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.
Journal of military pharmaco-medicine no2-2018 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 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 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 Osteoporosis is a dysmetabolic of bones causing losing intact of bone quantity, decreasing bone density and leading to fracture which is last result of osteoporosis The rate of patients with facture caused by osteoporosis is increasing In the United States, there are over 300.000 patients with femoral neck fracture caused by osteoporosis and about 5.2 millions patients who have fracture is over 45 years old in the beginning of 21th century [1] In the fracture types, vertebral fracture, femoral neck fracture, wristbone neck fracture (Colles and Smiths fracture) are considered as the special types of fracture due to osteoporosis In fact, studies have shown that fracture of elderly patients related with low bone density state [1] Therefore, most of fracture types relating to elderly patients can be considered as a fracture due to osteoporosis In a epidemiological research on 10,750 women in 7.6 years, Robbins et al (2007) showed that there were numerous fractural risk factors such as: 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 Journal of military pharmaco-medicine no2-2018 fracture history, smoking, history of using glucocorticoid, diabetes mellitus [6] In clinical practice, not only bone density is risk factor but also many others related to a fracture Measurement of bone density by dual-energy X-ray absorptiometry has many limitations Therefore, there must be a much better system to predict fracture And FRAX and GARVAN model showed, they based on risk factors of patient specially bone density to evaluate fracture risk of patients We performed this study with the aim: To detect fracture rate, fracture risk factor due to osteoporosis and predict fracture risk following FRAX and GARVAN model SUBJECTS AND METHODS Subject 206 women in our study were randomly selected and lived in Rachgia city, Kiengiang province, satisfied the condition * Sample size: Applying formula for determining sample size of a proportion of population: Z2 n= α 1− 2 p(1 − p ) d2 - n: is necessary sample size for crosssectional study - p: is osteoporosis proportion in the population chosen following a result of domestic study (15.4% following Vu Thi Thu Hien) - d: is estimated error, with d = 0.05 then Z2(1 – α/2) = 1.962 Sample size has tacture Risk Calculator Model Journal of military pharmaco-medicine no2-2018 GARVAN (Garvan) of the GARVAN Institute of Medical Research (Australia) and FRAX model of World Health Organization Both models have not been widely applied in Vietnam In this study, we applied the calculation model and Garvan Frax assessment predicted a high risk of fracture in Vietnam World Health Organization recommends highrisk prediction model FRAX fracture ≥ 3% broken femur and ≥ 20% for the whole body fracture (and need treatment) In our study, determining the value of high-risk prognostic FRAX > 3% and GARVAN > 3% Table 2: Predicting 10 years risk of femoral neck fracture by age group Age group FRAX model GARVAN model High risk Low risk High risk Low risk < 60 years old (n = 17) 16 (94.1) (5.9) 16 (94.1) (5.9) 60 - 69 years old (n = 128) 126 (98.4) (1.6) 60 (46.9) 68 (53.1) ≥ 70 years old (n = 61) 49 (80.3) 12 (19.7) (13.1) 53 (86.9) p < 0.05 < 0.05 - Both the FRAX and GARVAN models have the predicted values with the risk of femoral neck fracture The higher the age predicted, the higher fracture risk times [7] According to Kung (2007), in 10 years post-menopausal women: 10 years old increased risk of fractures predicted increase in 2.2 times - The FRAX model predicts age from 60 to 69: high risk 1.6%, low risk 98.4%; age over 70, high risk 19.7%, low risk 80.3%; the difference was statistically significant with p < 0.05 - In our study, the value of prognosis for FRAX risk fractures accounted for 5.9%, 1.6% and 19.7%, respectively aged 60, 69 - 60 < age and ≥ 70 years of age, prognosis value is higher-risk age GARVAN < 60 was 5.9%, from 60 69 age was 53.1% and from 70 years of 86.9% Therefore, the prognosis looks GARVAN close to reality higher than the clinical prediction of FRAX, this also conforms with the review of a number of authors [2, 3, 5] So to identify high risk fracture of an individual, the doctor needs to refer to both models rather than just a model - The GARVAN model showed the high risk of 60 - 69 age (53.1%), age over 70 was 86.9%, the difference was statistically significant with p < 0.05 - Both the FRAX and GARVAN models predict the group with age under 60 with high risk (5.9%) and low risk (94.1%) - The higher the age is, the higher the risk of fractures is For every years of age, the risk of fracture increased 1.8 125 Journal of military pharmaco-medicine no2-2018 Table 3: Predicting 10 years risk of femoral neck fracture by BMI group BMI group FRAX model GARVAN model High risk Low risk High risk Low risk BMI < 18.5 (n = 5) (60.0) (40.0) (80.0) (20.0) 18.5 ≤ BMI < 23.0 (n = 60) 53 (88.4) (11.6) 52 (86.7) (13.3) BMI ≥ 23.0 (n = 141) 135 (95.7) (4.3) 132 (93.6) (6.4) Compare p p = 0.002 - In FRAX model, BMI can prognose the risk factor of femoral neck fracture, but it has no value in GARVAN model - High risk of femoral neck fracture with BMI 23 was 4.3%, and this significant difference with p < 0.05 in FRAX model p = 0.03 clinical factors are added Women at 65 years old with BMI < 20 kg/m2 had risk of femoral neck fracture 1.3%, which increased 1.7% to 3.2% per clinical factor added, with risk factors, the risk of femoral neck fracture was 30% [4] - By the time, in GARVAN, this risk factor was 20% and 6.4%, there was no significant difference with p > 0.05 In this research, high risk of femoral neck fracture in under weigh women was 40.0% at FRAX predictive value (p < 0.05) and at GARVAN model was 20% According to Kanis (2008), low BMI can prognosis the risk of femoral neck fracture and this value will increase if So low BMI - one of 12 predictive factors of FRAX model - is one of the valuable factor in predicting the risk of fracture Table 4: Predict 10 years risk of femoral neck fracture due to history fracture of family History fracture of family FRAX model GARVAN model Low risk High risk Low risk High risk None fracture (n = 186) 179 (96.2) (2.8) 84 (45.6) 100 (54.4) fracture (n = 20) 12 (54.5) 10 (45.5) (0.0) 22 (10.,0) P < 0.05 History fracture of family has predictive value in both models According to FRAX model, predictive value of femoral neck fracture in family 126 p < 0.05 which had history fracture was 45.5%, while the rate was 2.8% in group of family without history factor, there was no significant difference with p < 0.05 Journal of military pharmaco-medicine no2-2018 In GARVAN model, predictive value of femoral neck fracture in family has history fracture was 100% and in the non-history fracture family was 54.4%, difference has no meaning History fracture of family is one of 12 predictive factors in FRAX model But the high risk of femoral fracture that FRAX model can predict is very low (0%) Study by Billington (2016) has shown that history fracture of family has significant effect on predicting the risk of fracture in elderly women of FRAX model If we exclude this factor out of FRAX model, predictive value will decrease 1.5 - 4.3% per women [2] CONCLUSION In the fracture risk factors, age related factor accounted for the highest proportions and BMI account for lowest proportion A number of patients with risk factor that accounts for the highest proportion FRAX and GARVAN models have valid for prognosing the risk of femoral neck fracture after 10 years REFERENCES Nguyen Van Tuan, Nguyen Dinh Nguyen Osteoporosis: Cause, diagnosis, therapy, prevention Medical Publishing Hourse 2007, pp.120-143 Billington E.O, Gamble G.D, Reid I.R Reasons for discrepancies in hip fracture risk estimates using FRAX and GARVAN calculators Maturitas 2016, 85, pp.11-18 Bolland M.J et al Evaluation of the FRAX and GARVAN fracture risk calculators in older women J Bone Miner Res 2011, 26 (2), pp.420-427 Kanis J.A et al FRAX and the assessment of fracture probability in men and women from the UK Osteoporos Int 2008, 19 (4), pp.385-397 Pluskiewicz W et al High fracture probability predicts fractures in a 4-year follow-up in women from the RAC-OST-POL study Osteoporos Int 2015, 26 (12), pp.2811-2820 Robbins J et al Factors associated with 5-year risk of hip fracture in postmenopausal women Jama 2007, 298 (20), pp.2389-2398 Taylor B.C et al Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures J Am Geriatr Soc 2004, 52 (9), pp.1479-1486 127 ... on risk factors of patient specially bone density to evaluate fracture risk of patients We performed this study with the aim: To detect fracture rate, fracture risk factor due to osteoporosis and. .. Predict 10 years risk of femoral neck fracture due to history fracture of family History fracture of family FRAX model GARVAN model Low risk High risk Low risk High risk None fracture (n = 186)... fracture and this value will increase if So low BMI - one of 12 predictive factors of FRAX model - is one of the valuable factor in predicting the risk of fracture Table 4: Predict 10 years risk