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Trabecular bone score may improve FRAX® prediction accuracy for major osteoporotic fractures in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study

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Abstract

Summary

FRAX® is widely used to evaluate fracture risk of individuals in clinical settings. However, FRAX® prediction accuracy is not sufficient, and improvement is desired. Trabecular bone score, a bone microarchitecture index, may improve FRAX® prediction accuracy for major osteoporotic fractures in community-dwelling elderly Japanese men.

Introduction

To improve fracture risk assessment in clinical settings, we evaluated whether the combination of FRAX® and Trabecular Bone Score (TBS) improves the prediction accuracy of major osteoporotic fractures (MOFs) in elderly Japanese men compared to FRAX® alone.

Methods

Two thousand and twelve community-dwelling men aged ≥65 years completed the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Baseline Study comprising lumbar spine (LS) and femoral neck areal bone mineral density (aBMD) measurements, and interviews regarding clinical risk factors required to estimate 10-year risk of MOF (hip, spine, distal forearm, and proximal humerus) using the Japanese version of FRAX® (v.3.8). TBS was calculated for the same vertebrae used for LS-aBMD with TBS iNsight software (v.2.1). MOFs that occurred during the follow-up period were identified by interviews or mail and telephone surveys. Prediction accuracy of a logistic model combining FRAX® score and TBS compared to FRAX® alone was evaluated by area under receiver-operating characteristic curves (AUCs), as well as category-free integrated discrimination improvement (IDI) and net reclassification improvement (NRI).

Results

We identified 22 men with MOFs during 8140 person-years (PY) of follow-up among 1872 men; 67 men who suffered from fractures other than MOFs were excluded. Participants with MOFs had significantly lower TBS (p = 0.0015) and higher FRAX® scores (p = 0.0089) than those without. IDI and NRI showed significant improvements in reclassification accuracy using FRAX® plus TBS compared to FRAX® alone (IDI 0.006 (p = 0.0362), NRI 0.452 (p = 0.0351)), although no difference was observed in AUCs between the two.

Conclusions

TBS may improve MOF prediction accuracy of FRAX® for community-dwelling elderly Japanese men.

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Acknowledgments

The Fujiwara-kyo Study Group (chaired by Norio Kurumatani with Nozomi Okamoto as secretary general), comprising Nobuko Amano, Yuki Fujita, Akihiro Harano, Kan Hazaki, Masayuki Iki, Junko Iwamoto, Akira Minematsu, Masayuki Morikawa, Keigo Saeki, Noriyuki Tanaka, Kimiko Tomioka, and Motokazu Yanagi, performed most non-skeletal measures in the present study and provided the data to the FORMEN Study. The FORMEN Study was supported by Grant-in-Aid for Scientific Research (no. 20659103: 2008–2009, no. 21390210: 2009–2011, no. 20590661: 2008–2010) from the Japanese Society for the Promotion of Science; a Grant-in-Aid for Young Scientists (no. 20790451: 2008–2010) from the Japanese Ministry of Education, Culture, Sports, Science and Technology; a Grant-in-Aid for Study on Milk Nutrition (2008) from the Japan Dairy Association; a Grant (2007) from the Foundation for Total Health Promotion; a St. Luke’s Life Science Institute Grant-in-Aid for Epidemiological Research (2008); and a Grant (2008) from the Physical Fitness Research Institute, MEIJIYASUDA Life Foundation of Health and Welfare. The funding bodies and collaborators had no role in designing the study, in analyzing and interpreting the data, in writing the manuscript, or in deciding where to submit the manuscript for publication. The authors thank the Toyukai Medical Corporation (Tokyo, Japan), Toyo Medic Corporation (Tokyo, Japan), and SRL Inc. (Tokyo, Japan) for their technical assistance.

Conflicts of interest

Renaud Winzenrieth is a senior scientist at Med-Imaps. Masayuki Iki, Yuki Fujita, Junko Tamaki, Katsuyasu Kouda, Akiko Yura, Yuho Sato, Jong-Seong Moon, Nozomi Okamoto, and Norio Kurumatani declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    M. Iki, Y. Fujita, K. Kouda & A. Yura

  2. Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    J. Tamaki

  3. Department of Health and Nutrition, Faculty of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui, 915-8586, Japan

    Y. Sato

  4. Department of Nursing and Medical Care, Faculty of Health Science, Kio University, 4-2-2 Umami-naka, Koryo-cho, Kita-Katsuragi-gun, Nara, 635-0832, Japan

    J.-S. Moon

  5. Med-Imaps, Hôpital Xavier Arnozan, Avenue du Haut Lévèque, Pessac, 33600, France

    R. Winzenrieth

  6. Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan

    N. Okamoto & N. Kurumatani

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  1. M. Iki
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  2. Y. Fujita
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  7. J.-S. Moon
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  8. R. Winzenrieth
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Correspondence to M. Iki.

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Iki, M., Fujita, Y., Tamaki, J. et al. Trabecular bone score may improve FRAX® prediction accuracy for major osteoporotic fractures in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Osteoporos Int 26, 1841–1848 (2015). https://doi.org/10.1007/s00198-015-3092-3

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