Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project

Erjiang, E; Wang, Tingyan; Yang, Lan; Dempsey, Mary; Brennan, Attracta; Yu, Ming; Chan, Wing P.; Whelan, Bryan; Silke, Charlotte; O’Sullivan, Miriam; Rooney, Bridie; McPartland, Aoife; O'Malley, G; Carey, John J.

doi:10.1016/j.jocd.2021.03.003

Cited by 10 publications

(11 citation statements)

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“…For example, in our previous research results, we proposed seven ML technologies which improve clinical detection of low BMD 27 and used OST model as a screening tool for osteoporosis in Irish men and women. 42 We also proposed and implemented a free online tool to assess the risk of osteoporosis, named DXA-HIP Osteoporosis Assessment Tool (https://dxa-hip.shinyapps.io/dxa-hip/). Users enter their gender, age, weight and height; and the tool calculates the probability, risk level and future trends of osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Conceptual design of the dual X-ray absorptiometry health informatics prediction system for osteoporosis care

Erjiang

Carey

Wang

et al. 2022

Health Informatics J

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Osteoporotic fractures are a major and growing public health problem, which is strongly associated with other illnesses and multi-morbidity. Big data analytics has the potential to improve care for osteoporotic fractures and other non-communicable diseases (NCDs), reduces healthcare costs and improves healthcare decision-making for patients with multi-disorders. However, robust and comprehensive utilization of healthcare big data in osteoporosis care practice remains unsatisfactory. In this paper, we present a conceptual design of an intelligent analytics system, namely, the dual X-ray absorptiometry (DXA) health informatics prediction (HIP) system, for healthcare big data research and development. Comprising data source, extraction, transformation, loading, modelling and application, the DXA HIP system was applied in an osteoporosis healthcare context for fracture risk prediction and the investigation of multi-morbidity risk. Data was sourced from four DXA machines located in three healthcare centres in Ireland. The DXA HIP system is novel within the Irish context as it enables the study of fracture-related issues in a larger and more representative Irish population than previous studies. We propose this system is applicable to investigate other NCDs which have the potential to improve the overall quality of patient care and substantially reduce the burden and cost of all NCDs.

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Section: Discussionmentioning

confidence: 99%

Conceptual design of the dual X-ray absorptiometry health informatics prediction system for osteoporosis care

Erjiang

Carey

Wang

et al. 2022

Health Informatics J

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“…Details of the entire DXA-HIP cohort have been described [ 25 , 32 ]. In brief, a convenience cohort was established for clinical research using DXA data from 3 centers which include 4 GE-Lunar Prodigy DXA machines, using G.E.…”

Section: Methodsmentioning

confidence: 99%

“…The collection and analysis of the data for the DXA-HIP project were approved by our Institutions Ethics Committee and in compliance with G.D.P.R. regulations [ 25 , 32 , 36 ]. In this study, due to the inherent thresholds in the FRAX tool [ 26 ], we include Caucasian subjects aged between 40 and 90 years of age with weight less than 125 kg.…”

Section: Methodsmentioning

confidence: 99%

“…The Osteoporosis Self-assessment Tool (OST) is one of the simplest algorithms requiring only age and weight to aid in the identification of people likely to have a DXA diagnosis of osteoporosis [ 18 – 23 ]. Appropriate use of the OST index could significantly reduce the number of people requiring a DXA screening test [ 21 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Strengths of the FRAX algorithm include the availability of an online calculation option, with or without DXA testing, and the ability to include additional risk factors such as glucocorticoids, secondary causes, and a parental history of hip fracture [ 26 , 29 ]. This is particularly attractive when access to DXA is limited [ 14 , 20 , 26 , 29 ], such as in our center, where reducing unnecessary testing is important [ 25 , 30 ]. Irish legislation governing the justification of the risks associated with exposure to ionizing radiation prohibits undertaking such exposures if alternative methods are available which can achieve the same objectives [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

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Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

Yang

Dempsey²,

Brennan³

et al. 2023

Arch Osteoporos

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Summary Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. Purpose FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. Method A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland–Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. Results Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. Conclusions Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.

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Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual‐Energy X‐Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project

Carey

Erjiang²,

Wang

et al. 2023

JBMR Plus

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Osteoporosis is a common disease that has a significant impact on patients, healthcare systems, and society. World Health Organization (WHO) diagnostic criteria for postmenopausal women were established in 1994 to diagnose low bone mass (osteopenia) and osteoporosis using dual‐energy X‐ray absorptiometry (DXA)‐measured bone mineral density (BMD) to help understand the epidemiology of osteoporosis, and identify those at risk for fracture. These criteria may also apply to men ≥50 years, perimenopausal women, and people of different ethnicity. The DXA Health Informatics Prediction (HIP) project is an established convenience cohort of more than 36,000 patients who had a DXA scan to explore the epidemiology of osteoporosis and its management in the Republic of Ireland where the prevalence of osteoporosis remains unknown. In this article we compare the prevalence of a DXA classification low bone mass (T‐score < −1.0) and of osteoporosis (T‐score ≤ −2.5) among adults aged ≥40 years without major risk factors or fractures, with one or more major risk factors, and with one or more major osteoporotic fractures. A total of 33,344 subjects met our study inclusion criteria, including 28,933 (86.8%) women; 9362 had no fractures or major risk factors, 14,932 had one or more major clinical risk factors, and 9050 had one or more major osteoporotic fractures. The prevalence of low bone mass and osteoporosis increased significantly with age overall. The prevalence of low bone mass and osteoporosis was significantly greater among men and women with major osteoporotic fractures than healthy controls or those with clinical risk factors. Applying our results to the national population census figure of 5,123,536 in 2022 we estimate between 1,039,348 and 1,240,807 men and women aged ≥50 years have low bone mass, whereas between 308,474 and 498,104 have osteoporosis. These data are important for the diagnosis of osteoporosis in clinical practice, and national policy to reduce the illness burden of osteoporosis. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project

Cited by 10 publications

References 45 publications

Conceptual design of the dual X-ray absorptiometry health informatics prediction system for osteoporosis care

Conceptual design of the dual X-ray absorptiometry health informatics prediction system for osteoporosis care

Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual‐Energy X‐Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project

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