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Repurposing a fracture risk calculator (FRAX) as a screening tool for women at risk for sarcopenia

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Abstract

Summary

Osteoporosis and sarcopenia share risk profiles, so we tested a fracture risk assessment tool (FRAX) as a screening tool for sarcopenia. FRAX probabilities without bone mineral density predicted sarcopenia with high sensitivity and reasonable specificity. There is potential to use this FRAX as a screening tool for sarcopenia.

Purpose

There is a need for simple screening tools for sarcopenia. As osteoporosis and sarcopenia share risk profiles, we tested the performance of a fracture risk assessment tool for discriminating individuals at risk for sarcopenia.

Methods

In this longitudinal study, FRAX (Australia) probabilities were calculated for 354 women (ages 40–90 years) in the Geelong Osteoporosis Study. Sarcopenia was assessed a decade later using DXA-derived low appendicular lean mass (Lunar; ALM/height2 < 5.5 kg/m2) and low handgrip strength (Jamar; HGS < 16 kg), according to EWGSOP2. We determined FRAX probabilities (%) for hip fracture (HF-FRAX) and major osteoporotic fracture (MOF-FRAX), with and without BMD. Area under the receiver operator characteristic (AUROC) curves quantified the performance of FRAX for predicting sarcopenia.

Results

Baseline median (IQR) values for HF-FRAX without BMD were 0.4 (0.1–1.3) and for MOF-FRAX without BMD, 2.4 (1.2–5.2); comparable figures for HF-FRAX with BMD were 0.2 (0.0–0.7) and for MOF-FRAX with BMD, 2.1 (1.1–4.4). At follow-up, sarcopenia was identified for 11 (3.1%) women. When FRAX was calculated without BMD, the AUROC was 0.90 for HF-FRAX and 0.88 for MOF-FRAX. Optimal thresholds were 0.9 for HF-FRAX (sensitivity 90.9%, specificity 62.4%) and 5.3 for MOF-FRAX (sensitivity 81.8%, specificity 71.7%). Calculating FRAX with BMD did not improve the predictive performance of FRAX for sarcopenia.

Conclusion

Here we provide preliminary evidence to suggest that FRAX probabilities without BMD might predict sarcopenia with high sensitivity and reasonable specificity. Given that FRAX clinical risk factors are identified without equipment, there is potential to use this or a modified version of the FRAX tool to screen for individuals at risk of sarcopenia.

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Acknowledgements

The authors acknowledge the study participants. The authors thank Professor Graham Giles of the Cancer Epidemiology Centre of The Cancer Council Victoria, for permission to use the Dietary Questionnaire for Epidemiological Studies (Version 2), Melbourne: The Cancer Council Victoria 1996.

Funding

The Geelong Osteoporosis Study (GOS) was funded by the National Health and Medical Research Council (NHMRC) Australia (projects 251638, 628582). The funding organisations played no role in the design or conduct of the study, in the collection, management, analysis and interpretation of the data, nor in the preparation, review and approval of the manuscript. MCT was supported by a Deakin Postgraduate Scholarship, KLH-K by an Alfred Deakin Postdoctoral Research Fellowship, NKH by a Deakin Postdoctoral Fellowship and LJW by a NHMRC Fellowship (#1064272).

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Authors and Affiliations

  1. Institute for Mental and Physical Health and Clinical Translation (iMPACT), Deakin University, Geelong, Victoria, Australia

    J.A. Pasco, M.C. Tembo, K.L. Holloway-Kew, N.K. Hyde, L.J. Williams & M.A. Kotowicz

  2. Department of Medicine – Western Health, The University of Melbourne, St Albans, Victoria, Australia

    J.A. Pasco & M.A. Kotowicz

  3. Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia

    J.A. Pasco

  4. Barwon Health, Geelong, Victoria, Australia

    J.A. Pasco & M.A. Kotowicz

  5. Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia

    M. Mohebbi

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  1. J.A. Pasco
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  2. M. Mohebbi
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  3. M.C. Tembo
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  4. K.L. Holloway-Kew
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  5. N.K. Hyde
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  6. L.J. Williams
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  7. M.A. Kotowicz
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Correspondence to J.A. Pasco.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Human Research Ethics Committee at Barwon Health.

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Informed consent was obtained from all individual participants included in the study.

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Pasco, J., Mohebbi, M., Tembo, M. et al. Repurposing a fracture risk calculator (FRAX) as a screening tool for women at risk for sarcopenia. Osteoporos Int 31, 1389–1394 (2020). https://doi.org/10.1007/s00198-020-05376-2

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  • DOI: https://doi.org/10.1007/s00198-020-05376-2

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