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Summary <p><i>T</i>-scores alone are inadequate for identifying hip fracture risk. Incorporating FRAX-HFP scores and femoral strength improves risk assessment. Tailored interventions are needed for different ethnicities, with a focus on females due to higher fracture risk. Sex-specific thresholds and targeted prevention strategies are essential for effective fracture prevention.</p> Background <p>We investigated the age-related trajectories of areal bone mineral density (aBMD), fracture risk assessment tool (FRAX)–based 10-year probability of hip fracture (FRAX-HFP), trochanteric soft tissue thickness (TSTT), and femoral strength in a multi-ethnic cohort of community-dwelling older adults in Singapore. We also examined the relationship between FRAX-HFP and femoral strength.</p> Methods <p>Dual-energy X-ray absorptiometry (DXA) scans were conducted for Singaporean older adults (<i>n</i> = 2235), enrolled in the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study. aBMD and FRAX-HFP were recorded for the subjects. TSTT was derived from whole-body DXA scans. Femoral strength was derived from DXA-based 3D finite element models. Age-related trajectories were compared for three major ethnicities in Singapore. The relationship between FRAX-HFP and femoral strength was examined.</p> Results <p>The study included 2204 older adults (1224 females (73.71 ± 8.37&#xa0;years), 980 males (73.45 ± 8.34&#xa0;years)). Age-related trajectories for aBMD, FRAX-HFP, TSTT, and femoral strength indicated that Chinese ethnicity is at high risk for fracture, compared to Indians and Malays. Separately, FRAX-HFP identified 16% of males and 27% of females, and femoral strength identified 3% of males and 1% of females at risk. Both FRAX-HFP score and femoral strength identified 24% of males and 35% of females at risk.</p> Conclusion <p>Age-related trajectories for aBMD, FRAX-HFP, TSTT, and femoral strength were found to be consistent with the hip fracture trends in Singapore. FRAX-HFP and femoral strength identified different individuals at risk, indicating that each, either alone or combined with aBMD, could improve the ability to assess hip fracture risk.</p>

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Relationship between areal BMD, FRAX®, and femoral strength in community-dwelling older Asian adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月4日

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  • Dheeraj Jha,
  • Manju Chandran,
  • Dario Koller,
  • Vee San Cheong,
  • Anitha D. Praveen,
  • Alexander Baker,
  • Preeti Gupta,
  • Ecosse L. Lamoureux,
  • Halldór Pálsson,
  • Stephen J. Ferguson,
  • Benedikt Helgason

摘要

Summary

T-scores alone are inadequate for identifying hip fracture risk. Incorporating FRAX-HFP scores and femoral strength improves risk assessment. Tailored interventions are needed for different ethnicities, with a focus on females due to higher fracture risk. Sex-specific thresholds and targeted prevention strategies are essential for effective fracture prevention.

Background

We investigated the age-related trajectories of areal bone mineral density (aBMD), fracture risk assessment tool (FRAX)–based 10-year probability of hip fracture (FRAX-HFP), trochanteric soft tissue thickness (TSTT), and femoral strength in a multi-ethnic cohort of community-dwelling older adults in Singapore. We also examined the relationship between FRAX-HFP and femoral strength.

Methods

Dual-energy X-ray absorptiometry (DXA) scans were conducted for Singaporean older adults (n = 2235), enrolled in the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study. aBMD and FRAX-HFP were recorded for the subjects. TSTT was derived from whole-body DXA scans. Femoral strength was derived from DXA-based 3D finite element models. Age-related trajectories were compared for three major ethnicities in Singapore. The relationship between FRAX-HFP and femoral strength was examined.

Results

The study included 2204 older adults (1224 females (73.71 ± 8.37 years), 980 males (73.45 ± 8.34 years)). Age-related trajectories for aBMD, FRAX-HFP, TSTT, and femoral strength indicated that Chinese ethnicity is at high risk for fracture, compared to Indians and Malays. Separately, FRAX-HFP identified 16% of males and 27% of females, and femoral strength identified 3% of males and 1% of females at risk. Both FRAX-HFP score and femoral strength identified 24% of males and 35% of females at risk.

Conclusion

Age-related trajectories for aBMD, FRAX-HFP, TSTT, and femoral strength were found to be consistent with the hip fracture trends in Singapore. FRAX-HFP and femoral strength identified different individuals at risk, indicating that each, either alone or combined with aBMD, could improve the ability to assess hip fracture risk.