shown fracture which is last result of osteoporosis. that fracture of elderly patients related with The rate of patients with facture caused low bone density state [1]. Therefore, most by osteoporosis is increasing. In the United of fracture types relating to elderly patients States, there are over 300.000 patients can be considered as a fracture due to with femoral neck fracture caused by osteoporosis. In a epidemiological research osteoporosis and about 5.2 millions patients on 10,750 women in 7.6 years, Robbins who have fracture is over 45 years old in et al (2007) showed that there were the beginning of 21 th century [1]. In the numerous fractural risk factors such as: fracture types, vertebral fracture, femoral age, weight, height, race, physical activity, * 103 Military Hospital Corresponding author: Pham Thanh Binh (thanhbinh4121d@gmail.com) Date received: 20/11/2017 Date accepted: 24/01/2018 122
2. Journal of military pharmaco-medicine n o2-2018 fracture history, smoking, history of using + Agree to take part in this research. glucocorticoid, diabetes mellitus [6]. In * Excluded criteria: women having clinical practice, not only bone density is Cushing syndrome, hyperparathyroidism, risk factor but also many others related to hyperthyroidism, chronic liver disease, a fracture. Measurement of bone density malabsorption syndrome, getting by dual-energy X-ray absorptiometry has ovariotomy, using replaced hormone, many limitations. Therefore, there must metastasis cancer, multiple myeloma, be a much better system to predict motionless over 3 months, chronic bone- fracture. And FRAX and GARVAN model joint disease, pregnant.., didn’t agree to showed, they based on risk factors of take part in this study. patient specially bone density to evaluate fracture risk of patients. We performed 2. Method. this study with the aim: To detect fracture - Descriptive cross-sectional study. rate, fracture risk factor due to - Patients were asked about disease osteoporosis and predict fracture risk history, taken clinical examination to discover following FRAX and GARVAN model . fracture risk factors due to osteoporosis. SUBJECTS AND METHODS - Measure bone mineral density. 1. Subject. - Use FRAX and GARVAN model to 206 women in our study were randomly estimate fracture risk. To classify fracture selected and lived in Rachgia city, risk of neck of femur after 10 years following Kiengiang province, satisfied the condition. FRAX and GARVAN model: ≥ 3% high * Sample size: risk, < 3% low risk. Applying formula for determining - Data was processed by SPSS software, sample size of a proportion of population: compared 2 proportions, compared 2 average values. 2 Z α  p. (1− p) 1−  n =  2  RESULTS AND DISCUSSION d2 Osteoporosis has numerous risk factors, - n: is necessary sample size for cross- fracture also has numerous risk factors, sectional study. but the risk factors of fracture and - p: is osteoporosis proportion in the osteoporosis are different. In this study, population chosen following a result of we investigated proportion of fracture risk domestic study (15.4% following Vu Thi factors of 206 subjects. Thu Hien). * Risk factors of fractures: - d: is estimated error, with d = 0.05 Age ≥ 60: 189 patients (91.7%); BMI then Z 2 = 1.96 2 (1 – α/2) < 18.5: 5 patients (2.4%); no procreation: Sample size has to be higher than 196 21 patients (10.2%); menstruation after subjects who respond condition. 15 years: 151 patients (73.3%); menopause * Selected criteria: before 53 years: 159 patients (77.2%); + Women over 40 years old living at after menopause > 10 years: 165 patients Rachgia city, Kiengiang province. (80.1%); osteoporosis: 23 patients (11.2%); 123
3. Journal of military pharmaco-medicine n o2-2018 fall history: 38 patients (18.4%); family has - Subject had 4 risk factors took the member get fracture: 22 patients (10.7%). highest proportion 31.1%, next was 3 risk Group of risk factors with low proportion factors 27.2%, from 5 risk factors was included: BMI < 18.5, no procreation, 21.3%. In comparison with other authors’s osteoporosis, fall history, family has study, we have seen that our result was member get fracture. different because the feature of sample * Distribution of patients following selection. There are many studies which amount of risk factors: selected subject over 20 years, therefore, No risk factor: 5 patients (2.4%); 1 factor: proportion of risk factors was low. Our 10 patients (4.9%); 2 factors: 27 patients subject is menopause women whose the (3.1%); 3 factors: 56 patients (27.2%); lowest age was 48, and the highest was 4 factors: 64 patients (31.1%). 85, therefore proportion of fracture risk - There was only 2.4% of subject factors was high and subjects appear having no factor. many risk factors were also high. Table 1: Relation between fracture and osteoporosis. Fracture (n = 30) No fracture OR, p Amount Proportion Amount Proportion Osteoporosis (n = 23) 12 52.2 11 47.8 OR = 9.8 (3.43 - 28.71) No osteoporosis (n = 183) 18 9.8 165 90.2 p < 0.05 - Fracture had relation with osteoporosis. bones. Although there is a close relation Proportion of fracture subjects in osteoporosis between mineral density with fracture risk, group was significantly higher than non- but there are also others factors play the osteoporosis group. OR = 9.8, p < 0.05. important roles in the development of the - Osteoporosis makes increasing fracture bone’s strength and are absolute risk risk, specialy neck of femur and vertebrae. induce fracture. Decreasing of mineral Low bone density is one of the most density and strength of bone is cause of important factors of osteoporosis which fracture due to osteoporosis. cause fracture. Bone mineral density of - Currently, the general trend in the adult is detected by both peak bone assessment of fracture risk is based on density at adulthood and lose-bone state multi-factors, rather than just relying on in the next years. Osteoporosis-induced bone density factors or a history of fracture is caused by consequence of previous fractures. There are two most trauma, can be slight or severe and popular models to estimate the risk of influence their quality and strength of fracture: Fracture Risk Calculator Model 124
4. Journal of military pharmaco-medicine n o2-2018 GARVAN (Garvan) of the GARVAN high risk of fracture in Vietnam. World Institute of Medical Research (Australia) Health Organization recommends high- and FRAX model of World Health risk prediction model FRAX fracture ≥ 3% Organization. Both models have not been broken femur and ≥ 20% for the whole body widely applied in Vietnam. In this study, fracture (and need treatment). In our study, we applied the calculation model and determining the value of high-risk prognostic Garvan Frax assessment predicted a FRAX > 3% and GARVAN > 3%. Table 2: Predicting 10 years risk of femoral neck fracture by age group. FRAX model GARVAN model Age group High risk Low risk High risk Low risk 16 1 16 1 < 60 years old (n = 17) (94.1) (5.9) (94.1) (5.9) 126 2 60 68 60 - 69 years old (n = 128) (98.4) (1.6) (46.9) (53.1) 49 12 8 53 ≥ 70 years old (n = 61) (80.3) (19.7) (13.1) (86.9) p < 0.05 < 0.05 - Both the FRAX and GARVAN models times [7]. According to Kung (2007), in have the predicted values with the risk of 10 years post-menopausal women: 10 years femoral neck fracture. The higher the age old increased risk of fractures predicted predicted, the higher fracture risk. increase in 2.2 times. - The FRAX model predicts age from - In our study, the value of prognosis 60 to 69: high risk 1.6%, low risk 98.4%; for FRAX risk fractures accounted for age over 70, high risk 19.7%, low risk 5.9%, 1.6% and 19.7%, respectively 80.3%; the difference was statistically aged 60, 69 - 60 < age and ≥ 70 years significant with p < 0.05. of age, prognosis value is higher-risk - The GARVAN model showed the age GARVAN < 60 was 5.9%, from 60 - high risk of 60 - 69 age (53.1%), age over 69 age was 53.1% and from 70 years of 70 was 86.9%, the difference was 86.9%. Therefore, the prognosis looks statistically significant with p < 0.05. GARVAN close to reality higher than the - Both the FRAX and GARVAN models clinical prediction of FRAX, this also predict the group with age under 60 with conforms with the review of a number of high risk (5.9%) and low risk (94.1%). authors [2, 3, 5]. So to identify high risk - The higher the age is, the higher the fracture of an individual, the doctor risk of fractures is. For every 5 years of needs to refer to both models rather age, the risk of fracture increased 1.8 than just a model. 125
5. Journal of military pharmaco-medicine n o2-2018 Table 3: Predicting 10 years risk of femoral neck fracture by BMI group. FRAX model GARVAN model BMI group High risk Low risk High risk Low risk 3 2 4 1 BMI < 18.5 (n = 5) (60.0) (40.0) (80.0) (20.0) 53 7 52 8 18.5 ≤ BMI < 23.0 (n = 60) (88.4) (11.6) (86.7) (13.3) 135 6 132 9 BMI ≥ 23.0 (n = 141) (95.7) (4.3) (93.6) (6.4) Compare p p = 0.002 p = 0.03 - In FRAX model, BMI can prognose clinical factors are added. Women at the risk factor of femoral neck fracture, 65 years old with BMI < 20 kg/m 2 had risk but it has no value in GARVAN model. of femoral neck fracture 1.3%, which - High risk of femoral neck fracture with increased 1.7% to 3.2% per 1 clinical BMI 23 was 4.3%, factor added, with 6 risk factors, the risk and this significant difference with p < 0.05 of femoral neck fracture was 30% [4] in FRAX model. In this research, high risk of femoral - By the time, in GARVAN, this risk neck fracture in under weigh women was factor was 20% and 6.4%, there was no 40.0% at FRAX predictive value (p < 0.05) significant difference with p > 0.05. and at GARVAN model was 20%. According to Kanis (2008), low BMI So low BMI - one of 12 predictive factors can prognosis the risk of femoral neck of FRAX model - is one of the valuable fracture and this value will increase if factor in predicting the risk of fracture. Table 4: Predict 10 years risk of femoral neck fracture due to history fracture of family. FRAX model GARVAN model History fracture of family Low risk High risk Low risk High risk 179 5 84 100 None fracture (n = 186) (96.2) (2.8) (45.6) (54.4) 12 10 0 22 fracture (n = 20) (54.5) (45.5) (0.0) (10.,0) P < 0.05 p < 0.05 History fracture of family has predictive which had history fracture was 45.5%, value in both models. while the rate was 2.8% in group of family According to FRAX model, predictive without history factor, there was no value of femoral neck fracture in family significant difference with p < 0.05. 126
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