Fragility fracture is a serious clinical event, because it is associated with increased risk of mortality and reduced quality of life. The risk of fracture is determined by multiple risk factors, and their effects may be interactional. Over the past 10 years, a number of predictive models (e.g., FRAX, Garvan Fracture Risk Calculator, and Qfracture) have been developed for individualized assessment of fracture risk. These models use different risk profiles to estimate the probability of fracture over 5- and 10-year period. The ability of these models to discriminate between those individuals who will and will not have a fracture (i.e., area under the receiver operating characteristic curve [AUC]) is generally acceptable-to-good (AUC, 0.6 to 0.8), and is highly variable between populations. The calibration of existing models is poor, particularly in Asian populations. There is a strong need for the development and validation of new prediction models based on Asian data for Asian populations. We propose approaches to improve the accuracy of existing predictive models by incorporating new markers such as genetic factors, bone turnover markers, trabecular bone score, and time-variant factors. New and more refined models for individualized fracture risk assessment will help identify those most likely to sustain a fracture, those most likely to benefit from treatment, and encouraging them to modify their risk profile to decrease risk.
Asian Continental Ancestry Group ; Bone Remodeling ; Calibration ; Humans ; Mortality ; Osteoporosis ; Quality of Life ; Risk Assessment ; Risk Factors ; ROC Curve

Objectives: Vertebral fractures are associated with disability and mortality, but most vertebral fractures are asymptomatic. The present study aimed to determine the incidence of and develop a predictive nomogram for asymptomatic vertebral fractures in Vietnamese adults. Methods: This cohort study as a part of the Vietnam Osteoporosis Study involved 168 men and 287 women aged 50 years and older without a clinically diagnosed vertebral fracture. Their spine x-rays were taken at the recruitment and subsequent 2-year visit. Vertebral fractures were ascertained using the Genant’s semiquantitative method. We employed the Bayesian Model Averaging method to search for the optimal model for predicting asymptomatic vertebral fractures. A predictive nomogram was also developed to facilitate risk prediction. Results: During a median of 2.38 years of follow-up, 13 men and 16 women developed an asymptomatic vertebral fracture, yielding the overall incidence rate of 28 fractures per 1000 person-years, or 33 fractures/1000 personyears in men and 24 fractures/1000 person-years in women, respectively. Most asymptomatic vertebral fractures were moderate, almost 1.5 times more common than mild fractures. The optimal model for predicting incident asymptomatic vertebral fractures included age, male sex and lower femoral neck T-score. The area under the receiver’s operating characteristic curve was 0.91, with 95% CI ranging from 0.86 to 0.96. Conclusions Asymptomatic vertebral fractures were relatively common among adults in Vietnam. A simple model with sex, age and femoral neck T-score is helpful for selective screening of asymptomatic vertebral fractures in Vietnamese individuals.

Objectives: Vertebral fractures are associated with disability and mortality, but most vertebral fractures are asymptomatic. The present study aimed to determine the incidence of and develop a predictive nomogram for asymptomatic vertebral fractures in Vietnamese adults. Methods: This cohort study as a part of the Vietnam Osteoporosis Study involved 168 men and 287 women aged 50 years and older without a clinically diagnosed vertebral fracture. Their spine x-rays were taken at the recruitment and subsequent 2-year visit. Vertebral fractures were ascertained using the Genant’s semiquantitative method. We employed the Bayesian Model Averaging method to search for the optimal model for predicting asymptomatic vertebral fractures. A predictive nomogram was also developed to facilitate risk prediction. Results: During a median of 2.38 years of follow-up, 13 men and 16 women developed an asymptomatic vertebral fracture, yielding the overall incidence rate of 28 fractures per 1000 person-years, or 33 fractures/1000 personyears in men and 24 fractures/1000 person-years in women, respectively. Most asymptomatic vertebral fractures were moderate, almost 1.5 times more common than mild fractures. The optimal model for predicting incident asymptomatic vertebral fractures included age, male sex and lower femoral neck T-score. The area under the receiver’s operating characteristic curve was 0.91, with 95% CI ranging from 0.86 to 0.96. Conclusions Asymptomatic vertebral fractures were relatively common among adults in Vietnam. A simple model with sex, age and femoral neck T-score is helpful for selective screening of asymptomatic vertebral fractures in Vietnamese individuals.

Objectives: Vertebral fractures are associated with disability and mortality, but most vertebral fractures are asymptomatic. The present study aimed to determine the incidence of and develop a predictive nomogram for asymptomatic vertebral fractures in Vietnamese adults. Methods: This cohort study as a part of the Vietnam Osteoporosis Study involved 168 men and 287 women aged 50 years and older without a clinically diagnosed vertebral fracture. Their spine x-rays were taken at the recruitment and subsequent 2-year visit. Vertebral fractures were ascertained using the Genant’s semiquantitative method. We employed the Bayesian Model Averaging method to search for the optimal model for predicting asymptomatic vertebral fractures. A predictive nomogram was also developed to facilitate risk prediction. Results: During a median of 2.38 years of follow-up, 13 men and 16 women developed an asymptomatic vertebral fracture, yielding the overall incidence rate of 28 fractures per 1000 person-years, or 33 fractures/1000 personyears in men and 24 fractures/1000 person-years in women, respectively. Most asymptomatic vertebral fractures were moderate, almost 1.5 times more common than mild fractures. The optimal model for predicting incident asymptomatic vertebral fractures included age, male sex and lower femoral neck T-score. The area under the receiver’s operating characteristic curve was 0.91, with 95% CI ranging from 0.86 to 0.96. Conclusions Asymptomatic vertebral fractures were relatively common among adults in Vietnam. A simple model with sex, age and femoral neck T-score is helpful for selective screening of asymptomatic vertebral fractures in Vietnamese individuals.

Objectives: Vertebral fractures are associated with disability and mortality, but most vertebral fractures are asymptomatic. The present study aimed to determine the incidence of and develop a predictive nomogram for asymptomatic vertebral fractures in Vietnamese adults. Methods: This cohort study as a part of the Vietnam Osteoporosis Study involved 168 men and 287 women aged 50 years and older without a clinically diagnosed vertebral fracture. Their spine x-rays were taken at the recruitment and subsequent 2-year visit. Vertebral fractures were ascertained using the Genant’s semiquantitative method. We employed the Bayesian Model Averaging method to search for the optimal model for predicting asymptomatic vertebral fractures. A predictive nomogram was also developed to facilitate risk prediction. Results: During a median of 2.38 years of follow-up, 13 men and 16 women developed an asymptomatic vertebral fracture, yielding the overall incidence rate of 28 fractures per 1000 person-years, or 33 fractures/1000 personyears in men and 24 fractures/1000 person-years in women, respectively. Most asymptomatic vertebral fractures were moderate, almost 1.5 times more common than mild fractures. The optimal model for predicting incident asymptomatic vertebral fractures included age, male sex and lower femoral neck T-score. The area under the receiver’s operating characteristic curve was 0.91, with 95% CI ranging from 0.86 to 0.96. Conclusions Asymptomatic vertebral fractures were relatively common among adults in Vietnam. A simple model with sex, age and femoral neck T-score is helpful for selective screening of asymptomatic vertebral fractures in Vietnamese individuals.

Objectives: Vertebral fractures are associated with disability and mortality, but most vertebral fractures are asymptomatic. The present study aimed to determine the incidence of and develop a predictive nomogram for asymptomatic vertebral fractures in Vietnamese adults. Methods: This cohort study as a part of the Vietnam Osteoporosis Study involved 168 men and 287 women aged 50 years and older without a clinically diagnosed vertebral fracture. Their spine x-rays were taken at the recruitment and subsequent 2-year visit. Vertebral fractures were ascertained using the Genant’s semiquantitative method. We employed the Bayesian Model Averaging method to search for the optimal model for predicting asymptomatic vertebral fractures. A predictive nomogram was also developed to facilitate risk prediction. Results: During a median of 2.38 years of follow-up, 13 men and 16 women developed an asymptomatic vertebral fracture, yielding the overall incidence rate of 28 fractures per 1000 person-years, or 33 fractures/1000 personyears in men and 24 fractures/1000 person-years in women, respectively. Most asymptomatic vertebral fractures were moderate, almost 1.5 times more common than mild fractures. The optimal model for predicting incident asymptomatic vertebral fractures included age, male sex and lower femoral neck T-score. The area under the receiver’s operating characteristic curve was 0.91, with 95% CI ranging from 0.86 to 0.96. Conclusions Asymptomatic vertebral fractures were relatively common among adults in Vietnam. A simple model with sex, age and femoral neck T-score is helpful for selective screening of asymptomatic vertebral fractures in Vietnamese individuals.

Objectives: The association between body composition parameters and peak bone mineral density is not well documented. The aim of this study is to assess the relative contributions of lean mass and fat mass on peak bone mineral density (BMD). Methods: The study involved 416 women and 334 men aged between 20 and 30 years who were participants in the population-based Vietnam Osteoporosis Study. Whole body composition parameters (eg, fat mass and lean mass) and BMD at the lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. The association between lean mass and fat mass and BMD was analyzed by the linear regression model using the Least Absolute Shrinkage and Selection Operator (LASSO). Results: Peak BMD in men was higher than women, and the difference was more pronounced at the femoral neck (average difference: 0.123 g/㎠; 95% confidence interval [CI] 0.105–0.141 g/㎠) than at the lumbar spine (average difference 0.019 g/㎠; 95% CI, 0.005–0.036 g/㎠). Results of LASSO regression indicated that lean mass was the only predictor of BMD for either men or women. Each kilogram increase in lean mass was associated with ∼0.01 g/㎠ increase in BMD. Lean mass alone explained 16% and 36% of variation in lumbar spine and femoral neck BMD, respectively. Conclusions Lean mass, not fat mass, is the main determinant of peak bone mineral density. This finding implies that good physical activity during adulthood can contribute to the maximization of peak bone mass during adulthood.

Objectives: The association between body composition parameters and peak bone mineral density is not well documented. The aim of this study is to assess the relative contributions of lean mass and fat mass on peak bone mineral density (BMD). Methods: The study involved 416 women and 334 men aged between 20 and 30 years who were participants in the population-based Vietnam Osteoporosis Study. Whole body composition parameters (eg, fat mass and lean mass) and BMD at the lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. The association between lean mass and fat mass and BMD was analyzed by the linear regression model using the Least Absolute Shrinkage and Selection Operator (LASSO). Results: Peak BMD in men was higher than women, and the difference was more pronounced at the femoral neck (average difference: 0.123 g/㎠; 95% confidence interval [CI] 0.105–0.141 g/㎠) than at the lumbar spine (average difference 0.019 g/㎠; 95% CI, 0.005–0.036 g/㎠). Results of LASSO regression indicated that lean mass was the only predictor of BMD for either men or women. Each kilogram increase in lean mass was associated with ∼0.01 g/㎠ increase in BMD. Lean mass alone explained 16% and 36% of variation in lumbar spine and femoral neck BMD, respectively. Conclusions Lean mass, not fat mass, is the main determinant of peak bone mineral density. This finding implies that good physical activity during adulthood can contribute to the maximization of peak bone mass during adulthood.

Objectives: Vertebral fracture is both common and serious among adults, yet it often goes undiagnosed. This study aimed to develop a shape-based algorithm (SBA) for the automatic identification of vertebral fractures. Methods: The study included 144 participants (50 individuals with a fracture and 94 without a fracture) whose plain thoracolumbar spine X-rays were taken. Clinical diagnosis of vertebral fracture (grade 0 to 3) was made by rheumatologists using Genant’s semiquantitative method. The SBA algorithm was developed to determine the ratio of vertebral body height loss. Based on the ratio, SBA classifies a vertebra into 4 classes: 0 = normal, 1 = mild fracture, 2 = moderate fracture, 3 = severe fracture). The concordance between clinical diagnosis and SBAbased classification was assessed at both person and vertebra levels. Results: At the person level, the SBA achieved a sensitivity of 100% and specificity of 62% (95% CI, 51%–72%). At the vertebra level, the SBA achieved a sensitivity of 84% (95% CI, 72%–93%), and a specificity of 88% (95% CI, 85%–90%). On average, the SBA took 0.3 s to assess each X-ray. Conclusions The SBA developed here is a fast and efficient tool that can be used to systematically screen for asymptomatic vertebral fractures and reduce the workload of healthcare professionals.

OBJECTIVES: Osteoporosis and fracture impose a significant health care burden on the contemporary populations in developing countries. The Vietnam Osteoporosis Study (VOS) sought to assess the burden of osteoporosis and its comorbidities in men and women. METHODS: The study was designed as a population-based family investigation in which families were randomly recruited from Ho Chi Minh City, Vietnam. Individuals were assessed for bone health, including bone mineral density (BMD) and body composition and trabecular and cortical bone properties by pQCT (peripheral quantitative computed tomography). Fasting blood samples were obtained for the analysis of plasma glucose, glycosylated hemoglobin, and bone turnover markers. Genomic DNA extraction from whole blood samples for further genetic and genomic analyses. RESULTS: We have recruited more than 4157 individuals from 817 families. The average age of participants was 51, with approximately 45% of the individuals aged 50 years and older. Approximately 3% of participants were obese (body mass index ≥ 30 kg/m²), and 21% were overweight. Notably, 11% of participants aged 40 years and older were diabetic. Among those aged 50 years and older, approximately 14% of women and 5% of men had osteoporosis (i.e., femoral neck BMD T-scores ≤−2.5). There were modest correlations between volumetric BMD and areal BMD. CONCLUSIONS: VOS is a major bone research project in Vietnam aimed at comprehensively documenting the burden osteoporosis, its co-occurrence of chronic diseases, and their underlying etiologies. The Study will make important contributions to the literature of bone health worldwide.
Blood Glucose ; Body Composition ; Bone Density ; Bone Remodeling ; Chronic Disease ; Comorbidity ; Delivery of Health Care ; Developing Countries ; DNA ; Fasting ; Female ; Femur Neck ; Hemoglobin A, Glycosylated ; Humans ; Male ; Muscle Strength ; Osteoporosis* ; Overweight ; Sarcopenia ; Vietnam*