Значительное интервальное снижение минеральной плотности костной ткани у пациентов с остеопенией не является частью отчета FRAX
Charles Intenzo, 1,* Aishwarya Gulati,1 Gabriela Bober,1 Serge Jabbour,2 Jeffrey Miller,2 Intekab Ahmed,2 Kevin Furlong,2 Sung Kim,1 Christine Wu,3 David Capuzzi,2 John P. Bilezikian4
1 Division of Nuclear medicine and Molecular Imaging, Thomas Jefferson University Hospital, Philadelphia, PA, USA2 Division of Endocrinology and Metabolism, Thomas Jefferson University Hospital, Philadelphia, PA, USA3 Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA4 Metabolic Bone Disease Unit, Columbia University Medical Center and Vagelos College of Physicians and Surgeons, New York, NY, USA
ABSTRACT
Background: Bone mineral density (BMD), considered to be a gold standard for the diagnosis of osteoporosis, is most commonly measured by dual-energy x-ray absorptiometry (DXA). For patients with osteopenia, the Fracture Risk Assessment Tool (FRAX) incorporates acknowledged other risk factors to assess overall fracture risk and aids in patient management. If the FRAX score in an osteopenic patient predicts a 10-year fracture risk of >20% for a major osteoporotic fracture or >3% for a hip fracture, pharmacologic therapy is indicated. However, FRAX does not include an assessment of a significant decline in BMD over time.
Methodology: Our goal was to determine the frequency with which BMD declines in patients with osteopenia by DXA, but whose FRAX score continues to be below treatment thresholds.
Results: Over a 2-year interval, 1112 (15.6%) of 7133 patients with osteopenia by DXA experienced a significant decrease in BMD but had their FRAX score remain in the range where therapy would by convention not be recommended.
Conclusion: Since a decline in BMD is, by itself, a clinical risk factor for an osteoporotic fracture, FRAX assessment may therefore potentially underestimate true fracture risk if a significant interval decline in BMD is measured.
Keywords: Osteopenia, DXA, FRAX