Comparison of Performance of Risk Assessment Tools for Low BMD and Fracture Risk Identification in Pakistani Women

Abstract

Objective: To evaluate the efficacy of four risk assessment tools for identifying low Bone Mineral Density (BMD) in a sample of Pakistani females. Methodology: It was a cross sectional study including 200 females above 40 years. DXA scans were performed. Subjects were categorized into low risk and high risk categories for low BMD on the basis of T scores. Questionnaires were filled and risk indices were calculated for all subjects. Sensitivity, specificity, positive and negative predictive values were calculated, Receiver Operating characteristic (ROC) curves were plotted and Area Under Curve (AUC) were obtained. Results: A total of 200 females including 174(87%) postmenopausal, and 26(13%) premenopausal were included. Average age was 60.76±10.52 years with average age of menopause being 47.64±6.63 years. In terms of sensitivity, specificity and AUC, the WHO risk assessment tool FRAX showed the best performance with a sensitivity of 79%, specificity 94% and AUC of 0.869 for detecting low BMD. Conclusion: It is not cost effective to use DXA for screening purposes. We propose that risk assessment tools such as FRAX may be utilized to identify individuals with low BMD. This may prove beneficial in minimizing the medical and social burden that fragility fractures pose to developing health care systems