Performance of the Fracture Risk Assessment Tool Associated with Muscle Mass Measurements and Handgrip to Screen for the Risk of Osteoporosis in Young Postmenopausal Women

Abstract

Objective To evaluate the improvement in screening accuracy of the Fracture Risk Assessment Tool (FRAX) for the risk of developing osteoporosis among young postmenopausal women by associating with it clinical muscle mass measures.

Methods A sample of postmenopausal women was submitted to calcaneal quantitative ultrasound (QUS), application of the FRAX questionnaire, and screening for the risk of developing sarcopenia at a health fair held in the city of São Bernardo do Campo in 2019. The sample also underwent anthropometric measurements, muscle mass, walking speed and handgrip tests. A major osteoporotic fracture (MOF) risk ≥ 8.5% on the FRAX, a classification of medium risk on the clinical guideline of the National Osteoporosis Guideline Group (NOGG), and a QUS T-score ≤ -1.8 sd were considered risks of having low bone mass, and QUS T-score ≤ -2.5sd, risk of having fractures.

Results In total, 198 women were evaluated, with a median age of 64 ±  7.7 years, median body mass index (BMI) of 27.3 ±  5.3 kg/m² and median QUS T-score of −1.3 ±  1.3 sd. The accuracy of the FRAX with a MOF risk ≥ 8.5% to identify women with T-scores ≤ -1.8 sd was poor, with an area under the curve (AUC) of 0.604 (95% confidence interval [95%CI]: 0.509–0.694) for women under 65 years of age, and of 0.642 (95%CI: 0.571–0.709) when age was not considered. Including data on muscle mass in the statistical analysis led to a significant improvement for the group of women under 65 years of age, with an AUC of 0,705 (95%CI: 0.612–0.786). The ability of the high-risk NOGG tool to identify T-scores ≤ -1.8 sd was limited.

Conclusion Clinical muscle mass measurements increased the accuracy of the FRAX to screen for osteoporosis in women aged under 65 years.

Resumo

Objetivo Avaliar a melhora da precisão da Fracture Risk Assessment Tool (Ferramenta de Avaliação do Risco de Fraturas, FRAX, em inglês) no rastreio do risco de desenvolver osteoporose em mulheres jovens pós-menopáusicas com a associação de medidas clínicas de massa muscular e preensão manual.

Métodos Uma amostra de mulheres pós-menopáusicas foi submetida a ultrassom quantitativo (USQ) de calcâneo, à aplicação do questionário FRAX, e rastreadas quanto ao risco de desenvolver sarcopenia em uma feira de saúde realizada em 2019 em São Bernardo do Campo. Além disso, a amostra também foi submetida a antropometria, e a testes de massa muscular, velocidade de marcha, e preensão manual. Um risco de grandes fraturas osteoporóticas (GFOs) ≥ 8,5% no FRAX, classificação de médio risco nas diretrizes clínicas do National Osteoporosis Guideline Group (NOGG), e T-score no USQ ≤ -1,8 dp foram considerados riscos de ter baixa massa óssea, e T-score no QUS ≤ -2,5 sd, risco de ter fraturas.

Resultados Ao todo, 198 mulheres foram avaliadas, com idade média de 64 ±  7,7 anos, índice de massa corporal (IMC) médio de 27,3 ±  5,3 kg/m², e T-score médio no USQ de -1,3 ±  1,3 sd. A precisão do FRAX com um risco de GFO ≥ 8,5% para identificar mulheres com T-score ≤ -1,8 dp foi precária, com uma área sob a curva (ASC) de 0,604 (intervalo de confiança de 95% [IC95%]: 0,509–0,694), para mulheres menores de 65 anos de idade, e de 0,642 (IC95%: 0,571–0,709) quando a idade não foi considerada. A inclusão de dados da massa muscular na análise estatística levou a uma melhora significativa no grupo menor de 65 anos de idade, com uma ASC de 0,705 (IC95%: 0,612–0,786). A habilidade da ferramenta NOGG de alto risco para identificar T-scores ≤ -1,8 dp foi limitada.

Conclusão As medidas clínicas da massa muscular aumentaram a precisão do FRAX no rastreio de osteoporose em mulheres menores de 65 anos de idade.

Keywords

osteoporosis - menopause - FRAX - NOGG - sarcopenia

Palavras-chave

osteoporose - menopausa - FRAX - NOGG - sarcopenia

Contributors

All authors participated in the concept and design of the study, in the analysis and interpretation of data, in the draft or revision of the manuscript, and they have approved the manuscript as submitted. All authors are responsible for the reported research.

Publication History

Received: 05 October 2020

Accepted: 13 October 2021

Article published online:
29 January 2022

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