Fragility Score: a REMS-based indicator for the prediction of incident fragility fractures at 5 years

Abstract

Background Accurate estimation of the imminent fragility fracture risk currently represents a challenging task. The novel Fragility Score (FS) parameter, obtained during a Radiofrequency Echographic Multi Spectrometry (REMS) scan of lumbar or femoral regions, has been developed for the non-ionizing estimation of skeletal fragility. Aims The aim of this study was to assess the performance of FS in the early identification of patients at risk for incident fragility fractures with respect to bone mineral density (BMD) measurements. Methods Data from 1989 Caucasians of both genders were analysed and the incidence of fractures was assessed during a follow-up period up to 5 years. The diagnostic performance of FS to discriminate between patients with and without incident fragility fracture in comparison to that of the BMD T-scores measured by both Dual X-ray Absorptiometry (DXA) and REMS was assessed through ROC analysis. Results Concerning the prediction of generic osteoporotic fractures, FS provided AUC = 0.811 for women and AUC = 0.780 for men, which resulted in AUC = 0.715 and AUC = 0.758, respectively, when adjusted for age and body mass index (BMI). For the prediction of hip fractures, the corresponding values were AUC = 0.780 for women and AUC = 0.809 for men, which became AUC = 0.735 and AUC = 0.758, respectively, after age- and BMI-adjustment. Overall, FS showed the highest prediction ability for any considered fracture type in both genders, resulting always being significantly higher than either T-scores, whose AUC values were in the range 0.472–0.709. Conclusion FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk.

Radiofrequency echographic multi spectrometry (REMS) in the diagnosis and management of osteoporosis: state of the art

“…When considering the precision and repeatability of the Fragility Score, the intra-operator variability is minimal (RMS-CV = 0.49% for lumbar spine and RMS-CV = 0.43% for femoral neck), as is the inter-operator variability (RMS-CV = 0.73% for lumbar spine and RMS-CV = 0.64% for femoral neck) [ 15 ]. This is thought to be due to the automated selection of the region of interest and has been borne out in a recent review of REMS with excellent agreement and accuracy reported [ 7 ].…”

“…The use of Fragility Score to predict fracture risk has been tested in a prospective, 5-year follow-up study in 1989 Caucasian men and women [ 15 ]. The diagnostic performance to predict future major osteoporotic fractures (over the next 5 years) was good in both women (AUC = 0.811) and men (AUC = 0.780) (AUC = 0.809 in men and AUC = 0.780 in women after adjustment for age and BMI) [ 15 ].…”

Ten tips on how to assess bone health in patients with chronic kidney disease

“…The ultrasound signals backscattered from the bone structures are analyzed and the pattern compared with models of fractured and non-fractured patients. The resulting fragility score relates to bone microarchitecture and may improve fracture prediction [ 129 ].…”

Radiofrequency Echographic Multispectrometry (REMS): A New Option in the Assessment Bone Status in Adults with Osteogenesis Imperfecta

“…Several recent studies have shown a good diagnostic agreement between the BMD values obtained using the REMS technique compared to the DXA method. Moreover, REMS assessment was characterized by good repeatability and adequate precision but it was also able to predict the risk of fragility fractures [15][16][17]. In addition, REMS technology seems to be able to overcome some limitations of DXA, such as the overestimation of BMD in the presence of artifacts, osteophytes and fractures, and also to provide bone qualitative information [18,19].…”