Screening of osteoporosis and risk of osteoporotic fracture among the population in old Dhaka city using Quantitative Ultrasound (QUS) and Fracture Risk Assessment Tool (FRAX)
DOI:
https://doi.org/10.3329/ajmbr.v11i3.78477Keywords:
bone health, postmenopausal women, community screening, public health intervention, non-invasive diagnosticsAbstract
Osteoporosis is a silent, progressive skeletal disorder characterized by decreased bone strength, leading to an increased risk of fractures, particularly among aging populations. This cross-sectional study was conducted over six months from June to December 2018 in the Tatibazar area of Old Dhaka, Bangladesh, to assess bone health using quantitative ultrasound (QUS) and estimate fracture risk through the Fracture Risk Assessment Tool (FRAX). A total of 188 conveniently selected participants aged 40 years and older underwent BMD screening with QUS. The FRAX tool, a validated clinical prediction model, was used to calculate the 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HF) based on clinical risk factors, with and without BMD input. The prevalence of osteopenia and osteoporosis was 31.4% and 11.2%, respectively. Age group (P < 0.001), BMI (P = 0.013), and smoking (P = 0.019) were significantly associated with lower T-scores. According to FRAX with BMD, 5.3% of participants had a moderate to high risk of MOF, and 12.2% had a high risk of HF. Age, prior fracture, glucocorticoid use, and rheumatoid arthritis were significantly linked to MOF risk; age, BMI, smoking, glucocorticoid use, and rheumatoid arthritis were linked to HF risk. The findings highlight a high burden of reduced bone mass and fracture risk in the urban aging population of Dhaka. These results emphasize the need for early diagnosis and preventive strategies, especially in resource-limited settings. Further studies are required to validate the effectiveness of QUS and FRAX as population-level screening tools in Bangladesh.
Asian J. Med. Biol. Res. 2025, 11(3), 49-58
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References
Ali M, Z Uddin and A Hossain, 2021. Prevalence and patterns of risk of osteoporosis in Bangladeshi adult population: an analysis of calcaneus quantitative ultrasound measurements. Osteology, 1: 187-196.
Barrett-Connor E, ES Siris, LE Wehren, PD Miller, TA Abbott, ML Berger, AC Santora and LM Sherwood, 2005. Osteoporosis and fracture risk in women of different ethnic groups. J. Bone Miner. Res., 20: 185-194.
Bauer DC, SK Ewing, JA Cauley, KE Ensrud, SR Cummings and ES Orwoll, 2007. Quantitative ultrasound predicts hip and non-spine fracture in men: the MrOS study. Osteoporos. Int., 18: 771-777.
Begum SM, R Begum and R Alam, 2015. Bone mineral density and osteoporosis in women of rural and urban dwellers. Bangladesh J. Nucl. Med., 18: 39-42.
Black DM and CJ Rosen, 2016. Clinical practice: postmenopausal osteoporosis. N. Engl. J. Med., 374: 254-262.
Burke É, R Carroll, M O'Dwyer, JB Walsh, P McCallion and M McCarron, 2019. Quantitative examination of the bone health status of older adults with intellectual and developmental disability in Ireland: a cross-sectional nationwide study. BMJ Open., 9: e026939.
Chen P, Z Li and Y Hu, 2016. Prevalence of osteoporosis in China: a meta-analysis and systematic review. BMC Public Health, 16: 1039.
Chin KY and S Ima-Nirwana, 2013. Calcaneal quantitative ultrasound as a determinant of bone health status: what properties of bone does it reflect? Int. J. Med. Sci., 10: 1778-1783.
Hans D, C Durosier, JA Kanis, H Johansson, AM Schott-Pethelaz and MA Krieg, 2008. Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 elderly women. J. Bone Miner. Res., 23: 1045-1051.
Jin N, S Lin, Y Zhang and F Chen, 2010. Assessment of the discrimination of the Achilles InSight calcaneus quantitative ultrasound device for osteoporosis in Chinese women: compared with dual-energy X-ray absorptiometry measurements. Eur. J. Radiol., 76: 265-268.
Kadam NS, SA Chiplonkar, AV Khadilkar and VV Khadilkar, 2018. Prevalence of osteoporosis in apparently healthy adults above 40 years of age in Pune City, India. Indian J. Endocrinol. Metab., 22: 67-73.
Kanis JA, F Borgstrom, C De Laet, H Johansson, O Johnell, B Jonsson, A Oden, N Zethraeus, B Pfleger and N Khaltaev, 2005. Assessment of fracture risk. Osteoporos. Int., 16: 581-589.
Kanis JA, O Johnell, A Oden, H Johansson and E McCloskey, 2008. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos. Int., 19: 385-397.
Khan AH, L Jafri, S Ahmed and S Noordin, 2018. Osteoporosis and its perspective in Pakistan: a review of evidence and issues for addressing fragility fractures. Ann. Med. Surg, 29: 19-25.
Kung AW, KK Lee, AY Ho, G Tang and KD Luk, 2007. Ten-year risk of osteoporotic fractures in postmenopausal Chinese women according to clinical risk factors and BMD T-scores: a prospective study. J. Bone Miner. Res., 22: 1080-1087.
Mahboub SM, MN Al-Muammar and AA Elareefy, 2014. Evaluation of the prevalence and correlated factors for decreased bone mass density among pre- and post-menopausal educated working women in Saudi Arabia. J. Health Popul. Nutr., 32: 513-519.
Mithal A, B Bansal, CS Kyer and P Ebeling, 2014. The Asia-Pacific regional audit–epidemiology, costs, and burden of osteoporosis in India 2013: a report of International Osteoporosis Foundation. Indian J. Endocrinol. Metab., 18: 449-454.
Misra A, 2015. Ethnic-specific criteria for classification of body mass index: a perspective for Asian Indians and American Diabetes Association position statement. Diabetes Technol. Ther., 17: 667-671.
Nicholson PH, R Müller, G Lowet, XG Cheng, T Hildebrand, P Rüegsegger, G van der Perre, J Dequeker and S Boonen, 1998. Do quantitative ultrasound measurements reflect structure independently of density in human vertebral cancellous bone? Bone, 23: 425-431.
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, 2001. Osteoporosis prevention, diagnosis, and therapy. JAMA, 285: 785-795.
Pasco JA, SE Lane, SL Brennan, EN Timney, G Bucki-Smith, AG Dobbins, GC Nicholson and MA Kotowicz, 2014. Fracture risk among older men: Osteopenia and osteoporosis defined using cut-points derived from female versus male reference data. Osteoporos. Int., 25: 857-862.
Puth MT, M Klaschik, M Schmid, K Weckbecker and E Münster, 2018. Prevalence and comorbidity of osteoporosis: a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany. BMC Musculoskelet. Disord., 19: 144.
Qiao D, X Liu, R Tu, X Zhang, X Qian, H Zhang, J Jiang, Z Tian, Y Wang, X Dong, Z Luo, X Liu, H Tian, G Zhang, J Pan and C Wang, 2020. Gender-specific prevalence and influencing factors of osteopenia and osteoporosis in Chinese rural population: the Henan rural cohort study. BMJ Open, 10: e028593.
Rajendran KS, K Prasanna, LDV Nair, L Rajaram, M Kalappan and MK Sivanesan, 2015. Evaluation of osteoporosis using calcaneal QUS and FRAX score as a screening tool in a semi urban tertiary care hospital of South India. Int. J. Adv. Med., 2: 341-345.
Siris ES, R Adler, J Bilezikian, M Bolognese, B Dawson-Hughes, MJ Favus, ST Harris, SM Jan de Beur, S Khosla, NE Lane and R Lindsay, 2014. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos. Int., 25: 1439-1443.
Shetty S, N Kapoor, D Naik, HS Asha, S Prabu, N Thomas, MS Seshadri and TV Paul, 2014. Osteoporosis in healthy South Indian males and the influence of lifestyle factors and vitamin D status on bone mineral density. J. Osteoporos., 2014: 723238.
Sözen T, L Özışık and NÇ Başaran, 2017. An overview and management of osteoporosis. European Eur. J. Rheumatol., 4: 46.
Steiner B, HP Dimai, H Steiner, S Cirar and A Fahrleitner‐Pammer, 2019. Prescreening for osteoporosis with quantitative ultrasound in postmenopausal white women. J. Ultrasound Med., 38:1553-1559.
Strozyk D, TM Gress and LP Breitling, 2018. Smoking and bone mineral density: Comprehensive analyses of the third National Health and Nutrition Examination Survey (NHANES III). Arch. Osteoporos., 13: 16.
Thulkar J, S Singh, S Sharma and T Thulkar, 2016. Preventable risk factors for osteoporosis in postmenopausal women: systematic review and meta-analysis. J. Midlife Health, 7: 108-113.
Vaishya R, V Vijay, AK Agarwal and P Maheshwari, 2017. Assessment of osteoporotic fracture risk in urban Indian population using quantitative ultrasonography and FRAX tool. Indian J. Med. Res., 146: S51-S56.
Vondracek SF and SA Linnebur, 2009. Diagnosis and management of osteoporosis in the older senior. Clin. Interv. Aging, 14: 121-136.
Wright NC, AC Looker, KG Saag, JR Curtis, ES Delzell, S Randall and B Dawson‐Hughes, 2014. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J. Bone Miner. Res., 29: 2520-2526.
Zhang L, F Sun, Y Li, Z Tang and L Ma, 2021. Multimorbidity in community-dwelling older adults in Beijing: prevalence and trends, 2004–2017. J. Nutr. Health Aging, 25: 116-119.
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