Estimations of bone mineral density defined osteoporosis prevalence and cutpoint T-score for defining osteoporosis among older Chinese population: a framework based on relative fragility fracture risks

Abstract

The clinical significance of osteoporosis lies in the fractures which occur, and the most important fracture is hip fracture. According to the WHO criteria, T-score is defined as: (BMD patient -BMD young normal mean )/SD young normal population , where BMD is bone mineral density and SD is the standard deviation. In adult women, the cutpoint value of patient BMD 2.5 SD below BMD young normal mean satisfies that, when the femoral neck is measured, osteoporosis prevalence is about 16.2% for those aged ≥50 years, the same as the lifetime risk of hip fragility fracture (FF) (1,2). If other sites are also considered, this cutpoint value identifies approximately 30% of postmenopausal women as having osteoporosis, which is approximately equivalent to the lifetime risk of FF at the spine, hip, or forearm. It is commonly considered that this osteoporotic portion of the population has a faster bone mass loss, and interventions

An update of our understanding of radiographic diagnostics for prevalent osteoporotic vertebral fracture in elderly women

“…This has led to some practical difficulties. For example, osteoporotic hip fracture prevalence among Chinese is generally no more than half that of Caucasians (6,56), and we demonstrated that both radiographic OVF and clinical OVF follow the same trend with their prevalences among Chinese being no more than half of those among Caucasians (6,7,36). However, earlier studies reported that OVF among East Asians is as prevalent as that of Caucasians (57,58).…”

“…There is no ground truth justification for the classification of osteoporosis by the prevailing cutpoint T-score, particularly for non-Caucasian populations (5). Cutpoint T-score is also affected by the quality of the BMD reference database (6). Moreover, osteoporotic fracture commonly occurs in subjects not in the category of BMD-defined osteoporosis.…”

Lower Prevalence and Severity of Degenerative Changes in the Lumbar Spine in Elderly Hong Kong Chinese Compared with Age-matched Italian Caucasian Women

“…42 Osteoporosis prevalence is known to be higher among Caucasians compared with that of Chinese. 46 In our study, we note a difference in hip fragility fracture rate between the Italian and Hong Kong cohorts. This likely a result of a combination of fracture susceptibility and recruitment differences.…”

“…Within the United States, a much lower hip fracture rate among older Asians than among Caucasians has been consistently noted, while these comparisons were less affected by lifestyle differences. [44][45][46] On the other hand, Hong Kong Chinese and Chinese in the United States both have a hip fracture prevalence of no more than half of that of Caucasians. 46 Ross et al 47 described that, although the lifestyle of the Hawaii Japanese is more westernized than Okinawa Japanese, the hip fracture rates of Hawaii Japanese and Okinawa Japanese are almost the same.…”

A software program for automated compressive vertebral fracture detection on elderly women’s lateral chest radiograph: Ofeye 1.0

“…Though BMD has been commonly used in decision-making for the diagnosis of osteoporosis, it is associated with many inherent limitations (7,8). How to define cutpoint T-scores for differential ethnic groups remains controversial (9). In addition, osteoporotic fracture commonly occurs in subjects not in the category of BMDdefined osteoporosis, and thus would not be selected for pharmacological therapy based on BMD score alone (10)(11)(12)(13)(14).…”